Time Of Surgery Research Articles

Factors Affecting Outcomes and Complications of Primary Anterior Cruciate Ligament Reconstruction: A Retrospective Study of 110 Patients.

Anterior cruciate ligament injury poses a major effect on the quality of life of patients. Anterior cruciate ligament reconstruction (ACLR) remains the mainstay of treatment. To (1) test for the correlation of patients' characteristics such as body mass index (BMI), age, smoking status, and postoperative infrapatellar numbness with the subjective outcome of primary ACLR and (2) investigate whether postsurgical complications can be related to the studied patients' characteristics. Case series; Level of evidence, 4. Demographic data and operational notes from patients who underwent primary ACLR at the institute between 2011 and 2022 were extracted. Patients' surgical outcomes were evaluated subjectively using the International Knee Documentation Committee (IKDC) score and the Knee injury and Osteoarthritis Outcome Score (KOOS). Pre- and postoperative scoring were completed at postoperative follow-up in December of 2022, patients completed both the IKDC and the KOOS questionnaires. Patients were asked to rate their knee function out of 10 before and after surgery. This rating was based on the patients' self-assessment of their functional ability without the use of a formal instrument. Knee function was assigned as better, worse, or the same through a comparison of patients' reported scores before and after surgery. Male patients comprised 108 (98.2%) of the total cohort, the mean ± SD age at the time of surgery was 27.92 ± 7.39 years, and BMI was 26.54 ± 3.89. The mean follow-up time was 48.92 ± 27.99 months. Most patients did not need postsurgical intervention (n = 97; 88.2%), while 4 (3.6%), 7 (6.4%), and 2 (1.8%) needed revision, debridement, or both, respectively. The mean IKDC score and KOOS, respectively, were 74.37 ± 20.17 and 85.50 ± 14.83. Patients' BMI had a significant effect on IKDC score (74.68 ± 20.0; P < .001), and infrapatellar numbness after surgery also affected patients' IKDC score (P = .002) and KOOS (P = .043). The age at the time of ACLR was associated with contralateral leg surgery (P = .017). This study showed that higher BMI and infrapatellar numbness negatively affect the subjective outcomes after primary ACLR. Older age at the time of primary ACLR was associated with a higher likelihood of surgery in the contralateral leg.

Surgical results of tetralogy of Fallot repair with pulmonary valve preservation techniques

The long-term complications arising from chronic pulmonary insufficiency after surgical correction of tetralogy of Fallot (TOF) are well documented. In our center, innovative techniques for pulmonary valve (PV) preservation have been adopted and developed for over 10 years. All patients with TOF and PV stenosis who underwent surgery at our center between January 2008 and December 2022 were included in this study. Patients were evaluated using echocardiography during follow-up, comparing those who underwent classic surgery with transannular patch (TAP) placement and those who underwent PV preservation techniques. Of the 134 patients, 99 (73.9%) were successfully treated using PV preservation techniques. At the time of surgery, the median age was 4.3 months (interquartile range [IQR] 3.4-5.9 months). The median preoperative PV z-score was -2.87 (IQR -3.61;-2.48). The median follow-up time from surgery was 6.6 years (IQR 3.5-8.4 years). During the median follow-up, the right ventricular area change fraction was 47% (IQR 43-50%) in patients treated with PV preservation and 43% (IQR 41-47%) in the TAP group (p=0.005). These data were associated with better PV function in patients treated with preservation. Specifically, insufficiency was mild in 12%, moderate in 35%, and severe in 53% of patients in the TAP group. Conversely, insufficiency was mild in 53%, moderate in 35%, and severe in 11% of patients treated with preservation (p<0.001). Annular integrity and PV function can be preserved during early TOF correction. PV preservation can prevent the long-term development of pulmonary insufficiency and right ventricular dysfunction.

Does hand dominance influence clinical outcomes and implant survival in shoulder arthroplasty?

