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Journal of pediatric urology 63건

  1. [해외논문]   Prospective multicenter study on robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV): Outcomes and complications  

    Boysen, William R. (University of Chicago, Section of Urology, Chicago IL, USA ) , Akhavan, Ardavan (Weill Cornell Medical College, Department of Urology, New York NY, USA ) , Ko, Joan (Johns Hopkins University, Department of Urology, Baltimore MD, USA ) , Ellison, Jonathan S. (Seattle Children's Hospital, Department of Urology, Seattle WA, USA ) , Lendvay, Thomas S. (Seattle Children's Hospital, Department of Urology, Seattle WA, USA ) , Huang, Jonathan (Emory University, Department of Urology, Atlanta GA, USA ) , Garcia-Roig, Michael (Emory University, Department of Urology, Atlanta GA, USA ) , Kirsch, Andrew (Children's Healthcare of Atlanta, Pediatric Urology, Atlanta GA, United States ) , Koh, Chester J. (Texas Children's Hospital, Department of Urology, Houston TX, USA ) , Schulte, Marion (Cincinnati Children's Hospital, Department of Surgery, Cincinnati OH, USA ) , Noh, Paul (Cincinnati Children's Hospital, Department of Surgery, Cincinnati OH, USA ) , Monn, M. Francesca (Indiana University, Division of Pediatric Urology, Indianapolis IN, USA ) , Whittam, Benjamin (Indiana University, Division of Pediatric Urology, Indianapolis IN, USA ) , Kawal, Trudy (Children's Hospital of Philadelphia, Division of Urology, Philadelphia PA, USA ) , Shukla, Aseem (Children') , Srinivasan, Arun , Gundeti, Mohan S.
    Journal of pediatric urology v.14 no.3 ,pp. 262.e1 - 262.e6 , 2018 , 1477-5131 ,

    초록

    Summary Background Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV) is a minimally invasive alternative to open surgery. We have previously reported retrospective outcomes from our study group, and herein provide an updated prospective analysis with a focus on success rate, surgical technique, and complications among surgeons who have overcome the initial learning curve. Objective To assess the safety and efficacy of RALUR-EV in children, among experienced surgeons. Design and methods We reviewed our prospective database of children undergoing RALUR-EV by pediatric urologists at eight academic centers from 2015 to 2017. Radiographic success was defined as absence of vesicoureteral reflux (VUR) on postoperative voiding cystourethrogram. Complications were graded using the Clavien scale. Univariate regression analysis was performed to assess for association among various patient and technical factors and radiographic failure. Results In total, 143 patients were treated with RALUR-EV for primary VUR (87 unilateral, 56 bilateral; 199 ureters). The majority of ureters (73.4%) had grade III or higher VUR preoperatively. Radiographic resolution was present in 93.8% of ureters, as shown in the summary table. Ureteral complications occurred in five ureters (2.5%) with mean follow-up of 7.4 months (SD 4.0). Transient urinary retention occurred in four patients following bilateral procedure (7.1%) and in no patients after unilateral. On univariate analysis, there were no patient or technical factors associated with increased odds of radiographic failure. Discussion We report a radiographic success rate of 93.8% overall, and 94.1% among children with grades III–V VUR. In contemporary series, alternate management options such as endoscopic injection and open UR have reported radiographic success rates of 90% and 93.5% respectively. We were unable to identify specific patient or technical factors that influenced outcomes, although immeasurable factors such as tissue handling and intraoperative decision-making could not be assessed. Ureteral complications requiring operative intervention were rare and occurred with the same incidence reported in a large open series. Limitations include lack of long-term follow-up and absence of radiographic follow-up on a subset of patients. Conclusions Radiographic resolution of VUR following RALUR is on par with contemporary open series, and the incidence of ureteral complications is low. RALUR should be considered as one of several viable options for management of VUR in children. Summary Table Outcomes, overall and by preoperative vesicoureteral reflux (VUR) grade Radiographic resolution by preoperative VUR grade n a (%) I 15/16 (93.8) II 24/26 (92.1) III 49/52 (92.4) IV 38/41 (92.7) V 10/10 (100.0) Overall 136/145 (93.8) a Number of ureters without VUR present/number of ureters studied with voiding cystourethrogram or radionuclide cystogram.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  2. [해외논문]   Editorial comment regarding: Prospective multicenter study on robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV): Outcomes and complications  

