Journal of Pediatric Urology最新文献

{"title":"Robotic approach to pediatric augmentation cystoplasty: Feasibility, long-term outcomes, and technical refinements.","authors":"Priyank Yadav, Deepak K Kandpal, Sujit K Chowdhary","doi":"10.1016/j.jpurol.2025.07.012","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.07.012","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric bladder dysfunction refractory to conservative management poses significant risks to renal function. While open augmentation cystoplasty is the standard for surgical intervention, robotic-assisted techniques offer a minimally invasive alternative. This study evaluates our institutional experience with robotic augmentation cystoplasty in children, focusing on technical modifications, perioperative outcomes, and long-term functional results.</p><p><strong>Patients and methods: </strong>This prospective series included 11 children who underwent robotic augmentation cystoplasty between January 2014 and December 2023. All had small-capacity, high-pressure bladders unresponsive to anticholinergics, clean intermittent catheterization, and/or intravesical botulinum toxin injection. Preoperative workup included ultrasonography, dimercaptosuccinic acid scans, and videourodynamic studies. A standardized technique using a detubularized ileal U-pouch and bladder bivalving was performed using the da Vinci Si/Xi system. Concomitant procedures included ureteric reimplantation and Mitrofanoff appendicovesicostomy in select cases. Outcomes assessed included operative parameters, urodynamic changes, complication rates, and long-term renal function.</p><p><strong>Results: </strong>All surgeries were completed robotically without conversion. The mean age at surgery was 8.4 years (range: 2-15 years). Mean operative time was 355.5 min and mean estimated blood loss was 294.5 ml. Concomitant ureteric reimplantation was performed in 6 patients and Mitrofanoff creation in 1 patient. Mean bladder capacity improved from 86.4 ml to 283.6 ml (mean increase 383 %), and mean detrusor pressure decreased from 57.5 cm H₂O to 21.8 cm H₂O (62.1 % reduction). There were no major complications. Over a mean follow-up of 74 months, all patients reported improved continence and stable upper tract outcomes.</p><p><strong>Conclusion: </strong>Robotic augmentation cystoplasty is a safe, effective, and durable alternative to open surgery in well-selected pediatric patients. Long-term outcomes demonstrate significant functional improvement. Our selective approach to Mitrofanoff creation may minimize morbidity while preserving surgical success.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707843","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":"Assessing the risk of voiding dysfunction in children with ureteroceles: A systematic review and meta-analysis.","authors":"Jin Kyu Kim, Nikhil Batra, Pete Arnold, Renee Shavnore, Konrad M Szymanski, Martin Kaefer, Joshua Roth, Benjamin Whittam, Pankaj Dangle, Kirstan Meldrum, Richard Rink, Mark Cain, Rosalia Misseri","doi":"10.1016/j.jpurol.2025.07.006","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.07.006","url":null,"abstract":"<p><strong>Introduction: </strong>Ureterocele is a congenital anomaly potentially associated with voiding dysfunction (VD), often requiring surgical intervention. While surgery aims to relieve obstruction and preserve renal function, postoperative VD and related complications remain significant concerns.</p><p><strong>Objectives: </strong>This systematic review aims to evaluate the prevalence of VD and associated outcomes in children following ureterocele surgery.</p><p><strong>Study design: </strong>A systematic search of Medline, Embase, and Web of Science identified studies reporting VD (lower urinary tract dysfunction/symptoms) or related outcomes in children undergoing ureterocele interventions. Random effects meta-analysis was performed to calculate pooled prevalence rates for VD, incontinence, elevated post-void residuals (PVR), and recurrent UTIs. Heterogeneity was assessed using I² statistics, and publication bias was evaluated with funnel plots and trim-and-fill analyses.