Journal of Pediatric Urology最新文献

{"title":"Education and training in hypospadias surgery: Current status, competency assessment, and the role of modern educational tools","authors":"Ibrahim Ulman ,&nbsp;Tariq Abbas ,&nbsp;Ursula Tonnhofer ,&nbsp;Luis H. Braga ,&nbsp;Ahmed T. Hadidi","doi":"10.1016/j.jpurol.2026.105733","DOIUrl":"10.1016/j.jpurol.2026.105733","url":null,"abstract":"<div><h3>Introduction</h3><div>Hypospadias is one of the most common congenital anomalies, yet surgical training remains variable worldwide. Despite advances in surgical techniques, outcomes continue to be challenged by high complication rates, uneven case distribution, and lack of standardized curricula.</div></div><div><h3>Objective</h3><div>To evaluate current hypospadias training, competency assessment, and the role of modern educational tools, using data from the Hypospadias International Society (HIS) 2024 Cairo meeting and a review of the literature.</div></div><div><h3>Study design</h3><div>This narrative review integrates published evidence with findings from a cross-sectional survey of 103 international HIS members and congress attendees. The survey explored surgical exposure, perceived training needs, and preferred educational modalities.</div></div><div><h3>Results</h3><div>Survey respondents reported a gap between the ideal number of hypospadias procedures required for competency and the actual exposure achieved during residency and fellowship. While most endorsed microsurgical training and stepwise progression, limited case volumes and inconsistent curricula were identified. Competency-based assessment tools such as the Objective Structured Assessment of Technical Skills (OSATS) and structured feedback provide more objective evaluation compared to traditional models. Advances in simulation—including animal models, 3D-printed and synthetic replicas, and emerging VR/AR platforms—offer reproducible environments for skill development. E-learning and tele-mentoring further expand access to training across regions.</div></div><div><h3>Discussion</h3><div>Hypospadias education benefits from combining traditional high-volume center experience with reproducible modern training tools. Structured curricula and competency-based assessments may reduce variability in surgical outcomes.</div></div><div><h3>Conclusion</h3><div>Training in hypospadias surgery should emphasize structured frameworks, objective assessment, and innovative modalities. Concentrating training in specialized centers, while integrating simulation and digital platforms, may better prepare future surgeons and improve patient outcomes.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"22 2","pages":"Article 105733"},"PeriodicalIF":1.9,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081021","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}

{"title":"Letter to the Editor re: \"ROS scavengers and genital skin healing in boys with hypospadias\".","authors":"Nav La, Schawanya K Rattanapitoon, Chutharat Thanchonnang, Nathkapach K Rattanapitoon","doi":"10.1016/j.jpurol.2026.105729","DOIUrl":"https://doi.org/10.1016/j.jpurol.2026.105729","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":"105729"},"PeriodicalIF":1.9,"publicationDate":"2026-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097307","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}

{"title":"Response to Letter to the Editor re: \"Evaluating the utility of ChatGPT in enhancing parental education and clinical support in hypospadias care\".","authors":"Putu Angga Risky Raharja, Tariq O Abbas","doi":"10.1016/j.jpurol.2026.105723","DOIUrl":"https://doi.org/10.1016/j.jpurol.2026.105723","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":"105723"},"PeriodicalIF":1.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149772","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}

