Pub Date : 2024-10-01DOI: 10.1016/j.jpurol.2024.06.011
<div><h3>Introduction</h3><div>Hydronephrosis<span> grading systems risk stratify patients with potential ureteropelvic junction obstruction, but only some criteria are measured objectively. Most notably, there is no consensus definition of renal parenchymal thinning.</span></div></div><div><h3>Objectives</h3><div>The objective of this study was to assess the association between sonographic measures of renal length, renal pelvic diameter, and renal parenchymal thickness and the outcomes of a)renal hypofunction(differential renal function{DRF} <40%) and b)high-risk renal drainage(T1/2 > 40 min).</div></div><div><h3>Study design</h3><div><span><span>An institutional database of patients who had diuretic renograms(DR) for unilateral hydronephrosis was reviewed. Only infants with Society for Fetal Urology(SFU) grades 3/4 hydronephrosis without </span>hydroureter<span><span><span> on postnatal sonogram and had a DR within 120 days were included. The following measurement variables were analyzed: anterior posterior renal pelvic diameter(APRPD), renal length(RL), renal parenchymal thickness(PT), minimal renal parenchymal thickness(MPT = shortest distance from mid-pole </span>calyx to parenchymal edge), and renal pyramidal thickness(PyrT). RL, PT, MPT, PyrT measurements were expressed as ratios (hydronephrotic kidney/contralateral kidney). Multivariate </span>logistic regression was performed for each outcome by comparing three separate renal measurement models. </span></span><u>Model 1</u>: RLR, APRPD, MPTR; <u>Model 2</u>: RLR, APRPD, PTR, <u>Model 3</u>: RLR, APRPD, PyrTR. Individual performance of variables from the best performing model were assessed via ROC curve analysis.</div></div><div><h3>Results</h3><div>196 patients were included (107 with SFU grade 3, 89 with SFU grade 4) hydronephrosis. Median patient age was 29[IQR 16,47.2] days. 10% had hypofunction, and 20% had T1/2 > 40 min 90% with hypofunction and 87% with high-risk drainage had SFU4 hydronephrosis. Model 1 exhibited the best performance, but on multivariate analysis, only APRPD and MPTR were independently associated with both outcomes. No other measure of parenchymal thickness reached statistical significance. The odds of hypofunction and high-risk drainage increase 10% per 1 mm increase in APRPD(aOR 1.1 [CI 1.03–1.2], p = 0.005; aOR 1.1 [CI 1.03–1.2], p = 0.003). For every 0.1unit increase in MPTR the odds of hypofunction decrease by 40%(aOR 0.6 [CI 0.4–0.9], p = 0.019); and the odds of high-risk drainage decrease by 30%(aOR 0.7 [CI 0.5–0.9], p = 0.011). Optimal statistical cut-points of APRPD >16 mm and/or MPTR <0.36 identified patients at risk for obstructive parameters on DR.</div></div><div><h3>Discussion and conclusion</h3><div><span>Of the sonographic hydronephrosis measurement variables analyzed, only APRPD and MPTR were independently associated with objective definitions of obstruction based on renal function and drainage categories. Patients who maintain APRP
{"title":"Objective sonographic measurements of renal pelvic diameter and renal parenchymal thickness can identify renal hypofunction and poor drainage in patients with antenatally detected unilateral ureteropelvic junction obstruction","authors":"","doi":"10.1016/j.jpurol.2024.06.011","DOIUrl":"10.1016/j.jpurol.2024.06.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Hydronephrosis<span> grading systems risk stratify patients with potential ureteropelvic junction obstruction, but only some criteria are measured objectively. Most notably, there is no consensus definition of renal parenchymal thinning.</span></div></div><div><h3>Objectives</h3><div>The objective of this study was to assess the association between sonographic measures of renal length, renal pelvic diameter, and renal parenchymal thickness and the outcomes of a)renal hypofunction(differential renal function{DRF} <40%) and b)high-risk renal drainage(T1/2 > 40 min).