1
|
Hagen JC, James LT, Jensen H, Zamilpa I, Ashton DJ, James CA. Percutaneous Left Colostomy for Fecal Incontinence. J Vasc Interv Radiol 2022; 33:1012-1014. [DOI: 10.1016/j.jvir.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/22/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022] Open
|
2
|
Wyatt RA, James ST, Canon SJ, Patel AS, Zamilpa I. Hydronephrosis and Hydroureter Improvement Rates in Robotic-Assisted Laparoscopic Uretero-Ureterostomies: Does Anastomotic Site Matter? Urology 2021; 158:180-183. [PMID: 34186130 DOI: 10.1016/j.urology.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/08/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare improvement/change of hydronephrosis and hydroureter in patients with complete ureteral duplications that underwent upper and lower robotic-assisted laparoscopic uretero-ureterostomies. The hypothesis being that improvement of hydronephrosis and hydroureter between the two groups was similar. METHODS 35 subjects met inclusion criteria and were reviewed retrospectively. 'Upper' anastomoses were defined as those being done below the lower pole of the kidney (Group 1), while 'lower' anastomoses were those done below the iliac vessels (Group 2). Primary variables analyzed were antero-posterior and diameter measurements of the renal pelvis and ureter, respectively, before and after surgery. Secondary variables included operative time, length of hospital stay, and complication rates. RESULTS Group 1 consisted of 20 subjects while Group 2 consisted of 15 subjects. Presenting diagnoses were hydronephrosis in 31 subjects and incontinence in 4 subjects. Group 1 mean AP renal diameters decreased by 62.9% (P<.05), while Group 2 decreased by 65.4% (P<.05). Group 1 mean hydroureter diameter measurements decreased by 80.3% (P<.05), while Group 2 decreased by 83% (P<.05). The improvement in hydronephrosis and hydroureter between the two groups was not statistically different. Group 1 median operative time (271 minutes) was longer than Group 2 (201 minutes) (P<.05). There was no significant difference in hospital stay between the groups and there were no significant complications within the cohort. CONCLUSION The improvement rate of hydronephrosis and hydroureter is similar in upper versus lower RAL UU. Operative time was significantly shorter in the lower anastomosis group.
Collapse
Affiliation(s)
- Richard A Wyatt
- The University of Arkansas for Medical Sciences, Little Rock, AR
| | - Sammie T James
- The University of Arkansas for Medical Sciences, Little Rock, AR
| | | | | | | |
Collapse
|
3
|
Canon SJ, Smith JC, Sullivan E, Patel A, Zamilpa I. Comparative analysis of perioperative prophylactic antibiotics in prevention of surgical site infections in stented, distal hypospadias repair. J Pediatr Urol 2021; 17:256.e1-256.e5. [PMID: 33349560 DOI: 10.1016/j.jpurol.2020.11.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/06/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE There is limited evidence that prophylactic antibiotics prevent surgical site infection in stented, distal hypospadias repair. Our hypothesis is that the use of prophylactic antibiotics does not affect the rate of surgical site infection in this setting. METHODS We conducted a retrospective study of consecutive patients over a 6-year period with distal penile hypospadias treated with urethral stenting. Variables analyzed include age, type of repair, usage of preoperative and/or postoperative antibiotics, and length of follow-up. Patients with a history of proximal or re-operative hypospadias repair were excluded. Surgical site infection was defined by the presence of postoperative penile erythema and/or purulent drainage treated with therapeutic antibiotics. Secondary outcome analysis included the presence of other hypospadias complications. RESULTS 441 consecutive subjects met our inclusion criteria with a mean age of 13.3 months. Patients were categorized into groups: Group 1 - Preoperative antibiotics (n = 64), Group 2 - Both Preoperative & Postoperative antibiotics (n = 159), Group 3 - Postoperative antibiotics (n = 122), Group 4 - No Preoperative or Postoperative antibiotics (n = 96). Two surgical site infections were reported out of the 441 patients: 1 in Group 3 and 1 in Group 4 (p = 0.513). There was no significant difference in the total patients with a hypospadias complication between groups. In the table below, Groups 1-3 were combined (345 patients) for comparison to Group 4 (No antibiotics, 96 patients) for further analysis with no difference in SSIs (p = 0.388) or respective hypospadias complications. CONCLUSIONS The use of perioperative prophylactic antibiotics, both before and after surgery for distal, stented hypospadias repair, have not been shown to reduce the rate of surgical site infections nor hypospadias complications. Consequently, the benefit of prophylactic antibiotics in this setting is unclear.