    Gargollo, Patricio C.
    Journal of pediatric urology v.14 no.3 ,pp. 263 - 264 , 2018 , 1477-5131 ,

    초록

    Summary Background Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV) is a minimally invasive alternative to open surgery. We have previously reported retrospective outcomes from our study group, and herein provide an updated prospective analysis with a focus on success rate, surgical technique, and complications among surgeons who have overcome the initial learning curve. Objective To assess the safety and efficacy of RALUR-EV in children, among experienced surgeons. Design and methods We reviewed our prospective database of children undergoing RALUR-EV by pediatric urologists at eight academic centers from 2015 to 2017. Radiographic success was defined as absence of vesicoureteral reflux (VUR) on postoperative voiding cystourethrogram. Complications were graded using the Clavien scale. Univariate regression analysis was performed to assess for association among various patient and technical factors and radiographic failure. Results In total, 143 patients were treated with RALUR-EV for primary VUR (87 unilateral, 56 bilateral; 199 ureters). The majority of ureters (73.4%) had grade III or higher VUR preoperatively. Radiographic resolution was present in 93.8% of ureters, as shown in the summary table. Ureteral complications occurred in five ureters (2.5%) with mean follow-up of 7.4 months (SD 4.0). Transient urinary retention occurred in four patients following bilateral procedure (7.1%) and in no patients after unilateral. On univariate analysis, there were no patient or technical factors associated with increased odds of radiographic failure. Discussion We report a radiographic success rate of 93.8% overall, and 94.1% among children with grades III–V VUR. In contemporary series, alternate management options such as endoscopic injection and open UR have reported radiographic success rates of 90% and 93.5% respectively. We were unable to identify specific patient or technical factors that influenced outcomes, although immeasurable factors such as tissue handling and intraoperative decision-making could not be assessed. Ureteral complications requiring operative intervention were rare and occurred with the same incidence reported in a large open series. Limitations include lack of long-term follow-up and absence of radiographic follow-up on a subset of patients. Conclusions Radiographic resolution of VUR following RALUR is on par with contemporary open series, and the incidence of ureteral complications is low. RALUR should be considered as one of several viable options for management of VUR in children. Summary Table Outcomes, overall and by preoperative vesicoureteral reflux (VUR) grade Radiographic resolution by preoperative VUR grade n a (%) I 15/16 (93.8) II 24/26 (92.1) III 49/52 (92.4) IV 38/41 (92.7) V 10/10 (100.0) Overall 136/145 (93.8) a Number of ureters without VUR present/number of ureters studied with voiding cystourethrogram or radionuclide cystogram.

    원문보기

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    무료다운로드 유료다운로드

    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

    이미지

    Fig. 1 이미지
  3. [해외논문]   Response to commentary to “Prospective multicenter study on robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV): Outcomes and complications”  

    Boysen, William R. (Correspondence to: M.S. Gundeti, University of Chicago, Chicago, IL, USA, Tel.: +1 773 702 6150) , Gundeti, Mohan S. (fax: +1 773 702 1001)
    Journal of pediatric urology v.14 no.3 ,pp. 265 - 266 , 2018 , 1477-5131 ,

