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{{Infobox medical condition
{{Infobox medical condition (new)
| Name = Urofacial syndrome
| name = Urofacial syndrome
| Image = Image:Autosomal recessive - en.svg|thumb|
| synonyms = Ochoa syndrome
| Alt =
| image = Autosomal recessive - en.svg
| Caption = Ochoa Syndrome has an autosomal recessive pattern of inheritance.
| alt =
| caption = Ochoa Syndrome has an autosomal recessive pattern of inheritance.
| DiseasesDB = 32631
| pronounce =
| ICD10 = N31.8
| field =
| ICD9 =
| symptoms =
| complications =
⚫
| ICDO =
| OMIM = 236730
| onset =
| MedlinePlus =
| duration =
| types =
⚫
| eMedicineSubj =
| causes =
⚫
| eMedicineTopic =
| MeshID = C536480
| risks =
| Orphanet = 2704
| diagnosis =
| differential =
| prevention =
| treatment =
| medication =
| prognosis =
| frequency =
| deaths =
}}
}}
'''Urofacial syndrome''' ( or '''hydronephrosis with peculiar facial expression'''),<ref name=omim>{{OMIM|236730}}</ref> is an [[autosome|autosomal]] [[dominance (genetics)|recessive]]<ref name=osar>{{Cite journal| last1 = Chauve| doi = 10.1002/1096-8628(20001106)95:1<10::AID-AJMG3>3.0.CO;2-Z | first1 = X.| last2 = Missirian | first2 = C.| last3 = Malzac | first3 = P.| last4 = Girardot | first4 = L.| last5 = Guys | first5 = J. M.| last6 = Louis | first6 = C.| last7 = Philip | first7 = N.| last8 = Voelckel | first8 = M. A.| title = Genetic homogeneity of the urofacial (Ochoa) syndrome confirmed in a new French family| date = Nov 2000| journal = American Journal of Medical Genetics| volume = 95| pages = 10&ndash;12| month = | pmid = 11074487| issue = 1}}</ref> [[congenital disorder]] characterized by inverted facial expressions in association with obstructive disease of the urinary tract. The inverted facial expression presented by children with this syndrome allows for early detection of the syndrome, this inverted smile is easy to see when the child is smiling and laughing. Early detection is vital for establishing a better prognosis as urinary related problems associated with this disease can cause harm if left untreated. [[Urinary incontinence|Incontinence]] is another easily detectable symptom of the syndrome that is due to [[detrusor]]-[[sphincter]] discoordination, although it can easily be mistaken for [[pyelonephritis]].
'''Urofacial syndrome''', or '''Ochoa syndrome''', is an [[autosome|autosomal]] [[dominance (genetics)|recessive]]<ref name=osar>{{Cite journal| last1 = Chauve| doi = 10.1002/1096-8628(20001106)95:1<10::AID-AJMG3>3.0.CO;2-Z | first1 = X.| last2 = Missirian | first2 = C.| last3 = Malzac | first3 = P.| last4 = Girardot | first4 = L.| last5 = Guys | first5 = J. M.| last6 = Louis | first6 = C.| last7 = Philip | first7 = N.| last8 = Voelckel | first8 = M. A.| title = Genetic homogeneity of the urofacial (Ochoa) syndrome confirmed in a new French family| date = Nov 2000| journal = American Journal of Medical Genetics| volume = 95| pages = 10&ndash;12| pmid = 11074487| issue = 1}}</ref> [[congenital disorder]] characterized by an association of a lower urinary tract and bowel dysfunction with a typical facial expression: when attempting to smile, the patient seems to be crying or grimacing. It was first described by the Colombian physician Bernardo Ochoa in the early 1960s. The inverted facial expression presented by children with this syndrome allows for early detection of the syndrome, which is vital for establishing a better prognosis as urinary related problems associated with this disease can cause harm if left untreated. [[Urinary incontinence|Incontinence]] is another easily detectable symptom of the syndrome that is due to [[detrusor]]-[[sphincter]] discoordination.


