Pub Date : 2024-10-01DOI: 10.1016/j.jpurol.2024.07.015
Background
Treatment of high cryptorchidism can be challenging, often with frustrating results. We report 25 years of experience in the treatment of the cryptorchidism with very short spermatic vessels using an original two-stage orchiopexy that preserves the spermatic vessels.
Methods
We reviewed the clinical charts of children affected by cryptorchidism with very short spermatic vessels treated through our original surgical approach in tree Institutes of Pediatric Surgery. The first stage of the procedure started with an inguinal incision and a standard orchiopexy with a deep mobilization in the retroperitoneum to straighten the spermatic vessels that are entirely preserved. After realizing intraoperatively that such maximal retroperitoneal mobilization cannot ensure a satisfactory scrotal position of the testis, the spermatic cord is wrapped in a thin sheet of polytetrafluoroethylene (PTFE) shaped as a conduit. The testis is fixed to the bottom of the scrotum which remains invaginated due to the tension. [Fig. A - scheme of the operation]. This first stage can also be performed in laparoscopy, with a video-assisted positioning of the PTFE conduit [Fig. B - laparoscopic view with vessels and vas respectively marked by black and white arrows]. The second surgical stage is scheduled after 6–12 months to remove the PTFE conduit.
Results
A group of 100 children affected by cryptorchidism and very short spermatic vessels (9 bilateral, 86 intra-abdominal, 23 “peeping” at the internal ring) for a total of 109 testes underwent surgery with a two-stage procedure. From the first to the second stage, a progressive lowering of each testis towards the scrotum was observed. During the second stage, after removal of the PTFE sheet, the preserved cord was loose in the inguinal canal and all the testes were located in the scrotum: 68 testes were found correctly located with no further care needed, while 41 were still in a high scrotal position. However, the latter were easily detached from the scrotal bottom and re-fixed in a more satisfactory location. At 1–9 years follow-up all the testes but one (99%) were in the correct scrotal position with stable or increased testicular volume [Fig. C], while 1 testis vanished. No complications were observed all along the follow-up.
Conclusions
This long term 25-year review indicates that our original surgical technique guarantees a high rate of success with neither evident contraindications nor drawbacks for patients affected by undescended testes with spermatic vessels so short to be untreatable through a standard orchiopexy.
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Pub Date : 2024-10-01DOI: 10.1016/j.jpurol.2024.07.009
Circumcision is commonly performed but anatomic variants occur and can affect outcomes if not addressed properly. The combination of concealed penis and penoscrotal webbing is fairly common and presents across a spectrum of severity. If not repaired, this can result in a buried penis that can cause penile adhesions, wound healing concerns, and make the penis appear shorter secondary to a retracted position. We present our technique that is reproducible and highly successful in addressing both of these concerns. The paraphimotic band approach is performed more commonly and is able to reliably correct webbing and concealment without an incision at the penoscrotal junction. When more severe defect is present, a Y shaped incision is made at the penoscrotal junction to mobilize skin flaps to correct the deficit. In our cohort of 885 patients, 736 were corrected using the paraphimotic band technique while 149 underwent a complex scrotoplasty. None of the patients required a secondary surgery for complications.
