Journal of Pediatric Urology最新文献

{"title":"Responsiveness and minimal important change of the Hindi version of the “Vancouver symptom score for dysfunctional elimination syndrome” questionnaire in children with overactive bladder","authors":"Leena Bharali,&nbsp;Viswas Chhapola,&nbsp;Soumya Tiwari","doi":"10.1016/j.jpurol.2025.06.020","DOIUrl":"10.1016/j.jpurol.2025.06.020","url":null,"abstract":"<div><h3>Background</h3><div><span>The Hindi translation of the “Vancouver Symptom Score for Dysfunctional Elimination Syndrome” (VSSDES) is the only valid and reliable BBD questionnaire available for use in the Hindi-speaking population. This study aimed to assess the responsiveness and minimum important change (MIC) of the Hindi-VSSDES in children with </span>overactive bladder (OAB).</div></div><div><h3>Methods</h3><div>This observational study included (between November 2022 and February 2024) toilet-trained children aged 5–16 years with OAB. The participants had to fill out the Hindi-VSSDES and a comparison tool (Thergaonkar scale [TS)) on their first visit and after 12 weeks of treatment. Additionally, they were asked to rate their perceived change in bladder bowel dysfunction by answering an anchor question (Global Rating of Change Scale [GRCS]) in Hindi at 12 weeks. Employing a construct validity approach, five a priori hypotheses concerning correlations, effect sizes, and the area under the ROC curve (AUC) were formulated to assess responsiveness. Responsiveness was deemed confirmed if ≥ 75 % of the hypotheses were fulfilled. The optimal cutoff on the ROC curve was the MIC value. An anchor-based MIC distribution graph was constructed. The methods complied with COSMIN recommendations.</div></div><div><h3>Results</h3><div>Seventy-five children were screened and 70 (mean age 7.9 ± 2.6 years) completed the 12-week follow-up. The mean total scores of Hindi-VSSDES at baseline (13 ± 6.8), and the 12-week follow-up (6.3 ± 4.4) were significantly different (<em>p</em> &lt; 0.001). We found no evidence of floor or ceiling effects. Four of the five predefined hypotheses were fulfilled, thereby validating the responsiveness. Hindi-VSSDES had a correlation of 0.76 and 0.5 with the TS and GRCS respectively. The AUC of ROC was 0.71 for the “improved” versus “no change” group using the GRCS anchor. The MIC value was 5.5 score points.</div></div><div><h3>Conclusion</h3><div>The Hindi-VSSDES is a responsive tool and the first Hindi BBD questionnaire with a known MIC value. It can be used in clinical practice and research to evaluate the effectiveness of interventions in OAB.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 6","pages":"Pages 1514-1521"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575721","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}

{"title":"Comparing the outcomes of three UU surgical methods for the treatment of complete duplex kidney: Changes to continually improve surgical success and reduce operative time and operative difficulty","authors":"Saisai Liu ,&nbsp;Hewei Xu ,&nbsp;Jun Wang,&nbsp;Yongji Deng,&nbsp;Xiaojiang Zhu,&nbsp;Haobo Zhu,&nbsp;Li-Qu Huang,&nbsp;Yunfei Guo","doi":"10.1016/j.jpurol.2025.06.024","DOIUrl":"10.1016/j.jpurol.2025.06.024","url":null,"abstract":"<div><h3>Introduction</h3><div><span>Duplex kidney<span> is a common malformation of the </span></span>urinary system among children. There are various treatment options for this malformation.</div></div><div><h3>Objective</h3><div>This study aimed to compare the therapeutic effects of three minimally invasive urinary tract<span> reconstruction surgery methods for complete duplex kidney among children and to compare demographic characteristics, perioperative data, surgical techniques, complications, and outcomes between these three methods.</span></div></div><div><h3>Patients and methods</h3><div><span>This retrospective study included 93 children with complete duplex kidney. A total of 35 patients underwent laparoscopic proximal ureteroureterostomy (Group A), 35 patients underwent laparoscopic distal ureteroureterostomy (Group B), and 23 patients underwent laparoscopic mobilization with open inguinal </span>incision ureteroureterostomy (Group C). Clinical data and surgery-related outcomes were recorded and collected. Routine follow-up was performed in all three groups. The rates of preoperative and postoperative renal pelvis separation, ureteral dilation, and operation time were compared among the three groups.