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Gnech M, 't Hoen L, Zachou A, Bogaert G, Castagnetti M, O'Kelly F, Quaedackers J, Rawashdeh YF, Silay MS, Kennedy U, Skott M, van Uitert A, Yuan Y, Radmayr C, Burgu B. Update and Summary of the European Association of Urology/European Society of Paediatric Urology Paediatric Guidelines on Vesicoureteral Reflux in Children. Eur Urol 2024; 85:433-442. [PMID: 38182493 DOI: 10.1016/j.eururo.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND AND OBJECTIVE The prescriptive literature on vesicoureteral reflux (VUR) is still limited and thus the level of evidence is generally low. The aim of these guidelines is to provide a practical approach to the treatment of VUR that is based on risk analysis and selective indications for both diagnostic tests and interventions. We provide a 2023 update on the chapter on VUR in children from the European Association of Urology (EAU) and European Society for Paediatric Urology (ESPU) guidelines. METHODS A structured literature review was performed for all relevant publications published from the last update up to March 2022. KEY FINDINGS AND LIMITATIONS The most important updates are as follows. Bladder and bowel dysfunction (BBD) is common in toilet-trained children presenting with urinary tract infection (UTI) with or without primary VUR and increases the risk of febrile UTI and focal uptake defects on a radionuclide scan. Continuous antibiotic prophylaxis (CAP) may not be required in every VUR patient. Although the literature does not provide any reliable information on CAP duration in VUR patients, a practical approach would be to consider CAP until there is no further BBD. Recommendations for children with febrile UTI and high-grade VUR include initial medical treatment, with surgical care reserved for CAP noncompliance, breakthrough febrile UTIs despite CAP, and symptomatic VUR that persists during long-term follow-up. Comparison of laparoscopic extravesical versus transvesicoscopic ureteral reimplantation demonstrated that both are good option in terms of resolution and complication rates. Extravesical surgery is the most common approach used for robotic reimplantation, with a wide range of variations and success rates. CONCLUSIONS AND CLINICAL IMPLICATIONS This summary of the updated 2023 EAU/ESPU guidelines provides practical considerations for the management and diagnostic evaluation of VUR in children. ADVANCING PRACTICE For children with VUR, it is important to treat BBD if present. A practical approach regarding the duration of CAP is to consider administration until BBD resolution. PATIENT SUMMARY We provide a summary and update of guidelines on the diagnosis and management of urinary reflux (where urine flows back up through the urinary tract) in children. Treatment of bladder and bowel dysfunction is critical, as this is common in toilet-trained children presenting with urinary tract infection.
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Affiliation(s)
- Michele Gnech
- Department of Paediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Lisette 't Hoen
- Department of Pediatric Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Alexandra Zachou
- Department of HIV and Sexual Health, Chelsea & Westminster Hospital, London, UK
| | - Guy Bogaert
- Department of Urology, University of Leuven, Leuven, Belgium
| | - Marco Castagnetti
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padua, Italy
| | - Fardod O'Kelly
- Division of Paediatric Urology, Beacon Hospital Dublin & University College Dublin, Ireland
| | - Josine Quaedackers
- Department of Urology, University Medical Center Groningen, Groningen, The Netherlands
| | - Yazan F Rawashdeh
- Department of Urology, Section of Pediatric Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Mesrur Selcuk Silay
- Division of Pediatric Urology, Department of Urology, Biruni University, Istanbul, Turkey
| | - Uchenna Kennedy
- Department of Pediatric Urology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Martin Skott
- Department of Urology, Section of Pediatric Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Allon van Uitert
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Yuhong Yuan
- Department of Medicine, London Health Science Centre, London, Ontario, Canada, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Christian Radmayr
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Berk Burgu
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
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Skott M, Gnech M, Hoen LA', Kennedy U, Van Uitert A, Zachou A, Yuan Y, Quaedackers J, Silay MS, Rawashdeh YF, Burgu B, Castagnetti M, O'Kelly F, Bogaert G, Radmayr C. Endoscopic dilatation/incision of primary obstructive megaureter. A systematic review. On behalf of the EAU paediatric urology guidelines panel. J Pediatr Urol 2024; 20:47-56. [PMID: 37758534 DOI: 10.1016/j.jpurol.