1
|
Cascio S, Kaefer M, Bagli D, Nelson CP, Nieuwhof-Leppink A, Braga LH, Herbst KW, Garriboli M, Kalfa N, Harper L, Fossum M. The importance of animal specificity in animal experimentation, part II: Physiological challenges and opportunities in relation to pediatric urology. J Pediatr Urol 2024; 20:315-317. [PMID: 38238242 DOI: 10.1016/j.jpurol.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 04/22/2024]
Abstract
When performing animal experimentation in Pediatric Urology studies, it is important to be aware of physiological differences between species and to understand when relevant disease models are available. Diseased animal models may be more relevant in many cases, rather than performing studies in healthy and normally developed animals. For example, they may be more appropriate for the study of congenital malformations, to investigate the secondary effects of prenatal urinary obstruction, to study the effect of prenatal exposure to endogenous or exogenous factors which may lead to disease, or in testing bioengineered structures. In this short educational article, we aim to describe some disease models that have been used to simulate human pathologies and how, if properly designed, these studies can lead to important new knowledge for human translation. In addition, we also highlight the importance of formulating a research question(s) before deciding on the animal experimental model and species to choose.
Collapse
Affiliation(s)
- Salvatore Cascio
- Department of Pediatric Surgery, School of Medicine, University College Dublin and Children's Health Ireland, Dublin, Ireland
| | - Martin Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Darius Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital and Harvard Medical School, MA, United States
| | - Anka Nieuwhof-Leppink
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - Luis H Braga
- Department of Surgery, Division of Urology, McMaster University, McMaster Children's Hospital, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada
| | - Katherine W Herbst
- Connecticut Children's Research Institute, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Massimo Garriboli
- Department of Pediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Nicolas Kalfa
- Service de Chirurgie Urologique Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France
| | - Luke Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - Magdalena Fossum
- Department of Pediatric Surgery, Surgical Clinic C, Rigshospitalet, Copenhagen University, Clinical Medicine, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| |
Collapse
|
2
|
Fossum M, Kaefer M, Bagli D, Harper L, Herbst KW, Nelson CP, Braga LH, Nieuwhof-Leppink A, Kalfa N, Garriboli M, Cascio S. The importance of animal specificity in animal experimentation, part I: Anatomy in relation to pediatric urology. J Pediatr Urol 2024; 20:312-314. [PMID: 38199905 DOI: 10.1016/j.jpurol.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
Why and when is animal experimentation relevant? The answer to this question depends on the research question. In this short educational article we aim to raise awareness of the importance of formulating a very specific research question before choosing an animal species. An awareness of anatomical and physiological differences vis-a-vis similarities between species, will increase the potential for obtaining data that is relevant for translation to human conditions.
Collapse
Affiliation(s)
- Magdalena Fossum
- Department of Pediatric Surgery, Center of Cancer and Organ Diseases, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Martin Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Darius Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Luke Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - Katherine W Herbst
- Division of Urology, Research Institute, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital and Harvard Medical School, MA, United States
| | - Luis H Braga
- Department of Surgery, Division of Urology, McMaster University, McMaster Children's Hospital, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada
| | - Anka Nieuwhof-Leppink
- Department Urotherapy, Wilhelmina Children's Hospital, Part of University Medical Center Utrecht, Netherlands
| | - Nicolas Kalfa
- Department of Pediatric Surgery and Urology, Lapeyronie Hospital, CHU Montpellier, France; UMR1302 Institute Desbrest of Epidemiology and Public Health, INSERM, University Montpellier, Montpellier, France
| | - Massimo Garriboli
- Department of Paediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Salvatore Cascio
- Department of Pediatric Surgery, School of Medicine, University College Dublin and Children's Health Ireland at Temple Street, Dublin, Ireland
| |
Collapse
|
3
|
Corbett HJ, Clothier J, Driver C, Farrugia MK, Garriboli M, Gopal M, Kulkarni M, Marshall D, MacDonald C, Radford A, Rhodes H, Williams A, McCarthy L. A consensus process to identify research priorities in paediatric urology in the United Kingdom. J Pediatr Urol 2024; 20:240.e1-240.e8. [PMID: 37957075 DOI: 10.1016/j.jpurol.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/03/2023] [Accepted: 10/12/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Paediatric urologists manage a spectrum of conditions, much of the evidence for relevant treatment pathways is of low quality. For many conditions treatment varies according to location and surgeon; children with the same condition might have surgery in one unit but watchful waiting in another. Underlying this variation are differences in opinion, and insufficient high-level evidence with few prospective randomized studies. Such studies may be challenging to design, fund and recruit into, and are more likely to succeed if there is a collaborative approach. Research prioritization is a tool to identify the research of most value. Delphi methodology is an interpretive technique aiming to gain the consensus view of interested parties. The British Association of Paediatric Urologists (BAPU) set out to ascertain consensus on what paediatric urologists, working in the UK, consider to be areas of priority for research. This paper describes the process used, and the resulting list of research questions. METHODS A scoping survey of paediatric urologists in the UK was undertaken to identify an initial set of research questions. These were refined by the BAPU research committee (BAPU RC), then prioritized using a modified Delphi process. During Stage 1a multiple new research questions were submitted leading to Stage 1b, an interim process. All UK paediatric urologists were invited to take part in Stage 2 of the prioritization process. RESULTS Sixty-five questions were submitted to the scoping survey by 24 paediatric urologists. The BAPU RC refined these to 60 questions, which were submitted to Stage 1a of the modified Delphi process. Sixty-seven people completed Stage 1a, at the same time submitting 224 additional research questions. The BAPU RC revised the entire question set, ensuring the key subject of the original question was not altered and novel questions were retained. The BAPU RC undertook interim scoring of the resultant 79 questions, the top scoring 25 questions plus 5 lower scoring 'wild card' questions (to ensure the breadth of the specialty was represented) were put forward to Stage 2. A total of 65 people completed Stage 2, including a lay representative. A list of 30 priority research questions was generated; the top 10 includes management of neuropathic bladder, posterior urethral valves, antibiotic prophylaxis, DSD & CAH, continence, male external genitalia, VUR and transition care (Table). CONCLUSION This process has provided BAPU, paediatric urologists in the UK, and funders with areas of research considered a priority in the specialty.
Collapse
Affiliation(s)
- Harriet J Corbett
- Department of Surgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, L12 2AP, UK.
| | - Joanna Clothier
- Paediatric Nephrology, Evelina London Children's Hospital, UK
| | - Chris Driver
- Department of Paediatric Surgery, Royal Aberdeen Children's Hospital, Westburn Road, Aberdeen, AB252ZN, UK
| | - Marie-Klaire Farrugia
- Department of Paediatric Urology, Chelsea & Westminster and Imperial College Hospitals, London SW10 9NH, UK
| | | | - Milan Gopal
- Department of Paediatric Surgery and Urology, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Milind Kulkarni
- Paediatric Urology, Norfolk and Norwich University Hospital NHS Trust, UK
| | - David Marshall
- Royal Belfast Hospital for Sick Children, 180 Falls Road, BELFAST, BT12 6BE, UK
| | | | - Anna Radford
- Department of Paediatric Surgery, Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust, UK
| | - Hannah Rhodes
- Department Paediatric Surgery and Urology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham B4 6NH, UK
| | - Alun Williams
- Department of Paediatric Urology, Nottingham University Hospitals NHS Trust, UK
| | - Liam McCarthy
- Department Paediatric Surgery and Urology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham B4 6NH, UK
| |
Collapse
|
4
|
Nieuwhof-Leppink AJ, Garriboli M, Cascio S, Braga LH, Haid B, Nelson CP, Dönmez MI, Ching CB, Harper L. Elevating pediatric urology care: The crucial role of nursing research in quality improvement. J Pediatr Urol 2024:S1477-5131(24)00154-2. [PMID: 38531759 DOI: 10.1016/j.jpurol.2024.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 03/28/2024]
Affiliation(s)
- Anka J Nieuwhof-Leppink
- Department Urotherapy, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, Netherlands.
| | - Massimo Garriboli
- Department of Pediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom.
| | - Salvatore Cascio
- Department of Pediatric Surgery, School of Medicine, University College Dublin and Children's Health Ireland, Dublin, Ireland.
| | - Luis H Braga
- Department of Surgery, Division of Urology, McMaster University, McMaster Children's Hospital, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.
| | - Bernhard Haid
- Department of Pediatric Urology, Ordensklinikum Linz Hospital of the Sisters of Charity, Austria.
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital and Harvard Medical School, USA.
| | - Muhammet Irfan Dönmez
- Division of Pediatric Urology, Department of Urology, Istanbul University Istanbul Faculty of Medicine, Turkey.
| | - Christina B Ching
- Department of Pediatric Urology, Nationwide Children's Hospital, 700 Children's Dr Columbus, OH 43205, USA.
| | - Luke Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France.
| |
Collapse
|
5
|
Mosa H, Olczak B, Paul A, Mishra P, Taghizadeh A, Garriboli M. Response to letter to the editor: are there anatomical limiting factors to foreskin reconstruction at the time of single-stage hypospadias repair? J Pediatr Urol 2024:S1477-5131(24)00140-2. [PMID: 38670857 DOI: 10.1016/j.jpurol.2024.02.025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Hazem Mosa
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Bartlomiej Olczak
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Anu Paul
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Pankaj Mishra
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Arash Taghizadeh
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Massimo Garriboli
- Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health, London, United Kingdom.
| |
Collapse
|
6
|
Nieuwhof-Leppink AJ, Garriboli M, Cascio S, Braga LH, Haid B, Nelson CP, Dönmez MI, Ching CB, Harper L. Elevating pediatric urology care: The crucial role of nursing research in quality improvement. J Pediatr Urol 2024:S1477-5131(24)00073-1. [PMID: 38360426 DOI: 10.1016/j.jpurol.2024.01.032] [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] [Received: 01/18/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
This educational article highlights the critical role of pediatric urology nursing research in improving the care of children with urological conditions. It discusses the multifaceted nature of pediatric urology nursing, addresses challenges such as limited nurse scientists and resource constraints, and highlights the need to overcome barriers to increase research involvement. The authors emphasize the importance of prioritizing research areas, the promotion of collaboration, and the provision of adequate funding and academic time for pediatric nurses to contribute to evidence-based practice, to improve patient outcomes. Furthermore, it highlights the importance of research in advancing nursing practice, shaping protocols, and advocating for the rights and needs of children with urological conditions and their families.
