Proximal Defects Research Articles

Mathematical modeling of dynamic loading features of hip joint after resection of proximal femur tumors

The problem of achieving positive results in the treatment of patients with tumors of the upper third of the femur remains relevant. Among the methods for studying the functioning of the hip joint and for analyzing the specific loads it is used mathematical modeling method. Purpose: using the method of mathematical modeling, to study the characteristics of dynamic load in hip joint with the presence of bone and soft tissue post-resection defects in the upper third of the femur.Methods: in this study method of mathematical modeling by OpenSim software has been used. Basic muscle-skeletal model and created models with reproduction of hip joint condition after the resection of malignant tumor of the upper third of the femur and proximal femur replacement with and without myoplasty used. Load transmitted from the endoprosthesis head to the acetabulum studied. Results: it is revealed change of load direction from the anterior toward posterior acetabular wall with threefold volume in comparison to basic model was defined during the modeling process and analyzing of significant defects in femoral abduction and flexion muscles with substitution of proximal femur defects using modular endorposthesis. Also, important decline of pressing load to the acetabular bottom noted. This situation results in severe function impairment of the lower extremity and determines hip joint instability. Method of abduction muscles repair at the cost of proximal transposition of m. vests laterals allows to compensate load changes in the acetabulum.Conclusion: reproduction of abduction muscle defects in the model results in load direction changes in anteposterior direction, functional impairment of the lower extremity and increases risk of hip joint instability. Appropriate method of abduction muscle defects repair using m. vastus laterals is presented.

Clinical Application of Technetium-99m-Labeled Red Blood Cells Subcutaneous Radionuclide Venography and Abdominal/Pelvic Hybrid SPECT/CT Imaging in Patients with Suspicion of Proximal Deep Vein Thrombosis

Technetium-99m-labeled red blood cells subcutaneous radionuclide venography can apply to evaluate deep venous flow of lower extremities. We introduce additional abdominal/pelvic hybrid SPECT/CT (single-photon emission computed tomography with computed tomography) to scrutinize the proximal deep venous flow defects in the iliac vein. SPECT/CT imaging is collected when disturbed or asymmetrical iliac venous flow is noted on the planar imaging of Tc-99m-labeled red blood cells subcutaneous radionuclide venography. The region of SPECT/CT imaging includes abdominal aorta, inferior vena cava and bilateral iliac vessels. We present three cases with suspicion of deep vein thrombosis in the iliac vein. Tc-99m-labeled red blood cells subcutaneous radionuclide venography with SPECT/CT revealed not only provides us the venous flow but also other information including abnormal vessel structure, space-occupying lesion and abnormality in other organs. In conclusion, if disturbed or asymmetrical iliac venous flow and abnormal collateral venous drainage in the abdomen are noted on the Tc-99mlabeled red blood cells subcutaneous radionuclide venography, SPECT/CT imaging may arrange for further information and differential diagnosis of lower extremities swelling; not only in detecting deep vein thrombosis.

Treatment of Bone Defect with Modular Metal Augmentation Using a Downsized Block in Total Knee Arthroplasty: Technical Note and Report of 17 Cases

In total knee arthroplasty (TKA), a treatment of bone defect varies depending on the location and extent of defect and requires proper surgical procedure. Metal augmentation is readily available for both femoral and tibial bone defects. We report the operative technique of modular metal augmentation using a downsized block for ambiguous proximal tibial and distal femoral bone defects in primary and revision TKA. Regarding bone defects, bone loss can be minimized by using a different size of metal augmentation, and suitable reinforcement for bone defects can be achieved. Once our technique is properly used, it will be very helpful in treating bone defects.

Vascularized fibular graft for chronic osteomyelitis of humerus in a 10 years child

Introduction: Reconstruction of large skeletal defects secondary to osteomyelitis remains a challenging problem. Free vascularized bone can be used to reconstruct large skeletal defects greater than 6 cm or bone defects of smaller size that failed to heal with nonvascularized bone grafting. There are only few case reports which describe it in such a young age group. Case report: We report a case of a 9 years male child with a right proximal humerus osteomyelitic defect treated with a vascularized fibular graft and plating with a 6 months follow up having a satisfactory functional outcome. Conclusion: free vascularized fibula transfer is an efficient technique for exceptional cases of multi-operated and aseptic resistant non-union with bone defect of the humerus. The indications for vascularized bone grafting are skeletal defects greater than 6 cm or smaller defects that have failed to heal with nonvascular bone graft with a reported success rate of 77%-90%.

