Wilfried Krois

Trends in Hypospadias Surgery: Results of a Worldwide Survey

BACKGROUND Hypospadias is a challenging field of urogenital reconstructive surgery, with different techniques currently being used. OBJECTIVE Evaluate international trends in hypospadias surgery. DESIGN, SETTING, AND PARTICIPANTS Paediatric urologists, paediatric surgeons, urologists, and plastic surgeons worldwide were invited to participate an anonymous online questionnaire (http://www.hypospadias-center.info). MEASUREMENTS General epidemiologic data, preferred technique in the correction of hypospadias, and preferred technique in the correction of penile curvature were gathered. RESULTS AND LIMITATIONS Three hundred seventy-seven participants from 68 countries returned completed questionnaires. In distal hypospadias (subcoronal to midshaft), the tubularised incised plate (TIP) repair is preferred by 52.9-71.0% of the participants. Meatal advancement and glanuloplasty (MAGPI) is still a preferred method in glandular hypospadias. In the repair of proximal hypospadias, the two-stage repair is preferred by 43.3-76.6%. TIP repair in proximal hypospadias is used by 0.9-16.7%. Onlay flaps and tubes are used by 11.3-29.5% of the study group. Simple plication and Nesbits procedure are the techniques of choice in curvature up to 30°; urethral division and ventral incision of the tunica albuginea with grafting is performed by about 20% of the participants in severe chordee. The frequency of hypospadias repairs does not influence the choice of technique. CONCLUSIONS In this study, we identified current international trends in the management of hypospadias. In distal hypospadias, the TIP repair is the preferred technique. In proximal hypospadias, the two-stage repair is most commonly used. A variety of techniques are used for chordee correction. This study contains data on the basis of personal experience. However, future research must focus on prospective controlled trials.

Breast-conserving therapy for centrally located breast cancer.

Objective:To analyze whether breast-conserving therapy (BCT) may be an oncologically safe approach and result in a good cosmesis in patients with centrally located breast cancer (CLBC). Summary Background Data:Only underpowered, retrospective, single-arm studies have suggested that oncoplastic BCT for CLBC may be oncologically safe and may result in a good cosmesis. Methods:The authors retrospectively analyzed the overall and recurrence-free survival in 1485 patients with breast cancer undergoing BCT comparing CLBC with non-CLBC. Moreover, the authors described 4 different oncoplastic techniques for BCT in patients with CLBC and compared the cosmetic results with simple lumpectomy according to a recently elaborated objective cosmetic evaluation system, the Breast Symmetry Index. Results:Kaplan-Meier curves show no significant difference in a 5-year overall, local, or distant recurrence-free survival between patients with CLBC and non-CLBC after BCT (94% vs. 96%; 100% vs. 98%; 92% vs. 90%; median follow–up, 35.3 months). The cosmetic outcome after oncoplastic BCT compared with simple lumpectomy differed significantly (Breast Symmetry Index: 22 ± 6%d vs. 44 ± 12%d; P < 0.05). Conclusions:The results demonstrate that BCT for CLBC is oncologically safe and that oncoplastic techniques improve cosmesis.

Decision making among different treatment options for neurologically impaired boys with undescended testis: A multinational pediatric survey

OBJECTIVE To determine the attitude of referring pediatricians towards the decision of treatment modalities for undescended testis (UDT) in neurologic impaired boys (NIB). METHODS AND MATERIALS An online questionnaire was offered to registered pediatricians in Austria and Germany for online completion. RESULTS 221 male (61.6%) and 138 female (38.4%) pediatricians completed the survey; 326 (90.8%) believe that UDT should be treated according to national guidelines; 31 (8.6%) believe that UDT should be treated according to the parental wish, whereas only 2 (0.6%) tend to no treatment at all. Tumor prophylaxis, further sexual life, legal concerns, risks of anesthesia, and the choice of the parents have major impact on the perception of UDT. Moreover, fertility and limited life expectancy seem to be of minor importance only. In general, Pearson χ2 test could not identify age and sex of pediatricians as significant predictor of how the importance of the treatment of UDT is appraised. CONCLUSION From the pediatric point of view UDT in NIB is an important issue and should be treated according to guidelines. Nevertheless, this study indicates the problems in decision-making and choosing the best management for UDT in NIB. Undoubtedly, further ethical discussion is needed to optimize treatment of UDT in NIB.

