Jan D. van Gool

University Hospital Essen | UK Essen · Institute of Computer Science in Medicine, Biostatistics, and Epidemiology

Introduction: Due to a continuing increase of bacterial resistance in common uropathogens, we wanted to revisit our standards for the diagnosis and treatment of lower urinary tract infections, in the setting of urological outpatient care in a conurbation in Germany. Patients and methods: All subjects presenting with significant bacteriuria at ou...

A 2016 plea for revision of the 1 mg/day upper level of folic acid intake prompted us to comprehensively review the 1945–2017 literature on folic acid hazards in subjects with low cyanocobalamin. The concept of folic acid treatment ‘masking’ the anemia in undiagnosed cyanocobalamin deficiency, thereby delaying the diagnosis of neuropathy, does not...

With 4 mg folic acid daily, it may take 20 weeks to reach red-blood-cell folate levels between 1,050 and 1,340 nmol/L, optimal for reduction of the neural tube defect risk. Therefore, folic acid supplementation should be started 5-6 months before conception. The residual risk with optimal red-blood-cell folate levels is reportedly 4.5 per 10,000 to...

Objective: Functional urinary incontinence causes considerable morbidity in 8.4% of school-age children, mainly girls. To compare oxybutynin, placebo, and bladder training in overactive bladder (OAB), and cognitive treatment and pelvic floor training in dysfunctional voiding (DV), a multi-center controlled trial was designed, the European Bladder...

Nicht-neurogene Blasenfunktionsstörungen können die Blasenspeicher- oder Entleerungsfunktion betreffen. Je nachdem welche Funktionsstörung überwiegt, sprechen wir in der Speicherphase von einem Drangsyndrom oder überaktiven Blase (OAB) des Kindesalters, in der Entleerungsphase von einer dysfunktionellen Entleerung oder Detrusor-Sphinkter-Dyskoordin...

Antibiotic prophylaxis (low dose chemoprophylaxis) has been prescribed since the introduction of clean intermittent catheterization in children with spina bifida. We hypothesized that stopping low dose chemoprophylaxis does not increase the number of urinary tract infections in these patients. A total of 176 patients with spina bifida participated...

To evaluate the effects of exogenous melatonin on the frequency of wet nights, on the sleep-wake cycle, and on the melatonin profile in children with therapy-resistant MNE. 24 patients were included. Patients had to maintain a diary including time of sleep and arousal, and whether they had a dry or a wet bed in the morning. We measured baseline mel...

Zusammenfassung Blasenfunktionsstörungen begünstigen Harnwegsinfektionen, sind häufig assoziiert mit einem vesikoureteralen Reflux und begleitenden renalen Parenchymschäden. Die vorliegende Arbeit möchte einen Überblick geben, in welcher Weise Blasenfunktionsstörungen, differenziert in Störungen der Speicherphase (Drangsyndrom, OAB) und Störungen d...

Various types of bladder dysfunction are associated with urinary tract infection, renal damage and vesicoureteral reflux (VUR). In this article the influence of functional bladder disturbances such as detrusor instability (overactive bladder, OAB) and bladder sphincter dyssynergia (dysfunctional voiding), on the resolution of vesicoureteral reflux...

Pränatal sowie postnatal diagnostizierte Dilatationen des Nierenbeckenkelchsystems bedürfen der weiterführenden Evaluation durch Sonographie, 99mTc-MAG3-Szintigraphie und optional ein Miktionszysturethrogramm. Die sonographische Erstuntersuchung sollte zwischen dem 3. bis 5. Lebenstag erfolgen, nur in besonderen Fällen 10–12 h postpartal. Als Stand...

Prenatally or postnatally diagnosed dilatation of the upper urinary tract initiates postnatal investigations, including sonography, dynamic renography (MAG 3) and optional voiding cystourethrography. The first ultrasound examination should be performed 3-5 days after birth and in urgent cases 10-12 h after delivery of the baby. Dynamic renography (...

In the setting of the European Bladder Dysfunction Study, a multicenter, randomized, controlled trial of treatment options for functional incontinence in children, we assessed the concordance between reported and reviewed urodynamic scores. A total of 97 children with clinically diagnosed urge syndrome and 105 with clinically diagnosed dysfunctiona...

The objective of this study was to compare prospectively, in urge syndrome and dysfunctional voiding, clinical patterns with urodynamic patterns, to assess changes in urodynamic patterns after treatment, and to correlate urodynamic patterns and parameters with treatment outcome. In the European Bladder Dysfunction Study 97 children with clinically...