BackgroundTotal shoulder arthroplasty (TSA) is a successful treatment method for patients with end-stage glenohumeral osteoarthritis and different factors influencing the clinical outcome have been determined. However, the role of hand dominance on the postoperative clinical results and implant survival is not well analyzed. Hypothesis: Hand Dominance does not influence the outcome after TSA. Patients and methodsIn this single center cohort study, 138 consecutive patients with primary Osteoarthritis (OA)were treated with a TSA and evaluated with a mean follow-up of 45 months (range 24–158 months). 62.32 % (86 patients) underwent TSA on the dominant side (DOM group) and 37.68 % (52 patients) on their non-dominant side (NON-DOM group). For clinical evaluation the adjusted Constant-Murley (CS) score, pain (Numeric analog scale (NAS)), subjective satisfaction and range of motion (ROM) were recorded. Furthermore, survivorship analysis was performed for the endpoint revision for any reason. ResultsBoth dominant (DOM) and non-dominant (NON-DOM) groups demonstrated significant improvement in all clinical outcomes from pre-to postoperative (p < 0.0001) with no between-group differences (p > 0.05). Implant survival was 98.8 % at 123 months (DOM) and 90 % at 158 months (NON-DOM) (p = 0.89). ConclusionHand dominance did not influence postoperative outcomes, survivorship, or age at time of surgery. Patients can expect excellent results after TSA regardless of their predominant dexterity. Level of evidenceRetrospective cohort study, Level III.

Risk factors affecting all-cause mortality in cats hospitalized by a referral soft tissue service.

The objective of this study was to describe the all-cause mortality rate in cats hospitalized by the soft tissue surgery service of an academic referral hospital over a 5-year period and to identify specific risk factors for mortality. The hypotheses were that the all-cause mortality rate during hospitalization would be low, and cats undergoing emergency surgery and those with an American Society of Anesthesiologists (ASA) status of 3 or more would be at increased risk for mortality. The case log of cats hospitalized by the soft tissue surgery service at the University of Georgia was searched retrospectively to identify all cats hospitalized in the years 2015-2020. Data collected about each cat included age, sex and neuter status, weight, body condition score (1-9), pre-existing heart disease, chronic kidney disease, concurrent infection or cancer, emergency status, time of surgery (daytime vs after hours, which was defined as after 4 pm), if the surgery was performed on a weekday or weekend, and general type of surgery. Univariable logistic regressions were implemented to test and estimate odds ratios for the effects of risk factors on in-hospital mortality. A multivariable logistic regression was developed that initially included all risk factors with P <0.05 on univariable analysis. Log-likelihood ratio test P values and profile-likelihood confidence intervals were reported. The all-cause mortality rate was 6.1%. Analysis was limited because of low mortality, but multivariable analysis identified increasing ASA status and emergency surgery as significant risk factors for increased mortality while hospitalized. The findings of this study confirmed that increasing ASA status and emergency procedures are significant risk factors for mortality in cats. Clinicians should be aware of these risk factors and consider how to best monitor and manage these feline patients.

Metoidioplasty in Norway: A 13-year Experience from a National Center.

Genital surgery is often considered the final step in surgical gender-affirming treatment. Metoidioplasty is a variant where the enlarged clitoris is lengthened and straightened. The technique has several advantages but is not without complications. We evaluated the surgical outcomes after metoidioplasty from our national center from 2007 to 2020. All patients who had undergone the metoidioplasty procedure at Oslo University Hospital from January 1, 2007, to December 31, 2020, were identified by the Local Quality Register of Gender Incongruence. Demographic, clinical, and surgical variables were recorded. Statistical analysis was carried out with SPSS. A total of 84 patients were identified. The median age at the time of surgery was 27.5 years. Of 84 patients, 48 (57.1%) experienced some kind of complication after the surgery, with an average of 1.7 complications. Complications related to the urethroplasty were the most common, with strictures occurring in 19 (22.6%) patients and urethral fistulas occurring in 11 (13.1%) patients. Forty-one patients (48.8%) needed 1 or more secondary procedures. After the management of strictures and fistulas, a secondary testis implant correction was the most frequent revision procedure performed in 38.1% (32) of patients. With increasing body mass index, the risk of complications and of undergoing secondary procedures also increased significantly (P = 0.045 and 0.019, respectively). Metoidioplasty is an operation with a relatively high complication rate, mainly related to urethroplasty. There is an urgent need for future research with a focus on quality of life and long-term follow-up.

