Urethrocutaneous fistula repair after hypospadias surgery

To evaluate and compare the success rates of simple and layered repairs of urethrocutaneous fistulae after hypospadias repair

And Yet they Co-Move! Public Capital and Productivity in OECD.

In this paper we add to the debate on the public capital-productivity link by applying very recent developments in the panel time series literature that take into account cross sectional correlation in non-stationary panels. In particular we evaluate the productive effect of public capital by estimating various production functions on a panel of 21 OECD countries over the period 1975-2002. Our results suggest that public capital has a positive long run impact on output, with elasticities that range between 0.05-0.15, depending on model specification. These findings are robust to the existence of spillover effects from public capital investments in other countries and to the inclusion of other productivity determinants, like human capital, the stock of patents and R&D capital. Finally, we do not find any important effect of public capital on GDP in the short run: this suggests that public infrastructure investments might not be a powerful countercyclical policy instrument

Diagnostic laparoscopy in a Gartner's duct cyst

Gartner's duct cysts associated with renal dysgenesis are rare malformations and represent a diagnostic challenge. We report on one such case in which final diagnosis was achieved by laparoscopy and discuss the possible role of minimally invasive surgery in the management of this condition

Searching for the Least Invasive Management of Pelvi-Ureteric Junction Obstruction in Children: A Critical Literature Review of Comparative Outcomes

Introduction: To review the published evidence on the minimally invasive pyeloplasty techniques available currently with particular emphasis on the comparative data about the various minimally invasive alternatives to treat pelvi-ureteric junction obstruction and gauge if one should be favored under certain circumstances. Materials and Methods: Non-systematic review of literature on open and minimally invasive pyeloplasty including various kinds of laparoscopic procedures, the robotic-assisted laparoscopic pyeloplasty, and endourological procedures. Results: Any particular minimally invasive pyeloplasty procedure seems feasible in experienced hands, irrespective of age including infants. Comparative data suggest that the robotic-assisted procedure has gained wider acceptance mainly because it is ergonomically more suited to surgeon well-being and facilitates advanced skills with dexterity thanks to 7 degrees of freedom. However, costs remain the major drawback of robotic surgery. In young children and infants, instead, open surgery can be performed via a relatively small incision and quicker time frame. Conclusions: The best approach for pyeloplasty is still a matter of debate. The robotic approach has gained increasing acceptance over the last years with major advantages of the surgeon well-being and ergonomics and the ease of suturing. Evidence, however, may favor the use of open surgery in infancy

Transurethral incision of duplex system ureteroceles in neonates: does it increase the need for secondary surgery in intravesical and ectopic cases?

Abstract: OBJECTIVE To evaluate the relevance of ureterocele ectopia and associated reflux on the outcome of duplex system ureteroceles (DSU) after neonatal transurethral incision (TUI). PATIENTS AND METHODS The study included 41 neonates with a diagnosis of DSU; the ureterocele was ectopic in 24 (58%). Before TUI, vesico-ureteric reflux (VUR) was present in 13 lower moieties (32%) and seven contralateral ureters (17%). TUI was always performed within the first month of life. The follow-up and management were tailored for each patient from the findings at ultrasonography, voiding cysto-urethrography and renal scintigraphy. Results of intravesical and ectopic DSU were compared using Fisher''s exact test. RESULTS TUI was effective in allowing ureteric decompression in all but one patient (2.4%). After TUI, VUR ceased in six lower ipsilateral moieties and in two contralateral ureters, while new VUR occurred in three contralateral kidneys. De novo VUR in the punctured moiety appeared in 13 cases (32%). Nine upper poles were not functioning. Twenty-one patients (51%) required secondary surgery. Ureteric reimplantation was indicated exclusively for reflux in the punctured moiety in only in two cases (5%), while in a further two iatrogenic reflux in a nonfunctioning upper moiety required total heminephro-ureterectomy. There was no significant difference between intravesical and ectopic ureteroceles in the occurrence of VUR in the punctured moiety, rate of nonfunctioning upper poles or need for secondary surgery. CONCLUSIONS About half of the patients with a DSU need secondary surgery, but this is rarely indicated for de novo reflux in the punctured moiety only. The need for secondary surgery was greater whenever there was associated reflux before endoscopic incision. There was no difference in the outcome of intravesical and ectopic ureteroceles and such distinction seems no longer to be of clinical relevanc

Double-J stent insertion across vesicoureteral junction--is it a valuable initial approach in neonates and infants with severe primary nonrefluxing megaureter?

