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Journal of pediatric urology 63건

  1. [해외논문]   Renal function outcomes in pediatric patients with symptomatic reflux into the transplanted kidney treated with redo ureteroneocystostomy  

    Wang, Mary K. (Department of Urology, University of California, San Francisco, CA, USA ) , Chuang, Kai-wen (Department of Urology, University of California, San Francisco, CA, USA ) , Li, Yi (Department of Urology, University of California, San Francisco, CA, USA ) , Gaither, Thomas (Department of Urology, University of California, San Francisco, CA, USA ) , Brakeman, Paul (Department of Pediatrics, University of California, San Francisco, CA, USA ) , Gonzalez, Lynette (Department of Pediatrics, University of California, San Francisco, CA, USA ) , Brennan, Jessica (Department of Pediatrics, University of California, San Francisco, CA, USA ) , Baskin, Laurence S. (Department of Urology, University of California, San Francisco, CA, USA)
    Journal of pediatric urology v.14 no.3 ,pp. 275.e1 - 275.e5 , 2018 , 1477-5131 ,

    초록

    Summary Introduction Asymptomatic post-renal transplant reflux is common but only 5–10% patients are diagnosed with vesico-ureteral reflux in the setting of post-transplant febrile urinary tract infections, requiring redo ureteroneocystostomy (redo-UNC). Here we report the renal function outcomes of 37 such patients, stratified by lower urinary tract (LUT) status. Objective We hypothesized that those with pre-transplant LUT dysfunction would have lower glomerular filtration rate (GFR) on follow-up. Study design Using procedure codes, 37 patients who underwent renal transplant followed by redo-UNC for transplant reflux at our institution between 1991 and 2014 were identified. Patient characteristics and GFR levels from four different time points were recorded. Comparisons were made between those with and without LUT dysfunction, using Fisher's exact, Wilcoxon rank sum, or signed-rank tests. Generalized estimating equations were constructed to account for the clustered nature of GFR within each LUT group and to assess their change over time. Results Twelve patients (32%) had pre-transplant LUT dysfunction. The proportion of males in this group was significantly higher (75% vs. 32%, p = 0.032), and there was no statistical difference towards presenting earlier with post-transplant reflux (1.4 vs. 2.3 years, p = 0.087). After an average of 4.9 years, the median GFRs were similar between the two groups (53 mg/dL vs. 58 mg/dL, p = 0.936). There was no significant difference in GFR at this last follow-up time point in patients with and without LUT dysfunction. Discussion Vesicoureteral reflux in the setting of renal transplantation is common and doesn't often require repair. In our series, we found that those with LUT dysfunction did not present statistically sooner with symptomatic transplant reflux. Longer-term follow-up did show a decline in GFR but did not reveal a difference in GFR in patients' with and without LUT dysfunction. Conclusions Pediatric post-transplant GFR after open redo ureteral reimplant decreases over time in similar fashion in patients with symptomatic reflux regardless of whether they have LUT dysfunction or normal anatomy. Vigilance should apply to the recognition, treatment, and follow-up of all symptomatic transplant reflux regardless of LUT status.

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  2. [해외논문]   Who, where, and why are patients lost to follow-up? A 20-year study of bladder exstrophy patients at a single institution  

    Haddad, Emily (Cook Children's Health Care System, Fort Worth, TX, USA ) , Sancaktutar, Ahmet Ali (Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA ) , Palmer, Blake W. (Cook Children's Health Care System, Fort Worth, TX, USA ) , Aston, Christopher (Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA ) , Kropp, Bradley P. (Cook Children's Health Care System, Fort Worth, TX, USA)
    Journal of pediatric urology v.14 no.3 ,pp. 276.e1 - 276.e6 , 2018 , 1477-5131 ,

