Journal of Pediatric Urology最新文献

Background: Patients with neurogenic bladder are at risk of developing renal deterioration secondary to increased intravesical pressures. To date, urodynamics is the gold standard test to properly assess bladder dynamics. Home bladder manometry is a low-cost and simple method to evaluate bladder pressures and volumes during clean intermittent catheterization (CIC). Previous literature has shown that home manometry measurements correlate with urodynamic pressures and hydronephrosis on ultrasound. However, no studies have evaluated the challenges and barriers faced by caregivers with the process.

Objective: Our objective was to investigate the experiences and perceptions of caregivers, healthcare providers, and nurses with home manometry.

Study design: We conducted semi-structured interviews and focus group discussions with 23 stakeholders. Stakeholders included caregivers of pediatric spina bifida neurogenic bladder patients, providers, and nursing staff. Grounded Theory Methods were used to analyze transcripts and identify preliminary concepts that described attitudes towards the current home bladder manometry process.

Results: Interview participants were composed of 10 (43 %) caregivers, 9 (40 %) healthcare providers, and 4 (17 %) nursing staff. The mean age was 39 years (range 26-66). The four themes identified during discussions were perspectives on home manometry, patient-specific characteristics, challenges with home manometry, and learning experience. All caregivers expressed understanding and agreement with the purpose and importance of home manometry. Emergent concepts identified as targets for improvement were the need for standardization of teaching processes with focus on hands-on practice, understanding of patient characteristics and the home environment that make the process more challenging, and the need for appropriate materials including extension tubing and catheters.

Conclusions: Home bladder manometry is a feasible and beneficial way for neurogenic bladder patients to monitor their bladder pressures and volumes at home. This qualitative study offers valuable insights into the experiences and viewpoints of caregivers, healthcare providers, and nurses regarding both home manometry and the general experience with CIC.

Introduction: Pediatric stone disease incidence has increased steadily over the last few decades. Several interrelated factors have been proposed to contribute to these epidemiologic trends including increased ambient temperature, body habitus, and food insecurity.

Objective: Given the significant cohort of children living with food insecurity in the United States, the aim of this study is to explore the relationship between food desert residence and obstructing stone disease resulting in surgical intervention in a cohort of pediatric patients.

Study design: Records of pediatric patients who presented to a single tertiary pediatric medical center for urolithiasis between 2009 and 2023 were retrospectively reviewed. Patients were included in the study if they had an obstructing stone; were older than 5 years of age; lacked anatomical predispositions to stone formation; and were regularly consuming a solid diet. Variables studied included demographics, BMI, medical comorbidities and family history, procedures performed, and stone burden. Patients' likelihood of living in a food desert was approximated using the United States Department of Agriculture Food Access Research Atlas.

Results: Of 637 patients reviewed, 199 pediatric patients (90 male and 109 female) were included in our analysis. One hundred and thirty patients (65.3%) had undergone ureteroscopy. Fifty-seven patients (28.6%) had a documented psychiatric comorbidity at time of presentation, with ADHD being the most common psychiatric comorbidity treated via medical management (n = 25, 43.9%). Our analysis demonstrated a significant association between surgical intervention, food desert residence (p = 0.003), and increased stone size (p = 0.001). Additionally, increased time between discharge on medical expulsive therapy and surgery decision was associated with past medical history of stones (p = 0.033) and food desert residence while undergoing stimulant treatment for ADHD (p < 0.001).

Conclusion: In this study, we found a significant association between food desert residence and obstructing pediatric stone disease resulting in surgical intervention. We also discuss a potential new association with pediatric stone disease: psychiatric comorbidity and the medical management of such diagnoses. To our knowledge, our study is among the first to assess the association between food insecurity and surgical intervention of pediatric urolithiasis. Given the importance diet plays in medical management of stone development, clinicians should take care to assess food security status of pediatric urolithiasis patients. Limitations to our study include a patient cohort from a singular hospital system, small sample size, and the changing nature of a patients' food security status.

Background: The early detection of the anatomical anomalies (e.g. micropenis) of the male external genital organs is crucial for both medical and psychological reasons. During routine pediatric visits, careful inspection using standards of penis size is beneficial for the diagnosis of micropenis and macropenis. Stretched penile length (SPL) has been shown to be more dependable than the flaccid penis length. Consequently, the SPL must be measured and compared to age-appropriate normal values.

Objective: This cross-sectional study aimed to determine the normal range of stretched penile length in newborns and children aged 1 month to 5 years in Syria and explore the correlation between SPL, height, and weight.

Study design: Data was collected from 300 Syrian males aged 0-5 years. SPL measurements were taken using a standardized procedure. Participants were divided into eight age groups. Statistical analysis determined the mean SPL, standard deviation, range, and rate of increase in SPL for each group. The distribution of SPL data was assessed using the Shapiro-Wilk test. Pearson correlation analysis examined the relationship between SPL and height, weight, and BMI.

Results: Mean SPL increased with age, ranging from 2.36 cm in newborns to 4.29 cm in children aged 48-60 months. The 48-60 months group exhibited the largest range of SPL. The rate of SPL increase was highest in children aged 1-2.9 months. SPL values followed a normal distribution. Significant positive correlations were found between SPL and weight in the 36-47.99 months group and between SPL and height in the 6-11.9 months and 36-47.99 months groups.

Conclusion: This study establishes the normal reference range of SPL in Syrian newborns and children aged 1 month to 5 years. The findings indicate that SPL is influenced significantly by height and weight in certain age groups. These results contribute to understanding penile development and can assist in the diagnosis and treatment of conditions affecting penile size.