    초록

    Summary Background Robot-assisted laparoscopic extravesical ureteral reimplantation (RALUR-EV) is a minimally invasive alternative to open surgery. We have previously reported retrospective outcomes from our study group, and herein provide an updated prospective analysis with a focus on success rate, surgical technique, and complications among surgeons who have overcome the initial learning curve. Objective To assess the safety and efficacy of RALUR-EV in children, among experienced surgeons. Design and methods We reviewed our prospective database of children undergoing RALUR-EV by pediatric urologists at eight academic centers from 2015 to 2017. Radiographic success was defined as absence of vesicoureteral reflux (VUR) on postoperative voiding cystourethrogram. Complications were graded using the Clavien scale. Univariate regression analysis was performed to assess for association among various patient and technical factors and radiographic failure. Results In total, 143 patients were treated with RALUR-EV for primary VUR (87 unilateral, 56 bilateral; 199 ureters). The majority of ureters (73.4%) had grade III or higher VUR preoperatively. Radiographic resolution was present in 93.8% of ureters, as shown in the summary table. Ureteral complications occurred in five ureters (2.5%) with mean follow-up of 7.4 months (SD 4.0). Transient urinary retention occurred in four patients following bilateral procedure (7.1%) and in no patients after unilateral. On univariate analysis, there were no patient or technical factors associated with increased odds of radiographic failure. Discussion We report a radiographic success rate of 93.8% overall, and 94.1% among children with grades III–V VUR. In contemporary series, alternate management options such as endoscopic injection and open UR have reported radiographic success rates of 90% and 93.5% respectively. We were unable to identify specific patient or technical factors that influenced outcomes, although immeasurable factors such as tissue handling and intraoperative decision-making could not be assessed. Ureteral complications requiring operative intervention were rare and occurred with the same incidence reported in a large open series. Limitations include lack of long-term follow-up and absence of radiographic follow-up on a subset of patients. Conclusions Radiographic resolution of VUR following RALUR is on par with contemporary open series, and the incidence of ureteral complications is low. RALUR should be considered as one of several viable options for management of VUR in children. Summary Table Outcomes, overall and by preoperative vesicoureteral reflux (VUR) grade Radiographic resolution by preoperative VUR grade n a (%) I 15/16 (93.8) II 24/26 (92.1) III 49/52 (92.4) IV 38/41 (92.7) V 10/10 (100.0) Overall 136/145 (93.8) a Number of ureters without VUR present/number of ureters studied with voiding cystourethrogram or radionuclide cystogram.

    원문보기

    원문보기
    무료다운로드 유료다운로드

    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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    Fig. 1 이미지
  4. [해외논문]   Staged laparoscopic traction orchiopexy for intra-abdominal testis: Is it always feasible?  

    Elsherbeny, Mohammed (Faculty of Medicine, Ain Shams University, Cairo, Egypt ) , Abdallah, Ahmed (Benha Children's Hospital, Qalyoubyyah, Egypt ) , Abouzeid, Amr (Faculty of Medicine, Ain Shams University, Cairo, Egypt ) , Ghanem, Wael (Faculty of Medicine, Ain Shams University, Cairo, Egypt ) , Zaki, Ahmed (Faculty of Medicine, Ain Shams University, Cairo, Egypt)
    Journal of pediatric urology v.14 no.3 ,pp. 267.e1 - 267.e4 , 2018 , 1477-5131 ,

    초록

    Summary Background and objectives Laparoscopic orchiopexy for intra-abdominal testis is a well-known and commonly practiced technique. The traction technique is based on elongation of the testicular vessels without cutting them, in contrast with the two-stage Fowler-Stephens technique in which the testicular vessels are divided. The current study evaluated the feasibility of the traction technique according to the type of intra-abdominal testis. Patients and methods The study included 20 boys with 22 intra-abdominal testes and who underwent staged laparoscopic traction orchiopexy between October 2013 and October 2015. Eighteen testes were proximal to the internal ring by 2 cm (type IVa). The patients' ages ranged between 6 months and 5 years (mean 2.2 years; median 2 years). Patients were followed up for 1 year for testicular atrophy and satisfactory scrotal site relocation. Results This study did not detect any cases of testicular atrophy among the participants (0/22), while failure to achieve satisfactory scrotal site was found in two out of the four cases with type IVa intra-abdominal testes. Discussion Traction techniques for elongating the testicular vessels were employed years ago, but this was revisited by Shehata in 2008. It has the advantage of preserving the main testicular blood supply, which can be reflected by the decreasing rate of testicular atrophy when compared with the Fowler-Stephens orchiopexy. The results of the traction technique may be less satisfactory regarding the testicular location for higher types of intra-abdominal testes (type IVa). Conclusion Staged laparoscopic traction orchiopexy was a feasible technique for intra-abdominal testes (within 2 cm of the internal ring), but the results were less satisfactory when applied for higher intra-abdominal testes (type IVa). Display Omitted

