Journal of Pediatric Urology最新文献

Background: Testicular torsion is a well-documented pediatric urological emergency that poses a time-sensitive risk to the testicle and long-term morbidity. Despite the urgent nature of testicular torsion, few studies have explored the institutional and clinical factors that influence diagnosis and management. To address this gap, we performed qualitative focus group interviews across the National Surgical Quality Improvement Program Pediatric (NSQIPP) Testicular Torsion Collaborative to better understand facilitators and barriers to testicular torsion care.

Methods: Relevant stakeholders involved in testicular torsion care (i.e. emergency department, radiology, urology, peri-operative services, anesthesia, and surgical quality leadership) across the Testicular Torsion Collaborative were invited to participate in focus group interviews led by a moderator and included a note-taker. All focus groups were recorded and transcribed via Zoom™ audio-visual conferencing software. Inductive coding was performed by 3 reviewers using Dedoose (Los Angeles CA). Themes were designated within the Theoretical Domain Framework (TDF) construct for implementation science and determined to be either a facilitator or barrier to testicular torsion care.

Results: Of the 29 invited sites, 10 sites and 47 individuals participated. Thematic saturation was reached for 20 themes, each represented in at least 2 focus group discussions. All elements of the TDF were represented in the discussions. Community education, culture of quality, high standard of care expectations, and leveraging available data were universally seen as facilitators. Long term follow-up and outcomes, manual detorsion care, and competing care demands were universally seen as barriers.

Conclusions: Based on focus groups of stakeholders in all aspects of testicular torsion care, opportunities to improve care include leveraging quality improvement culture and resources (i.e. trained personnel, data). Barriers to care include competing care demands arising from outside transfers and institutional clinical volume. We hope readers can use this data as a framework to improve in testicular torsion care.

Introduction: Duchenne muscular dystrophy (DMD), a severe, progressive disease, causes loss of function of skeletal muscles. Urological symptoms in DMD include detrusor overactivity, bladder hypocontractility, urinary incontinence, detrusor-sphincter dyssynergia and urolithiasis. This narrative review summarises available evidence and provides recommendations for bladder dysfunction management.

Materials and methods: A literature search was performed using the PubMed, Scopus, Embase, Cochrane and Web of Science search engines. The objectives of the review were: to investigate the incidence of lower urinary tract symptoms (LUTS), defecation problems, urinary tract infections (UTIs) and urolithiasis and the impact of urological problems on the quality of life of children with DMD. Following PRISMA guidelines and applying the Patient, Intervention, Comparison, Outcome (PICO) framework, nine non-randomised studies were selected, and MINORS criteria were used to validate their quality.

Results: All selected studies included DMD patients alone or in a mixed cohort with Becker Muscular Dystrophy (BMD) patients (DMD: 76-84 %). Diagnosis was mostly confirmed clinically. A single institute study design was noted for alle publications. Only one study incorporated short follow-up. Inclusion of a urologist in multidisciplinary teams was uncommon. Definitions and assessments of LUTS varied widely, and their prevalence ranged from 32 % to 85 %. Most frequently reported LUTS were hesitancy, urgency, day-time or night-time urinary incontinence and frequency. The prevalence of concomitant defecation problems ranged from 32 % to 70 %. Information on UTIs, urolithiasis, quality of life and intervention outcomes, for example, anticholinergics use was sparse.

Conclusions: DMD is a progressive muscle disease with urological complications. This review revealed a high prevalence of LUTS, including hesitancy, urgency, and incontinence, along with significant defecation issues. However, limited information is available on UTI, urolithiasis, quality of life, and treatment outcomes for these symptoms. Special attention is warranted for LUTS and bowel function. Multidisciplinary treatment including a paediatric urologist is beneficial.

Introduction: There is a paucity of research regarding transition to adult services within pediatric and adolescent urology. Several recent articles have discussed the barriers in transitioning urologic patients from pediatric to adult health care, but empiric data that may drive intervention are lacking. This study proposes to begin to address this gap in literature and to provide information that may lead to improved understanding of how best to support transition in urologic care.

Objectives: 1) to identify modifiable and non-modifiable factors related to transition readiness as measured by Transition Readiness Assessment Questionnaire (TRAQ) scores in a congenital urologic population and 2) to evaluate the relationships between TRAQ scores (a validated questionnaire measuring transition readiness) and scores measuring anxiety levels related to transition (using an adapted, non-validated questionnaire).

Study design: This is a cross-sectional study of adolescent and young adult patients with complex congenital urologic diagnoses. Subjects were electronically administered the validated TRAQ and a study-developed ADHERENT survey, which assesses anxiety and worry surrounding transition. Regression models for the outcomes of the TRAQ and ADHERENT scales were developed to assess multivariable associations with variables of clinical importance.

Results: The youngest subgroup (14-17 years of age) compared to the oldest subgroup (21-25 years of age) had significantly lower TRAQ scores [regression estimate = 12.3 (95 % CI: 2.9, 21.7), p = 0.010]. Additionally, single participants versus those in a stable relationship had significantly lower TRAQ scores [estimate = 8.7 (95 % CI: 1.9, 15.4), p = 0.012]. The Spearman correlation coefficient between TRAQ and ADHERENT scores was 0.52 (p = <0.001), indicating a positive, moderate relationship between the two measures, suggesting more readiness correlated with less anxiety.

Discussion: This study found that age, higher education, and stable relationship status were associated with higher measures of transition readiness. There was a correlation found between more transition readiness and less anxiety surrounding transition. This finding can be used to inform future research and emphasizes the need for multidisciplinary support throughout the transition process.

Conclusion: Early discussion of transition of care and education around transition readiness are not the only solution to improving transition success. The second phase of ADHERENT seeks to understand the patient experience and to include adolescents and young adults in shaping effective healthcare transition strategies.