Volume 10 Issue 11, November 2013

Although a moderate body of evidence supports the efficacy of ileovesicostomy for neurogenic bladder in adults, its use in children has been largely undocumented. However, recent data show that this procedure should be considered for a selected paediatric population.

The American Academy of Paediatrics has revised its guidelines on the management of first UTI in children. The translation of evidence-based guidelines into clinical practice is often slow and inconsistent, but a recently published implementation study has demonstrated that rapid adoption of evidence-based UTI recommendations is achievable and beneficial.

Fetal intervention for lower urinary tract obstruction (LUTO) has been technically feasible since the 1980s, with vesicoamniotic shunting being the most commonly employed technique. Despite the recent publication of the first and only randomized trial of fetal shunting, questions linger about the long-term efficacy and clinical impact of prenatal intervention.

A recent study has reported a novel approach to primary bladder exstrophy closure without osteotomy in newborns. In this study, most patients were managed on a paediatric urology ward with an epidural catheter, with similar outcomes to patients treated in an intensive care unit with ventilation and muscle relaxation.

Pelvic lymph node dissection (PLND) has an important role in staging and therapy of prostate cancer, especially for high-risk disease. A novel tool has been proposed to correctly predict the probability of node-negative status after radical prostatectomy with PLND that could help postoperative decision making.

A newly developed genetic risk score derived from studies of several single nucleotide polymorphisms has the potential to improve the prediction of prostate cancer detection on biopsy for men with PSA levels of 1–3 ng/ml. Understanding the score's characteristic differences from biomarkers is important in order to utilize it correctly.

Radium-223 is an emitter of high-energy α particles that binds selectively to areas of high bone turnover. In a recently published phase III trial, it prolonged overall survival of patients with symptomatic, castration-resistant prostate cancer with bone metastases and, as a result, has gained FDA approval for this indication.

In this Review, Sávio and Nguyen discuss the use of robot-assisted laparoscopic surgery (RALS) for the management of common paediatric urological problems, identifying unique challenges associated with performing RALS in children and ways to address these challenges.

Children with vesicoureteral reflux (VUR), who are already at high risk of renal injury, are at particular risk for bladder and bowel dysfunction (BBD). In this Review, Elder and Diaz describe the association between BBD and VUR, the evaluation for BBD, and its management in children with VUR.

No universal guidelines exist for the management of patients with mild to moderate antenatal hydronephrosis (ANH). In this Review, the authors assess the data and present their own approach to postnatal risk stratification and management, including recommendations regarding serial ultrasonography schedule, prophylactic antibiotics, voiding cystourethrogram and renal scintigraphy.

In this Review, Cimador et al. consider the prevalence of failed paediatric hypospadias, possible risk factors for the failure of primary repairs, and principles for the management of major complications associated with failed hypospadias.

Nocturnal enuresis, daytime urinary incontinence, lower urinary tract symptoms and faecal incontinence are more common in children with special needs than in typically developing children. This Review provides an overview of the neglected topic of incontinence in children and adolescents with special needs, focusing on those with intellectual disabilities and attention deficit hyperactivity disorder.