Journal of Pediatric Urology最新文献

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.

Introduction/background: Testicular torsion (TT) represents an emergent pediatric condition that requires timely surgical intervention to minimize the likelihood of testicular loss. Numerous reasons may affect the survival rate of a torsed testis, including longer symptom duration, younger age, and higher degree of TT observed intraoperatively. "Door To Detorsion time" (DTD) has been described but not fully validated.

Objective: We sought to evaluate the DTD on outcomes of TT.

Study design: We identified males 1-18 years old with TT over a 10-year period (January 1, 2015-December 31, 2024) in this retrospective and observational study. Univariate and multivariate analyses determined whether DTD, patient age, symptom duration, and degree of TT observed during surgery were predictors of testicular salvage.

Results: Of the 286 patients diagnosed with TT, the median age was 14 years, and the median symptom duration was 9 h. The median DTD was 146.5 min (ranging between 25 and 668 min): 133 min with a viable testes and 166 min with a nonviable testes. A total of 195 (68 %) patients underwent an orchiopexy compared to 91 (32 %) patients who had an orchiectomy. A multivariate analysis demonstrated that each 10-min increase in DTD was associated with a 6 % increase in odds of undergoing an orchiectomy. Each additional hour of DTD was associated with a 35 % increase in odds of an orchiectomy. For each additional hour of symptom duration, the odds of undergoing an orchiectomy versus an orchiopexy increased by 3 %. Patients with a degree of TT > 540 had a 4.85 times higher odds of orchiectomy compared to those treated with 0 degrees of TT. Patients with symptoms lasting 24 h or longer had an 8.9 times higher odds of requiring an orchiectomy compared to those treated within 24 h. For each additional year of age, the odds of an orchiectomy decreased by 14 %.

Discussion: Our study concurs with the literature with respect to a significantly increased risk of needing an orchiectomy with a longer DTD and extended symptom duration, with critical timepoints of greater than 6 h, greater than 12 h, and greater than 18 h.

Conclusion: The DTD is a very significant but often ignored factor. Every 10 min delay in the Emergency Department reduces the survival of the testis. Recognizing the symptoms of TT especially in younger males and seeking timely medical attention, coupled with a hastened hospital course prior to surgery, decrease the need for testicular loss.

Objectives: This study aimed to explore the effects of rewarding situational simulation games in the perioperative period of children with concealed penis.

Methods: A total of 82 children diagnosed with concealed penis and scheduled for elective surgery were selected as the study participants between April 2022 and October 2022 in the urology department of a Grade III hospital in Changsha, Hunan Province. Of these, 41 children were in the control group and 41 in the experimental group. The control group was given routine health education, whereas the experimental group additionally received a rewarding situational simulation game. The intervention times were 1 day before surgery, in the waiting area before surgery, during the induction period of anaesthesia and 24 h after surgery, once in each period - a total of four times. The general data of the children and their main caregivers were recorded and analysed. The Chinese version of the modified Yale Preoperative Anxiety Scale (m-YPAS) was used. The SPSS 25.0 statistical software package was used to analyse the data in this study.

Results: The m-YPAS scores in the experimental group were significantly lower than those in the control group at the two time points before surgery (32.9 ± 7.0 vs 42.6 ± 8.6) and during anaesthesia induction (38.6 ± 5.8 vs 51.1 ± 9.1), and the difference was statistically significant (p < 0.05). The Induction Compliance Checklist score of the experimental group was lower than that of the control group, and the difference was statistically significant (p < 0.05).

Conclusions: The rewarding situational simulation game can reduce the preoperative anxiety level of children undergoing concealed penis surgery and improve the degree of cooperation during anaesthesia induction.

Background: Testicular torsion is a well-documented pediatric urological emergency that poses a time-sensitive risk to the testicle and long-term morbidity. Despite the urgent nature of testicular torsion, few studies have explored the institutional and clinical factors that influence diagnosis and management. To address this gap, we performed qualitative focus group interviews across the National Surgical Quality Improvement Program Pediatric (NSQIPP) Testicular Torsion Collaborative to better understand facilitators and barriers to testicular torsion care.

Methods: Relevant stakeholders involved in testicular torsion care (i.e. emergency department, radiology, urology, peri-operative services, anesthesia, and surgical quality leadership) across the Testicular Torsion Collaborative were invited to participate in focus group interviews led by a moderator and included a note-taker. All focus groups were recorded and transcribed via Zoom™ audio-visual conferencing software. Inductive coding was performed by 3 reviewers using Dedoose (Los Angeles CA). Themes were designated within the Theoretical Domain Framework (TDF) construct for implementation science and determined to be either a facilitator or barrier to testicular torsion care.