Risk factors for symptomatic lymphocele in patients undergoing robot-assisted radical prostatectomy with pelvic lymphadenectomy: What we learned after more than 350 cases

ObjectiveWe investigated patients who underwent robotic radical prostatectomy with lymphadenectomy, analyzing the prevalence and risk factors associated with symptomatic lymphoceles (SLCs). MethodsWe evaluated 354 consecutive patients who underwent robotic radical prostatectomy with lymphadenectomy by our team between June 2018 and June 2023. After analyzing the prevalence of SLCs, patients were divided into two groups, with and without SLCs. The variables were age, body mass index (BMI), prostate-specific antigen, surgery time, blood loss, length of stay, pathological International Society of Urological Pathology grade and the number of removed lymph nodes. These variables were compared between these groups using Chi-square and Student's t-tests, according to the type of the variable. In all analyses, a significance level of <0.05 was considered. ResultsThe prevalence of SLCs in this sample of patients undergoing radical prostatectomy with lymphadenectomy was 1.98% (7/354), which is slightly lower than the minimum rate reported in the literature. In our analysis, BMI (p=0.041), number of lymph nodes removed (p=0.007) and length of stay (p=0.007) were factors associated with the presence of SLCs. ConclusionThe prevalence of SLCs in patients undergoing robotic radical prostatectomy with lymphadenectomy is approximately 2%. Higher BMI, number of lymph nodes removed, and length of stay are factors associated with the presence of SLCs.

Comparative Accuracy of dCAIS and Freehand Techniques for Immediate Implant Placement in the Maxillary Aesthetic Zone: An In Vitro Study

ObjectiveTo evaluate the accuracy of immediate implant placement in fresh extraction sockets in the maxillary aesthetic zone using a dynamic computer-assisted implant surgery system (dCAIS), with the evaluation of possible deviations versus freehand placement. MethodsA total of 18 implants were placed by an experienced surgeon in fresh extraction sockets of anterior teeth in 6 maxillary models. Nine implants were placed using the dCAIS system and 9 implants were placed using the conventional freehand technique. The following outcome parameters were measured and compared: positional deviation at entry, apex point and angular deviations between planned and placed implant position. Surgery time was measured for each procedure. Descriptive and statistical analyses were performed on all outcome parameters. ResultsGlobal entry deviations were not significantly different between the two techniques (p=0.078). dCAIS resulted in significantly more accurate implant placement in terms of global apex deviation with values of 1.28±0.36 mm and angular deviations with values of 1.29±0.64°, compared to 2.06±0.60 mm and 5.05±2.54° with freehand placement (p<0.001). The dental implant placement time was approximately three times longer when using dCAIS (10.99 ± 3.43 min) versus freehand (3.25± 0.63 min) (p < 0.001). ConclusionsdCAIS achieved more precise immediate implant placement in terms of apex deviation and angulation than freehand placement, but increased the surgery time. Clinical significancedCAIS provides greater accuracy in the placement of immediate implants in the maxillary aesthetic zone following prosthetic-driven digital planning compared to freehand surgery.

Incidence, Risk Factors, and Functional Outcomes of Symptomatic Postoperative Spinal Epidural Hematoma: A Case-Control Study

Symptomatic postoperative spinal epidural hematomas (PEDHs) are rare complications with significant implications on patients' functional outcomes. Strategies for PEDH prevention are poorly understood. This study sought to evaluate preoperative and intraoperative variables predicting the risk of PEDH, and patients' functional outcomes after PEDH evacuation. This is a single institution study of all PEDH cases requiring a reoperation and matched controls over six year period. The incidence of PEDH was calculated by region and operative technique. The preoperative and intraoperative parameters of 40 cases and 40 matched controls were compared. 5,941 spine surgeries and 40 symptomatic PEDH cases requiring reoperation were identified (0.67% overall incidence). The highest incidence of PEDH was observed after minimally invasive lumbar laminectomimes. Higher preoperative diastolic blood pressure was a risk factor for PEDH. Of the 17 PEDH cases that had a drain placed at the time of index surgery, 8 patients (47%) still had the drain in place at the time of diagnosis of PEDH. Among the posterior index approaches, 18 cases (51.43%), one cervicothoracic and seventeen lumbar, did not develop paresis at the time of PEDH diagnosis. 17 cases (48.57%), nine cervicothoracic and eight lumbar, developed paresis. Ten of the patients with paresis had complete resolution of motor weakness, while seven never achieved complete resolution. While the incidence of PEDH was below one percent, nearly half of the patients developed motor weakness as a presenting symptom and a third of the patients never had resolution of the weakness.

