Journal of Pediatric Urology最新文献

Background: Children with vesicoureteral reflux (VUR), particularly high-grade VUR, are known to be at increased risk for urinary tract infection (UTI). Current guidelines highlight certain clinical factors in the management of children with VUR; however, the clinical utility of upper tract dilation in the setting of VUR remains unclear.

Objective: The purpose of this study is to evaluate risk factors for febrile UTI (fUTI) in children with primary VUR in a modern cohort with emphasis on upper tract dilation parameters, including hydronephrosis and hydroureter.

Methods: A prospectively maintained database of children with VUR at a single academic institution from July 2013 to February 2023 was reviewed. Demographic and clinical data were included. Ultrasounds closest to initial VCUG were reviewed for upper tract dilation, including the presence of hydronephrosis, Society of Fetal Urology (SFU) hydronephrosis grade, presence of hydroureter, and anterior-posterior renal pelvic diameter (APRPD). The primary outcome of interest was the development of a fUTI after VUR diagnosis. Patients were censored after their first fUTI or after VUR surgery.

Results: A total of 235 children with primary VUR were evaluated, including 125 (53.2 %) females and 110 (46.8 %) males. The median age of VUR diagnosis was 10.8 months (IQR: 2.3-63.6 months). A total of 41 (17.4 %) children developed a fUTI after VUR diagnosis with a median follow up of 2.3 years (IQR: 0.9-4.6 years). On univariate analysis, variables found to be associated with fUTI included age <1 year at VUR diagnosis (p = 0.021), female sex (p = 0.013), high-grade VUR (p = 0.024), APRPD ≥7 mm (p = 0.007), high-grade hydronephrosis (p = 0.004), presence of hydronephrosis (p = 0.029), and hydroureter (p = 0.008). In children with VUR and high-grade hydronephrosis, a larger APRPD was associated with higher fUTI rates (p = 0.008). On multivariate analysis controlling for age, sex, and VUR grade, APRPD ≥7 mm (OR 2.8, p = 0.009), high-grade hydronephrosis (OR 2.5, p = 0.025), and presence of hydronephrosis (OR 2.3, p = 0.049) were independent risk factors for fUTI. On multivariate models controlling for other upper tract dilation parameters, APRPD ≥7 mm was the most significant parameter associated with increased fUTI risk in primary VUR.

Conclusion: Upper tract dilation is a novel, independent risk factor for fUTI in children with primary VUR, with APRPD being the strongest predictor. Clinicians may consider upper tract dilation parameters in addition to age, sex, and VUR grade when individualizing care in children with primary VUR.

Biofeedback has been shown to be an effective tool in the treatment of pelvic floor dysfunction in patients with bowel and bladder dysfunction, and commonly, biofeedback is provided within a physical therapy plan of care. In building a pelvic floor physical therapy program at our institution, we have found that physical therapy extends beyond biofeedback. Our preliminary experience demonstrates that patients experience more rapid symptomatic improvement when biofeedback is combined with additional therapy to address abnormal core and respiratory function.

Zinner syndrome is a rare congenital malformation of the urinary system that occurs exclusively in males. It consists of renal agenesis, ipsilateral obstruction of the ejaculatory duct, and cystic changes in the seminal vesicles. It is rarely described in the pediatric population due to the absence of symptoms, as well as the failure to recognize it due to masking by other morphological changes and conditions. Four patients from the pediatric population are presented. Two patients were asymptomatic, and the changes were detected incidentally or during other diagnostic procedures. The other two patients exhibited symptoms and signs such as testicular pain, abdominal pain, hematuria, and hematospermia, along with megaureter. Ultrasound serves as the initial diagnostic method, while confirmation of Zinner's syndrome is established by MR urography. In cases that ultrasound verified kidney agenesis and ipsilateral anechoic, avascular tubulocystic structures, it is necessary to perform follow-up MR urography to confirm or exclude Zinner's syndrome. Following diagnosis, asymptomatic pediatric patients should be monitored every 6 months to a year, using ultrasound, with particular attention to cyst size and content.

Introduction: Robot-assisted Laparoscopic Appendicovesicostomy (RALAPV) is increasingly performed as a minimally invasive alternative to the open appendicovesicostomy (OPAV), but questions remain regarding the efficacy of the RALAPV compared to OPAV.

Objective: To assess and compare outcomes for non-augmented RALAPV to the open surgical approach.

Materials and methods: An IRB approved prospective registry was retrospectively examined to abstract all patients who underwent APV without augment between 2012 and 2023. Baseline demographics, intra and post-operative characteristics, and long-term outcomes were aggregated and compared. P-values were two sided and a p-value <0.05 was considered statistically significant.

Results: 52 children were identified, 19 (36.5%) OAPV and 33 (63.5%) RALAPV. The median age at surgery was 8.5 years for OAPV and 9.3 years for RALAPV (p = 0.29). Longer operative time was noted in the RALPAV group (346 min vs 289 min, p = 0.04), with a lower estimated blood loss (5 cc vs 30 cc, p = 0.003), shorter median length of hospital stay (4 days vs 5 days, p = 0.07), and lower IV morphine administration (0.04 mg/kg/d vs 0.09 mg/kg/d, p = 0.01). Similar surgical reintervention rate was seen in both cohorts (42% OAPV vs 36% RALAPV, p = 0.77). At the end of follow-up, continence was achieved in 18 (95%) OAPV and 33 (100%) RALAPV patients (p = 0.37) CONCLUSIONS: RALAPV shows comparable success to patients who underwent OPAV procedures. The longer follow-up interval for OPAV highlights minimally invasive surgery as a recent adoption.

Introduction: The most common congenital genital abnormality of the urinary system in infants is hypospadias; its frequency is rising to 0.33 percent globally. Surgical reconstruction is the most effective treatment for hypospadias.Parents, as surrogate decision-makers for children, frequently experience decision-making conflicts when making decisions. Stress is neither a straightforward stimulus nor a simple response. However, a stressor (stimulus) caused by life events and influenced by numerous intermediate factors including personality, social support, and psychosomatic symptoms or diseases is a multi-factor process of stress response (response). The surgical decision conflict of parents of children with hypospadias is a type of stress response, and social support may have an effect on parents' hope, psychological resilience, and decision conflict, with hope and psychological resilience serving as mediators between social support and decision conflict.

Aim: To investigate the structural relationship between parental social support, hope, psychological resilience, and parents decision conflict in children with hypospadias.

Study design: A cross-sectional design was used to collect the data of 210 parents of children with hypospadias from Department of Urology, Shenzhen Children's Hospital from April 2022 to March 2023.

Results: Social support indirectly affects decision conflict through hope and psychological resilience, with a total indrect effect of -0.511 (P < 0.05).

Discussion: Decision conflicts and regret can be reduced if medical professionals provide adequate and clear information, decision assistance, and meet support requirements during the decision-making process. Improving the level of psychological resilience, hope, and social support among parents of children with hypospadias is a crucial strategy for reducing the level of decision conflict they experience. In the process of making surgical decisions for children with hypospadias, the more sufficient social support from relatives, friends, and medical staff can stimulate their hope, boost their belief in the success of surgery, and the greater their psychological resilience, the more effectively decision conflict can be reduced. Some potential limitations of this study should be considered. Firstly, this study was a cross-sectional survey design. It may have some limitations in providing causal relationships between selected variables. Second, the survey investigated only one hospital, which reduces the generalizability of the findings.

Conclusion: The data support the proposed model and confirm the structural relationship among the four study variables. This study provides new information on the mediating role of hope and psychological resilience between social support and decision-making conflict.