</div></div><div><h3>Study design</h3><div><span><span>An institutional database of patients who had diuretic renograms(DR) for unilateral hydronephrosis was reviewed. Only infants with Society for Fetal Urology(SFU) grades 3/4 hydronephrosis without </span>hydroureter<span><span><span> on postnatal sonogram and had a DR within 120 days were included. The following measurement variables were analyzed: anterior posterior renal pelvic diameter(APRPD), renal length(RL), renal parenchymal thickness(PT), minimal renal parenchymal thickness(MPT = shortest distance from mid-pole </span>calyx to parenchymal edge), and renal pyramidal thickness(PyrT). RL, PT, MPT, PyrT measurements were expressed as ratios (hydronephrotic kidney/contralateral kidney). Multivariate </span>logistic regression was performed for each outcome by comparing three separate renal measurement models. </span></span><u>Model 1</u>: RLR, APRPD, MPTR; <u>Model 2</u>: RLR, APRPD, PTR, <u>Model 3</u>: RLR, APRPD, PyrTR. Individual performance of variables from the best performing model were assessed via ROC curve analysis.</div></div><div><h3>Results</h3><div>196 patients were included (107 with SFU grade 3, 89 with SFU grade 4) hydronephrosis. Median patient age was 29[IQR 16,47.2] days. 10% had hypofunction, and 20% had T1/2 > 40 min 90% with hypofunction and 87% with high-risk drainage had SFU4 hydronephrosis. Model 1 exhibited the best performance, but on multivariate analysis, only APRPD and MPTR were independently associated with both outcomes. No other measure of parenchymal thickness reached statistical significance. The odds of hypofunction and high-risk drainage increase 10% per 1 mm increase in APRPD(aOR 1.1 [CI 1.03–1.2], p = 0.005; aOR 1.1 [CI 1.03–1.2], p = 0.003). For every 0.1unit increase in MPTR the odds of hypofunction decrease by 40%(aOR 0.6 [CI 0.4–0.9], p = 0.019); and the odds of high-risk drainage decrease by 30%(aOR 0.7 [CI 0.5–0.9], p = 0.011). Optimal statistical cut-points of APRPD >16 mm and/or MPTR <0.36 identified patients at risk for obstructive parameters on DR.</div></div><div><h3>Discussion and conclusion</h3><div><span>Of the sonographic hydronephrosis measurement variables analyzed, only APRPD and MPTR were independently associated with objective definitions of obstruction based on renal function and drainage categories. Patients who maintain APRP","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"20 5","pages":"Pages 921-928"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141524663","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}
<div><h3>Introduction</h3><div><span>The management of intra-abdominal testis (IAT) represents a significant clinical challenge, necessitating the transposition of the testis from the </span>abdominal cavity<span> to the scrotum. This procedure is rendered complex by the abbreviated length of the testicular vessels.</span></div></div><div><h3>Objective</h3><div>Our purpose in this study was to conduct a systematic review and meta-analysis comparing Shehata technique (ST) versus Fowler Stephens technique (FST) in treating patients with IAT.</div></div><div><h3>Study design</h3><div>We conducted a comprehensive literature search using several databases, including Ovid Medline, Cochrane, PubMed, Google Scholar, Web of Sciences, EMBASE, and SCOPUS until February 2024. This study included research that compared ST and FST for managing intra-abdominal testis. We evaluated the rates of atrophy and retraction, as well as the overall success rates, for both techniques.</div></div><div><h3>Results</h3><div><span>Six studies were identified as appropriate for meta-analysis, comparing orchidopexy performed using the ST with 169 patients, against the FST involving 162 patients. The comparison showed no statistically significant age difference at the time of surgery between the groups (I</span><sup>2</sup> = 0%) (WMD 0.05, 95% CI − 1.24 to 1.34; p = 0.94). Operative time in first the stage was lower in the FST group than ST group (I<sup>2</sup> = 95%) (WMD 10.90, 95% CI 1.94 to 19.87; p = 0.02). Operative time in the second stage was lower in the ST group than FST group (I<sup>2</sup> = 83%) (WMD - 6.15, 95% CI - 12.21 to −0.10; p = 0.05). Our analysis showed that ST had a similar atrophy rate (I<sup>2</sup> = 0%) (OR: 0.45, 95% CI: 0.20 to 1.01; p = 0.05). No difference was found between techniques in terms of retraction rate (I<sup>2</sup> = 0%) (OR: 0.64, 95% CI: 0.17 to 2.47; p = 0.52). The ST demonstrated a notably higher overall success rate compared to FST (I<sup>2</sup> = 1%) (RR: 1.14, 95% CI: 1.03 to 1.27; p = 0.009). Overall success rate in ST and FST were 87% and 74%, respectively. Overall atrophy rate in ST and FST were 5% and 12%, respectively. Overall retraction rate in ST and FST were 5% and 10%, respectively.