    초록

    Summary Introduction Individuals with bladder and cloacal exstrophy are at increased risk for kidney disease, renal failure, and bladder complications. Given the social implications and sensitive nature of the disease, these patients are also at risk for psychosocial problems. Lack of regular medical follow-up visits may pose serious risks to their long-term health status. The aim of this study is determine what factors place an affected individual at risk for limited long term follow up. Materials and methods We identified all patients with bladder or cloacal exstrophy seen by the pediatric urology department at the Oklahoma University Health Sciences Center (OUHSC) between January 1996 and August 2016. Patient data included demographics, insurance coverage, distance from patient's home to the clinic, medical and surgical history, and the date of their last clinic visit. Two groups for comparison were (1) those that had been seen within the last 2 years, and (2) those that were counted as failing to maintain follow-up because 2 or more years had passed since their last clinic visit. These groups were compared using the Student t -test, the chi-square test, or the Fisher exact test and p Results and discussion Ninety-one patients with bladder or cloacal exstrophy were seen by the pediatric urology department between January 1996 and August 2016. Of the 91 patients, 24 left the clinic for known reasons thus leaving 67 patients that were considered for analyses: 51 had been seen within the last 2 years while 16 were counted as lost to follow-up. These two groups (active and lost to follow-up) did not differ significantly for age at last clinic visit, distance between family's home and clinic, history of bladder reconstruction, sex, or insurance status. There was a significant difference between the two groups in the medical complexity of their condition. The group active in urological care had more patients with cloacal exstrophy and additional anomalies than the group lost to follow-up. Conclusions Patients with bladder exstrophy and cloacal exstrophy are less likely to maintain annual follow-up visits with their urologist if they have a simpler diagnosis requiring fewer surgical interventions. For patients with exstrophy, regular clinic visits prioritizing education and psychosocial support may prevent hospitalizations, emergency interventions, and poor overall health outcomes. To maintain contact with the medical team and promote optimal health outcomes, a social worker or care coordinator/educator may play an integral part in addressing the unique needs of this population.

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  3. [해외논문]   Is the renal pyramidal thickness a good predictor for pyeloplasty in postnatal hydronephrosis?  

    Hodhod, Amr (Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada ) , Capolicchio, John-Paul (Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada ) , Jednak, Roman (Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada ) , Eid, Hadeel (Pediatric Radiology Division, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada ) , El-Doray, Abd El-Alim (Department of Urology, Faculty of Medicine, Menoufia University, Al Minufya, Egypt ) , El-Sherbiny, Mohamed (Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada)
    Journal of pediatric urology v.14 no.3 ,pp. 277.e1 - 277.e6 , 2018 , 1477-5131 ,

    초록

    Summary Objectives We evaluated the feasibility and value of renal pyramidal thickness (PT) as a predictor of pyeloplasty in high-grade postnatal hydronephrosis. Patients and methods We retrospectively reviewed the charts of patients who presented with postnatal hydronephrosis from 2008 to 2013. Included cases had grade 3 or 4 hydronephrosis. We included only units diagnosed as ureteropelvic junction obstruction. Gender, laterality, hydronephrosis side, renogram data, and follow-up data were recorded. Two investigators reviewed all patients' ultrasounds images. We measured PT and pelvic anteroposterior diameter (APD) in the last ultrasound before surgery. For those managed conservatively, measurements were obtained from the ultrasound with worst hydronephrosis. PT was measured in supine position in the middle third of the sagittal plane ( Figure ). We assessed the reliability of PT measurement using the intraclass correlation coefficient (ICC). Univariate and multivariate analyses were used to correlate the collected parameters to pyeloplasty incidence. Receiver operating characteristic curve was used to evaluate the cutoff value of PT that predicts pyeloplasty. Results The total included cases were 155 patients (165 units). One hundred and fourteen units had grade 3 hydronephrosis and 51 units had grade 4 hydronephrosis. Fifty-two cases (55 units) underwent pyeloplasty. The median follow-up period was 37.6 months. PT measurement was reliable (ICC = 0.94). Univariate analysis revealed that SFU grading, APD, PT, T1/2, and MAG-3 curves were associated with surgery. Multivariate analysis showed that PT was a single independent predictor for pyeloplasty. PT ≤ 3 mm had 98.1% sensitivity and 89.7% specificity in predicting pyeloplasty. Discussion PT is the first portion of renal parenchyma that is affected in high-grade hydronephrosis. Moreover, it changes little over the first 9 years of life. PT measurement in hydronephrosis was not previously evaluated. We found that PT was easily measured in most kidneys with high negative predictive value. The PT value as an indicator for pyeloplasty should undergo extensive assessment by other institutions with different protocols. Conclusion Being a slowly growing part of the parenchyma, PT can be a good measurable parameter to predict pyeloplasty. Measurement of PT in hydronephrosis is reliable. PT ≤ 3 mm can predict pyeloplasty with 98.1% sensitivity and 89.7% specificity. Display Omitted

