Bioelectronic medicine in modulation of cortical spreading depolarization and beyond

Bioelectronic interventions,specifically trigeminal nerve st imulat ion(TNS),have attracted considerable attention in conditions where cortical spreading depolarizations(CSDs)accompanied by compromised cerebral perfusion may exacerbate neurological damage.While pharmacological interventions have demonstrated initial potential in addressing CSDs,a standardized treatment approach has not yet been established.The objective of this perspective is to explore emerging bioelectronic methodologies for addressing CSDs,particularly emphasizing TNS,and to underscore TNS’s capacity to enhance neurovascular coupling and cerebral perfusion.

Outpatient insulin use in type 2 diabetes mellitus and acute respiratory distress syndrome outcomes:A retrospective cohort study

BACKGROUND The impact of type 2 diabetes mellitus(T2DM)on acute respiratory distress syndrome(ARDS)is debatable.T2DM was suspected to reduce the risk and complications of ARDS.However,during coronavirus disease 2019(COVID-19),T2DM predisposed patients to ARDS,especially those who were on insulin at home.AIMTo evaluate the impact of outpatient insulin use in T2DM patients on non-COVID-19 ARDS outcomes.METHODS We conducted a retrospective cohort analysis using the Nationwide Inpatient Sample database.Adult patients diagnosed with ARDS were stratified into insulin-dependent diabetes mellitus(DM)(IDDM)and non-insulindependent DM(NIDDM)groups.After applying exclusion criteria and matching over 20 variables,we compared cohorts for mortality,duration of mechanical ventilation,incidence of acute kidney injury(AKI),length of stay(LOS),hospitalization costs,and other clinical outcomes.RESULTS Following 1:1 propensity score matching,the analysis included 274 patients in each group.Notably,no statistically significant differences emerged between the IDDM and NIDDM groups in terms of mortality rates(32.8%vs 31.0%,P=0.520),median hospital LOS(10 d,P=0.537),requirement for mechanical ventilation,incidence rates of sepsis,pneumonia or AKI,median total hospitalization costs,or patient disposition upon discharge.CONCLUSION Compared to alternative anti-diabetic medications,outpatient insulin treatment does not appear to exert an independent influence on in-hospital morbidity or mortality in diabetic patients with non-COVID-19 ARDS.

Complex Regional Pain Syndrome: Outpatient Pain Management in the Chronic Setting: A Case Report

Background: Complex Regional Pain Syndrome (CRPS), previously known as reflex sympathetic dystrophy and causalgia, is a neuropathic pain condition that usually develops after an injury to an extremity. CRPS can be a debilitating condition with high levels of pain and reduced function. Aim: This case report aims to discuss the multimodal approach in the management of a patient who presented with ongoing poorly controlled pain secondary to CRPS from an injury that happened years prior. Case Presentation: A 45-year-old female was involved in a motor vehicle accident where her right leg was injured. She underwent several surgeries and developed CRPS that significantly reduced her mobility and quality of life. She presented to the pain clinic years after her initial injury and a multimodal regimen was started for her resulting in significantly improved function. Conclusion: CRPS can be a severely debilitating condition. While early diagnosis and management are important, ongoing management in the outpatient chronic pain setting is important in maintaining a good level of function.

Education and training evolution in urolithiasis:A perspective from European School of Urology

Objective:With the worldwide increase in urolithiasis prevalence,the present study aimed to delineate and summarise recent evolutions in training for the management of urolithiasis.Methods:A PubMed search using the key words“simulation”,“training”,“ureteroscopy”,“RIRS”,“URS”,“percutaneous nephrolithotomy”,“PCNL”,“virtual reality”,“augmented reality”,“artificial intelligence”,“healthcare”,“curriculum”,and“assessment”was used to examine how education and training in urolithiasis have adapted over recent years.Focus was placed on the role of high-and low-fidelity simulation models,virtual reality and artificial intelligence,and standardised assessment and curriculum.Results:This review supports the necessity to incorporate technology,simulation,and other skill enhancement training modalities into surgical training.However,these cannot solely replace mentored training with an experienced professional supervisor.Whilst technological and simulation advancements are likely to prove increasingly important in urolithiasis training,it is just as important for stratification of robust curricula with validated assessment.We also propose a pathway for future training.Conclusion:Endourology subspeciality training programmes have successfully incorporated simulation model-based training for skill acquisition,refinement,and improving operative outcomes.Success is achieved by maintaining a delicate balance between machine and in person mentor-based training.A trainee-centred model that follows the proposed curriculum could aid this balance for the future generation of trainees.

