Pediatric Urology Practice Research Articles

Остаточная моча: вопросы диагностики.

Introduction. To date, the problem of the presence of post voiding residual (PVR) in children remains urgent. PVR is the amount of urine remaining in the bladder after its voluntary emptying. The following conditions are associated with this, requiring the participation of a specialist: urinary tract infection, urolithiasis, bladder dysfunction. Materials and methods. A group of 125 children who were treated at medical centre «Alenka» for bladder dysfunction was under observation. In 42 of them, PVR was detected during uroflowmetric monitoring (UM) for 2 days on the SIGMA model uroflowmeter device, option F. Results. Processing and analysis of the data obtained allowed us to conclude that the reliability of the ultrasound diagnostic method is low (x2 =0.013; p>0.05) when detecting PVR and high during voiding cystourethrography (x2= 3.889; p<0.05). During uroflowmetric monitoring, there was a tendency to decrease the frequency of PVR with age. The average effective volume was reduced in 34 children (20 boys and 14 girls), was within the age norm in 3 boys and increased in 5 children (3 boys and 2 girls). Thus, PVR occurred almost 7 times more often with a decrease in the volume of the bladder than with an increase in it, which changes the idea of the nature of residual urine. Conclusion. According to the conducted research, it becomes clear that the symptom of residual urine is a common sign in pediatric urological practice. The most accurate method for determining PVR is two-day uroflowmonitoring, followed by miction cystography in terms of accuracy. Ultrasound examination reveals residual urine unreliably.

Erectile Dysfunction in Adolescents and Young Adults.

The goal of this paper is to provide a summary of the recent research, evaluation, work-up, and treatment recommendations regarding erectile dysfunction in adolescents and young adults to better equip pediatric urologists to manage patients with this condition. The latest research regarding erectile dysfunction in this population includes organic and psychogenic etiologies, correlations between the COVID-19 pandemic, and online pornography consumption. In our large pediatric urology practice, we found an 31x increase of adolescent males presenting with erectile dysfunction since 2014. The majority of cases are attributed to a psychogenic etiology such as anxiety or depression. It is likely that with stress from anxiety and depression, cortisol levels rise, increasing vascular resistance and leading erectile dysfunction in this population. Most patients want to be reassured of normal testosterone levels, offered cognitive behavioral therapy, and be rehabilitated with tadalafil starting at 5mg p.o. daily until tapered.

Emergent robot-to-open conversion – Multidisciplinary simulation training in crisis management

Anticipating and addressing unexpected intraoperative events and anatomies are some of the most challenging aspects of pediatric urologic practice; uncontrolled hemorrhage is one of the most anxiety provoking and precarious. The increasing application of the robotic platform in pediatric urology adds another layer of complexity as surgeons are not immediately at the patient's bedside. Should hemorrhage occur in robotic cases, clear communication and seamless coordination between members of the operating room team are paramount to optimize patient safety and minimize errors. This is especially important in pediatric cases for which the margin of error is narrow. Non-technical skills, including leadership, decision-making, situational awareness, stress management, and team-communication, become increasingly critical. While many programs have focused on robotic training, few prepare the operating room team and surgical trainees to manage these unforeseen, emergent intraoperative scenarios. This review discusses the role of a multidisciplinary, in situ robot-to-open conversion simulation program in addressing this educational gap, ways to approach establishing these programs, and potential barriers.

