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Garne E, Loane M, Tan J, Ballardini E, Brigden J, Cavero-Carbonell C, Coi A, Damkjaer M, Garcia-Villodre L, Gissler M, Given J, Heino A, Jordan S, Limb E, Neville A, Rissmann A, Santoro M, Scanlon I, Urhoj SK, Wellesley D, Morris J. European study showed that children with congenital anomalies often underwent multiple surgical procedures at different ages across Europe. Acta Paediatr 2023; 112:1304-1311. [PMID: 36823678 DOI: 10.1111/apa.16726] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 02/25/2023]
Abstract
AIM Children with congenital anomalies often require surgery but data on the burden of surgery for these children are limited. METHODS A population-based record-linkage study in Finland, Wales and regions of Denmark, England, Italy and Spain. A total of 91 504 children with congenital anomalies born in 1995-2014 were followed to their tenth birthday or the end of 2015. Electronic linkage to hospital databases provided data on inpatient surgical procedures and meta-analyses of surgical procedures were performed by age groups. RESULTS The percentage of children having surgery in the first year was 38% with some differences across regions and 14% also underwent surgery at age 1-4 years. Regional differences in age at the time of their first surgical procedure were observed for children with cleft palate, hydronephrosis, hypospadias, clubfoot and craniosynostosis. The children had a median of 2.0 (95% CI 1.98, 2.02) surgical procedures before age 5 years with children with oesophageal atresia having the highest median number of procedures (4.5; 95% CI 3.3, 5.8). CONCLUSION A third of children with congenital anomalies required surgery during infancy and often more than one procedure was needed before age 5 years. There was no European consensus on the preferred age for surgery for some anomalies.
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Affiliation(s)
- Ester Garne
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Maria Loane
- Faculty of Life and Health Sciences, Ulster University, Coleraine, UK
| | - Joachim Tan
- Population Health Research Institute, St George's, University of London, London, UK
| | - Elisa Ballardini
- Neonatal Intensive Care Unit, Paediatric Section, IMER Registry (Emilia Romagna Registry of Birth Defects), Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Joanna Brigden
- Population Health Research Institute, St George's, University of London, London, UK
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Alessio Coi
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Mads Damkjaer
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Laura Garcia-Villodre
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare Helsinki, Helsinki, Finland.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Joanne Given
- Faculty of Life and Health Sciences, Ulster University, Coleraine, UK
| | - Anna Heino
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare Helsinki, Helsinki, Finland
| | - Sue Jordan
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
| | - Elizabeth Limb
- Population Health Research Institute, St George's, University of London, London, UK
| | - Amanda Neville
- Emilia Romagna Registry of Birth Defects and Center for Clinical and Epidemiological Research, University of Ferrara, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Michele Santoro
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Ieuan Scanlon
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea, UK
| | - Stine Kjaer Urhoj
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark.,Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Diana Wellesley
- Faculty of Medicine and Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Joan Morris
- Population Health Research Institute, St George's, University of London, London, UK
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2
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Factors which delay surgery for undescended testis in Ontario: A retrospective population based cohort study on timing of orchidopexy between 2006 and 2012. J Pediatr Urol 2022; 18:695.e1-695.e7. [PMID: 35970738 DOI: 10.1016/j.jpurol.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Delays in performing orchidopexy (OP) for undescended testis (UDT) result in loss of germ cells. Despite practice guidelines recommending OP by 18 months of age, significant delays in OP occur. This delay may impact fertility and increase the risk of testicular malignancy in boys with UDT. OBJECTIVE The objective of this study is to identify factors associated with delayed OP with the goal of identifying modifiable risk factors. STUDY DESIGN A population-based, retrospective cohort study was conducted using linked databases held at ICES to evaluate factors associated with timing of OP in Ontario for 4339 male newborns undergoing their first OP between 2006 and 2012. Primary outcome was delayed OP (>18 months). Multivariable logistic regression analysis was performed to identify patient, physician, and hospital risk factors for delayed OP. RESULTS Median age at OP was 24 months, while median age at first surgical consult was 20 months (IQR 10-60 months). Older age at first surgical consult (>12 months vs. <9 months, OR 17.83) was identified as the primary risk factor for delayed OP, besides ICU hospitalization (OR 3.42), associated hypospadias (OR 2.30), higher hospital OP volume (OR 1.91), more healthcare visits in first year of life (OR 1.05), and older surgeon age (OR 1.02). DISCUSSION Our findings support reports that OP is often performed past guideline recommendations. Interventions that result in earlier referral for UDT (<6 months) may result in timely OP. Limitations for this study include potential misclassification or missing data within the utilized databases. CONCLUSION The most important barrier to timely OP is delay in first surgical consultation. Aiming for an earlier referral through guideline modifications or education to referring providers may help achieve the goal of timely OP.
