Journal of Pediatric Urology最新文献

Background: A varicocele is an abnormal dilation of the pampiniform plexus of veins in the scrotum that commonly affects postpubertal males. The condition has been associated with male infertility, testicular hypotrophy, and pain. However, the clinical experiences of adolescent patients and their families regarding the evaluation, surveillance, and management of varicoceles have not been previously examined.

Objective: This study explores the patient's and family's experiences of varicocele diagnosis and subsequent management to better understand the salient factors impacting decision-making and care.

Methods: We conducted semi-structured interviews with patients and their families between August 2022 and January 2023. A total of 39 participants (16 adolescent males and 23 parents) were recruited following varicocele diagnosis and treatment at an urban, tertiary care hospital in California. Purposive sampling was adopted for the recruitment of participants through medical record screening to identify eligibility. Utilizing a modified grounded theory approach through the use of constant comparison and memo writing, the analysis consisted of open coding, axial coding, and selective coding, resulting in the production of core concepts and categories.

Results: Results demonstrate that parents and adolescents can benefit from improved understanding and education about long-term expectations during the diagnosis and treatment of adolescent varicoceles. Qualitative analysis indicates: 1) parents and adolescents have common concerns regarding fertility; however, this is exacerbated by the complexity of medical decision-making being dependent on adolescent and parental understanding of the full scope of varicocele impacts and outcomes, and 2) the psychosocial impact of a varicocele on adolescent self-esteem and sexual function are significant drivers for seeking care, which often manifested through discussions on masculinity through notions of 'manhood' and future sexual performance.

Discussion: Discussions with patients and families largely focused on their concerns regarding fertility, sexual function, and aesthetics (impacting self-esteem); however, their primary concern was for the need for more accurate and comprehensive information, which includes the natural history of the condition and the full scope of treatment options. Future studies should examine the experiences of patients and families from diverse backgrounds and geographic locations to identify potential differences in experiences.

Conclusion: Findings identified the need for potential improvement in communication between pediatric urologists and families to alleviate anxiety and uncertainty among patients and families and empower them to make informed decisions about their care.

Background: The optimal treatment of vesicoureteral reflux is controversial. When patients need surgery, the gold standard is open vesicoureteral reimplantation. Despite the more frequent use of laparoscopy when managing vesicoureteral reflux, we have found scarce comparative studies comparing the open versus the laparoscopic Lich-Gregoir reimplantation.

Objective: The aim of this study is to compare the open Lich-Gregoir reimplantation technique versus the laparoscopic approach, in patients with primary vesicoureteral reflux in terms of complications and the procedure´s success, to document the benefits of minimal invasion.

Study design: This is a cross-sectional retrospective study of a single Institution, in which we collected the information of pediatric patients with primary vesicoureteral reflux from their clinical charts, in whom either an open or laparoscopic reimplantation following the Lich- Gregoir technique was performed, between January 1, 2013, and December 31, 2017. Patients with incomplete records were excluded. This was a non-probabilistic, consecutive case sample. The Chi-square test or Mann-Whitney´s U were used, as appropriate, to establish between-group differences.

Results: Sixty-eight patients were included, 27 in the open Lich-Gregoir group (OLG), and 41 in the laparoscopic Lich- Gregoir group (LLG). We found no statistical differences in operative times and mean hospital stay. Post-operative complications in the OLG versus the LLG group were similar. The open procedure was successful in 85.2 % and in 90.2 % laparoscopic cases, with no statistically significant difference between groups.

Discussion: We found no statistically significant differences between an open and a laparoscopic approach. The percentage of success was below the expected, this could be result of the large percentage of patients with high-grade reflux and the patients' complex anatomy in both groups. Our study is limited by the small number of patients and by its retrospective design.

Conclusions: The laparoscopic approach with the Lich-Gregoir technique yields similar results to the open technique. However, in this study, we were unable to demonstrate any additional benefits from the laparoscopic approach.

Background: Hemorrhagic cystitis (HC) is a serious complication following hematopoietic stem cell transplantation (HSCT) associated with significant morbidity and mortality. Early identification of at-risk patients and prompt diagnosis are crucial for effective management. This prospective cohort study evaluated the potential of uroflowmetry as a predictive tool for detecting HC in pediatric HSCT patients.

Methods: Thirty-one children who underwent allogeneic HSCT were enrolled. Uroflowmetry was performed on admission (Day 0), post-HSCT Day 1 and Day 15, and at HC onset. Uroflowmetric parameters, including maximum flow rate (Qmax), average flow rate (Qavg), voided volume (VV), and flow curve shape, were compared between HC and non-HC patients.

