Pub Date : 2024-10-01DOI: 10.1016/j.jpurol.2024.08.019
Hüseyin Özbey, Burak Maşalı, Bilge Bilgiç
{"title":"Notes from the underforeskin - Comment on “Technical nuances of the concealed penis”","authors":"Hüseyin Özbey, Burak Maşalı, Bilge Bilgiç","doi":"10.1016/j.jpurol.2024.08.019","DOIUrl":"10.1016/j.jpurol.2024.08.019","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"20 5","pages":"Pages 1004-1005"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269694","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}
Pub Date : 2024-10-01DOI: 10.1016/j.jpurol.2024.05.012
<div><h3>Introduction</h3><div><span>It is known the prevalence of varicoceles in adolescent men is 14–29% but there is debate surrounding implications on fertility. As obtaining a </span>semen analysis (SA) may be challenging, there is need for objective tests as measures of fecundity. Our aim was to investigate the relationship between testicular volume differential (TVD), varicocele grade, and total testicular volume (TTV) on seminal parameters including total motile sperm count (TMSC).</div></div><div><h3>Materials and methods</h3><div>We conducted a retrospective single-center chart review over 14 years of 486 Tanner V adolescent males. Three hundred and four met inclusion of palpable, non-operated left-sided varicocele who underwent at least one SA and ultrasound. Abnormal TMSC was defined by World Health Organization 2010 criteria for minimal reference ranges. Multivariate logistic regression, receiver operating characteristic analysis with Youden J-statistic and descriptive statistics were performed.</div></div><div><h3>Results</h3><div>Three hundred and four Tanner V adolescents with median age of 18.0 years (18.0–19.0), median TTV of 34.5 cc (28.9, 40.2) and median TMSC of 62.5 million/ejaculate (25.4, 123.4) were evaluated. TTV cutoff of 29.5 cc was found to predict TMSC of <9 million/ejaculate with negative predictive value of 96.2% and odds ratio of 6.08 ([2.13–17.42], p < 0.001). TVD greater than 20% did not reach statistical significance with an odds ratio of 1.66 ([0.41–6.62], p = 0.50).</div></div><div><h3>Discussion</h3><div>In clinical practice, each patient will need to have an individualized plan. Based on our data, for older adolescents (17 or 18 years) with varicocele and an abnormal TTV, clinicians may have a lower threshold for advising SA, and if unable to obtain, surgical intervention and/or closer surveillance should be stressed. Patients should be informed of their six-fold increase in abnormal SA. Patients with normal TTV should be advised they are at lower risk of having abnormal SA. Younger patients with varicocele and an initial TVD>20%, should be followed closely but intervention delayed until 17 or 18 to better assess TTV. The importance of trending patient data should be emphasized as a single measurement has low predictive value for developing adolescents. Limitations of our study include a retrospective design and the lack of uniform correlation between adolescent SA and paternity.</div></div><div><h3>Conclusions</h3><div><span>Total testicular volume less than 29.5 cc increased odds of abnormal semen analysis by over six times and had a negative predictive value of 96.2%. Ultrasound results may be useful for risk stratification and counselling on appropriateness of surgical intervention.</span><span><figure><span><img><ol><li><span><span>Download: <span>Download high-res image (159KB)</span></span></span></li><li><span><span>Download: <span>Download full-size image</span></span></span></li></ol></sp
导言：众所周知，精索静脉曲张在青少年男性中的发病率为 14%-29%，但围绕其对生育能力的影响还存在争议。由于获得精液分析（SA）可能具有挑战性，因此需要客观的测试来衡量生育能力。我们的目的是研究睾丸体积差（TVD）、精索静脉曲张等级和睾丸总体积（TTV）与精液参数（包括总活动精子数（TMSC））之间的关系：我们对 486 名坦纳 V 型青少年男性进行了 14 年的回顾性单中心病历审查。其中有 34 名符合可触及、未手术的左侧精索静脉曲张患者，他们至少接受了一次 SA 和超声检查。TMSC异常是根据世界卫生组织2010年最小参考范围标准定义的。研究人员进行了多变量逻辑回归、Youden J统计的接收者操作特征分析和描述性统计：共评估了 34 名坦纳 V 型青少年，他们的中位年龄为 18.0 岁（18.0-19.0），中位 TTV 为 34.5 cc（28.9-40.2），中位 TMSC 为 6250 万/射精（25.4-123.4）。结果发现，29.5 毫升的 TTV 临界值可预测讨论的 TMSC：在临床实践中，每位患者都需要制定个性化的计划。根据我们的数据，对于年龄较大（17 或 18 岁）、患有精索静脉曲张且 TTV 异常的青少年，临床医生可能会降低建议 SA 的门槛，如果无法获得 SA，则应强调手术干预和/或更密切的监测。应告知患者他们的异常 SA 增加了六倍。应告知 TTV 正常的患者，他们出现异常 SA 的风险较低。对于患有精索静脉曲张且初始 TVD>20% 的年轻患者，应进行密切随访，但应将干预延迟至 17 或 18 岁，以便更好地评估 TTV。由于单次测量对发育期青少年的预测价值较低，因此应强调对患者数据进行趋势分析的重要性。我们的研究存在局限性，包括研究设计具有回顾性，以及青少年睾丸肿大与亲子关系之间缺乏统一的相关性：结论：睾丸总体积小于 29.5 毫升会使精液分析异常的几率增加六倍以上，其阴性预测值为 96.2%。超声波结果可能有助于进行风险分层，并就手术干预的适当性提供咨询。
