William Kennedy

All Publications

• The Relationship between Neonatal Circumcision, Urinary Tract Infection, and Health. The world journal of men's health Eisenberg, M. L., Galusha, D., Kennedy, W. A., Cullen, M. R. 2018

  Abstract

  The risk-benefit profile of neonatal circumcision is not clear. Most studies have focused on urinary tract infections but other health sequelae have not been evaluated. While evidence supports benefits of circumcision, a lack of randomized trials has been cited as a weakness. National guidelines provide mixed recommendations regarding neonatal circumcision. We review the weight of evidence and utilize current statistical methodology on observational data to examine the risks and benefits of neonatal circumcision.

  View details for PubMedID 29623700

• Identification of transcripts associated with renal damage due to ureteral obstruction as candidate urinary biomarkers. American journal of physiology. Renal physiology Wu, B., Gong, X., Kennedy, W. A., Brooks, J. D. 2018

  Abstract

  Renal obstruction is a common cause of renal failure in adults and children and is suspected when hydronephrosis is detected on imaging. Since not all cases of hydronephrosis are associated with renal damage, biomarkers are needed to guide intervention to relieve obstruction. We performed gene expression profiling on the kidneys from adult mice over a detailed time course after obstruction and compared these data to a neonatal model of bilateral high grade obstruction induced by conditional deletion of the calcineurin SS1 (Cnb1) gene. Having identified a set of 143 transcripts modulated in both adult and neonatal obstruction, we tested their expression in a model of short-term obstruction (1 day), where renal damage is transient and reversible, and long-term obstruction (5 days), where significant renal damage is permanent. A significantly number of transcripts increased early after obstruction, and later normalized, while 26 transcripts remained elevated 10 and 28 days after relief of 5 days of ureteral obstruction. Using QPCR, elevated levels of several of these candidate RNA biomarkers of renal damage were detected in urine from obstructed mice. In addition, several of these candidate RNA biomarkers of damage due to obstruction were detectable in catheterized urine samples from children undergoing surgery for ureteropelvic junction obstruction (UPJO). Measurement of urinary transcripts modulated in response to renal obstruction could serve as biomarkers of renal damage with important clinical applications.

  View details for PubMedID 29488389

• Editorial Comment. Urology Bennett, C. L., Prasad, S. M., Kennedy, W. A. 2016; 94: 15-6

  View details for DOI 10.1016/j.urology.2016.02.062

  View details for PubMedID 27207146

• Indirect inguinal hernia with uterine tissue in a male: A case of persistent Mullerian duct syndrome and literature review CUAJ-CANADIAN UROLOGICAL ASSOCIATION JOURNAL Ahdoot, M., Qadan, M., Santa-Maria, M., Kennedy, W. A., Ilano, A. 2013; 7 (1-2): E121-E124

  View details for DOI 10.5489/cuaj.253

  View details for Web of Science ID 000209409700015

• Indirect inguinal hernia with uterine tissue in a male: A case of persistent Mullerian duct syndrome and literature review. Canadian Urological Association journal = Journal de l'Association des urologues du Canada Ahdoot, M., Qadan, M., Santa-Maria, M., Kennedy, W. A., Ilano, A. 2013; 7 (1-2): E121-4

  Abstract

  A 32-year-old male presenting with a direct inguinal hernia was found to have uterine tissue extending through the inguinal canal, warranting a diagnosis of persistent Mullerian duct syndrome (PMDS). PMDS is an extremely rare form of internal male pseudo-hermaphroditism in which female internal sex organs, including the uterus, cervix and proximal vagina, persist in a 46XY male with normal external genitalia. The condition results from a congenital insensitivity to anti-Mullerian hormone, or lack of anti-Mullerian hormone, leading to persistence of the female internal sex organs in a male. Clinically, this condition is associated with cryptochoridism. Controversy persists regarding the appropriate treatment of PMDS, since resection of the remnant structures is associated with potential morbidity, but retention risks development of occasional malignancies. We review the literature and discuss various aspects of pathophysiology, diagnosis, and management of PMDS.

  View details for DOI 10.5489/cuaj.253

  View details for PubMedID 23671501

  View details for PubMedCentralID PMC3650826

• A comparison of calcium hydroxyapatite and dextranomer/hyaluronic Acid for the endoscopic treatment of vesicoureteral reflux. Advances in urology Ngo, T. C., Wong, I. Y., Kennedy, W. A. 2013; 2013: 263602-?

  Abstract

  Purpose. Minimal data exists comparing dextranomer/hyaluronic acid (Dx/HA) and calcium hydroxyapatite (CaHA) for the endoscopic treatment of VUR in the hands of a single user. Materials and Methods. We reviewed our consecutive single-user case series of 27 children (42 ureters) receiving endoscopic treatment with CaHA and 21 children (33 ureters) who received Dx/HA injection. Children receiving CaHA injections were divided into two groups of 13 and 14 patients (Coaptite I and II) to assess the learning curve effects. Postoperatively, RBUS and VCUG were performed. Multiple regression analysis was performed to assess statistical significance of success rates. Results. The total CaHA group had a per-ureter success rate (Grade 0) of 52% after one injection. When separated into two cohorts, the single injection per-ureter success rates were 43% for Coaptite I and 62% for Coaptite II. In contrast, the Dx/HA series had a single injection per-ureter success rate (Grade 0) of 78%. Conclusions. Our consecutive case experience shows improved results for Dx/HA compared to CaHA, though the learning curve effects and evolution of injection technique likely played a role in the improved outcomes in the Dx/HA cohort. A randomized controlled multicenter trial would provide the most accurate data comparing these two agents.