It may be associated with ''[[HPSE2]]''.<ref name="pmid20560210">{{cite journal |vauthors=Daly SB, Urquhart JE, Hilton E |title=Mutations in HPSE2 Cause Urofacial Syndrome |journal=Am J Hum Genet |volume= 86|issue= 6|pages= 963–969|date=June 2010 |pmid=20560210 |doi=10.1016/j.ajhg.2010.05.006 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9297(10)00253-3 |pmc=3032078 |displayauthors=etal }}</ref>
It may be associated with ''[[HPSE2]]''.<ref name="pmid20560210">{{cite journal | vauthors = Daly SB, Urquhart JE, Hilton E, McKenzie EA, Kammerer RA, Lewis M, Kerr B, Stuart H, Donnai D, Long DA, Burgu B, Aydogdu O, Derbent M, Garcia-Minaur S, Reardon W, Gener B, Shalev S, Smith R, Woolf AS, Black GC, Newman WG | title = Mutations in HPSE2 cause urofacial syndrome | journal = Am. J. Hum. Genet. | volume = 86 | issue = 6 | pages = 963–9 | date = June 2010 | pmid = 20560210 | pmc = 3032078 | doi = 10.1016/j.ajhg.2010.05.006 }}</ref>


==Signs and symptoms==
==Characteristics==
Infants with the disorder exhibit an inverted smile; they appear to be crying when they are actually smiling, in conjunction with [[uropathy]]. They also may be affected by [[hydronephrosis]]. Symptoms of this disease can start at very young ages. Many people with this syndrome will die in their teens to early 20s because of the renal failure (uropathy) if not diagnosed and treated. Children with the syndrome have abnormal facial development that cause an inverted smile, nerve connections are however normal. When attempting to smile, the child will appear to cry. Urinary problems arise as a result of a [[neurogenic bladder]]. Most patients older than the age of toilet training, present with [[enuresis]], [[urinary-tract infection]], [[hydronephrosis]], and a spectrum of radiological abnormalities typical of obstructive or [[neurogenic bladder]]s. Radiological abnormalities include things such as: trabeculated bladder, vesicoureteral reflex, external sphincter spasm, [[pyelonephritis]], hyperreflexic bladder, noninhibited [[detrusor]] contraction, etc.. Urinary abnormalities might result in renal deterioration and failure. This can be prevented by taking proper measures to restore normal [[micturition]] and by taking antibiotics to prevent infections. In some cases, the affected patients become [[hypertensive]] and progress to end-stage renal disease, while others become [[uremic]]. Additionally, most patients suffer from [[constipation]].<ref name="Wang 1997 1461–1467">{{cite journal|last=Wang|first=C Y|author2=B Hawkins-Lee |author3=B Ochoa |author4=R D Walker |author5=J X She |title=Homozygosity and linkage-disequilibrium mapping of the urofacial (Ochoa) syndrome gene to a 1-cM interval on chromosome 10q23-q24.|journal=The American Journal of Human Genetics|date=June 1997|volume=60|pages=1461–1467|pmc=1716147|pmid=9199567|issue=6|doi=10.1086/515469}}</ref>
Infants with the disorder exhibit an inverted smile; they appear to be crying when they are actually smiling, in conjunction with [[uropathy]]. They also may be affected by [[hydronephrosis]]. Symptoms of this disease can start at very young ages. Many people with this syndrome will die in their teens to early 20s because of the renal failure (uropathy) if not diagnosed and treated. Children with the syndrome have abnormal facial development that cause an inverted smile; nerve connections are however normal. When attempting to smile, the child will appear to cry. Urinary problems arise as a result of a [[neurogenic bladder]]. Most patients older than the age of toilet training, present with [[enuresis]], [[urinary-tract infection]], [[hydronephrosis]], and a spectrum of radiological abnormalities typical of obstructive or neurogenic bladders. Radiological abnormalities include things such as: trabeculated bladder, vesicoureteral reflex, external sphincter spasm, [[pyelonephritis]], hyperreflexic bladder, noninhibited [[detrusor]] contraction, etc. Urinary abnormalities might result in renal deterioration and failure. This can be prevented by taking proper measures to restore normal [[micturition]] and by taking antibiotics to prevent infections. In some cases, the affected patients become [[hypertensive]] and progress to end-stage renal disease, while others become [[uremic]]. Additionally, most patients suffer from [[constipation]].<ref name="pmid9199567">{{cite journal | vauthors = Wang CY, Hawkins-Lee B, Ochoa B, Walker RD, She JX | title = Homozygosity and linkage-disequilibrium mapping of the urofacial (Ochoa) syndrome gene to a 1-cM interval on chromosome 10q23-q24 | journal = Am. J. Hum. Genet. | volume = 60 | issue = 6 | pages = 1461–7 | date = June 1997 | pmid = 9199567 | pmc = 1716147 | doi = 10.1086/515469}}</ref>
Early detection of this syndrome is possible through the peculiar faces that children present.
Early detection of this syndrome is possible through the peculiar faces that children present.{{cn|date=October 2021}}


