Journal of Pediatric Urology最新文献

{"title":"Comment on \"Comparing clinical and radiological success in open versus endoscopic surgery of primary vesicoureteral reflux\".","authors":"Amnuay Kleebayoon, Viroj Wiwanitkit","doi":"10.1016/j.jpurol.2025.02.042","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.02.042","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657571","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":"Staged orchiopexy in low intra-abdominal undescended testis with short spermatic cord: Open traction vs. Laparoscopic Fowler-Stephens - A matter of surgeon preference.","authors":"Hooman Kamran, Tohid Razmi, Arshin Ghaedi, Ali Bahador, Hamidreza Foroutan, Mehdi Forooghi","doi":"10.1016/j.jpurol.2025.02.041","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.02.041","url":null,"abstract":"<p><strong>Introduction: </strong>Among techniques for short spermatic vessels in nonpalpable undescended testis (UDT), the Fowler-Stephens (F-S) procedure is the most favored. However, traction methods have regained popularity with gradual testicular tension for elongation to avoid ligating the spermatic vessels.</p><p><strong>Objective: </strong>To compare two techniques for low intra-abdominal UDT with a short spermatic cord: staged laparoscopic F-S and a modified staged open traction technique, and to determine if long-practicing surgeons should change their preferred method.</p><p><strong>Study design: </strong>Seventy boys under six with nonpalpable low intra-abdominal UDT and short cords underwent either staged laparoscopic F-S or staged open traction orchiopexy. Based on surgical exploration and the surgeons' opinions, the included patients had vessels too short for one-stage orchiopexy. Two expert pediatric surgeons performed the surgeries, each using their preferred technique. Surgeon 1 used staged open traction, anchoring the testis to the pubic tubercle with low tension, followed by canal mobilization and fixation in the scrotum, while Surgeon 2 performed staged laparoscopic F-S. Post-operative ultrasonography at six months assessed success based on the absence of testicular atrophy and correct testis location.</p><p><strong>Results: </strong>Of the 70 boys, 36 (51.4 %) underwent staged open traction, and 34 (48.6 %) underwent staged laparoscopic F-S. The median age was 1.7 years. No intra- or post-operative complications occurred, and all testes were correctly placed in the scrotum. Testicular atrophy occurred in 6 patients (8.6 %): 2 (5.6 %) in the traction group and 4 (11.8 %) in the F-S group (p-value: 0.422). Atrophy was more common in bilateral cases, but all instances were unilateral (p-value: 0.022).</p><p><strong>Discussion: </strong>Both techniques had comparable results with no post-operative complications, and all testes were correctly positioned in the scrotum during follow-up. Although 5.6 % of patients in the traction group and 11.8 % in the F-S group experienced testicular atrophy, the difference was not statistically significant. Surgeon 1 performed all open traction surgeries, and Surgeon 2 performed all F-S operations due to their preferences and over 10 years of experience. Acceptable and comparable outcomes in both techniques show that both are safe when performed by an expert surgeon. We suggest that surgeons continue using their preferred technique if they are experts in it for the treatment of UDT. Although we assume our modified open traction method has an acceptable learning curve for less experienced surgeons, this needs further study.</p><p><strong>Conclusions: </strong>Both staged traction and F-S techniques, performed by expert surgeons, yielded comparable outcomes, supporting the continued use of preferred methods.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630581","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 of incisional negative pressure wound therapy in reconstructive pediatric and young adult urology to reduce surgical site occurrences: A pilot study.","authors":"Kelly T Harris, Catalina Hwang, Brian Caldwell, Vijaya Vemulakonda, Dan Wood, Duncan T Wilcox, Kyle O Rove","doi":"10.1016/j.jpurol.2025.03.001","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.03.001","url":null,"abstract":"<p><strong>Background: </strong>Surgical site occurrences (SSO) contribute to the morbidity and cost of postoperative complications. In adult and pediatric surgical literature, enthusiasm for incisional negative pressure wound therapy (iNPWT) on closed surgical incisions has been ongoing.</p><p><strong>Objective: </strong>The aim of this pilot study is to report the early outcomes of iNPWT in reconstructive pediatric and young adult urologic surgery.