包皮环切术是常见的手术，但也会出现解剖变异，如果处理不当，会影响手术效果。隐匿阴茎和阴茎包皮蹼的组合相当常见，严重程度不一。如果不进行修复，可能会导致阴茎被埋藏，造成阴茎粘连、伤口愈合问题，并使阴茎因位置后缩而显得较短。我们介绍的这项技术具有可重复性，在解决这两个问题方面非常成功。阴茎系带旁方法更常用，无需在阴茎阴囊交界处切开，就能可靠地矫正蹼状和隐匿。当出现更严重的缺损时，可在阴茎睾丸交界处做一个 Y 形切口，调动皮瓣来矫正缺损。在我们的 885 例患者中，736 例采用了阴囊旁带技术进行矫正，149 例接受了复杂的阴囊成形术。没有一名患者因并发症而需要二次手术。
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Pub Date : 2024-10-01DOI: 10.1016/j.jpurol.2024.01.029
<div><h3>Introduction</h3><div><span><span><span>The National Spina Bifida </span>Patient Registry<span> (NSBPR) assesses bladder and </span></span>bowel incontinence using ordinal categories, but prior NSBPR analyses employed binary classification. Our aims were to </span><strong>1)</strong> perform the first NSBPR analysis of bladder and bowel incontinence as ordinal outcomes to compare to the binary definition and subject variables; <strong>2)</strong> explore the correlation of incontinence with undergarment usage, and <strong>3)</strong><span> assess incontinence status following continence surgeries.</span></div></div><div><h3>Methods</h3><div>Data from NSBPR participants’ most recent clinic visit from 2013 to 2020 were analyzed. Ordinal categories of incontinence were compared to previously used binary definitions. Incontinence surgical outcomes were analyzed for those with data at least three months post-operatively. Chi-square tests evaluated associations among categorical variables. Univariate and ordinal logistic regression models were used to test associations of ordinal incontinence status with patient and condition factors. Statistical tests were 2-sided; p values < 0.05 were considered significant.</div></div><div><h3>Results</h3><div>Analysis of 7217 individuals using ordinal incontinence outcomes showed little difference from previously used binary outcomes. The final multivariable logistic regression models with ordinal multinomial outcomes showed that associations of incontinence with age, sex, race/ethnicity, health insurance, level of lesion, and continence management technique were similar to prior studies. Among those reporting never being incontinent of both bladder and bowel, 14% reported using protective undergarments. Of the 500 individuals who had bladder outlet surgery, 38% reported never being incontinent of urine. Of 1416 individuals who had appendicostomy (ACE) bowel surgery, 48% reported never being incontinent of stool.</div></div><div><h3>Discussion</h3><div>Our current analysis showed that ordinal continence outcome classification had similar continence findings as previous studies using the binary definition of continence. Expanding the binary definition of continence to include monthly episodes of incontinence did not greatly increase the proportion of continent individuals and, therefore, would have not likely made meaningful differences in continence outcomes in prior NSBPR analyses. However, it is known that even mild incontinence can affect quality of life, therefore, capturing any level of incontiennce is of clinical importance. Confirmation of the association of continence outcomes with sociodemographic, condition-related, and interventional factors with both approaches further validates previous analyses using the binary definition of continence.</div></div><div><h3>Conclusion</h3><div>The previously used binary definition of bladder and bowel continence appears robust. Undergarment choice was a poo
{"title":"Comparing binary & ordinal definitions of urinary & stool continence outcomes: Data from the National Spina Bifida Patient Registry","authors":"","doi":"10.1016/j.jpurol.2024.01.029","DOIUrl":"10.1016/j.jpurol.2024.01.029","url":null,"abstract":"<div><h3>Introduction</h3><div><span><span><span>The National Spina Bifida </span>Patient Registry<span> (NSBPR) assesses bladder and </span></span>bowel incontinence using ordinal categories, but prior NSBPR analyses employed binary classification. Our aims were to </span><strong>1)</strong> perform the first NSBPR analysis of bladder and bowel incontinence as ordinal outcomes to compare to the binary definition and subject variables; <strong>2)</strong> explore the correlation of incontinence with undergarment usage, and <strong>3)</strong><span> assess incontinence status following continence surgeries.</span></div></div><div><h3>Methods</h3><div>Data from NSBPR participants’ most recent clinic visit from 2013 to 2020 were analyzed. Ordinal categories of incontinence were compared to previously used binary definitions. Incontinence surgical outcomes were analyzed for those with data at least three months post-operatively. Chi-square tests evaluated associations among categorical variables. Univariate and ordinal logistic regression models were used to test associations of ordinal incontinence status with patient and condition factors. Statistical tests were 2-sided; p values < 0.05 were considered significant.