William DeFoor

Cincinnati Children's Hospital Medical Center | CCHMC · Division of Pediatric Urology

Background Intraluminal polyps are a known complication following creation of a urinary continent catheterizable channel (Mitrofanoff). These polyps can lead to difficult catheterizations in addition to symptomatic bleeding. However, there is limited data available regarding management and outcomes of these polyps. We aim to describe clinical prese...

Introduction In utero myelomeningocele (MMC) repair has resulted in significant decrease in need for shunt-dependent hydrocephalus, however its impact on bladder function remains less clear. Neurogenic detrusor overactivity (NDO) due to MMC can be addressed with combination of clean intermittent catheterization (CIC) and anticholinergic (AC) therap...

Introduction When creating a continent catheterizable channel (CCC) the choice of bowel segment used as the conduit should be tempered with the morbidity associated with it. The split-appendix technique allows the creation of both a urinary and fecal CCC without the need for a bowel anastomosis. However, there is concern that by splitting the appen...

Introduction: In patients with neurogenic bladder outlet incompetence, a bladder outlet procedure (BOP) may be required to achieve urinary continence. However, when performed in isolation, a BOP can be associated with bladder deterioration and upper-tract injury. In the event of bladder deterioration, additional procedures such as bladder augmenta...

Introduction: Obesity has been thought to increase the risk of complications and need for additional resources with surgery, but only a limited amount of evidence is available in the pediatric population. Objective: The objectives were to describe the weight status of pediatric and adolescent patients undergoing a continent urinary tract reconst...

Objective To determine the diagnostic performance of ultrasound for diagnosing ureteral calculi in children using a clinical effectiveness approach. Methods Billing records and imaging reports were used to identify children (≤ 18 years old) evaluated for suspected urolithiasis using ultrasound between March 2012 and March 2017. Patients without un...

Introduction: Reaugmentation cystoplasty rates vary in the literature but have been reported as high as 15%. It is likely that bladders augmented with detubularized and reconfigured bowel are less likely to require reaugmentation. The purpose of this study was to assess the incidence of reaugmentation among patients with spina bifida in two high v...

Introduction Anuria from end‐stage renal disease leads to a defunctionalized bladder and may pose technical challenges at the time of renal transplantation. Anuria’s effect on bladder function after renal transplantation is considered to be minimal in adults, although a paucity of evidence is available in children. The purpose of this study was to...

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Objective To review and compare 4 different surgical approaches for partial nephrectomy of a nonfunctioning moiety in children with upper urinary tract duplication anomalies. Materials and methods A retrospective review of all pediatric patients who underwent open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), robotic partial n...

Introduction: A nutritional assessment is a critical but often neglected aspect of a preoperative evaluation. Malnutrition is clearly associated with worse surgical outcomes in adults undergoing major abdominal surgery, whereas a paucity of evidence is available in the pediatric population. Objective: The objectives were to describe the preopera...

Background: The incidence of pediatric nephrolithiasis in the United States is increasing. There is a paucity of literature comparing the diagnostic performance of computed ultrasound (US) to tomography (CT) in the pediatric population. Objective: To determine the diagnostic performance of renal US for nephrolithiasis in children using a clinica...

Robotic assisted laparoscopy pyeloplasty (RALP) has been associated with shorter recovery, less pain and improved cosmesis. To minimize visible scars, the hidden incision endoscopic surgery (HIdES) trocar placement has been previously developed. Our aim was to compare outcomes between the HIdES and traditional port placement (TPP) for pediatric RAL...

Background: Obesity has been associated with daytime urinary incontinence (UI), likely due to increased intra-abdominal pressure. Objectives: To assess incontinence symptoms in severely obese adolescents before and 3 years after bariatric surgery. Setting: Tertiary care pediatric hospitals in the United States. Methods: The Teen-Longitudinal...

