Journal of Pediatric Urology最新文献

{"title":"The significance of ureterocele diameter for management and outcome.","authors":"Lukas Steinkellner, Jonas Thüminger, Mona Kerling, Nadine Gisnapp, Christa Gernhold, Josef Oswald, Bernhard Haid","doi":"10.1016/j.jpurol.2025.05.002","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.05.002","url":null,"abstract":"<p><strong>Introduction: </strong>Ureteroceles are rare congenital malformations of the urinary tract and challenging in management. Other than localisation (ectopic or orthotopic) and features of the upper tract, there are no well-tested predictive variables. We aimed at evaluating the initial sonographically measured ureterocele diameter (UD) as a predictor for underlying anatomy, success of primary management and long-term complications.</p><p><strong>Patients and methods: </strong>All patients (n = 131, 41m/90f) referred to a single tertiary department with the diagnosis of an ureterocele between 07/1995 and 07/2019 were included. The UD was measured sonographically at the time of initial diagnosis. Most patients (n = 108, 82.4 %) underwent scintigraphy (either MAG3 or DMSA-scan) and voiding cystourethrography. After initial wait-and-see or primary endoscopic intervention, complications and symptomatic or high-grade VUR were indications for further surgical treatment, following an individualised protocol. Beneath data from sonographic exams, occurrence of urinary tract infections and voiding problems, all surgical and endoscopic data was recorded. Variables were examined using univariate and stepwise multivariate statistical methods.</p><p><strong>Results: </strong>With a median age at first presentation of 2 months (IQR 8) the mean follow-up accounted to 6.5 years ± 4.8 years (range 0-20 years, median 5.4 years, IQR 7.3). Information on the initial diameter was available in 123 patients (94 %) with a median of 14 mm (IQR 14, range: 4-40). In a stepwise multivariate analysis, the UD significantly correlated with the localisation (ectopic/orthotopic, p = 0.001, AUC 0.7), successful primary endoscopic intervention (p = 0.02, AUC 0.71) and successful wait-and-see (p = 0.003, AUC 0.82). Female sex showed a significant impact on the probability of successful primary endoscopic intervention (p = 0.002, AUC 0.71) and was besides age the only variable correlating with UTIs prior to treatment (p = 0.01, AUC 0.8) whereas UD was not. Figure. The anatomic localisation (ectopic or orthotopic) showed less significance than UD in all the analyses performed. In a prediction model based on the multivariate analysis a diameter of <10 mm and >26 mm showed a ≥90 % probability of either orthotopic or ectopic localisation.</p><p><strong>Conclusion: </strong>In this retrospective cohort sonographically measured ureterocele diameter was an easy and non-invasively detectable feature predicting localisation and proved a stronger predictive variable for the success of primary management strategies, superior to endoscopically verified ureterocele localisation, in a stepwise multivariant analysis. Furthermore, UD was predictive of long-term complications with an AUC of 0.7. Conversely, neither UD nor localisation predicted the frequency of UTIs prior to treatment, underlining the importance of CAP, especially in female patients.</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":"144094126","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":"Commentary to \"Early spontaneous resolution of vesicoureteral reflux from voiding cystourethrogram: A comparison of contemporary prediction models\".","authors":"Hans G Pohl","doi":"10.1016/j.jpurol.2025.04.041","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.04.041","url":null,"abstract":"","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":"144094118","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":"Comparison of open and robot-assisted repair for ureteropelvic junction obstruction: Outcomes and direct costs from a single-institution.","authors":"Aznive Aghababian, Suhaib Abdulfattah, Sahar Eftekharzadeh, Alice Xiang, John Weaver, Jason Van Batavia, Dana Weiss, Christopher Long, Stephen Zderic, Mark Zaontz, Thomas F Kolon, Arun K Srinivasan, Aseem R Shukla, Sameer Mittal","doi":"10.1016/j.jpurol.2025.05.001","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.05.001","url":null,"abstract":"<p><strong>Introduction: </strong>Robot-assisted laparoscopic pyeloplasty (RALP) is commonly performed to repair ureteropelvic junction obstruction (UPJO), but concerns remain regarding its efficacy and safety, as well as its cost compared to open pyeloplasty (OP). We hypothesized that primary RALP is equally efficacious to OP, with comparable direct costs.</p><p><strong>Methods: </strong>An IRB-approved single institutional registry was retrospectively reviewed to identify all patients undergoing primary OP and RALP between July 2012 and March 2020. Intra- and postoperative surgical details were aggregated and compared. Successful reconstruction was defined as no need for additional interventions besides stent removal. Direct cost from day 0-60 from surgery was assessed for consecutive patients operated in FY2018 - 2019.