A multinational survey on the management of the urinary tract in newborns with spina bifida: Are we following current EAU/ESPU guidelines?

AIMS: In August 2019, the European Association of Urology (EAU) and European Society for Paediatric Urology (ESPU) published updated guidelines on the management of neurogenic bladder in children and adolescents. Our study aimed to establish whether members of the ESPU are adhering to these guidelines. METHODS: We designed a survey comprising 26 questions using SurveyMonkey®. Respondents were asked about management of neurogenic bladder at birth in newborns with spina bifida (SB), urological investigations, as well as short and long-term follow-up in their institutions. RESULTS: There were 103 respondents to the survey (754 recipients, giving a response rate of 14%) spanning 36 countries. 100% of respondents carry out a renal/bladder ultrasound at birth. Only 53% routinely commence clean intermittent catheterization soon after birth as recommended by the guidelines. Only 56% recommend anticholinergic medications after abnormal videourodynamics (VUDs). The guidelines recommend the use of continued antibiotic prophylaxis if there is evidence of vesicoureteral reflux and hostile bladder/non-conclusive results on VUDs which is followed by only 30% of providers. 63% of respondents carry out baseline VUDs at the recommended time. Seeing larger volumes of SB patients, having a formal SB protocol, having formal SB multidisciplinary clinics and working in a tertiary referral center did not make respondents more likely to adhere to guidelines. CONCLUSIONS: Our survey demonstrated that large variations from the EAU/ESPU guidelines exist in practice. The study confirms that further work is required across institutions and countries to implement these evidence-based recommendations for standardized practice.

Omphalomesenteric Duct Remnant: A Rare and Unusual Cause of Intestinal Atresia.

Intestinal atresia is generally considered to result from mesenteric vascular disruptions during fetal life. This report describes an unusual case of ileal atresia, resulting from an omphalic ring closure anomaly and an omphalomesenteric duct (OMD) remnant. A 2-day-old male neonate presented with bilious vomiting and abdominal distension. At laparotomy, the distal portion of the atretic ileum was entrapped within the umbilical ring, causing volvulus of the proximal dilated atretic bowel around the fixed distal bowel at the omphalic ring. This case report supports OMD remnants as a rare, potential cause of jejunoileal atresia.

False-negative rate of ultrasound-guided fine-needle aspiration cytology for identifying axillary lymph node metastasis in breast cancer patients.

Axillary nodal status remains an important determinant of prognosis and of the therapeutic strategy in patients with a newly diagnosed breast cancer. The aim of this study was to assess the false-negative rate of ultrasound (US)-guided fine-needle aspiration cytology (FNAC) in axillary node staging at breast cancer diagnosis. All patients with a newly diagnosed breast cancer who had an indeterminate or suspicious axillary node sampled with an FNAC between 2007 and 2014 were included in the study. FNAC results were compared to the final histopathological results of surgically removed axillary lymph nodes. Patient demographics, tumor, and nodal characteristics were analyzed. Diagnostic accuracy tests were performed using IBM SPSS, version 22. A total of 3515 patients with breast cancer were identified, 675 of whom had ultrasound-guided FNAC of ipsilateral axillary lymph nodes (mean age: 55 years; Range: 26-84). A benign (C2) result was observed in 52% (n = 351) and a malignant (C5) result in 35% (n = 238). C1 was obtained in 11% (n = 76), C3 in 0.6% (n = 4), and C4 in 0.9% (n = 6). Of the 238 patients with a malignant (C5) FNAC, 99.6% had confirmed axillary lymph node metastatic disease on histopathology. Of the 351 patients with benign FNAC (C2), 31% (n = 108) of patients had a positive lymph node on histology. The false-negative rate of preoperative FNAC remains too high (31%) to omit definitive surgical staging of the axilla. The high diagnostic accuracy when a positive FNAC is obtained allows appropriate tailored decisions regarding definitive therapy.

The Irish Experience with Sacrococcygeal Teratomas: Are Type IV Lesions More Common than We Think?

INTRODUCTION: Sacrococcygeal teratomas (SCTs) are rare tumors occurring in approximately 1 in 35,000 to 40,000 live births. The Altman classification is used to describe SCTs. There are four types, with type 1 predominantly external through to type IV which is a presacral, completely internal mass. As far as the authors are aware, this is the first study to focus on type IV SCT lesions. MATERIALS AND METHODS: Using ICD-10-AM (The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification) codes, we identified all patients in the Republic of Ireland with a diagnosis of SCT from 2004 to 2020. The following information was obtained for each patient: gender, time of diagnosis, clinical presentation, method of diagnosis, Altman classification, biomarkers, age at operation, surgical technique, pathology, recurrence, and age at most recent follow-up. RESULTS: There were 29 patients in total; 23 females (79%) and 6 males (21%). In total, 16 (55%) were diagnosed antenatally, 4 (14%) at less than 1 month, 4 (14%) less than 1 year, 3 (10%) age 2 to 4 years, and 2 (7%) were aged 5 to 12 years. In addition, 22 (76%) were mature teratomas, 2 (7%) immature teratomas, and 5 (17%) were malignant tumors. There were 6 (21%) type I lesions, 9 (30%) type II, 6 (21%) type III, and 8 (28%) type IV lesions. CONCLUSION: In Altman's original 1974 study, type IV lesions were present in 10% of cases. As a result, this is the most frequently quoted figure. Type IV lesions were present in 28% of cases in our study. We propose that type IV lesions may be more common than the current literature suggests and consequently a higher index of suspicion of their presence should be entertained.

