Journal of Pediatric Urology最新文献_第5页

Predictors of follow-up of pediatric stone patients after surgical intervention 小儿结石患者手术治疗后随访的预测因素。

IF 2 3区医学 Q2 PEDIATRICS

Journal of Pediatric Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.jpurol.2024.09.003

Megan Stout , Alyssa Lombardo , Nora Thompson , Jason Benedict , Seth Alpert , Daniel DaJusta , Molly Fuchs , Rama Jayanthi , Daryl Mcleod , Christina B. Ching

Objective

We investigated if socioeconomic and demographic factors predict post-surgical follow-up in pediatric stone patients.

Materials and methods

All patients having kidney stone surgery at a single academic pediatric hospital over a 5 year period (2016–2020) were identified through the use of CPT® codes specific to ureteroscopy, shock wave lithotripsy, and percutaneous nephrolithotomy. Electronic charts were reviewed for patient demographics, stone characteristics, and characteristics of intervention. Unique patients with a scheduled post-operative follow-up office visit following a first time stone surgery were included in the patient cohort (Figure 1). Primary outcome was attendance of a scheduled provider visit within 6 months after surgery. Secondary outcomes included completion of scheduled post-operative imaging and 24-h urine study. Univariable analysis was performed.

Results

195 pediatric patients, a median age of 15.4 years (IQR: 11.34, 17.14) at surgery, were identified. The majority were non-Hispanic white (86.2%) and female (62.1%). Most had undergone ureteroscopy alone (85.6%). Of the 195 patients, 146 (74.9%) attended a post-operative office visit. Indicators of lower socioeconomic status, such as having public insurance and being from a single-parent home, were associated with not attending a scheduled follow-up visit (p < 0.01 and p = 0.02, respectively). Patients with a pre-operative urology clinic visit were more likely to follow-up with a clinic visit (p = 0.02), while those with a larger total stone burden treated were more likely to undergo ordered imaging (p < 0.01).

Discussion

We found that indicators of lower socioeconomic status, such as having public insurance status and being in a single-parent household, were associated with lower pediatric follow-up compliance after kidney stone surgery, while patients seen in the urology clinic preoperatively were more likely to attend follow-up.

Conclusion

Identifying factors that may predict non-compliance could be used to help at-risk patient populations.

摘要我们研究了社会经济和人口因素能否预测小儿结石患者的术后随访：通过使用输尿管镜检查、冲击波碎石和经皮肾镜取石术专用的 CPT® 编码，确定了一家学术性儿科医院在 5 年内（2016-2020 年）接受肾结石手术的所有患者。对电子病历进行了审查，以了解患者的人口统计学特征、结石特征和介入治疗特征。首次接受结石手术后按计划进行术后复诊的患者被纳入患者队列（图 1）。主要结果是术后 6 个月内是否按时就诊。次要结果包括完成预定的术后成像和 24 小时尿液检查。进行了单变量分析：共发现 195 名儿童患者，手术时的中位年龄为 15.4 岁（IQR：11.34, 17.14）。大多数患者为非西班牙裔白人（86.2%）和女性（62.1%）。大多数患者只接受了输尿管镜检查（85.6%）。在 195 名患者中，146 人（74.9%）接受了术后门诊。社会经济地位较低的指标，如拥有公共保险和来自单亲家庭，与未参加预定的随访有关（P 讨论）：我们发现，社会经济地位较低的指标，如拥有公共保险和来自单亲家庭，与肾结石手术后较低的儿科随访依从性有关，而术前在泌尿科门诊就诊的患者更有可能参加随访：结论：找出可预测不遵医嘱的因素可用于帮助高危患者群体。

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引用次数: 0

Response to commentary: “Experimental study of the effectiveness of warm ischemia and cold ischemia during testis-sparing surgery in rats” 对评论的回应："大鼠保睾手术中温缺血和冷缺血有效性的实验研究"。

IF 2 3区医学 Q2 PEDIATRICS

Journal of Pediatric Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.jpurol.2024.09.028

