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Lucas-Herald AK, Montezano AC, Alves-Lopes R, Haddow L, O’Toole S, Flett M, Lee B, Amjad SB, Steven M, McNeilly J, Brooksbank K, Touyz RM, Ahmed SF. Effects of Sex Hormones on Vascular Reactivity in Boys With Hypospadias. J Clin Endocrinol Metab 2024; 109:e735-e744. [PMID: 37672642 PMCID: PMC10795938 DOI: 10.1210/clinem/dgad525] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Arteries from boys with hypospadias demonstrate hypercontractility and impaired vasorelaxation. The role of sex hormones in these responses in unclear. AIMS We compared effects of sex steroids on vascular reactivity in healthy boys and boys with hypospadias. METHODS Excess foreskin tissue was obtained from 11 boys undergoing hypospadias repair (cases) and 12 undergoing routine circumcision (controls) (median age [range], 1.5 [1.2-2.7] years) and small resistance arteries were isolated. Vessels were mounted on wire myographs and vascular reactivity was assessed in the absence/presence of 17β-estradiol, dihydrotestosterone (DHT), and testosterone. RESULTS In controls, testosterone and 17β-estradiol increased contraction (percent of maximum contraction [Emax]: 83.74 basal vs 125.4 after testosterone, P < .0002; and 83.74 vs 110.2 after estradiol, P = .02). 17β-estradiol reduced vasorelaxation in arteries from controls (Emax: 10.6 vs 15.6 to acetylcholine, P < .0001; and Emax: 14.6 vs 20.5 to sodium nitroprusside, P < .0001). In hypospadias, testosterone (Emax: 137.9 vs 107.2, P = .01) and 17β-estradiol (Emax: 156.9 vs 23.6, P < .0001) reduced contraction. Androgens, but not 17β-estradiol, increased endothelium-dependent and endothelium-independent vasorelaxation in cases (Emax: 77.3 vs 51.7 with testosterone, P = .02; and vs 48.2 with DHT to acetylcholine, P = .0001; Emax: 43.0 vs 39.5 with testosterone, P = .02; and 39.6 vs 37.5 with DHT to sodium nitroprusside, P = .04). CONCLUSION In healthy boys, testosterone and 17β-estradiol promote a vasoconstrictor phenotype, whereas in boys with hypospadias, these sex hormones reduce vasoconstriction, with androgens promoting vasorelaxation. Differences in baseline artery function may therefore be sex hormone-independent and the impact of early-life variations in androgen exposure on vascular function needs further study.
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Affiliation(s)
- Angela K Lucas-Herald
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Center for Research Excellence, University of Glasgow, 126 University Avenue, Glasgow G12 8TA, UK
- Developmental Endocrinology Research Group, School of Medicine, Dentistry and Nursing, University of Glasgow, Royal Hospital for Children, 1345 Govan Road, Glasgow G51 4TF, UK
| | - Augusto C Montezano
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Center for Research Excellence, University of Glasgow, 126 University Avenue, Glasgow G12 8TA, UK
- Research Institute of McGill University Health Center, McGill University, 1001 Boul Décarie, Montréal, QC H4A 3J1, Canada
| | - Rheure Alves-Lopes
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Center for Research Excellence, University of Glasgow, 126 University Avenue, Glasgow G12 8TA, UK
| | - Laura Haddow
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Center for Research Excellence, University of Glasgow, 126 University Avenue, Glasgow G12 8TA, UK
| | - Stuart O’Toole
- Department of Pediatric Surgery, Royal Hospital for Children, Royal Hospital for Children, 1345 Govan Road, Glasgow G51 4TF, Scotland, UK
| | - Martyn Flett
- Department of Pediatric Surgery, Royal Hospital for Children, Royal Hospital for Children, 1345 Govan Road, Glasgow G51 4TF, Scotland, UK
| | - Boma Lee
- Department of Pediatric Surgery, Royal Hospital for Children, Royal Hospital for Children, 1345 Govan Road, Glasgow G51 4TF, Scotland, UK
| | - S Basith Amjad
- Department of Pediatric Surgery, Royal Hospital for Children, Royal Hospital for Children, 1345 Govan Road, Glasgow G51 4TF, Scotland, UK
| | - Mairi Steven
- Department of Pediatric Surgery, Royal Hospital for Children, Royal Hospital for Children, 1345 Govan Road, Glasgow G51 4TF, Scotland, UK
| | - Jane McNeilly
- Developmental Endocrinology Research Group, School of Medicine, Dentistry and Nursing, University of Glasgow, Royal Hospital for Children, 1345 Govan Road, Glasgow G51 4TF, UK
- Department of Clinical Biochemistry, Queen Elizabeth University Hospital, Glasgow G51 4TF, Scotland, UK
| | - Katriona Brooksbank
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Center for Research Excellence, University of Glasgow, 126 University Avenue, Glasgow G12 8TA, UK
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Center for Research Excellence, University of Glasgow, 126 University Avenue, Glasgow G12 8TA, UK
- Research Institute of McGill University Health Center, McGill University, 1001 Boul Décarie, Montréal, QC H4A 3J1, Canada
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, School of Medicine, Dentistry and Nursing, University of Glasgow, Royal Hospital for Children, 1345 Govan Road, Glasgow G51 4TF, UK
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Lucas-Herald AK, Alkanhal KI, Caney E, Malik I, Alimussina M, McNeilly JD, Bradnock T, Lee B, Steven M, Flett M, O’Toole S, McGowan R, Faisal Ahmed S. Gonadal Function in Boys with Bilateral Undescended Testes. J Endocr Soc 2024; 8:bvad153. [PMID: 38205164 PMCID: PMC10777671 DOI: 10.1210/jendso/bvad153] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Indexed: 01/12/2024] Open
