A comprehensive analysis of robot-assisted surgery uptake in the pediatric surgical discipline

Artículo de revisión sistemática1-8Introduction: Robotic assisted surgery (RAS) is one of the most recent surgical approaches that has quickly been adopted by the pediatric urology community. Over the last decade, a vast amount of manuscripts has been published, supporting the safety and applicability of RAS in the pediatric population. The quality of published literature about this innovative technology remains supported by case-reports and retrospective case-series. Historical behavior of literature productivity and implementation of laparoscopy followed a similar trend. We present the historical publication uptake of RAS in pediatric urology and other surgical disciplines using a bibliometric comparison of the most cited manuscripts. Materials and Methods: A systematic search and review of the literature was undertaken by the authors. Literature search was performed in OVID, PubMed, EMBASE, Scopus, Web of Science, and Google Scholar. The search period included all publications between 1985 and June 2018. All languages were included. Data analysis for graphical representation was performed using VOSviewer® version 1.6.8 and Impact Index Analysis was used to adjust the citations by the time since publication. Results: A total of 1,014 titles were identified. After applying exclusion criteria, 200 papers were included for the RAS arm and 402 for the laparoscopic one. Case-series was the most common type of publication. Average citations for laparoscopic manuscripts was 23 (SD ± 31) and for RAS was 20 (SD ± 31.5). The impact index analysis showed an average of 95 (SD ± 167) for laparoscopic manuscripts vs. 66 (SD ± 101) for RAS. The laparoscopic manuscript with the highest citation count had 199 citations with an impact index of 12.1. And the RAS manuscript with the highest citation count had 280 citations and an impact index of 4.3. Conclusion: Literature productivity in pediatric laparoscopic and RAS has quickly grown. Pediatric Urologists play a key role in the introduction of this innovative tool. Literature supporting its implementation and future consolidation requires to focus on increasing the level of evidence

Prenatal exposure to organochlorine pesticides and TSH status in newborns from Southern Spain

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Acute labio-scrotal pain in a patient with ovotesticular syndrome. Case report

Q2Reporte de casoe123-e126Ovotesticular syndrome (OTS) belongs to the group of disorders of sex development (DSD). We present a case of a patient with OTS presenting with acute labioscrotal pain. A surgical exploration was indicated, and hemorrhage was identified. A gonadectomy was performed and the final pathology report revealed an ovotestis with a bleeding follicle, normal ovarian parenchyma and atrophic testicular parenchyma. After reviewing the literature there is scarce information on this complex topic, but conservative management could be an option if the risk of a gonadal malignancy is low

Is hypospadias a spectrum of different diseases? MAMLD1 gen : A new candidate gene for hypospadias

Las hipospadias resultan de un arresto en el desarrollo normal de la uretra, creando un meato ectópico proximal en la cara ventral del pene. Estudios moleculares y un mejor conocimiento de la embriogénesis del tubérculo genital demuestran una compleja interacción de genes, hormonas y el ambiente con el desarrollo de hipospadias. Es posible que esta entidad sea la expresión fenotípica común de varias enfermedades diferentes. Recientemente se describió un nuevo gen candidato en el desarrollo de hipospadias llamado MAMLD1, involucrado en la producción normal de testosterona durante la embriogénesis.Q4Artículo de revisión155-160Hypospadias is the result of an abnormal development of the urethra causing an ectopic and more proximal placement of the meatus in the ventral side of the penis. Recent molecular studies, and a better understanding of the normal development of the genital tubercle, have demonstrated a complex interaction between genes, hormones and the environment with the development of hypospadias. It is possible that hypospadias is the phenotypic expression of different diseases. Recently a new candidate gene for hypospadias has been discovered, called MAMLD1, which is involved in the normal production of testosterone during foetal development

Patrón termográfico en tiempo real para el monitoreo de reperfusión testicular intraoperatorio en caso de torsión testicular

