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A E MacNeily

Publications and source records attributed to A E MacNeily.

18 recordsLinked to original sources
PubMed2006

Renal transplantation in children 15 Kg or less: the British Columbia Children's Hospital experience.

PURPOSE: Small infants are the most challenging group of patients to undergo renal transplantation. PURPOSE: We reviewed the transplantation experience at our institution with children less than 15 kg at transplantation. MATERIALS AND METHODS: We retrospectively reviewed the records of 24 recipients in a 20-year period. Technical and allograft outcomes were compared to those in the North American Pediatric Renal Transplant Cooperative Study database. RESULTS: Since the inception of our program 24 recipients weighing 15 kg or less who were 6 years or younger have undergone transplantation. Seven grafts (29%) were from living donors. At transplantation mean age was 3.1 years (range 1.8 to 5.7) and mean weight was 13.4 kg (range 9.0 to 15.7). Average cold and warm ischemic times were 14.1 hours (range 3.4 to 37.2) and 23.1 minutes (range 21 to 41), respectively. Early complications were ureteral stricture requiring pyeloureterostomy in 1 case, reversible acute tubular necrosis in 2 and early arterial thrombosis salvaged by immediate thrombectomy in 1. Delayed complications were arterial stenosis requiring angioplasty in 2 cases, and 3 delayed deaths related to malignant hypertension in 2 and sepsis in 1. No grafts were lost due to thrombosis. Mean serum creatinine at years 1 to 3 and 5 were 48.5, 67.5, 79.1 and 84.4 mumol/l, respectively. Graft survival was 92% (22 patients after censoring 1 who died with a functioning graft) at 2 and 5 years. Overall results compare favorably to those in the North American Pediatric Renal Transplant Cooperative Study. CONCLUSIONS: With a multidisciplinary team effort successful results can be achieved in this challenging group of patients.

Body Weight↗
PubMed2006

Screening asymptomatic siblings for vesicoureteral reflux: sound science or religious rhetoric?

INTRODUCTION: Many urologists endorse the concept of screening asymptomatic siblings of children known to have vesicoureteral reflux. Others oppose screening until there is better evidence to justify the cost and potential morbidity of adopting a widespread screening program. METHODS: A literature review of the following topics was carried out: 1) screening programs in general; 2) reflux in general; 3) familial reflux; and 4) screening for familial reflux. RESULTS: The evidence supporting our traditional surgical and medical management strategies for reflux is weak. The evidence supporting screening is lacking. Public Health organizations do not address the issue of screening for this condition. Despite this, there is a significant body of peer reviewed literature and compelling expert opinion, in support of screening. Possible reasons for this are explored. CONCLUSIONS: A randomized controlled trial to definitively assess the utility of screening would be larger and more challenging to perform than any ever done in the history of this condition. Until such time that high quality evidence exists, screening of asymptomatic siblings will continue to be based upon our individual clinical experience and teachings, the morbidity of the index case, and socioeconomic factors. We must continue to re-evaluate our management strategies for this condition in light of new information as it accrues.

Child↗
PubMed2004

Quantitative assessment of a new preparatory tool for board certification in urology.

OBJECTIVE: To analyse the performance of candidates in a Canadian national mock-examination for final-year urology residents with respect to North American speciality examinations in urology. METHODS: In 1997 the Queen's Urology Examination Skills Training Program (QUEST) was established as an annual national mock examination for final-year Canadian urology residents. It consists of a short answer question component and an objective structured clinical examination. During the 5-year period (1997-2001), 91 final-year residents from all 11 Canadian urology residency-training programmes participated in QUEST and the Royal College of Physicians and Surgeons of Canada certifying examinations (RCPSCE); 43 (47%) of candidates also attempted the American Board of Urology part 1 qualifying examinations (ABU 1). Performance on QUEST was correlated with the RCPSCE and ABU 1 in a blinded fashion after submitting QUEST scores to governing bodies. Thresholds were determined to help to predict a candidate's performance on the RCPSCE and ABU 1, based on QUEST scores. RESULTS: There was a moderately close correlation between overall QUEST and RCPSCE performance (r = 0.68, P < 0.001) and a moderate correlation between overall QUEST and ABU 1 performance (r = 0.42, P = 0.005). For the following QUEST scores, the probability of success on the RCPSCE was: < 65%, 67% pass; 66-75%, 80% pass; > 75%, 100% pass (P = 0.002). For ABU 1, QUEST overall score of 80% gave a 69% probability of scoring > or = 70% on ABU 1 (P = 0.003). CONCLUSIONS: QUEST is a moderate predictor of performance on speciality examinations in urology. We consider that the time, effort and expense to maintain QUEST are justified.

