Journal of Pediatric Urology最新文献

Background: Ureteropelvic junction obstruction (UPJO) is an anatomical lesion in the renal collecting system and is one of the most common congenital causes of hydronephrosis, occurring in 1-5 % of pregnancies. Surgical predictive scores have been extensively studied as a promising way to assist and optimize management in cases of UPJO.

Objective: Apply the pyeloplasty predictive score and evaluate its effectiveness in patients with UPJO treated at a tertiary care hospital.

Study design: The Pyeloplasty Prediction Score (PPS) was retrospectively applied to patients diagnosed with UPJO and treated at a tertiary care hospital. The PPS is based on the Society for Fetal Urology grading system, the anteroposterior diameter of the pelvis, and the absolute percentage of the difference in renal length. The PPS ranges from 0 to 12 and is calculated by adding each of the scored variables, classifying surgical risk as low, intermediate, and high.

Results: Out of the 48 kidney units studied, 18 did not undergo surgical treatment, and 30 underwent pyeloplasty. The number of units with low, intermediate, and high non-surgical PPS was 8, 8, and 2, respectively, and surgical PPS was 1, 8, and 21. The sensitivity of the PPS was 96.67 %, and the specificity was 44.44 %. The positive predictive value was 74.36 %, and the negative predictive value was 88.89 %.

Discussion: The majority of surgical kidney units had a high score. The only patient operated on with low risk had associated vesicoureteral reflux in the same unit. Half of the non-surgical patients had a low score. The two high-risk non-surgical cases had megacalicosis as the final diagnosis.

Conclusion: PPS may aid the clinical practice of UPJO due to its high sensitivity in high and low scores, necessitating an individualized clinical and radiological assessment in intermediate-risk cases.

Introduction: This study aimed to investigate the role of advanced ultrasonographic techniques-Shear Wave Elastography (SWE) and Superb Microvascular Imaging (SMI)-in evaluating testicular parenchymal damage following surgical detorsion in patients with testicular torsion. Additionally, the study assessed the potential contribution of these modalities to clinical decision-making.

Materials and methods: Seventeen patients who underwent surgical detorsion without orchiectomy for testicular torsion between January 2015 and January 2025 were included in the study. In each case, both the detorsed and contralateral testes were evaluated. Testicular volume, SMI score, and SWE values were measured using a standardized ultrasonography protocol. Between-group comparisons were performed using the Mann-Whitney U test, and correlations between continuous variables were analyzed using Spearman's rank correlation coefficient.

Results: The mean age of the patients included in the study was 13.8 ± 3.6 years. In the majority of cases (76.5 %), the duration of torsion was less than 24 h. There were no statistically significant differences between detorsed and contralateral testes in terms of testicular volume, SWE values, or SMI scores (p > 0.05). However, in the detorsed group, testicular volume showed a strong negative correlation with SWE values (r = -0.6965, p = 0.002) and a positive correlation with SMI scores (r = 0.668, p = 0.003) (Tble 1).

Conclusion: These findings suggest that volume measurements alone may be insufficient to accurately reflect testicular function. Functional ultrasonographic modalities such as SWE and SMI may offer substantial benefits in the postoperative monitoring of detorsed testes and in predicting long-term outcomes. These advanced imaging techniques may also facilitate more objective decision-making regarding testicular preservation versus orchiectomy.

Introduction: The use of artificial intelligence (AI) applications is expanding rapidly. Here, we report an annual update of the AI-PEDURO (Artifical Intelligence in PEDiatric UROlogy) online repository (www.aipeduro.com), which reviews new AI models in pediatric urology, highlights emerging trends, and updates the living scoping review.

Material and methods: AI-PEDURO curates a living scoping review and online repository of models applied to pediatric urology. In this PRISMA-ScR concordant review, we searched MEDLINE, EMBASE, Scopus, and CINAHL from June 2024 to July 2025 for the 1-year update of AI-PEDURO. We synthesized eligible studies by study and model characteristics. Each study was appraised with the APPRAISE-AI tool, correlations between study quality and publication year were assessed, and all models were added to the continuously updated AI-PEDURO online repository.

