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Taghavi K, Sarnacki S, Blanc T, Boyer O, Heloury Y. The rationale for nephron-sparing surgery in unilateral non-syndromic Wilms tumour. Pediatr Nephrol 2024; 39:1023-1032. [PMID: 37603086 PMCID: PMC10899288 DOI: 10.1007/s00467-023-06099-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 08/22/2023]
Abstract
The central question of nephron-sparing surgery in unilateral non-syndromic Wilms tumour sits at a crossroads between surgery, oncology, and nephrology. There has been a significant paradigm shift in paediatric oncology towards reducing toxicity and addressing long-term treatment-related sequalae amongst childhood cancer survivors. After paediatric nephrectomy and 30-50 years of follow-up, 40% of patients will have chronic kidney disease, including 22% with hypertension and 23% with albuminuria. It is difficult to predict which patients will progress to develop hypertension, reduced glomerular filtration rate, albuminuria, and a higher cardiovascular risk. For these reasons, nephron-sparing surgery when it is technically feasible must be considered. To decrease the incidence of positive surgical margins (viable tumour present at a resection margin), incomplete lymph node sampling, and complications, these procedures should be performed at specialist and experienced reference centres. Based on the impacts of individual treatment pathways, survivors of childhood WT need to be followed through adulthood for early detection of chronic kidney disease, hypertension, and prevention of cardiovascular events.
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Affiliation(s)
- Kiarash Taghavi
- Department of Paediatric Urology, Monash Children's Hospital, Victoria, Melbourne, Australia.
- Department of Paediatrics, Monash University, Victoria, Melbourne, Australia.
- Department of Pediatric Surgery, Urology and Transplantation, Hôpital Universitaire Necker-Enfants Malades, APHP, Université de Paris Cité, Paris, France.
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Urology and Transplantation, Hôpital Universitaire Necker-Enfants Malades, APHP, Université de Paris Cité, Paris, France
| | - Thomas Blanc
- Department of Pediatric Surgery, Urology and Transplantation, Hôpital Universitaire Necker-Enfants Malades, APHP, Université de Paris Cité, Paris, France
| | - Olivia Boyer
- Department of Pediatric Nephrology, MARHEA Reference Center, Imagine Institute, Hôpital Universitaire Necker-Enfants Malades, APHP, Université de Paris Cité, Paris, France
| | - Yves Heloury
- Department of Pediatric Surgery, Urology and Transplantation, Hôpital Universitaire Necker-Enfants Malades, APHP, Université de Paris Cité, Paris, France
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Preston M, Morris A, Villegas R, Huston J, Heloury Y, Grover SR. Response to letter to the editor: Lost in Transition. J Pediatr Urol 2024:S1477-5131(24)00101-3. [PMID: 38443193 DOI: 10.1016/j.jpurol.2024.02.020] [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: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024]
Affiliation(s)
- M Preston
- The Royal Children's Hospital, Gynaecology, 50 Flemington Road, Parkville, Australia.
| | - A Morris
- The Royal Children's Hospital, Gynaecology, 50 Flemington Road, Parkville, Australia
| | - R Villegas
- The Royal Children's Hospital, Gynaecology, 50 Flemington Road, Parkville, Australia
| | - J Huston
- The Royal Children's Hospital, Urology, 50 Flemington Road, Parkville, Australia
| | - Y Heloury
- The Royal Children's Hospital, Urology, 50 Flemington Road, Parkville, Australia
| | - S R Grover
- The Royal Children's Hospital, Gynaecology, 50 Flemington Road, Parkville, Australia; The Department of Paediatrics, University of Melbourne, Grattan Street, Parkville, Australia
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Preston M, Morris A, Villegas R, Huston J, Heloury Y, Grover SR. Surgical timing and complications, with body image, quality of life, sexual function and genital sensation in patients with congenital adrenal hyperplasia. J Pediatr Urol 2024:S1477-5131(24)00018-4. [PMID: 38286725 DOI: 10.1016/j.jpurol.2024.01.015] [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: 08/31/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 01/31/2024]
Abstract
INTRODUCTION The aim of this project was to document the long-term outcomes relating to sexual function, genital sensation, body image and quality of life, in an Australian cohort of adolescent and adult women with congenital adrenal hyperplasia (CAH) who have undergone feminising genitoplasty in infancy, childhood or adolescence. MATERIALS AND METHODS Identification and follow-up of women with CAH aged 12-40 years who had their first feminising genitoplasty or ongoing management at a single tertiary referral center with multidisciplinary care (n = 80). Medical records were reviewed for Prader stage, and operative outcomes. The prospective component of the study included tracing indivudals aged 12-40 years (n = 69), of whom 34 were contactable. Twenty-one responded to the invitation to participate in the study, completing some or all of a series of validated standardized questionnaires and/or participation in examination of external genital with sensation testing. Results were compared to a control population of similar age distribution (n = 23). RESULTS The median Prader stage was 3, median age at surgery was four months, median hospital stay of three days with 80 % of surgery undertaken by one surgeon. There was one major and eight minor complications. Re-operation rates were low. There was no difference between participants and controls in terms of sexual function, quality of life, or body image outcomes including genital appearance. Participants had increased sensitivity to soft touch on genital sensation testing compared to controls. Most participants (71 %) reported that early timing of surgery was 'good', four (19 %) felt their surgery was too late, one felt their surgery was too early, and one was unsure. Most were happy with the outcome of their surgery. DISCUSSION Outcomes after feminising genitoplasty are mixed and influenced not only by the surgery itself, but also the ongoing management of the condition alongside each patient's own cultural and social context. At present there is no comparative data available on the sexual, mental, body image and quality of life outcomes of young females with CAH who have had their operation delayed until adulthood. Our study is limited by low participant response rate, and difficulty recruiting 1:1 control population for all participants, but nevertheless provides some insight into the outcomes of these patients for which limited data is available. CONCLUSION In the population studied feminising genitoplasty in infancy and childhood had overall positive outcomes. This occurred in a tertiary center with expert multidisciplinary individualised care.
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Affiliation(s)
- M Preston
- The Royal Children's Hospital, Gynaecology, 50 Flemington Road, Parkville, Australia.
| | - A Morris
- The Royal Children's Hospital, Gynaecology, 50 Flemington Road, Parkville, Australia
| | - R Villegas
- The Royal Children's Hospital, Gynaecology, 50 Flemington Road, Parkville, Australia
| | - J Huston
- The Royal Children's Hospital, Urology, 50 Flemington Road, Parkville, Australia
| | - Y Heloury
- The Royal Children's Hospital, Urology, 50 Flemington Road, Parkville, Australia
| | - S R Grover
- The Royal Children's Hospital, Gynaecology, 50 Flemington Road, Parkville, Australia; The Department of Paediatrics, University of Melbourne, Grattan Street, Parkville, Australia
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Herndon CA, Caldamone A, Heloury Y, Misseri R, Nelson C, Stein R. Editorial. J Pediatr Urol 2023:S1477-5131(23)00160-2. [PMID: 37198073 DOI: 10.1016/j.jpurol.2023.04.031] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 05/19/2023]
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Herndon CDA, Caldamone A, Heloury Y, Misseri R, Nelson C, Stein R. Editorial. J Pediatr Urol 2023; 19:155. [PMID: 36967205 DOI: 10.1016/j.jpurol.2023.03.006] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/01/2023] [Indexed: 03/29/2023]
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Herndon CA, Caldamone A, Heloury Y, Hoebeke P, Nelson C, Stein R. Editorial. J Pediatr Urol 2022; 18:407-408. [PMID: 36336413 DOI: 10.1016/j.jpurol.2022.09.022] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 11/05/2022]
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Faraj S, Loubersac T, Bouchot O, Heloury Y, Leclair MD. Adults with previous hypospadias surgery during childhood: Beware of bulbar strictures. J Pediatr Urol 2022; 18:4.e1-4.e8. [PMID: 34863623 DOI: 10.1016/j.jpurol.2021.11.001] [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: 02/18/2021] [Revised: 10/12/2021] [Accepted: 11/01/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Urethral strictures represent the most frequent long-term complication in men after history of hypospadias surgery. OBJECTIVES To better define the spectrum of men previously treated for hypospadias during childhood, presenting at an adult urology clinic with persistent urethral complications. STUDY DESIGN Retrospective review of the records of 42 consecutive adult patients with a personal history of hypospadias repair during childhood referred at one adult tertiary urology center between 2004 and 2017. Those with persistent urethral strictures were included: 28 patients (median age 28yr [17-81]). Residual chordee, aesthetic concerns, isolated fistulas, and motives of consultation unrelated to hypospadias were excluded. Early initial success rate and location of urethral stricture were studied. Statistical Analysis was done by non-parametric tests. RESULTS On the 42 consecutive adults eligible, a total of 28 patients had a persistent urethral stricture. During childhood, 13/28 boys had required multiple surgical revision procedures, including six of them for postoperative urethral strictures. During adulthood, initial urethral assessment revealed 29 urethral strictures in 28 patients (penile urethra 23/29, bulbar urethra 8/29). The early initial success rate of stricture treatment was 50% (median follow-up: 4 years [1-7]). Additional surgical procedures were needed and performed in 11 patients. Eight patients were eventually diagnosed with a bulbar stricture, either isolated (n = 5) or combined with a distal stricture (n = 3), without significant relationship with initial position of meatus. DISCUSSION Predictive factors for bulbar strictures locations could not be identified. It was however observed that symptomatic bulbar strictures do exist in adults, in the long term after penile hypospadias repair during childhood, independently of the initial site of hypospadias, initial success of primary repair, and the type of surgical reconstructions performed during childhood. CONCLUSION Bulbar strictures represent more than 25% of the overall strictures diagnosed in adult patients treated for hypospadias during childhood, independently of the original site of urethral reconstruction.
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Affiliation(s)
| | - Thomas Loubersac
- Chirurgie infantile, CHU de Nantes, Nantes, France; Urologie, CHU de Nantes, Nantes, France.
| | | | - Yves Heloury
- Chirurgie infantile, Hopital Necker Enfants Malades, Paris, France.
