Pub Date : 2026-04-01Epub Date: 2025-12-23DOI: 10.1016/j.jpurol.2025.105703
Sriman Bidhan Baray , Saidanvar Agzamkhodjaev , Mansour Ali , Muhammad E.H. Chowdhury , Tariq O. Abbas
Background
Penile curvature (PC) may occur in up to 10 % of male births worldwide and is typically associated with the birth defect hypospadias. While the extent of PC impacts surgical management and patient outcomes, curvature evaluation is inconsistent between surgeons due to a lack of reliable assessment techniques. Our goal was to create a dependable, automated deep-learning solution to precisely assess PC from real-time intraoperative 2D images.
Materials and methods
A dataset of 421 images was assembled and annotated by four human experts. Annotations were used to calculate PC angles and determine ground truth curvature degrees in each case. All images and ground truth angle information were used to train 3 different deep-learning models. A YOLOv8 model was trained to localize and crop the penile region, then a deep-learning model was employed to segment the shafts and generate binary mask images. In the final stage, a modified HRNet model was used to integrate angle error, predict four key points denoting mid-axes of the proximal and distal shaft, and then use these landmarks to calculate curvature automatically.
Results
The proposed system demonstrated a high level of reliability in localizing penile areas, as evidenced by a mean average precision score of 99.4 %. Furthermore, our pipeline exhibited strong performance in the segmentation task, achieving an impressive Intersection over the Union metric of 83.56 % and a Dice Similarity Coefficient of 91.02 %. In terms of angle prediction, the system achieved a mean absolute error of 7.9°. By comparison, variability among human raters ranged between 6.5 and 12.0° (median ≈ 8.9°), consistent with previously reported manual errors of 3.5–13.6°. Thus, the AI system matched or outperformed human raters, providing more consistent and reliable curvature estimation. The model achieved a median error of 7.8° across 421 images, with 82 % of predictions within ±10° of ground truth. Only 6 % of cases crossed the 30° surgical threshold, confirming the tool's reliability for clinical decision-making.
Discussion
This study demonstrates the successful implementation of deep learning and keypoint-based measurement of PC that could significantly improve patient assessment by surgeons and hypospadiology researchers.
{"title":"Implementation of deep learning for measurement of penile curvature on real 2D intraoperative images","authors":"Sriman Bidhan Baray , Saidanvar Agzamkhodjaev , Mansour Ali , Muhammad E.H. Chowdhury , Tariq O. Abbas","doi":"10.1016/j.jpurol.2025.105703","DOIUrl":"10.1016/j.jpurol.2025.105703","url":null,"abstract":"<div><h3>Background</h3><div>Penile curvature (PC) may occur in up to 10 % of male births worldwide and is typically associated with the birth defect hypospadias. While the extent of PC impacts surgical management and patient outcomes, curvature evaluation is inconsistent between surgeons due to a lack of reliable assessment techniques. Our goal was to create a dependable, automated deep-learning solution to precisely assess PC from real-time intraoperative 2D images.</div></div><div><h3>Materials and methods</h3><div>A dataset of 421 images was assembled and annotated by four human experts. Annotations were used to calculate PC angles and determine ground truth curvature degrees in each case. All images and ground truth angle information were used to train 3 different deep-learning models. A YOLOv8 model was trained to localize and crop the penile region, then a deep-learning model was employed to segment the shafts and generate binary mask images. In the final stage, a modified HRNet model was used to integrate angle error, predict four key points denoting mid-axes of the proximal and distal shaft, and then use these landmarks to calculate curvature automatically.</div></div><div><h3>Results</h3><div>The proposed system demonstrated a high level of reliability in localizing penile areas, as evidenced by a mean average precision score of 99.4 %. Furthermore, our pipeline exhibited strong performance in the segmentation task, achieving an impressive Intersection over the Union metric of 83.56 % and a Dice Similarity Coefficient of 91.02 %. In terms of angle prediction, the system achieved a mean absolute error of 7.9°. By comparison, variability among human raters ranged between 6.5 and 12.0° (median ≈ 8.9°), consistent with previously reported manual errors of 3.5–13.6°. Thus, the AI system matched or outperformed human raters, providing more consistent and reliable curvature estimation. The model achieved a median error of 7.8° across 421 images, with 82 % of predictions within ±10° of ground truth. Only 6 % of cases crossed the 30° surgical threshold, confirming the tool's reliability for clinical decision-making.</div></div><div><h3>Discussion</h3><div>This study demonstrates the successful implementation of deep learning and keypoint-based measurement of PC that could significantly improve patient assessment by surgeons and hypospadiology researchers.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"22 2","pages":"Article 105703"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2025-12-31DOI: 10.1016/j.jpurol.2025.105716
Camila Moreno Bencardino , Mandy Rickard , Joana Dos Santos, Joao L. Pippi Salle, Rodrigo Romao, Michael E. Chua, Armando J. Lorenzo
Objective
To evaluate whether the presence of ipsilateral lower pole vesicoureteral reflux (iLPR) should influence surgical decision-making in cases of associated upper pole (UP) pathology otherwise amenable to a uretero-ureterostomy (UU).
