Introduction: Bladder and bowel dysfunction (BBD) is a commonly experienced disorder that can cause adverse physical and psychological impacts on a child and their family.
Objective: This study aimed to assess the yield of clinically significant sensitive genitourinary (GU) examination findings and whether findings influence BBD management.
Methods: A cross-sectional, descriptive, correlational research design was used to study the relationship between GU examination findings and management of pediatric BBD. Data captured were baseline characteristics, urinary symptoms, GU examination findings, and required interventions. Clinically significant GU examination findings were defined as abnormalities requiring medical management such as prescription medications, in-office surgical procedures, or operating room surgical procedures. The primary outcome of interest included GU examination findings and treatments for additional diagnosis discovered during the physical examination. Clopper-Pearson 95 % confidence intervals (CI) were calculated for GU interventions needed for each exam outcome type. Fisher's Exact test was used to determine an association between GU examination findings and additional interventions.
Results: Sixty-six patients met inclusion criteria. 91 % (n = 60) had GU examination findings within normal limits and no one (0 %, 95 % CI: 0.000, 0.059) required an additional intervention. 9 % (n = 6) returned with abnormal findings. Five (83 %0.95 % CI: 0.359, 0.996) of the patients with abnormal GU examination findings required an intervention such as a procedure, prescribed medication, or surgery.
Discussion: The literature suggests normal anatomy in 98 % of children with BBD, while 91 % of our study cohort demonstrated normal exam findings. Patients with abnormal findings were offered interventions that are not considered standard BBD care. Nearly all patients with an abnormal examination chose to proceed with an intervention to address the abnormal finding. Previous BBD studies have not explicitly mentioned genital assessments or the significance of a GU examination. Current literature lacks standardization of physical exam components during BBD visits, however, many agree that a detailed clinical history is essential in diagnosing BBD. For patients with refractory BBD who are not improving with standard care, an in-person GU examination would be warranted. Additionally, radiologic imaging should be considered for patients who do not respond to initial therapies.
Conclusion: Our study demonstrates that the rate of clinically significant examination findings during BBD visits is low. Omitting GU examinations does not appear to compromise the quality of care.
Pyeloplasty at an early age (<2 years) can be treated by a flank open, laparoscopy or robotic approach. We want to demonstrate our strategy and how to construct a very inexpensive pyelostent from a Foley tube. The Ottoni catheter is made from a Foley tube, sectioning the proximal end keeping a plastic circular basement for fixation to the skin. Surgery consists of a small classical lumbar flank incision proportional to a thumb finger in length. The Ottoni catheter is placed as an external stent (Fig 3). Patients stay in hospital overnight and remove the stent after 4 days PO.
Background: The prevalence of pediatric urolithiasis has increased rapidly, leading to more emergency department (ED) visits across the United States.
Objective: The purpose of this study was to determine emergency care practices for children and adolescents with urinary stones and characteristics associated with management.
Methods: We performed a cross-sectional study of the 2021 Nationwide Emergency Department Sample to identify pediatric patients (≤21 years) presenting to an ED in the United States with a primary diagnosis of urinary stone disease. The primary outcome was patient disposition. Multivariable logistic regression was used to identify patient and hospital characteristics associated with hospital admission. Imaging utilization was a secondary outcome of the study.
Results: There were 57 pediatric ED visits for urinary stone disease per 100,000 population in the study (mean age 17.7 years; 59.6 % female). Most patients (91.2 %) were treated and discharged, while 6.9 % were admitted to the same hospital. Computed tomography was the primary imaging modality (60.2 %), with utilization increasing with age. Considerable variability in disposition and imaging utilization was observed, with hospital admission rates ranging from 1.3 % to 55.1 % and CT use from 1.7 % to 77.5 % among patient and hospital subgroups.
Conclusions: This study reveals a high rate of pediatric urinary stone presentations to United States EDs. Significant variations in disposition and imaging utilization across different patient and hospital characteristics highlight the need for standardized, evidence-based approaches to pediatric urinary stone care.
Introduction: Posterior urethral valve (PUV) is a congenital condition marked by obstructing persistent urogenital membrane, leading to urinary tract infections, bladder dysfunction, and kidney damage. It affects males only, mostly suspected antenatally and confirmed in early infancy. It requires early diagnosis and intervention to prevent long-term complications. Effective communication of follow-up and treatment protocols with families is crucial, as informed patients play an active role in decision-making and experience less anxiety.