Introduction Children with neurogenic bladder (NGB) often require a lifetime of clean intermittent catheterization (CIC), typically using uncoated catheters (UCs). Hydrophilic catheters (HCs) have lower friction than UCs with reported less damage to the urethra. The purpose of this study is to compare outcomes between these catheters. Methods An i...

Introduction Stomal stenosis is the most common complication after the creation of a continent catheterizable channel (CCC), but is challenging to treat. Objective To describe early experience with triamcinolone injection for the treatment of stomal stenosis. Materials and methods A retrospective review was performed of patients who had undergone...

Introduction: Patients with anorectal malformations (ARMs) have a high incidence of genitourinary anomalies. Those with a recto-bladder neck fistula may represent a high-risk group, but their long-term urologic outcomes are poorly described. Objective: To evaluate the clinical and urodynamic outcomes in a large cohort of patients with an ARM sub...

Purpose: The metabolic evaluation of children with nephrolithiasis begins with a 24-h urine collection. For adults, the diagnostic yield increases with consecutive collections; however, little is known regarding the variability of multiple 24-h studies in the pediatric population. We sought to evaluate the variability of consecutive 24-h urine col...

Purpose: The prevalence of urinary stone disease is increasing in children. We have previously reported a high rate of urinary metabolic abnormalities in stone-forming children including hypercalciuria and hypocitraturia. The purpose of this study is to determine if a calcium to citrate ratio can help predict those at risk for recurrent stone form...

Purpose: The purpose of this study is twofold: first, to describe the non-narcotic pathway (NNP) for the management of postoperative pain after robotic pyeloplasty (RP); second, to compare perioperative outcomes for children undergoing RP whose postoperative pain was managed with and without the NNP. Patients and methods: A retrospective review...

Trauma nephrectomy, renorrhaphy, and partial nephrectomy

Purpose: Published cohorts of children with vesicoureteral reflux placed on antibiotic prophylaxis differ in baseline characteristics and methodology. These data have been combined in meta-analyses to derive treatment recommendations. We analyzed these cohorts in an attempt to understand the disparate outcomes reported. Materials and methods: Ei...

The history and physical examination of an adolescent male are critical to early detection of scrotal abnormalities. Although rare, paratesticular rhabdomyosarcoma grows quickly and can be life-threatening. This article focuses on the importance of prompt recognition, diagnosis, and appropriate management of paratesticular rhabdomyosarcoma in an ad...

Introduction: Botulinum toxin injection (BTI) has been advocated as a second line therapy in management of neuropathic bladder in pediatric population for refractory patients to conventional medical management such as anticholinergics. The purpose was to review the safety and efficacy of BTI in children with neuropathic bladder refractory to conse...

Mortality from end stage renal disease (ESRD) in patients with anorectal malformation (ARM) is reported to be between 2.5 and 6 %. The risk differs depending on the type of ARM (6.4 % "high" vs. 1.1 % "low"). The purpose of this study was to review the characteristics of the ARM patients who received a kidney transplant (KT) to potentially identify...

Traumatic accidents are responsible for almost half of deaths of children between the ages of 1 and 14 years. Motor vehicles are most commonly involved, with pedestrian accidents being a leading cause in the 5-9-year age group. Injuries to the urinary tract and associated complications remain a source of significant morbidity following trauma in th...

Observational studies in obese adults have found abnormal urinary metabolic indices that predispose to nephrolithiasis. Few studies have been performed in severely obese adolescents. To assess urinary stone risk factors in severely obese adolescents and in those undergoing 2 types of weight loss surgery. Children's hospital, United States. A prospe...

Children born with a persistent cloaca undergo complex pelvic reconstruction early in their life. Long-term risks of bladder dysfunction and chronic kidney disease (CKD) are well described. In this study, we report upper urinary tract outcomes and the risk of CKD stage progression. A retrospective cohort study was performed of all patients undergoi...

Purpose: To determine the applicability and long-term outcome of endoscopic injection of dextranomer/hyaluronic acid (Dx/HA) to correct incontinence in patients who had previously undergone continent urinary reconstruction. Patients and methods: A retrospective cohort study was performed of all patients who underwent Dx/HA injection at our insti...