Emine Doğan, Ayşe Karaman

引用次数: 0

End-stage and chronic kidney disease in classic bladder exstrophy: A retrospective muti-institutional cohort study 典型膀胱外翻患者的终末期肾病和慢性肾病：一项跨机构队列回顾性研究。

IF 2 3区医学 Q2 PEDIATRICS

Journal of Pediatric Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.jpurol.2024.10.016

Joshua D. Roth , Diana Bowen , Molly E. Fuchs , Patricio C. Gargollo , Harrison Gottlich , David S. Hains , Andrew C. Strine , Konrad M. Szymanski

Introduction

While most children with classic bladder exstrophy (CBE) are born with normal kidneys, some experience renal deterioration in adulthood. Little is known about the incidence of end-stage and chronic kidney disease (ESKD and CKD, respectively) in this population. Our group has recently published on surgical outcomes in a multi-institutional cohort of 216 people with CBE. Our aim was to describe the incidence of ESKD and prevalence of CKD in this cohort of people with CBE.

Methods

We retrospectively reviewed records of patients with CBE followed at five tertiary care centers described previously. The primary outcome was incidence of ESKD, defined as permanent peritoneal/hemodialysis or renal transplantation. The secondary outcome was prevalence of CKD stage 3 or higher (CKD3+, estimated glomerular filtration rate [eGFR]<60 ml/min/1.73 m²) at the last appointment. Creatinine-based eGFRs were calculated using the CKD-EPI Creatinine Equation (adults) and the Schwartz formula (children). Survival analysis and Fisher's exact test were used.

Results

A total of 201 patients (93 % of the original cohort) had renal function data available (63 % male). Four patients who had a primary urinary diversion remained diverted at a median follow-up of 20.1 years. None developed ESKD and one developed CKD3+. The remaining 197 patients had a primary bladder closure. At a median follow-up of 18.8 years old, 12 were diverted, 108 were augmented and 77 were neither. Three patients developed ESKD (1.5 %) at a median age of 23.4 years (1 hemodialysis, 2 transplantation). On survival analysis, the risk of ESKD was 0 % at 10 years, 1 % at 20 years and 5 % at 30 years (Figure 1). This was higher than the risk of 0.003 % at 21 years of age in the general population (p < 0.001). The median age of 141 individuals with eGFR data was 21.6 years old (65 % male). No children, 4 % of adolescents and 8 % of adults had CKD3+ (p = 0.45). On exploratory analyses, prevalence of CKD3+ did not differ by center or birth year (p ≥ 0.99).

Conclusions

The risk of ESKD and CKD among patients with CBE is not insignificant and appears to be more common than the general population. The potential role of modifiable contributing factors, such as increased bladder outlet resistance, warrants further investigation. Reliable long-term follow up is needed in this population to monitor for ESKD and CKD.

导言：虽然大多数典型膀胱外翻（CBE）患儿出生时肾脏正常，但有些患儿成年后肾功能会恶化。人们对这一人群中终末期肾病和慢性肾病（分别为 ESKD 和 CKD）的发病率知之甚少。我们小组最近发表了一篇关于 216 名 CBE 患者的多机构队列手术结果的文章。我们的目的是描述这一 CBE 患者队列中 ESKD 的发病率和 CKD 的患病率：我们回顾性地查看了前述五个三级医疗中心的 CBE 患者的随访记录。主要结果是ESKD的发生率，ESKD的定义是永久性腹膜透析/血液透析或肾移植。次要结果是最后一次就诊时 CKD 3 期或更高（CKD3+，估计肾小球滤过率 [eGFR]2）的患病率。以肌酐为基础的 eGFR 采用 CKD-EPI 肌酐方程（成人）和 Schwartz 公式（儿童）计算。采用生存分析和费雪精确检验：共有 201 名患者（占原始队列的 93%）提供了肾功能数据（63% 为男性）。四名进行了原发性尿路改道的患者在中位随访 20.1 年后仍未改道。其中无一人发展为 ESKD，一人发展为 CKD3+。其余 197 名患者接受了原发性膀胱闭合术。在中位 18.8 年的随访中，12 名患者进行了膀胱改道，108 名患者进行了膀胱扩容，77 名患者既没有进行膀胱扩容也没有进行膀胱改道。3 名患者（1.5%）在中位 23.4 岁时出现 ESKD（1 例血液透析，2 例移植）。根据生存分析，10 年内发生 ESKD 的风险为 0%，20 年内为 1%，30 年内为 5%（图 1）。这高于普通人群 21 岁时的 0.003% 的风险（P 结论）：CBE 患者罹患 ESKD 和 CKD 的风险并非微不足道，而且似乎比普通人群更为常见。膀胱出口阻力增加等可改变的致病因素的潜在作用值得进一步研究。需要对这类人群进行可靠的长期随访，以监测 ESKD 和 CKD。