Randomized intervention to assess the effectiveness of an educational video on organ donation intent among Hispanics in the New York metropolitan area

BACKGROUND The Hispanic community has a high demand for organ donation but a shortage of donors.Studies investigating factors that could promote or hinder organ donation have examined emotional video interventions.Factors acting as barriers to organ donation registration have been classified as:(1)Bodily integrity;(2)medical mistrust;(3)“ick”-feelings of disgust towards organ donation;and(4)“jinx”-fear that registration may result in one dying due to premeditated plans.We predict that by providing necessary information and education about the donation process via a short video,individuals will be more willing to register as organ donors.AIM To determine perceptions and attitudes regarding barriers and facilitators to organ donation intention among Hispanic residents in the New York metropolitan area.METHODS This study was approved by the Institutional Review Board at Northwell Health.The approval reference number is No.19-0009(as presented in Supplementary material).Eligible participants included Hispanic New York City(NYC)residents,18 years of age and above,who were recruited voluntarily through Cloud Research and participated in a larger randomized survey study of NYC residents.The survey an 85-item Redcap survey measured participant demographics,attitudes,and knowledge of organ donation as well as the intention to register as an organ donor.Attention checks were implemented throughout the survey,and responses were excluded for those who did fail.Participants were randomly assigned two-between subject conditions:To view a short video on organ donation and then proceed to complete the survey(i.e.,video first)and view the same video at the end of the survey(video last).No intra-group activities were conducted.This study utilized an evidenced-based emotive educational intervention(video)which was previously utilized and was shown to increase organ donation registration rates at the Ohio Department of Motor Vehicles.Results were analyzed using Jamovi statistical software.Three hundred sixty-five Hispanic individuals were included in the analysis.Once consent was obtained and participants entered the survey(the survey sample is presented in Supplementary material),participants were asked to report on demographic variables and their general impression of organ donation after death.The video depicted stories regarding organ donation after death from various viewpoints,including from the loved ones of a deceased person who died waiting for a transplant;from the loved ones of a deceased person whose organs were donated upon death;and,from those who were currently waiting for a transplant.RESULTS Using a binomial logistic regression,the analysis provides information about the relationship between the effects of an emotive video and the intention to donate among Hispanic participants who were not already registered as donors.The willingness to go back and register was found to be significantly more probable for those who watched the emotive video before being asked about their organ donation opinions(odds ratio:2.05,95%confidence interval:1.06-3.97).Motivations for participation in organ donation were also captured with many stating the importance of messages coming from“people like me”and a message that highlights“the welfare of those in need”.Overall,the findings suggest that using an emotive video that addresses organ donation barriers to prompt organ donation intentions can be effective among the Hispanic populous.Future studies should explore using targeted messaging that resonates with specific cultural groups,highlighting the welfare of others.CONCLUSION This study suggests that an emotive educational intervention is likely to be effective in improving organ donation registration intent among the Hispanic population residing in NYC.

Utility of short-term telemetry heart rhythm monitoring and CHA2DS2-VASc stratification in patients presenting with suspected cerebrovascular accident

BACKGROUND Inpatient telemetry heart rhythm monitoring overuse has been linked to higher healthcare costs.AIM To evaluate if CHA2DS2-VASc score could be used to indicate if a patient admitted with possible cerebrovascular accident(CVA)or transient ischemic attack(TIA)requires inpatient telemetry monitoring.METHODS A total of 257 patients presenting with CVA or TIA and placed on telemetry monitoring were analyzed retrospectively.We investigated the utility of telemetry monitoring to diagnose atrial fibrillation/flutter and the CHA2DS2-VASc scoring tool to stratify the risk of having CVA/TIA in these patients.RESULTS In our study population,63(24.5%)of the patients with CVA/TIA and telemetry monitoring were determined to have no ischemic neurologic event.Of the 194(75.5)patients that had a confirmed CVA/TIA,only 6(2.3%)had an arrhythmia detected during their inpatient telemetry monitoring period.Individuals with a confirmed CVA/TIA had a statistically significant higher CHA2DS2-VASc score compared to individuals without an ischemic event(3.59 vs 2.61,P<0.001).CONCLUSION Given the low percentage of inpatient arrhythmias identified,further research should focus on discretionary use of inpatient telemetry on higher risk patients to diagnose the arrhythmias commonly leading to CVA/TIA.A prospective study assessing event rate of CVA/TIA in patients with higher CHA2DS2-VASc score should be performed to validate the CHA2DS2-VASc score as a possible risk stratifying tool for patients at risk for CVA/TIA.

