Multi-stakeholder opinion statement on the care of individuals born with differences of sex development: common ground and opportunities for improvement.

BACKGROUND: In the last 15 years, the care provided for individuals born with differences of sex development (DSD) has evolved, with a strong emphasis on interdisciplinary approaches. However, these developments have not convinced some stakeholders to embrace the current model of care. This care model has also paid insufficient attention to socio-cultural differences and global inequalities. SUMMARY: This article is an opinion statement, resulting from in-depth discussions and reflection among clinicians, patients, and family support organizations based in the US and Europe, where we seek areas of common ground and try to identify opportunities to further develop resources. The product of these conversations is summarized in 10 panels. The corresponding sections provide additional discussion on some of the panel items. KEY MESSAGES: Participants identified areas of agreement and gained a deeper understanding of the reasons behind disagreements on certain matters and identified the necessary steps to foster future consensus. We offer preliminary recommendations for guiding clinical management and resource allocation. By promoting a broader consensus, we aim to enhance the quality of care and well-being for individuals of all ages who have a DSD.

Robot-assisted reconstructive surgery of lower urinary tract in children: a narrative review on technical aspects and current literature.

Background and Objective: Robotic approach is used widely for paediatric upper tract urinary reconstruction. This is a narrative review looking at the current status of robotic approach in lower urinary tract reconstruction. The aim of this article is to highlight the important technical aspects of commonly performed robotic lower urinary tract reconstructive surgeries and review the current literature. Methods: MEDLINE database search was conducted using MeSH terms and Boolean operators from Jan 2000 to Jun 2022. Abstracts were screened to exclude those in languages other than English as also articles pertaining to (I) upper urinary tract surgery, (II) only laparoscopic surgery (not robot-assisted) and (III) non-urological topics. Selected articles were then reviewed and search expanded to include their references with a focus on advanced lower urinary tract reconstruction. Key Content and Findings: The technical aspects of robotic ureteric reimplantation, continent catheterisable channel and autoaugmentation are discussed in detail. The early outcomes are comparable to open surgery. The true advantage of robotic approach becomes apparent when performing lower urinary tract reconstruction, where space in the pelvis is limited and access is challenging. Only a few centres are currently performing bladder neck surgery and bladder augmentation. Conclusions: Robotic lower urinary tract reconstruction in children is feasible and safe. Robotic approach offers better access, especially in the limited space within the pelvis. It reduces blood loss and post-operative pain allowing early recovery and discharge. Long-term follow-up with increasing experience could further validate these early observations.

Paediatric urology in Sub-Saharan Africa: challenges and opportunities.

The need for paediatric urological care in low- and middle-income countries in sub-Saharan Africa (SSA) is enormous due to a burgeoning paediatric-aged population and a disproportionate burden of congenital malformations. There are formidable challenges in the provision of a skilled workforce and appropriate infrastructure, resulting in a huge unmet need with consequent effects on the long-term health and prosperity of the population. Constraints of funding, geography, culture, surgical and anaesthetic skills, and instrumentation means that many conditions present late and with complications that could have been avoided by an earlier attendance. It also means that the management of congenital malformations, e.g., bladder exstrophy and congenital obstructive posterior urethral membrane, differ substantially from that seen in the developed world, with the outlook for children with renal failure being particularly bleak. Collaborations between paediatric urologists from high- and low-income countries are beginning to help with the development of a surgical infrastructure customised to paediatric care, and with the training of specific paediatric urological knowledge and skills. These collaborations, whilst welcome, still require substantial expansion to achieve more equitable access to appropriate paediatric urological care for children in SSA. Future efforts have to focus on the creation of sustainable and equal partnerships between urologists from low- and high-income healthcare environments, with an emphasis on providing sustainable management, appropriate to local need and available resources. The provision of shared learning, utilising the benefits of global digital communication, will improve mutual understanding of needs in a resource-poor environment and the involvement of trainees from both income settings can help perpetuate long-term collaborations.

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.