{"title":"Size matters: Total testicular volume predicts sperm count in Tanner V varicocele patients","authors":"","doi":"10.1016/j.jpurol.2024.05.012","DOIUrl":"10.1016/j.jpurol.2024.05.012","url":null,"abstract":"<div><h3>Introduction</h3><div><span>It is known the prevalence of varicoceles in adolescent men is 14–29% but there is debate surrounding implications on fertility. As obtaining a </span>semen analysis (SA) may be challenging, there is need for objective tests as measures of fecundity. Our aim was to investigate the relationship between testicular volume differential (TVD), varicocele grade, and total testicular volume (TTV) on seminal parameters including total motile sperm count (TMSC).</div></div><div><h3>Materials and methods</h3><div>We conducted a retrospective single-center chart review over 14 years of 486 Tanner V adolescent males. Three hundred and four met inclusion of palpable, non-operated left-sided varicocele who underwent at least one SA and ultrasound. Abnormal TMSC was defined by World Health Organization 2010 criteria for minimal reference ranges. Multivariate logistic regression, receiver operating characteristic analysis with Youden J-statistic and descriptive statistics were performed.</div></div><div><h3>Results</h3><div>Three hundred and four Tanner V adolescents with median age of 18.0 years (18.0–19.0), median TTV of 34.5 cc (28.9, 40.2) and median TMSC of 62.5 million/ejaculate (25.4, 123.4) were evaluated. TTV cutoff of 29.5 cc was found to predict TMSC of <9 million/ejaculate with negative predictive value of 96.2% and odds ratio of 6.08 ([2.13–17.42], p < 0.001). TVD greater than 20% did not reach statistical significance with an odds ratio of 1.66 ([0.41–6.62], p = 0.50).</div></div><div><h3>Discussion</h3><div>In clinical practice, each patient will need to have an individualized plan. Based on our data, for older adolescents (17 or 18 years) with varicocele and an abnormal TTV, clinicians may have a lower threshold for advising SA, and if unable to obtain, surgical intervention and/or closer surveillance should be stressed. Patients should be informed of their six-fold increase in abnormal SA. Patients with normal TTV should be advised they are at lower risk of having abnormal SA. Younger patients with varicocele and an initial TVD>20%, should be followed closely but intervention delayed until 17 or 18 to better assess TTV. The importance of trending patient data should be emphasized as a single measurement has low predictive value for developing adolescents. Limitations of our study include a retrospective design and the lack of uniform correlation between adolescent SA and paternity.</div></div><div><h3>Conclusions</h3><div><span>Total testicular volume less than 29.5 cc increased odds of abnormal semen analysis by over six times and had a negative predictive value of 96.2%. Ultrasound results may be useful for risk stratification and counselling on appropriateness of surgical intervention.</span><span><figure><span><img><ol><li><span><span>Download: <span>Download high-res image (159KB)</span></span></span></li><li><span><span>Download: <span>Download full-size image</span></span></span></li></ol></sp","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"20 5","pages":"Pages 960-966"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141320962","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}
Pub Date : 2024-10-01DOI: 10.1016/j.jpurol.2024.05.010
<div><h3>Background</h3><div>The transfer of pediatric<span> patients with testicular torsion from community hospitals to pediatric centers can be a time and resource-intensive step toward emergent surgical intervention.</span></div></div><div><h3>Objective</h3><div>We sought to describe trends of patient transfer in our state and compare clinical outcomes and health system costs between patients transferred and treated primarily at a pediatric center.</div></div><div><h3>Study design</h3><div><span>This retrospective cohort study compared patients aged 1–18 years who presented directly to a pediatric center to those transferred for acute testicular torsion from 2018 to 2023. Exclusion criteria included age <1 year, non-urgent surgery, and admission from clinic. Patient age, </span>BMI<span>, Tanner stage, ASA class, insurance coverage, and presentation time were covariates. Group characteristics and times from symptom onset to initial ED presentation to surgery were compared via two-sided Student's t-tests. Clinical outcomes (orchiectomy, testicular atrophy) were compared via Fisher's exact tests. Costs from transferring hospitals were estimated from costs at our institution, and medical transport costs were extrapolated from contract prices between transport agencies and the pediatric center to compare total episode-of-care cost.