Methods: A cross-sectional study was conducted on June 20, 2024, by searching YouTube with the keyword "posterior urethral valve." From the first 120 videos, 60 were excluded for being off-topic, duplicates, non-English, or lacking audio. The remaining 60 videos were analyzed for views, duration, comments, likes, and upload source. Video content was categorized into general information, ultrasound imaging, case discussion, and surgical teaching. Two independent urology specialists evaluated the video quality using DISCERN and JAMA Benchmark Criteria.
Results: Of the 60 analyzed videos, 71.6 % were uploaded by physicians. The most common content was general information on symptoms and treatment. The mean JAMA score was 2.45, and the mean DISCERN score was 45.8. According to DISCERN, 8.3 % of videos were "very poor," 25 % were "poor," 30 % were "fair," 11.6 % were "good," and 23 % were "excellent." Videos uploaded by physicians had significantly higher DISCERN reliability and total scores, indicating better quality. No significant correlation was found between DISCERN scores and likes, comments, or views, but video duration was positively correlated with higher scores.
Discussion: Among the analyzed videos, those uploaded by physicians had significantly higher DISCERN total scores, emphasizing their superior quality compared to other sources. Video duration positively correlated with DISCERN and JAMA scores, while metrics such as likes, comments, and views did not reflect content quality.
Conclusion: Creating evidence-based, clear, and engaging content that follows DISCERN and JAMA criteria is essential. Future studies should explore animated formats, diverse keywords, and track content trends over time.
Introduction: In pediatric urology, urodynamic studies are considered the most reliable method for assessing the function of the lower urinary tract. These evaluations play a particularly important role in guiding treatment decisions for neurogenic bladder conditions.
Objective: The aim of this study is to assess the impact of artifacts on the interobserver and intraobserver agreement in the interpretation of pediatric urodynamic traces.
Methods: Two pediatric urology experts, each with a broad spectrum of clinical expertise, conducted a thorough retrospective analysis of the urodynamic tracings. This evaluation was independently performed by the specialists on two separate occasions, with a three-month interval between sessions. The patients were categorized into three groups based on the quality of their recordings: Group 1: No artifacts (n = 30), Group 2: 1-5 artifacts (n = 30), Group 3: More than 5 artifacts (n = 30).
Results: A total of 90 patients were included in our study, with each group comprising 30 participants. Observer 1's initial and fourth-month measurements by groups, a statistically significant difference was found between the initial MDP measurement values of the cases according to the groups (p = 0.012). High interobserver agreement was observed for EBC, CBC, MDP, and Q max variables across all groups (p < 0.001 for each comparison). In intra-observer agreement for qualitative assessments (compliance, detrusor function, character of overactivity, and DSD), Observer 2 demonstrated lower agreement in groups 2 and 3. Group 3, which had urodynamics with a lot of artifacts, was the group with the lowest agreement values.
Discussion: Few studies in the literature assess the intra- and interobserver agreement of urodynamic studies, with reported variations. Venhola et al. and Zimmern et al. found inconsistent interpretations among observers. Quantitative assessments showed higher reliability than qualitative ones. Our study aligns with these findings, indicating variability due to artifacts and differing interpretations of detrusor overactivity.
Conclusion: Artifacts significantly impact interobserver and intraobserver agreement in pediatric urodynamic studies. While quantitative parameters showed higher agreement, particularly in recordings with fewer artifacts, the presence of numerous artifacts in Group 3 led to decreased consistency in evaluations.
Type of study: Retrospective observational study.
Introduction: There exists a prevailing concern regarding the heightened susceptibility of women with a solitary kidney to unfavorable consequences during pregnancy. Irrespective of the underlying etiology, individuals with a solitary kidney are advised to have regular annual screenings for blood pressure and urinalysis due to their increased susceptibility to developing proteinuria, hypertension, and renal failure.
Objective: To investigate the risk of adverse pregnancy outcomes in women with a maternal solitary kidney by comparing maternal and fetal outcomes to those of healthy pregnant women.
Methods: This retrospective, single-center study was conducted with 29 pregnant women with maternal solitary kidney and 60 healthy controls at a tertiary hospital. Obstetric data such as gestational hypertension, preeclampsia, preterm labor, birth week, mode of delivery, Apgar scores, and neonatal intensive care requirements, were compared between the groups. A binary logistic regression analysis was performed to determine the obstetric complications increased by the presence of maternal solitary kidney.
