This is the first study to demonstrate a successful autologous ADSCs transplantation. It confirms that ADSCs can survive and integrate within the urethral wall.
Purpose: To compare the efficacy and costs of circumcision versus topical treatment using a prospective pharmacoeconomic protocol.
Materials and Methods:We treated 59 patients (3-10 years of age) randomized into two groups: 29 underwent an 8-week course of topical treatment with 0.2% betamethasone-hyaluronidase cream twice a day; and 30 underwent circumcision. Topical treatment success was defined as complete exposure of the glans. In cases of treatment failure, circumcision was performed and its cost imputed to that of the initial treatment. The pharmacoeconomic aspects were defined according to the Brazilian National Public Health System database and the Brazilian Community Pharmacies Index. Results: The two groups were statistically similar for all clinical parameters evaluated. Topical treatment resulted in complete exposure of the glans in 52% of the patients. Topical treatment was associated with preputial pain and hyperemia. However, treatment suspension was unnecessary. Minor complications were observed in 16.6% of the surgical group patients. The mean cost per patient was US$ 53.70 and US$ 125.20, respectively, for topical steroid treatment (including the costs related to treatment failure) and circumcision. The total costs were US$ 2,825.32 and US$ 3,885.73 for topical treatment and circumcision, respectively. Conclusions: Topical treatment of phimosis can reduce costs by 27.3% in comparison with circumcision. Therefore, topical treatment of phimosis should be considered prior to the decision to perform surgery.
204THE JOURNAL OF UROLOGY® METHODS: We modified the standard 8.5 french infant optical urethrotome (Richard Wolf Medical Instruments Corporation, Vernon Hills, Illinois) to accommodate shaft insertion into the working element of a 9 french infant resectoscope. This resulted in blade shaft insertion at the twelve-o-clock position rather than the six-o-clock position giving an inferiorly directed blade. The first case scenario demonstrates incision of PUV s in a one week old infant. The crescent blade urethrotome is used to engage the valve tissue at the 5 and 7 o'clock positions and incise without the need to rotate orientation of the cystoscope. A wide open urethral channel is achieved. A 12 o'clock incision is not required here. The second scenario utilizes the crescent blade urethrotome to incise an obstructing ureterocele in a young female. The ureteral orifice is engaged with the blade, and a series of incisions are made horizontally until adequate unroofing of the ureterocele is achieved.RESULTS: This modified instrument allows use of the pediatric optical urethrotome in the proper upright and ergonomic position obviating the need to rotate the scope and lens system prior to incision. In addition, use of the instrument in this manner allows the surgeon more delicate manipulation of the scope required in pediatric patients, especially in neonates, during incision of PUVs. We have found this technique to be safe, effective, and minimize instrumentation of the delicate newborn male urethra. Although we have not required electrocautery, this instrument does allow passage of a bugbee electrode.CONCLUSIONS: The modified pediatric urethrotome is a well balanced and ergonomic instrument allowing safe and effective incision of PUV s and ureteroceles in the pediatric population. This instrument is available from Richard Wolf USA as the optical pediatric urethrotome-McLorie modification.
RESULTS:The patient had a nice evolution and after cystostomy tube removal the fistula was indeed closed.CONCLUSIONS: lnfratrigonal vesicovaginal fistulas in children, differently from adults should be better treated through the abdomen, observing the general principles of fistula closure: complete isolation of the organs involved, removal of fibrotic tissue, closure in various layers, use of fibrin glue and interposition of well-vascularized flaps.
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