</div></div><div><h3>Results</h3><div>The operation times in Group A, Group B, and Group C were 121.46 ± 35.15 min, 110.09 ± 25.60 min, and 87.95 ± 21.03 min, respectively (<em>P</em><span> &lt; 0.001), which were significantly different. The laparoscopic combined open surgery group had the shortest time. The overall incidence of complications in the three groups of surgeries was 31.4 %, 17.1 %, and 4.35 %, respectively. There was a statistically significant difference in the incidence of complications between Group A and Group C (31.4 % vs. 4.35 %; P = 0.013). In Group A, more severe postoperative complications related to the anastomotic site were reported; 14.3 % of patients in this group required secondary surgery.</span></div></div><div><h3>Discussion</h3><div>Herein, we comprehensively compared the clinical efficacy and safety of three surgical procedures and found that laparoscopic ipsilateral ureteroureterostomy (LIUU) is a safe and effective treatment for complete duplex kidney. Based on these findings, we reformed a small inguinal incision during LIUU and combined it with extracorporeal<span> methods to efficiently reconstruct the ureter, thereby significantly decreasing surgical time, reducing surgical difficulty, and further improving the treatment effect on complete duplex kidney.</span></div></div><div><h3>Conclusions</h3><div>LIUU is a safe and effective treatment for complete renal duplication, whereas proximal UU is associated with more serious complications related to the anastomotic site. Laparoscopic mobilization with open inguinal incision anastomosis showed high efficacy and safety, a shortened operation time and a lower incidence of severe complications.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 6","pages":"Pages 1756-1763"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144618682","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}

{"title":"Assessing the risk of voiding dysfunction in children with ureteroceles: A systematic review and meta-analysis","authors":"Jin Kyu Kim,&nbsp;Nikhil Batra,&nbsp;Pete Arnold,&nbsp;Renee Shavnore,&nbsp;Konrad M. Szymanski,&nbsp;Martin Kaefer,&nbsp;Joshua Roth,&nbsp;Benjamin Whittam,&nbsp;Pankaj Dangle,&nbsp;Kirstan Meldrum,&nbsp;Richard Rink,&nbsp;Mark Cain,&nbsp;Rosalia Misseri","doi":"10.1016/j.jpurol.2025.07.006","DOIUrl":"10.1016/j.jpurol.2025.07.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Ureterocele is a congenital anomaly potentially associated with voiding dysfunction (VD), often requiring surgical intervention. While surgery aims to relieve obstruction and preserve renal function, postoperative VD and related complications remain significant concerns.</div></div><div><h3>Objectives</h3><div>This systematic review aims to evaluate the prevalence of VD and associated outcomes in children following ureterocele surgery.</div></div><div><h3>Study design</h3><div>A systematic search of Medline, Embase, and Web of Science identified studies reporting VD (lower urinary tract dysfunction/symptoms) or related outcomes in children undergoing ureterocele interventions. Random effects meta-analysis was performed to calculate pooled prevalence rates for VD, incontinence, elevated post-void residuals (PVR), and recurrent UTIs. Heterogeneity was assessed using I² statistics, and publication bias was evaluated with funnel plots and trim-and-fill analyses.</div></div><div><h3>Results</h3><div>Fourteen retrospective studies including 1266 patients were analyzed. VD was reported in 25 % of patients (95 % CI 15–36 %), with significant heterogeneity (I² = 91.2 %). Incontinence occurred in 11 % (95 % CI 6–18 %), and elevated PVR were present in 20 % (95 % CI 7–38 %). Recurrent UTIs occurred in 22 %, but febrile UTIs were lower at 9 % (95 % CI 5–14 %), with minimal heterogeneity (I² = 0 %). Heterogeneity and bias were notable, likely due to varied definitions, surgical techniques, and follow-up durations across studies. Risk of bias was high, especially in domain 1 (bias due to confounding) with high likelihood of publication bias with trim-and-fill analysis suggesting lower rates of VD (8.5 %, 95 % CI 2.5–17.1 %)</div></div><div><h3>Discussion</h3><div>This study has key limitations, including biases from retrospective data, reliance on aggregate outcomes, heterogeneity in definitions and methods, and possible reporting biases. As children in this systematic review have undergone interventions, it is difficult to ascertain whether VD is attributable to congenital patient factors or more influenced by surgical technique. Despite this, the review provides a highest level of summary of voiding dysfunction prevalence in children with ureterocele.