[Costs of intimate partner violence against women. A systematic review]. / Kosten Intimer Partnergewalt gegen Frauen. Ein systematischer Review.

About one in four women in Germany have experienced intimate partner violence at some point in their lives. Intimate partner violence against women is associated with a wide range of acute and long-term physical and psychological health problems. Partner violence also incurs huge costs to healthcare services, social care and the legal system with a subsequent loss in economic productivity. This systematic review will present existing studies on cost estimations with a particular focus on the types of costs and methodological problems in the studies which will provide information for the development of future surveys estimating the costs of partner violence. Electronic databases were searched in addition to manual searches. The database search for identification of such studies was only partially successful because administrative reports predominated. A total of nine cost estimates were identified which fulfilled the inclusion criteria and three studies considered direct, indirect and intangible costs. Due to the fragmentary data there is considerable heterogeneity in the cost categories and it can be assumed that the real costs are higher than those found in the studies. For reasons of international comparability, future data collection should be based on standard indicators which still need to be formulated.

Surgical results of complete hypospadias repair in two stages.

Between 1980 and 1992, 403 patients with hypospadias and with no previous operations were treated in Hyogo College of Medicine. Surgery was not performed in children younger than 3 years. The major points in the surgical repair were complete resection of the chordee, normal location of the meatus and reducing complications such as fistula formation or stricture. In order to achieve these aims we performed a two-stage repair, with the second operation at leat 12 months after the first one. In 57 of 245 patients with "chordee without hypospadias" and slight to moderate degree of hypospadias we performed surgery by the Crawford-Ikoma technique, which is characterized by 3 layers of watertight continuous sutures at the time of urethroplasty. The incidence of postoperative fistulae was 1.8%, the rate of strictures was 3.5%. After the Mays-Ikoma technique, where we perform a glandular urethroplasty in addition to chordectomy in the first stage, we diagnosed an urethral fistula in 7.9% and a stricture in 2.3%. A severe degree of hypospadias was seen in 158 patients. After performing the Crawford-Ikoma technique we acknowledged a rate of postoperative fistulae in 3.6% and strictures in 10.7%. The incidence of fistulae after the Mays-Ikoma technique was 8.9% and of strictures 1.1%. Altogether we found persistent chordee in 2 cases.

Pyeloplasty in hydronephrosis: examination of surgical results from a morphologic point of view.

BACKGROUND: Dilatation of the upper urinary tract is the most common congenital urogenital anomaly. Pyeloplasty is the therapy of choice in those patients with significant obstruction of the ureteropelvic junction. There are not many reports concerning the operative long-term results from a morphologic point of view. Furthermore, little information is available about children with giant hydronephrosis treated without resection of the dilated renal pelvis. METHODS: Between 1973 and 1993, 231 children with 262 renal units (kidney, renal pelvis, ureter) were treated at our institution. Giant hydronephrosis was observed in 52 renal units. The clinical and follow-up data were obtained from the patients' records. The dilatation of the upper urinary tract, confirmed by means of intravenous pyelogram, was divided into 5 grades. RESULTS: In 215 renal units, reconstructive surgery was performed without reduction of the renal pelvis. Revision of the pyeloplasty was necessary in 5 of the 215 renal units. The dilatation of the upper urinary tract improved or remained stable in 99.4% of the renal units during the follow-up period of 4.8 years (range, 1 month to 21 years). CONCLUSION: Surgical reconstruction of the ureteropelvic junction obstruction is a safe and successful procedure. The excision of the dilated pelvis does not seem to be necessary, even in patients with giant hydronephrosis.

Asymptomatic vesicoureteral reflux in children.

Between 1973 and 1992, a routine voiding cystourethrography screening was performed in all children attending our urological clinic. A total of 1023 children were diagnosed as cases of primary vesicoureteral reflux; 166 (210 renal units) of them were asymptomatic and were studied retrospectively. Ninety-one patients presented with enuresis, 39 with hypospadias, 14 with undescended testis, 8 with asymptomatic proteinuria and 14 had other manifestations such as intersexuality, inguinoscrotal swelling, abnormal external genitalia, etc. We documented high-grade reflux (IV-V) in 16.2% and renal scarring in 16.7% of the 210 renal units. None of the children showed features of urinary tract infection (UTI) or had a definite history in the past, but 23.5% of the 166 cases developed UTI during their follow-up period. Spontaneous resolution of reflux was observed in 52.7% of the 150 renal units and progression of renal scarring in 20% during follow-up. Antireflux operation was performed in 15 cases (26 renal units). In 9 children (5.4%) we found gross renal damage which progressed in two cases to end-stage renal disease followed by renal transplantation. A small kidney was noted in 5 patients and hypertension in two. It is concluded that the natural history of asymptomatic reflux is almost the same as in symptomatic reflux. Thus, routine voiding cystourethrography is suggested in all children attending a urological clinic in order to detect reflux as early as possible.