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 management
Washington, DC, May 16, 2011—New studies providing key insights into pediatric stone disease, bedwetting
and 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 posters
outline 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 Stone
Formers (#1382): Children with urolithiasis are more prone to fracture due to low bone-mineral density, making
them at at-risk population for future osteoporosis and a key target for early intervention, according to new data
from 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 of
pediatric stone formers had Z-scores less than -1, a value associated with increased fracture risk. Because bone
mass accrual peaks in adolescence, identifying low bone mineral density in pediatric stone formers may allow
for 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 to
new data from researchers in Detroit. Authors examined records for 417 enuretic children who had undergone
tonsillectomy and adenoidectomy for OSAS, and conducted phone interviews to assess daytime and nighttime
enuresis following the surgery (median post-operative follow up of 11.7 months). Approximately half the
respondents 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 enuresis
symptoms following surgical treatment for OSAS.
Application of Urinary Carbohydrate Antigen 19-9 as a Non-Invasive Method for Determining Conservative or
Surgical 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. ureteropelvic junction obstruction (UPJO) and which patients being managed conservatively are candidates for
pyeloplasty, according to researchers at Children’s Hospital Medical Center in Tehran. Authors examined 36
children 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, while
patients on conservative management experienced a decrease at 12 months. CA 19-9 levels were significantly
correlated with changes in renal pelvis diameter.
NOTE TO REPORTERS: Experts are available to discuss this study outside normal briefing times. To arrange an
interview with an expert, please contact the AUA Communications Office at the number above or e-mail
wisett@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 members
throughout 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.
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3. 1382
ARE CHILDREN WITH STONES AT RISK FOR BREAKING BONES? BONE MINERAL DENSITY ANALYSIS IN
PEDIATRIC STONE FORMERS
Candace 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 associated
with increased risk of bone fractures. The objective of this study was to evaluate BMD among our pediatric
stone patients.
METHODS: Retrospective review of all patients undergoing dual-energy x-ray absorptiometry (DXA) scan since
2000 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 urine
profiles were assessed. Since 2009, patients with ? 1 stone have been prospectively queried about fracture
history. Hypercalciuria was defined as Ca/Cr ratio > 0.2 and/or > 4 mg/kg/day. Statistical testing was performed
with Fisher's 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. Average
lumbar 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) 0.76
children have completed 24- Z-score < -1, n (%) 22 (51.2) 14 (38.9) 0.36
hour urine stone risk analysis, Z-score < -2, n (%) 9 (20.9) 7 (19.4) 1.00
demonstrating 45.6% with Mean radial Z-score (SD) -0.2 (1.35) -0.8 (1.46) 0
hypercalciuria. Table 1
stratifies BMD Z-score based on presence or absence of hypercalciuria. Hypercalciuria was not associated with
risk of BMD Z-score < -1 (p=0.36). Among 22 stone-formers who were prospectively queried about bone fracture
history, 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 in
children. 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, it
may be the ideal time for dietary and/or medical intervention to decrease future osteoporotic risk.
Source of Funding: CCRAC grant #2001-5

4. 827
ENURETIC CHILDREN WITH OBSTRUCTIVE SLEEP APNEA SYNDROME (OSAS): SHOULD THEY SEE
OTOLARYNGOLOGY FIRST?
Larisa Kovacevic, Ali Dabaja, Michael Jurewicz, Brittany Renolds, Amy Rutt, David Madgi, Yegappan Lakshmanan,
Detroit, MI
INTRODUCTION AND OBJECTIVES: (1)To Investigate the effect of tonsillectomy and adenoidectomy(T&A)on
enuresis 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 between
September 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 pre
and post T&A. Student?s t test and Fisher?s exact test were used for data analysis. Pre and post-surgery
differences between groups were examined by parametric analysis of covariance (ANCOVA). A binary logistic
regression 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 mean
postoperative follow-up was 11.7 months. Of the 49 responders 30 showed resolution of their NE in less then 1
month 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 was
associated with male gender, prematurity, obesity, non MNE, and family history of NE. Prematurity was the
single best predictor of failure to respond to T&A. Improved arousal may be partly responsible for the effect of
T&A on both NE and DE in children with OSAS.
Source of Funding: none

5. 456
APPLICATION OF URINARY CARBOHYDRATE ANTIGEN 19-9 AS A NON-INVASIVE METHOD FOR DETERMINING
CONSERVATIVE OR SURGICAL MANAGEMENT OF CHILDREN WITH URETEROPELVIC JUNCTION OBSTRUCTION
Abdol-Mohammad Kajbafzadeh, Saman S. Talab, Azadeh Elmi, Delaram Jan, Parisa Mazaheri, Shadi A. Esfahani,
Tehran, Iran
INTRODUCTION 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 of
urinary CA 19-9 level as a non-invasive method for facilitating clinical decisions regarding surgical versus
conservative management in children with UPJO.
METHODS: The study included 36 children with UPJO treated with pyeloplasty (GI) and 24 children with dilated
nonobstructed kidneys who were treated
conservatively (GII). Voided urine samples were
obtained for CA 19-9 measurement before
treatment, and every 3 months during follow-
up. Additionally, ultrasonography in three-
month intervals and annual renography were
performed. Follow-up ranged from 12-27
months (average 16.4 months). Surgical
intervention was considered for patients with
>10% loss of renal function.
RESULTS: In GI preoperative CA 19-9 was
significantly higher than in GII and a cutoff value
of 41.06 U/ml yielded a sensitivity of 96.7% and
a specificity of 93%. Compared to initial
measurements, CA 19-9 decreased significantly
at 3 months after pyeloplasty in GI and in the
12th month in GII with significant correlation
with changes in renal pelvis diameter. In three
patients due to rising CA 19-9 levels during
follow-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 management
protocol in children with UPJO. The practical clinical implications of the biomarker for long-term follow-up of
children with UPJO after pyeloplasty and those receiving conservative treatment are significant.
Source of Funding: None