Journal of Pediatric Urology最新文献

Modern surgical advances have improved outcomes, yet compassion remains underemphasized in surgical practice. There is ample evidence demonstrating the benefits of compassionate care for both providers and patients. The "Surgery with Compassion" initiative aims to incorporate this essential quality into surgical practice. As part of this concept, we developed the "Surgical Compassion Pause," a brief, intentional moment of reflection introduced just after the Time Out procedure. It is centered on both the patient and the surgical team and is based on the "4 C's"-Conscious Awareness, Courage, Commitment to Purpose, and Caring Connections-which together create a safe and meaningful operating room environment. This pause strengthens team bonds and provides reassurance to patients and families. We propose that, when combined with broader compassion training, it creates lasting, positive impacts for everyone involved.

Introduction: Monosymptomatic nocturnal enuresis (MNE) is defined as urinary incontinence occurring during sleep in absence of daytime lower urinary tract symptoms. International Children Continence Society (ICCS) classifies treatment success as complete response (100 % resolution of symptoms), partial response (50-99 % reduction in symptoms) and no response (<50 % resolution of symptoms). There are no symptom scores for management or follow-up for MNE in the existing literature.

Objective: In this study, we aimed to develop a symptom score for monitorization of MNE treatment.

Study design: Existing symptom scores were investigated, experts' recommendations for items were collected and 20 children with MNE's caregivers were interviewed with open-ended questions to build the draft questionnaire. Generated items were applied to 20 different caregivers of children with MNE as a pilot study, and Nocturnal Enuresis Symptom Score was generated with a total of 9 questions with a 0-3 scale for each item. Stability, reliability and validity was analysed, A ROC curve was built to determine a cut-off value for response assessment.

Results: The study included 85 children (51 (60 %) boys, 34 (40 %) girls) aged 9 (5-17) years. Cronbach's alpha for items was 0.867. One month follow-up showed non-response in 24 (28 %), partial response in 31 (37 %) and complete response in 30 (35 %) children based on ICCS classification Decreased number of wet nights were observed in 17 % (0-50), 73 % (50-87) and 100 %, whereas NESS score improvements were 7 %, 35 % and 78 % respectively (r = 0.708). With a cut-off NESS value of 25.6; 72 % of sensitivity and 70 % of specificity were achieved to discriminate between partial and non-responders. ICCS classification (<50 %) and NESS classification (<25 %) for non-responders were strongly correlated (r = 0.893). A cut-off value of NESS over 15.5 predicts the non-responder group with 69 % sensitivity and 62 % specificity with an AUC of 0.664.

Discussion: In previous studies, different measurements were used to assess the outcomes of different management strategies for MNE such as the number of wet nights per 15 or 30 days or existing QoL questionnaires. Those studies were limited by a lack of standardized disease-specific methods for decision-making. Our symptom score may help clinicians to better classify treatment responses with a cut-off value of 25.6 % reduction. The major limitation is the lack of linguistic validation in different populations, which may be a topic for future research.

Conclusion: NESS may be useful to monitor patients with MNE in a standardized manner.

Background: Functional daytime urinary incontinence (DUI) is a frequently occurring condition among children. The etiology of DUI is multifactorial, involving genetic, biological, and psychosocial factors. Autism Spectrum Disorder (ASD) seems related to DUI, as children with ASD have a higher risk of developing DUI. Sensory processing issues are prevalent in children with ASD and may contribute to DUI.

Objective: This study aims to elucidate the role of sensory processing issues in children with functional daytime urinary incontinence in relation to ASD.

Methods: A cross-sectional study was conducted, including parents of children aged 6-12 years old, categorized into four groups: healthy children, children with DUI-only, children with ASD-only, and children with both DUI and ASD. Parents completed the Dutch version of the Short Sensory Profile (SSP-NL) to compare sensory processing between groups.

Results: A total of 225 eligible children participated in this study, with 75 otherwise healthy children, 58 children with DUI-only, 49 with ASD-only, and 43 children with DUI and ASD. Children with DUI-only scored significantly lower compared to their healthy peers in the SSP-NL domains of 'Low energy/weak' and the quadrant 'Low registration', indicating sensory under-responsivity and potential limitations in multisensory processing. Children diagnosed with ASD had the most sensory processing issues, independent of their DUI status.

Conclusion: Our study suggests that children with DUI may experience more sensory processing issues than their healthy peers. A better understanding of these issues associated with incontinence may improve urotherapy by taking into account children's sensory challenges and by teaching them adaptive behavior.

Introduction: Robotic uretero-ureterostomy (RUU) is a minimally invasive surgical technique that has gained popularity in recent years, especially for the treatment of duplex systems, as an alternative to ureteral reimplantation.

Aims of the study: Focusing on technical considerations and supporting its use, we aim to describe our procedure and results in children.

Materials and methods: From November 2018 to December 2023, we collected data on RUU performed by Da Vinci Surgical Robot Xi® in pediatric patients at our center. All patients underwent preoperative ultrasound, functional studies, and cystourethrography. Surgery was indicated for duplex systems with ectopic upper ureter. The orthotopic ureter was stented during preoperative cystoscopy. Three or four trocars were placed along the transverse umbilical line with the patient in 20° Trendelenburg position. The ectopic ureter was isolated below the iliac vessels, transected distally and anastomosed end-to-side to the stented ureter.