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引用次数: 0

Potential impact of severe hydronephrosis secondary to ureteropelvic junction obstruction on pediatric blood pressure 输尿管盆腔交界处梗阻导致的严重肾积水对小儿血压的潜在影响。

IF 2 3区医学 Q2 PEDIATRICS

Journal of Pediatric Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.jpurol.2024.10.014

Qingqing Tian, Chu Zhang, Xiang Zhao, Kechi Yu, Erhu Fang, Xuefeng Zhou, Yonghua Niu, Ning Li

Background

Hydronephrosis could affect blood pressure (BP) according to published case reports and animal experiments. The impact on pediatric BP is often overlooked due to children's inherently lower BP, superior vascular elasticity and greater resistance to hypertension than adults.

Objective

This study aimed to prospectively observe the effects of hydronephrosis, secondary to ureteropelvic junction obstruction (UPJO), on pediatric BP.

Methods

Children with hydronephrosis secondary to UPJO who required pyeloplasty were categorized into five age groups: neonates, infants, toddlers, preschoolers, and school-aged children. Preoperative and postoperative systolic blood pressure (SBP), diastolic blood pressure (DBP), active renin concentration (ARC), and aldosterone concentration (AC) were compared among these age groups, followed by comparison with a control group of children without nephritis or cardiovascular conditions. The impact of severe hydronephrosis secondary to UPJO on pediatric BP and its association with the renin-angiotensin-aldosterone system (RAAS) were examined.

Results

This study enrolled 114 children with severe hydronephrosis secondary to UPJO and 153 without nephritic or cardiovascular conditions between September 2021 and June 2023. As the control group aged, SBP and DBP increased, whereas ARC and AC decreased. Overall, hydronephrosis group had higher SBP, DBP, ARC, and AC than the controls group. These differences differed between the age groups. After pyeloplasty, the postoperative BP of hydronephrosis group approximated that of the control group. Postoperative ARC levels were higher than those in the control group but were much lower than the preoperative levels. AC did not decrease significantly after surgery. The change in DBP in children with hydronephrosis before and after pyeloplasty showed a positive correlation with the change in AC.

Conclusions

Pediatric patients with severe hydronephrosis, a condition secondary to UPJO, displayed elevated BP, ARC, and AC. Following pyeloplasty, these patients noted a reduction in BP. The correlation between elevated blood pressure and the RAAS necessitates further comprehensive investigation.

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Summary figure.

