Global minimally invasive pyeloplasty study in children: Results from the Pediatric Urology Expert Group of the European Association of Urology Young Academic Urologists working party

INTRODUCTION

Minimally invasive pyeloplasty (MIP) for ureteropelvic junction (UPJ) obstruction in children has gained popularity over the past decade as an alternative to open surgery. The present study aimed to identify the factors affecting complication rates of MIP in children, and to compare the outcomes of laparoscopic (LP) and robotic-assisted laparoscopic pyeloplasty (RALP).

MATERIALS AND METHODS

The perioperative data of 783 pediatric patients (<18 years old) from 15 academic centers who underwent either LP or RALP with an Anderson Hynes dismembered pyeloplasty technique were retrospectively evaluated. Redo cases and patients with anatomic renal abnormalities were excluded. Demographics and operative data, including procedural factors, were collected. Complications were classified according to the Satava and modified Clavien systems. Failure was defined as any of the following: obstructive parameters on diuretic renal scintigraphy, decline in renal function, progressive hydronephrosis, or symptom relapse. Univariate and multivariate analysis were applied to identify factors affecting the complication rates. All parameters were compared between LP and RALP.

RESULTS

A total of 575 children met the inclusion criteria. Laparoscopy, increased operative time, prolonged hospital stay, ureteral stenting technique, and time required for stenting were factors influencing complication rates on univariate analysis. None of those factors remained significant on multivariate analysis. Mean follow-up was 12.8 ± 9.8 months for RALP and 45.2 ± 33.8 months for LP (P = 0.001). Hospital stay and time for stenting were shorter for robotic pyeloplasty (P < 0.05 for both). Success rates were similar between RALP and LP (99.5% vs 97.3%, P = 0.11). The intraoperative complication rate was comparable between RALP and LP (3.8% vs 7.4%, P = 0.06). However, the postoperative complication rate was significantly higher in the LP group (3.2% for RALP and 7.7% for LP, P = 0.02). All complications were of no greater severity than Satava Grade IIa and Clavien Grade IIIb.

DISCUSSION

This was the largest multicenter series of LP and RALP in the pediatric population. Limitations of the study included the retrospective design and lack of surgical experience as a confounder.

CONCLUSIONS

Both minimally invasive approaches that were studied were safe and highly effective in treating UPJ obstruction in children in many centers globally. However, shorter hospitalization time and lower postoperative complication rates with RALP were noted. The aims of the study were met.

Relationship between penile size and somatometric parameters in 2276 healthy young men

The aim of this study was to determine the average penile length of a group of healthy, young Turkish men, and to investigate the relationship between penile length and somatometric parameters in the same group. The flaccid and stretched length and circumference of the penis was measured in a group of 2276 physically normal, young men. The correlation between penile length and weight, height and body mass index (BMI) of the participants was determined by Pearson's analysis. The mean age of the participants was 21.1 ± 3.1 (18-39) years. The mean flaccid, fully stretched and circumferential length of the participants' penises were 8.95 ± 1.04, 13.98 ± 1.58 and 8.89 ± 0.86 cm, respectively. There was a significant relationship between all of these variables (P<0.01). Although weak positive correlations were found between the mean circumference length and BMI, there were no correlations between both the flaccid and stretched lengths and BMI. The penile length must be known to be able to determine the abnormal penile sizes and to make convenient decisions in the counseling and/or treatment of people with short penis concerns. Our study provides mean penile lengths in a large sample of healthy, young Turkish men, and the penile dimensions were found to be weakly correlated with somatometric parameters.

The effect of music therapy during shockwave lithotripsy on patient relaxation, anxiety, and pain perception

OBJECTIVES

To research the effect of listening to music during shock wave lithotripsy (SWL) on the patient's pain control, anxiety levels, and satisfaction.

PATIENTS AND METHODS

The study comprised 400 patients from three hospitals. Half of patients listened to music during their first SWL session but not during their second session. The other half had no music for the first session but the second session was accompanied by music. During all sessions, with and without music, pulse rates, blood pressure, State-Trait Anxiety Inventory-State Anxiety scores (STAI-SA), Visual Analog Scale (VAS scores for pain), willingness to repeat procedure (0 = never to 4 happily), and patient satisfaction rates (0 = poor to 4 = excellent) were assessed.

RESULTS

There was no statistical difference between the two groups in terms of blood pressure and pulse rates. In both groups, the STAI-SA and VAS pain scores were lower in the session when music was listened to (p < 0.001). The patients requested more SWL treatment be completed while listening to music and their satisfaction was greater.

CONCLUSION

Music lowered the anxiety and pain scores of patients during SWL and provided greater satisfaction with treatment. Completing this procedure while the patient listens to music increases patient compliance greatly and reduces analgesic requirements.