==Cause==
==Cause==
Urofacial Syndrome occurs due to either disruption or mutation of a gene on [[chromosome]] [[Chromosome 10|10q23q24]].<ref>{{cite journal|last=Kulkarni|first=R|author2=Manish K Arya |title=Ochoa or Urofacial Syndrome|journal=Indian Pediatrics|date=15 April 2009|volume=1|issue=1|pages=445–446|url=http://www.indianpediatrics.net/may2010/may-445-446.htm|accessdate=November 26, 2012}}</ref> The gene is located on a 1 [[centimorgan]] interval between D10S1433 and D10S603.<ref name="Wang 1997 1461–1467"/> Alteration of this gene leads to alteration of facial and urinary developmental fields. This gene is believed to be the [[HPSE2]] gene. The [[HPSE2]] gene is expressed in both the central nervous system as well as the bladder. [[Heparanase|Heparanase 2]] is protein coded by exons 8 and 9 on the [[HPSE2]] gene. This protein is believed to be altered in the case of this syndrome.<ref>{{cite journal|last=Daly|first=Sarah B.|author2=Jill E. Urquhart, Emma Hilton, Edward A McKenzie. Richard A. Kammerer|title=Mutations in HPSE2 Cause Urofacial Syndrome|journal=AJHG|date=June 2010|volume=86|issue=6|pages=963–969|doi=10.1016/j.ajhg.2010.05.006|pmid=20560210|pmc=3032078}}</ref> Studies performed on mice indicate that [[HPSE2]] has no [[enzymatic activity]].<ref>{{cite journal|last=Zhang|first=Yinghui|author2=Denise S. Ryan |author3=Kraig S. Bower |author4=Neta Ilan |author5=Israel Vlodavsky |author6=Gordon W. Laurie |title=Focus on Molecules: Heparanse|journal=NCBI|date=May 2010|doi=10.1016/j.exer.2010.05.004|pmc=2933305|pmid=20478306|volume=91|issue=4|pages=476–7}}</ref>
Urofacial syndrome occurs due to either disruption or mutation of a gene on chromosome [[Chromosome 10|10q23q24]].<ref>{{cite journal|last=Kulkarni|first=R|author2=Manish K Arya |title=Ochoa or Urofacial Syndrome|journal=Indian Pediatrics|date=15 April 2009|volume=1|issue=1|pages=445–446|doi=10.1007/s13312-010-0067-5|pmid=20519791|s2cid=31060159|url=http://www.indianpediatrics.net/may2010/may-445-446.htm|access-date=November 26, 2012}}</ref> The gene is located on a 1 [[centimorgan]] interval between D10S1433 and D10S603.<ref name="pmid9199567"/> Alteration of this gene leads to alteration of facial and urinary developmental fields. This gene is believed to be the [[HPSE2]] gene. The HPSE2 gene is expressed in both the central nervous system as well as the bladder. [[Heparanase|Heparanase 2]] is protein coded by exons 8 and 9 on the HPSE2 gene. This protein is believed to be altered in the case of this syndrome.<ref name="pmid20560210"/> Studies performed on mice indicate that HPSE2 has no [[enzymatic activity]].<ref>{{cite journal|last=Zhang|first=Yinghui|author2=Denise S. Ryan |author3=Kraig S. Bower |author4=Neta Ilan |author5=Israel Vlodavsky |author6=Gordon W. Laurie |title=Focus on Molecules: Heparanse|journal=Experimental Eye Research|date=May 2010|doi=10.1016/j.exer.2010.05.004|pmc=2933305|pmid=20478306|volume=91|issue=4|pages=476–7}}</ref>