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Blanc T, Meignan P, Vinit N, Ballouhey Q, Pio L, Capito C, Harte C, Vatta F, Galmiche-Rolland L, Minard V, Orbach D, Berteloot L, Muller C, Kohaut J, Broch A, Braik K, Binet A, Heloury Y, Fourcade L, Lardy H, Sarnacki S. Correction to: Robotic Surgery in Pediatric Oncology: Lessons Learned from the First 100 Tumors-A Nationwide Experience. Ann Surg Oncol 2021; 28:901. [PMID: 34601667 DOI: 10.1245/s10434-021-10861-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Thomas Blanc
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France. .,Université de Paris, Paris, France. .,Département « Croissance et Signalisation », Centre National de la Recherche Scientifique UMR8253, Institut National de la Santé et de la Recherche Médicale U1151, Institut Necker Enfants Malades, Université de Paris, Paris, France.
| | - Pierre Meignan
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Nicolas Vinit
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Quentin Ballouhey
- Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France
| | - Luca Pio
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carmen Capito
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Harte
- Department of Pediatric Anesthesia, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fabrizio Vatta
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Louise Galmiche-Rolland
- Department of Pathology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Véronique Minard
- Department of Pediatric and Adolescent Oncology, Institut Gustave Roussy, Villejuif, France
| | - Daniel Orbach
- Department of Pediatric Oncology SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, PSL Research University, Paris, France
| | - Laureline Berteloot
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cécile Muller
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jules Kohaut
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aline Broch
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Karim Braik
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Aurélien Binet
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Yves Heloury
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
| | - Laurent Fourcade
- Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France
| | - Hubert Lardy
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
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Blanc T, Meignan P, Vinit N, Ballouhey Q, Pio L, Capito C, Harte C, Vatta F, Galmiche-Rolland L, Minard V, Orbach D, Berteloot L, Muller C, Kohaut J, Broch A, Braik K, Binet A, Heloury Y, Fourcade L, Lardy H, Sarnacki S. ASO Visual Abstract: Robotic Surgery in Pediatric Oncology-Lessons Learned from the First 100 Tumors: A Nationwide Experience. Ann Surg Oncol 2021. [PMID: 34549364 DOI: 10.1245/s10434-021-10850-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Thomas Blanc
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France. .,Université de Paris, Paris, France. .,Département « Croissance et Signalisation », Center National de la Recherche Scientifique UMR8253, Institut National de la Santé et de la Recherche Médicale U1151, Institut Necker Enfants Malades, Université de Paris, Paris, France.
| | - Pierre Meignan
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Nicolas Vinit
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Quentin Ballouhey
- Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France
| | - Luca Pio
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carmen Capito
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Harte
- Department of Pediatric Anesthesia, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fabrizio Vatta
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Louise Galmiche-Rolland
- Department of Pathology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Véronique Minard
- Department of Pediatric and Adolescent Oncology, Institut Gustave Roussy, Villejuif, France
| | - Daniel Orbach
- Department of Pediatric Oncology SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, PSL Research University, Paris, France
| | - Laureline Berteloot
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cécile Muller
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jules Kohaut
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aline Broch
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Karim Braik
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Aurélien Binet
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Yves Heloury
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
| | - Laurent Fourcade
- Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France
| | - Hubert Lardy
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
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Blanc T, Meignan P, Vinit N, Ballouhey Q, Pio L, Capito C, Harte C, Vatta F, Galmiche-Rolland L, Minard V, Orbach D, Berteloot L, Muller C, Kohaut J, Broch A, Braik K, Binet A, Heloury Y, Fourcade L, Lardy H, Sarnacki S. Robotic Surgery in Pediatric Oncology: Lessons Learned from the First 100 Tumors-A Nationwide Experience. Ann Surg Oncol 2021; 29:1315-1326. [PMID: 34523002 DOI: 10.1245/s10434-021-10777-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/21/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND While robotics has become commonplace in adult oncology, it remains rare in pediatric oncology due to the rarity of childhood cancers. We present the results of a large nationwide experience with robotic oncology, with the aim of providing practical and feasible guidelines for child selection. METHODS This was a prospective analysis performed over a period of 4 years. Treatment was delivered according to the Société Internationale d'Oncologie Pédiatrique/International Society of Paediatric Oncology Europe Neuroblastoma Group (SIOP/SIOPEN) protocols. Indications were approved by a certified tumor board. RESULTS Overall, 100 tumors were resected during 93 procedures (abdomen, 67%; thorax, 17%; pelvis, 10%; retroperitoneum, 6%) in 89 children (56 girls). The median age at surgery was 8.2 years (range 3.6-13); 19 children (21%) harbored germinal genetic alterations predisposing to cancer. No intraoperative tumor ruptures occurred. Seven conversions (8%) to an open approach were performed. Neuroblastic tumors (n = 31) comprised the main group (18 neuroblastomas, 4 ganglioneuroblastomas, 9 ganglioneuromas) and renal tumors comprised the second largest group (n = 24, including 20 Wilms' tumors). The remaining 45 tumors included neuroendocrine (n = 12), adrenal (n = 9), germ-cell (n = 7), pancreatic (n = 4), thymic (n = 4), inflammatory myofibroblastic (n = 4), and different rare tumors (n = 5). Overall, 51 tumors were malignant, 2 were borderline, and 47 were benign. The median hospital stay was 3 days (2-4), and five postoperative complications occurred within the first 30 days. During a median follow-up of 2.4 years, one child (Wilms' tumor) presented with pleural recurrence. One girl with Wilms' tumor died of central nervous system metastasis. CONCLUSIONS Robotic surgery for pediatric tumors is a safe option in highly selected cases. Indications should be discussed by tumor boards to avoid widespread and uncontrolled application.
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Affiliation(s)
- Thomas Blanc
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France. .,Université de Paris, Paris, France. .,Département « Croissance et Signalisation », Centre National de la Recherche Scientifique UMR8253, Institut National de la Santé et de la Recherche Médicale U1151, Institut Necker Enfants Malades, Université de Paris, Paris, France.
| | - Pierre Meignan
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Nicolas Vinit
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Quentin Ballouhey
- Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France
| | - Luca Pio
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carmen Capito
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Harte
- Department of Pediatric Anesthesia, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fabrizio Vatta
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Louise Galmiche-Rolland
- Department of Pathology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Véronique Minard
- Department of Pediatric and Adolescent Oncology, Institut Gustave Roussy, Villejuif, France
| | - Daniel Orbach
- Department of Pediatric Oncology SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, PSL Research University, Paris, France
| | - Laureline Berteloot
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cécile Muller
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jules Kohaut
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aline Broch
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Karim Braik
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Aurélien Binet
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Yves Heloury
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
| | - Laurent Fourcade
- Department of Pediatric Surgery, Hôpital des Enfants, Limoges, France
| | - Hubert Lardy
- Department of Pediatric Surgery, Hôpital Clocheville, Tours, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université de Paris, Paris, France
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11
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Berteloot L, Berthaud R, Temmam S, Lozach C, Zanelli E, Blanc T, Heloury Y, Capito C, Chardot C, Sarnacki S, Garcelon N, Lacaille F, Charbit M, Pastural M, Rabant M, Boddaert N, Leruez-Ville M, Eloit M, Sermet-Gaudelus I, Dehoux L, Boyer O. Arterial abnormalities identified in kidneys transplanted into children during the COVID-19 pandemic. Am J Transplant 2021; 21:1937-1943. [PMID: 33346946 PMCID: PMC9906447 DOI: 10.1111/ajt.16464] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 01/25/2023]
Abstract
Graft artery stenosis can have a significant short- and long-term negative impact on renal graft function. From the beginning of the COVID-19 pandemic, we noticed an unusual number of graft arterial anomalies following kidney transplant (KTx) in children. Nine children received a KTx at our center between February and July 2020, eight boys and one girl, of median age of 10 years. Seven presented Doppler features suggesting arterial stenosis, with an unusual extensive pattern. For comparison, over the previous 5-year period, persistent spectral Doppler arterial anomalies (focal anastomotic stenoses) following KTx were seen in 5% of children at our center. We retrospectively evidenced severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in five of seven children with arterial stenosis. The remaining two patients had received a graft from a deceased adolescent donor with a positive serology at D0. These data led us to suspect immune postviral graft vasculitis, triggered by SARS-CoV-2. Because the diagnosis of COVID-19 is challenging in children, we recommend pretransplant monitoring of graft recipients and their parents by monthly RT-PCR and serology. We suggest balancing the risk of postviral graft vasculitis against the risk of prolonged dialysis when considering transplantation in a child during the pandemic.
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Affiliation(s)
- Laureline Berteloot
- Pediatric Radiology Department, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France,INSERM U1163, Institut Imagine, Paris, France,Correspondence Laureline Berteloot, Pediatric Radiology Department, Hôpital universitaire Necker Enfants Malades, 149 rue de Sèvres, 75015, Paris, France.
| | - Romain Berthaud
- Pediatric Nephrology Department, MARHEA reference center, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France,Université de Paris, Paris, France
| | - Sarah Temmam
- Institut Pasteur, Laboratory of Pathogen Discovery, Paris, France
| | - Cécile Lozach
- Pediatric Radiology Department, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France,Université de Paris, Paris, France
| | - Elisa Zanelli
- Pediatric Radiology Department, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France,Université de Paris, Paris, France
| | - Thomas Blanc
- Université de Paris, Paris, France,Pediatric Surgery and Urology Department, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Yves Heloury
- Université de Paris, Paris, France,Pediatric Surgery and Urology Department, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Carmen Capito
- Pediatric Surgery and Urology Department, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Christophe Chardot
- Université de Paris, Paris, France,Pediatric Surgery and Urology Department, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Sabine Sarnacki
- Université de Paris, Paris, France,Pediatric Surgery and Urology Department, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Nicolas Garcelon
- Data Science Platform, Paris Descartes—Sorbonne Paris Cite University, Institut Imagine, France
| | - Florence Lacaille
- Department of Pediatric Gastroenterology-Hepatology-Nutrition, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Marina Charbit
- Pediatric Nephrology Department, MARHEA reference center, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | | | - Marion Rabant
- Université de Paris, Paris, France,Department of Pathology, APHP, Hôpital Universitaire Necker-Enfants malades, Paris, France,INSERM U1151, Paris, France
| | - Nathalie Boddaert
- Pediatric Radiology Department, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France,INSERM U1163, Institut Imagine, Paris, France,Université de Paris, Paris, France
| | - Marianne Leruez-Ville
- Université de Paris, Paris, France,Virology Laboratory, APH-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Marc Eloit
- Institut Pasteur, Laboratory of Pathogen Discovery, Paris, France
| | - Isabelle Sermet-Gaudelus
- Université de Paris, Paris, France,EA 7328 University of Paris, Institut Imagine, Paris, France,INSERM U1151, Institut Necker Enfants malades, National Cystic Fibrosis Reference Center, Paris, France
| | - Laurène Dehoux
- Pediatric Nephrology Department, MARHEA reference center, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Olivia Boyer
- INSERM U1163, Institut Imagine, Paris, France,Pediatric Nephrology Department, MARHEA reference center, AP-HP, Hôpital Universitaire Necker-Enfants malades, Paris, France,Université de Paris, Paris, France
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Caldamone A, Heloury Y, Herndon CDA, Hoebeke P, Nelson C, Wood D. Editorial. J Pediatr Urol 2021; 17:139-140. [PMID: 33888279 DOI: 10.1016/j.jpurol.2021.03.029] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/11/2021] [Indexed: 11/15/2022]
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13
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Caldamone AA, Heloury Y, Herndon CDA, Hoebeke P, Nelson C, Wood D. Editorial. J Pediatr Urol 2021; 17:1. [PMID: 33663807 DOI: 10.1016/j.jpurol.2021.01.033] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
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14
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Caldamone A, Heloury Y, Herndon CDA, Hoebeke P, Nelson C, Wood D. Editorial. J Pediatr Urol 2020; 16:269. [PMID: 32563440 DOI: 10.1016/j.jpurol.2020.06.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 11/19/2022]
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15
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Bouty A, Blanc T, Leclair MD, Lavrand F, Faure A, Binet A, Rod J, O'Brien M, Sarnacki S, Nightingale M, Heloury Y, Varlet F, Scalabre A. Minimally invasive surgery for unilateral Wilms tumors: Multicenter retrospective analysis of 50 transperitoneal laparoscopic total nephrectomies. Pediatr Blood Cancer 2020; 67:e28212. [PMID: 32064752 DOI: 10.1002/pbc.28212] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 08/28/2019] [Revised: 12/18/2019] [Accepted: 01/23/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate feasibility and outcomes of minimally invasive surgery (MIS) in Wilms tumor (WT). METHODS International multicenter review of MIS total nephrectomies for WT between 2006 and 2018. Medical records of confirmed WT were retrospectively assessed for demographic, imaging, treatment, pathology, and oncological outcome data. RESULTS Fifty patients, with a median age of 38 months (6-181), were included in 10 centers. All patients received neoadjuvant chemotherapy, as per SIOP protocol. Median tumor volume post-chemotherapy was 673 mL (18-3331), 16 tumors crossed the lateral border of the spine, and three crossed the midline. Six patients with tumors that crossed the lateral border of the spine (tumor volumes 1560 mL [299-2480]) were converted to an open approach. There was no intraoperative tumor rupture. Overall, MIS was completed in 19% of the 195 nephrectomies for WT presenting during the study period. Tumor was stage I in 29, II in 16, and III in 5, and histology was reported as low in three, intermediate in 42, and high risk in five. Three patients had positive tumor margins. After a median follow-up of 34 months (2-138), there were two local recurrences (both stage I, intermediate risk, 7 and 9 months after surgery) and one metastatic relapse (stage III, high risk, four months after surgery). The three-year event-free survival was 94%. CONCLUSION MIS is feasible in 20% of WT, with oncological outcomes comparable with open surgery, no intraoperative rupture, and a low rate of local relapse. Ongoing surveillance is, however, needed to evaluate this technique as it becomes widespread.