Collapse
Affiliation(s)
- Anka J Nieuwhof-Leppink
- Department Urotherapy, Medical Psychology and Urology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, Netherlands.
| | - Massimo Garriboli
- Department of Pediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom.
| | - Salvatore Cascio
- Department of Pediatric Surgery, School of Medicine, University College Dublin and Children's Health Ireland, Dublin, Ireland.
| | - Luis H Braga
- Department of Surgery, Division of Urology, McMaster University, McMaster Children's Hospital, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.
| | - Bernhard Haid
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Austria.
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital and Harvard Medical School, USA.
| | - Muhammet Irfan Dönmez
- Division of Pediatric Urology, Department of Urology, Istanbul University Istanbul Faculty of Medicine, Turkey.
| | - Christina B Ching
- Department of Pediatric Urology, Nationwide Children's Hospital, 700 Children's Dr Columbus, OH 43205, USA.
| | - Luke Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France.
| |
Collapse
|
7
|
Mosa H, Olczak B, Paul A, Mishra P, Taghizadeh A, Garriboli M. Are there anatomical limiting factors to foreskin reconstruction at the time of single-stage hypospadias repair? J Pediatr Urol 2023; 19:700.e1-700.e10. [PMID: 37775457 DOI: 10.1016/j.jpurol.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/15/2023] [Accepted: 08/01/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Foreskin reconstruction (FR) at the time of primary hypospadias repair is a truly anatomically complete reconstruction of the hypospadic penis. We prospectively collected penile and preputial measurement of children undergoing single-stage hypospadias repair and FR with the aim to identify possible relations between penile and preputial anatomy and the likelihood to develop complications. MATERIALS AND METHODS We prospectively studied children who underwent single stage hypospadias repair associated with FR from 2016 to 2019. We recorded intra-operative foreskin and penile measurements and post-operative outcomes. Logistic Regression analysis was performed to explore independent factors affecting urethroplasty and skin complications. Chi square test was used to compare outcomes in different groups based on ventral foreskin defect (VFD) width, Glans size, age at surgery and meatal location. RESULTS From a total of 181 consecutive patients, 86 boys who underwent a single stage hypospadias repair combined with FR were included in the study. Patients were excluded because they were either lost at follow up (n = 10), required a 2-stage repair (n = 2), were circumcised at birth (n = 3) or parents requested a circumcision (n = 78); in 2 patients, a decision to perform circumcision was made intraoperatively due to aesthetic reasons (monk-hood deformity of the prepuce). Median age at surgery was 17 months. Mean glans width was 14.4 mm. Mean unstretched and stretched foreskin circumference were 29.5 mm and 40.9 mm, respectively. Mean VFD (the distance between the proximal insertion of the foreskin hood on either side of the midline at the level of the coronal sulcus) was 7.2 mm (Fig. 1). At median follow-up of 8 months (6-23), 9 complications were recorded (10.4%): foreskin dehiscence occurred in 1% (1/86), a foreskin fistula was noted in 4.6% (4/86), tight, non-retractile, foreskin in 1% (1/86); urethrocutaneous fistula in 2.3% (2/86) and complete dehiscence of the glans and foreskin in 1 (1.2%). Multiple logistic regression analysis demonstrated that none of the measurements obtained was an independent risk factor for developing urethroplasty or skin complications. There was no significant difference in complications between wide VFD (>7 mm) vs. narrow VFD (≤7 mm), large glans (>14 mm) vs. small glans (≤14 mm), age at surgery ≤24 months vs. > 24 month and meatal location distal (glanular, coronal, subcoronal and distal penile) vs. proximal (midpenile, proximal penile and penoscrotal). CONCLUSION To the best of our knowledge, this is the first study reporting a prospective and objective assessment of the foreskin in the context of single stage hypospadias repair. Individual anatomical differences in preputial and penile anatomy do not seem to affect the likelihood of skin and urethroplasty complications. FR can, therefore, be offered to all boys undergoing primary single stage hypospadias repair . Further studies on larger numbers and external validation of these measurements is necessary.
Collapse
Affiliation(s)
- Hazem Mosa
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Bartlomiej Olczak
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Anu Paul
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Pankaj Mishra
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Arash Taghizadeh
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Massimo Garriboli
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom; Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health, United Kingdom.
| |
Collapse
|
8
|
Garriboli M, Clothier J, Selvaggio G, Harper L. Editorial: Posterior urethral valves: advances in diagnosis, management, and long-term follow up. Front Pediatr 2023; 11:1252048. [PMID: 37539010 PMCID: PMC10395328 DOI: 10.3389/fped.2023.1252048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 08/05/2023] Open
Affiliation(s)
- Massimo Garriboli
- Paediatric Urology, Evelina London Children’s Hospital, London, United Kingdom
- Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health, London, United Kingdom
| | - Joanna Clothier
- Paediatric Nephrology and Bladder Service, Evelina London Children’s Hospital, London, United Kingdom
| | - Giorgio Selvaggio
- Department of Paediatric Surgery, V. Buzzi Children’s Hospital, Milan, Italy
| | - Luke Harper
- Department of Paediatric Urology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| |
Collapse
|
9
|
Paraboschi I, Giannettoni A, Mantica G, Polymeropoulos A, Mishra P, Clothier J, Garriboli M. Posterior Urethral Valves, Unilateral Vesicoureteral Reflux, and Renal Dysplasia (VURD) Syndrome: Long-Term Longitudinal Evaluation of the Kidney Function. Int J Environ Res Public Health 2023; 20:6238. [PMID: 37444086 PMCID: PMC10341772 DOI: 10.3390/ijerph20136238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 05/11/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
The presence of unilateral vesicoureteral reflux (VUR), and renal dysplasia associated with posterior urethral valves (PUV) (VURD syndrome) was believed to represent a pressure-released pop-off mechanism protecting kidney function. We aimed to investigate its role with respect to long-term kidney function in a cross-sectional and longitudinal analysis. We compared the iohexol glomerular filtration rate (GFR) measured at 5 (GFR5) and 10 (GFR10) years of age in children with (Group A) and without (Group B) VURD syndrome, who underwent PUV resection under 2 years of age. VURD syndrome was diagnosed in cases of unilateral loss of kidney function (<15% on nuclear medicine test) associated with ipsilateral grade IV-V VUR. VURD syndrome was diagnosed in 16 (12.8%) out of 125 patients who met the inclusion criteria. While the median GFR5 was similar in the 2 groups [Group A: 87.3 (74.7-101.2) mL/min/1.73 m2 vs. Group B: 99.6 (77-113) mL/min/1.73 m2, p-value: 0.181], the median GFR10 values were significantly lower in children with VURD syndrome [Group A: 75.7 (71.2-85.9) mL/min/1.73 m2 vs. Group B: 95.1 (81.2-114.2) mL/min/1.73 m2, p-value: 0.009]. Similar results were obtained in a longitudinal analysis of the children with GFR measurement available both at 5 and 10 years of age [GFR5 in Group A: 93.1 (76.9-103.5) mL/min/1.73 m2 vs. Group B: 97.5 (80-113) mL/min/1.73 m2, p-value: 0.460; GFR10: Group A: 71.9 (71.9-85.9) mL/min/1.73 m2 vs. Group B: 94.8 (81.5-110.6) mL/min/1.73 m2, p-value: 0.024]. In conclusion, VURD syndrome does not show a protective role in kidney function preservation. On the contrary, it seems to be associated with a deterioration of the kidney function on a long-term follow-up.
