Pub Date : 2024-09-10DOI: 10.1016/j.jpurol.2024.08.022
Tryggve Nevéus
{"title":"Letter to the editors regarding Pillai RR, Sara B. Effectiveness of bladder retraining programme on bedwetting frequency and relapse rate of children with nocturnal enuresis. J Pediatr Urol. 2024.","authors":"Tryggve Nevéus","doi":"10.1016/j.jpurol.2024.08.022","DOIUrl":"https://doi.org/10.1016/j.jpurol.2024.08.022","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289727","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 : 2024-09-10DOI: 10.1016/j.jpurol.2024.09.001
Eeke Leerssen
{"title":"Response to commentary re \"Seeking clinical consensus on risk assessment in anatomical infravesical obstruction of boys - a Delphi study\".","authors":"Eeke Leerssen","doi":"10.1016/j.jpurol.2024.09.001","DOIUrl":"https://doi.org/10.1016/j.jpurol.2024.09.001","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348867","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 : 2024-09-07DOI: 10.1016/j.jpurol.2024.09.004
Benjamin Wagstaff, Gayathri Panabokke, Andrew Barker, Japinder Khosa, Naeem Samnakay
Bladder dysfunction (BD) is a common presenting complaint to paediatric urology outpatient clinics, accounting for up to 47% of referrals and affecting one in ten children of toilet training age. Boys with bladder dysfunction have been shown to have higher rates of posterior urethral valves (PUV) however when to consider cystourethroscopy in this group is unclear. Our primary aim was to assess the likelihood of detecting PUV in a cohort of boys of toilet training age presenting to a paediatric urologist with symptoms of bladder dysfunction. Our secondary aim was to assess whether resection of PUV was associated with improved clinical outcome. Retrospective review of male patients aged 4–16 (January 2007 to December 2023), referred to paediatric urologist in an Australian outpatient clinic with BD undergoing cystourethroscopy. Those with known renal tract or spinal pathology were excluded. Patients were divided into four groups according to their symptoms/investigation results. Patients were followed up to assess improvement in symptoms following resection of PUV. 247 boys were included in this study with a median age of 8.1 years. 81/247 (32.8%) had PUV on cystourethroscopy. The highest incidence of PUV 13/25 (52%) was in those patients with BD, haematuria or UTI and ultrasound (USS) changes. There was no difference in outcome improvement in those who underwent resection of PUV when compared with those without PUV. Our study findings concur with results from previous literature identifying higher rates of PUV in older boys with bladder dysfunction. We have utilised straightforward clinical criteria to provide a targeted framework for screening with cystourethrogram. There was no difference in outcomes when PUV was resected, compared to those without PUV. Limitations of this study include the retrospective nature, possible selection and reporting biases. The likelihood of detecting PUV in our cohort of boys aged 4–16 with bladder dysfunction was 32.8%. The four groups provide clinicians with guidance on who may benefit from cystoscopy. This study provides future scope for a prospective interventional study of PUV in boys with BD.