Paciente de 5 años de edad con historia de 8 horas de torsión testicular es llevado a cirugía. Se realiza registro imaginonlógico termográfico seriado en tiempo real del momento en que se realiza la destorsión utilizando una cámara infrarroja FLIR One. La temperatura escrotal previa a la cirgía era de 43,6°C del lado afectado y 41,7°C del lado sano. La temperatura corporal del paciente era de 36,8°C. Inmediatemente el testiculo fue extraído y previo a la destorsión, la temperatura era de 31,5°C. A los 30 segundos de la destorsión la temperatura aumentó a 34,3°C. El uso de termografía intraoperatoria permite identificar cambios discretos que se correlacionan con aumento del flujo testicular. Estudios futuros se enfocarán en establecer variables predictorias de sobrevida del parenquima testicular al igual que definir variables intraoperatorias para definir manejos quirurgicos como orquiectomia, preservación con flap de tunica vaginal entre otras.294-298A 5-year-old patient presents to the emergency department with testicular torsion. Intraoperative sequential infrared thermographic images were registered in real-time using a FLIR One (FLIR Systems, Inc., Wilsonville, OR, US) infrared camera. The temperatures of the scrotum and the testis prior to scrotal exploration were 43.6°C on the affected side, and 41.7°C on the contralateral side. The core temperature of the patient was 36.8°C. Immediately after the tunica vaginalis had been opened and the testis had been brought out through the incision, the temperature of the testicle was 31.5°C. After 30 seconds of being detorted, the temperature increased to 34.3°C. The use of intraoperative infrared thermographic imaging helps to detect discrete changes in testicular temperature, which suggests it may be useful to objectively assess reperfusion. Future studies will require more patients to correlate postoperative blood flow to the injured testis as well as volume changes after surgery to see if the intraoperative thermography findings can be used as a predictive tool for postoperative outcomes

Recent GRBs observed with the 1.23m CAHA telescope and the status of its upgrade

We report on optical observations of Gamma-Ray Bursts (GRBs) followed up by our collaboration with the 1.23m telescope located at the Calar Alto observatory. The 1.23m telescope is an old facility, currently undergoing upgrades to enable fully autonomous response to GRB alerts. We discuss the current status of the control system upgrade of the 1.23m telescope. The upgrade is being done by the ARAE our group, based on members of IAA (Instituto de Astrofiisica de Andalucia). Currently the ARAE group is responsible to develop the BOOTES network of robotic telescopes based on the Remote Telescope System, 2nd Version (RTS2), which controls the available instruments and interacts with the EPICS database of Calar Alto. Currently the telescope can run fully autonomously or under observer supervision using RTS2. The fast reaction response mode for GRB reaction (typically with response times below 3 minutes from the GRB onset) still needs some development and testing. The telescope is usually operated in legacy interactive mode, with periods of supervised autonomous runs under RTS2. We show the preliminary results of several GRBs followed up with observer intervention during the testing phase of the 1.23m control software upgrade.Comment: 15 pages, 7 figures. Accepted for publication in the Special issue "Robotic Astronomy" of Advances in Astronomy. It includes two iterations with the referee

