Laparoscopic Single-Site Surgery in Pediatric Urology: Where Do We Stand Today?

Since the first description of the laparoendoscopic single-site surgery (LESS) in the pediatric urology population, various authors have shared their experiences and results. We aim to provide a review of current studies of LESS and share our experience with this modality. The current literature describes the use of LESS for most surgeries performed in the pediatric urology population with similar results to open and standard laparoscopic surgery. The authors have described their experiences with transabdominal and retroperitoneal nephrectomy, nephroureterectomy, pyeloplasty, orchidopexy, varicocelectomy, and renal cyst decortication. In our experience, LESS has taken a role for extirpative surgery since we use other modalities for upper tract reconstruction. The data available has validated LESS as safe and has demonstrated similar results to standard laparoscopic surgery and open surgery with better cosmetic results.

Knowledge of and attitudes toward organ donation: a survey of medical students in Puerto Rico.

OBJECTIVE: The increasing demand for organ transplants exceeds the organ donation rate. Addressing this discrepancy is challenging for organ procurement agencies and health professionals involved in the care of patients in dire need of organs. Research suggests that health-care professionals' knowledge of, attitudes toward, and behavior in terms of organ donation and transplantation are deciding variables in promoting organ donation. In Puerto Rico, there is a lack of information regarding medical student's knowledge of and/or attitudes toward organ donation, a lack that our study was designed to address. METHODS: Two hundred thirty participants (98 first-year, 45 second-year, and 87 third-year medical students) completed a questionnaire consisting of 55 questions; 10 questions assessed knowledge and 20, attitudes about organ and tissue donation. The remaining questions inquired after demographic information, history of blood donation, and educational experience. RESULTS: In terms of their knowledge about organ donation, the participating students had a mean score of 6.29 on a 10-point scale-with 10 being the highest possible knowledge score-and 45.7% of them scored 7 or more. These data also showed that participants had a positive attitude toward organ donation (44.9; range 14 to 56), with approximately 72% having a favorable view. However, while 40% of the participating students stated their intentions to donate their organs, only 23% of them had donor cards. CONCLUSION: We determined that medical students have a positive attitude towards organ donation. However, a substantial lack of knowledge of organ donation among our subjects is a barrier to their taking the necessary measures to become active donors. Our data highlight the need to incorporate educational programs to increase knowledge and awareness regarding organ donation and the transplantation process.

A Simplified Adult Acquired Buried Penis Repair Classification System With an Analysis of Perioperative Complications and Urethral Stricture Disease.

OBJECTIVE: To propose a simple classification system for buried penis repairs and present an analysis of perioperative data based on category. METHODS: Patients undergoing buried penis repair at a single institution were examined. Classification was as follows: Category I-penile unburying with local flap; II-skin graft; III-scrotal surgery; IV-escutcheonectomy; V-abdominal panniculectomy. Complex repairs were Category III or above. Success was defined as an unburied penis without additional unburying surgery. RESULTS: Between 2007 and 2017, 64 patients underwent repair with 44 (69%) considered complex. Patients undergoing complex repairs had a higher body mass index (median 48 vs 36 kg/m2, P < .01). A total of 30 patients (47%) had urethral strictures, with no association to buried penis complexity (P = .43). High-grade complications (Clavien ≥ 3) occurred in 10 patients (23%) in the high-complexity group with none in the low-complexity group (P = .02). Seven of 10 (70%) of high-grade complications were wound related. Successful unburying was seen in 58 patients (91%). All failures occurred in the high-complexity group. Median follow-up was 209 days. CONCLUSION: Buried penis repairs are highly successful. We propose a classification based on surgical complexity. Patients requiring complex repairs have higher body mass index and increased risk of high-grade complications. While urethral strictures are found in nearly half of patients, there is no association with the severity of disease. Ongoing modifications of technique and perioperative care may improve outcomes.