Augmentation of the insufficient tissue bed for surgical repair of hypospadias using acellular matrix grafts: A proof of concept study.

Acellular matrices produced by tissue decellularisation are reported to have tissue integrative properties. We examined the potential for incorporating acellular matrix grafts during procedures where there is an inadequate natural tissue bed to support an enduring surgical repair. Hypospadias is a common congenital defect requiring surgery, but associated with long-term complications due to deficiencies in the quality and quantity of the host tissue bed at the repair site. Biomaterials were implanted as single on-lay grafts in a peri-urethral position in male pigs. Two acellular tissue matrices were compared: full-thickness porcine acellular bladder matrix (PABM) and commercially-sourced cross-linked acellular matrix from porcine dermis (Permacol™). Anatomical and immunohistological outcomes were assessed 3 months post-surgery. There were no complications and surgical sites underwent full cosmetic repair. PABM grafts were fully incorporated, whilst Permacol™ grafts remained palpable. Immunohistochemical analysis indicated a non-inflammatory, remodelling-type response to both biomaterials. PABM implants showed extensive stromal cell infiltration and neovascularisation, with a significantly higher density of cells (p < 0.001) than Permacol™, which showed poor cellularisation and partial encapsulation. This study supports the anti-inflammatory and tissue-integrative nature of non-crosslinked acellular matrices and provides proof-of-principle for incorporating acellular matrices during surgical procedures, such as in primary complex hypospadias repair.

Searching for the Least Invasive Management of Pelvi-Ureteric Junction Obstruction in Children: A Critical Literature Review of Comparative Outcomes.

Introduction: To review the published evidence on the minimally invasive pyeloplasty techniques available currently with particular emphasis on the comparative data about the various minimally invasive alternatives to treat pelvi-ureteric junction obstruction and gauge if one should be favored under certain circumstances. Materials and Methods: Non-systematic review of literature on open and minimally invasive pyeloplasty including various kinds of laparoscopic procedures, the robotic-assisted laparoscopic pyeloplasty, and endourological procedures. Results: Any particular minimally invasive pyeloplasty procedure seems feasible in experienced hands, irrespective of age including infants. Comparative data suggest that the robotic-assisted procedure has gained wider acceptance mainly because it is ergonomically more suited to surgeon well-being and facilitates advanced skills with dexterity thanks to 7 degrees of freedom. However, costs remain the major drawback of robotic surgery. In young children and infants, instead, open surgery can be performed via a relatively small incision and quicker time frame. Conclusions: The best approach for pyeloplasty is still a matter of debate. The robotic approach has gained increasing acceptance over the last years with major advantages of the surgeon well-being and ergonomics and the ease of suturing. Evidence, however, may favor the use of open surgery in infancy.

European Association of Urology Guidelines Office Rapid Reaction Group: An Organisation-wide Collaborative Effort to Adapt the European Association of Urology Guidelines Recommendations to the Coronavirus Disease 2019 Era.

The coronavirus disease 2019 (COVID-19) pandemic is unlike anything seen before by modern science-based medicine. Health systems across the world are struggling to manage it. Added to this struggle are the effects of social confinement and isolation. This brings into question whether the latest guidelines are relevant in this crisis. We aim to support urologists in this difficult situation by providing tools that can facilitate decision making, and to minimise the impact and risks for both patients and health professionals delivering urological care, whenever possible. We hope that the revised recommendations will assist urologist surgeons across the globe to guide the management of urological conditions during the current COVID-19 pandemic.

Experience with detrusorotomy in children by open and robotic approach.