The purpose of this work was to analyze prospectively the prevalence of behavioral disorders in children with urinary incontinence because of nonneuropathic bladder-sphincter dysfunction before and after treatment for incontinence. A total of 202 children with nonneuropathic bladder-sphincter dysfunction were enrolled in the European Bladder Dysfun...

We prospectively assessed response and cure rates of alarm treatment, following pretreatment with antimuscarinics and/or holding exercises aimed at increasing maximum volume voided in 149 children with monosymptomatic nocturnal enuresis. In a prior trial the same 149 children had been randomized into 5 groups to assess interventions for increasing...

To compare urine volumes voided and output rates in prepubertal children with and without monosymptomatic nocturnal enuresis (MNE), to investigate the balance between nocturnal urine output and functional bladder capacity. In 76 prepubertal children with MNE, all voidings were collected over 48 hours: bedwetting volume (BWV), early-morning voiding...

We assessed prospectively the efficacy of holding exercises and/or antimuscarinics (oxybutynin chloride and placebo) for increasing maximum voided volume in prepubertal children with monosymptomatic nocturnal enuresis. We randomly allocated 149 children to 5 groups, namely holding exercises with placebo (group A), holding exercises with oxybutynin...

To determine the congruence between self-reported and objective data on incontinence, voided volume (VV) and voiding frequency (VF), in a prospective study of treatment of functional urinary incontinence (UI) due to urge syndrome or dysfunctional voiding in children. In all, 202 children, enrolled in the European Bladder Dysfunction Study (EBDS), p...

Functional bladder capacity (FBC) and urine output are important variables in the management of incontinence and nocturnal enuresis. The lack of reference ranges for FBC vs. age, and the arbitrarily defined time-windows for measuring urine output, impede the clinical use of these variables in children. To solve these impediments, we had 26 girls an...

To clarify the relationship between disordered defecation and non-neuropathic bladder-sphincter dysfunction (NNBSD) by comparing the prevalence of symptoms of disordered defecation in children with NNBSD before and after treatment for urinary incontinence (UI), and assessing the effect of such symptoms on the cure rate for UI. In the European Bladd...

Linear correlations for cystometric/cystographic bladder capacity with age universally serve as clinical yardsticks in pediatric urology and nephrology. However, these correlations do not account for growth or the range in values, as the relation of cystometric/cystographic bladder capacity with age is nonlinear. Also, vesicoureteral reflux might i...

Renal scarring and renal failure remain life-threatening for children born with spinal dysraphism. We reviewed our data of spina bifida patients to evaluate whether optimal treatment of the neurogenic bladder from birth onwards can preserve kidney function. We reviewed data on all newborns with spinal dysraphism who were referred to our hospital be...

Urinary tract infections (UTI) in children differ in every aspect from UTI in adults. Children have more complicating factors, differential diagnosis between cystitis and pyelonephritis often is impossible, and pyelonephritis carries a risk of 15-35% for irreversible scars in the kidney parenchyma. It is imperative for the general physician to be a...

Monosymptomatic Nocturnal Enuresis (MNE) is a frequent problem in childhood and adolescence. The spontaneous resolution (only 18% per year) from the age of 6 years warrants a therapeutic intervention. Both the alarm treatment and the synthetic diuretic hormone therapy (dDAVP) have a documented response rate, but cure rate one year after therapy rem...

To determine whether a lasting therapeutic effect can be expected from long-term antimuscarinic therapy for neurogenic detrusor overactivity in spina bifida and to answer the question whether detrusor overactivity in spina bifida children with detrusor/sphincter dyssynergia is primarily based on the neuropathy or, in part, can be a secondary detrus...

Unlabelled: To analyse the risk factors for recurrent urinary tract infection (UTI) and the possible influence of potty-training, a questionnaire with 41 questions was completed by 4,332 parents of children completing the last 2 years of normal primary school. Statistical analysis was done with the Chi-squared test and Yates correction. Three grou...

Many surgical options exist to enhance bladder neck closing pressure in women. Most procedures are relatively large with a success rate of between 70% and 90%. Sling procedures with the sling placed between the anterior vaginal wall and bladder neck cause a risk of traumatic lesions of the bladder neck at operation and of postoperative erosion of t...