</p><p><strong>Study design: </strong>This is a pilot prospective cohort study at a single, tertiary care, free-standing children's hospital. Wound complication outcomes with use of iNPWT are compared to a historical cohort that underwent routine incision closures. A multivariate logistic regression model was used to predict the risk of composite SSO within the first 30 days after surgery.</p><p><strong>Results: </strong>On univariate analysis, the percentage of patients experiencing SSO fell from 24.0 % to 6.9 % with introduction of iNPWT (p = 0.065). On multivariate analysis, compared to the pre-iNPWT group, placement of iNPWT was associated with a reduction in risk of composite SSO [OR 0.084 (0.009-0.415, p = 0.01].</p><p><strong>Discussion: </strong>Strengths of this study are that it was prospective in nature and there was consistency in iNPWT placement and management throughout the study period. Until more reliable biological markers of SSO risk are available, we believe that interventions to prevent SSO must be broadly applied. One limitation is that the financial and physical cost of having an iNPWT placed could not be measured for each individual patient.</p><p><strong>Conclusion: </strong>In this pilot study, iNPWT was found to be a successful intervention to reduce SSO in reconstructive pediatric and young adult urology patients. Use of iNPWT could be considered for all, but perhaps particularly in those with a baseline high risk of SSO, including those with obesity or connective tissue disorders.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634063","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":"The short-term efficacy of modified plate reconstruction and tubularization urethroplasty for posterior hypospadias.","authors":"Yonglong Wu, Wenni Li, Shoufu Wang, Yang Hu, Ying Zhang, Bo Xu, Haichen Chen","doi":"10.1016/j.jpurol.2025.02.039","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.02.039","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the short-term efficacy of modified plate reconstruction and tubularization urethroplasty for posterior hypospadias.</p><p><strong>Material and method: </strong>We retrospectively collected the clinical data of posterior hypospadias patients who were newly diagnosed and underwent plate reconstruction and tubularization urethroplasty (PRTU) or modified PRTU. Surgical modifications were to reconstruct the glans segment of the urethra with a free flap, thus presenting an orthotopic urethral opening, and to preserve the Buck's fascia at the coronal sulcus for approximately 1 cm to enhance coverage of the shaped urethra. Regular follow-up was taken in clinic or online. We compared complication rate, HOSE score and uroflowmetry testing results between these two groups.</p><p><strong>Results: </strong>A total of 107 children underwent either PRTU or modified PRTU, and 102 of them were fully followed-up (55 cases of PRTU and 47 cases of modified PRTU). All of the patients were diagnosed with posterior hypospadias. The age at operation ranged from 1 year to 1 month to 14 years old (mean age 3 years and 2 months). The postoperative follow-up period ranged from six to 63 months, with an average follow-up period of 23.2 months, and 102 patients provided comprehensive post-operative data, exhibiting a comprehensive follow-up rate of 95.3 %. There's a statistically significant difference in the incidence of dehiscence of urethra between PRTU group (10 cases) and modified PRTU group (2 cases).</p><p><strong>Conclusion: </strong>Modified PRTU is a safe, practical, and effective method for hypospadias. This procedure is appropriate for repairing posterior-type hypospadias combined with penoscrotal transposition, while reducing the risk of postoperative urethral dehiscence and achieve good appearance.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657574","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 of Black-Star® magnetic-end double-J stent in transperitoneal and retroperitoneal pediatric robotic assisted laparoscopic pyeloplasty.","authors":"Fabrizio Vatta, Hortense Alliot, Sébastien Faraj, Caroline Camby, Marc-David Leclair, Thomas Loubersac","doi":"10.1016/j.jpurol.2025.02.040","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.02.040","url":null,"abstract":"<p><strong>Objective: </strong>The Black-Star® magnetic-end double-J ureteral stent (MEDJUS) is commonly used in pediatric urology, but few studies have analyzed its use in pediatric robotic-assisted laparoscopic pyeloplasty (RALP), particularly with a retroperitoneal approach. The aim was to review our series and analyze possible factors associated with failure of stent insertion or retrieval.