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  1. 1. EMBARGOED FOR RELEASE UNTIL MONDAY, MAY 16, 2011 AT 11:00 A.M. Contact: Wendy Waldsachs Isett, AUA 410-977-4770, wisett@AUAnet.org NEW DATA PROVIDE INSIGHT INTO PEDIATRIC UROLOGY CONDITIONS, TREATMENT Research brings new approaches to pediatric nephrolithiasis, enuresis and ureteropelvic junction obstruction managementWashington, DC, May 16, 2011—New studies providing key insights into pediatric stone disease, bedwettingand ureteropelvic junction obstruction treatment will be presented on Monday, May 16, 2011 at 11:00 a.m.during a special press panel briefing at the AUA Annual Scientific Meeting in Washington, DC. These postersoutline key interventions to help guide parents and physicians in treating the most vulnerable urology patients.The panel briefing for press will be moderated by Dr. Anthony Atala, a pediatric urologist and AUA spokesman.The studies being presented include:Are Children with Stones at Risk for Breaking Bones? Bone Mineral Density Analysis in Pediatric StoneFormers (#1382): Children with urolithiasis are more prone to fracture due to low bone-mineral density, makingthem at at-risk population for future osteoporosis and a key target for early intervention, according to new datafrom researchers in Dallas. Employing a retrospective review of pediatric patients (average age of 12.2 years)undergoing dual-energy x-ray absorptiometry scans for urolithiasis, authors found that more than 40 percent ofpediatric stone formers had Z-scores less than -1, a value associated with increased fracture risk. Because bonemass accrual peaks in adolescence, identifying low bone mineral density in pediatric stone formers may allowfor early intervention to ameliorate future bone loss.Enuretic Children with Obstructive Sleep Apnea Syndrome (OSAS): Should They See Otolaryngology First?(#827): Tonsillectomy and adenoidectomy may help resolve enuresis in some children with OSAS, according tonew data from researchers in Detroit. Authors examined records for 417 enuretic children who had undergonetonsillectomy and adenoidectomy for OSAS, and conducted phone interviews to assess daytime and nighttimeenuresis following the surgery (median post-operative follow up of 11.7 months). Approximately half therespondents who underwent tonsillectomy and adenoidectomy showed resolution of nocturnal enuresis.Prematurity, however, was noted by authors as the single-best predictor of failure to see resolution of enuresissymptoms following surgical treatment for OSAS.Application of Urinary Carbohydrate Antigen 19-9 as a Non-Invasive Method for Determining Conservative orSurgical Management of Children with Ureteropelvic Junction Obstruction (#456): urinary carbohydrate antigen(CA) 9-19 may be a valuable marker for determining the extent to which initial treatment is required for
  2. 2. ureteropelvic junction obstruction (UPJO) and which patients being managed conservatively are candidates forpyeloplasty, according to researchers at Children’s Hospital Medical Center in Tehran. Authors examined 36children with high-levels of CA 19-9 who had undergone pyeloplasty for UPJO, and 24 children with dilated, non-obstructed kidneys. Pyeloplasty resulted in a significant post-operative decrease in CA 19-9 at three-months, whilepatients on conservative management experienced a decrease at 12 months. CA 19-9 levels were significantlycorrelated with changes in renal pelvis diameter.NOTE TO REPORTERS: Experts are available to discuss this study outside normal briefing times. To arrange aninterview with an expert, please contact the AUA Communications Office at the number above or e-mailwisett@AUAnet.org. About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 17,000 membersthroughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients. ###
  3. 3. 1382ARE CHILDREN WITH STONES AT RISK FOR BREAKING BONES? BONE MINERAL DENSITY ANALYSIS INPEDIATRIC STONE FORMERSCandace Granberg, Katherine Twombley, Aditya Bagrodia, Khashayar Sakhaee, Naim Maalouf, Linda A. Baker,Nicol C. Bush, Dallas, TX INTRODUCTION AND OBJECTIVES: Adult stone formers are known to have lower bone mineral density (BMD)and higher rates of osteoporotic fractures compared to non-stone formers. Low BMD in children is associatedwith increased risk of bone fractures. The objective of this study was to evaluate BMD among our pediatricstone patients.METHODS: Retrospective review of all patients undergoing dual-energy x-ray absorptiometry (DXA) scan since2000 with a confirmed diagnosis of urolithiasis was performed. Immobilized patients were excluded. Z-scores,expressed as number of age- and gender-matched standard deviations from the mean, and 24-hour urineprofiles were assessed. Since 2009, patients with ? 1 stone have been prospectively queried about fracturehistory. Hypercalciuria was defined as Ca/Cr ratio > 0.2 and/or > 4 mg/kg/day. Statistical testing was performedwith Fishers exact and t-test, with p<0.05 considered statistically significant.RESULTS: 132 confirmed stone-formers (76F:56M) underwent DXA analysis at average age 12.2 years. Averagelumbar and radial forearm BMD Z-scores were -0.8 (range -4.2 to +2.7) and -0.5 (range -2.9 to +2.2),respectively. Lumbar BMD Z-scores were < -1.0 in 51/127 Table 1: DXA results based on presence or absence of hypercalciuria Non-hypercalciuric Hypercalciuric p-value(40.2%) patients, and < -2.0 in Total patients (n=79) 43 (54.4%) 36 (45.6%)21/127 (16.5%). 