Sociodemographics and the impact of a colostomy to indigent families and children with colorectal disorders in Honduras

INTRODUCTION To describe the social impact of a colostomy on indigent families and affected children with anorectal malformations (ARM) or Hirschsprungs disease (HD) in San Pedro Sula, Honduras, we specifically targeted very low-income households that attended an international medical brigade for ARM and HD in 2016. METHODS The impact of a colostomy on the families and childrens daily life was analyzed by personal interviews with a questionnaire. RESULTS Twenty families with children were included in the study. Childrens age ranged from 5 months to 27years (median 2.31). Annual income was reported to be less than

EBV-positive B-cell lymphoma manifestation of the liver in an infant with RAG1 severe combined immunodeficiency disease

500 USD in 42.8%. Impairment of daily family life by the colostomy was reported in 85%. Parents of preschool children younger than 7 years are more affected than parents of older children, whereas children older than 7 years reported on more social problems. Moreover, 50% of the school-aged children did not attend school owing to issues directly related to their colostomy. DISCUSSION Colostomies for children in the low middle-income country Honduras have significant social and economic implications for low-income families. In ARM and HD, medical brigades can offer help for definitive surgical repair to overcome and shorten the period of a colostomy presence to improve physical and psychosocial impairment, especially when performed before the children reach the school age. TYPE OF STUDY Cost Effectiveness Study. LEVEL OF EVIDENCE II.

Health literacy and health-related quality of life in patients with anorectal malformations: A comparison between a charity hospital in Honduras and a tertiary care center in the United States

A 4-month-old male with pneumonia, cytomegalovirus (CMV) viremia and Pneumocystis jirovecii infection was diagnosed with lymphopenia of T and B cells and natural killer (NK) cell lymphocytosis based on RAG1 deficiency (homozygous frameshift mutation: c.256_ 257delAA; p.Lys86Valfs*33)—severe combined immunodeficiency disease (SCID; T−; B−; NK+). After treatment with Ganciclovir R

The use of a breast symmetry index for objective evaluation of breast cosmesis

BACKGROUND/PURPOSE We conduct an annual medical mission to Hospital Ruth Paz para Niños Quemados y Cirugía Pediátrica in Honduras to operate on cases of anorectal malformations (ARM). To improve our knowledge of these patients, we compared their health-related quality of life (HRQoL), and the health literacy of their caregivers from this hospital and ours in the United States. METHODS The BRIEF Health Literacy Screen (BHLS) and Pediatric Quality of Life Inventory 4.0 (PedsQL) were used, respectively, to assess the health literacy and HRQoL of their guardians. All patients scheduled for an ARM-related operation in October 2016 were eligible for inclusion, and a matched population was selected in Nationwide Childrens Hospital, Columbus, Ohio. RESULTS The sample comprised 127 patients, with 22 from Honduras and 105, the US. About 13.6% and 80% of Honduran and American caregivers, respectively, had adequate literacy. Honduran and American caregivers of patients aged 12 months and below rated the HRQoL of their children at 87 and 82, respectively; aged between two and four years, at 84 and 77; aged between two and four years, at 85 and 79; and of teens, at 59 and 66. For adults, the rate was 71 and 77 in Honduras and the US, respectively. CONCLUSION Although health literacy is extremely low in the Honduran group, its HRQoL was comparable to that of its American counterpart. Improving health literacy by educating caregivers could be an additional goal for medical missions in the future. LEVEL OF EVIDENCE Level III.