Education, Medical, Undergraduate↗
PubMed2003

The American Urological Association In-Service Examination: performance correlates with Canadian and American specialty examinations.

PURPOSE: To our knowledge literature that correlates American Urological Association In-Service Examination (AUA ISE) scores with performance on final specialty examinations is lacking. We report an analysis of Canadian resident performance on the AUA ISE in relation to the Royal College of Physicians and Surgeons of Canada Certifying Examinations in Urology (RCPSCE) and the American Board of Urology Qualifying Examination Part 1 (ABU 1). MATERIALS AND METHODS: During the 5-year period 1997 to 2001 AUA ISE scores were analyzed from 91 final year residents attempting the RCPSCE and a subset of 43 of the 91 (47%) attempting ABU 1. Blinded correlation of scores on the AUA ISE with RCPSCE and ABU 1 was performed. RESULTS: Final year postgraduate year (PGY 5) AUA ISE results correlated strongly with the RCPSCE (r = 0.68, p <0.001) and ABU 1 (r = 0.600, p <0.001). PGY 4 and PGY 3 scores showed a statistically significant correlation, while PGY 2 performance did not meet statistical significance. For the RCPSCE a cutoff point could be determined for pass/failure, namely an AUA ISE raw score of 43% to 55% equaled a 75% pass, a score of 55% to 70% equaled a 88% pass and greater than 70% resulted in a 100% pass. The probability of scoring 70% or greater on ABU 1 as a best guess estimate of successful certification could also be predicted based on AUA ISE raw scores. CONCLUSIONS: The AUA ISE is a good predictor of performance on Canadian and American specialty examinations with the strongest correlation in the final year of residency.

Canada↗
PubMed2001

Pediatric urinary tract infections: current controversies.

Few topics in pediatric urology engender such vigorous debate as the who, when, how, and why related to the investigation of pediatric urinary tract infections (UTIs). Further controversy stems from management of the underlying pathology. This article first discusses the patient characteristics that are important in the evaluation of pediatric patients with UTIs, and the indications for screening tests (such as voiding cystourethrograms, ultrasound, dimercaptosuccinic acid renal scintigraphy, and intravenous pyelography). Following this, the author reviews what is known about three controversial aspects about the management of these patients. First, although the role of the prepuce in pediatric UTI is well established, the role of routine circumcision is not. Second, the natural history and etiology of antenatally detected vesicoureteral reflux (VUR) has provoked us to view the concept of "primary reflux" in a new light. Third, although the way to diagnose vesicoureteral reflux is generally agreed upon, the utility of our surgical management in view of long-term follow-up is less clear.

Child↗
PubMed2001

Challenges in postgraduate urological education.

One of the most crucial responsibilities urologists assume is the education and training of future members of our specialty. This responsibility has become increasingly difficult to fulfil due to a number of influences seemingly beyond our control. The purpose of this review is to summarize some of the challenges facing urological educators in Canada today. Some solutions to these challenges are offered. Where applicable, supporting data from current educational literature are provided.

Canada↗
PubMed2000

Initial assessment of a new preparatory tool for board certification in urology.

