Journal of Pediatric Urology最新文献

Objective: Posterior urethral valves (PUV) leads to early chronic kidney disease (CKD) and renal failure in some children, while others may maintain preserved kidney function even into adulthood. Our goal was to assess the association between early imaging features and CKD progression in children with PUVs. We hypothesized that imaging features identified on PRUS and VCUG would be associated with CKD progression and could` be used in conjunction with nadir creatinine to predict future renal function.

Methods: Following individual institutional research board approvals, we performed a retrospective cohort study at two institutions. Electronic medical records were queried to identify all patients with a history of PUVs treated between 1990 and 2022. Children who presented in the first year of life and had their initial renal bladder ultrasound (RBUS) and voiding cystourethrogram (VCUG) performed within the first 90 days of life were included. The primary outcome, CKD progression, was defined as development of ESKD requiring dialysis or renal transplant or a decline in eGFR of greater than 50 %. Clinical variables of interest included: findings on initial RBUS (urinoma, cystic dysplasia, solitary kidney), vesicoureteral reflux on initial postnatal VCUG (degree and laterality), and nadir creatinine. Hazard ratios (HRs) were calculated from Cox proportional hazards regression for univariate and multivariable regression.

Results: Out of 537 patients with PUVs, 274 met our inclusion criteria. Median follow up was 5.84 years (IQR 2-10.2), and 55 patients (20 %) reached our primary outcome. Multivariable analysis showed the presence of any degree of vesicoureteral reflux, HR 3.1 (95 % CI 1.62-5.93), and nadir creatinine, HR 5.53 (95 % CI 4-7.64), were predictive of CKD progression When nadir creatinine within the first year of life is used as a sole predictor of CKD progression, the area under the receiver-operator curve was 0.89 (95 % CI 0.83-0.91).

Conclusions: This study confirms nadir creatinine as a strong predictor for CKD progression and ESKD in patients with PUVs. In our cohort, the presence of any degree or laterality of vesicoureteral reflux, was also a significant predictor for CKD progression.

Introduction: Urethral strictures following endoscopic management of Posterior Urethral Valves (PUV) varies from 0 % to 25 % and occurs due to iatrogenic injury of the urethra.

Objectives: To assess the outcomes of children undergoing urethral reconstruction following an iatrogenic injury during endoscopic management of PUV.

Methods: A retrospective review of a prospectively maintained database from 2015 to 2023 was undertaken of children who were referred following an iatrogenic injury to the urethra from prior endoscopic management of PUV.

Results: Seven boys with a history of PUV were referred following an iatrogenic bulbar urethral injury. All presented by age 2 and all had multiple attempted dilatations performed in external institutions. Two patients had also undergone an anastomotic urethroplasty with subsequent failure and recurrence of the stricture in the bulbar urethra, to a near obliterative state. The 5 patients who had no prior attempted urethroplasty, underwent a dorsal onlay. The 2 patients who had an attempted anastomotic urethroplasty with subsequent failure, both presented with bulbar necrosis. A pedicled preputial flap was used for both patients for reconstruction.

Conclusion: Iatrogenic injury of the urethra can occur during endoscopic ablation of PUV. Urethroplasty is successful and best performed with a preputial skin graft if available.

Background: Historically, word of mouth, total citation count, H-index, and expert opinion were some of the primary metrics used to identify the most influential papers. This method is subject to significant bias. The disruption score was initially created with the intent of measuring the degree to which a publication introduces a new idea, is repeatedly referenced and may be used as an additional publication evaluation metric.

Objective: To use disruptive score, a novel bibliometric index to identify influential papers in pediatric urology.

Methods: A customized search was executed using PubMed to identify papers from NEJM, JAMA, European Urology, Journal of Urology, Urology, Journal of Pediatric Urology, and Journal of Pediatric Surgery between 1954 to 2022 to identify pediatric urology related publications. Once accrued, all papers collected were run through a validated data set to identify a disruption score, where the 50 most disruptive papers were identified. The disruption score ranged from 1 to -1, with a positive score representing papers that are disruptive (challenge current knowledge), whereas a negative score represents developmental papers (help support previous publications). The 50 most disruptive papers were then cross referenced with the NIH iCite tool to identify how many times the article was cited and then the most disruptive articles and the most cited articles were compared.