</span></div></div><div><h3>Results</h3><div><span>A total of 133 cases (37 primaries, 96 transfers) met inclusion criteria. Transfers increased over the study period (67%–75%). There were no significant differences in age, Tanner stage, ASA score, BMI, or time of day of presentation between groups. Median transfer distance was 12 miles (IQR 7–22) and time was 1 h (IQR 1–2). More than half of cases (53%) were transferred due to hospital policy regarding surgical treatment of minors, and 25% due to lack of urology coverage. Time from initial ED site to OR was nearly doubled for the transfer group (median 4.5 vs 2.5 h, p = 0.02). Despite a higher rate of </span>orchiectomy in the primary group (43 vs 22%, p = 0.01), this difference was not significant after stratification by symptom duration. The estimated average cost of care for patients transferred was twice that of primary patients ($15,082 vs $6898).</div></div><div><h3>Discussion</h3><div>Transfer of pediatric patients in our state for testicular torsion has increased in recent years. Hospital policies and local urology coverage are primary drivers of patient transfer which nearly doubled time to surgical intervention and more than doubled cost of care. Clinical outcomes were driven by delayed presentation.</div></div><div><h3>Conclusion</h3><div>Transfer of pediatric patients for testicular torsion nearly doubles time to surgical intervention and more than doubles cost of care. Restrictive hospital policies and gaps in rural hospital urology coverage present opportunities to improve the quality and efficiency of care for these children.<span><div><span><span><p>
{"title":"The ball's in your court: Trends, causes, outcomes, and costs of patient transfer for pediatric testicular torsion","authors":"","doi":"10.1016/j.jpurol.2024.05.010","DOIUrl":"10.1016/j.jpurol.2024.05.010","url":null,"abstract":"<div><h3>Background</h3><div>The transfer of pediatric<span> patients with testicular torsion from community hospitals to pediatric centers can be a time and resource-intensive step toward emergent surgical intervention.</span></div></div><div><h3>Objective</h3><div>We sought to describe trends of patient transfer in our state and compare clinical outcomes and health system costs between patients transferred and treated primarily at a pediatric center.</div></div><div><h3>Study design</h3><div><span>This retrospective cohort study compared patients aged 1–18 years who presented directly to a pediatric center to those transferred for acute testicular torsion from 2018 to 2023. Exclusion criteria included age <1 year, non-urgent surgery, and admission from clinic. Patient age, </span>BMI<span>, Tanner stage, ASA class, insurance coverage, and presentation time were covariates. Group characteristics and times from symptom onset to initial ED presentation to surgery were compared via two-sided Student's t-tests. Clinical outcomes (orchiectomy, testicular atrophy) were compared via Fisher's exact tests. Costs from transferring hospitals were estimated from costs at our institution, and medical transport costs were extrapolated from contract prices between transport agencies and the pediatric center to compare total episode-of-care cost.</span></div></div><div><h3>Results</h3><div><span>A total of 133 cases (37 primaries, 96 transfers) met inclusion criteria. Transfers increased over the study period (67%–75%). There were no significant differences in age, Tanner stage, ASA score, BMI, or time of day of presentation between groups. Median transfer distance was 12 miles (IQR 7–22) and time was 1 h (IQR 1–2). More than half of cases (53%) were transferred due to hospital policy regarding surgical treatment of minors, and 25% due to lack of urology coverage. Time from initial ED site to OR was nearly doubled for the transfer group (median 4.5 vs 2.5 h, p = 0.02). Despite a higher rate of </span>orchiectomy in the primary group (43 vs 22%, p = 0.01), this difference was not significant after stratification by symptom duration. The estimated average cost of care for patients transferred was twice that of primary patients ($15,082 vs $6898).</div></div><div><h3>Discussion</h3><div>Transfer of pediatric patients in our state for testicular torsion has increased in recent years. Hospital policies and local urology coverage are primary drivers of patient transfer which nearly doubled time to surgical intervention and more than doubled cost of care. Clinical outcomes were driven by delayed presentation.