Abstract
Background Bilateral undescended testes (BUDT) may be a marker of an underlying condition that affects sex development or maturation. Aims To describe the extent of gonadal dysfunction in cases of BUDT who had systematic endocrine and genetic evaluation at a single tertiary pediatric center. Methods A retrospective review was conducted of all boys with BUDT who had endocrine evaluation between 2008 and 2021 at the Royal Hospital for Children, Glasgow (RHCG). Continuous variables were analyzed using Mann-Whitney U and non-continuous variables using Fisher's exact, via Graphpad Prism v 8.0. Multivariable logistic regression was used to identify any associations between groups. A P < .05 was considered statistically significant. Results A total of 243 bilateral orchidopexies were performed at RHCG between 2008 and 2021. Of these 130 (53%) boys were seen by the endocrine team. The median (range) age at first orchidopexy was 1 year (0.2, 18.0) with 16 (12%) requiring re-do orchidopexy. The median External Masculinization Score of the group was 10 (2, 11) with 33 (25%) having additional genital features. Of the 130 boys, 71 (55%) had extragenital anomalies. Of the 70 who were tested, a genetic abnormality was detected in 38 (54%), most commonly a chromosomal variant in 16 (40%). Of the 100 who were tested, endocrine dysfunction was identified in 38 (38%). Conclusion Genetic findings and evidence of gonadal dysfunction are common in boys who are investigated secondary to presentation with BUDT. Endocrine and genetic evaluation should be part of routine clinical management of all cases of BUDT.
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Affiliation(s)
- Angela K Lucas-Herald
- Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Khalid I Alkanhal
- Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, UK
- Obesity and Endocrine Metabolism Center, King Fahad Medical City, 58046 Riyady 11525, Saudi Arabia
| | - Emma Caney
- Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Iman Malik
- Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Malika Alimussina
- Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Jane D McNeilly
- Department of Clinical Biochemistry, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Timothy Bradnock
- Department of General Paediatric Surgery, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Boma Lee
- Department of Paediatric Urology, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Mairi Steven
- Department of Paediatric Urology, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Martyn Flett
- Department of Paediatric Urology, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Stuart O’Toole
- Department of Paediatric Urology, Royal Hospital for Children, Glasgow G51 4TF, UK
| | - Ruth McGowan
- Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, UK
- West of Scotland Centre for Genomic Medicine, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, University of Glasgow, Royal Hospital for Children, Glasgow G51 4TF, UK
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Lucas-Herald AK, Montezano AC, Alves-Lopes R, Haddow L, Alimussina M, O’Toole S, Flett M, Lee B, Amjad SB, Steven M, Brooksbank K, McCallum L, Delles C, Padmanabhan S, Ahmed SF, Touyz RM. Vascular dysfunction and increased cardiovascular risk in hypospadias. Eur Heart J 2022; 43:1832-1845. [PMID: 35567552 PMCID: PMC9113289 DOI: 10.1093/eurheartj/ehac112] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 12/30/2021] [Accepted: 02/15/2022] [Indexed: 11/30/2022] Open
Abstract
AIMS Hypogonadism is associated with cardiovascular disease. However, the cardiovascular impact of hypogonadism during development is unknown. Using hypospadias as a surrogate of hypogonadism, we investigated whether hypospadias is associated with vascular dysfunction and is a risk factor for cardiovascular disease. METHODS AND RESULTS Our human study spanned molecular mechanistic to epidemiological investigations. Clinical vascular phenotyping was performed in adolescents with hypospadias and controls. Small subcutaneous arteries from penile skin from boys undergoing hypospadias repair and controls were isolated and functional studies were assessed by myography. Vascular smooth muscle cells were used to assess: Rho kinase, reactive oxygen species (ROS), nitric oxide synthase/nitric oxide, and DNA damage. Systemic oxidative stress was assessed in plasma and urine. Hospital episode data compared men with a history of hypospadias vs. controls. In adolescents with hypospadias, systolic blood pressure (P = 0.005), pulse pressure (P = 0.03), and carotid intima-media thickness standard deviation scores (P = 0.01) were increased. Arteries from boys with hypospadias demonstrated increased U46619-induced vasoconstriction (P = 0.009) and reduced acetylcholine-induced endothelium-dependent (P < 0.0001) and sodium nitroprusside-induced endothelium-independent vasorelaxation (P < 0.0001). Men born with hypospadias were at increased risk of arrhythmia [odds ratio (OR) 2.8, 95% confidence interval (CI) 1.4-5.6, P = 0.003]; hypertension (OR 4.2, 95% CI 1.5-11.9, P = 0.04); and heart failure (OR 1.9, 95% CI 1.7-114.3, P = 0.02). CONCLUSION Hypospadias is associated with vascular dysfunction and predisposes to hypertension and cardiovascular disease in adulthood. Underlying mechanisms involve perturbed Rho kinase- and Nox5/ROS-dependent signalling. Our novel findings delineate molecular mechanisms of vascular injury in hypogonadism, and identify hypospadias as a cardiovascular risk factor in males.