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3
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Urhoj SK, Tan J, Morris JK, Given J, Astolfi G, Baldacci S, Barisic I, Brigden J, Cavero-Carbonell C, Evans H, Gissler M, Heino A, Jordan S, Lutke R, Odak L, Puccini A, Santoro M, Scanlon I, de Walle HEK, Wellesley D, Zurriaga Ó, Loane M, Garne E. Hospital length of stay among children with and without congenital anomalies across 11 European regions—A population-based data linkage study. PLoS One 2022; 17:e0269874. [PMID: 35867669 PMCID: PMC9307180 DOI: 10.1371/journal.pone.0269874] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Congenital anomalies are a leading cause of childhood morbidity, but little is known about the long-term outcomes. Objective To quantify the burden of disease in childhood for children with congenital anomalies by assessing the risk of hospitalisation, the number of days spent in hospital and proportion of children with extended stays (≥10 days). Methods European population-based record-linkage study in 11 regions in eight countries including children with congenital anomalies (EUROCAT children) and without congenital anomalies (reference children) living in the same regions. The children were born between 1995 and 2014 and were followed to their tenth birthday or 31/12/2015. European meta-analyses of the outcome measures were performed by two age groups, <1 year and 1–4 years. Results 99,416 EUROCAT children and 2,021,772 reference children were linked to hospital databases. Among EUROCAT children, 85% (95%-CI: 79–90%) were hospitalised in the first year and 56% (95%-CI: 51–61%) at ages 1–4 years, compared to 31% (95%-CI: 26–37%) and 25% (95%-CI: 19–31%) of the reference children. Median length of stay was 2–3 times longer for EUROCAT children in both age groups. The percentages of children with extended stays (≥10 days) in the first year were 24% (95%-CI: 20–29%) for EUROCAT children and 1% (95%-CI: 1–2%) for reference children. The median length of stay varied greatly between congenital anomaly subgroups, with children with gastrointestinal anomalies and congenital heart defects having the longest stays. Conclusions Children with congenital anomalies were more frequently hospitalised and median length of stay was longer. The outlook improves after the first year. Parents of children with congenital anomalies should be informed about the increased hospitalisations required for their child’s care and the impact on family life and siblings, and they should be adequately supported.
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Affiliation(s)
- Stine Kjaer Urhoj
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Joachim Tan
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Joan K. Morris
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Joanne Given
- Faculty of Life and Health Sciences, Ulster University, Northern Ireland, United Kingdom
| | - Gianni Astolfi
- Dept. of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Silvia Baldacci
- Unit of Epidemiology of Rare diseases and Congenital anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Ingeborg Barisic
- Children’s Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative Medicine, Medical School University of Zagreb, Zagreb, Croatia
| | - Joanna Brigden
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (UVEG-FISABIO), Valencia, Spain
| | - Hannah Evans
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland
| | - Anna Heino
- Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland
| | - Sue Jordan
- Faculty of Medicine, Health and Life Sciences, Swansea University, Wales, United Kingdom
| | - Renée Lutke
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ljubica Odak
- Children’s Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative Medicine, Medical School University of Zagreb, Zagreb, Croatia
| | - Aurora Puccini
- Territorial Assistance Service–Drug and Medical Device Area, Emilia Romagna Health Department, Bologna, Italy
| | - Michele Santoro
- Unit of Epidemiology of Rare diseases and Congenital anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Ieuan Scanlon
- Faculty of Medicine, Health and Life Sciences, Swansea University, Wales, United Kingdom
| | - Hermien E. K. de Walle
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Diana Wellesley
- Clinical Genetics, Princess Anne Hospital, University of Southampton and Wessex Clinical Genetics Service, Southampton, United Kingdom
| | - Óscar Zurriaga
- Department of Preventive Medicine and Public Health, Rare Diseases Research Unit UVEG-FISABIO Valencia and Spanish Consortium for Biomedical Research in Epidemiology and Public Health, University of Valencia (Spain) and Valencia Region (Spain) Health Authority (Conselleria de Sanitat Universal I Salut Pública), Valencia, Spain
| | - Maria Loane
- Faculty of Life and Health Sciences, Ulster University, Northern Ireland, United Kingdom
| | - Ester Garne
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- * E-mail:
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4