</div></div><div><h3>Conclusion</h3><div>Within limitation of current evidence, there is notable prevalence of postoperative voiding dysfunction and incontinence in children undergoing ureterocele surgery. The findings emphasize the need for standardized definitions and prospective studies to better characterize long-term outcomes and improve clinical decision-making for this population.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 6","pages":"Pages 1467-1474"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707907","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}

{"title":"Robotic approach to pediatric augmentation cystoplasty: Feasibility, long-term outcomes, and technical refinements","authors":"Priyank Yadav ,&nbsp;Deepak K. Kandpal ,&nbsp;Sujit K. Chowdhary","doi":"10.1016/j.jpurol.2025.07.012","DOIUrl":"10.1016/j.jpurol.2025.07.012","url":null,"abstract":"<div><h3>Introduction</h3><div>Pediatric bladder dysfunction refractory to conservative management poses significant risks to renal function. While open augmentation cystoplasty is the standard for surgical intervention, robotic-assisted techniques offer a minimally invasive alternative. This study evaluates our institutional experience with robotic augmentation cystoplasty in children, focusing on technical modifications, perioperative outcomes, and long-term functional results.</div></div><div><h3>Patients and methods</h3><div>This prospective series included 11 children who underwent robotic augmentation cystoplasty between January 2014 and December 2023. All had small-capacity, high-pressure bladders unresponsive to anticholinergics, clean intermittent catheterization, and/or intravesical botulinum toxin injection. Preoperative workup included ultrasonography, dimercaptosuccinic acid scans, and videourodynamic studies. A standardized technique using a detubularized ileal U-pouch and bladder bivalving was performed using the da Vinci Si/Xi system. Concomitant procedures included ureteric reimplantation and Mitrofanoff appendicovesicostomy in select cases. Outcomes assessed included operative parameters, urodynamic changes, complication rates, and long-term renal function.</div></div><div><h3>Results</h3><div>All surgeries were completed robotically without conversion. The mean age at surgery was 8.4 years (range: 2–15 years). Mean operative time was 355.5 min and mean estimated blood loss was 294.5 ml. Concomitant ureteric reimplantation was performed in 6 patients and Mitrofanoff creation in 1 patient. Mean bladder capacity improved from 86.4 ml to 283.6 ml (mean increase 383 %), and mean detrusor pressure decreased from 57.5 cm H₂O to 21.8 cm H₂O (62.1 % reduction). There were no major complications. Over a mean follow-up of 74 months, all patients reported improved continence and stable upper tract outcomes.</div></div><div><h3>Conclusion</h3><div>Robotic augmentation cystoplasty is a safe, effective, and durable alternative to open surgery in well-selected pediatric patients. Long-term outcomes demonstrate significant functional improvement. Our selective approach to Mitrofanoff creation may minimize morbidity while preserving surgical success.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 6","pages":"Pages 1611-1618"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707843","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}

{"title":"What's in a name: Imaging nomenclature in variations of sex development","authors":"Y. Frances Fei ,&nbsp;Jennifer A. Hansen–Moore ,&nbsp;Mitchell A. Rees ,&nbsp;Justin A. Indyk ,&nbsp;V. Rama Jayanthi","doi":"10.1016/j.jpurol.2025.07.031","DOIUrl":"10.1016/j.jpurol.2025.07.031","url":null,"abstract":"<div><h3>Study objective</h3><div>In patients with variations of sex development (VSD), phenotype may not match with karyotype and/or gonadal tissue. The neutral term “gonad” is often preferred (instead of “ovaries” or “testes”) to avoid confusion. This study describes the variability of nomenclature in imaging reports.