Methods
We conducted a single-institution retrospective review of 41 pediatric patients with duplex system anomalies who underwent UU over five years. Patients were segregated into two groups: those without evidence of iLPR (including those with unknown reflux status), and those with documented iLPR. Primary outcomes included postoperative urinary tract infections (UTIs), surgical complications, and improvement/resolution of hydronephrosis.
Results
Of 41 patients, 11 had confirmed iLPR. Demographics, preoperative ultrasound findings, and clinical presentation were comparable between groups. We followed a stent-free, radiation-free, open surgical technique, with most patients discharged within 24 hours. Complication rates—including UTIs, infected ureteral stumps, and anastomotic leaks—were similar between groups and not statistically significant. During postoperative surveillance, UTIs occurred in 21 % of the no/unknown-iLPR group and 36 % of the LPR group (p = 0.55), though most were isolated events. UP hydronephrosis improved or resolved in over 90 % of cases, with no significant difference between groups.
Conclusion
UU is a safe and effective surgical option for managing duplex UP anomalies, even in the presence of reflux. Our findings challenge historical exclusion of iLPR patients from UU consideration and suggest that routine preoperative VCUGs may not be necessary, particularly in the absence of other indications for obtaining a cystogram.
{"title":"Should the presence of ipsilateral lower pole vesicoureteral reflux impact the decision to offer a uretero-ureterostomy for children with duplication anomalies?","authors":"Camila Moreno Bencardino , Mandy Rickard , Joana Dos Santos, Joao L. Pippi Salle, Rodrigo Romao, Michael E. Chua, Armando J. Lorenzo","doi":"10.1016/j.jpurol.2025.105716","DOIUrl":"10.1016/j.jpurol.2025.105716","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate whether the presence of ipsilateral lower pole vesicoureteral reflux (iLPR) should influence surgical decision-making in cases of associated upper pole (UP) pathology otherwise amenable to a uretero-ureterostomy (UU).</div></div><div><h3>Methods</h3><div>We conducted a single-institution retrospective review of 41 pediatric patients with duplex system anomalies who underwent UU over five years. Patients were segregated into two groups: those without evidence of iLPR (including those with unknown reflux status), and those with documented iLPR. Primary outcomes included postoperative urinary tract infections (UTIs), surgical complications, and improvement/resolution of hydronephrosis.</div></div><div><h3>Results</h3><div>Of 41 patients, 11 had confirmed iLPR. Demographics, preoperative ultrasound findings, and clinical presentation were comparable between groups. We followed a stent-free, radiation-free, open surgical technique, with most patients discharged within 24 hours. Complication rates—including UTIs, infected ureteral stumps, and anastomotic leaks—were similar between groups and not statistically significant. During postoperative surveillance, UTIs occurred in 21 % of the no/unknown-iLPR group and 36 % of the LPR group (p = 0.55), though most were isolated events. UP hydronephrosis improved or resolved in over 90 % of cases, with no significant difference between groups.</div></div><div><h3>Conclusion</h3><div>UU is a safe and effective surgical option for managing duplex UP anomalies, even in the presence of reflux. Our findings challenge historical exclusion of iLPR patients from UU consideration and suggest that routine preoperative VCUGs may not be necessary, particularly in the absence of other indications for obtaining a cystogram.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"22 2","pages":"Article 105716"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146026201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2025-12-13DOI: 10.1016/j.jpurol.2025.12.013
David Heap, Ahmad Haffar, Carla Hoeck, Tanisha Martheswaran, Jason Yang, Erin Mayeaux, Catherine Robey, John P Gearhart, Isam W Nasr, Chad B Crigger, Joann B Hunsberger
