How the First Year of COVID-19 Affected Elective Pediatric Urology Patients: A Longitudinal Study Based on Waiting Lists and Surveys From 10 European Centers.

Introduction: COVID-19 impacted healthcare systems worldwide, and elective surgical activity was brought to a minimum. Although children were not primarily affected by the disease, pediatric urology was halted by clinical closedown and staff allocation. We aimed to document how these prioritizations affected waiting lists, and to investigate how European centers dealt with the challenge of these logistical and financial prioritizations. Materials and Methods: This was a 1-year prospective study, starting March 2020. Participants were surveyed at 3-month intervals about waiting lists for several common procedures as well as OR capacity and funding. Further, centers retrospectively reported on surgical and outpatient activity rates during 2019-2021. Waiting list tendencies were evaluated in relation to study baseline. Results: A marked decrease in surgical and outpatient activity was seen in the spring of 2020. Some included pediatric urology centers were able to increase their budget (15%) and staff working hours (20%) during part of the study period. Still, at the end of the study, the centers had increased the total number of patients on waiting lists with 11%, whereas the average days on waiting lists had accumulated with 73%, yielding a total of 6,102 accumulated waiting days in the study population. Centers with decreased resources had markedly negative effects on waiting lists. Conclusions: Correlations between COVID-19 derived burdening of healthcare systems and the availability of pediatric urology greatly depends on the prioritizations made at individual centers. Ongoing monitoring of these correlations is warranted to safely avoid unnecessary negative impact on the pediatric population.

Various aspects of transition of care for adolescents with urological conditions.

Transition into adulthood is a common issue in many disciplines. However, urology faces additional difficulties due to different models of care and training as well as a wide diversity of pathologies. The goal of this paper is to discuss various aspects of the transition of urological care. This review provides some examples of pathologies that might require special attention of specialists. Most patients with rare diseases must be closely followed up in the long term. However, high-volume conditions may also have a huge impact on the well-being and quality of life in adulthood. Children who are cured due to oncological conditions will probably need additional attention in adulthood. The urological care during childhood is provided by a pediatric urologist, a pediatric surgeon or a urologist, depending on the local regulations and the organization of care. All patients are subsequently referred to a general urologist. Nowadays, a multidisciplinary approach is recommended in many cases, with a pediatric urologist as one of the team members. The patient, caregivers and healthcare professionals must be fully involved and focused on close cooperation to make the transition process smooth and successful.

Sexual function and health status in adult patients with Congenital Adrenal Hyperplasia.

INTRODUCTION: Congenital Adrenal Hyperplasia (CAH) is the most common reason for undifferentiated genital appearance in new-borns. Psychosexual outcome in women with CAH has been rarely evaluated, but it seems to be one of the most important factors determining the indications for the surgical treatment of CAH. OBJECTIVE: This is to assess sexual function and the health status (HS) in adult females with CAH who had feminizing genitoplasty in childhood. MATERIAL AND METHOD: The protocol was approved by the Ethical Committee, and the hospital database was searched for patients with CAH who had genitoplasty between 1975 and 2000. 57 adult patients were identified, and 9 (18%) patients agreed to participate in the study. Mean age at operation was 5.4 years, and mean follow-up duration was 10.9 years. The Female Sexual Function Index (FSFI) was used to evaluate sexual function, and the 36-item Short Form Health Survey (SF-36) was used to evaluate their health status (HS). A FSFI score < 26,55 was classified as Female Sexual Dysfunction (FSD). The control group consisted of 10 adult female volunteers of comparable age, without any oncological or chronic diseases. Fisher's exact test was used for statistical analysis. RESULTS: All patients in the CAH group had female gender identity. One was homosexual, and one reported not having any sexual activity. In the control group, all patients had female gender identity. All were heterosexual and one reported not having any sexual activity. The sexual function in five domains and total score were similar in both groups. More pain was reported in the CAH group as compared with the control group, and it was statistically significant. In the CAH group, 5/9 patients had FSD. In the control group, 4/10 patients had FSD. The difference was statistically insignificant (p = 0.66). Mean SF-36 score in the CAH group was 47.1 points, while it was 46.7 points in the control group. The testosterone level in all CAH patients was within the normal range (0.13-1.1 ng/ml). The 17-OH progesterone level was above normal range in 5/9 (55.6%) patients with CAH. All women in the CAH group were hormonally treated. In the control group, all patients had a normal testosterone level (0.15-0.68 ng/ml); the 17-OH progesterone level was in normal range in this group. DISCUSSION: We compared our results with the literature data, which used the same questionnaires as in our study. CONCLUSIONS: Health status and sexual function in the traceable CAH patients didn't differ from the control group.