{"title":"Boys with bladder dysfunction may have posterior urethral valves – A simple framework to aid investigation","authors":"Benjamin Wagstaff, Gayathri Panabokke, Andrew Barker, Japinder Khosa, Naeem Samnakay","doi":"10.1016/j.jpurol.2024.09.004","DOIUrl":"https://doi.org/10.1016/j.jpurol.2024.09.004","url":null,"abstract":"Bladder dysfunction (BD) is a common presenting complaint to paediatric urology outpatient clinics, accounting for up to 47% of referrals and affecting one in ten children of toilet training age. Boys with bladder dysfunction have been shown to have higher rates of posterior urethral valves (PUV) however when to consider cystourethroscopy in this group is unclear. Our primary aim was to assess the likelihood of detecting PUV in a cohort of boys of toilet training age presenting to a paediatric urologist with symptoms of bladder dysfunction. Our secondary aim was to assess whether resection of PUV was associated with improved clinical outcome. Retrospective review of male patients aged 4–16 (January 2007 to December 2023), referred to paediatric urologist in an Australian outpatient clinic with BD undergoing cystourethroscopy. Those with known renal tract or spinal pathology were excluded. Patients were divided into four groups according to their symptoms/investigation results. Patients were followed up to assess improvement in symptoms following resection of PUV. 247 boys were included in this study with a median age of 8.1 years. 81/247 (32.8%) had PUV on cystourethroscopy. The highest incidence of PUV 13/25 (52%) was in those patients with BD, haematuria or UTI and ultrasound (USS) changes. There was no difference in outcome improvement in those who underwent resection of PUV when compared with those without PUV. Our study findings concur with results from previous literature identifying higher rates of PUV in older boys with bladder dysfunction. We have utilised straightforward clinical criteria to provide a targeted framework for screening with cystourethrogram. There was no difference in outcomes when PUV was resected, compared to those without PUV. Limitations of this study include the retrospective nature, possible selection and reporting biases. The likelihood of detecting PUV in our cohort of boys aged 4–16 with bladder dysfunction was 32.8%. The four groups provide clinicians with guidance on who may benefit from cystoscopy. This study provides future scope for a prospective interventional study of PUV in boys with BD.","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142267635","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}
The postpubertal effects of testis-sparing surgery on prepubertal testicular tumors are not fully understood. In this study, we aimed to evaluate the effect of different durations of warm and cold ischemia during a rat prepubertal testis-sparing surgery model on the ischemic and contralateral normal testes in the postpubertal period. The study encompassed a group of 54 male rats in the prepubertal stage who were then arranged to be put into nine groups: sham (Sh), control-cold (Cc), control-biopsy (Cb), 30, 60 or 90min warm ischemia (WIb,WIb,WIb) and cold ischemia (CIb,CIb,CIb). In the ischemia groups, a microvascular clamp was applied to the right spermatic cord, then testicular biopsy was taken. In the cold ischemia groups, the testicles were preserved in sterile ice mud. After the experiment, the rats were observed for 4 weeks to pinpoint any changes during their progression into the post-pubertal period. In our investigation, rats in all groups exhibited similar weight gains. The postpubertal size of the right testis in the testicular biopsy groups was found to be smaller compared to the remaining groups. In the warm ischemia group, testicular atrophy occurred after ischemic duration exceeding 30 min. Conversely, no testicular atrophy was observed in the cold ischemia groups. The dimensions of the rats' left testicles were similar. On histopathology, right testicular Johnsen scores were significantly lower in the warm ischemic groups than in the cold ischemic groups. Our study is the first to investigate the postpubertal effects of varying durations of warm and cold ischemia in a prepubertal testis-sparing surgery model. In our study, the Johnsen scores of testes subjected to 30, 60, and 90 min of ischemia were found to be higher in the cold ischemia groups compared to the warm ischemia groups. As the ischemia duration prolonged, a discernible progression of testicular atrophy was observed in the warm ischemia groups, contrasting with the sustained stability of testicular sizes in the cold ischemia groups. Warm ischemia applied to the testis causes damage to the testicle within the first 30 min and leads to atrophy after 30 min. In the cases of warm ischemia, both the Johnsen scores, which serve as indicators of post-pubertal fertility, and the testicular size decline in parallel with the duration of ischemia.
