Journal of Pediatric Urology最新文献

Introduction: Vesicoureteral reflux (VUR) is a common congenital or acquired urinary disorder in children. Chat Generative Pre-trained Transformer (ChatGPT) is an artificial intelligence-driven platform offering medical information. This research aims to assess the reliability and readability of ChatGPT-4o's answers regarding pediatric VUR for general, non-medical audience.

Materials and methods: Twenty of the most frequently asked English-language questions about VUR in children were used to evaluate ChatGPT-4o's responses. Two independent reviewers rated the reliability and quality using the Global Quality Scale (GQS) and a modified version of the DISCERN tool. The readability of ChatGPT responses was assessed through the Flesch Reading Ease (FRE) Score, Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index (GFI), Coleman-Liau Index (CLI), and Simple Measure of Gobbledygook (SMOG).

Results: Median mDISCERN and GQS scores were 4 (4-5) and 5 (3-5), respectively. Most of the responses of ChatGPT have moderate (55 %) and good (45 %) reliability according to the mDISCERN score and high quality (95 %) according to GQS. The mean ± standard deviation scores for FRE, FKGL, SMOG, GFI, and CLI of the text were 26 ± 12, 15 ± 2.5, 16.3 ± 2, 18.8 ± 2.9, and 15.3 ± 2.2, respectively, indicating a high level of reading difficulty.

Discussion: While ChatGPT-4o offers accurate and high-quality information about pediatric VUR, its readability poses challenges, as the content is difficult to understand for a general audience.

Conclusion: ChatGPT provides high-quality, accessible information about VUR. However, improving readability should be a priority to make this information more user-friendly for a broader audience.

Background: Children with enuresis are often requested to complete voiding diaries in the diagnostic process. There is no consensus on the optimal number of days of registration in the voiding diary that would allow correct patient characterization.

Objectives: To examine the intra-individual variation in the parameters yielded from voiding diaries and evaluate if one week of registration is sufficient when evaluating the nocturnal urine production (NUP) and maximum voided volume (MVV) in children with monosymptomatic nocturnal enuresis (MNE).

Methods: We analyzed 228 voiding diaries completed for 14 days from treatment naïve children aged 6-14 years with MNE. NUP was estimated by diaper weight and volume of first morning void. MVV was registered both including and excluding first morning void.

Results: We found no significant differences in terms of NUP and MVV between week one and two, between one week or 14 days of registration, or when comparing two and four days of daytime registration. When using current ICCS definitions, 8 % of children with reduced MVV and no nocturnal polyuria and 12 % of children with nocturnal polyuria and normal MVV changed characterization when comparing two weeks of registration with two days of registration.

Conclusion: One week of nighttime-registration and two days of daytime-registration is sufficient to provide valid estimates of NUP and MVV. Two days could be sufficient to calculate subtype characterization according to ICCS definitions and possibly enhance compliance.

Randomized controlled trials (RCTs) are at the top of the pyramid of evidence as they offer the best answer on the efficacy of a new treatment. RCTs are true experiments in which participants are randomly allocated to receive a certain intervention (experimental group) or a different intervention (comparison group), or no treatment at all (control or placebo group). Randomization, along with other methodological features such as blinding and allocation concealment, safeguard against biases. This review will focus on parallel group RCT design as it is the most common design in the field of Pediatric Urology. RCTs can be designed using a superiority, equivalency, or non-inferiority hypothesis, and are usually preceded by a pilot, where the trial protocol is implemented in a small number of patients, mimicking the larger, definitive study. Even though regarded as the best available option to bring out scientific data, RCTs might be prone to mislead. If RCTs are small and underpowered, a difference of even one single event between groups, may completely change the trial results. To safeguard against RCTs weakness, a fragility concept of statistical significance was developed and called the Fragility Index (FI). RCTs may not be appropriate, ethical, or feasible for all surgical interventions. They may have limitations such as prohibitive cost and unrealistic large sample sizes. Nearly 60 % of surgical research questions cannot be answered by RCTs. Therefore, clinical practice should be based on the best available evidence on a given topic, regardless of the study design. However, even in these situations, conclusions drawn from observational studies must be interpreted with caution.

Introduction: Periodic follow-up prior to and after puberty to evaluate for long-term sequalae following hypospadias repair is commonly recommended. Few studies have evaluated this follow-up, especially into adulthood. This study aimed to evaluate adherence to routine postoperative follow-up appointments over 10 years following elective hypospadias repair.

Material and methods: Retrospective review of all patients undergoing hypospadias repair at our institution under the age of 10 from January-December 2012 was performed. Data were extracted including demographics, meatal location, type of hypospadias and chordee repair, use of postoperative stent, adherence to follow-up, re-operations, and postoperative concerns. Primary outcome was adherence to long-term follow-up. Secondary outcomes included re-operative rates and complications.

Results: A total of 213 patients underwent hypospadias repair in 2012 with 52 (24 %) having a distal repair without urethral stent, 112 (53 %) distal repair with urethral stent, 29 (14 %) midshaft repair with urethral stent, and 20 (9 %) proximal repair with urethral stent. Almost all patients followed up for stent removal at our clinic (88 %), and the remaining with a local provider. Overall, 64 % of patients presented for their postoperative check within 3 months which was consistent between groups (p = 0.300). Only 12 % (25/213) of patients followed up after toilet training with the proximal group having the highest rate at 40 % (8/20, p = 0.003). In those following up after toilet training, 36 % (9/25) of patients followed up due to clinical symptoms attributed to their hypospadias repair or another unrelated urologic issue; the vast majority (87.5 %) of those with proximal hypospadias did so without any urologic issues. 15 % (31/213) of patients never followed up. Five (2.7 %) patients underwent secondary procedures related to their initial hypospadias surgery.

Discussion: We noted poor rates of follow-up at our institution for boys undergoing hypospadias repair. Short-term follow-up was uniformly poor. After toilet training, boys with proximal hypospadias were more likely to follow-up. This study is limited in being a retrospective, single center study and that some urologic follow-up may not have been captured outside of our tertiary referral center.

Conclusions: Despite our recommendations, patient adherence to follow-up after hypospadias repair is poor. More research and attention are needed to optimize and better understand poor adherence to long-term follow-up. Follow-up is essential to assess true rates of long-term complications, and to help develop specific education regarding consequences of unrecognized surgical complications, especially in more complex cases. Sharing such information may ensure parents understand the need for routine and regular evaluation.