Collapse
Affiliation(s)
- Stephen J Canon
- Arkansas Children's Hospital, 1 Children's Way Slot 840, Little Rock, AR, 72202, USA.
| | - Jacob C Smith
- Baylor Scott and White-Temple, 2401 S. 31st St, Temple, TX, 76508, USA.
| | - Elizabeth Sullivan
- University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, USA.
| | - Ashay Patel
- Arkansas Children's Hospital, 1 Children's Way Slot 840, Little Rock, AR, 72202, USA.
| | - Ismael Zamilpa
- Arkansas Children's Hospital, 1 Children's Way Slot 840, Little Rock, AR, 72202, USA.
| |
Collapse
|
4
|
Abstract
Introduction: Telemedicine allows health care professionals to diagnose and treat patients remotely. Enuresis is one of the most common chronic problems in childhood and specialized care can be limited. Utilization of telemedicine in this setting has not been previously analyzed. Materials and Methods: This study's aim is to evaluate the feasibility and effectiveness of telemedicine follow-up treatment of enuresis compared with traditional follow-up at our institution. A retrospective review of patients treated for nocturnal enuresis with either telemedicine (Group 1) or traditional (Group2) follow-up care was conducted. Patients, aged 5-18 years, treated for enuresis between July 2016 and December 2017 were included. Patients with confounding disease were excluded. Resolution of enuresis was the primary outcome as categorized by the International Children's Continence Society standards. Results: Seventy-seven (n = 77) patients met inclusion criteria with 23 patients in Group 1 and 54 patients in Group 2. Two patients in each group were lost to follow-up and 61.9% in Group 1 and 48.1% in Group 2 responded to treatment. The average age for both groups was 9.2 years. Patients in Group 1 averaged four appointments per patient and patients in Group 2 averaged 3.04 appointments per patient. Telemedicine follow-up patients missed fewer appointments (0.14) than patients with traditional follow-up (0.5) (p-value = 0.016). Thirteen of 21 patients (61.9%) responded to treatment in Group 1 (7 partial and 6 complete responders) as compared with 25 of 52 patients (48.1%) responding to treatment in Group 2 (8 partial and 17 complete responders) (p = 0.22). Of patients in Group 1, 87% reported they would use telemedicine again. Conclusions: Telemedicine follow-up of patients with enuresis demonstrated comparable effectiveness. Most patient families demonstrate a favorable opinion of using telemedicine again for this problem. Further research to understand the efficacy and benefits of telemedicine in this setting is needed.
Collapse
Affiliation(s)
- Elias Smith
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Joseph Cline
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ashay Patel
- Urology, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Ismael Zamilpa
- Urology, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Stephen Canon
- Urology, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| |
Collapse
|
5
|
Richard MA, Sok P, Canon S, Brown AL, Peckham-Gregory EC, Nembhard WN, Carmichael SL, Ehli EA, Kallsen NA, Peyton SA, Davies GE, Patel A, Zamilpa I, Wyatt RA, Hobbs CA, Scheurer ME, Lupo PJ. The role of genetic variation in DGKK on moderate and severe hypospadias. Birth Defects Res 2019; 111:932-937. [PMID: 31102501 DOI: 10.1002/bdr2.1522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/08/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Recent genome-wide association studies of hypospadias have implicated the role of genetic variants in or near the diacylglycerol kinase kappa (DGKK) gene. However, these variants are largely identified among samples of mild and moderate hypospadias cases. Therefore, we evaluated previously identified DGKK variants among second- and third-degree hypospadias cases and controls recruited in Arkansas, a state characterized by a high birth prevalence of hypospadias. METHODS Second- and third-degree hypospadias non-Hispanic white cases (n = 36 and n = 9, respectively) and controls (n = 45) were recruited at Arkansas Children's Hospital. Preputial tissue was collected on cases and controls between 2013 and 2017. Cases and controls were genotyped using the Illumina Infinium Global Screening Array. We used logistic regression models to assess the association of genotyped and imputed genetic variants mapped to the DGKK region with second- and third-degree hypospadias. RESULTS All families self-reported as non-Hispanic white and genetic principal component analyses did not demonstrate evidence of population stratification. Five DGKK variants previously reported as associated with hypospadias were identified in the genotype data. None of the variants were associated with second- or third-degree hypospadias (range of odds ratios = 0.7-0.9, all p > .05). CONCLUSIONS In our analyses, genetic variation in DGKK does not play a role in the development of moderate and severe hypospadias. Our findings provide support to the etiologic heterogeneity of hypospadias by all classifications of severity.
