Aniruddh Deshpande

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• PhD FRACS MCh AFRACMA
• Paediatric Urologist and Head Department of Surgery at Children's Hospital at Westmead

We evaluated quality of life in children with urinary incontinence using a disease specific tool (Pediatric Incontinence Questionnaire) and determined factors that decrease quality of life in affected children. The Pediatric Incontinence Questionnaire was self-administered by children 6 to16 years old with urinary incontinence while attending outpa...

Posterior urethral valves (PUV) constitute a significant urological cause of chronic kidney disease (CKD) in children. The condition is characterised by the unique pathophysiology of the evolution of bladder dysfunction after relief of obstruction, which contributes to CKD. Improvements in prenatal diagnosis followed by selective foetal interventio...

The urinary tract consists of the bladder, ureters, and kidneys, and is an essential organ system for filtration and excretion of waste products and maintaining systemic homeostasis. In this capacity, the urinary tract is impacted by its interactions with other mucosal sites, including the genitourinary and gastrointestinal systems. Each of these s...

Bladder dysfunction and behavioural disorders in children are commonly concomitant; hence, it is difficult to treat each in isolation. Pharmacotherapy is common treatment for behavioural disorders, and these medications may have intended or unintended positive or negative bladder sequelae. This review identifies the literature regarding the effects...

Main problem. There is uncertainty about the effect of transcutaneous electrical nerve stimulation on quality of life and psychosocial outcomes in children with lower urinary tract symptoms. We aim to describe its impact on quality of life, psychosocial outcomes and lower urinary tract symptoms in Australian children with overactive bladder while e...

Pages 282-285) [1] recently described three young adults with hypogonadotropic hypogonadism (HH) treated with gonadotropin therapy to induce testicular descent. Our recent experience in two adolescents with HH supports the authors' proposal that age is not a limiting factor in the use of gonado-tropins to induce testicular descent, but highlights t...

TIP repair for paediatric hypospadias

Over the past two decades, there have been significant developments in paediatric urodynamic studies focusing on less-invasive monitoring devices, as well as re-defining normative values. This article reviews current paediatric urodynamic study methods and their reliability, and discusses new emerging ambulatory urodynamics and novel telemetric uro...

Posterior urethral valves (PUV) are the most common cause of congenital urethral obstruction and are unique in the challenges they pose in management. Endoscopic ablation/incision of the valves is usually offered as the primary treatment of choice. Following this, a range of different clinical patterns are observed, each with varying bladder dysfun...

Background. Enuresis, also referred to as nocturnal enuresis, is characterised by discrete episodes of urinary incontinence during sleep in children aged ≥5 years in the absence of congenital or acquired neurological disorders. This guideline is an update of the 2017 version. Recommendations. The guideline provides recommendations and suggestions f...

Main problem. There is uncertainty about the effect of transcutaneous electrical nerve stimulation on quality of life and psychosocial outcomes in children with lower urinary tract symptoms. We aim to describe its impact on quality of life, psychosocial outcomes and lower urinary tract symptoms in Australian children with overactive bladder while e...

24 Winter 2024 | Volume 30 Number 2 Australian + New Zealand Continence Journal Can targeted, non-invasive, EMG-uroflowmetry led assessments help characterisation of non-neurogenic bladder dysfunction in children? Dr Naveen Wijekoon1 , A/Prof Aniruddh Deshpande2 1 Children’s Hospital At Westmead, Westmead, Australia 2Children’s Hospital At Westme...

Purpose: Children who require specialist outpatient care typically wait substantial periods during which their condition may progress, making treatment more difficult and costly. Timely and effective therapy during this period may reduce the need for lengthy specialist care. This study evaluated the cost-effectiveness of an individualized, evidenc...

Paediatric functional bladder disorders especially those causing daytime symptoms are a common cause of significant psychosocial and/or physical morbidity and impaired quality of life. Despite the availability of many therapeutic modalities, a significant number of children appear to be refractory to treatment and continue to have symptoms. In this...

Children with a neurogenic bladder are at risk of developing recurrent urinary tract infections and long-term kidney failure. Due to an altered lower urinary tract, children may be overtreated for simple bacteriuria or undertreated for a potentially severe urinary tract infection. This group of patients represent high users of healthcare, and are a...

Background Hospital acquired urinary tract infections (UTIs) have a detrimental effect on patients, families and hospital resources. The Sydney Children’s Hospital Network (SCHN) participates in the National Surgical Quality Improvement Program - Pediatric (NSQIP-P) to monitor post operative complications. NSQIP-P data revealed that the median UTI...

