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Many urological societies have provided evidence-based guidelines to help the urologist make therapeutic choices. However, the recommendations in these guidelines may be heterogeneous because they were developed using various methods. The objective of this study was to review key guidelines on the surgical management of urinary stones to provide practical guidance for clinical application.Guidelines on urolithiasis from all international urological societies were searched through the society websites. A search on PubMed® and Medline® restricted to publications in English was also performed for guidelines published between January 1, 2010 and July 1, 2017. Only the latest versions of guidelines containing an evaluation of the level of evidence and the grade of recommendation were included in the final analysis. All recommendations on surgical stone management and recommended techniques for each surgical modality were included. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument was used to assess the quality of the included guidelines.Three international guidelines were included in analysis, including those of AUA (American Urological Association)/ES (Endourological Society), EAU (European Association of Urology) and SIU (Société Internationale d'Urologie)/ICUD (International Consultation on Urological Diseases). We highlighted the heterogeneity in the level of evidence and the grade of recommendation which arose due to the different methods of evaluations that had been adopted. Despite this our review highlighted the considerable similarities among the guidelines. In certain specific situations for which no good evidence was available the recommendations could only be based on expert opinion.An option to provide clear guidance to the urologist might be to combine these international guidelines into one to reduce confusion about the surgical management of urolithiasis.

Etwa 15% der Frauen und 10% der Männer im Alter von über 65 Jahren leiden an einer Harninkontinenz. Die Unterscheidung zwischen einer Drang-, einer Belastungs- und einer Überlaufinkontinenz kann meist durch eine genaue Anamnese erfolgen und ist für die Therapie entscheidend. Die ersten Abklärungsschritte können in der Hausarztpraxis erfolgen, insbesondere der Ausschluss eines Harnwegsinfektes oder einer Überlaufblase. Die Beratung von Patienten über Änderungen der Trinkgewohnheiten und des Miktionsverhaltens sowie die Beratung bezüglich geeigneter Inkontinenzprodukte sind wichtige erste Schritte bei den Therapiemassnahmen. Ebenso können medikamentöse Therapiemassnahmen bereits durch den Grundversorger ergriffen werden. Die therapierefraktäre Harninkontinenz, insbesondere die auf Anticholinergika nicht ansprechende Dranginkontinenz, gehört urologisch abgeklärt, da ein Blasentumor oder andere Erkrankungen der Blase als Ursache vorliegen können.

About 15% of the women and 10% of the men past the age of 65 years suffer from urinary incontinence. In most cases, accurate history taking can help differentiate between urge incontinence, stress incontinence and overflow incontinence, and is essential in choosing the appropriate treatment. Initial diagnostic testing can be conducted by the general practitioner, especially tests to exclude urinary tract infections or to rule out an overactive bladder. Patient education on changes to fluid intake and voiding habits as well as advice on suitable incontinence products are important first steps in the management of urinary continence. Also, drug treatment can be initiated in general practice. Patients with refractory urinary incontinence, particularly those who did not respond to anticholinergic medication, should be referred to a urologist for further evaluation since there may be an underlying tumour or other disorder of the bladder that is causing the incontinence.Etwa 15% der Frauen und 10% der Männer im Alter von über 65 Jahren leiden an einer Harninkontinenz. Die Unterscheidung zwischen einer Drang-, einer Belastungs- und einer Überlaufinkontinenz kann meist durch eine genaue Anamnese erfolgen und ist für die Therapie entscheidend. Die ersten Abklärungsschritte können in der Hausarztpraxis erfolgen, insbesondere der Ausschluss eines Harnwegsinfektes oder einer Überlaufblase. Die Beratung von Patienten über Änderungen der Trinkgewohnheiten und des Miktionsverhaltens sowie die Beratung bezüglich geeigneter Inkontinenzprodukte sind wichtige erste Schritte bei den Therapiemassnahmen. Ebenso können medikamentöse Therapiemassnahmen bereits durch den Grundversorger ergriffen werden. Die therapierefraktäre Harninkontinenz, insbesondere die auf Anticholinergika nicht ansprechende Dranginkontinenz, gehört urologisch abgeklärt, da ein Blasentumor oder andere Erkrankungen der Blase als Ursache vorliegen können.Environ 15% des femmes et 10% des hommes âgée de plus de de 65 ans souffrent d'incontinence urinaire. Dans le plupart des cas, une anamnèse soigneuse peut aider à différencier entre l'incontinence par impériosité, l'incontinence de stress et l'incontinence par regorgement, ce qui est essentiel pour choisir le traitement approprié. L'évaluation diagnostique initiale peut être effectuée par le médecin généraliste, en particulier les tests pour exclure une infection urinaire ou une incontinence par regorgement. L'éducation des malades visant à changer les habitudes de prise liquidienne et d'uriner, ainsi qu'à conseiller des produits appropriés à l'incontinence représente une importante première étape dans la prise en charge de ce problème. Le traitement médicamenteux peut également être instauré en pratique générale. Les malades ayant une incontinence urinaire réfractaire, en particulier ceux qui ne répondent pas à un anticholinergique, devraient être référés à un urologue pour étendre les investigations puisqu'une tumeur sous-jacente ou une autre anomalie de la vessie peut être responsable de l'incontinence.