</div></div><div><h3>Results</h3><div>Analysis of 7217 individuals using ordinal incontinence outcomes showed little difference from previously used binary outcomes. The final multivariable logistic regression models with ordinal multinomial outcomes showed that associations of incontinence with age, sex, race/ethnicity, health insurance, level of lesion, and continence management technique were similar to prior studies. Among those reporting never being incontinent of both bladder and bowel, 14% reported using protective undergarments. Of the 500 individuals who had bladder outlet surgery, 38% reported never being incontinent of urine. Of 1416 individuals who had appendicostomy (ACE) bowel surgery, 48% reported never being incontinent of stool.</div></div><div><h3>Discussion</h3><div>Our current analysis showed that ordinal continence outcome classification had similar continence findings as previous studies using the binary definition of continence. Expanding the binary definition of continence to include monthly episodes of incontinence did not greatly increase the proportion of continent individuals and, therefore, would have not likely made meaningful differences in continence outcomes in prior NSBPR analyses. However, it is known that even mild incontinence can affect quality of life, therefore, capturing any level of incontiennce is of clinical importance. Confirmation of the association of continence outcomes with sociodemographic, condition-related, and interventional factors with both approaches further validates previous analyses using the binary definition of continence.</div></div><div><h3>Conclusion</h3><div>The previously used binary definition of bladder and bowel continence appears robust. Undergarment choice was a poo","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139889815","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}
Pub Date : 2024-10-01DOI: 10.1016/j.jpurol.2024.07.012
{"title":"Response to correspondence regarding “Emergent robot-to-open conversion-multidisciplinary simulation training in crisis management”","authors":"","doi":"10.1016/j.jpurol.2024.07.012","DOIUrl":"10.1016/j.jpurol.2024.07.012","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141697712","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}
Pub Date : 2024-10-01DOI: 10.1016/j.jpurol.2024.05.020
<div><h3>Introduction</h3><div>Countless papers have been published regarding the management and clinical outcome of vesicoureteral reflux (VUR), still no active treatment has been proven superior to another, regarding preserving renal function. When considering comparable treatment alternatives, qualitative research is needed to understand the parents’ perspectives and preferences.</div></div><div><h3>Objective</h3><div>This study aims to describe the parents’ experiences of infant high-grade VUR (hVUR) regarding continuous antibiotic prophylaxis (CAP), surgical intervention (SI), urinary tract infection (UTI) and renal damage.</div></div><div><h3>Materials and methods</h3><div>We performed four randomized, semi-structured focus groups (FG) with 19 parents to 15 children (aged 1,5–6 years). All children had been diagnosed with hVUR at <8 months of age and treated with CAP (all groups) and SI (two groups). Discussions were recorded, transcribed and analysed to content. The sample size for the FGs was based on category saturation, which was confirmed through comparison analysis in multiple FGs.</div></div><div><h3>Results</h3><div>The FGs generated 2,897 parent-reported experiences, of which this study reports on 1,123, sorted into the abovementioned four themes and underlying categories. Negative experiences regarding CAP, such as stress regarding the daily intake and worries about long-term use and side effects, were abundant, whereas positive experiences were few. The experiences regarding SI were negatively affected by inadequate information and postoperative difficulties and positively by empathy, accurate information and adequate preparations. The increased risk of UTIs were described as a constant emotional stress causing restricted social activities, frequent visits to the hospital and challenges regarding urine-sampling. There was a common awareness of renal damage, but few experiences reflected any actual worry.</div></div><div><h3>Discussion</h3><div>The daily struggle with medications and monitoring for symptoms, concerns of future antibiotic resistance and a parental preference of SI have been documented in previous studies. FG methodology effectively collects data from several participants during the same occasion, the goal being to generate discussions that enable researchers to see the world from the participants’ perspective. Since the management of infants with hVUR is still under debate, qualitative research can remind of valuable patient and parent perspectives.</div></div><div><h3>Conclusion</h3><div>This study shows that CAP and the risk of UTI have non-negligible, everyday impact on family life, while renal damage seems of secondary importance. The concerns of surgical treatment are related to an isolated occasion, which can be optimized with proper care and improved preoperative preparations. Awareness of parents’ experiences and preferences is helpful when managing children with hVUR.<span><div><span><span><p><span>Summ
