Publications by authors named "Luke Harper"

49 Publications

Functional and radiological outcome after forearm plating in children and adolescent fracture.

Acta Orthop Belg 2021 Mar;87(1):143-149

The literature on forearm overgrowth after plating in traumatic conditions is relatively poor though this technique can be useful when intra-medullary nailing is not sufficient in pediatric cases. The goal of this study was to assess a potential overgrowth after plating and identify impact on function. We conducted a retrospective study of all pediatric patients who underwent open surgery of the radius and/or ulna diaphysis with internal fixation by plating, in our institution, between October 2013 and July 2019. At last follow-up, functional and radiological outcomes were compared between the operated and uninjured forearm. Range of motion (ROM) of the wrist and elbow, clinical scores, radial and ulnar length were measured. A positive bone length discrepancy of more than 2mm was considered as an overgrowth. Were also studied the radio-ulnar index, radial inclination and radiocarpal angle. Thirteen patients were included. The mean age was 12.1 years old (±3.0 years), they were plated on the radius (10 cases) or on the ulna (3 cases). Mean follow- up was 4.4 years (± 1.8). In two cases, the plated bone (radius) was significantly longer than the uninjured one. There was no significant difference regarding radio-ulnar index, radial inclination and radiocarpal angle. The only statistically significant difference between the operated and uninjured forearm was the pronation/supination range, which was greater in the uninjured forearm (mean 160 ±48° versus 175 ±49°, p=0.01). This study confirms the good functional and radiological outcomes after plating even in a skeletally immature forearm. Level of evidence : IV.
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March 2021

Comment to "Identification of risk factors associated with numerous reoperations following primary hypospadias repair".

Authors:
Luke Harper

J Pediatr Urol 2021 02 30;17(1):62-63. Epub 2020 Dec 30.

Department of Pediatric Urology, Hopital Pellegrin-Enfants, CHU Bordeaux, Bordeaux, France. Electronic address:

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http://dx.doi.org/10.1016/j.jpurol.2020.11.049DOI Listing
February 2021

Management of lower urinary tract fibroepithelial polyps in children.

J Pediatr Surg 2021 Feb 10;56(2):332-336. Epub 2020 Jun 10.

Service de chirurgie pédiatrique, Hôpital Mère-Enfant, Centre Hospitalier Universitaire de Limoges, 8 Avenue Dominique Larrey 87042, Limoges, France. Electronic address:

Introduction: Fibroepithelial polyps (FEP) of the lower urinary tract are relatively common in adults but rare in children, with fewer than 250 cases reported in the literature to date.

Objective: The aim of this study was to address the experience of FEP management in children.

Study Design: A retrospective multicenter review was undertaken in children with defined FEP of the lower urinary tract managed between 2008 and 2018. The data at 18 pediatric surgery centers were collected. Their demographic, radiological, surgical, and pathological information were reviewed.

Results: A total of 33 children (26 boys; 7 girls) were treated for FEP of the lower urinary tract at 13 centers. The most common presentation was urinary outflow as hematuria (41%), acute urinary retention (25%), dysuria (19%), or urinary infections (28%). A prenatal diagnosis was made for three patients with hydronephrosis. Almost all of the children (94%) underwent ultrasound imaging of the urinary tract as the first diagnostic examination, 23 (70%) of them also either had an MRI (15%), cystourethrography (25%), computerized tomography (6%), or cystoscopy (45%). Two of these children (6%) had a biopsy prior to the surgery. The median preoperative delay was 7.52 (range: 1-48) months. Most of the patients were treated endoscopically, although four (12.1%) had open surgery and two (6.1%) had an additional incision for specimen extraction. The median hospital stay was 1.5 (range: 1-10) days. There were no recurrences and no complications after a median follow-up of 13 (range: 1-34) months.

Discussion: The main limitation of our study is the retrospective design, although it is the largest one for this pathology.

Conclusion: This series supports sonography as the most suitable diagnosis tool before endoscopy to confirm the diagnosis and to perform the resection for most FEP in children. This report confirms the recognized benign nature in the absence of recurrences.

Level Of Evidence: Level V.
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http://dx.doi.org/10.1016/j.jpedsurg.2020.05.030DOI Listing
February 2021

Editorial Comment.

Authors:
Luke Harper

J Urol 2020 09 15;204(3):577. Epub 2020 Jun 15.