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Affiliation(s)
- Angela K Lucas-Herald
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Centre for Research Excellence, University of Glasgow, 126 University Avenue, Glasgow G12 8TA, UK
- Developmental Endocrinology Research Group, School of Medicine, Dentistry and Nursing, University of Glasgow, Royal Hospital for Children, 1345 Govan Road, Glasgow G45 8TF, UK
| | - Augusto C Montezano
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Centre for Research Excellence, University of Glasgow, 126 University Avenue, Glasgow G12 8TA, UK
| | - Rheure Alves-Lopes
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Centre for Research Excellence, University of Glasgow, 126 University Avenue, Glasgow G12 8TA, UK
| | - Laura Haddow
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Centre for Research Excellence, University of Glasgow, 126 University Avenue, Glasgow G12 8TA, UK
| | - Malika Alimussina
- Developmental Endocrinology Research Group, School of Medicine, Dentistry and Nursing, University of Glasgow, Royal Hospital for Children, 1345 Govan Road, Glasgow G45 8TF, UK
| | - Stuart O’Toole
- Department of Pediatric Surgery, Royal Hospital for Children, 1345 Govan Road, Glasgow G45 8TF, UK
| | - Martyn Flett
- Department of Pediatric Surgery, Royal Hospital for Children, 1345 Govan Road, Glasgow G45 8TF, UK
| | - Boma Lee
- Department of Pediatric Surgery, Royal Hospital for Children, 1345 Govan Road, Glasgow G45 8TF, UK
| | - S Basith Amjad
- Department of Pediatric Surgery, Royal Hospital for Children, 1345 Govan Road, Glasgow G45 8TF, UK
| | - Mairi Steven
- Department of Pediatric Surgery, Royal Hospital for Children, 1345 Govan Road, Glasgow G45 8TF, UK
| | - Katriona Brooksbank
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Centre for Research Excellence, University of Glasgow, 126 University Avenue, Glasgow G12 8TA, UK
| | - Linsay McCallum
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Centre for Research Excellence, University of Glasgow, 126 University Avenue, Glasgow G12 8TA, UK
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Centre for Research Excellence, University of Glasgow, 126 University Avenue, Glasgow G12 8TA, UK
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Centre for Research Excellence, University of Glasgow, 126 University Avenue, Glasgow G12 8TA, UK
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, School of Medicine, Dentistry and Nursing, University of Glasgow, Royal Hospital for Children, 1345 Govan Road, Glasgow G45 8TF, UK
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Centre for Research Excellence, University of Glasgow, 126 University Avenue, Glasgow G12 8TA, UK
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Lucas-Herald AK, Alves-Lopes R, Haddow L, O’Toole S, Flett M, Amjad SB, Lee B, Steven M, Montezano AC, Ahmed SF, Touyz R. SUN-551 Impaired Vascular Relaxation and Altered eNOS Regulation in Boys with Hypospadias. J Endocr Soc 2020. [PMCID: PMC7207847 DOI: 10.1210/jendso/bvaa046.1224] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background: Sex hormones influence vascular function. Whether boys with hypospadias who have insufficient androgen exposure during the masculinisation programming window have altered vascular function is unknown. Objective: To investigate whether vascular function is impaired in boys with hypospadias and to explore the putative role of eNOS. Methods: Peripheral arteries from excess foreskin tissue obtained from boys undergoing hypospadias repair (cases) or circumcision (controls) were used. Vascular function was assessed by myography. mRNA expression was measured by qPCR in vascular smooth muscle cells (VSMCs). Nitric oxide (NO) was measured by DAF fluorescence assay and peroxynitrite levels measured via ELISA. Results: 23 boys with hypospadias and 34 age-matched controls were studied. There were 18 (52%) cases of distal, 7 (22%) of midshaft and 9 (26%) of proximal hypospadias and none of them had biochemical evidence of hypogonadism or a variant in AR. Clinical cardiometabolic parameters were similar between groups. Endothelium-dependent relaxation to acetylcholine (ACh) and endothelium-independent relaxation to sodium nitroprusside (SNP) were reduced in arteries from cases vs controls (Emax %U46619: 72.4 vs 1.2, p<0.0001 and Emax %U46619: (42.7 vs 11.8, p<0.01 respectively). Incubation with the NO synthase inhibitor, L-NAME (1x10-5 M) worsened endothelial-dependent relaxation in controls (Emax % U46619: 76.8 vs 1.2, p<0.0001) but had no effect in cases (Emax % U46619:60.6 vs 72.4, p=0.3). Testosterone (1x10-7 M) ameliorated vascular relaxation (p<0.05), whereas17[[Unsupported Character - Symbol Font 𝝱]];-estradiol stimulation (1x10-9 M) did not. In cultured VSMCs, mRNA expression of eNOS and iNOS was reduced whereas that of nNOS was increased in cases versus controls. Nitric oxide production was reduced in cases (5 fold, p<0.01), as was peroxynitrite production (0.5 fold, p<0.05). Testosterone increased expression of eNOS in VSMCs. There was no difference in mRNA expression of the AR and GPRC6A but cases had increased expression of ESR1 (2.71 fold), ESR2 (2.63 fold) and GPR30 (2.86 fold) (p<0.05). Conclusion: Arteries in eugonadal boys with hypospadias show vascular dysfunction which involves impaired NOS/NO regulation effects that are ameliorated with testosterone but not oestrogen. These processes may predispose to long-term cardiovascular disease.
