Pub Date : 2025-12-01DOI: 10.1016/j.jpurol.2025.05.002
Lukas Steinkellner , Jonas Thüminger , Mona Kerling , Nadine Gisnapp , Christa Gernhold , Josef Oswald , Bernhard Haid
<div><h3>Introduction</h3><div>Ureteroceles<span><span> are rare congenital malformations of the </span>urinary tract<span> and challenging in management. Other than localisation (ectopic or orthotopic) and features of the upper tract, there are no well-tested predictive variables. We aimed at evaluating the initial sonographically measured ureterocele diameter (UD) as a predictor for underlying anatomy, success of primary management and long-term complications.</span></span></div></div><div><h3>Patients and methods</h3><div><span>All patients (n = 131, 41m/90f) referred to a single tertiary department with the diagnosis of an ureterocele between 07/1995 and 07/2019 were included. The UD was measured sonographically at the time of initial diagnosis. Most patients (n = 108, 82.4 %) underwent scintigraphy (either MAG3 or DMSA-scan) and </span>voiding cystourethrography<span>. After initial wait-and-see or primary endoscopic intervention, complications and symptomatic or high-grade VUR<span> were indications for further surgical treatment, following an individualised protocol. Beneath data from sonographic exams, occurrence of urinary tract infections and voiding problems, all surgical and endoscopic data was recorded. Variables were examined using univariate and stepwise multivariate statistical methods.</span></span></div></div><div><h3>Results</h3><div>With a median age at first presentation of 2 months (IQR 8) the mean follow-up accounted to 6.5 years ± 4.8 years (range 0–20 years, median 5.4 years, IQR 7.3). Information on the initial diameter was available in 123 patients (94 %) with a median of 14 mm (IQR 14, range: 4–40).</div><div>In a stepwise multivariate analysis, the UD significantly correlated with the localisation (ectopic/orthotopic, p = 0.001, AUC 0.7), successful primary endoscopic intervention (p = 0.02, AUC 0.71) and successful wait-and-see (p = 0.003, AUC 0.82). Female sex showed a significant impact on the probability of successful primary endoscopic intervention (p = 0.002, AUC 0.71) and was besides age the only variable correlating with UTIs prior to treatment (p = 0.01, AUC 0.8) whereas UD was not. Figure. The anatomic localisation (ectopic or orthotopic) showed less significance than UD in all the analyses performed. In a prediction model based on the multivariate analysis a diameter of <10 mm and >26 mm showed a ≥90 % probability of either orthotopic or ectopic localisation.</div></div><div><h3>Conclusion</h3><div>In this retrospective cohort sonographically measured ureterocele diameter was an easy and non-invasively detectable feature predicting localisation and proved a stronger predictive variable for the success of primary management strategies, superior to endoscopically verified ureterocele localisation, in a stepwise multivariant analysis. Furthermore, UD was predictive of long-term complications with an AUC of 0.7. Conversely, neither UD nor localisation predicted the frequency of UTIs prior to treatment, un
{"title":"The significance of ureterocele diameter for management and outcome","authors":"Lukas Steinkellner , Jonas Thüminger , Mona Kerling , Nadine Gisnapp , Christa Gernhold , Josef Oswald , Bernhard Haid","doi":"10.1016/j.jpurol.2025.05.002","DOIUrl":"10.1016/j.jpurol.2025.05.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Ureteroceles<span><span> are rare congenital malformations of the </span>urinary tract<span> and challenging in management. Other than localisation (ectopic or orthotopic) and features of the upper tract, there are no well-tested predictive variables. We aimed at evaluating the initial sonographically measured ureterocele diameter (UD) as a predictor for underlying anatomy, success of primary management and long-term complications.</span></span></div></div><div><h3>Patients and methods</h3><div><span>All patients (n = 131, 41m/90f) referred to a single tertiary department with the diagnosis of an ureterocele between 07/1995 and 07/2019 were included. The UD was measured sonographically at the time of initial diagnosis. Most patients (n = 108, 82.4 %) underwent scintigraphy (either MAG3 or DMSA-scan) and </span>voiding cystourethrography<span>. After initial wait-and-see or primary endoscopic intervention, complications and symptomatic or high-grade VUR<span> were indications for further surgical treatment, following an individualised protocol. Beneath data from sonographic exams, occurrence of urinary tract infections and voiding problems, all surgical and endoscopic data was recorded. Variables were examined using univariate and stepwise multivariate statistical methods.