</p><p><strong>Study design: </strong>Retrospective review from a prospective database of children who underwent trans-peritoneal RALP (T-RALP) and retroperitoneal (R-RALP) pyeloplasty between 2020 and 2023. Success was defined as the successful insertion MEDJUS during RALP and its removal under local anesthesia.</p><p><strong>Results: </strong>Of the 33 patients who underwent RALP (14 T-RALP, 19 R-RALP), MEDJUS was successfully placed in 23 (74 %) (9 transperitoneal, 14 retroperitoneal), while eight patients had difficulty inserting the stent. In two patients, use of Black-Star® was not attempted (one patient was too tall, surgeon preference in the other). Of the 23 patients in whom MEDJUS was inserted, retrieval failed in five. Overall, successful insertion and retrieval occurred in 58 % of cases. Statistical analysis revealed an association between age and weight, and success of insertion (p values of 0.05 and 0.04, respectively). Moreover, all failures of retrieval occurred in patients who underwent a retroperitoneal approach (p-value 0.04).</p><p><strong>Conclusion: </strong>The use of MEDJUS showed good results for RALP. Overall success rate in terms of avoiding a second general anesthesia for stent retrieval was 60 %. Our experience indicates an association between successful stent insertion and increasing age and weight. Additionally, we observed a higher rate of retrieval failure in patients who underwent a retroperitoneal approach.</p><p><strong>Clinical trial registration: </strong>It is a retrospective study registered at our local ethical committee at Nantes Université \"Groupe Nantais d'Ethique dans le Domaine de la Santé\" (GNEDS) (23-85-06-300).</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742997","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":"Initial puncture vs observational management of ureteroceles.","authors":"H Gil Rushton, Hans Pohl","doi":"10.1016/j.jpurol.2025.02.037","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.02.037","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674097","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":"\"Think before you pop\" - Outcomes of non-operative management of ureteroceles.","authors":"Karl F Godlewski, Arun K Srinivasan","doi":"10.1016/j.jpurol.2025.02.038","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.02.038","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692556","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":"Bladder outlet procedures without augmentation cystoplasty: Long-term outcomes and association of preoperative bladder compliance with subsequent augmentation cystoplasty or urinary diversion and DMSA abnormalities.","authors":"Alexandra M C Carolan, Shane F Batie, Yvonne Y Chan, Micah A Jacobs, Bruce J Schlomer","doi":"10.1016/j.jpurol.2025.02.033","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.02.033","url":null,"abstract":"<p><strong>Background: </strong>A bladder outlet procedure (BOP) without augmentation cystoplasty (AC) for incontinence from neurogenic bladder has risks including renal damage and future surgeries.</p><p><strong>Objective: </strong>Our objective was to obtain long-term outcomes after BOP without AC and identify risk factors for adverse outcomes. We hypothesized that high preoperative bladder compliance is associated with lower risk of subsequent AC or diversion (AC/D) and dimercaptosuccinic acid renal scan (DMSA) abnormalities.</p><p><strong>Design: </strong>After retrospective review and longitudinal dataset creation, cumulative incidences of outcomes to 15 years were calculated. The association of preoperative bladder compliance with subsequent AC/D and DMSA abnormalities was studied by log-rank test, interval likelihood ratios (ILR), and receiver operative curve analysis.</p><p><strong>Results: </strong>119 patients underwent BOP without AC from 2000 to 2022 at median age of 7.4 years (IQR 5.6-11.5). 39 underwent AC during follow up, 4 underwent diversion. Median follow-up was 11.6 years (IQR 7.3-14.1). At 15 years, cumulative incidence of AC/D was 48 % (95 % CI 37-59 %) and DMSA abnormalities was 38 % (95 % CI 29-49 %). For the 85 patients with preoperative urodynamic tracings, ILRs for subsequent AC/D and DMSA abnormality for the 55 % of patients with bladder compliance <15 mL/cm H2O were 2.0 and 1.9. For the 28 % with compliance ≥15 to <35 mL/cm H2O, ILRs were 0.6 and 0.5. The 16 % of patients with compliance ≥35 mL/cm H2O had ILRs of zero for both outcomes. Preoperative bladder compliance was associated with subsequent AC/D (p = 0.004) and DMSA abnormalities (p = 0.015) by log-rank test (Summary Figure).