Department of Pediatric Urology, Hôpital Pellegrin-Enfants, CHU Bordeaux, Bordeaux, France.

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http://dx.doi.org/10.1097/JU.0000000000001035.01DOI Listing
September 2020

How to more effectively determine what is true: The limits of intuition.

J Pediatr Urol 2020 Aug 13;16(4):495-496. Epub 2020 May 13.

Department of Pediatric Surgery, Surgical Clinic C, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. Electronic address:

The plethora of scientific data and explosion of published materials often leave it challenging to develop a clear and concise overview of many scientific topics. A number of factors may contribute to our misunderstanding. It is the focus of this article to describe primary reasons for failure to establish a clear, factual and functional understanding regarding scientific areas of inquiry.
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http://dx.doi.org/10.1016/j.jpurol.2020.05.004DOI Listing
August 2020

Further medical experience will be required to validate these results: How experience -based medicine shapes the validity of medical evidence.

J Pediatr Urol 2020 Feb 14;16(1):112-113. Epub 2019 Nov 14.

Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. Electronic address:

This communication contextualizes the importance of clinical experience or experience-based medicine within the current paradigm of evidence-based medicine, complementing our previously published series of five short educational articles on evidence-based medicine. Previously we focused on optimizing medical decisions using publications of well-conducted research. Previous commentaries included a backgrounder, the hierarchy of evidence, data acquisition, tools for critical appraisal, and clinical use of evidence based medicine.
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http://dx.doi.org/10.1016/j.jpurol.2019.10.022DOI Listing
February 2020

Evidence-based medicine V: how to use in clinical practice.

J Pediatr Urol 2019 Oct 9;15(5):568-569. Epub 2019 Aug 9.

Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada.

In this penultimate installment in the educational series on evidence-based medicine, the Research Committee of the European Society of Pediatric Urology will focus on clinical application. In previous communications, optimizing medical decisions was focused on through the use of well-conducted research publications, and the topics of background, hierarchy of evidence, information acquisition, and critical appraisal tools were covered. The goal is to guide the clinician in using evidentiary tools for setting up a clinical question, finding appropriate information, searching appropriate databases, and evaluating the results with the patient in mind.
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http://dx.doi.org/10.1016/j.jpurol.2019.07.025DOI Listing
October 2019

Managing children with hydronephrosis: common pitfall during ultrasound follow-up to remember.

Arch Dis Child 2020 06 12;105(6):610-611. Epub 2019 Jul 12.

Paediatric Surgery, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.

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http://dx.doi.org/10.1136/archdischild-2019-317386DOI Listing
June 2020

Divergent Intramedullary Nailing (DIN): A Modified Intramedullary Nailing Technique to Treat Paediatric Distal Tibial Fractures.

J Pediatr Orthop 2019 Nov/Dec;39(10):e773-e776

Department of Pediatric Orthopaedics, University Hospital of Bordeaux, France.

Introduction: Elastic stable intramedullary nailing (ESIN) allows for efficient reduction and stabilization of fractures of the tibial shaft in children and adolescents. However, for fractures of the distal third of the tibia, traditional ESIN could be inappropriate, thus compromising the stability and the healing of the fracture. The aim of this study was to present and to assess a new technique of modified ESIN to treat fracture of the distal third of the tibia, called divergent intramedullary nailing (DIN).

Methods: We performed a retrospective monocentric study. All patients less than 16 years old, managed in our pediatric orthopaedics department, and operated upon according to the DIN technique for a displaced and/or unstable fracture of the distal third of the tibia were included. Demographic and surgical data were collected. X-rays were performed preoperatively, postoperatively, at 6 weeks, and every 6 months. The surgical technique starts as does the classic ESIN. However, nails are not curved, so that they cross only once at the proximal part of the tibia; they are divergent and supported by the medial and lateral distal part of the tibial shaft. This allows for reduction and stabilization of the fracture.

Results: A total of 13 patients were included, with a mean age of 10 years and a mean follow-up of 32 months. The size of the nail varied between 2.5 and 4 mm. The mean surgical time was 54 minutes. The DIN technique provided a satisfying reduction (coronal and sagittal angulation <3 degrees) for the 13 fractures. In addition, there was no secondary displacement at 6 weeks. All patients were healed at 6 months, with no clinical torsion or axis malalignment.