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Affiliation(s)
| | | | | | | | - Martyn Flett
- Royal Hospital for Children, Glasgow, United Kingdom
| | | | - Boma Lee
- Royal Hospital for Children, Glasgow, United Kingdom
| | - Mairi Steven
- Royal Hospital for Children, Glasgow, United Kingdom
| | | | | | - Rhian Touyz
- University of Glasgow, Glasgow, United Kingdom
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Bethell GS, Chhabra S, Shalaby MS, Corbett H, Kenny SE, Lall A, Taghizadeh A, Lee B, Driver C, Keene D, Marshall D, Murphy F, McAndrew F, Nicholls G, Chandran H, Steinbrecher H, Evans K, McCarthy L, Steven M, Shenoy M, Farrugia MK, Woodward M, Flett M, Gopal M, Godbole P, Daniel R, Romero RM, Wragg R, Manoharan S, Griffin S, O'Toole S, Abbas T, Kalidasan V. Parental decisional satisfaction after hypospadias repair in the United Kingdom. J Pediatr Urol 2020; 16:164.e1-164.e7. [PMID: 32147349 DOI: 10.1016/j.jpurol.2020.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 08/30/2019] [Accepted: 01/11/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND In hypospadias, the aim of surgical treatment is to achieve both desirable functional and cosmetic outcomes; however, complications following surgery are common and 18% of boys require re-operation. In mild degrees of hypospadias, repair may be offered entirely to improve cosmesis, meaning parents should be fully informed of this and the potential for complications, during the consent process. Parents' decision-making may be aided by making them aware of how others in a similar position have felt about the decision that they made for their child. One method of measuring parental satisfaction is decisional regret (DR). OBJECTIVES To assess parental satisfaction following hypospadias surgery in the United Kingdom by assessing DR and to determine the feasibility of obtaining meaningful data via a mobile phone survey. STUDY DESIGN The National Outcomes Audit in Hypospadias database was commissioned by the British Association of Paediatric Surgeons to capture clinical information from hypospadias repairs. Following ethical approval (16/NW/0819), a text message was sent to mobile numbers in the database inviting participation in a questionnaire incorporating the validated DR scale (DRS). The primary outcome measure was mean DRS score, which was correlated with clinical information, a score of zero indicated no regret and 100 indicated maximum regret. RESULTS There were 340 (37%) responses. The median age at the primary procedure was 16 (interquartile range 13-20) months. No DR (score = 0) was detected in 186 (55% [95%CI 49-60]) respondents; however, moderate-to-severe DR (score = 26-100) was seen in 21 (6.2% [95%CI 3.6-8.7]) respondents. On multivariate analysis, a distal meatus, a small glans and developing complications requiring repeat surgery were all associated with increased levels of regret (Table). There was no association between DR and cases performed per surgeon. DISCUSSION Around half of respondents demonstrated no DR and postoperative complications requiring surgery were associated with the highest levels of DR, which is similar to a Canadian study. Lorenzo et al. however found that DR was associated with circumcision, which was undertaken in all boys; however, in this UK study, around a third of boys were circumcised and regret levels between those circumcised and those not circumcised were similar. The limitations of this work include the following: surgeons submitting their own data on complications and there is potential of selection bias between respondents and non-respondents as with any survey. CONCLUSIONS Data from this study can be used to improve pre-operative counselling during the consent process. Smart mobile phone technology can be used successfully to distribute and collect parent-reported outcomes.
