Journal of Pediatric Urology最新文献

Background: The role of hormonal therapy as an adjunct to surgery in managing undescended testes (UDT) remains controversial. Its implications for future fertility are still unclear, and clinical practices vary globally.

Objective: To evaluate the effects of combined hormonal and surgical treatment versus surgery alone on fertility potential in males with UDT.

Study design: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Databases searched included PubMed, Scopus, Embase, ClinicalTrials.gov, and Cochrane up to April 14, 2025. Eligible studies were randomized controlled trials and cohort studies comparing combined hormonal and surgical therapy with surgery alone, reporting on fertility-related potentials. Risk of bias was assessed using RoB 2.0 or the Newcastle-Ottawa Scale, and data synthesis was performed using RevMan 5.4.

Results: Nine studies comprising 652 patients were included. Hormonal therapy combined with surgery significantly increased the number of spermatogonia per tubule (mean difference [MD] 0.23; 95 % CI: 0.07 to 0.38; p = 0.003), with more pronounced effects in bilateral UDT (MD 0.35; 95 % CI: 0.17-0.53; p = 0.001). However, no significant improvements were observed in long-term fertility markers, including sperm count, inhibin B, or testosterone. FSH levels were slightly lower in the combined group (MD -0.77 IU/L; 95 % CI: -1.29 to -0.26; p = 0.003).

Conclusion: Adjunctive hormonal therapy may enhance early germ cell maturation, particularly in bilateral UDT. However, current evidence does not demonstrate clear long-term benefits in fertility-related potentials. Future high-quality, biomarker-stratified, and longitudinal studies are essential, and should include direct endpoints such as sperm counts and paternity, to fully determine the clinical utility of pre-orchidopexy hormonal treatment.

Background: Megaureter, either obstructive or refluxing in nature, is a common urological condition in pediatric patients that often requires surgical intervention. Ureteral reimplantation is the standard treatment when conservative management fails, with the Cohen cross-trigonal technique being the most widely adopted approach due to its reliability and established success rates. However, alternative techniques, such as modified intravesical detrusorrhaphy (MDR), are being explored to potentially reduce complications and improve outcomes.

Objective: This prospective comparative study aimed to compare the efficacy and outcomes of the Cohen procedure and the modified intravesical detrusorrhaphy (MDR) technique in the surgical management of pediatric patients with obstructive or refluxing megaureter.

Study design: A total of 44 patients diagnosed with obstructive or refluxing megaureter were randomly assigned to undergo either the Cohen (n = 22) or MDR (n = 22) procedure based on order of presentation. Demographic data, imaging results (VCUG, DTPA, DMSA), and ultrasonography findings were collected preoperatively. Intraoperative parameters (operation time, complications) and postoperative outcomes (catheter and drain removal time, short- and medium-term follow-up imaging) were assessed and compared between the groups. Postoperative imaging included ultrasonography at 1 week and 1 month, and VCUG at 6 months.

Results: The study cohort included 22 males and 22 females, with a mean age of 5.00 ± 3.76 years (range: 1-16). Surgical indications were obstructive megaureter in 18 patients (40.9 %) and refluxive megaureter in 26 (59.1 %). There was no statistically significant difference in mean operation times or complication rates between the two groups (p > 0.05). During medium-term follow-up, recurrent VUR was detected in one patient from each group.

Discussion: Both the Cohen and MDR techniques demonstrated comparable efficacy and safety in treating pediatric megaureter. The similarity in outcomes, including complication and recurrence rates, suggests that MDR may be a viable alternative to the more established Cohen procedure, especially when individualized surgical considerations are taken into account.

Conclusion: Ureteral reimplantation remains a highly successful intervention for megaureter. This study supports the use of both the Cohen and MDR techniques, with MDR offering comparable results, thereby expanding the surgical options available for managing this condition.

Background: In this video we report Modified Anatomical Repair of Epispadias (MARE)- where glans-frenular unit is preserved during urethral disassembly of Mitchell's technique.

Methods/technique: The epispadiac urethra and spongiosa were completely dissected off the corporal bodies; distally the urethra was dissected off, but the attachment at the frenulum and prepuce to hemi-glans was retained. The neourethra was tubularised using 7-0 Polydiaxone (PDS) over an 8Fr silastic catheter; neo-metaus was fashioned in a ventral position in the glans. The corporal bodies were approximated dorsally ventralising the repaired neourethra. Glansplasty was done after glans sculpting to prevent glans cleft. Skin cover was provided by rotation of ventral penile skin.

Results: Between 2000 and 2023, seven male epispadias patients; median age - 18 months (15-24 months) underwent MARE. All had penile epispadias without incontinence. Mean operative time was 180 min (150-210 min). There were no intraoperative/immediate post-operative complication or ischaemic glans loss. Median follow-up was 18 [12-36] months and there was no residual dorsal chordee/fistula. All had satisfactory cosmetic outcome.

Conclusion: This pilot study reports satisfactory outcomes of MARE where glans-frenular unit is preserved during urethral disassembly. It minimises glans loss by preserving blood supply between hemi-glans via the frenulum/ventral foreskin.