Background No standardized manner exits to objectively compare renal tumor complexity in children and adolescents. However, the RENAL Nephrometry scoring system has been recently developed in adults and shown to predict tumor complexity and correlate with clinical outcomes. Thus, the study objective was to evaluate RENAL Nephrometry tumor score in...

Purpose: New contralateral vesicoureteral reflux after unilateral ureteral reimplantation is well described in the literature. Management of high grade vesicoureteral reflux with resolved contralateral reflux is less extensively studied. Most surgeons perform a bilateral procedure in these cases. We report the results when an open procedure was de...

To better understand the impact of nephron-sparing surgery (NSS) on renal function in patients with nonsyndromic unilateral Wilms tumor (uWT), a group of such patients treated with NSS were compared with a stage-matched cohort managed with radical nephrectomy (RN). The recommended management of nonsyndromic uWT is RN. However, NSS may decrease the...

Continent catheterizable channels have revolutionized reconstructive surgery to achieve both urinary and fecal continence. The Mitrofanoff and Malone antegrade continent catheterizable channels offer improved quality of life relative to permanent incontinent stomas. A frequently employed surgical option for creating a Mitrofanoff when an existing a...

Continent lower urinary tract reconstruction is an invaluable tool to treat urinary incontinence, allow accessible intermittent catheterization, and protect the upper urinary tracts from high bladder pressures in children with neuropathic bladders. It has been used extensively in the past few decades around the world, and a large body of evidence h...

To present our experience with infant pyeloplasty, comparing outcomes between robotic-assisted laparoscopic pyeloplasty (RALP) and open pyeloplasty (OP). A retrospective review was performed of all children <1 year of age who underwent unilateral dismembered pyeloplasty at a single pediatric institution since January 2007. Patients with standard la...

Background and purpose: Laparoscopy is a common approach to manage varicoceles in both the adult and pediatric population. The purpose of this study is to report our experience and compare outcomes between conventional laparoscopy and laparoendoscopic single-site (LESS) surgery for varicocelectomy in the pediatric population. Patients and methods...

To report our analysis of complications on pediatric robotic urologic procedures. A retrospective review was performed for all robotic surgeries by pediatric urologists at a single pediatric institution, from the start of the robotic surgery program in February 2009 through February 2013. Data included patient demographics, intraoperative details,...

We describe pediatric robotic assisted laparoscopic left nephropexy in a 12-year-old female for symptomatic nephroptosis after partial nephroureterectomy.

Recent investigations described the use of NGAL, a sensitive biomarker for kidney injury, in the setting of ureteropelvic junction obstruction. We prospectively evaluated urinary NGAL levels in the affected renal pelvis and bladder of children with ureteropelvic junction obstruction undergoing unilateral dismembered pyeloplasty. Our hypothesis was...

Purpose: We report our experience and compare the outcomes between standard and robot-assisted laparoscopic pyeloplasty to treat ureteropelvic junction obstruction in children. Materials and methods: A retrospective cohort study was performed of all children who underwent standard or robot-assisted laparoscopic pyeloplasty for ureteropelvic junc...

Recent Surveillance Epidemiology and End Results (SEER) data indicate that the annual cancer incidence in adolescents is higher than in children, and is on the rise. However, the amount of attention, research funding, and therapeutic progress made in the adolescent oncology population pales in comparison with that of pediatric oncology. Issues of a...

Purpose Patients with posterior urethral valves (PUV) represent a cohort with wide variability in their clinical presentation. The management of these patients thus varies depending on the severity of pathology. Optimizing the clinical outcomes of individual patients with PUV is challenging in the most severely affected patients. The effectivenes...

Purpose: Advances in medicine and multidisciplinary care have resulted in increased life expectancy and improved quality of life for patients with chronic congenital urological conditions (CUC). Current survival into adulthood approaches 80%. These patients are often followed with multiple serial radiographic studies to monitor their health and i...