Mutations in the [[HPSE2]] gene on [[chromosome]] [[chromosome 10 (human)|10q23q24]] have been observed to cause Ochoa Syndrome. This means the defective gene responsible for the disorder is located on an [[autosome]] (chromosome 10 is an autosome), and two copies of the defective gene (one inherited from each parent) are required in order to be born with the disorder. The parents of an individual with an autosomal recessive disorder both [[genetic carrier|carry]] one copy of the defective gene, but usually do not experience any signs or symptoms of the disorder.
Mutations in the HPSE2 gene on [[chromosome]] 10q23q24 have been observed to cause Ochoa Syndrome. This means the defective gene responsible for the disorder is located on an [[autosome]] (chromosome 10 is an autosome), and two copies of the defective gene (one inherited from each parent) are required in order to be born with the disorder. The parents of an individual with an autosomal recessive disorder both [[genetic carrier|carry]] one copy of the defective gene, but usually do not experience any signs or symptoms of the disorder.{{cn|date=October 2021}}


The relationship between a defective [[HPSE2]] gene and Ochoa syndrome is unclear. There is postulation that the genetic changes may lead to an abnormality in the brain region, evidence for this postulation is that the areas of the brain that control facial expression and urination are in close proximity of each other. Other hypotheses think that the defective [[heparanase|heparanase 2]] protein may lead to problems with development of the [[urinary tract]] or with muscle function in the face and bladder.<ref>{{cite web|title=Ochoa Syndrome|url=http://ghr.nlm.nih.gov/condition/ochoa-syndrome|publisher=Genetics Home Reference|accessdate=30 November 2012}}</ref>
The relationship between a defective HPSE2 gene and Ochoa syndrome is unclear. Early on, there was speculation that the genetic changes may lead to an abnormality in the brain stem. Evidence for this postulation was that the areas of the brain that control facial expression (VII nerve nuclei) and urination (the pontine micturition centre) were believed to be in close proximity of each other. Other hypotheses posit that the defective heparanase 2 protein may lead to problems with development of the [[urinary tract]] autonomic nervous system, or with muscle function in the face and bladder.<ref>{{cite web|title=Ochoa Syndrome|url=http://ghr.nlm.nih.gov/condition/ochoa-syndrome|publisher=Genetics Home Reference|access-date=30 November 2012}}</ref>

==Diagnosis==
{{Empty section|date=August 2017}}


==Treatment==
==Treatment==
The treatment varies based on the condition and extent of the [[uropathy]].
Treatment can include [[amoxicillin]]-clavulanic acid, [[intravenous fluid]] administration and [[paracetamol]] oral for pain relief.<ref>Stamatiou KN, Karakos CD. Urofacial syndrome: A subset of neurogenic bladder dysfunction syndromes?. Indian J Urol 2010;26:582-4</ref> Other treatment varies based on the condition and extent of [[uropathy]].
To empty the bladder regularly, clean intermittent catheterization (CIC) can be used. If the urodynamic study shows non-inhibited detrusor contractions, an anticholinergic drug should be given additionally. To prevent recurrent infections, especially in the case of vesicoureteral reflux, the treatment can also include an antibiotic prophylaxis.{{cn|date=October 2021}}