Bowel bladder dysfunction in control children in a pediatric urology office

IntroductionBowel bladder dysfunction (BBD) is common in children. Risk factors for BBD include age, gender, obesity, and behavioral issues such as ADHD. We investigated the modified Swedish Bowel-Bladder questionnaire as a sensitive indicator of BBD in healthy children. ObjectivesWe tested the usefulness of the Swedish Bowel-Bladder Questionnaire (BBQ) as an indicator of BBD in children not complaining of bowel/bladder dysfunction at the time of their visit to a pediatric urologist. Our secondary aim was to identify correlations between BBQ scores and risk factors such as gender, BMI, and ADHD. Study designAll families in our Pediatric Urology practice with patients >30 months old who were reportedly toilet trained were provided the Swedish BBQ. Total score as well as sub-scores for storage, emptying, and constipation were prospectively collected. Presenting diagnosis, gender, BMI, and ADHD history were collected. BBQ scores for patients with voiding dysfunction were compared to controls: a) those with genital problems (e.g. hydrocele/undescended testes), b) those with CAKUT (congenital anomalies of the kidneys and urinary tract). BBQ scores were analyzed as a continuous variable vs the potential risk factors (ADHD, obesity, age, and gender) using univariable/multivariable regression analysis. ResultsThe median BBQ score for the 328 control patients (95 CAKUT and 233 genital) was 2.25 with an IQR: 1 to 6. In contrast, the median BBQ was higher for those with possible voiding dysfunction; n=282; 9 with an IQR: 5 to 15). Total BBQ score exceeded 6 in 16% (52/328) of control patients. On multivariable analysis, age-adjusted total BBQ scores increased with ADHD in our controls (p=0.03) but were unaffected by gender or BMI. On multivariable analysis of the voiding dysfunction group, total BBQ scores similarly decreased with age (p<0.001) and increased with ADHD (p<0.001) and were affected by gender (p=0.024). BMI percentile had no significant effect in either cohort. Discussion and ConclusionThe Swedish BBQ was used in a U.S population and demonstrated trends towards increased voiding dysfunction associated with younger age, female gender, and ADHD. We learned that voiding dysfunction in children with ADHD is not associated with constipation and improves over time. Additionally, 16% of children with genital or urinary abnormalities and no voiding complaints have noticeable BBD uncovered by the BBQ. Hence, we conclude that the Swedish BBQ is a sensitive indicator of BBD even in children not complaining of those problems.

Intraperitoneal perforations of the bladder in pediatric urological practice. Comparative evaluation of the effectiveness of various therapeutic and diagnostic approaches

Intraperitoneal perforations of the bladder in pediatric urological practice. Comparative evaluation of the effectiveness of various therapeutic and diagnostic approaches

Does KUB play a role in the diagnosis of bladder bowel dysfunction?

Kidney ureter bladder radiography (KUB) is widely used for the evaluation of constipation in children with bladder and bowel dysfunction (BBD); however, there is varying evidence to support its routine diagnostic use. One drawback to KUB is radiation exposure. The dangers of radiation in children are well-documented, and per As Low As Reasonably Achievable, non-beneficial radiation should be avoided. This risk is especially high in children who undergo repeated imaging in the follow up of constipation treatment. We sought to assess the utility of KUB in diagnosing children with BBD by comparing it to four diagnostic tests and/or validated instruments: the Dysfunctional Voiding Symptom Score (DVSS), Rome IV criteria, rectal diameter on ultrasound (RD), and the Bristol Stool Form Score (BSFS). We prospectively enrolled a cohort of patients presenting to an academic pediatric urology practice with symptoms of BBD. Severity of stool burden on KUB (mild, moderate, or severe), RD on ultrasound (≥3.4cm), DVSS, Rome IV, and BSFS were obtained for each patient. All imaging was interpreted by a pediatric radiologist and pediatric urologist. Primary outcomes were the association between the four diagnostic tests and KUB stool burden. Bivariate analysis of all individual variables versus KUB was performed, as well as multivariate regressions to determine if multiple measures were predictive of KUB stool burden when combined. Between October 2020 and May 2022, 50 patients were enrolled. All children were under the age of 18, with a median age of 8 years (IQR 3-13). 38% were male. Median BMI-for-age-percentile was 80.8 (IQR 50.3-98.3). When comparing individual variables to KUB in bivariate analyses, it was found that RD on ultrasound is predictive of significant stool burden on KUB (p=0.03). No other individual variables were predictive. In the multivariate analyses, no combination of tests was found to be predictive of KUB. We compared the effectiveness of four commonly used diagnostic tests in children with BBD to validate the use of KUB. In conclusion, our results support the use of RD on ultrasound as a non-radiating alternative to KUB to assess stool burden. Data also suggest that KUB for fecal load does not correlate with urinary (DVSS) or bowel (Rome IV, BSFS) symptoms in BBD, and that symptoms scores should still be used independently for diagnosis and monitoring of treatment response. In conclusion, KUB has a limited role in the diagnosis of BBD.