Description of Clinical Factors Associated with Testicular Torsion

Introducción La torsión testicular es una urgencia urológica que afecta 4,5 de cada 100.000 hombres menores de 25 años. Requiere un diagnóstico oportuno y una intervención en las primeras 4 a 6 horas para evitar la pérdida irreversible del parénquima testicular. Objetivo Describir los signos y síntomas más relevantes en el diagnóstico de torsión testicular. Materiales y Métodos Se recogió información de pacientes que consultaron por urgencias entre enero de 2010 y enero de 2015. De las historias clínicas se extrajeron: edad, lateralidad, síntomas, hallazgos al examen físico, intervención y hallazgos intraoperatorios. Las variables fueron evaluadas mediante análisis bivariado. Resultados Un total de 117 pacientes manifestaron como determinantes diagnósticos de torsión testicular: La edad entre 10 y 18 años, 67% de los casos (p¼0,0001). Al examen físico el tamaño del hemiescroto, la posición y orientación del testículo se presentaron respectivamente: 85% aumentado (p¼0,046), 60% ascendido (p¼0,048) y 67% horizontalizado (p¼0,004). El dolor “pulsatil”fue el más frecuente, descrito en un 63,4% de los casos (p¼0,028). Los que consultaron en las primeras 12 horas tuvieron mejor desenlace 63% (p¼0,0001) al igual que los intervenidos en las primeras 6 horas 80% (p¼0,049).Q4Artículo original167-173Introduction Testicular torsion is a urological emergency that affects 4.5 out of 100,000 men under 25 years. It requires prompt diagnosis and intervention within the first 4 to 6 hours to avoid irreversible loss of testicular parenchyma. Objective To describe the most important signs and symptoms in the diagnosis of testicular torsion. Materials and Methods We extracted information from the clinical records of patients who consulted to the emergency department between January 2010 and January 2015. The analyzed variables were: age, laterality, related symptoms, physical examination findings and intraoperative findings. The variables were evaluated by bivariate analysis. Results A total of 117 patients presented with testicular torsion: age range was between 10 and 18 years, 67% of cases (p¼0.0001). In the physical exam increased hemiscrotum size was present in 85% (p¼0.046), an ascended position was seen in 60% (p¼0.048) and 67% were horizontalized (p¼0.004). Pain described as “pulsatile”was the most common type in 63.4% of the cases (p¼0.028). Those who consulted within the first 12 hours had a better outcome (p¼0.0001), as well as those intervened within the first 6 hours (p¼0.049)

Overactive Bladder (non-neurogenic) in adults. Guideline of Sociedad Colombiana de Urología

Propósito El propósito de esta guía es generar lineamientos para una adecuada aproximación diagnóstica y terapéutica de la vejiga hiperactiva no neurogénica para lograr un adecuado control de los síntomas, disminución de las complicaciones y mejoría de la calidad de vida. Esta guía propone estrategias clínicas que pueden ser utilizadas sin olvidar la importancia de individualizar al paciente, y no debe ser interpretada rígidamente. Está dirigida a médicos con práctica general y especializada.Q4Guías de práctica clínica62.e1-62.e15Adulto

Long-term follow-up after traditional versus modified perineal approach in the management of female epispadias

Q2e1–497.e5Objective Isolated female epispadias (IFE) is a rare congenital anomaly. The defect extends to the bladder neck, which is usually incompetent. The traditional surgical approach includes urethral and genital reconstruction in the first year, followed by bladder neck reconstruction (Young-Dees-Leadbetter cervicoplasty (YDL)) at the age of social continence. An alternative single-stage technique includes urethral, bladder neck and clitoris repair by a perineal approach. The aim of the present study was to describe long-term follow-up of patients who underwent the traditional vs alternative approach. Materials and methods A retrospective review was performed of all female epispadias cases managed between 2000 and 2013. The YDL procedure (Group 1) vs single-stage perineal approach (Group 2) cases were followed and compared. Collected variables included: patients' demographics, age at diagnosis and surgery, presence of associated anomalies, clinical presentation, presence of vesicoureteral reflux (VUR), and pre-operative and postoperative continence. Results A total of 12 cases of female epispadias were managed and followed between 2000 and 2013. No major complications occurred in either group. Urinary continence evaluated in seven children showed that none (0/3) and 4/7 (57%) were continent following the initial procedure in Group 1 and Group 2, respectively. All patients in Group 1 failed to achieve continence and required re-intervention. Conclusions Female epispadias could be successfully repaired using a single-stage modified perineal approach that achieved good continence with volitional voiding, good cosmetic results and compared favorably with the ones repaired with the YDL technique. The additional step of performing bladder neck tailoring to achieve a funneling configuration seemed to be useful in improving continence