Results: Of the 29 invited sites, 10 sites and 47 individuals participated. Thematic saturation was reached for 20 themes, each represented in at least 2 focus group discussions. All elements of the TDF were represented in the discussions. Community education, culture of quality, high standard of care expectations, and leveraging available data were universally seen as facilitators. Long term follow-up and outcomes, manual detorsion care, and competing care demands were universally seen as barriers.

Conclusions: Based on focus groups of stakeholders in all aspects of testicular torsion care, opportunities to improve care include leveraging quality improvement culture and resources (i.e. trained personnel, data). Barriers to care include competing care demands arising from outside transfers and institutional clinical volume. We hope readers can use this data as a framework to improve in testicular torsion care.

Introduction: Duchenne muscular dystrophy (DMD), a severe, progressive disease, causes loss of function of skeletal muscles. Urological symptoms in DMD include detrusor overactivity, bladder hypocontractility, urinary incontinence, detrusor-sphincter dyssynergia and urolithiasis. This narrative review summarises available evidence and provides recommendations for bladder dysfunction management.

Materials and methods: A literature search was performed using the PubMed, Scopus, Embase, Cochrane and Web of Science search engines. The objectives of the review were: to investigate the incidence of lower urinary tract symptoms (LUTS), defecation problems, urinary tract infections (UTIs) and urolithiasis and the impact of urological problems on the quality of life of children with DMD. Following PRISMA guidelines and applying the Patient, Intervention, Comparison, Outcome (PICO) framework, nine non-randomised studies were selected, and MINORS criteria were used to validate their quality.

Results: All selected studies included DMD patients alone or in a mixed cohort with Becker Muscular Dystrophy (BMD) patients (DMD: 76-84 %). Diagnosis was mostly confirmed clinically. A single institute study design was noted for alle publications. Only one study incorporated short follow-up. Inclusion of a urologist in multidisciplinary teams was uncommon. Definitions and assessments of LUTS varied widely, and their prevalence ranged from 32 % to 85 %. Most frequently reported LUTS were hesitancy, urgency, day-time or night-time urinary incontinence and frequency. The prevalence of concomitant defecation problems ranged from 32 % to 70 %. Information on UTIs, urolithiasis, quality of life and intervention outcomes, for example, anticholinergics use was sparse.

Conclusions: DMD is a progressive muscle disease with urological complications. This review revealed a high prevalence of LUTS, including hesitancy, urgency, and incontinence, along with significant defecation issues. However, limited information is available on UTI, urolithiasis, quality of life, and treatment outcomes for these symptoms. Special attention is warranted for LUTS and bowel function. Multidisciplinary treatment including a paediatric urologist is beneficial.

Background: Reconstruction of the genitalia in patients with classic bladder exstrophy (CBE) is essential to support satisfactory sexual function and fertility. However, due to the complexity of both urinary and genital reconstructive procedures, long-term sexual function may be significantly impaired in adulthood.

Objectives: To assess long-term sexual outcomes and the prevalence of sexual and erectile dysfunctions in patients with classic bladder exstrophy (CBE). Secondary objectives were to identify predictive factors of sexual dysfunction and describe fertility outcomes.

Patients and methods: This retrospective single-center cohort study (part of QUALEXSTRO study) assessed sexuality and fertility in patients aged ≥15 years treated for CBE, using standardized and validated questionnaires: the Female Sexual Function Index (FSFI) for women and the Simplified International Index of Erectile Function (IIEF-5) for men.

Results: Among 63 eligible patients (36 men and 27 women), 22 men and 20 women completed the questionnaire. Median [IQR] age and follow-up were 28 [20-37] and 26 [19-35] years in women, and 23 [17-30] and 21 [16-27] years in men. Thirteen (65 %) women underwent genital surgery (median [IQR] age at first genital surgery: 14 [12-17] years). Among women, 13 (65 %) were sexually active, their median [IQR] age was 34 [27-40] years. Median [IQR] FSFI was 28.4 [14.2-30.1], with 42.6 % meeting criteria for sexual dysfunction (FSFI<26.55). In men, the Ransley-Cantwell technique was mainly used for epispadias repair; 63.6 % required additional urethral surgeries. Twelve men (54.5 %) were sexually active, with a median [IQR] age of 28 [21-37] years. Among them, median [IQR] IIEF-5 score was 23 [16.5-23], and 4 patients (33.3 %) had ED (IIEF-5<22). Satisfaction with genital appearance was low (37.5 % in women, 11.8 % in men). Among sexually active women, 66.7 % became pregnant; 7 delivered 9 children. One man fathered two children naturally.

Conclusions: Patients with CBE report high rates of sexual activity, but variable levels of satisfaction with genital appearance and sexual function. Standard scoring tools may not adequately reflect the specific anatomical and functional characteristics of this population, pointing out the need for adapted assessment instruments to evaluate surgical outcomes more accurately.