Intravitreal dexamethasone implant concomitant to cataract surgery in retinitis pigmentosa: potential retinal preservation effect

PurposeTo evaluate the potential maintenance of the ellipsoid zone (EZ) by optical coherence tomography (OCT) of retinitis pigmentosa (RP) patients, treated with intravitreal dexamethasone implant at the same time of cataract surgery. DesignIn this retrospective cohort study, sixty-two eyes of patients with RP and cataract were enrolled and sorted in two groups. MethodsThe first group (“Ozucat" group) included 26 eyes of patients who underwent cataract surgery combined to dexamethasone intravitreal implant (Ozurdex, DEX implant). The second (“cataract alone” group) included 38 eyes who underwent only cataract surgery. Main Outcomes MeasureWe evaluated best corrected visual acuity (BCVA) in ETDRS letters and EZ length with retinal structural assessment (OCT). ResultsIn the Ozucat group, the increase in EZ length from baseline was statistically significant both at 6-months (p<0.0001) and 12-months (p<0.0001) compared to “cataract alone” group. However, no statistical difference in BCVA was highlighted between the two groups. ConclusionOur study showed that eyes with typical RP, presenting cataract and concomitant signs of retinal inflammation, treated by combined cataract surgery and intravitreal dexamethasone implant, exhibited a maintenance of the EZ integrity, suggesting a potential retinal preservation effect of steroids.

Publishing during a Pandemic: Analyzing Recent Publication Times in Hand Surgery.

Timely distribution of research is crucial for improving treatments and patient care; however, the publication process is historically unhurried. The primary goal of this study was to analyze the time to publication in hand surgery for 5 years and to examine potential factors affecting publication speed. A 5-year review (2017-2021) was performed on 4 major hand surgery journals. The Journal of Hand Surgery American Volume, Journal of Hand Surgery European Volume, Journal of Plastic Surgery and Hand Surgery, and Plastic and Reconstructive Surgery were included in the review. Differences were assessed using analysis of variance or 2-sided independent t tests for continuous variables. There was a significant difference in submission-to-publication time between journals (P < 0.001). This differed by year (P < 0.001), with a significant increase in time from submission to publication after 2019, during the COVID-19 pandemic (447 ± 198 versus 406 ± 169 d, P < 0.001). Geographic region of the primary institution did affect submission-to-publication time (P < 0.001). No significant difference was seen in submission-to-publication time based on the number of institutions contributing, article type, or first author or corresponding author surgical specialty (P > 0.05). Time to publication in hand surgery varies by hand surgery journal and significantly increased during the COVID-19 pandemic. New research reflects work done over a year ago at least. Participation in the peer-review process should be encouraged and bolstered within the hand surgery community to improve research dissemination times within the field.

Evaluating the risks of pleural effusions and chest tube placement at the time of cytoreductive surgery for advanced ovarian cancer

Evaluating the risks of pleural effusions and chest tube placement at the time of cytoreductive surgery for advanced ovarian cancer

Timing of single-event multilevel surgical interventions on long-term motor outcomes in children and adolescents with cerebral palsy: A systematic review and meta-analysis