</div></div><div><h3>Discussion</h3><div>The ST, renowned for its pioneering two-stage laparoscopic approach that leverages mechanical traction to lengthen the testicular vessels, is gaining popularity due to its recognized safety and efficacy. Conversely, the Fowler-Stephens technique, a traditional method that relies on collateral blood supply<span> for testicular mobilization, has come under examination for its potential link to an increased risk of testicular atrophy.</span></div></div><div><h3>Conclusion</h3><div><span>This meta-analysis reveals that the Shehata technique has similar or better outcomes compared to the Fowler-Stephens technique in IAT management. Further prospective multicentric randomized controlled trials are warrant
{"title":"Shehata technique versus Fowler-Stephens orchidopexy in intra-abdominal testis: A meta-analysis","authors":"Mustafa Azizoglu , Mostafa Zain , Esra Karakas , Mostafa Kotb , Tahsin Onat Kamci , Ayten Ceren Bakir , Sameh Shehata","doi":"10.1016/j.jpurol.2024.07.004","DOIUrl":"10.1016/j.jpurol.2024.07.004","url":null,"abstract":"<div><h3>Introduction</h3><div><span>The management of intra-abdominal testis (IAT) represents a significant clinical challenge, necessitating the transposition of the testis from the </span>abdominal cavity<span> to the scrotum. This procedure is rendered complex by the abbreviated length of the testicular vessels.</span></div></div><div><h3>Objective</h3><div>Our purpose in this study was to conduct a systematic review and meta-analysis comparing Shehata technique (ST) versus Fowler Stephens technique (FST) in treating patients with IAT.</div></div><div><h3>Study design</h3><div>We conducted a comprehensive literature search using several databases, including Ovid Medline, Cochrane, PubMed, Google Scholar, Web of Sciences, EMBASE, and SCOPUS until February 2024. This study included research that compared ST and FST for managing intra-abdominal testis. We evaluated the rates of atrophy and retraction, as well as the overall success rates, for both techniques.</div></div><div><h3>Results</h3><div><span>Six studies were identified as appropriate for meta-analysis, comparing orchidopexy performed using the ST with 169 patients, against the FST involving 162 patients. The comparison showed no statistically significant age difference at the time of surgery between the groups (I</span><sup>2</sup> = 0%) (WMD 0.05, 95% CI − 1.24 to 1.34; p = 0.94). Operative time in first the stage was lower in the FST group than ST group (I<sup>2</sup> = 95%) (WMD 10.90, 95% CI 1.94 to 19.87; p = 0.02). Operative time in the second stage was lower in the ST group than FST group (I<sup>2</sup> = 83%) (WMD - 6.15, 95% CI - 12.21 to −0.10; p = 0.05). Our analysis showed that ST had a similar atrophy rate (I<sup>2</sup> = 0%) (OR: 0.45, 95% CI: 0.20 to 1.01; p = 0.05). No difference was found between techniques in terms of retraction rate (I<sup>2</sup> = 0%) (OR: 0.64, 95% CI: 0.17 to 2.47; p = 0.52). The ST demonstrated a notably higher overall success rate compared to FST (I<sup>2</sup> = 1%) (RR: 1.14, 95% CI: 1.03 to 1.27; p = 0.009). Overall success rate in ST and FST were 87% and 74%, respectively. Overall atrophy rate in ST and FST were 5% and 12%, respectively. Overall retraction rate in ST and FST were 5% and 10%, respectively.</div></div><div><h3>Discussion</h3><div>The ST, renowned for its pioneering two-stage laparoscopic approach that leverages mechanical traction to lengthen the testicular vessels, is gaining popularity due to its recognized safety and efficacy. Conversely, the Fowler-Stephens technique, a traditional method that relies on collateral blood supply<span> for testicular mobilization, has come under examination for its potential link to an increased risk of testicular atrophy.