This Month in Pediatric Urology

Abstract

You have accessJournal of UrologyThis Month in Pediatric Urology1 May 2020This Month in Pediatric Urology Julian Wan Julian WanJulian Wan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000784AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail The pediatric articles published in this issue of The Journal represent 2 ends of the pathological spectrum. Peycelon et al focus on the beginning in their report on in utero maternal hormone levels that may predict the risk for hypospadias.1 Aksenov and Granberg evaluate the potential complications of minimally invasive surgery to treat common conditions such as ureteropelvic junction narrowing and vesicoureteral reflux.2 Linking the articles is the acquisition, collection and analysis of large pools of data. The collection, storage, examination and commerce of personal data including medical information has expanded in the last few decades and is likely to continue to grow as greater segments of the population become associated with electronic medical record systems. Despite the many real concerns about privacy and exploitation, there are legitimate scientific applications of these larger data collections. By sampling blood collected as part of general screening, specific disease relationships can be identified and complications may emerge when gathering reports of procedures. Association of Maternal Human Chorionic Gonadotropin and Hypospadias Using a large national registry, Peycelon et al (page 1017) from France examined the association between first trimester maternal serum free beta-human chorionic gonadotropin (HCG) levels and subsequent finding of hypospadias in the newborn. It has been established that tubularization of the urethra occurs early and is usually complete by 16 to 18 weeks of gestation. This process is affected by testosterone activity which, in turn, is affected by the release of HCG from maternal placental syncytiotrophoblasts. The authors suspect that the relationship may depend more on total HCG rather than just the beta subunit. Using a large metropolitan Paris database of maternal blood samples taken as part of routine prenatal screening, they found that proximal hypospadias, but not distal hypospadias or hypospadias overall, was associated with significantly higher levels of beta-HCG. The study was controlled for age and excluded pregnancies that were initiated by artificial reproductive technologies (a known risk for hypospadias), chromosomal anomalies, twins, fetal death and terminations. However, the authors acknowledged the limitations inherent with this type of analysis, most of which relate to potential bias from underreporting of less severe forms and the small number of proximal hypospadias cases (13 of 194 hypospadias cases). Complications of Minimally Invasive Surgery in Children To assess complications in patients treated with minimally invasive surgery, Aksenov et al (page 1010) from North Carolina and Minnesota conducted a review of the existing literature.2 While the Clavien-Dindo (CD) system of classification has been widely used, it was used in only a third of the articles in their review, whereas for the remaining articles complications were adjudicated by the authors and assigned a CD grade. In particular, the authors focused on complications resulting in subsequent surgical, radiological and endoscopic interventions (CD grade IIIa without general anesthesia, CD grade IIIb with general anesthesia). They also noted conversion rates related to open surgery. A significantly lower rate of grade III complications was reported for nephrectomy than for pyeloplasty and ureteral reimplantation. Complex reconstructions, as one would expect intuitively, resulted in the highest grade III complication rate at 12%. Likewise, the complication rate was highest for conversion to open surgery, followed by partial nephrectomy, nephrectomy and ureteral reimplantation. The lowest complication rate occurred after pyeloplasty (1%) which may reflect longer experience with this procedure. The clear separation of open conversion and the need for a complication related subsequent procedure is of practical use when discussing possible risks with families, patients and referring physicians.