Charlotte Melling - Academia.edu (original) (raw)

Uploads

Papers by Charlotte Melling

Journal of Pediatric Surgery

RESEARCH QUESTION 3 1.4 OBJECTIVE ASSESSMENT OF BLADDER FUNCTION IN CHILDREN 1.4.1 UROFLOWMETRY (... more RESEARCH QUESTION 3 1.4 OBJECTIVE ASSESSMENT OF BLADDER FUNCTION IN CHILDREN 1.4.1 UROFLOWMETRY (UF) 78 1.4.2 INVASIVE URODYNAMICS (UDS) 83 SUMMARY RESEARCH QUESTION 4 91 RESEARCH QUESTIONS 5A, B & C 91 RESEARCH QUESTION 6 91 SECTION 2: METHODS 92 2.1 A NATIONAL AUDIT OF PRACTICE OF MANAGEMENT OF CHILDREN WITH IOAB 93 2.2 THE OVERT PILOT RCT FOR CHILDREN WITH IOAB 96 2.2.1 TRIAL DESIGN 96 2.2.2 PRACTICAL PROCEDURES AND TECHNIQUES 2.2.3 THE AUTHOR'S CONTRIBUTIONS TO OVERT 2.2.4 ACADEMIC OUTPUT 2.2.5 PROFESSIONAL DEVELOPMENT 2.3 BLADDER DIARY COMPLETION BY CHILDREN WITH SYMPTOMS SUGGESTIVE OF IOAB 2.4 URODYNAMICS FOR CHILDREN WITH SYMPTOMS SUGGESTIVE OF IOAB 2.4.1 COLLECTION OF URODYNAMIC DATA 2.4.2 METHOD OF UDS 2.4.3 URODYNAMIC DATA ANALYSIS SECTION 3: RESULTS 125 3.1 A NATIONAL AUDIT OF PRACTICE OF THE MANAGEMENT OF CHILDREN WITH IOAB 3.2 THE OVERT PILOT RCT FOR CHILDREN WITH IOAB 3.3 BLADDER DIARY COMPLETION BY CHILDREN WITH SYMPTOMS SUGGESTIVE OF IOAB 3.4 URODYNAMIC OBERVATIONS IN CHILDREN WITH SYMPTOMS SUGGESTIVE OF IOAB 3.4.1 UF AND UDS FINDINGS IN THOSE WITHOUT DETRUSOR OVERACTIVITY 3.4.2 UF AND UDS FINDINGS IN THOSE WITH PROVEN DETRUSOR OVERACTIVITY 3.5 COMPARISON OF URODYNAMIC FINDINGS BETWEEN CHILDREN WITH AND WITHOUT IOAB 3.5.1 COMPARISON OF UF FINDINGS BETWEEN THOSE WITH AND WITHOUT DETRUSOR OVERACTIVITY 3.5.2 COMPARISON OF UDS FINDINGS BETWEEN THOSE WITH AND WITHOUT DETRUSOR OVERACTIVITY 3.5.3 COMPARISON OF UF WITH UDS IN THOSE WITHOUT DETRUSOR OVERACTIVITY. 3.5.4 COMPARISON OF UF WITH UDS IN THOSE WITH DETRUSOR OVERACTIVITY. 3.6 COMPARISON OF UDS RESULTS FOLLOWING TREATMENT WITH EITHER TOLTERODINE OR BOTOX ® IN CHILDREN WITH IOAB 3.6.1 BASELINE UDS PARAMETERS 3.6.2 BASELINE VS POST-INTERVENTION UDS: TOLTERODINE TREATMENT ARM 3.6.3 BASELINE VS POST-INTERVENTION UDS: BOTOX ® TREATMENT ARM 3.6.4 BASELINE VS POST-INTERVENTION UDS: TOLTERODINE VS BOTOX ® SECTION 4: DISCUSSION 172 4.1 A NATIONAL AUDIT OF PRACTICE OF THE MANAGEMENT OF CHILDREN WITH IOAB 4.1.1 RELATING THE AUDIT RESULTS TO CURRENT KNOWLEDGE 4.1.2 RELATING THE AUDIT RESULTS TO OVERT 4.1.3 RELEVANCE OF OVERT TO UK PAEDIATRIC UROLOGISTS 4.2 THE OVERT PILOT RCT FOR CHILDREN WITH IOAB 4.2.1 HOW THE OVERT OBJECTIVES WERE MET 4.2.2 HOW THE MD OBJECTIVES WERE MET 4.2.3 CONSIDERATIONS FOR A FUTURE MULTI-CENTRE RCT 4.3 BLADDER DIARY COMPLETION BY CHILDREN WITH SYMPTOMS SUGGESTIVE OF IOAB 4.3.1 RELATING THE RESULTS TO OVERT 4.3.2 RELATING THE RESULTS TO THE MD 4.3.3 RELATING THE RESULTS TO A FUTURE RCT 4.4 URODYNAMIC OBSERVATIONS IN CHILDREN WITH SYMPTOMS SUGGESTIVE OF IOAB 4.4.1 URODYNAMIC FINDINGS IN CHILDREN WITHOUT DETRUSOR OVERACTIVITY 4.4.2 URODYNAMIC FINDINGS IN CHILDREN WITH DETRUSOR OVERACTIVITY 4.4.3 CLINICAL SIGNIFICANCE 4.5 COMPARISON OF URODYNAMIC FINDINGS BETWEEN CHILDREN WITH AND WITHOUT IOAB 4.5.1 COMPARING UF FINDINGS IN CHILDREN WITH AND WITHOUT DETRUSOR OVERACTIVITY 4.5.2 COMPARING UDS FINDINGS IN CHILDREN WITH AND WITHOUT DETRUSOR OVERACTIVITY 4.5.3 COMPARING UF AND UDS FINDINGS IN CHILDREN WITH AND WITHOUT DETRUSOR OVERACTIVITY 4.6 COMPARISON OF URODYNAMIC RESULTS FROM A PILOT RCT FOR CHILDREN WITH IOAB