</span></div></div><div><h3>Conclusion</h3><div><span>This meta-analysis reveals that the Shehata technique has similar or better outcomes compared to the Fowler-Stephens technique in IAT management. Further prospective multicentric randomized controlled trials are warrant","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"20 5","pages":"Pages 977-984"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141694538","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.2024.07.023
Murat Can Karaburun, Aykut Akıncı
{"title":"Reply to Commentary re “The impact of audiovisual information on parental anxiety levels prior to hypospadias surgery: A prospective single center cohort study”","authors":"Murat Can Karaburun, Aykut Akıncı","doi":"10.1016/j.jpurol.2024.07.023","DOIUrl":"10.1016/j.jpurol.2024.07.023","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"20 5","pages":"Pages 1021-1022"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906874","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.2024.07.025
N. Valeska Halstead
{"title":"Commentary to: Sentiment analysis of U.S. News & World Report Best Children's Hospital urology rankings: A difference in positivity between the public and academic worlds","authors":"N. Valeska Halstead","doi":"10.1016/j.jpurol.2024.07.025","DOIUrl":"10.1016/j.jpurol.2024.07.025","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"20 5","pages":"Pages 1023-1024"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141933578","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.2024.07.006
Maternik Michal , Lakomy-Gawryszewska Agata , Józefowicz Katarzyna , Chudzik Ilona , Gołębiewski Andrzej , Żurowska Aleksandra
<div><h3>Introduction</h3><div>Among the conditions underlying childhood daytime incontinence the most frequent is overactive bladder (OAB). Parasacral transcutaneous electrical nerve stimulation (parasacral TENS) is a promising therapy for OAB treatment in children; however, there is no standard treatment protocol.</div></div><div><h3>Objective</h3><div>To evaluate the immediate and continued effects of parasacral TENS monotherapy in children with OAB.</div></div><div><h3>Study design</h3><div>57 children at mean age 10.8 years diagnosed with OAB at a single centre were prospectively enrolled from 2013 to 2018. The inclusion criterion was typical OAB symptoms. The treatment results were evaluated based on objective measurements from bladder diaries, 48 h frequency/volume (48 h F/V) charts, and uroflowmetry. The parasacral TENS treatment lasted for 4 months, twice daily, with 1 h sessions. Results were evaluated at three time points: 2 months of therapy, 4 months (end of active therapy), and 10 months (6 months after cessation of therapy).</div></div><div><h3>Results</h3><div>After 4 months of parasacral TENS treatment, the number of days with daytime incontinence decreased from 7.23 to 3.94/14 days (p < 0.05), nocturnal enuresis decreased from 6.81 to 3.77/14 days (p < 0.05), and urgency episodes from 7.36 to 3.58 in 14 days (p < 0.05). Treatment effects remained stable 6 months after therapy cessation regarding days with daytime incontinence (from 3.94 [immediately after treatment] to 3.28 in 14 days [6 months after treatment cessation]), nocturnal enuresis (from 3.77 to 2.91 in 14 days), and urgency episodes (from 3.58 to 2.12 in 14 days) (p < 0.05). Complete response after 6 months of therapy was observed in 32% of patients with daytime incontinence, 35% with nocturnal enuresis, and 50% with urgency episodes.</div></div><div><h3>Discussion</h3><div>A recent systematic review of parasacral TENS in children with OAB included only two studies with a follow up of 6 months or longer after treatment cessation; therefore, little is known about the continued effects of parasacral TENS. High rates of complete symptom remission were reported in studies where only subjective symptoms were evaluated. Results of our study reveal that the positive effect of treatment persist. The strengths of the present study include its prospective design, large sample size, and uniform standard urotherapy performed prior to TENS.