Music as an adjunct to combination analgesia for neonatal circumcision: A randomized controlled trial.

Introduction: Neonatal circumcision is one of the most frequently performed procedures in male infants; it is also particularly painful. In a previous trial, we showed that the combination of Eutectic Mixture of Local Anesthetics (EMLA) + Sucrose + Ring Block (RB) was significantly effective in reducing pain during circumcision.

Objective: In this study, we added music as an adjunct aiming to further reduce the pain scores.

Burnout of residents: Overview from various medical institutions - A suggested model for improvement.

Background: Burnout is a common issue among residents across the globe. Although several attempts were made to propose better working hours for residents, burnout is still prevalent as depicted by several studies.

Objectives: The aim of the paper is to review several worldwide studies related to burnout in residents and propose potential suggestions.

Practice patterns in ordering a voiding cystourethrogram for pediatric patients among different specialties in a Middle Eastern tertiary care center.

Introduction: Voiding cystourethrogram (VCUG) is a very popular test performed to evaluate genitourinary tract anomalies. Nevertheless, this test can be overused and can lead to unnecessary patient discomfort, radiation exposure, and cost. We sought to study the practice patterns in ordering a VCUG in a Middle Eastern tertiary care center.

Combination Analgesia for Neonatal Circumcision: A Randomized Controlled Trial.

Objectives: There is no consensus on the most effective pain management for neonatal circumcision. We sought to compare different modalities.

Methods: This is a double-blinded randomized controlled trial comparing 3 combination analgesics used during circumcision (EMLA + sucrose; EMLA + sucrose + dorsal penile nerve block [DPNB]; EMLA + sucrose + ring block [RB]) with the traditional topical analgesic cream EMLA alone.

Impact of Adjuvant Urinary Diversion versus Valve Ablation Alone on Progression from Chronic to End Stage Renal Disease in Posterior Urethral Valves: A Single Institution 15-Year Time-to-Event Analysis.

Purpose: Long-term progression to end stage renal disease of valve ablation alone vs ablation followed by additional urinary diversion were compared among children with stage 3 chronic kidney disease due to posterior urethral valves.

Materials And Methods: We performed a retrospective study of children with posterior urethral valves and stage 3 chronic kidney disease treated at a single institution between 1986 and 2011. The 3 treatment groups were classified as group 1-valve ablation alone, group 2-ablation plus subsequent vesicostomy and group 3-ablation followed by ureterostomies and/or pyelostomies.

Functioning metastatic paraganglioma of the urinary bladder in a 10-year-old child.

Paragangliomas of the urinary bladder are very rare tumours representing less than 1% of bladder tumours. Preoperative diagnosis is essential to avoid perioperative complications related to catecholamine release. A high index of suspicion should be maintained when the classical symptoms of voiding-related paroxysms of headache, palpitation and dizziness are present.

Partial nephrectomy for metastatic renal cell carcinoma: Where do we stand?

Nephron-sparing surgery (NSS) for renal cell carcinoma (RCC) offers comparable oncologic results, but a lower risk of chronic kidney disease, when compared with radical nephrectomy. However, there are limited data in the literature examining the safety of NSS in the setting of metastatic RCC. To evaluate the feasibility of NSS and impact on cancer-specific survival (CSS) in patients with metastatic disease, we performed a systematic review of the literature.

Congenital vesicovaginal fistula: spontaneous or forced? Two cases and literature review.

Introduction And Hypothesis: Congenital vesicovaginal fistula is an exceedingly rare entity. There is no consensus regarding the nature and origin of this condition. We report two cases with congenital vesicovaginal fistula and compile previously reported cases in the English literature.

TGF-β1 induces EMT reprogramming of porcine bladder urothelial cells into collagen producing fibroblasts-like cells in a Smad2/Smad3-dependent manner.

Activation of fibroblasts and their differentiation into myofibroblasts, excessive collagen production and fibrosis occurs in a number of bladder diseases. Similarly, conversion of epithelial cells into mesenchymal cells (EMT) has been shown to increase fibroblasts like cells. TGF-β1 can induce the EMT and the role of TGF-β1-induced EMT during bladder injury leading to fibrosis and possible organ failure is gaining increasing interest.

Comparative histological and functional controlled analysis of tubularized incised plate urethroplasty with and without dorsal inlay graft: a preliminary experimental study in rabbits.

Purpose: We analyzed the histological and functional characteristics of the tubularized incised plate vs dorsal inlay graft urethroplasty in an experimental rabbit model.

Materials And Methods: A total of 24 New Zealand male rabbits were randomly allocated into 4 groups, including sham operation, urethroplasty, tubularized incised plate urethroplasty and dorsal inlay graft urethroplasty. In the urethroplasty group the anterior urethral wall was half excised and the dorsal aspect was tubularized.

Physiological changes in transperitoneal versus retroperitoneal laparoscopy in children: a prospective analysis.

Purpose: The choice of minimally invasive surgical approaches in pediatric urology is largely influenced by surgeon preference and experience. Little is known about the differences in physiological variables that might objectively influence the choice of surgical approach. We compared the cerebral and systemic hemodynamic effects of transperitoneal vs retroperitoneal CO(2) insufflation in children.

Current status of retrograde intrarenal surgery for management of nephrolithiasis in children.

