Recurrence of congenital diaphragmatic hernia (CDH) was retrospectively evaluated after correction with or without a patch in an institution where tension-free repair is advocated. Methods Demographics and outcomes of patients with a postero-lateral CDH repaired (2000-2016) were analysed (univariate tests and binary logistic regression adjusting for time since start of study, gender, defect side, liver herniation, patch, surgical approach, absence of postero-lateral rim and length of follow-up). Results Of 203 patients, 107 received a patch (P), and 96 were not patched (NP). Groups were not different for gestational age birthweight, gender, defect side and minimally-invasive approach rate. Preoperative ECMO incidence (P:29.9% vs. NP:2.1%, p<0.01), liver herniation (P:57.0% vs. NP:22.9%, p<0.01) and absence of a postero-lateral rim (P:61.7% vs. NP:8.3%, p<0.01) were higher in the P group. The mortality rate was 10.8% (P:15.0% vs. NP:6.2%, p=0.07). Recurrence was not different (P:9.3% vs. NP:4.2%, p=0.15). Multivariate analysis showed that recurrence was higher after thoracoscopy compared to open (OR=12.2 [2.2-68], p<0.01); neither the use of patch (OR=2.3, [0.5-10.4], p=0.28) nor any other factors were associated with recurrence. Conclusion In this single centre series where tension-free repair was advocated, patch repair of CDH was not associated with higher recurrence, though access route was.
Purpose To correlate age at hypospadias repair with early post-operative complications and highlight need for adaptation to post-operative care in older children. Methods Anecdotal evidence suggests boys with delayed surgery for hypospadias suffer increased rates of early post-operative complication. Hence, a retrospective analysis was conducted of all patients undergoing hypospadias repair between March 2019 and 2022. Results Ninety eight patients were divided into Group A (< 2years of age at first surgery) or Group B (> 2years). While patients in Group A encountered no early post-operative complications, seven in Group B (11%) suffered a range of complications including dislodged stents (3/7), significant spasmodic pain requiring prolonged hospital stay (2/7) and urinary retention (2/7). More than half of these children required emergency supra-pubic catheter insertion. Conclusion Significantly more children undergoing hypospadias surgery after the age of 2 years suffered complications within the early post-operative period. This resulted in prolonged hospital stays and a number returning to theatre for insertion of a supra-pubic catheter. We recommend a tailored approach to the post-operative care of older children undergoing hypospadias repair, including strict parental education regarding dressing/stent care and medication compliance, as well as efforts to enhance robustness of dressings and stent anchorage in children likely to pull at stents.
Introduction Virtual consultation (VC) has exponentially increased during the COVID-19 pandemic. Lessons from using this modality during the pandemic will need to be appraised carefully before integrating it into the routine practice. Some paediatric urology patients can potentially be excellent candidates for routine VC. Objectives Investigate the ability of clinicians to make management plans using VCs and identify accordingly the group of patients that can benefit from routine VC. Evaluate the routine use of VC without travel restrictions. Methods Designed in two phases. Phase 1, during the lockdown, prospective collection of data after the consultation assessing the clinician satisfaction in making a decision by VC. The results were then divided according to the patient pathology; internal organ pathology (IOP), functional urological pathology (FUP) or external organ pathology (EOP). Data was then analysed to demonstrate if different outcomes can be related to the pathology. Phase 2 after the ease of the lockdown to judge the lessons learnt looking at the same parameters in patients who are selected to receive VC and evaluate journey saved by the patients, measured in miles. Results One hundred and forty-four consultations were assessed. One hundred and fourteen in phase 1 and 30 from phase 2. Mean age 7.2 years. In phase 1, 57% of patients were reviewed by consultants and 72% were followed up. Thirty-seven per cent had IOP, 24.5% FUP and 38.5% EOP. Clinicians were more likely to reach a decision with patients with IOP and FUP P < 0.0001 and 0.0024, respectively. Phase 2 demonstrated the change of practice where 93% of the patients were either IOP or FUP. An average of 27 miles per patient was saved on journeys. Discussion VC for paediatric urology patients was employed effectively to avoid hospital contact during the lockdown. From the lessons learnt that patients with IOP and FUP can continue to benefit from VC after the ease of lockdown without compromising the decision making. VC is a viable way to structure services in the future for selected paediatric urology conditions.
IntroductionTreatment of neuropathic bladder secondary to spina bifida is an ongoing challenge. Although different management strategies and protocols are available in the literature, reliance on expert opinion remains fundamental. A conservative approach can be utilized, but patients must be closely monitored throughout the management process. The objective of this study was to review the management and outcomes of neuropathic bladder in spina bifida by appraising long-term bladder and renal function in patients treated at a medical center utilizing a conservative management style.MethodsThis is a single-center retrospective review of urology care for all spina bifida patients 5–19 years of age with a neuropathic bladder who attended follow-ups between April 2000 and April 2020. Only patients with more than 5 years of follow-up were included. Renal functions, continence and results of invasive video urodynamics (IUD) and any surgical interventions were recorded.ResultsSeventy-one patients (mean age = 10.5 years) were identified after exclusions. Bladder compliance between first and last IUDs increased significantly (p = 0.0056). Anticholinergic treatment was started at the first outpatient appointment. Intravesical botulinum toxin injection was the second line treatment in ten patients. 94% of patients had an end fill pressure below 40 cm H2O in their last IUD. 82% were socially continent (dry or occasional damp patches) with or without catheterisations at the age of 11.5 years. One patient in the cohort had bladder augmentation.ConclusionThe optimal management of neuropathic bladder secondary to spina bifida remains controversial. Bladder and renal functional outcomes can be improved with close monitoring and less invasive management.
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