  View details for DOI 10.1155/2013/263602

  View details for PubMedID 24235969

  View details for PubMedCentralID PMC3819879

• Radiation Exposure During Pediatric Videourodynamics JOURNAL OF UROLOGY Ngo, T. C., Clark, C. J., Wynne, C., Kennedy, W. A. 2011; 186 (4): 1672-1676

  Abstract

  Videourodynamics is useful for evaluating and treating neurological disorders in children. Traditional urodynamic parameters can be obtained while simultaneous visualization of the urinary system can reveal anatomical anomalies. This additional information comes at the cost of radiation exposure to the child. We characterized radiation exposure from videourodynamics.We reviewed all recent videourodynamic studies and recorded patient demographics, urological diagnoses, physical attributes, total fluoroscopy time, total radiation exposure in mGy, bladder capacity and the number of filling cycles performed. Multivariate linear regression was used to identify patient factors that independently influenced total radiation exposure.A total of 64 videourodynamic studies were performed in 34 female and 28 male patients with a mean age of 8.6 years (95% CI 7.2-10.0). The most common diagnosis was neurogenic bladder in 40 patients, although 49 had multiple diagnoses. Mean total fluoroscopy time was 1.8 minutes (95% CI 1.4-2.1) and mean total radiation exposure was 10 mGy (95% CI 7.5-13.3). On multivariate linear regression patient weight and bladder capacity were the only independent predictors of total radiation exposure.Videourodynamics entail significant radiation exposure. Patient weight and bladder capacity were independent predictors of total radiation exposure. Physician awareness of radiation exposure may result in the judicious use of fluoroscopy and aid in counseling parents on the risk of videourodynamics. Further research is needed to quantify organ specific doses of radiation due to medical imaging in children and the associated cancer risks.

  View details for DOI 10.1016/j.juro.2011.04.014

  View details for Web of Science ID 000295043000032

  View details for PubMedID 21862046

• Sacral Nerve Stimulator Revision Due to Somatic Growth JOURNAL OF UROLOGY Clark, C., Tin Ngo, T., Comiter, C. V., Anderson, R., Kennedy, W. 2011; 186 (4): 1576-1580

  Abstract

  Sacral nerve modulation is a Food and Drug Administration approved treatment for refractory urgency, frequency, urge incontinence and nonobstructive urinary retention in adults. The sparse literature on sacral nerve modulation in children focuses on its initial efficacy in patients with neurogenic bladder and dysfunctional elimination. We describe our initial experience with sacral nerve modulation and the phenomenon of growth spurts associated with lead malfunction that necessitates revision.After receiving institutional review board approval we retrospectively reviewed the charts of pediatric patients who underwent sacral nerve modulation surgery at our institution. Charts were examined for patient demographics, subjective success, the need for further surgery and success after revision.Four patients underwent sacral nerve modulation at an average age of 12.1 years. All patients reported initial success, defined as greater than 50% symptom improvement. Subsequently 3 patients required a total of 5 revisions due to lead malfunction with an average of 1.5 years between surgeries. In those requiring revision the average somatic growth between revisions was 8.1 cm. Return of efficacy was reported after each revision. All patients had functioning nerve stimulators in place and continued to have a positive subjective response.The sparse data on sacral nerve modulation in children shows efficacy and safety similar to those in adults. Somatic growth may be associated with lead malfunction and require surgical revision. We report a small series showing that revision can be done successfully and safely. Informed consent for sacral nerve modulation in pediatric patients should include a discussion of somatic growth as a possible cause of lead malfunction necessitating revision.

  View details for DOI 10.1016/j.juro.2011.03.098

  View details for Web of Science ID 000295043000003

  View details for PubMedID 21855923

• Compliance With Antibiotic Prophylaxis in Children With Vesicoureteral Reflux: Results From a National Pharmacy Claims Database JOURNAL OF UROLOGY Copp, H. L., Nelson, C. P., Shortliffe, L. D., Lai, J., Saigel, C. S., Kennedy, W. A. 2010; 183 (5): 1994-1999

  Abstract

  Antibiotic prophylaxis is commonly used for medical management of vesicoureteral reflux. Little information exists on compliance with antibiotic prophylaxis in patients with vesicoureteral reflux.We queried the i3 Innovus (Ingenix) pharmacy claims 2002 to 2007 database for patients 18 years old or younger with vesicoureteral reflux (ICD-9 code 593.7 plus claim for cystogram) and analyzed those with at least 1 year of followup data. Criteria for management with antibiotic prophylaxis were 2 or more 30-day supplies of antibiotic prescriptions, or 4 or more 14-day supplies of prescriptions if the antibiotic was a penicillin or cephalosporin. Antibiotic prophylaxis compliance was determined using a medication possession ratio, an estimate of the proportion of time that patients have a prescribed drug available for use. Compliance was established as a medication possession ratio of 80% or greater, meaning coverage with antibiotic prophylaxis for 80% of the year or more.Of 9,496 patients with vesicoureteral reflux 5,342 (56.3%) were treated with antibiotic prophylaxis. Most patients were female (81%) and 5 years old or younger (79%). Trimethoprims/sulfonamides were most commonly prescribed (62%) and antiseptics were next (24%). Of patients prescribed antibiotic prophylaxis 40% were compliant. Compliance was lower for 6 to 10-year-olds (OR 0.71, 95% CI 0.61-0.83) and 11 to 18-year-olds (OR 0.56, 95% CI 0.41-0.79) compared to younger children (5 years or less). Increased compliance was associated with 1 or more hospitalizations (OR 1.70, 95% CI 1.48-1.97) and 1 or more urologist visits (OR 1.41, 95% CI 1.25-1.58).Among patients with vesicoureteral reflux who are prescribed prophylactic antibiotics 40% are compliant with treatment. Young age, frequent hospitalization and specialist visits are associated with compliance. This knowledge may help to develop effective interventions to improve compliance and underscores the importance of reporting compliance in clinical studies evaluating the usefulness of antibiotic prophylaxis in vesicoureteral reflux management.

  View details for DOI 10.1016/j.juro.2010.01.036

  View details for Web of Science ID 000276747600134

  View details for PubMedID 20303526

  View details for PubMedCentralID PMC3319712

• Urinary Tract Infection in Children: When to Worry UROLOGIC CLINICS OF NORTH AMERICA Clark, C. J., Kennedy, W. A., Shortliffe, L. D. 2010; 37 (2): 229-?

