Journal of Pediatric Urology最新文献

Background and objective: This study aimed to explore the impact of positive or negative feedback on the performance of trainees in pediatric urology during simulation exercises in pediatric laparoscopy.

Methods: Twenty-five students enrolled in a national Pediatric Urology Laparoscopy Simulation participated in the study. They performed the Fundamentals of Laparoscopic Surgery (FLS) skills, specifically peg-transfer and intracorporeal knot-tying, in a randomized study design while receiving positive or negative feedback from an attending pediatric urologist. On the first day, all students performed FLS peg-transfer and intracorporeal knot-tying tasks on a pediatric laparoscopic simulator. On the second day, students were randomized to receive either positive or negative comments during the procedure. Task performances, measured by task time and errors, was compared between both groups. Statistical analysis was conducted using the Mann-Whitney U test.

Key findings and limitations: The difference in execution time between exercises with and without feedback was significantly greater in the group that received negative feedback compared to the group that received positive feedback (p = 0.003). Students who received positive feedback increased their time by a median of 2 s, whereas students who received negative comments increased their time by a median of 34 s.

Conclusions and clinical implications: Feedback should be delivered in a manner that is supportive, respectful, and improvement-focused rather than discouragement. Understanding these dynamics can guide the development of effective feedback strategies to optimize learning and enhance performance outcomes in training for minimally invasive surgery in pediatric urology.

Introduction: Calcium phosphate stones are commonly found in medically complex children (MCC) receiving enteral feeds. The objective of this study is to investigate the etiology for calcium phosphate stones in this patient population.

Study design: This is a retrospective cohort study of gastrostomy fed, MCC who presented to a high-volume Pediatric Stone Center from 2015 to 2019. MCC were defined as those with a diagnosis of cerebral palsy and/or severe developmental delay who were non-ambulatory. A control group was composed of newly presenting patients to the stone clinic without comorbid conditions. Twenty-four hour urine collections were performed prior to medical intervention and were compared between MCC and controls.

Results: Twenty-four MCC children were compared to 38 controls. The median age (interquartile range [IQR]) and weight of MCC were 11.9 (7.5, 16.3) years and 28.6 (21.0, 37.0) kg. Urine supersaturation of calcium phosphate (SSCaP) was similar in MCC and controls (1.7 and 2.0, p = 0.40). Weight-based 24-h urine calcium and phosphorus excretion were also similar in MCC and controls. The median BSA-adjusted urine volume was significantly higher in MCC vs controls (2.2 vs. 1.2 L/1.73 m², p < 0.001), which contributed to lower 24-h average urinary phosphorus (271.9 vs. 689.7 mg/L, p < 0.001) and calcium concentrations (73.3 vs. 132.8 mg/L, p < 0.001). However, urine pH was significantly higher in MCC (7.4 vs. 6.3, p < 0.001), as was net gastrointestinal absorption of alkali (1.1 vs. 0.3 mEq/kg/day, p < 0.001). In regression analysis, SSCaP increased by a factor of 2.82 for every 1-unit increase in urine pH (p < 0.001).

Conclusion: A high urine pH is associated with an increased risk of calcium phosphate nephrolithiasis in MCC. This may be caused by a higher alkaline content of enteral feeding formulations compared to children on a standard American diet.

Introduction: Clean intermittent catheterization (CIC) has significant advantages over indwelling catheters. To facilitate CIC, a continent catheterizable channel (CCC) to the bladder is required in some cases. The Mitrofanoff appendicovesicostomy (APV) is considered the gold standard for pediatric CCC creation. However, when the appendix is unavailable or unsuitable for the creation of a CCC alternatives are required.

Objective: This study aims to share our single-center experience with using a spare ureter as a CCC in pediatric patients and compare its advantages and complications to those of APV and the use of bowel segments.

Study design: A retrospective review of the medical records of all pediatric patients who underwent CCC creation between 2001 and 2023 was performed. The inclusion criteria were age younger than 18 years at surgery and the use of an appendix, ileal segment, or ureter for CCC creation.

Results: A total of 108 pediatric patients underwent CCC creation. Of these, 90 had an APV, 5 had an ileal segment CCC, and 13 had a ureteral CCC. Operating times were not significantly different among the groups. The median follow-up was 78 months for the ureter group, 66 months for the APV groups and 13 months for the ileal group. The stomal continence rates were 92 % for the ureter group, 97 % for the APV group, and 100 % for the ileal group. Stomal complications occurred in 15.4 % of ureter CCCs, 25.6 % of APVs, and 40 % of ileal CCCs. No significant differences in complication rates were observed among the groups.

Discussion: Our findings demonstrate that ureteral CCCs have acceptable complication rates and functional outcomes comparable to those of APVs and ileal CCCs. The limitations of this study include its retrospective design and small sample size, especially in the ureteral and ileal groups. Future prospective studies with larger cohorts are recommended to further validate these findings.

Conclusion: Our study indicates that the utilizazion of a spare ureter for CCC creation is a feasible and effective alternative in pediatric patients with a nonfunctioning kidney.

Background: The current gold-standard for detecting vesicoureteral reflux (VUR) is the voiding cystourethrogram (VCUG). However, VCUGs require ionizing radiation and bladder catheterization that can be challenging to perform and traumatic for pediatric patients and their parents.