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Affiliation(s)
- Aurore Bouty
- Paediatric Urology Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Thomas Blanc
- Paediatric Surgery Department, Hopital Necker Enfants Malades, Paris, France
| | - Marc David Leclair
- Paediatric Surgery Department, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Frederic Lavrand
- Paediatric Surgery Department, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Alice Faure
- Paediatric Surgery Department, Centre Hospitalier Universitaire de Marseille, Marseille, France
| | - Aurelien Binet
- Paediatric Surgery Department, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Julien Rod
- Paediatric Surgery Department, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Mike O'Brien
- Paediatric Urology Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Sabine Sarnacki
- Paediatric Surgery Department, Hopital Necker Enfants Malades, Paris, France
| | - Michael Nightingale
- Paediatric Surgery Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Yves Heloury
- Paediatric Urology Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Francois Varlet
- Paediatric Surgery Department, Centre Hospitalier Universitaire, Saint-Etienne, France
| | - Aurelien Scalabre
- Paediatric Surgery Department, Centre Hospitalier Universitaire, Saint-Etienne, France
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Caldamone A, Heloury Y, Herndon CDA, Hoebeke P, Nelson C. Editorial. J Pediatr Urol 2020; 16:1. [PMID: 32334769 DOI: 10.1016/j.jpurol.2020.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Caldamone A, Herndon CDA, Heloury Y, Hoebeke P, Nelson C, Wood D. Editorial. J Pediatr Urol 2019; 15:593-594. [PMID: 31931971 DOI: 10.1016/j.jpurol.2019.11.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022]
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18
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How JA, Marino JL, Grover SR, Heloury Y, Sullivan M, Mellor A, McNally O, Jayasinghe Y. Surgically Managed Ovarian Masses at the Royal Children's Hospital, Melbourne -19 Year Experience. J Pediatr Surg 2019; 54:1913-1920. [PMID: 31160084 DOI: 10.1016/j.jpedsurg.2019.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 07/16/2018] [Revised: 04/07/2019] [Accepted: 05/11/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND/PURPOSE To describe the clinicopathological characteristics and management of surgically removed ovarian masses at the Royal Children's Hospital, Melbourne from 1993 to 2012. METHODS Medical records were reviewed retrospectively. Data regarding clinical findings, imaging and surgical management were evaluated. RESULTS There were 266 ovarian masses found in 258 surgeries (eight had bilateral masses). Most were benign (246/266, 92.5%), 2.3% (6/266) were borderline, and 5.3% (14/266) were malignant. The most common presenting symptom was abdominal pain for benign masses (169/246, 68.7%), and a palpable mass for borderline and malignant masses (12/20, 60.0%). Sensitivity and specificity of ultrasound for detection of malignancy was 64.7% and 52.9% respectively. Ovarian torsion occurred in 22.1% (n=57), none with malignancy, with seven cases diagnosed under one year of age. Sensitivity and specificity of ultrasound for ovarian torsion was 22.0% and 91.9%, respectively. The proportion undergoing ovarian cystectomy rather than oophorectomy has increased from 56.3% during 1993-1997 to 93.8% during 2008-2012 (p<0.005). Ovarian torsion was managed with ovarian conservation in 82.6% of cases between 2008-2012. CONCLUSION The majority of pediatric and adolescent ovarian masses were benign. Sensitivity of ultrasound was fair for detection of malignancy, and poor for ovarian torsion. Conservative surgeries are increasingly common. LEVEL OF EVIDENCE Level IV - case series with no comparison group TYPE OF STUDY: Retrospective Study.
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Affiliation(s)
- J A How
- Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia.
| | - J L Marino
- Department of Obstetrics and Gynecology, Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria, Australia
| | - S R Grover
- Department of Pediatric & Adolescent Gynecology, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia; Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Y Heloury
- Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia; Department of Pediatric Surgery, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia
| | - M Sullivan
- Children's Cancer Centre, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia
| | - A Mellor
- Mater Adolescent and Young Adult Health Centre, Raymond Terrace, South Brisbane, Queensland, Australia
| | - O McNally
- Department of Gynecological Oncology, Royal Women's Hospital, Melbourne, 20 Flemington Road, Parkville, Victoria, Australia
| | - Y Jayasinghe
- Department of Obstetrics and Gynecology, Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria, Australia; Department of Pediatric & Adolescent Gynecology, Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia
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Blanc T, Pio L, Clermidi P, Muller C, Orbach D, Minard-Colin V, Harte C, Meignan P, Kohaut J, Heloury Y, Sarnacki S. Robotic-assisted laparoscopic management of renal tumors in children: Preliminary results. Pediatr Blood Cancer 2019; 66 Suppl 3:e27867. [PMID: 31136081 DOI: 10.1002/pbc.27867] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 01/08/2019] [Revised: 05/12/2019] [Accepted: 05/17/2019] [Indexed: 12/24/2022]
Abstract
AIM We present the preliminary results of robotic-assisted laparoscopic (RAL) total and partial nephrectomy for renal malignant tumors in children. METHODS This is a prospective study of patients operated with RAL between December 2016 and September 2018. Patients with Wilms tumors were treated according to the SIOP-2001 protocol. Patient and tumor characteristics, type of surgery, surgical-related morbidity, and oncologic outcomes were recorded. Results were compared with a series of patients with similar age- and tumor-related characteristics operated during the same period by an open surgical approach. RESULTS Ten children underwent RAL nephrectomy with a mean age of five years (3.2-14.1 years). Total nephrectomy was done in six cases for Wilms tumor and in one case for renal sarcoma; three cases were converted. Complete removal of tumor without rupture was achieved in all cases. Postoperative course was uneventful, and patients were discharged between days 2 and 7. Neither recurrence nor medium-term complications occurred. Nine patients are alive with a median follow-up of 16 months (6-27 months) and one female died from complications of central nervous system metastases one year after surgery. When compared with the open surgical approach group, median tumor volume was smaller (P = 0.005), hospital stay was shorter (P = 0.01), and operative time was similar (P = 0.20). CONCLUSIONS RAL total and partial nephrectomy procedure for renal tumor in children may be an option in carefully selected cases. Indication should be discussed at tumor boards and surgery performed while adhering strictly to oncological surgical rules.