PURPOSE: To present the author's experience with detrusorotomy (DM) for refractory detrusor overactivity (RDO) with open and robotic approach. METHODS: Children who underwent DM for RDO in a single surgeon series since 2012 were identified from a prospectively maintained database. Those who completed the defined strict bladder cycling regime postoperatively were included in this report excluding those who failed the bladder cycling regime. RESULTS: Ten children (M7: F3) were included in this report, six open and four robotic. All procedures were completed with no conversion to open in the robotic group. There were no intra or postoperative complications from the procedures. Duration of procedure was lower in robotic group (125 min) vs the open group at (208 min). Hospital stay was also lower in the robotic group (2.7 days) compared to the open group (5.6 days). All children in open group had concomitant Mitrofanoff channel created for bladder drainage. One child in robotic group had concomitant Mitrofanoff channel during DM. Median follow-up is longer at 54 months (31-82) in open group compared to 14 months (5-21). All children are clinically well with safe upper tracts on US scan in both series. Estimated % change in bladder capacity is similar in both groups at 140 (90-200) and 126 (80-200) for open and robotic groups, respectively. CONCLUSIONS: DM as an extension of medical treatment for RDO can be performed safely and is effective in children. Preliminary experience with robotic approach to DM is promising with reduced duration of procedure and hospital stay.

Robotic Approach to Creation of Continent Catheterisable Channels-Technical Steps, Current Status, and Review of Outcomes.

Purpose: To report the current status of Robotic approach to creation of Catheterisable channel (CC) with the author's personal experience compared to published literature on technical steps, follow up, and outcomes. Methods: CC data was extracted from the prospective database set up for all Robotic pediatric urology procedures performed by the author at his institution. A literature search was then performed to look at the evidence base. Results: Eighteen consecutive cases (8M:7F) of Robotic approach to creation of CC was identified and included. All attempted cases were successfully completed without any conversion to open approach. Median age at surgery was 10.75 years (IQR 6.9-16.5); Median OT 197 min (IQR 131-295) with concomitant procedures in 4 cases. Appendix was used in 14 cases as CC conduit and distal ureter in 4 cases. Median Length of stay (LOS) was 2.75 days (IQR 2-6) and Median FU 27.3 m. Whilst FU duration is comparable to published series, average OT and LOS was much lower in this series. The LOS in this robotic series is much lower than the author's experience with open approach (2.75 vs. 5.8 days). No major complications postoperatively except for one exit site wound infection managed conservatively. None of the CC have been revised in this series and all channels are patent with 12 F or 14 F admissible catheter size. There were no cases of incontinence related to technique of creation of CC and no incidence of exit site stomal stenosis with use of ACE stopper until channel matures and Clean intermittent catheterisation (CIC) is established. Conclusion: Robotic approach to CC is feasible, safe with excellent outcomes and minimum morbidity. Robotic complex bladder reconstructive surgery offers some advantages to children compared to open approach but is only currently performed in few tertiary centers with expertise.

Current Use of and Indications for Robot-assisted Surgery in Paediatric Urology.

The use of robot-assisted surgery (RAS) by paediatric urologists is increasing. This mini review looks at the current status of RAS in paediatric urology. The challenges involved in RAS use in children are reviewed, as well as the indications for and feasibility of procedures performed and, where possible, outcomes with RAS. PATIENT SUMMARY: The current status of robot-assisted surgery (RAS) in paediatric urology, together with the challenges in using RAS for children is outlined in this mini review. Innovative adaptation has pushed the boundaries as regards the feasibility of RAS procedures in children with good outcomes.

Robot Docking Time: Cumulative Summation Analysis of a Procedure-Independent Learning Curve in Pediatric Urology.

PURPOSE: The learning curve is an important method of assessment of progression in the use of a new technique or device and, in the field of robotic surgery, is most commonly described for individual procedures, often concentrating on console time and outcomes. We contemplated whether a learning curve of the similar nature and duration was exhibited in the procedure-independent variable of docking time. MATERIALS AND METHODS: The time from first incision to end of robot docking was found for a single surgeon's first 55 robotic cases, which encompassed a range of pediatric urological procedures. Raw and cumulative summation (CUSUM) data were found and plotted, with learning- and maintenance-phase times compared statistically. RESULTS: A classical learning curve of ∼30 cases was found with a statistically significant reduction in time between learning and maintenance phases. CONCLUSIONS: A learning curve of similar nature and duration to procedure-specific analyses was found for docking time. The variability of port placement and robot positioning for multiple procedures further increases the significance of this result.