简介有关膀胱输尿管反流（VUR）的治疗方法和临床结果的论文不胜枚举，但在保护肾功能方面，仍没有一种积极的治疗方法被证明优于其他治疗方法。在考虑可比的治疗方案时，需要进行定性研究，以了解家长的观点和偏好：本研究旨在描述婴儿高位尿崩症（hVUR）家长在持续抗生素预防（CAP）、手术干预（SI）、尿路感染（UTI）和肾损伤方面的经验：我们对 15 名儿童（1.5-6 岁）的 19 名家长进行了四次随机、半结构化的焦点小组（FG）讨论。所有儿童均被诊断为尿毒症：焦点小组共收集了 2,897 份家长报告的经历，本研究报告了其中的 1,123 份，这些经历按上述四个主题和基本类别进行了分类。关于 CAP 的负面经历很多，例如对每日摄入量的压力以及对长期使用和副作用的担忧，而正面经历则很少。有关 SI 的经历受到信息不足和术后困难的负面影响，而受到同理心、准确信息和充分准备的正面影响。尿毒症风险的增加被描述为一种持续的情绪压力，导致社交活动受限、频繁去医院以及尿液采样方面的挑战。他们普遍意识到肾脏受损的危险，但很少有实际担心的经历：讨论：在以往的研究中已经记录了每天与药物和症状监测的斗争、对未来抗生素耐药性的担忧以及父母对住院治疗的偏好。FG 方法可有效收集同一场合多名参与者的数据，其目的是引发讨论，使研究人员能够从参与者的角度看世界。由于对患有急性尿潴留的婴儿的管理仍在争论之中，定性研究可以提醒人们注意病人和家长的宝贵观点：本研究表明，CAP 和尿毒症风险对家庭生活的日常影响不可忽视，而肾损伤似乎是次要的。对手术治疗的担忧与个别情况有关，如果护理得当并改进术前准备工作，这种担忧就会得到缓解。了解家长的经验和偏好有助于管理膀胱尿道返流患儿。
{"title":"Parents’ experiences of treatment and outcomes in high-grade vesicoureteral reflux in infants – One piece in the puzzle of VUR management?","authors":"","doi":"10.1016/j.jpurol.2024.05.020","DOIUrl":"10.1016/j.jpurol.2024.05.020","url":null,"abstract":"<div><h3>Introduction</h3><div>Countless papers have been published regarding the management and clinical outcome of vesicoureteral reflux (VUR), still no active treatment has been proven superior to another, regarding preserving renal function. When considering comparable treatment alternatives, qualitative research is needed to understand the parents’ perspectives and preferences.</div></div><div><h3>Objective</h3><div>This study aims to describe the parents’ experiences of infant high-grade VUR (hVUR) regarding continuous antibiotic prophylaxis (CAP), surgical intervention (SI), urinary tract infection (UTI) and renal damage.</div></div><div><h3>Materials and methods</h3><div>We performed four randomized, semi-structured focus groups (FG) with 19 parents to 15 children (aged 1,5–6 years). All children had been diagnosed with hVUR at <8 months of age and treated with CAP (all groups) and SI (two groups). Discussions were recorded, transcribed and analysed to content. The sample size for the FGs was based on category saturation, which was confirmed through comparison analysis in multiple FGs.</div></div><div><h3>Results</h3><div>The FGs generated 2,897 parent-reported experiences, of which this study reports on 1,123, sorted into the abovementioned four themes and underlying categories. Negative experiences regarding CAP, such as stress regarding the daily intake and worries about long-term use and side effects, were abundant, whereas positive experiences were few. The experiences regarding SI were negatively affected by inadequate information and postoperative difficulties and positively by empathy, accurate information and adequate preparations. The increased risk of UTIs were described as a constant emotional stress causing restricted social activities, frequent visits to the hospital and challenges regarding urine-sampling. There was a common awareness of renal damage, but few experiences reflected any actual worry.</div></div><div><h3>Discussion</h3><div>The daily struggle with medications and monitoring for symptoms, concerns of future antibiotic resistance and a parental preference of SI have been documented in previous studies. FG methodology effectively collects data from several participants during the same occasion, the goal being to generate discussions that enable researchers to see the world from the participants’ perspective. Since the management of infants with hVUR is still under debate, qualitative research can remind of valuable patient and parent perspectives.</div></div><div><h3>Conclusion</h3><div>This study shows that CAP and the risk of UTI have non-negligible, everyday impact on family life, while renal damage seems of secondary importance. The concerns of surgical treatment are related to an isolated occasion, which can be optimized with proper care and improved preoperative preparations. Awareness of parents’ experiences and preferences is helpful when managing children with hVUR.<span><div><span><span><p><span>Summ","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141320961","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}
Pub Date : 2024-10-01DOI: 10.1016/j.jpurol.2024.06.039
Introduction
Phimosis is defined as the inability to retract the foreskin, preventing partial or complete exposure of the glans.