</span></span></div></div><div><h3>Results</h3><div>With a median age at first presentation of 2 months (IQR 8) the mean follow-up accounted to 6.5 years ± 4.8 years (range 0–20 years, median 5.4 years, IQR 7.3). Information on the initial diameter was available in 123 patients (94 %) with a median of 14 mm (IQR 14, range: 4–40).</div><div>In a stepwise multivariate analysis, the UD significantly correlated with the localisation (ectopic/orthotopic, p = 0.001, AUC 0.7), successful primary endoscopic intervention (p = 0.02, AUC 0.71) and successful wait-and-see (p = 0.003, AUC 0.82). Female sex showed a significant impact on the probability of successful primary endoscopic intervention (p = 0.002, AUC 0.71) and was besides age the only variable correlating with UTIs prior to treatment (p = 0.01, AUC 0.8) whereas UD was not. Figure. The anatomic localisation (ectopic or orthotopic) showed less significance than UD in all the analyses performed. In a prediction model based on the multivariate analysis a diameter of <10 mm and >26 mm showed a ≥90 % probability of either orthotopic or ectopic localisation.</div></div><div><h3>Conclusion</h3><div>In this retrospective cohort sonographically measured ureterocele diameter was an easy and non-invasively detectable feature predicting localisation and proved a stronger predictive variable for the success of primary management strategies, superior to endoscopically verified ureterocele localisation, in a stepwise multivariant analysis. Furthermore, UD was predictive of long-term complications with an AUC of 0.7. Conversely, neither UD nor localisation predicted the frequency of UTIs prior to treatment, un","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 6","pages":"Pages 1744-1750"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jpurol.2025.06.008
Abdullah Sarman , Suat Tuncay , Ali Ay
{"title":"Response to Letter to the editor re: “The impact of foot reflexology on postoperative pain and fear in children following circumcision: A randomized controlled trial”","authors":"Abdullah Sarman , Suat Tuncay , Ali Ay","doi":"10.1016/j.jpurol.2025.06.008","DOIUrl":"10.1016/j.jpurol.2025.06.008","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 6","pages":"Pages 1687-1688"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jpurol.2025.06.030
Julia B. Finkelstein , Bryce Weber , Susan Quigley , Shuvro De , Anja Zann , Kyle Rove , Debra Liebrecht , Rebecca Zee , Yvonne Chan , Shane Battie , Hans Pohl , Ching Man Carmen Tong , Anne Dudley , Leslie McQuiston , Emily T. Durkin , Tanya D. Davis , Jill Whitehouse , Ethan Polsky , Mary Killian , His-Yang Wu , Jonathan S. Ellison
Background
Testicular torsion is a pediatric emergency that poses a time-sensitive risk to the testicle. Best practices for testicular torsion protocols remain unclear. We convened the Testicular Torsion Collaborative, leveraging National Surgical Quality Improvement Program Pediatric (NSQIPP) Testicular Torsion Process Measure collection to assess factors associated with favorable metrics.
Methods
Data were accrued across 29 participating NSQIPP sites, excluding neonatal and non-urgent cases. Post-processed data available through NSQIPP included site of initial presentation and time stamps for presentation, ultrasound, and operating room entry; number of cases greater than the NSQIPP median for each time stamp; and orchiectomy rate. Hospital level data and torsion-related care processes were collected from each participating site via an electronic survey.
Results
From 10/1/2021 to 9/30/22, 1007 testicular torsion patients were included, with 494 (49.1 %) transferred from another institutions. A standardized evaluation protocol was associated with fewer patients exceeding the NSQIPP median from presentation to ultrasound (38.8 % vs 60 %, p = 0.03). Testicular Workup for Ischemia and Suspected Torsion (TWIST) score use was associated with a shorter time frame from presentation to ultrasound (0.7 vs 1.1 h, p = 0.03). Free-standing children's hospitals (p > 0.01) and institutions with an American College of Surgeons Children's Surgery Verification (p = 0.03) also demonstrated improved time to ultrasound. Overall orchiectomy rate was 15.8 % and there were no statistical differences noted across the study variables.
Conclusions
Across a wide spectrum of hospitals within NSQIPP, we demonstrate that certain torsion-related processes and hospital-level factors are associated with faster times to ultrasound. The NSQIPP Testicular Torsion Collaborative will continue to explore interventions to improve testicular torsion care and outcomes.