  Abstract

  Urinary tract infection (UTI) is a frequent diagnosis in children who are referred to the urologist. Although most infections will resolve without complication after appropriate treatment, a wide array of potential complicating factors exists, which can make difficult the rapid resolution of a UTI. Clinical scenarios involving these factors require a high index of suspicion and prompt initiation of appropriate therapy.

  View details for DOI 10.1016/j.ucl.2010.03.009

  View details for Web of Science ID 000279321900009

  View details for PubMedID 20569801

• Clinical Presentation and Urachal Remnant Pathology: Implications for Treatment 60th Annual Meeting of the American-Academy-of-Pediatrics/International-Childrens-Continence-Society Copp, H. L., Wong, I. Y., Krishnan, C., Malhotra, S., Kennedy, W. A. ELSEVIER SCIENCE INC. 2009: 1921–24

  Abstract

  Symptomatic pediatric urachal remnants are frequently excised but to our knowledge it is unknown whether incidentally identified urachal remnants require removal. Urachal remnant excision in childhood is advocated to avoid future malignancy. Urachal anomalies that contain fibrostromal tissue without epithelium may have lower malignant potential and not require excision. In contrast, lesions with epithelium may have increased potential to undergo malignant transformation. We examined whether incidentally identified urachal remnants would be less likely to contain epithelial elements and not require removal.At our institution 29 patients underwent surgical excision of a urachal anomaly from 1999 to 2008. We retrospectively investigated the presentation mode, radiographic findings, associated genitourinary abnormalities, operative approach, tissue pathology, complications and followup in each patient.The male-to-female ratio was 1.2:1. Patient presentation was incidental (5) or symptomatic (24). Symptomatic presentations included umbilical discharge without omphalitis in 13 cases, umbilical discharge with omphalitis in 7, omphalitis without umbilical discharge in 3 and urinary tract infection in 1. The epithelial types identified were transitional, gastrointestinal, squamous, metaplastic and mixed. Epithelium was present on pathological analysis in 3 of 5 patients who presented incidentally and in 17 of 24 who presented symptomatically. Statistical analysis showed no association between presentation mode and pathology (p = 0.63). Five patients 4 weeks to 2.5 months old had vesicoureteral reflux on voiding cystourethrogram for urachal remnant evaluation.Analysis of 29 patients with urachal anomalies showed no association between incidental presentation and fibrostromal pathology. Patients presenting without symptoms were as likely to have epithelial elements in the urachal remnant as those presenting with symptoms. We could not define treatment recommendations for incidentally identified urachal remnants based on predicting the histopathological composition.

  View details for DOI 10.1016/j.juro.2009.03.026

  View details for Web of Science ID 000269764300104

  View details for PubMedID 19695622

• MR Voiding Cystography for Evaluation of Vesicoureteral Reflux AMERICAN JOURNAL OF ROENTGENOLOGY Vasanawala, S. S., Kennedy, W. A., Ganguly, A., Fahrig, R., Rieke, V., Daniel, B., Barth, R. A. 2009; 192 (5): W206-W211

  Abstract

  The purpose of our study is to present a real-time interactive continuous fluoroscopy MRI technique for vesicoureteral reflux (VUR) diagnosis.MR voiding cystography with a real-time interactive MR fluoroscopic technique on an open MRI magnet is feasible for the evaluation of VUR in children.

  View details for DOI 10.2214/AJR.08.1251

  View details for Web of Science ID 000265387300045

  View details for PubMedID 19380524

• Dichorionic diamniotic twin pregnancy discordant for bladder exstrophy. Advances in urology Tu, W., Chueh, J., Kennedy, W. 2009: 186483-?

  Abstract

  A 38 year-old woman presented with a dichorionic diamniotic twin pregnancy at gestational age of 32 weeks concerning for an abdominal wall mass in one of the twins. Initial ultrasound evaluation was suspicious for an omphalocele, but the affected twin was found to have bladder exstrophy at birth. This illustrates the difficulties of accurate prenatal diagnosis of bladder exstrophy in a twin pregnancy at a late gestation.

  View details for DOI 10.1155/2009/186483

  View details for PubMedID 19753322

  View details for PubMedCentralID PMC2742653

• Persistent and recurrent postsurgical varicoceles: Venographic anatomy and treatment with n-butyl cyanoacrylate embolization JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Sze, D. Y., Kao, J. S., Frisoli, J. K., McCallum, S. W., Kennedy, W. A., Razavi, M. K. 2008; 19 (4): 539-545

  Abstract

  To elucidate the mechanism of persistence or recurrence of varicoceles after surgical repair by examining the venographic anatomy, and to review the efficacy of treatment of these patients with n-butyl cyanoacrylate (NBCA) embolization.From 2001 to 2007, 17 patients with persistent or recurrent varicoceles were studied by retrograde venography 4 months to 18 years after open surgical repair. All patients were then treated with NBCA glue embolization of the entire gonadal vein and the venographically identified duplications and collateral vessels, with three patients undergoing bilateral procedures. Venographic anatomy and clinical success were retrospectively analyzed.The majority of patients (65%) exhibited duplications draining into a single left gonadal vein. Duplications were most frequently found to be confined to the pelvis and inguinal canal. Communication with other retroperitoneal veins, including the renal hilar, lumbar, iliac, and circumaortic renal vein, was relatively uncommon. NBCA embolization effectively treated the main gonadal vein as well as the duplications and communications, with only one patient developing thrombophlebitic complications.Duplication of the gonadal vein in the pelvic or inguinal region with apparent incomplete ligation or resection is a common finding in patients with persistence or recurrence of varicocele after surgery. NBCA embolization effectively treats these duplicated vessels, resulting in a high rate of clinical success on short-term follow-up.