</p><p><strong>Discussion: </strong>Patients with low preoperative bladder compliance (<15 mL/cm H2O) had high risk of subsequent AC/D and DMSA abnormalities, while patients with high preoperative compliance (≥35 mL/cm H2O) had low risk of these outcomes. There was continued rise in incidence of subsequent AC/D, CKD diagnosis, upper tract changes, and urodynamics with end fill pressure >40 cm H2O from 10 to 15 years after BOP without AC. Limitations include retrospective nature, lack of preoperative DMSA in most, and lack of standardized indications for surgery.</p><p><strong>Conclusion: </strong>Following BOP without AC, preoperative bladder compliance ≥35 mL/cm H2O was seen in a minority of patients and was associated with low risk of subsequent AC/D and DMSA abnormalities. These results provide practical information for urologists and families for a shared decision making process and support selective use of BOP without AC in patients with high bladder compliance. Long-term monitoring remains important.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630579","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 comment: Modified J-shaped incision for combined pediatric liver-kidney transplants (CLKT): Focusing on the urological outcomes.","authors":"Romy Gander, Jose Andrés Molino, Isabel González-Barba, Marino Asensio","doi":"10.1016/j.jpurol.2025.02.031","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.02.031","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624795","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":"Addressing inequities in cryptorchidism care: The impact of social determinants on timely & true undescended testis referrals - A six-year study from a high-volume referral center.","authors":"Jin Kyu Kim, Renee Shavnore, Pete Arnold, Nikhil V Batra, Konrad M Szymanski, Benjamin M Whittam, Martin Kaefer, Mark P Cain, Pankaj Dangle, Kirstan K Meldrum, Richard C Rink, Rosalia Misseri, Joshua D Roth","doi":"10.1016/j.jpurol.2025.02.036","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.02.036","url":null,"abstract":"<p><strong>Introduction: </strong>The American Urological Association (AUA) recommends urology referral and surgery for undescended testicle (UDT) before 18 months of age, but it has been shown that many referrals occur later, influenced by social factors.</p><p><strong>Objective: </strong>This study aims to identify key social factors that impact UDT referral timing and appropriateness.</p><p><strong>Study design: </strong>Pediatric patients referred to our institution for UDT management from 2018 to 2023 were analyzed. Referral appropriateness was assessed by whether the child had a true UDT, defined as undergoing orchiopexy. Timeliness was defined as referral before 15 months of age, accounting for median 3 months interval to surgery. Demographics and socioeconomic data were gathered, including health literacy index (HLI), area deprivation index (ADI), and provider training (physician vs. advanced practice provider [APP]).</p><p><strong>Results: </strong>Of 1821 patients, 45.6 % of patients had bilaterally descended testicles, and the median referral age was 2.5 years (IQR: 1.2-6.6), with only 27.3 % referred before 15 months. Taken together, 15.3 % of referrals were both appropriate and timely. Multivariate analysis identified three significant factors for true UDT referrals: APP referrals (OR 1.37, p = 0.028), higher ADI percentile (OR 1.005, p = 0.021), and Black race compared to non-Hispanic White (OR 1.80, p < 0.001). Hispanic children more likely to be referred late on multivariate analysis (OR 1.53, p = 0.029); upon random evaluation of approximately 10 % of our study population, 16.5 % had pre-referral ultrasounds, with more APPs ordering these ultrasounds. Sensitivity analysis confirmed less true and timely referrals for APP referrals and Hispanic and Black races.</p><p><strong>Discussion: </strong>This study is limited by retrospective nature and unmeasured confounders such as parental knowledge or healthcare-seeking behaviors. However, our findings corroborate the disparity also noted from racial differences in analyses of the PHIS database and Cerner Real-World Data. In addition, APP referrals and higher ADI percentile emerged as independent predictors of inappropriate or delayed referrals, underscoring the systemic inequities previously reported.</p><p><strong>Conclusions: </strong>Our findings highlight that nearly half of the children referred for UDT have normally descended or retractile testicles not necessitating referral, and two-thirds are referred late. Significant disparities in referral quality and timing are associated with race, socioeconomic factors, and provider type. Targeted educational interventions focusing on APPs, high-ADI communities, non-White populations, or broader campaigns may help address these disparities effectively.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615774","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}