BackgroundThe aim of this meta-analysis was to evaluate the impact of the timing of single-event multilevel surgery (SEMLS) on long-term motor outcomes in children and adolescents with cerebral palsy (CP). MethodsA systematic review and meta-analysis were conducted by searching PubMed, Cochrane Library, Embase, and Web of Science databases for studies up to April 2024. Twelve eligible studies were included, from which we examined patients’ gait, stride length, walking speed, and the gross motor function measure (GMFM66). ResultsGait analysis showed significant improvements in CP patients after SEMLS, which included an increased gait deviation index (p < 0.001), reduced Gillette gait index (p < 0.001), and reduced gait profile score (p < 0.001). Subgroup analysis showed that age at surgery (<12 years old vs. 12−18 years old) was not a factor affecting patients’ gait. Spatial and temporal parameters such as stride length (p < 0.001) and walking velocity (p = 0.02) also improved significantly after surgery. However, there were only trends towards broader motor function gains measured by the GMFM66 (p = 0.39). ConclusionsSEMLS effectively improved key gait and mobility parameters in children and adolescents with CP, and was not affected by younger or older surgical ages (<12 years old or 12−18 years old). However, these gait improvements do not uniformly translate into broader motor function gains.

CA-125 KELIM score predicts progression-free and overall survival in patients with epithelial ovarian cancer undergoing HIPEC at time of interval cytoreductive surgery

CA-125 KELIM score predicts progression-free and overall survival in patients with epithelial ovarian cancer undergoing HIPEC at time of interval cytoreductive surgery

Clinical Comparison of a Small-Aperture Intraocular Lens Versus a Monofocal Control.

To evaluate range of visual acuity, visual quality, and safety of the IC-8 small-aperture (SA) intraocular lens (IOL) (Apthera; Bausch & Lomb, Inc) in patients with cataract. This was a prospective, multicenter, open-label, parallel-group, non-randomized, examiner-masked, 12-month clinical study conducted at 21 sites in the United States. Included patients (N = 453) received either the SA IOL (targeted to -0.75 diopters) in one eye and a monofocal or monofocal toric IOL (targeted to plano) in the fellow eye (SA IOL group, n = 343) or bilateral monofocal/monofocal toric IOLs (control group, n = 110). At 6 months, the SA IOL group achieved superior binocular uncorrected intermediate and near visual acuity (P < .0001) and equivalent binocular uncorrected distance visual acuity versus the control group. In SA IOL eyes, 99.1% achieved monocular corrected distance visual acuity of 0.3 logarithm of the minimum angle of resolution or better. The SA IOL and control groups had comparable binocular photopic and mesopic contrast sensitivities at 6 months both with and without glare. The SA IOL group reported few visual symptoms overall, although at higher rates than in the control group. The SA IOL group exhibited improved intermediate and near vision, comparable distance vision and binocular contrast sensitivities, and few visual symptoms or adverse events versus the bilateral monofocal/monofocal toric IOL group, suggesting that the SA IOL is an effective option for presbyopia correction at the time of cataract surgery. [J Refract Surg. 2024;40(11):e824-e835.].

11322 Predictors of Venous Thromboembolism in Myomectomy: Evaluating the Influence of Route of Surgery, Myoma Burden, and Operative Time

11322 Predictors of Venous Thromboembolism in Myomectomy: Evaluating the Influence of Route of Surgery, Myoma Burden, and Operative Time

Echocardiographic Markers of Early Left Ventricular Dysfunction in Asymptomatic Aortic Regurgitation: Is It Time to Change the Guidelines?

The ideal timing for surgery in asymptomatic chronic aortic regurgitation (AR) remains unclear. New thresholds for left ventricular ejection fraction (LVEF), left ventricular (LV) indexed end-systolic volume (iESV), and global longitudinal strain (GLS) have been associated with mortality in these patients. These represent markers of early LV dysfunction. The authors sought to assess the relationship between these markers (LVEF<60%, iESV≥45mL/m2, and GLS worse than -15%) and mortality, comparing them to Class I/IIa American College of Cardiology/American Heart Association guideline recommendations and absence of any of these. A total of 673 asymptomatic patients with chronic clinically significant (≥ moderate-severe) AR between 2004 and 2019 at a single referral center were retrospectively analyzed. The primary study outcome was all-cause mortality. Mean age was 57 ± 17 years, 97 (14%) were female, 293 (45%) had hypertension, and 273 (41%) had an abnormal number of valve cusps. Aortic valve replacement was performed in 281 (48%) patients, and 69 (10%) died while under surveillance (without aortic valve replacement). LVEF<60% was present in 296 (44%) patients, 122 (25%) of 482 had GLS worse than -15%, and 261 (39%) had iESV≥45mL/m2. Mortality under surveillance was highest when Class I/IIa recommendations were present (HR: 4.22; 95%CI: 2.15-8.29), followed by the presence of 1 or more markers of early LV dysfunction (HR: 2.18; 95%CI: 1.21-3.92); no markers was used as the reference (all, P< 0.05). LVEF showed the strongest association with mortality, statistically slightly better than GLS and iESV. In the absence of ClassI/IIa recommendations, 1 marker of early LV dysfunction was associated with higher, although not statistically significant, mortality compared with no markers (P=0.063), followed by 2 markers; highest mortality was when all 3markers were present (HR: 5.46; 95%CI: 2.51-11.90; P< 0.001). Patients with asymptomatic clinically significant chronic AR incur a survival penalty when Class I/IIa guideline recommendations are attained. In patients without these recommendations, at least 2 markers of early LV dysfunction identify those with higher mortality risk who may benefit from early surgery.

