Journal of Pediatric Urology最新文献

Introduction: The bowel-bladder interaction is well established, as is the fact that constipation can lead to daytime incontinence and/or recurrent urinary tract infections. However, the link between constipation and enuresis is less clear. The bowel's influence on enuresis is possibly important even though fecal disimpaction by itself will not make the child dry at night. Furthermore, parents and patients may be unaware of the child's constipation until the enuresis is evaluated. The same should apply to healthy children. The hypothesis that a full bowel affects bladder function appears to be logical; however, this may not be applicable in enuresis. A crucial question is if constipation is more common among children with enuresis than in the general population.

Aim: To evaluate the prevalence of constipation in children with enuresis as compared to children without bladder problems.

Subjects and methods: In this case-control study the former group was recruited from a pediatric clinic and the latter from the general population in the same geographic area. All children had their horizontal rectal diameter measured via abdominal ultrasound. Their bowel movements over two weeks and bladder function over two days were recorded at home.

Results: We recruited 66 children with enuresis and 58 healthy controls. The ages ranged from 6 to 11 (mean 7.3 ± 1.3) years and 50 (40 %) of them were girls. The groups had no difference in rectal diameter (28.9 ± 7.7 vs 28.2 ± 10.1 mm, P = 0.672) and they had a similar prevalence of constipation according to the Rome IV criteria. The children with enuresis had fewer bowel movements per two weeks (11.2 ± 4.1 vs 14.8 ± 6.9, P < 0.001) than controls, but they had no more constipation symptoms. However, bladder diaries showed that children with enuresis had smaller voided volumes (87.1 ± 31.8 vs 127.5 ± 44.5 % of expected bladder capacity; P < 0.001) than controls.

Conclusion: We did not find support for constipation being more prevalent among children with enuresis than controls. But we did find decreased functional bladder capacity in patients with enuresis which may be an indirect sign of detrusor overactivity.

Purpose: Adolescents with Neurogenic Lower Urinary Tract Dysfunction (NLUTD) face significant challenges in their quality of life and readiness to transition to adult healthcare services. This study examines the impact of various demographic and clinical factors on transition readiness.

Methods: We performed a retrospective review of prospectively collected data from 75 adolescents with NLUTD managed at a specialized tertiary referral pediatric facility. We employed multivariate linear regression analysis to explore the relationship between transition readiness scores collected from the Good2Go questionnaire, including the total transition readiness score and its sub-domains (self-advocacy, knowledge, self-care, and social support), and predictors such as age, sex, reconstructive surgery status, and clean intermittent catheter (CIC) usage.

Results: The mean age of participants was 16.74 years (SD 2.44). Reconstructive surgery had been performed in 32 % of patients, and 77.3 % were on CIC. Multivariate regression analysis indicated that age significantly predicted transition readiness across several domains. Each additional year of age was associated with a 4.40-point increase in the total transition readiness score, a 3.66-point increase in knowledge, a 4.26-point increase in self-advocacy and a 5.41-point increase in self-care. Conversely, CIC significantly negatively impacted the social support domain, with scores decreasing by 9.69 points. Reconstructive surgery was significantly associated with lower self-care scores, with an average decrease of 12.12 points among those who had undergone surgery.

Conclusion: Age significantly improves transition readiness in adolescents with NLUTD, reflecting cognitive and developmental growth. However, the negative effects of CIC on social support and reconstructive surgery on self-care underscore the need for personalized interventions to optimize health outcomes during the transition to adult care.

Introduction: Pre-pubertal testicular torsion has typically been associated with high rates of orchiectomy, but there are scarce data on postoperative atrophy in salvaged testicles.

Objective: To study testicular salvage rates in pre-pubertal boys undergoing surgery for acute testicular torsion in a large, tertiary care academic center to assess true 'testicle loss rate'.

