A wide range of topics is covered in the Paediatric Urology section in this month's issue: retrograde ureteroscopy for distal ureteric stones, outcomes of continent catheterizable stomas for urinary ...and faecal incontinence, an exploration of a possible common cause between enuresis in childhood and urinary and faecal incontinence in adult life, and a description of a new surgical procedure, the colpo‐wrap.
OBJECTIVE
To compare the efficacy and safety of ureteroscopy plus intracorporeal lithotripsy (ULT) with extracorporeal shock wave lithotripsy (ESWL) for treating distal ureteric calculi in childhood, as such stones are commonly treated by ESWL as the first option in adults but there is no agreement on the method of treating them in children.
PATIENTS AND METHODS
From July 2002 to July 2003, children presenting with ureteric stones were consecutively randomized for treatment using ULT or ESWL. The two groups were matched for age, sex and stone position in the distal ureter. A 7.5 F ureteroscope combined with a ballistic lithotripter or holmium‐YAG laser was used for ULT. ESWL was administered using a second‐generation lithotripter. The success rate, effectiveness quotient, complication rate and hospitalization were evaluated and compared using Student's t‐test (chi‐square) and Fisher's exact test as appropriate. In all, 31 patients (21 girls and 10 boys, mean age 7.2 years, range 2–17) were treated, by ULT in 17 (12 girls and five boys) and ESWL as a primary procedure in 14 (five boys and nine girls).
RESULTS
After one ULT, all the girls and four boys, and after ESWL, four girls and two boys, were rendered stone‐free at the first treatment. The total stone‐free rate was 16 of 17 for ULT and six of 14 for ESWL (P = 0.004). Eight patients had a second ESWL and three then became stone‐free. The five patients in whom both ESWL treatments failed had a successful ULT. There was no significant difference between the groups in complication rate and hospitalization. General anaesthesia was required in all patients <12 years old treated by ULT or ESWL. The calculated efficiency quotient for treating distal ureteric calculi was significantly lower for ESWL than ULT (P < 0.05).
CONCLUSIONS
ULT should be recommended as the treatment of choice for distal ureteric calculi in children; using small ureteroscopes the target stone was treated safely and effectively.
A particular case of hydronephrosis in ectopic kidney due to a malrotation and vascular anomalies in a young girl is described. The patient was previously operated for ureteropelvic junction ...obstruction at the age of two. Clinic and radiographic and pathologic findings are discussed and the literature is reviewed.
Gambling disorder has been recently reclassified under the category “substance-related and addictive disorders”. Recent studies performed through functional MRI (fMRI) have shown that the ...perseverance of some behaviors can alter brain activation 1,2. In this work we aim at investigating functional connectivity changes in pathological gamblers (PGs) in comparison to healthy controls (HCs) by means of resting state functional Magnetic Resonance Imaging (rs-fMRI).
Thirteen HCs and fourteen PGs were recruited (all right handed males; drugs free; mean age 36 ± 10 yrs). All acquisitions were performed through a 1,5 T MRI scanner using a 8-channels phased-array head coil. Multi-session temporal concatenated Independent Component Analysis (concat-ICA) was carried out to achieve activations information on functionally linked brain regions. The resulted components were then matched and compared between groups. Correction for multiple comparisons across space was applied assuming an overall significance of p < 0.05 using permutation testing and threshold-free cluster enhancement.
Functional connectivity was found to be increased in PGs, compared to HCs, in several networks including: anterior cingulate cortex, accumbens nucleus, head of the caudate nucleus, middle left temporal gyrus, right insula, right cerebellar hemisphere cortex and cerebellar vermis.
We can conclude that an hyperconnectivity together with an overactivation of specific regions is observed in PGs. The persistent activation of specific functional networks during gambling tasks might represent the neurofunctional basis of PGs state-reduced triggering threshold to gaming underlying the clinical features of gambling disorder. These preliminary results confirms the crucial role of fMRI studies to investigate brain networks and their changes in specific clinical functional disorders.
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