</p><p><strong>Results: </strong>Of 424 patients undergoing pyeloplasty, 346 patients were included in our analysis: 75 OP and 271 RALP. Patients underwent surgery at a median age of 39.8 months with younger patients in the OP group (p < 0.001). The 30-day complication rate was not different between groups, while higher-grade complications (Clavien G3 and 4) were significantly more prevalent in OP group (8.0 % vs 1.8 %, p < 0.01). With median follow-up of 17.5 months (IQR 8.8-34.1), no difference in overall long-term success was observed between the groups (96.0 vs 96.7, p = 0.73). The subset analysis performed for patients who had pyeloplasty at an age younger than 12 months showed similar results. 0-to-30 day direct costs were not significantly different between the two groups, but higher in the RALP group in the 30-60 day period secondary to additional procedures for stent removal. However, the total 0-60 day costs were not significantly different between RALP and OP (p = 0.47). Multivariate analyses identified 30-day post-operative complications as the only predictor for both success and direct cost.</p><p><strong>Conclusions: </strong>In this contemporary cohort, RALP had similar success rate and was associated with fewer high grade post-operative complications compared to OP. While 30-60 day costs were higher in RALP due to post-operative stent removal, the overall 0-60 day costs were not statistically different between the two cohorts.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094121","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 \"Canmemis A, Ozel SK. The impact of artifact levels on intra- and interobserver agreement in pediatric urodynamic traces\".","authors":"Arzu Canmemis, Seyhmus K Ozel","doi":"10.1016/j.jpurol.2025.04.038","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.04.038","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086327","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":"Combined use of Mathieu V incision sutured meatoplasty (MAVIS) and incision of the urethral plate (IP) in distal hypospadias repair, MAVIS-IP urethroplasty modification.","authors":"Mustafa Ozgur Tan","doi":"10.1016/j.jpurol.2025.04.040","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.04.040","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086325","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":"Reply to letter regarding \"Two-flip Mathieu's technique in distal hypospadias with small glans\".","authors":"Vikesh Agrawal, Ramesh Babu","doi":"10.1016/j.jpurol.2025.04.039","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.04.039","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132581","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":"RE: Canmemis A, Ozel SK. The impact of artifact levels on intra- and interobserver agreement in pediatric urodynamic traces. J Pediatr Urol. 2025 Apr;21(2):362-369. doi: 10.1016/j.jpurol.2024.12.010. Epub 2024 Dec 15. PMID: 39725590.","authors":"Peter F W M Rosier","doi":"10.1016/j.jpurol.2025.04.037","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.04.037","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144127919","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 Vortex shunt: Short-term feasibility studies in the fetal lamb model of lower urinary tract obstruction and pleural effusion.","authors":"Enrico Danzer, Yair J Blumenfeld, Tomohiro Arai, Marianna Scuglia, Eric Johnson, James K Wall, Wasinee Tianthong, David Basurto, Roland Devlieger, Jan Deprest, Francesca M Russo, Kunj R Sheth","doi":"10.1016/j.jpurol.2025.04.027","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.04.027","url":null,"abstract":"<p><strong>Background: </strong>The suboptimal shunt design of the currently available vesico-amniotic and thoraco-amniotic shunts is likely at tributed to the risk of shunt failure, either by displacement, kinking, or obstruction, resulting in treatment failure and the need for additional fetal intervention.</p><p><strong>Objective: </strong>To evaluate the feasibility of ultrasound-guided insertion, drainage, and short-term dislodgement risks of the novel Vortex shunt in fetal lambs with surgically induced lower urinary tract obstruction (LUTO) and pleural effusion.</p><p><strong>Study design: </strong>LUTO was surgically created in eight fetal lambs at a median of 71 days (range 69-72; term = 145) gestation. LUTO phenotype developed in 5, of which four survived to shunt insertion at a median of 98 days (range 97-99). The three lambs that did not develop the LUTO phenotype and the one intrauterine fetal demise underwent pleural effusion creation. In the shunted LUTO fetuses 24 h post-deployment, the location and patency of the shunt were evaluated on fetal ultrasound and autopsy. In pleural effusion fetuses, shunt deployment was followed by immediate euthanasia and obduction.