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Affiliation(s)
- G S Bethell
- Alder Hey Children's Hospital, Liverpool, L14 5AB, UK; University of Liverpool, Liverpool, Merseyside, L69 3BX, UK
| | - S Chhabra
- Alder Hey Children's Hospital, Liverpool, L14 5AB, UK; University of Liverpool, Liverpool, Merseyside, L69 3BX, UK
| | - M S Shalaby
- Bristol Royal Hospital for Children, Bristol, BS2 8BJ, UK
| | - H Corbett
- Alder Hey Children's Hospital, Liverpool, L14 5AB, UK
| | - S E Kenny
- Alder Hey Children's Hospital, Liverpool, L14 5AB, UK; University of Liverpool, Liverpool, Merseyside, L69 3BX, UK.
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Al-Juraibah F, Lucas-Herald A, Nixon R, Toka C, Wang C, Flett M, O'Toole S, Ahmed SF. Association Between Extra-Genital Congenital Anomalies and Hypospadias Outcome. Sex Dev 2019; 13:67-73. [DOI: 10.1159/000497260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2018] [Indexed: 12/13/2022] Open
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MacDonald C, Small R, Flett M, Cascio S, O'Toole S. Predictors of complications following retroperitoneoscopic total and partial nephrectomy. J Pediatr Surg 2019; 54:331-334. [PMID: 30502005 DOI: 10.1016/j.jpedsurg.2018.10.097] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 10/30/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Recent reports in the literature suggest an increased risk of complications with retroperitoneal as opposed to transperitoneal approach to partial nephrectomy (PN) and total nephrectomy (TN). We are a large unit performing predominantly retroperitoneoscopic PN and TN. We aim to review our outcomes and perform analysis to elucidate the predictors of complications following the retroperitoneal approach for extirpative kidney surgery. METHODS We performed a single center retrospective review of children undergoing MIMS TN and PN between 2005 and 2015. Variables were tested for association with outcomes using Chi2 and Spearman's Rho correlation. RESULTS We performed 173 MIMS nephrectomies, 119 total and 54 partial. Median age and weight were 5 years (6 months to 18 years) and 24.9 kg (7.7 to 85 kg) and operative time 147 min. There were 4 conversions and 17 postoperative complications. 19.6% children required further surgery, including 8 completion stumpectomies. Retroperitoneal approach did not have increased risk compared to transperitoneal for need of further surgery. Partial nephrectomy was not associated with higher rate of intraoperative complication or LOS. Predictors of intraoperative complication were vessel closure technique. Associations with need for further surgery were: ESRF, contralateral disease, bladder dysfunction, presence of PD catheter, and need for concomitant procedure. CONCLUSION Our conversion rate (1.9%) and need for further surgery (13.1%) following the retroperitoneal approach to the kidney are favorable to the literature. Need for reoperation is often associated with the underlying diagnosis and the natural sequelae of the disease process. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Robert Small
- The Royal Hospital for Children, Glasgow, Scotland
| | - Martyn Flett
- The Royal Hospital for Children, Glasgow, Scotland
| | | | - Stuart O'Toole
- The Royal Hospital for Children, Glasgow, Scotland. Stuart.O'
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Lucas-Herald AK, Alves-Lopes R, Haddow L, O'Toole S, Amjad SB, Flett M, Steven M, Lee B, Montezano AC, Ahmed SF, Touyz RM. Abstract 040: Vascular Dysfunction and Androgen Deficiency - Insights From Children With Hypospadias. Hypertension 2018. [DOI: 10.1161/hyp.72.suppl_1.040] [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] [Indexed: 11/16/2022]
Abstract
Background:
Hypospadias in boys may be associated with a lack of androgen exposure during the masculinisation programming window. As testosterone has effects on the vasculature, we assessed whether boys with hypospadias show any evidence of vascular dysfunction.
Methods:
Excess foreskin tissue was obtained from boys undergoing hypospadias repair (cases) or circumcision (controls) and small arteries dissected from this tissue. Vascular contractility was assessed by wire myography in response to U46619 (thromboxane A2 analogue). Vascular smooth muscle cells (VSMCs) were cultured and generation of reactive oxygen species (ROS) was measured by amplex red and chemiluminescence. NADPH oxidase (Nox) mRNA expression was measured by qPCR.
Results:
19 cases and 22 age-matched controls were enrolled in this study (median age 1.9 (range 1.3,12.2) years). There were no differences in clinical cardiometabolic or biochemical parameters between the cases and controls. Arteries from cases demonstrated increased constriction to U46619 compared to controls (Emax 175.6 vs 66.3 p<0.001), an effect inhibited by the ROS scavenger N-acetylcysteine (NAC). VSMC superoxide anion (5.3 fold) production and H
2
0
2
(3.3 fold) levels were increased in cases compared to controls (p<0.05). Expression of Nox5, a major ROS-generating oxidase in vascular cells, was increased in cases (2.6 fold,p<0.05). Exposure of vessels to testosterone increased vasoconstriction to U46619 (Emax 66.3 to 124.6 p<0.001) in controls, but not in cases. Incubation with NAC abolished the testosterone-induced vascular effects. Vascular hypercontractility in boys with hypospadias was associated with reduced endothelium-dependent and -independent vasorelaxation, compared with controls.