Objectives
To compare the efficacy of topical treatment with betamethasone alone and in combination with hyaluronidase, evaluate systemic absorption of cortisol, and identify factors that predispose the success of topical treatment of phimosis in children aged 3–10 years.
Methods
This randomized double-blinded clinical trial involved 152 participants (3–10 years old) with phimosis. The children were divided into two groups: betamethasone associated with hyaluronidase (betamethasone valerate 2.5 mg + hyaluronidase 150 UTR; Group A) and betamethasone (betamethasone valerate 2.5 mg; Group B). Parents were instructed on how to use the ointment (twice a day, after hygiene, for 60 days) and on collecting salivary cortisol measurements at 11pm and 9am, before and after treatment. Participants were evaluated after 30 and 60 days. Fisher's exact test and paired t-test were used to analyze the data.
Results
Ninety children (69.77%) were successfully treated with the proposed treatment, with the success rate for Group A being 75.38% versus 64.06% for Group B, p = 0.18). Systemic absorption evaluated by salivary cortisol did not show differences after the intervention (p > 0.05), indicating that there was no systemic absorption when using ointments with or without hyaluronidase. The factors of age (OR = 0.98 – CI: 0.97–1.00), adherence (OR = 1.49 – CI: 0.53–4.16), balanoposthitis (OR = 1.85 – CI: 0.47–7.19), and previous use of corticosteroids (OR = 1.21 – CI: 0.53–2.72) also did not show influenced results
Conclusion
Topical therapy for true phimosis with betamethasone 0.2% + hyaluronidase, despite showing no differences when compared with betamethasone 0.2% alone, for a period of up to 60 days, proved to be safe, effective, and with good results. The variables analyzed could not predict the expected clinical response.
{"title":"Does the addition of hyaluronidase to betamethasone in topical treatment of phimosis improves results? – A randomized double-blind clinical trial","authors":"","doi":"10.1016/j.jpurol.2024.06.039","DOIUrl":"10.1016/j.jpurol.2024.06.039","url":null,"abstract":"<div><h3>Introduction</h3><div>Phimosis is defined as the inability to retract the foreskin, preventing partial or complete exposure of the glans.</div></div><div><h3>Objectives</h3><div>To compare the efficacy of topical treatment with betamethasone alone and in combination with hyaluronidase, evaluate systemic absorption of cortisol, and identify factors that predispose the success of topical treatment of phimosis in children aged 3–10 years.</div></div><div><h3>Methods</h3><div>This randomized double-blinded clinical trial involved 152 participants (3–10 years old) with phimosis. The children were divided into two groups: betamethasone associated with hyaluronidase (betamethasone valerate 2.5 mg + hyaluronidase 150 UTR; Group A) and betamethasone (betamethasone valerate 2.5 mg; Group B). Parents were instructed on how to use the ointment (twice a day, after hygiene, for 60 days) and on collecting salivary cortisol measurements at 11pm and 9am, before and after treatment. Participants were evaluated after 30 and 60 days. Fisher's exact test and paired t-test were used to analyze the data.</div></div><div><h3>Results</h3><div>Ninety children (69.77%) were successfully treated with the proposed treatment, with the success rate for Group A being 75.38% <em>versus</em> 64.06% for Group B, p = 0.18). Systemic absorption evaluated by salivary cortisol did not show differences after the intervention (p > 0.05), indicating that there was no systemic absorption when using ointments with or without hyaluronidase. The factors of age (OR = 0.98 – CI: 0.97–1.00), adherence (OR = 1.49 – CI: 0.53–4.16), balanoposthitis (OR = 1.85 – CI: 0.47–7.19), and previous use of corticosteroids (OR = 1.21 – CI: 0.53–2.72) also did not show influenced results</div></div><div><h3>Conclusion</h3><div>Topical therapy for true phimosis with betamethasone 0.2% + hyaluronidase, despite showing no differences when compared with betamethasone 0.2% alone, for a period of up to 60 days, proved to be safe, effective, and with good results. The variables analyzed could not predict the expected clinical response.</div></div><div><h3>ReBEC</h3><div>RBR-76bhgyb.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141698715","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}
Pub Date : 2024-10-01DOI: 10.1016/j.jpurol.2024.06.024