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Gates RL, Shelton J, Diefenbach KA, Arnold M, St Peter SD, Renaud EJ, Slidell MB, Sømme S, Valusek P, Villalona GA, McAteer JP, Beres AL, Baerg J, Rentea RM, Kelley-Quon L, Kawaguchi AL, Hu YY, Miniati D, Ricca R, Baird R. Management of the undescended testis in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee Systematic Review. J Pediatr Surg 2022; 57:1293-1308. [PMID: 35151498 DOI: 10.1016/j.jpedsurg.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/31/2021] [Accepted: 01/08/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE Management of undescended testes (UDT) has evolved over the last decade. While urologic societies in the United States and Europe have established some guidelines for care, management by North American pediatric surgeons remains variable. The aim of this systematic review is to evaluate the published evidence regarding the treatment of (UDT) in children. METHODS A comprehensive search strategy and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were utilized to identify, review, and report salient articles. Five principal questions were asked regarding imaging standards, medical treatment, surgical technique, timing of operation, and outcomes. A literature search was performed from 2005 to 2020. RESULTS A total of 825 articles were identified in the initial search, and 260 were included in the final review. CONCLUSIONS Pre-operative imaging and hormonal therapy are generally not recommended except in specific circumstances. Testicular growth and potential for fertility improves when orchiopexy is performed before one year of age. For a palpable testis, a single incision approach is preferred over a two-incision orchiopexy. Laparoscopic orchiopexy is associated with a slightly lower testicular atrophy rate but a higher rate of long-term testicular retraction. One and two-stage Fowler-Stephens orchiopexy have similar rates of testicular atrophy and retraction. There is a higher relative risk of testicular cancer in UDT which may be lessened by pre-pubertal orchiopexy.
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Affiliation(s)
- Robert L Gates
- University of South Carolina School of Medicine - Greenville, Greenville, SC, United States
| | - Julia Shelton
- University of Iowa, Stead Family Children's Hospital, Iowa City, IA, United States
| | - Karen A Diefenbach
- Ohio State University, Nationwide Children's Hospital, Columbus, OH, United States
| | - Meghan Arnold
- University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI, United States
| | | | - Elizabeth J Renaud
- Alpert Medical School of Brown University, Hasbro Children's Hospital, Providence, RI, United States
| | - Mark B Slidell
- Comer Children's Hospital, The University of Chicago Medicine, Chicago, IL, United States
| | - Stig Sømme
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, United States
| | - Patricia Valusek
- Pediatric Surgical Associates, Children's Minnesota, Minneapolis, MN, United States
| | | | - Jarod P McAteer
- Providence Pediatric Surgery, Sacred Heart Children's Hospital, Spokane, WA, United States
| | - Alana L Beres
- University of California, Davis, Sacramento CA, United States
| | - Joanne Baerg
- Loma Linda University Children's Hospital, Loma Linda, CA, United States
| | | | - Lorraine Kelley-Quon
- Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Akemi L Kawaguchi
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Yue-Yung Hu
- Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Doug Miniati
- Division of Pediatric Surgery, Kaiser Permanente Roseville Women and Children's Center, Roseville, CA, United States
| | - Robert Ricca
- University of South Carolina School of Medicine - Greenville, Greenville, SC, United States.
| | - Robert Baird
- Division of Pediatric Surgery, BC Children's Hospital, University of British Columbia, Vancouver, BC, United States
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5
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Zhang ZC, Liu X, Chen HS, Shi Y, Lin T, He DW, Wei GH, Luo YT. Analysis of the social and clinical factors affecting the age of children when receiving surgery for hypospadias: a retrospective study of 1611 cases in a single center. Asian J Androl 2021; 23:527-531. [PMID: 33723097 PMCID: PMC8451499 DOI: 10.4103/aja.aja_11_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We aimed to explore the associations between the age at which children undergo surgery for hypospadias and a range of social and clinical factors in a single center. Our aim was to promote the early surgical treatment of children with hypospadias. For a 6-year period, social and clinical data were collected from all children undergoing surgery to repair hypospadias in Children's Hospital of Chongqing Medical University (Chongqing, China), located in southwest of China. We analyzed the correlations between age at surgery and a range of social and clinical factors. A total of 1611 eligible cases were recruited, with a mean age of 54.3 months and a median age of 42 months: 234 cases (14.5%) were classified into a "timely operation" group, 419 (26.0%) cases into a "subtimely operation" group, and 958 (59.5%) cases into a "delayed operation" group. According to multivariate regression analyses, the higher the regional economic level, the closer the urethral opening to the perineum, and the higher the educational level of the guardians was, the younger the children were when they underwent the initial surgery for hypospadias; this was also the case for families without other children. Our subgroup analysis showed that the primary educational level of the guardians was a risk factor for subtimely surgery in their children (odds ratio [OR] = 1.52, 95% confidence interval [CI]: 1.08-2.15, P < 0.05). A lower regional economic level (OR = 1.87, 95% CI: 1.26-2.78, P < 0.01), a lower educational level of the guardians (OR = 3.84, 95% CI: 2.31-6.41, P < 0.01), and an anterior-segment urethral opening (OR1 [vs middle hypospadias] = 2.07, 95% CI: 1.42-3.03; OR2 [vs posterior hypospadias] = 2.63, 95% CI: 1.75-3.95; P < 0.01) were all risk factors for delayed surgery in children.