Premature Infant With Abdominal Wall and Proximal Lower Limb Defects

A premature newborn was found to have a previously unknown lower abdominal defect. ### Prenatal and Birth Histories: ### Presentation: The infant had no respiratory effort at birth and was intubated in the delivery room. A large abdominal defect was noted, and stool was seen passing from a patent anus. Initial heart rate was 55 beats per minute. Positive pressure ventilation, surfactant, and chest compressions were administered without result. An emergency umbilical venous catheter was inserted, and the infant received 5 rounds of epinephrine and empiric bilateral thoracenteses before resuscitation was discontinued because of lack of response. The parents declined autopsy. ### Physical Examination: Postresuscitation examination revealed redundant skin over the scalp and neck. There was a 5-cm-long, transverse, full-thickness infraumbilical abdominal defect with liver and gallbladder exposed. The small intestine was completely eviscerated. Bilateral, symmetrical, 3-cm-long skin defects …

A conserved genetic mechanism specifies deutocerebral appendage identity in insects and arachnids

The segmental architecture of the arthropod head is one of the most controversial topics in the evolutionary developmental biology of arthropods. The deutocerebral (second) segment of the head is putatively homologous across Arthropoda, as inferred from the segmental distribution of the tripartite brain and the absence of Hox gene expression of this anterior-most, appendage-bearing segment. While this homology statement implies a putative common mechanism for differentiation of deutocerebral appendages across arthropods, experimental data for deutocerebral appendage fate specification are limited to winged insects. Mandibulates (hexapods, crustaceans and myriapods) bear a characteristic pair of antennae on the deutocerebral segment, whereas chelicerates (e.g. spiders, scorpions, harvestmen) bear the eponymous chelicerae. In such hexapods as the fruit fly, Drosophila melanogaster, and the cricket, Gryllus bimaculatus, cephalic appendages are differentiated from the thoracic appendages (legs) by the activity of the appendage patterning gene homothorax (hth). Here we show that embryonic RNA interference against hth in the harvestman Phalangium opilio results in homeonotic chelicera-to-leg transformations, and also in some cases pedipalp-to-leg transformations. In more strongly affected embryos, adjacent appendages undergo fusion and/or truncation, and legs display proximal defects, suggesting conservation of additional functions of hth in patterning the antero-posterior and proximo-distal appendage axes. Expression signal of anterior Hox genes labial, proboscipedia and Deformed is diminished, but not absent, in hth RNAi embryos, consistent with results previously obtained with the insect G. bimaculatus. Our results substantiate a deep homology across arthropods of the mechanism whereby cephalic appendages are differentiated from locomotory appendages.

Interim Clinical Outcomes in Nanocomposite Bone Material Repairing Large Proximal Femoral Defect of Fibrous Dysplasia

Background and Objectives. To evaluate the clinical effectiveness and safety of using nanocomposite bone material in the repair of large proximal femoral defects that are due to fibrous dysplasia. Method. Thirty‐one patients were analyzed retrospectively, including 13 males and 18 females, and the mean age was 30.9 years (13–59). The median follow‐up period was 50 months (30–78) and the masses of artificial bone transplants were in the range of 15~40 g (average of 23.4 g). Functional and radiographic outcomes were evaluated. Results. All wounds healed to grade A. There were no infections, nonspecific inflammatory reactions, rejection reactions, or fractures. One case had fat liquefaction and healed after dressing. All patients had no recurrence until the last follow‐up. At the last follow‐up, the mean Musculoskeletal Tumor Society’s (MSTS) 93 score was 28.42 ± 1.31, the mean Harris hip score was 84.23 ± 8.97, and mean radiopaque density ratio was 0.78 ± 0.09. Radiologic analysis indicated that nanocomposite bone material had been completely incorporated with the host bone within a year. Conclusions. This study indicated that the nanocomposite bone material had biological safety and good biocompatibility. In conclusion, the nanocomposite bone material is an ideal artificial bone substitute and worthy of promotion in the field of orthopedics.