Collapse
Affiliation(s)
- Irene Paraboschi
- Pediatric Nephro-Urology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
- Department of Pediatric Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy
| | - Adele Giannettoni
- Pediatric Nephro-Urology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Guglielmo Mantica
- Department of Urology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Alexios Polymeropoulos
- Department of Statistics ad Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Pankaj Mishra
- Pediatric Nephro-Urology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Joanna Clothier
- Pediatric Nephro-Urology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Massimo Garriboli
- Pediatric Nephro-Urology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
- Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health, London WC1N 1EH, UK
| |
Collapse
|
10
|
Szymanski KM, Kaefer M, Fossum M, Kalfa N, Herbst KW, Braga LH, Cascio S, Garriboli M, Nelson CP, Nieuwhoff-Leppink A, Bagli D, Harper L. What are validated questionnaires and which ones measure quality of life? J Pediatr Urol 2023:S1477-5131(23)00121-3. [PMID: 37080794 DOI: 10.1016/j.jpurol.2023.03.034] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/26/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Konrad M Szymanski
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Martin Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Magdalena Fossum
- Department of Pediatric Surgery, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Nicolas Kalfa
- Service de Chirurgie et Urologie Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier; Institut Debrest de Santé Publique IDESP, UMR INSERM - Université Montpellier, France
| | - Katherine W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Luis H Braga
- McMaster University/Department of Surgery/Urology, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Hamilton, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Salvatore Cascio
- Department of Paediatric Urology, Children's Health Ireland at Temple Street, Dublin, Ireland; University College Dublin, Ireland
| | - Massimo Garriboli
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom; Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health, United Kingdom
| | - Caleb P Nelson
- Urology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States
| | - Anka Nieuwhoff-Leppink
- Department Psychology, Urotherapy and Urology Section, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Darius Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Luke Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France.
| |
Collapse
|
11
|
Paraboschi I, Farneti F, Mantica G, Kalpana P, Tagizadeh A, Anu P, Pankaj M, Garriboli M. Surgical management of complicated duplex kidney: A tertiary referral centre 10-year experience. Afr J Paediatr Surg 2023; 20:51-58. [PMID: 36722570 PMCID: PMC10117018 DOI: 10.4103/ajps.ajps_139_21] [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: 12/23/2022] Open
Abstract
AIM The management of a complicated duplex kidney remains a challenge for paediatric urologists. The aim of this study is to report a 10-year experience of the surgical management of complicated duplex kidney in a single tertiary care paediatric referring hospital. MATERIALS AND METHODS Clinical records of all children who undergone a surgical procedure for complicated duplex systems between January 2009 and March 2019 at our institution were retrospectively reviewed. Clinical manifestations, surgical procedures, complications and follow-up were collected and analysed. Logistic regression was performed to explore if any patient's characteristic or underlying associated comorbidity (ureterocoele, ectopic ureter, obstruction, etc.,) could be positively linked to the chance to develop recurrent urinary tract infections (UTIs). RESULTS We have identified 95 children who received a surgical treatment for 102 complicated duplex kidneys. The presence of an ureterocoele was recorded in 41 (43.2%) patients, an ectopic ureter in 25 (26.3%), a vesicoureteral reflux (VUR) in 40 (42.1%), a vesicoureteric junction obstruction in 24 (25.3%) and an ureteropelvic junction obstruction in 3 (3.2%). An invasive approach such as an heminephrectomy (71.6%) was required in the majority of cases. Higher risk of developing a UTI has been demonstrated in children diagnosed postnatally (P < 0.001) and in those with an associated obstruction (P < 0.05). CONCLUSIONS No standardised management could be recommended for the surgical treatment of complicated duplex kidney. Children without antenatal diagnosis and with either an upper tract obstruction or VUR are at greater risk to develop UTI and need to be looked after more closely.
Collapse
Affiliation(s)
- Irene Paraboschi
- Department of Paediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Farneti
- Department of Paediatrc Nephro-Urology, Evelina London Children's Hospital, London, UK
| | - Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Patil Kalpana
- Department of Paediatrc Nephro-Urology, Evelina London Children's Hospital, London, UK
| | - Arash Tagizadeh
- Department of Paediatrc Nephro-Urology, Evelina London Children's Hospital, London, UK
| | - Paul Anu
- Department of Paediatrc Nephro-Urology, Evelina London Children's Hospital, London, UK
| | - Mishra Pankaj
- Department of Paediatrc Nephro-Urology, Evelina London Children's Hospital, London, UK
| | - Massimo Garriboli
- Department of Paediatrc Nephro-Urology, Evelina London Children's Hospital, London, UK
| |
Collapse
|
12
|
Fossum M, Kaefer M, Herbst KW, Harper L, Beckers GMA, Nelson CP, Garriboli M, Nieuwhof-Leppink A, Bagli D, Kalfa N. The orchestration of gene expression and the editing role of microRNA. J Pediatr Urol 2022:S1477-5131(22)00631-3. [PMID: 36653199 DOI: 10.1016/j.jpurol.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Abstract
In this short educational communication the ESPU Research Committee presents the role of non-coding RNA and how these can affect gene expression. In particular we discuss the role of microRNA on post transcriptional changes and how these may cause pathological conditions within Pediatric Urology and how microRNA could be useful in future clinical practice.
Collapse
Affiliation(s)
- M Fossum
- Department of Pediatric Surgery, Rigshospitalet, Dept of Medical Sciences, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - K W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - L Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | | | - C P Nelson
- Department of Urology, Boston Children's Hospital and Department of Surgery, Harvard Medical School, Harvard University, Boston, MA, USA
| | - M Garriboli
- Department of Paediatric Urology, Evelina Children's Hospital, Guy's and St. Thomas NHS Foundation Trust, London, United Kingdom
| | - A Nieuwhof-Leppink
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - D Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - N Kalfa
- Service de Chirurgie Urologique Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France; Institut Debrest de Santé Publique IDESP, UMR INSERM - Université Montpellier, Montpellier, France
| |
Collapse
|
13
|
Paraboschi I, Nwachukwu I, Mishra P, Taghizadeh I, Paul A, Garriboli M. High pressure baloon dilatation (HPBD) vs cutting balloon ureterotomy (CBU) in the management of primary obstructive megaureter (POM). EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01309-x] [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: 11/07/2022] Open
|
14
|
Mosa H, Paul A, Solomon E, Garriboli M. How accurate is eyeball measurement of curvature? A tool for hypospadias surgery. J Pediatr Urol 2022; 18:470-476. [PMID: 35534383 DOI: 10.1016/j.jpurol.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/24/2021] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Correction of penile curvature or "chordee" is a major component in the management of hypospadias. Accurate assessment and management of penile curvature influence both short- and long-term outcomes of surgery. AIM OF THE STUDY The objective of this study is to investigate the accuracy of eyeball measurement and how does it compare to objective measurement by standard goniometry (SG) and smartphone app goniometry (AG). MATERIALS AND METHODS A Dropbox file request link was shared with paediatric urologists on various social media platforms requesting participants to upload a picture of their index finger showing what they thought 30 degrees of curvature look like using their proximal inter phalangeal joint as the point of maximal curvature., The images were assessed using SG to measure the angle of curvature. The images were also assessed using AG by the principal investigator, a physician, a scrub nurse and a paediatric urology consultant., Statistical analysis was performed using SPSS statistics software version 26 (Armonk, NY: IBM Corp). A one sample t-test and a one-way chi squared test were used to evaluate significant frequency differences. Pearson correlation was used to compare AG measurements to test intra- and inter-observer reliability and to compare AG measurements vs SG measurements. Assuming 5-degree variability in goniometer measurements and 2-degree difference between the sample and population, the number of participants needed was calculated to be 49. RESULTS Fifty-two responses were received.32.7% of respondents simulated 30° accurately (17/52). A significant proportion (23/52, 44.2%) overrepresented the degree of curvature and 23.1% (12/52) underrepresented it (p = 0.01). Compared with objective measures, eyeball estimates differed by an average of 10° ± 1.5 SE. Measurements obtained by AG were comparable to measures obtained by SG and showed excellent intra-observer and inter-observer correlation (R = 0.983, P < 0.001). DISCUSSION We demonstrated a significant discrepancy between eyeball assessment of curvature and objective measurements in a cohort of hypospadiologists. This can be very relevant to intraoperative decision making. The limitation of the study is the use of a simulated model rather than assessment of curvature in patients with hypospadias. Another limitation is the lack of standardization of the way the pictures were taken. CONCLUSION We demonstrated a tendency among hypospadiologists to overestimate or underestimate curvature by an average of 10° on eyeball assessment. The use of App Goniometry shows excellent interobserver reliability and is comparable to standard goniometry in curvature assessment.
Collapse
Affiliation(s)
- Hazem Mosa
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Anu Paul
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Eskinder Solomon
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Massimo Garriboli
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom; Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health, London, United Kingdom.
| |
Collapse
|
15
|
Garriboli M, Deguchi K, Totonelli G, Georgiades F, Urbani L, Ghionzoli M, Burns AJ, Sebire NJ, Turmaine M, Eaton S, De Coppi P. Development of a porcine acellular bladder matrix for tissue-engineered bladder reconstruction. Pediatr Surg Int 2022; 38:665-677. [PMID: 35316841 PMCID: PMC8983501 DOI: 10.1007/s00383-022-05094-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Accepted: 02/02/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Enterocystoplasty is adopted for patients requiring bladder augmentation, but significant long-term complications highlight need for alternatives. We established a protocol for creating a natural-derived bladder extracellular matrix (BEM) for developing tissue-engineered bladder, and investigated its structural and functional characteristics. METHODS Porcine bladders were de-cellularised with a dynamic detergent-enzymatic treatment using peristaltic infusion. Samples and fresh controls were evaluated using histological staining, ultrastructure (electron microscopy), collagen, glycosaminoglycans and DNA quantification and biomechanical testing. Compliance and angiogenic properties (Chicken chorioallantoic membrane [CAM] assay) were evaluated. T test compared stiffness and glycosaminoglycans, collagen and DNA quantity. p value of < 0.05 was regarded as significant. RESULTS Histological evaluation demonstrated absence of cells with preservation of tissue matrix architecture (collagen and elastin). DNA was 0.01 μg/mg, significantly reduced compared to fresh tissue 0.13 μg/mg (p < 0.01). BEM had increased tensile strength (0.259 ± 0.022 vs 0.116 ± 0.006, respectively, p < 0.0001) and stiffness (0.00075 ± 0.00016 vs 0.00726 ± 0.00216, p = 0.011). CAM assay showed significantly increased number of convergent allantoic vessels after 6 days compared to day 1 (p < 0.01). Urodynamic studies showed that BEM maintains or increases capacity and compliance. CONCLUSION Dynamic detergent-enzymatic treatment produces a BEM which retains structural characteristics, increases strength and stiffness and is more compliant than native tissue. Furthermore, BEM shows angiogenic potential. These data suggest the use of BEM for development of tissue-engineered bladder for patients requiring bladder augmentation.