</div></div><div><h3>Conclusion</h3><div>Transfer of pediatric patients for testicular torsion nearly doubles time to surgical intervention and more than doubles cost of care. Restrictive hospital policies and gaps in rural hospital urology coverage present opportunities to improve the quality and efficiency of care for these children.<span><div><span><span><p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"20 5","pages":"Pages 929-936"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141310942","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}
Pub Date : 2024-10-01DOI: 10.1016/j.jpurol.2024.07.002
Molly E. Fuchs , Shruthi Srinivas , Raquel Quintanilla Amoros , Venkata R. Jayanthi , Richard J. Wood , Daniel G. Dajusta
Background
Girls with cloacal malformation are at risk of bladder dysfunction, with nearly 90% exhibiting some degree of dysfunction. Surgical dissection, particularly with total urogenital mobilization (TUM), has been hypothesized as a cause of worsening bladder function despite this population commonly having associated vertebral and spinal cord abnormalities that may also explain bladder dysfunction. More recently there has been great effort to select the appropriate surgical technique for cloacal repair in each patient in order to minimize dissection and potential damage to the bladder. We aimed to evaluate the effect of surgical cloacal repair on bladder function based on pre and post-surgery urodynamics (UDS) testing.
Methods
A prospectively collected database of patients with anorectal malformation at a single center was queried for girls with cloacal malformations who had undergone surgical repair from 2015 to 2022. It is our current protocol to perform UDS before and after cloacal repair. Only patients who completed both pre and post-surgery UDS were included. UDS were evaluated and classified using the UMPIRE protocol.
Results
A total of 48 patients were included in the cohort. The majority of patients (79.2%) had stable or improved UDS post-op leaving 10 patients (20.8%) who had worsening UDS. Long common channel (≥3 cm) was the only factor significantly associated with worsening UDS. (p = 0.03) Nearly 30% (n = 8) of those undergoing UGS had worse post-op UDS compared to 9.5% (n = 2) with TUM. All patients who worsened UDS initially had safe UDS that changed to intermediate, except for one who worsened to hostile in the setting of significant social challenges and non-compliance.
Only common channel length was predictive of worsening UDS, while the type of surgical approach and spine status were not. While the overall risk of worsening UDS after TUM is only 9.5%, patients with normal spines undergoing TUM had the lowest risk, seen in only one in 15 patients (6.6%).
Conclusions
Common channel length was the most significant predictor of worsening UDS, while spine status and surgical technique (TUM vs UGS) did not significantly impact this finding.
By following this established surgical protocol based on common channel and urethral lengths, is rare for the surgical cloacal repair to result in worsening post-op UDS, particularly in those undergoing TUM for short common channel and normal spine.
{"title":"The effect of surgical reconstruction on bladder function in cloacal malformation: A study of urodynamics","authors":"Molly E. Fuchs , Shruthi Srinivas , Raquel Quintanilla Amoros , Venkata R. Jayanthi , Richard J. Wood , Daniel G. Dajusta","doi":"10.1016/j.jpurol.2024.07.002","DOIUrl":"10.1016/j.jpurol.2024.07.002","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Girls with cloacal malformation are at risk of </span>bladder dysfunction, with nearly 90% exhibiting some degree of dysfunction. Surgical dissection, particularly with total urogenital mobilization (TUM), has been hypothesized as a cause of worsening </span>bladder function<span><span> despite this population commonly having associated vertebral and spinal cord abnormalities that may also explain bladder dysfunction. More recently there has been great effort to select the appropriate surgical technique for cloacal repair in each patient in order to minimize dissection and potential damage to the bladder. We aimed to evaluate the effect of surgical cloacal repair on bladder function based on pre and post-surgery </span>urodynamics (UDS) testing.