Conclusions:
These novel data, from a unique cohort of patients, demonstrate that small arteries from boys with hypospadias exhibit increased vascular contractility and decreased vasorelaxation with associated increased Nox-derived ROS generation. The functional significance of vascular dysfunction in these boys is unclear but may play a role in immediate surgical outcome as well as altered long-term cardiovascular risk.
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Affiliation(s)
- Angela K Lucas-Herald
- Institute for Cardiovascular and Med Sciences, BHF Cntr for Rsch Excellence, Univ of Glasgow, Glasgow, United Kingdom
| | - Rheure Alves-Lopes
- Institute for Cardiovascular and Med Sciences, BHF Cntr for Rsch Excellence, Univ of Glasgow, Glasgow, United Kingdom
| | - Laura Haddow
- Institute for Cardiovascular and Med Sciences, BHF Cntr for Rsch Excellence, Univ of Glasgow, Glasgow, United Kingdom
| | - Stuart O'Toole
- Dept of Paediatric Surgery, Royal Hosp for Children, Glasgow, United Kingdom
| | - Syed Basith Amjad
- Dept of Paediatric Surgery, Royal Hosp for Children, Glasgow, United Kingdom
| | - Martyn Flett
- Dept of Paediatric Surgery, Royal Hosp for Children, Glasgow, United Kingdom
| | - Mairi Steven
- Dept of Paediatric Surgery, Royal Hosp for Children, Glasgow, United Kingdom
| | - Boma Lee
- Dept of Paediatric Surgery, Royal Hosp for Children, Glasgow, United Kingdom
| | - Augusto C Montezano
- Institute for Cardiovascular and Med Sciences, BHF Cntr for Rsch Excellence, Univ of Glasgow, Glasgow, United Kingdom
| | - Syed Faisal Ahmed
- Developmental Endocrinology Rsch Group, Sch of Medicine, Dentistry and Nursing, Univ of Glasgow, Glasgow, United Kingdom
| | - Rhian M Touyz
- Institute for Cardiovascular and Med Sciences, BHF Cntr for Rsch Excellence, Univ of Glasgow, Glasgow, United Kingdom
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Abstract
12 5½-yr.-o!d rhesus monkeys, 6 of each sex, were reunited with other-sexed peers with which they had been paired for 6 mo. during early adolescence. Responses of Ss to reunion with familiar animals were compared with their responses to pairing with unfamiliar other-sexed peers. The members of familiar pairs had been separated for nearly 2 yr. prior to the reunion described here. Familiar animals never aggressed one another, but males aggressed unfamiliar females. Ss directed more threats toward unfamiliar than familiar animals. Males mounted familiar females more often than unfamiliar ones, but it was apparent that heterosexual attractiveness in general was not based exclusively on familiarity.
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Affiliation(s)
- J. Erwin
- Department of Psychology, Department of Behavioral Biology, School of Medicine, and California Primate Research Center, University of California, Davis
| | - M. Flett
- Department of Psychology, Department of Behavioral Biology, School of Medicine, and California Primate Research Center, University of California, Davis
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10
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Sekaran P, O'Toole S, Flett M, Cascio S. Increased Occurrence of Disorders of Sex Development, Prematurity and Intrauterine Growth Restriction in Children with Proximal Hypospadias Associated with Undescended Testes. J Urol 2013; 189:1892-6. [DOI: 10.1016/j.juro.2012.11.047] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 11/06/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Prabhu Sekaran
- Department of Urology, Royal Hospital for Sick Children, Glasgow, Scotland, United Kingdom
| | - Stuart O'Toole
- Department of Urology, Royal Hospital for Sick Children, Glasgow, Scotland, United Kingdom
| | - Martyn Flett
- Department of Urology, Royal Hospital for Sick Children, Glasgow, Scotland, United Kingdom
| | - Salvatore Cascio
- Department of Urology, Royal Hospital for Sick Children, Glasgow, Scotland, United Kingdom
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11
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Broadis E, Barbour L, O'Toole S, Fyfe A, Flett M, Irwin G, Ramage IJ. Bilateral ureteric obstruction secondary to renal papillary necrosis. Pediatr Surg Int 2010; 26:867-9. [PMID: 20422417 DOI: 10.1007/s00383-010-2608-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 04/14/2010] [Indexed: 10/19/2022]
Abstract
A 2-year-old male presented to hospital with a 5-day history of vomiting and pyrexia. He was initially treated with non-steroidal medication as an anti-pyretic. Initial investigations demonstrated a raised urea and creatinine and he was treated with intravenous fluids. Within 24 h he became anuric with progressive renal insufficiency. Ultrasound scan demonstrated minimal bilateral hydronephrosis with debris in the lower pole calyces. The bladder was empty. Cystoscopy and retrograde contrast imaging revealed bilateral ureteric obstruction. Double J stents were inserted and his renal function returned to normal within 4 days. We believe the aetiology to be renal papillary necrosis and bilateral ureteric obstruction secondary to the administration of ibuprofen in association with dehydration.