Results: Within the update period, 22 new studies were identified and added to the repository, bringing the total to 81. Hydronephrosis and pyeloplasty remained the most common topics, followed by vesicoureteral reflux and urinary tract infection. APPRAISE-AI assessment showed study quality was generally low to moderate. Based on the appraisal, model strengths were in clinical relevance and reporting quality, while weaknesses were methodological rigor, reproducibility, and error analysis.

Conclusions: Models continue to be applied to a wide range of clinical topics and are of generally moderate quality. While AI models have yet to make the transition into widespread clinical application in pediatric urology, there is significant promise from these pre-clinical models.

Purpose: To evaluate the role of manual detorsion (MD) in gonadal salvage and determining non-emergency surgery in testicular torsion (TT).

Methods: We retrospectively analysed paediatric patients treated for TT over 10 years at a tertiary centre. MD was attempted based on surgeon preference. Successful MD was defined by complete pain resolution, and normal colour Doppler ultrasound showing no spermatic cord torsion and normal perfusion. All patients underwent surgical exploration. Data analysed included age, referral status, pain duration, MD attempt and result, time to surgery, surgical findings, and outcomes. A comparative analysis between data from previous a published series (2014-2018) and after previous published series (2019-2023) was executed.

Results: Two hundred and seventy-six patients were included. Sixty percent were referred from other centres (165/276). MD was attempted in 57 % (156/276), resulting in significantly less gonadal loss (9 % vs 46 %, p < 0.05). MD was successful in 44 % (68/156) of attempts; all underwent non-emergency bilateral orchiopexy; one patient developed new TT during the waiting period, successfully treated with MD; at surgery, three (3/68, 4 %) cases had partial non-ischemic cord torsion and none suffered testicular loss. After unsuccessful MD, residual cord torsion was 33 % (29/88). After median follow-up of 8 months, gonadal loss (14/156, 9 %) occurred after unsuccessful MD; no losses occurred following successful MD. Successful MD correlated with significantly improved gonadal salvage (p < 0.05). There was no gonadal loss after non-emergency surgery.

Conclusion: Our data shows that attempting MD results in increased testicular salvage rates, and that a successful manoeuvre may safely enable non-emergency orchiopexy.

Introduction: Timely diagnosis and management of acute testicular torsion (ATT) is a benchmark for quality of care. We sought to evaluate whether patient sociodemographic factors and transfer status had an impact on hospital throughput and orchiectomy in ATT patients.

Methods: From 1/1/2022 to 9/9/2023, patients were identified by CPT code for operations to treat ATT and confirmed by chart review. Patient demographics were noted, and socioeconomic status (SES) was estimated using a distress score produced via the Distressed Communities Index (DCI), a multidimensional measure of social context. We denoted patients who were transferred to our urban tertiary care children's hospital and tracked emergency department (ED) registration time, time of arrival in the operating room (OR), and whether a repeat scrotal ultrasound (SUS) was performed for transfer patients. Based on a quality improvement measurement framework, the time between ED and OR (i.e., hospital throughput) served as our process measure, and orchiectomy rate was our outcome measure.

Results: 100 patients were diagnosed with ATT at a median age of 14 years (IQR 12-15). Median time from ED to OR was 110 min (IQR 79-144). Sixty-one patients were transferred to our institution, and this cohort reflected a higher proportion of White, non-Hispanic patients (p = 0.04) with a lower median distress score (14.4 vs 36.8, p = 0.03). Obtaining a repeat SUS in 25 transfer patients (41 %) prolonged the time to OR by a median of 20 min (p < 0.01). Regardless of repeat SUS, transfer patients had faster hospital throughput than those patients who presented primarily to our institution (p < 0.01). Overall, the orchiectomy rate was 18 %, and this outcome was associated with younger patient age (p < 0.01) and longer reported duration of symptoms (p < 0.01).

Discussion: Transfer patients had a higher SES and experienced faster hospital throughput than patients presenting primarily to our institution. Repeating SUS in transfer patients added modestly to the time to OR but did not impact the likelihood of orchiectomy. In fact, neither transfer status nor sociodemographic factors, other than patient age, were associated with orchiectomy. Further research is needed to identify factors that affect testicular viability and what efforts might improve surgical outcomes.

Conclusions: Patients with ATT transferred to our institution after presenting to a local hospital experienced prompt management with quicker time from ED to OR, though this did not impact their surgical outcome. Only younger patient age and longer reported duration of symptoms increased the likelihood of orchiectomy.