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    무료다운로드 유료다운로드

    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

    이미지

    Fig. 1 이미지
  5. [해외논문]   The effect of prior endoscopic correction of vesicoureteral reflux on open ureteral reimplantation: Surgical outcomes and costs  

    Friedlander, D.A. (Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA ) , Ludwig, W.W. (Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA ) , Jayman, J.R. (Division of Pediatric Urology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA ) , Akhavan, A. (Department of Urology, Weill Cornell Medical College, New York, NY, USA)
    Journal of pediatric urology v.14 no.3 ,pp. 268.e1 - 268.e5 , 2018 , 1477-5131 ,

    초록

    Summary Introduction Endoscopic injection of a bulking agent is a common first-line approach to the treatment of vesicoureteral reflux (VUR). While early outcomes are comparable to open ureteroneocystotomy, 5–25% of children will eventually develop recurrent reflux necessitating repeat injections or open ureteral reimplantation. Objective To determine whether prior endoscopic injection of a bulking agent impacts outcomes of subsequent open ureteral reimplantation. Study design Using a retrospective cohort design, radiographic and clinical outcomes of open ureteral reimplantation were compared between patients with and without prior endoscopic correction of reflux. Surgical and hospitalization data were also compared between groups and a cost comparison was performed to assess differences in healthcare costs between the two cohorts. Units of analysis included total ureters or total patients. For certain variables, subanalysis of unilateral versus bilateral reimplantation was included. Results A total of 258 patients underwent open reimplantation for VUR between 2007 and 2016 by five pediatric urologists. Final analysis (see Summary Table ) included 192 patients with pre-operative and postoperative voiding cystourethrogram (VCUG) and follow-up data at a median 4.95 months. Among 317 reimplanted refluxing ureters, radiographic resolution was reached in 26/27 (96.3%) patients with and 279/290 (96.2%) without prior endoscopic treatment ( P = 0.981). Clinical success was achieved in 17/17 (100%) patients with and 174/175 (99.4%) without prior endoscopic treatment ( P = 0.755). There were no statistically significant differences between duration of surgery or length of hospital stay. There were no statistically significant differences between total charges, total costs, and operating room (OR) costs between groups. Discussion This study indicated that prior endoscopic injection of a bulking agent did not impact the outcomes or costs of subsequent open ureteroneocystotomy. While prior studies have demonstrated tissue changes associated with injection of a bulking agent, these did not seem to significantly impact the difficulty of later open surgery or the success rates compared to patients who proceeded directly to open correction of reflux. Conclusion Open ureteral reimplantation for recurrent VUR after failed endoscopic injection of a bulking agent was safe and effective, with comparable outcomes and costs to open surgery in patients without prior endoscopic correction. Summary Table No prior endoscopic treatment ( n = 175) Prior endoscopic treatment ( n = 17) P -value Reimplanted ureters 311 31 – Median duration of surgery, minutes (range) a 144 (46–269) 144 (83–334) 0.595 Median length of stay, days (range) 3 (1–17) 3 (2–7) 0.793 Radiographic resolution per ureter (%) b 279 (96.2) 26 (96.3) 0.981 Clinical resolution (%) 174 (99.4) 17 (100) 0.755 Total charges, USD (range) $12,069 ($5528–45,570) $11,911 ($8756–22,918) 0.925 Total costs, USD (range) $9876 ($4977–33,315) $9557 ($7321–17,016) 0.990