<p><strong>Introduction: </strong>Cloacal Exstrophy (CE), also known as OEIS complex (Omphalocele, Exstrophy of the cloaca, Imperforate anus, and Spinal defects), is the rarest and most severe congenital malformation of the bladder exstrophy-epispadias spectrum, characterized by an open bladder and exposed portions of the large intestine, along with bony anomalies. The objective of this study is to describe the experience of a high-volume exstrophy center's perioperative pathway, with a focus on analgesic use as well as urologic, orthopedic, and dietary interventions, for bladder repair of cloacal exstrophy.</p><p><strong>Method: </strong>An IRB-approved, prospectively-maintained institutional approved Bladder Exstrophy-Epispadias Complex database was reviewed for patients with CE who had undergone bladder closure between 2017 and 2024. Electronic medical records were retrospectively reviewed to examine patient demographics, use of pelvic osteotomy, immobilization status, pediatric intensive care unit (PICU) admission, perioperative analgesia and sedation, nutritional support, drainage tubes, blood transfusion, antibiotic coverage, hospital length of stay, postoperative complications and closure failure.</p><p><strong>Results: </strong>One hundred seventy-six CE and CE-variant patients were identified and 23 underwent bladder closure during this period. The median age at pelvic osteotomy was 1.93 years (IQR, 1.48-2.43, range 1-7). A delay of 14 days (IQR, 10-16) between osteotomy and closure was used in all but two patients. External fixation device and Buck's traction remained for 42 (IQR, 42-47) days. Post-closure, PICU stay was 8 days (IQR, 7-13) with 78 % requiring invasive ventilation for 4.5 days (IQR, 2-13.8). All patients required blood transfusions (2, IQR, 1-3). Enteral feeding resumed by day 11.5 (IQR, 5.8-16.5) for all but one and parenteral nutrition for 21 days (IQR, 13.5-53). Patient-controlled analgesia (PCA) was used in all patients for both pre- and post-closure, morphine most commonly (76 % and 48 %, respectively). Opioid use totaled 45 days (IQR, 40-60). Acetaminophen use was universal and NSAIDs used in 43 % (pre) and 57 % (post), clonidine in 62 % (pre) and 96 % (post). Bladder closure was successful in 87 %, while 13 % required repeat operation. Length of stay averaged 62 days (IQR, 51-86), range 42-191.</p><p><strong>Discussion: </strong>While our study was limited by a small patient population, this data highlights the complexity and resource-intensive nature of CE bladder closure, emphasizing the need for comprehensive multidisciplinary management at specialized centers.</p><p><strong>Conclusion: </strong>Our 87 % success rate in bladder closure for patients with CE underscores the effectiveness of the multidisciplinary approach described when managing the complex perioperative course of these patients. However, challenges remain including prolonged hospitalization, ventilation requirements and slow reintroduction of ent
{"title":"Multidisciplinary perioperative management of cloacal exstrophy bladder closure: A single institution's approach.","authors":"David Heap, Ahmad Haffar, Carla Hoeck, Tanisha Martheswaran, Jason Yang, Erin Mayeaux, Catherine Robey, John P Gearhart, Isam W Nasr, Chad B Crigger, Joann B Hunsberger","doi":"10.1016/j.jpurol.2025.12.013","DOIUrl":"10.1016/j.jpurol.2025.12.013","url":null,"abstract":"<p><strong>Introduction: </strong>Cloacal Exstrophy (CE), also known as OEIS complex (Omphalocele, Exstrophy of the cloaca, Imperforate anus, and Spinal defects), is the rarest and most severe congenital malformation of the bladder exstrophy-epispadias spectrum, characterized by an open bladder and exposed portions of the large intestine, along with bony anomalies. The objective of this study is to describe the experience of a high-volume exstrophy center's perioperative pathway, with a focus on analgesic use as well as urologic, orthopedic, and dietary interventions, for bladder repair of cloacal exstrophy.</p><p><strong>Method: </strong>An IRB-approved, prospectively-maintained institutional approved Bladder Exstrophy-Epispadias Complex database was reviewed for patients with CE who had undergone bladder closure between 2017 and 2024. Electronic medical records were retrospectively reviewed to examine patient demographics, use of pelvic osteotomy, immobilization status, pediatric intensive care unit (PICU) admission, perioperative analgesia and sedation, nutritional support, drainage tubes, blood transfusion, antibiotic coverage, hospital length of stay, postoperative complications and closure failure.