Purpose: Children referred to specialist outpatient clinics by primary-care providers often have long waiting times before being seen. We assessed whether an individualized, web-based, evidence-informed management support for children with urinary incontinence while waiting reduced requests for specialist appointments. Materials and methods: A m...

Background Cystinuria is a rare genetic kidney stone disease, with no cure. Current treatments involve lowering urinary cystine levels and increasing cystine solubility. This systematic review evaluates the available literature regarding non-surgical interventions for cystinuria. Methods Key electronic databases were searched for studies that desc...

Aim: Compared to open pyeloplasty (OP), we hypothesised that laparoscopic pyeloplasty (LP) is associated with early recovery, a shorter length of stay (LOS) and less analgesia requirement. Methods: Between 2011 and 2016, 146 dismembered pyeloplasty cases were reviewed, of which 113 were in the OP group and 33 were in the LP group. We evaluated b...

Objective To assess the impact of parasacral transcutaneous electrical nerve stimulation (parasacral TENS) on quality of life (QoL) and psychological aspects in children treated for overactive bladder (OAB). Methods This international, multicenter, prospective cohort study involved individuals of 6 to 16 years of age under TENS treatment for OAB....

Introduction Parental decision regret in hypospadias surgery is a recognised source of long-lasting psycho-social morbidity. High parental decision regret after their child’s hypospadias repair is reported. The aim of this study is to report on decision regret in Australian parents, who accepted and declined surgery for their son and explore underl...

Hemophilia is an inherited clotting disorder that typically presents as spontaneous hemorrhage or prolonged, excessive bleeding following minor trauma. Abnormalities of the genitourinary tract are a rare manifestation of the disease. Here, we report a case of undiagnosed hemophilia B in a teenage boy presenting with worsening testicular pain and a...

Background Atypical Congenital Obstructive Urethral Lesions (ACOUL) are uncommon causes of urethral obstruction in children. They include Cobb’s collar or Moorman’s ring, Type III posterior urethral valve (PUV), congenital urethral narrowing and anterior urethral valves. This study is aimed to evaluate the knowledge and current practice amongst cli...

Background: Parental decision regret in hypospadias surgery is a recognised source of long-lasting psycho-social morbidity. Its reported prevalence is high but until now, it has not been studied in Australasian context or among parents who declined the repair for their son. The aim of this study is to report on decision regret in an Australian coho...

Aims We evaluated the efficacy of standard urotherapy and combination therapies in treatment of bladder dysfunction in children with treated behavioral disorders. Methods Prospective study of children (6-16 years) with bladder dysfunction and behavioral disorders was conducted between March 2018-2020. Eligible children were initially offered stand...

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Purpose: This systematic review evaluates the current intervention strategies for cystinuria and assesses their quality and efficacy in order to determine the need to identify new and improved strategies for treatment. Materials and Methods: A literature search for interventions in cystinuria was conducted on key electronic databases for studies pu...

We conducted a systematic review of the literature to establish the prevalence of and predictive factors for parental decision regret in hypospadias surgery. A search strategy without language restrictions was developed with expert help, and two reviewers undertook independent study selection. Five studies were included in this review (four for qua...

We report a case of Anaplastic Large Cell Lymphoma mimicking a psoas abscess in a 6-year-old girl which posed significant diagnostic challenges. She presented with a vague two-month history of anaemia, fevers and back and abdominal pain. Axial imaging including MRI suggested a diffuse, inflammatory lesion in the right psoas muscle and she was comme...

Van der Woude syndrome (VWS) and popliteal pterygium syndrome (PPS) spectrum are due to genetic variants in the IRF6 which phenotypically has been known to manifest with midline defects such as cleft lip and palate in VWS and additional nail, limb and genital anomalies in PPS. We report a case of VWS with the previously unrecognised phenotypic feat...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of alpha blockers for treating functional daytime urinary incontinence in children.

Acute kidney injury (AKI) can be fatal and is a well-defined risk factor for the development of chronic kidney disease. Group 2 innate lymphoid cells (ILC2s) are innate producers of type-2 cytokines and are critical regulators of homeostasis in peripheral organs. However, our knowledge of their function in the kidney is relatively limited. Recent e...

Menkes disease (MD) usually presents in infancy with respiratory and neurological complications. Severe isolated vasculo-connective tissue involvement in infancy is rare, and hence the precise and timely diagnosis is difficult. We report a case of an 8-week-old male infant who succumbed to acute, severe exsanguination, and hemorrhagic shock seconda...