Introduction: Functional constipation (FC) is the most prevalent digestive complaint in children and adolescents, significantly impacting quality of life and often associated with fecal incontinence, emotional disturbances, and urinary symptoms. Although its diagnosis is primarily clinical and based on the Rome IV criteria, the lack of objective severity parameters and reliance on self-reported symptoms can hinder early identification. In this context, the present study aimed to evaluate the diagnostic accuracy of commonly used auxiliary tools - the pediatric-adapted Cleveland Clinic Constipation Score (CCS), the Bristol Stool Scale, the Dysfunctional Voiding Symptom Score (DVSS), and rectal diameter (RD) - using the Rome IV criteria as the gold standard.

Methods: This cross-sectional study included 106 patients aged 4-17 years, evaluated in general pediatric and specialized lower urinary tract dysfunction outpatient clinics. Each assessment tool was compared against the Rome IV criteria in terms of sensitivity, specificity, and overall accuracy.

Results: The CCS demonstrated the highest diagnostic accuracy (92.1 %), with a sensitivity of 89.5 % and specificity of 80.0 %, establishing it as an effective tool not only for diagnosing FC but also for grading its severity. Item 4 of the DVSS, which assesses the perception of effort during defecation, showed an accuracy of 72.5 % and should be valued by healthcare professionals as a relevant marker of FC. In contrast, the Bristol Stool Scale (types 1 and 2), RD measurement, and DVSS item 3 (bowel movement frequency) presented low accuracy levels (<60 %).

Conclusion: With its high accuracy, the CCS has proven to be a valid and reliable tool that supports the diagnosis of functional constipation and may also assist in determining its severity. Additionally, DVSS item 4 proves useful in clinical evaluation, while other instruments should be considered auxiliary tools, applied selectively based on individual patient needs.

Purpose: Urothelial cell carcinoma of the bladder (UCCB) is a common malignancy in adults but is rarely seen in children. Due to its rarity in the pediatric population, we utilized a national database to compare demographics, tumor characteristics, staging, and outcomes among pediatric patients, young adults (YA), and older adults (OA).

Materials and methods: We performed a retrospective cohort study using the National Cancer Database (NCDB) to identify patients diagnosed with UCCB (ICD-O-3 histology codes 8120-8131) from 2004 to 2020. Patients were grouped as Pediatric (≤21 years), Young Adult (22-50 years), and Older Adult (>50 years). Cases with missing survival data were excluded. We analyzed demographic data, tumor stage, treatment, and overall survival using chi-square tests, Kaplan-Meier survival estimates, and Cox regression models.

Results: We identified 235 pediatric (0.1 %), 22,034 YA (4.3 %), and 488,182 OA (95.6 %) cases. Among pediatric cases, 64 % were male, and most were non-Hispanic white. Non-muscle-invasive bladder cancer (NMIBC; Stage Ta, Tis, T1) was present in 96.2 % of pediatric cases, compared to 3.8 % having muscle-invasive disease (MIBC; Stage T2-T4). Pediatric patients had superior 1-, 2-, 5-, and 10-year survival rates compared to older cohorts. Across all age groups, invasive disease was associated with worse outcomes. Surgery was the primary treatment for 98.3 % of pediatric patients, with 19.6 % receiving intraoperative or adjuvant chemotherapy, compared to 31.7 % in the YA group and 33.1 % in the OA group. Treatment approaches depend largely on muscle-invasive status and have evolved over time.

Conclusions: This is the most extensive study to date on pediatric UCCB, revealing a predominance of NMIBC and improved survival rates in children compared to adults. Pediatric patients were less likely to receive chemotherapy despite high surgical rates. These findings underscore the need for further research to inform the development of standardized treatment for pediatric UCCB.

Objective: This study evaluates the growth potential of the affected testis and its influencing factors in patients undergoing redo orchiopexy (RO).

Material and methods: Between 2014 and 2024, 53 patients (4.6 %) with 57 testes who underwent RO among 1130 inguinal orchiopexies were analyzed retrospectively. Changes in testicular volume (TV), testicular growth percentage (TGP), and testicular atrophy index (TAI) after failed orchiopexy (FO) and redo orchiopexy were assessed using Doppler ultrasonography. Age, testis location, laterality, surgical approach, fixation, and the interval between operations were obtained from patient data.

Results: The mean age at FO and RO was 3.18 years and 5.08 years, respectively. The mean interval between FO and RO was 22.8 months(range 6-117 months). Among 39 unilateral undescended testes, TAI increased in 22(56 %) and regressed in 4(10 %) after FO. Following RO, TAI decreased by over 10 % in 21 cases(53 %), while an increase was observed in 11(28 %). Mean TAI values were 30.9 at baseline, 41.65 after FO, and 27.47 after RO(p = 0.068, p = 0.625). Older age at surgery correlated with TAI increase (p = 0.011). In 57 testes, mean TGP significantly increased from 29.8 to 134.68 after RO(p = 0.02). Early RO(≤1 year, n = 29) showed a higher TGP(169 %) compared to late RO(>1 year, n = 23,%101), though the difference was not statistically significant(p = 0.224).

Conclusions: Testicular asymmetry increases less in patients undergoing surgery at a younger age. Redo orchiopexy within the first year helps restore the growth potential of the affected testis more effectively, mitigating the adverse effects of failed orchiopexy.