背景：睾丸扭转是一种儿科急症，对睾丸有时间敏感性风险。睾丸扭转方案的最佳实践尚不清楚。我们召集了睾丸扭转协作，利用国家儿科手术质量改进计划（NSQIPP）睾丸扭转过程测量收集来评估与有利指标相关的因素。方法：在29个参与NSQIPP的站点收集数据，不包括新生儿和非紧急病例。NSQIPP提供的后处理数据包括初次就诊地点、就诊时间、超声检查和进入手术室；每个时间戳的病例数大于NSQIPP中位数；睾丸切除率。通过电子调查从每个参与站点收集医院级数据和与扭转相关的护理过程。结果：2021年1月10日至22年9月30日共纳入1007例睾丸扭转患者，其中转院494例（49.1%）。标准化评估方案与超过NSQIPP中位值的患者较少相关（38.8% vs 60%, p = 0.03）。睾丸缺血和疑似扭转检查（TWIST）评分的使用与从出现到超声检查的时间较短相关（0.7 vs 1.1 h, p = 0.03）。独立儿童医院（p < 0.01）和获得美国外科医师学会儿童外科认证的机构（p < 0.03）的超声检查时间也有所改善。总体睾丸切除术率为15.8%，研究变量间无统计学差异。结论：在NSQIPP范围内的广泛医院中，我们证明了某些与扭转相关的过程和医院层面的因素与更快的超声时间有关。NSQIPP睾丸扭转协作将继续探索干预措施，以改善睾丸扭转的护理和结果。
{"title":"Leveraging NSQIPP testicular torsion process measures: Initial survey of the NSQIPP testicular torsion collaborative","authors":"Julia B. Finkelstein , Bryce Weber , Susan Quigley , Shuvro De , Anja Zann , Kyle Rove , Debra Liebrecht , Rebecca Zee , Yvonne Chan , Shane Battie , Hans Pohl , Ching Man Carmen Tong , Anne Dudley , Leslie McQuiston , Emily T. Durkin , Tanya D. Davis , Jill Whitehouse , Ethan Polsky , Mary Killian , His-Yang Wu , Jonathan S. Ellison","doi":"10.1016/j.jpurol.2025.06.030","DOIUrl":"10.1016/j.jpurol.2025.06.030","url":null,"abstract":"<div><h3>Background</h3><div>Testicular torsion<span> is a pediatric<span> emergency that poses a time-sensitive risk to the testicle. Best practices for testicular torsion protocols remain unclear. We convened the Testicular Torsion Collaborative, leveraging National Surgical Quality Improvement Program Pediatric (NSQIPP) Testicular Torsion Process Measure collection to assess factors associated with favorable metrics.</span></span></div></div><div><h3>Methods</h3><div>Data were accrued across 29 participating NSQIPP sites, excluding neonatal and non-urgent cases. Post-processed data available through NSQIPP included site of initial presentation and time stamps for presentation, ultrasound, and operating room entry; number of cases greater than the NSQIPP median for each time stamp; and orchiectomy rate. Hospital level data and torsion-related care processes were collected from each participating site via an electronic survey.</div></div><div><h3>Results</h3><div>From 10/1/2021 to 9/30/22, 1007 testicular torsion patients were included, with 494 (49.1 %) transferred from another institutions. A standardized evaluation protocol was associated with fewer patients exceeding the NSQIPP median from presentation to ultrasound (38.8 % vs 60 %, p = 0.03). Testicular Workup for Ischemia and Suspected Torsion (TWIST) score use was associated with a shorter time frame from presentation to ultrasound (0.7 vs 1.1 h, p = 0.03). Free-standing children's hospitals (p > 0.01) and institutions with an American College of Surgeons Children's Surgery Verification (p = 0.03) also demonstrated improved time to ultrasound. Overall orchiectomy rate was 15.8 % and there were no statistical differences noted across the study variables.</div></div><div><h3>Conclusions</h3><div>Across a wide spectrum of hospitals within NSQIPP, we demonstrate that certain torsion-related processes and hospital-level factors are associated with faster times to ultrasound. The NSQIPP Testicular Torsion Collaborative will continue to explore interventions to improve testicular torsion care and outcomes.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 6","pages":"Pages 1844-1850"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jpurol.2025.08.007
Fahri Yavuz İlki, Cihat Ozcan, Alper Murat Albayrak, Yusuf Kadir Topçu, Selçuk Sarikaya, Selahattin Bedir
Objective
This study aimed to compare semen parameters between adolescents with clinically diagnosed varicocele and healthy controls, in order to evaluate the potential impact of varicocele on spermatogenesis during adolescence.