{"title":"Commentary to: “Parents’ experiences of treatment and outcomes in high-grade vesicoureteral reflux in infants – One piece in the puzzle of VUR management?”","authors":"","doi":"10.1016/j.jpurol.2024.06.024","DOIUrl":"10.1016/j.jpurol.2024.06.024","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141608273","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}
Pub Date : 2024-10-01DOI: 10.1016/j.jpurol.2023.12.016
<div><h3>Introduction</h3><div><span>The presence of an ovotestis is a rare </span>difference of sex development<span>. The diagnosis can be difficult with the gold standard being the presence of both testicular cords and ovarian follicles within the same gonad.</span></div></div><div><h3>Objective</h3><div>Herein we describe two new markers of ovotesticular syndrome: ovotesticular cords and ovotesticular follicles.</div></div><div><h3>Study design</h3><div>Twenty human gonads with a previous diagnosis of ovotestis were re-stained with markers for testicular cords (SOX9, TSPY, SALL4, DDX4, cP450, AR, α-actin) and ovarian tissue (FOXL2, SALL4, DDX4). Ovotesticular cords were defined as structures expressing both testicular Sertoli cell<span><span> marker (SOX9) and an ovarian follicular cell marker (FOXL2), and in Y chromosome positive specimens, TSPY-positive testicular germ cells. Ovotesticular follicles were defined as a hybrid ovarian follicle containing FOXL2-positive </span>granulosa cells and a central oocyte, but also containing cells expressing the testicular Sertoli cell marker, SOX9, intermingled within FOXL2-positive granulosa cells and male and female germ cells.</span></div></div><div><h3>Results</h3><div>Six of twenty ovotestis did not meet our criterion for the diagnosis of ovotestis lacking the histologic evidence of both testicular and ovarian tissue. The remaining 13 patients in which 14 separate specimens were evaluated, contained ovotestis defined by the presence of testicular cords and ovarian follicles. Eleven of the 14 ovotestis specimens (79 %) contained ovotesticular cords. Four of 11 ovotestis specimens (36 %) contained ovotesticular follicles.</div></div><div><h3>Discussion</h3><div>We recommend using eight immunohistochemical markers to diagnose an ovotestis: 1) SOX9, TSPY, SALL4, DDX4, cytochrome P450<span>, AR, smooth muscle α-actin for the testicular component and FOXL2 and SALL4, DDX4 for the ovarian component. SOX9 and TSPY (useful only in the presence of a Y karyotype) are specific testicular markers and FOXL2 the only specific ovarian marker. We found ovotesticular cords and ovotesticular follicles in both human bipolar and mixed ovotestis specimens both with and without the presence of the Y chromosome. The clinical significance of ovotesticular cords and follicles remains unknown. We did not observe any obvious abnormalities in cellular architecture with the juxtaposition of testicular cells and ovarian cells.</span></div></div><div><h3>Conclusion</h3><div>We have identified two new structures in humans with ovotestis, ovotesticular cords and ovotesticular follicles (Figure), which appears to be additional markers to facilitate the diagnosis of ovotesticular gonads.<span><figure><span><img><ol><li><span><span>Download: <span>Download high-res image (769KB)</span></span></span></li><li><span><span>Download: <span>Download full-size image</span></span></span></li></ol></span><span><span><p><span>Summary figure</
{"title":"Ovotesticular cords and ovotesticular follicles: New histologic markers for human ovotesticular syndrome","authors":"","doi":"10.1016/j.jpurol.2023.12.016","DOIUrl":"10.1016/j.jpurol.2023.12.016","url":null,"abstract":"<div><h3>Introduction</h3><div><span>The presence of an ovotestis is a rare </span>difference of sex development<span>. The diagnosis can be difficult with the gold standard being the presence of both testicular cords and ovarian follicles within the same gonad.</span></div></div><div><h3>Objective</h3><div>Herein we describe two new markers of ovotesticular syndrome: ovotesticular cords and ovotesticular follicles.</div></div><div><h3>Study design</h3><div>Twenty human gonads with a previous diagnosis of ovotestis were re-stained with markers for testicular cords (SOX9, TSPY, SALL4, DDX4, cP450, AR, α-actin) and ovarian tissue (FOXL2, SALL4, DDX4). Ovotesticular cords were defined as structures expressing both testicular Sertoli cell<span><span> marker (SOX9) and an ovarian follicular cell marker (FOXL2), and in Y chromosome positive specimens, TSPY-positive testicular germ cells. Ovotesticular follicles were defined as a hybrid ovarian follicle containing FOXL2-positive </span>granulosa cells and a central oocyte, but also containing cells expressing the testicular Sertoli cell marker, SOX9, intermingled within FOXL2-positive granulosa cells and male and female germ cells.