==Epidemiology==
==Epidemiology==
Urofacial (Ochoa) syndrome received the Ochoa name because of the first person to describe it back in 1987, Bernardo Ochoa.<ref name="Wang 1997 1461–1467"/>
Urofacial (Ochoa) syndrome received the Ochoa name because of the first person to describe it in 1987, Bernardo Ochoa.<ref name="pmid9199567"/>

==See also==
*[[hydronephrosis]]
*[[uropathy]]
*[[pyelonephritis]]
*[[neurogenic bladder]]
*[[HPSE2]]


==References==
==References==
{{reflist}}
{{reflist}}


==External links==
== External links ==
{{Medical resources
*[http://www.uhseast.com/113717.cfm www.uhseast.com]
| DiseasesDB = 32631
| ICD10 = N31.8
| ICD9 =
⚫
| ICDO =
| OMIM = 236730
| MedlinePlus =
⚫
| eMedicineSubj =
⚫
| eMedicineTopic =
| MeshID = C536480
| Orphanet = 2704
}}



[[Category:Rare diseases]]
[[Category:Rare diseases]]

Latest revision as of 16:26, 5 November 2024

Urofacial syndrome
Other namesOchoa syndrome
Ochoa Syndrome has an autosomal recessive pattern of inheritance.

Urofacial syndrome, or Ochoa syndrome, is an autosomal recessive[1] congenital disorder characterized by an association of a lower urinary tract and bowel dysfunction with a typical facial expression: when attempting to smile, the patient seems to be crying or grimacing. It was first described by the Colombian physician Bernardo Ochoa in the early 1960s. The inverted facial expression presented by children with this syndrome allows for early detection of the syndrome, which is vital for establishing a better prognosis as urinary related problems associated with this disease can cause harm if left untreated. Incontinence is another easily detectable symptom of the syndrome that is due to detrusor-sphincter discoordination.

It may be associated with HPSE2.[2]

Signs and symptoms

[edit]

Infants with the disorder exhibit an inverted smile; they appear to be crying when they are actually smiling, in conjunction with uropathy. They also may be affected by hydronephrosis. Symptoms of this disease can start at very young ages. Many people with this syndrome will die in their teens to early 20s because of the renal failure (uropathy) if not diagnosed and treated. Children with the syndrome have abnormal facial development that cause an inverted smile; nerve connections are however normal. When attempting to smile, the child will appear to cry. Urinary problems arise as a result of a neurogenic bladder. Most patients older than the age of toilet training, present with enuresis, urinary-tract infection, hydronephrosis, and a spectrum of radiological abnormalities typical of obstructive or neurogenic bladders. Radiological abnormalities include things such as: trabeculated bladder, vesicoureteral reflex, external sphincter spasm, pyelonephritis, hyperreflexic bladder, noninhibited detrusor contraction, etc. Urinary abnormalities might result in renal deterioration and failure. This can be prevented by taking proper measures to restore normal micturition and by taking antibiotics to prevent infections. In some cases, the affected patients become hypertensive and progress to end-stage renal disease, while others become uremic. Additionally, most patients suffer from constipation.[3] Early detection of this syndrome is possible through the peculiar faces that children present.[citation needed]

Cause

[edit]

Urofacial syndrome occurs due to either disruption or mutation of a gene on chromosome 10q23q24.[4] The gene is located on a 1 centimorgan interval between D10S1433 and D10S603.[3] Alteration of this gene leads to alteration of facial and urinary developmental fields. This gene is believed to be the HPSE2 gene. The HPSE2 gene is expressed in both the central nervous system as well as the bladder. Heparanase 2 is protein coded by exons 8 and 9 on the HPSE2 gene. This protein is believed to be altered in the case of this syndrome.[2] Studies performed on mice indicate that HPSE2 has no enzymatic activity.[5]