Materials and methods
Fifty-nine adolescent males were included in this cross-sectional study. Thirty participants had clinically confirmed varicocele, while 29 served as healthy controls. Semen samples were collected following a 4-day abstinence period and were analyzed for volume, concentration, total sperm count, motility, and morphology according to WHO criteria. Morphological evaluation was performed using Kruger strict criteria. Statistical comparisons between groups were conducted using the t-test or Mann–Whitney U test, depending on data distribution.
Results
Semen volume, total sperm count, and Kruger morphology scores were significantly lower in the varicocele group compared to controls (p < 0.05). Although sperm concentration was lower in the varicocele group, this difference did not reach statistical significance (p = 0.0598). No significant differences were observed between groups in terms of total motility, progressive motility, or immotile sperm rate.
Conclusion
Adolescent varicocele may negatively affect key semen quality parameters, particularly sperm morphology and total sperm output. These findings support the importance of regular semen analysis and close monitoring in adolescents with varicocele, especially in those presenting with abnormal parameters.
{"title":"Comparative analysis of semen parameters in adolescent males with and without varicocele","authors":"Fahri Yavuz İlki, Cihat Ozcan, Alper Murat Albayrak, Yusuf Kadir Topçu, Selçuk Sarikaya, Selahattin Bedir","doi":"10.1016/j.jpurol.2025.08.007","DOIUrl":"10.1016/j.jpurol.2025.08.007","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to compare semen parameters between adolescents with clinically diagnosed varicocele and healthy controls, in order to evaluate the potential impact of varicocele on spermatogenesis during adolescence.</div></div><div><h3>Materials and methods</h3><div>Fifty-nine adolescent males were included in this cross-sectional study. Thirty participants had clinically confirmed varicocele, while 29 served as healthy controls. Semen samples were collected following a 4-day abstinence period and were analyzed for volume, concentration, total sperm count, motility, and morphology according to WHO criteria. Morphological evaluation was performed using Kruger strict criteria. Statistical comparisons between groups were conducted using the t-test or Mann–Whitney U test, depending on data distribution.</div></div><div><h3>Results</h3><div>Semen volume, total sperm count, and Kruger morphology scores were significantly lower in the varicocele group compared to controls (p < 0.05). Although sperm concentration was lower in the varicocele group, this difference did not reach statistical significance (p = 0.0598). No significant differences were observed between groups in terms of total motility, progressive motility, or immotile sperm rate.</div></div><div><h3>Conclusion</h3><div>Adolescent varicocele may negatively affect key semen quality parameters, particularly sperm morphology and total sperm output. These findings support the importance of regular semen analysis and close monitoring in adolescents with varicocele, especially in those presenting with abnormal parameters.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 6","pages":"Pages 1888-1892"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Urethral catheterization is a standard clinical procedure, but pediatric data on balloon-related complications remain scarce. Balloon failure during removal may be associated with the type of inflation media and the size of the catheter lumen. Adult findings may not apply to pediatric catheters due to structural differences.
Objective
To compare the performance of sterile water and 0.9 % saline solution as inflation media in pediatric Foley catheters and evaluate balloon deflation and crystalline deposits under controlled in vitro conditions.
Methods
Foley catheters (8Fr, 10Fr, 14Fr, 16Fr) were used. Balloon inflation channels were assessed by cross-sectional area and perimeter. A total of 236 catheters were filled with either sterile water or saline, immersed in artificial urine at 37 °C for 15 days, and later inspected for deflation performance and crystal deposits. Select samples were stained with eosin, toluidine blue, and aniline blue for microscopic analysis.
Results
Pediatric catheters showed significantly smaller inflation lumens than adult catheters. Balloon integrity was preserved in 99.6 % of cases, with no significant volume loss differences between inflation solutions. However, eosin staining revealed crystalline deposits in two saline-inflated pediatric catheters. No deposits were observed with sterile water or under unstained conditions.
Conclusion
While both inflation media performed similarly in short-term use, crystal formation in saline-filled catheters suggests sterile water may be preferable in prolonged pediatric catheterization.