Multidisciplinary Management of An Unusual Isolated Alveolar Bone Infection- A Rare Case Report

Restoration of proximal defect of tooth is of paramount importance as its improper restoration usually results in fracture of the restoration or deteriorated periodontal health. The article reports a case with a discreet mass of alveolar bone necrosis closed to the overhanged amalgam restoration in the proximal box of the maxillary molar. As a result of this improper proximal restoration it led to deep periodontal pocket and subsequent alveolar bone necrosis which was managed successfully with combined Endodontic-Periodontic treatment. This article highlights the unfortunate sequelae of bone necrosis as a consequence of an incorrect or overlooked dental treatment and its comprehensive management.

Impact of penile degloving and proximal ventral dissection on curvature correction in children with proximal hypospadias.

Penile degloving is an important step in orthoplasty. Although its role in correcting mild curvature in distal and midshaft hypospadias has been previously reported, its impact on ventral curvature (VC) correction in proximal defects warrants further investigation. Therefore, we sought to document the effect of degloving and proximal urethral dissection on VC correction in children with proximal hypospadias. We retrospectively reviewed the records of 137 patients who underwent proximal hypospadias repair between 1998 and 2006. VC, defined as mild (<30%), moderate (30%-45%), and severe (>45%), was recorded before penile degloving and after erection test. Percent improvement in VC and need for further treatment (beyond degloving and proximal dissection) based on preoperative degree of curvature were assessed. ANOVA test was used to compare improvement among the 3 groups. Mean age at repair was 14 months (range: 6-24). Penile degloving associated with proximal urethral dissection when necessary was responsible for the improvement in the degree of curvature in 7 of 9 (77%) patients with mild VC, 23 of 44 (52%) with moderate and 35 of 84 (40%) with severe VC. Additionally, degloving alone was sufficient for VC correction in 7 of 9 (77%) mild cases, 14 of 44 (30%) moderate and only 2 of 84 (2%) severe cases. The difference among these 3 groups was statistically significant (p < 0.001). Penile degloving alone can correct VC. The percentage of improvement depends on the preoperative degree of curvature, with severe VC cases showing the least improvement.

Simultaneous treatment of tibial bone and soft-tissue defects with bone transport

Objective To explore the curative efficacy of simultaneous treatment of tibial bone and soft-tissue defects with external fixator and bone transport.Methods From February 2006 to October 2012,7 patients with tibial bone and soft tissue defects were treated by bone transport at our department.They were 4 men and 3 women,with an average age of 31.8 years (from 16 to 52 years).All their fractures were Gustlio type Ⅲ B and 3 of them were complicated with infection.Their average Mangled Extremity Severity Score (MESS) was 4.8 points (from 4 to 6 points).Their average soft tissue loss after debridement was 30.4 cm2 (from 12 to 70 cm2),and their average bone defect was 9.2 cm long (from 4 to 17 cm).Distal tibial osteotomy for proximal migration to repair the bone defect was used in 4 cases of proximal tibial defect while proximal tibial osteotomy for distal migration was used in the other 3 cases of distal defect.The wounds were covered by vacuum sealing drainage (VSD) dressing or filled with povidone-iodine gauze.Results The average follow-up period was 19.3 months (from 9 to 36 months).Bone defects were repaired in all.Primary bone healing was achieved in 5 cases while bone grafting had to be performed in the other 2 cases to repair bone non-union after bone transport.The average healing index (healing time/defect length) was 1.8 month/cm.The wounds were healed in all the 7 cases,6 of which obtained primary healing and one of which healed after skin grafting.The average time for wound healing was 3.3 months (from 2.5 to 6.0 months).Footdrop was observed in 2 cases and pin track infection in one.Conclusion Simultaneous treatment of complex defects at lower extremity with external fixator and bone transport should be recommended,because it is simple and efficient. Key words: Bone transplantation; Tibia; Wounds and injuries; External fixator; Tissue defect

