Improvements were seen in 63.3% (n = 19) of patients evaluated at 6 months and 63.6% (n = 14) of patients evaluated at 12 months. The positive predictive value of
the study was 80%. A simpler 1-variable algorithm using T(1/2) (half-time) could correctly classify 86.9% of patients with shunt obstruction, compared with a 4-variable algorithm that correctly classified 80% of patients.
CONCLUSION: Shunt patency studies are very useful for evaluation of shunt patency. Their results can be interpreted using a single-variable (T(1/2)) algorithm. Patients most likely to respond to a revision surgery are those who had a good response to original placement of a ventriculoperitoneal shunt.”
“Purpose: Reconstruction
of long segment urethral stricture disease in adults with a history of pediatric hypospadias repair remains complex secondary to poor urethral blood supply, extensive Smoothened antagonist penile scarring and the need for significant amounts of graft or flap tissue. We describe our experience with staged urethroplasty in this cohort of men.
Materials and Methods: A total of 15 males underwent staged urethroplasty for urethral Tanespimycin purchase stricture disease following previous hypospadias repair in childhood. All men underwent 2-stage repair with a minimum of 6 months separating each operation. Bulbar urethral stricture disease due to previous dilation was seen in 2 of the Aldehyde_oxidase 15 men (14%). Graft sources included buccal mucosa in 12 cases, full-thickness hairless abdominal wall skin in 2, penile skin in 1 and posterior auricular tissue in 1.
Results: Median patient followup was 22 months (range 5 to 62) after stage 2 closure. Median patient age at presentation was 31 years (range 19 to 57). Mean stricture length was 8 cm (range 5 to 14) and mean graft area was 22 cm(2) (range
10 to 38). There was no clinical evidence of stricture recurrence, fistula or wound dehiscence at last followup in 13 of the 15 men (86%). Two men with a congenital hypoplastic glans were left with distal hypospadias. Minor voiding symptoms were described in 3 of the 15 men (21%) with resolution in all by 6 months postoperatively.
Conclusions: We describe outcomes after staged reconstruction for extensive urethral stricture disease in men after previous pediatric hypospadias repair in childhood. At intermediate followup staged urethroplasty provided acceptable outcomes.”
“INTRODUCTION: Because of the difficulty in distinguishing idiopathic normal pressure hydrocephalus (INPH) from other neurodegenerative conditions unrelated to cerebrospinal fluid (CSF) dynamics, response to CSF shunting remains highly variable. We examined the utility of CSF drainage and CSF pressure (Pcsf) dynamics in predicting response to CSF shunting for patients with INPH.