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  4. [해외논문]   Age-related changes in urinary flow following dorsal inlay graft urethroplasty for hypospadias in early childhood: Potential improvement over 11 years of age  

    Kim, Woo Jin (Correspondence to: W.J. Kim, Department of Urology, Kanagawa Children's Medical Center, 2-138-4, Mutsukawa, Minami-ku, Yokohama, 232-8555, Japan, Tel.: +81 45 711 2351) , Hayashi, Chihiro , Yamazaki, Yuichiro
    Journal of pediatric urology v.14 no.3 ,pp. 278.e1 - 278.e5 , 2018 , 1477-5131 ,

    초록

    Summary Introduction One of the goals of hypospadias repair is to create a neourethra with normal urinary stream and normal growth. Several studies have reported that dorsal inlay graft urethroplasty (DIG) has wide indications for various clinical phenotypes of hypospadias, with good short-term outcomes and few complications. However, there have been no reports that evaluated both short-term and long-term functional outcomes using uroflowmetry in patients with DIG. Objective The aim was to investigate whether uroflowmetry parameters change with time following DIG for hypospadias in early childhood. Materials and methods Uroflowmetry parameters after DIG for hypospadias in childhood were retrospectively evaluated and compared between two defined ages at follow-up: 4–6 years and 11–13 years. Maximum urinary flow ( Q max ) under the 25th percentile on the Miskolc nomogram was defined as obstruction. To evaluate the shapes of uroflow quantitatively, the flow index (FI) was used. The FI cut-offs for the flow shapes were defined as tower >1.253, plateaus Results Thirty-four patients met the inclusion criteria. The median operative age was 1.8 years (range 1.0–4.9 years). The median follow-up time was 10.3 years (range 7.2–12.3 years). The mean ± SD Q max at the two follow-up times increased with time, from 9.2 ± 3.7 to 18.8 ± 7.8. The mean ± SD FI changed from 0.53 ± 0.19 to 0.85 ± 0.31. Both Q max and the FI were significantly improved ( p p n = 11, 32.4%) than at 4–6 years ( n = 31, 91.2%) ( p Table ). The number of patients with plateau shapes was significantly decreased ( p = 0.001). Discussion Only one report noted long-term outcomes and spontaneous uroflowmetry resolution after tubularized incised plate urethroplasty. The current report is the first to present the short-term and long-term uroflowmetry outcomes after DIG. In addition, the FI was used for the first time to evaluate uroflowmetry after hypospadias repair. It was found that the uroflowmetry parameters improved spontaneously over 11 years of age following DIG for hypospadias in early childhood. Conclusion Uroflowmetry parameters improved spontaneously over 11 years of age following DIG for hypospadias in early childhood. Table Outcomes of uroflowmetry at the two follow-up evaluations. Uroflowmetry results Age at uroflowmetry 4–6 years 11–13 years Distribution of Q max as percentile evaluated by Miskolc nomogram, n (%) 25–50th percentile 2 (5.9) 7 (20.6) 50–75th percentile 1 (2.9) 6 (17.6) >75th percentile 0 (0) 10 (29.4) Uroflow shapes evaluated by the flow index, n (%) Plateaus 24 (70.6) 10 (29.4)

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  5. [해외논문]   Incontinence affects health-related quality of life in children and adolescents with spina bifida  

    Szymanski, Konrad M. (Correspondence to: K.M. Szymanski, Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN, 46202, USA, Tel.: +1 317 944 7446) , Cain, Mark P. (fax: +1 317 944 7481) , Whittam, Benjamin , Kaefer, Martin , Rink, Richard C. , Misseri, Rosalia
    Journal of pediatric urology v.14 no.3 ,pp. 279.e1 - 279.e8 , 2018 , 1477-5131 ,