</p><p><strong>Results: </strong>Fourteen retrospective studies including 1266 patients were analyzed. VD was reported in 25 % of patients (95 % CI 15-36 %), with significant heterogeneity (I² = 91.2 %). Incontinence occurred in 11 % (95 % CI 6-18 %), and elevated PVR were present in 20 % (95 % CI 7-38 %). Recurrent UTIs occurred in 22 %, but febrile UTIs were lower at 9 % (95 % CI 5-14 %), with minimal heterogeneity (I² = 0 %). Heterogeneity and bias were notable, likely due to varied definitions, surgical techniques, and follow-up durations across studies. Risk of bias was high, especially in domain 1 (bias due to confounding) with high likelihood of publication bias with trim-and-fill analysis suggesting lower rates of VD (8.5 %, 95 % CI 2.5-17.1 %) DISCUSSION: This study has key limitations, including biases from retrospective data, reliance on aggregate outcomes, heterogeneity in definitions and methods, and possible reporting biases. As children in this systematic review have undergone interventions, it is difficult to ascertain whether VD is attributable to congenital patient factors or more influenced by surgical technique. Despite this, the review provides a highest level of summary of voiding dysfunction prevalence in children with ureterocele.</p><p><strong>Conclusion: </strong>Within limitation of current evidence, there is notable prevalence of postoperative voiding dysfunction and incontinence in children undergoing ureterocele surgery. The findings emphasize the need for standardized definitions and prospective studies to better characterize long-term outcomes and improve clinical decision-making for this population.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707907","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":"Robot-assisted pyeloplasty in children: feasibility and safety of magnetic-end and standard double-J ureteral stent insertion.","authors":"M Piraprez, T Planchamp, O Abbo","doi":"10.1016/j.jpurol.2025.07.004","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.07.004","url":null,"abstract":"<p><strong>Introduction: </strong>The need for drainage and the choice of drain in pyeloplasty are still debated. The most popular method at present is the double-J ureteral stent (DJUS), but this requires general anaesthesia (GA) for its removal. To avoid this, magnetic-end double-J ureteral stent (MEDJUS - Magnetic Black-Star®) has recently been developed. The present study reports the feasibility and safety of magnetic-end and standard double-J ureteral stent insertion and removal during robot-assisted pyeloplasty in children.</p><p><strong>Methods: </strong>We retrospectively analysed the clinical data of patients who underwent robot-assisted laparoscopic pyeloplasty (RALP) and who have had an attempt to insert MEDJUS or DJUS in our department from January 2015 to April 2024. The variables evaluated included the chosen drainage method (DJUS, Magnetic Black-Star® \"S\"-7 French magnet or \"XS\"-4.8 French magnet), the technical difficulty related with stent insertion or removal, intra- and postoperative complications and the clinical and radiological outcomes of the procedure.</p><p><strong>Results: </strong>Between 2015 and 2024, a total of 91 patients (46 girls, 45 boys) underwent RALP with an attempt to insert either a MEDJUS or DJUS. Median age was 9.2 years (1.5-17.7), median weight 31.9 kg (9.5-71). MEDJUS stent was attempted in 29 patients. The insertion success rate was 51.8 % (n = 15). Separately, the Magnetic Black-Star® S and XS insertion success rates were 37.5 % and 69.2 %, respectively. The rate of office removal was 93.3 % (n = 14/15). The only identified risk factor for failure was younger age, in the MEDJUS XS sub-group only. Seventy patients benefited from an attempt to implant DJUS. The insertion success rate was 92.8 % (n = 65). It would appear that the DJUS failures occurred in younger children of lower weight (median age 7.08 years (1.56-11.5); median weight 25 kg (9.5-52)); however, these results were not statistically significant. There was a statistically significant difference between the insertion rate of DJUS and MEDJUS XS (p = 0.0119).</p><p><strong>Conclusion: </strong>Anterograde insertion of DJUS is a safe and feasible drainage method for RALP in children. MEDJUS avoids the further need for general anaesthesia. However, its anterograde insertion, although feasible, has a high failure rate (48 %). For the time being, its use seems to be limited to the Black-Star® XS magnetic stent, whose results are better, and for older patients. Even so, the failure rate remains high (30 %) and significantly higher than that of the DJUS, despite the equivalent size of the magnet and probe.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144707910","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":"Lower urinary tract symptoms in children with mild to moderate spastic cerebral palsy: Associations with functional level, trunk and respiratory parameters.","authors":"Emine Nacar, Sinem Suner-Keklik, Ayşe Numanoğlu-Akbaş","doi":"10.1016/j.jpurol.2025.07.007","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.07.007","url":null,"abstract":"<p><strong>Introduction and objective: </strong>Lower urinary tract symptoms (LUTS) are common in children with cerebral palsy (CP). Increased severity of functional impairment and impairments in trunk-related structures may be associated with increased severity of LUTS. The aim of our study was to examine the distribution of LUTS in children with mild to moderate spastic type CP and to investigate the relationship between LUTS severity and functional level, trunk control, trunk muscle strength and endurance, respiratory functions and rib cage mobility.