Objectives Carotid body tumours are rare in children, and a sclerosing carotid body paraganglioma has never been reported in the paediatric age group. We report a case of a young female with a sclerosing paraganglioma of the right carotid bifurcation and the unique management issues that it created. Methods & results A nine-year-old girl presented...

Background/Purpose Vanishing Testes Syndrome¹ (VTS) is one of the most common causes of impalpable testes in children. The role of removal of testicular nubbins owing to malignant potential in VTS is unclear. We sought to evaluate whether testicular nubbins need to be excised owing to this potential. Methods We conducted a retrospective review of...

Background Fetal volvulus is a rare, yet life-threatening condition that requires skilful diagnosis and management. Volvulus occurs when bowel loops become twisted and the twisting of the mesenteric artery leads to congestion, impaired venous return, and bowel necrosis. Case Description We present a case of fetal ileal volvulus suspected on third...

Introduction: Enuresis (or Nocturnal Enuresis) is defined as discreet episodes of urinary incontinence during sleep in children over 5 years of age in the absence of congenital or acquired neurological disorders. Recommendations: Suggestions and recommendations are made on the various therapeutic options available within a South African context. Th...

Herein we describe a case of a 14-year-old with straddle injury to the base of the penis, sustained during an indoor rock climbing accident, who presented with severe urethrragia. Urethral injury was confirmed with retrograde urethrography. The patient became haemodynamically unstable from persistent blood loss, and corporal arterial injury was dia...

Purpose: This study aimed to assess the outcome of intravesical ureteric reimplantation for primary obstructed megaureter (POM) performed in infants under 1 year of age. Materials and methods: A retrospective cohort study was carried out of all infants undergoing intravesical ureteric reimplantation surgery for POM at two pediatric centers in th...

Intraperitoneal bladder rupture is uncommon in very young children, but its incidence may increase with increasing use of seat and lap belts. To the best of our knowledge, there are no prior reports of laparoscopic repair of this injury in children. We describe two recent cases and discuss useful technical points that facilitate a successful laparo...

Congenital thoracic malformations (CTM) are rare lung lesions that are managed with surgical resection or active surveillance. The objective of this study was to comprehensively assess large and small airway function in children with CTM who underwent lobectomy in early life. We hypothesise that sensitive measures of lung function will demonstrate...

Congenital cystic adenomatoid malformation (CCAM) is the most common congenital lung lesion. Surgery is the definitive treatment and lobectomy is commonly preferred. Our aim was to determine forced expiratory flows and volumes as well as the lung clearance index (LCI) measured by multiple-breath nitrogen washout technique (MBWO) in children who und...

Background Role of ultrasonography in diagnosis of acute appendicitis in children is being debated. This study was conducted ahead of a clinical trial and aimed to evaluate the adjunctive role of ultrasonography in this group.Methods Retrospective chart review of consecutive children undergoing appendicectomy in an Australian tertiary children's ho...

Anterior urethral diverticula are rare in children. Anterior urethral valves and associated diverticulum is the commonly discussed pathological entity in children. There is a lack of awareness among clinicians regarding less common presentations of anterior urethral diverticula in children; which can have a diverse involvement of the urinary tract....

This is the protocol for a review and there is no abstract. The objectives are as follows: The aim of this review is to assess the benefits and harms of antibiotic prophylaxis given during the perioperative period, for reducing the risk of UTIs following transurethral urological procedures in both adults and children.

This is the protocol for a review and there is no abstract. The objectives are as follows: This review aims to look at the benefits and harms of interventions for undescended testes in children performed in order to facilitate placement of the testis or testes in a scrotal position without subsequent atrophy.

Since the publication of the 2006 International Children's Continence Society (ICCS) guidelines on terminologies for lower urinary tract dysfunction in children, little is known of their impact. In this study, we aim to quantify the adherence to the guidelines in the published literature, and to examine whether Medical Subject Headings (MeSH) in ME...

What's known on the subject? and What does the study add? Ambulatory urodynamic studies (UDS) allow assessment of urinary bladder function by recording bladder events during natural filling and emptying. The International Children's Continence Society supports the use of ambulatory UDS as a test of choice in children with bladder dysfunction. There...

Background: Enuresis (bedwetting) is a socially stigmatising and stressful condition which affects around 15% to 20% of five-year olds and up to 2% of young adults. Although there is a high rate of spontaneous remission, the social, emotional and psychological costs to the children can be great. Drugs (including desmopressin, tricyclics and other...

Objectives: The aim of the present study was to report caregiver perceptions to antireflux surgery and gastrostomy in children with severe neurological impairment and to report the complications of the surgery. Methods: Children were identified from a clinic database and clinical information and surgical complications were extracted from the dat...

