Global minimally invasive pyeloplasty study in children: Results from the Pediatric Urology Expert Group of the European Association of Urology Young Academic Urologists working party.

INTRODUCTION: Minimally invasive pyeloplasty (MIP) for ureteropelvic junction (UPJ) obstruction in children has gained popularity over the past decade as an alternative to open surgery. The present study aimed to identify the factors affecting complication rates of MIP in children, and to compare the outcomes of laparoscopic (LP) and robotic-assisted laparoscopic pyeloplasty (RALP). MATERIALS AND METHODS: The perioperative data of 783 pediatric patients (<18 years old) from 15 academic centers who underwent either LP or RALP with an Anderson Hynes dismembered pyeloplasty technique were retrospectively evaluated. Redo cases and patients with anatomic renal abnormalities were excluded. Demographics and operative data, including procedural factors, were collected. Complications were classified according to the Satava and modified Clavien systems. Failure was defined as any of the following: obstructive parameters on diuretic renal scintigraphy, decline in renal function, progressive hydronephrosis, or symptom relapse. Univariate and multivariate analysis were applied to identify factors affecting the complication rates. All parameters were compared between LP and RALP. RESULTS: A total of 575 children met the inclusion criteria. Laparoscopy, increased operative time, prolonged hospital stay, ureteral stenting technique, and time required for stenting were factors influencing complication rates on univariate analysis. None of those factors remained significant on multivariate analysis. Mean follow-up was 12.8 ± 9.8 months for RALP and 45.2 ± 33.8 months for LP (P = 0.001). Hospital stay and time for stenting were shorter for robotic pyeloplasty (P < 0.05 for both). Success rates were similar between RALP and LP (99.5% vs 97.3%, P = 0.11). The intraoperative complication rate was comparable between RALP and LP (3.8% vs 7.4%, P = 0.06). However, the postoperative complication rate was significantly higher in the LP group (3.2% for RALP and 7.7% for LP, P = 0.02). All complications were of no greater severity than Satava Grade IIa and Clavien Grade IIIb. DISCUSSION: This was the largest multicenter series of LP and RALP in the pediatric population. Limitations of the study included the retrospective design and lack of surgical experience as a confounder. CONCLUSIONS: Both minimally invasive approaches that were studied were safe and highly effective in treating UPJ obstruction in children in many centers globally. However, shorter hospitalization time and lower postoperative complication rates with RALP were noted. The aims of the study were met.

[Comprehensive long-term analysis of hypospadias repair using vascularized flaps and tubularized incized plates--report on 588 cases]. / Dlouhodobé výsledky rekonstrukce hypospadie pomocí vaskularizovaných laloku a tubulizace incidované ploténky--588 prípadu.

BACKGROUND: The article presents a comprehensive long-term analysis of the modem hypospadias repair based on preservation and use of the urethral plate. METHODS AND RESULTS: In years 1987 to 2004, 476 patients (aged 8 months to 45 years) were operated using a praeputial (mostly) flap. 81% were indicated for reconstruction of a proximal form of hypospadias, mostly penile. In years 1986 to 1991, a tubularized flap was performed in 31 patients. Since 1992, an onlay island flap in 394 patients, inlay-onlay flap in 43 patients and onlay-tube-onlay flap in 8 patients have been used. In years 2000 to 2004, 112 patients (aged 13 months do 17 years) were operated using tubularized incised plate (TIP) repair, mostly because of distal form of hypospadias. To cover the neourethra, a dartos flap was used in 72 and spongioplasty in 37 patients. We achieved the primary healing in 89% and 91%, resp., of patients after onlay and onlay-inlay island flap repairs with an average follow-up of 6,7 and 5,7 years, respectively. The most frequent complications were fistula or dehiscence of the glans. After the TIP repair combined with a dartos flap, 89% of the first operated patients healed without complications with an average follow-up of 2.3 years. A higher complication rate (40%) was found after a spongioplasty with foreskin preservation. Secondary repairs were also associated with more complications. CONCLUSIONS: Using onlay and inlay-onlay one-stage repairs, or using TIP one-stage repair combined with a dartos flap, a successful primary hypospadias repair was achieved in 90% of patients. The definite repair should be completed during early childhood.

The expression of PAX5, p53 immunohistochemistry and p53 mutation analysis in superficial bladder carcinoma tissue. Correlation with pathological findings and clinical outcome.