Results: The number of spontaneous abortions, serum creatinine and blood urea nitrogen levels were significantly higher in the patients with solitary kidney (p < 0.05). The birth week was earlier among the patients with a solitary kidney compared to the controls (p = 0.013). The preterm and cesarean delivery rates were also higher in the case group (p = 0.002 and p = 0.035, respectively). The pregnant women with solitary kidney were found to have higher rates of gestational hypertension, preeclampsia, and maternal intensive care requirements (p = 0.008, p = 0.015, and p = 0.008, respectively). Logistic regression analysis revealed a seven-fold increase in the rate of preterm labor (1.45-37.64) and a three-fold increase in preeclampsia (1.27-22.08) among the pregnant women with a solitary kidney.
Conclusion: Patients with solitary kidney are at high risk of encountering pregnancy complications, such as gestational hypertension, preeclampsia, and preterm labor. These pregnant women should be followed up carefully, starting from the first prenatal visit.
Introduction: Epidermolysis bullosa (EB) can severely affect the urinary tract, leading to strictures and urine outflow obstruction, which pose significant risks to kidney function. Procedures involving the urinary mucosa often exacerbate these issues, making safe bladder emptying a major challenge. This study reviews surgical methods for managing urological complications in EB patients, with a focus on the Macedo procedure, which offers a promising alternative that avoids further bladder mucosa irritation and prevents disease exacerbation.
Material and methods: We conducted a systematic review of urological surgeries in EB patients using PubMed, Web of Science, and Google Scholar, adhering to PRISMA guidelines. We propose the Macedo procedure as a novel, safe, and effective technique for managing these patients' urological issues.
Results: The review revealed that most existing urological procedures for EB-related urethral obstruction often result in suboptimal outcomes, leading to permanent suprapubic catheters or vesicostomies. The Macedo ileum-based reservoir, with its continent stoma, significantly enhances the quality of life. By ensuring that catheters contact only the ileal mucosa, the procedure prevents exacerbation of EB lesions while maintaining efficient urine outflow and bladder drainage. We applied this technique to our EB patient with complete urethral obstruction following unsuccessful urethral dilations and a vesicostomy. The Macedo reservoir with a continent catheterizable stoma markedly improved the patient's quality of life, with promising initial outcomes despite limited follow-up.
Conclusion: The Macedo procedure represents a valuable surgical option for catheterization in EB patients, reducing urothelial irritation and preventing disease progression, and has the potential to improve patients' quality of life.
Introduction: Cryptorchidism impairs sperm development and increases the risk of infertility and testicular cancer. Estrogen signalling is critical for proper descent of the testicles, and hormonal imbalances play a role in cryptorchidism. CYP19, also known as aromatase, encodes an enzyme that converts testosterone, a male sex hormone, into estradiol, the main form of estrogen. While estrogen receptors can be activated by estrogen, CYP19 plays an important role in regulating local estrogen levels in tissues such as the testes, as it affects cellular processes controlled by estrogen receptors.
Objective: We aimed to investigate the relationship between polymorphisms in the CYP19 (rs2414096) and ESR2 (rs4986938) and susceptibility to cryptorchidism.
Study design: We genotyped CYP19 (rs2414096) and ESR2 (rs4986938) polymorphisms using PCR-RFLP in DNA isolated from blood samples of cryptorchid children (n = 41) and healthy controls (n = 42). The differences in genotype and allele frequencies between the cryptorchidism and control groups were calculated using the chi-square (χ2).
Results: In cryptorchidism patients, genotypes (p < 0.05) and allele frequencies (p < 0.05) of CYP19 (rs2414096) and ESR2 (rs4986938) polymorphisms showed significant differences compared to controls. CYP19 (rs2414096) and ESR2 (rs4986938), the AA genotype and A allele frequency may be risk factors for cryptorchidism, while the GG genotype and G allele may be protective against cryptorchidism.
Discussion: Our study provides compelling evidence for a significant association between polymorphisms in the CYP19 (rs2414096) and ESR2 (rs4986938) polymorphisms and cryptorchidism susceptibility. These findings extend previous research implicating genetic factors in testicular descent but go further by identifying specific polymorphisms associated with increased risk. While previous studies have suggested a role for estrogen imbalance in cryptorchidism, our results provide concrete genetic evidence supporting this hypothesis. The relatively small sample size necessitates replication in larger cohorts to further validate our findings. Additionally, functional studies are warranted to elucidate the precise mechanisms by which these genetic variants influence cryptorchidism risk. Despite these limitations, our results represent a significant step in unravelling the complex aetiology of this common birth defect.
Conclusion: Our findings show that polymorphisms in CYP19 (rs2414096) and ESR2 (rs4986938), which play a role in estrogen production, are significantly associated with cryptorchidism susceptibility, highlighting the potential role of estrogen pathway variations in testicular descent.
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