Foreskin healing after distal hypospadias repair: Does stenting affect the outcome?

BACKGROUND: Distal penile hypospadias account for about 70% of all cases of hypospadias. There is a variety of operative techniques that could be performed when foreskin reconstruction is an option. The urethral stent is left in the urethra to prevent complications. OBJECTIVES: To determine whether the duration of stenting influences the healing of foreskin after distal hypospadias repair. MATERIAL AND METHODS: Data from 2 institutions was retrospectively analyzed. Inclusion criteria were as follows: 1) a modified meatal advancement glanuloplasty without tubularization of the urethral plate, 2) foreskin reconstruction and 3) follow-up - 12 months. All other types of reconstruction and re-do procedures were excluded. The period of urethral stenting was determined intraoperatively depending on the surgeon's preferences. Mean age at operation was 23.3 months. The cohort was divided into 3 groups. In Group I (G-I), no catheter was left or it was removed the next day after surgery. In Group II, the catheter was left for more than 5 days. In those 2 groups, the surgery was done by different surgeons. Group III consisted of 35 patients who had a stent for <2 days, and the procedure was performed by the same surgeon. The χ2 with Yates's correction and Pearson's χ2 tests were used for the statistical analysis. RESULTS: Overall, 11 patients had foreskin dehiscence and needed re-do surgery. None of the patients required operation because of foreskin stenosis. Complications occurred in 3 out of 33 patients (9%) in Group I, 2 out of 27 in Group II (7.4%) and 6 out of 35 in Group III (17%). There was no statistically significant difference between Groups I and II (p = 0.8144), nor between Groups I and III (p = 0.5344). In the non-parametric Pearson's χ2 test, no significant difference was found in such grouped data (p = 0.4239). CONCLUSIONS: Prolonged urethral stenting does not reduce the risk of a re-do foreskin surgery after hypospadias repair.

Open and Laparoscopic Colposuspension in Girls with Refractory Urinary Incontinence.

INTRODUCTION: Lower urinary tract symptoms (LUTS) are very common in children. Standard treatments consist of urotherapy, antibiotic prophylaxis, anti-muscarinics, physical therapy, and the treatment of coexisting constipation. A small group of girls also present with stress incontinence or with stress-induced urge incontinence. In cases of persistent LUTS due to congenital bladder neck insufficiency (BNI), surgical treatment might be considered. The aim of this paper is to assess the results of open and laparoscopic colposuspension in children with refractory urinary incontinence (UI). MATERIALS AND METHODS: The results of 18 open and 18 laparoscopic consecutive colposuspensions were analyzed. All patients had UI and failed conservative treatment. BNI was proven by repeated perineal ultrasound and video-urodynamic study. The laparoscopic procedure was performed preperitoneally and the open procedure was via a transverse lower abdominal incision. The same postoperative protocol was used in both groups. RESULTS: The mean operation time was 65 min for the open and 90 min for the lap procedure (p < 0.05). Full success was achieved in 7/18 in the open and in 8/18 in the lap group and partial response was seen in 3/18 and in 5/18, respectively (p = 0.64). No intraoperative complications occurred in this cohort. CONCLUSION: Open and laparoscopic colposuspension can be used to treat refractory UI in children with BNI when non-invasive methods fail.

Preliminary Analysis of the Expression of Selected Proangiogenic and Antioxidant Genes and MicroRNAs in Patients with Non-Muscle-Invasive Bladder Cancer.

