Proximal hypospadias Kraft, Kate H; Shukla, Aseem R; Canning, Douglas A
TheScientificWorld,
04/2011, Letnik:
11
Journal Article
Recenzirano
Odprti dostop
Hypospadias results from abnormal development of the penis that leaves the urethral meatus proximal to its normal glanular position. Meatal position may be located anywhere along the penile shaft, ...but more severe forms of hypospadias may have a urethral meatus located at the scrotum or perineum. The spectrum of abnormalities may also include ventral curvature of the penis, a dorsally redundant prepuce, and atrophic corpus spongiosum. Due to the severity of these abnormalities, proximal hypospadias often requires more extensive reconstruction in order to achieve an anatomically and functionally successful result. We review the spectrum of proximal hypospadias etiology, presentation, correction, and possible associated complications.
PURPOSEBladder exstrophy (BE) poses challenges both during the surgical repair and throughout follow-up. In 2013, a multi-institutional BE consortium was initiated, which included utilization of ...unified surgical principles for the complete primary repair of exstrophy (CPRE), real-time coaching, ongoing video capture and review of video footage, prospective data collection, and routine patient data analysis, with the goal of optimizing the surgical procedure to minimize devastating complications such as glans ischemia and bladder dehiscence while maximizing the rate of volitional voiding with continence and long-term protection of the upper tracts. This study reports on our short-term complications and intermediate-term continence outcomes.MATERIALS AND METHODSA single prospective database for all patients undergoing surgery with a BE epispadias complex diagnosis at 3 institutions since February 2013 was used. For this study, data for children with a diagnosis of classic BE who underwent primary CPRE from February 2013 to February 2021 were collected. Data recorded included sex, age at CPRE, adjunct surgeries including ureteral reimplantations and hernia repairs at the time of CPRE, osteotomies, and immobilization techniques, and subsequent surgeries. Data on short-term postoperative outcomes, defined as those occurring within the first 90 days after surgery, were abstracted. In addition, intermediate-term outcomes were obtained for patients operated on between February 2013 and February 2017 to maintain a minimum follow-up of 4 years. Outcomes included upper tract dilation on renal and bladder ultrasound, presence of vesicoureteral reflux, cortical defects on nuclear scintigraphy, and continence status. Bladder emptying was assessed with respect to spontaneous voiding ability, need for clean intermittent catheterization, and duration of dry intervals. All operating room encounters that occurred subsequent to initial CPRE were recorded.RESULTSCPRE was performed in 92 classic BE patients in the first 8 years of the collaboration (62 boys), including 46 (29 boys) during the first 4 years. In the complete cohort, the median (interquartile range) age at CPRE was 79 (50.3) days. Bilateral iliac osteotomies were performed in 89 (97%) patients (42 anterior and 47 posterior). Of those undergoing osteotomies 84 were immobilized in a spica cast (including the 3 patients who did not have an osteotomy), 6 in modified Bryant's traction, and 2 in external fixation with Buck's traction. Sixteen (17%) patients underwent bilateral ureteral reimplantations at the time of CPRE. Nineteen (21%) underwent hernia repair at the time of CPRE, 6 of which were associated with orchiopexy. Short-term complications within 90 days occurred in 31 (34%), and there were 13 subsequent surgeries within the first 90 days. Intermediate-term outcomes were available for 40 of the 46 patients, who have between 4 and 8 years of follow-up, at a median of 5.7 year old. Thirty-three patients void volitionally, with variable dry intervals.CONCLUSIONSCumulative efforts of prospective data collection have provided granular data for evaluation. Short-term outcomes demonstrate no devastating complications, that is, penile injury or bladder dehiscence, but there were other significant complications requiring further surgeries. Intermediate-term data show that boys in particular show encouraging spontaneous voiding and continence status post CPRE, while girls have required modification of the surgical technique over time to address concerns with urinary retention. Overall, 40% of children with at least 4 years of follow-up are voiding with dry intervals of > 1 hour.
Utility-value (UV) interventions, in which students complete writing assignments about the personal usefulness of course material, show great promise for promoting interest and performance in ...introductory college science courses, as well as persistence in science, technology, engineering, and mathematics fields. As researchers move toward scaling up this intervention, it's important to understand which features are key to its effectiveness. For example, prior studies have used different types of UV assignments (i.e., self-focused essays and other-focused letters) and different assignment structures (i.e., over time, researchers provided a variety of tasks or choices between tasks), without comparing them. It is not known whether these assignment features are incidental details or key aspects of the intervention that impact its effectiveness. In the current study, we systematically compared different UV assignments, as well as ways of combining them, in a randomized controlled trial in an introductory college biology course (N = 590). Specifically, we compared different versions of the intervention in terms of their relative effectiveness for promoting course performance and the motivational mechanisms through which they operated. The intervention was most effective when students had opportunities to write about utility for both the self and others. Grades were higher in conditions in which students were either assigned a variety of self-focused and other-focused assignments or given the choice between the two. Among students with low performance expectations, grades were higher when students were assigned a specific combination: a self-focused assignment followed by other-focused assignments. Results suggest that different versions of the intervention may work through different mechanisms.
Educational Impact and Implications Statement
The current study is the first to systematically compare different versions of the UV intervention, in which students complete writing assignments describing how what they are learning is relevant and useful. Our results suggest that college science educators and intervention scientists can help students perform better in difficult introductory classes if they give students opportunities to write about utility for both themselves and close others over the course of the semester by giving students a variety of UV writing assignments or allowing them to choose between the different types.
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