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Affiliation(s)
- Thomas Blanc
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France.,Paris Descartes University, Université Sorbonne Paris Cité, Paris, France.,INSERM U1151-CNRS UMR 8253, Université Paris Descartes, Institut Necker-Enfants Malades, Département « Croissance et Signalisation », Hôpital Necker-Enfants Malades, Paris, France
| | - Luca Pio
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France.,Paris Descartes University, Université Sorbonne Paris Cité, Paris, France
| | - Pauline Clermidi
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France.,Paris Descartes University, Université Sorbonne Paris Cité, Paris, France
| | - Cecile Muller
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France.,Paris Descartes University, Université Sorbonne Paris Cité, Paris, France
| | - Daniel Orbach
- Department of Pediatric Oncology, Oncology Center SIREDO (Care, Innovation, Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, Paris, France
| | - Veronique Minard-Colin
- Department of Oncology for Child and Adolescents, Gustave Roussy, Cancer Center, Paris, France
| | - Caroline Harte
- Department of Pediatric Anesthesia, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Meignan
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France
| | - Jules Kohaut
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France.,Paris Descartes University, Université Sorbonne Paris Cité, Paris, France
| | - Yves Heloury
- Urology Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Sabine Sarnacki
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Department of Pediatric Surgery and Urology, Paris, France.,Paris Descartes University, Université Sorbonne Paris Cité, Paris, France
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Caldamone A, Heloury Y, Herndon CDA, Hoebeke P, Wood D. Editorial. J Pediatr Urol 2019; 15:297. [PMID: 31542147 DOI: 10.1016/j.jpurol.2019.09.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 08/16/2019] [Indexed: 10/26/2022]
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21
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Caldamone A, Heloury Y, Herndon CDA, Hoebeke P, Wood D. Editorial. J Pediatr Urol 2019; 15:203. [PMID: 31221395 DOI: 10.1016/j.jpurol.2019.06.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Caldamone A, Heloury Y, Herndon CDA, Hoebeke P, Wood D. Editorial. J Pediatr Urol 2019; 15:107. [PMID: 31103191 DOI: 10.1016/j.jpurol.2019.04.026] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 04/04/2019] [Indexed: 10/26/2022]
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23
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Caldamone A, Heloury Y, Herndon CDA, Hoebeke P, Wood D. Editorial. J Pediatr Urol 2018; 14:485. [PMID: 30551785 DOI: 10.1016/j.jpurol.2018.11.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 11/25/2022]
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Allingham C, Gillam L, McCarthy M, Zacharin M, Jayasuriya S, Heloury Y, Orme L, Sullivan M, Peate M, Jayasinghe Y. Fertility Preservation in Children and Adolescents With Cancer: Pilot of a Decision Aid for Parents of Children and Adolescents With Cancer. JMIR Pediatr Parent 2018; 1:e10463. [PMID: 31518288 PMCID: PMC6715396 DOI: 10.2196/10463] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/09/2018] [Accepted: 08/07/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Future infertility is a significant concern for survivors of childhood and adolescent cancer. Children and adolescents may have the opportunity to undergo fertility preservation (FP) procedures (which preserve gonadal tissue or gametes for future use) prior to the cancer treatment. However, the decision is very complex, as it is often made by parents as proxy decision makers at the time of cancer diagnosis, and is time-sensitive (needing to occur before the cancer treatment begins). Furthermore, FP procedures in children and adolescents are experimental and cannot guarantee future fertility. An uninformed decision may result in future decision regret. OBJECTIVE This study aimed to assess the acceptability, usability, and feasibility of a Web-based FP decision aid (DA) in parents of children and adolescents with cancer and clinicians. Fertility knowledge and decision regret were compared in families who reviewed the DA compared with those who did not. METHODS The Web-based DA was developed according to the International Patient Decision Aid Standards. A cross-sectional study of parents of patients with cancer, who discussed fertility, and clinicians at a tertiary children's hospital was undertaken. The acceptability, usability, and feasibility of the DA were assessed using a pre-post survey design. Measures included the validated Decision Regret Scale, a purpose-designed fertility-related knowledge scale, questions regarding satisfaction with the DA, and open-ended responses for additional feedback. Furthermore, clinicians involved in FP were also invited to review the DA. RESULTS We enrolled 34 parents and 11 clinicians in this study. Participants who reviewed the DA (15 parents and 11 clinicians) expressed satisfaction with its content and functionality. Parents reported an improved understanding of cancer treatments, infertility, and FP procedures and did not report greater decision regret after DA review. Most parents (13/15, 86%) would recommend the DA to other parents. All clinicians had a consensus that this was a valid and relevant information source for all involved in fertility care. CONCLUSIONS It is an international standard of care to discuss the impact of cancer treatment on fertility before cancer treatment. This is the first fertility DA for parents of children and adolescents with cancer and is found to be relevant and acceptable by parents and clinicians. This DA has the potential to help support parents to make informed fertility-related decisions for their children and adolescents. However, future research is needed to assess the impact of the DA on prospective decision making.
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Affiliation(s)
- Catherine Allingham
- Department of Obstetrics & Gynaecology, The Royal Women's Hospital, University of Melbourne, Parkville, Australia.,Department of Paediatric & Adolescent Gynaecology, The Royal Children's Hospital, Parkville, Australia
| | - Lynn Gillam
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia.,Children's Bioethics Centre, The Royal Children's Hospital, Parkville, Australia
| | - Maria McCarthy
- Department of Psychology, The Royal Children's Hospital, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Margaret Zacharin
- Murdoch Children's Research Institute, Parkville, Australia.,Department of Endocrinology, The Royal Children's Hospital, Parkville, Australia
| | - Sadunee Jayasuriya
- Department of Obstetrics & Gynaecology, The Royal Women's Hospital, University of Melbourne, Parkville, Australia.,Monash University, Clayton, Australia
| | - Yves Heloury
- Department of Urology, The Royal Children's Hospital, Parkville, Australia
| | - Lisa Orme
- Children's Cancer Centre, The Royal Children's Hospital, Parkville, Australia
| | - Michael Sullivan
- Children's Cancer Centre, The Royal Children's Hospital, Parkville, Australia
| | - Michelle Peate
- Department of Obstetrics & Gynaecology, The Royal Women's Hospital, University of Melbourne, Parkville, Australia
| | - Yasmin Jayasinghe
- Department of Obstetrics & Gynaecology, The Royal Women's Hospital, University of Melbourne, Parkville, Australia.,Department of Paediatric & Adolescent Gynaecology, The Royal Children's Hospital, Parkville, Australia
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Caldamone A, Heloury Y, Herndon CDA, Hoebeke P, Wood D. Editorial. J Pediatr Urol 2018; 14:365. [PMID: 30502060 DOI: 10.1016/j.jpurol.2018.10.031] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 11/18/2022]
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26
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Bouty A, Burnand K, Nightingale M, Roberts A, Campbell M, O'Brien M, Heloury Y. What is the risk of local recurrence after laparoscopic transperitoneal radical nephrectomy in children with Wilms tumours? Analysis of a local series and review of the literature. J Pediatr Urol 2018; 14:327.e1-327.e7. [PMID: 29705138 DOI: 10.1016/j.jpurol.2018.03.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 12/27/2017] [Accepted: 03/12/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND To reduce long-term morbidity (adhesions-related complications and impaired quality of life due to scars), laparoscopy has been used as an alternative to open surgery in Wilms tumours (WTs). However, concerns have been raised on the risk of local recurrence after this type of resection. OBJECTIVE The aim was to determine the incidence of local recurrence after laparoscopic transperitoneal radical nephrectomy (LTRN). STUDY DESIGN We analysed 18 local cases and conducted a review of the English literature in Pubmed from 2004 to 2017 with the following keywords: (Wilms OR nephroblastoma) AND (laparoscopy OR minimally invasive surgery) AND 2004:3000. The review was conducted according to PRISMA guidelines. Data were collected independently in duplicate in a preformed Excel database. Review articles and duplicated case reports were excluded. Patients with retroperitoneoscopic or nephron-sparing surgery were also excluded. RESULTS One hundred and four LTRNs have been performed for WT with neoadjuvant chemotherapy in 93 cases. Tumour was ruptured preoperatively in three cases but never intraoperatively. The median volume of the tumour was 229.4 mL (3.8-776 mL). Local stage was specified in 86 cases: 49 stage I, 28 stage II, and nine stage III. Lymph nodes were sampled in 48 patients (median 2.3 [0-14] nodes). Histology was reported in 90 cases: 27 favourable and two unfavourable histology (COG); and six low, 50 intermediate, and five high-risk tumours (International Society of Paediatric Oncology). With a median follow-up of 20.5 months (1-114 months), there were four local recurrences (3.8%) at a median of 8.5 (7-9) months after surgery. Three tumours were initial local stage I (2 intermediate and 1 high risk) and one stage III. The results are presented in the Figure. DISCUSSION The incidence of local recurrence after LTRN is 3.8%. This is lower than previously reported after open resection. However, tumours amenable to minimally invasive surgery are smaller, with higher numbers of low stage and standard histology. Additionally, the quality of the reports is suboptimal and follow-up is relatively short. CONCLUSION LTRN does not seem to increase the incidence of local recurrence in WT but inclusion of patients in international protocols with prolonged and systematic follow-up is of utmost importance to carefully evaluate this risk.
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Affiliation(s)
- Aurore Bouty
- Urology Department, Royal Children's Hospital, Parkville, Victoria, Australia.
| | - Kate Burnand
- Paediatric and Neonatal Surgery Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Michael Nightingale
- Paediatric and Neonatal Surgery Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Annie Roberts
- Paediatric and Neonatal Surgery Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Marty Campbell
- Oncology Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Mike O'Brien
- Urology Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Yves Heloury
- Urology Department, Royal Children's Hospital, Parkville, Victoria, Australia
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Abstract
BACKGROUND Congenital adrenal hyperplasia (CAH) is an autosomal recessive condition resulting in excess androgen production. Females are typically born with ambiguous genitalia and often undergo feminising genitoplasty in infancy or childhood. Recently, there has been considerable international debate as to whether distressing urinary symptoms in CAH patients are truly present and, if so, whether these urinary problems are a consequence of the feminising genitoplasty. OBJECTIVE To identify and assess any urinary symptoms in an Australian cohort of adolescent and adult women with CAH who have undergone feminising genitoplasty in infancy, childhood or adolescence as a part of their management. STUDY DESIGN Females with CAH aged 12-40 years, who had undergone feminising genitoplasty, and were identified from a hospital database (n = 72). Those aged 12-15 years were assessed using the Paediatric Incontinence Symptom Index questionnaire in conjunction with sections of the Bristol Female Lower Urinary Tract Symptoms Scored Form questionnaire. Those aged 16-40 years were assessed using the Bristol Female Lower Urinary Tract Symptoms Scored Form questionnaire. Uroflowmetry studies and post-void residual volume ultrasounds were also conducted. Previously published normative data were used for the control population. RESULTS Responses to the questionnaire indicated that CAH patients had a higher incidence of urgency, frequency, urge incontinence, unexplained incontinence and nocturnal incontinence, when compared to previously published control data. Average and maximum urine flow rates measured by uroflowmetry were within normal range; however, the 16-40-year-old age group had significantly increased mean post-void residual volumes (P < 0.001) (Summary table). DISCUSSION The presence of lower urinary tract symptoms in these patients has previously been interpreted as a direct outcome of feminising genitoplasty; however, these results could also be accounted for by the virilisation of pelvic floor musculature. Androgens have been shown to increase skeletal muscle mass, but their exact impact on the pelvic floor musculature requires further research. Three previous studies have measured post-void residual volumes in patients with CAH, all of which found it them be raised. CONCLUSIONS Patients with CAH appeared to have overall normal urinary flow but increased post-void residual volumes. The data suggested that this population of patients has an increased probability of incontinence, urgency, and frequency when compared to a control population. These results confirmed findings of other small studies; however, it remains unclear if these changes reflected the underlying diagnosis or were a consequence of management.
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Affiliation(s)
- M Bogdanska
- Gynaecology Department, Royal Children's Hospital, Melbourne, Australia
| | - A Morris
- Gynaecology Department, Royal Children's Hospital, Melbourne, Australia
| | - J M Hutson
- Department of Paediatrics, University of Melbourne, Melbourne, Australia; Urology Department, Royal Children's Hospital, Melbourne, Australia
| | - Y Heloury
- Urology Department, Royal Children's Hospital, Melbourne, Australia; Murdoch Children Research Institute, Melbourne, Australia
| | - S R Grover
- Gynaecology Department, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia.