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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    Fig. 1 이미지
  6. [해외논문]   Diffusion-weighted magnetic resonance imaging is more sensitive than dimercaptosuccinic acid scintigraphy in detecting parenchymal lesions in children with acute pyelonephritis: A prospective study  

    Bosakova, Alice (Department of Pediatric Medicine, University Hospital Ostrava, Czech Republic ) , Salounova, Dana (VSB-Technical University of Ostrava, Faculty of Economics, Czech Republic ) , Havelka, Jaroslav (Radiology, University Hospital Ostrava, Czech Republic ) , Kraft, Otakar (Nuclear Medicine, University Hospital Ostrava, Czech Republic ) , Sirucek, Pavel (Nuclear Medicine, University Hospital Ostrava, Czech Republic ) , Kocvara, Radim (Department of Urology, General University Hospital and Charles University 1st Faculty of Medicine, Prague, Czech Republic ) , Hladik, Michal (Department of Pediatric Medicine, University Hospital Ostrava, Czech Republic)
    Journal of pediatric urology v.14 no.3 ,pp. 269.e1 - 269.e7 , 2018 , 1477-5131 ,

    초록

    Summary Introduction Static renal scintigraphy is the gold standard for detection of inflammatory changes in the renal parenchyma in acute pyelonephritis. Our aim was to determine whether diffusion-weighted magnetic resonance imaging (DW-MRI) was comparable with static renal scintigraphy (DMSA-SRS) to demonstrate acute renal parenchymal lesions. Objective To compare 99m Tc-dimercaptosuccinic acid static renal scintigraphy (DMSA-SRS) with diffusion-weighted magnetic resonance imaging (DW-MRI) for detecting acute inflammatory changes in the renal parenchyma in children with febrile urinary tract infection. Methods Thirty-one children (30 girls) aged 3–18 years with a first episode of febrile UTI without a previously detected congenital malformation of the urinary tract, were prospectively included. DMSA-SRS and DW-MRI were performed within 5 days of diagnosis to detect renal inflammatory lesions. The DW-MRI examination was performed without contrast agent and without general anesthesia. Late examinations were performed after 6 months using both methods to detect late lesions. Results DW-MRI confirmed acute inflammatory changes of the renal parenchyma in all 31 patients (100%), mostly unilateral. DMSA-SRS detected inflammatory lesions in 22 children (71%; p = 0.002). The lesions were multiple in 26/31 children (84%) on DW-MRI and in 9/22 (40%) on DMSA-SRS. At the control examination, scarring of the renal parenchyma was found equally by DW-MRI and DMSA-SRS in five patients (16%), three of whom were the same patients. The overall concordance of positive and negative late findings occurred in 87% of patients. There was correspondence in the anatomical location of acute and late lesions. Discussion The clinical significance of acute and late parenchymal findings on DWI-MR is yet to be determined. A limitation of our study is the age of the patients (older than 3 years) who are less sensitive to scar development; therefore, a smaller number of patients with scars could be analyzed during control examination. Further studies using the DW-MRI should confirm its reliability to detect acute and late lesions in younger children and infants and determine the clinical consequences. Conclusion DW-MRI has higher sensitivity for detecting acute renal inflammatory lesions and multifocal lesions than DMSA-SRS. The incidence of scars was low and corresponded with the anatomical location of acute and late lesions. Display Omitted

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

    이미지

    Fig. 1 이미지
  7. [해외논문]   Re. “Diffusion weighted magnetic resonance imaging is more sensitive than dimercaptosuccinic acid scintigraphy in detecting parenchymal lesions in children with acute pyelonephritis: A prospective study”  