  View details for DOI 10.1016/j.jvir.2007.11.009

  View details for Web of Science ID 000254760900011

  View details for PubMedID 18375298

• Results of a 2-year multicenter trial of endoscopic treatment of vesicoureteral reflux with synthetic calcium hydroxyapatite JOURNAL OF UROLOGY Mevorach, R. A., Hulbert, W. C., Rabinowitz, R., Kennedy, W. A., Kogan, B. A., Kryger, J. V., Caldamone, A., Clark, W. R., Kaplan, G. W., Durkee, C. T., Elder, J. S. 2006; 175 (1): 288-291

  Abstract

  With no FDA approved material available for endoscopic treatment of vesicoureteral reflux, in 2001 we began a prospective multicenter trial of synthetic calcium hydroxyapatite as a subureteral bulking agent in children with traditional indications for surgical repair.A total of 98 patients (155 ureters) with grades II to IV reflux were enrolled at 10 sites in the United States to obtain 86 patients with completed protocol end points at 3 months. Of the 86 patients 74 underwent renal and bladder ultrasonography, blood count and serum chemistry analysis, and VCUG at 1 year. A total of 46 patients (47%) completed 2-year study end points, including VCUG.At 1 and 2 years 24 of the 74 patients (32%) were cured. Ureteral cure rates were 46% and 40% at 1 and 2 years, respectively. With 35 patients treated and 85% compliance with the required 2-year VCUG the primary center achieved 2-year cure rates of 66% of patients and 72% of ureters.Synthetic calcium hydroxyapatite is a safe, durable and effective material for endoscopic treatment of VUR. Increased experience with the injection of synthetic calcium hydroxyapatite yields improved results.

  View details for DOI 10.1016/S0022-5347(05)00013-3

  View details for Web of Science ID 000234001100073

  View details for PubMedID 16406928

• The effect of oxybutynin treatment on cognition in children with diurnal incontinence Annual Meeting of the Section on Urology of the American-Academy-of-Pediatrics Sommer, B. R., O'Hara, R., Askari, N., Kraemer, H. C., Kennedy, W. A. ELSEVIER SCIENCE INC. 2005: 2125–27

  Abstract

  Oxybutynin is a powerful anticholinergic drug already known to impair cognition in the elderly. The impact of this drug on cognitive functioning in the pediatric population is unknown. We report the results of a study designed to assess the effect of oxybutynin on cognitive function in children.A total of 25 patients presenting with the primary symptom of daytime enuresis were recruited for this nonrandomized trial. All subjects initially received 4 weeks of behavior modification, followed by an additional 4 weeks of behavior modification either alone or with oxybutynin for continued treatment of enuresis. Neuropsychological testing was performed at baseline (4 weeks) and after additional therapy (8 weeks).Patient demographics included a male-to-female ratio of 11:14 and a mean age of 7.2 +/- 1.8 years. A total of 10 patients were assigned to the control group receiving behavior modification, and 15 patients were assigned to the treatment group receiving behavior modification plus oxybutynin. The oxybutynin treated patients had a lower overall performance at baseline pretreatment testing. However, performance in this group improved following treatment with oxybutynin.Oxybutynin, a commonly used pharmacological agent in pediatric urology, was not associated with cognitive impairment following treatment. However, we observed lower baseline cognitive functioning in patients whose parents chose oxybutynin over behavior modification alone. This finding may represent a selection bias. However, it also supports the need for a multidisciplinary approach to the treatment of patients with dysfunctional voiding, as some may have cognitive difficulties that have not previously been explored.

  View details for PubMedID 15879864

• Juvenile posttraumatic high-flow priapism: current management dilemmas JOURNAL OF PEDIATRIC SURGERY Marotte, J. B., Brooks, J. D., Sze, D., Kennedy, W. A. 2005; 40 (4)

  Abstract

  High-flow priapism results from disruption of the intercavernosal artery resulting in an arteriocavernosal fistula and is rarely encountered in the pediatric and adolescent population. Clinically it manifests as a painless, prolonged erection after perineal trauma. Treatment has ranged from expectant management to open surgical exploration with vessel ligation. Internal pudendal arteriogram and superselective embolization with autologous blood clot has emerged as a safe and effective treatment modality in the young male population. Here the authors present 3 patients with high-flow priapism and discuss management of this rare clinical entity.

  View details for DOI 10.1016/j.jpedsurg.2005.01.023

  View details for Web of Science ID 000229359300042

  View details for PubMedID 15852259

• Urinary tract infections in children: treatment UROLOGIC CLINICS OF NORTH AMERICA Malhotra, S. M., Kennedy, W. A. 2004; 31 (3): 527-?

  Abstract

  Urinary tract infection is a frequent diagnosis in children who are referred to the urologist. Infections vary in scope and severity, warranting thoughtful consideration of appropriate therapy. Infections of the genitourinary system may include bacterial,viral, fungal, or parasitic microorganisms. Adequate therapy requires rapid detection and control of these conditions to prevent pyelonephritic renal scarring and its sequelae.

  View details for DOI 10.1016/j.ucl.2004.04.013

  View details for Web of Science ID 000223767000015

  View details for PubMedID 15313062

• Fetal renal growth as assessed through renal parenchymal area derived from prenatal and perinatal ultrasonography JOURNAL OF UROLOGY Kennedy, W. A., Chitkara, U., Abidari, J. M., Shortliffe, L. M. 2003; 169 (1): 298-302

  Abstract

  Few quantitative parameters allow for comparison of serial studies in children with prenatally detected genitourinary abnormalities. We establish the first ultrasonographically based fetal renal parenchymal growth curve that could serve as a standard for fetal renal growth assessment.Longitudinal ultrasounds of 246 normal fetal kidneys from 16 to 38 weeks of gestation were scanned with renal parenchymal area calculated and growth curves plotted. Our previously determined nomogram from birth to adolescence was then combined with this fetal nomogram to produce a composite renal growth curve. Data were plotted as mean parenchymal area +/- 2 SD using lines determined by polynomial regression.Renal growth curves were constructed independently for the right and left fetal kidneys as well as the total fetal renal parenchymal area. The polynomial regression equation for the right renal parenchymal area was y = -0.0076x(2) + 0.7141x - 8.5344 (r(2) = 0.91). The polynomial regression equation for the left renal parenchymal area was y = -0.0036x(2) + 0.5161x - 6.2337 (r(2) = 0.96). The polynomial regression equation for the total fetal renal parenchymal area was y = -0.0113x(2) + 1.234x - 14.814 (r(2) = 0.95).We propose a new quantitative standard to evaluate appropriate fetal kidney size the prenatal renal parenchymal area growth curve. Renal parenchymal growth curves for the normal fetal kidney may serve as a valuable tool to assess fetal renal pathology.