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Burnand K, Roberts A, Bouty A, Nightingale M, Campbell M, Heloury Y. Laparoscopic nephrectomy for Wilms' tumor: Can we expand on the current SIOP criteria? J Pediatr Urol 2018; 14:253.e1-253.e8. [PMID: 29501377 DOI: 10.1016/j.jpurol.2018.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 08/28/2017] [Accepted: 01/08/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Wilms' tumor now has a good overall prognosis with open radical nephrectomy having been the mainstay of surgical treatment. Recently laparoscopic nephrectomy (LN) has been growing in popularity. The aim of our study was to review our indications and outcomes for laparoscopic resections for Wilms' tumor and compare indications with International Society of Paediatric Oncology (SIOP) criteria for LN. MATERIAL AND METHODS Patient demographics, preoperative management, surgical data, respect of SIOP criteria, complications, disease outcome, and follow-up were recorded on consecutive children who underwent nephrectomy for Wilms' tumor. RESULTS AND DISCUSSION Fifty-four consecutive children with Wilms' tumor underwent a nephrectomy; 20 had a LN (Table). Nine of 20 (45%) patients who had LN did not meet SIOP criteria for LN. No patients had an intraoperative tumor rupture and one patient had positive margins because of preoperative rupture. There were two conversions: one caused by difficulty accessing the renal hilum and the other caused by difficulty maintaining oxygen saturations. There was one local recurrence. CONCLUSION SIOP criteria are conservative and safe. Indications can be extended for teams experienced in surgical oncology and laparoscopy after agreement at a multidisciplinary meeting (MDM).
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Affiliation(s)
- Katherine Burnand
- Department of Paediatric Surgery, Royal Children's Hospital, Melbourne, Australia.
| | - Annie Roberts
- Department of Paediatric Surgery, Royal Children's Hospital, Melbourne, Australia
| | - Aurore Bouty
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Australia
| | - Michael Nightingale
- Department of Paediatric Surgery, Royal Children's Hospital, Melbourne, Australia
| | - Martin Campbell
- Department of Paediatric Oncology, Royal Children's Hospital, Melbourne, Australia
| | - Yves Heloury
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Australia
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Caldamone A, Heloury Y, Herndon CDA, Hoebeke P, Wood D. Editorial. J Pediatr Urol 2018; 14:207. [PMID: 29958638 DOI: 10.1016/j.jpurol.2018.06.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 10/28/2022]
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30
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Hand M, Kemertzis MA, Peate M, Gillam L, McCarthy M, Orme L, Heloury Y, Sullivan M, Zacharin M, Jayasinghe Y. A Clinical Decision Support System to Assist Pediatric Oncofertility: A Short Report. J Adolesc Young Adult Oncol 2018; 7:509-513. [PMID: 29733237 DOI: 10.1089/jayao.2018.0006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Fertility preservation discussions with pediatric and adolescent cancer patients can be difficult for clinicians. This study describes the acceptability of a fertility clinician decision support system (CDSS). METHODS A cross-sectional study of clinicians at The Royal Children's Hospital, Melbourne. Participants were trained on CDSS purpose, contents, and use. A survey captured the perceived benefits and weaknesses of the CDSS. RESULTS Thirty-nine clinicians participated. Over 90% felt the CDSS aims and format were clear, and understood the components. Over 80% felt it would enable adherence to clinical pathways, policy, and standards of care. CONCLUSIONS The CDSS provided significant perceived benefits to oncofertility care.
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Affiliation(s)
- Meredith Hand
- 1 Department of Obstetrics & Gynaecology, Royal Women's Hospital, University of Melbourne , Victoria, Australia
| | - Matthew A Kemertzis
- 1 Department of Obstetrics & Gynaecology, Royal Women's Hospital, University of Melbourne , Victoria, Australia .,2 Department of Gynaecology, Royal Children's Hospital , Melbourne, Victoria, Australia
| | - Michelle Peate
- 1 Department of Obstetrics & Gynaecology, Royal Women's Hospital, University of Melbourne , Victoria, Australia
| | - Lynn Gillam
- 3 School of Population and Global Health, University of Melbourne , Parkville, Victoria, Australia .,4 Children's Bioethics Centre, Royal Children's Hospital , Melbourne, Victoria, Australia
| | - Maria McCarthy
- 5 Social and Mental Health Research Group, Murdoch Children's Research Institute , Melbourne, Victoria, Australia
| | - Lisa Orme
- 6 Children's Cancer Centre, Royal Children's Hospital , Parkville, Victoria, Australia
| | - Yves Heloury
- 7 Department of Surgery, Royal Children's Hospital , Parkville, Victoria, Australia
| | - Michael Sullivan
- 6 Children's Cancer Centre, Royal Children's Hospital , Parkville, Victoria, Australia
| | - Margaret Zacharin
- 8 Department of Endocrinology, Royal Children's Hospital , Parkville, Victoria, Australia
| | - Yasmin Jayasinghe
- 1 Department of Obstetrics & Gynaecology, Royal Women's Hospital, University of Melbourne , Victoria, Australia .,2 Department of Gynaecology, Royal Children's Hospital , Melbourne, Victoria, Australia .,9 Department of Obstetrics and Gynaecology, University of Melbourne , Parkville, Victoria, Australia
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Caldamone A, Heloury Y, Herndon CDA, Hoebeke P, Wood D. Editorial. J Pediatr Urol 2018; 14:91. [PMID: 29793745 DOI: 10.1016/j.jpurol.2018.04.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 11/28/2022]
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32
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Leclair MD, Heloury Y. Response to commentary re 'Primary female epispadias: Perineal approach or Kelly repair?'. J Pediatr Urol 2018; 14:41. [PMID: 29162328 DOI: 10.1016/j.jpurol.2017.09.017] [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: 09/19/2017] [Accepted: 09/23/2017] [Indexed: 12/01/2022]
Affiliation(s)
- M-D Leclair
- Hopital Mère-Enfant, Chu de Nantes, Nantes, France.
| | - Y Heloury
- Royal Children Hospital, Melbourne, Australia
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33
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Pacilli M, Heloury Y, O'Brien M, Lionti T, Rowell M, Hutson J. Orchidopexy in children with Prader-Willi syndrome: Results of a long-term follow-up study. J Pediatr Urol 2018; 14:63.e1-63.e6. [PMID: 29102298 DOI: 10.1016/j.jpurol.2017.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 10/05/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Prader-Willi syndrome (PWS) is a rare (1:20.000) genetic condition affecting both males and females. Among other features, in boys, the syndrome is characterized by cryptorchidism in 86-100% of cases, hypogonadism, delayed puberty and infertility. The aim of the present study is to appraise the results of orchidopexy in this selected population of children. STUDY DESIGN A follow-up study of children with PWS treated for undescended testes at a single institution over a 20-year period was performed. Patients were identified from a National PWS registry and reviewed at a special follow-up clinic. Data were collected from electronic and hard copies records and reported as median (range). RESULTS Thirty-three children (1-17 years) were identified. Co-morbidities were present in 22 (66%) and 15 (45%) were on growth-hormone therapy. Six patients (19%) had normal testes palpable in the scrotum; twenty-seven (81%) had undescended testes and required orchidopexy. Thirteen (48%) underwent a bilateral procedure for a total of 40 procedures. A 2-stage Fowler-Stephens orchidopexy was required in 2 (7%) testes. At surgery hypotrophic testes were documented in 6 (22%) patients. Age at orchidopexy was 1.4 years (0.5-5.5). Age at FU was 7.2 years (1.7-17). Length of follow-up is 3.5 years (0.4-14). At follow-up 16 (40%) testes were of normal size and palpable in the scrotum; 7 (17.5%) testes required redo-orchidopexy. All patients (6/33) over 16 years of age that had testosterone levels tested had values below normal limits after successful orchidopexy. CONCLUSIONS This study evaluates the results of orchidopexy in a large population of children with PWS. At follow-up, only 40% of testes were of normal size and in the scrotum. This information should be taken into consideration for patients' management and pre-operative parents' counseling.
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Affiliation(s)
- Maurizio Pacilli
- Department of Paediatric Surgery and Department of Paediatrics, Monash University, Monash Children's Hospital, Melbourne, Australia; Department of General Surgery, Monash Children's Hospital and Department of Paediatrics, Monash University, Melbourne, Australia.
| | - Yves Heloury
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Australia
| | - Mike O'Brien
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Australia
| | - Tess Lionti
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Margaret Rowell
- Developmental Medicine, Royal Children's Hospital, Melbourne, Australia
| | - John Hutson
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Australia
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Caldamone A, Heloury Y, Herndon CDA, Hoebeke P, Wood D. Editorial. J Pediatr Urol 2017; 13:555-556. [PMID: 29248272 DOI: 10.1016/j.jpurol.2017.11.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 11/10/2017] [Indexed: 10/18/2022]
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35
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Bouty A, Faure A, Shaw L, Ah Toy J, Dobremez E, O'Brien M, Heloury Y. Is peritoneal dialysis feasible after laparotomy in children? A case-control series to compare outcomes. J Pediatr Urol 2017; 13:612.e1-612.e7. [PMID: 28571995 DOI: 10.1016/j.jpurol.2017.04.009] [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: 11/03/2016] [Accepted: 04/06/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Peritoneal dialysis (PD) is the modality of choice for children with end-stage renal disease (ESRD) awaiting renal transplant; however, this option is sometimes avoided for those with previous laparotomy. The goal of this study was to compare the outcomes of PD in patients with and without previous laparotomy. PATIENTS AND METHODS Twenty-four patients who had been started on peritoneal dialysis were retrospectively analysed. Group LAP consisted of six patients with previous laparotomy, and Group NO-LAP of 18 controls with either retroperitoneal or no abdominal surgery. The percentage of theoretical maximum volume of infusion, time to reach it, complications (infection and drainage difficulties), and number of catheters needed to finish therapy were analysed. RESULTS The characteristics of patients and technique of insertion are presented in Table. The percentage of maximum theoretical volume of infusion was similar in both groups. Median of catheter survival was similar in both groups. Complications were divided into malfunction (slow drainage, obstruction or leak) and infection. Incidence of complications per catheter and per month of dialysis was ten times lower in Group NO-LAP. Peritoneal dialysis failed in one patient with recurrent intraperitoneal adhesions after adhesiolysis in Group LAP. CONCLUSION Despite a higher incidence of complications (malfunction and infections), PD remains an acceptable option after laparotomy. In this series, it was sufficient in achieving adequate filtration in five patients.