Conclusions: The current study confirms the feasibility and the efficiency of the DIN method to treat fracture of the distal third of the tibia.
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http://dx.doi.org/10.1097/BPO.0000000000001366DOI Listing
January 2020

Efficacy, pain, and overall patient satisfaction with pediatric upper arm fracture reduction in the emergency department.

Orthop Traumatol Surg Res 2019 05 6;105(3):513-515. Epub 2019 Mar 6.

Department of Pediatric Surgery, Hopital Pellegrin-Enfants, CHU Bordeaux, Bordeaux, France.

Introduction: Immediate closed reduction and cast immobilization performed under sedation in the emergency room is the mainstay management for most isolated displaced or angulated upper limb fractures in children. We aimed to determine if this approach is safe, effective and if patients, parents and staff are satisfied with this approach.Our working hypothesis was this management provides a high satisfaction rate.

Patients And Methods: Between January 2017 and October 2017 we included 118 children presenting with upper arm fractures amenable to closed reduction under our institutional analgesia protocol. Children received 0.4mg/kg of Oramorph oral solution, they were then evaluated 40minutes later, and if their Face Legs Activity Cry Consolability (for children under 16 years-old) and/or Visual Analog Scale (for children over 6 years-old) were under 4, they underwent closed reduction by an orthopaedic resident under Nitrous oxide. If their pain assessment scale was above 4, they received an extra 0.4mg/kg of Oramorph oral solution and underwent closed reduction 40minutes later under nitrous oxide. These children were managed without hospitalization, as outpatients. Children>6, families and nursing staff were also given a visual satisfaction scale (using a 1-10 score) just before being discharged from the ER in order to evaluate their experience.

Results: Closed reduction in the ER was judged satisfactory from an orthopedic point-of-view in 115 cases (97.6%). Parents, children and the nursing team gave the experience in the ER an average satisfaction score of 9 out of 10.

Conclusion: ER reduction is not only safe and effective but is also associated with a high satisfaction rate amongst children, their families and the nursing staff.
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http://dx.doi.org/10.1016/j.otsr.2018.10.027DOI Listing
May 2019

Long-Term (>10 Years) Results After Endoscopic Injection Therapy for Vesicoureteral Reflux.

J Laparoendosc Adv Surg Tech A 2018 Nov 23;28(11):1408-1411. Epub 2018 Jul 23.

2 Department of Pediatric Surgery, Children's Hospital , CHU Toulouse, France .

Objective: Endoscopic injection is an accepted alternative for the treatment of vesicoureteral reflux (VUR) with the most commonly used agent being dextranomer/hyaluronic acid (Dx/HA). There are few reports on very long-term results after this treatment, although the biodegradable nature of the product could indicate that results might deteriorate on the long term. We, therefore, decided to evaluate the efficacy of Dx/HA copolymer endoscopic injection, in terms of recurrence of febrile urinary tract infections (fUTIs) in children, with a follow-up of at least 10 years.

Materials And Methods: We analyzed the medical data of all children who were diagnosed with VUR and underwent endoscopic injection with >10 years follow-up, in two University Hospitals. We reviewed their medical files and then contacted patients by phone.

Results: We found 68 patients who had undergone endoscopic treatment of VUR with a follow-up of minimum 10 years. We were able to contact 53 of these patients of whom 38 were girls, and 36 had bilateral VUR with a total of 89 ureteral units. Mean age at surgery was 86 months (26-136). Mean follow-up was 12.5 years (range: 10.5-15). No child presented postinjection obstruction. Thirteen patients presented with a recurrence of fUTI during the postoperative course of whom 8 presented persistent VUR. All recurrences of fUTI occurred within the first 5 years of follow-up. Four underwent a second injection and 4 underwent open reimplantation. Success rate per patient was 85%.

Conclusion: Results of endoscopic injection using Dx/HA remain stable over time (>10 years). In our series, recurrences of fUTI occur within the first 5 years of follow-up.
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http://dx.doi.org/10.1089/lap.2018.0035DOI Listing
November 2018

Optimal postoperative immobilisation for supracondylar humeral fractures.

Orthop Traumatol Surg Res 2018 09 25;104(5):645-649. Epub 2018 May 25.

Service de chirurgie pédiatrique, CHU de Bordeaux, site Pellegrin, place Amélie Raba-Leon, 33076 Bordeaux, France.