Outcomes Of Early And Delayed Intervention Of Maxillofacial Trauma

Background: Maxillofacial trauma is routinely evaluated on the basis of high and low velocity injuries, types of fractures in the literature. On the other hand, we have evaluated them on the basis of timing of surgery after trauma and their outcomes. In India RTA (Road traffic accidents) scenario is quite different from other countries. The highway traffic consists of a variety of vehicles from a cyclist, a two-wheeler, a four-wheeler to a heavy loaded truck. Animals like cows and dogs frequent the highways. Hence, we have classified the patients based on Single jaw and Panfacial fractures with or without the presence of extensive soft tissue injuries. Materials and Methods: In this retrospective record-based descriptive study, 200 patients that were treated at Sri Aurobindo Hospital between January 2023 to July 2024 for maxillofacial trauma were reviewed. Of which 176 patients were surgically operated, averaging 30 years of age and ranging from 12-70 years. For the purpose of our study these 176 patients were categorized into two groups, first of single jaw fractures(108 patients) and second of Panfacial fractures (68 patients). Single Jaw fractures were further divided as mandibular (84 patients); maxilla &amp; zygomaticomaxillary complex fractures (24 patients). These were further evaluated and categorized as those patients who were treated within 72 hours (Early) and after 72 hours (Delayed) following injury. All patients of both the groups were treated with open reduction and internal fixation. Individual complications that of soft tissue dehiscence, plate/bone exposure, bone graft rejection, oroantral/palatal fistula, non-union of fractured segments, infections were analyzed. These complications were again assessed on the basis of their timing; those occurring within 72 hours and those after 72 hours. Results: When each type of complication was compared and evaluated, there was significantly more complication noted among delayed group than in early group. Conclusion: The restoration of the aesthetics and functionality of the face, post-trauma is a critical and an arduous task. As the anatomical complexity of the face must be addressed, timely intervention to achieve optimal functional and aesthetic outcomes is pertinent. Thus, the treatment should be done at the earliest when feasible

Lymphadenectomy for Perihilar Cholangiocarcinoma: Therapeutic Benefit of Lymph Node Number and Station

INTRODUCTIONWe sought to characterize the benefit of lymphadenectomy among patients undergoing curative-intent surgery for perihilar cholangiocarcinoma (pCCA) utilizing the therapeutic index. METHODSData on patients who underwent curative-intent resection for pCCA between 2000-2023 were obtained from 8 high-volume international hepatobiliary centers. Multivariable Cox regression analysis was used to assess clinicopathological factors associated with overall survival (OS). The therapeutic index was determined to assess the therapeutic benefit of lymphadenectomy. RESULTSAmong 341 patients, median number of LNs evaluated was 7 (IQR: 4-11). A total of 127 (37.2%) patients underwent lymphadenectomy of station 12 only, while 146 (42.8%) patients had LNs from stations 12 plus 8 ± 13 harvested. On multivariable analysis, lymphadenectomy of stations 12 plus 8 ± 13 was associated with improved OS (referent, station 12 only: HR 0.51, 95%CI 0.32-0.80). The therapeutic index was highest among patients who underwent LN evaluation of stations 12 plus 8 ± 13 (33.1) and had ≥ 6 LNs harvested (26.3). CONCLUSIONSAt the time of surgery of pCCA, lymphadenectomy should include station 12, as well as stations 8 and 13, with the goal to evaluate > 6 LNs to ensure optimal staging and maximize the therapeutic benefit for patients.