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Historically, ureteral reimplantation (UR) has been the gold standard for treatment of primary obstructive megaureter (POM) with declining renal function, worsening obstruction, or recurrent urinary tract infections. In infants, open surgery with reimplantation of a grossly dilated ureter into a small bladder, can be technically challenging with significant morbidity. Therefore, less invasive endoscopic management such as dilatation or incision of the ureter-vesical junction, has emerged as an alternative to reimplantation during the last decades. OBJECTIVE To systematically evaluate the effectivity, safety, and potential benefits of endoscopic treatment (dilatation with or without balloon or incision) of POM in comparison to UR. STUDY DESIGN A systematic review was conducted. Randomized controlled trials (RCTs), nonrandomized comparative studies (NRSs), and single-arm case series including a minimum of 20 participants and a mean follow-up more than 12 months were eligible for inclusion. RESULTS Of 504 articles identified, 8 articles including 338 patients were eligible for inclusion (0 RCTs, 1 NRSs, and 7 case series). Age at time of surgery was minimum 15 days to a maximum of 192 months. Indications for endoscopic treatment (ET) included patients with loss of split renal function (>10%) and worsening of hydroureteronephrosis. The studies analysed reported a success rate ranging from 35% to 97%. Success was defined as stabilization of differential renal function without further procedures. A post-operative complication rate of 23-60% was reported (mostly transient haematuria, urinary tract infections and stent migration or intolerance). In 14% of the cases salvage UR following initial ET, was performed due to relapse of symptomatic POM. CONCLUSION Endoscopic treatment for persistent or progressive POM in children is a minimally invasive alternative to UR with a long-term modest success rate. Additionally, it can be performed within a wide age span, with equal success rate and complication rates.
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Affiliation(s)
- Martin Skott
- Department of Urology, Section of Pediatric Urology, Aarhus University Hospital, Aarhus, Denmark.
| | - Michele Gnech
- Department of Paediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Lisette A 't Hoen
- Department of Pediatric Urology, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Uchenna Kennedy
- Department of Pediatric Urology, University Children's Hospital Zurich, Switzerland.
| | - Allon Van Uitert
- Department of Urology, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - Alexandra Zachou
- Department of HIV and Sexual Health, Chelsea & Westminster Hospital, London, United Kingdom.
| | - Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Josine Quaedackers
- Department of Urology and Pediatric Urology, University Medical Center Gronningen, Rijks University Groningen, Groningen, the Netherlands.
| | - Mesrur Selcuk Silay
- Division of Pediatric Urology, Department of Urology, Istanbul Birurni University, Istanbul, Turkey.
| | - Yazan F Rawashdeh
- Department of Urology, Section of Pediatric Urology, Aarhus University Hospital, Aarhus, Denmark.
| | - Berk Burgu
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey.
| | - Marco Castagnetti
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padua, Italy.
| | - Fardod O'Kelly
- Division of Paediatric Urology, Beacon Hospital, Dublin, Ireland, University College Dublin, Ireland.
| | - Guy Bogaert
- Department of Urology, University of Leuven, Leuven, Belgium.
| | - Christian Radmayr
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria.
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Munk A, Skott M, Rawashdeh YF. Acute preputial strangulation secondary to hair tourniquet syndrome. Pediatr Int 2023; 65:e15637. [PMID: 37804052 DOI: 10.1111/ped.15637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/30/2023] [Accepted: 07/26/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Anders Munk
- Department of Urology, Section of Paediatric Urology, Aarhus University Hospital, Aarhus N, Denmark
| | - Martin Skott
- Department of Urology, Section of Paediatric Urology, Aarhus University Hospital, Aarhus N, Denmark
| | - Yazan F Rawashdeh
- Department of Urology, Section of Paediatric Urology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Skott M, Korsgaard U, Rawashdeh YF. A case of penile duplication with neonatal teratoma and bladder neck incompetence. Scand J Urol 2021; 55:422-426. [PMID: 34286674 DOI: 10.1080/21681805.2021.1953580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
An 8-year-old boy presented with a duplicated penis and urinary incontinence. He had a history of a perineal teratoma which was removed during his first week of life. Examination revealed a large prepuce, 90-degree counter clockwise rotation of the penis, an orthotopic megalomeatus and an additional smaller glans dorsally. Cystourethroscopy and artificial erection showed a wide-open bladder neck and deviation of the penis(es) to the right. There were two cavernosae in the orthotopic penis and one in the duplicated rudimentary penis. The patient was subjected to Young-Dees bladder neck reconstruction and two years later, excision of the rudimentary penis. A satisfactory cosmetic result was achieved, the patient is voiding normally, and urinary incontinence improved. Penile duplication is a rare anomaly, which presents differently in each patient. Therefore, treatment should be individualized, and the goal of surgery being to achieve as a near normal cosmetic and functional result as possible.