OBJECTIVES: To establish a Canadian national examination simulating the qualifying Urology examinations of the Royal College of Physicians and Surgeons of Canada (RCPSC) and to survey candidate perceptions regarding the mock examination's utility as a preparatory tool for the RCPSC examinations and the adequacy of examination preparation provided by their residency training program. METHODS: From January 1997 to February 1999, the Queen's Urology Examination Skills Training (QUEST) program was established, consisting of a short answer question component and an objective structured clinical examination. All participants and residency program directors received detailed feedback regarding candidate performance. RESULTS: All 11 Canadian training programs were represented, for a total of 64 participants. The 56 final-year candidates participating in QUEST and the RCPSC examinations in the same calendar year represented 66% of Canadian residents attempting the RCPSC examinations during that period. QUEST participants were surveyed immediately after the RCPSC examinations (response rate 84%). Of the respondents, 96% believed that QUEST was representative of the RCPSC examinations, and 100% said they would recommend it to future residents. Most respondents (92%) believed that the QUEST program improved their performance on the RCPSC examinations. Regarding the examination preparation received, 32 (68%) of 47 believed their program provided inadequate preparation for the RCPSC examinations. CONCLUSIONS: Support is strong among Canadian urology residents for a preparatory examination such as the QUEST program. A significant majority of residents believed that they received inadequate preparation for the RCPSC examinations from their residency training program.

Canada↗
PubMed2000

Cerebrospinal fluid pseudocyst: a postoperative complication of augmentation ileocystoplasty in myelodysplastic children.

Peritoneal cerebrospinal fluid pseudocyst (CSFoma) formation is a rare postoperative complication of augmentation cystoplasty in children, with only three other cases being reported in the world literature. We describe two patients with CSFoma formation following augmentation ileocystoplasty. The management of these cases and a brief review of the pathogenesis and management of this condition are presented.

Cerebrospinal Fluid↗
PubMed2000

Personal finances of urology residents in Canada.

PURPOSE: We examined how Urology residents in Canada manage their personal finances. MATERIALS AND METHODS: A survey instrument was designed to elicit information on demographics, expenses, savings and incomes. The questionnaire was completed by 40 Urology residents attending the 2000 Queen's Urology Exam Skills Training (QUEST) program. RESULTS: Twenty-eight residents (70%) had educational debt (median debt $50 000). Seventeen residents (45%) paid credit card interest charges within the last year. Four residents (10%) maintained an unpaid credit card balance > $7500 at 17% annual interest rate. Twenty-six residents (67%) contributed to Registered Retirement Savings Program (RRSP) accounts. Seventeen residents (44%) contributed to non-RRSP retirement accounts. Nineteen residents (50%) budgeted expenses. Median resident income was $45 000. Thirteen residents (34%) had cash reserves < $250. CONCLUSION: Many residents save little, and incur substantial debt over and above educational loans. Many residents would benefit from instruction concerning prudent financial management. Residents should be informed of the consequences of low saving and high debt.

Adult↗
PubMed1998

Antenatal hydronephrosis: thresholds of renal pelvic diameter to predict insignificant postnatal pelviectasis.

We tested the parameters of gestational age and renal pelvic anteroposterior (AP) diameter of antenatally detected pelvicaliectasis for their ability to determine insignificant postnatal renal pelvic dilatation. A retrospective analysis of 10,365 antenatal sonograms revealed 121 kidneys with pelvicaliectasis, from which 99 sonograms with sufficient postnatal follow-up were reviewed. Gestational ages were classified as <20, 20-30, or >30 weeks. Thresholds of renal pelvic AP diameter in each gestational period that were predictive of postnatal insignificance were determined to be <6, <8, and <10 mm, respectively. Insignificance postnatally was defined as no or minimal renal pelvic splitting (Society for Fetal Urology grade <II/IV). By categorizing the antenatal sonograms into gestational periods and varying the threshold of AP diameter in each period, the overall sensitivity, specificity, positive predictive value, and negative predictive value of these parameters were 89%, 96%, 95%, and 91%, respectively. We conclude that applying these parameters to antenatal pelvicaliectasis could ultimately provide a clinical management strategy that would aid in the prediction of an insignificant postnatal outcome and obviate unnecessary investigations, anxiety, and cost.

Dilatation, Pathologic↗
PubMed1995

Pediatric urethropelvic junction obstruction - an update.

