Journal of Pediatric Urology最新文献

This article presents the clinical experience of our center with the SHURUI Single-Port Serpentine-Arm Robotic System for pyeloplasty in infants with ureteropelvic junction obstruction.

Background: Pediatric urology in low-income countries is expanding due to demographic and epidemiological factors, yet data on workforce capacity and equipment availability remain limited. This study provides a nationwide assessment of pediatric urology resources in Senegal.

Objective: To evaluate human resources, training exposure, clinical practice patterns, and availability of pediatric urology equipment across Senegal.

Study design: A nationwide cross-sectional survey was conducted from October 2024 to January 2025 using national directories of pediatric surgeons and urologists. An online survey collected data on training background, clinical practice, perceived challenges, and access to pediatric urology equipment. Descriptive statistical analysis was performed.

Results: Ninety practitioners responded, including all pediatric surgeons practicing nationally and 60 % of registered urologists. Active involvement in pediatric urology was reported by 88.9 % of respondents. Formal degree-level pediatric urology training was completed by 2.2 %, while 20 % reported international training experience. Equipment availability varied markedly across regions: functional cystoscopes were available in 34.3 % of facilities, laser lithotripsy in 20 %, nephroscopes in 11.4 %, and no functional cystomanometers or bladder scanners were identified. Limited access to equipment was the most frequently reported challenge.

Discussion: These findings are consistent with reports from other low-resource settings and highlight persistent gaps in subspecialty training and access to essential pediatric urology infrastructure. The study is limited by self-reported data and incomplete response among urologists.

Conclusion: This nationwide survey identifies critical gaps in pediatric urology capacity in Senegal. The findings provide a data-driven foundation to inform workforce planning, equipment allocation, and the development of context-appropriate strategies to strengthen pediatric urology services in similar low-resource settings.

Objectives: We investigated the association between maternal overactive bladder (OAB) and voiding dysfunction (VD) in their children, and evaluated urinary nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) levels as potential biomarkers for early identification of VD.

Methods: This prospective cross-sectional study included 196 participants: mothers with OAB (n = 39), their children with VD (n = 36), their children without VD (n = 41), healthy mothers (n = 40), and healthy children of healthy mothers (n = 40). Maternal OAB was diagnosed using the OAB-V8 questionnaire, while VD in children was assessed using the Dysfunctional Voiding Symptom Score (DVSS). Urinary NGF and BDNF levels were measured via ELISA. Receiver operating characteristic (ROC) analyses were performed to assess the diagnostic accuracy of these biomarkers.

Results: NGF and BDNF levels were significantly higher in mothers with OAB compared to controls (p < 0.001 for both). Children of OAB mothers with VD demonstrated markedly elevated DVSS scores, NGF, and BDNF levels compared to both healthy children of OAB mothers and children of healthy mothers (all p < 0.001). ROC analysis showed strong diagnostic performance for NGF (AUC = 0.828, cut-off 267.7 pg/ml, 75 % sensitivity, 99 % specificity) and acceptable performance for BDNF (AUC = 0.754, cut-off 3.06 ng/ml, 64 % sensitivity, 93 % specificity).

Conclusion: Urinary NGF and BDNF levels were significantly elevated in mothers with OAB and their affected children. NGF demonstrated superior diagnostic accuracy for identifying VD in children, while BDNF may provide complementary value. These findings support the role of neurotrophin-related mechanisms in intergenerational transmission of lower urinary tract dysfunction.

We hereby report Curvature correction, Lateral foreskin Approximation & Scrotal Switch (CLASS) procedure as a first-stage of Penile encasement/scrotal transposition (PEST) deformity & proximal-hypospadias. At first stage, the encased penis was released by making two inverted "U" shaped incisions on either side of two hemi scrota; the dorsal foreskin was left attached to glans; lateral foreskin flaps, straightened at the coronal sulcus, were approximated in the midline after chordee correction. Fifteen patients with perineal hypospadias & PEST deformity underwent CLASS procedure and second stage with good success. Further large prospective studies are essential to validate this procedure.

Introduction: The article presents the INSIDE-OUT longitudinal technique for bladder neck closure in children, a simplified approach aimed at improving outcomes in pediatric patients, particularly those with myelomeningocele. Traditionally, these patients undergo bladder neck plasty or sling procedures, which, while potentially preserving bladder function, achieve continence rates of approximately 50 %. In contrast, the new INSIDE-OUT technique boasts a success rate exceeding 90 %.

Methods: The method begins with a midline incision of the bladder, allowing for internal exposure of the bladder neck. A Foley catheter is inserted and traction applied while plastic tubes are positioned in the ureters to facilitate transection of the bladder neck. The technique involves circumferential dissection of the bladder neck from the inside, creating flaps that are elevated to skin level. Closure occurs in two layers, using specific sutures for mucosal and seromuscular layers.

Discussion: Results show a continence rate exceeding 95 % after over a decade of implementation. We believe that the INSIDE-OUT technique should be more widely considered in complex bladder reconstructions, emphasizing the need to educate patients about the risks associated with improper catheterization. This innovative approach promises better outcomes for children facing complex urinary issues.

Background: Primary nocturnal enuresis (PNE) is a prevalent pediatric disorder often associated with delayed cortical maturation and autonomic dysregulation. Growing evidence suggests that metabolic deficiencies, particularly in vitamin D, vitamin B₁₂, and folate, may influence neuronal development and the neural circuits regulating micturition.

Objective: To investigate the association between serum levels of vitamin D, vitamin B₁₂, and folate and neurophysiological parameters in children with PNE.

Methods: A cross-sectional study was conducted in 68 children aged 5-14 years with PNE and 20 age-matched healthy controls. All participants underwent clinical assessment, electroencephalography (EEG), magnetic resonance imaging (MRI), and computerized attention testing (TOVA). Serum concentrations of 25-hydroxyvitamin D, vitamin B₁₂, folate, ferritin, and hemoglobin were measured using immunoassay methods.

Results: Children with PNE demonstrated significantly lower serum levels of vitamin D (16.4 ± 2.8 ng/mL vs 26.7 ± 3.1 ng/mL; p < 0.01), vitamin B₁₂ (198 ± 41 pg/mL vs 283 ± 33 pg/mL; p = 0.001), and folate (4.1 ± 0.8 ng/mL vs 13.6 ± 1.2 ng/mL; p = 0.001) compared with controls, whereas ferritin and hemoglobin showed no significant difference. EEG revealed delayed cortical maturation in 66 % of cases, and MRI demonstrated minor, non-specific structural variants in 34 % of children with PNE.

Conclusions: Lower serum levels of vitamin D, vitamin B₁₂, and folate were associated with neurophysiological markers of delayed cortical maturation in children with PNE. Given the cross-sectional design, these findings should be interpreted as exploratory and hypothesis-generating. The observed associations warrant further longitudinal and interventional studies to determine whether micronutrient status is independently related to neurophysiological maturation or clinical outcomes in children with PNE.