Objective: To investigate the feasibility of a novel urinary catheter-free modality for diagnosing VUR using in vitro and ex vivo models.

Design, setting, and participants: Polyethyleneimine (PEI) and pressurized CO₂ gas were utilized to formulate our polymer in a standardized and reproducible method. The CO₂-loaded PEI solution was stimulated using moderate intensity ultrasound in latex balloons and ev-vivo porcine bladders. Degassed, deionized water served as the control.

Outcome measurements and statistical analysis: A Butterfly iQ ultrasound imaging system connected to a 9th generation iPad was utilized to observe any effervescence (bubbles).

Results: In both the balloon and ex vivo bladder models, CO₂ effervescence is reproducible and visualizable from the CO₂-loaded polymer solution under US imaging after stimulation.

Conclusions: We have demonstrated the ability to selectively release CO₂ from CO₂-loaded PEI nanoparticles to serve as an ultrasound contrast agent in both in vitro and ex vivo models. Future combined kidney-bladder porcine model experiments will be a critical step as we work towards validating and translating this agent as an effective modality for the diagnosis of VUR.

Patient summary: In this feasibility study, we evaluated early pre-clinical models of a urinary catheter-free modality for the diagnosis of vesicoureteral reflux. We utilized a novel CO₂-loaded nanoparticle solution that creates bubbles when activated with moderate intensity ultrasound. These bubbles were clearly visualizable with regular diagnostic ultrasound imaging in both a latex balloon and porcine bladder model.

Introduction: Hypospadias is a common congenital malformation occurring in up to 80 in 10,00 live male births, with emerging evidence associating exogenous environmental exposures with increased disease incidence. Military personnel are at particularly higher risk for such exposures and indeed, the rate of hypospadias in infant males born to United States military servicewomen deployed during the Gulf War has been reported to be more than 5 times greater compared to undeployed female military personnel.

Objective: To characterize contemporary trends in hypospadias incidence in the general population as well as high risk groups such as males born from US servicewomen using the National Birth Defects Prevention Network.

Study design: We queried the National Birth Defects Prevention Network and the Office of Statewide Health Planning and Developing for rates of hypospadias in the general US population and each state as well as the Department of Defense. Hypospadias rates were compared between 2014 and 2018. Median household income by state was obtained from the 2018 United States Census Bureau Data to compare differences in hypospadias incidence by state and median household income from 2014 to 2018.

Results: The incidence of hypospadias in the United States was 71.6 per 10,000 male births between 2014 and 2018 (Table 1). In 2018, the states/entities with the highest incidence of hypospadias were the Department of Defense (113.19 per 10,000), Colorado (113.47 per 10,000), Tennessee (109.14 per 10,000), and Alabama (104.06 per 10,000). There was no significant association between hypospadias incidence and median state household income (p = 0.71).

Discussion: Our findings suggest that hypospadias incidence was significantly higher within the Department of Defense registry and in the states of Colorado, Tennessee, and Alabama compared to the national average. This identifies a regionalized incidence for hypospadias which is likely multifactorial and warrants further investigation.

Conclusions: The incidence of hypospadias in the United States was 71.6 per 10,000 male births in 2014-2018, with the highest rates reported in the Department of Defense, Colorado, Tennessee, and Alabama.

Introduction: Hypospadias reconstruction seeks to correct structural problems associated with this congenital condition to improve patient quality-of-life (QoL) and overall well-being. While corrective surgery can lead to major functional and psychosocial improvements, some patients experience continuing problems that require additional procedures. This study evaluates patient-reported outcomes (PROs) in hypospadias care, particularly penile satisfaction and QoL after surgery, to fill this essential gap in the literature.

Methods: Computerized bibliographic searches were performed in PubMed, ScienceDirect, Cochrane Library, and ClinicalTrials. Up to July 30th, 2024. Funnel plots and ROBINS-I questioners were used to assess publication and overall risk of bias. The random effect model was applied to determine the pooled parameters when I² was more than 50 %. The fixed effect model was applied to the contrary. Confidence intervals (CIs) of 95 % were calculated.

Result: Eight studies were selected which included a total of 726 patients who self-evaluated satisfaction levels following hypospadias repair procedures the earliest of which was published on 2008. Three studies involving 144 people also examined QoL metrics among patients underwent hypospadias repair, with low publication bias and low-to-moderate overall risk of bias across the included studies. The pooled results indicated that subjects without hypospadias (control group) reported significantly higher satisfaction with penile appearance in 4 studies with continuous data (mean difference -1.43, 95 % CI -2.79-0.07, p < 0.05, high heterogeneity I² = 90 %, p<0.05) and 4 studies with dichotomous data (odds ratio 0.1, 95 % CI 0.07-0.15, p < 0.05, low heterogeneity I² = 0 %, p = 0.48). There is no significant difference of QoL between two groups (mean difference 0.62, 95 % CI -2.05-3.28, p < 0.65, moderate level of heterogeneity I² = 69 %, p < 0.05).

Conclusion: Our research shows that post-hypospadias repair surgery patient satisfaction is inadequate, but their quality of life is equivalent to those without hypospadias. This study enhances understanding of hypospadias patients' key issues and suggests ways to improve quality of life after corrective surgery.