</p><p><strong>Results: </strong>One hundred seventy-six CE and CE-variant patients were identified and 23 underwent bladder closure during this period. The median age at pelvic osteotomy was 1.93 years (IQR, 1.48-2.43, range 1-7). A delay of 14 days (IQR, 10-16) between osteotomy and closure was used in all but two patients. External fixation device and Buck's traction remained for 42 (IQR, 42-47) days. Post-closure, PICU stay was 8 days (IQR, 7-13) with 78 % requiring invasive ventilation for 4.5 days (IQR, 2-13.8). All patients required blood transfusions (2, IQR, 1-3). Enteral feeding resumed by day 11.5 (IQR, 5.8-16.5) for all but one and parenteral nutrition for 21 days (IQR, 13.5-53). Patient-controlled analgesia (PCA) was used in all patients for both pre- and post-closure, morphine most commonly (76 % and 48 %, respectively). Opioid use totaled 45 days (IQR, 40-60). Acetaminophen use was universal and NSAIDs used in 43 % (pre) and 57 % (post), clonidine in 62 % (pre) and 96 % (post). Bladder closure was successful in 87 %, while 13 % required repeat operation. Length of stay averaged 62 days (IQR, 51-86), range 42-191.</p><p><strong>Discussion: </strong>While our study was limited by a small patient population, this data highlights the complexity and resource-intensive nature of CE bladder closure, emphasizing the need for comprehensive multidisciplinary management at specialized centers.</p><p><strong>Conclusion: </strong>Our 87 % success rate in bladder closure for patients with CE underscores the effectiveness of the multidisciplinary approach described when managing the complex perioperative course of these patients. However, challenges remain including prolonged hospitalization, ventilation requirements and slow reintroduction of ent","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":"105697"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-19DOI: 10.1016/j.jpurol.2026.105745
Matthieu Peycelon, Alaa El-Ghoneimi
{"title":"Response to Letter to the Editor re: \"Laparoscopic Mitrofanoff procedure in children: Feasibility and outcome analysis over 18 years in a single centre\".","authors":"Matthieu Peycelon, Alaa El-Ghoneimi","doi":"10.1016/j.jpurol.2026.105745","DOIUrl":"10.1016/j.jpurol.2026.105745","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":"105745"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146113622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2025-12-27DOI: 10.1016/j.jpurol.2025.105710
C R J Woodhouse
{"title":"Commentary to \"Update and mid-term follow up of classic bladder exstrophy managed by the Toronto approach (modified staged repair): Continence status, sexual function and upper tract functional outcomes\".","authors":"C R J Woodhouse","doi":"10.1016/j.jpurol.2025.105710","DOIUrl":"10.1016/j.jpurol.2025.105710","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":"105710"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2025-12-09DOI: 10.1016/j.jpurol.2025.12.002
Karim Awad, Mohamed Sameh Shalaby, Laura Jackson, Mark N Woodward
{"title":"Response to Letter to the Editor re: \"Laparoscopic single-stage orchidopexy followed by groin exploration: The best two-stage orchidopexy?\"","authors":"Karim Awad, Mohamed Sameh Shalaby, Laura Jackson, Mark N Woodward","doi":"10.1016/j.jpurol.2025.12.002","DOIUrl":"10.1016/j.jpurol.2025.12.002","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":"105685"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145900757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-02DOI: 10.1016/j.jpurol.2025.105720
Hasan Deliağa, Betül Altundal, Hakan Özcan, Sefer Tolga Okay, Esra Özçakır, Mete Kaya
Objective: To evaluate the diagnostic accuracy of the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score in children presenting with acute scrotum and to assess its impact on clinical and surgical outcomes.
Methods: We retrospectively reviewed 324 pediatric patients admitted with acute scrotum between March 2020 and February 2025. Patients were divided into two groups: those evaluated before TWIST implementation (pre-TWIST, n = 178) and after (post-TWIST, n = 146). Demographic, clinical, laboratory, radiological, operative, and follow-up data were collected. The diagnostic performance of the TWIST score was assessed using receiver operating characteristic (ROC) analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios were calculated for a cut-off score of ≥6.