Double metal tibial blocks augmentation in total knee arthroplasty

Severe uncontained tibial bone defects occurring during total knee arthroplasty are challenging, and which treatment method is the best remains unknown. In this study, clinical and radiographic outcomes of double metal blocks augmentation were examined. Between 2004 and 2012, double metal blocks augmentation was carried out in 17 patients with severe asymmetric uncontained tibial bone defects. The first block was attached to the tibial tray with screws, and then the second block was cemented to the first block. Out of 17 patients, 13 (8 primary, 5 revision) were available for final follow-up at a median of 69 months (range 24-99). For clinical assessment, range of motion and Knee Society score were evaluated preoperatively and annually thereafter. At the final follow-up, Western Ontario and McMaster Universities Osteoarthritis Index, Oxford knee, Short Form-36, Lower extremity functional scale, and Lower extremity activity scale scores were evaluated. Radiographic assessment for radiolucent lines at the block-cement-bone interfaces and signs of failure was performed annually using fluoroscopy and standard radiographs. Range of motion and Knee Society score were significantly improved post-operatively. Other clinical outcomes were favourable. Radiolucent lines were seen on fluoroscopy in three knees, but no sign of failure, such as loosening, collapse, or instability, was observed at the final follow-up. Double metal blocks augmentation is a favourable and useful method, which does not cause mechanical failure or protrusion of the prosthetic because of its modularity, to manage severe asymmetric uncontained proximal tibial bone defects >15 mm in total knee arthroplasty. Case series, Level IV.

Influence of proximal box elevation on the marginal quality and fracture behavior of root-filled molars restored with CAD/CAM ceramic or composite onlays.

This study investigated the influence of proximal box elevation (PBE) with composite resin when applied to deep proximal defects in root-filled molars with mesio-occluso-distal (MOD) cavities, which were subsequently restored with computer-aided designed/computer-aided manufacturing (CAD/CAM) ceramic or composite restorations. Root canal treatment was performed on 48 human mandibular molars. Standardized MOD cavities were prepared with the distal box located 2 mm below the cemento-enamel junction (CEJ). The teeth were randomly assigned to one of four experimental groups (n = 12). In groups G1 and G2, the distal proximal box was elevated up to the level of the CEJ with composite resin (PBE). No elevation was performed in the remaining two groups (G3, G4). CAD/CAM restorations were fabricated with feldspathic ceramic (Vita Mark II, CER) in groups G1 (PBE-CER) and G3 (CER) or with resin nano-ceramic blocks (Lava Ultimate, LAV) in groups G2 (PBE-LAV) and G4 (LAV). Replicas were taken before and after thermomechanical loading (TML; 1.2 Mio cycles; 49 N; 3,000 thermocycles between 50 °C and 5 °C). Following TML, load was applied until failure. Fracture analysis was performed under a stereomicroscope (×16). Marginal quality before and after TML (tooth restoration, composite restoration) was evaluated using scanning electron microscopy (×200). After TML, lower percentages of continuous margins were observed in groups G1-G3 compared with pre-TML assessments; however, the differences were not statistically significant. For group G4-LAV, the marginal quality after TML was significantly better than in any other group. The highest mean fracture value was recorded for group G4. No significant difference was found for this value between the groups with PBE compared with the groups without PBE, regardless of the material used. The specimens restored with ceramic onlays exhibited fractures that were mainly restricted to the restoration while, in teeth restored with composite onlays, the percentage of catastrophic failures (fractures beyond bone level) was increased. PBE had no impact on either the marginal integrity or the fracture behavior of root canal-treated mandibular molars restored with feldspathic ceramic onlays. CAD/CAM-fabricated composite onlays were more favorable than ceramic onlays in terms of both marginal quality and fracture resistance, particularly in specimens without PBE. Composite onlays with or without PBE may be a viable approach for the restoration of root-filled molars with subgingival MOD cavities.