    Pohl, Hans G.
    Journal of pediatric urology v.14 no.3 ,pp. 270 - 271 , 2018 , 1477-5131 ,

    초록

    Summary Introduction Static renal scintigraphy is the gold standard for detection of inflammatory changes in the renal parenchyma in acute pyelonephritis. Our aim was to determine whether diffusion-weighted magnetic resonance imaging (DW-MRI) was comparable with static renal scintigraphy (DMSA-SRS) to demonstrate acute renal parenchymal lesions. Objective To compare 99m Tc-dimercaptosuccinic acid static renal scintigraphy (DMSA-SRS) with diffusion-weighted magnetic resonance imaging (DW-MRI) for detecting acute inflammatory changes in the renal parenchyma in children with febrile urinary tract infection. Methods Thirty-one children (30 girls) aged 3–18 years with a first episode of febrile UTI without a previously detected congenital malformation of the urinary tract, were prospectively included. DMSA-SRS and DW-MRI were performed within 5 days of diagnosis to detect renal inflammatory lesions. The DW-MRI examination was performed without contrast agent and without general anesthesia. Late examinations were performed after 6 months using both methods to detect late lesions. Results DW-MRI confirmed acute inflammatory changes of the renal parenchyma in all 31 patients (100%), mostly unilateral. DMSA-SRS detected inflammatory lesions in 22 children (71%; p = 0.002). The lesions were multiple in 26/31 children (84%) on DW-MRI and in 9/22 (40%) on DMSA-SRS. At the control examination, scarring of the renal parenchyma was found equally by DW-MRI and DMSA-SRS in five patients (16%), three of whom were the same patients. The overall concordance of positive and negative late findings occurred in 87% of patients. There was correspondence in the anatomical location of acute and late lesions. Discussion The clinical significance of acute and late parenchymal findings on DWI-MR is yet to be determined. A limitation of our study is the age of the patients (older than 3 years) who are less sensitive to scar development; therefore, a smaller number of patients with scars could be analyzed during control examination. Further studies using the DW-MRI should confirm its reliability to detect acute and late lesions in younger children and infants and determine the clinical consequences. Conclusion DW-MRI has higher sensitivity for detecting acute renal inflammatory lesions and multifocal lesions than DMSA-SRS. The incidence of scars was low and corresponded with the anatomical location of acute and late lesions. Display Omitted

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    원문보기
    무료다운로드 유료다운로드

    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

    이미지

    Fig. 1 이미지
  8. [해외논문]   Laparoscopic inguinal hernia repair by modified peritoneal leaflet closure: Description and initial results in children  

    Van Batavia, Jason P. (Division of Urology, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA ) , Tong, Carmen (Department of Urology, Einstein Healthcare Network, Philadelphia, PA, USA ) , Chu, David I. (Division of Urology, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA ) , Kawal, Trudy (Division of Urology, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA ) , Srinivasan, Arun K. (Division of Urology, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA)
    Journal of pediatric urology v.14 no.3 ,pp. 272.e1 - 272.e6 , 2018 , 1477-5131 ,

