Prospective study on the incidence of bladder/cloacal exstrophy and epispadias in Europe

Cervellione, Raimondo M.; Mantovani, Alberto; Gearhart, John P.; Bogaert, Guy; Gobet, Rita; Caione, Paolo; Dickson, Alan P.

doi:10.1016/j.jpurol.2015.03.023

Cited by 54 publications

(34 citation statements)

References 9 publications

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“…Bladder exstrophy is a rare congenital abnormality, with an incidence of 1:45 500, requiring major corrective surgery in early infancy. This involves closure of the bladder and abdominal wall.…”

Section: Introductionmentioning

confidence: 99%

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A study of the dosage and duration for levobupivacaine infusion by the caudal‐epidural route in infants aged 3‐6 months

Vashisht

Bendon

Okonkwo

et al. 2018

Pediatric Anesthesia

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Summary Background The local anesthetic, levobupivacaine, is the safer enantiomer of racemic bupivacaine. Present protocols for levobupivacaine are based on studies and pharmacokinetic modeling with racemic bupivacaine. Aims The aim is to investigate total serum levobupivacaine concentrations after a caudalepidural loading dose followed by a maintenance infusion over 48 hours in infants aged 3‐6 months. Methods The clinical trial was conducted in eight infants aged 3‐6 months, undergoing bladder exstrophy repair. Pharmacokinetic modeling allowed optimization of clinical sampling to measure total levobupivacaine and α1‐acid glycoprotein and prediction of the effect of α1‐acid glycoprotein on levobupivacaine plasma protein binding. Results The observed median total levobupivacaine serum concentration was 0.30 mg/L (range: 0.20‐0.70 mg/L) at 1 hour after the loading dose of 2 mg/kg. The median total levobupivacaine concentration after 47 hours of infusion, at 0.2 mg/kg/h, was 1.21 mg/L (0.07‐1.85 mg/L). Concentrations of α1‐acid glycoprotein were found to rise throughout the study period. Pharmacokinetic modeling suggested that unbound levobupivacaine quickly reached steady state at a concentration of approximately 0.03 mg/L. Conclusion The study allows the development of a pharmacokinetic model, combining levobupivacaine and α1‐acid glycoprotein data. Modeling indicates that unbound levobupivacaine quickly reaches steady state once the infusion is started. Simulations suggest that it may be possible to continue the infusion beyond 48 hours.

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Section: Introductionmentioning

confidence: 99%

“…Bladder exstrophy is a rare congenital abnormality, with an incidence of 1:45 500, 12 Here we present a clinical trial examining serum concentrations of total levobupivacaine and AAG in this group of patients.…”

Section: Introductionmentioning

confidence: 99%

A study of the dosage and duration for levobupivacaine infusion by the caudal‐epidural route in infants aged 3‐6 months

Vashisht

Bendon

Okonkwo

et al. 2018

Pediatric Anesthesia

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show abstract

“…Typiske symptomer, kliniske funn og funn ved supplerende undersøkelser ved urinveismisdannelser assosiert med urininkontinens (3)(4)(5). Ved blaereekstrofi, kloakkekstrofi og epispadi stilles diagnosen ved klinisk undersøkelse av det nyfødte barnet.…”

Section: Tabellunclassified

“…Ofte har penis en krumning oppover ved denne tilstanden. Insidensen av epispadi i Europa har blitt rapportert til 1: 100 000 hos gutter og 1: 300 000 hos jenter (5).…”

Section: Blaereekstrofi Epispadi Og Kloakkekstrofiunclassified

Kirurgisk behandling ved urininkontinens hos barn

Skari¹,

Urdal²,

Bjerre³

et al. 2020

Tidsskriftet

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“…These results are significantly better than the 1991 BAPS figures and now comparable with that seen in other high-volume international institutions, such as Johns Hopkins hospital in Baltimore, United States that reported a 70% continence rate using the same Modern Staged Repair of Bladder Exstrophy approach. 19 Cervellione et al published another review of practice of BE surgery in 2015, 20 showing that only 12 centers in Europe (14%) could be considered as "high volume," treating six or more cases of BE annually, with 26% of centers treating only one. The UK and the Netherlands at the moment represent the only models of centralization of treatment of exstrophy in Europe.…”

Section: Centralization In Bladder Exstrophymentioning

confidence: 99%

Centralization of Pediatric Surgical Procedures in the United Kingdom

Durkin

Davenport

2017

Eur J Pediatr Surg

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The NHS provides more than 98% of all surgical procedures in infants and children in the United Kingdom through a comprehensive network of secondary (typically for the general surgery of childhood) and tertiary (specialist neonatal and specialist pediatric surgery) centers [n = 22]), typically located within large conurbations. It was originally envisaged that these specialized centers would be able to provide the full range of surgical interventions (aside from organ transplantation). However, there has been a trend toward centralization of some key procedures, previously thought to be within general neonatal surgery.The architype for centralization is the management of biliary atresia (BA). Since 1999, within England and Wales, this has been exclusively managed in three centers (King's College Hospital, London; Birmingham Children's Hospital and Leeds General Infirmary). All of these provide facilities for the diagnosis of BA, primary surgical management (Kasai portoenterostomy), and liver transplantation if required. The case for centralization was made by rigorous national outcome analysis during the 1990s showing marked disparity based on case volume and driven by parents' organizations and national media. Following centralization, national outcome data showed improvement and provided a benchmark for others to follow.The management of bladder exstrophy was later centralized in England and Wales, albeit not based on strict outcome data, to two centers (Great Ormond Street, London and Royal Manchester Children's Hospital).

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Prospective study on the incidence of bladder/cloacal exstrophy and epispadias in Europe

Abstract: There is a case for proposing a rationalisation of the treatment of this group of conditions in a small number of exstrophy units around Europe.

Cited by 54 publications

References 9 publications

A study of the dosage and duration for levobupivacaine infusion by the caudal‐epidural route in infants aged 3‐6 months

A study of the dosage and duration for levobupivacaine infusion by the caudal‐epidural route in infants aged 3‐6 months

Kirurgisk behandling ved urininkontinens hos barn

Centralization of Pediatric Surgical Procedures in the United Kingdom

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