</p><p><strong>Methods: </strong>Fifty-three children with spastic CP with Gross Motor Functional Classification System (GMFCS) levels I-II and III were included in the study. LUTS was assessed using Dysfunctional Voiding and Incontinence Scoring System (DVISS); functional levels were assessed using GMFCS; and trunk control was assessed using Trunk Control Measurement Scale (TCMS). Transversus Abdominis (TrA) muscle strength was measured with Stabilizer Compression Biofeedback Unit; trunk muscle strength was measured with Sit-ups and Modified Push-up test; trunk muscle endurance was measured with McGill's trunk flexion, trunk extension, lateral bridge tests and prone bridge test. Pulmonary function was assessed by Contec SP10 Spirometer and chest mobility was assessed by chest circumference measurement.</p><p><strong>Results: </strong>There was statistically significant difference between GMFCS level I and level III mean DVISS scores (p = 0.002). There was moderate negative correlation between DVISS and TCMS score (p = 0.002; r = -0.416), moderate positive correlation between TrA muscle strength (p = 0.001; r = 0.482), modified push-up test (p = 0.025; r = -0.308), trunk extension test (p = 0.021; r = -0.316), prone bridge test (p = 0.008; r = -0.362), FEV1/FVC (p = 0.020; r = -0.320), FEV1 (p = 0.005; r = -0.384), PEF (p = 0.007; r = -0.367).</p><p><strong>Conclusion: </strong>This study shows that LUTS is common in children with mild to moderate spastic CP and that the severity of these symptoms increases significantly as the severity of functional impairment increases. In addition, it was determined that the decrease in trunk control, trunk muscle strength and endurance, respiratory functions and chest mobility were associated with an increase in LUTS. These findings suggest that isolated pelvic floor training alone may not be sufficient to improve lower urinary tract health in children with CP, but instead, a holistic rehabilitation approach that supports motor function, trunk stability and respiratory capacity should be adopted.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760393","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":"An assessment of social determinants of health and time to presentation for testicular torsion.","authors":"Tori Kostman, Ashley Pittman, Liyun Zhang, Amy Pan, Jonathan S Ellison","doi":"10.1016/j.jpurol.2025.06.036","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.06.036","url":null,"abstract":"<p><strong>Introduction: </strong>Testicular torsion is a time-sensitive urologic emergency that requires prompt intervention to preserve testicular function. Previous studies have investigated orchiectomy rates in association with social determinants of health (SDoHs) and found that those without private insurance and Black individuals have higher rates of orchiectomy following testicular torsion. However, there is limited data regarding the impact of SDoHs and time to presentation to a healthcare facility for pediatric patients with testicular torsion.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of pediatric patients with testicular torsion between 2013 and 2022. Patients were excluded from the study if they were 18 and older, less than one month old, did not have documented time of symptom onset, or did not receive urgent surgical treatment at our facility. Time to presentation and surgical outcome was analyzed in association with race, ethnicity, use of interpreter and insurance status.</p><p><strong>Results: </strong>A total of 253 pediatric patients with a median age of 13.9 years were included in the study. There was no significant relationship between ethnicity, race and use of an interpreter and time to presentation. However, patients with public insurance had a longer time to presentation (11.5 h, IQR 3.9-49.3) when compared to those with private insurance and (4.9 h, IQR 2.75-26.2, p = 0.004). There was no relationship between race, Hispanic and non-Hispanic ethnicity, use of an interpreter and insurance status with orchiectomy rates.