{"title":"Sterile water or saline solution for inflating the balloon of pediatric catheters","authors":"Isabella Guerrero Hurtado Nurse , Valentina Castillo Belalcázar Nurse , Mauricio Palacios Gómez","doi":"10.1016/j.jpurol.2025.08.008","DOIUrl":"10.1016/j.jpurol.2025.08.008","url":null,"abstract":"<div><h3>Background</h3><div>Urethral catheterization is a standard clinical procedure, but pediatric data on balloon-related complications remain scarce. Balloon failure during removal may be associated with the type of inflation media and the size of the catheter lumen. Adult findings may not apply to pediatric catheters due to structural differences.</div></div><div><h3>Objective</h3><div>To compare the performance of sterile water and 0.9 % saline solution as inflation media in pediatric Foley catheters and evaluate balloon deflation and crystalline deposits under controlled <em>in vitro</em> conditions.</div></div><div><h3>Methods</h3><div>Foley catheters (8Fr, 10Fr, 14Fr, 16Fr) were used. Balloon inflation channels were assessed by cross-sectional area and perimeter. A total of 236 catheters were filled with either sterile water or saline, immersed in artificial urine at 37 °C for 15 days, and later inspected for deflation performance and crystal deposits. Select samples were stained with eosin, toluidine blue, and aniline blue for microscopic analysis.</div></div><div><h3>Results</h3><div>Pediatric catheters showed significantly smaller inflation lumens than adult catheters. Balloon integrity was preserved in 99.6 % of cases, with no significant volume loss differences between inflation solutions. However, eosin staining revealed crystalline deposits in two saline-inflated pediatric catheters. No deposits were observed with sterile water or under unstained conditions.</div></div><div><h3>Conclusion</h3><div>While both inflation media performed similarly in short-term use, crystal formation in saline-filled catheters suggests sterile water may be preferable in prolonged pediatric catheterization.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 6","pages":"Pages 1859-1864"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jpurol.2025.08.010
Jin Kyu Kim, Rosalia Misseri
{"title":"Response to Commentary on “Assessing the risk of voiding dysfunction in children with ureteroceles: A systematic review and meta-analysis”","authors":"Jin Kyu Kim, Rosalia Misseri","doi":"10.1016/j.jpurol.2025.08.010","DOIUrl":"10.1016/j.jpurol.2025.08.010","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 6","pages":"Page 1476"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jpurol.2025.07.008
Kimberly Dawes , Suhaib Abdulfattah , Jay Shah , Akshat Modi , Bhavan Jikar , Vidhi Joshi , Vedanti Dave , Kajal Patel , Ritu Bhatt , Dana Weiss , Rakesh S. Joshi , Aseem R. Shukla , Jaishri Ramji
Introduction
Urinary continence is a goal of bladder exstrophy epispadias complex (BEEC) surgical management. However, it is often not achieved until school age or later. Little is known about the mental health implications of this incontinence on caregivers and whether this should affect timing of surgical interventions to achieve continence. We hypothesized that caregivers of children with continuous incontinence or dry intervals <1 h per day/night exhibit adverse mental health outcomes.
Objective
To evaluate the relationship between urinary incontinence of children with BEEC and caregiver mental health outcomes.
Materials and methods
In this IRB-approved study, randomly selected caregivers of a cohort of children with BEEC were administered the RAND 36-Item Short Form Survey (SF-36), Beck Anxiety Inventory, and Beck Depression Inventory. Dry intervals were determined by interviewing caregivers or outpatient records. BEEC patient sex, age, time from initial repair, and diagnosis along BEEC were recorded. Kruskal–Wallis rank test and linear regression analyses were performed to assess associations between dry intervals and mental health scores. P-values were 2-sided and a p < 0.05 was considered statistically significant.
Results
110 BEEC caregivers were surveyed of a total of 110 children with BEEC, 84 (76.3 %) reported their children had total incontinence or dry interval <1 h per day/night. Caregiver mental health outcomes —anxiety, emotional well-being, and social functioning — were not significantly associated with dry interval stratification. Depression scores did increase with decreasing dry interval. However, all scores remained within normal parameters. Notably, social functioning scores were associated with decreased anxiety (p < 0.001) and higher emotional well-being scores were associated with decreased depression (p < 0.001).
Conclusion
Continence status was not independently associated with most caregiver mental health outcomes. A trend towards increased depression scores with greater incontinence suggests the need for longitudinal follow-up.
