This Month in Pediatric Urology

Abstract

You have accessJournal of UrologyThis Month in Pediatric Urology1 Aug 2022This Month in Pediatric Urology Stacy T. Tanaka Stacy T. TanakaStacy T. Tanaka More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002760AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Pediatric Ureteroscopy Laser Outcomes The application of new medical technology in children commonly lags innovation in adult patients. Jaeger et al (page 426) at Boston Children’s Hospital in Boston, Massachusetts describe their early-adopter experience using a superpulse thulium fiber laser (SPTF) to treat upper tract stones in children.1 The group started using SPTF in September 2020. In a retrospective analysis, the authors compared stone-free rates in patients less than 21 years of age treated with either SPTF (23) or low-power Ho:YAG (holmium:yttrium-aluminum-garnet) laser (69). Stone-free rate, measured by primarily renal ultrasound within 90 days of the procedure, was higher in patients treated with SPTF (70% vs 59%). Because of concern about SPTF generating higher temperatures, the authors were careful to use continuous irrigation and low power settings. The SPTF was not associated with higher postoperative complications or an increase in operative time. The authors’ careful analysis addresses some of the limitations of the retrospective nature of this study. Nevertheless, their success with SPTF without increase in complication rate or operative time is very promising. Salvage Surgery Rates for Pediatric Testicular Torsion Hospital rating systems have weaknesses, but are there any strengths? Mandated reporting of hospital metrics can be a motivator to focus attention on specific aspects of care quality. In 2015, the US News & World Report introduced the quality metric of “time from ED/clinic to operating room” for testicular torsion in their Best Children’s Hospital Rankings. Using the Pediatric Health Information System database, which includes 52 children’s hospitals across the United States, Chun et al (page 441) from Children’s Hospital of Pittsburgh in Pittsburgh, Pennsylvania compared testicular salvage rate before and after this metric was introduced.2 The authors found that the salvage rate improved. Of course, temporal association does not prove causation. However, it is suggestive that salvage rates did not change at hospitals that were receiving full score when the metric was introduced but did increase at hospitals not initially receiving the full score. From 2015 to 2019, the number of hospitals that received a full score for this question increased from 62% to 98%. Hospital rating systems are here to stay. Although it will take work, there is the potential for the pediatric urology community to replace flawed measures with meaningful ones that can nudge care quality. Dietary Risk Factors for Pediatric Kidney Stones Dietary counseling for children with stone disease is primarily based on adult data. Wang et al (page 434) from Boston Children’s Hospital in Boston, Massachusetts present one of the only studies to investigate the relationship between dietary nutrient intake and urolithiasis occurrence in children.3 At Boston Children’s, the primary care clinic was administering the Harvard Service Food Frequency Questionnaire at well child visits while the pediatric stone clinic was administering the Youth Adolescent Food Frequency Questionnaire to first-time stone formers within 6 months of diagnosis. The Harvard School of Public Health Nutrition Department has an analysis mechanism to translate data from both these validated surveys to standardized daily nutrition intake. The authors elegantly used this information to perform a case-control study in 57 stone patients and 228 controls. Unsurprisingly, they found that stone formers had higher sodium intake and lower potassium intake. Unexpectedly, they also found an association with increased calcium intake and increased beta-carotene intake. Although carrots are the most well-known dietary source of beta-carotene, high oxalate foods like spinach and kale also have beta-carotene; however, there did not appear to be an association with dietary oxalate intake. Unfortunately, the dietary surveys did not include data on water intake or specific diets (eg ketogenic diet). However, this novel exploratory study generates intriguing questions for future pediatric stone research.