</span></div></div><div><h3>Results</h3><div>Six of twenty ovotestis did not meet our criterion for the diagnosis of ovotestis lacking the histologic evidence of both testicular and ovarian tissue. The remaining 13 patients in which 14 separate specimens were evaluated, contained ovotestis defined by the presence of testicular cords and ovarian follicles. Eleven of the 14 ovotestis specimens (79 %) contained ovotesticular cords. Four of 11 ovotestis specimens (36 %) contained ovotesticular follicles.</div></div><div><h3>Discussion</h3><div>We recommend using eight immunohistochemical markers to diagnose an ovotestis: 1) SOX9, TSPY, SALL4, DDX4, cytochrome P450<span>, AR, smooth muscle α-actin for the testicular component and FOXL2 and SALL4, DDX4 for the ovarian component. SOX9 and TSPY (useful only in the presence of a Y karyotype) are specific testicular markers and FOXL2 the only specific ovarian marker. We found ovotesticular cords and ovotesticular follicles in both human bipolar and mixed ovotestis specimens both with and without the presence of the Y chromosome. The clinical significance of ovotesticular cords and follicles remains unknown. We did not observe any obvious abnormalities in cellular architecture with the juxtaposition of testicular cells and ovarian cells.</span></div></div><div><h3>Conclusion</h3><div>We have identified two new structures in humans with ovotestis, ovotesticular cords and ovotesticular follicles (Figure), which appears to be additional markers to facilitate the diagnosis of ovotesticular gonads.<span><figure><span><img><ol><li><span><span>Download: <span>Download high-res image (769KB)</span></span></span></li><li><span><span>Download: <span>Download full-size image</span></span></span></li></ol></span><span><span><p><span>Summary figure</","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139395230","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}
Pub Date : 2024-10-01DOI: 10.1016/j.jpurol.2024.04.023
{"title":"Commentary on bowel bladder dysfunction in control children in a pediatric urology office. Ref Rodriguez P, Rehfuss A, Adam Howe A, Giramonti K, Feustel PJ, Kogan BA (J Ped Urol, https://doi.org/10.1016/j.jpurol.2024.04.023)","authors":"","doi":"10.1016/j.jpurol.2024.04.023","DOIUrl":"10.1016/j.jpurol.2024.04.023","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141137714","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}
Pub Date : 2024-10-01DOI: 10.1016/j.jpurol.2024.05.016
<div><h3>Background</h3><div>Recently, associations between recurrent urinary<span><span> tract infections (UTI) and the urinary </span>microbiome (urobiome) composition have been identified in adults. However, little is known about the urobiome in children. We aimed to characterize the urobiome of children with species-level resolution and to identify associations based on UTI history.</span></div></div><div><h3>Study design</h3><div><span>Fifty-four children (31 females and 21 males) from 3 months to 11 years of age participated in the study. Catheterized urine specimens were obtained from children undergoing a clinically indicated voiding cystourethrogram<span>. To improve the analysis of the pediatric urobiome, we used a novel protocol using filters to collect biomass from the urine coupled with synthetic long-read </span></span>16S rRNA gene sequencing to obtain culture-independent species-level resolution data. We tested for differences in microbial composition between sex and history of UTIs using non-parametric tests on individual bacteria and alpha diversity measures.</div></div><div><h3>Results</h3><div>We detected bacteria in 61% of samples from 54 children (mean age 40.7 months, 57% females). Similar to adults, urobiomes were distinct across individuals and varied by sex. The urobiome of females showed higher diversity as measured by the inverse Simpson and Shannon indices but not the Pielou evenness index or number of observed species (p = 0.05, p = 0.04, p = 0.35, and p = 0.11, respectively). Additionally, several species were significantly overrepresented in females compared to males, including those from the genera <span><span>Anaerococcus</span><span><em>, </em><span>Prevotella</span><em>,</em></span></span> and <em>Schaalia</em> (p = 0.03, 0.04, and 0.02, respectively). Urobiome diversity increased with age, driven mainly by males. Comparison of children with a history of 1, 2, or 3+ UTIs revealed that urobiome diversity significantly decreases in the group that experienced 3+ UTIs as measured by the Simpson, Shannon, and Pielou indices (p = 0.03, p = 0.05, p = 0.01). Several bacteria were also found to be reduced in abundance.