{"title":"Experimental study of the effectiveness of warm ischemia and cold ischemia during testis-sparing surgery in rats","authors":"Emine Doğan, Ayşe Karaman, Habibe Meltem Özgüner, Cengiz Karakaya","doi":"10.1016/j.jpurol.2024.08.015","DOIUrl":"https://doi.org/10.1016/j.jpurol.2024.08.015","url":null,"abstract":"The postpubertal effects of testis-sparing surgery on prepubertal testicular tumors are not fully understood. In this study, we aimed to evaluate the effect of different durations of warm and cold ischemia during a rat prepubertal testis-sparing surgery model on the ischemic and contralateral normal testes in the postpubertal period. The study encompassed a group of 54 male rats in the prepubertal stage who were then arranged to be put into nine groups: sham (Sh), control-cold (Cc), control-biopsy (Cb), 30, 60 or 90min warm ischemia (WIb,WIb,WIb) and cold ischemia (CIb,CIb,CIb). In the ischemia groups, a microvascular clamp was applied to the right spermatic cord, then testicular biopsy was taken. In the cold ischemia groups, the testicles were preserved in sterile ice mud. After the experiment, the rats were observed for 4 weeks to pinpoint any changes during their progression into the post-pubertal period. In our investigation, rats in all groups exhibited similar weight gains. The postpubertal size of the right testis in the testicular biopsy groups was found to be smaller compared to the remaining groups. In the warm ischemia group, testicular atrophy occurred after ischemic duration exceeding 30 min. Conversely, no testicular atrophy was observed in the cold ischemia groups. The dimensions of the rats' left testicles were similar. On histopathology, right testicular Johnsen scores were significantly lower in the warm ischemic groups than in the cold ischemic groups. Our study is the first to investigate the postpubertal effects of varying durations of warm and cold ischemia in a prepubertal testis-sparing surgery model. In our study, the Johnsen scores of testes subjected to 30, 60, and 90 min of ischemia were found to be higher in the cold ischemia groups compared to the warm ischemia groups. As the ischemia duration prolonged, a discernible progression of testicular atrophy was observed in the warm ischemia groups, contrasting with the sustained stability of testicular sizes in the cold ischemia groups. Warm ischemia applied to the testis causes damage to the testicle within the first 30 min and leads to atrophy after 30 min. In the cases of warm ischemia, both the Johnsen scores, which serve as indicators of post-pubertal fertility, and the testicular size decline in parallel with the duration of ischemia.","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142267604","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 : 2024-09-03DOI: 10.1016/j.jpurol.2024.08.021
Catalina K. Hwang, Emma L. Gause, Vishnu Iyer, Jackson Schmidt, Judith C. Hagedorn, Alexander J. Skokan
To describe the intermediate-term incidence of hypertension following pediatric renal trauma relative to that in an extremity (control group) trauma cohort. This was a single-institution matched cohort study of pediatric patients presenting to a Level I trauma center between 2010 and 2019. The primary cohort included patients who sustained renal trauma, and a comparator cohort of sex- and age-matched patients with isolated extremity fracture was identified. The primary outcome was new hypertension, and a sensitivity analysis was conducted of any elevated blood pressure (EBP). Conditional logistic regression was performed and adjusted for overweight/obese status. There were 62 renal trauma patients included, representing 35% of all eligible patients seen in the study period. Hypertension was not found to be more prevalent with renal trauma (OR 1.18, 95% CI: 0.41, 3.39). The incidence of hypertension (9.7–11.3%) and EBP (22.6–32.3%) was comparable between renal trauma and control groups. Despite a high incidence of EBP and hypertension in pediatric patients after renal or extremity trauma, we did not observe an association between renal trauma and postinjury hypertension. We identified no cases of malignant or symptomatic hypertension, and no surgical interventions for renovascular hypertension was performed. Our findings suggest that only select patients, rather than most renal trauma patients, may benefit from monitoring for postinjury hypertension.
{"title":"The incidence of hypertension among children after renal trauma: A matched cohort analysis","authors":"Catalina K. Hwang, Emma L. Gause, Vishnu Iyer, Jackson Schmidt, Judith C. Hagedorn, Alexander J. Skokan","doi":"10.1016/j.jpurol.2024.08.021","DOIUrl":"https://doi.org/10.1016/j.jpurol.2024.08.021","url":null,"abstract":"To describe the intermediate-term incidence of hypertension following pediatric renal trauma relative to that in an extremity (control group) trauma cohort. This was a single-institution matched cohort study of pediatric patients presenting to a Level I trauma center between 2010 and 2019. The primary cohort included patients who sustained renal trauma, and a comparator cohort of sex- and age-matched patients with isolated extremity fracture was identified. The primary outcome was new hypertension, and a sensitivity analysis was conducted of any elevated blood pressure (EBP). Conditional logistic regression was performed and adjusted for overweight/obese status. There were 62 renal trauma patients included, representing 35% of all eligible patients seen in the study period. Hypertension was not found to be more prevalent with renal trauma (OR 1.18, 95% CI: 0.41, 3.39). The incidence of hypertension (9.7–11.3%) and EBP (22.6–32.3%) was comparable between renal trauma and control groups. Despite a high incidence of EBP and hypertension in pediatric patients after renal or extremity trauma, we did not observe an association between renal trauma and postinjury hypertension. We identified no cases of malignant or symptomatic hypertension, and no surgical interventions for renovascular hypertension was performed. Our findings suggest that only select patients, rather than most renal trauma patients, may benefit from monitoring for postinjury hypertension.","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142267636","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 : 2024-09-03DOI: 10.1016/j.jpurol.2024.08.020
Danniele Almeida Neri, Bruna Afonso Venturini, Eliakim Massuqueto, Glícia Estevam de Abreu, Matheus Mascarenhas Portugal, Juliana Costa, Maria Karolina Velame Souza Santos, Catarina de Araújo Rosier, Gabriel Monteiro, Ubirajara Barroso Jr.