Partial nephrectomy has been previously reported as safe and effective in appropriately selected children with renal cell carcinoma (RCC). However, there are limited reports of laparoscopic or robotic partial nephrectomy for oncologic surgery in children. Additionally, nodal involvement is common in pediatric RCC, and may present even with small pr...

Calcium nephrolithiasis in children is increasing in prevalence and tends to be recurrent. Although children have a lower incidence of nephrolithiasis than adults, its etiology in children is less well understood; hence, treatments targeted for adults may not be optimal in children. To better understand metabolic abnormalities in stone-forming chil...

The objectives of the study were to (1) describe evaluation and treatment patterns for adolescent males presenting with a concern for sexually transmitted infection (STI) in a pediatric emergency department, (2) assess the rates of STIs in symptomatic males, and (3) determine the utility of urinalysis alone in predicting STIs in adolescent males. A...

Purpose: The current radiographic evaluation of patients with suspected uretero-pelvic junction obstruction (UPJO) includes ultrasonography and a well-tempered diuretic renogram. Controversy exists regarding the indications for surgical intervention in asymptomatic patients. Urinary neutrophil gelatinase-associated lipocalin (NGAL) is known to be a...

Normal Range Mean %Abnormal BMI 49.0 Volume (liters) 0.5 - 4 1.30 0 pH 5.8-6.2 6.12 50 Calcium (mg/day) Male < 250 Female < 200 127 10 SS Calcium oxalate 6-10 6.9 30 Oxalate (mg/day) 20-40 36.6 30 SS Calcium phosphate 0.5-2.0 1.26 30 SS Uric acid 0-1 1.10 40 Uric acid (g/day) Male < 0.8 Female < 0.75 0.63 30 Citrate (mg/day) Male > 45...

Robot-assisted laparoscopic pyeloplasty has become more widely used. Intraoperative placement and confirmation of ureteral stent position can be cumbersome with the robotic arms in place. We present a technique of percutaneous antegrade stent placement that is reliable with minimal morbidity. A retrospective cohort study was performed. Patient demo...

One of the main ergonomic challenges during surgical procedures is surgeon posture. There have been reports of a high number of work related injuries in laparoscopic surgeons. The Alexander technique is a process of psychophysical reeducation of the body to improve postural balance and coordination, permitting movement with minimal strain and maxim...

Children with end-stage renal disease and bladder dysfunction may require augmentation cystoplasty before kidney transplantation. Previous reports have suggested unacceptable urinary tract infection rates in these immunosuppressed patients. We reviewed our experience in this population. We retrospectively studied patients undergoing augmentation cy...

Purpose: One of the main ergonomic challenges during surgical procedures is the surgeon's posture. This issue is further compounded by the surgical equipment used in Laparoscopic/Minimally invasive procedures (MIS). The Alexander Technique (AT) is a process of psychophysical education of the musculo-skeletal system in order to improve posture and c...

Children with chronic renal insufficiency and neuropathic bladder resistant to medical management may require lower urinary tract reconstruction before renal transplantation. A low pressure urinary reservoir optimizes the chance of graft survival and may slow native kidney death. We evaluated whether the renal deterioration rate is affected by augm...

Advances in technology and the continued evolution in the design of ureteroscopes now permit a primary endoscopic approach to the upper urinary tract of pediatric patients on a routine basis to treat a diverse group of conditions that include urolithiasis, hematuria and strictures. The purpose of this review article is to demonstrate that ureterosc...

To determine which risk factors help predict recurrent stone formation. Urinary stone disease is relatively rare in children. At our institution, a full urinary metabolic evaluation is initiated after the first stone episode. A retrospective cohort study was performed to assess urinary metabolic profiles in children with urolithiasis. Twenty-four-h...