Results: The median age and symptom duration did not differ significantly between groups. The proportion of patients undergoing scrotal exploration decreased significantly after TWIST implementation (56.2 % vs. 36.5 %, p < 0.001). Among operated patients, the median time from admission to surgery was shorter post-TWIST (0.75 h vs. 2 h, p < 0.001). Negative exploration rates fell significantly (51.0 % vs. 7.5 %, p < 0.001), and detorsion/fixation procedures significantly increased (77.3 % vs. 42.0 %, p < 0.001), without significant change in orchiectomy rates (7 % vs. 15 %, p = 0.109). Testicular atrophy following detorsion occurred in 9 % and 7.5 % of patients in the pre- and post-TWIST groups, respectively (p = 0.759). Diagnostic accuracy analysis showed an AUC of 0.94 (95 % CI: 0.91-0.98, p < 0.001). At a cut-off ≥6, sensitivity was 73.5 % and specificity was 96.9 %, with PPV 92.3 %, NPV 87.9 %, LR+ 23.7, and LR- 0.27.
Conclusions: Implementation of the TWIST score improved the management of pediatric acute scrotum by reducing unnecessary explorations and surgical delays while maintaining high diagnostic accuracy for testicular torsion. A cut-off of ≥6 provides strong rule-in value, whereas low scores reliably exclude torsion, supporting TWIST as a practical decision-making tool in the acute setting.
目的：评价睾丸缺血和疑似扭转检查（TWIST）评分对儿童急性阴囊的诊断准确性，并评价其对临床和手术结果的影响。方法：我们回顾性分析了2020年3月至2025年2月期间入院的324例急性阴囊患儿。患者分为两组：实施TWIST前（n = 178）和实施TWIST后（n = 146）。收集了人口学、临床、实验室、放射学、手术和随访资料。采用受试者工作特征（ROC）分析评估TWIST评分的诊断效能。计算敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和似然比，临界值≥6。结果：两组患者的中位年龄和症状持续时间无显著差异。TWIST实施后进行阴囊探查的患者比例显著降低（56.2% vs 36.5%, p < 0.001）。在手术患者中，twist术后从入院到手术的中位时间更短（0.75 h vs. 2 h, p < 0.001）。阴性探查率显著下降（51.0%比7.5%,p < 0.001），扭转/固定手术显著增加（77.3%比42.0%,p < 0.001），睾丸切除术率无显著变化（7%比15%，p = 0.109）。扭曲前后睾丸萎缩发生率分别为9%和7.5% （p = 0.759）。诊断准确性分析显示AUC为0.94 （95% CI: 0.91-0.98, p < 0.001）。截止值≥6时，敏感性为73.5%，特异性为96.9%，其中PPV为92.3%，NPV为87.9%，LR为+ 23.7，LR为- 0.27。结论：TWIST评分的实施改善了小儿急性阴囊的治疗，减少了不必要的探查和手术延误，同时保持了睾丸扭转的高诊断准确性。临界值≥6提供了强有力的规则价值，而低分数可靠地排除了扭转，支持TWIST作为急性环境中实用的决策工具。
{"title":"Optimizing the management of pediatric acute scrotum: Clinical and surgical benefits of the TWIST scoring application.","authors":"Hasan Deliağa, Betül Altundal, Hakan Özcan, Sefer Tolga Okay, Esra Özçakır, Mete Kaya","doi":"10.1016/j.jpurol.2025.105720","DOIUrl":"10.1016/j.jpurol.2025.105720","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the diagnostic accuracy of the Testicular Workup for Ischemia and Suspected Torsion (TWIST) score in children presenting with acute scrotum and to assess its impact on clinical and surgical outcomes.</p><p><strong>Methods: </strong>We retrospectively reviewed 324 pediatric patients admitted with acute scrotum between March 2020 and February 2025. Patients were divided into two groups: those evaluated before TWIST implementation (pre-TWIST, n = 178) and after (post-TWIST, n = 146). Demographic, clinical, laboratory, radiological, operative, and follow-up data were collected. The diagnostic performance of the TWIST score was assessed using receiver operating characteristic (ROC) analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios were calculated for a cut-off score of ≥6.