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Affiliation(s)
- A Bouty
- Department of Urology, Royal Children's Hospital, Parkville, Australia.
| | - A Faure
- Department of Paediatric Surgery, Hôpital Marseille Nord, Marseille, France
| | - L Shaw
- Department of Nephrology, Royal Children's Hospital, Parkville, Australia
| | - J Ah Toy
- Department of Urology, Royal Children's Hospital, Parkville, Australia
| | - E Dobremez
- Department of Paediatric Surgery, Hôpital Pellegrin enfants, Bordeaux, France
| | - M O'Brien
- Department of Urology, Royal Children's Hospital, Parkville, Australia
| | - Y Heloury
- Department of Urology, Royal Children's Hospital, Parkville, Australia
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Caldamone AA, Heloury Y, Herndon CDA, Hoebecke P, Wood D. Editorial. J Pediatr Urol 2017; 13:421. [PMID: 29080774 DOI: 10.1016/j.jpurol.2017.10.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE The purpose of the study was to determine if there were differences in the complication rates between foreskin reconstruction (FR) and circumcision (CIRC) in distal hypospadias repairs. The primary outcomes were urethrocutaneous fistula (UF) and dehiscence. METHODS The data of distal hypospadias operated between 2005 and 2013 were retrospectively reviewed. The inclusion criteria were any distal hypospadias repair that required an urethroplasty. The exclusion criteria were follow-up <1 year, redo procedures, chordee greater than 20°, and incomplete data. Univariate and multivariate analysis was performed on the results. RESULTS 213 patients were included (95 FR and 118 CIRC). The 2 groups were comparable for age at surgery 19.32 months in FR and 14.25 months in CIRC. Mathieu repair was more common in FR (47/95-49.47%) than in CIRC (45/118-38.14%). The total subsequent procedures required were 23 in FR and 57 in CIRC. The incidence of UF was 6.3% (6/95) in FR and 27.1% (32/118) in CIRC (p < 0.001, OR 5.52, 95% CI 2.2-13.9). Complete dehiscence rates were 3.16% (3/95) FR vs 11.02% (13/118) for CIRC (p = 0.037, OR 3.8, 95% CI 1.05-13.74). The incidence of patients requiring reoperation was 18.9% (18/95) in FR versus 45.8% (54/118) in CIRC (p < 0.001, OR 3.61, 95% CI 1.93-6.76). CONCLUSIONS Foreskin Reconstruction conferred a significantly lower rate of complications, particularly the UF rate, dehiscence rate, and number of patients that required reoperation. Our rate of complications in the CIRC group is much higher than other published data.
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Affiliation(s)
- Rajay Rampersad
- Department of Paediatric Urology, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, VIC, 3052, Australia.
| | - Yoke Lin Nyo
- Department of Paediatric Urology, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - John Hutson
- Department of Paediatric Urology, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Mike O'Brien
- Department of Paediatric Urology, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Yves Heloury
- Department of Paediatric Urology, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Murdoch Children's Research Institute, Parkville, VIC, Australia
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Ho WLC, Bourne H, Gook D, Clarke G, Kemertzis M, Stern K, Agresta F, Heloury Y, Clark H, Orme L, Jayasinghe Y, Zacharin MR. A short report on current fertility preservation strategies for boys. Clin Endocrinol (Oxf) 2017; 87:279-285. [PMID: 28504866 DOI: 10.1111/cen.13377] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 05/02/2017] [Accepted: 05/10/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Advances in cancer treatment have led to improved long-term survival after childhood cancer, but often at a price of impaired future fertility. Fertility preservation (FP) in male children and early adolescents poses unique challenges as efficacy is unproven. OBJECTIVES To describe characteristics of testicular tissue cryopreservation (TTCP) specimens taken from paediatric and adolescent patients, stratified by age, and prior chemotherapy, if any, and to demonstrate evidence for germ cells. MATERIALS AND METHODS Retrospective review of gonadal biopsies and clinical records of patients consented into the Royal Children's Hospital FP programme between 1987 and 2015. Tissue was sliced into blocks, with one section sent for histopathology prior to cryopreservation. In boys ≥12 years where spermatogenesis could be expected, a portion of tissue was disaggregated completely to look for mature sperm and if found, additional tissue was dissected and the resulting suspension frozen. RESULTS Testicular tissue cryopreservation specimens in 44 males (0.3-16.8 years) provided an average of 7.8 slices per patient. All the specimens were taken at the same time as another necessary surgical procedure, under one general anaesthesic. There was only one complication of scrotal wound dehiscence. Seven of the forty-four (15.9%) patients had chemotherapy prior to testicular biopsy, while the rest were chemotherapy naïve. Five of these were prepubertal, and two were pubertal patients. Eleven subjects had tissue dissected with mature sperm found in eight. Of these eight patients where sperm were found, all were pubertal with testicular size of more than 10 mL and showing histological evidence of spermatogenesis. No histologic specimen demonstrated any malignant cells. CONCLUSIONS Testicular tissue cryopreservation can be performed in young patients without delay, preferably prior to cancer treatment. As testicular tissue contains germ cells from which haploid spermatozoa are ultimately derived, future technologies may allow their utilization for fertility in humans. This may be the only hope for biological offspring in some patients undergoing fertility compromising treatment. Retrieval of mature sperm from some pubertal patients, however, offers realistic hope to these patients of future fertility.
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Affiliation(s)
- Wei Li Cindy Ho
- Royal Children's Hospital, Melbourne, Vic., Australia
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
- Murdoch Children's Research Institute, Parkville, Vic., Australia
| | - Harold Bourne
- Melbourne IVF, East Melbourne, Vic., Australia
- Reproductive Services, Royal Women's Hospital, Melbourne, Vic., Australia
| | - Debra Gook
- Melbourne IVF, East Melbourne, Vic., Australia
- Reproductive Services, Royal Women's Hospital, Melbourne, Vic., Australia
| | - Gary Clarke
- Andrology Unit, Laboratory Services Department, Royal Children's and Royal Women's Hospital, Melbourne, Vic., Australia
| | - Matthew Kemertzis
- Department of Obstetrics & Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Vic., Australia
| | - Kate Stern
- Melbourne IVF, East Melbourne, Vic., Australia
- Reproductive Services, Royal Women's Hospital, Melbourne, Vic., Australia
| | | | - Yves Heloury
- Royal Children's Hospital, Melbourne, Vic., Australia
| | | | - Lisa Orme
- Royal Children's Hospital, Melbourne, Vic., Australia
| | - Yasmin Jayasinghe
- Royal Children's Hospital, Melbourne, Vic., Australia
- Department of Obstetrics & Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, Vic., Australia
| | - Margaret R Zacharin
- Royal Children's Hospital, Melbourne, Vic., Australia
- Murdoch Children's Research Institute, Parkville, Vic., Australia
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Caldamone A, Heloury Y, Hoebeke P, Herndon CDA, Wood D. Editorial. J Pediatr Urol 2017; 13:241. [PMID: 28600201 DOI: 10.1016/j.jpurol.2017.05.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/02/2017] [Indexed: 11/27/2022]
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40
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King SK, Stathopoulos L, Pinnuck L, Wells J, Hutson J, Heloury Y. Retrograde continence enema in children with spina bifida: Not as effective as first thought. J Paediatr Child Health 2017; 53:386-390. [PMID: 27862592 DOI: 10.1111/jpc.13408] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 06/20/2016] [Revised: 08/22/2016] [Accepted: 09/22/2016] [Indexed: 12/15/2022]
Abstract
AIM The aim of the study is to investigate the effectiveness of Peristeen retrograde continence enema (RCE) in the management of faecal incontinence in children with spina bifida. METHODS We identified a homogenous group of spina bifida patients in whom RCE was initiated (Jan 2006-July 2013). Confidential assessments included (i) Fecal Incontinence Quality Of Life (FIQOL), (ii) St Marks Faecal Incontinence score, (iii) Cleveland Clinic Constipation score and (iv) Neurogenic Bowel Dysfunction score. RESULTS Of 20 patients, 11 (mean age 14.5 ± 5.3 years) were male. Of 20 patients, nine were still using RCE (mean follow-up 4.1 years). Three patients ceased RCE within 10 days, six after 4-12 months and two after 36-48 months. Reasons for cessation included balloon difficulties (n = 4), procedure deemed too difficult (n = 4) and pain (n = 3). There were no differences between the groups in length of training time for technique, instillate fluid/volume used and time taken to perform RCE. There were no differences between the groups for quality of life, faecal incontinence or constipation scores. CONCLUSIONS We demonstrated a high rate of cessation with RCE in patients with spina bifida. This could not be explained by associated conditions, or by enema-related parameters. One possible explanation is the lack of ongoing outpatient support for the children and their families.
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Affiliation(s)
- Sebastian K King
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Surgical Research Laboratory, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Lefteris Stathopoulos
- Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Loreto Pinnuck
- Department of Stoma Therapy, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Judy Wells
- Department of Stoma Therapy, and, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - John Hutson
- Surgical Research Laboratory, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Urology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Yves Heloury
- Department of Urology, The Royal Children's Hospital, Melbourne, Victoria, Australia
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Caldamone A, Hoebeke P, Heloury Y, Anthony Herndon CD, Wood D. Editorial. J Pediatr Urol 2017; 13:121. [PMID: 28528819 DOI: 10.1016/j.jpurol.2017.03.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Caldamone A, Hoebeke P, Heloury Y, Anthony Herndon CD, Wood D. Editorial. J Pediatr Urol 2016; 12:333. [PMID: 27889220 DOI: 10.1016/j.jpurol.2016.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 11/06/2016] [Indexed: 11/29/2022]
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Giutronich S, Scalabre A, Blanc T, Borzi P, Aigrain Y, O'Brien M, Mouriquand PDE, Heloury Y. Spontaneous bladder rupture in non-augmented bladder exstrophy. J Pediatr Urol 2016; 12:400.e1-400.e5. [PMID: 27499279 DOI: 10.1016/j.jpurol.2016.04.054] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 04/17/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Bladder perforation is not commonly described in bladder exstrophy patients without bladder augmentation. The goal of this study was to identify the risk factors of spontaneous perforation in non-augmented exstrophy bladders. METHODS The study was a retrospective multi-institutional review of bladder perforation in seven male and two female patients with classic bladder exstrophy-epispadias (E-E). RESULTS Correction of E-E was performed using Kelly repair in two and staged repair in seven (Table). Bladder neck repair was performed in eight patients at a mean age of 6 years. Three patients had additional urethral surgery. Before rupture, six patients were voiding only per urethra. Two patients were voiding urethrally but were also performing occasional CIC via a Mitrofanoff. One patient was performing CIC 3 hourly per urethra. Six were dry during the day. Six of the patients had lower urinary tract symptoms: five had frequency and four were straining to void. Two had suffered episodes of urinary retention. Pre-rupture ultrasound showed that the upper urinary tract was dilated in four patients. Micturating cystourethrogram was performed in six showing vesico-ureteral reflux in five. Two had urethral stenosis. Nuclear medicine was done in three patients with two abnormal differential function. Urodynamics was performed in two patients with low capacity (100 mL) and hypocompliant (<10) bladders. Both had high leak point pressures: 60 cmH2O at 100 mL. The mean age at rupture was 11 years, with a range of 5-20 years. Patients presented with abdominal pain, associated with signs of intestinal obstruction in seven and fever in two. Eight patients underwent laparotomy and one prolonged drainage via SPC. Simple closure was performed in seven and bladder neck closure in one, because of extension of the rupture inferiorly. All patients recovered well. Following rupture, five underwent augmentation and Mitrofanoff. One of these suffered a recurrent rupture. Two other patients refused augmentation and Mitrofanoff and one of these has since had a subsequent rupture. CONCLUSIONS The limitations of this series include the small number of patients and its retrospective nature, without knowledge of the incidence. Bladder rupture is a risk even in non-augmented bladder exstrophy. It is potentially life-threatening and most often requires laparotomy. Rupture occurs because of poor bladder emptying and/or high pressure. Urodynamics may identify those at risk. CIC with or without augmentation should not be delayed once poor bladder emptying and/or high pressure are identified.
