Journal of Pediatric Urology最新文献

Background: Testicular torsion is a common scrotal emergency in urology and delayed diagnosis can lead to loss of the testis. The research results concerning the relationship between climatic factors and testicular torsion are inconsistent. This scoping review aims to summarize and analyze current clinical studies that have investigated the relationship between meteorological factors and testicular torsion, in order to improve clinicians' understanding of testicular torsion.

Methods: A comprehensive search of four major foreign databases was conducted to identify relevant literature on the correlation between meteorological factors and testicular torsion. The search period spanned from the inception of the databases to 12 June 2024. A scoping review method was employed, with the collected literature information subjected to visual analysis using charts and tables.

Results: A total of 111 articles were retrieved, and following initial and secondary screening, 19 articles were included for summary and analysis.

Conclusions: The findings indicate that testicular torsion is related to low temperatures and large diurnal temperature differences. To further elucidate the etiology of testicular torsion, it is necessary to expand the sample size and design more rigorous research protocols.

Introduction: The ileovesicostomy (IV) is a surgical option for patients with refractory bladder dysfunction at-risk of upper tract deterioration who cannot catheterize or lack social support for managing an augmentation cystoplasty (AC). Long-term outcomes after IV in children are lacking in the literature.

Objective: We assessed the risk of long-term surgical complications in pediatric patients with IV at a single children's hospital.

Study design: We retrospectively reviewed the records of patients undergoing IV between 2002 and 2021 at a single children's hospital. The primary outcome was the rate of surgical complications in IV patients after initial reconstruction. Specific complications of interest included intra-abdominal, reservoir, and stomal complications, respectively. We also assessed renal outcomes, including the change in glomerular filtration rate (ΔGFR) and Society of Fetal Urology (ΔSFU) hydronephrosis from the time of surgery to last follow up.

Results: The study comprised 17 IV patients, with most patients having a diagnosis of spina bifida (65 %). Median follow-up was 6.4 years. The mean rate of surgical complications per patient year was 0.11 ± 0.20. On survival analysis, the time to first complication for IV was 84.4 months. The incidence of intra-abdominal, reservoir, and stomal complications over the study period was 2/17 (11.8 %) for each of these complication types. The mean ΔSFU grade from the time of surgery to last follow up was -1.24 ± 1.48 and mean ΔGFR was -2.5 ± 32.7 ml/min.

Discussion: We found that IV in pediatric patients experience a low rate (0.11/year) of complications and that median time to first complication was 84 months. Additionally, IV offers adequate renal preservation. Our study is limited, though, by its retrospective nature, small sample size, heterogenous population and lack of comparison group.

Conclusion: Our experience demonstrates that IV has a low rate of surgical complications and preserves renal function. We believe it is a reasonable surgical option for the well selected patient with refractory bladder dysfunction at-risk of upper tract deterioration who is unable to reliably catheterize.

Introduction: Vesicostomy button drainage is a recognised alternative to clean intermittent catheterization (CIC) in children with urethral obstruction, sensate urethra or neurological/behavioural issues.

Aim: To report the indications, complications and long-term bladder functional outcomes in a 15-year cohort of patients with button vesicostomy.

Materials and methods: AMT Mini one gastrostomy button^R was inserted via a surgical vesicostomy, or percutaneously under cystoscopic guidance. Retrospective data included demographics, indications, complications, and long-term bladder capacity/emptying pre-post-button removal.

Results: 29 children (23 males) underwent vesicostomy button insertion at 3.5 (0.5-14.5) years. Diagnosis was neurogenic (11), bladder outlet obstruction (9), cloaca/urogenital sinus (3), anorectal malformation (ARM) (2), other bladder dysfunction (3) and diversion (1). There were no short-term complications. UTI occurred in 31 %, leakage in 28 % and blockage in 7 %. At a median of 10 (2-18) years, 14 (48 %) are still on button drainage; 6 (21 %) progressed to Mitrofanoff catheterisation. In 9 (31 %) who no longer require the button, all children were able to void urethrally, with good emptying, at 4.5 (1-7) years follow-up.

Discussion: Continent vesicostomy allows toilet-training and improved quality of life. We estimated that the cost of a button vesicostomy and tubing approximates £1502 per year. 5-6 Speedicaths per day (costing £38 per pack) cost £2772 per year. Asymptomatic bacterial colonisation does not require antibiotic treatment; it is best avoided by changing the button every 12 weeks. Symptomatic febrile UTI's are commonly secondary to the underlying pathology; we recommend changing the button half-way through the antibiotic treatment course. Leakage was managed by increasing the water in the balloon. Button blockage, commonly due to balloon encrustation, is preventable by regular button changes. Button drainage may be temporary (until bladder dysfunction resolves, or changed to a Mitrofanoff), or a long-term (in life-long neuro-developmental/behavioural issues). The button was no longer required in 9: bladder function improved post spinal cord un-tethering in 3; 2 PUV; 2 ARM; 1 myopathy and 1 diversion. Of note, the button did not appear to affect bladder dynamics with sustained resolution of bladder dysfunction in 31 %. Our main limitation was diversity of pathologies, making comparison of urodynamics more challenging: a larger study with more numbers in each patient group would be the next step.

Conclusion: Suprapubic buttons are a safe second-line bladder drainage option in patients who are unable to CIC. The technique may be a temporary solution where bladder dysfunction may resolve, or until the child is ready for catheterisation via a Mitrofanoff.

Introduction: Testicular torsion is a surgical emergency that is managed with either septopexy-only or tunica vaginalis flap with septopexy if the testis is potentially viable or orchiectomy if not. Minimizing time from ischemia onset to surgery maximizes the likelihood of testicular preservation. While factors such as time from door to OR can be easily targeted, others such as inequalities in access to care are more difficult to address.

Objective: We sought to determine whether patient transfer affects testicular outcomes intraoperatively and in the long-term. Secondary goals included investigating the impact of race and Child Opportunity Index (COI) on testicular torsion outcomes and defining the optimal time cutoff from symptom onset to presentation that predicts salvage.

Methods: We reviewed our prospective testicular torsion database to identify boys who underwent operative intervention for testicular torsion between January 2015 and March 2022. The association of race and COI with testicular salvage, defined as septopexy-only, was evaluated with univariate and multivariate logistic regression controlling for time to presentation, while the association of transfer with salvage was evaluated with univariate and multivariate logistic regression controlling for age, time to presentation, and time to OR. To determine the optimal cutoff for time to presentation to predict testicular salvage, the Youden index was calculated.

Results: Race and COI were not associated with testicular salvage on either univariate or multivariate logistic regression that controlled for time to presentation. Transfer status was not associated with salvage, while age, time from symptoms to presentation, and time from institutional arrival to OR were associated with salvage. The optimal time cutoff to predict salvage using the Youden index was 10.5 hours from symptom onset to presentation and 14.5 hours from symptom onset to detorsion.

Discussion: Time to presentation was the strongest, modifiable risk factor associated with testicular salvage. As it may be difficult for children to accurately communicate their symptoms, diagnosis and prompt management of testicular torsion can be delayed. Improvement in outcomes can be achieved by placing greater efforts into patient, parental, and primary care provider education of the signs and symptoms of testicular torsion.

Conclusions: Race, COI, and transfer status were not found to have a statistically significant effect on testicular salvage outcomes in patients presenting with testicular torsion. Despite the common premise of a 6-hour window until testicular loss, we found that intervention within the acute window of 14.5 hours from symptom onset is still associated with salvage.