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study of patients from 2007 to 2021 with a diagnosis of complete androgen insensitivity syndrome (CAIS), 45X/46XY or 46XX/46XY sex chromosomal mosaicism (SCM), and 46XY gonadal dysgenesis (GD).</div></div><div><h3>Results</h3><div>69 reports were analyzed, including 18 pelvic ultrasounds or magnetic resonance imaging (MRI) from patients with CAIS, 27 from patients with SCM, and 16 from patients with GD. In cases of CAIS, no imaging reports referred to “gonads.” In SCM, one ultrasound and one MRI noted “gonads.” In GD, one ultrasound and 3 MRI mentioned “gonads.” In 32 cases (46 %), the VSD diagnosis was listed as a reason for obtaining the imaging. Of these, only 4/32 (12 %) reports used “gonads” instead of “ovaries” and/or “testes.”</div></div><div><h3>Conclusion</h3><div>There is wide variability in nomenclature used for gonadal tissue in patients with VSD, which is often inaccurate and confusing. There is a need for establishment of best practice guidelines in radiological reporting for patients with VSD. We recommend usage of the neutral term “gonads” with a known VSD and other conditions which commonly lead to a VSD diagnosis, such as incongruence between gonadal appearance, karyotype, and/or sex assigned at birth, and atypical genitalia.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 6","pages":"Pages 1630-1635"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144835461","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}

{"title":"Comparing bladder bowel dysfunction (BBD) in children with attention deficit hyperactivity disorder (ADHD) with or without ADHD medical therapy and their initial response to BBD treatment","authors":"Amy A. Huang ,&nbsp;Christopher S. Cooper ,&nbsp;Laura L. Fuller ,&nbsp;Jude Shelton ,&nbsp;Hanh T.D. Pham ,&nbsp;Gina M. Lockwood ,&nbsp;Douglas W. Storm ,&nbsp;Angelena B. Edwards","doi":"10.1016/j.jpurol.2025.08.005","DOIUrl":"10.1016/j.jpurol.2025.08.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Children with attention deficit hyperactivity disorder (ADHD) are 4.5x more likely to have incontinence than their peers. Previous studies on comorbid ADHD and bladder bowel dysfunction (BBD) only included children with ADHD taking stimulant medications.</div></div><div><h3>Objective</h3><div>Comparing response to BBD treatment between patients with ADHD taking and not taking ADHD medications.</div></div><div><h3>Study design</h3><div>We reviewed urology patients 5–18 years of age seen between 1/1/2015 and 12/30/2022. Inclusion criteria included: BBD diagnosis, formal psychological diagnosis of ADHD and completion of our clinic's pediatric BBD questionnaire. BBD treatments included urotherapy behavioral modifications, bowel medications, and anticholinergic medications. An age-matched control cohort with BBD without ADHD served as a baseline reference of BBD. A linear mixed model compared BBD score trends between children with BBD with and without ADHD and between children taking and not taking ADHD medications.</div></div><div><h3>Results</h3><div>Patients with ADHD and BBD (n = 122) had higher baseline BBD scores on average than controls with BBD (n = 300), 8.86 and 11.68 points for those taking and not taking ADHD medication, respectively (p &lt; 0.001). At the final visit, the ADHD cohort had significantly higher final BBD scores, 23.46, when compared to controls, 18.16 (p &lt; 0.001). In the “urotherapy-only” group, patients not taking ADHD medication had 13.40-point higher baseline BBD score than those taking ADHD medications (p = 0.005). In the “urotherapy &amp; bowel medication” and “urotherapy, bowel, &amp; anticholinergic medication” groups, patients not taking ADHD medication had similar rates of improvement and BBD scores at baseline and the first follow-up visit to patients taking ADHD medication. The rate of improvement between patients taking and not taking ADHD medication was significantly different in the urotherapy-only group.</div></div><div><h3>Discussion</h3><div>Children with comorbid ADHD, regardless of ADHD medical therapy, have more severe BBD than their peers with BBD alone. Patients not taking ADHD medications improved with BBD treatment. However, ADHD medical therapy status may affect BBD management in children only performing behavioral modifications such as timed voiding or potty watch utilization.</div></div><div><h3>Conclusion</h3><div>Children with BBD and ADHD had more severe BBD scores than peers with BBD only. In the ADHD population, the children not taking ADHD medication had more severe baseline BBD than those taking ADHD medication within the group receiving urotherapy alone but demonstrated improvement in their BBD symptoms. Children with ADHD, regardless of ADHD medication status, were similar in their baseline and first follow-up visit BBD scores and rates of improvement when bowel and/or anticholinergic medications were added to urotherapy.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 6","pages":"Pages 1529-1535"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958349","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}