{"title":"Assessing inter-rater reliability of objective renal sonographic measurements for identification of clinically significant ureteropelvic junction obstruction","authors":"C. Corbett ,&nbsp;J.S. Kim ,&nbsp;H. Aboughalia ,&nbsp;V. Kucherov ,&nbsp;B. Hisam ,&nbsp;T. Myint ,&nbsp;A. Krill","doi":"10.1016/j.jpurol.2026.105727","DOIUrl":"10.1016/j.jpurol.2026.105727","url":null,"abstract":"<div><h3>Introduction</h3><div>Anterior posterior renal pelvis diameter (APRPD) and minimal parenchymal thickness ratio (MPTR) on renal ultrasonography (RUS) have been identified as measures to help risk stratify patients with hydronephrosis for adverse findings on diuretic renography (DR). Widespread adoption of these measures requires reliable assessment by providers to ensure accurate risk stratification.</div></div><div><h3>Objective</h3><div>To assess the inter-rater reliability between pediatric radiologists measuring APRPD and minimum parenchymal thickness (MPT) on RUS in patients who also underwent DR for evaluation of hydronephrosis. A secondary objective was to assess whether individual radiologist measurements for APRPD and MPT differed based on Society for Fetal Urology (SFU) grade, prolonged drainage time on DR, or decreased differential renal function (DRF) (&lt;40 %).</div></div><div><h3>Study design</h3><div>We conducted a retrospective cohort study of children who underwent DR within 120 days of RUS for the evaluation of hydronephrosis. We included patients with isolated unilateral SFU grade 3 and 4 hydronephrosis. Non-parametric tests were used to compare cohorts with and without prolonged drainage time (t_1/2 &gt; 40 min) or decreased DRF (&lt;40 %) on DR. Covariables included SFU grade, laterality, sex, antenatal diagnosis of hydronephrosis, and time interval between studies. Intraclass-correlation coefficient (ICC) for absolute agreement was calculated for APRPD and MPT.</div></div><div><h3>Results</h3><div>112 patients met inclusion criteria. Studies occurred between October 2011 and January 2024. Median age at the time of DR was 1.6 years and the median interval between RUS and DR was 30 days. The majority of patients were male (71 %), had antenatal detection of hydronephrosis (85 %), and had left sided hydronephrosis (63 %). Rates of SFU grade 3 and 4 hydronephrosis were similar (45 % and 55 %, respectively). Patients with decreased DRF or prolonged drainage time were more likely to have SFU grade 4 hydronephrosis. For APRPD and MPT, ICC values were good to excellent, with ICC of 0.88 (95 % CI 0.82–0.92) and 0.86 (95 % CI 0.77–0.91) respectively, and remained so on subgroup analysis by SFU grade. APRPD and MPT measurements were significantly different in patients with SFU grade 3 vs 4 hydronephrosis for both radiologists.</div></div><div><h3>Discussion and conclusion</h3><div>APRPD and MPT were reliably measured by radiologists with good to excellent ICC. These have the potential to serve as objective measures to assess risk of abnormal findings on DR. Future prospective studies to assess their utility in risk stratifying patients with hydronephrosis and suspected UPJ obstruction are warranted.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"22 2","pages":"Article 105727"},"PeriodicalIF":1.9,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146026202","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}

{"title":"Letter to the Editor re: \"Evaluating the utility of ChatGPT in enhancing parental education and clinical support in hypospadias care\".","authors":"Luisa Giudice, Stefano Granieri, Stefania Galassi, Sante De Santis, Emmanuel Pio Pastore","doi":"10.1016/j.jpurol.2026.105724","DOIUrl":"https://doi.org/10.1016/j.jpurol.2026.105724","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":"105724"},"PeriodicalIF":1.9,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146064391","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}

{"title":"Minimizing radiation exposure in pediatric nephrolithiasis: The effectiveness of a low-dose computed tomography protocol","authors":"Wyatt MacNevin ,&nbsp;Mareen S. Kraus ,&nbsp;Chrissy Gamache ,&nbsp;Elena Tonkopi ,&nbsp;Kathleen O'Brien ,&nbsp;Karen Milford ,&nbsp;Dawn L. MacLellan ,&nbsp;Daniel T. Keefe","doi":"10.1016/j.jpurol.2026.105728","DOIUrl":"10.1016/j.jpurol.2026.105728","url":null,"abstract":"<div><h3>Purpose</h3><div>Ultrasonography is the recommended first-line investigation for the diagnosis of pediatric nephrolithiasis. Despite higher sensitivity and specificity for this condition, computed tomography is reserved for more complex cases due to its radiation exposure. Despite increasing stone prevalence in the pediatric population, there is a lack of low-dose computed tomography pediatric urolithiasis protocols and descriptions of low-dose protocols are sparse. Herein we report the development and implementation of a low-dose protocol to reduce radiation exposure to this vulnerable population.</div></div><div><h3>Materials and methods</h3><div>A novel low-dose computed tomography protocol was designed through multidisciplinary collaboration, literature review, and phantom trials. Patients undergoing computed tomography for urolithiasis assessment were evaluated using the novel low-dose protocol and were compared to a retrospective cohort. Radiation reduction was characterized using descriptive statistics and comparative analysis.</div></div><div><h3>Results</h3><div>Mean (± standard deviation) age for the low-dose group was 12.6 ± 4.2 years (n = 26) compared to 12.4 ± 3.7 years for the standard-dose group (n = 15). The low-dose protocol reduced radiation dose when compared to the standard-dose group by 55.5 % (≥45 kg) (p = 0.02) and 27.8 % (&lt;45 kg) (p = 0.03). The low-dose protocol visualized stones seen on ultrasound with 100 % accuracy (n = 6), and in 61.5 % (n = 16/26) of patients. There was no difference in stone sizes between groups.</div></div><div><h3>Conclusions</h3><div>Reduced-dose computed tomography protocols are effective for assessing urolithiasis while reducing radiation exposure. Implementation of reduced-dose computed tomography protocols in cases of suspected urolithiasis is advised to limit radiation exposure while maintaining diagnostic imaging detail.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"22 2","pages":"Article 105728"},"PeriodicalIF":1.9,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146080986","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}