Heme oxygenase-1 (HO-1) is an enzyme contributing to the development and progression of different cancer types. HO-1 plays a role in pathological angiogenesis in bladder cancer and contributes to the resistance of this cancer to therapy. It also regulates the expression of microRNAs in rhabdomyosarcoma and non-small cell lung cancer. The expression of HO-1 may be regulated by hypoxia inducible factors (HIFs) and Nrf2 transcription factor. The expression of HO-1 has not so far been examined in relation to Nrf2, HIF-1α, and potential mediators of angiogenesis in human bladder cancer. We measured the concentration of proinflammatory and proangiogenic cytokines and the expression of cytoprotective and proangiogenic mRNAs and miRNAs in healthy subjects and patients with bladder cancer. HO-1 expression was upregulated together with HIF-1α, HIF-2α, and Nrf2 in bladder cancer in comparison to healthy tissue. VEGF was elevated both at mRNA and protein level in the tumor and in sera, respectively. Additionally, IL-6 and IL-8 were increased in sera of patients affected with urothelial bladder cancer. Moreover, miR-155 was downregulated whereas miR-200c was elevated in cancer biopsies in comparison to healthy tissue. The results indicate that the increased expression of HO-1 in bladder cancer is paralleled by changes in the expression of other potentially interacting genes, like Nrf2, HIF-1α, HIF-2α, IL-6, IL-8, and VEGF. Further studies are necessary to also elucidate the potential links with miR-155 and miR-200c.

Results of varicocele treatment with laparoscopic Palomo technique in children and adolescents in years 2002-2012.

INTRODUCTION: Varicocele is caused by enlargement of internal testicular veins, including the pampiniform veno- us plexus. It is assumed that it occurs in 8% to 16% of the male population and predisposes to male infertility. The aim of our study was to assess laparoscopic treatment of the varicocele in children using the Palomo method. MATERIAL AND METHODS: In the years 2002-2012, our clinic treated 114 boys with the varicocele on the left side. In all patients the procedure involved ligation of veins, the testicular artery and lymphatic vessels with the Roeder knot. The average time of the procedure was 29 min. RESULTS: Varicocele recurrence was found in 2 out of 94 patients reporting for the follow-up visit, and this corresponds to 2.1% of the studied group. The postoperative hydrocele occurred in 20 patients, of which 5 (5.3% of the studied group) required surgical treatment with the Winkelmann technique, while in 15 (15.9% of the studied group) disappeared spontaneously during the average follow-up period of 1 year. No other intra- or postoperative complications occurred in any patient. Also no case of testicular atrophy was diagnosed. CONCLUSION: The results obtained from our laparoscopy patients using the Palomo method in treatment of varicocele can be considered satisfactory.

The retroperitoneal, inguinal approach to distal part of the ureter.

INTRODUCTION: The inguinal approach to the distal part of the ureter allows the surgeon to perform various types of procedures and is considered to be one of the minimally invasive techniques in pediatric surgery. We aim to describe our initial experience with the surgery of the distal ureter performed through an inguinal mini-incision. MATERIAL AND METHODS: Between March 2012 and June 2013, 8 patients were treated using a minimally invasive inguinal technique. The indications for surgical correction were single system primary obstructive megaureter, obstructive megaureter of the upper pole in a duplex kidney and distal ureteral stones. In all patients with single system obstructive megaureter and significant hydronephrosis, ureterocutaneostomy was performed. In one patient with duplex system primary obstructive megaureter and significant hydronephrosis of the upper pole, ureteroureterostomy of the dilated ureter to the normal caliber ureter in the distal part was performed. In the second patient with duplex system primary obstructive megaureter and reduced marker excretion of the upper pole in renal scintigraphy, ureterocutaneostomy was performed. In both cases of distal ureteral stones, deposits were removed by a simple incision. RESULTS: We did not observe any perioperative or postoperative complications. The imaging studies have shown that ureteral dilatation decreased in all but one child in whom the upper pole and the ureter were resected due to lack of function. CONCLUSIONS: The inguinal approach allows for the adequate visualization of the distal ureter, creating the conditions for implementation of the various procedures, reduces the risk of retrovesical plexus injury and minimizes visible scars.

Clinical consequences of nephrectomy performed on medical grounds.