</div></div><div><h3>Conclusions</h3><div>The use of parasacral TENS in children with OAB is effective and results in a significant reduction in daytime incontinence, nocturnal enuresis, and urgency episodes. A longer treatment duration of 4 months leads to more improvement and the effects remain stable 6 months after treatment cessation.<span><div><span><span><p><span>Summary Table</span>. <!-->Treatment results regarding daytime incontinence, nocturnal enuresis, and urgency episodes.</p></span></span><div><table><thead><tr><td><spa
{"title":"Immediate and continued results of parasacral transcutaneous electrical nerve stimulation in paediatric patients with overactive bladders","authors":"Maternik Michal , Lakomy-Gawryszewska Agata , Józefowicz Katarzyna , Chudzik Ilona , Gołębiewski Andrzej , Żurowska Aleksandra","doi":"10.1016/j.jpurol.2024.07.006","DOIUrl":"10.1016/j.jpurol.2024.07.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Among the conditions underlying childhood daytime incontinence the most frequent is overactive bladder (OAB). Parasacral transcutaneous electrical nerve stimulation (parasacral TENS) is a promising therapy for OAB treatment in children; however, there is no standard treatment protocol.</div></div><div><h3>Objective</h3><div>To evaluate the immediate and continued effects of parasacral TENS monotherapy in children with OAB.</div></div><div><h3>Study design</h3><div>57 children at mean age 10.8 years diagnosed with OAB at a single centre were prospectively enrolled from 2013 to 2018. The inclusion criterion was typical OAB symptoms. The treatment results were evaluated based on objective measurements from bladder diaries, 48 h frequency/volume (48 h F/V) charts, and uroflowmetry. The parasacral TENS treatment lasted for 4 months, twice daily, with 1 h sessions. Results were evaluated at three time points: 2 months of therapy, 4 months (end of active therapy), and 10 months (6 months after cessation of therapy).</div></div><div><h3>Results</h3><div>After 4 months of parasacral TENS treatment, the number of days with daytime incontinence decreased from 7.23 to 3.94/14 days (p < 0.05), nocturnal enuresis decreased from 6.81 to 3.77/14 days (p < 0.05), and urgency episodes from 7.36 to 3.58 in 14 days (p < 0.05). Treatment effects remained stable 6 months after therapy cessation regarding days with daytime incontinence (from 3.94 [immediately after treatment] to 3.28 in 14 days [6 months after treatment cessation]), nocturnal enuresis (from 3.77 to 2.91 in 14 days), and urgency episodes (from 3.58 to 2.12 in 14 days) (p < 0.05). Complete response after 6 months of therapy was observed in 32% of patients with daytime incontinence, 35% with nocturnal enuresis, and 50% with urgency episodes.</div></div><div><h3>Discussion</h3><div>A recent systematic review of parasacral TENS in children with OAB included only two studies with a follow up of 6 months or longer after treatment cessation; therefore, little is known about the continued effects of parasacral TENS. High rates of complete symptom remission were reported in studies where only subjective symptoms were evaluated. Results of our study reveal that the positive effect of treatment persist. The strengths of the present study include its prospective design, large sample size, and uniform standard urotherapy performed prior to TENS.</div></div><div><h3>Conclusions</h3><div>The use of parasacral TENS in children with OAB is effective and results in a significant reduction in daytime incontinence, nocturnal enuresis, and urgency episodes. A longer treatment duration of 4 months leads to more improvement and the effects remain stable 6 months after treatment cessation.<span><div><span><span><p><span>Summary Table</span>. <!-->Treatment results regarding daytime incontinence, nocturnal enuresis, and urgency episodes.</p></span></span><div><table><thead><tr><td><spa","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"20 5","pages":"Pages 868-876"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141691961","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.2024.07.031