The combination of trimethoprim/sulfamethoxazole is often used to treat uncomplicated urinary tract infections in children. The rationale for combining trimethoprim and sulfamethoxazole is that they may act synergistically to increase antibacterial activity. However, approximately 3% of patients show allergic reactions to sulfamethoxazole, of which...

Endoscopic injection of dextranomer/hyaluronic acid is an option for primary vesicoureteral reflux. Few groups have assessed the rate of urinary tract infection after dextranomer/hyaluronic acid injection. We reviewed our experience with dextranomer/hyaluronic acid injection, and determined the incidence of and risk factors for postoperative urinar...

IntroductionSurgical indications and patient selectionOperative techniqueOutcomesComplicationsConclusion References

In rare instances when native bladder tissue is either unsuitable or unavailable a continent neobladder may be an option for pediatric lower urinary tract reconstruction. We report our long-term outcomes and experience in this challenging patient population. A retrospective cohort study was performed of all patients who underwent creation of a neob...

Obstructive uropathy secondary to posterior urethral valves is an important cause of end stage renal disease in children. Early diagnosis and intervention to decrease bladder pressure and stabilize the upper urinary tract are important to delay or prevent the progression of renal insufficiency. We analyzed the records of patients with posterior ure...

Severe bowel dysfunction often accompanies neurogenic bladder, and Malone antegrade continence enema procedures can lead to improvement in the quality of life for these patients. The most commonly reported complication has been stomal stenosis of the conduit. We report our experience with the use of the MIC-KEY gastrostomy button for the management...

We have previously reported a high rate of urinary metabolic abnormalities in stone forming children compared to normal controls. At our institution a 24-hour urine evaluation is initiated after the first stone episode in children, to measure stone risk indices. The purpose of this study was to determine which children are at the greatest risk for...

Purpose Obstructive uropathy secondary to posterior urethral valves (PUV) is still an important cause of end stage renal disease (ESRD) in children. The PURPOSE of this study is to analyze patients with PUV to determine risk factors that might be predictive for ultimate renal failure. Material and Methods A retrospective cohort study was performed...

Although rarely indicated, surgical treatment of severe megaureter can pose a formidable technical challenge, especially in the small infant. We present our experience and outcomes with end cutaneous ureterostomy as a temporizing adjunct to future ureteral reimplantation. We performed a retrospective cohort study of patients who underwent end cutan...

Little has been reported concerning the efficacy of endoscopic injection of dextranomer/hyaluronic acid for the treatment of residual incontinence following bladder neck reconstruction. We present the experience of 2 institutions using endoscopic submucosal injection of dextranomer/hyaluronic acid to correct incontinence in patients who had previou...

Urinary stone disease is relatively rare in children and urinary metabolic evaluations have been the standard in our practice. We have previously reported a high rate of urinary metabolic abnormalities in stone forming children. We compared urinary chemistry values in normal and stone forming children. A prospective study was performed to assess ur...

The efficacy of endoscopic injection of dextranomer/hyaluronic acid to correct primary vesicoureteral reflux is well documented. We present experience at 2 institutions with endoscopic treatment for vesicoureteral reflux after failed ureteroneocystostomy. A retrospective review was performed of the records of all patients who underwent endoscopic d...

Recurrent urinary tract infections are common in complex pediatric urological cases, particularly those requiring clean intermittent catheterization. At our institution gentamicin bladder irrigations have been used for antimicrobial prophylaxis and to treat symptomatic bacteriuria, particularly when the infection does not involve the upper urinary...

To assess the efficacy of perioperative antibiotics in decreasing post-operative morbidity among patients undergoing tonsillectomy or adenotonsillectomy. Meta-analysis based on a structured search of the literature, using MEDLINE and the Cochrane database. Only articles, which included both treatment and control groups, were included in the final a...

Severe bowel dysfunction often accompanies neurogenic bladder, and Malone antegrade continence enema (MACE) procedures can lead to improvement in the quality of life of these patients. However, complications such as catheter false passage with subsequent intraperitoneal instillation of irrigation can lead to significant morbidity. We present our ex...