Collapse
Affiliation(s)
- Massimo Garriboli
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Department of Nephro-Urology, Evelina London Children's Hospital, Guys and St. Thomas NHS Foundation Trust, London, UK
| | - Koichi Deguchi
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
- Department of Pediatric Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Giorgia Totonelli
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Fanourios Georgiades
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Luca Urbani
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Marco Ghionzoli
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Alan J Burns
- Neural Development Unit, Institute of Child Health, University College London, 30 Guilford Street, London, UK
| | - Neil J Sebire
- Department of Histopathology, Institute of Child Health and Great Ormond Street Hospital, University College London, London, UK
| | - Mark Turmaine
- Division of Bioscience, University College London, London, UK
| | - Simon Eaton
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Paolo De Coppi
- Stem Cells and Regenerative Medicine Section, Developmental Biology and Cancer Programme UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
- Paediatric Surgery Department, Great Ormond Street Hospital, London, UK.
| |
Collapse
|
16
|
Garriboli M, Dzwigala M, Clothier J. Posterior urethral valves and urachal cyst: an unusual combination. BMJ Case Rep 2022; 15:e248460. [PMID: 35418380 PMCID: PMC9014000 DOI: 10.1136/bcr-2021-248460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Combination of posterior urethral valves and urachus remnants has been described as rare occurrence. We report a case of a baby boy with normal antenatal scans, in whom the presence of large urachal cyst and posterior urethral valves causing high pressure bladder and chronic kidney disease was found. The patient underwent ablation of posterior urethral valves at 23 days of life and urachal cyst removal at age of 4 and a half months.
Collapse
Affiliation(s)
- Massimo Garriboli
- Paediatric Nephro-Urology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health, London, UK
| | - Monica Dzwigala
- Paediatric Nephro-Urology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joanna Clothier
- Paediatric Nephro-Urology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
17
|
Chong C, Hamza Y, Tan YW, Paul A, Garriboli M, Wright AJ, Olsburgh J, Taylor C, Sinha MD, Mishra P, Taghizadeh A. Long-term urology outcomes of anorectal malformation. J Pediatr Urol 2022; 18:150.e1-150.e6. [PMID: 35283020 DOI: 10.1016/j.jpurol.2022.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 05/06/2021] [Revised: 12/09/2021] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Urological problems are a recognised feature of anorectal malformation (ARM). Previous assumptions of favourable long-term urinary outcomes are being challenged. OBJECTIVE We hypothesised that urinary tract problems are common in ARM and frequently persist into adulthood. We retrospectively reviewed long-term renal and bladder outcomes in ARM patients. STUDY DESIGN Patients with ARM born between 1984-2005 were identified from electronic hospital databases. Their case notes were reviewed. Renal outcomes included serum creatinine and the need for renal replacement therapy. Bladder outcomes included symptom review, bladder medication, need for intermittent catheterisation, videourodynamics and whether the patient had undergone augmentation cystoplasty. RESULT (TABLE 1): The case notes of 50 patients were reviewed. The median age at last follow up was 18 years (range 12-34 years). The level of fistula was noted to be high in 17 patients, intermediate in eight, and low in 10. Four had cloaca. Congenital urological abnormalities were present in 25 (50%). An abnormal spinal cord was present in 22 (44%) patients. VACTERL association occurred in 27 (54%). Chronic kidney disease stage II or above was found in 14 (28%) patients, of whom four required a renal transplant. Abnormal bladder outcomes were found in 39 (78%) patients. Augmentation cystoplasty with Mitrofanoff had been performed in 12. Of those who had not undergone cystoplasty, 17 had urinary symptoms, including urinary incontinence in 12. Of the 39 patients with abnormal bladder outcome, 19 (49%) did not have a spinal cord abnormality. There was no significant statistical association between level of ARM and abnormal renal outcome or presence of bladder abnormality. DISCUSSION Adverse renal and bladder outcomes are common in our cohort of young people with ARM with a significantly higher incidence compared with current literature. We did not demonstrate an association between level of ARM or presence of spinal cord anomaly with persistent bladder problems. Congenital urological anomalies are more common in those who later have an abnormal renal outcome. Although this difference is statistically significant, one fifth of patients born with anatomically normal upper tracts develop reduced renal function, implying an important acquired component. CONCLUSION Bladder problems and reduced renal function affect a significant proportion of young adults with ARM. Neither adverse outcome is reliably predicted from ARM level, congenital urological anomaly or spinal cord anomaly. We advise continued long-term bladder and kidney follow-up for all patients with ARM.
Collapse
Affiliation(s)
- Clara Chong
- Department of Paediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom; Department of Paediatric Surgery, Evelina London Children's Hospital, London, United Kingdom.
| | - Yaser Hamza
- Kings College London, London, United Kingdom
| | - Yew Wei Tan
- Department of Paediatric Surgery, Evelina London Children's Hospital, London, United Kingdom
| | - Anu Paul
- Department of Paediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Massimo Garriboli
- Department of Paediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Anne J Wright
- Department of Paediatric Nephrourology, Evelina London Children's Hospital, London, United Kingdom
| | - Jonathon Olsburgh
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Claire Taylor
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Manish D Sinha
- Kings College London, London, United Kingdom; Department of Paediatric Nephrourology, Evelina London Children's Hospital, London, United Kingdom
| | - Pankaj Mishra
- Department of Paediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Arash Taghizadeh
- Department of Paediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom; Kings College London, London, United Kingdom
| |
Collapse
|
18
|
Mantica G, Leonardi R, Diaz R, Malinaric R, Parodi S, Tappero S, Paraboschi I, Álvarez-Maestro M, Yuen-Chun Teoh J, Garriboli M, Ortega Polledo LE, Soriero D, Pertile D, De Marchi D, Pini GL, Rigatti L, Ghosh SK, Akanji Onigbinde O, Tafuri A, M Carrion D, Nikles S, Antoni A, Fransvea P, Esperto F, Herbella FA, Oxley da Rocha A, Vanaclocha V, Sánchez-Guillén L, Wainman B, Quiroga-Garza A, Fregatti P, Murelli F, Van der Merwe A, Rivas JG, Terrone C. Reporting ChAracteristics of cadaver training and sUrgical studies: The CACTUS guidelines. Int J Surg 2022; 101:106619. [DOI: 10.1016/j.ijsu.2022.106619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/17/2022] [Accepted: 04/08/2022] [Indexed: 11/10/2022]
|
19
|
Iqbal S, Ibrahim Y, Garriboli M. Appellation Preferences of Parents of Children Attending Hospital. Clin Pediatr (Phila) 2022; 61:289-294. [PMID: 35090348 PMCID: PMC8892054 DOI: 10.1177/00099228211072972] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Communication, carer-health care professional relationship, and power dynamics are important considerations in pediatric health care. There is paucity of evidence about best practice for addressing parents of children in a hospital care setting, potentially affecting health care provision. We surveyed parents attending Evelina London Children's Hospital to assess the preferences of parents to different appellations used by health care professionals to address them and their impact on parents' perception of involvement in the care of their child. Two hundred fifty-four (84.6%) parents responded to the survey. Two hundred one (92.6%) parents did not feel the way they were addressed contributed to them feeling their value was neglected from the care of their child. At the center studied, appellations most acceptable to parents were their first name or "Mum"/"Dad." In current practice, the appellation used most is "Mum"/"Dad," 112 (69.1%) and 40 (62%), respectively.
Collapse
Affiliation(s)
- Shahid Iqbal
- GKT School of Medical Education, Faculty of Life Sciences & Medicine, King’s College London, London, UK,Shahid Iqbal, GKT School of Medical Education, Faculty of Life Sciences & Medicine, King’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, UK.
| | - Youssef Ibrahim
- Paediatric Urology, Evelina London Children’s Hospital, London, UK
| | - Massimo Garriboli
- Paediatric Urology, Evelina London Children’s Hospital, London, UK,Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health, London, UK
| |
Collapse
|
20
|
Garriboli M, Solomon E. On-table urodynamic with ureteric occlusion: A resource for measuring bladder capacity and compliance in the management of patients with gross vesico-ureteric reflux. Neurourol Urodyn 2021; 41:448-455. [PMID: 34888917 DOI: 10.1002/nau.24847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 11/08/2021] [Accepted: 11/13/2021] [Indexed: 11/11/2022]
Abstract
AIM To describe a technique for on-table urodynamic with ureteric occlusion (OUUO) and present a case series comparing bladder capacity and pressure measurements performed with and without ureteric occlusion in patients with gross vesico-ureteric reflux (grade ≥ IV VUR) to highlight the clinical utility. METHODS We performed OUUO in seven patients who were being considered for surgical management of VUR and/or nephro-ureterectomy. We occluded the refluxing ureters using hysterosalpingogram catheters (HSG, single lumen 5.5 Fr catheter with 1.5 ml balloon), guidewires, and rigid cystoscope. A 6 Fr dual-lumen urodynamic (UD) catheter is then inserted into the bladder to perform OUUO. Bladder capacity and Compliance (C = ∆bladder volume/∆detrusor pressure) are recorded and compared with values obtained at standard UD (without ureteric occlusion). RESULTS The age range of the seven patients was 2.0-15.5 years. The etiology for the gross VUR were posterior urethral valve (PUV) and neuropathic. The bladder capacity and compliance finding between UD and OUUO findings were comparable in five patients. However, there was a clinically significant difference in bladder capacity (20%-50% decrease) and compliance (50%-90%) between UD and OUUO findings in two out of seven patients. CONCLUSION In the presence of gross VUR, OUUO allows for a potentially more accurate assessment of bladder capacity and compliance. OUUO should be considered when planning ureteric opening bulking/reimplantation and nephro-ureterectomy.