背景：根据已发表的病例报告和动物实验，肾积水可能会影响血压（BP）。由于儿童本身血压较低，血管弹性较好，对高血压的抵抗力强于成人，因此对儿童血压的影响常常被忽视：本研究旨在前瞻性地观察继发于输尿管肾盂连接处梗阻（UPJO）的肾积水对小儿血压的影响：方法：将需要进行肾盂成形术的UPJO继发性肾积水患儿分为五个年龄组：新生儿、婴儿、幼儿、学龄前儿童和学龄儿童。对这些年龄组的术前和术后收缩压（SBP）、舒张压（DBP）、活性肾素浓度（ARC）和醛固酮浓度（AC）进行比较，然后与没有肾炎或心血管疾病的对照组儿童进行比较。研究还探讨了继发于 UPJO 的严重肾积水对小儿血压的影响及其与肾素-血管紧张素-醛固酮系统（RAAS）的关系：这项研究在 2021 年 9 月至 2023 年 6 月期间招募了 114 名继发于 UPJO 的严重肾积水儿童和 153 名无肾炎或心血管疾病的儿童。随着对照组年龄的增长，SBP 和 DBP 上升，而 ARC 和 AC 下降。总体而言，肾积水组的 SBP、DBP、ARC 和 AC 均高于对照组。这些差异在不同年龄组之间存在差异。肾盂成形术后，肾积水组的术后血压接近对照组。术后 ARC 水平高于对照组，但远低于术前水平。术后 AC 没有明显下降。肾盂成形术前后肾积水患儿的 DBP 变化与 AC 变化呈正相关：结论：继发于 UPJO 的严重肾积水儿童患者的血压、ARC 和 AC 均升高。肾盂成形术后，这些患者的血压有所下降。血压升高与 RAAS 之间的相关性需要进一步全面研究。

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引用次数: 0

Commentary on: “Onabotulinum toxin A injections: A novel option for management of refractory nocturnal enuresis” by Tyler Overholt, Davis Temple, Adam Cohen, Anthony Atala, Marc Colaco, Steve Hodges 评论"奥诺布林毒素 A 注射：Tyler Overholt、Davis Temple、Adam Cohen、Anthony Atala、Marc Colaco、Steve Hodges 撰写的 "治疗难治性夜间遗尿症的新选择"。

IF 2 3区医学 Q2 PEDIATRICS

Journal of Pediatric Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.jpurol.2024.09.038

Valeska Bidault-Jourdainne

引用次数: 0

Stratification of Wilms tumor patients using physicochemical properties of the adaptive immune receptor polypeptides, IGL and TRG 利用适应性免疫受体多肽 IGL 和 TRG 的理化特性对 Wilms 肿瘤患者进行分层。

IF 2 3区医学 Q2 PEDIATRICS

Journal of Pediatric Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.jpurol.2024.10.012

David P. Adams , Etienne C. Gozlan , Nikhila Medikonda , Joanna J. Song , Arpan Sahoo , Michelle Yeagley , George Blanck

Introduction

Wilms tumor (WT) is the most common pediatric renal malignancy. Current guidelines that stratify WT risk and determine treatment courses are inadequate, as over 60 % of WT survivors develop treatment-related complications. Recently, numerous advances in establishing patient sub-groups with different clinical features have been realized by evaluating the adaptive immune receptor (IR) complementarity determining region-3 (CDR3) amino acid (AA) sequences, a reasonable series of successes, given the prominent role of the CDR3 in antigen binding, including tumor antigen binding. However, the possibility that adaptive IR chemical variability correlates with distinct survival outcomes for WT has not yet been explored.

Objective

The goal of this study was to isolate the T-cell receptor and B-cell receptor recombination, sequencing reads from WT RNAseq files, representing the actual tumor tissue, translate the sequences to AAs, identify the adaptive IR CDR3 domains, and determine whether the physicochemical properties of those CDR3 AA sequences correlated with survival probability distinctions.

Study design

WT RNA-seq files were mined to obtain the CDR3 AAs for various adaptive IRs. The physicochemical properties of these CDR3s were examined for trends in how those properties correlated with survival probabilities for WT patients, using a Kaplan–Meier analyses, verified via several approaches.

Results

The above processes indicated the association of the (a) IGL CDR3s′ instability index and the (b) TRG CDR3s’ fraction disorder promoting features with better outcomes. Additionally, the IGL CDR3 data were assessed using the Predictor of Natural Disordered Regions web tool, which strengthened the evidence for the association with the IGL CDR3 instability index with a better outcome.

Discussion

The approaches described here indicate that greater adaptive IR CDR3 instability and flexibility may serve as prognostic indicators; and may indicate the flexibility of CDR3 domains provides for greater opportunity to bind tumor antigens.

Conclusion

Further exploration and development of these approaches and findings may lead to new guidelines for more precise treatment regimens, or even watchful waiting periods, that could thereby decrease the lifetime occurrence of adverse events.

