Danielle D. Sweeney

A tissue‐engineered suburethral sling in an animal model of stress urinary incontinence

To create and evaluate the functional effects of a tissue‐engineered sling in an animal model of stress urinary incontinence (SUI).

Laparoscopy in paediatric urology: present status

The spectrum of laparoscopic surgery in children has developed dramatically; what was initially used as a diagnostic method to identify an impalpable testis is now commonly used for complex reconstructive procedures such as pyeloplasty. Laparoscopic orchidopexy and nephrectomy are well established and are used at many centres. Laparoscopic partial nephrectomy, adrenalectomy and dismembered pyeloplasty series have reported shorter hospital stays and operative times that are comparable with that of open techniques, and/or decreasing with experience. The initial experiences with laparoscopic ureteric re‐implantation and laparoscopically assisted bladder reconstructive surgery are reported, with encouraging results for feasibility, hospital stay, and cosmetic outcome.

Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Children

PURPOSE To examine our experience of laparoscopic pyeloplasty for the treatment of ureteropelvic junction obstruction (UPJO) in the pediatric population. METHODS From November 2001 to June 2009, 112 patients underwent transperitoneal laparoscopic pyeloplasty for the treatment of symptomatic or radiographic UPJO. Data were collected retrospectively. Patients were followed at regular intervals with imaging and symptom assessment. Failure was defined as inability to complete the intended procedure, persistent flank pain, radiographic evidence of obstruction, or the need for definitive adjunctive procedures. RESULTS Mean patient age was 9.4 years (0.2-20.5 years), and follow-up was available on all 112 patients with a mean duration of 15.3 months (0.6-84.5 months). There was one open conversion in the series. Mean operative time was 254 minutes (102-525 minutes). There was one minor intraoperative complication reported (0.8%). There were 12 (10.8%) postoperative complications; most were relatively minor with complete resolution and without long-term sequelae. Postoperative ultrasonography has been performed in 102 patients, with 99 (97%) patients demonstrating improvement of the UPJO. Three patients (3%) continued to have symptomatic and/or radiographic evidence of obstruction that necessitated the need for adjunctive procedures, which included laser endopyelotomy in 2 patients, and a re-do open pyeloplasty in 1 patient. Of those cases that were completed laparoscopicaly, the overall success rate was 97.2%. CONCLUSIONS Laparoscopic pyeloplasty for UPJO in the pediatric population is technically challenging; however, with experience, one can expect excellent success rates comparable to open pyeloplasty, with minor complications with reasonable operative times.

Laparoscopic Retroperitoneal Lymph Node Dissection for High-Risk Pediatric Patients with Paratesticular Rhabdomyosarcoma

BACKGROUND AND PURPOSE Retroperitoneal lymph node dissection (RPLND) is recommended in children 10 years or older with paratesticular rhabdomyosarcoma (PTRMS). Primary tumors >5 cm are an additional risk factor for disease recurrence in the retroperitoneum. We report our experience with laparoscopic RPLND (LRPLND) in high-risk pediatric patients with PTRMS. PATIENTS AND METHODS Three patients, mean age 13.6 years (range 10-16 yrs), underwent modified template LRPLND after radical orchiectomy for preoperative rhabdomyosarcoma stage T(1a)N(0)M(0), T(1b)N(0)M(0), and T(2b)N(0)M(0), respectively. Primary paratesticular masses measured a mean 7.5 cm (range 4-10 cm). LRPLND was performed a mean of 8.6 days (range 7-12 d) after radical orchiectomy using four trocars that were placed equidistant in the midline. RESULTS Average operative time was 382 minutes (range 245-656 minutes). Mean estimated blood loss was 53 mL (range 10-75 mL), and mean postoperative hospital stay was 2.5 days (range 2-3 d). There were no postoperative complications. Retroperitoneal nodes had negative findings for microscopic disease in two patients and positive findings in one patient. All patients received adjuvant chemotherapy with vincristine, actinomycin, and cyclophosphamide. CONCLUSION LRPLND for high-risk pediatric patients with PTRMS is a safe diagnostic and therapeutic procedure with the benefit of rapid convalescence, enabling early commencement of adjuvant chemotherapy.