Collapse
Affiliation(s)
- Melissa A Richard
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Pagna Sok
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Stephen Canon
- Arkansas Children's Hospital, Little Rock, Arkansas.,Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Austin L Brown
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Wendy N Nembhard
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, Arkansas
| | - Suzan L Carmichael
- Department of Pediatrics, Stanford University School of Medicine, California
| | - Erik A Ehli
- Avera Institute for Human Genetics, Sioux Falls, South Dakota
| | - Noah A Kallsen
- Avera Institute for Human Genetics, Sioux Falls, South Dakota
| | - Shanna A Peyton
- Avera Institute for Human Genetics, Sioux Falls, South Dakota
| | - Gareth E Davies
- Avera Institute for Human Genetics, Sioux Falls, South Dakota
| | - Ashay Patel
- Arkansas Children's Hospital, Little Rock, Arkansas.,Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ismael Zamilpa
- Arkansas Children's Hospital, Little Rock, Arkansas.,Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Richard A Wyatt
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Charlotte A Hobbs
- Division of Birth Defects Research, Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Arkansas Children's Research Institute, Little Rock, Arkansas
| | | | - Philip J Lupo
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
6
|
Brockway WJ, Bradsher AJ, Hook JE, Patel AS, Zamilpa I, Canon SJ. 2-octyl cyanoacrylate hypospadias repair dressing: a retrospective, controlled comparison. Can J Urol 2019; 26:9675-9679. [PMID: 30797251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION 2-octyl cyanoacrylate (OC) has been shown to be a viable option for usage following standard circumcision but data on its utilization following hypospadias repair is limited. Both OC and a standard waterproof transparent dressing (WD) are used following hypospadias repair at our children's hospital. Our hypothesis is that patients with distal hypospadias repair using OC for surgical dressing have similar outcomes as compared to patients with WD. MATERIALS AND METHODS A retrospective study was performed evaluating all patients with distal hypospadias repair during a 2 year period. OC was primarily used by one of the three physicians in the practice with the other two primarily used WD for surgical dressing. The primary endpoints evaluated include hematoma requiring surgical drainage, infection, meatal stenosis, urethrocutaneous fistula, dehiscence, and diverticulum. Standard follow up after hypospadias repair includes a 1 week follow up for patients requiring urethral stent removal and reevaluation for all patients 3-4 months after surgery. REDCap was used in order to compile the database used in this study. RESULTS A total of 280 patients underwent distal hypospadias repair during this interval. One hundred twenty-two patients had OC used with 3 (2.4%) having complications: 2 fistulas and 1 with both meatal stenosis and fistula. One hundred fifty-eight patients were dressed with WD with 5 (3.2%) complications: 4 fistulas and 1 meatal stenosis. No patients had hematoma, wound dehiscence, diverticulum, or infection. CONCLUSION A low rate of complication was observed following distal hypospadias repair using both 2-octyl cyanoacrylate and a standard waterproof transparent dressing. 2-octyl cyanoacrylate is a safe option for surgical dressing following distal hypospadias repair but its utilization in this setting is surgeon dependent.