{"title":"Does incontinence in a child with bladder exstrophy negatively affect caregivers? A mental health inventory survey","authors":"Kimberly Dawes , Suhaib Abdulfattah , Jay Shah , Akshat Modi , Bhavan Jikar , Vidhi Joshi , Vedanti Dave , Kajal Patel , Ritu Bhatt , Dana Weiss , Rakesh S. Joshi , Aseem R. Shukla , Jaishri Ramji","doi":"10.1016/j.jpurol.2025.07.008","DOIUrl":"10.1016/j.jpurol.2025.07.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Urinary continence is a goal of bladder exstrophy epispadias complex (BEEC) surgical management. However, it is often not achieved until school age or later. Little is known about the mental health implications of this incontinence on caregivers and whether this should affect timing of surgical interventions to achieve continence. We hypothesized that caregivers of children with continuous incontinence or dry intervals <1 h per day/night exhibit adverse mental health outcomes.</div></div><div><h3>Objective</h3><div>To evaluate the relationship between urinary incontinence of children with BEEC and caregiver mental health outcomes.</div></div><div><h3>Materials and methods</h3><div>In this IRB-approved study, randomly selected caregivers of a cohort of children with BEEC were administered the RAND 36-Item Short Form Survey (SF-36), Beck Anxiety Inventory, and Beck Depression Inventory. Dry intervals were determined by interviewing caregivers or outpatient records. BEEC patient sex, age, time from initial repair, and diagnosis along BEEC were recorded. Kruskal–Wallis rank test and linear regression analyses were performed to assess associations between dry intervals and mental health scores. P-values were 2-sided and a p < 0.05 was considered statistically significant.</div></div><div><h3>Results</h3><div>110 BEEC caregivers were surveyed of a total of 110 children with BEEC, 84 (76.3 %) reported their children had total incontinence or dry interval <1 h per day/night. Caregiver mental health outcomes —anxiety, emotional well-being, and social functioning — were not significantly associated with dry interval stratification. Depression scores did increase with decreasing dry interval. However, all scores remained within normal parameters. Notably, social functioning scores were associated with decreased anxiety (p < 0.001) and higher emotional well-being scores were associated with decreased depression (p < 0.001).</div></div><div><h3>Conclusion</h3><div>Continence status was not independently associated with most caregiver mental health outcomes. A trend towards increased depression scores with greater incontinence suggests the need for longitudinal follow-up.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 6","pages":"Pages 1458-1463"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jpurol.2025.08.017
Heera Tharanendran, Ramesh Babu
Introduction/aims
We hereby report a novel vesicoscopic supra trigonal ureteric reimplantation detrusorraphy (STURDY) technique for unilateral duplex systems with vesicoureteric reflux (VUR).
Methods
A 3-year-old boy and a 1-year-old girl with recurrent urinary tract infections (UTIs) and left duplex VUR/ureterocele underwent vesicoscopic STURDY.
Technique
After establishing pneumovesicum, a vertical incision was made cranially along the ureter for 2–3 cm incising both the mucosa and detrusor, preserving the vas deferens. Duplex ureters were carefully dissected and brought intravesically, and a detrusorraphy was performed underneath. The mucosa was closed over the ureters sandwiching the ureter between detrusorraphy and mucosal closure. In both cases double-J-stents were kept for 6-weeks.
Results
Both patients had uneventful postoperative period. Follow-up ultrasound showed significant improvement in hydroureteronephrosis. At one-year follow-up there was no reflux and function was preserved.
Discussion
There is limited literature on transvesicoscopic common-sheath ureteric reimplantation in duplication anomalies. Cohen's technique is commonly preferred due to its simplicity and high success rates, but it aligns all three ureteric orifices on one side, hindering future upper tract access.
Conclusion
The novel vesicoscopic STURDY technique reported is safe, effective, preserves vascularity of both ureters and allows future ureterorenoscopy. Further studies with long-term follow-up are warranted.