Study design: We performed a retrospective review of all pre-pubertal (aged 3 months-10 years) patients treated for acute testicular torsion over a 9-year study period (2015-2023). Patients underwent surgery by one of seven fellowship trained pediatric urologists over the study period. Variables extracted were age, duration of symptoms, laterality, presence of atypical symptoms or ipsilateral undescended testicle, TWIST score and degrees of torsion. Follow up was assessed in days since surgery. We hypothesized that age and longer duration of symptoms would be associated with likelihood of orchiectomy and postoperative atrophy (defined as ≥50 % difference in size compared to contralateral testicle at last follow-up ≥3 months postoperatively).

Results: Of 85 pre-pubertal patients with acute testicular torsion with median (interquartile range [IQR]) age 5.0 (2-7.8) years, 76 (89.4 %) were left-sided, median (IQR) TWIST score was 5 (4-6) and median (IQR) duration of symptoms prior to surgery was 28.5 (9.4-65.4) hours. Overall, 47 (55.3 %) underwent ipsilateral orchiectomy. Compared to patients undergoing orchiopexy, those undergoing orchiectomy had statistically longer duration of symptoms (median 60 vs. 16.2 h, odds ratio [OR] 1.03, p < 0.01). Among patients undergoing orchiopexy with available follow-up, 16/30 (53.3 %) had atrophy 6-12 months postoperatively. Patients with atrophy were younger (median age 3.3 vs. 6 years; OR 0.6, p = 0.01) and had higher TWIST scores (median 5 vs. 3; OR 2.2, p = 0.02) compared to patients without atrophy. Among all patients who either had orchiectomy or available follow-up post orchiopexy (n = 77), overall testicle loss rate (sum of orchiectomy and postoperative atrophy, divided by all patients undergoing surgery) was 81.8 %, ranging from 57 % for patients <12 h of symptoms, 72 % for 12-24 h of symptoms and 88 % for patients with >24 h of symptoms (p = 0.06).

Conclusion: In this single-center cohort of pre-pubertal patients with acute testicular torsion, over half of orchiopexied testicles underwent atrophy (regardless of symptom duration), contributing to a high global testicular loss rate of approximately 80 %. Younger patients were more likely to undergo atrophy following orchiopexy. Pre-pubertal testicular torsion was a distinctly left-sided phenomenon. These data can allow tailored counseling and setting families' expectations in boys diagnosed with acute testicular torsion.

Purpose: Our institution has prospectively studied outcomes from standardized follow-up algorithms for patients with myelomeningocele (MMC). This study conducts a cohort analysis of patients who underwent in-utero MMC closure, constructing a Kaplan-Meier survival curve to address a common question from families: "What is the chance my child will need bladder augmentation at 4, 10, and 15 years?" The Kaplan-Meier curve estimates the probability of survival under varying conditions and time intervals, adjusted to express "bladder intactness" compared to augmented bladder over time since birth.

Material and methods: We evaluated our database and selected patients with MMC operated in utero and treated at our institution between 2011 and May 2024. All patients were treated by the same examiner, with the information recorded in a specific electronic medical record, adopting the same follow-up protocol for neurogenic bladder, implemented at our institution. We have included only patients that started follow-up with us before 1 year of age. Incidence of lower urinary tract surgery was used for creating a Kaplan-Meyer survival curve.

Results: From a total of 168 cases, we have found 103 patients that filled our inclusion criteria for the study. Urological surgery was performed in 13 patients (12.6 %): (10 augmentations and 3 vesicostomies). The mean age at the time of surgery was 5.2 years (median 4.8 years) and follow-up time until surgery was 59.8 months (median 54). The first urodynamic study showed bladder categorization as follows: high-risk in 49.5 % (n: 51), incontinent in 22.3 % (n: 23), underactive bladder in 7.8 % (n: 8), and normal pattern in 20.4 % (n: 21). At 110 months (∼9 years), surgery-free survival was 54.4 %. Our overall follow-up in the series was 46 months.

Conclusion: This analysis confirms the limited data available in the literature regarding the evolution of bladder function in patients with MMC corrected in utero and attempts to estimate the probability of experimental evolution over the observation period. At 110 months (∼9 years), surgery-free survival was 54.4 %.