Background: Supracondylar humeral fractures (SCHFs) are very common in paediatric patients. In France, percutaneous fixation with two lateral-entry pins is widely used after successful closed reduction. Postoperative immobilisation is typically with a long arm cast combined with a tubular-bandage sling that immobilises the shoulder and holds the arm in adduction and internal rotation to prevent external rotation of the shoulder, which might cause secondary displacement. The objective of this study was to compare this standard immobilisation technique to a posterior plaster splint with a simple sling.

Hypothesis: Secondary displacement is not more common with a posterior plaster splint and sling than with a long arm cast.

Material And Methods: One hundred patients with extension Gartland type III SCHFs managed by closed reduction and percutaneous fixation with two lateral-entry pins between December 2011 and December 2015 were assessed retrospectively. Postoperative immobilisation was with a posterior plaster splint and a simple sling worn for 4 weeks. Radiographs were obtained on days 1, 45, and 90.

Results: Secondary displacement occurred in 8% of patients. No patient required revision surgery.

Discussion: The secondary displacement rate was comparable to earlier reports. Of the 8 secondary displacements, 5 were ascribable to technical errors. The remaining 3 were not caused by rotation of the arm and would probably not have been prevented by using the tubular-bandage sling.

Conclusion: A posterior plaster splint combined with a simple sling is a simple and effective immobilisation method for SCHFs provided internal fixation is technically optimal.

Level Of Evidence: IV retrospective observational study.
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http://dx.doi.org/10.1016/j.otsr.2018.03.015DOI Listing
September 2018

ZORRO: Z Omphaloplasty Repair for Omphalocele.

J Pediatr Surg 2018 Jul 6;53(7):1424-1427. Epub 2018 Apr 6.

Department of Neonatology, CHU Félix Guyon, Saint Denis, La Réunion, France.

Purpose: To suggest a novel technique for omphalocele closure which uses the circular base of the umbilical cord, thus allowing for a more physiological healing process and natural-looking scar.

Methods: Among 16 neonates operated for omphalocele between 2011 and 2016, 12 were closed with a one-stage procedure using a Z omphaloplasty (ZORRO). Median gestational age was 36.5 weeks; median birth weight was 3210 g. The umbilical arteries were divided and ligated outside the peritoneal cavity above the parietal musculocutaneous plane. The upper part of the defect was closed vertically in the midline, while the lower part was closed in a circular fashion by imbricating 2 lateral cutaneous Z flaps thus forming a new cordonal base.

Results: The postoperative course was uneventful in all cases. The reconstructed cordonal bases healed as would a normal umbilical cord, with central umbilication surrounded by healthy skin. With a median follow-up period of 11 months, the umbilicus was in the normal position, with a 0.6 xyphoumbilical/xyphopubic ratio.

Conclusions: This technique mimics the natural necrosis mechanism and physiological healing of the umbilicus thus allowing for an esthetic and "natural looking" umbilicus.
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http://dx.doi.org/10.1016/j.jpedsurg.2018.04.003DOI Listing
July 2018

Children with abnormal DMSA nuclear scan present a higher risk of recurrent febrile urinary tract infections.

World J Pediatr 2019 Apr 20;15(2):204-205. Epub 2018 Mar 20.

Methodological Support Unit, CHU de La Reunion, La Reunion, France.

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http://dx.doi.org/10.1007/s12519-018-0152-8DOI Listing
April 2019

Bladder Dysfunction in Children with Neurofibromatosis Type I: Report of Four Cases and Review of the Literature.

Urol Int 2018 7;100(3):339-345. Epub 2018 Mar 7.

University of Bordeaux, Bordeaux, France.

Aim: Neurofibromatosis type 1 (NF1) is a rare autosomal dominant disorder. Malignant transformation into malignant peripheral nerve sheath tumors (MPNST) can occur. However, urinary tract involvement is rare. We report 4 cases of NF1 with bladder dysfunction.

Methods: A retrospective single center analysis of 4 patients was conducted over a 17-year period, focusing on urinary tract involvement.

Results: NF1 was diagnosed at a median of 16.5 months (4-36) and urinary involvement occurred at a median of 5.25 years (4-9) after diagnosis. Bladder dysfunction was due to spinal cord compression in 2 cases, bladder invasion in 1 case, and cerebral lesions in 1 case. Malignant transformation of neurofibromas into MPNST occurred in 2 patients. Mechanisms of urinary involvement in NF1 are diverse and no pre-established protocol of management and follow-up exists.