Collapse
Affiliation(s)
- Massimo Garriboli
- Paediatric Urology, Evelina London Children's Hospital, London, UK.,Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health, London, UK
| | - Eskinder Solomon
- Paediatric Urology, Evelina London Children's Hospital, London, UK.,Department of Urology, Guy's Hospital, Great Maze Pond, London, UK
| |
Collapse
|
21
|
Mosa H, Giannettoni A, Patil K, Mishra P, Taghizadeh A, Paul A, Garriboli M. Pediatric Nephrectomy: Comparison of Perioperative Outcomes of Three Different Minimally Invasive and Open Approaches. J Laparoendosc Adv Surg Tech A 2021; 31:1466-1470. [PMID: 34847738 DOI: 10.1089/lap.2021.0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Minimally invasive surgery (MIS) is now the gold standard for nephrectomy in pediatric patients. Retroperitoneoscopic (using either one or two instruments) and transperitoneal (TP) approaches are described. We compared the perioperative outcomes of different techniques [single-instrument retroperitoneoscopic (SIRP), two-instrument retroperitoneoscopic (TIRP), TP, and open approach]. Patients and Methods: Retrospective review of patients who underwent nephrectomy surgery in the period from January 2009 to January 2020 at a single center was carried out. We excluded patients who underwent other procedures under the same anesthetic, underwent heminephrectomy, and those with incomplete records. The primary outcome measures were operative time, intraoperative complications, postoperative complications, and length of hospital stay. One-way analysis of variance (ANOVA) test was used to analyze continuous variables. Chi square test was used to compare categorical variables. Results: A total of 213 nephrectomies were analyzed; SIRP (n = 35), TIRP (n = 50), TP (n = 74), and open (n = 54). Median age (months) was 71 for SIRP, 113 for TIRP, 67 for TP, and 21 for open. No statistical difference was identified for mean operative time (P = .067) or mean hospital stay (P = .69). Intraoperative complications were significantly more in the open group (P = .03). Postoperative complications were rare and only noted in the open group. There was no conversion to open surgery in the SIRP and TIRP groups. Conversion rate was 5.4% (4/74) in the TP group. Conclusion: MIS nephrectomy is safe, and no difference among techniques (SIRP, TIRP and TP) has been demonstrated. They are comparable to open surgery in terms of operative time and hospital stay, but are associated with significantly less complications.
Collapse
Affiliation(s)
- Hazem Mosa
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Adele Giannettoni
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Kalpana Patil
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Pankaj Mishra
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Arash Taghizadeh
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Anu Paul
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Massimo Garriboli
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom.,Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health, Evelina Children's Hospital, London, United Kingdom
| |
Collapse
|
22
|
Garriboli M, Ibrahim S, Clothier J. Spontaneous bladder rupture secondary to posterior urethral valves in a boy with Down syndrome. BMJ Case Rep 2021; 14:e240857. [PMID: 34551910 PMCID: PMC8461274 DOI: 10.1136/bcr-2020-240857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 11/04/2022] Open
Abstract
We describe a case of a 3-year-old boy with Down syndrome who developed a bladder rupture as a consequence of an undiagnosed posterior urethral valve (PUV). He had a history of urinary tract infections and constipation and was acutely admitted in poor condition and underwent laparotomy that revealed peritoneal sepsis secondary to bladder perforation. Bladder was drained using a suprapubic catheter and the condition of the boy gradually improved. Once stable, a cystourethroscopy confirmed the presence of PUV. Video-urodynamic studies performed at the check cystoscopy showed the bladder to be of reduced compliance (end fill pressure at 100 mL fill 30 cmH2O) with raised voiding pressures (76-100 cmH2O) and significant incomplete bladder emptying. Currently, the patient is doing very well, serum creatinine has normalised, he is infection-free and thriving; his bladder is managed with a vesicostomy.
Collapse
Affiliation(s)
- Massimo Garriboli
- Department of Nephro-Urology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL, London, UK
| | - Shimaa Ibrahim
- Department of Nephro-Urology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joanna Clothier
- Department of Nephro-Urology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
23
|
Bhandarkar KP, Paul A, Mishra P, Taghizadeh A, Garriboli M. Perioperative morbidity of paediatric laparoscopic nephrectomy by transperitoneal and retroperitoneal approaches- any difference? Scand J Urol 2021; 55:257-261. [PMID: 33825673 DOI: 10.1080/21681805.2021.1908419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM Minimal invasive approaches for paediatric nephrectomy include transperitoneal (TP) and retroperitoneal (RP); both having advantages and disadvantages. We aimed to ascertain if there was any difference in perioperative morbidities between these two approaches. METHODS We performed a retrospective review of laparoscopic TP and RP nephrectomies performed in our institution over 10 years from May 2009 till May 2019. Outcome measures included intraoperative complications, prolonged requirement of opioid analgesics (more than 24 h), hospital stay, incidence of wound infection and urinary tract infections. Data were analysed using Fisher's exact test and Mann Whitney test. RESULTS A total of 152 nephrectomies were performed in 139 patients; 81 were TP and 71 were RP. Age ranged from 8 months to 16 years. Median hospital stay was 2 days in both groups. There were no intraoperative complications. Outcome measures were sub-categorised as follows. Requirement of opioid analgesia for more than 24 h was documented in 2 patients in each group, leading to longer hospital stay of 3 days. A febrile urinary tract infection requiring antibiotics was detected in 4; 1 in TP and 3 in RP. Wound infection requiring antibiotics occurred in 1 patient (in RP group). No statistically significant difference was found between the two groups in any of the subcategories. CONCLUSION TP and RP nephrectomy have similar perioperative morbidity. The decision to utilise either approach should be dependent on the surgeon's skills and experience and appropriately tailored to individual patient needs.
Collapse
Affiliation(s)
| | - Anu Paul
- Paediatric Urology, Evelina London Children's Hospital, London, UK
| | - Pankaj Mishra
- Paediatric Urology, Evelina London Children's Hospital, London, UK
| | - Arash Taghizadeh
- Paediatric Urology, Evelina London Children's Hospital, London, UK
| | - Massimo Garriboli
- Paediatric Urology, Evelina London Children's Hospital, London, UK.,Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health, London, UK
| |
Collapse
|
24
|
Paraboschi I, Jannello L, Mantica G, Roberts L, Olubajo S, Paul A, Mishra P, Taghizadeh A, Garriboli M. Outcomes and costs analysis of Externalized PyeloUreteral versus internal Double-J ureteral stents after paediatric laparoscopic Anderson-Hynes pyeloplasty. J Pediatr Urol 2021; 17:232.e1-232.e7. [PMID: 33388262 DOI: 10.1016/j.jpurol.2020.12.006] [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: 10/19/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The gold standard treatment for Uretero-Pelvic Junction Obstruction (UPJO) is laparoscopic dismembered pyeloplasty according to the Anderson-Hynes technique. The internal Double-J ureteral (DJ) and the Externalized PyeloUreteral (EPU) stents are usually the drainage of choice. Only a few articles have compared the clinical impact of the different drainage techniques on the perioperative morbidity and none presented a cost analysis of the incurred hospital stay. OBJECTIVE To present the clinical outcome and financial analysis of a cohort of children who underwent a laparoscopic pyeloplasty comparing the use of the DJ versus EPU stent. STUDY DESIGN Retrospective study of consecutives children who underwent laparoscopic Anderson-Hynes pyeloplasty in a single tertiary paediatric referral centre from January 2017 to March 2020. Patients were grouped according to the type of stent used: DJ stent vs EPU stent. RESULTS Fifty-three laparoscopic pyeloplasties were performed on 51 patients: 27 (50.9%) had an EPU stent and 26 (49.1%) a DJ stent. There was no statistically significant difference between the two patient groups with regards to surgical time, hospital stay, stent-related complications or the need for re-do surgery. All the EPU stents were removed with an outpatient admission 8.1 days ± 3.1 after surgery while the DJ stents were removed with a cystoscopy 61.6 days ± 30.2 after surgery (p value < 0.001). On a financial analysis (Figure), the hospital costs for stent removal were significantly lower for the EPU stent group (£ 686.7 ± 263.4 vs £ 1425 ± 299.5, p value < 0.01). DISCUSSION Both drainage methods have some disadvantages. Possible complications associated with DJ stents include migration and artificial vesicoureteral reflux which may lead to higher incidence of Urinary Tract Infections. Possible disadvantages of the EPU stent insertion are related to the damage of the renal parenchyma and to the risk of developing skin site infections and urinary leaks. However, in our series the EPU stent has not been associated with a higher incidence of bleeding, leakage or discomfort. In addition to clinical considerations, there is a financial implication to be considered. With this regard, the EPU stent was associated with a significant reduction in the incurred hospital costs. CONCLUSIONS The use of DJ and EPU stents is equivalent in regards of overall complications and success rates. DJ and EPU stents provided comparable success and complication rates, however the latter avoids the need of an additional general anaesthesia and reduces the overall incurred hospital costs.