To analyse if family situation, personal habits and toilet training methods can influence the achievement of bladder control. A questionnaire with 41 questions was distributed to 4332 parents of children completing the last 2 years of normal primary school. The questionnaire had been tested for reproducibility of the answers in a random subgroup of...

The terminology used to describe wetting children is defined. The etiologies of monosymptomatic nocturnal enuresis and nonneuropathic bladder-sphincter dysfunction are described. Treatment strategies and the results of recent large scale studies are presented.

In spinal cord stimulation (SCS) large diameter cutaneous (Abeta) fibres in the dorsal columns (DCs) are activated and have an inhibiting effect on the transmission of pain signals by Adelta and C fibres from the corresponding dermatome(s). The largest Abeta fibres can be activated up to a maximum depth of about 0.25 mm in the DCs. No data are avai...

Transgenerational effects of diethylstilbestrol (DES) have been reported in animals, but effects in human beings are unknown. Alerted by two case reports, we aimed to establish the risk of hypospadias in the sons of women who were exposed to DES in utero. We did a cohort study of all sons of a Dutch cohort of 16284 women with a diagnosis of fertili...

To determine the prevalence of daytime- with/without night-time wetting, in Belgium, in a group of 10 to 14 year old schoolchildren, and to study the voiding habits. A questionnaire of 41 questions was developed and completed by 4,332 parents at home. Wetting or soiling episodes were reported by a total of 528 (12%) of the children: monosymptomatic...

This study aimed to investigate the family situation, personal behaviour and current micturition habits, the time of beginning and the method of potty-training in two groups of children with different outcomes of bladder control. Parents of 140 children, between 7 and 15 years old, filled in a questionnaire comprising 43 questions. They were divide...

 Pediatric urodynamics taught us that detrusor-sphincter dyssynergia creates a bladder outlet obstruction in about 50% of any population of children with myelomeningocele. This functional obstruction causes renal damage due to obstructive uropathy, exactly the same way as a congenital anatomical urethral obstruction does. Pediatric urodynamics also...

The aim of this study was to investigate the effect of rectosigmoidectomy and Duhamel-type pull-through procedure on lower urinary tract function in children with Hirschsprungs disease. During a 3-year period the authors assessed 11 consecutive children with Hirschsprung's disease prospectively by standard urodynamic investigations, before and afte...

Until 1986 many urologists performed currently outdated, redundant internal urethrotomy as standard therapy for recurrent urinary tract infection in girls. We describe the results of therapy in patients who became incontinent due to previous internal urethrotomy. Between 1986 and 1995, 21 female patients with post-Otis urethrotomy incontinence have...

The treatment of ectopic ureterocele is controversial. In addition to debate on optimal therapy, discussion exists on whether there is further risk of deteriorating bladder function after extensive bladder surgery during the first year of life, which is a reason to postpone surgery. In a prospective nonrandomized trial we treated 40 patients regard...

In the Netherlands, pediatric kidney transplantation programs are available in four centers. We retrospectively analyzed the results obtained over the past decade. Between 1985 and 1995, 231 patients (139 boys) received 269 transplants, including 61 repeat. The recipients were aged 1.9–21.8 yrs (mean 10.9), the donors 0.3–63.3 yrs (median 11.4, mea...

To assess the outcome of using sling suspensions combined with clean intermittent catheterization (CIC) in patients with spina bifida, of whom a third are incontinent through pelvic floor paralysis. Between March 1992 and April 1997, 14 male patients (mean age at surgery 11.7 years, range 6.5-15.2) with spina bifida and neurogenic sphincter inconti...

Lasting cure rates in monosymptomatic nocturnal enuresis (MNE), using the alarm, imipramine or desmopressin, have been quoted as 43%, 17% and 22%, respectively. The low cure rates in addition to the number of different treatments indicate insufficient knowledge of MNE. Only research on arginine vasopressin (AVP) levels and nocturnal enuresis is uni...

To investigate in a prospective study the clinical and urodynamic characteristics associated with the correlation previously reported between non-neuropathic bladder sphincter dysfunction and minimal meatal deformities in girls. From January 1995 to June 1996 all girls referred for urodynamics to investigate non-neuropathic bladder sphincter dysfun...

Although nonneuropathic bladder sphincter dysfunction in children is frequently encountered, there is no consensus on the assessment of children presenting with this problem. An example is given of how these children can be assessed. After a noninvasive screening consisting of history, voiding diary, clinical examination, urinalysis, ultrasound and...