Robotic Pyeloplasty in Children: A "Barbed" Shortcut.

INTRODUCTION: Dismembered pyeloplasty remains the gold standard for the treatment of pelviureteric junction obstruction (PUJO). Robotic approach to this procedure has proven its efficacy and is gaining popularity. The introduction of barbed sutures such as "V-Loc™" (Covidien) has provided an addition to the sutures available for pyeloplasty. This work provides our experience with the V-Loc suture for closure of pelvis in children for robotic pyeloplasty (RP). MATERIALS AND METHODS: A review of 10 pediatric RP (da Vinci Robotic System) during which the V-Loc suture was used was performed. Comparison was made with 15 cases in which 5-0 Vicryl® suture was used as an alternative. Overall median age was 4 (range 9 months to 16 years), M:F = 14:9. All had confirmed PUJO on renal ultrasound and mercaptoacetyltriglycine (mertiatide) (MAG-3). RP was done in the standard Anderson-Hynes manner with the placement of a multilength JJ ureteral stent intraoperatively. Patients had removal of the JJ stent 6 weeks postoperatively followed by renal ultrasound 3-4 months later. RESULTS: Twenty-five RPs have been performed between May 2013 and November 2015, of which 10 have had closure of the pelvis performed using the V-Loc suture and 15 with Vicryl. One patient (6.67%) in the Vicryl group underwent redo-pyeloplasty secondary to a stent-related complication. The entire V-Loc group made an eventful initial recovery; however, four (40%) developed worsening hydronephrosis and drainage on ultrasound and MAG-3 after stent removal, despite remaining completely asymptomatic. These four required either restenting and observation (n = 1) or redo-pyeloplasty (n = 3). Histology demonstrated a "plaque-like" inflammatory reaction at the pelvic suture line. CONCLUSION: Closure of the pelvis using V-Loc suture material during RP can lead to a significant hydronephrosis requiring further procedures, including redo-pyeloplasty. These children can be asymptomatic and so extra vigilance on postoperative follow-up is essential.

Single-stage urethroplasty with buccal mucosal inlay graft for stricture caused by balanitis xerotica obliterans in boys: Outcomes in the medium term.

INTRODUCTION: Balanitis xerotica obliterans (BXO) is a common condition that can affect the foreskin, glans, meatus, and urethra, and rarely can also involve urethra leading to stricture. Numerous procedures have been suggested to treat urethral stricture secondary to BXO but these have had variable results. OBJECTIVE: We describe the first prospective study of a single stage buccal mucosal inlay grafting in children with urethral strictures resistant to existing remedies. MATERIALS AND METHODS: We treated five boys with resistant urethral strictures secondary to BXO with a single stage buccal mucosal inlay graft (BMIG, Figure). Uroflowmetry was performed both pre- and post-operatively. Functional outcome was the prime measure determining success. RESULT: All the boys had a successful functional outcome and all expressed satisfaction with cosmetic outcome as well. Uroflow parameters improved remarkably, with maximum and mean urinary flow rates significantly improved from 4.2 mL/s to 26 mL/s (p = 0.0002) and from 1.6 mL/s to 12.2 mL/s (p = 0.003), respectively. Median follow-up was 34 months (range 30-42 months). DISCUSSION: This paper is the first to describe the successful use of buccal mucosal inlay grafts to treat refractory BXO stricture in children. Various surgical techniques have been proposed particularly in adults including single vs. staged procedures, preputial and post auricular grafts, circular mucosal buccal grafts, as well as double mucosal grafts placed both ventrally and dorsally. All of these procedures are not without problems, and had variable results and outcome. Most of the procedures have been described in adult urethra and are not suitable for paediatric small calibre urethra. Our technique of dorsal inlay graft gives a robust structure to the distal urethra avoiding diverticula, pooling or urine spraying and can be placed onto proximal urethra as well. We have not seen recurrence of BXO in our buccal grafts, which is reported in other grafts from prepuce and post auricular grafts. The number of patients presented in our study is limited, nonetheless an excellent result in all our cases makes this a compelling approach to manage BXO urethral strictures. An early intervention in such cases is paramount to convert a salvage operation to a pre-emptive procedure. CONCLUSION: A single stage buccal mucosal inlay grafting in children with BXO stricture can offer an excellent outcome.

