This Month in Pediatric Urology

Abstract

You have accessJournal of UrologyThis Month in Pediatric Urology1 Dec 2020This 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.0000000000001267AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Three articles in this issue of The Journal focus on common pediatric urological diagnoses: bladder-bowel dysfunction (BBD), febrile urinary tract infection (fUTI) in infants and distal hypospadias. These authors paused while seeing these everyday cases to ask how we can improve care for patients with these routine diagnoses. Development and Validation of Symptom Score for Total Bladder-Bowel Dysfunction: Subscales for Overactive Bladder and Dysfunctional Voiding Because bladder-bowel dysfunction encompasses such a wide range of symptoms, including infrequent voiding, genital pain and urinary frequency, many clinicians take an “I know it when I see it” approach to clinical assessment. BBD negatively affects outcomes in children with vesicoureteral reflux and recurrent urinary tract infections. However, research studies on these topics are limited unless we have a standardized assessment method. Sillén et al (1333) from Sweden present a validated BBD symptom score for children 3 to 16 years old.1 Children with monosymptomatic enuresis, which is not included in the definition of BBD, were excluded. This instrument improves on existing pediatric questionnaires. It is able to distinguish between storage and emptying dysfunction, and it can assess treatment response. Currently the questionnaire has only been validated in Swedish. Use of a standardized BBD questionnaire across research studies should be a common goal of the pediatric urology community. Impact of Long-Term Low Dose Antibiotic Prophylaxis on Gut Microbiota in Children Following febrile urinary tract infection antibiotic prophylaxis is routinely started in infants with vesicoureteral reflux. There has been concern that altering the microbiome can increase the risk of obesity and pediatric allergic diseases. Akagawa et al (1320) from Japan performed 16S ribosomal gene sequencing on stool samples of infants treated for fUTI before, during and 5 to 6 months after antibiotic treatment.2 Continuous antibiotic prophylaxis with trimethoprim-sulfamethoxazole was started in those infants diagnosed with vesicoureteral reflux, while those without reflux served as controls. Although gut microbiota diversity initially decreased after treatment of fUTI, diversity recovered 1 to 2 months after treatment and was maintained in both groups. Antibiotic resistance could not be measured by this methodology. The results from this small study are reassuring and offer novel insights regarding the many infants who are started on antibiotic prophylaxis. Competency in Tubularized Incised Plate Repair for Distal Hypospadias: Cumulative Sum Learning Curve Analysis of a Single Surgeon Experience Distal hypospadias repair is a common pediatric urological procedure. Zu’bi et al (1326) from Canada and Madison, Wisconsin asked the question “How long does it take after establishing independent practice for a single surgeon to become competent and proficient?”3 They found that the complication rate and operative time started to decrease after the 234th case. The study has limitations because complications can continue to arise long after the initial procedure. Although the results are not surprising, the study prompts frank discussion of the importance of tracking our own complication rates, whether just starting or in practice for many years, and the technical modifications we can make to lower them.