To evaluate whether colonic enema irrigation influences the urodynamic characteristics of patients with spina bifida, an overactive bladder and detrusor sphincter dyssynergia (DSD). Since 1991, 83 patients with spina bifida at our institution have treated their bowel dysfunction by colonic irrigation every 24-48 h. In 12 patients (seven boys and fi...

To assess the effectiveness of a 10-day inpatient treatment programme for persistent urge incontinence based on behavior modification via biofeedback of micturition behavior. 95 patients aged 6-17 (86 girls, 9 boys) with documented and persistent urge incontinence, with or without dysfunctional voiding, mostly based on recurrent urinary tract infec...

Faecal incontinence and constipation are well known problems in children with spina bifida. Effective treatment can be difficult and this gave the condition a low priority despite the obvious physical and psychological sequelae. Positive experience with colonic enemas (CE) in the paediatric post-operative care have led us to adopt this method as th...

Objective To evaluate the incidence and significance of the urodynamic registration of an after-contraction in the bladder of children. Patients and methods In a prospective study, 250 children with a non-neurogenic voiding dysfunction (132 girls and 118 boys) were assessed for the occurrence of after-contractions during their video-urodynamic exam...

A consecutive series of 90 children with anorectal malformations was reviewed for urologic problems related to lower urinary tract dysfunction. Neurogenic bladder-sphincter dysfunction was seen in 22 patients (24%), all but one of whom had sacral agenesis. Vesicoureteral reflux was present in 60% of the patients with dysfunction, and 32% had reflux...

A series of 90 children with anorectal malformations received a total of 163 urodynamic studies. The mean number of studies per patient was 1.8 (range, 1 to 7), and the mean age at the time of initial evaluation was 17 months (range, 1 to 128). Sacral anomalies were found in 38 children (42%); 30 of them had partial sacral agenesis and eight had sa...

To determine the effect of neurosurgical untethering on the lower urinary tract and male sexual function, in patients with tethered spinal cord. Thirty-six children with tethered spinal cord due to neurospinal dysraphism were assessed clinically and urodynamically before and after surgical untethering. Sexual function was evaluated in 14 boys befor...

To treat enuresis risoria (giggle micturition) by a self-administered electric and imaginary shock and to evaluate the outcome after behavioural therapy. Six boys and three girls with enuresis risoria were evaluated and treated. The mean age at referral was 10.4 years (range 5.7-14.2). All children had episodes of involuntary complete bladder empty...

The effect of posterior sagittal anorectoplasty (PSARP) and its variants on lower urinary tract function was investigated urodynamically in 32 patients with anorectal malformations. In 27 patients urodynamic evaluation was performed before and after surgery and in 4 it was done postoperatively only. One child was clinically assessed with no postope...

A total of 50 children with the caudal regression syndrome (caudal dysplasia sequence) underwent urodynamic evaluation of lower urinary tract function. Of the patients 15 had isolated sacral agenesis, 13 had sacral agenesis in combination with an anorectal malformation and 22 had an anorectal malformation without sacral anomaly. Neurogenic bladder-...

We evaluated 8 girls and 3 boys with benign sacrococcygeal teratoma for lower urinary tract dysfunction. All children underwent ultrasonography of the urinary tract, voiding cystourethrography and at least 2 standard urodynamic evaluations. Mean patient age at first urodynamic study was 59 months (range 1 to 136). Nine of the 11 children had abnorm...

We report the case of a male newborn with covered bladder exstrophy, high anorectal malformation, and rectourethral fistula. The child had a split symphysis and diverging rectus muscles in the infraumbilical region. The ventral part of the bladder was covered with thin, fragile skin and some portions of the bladder bulged out as abdominal-wall hern...

A 10-year-old girl with spina bifida underwent surgery to increase the capacity of her neurogenic bladder using an isolated loop of intestine. During the operation serious circulatory and respiratory problems occurred after the peritoneum was opened, when the ileum was manipulated using gloves containing latex. Latex allergy can lead to potentially...

The prevalence of nonneuropathic bladder/sphincter dysfunction was assessed with a questionnaire in 310 of the 386 children enrolled in the European branch of the International Reflux Study in Children. Despite the exclusion criteria (neuropathic bladder, anatomical malformations other than vesicoureteral reflux and overt dysfunctional voiding or u...

Assessment of children with daytime wetting starts with the distinction between 'enuresis diurna' and 'functional incontinence', incontinence being defined as any form of wetting caused by bladder/sphincter dysfunction. Standard history-taking does not allow for a sharp enough distinction: pertinent questions have to be asked about daytime wetting,...