  View details for DOI 10.1097/01.ju.0000041762.66236.29

  View details for Web of Science ID 000179921200101

  View details for PubMedID 12478175

• Serial followup of the contralateral renal size in children with multicystic dysplastic kidney Annual Meeting of the Section-on-Urology American-Academy-of-Pediatrics Abidari, J. M., Park, K. H., Kennedy, W. A., Shortliffe, A. D. ELSEVIER SCIENCE INC. 2002: 1821–25

  Abstract

  Multicystic dysplastic kidneys have negligible renal function and the contralateral kidney (solitary kidney) frequently exhibits abnormalities that may affect growth. We previously showed that nomograms related to renal size constructed from digitalized ultrasonographic measurements of renal parenchymal area are a sensitive measure of renal growth and correlate with functional mass. We assess the age-dependent characteristics of compensatory renal growth in infants and children with multicystic dysplastic kidneys by construction of a growth curve for the contralateral kidney, assess these characteristics in comparison to normal renal growth of right and left kidneys, analyze the extent of compensatory renal growth and evaluate abnormal growth in solitary kidneys in infants and children.From 1988 to 2000 we reviewed 152 serial sonograms from 48 patients with a diagnosis of multicystic dysplastic kidneys. We also reviewed 209 renal sonograms in patients whose studies, done for other purposes, showed normal bilateral kidneys. Using computer planimetry, parenchymal area and pelvicaliceal area were determined after digitalization of ultrasound images. Parenchymal area was calculated by parenchymal area minus pelvicaliceal area and expressed as a mean of 3 measurements. A parenchymal area growth curve was generated for the contralateral kidney in the multicystic dysplastic kidney group from birth to 216 months, and for right and left normal kidneys from birth to 338 months. Data were plotted as mean parenchymal area +/- 2 SD on a nomogram generated by linear regression. Differences in parenchymal area between normal right and left kidneys, between normal kidneys and the contralateral to multicystic dysplastic kidney were analyzed by unpaired Student t test.Of the 48 patients with multicystic dysplastic kidneys 36 had contralateral normal kidneys and 12 (25%) had a contralateral abnormality. Of the 12 cases 4 and an additional 5 without an identified abnormality (9 of 48) or 18.7% had solitary kidneys 2 SD below the normal growth curve for total parenchymal area, indicating a smaller than expected increase in compensatory renal growth. Conversely, 8 of 12 including 1 with grade V reflux into a solitary kidney exhibited normative compensatory renal growth. Left normal kidneys demonstrated a small but statistically significantly larger parenchymal area throughout growth. Solitary kidneys did not demonstrate growth differences associated with side. Solitary kidneys showed accelerated growth from 0 to 22 months while normal kidneys showed accelerated growth from 0 to 15 months.Nomograms constructed from ultrasonographic measurements of renal parenchymal area may be useful for assessing abnormal renal growth in solitary kidneys. Patients with solitary kidneys identified by conventional ultrasonographic measurement as normal may not exhibit expected growth. Clinical decision making may be improved by identification of solitary kidneys at risk for poor growth.

  View details for DOI 10.1097/01.ju.0000027230.09175.80

  View details for Web of Science ID 000178188000072

  View details for PubMedID 12352368

• Effect of circumcision on prostatic bacterial colonization and subsequent bacterial seeding following transrectal ultrasound-guided prostate biopsies. Techniques in urology Lai, F. C., Kennedy, W. A., Lindert, K. A., Terris, M. K. 2001; 7 (4): 305-309

  Abstract

  This study was designed to compare the prevalence of prostatic bacterial growth between circumcised and uncircumcised males and determine whether the lack of circumcision results in a change in the incidence of bacterial seeding following prostate needle biopsy.Forty-six men (21 circumcised and 25 uncircumcised) undergoing ultrasound and biopsy to rule out prostate cancer were evaluated with questionnaires regarding previous history of urinary tract infection (UTI), any symptoms suggestive of UTI, and obstructive voiding symptoms. None of the patients received preprocedure antibiotics. Preprocedure and postprocedure urine samples, prostate biopsy core, and postprocedure blood samples were obtained for culture. After the cultures were obtained, patients received oral antibiotics.Patient characteristics between circumcised and uncircumcised patients were similar in terms of age, prostate-specific antigen level, voiding symptoms, history of UTI, prostate biopsy technique, and incidence of prostate cancer. The prevalence of preprocedure bacteriuria was slightly higher in the uncircumcised men (14 [56%] of 25 patients) vs. the circumcised men (8/21 [38%] patients), although this was not statistically significant (r = .2, p = .1). The prevalence of postprocedure bacteriuria was significantly higher (p = .04) in the uncircumcised men (12/25 [48%] patients) vs. the circumcised men (4/21 [19%] patients). No correlation was found between circumcision status and incidence of bacterial colonization in the prostate tissue. A statistically significant difference (p = .003) was found between the lack of circumcision and postprocedure bacteremia.Circumcision status does not effect the prevalence of bacterial growth in the urine and the prostate tissue. Uncircumcised men have a higher incidence of bacteriuria and bacteremia following prostate needle biopsies.