Collapse
Affiliation(s)
- Irene Paraboschi
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom; DINOGMI University of Genoa, Genoa, Italy; Paediatric Surgery Unit, Giannina Gaslini Research Institute and Children Hospital, Genoa, Italy
| | - Letizia Jannello
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Guglielmo Mantica
- DINOGMI University of Genoa, Genoa, Italy; Department of Urology, San Martino Hospital, University of Genoa, Genoa, Italy
| | - Luke Roberts
- Health Informatics, Evelina London Children's Hospital, London, United Kingdom
| | - Seyi Olubajo
- Financial Developments and Costing, Finance, Guy's and St Thomas Foundation Trust
| | - Anu Paul
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Pankaj Mishra
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Arash Taghizadeh
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Massimo Garriboli
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom; Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health.
| |
Collapse
|
25
|
Mosa H, Garriboli M. Congenital Anterior Urethrocutaneous Fistula with a Persistent Urethral Groove. European J Pediatr Surg Rep 2021; 9:e9-e12. [PMID: 33532172 PMCID: PMC7846429 DOI: 10.1055/s-0040-1721469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/09/2020] [Indexed: 11/27/2022] Open
Abstract
Congenital anterior urethrocutaneous fistula (CAUF) is a rare penile anomaly with only 63 cases reported in the literature. The anomaly can present in isolation or in association with chordee or hypospadias. We report the case of an 8-month-old boy with CAUF that resembles the embryological urethral groove. On examination, a wide urethral groove was noted to cover the midshaft of the penis with a well formed urethra extending proximally and distally and with a normal glandular anatomy, a wide glandular meatus, and a complete foreskin. The urethral groove was tubularized and covered in layers. Surgery was complicated with early superficial skin dehiscence not affecting the urethral repair. Refashioning of the skin was then performed. A satisfactory aesthetic and functional outcome was observed at 7 years' follow-up. Defining the anatomy of CAUF and distal urethra is key in management of these children.
Collapse
Affiliation(s)
- Hazem Mosa
- Department of Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Massimo Garriboli
- Department of Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| |
Collapse
|
26
|
Mantica G, Malinaric R, Dotta F, Paraboschi I, Guano G, Rebuffo S, Garriboli M, Suardi N, Van der Merwe A, Terrone C. Urology apps: overview of current types and use. Cent European J Urol 2020; 73:369-372. [PMID: 33133667 PMCID: PMC7587494 DOI: 10.5173/ceju.2020.0090] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/20/2020] [Accepted: 07/23/2020] [Indexed: 01/22/2023] Open
Abstract
Introduction In recent years numerous applications have been developed with different purposes, aimed both at simplifying the lives of doctors and patients also within the urological field. Material and methods In January 2020 we conducted a search in the Apple App Store and Google Play Store. Results A total of 521 apps were reviewed, an increase of 8 times as compared to the last complete available review of eight years ago. Most of the urological apps are geared towards the patient and provide information and services to improve the understanding and treatment of different diseases. Some of these apps also get the patient directly in touch with healthcare staff allowing for an improvement in doctor-patient communication. Conclusions Although the usefulness of many of these tools is undoubted, the problem of scientific validation, content control and privacy are not yet solved.
Collapse
Affiliation(s)
- Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Italy
| | - Rafaela Malinaric
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Italy
| | - Federico Dotta
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Italy
| | - Irene Paraboschi
- Paediatric Surgery Unit, Istituto Giannina Gaslini, DiNOGMI University of Genova, Italy
| | - Giovanni Guano
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Italy
| | - Silvia Rebuffo
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Italy
| | - Massimo Garriboli
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Nazareno Suardi
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Italy
| | - André Van der Merwe
- Department of Urology, Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Italy
| |
Collapse
|
27
|
Garriboli M, Mishra P, Taghizadeh A, Paul A. The Response of a Tertiary Paediatric Urology Unit to the COVID-19 Pandemic in central London: what have we learned? Br J Surg 2020; 107:e578-e580. [PMID: 32924140 PMCID: PMC7929335 DOI: 10.1002/bjs.11978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Pankaj Mishra
- Paediatric Urology Department, Evelina London Children's Hospital
| | - Arash Taghizadeh
- Paediatric Urology Department, Evelina London Children's Hospital
| | - Anu Paul
- Paediatric Urology Department, Evelina London Children's Hospital
| |
Collapse
|
28
|
Mantica G, Pini G, De Marchi D, Paraboschi I, Esperto F, Van der Merwe A, Van Deventer H, Garriboli M, Suardi N, Terrone C, Leonardi R. Intensive simulation training on urological mini-invasive procedures using Thiel-embalmed cadavers: The IAMSurgery experience. Arch Ital Urol Androl 2020; 92. [PMID: 32597107 DOI: 10.4081/aiua.2020.2.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 12/07/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The objective of the study was to evaluate the benefits perceived by the use of cadaver models by IAMSurgery attendees and to define indications to standardize future similar training camps. MATERIALS AND METHODS A 25-item survey was distributed via e-mail to all the participants of previous training courses named as "Urological Advanced Course on Laparoscopic Cadaver Lab" held at the anatomy department of the University of Malta, for anonymous reply. Participants were asked to rate the training course, the Thiel's cadaveric model, and make comparison with other previously experienced simulation tools. RESULTS The survey link was sent to 84 attendees, with a response rate of 47.6% (40 replies). There was improvement in the median self-rating of the laparoscopic skills before and after the training camp with a mean difference of 0.55/5 points in the post-training skills compared to the basal (p < 0.0001). The 72.2% of the urologists interviewed considered Thiel's HCM better than other training methods previously tried, while five urologists (27.8%) considered it equal (p = 0.00077). Globally, 77.5% (31) of attendees found the training course useful, and 82.5% (33) would advise it to colleagues. CONCLUSIONS Thiel's fixed human cadaveric models seem to be ideal for training purposes, and their use within properly structured training camps could significantly improve the surgical skills of the trainees. An important future step could be standardization of the training courses using cadavers, and their introduction into the standardized European curriculum.
Collapse
Affiliation(s)
- Guglielmo Mantica
- IAMSurgery, International Accademy of Miniinvasive Surgery; Department of Urology, Policlinico San Martino Hospital, University of Genova.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
Antenatal hydronephrosis is a common finding detected on prenatal ultrasound. Although hydronephrosis will spontaneously resolve in the majority of newborns, there is a significant amount of cases that will worsen with the risk of a progressive and permanent loss of renal function. There is an increasing concern among experts that the current criteria for evaluation of clinically significant obstructions are limited. Our aim is to provide a systematic review of the available literature on biomarkers of renal injury, potential targets for diagnosis and prognosis of children with hydronephrosis. The main search was conducted in the electronic databases from inception through March 2019 using various combinations of the keywords: pelvic-ureteric [All Fields] AND junction [All Fields] AND obstruction [All Fields] AND “biomarkers” [MeSH Terms] OR “biomarkers” [All Fields] OR “biomarker” [All Fields]. To broaden the research, additional articles were identified through hand-searching review of the references reported in each study previously selected. Histopathological studies, studies with no control group or with participants suffering from concomitant urological diseases and articles published in language other than English were excluded. Data on study design, sample size, average patient age, hydronephrosis definition used, surgical indication, duration and pattern of follow-up, details on biomarker studied, diagnostic test characteristics, area under the curve (AUC) on receiver operating characteristic (ROC) analysis with the best cut-off (BCO) values, sensitivity, specificity and outcomes were all collected. 38 articles analysing 41 biomarkers were selected. The most frequent proteins investigated were neutrophil gelatinase-associated lipocalin (NGAL) (n=9; 23.7%), monocyte chemotactic peptide-1 (MCP1) (n=8; 21.1%), transforming growth factor β1 (TGFβ1) (n=7; 18.4%), epidermal growth factor (EGF) (n=6; 15.8%) and kidney injury molecule 1 (KIM 1) (n=6; 15.8%). Twenty-seven (71.1%) studies evaluated the effect of pyeloplasty on voided urine biomarker concentrations, comparing their values before and after surgery. Twelve (31.6%) studies investigated the correlation between preoperative biomarker concentration and the anterior posterior renal pelvis diameter (DAP) while 20 (52.6%) studies investigated the correlation between preoperative biomarker concentration with the split renal function (SRF) measured on nuclear medicine assessments. ROC curves were used to investigate the performance of urinary biomarkers in the total patient data set in 27 (71.1%) studies. Some biomarkers offer promising results. However, a critic analysis of the published studies demonstrates bias and lack of consistency suggesting that larger multicentre and carefully designed prospective studies are still needed to evaluate the clinical usefulness of urinary biomarkers in the diagnosis and follow-up of children with congenital obstructive hydronephrosis.
Collapse
Affiliation(s)
- Irene Paraboschi
- Paediatric Surgery Unit, Istituto Giannina Gaslini, DiNOGMI, University of Genova, Genoa, Italy
| | - Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Neil R Dalton
- WellChild Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Charles Turner
- WellChild Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | | |
Collapse
|
30
|
Abstract
We present a rare case of association of anterior rectal duplication and posterior urethral valve (PUV). A term neonate with no antenatal concerns was admitted with urosepsis and acute renal injury at 18 days of age. History revealed a poor urinary stream and dribbling. After resuscitation and stabilisation, renal tract ultrasound and micturating cysto-urethrogram were performed. Cystourethroscopy showed PUV and a mass indenting the bladder posteriorly. MRI confirmed the presence of a cystic lesion anterior to the rectum suspicious of rectal duplication. Laparoscopic-assisted excision of the anterior rectal duplication cyst was then performed. The infant recovered uneventfully. Creatinine normalised postoperatively and has been stable at follow-up.