Results: The incidence of HC within 100 days post-HSCT was 58 %, with a mean onset time of 35 days. At baseline (Day 0), HC patients had significantly lower Qmax (12.5 vs. 17.8 mL/s), Qavg (6.8 vs. 9.5 mL/s), and VV (185 vs. 245 mL) compared to non-HC patients (all p < 0.05). Age-stratified analysis revealed the observation of these differences across all age groups. At HC onset, compared to Day 0, patients experienced a significant decrease in Qmax (8.7 vs. 12.5 mL/s) and Qavg (4.2 vs. 6.8 mL/s) (both p < 0.05). Flow curve analysis demonstrated a shift from bell-shaped to interrupted curves in HC patients over time.

Conclusions: Uroflowmetry can potentially predict and detect HC in pediatric HSCT patients. Lower baseline uroflowmetric parameters may identify patients at higher risk for HC, while a significant decrease in these parameters from baseline may indicate HC onset. Uroflowmetry is a simple, non-invasive tool that can be performed at home and monitored remotely, facilitating early detection and intervention for HC in this population.

Background: No studies have evaluated the day-to-day variations in urinary incontinence (UI) and fecal incontinence (FI) among adults with spina bifida (SB). We aimed to 1) describe variations in UI/FI over 30 days, 2) assess factors associated with anxiety about incontinence, and 3) correlate anxiety about incontinence and health-related quality of life (HRQOL) among adults with SB (exploratory).

Methods: Adults with SB participated in a larger 30-day smartphone-based ecological momentary assessment (EMA) study of well-being and incontinence. We analyzed baseline demographics, temporal variables (baseline UI/FI, incontinence, and anxiety on days prior), and incontinence episode-specific variables (number of daily episodes, incontinence interval, quantity). Urinary and fecal incontinence-related anxiety (UIA/FIA) was measured on a 5-point Likert scale ("How anxious were you because of urine/stool leaks today?"), HRQOL with QUALAS-A (scores range 0-100, 0 = lowest HRQOL). Mixed-effects, random intercept ordinal and linear regression was used.

Results: Eighty-nine adults participated at a median age of 33 years old (71 % female, 53 % shunted, 49 % community ambulators). Participants contributed 2578 total diary days: 61 % were associated with any incontinence (41 % UI only, 6 % FI only, 13 % both). Eighty-two (92 %) adults reported UI on a median of 16 days, but experiences varied: 6 % had a single episode, while 33 % had UI on 28-30 days (Summary Figure). Seventy adults (79 %) reported FI on a median of 5 days, less frequently than UI (p < 0.001), but experiences varied: 11 % had a single FI episode, while 31 % had FI on 10 or more days. Fewer participants reported any UIA than FIA (50 % vs. 72 %, respectively, p < 0.001). On multivariate regression, (1) higher UIA was reported by individuals with higher baseline UIA, higher UIA on days prior, multiple daily episodes and higher UI quantity (p ≤ 0.02), while (2) higher FIA was reported by those with lower baseline HRQOL, fewer FI episodes on days prior, higher FIA on days prior, and higher UI quantity (p ≤ 0.02). FIA was correlated with lower end-of-study HRQOL (p = 0.03).

Discussion: Instances of incontinence are not uniform experiences. Their effects vary with factors beyond the actual episode. This suggests novel potential points of intervention to improving long-term HRQOL among people with incontinence.

Conclusion: Day-to-day experiences of UI and FI vary among adults with SB across multiple dimensions. Anxiety about incontinence when it occurs varies not only based on individual- and episode-specific characteristics, but also on incontinence in the preceding days. Operationalizing these insights into potential clinical interventions warrants further investigation.

Background: Exstrophy-epispadias complex (EEC) classically presents as bladder exstrophy (BE) and requires lifetime urologic care. As men and women with BE age, there is an often difficult period of transition to adulthood in terms of addressing urologic and general health challenges. BE can lead to many urinary and sexual health issues as these patients age, which is often made more complex given their past surgical history and anatomy.

Objective: Given the relative paucity of research involving adult BE patients, we aim to provide a review of evidence-based best practice management for these patients to guide treating urologists and identify gaps in knowledge.

Methodology: All recommendations are based on peer-reviewed research from trusted academic search engines to the degree that relevant research is available. Where evidence is scant, we rely on expert opinion and comparisons with other congenital urologic conditions where relevant. We also offer common clinical situations that arise as men and women with BE and other conditions age into adulthood to better understand the management of this complex population.

Conclusions: As patients with BE age, they experience a unique set of sexual, urinary, and general health challenges. Like other congenital urological conditions, long term care involving multidisciplinary teams at centers of excellence with a system for transition from pediatric to adult urology can lead to improved outcomes. Further research is needed regarding health outcomes in adults with BE as well as barriers limiting healthcare utilization.