Finite element assessment of block-augmented total knee arthroplasty

Loosening and migration of tibial prostheses have been identified as causes of early total knee replacement (TKR) failure. The problem is made more complex when defects occur in the proximal tibia compromising fixation and alignment. Clinical studies using metal augments have shown these to be an alternative to other means of defect treatment. Finite element (FE) analysis can be used to identify regions that may be prone to loosening and migration. In the current work, 3D FE models of TKR uncontained type-2 defects treated with block augments have been constructed and analysed. It has been shown that a metal augment is the most suitable. The use of bone cement (PMMA) to fill proximal defects is not considered suitable as stresses carried by the cement block exceed those of the fatigue limit of bone cement. It has been shown that the stresses in the proximal cancellous bone of block-augmented models are significantly below levels likely to cause damage due to overloading. Furthermore, the use of stem extensions has been shown to reduce the cancellous bone stresses in the proximal region thus increasing the likelihood of bone resorption. Given this, it is recommended that stem extensions are not required unless necessary to mitigate some other problem.

Avoidance and management of complications in open surgical ureter reconstruction

Open surgical reconstruction of the ureter is a urological procedure with a potentially high risk of complications. The correct selection of patients and time of operation are important aspects regarding the treatment strategy. Position and length of the affected ureter segment to be reconstructed determine the surgical intervention possibilities. The psoas hitch procedure is a well-established technique for distal reconstruction of the ureter where most iatrogenic injuries occur. In more proximal or complex defects, several procedures are available. Partial or complete replacement of the ureter with bowel is still considered the standard for bridging long ureteral defects but is accompanied with higher intra- and postoperative complication rates. In specific patients and situations, autotransplantation of the kidney and subcutaneous pyelovesical bypasses are clinical options. Using mucosal grafts or tissue engineering may be new therapeutic prospects to cover ureteral defects but the clinical impact still needs to be clarified. All therapeutic strategies share the fact that great surgical expertise and experience are necessary as the operative technique must be mastered to avoid severe complications.

SAMS, a Syndrome of Short Stature, Auditory-Canal Atresia, Mandibular Hypoplasia, and Skeletal Abnormalities Is a Unique Neurocristopathy Caused by Mutations in Goosecoid

Short stature, auditory canal atresia, mandibular hypoplasia, and skeletal abnormalities (SAMS) has been reported previously to be a rare, autosomal-recessive developmental disorder with other, unique rhizomelic skeletal anomalies. These include bilateral humeral hypoplasia, humeroscapular synostosis, pelvic abnormalities, and proximal defects of the femora. To identify the genetic basis of SAMS, we used molecular karyotyping and whole-exome sequencing (WES) to study small, unrelated families. Filtering of variants from the WES data included segregation analysis followed by comparison of in-house exomes. We identified a homozygous 306 kb microdeletion and homozygous predicted null mutations of GSC, encoding Goosecoid homeobox protein, a paired-like homeodomain transcription factor. This confirms that SAMS is a human malformation syndrome resulting from GSC mutations. Previously, Goosecoid has been shown to be a determinant at the Xenopus gastrula organizer region and a segment-polarity determinant in Drosophila. In the present report, we present data on Goosecoid protein localization in staged mouse embryos. These data and the SAMS clinical phenotype both suggest that Goosecoid is a downstream effector of the regulatory networks that define neural-crest cell-fate specification and subsequent mesoderm cell lineages in mammals, particularly during shoulder and hip formation. Our findings confirm that Goosecoid has an essential role in human craniofacial and joint development and suggest that Goosecoid is an essential regulator of mesodermal patterning in mammals and that it has specific functions in neural crest cell derivatives.

Freestyle propeller flaps from the lower abdomen: A valuable reconstructive option for proximal thigh defects

The concepts of freestyle flap design allows for flap creation from virtually every place in the body. Descriptions of named flaps based on their arterial origin are commonly described in the literature, allowing for predictable flap design. However, in certain cases, isolating a flap based on a Doppler signal and retrograde perforator dissection will allow for appropriate flap creation and wound coverage. We describe a 52-year-old female with a chronic open wound that failed wound care and local soft tissue rearrangement. This led to detection of a strong perforator signal in the lower lateral abdomen prompting the use of a freestyle propeller flap. The patient recovered without complication. Twelve-month follow-up demonstrated trunk and lower extremity mobility without impairment. We describe a successful and novel use of a rare, unnamed perforator from the lower, lateral abdomen by employing the freestyle propeller flap for coverage of a proximal thigh wound.