In children with 'functional incontinence', defined as any form of (daytime) wetting caused by non-neuropathic bladder/sphincter dysfunction, most signs and symptoms are rooted in habitual non-physiological responses to signals from bladder and urethra. These responses develop at toddler age, when children learn how to remain dry. Once they have be...

The prevalence of nonneuropathic bladder/sphincter dysfunction was assessed with a questionnaire in 310 of the 386 children enrolled in the European branch of the International Reflux Study in Children. Despite the exclusion criteria (neuropathic bladder, anatomical malformations other than vesicoureteral reflux and overt dysfunctional voiding or u...

Although the primary objective of clean intermittent (self) catheterization (CIC) was to regain continence in (older) children with myelomeningocele (MMC), we used the method also in the very young with detrusor-sphincter dyssynergia, to prevent future damage from the combined effects of obstruction and urinary tract infection (UTI). The results, i...

To evaluate the risk for kidney damage in a male fetus with obstructive uropathy, a percutaneous bladder puncture was performed at 26 weeks gestational age and contrast was injected into the fetal bladder. A clear picture was obtained of the bladder with marked widening of the prostatic urethra and posterior urethral valves, and massive bilateral v...

Before considering the investigation of patients with neurogenic bladder it is important to stress that the neurogenic bladder does not usually occur in isolation, and in the paediatric age group spina bifida or myelomeningocoele are probably the most frequently seen predominating causative factors. Diseases of the vertebral column and the spinal c...

140 urodynamic investigations have been carried out on 91 unselected patients with myelomeningocele (MMC). Four patterns of bladder dysfunction could be demonstrated at a very early age, and proved essentially unchanged at repeat investigation. Two patterns were characterised by hyperreflexia of pelvic floor muscles during bladder emptying; detruso...

Primary hyperoxaluria is an inborn error of glyoxylate metabolism resulting in recurrent calcium oxalate urolithiasis. The term oxalosis is used to indicate nephrocalcinosis and extrarenal deposits of calcium oxalate. The main symptoms are related to the deposition of calcium oxalate in kidneys and urinary tract and to uremia developing in the term...

Two brothers, aged 16 and 11 years, had recurrent episodes of vomiting, diarrhoea and abdominal pain, starting in infancy. In spite of extensive investigations no cause of their enterocolitis could be established. After several years symptomatic treatment was discontinued without any recurrence of symptoms. Their father and several paternal relativ...

The sacral roots, because of their anatomic and functional organization, are well suited to chronic stimulation. Data from our previous experiments on female dogs suggested that effective voiding responses to stimulation could be obtained by using the ventral root of S2, the sacral nerve in canines with the greatest detrusor representation. Elimina...

The haemolytic uraemic syndrome is an acute illness characterised by the occurrence of renal injury, haemolytic anaemia with red cell fragmentation and thrombocytopenia. Haemorrhagic diathesis, arterial hypertension and neurological manifestations often complicate the acute phase of the disease. In this article, we shall discuss in more detail the...

Reflexes concerned with viscerosomatic and somatovisceral interplay in the sacral spinal cord were evaluated in spinalized animals, as part of a study on direct spinal cord stimulation of micturition. Urodynamic evaluation consisted of continuous recording of bladder pressure, urethral pressures and electromyograms of striated anal and urethral sph...

Urodynamic evaluation of urethral sphincter function can be carried out by constant carbon dioxide perfusion, constant water perfusion, or by the use of membrane catheters. A comparison of these 3 techniques was made in in vitro experiments. Results, and advantages and disadvantages of each technique are discussed. From all factors considered in th...

Urodynamic investigations, including pressure studies, anal sphincter electromyography, and cystourethrography, done in young girls having symptomatic urinary infection show hyperreflexive activity of both striated sphincter and detrusor muscles, due to increased afferent input. In our series, this activity ranged froma a pattern similar to "uninhi...

With reference to the case histories of 2 children with chronic granulomatous disease, the authors present a detailed discussion of the clinical picture and of the functional and metabolic abnormalities of the granulocytes which constitute the essential element of this disease.

This paper reports a technique for simultaneous measurement of intravesical pressure, intra‐abdominal pressure, electromyographic activity of the external anal sphincter and urinary flow. Using this technique during filling of the bladder and during micturition in 38 children with myelomeningocele and neurogenic bladder disturbance, it was possible...