</span></div></div><div><h3>Methods</h3><div>A prospectively collected database of patients with anorectal malformation at a single center was queried for girls with cloacal malformations who had undergone surgical repair from 2015 to 2022. It is our current protocol to perform UDS before and after cloacal repair. Only patients who completed both pre and post-surgery UDS were included. UDS were evaluated and classified using the UMPIRE protocol.</div></div><div><h3>Results</h3><div>A total of 48 patients were included in the cohort. The majority of patients (79.2%) had stable or improved UDS post-op leaving 10 patients (20.8%) who had worsening UDS. Long common channel (≥3 cm) was the only factor significantly associated with worsening UDS. (p = 0.03) Nearly 30% (n = 8) of those undergoing UGS had worse post-op UDS compared to 9.5% (n = 2) with TUM. All patients who worsened UDS initially had safe UDS that changed to intermediate, except for one who worsened to hostile in the setting of significant social challenges and non-compliance.</div><div>Only common channel length was predictive of worsening UDS, while the type of surgical approach and spine status were not. While the overall risk of worsening UDS after TUM is only 9.5%, patients with normal spines undergoing TUM had the lowest risk, seen in only one in 15 patients (6.6%).</div></div><div><h3>Conclusions</h3><div>Common channel length was the most significant predictor of worsening UDS, while spine status and surgical technique (TUM vs UGS) did not significantly impact this finding.</div><div>By following this established surgical protocol based on common channel and urethral lengths, is rare for the surgical cloacal repair to result in worsening post-op UDS, particularly in those undergoing TUM for short common channel and normal spine.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"20 5","pages":"Pages 904-910"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141692394","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}
Pub Date : 2024-10-01DOI: 10.1016/j.jpurol.2024.06.043
Stanley J. Kogan
{"title":"Commentary to the ball's in your court: Trends, causes, outcomes, and costs of patient transfer for pediatric testicular torsion","authors":"Stanley J. Kogan","doi":"10.1016/j.jpurol.2024.06.043","DOIUrl":"10.1016/j.jpurol.2024.06.043","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"20 5","pages":"Pages 937-938"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141692739","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}
Previous studies showed that extra blood supply can decrease testicular atrophy following laparoscopic orchiopexy. We evaluated the impact of preserving the gubernacular attachment (which contains blood supply from cremasteric artery and its anastomoses) on atrophy rates following open conventional orchiopexy.
Study design
This double-blinded randomized trial was implemented from March 2022 to September 2023. Included boys with non-palpable testis, even with examination under anesthesia, underwent diagnostic laparoscopy to evaluate the testis's location and size. Nubbin testes and those with > 2-cm distance from the internal inguinal ring. Participants were assigned into two groups (gubernaculum sparing (GS) and excision (GE)) by permuted block randomization. Overall success was defined as achieving both morphologic success (atrophy <20% of the intraoperative size) and anatomical success (scrotal or high-scrotal locations). Boys were followed at three- and six-month post-surgery via ultrasound. Independent t-test, repeated ANOVA, and Friedman's tests were used where appropriate.
Results
Of 92 boys (105 UDTs overall), 75 testes (36 in GS, 39 in GE groups) were used in the analysis. The mean age of participants was 25 ± 17 months (range 6–84). The mean testis size of cases intraoperatively was 460 ± 226, 396 ± 166, and 520 ± 258 mm3 among all participants, GS, and GE cases, respectively. Both groups showed a significant decrease in testicular volume on both follow-up checkpoints, but this decrement was significantly higher in the GE group (p < 0.001). The anatomical success rate was significantly higher among GS boys (97.2% versus 82.1%; p = 0.038). The overall success rate was significantly higher for the GS group (61.1% versus 25.6%; p = 0.002).
Conclusion
Although mean testicular volume decreased in both groups, we found superior morphologic and overall success rates among the GS group. The greatest size reduction was noted at the three-month post-surgery compared to the six-month checkpoint.