Maternal-fetal ultrasound has dramatically increased the detection of asymptomatic ureteropelvic junction obstruction. Techniques to assess obstruction and function in the pediatric kidney are imperfect and only recently have diuretic renography and ultrasound been standardized. Considerable controversy has arisen regarding the need for and appropriate timing of surgical correction in pediatric asymptomatic ureteropelvic junction obstruction. Experimental research has suggested that the reninangiotensin system and perhaps growth factors play a role in the response to congenital asymptomatic ureteropelvic junction obstruction. Until several large-scale prospective clinical studies in North America and Britain come to fruition, many aspects of this condition will remain poorly understood.

Journal Article↗
PubMed1994

The Mitrofanoff principle: expanding upon a versatile technique.

OBJECTIVE: To illustrate how the original principle of an appendicovesicostomy can be expanded upon and applied successfully to numerous urological conditions utilizing a variety of surgical techniques. MATERIALS AND METHODS: Over the 8-year period 1985-1993 the Mitrofanoff principle was utilized 105 times in 100 consecutive patients. Seven different types of catheterizing conduit were constructed in conjunction with six varieties of urinary reservoir for patients falling into one of seven different categories of uropathy. RESULTS: At a median follow-up of 30 months, the continence rate for patients was 91%. The re-operation rate for conduit complications was 33%. Neither continence rates nor complications specific to the Mitrofanoff were related to the underlying uropathy, the type of conduit constructed, the urinary reservoir employed, and the patient's age at surgery. CONCLUSION: The Mitrofanoff principle of continent urinary diversion is a versatile technique with a predictable success rate applicable to a wide variety of urological conditions. Patients and surgeons should be aware of the significant rates of revision required on the catheterizing conduit to enable continence to be ultimately achieved.

Adolescent↗
PubMed1993

Does early pyeloplasty really avert loss of renal function? A retrospective review.

We reviewed 75 cases of isolated, unilateral pediatric ureteropelvic junction obstruction and 167 diuretic radionuclide renograms performed during the last 8 years. Differential function of the affected kidney was calculated using scintillation count data at 1 and 3 minutes, and the area under the renogram curve between 1 and 3 minutes. There was no significant difference among the 3 measures of per cent differential function for a given patient. Per cent differential function on the first renogram preoperatively neither declined as age at presentation advanced nor did it vary according to the clinical presentation. Similarly, the changes in postoperative per cent differential function were unaffected by the age at initial presentation, manner of presentation, occurrence of postoperative complications or the surgeon. These data do not support the concept that pyeloplasty for the isolated, unilateral ureteropelvic junction obstruction should be performed early to avert loss of renal function.

Adolescent↗
PubMed1992

A comparison of two continent catheterizable vesicocutaneous techniques.

In a rabbit model we describe and compare two continent catheterizable diversion techniques for which the bladder is intact and the stoma is situated in the lower abdomen. Both mechanisms are formed from a short segment of ileum; one utilizes the principles of the encircling loop technique as described by Koff and the second, the Kock principle (intravesical nipple). Both models were evaluated for the following parameters: ease of catheterization (87%, 79% respectively), continence (91%, 86% respectively), and ease of construction. We present evidence that both techniques are applicable to the clinical setting.

Animals↗
PubMed1991

Sonographic visualization of the ureter in pregnancy.

We describe a method of differentiating physiological from pathological dilatation of the renal collecting system in pregnant patients. In physiological hydronephrosis the dilated ureter extends down only to the level of the common iliac artery. In 2 patients with distal ureteral stones a dilated ureter was visualized past the vessels. To determine the frequency and reliability of visualizing the ureters in pregnant patients 105 consecutive asymptomatic pregnant patients were examined. Hydronephrosis was found in 83 kidneys in 59 of the patients. The dilated ureter was visualized in 64 of the renal units. The anatomy was well demonstrated by color flow Doppler scanning and in all of these cases the dilated ureter was seen to taper where it crossed the common iliac artery. These results suggest that the presence of a dilated ureter past the iliac artery is strong evidence for pathological distal ureteral obstruction in pregnancy.

Adult↗