Journal of Pediatric Urology最新文献

Introduction: Periodic follow-up prior to and after puberty to evaluate for long-term sequalae following hypospadias repair is commonly recommended. Few studies have evaluated this follow-up, especially into adulthood. This study aimed to evaluate adherence to routine postoperative follow-up appointments over 10 years following elective hypospadias repair.

Material and methods: Retrospective review of all patients undergoing hypospadias repair at our institution under the age of 10 from January-December 2012 was performed. Data were extracted including demographics, meatal location, type of hypospadias and chordee repair, use of postoperative stent, adherence to follow-up, re-operations, and postoperative concerns. Primary outcome was adherence to long-term follow-up. Secondary outcomes included re-operative rates and complications.

Results: A total of 213 patients underwent hypospadias repair in 2012 with 52 (24 %) having a distal repair without urethral stent, 112 (53 %) distal repair with urethral stent, 29 (14 %) midshaft repair with urethral stent, and 20 (9 %) proximal repair with urethral stent. Almost all patients followed up for stent removal at our clinic (88 %), and the remaining with a local provider. Overall, 64 % of patients presented for their postoperative check within 3 months which was consistent between groups (p = 0.300). Only 12 % (25/213) of patients followed up after toilet training with the proximal group having the highest rate at 40 % (8/20, p = 0.003). In those following up after toilet training, 36 % (9/25) of patients followed up due to clinical symptoms attributed to their hypospadias repair or another unrelated urologic issue; the vast majority (87.5 %) of those with proximal hypospadias did so without any urologic issues. 15 % (31/213) of patients never followed up. Five (2.7 %) patients underwent secondary procedures related to their initial hypospadias surgery.

Discussion: We noted poor rates of follow-up at our institution for boys undergoing hypospadias repair. Short-term follow-up was uniformly poor. After toilet training, boys with proximal hypospadias were more likely to follow-up. This study is limited in being a retrospective, single center study and that some urologic follow-up may not have been captured outside of our tertiary referral center.

Conclusions: Despite our recommendations, patient adherence to follow-up after hypospadias repair is poor. More research and attention are needed to optimize and better understand poor adherence to long-term follow-up. Follow-up is essential to assess true rates of long-term complications, and to help develop specific education regarding consequences of unrecognized surgical complications, especially in more complex cases. Sharing such information may ensure parents understand the need for routine and regular evaluation.

Objective: Posterior urethral valves (PUV) leads to early chronic kidney disease (CKD) and renal failure in some children, while others may maintain preserved kidney function even into adulthood. Our goal was to assess the association between early imaging features and CKD progression in children with PUVs. We hypothesized that imaging features identified on PRUS and VCUG would be associated with CKD progression and could` be used in conjunction with nadir creatinine to predict future renal function.

Methods: Following individual institutional research board approvals, we performed a retrospective cohort study at two institutions. Electronic medical records were queried to identify all patients with a history of PUVs treated between 1990 and 2022. Children who presented in the first year of life and had their initial renal bladder ultrasound (RBUS) and voiding cystourethrogram (VCUG) performed within the first 90 days of life were included. The primary outcome, CKD progression, was defined as development of ESKD requiring dialysis or renal transplant or a decline in eGFR of greater than 50 %. Clinical variables of interest included: findings on initial RBUS (urinoma, cystic dysplasia, solitary kidney), vesicoureteral reflux on initial postnatal VCUG (degree and laterality), and nadir creatinine. Hazard ratios (HRs) were calculated from Cox proportional hazards regression for univariate and multivariable regression.

Results: Out of 537 patients with PUVs, 274 met our inclusion criteria. Median follow up was 5.84 years (IQR 2-10.2), and 55 patients (20 %) reached our primary outcome. Multivariable analysis showed the presence of any degree of vesicoureteral reflux, HR 3.1 (95 % CI 1.62-5.93), and nadir creatinine, HR 5.53 (95 % CI 4-7.64), were predictive of CKD progression When nadir creatinine within the first year of life is used as a sole predictor of CKD progression, the area under the receiver-operator curve was 0.89 (95 % CI 0.83-0.91).

Conclusions: This study confirms nadir creatinine as a strong predictor for CKD progression and ESKD in patients with PUVs. In our cohort, the presence of any degree or laterality of vesicoureteral reflux, was also a significant predictor for CKD progression.