{"title":"Gubernaculum-sparing orchiopexy versus gubernaculum excision; A randomized trial on success and atrophy rates","authors":"Reza Abbasion , Mahdi Mottaghi , Parisa Saeidi Sharifabad , Masoud Mahdavi Rashed , Hassan Mehrad-Majd , Mohammadhadi Mohammadzadeh Rezaei","doi":"10.1016/j.jpurol.2024.06.041","DOIUrl":"10.1016/j.jpurol.2024.06.041","url":null,"abstract":"<div><h3>Introduction and objective</h3><div>Previous studies showed that extra blood supply<span><span> can decrease testicular atrophy following laparoscopic </span>orchiopexy. We evaluated the impact of preserving the gubernacular attachment (which contains blood supply from cremasteric artery and its anastomoses) on atrophy rates following open conventional orchiopexy.</span></div></div><div><h3>Study design</h3><div><span>This double-blinded randomized trial was implemented from March 2022 to September 2023. Included boys with non-palpable testis, even with examination under anesthesia, underwent diagnostic laparoscopy to evaluate the testis's location and size. Nubbin testes and those with > 2-cm distance from the internal inguinal ring. Participants were assigned into two groups (gubernaculum sparing (GS) and excision (GE)) by permuted block randomization. Overall success was defined as achieving both morphologic success (atrophy <20% of the intraoperative size) and anatomical success (scrotal or high-scrotal locations). Boys were followed at three- and six-month post-surgery via ultrasound. Independent t-test, repeated ANOVA, and </span>Friedman's tests were used where appropriate.</div></div><div><h3>Results</h3><div>Of 92 boys (105 UDTs overall), 75 testes (36 in GS, 39 in GE groups) were used in the analysis. The mean age of participants was 25 ± 17 months (range 6–84). The mean testis size of cases intraoperatively was 460 ± 226, 396 ± 166, and 520 ± 258 mm<sup>3</sup> among all participants, GS, and GE cases, respectively. Both groups showed a significant decrease in testicular volume on both follow-up checkpoints, but this decrement was significantly higher in the GE group (<em>p</em> < 0.001). The anatomical success rate was significantly higher among GS boys (97.2% versus 82.1%; <em>p</em> = 0.038). The overall success rate was significantly higher for the GS group (61.1% versus 25.6%; <em>p</em> = 0.002).</div></div><div><h3>Conclusion</h3><div>Although mean testicular volume decreased in both groups, we found superior morphologic and overall success rates among the GS group. The greatest size reduction was noted at the three-month post-surgery compared to the six-month checkpoint.</div></div><div><h3>Trial registration</h3><div><span><span>https://irct.ir/trial/58842</span><svg><path></path></svg></span>.<span><figure><span><img><ol><li><span><span>Download: <span>Download high-res image (385KB)</span></span></span></li><li><span><span>Download: <span>Download full-size image</span></span></span></li></ol></span><span><span><p><span>Summary figure</span>. </p></span></span></figure></span></div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"20 5","pages":"Pages 969-976"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141608206","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}
Pub Date : 2024-10-01DOI: 10.1016/j.jpurol.2024.02.026
Introduction
Abdominal radiographs are frequently used for evaluation of bowel and bladder dysfunction in pediatric urology. However, the dose of radiation delivered with each study is estimated from machine settings as opposed to measurement of the true entrance skin dose. In addition, the correlation of radiographic constipation with patient symptoms has been questioned.
Objective
To evaluate the practices for obtaining abdominal radiographs and the true entrance skin dose of radiation for each examination in order to identify targets for radiation reduction.
Study design
Pediatric urology patients were prospectively enrolled from June 2022 through June 2023. Dosimeters were attached to the navel to collect entrance skin doses from single view abdominal x-ray. Estimated doses were compared to measured entrance skin dose as well as patient characteristics. Exam parameters were evaluated to identify targets for radiation reduction.
Results
A total of 75 patients were recruited for this study with a median age of 10.0 years (IQR 6–14). Most evaluations were done to assess for bowel and bladder dysfunction (68 exams, 91%). The protocol for exams was not standardized resulting in 27% of patients undergoing a medium or high dose strength and 55% undergoing 1 or more image. The median estimated dose was 0.63 mGy (IQR 0.3–1.2 mGy). The median measured dose was 0.77 mGy (IQR 0.31–2.01 mGy) which was significantly different than the estimations (p < 0.001). The estimated dose, measured dose and estimate error were all found to be positively correlated with patient characteristics including age and body mass index (See Figure). Increasing age and body mass index also showed a higher likelihood of increased dose strength and image acquisition.
Discussion
The measured entrance skin dose of radiation is significantly higher than prior estimates. The measured dose but also the estimate error increased with patient age and size which is likely related to higher settings used for image acquisition as patients age. Standardized protocols using low dose settings and limiting image acquisition to the pelvis may reduce radiation exposure in children with bowel and bladder dysfunction while providing adequate diagnostic data.
Conclusion
Radiation dose for abdominal radiographs is higher than previously estimated. Older and larger children received higher doses which may be mediated by increased dose strength and image acquisition. Standardization of protocols could lower radiation exposure.