  View details for PubMedID 11763496

• The effects of intravesical lidocaine on bladder dynamics of children with myelomeningocele Joint Meeting of the American-Academy-of-Pediatrics Section on Urology/European-Society-for-Paediatric-Urology Lapointe, S. P., Wang, B. Y., Kennedy, W. A., Shortliffe, L. M. ELSEVIER SCIENCE INC. 2001: 2380–82

  Abstract

  Other studies have suggested that intravesical lidocaine may temporarily improve bladder dynamics but details of these effects and their application to children have not been examined. We evaluated the effects of intravesical lidocaine on bladder urodynamics of children with myelomeningocele and tried to correlate these effects with subsequent clinical response to oral oxybutynin.Charts of children with myelomeningocele who had undergone urodynamic examinations from 1992 to 1998 were reviewed retrospectively. In children with uninhibited contractions or poor compliance 150 to 300 mg. lidocaine were instilled for 8 minutes and cystometry was repeated. Changes in bladder capacity and compliance, number of uninhibited contractions and bladder volume at which pressure of 40 cm. H2O was reached were recorded before and after the lidocaine instillation. Clinical response to subsequent treatment with oral oxybutynin was assessed from chart review.A total of 48 urodynamic studies in 22 girls and 20 boys with a mean age plus or minus standard deviation of 8.3 +/- 5.7 years and myelomeningocele were evaluable. After instillation of lidocaine, urodynamics showed increased bladder capacity in 70.8% of studies (34 of 48), with an average increase in volume of 66% (p <0.05). No change or decreased bladder capacity occurred in 29.2% of studies. Bladder compliance improved in 61.7% of the studies (29 of 47, p <0.05) and worsened in 38.3%. Bladder volume at which the pressure of 40 cm. H2O was reached increased in 77.8% of studies (14 of 18, p <0.05). After lidocaine the number of uninhibited contractions decreased by 3.2 in 56.8% of studies (21 of 37, p <0.05). Correlation of lidocaine induced changes in bladder capacity, compliance and number of uninhibited contractions with improvement on oral oxybutynin was 70.6%, 64.3% and 66.7%, respectively.Intravesical lidocaine can improve bladder capacity and compliance and decrease the number of uninhibited contractions in many children with neurogenic bladder caused by myelomeningocele. These observations suggest that intravesical lidocaine has effects on the neurogenic bladder that improve bladder dynamics. Although intravesical lidocaine testing may not reliably predict clinical response to oral oxybutynin at the prescribed dosages, a possible therapeutic role for intravesical lidocaine or similar agents should be explored further.

  View details for Web of Science ID 000168623700050

  View details for PubMedID 11371945

• Evaluation of sonographic renal parenchymal area in the management of hydronephrosis JOURNAL OF UROLOGY Rodriguez, L. V., Lock, J., Kennedy, W. A., Shortliffe, L. M. 2001; 165 (2): 548-551

  Abstract

  We used quantitative parameters of renal sonography to differentiate children with significant obstruction requiring surgical intervention from those without significant obstruction who were followed conservatively.We retrospectively reviewed the records of children who underwent evaluation for hydronephrosis. Those with a history of vesicoureteral reflux, anatomical abnormalities or neurogenic bladder were excluded from study. Patients were divided according to hydronephrosis grade into groups 1-grades III and IV followed conservatively, 2-grades III and IV requiring surgical intervention, 3-unilateral grade II and 4-bilateral. All images were scanned into a computer. Renal parenchymal and pelvic area was determined using National Institutes of Health image software. Parenchymal-to-pelvic area ratios were calculated from all images. We evaluated the ability of these measurements to determine the likelihood of surgical intervention.The records of 81 children were available for analysis. Deterioration in parenchymal area growth was a predictor of surgical intervention. Such patients had catch-up growth of the affected kidney after pyeloplasty. A parenchymal-to-pelvic area ratio of greater than 1.6 on the initial ultrasound study after birth predicted cases that would need pyeloplasty in the future (p <0.05). No patient with grade II hydronephrosis required surgical intervention.Following serial parenchymal area on serial ultrasound is useful for evaluating children with hydronephrosis. Those with a parenchymal area below the nomogram for growth usually require pyeloplasty. A parenchymal-to-pelvic area ratio of less than 1.6 on the initial ultrasound study after birth in patients with prenatally diagnosed ureteropelvic junction obstruction or on initial ultrasound in those diagnosed postnatally indicated the need for surgical intervention in this limited series.

  View details for Web of Science ID 000166366900070

  View details for PubMedID 11176432

• The modern endoscopic approach to ureterocele JOURNAL OF UROLOGY Hagg, M. J., Mourachov, P. V., Snyder, H. M., Canning, D. A., Kennedy, W. A., Zderic, S. A., Duckett, J. W. 2000; 163 (3): 940-943

  Abstract

  During the last 20 years the surgical approach to ureterocele has evolved from major open surgery to minimally invasive endoscopic puncture. We believe that the endoscopic approach decreases the need for open surgical procedures. We identified specific factors that predict the need for repeat surgery.We reviewed the charts of 60 new patients with ureterocele treated with primary endoscopic incision between 1991 and 1995. Followup ranged from 4 to 62 months (mean 20). Mode of presentation, ureterocele location, associated vesicoureteral reflux and association of the ureterocele with a duplex system were evaluated. Ureterocele wall thickness was assessed subjectively via radiographic and cystoscopic methods, and categorized as thin, intermediate and thick.All 9 patients with a single system ureterocele had an intravesical ureterocele. No patient had associated reflux nor did any require a secondary open procedure. In 3 cases new onset ipsilateral reflux into the ureterocele spontaneously resolved. Of the 51 patients with a duplex system and associated ureterocele 19 (37%) required a secondary open procedure. The ureterocele was intravesical and ectopic in 22 (43%) and 29 (57%) cases, respectively. Reflux was associated with the ureterocele in 27 patients (53%), and 12 (44%) required a secondary open procedure. A total of 11 patients underwent ureteral reimplantation of 15 refluxing renal units and only 2 renal units required ureteral tapering. Reflux is no longer present in 14 of the 15 renal units (93%). Patients with a thick walled ureterocele required repeat puncture more frequently than those with a nonthick ureterocele.With the use of modern endoscopic techniques children with intravesical and single system ureteroceles require secondary open surgery less frequently than those with ectopic and duplex system ureteroceles. The mode of presentation does not predict the need for a repeat open procedure. Thick walled ureteroceles require repeat endoscopic puncture more frequently than thin and intermediate walled ureteroceles.