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Affiliation(s)
- Martin Skott
- Department of Urology, Section of Paediatric Urology, Aarhus University Hospital, Aarhus N, Denmark
| | - Ulrik Korsgaard
- Department of Pathology, Aarhus University Hospital, Aarhus N, Denmark
| | - Yazan F Rawashdeh
- Department of Urology, Section of Paediatric Urology, Aarhus University Hospital, Aarhus N, Denmark
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Hanifa MA, Skott M, Maltesen RG, Rasmussen BS, Nielsen S, Frøkiær J, Ring T, Wimmer R. Tissue, urine and serum NMR metabolomics dataset from a 5/6 nephrectomy rat model of chronic kidney disease. Data Brief 2020; 33:106567. [PMID: 33304964 PMCID: PMC7708935 DOI: 10.1016/j.dib.2020.106567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 01/05/2023] Open
Abstract
Serum, urine and tissue from a rat model of chronic kidney disease (CKD) were analysed using nuclear magnetic resonance (NMR) spectroscopy-based metabolomics methods, and compared with samples from sham operated rats. Both urine and serum were sampled at multiple timepoints, and the results have been reported elsewhere (https://doi.org/10.1007/s11306-019-1569-3[1]). The data could be useful to researchers working with human CKD or rat models of the disease. In addition, several different types of NMR spectra were recorded, including 1D NOESY, CPMG, and 2D J-resolved spectra, and the data could be useful for method comparison and algorithm development, both in terms of NMR spectroscopy and multivariate analysis.
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Affiliation(s)
- Munsoor A Hanifa
- Department of Chemistry and Bioscience, Aalborg University, 9220 Aalborg, Denmark.,Department of Anaesthesia and Intensive Care Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - Martin Skott
- Department of Urology, Aarhus University Hospital, 8250 Aarhus N, Denmark
| | - Raluca G Maltesen
- Department of Anaesthesia and Intensive Care Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Bodil S Rasmussen
- Department of Anaesthesia and Intensive Care Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | | | - Jørgen Frøkiær
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
| | - Troels Ring
- Department of Biomedicine, Aarhus University, 8000 Aarhus C, Denmark.,The Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburg, PA 15261, United States of America
| | - Reinhard Wimmer
- Department of Chemistry and Bioscience, Aalborg University, 9220 Aalborg, Denmark
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Hanifa MA, Maltesen RG, Rasmussen BS, Buggeskov KB, Ravn HB, Skott M, Nielsen S, Frøkiær J, Ring T, Wimmer R. Citrate NMR peak irreproducibility in blood samples after reacquisition of spectra. Metabolomics 2019; 16:7. [PMID: 31858270 DOI: 10.1007/s11306-019-1629-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND In our metabolomics studies we have noticed that repeated NMR acquisition on the same sample can result in altered metabolite signal intensities. AIMS To investigate the reproducibility of repeated NMR acquisition on selected metabolites in serum and plasma from two large human metabolomics studies. METHODS Two peak regions for each metabolite were integrated and changes occurring after reacquisition were correlated. RESULTS Integral changes were generally small, but serum citrate signals decreased significantly in some samples. CONCLUSIONS Several metabolite integrals were not reproducible in some of the repeated spectra. Following established protocols, randomising analysis order and biomarker validation are important.