{"title":"Management of grade IV pediatric blunt renal trauma: Conservative, interventional or surgical? Our experience between 2013 and 2020.","authors":"Sandrine Viaccoz, Marie Heyne-Pietschmann, Steffen Berger, Mazen Zeino","doi":"10.1016/j.jpurol.2026.105726","DOIUrl":"https://doi.org/10.1016/j.jpurol.2026.105726","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Discussion: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"22 2","pages":"105726"},"PeriodicalIF":1.9,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113630","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}

{"title":"Feasibility and safety of double-J ureteral stent with a timed-release extraction string in children","authors":"Zhi Qiang Wei ,&nbsp;Fu Ran Wang","doi":"10.1016/j.jpurol.2026.105725","DOIUrl":"10.1016/j.jpurol.2026.105725","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Conventional removal of double-J ureteral stent (DJUS) in children typically requires cystoscopy under general anesthesia, which entails perioperative risks and increased healthcare costs. The DJUS with a timed-release extraction string (DJUS-TRES) potentially overcomes these limitations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To evaluate the feasibility and safety of DJUS-TRES in children.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study design&lt;/h3&gt;&lt;div&gt;We prospectively collected data on children undergoing urological surgeries with DJUS-TRES between September 2022 and May 2025, with subsequent retrospective analysis. Postoperatively, the absorbable suture securing the extraction string undergoes hydrolysis, releasing the string. Once the string is spontaneously expelled through the urethra, the stent can be removed by traction in an outpatient settings or at home. Cystoscopic removal was reserved for cases where the string was not expelled after two months or if traction removal was unsuccessful.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;DJUS-TRES was successfully placed in 69 out of 73 children (94.5 %), with a median age of 3.6 years (range: 1.2 months to 16 years). All four placement failures occurred during antegrade approach, due to inability to pass the ureterovesical junction (UVJ) (n = 2), misplacement into the preputial cavity (n = 1), and ureteral retention of the extraction string (n = 1). String removal was attempted within two months in 66 cases and was successful in 60 (90.9 %). Causes of failure included non-expulsion due to encrustation (n = 4) and string fracture during traction (n = 2). Complications included one case (1.5 %) of severe encrustation requiring pneumovesicoscopic removal, stent migration (n = 4, 5.8 %), stent-associated urinary tract infection (UTI; n = 13, 18.8 %), and significant urinary symptoms (n = 9, 13.0 %).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;DJUS-TRES enabled stent removal without anesthesia or invasive procedures in most patients. However, several specific characteristics were observed. First, antegrade placement failed in approximately 14 % of attempts, primarily due to impaired passage of the distal stent end across the UVJ. Second, it carries a risk of urinary symptoms—such as foreign body sensation, urinary incontinence, and dysuria—likely resulting from the string in the urethra, interfering with sphincter function and causing obstructive voiding. Third, the most common complication was UTI, with stent migration and string encrustation occurring less frequently. Although the success rate of DJUS-TRES removal was moderately lower, it offered a favorable safety profile and minimized tissue damage compared to cystoscopy and other invasive alternatives.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;The DJUS-TRES provides a safe and effective option for stent removal without the need for cystoscopy or anesthesia. Given the risks of failure and complications, further prospective controlled studies are w","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"22 2","pages":"Article 105725"},"PeriodicalIF":1.9,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015890","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}

{"title":"Response to Commentary on \"Socioeconomic and demographic factors predict post-surgical follow-up\".","authors":"Megan A Stout, Jason Benedict, Christina B Ching","doi":"10.1016/j.jpurol.2025.105721","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.105721","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":"105721"},"PeriodicalIF":1.9,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113583","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}

{"title":"Ventral flap aided glans urethral disassembly (V-GUD) technique for distal hypospadias.","authors":"Nirmalan Shajini, Ramesh Babu","doi":"10.1016/j.jpurol.2025.105718","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.105718","url":null,"abstract":"<p><strong>Background: </strong>We hereby report ventral flap aided glans urethral disassembly (V- GUD), a modification of GUD technique for distal hypospadias repair.</p><p><strong>Methods/technique: </strong>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.</p><p><strong>Results: </strong>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 %).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":"105718"},"PeriodicalIF":1.9,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145998414","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}