Collapse
Affiliation(s)
- W Jordan Brockway
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | | | | | | | | |
Collapse
|
7
|
Canon S, Marquette MK, Crane A, Patel A, Zamilpa I, Bai S. Prophylactic Antibiotics After Stented, Distal Hypospadias Repair: Randomized Pilot Study. Glob Pediatr Health 2018; 5:2333794X18770074. [PMID: 29761139 PMCID: PMC5946338 DOI: 10.1177/2333794x18770074] [Citation(s) in RCA: 2] [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: 12/06/2017] [Accepted: 03/03/2018] [Indexed: 11/15/2022] Open
Abstract
The usage of prophylactic oral antibiotics following distal hypospadias repair with stenting has been recently challenged. This study evaluated the incidence of symptomatic urinary tract infections (UTIs) following stented, distal hypospadias repair and the impact of prophylactic antibiotic therapy. Subjects 0 to 5 years of age with distal hypospadias were randomized to either Group 1 (antibiotics) or Group 2 (no prophylactic therapy). Urinalysis/urine culture was obtained intraoperatively with no preoperative antibiotics given. Phone interviews at 1 month and 3 months after surgery were done. Forty-eight patients were successfully randomized to either Group 1 (24) or Group 2 (24). The incidence of symptomatic UTI in this pilot study is low, and prophylactic antibiotic therapy does not appear to lower the incidence of symptomatic UTI. A larger, randomized, multicenter trial is needed to determine whether antibiotic prophylaxis reduces the risk of symptomatic UTIs following stented, distal hypospadias repair.
Collapse
Affiliation(s)
- Stephen Canon
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Arkansas Children's Hospital, Little Rock, AR, USA
| | - Mary K Marquette
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Adam Crane
- Arkansas Children's Hospital, Little Rock, AR, USA
| | - Ashay Patel
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Arkansas Children's Hospital, Little Rock, AR, USA
| | - Ismael Zamilpa
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Arkansas Children's Hospital, Little Rock, AR, USA
| | - Shasha Bai
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
8
|
Smith J, Patel A, Zamilpa I, Bai S, Alliston J, Canon S. Analysis of preoperative antibiotic prophylaxis in stented, distal hypospadias repair. Can J Urol 2017; 24:8765-8769. [PMID: 28436366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Surgical site infection [SSI] is a risk for any surgical procedure, including hypospadias repair. Prophylactic antibiotic therapy for patients having surgery is often effective in preventing SSIs, but with increasing rates of antibiotic resistance, this practice has been questioned. The objectives of this study are 1) to assess the incidence of SSIs in patients following stented, distal hypospadias repair and 2) to observe for any potential difference in the incidence of SSIs for patients with and without preoperative antibiotic utilization in this setting. MATERIALS AND METHODS We retrospectively reviewed consecutive patients treated with stented, distal hypospadias repair from 2011 to 2014 by three surgeons and compared two groups: patients who received preoperative antibiotics and patients who did not. Patients with a history of previous hypospadias repair were excluded from the study. RESULTS Two hundred twenty-four subjects were identified. Group 1 (135) received preoperative antibiotic and Group 2 (89) did not receive preoperative antibiotics. There was no statistically significant difference in SSI prevalence with 0 patients in Group 1 and 1 patient in Group 2 having a SSI. CONCLUSION Although prophylactic antibiotics prior to hypospadias repair are most often used by pediatric urologists, this study demonstrates further evidence that antibiotics prior to this procedure do not appear to lower the rate of SSI. This study is limited by its retrospective nature and disparate mean follow up in the two cohorts. Surgical site infection does not appear to be decreased by prophylactic antibiotic therapy before distal hypospadias repair.
Collapse
Affiliation(s)
- Jacob Smith
- Pediatric Urology Division, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | | | | | | | | | | |
Collapse
|
9
|
Canon S, Zamilpa I, Patel A, Marquette M. MP32-02 TELEMEDICINE UTILIZATION IN PEDIATRIC UROLOGY AND BEYOND. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
10
|
Zamilpa I, Patel A, Booth J, Canon S. To Finish the Cut or Not. Clin Pediatr (Phila) 2017; 56:157-161. [PMID: 27162177 DOI: 10.1177/0009922816648287] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We retrospectively evaluated the management of patients with unrecognized glanular hypospadias and a completed (group 1) or aborted (group 2) neonatal circumcision. The rate and type of subsequent surgeries performed were analyzed. Penile curvature, urinary stream deviation, and their impact on management were evaluated. Surgery was done in 55% of patients-40% of group 1 and 86% of group 2. Completion of the circumcision was done in 63% of group 2. Hypospadias repair was performed in 56% of group 1 and in 34% of group 2. Penile curvature rate did not affect the rate or type of surgery performed. Urinary stream deviation did not affect the rate of repair, but was a significant factor leading to hypospadias repair. We concluded that providers performing neonatal circumcisions do not have to abort the procedure when a glanular hypospadias is noticed. Most patients will require circumcision completion only.