Characterizing psychosocial services in a pediatric urology practice

Psychosocial needs, which encompass behavioral health and social determinants of health (SDOH), are important mediators of the patient experience and health outcomes. However, many practices have limited experience with systematically assessing the non-billable psychosocial services provided to patients and families. To characterize the non-billable activities of three psychosocial providers in a pediatric urology practice at a freestanding children's hospital. Following Institutional Review Board approval, an adapted version of the Care Coordination Measurement Tool (CCMT) was used to collect data prospectively on non-billable activities performed by a psychologist, social worker (SW), and certified child life specialist (CCLS) in a pediatric urology department. Variables included activity type, time spent per activity, and outcomes affected. Demographic data included age, sex, race, state, zip code, insurance type, and language. From April to October 2022, 3096 activities were performed in support of psychosocial needs over 947 encounters for 527 patients. The median patient age was 9.2 years (IQR 4.8-12.4); 48.4% were male. The psychosocial providers most commonly identified care coordination needs related to delivery of urologic care (73.4%), mental/behavioral/developmental health (29.1%), and referral and appointment management (19.9%). The largest proportion of time was spent on providing direct psychosocial support (45.9%), consisting of psychosocial assessments, education, and other behavioral health interventions. A large proportion of time was also spent on care coordination activities, namely logistics and navigation support (35.9%). Relative time allocation across activities varied by provider type (p<0.001); care coordination constituted 64.2% of non-billable activities for the psychologist, 57.8% for the SW, and 12.3% for the CCLS. Activities were associated with treatment plan modification in 37.7% (n=357), outpatient coordination in 22.5% (n=213), and treatment plan adherence in 19.0% (n=180) of encounters. This study enhances our understanding of psychosocial needs of patients in a pediatric urology practice by assessing non-billable psychosocial services not otherwise captured in the clinical workflow. In addition to direct psychosocial support, care coordination activities constitute a large proportion of such services. These data provide valuable insight into the range of activities necessary for the provision of specialty pediatric medical care. Psychosocial providers in a pediatric urology practice perform many non-billable care coordination and psychosocial support activities. Characterizing these activities is important for beginning to understand patients' psychosocial needs and informing resource deployment.

Factors affecting the postoperative quality of life and psychological well-being in pediatric urology patients

While most studies in pediatric urology investigate the clinical results, very few explore the relationship between surgery and quality of life and psychosocial well-being in pediatric urology practice. The determination of the effects of the surgical method on the quality of life (QoL) is of increasing importance. This study investigated the effect of surgery type on the postoperative QoL and psychological well-being of pediatric urological surgery patients. A total of 151 children and adolescents (4-18 years old) undergoing elective urological surgery between September 2020 and July 2021 were evaluated preoperatively; those who currently had psychiatric disorders were excluded. Of the 98 patients undergoing subsequent detailed preoperative assessment using standardized instruments to evaluate QoL and depression and anxiety symptom levels, only 63 could be re-evaluated postoperatively at a 6-month follow-up. Additionally, preoperative parental psychiatric symptom load was assessed using standardized self-report forms. The patients were classified into two categories for analysis-open versus endourological surgery and major versus minor surgery. In the latter category, there was a significant increase in the postoperative QoL in children undergoing minor urological surgery (p=0.037). Furthermore, the table depicted the regression analysis indicating the predictors for lower postoperative QoL. Those predictors were higher parental preoperative psychiatric symptom load, a greater number of previous surgeries, and female gender (p<0.001, adjusted R2=0.304). Postoperative QoL of children/adolescents undergoing pediatric urology surgery is affected more by the patient's preoperative medical condition and the psychological status of the patient's parents, rather than the surgical method opted for.