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12
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Mofidi R, Flett M, Nagy J, Ross R, Griffiths G, Chakraverty S, Stonebridge P. Balloon Angioplasty as the Primary Treatment for Failing Infra-inguinal Vein Grafts. Eur J Vasc Endovasc Surg 2009; 37:198-205. [DOI: 10.1016/j.ejvs.2008.10.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Accepted: 10/28/2008] [Indexed: 10/21/2022]
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13
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Mofidi R, Flett M, Milne A, Chakraverty S. Endovascular repair of an anastomotic leak following open repair of abdominal aortic aneurysm. Cardiovasc Intervent Radiol 2007; 30:1013-5. [PMID: 17533537 DOI: 10.1007/s00270-007-9076-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Revised: 12/19/2006] [Accepted: 01/12/2007] [Indexed: 10/23/2022]
Abstract
This report describes the case of an early postoperative anastomotic leak following elective open repair of an infrarenal abdominal aortic aneurysm which was successfully treated by endovascular stent-grafting. A 71-year-old man underwent open tube graft repair of abdominal aortic aneurysm. Twelve days later he presented with a contained leak from the distal anastomosis, which was confirmed on CT scan. This was successfully treated with a bifurcated aortic stent-graft. This case illustrates the usefulness of the endovascular approach for resolving this rare surgical complication of open repair of abdominal aortic aneurysm and the challenges associated with the deployment of such a device within an aortic tube graft.
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Affiliation(s)
- R Mofidi
- Department of Vascular Surgery and Radiology, Ninewells Hospital, Dundee DD1 9SY, UK.
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14
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Isaac GH, Siebel T, Schmalzried TP, Cobb AG, O'Sullivan T, Oakeshott RD, Flett M, Vail TP. Development rationale for an articular surface replacement: a science-based evolution. Proc Inst Mech Eng H 2006; 220:253-68. [PMID: 16669392 DOI: 10.1243/095441105x69132] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hip resurfacing has an enduring appeal because of the advantages of bone conservation and maximal joint stability. However, a far from satisfactory experience with earlier resurfacing designs led to its virtual disappearance in the 1980s. The concept was reintroduced in the late 1990s. The current generation of resurfacing devices generally consisted of a large-diameter metal-on-metal articulation, the femoral components being cemented and the acetabular components utilizing various forms of cementless fixation. The encouraging medium-term results, with a follow-up of up to 8 years using the current generation of surface replacement joints, combined with favourable reports related to long-term performance of some metal bearings have led to a rapid increase in the use of such components with these devices. This trend is most marked in younger, more active patients who have expectations of restoration of lifestyle in addition to improved mobility and pain relief and in whom failure with conventional total hip replacement is much higher than previously reported with more sedentary patients. The aim of this paper is, firstly, to highlight a number of areas of improvement and, secondly, to explain how these may be addressed by making modifications to the design of both implants and instrumentation and to the surgical technique. The areas identified for improvement were tissue preservation (thinner components, and reduced steps between sizes), acetabular cup issues (fixation, insertion, and positioning), femoral component issues (design, loading, and cementation), improved bearing surface characteristics, and simplified precise instrumentation with a low-trauma surgical technique.
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Affiliation(s)
- G H Isaac
- DePuy International Limited, Leeds, UK.
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15
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Lin ZM, Meakins S, Morlock MM, Parsons P, Hardaker C, Flett M, Isaac G. Deformation of press-fitted metallic resurfacing cups. Part 1: Experimental simulation. Proc Inst Mech Eng H 2006; 220:299-309. [PMID: 16669396 DOI: 10.1243/095441105x69150] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The interference press fit of a metallic one-piece acetabular cup employed for metal-on-metal hip resurfacing procedures was investigated experimentally under laboratory conditions in the present study, in particular regarding the cup deformation. Tests were carried out in cadavers as well as polyurethane foams of various grades with different elastic moduli to represent different cancellous bone qualities. The cadaver test was used to establish the most suitable configuration of the foam model representing realistic support and geometrical conditions at the pelvis. It was found that a spherical cavity, with two identical areas relieved on opposite sides, was capable of creating a two-point pinching action of the ischeal and ilial columns on the cup as the worst-case scenario. Furthermore, the cup deformation produced from such a two-point loading model with a grade 30 foam was similar to that measured from the cadaver test. Therefore, such a protocol was employed in subsequent experimental tests. For a given size of the outside diameter of the cup of 60 mm, the cup deflection was shown to be dependent largely on the cup wall thickness and the diametral interference between cup and prepared cavity at implantation. For a relatively thin cup with a wall thickness between 2.3 mm (equator) and 4 mm (pole) and with a modest nominal diametral interference of 1 mm, which corresponds to an actual interference of approximately 0.5 mm, the maximum diametral cup deflection (at the rim) was around 60 μm, compared with a diametral clearance of 80-120 μm between the femoral head and the acetabular cup, generally required for fluid-film lubrication and tribological performances. Stiffening of the cup, by both thickening and lateralizing by 1 mm, reduced the cup deformation to between 30 and 50 μm with actual diametral interferences between 0.5 and 1 mm.