UNLABELLED: Epidemiological data show that chronic kidney disease (CKD) is a serious social problem and nowadays is included amongst civilisation diseases. Knowing the relation between decrease in the number of nephrons and progressing kidney damage caused by it, we can treated each nephrectomy from medical reasons as a risk factor for development of CKD. The aim of this study was a retrospective analysis of clinical effects of nephrectomy, taking into account evaluation of a functional status of the sole kidney. PATIENTS AND METHODS: The study covered 182 patients after nephrectomy in the period from 1979 to 2008. The morphological and functional status of the remaining kidney was evaluated using ultrasound scanning and on a basis of serum levels of creatinine, as well as the glomerular filtration rate. Occurrence of proteinuria and blood pressure values were also verified. RESULTS: The average creatinine serum levels increases after nephrectomy and is positively correlated with the age. The mean eGFR level is lower after nephrectomy and is correlated with kidney dimensions in the long-term control after nephrectomy, and with the age. The average systolic and diastolic blood pressure after nephrectomy in the long-term observation was higher as compare with values before procedure. Presence of protein in the urine of patients after nephrectomy correlated positively with increased blood pressure values. CONCLUSIONS: Nephrectomy constitute the risk factor of development of CKD and hypertension. Patients after nephrectomy needs systematic nephrological care to prevent CKD progression.

[Comparison of self-estimation of disuric disorders gauged IPSS scale and qualities of lives QoL with self-estimation of sexual life gauged by IIEF-5 scale]. / Porównanie samooceny dolegliwosci dysurycznych mierzonych przy uzyciu skali IPSS i jakosci zycia QoL z samoocena zycia plciowego mierzonego skala IIEF-5.

Evaluation of men with a point scale is a simple method that can be used both in primary care and specialist in-patient treatment. Although its use is not widespread. International scoring system for evaluation of symptoms of the prostate is common in Poland (IPSS). Responses to the questionnaire are the basis of IPSS scale. Quality of life form (QoL) is in addition to the scale of IPSS. It defines subjective assessment of patient well-being in case of symptoms of lower urinary tract at the same level as at the time of the study. 5-point questionnaire IIEF-5 has been used in Poland since 1999 to assess men's sexual life. The aim of the study is to compare the assessment of disuric disorders measured using the International Prostate System Score (IPSS) and Quality of Life scale versus scale of men's sexual self-esteem IIEF-5 in men at the age of 50-70. The study included 1746 randomly selected residents of the district Cracow-Downtown, at the age of 50-70. Medical interview was carried out (including complaints of lower urinary tract symptoms (IPSS), quality of life (QoL) and sexual dysfunction (IIEF-5); physical examination with assessment of individual systems with particular emphasis on genitourinary system, physical examination of the prostate (DRE), PSA level in total and free fractions, a biopsy of the prostate under ultrasound control if necessary. For the analysis qualified 1746 men. The men were divided into groups called groups of disease: a suspicion of prostate cancer, can not rule out prostate cancer, prostate cancer confirmed, probable benign prostatic hyperplasia (BPH), no lesions. The largest was the group with probable benign prostatic hyperplasia 64.89% of the total respondents, followed by a group of men without lesions, 26.29%, a group of probable prostate cancer was 6.41% of the respondents, a group with whom you can not rule out prostate cancer was 1.89%, the smallest was the group with confirmed prostate cancer, 0.52% of all male respondents. The age groups were: 498 respondents aged 50-54 years and 391 aged 55-59, 397 aged 60-64 and 460 aged 65-70. Mean age was 59.24 years. Ppicked up data were processed and analized by STATA- 5,0. Differences between groups relative to answers for the questions of scales: IPSS, QoL and IIEEF5 questionnaire were analized by Mann-Whitney, Kruskal- Wallis, Scheffe's and chi2 tests. Homogeneity of the IPSS were analised by a Cronbach coefficient test. Accordance of each questions of the scale to whole scale were analised by correlation and line regression tests. Based on the analysis of the total scale score by IPSS and QoL scale and quality of life questionnaire IIEF-5 showed that in the process of aging in the population more frequently in older than in younger men, there are complaints from the urinary tract and deteriorating quality of life of self-esteem and quality of life of sexual self-esteem. After analyzing the result of scale: IPSS, QoL, and IIEF-5 in the disease groups, it was found that the total score of IPSS differentiates men in the group with probable benign prostatic hyperplasia, from a group of men without lesions and men with suspected prostate cancer. Statistically significant reduction in quality of life (QoL) in patients with confirmed prostate cancer and in the group with probable benign prostatic hyperplasia compared with men without lesions. The highest self-esteem sex life (IIEF-5) was found in men without lesions and the lowest in the group with known prostate cancer. The scale of quality of life (QoL) was significantly positively correlated with the results of IPSS scale, as well as with each of its questions. Deterioration in the quality of life occurred as a crescendo pain of lower respiratory tract. With the increase in the incidence and severity of each symptom on a scale IPSS worsening of self-esteem was examined using a scale IIEF-5. U of men with the deterioration of the quality of life measured by the scale of QoL, worsening their sexual self-esteem scale IIEF-5. In the process of aging are growing complaints from the lower urinary tract, self-esteem deteriorates the quality of life, including sexual life, which is especially marked in men with enlarged prostate. The scale of quality of life (QoL) is significantly positively correlated with the results of IPSS scale. With the increase in the incidence and severity of symptoms on a scale IPSS had decreased self-test using the IIEF-5 scale. The deterioration of quality of life measured with QoL was associated with decreased sexual self-esteem scale IIEF-5.