Treatment of cryptorchidism in pediatric surgical practice: a multicenter study

Introduction. Cryptorchidism is a common disease in pediatric urological and andrological practice since the issues of tactical approaches and its optimal treatment remain extremely relevant. Cryptorchidism makes a significant contribution to the structure of male infertility.Objective. To conduct a retrospective analysis of treatment results in children and adolescents with cryptorchidism.Materials &amp; methods. This study summarises the treatment results of 8308 patients with cryptorchidism aged from 6 months to 17 years who underwent inpatient treatment in the Russian Federation and the Republic of Uzbekistan.Results. It was revealed that from 2015 to 2019, patients were admitted for surgical treatment evenly over the years. The ratio of right-sided / left-sided / bilateral cryptorchidism was 4.6 : 4.4 : 1 The inguinal form prevailed more than 6 times over the abdominal location. At the same time, 26.1% of the patients underwent surgery at the optimal time, and 9.8% were older than 10 years. More often, children are operated from an open inguinal access (95.0%), much less often — laparoscopically and percutaneously. Stage-by-stage treatment was carried out in 6.0% of patients.Conclusion. Thus, the approach presented in the study in the surgical treatment of cryptorchidism provided good treatment results. The number of disease relapses was 1.9% (mainly among children over 7 years old). Most surgeons are very reserved about primary orchidectomies (only 3.8% were performed).

MP18-19 SHOULD KUB BE USED IN THE DIAGNOSIS OF BLADDER BOWEL DYSFUNCTION?

You have accessJournal of UrologyCME1 Apr 2023MP18-19 SHOULD KUB BE USED IN THE DIAGNOSIS OF BLADDER BOWEL DYSFUNCTION? Alexandra Siegal, Neha Malhotra, Erin Miller, Joy Masseaux, Eva Baldisserotto, Antonio Quiros, and Fernando Ferrer Alexandra SiegalAlexandra Siegal More articles by this author , Neha MalhotraNeha Malhotra More articles by this author , Erin MillerErin Miller More articles by this author , Joy MasseauxJoy Masseaux More articles by this author , Eva BaldisserottoEva Baldisserotto More articles by this author , Antonio QuirosAntonio Quiros More articles by this author , and Fernando FerrerFernando Ferrer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003238.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Plain kidney ureter bladder radiography (KUB) is widely used for the evaluation of constipation in children with bladder and bowel dysfunction (BBD); however, there is varying evidence to support its routine diagnostic use. One drawback to KUB is radiation exposure. The dangers of radiation in children are well-documented and As Low As Reasonably Achievable states to avoid non-beneficial radiation. This risk is especially high in children who undergo repeated imaging in the follow up of constipation treatment. We sought to assess the effectiveness of KUB to diagnose children with BBD by comparing it to four diagnostic tests: the Dysfunctional Voiding Symptom Score (DVSS), Rome IV criteria, rectal diameter on ultrasound (RD), and the Bristol Stool Score. METHODS: We prospectively enrolled a cohort of patients presenting to an academic pediatric urology practice with symptoms of BBD. Severity of stool burden on KUB (mild, moderate, or severe), RD on ultrasound (≥3.4 cm), DVSS, Rome IV, and Bristol Stool Score were obtained for each patient. All imaging was interpreted by a pediatric radiologist and urologist. Primary outcomes were the association between the four diagnostic tests and KUB stool burden. Secondary measure were age, sex, BMI, treatment, and outcomes. Pearson’s rho bivariate analysis of all individual variables versus KUB was performed, as well as multivariate regressions to determine if multiple measures were predictive of KUB stool burden when combined. RESULTS: Between October 2020 and May 2022, 50 patients were enrolled. All children were under the age of 18, with a mean age of 7.5+/-2.2 years, and 38% were male. Average BMI was 19.16+/-5.34. When comparing individual variables to KUB in bivariate analyses, it was found that RD on ultrasound is predictive of significant stool burden on KUB (p=0.03). No other individual variables were predictive. In the multivariate analyses, no combination of tests was found to be predictive of KUB. Increased RD on ultrasound was not predictive of treatment response. CONCLUSIONS: We compared the effectiveness of four commonly used diagnostic tests in children with BBD to validate the use of KUB. We found insufficient evidence to support a diagnostic association between clinical symptoms (DVSS and Rome IV) and fecal load on KUB. Our results support the use of RD on ultrasound as a non-radiating alternative to KUB to determine stool burden. RD has been proposed to provide an objective measure for diagnosis and monitoring of treatment response; however, unlike prior studies, we did not find initial increased RD to be predictive of treatment response. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e231 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexandra Siegal More articles by this author Neha Malhotra More articles by this author Erin Miller More articles by this author Joy Masseaux More articles by this author Eva Baldisserotto More articles by this author Antonio Quiros More articles by this author Fernando Ferrer More articles by this author Expand All Advertisement PDF downloadLoading ...