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Affiliation(s)
- Munsoor A Hanifa
- Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, 9220, Aalborg, Denmark
- Department of Anesthesia and Intensive Care Medicine, Aalborg University Hospital, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000, Aalborg, Denmark
| | - Raluca G Maltesen
- Department of Anesthesia and Intensive Care Medicine, Aalborg University Hospital, 9000, Aalborg, Denmark
| | - Bodil S Rasmussen
- Department of Anesthesia and Intensive Care Medicine, Aalborg University Hospital, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000, Aalborg, Denmark
| | - Katrine B Buggeskov
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, 2100, Copenhagen, Denmark
| | - Hanne B Ravn
- Department of Cardiothoracic Anesthesiology, Rigshospitalet, Copenhagen University Hospital, 2100, Copenhagen, Denmark
| | - Martin Skott
- Department of Urology, Aarhus University Hospital, 8250, Aarhus N, Denmark
| | | | - Jørgen Frøkiær
- Department of Clinical Medicine, Aarhus University, 8200, Aarhus N, Denmark
| | - Troels Ring
- Department of Biomedicine, Aarhus University, 8000, Aarhus C, Denmark
- The Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburg, PA, 15261, USA
| | - Reinhard Wimmer
- Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, 9220, Aalborg, Denmark.
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Hanifa MA, Skott M, Maltesen RG, Rasmussen BS, Nielsen S, Frøkiær J, Ring T, Wimmer R. Tissue, urine and blood metabolite signatures of chronic kidney disease in the 5/6 nephrectomy rat model. Metabolomics 2019; 15:112. [PMID: 31422467 DOI: 10.1007/s11306-019-1569-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/22/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Progressive chronic kidney disease (CKD) is an important cause of morbidity and mortality. It has a long asymptomatic phase, where routine blood tests cannot identify early functional losses, and therefore identifying common mechanisms across the many etiologies is an important goal. OBJECTIVES Our aim was to characterize serum, urine and tissue (kidney, lung, heart, spleen and liver) metabolomics changes in a rat model of CKD. METHODS A total of 17 male Wistar rats underwent 5/6 nephrectomy, whilst 13 rats underwent sham operation. Urine samples were collected weekly, for 6 weeks; blood was collected at weeks 0, 3 and 6; and tissue samples were collected at week 6. Samples were analyzed on a nuclear magnetic resonance spectroscopy platform with multivariate and univariate data analysis. RESULTS Changes in several metabolites were statistically significant. Allantoin was affected in all compartments. Renal asparagine, creatine, hippurate and trimethylamine were significantly different; in other tissues creatine, dimethylamine, dimethylglycine, trigonelline and trimethylamine were significant. Benzoate, citrate, dimethylglycine, fumarate, guanidinoacetate, malate, myo-inositol and oxoglutarate were altered in urine or serum. CONCLUSION Although the metabolic picture is complex, we suggest oxidative stress, the gut-kidney axis, acid-base balance, and energy metabolism as promising areas for future investigation.
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Affiliation(s)
- Munsoor A Hanifa
- Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, 9220, Aalborg, Denmark
- Department of Anaesthesia and Intensive Care Medicine, Aalborg University Hospital, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000, Aalborg, Denmark
| | - Martin Skott
- Department of Urology, Aarhus University Hospital, 8250, Aarhus N, Denmark
| | - Raluca G Maltesen
- Department of Anaesthesia and Intensive Care Medicine, Aalborg University Hospital, 9000, Aalborg, Denmark
| | - Bodil S Rasmussen
- Department of Anaesthesia and Intensive Care Medicine, Aalborg University Hospital, 9000, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, 9000, Aalborg, Denmark
| | | | - Jørgen Frøkiær
- Department of Clinical Medicine, Aarhus University, 8200, Aarhus N, Denmark
| | - Troels Ring
- Department of Biomedicine, Aarhus University, 8000, Aarhus C, Denmark
- Department of Critical Care Medicine, The Center for Critical Care Nephrology, University of Pittsburgh, Pittsburg, PA, 15261, USA
| | - Reinhard Wimmer
- Department of Chemistry and Bioscience, Aalborg University, Fredrik Bajers Vej 7H, 9220, Aalborg, Denmark.