</p><p><strong>Conclusions: </strong>This study found that within the pediatric population, public insurance status predicted longer time to presentation for patients presenting with testicular torsion. This highlights the importance of access to healthcare facilities for those presenting with testicular torsion. Further work is needed to identify modifiable barriers to presentations in care for testicular torsion.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667882","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 editor on \"Simple Anatomical Closure-SAC\" for distal hypospadias repair without glans wings dissection: Technical description and preliminary results.","authors":"Hüseyin Özbey","doi":"10.1016/j.jpurol.2025.06.037","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.06.037","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667883","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":"Conventional vs. device-assisted paediatric circumcision: A systematic review and meta-analysis.","authors":"Abdul-Hadi Kafagi, Ahmed E Ibrahim, Zaidi Hamid, Abdul Rhaman Kafagi, Abdulrahman Shandala, Abdulrahman Al Marzouq, Mahmoud Elmousili","doi":"10.1016/j.jpurol.2025.06.035","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.06.035","url":null,"abstract":"<p><strong>Objective: </strong>To compare the safety, efficacy, and postoperative outcomes of conventional versus device-assisted techniques in paediatric circumcisions.</p><p><strong>Methods: </strong>Systematic review of all studies up to March 2025. Studies were identified from all major databases, including PubMed, the Cochrane Library, Scopus and Web of Science. All randomised controlled trials and prospective and retrospective cohort studies comparing conventional scalpel-based and device-assisted paediatric circumcision were included; studies involving patients older than 18 years were excluded. The primary outcomes were bleeding, bleeding requiring sutures, surgical site infection, edema, delayed healing or separation, reoperation or revision, urinary retention and inadequate skin removal. Operative time and financial costs were assessed as a secondary outcome.</p><p><strong>Results: </strong>Twenty-three studies involving 23,490 patients were included. Device-assisted circumcision was associated with significantly shorter operative time (P < 00.00001), reduced post-operative bleeding (P = 00.04), and fewer revision surgeries (P = 00.007) compared to conventional techniques. No significant differences were observed in bleeding requiring sutures (P = 00.08), surgical site infection (P = 00.07), delayed healing (P = 00.34), urinary retention (P = 00.45), edema (P = 00.59), or inadequate skin removal (P = 00.11). Subgroup analysis of randomised controlled trials (RCTs) confirmed a significantly shorter operative time with device-assisted techniques (P < 00.00001), with other outcomes showing consistent trends but not reaching statistical significance.</p><p><strong>Conclusion: </strong>Device-assisted paediatric circumcision appears to be associated with shorter operative times and reduced bleeding compared to conventional methods, with comparable rates of most complications. However, the evidence is limited by significant heterogeneity, variability in study quality, and a predominance of observational data. While the findings suggest potential advantages in high-volume or resource-limited settings, larger, well-conducted randomised controlled trials are needed to confirm these results and guide clinical decision-making.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765034","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 Editor on 'Simple Anatomical Closure-SAC for distal hypospadias repair without glans wings dissection: Technical description and preliminary results' \".","authors":"Haluk Emir, Ali Sezer, Ali Ekber Hakalmaz","doi":"10.1016/j.jpurol.2025.06.038","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.06.038","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667884","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 on \"Effectiveness of urotherapy and biofeedback treatment in dysfunctional voiding and factors affecting success\".","authors":"Bekir Erdeve, Serdar Moralıoğlu","doi":"10.1016/j.jpurol.2025.06.039","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.06.039","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667885","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":"Abdominoscrotal hydrocele: A simple strategy for reliable surgical correction.","authors":"Marco Pistone, Giorgio Persano, Antonio Franco, Giorgio Franco, Fabio Ferro","doi":"10.1016/j.jpurol.2025.05.028","DOIUrl":"https://doi.org/10.1016/j.jpurol.2025.05.028","url":null,"abstract":"","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564911","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}