Journal of Pediatric Urology最新文献

{"title":"The impact of foot reflexology on postoperative pain and fear in children following circumcision: A randomized controlled trial.","authors":"Abdullah Sarman, Suat Tuncay, Ali Ay","doi":"10.1016/j.jpurol.2025.05.014","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.05.014","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain and fear are common in children after surgical interventions and can negatively impact the healing process. Circumcision, as a common surgical procedure, often results in both physical pain and psychological fear in children. Foot reflexology, a non-pharmacological method, is effective in reducing pain and stress by applying pressure to specific points on the feet that correspond to various parts of the body. Reflexology, especially in children, stands out as an alternative approach to managing postoperative pain and fear. The integration of such complementary methods into post-surgical care can help accelerate the healing process in children.</p><p><strong>Objective: </strong>This study aimed to assess the effectiveness of foot reflexology in managing postoperative pain and fear in children following circumcision.</p><p><strong>Materials and methods: </strong>This study was conducted as a randomized controlled trial. The study included 84 children, aged 5-10 years, hospitalized for circumcision at a pediatric surgery clinic in a public hospital in eastern Turkey. Participants were randomized into experimental (n = 42) and control (n = 42) groups based on age. Reflexology was applied to the children in the experimental group after circumcision. Data were gathered using the Patient Descriptive Information Form, Wong-Baker FACES® Pain Rating Scale, and Child Fear Scale. Number, percentage, mean, t test in independent groups and paired t test were used in the evaluation of the data.</p><p><strong>Results: </strong>The primary source of postoperative pain in both groups was the incision site, while painful procedures were the leading cause of fear. Children who received reflexology postoperatively reported significantly lower pain and fear scores compared to those in the control group.</p><p><strong>Conclusion: </strong>Foot reflexology is an effective non-pharmacological intervention for reducing pain and fear in children's post-circumcision. Pediatric nurses should consider incorporating reflexology into routine care to enhance pain management outcomes. Nursing education programs should consider including training in reflexology and other non-pharmacological pain management techniques to improve pediatric postoperative care.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173831","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}

{"title":"Use and institutional variation in surgical antibiotic prophylaxis for pediatric clean (class I) penile and groin procedures.","authors":"Brendan T Frainey, Isabella Zaniletti, Leslie M Peard, Sophie E Katz, Lauren E Corona","doi":"10.1016/j.jpurol.2025.05.006","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.05.006","url":null,"abstract":"<p><strong>Background: </strong>The majority of ambulatory pediatric penile, inguinal and scrotal cases are considered clean (class I) surgical wounds and guidelines do not recommend surgical antibiotic prophylaxis (SAP) use. Despite these recommendations, few data exist that have assessed utilization and outcomes of interest associated with SAP use for ambulatory pediatric urology procedures.</p><p><strong>Objective: </strong>To better understand national and individual hospital utilization of SAP for common, ambulatory pediatric urologic procedures at lowest risk for surgical site infection (SSI) and for which the benefits of SAP are limited.</p><p><strong>Study design: </strong>We queried the Pediatric Health Information System (PHIS) database for males (29 days-18 years) undergoing outpatient penile and/or \"groin\" (inguinal/scrotal) procedures from 2016 to 2023. SAP use was abstracted. Demographic and clinical characteristics were compared between procedures with no SAP use vs. any SAP use and a multivariable logistic regression model with generalized estimating equation to account for clustered data on hospitals was performed to identify factors associated with increased odds of use. Secondary outcomes of interest included post-operative ED visits, surgical site infections, allergic reactions, and Clostridium difficile infections. National trends in SAP use were compared by year and between hospitals that consistently reported data over the study period.</p><p><strong>Results: </strong>A total of 108,419 procedures (46 % penile, 42 % groin, 12 % combination) were included. Median age at surgery was 2 (IQR 0,7) years. Overall, 14 % of procedures had SAP use. Groin procedures had higher rates of antibiotic use compared to penile procedures (19 % vs 8 %, p < 0.001). On adjusted analysis, groin procedures (aOR 2.12), combined groin + penile procedures (aOR 2.43), older age (aOR 2.54), and urologist as proceduralist (aOR 1.52) were independently associated with greater odds of antibiotic use. Rates of secondary outcomes were similar between groups. There was significant variability in SAP between centers (range 0 %-32 % groin; 0 %-16.7 % penile, p < 0.001) over the study period (Figure 1B).</p><p><strong>Discussion: </strong>SAP use for uncomplicated pediatric penile and groin procedures was 14 % overall, with variability in use between hospitals. Groin procedures, older patients, and a urologic proceduralist were associated with increased odds of antibiotic use.</p><p><strong>Conclusion: </strong>Despite improvements over time, SAP use persists for uncomplicated, clean pediatric urologic procedures, with significant variability across centers. This highlights an opportunity for standardization of practice within pediatric urology to optimize the balance between SSI prevention and promotion of antimicrobial stewardship.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142820","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}

