Our results demonstrate a multifactorial development of CPSP. This process may contribute not only to the occurrence of chronic postsurgical pain but also to the biopsychosocial impairment in these patients as often seen in other chronic pain populations.

All patients with CPSP reported on preoperative chronic pain. Patients with preoperative pain, related or not related to the surgical site were significantly at risk to develop CPSP. High preoperative pain chronicity stages and pain severity grades were associated with CPSP. CPSP patients reported poorer mental health related quality of life and more severe psychosomatic dysfunction before and 3 months after surgery.

Vesicoureteral reflux (VUR) represents one of the most significant risk factors for acute pyelonephritis in children. The current indications for the surgical correction of VUR depend on the presence or absence of renal scars. If no scars are present, primary ureteral reimplantation is only indicated in high-grade bilateral VUR, whereas in the presence of renal scars surgical correction is indicated in low/high grade reflux at a young age. Since there are numerous techniques for antireflux surgery available, it is the purpose of this article to critically review these techniques with their specific advantages, typical complications and postoperative management. In general, all surgical technique have a high success rate of 92-98%. The extravesical Lich-Gregoir technique is primarily indicated in unilateral VUR. Children with a high-grade VUR, who are under the age of 3 years and boys are prone to the development of postoperative urinary retention and might be considered for intravesical surgical techniques. The Politano-Leadbetter technique is very helpful in correcting bilateral VUR of any grade in one session to create a neo-ostium in an anatomically correct position which is easily accessible for endourological manipulations. The Psoas hitch ureteroneocystotomy is an excellent technique to correct VUR associated with megaureter, or with duplicated ureters, and VUR failures. Endoscopic subureteral injections are primarily reserved for low grade VUR with a one session success rate of >90%. Endoscopic subureteral injections appear to be an alternative to long-term antibiotics in grade I-III VUR. Laparoscopic antireflux surgery has not gained widespread use due to the very long operating times. Contralateral VUR will occur in about 20% of children undergoing unilateral antireflux surgery; risk factors are severe VUR and VUR into a duplicated system. Postoperative follow-up nowadays consists of urinalysis and ultrasonography; voiding cystourethrography is only indicated in case of febrile urinary tract infection. Despite the excellent success rates following antireflux surgery one has to keep in mind that surgery only corrects the anatomical abnormality. The long-term outcome with regard to renal function, posttherapeutic febrile urinary tract infections and arterial hypertension does not differ significantly from the medication group except for those patients with a demonstrated a genetic background. Therefore, the indication for surgery and the surgical technique applied have to be discussed thoroughly and must be associated with a minimal complication rate.

This study demonstrated that the intensity and prevalence of PPP are high even some 4 years after injury. The validated instruments MPSS (measuring pain chronicity) and Oswestry disability score proved to be appropriate for classifying outcome after pelvic ring fractures.

The high prevalence of severe and chronic pain in cancer patients before scheduled radical prostatectomy--combined with considerable disability effects and markedly reduced quality of life necessitate a short routine screening-analysis of the severity spectrum of pain and psychopathology. Patient self-rated pain chronicity staging and psychological distress analysis will allow a disorder severity-guided treatment and the prevention of suffering and additional new chronic post-surgical pain.

This study demonstrated that higher degrees of preoperative chronic pain were associated with the development of more intense pain after radical prostatectomy. Preoperative psychological distress and reduced physical health were associated with a marked increase in postoperative pain intensity.

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OBJECTIVES: In the present study, cellular or exosomal expression of H19, an oncofetal lncRNA gene, was evaluated during androgen stimulation via dihydrotestosterone (DHT) or AR blockage via enzalutamide in cultured hormone-sensitive Pca cells which overexpres AR (LNCaP-AR +). BACKGROUND: Prostate cancer (PCa) is an androgen-dependent disease. Androgen receptor (AR) antagonists (i.e. enzalutamide) have been used for the treatment of patients with metastatic castrationresistant prostate cancer (CRPC). Exosomes and their contents (non-coding RNA) play an important role in tumor development and progression. METHODS: Cells were treated with DHT (10 nM) and/or enzalutamide (10 uM) for 24 h. Cellular and exosomal expression of H19 was investigated using a quantitative polymerase chain reaction assay. RESULTS: Our fi ndings reveal that cellular H19 expression decreased approximately 2.3fold in mean upon androgen stimulation of Pca cells. AR blockage using enzalutamide restored DHT effect and we found increased H19 expression (≤ 2.5-fold, p < 0.05) upon the combined use of DHT and enzalutamide compared to control cells. Similar to its cellular effect, DHT treatment also led to declined exosomal expression of H19 (≤ 3-fold, p < 0.0001). Restorative effect of enzalutamide on decreased H19 expression induced by androgen stimulation was not observed in exosomes. CONCLUSION: This experimental study provides evidence that H19 might be involved in androgen receptor pathway. Further research is needed to explore the role of H19 in Pca and intercellular communication via exosomes (Fig. 2, Ref. 32).