Appearance of aseptic vascular grafts after endovascular aortic repair on[(18)F]fluorodeoxyglucose positron emission tomography/computed tomography

BACKGROUND Diagnosis of prosthetic vascular graft infection with[(18)F]fluorodeoxyglucose positron emission tomography/computed tomography(18F-FDG PET/CT)allows for early detection of functional changes associated with infection,based on increased glucose utilization by activated macrophages and granulocytes.Aseptic vascular grafts,like all foreign bodies,can stimulate an inflammatory response,which can present as increased activity on 18F-FDG PET/CT.Consequently,distinguishing aseptic inflammation from graft infection,though important,can be difficult.In the case of endovascular aneurysm repair(EVAR),a minimally invasive procedure involving the transfemoral insertion of an endoprosthetic stent graft,the normal postoperative appearance of these grafts on 18F-FDG PET/CT can vary over time,potentially confounding study interpretation.AIM To investigate the visual,semiquantitative,and temporal characteristics of aseptic vascular grafts in patients status post EVAR.METHODS In this observational retrospective cohort study,patients with history of EVAR who underwent 18F-FDG PET/CT for indications other than infection were identified retrospectively.All patients were asymptomatic for graft infection-no abdominal pain,fever of unknown origin,sepsis,or leukocytosis-at the time of imaging and for≥2 mo after each PET/CT.Imaging studies such as CT for each patient were also reviewed,and any patients with suspected or confirmed vascular graft infection were excluded.One hundred two scans performed on 43 patients(34 males;9 females;age=77±8 years at the time of the final PET/CT)were retrospectively reviewed.All 43 patients had an abdominal aortic(AA)vascular graft,40 patients had a right iliac(RI)limb graft,and 41 patients had a left iliac(LI)limb graft.Twentytwo patients had 1 PET/CT and 21 patients had from 2 to 9 PET/CTs.Grafts were imaged between 2 mo to 168 mo(about 14 years)post placement.Eight grafts were imaged within 6 mo of placement,including three that were imaged within three months of placement.The mean interval between graft placement and PET/CT for all 102 scans was 51±39 mo.PET/CT data was reconstructed with region-of-interest analysis of proximal,mid and distal portions of the grafts and background ascending aorta.Maximum standardized uptake value(SUVmax)was recorded for each region.SUVmax-to-background uptake ratios(URs)were calculated.Visual assessment was performed using a 2-pattern grading scale:Diffuse(homogeneous uptake less than liver uptake)and focal(one or more areas of focal uptake in any part of the graft).Statistical analysis was performed.RESULTS In total,there were 306 AA grafts,285 LI grafts,282 RI grafts,and 306 ascending aorta background SUVmax measurements.For all 102 scans,mean SUVmax values for AA grafts were 2.8-3.0 along proximal,mid,and distal segments.Mean SUVmax values for LI grafts and RI grafts were 2.7-2.8.Mean SUVmax values for background were 2.5±0.5.Mean URs were 1.1-1.2.Visual analysis of the scans reflected results of quantitative analysis.On visual inspection,98%revealed diffuse,homogeneous 18F-FDG uptake less than liver.Graft URs and visual pattern categories were significantly associated for AA graft URs(F-ratio=21.5,P<0.001),LI graft URs(F-ratio=20.4,P<0.001),and RI graft URs(F-ratio=30.4,P<0.001).Thus,visual patterns of 18F-FDG uptake corresponded statistically significantly to semiquantitative URs.The age of grafts showing focal patterns was greater than grafts showing diffuse patterns,87±89 vs 50±37 mo,respectively(P=0.02).URs were significantly associated with graft age for AA grafts(r=0.19,P=0.001).URs were also significantly associated with graft age for LI grafts(r=0.25,P<0.0001),and RI grafts(r=0.31,P<0.001).Quartiles of similar numbers of graft(n=25-27)grouped by graft age indicated that URs were significantly higher for 4th quartile vs 2nd quartile URs(F-ratio=19.5,P<0.001).When evaluating URs,graft SUVmax values within 10%-20%of the ascending aorta SUVmax is evident in aseptic grafts,except for grafts in the oldest quartiles.In this study,grafts in the oldest quartiles(>7 years post EVAR)showed SUVmax up to 30%higher than the ascending aorta SUVmax.CONCLUSION Characteristics of an aseptic vascular stent graft in the aorta and iliac vessels on 18F-FDG PET/CT include graft SUVmax values within 10%-20%of the ascending aorta background SUVmax.The SUVmax of older aseptic grafts can be as much as 30%above background.The visual uptake pattern of diffuse,homogeneous uptake less than liver was seen in 98%of aseptic vascular grafts,making this pattern particularly reassuring for clinicians.