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Affiliation(s)
- Zhi-Cheng Zhang
- Department of Urology, Chongqing Medical University Affiliated Children's Hospital, Chongqing 400010, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400010, China.,National Clinical Research Center for Child Health and Disorders, Chongqing 400010, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400010, China.,Children's Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Xing Liu
- Department of Urology, Chongqing Medical University Affiliated Children's Hospital, Chongqing 400010, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400010, China.,National Clinical Research Center for Child Health and Disorders, Chongqing 400010, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400010, China.,Children's Hospital of Chongqing Medical University, Chongqing 400010, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400010, China
| | - Hong-Song Chen
- Department of Urology, Chongqing Medical University Affiliated Children's Hospital, Chongqing 400010, China.,Children's Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Yan Shi
- Department of Urology, Chongqing Medical University Affiliated Children's Hospital, Chongqing 400010, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400010, China.,National Clinical Research Center for Child Health and Disorders, Chongqing 400010, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400010, China.,Children's Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Tao Lin
- Department of Urology, Chongqing Medical University Affiliated Children's Hospital, Chongqing 400010, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400010, China.,National Clinical Research Center for Child Health and Disorders, Chongqing 400010, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400010, China.,Children's Hospital of Chongqing Medical University, Chongqing 400010, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400010, China
| | - Da-Wei He
- Department of Urology, Chongqing Medical University Affiliated Children's Hospital, Chongqing 400010, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400010, China.,National Clinical Research Center for Child Health and Disorders, Chongqing 400010, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400010, China.,Children's Hospital of Chongqing Medical University, Chongqing 400010, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400010, China
| | - Guang-Hui Wei
- Department of Urology, Chongqing Medical University Affiliated Children's Hospital, Chongqing 400010, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing 400010, China.,National Clinical Research Center for Child Health and Disorders, Chongqing 400010, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400010, China.,Children's Hospital of Chongqing Medical University, Chongqing 400010, China.,Chongqing Key Laboratory of Pediatrics, Chongqing 400010, China
| | - Ye-Tao Luo
- Children's Hospital of Chongqing Medical University, Chongqing 400010, China
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6
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Jay MA, Arat A, Wijlaars L, Ajetunmobi O, Fitzpatrick T, Lu H, Lei S, Skerritt C, Goldfeld S, Gissler M, Gunnlaugsson G, Hrafn Jónsson S, Hjern A, Guttmann A, Gilbert R. Timing of paediatric orchidopexy in universal healthcare systems: international administrative data cohort study. BJS Open 2020; 4:1117-1124. [PMID: 32706149 PMCID: PMC7709362 DOI: 10.1002/bjs5.50329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/24/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND International guidelines in 2008 recommended orchidopexy for undescended testis at 6-12 months of age to reduce the risk of testicular cancer and infertility. Using administrative data from England, Finland, Ontario (Canada), Scotland and Sweden (with data from Victoria (Australia) and Iceland in supplementary analyses), the aim of this study was to investigate compliance with these guidelines and identify potential socioeconomic inequities in the timing of surgery before 1 and 3 years. METHODS All boys born in 2003-2011 with a diagnosis code of undescended testis and procedure codes indicating orchidopexy before their fifth birthday were identified from administrative health records. Trends in the proportion of orchidopexies performed before 1 and 3 years of age were investigated, as were socioeconomic inequities in adherence to the guidelines. RESULTS Across all jurisdictions, the proportion of orchidopexies occurring before the first birthday increased over the study period. By 2011, from 7·6 per cent (Sweden) to 27·9 per cent (Scotland) of boys had undergone orchidopexy by their first birthday and 71·5 per cent (Sweden) to 90·4 per cent (Scotland) by 3 years of age. There was limited evidence of socioeconomic inequities for orchidopexy before the introduction of guidelines (2008). Across all jurisdictions for boys born after 2008, there was consistent evidence of inequities in orchidopexy by the first birthday, favouring higher socioeconomic position. Absolute differences in these proportions between the highest and lowest socioeconomic groups ranged from 2·5 to 5·9 per cent across jurisdictions. CONCLUSION Consistent lack of adherence to the guidelines across jurisdictions questions whether the guidelines are appropriate.