Results: Eight robotic UU (7 females, 1 males) were performed. Median age and weight were 4.4 years (0,6-12,2) and 15,8 kg (8.5-62) respectively. Median operative time was 129,5 min (108-275) and median console time 66 min (36-175). Four robotic arms were used in 6 patients and 3 in the remaining two. Median distance between trocars was 4.8 cm (4-5). All patients maintained the stent for a median time of 45,5 days (37-67). No intraoperative complications nor conversion were reported. Median hospital stay was 3 days (2-9) and median follow-up 7 months (3.2-29). All patients reported a successful procedure as assessed clinically by resolution of urinary incontinence and ultrasonographically by reduced or resolved urinary dilatation.

Conclusions: RUU can be safely performed in pediatric patients, including low-weight ones. It has acceptable operative times, short hospital stays and optimal success rates with no intraoperative complications. RUU is a feasible and safe alternative technique to duplex systems, resolving symptoms and obstruction and avoiding major bladder surgery.

Introduction and objective: Bladder exstrophy-epispadias complex (BEEC) is a rare, but serious congenital malformation. After achieving urinary continence and upper tract preservation, genital reconstruction is performed for function and cosmesis. We evaluated our institutional experience with vaginoplasty, including technical considerations and post-operative outcomes.

Patients and methods: An IRB-approved database was used to conduct an institutional retrospective review of BEEC patients undergoing vaginoplasty from 2000 to 2024. Patients with XY karyotype, primary vaginoplasty during BEEC closure or at another institution, or no urologic follow-up visits at least six months post-vaginoplasty were excluded. Data on age, reconstructive method, and suture type was collected. Post-operative complications were analyzed with the primary surgical outcome of vaginal stenosis requiring re-operation (VS) and secondary surgical outcomes including urinary tract infection (UTI), surgical site infection (SSI), dehiscence, rectal injury, fistula, and symptomatic pelvic organ prolapse (POP) after vaginoplasty.

Results: A total of 240 female BEEC patients were identified with 54 (22.5 %) undergoing vaginoplasty. Median age at vaginoplasty was 15.6 years old. The majority of cases were perineal flap vaginoplasty (88.9 %). Nylon suture was most commonly used (46.3 %), with Vicryl and PDS used in 31.5 % and 22.2 % of cases, respectively. Median follow-up time was 55.2 months. Post-operative complication rates were VS 14.8 %, UTI 3.7 %, SSI 7.4 %, dehiscence 3.7 %, rectal injuries 0 %, fistula 0 %, and symptomatic POP 12.9 % (Table 1). The perioperative complication rate per-patient from post-operative day 1-90 was 20.4 % and the overall lifetime complication rate per-patient was 33.3 %. We found no significant association between reconstructive method and VS (p = 0.2). Among VS events, PDS was used in 50 % of cases (p = 0.041). On univariable analysis, PDS use was significantly associated with VS (OR 4.75, 95 % CI [1.02-23.1], p = 0.042). This finding remained significant when adjusting for reconstructive method on multivariable analysis (OR 5.83, 95 % CI [1.06-32.3], p = 0.043) (Table 2).

Conclusions: As children with BEEC mature into adulthood, optimizing surgical outcomes for genital reconstruction is critical. In this large retrospective cohort of BEEC patients undergoing vaginoplasty, we observed that VS was the most common post-operative complication. Symptomatic POP was the second most common post-operative complication, but of these patients, the majority were managed conservatively. Use of PDS during vaginoplasty was significantly associated with VS, suggesting that other suture types may be more advantageous for successful surgical outcomes, but further investigation into the clinical significance of this finding is warranted.

Purpose: Evidence-based guidelines for contralateral orchiopexy during testicular torsion surgery are lacking. We aim to evaluate the rates of contralateral orchiopexy at time of testicular torsion surgery.

Material and methods: Utilizing Kids Inpatient Database, we performed a retrospective cohort study of children <18 years old who had surgery for testicular torsion from 2016 to 2019. Patients were identified using the ICD10 testicular torsion diagnosis code. Primary outcome was the rate of contralateral orchiopexy. Multivariable logistic regression evaluated patient and hospital factors associated with contralateral orchiopexy.

Results: We identified 1544 children who had surgery for testicular torsion. Of the 531 patients who underwent ipsilateral orchiopexy, 170 (32 %) did not have concurrent contralateral orchiopexy. Of the 528 patients who underwent orchiectomy, 186 patients (35 %) did not have concurrent contralateral orchiopexy. Overall, 1188/1544 (76.9 %) children underwent bilateral orchiopexy, and 356/1544 (23.1 %) did not undergo contralateral fixation. Multivariable logistic regression analysis showed that increased patient age was associated with decreased likelihood of having a contralateral orchiopexy (OR = 0.96, 95 % CI [0.94-0.98], p < 0.01). Patients having surgery at Western region (OR = 0.50, 95 % CI [0.34-0.73], p < 0.01), private non-profit (OR = 0.60, 95 % CI [0.39-0.92], p < 0.02) and private investor owned (OR = 0.58, 95 % CI [0.35-0.95], p < 0.03) hospitals were less likely to have a contralateral orchiopexy.

Conclusions: We observed that roughly a quarter of children having surgery for testicular torsion do not undergo a contralateral orchiopexy. Increasing patient age, surgery in Western region hospital, and private hospital, were associated with decreased likelihood of contralateral orchiopexy.