Introduction: Urethral strictures following endoscopic management of Posterior Urethral Valves (PUV) varies from 0 % to 25 % and occurs due to iatrogenic injury of the urethra.

Objectives: To assess the outcomes of children undergoing urethral reconstruction following an iatrogenic injury during endoscopic management of PUV.

Methods: A retrospective review of a prospectively maintained database from 2015 to 2023 was undertaken of children who were referred following an iatrogenic injury to the urethra from prior endoscopic management of PUV.

Results: Seven boys with a history of PUV were referred following an iatrogenic bulbar urethral injury. All presented by age 2 and all had multiple attempted dilatations performed in external institutions. Two patients had also undergone an anastomotic urethroplasty with subsequent failure and recurrence of the stricture in the bulbar urethra, to a near obliterative state. The 5 patients who had no prior attempted urethroplasty, underwent a dorsal onlay. The 2 patients who had an attempted anastomotic urethroplasty with subsequent failure, both presented with bulbar necrosis. A pedicled preputial flap was used for both patients for reconstruction.

Conclusion: Iatrogenic injury of the urethra can occur during endoscopic ablation of PUV. Urethroplasty is successful and best performed with a preputial skin graft if available.

Background: Historically, word of mouth, total citation count, H-index, and expert opinion were some of the primary metrics used to identify the most influential papers. This method is subject to significant bias. The disruption score was initially created with the intent of measuring the degree to which a publication introduces a new idea, is repeatedly referenced and may be used as an additional publication evaluation metric.

Objective: To use disruptive score, a novel bibliometric index to identify influential papers in pediatric urology.

Methods: A customized search was executed using PubMed to identify papers from NEJM, JAMA, European Urology, Journal of Urology, Urology, Journal of Pediatric Urology, and Journal of Pediatric Surgery between 1954 to 2022 to identify pediatric urology related publications. Once accrued, all papers collected were run through a validated data set to identify a disruption score, where the 50 most disruptive papers were identified. The disruption score ranged from 1 to -1, with a positive score representing papers that are disruptive (challenge current knowledge), whereas a negative score represents developmental papers (help support previous publications). The 50 most disruptive papers were then cross referenced with the NIH iCite tool to identify how many times the article was cited and then the most disruptive articles and the most cited articles were compared.

Results: In total, 12,085 articles were identified and included. The database for analysis of disruption score included articles published from 1954 to 2014, leaving a total of 6544 of the papers for which a disruption score was calculated. Most of the articles identified were published in the Journal of Urology (n = 32) and Journal of Pediatric Surgery (n = 15). Fourteen of the top 50 papers were published prior to 1980 and 7 after 2000. Of the 35 total articles with iCite data available, only 8 articles had greater than 100 total citations.

Discussion: Many of the most disruptive articles identified did not have a large number of citations, highlighting the need to look beyond citation counts when assessing article importance. While this method was able to highlight some lesser-known articles, it does not appear that these citations are all highly impactful, which may be due to the relative youth of the field.

Conclusion: Disruption score provides a new way to assess the impact of publications within the field of pediatric urology. While novel, we feel this metric should be used with caution in pediatric urology at this time.

Introduction: Posterior urethral valves may lead to persistent hydronephrosis (HN) and bladder dysfunction despite successful endoscopic valve ablation (EVA).

Objectives: To evaluate the effect of overnight bladder drainage (OBD) on upper urinary tracts and bladders of boys post EVA.

Materials and methods: Boys who had persistent HN after EVA were included. Patients were randomly allocated into OBD or no OBD groups. Timed voiding, anticholinergics and antibiotic prophylaxis were offered for both groups. After 12 months, patients were evaluated for compliance to OBD, daytime continence, febrile urinary tract infections (UTIs), renal function by serum creatinine and ^99mTc-dimercaptosuccinic acid scan, HN, vesicoureteral reflux (VUR) and bladder morphology assessed by ultrasound and voiding cystourethrogram.

Results: Ninety-nine patients; 47 underwent OBD while 52 had no OBD, completed 12 months of follow-up. Compliance to OBD was reported in 87.04 %. OBD group showed significant improvement in daytime continence, HN, VUR, bladder capacity and outline. However, febrile UTIs, renal function affection, bladder wall thickness and post-void urine residual were comparable between both groups.

Conclusions: OBD might improve daytime continence, HN, VUR and abnormal bladder morphology that persist after EVA with no subsequent febrile UTIs or renal function affection. Yet, compliance to OBD remains a matter of concern.