A peer-reviewed consensus guideline for the management of the primary megaureter has been established. The guideline is based on current evidence and peer practice and the BAPU recognized that new techniques requiring further studies may have a role in future management.

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Critical Care 2017, 21(Suppl 1):P349 Introduction Imbalance in cellular energetics has been suggested to be an important mechanism for organ failure in sepsis and septic shock. We hypothesized that such energy imbalance would either be caused by metabolic changes leading to decreased energy production or by increased energy consumption. Thus, we set out to investigate if mitochondrial dysfunction or decreased energy consumption alters cellular metabolism in muscle tissue in experimental sepsis. Methods We submitted anesthetized piglets to sepsis (n = 12) or placebo (n = 4) and monitored them for 3 hours. Plasma lactate and markers of organ failure were measured hourly, as was muscle metabolism by microdialysis. Energy consumption was intervened locally by infusing ouabain through one microdialysis catheter to block major energy expenditure of the cells, by inhibiting the major energy consuming enzyme, N+/K + -ATPase. Similarly, energy production was blocked infusing sodium cyanide (NaCN), in a different region, to block the cytochrome oxidase in muscle tissue mitochondria. Results All animals submitted to sepsis fulfilled sepsis criteria as defined in Sepsis-3, whereas no animals in the placebo group did. Muscle glucose decreased during sepsis independently of N+/K + -ATPase or cytochrome oxidase blockade. Muscle lactate did not increase during sepsis in naïve metabolism. However, during cytochrome oxidase blockade, there was an increase in muscle lactate that was further accentuated during sepsis. Muscle pyruvate did not decrease during sepsis in naïve metabolism. During cytochrome oxidase blockade, there was a decrease in muscle pyruvate, independently of sepsis. Lactate to pyruvate ratio increased during sepsis and was further accentuated during cytochrome oxidase blockade. Muscle glycerol increased during sepsis and decreased slightly without sepsis regardless of N+/K + -ATPase or cytochrome oxidase blocking. There were no significant changes in muscle glutamate or urea during sepsis in absence/presence of N+/K + -ATPase or cytochrome oxidase blockade. ConclusionsThese results indicate increased metabolism of energy substrates in muscle tissue in experimental sepsis. Our results do not indicate presence of energy depletion or mitochondrial dysfunction in muscle and should similar physiologic situation be present in other tissues, other mechanisms of organ failure must be considered. , and long-term follow up has shown increased fracture risk [2]. It is unclear if these changes are a consequence of acute critical illness, or reduced activity afterwards. Bone health assessment during critical illness is challenging, and direct bone strength measurement is not possible. We used a rodent sepsis model to test the hypothesis that critical illness causes early reduction in bone strength and changes in bone architecture. Methods 20 Sprague-Dawley rats (350 ± 15.8g) were anesthetised and randomised to receive cecal ligation and puncture (CLP) (50% cecum length, 18G needle single pass through anterior and posterior wa...

Very few among us faced the last global pandemic: the 9 "Spanish flu" pandemic of 1918-1919 transformed the 10 world a century ago [1]. The modern world in 2020 is facing 11 a new pandemic with . We initially followed 12 from afar, as the pandemic started in China and then spread 13 further to South Korea, Iran, Italy, and Spain, and now 14 further on worldwide. The COVID-19 pandemic is now in 15 our hospitals and houses. While people feel united in the fight against this 16 common threat, it is becoming obvious that the lack of 17 coordination between countries makes a united fight 18 more difficult [3]. Worldwide, health care systems 19 strongly depend on the politics and culture of individual 20 countries, with wide variations seen. The spectrum of 21 possibilities ranges from health systems in which (almost) 22 55 preventing morbidity (urinary tract infections [UTIs]) as on 56 a long-term perspective of preventing renal function loss 57 and assuring normal genital cosmesis and function. One 58 might wonder how urgent surgery is for a congenital 59 malformation. Life-threatening malformations, such as in 60 the heart or lung, are considered urgent without any doubt, 61 but how urgent is repair of hypospadias or bladder 62 exstrophy? As we have to expect major limitations in 63 access to surgical capacity over the coming months, the 64 variety of surgical indications that need to be considered for 65 prioritisation includes obstructive uropathy and recurrent 66 febrile UTIs putting children at intermediate-term risk of 67 loss of renal function. However, it is nearly impossible to 68 translate these issues to a definitive recommendation of 69 how long such interventions could be postponed, as the 70 dynamics of renal function loss depend on many variables 71 that are mostly impossible to predict [6]. It is likely that a 72 timeframe of 6-12 wk might be relevant for severe 73 obstruction, but for UTI-associated renal function loss such 74 a timeframe is harder to quantify.75 Paediatric urology guidelines are based on expert 76 opinions and these have shifted over time. Exstrophy E U R O P E A N U R O L O G Y X X X ( 2 0 1 9 ) X X X -X X X a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o mEURURO 8816 1-2 77 vesicae used to be considered an emergency requiring 78 immediate closure, whereas the current trend now is for 79 delayed closure. Wilms tumour has two different scientifi-80 cally validated treatments: chemotherapy first or surgery 81 first. 82 The result of this lack of evidence regarding "high 83 priority" surgery has led to variations in the delay of 84 paediatric urology procedures in many European countries. 85 In Belgium, France, Turkey, and Germany, all outpatient 86 cases have been cancelled and only surgeries related to 87 organ viability have been performed since the first week of 88 March 2020 (testicular torsion, incarcerated inguinal 89 hernia, obstructing ureteral stones, Wilms tumour in the 90 timeframe...

(1) Standardized forms, for the recording of clinical information preoperatively, ensure relevant guidelines are implemented in practice. (2) Multidisciplinary teams provide a vital safety net for their patients and colleagues.

Pediatric testicular tumors have predominantly favorable histology, which may permit testicular sparing surgery (TSS). Limited guidance exists for TSS in adults and is absent in pediatric practice. The international survey and retrospective case series evaluated the current use of TSS in pediatric testicular tumors. Alongside the complementary literature review the aim of this work was to provide evidence that could be used to produce a guideline document. Published evidence advocates small mass size as an indicator for TSS, this was not supported in the pediatric literature. Frozen section examination at TSS was not always performed by surgeons and yet the literature reports close to 100 % specificity. Tumor markers and ultrasound findings are also used as indicators for TSS, a finding reflected in our survey results. Multiple case series are reported but no large data series exists, which will require international collaboration rather than a drive to publish the results of individual centers. Common indicators for TSS use; such as tumor markers and imaging are known but further work needs to evaluate the role of on-table histology and the risks of this not being available.

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.

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