A Novel Approach to Extensive Chest Wall Reconstruction in a Child.

Reconstruction of extensive chest wall defects is challenging in young children. Rigid prosthetic plates, designed to prevent paradoxic respiration, do not grow with the child and may result in progressive chest and spinal deformity. Also because of the greater proportionate size of the thorax relative to the limbs in young children, extrathoracic soft tissue flaps may be too small for an adequate reconstruction. Here we report reconstruction of a large chest wall defect after resection of a Ewing's sarcoma in a 2-year-old boy using Permacol membrane (Medtronic, Minneapolis, MN) supported by a diagonally translocated seventh rib and covered by a latissimus dorsi flap.

Accuracy assessment for navigated maxillo-facial surgery using an electromagnetic tracking device.

PURPOSE: To evaluate the accuracy and the usability of an electromagnetic tracking device in maxillo-facial surgery through testing on a phantom skull under operating room (OR) conditions. MATERIAL AND METHODS: A standard plastic skull phantom was equipped with a custom made model of the maxilla and with target markers and dental brackets. Imaging was performed with a computed tomography (CT) scanner. The extent and robustness of the electromagnetic tracking system's target registration error (TRE) was evaluated under various conditions. RESULTS: For each measurement a total of 243 registrations were performed with 5 point registration and 4374 registrations with 6 point registration. The average target registration error for the 5 point registration under OR conditions was 2.1 mm (SD 0.86) and 1.03 (SD 0.53) for the 6 point registration. Metallic instruments applied to the skull increased the TRE significantly in both registration methods. CONCLUSION: The electromagnetic tracking device showed a high accuracy and performed stable in both registration methods. Electromagnetic interference due to metallic instruments was significant but the extent of TRE was still acceptable in comparison to optical navigation devices. A benefit of EM tracking is the absence of line-of-sight hindrance. The test setting simulating OR conditions has proven suitable for further studies.

The accuracy of image guided surgery based on cone beam computer tomography image data.

OBJECTIVE: The objective of this study was to verify if accurate patient-to-image registration for precision navigation in maxillofacial surgery is possible based on cone beam computed tomography (CBCT) image data. STUDY DESIGN: A maxillary registration template was placed on a standard plastic skull phantom that was equipped with a custom made model of the maxilla and with target markers. Imaging was performed with a CBCT device (Newtom 9000 Digital Volume Tomograph (DVT), QR s.r.l., Verona, Italy) and a computed tomography (CT) scanner (Somatom 4, Siemens, Forchheim, Germany). Using an infrared navigation system (Polaris, NDI, Waterloo, Ontario), multiple pair-point registration of both image data sets and the phantom were performed. The target registration error (TRE) was evaluated. RESULTS: A total of 243 registrations were performed for either image data set. The spatial distribution of TRE on the skull showed increasing inaccuracy with growing distance from the registration markers. The average target registration error was 1.50 +/- 0.82 mm with CBCT and 1.57 +/- 0.84 mm with CT image data and did not differ significantly. Error distribution correlated strongly between CT- and CBCT-based registration. CONCLUSIONS: The overall registration accuracy based on CBCT image data was similar to CT. The strong correlation of the geometric distribution of TRE between CT- and CBCT-based measurements proves that CBCT can be equivalent to CT in image-guided maxillofacial surgery.

System design of a hand-held mobile robot for craniotomy.

This contribution reports the development and initial testing of a Mobile Robot System for Surgical Craniotomy, the Craniostar. A kinematic system based on a unicycle robot is analysed to provide local positioning through two spiked wheels gripping directly onto a patients skull. A control system based on a shared control system between both the Surgeon and Robot is employed in a hand-held design that is tested initially on plastic phantom and swine skulls. Results indicate that the system has substantially lower risk than present robotically assisted craniotomies, and despite being a hand-held mobile robot, the Craniostar is still capable of sub-millimetre accuracy in tracking along a trajectory and thus achieving an accurate transfer of pre-surgical plan to the operating room procedure, without the large impact of current medical robots based on modified industrial robots.