Journal of Pediatric Urology最新文献

Introduction: The kidney is the most frequently injured organ in pediatric blunt abdominal trauma. The success of conservative treatment is well-demonstrated for American Association for the Surgery of Trauma (AAST) grade I-III renal injuries. However, the optimal management of grade IV trauma remains controversial. This study aims to enhance the understanding of the optimal therapeutic approach for children with such lesions.

Materials and methods: Medical records of all children presenting with blunt abdominal trauma at our center between January 2013 and January 2020 were reviewed. Renal injuries were classified according to the 2018 AAST grading system, and mechanisms of injury were recorded. Detailed analysis was conducted on the patients with grade IV renal trauma, including mechanism of trauma, associated injuries, imaging, management, length of hospital stay, and follow-up.

Results: All 16 children with grade IV renal trauma were initially managed conservatively. Six (38 %) required no further intervention. Minimally invasive measures-ureteral stenting or angioembolization-were necessary for seven (43 %) patients. Urgent surgical exploration was needed in three (19 %) patients due to hemodynamic instability or vascular trauma. Nephrectomy was avoided in all three and no patient developed hypertension during follow-up. Renal function loss was observed in the only patient with renal arterial dissection.

Discussion: Approximately 40 % of our patients with grade IV blunt renal trauma were successfully managed conservatively. When including both conservatively and minimally invasively treated patients, the success rate rose to 80 %. Many injuries resulted from high-velocity winter sports accidents. This may have contributed to the severity of trauma at presentation.

Conclusion: Conservative management was initially attempted in all patients with grade IV blunt renal trauma and succeeded in 40 % of cases. The success rate rose to 80 % when minimally invasive treatments were included. High-velocity winter sports injuries were associated with more severe trauma, but conservative management remained feasible in hemodynamically stable patients. This highlights the importance of mechanism of injury in guiding treatment and the potential need to adapt pediatric grade IV renal trauma classifications to optimize timing of intervention.

Background: We hereby report ventral flap aided glans urethral disassembly (V- GUD), a modification of GUD technique for distal hypospadias repair.

Methods/technique: Children with distal hypospadias and mobile meatus/urethra were selected. Ventral Mathieu-type perimeatal skin flap was marked around hypospadiac meatus and a stay stitch was placed to aid in distal urethral mobilisation by release of dartos bands holding it. Glans wings were raised and the urethra was disassembled from the glans. The neourethral meatus was fashioned at the advanced position in glans. An 8Fr silastic Foley's catheter was left indwelling for 7 days.

Results: Between 2021 and 2024, 58 boys with coronal hypospadias; median age 18 months (15-24 months), underwent this procedure. The mean operative time was 75 min (60-90). There were no urethrocutaneous fistula/glans dehiscence/meatal retraction. Three (5.1 %) developed meatal stenosis, who responded to meatal dilatation performed on an out-patient basis. Uroflowmetry in older children (n = 24) at 4-year follow-up showed bell-shaped curve with excellent paediatric penile perception score (95 %).

Conclusion: Our technique uses a ventral peri-meatal flap to hold the distal urethra during mobilisation, reducing mechanical trauma/vascular compromise to urethra. It has excellent functional and cosmetic outcomes in short-term. Larger studies with comparator are warranted.

Objective: To evaluate the diagnostic accuracy of the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score in children presenting with acute scrotum and to assess its impact on clinical and surgical outcomes.

Methods: We retrospectively reviewed 324 pediatric patients admitted with acute scrotum between March 2020 and February 2025. Patients were divided into two groups: those evaluated before TWIST implementation (pre-TWIST, n = 178) and after (post-TWIST, n = 146). Demographic, clinical, laboratory, radiological, operative, and follow-up data were collected. The diagnostic performance of the TWIST score was assessed using receiver operating characteristic (ROC) analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios were calculated for a cut-off score of ≥6.

Results: The median age and symptom duration did not differ significantly between groups. The proportion of patients undergoing scrotal exploration decreased significantly after TWIST implementation (56.2 % vs. 36.5 %, p < 0.001). Among operated patients, the median time from admission to surgery was shorter post-TWIST (0.75 h vs. 2 h, p < 0.001). Negative exploration rates fell significantly (51.0 % vs. 7.5 %, p < 0.001), and detorsion/fixation procedures significantly increased (77.3 % vs. 42.0 %, p < 0.001), without significant change in orchiectomy rates (7 % vs. 15 %, p = 0.109). Testicular atrophy following detorsion occurred in 9 % and 7.5 % of patients in the pre- and post-TWIST groups, respectively (p = 0.759). Diagnostic accuracy analysis showed an AUC of 0.94 (95 % CI: 0.91-0.98, p < 0.001). At a cut-off ≥6, sensitivity was 73.5 % and specificity was 96.9 %, with PPV 92.3 %, NPV 87.9 %, LR+ 23.7, and LR- 0.27.

Conclusions: Implementation of the TWIST score improved the management of pediatric acute scrotum by reducing unnecessary explorations and surgical delays while maintaining high diagnostic accuracy for testicular torsion. A cut-off of ≥6 provides strong rule-in value, whereas low scores reliably exclude torsion, supporting TWIST as a practical decision-making tool in the acute setting.