    초록

    Summary Introduction Inguinal hernias are common in infants and children. While the gold standard for hernia repair in the pediatric period has been via an open inguinal incision with dissection and high ligation of the hernia sac, over the past two decades laparoscopic herniorrhaphy has increased in popularity. The advantages of laparoscopy include decreased post-operative pain, improved cosmetic results, ability to easily assess the contralateral side for an open internal inguinal ring, and decreased risk of metachronous hernias. Herein, we describe a modified laparoscopic herniorrhaphy using a peritoneal leaflet closure and report our operative experience with intermediate-term results. Methods We retrospectively reviewed our IRB-approved registry for all children who underwent initial laparoscopic herniorrhaphy at our tertiary care center over a 2.5-year period. All surgeries were performed by a single surgeon using a technique we have termed the peritoneal leaflet closure. This technique involves incising the peritoneum circumferentially around the open internal ring and developing peritoneal leaflets which are then closed together over the ring with a running non-absorbable barbed stitch ( Figure ). Intraoperative findings and complications, operative times, and post-operative complications were reviewed for all children. Results A total of 50 initial laparoscopic hernia repairs (4 bilateral, 42 unilateral) were performed in 46 children (43 boys, 3 girls) at a median age of 5.9 years (range 0.5–16.7). Median operative time was 73 min (range 48–138) for unilateral and 106 min (range 104–135) for bilateral herniorrhaphy. No patient had an intraoperative complication. Two children (4%) had contralateral open rings discovered at time of surgery and underwent unplanned bilateral laparoscopic hernia repair. All patients went home on the same day as the procedure and three children (6%) had minor post-operative complaints (umbilical bulge, thigh pain, and urine holding) that all self-resolved. Thirty-nine children had follow-up data available. Intermediate-term complications occurred in two children (5%): one boy developed a contralateral hydrocele (despite a closed ring at surgery) and one boy had a hernia recurrence that required open repair. Overall, operative success with the modified peritoneal leaflet closure technique was therefore 97% (38 of 39 children with follow-up). All 37 boys who followed up had bilateral descended testes of normal size and consistency. Conclusions Laparoscopic herniorrhaphy using a peritoneal leaflet closure technique is safe and effective when used in infants and children to close an indirect hernia (i.e. patent processus vaginalis). No intraoperative complications occurred in this cohort and success rate was 97%. Display Omitted

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  9. [해외논문]   Commentary to 'Laparoscopic inguinal hernia repair by modified peritoneal leaflet closure: Description and initial results in children'  

    Campbell, Jeffrey B. (Correspondence to: J.B. Campbell)
    Journal of pediatric urology v.14 no.3 ,pp. 273 - 273 , 2018 , 1477-5131 ,

    초록

    Summary Introduction Inguinal hernias are common in infants and children. While the gold standard for hernia repair in the pediatric period has been via an open inguinal incision with dissection and high ligation of the hernia sac, over the past two decades laparoscopic herniorrhaphy has increased in popularity. The advantages of laparoscopy include decreased post-operative pain, improved cosmetic results, ability to easily assess the contralateral side for an open internal inguinal ring, and decreased risk of metachronous hernias. Herein, we describe a modified laparoscopic herniorrhaphy using a peritoneal leaflet closure and report our operative experience with intermediate-term results. Methods We retrospectively reviewed our IRB-approved registry for all children who underwent initial laparoscopic herniorrhaphy at our tertiary care center over a 2.5-year period. All surgeries were performed by a single surgeon using a technique we have termed the peritoneal leaflet closure. This technique involves incising the peritoneum circumferentially around the open internal ring and developing peritoneal leaflets which are then closed together over the ring with a running non-absorbable barbed stitch ( Figure ). Intraoperative findings and complications, operative times, and post-operative complications were reviewed for all children. Results A total of 50 initial laparoscopic hernia repairs (4 bilateral, 42 unilateral) were performed in 46 children (43 boys, 3 girls) at a median age of 5.9 years (range 0.5–16.7). Median operative time was 73 min (range 48–138) for unilateral and 106 min (range 104–135) for bilateral herniorrhaphy. No patient had an intraoperative complication. Two children (4%) had contralateral open rings discovered at time of surgery and underwent unplanned bilateral laparoscopic hernia repair. All patients went home on the same day as the procedure and three children (6%) had minor post-operative complaints (umbilical bulge, thigh pain, and urine holding) that all self-resolved. Thirty-nine children had follow-up data available. Intermediate-term complications occurred in two children (5%): one boy developed a contralateral hydrocele (despite a closed ring at surgery) and one boy had a hernia recurrence that required open repair. Overall, operative success with the modified peritoneal leaflet closure technique was therefore 97% (38 of 39 children with follow-up). All 37 boys who followed up had bilateral descended testes of normal size and consistency. Conclusions Laparoscopic herniorrhaphy using a peritoneal leaflet closure technique is safe and effective when used in infants and children to close an indirect hernia (i.e. patent processus vaginalis). No intraoperative complications occurred in this cohort and success rate was 97%. Display Omitted