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Sørensen FE, Skott M, Rawashdeh YF, Kirkeby HJ. Syringocele: a retrospective study and review of the literature. Scand J Urol 2019; 53:269-274. [PMID: 31411088 DOI: 10.1080/21681805.2019.1649719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: A syringocele is a cystic dilation of the ducts from the bulbourethral glands located in the bulbous part of the male urethra. It is a rare condition primarily reported in children and young adults. The objective was to evaluate the diagnostic pattern and management strategy in patients of all ages diagnosed with syringocele.Methods: A retrospective review of patients with syringocele in the period 2004-2018 was performed. Age at diagnosis, primary symptoms, the diagnostic modalities used, treatments and effects were registered.Results: In the period, 19 patients with syringoceles were identified, eight children and 11 adults. The majority of the patients presented with obstructive voiding symptoms. All patients underwent cystourethroscopy. Supplementary diagnostics as voiding cystourethrography, retrograde urethrography, uroflowmetry, magnetic resonance imaging or transrectal ultrasonography were used inconsistently. Sixteen of the patients underwent marsupialization, one child underwent open excision and two patients were managed conservatively. Three of the children were re-operated on with endoscopic marsupialization. One of the adult patients did not respond to marsupialization and was treated with and vesico-appendico-cutaneostomy.Discussion: A review of the case reports published in the period 1996-2018 was performed and compared to these results. This review found 77 cases, 50 children and 27 adults. The reported symptoms, diagnostics and treatments were in line with the findings of this study.Conclusions: Based on these findings and the literature it is recommended that syringoceles should be diagnosed by cystourethroscopy and urethrography. Patients with symptomatic syringoceles should be offered treatment. First line treatment is endoscopic marsupialization.
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Affiliation(s)
| | - Martin Skott
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
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Skott M, Schrøder H, Hindkjaer J, Kirkeby HJ. Sperm preservation by electroejaculation before anticancer therapy. Scand J Urol 2019; 52:461-463. [PMID: 30652521 DOI: 10.1080/21681805.2018.1534883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND This report presents a case where electroejaculation (EEJ) was used for semen cryopreservation (SCP), prior to gonadotoxic anti-cancer treatment in a 14-year old boy diagnosed with Hodgkins disease. METHOD Two sessions of EEJ were performed with an interval of 48 hours. RESULTS No complications were seen and the procedures resulted in nine frozen straws of motile spermatozoa. CONCLUSION EEJ is a safe and feasible procedure for SCP in an adolescent cancer patient who is unable to masturbate or use penile vibratory stimulation (PVS).
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Affiliation(s)
- M Skott
- a Department of Urology , Aarhus University Hospital , Denmark
| | - H Schrøder
- b Department of Paediatrics , Aarhus University Hospital , Denmark
| | - J Hindkjaer
- c The Fertility Clinic and Centre for Preimplantation Genetic Diagnosis , Aarhus University Hospital , Denmark
| | - H J Kirkeby
- a Department of Urology , Aarhus University Hospital , Denmark
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Skott M, Nørregaard R, Birke-Sørensen H, Palmfeldt J, Kwon TH, Jonassen T, Frøkiær J, Nielsen S. Development of intestinal ischemia/reperfusion-induced acute kidney injury in rats with or without chronic kidney disease: Cytokine/chemokine response and effect of α-melanocyte-stimulating hormone. Kidney Res Clin Pract 2014; 33:79-88. [PMID: 26877955 PMCID: PMC4714152 DOI: 10.1016/j.krcp.2014.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 02/04/2014] [Accepted: 02/10/2014] [Indexed: 01/11/2023] Open
Abstract
Background The primary aim of the study was to investigate the cytokine/chemokine response in the kidney, lung, and liver following acute kidney injury (AKI). The secondary aim was to test whether α-melanocyte-stimulating hormone (α-MSH) could prevent a reduction in organ function, and attenuate the inflammatory cytokine/chemokine response within the kidney, lung, and liver following AKI in rats with or without preexisting chronic kidney disease (CKD). Methods A two-stage animal model, in which AKI was induced in rats with preexisting CKD, induced by 5/6 nephrectomy (Nx), was used. Six weeks later, AKI was induced by intestinal ischemia and reperfusion (IIR). Sham procedures [S(Nx) and S(IIR)] were also performed. Results Increasing levels of serum creatinine (sCr) demonstrated progressive development of CKD in response to Nx, and following IIR sCr levels increased further significantly, except in the S(Nx) group treated with α-MSH. However, no significant differences in the fractional increase in sCr were observed between any of the groups exposed to IIR. In kidney, lung, and liver tissue the levels of interleukin (IL)-1β were significantly higher in rats undergoing IIR when compared to the S(IIR) and control rats. The same pattern was observed for the chemokine monocyte chemoattractant protein (MCP)-1 in lung and liver tissue. Furthermore, kidney IL-1β and RANTES levels were significantly increased after IIR in the Nx rats compared to the S(Nx) rats. Conclusion Both the functional parameters and the cytokine/chemokine response are as dramatic when AKI is superimposed onto CKD as onto non-CKD. No convincing protective effect of α-MSH was detected.