{"title":"Patient and caregiver knowledge of pediatric testicular torsion: A scoping review.","authors":"Wyatt MacNevin, Nicholas Dawe, Abrahim Chidiac, Dawn Lee MacLellan, Karen Milford, Daniel T Keefe","doi":"10.1016/j.jpurol.2025.05.015","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.05.015","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric testicular torsion (PedTT) is a surgical emergency that requires prompt presentation. Delay in intervention can lead to testicular loss. In the PedTT care pathway, the pre-hospital phase prior to presenting to the emergency department, is the strongest determining factor for testicular salvage. Although the severe nature of testicular pain is likely to prompt many families to seek emergent care, patients with milder symptoms may delay presentation if they and their caregivers are unaware of PedTT as a disease entity. Understanding caregiver and pediatric knowledge of PedTT will aid in better designing and delivering educational initiatives to reduce pre-hospital delay and improve testicular salvage. This study is a comprehensive scoping review of the literature reporting on pediatric and caregiver knowledge of PedTT, and outcomes of educational initiatives.</p><p><strong>Methods: </strong>A scoping review was performed on all English-language literature reporting on pediatric and caregiver knowledge of PedTT, as well as PedTT-based educational initiatives. Both qualitative and quantitative studies were reviewed, analyzed, and compiled.</p><p><strong>Results: </strong>A total of 2773 articles were identified, with 21 studies included. After review, 11 studies focused on caregiver perspectives of PedTT, 5 studies examined patient perspectives, and 8 studies identified PedTT educational initiatives, with overlap between publications. Overall, knowledge gaps were identified in the definition of PedTT, presenting symptoms, and critical time frame for salvage by both pediatric and caregiver groups. Caregivers expressed a need and a desire for increased public awareness and teaching around PedTT. School-based educational initiatives were well-received among participants, with social media-based initiatives showing promise.</p><p><strong>Conclusions: </strong>Both pediatric and caregiver knowledge of PedTT is low, and lack of awareness may contribute to delayed presentation. Educational initiatives have been shown to improve PedTT knowledge and awareness. Results from this study can be used to optimize PedTT educational efforts to improve caregiver and public knowledge.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150832","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}

{"title":"Response to: Letter to the Editor re: \"Smooth sailing or rocky road in navigating the ureteral orifice: Does preoperative tamsulosin improve success of primary ureteroscopy in children?\"","authors":"Kathy H Huen, Carol A Davis-Dao","doi":"10.1016/j.jpurol.2025.05.011","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.05.011","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159662","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}

{"title":"Subject: Response to the letter to the editor: Increased risk of chronic kidney disease in children with anorectal malformations.","authors":"Haluk Emir, Ali Ekber Hakalmaz, Esra Karabağ Yılmaz","doi":"10.1016/j.jpurol.2025.05.009","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.05.009","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142817","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}

{"title":"Back to the flaps in hypospadias repair?","authors":"Mustafa Ozgur Tan","doi":"10.1016/j.jpurol.2025.04.043","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.04.043","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132578","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}

{"title":"Letter to the editor re Increased risk of chronic kidney disease in children with anorectal malformations.","authors":"Isabel Planas Díaz, Isabel Casal-Beloy, María José Moya Jiménez, Rosa María Romero Ruíz","doi":"10.1016/j.jpurol.2025.04.042","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.04.042","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132580","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}

{"title":"Anterograde spermatic vein sclerotherapy: Step-by-step Tauber procedure.","authors":"D G Minoli, M Gnech, E A De Marco, C Bebi, G Rotondi, V Bagnara, F Mitzman, E Thomas, A Berrettini","doi":"10.1016/j.jpurol.2025.05.007","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.05.007","url":null,"abstract":"<p><strong>Introduction: </strong>Varicocele is a common condition characterised by the abnormal dilation of pampiniform plexus veins due to venous reflux and it becomes more frequent with puberty. Since varicocele treatment has been correlated with testicular catch-up growth and improved sperm parameters, a variety of surgical techniques have been developed.</p><p><strong>Materials and methods: </strong>The patient is positioned in the supine position. A 2 cm incision at the scrotal root level is performed. After dissection, the pampiniform plexus veins are identified and the most dilated and straight is isolated and prepared for cannulation. A 20-24 G, 7 cm long, hollow, flexible and transparent cannula is employed with the oblique-cut ending inserted in the selected vein. After assessing the vein patency, the fluoroscopic C-arm is positioned and a contrast agent is injected for visualization of the spermatic vein up until its convergence with the renal vein. The sclerosing agent (Aethoxysklerol/Fibrovein) is mixed with air to make a foam and immediately injected into the spermatic vein under fluoroscopic vision. This allows modulation of the amount of sclerosing agent which is injected until the complete disappearance of the contrast medium is clearly seen on the monitor. The cannula is then removed avoiding any spillage by a normal saline flush. The vein is ligated cranially and caudally and tissues closed with absorbable sutures.</p><p><strong>Results: </strong>Antegrade sclerotherapy is safe and effective for the treatment of paediatric varicocele. Radiation doses during the procedure are minimal.</p><p><strong>Conclusion: </strong>Tauber's technique could be considered an appropriate option for the treatment of varicocele in the paediatric population.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132577","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}

