Adult patients treated for bladder exstrophy at a young age: What are their current demands?

INTRODUCTION: Bladder exstrophy-epispadias complex is a rare condition that necessitates numerous surgical procedures during a patient's youth to achieve adequate urine storage and continence. This study aimed to identify the specific needs and functional challenges faced by adults who underwent pediatric bladder exstrophy reconstructions and assessing the management of these issues in an adult population. METHODS: A retrospective chart review was conducted for all bladder exstrophy complex patients who underwent surgery at a young age and were subsequently referred to our center between 2005 and 2020. Inclusion criteria included patients with cloacal or classical bladder exstrophy older than 18 years. We recorded the reasons for referral, management of contemporary complaints, types of past and present urinary reconstructions, and their current functional status. RESULTS: The study included 38 patients. The primary reasons for referral were incontinence (39%) and catheterization difficulties (24%). Management typically involved partial or complete surgical revision of their urinary reservoir, occasionally combined with a bladder neck procedure. Ultimately, only three patients continued to experience incontinence, while none reported catheterization issues after they underwent treatment at our center. Long-term exstrophy-related reconstruction complications included urinary tract infections (39%), stones (29%), stenosis (24%), fistulas (13%), chronic renal disease (16%), metabolic abnormalities (3%), and cancer (3%). CONCLUSIONS: Adults who previously underwent bladder exstrophy reconstruction exhibit a wide range of urologic reconstructions. Their needs often revolve around continence and catheterization concerns. Most patients with satisfactory functional outcomes perform selfcatheterization through a continent cutaneous channel and have either a continent pouch or an augmented bladder.

Paediatric minimally invasive abdominal and urological surgeries: Current trends and perioperative management.

Minimally invasive surgery during abdominal, thoracic and urological procedures has become the standard management of many surgical interventions in adults. Recent development of smaller devices has allowed the management of many paediatric surgeries using these minimally invasive techniques. However, the lack of knowledge of (a) adequate management of haemodynamic and respiratory alterations occurring during those procedures and (b) postoperative advantages of these techniques over open surgeries, still impairs their development. The current review aimed to clarify mechanisms of those haemodynamic and respiratory alterations, propose easy rules in order to overcome them and shed the light on potential postoperative advantages of minimally invasive surgery in paediatrics.

Intraoperative hemodynamic factors predicting early postoperative renal function in pediatric kidney transplantation.

BACKGROUND: The anesthetic management of kidney transplantation in children remains somewhat empirical. The goal of the present study was to investigate intraoperative hemodynamic factors affecting posttransplantation kidney function. METHODS: We performed a retrospective analysis of data from patients undergoing kidney transplantation in our pediatric teaching hospital from 2000 to 2014. Data collected included: donor and recipient demographic data, recipient comorbidities, fluids administered intraoperatively, and intraoperative blood pressure and central venous pressure. The main outcome of the study was the creatinine clearance at day 1 corrected to a body surface area of 1.73 m². Analysis was performed using Classification Tree Analysis with 10-fold cross-validation. RESULTS: One hundred and two patients were included. The following predictors of increased postoperative creatinine clearance at day 1 were identified: decreasing recipient weight, mean blood pressure-to-weight ratio 10 minutes after reperfusion, reduced cold ischemia duration, and increased intraoperative albumin infusion. Increased creatinine clearance was observed when mean blood pressure-to-weight ratio 10 minutes after reperfusion was ≥4.3 in patients weighing 13-21 kg and ≥2.5 in those ≥22 kg. Overall, the model explained 64% (and at cross-validation 60%) of creatinine clearance variability at day 1. CONCLUSION: Intraoperative hemodynamics during kidney transplantation should be optimized in order to increase mean blood pressure according to values indicated by our analyses. Cold ischemia duration should be shortened as far as possible.

Sonographic measurement of corpus spongiosum in male fetuses.

OBJECTIVE: To establish a nomogram of the corpus spongiosum dimensions in male fetuses and to evaluate its correlation with penile length. These references can be useful when fetal genital anomalies are suspected, particularly to distinguish micropenis from concealed penis cases. METHOD: A cross-sectional prospective study was conducted on 486 fetuses of normal singleton pregnancies between 18 and 40 weeks. Corpus spongiosum length, penile length, penile diameter and scrotal diameter were measured by one operator. All measurements were analyzed according to gestational age. RESULTS: The four measurements were studied as a function of gestational age. Median values, 3(rd) and 97(th) percentiles were determined using regression curves. A correlation between penile length and corpus spongiosum length (r(2) = 0.845) was observed. CONCLUSION: We established measurements of the length of fetal corpus spongiosum and a correlation between the former and the penile length. These references can be useful when fetal genital anomalies are suspected.