{"title":"Vesicoscopic supra trigonal ureteric reimplantation and detrusorraphy (STURDY) for vesicoureteric reflux in children with duplex systems","authors":"Heera Tharanendran, Ramesh Babu","doi":"10.1016/j.jpurol.2025.08.017","DOIUrl":"10.1016/j.jpurol.2025.08.017","url":null,"abstract":"<div><h3>Introduction/aims</h3><div>We hereby report a novel vesicoscopic supra trigonal ureteric reimplantation detrusorraphy (STURDY) technique for unilateral duplex systems with vesicoureteric reflux (VUR).</div></div><div><h3>Methods</h3><div>A 3-year-old boy and a 1-year-old girl with recurrent urinary tract infections (UTIs) and left duplex VUR/ureterocele underwent vesicoscopic STURDY.</div></div><div><h3>Technique</h3><div>After establishing pneumovesicum, a vertical incision was made cranially along the ureter for 2–3 cm incising both the mucosa and detrusor, preserving the vas deferens. Duplex ureters were carefully dissected and brought intravesically, and a detrusorraphy was performed underneath. The mucosa was closed over the ureters sandwiching the ureter between detrusorraphy and mucosal closure. In both cases double-J-stents were kept for 6-weeks.</div></div><div><h3>Results</h3><div>Both patients had uneventful postoperative period. Follow-up ultrasound showed significant improvement in hydroureteronephrosis. At one-year follow-up there was no reflux and function was preserved.</div></div><div><h3>Discussion</h3><div>There is limited literature on transvesicoscopic common-sheath ureteric reimplantation in duplication anomalies. Cohen's technique is commonly preferred due to its simplicity and high success rates, but it aligns all three ureteric orifices on one side, hindering future upper tract access.</div></div><div><h3>Conclusion</h3><div>The novel vesicoscopic STURDY technique reported is safe, effective, preserves vascularity of both ureters and allows future ureterorenoscopy. Further studies with long-term follow-up are warranted.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 6","pages":"Pages 1945-1946"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.jpurol.2025.08.011
Abdullah Kocaoglan , Melih Aksamoglu , Mehmet Sait Menzilcioglu , Mehmet Ozturk
Objective
The most common chronic complication of vesicoureteral reflux (VUR) is the presence of renal scarring and dimercapto succinic acid (DMSA) renal scan is utilized for its detection. In this study, we have aimed to assess whether shear wave speed (SWS) differs between normal and refluxing kidneys.
Materials and method
Fifty pediatric VUR patients and 21 healthy children with available DMSA obtained within the previous year were included in the study. In the patient group, with grade 3, 4 and 5 kidney reflux were defined as “kidneys with high-grade reflux”, and were subdivided into scarred and unscarred kidneys. In the VUR group population, kidneys with grade 1 and 2 reflux were defined as “r kidneys with low-grade reflux”, and in VUR group with unilateral reflux, kidneys on the non-reflux side were defined as “contralateral non-refluxing kidneys”. A total of 42 kidneys in the non-VUR group of 21 patients were defined as “non-VUR kidneys”. The control non-VUR group included children who had DMSA scans for non-urological reasons (e.g., unexplained fever or abdominal pain), and showed no VUR. Three VUR group had solitary kidney and a total of 139 kidneys were investigated. Ultrasound elastography evaluation of the upper, middle and lower zones of the kidneys was performed. Three regions of interest (ROIs) were placed in each zone to evaluate the cortex, excluding the capsule and medulla as much as possible during measurements. A total of 9 measurements were performed in each kidneys and the mean shearwave elastography (SWE) speeds of the parenchyma were recorded in m/sec.
Results
We have found that the SWS were significantly higher in kidneys with DMSA-proven scarring compared to those without scarring and to the control group (p < 0.05). In the Receiver Operating Characteristic (ROC) analysis performed, SWS of 2.06 m/s had 83.7 % sensitivity (95 % confidence Interval (CI) 70.3–92.7) and 76.5 % specificity (95 % CI 50.1–93.2; p < 0.001; AUC: 0.795) in differentiating between scarred and non-scarred kidneys with high-grade reflux (Figure 2).
Conclusion
In conclusion, shear wave elastography can differentiate between renal functional units with and without DMSA-proven scarring. Although the precise scar location was not assessed, SWE appears to reflect global changes in cortical stiffness. Its non-invasive nature and accessibility make it a promising adjunct to conventional imaging methods.