Magdalena Fossum
{"title":"Editorial comments to “Assessing the effects of bladder decellularization protocols on extracellular matrix (ECM) structure, mechanics, and biology” (JPUROL-D-24-00006)","authors":"Magdalena Fossum","doi":"10.1016/j.jpurol.2024.07.031","DOIUrl":"10.1016/j.jpurol.2024.07.031","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"20 5","pages":"Pages 855-856"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108584","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.2024.07.005
Darren Ha , N. Valeska Halstead , Eliza D. Blanchette , Duncan T. Wilcox , Vijaya M. Vemulakonda , Daniel N. Wood , Kyle O. Rove
<div><h3>Introduction</h3><div>The opioid epidemic response led to increased use of postoperative, non-opioid analgesia. Some pediatric urologists do not routinely use non-steroidal anti-inflammatory drugs (NSAIDs) for fear of causing acute kidney injury (AKI). While previous studies have demonstrated the safety and efficacy of NSAIDs in children, safety after lower urinary tract reconstruction has not been well characterized.</div></div><div><h3>Objective</h3><div>ptUsing the Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI (increase in creatinine ≥0.3 mg/dL or increase in creatinine ≥1.5x baseline or urine output <0.5 mL/kg/hr for 6 h), we hypothesized there would be a difference in the incidence of postoperative AKI between patients who did and did not receive NSAIDs following surgery.</div></div><div><h3>Study design</h3><div>Patients 2–18 years old who underwent lower urinary tract reconstruction (i.e., bladder augmentation and/or creation of a catheterizable channel) from 2009 to 2021 and had documented urine output were retrospectively reviewed. Chronic kidney disease (CKD) stage was calculated from creatinine and cystatin C within 6 months of surgery using the CKiD U25 equations. Patients who received NSAIDs were propensity matched on <strong>11</strong> characteristics with patients undergoing similar surgeries who did not receive NSAIDs. The primary outcome was incidence of AKI within 48 h of surgery.</div></div><div><h3>Results</h3><div>The unmatched cohorts included 243 patients. Propensity matching identified 166 patients in the NSAID arm and 41 in the no NSAID arm. 26 patients with CKD stage 2–3 were included. There was no significant difference in the incidence of postoperative AKI based on any KDIGO criteria (17.1% no NSAID versus 16.3% NSAID, p = 0.87). Median postoperative opioids fell from 0.88 mg/kg in the no NSAID arm to 0.37 mg/kg morphine equivalents in the NSAID arm, although this was not statistically significant. Log-rank testing by Kaplan–Meier analysis demonstrated no difference in time to incidence of low urine output between the groups (p = 0.32). In the whole population not stratified by NSAID use, no differences were seen in AKI between those with and without CKD (16.7% with versus 17.9% without CKD).</div></div><div><h3>Discussion</h3><div>There was no difference in the incidence of postoperative AKI among patients who did and did not receive NSAIDs after lower urinary tract reconstruction, excluding those with advanced CKD.</div></div><div><h3>Conclusion</h3><div>These results support that postoperative NSAIDs were an unlikely source of AKI. However, AKI remained a risk following these surgeries, regardless of NSAID use, likely owing to underlying disease, longer operations, and fluid shifts.<span><div><span><span><p><span>Summary Table</span>. <!-->Incidence of postoperative AKI among patients who did and did not receive NSAIDs in the operating room or within 6 h after surgery.</p></span></s