{"title":"Continence outcomes following reconstructive lower urinary tract surgery in incontinent adults and adolescents previously operated in childhood for exstrophy/epispadias complex.","authors":"Ashwin Shekar P, Anuj Yadav, Bobby Visvaroop, Ganesh Gopalakrishnan","doi":"10.1016/j.jpurol.2025.05.008","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.05.008","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the presentation and outcome of surgical management strategies applied to the adolescent and adult patient population (age >14 years) with bladder exstrophy/epispadias complex (BEEC) who presented with persistent incontinence even after previous numerous surgeries at our institution.</p><p><strong>Methods: </strong>A retrospective review of the electronic medical records of patients with BEEC managed from January 1998 to December 2022 was undertaken. Patients aged >14 years at presentation, with detailed medical records were selected. Of these, we identified patients who underwent surgical intervention for incontinence primarily. Data on presenting symptoms, clinical findings, previous and present surgical intervention, post-operative complications, secondary procedures and follow-up periods were recorded. Data on continence was collected in the form of clean intermittent catherization (CIC) or voiding frequency, dry intervals and diaper usage. Subjective assessment of continence was assessed by a cross sectional survey using the International Consultation on Incontinence modular Questionnaire Urinary Incontinence (ICIQ-UI) short form. A patient was considered socially continent if he or she could perform normal activities without fear of urinary leak.</p><p><strong>Results: </strong>A total of 27 (16 male and 11 female) patients of BEEC, aged 14 years and above who underwent surgical intervention for persistent incontinence in adolescence or adulthood following previous repairs over this 24-year period were identified and their records reviewed. Median age of presentation was 21 years (IQR, 14-25.8) and they had undergone a median of 4 surgeries prior to presentation (range, 2-10). Three patients had already been augmented with bowel along with a Mitrofanoff channel. The median follow-up was 42 months (range, 24-117). Regarding continence outcomes, at last follow-up, only one patient was volitionally voiding to completion, with the rest doing CIC through Mitrofanoff channel or by perurethral route with nearly 60 % (14/24) having a dry interval of 90 min. After excluding 3 patients who underwent incontinent urinary diversion, 17/24 (71.7 %) patients had no need for diapers and only 5/24 (21 %) had severe persistence urinary incontinence based on ICIQ UI scores. More importantly, 16/24 (67 %) of the patients in our cohort group were socially continent.</p><p><strong>Conclusions: </strong>BEEC is difficult to manage, especially in resource-poor settings and some children reach adolescence and remain incontinent. However, with careful preoperative assessment and exact surgical precision, a decent level of social continence can be expected, even in these patients presenting late in adulthood.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132579","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}

{"title":"Objective assessment of penile curvature in hypospadias: A narrative review.","authors":"Ramesh Babu, Vvs Chandrasekharam, Tariq O Abbas","doi":"10.1016/j.jpurol.2025.05.004","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.05.004","url":null,"abstract":"<p><strong>Background: </strong>Hypospadias-associated ventral curvature (VC) exerts a critical influence on surgical decision-making and repair outcomes. Despite the clinical significance of VC, assessment is frequently performed by unaided visual inspection (UVI) which is prone to error. Alternative objective measurement techniques have therefore been proposed, including goniometry, smartphone applications, and artificial intelligence (AI)-based tools.</p><p><strong>Objective: </strong>This review aims to evaluate the various techniques available for VC measurement in hypospadias surgery, focusing on their accuracy, reliability, and clinical utility.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted using PubMed, MEDLINE, and the Cochrane Database, covering publications from 1994 to 2024. Included studies assessed VC measurement techniques, including UVI, standard goniometry, smartphone-based goniometry, and AI-based tools. Risk of bias was determined using the Robvis tool.</p><p><strong>Results: </strong>Of 501 studies identified, 13 met the inclusion criteria. Findings revealed that UVI was associated with significant inaccuracy, leading to misclassification of VC severity and potential errors in surgical planning. Standard goniometry, while objective, was cumbersome in pediatric patients due to parallax errors and anatomical constraints. Smartphone-based goniometry provided improved accuracy and interobserver reliability. AI-based methods demonstrated the highest precision by minimizing subjectivity and enhancing standardization.</p><p><strong>Conclusion: </strong>Objective measurement techniques, particularly smartphone-based and AI-driven approaches, are superior to UVI in assessing penile curvature in hypospadias. Future advances in AI technology and digital imaging may further refine VC assessment, leading to improved surgical outcomes. Adoption of standardized, objective measurement methods should be encouraged in clinical practice.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094123","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}