Purpose: To review the current status of retrograde intrarenal surgery (RIRS) for renal stones in children focusing on its indications, outcomes and success in the management of nephrolithiasis.

Materials And Methods: Between 1988 and 2009, a comprehensive PubMed/MEDLINE literature review on RIRS was conducted.

Results: The available literature is limited and heterogeneous, skewed by favorable results on ureteral stone outcomes.

Hypertension in children with poorly functioning unilateral kidneys: predictors of resolution after nephrectomy.

Objective: To identify the outcome of nephrectomy and predictors of hypertension (HTN) resolution in children with poorly functioning unilateral kidneys (differential renal function, DRF of < 15%), as concurrent HTN is often an indication for nephrectomy.

Patients And Methods: Over a 7.5-year period, a single centre retrospective analysis of 89 children with unilateral nonfunctioning/poorly functioning kidney who underwent nephrectomy was conducted.

Do patients with classic bladder exstrophy have fecal incontinence? A web-based study.

Objectives: To explore the occurrence of fecal incontinence in patients with classic bladder exstrophy (CBE) by administering a web-based pilot study.

Methods: A questionnaire assessing fecal continence status was devised. Questions included demographics, age to achieve toilet training for bowels, and the patient perception of the degree of fecal soiling during day and night, if present.

Assessment of urethral plate appearance through digital photography: do pediatric urologists agree in their visual impressions of the urethral plate in children with hypospadias?

Objective: There is a paucity of literature on a definition or set criteria evaluating urethral plate (UP) quality. We sought to determine whether pediatric urologists are in agreement in their assessment of UP quality.

Materials And Methods: A cohort of 21 pediatric urologists attending a national annual meeting were surveyed with a questionnaire inquiring about practice patterns and perceived impressions of UP quality.

Pediatric urology training: performance-based assessment using the fundamentals of laparoscopic surgery.

Background: Despite the proven utility of laparoscopy in pediatric urology, widespread adoption of the surgical approach has been limited. The Fundamentals of Laparoscopic Surgery (FLS) is a reliable teaching mode for surgeons. Our study objective was to evaluate the effectiveness of a laparoscopic training course via a performance based assessment of participants' technical skills on the FLS module.

Ureteral duplication with lower pole ureteropelvic junction obstruction: laparoscopic pyeloureterostomy as alternative to open approach in children.

Objectives: Despite the widespread introduction of laparoscopy in pediatric urology, many reconstructive procedures, such as ureterostomy and pyeloureterostomy, are still performed in an open fashion because of the perceived intricacy and demanding nature. As we continue to introduce advanced laparoscopic skills into the care of children, we describe our laparoscopic pyeloureterostomy technique for correction of lower pole ureteropelvic junction obstruction in a pediatric patient with duplication anomaly.

Methods: The pyeloureterostomy was performed laparoscopically, using three 5-mm trocars.

Distal hypospadias repair with or without foreskin reconstruction: A single-surgeon experience.

Objective: Dartos flap coverage is routinely used as a protective layer during tubularized incised plate urethroplasty (TIPU) except when an associated foreskin reconstruction (FSR) precludes its use. In this study we compare the outcome of distal hypospadias repair with and without foreskin reconstruction by the same surgeon.

Materials And Methods: Between September 2002 and June 2007, 215 children with distal hypospadias underwent stented TIPU by a single surgeon.

Potential complications with the prescrotal approach for the palpable undescended testis? A comparison of single prescrotal incision to the traditional inguinal approach.

Purpose: Prescrotal orchiopexy is emerging as an alternative surgical approach to undescended testicles. We compare operative times, success rates and complications of single incision prescrotal orchiopexy and the traditional inguinal approach.

Materials And Methods: During a 3-year period all patients who underwent prescrotal orchiopexy were retrospectively reviewed and compared to age matched controls operated on via the traditional inguinal approach.

Pathological correlation between needle biopsy and radical prostatectomy specimen in patients with localized prostate cancer.

Objective: This study aims to evaluate the accuracy of transrectal ultrasound (TRUS) guided prostate biopsies in predicting pathological grading and tumour distribution in the final pathological specimen of patients who underwent radical prostatectomy for clinically localized prostate cancer. The study ultimately aims to gain more understanding of the pathological behaviour of prostate cancer and the limitations of the currently available diagnostic and prognostic tools.

Material And Methods: We reviewed the records of 100 patients with localized carcinoma of the prostate diagnosed by TRUS-guided prostate biopsy and treated with radical retropubic prostatectomy, comparing tumour laterality and Gleason score in core biopsies with tumour distribution and Gleason score of the surgical specimen.

Secondary adenocarcinoma of the urinary bladder from a primary gastric cancer.

Primary bladder tumor is a frequent urological malignancy, whereas the incidence of secondary bladder tumor from a distant organ is quite rare. Secondary bladder neoplasms represent no more than 3% of all malignant bladder tumors in surgical specimens, of which distant metastases from stomach account for about 4%. The signs of bladder neoplasm in a patient with malignancy elsewhere should alarm the clinician for a possible metastatic origin.

The workup of microscopic and gross hematuria.

Based on the American Urological Association best practice policy statement, the workup of microscopic hematuria is summarized in the above algorithm (Fig. 1). The presence of gross hematuria is always an indication for prompt full investigation.