Journal of Pediatric Urology最新文献

Purpose: To evaluate the efficacy of our novel technique utilizing a para-fistulous penile skin flap to repair urethrocutaneous fistulas in children.

Methods: A Prospective case series study included repairing 69 urethrocutaneous fistulas with our technique. It consists of a para-fistulous penile skin flap, with a second dartos layer obtained with a specific approach and a third full-thickness skin layer. Concomitant Meatoplasty was performed for associated meatal stenosis. Surgical success is defined as normal voiding without fistula recurrence. Both univariate and multivariate analyses were utilized to assess predictors of fistula recurrence.

Results: The mean age ±SD was 6.5 ± 4.8 years, and the mean fistula size was 6.5 ± 3.9 mm. A total of 40 fistulas (58 %) measured ≥5 mm, while 29 (42 %) were <5 mm. Sixty cases (93.8 %) were diagnosed with a single fistula, while four patients (6.3 %) had multiple fistulas. Additionally, 11 cases (17.2 %) were associated with meatal stenosis. The mean operative time was 56.8 ± 6.8 min, and the mean follow-up period was 11.75 ± 5 months. Four patients (6.2 %) experienced low-grade complications. Sixty-three cases (91.3 %) achieved successful fistula repair, and the success rate for large (>5 mm) and multiple fistulas was 95 % and 88.9 %, respectively. On univariate analysis, Multiple Previous hypospadias repairs, preoperative meatal stenosis, postoperative wound infection, and superficial skin necrosis were significantly associated with fistula recurrence (P < 0.05); however, multivariate regression analysis showed a significant correlation with preoperative meatal stenosis (p = 0.003) and superficial skin necrosis (p = 0.045).

Conclusion: This study demonstrates the efficacy of our novel Para-fistulous Penile Skin Flap technique in repairing urethrocutaneous fistulas in pediatrics, achieving good outcomes for both large and multiple fistulas. Preoperative meatal stenosis and postoperative superficial skin necrosis were the independent predictors of fistula recurrence.

Objective: To evaluate the effectiveness of a modified quick checklist for quality control in reducing the incidence of technical artifacts during pediatric urodynamic studies (UDS).

Methods: A single-center quasi-experimental study with a pre-post intervention design was conducted, comprising three phases: technical artifact analysis (baseline period), modified quick checklist development, and intervention effect evaluation (intervention period). During the baseline period, urodynamic data from 174 pediatric patients were retrospectively collected. Technical artifact classification criteria were established based on guidelines from the International Continence Society (ICS) and the International Children's Continence Society (ICCS), adapted to pediatric characteristics. A modified quick checklist was subsequently developed, validated via expert consultation (content validity index, CVI) and optimized through pre-testing. The intervention phase enrolled 127 pediatric patients, applying the modified quick checklist and comparing technical artifact rates between groups.

Results: No significant differences were observed between the baseline and intervention groups regarding age, gender, or underlying conditions (P > 0.05). Following the implementation of the modified quick checklist, there was a significant improvement in the completion rate of the standard cough test before perfusion (χ² = 6.108, P = 0.013), complete measurement records (χ² = 7.730, P = 0.005), and the completion rate of the standard cough test before pressure measurement termination (χ² = 32.008, P < 0.001). However, no statistically significant differences were noted in indicators such as abdominal pressure variability or catheter displacement.

Conclusion: The modified pediatric urodynamic quality control checklist effectively reduces technical artifacts in pediatric UDS examinations, enhances procedural standardization and data quality, and serves as a practical quality control tool for the precise assessment of pediatric lower urinary tract dysfunction.

Objective: This study evaluates long-term outcomes after pyeloplasty for unilateral ureteropelvic junction obstruction (UPJO), examines the correlation between early postoperative imaging and outcomes, and identifies predictors of functional recovery.

Material and methods: This retrospective study analyzed 116 pediatric patients who underwent open dismembered pyeloplasty for unilateral UPJO from 2010 to 2023, with a minimum of three years postoperative follow-up. Patients were classified as "recovered" if their differential renal function (DRF) improved by over 5 % on the final renogram. We examined various parameters, including the ipsilateral-to-contralateral renal parenchymal thickness ratio (ParT ratio), anteroposterior pelvic diameter (APD), percent regression in APD (APDred%), and APD/parenchymal thickness ratio (APD/PT) at baseline and monthly postoperative ultrasounds. Nonparametric tests were used for group comparisons, and multivariable logistic regression identified independent predictors of recovery. We also evaluated early postoperative measurements (3 and 6 months for ultrasound; 12 months for renography) against final values to determine correlations with long-term outcomes.

Results: The median age at surgery was 24 months (IQR 6-96), with a median follow-up of 96 months (IQR 60-120). Among patients with a ≥5 % increase in long-term differential renal function (n = 26), baseline renal function was lower (33.7 % vs. 41.5 %; p = 0.002) than in those who did not improve. The improved group also had a lower ParT ratio at baseline and six months (0.43 vs. 0.51; p = 0.046). A higher percentage of the improved group had surgery before one year of age (58 % vs. 33 %; p = 0.038). Logistic regression identified age under one year and lower baseline renal function as predictors of recovery. At one year postoperatively, renal function remained stable in 115 out of 116 patients (99 %) according to subsequent renograms. Six-month ultrasound results closely aligned with final pelvic diameter regression, whereas other measures did not significantly correlate with improvement. There were no significant differences in antenatal hydronephrosis, SFU grades, or rates of febrile urinary tract infections between the groups.

Conclusion: In pediatric UPJO, age at surgery <1 year and lower baseline DRF are associated with postoperative functional improvement. Six-month ultrasound measurements of AP diameter reduction accurately reflect pelvic outcome at long-term follow-up, while the one-year renogram provides an appropriate assessment of long-term renal function.