目的：膀胱输尿管反流（VUR）最常见的慢性并发症是肾脏瘢痕形成，采用二巯基琥珀酸（DMSA）肾脏扫描检测。在这项研究中，我们的目的是评估正常肾脏和反流肾脏的横波速度（SWS）是否不同。材料与方法：本研究纳入50例儿童VUR患者和21例在前一年获得可获得DMSA的健康儿童。在患者组中，3级、4级和5级肾反流被定义为“高级别反流肾”，并细分为疤痕肾和无疤痕肾。在VUR组人群中，1级和2级反流肾脏被定义为“低级别反流肾脏”，在单侧反流的VUR组中，非反流侧肾脏被定义为“对侧非反流肾脏”。非vur组共21例患者，其中42例肾脏被定义为“非vur肾脏”。对照组包括因非泌尿系统原因（如不明原因的发热或腹痛）进行DMSA扫描且未显示VUR的儿童。3例VUR组为孤立肾，共139例。超声弹性成像评估肾脏的上、中、下区。在每个区域放置三个感兴趣区域（roi）来评估皮层，在测量过程中尽可能地排除囊和髓质。每个肾脏共进行了9次测量，并记录了实质的平均剪切波弹性成像速度（SWE），单位为m/sec。结果：我们发现dmsa证实有瘢痕的肾脏的SWS明显高于无瘢痕组和对照组（p < 0.05）。在受试者工作特征（ROC）分析中，2.06 m/s的SWS在鉴别严重反流的瘢痕和非瘢痕肾脏方面具有83.7%的敏感性（95%可信区间（CI） 70.3-92.7）和76.5%的特异性（95% CI 50.1-93.2; p < 0.001; AUC: 0.795）（图2）。结论：剪切波弹性成像可以区分有和没有dmsa证实的疤痕的肾功能单位。虽然没有评估精确的疤痕位置，但SWE似乎反映了皮质刚度的整体变化。它的非侵入性和可及性使其成为传统成像方法的一个有前途的辅助手段。
{"title":"Ultrasound elastographic evaluation of renal parenchyma in pediatric patients with vesicoureteral reflux","authors":"Abdullah Kocaoglan , Melih Aksamoglu , Mehmet Sait Menzilcioglu , Mehmet Ozturk","doi":"10.1016/j.jpurol.2025.08.011","DOIUrl":"10.1016/j.jpurol.2025.08.011","url":null,"abstract":"<div><h3>Objective</h3><div>The most common chronic complication of vesicoureteral reflux (VUR) is the presence of renal scarring and dimercapto succinic acid (DMSA) renal scan is utilized for its detection. In this study, we have aimed to assess whether shear wave speed (SWS) differs between normal and refluxing kidneys.</div></div><div><h3>Materials and method</h3><div>Fifty pediatric VUR patients and 21 healthy children with available DMSA obtained within the previous year were included in the study. In the patient group, with grade 3, 4 and 5 kidney reflux were defined as “kidneys with high-grade reflux”, and were subdivided into scarred and unscarred kidneys. In the VUR group population, kidneys with grade 1 and 2 reflux were defined as “r kidneys with low-grade reflux”, and in VUR group with unilateral reflux, kidneys on the non-reflux side were defined as “contralateral non-refluxing kidneys”. A total of 42 kidneys in the non-VUR group of 21 patients were defined as “non-VUR kidneys”. The control non-VUR group included children who had DMSA scans for non-urological reasons (e.g., unexplained fever or abdominal pain), and showed no VUR. Three VUR group had solitary kidney and a total of 139 kidneys were investigated. Ultrasound elastography evaluation of the upper, middle and lower zones of the kidneys was performed. Three regions of interest (ROIs) were placed in each zone to evaluate the cortex, excluding the capsule and medulla as much as possible during measurements. A total of 9 measurements were performed in each kidneys and the mean shearwave elastography (SWE) speeds of the parenchyma were recorded in m/sec.</div></div><div><h3>Results</h3><div>We have found that the SWS were significantly higher in kidneys with DMSA-proven scarring compared to those without scarring and to the control group (p < 0.05). In the Receiver Operating Characteristic (ROC) analysis performed, SWS of 2.06 m/s had 83.7 % sensitivity (95 % confidence Interval (CI) 70.3–92.7) and 76.5 % specificity (95 % CI 50.1–93.2; p < 0.001; AUC: 0.795) in differentiating between scarred and non-scarred kidneys with high-grade reflux (Figure 2).</div></div><div><h3>Conclusion</h3><div>In conclusion, shear wave elastography can differentiate between <em>renal functional units</em> with and without DMSA-proven scarring. Although the precise scar location was not assessed, SWE appears to reflect global changes in cortical stiffness. Its non-invasive nature and accessibility make it a promising adjunct to conventional imaging methods.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 6","pages":"Pages 1932-1937"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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