Uroflowmetry is a non-invasive examination considered as a first-line assessment for children with lower urinary tract symptoms (LUTS). Currently, the performance of two uroflowmetry tests is recommended by ICCS for all patients with LUTS. This study aims to evaluate the differences between two uroflowmetry tests in children with lower urinary tract symptoms and their impact on the patient's diagnostic workup and clinical outcome. Forty patients with LUTS, aged 4–17 years, were evaluated prospectively with two consecutive uroflowmetry tests and ultrasonography. They were classified based on the ICCS criteria for curve pattern and divided into two groups based on the SPU classification of fractionated (staccato and intermittent) and smooth (bell, tower and plateau). They were also separated into three groups based on estimated bladder capacity (voided volume + post-void residual on ultrasound): high (>115%), low (<60%) or normal capacity. The mean age was 8 (IQR 6.0–10.0) years and 25 (62.5%) patients were female. There was an increase in nonbell-shaped curves from the first (32.5%) to the second test (52.5%). The curve shape between the uroflowmetries based on ICCS classification showed a Kappa value of 0.349 (fair). Classifying curves as fractionated or smooth yielded a Kappa value of 0.714 (substantial) (table). The Bland–Altman test showed disagreement in the parameter of time to Qmax. There was a significant difference in categorizing bladder capacity as high, low, or normal: it was concordant in 63.6% for high, 68.4% for normal and 50% for low capacity (p = 0.001). Despite the disagreement found classifying the curves based on the ICCS pattern, also demonstrated in other studies, there was a substantial agreement using the SPU criteria. It reinforces the greater reliability of the SPU system and it may be the key to reduce the subjectivity of uroflowmetry. Even though this classification being associated with a higher agreement in interpretation of the curves, repeating uroflowmetry does not present a clinically significant divergence that changes the patient's diagnostic workup. Our study is limited by the lack of EMG and larger sample. Considering the flow curve pattern, the agreement between two uroflowmetries was substantial according to the SPU and only reasonable by the ICCS classification. Regardless of some differences found between the flows, a second uroflowmetry test might not have clinical relevance that justifies its recommendation for all patients.
{"title":"Agreement between two uroflowmetry tests in children with lower urinary tract symptoms","authors":"Danniele Almeida Neri, Bruna Afonso Venturini, Eliakim Massuqueto, Glícia Estevam de Abreu, Matheus Mascarenhas Portugal, Juliana Costa, Maria Karolina Velame Souza Santos, Catarina de Araújo Rosier, Gabriel Monteiro, Ubirajara Barroso Jr.","doi":"10.1016/j.jpurol.2024.08.020","DOIUrl":"https://doi.org/10.1016/j.jpurol.2024.08.020","url":null,"abstract":"Uroflowmetry is a non-invasive examination considered as a first-line assessment for children with lower urinary tract symptoms (LUTS). Currently, the performance of two uroflowmetry tests is recommended by ICCS for all patients with LUTS. This study aims to evaluate the differences between two uroflowmetry tests in children with lower urinary tract symptoms and their impact on the patient's diagnostic workup and clinical outcome. Forty patients with LUTS, aged 4–17 years, were evaluated prospectively with two consecutive uroflowmetry tests and ultrasonography. They were classified based on the ICCS criteria for curve pattern and divided into two groups based on the SPU classification of fractionated (staccato and intermittent) and smooth (bell, tower and plateau). They were also separated into three groups based on estimated bladder capacity (voided volume + post-void residual on ultrasound): high (>115%), low (<60%) or normal capacity. The mean age was 8 (IQR 6.0–10.0) years and 25 (62.5%) patients were female. There was an increase in nonbell-shaped curves from the first (32.5%) to the second test (52.5%). The curve shape between the uroflowmetries based on ICCS classification showed a Kappa value