{"title":"Risk of acute kidney injury after lower urinary tract reconstruction with early NSAID therapy: A propensity matched retrospective analysis","authors":"Darren Ha , N. Valeska Halstead , Eliza D. Blanchette , Duncan T. Wilcox , Vijaya M. Vemulakonda , Daniel N. Wood , Kyle O. Rove","doi":"10.1016/j.jpurol.2024.07.005","DOIUrl":"10.1016/j.jpurol.2024.07.005","url":null,"abstract":"<div><h3>Introduction</h3><div>The opioid epidemic response led to increased use of postoperative, non-opioid analgesia. Some pediatric urologists do not routinely use non-steroidal anti-inflammatory drugs (NSAIDs) for fear of causing acute kidney injury (AKI). While previous studies have demonstrated the safety and efficacy of NSAIDs in children, safety after lower urinary tract reconstruction has not been well characterized.</div></div><div><h3>Objective</h3><div>ptUsing the Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI (increase in creatinine ≥0.3 mg/dL or increase in creatinine ≥1.5x baseline or urine output <0.5 mL/kg/hr for 6 h), we hypothesized there would be a difference in the incidence of postoperative AKI between patients who did and did not receive NSAIDs following surgery.</div></div><div><h3>Study design</h3><div>Patients 2–18 years old who underwent lower urinary tract reconstruction (i.e., bladder augmentation and/or creation of a catheterizable channel) from 2009 to 2021 and had documented urine output were retrospectively reviewed. Chronic kidney disease (CKD) stage was calculated from creatinine and cystatin C within 6 months of surgery using the CKiD U25 equations. Patients who received NSAIDs were propensity matched on <strong>11</strong> characteristics with patients undergoing similar surgeries who did not receive NSAIDs. The primary outcome was incidence of AKI within 48 h of surgery.</div></div><div><h3>Results</h3><div>The unmatched cohorts included 243 patients. Propensity matching identified 166 patients in the NSAID arm and 41 in the no NSAID arm. 26 patients with CKD stage 2–3 were included. There was no significant difference in the incidence of postoperative AKI based on any KDIGO criteria (17.1% no NSAID versus 16.3% NSAID, p = 0.87). Median postoperative opioids fell from 0.88 mg/kg in the no NSAID arm to 0.37 mg/kg morphine equivalents in the NSAID arm, although this was not statistically significant. Log-rank testing by Kaplan–Meier analysis demonstrated no difference in time to incidence of low urine output between the groups (p = 0.32). In the whole population not stratified by NSAID use, no differences were seen in AKI between those with and without CKD (16.7% with versus 17.9% without CKD).</div></div><div><h3>Discussion</h3><div>There was no difference in the incidence of postoperative AKI among patients who did and did not receive NSAIDs after lower urinary tract reconstruction, excluding those with advanced CKD.</div></div><div><h3>Conclusion</h3><div>These results support that postoperative NSAIDs were an unlikely source of AKI. However, AKI remained a risk following these surgeries, regardless of NSAID use, likely owing to underlying disease, longer operations, and fluid shifts.<span><div><span><span><p><span>Summary Table</span>. <!-->Incidence of postoperative AKI among patients who did and did not receive NSAIDs in the operating room or within 6 h after surgery.</p></span></s","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"20 5","pages":"Pages 911-920"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141696371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.jpurol.2024.07.032
Martin A. Koyle
{"title":"Commentary to “Undescended testis: A roundtable discussion based on clinical scenarios – Part 2”","authors":"Martin A. Koyle","doi":"10.1016/j.jpurol.2024.07.032","DOIUrl":"10.1016/j.jpurol.2024.07.032","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"20 5","pages":"Pages 956-957"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145860","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.2024.07.021
F. Yiu, R.M. Sturm
{"title":"Response regarding “Assessing the effects of bladder decellularization protocols on extracellular matrix (ECM) structure, mechanics, and biology”","authors":"F. Yiu, R.M. Sturm","doi":"10.1016/j.jpurol.2024.07.021","DOIUrl":"10.1016/j.jpurol.2024.07.021","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"20 5","pages":"Pages 853-854"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845024","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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