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Affiliation(s)
- Z M Lin
- School of Mechanical Engineering, University of Leeds, Leeds, UK.
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16
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Khan AL, Flett M, Yalamarthi S, Jeffrey RR, Ah-See AK, Park KGM, Keenan RA. The role of the intra-aortic balloon pump counterpulsation (IABP) in emergency surgery. Surgeon 2003; 1:279-82. [PMID: 15570779 DOI: 10.1016/s1479-666x(03)80045-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Elective surgical procedures are often delayed for up to six months in patients who have suffered a myocardial infarction (MI) because of the substantial risk of re-infarction and high peri-operative mortality. The optimal management of patients who have sustained a recent myocardial infarction and who require an emergency abdominal operation, however, has yet to be defined. The use of an intraaortic balloon pump (IABP) may play a role in such patients by improving the function of the injured heart. Three cases are presented in which IABP was used in patients who had recently sustained a myocardial infarction and who required emergency abdominal surgery. A review of the literature is presented and the application of IABP in such circumstances is discussed. Although clinical experience is limited, the use of the IABP may be useful in selected patients who have sustained a recent MI and who require emergency surgery.
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Affiliation(s)
- A L Khan
- University Department of Surgery, University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
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17
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Foon KA, John WJ, Chakraborty M, Sherratt A, Garrison J, Flett M, Bhattacharya-Chatterjee M. Clinical and immune responses in advanced colorectal cancer patients treated with anti-idiotype monoclonal antibody vaccine that mimics the carcinoembryonic antigen. Clin Cancer Res 1997; 3:1267-76. [PMID: 9815809] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Carcinoembryonic antigen (CEA) is expressed in a wide variety of adenocarcinomas, and it is well recognized that cancer patients are immunologically "tolerant" to CEA. The purpose of this study was to determine whether we could break immune tolerance to CEA by vaccinating patients with a monoclonal anti-idiotype antibody that is the internal image of CEA and to determine what impact this might have on patient survival. Twenty-four patients with advanced CEA-positive colorectal cancer who failed standard therapies except for two were entered into this Phase Ib trial. One patient was considered not assessable, because on the day of entering into the study, she was diagnosed with acute myelogenous leukemia. Patients were treated with 1, 2, or 4 mg of aluminum hydroxide-precipitated 3H1 anti-idiotype antibody every other week for four injections and then monthly until tumor progression was observed. Immunological monitoring included humoral and cellular idiotypic and CEA responses, and all patients were evaluated for toxicity, response, and survival. Hyperimmune sera from 17 of 23 patients demonstrated an anti-anti-idiotypic Ab3 response, and 13 of these responses were demonstrated to be true anti-CEA responses (Ab1'). The antibody response was polyclonal, and 11 mediated antibody-dependent cellular cytotoxicity. Ten patients had idiotypic T-cell responses, and five had specific T-cell responses to CEA. None of the patients had objective clinical responses, but overall median survival for the 23 evaluable patients was 11.3 months, with 44% 1-year survival (95% confidence interval, 23-64%). Toxicity was limited to local swelling and minimal pain. Anti-idiotype monoclonal antibody 3H1 that mimics CEA was able to break immune tolerance in the majority of treated patients. Overall survival of 11.3 months was comparable to other phase II data with advanced colorectal cancer patients treated with a variety of chemotherapy agents, including irinotecan, with considerably less toxicity. Although it is not clear that the vaccine itself had an impact on survival, this should be determined in a Phase III randomized trial.
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Affiliation(s)
- K A Foon
- Lucille Parker Markey Cancer Center, Department of Internal Medicine, Division of Hematology/Oncology, University of Kentucky Medical Center, Lexington, Kentucky 40536, USA
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18
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Eckett K, Vassallo LM, Flett M. A service manager model: instituting case management. Nurs Manag (Harrow) 1996; 27:52-3. [PMID: 8632874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Using a service manager model as opposed to a traditional nurse case manager archetype fosters multidisciplinary team interaction. Benefits of this approach to the hospital, the staff and the patients are identified.
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19
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Abstract
Abstract
Benign tumours of the rectum may be destroyed by diathermy or cryotherapy, or may be locally excised using a urological resectoscope or by more invasive techniques such as the York-Mason trans-sphincteric resection1,2. Transanal endoscopic microsurgical excision of such tumours has the advantage of allowing a magnified view during excision, which enables resection of an unfragmented specimen with clear margins3. More proximal lesions can also be resected. However, the technique requires a prolonged period of anal dilatation using a 4-cm diameter sigmoidoscope, which may compromise sphincter function4,5. The aim of this prospective study was to examine sphincter function before and after transanal endoscopic microsurgical excision of rectal tumours.
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Affiliation(s)
- D Hemingway
- Department of Coloproctology, Glasgow Royal Infirmary, UK
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20
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