Mutations in the HPSE2 gene on chromosome 10q23q24 have been observed to cause Ochoa Syndrome. This means the defective gene responsible for the disorder is located on an autosome (chromosome 10 is an autosome), and two copies of the defective gene (one inherited from each parent) are required in order to be born with the disorder. The parents of an individual with an autosomal recessive disorder both carry one copy of the defective gene, but usually do not experience any signs or symptoms of the disorder.[citation needed]

The relationship between a defective HPSE2 gene and Ochoa syndrome is unclear. Early on, there was speculation that the genetic changes may lead to an abnormality in the brain stem. Evidence for this postulation was that the areas of the brain that control facial expression (VII nerve nuclei) and urination (the pontine micturition centre) were believed to be in close proximity of each other. Other hypotheses posit that the defective heparanase 2 protein may lead to problems with development of the urinary tract autonomic nervous system, or with muscle function in the face and bladder.[6]

Diagnosis

[edit]

Treatment

[edit]

The treatment varies based on the condition and extent of the uropathy. To empty the bladder regularly, clean intermittent catheterization (CIC) can be used. If the urodynamic study shows non-inhibited detrusor contractions, an anticholinergic drug should be given additionally. To prevent recurrent infections, especially in the case of vesicoureteral reflux, the treatment can also include an antibiotic prophylaxis.[citation needed]

Epidemiology

[edit]

Urofacial (Ochoa) syndrome received the Ochoa name because of the first person to describe it in 1987, Bernardo Ochoa.[3]

References

[edit]
  1. ^ Chauve, X.; Missirian, C.; Malzac, P.; Girardot, L.; Guys, J. M.; Louis, C.; Philip, N.; Voelckel, M. A. (Nov 2000). "Genetic homogeneity of the urofacial (Ochoa) syndrome confirmed in a new French family". American Journal of Medical Genetics. 95 (1): 10–12. doi:10.1002/1096-8628(20001106)95:1<10::AID-AJMG3>3.0.CO;2-Z. PMID 11074487.
  2. ^ a b Daly SB, Urquhart JE, Hilton E, McKenzie EA, Kammerer RA, Lewis M, Kerr B, Stuart H, Donnai D, Long DA, Burgu B, Aydogdu O, Derbent M, Garcia-Minaur S, Reardon W, Gener B, Shalev S, Smith R, Woolf AS, Black GC, Newman WG (June 2010). "Mutations in HPSE2 cause urofacial syndrome". Am. J. Hum. Genet. 86 (6): 963–9. doi:10.1016/j.ajhg.2010.05.006. PMC 3032078. PMID 20560210.
  3. ^ a b c Wang CY, Hawkins-Lee B, Ochoa B, Walker RD, She JX (June 1997). "Homozygosity and linkage-disequilibrium mapping of the urofacial (Ochoa) syndrome gene to a 1-cM interval on chromosome 10q23-q24". Am. J. Hum. Genet. 60 (6): 1461–7. doi:10.1086/515469. PMC 1716147. PMID 9199567.
  4. ^ Kulkarni, R; Manish K Arya (15 April 2009). "Ochoa or Urofacial Syndrome". Indian Pediatrics. 1 (1): 445–446. doi:10.1007/s13312-010-0067-5. PMID 20519791. S2CID 31060159. Retrieved November 26, 2012.
  5. ^ Zhang, Yinghui; Denise S. Ryan; Kraig S. Bower; Neta Ilan; Israel Vlodavsky; Gordon W. Laurie (May 2010). "Focus on Molecules: Heparanse". Experimental Eye Research. 91 (4): 476–7. doi:10.1016/j.exer.2010.05.004. PMC 2933305. PMID 20478306.
  6. ^ "Ochoa Syndrome". Genetics Home Reference. Retrieved 30 November 2012.
[edit]
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