Implementation of Level-3 Autonomous Patient-Specific Quality Assurance with Automated Human Interactive Devices

Purpose: Patient-specific quality assurance (PSQA) requires manual operation of different workstations, which is time-consuming and error-prone. Therefore, developing automated solutions to improve efficiency and accuracy is a priority. The purpose of this study was to develop a general software interface with scripting on a human interactive device (HID) for improving the efficiency and accuracy of manual quality assurance (QA) procedures. Methods: As an initial application, we aimed to automate our PSQA workflow that involves Varian Eclipse treatment planning system, Elekta MOSAIQ oncology information system and PTW Verisoft application. A general platform, the AutoFrame interface with two imbedded subsystems—the AutoFlow and the PyFlow, was developed with a scripting language for automating human operations of aforementioned systems. The interface included three functional modules: GUI module, UDF script interpreter and TCP/IP communication module. All workstations in the PSQA process were connected, and most manual operations were automated by AutoFrame sequentially or in parallel. Results: More than 20 PSQA tasks were performed both manually and using the developed AutoFrame interface. On average, 175 (±12) manual operations of the PSQA procedure were eliminated and performed by the automated process. The time to complete a PSQA task was 8.23 (±0.78) minutes for the automated workflow, in comparison to 13.91 (±3.01) minutes needed for manual operations. Conclusion: We have developed the AutoFrame interface framework that successfully automated our PSQA procedure, and significantly reduced the time, human (control/clicking/typing) errors, and operators’ stress. Future work will focus on improving the system’s flexibility and stability and extending its operations to other QA procedures.

Optimizing Surgical Conditions with the Use of a Modified Spontaneous Respiration, Intravenous Anesthesia and High-Flow Nasal Oxygen for Pediatric Laser Laryngeal Surgery

The use of SponTaneous Respiration using IntraVEnous anesthesia and High-flow nasal oxygen (STRIVE-Hi) in laryngeal surgery has become more widely reported. This method eliminates the endotracheal tube as a fuel for a potential fire. However, little has been published on its use in the pediatric population. Our case report describes its use in a 2-year-old undergoing micro-direct laryngoscopy with CO2 assisted supraglottoplasty and rigid bronchoscopy for airway obstruction from congenital laryngomalacia. The STRIVE-Hi technique was modified for the pediatric patient by using a lower flow through the nasal cannula (4 L). No major changes in SpO2 were detected during the 30-minute procedure. With back up airway safety equipment in place, STRIVE is proving to be a safe technique with major advantages when used in this unique scenario.

Postmenopausal Osteoporosis and Osteopenia Management with a Combination of Once-Monthly Oral Ibandronate and Cholecalciferol—A Systematic Review

Postmenopausal osteoporosis and osteopenia are chronic and uncurable conditions that invariably lead to an increased risk of vertebral, hip, and femoral neck fracture if left untreated. Clinical guidelines establish, in general, pharmacological combinations allied to lifestyle changes as the mainstay of their management, and also increasing bone marrow density, lowering fracture risk, and improving quality of life are their main therapeutic goals. The objective of this systematic review was to analyze the available data in the scientific medical literature regarding the role of the ibandronate and cholecalciferol combination in postmenopausal osteoporosis and osteopenia management. Based on our results, we concluded that the above combination is safe and feasible for the clinical control of both conditions.

Role of simulation in kidney stone disease:A systematic review of literature trends in the 26 years

BACKGROUND Minimally invasive techniques for treatment of urinary stones requires expertise,experience and endoscopic skills.Simulators provide a low-stress and low-risk environment while providing a realistic set-up and training opportunities.AIM To report the publication trend of‘simulation in urolithiasis’over the last 26 years.METHODS Research of all published papers on“Simulation in Urolithiasis”was performed through PubMed database over the last 26 years,from January 1997 to December 2022.Papers were labelled and divided in three subgroups:(1)Training papers;(2)Clinical simulation application or surgical procedures;and(3)Diagnostic radiology simulation.Each subgroup was then divided into two 13-year time periods to compare and identify the contrast of different decades:period-1(1997-2009)and period-2(2010-2022).RESULTS A total of 168 articles published on the application of simulation in urolithiasis over the last 26 years(training:n=94,surgical procedures:n=66,and radiology:n=8).The overall number of papers published in simulation in urolithiasis was 35 in Period-1 and 129 in Period-2,an increase of+269%(P=0.0002).Each subgroup shows a growing trend of publications from Period-1 to Period-2:training papers+279%(P=0.001),surgical simulations+264%(P=0.0180)and radiological simulations+200%(P=0.2105).CONCLUSION In the last decades there has been a step up of papers regarding training protocols with the aid of various simulation devices,with simulators now a part of training programs.With the development of 3D-printed and high-fidelity models,simulation for surgical procedure planning and patients counseling is also a growing field and this trend will continue to rise in the next few years.