{"title":"Rotation of the corpora cavernosa for ventral penile curvature: A length-preserving approach","authors":"Sonia Pérez-Bertólez","doi":"10.1016/j.jpurol.2025.08.009","DOIUrl":"10.1016/j.jpurol.2025.08.009","url":null,"abstract":"<div><div>Ventral penile curvature (VPC) poses a significant surgical challenge, particularly in cases of severe angulation. Conventional techniques such as dorsal plication often result in penile shortening, while ventral grafting requires additional surgical stages. Corporal rotation offers an effective, length-preserving alternative but remains underutilized in pediatric patients. We describe a standardized technique for corporal rotation in children with or without hypospadias. In a series of 21 patients with long-term follow-up (median: 4.1 years), complete penile straightening was achieved in all cases, with no recurrence or significant shortening. This technique provides a reliable, reproducible option for VPC correction in pediatric urology.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 6","pages":"Pages 1955-1959"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958377","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}

{"title":"Response to Letter to the editor re: “Rotation of the corpora cavernosa for ventral penile curvature: A length-preserving approach”","authors":"Sonia Pérez-Bertólez","doi":"10.1016/j.jpurol.2025.08.025","DOIUrl":"10.1016/j.jpurol.2025.08.025","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 6","pages":"Pages 1961-1962"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145054312","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}

{"title":"Staged tubularized preputial graft in proximal hypospadias, are we in the right direction?","authors":"Amr K. Salama ,&nbsp;Waleed Dawood ,&nbsp;Ahmed Gaawan ,&nbsp;Ahmed Fahmy ,&nbsp;Mohamed Youssif ,&nbsp;Samir Orabi ,&nbsp;Haytham Badawy","doi":"10.1016/j.jpurol.2025.07.028","DOIUrl":"10.1016/j.jpurol.2025.07.028","url":null,"abstract":"<div><h3>Background</h3><div>Hypospadias is one of the most common congenital defects of male external genitalia. Correction of severe ventral curvature remains a main challenge to surgeons. The aim of this work was to assess short term outcomes of the staged tubularized preputial graft in primary proximal hypospadias with severe ventral curvature in our center with the hypothesis that it’s comparable to published results in the two stage repair technique.</div></div><div><h3>Methods</h3><div>A retrospective analysis of prospectively collected data that included 40 children was done, who had primary proximal hypospadias with moderate to severe ventral curvature (Study period started in December 2019 till January 2023). All patients had undergone staged tubularized preputial graft repair. Complication rates were evaluated. Cosmetic and functional outcomes were assessed using HOSE score.</div></div><div><h3>Results</h3><div>Forty patients aged from 6 months to 8 years had proximal hypospadias with ventral curvature with a mean ventral curvature 56.13 ± 18.96° after complete penile degloving. At the second stage all grafts were taken except in two patients. Following the first stage, 4 patients only had mild residual curvature that were corrected in the second stage. Over a median (IQR) follow up of 2.9 (1.2–4.0) years after second stage, 5 patients (13.1 %) had glans dehiscence, 6 patients (15.8 %) had urethro-cutaneous fistula, 4 patients had meatal stenosis (8 %), and two patients had neourethral stricture (5.3 %). Twenty-one patients had HOSE score 15 out 16 and others had score ranged from 12 to 14.</div></div><div><h3>Conclusion</h3><div>Repair of proximal hypospadias with severe curvature remains a challenge to paediatric urologists. A two-stage hypospadias repair with preputial grafting has achieved comparable success to other techniques. Complications (specifically glanular dehiscence and fistulas) should be explained thoroughly to the parents/caregivers which might need additional surgeries to correct it in the future.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 6","pages":"Pages 1581-1588"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000865","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}