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    원문보기
    무료다운로드 유료다운로드

    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  10. [해외논문]   Cryopreservation of testicular tissue in pre-pubertal and adolescent boys at risk for infertility: A low risk procedure  

    Ming, Jessica M. (Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Ontario, Canada ) , Chua, Michael E. (Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Ontario, Canada ) , Lopes, Roberto Iglesias (Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Ontario, Canada ) , Maloney, Anne Marie (Division of Oncology, Hospital for Sick Children and Department of Pediatrics, University of Toronto, Ontario, Canada ) , Gupta, Abha A. (Division of Oncology, Hospital for Sick Children and Department of Pediatrics, University of Toronto, Ontario, Canada ) , Lorenzo, Armando J. (Division of Urology, Hospital for Sick Children and Department of Surgery, University of Toronto, Ontario, Canada)
    Journal of pediatric urology v.14 no.3 ,pp. 274.e1 - 274.e5 , 2018 , 1477-5131 ,

    초록

    Summary Introduction Cryopreservation of testicular tissue (TT) has become an increasingly attractive option for fertility preservation (FP), particularly for pre-pubertal boys at risk for gonadotoxicity from cancer therapy. At our institution, all at-risk families undergo counseling regarding infertility risk and available FP strategies, including this vulnerable patient population. As the technology required to use the acquired tissue is, as yet, unproven, it is paramount to document minimal morbidity and complications from this procedure. Herein, we report these outcomes for all pre-pubertal patients who have undergone TT biopsies for FP. Methods We retrospectively reviewed consecutive patients who underwent unilateral open TT biopsies between January 2014 and December 2016. Patient diagnosis, age, concomitant procedures, anesthetic type, complications, procedure times, planned therapy, and bleeding were evaluated. Results Of a total of 34 patients, mean age at biopsy was 6.9 ± 4.4years. Diagnoses included: leukemia/lymphoma ( n = 12), solid tumors ( n = 15) and non-neoplastic disorders (hemophagocytic lymphohistiocytosis, aplastic anemia; n = 7). Twenty-two patients (64.7%) were scheduled for stem cell transplantation. Eleven (32.4%) patients had not received any chemotherapy prior to TT biopsy, while all others had exposure preceding the biopsy. Biopsies were performed in conjunction with other procedures (central line placement, bone marrow biopsy, lumbar puncture, lymph node biopsy) in 29 cases (85.3%), with stand-alone procedures performed in the remainder ( n = 5). In stand-alone cases, mean anesthetic time was 22 ± 8.7 min. Overall, two (5.9%) patients had complications after biopsy: 1) ipsilateral epididymo-orchitis (resolved with antibiotics) and 2) ipsilateral torsed appendix testis (managed conservatively) ( Table ). Conclusion In this series, pre-pubertal TT biopsy for cryopreservation was safely performed, and was most often coordinated concomitantly with other medically necessary procedures. The safety profile reported herein supports performing this procedure while technological advances fulfill the requirements to make it a viable option for future fertility. Table Patient characteristics. Age at surgery (years) Diagnosis Platelet (×10 9 /L) 7.8 Relapse high risk precursor B cell ALL a 270 6.4 Burkitt's lymphoma 520 14.6 Relapsed intravascular large B cell lymphoma a 78 8.8 Rhabdomyosarcoma of R parameningeal 352 3.4 Aplastic anemia 51 12.6 Relapsed precursor B ALL a 134 4.4 Neuroblastoma a 62 3.8 Neuroblastoma 474 10.4 Metastatic medulloblastoma a 338 8.5 Relapse Burkitt's lymphoma a 80 5.7 JMML a 352 12.8 Metastaticmedulloblastoma

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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