Orthobiologics: An Updated Definition

Orthobiologics is a subset of regenerative medicine, which focuses on treating the musculoskeletal system. The main therapeutics utilized include platelet-rich plasma, stem cells, exosomes, and scaffolding matrices. Continuous discoveries and new innovations have led to an increase in both popularity and usage of these therapeutics by various medical and scientific communities. Despite its potential, however, the field is viewed with significant skepticism secondary to poor documentation, a lack of standardization, vague nomenclature, disorganized research protocols, and an absence of a clear understanding of the mechanisms underlying the effects of the various therapeutics. This ambiguity led to a surge in direct-to-consumer marketing by “Stem Cell Clinics”, putting patient’s health at risk and further delegitimizing the field. These shortcomings led to a recent push for standardization by both professionals and organizations alike;a move that has put Orthobiologics on the path toward becoming a guideline-driven, protocol-based, and research-backed specialty. And with these rapid changes comes the need for an updated definition of “Orthobiologics”, a crucial element of any legitimate and standardized medical field.

Expert consensus on the monitoring and treatment of sepsis-induced immunosuppression

Emerged evidence has indicated that immunosuppression is involved in the occurrence and development of sepsis.To provide clinical practice recommendations on the immune function in sepsis,an expert consensus focusing on the monitoring and treatment of sepsis-induced immunosuppression was developed.Literature related to the immune monitoring and treatment of sepsis were retrieved from PubMed,Web of Science,and Chinese National Knowledge Infrastructure to design items and expert opinions were collected through an online questionnaire.Then,the Delphi method was used to form consensus opinions,and RAND appropriateness method was developed to provide consistency evaluation and recommendation levels for consensus opinions.This consensus achieved satisfactory results through two rounds of questionnaire survey,with 2 statements rated as perfect consistency,13 as very good consistency,and 9 as good consistency.After summarizing the results,a total of 14 strong recommended opinions,8 weak recommended opinions and 2 non-recommended opinions were produced.Finally,a face-to-face discussion of the consensus opinions was performed through an online meeting,and all judges unanimously agreed on the content of this consensus.In summary,this expert consensus provides a preliminary guidance for the monitoring and treatment of immunosuppression in patients with sepsis.

Renal functional outcomes are not adversely affected by selective angioembolization following percutaneous nephrolithotomy

Objective:Selective angioembolization(SAE)effectively diagnoses and treats iatrogenic vascular complications following percutaneous nephrolithotomy(PCNL).Methods:We retrospectively reviewed 1329 consecutive PCNLs and identified patients who underwent SAE following PCNL with at least 12-month follow-up.Estimated glomerular filtration rate(eGFR)was calculated for all patients preoperatively,postoperatively and at last followup.A 1:2 matched cohort analysis was performed.Results:Twenty-three patients underwent SAE and matched to 46 controls.There was no statistically significant difference in preoperative,postoperative,and follow-up eGFR when comparing patients who underwent SAE and those with an uneventful course.Conclusion:Long-term eGFR is comparable in patients who undergo uncomplicated PCNL and those requiring SAE.

The genetic framework for development of nephrolithiasis

Over 1%-15% of the population worldwide is affected by nephrolithiasis,which remains the most common and costly disease that urologists manage today.Identification of atrisk individuals remains a theoretical and technological challenge.The search for monogenic causes of stone disease has been largely unfruitful and a technological challenge;however,several candidate genes have been implicated in the development of nephrolithiasis.In this review,we will review current data on the genetic inheritance of stone disease,as well as investigate the evolving role of genetic analysis and counseling in the management of nephrolithiasis.