of 0.349 (fair). Classifying curves as fractionated or smooth yielded a Kappa value of 0.714 (substantial) (table). The Bland–Altman test showed disagreement in the parameter of time to Qmax. There was a significant difference in categorizing bladder capacity as high, low, or normal: it was concordant in 63.6% for high, 68.4% for normal and 50% for low capacity (p = 0.001). Despite the disagreement found classifying the curves based on the ICCS pattern, also demonstrated in other studies, there was a substantial agreement using the SPU criteria. It reinforces the greater reliability of the SPU system and it may be the key to reduce the subjectivity of uroflowmetry. Even though this classification being associated with a higher agreement in interpretation of the curves, repeating uroflowmetry does not present a clinically significant divergence that changes the patient's diagnostic workup. Our study is limited by the lack of EMG and larger sample. Considering the flow curve pattern, the agreement between two uroflowmetries was substantial according to the SPU and only reasonable by the ICCS classification. Regardless of some differences found between the flows, a second uroflowmetry test might not have clinical relevance that justifies its recommendation for all patients.","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142267637","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 : 2024-08-31DOI: 10.1016/j.jpurol.2024.08.016
Julia Bhuiyan, Raghuveer Kavarthapu, Mary Soliman, G Thomas Brown, Jacqueline C. Yano, Tazim Dowlut-McElroy, Veronica Gomez-Lobo
{"title":"Histologic analysis of gonadal tissue in patients with Turner syndrome and Y chromosome material (Response to commentary)","authors":"Julia Bhuiyan, Raghuveer Kavarthapu, Mary Soliman, G Thomas Brown, Jacqueline C. Yano, Tazim Dowlut-McElroy, Veronica Gomez-Lobo","doi":"10.1016/j.jpurol.2024.08.016","DOIUrl":"https://doi.org/10.1016/j.jpurol.2024.08.016","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142267639","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 : 2024-08-31DOI: 10.1016/j.jpurol.2024.08.012
Lily Kong, Carter Sevick, Gemma Beltran, Kyle Rove, Duncan Wilcox, Sarah Hecht
Surgical management for neurogenic bladder requires complex decision-making by physicians, patients, and caregivers. Assessing decisional regret (DR) as a patient-reported outcome among caregivers could inform future counseling and shared decision-making. To assess DR among caregivers of children with neurogenic bladder following reconstructive bladder surgery. A questionnaire including a validated DR survey was distributed to English-speaking caregivers of children with neurogenic bladder who had undergone reconstructive bladder surgery at Children's Hospital Colorado. DR scores range from zero to 100, with higher numbers indicating higher regret. Wilcoxon rank sum test and Spearman correlation were performed to assess differences in DR scores by patient demographic factors or disease factors. Forty-five of 210 English-speaking caregivers completed the DR survey. The median DR score was 5, with 40% of subjects reporting with a DR score of zero and 24% of subjects with a DR score of 30 or higher. Patient sex and Mitrofanoff leakage were found to be associated with DR, with caregivers of male patients reporting significantly higher DR. Surgical procedure did not have a statistically significant impact on DR scores. Sparse existing data exploring DR among patients with neurogenic bladder suggest DR following reconstructive bladder surgery is low, with few identifiable predictors of regret. While the majority of caregivers in our study report little or no DR, one quarter of caregivers report moderate to high DR. The limitations of this study include small cohort size, low response rate, exclusion of non-English speaking patients, and the potential for recall bias due to the survey design of the study. Caregiver DR following bladder reconstruction in children with neurogenic bladder is generally low, however a subset of caregivers reports significant DR. This study suggests that caregivers of male children may have higher DR, a finding that merits further investigation.