Preliminary Experience with Instillation of Triamcinolone Acetonide into the Urethra for Idiopathic Urethritis: A Prospective Pilot Study.

BACKGROUND: Idiopathic bulbar urethritis (IBU) is characterized by hematuria ± dysuria without infection. Symptoms result from inflammation of the bulbar urethra, distal to external sphincter. IBU is difficult to manage and there is no recommended therapy. OBJECTIVE: To determine whether instillation of triamcinolone acetonide is a useful treatment of IBU and its associated complications. SETTING AND PARTICIPANTS: Data were prospectively collected, for 22 months, on 14 consecutive patients presenting with terminal hematuria or blood spotting ± dysuria to a pediatric urology unit. Median age was 12 years (range: 10-15). Mean symptom duration was 13 months (range: 8-24). Normal baseline laboratory blood tests, urine cultures, and ultrasound assessments were seen in all; therefore, none were excluded on the basis of a known pathology. Follow-up telephone interviews, to assess symptom persistence and side effects, were performed at 6 weeks postintervention. The mean follow-up period was 15 months (range: 4-20). INTERVENTION: Visual confirmation of IBU was obtained cystoscopically and 40 mg of triamcinolone was instilled to the inflamed area under direct vision using an open-ended ureteral catheter. OUTCOME MEASUREMENTS: Symptoms resolution was the primary outcome. Repeat cystoscopic assessment ± triamcinolone instillation was recorded, as was the occurrence of complications. RESULTS AND LIMITATIONS: Seven patients (50%) required at least one further treatment. Overall complete or partial resolution was reported in 12/14 patients (85.7%). No side effects were reported. CONCLUSIONS: This small prospective series demonstrates that intraurethral instillation of triamcinolone seems to be a promising treatment option to alleviate inflammatory symptoms in majority of cases of idiopathic urethritis. Patient Summary: Fourteen boys with inflammation of the urethra, with no identifiable cause, were treated by topically triamcinolone, directly to the inflamed area. We demonstrate an 85.7% complete/partial resolution of symptoms with no side effects seen.

Role of Robotics in Children: A brave New World!

CONTEXT: The key in the evolution towards minimally invasive surgery is the availability of appropriate equipment, especially when procedures involve children. While robotic procedures in adults continue to struggle to prove measurable advantages compared with open or classical laparoscopic ones, the use of the robotic platform (RP) in pediatric urology is steadily increasing. OBJECTIVE: To review the contemporary literature regarding the use of robotic-assisted (RA) urologic interventions in children. EVIDENCE ACQUISITION: A nonsystematic review of the literature was conducted through PubMed database between 2002 and 2017, with an emphasis on large series. EVIDENCE SYNTHESIS: A few major challenges must be considered before using the RP in children: anesthesia, placement of trocars, and technical difficulties related to small space. To date, only the robot-assisted pyeloplasty is recognized as safe and efficient with an equivalent outcome compared to the open or classical laparoscopy; this was supported by large multicentric studies, which are not available for most of the other procedures. CONCLUSIONS: RA procedure in children has been proven safe and effective. Still in its infancy, further data over time is likely to prove different RA procedures to be equivalent to open or laparoscopy in terms of outcome. PATIENT SUMMARY: The advent of the robotic platform means an evolution towards minimizing surgical trauma for the child. Currently, the available platforms designed for adults are adapted to work in children. However, it might be expected in the future that new technologies will improve the technical possibilities to improve the robotic platform for minimally invasive surgery in children. To date, a few applications are considered safe and efficient (in experienced hands), considering that the team has to be aware of some challenges to overcome regarding anesthesia, material, and technique adaptation to the patient. The most accepted robotic applications in children comprises of the robot-assisted pyeloplasty, hemi-nephrectomy, and ureteric reimplantation.