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Affiliation(s)
- Sarah Giutronich
- Department of Paediatric Urology, Royal Children's Hospital, Flemington Road, Parkville, VIC, Australia.
| | - Aurélien Scalabre
- Department of Paediatric Urology, Hopital Femme Mere Enfant, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | - Thomas Blanc
- Department of Paediatric Surgery, Hopital Necker Enfants Malades, Paris, France
| | - Peter Borzi
- Department of Paediatric Surgery, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia
| | - Yves Aigrain
- Department of Paediatric Surgery, Hopital Necker Enfants Malades, Paris, France
| | - Mike O'Brien
- Department of Paediatric Urology, Royal Children's Hospital, Flemington Road, Parkville, VIC, Australia
| | - Pierre D E Mouriquand
- Department of Paediatric Urology, Hopital Femme Mere Enfant, Hospices Civils de Lyon and Claude Bernard University, Lyon, France
| | - Yves Heloury
- Department of Paediatric Urology, Royal Children's Hospital, Flemington Road, Parkville, VIC, Australia
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45
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Eggers S, Sadedin S, van den Bergen JA, Robevska G, Ohnesorg T, Hewitt J, Lambeth L, Bouty A, Knarston IM, Tan TY, Cameron F, Werther G, Hutson J, O'Connell M, Grover SR, Heloury Y, Zacharin M, Bergman P, Kimber C, Brown J, Webb N, Hunter MF, Srinivasan S, Titmuss A, Verge CF, Mowat D, Smith G, Smith J, Ewans L, Shalhoub C, Crock P, Cowell C, Leong GM, Ono M, Lafferty AR, Huynh T, Visser U, Choong CS, McKenzie F, Pachter N, Thompson EM, Couper J, Baxendale A, Gecz J, Wheeler BJ, Jefferies C, MacKenzie K, Hofman P, Carter P, King RI, Krausz C, van Ravenswaaij-Arts CMA, Looijenga L, Drop S, Riedl S, Cools M, Dawson A, Juniarto AZ, Khadilkar V, Khadilkar A, Bhatia V, Dũng VC, Atta I, Raza J, Thi Diem Chi N, Hao TK, Harley V, Koopman P, Warne G, Faradz S, Oshlack A, Ayers KL, Sinclair AH. Disorders of sex development: insights from targeted gene sequencing of a large international patient cohort. Genome Biol 2016; 17:243. [PMID: 27899157 PMCID: PMC5126855 DOI: 10.1186/s13059-016-1105-y] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/10/2016] [Indexed: 01/20/2023] Open
Abstract
Background Disorders of sex development (DSD) are congenital conditions in which chromosomal, gonadal, or phenotypic sex is atypical. Clinical management of DSD is often difficult and currently only 13% of patients receive an accurate clinical genetic diagnosis. To address this we have developed a massively parallel sequencing targeted DSD gene panel which allows us to sequence all 64 known diagnostic DSD genes and candidate genes simultaneously. Results We analyzed DNA from the largest reported international cohort of patients with DSD (278 patients with 46,XY DSD and 48 with 46,XX DSD). Our targeted gene panel compares favorably with other sequencing platforms. We found a total of 28 diagnostic genes that are implicated in DSD, highlighting the genetic spectrum of this disorder. Sequencing revealed 93 previously unreported DSD gene variants. Overall, we identified a likely genetic diagnosis in 43% of patients with 46,XY DSD. In patients with 46,XY disorders of androgen synthesis and action the genetic diagnosis rate reached 60%. Surprisingly, little difference in diagnostic rate was observed between singletons and trios. In many cases our findings are informative as to the likely cause of the DSD, which will facilitate clinical management. Conclusions Our massively parallel sequencing targeted DSD gene panel represents an economical means of improving the genetic diagnostic capability for patients affected by DSD. Implementation of this panel in a large cohort of patients has expanded our understanding of the underlying genetic etiology of DSD. The inclusion of research candidate genes also provides an invaluable resource for future identification of novel genes. Electronic supplementary material The online version of this article (doi:10.1186/s13059-016-1105-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stefanie Eggers
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Victorian Clinical Genetic Services, Melbourne, VIC, Australia
| | - Simon Sadedin
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | | | | | - Thomas Ohnesorg
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Jacqueline Hewitt
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,University of Melbourne, School of Bioscience, Melbourne, VIC, Australia.,Department Of Paediatric Urology, Monash Children's Hospital, Clayton, VIC, Australia
| | - Luke Lambeth
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia
| | - Aurore Bouty
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Ingrid M Knarston
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Tiong Yang Tan
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia.,Victorian Clinical Genetic Services, Melbourne, VIC, Australia
| | - Fergus Cameron
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - George Werther
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - John Hutson
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Michele O'Connell
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Sonia R Grover
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Yves Heloury
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Margaret Zacharin
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Philip Bergman
- Department of Paediatric Endocrinology and Diabetes, Monash Children's Hospital, Clayton, VIC, Australia.,Monash Medical Centre, Clayton, VIC, Australia
| | - Chris Kimber
- Monash Children's Hospital, Clayton, VIC, Australia
| | - Justin Brown
- Department of Paediatric Endocrinology and Diabetes, Monash Children's Hospital, Clayton, VIC, Australia.,Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Nathalie Webb
- Department Of Paediatric Urology, Monash Children's Hospital, Clayton, VIC, Australia
| | - Matthew F Hunter
- Department of Paediatrics, Monash University, Clayton, VIC, Australia.,Monash Genetics, Monash Health, Clayton, VIC, Australia
| | - Shubha Srinivasan
- The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, NSW, Australia
| | - Angela Titmuss
- The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, NSW, Australia
| | - Charles F Verge
- Sydney Children's Hospital, Randwick, NSW, Australia.,School of Women's and Children's Health, UNSW, Sydney, NSW, Australia
| | - David Mowat
- Department of Medical Genetics, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Grahame Smith
- Urology and Clinical Programs, The Children's Hospital at Westmead, Westmead, NSW, Australia.,The University of Sydney, Westmead, NSW, Australia
| | - Janine Smith
- Department of Clinical Genetics, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Lisa Ewans
- Department of Medical Genomics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Genetic Medicine, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Carolyn Shalhoub
- Department of Medical Genetics, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Patricia Crock
- John Hunter Children's Hospital, New Lambton Heights, NSW, Australia
| | - Chris Cowell
- The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Westmead, NSW, Australia
| | - Gary M Leong
- Department of Paediatric Endocrinology and Diabetes, Lady Cilento Children's Hospital, Brisbane, QLD, Australia
| | - Makato Ono
- Department of Paediatrics, Tokyo Bay Medical Centre, Tokyo, Chiba, Japan
| | - Antony R Lafferty
- Centenary Hospital for Women and Children, Canberra, ACT, Australia.,ANU Medical School, Canberra, ACT, Australia
| | - Tony Huynh
- Department of Paediatric Endocrinology and Diabetes, Lady Cilento Children's Hospital, Brisbane, QLD, Australia
| | - Uma Visser
- Sydney Children's Hospital, Randwick, NSW, Australia
| | - Catherine S Choong
- Department of Endocrinology and Diabetes, Princess Margaret Hospital, Subiaco, WA, Australia.,School of Paediatrics and Child Health, The University of Western Australia, Crawley, WA, Australia
| | - Fiona McKenzie
- School of Paediatrics and Child Health, The University of Western Australia, Crawley, WA, Australia.,Genetic Services of Western Australia, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Nicholas Pachter
- School of Paediatrics and Child Health, The University of Western Australia, Crawley, WA, Australia.,Genetic Services of Western Australia, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Elizabeth M Thompson
- SA Clinical Genetics Service, SA Pathology at the Women's and Children's Hospital, North Adelaide, SA, Australia.,School of Medicine, University of Adelaide, North Terrace, Adelaide, SA, Australia
| | - Jennifer Couper
- Women's and Children's Hospital and Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Anne Baxendale
- SA Clinical Genetics Service, SA Pathology at the Women's and Children's Hospital, North Adelaide, SA, Australia
| | - Jozef Gecz
- School of Medicine and The Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
| | - Craig Jefferies
- Diabetes and Endocrinology, Auckland District Health Board, Auckland, New Zealand
| | | | - Paul Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Philippa Carter
- Starship Paediatric Diabetes and Endocrinology, Auckland, New Zealand
| | - Richard I King
- Canterbury Health Laboratories, Christchurch, Canterbury, New Zealand
| | - Csilla Krausz
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | | | - Leendert Looijenga
- Department of Pathology, Josephine Nefkens Institute, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Sten Drop
- Department of Paediatrics, Division of Endocrinology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Stefan Riedl
- St Anna Children's Hospital, Vienna, Austria.,Paediatric Department, Medical University of Vienna, Vienna, Austria
| | - Martine Cools
- Department of Paediatric Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Angelika Dawson
- Genomic Laboratory, Diagnostic Services of Manitoba and Genetics & Metabolism Program, WRHA, Winnipeg, MB, Canada.,Department Biochemistry & Medical Genetics and Paediatrics & Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Achmad Zulfa Juniarto
- Division of Human Genetics, Centre for Biomedical Research Faculty of Medicine Diponegoro University (FMDU), Semarang, Indonesia
| | - Vaman Khadilkar
- Growth and Pediatric Endocrine Clinic, Hirabai Cowasji Jehangir Medical Research Institute, Pune, India.,Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Anuradha Khadilkar
- Growth and Pediatric Endocrine Clinic, Hirabai Cowasji Jehangir Medical Research Institute, Pune, India.,Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | | | - Vũ Chí Dũng
- Department of Endocrinology, Metabolism and Genetics National Children's Hospital, Hanoi, Vietnam
| | - Irum Atta
- National Institute of Child Health, Karachi, Pakistan
| | - Jamal Raza
- National Institute of Child Health, Karachi, Pakistan
| | | | - Tran Kiem Hao
- Paediatric Centre, Hue Central Hospital, Hue city, Vietnam
| | - Vincent Harley
- Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - Peter Koopman
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
| | - Garry Warne
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Sultana Faradz
- Division of Human Genetics, Centre for Biomedical Research Faculty of Medicine Diponegoro University (FMDU), Semarang, Indonesia
| | - Alicia Oshlack
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,University of Melbourne, School of Bioscience, Melbourne, VIC, Australia
| | - Katie L Ayers
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Andrew H Sinclair
- Murdoch Childrens Research Institute, Melbourne, VIC, Australia. .,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
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Faure A, Bouty A, Caruana G, Williams L, Burgess T, Wong MN, James PA, O'Brien M, Walker A, Bertram JF, Heloury Y. DNA copy number variants: A potentially useful predictor of early onset renal failure in boys with posterior urethral valves. J Pediatr Urol 2016; 12:227.e1-7. [PMID: 27160979 DOI: 10.1016/j.jpurol.2016.02.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 12/14/2015] [Accepted: 02/29/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Posterior urethral valves (PUV) are among the most common urological causes of chronic kidney disease (CKD) in childhood. Recently, genomic imbalances have been cited as potential risk factors for altered kidney function and have been associated with CKD. The phenotypic effects of a copy number variant (CNV) in boys with PUV are unknown. Here, it was hypothesised that the progression to early renal failure in PUV patients may be influenced by genetic aberrations. OBJECTIVE To assess the relationship between CNVs and renal outcomes. PATIENTS AND METHODS Between September 2012 and July 2015, 45 children with PUV were recruited to evaluate the presence of CNVs in their DNA. The patients' medical records were retrospectively reviewed. The criteria for outcomes of renal function included: assessments of the nadir serum creatinine in the first year of life, the estimated glomerular filtration rate at 1 and 5 years, and the requirement for renal replacement. RESULTS Thirteen CNVs were identified in 12 boys (29% of the cohort). Microarray analysis revealed two pathogenic CNVs (well-established CNVs known to be associated with genetic disease) and 11 of unknown significance (CNVs with insufficient current available evidence for unequivocal determination of clinical significance), including genes that have been previously implicated in kidney diseases and urogenital disorders. The median follow-up was 10.2 years (range 3-17.5) in the group of patients with CNV compared with 5.8 years (range 1-16.6) in those CNV-. The nadir creatinine values were significantly higher in boys with CNVs than in those without CNVs (57.5 μmol/L (range 23-215) and 28 μmol/L (range 18-155), respectively (P = 0.05) (Figure). Boys CNV+ had a worse prognosis, with a higher incidence of Stage-V CKD compared with the control group (33% with CNVs vs. 9% in CNV-, P = 0.06) at a median age of 22 months (range 8 months-16 years). Four (33%) patients CNV+ underwent renal transplantation. DISCUSSION The role of CNVs in the deterioration of renal function remains unknown. It can be hypothesised that CNVs could be a contributing factor or may serve as an accelerant for the progression to renal failure. CONCLUSION The CNVs >100 Kb were significantly associated with early onset renal failure in children with PUV. Prenatal detection of CNV could help to identify foetuses at high risk of severe renal impairment in cases of suspected PUV, especially in cases without oligohydramnios or severe pulmonary hypoplasia. These preliminary results should be confirmed in a larger cohort of patients.