Screening results for the Child Development Review (CDR) and the Denver II Developmental Screening Test (Denver II) were compared in two locations: the Cheyenne River Reservation in South Dakota and Sioux Falls, S.D. Seventy-three white, Native American and other minority children, half originating from the reservation and half from Sioux Falls, were randomly assigned to take one developmental screening test. A chi-square analysis indicated a significant difference in results across tests. Specifically, more CDR than Denver II subjects passed the screening and more Denver II than CDR subjects failed the screening. This pattern held for subjects living on, but not off, the reservation. Thus, for Native American, white and other minority children living on the Cheyenne River Reservation, the CDR may be undersensitive and/or the Denver II oversensitive to suspect presentations. Medical practitioners are advised to use these instruments with caution in rural settings.

Anterior nasal obstruction secondary to cystic or solid masses is believed to be uncommon. Previous single or series case reports of intranasal mucoceles of the nasolacrimal duct have been published in otolaryngology, ophthalmology, or radiology journals but were not found in general pediatric journals. A 5-year retrospective chart review from our children’s hospital found 10 previously unreported cases of intranasal mucocele of the lacrimal duct causing neonatal nasal obstruction. The purpose of this report is to familiarize pediatricians with this entity, which was the most common cause of anatomic anterior nasal obstruction at our hospital.

Objective To assess the extent to which parents of children with autism compared with parents of children with asthma or other special health care needs report receiving primary care for their child consistent with the American Academy of Pediatrics medical home model. Design Population-based cross-sectional study. Setting National Survey for Children's Health 2003-2004 telephone interview. Participants Parents of 495 children with autism, parents of 6716 children with asthma, and parents of 11 403 children with other special health care needs without asthma. Main Exposures Autism and other special health care needs including asthma. Main Outcome Measures Medical home score and components of care, as follows: personal provider and preventive; family-centered, compassionate, and culturally appropriate; accessible; comprehensive; and coordinated. Results The odds of parents reporting care consistent with that in a medical home were less likely for children with autism (odds ratio, 0.45; 95% confidence interval, 0.30-0.66) and more likely for children with asthma (odds ratio, 1.17; 95% confidence interval, 1.06-1.30) compared with children with other special health care needs (1 [reference]). These differences persisted even after controlling for condition severity, personal characteristics, and insurance status. Specific components of a medical home less prevalent among children with autism than among children with other special health care needs included family-centered, comprehensive, and coordinated care. Conclusion Although we could not evaluate the reasons why, a large percentage of children with autism do not receive primary care consistent with that in a medical home.