Accuracy of telemedicine for diagnosis and pre-operative assessment of pediatric penile conditions

Patients with penile conditions comprise a significant proportion of any pediatric urology practice, and physical examination is the mainstay of diagnosis for such conditions. While the rapid adoption of telemedicine (TM) facilitated access to pediatric urology care during the pandemic, the accuracy of TM-based diagnosis for pediatric penile anatomy and pathology has not been studied. Our aim was to characterize the diagnostic accuracy of TM-based evaluation of pediatric penile conditions by comparing diagnosis during the initial virtual visit (VV) with a subsequent in-person visit (IPV). We also sought to assess the agreement between scheduled and actual surgical procedure performed. A single-institution prospective database of male patients less than 21 years of age who presented for evaluation of penile conditions between August 2020 and December 2021 was analyzed. Patients were included if they had an IPV with the same pediatric urologist within 12 months of the initial VV. Diagnostic concordance was based on a surgeon-reported survey of specific penile diagnoses, completed at both initial VV and follow-up IPV. Surgical concordance was assessed based on the proposed versus billed CPT code(s). Median age among 158 patients was 10.6 months. The most frequent VV diagnoses were penile adhesions (n=37), phimosis (n=26), "other" (n=24), post-circumcision redundancy (n=18), and buried penis (n=14). Initial VV and subsequent IPV diagnoses were concordant in 40.5% (64/158); 40/158 (25%) had partial concordance (at least one diagnosis matched). There was no difference in age, race, ethnicity, median time between visits, or device type between patients with concordant vs. discordant diagnoses. Of 102 patients who underwent surgery, 44 had VV only while 58 had IPV prior to surgery. Concordance of scheduled versus actual penile surgery was 90.9% in those patients who only had a VV prior to surgery. Overall, surgery concordance was lower among those with hypospadias repairs vs. non-hypospadias surgery (79.4% vs. 92.6%, p=0.05). Among pediatric patients being evaluated by TM for penile conditions, there was poor agreement between VV-based and IPV-based diagnoses. However, besides hypospadias repairs, agreement between planned and actual surgical procedures performed was high, suggesting that TM-based assessment is generally adequate for surgical planning in this population. These findings leave open the possibility that, among patients not scheduled for surgery or IPV, certain conditions might be misdiagnosed or missed entirely.

Surgical Treatment of Meatal Stenosis: Lessons Learned from the Pediatric Urology Practice

ObjectiveTo evaluate the indications for surgery and outcome of meatotomy and meatoplasty in a big cohort of children. MethodsWe retrospectively evaluated 2211 children who underwent either meatotomy or meatoplasty between 2009 and 2020 utilizing the same operative setup.For continuous data, we performed t-test and Mann–Whitney U test. For categorical data, chi-squared test or Fisher's exact test was used. A binary logistic regression model was used to compare the indications for surgery between the groups. ResultsOf 2211 children, 1906 underwent meatotomy and 305 meatoplasty. The mean age was 5 years (range: 1m-15y) and there was no age difference between the groups. There was no difference between duration of surgery, recovery time, or complication rates between the groups. Deviated stream was the most frequent indication for treatment 1477 (67%). On Univariate logistic regression children with the following indications: dysuria, meatitis, and urinary retention had increased odds toward meatoplasty, while the indication of deviated stream had increased odds toward meatotomy. On Multivariate Logistic regression only deviated stream (Odd-ratios 1.47, P: .005) and urinary retention (Odds-ratio 4.5, P: .027) remained significant for meatotomy and meatoplasty respectively. Eleven (0.58%) children who underwent meatotomy developed recurrent Urethral Meatal Stenosis and underwent another surgery. Sixty-nine children (3.6%) after meatotomy required manual opening of the meatus on the first post-operative visit. None of the children, who underwent meatoplasty needed reoperation. ConclusionMeatotomy had a higher reoperation rate and frequently required manual meatal spreading in early postoperative period. We believe meatoplasty is a preferable surgery for pediatric UMS.