Journal of Pediatric Urology, 2021

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Journal of Pediatric Urology, 2020

INTRODUCTION Acute scrotal pain is a common problem in children. Amongst the various causes, only... more INTRODUCTION Acute scrotal pain is a common problem in children. Amongst the various causes, only testicular torsion (TT) needs urgent, and arguably any, surgical intervention. However TT accounts for only approximately 25% of cases. The diagnosis of TT is currently based mainly on history and clinical examination in the UK. OBJECTIVE We sought to find the incidence of finding TT during emergency scrotal exploration in four paediatric surgical centres in the UK. We also assessed the preoperative utilisation of clinical risk scores and Doppler ultrasound (DUS) to aid in the diagnosis. PATIENTS AND METHODS A retrospective review of 50 consecutive scrotal explorations done for acute scrotal pain at four tertiary pediatric surgical centres in 2019, including the preoperative utilisation of DUS, was analysed. Additionally an online survey was also sent out to consultant members of the British Association of Paediatric Urology to gauge their threshold for exploration, use of preoperative investigations and incidence of finding TT in their practice. RESULTS In the four UK centres reviewed, TT was found in 24.5% (SD = 8.54) of explorations. The overall utilisation of preoperative DUS was 10%. The online survey revealed a low threshold for exploration. However 72% of respondents recalled finding TT in <50% of explorations, with just over a third reporting finding TT in only 10% of explorations. There was low utilisation of preoperative DUS and clinical risk scores. DISCUSSION The incidence of finding TT during exploration in this cohort is the same as the incidence of TT in a population of children presenting with acute scrotal pain. We hypothesise that this is due to low accuracy of clinical assessment, low utilisation of preoperative clinical and radiological aids and the practice of exploring torted testicular appendages. Improving awareness and training in these modalities will increase diagnostic accuracy, limiting emergency scrotal explorations to those children with a higher risk of testicular torsion. A care pathway for children presenting with acute scrotal pain is suggested () CONCLUSIONS: There is a low incidence of finding testicular torsion during paediatric scrotal explorations in the UK. There is low preoperative utilisation of clinical risk scores and Doppler ultrasound, which if utilised, could improve diagnostic accuracy.

Journal of Pediatric Endoscopic Surgery, 2020

Purpose Laparoscopy is the gold standard to assess for presence of an intra-abdominal testis. How... more Purpose Laparoscopy is the gold standard to assess for presence of an intra-abdominal testis. However, techniques for the subsequent orchidopexy vary, and include the recently described staged laparoscopic traction orchidopexy (SLTO) (Shehata in Pediatr Surg 51(2):211-215, 2016). SLTO enables elongation of the testicular vessels without division, with initial success rates reportedly superior to Fowler-Stephens. We present the first UK data following a preliminary study using SLTO. Methods 19 boys prospectively presenting with 22 intra-abdominal testes (IAT) underwent STLO in a single centre, with a median age of 2.5 years (IQR 1.4-5.2) at first stage. 3/19 (16%) boys had bilateral IAT and nine (41%) were left-sided. Pneumoperitoneum was established using 5 mm umbilical and 3 mm accessory ports in bilateral iliac fossae. The gubernaculum and lateral peritoneal attachments were divided prior to securing the intra-abdominal testis to the contralateral anterior abdominal wall with 2/0 Ti-cron™. Second-stage procedures were planned for 3-6 months later. The securing stitch was cut; an 11 mm STEP port was placed trans-scrotally to retrieve the testis and secured in a sub-dartos pouch. Outcome measures included palpable testes in the scrotum and surgical complications. Results 13/22 IAT have undergone follow-up. Twelve (92%) IAT were palpable in the scrotum following SLTO. There was one diathermy-related bladder injury necessitating laparoscopic repair, and 3/22 (13.6%) slipped sutures, requiring repeat first-stage procedures. Conclusions Staged laparoscopic traction orchidopexy is a feasible technique, which can be performed as an alternative to Fowler-Stephens procedure, with potentially better outcomes for the testis. The complications described should be preventable as the technique evolves.

Journal of Pediatric Urology, 2019

Please cite this article as: Koh C et al., Efficacy of electromotive drug administration in deliv... more Please cite this article as: Koh C et al., Efficacy of electromotive drug administration in delivering botulinum toxin a in children with neuropathic detrusor overactivitydoutcomes of a pilot study,