</p><p><strong>Results: </strong>The median age and symptom duration did not differ significantly between groups. The proportion of patients undergoing scrotal exploration decreased significantly after TWIST implementation (56.2 % vs. 36.5 %, p < 0.001). Among operated patients, the median time from admission to surgery was shorter post-TWIST (0.75 h vs. 2 h, p < 0.001). Negative exploration rates fell significantly (51.0 % vs. 7.5 %, p < 0.001), and detorsion/fixation procedures significantly increased (77.3 % vs. 42.0 %, p < 0.001), without significant change in orchiectomy rates (7 % vs. 15 %, p = 0.109). Testicular atrophy following detorsion occurred in 9 % and 7.5 % of patients in the pre- and post-TWIST groups, respectively (p = 0.759). Diagnostic accuracy analysis showed an AUC of 0.94 (95 % CI: 0.91-0.98, p < 0.001). At a cut-off ≥6, sensitivity was 73.5 % and specificity was 96.9 %, with PPV 92.3 %, NPV 87.9 %, LR+ 23.7, and LR- 0.27.</p><p><strong>Conclusions: </strong>Implementation of the TWIST score improved the management of pediatric acute scrotum by reducing unnecessary explorations and surgical delays while maintaining high diagnostic accuracy for testicular torsion. A cut-off of ≥6 provides strong rule-in value, whereas low scores reliably exclude torsion, supporting TWIST as a practical decision-making tool in the acute setting.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":"105720"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145998411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-02DOI: 10.1016/j.jpurol.2025.105719
Lisa B E Shields, Kahir Jawad, Wayland J Wu, Eran Rosenberg
Introduction/background: Testicular torsion (TT) represents an emergent pediatric condition that requires timely surgical intervention to minimize the likelihood of testicular loss. Numerous reasons may affect the survival rate of a torsed testis, including longer symptom duration, younger age, and higher degree of TT observed intraoperatively. "Door To Detorsion time" (DTD) has been described but not fully validated.
Objective: We sought to evaluate the DTD on outcomes of TT.
Study design: We identified males 1-18 years old with TT over a 10-year period (January 1, 2015-December 31, 2024) in this retrospective and observational study. Univariate and multivariate analyses determined whether DTD, patient age, symptom duration, and degree of TT observed during surgery were predictors of testicular salvage.
Results: Of the 286 patients diagnosed with TT, the median age was 14 years, and the median symptom duration was 9 h. The median DTD was 146.5 min (ranging between 25 and 668 min): 133 min with a viable testes and 166 min with a nonviable testes. A total of 195 (68 %) patients underwent an orchiopexy compared to 91 (32 %) patients who had an orchiectomy. A multivariate analysis demonstrated that each 10-min increase in DTD was associated with a 6 % increase in odds of undergoing an orchiectomy. Each additional hour of DTD was associated with a 35 % increase in odds of an orchiectomy. For each additional hour of symptom duration, the odds of undergoing an orchiectomy versus an orchiopexy increased by 3 %. Patients with a degree of TT > 540 had a 4.85 times higher odds of orchiectomy compared to those treated with 0 degrees of TT. Patients with symptoms lasting 24 h or longer had an 8.9 times higher odds of requiring an orchiectomy compared to those treated within 24 h. For each additional year of age, the odds of an orchiectomy decreased by 14 %.
Discussion: Our study concurs with the literature with respect to a significantly increased risk of needing an orchiectomy with a longer DTD and extended symptom duration, with critical timepoints of greater than 6 h, greater than 12 h, and greater than 18 h.
Conclusion: The DTD is a very significant but often ignored factor. Every 10 min delay in the Emergency Department reduces the survival of the testis. Recognizing the symptoms of TT especially in younger males and seeking timely medical attention, coupled with a hastened hospital course prior to surgery, decrease the need for testicular loss.