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Affiliation(s)
- A Faure
- Department of Urology, Royal Children's Hospital, Parkville, VIC 3052, Australia.
| | - A Bouty
- Department of Urology, Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - G Caruana
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, and Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC 3800, Australia
| | - L Williams
- Royal Children's Hospital, VCGS, Parkville, VIC 3052, Australia
| | - T Burgess
- Royal Children's Hospital, VCGS, Parkville, VIC 3052, Australia; Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC 3010, Australia
| | - M N Wong
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, and Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC 3800, Australia
| | - P A James
- Royal Children's Hospital, VCGS, Parkville, VIC 3052, Australia
| | - M O'Brien
- Department of Urology, Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - A Walker
- Department of Paediatric Nephrology, Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - J F Bertram
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, and Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC 3800, Australia
| | - Y Heloury
- Department of Urology, Royal Children's Hospital, Parkville, VIC 3052, Australia
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47
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Faure A, Atkinson J, Bouty A, O'Brien M, Levard G, Hutson J, Heloury Y. DICER1 pleuropulmonary blastoma familial tumour predisposition syndrome: What the paediatric urologist needs to know. J Pediatr Urol 2016; 12:5-10. [PMID: 26454454 DOI: 10.1016/j.jpurol.2015.08.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 06/24/2015] [Accepted: 08/22/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Germline-inactivating DICER1 mutations are responsible of a familial tumour susceptibility syndrome with an increased risk of tumours, mainly pleuropulmonary blastoma (PPB). DICER1 mutations also cause a range of other tumours, some of them in urogenital organs (cystic nephroma [CN], ovarian sex cord-stromal tumours, bladder and cervix embryonal rhabdomyosarcoma [ERMS]). OBJECTIVE The aim was to clarify the range of urogenital phenotypes associated with DICER1 mutations and to give practical course of action to paediatric urologist that are exposed to DICER1-related conditions. STUDY DESIGN A literature review was performed. Pertinent papers focused on urogenital diseases associated with DICER1 mutations were reviewed. RESULTS Seventy per cent of CN have a DICER1 germline mutation. The majority of them (80%) have PPB. Like PPB, CN could undergo a malignant progression to a primitive sarcoma. Some rare cases of Wilms tumours were reported. Regarding gonadal manifestations, sex-cord stromal neoplasia of the ovary, especially Sertoli-Leydig cell tumour (SLCT), is the most frequent tumour associated with DICER1 germline mutation. Germline DICER1 mutations also predispose to uterine cervix and bladder ERMS. DISCUSSION The presence of unusual tumours suggesting DICER1 mutations may alert clinicians. The first step is to obtain a complete familial history. The variable clinical presentation and the modest penetrance raise concerns about the appropriateness of genetic testing to patients and their relatives. The education of DICER1 mutations carriers about tumour-related symptoms is consensual. In the first 5 years of life, a yearly chest X-ray and abdominal ultrasound are recommended. CONCLUSION The presence of a CN, ovarian SLCT or urogenital ERMS in a child should alert the clinician to the possibility of DICER1 mutation and the associated risk of PPB. Individuals with one of the typical DICER1 conditions should be offered DICER1 analysis. Despite the low penetrance, a genetic counselling and testing should be offered to the family of the affected child.
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Affiliation(s)
- Alice Faure
- Royal Children's Hospital, Department of Paediatric Urology, Melbourne, Australia.
| | - John Atkinson
- Royal Children's Hospital, Department of Paediatric Urology, Melbourne, Australia
| | - Aurore Bouty
- Royal Children's Hospital, Department of Paediatric Urology, Melbourne, Australia
| | - Mike O'Brien
- Royal Children's Hospital, Department of Paediatric Urology, Melbourne, Australia
| | - Guillaume Levard
- Paediatric Surgery Department, University Hospital, Poitiers, France
| | - John Hutson
- Royal Children's Hospital, Department of Paediatric Urology, Melbourne, Australia; FD Stephens Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Yves Heloury
- Royal Children's Hospital, Department of Paediatric Urology, Melbourne, Australia
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48
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Bouty A, Ayers KL, Pask A, Heloury Y, Sinclair AH. The Genetic and Environmental Factors Underlying Hypospadias. Sex Dev 2015; 9:239-259. [PMID: 26613581 DOI: 10.1159/000441988] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2015] [Indexed: 12/22/2022] Open
Abstract
Hypospadias results from a failure of urethral closure in the male phallus and affects 1 in 200-300 boys. It is thought to be due to a combination of genetic and environmental factors. The development of the penis progresses in 2 stages: an initial hormone-independent phase and a secondary hormone-dependent phase. Here, we review the molecular pathways that contribute to each of these stages, drawing on studies from both human and mouse models. Hypospadias can occur when normal development of the phallus is disrupted, and we provide evidence that mutations in genes underlying this developmental process are causative. Finally, we discuss the environmental factors that may contribute to hypospadias and their potential immediate and transgenerational epigenetic impacts.
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Affiliation(s)
- Aurore Bouty
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Vic., Australia.,Department of Surgery, Royal Children's Hospital, University of Melbourne, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - Katie L Ayers
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - Andrew Pask
- Department of Zoology, University of Melbourne, Melbourne, Vic., Australia
| | - Yves Heloury
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Vic., Australia.,Department of Surgery, Royal Children's Hospital, University of Melbourne, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - Andrew H Sinclair
- Murdoch Children's Research Institute, Royal Children's Hospital, University of Melbourne, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
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49
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Sarkar A, Tantoco J, Kimber C, Heloury Y, Ferguson P, Cheng W. Stepwise approach to laparoscopic appendicectomy in children. Indian J Surg 2014; 76:243-6. [PMID: 25177128 DOI: 10.1007/s12262-013-0858-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 01/17/2013] [Indexed: 11/27/2022] Open
Abstract
Traditionally, three ports are used in laparoscopic appendicectomy. However to reduce surgical incision and cost, it is feasible to remove the appendix using fewer ports. In this study, we compared the efficacy of stepwise and standard approach in laparoscopic appendicectomies in children. Between August 2008 and September 2010, 378 children with appendicitis were allotted to either the stepwise or standard laparoscopy group depending on the operating surgeon's preference. In the former group, an operating telescope was inserted first. The number of ports used was based on the pathology (stepwise approach). In the latter group, three ports were inserted in all patients (standard approach). The two groups were similar. In the stepwise group, we performed 95 single port (utilising a scope with an instrument channel), 37 two ports and 13 three ports appendicectomies. In the stepwise group, operating time was shorter (not yet statistically significant) and it reduced the port numbers by more than 50 %. The stepwise approach provides an evidence-based management of appendicitis with comparable outcomes. This procedure further reduces incision trauma, operating times and the cost of operation. However, the reduction of post-operative analgesic requirement needs further study.
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Affiliation(s)
- Anisha Sarkar
- Southern Health, Melbourne, Australia ; Level 5, Block E, 246 Clayton Road, Clayton, Melbourne, VIC 3168 Australia
| | - Joselito Tantoco
- Department of Paediatric Surgery, Monash Medical Centre, Melbourne, VIC Australia
| | - Chris Kimber
- Department of Paediatric Surgery, Monash Medical Centre, Melbourne, VIC Australia
| | - Yves Heloury
- Department of Paediatric Surgery, Monash Medical Centre, Melbourne, VIC Australia
| | - Peter Ferguson
- Department of Paediatric Surgery, Monash Medical Centre, Melbourne, VIC Australia
| | - Wei Cheng
- Department of Paediatric Surgery, Monash Medical Centre, Melbourne, VIC Australia
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Affiliation(s)
- Yves Heloury
- Royal Children's Hospital, Parkville, Victoria, Australia
| | - Earl Y. Cheng
- Department of Urology, Lurie Children's Hospital of Chicago, The Feinberg School of Medicine at Northwestern University, Chicago, Illinois
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