Urology :: Research
The CHOC Children's Urology Center is dedicated to providing patients and their families the most up-to-date, state-of-the-art, research-based diagnoses and treatments.
We are proud to be participating in these ongoing clinical research projects:
- Multi-Center Study for Constructing a Nomogram for Prediction of Resolution of Vesicoureteral Reflux
- Randomized Control Trial of using On-Q Pump® for Urological Post-Operative Pain Management
- Determining the Value of Early Prophylactic Treatment with Clean Intermittent Catheterization and Anti-Cholinergic Medication in the Spina Bifida Population
- Determining the Value of Home Pressure Monitoring in Patients Performing Regular Catheterization for Neurogenic Bladders
- Two Multi-Centered Randomized Controlled Trials of New Medications for the Treatment of Neurogenic Bladder
As we continue researching and finding new and innovative treatments for pediatric urology conditions, disorders and diseases, we proudly share our findings to the world. Below are some of our recently published findings:
- Is the appearance of the Deflux Mound predictive of Reflux Resolution?
Authors: Guy Hidas, Tandis Soltani, Antoine Khoury
Introduction and Objectives: The results of endoscopic correction of vesicoureteral reflux (ECVUR) have improved with the introduction of the double HIT technique. Some have advocated abandoning the postoperative VCUG based on the appearance of the mound and the absence of hydro-distention (HD) at the end of the procedure. We sought to evaluate the correlation of the appearance of the mound with the outcome based on a three month VCUG.
Methods: Eleven primary vesicoureteral reflux cases (15 renal units, six failed and 8 successful procedures) were selected randomly from our video library. Online survey questionnaire was distributed to 234 pediatric urology experts. Each survey question contained preoperative VCUG image as well as figures of the ureteral orifice before and after injection. Experts were asked to predict whether they thought that the Deflux mound appearance will be associated with a successful resolution of reflux at a 3 month postoperative VCUG. Percentage of correctly answered questions as well as sensitivity and specificity and predicting values of expert ability to predict outcome were analyzed.
Results: 70 Pediatric urologists responded to the survey, for a total of 1050 data points. Overall 67% of the experts were able to predict the resolution of reflux based on the appearance of the Deflux mound, (68 % were able to correctly predict success and 65% correctly predicted failure). Mound appearance predictability reached a 0.68 sensitivity, 0.65 specificity, positive predictive value of 0.74 and negative predictive value of 0.57. Mean outcome predictability per expert was 66% (range 26% to 86%).
Conclusions: The appearance of the Deflux mound and the lack of HD at the completion of the procedure is not a reliable predictor of outcome. Based on the above experience, postoperative VCUG is still required to truly determine reflux resolution.
- Intra operative cell dissociation technology for aerosol transfer of bladder urothelial and smooth muscle cells onto the demucosalized intestinal segment for bladder augmentation: In-Vitro study
Authors: Guy Hidas, Hak Lee, Andrej Bahoric, Shuman Liu, Zhongo Lin, Xiaolin Zi, Samah Saharti,David Kerbl, Hung, Troung, Antoine Khoury
Purpose: We have previously demonstrated that the application of an urothelial and detrusor cells suspension using the aerosol spray technique to a demucosalized colonic segment results in a uniform layer of urothelial lining. This lining remained stable and renewed itself on an ongoing basis without regrowth of colonic mucosa when used for cystoplasty . Cellular dissociation was so far performed in our basic science lab. The aim of this study is to develop a simplified bladder dissociation technique that can be performed in the operating room without the need for a tissue culture laboratory. This would go a long way towards translating this technology to human application as the simplified procedure will be widely available in every standard operating room.
Methods: Pig bladder was harvested at the termination of educational surgical course in our lab (non sterile condition). We separated the detrusor from the urothelium and rinsed the tissue with sterile saline solution containing streptomycin and penicillin. Mechanical mincing and incubation with Collagenase IV was performed in a 5 ml conical glass vial that was placed in a fibrinoterm incubator, In order to find the optimal dissociation protocol we performed multiple procedures with different incubation times (1,1.5,2 hour) and 2ml Collagenase IV concentration (1,2,4mg/ml). Two mls. Of autologus serum was mixed with the cellular solution. The cell concentration was counted and aerosolized on a culture dish. Cells were cultured with KSFM and antibiotic media for one week in order to confirm viability and in-vitro proliferation ability.
Results: We performed 40 procedures on 8 pig bladders using the different collagenase IV concentrations and incubation times. The highest count of viable cells was observed with 4mg/ml Collagenase IV incubated for 2 hours. Using this protocol we repeated the experiment 24 times using 8 pig bladders. We obtained 49x106/ml mean (range 17-148 x106/ml) dissociated urothelial cells and 75.7x106/ml mean (range 9-296 x106/ml) dissociated mucosa and smooth muscle cells. Despite the non sterile bladder tissue obtained from the educational course we were able to culture 60% of the culture plates for one week. Other plates were contaminated.
Conclusion: Bladder tissue cellular dissociation by the surgeon in the operating room is feasible and effective. In vivo studies as well as development of a kit to assist performing all dissociation steps semi-automatically are the next relevant research steps.
- Application of Continuous Incisional Infusion of Local Anesthetic after Major Pediatric Urological Surgery
Authors: Guy Hidas, Hak Lee, Shawn Beck, Edwin Tan, Zeev N Kain, Antoine Khoury
Purpose: ON-Q pain relief system (Kimberly-Clarke) is an elastomeric pump that delivers 0.25% bupivacaine at the incision site via small flexible catheters that are tunneled subcutaneously at the completion of a patient's surgery. Infusion rate is fixed and predetermined according to the patient's weight (range: 1-4 ml/hour). The aims of this study are to determine the efficacy of this system in improving postoperative pain, reducing narcotic requirement, and shortening recovery time after pediatric urological surgery.
Methods: Following Institutional Review Board approval, we preformed a retrospective case-control analysis comparing patients treated postoperatively with the ON-Q system to patients treated with standard of care intravenous and oral medications. Patients in both groups received 0.25% bupivacaine infiltration of the incision site at the end of the procedure. All urological surgeries were performed via dorsallumbotomy, Pfannenstiel and genital incisions. Pain scores were measured by staff nurses every 2-4 hours or upon patient complaining about pain. Pain was measured using a VAS or a FLACC scale depending on child's age. Information regarding narcotic and analgesics consumption along with recovery parameters like fever, start of oral nutrition and length of hospitalization (LOH) were collected and compared.
Results: 20 consecutive patients received the ON-Q system and were matched with 20 consecutive patients treated with the standard pain medications. Age, gender and incision type were similar in the two groups. Patients in the ON-Q group experienced lower ratings of maximal pain on the first postoperative day compare to the control group (3 vs. 5.2 respectively, p=0.03) and a trend toward lower pain score on day two (1.8 vs. 3.5 respectively, p=0.055). Systemic intravenous and oral narcotic and analgesic were significantly lower in the first 36 hours postoperatively for the ON-Q group compare to the control group (1.01 vs. 2.68 mean Morphine equivalent doses respectively, p=0.02). No differences in rate of fever, start oral nutrition and LOH were found between the groups.
Conclusions: Continuous incisional infusion of local anesthetic with the ON-Q system is a viable option for postoperative pain management in children undergoing major urological surgeries. This technology significantly decreases the need for systemic narcotic consumption.