OBJECTIVES: The expression pattern of PAX5 in the tissue of superficial bladder transitional cell carcinoma (TCC), its prognostic value and its correlation with p53 immunohistochemistry and p53 mutation analysis were evaluated. METHODS: Study comprised 61 patients with histologically confirmed superficial bladder TCC. Expression level of PAX5 mRNA was investigated using reverse transcriptase-polymerase chain reaction (RT-PCR) and determined semiquantitatively. The presence of p53 mutations was determined by SSCP and confirmed by direct sequencing. The p53 immunohistochemistry was performed with DO1 antibody and semiquantitatively evaluated using HSCORE (HS) method. As the control group for the evaluation of the PAX5 expression served 8 men with benign prostatic hyperplasia. RESULTS: PAX5 expression was found in 50 patients with bladder TCC but in no patient from the control group. Its quantity however correlated neither with the stage nor with the grade of the tumor. P53 mutation was confirmed only in 1 patient with pTaG2 tumor in exon 5 (deletion of proline 128). On the contrary, positive immunohistochemical staining of p53 was detected in most patients. Using the cutoff value of HS 200, 56.9% of patients showed p53 overexpression. Quantity of p53 immunochistochemical positivity did not correlate with the quantity of PAX5 expression. Using the cutoff values of HS 200 for p53 and of 0.2 for PAX5, 7 of 8 patients with future progression had p53 and 4 had PAX5 overexpression respectively. CONCLUSION: The expression of gene PAX5 is a frequent event in superficial TCC of the bladder.

[Onlay island flap urethroplasty in the treatment of urethral strictures]. / Uretroplastika stopkatým lalokem onlay v lécbe striktury uretry.

UNLABELLED: A skin island flap was used to create a neourethra in 65 patients aged 2 to 66 years with prolonged or multiple stricture of the anterior urethra. Before, all patients were treated repeatedly and unsuccessfully by open or endoscopic surgery. The principle of the used onlay technique was to supplement the missing lumen of the urethra by an island, usually preputial flap. In case of as missing segment of the urethra the original inlay-onlay technique was applied. After a mean follow-up period of 27 months 12 complications (18.4%) were recorded, six strictures of the proximal anastomosis, three fistulas and three dehiscences of the glans. CONCLUSION: The onlay island flap urethroplasty makes it possible to cure prolonged and multiple strictures of the urethra in one stage and with a relatively low complication rate.

Development of metaphylaxis in calcium urolithiasis: a restriction of conventional drug therapy.

Between 1978 and 1992 (mean 9.2 years), metaphylaxis was introduced to 110 patients originally hospitalized for recurrent urinary calcium stones (mostly bilateral or multiple). Patients with hyperparathyroidism or with sponge kidney were excluded from the study. Until 1984, the condition had been treated mostly using conventional drug metaphylaxis (thiazides and allopurinol in 75% and 57%, respectively). After that year, there was a gradual decrease in the number of patients treated with thiazides (to 15%) and allopurinol (to 10%). This was associated with a steep rise in the proportion of patients treated with inhibitors (magnesium to 36% and citrates to 30%), or exclusively with non-medicamentous therapy (to 31%). These fundamental changes in approach have not reduced the effectiveness of metaphylaxis, and recurrence rates in individual years have not changed significantly either. Metaphylaxis was successful in 105 patients (95%) and the rate of recurrence has declined from 0.9 to 0.08 stones per year. The restriction of conventional drug metaphylaxis has entailed a marked decrease in the incidence of side effects of therapy and, consequently, a reduced need for follow-up tests and outpatient follow-up.

[Adverse effects of drug metaphylaxis of urolithiasis]. / K nekterým nezádoucím úcinkum medikamentózní metafylaxe urolitiázy.

The authors examined 133 patients with urolithiasis, treated with hydrochlorothiazide and 81 patients treated with allopurinol. In those treated with hydrochlorothiazide the calciuria and Ca/creat. index declined, and uricaemia rose. After treatment uricosuria increased significantly in 41% patients. The detection of diabetes did not exceed the prevalence in the population. In patients treated with allopurinol the uricaemia and uricosuria declined, a hepatic disorder with supraliminal rise of ALT was recorded in 23% of the patients and led to discontinuation of treatment in 15% of the patients.