Glenns Urologic Surgery Pdf 23
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Eugene J. Shunk, MDDr. Shunk’s interest in pediatric urology began in the late 1970s when he began practicing in the pediatric urology department of Children’s Hospital in Boston. His education includes basic science and clinical experience in the fields of pediatric urology and neonatal surgery. He has been Assistant Professor of Pediatrics and Director of the Children’s Hospital Urology Clinic at Harvard Medical School and Director of Pediatric Urology at Children’s Hospital. He is a member of the American Urological Association, the American Society of Pediatric Urology, the American Academy of Pediatrics, and the American Society for Clinical Investigation.
Recent studies have suggested that the reoperation rate for VUR following endoscopic injection is not significantly different from that for open surgery. As such, it is reasonable to assume that the success rate will approach that of open surgery at the end of the learning curve. In our experience, this has not been the case. There have been several reasons for this. Most importantly, the bladder wall is not an accessible organ to the endoscopist, so there is a limit to how deep the endoscope can penetrate to reach the bladder wall. The endoscope has difficulty reaching the trigone and the dome of the bladder in children.
The aim of the study was to evaluate the long-term success rate after ET for VUR grade III/IV to identify predictors of success that would allow doctors to better counsel patients before surgery and offer patients the best likelihood of success.
In the present study, all VUR III/IV patients with short and long term follow-up after ET were included. Moreover, we included all the patients operated on between July 2008 and July 2016, for two main reasons: first, the last 11% of the series includes all patients who underwent a second endoscopic injection attempt after failed initial surgery. As a result, we can evaluate the overall success rate, both in terms of number and type of procedures, and whether these patients can undergo a second injection attempt. The second reason is that our department is a referral centre for PTUR and ET, so we had a relatively high number of patients operated on for VUR. As a result, our data provide a representative experience of a cohort of patients with low grade VUR treated either surgically or endoscopically.
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