[Strategy in preventing of uretero-intestinal anastomosis strictures in patients with low-pressure intestinal neobladder]. / Strategia postepowania w zapobieganiu zwezeniom zespolenia moczowodowo- jelitowego u chorych z niskocisnieniowym pecherzem jelitowym.

Ureteroileal stenoses occur in 1.2-20% patients with neobladders. They constitute a serious clinical complication since, as every obstruction of urine flow from the kidney. Ureteroileal stenoses develop usually within firs 6 to 12 months following the extended urological procedure such as radical cystectomy with the creation of ileal orthotopic neobladder. Ureteroileal stenosis belongs to the most difficult complications after creation of ileal neobladder. The experience of our clinic between 2001 and 2011 covers 3500 cases of patients with bladder cancer. 226 patients underwent cystectomy, 120 were treated with urinary diversion m. Bricker and 106 underwent low pressure ileal neobladder modo Studer. Ureters anastomosed with the intestine Michalowskis way of a flap. The authors performed 344 ureteroileal anastomoses, 212 ureteroileal anastomoses with the ileal neobladder modo Studer and 11 stenoses were detected, in 5 patients one-side, in 3 bilateral. In our practice there was altogether 11 detected stenoses which constitutes 5.18%. Based on our experience, in the course of radical removal of the bladder during the preparation of the least possible damage the blood supply ureter, ureter prior to implantation should be checked for leaks, catheter should be made of soft material. The performance of the left ureter to carry out the right side of the mesentery, be careful not without angulation. In the course of the uretero-intestinal anastomosis should not be stitched in place to destroy the vascular anastomosis of ureter to intestine anastomosis and the same should be done without tension. Protect the integrity of the anastomosis, aseptic oncology. Uretero-intestinal anastomosis performed without anti-reflux protection.

[Bladder cancer biomarkers]. / Wyznaczniki procesu nowotworowego w raku pecherza moczowego.

Bladder cancer is one of the most prevalent cancers worldwide. Non-muscle invasive bladder cancer has a 70% rate of recurrence. Its biological tendency to recur and progress mandates close follow-up for the early detection of recurrent tumors. Urine cytology is the most widely used noninvasive test to detect urothelial tumors. However, it is limited by its low sensitivity. On the other hand, cystoscopy is the gold standard procedure to follow patients with a history of bladder cancer but this test is invasive and expensive. Therefore, there is a real need to develop new tests that can be used in bladder cancer surveillance. In recent years there is a constant effort to find a better non-invasive marker for bladder cancer. Many markers for the detection of bladder cancers have been tested and almost all urinary markers reported are better than cytology with regard to sensitivity, but they score lower in specificity. Our knowledge of molecular pathways in bladder cancer is growing and new methods of marker development emerge, but the perfect marker is still to be found. Currently, there are not clinically usable molecular markers that can guide us in diagnosis or surveillance, nor guide us in lowering the frequency of urethrocystoscopy in bladder cancer. This article reports some of the more prominent urine markers in use today.