Results: In total, 12,085 articles were identified and included. The database for analysis of disruption score included articles published from 1954 to 2014, leaving a total of 6544 of the papers for which a disruption score was calculated. Most of the articles identified were published in the Journal of Urology (n = 32) and Journal of Pediatric Surgery (n = 15). Fourteen of the top 50 papers were published prior to 1980 and 7 after 2000. Of the 35 total articles with iCite data available, only 8 articles had greater than 100 total citations.

Discussion: Many of the most disruptive articles identified did not have a large number of citations, highlighting the need to look beyond citation counts when assessing article importance. While this method was able to highlight some lesser-known articles, it does not appear that these citations are all highly impactful, which may be due to the relative youth of the field.

Conclusion: Disruption score provides a new way to assess the impact of publications within the field of pediatric urology. While novel, we feel this metric should be used with caution in pediatric urology at this time.

Introduction: Posterior urethral valves may lead to persistent hydronephrosis (HN) and bladder dysfunction despite successful endoscopic valve ablation (EVA).

Objectives: To evaluate the effect of overnight bladder drainage (OBD) on upper urinary tracts and bladders of boys post EVA.

Materials and methods: Boys who had persistent HN after EVA were included. Patients were randomly allocated into OBD or no OBD groups. Timed voiding, anticholinergics and antibiotic prophylaxis were offered for both groups. After 12 months, patients were evaluated for compliance to OBD, daytime continence, febrile urinary tract infections (UTIs), renal function by serum creatinine and ^99mTc-dimercaptosuccinic acid scan, HN, vesicoureteral reflux (VUR) and bladder morphology assessed by ultrasound and voiding cystourethrogram.

Results: Ninety-nine patients; 47 underwent OBD while 52 had no OBD, completed 12 months of follow-up. Compliance to OBD was reported in 87.04 %. OBD group showed significant improvement in daytime continence, HN, VUR, bladder capacity and outline. However, febrile UTIs, renal function affection, bladder wall thickness and post-void urine residual were comparable between both groups.

Conclusions: OBD might improve daytime continence, HN, VUR and abnormal bladder morphology that persist after EVA with no subsequent febrile UTIs or renal function affection. Yet, compliance to OBD remains a matter of concern.

Background: A varicocele is an abnormal dilation of the pampiniform plexus of veins in the scrotum that commonly affects postpubertal males. The condition has been associated with male infertility, testicular hypotrophy, and pain. However, the clinical experiences of adolescent patients and their families regarding the evaluation, surveillance, and management of varicoceles have not been previously examined.

Objective: This study explores the patient's and family's experiences of varicocele diagnosis and subsequent management to better understand the salient factors impacting decision-making and care.

Methods: We conducted semi-structured interviews with patients and their families between August 2022 and January 2023. A total of 39 participants (16 adolescent males and 23 parents) were recruited following varicocele diagnosis and treatment at an urban, tertiary care hospital in California. Purposive sampling was adopted for the recruitment of participants through medical record screening to identify eligibility. Utilizing a modified grounded theory approach through the use of constant comparison and memo writing, the analysis consisted of open coding, axial coding, and selective coding, resulting in the production of core concepts and categories.

Results: Results demonstrate that parents and adolescents can benefit from improved understanding and education about long-term expectations during the diagnosis and treatment of adolescent varicoceles. Qualitative analysis indicates: 1) parents and adolescents have common concerns regarding fertility; however, this is exacerbated by the complexity of medical decision-making being dependent on adolescent and parental understanding of the full scope of varicocele impacts and outcomes, and 2) the psychosocial impact of a varicocele on adolescent self-esteem and sexual function are significant drivers for seeking care, which often manifested through discussions on masculinity through notions of 'manhood' and future sexual performance.