神经源性膀胱的手术治疗需要医生、患者和护理人员做出复杂的决策。作为患者报告的结果，评估护理人员的决策后悔（DR）可为未来的咨询和共同决策提供参考。目的：评估膀胱重建手术后神经源性膀胱患儿护理人员的决策后悔度。我们向在科罗拉多儿童医院接受膀胱重建手术的神经源性膀胱患儿的英语护理人员发放了一份问卷，其中包括一项经过验证的DR调查。DR评分从0到100分不等，数字越大表示越遗憾。我们采用 Wilcoxon 秩和检验和 Spearman 相关性来评估患者人口统计因素或疾病因素对 DR 分数的影响。210 位讲英语的护理人员中有 45 位完成了 DR 调查。DR 评分中位数为 5 分，40% 的受试者报告 DR 评分为零，24% 的受试者报告 DR 评分为 30 分或更高。研究发现，患者性别和米特罗法诺夫渗漏与DR有关，男性患者的护理人员报告的DR明显更高。手术过程对 DR 评分没有统计学意义上的影响。关于神经源性膀胱患者 DR 的现有稀缺数据表明，膀胱重建手术后的 DR 很低，几乎没有可识别的后悔预测因素。在我们的研究中，虽然大多数护理人员表示很少或根本没有 DR，但也有四分之一的护理人员表示有中度到高度的 DR。本研究的局限性包括队列规模小、响应率低、排除了非英语患者，以及由于研究的调查设计而可能导致的回忆偏差。神经源性膀胱患儿膀胱重建术后护理人员的 DR 一般较低，但也有一部分护理人员报告了显著的 DR。本研究表明，男性患儿的护理人员可能会有更高的 DR，这一发现值得进一步研究。
{"title":"Caregiver decisional regret following reconstructive bladder surgery in children with neurogenic bladder","authors":"Lily Kong, Carter Sevick, Gemma Beltran, Kyle Rove, Duncan Wilcox, Sarah Hecht","doi":"10.1016/j.jpurol.2024.08.012","DOIUrl":"https://doi.org/10.1016/j.jpurol.2024.08.012","url":null,"abstract":"Surgical management for neurogenic bladder requires complex decision-making by physicians, patients, and caregivers. Assessing decisional regret (DR) as a patient-reported outcome among caregivers could inform future counseling and shared decision-making. To assess DR among caregivers of children with neurogenic bladder following reconstructive bladder surgery. A questionnaire including a validated DR survey was distributed to English-speaking caregivers of children with neurogenic bladder who had undergone reconstructive bladder surgery at Children's Hospital Colorado. DR scores range from zero to 100, with higher numbers indicating higher regret. Wilcoxon rank sum test and Spearman correlation were performed to assess differences in DR scores by patient demographic factors or disease factors. Forty-five of 210 English-speaking caregivers completed the DR survey. The median DR score was 5, with 40% of subjects reporting with a DR score of zero and 24% of subjects with a DR score of 30 or higher. Patient sex and Mitrofanoff leakage were found to be associated with DR, with caregivers of male patients reporting significantly higher DR. Surgical procedure did not have a statistically significant impact on DR scores. Sparse existing data exploring DR among patients with neurogenic bladder suggest DR following reconstructive bladder surgery is low, with few identifiable predictors of regret. While the majority of caregivers in our study report little or no DR, one quarter of caregivers report moderate to high DR. The limitations of this study include small cohort size, low response rate, exclusion of non-English speaking patients, and the potential for recall bias due to the survey design of the study. Caregiver DR following bladder reconstruction in children with neurogenic bladder is generally low, however a subset of caregivers reports significant DR. This study suggests that caregivers of male children may have higher DR, a finding that merits further investigation.","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269693","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 : 2024-08-31DOI: 10.1016/j.jpurol.2024.08.018
Chu Zhang, Qingqing Tian, Xiang Zhao, Ning Li
{"title":"Correction of residual ventral penile curvature after division of the urethral plate in the first stage of a 2-stage proximal hypospadias repair","authors":"Chu Zhang, Qingqing Tian, Xiang Zhao, Ning Li","doi":"10.1016/j.jpurol.2024.08.018","DOIUrl":"https://doi.org/10.1016/j.jpurol.2024.08.018","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142267638","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 : 2024-08-31DOI: 10.1016/j.jpurol.2024.08.013
Matthew R. Danzig, Seth A. Alpert, Hillary L. Copp, Travis W. Groth, Christopher D. Jaeger, Kathleen Kieran, Katherine Sheridan, Benjamin M. Whittam, Elizabeth B. Yerkes, Jonathan S. Ellison
North American Pediatric Urology fellowship programs underwent a structural change in 2021 that allows more flexibility in training. Given this opportunity as well as widespread concern about the development of contemporary surgical trainees, it is prudent to understand in detail the current state of preparedness of pediatric urology fellowship graduates for independent practice. The study aimed to determine recent pediatric urology graduates’ reported levels of comfort both at graduation and following the start of clinical practice in performing select index procedures. We also queried the aspects of training and clinical practice perceived to be the most valuable for the development of surgical confidence. Graduates of ACGME approved pediatric urology fellowships from 2016 to 2021 were surveyed. Index procedures were described via brief case vignettes. Respondents were asked to indicate their comfort level with each index procedure following fellowship graduation and at the current time point. Comfort levels were defined by the degree of support that respondents would seek from