    초록

    Summary Purpose Despite devoting many resources to managing urinary and fecal incontinence (UI and FI) in children with spina bifida (SB), it remains unclear whether either is associated with lower health-related quality of life (HRQOL). We sought to determine the impact of UI and FI on HRQOL in this population. Materials and methods Children with SB (8–17 years) living in the United States were surveyed online and in SB clinics (2013–15). We evaluated incontinence over the previous 4 weeks using a UI dry interval ( Results The mean age of 298 children was 12.5 years (52.0% male). Overall, 73.1% had UI, 52.3% had FI, and 43.6% had both. Adjusting for concurrent UI and FI, any UI was associated with lower HRQOL in 14–17 year olds ( p p = 0.048), but not 8–9 year olds ( p = 0.98) ( Figure ). All age groups reported lower HRQOL with FI ( p ≤ 0.0001). On multivariate analysis, UI and FI incontinence intervals were not associated with lower HRQOL for any age group ( p ≥ 0.58 and p ≥ 0.10, respectively). Higher quantities of UI were associated with ever-lower HRQOL, particularly in 14–17 year olds ( p ≤ 0.02). Any quantity of FI was associated with lower HRQOL in all ages. The findings did not change significantly on exploratory analysis correcting for demographic and clinical variables. Discussion We report the first evidence that incontinence matters to children and adolescents with SB. Being a cross-sectional study, we were unable to track HRQOL over time. A prospective study is required to assess if HRQOL impact of UI indeed changes as a child grows up and if improving incontinence with treatments improves HRQOL. Findings are similar to those reported in adults with SB and suggest that the concept of “social continence” based on time interval has no HRQOL relevance in children, adolescents or adults with SB. Conclusions UI is negatively associated with HRQOL in children with SB in an age-dependent fashion: starting in 10 year olds and increasing until 14 years. FI correlates with lower HRQOL regardless of age. Similar to findings in adults with SB, HRQOL is lower with increasing amounts of UI and not the length of a dry interval. FI impacts HRQOL uniformly, regardless of frequency or amount. Display Omitted

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  6. [해외논문]   Histological and morphological characteristics of the prepuce of penis skin structure in different age groups  

    Dossanova, A. (JCS Astana Medical University, Astana, Kazakhstan ) , Lozovoy, V. (JCS Astana Medical University, Astana, Kazakhstan ) , Manekenova, K. (JCS Astana Medical University, Astana, Kazakhstan ) , Lozovaya, Y. (JCS Astana Medical University, Astana, Kazakhstan ) , Seidakhmetov, M. (JCS Astana Medical University, Astana, Kazakhstan ) , Dossanov, B. (JCS Astana Medical University, Astana, Kazakhstan ) , Omarov, T. (JCS Astana Medical University, Astana, Kazakhstan ) , Botabaeva, A. (JCS Astana Medical University, Astana, Kazakhstan ) , Shakeeva, A. (JCS Astana Medical University, Astana, Kazakhstan ) , Baubekov, Z. (West Kazakhstan Medical University, Aktobe, Kazakhstan)
    Journal of pediatric urology v.14 no.3 ,pp. 280.e1 - 280.e6 , 2018 , 1477-5131 ,

    초록

    Summary Background Hypospadias is one of the most common congenital abnormalities in childhood. The number of cases has rapidly grown in recent years. Objectives The purpose of this research was to analyze the histological and morphological differences of the foreskin samples taken from boys in three age groups. Study design A total of 30 Asian patients participated in the research. Clinical materials obtained via biopsy were divided into three age groups. The first group included 10 biopsy materials of preputial skin taken from boys aged Results Obtained results showed that the number of vein clusters in the prepuce and the cases of vessel wall fibrosis grew with age. It is worth noting that no such discoveries were made in younger boys (aged Discussion It is believed that it is important to continue investigating the prepuce in hypospadias, in order to gain a better understanding of the abnormality depending on type. Conclusion Peculiarities of prepuce in hypospadias discovered in different age groups allowed a full understanding of the pathology development processes.

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  7. [해외논문]   Combined use of flexible ureteroscopic lithotripsy with micro-percutaneous nephrolithotomy in pediatric multiple kidney stones  

    Li, Jun (Correspondence to: W. Wang, Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China, Tel.: +86 010 6313 9043) , Wang, Wenying (fax: +86 010 6313 9043) , Du, Yuan , Tian, Ye
    Journal of pediatric urology v.14 no.3 ,pp. 281.e1 - 281.e6 , 2018 , 1477-5131 ,