Collapse
Affiliation(s)
| | - Ashay Patel
- 1 Arkansas Children's Hospital, Little Rock, AR, USA
| | - Joshua Booth
- 2 Arkansas Children's Hospital, Fayetteville, AR, USA
| | - Stephen Canon
- 3 University of Arkansas for Medical Sciences, Little Rock, AR, USA
| |
Collapse
|
11
|
Patel A, Pickhardt MW, Littlejohn N, Zamilpa I, Rettiganti M, Luo C, Canon S. Shortened operative time for pediatric robotic versus laparoscopic dismembered pyeloplasty. Can J Urol 2016; 23:8308-8311. [PMID: 27347627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Robotic-assisted laparoscopic pyeloplasty (RALP) is increasingly becoming the standard procedure for management of ureteropelvic junction obstruction (UPJO) in the pediatric population, but few studies have shown a clear advantage over the more technically demanding laparoscopic pyeloplasty (LP) in children. The objective was to study the patients treated with RALP or LP at our institution and the associated outcomes for each minimally invasive approach for the correction of UPJO. MATERIALS AND METHODS Our laparoscopic and robotic database was queried to identify all patients with a history of primary robotic-assisted or laparoscopic dismembered pyeloplasty for the correction of UPJO performed at our institution from January 2010 through November 2013 and were retrospectively reviewed. We analyzed age, surgical time, blood loss, hospital stay length, postoperative complications, and success rate. RESULTS Seventy-three total patients were identified as having RALP or LP during this time period with five patients excluded from the analysis. We identified 55 patients with RALP and 13 patients with LP. No differences in success rate or postoperative complications were found for the two cohorts. The length of procedure was significantly shorter for the RALP group compared to the LP group.
Collapse
Affiliation(s)
- Ashay Patel
- Division of Pediatric Urology, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | | | | | | | | | | | | |
Collapse
|
12
|
Abstract
In Arkansas, telemedicine is used commonly in obstetrics through Antenatal and Neonatal Guidelines, Education and Learning System (ANGELS), the existing statewide telemedicine network. This network is used primarily for tele-ultrasound and maternal-fetal medicine consultation. This study is a retrospective case series, describing all the patients who had a prenatally diagnosed urologic anomaly that required prenatal urologic consultation. From 2009-2013, approximately 1300 anomalies were recorded in the Arkansas Fetal Diagnosis and Management (AFDM) database, 14% of which were urologic anomalies. Twenty-six cases required prenatal urologic consultation, 25 of which were conducted via telemedicine. Teleconsultation allowed patients to combine maternal-fetal medicine and urologic consultations in one visit, saving time and effort and ultimately, for most patients, providing reassurance that delivery could be accomplished locally with postnatal follow-up already arranged. While there are several studies reporting the use of telemedicine for various subspecialty consultations, to our knowledge, this is the first to describe the use of telemedicine for prenatal urology consultation. Future research could randomize patients prospectively to allow comparison of both the outcomes as well as the patient experience.