Collapse
Affiliation(s)
| | | | - Massimo Garriboli
- Paediatric Urology, Evelina London Children's Healthcare, London, UK
| |
Collapse
|
31
|
Manuele R, Senni C, Patil K, Taghizadeh A, Garriboli M. Foreskin reconstruction at the time of single-stage hypospadias repair: is it a safe procedure? Int Urol Nephrol 2018; 51:187-191. [PMID: 30506425 DOI: 10.1007/s11255-018-2043-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/22/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Foreskin reconstruction (FR) is a recognised, yet debated, option for patients undergoing single-stage hypospadias repair (HR). METHODS We evaluated the incidence of complications after single-stage HR in our institution. This is a retrospective review of all single-stage HR. Patients were classified into group 1 (circumcision) and group 2 foreskin reconstruction (FR). Urethroplasty and foreskin complications were recorded. Statistics used are as follows: Mann-Whitney test to compare age at operation and length of follow-up (FU); Chi-Square test to analyse the incidence of urethral complications and need for reoperation; Log rank test to compare the survival curves; p statistically significant < 0.05. Data are presented as median (range). RESULTS 304 patients were identified, operated between January 2010 and December 2016, and 20 were excluded: 6 already circumcised at the time of the surgery, 3 with megameatus intact prepuce, 11 lost at FU. 284 patients were included: 161 circumcised and 123 FR. Median age at the operation was 17 months (8-179) (group 1) and 17 months (8-148) (group 2) (p = 0.71). Length of FU was 19 months (8-91) (group 1) and 17 months (4-87) (group 2) (p = 0.45). The survival curve was homogeneous (p = 0.28). Urethroplasty complications occurred in 32/161 (20%) (group 1) and in 21/123 (17%) (group 2) (p = 0.55). Foreskin complications occurred in 18/123 (15%). A second operation was required in 33 boys in each group, (20% group 1 and 27% group 2) (p = 0.21). CONCLUSION FR does not increase the complication rate or the need for a reoperation after single-stage HR. Parents should be offered the option between the two procedures according to their personal preference.
Collapse
Affiliation(s)
- Riccardo Manuele
- Paediatric Urology, Evelina London Children's Hospital, London, UK.
| | - Carlotta Senni
- Paediatric Urology, Evelina London Children's Hospital, London, UK
| | - Kalpana Patil
- Paediatric Urology, Evelina London Children's Hospital, London, UK
| | - Arash Taghizadeh
- Paediatric Urology, Evelina London Children's Hospital, London, UK
| | | |
Collapse
|
32
|
Davidson JR, Wright NJ, Garriboli M. Urethral Duplication with Two Hypospadic Meati-An Unusual Variant. European J Pediatr Surg Rep 2016; 4:37-40. [PMID: 28018807 PMCID: PMC5177562 DOI: 10.1055/s-0036-1588015] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 07/18/2016] [Indexed: 11/16/2022] Open
Abstract
Duplication of the urethra is a rare congenital anomaly, with approximately 300 cases reported in the literature. We report a unique case of this condition in a male infant. This case differs from the classical Effman type II-A2 duplication because of the presence of two hypospadic urethral meati, as opposed to a ventral or dorsal accessory meatus with a normally positioned distal urethra. The patient underwent a single-stage repair consisting of a proximal urethra-urethral anastomosis and distal urethral tubularization at 21 months of age with excellent results in terms of both function and cosmesis.
Collapse
Affiliation(s)
| | - Naomi Jane Wright
- Department of Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| | - Massimo Garriboli
- Department of Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom
| |
Collapse
|
33
|
Duess JW, Zani-Ruttenstock EM, Garriboli M, Puri P, Pierro A, Hoellwarth ME. Outcome of right-sided diaphragmatic hernia repair: a multicentre study. Pediatr Surg Int 2015; 31:465-71. [PMID: 25801417 DOI: 10.1007/s00383-015-3695-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 03/11/2015] [Indexed: 11/29/2022]
Abstract
AIM Right-sided congenital diaphragmatic hernia (R-CDH) occurs in 14 to 25% of all CDH cases. The current literature comparing the outcome of R-CDH vs left CDH (L-CDH) is inconsistent, with some studies reporting higher and others lower mortality in R-CDH compared to L-CDH. The aim of our multicentre study was to analyse characteristics and outcome of R-CDH. METHODS We retrospectively reviewed the medical records of 178 consecutive infants with CDH who underwent surgical repair of CDH at three European tertiary pediatric surgical centres from three different countries between 2000 and 2009. The analysis focused on demographic data, morbidity and mortality in R-CDH compared with L-CDH. RESULTS Out of a total of 178 children, 32 (18.0%) right-sided and 146 (82.0 %) left-sided cases of CDH were identified. Prenatal diagnosis was made in 8 R-CDH vs 67 L-CDH (25.0 vs 45.9%, p = 0.030). Median gestational age in R-CDH was 39 weeks (range 29-42 weeks) and 39 weeks in L-CDH (range 28-43 weeks, p = 0.943). Median birth weight in R-CDH was 3233 g (range 905-4480 g) and in L-CDH was 3060 g (range 1065-5240 g, p = 0.184). Major associated anomalies were present in 19 R-CDH vs 46 L-CDH (59.4 vs 31.5%, p = 0.003). Extracorporeal membrane oxygenation (ECMO) was required in 3 R-CDH vs 19 L-CDH (9.4 vs 13.0%, p = 0.571). A diaphragmatic patch was used in 13 R-CDH and 59 L-CDH (40.6 vs 40.4%, p = 0.982). Fundoplication for GERD was required in 1 R-CDH and 19 L-CDH (3.1 vs 13.0 %, p = 0.109). No significant differences were observed in recurrence rate (9.4 vs 8.9%, p = 0.933). Postoperative mortality rate was significantly higher in R-CDH compared to L-CDH (21.9 vs 8.2%, p = 0.023). In R-CDH, prenatal diagnosis and patch repair correlated with mortality by univariate regression (p = 0.005 and p = 0.019). CONCLUSION This multicentre study shows that prenatal diagnosis and patch repair were associated with an increased mortality rate in R-CDH. However, the morbidity following repair of R-CDH was not significantly different from that in L-CDH in survivors.
Collapse
Affiliation(s)
- Johannes W Duess
- Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria,
| | | | | | | | | | | |
Collapse
|
34
|
Abstract
Regenerative medicine is an emerging field that is focused on the repair, replacement or regeneration of tissues and organs. It involves multiple disciplines dedicated to delivering different aspects of the regeneration process, including cell biology, material sciences and bioengineering. The development of tissue engineering strategies incorporating the use of autologous stem cells holds particular promise for overcoming insufficiencies from using cells from the patient's own diseased tissues and providing solutions for treatment of many disorders of the genitourinary tract. Many experimental projects have successfully utilized stem cells and several pilot studies in humans indicate the potential of stem cell therapy. However, the discipline is still young and further knowledge of both materials and stem cell biology is required before this promise can be realized through clinical application. This review examines the principles related to regenerative medicine and bioengineering focusing on the stem cell isolation expansion and clinical application. Analysis of current achievements will be reviewed alongside the challenges that remain to be addressed in considering the present and future perspectives of regenerative medicine applied to urology.
Collapse
Affiliation(s)
- Massimo Garriboli
- Department of Paediatric Urology, Evelina Children's Hospital, Guy's and St. Thomas NHS Foundation Trust, London, United Kingdom
| | - Anna Radford
- Department of Biology, Jack Birch Unit of Molecular Carcinogenesis, University of York, York, United Kingdom
| | - Jennifer Southgate
- Department of Biology, Jack Birch Unit of Molecular Carcinogenesis, University of York, York, United Kingdom
| |
Collapse
|
35
|
Ghionzoli M, Repele A, Sartiani L, Costanzi G, Parenti A, Spinelli V, David AL, Garriboli M, Totonelli G, Tian J, Andreadis ST, Cerbai E, Mugelli A, Messineo A, Pierro A, Eaton S, De Coppi P. Human amniotic fluid stem cell differentiation along smooth muscle lineage. FASEB J 2013; 27:4853-65. [PMID: 23995291 PMCID: PMC6188351 DOI: 10.1096/fj.12-218578] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 08/19/2013] [Indexed: 12/11/2022]
Abstract
Functional smooth muscle engineering requires isolation and expansion of smooth muscle cells (SMCs), and this process is particularly challenging for visceral smooth muscle tissue where progenitor cells have not been clearly identified. Herein we showed for the first time that efficient SMCs can be obtained from human amniotic fluid stem cells (hAFSCs). Clonal lines were generated from c-kit(+) hAFSCs. Differentiation toward SM lineage (SMhAFSCs) was obtained using a medium conditioned by PDGF-BB and TGF-β1. Molecular assays revealed higher level of α smooth muscle actin (α-SMA), desmin, calponin, and smoothelin in SMhAFSCs when compared to hAFSCs. Ultrastructural analysis demonstrated that SMhAFSCs also presented in the cytoplasm increased intermediate filaments, dense bodies, and glycogen deposits like SMCs. SMhAFSC metabolism evaluated via mass spectrometry showed higher glucose oxidation and an enhanced response to mitogenic stimuli in comparison to hAFSCs. Patch clamp of transduced hAFSCs with lentiviral vectors encoding ZsGreen under the control of the α-SMA promoter was performed demonstrating that SMhAFSCs retained a smooth muscle cell-like electrophysiological fingerprint. Eventually SMhAFSCs contractility was evident both at single cell level and on a collagen gel. In conclusion, we showed here that hAFSCs under selective culture conditions are able to give rise to functional SMCs.