A fetal sheep model for studying compensatory mechanisms in the healthy contralateral kidney after unilateral ureteral obstruction.

INTRODUCTION: Fetal unilateral ureteral obstruction (UUO) triggers complex pathophysiology involving not only the affected organ but also the contralateral kidney, which undergoes evident compensatory changes. OBJECTIVE: We hypothesized that it would be possible to characterize a transcriptomic fingerprint and selected molecular mechanisms for compensatory growth of contralateral kidneys in UUO, specifically focusing on mediators, carriers, membrane transport, and organ crosstalk in an ovine fetal UUO model. STUDY DESIGN: A fetal ovine model of complete UUO was created on the 60th day of gestation. For transcriptomics profiling, total RNA was extracted from vital renal biopsies of contralateral (non-obstructed) kidneys harvested on the 80th day of gestation, and kidneys of untreated fetuses served as controls. Statistical analysis provided the set of differentially regulated genes further forwarded to bioinformatics analysis for identification of eventual compensatory molecular mechanisms. Histological analysis was performed with hematoxylin and eosin and periodic acid-Schiff stains. RESULTS: Contralateral kidneys showed compensatory hypertrophic renal growth, represented on the molecular side by 324 protein coding genes differentially regulated compared with the control kidney samples. Bioinformatics analysis identified an interactome (Figure) consisting of 102 genes with 108 interactions mainly involving transporters (protein transport and protein localization as well as in protein degradation), signaling molecules, DNA/nucleotide/RNA processing, and components of catabolism and cell cycle regulation. Within the interactome, nine receptors were identified as differentially regulated on the contralateral kidney, involving potential renoprotective ligands of the prostaglandin and the bradykinin receptor, arginine vasopressin receptor 1B, and integrin beta 4. Interestingly, a broad range of molecules found differentially expressed, has been previously described in stress response, renoprotection and repair (e.g., MAPK3, MCP1, DICER1, and others). DISCUSSION: The compensatory renal growth interactome provides a network of transcripts significantly altered in the contralateral kidney, potentially allowing novel insights into mechanisms, interactions, and signaling pathways associated with compensatory growth, and renal protection and repair. Interestingly, the finding of an embedded gene signature reflecting signaling and communication suggests a key role of these processes in CRG either by crosstalk, soluble substances, carriers, or membrane signaling. CONCLUSIONS: Using a transcriptomics approach, it was possible to identify a gene expression fingerprint of contralateral renal growth in a fetal UUO model. Further studies are warranted to validate those processes and to allow incorporation of this knowledge in new fetal diagnostic or even therapeutic strategies.

Relevance of current guidelines in the management of VUR.

UNLABELLED: In recent years, there have been fundamental changes in the understanding of vesicoureteral reflux (VUR). This is reflected by current international guidelines that cover diagnosis, screening, and treatment of VUR. However, literature is still lacking and many questions are unsolved. In this article, we shortly review the important aspects of the current guidelines. Due to the lack of high-powered randomized controlled trials, guidelines often are based on an expert's opinion rather than evidence. In this review article, we address the controversies in the management of VUR; siblings and children with antenatally diagnosed hydronephrosis and the management of a patient with VUR. CONCLUSION: With an individualized approach and patient risk stratification, the goal today must be to address the clinical problem, avoid unnecessary tests, and provide good quality of life for the patient and parents.

Abstracts presented at the European Society for Pediatric Urology (ESPU) meetings (2003-2010): characteristics and outcome.