Collapse
Affiliation(s)
- Nader Z Rabie
- Department of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, USA
| | - Stephen Canon
- Department of Pediatric Urology, University of Arkansas for the Medical Sciences, USA
| | - Ashay Patel
- Department of Pediatric Urology, University of Arkansas for the Medical Sciences, USA
| | - Ismael Zamilpa
- Department of Pediatric Urology, University of Arkansas for the Medical Sciences, USA
| | - Everett F Magann
- Department of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, USA
| | | |
Collapse
|
13
|
Lapicz L, Canon S, Patel A, Zamilpa I. PD24-07 DOES A POSITIVE URINE DIPSTICK OR URINE CULTURE AT THE TIME OF URODYNAMIC EVALUATION PREDICT POST-PROCEDURAL FEBRILE URINARY TRACT INFECTION? J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
14
|
Canon S, Shera A, Patel A, Zamilpa I, Paddack J, Fisher PL, Smith J, Hurtt R. A pilot study of telemedicine for post-operative urological care in children. J Telemed Telecare 2014; 20:427-30. [PMID: 25316038 DOI: 10.1177/1357633x14555610] [Citation(s) in RCA: 65] [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: 01/18/2023]
Abstract
We conducted a retrospective study of paediatric urological surgery patients over a 12-month period. We compared patients followed up by telemedicine with those who had post-operative follow-up on site at the Arkansas Children's Hospital (ACH) in Little Rock. All pre-operative patients living in northwest Arkansas were given the opportunity to use telemedicine from a satellite clinic at Lowell, 328 km from the hospital. Of 61 patients, 10 chose telemedicine and 51 chose to be evaluated at the ACH clinic. All telemedicine visits were completed successfully, but in four cases, the video clarity of the telemedicine images was not sufficient for decision-making, and a digital photograph was sent by email to the physician at the ACH. There were no post-operative surgical complications in either patient group. In the telemedicine group, the median distance to the ACH was 330 km, and the median distance to the remote clinic was 35 km. In the on-site group, the median distance to the ACH was 293 km, which was significantly less (P=0.03). In the on-site group, the median travel time to the ACH was 174 min. If the telemedicine group had driven to the hospital, the median travel time would have been 192 min. Logistic regression showed that for every 37 km increase in distance to ACH, patients had a 111% increase in the odds of receiving telemedicine compared to receiving on-site care (OR=2.1, 95% CI: 1.0, 4.4). The pilot study supports the use of telemedicine for the post-operative evaluation of paediatric urology surgery patients and suggests that substantial travel distance and time savings can be made.
Collapse
Affiliation(s)
- Stephen Canon
- Pediatric Urology Division, Arkansas Children's Hospital, Little Rock, Arkansas, USA University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Annashia Shera
- Pediatric Urology Division, Arkansas Children's Hospital, Little Rock, Arkansas, USA University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ashay Patel
- Pediatric Urology Division, Arkansas Children's Hospital, Little Rock, Arkansas, USA University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ismael Zamilpa
- Pediatric Urology Division, Arkansas Children's Hospital, Little Rock, Arkansas, USA University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - John Paddack
- Pediatric Urology Division, Arkansas Children's Hospital, Little Rock, Arkansas, USA University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Paige L Fisher
- Arkansas Children's Hospital Research Institute, Little Rock, Arkansas, USA Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Jacob Smith
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Robbie Hurtt
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA Division of Urology, Department of Surgery, University of Mississippi Medical Center, USA
| |
Collapse
|
15
|
Shnorhavorian M, Song K, Zamilpa I, Wiater B, Mitchell MM, Grady RW. Spica casting compared to Bryant's traction after complete primary repair of exstrophy: safe and effective in a longitudinal cohort study. J Urol 2010; 184:669-73. [PMID: 20639033 DOI: 10.1016/j.juro.2010.03.057] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Indexed: 11/16/2022]
Abstract
PURPOSE Bryant's traction is the most commonly used method for immobilization after bladder exstrophy repair. We hypothesized that spica casting is a safe and effective alternative to Bryant's traction after complete primary repair of exstrophy. MATERIALS AND METHODS Complete primary repair of exstrophy was performed for initial repair in 39 consecutive children by all surgeons at Seattle Children's Hospital since 1998. Three sequential cohorts were evaluated-Bryant's traction without osteotomy (13 patients), spica casting without osteotomy (14) and spica casting with osteotomy. These 3 sequential cohorts represent eras of care and an evolution of practice. Primary outcomes included major complications related to immobilization, dehiscence, urinary incontinence and length of stay. We defined complications of immobilization as nonunion of pelvic osteotomy, femoral nerve palsy, revision of spica cast requiring return to the operating room, infection at the osteotomy site and activity limiting pain at the osteotomy site. Fisher's exact test or t test was used to determine statistical significance. RESULTS There was no difference in urinary continence (p = 0.09). Use of Bryant's traction was associated with double the length of stay (p >0.001). There was no correlation of major complications to the type of immobilization used. CONCLUSIONS Spica casting compared to Bryant's traction is associated with shorter hospitalization following complete primary repair of exstrophy and does not have a significant difference in the rate of complications. In our longitudinal cohort study with long-term followup spica cast was safe and effective for patients with bladder exstrophy, and should be considered an acceptable method of immobilization.