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Summary figure.

简介Wilms瘤（WT）是最常见的儿科肾脏恶性肿瘤。由于超过 60% 的 Wilms 肿瘤幸存者会出现与治疗相关的并发症，因此目前用于 WT 风险分层和确定治疗方案的指南并不完善。最近，通过评估适应性免疫受体（IR）互补决定区-3（CDR3）氨基酸（AA）序列，在建立具有不同临床特征的患者亚组方面取得了许多进展，鉴于CDR3在抗原结合（包括肿瘤抗原结合）中的突出作用，这是一系列合理的成功。然而，适应性红外化学变异与 WT 不同生存结果相关的可能性尚未得到探讨：本研究的目的是从代表实际肿瘤组织的 WT RNAseq 文件中分离出 T 细胞受体和 B 细胞受体重组测序读数，将这些序列转化为 AA，识别适应性 IR CDR3 结构域，并确定这些 CDR3 AA 序列的理化性质是否与生存概率差异相关：研究设计：挖掘WT RNA-seq文件以获得各种适应性IR的CDR3 AAs。研究设计：挖掘 WT RNA-seq 文件，获得各种适应性 IRs 的 CDR3 AAs。采用 Kaplan-Meier 分析法研究这些 CDR3 的理化性质与 WT 患者生存概率的相关趋势，并通过多种方法进行验证：上述过程表明，(a) IGL CDR3s 的不稳定性指数和(b) TRG CDR3s 的部分紊乱促进特征与更好的预后有关。此外，IGL CDR3 数据使用自然紊乱区域预测网络工具进行了评估，这加强了 IGL CDR3 不稳定指数与更好结果相关性的证据：讨论：本文描述的方法表明，适应性更强的IR CDR3不稳定性和灵活性可作为预后指标；并可能表明CDR3结构域的灵活性为结合肿瘤抗原提供了更多机会：对这些方法和发现的进一步探索和发展可能会为更精确的治疗方案甚至观察等待期提供新的指导，从而减少不良事件的终生发生。

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引用次数: 0

Endoscopic balloon dilatation of primary obstructive megaureter: An effective first line management in children 原发性梗阻性巨输尿管的内窥镜球囊扩张术：有效的儿童一线治疗方法

IF 2 3区医学 Q2 PEDIATRICS

Journal of Pediatric Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.jpurol.2024.09.007

Olugbenga Awolaran , Ijeoma Nwachukwu , Anu Paul , Massimo Garriboli , Arash Taghizadeh , Sara Lobo , Karim Awad , Kate Burns , Mohamed Shalaby , Mark Woodward , Pankaj Mishra

<div><h3>Aim</h3><div>This study evaluates outcomes of endoscopic balloon dilatation (EBD) in the management of primary obstructive megaureter (POM) in children.</div></div><div><h3>Methods</h3><div>Retrospective data between 2013 and 2023 from two tertiary paediatric surgical centres in the UK were reviewed. Pre and post-operative clinical and imaging parameters of children managed with EBD were assessed. Failure of procedure was defined as requiring further intervention due to persistent/recurrent symptoms, upper tract dilatation and/or obstruction on MAG3 over the follow up period.</div></div><div><h3>Results</h3><div>55 children with 61 renal units were evaluated. Median age at treatment was 18 months with a median follow up of 24 months. There was significant reduction in upper tract ultrasound measurements following balloon dilatation but there was no significant difference between the pre and post-operative renal function on MAG3. No significance difference was demonstrated when the outcomes of cutting and non-cutting balloons were compared. No significant difference was shown when outcomes after EBD were compared between infants vs older children as well as ureteric dilatation less than or over 25 mm (p = 0.841). 87% were successfully treated with a single dilatation and this increased to 95% after second dilatation. The remaining 5% had ureteric re-implantation.</div></div><div><h3>Discussion</h3><div>Although a retrospective study, the patient population is relatively large. 87% success rate shown after EBD is comparable to similar studies. It has been suggested that children less than 12months and those with severe ureteric dilatation (>25 mm) may not be suitable for EBD. No significant difference was demonstrated when the outcomes of these categories of children were compared to other children with POM. All of the patients that had repeat balloon dilatation required no further intervention, a finding that has so far not been well evaluated in available literature.</div></div><div><h3>Conclusions</h3><div>This study demonstrates 87% success rate after single EBD in children with POM and this outcome increased to 95% following a second dilatation. EBD is shown to be an effective definitive surgical management option of POM. It can be safely offered as first line management in all patient groups and repeated if no initial response.<span><div><span><span><p><span>Summary table</span>. </p></span></span><div><table><thead><tr><td><span>Empty Cell</span></td><th>P-value</th></tr></thead><tbody><tr><th>Outcomes based on age (median post-op APD)</th></tr><tr><td><ul><li><span></span><span><div>- <12months</div></span></li></ul></td><td>20 units (13 mm)</td><td>0.433</td></tr><tr><td><ul><li><span></span><span><div>- >/ = 12mo</div></span></li></ul></td><td>41 units (13 mm)</td></tr><tr><th>Outcomes based on severity of DUD diameter (median post-op DUD)</th></tr><tr><td><ul><li><span></span><span><div>- <25 mm</div></span></li></ul