    초록

    Summary Background We investigated the clinical value of treating pediatric multiple kidney stones with extensive distribution using flexible ureteroscopic lithotripsy (FUL) combined with micro-percutaneous nephrolithotomy (micro-PNL). Patients and methods In total, 21 pediatric patients with multiple renal calculi between May 2016 and June 2017 received FUL combined with micro-PNL. The group included 13 boys and eight girls; the patients' mean age was 3.8 years (range 1–8 years). The maximum stone diameter ranged from 1.0 to 1.5 cm. FUL was first performed in the lithotomy position to fragment stones that were located in the renal pelvis, and upper and mid-renal calyx. Patients were then moved to a prone position, and micro-PNL was performed to treat lower pole stones that could not be reached by the flexible ureteroscope during FUL. Percutaneous renal access to the lower calyx was achieved using a 4.8F “all-seeing needle” with ultrasound guidance, and stone fragmentation was performed with a 200-μm holmium laser at different settings to disintegrate 1- to 2-mm fragments. Results All 21 pediatric patients with multiple kidney stones underwent combined FUL and micro-PNL. The stone free rate (SFR) was 85.7% (18/21). The mean surgical time was 45 min (range 30–70 min). The mean volume of irrigation fluid used was 480 mL (range 300–1200 mL). The mean surgical time for FUL and micro-PNL was 31 min and 14 min, respectively, and the mean volume of fluid used for FUL and micro-PNL was 360 mL and 120 mL, respectively. According to the modified Clavien classification, grade 1 and 2 postoperative complications occurred in five and one patients, respectively. The mean decrease in the level of hemoglobin was 0.4 g/dL (0–0.7 g/dL), and no patients required a transfusion. The average hospital stay was 3 days (range 2–5 days). Conclusion Combined FUL and micro-PNL is a safe, effective, and minimally invasive operation to remove multiple renal calculi with extensive distribution in children in selected cases.

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  8. [해외논문]   CEVL interactive: Regional nerve blocks in everyday pediatric urology: 1. Ultrasound guided regional anesthetic block of ilioinguinal and iliohypogastric nerves (USGIINB)  

    Shah, Ravi
    Journal of pediatric urology v.14 no.3 ,pp. 282 - 284 , 2018 , 1477-5131 ,

    초록

    Summary Background We investigated the clinical value of treating pediatric multiple kidney stones with extensive distribution using flexible ureteroscopic lithotripsy (FUL) combined with micro-percutaneous nephrolithotomy (micro-PNL). Patients and methods In total, 21 pediatric patients with multiple renal calculi between May 2016 and June 2017 received FUL combined with micro-PNL. The group included 13 boys and eight girls; the patients' mean age was 3.8 years (range 1–8 years). The maximum stone diameter ranged from 1.0 to 1.5 cm. FUL was first performed in the lithotomy position to fragment stones that were located in the renal pelvis, and upper and mid-renal calyx. Patients were then moved to a prone position, and micro-PNL was performed to treat lower pole stones that could not be reached by the flexible ureteroscope during FUL. Percutaneous renal access to the lower calyx was achieved using a 4.8F “all-seeing needle” with ultrasound guidance, and stone fragmentation was performed with a 200-μm holmium laser at different settings to disintegrate 1- to 2-mm fragments. Results All 21 pediatric patients with multiple kidney stones underwent combined FUL and micro-PNL. The stone free rate (SFR) was 85.7% (18/21). The mean surgical time was 45 min (range 30–70 min). The mean volume of irrigation fluid used was 480 mL (range 300–1200 mL). The mean surgical time for FUL and micro-PNL was 31 min and 14 min, respectively, and the mean volume of fluid used for FUL and micro-PNL was 360 mL and 120 mL, respectively. According to the modified Clavien classification, grade 1 and 2 postoperative complications occurred in five and one patients, respectively. The mean decrease in the level of hemoglobin was 0.4 g/dL (0–0.7 g/dL), and no patients required a transfusion. The average hospital stay was 3 days (range 2–5 days). Conclusion Combined FUL and micro-PNL is a safe, effective, and minimally invasive operation to remove multiple renal calculi with extensive distribution in children in selected cases.