{"title":"Deep drop in uroflowmetry of healthy children and adolescents","authors":"Li Yi Lim ,&nbsp;Stephen Shei-Dei Yang","doi":"10.1016/j.jpurol.2025.03.008","DOIUrl":"10.1016/j.jpurol.2025.03.008","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Uroflowmetry&lt;span&gt; is useful in the evaluation of patients with suspected lower urinary tract dysfunction (LUTD). The pattern may serve as a guide to a specific condition, so it is critical to interpret it accurately and consistently. There are various definitions for staccato patterns, but they are primarily descriptive and result in low inter-observer reliability. Some authors stated that a staccato pattern must include a specific amount of \"deep drops,\" \"notches,\" \"peaks,\" and \"fluctuations.\" However, our observations show that these features are common even in uroflowmetry curves of healthy individuals.&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To propose comprehensive criteria for defining \"deep drop (DD)”, assess the incidence of DD in uroflowmetry curves of healthy children and adolescents, and to evaluate the inter-rater agreement for this new definition.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and methods&lt;/h3&gt;&lt;div&gt;This study defines DD as a \"sudden decrease of flow ≥√Qmax followed by a rebound of flow ≥2 ml/s\". 1787 participants, aged 5–18 years, took 3158 uroflowmetry measurements. Uroflowmetry with artefacts (n = 466) as illustrated in the Supplementary Figure and low voided volume (VV) (n = 1425) were excluded.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Of the 1267 uroflowmetry curves included in the analysis, 16.0 %, 7.4 % and 7.3 % had one, two, and ≥three DDs, respectively. The incidence of any DD increased from 26.1 % at VV 50–75 ml of estimated bladder capacity (EBC) to 51.2 % at VV &gt;150 % of EBC (see Supplementary Table). Excluding uroflowmetry with large voided volume (LVV), the incidence of deep drops decreased to 15.7 %, 6.7 %, and 5.2 % for one, two, and three deep drops, respectively. Among 261 participants with two uroflowmetry measurements, 53.3 % had no DD on both occasions, while 4.6 % and 1.5 % had ≥ two and ≥three DDs on both occasions, respectively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;&lt;span&gt;DDs are common in the uroflowmetry of healthy subjects, but ≥2 DDs are uncommon. Based on these findings, the occurrence of ≥2 DDs on uroflowmetry, particularly if observed repeatedly, may warrant further evaluation for possible LUTD. Further research is needed to determine the validity of the DD definition and number of DD required to define the staccato pattern by correlating the urodynamic findings of patients with DD.&lt;/span&gt;&lt;span&gt;&lt;div&gt;&lt;span&gt;&lt;span&gt;&lt;p&gt;&lt;span&gt;Summary table 1&lt;/span&gt;. &lt;!--&gt;The frequency of deep drops increased as the voided volume (expressed in % of estimated bladder capacity (EBC)) increased.&lt;/p&gt;&lt;/span&gt;&lt;/span&gt;&lt;div&gt;&lt;table&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td&gt;&lt;strong&gt;EBC&lt;/strong&gt;&lt;/td&gt;&lt;td&gt;&lt;strong&gt;Percentage of uroflowmetry with the following number of deep drops&lt;/strong&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;&lt;strong&gt;0&lt;/strong&gt;&lt;/td&gt;&lt;td&gt;&lt;strong&gt;1&lt;/strong&gt;&lt;/td&gt;&lt;td&gt;&lt;strong&gt;2&lt;/strong&gt;&lt;/td&gt;&lt;td&gt;&lt;strong&gt;≥3&lt;/strong&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;&lt;strong&gt;50 to 75%&lt;/strong&gt;&lt;/td&gt;&lt;td&gt;73.9 %&lt;/td&gt;&lt;td&gt;15.2 %&lt;/td&gt;&lt;td&gt;7.0 %&lt;/td&gt;&lt;td&gt;3.9 %&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;&lt;strong&gt;&g","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 6","pages":"Pages 1503-1508"},"PeriodicalIF":1.9,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795731","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}