Conclusion: Although rare, dysfunction of the bladder can arise in NF1 and innovative strategies then need to be considered. This is best achieved with the help of a multidisciplinary team and a national reference center when available.
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http://dx.doi.org/10.1159/000487193DOI Listing
December 2018

A brief description of study design.

J Pediatr Urol 2018 04 2;14(2):135-136. Epub 2018 Mar 2.

Service de Chirurgie et Urologique, Pediatrique Hopital Lapeyronie, CHU de Montpellier, Universite de Montpellier, France.

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http://dx.doi.org/10.1016/j.jpurol.2017.12.011DOI Listing
April 2018

Ethical issues in research: Human and animal experimentation.

J Pediatr Urol 2018 06 9;14(3):287-288. Epub 2018 Feb 9.

Service de Chirurgie et Urologique Pédiatrique Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France.

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http://dx.doi.org/10.1016/j.jpurol.2017.12.012DOI Listing
June 2018

Ethical issues in research: Human and animal experimentation.

J Pediatr Urol 2018 06 2;14(3):286. Epub 2017 Dec 2.

Service de Chirurgie et Urologique Pédiatrique Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France.

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http://dx.doi.org/10.1016/j.jpurol.2017.10.019DOI Listing
June 2018

How can we decrease preoperative anxiety in parents of children undergoing surgery?

Arch Dis Child 2018 10 4;103(10):1001-1002. Epub 2018 Jan 4.

Department of Paediatric Surgery, Hopital Pellegrin-Enfants, CHU Bordeaux, Bordeaux, Aquitaine, France.

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http://dx.doi.org/10.1136/archdischild-2017-314579DOI Listing
October 2018

Can quantity of amniotic fluid reliably predict postnatal renal function in boys with posterior urethral valves: a decision curve analysis.

Prenat Diagn 2017 Sep 6;37(9):931-934. Epub 2017 Aug 6.

Unité de Soutien Méthodologique, CHU de La Réunion, Saint-Denis, La Reunion, France.

Objective: Prenatal management of male fetuses with suspected posterior urethral valves depends on reliable markers for postnatal long-term renal function. Whether ultrasound parameters, including the presence or absence of oligohydramnios, are reliable remains the subject of debate. We decided to evaluate the reliability of quantity of amniotic fluid to predict postnatal renal function using decision curve analysis (DCA), a method for evaluating the clinical utility of a diagnostic test.

Methods: We analyzed retrospectively 51 male fetuses born with prenatally suspected posterior urethral valves between 2009 and 2012. We studied the relationship between quantity of amniotic fluid on prenatal ultrasound and the nadir creatinine during the first year of life as a proxy of postnatal renal function using DCA.

Results: Twelve fetuses presented with prenatal oligohydramnios. Thirty-one children had a normal nadir creatinine, of which one had prenatal oligohydramnios (3.2%). Thirteen had a nadir creatinine between 35 and 75 μmol/L, of which four had prenatal oligohydramnios (30.8%). Seven had a nadir creatinine >75 μmol/L, all of them had prenatal oligohydramnios.

Conclusion: In this retrospective study, DCA confirms the relationship between prenatal quantity of amniotic fluid volume and postnatal renal function. © 2017 John Wiley & Sons, Ltd.
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http://dx.doi.org/10.1002/pd.5120DOI Listing
September 2017

Critical Analysis of a Series of Early Inguinal Ureterostomies: Are They Useful and How Well Are They Tolerated?

Urol Int 2017 13;98(3):328-333. Epub 2016 Dec 13.

Department of Urology, Royal Children's Hospital, Parkville, Australia.

Introduction: The study aimed to evaluate the advantages of temporary inguinal ureterostomy in the management of neonates with uropathies and early or recurrent pyelonephritis.

Patients And Methods: We performed a retrospective analysis of all patients who underwent ureterostomies between 1989 and 2012, with specific regards to indications and outcomes. We also performed a survey of parents to evaluate their acceptance of diversion.