  View details for Web of Science ID 000085250300081

  View details for PubMedID 10688025

• Biochemical and physiological characterization of the urinary bladder in Ehlers-Danlos syndrome International Bladder Research Congress Deveaud, C. M., Kennedy, W. A., Zderic, S. A., Howard, P. S. KLUWER ACADEMIC/PLENUM PUBL. 1999: 201–214

  View details for Web of Science ID 000081630200018

  View details for PubMedID 10599425

• Epidermal growth factor suppresses renal tubular apoptosis following ureteral obstruction UROLOGY Kennedy, W. A., Buttyan, R., GARCIAMONTES, E., DAGATI, V., Olsson, C. A., Sawczuk, I. S. 1997; 49 (6): 973-980

  Abstract

  Acute unilateral ureteral obstruction (UUO) results in ipsilateral hydronephrosis characterized by a decrease in epidermal growth factor (EGF) mRNA expression and EGF protein levels in the distal renal tubules. UUO results in programmed cell death with increases in the characteristic markers of apoptosis. To suppress the apoptotic response during UUO, recombinant EGF was administered during renal obstruction and the ensuing molecular and histologic changes were studied.Mature Sprague-Dawley rats underwent left ureteral obstruction and the kidneys were harvested at 24, 48, and 72 hours. Markers of apoptosis included DNA laddering pattern on agarose gel electrophoresis, in situ gap labeling of fragmented DNA for quantitative apoptotic body determination, polyadenylated mRNA expression of SGP-2, and in situ hybridization for sulfated glycoprotein-2 (SGP-2) mRNA. Studies were repeated in rats following administration of 10, 20, and 40 micrograms of subcutaneous recombinant EGF on a daily basis after UUO.Subcutaneous injection of EGF into unilaterally obstructed rats promotes renal tubular epithelial cell regeneration, as demonstrated by increased cortical mitotic activity. Systemic EGF supplementation in these unilaterally obstructed rats also resulted in a decrease in the intensity of the DNA laddering pattern associated with renal tubular apoptosis. An in situ labeling procedure to identify apoptotic nuclei in the ureterally obstructed kidneys revealed a 50% reduction in apoptosis after EGF administration. Northern blot analysis and in situ hybridization for SGP-2 mRNA or clustering gene product also revealed a decreased expression in the obstructed and EGF-treated renal parenchyma.These data suggest that EGF, apart from its known role as a mitogenic substance for renal tubular epithelial cells, is also a critical in vivo renal cell survival factor for the developmentally mature kidney.

  View details for Web of Science ID A1997XC72100036

  View details for PubMedID 9187715

• Acute urinary retention secondary to urethral inflammation from a vaginal contraceptive suppository in a 17-year-old boy UROLOGIA INTERNATIONALIS Saborio, D. V., Kennedy, W. A., Hoke, G. P. 1997; 58 (2): 128-130

  Abstract

  We report the case of a 17-year-old boy who developed acute urinary retention following unprotected intercourse. His partner employed for the first time a nonoxynol-9-based commercial vaginal contraceptive insert. During intercourse the patient felt severe burning pain in the urethra. He was subsequently unable to void. Flexible cystourethroscopy revealed gross mucosal erythema and inflammation in the distal urethra and navicular fossa. We discuss the clinical management and review relevant literature.

  View details for Web of Science ID A1997WN83100014

  View details for PubMedID 9096278

• UROLOGY PEER-REVIEW AT THE NATIONAL-INSTITUTES-OF-HEALTH JOURNAL OF UROLOGY Olsson, C. A., Kennedy, W. A. 1995; 154 (5): 1866-1869

  Abstract

  Urology is a field with many subspecialties and, as a consequence, urological research grant applications are distributed to a variety of different study sections at the National Institutes of Health (NIH). It has long been the conviction of urological investigators that urological grant funding suffers as a result of this distribution. We investigated the composition of these study sections to identify the prevalence of urological expertise (or lack thereof). The review challenges the concept that urological research grant applications are being subjected to adequate peer review.Aided by personnel from the National Institute for Diabetes, and Digestive and Kidney Diseases, and the National Cancer Institute, 22 study sections to which urological grants are distributed were identified. A 3 to 5-year retrospective MEDLINE analysis of all the scientific publications of each study section member was done. Urological experts were identified by the criterion of having more than 1 urological publication published per year or a proportional equivalent. An equivalent analysis was performed for the study sections reviewing cardiology grants to serve as a comparison.Data analysis revealed that only 12 of 351 study section members reviewing urological grants are urological experts (3.4%). Only 3.1% of the collective published productivity of these members is in the broadly defined field of urological investigation. Omitting the published productivity of these 12 experts, less than 1% of the published works of the remaining 339 members reflects interest or expertise in urological investigations. Of the 22 study sections only 8 have urological expertise represented in their membership. Except for 1 study section, representation of urological experts was usually limited to 1 individual reflecting a 5.9 to 11.1% minority in these study sections.The lack of urological expertise represented on the NIH study sections reviewing basic and clinical urological research grant applications has far reaching ramifications. Consequently, grant applications on genitourinary diseases that commonly afflict a preponderance of Americans are inadequately reviewed at the NIH. Only through the provision of appropriate peer reviewers will this problem be solved.