{"title":"Prospective assessment of entrance skin dose and targets for radiation reduction during abdominal plain films in pediatric urology patients","authors":"","doi":"10.1016/j.jpurol.2024.02.026","DOIUrl":"10.1016/j.jpurol.2024.02.026","url":null,"abstract":"<div><h3>Introduction</h3><div><span>Abdominal radiographs are frequently used for evaluation of bowel and bladder dysfunction in </span>pediatric urology. However, the dose of radiation delivered with each study is estimated from machine settings as opposed to measurement of the true entrance skin dose. In addition, the correlation of radiographic constipation with patient symptoms has been questioned.</div></div><div><h3>Objective</h3><div>To evaluate the practices for obtaining abdominal radiographs and the true entrance skin dose of radiation for each examination in order to identify targets for radiation reduction.</div></div><div><h3>Study design</h3><div>Pediatric urology patients were prospectively enrolled from June 2022 through June 2023. Dosimeters were attached to the navel to collect entrance skin doses from single view abdominal x-ray. Estimated doses were compared to measured entrance skin dose as well as patient characteristics. Exam parameters were evaluated to identify targets for radiation reduction.</div></div><div><h3>Results</h3><div><span>A total of 75 patients were recruited for this study with a median age of 10.0 years (IQR 6–14). Most evaluations were done to assess for bowel and bladder dysfunction (68 exams, 91%). The protocol for exams was not standardized resulting in 27% of patients undergoing a medium or high dose strength and 55% undergoing 1 or more image. The median estimated dose was 0.63 mGy (IQR 0.3–1.2 mGy). The median measured dose was 0.77 mGy (IQR 0.31–2.01 mGy) which was significantly different than the estimations (</span><em>p</em><span> < 0.001). The estimated dose, measured dose and estimate error were all found to be positively correlated with patient characteristics including age and body mass index (See Figure). Increasing age and body mass index also showed a higher likelihood of increased dose strength and image acquisition.</span></div></div><div><h3>Discussion</h3><div>The measured entrance skin dose of radiation is significantly higher than prior estimates. The measured dose but also the estimate error increased with patient age and size which is likely related to higher settings used for image acquisition as patients age. Standardized protocols using low dose settings and limiting image acquisition to the pelvis may reduce radiation exposure in children with bowel and bladder dysfunction while providing adequate diagnostic data.</div></div><div><h3>Conclusion</h3><div>Radiation dose for abdominal radiographs is higher than previously estimated. Older and larger children received higher doses which may be mediated by increased dose strength and image acquisition. Standardization of protocols could lower radiation exposure.</div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"20 5","pages":"Pages 793-798"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140044238","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}
Pub Date : 2024-10-01DOI: 10.1016/j.jpurol.2024.06.040
Michael Sennert , Christina Perske , Mohammed Fawzy , Johannes Wirmer , Ahmed T. Hadidi
<div><h3>Aim of the work</h3><div>Preoperative hormone stimulation (PHS) is used to increase the glans size and may improve the cosmetic appearance after hypospadias surgery. The exact effect of PHS on different penile tissues remains unclear and controversial. Previous studies showed that PHS increased vessel density in the foreskin. However, the effect of PHS on the urethral has never been studied before. In this study we examine the PHS effects on the urethral plate.</div></div><div><h3>Materials and methods</h3><div>Specimens of the urethral plate and the underlying tissue were excised to correct severe chordee in 16 children with proximal and perineal hypospadias with severe chordee in 2 groups. Group A consisted of 8 children received PHS prior to surgery. Group B included 8 children with proximal and perineal hypospadias with severe chordee who did not receive PHS and served as a control group. Specimens were examined blindly using hematoxylin-eosin and elastic van-Gieson stain as well as factor 8 and SMA antibodies.</div></div><div><h3>Results</h3><div>The median age of Group A was 13 (range 10–20) months. The median age of Group B (without prior PHS) was 17 (range 14–29) months (p = 0,03).</div><div>The median vessel-density in group A (82 vessels per mm<sup>2</sup>) was significantly higher than in Group B (65 per mm<sup>2</sup>), (p < 0.05). The median vessel diameter was also significantly higher in Group A (13 μm) than in Group B (11 μm), (p < 0.05). The median epithelial layer thickness in Group A was 110 μm and in Group B 98 μm, but showed no statistical significance (p = 0,16). There was no significant change in dartos fascia layer thickness or androgen receptor expression. There was no visual change in the organization of elastic fibers.