Results: We included 18 patients (12 primary high-grade vesicoureteral reflux [VUR] and 6 primary obstructive megaureters [MUs]). Indications were recurrent febrile urinary tract infections (UTIs) despite antibiotic prophylaxis, doubtful function of the overlying kidney for the oldest cases, when renal function was only assessed by intravenous urography, or both. Cutaneous diversion was performed between the ages of 2 weeks to 5 months (median: 1.8 months). Renal function was assessed prior to undiversion to choose between reimplantation and nephrectomy. The incidence of febrile UTIs significantly decreased during the period of diversion. Urinary diversion was judged socially acceptable by parents. Ureterostomy did not modify the overlying kidney function.

Conclusion: Temporary inguinal ureterostomy does not enable better evaluation of renal function by suppressing the pressure of an obstacle or refluxing urines. Its remaining indication seems to be the prevention of recurrent UTIs in neonates and infants with VUR or MU, pending reimplantation.
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http://dx.doi.org/10.1159/000452865DOI Listing
October 2017

Preliminary experience using a tunica vaginalis flap as the dorsal component of Bracka's urethroplasty.

BJU Int 2017 03 17;119(3):470-473. Epub 2016 Aug 17.

Department of Pediatric Surgery, CHU F Guyon, Bellepierre, Saint-Denis de La Réunion, Réunion Island, France.

Objective: To evaluate clinical use of a tunica vaginalis flap as the dorsal component of a two-stage urethroplasty in boys with cripple hypospadias.

Patients And Methods: We performed the first stage of a Bracka two-stage urethroplasty, using a tunica vaginalis flap as the dorsal component in six boys with cripple hypospadias. We analysed their clinical characteristics and the results of this technique.

Results: The mean (range) age of the boys was 57 (34-120) months. The mean (range) number of previous procedures the boys had undergone was 4 (3-5). At the 6-month follow-up, all the boys presented significant fibrosis of the dorsal graft rendering it unusable for tubularisation.

Conclusions: Exposure to the external environment seems to induce retraction and fibrosis of the tunica vaginalis. We believe one should be very cautious about using tunica vaginalis as the dorsal component of a two-stage urethroplasty, as significant fibrosis might well render the flap unusable.
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http://dx.doi.org/10.1111/bju.13604DOI Listing
March 2017

A novel approach to evaluating the benefit of post-urinary tract infection renal ultrasonography, using decision curve analysis.

Pediatr Nephrol 2016 10 14;31(10):1631-6. Epub 2016 May 14.

Unité de Soutien Méthodologique, CHU de La Réunion, Saint-Denis, Réunion, France.

Background: The benefit of post-urinary tract infection (UTI) sonography to detect clinically significant renal abnormalities remains a subject open to debate. Decision curve analysis (DCA) is a novel method for evaluating the clinical usefulness of diagnostic tests. Our objective was to determine, using DCA, the benefit of post-UTI sonography and of post-UTI sonography with biological markers of inflammation to predict the risk of recurrence of febrile UTI in children aged 2 to 24 months without known uropathy.

Methods: We retrospectively analyzed all children aged 2 to 24 months, without known uropathy, who presented with a first episode of febrile UTI between 2009 and 2012 and followed them for 30 months. We then used DCA to estimate the benefit of post-UTI sonography or post-UTI sonography + biological markers of inflammation for detecting the risk of recurrence.

Results: A total of 318 children [144 boys (45.3 %) and 174 girls (54.7 %)], with a mean age of 6.9 ± 5.6 months, were identified. Of these, 210 children presented with a significant inflammation [66.2 %; 95 % confidence interval (CI) 61.0-71.4], and 30 (9.4 %; 95 % CI 6.2-12.6) presented with abnormal post-UTI sonographic findings. Eighteen (5.7 %; 95 % CI 3.1-8.2) children presented with recurrent UTI at 30 months.

Conclusions: There were significantly more recurrences in those children who presented with abnormal sonographic findings than in those who did not (relative risk 7.68; 95 % CI 3.03-19.46). However, taking into account the effect of false-positives and false negatives, the DCA revealed that for threshold probabilities of >30 %, at which patients/doctors are concerned about unnecessary interventions (whether tests or treatments), neither post-UTI sonography nor post-UTI sonography + biological markers of inflammation have sufficient value to improve care.
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http://dx.doi.org/10.1007/s00467-016-3410-9DOI Listing
October 2016

Prescription errors in the National Health Services, time to change practice.

Scott Med J 2016 Feb 21;61(1):1-6. Epub 2016 Apr 21.

Dudley Group of Hospitals NHS Trust, UK.