Cystinosis as a lysosomal storage disease with multiple mutant alleles: Phenotypic-genotypic correlations.

Cystinosis is an autosomal recessive lysosomal storage disease with an unclear enzymatic defect causing lysosomal cystine accumulation with no corresponding elevation of plasma cystine levels leading to multisystemic dysfunction. The systemic manifestations include a proximal renal tubular defect (Fanconi-like), endocrinal disturbances, eye involvements, with corneal, conjunctival and retinal depositions, and neurological manifestations in the form of brain and muscle dysfunction. Most of the long-term ill effects of cystinosis are observed particularly in patients with long survival as a result of a renal transplant. Its responsible CTNS gene that encodes the lysosomal cystine carrier protein (cystinosin) has been mapped on the short arm of chromosome 17 (Ch17 p13). There are three clinical forms based on the onset of main symptoms: nephropathic infantile form, nephropathic juvenile form and non-nephropathic adult form with predominant ocular manifestations. Avoidance of eye damage from sun exposure, use of cystine chelators (cysteamine) and finally renal transplantation are the main treatment lines. Pre-implantation genetic diagnosis for carrier parents is pivotal in the prevention of recurrence.

Abstract 2886: Multidimensional single-cell analysis of BCR signaling reveals proximal activation defect as a hallmark of Chronic Lymphocytic Leukemia B cells.

Abstract Chronic Lymphocytic Leukemia (CLL) is defined by a perturbed B-cell receptor-mediated signaling machinery. To assess the aberrant behavior of BCR signaling in CLL B cells, we developed an experimental methodology combining immunophenotyping, multiplexed phosphospecific flow cytometry, and multifactorial statistical modeling. Utilizing patterns of signaling network covariance, we modeled the complex nature of BCR signaling using Partial Least Squares Regression (PLSR) to gain new insights into the strongest predictors of discrimination between CLL and normal B cells. We identified a dynamic and variable imbalance between proximal (pSYK, pBTK) and distal (pPLCγ2, pBLNK, ppERK) phosphoresponses. Furthermore, PLSR identified the relationship between upstream tyrosine kinase SYK and its target, PLCγ2, as maximally predictive and sufficient to distinguish CLL from healthy samples, pointing to this juncture in the signaling pathway as key to the pathogenic properties of CLL B cells. Specific BCR pathway signaling signatures that correlate with the disease and its degree of aggressiveness were identified. Single-cell multidimensional analysis of BCR signaling permitted focused study of the variability and heterogeneity of signaling behavior from patient-to-patient, and from cell-to-cell. Heterogeneity in the PLSR response variable within the B cell population is both a characteristic mark of healthy samples and predictive of disease aggressiveness. Citation Format: M. Lia Palomba, Kelly Piersanti, Carly G. K. Ziegler, Jesse Cotari, Robert Balderas, Sami N. Malek, Erlene Seymour, Andrew D. Zelenetz, Marcel R. M. van den Brink, Gregoire Altan-Bonnet. Multidimensional single-cell analysis of BCR signaling reveals proximal activation defect as a hallmark of Chronic Lymphocytic Leukemia B cells. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2886. doi:10.1158/1538-7445.AM2013-2886 Note: This abstract was not presented at the AACR Annual Meeting 2013 because the presenter was unable to attend.

Comparison of the diagnostic accuracy of direct digital radiography system, filtered images, and subtraction radiography

Background:To compare the diagnostic accuracy of three different imaging systems: Direct digital radiography system (DDR-CMOS), four types of filtered images, and a priori and a posteriori registration of digital subtraction radiography (DSR) in the diagnosis of proximal defects.Materials and Methods:The teeth were arranged in pairs in 10 blocks of vinyl polysiloxane, and proximal defects were performed with drills of 0.25, 0.5, and 1 mm diameter. Kodak RVG 6100 sensor was used to capture the images. A posteriori DSR registrations were done with Regeemy 0.2.43 and subtraction with Image Tool 3.0. Filtered images were obtained with Kodak Dental Imaging 6.1 software. Images (n = 360) were evaluated by three raters, all experts in dental radiology.Results:Sensitivity and specificity of the area under the receiver operator characteristic (ROC) curve (Az) were higher for DSR images with all three drills (Az = 0.896, 0.979, and 1.000 for drills 0.25, 0.5, and 1 mm, respectively). The highest values were found for 1-mm drills and the lowest for 0.25-mm drills, with negative filter having the lowest values of all (Az = 0.631).Conclusion:The best method of diagnosis was by using a DSR. The negative filter obtained the worst results. Larger drills showed the highest sensitivity and specificity values of the area under the ROC curve.