The protective effects of pomegranate extracts against renal ischemia-reperfusion injury in male rats

Aim:

To evaluate the possible protective effect of pomegranate extract (PE) on rats following renal ischemia–reperfusion (I/R) injury.

Materials and Methods:

Twenty-four Wistar rats were divided into three groups. Sham group underwent laparotomy then waited for 45 minutes without ischemia. I/R group were subjected to left renal ischemia for 45 minutes followed by 60 minutes of reperfusion. I/R + PE group were subjected to the same renal I/R as the I/R group were also given 225 mg/kg PE peroral 30 minutes prior to the ischemia. Malondialdehyde (MDA), total antioxidant capacity (TAC), total oxidant status (TOS), and oxidative stress index (OSI) were determined on the blood samples and kidney tissues. Histopathological analyses were conducted on the kidney tissues.

Results:

Serum TAC levels were significantly decreased in I/R group when compared with S group (P = 0.001). Serum MDA levels were increased in I/R group; however, it was not statistically significant. In rat kidney tissues, TOS levels and OSI index were significantly increased after I/R injury, while TAC levels were decreased. In I/R + PE group, PE reversed the negative effects of I/R injury. PE pretreatment was effective in decreasing tubular necrosis score.

Conclusion:

PE pretreatment ameliorated the oxidative damage and histopathological changes occurring following renal I/R injury.

No evidence of depression, anxiety, and sexual dysfunction following penile fracture

There is a gap in the literature about psychological status of patients following penile fracture surgery. We aimed to assess the long-term psychological status of penile fracture patients who have been treated by immediate surgical repair. A total of 32 patients with penile fracture have been treated surgically at our center. These 32 patients and 30 healthy control subjects were included in the study. All participants have completed the Hospital Anxiety and Depression Scale (HADS), Glombok-Rust Inventory of Satisfaction Scale (GRISS), and the premature ejaculation diagnostic tool (PEDT). The mean age of patients was 30.4 years and the mean body mass index was 27.3 kg m(-2). Sexual intercourse was the most common cause of the fracture. Immediate surgical repair was performed in all cases using a circumferential subcoronal incision and none of the patients had urethral injury intraoperatively. All tears were unilateral with a mean size of 1.5 cm. Only two patients had superficial dorsal vein rupture. At the day of assessment, the mean time elapsed after penile trauma was 15.9±6.3 months (range: 6-23). Only three patients had complications due to penile fracture including minimal penile curvature, penile nodule, and penile pain during intercourse. The mean scores obtained from PEDT, HADS, and GRISS did not show any statistically significant difference between groups. Anxiety, depression, premature ejaculation, and sexual dyssatisfaction levels were similar in both penile fracture patients who underwent immediate surgical repair and healthy control subjects. Immediate surgical repair of corporal ruptures have not shown any harmful psychogenic sequelae on patients with penile fracture.

The Application of Kidney Injury Molecule-1 to Determine the Duration Between Shockwave Lithotripsy Sessions

PURPOSE

We aimed to evaluate the role of kidney injury molecule-1 (KIM-1) in determining the intervals between shockwave lithotripsy (SWL) sessions.

PATIENTS AND METHODS

This was a prospective, controlled study. It included 40 patients with unilateral kidney stones and 40 healthy persons of a similar age group as controls. The patients' midflow urine samples were collected before SWL and 1 hour, 1 day, 1 week, and 1 month after the procedure.

RESULTS

The average age in the SWL and control groups was 45 ± 14 and 39 ± 15 years, respectively (P = 0.336). The average KIM-1 value before SWL was 0.74 ± 0.35 ng/mL, which was significantly higher than that of the control group (0.51 ± 0.14 ng/mL) (P < 0.001). Similarly, the average values of the urine samples after SWL were higher than those of the control group (P < 0.001). When the KIM-1 values of the patients given SWL were compared within the group, the KIM-1 values 1 hour (1.06 ± 0.51) and 1 day (0.99 ± 0.67) after the procedure were statistically clearly higher than those before the procedure (P < 0.001) and statistically clearly higher than those of the control group (P = 0.005). The KIM-1 values 1 week and 1 month after the procedure were not significantly different than the preprocedure values (P = 0.652 and P = 0.747, respectively).

CONCLUSION

KIM-1 is a noninvasive biomarker that may be used to show renal damage because of stones and early-stage renal damage linked to SWL. In addition, post-SWL KIM-1 values may be used to determine the interval between SWL sessions.

Endoscopic treatment of vesicoureteral reflux in children with posterior urethral valves

PURPOSE

We reviewed the clinical outcome of endoscopic injection therapy in children with vesicoureteral reflux persisting after posterior urethral valve ablation.

METHODS

We retrospectively reviewed the charts of 16 patients with posterior urethral valves who have undergone endoscopic injection to correct persistent reflux after successful relief of urethral obstruction. Breakthrough urinary tract infections, persistent high-grade reflux and failed ureteroneocystostomy were the indications of endoscopic antireflux surgery.