目的：本研究评估了内镜下球囊扩张术（EBD）治疗儿童原发性梗阻性巨输尿管（POM）的效果：研究回顾了英国两家三级儿科外科中心 2013 年至 2023 年间的回顾性数据。对接受 EBD 治疗的儿童的术前和术后临床及影像学参数进行了评估。手术失败的定义是在随访期间由于持续/反复出现症状、上道扩张和/或MAG3阻塞而需要进一步干预：共对 55 名儿童的 61 个肾单位进行了评估。中位治疗年龄为 18 个月，中位随访时间为 24 个月。球囊扩张术后上尿路超声测量结果明显降低，但术前和术后 MAG3 肾功能无明显差异。在比较切割球囊和非切割球囊的疗效时，没有发现明显差异。当比较婴儿与年长儿童以及输尿管扩张小于或大于 25 毫米时，EBD 的结果无明显差异（P = 0.841）。87%的患者在一次扩张后就能成功治疗，而在第二次扩张后，这一比例上升到了95%。其余5%的患者进行了输尿管再植：讨论：虽然这是一项回顾性研究，但患者人数相对较多。EBD术后87%的成功率与类似研究相当。有人认为，12 个月以下的儿童和输尿管严重扩张（>25 毫米）的儿童可能不适合接受 EBD。与其他POM患儿相比，这两类患儿的治疗效果没有明显差异。所有重复球囊扩张的患者都无需进一步干预，而这一结果迄今为止尚未在现有文献中得到充分评估：这项研究表明，POM 儿童接受一次 EBD 后的成功率为 87%，而第二次扩张后的成功率提高到 95%。EBD被证明是一种有效的POM最终手术治疗方案。它可以作为一线治疗方案安全地应用于所有患者群体，如果没有初步反应，还可以重复使用。

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引用次数: 0

Experiences and preferences of women with CAH and parents about disclosure of childhood surgery 患有 CAH 的妇女和父母对披露儿童手术的经历和偏好。

IF 2 3区医学 Q2 PEDIATRICS

Journal of Pediatric Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.jpurol.2024.09.030

Ashley W. Johnston , Mimi S. Kim , Paul Kokorowski , Devon J. Hensel , Patrice M. Yasuda , Richard C. Rink , Konrad M. Szymanski , Life with Congenital Adrenal Hyperplasia

Introduction

Complete disclosure of childhood genital surgery to patients with congenital adrenal hyperplasia (CAH) is a critical part of CAH care. There are no guidelines or uniform recommendations on the timing and content of surgical disclosure discussions.

Objective

Our objective was to describe the experiences and preferences of females with CAH and parents of females with CAH who underwent childhood genital surgery regarding surgical disclosure.

Methods

We conducted an anonymous cross-sectional online survey of females with CAH (46XX, ≥16 years [y] old) and parents of females with CAH who underwent genital surgery before age 4y in North America. Participants reported experiences, preferences, and advice about initial (“first time you were told”) and complete disclosure (“told all details”). Non-parametric statistics and qualitative analysis were used.