</div></div><div><h3>Conclusion</h3><div>This study is the first study to document the effect of PHS on the urethral plate in hypospadias with severe chordee. PHS significantly increased the median vessel-density as well as median vessel diameter as compared to a matching control group. The findings of the study may justify PHS administration before the first operation to improve the vascularity and may reduce the severity of chordee.<span><figure><span><img><ol><li><span><span>Download: <span>Download high-res image (991KB)</span></span></span></li><li><span><span>Download: <span>Download full-size image</span></span></span></li></ol></span><span><span><p><span>Summary figure</span>. <!-->Histochemical findings after factor 8 staining and vessel diameter measurement. A shows a patient without PHS. B shows a patient after PHS. The increase of factor 8 and thus blood vessels is clearly visible in patient B. C&D: An area of 0,1 mm<sup>2</sup> was encircled and then mean diameter was added to 4 other circles to calculate the mean vessel diameter. C shows the same patient in A (without PHS, mean diameter size 11 μm) and D shows the patient B (after PHS, mean diameter size 13 μm).</p></span><
{"title":"The effect of preoperative hormonal stimulation on the urethral plate; A histologic and histochemical study","authors":"Michael Sennert , Christina Perske , Mohammed Fawzy , Johannes Wirmer , Ahmed T. Hadidi","doi":"10.1016/j.jpurol.2024.06.040","DOIUrl":"10.1016/j.jpurol.2024.06.040","url":null,"abstract":"<div><h3>Aim of the work</h3><div>Preoperative hormone stimulation (PHS) is used to increase the glans size and may improve the cosmetic appearance after hypospadias surgery. The exact effect of PHS on different penile tissues remains unclear and controversial. Previous studies showed that PHS increased vessel density in the foreskin. However, the effect of PHS on the urethral has never been studied before. In this study we examine the PHS effects on the urethral plate.</div></div><div><h3>Materials and methods</h3><div>Specimens of the urethral plate and the underlying tissue were excised to correct severe chordee in 16 children with proximal and perineal hypospadias with severe chordee in 2 groups. Group A consisted of 8 children received PHS prior to surgery. Group B included 8 children with proximal and perineal hypospadias with severe chordee who did not receive PHS and served as a control group. Specimens were examined blindly using hematoxylin-eosin and elastic van-Gieson stain as well as factor 8 and SMA antibodies.</div></div><div><h3>Results</h3><div>The median age of Group A was 13 (range 10–20) months. The median age of Group B (without prior PHS) was 17 (range 14–29) months (p = 0,03).</div><div>The median vessel-density in group A (82 vessels per mm<sup>2</sup>) was significantly higher than in Group B (65 per mm<sup>2</sup>), (p < 0.05). The median vessel diameter was also significantly higher in Group A (13 μm) than in Group B (11 μm), (p < 0.05). The median epithelial layer thickness in Group A was 110 μm and in Group B 98 μm, but showed no statistical significance (p = 0,16). There was no significant change in dartos fascia layer thickness or androgen receptor expression. There was no visual change in the organization of elastic fibers.</div></div><div><h3>Conclusion</h3><div>This study is the first study to document the effect of PHS on the urethral plate in hypospadias with severe chordee. PHS significantly increased the median vessel-density as well as median vessel diameter as compared to a matching control group. The findings of the study may justify PHS administration before the first operation to improve the vascularity and may reduce the severity of chordee.<span><figure><span><img><ol><li><span><span>Download: <span>Download high-res image (991KB)</span></span></span></li><li><span><span>Download: <span>Download full-size image</span></span></span></li></ol></span><span><span><p><span>Summary figure</span>. <!-->Histochemical findings after factor 8 staining and vessel diameter measurement. A shows a patient without PHS. B shows a patient after PHS. The increase of factor 8 and thus blood vessels is clearly visible in patient B. C&D: An area of 0,1 mm<sup>2</sup> was encircled and then mean diameter was added to 4 other circles to calculate the mean vessel diameter. C shows the same patient in A (without PHS, mean diameter size 11 μm) and D shows the patient B (after PHS, mean diameter size 13 μm).</p></span><","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"20 5","pages":"Pages 859-864"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141608207","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}
Pub Date : 2024-10-01DOI: 10.1016/j.jpurol.2024.06.030
{"title":"Response to “Profiling the dynamic pediatric urobiome: Missing links and future directions!”","authors":"","doi":"10.1016/j.jpurol.2024.06.030","DOIUrl":"10.1016/j.jpurol.2024.06.030","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"20 5","pages":"Pages 896-897"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141550712","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}
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