Introduction: Medication error is a major source of iatrogenic illness. Error in prescription is the most common form of avoidable medication error. We present our study, performed at two, UK, National Health Services Hospitals.

Material And Methods: The prescription practice of junior doctor's working on general medical and surgical wards in National Health Service District General and University Teaching Hospitals in the UK was reviewed. Practice was assessed against standard hospital prescription charts, developed in accordance with local pharmacy guidance.

Results: A total of 407 prescription charts were reviewed in both initial audit and re-audit one year later. In the District General Hospital, documentation of allergy, weight and capital-letter prescription was achieved in 31, 5 and 40% of charts, respectively. Forty-nine per cent of discontinued prescriptions were properly deleted and signed for. In re-audit significant improvement was noted in documentation of the patient's name 100%, gender 54%, allergy status 51% and use of generic drug name 71%. Similarly, in the University Teaching Hospital, 82, 63 and 65% compliance was achieved in documentation of age, generic drug name prescription and capital-letter prescription, respectively. Prescription practice was reassessed one year later after recommendations and changes in the prescription practice, leading to significant improvement in documentation of unit number, generic drug name prescription, insulin prescription and documentation of the patient's ward.

Conclusion: Prescription error remains an important, modifiable form of medical error, which may be rectified by introducing multidisciplinary assessment of practice, nationwide standardised prescription charts and revision of current prescribing clinical training.
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http://dx.doi.org/10.1177/0036933015619585DOI Listing
February 2016

Can separation of the scrotal sac in proximal hypospadias reliably predict the need for urethral plate transection?

J Pediatr Urol 2016 Apr 17;12(2):121.e1-5. Epub 2015 Dec 17.

Department of Pediatric Surgery, CHU F Guyon, Bellepierre, Réunion Island, France. Electronic address:

Introduction: One of the main challenges in proximal hypospadias repair is correcting curvature. The best technique to achieve this remains the object of debate. Indeed, some authors believe the urethral plate should be kept and used as often as possible. In some cases, however, even after extensive mobilization and dorsal plication, significant curvature remains and it is necessary to transect the urethral plate. Having a reliable pre-dissection marker of the need for urethral transection would be useful in choosing a technique.We wanted to determine if presence of marked separation of the scrotal sac (SSS), also referred to as bifid scrotum, could reliably predict the need for urethral plate transection.

Study Design: We prospectively enrolled a series of boys with proximal hypospadias. We noted age, degree of hypospadias, meatal position, presence of cryptorchidism, and presence or absence of SSS. During surgery we fully degloved the penile shaft, freeing all ventral tissues, and radically dissected the more proximal bulbar urethra. We then performed an erection test. If there was residual curvature <30° we performed a dorsal plication, if it was >30° we transected the urethral plate.

Results: Twenty-nine patients were included, of whom 18 presented SSS. The average age was comparable in both groups, as was type of hypospadias and meatal position. We estimated transection of the urethral plate to be necessary in 15 out of the 18 children with SSS, and 2 out of the 11 children without SSS. The relative risk for requiring urethral plate transection in case of SSS in this series was 4.58.

Conclusion: Techniques that commit to urethral plate transection are criticized because they preclude using the urethral plate. In our study presence of SSS was predictive for the need to transect the plate. Obviously one can decide to keep the urethral plate at all cost, and mobilize it more than we did, or accept more residual curvature, but in reality our aim was to determine a preoperative marker allowing us to define a patient category. We believe presence of SSS is a marker of severity, and that this "severity" translates into "a less usable urethra". As recent studies caution us about the evolution of the reconstructed native urethra and the possibility that it may not grow as well as the other penile tissues, we believe this extra information could influence the surgeon's decision as to the most appropriate technique for each patient.
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http://dx.doi.org/10.1016/j.jpurol.2015.10.011DOI Listing
April 2016

Editorial comment.

Authors:
Luke Harper

J Urol 2015 Mar 24;193(3):981-2; discussion 982. Epub 2014 Nov 24.

Department of Pediatric Surgery, CHU Felix Guyon, Saint-Denis, Reunion Island.

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http://dx.doi.org/10.1016/j.juro.2014.09.122DOI Listing
March 2015

Inguinal hernia in premature boys: should we systematically explore the contralateral side?

J Pediatr Surg 2014 Sep 10;49(9):1419-23. Epub 2014 Feb 10.