RESULTS

Reflux was grade I in 1, grade II in 3, grade III in 11 and grade IV in 4 ureters. Mean age at injection was 6.9 ± 3.8 years and the mean interval from initial intervention to injection was 4.3 ± 2.4 years. Injected material was dextranomer/hyaluronic acid in the majority (87.5 %) of cases. Reflux was resolved or downgraded in 12 ureters (63.1 %) after a single injection. All failed cases had urodynamically documented bladder dysfunction.

CONCLUSION

More than half of the patients with vesicoureteral reflux, persisting after initial valve ablation, showed complete resolution or significant downgrading in their reflux grade after endoscopic injection. Given the technical difficulties and potential complications of open surgical reimplantation in valve patients, endoscopic subureteral injection can be considered as an effective alternative to cure persistent vesicoureteral reflux.

Effect of Voided Volume on Voiding Patterns and Reliability of Uroflowmetry-Electromyography Results in Children with Lower Urinary Tract Dysfunction

OBJECTIVE

To examine whether voided volume (VV) could change the uroflow patterns and result in children with lower urinary tract dysfunction (LUTD).

METHODS

Between January 2009 and May 2010, the children with LUTD were enrolled in this study. Uroflowmetry (UF) combined with electromyography (EMG) was performed two times and was reviewed independently by two urologists. UF-EMG curves were classified as bell, staccato, intermittent, plateau, and tower. Patients' expected bladder capacity (EBC) and VV were recorded. Patients were divided into four groups according to their VV and EBC. Group 1, VV <50% of EBC; group 2, VV between 50 and 100% of EBC; group 3, VV between 100 and 125% of EBC; group 4, VV >125% of EBC.

RESULTS

A total of 143 patients underwent UF-EMG at least two times and 382 results were obtained. Groups 1, 2, 3 and 4 consisted of 27, 60, 27 and 29 children, respectively. The percentages of normal, intermittent, plateau voiding patterns were 58.5, 12.8, 7.1% in group 1; 79.8, 5.4, 1.8% in group 2; 59.2, 8.5, 2.8% in group 3; and 37.2, 5.1, 2.6% in group 4, respectively. The percentages of staccato and tower pattern were 1.4, 20% in group 1; 9.1, 3.6% in group 2; 30, 0% in group 3; and 55.1, 0% in group 4, respectively. The rate of tower shape curve decreased as voided volume increased, but the rate of staccato curve increased as voided volume increased.

CONCLUSIONS

In case of exceeding the EBC, the test should be repeated with normal VV when UF results are being evaluated.

"We the BE": An educational mobile health application for children and families affected by bladder exstrophy-epispadias-cloacal exstrophy complex

GOALS

Despite the proliferation of over 45 000 smartphone mobile health applications (MHAs), as far as we know, there is no MHA for those living with rare diseases such as Bladder Exstrophy-Epispadias-Cloacal Exstrophy complex (BEEC). We hypothesized that an MHA could provide similar "on-demand" information and connectivity within health communities for patients with BEEC as they do for more common diseases. Thus, our primary goal was to create an MHA for patients and families affected by BEEC to provide them with important information about the condition and a format for them to connect with other affected patients and families. A secondary goal was to develop an adaptable MHA template for other rare diseases in the future.

METHODS

We began our app development by examining existing common-disease MHAs for thematic structure. We conducted an extensive literature search of PubMed and Google scholar for MHA development and existing MHAs related to BEEC, utilizing these search terms: mobile health applications, rare diseases, bladder exstrophy, and online health communities. Our app development team began with our clinical multidisciplinary team of pediatric urologists; a child psychiatrist; a patient/family mental health therapist; and a certified nurse practitioner. We hired a website engineer and a production team. All clinical members have extensive experience caring for children and families affected by BEEC. Additionally, clinical team members compiled lists of themes deemed relevant from these reviews and themes gleaned from their clinical experience that appear with some frequency or urgency and from the myriad of themes discussed within the literature for MHAs.

RESULTS

We found no existing rare disease MHAs in the literature or our search of app stores online. However, we derived basic app categories from existing MHA formats and the thematic content of all sources reviewed. These categories aligned with the groupings of our lists of clinical themes. Thus, we could subsume diverse themes within a broad categorical format: for example, child development (as "Psychological Development" in the app) or various clinical care options (as "Treatment"). This app structure became nine sections, as shown in. This format allows diverse information to be retrieved efficiently from broader categories. This app is being offered to affected families, healthcare providers, and individuals unrelated to where care is offered.

CONCLUSION

"We the BE" is the first MHA developed for a rare disease, BEEC. It has been published in a downloadable format for the general public at no cost. Further research is required to determine its efficacy for the BEEC community members; preliminary, unsolicited feedback from multiple users has been positive.