Long-term surgical outcomes of ileovesicostomy at a single children's hospital

IntroductionThe ileovesicostomy (IV) is a surgical option for patients with refractory bladder dysfunction at-risk of upper tract deterioration who cannot catheterize or lack social support for managing an augmentation cystoplasty (AC). Long-term outcomes after IV in children are lacking in the literature. ObjectiveWe assessed the risk of long-term surgical complications in pediatric patients with IV at a single children’s hospital. Study designWe retrospectively reviewed the records of patients undergoing IV between 2002 to 2021 at a single children’s hospital. The primary outcome was the rate of surgical complications in IV patients after initial reconstruction. Specific complications of interest included intra-abdominal, reservoir, and stomal complications, respectively. We also assessed renal outcomes, including the change in glomerular filtration rate (ΔGFR) and Society of Fetal Urology (ΔSFU) hydronephrosis from the time of surgery to last follow up. ResultsThe study comprised 17 IV patients, with most patients having a diagnosis of spina bifida (65%). Median follow-up was 6.4 years. The mean rate of surgical complications per patient year was 0.11 +/- 0.20. On survival analysis, the time to first complication for IV was 84.4 months. The incidence of intra-abdominal, reservoir, and stomal complications over the study period was 2/17 (11.8%) for each of these complication types. The mean ΔSFU grade from the time of surgery to last follow up was -1.24 +/- 1.48 and mean ΔGFR was -2.5 +/- 32.7 ml/min. DiscussionWe found that IV in pediatric patients experience a low rate (0.11/year) of complications and that median time to first complication was 84 months. Additionally, IV offers adequate renal preservation. Our study is limited, though, by its retrospective nature, small sample size, heterogenous population and lack of comparison group. ConclusionOur experience demonstrates that IV has a low rate of surgical complications and preserves renal function. We believe it is a reasonable surgical option for the well selected patient with refractory bladder dysfunction at-risk of upper tract deterioration who is unable to reliably catheterize.

Effectiveness of sacral neuromodulation with 3D printing and ultrasound localization for treating neurogenic bladder in patients with pelvic structural anomalies

ObjectiveTo assess the efficacy and safety of Sacral Neuromodulation (SNM) in conjunction with 3D printing and ultrasound localization for treating patients with neurogenic bladder and pelvic structural anomalies. MethodsThis prospective study involved 56 patients diagnosed with neurogenic bladder and pelvic anomalies. They were treated with SNM from January 2022 to December 2023. Patients were split into study and control groups based on the origins of their pelvic anomalies, with each group comprising 28 individuals. The study group underwent preoperative 3D printing and intraoperative ultrasound-assisted puncture, whereas the control group utilized intraoperative X-ray-assisted puncture. Metrics compared included the number of punctures, average puncture duration, intraoperative SNS tuning time, effective initial voltage, postoperative testing duration, phase two conversion rates, and the incidence of bleeding and infection. ResultsThe study group experienced significantly fewer punctures compared to the control group (2.21 ± 0.92 vs 9.29 ± 4.37) (P < 0.01), had a shorter average puncture duration (5.71 ± 2.69 min vs. 28.60 ± 9.69 min) (P < 0.01), and required a lower effective initial voltage (0.87 ± 0.23v vs. 1.38 ± 0.52v) (P < 0.01). X-ray exposure was eliminated in the study group, in contrast to 11.51 ± 4.62 mAs in the control group(P < 0.01). The phase two implantation rates were 67.8 % for the study group and 57.1 % for the control group(P = 0.04). No surgery-related complications occurred in either group. ConclusionCombining preoperative 3D printing with intraoperative ultrasound-assisted puncture significantly improves the accuracy of SNM placement, reduces surgery time, and eliminates X-ray exposure for both doctors and patients. This method is both safe and effective for patients with neurogenic bladder and pelvic anomalies.