Nocturnal enuresis, or bedwetting, is the most common cause of urinary incontinence in children. It is known to have a significant psychosocial impact on the child as well as the family. Nocturnal enuresis typically presents as failure to become dry at night after successful daytime toilet training. It can be primary or secondary (developing after...

Pediatric minimally invasive surgery is a rapidly developing field with a steep learning curve for each new procedure that is developed and integrated into practice. The European consensus is that the training across the learning curve should not be on the patients. Simulation is a widely accepted methodology to shorten the learning curve. Training...

Lower urinary tract symptoms, particularly urgency, frequency and incontinence are common in school-aged children but are often overlooked. They may cause considerable physical, social and psychological difficulties to children and their families, and usually are manifestations of underlying non-neurogenic voiding disorders. The differential diagno...

In neonates with a posterior urethral valve serum creatinine is increased. It decreases after successful relief of obstruction. Clinicians consider urinary diversion if serum creatinine remains increased. However, the optimal rate of decrease of serum creatinine is not defined. We generated useful data on the rate of serum creatinine decrease in ne...

Postoperative assessment after varicocele surgery in adolescence is commonly centred around catch-up growth of the testis. There is paucity of evidence on the correlation of catch-up growth with underlying testicular function in these patients. To assess the reliability of catch-up growth of the testis as an indicator of normalization of testicular...

We evaluated the incidence of new permanent defects in boys with grade 4 or 5 vesicoureteral reflux, identified the risk factors for new permanent defects and reviewed the outcome of different management approaches by assessing the rates of urinary tract infection and new permanent defects. This prospective cohort study recruited patients from July...

We report results of a pilot study investigating the safety and efficacy of Botulinum A toxin on urinary incontinence and bladder function in children with neurogenic bladder. This was a prospective, non-randomized clinical trial. Seven children with median age of 16 years with spina bifida who had high storage pressures, poor bladder compliance an...

We discuss the case of a young adolescent boy with ulcerative colitis who developed pneumomediastinum and subcutaneous emphysema in the neck and surrounding cervical soft tissues secondary to a probable retroperitoneal perforation of the colon. To our knowledge, this is the first reported case of this complication in the pediatric literature. Our e...

Acute recurrent pancreatitis in children can be caused by anomalies of fusion of pancreatic ducts such as the dominant dorsal duct syndrome wherein a dominant dorsal pancreatic duct is associated with stenosis of the minor papilla. Clinical presentations and management of 2 patients are discussed. An infant presented with severe acute pancreatitis...

Ectopic nephrogenic rests (ENR) are rare. The incidental discovery of these lesions in children has particular clinicosurgical implications, especially given the association between ENR and the development of extrarenal Wilms' tumors (ERWT). We reviewed the hospital records of patients with ERWT and ENR treated at our hospital over a 10-year period...

Esophageal stenosis due to the presence of abnormal tracheal cartilage in the wall of the esophagus is an uncommon disease, which presents with vomiting or a failure to thrive. Surgical excision of the cartilaginous segment is the preferred treatment. This is a report of a new technique for the treatment of esophageal stenosis in children. We perfo...

Transverse testicular ectopia (TTE) is an uncommon condition with different clinical presentations. A significant proportion of cases are diagnosed only during surgery and it is important to define the precise anatomy and associated anomalies in every case of TTE. Laparoscopy is being increasingly adopted in the treatment of undescended testis, esp...

We discuss an infant with MI secondary to cystic fibrosis, who was managed surgically by a double barrel ileostomy for mid - small bowel atresia and developed severe faecal impaction in the post - operative period. The faecal impaction was treated successfully with oral NAC and 0.2% NAC contrast enemas. The patient's liver function tests revealed a...

This paper reviews the history of clitoral surgery throughout the twentieth century. The changing operations, from amputation through to attempts to produce a normal clitoris mirror the changing attitudes and available knowledge. It also examines the current issues that arise out of available data on long-term outcomes of clitoroplasty.

Objective: Genital anomaly (GA) carries a risk of life-threatening comorbidity which is not well defined and is under reported. We aimed to determine the associated anomalies in children with GA who died. Materials and methods: We retrospectively reviewed the deaths among all GA patients presenting to our institution over 32 years (1970-2001). S...

The experience of a single institution on idiopathic fibrosing pancreatitis (IFP) is presented. This is a retrospective review of medical records of affected patients. There were 7 cases with a mean age of 7 years. Upper abdominal pain followed by jaundice was the most common presentation. One child had varicella and 1 developed Crohn's disease 3 y...