Collapse
Affiliation(s)
- Marco Ghionzoli
- 2UCL Institute of Child Health and Great Ormond St. Hospital for Children, 30 Guilford St., London WC1N 1EH, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Mushtaq I, Garriboli M, Smeulders N, Cherian A, Desai D, Eaton S, Duffy P, Cuckow P. Primary bladder exstrophy closure in neonates: challenging the traditions. J Urol 2013; 191:193-7. [PMID: 23871929 DOI: 10.1016/j.juro.2013.07.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE We describe a novel approach to neonatal bladder exstrophy closure that challenges the role of postoperative immobilization and pelvic osteotomy. MATERIALS AND METHODS We reviewed the primary management of bladder exstrophy at our institutions between 2007 and 2011. In particular we compared postoperative management in the surgical ward using epidural analgesia to muscle paralysis and ventilation in the intensive care unit. Clinical outcome measures were time to full feed, length of stay, postoperative complications and redo closure. Cost-effectiveness was also evaluated using hospital financial data. Data are expressed as median (range). Significance was explored by Fisher exact test and unpaired t-test. RESULTS A total of 74 patients underwent primary closure without osteotomy. Successful closure was achieved in 70 patients (95%). A total of 48 cases (65%) were managed on the ward (group A) and 26 (35%) were transferred to the intensive care unit (group B). The 2 groups were homogeneous for gestational age (median 39 weeks, range 27 to 41) and age at closure (3 days, 1 to 152). Complications requiring surgical treatment were noted in 4 patients (8.3%) in group A and 3 (11.5%) in group B (p = 0.609). Length of stay was significantly shorter for the group managed on the ward (11 vs 18 days, p <0.0001). Median costs were $42,732 for patients admitted to the intensive care unit and $16,214 for those admitted directly to the surgical ward (p <0.0001). CONCLUSIONS Primary closure of bladder exstrophy without lower limb immobilization and osteotomy is feasible. Postoperative care on the surgical ward using epidural analgesia results in shorter hospitalization.
Collapse
Affiliation(s)
- I Mushtaq
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - M Garriboli
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom; Department of Pediatric Surgery, UCL Institute of Child Health, London, United Kingdom
| | - N Smeulders
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - A Cherian
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - D Desai
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - S Eaton
- Department of Pediatric Surgery, UCL Institute of Child Health, London, United Kingdom
| | - P Duffy
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - P Cuckow
- Department of Pediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| |
Collapse
|
37
|
Bishay M, Lakshminarayanan B, Arnaud A, Garriboli M, Cross KM, Curry JI, Drake D, Kiely EM, De Coppi P, Pierro A, Eaton S. The role of parenteral nutrition following surgery for duodenal atresia or stenosis. Pediatr Surg Int 2013. [PMID: 23187894 DOI: 10.1007/s00383-012-3200-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 10/27/2022]
Abstract
PURPOSE In our institution, some children routinely receive parenteral nutrition (PN) following surgery for duodenal atresia/stenosis, while others do not. Our aim was to compare growth and infection rate between these two treatment strategies. METHODS This was a retrospective study of all children undergoing surgery for duodenal atresia/stenosis over 7 years. RESULTS Of the 54 children, 19 commenced PN soon after surgery (the 'Initial PN' group). Of the remaining 35 children, 13 (37 %) subsequently required PN (the 'Delayed PN' group). The remaining 22 never received PN (the 'Never PN' group). The proportion of patients experiencing clinically suspected sepsis was higher in those receiving PN ('Initial' plus 'Delayed'; 41 %) compared with those who never received PN (14 %; p = 0.04). The 'Initial PN' and 'Never PN' groups did not show a significant change in weight Z score over time. However, the 'Delayed PN' group showed a significant decrease in weight Z scores from the time of operation to the time of achieving full enteral feeds, and failed to catch up by the time of last follow-up. CONCLUSION Children with duodenal atresia/stenosis can be managed without PN. However, a third of these children subsequently require PN, lose weight centiles, and have a high rate of sepsis.
Collapse
Affiliation(s)
- M Bishay
- Surgery Unit, Department of Paediatric Surgery, UCL Institute of Child Health and Great Ormond Street Hospital for Children, 30 Guilford Street, London, WC1N 1EH, UK
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Garriboli M, Eaton S, Pierro A, De Coppi P. More patches or more lung in congenital diaphragmatic hernia? J Pediatr Surg 2012; 47:1968-9. [PMID: 23084221 DOI: 10.1016/j.jpedsurg.2012.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 06/29/2012] [Indexed: 11/26/2022]
|
39
|
López-Fernández S, Hernández F, Hernández-Martín S, Barrena S, Wang Z, Zou W, Andrés AM, Encinas JL, Garriboli M, Largo C, López-Santamaría M, Tovar JA. [Technical aspects of experimental intestinal transplant]. Cir Pediatr 2012; 25:103-108. [PMID: 23113399] [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: 06/01/2023]
Abstract
PURPOSE Our objective is to analyze the variables that influence the outcome of Small Bowel Transplantation (SBT) in rats in an experimental microsurgery program. The surgical technique and perioperative care are described in detail. METHODS Retrospective study of the SBT in rats conducted in our experimental surgery laboratory from 2002 to 2010. The animals were divided into group A (those who survived more than 48 hours) and group B (those who died earlier without justificable cause). We compared in both groups: number of transplants performed by the surgeon, warm ischemia time, cold ischemia time and duration of the procedure. RESULTS Five surgeons with different degrees of microsurgical training participated in the study. A total of 521 SBT were performed with an overall survival of 48%. The first successful transplant was performed after a median of 46 (25-68) transplants. Total procedure time (3.5 vs 2.9 hours) and warm ischemia time (51 vs 35 minutes) were higher in group B (p < 0.05). DISCUSSION The number of transplants required for learning the technique is high. However, survival is acceptable when the time needed for vascular anastomosis is reduced. The SBT in rats is a valuable model for surgical training and research of the phenomena related to SBT.
Collapse
Affiliation(s)
- S López-Fernández
- Departamento de Cirugía Pediátrica, Hospital Universitario La Paz, Madrid.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Totonelli G, Maghsoudlou P, Garriboli M, Riegler J, Orlando G, Burns AJ, Sebire NJ, Smith VV, Fishman JM, Ghionzoli M, Turmaine M, Birchall MA, Atala A, Soker S, Lythgoe MF, Seifalian A, Pierro A, Eaton S, De Coppi P. A rat decellularized small bowel scaffold that preserves villus-crypt architecture for intestinal regeneration. Biomaterials 2012; 33:3401-10. [PMID: 22305104 PMCID: PMC4022101 DOI: 10.1016/j.biomaterials.2012.01.012] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 01/05/2012] [Indexed: 12/20/2022]
Abstract
Management of intestinal failure remains a clinical challenge and total parenteral nutrition, intestinal elongation and/or transplantation are partial solutions. In this study, using a detergent-enzymatic treatment (DET), we optimize in rats a new protocol that creates a natural intestinal scaffold, as a base for developing functional intestinal tissue. After 1 cycle of DET, histological examination and SEM and TEM analyses showed removal of cellular elements with preservation of the native architecture and connective tissue components. Maintenance of biomechanical, adhesion and angiogenic properties were also demonstrated strengthen the idea that matrices obtained using DET may represent a valid support for intestinal regeneration.
Collapse
Affiliation(s)
- Giorgia Totonelli
- Surgery Unit, Institute of Child Health and Great Ormond Street Hospital, University College London, London WC1N 1EH, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Encinas Hernández JL, Soto C, García-Cabezas MA, Pederiva F, Garriboli M, Rodríguez R, Peiró JL, Carceller F, López-Santamaría M, Tovar JA. Brain malformations in the sheep model of myelomeningocele are similar to those found in human disease: preliminary report. Pediatr Surg Int 2008; 24:1335-40. [PMID: 18989683 DOI: 10.1007/s00383-008-2276-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [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: 11/29/2022]
Abstract
PURPOSE To examine if brain malformations, similar to those which account for cognitive disorders seen in human disease, are present in an ovine model of myelomeningocele (MMC). METHODS An MMC-like lesion was surgically created in 16 fetal lambs between 60 and 80 days of gestation. Ten did not undergo fetal repair (group A), 2 were repaired with an open two-layer closure (group B), 2 with open bioglue coverage (group C) and 2 with fetoscopic coverage (group D). Lambs were killed and their brains were examined. Two brains from normal unoperated lambs served as controls. RESULTS Thirteen lambs died in utero (81%). Two lambs in group A and 1 in group B were delivered at term. Group A brains showed hydrocephalus and extensive areas of polymicrogyria. There was also an extensive denudation of the ependymal lining under the polymicrogyric areas and the corpus callosum was thinner than normal. No hindbrain herniation was observed. Brains from group B and the control did not show any of these abnormalities. CONCLUSIONS Some of the central nervous system abnormalities associated to MMC in human patients are also found in the uncorrected fetal lamb model of MMC but not in the only survivor to intrauterine coverage. Further studies are necessary to ascertain if these abnormalities can be prevented by coverage of the defect.
Collapse
Affiliation(s)
- Jose Luis Encinas Hernández
- Department of Pediatric Surgery, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|