Discussion: Discussions with patients and families largely focused on their concerns regarding fertility, sexual function, and aesthetics (impacting self-esteem); however, their primary concern was for the need for more accurate and comprehensive information, which includes the natural history of the condition and the full scope of treatment options. Future studies should examine the experiences of patients and families from diverse backgrounds and geographic locations to identify potential differences in experiences.

Conclusion: Findings identified the need for potential improvement in communication between pediatric urologists and families to alleviate anxiety and uncertainty among patients and families and empower them to make informed decisions about their care.

Background: The optimal treatment of vesicoureteral reflux is controversial. When patients need surgery, the gold standard is open vesicoureteral reimplantation. Despite the more frequent use of laparoscopy when managing vesicoureteral reflux, we have found scarce comparative studies comparing the open versus the laparoscopic Lich-Gregoir reimplantation.

Objective: The aim of this study is to compare the open Lich-Gregoir reimplantation technique versus the laparoscopic approach, in patients with primary vesicoureteral reflux in terms of complications and the procedure´s success, to document the benefits of minimal invasion.

Study design: This is a cross-sectional retrospective study of a single Institution, in which we collected the information of pediatric patients with primary vesicoureteral reflux from their clinical charts, in whom either an open or laparoscopic reimplantation following the Lich- Gregoir technique was performed, between January 1, 2013, and December 31, 2017. Patients with incomplete records were excluded. This was a non-probabilistic, consecutive case sample. The Chi-square test or Mann-Whitney´s U were used, as appropriate, to establish between-group differences.

Results: Sixty-eight patients were included, 27 in the open Lich-Gregoir group (OLG), and 41 in the laparoscopic Lich- Gregoir group (LLG). We found no statistical differences in operative times and mean hospital stay. Post-operative complications in the OLG versus the LLG group were similar. The open procedure was successful in 85.2 % and in 90.2 % laparoscopic cases, with no statistically significant difference between groups.

Discussion: We found no statistically significant differences between an open and a laparoscopic approach. The percentage of success was below the expected, this could be result of the large percentage of patients with high-grade reflux and the patients' complex anatomy in both groups. Our study is limited by the small number of patients and by its retrospective design.

Conclusions: The laparoscopic approach with the Lich-Gregoir technique yields similar results to the open technique. However, in this study, we were unable to demonstrate any additional benefits from the laparoscopic approach.

Background: Hemorrhagic cystitis (HC) is a serious complication following hematopoietic stem cell transplantation (HSCT) associated with significant morbidity and mortality. Early identification of at-risk patients and prompt diagnosis are crucial for effective management. This prospective cohort study evaluated the potential of uroflowmetry as a predictive tool for detecting HC in pediatric HSCT patients.

Methods: Thirty-one children who underwent allogeneic HSCT were enrolled. Uroflowmetry was performed on admission (Day 0), post-HSCT Day 1 and Day 15, and at HC onset. Uroflowmetric parameters, including maximum flow rate (Qmax), average flow rate (Qavg), voided volume (VV), and flow curve shape, were compared between HC and non-HC patients.

Results: The incidence of HC within 100 days post-HSCT was 58 %, with a mean onset time of 35 days. At baseline (Day 0), HC patients had significantly lower Qmax (12.5 vs. 17.8 mL/s), Qavg (6.8 vs. 9.5 mL/s), and VV (185 vs. 245 mL) compared to non-HC patients (all p < 0.05). Age-stratified analysis revealed the observation of these differences across all age groups. At HC onset, compared to Day 0, patients experienced a significant decrease in Qmax (8.7 vs. 12.5 mL/s) and Qavg (4.2 vs. 6.8 mL/s) (both p < 0.05). Flow curve analysis demonstrated a shift from bell-shaped to interrupted curves in HC patients over time.

Conclusions: Uroflowmetry can potentially predict and detect HC in pediatric HSCT patients. Lower baseline uroflowmetric parameters may identify patients at higher risk for HC, while a significant decrease in these parameters from baseline may indicate HC onset. Uroflowmetry is a simple, non-invasive tool that can be performed at home and monitored remotely, facilitating early detection and intervention for HC in this population.