Results

Participants included 59 females with CAH (median age: 37y, 92% White, 93% non-Hispanic) and 41 parents (median: 36y, 85% White, 93% non-Hispanic, daughter median: 26y). The 76% of females who received complete disclosure were younger (median age: 33y) and underwent surgery more recently (median decade: 1980s) than the 14% who received only initial disclosure (median: 47y, 1970s) and the 10% who did not receive any disclosure (median: 60y, 1960s, p = 0.0003, Summary Figure). Females reported median ages of initial and complete disclosure as 7-10y and 11-13y, respectively. Disclosure was preferred by 98% of females with initial disclosure by age 14y and complete disclosure by 18y. Parents reported similar findings. Most disclosures were by mothers (initial: 82%, complete: 64%). Doctors were more involved in complete vs. initial disclosures (complete: 47%, initial: 13%, p < 0.001). Qualitative analysis of advice about surgical disclosure revealed 8 themes.

Conclusions

Disclosure of childhood genital surgery to women with CAH has increased over time. Although timing of disclosure varied, women preferred disclosure, and that it be initiated before age 14y and completed by age 18y.

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Summary figure. Surgical disclosure of females with CAH

简介：向先天性肾上腺皮质增生症（CAH）患者完全公开儿童生殖器手术是 CAH 治疗的关键部分。关于手术公开讨论的时间和内容，目前尚无指南或统一建议：我们的目的是描述接受过儿童生殖器手术的 CAH 女性患者及其父母在手术公开方面的经验和偏好：我们对北美地区的 CAH 女性患者（46XX，年龄≥16 岁）和 4 岁前接受过生殖器手术的 CAH 女性患者的父母进行了匿名横断面在线调查。参与者报告了关于初次（"第一次被告知"）和完全公开（"告知所有细节"）的经历、偏好和建议。研究采用了非参数统计和定性分析方法：参与者包括 59 名患有 CAH 的女性（年龄中位数：37 岁，92% 为白人，93% 为非西班牙裔）和 41 名父母（年龄中位数：36 岁，85% 为白人，93% 为非西班牙裔，女儿年龄中位数：26 岁）。与 14% 只接受初次披露（中位数：47 岁，20 世纪 70 年代）和 10% 未接受任何披露（中位数：60 岁，20 世纪 60 年代，P = 0.0003，摘要图）的女性相比，76% 接受完全披露的女性年龄更小（中位数年龄：33 岁），接受手术的时间更短（中位数年代：20 世纪 80 年代）。女性报告的初次披露和完全披露的中位年龄分别为 7-10 岁和 11-13 岁。98% 的女性倾向于在 14 岁之前首次披露，在 18 岁之前完全披露。父母也有类似的发现。大多数披露者是母亲（初次披露：82%，完全披露：64%）。医生在完全披露和首次披露中的参与度更高（完全披露：47%，首次披露：13%，完全披露：14%，首次披露：18%）：47%，初次：13%，P 结论：随着时间的推移，向患有 CAH 的妇女披露儿童生殖器手术的情况越来越多。虽然披露的时间各不相同，但女性更倾向于在 14 岁之前开始披露，并在 18 岁之前完成披露。

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引用次数: 0

Research on hypospadias and appeal to tradition fallacy 尿道下裂研究与诉诸传统的谬误。

IF 2 3区医学 Q2 PEDIATRICS

Journal of Pediatric Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.jpurol.2024.09.034

Hüseyin Özbey

引用次数: 0

Outcomes of dorsal inlay graft urethroplasty 背侧嵌体移植尿道成形术的效果。

IF 2 3区医学 Q2 PEDIATRICS

Journal of Pediatric Urology

Pub Date : 2025-02-01 DOI: 10.1016/j.jpurol.2024.09.037

Ramazan Karabulut, Zafer Turkyilmaz, Ali Atan, Cem Kaya, Kaan Sonmez

引用次数: 0