79 of 132 Mean lumbar Z-score (SD) -0.9 (1.08) -1.0 (1.83) 0.76children have completed 24- Z-score < -1, n (%) 22 (51.2) 14 (38.9) 0.36hour urine stone risk analysis, Z-score < -2, n (%) 9 (20.9) 7 (19.4) 1.00demonstrating 45.6% with Mean radial Z-score (SD) -0.2 (1.35) -0.8 (1.46) 0hypercalciuria. Table 1stratifies BMD Z-score based on presence or absence of hypercalciuria. Hypercalciuria was not associated withrisk of BMD Z-score < -1 (p=0.36). Among 22 stone-formers who were prospectively queried about bone fracturehistory, 7 (31.8%) had one or more fractures. Average BMD Z-score in those with versus without fractures was -1.1 and -0.7, respectively.CONCLUSIONS: Pediatric stone disease may identify an at-risk population for future osteoporosis and fractures.Over 40% of our pediatric stone formers had Z-scores < -1.0, a value associated with increased fracture risk inchildren. Screening DXA scans should be performed in pediatric stone-formers and/or hypercalciurics,particularly in those with a history of fracture. Since adolescence is the period for peak bone mass accrual, itmay be the ideal time for dietary and/or medical intervention to decrease future osteoporotic risk.Source of Funding: CCRAC grant #2001-5
  4. 4. 827ENURETIC CHILDREN WITH OBSTRUCTIVE SLEEP APNEA SYNDROME (OSAS): SHOULD THEY SEEOTOLARYNGOLOGY FIRST?Larisa Kovacevic, Ali Dabaja, Michael Jurewicz, Brittany Renolds, Amy Rutt, David Madgi, Yegappan Lakshmanan,Detroit, MIINTRODUCTION AND OBJECTIVES: (1)To Investigate the effect of tonsillectomy and adenoidectomy(T&A)onenuresis in children with OSAS, and (2) to identify factors that may predict lack of response of enuresis.METHODS: Children 5-18 years of age with OSAS and nocturnal enuresis (NE) who underwent T&A betweenSeptember 2008 and September 2010 were included. Study consisted of a phone interview and chart review.Severity of nocturnal and diurnal enuresis (DE), frequency, arousal and sleeping disturbances were assessed preand post T&A. Student?s t test and Fisher?s exact test were used for data analysis. Pre and post-surgerydifferences between groups were examined by parametric analysis of covariance (ANCOVA). A binary logisticregression model was used to identify the best predictive factor of non-response.RESULTS: Among the 417 children who underwent T&A 101 (24%) had NE, and of those 23 had DE. The meanpostoperative follow-up was 11.7 months. Of the 49 responders 30 showed resolution of their NE in less then 1month post-operatively. DE resolved in 4 children, improved in 4, and did not change in 15 children post T&A.CONCLUSIONS: T&A led to resolution of NE in about 50% of children with OSAS. Lower response rate wasassociated with male gender, prematurity, obesity, non MNE, and family history of NE. Prematurity was thesingle best predictor of failure to respond to T&A. Improved arousal may be partly responsible for the effect ofT&A on both NE and DE in children with OSAS.Source of Funding: none
  5. 5. 456APPLICATION OF URINARY CARBOHYDRATE ANTIGEN 19-9 AS A NON-INVASIVE METHOD FOR DETERMININGCONSERVATIVE OR SURGICAL MANAGEMENT OF CHILDREN WITH URETEROPELVIC JUNCTION OBSTRUCTIONAbdol-Mohammad Kajbafzadeh, Saman S. Talab, Azadeh Elmi, Delaram Jan, Parisa Mazaheri, Shadi A. Esfahani,Tehran, IranINTRODUCTION AND OBJECTIVES: Previously, we reported elevated level of urine carbohydrate antigen 19-9(CA 19-9) in ureteropelvic junction obstruction (UPJO). In present study we aimed to investigate feasibility ofurinary CA 19-9 level as a non-invasive method for facilitating clinical decisions regarding surgical versusconservative management in children with UPJO.METHODS: The study included 36 children with UPJO treated with pyeloplasty (GI) and 24 children with dilatednonobstructed kidneys who were treatedconservatively (GII). Voided urine samples wereobtained for CA 19-9 measurement beforetreatment, and every 3 months during follow-up. Additionally, ultrasonography in three-month intervals and annual renography wereperformed. Follow-up ranged from 12-27months (average 16.4 months). Surgicalintervention was considered for patients with>10% loss of renal function.RESULTS: In GI preoperative CA 19-9 wassignificantly higher than in GII and a cutoff valueof 41.06 U/ml yielded a sensitivity of 96.7% anda specificity of 93%. Compared to initialmeasurements, CA 19-9 decreased significantlyat 3 months after pyeloplasty in GI and in the12th month in GII with significant correlationwith changes in renal pelvis diameter. In threepatients due to rising CA 19-9 levels duringfollow-up along with decline in renal function(mean 12.8%) pyeloplasty was considered.CONCLUSIONS: Urinary CA 19-9 is a non-invasive clinically applicable marker for definition of managementprotocol in children with UPJO. The practical clinical implications of the biomarker for long-term follow-up ofchildren with UPJO after pyeloplasty and those receiving conservative treatment are significant.Source of Funding: None