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Affiliation(s)
- Martin Skott
- Department of Biomedicine, University of Aarhus, Aarhus, Denmark; The Water and Salt Research Center, University of Aarhus, Aarhus, Denmark
| | - Rikke Nørregaard
- The Water and Salt Research Center, University of Aarhus, Aarhus, Denmark; Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | | | - Johan Palmfeldt
- Research Unit for Molecular Medicine, Aarhus University Hospital, Skejby, Denmark
| | - Tae-Hwan Kwon
- Department of Biochemistry and Cell Biology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Thomas Jonassen
- Department of Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Frøkiær
- The Water and Salt Research Center, University of Aarhus, Aarhus, Denmark; Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Søren Nielsen
- Department of Biomedicine, University of Aarhus, Aarhus, Denmark; The Water and Salt Research Center, University of Aarhus, Aarhus, Denmark
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Skott M, Nørregaard R, Birke-Sørensen H, Palmfeldt J, Kwon TH, Frøkiaer J, Nielsen S. Acute kidney injury in rats with or without pre-existing chronic kidney disease: cytokine/chemokine response. Nephrology (Carlton) 2014; 19:410-9. [PMID: 24730452 DOI: 10.1111/nep.12263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2014] [Indexed: 11/28/2022]
Abstract
AIM Evidence suggests the possibility that pre-existing chronic kidney (CKD) disease may result in a more severe outcome of acute kidney injury (AKI). The aim of this study was to examine whether CKD enhances the inflammatory response in the kidney, as well as other organs, in response to AKI in rats. METHODS CKD was induced by 5/6 nephrectomy (Nx) and AKI by intestinal ischaemia and reperfusion (IIR). RESULTS For 6 weeks following Nx there was a progressive increase in serum creatinine with associated development of albuminuria. The increment in creatinine above baseline determination 90 min following IIR was comparable in 5/6 Nx and in the sham 5/6 Nx. Similarly, increased levels of serum alanine transaminase and histomorphological changes in the lungs were observed in the rats exposed to IIR compared with those exposed to sham IIR, with no additional significant impact of 5/6 Nx. In kidney tissue the levels of cytokines/chemokines were equally elevated regardless of exposure to sham IIR or IIR. In lung and liver tissue the levels of cytokines/chemokines were equally elevated in the rats that were exposed to IIR, regardless of exposure to sham Nx or Nx. CONCLUSION We conclude that the immediate severity of AKI induced by IIR in rats with CKD is similar to that induced in rats without CKD. However, the impact of Nx on the cytokine/chemokine response after AKI is not uniform in kidney, lung or liver tissue.
