1,720,971 research outputs found
Surgical Management of Primary Severe Hypospadias in Children: Systematic 20-Year Review
No full textPurpose: We systematically reviewed the literature published during the last 20 years on the treatment of primary proximal hypospadias associated with severe ventral curvature. Materials and Methods: We reviewed studies published between 1990 and December 2009, searching for "hypospadias" in MEDLINE (R)/PubMed (R), EMBASE (R), Web of Science (R) and the Cochrane Library. Results: The search yielded 69 pertinent studies. These studies were generally of low quality (69.5% surgical series). Based on the literature, curvature should be addressed stepwise starting with ventral dissection that extends underneath the urethral plate (urethral plate mobilization). Contrary to former practice, urethral plate division seems to have more of a role if significant curvature persists. Dorsal plication seems sufficient to correct only minor degrees of curvature, while a minority of cases require ventral lengthening. No urethroplasty techniques appear to be definitively superior. After urethral plate division a staged urethroplasty has lower complication rates but a second operation is required, which might otherwise be avoided in approximately 70% of cases. Conclusions: The present systematic review shows the weak evidence backing current management of primary severe hypospadias. We even lack a clear-cut definition of severe hypospadias and associated curvature. Hence, while we developed general recommendations for treatment based on our review of available evidence, we emphasize the need to establish shared criteria for accurate preoperative or introperative patient stratification, and to define objective outcome measures and followup intervals for data reporting to make comparison of surgical approaches reliable
The influence of perioperative factors on primary severe hypospadias repair
No full textHypospadias is one of the most common congenital malformations of the male genitalia. Severe cases present with associated curvature greater than 30 degrees and the meatus opening proximally to the penoscrotal junction. The perioperative management of patients with primary severe hypospadias is variable. Systematic evaluation of the upper urinary tract and the search for enlarged prostatic utricles seem unnecessary in patients with isolated primary severe hypospadias, and should be limited to severe cases with associated extraurinary malformations. Detection of a disorder of sex development is key for gender assignment and prognosis, but the identification of cases warranting a full work-up and the influence of such a diagnosis on the success of hypospadias repair is controversial. Preoperative hormonal stimulation allows for penile growth irrespective of the administration route. Associated morbidity is minimal, but its influence on the success of surgery is still unknown. An age of 6-18 months is generally recommended for surgery, but no trial data support this policy. Second-layer coverage of the urethroplasty and postoperative urinary drainage seem to reduce the complications of surgery, whereas postoperative antibiotic prophylaxis and type of dressing have minimal impact on surgical success. Overall, most interventions are based on weak evidence, and their influence on the outcomes of repair is ill-defined. Clinicians should be made aware of the evidence supporting any single intervention in order to standardize their management policies. We hope the issues outlined here will prompt researchers to design new studies to address the clinically relevant questions
Management of duplex system ureteroceles in neonates and infants
No full textUreteroceles associated with the upper pole of a complete ureteral duplication are known as duplex system ureteroceles (DSUs). A limited knowledge of the natural history of this condition makes its management in neonates and infants controversial. Asymptomatic neonates diagnosed antenatally in the absence of severe hydroureteronephrosis (HUN) are at low risk of developing urinary tract infections during the first months of life. These patients might, therefore, begin antibiotic prophylaxis and undergo comprehensive assessment by 3–6 months. Subsequently, conservative management can be viable in patients without severe HUN or high-grade vesicoureteral reflux (VUR). Cases of DSUs with severe HUN but no VUR can be treated by an upper urinary tract approach or by endoscopic decompression depending on upper pole function. Patients with preoperative VUR represent the most challenging cases. If VUR cure is considered necessary, lower urinary tract reconstruction is recommended. Endoscopic decompression allows for a definitive treatment in at least 50% of cases and, in the remaining cases, can be combined with conservative management or endoscopic treatment of VUR. Nonfunctioning or poorly functioning upper poles can be left in situ both in lower urinary tract reconstruction and after endoscopic decompression. Parental preferences should also be taken into account in the decision-making process
Abstracts presented at the European Society for Pediatric Urology (ESPU) meetings (2003-2010): Characteristics and outcome
No full textObjective: To determine the characteristics and outcome of abstracts presented to the meetings of the European Society for Pediatric Urology (ESPU). Material and methods: Abstract books from 2003 to 2010 were reviewed and subsequent publication of presented abstracts determined by MEDLINE/PubMed search. Results: Of 1194 abstracts, 50-78% per year originated from 15 to 20 European countries and 50-22% from 8 to 13 non-European countries; 233 (19%) were basic science and 961 (81%) clinical. Clinical abstracts included 135 (14%) multicenter/prospective/randomized trials. These figures did not change significantly over time. A total of 564 (47%) abstracts were subsequently published, 65% within 1 year of the meeting, mostly in the Journal of Urology (33%) and the Journal of Pediatric Urology (21%). Multicenter/prospective/randomized trials studies (OR 2.03; 95% CI 1.37-2.96) and abstracts originating from outside Europe (OR 1.61; 95% CI 1.26 -2.05) were significantly more likely to be subsequently published in full. Conclusion: The ESPU meetings are a true occasion for international exchange of scientific endeavors. Almost half of the abstracts are subsequently published. The Journal of Urology and the Journal of Pediatric Urology are consistently the two major target journals for publication. Non-European countries, irrespective of whether English-speaking or not, seem significantly more likely to publish their abstracts. (C) 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved
Management of boys with nonpalpable undescended testis
No full textCryptorchidism is one of the most common genitourinary disorders in young boys. Although the management of boys with palpable testis is standardized, there are no formal guidelines for the management of boys with nonpalpable testis. In this Review we look at the current trends in the diagnosis and treatment of this disorder, as well as the indications for therapy and surgical procedures. On the basis of current evidence, we find that there is no optimum orchidopexy technique for the treatment of intra-abdominal testis, although it is preferable to adopt techniques that preserve the spermatic vessels. We also briefly examine the follow-up of patients with this disorder and its common complications. As yet, there are no data that assess the potential of laparoscopic orchidopexy being a risk factor for impaired fertility later in life
Robot-assisted and laparoscopic repair of ureteropelvic junction obstruction: a systematic review and meta-analysis
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Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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