  View details for Web of Science ID A1995RY81700075

  View details for PubMedID 7563369

• BLADDER NECK CLOSURE IN ASSOCIATION WITH CONTINENT URINARY-DIVERSION JOURNAL OF UROLOGY Hensle, T. W., Kirsch, A. J., Kennedy, W. A., Reiley, E. A. 1995; 154 (2): 883-885

  Abstract

  Bladder neck closure is not a standard part of continent urinary diversion. When bladder augmentation and continent urinary diversion are done simultaneously, it is frequently convenient and advantageous to leave the native bladder neck intact as long as there is a reasonable degree of intrinsic continence. Even in patients with marginal control the effect of lowering intravesical pressure and increasing intravesical volume will often produce acceptable continence. At times, particularly in patients who have undergone multiple surgical procedures involving the bladder neck, there is poor intrinsic resistance. To provide acceptable continence in these cases bladder neck closure is a necessary part of continent diversion. Between 1990 and 1993 we treated 6 male and 7 female patients, most of whom underwent simultaneous bladder augmentation and continent urinary diversion, and they had poor intrinsic outlet resistance. Patient age ranged from 8 to 22 years. Underlying diagnoses included thoracic myelomeningocele in 5 patients, bladder exstrophy in 5, bladder leiomyosarcoma in 1 and extensive pelvic trauma in 1 as well as 1 previously separated conjoined twin. Three patients had artificial urinary sphincter failure and 3 had failure of urethral sling procedures. A clean intermittent catheterization program had failed in 12 patients and all 13 had diurnal incontinence. Bladder neck and urethral resistance was evaluated using voiding cystourethrography and urodynamics to measure leak point pressure and bladder capacity. Reliable bladder neck closure is historically difficult to achieve and is best done at the time of diversion. We have had initial success in 12 of our 13 cases and subsequently in all 13 using a technique of bladder neck division, 2-layer closure and omental interposition between the bladder neck closure and urethra.

  View details for Web of Science ID A1995RJ05100068

  View details for PubMedID 7609204

• RENAL TUBULAR APOPTOSIS AFTER PARTIAL URETERAL OBSTRUCTION Annual Meeting of the Section on Urology of the American-Academy-of-Pediatrics Kennedy, W. A., Stenberg, A., Lackgren, G., Hensle, T. W., Sawczuk, I. S. WILLIAMS & WILKINS. 1994: 658–64

  Abstract

  Partial ureteral obstruction in the weanling rat leads to hydronephrosis of the ipsilateral kidney and renal cell deletion through the process of programmed cell death known as apoptosis. The apoptotic response following partial ureteral obstruction in weanling Sprague-Dawley rats was studied using the traditional markers of apoptosis, including deoxyribonucleic acid (DNA) laddering pattern on agarose gel electrophoresis, in situ gap labeling of fragmented DNA for quantitative apoptotic body determination, polyadenylated messenger ribonucleic acid (mRNA) expression of sulfated glycoprotein-2, and polyadenylated mRNA expression of epidermal growth factor and transforming growth factor-beta. Partial ureteral obstruction resulted in a progressive increase in the intensity of DNA fragmentation associated with apoptosis during the initial 3 weeks. Quantitative apoptotic body counting revealed a 3-fold increase by week 3 of partial obstruction. This increase represented a level of apoptosis, which is 65% of that observed in complete ureteral obstruction. By week 2 of partial obstruction there was a 13-fold increase in the expression of sulfated glycoprotein-2 mRNA, as well as changes in the growth factor environment characterized by a decline in the constitutive expression of epidermal growth factor mRNA and an increase in the expression of transforming growth factor-beta mRNA. These altered levels represent changes in expression comparable to those observed during the apoptotic response following complete ureteral obstruction, although the time course is delayed by 2 to 3 weeks.

  View details for Web of Science ID A1994NW33000019

  View details for PubMedID 8021991

• PREGNANCY AFTER ORTHOTOPIC CONTINENT URINARY-DIVERSION SURGERY GYNECOLOGY & OBSTETRICS Kennedy, W. A., Hensle, T. W., Reiley, E. A., Fox, H. E., HAUS, T. 1993; 177 (4): 405-409

  Abstract

  Continent urinary diversion has become a common form of bladder management for the female exstrophy patient in whom primary reconstruction has failed. Reported are the results of successful pregnancies in four young adult females, who had previously undergone a flap vaginoplasty as part of earlier management and more recently a continent right colonic urinary reservoir with a perineal stoma (Indiana pouch). Pregnancy in each of these patients was characterized by several urinary tract infections, cervical prolapse and mild to severe maternal hydronephrosis. All of the patients had some degree of difficulty with clean intermittent catheterization. One patient required an indwelling catheter with prolonged bed rest. Maternal hydronephrosis resolved after delivery in all instances. All four patients delivered their infants by way of cesarean section, either emergently for maternal or fetal distress or electively. Cervical prolapse did not resolve in three patients and will require surgical repair. After delivery, all patients returned to their previous pattern of clean intermittent catheterization without loss of continence. All the infants delivered were healthy with appropriate weights and high Apgar scores (more than 8). Orthotopic (perineal stoma) continent urinary diversion is not a contraindication to pregnancy. However, our experience mandates delivery by cesarean section with close monitoring for maternal or fetal distress during gestation.

  View details for Web of Science ID A1993MA40400014

  View details for PubMedID 8211586

• POTASSIUM THIOPHOSPHATE LASER TREATMENT OF GENITOURINARY HEMANGIOMA IN THE PEDIATRIC POPULATION JOURNAL OF UROLOGY Kennedy, W. A., Hensle, T. W., GIELLA, J., HENDRICKS, J. G., Treat, M. 1993; 150 (3): 950-952

  Abstract

  Multiple hemangiomas of the urogenital system are uncommon lesions that usually recur and can cause significant morbidity. Three pediatric patients with urethral, bladder, penile, scrotal and vaginal hemangiomas underwent treatment of these lesions with the potassium thiophosphate laser. All patients had multiple lesions and suffered from recurrent bleeding before treatment. Potassium thiophosphate photocoagulation was delivered to the surface, urethral and vaginal lesions. Treatment-associated bleeding did not occur in any case. Followup urogenital and cystoscopic examinations revealed complete obliteration or marked diminution in the size of the treated hemangiomas. All patients had a decrease in the frequency and intensity of bleeding episodes and 2 were subsequently without further episodes of bleeding. Potassium thiophosphate laser photoablation provides excellent results in the pediatric population and is preferred to more extensive surgical intervention.

  View details for Web of Science ID A1993LR89000041

  View details for PubMedID 8345617