senior colleagues in preparation for case booking. Respondents were also asked about the most helpful operative settings during training and factors contributing to high and low comfort. Fifty-three pediatric urologists (49%) completed the survey out of 109 invited. Most respondents practiced at an academic center. Perceived comfort was very high for low complexity procedures. The responses varied more widely for procedures of moderate and significant complexity (Figure). Across the cohort, there was a substantial increase in comfort between graduation and the current time point for all procedures queried. The most highly valued operative settings in fellowship were those offering real or simulated independence. Respondents most often attributed high comfort to robust case volumes and overall surgical skill gained in fellowship. New pediatric urology faculty differ widely in surgical confidence, particularly for more complex procedures. There is meaningful growth in the confidence and self-perceived independence of pediatric urologists during their initial years of practice. The early years are a critical time of continuing maturation and development that should be supported with structured systems of mentorship. Future challenges include low case volumes for rare conditions and the centralization of complex care. These findings will provide valuable context for pediatric urology fellowship directors as they evaluate and redesign their programs under the new, more flexible structure. There are opportunities to formalize early practice mentorship to support the growth of new faculty.
{"title":"The development of surgical ability during pediatric urology fellowship and its evolution in the early years of practice","authors":"Matthew R. Danzig, Seth A. Alpert, Hillary L. Copp, Travis W. Groth, Christopher D. Jaeger, Kathleen Kieran, Katherine Sheridan, Benjamin M. Whittam, Elizabeth B. Yerkes, Jonathan S. Ellison","doi":"10.1016/j.jpurol.2024.08.013","DOIUrl":"https://doi.org/10.1016/j.jpurol.2024.08.013","url":null,"abstract":"North American Pediatric Urology fellowship programs underwent a structural change in 2021 that allows more flexibility in training. Given this opportunity as well as widespread concern about the development of contemporary surgical trainees, it is prudent to understand in detail the current state of preparedness of pediatric urology fellowship graduates for independent practice. The study aimed to determine recent pediatric urology graduates’ reported levels of comfort both at graduation and following the start of clinical practice in performing select index procedures. We also queried the aspects of training and clinical practice perceived to be the most valuable for the development of surgical confidence. Graduates of ACGME approved pediatric urology fellowships from 2016 to 2021 were surveyed. Index procedures were described via brief case vignettes. Respondents were asked to indicate their comfort level with each index procedure following fellowship graduation and at the current time point. Comfort levels were defined by the degree of support that respondents would seek from senior colleagues in preparation for case booking. Respondents were also asked about the most helpful operative settings during training and factors contributing to high and low comfort. Fifty-three pediatric urologists (49%) completed the survey out of 109 invited. Most respondents practiced at an academic center. Perceived comfort was very high for low complexity procedures. The responses varied more widely for procedures of moderate and significant complexity (Figure). Across the cohort, there was a substantial increase in comfort between graduation and the current time point for all procedures queried. The most highly valued operative settings in fellowship were those offering real or simulated independence. Respondents most often attributed high comfort to robust case volumes and overall surgical skill gained in fellowship. New pediatric urology faculty differ widely in surgical confidence, particularly for more complex procedures. There is meaningful growth in the confidence and self-perceived independence of pediatric urologists during their initial years of practice. The early years are a critical time of continuing maturation and development that should be supported with structured systems of mentorship. Future challenges include low case volumes for rare conditions and the centralization of complex care. These findings will provide valuable context for pediatric urology fellowship directors as they evaluate and redesign their programs under the new, more flexible structure. There are opportunities to formalize early practice mentorship to support the growth of new faculty.","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142267633","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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