Background: Hypospadias is a common congenital malformation. There are several classification systems for hypospadias. However, the phenotypic subtypes of hypospadias are inconsistently reported across databases due to the inherently subtle variability of the penile anatomy. Consistent classification of hypospadias would enable more accurate data regarding etiological correlates of specific subtypes as well as perioperative care and surgical outcomes. Existing classifications are designed for use by hypospadias surgeons, although there is a need for a system for epidemiologic data abstractors, who are generally not clinicians. The online Center for Disease Control (CDC) manual for birth defect surveillance includes a hypospadias atlas with photograph representation for different hypospadias phenotypic subtypes. However, this atlas is not widely known or used as a reference by pediatric urologists. We sought to evaluate the consistency amongst surgeons who specialize in managing this condition on the classification of hypospadias using the CDC atlas to determine whether this can be a tool in epidemiologic data collection.

Method: We developed a questionnaire using photographs taken directly from the CDC atlas for hypospadias. Demographic data regarding geographical location and years in practice also were obtained. The survey was distributed via email to members of the Society for Pediatric Urology and American Association of Pediatric Urologists. Responses were anonymously collected.

Result: 166 responses were received from 407 surveys request yielding a response rate of 40.8 %. Agreement with the CDC atlas on the classification of hypospadias by responders was 93.4 % for glanular hypospadias, 56.6 % for subcoronal hypospadias, 3.6 % for penile hypospadias, 54.2 for scrotal hypospadias, and 59 % for perineal hypospadias.

Conclusion: Our survey indicated that there is general disagreement in classification of hypospadias in the CDC atlas amongst members of pediatric urology societies. There exists a need for better standardization of a hypospadias classification system for epidemiologic research in hypospadias. Limitations of our study include a less than 50 % of survey responses received and large proportion of responders were from the United States.

Introduction: While most children with classic bladder exstrophy (CBE) are born with normal kidneys, some experience renal deterioration in adulthood. Little is known about the incidence of end-stage and chronic kidney disease (ESKD and CKD, respectively) in this population. Our group has recently published on surgical outcomes in a multi-institutional cohort of 216 people with CBE. Our aim was to describe the incidence of ESKD and prevalence of CKD in this cohort of people with CBE.

Methods: We retrospectively reviewed records of patients with CBE followed at five tertiary care centers described previously. The primary outcome was incidence of ESKD, defined as permanent peritoneal/hemodialysis or renal transplantation. The secondary outcome was prevalence of CKD stage 3 or higher (CKD3+, estimated glomerular filtration rate [eGFR]<60 ml/min/1.73 m²) at the last appointment. Creatinine-based eGFRs were calculated using the CKD-EPI Creatinine Equation (adults) and the Schwartz formula (children). Survival analysis and Fisher's exact test were used.

Results: A total of 201 patients (93 % of the original cohort) had renal function data available (63 % male). Four patients who had a primary urinary diversion remained diverted at a median follow-up of 20.1 years. None developed ESKD and one developed CKD3+. The remaining 197 patients had a primary bladder closure. At a median follow-up of 18.8 years old, 12 were diverted, 108 were augmented and 77 were neither. Three patients developed ESKD (1.5 %) at a median age of 23.4 years (1 hemodialysis, 2 transplantation). On survival analysis, the risk of ESKD was 0 % at 10 years, 1 % at 20 years and 5 % at 30 years (Figure 1). This was higher than the risk of 0.003 % at 21 years of age in the general population (p < 0.001). The median age of 141 individuals with eGFR data was 21.6 years old (65 % male). No children, 4 % of adolescents and 8 % of adults had CKD3+ (p = 0.45). On exploratory analyses, prevalence of CKD3+ did not differ by center or birth year (p ≥ 0.99).

Conclusions: The risk of ESKD and CKD among patients with CBE is not insignificant and appears to be more common than the general population. The potential role of modifiable contributing factors, such as increased bladder outlet resistance, warrants further investigation. Reliable long-term follow up is needed in this population to monitor for ESKD and CKD.

Background: Hydronephrosis could affect blood pressure (BP) according to published case reports and animal experiments. The impact on pediatric BP is often overlooked due to children's inherently lower BP, superior vascular elasticity and greater resistance to hypertension than adults.

Objective: This study aimed to prospectively observe the effects of hydronephrosis, secondary to ureteropelvic junction obstruction (UPJO), on pediatric BP.

Methods: Children with hydronephrosis secondary to UPJO who required pyeloplasty were categorized into five age groups: neonates, infants, toddlers, preschoolers, and school-aged children. Preoperative and postoperative systolic blood pressure (SBP), diastolic blood pressure (DBP), active renin concentration (ARC), and aldosterone concentration (AC) were compared among these age groups, followed by comparison with a control group of children without nephritis or cardiovascular conditions. The impact of severe hydronephrosis secondary to UPJO on pediatric BP and its association with the renin-angiotensin-aldosterone system (RAAS) were examined.

Results: This study enrolled 114 children with severe hydronephrosis secondary to UPJO and 153 without nephritic or cardiovascular conditions between September 2021 and June 2023. As the control group aged, SBP and DBP increased, whereas ARC and AC decreased. Overall, hydronephrosis group had higher SBP, DBP, ARC, and AC than the controls group. These differences differed between the age groups. After pyeloplasty, the postoperative BP of hydronephrosis group approximated that of the control group. Postoperative ARC levels were higher than those in the control group but were much lower than the preoperative levels. AC did not decrease significantly after surgery. The change in DBP in children with hydronephrosis before and after pyeloplasty showed a positive correlation with the change in AC.

Conclusions: Pediatric patients with severe hydronephrosis, a condition secondary to UPJO, displayed elevated BP, ARC, and AC. Following pyeloplasty, these patients noted a reduction in BP. The correlation between elevated blood pressure and the RAAS necessitates further comprehensive investigation.