1523 THE EFFECT OF ANDROGEN STIMULATION ON POST-OPERATIVE COMPLICATION RATES AFTER PENOSCROTAL HYPOSPADIAS REPAIR A SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Lower Urinary Tract & Genitalia I1 Apr 20121523 THE EFFECT OF ANDROGEN STIMULATION ON POST-OPERATIVE COMPLICATION RATES AFTER PENOSCROTAL HYPOSPADIAS REPAIR A SYSTEMATIC REVIEW AND META-ANALYSIS Ian Wright, Eric Cole, Armando Lorenzo, Julia Pemberton, Rachel Vizcarra, Forough Farrokhyar, and Luis Braga Ian WrightIan Wright Hamilton, Canada More articles by this author , Eric ColeEric Cole Hamilton, Canada More articles by this author , Armando LorenzoArmando Lorenzo Toronto, Canada More articles by this author , Julia PembertonJulia Pemberton Hamilton, Canada More articles by this author , Rachel VizcarraRachel Vizcarra Hamilton, Canada More articles by this author , Forough FarrokhyarForough Farrokhyar Hamilton, Canada More articles by this author , and Luis BragaLuis Braga Hamilton, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1291AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although androgen stimulation prior to penoscrotal hypospadias repair has been common and accepted practice in pediatric urology, data to support its beneficial effect is lacking. Furthermore, recent evidence from dermatological literature suggests that androgens may inhibit cutaneous wound healing. We performed a systematic review and meta-analysis to assess the current literature and to summarize the effect of preoperative androgen therapy on post-operative complication rates after proximal hypospadias repair. METHODS A comprehensive literature search of MEDLINE, EMBASE, CINHAL, SCIELO, CENTRAL, Cochrane Systematic Review Database, and the grey literature between 1990 and 2010 was conducted. Title, abstract, and full text screening was carried out independently by 2 authors and all discrepancies were resolved through consensus. Heterogeneity between studies was tested using Cochran's Chi-squared test and quantified by calculating I2. Meta-analysis was performed when appropriate. A pre-defined, fixed effects model was used in the absence of heterogeneity and random effects model in the presence of heterogeneity using Review Manager 5.1 (Cochrane Reviews). RESULTS Our comprehensive search yielded 11 studies that met inclusion criteria and were included in the final analysis. Six case series were subsequently excluded due to failure to stratify patients based on hormonal stimulation (HS). The remaining 5 studies assessed post-operative complications based on pre-operative HS: one was a randomized control trial (RCT) of patients with distal/midshaft hypospadias and 4 were observational studies of patients with proximal hypospadias. In a pooled analysis of patients (n=339) with proximal hypospadias, the use of pre-operative HS was associated with an increased risk of post-operative complications [OR=1.91, 95% CI 1.14-3.19] with I2 of 0%. The RCT (n=75) showed a decreased risk of post-operative complications in patients with distal/midshaft hypospadias treated with HS [OR=0.28 (.07, 1.15)]. CONCLUSIONS In published studies, it appears that stimulation with androgens prior to hypospadias repair leads to increased complication rates in patients with proximal defects. These findings should be interpreted with caution due to limitation inherent to meta-analysis of small observational studies. A well-designed, prospective study is needed to verify these findings and to further examine the relationship between HS and hypospadias repair outcomes. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e616-e617 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ian Wright Hamilton, Canada More articles by this author Eric Cole Hamilton, Canada More articles by this author Armando Lorenzo Toronto, Canada More articles by this author Julia Pemberton Hamilton, Canada More articles by this author Rachel Vizcarra Hamilton, Canada More articles by this author Forough Farrokhyar Hamilton, Canada More articles by this author Luis Braga Hamilton, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...