Abstract: Objectives. To evaluate the role of double-J stent insertion in perinatally detected primary nonrefluxing megaureters as a method to temporize treatment in patients with impaired renal function or to prevent function loss in patients treated expectantly, but deemed at high risk of deterioration. Methods. Two neonates and 8 infants with a ureter greater than 10 mm and an obstructive excretion pattern, including 3 cases with renal function less than 40%, were selected to undergo double-J stent insertion for a 6-month period. Patients underwent surgery if the ureter redilated and the excretion pattern was obstructive at reassessment 3 months after stent removal. Results. Stents were placed at a median age of 3 months (range 1 to 6). Open insertion was necessary in 5 cases (50%). Seven patients (70%) developed stent-related complications (five breakthrough urinary infections) requiring early stent removal in 2 (20%). Five patients (50%) underwent surgery at a median age of 14 months (range 13 to 27), including the 3 patients with decreased renal function at presentation. None required ureteral tapering. None experienced any renal function loss with respect to the initial evaluation. Conclusions. Double-J stent insertion across the vesicoureteral junction allows for effective internal drainage of primary nonrefluxing megaureters, but at the cost of a 70% morbidity rate and various technical drawbacks. Therefore, stenting should be considered on a case-by-case basis. The procedure seems valuable to temporize surgery in patients with decreased renal function. However, given the associated morbidity, it seems impractical for patients with preserved function selected in accordance with currently available prognostic indicators

Discrepancy between power-Doppler voiding urosonography and voiding cystourethrography is not relevant for the management of primary vesicoureteric reflux

Abstract: Aim: The aim of this study was to assess if discrepancy between power-Doppler voiding urosonography (PD-VUS) and voiding cystourethrography (VCUG) affects the management of patients with primary vesicoureteric reflux (VUR). Materials and Methods: Fifty-six children with suspected or known VUR were assessed both by PD-VUS and VCUG. Two independent observers, both pediatric surgeons, each aware of the results of only one imaging modality, advised children's management according to present care standards. Agreement between diagnostic findings at the two imaging modalities and between therapeutic advice of the two observers was evaluated Using K statistics. Results: PD-VUS diagnosed VUR in 3 patients and 6 ureteral units more than VCUG. VCUG showed VUR in 2 ureteral units, but in no patient more than PD-VUS. Accuracy of PD-VUS compared with VCUG was 92.8% and 94.6% considering ureteral units and patients, respectively. The two observers disagreed about the management of 4 (7%) of 56 cases. Agreement was significant (P < .001) both between findings at the two imaging modalities and between management options advised by the two independent observers

Adjustment and transformation strategies of ItalPoS Permanent GNSS Network

A private network of 133 Global Navigation Satellite Systems (GNSS) permanent sites, named ItalPoS (Italian Positioning Service) and uniformly covering the entire Italian territory, was established in April 2006 by the Italian Division of Leica Geosystems S.p.A. This network also involves several GPS stations of the INGV (Italian National Institute of Geophysics and Volcanology) RING (Real-time Integrated National Gps) network and GPS stations from other public and private bodies. Indeed Leica Geosystems contributed with its experience and its products to these networks which currently fulfil the national coverage where there are no ItalPoS stations. For instance, the purpose of the ItalPoS network is mainly GNSS data distribution in terms of real time corrections and RINEX files for the post-processing. In order to compute and distribute to private and scientific users a set of adjusted coordinates of the ItalPoS network in the IGS05 and ETRF89-2000 reference frames, a dataset of RINEX of about 120 GPS permanent sites was created and processed, using the distributed sessions approach, by means of Gamit/Globk 10.3 GPS data processor, also using some SOPAC (Scripps Orbits and Permanent Array Center) and EUREF (European Permanent Network) solutions to improve the reference frame definition and the internal constraints. This paper describes all the strategies adopted to estimate coordinates and velocities of the ItalPoS Network in IGS05 and in ETRF89-2000 reference frames in the whole Italian territory