Addressing quality of life in the patient with interstitial cystitis/bladder pain syndrome

Interstitial cystitis/bladder pain syndrome(IC/BPS)is a debilitating,chronic condition characterized by chronic pelvic pain,urinary urgency,and frequency and is well-known to be associated with a decrease in work productivity,emotional changes,sleep,sexual dysfunction,and mobility.Many metrics of quality of life(QoL)in this patient population have been developed;however,a unified,standardized approach to QoL in these patients has not been determined.The effects of IC/BPS and co-morbid conditions on QoL are described using current validated metrics.Next,data regarding successful treatment of IC/BPS in terms of QoL improvement are reviewed.While QoL is the single most important clinical measure of success in the treatment of patients suffering from IC/BPS,addressing QoL in this patient population remains a significant challenge,as its effects on QoL are highly variable and unable to be differentiated from the effects of comorbid conditions on QoL,including depression,poor sleep,and inability to work.Future studies will need to address treatment efficacy on the basis of IC/BPS specific QoL metrics,and multi-modal assessment and therapy to address comorbid disease will also play an important role in the future to ensure comprehensive management of these patients.

Non-alcoholic fatty liver and chronic kidney disease:Retrospect,introspect,and prospect

With the growing prevalence of obesity and diabetes in the United States and across the world,a rise in the overall incidence and prevalence of non-alcoholic fatty liver disease(NAFLD)is expected.The risk factors for NAFLD are also associated with the development of chronic kidney disease(CKD).We review the epidemiology,risk factors,genetics,implications of gut dysbiosis,and specific pathogenic mechanisms linking NAFLD to CKD.Mechanisms such as ectopic lipid accumulation,cellular signaling abnormalities,and the interplay between fructose consumption and uric acid accumulation have led to the emergence of potential therapeutic implications for this patient population.Transplant evaluation in the setting of both NAFLD and CKD is also reviewed.Potential strategies for surveillance and management include the monitoring of comorbidities,the use of non-invasive fibrosis scoring systems,and the measurement of laboratory markers.Lastly,we discuss the management of patients with NAFLD and CKD,from preventative measures to experimental interventions.

Prediction of surgical complications in the elderly:Can we improve outcomes?

As the number of Americans aged 65 years and older continues to rise,there is projected to be a corresponding increase in demand for major surgeries within this population.Consequently,it is important to utilize accurate preoperative risk stratification techniques that are applicable to elderly individuals.Currently,commonly used preoperative risk assessments are subjective and often do not account for elderly-specific syndromes that may pose a hazard for geriatric patients if not addressed.Failure to accurately risk-stratify these patients may increase the risk of postoperative complications,morbidity,and mortality.Therefore,we aimed to identify and discuss the more objective and better-validated measurements indicative of poor surgical outcomes in the elderly with special focus on frailty,patient optimization,functional status,and cognitive ability.

Management of Barrett’s esophagus with dysplasia refractory to radiofrequency ablation

Radiofrequency ablation(RFA)is very effective for eradication of flat Barrett’s mucosa in dysplastic Barrett’s esophagus after endoscopic resection of raised lesions.However,in a minority of the time,RFA may be ineffective at eradication of the Barrett’s mucosa.Achieving complete eradication of intestinal metaplasia can be challenging in these patients.This review article focuses on the management of patients with dysplastic Barrett’s esophagus refractory to RFA therapy.Management strategies discussed in this review include optimizing the RFA procedure,optimizing acid suppression(with medical,endoscopic,and surgical management),cryotherapy,hybrid argon plasma coagulation,and EndoRotor resection.

Management of 220 adolescents and adults with complications of hypospadias repair during childhood

Objective:The goal of hypospadias repair is to achieve normal voiding and good penile cosmesis with minimal complications.Some urethroplasties deteriorate from childhood to adolescence and late stage failures have been reported.We report our experience with adult patients who have had a previous repair during childhood and present with a late complication.Methods:We reviewed the records of 220 patients aged 15e39 years old with a history of hypospadias repair who presented to our clinic.Forty-five patients with chordee,39 with urethral strictures,11 urethral fistulae,five with hairy urethras,three with urethral diverticula,and 117 patients with an abnormal glans or subterminal meatus were repaired.Results:Median follow-up was 14 months.Two patients had persistent chordee.Island skin flap urethroplasty afforded one patient with a urethral fistula and another with a recurrent urethral stricture,while the buccal mucosa group had one fistula which healed spontaneously and two recurrent strictures.For the patients undergoing glanular repairs,seven had dehiscence or breakdown of the repair.All other operations were successful.Conclusion:Complications of childhood hypospadias repair may present later in life as some urethroplasties deteriorate with time.We now recommend to parents of children with repaired proximal hypospadias to come for follow-up as their child transitions to adolescence.