Collapse
Affiliation(s)
- Margarett Shnorhavorian
- Department of Urology, University of Washington and Division of Pediatric Urology, Seattle Children's Hospital, Seattle, Washington 98105, USA.
| | | | | | | | | | | |
Collapse
|
16
|
Sorensen MD, Koyle MA, Cowan CA, Zamilpa I, Shnorhavorian M, Lendvay TS. Injection volumes of dextranomer/hyaluronic acid are increasing in the endoscopic management of vesicoureteral reflux. Pediatr Surg Int 2010; 26:509-13. [PMID: 20140734 DOI: 10.1007/s00383-010-2558-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE Dextranomer/hyaluronic acid (Deflux) has been increasingly used for the treatment of vesicoureteral reflux (VUR). Experience has shown that injecting more volume of material is necessary to achieve greater success. We evaluate trends in the number of vials being used to treat VUR using a multi-institutional database and data from patients treated at our own institution. METHODS Children of age 0-19 years in the Pediatric Health Information System (PHIS) database from 2003 to 2008 were extracted with a VUR diagnosis (ICD-9 593.7x) and subureteric injection procedure code (CPT 52327). We identified children with reflux treated with endoscopic injection at Seattle Children's Hospital from 2005 to 2008. Hospital trends of the number of vials used were evaluated using multivariate linear regression. RESULTS From 2003 to 2008, we identified 4,078 endoscopic injection procedures in PHIS. There was a 33% increase in the average number of vials used per patient (p < 0.0001) with more than a threefold increase in the number of patients receiving three or more vials per procedure. All institutions increased the average vials used per patient with the most pronounced increase at the highest-volume centers. These trends were also present in the 186 children treated at our own institution. CONCLUSION Over the study period there was an increase in the number of vials of dextranomer/hyaluronic acid being used per patient to treat children with VUR. This practice may improve success rates but will increase the cost of treatment due to the inherent expense of the material.
Collapse
Affiliation(s)
- Mathew D Sorensen
- Department of Urology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356510, Seattle, WA 98195, USA.
| | | | | | | | | | | |
Collapse
|
17
|
Shnorhavorian M, Zamilpa I, Song K, Mitchell ME, Grady R. SPICA CASTING COMPARED TO BRYANT'S TRACTION AFTER COMPLETE PRIMARY REPAIR OF EXSTROPHY (CPRE): SAFE AND COST-EFFECTIVE IN LONGITUDINAL COHORT STUDY. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
18
|
Zamilpa I, Koyle MA. The role of the Malone antegrade continence enema (MACE) in the management of myelodeysplatic patients. J Pediatr Rehabil Med 2009; 2:61-6. [PMID: 21791795 DOI: 10.3233/prm-2009-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Myelodysplasia is a congenital neural tube defect commonly affecting bladder and bowel function. Management of fecal incontinence is paramount to achieve patient independence and self-confidence. When conservative measures fail alternative invasive methods can be successfully applied. The Malone antegrade continence enema (MACE) was introduced in the late 1980's to treat spina bifida patients with fecal incontinence refractory to conservative management. Since its introduction, multiple successful variations have been described and its role has expanded. Indeed, the MACE has revolutionized the care of myelodysplastic patients, their bowel function, and ultimately their self image.
Collapse
|
19
|
Abstract
Bullous pemphigoid is an acquired autoimmune bullous condition that is uncommon in childhood. Genital involvement is extremely rare. We present a case of a 7-year-old boy with bullous lesions confined to the glans penis. Precise diagnosis is based on clinical presentation and specific histopathologic testing. Oral corticosteroid therapy is the treatment of choice.
Collapse
Affiliation(s)
- Moben Mirza
- Division of Urology, Department of Surgery, University of New Mexico, MSC 105610, 1 University of New Mexico, Albuquerque, NM 87131, USA
| | | | | |
Collapse
|
20
|
Mirza M, Zamilpa I, Bunning J. Primary Renal Synovial Sarcoma. Urology 2008; 72:716.e11-2. [DOI: 10.1016/j.urology.2007.12.051] [Citation(s) in RCA: 15] [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] [Received: 10/03/2007] [Revised: 12/09/2007] [Accepted: 12/12/2007] [Indexed: 11/16/2022]
|