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.

[An experimental study of biomaterials resistant to calcinosis and thrombosis]. / Eksperimental'noe izuchenie biomaterialov, rezistentnykh k kal'tsinozu i trombozu.

Creation of hemocompatible materials resistant to calcinosis for plastic cardiosurgery call for employment of combined methods of their evaluation in experiment. The present study deals with some biochemical and physico-chemical aspects of biomaterial calcification inhibition on reduction of their porosity by means of N-vinylpyrrolidone, and also on immobilization of diphosphonates, phosphonates, and anti-aggregants. The method of radiation copolymerization was employed for immobilization of active agents. The effects of different biotissue specimens of varying modifications (pig aortal valves and cattle pericardium) and of Lavsan (polyethyleneterephthalate) on coagulation factor activation were studied in vivo (in goat) and in vitro. The specimen surface was inspected prior to and after the contact with blood and plasma using the techniques of scanning electron microscopy and photoelectron spectroscopy. The influence of the modifications on the calcium and phosphorus accumulation were studied after subcutaneous implantation of the specimens to rats, and the aggregating capacity of blood platelets was determined in incubation of Lavsan treated with an anti-aggregant. Combined studies revealed the optimal modification routine and the most active agents enabling one to obtain biomaterials that not only are resistant to calcification but also possess good hemocompatibility.

Haemocompatibility of segmented polyurethanes investigated in vivo.

Samples of segmented polyurethanes differing in composition and in surface morphology were introduced into the left ventricles of hearts of goats for 72 h. After removal of the samples, their surface and the surface of the heart endothelium were evaluated visually with respect to the formation of thrombi. Differences in the interaction of the individual polyurethanes with blood were examined by XPS photoelectron spectroscopy, SEM, and by infrared (i.r.) reflexion spectroscopy. The results suggest ways for improving the haemocompatibility of the surfaces of polyurethanes used as parts of the total artificial heart.

Incidence and risk of coronary heart disease in an industrial population. A five-year prospective study.

In a large machinery factory a cohort of 3754 men aged between 40 and 50 years have been studied for 5 years. Total and coronary mortality rates have been determined and also the incidence of certain non-fatal states which required hospitalization due to various types of coronary heart disease (CHD), hypertension, brain apoplexy, diabetes mellitus and malignancies. Among the subjects exposed to CHD risk factors (RF), i.e. among smokers, hypertensive and hypercholesterolemic subjects, and among those who had a positive coronary family history and a positive cardiovascular (chest pain) questionnaire, both total and coronary mortality rates were several fold higher and they increased almost exponentially with increasing numbers of RF. Among the RF it was the cardiovascular (chest pain) questionnaire which had the highest prognostic value. Workmen manifested a higher total and coronary mortality than did the employees in the technico-economical professions (TEP). The highest mortality rate was found among the workmen employed in heavy manual occupation. In contrast the lowest total coronary mortality rate was observed in the TEP having little responsibility in their vocation and also among qualified workmen and specialized technical and scientifical workers.

[Social sequelae of poliomyelitis]. / Soziale Folgen der Kinderlähmung.

114 children afflicted with poliomyelitis were examined for their intellectual standard and enrollment in school and society, the kind of paralysis having been taken into account. It was found that a large number of the children have to be tended, the majority of them requiring special care and enrollment in special schools (43.86 percent), whereas a smaller number (27.98 percent) of them are to be lodged in institutions for the bringing up of children under social welfare system. These 114 children were quite accidentally selected from the 366 children that are tended in the pediatric counseling department of the Clinic of Neurology at Pilsen. In conclusion, the authors compare their results with similar information in the literature and point out that it is necessary to provide schools and homes for these children, especially for preschool children and children with combined defects. They also recommend to reserve certain plants for these children, where they could work under medical and especially rehabilitative pedagogic control.