{"title":"The importance of door to detorsion time in children diagnosed with testicular torsion - Every minute counts!","authors":"Lisa B E Shields, Kahir Jawad, Wayland J Wu, Eran Rosenberg","doi":"10.1016/j.jpurol.2025.105719","DOIUrl":"10.1016/j.jpurol.2025.105719","url":null,"abstract":"<p><strong>Introduction/background: </strong>Testicular torsion (TT) represents an emergent pediatric condition that requires timely surgical intervention to minimize the likelihood of testicular loss. Numerous reasons may affect the survival rate of a torsed testis, including longer symptom duration, younger age, and higher degree of TT observed intraoperatively. \"Door To Detorsion time\" (DTD) has been described but not fully validated.</p><p><strong>Objective: </strong>We sought to evaluate the DTD on outcomes of TT.</p><p><strong>Study design: </strong>We identified males 1-18 years old with TT over a 10-year period (January 1, 2015-December 31, 2024) in this retrospective and observational study. Univariate and multivariate analyses determined whether DTD, patient age, symptom duration, and degree of TT observed during surgery were predictors of testicular salvage.</p><p><strong>Results: </strong>Of the 286 patients diagnosed with TT, the median age was 14 years, and the median symptom duration was 9 h. The median DTD was 146.5 min (ranging between 25 and 668 min): 133 min with a viable testes and 166 min with a nonviable testes. A total of 195 (68 %) patients underwent an orchiopexy compared to 91 (32 %) patients who had an orchiectomy. A multivariate analysis demonstrated that each 10-min increase in DTD was associated with a 6 % increase in odds of undergoing an orchiectomy. Each additional hour of DTD was associated with a 35 % increase in odds of an orchiectomy. For each additional hour of symptom duration, the odds of undergoing an orchiectomy versus an orchiopexy increased by 3 %. Patients with a degree of TT > 540 had a 4.85 times higher odds of orchiectomy compared to those treated with 0 degrees of TT. Patients with symptoms lasting 24 h or longer had an 8.9 times higher odds of requiring an orchiectomy compared to those treated within 24 h. For each additional year of age, the odds of an orchiectomy decreased by 14 %.</p><p><strong>Discussion: </strong>Our study concurs with the literature with respect to a significantly increased risk of needing an orchiectomy with a longer DTD and extended symptom duration, with critical timepoints of greater than 6 h, greater than 12 h, and greater than 18 h.</p><p><strong>Conclusion: </strong>The DTD is a very significant but often ignored factor. Every 10 min delay in the Emergency Department reduces the survival of the testis. Recognizing the symptoms of TT especially in younger males and seeking timely medical attention, coupled with a hastened hospital course prior to surgery, decrease the need for testicular loss.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":"105719"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145998467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2026-01-10DOI: 10.1016/j.jpurol.2026.105723
Putu Angga Risky Raharja, Tariq O Abbas
{"title":"Response to Letter to the Editor re: \"Evaluating the utility of ChatGPT in enhancing parental education and clinical support in hypospadias care\".","authors":"Putu Angga Risky Raharja, Tariq O Abbas","doi":"10.1016/j.jpurol.2026.105723","DOIUrl":"10.1016/j.jpurol.2026.105723","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":"105723"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-04-01Epub Date: 2025-12-13DOI: 10.1016/j.jpurol.2025.12.003
Celicia Little, Nicole Allentuck, Christina P Ho, Hans G Pohl, Mi Ran Shin, Matthew Oetgen, Robert Keating, Briony K Varda, Kaitlin Scarpaci
This nurse practitioner (NP)-led bowel management program services over 250 children ages 0-22 years focusing on holistic, individualized care to address neurogenic bowel dysfunction (NBD). The NP increases accessibility, provides comprehensive support, family education, personalized treatment plans, and close follow-up. By assessing the physical, emotional, and social needs of each child and family, the program improves quality of life, promotes self-management, and reduces complications like fecal incontinence and emergency room visits and hospitalizations related to constipation. Key interventions include collaboration with interdisciplinary teams, implementation of evidence-based bowel protocols, and continuous family engagement.
{"title":"An NP-led bowel management program for patients with spina bifida.","authors":"Celicia Little, Nicole Allentuck, Christina P Ho, Hans G Pohl, Mi Ran Shin, Matthew Oetgen, Robert Keating, Briony K Varda, Kaitlin Scarpaci","doi":"10.1016/j.jpurol.2025.12.003","DOIUrl":"10.1016/j.jpurol.2025.12.003","url":null,"abstract":"<p><p>This nurse practitioner (NP)-led bowel management program services over 250 children ages 0-22 years focusing on holistic, individualized care to address neurogenic bowel dysfunction (NBD). The NP increases accessibility, provides comprehensive support, family education, personalized treatment plans, and close follow-up. By assessing the physical, emotional, and social needs of each child and family, the program improves quality of life, promotes self-management, and reduces complications like fecal incontinence and emergency room visits and hospitalizations related to constipation. Key interventions include collaboration with interdisciplinary teams, implementation of evidence-based bowel protocols, and continuous family engagement.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":"105687"},"PeriodicalIF":1.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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