</p><p><strong>Results: </strong>The deployment of the Vortex shunt was successful in all animals. In the LUTO group, bladder drainage was observed immediately after shunt placement, and functionality was confirmed 24 h later. Immediate drainage of the pleural effusion after shunt insertion led to the resolution of the pleural effusion. Accurate shunt positioning was verified in all fetuses through post-procedural and pre-necropsy ultrasound and during autopsy. There were no complications related to the shunt deployment. The short duration between shunt placement and autopsy limits our ability to draw definitive conclusions about the long-term effects of our shunt.</p><p><strong>Discussion: </strong>These preclinical experiments provide proof-of-concept data on the novel fetal Vortex shunt. We demonstrated short-term safety and functionality without dislodgement after 24 h of deployment. The findings are the basis for long-term preclinical efficacy and safety studies in the LUTO fetal lamb model.</p><p><strong>Conclusion: </strong>The novel Vortex shunt was tested for short-term safety and functionality in a preclinical fetal lamb model of lower urinary tract obstruction and pleural effusion.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086330","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":"Commentary on socioeconomic and demographic factors predict post-surgical follow-up.","authors":"Ruohui Huang, Liqin Gu","doi":"10.1016/j.jpurol.2025.04.028","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.04.028","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144094115","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":"\"Simple Anatomical Closure-SAC\" for distal hypospadias repair without glans wings dissection: Technical description and preliminary results.","authors":"Ali Ekber Hakalmaz, Ali Sezer, Ayşe Karagöz Hakalmaz, Haluk Emir","doi":"10.1016/j.jpurol.2025.04.036","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.04.036","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Glans wings dissection is an important part of hypospadias repair to ensure safe coverage of the neourethra. We here describe our technique entitled \"Simple Anatomical Closure (SAC)\" procedure, without extensive glans wings dissection, to preserve the distal continuity of spongious tissues and their glanular attachments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Our aim is to evaluate the clinical results of the SAC procedure, while questioning the absolute necessity of glans wings dissection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and method: &lt;/strong&gt;Cases that underwent SAC procedure between 2018 and 2023 were retrospectively analyzed for demographic data, perioperative findings, and clinical outcomes. Anatomical inclusion criteria for performing SAC procedure were: primary distal hypospadias cases with a wide glans penis, wide ventral periurethral triangles and well-developed distal periurethral spongious tissues. Cases with more than 30 degrees of ventral curvature and/or dysplastic urethral plate were excluded. For the SAC technique: following total penile degloving and exposure of distal penile structures, the urethral plate mucosa is separated from glanular mucosa while ventral glanular periurethral triangles are deepithelialized. Urethral plate incision with or without inlay grafting is applied if indicated. A limited distal urethral spongious tissue dissection is performed towards the glans penis while preserving spongious continuity and glanular attachments. Dorsal midline plication and/or complete urethral dissection with ventral corporotomies are applied if necessary for correction of ventral curvature. Penile structures are then closed according to their anatomical order.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;SAC procedure was applied in 43 (2 glanular, 18 coronal, 23 subcoronal) primary distal hypospadias cases between 2018 and 2023. The median operation age was 25 months. Urethral plate incision was done in 39 cases and preputial inlay grafting added in 18. Ventral curvature was present in 34 cases (15-30°), which was corrected with penile degloving, dorsal midline plication, urethral dissection/separation and superficial ventral corporotomies, when necessary. Mean follow-up period was 32.5 months. Late term results revealed 1 fistula, 1 glanular tilt, and 2 mild distal glans dehiscences with no ventral curvature recurrence, penile rotation, diverticula, or stenosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Glans wings dissection is a commonly used technique during hypospadias repair that possibly increases success rates. However, in selected cases, reconstruction of penile structures without extensive glans wings dissection is possible. Recently described surgical modifications also have similar principles and recommend glanuloplasty without extensive glans wings dissection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;\"Simple Anatomical Closure\" procedure without glans wings dissection is a safe method for primary distal hypospadias repair,","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159565","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}