OBJECTIVE: To determine the characteristics and outcome of abstracts presented to the meetings of the European Society for Pediatric Urology (ESPU). MATERIAL AND METHODS: Abstract books from 2003 to 2010 were reviewed and subsequent publication of presented abstracts determined by MEDLINE/PubMed search. RESULTS: Of 1194 abstracts, 50-78% per year originated from 15 to 20 European countries and 50-22% from 8 to 13 non-European countries; 233 (19%) were basic science and 961 (81%) clinical. Clinical abstracts included 135 (14%) multicenter/prospective/randomized trials. These figures did not change significantly over time. A total of 564 (47%) abstracts were subsequently published, 65% within 1 year of the meeting, mostly in the Journal of Urology (33%) and the Journal of Pediatric Urology (21%). Multicenter/prospective/randomized trials studies (OR 2.03; 95% CI 1.37-2.96) and abstracts originating from outside Europe (OR 1.61; 95% CI 1.26-2.05) were significantly more likely to be subsequently published in full. CONCLUSION: The ESPU meetings are a true occasion for international exchange of scientific endeavors. Almost half of the abstracts are subsequently published. The Journal of Urology and the Journal of Pediatric Urology are consistently the two major target journals for publication. Non-European countries, irrespective of whether English-speaking or not, seem significantly more likely to publish their abstracts.

Orchidopexy patterns in Austria from 1993 to 2009.

OBJECTIVE: To evaluate orchidopexy patterns in Austria. MATERIAL AND METHODS: All boys with cryptorchidism who underwent orchidopexy (n = 19.998) in Austria between 1993 and 2009 were analyzed using the database Austrian Health Information System at the Austrian Federal Research and Planning Institute for Health Care. Regression models were constructed to examine associations between the probability of orchidopexy before 24 months of life and the following parameters: year of birth, federal state of residence, character of area of living (rural/urban) and hospital type. RESULTS: Average age at operation dropped from 6 to 4.3 years (mean 5.2 years, SD 3.8 years). Total incidence of orchidopexy was continuously rising throughout the study period (p < 0.0001), with an OR of 1.007 (95% C.I.: 1.004; 1.0100) per year. The rate of operations between 0 and 2 years (p < 0.001) and 3-7 years (p < 0.001) increased, while the rate in boys older than 7 years decreased (p < 0.001). Year of birth (p < 0.0001) and place of residence (p < 0.0001 and p < 0.024) are significant predictors for having early orchidopexy. CONCLUSION: In Austria the total incidence of orchidopexy is significantly rising. Moreover, the incidence of orchidopexies performed before 24 months of life is constantly rising with significant geographic differences.

Seromuscular grafts for bladder reconstruction: extra-luminal demucosalisation of the bowel.

OBJECTIVE: To develop a robust sterile, fully demucosalized and vascularized seromuscular patch for use as an adjunct to novel bioengineering techniques aimed at augmenting, reconstructing, or replacing the bladder because of endstage disease. To eliminate deep colonic epithelial crypts to prevent the possibility of colonocyte regrowth. To maintain sterility by excluding the possibility of contamination from the bowel contents. METHODS: Pilot studies were performed on euthanized pigs to optimize the technique, with tissue samples examined by immunohistochemistry. In vivo, vascularized seromuscular colonic flaps were created from the bowel exterior in 7 large white hybrid pigs. The dissection was facilitated by placing an inflated Foley catheter within the colonic lumen. The seromuscular ends were approximated with 5/0 Vicryl sutures and excess mucosa intussuscepted within the lumen. Demucosalized flaps were used to augment the bladder by composite cystoplasty and were examined immunohistochemically at 3 months. RESULTS: Pilot studies showed that the technique was successful in creating seromuscular segments with no epithelial remnants. When applied surgically, the seromuscular flaps survived and showed no evidence of colonocyte regrowth at 3 months. CONCLUSION: Extraluminal dissection creates robust seromuscular flaps and prevents both regrowth by colonic epithelial cells and contamination of the tissue by exposure to the bowel contents. This technique should find application in a range of bladder reconstruction techniques, including composite cystoplasty and autoaugmentation.