Unité de Chirurgie Viscérale et Urologique Pédiatrique, Département de Chirurgie Pédiatrique CHU Lapeyronie, Montpellier Université Montpellier I, Montpellier, France.

Objective: Bilateral surgery has been largely advocated in premature boys with unilateral inguinal hernia owing to the high incidence of contralateral patent processus vaginalis. Recently, the potential morbidity of herniotomy in low birth-weight babies and the progress in pediatric anesthesia questioned this attitude. This study aims to evaluate the incidence of contralateral metachronous hernia in a large series of premature boys and to compare the morbidity of preventive versus elective surgery.

Methods: This retrospective multicenter analysis of 964 premature boys presenting with unilateral inguinal hernia operated from 1998 to 2012 included 557 infants who benefited from a unilateral herniotomy and 407 from a bilateral herniotomy (median follow-up 12months).

Results: Contralateral metachronous hernia after unilateral surgery occurred in 11% (n=60) without significant difference according to the initial symptomatic side (9.5% on right vs 13% on left, p>0.05). Postoperative morbidity on the contralateral side was higher after preventive surgery than elective surgery with metachronous hernia (2.45% versus 0.9%, p=0.05) especially for secondary cryptorchidism (1% vs 0%, p=0.03). Despite the risk of metachronous incarcerated hernia, elective surgery did not increase the rate of testicular hypotrophy on the opposite side (0.7%, vs 0.7%, p>0.05).

Conclusion: Systematic bilateral herniotomy is unnecessary in almost 90% of patients and has a significant morbidity. Secondary surgery for metachronous hernia does not increase the risk of testicular lesion and even reduces the risk of secondary cryptorchidism. These results, along with the risk of hypofertility reported after bilateral surgery, may justify treating only the symptomatic side in premature boys.
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http://dx.doi.org/10.1016/j.jpedsurg.2014.01.055DOI Listing
September 2014

Fetal megacystis: etiologies, management, and outcome according to the trimester.

Urology 2014 Jul 16;84(1):185-90. Epub 2014 Apr 16.

Department of Pediatric Surgery, Timone and North Children's Hospital, Aix-Marseille University and Assistance Publique-Hôpitaux de Marseille, Marseille, France.

Objective: To describe the diagnostic criteria and outcome of fetal megacystis according to the gestational age at diagnosis.

Methods: A 7-year retrospective study was carried out from 2004 to 2011, including cases of megacystis referred to 2 prenatal fetal medicine units. The following data were collected and analyzed: maternal age, term at diagnosis (gestational weeks), ultrasonographic and magnetic resonance imaging data, karyotype, decision of the multidisciplinary prenatal team, fetopathology in cases of termination of pregnancy or fetal death, final diagnosis at birth after ultrasonography and voiding cystourethrography, and medical and surgical follow-up.

Results: Of the 69 fetuses included in this study, 82.6% were males; 26 were diagnosed during the first trimester, 21 during the second, and 22 during the third. During the first trimester, the main etiologies were urethral occlusions and prune-belly syndrome with poor fetal prognosis. Nineteen pregnancies (69%) were terminated for medical reasons including the association with other malformations, poor evolution, or miscarriage. Only 4 children were born alive. The main etiologies of megacystis discovered during the second and third trimesters were vesicoureteral reflux and urethral occlusion. Twenty of 22 fetuses (91%) were born alive when the fetal megacystis was discovered after 27 weeks of gestation.

Conclusion: Antenatal discovery of megacystis is a complex and challenging prognostic situation. The prognosis depends on the gestational age at discovery. Megacystis is not always associated with obstruction. In a newborn with megacystis, bladder outlet obstruction has to be excluded. Optimal counseling of the involved parents requires a multidisciplinary approach.
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http://dx.doi.org/10.1016/j.urology.2014.02.018DOI Listing
July 2014

Letter to the Editor Re 'Intravesical botulinum type-A toxin (Dysport®) in the treatment of idiopathic detrusor overactivity in child'.

Authors:
Luke Harper

J Pediatr Urol 2014 Aug 22;10(4):786. Epub 2014 Feb 22.

CHU F Guyon, Paediatric Surgery, Bellepierre, Saint-Denis, Reunion 97405, France. Electronic address:

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http://dx.doi.org/10.1016/j.jpurol.2014.01.020DOI Listing
August 2014