Orchiopexy After Prior Inguinal Surgery: A Distal Approach

PURPOSE Undescended testicle after groin surgery is a condition traditionally approached through an inguinal incision with en bloc mobilization of the spermatic cord and external oblique fascia, and extensive dissection of the proximal spermatic vessels. We report on a single surgeon series of orchiopexies after prior inguinal surgery approached through a single scrotal incision. MATERIALS AND METHODS From November 2001 to February 2007, 24 patients with a mean age of 6.4 years (range 1.3 to 16.2) presented with 27 undescended testicles. All patients had undergone previous groin surgery including 13 inguinal hernia repairs, 3 orchiopexies and 3 hernia repairs with orchiopexy. Of the 27 testicles 24 (21 patients) were successfully approached through a single scrotal incision (89%). If the scrotum could not be manipulated over or near the relatively fixed testicle, an inguinal incision was made (11%). Charts were retrospectively reviewed for technique and operative outcomes. RESULTS A mean followup of 12 months was available for 20 of 21 patients. A patent processus vaginalis was found in 3 (12.5%) patients and hernia repair was performed through the scrotal incision in these patients. There were no intraoperative complications. In 1 (4.2%) patient the testicular position was unacceptable and subsequently successful repeat scrotal orchiopexy was performed. At last followup all testes were in a satisfactory scrotal position without hydrocele, hernia or testicular atrophy. CONCLUSIONS The majority of orchiopexies after prior inguinal surgery can be approached through a single scrotal incision. Retrograde serial dissection of adhesions to the distal cord usually reveals adequate vessel length, thus avoiding extensive inguinal and/or retroperitoneal dissection.

Effect of carbohydrate-electrolyte sports beverages on urinary stone risk factors.

PURPOSE We evaluated the effects of consuming carbohydrate-electrolyte sports beverages (Gatorade((R))) on urinary stone risk factors. MATERIALS AND METHODS Twelve normal subjects (5 men, 7 women) and 12 hypercalciuric stone formers (2 men, 10 women) participated in a 4-week prospective, crossover study consisting of 3 study phases. In phase 1 subjects were placed on a monitored stone prevention diet that was continued throughout the study. In phase 2 subjects ingested 2 l Gatorade daily followed by a 7-day washout period. In phase 3 subjects ingested 2 l water daily. On the final day of phases 1, 2 and 3 a 24-hour urine collection and blood sample were analyzed for stone risk factors. Effects of group and phase were tested using repeated measures ANOVA and paired t tests. RESULTS Changes in urinary risk factors after Gatorade consumption revealed no statistically significant difference between normal subjects and stone formers. However, intrasubject variation occurred in both groups. Gatorade consumption in both groups increased urinary pH (p = 0.006), urinary chloride (p = 0.044) and urinary sodium (p = 0.008), and decreased urinary potassium (p = 0.035) and urinary uric acid (p = 0.019) in a statistically significant manner. In response to Gatorade consumption urinary volume, calcium and citrate were unchanged compared to water consumption and baseline. CONCLUSIONS Gatorade increased mean urinary sodium and chloride levels compared to water and baseline. However, the results were within normal urinary parameters. The change did not appear to be clinically significant as urinary calcium was unchanged. Overall consumption of Gatorade does not increase or decrease urinary stone risk factors.

342: Relationship Between Overactive Bladder (OAB) and Sexual Activity in Women

Study design, materials and methods Seventy-eight women diagnosed with OAB self-completed the Urinary Distress Inventory (UDI) and Personal Experiences Questionnaires (PEQ). The UDI questionnaire evaluated the presence and degree of bother associated with symptoms of urge incontinence (UI) and stress incontinence (SI). The PEQ measured sexual function with regard to sexual frequency, arousal, frequency of orgasm, and pain during intercourse. Kendall’s tau-b correlation coefficients were computed to describe the relationship between bladder and sexual function.