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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
  9. [해외논문]   Expert opinion: Regional nerve blocks in everyday pediatric urology: 1. Ultrasound guided regional anesthetic block of ilioinguinal and iliohypogastric nerves (USGIINB)  

    Simion, Carmen (Correspondence to: Carmen Simion)
    Journal of pediatric urology v.14 no.3 ,pp. 285 - 285 , 2018 , 1477-5131 ,

    초록

    Summary Background We investigated the clinical value of treating pediatric multiple kidney stones with extensive distribution using flexible ureteroscopic lithotripsy (FUL) combined with micro-percutaneous nephrolithotomy (micro-PNL). Patients and methods In total, 21 pediatric patients with multiple renal calculi between May 2016 and June 2017 received FUL combined with micro-PNL. The group included 13 boys and eight girls; the patients' mean age was 3.8 years (range 1–8 years). The maximum stone diameter ranged from 1.0 to 1.5 cm. FUL was first performed in the lithotomy position to fragment stones that were located in the renal pelvis, and upper and mid-renal calyx. Patients were then moved to a prone position, and micro-PNL was performed to treat lower pole stones that could not be reached by the flexible ureteroscope during FUL. Percutaneous renal access to the lower calyx was achieved using a 4.8F “all-seeing needle” with ultrasound guidance, and stone fragmentation was performed with a 200-μm holmium laser at different settings to disintegrate 1- to 2-mm fragments. Results All 21 pediatric patients with multiple kidney stones underwent combined FUL and micro-PNL. The stone free rate (SFR) was 85.7% (18/21). The mean surgical time was 45 min (range 30–70 min). The mean volume of irrigation fluid used was 480 mL (range 300–1200 mL). The mean surgical time for FUL and micro-PNL was 31 min and 14 min, respectively, and the mean volume of fluid used for FUL and micro-PNL was 360 mL and 120 mL, respectively. According to the modified Clavien classification, grade 1 and 2 postoperative complications occurred in five and one patients, respectively. The mean decrease in the level of hemoglobin was 0.4 g/dL (0–0.7 g/dL), and no patients required a transfusion. The average hospital stay was 3 days (range 2–5 days). Conclusion Combined FUL and micro-PNL is a safe, effective, and minimally invasive operation to remove multiple renal calculi with extensive distribution in children in selected cases.

    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.

    이미지

    Fig. 1 이미지
  10. [해외논문]   Ethical issues in research: Human and animal experimentation  

    Harper, Luke (Department of Pediatric Surgery, CHU Pellegrin-Enfants, Bordeaux, France ) , Herbst, Katherine W. (Division of Urology/Department of Research, Connecticut Children's Medical Center, Hartford, CT, USA ) , Kalfa, Nicolas (Service de Chirurgie et Urologique Pédiatrique Hôpital Lapeyronie, CHU de Montpellier, Université)
    Journal of pediatric urology v.14 no.3 ,pp. 286 - 286 , 2018 , 1477-5131 ,

    초록

    Summary Background We investigated the clinical value of treating pediatric multiple kidney stones with extensive distribution using flexible ureteroscopic lithotripsy (FUL) combined with micro-percutaneous nephrolithotomy (micro-PNL). Patients and methods In total, 21 pediatric patients with multiple renal calculi between May 2016 and June 2017 received FUL combined with micro-PNL. The group included 13 boys and eight girls; the patients' mean age was 3.8 years (range 1–8 years). The maximum stone diameter ranged from 1.0 to 1.5 cm. FUL was first performed in the lithotomy position to fragment stones that were located in the renal pelvis, and upper and mid-renal calyx. Patients were then moved to a prone position, and micro-PNL was performed to treat lower pole stones that could not be reached by the flexible ureteroscope during FUL. Percutaneous renal access to the lower calyx was achieved using a 4.8F “all-seeing needle” with ultrasound guidance, and stone fragmentation was performed with a 200-μm holmium laser at different settings to disintegrate 1- to 2-mm fragments. Results All 21 pediatric patients with multiple kidney stones underwent combined FUL and micro-PNL. The stone free rate (SFR) was 85.7% (18/21). The mean surgical time was 45 min (range 30–70 min). The mean volume of irrigation fluid used was 480 mL (range 300–1200 mL). The mean surgical time for FUL and micro-PNL was 31 min and 14 min, respectively, and the mean volume of fluid used for FUL and micro-PNL was 360 mL and 120 mL, respectively. According to the modified Clavien classification, grade 1 and 2 postoperative complications occurred in five and one patients, respectively. The mean decrease in the level of hemoglobin was 0.4 g/dL (0–0.7 g/dL), and no patients required a transfusion. The average hospital stay was 3 days (range 2–5 days). Conclusion Combined FUL and micro-PNL is a safe, effective, and minimally invasive operation to remove multiple renal calculi with extensive distribution in children in selected cases.

    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.

    이미지

    Fig. 1 이미지

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