</div></div><div><h3>Discussion</h3><div>In this study, we confirm that urobiome can be identified from catheter-collected urine specimens in infants as young as 3 months, providing further evidence that the pediatric bladder is not sterile. In addition to confirming variations in the urobiome related to sex, we identify age-related changes in children under 5 years of age, which conflicts with some prior research. We additionally identify associations with a history of UTIs.</div></div><div><h3>Conclusions</h3><div><span>Our study provides additional evidence that the pediatric urobiome exists. The bacteria in the bladder of children appear to be affected by early urologic events and warrants future research.</span><span><figure><span><img><ol><li><span><span>Download: <span>Download high-res image (576KB
{"title":"Characterization of pediatric urinary microbiome at species-level resolution indicates variation due to sex, age, and urologic history","authors":"","doi":"10.1016/j.jpurol.2024.05.016","DOIUrl":"10.1016/j.jpurol.2024.05.016","url":null,"abstract":"<div><h3>Background</h3><div>Recently, associations between recurrent urinary<span><span> tract infections (UTI) and the urinary </span>microbiome (urobiome) composition have been identified in adults. However, little is known about the urobiome in children. We aimed to characterize the urobiome of children with species-level resolution and to identify associations based on UTI history.</span></div></div><div><h3>Study design</h3><div><span>Fifty-four children (31 females and 21 males) from 3 months to 11 years of age participated in the study. Catheterized urine specimens were obtained from children undergoing a clinically indicated voiding cystourethrogram<span>. To improve the analysis of the pediatric urobiome, we used a novel protocol using filters to collect biomass from the urine coupled with synthetic long-read </span></span>16S rRNA gene sequencing to obtain culture-independent species-level resolution data. We tested for differences in microbial composition between sex and history of UTIs using non-parametric tests on individual bacteria and alpha diversity measures.</div></div><div><h3>Results</h3><div>We detected bacteria in 61% of samples from 54 children (mean age 40.7 months, 57% females). Similar to adults, urobiomes were distinct across individuals and varied by sex. The urobiome of females showed higher diversity as measured by the inverse Simpson and Shannon indices but not the Pielou evenness index or number of observed species (p = 0.05, p = 0.04, p = 0.35, and p = 0.11, respectively). Additionally, several species were significantly overrepresented in females compared to males, including those from the genera <span><span>Anaerococcus</span><span><em>, </em><span>Prevotella</span><em>,</em></span></span> and <em>Schaalia</em> (p = 0.03, 0.04, and 0.02, respectively). Urobiome diversity increased with age, driven mainly by males. Comparison of children with a history of 1, 2, or 3+ UTIs revealed that urobiome diversity significantly decreases in the group that experienced 3+ UTIs as measured by the Simpson, Shannon, and Pielou indices (p = 0.03, p = 0.05, p = 0.01). Several bacteria were also found to be reduced in abundance.</div></div><div><h3>Discussion</h3><div>In this study, we confirm that urobiome can be identified from catheter-collected urine specimens in infants as young as 3 months, providing further evidence that the pediatric bladder is not sterile. In addition to confirming variations in the urobiome related to sex, we identify age-related changes in children under 5 years of age, which conflicts with some prior research. We additionally identify associations with a history of UTIs.</div></div><div><h3>Conclusions</h3><div><span>Our study provides additional evidence that the pediatric urobiome exists. The bacteria in the bladder of children appear to be affected by early urologic events and warrants future research.</span><span><figure><span><img><ol><li><span><span>Download: <span>Download high-res image (576KB","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141306173","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}
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