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Affiliation(s)
- Martin Skott
- Department of Biomedicine, Aarhus University, Aarhus, Denmark; The Water & Salt Research Center, Aarhus University, Aarhus, Denmark
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Jelen S, Wacker S, Aponte-Santamaría C, Skott M, Rojek A, Johanson U, Kjellbom P, Nielsen S, de Groot BL, Rützler M. Aquaporin-9 protein is the primary route of hepatocyte glycerol uptake for glycerol gluconeogenesis in mice. J Biol Chem 2011; 286:44319-25. [PMID: 22081610 DOI: 10.1074/jbc.m111.297002] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
It has been hypothesized that aquaporin-9 (AQP9) is part of the unknown route of hepatocyte glycerol uptake. In a previous study, leptin receptor-deficient wild-type mice became diabetic and suffered from fasting hyperglycemia whereas isogenic AQP9(-/-) knock-out mice remained normoglycemic. The reason for this improvement in AQP9(-/-) mice was not established before. Here, we show increased glucose output (by 123% ± 36% S.E.) in primary hepatocyte culture when 0.5 mM extracellular glycerol was added. This increase depended on AQP9 because it was absent in AQP9(-/-) cells. Likewise, the increase was abolished by 25 μM HTS13286 (IC(50) ~ 2 μM), a novel AQP9 inhibitor, which we identified in a small molecule library screen. Similarly, AQP9 deletion or chemical inhibition eliminated glycerol-enhanced glucose output in perfused liver preparations. The following control experiments suggested inhibitor specificity to AQP9: (i) HTS13286 affected solute permeability in cell lines expressing AQP9, but not in cell lines expressing AQPs 3, 7, or 8. (ii) HTS13286 did not influence lactate- and pyruvate-dependent hepatocyte glucose output. (iii) HTS13286 did not affect glycerol kinase activity. Our experiments establish AQP9 as the primary route of hepatocyte glycerol uptake for gluconeogenesis and thereby explain the previously observed, alleviated diabetes in leptin receptor-deficient AQP9(-/-) mice.
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Affiliation(s)
- Sabina Jelen
- From the Water and Salt Research Center, Department of Biomedicine, Aarhus University, Wilhelm Meyers Allè, DK-8000 Aarhus C, Denmark
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Skott M, Norregaard R, Sorensen HB, Kwon TH, Frokiaer J, Nielsen S. Pre-existing renal failure worsens the outcome after intestinal ischaemia and reperfusion in rats. Nephrol Dial Transplant 2010; 25:3509-17. [DOI: 10.1093/ndt/gfq281] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Skott M, Andreassen TT, Ulrich-Vinther M, Chen X, Keyler DE, LeSage MG, Pentel PR, Bechtold JE, Soballe K. Tobacco extract but not nicotine impairs the mechanical strength of fracture healing in rats. J Orthop Res 2006; 24:1472-9. [PMID: 16705735 DOI: 10.1002/jor.20187] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The influence of nicotine and tobacco extract (without nicotine) alone and in combination on and mechanical strength of closed femoral fractures in rats was investigated. One hundred four male Sprague-Dawley rats were divided into four groups receiving: nicotine, tobacco extract, tobacco extract plus nicotine, and saline. One week prior to fracture, osmotic pumps were implanted subcutaneously in all animals to administer nicotine equivalent to the serum level of nicotine observed in a smoker consuming one to two packs of cigarettes daily. An equivalent volume of saline was administered to the control animals. Tobacco extract was administered orally. A closed transverse femoral diaphysial fracture was performed, and stabilized with an intramedullary pin. The fractures were mechanically tested after 21 days of healing. Tobacco extract alone decreased the mechanical strength. Ultimate torque and torque at yield point of the tobacco extract group were decreased by 21% (p=0.010) and 23% (p=0.056), respectively, compared with the vehicle (saline) group, and by 20% (p=0.023) and 26% (p=0.004), respectively, compared with the nicotine group. No difference was found between the tobacco extract and tobacco extract plus nicotine groups. An 18% (p=0.013) reduction in torque at yield point was observed in the tobacco extract plus nicotine group compared with the nicotine group. No differences in ultimate stiffness, energy absorption, and callus bone mineral content at the fracture line were found between any of the groups. Serum levels of nicotine were between 40-50 ng/mL in the group given nicotine alone and the group given tobacco extract plus nicotine (equivalent to serum levels observed in persons smoking one to two packs of cigarettes per day).
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Affiliation(s)
- Martin Skott
- Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Aarhus University Hospital, Norrebrogade 44, Building 1A, DK-8000 Aarhus C, Denmark.
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Lazarus S, Andersen A, Skott M, Feuerstein L, Vander Wal K. Spending more on Medicare is top priority for 33% in pre-Bush poll. Health Care Strateg Manage 2001; 19:15-7. [PMID: 11258240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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