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Affiliation(s)
- M. A. Jay
- Population Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | - A. Arat
- Clinical Epidemiology, Department of Medicine, Karolinska Institutet and Centre for Health Equity StudiesStockholmSweden
| | - L. Wijlaars
- Population Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | - O. Ajetunmobi
- Population Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | | | | | - S. Lei
- Murdoch Children's Research Institute, The Royal Children's HospitalAustralia
| | - C. Skerritt
- Bristol Royal Hospital for ChildrenBristolUK
| | - S. Goldfeld
- Murdoch Children's Research Institute, The Royal Children's HospitalAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVictoriaAustralia
| | - M. Gissler
- Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetHuddingeSweden
- Information Services DepartmentFinnish Institute for Health and WelfareHelsinkiFinland
| | - G. Gunnlaugsson
- Faculty of Sociology, Anthropology and FolkloristicsUniversity of IcelandReykjavíkIceland
| | - S. Hrafn Jónsson
- Faculty of Sociology, Anthropology and FolkloristicsUniversity of IcelandReykjavíkIceland
| | - A. Hjern
- Clinical Epidemiology, Department of Medicine, Karolinska Institutet and Centre for Health Equity StudiesStockholmSweden
| | - A. Guttmann
- Child Health Evaluative SciencesCanada
- Division of Paediatric Medicine, Hospital for Sick ChildrenCanada
- ICESCanada
- Dalla Lana School of Public HealthCanada
- Department of PaediatricsUniversity of TorontoTorontoOntarioCanada
| | - R. Gilbert
- Population Policy and Practice Research and Teaching DepartmentUniversity College London Great Ormond Street Institute of Child HealthLondonUK
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7
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Aldaqadossi HA, Shaker H, Youssof H, Kotb Y, Eladawy M. Outcomes of staged lingual mucosal graft urethroplasty for redo hypospadias repair. J Pediatr Urol 2019; 15:519.e1-519.e7. [PMID: 31303449 DOI: 10.1016/j.jpurol.2019.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/11/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The objective of this study was to present the outcomes for redo hypospadias repair using lingual mucosal graft (LMG). PATIENTS AND METHODS Between June 2012 and February 2017, 47 patients underwent staged LMG urethroplasty for redo hypospadias repair. The inclusion criteria were previous failed hypospadias repair with a paucity of local skin that interferes with correction using skin flaps and demands graft urethroplasty. During the first stage, a well-vascularized bed on the tunica albuginea was created. Then, the harvested LMG was secured to the prepared bed. The second-stage urethroplasty was carried out after six months. In this stage, tubularization of the previously implanted LMG was performed. In four cases, tubularization was difficult owing to graft contracture. This difficulty was managed by using the dorsally degloved penile skin as the onlay island flap in three cases and the buccal mucosa onlay graft in the fourth case. In all cases, a second protective layer from the dartos or tunica vaginalis was developed to cover the neourethra. RESULTS The median (interquartile range [IQR]) age of patients at the first stage was 5 (4-6) years, and the median (IQR) duration between both stages was 7 (6-8) months. The median (IQR) follow-up after the second stage was 15 (13-16) months. The median (IQR) number of previous operations was 2 (2-3). The median (IQR) length of the LMG was 3 (2.5-4) cm, and the median (IQR) width was 1 (1-2) cm. No donor-site major complications, but mild oral discomfort in the first week after graft harvesting, were reported in 39 (83%) patients. After the second stage, complications were reported in nine (19.2%) patients, meatal stenosis in five and fistula in four. The reported success rate was 80.9%. DISCUSSION Reconstruction of previously failed hypospadias is a challenge owing to local tissue scarring and a paucity of adjacent healthy tissue. In this study, the LMG was used in two-stage redo hypospadias repair after previous repair failure. In the present study, a success rate of 80.9% was reported after the second stage. According to this study and the published series, harvesting the LMG is associated with minimal immediate donor-site complications and no long-term morbidity. Another advantage of the LMG is easy harvesting with effortlessly reachable tongue in comparison with the buccal mucosa that is deep and requires application of a mouth retractor. CONCLUSIONS Two-stage LMG urethroplasty is a reliable procedure for salvage urethroplasty. Lingual mucosal graft harvesting is easy, with minor oral complications.
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Affiliation(s)
| | - H Shaker
- Fayoum University, Fayoum, Egypt
| | | | - Y Kotb
- Ain Shams University, Ain Shams, Egypt
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