Pediatric Bladder Tumors: A Ten-Year Retrospective Analysis

ObjectiveTo present our experience in a single pediatric urology practice over a 10-year period with bladder tumors in the pediatric population in an effort to add to the relatively small amount of existing data. We hope to expand the community's knowledge of presentations, management and natural history of pediatric bladder tumors. MethodsWe retrospectively queried our electronic medical records for International Classification of Diseases, Tenth Revision (ICD-10) and Current Procedural Terminology (CPT) codes relevant for bladder tumors. Patients with underlying bladder pathology, such as neurogenic bladder, history of bladder exstrophy, and history of bladder augmentation, were excluded. ResultsWe identified 30 patients with bladder tumors from 2011 to 2021. There were 21 males and 9 females. Age at diagnosis ranged from 16 months to 19 years. Tumors identified were: 11 of various inflammatory subtypes; 4 papillomas; 4 rhabdomyosarcomas; 3 papillary urothelial neoplasms of low malignant potential and 8 of other types. Treatment included transurethral resection of bladder tumor, chemoradiation and laparoscopic partial cystectomy. Twenty nine patients had disease limited to the bladder and 1 had disease outside the bladder. Follow-up ranged from 2 weeks to 13 years (median 19 months). All patients had no evidence of disease at most recent follow-up. ConclusionPediatric bladder tumors range from aggressive rhabdomyosarcomas to more benign urothelial lesions. Fortunately, the latter type of tumor is the more prevalent lesion. Knowledge of the treatment options and natural history of these tumors will hopefully be of benefit to clinicians and parents alike.

Ultrasound screening of kidney size in children with and without vesicoureteral reflux

"Evaluation of the size of the kidney's parameters of patients with vesicoureteral reflux (VUR) can provide relevant knowledge about the prognosis factors of VUR's complications. The study aimed to assess the size of the renal parameters of children with VUR and compare the results with healthy matched cases by the ultrasound method. Methods: In this case-control study, children under 14 years of age with VUR in our pediatric urology practice from May 2019 to May 2020 were included. Eighty children were included in the two groups (case (40 cases) and control group (40 cases)) in the study. The case group included children with VUR, while the control group included healthy children. The data regarding Urinary Tract Infection (UTI), the length and width of the kidney, the size of the pelvis, parenchyma thickness, and volume of the kidney were recorded. Results: The mean age of children was 3.07 ± 3.05 years, and 35.0% of them were male. The mean number of UTIs in the VUR group was 1.90 ± 1.15 and in the control group was 1.10±0.30 (P=0.031). The incidence of UTIs was significantly higher in the VUR group than in the control group (P&lt;0.001). Length, width, the posterior-anterior diameter of kidney, renal parenchyma thickness, and renal volume in the VUR group were significantly lower than the control group (P&lt; 0.001). There was no difference between case and control groups in terms of anterior-posterior diameter of the pelvis (P= 0.653). Conclusions: The results showed that the size of kidneys parameters in children with VUR was less than in the control group. Also, the incidence of UTIs in the VUR group was significantly higher than in the control group. Ultrasound is a safe and non-invasive tool that can use for checking the size of the children's kidneys with VUR for predict of possible complications "

Parent-Reported Experience With Pediatric Urology Telemedicine Visits During the COVID-19 Pandemic

IntroductionTelemedicine has had a slow integration into surgical subspecialties like urology. Little data exists on its effect on urologic patient-provider rapport nor long term clinical outcomes. The purpose of this study was to assess the feasibility and parent-reported experience with telemedicine visits in a tertiary pediatric urology practice during the COVID-19 pandemic.MethodsParents/guardians of pediatric urology patients who were seen via telemedicine between March 12th - October 30th, 2020, at Children’s Hospital Colorado main campus or a satellite campus were contacted within 1 week of their child’s visit and invited to take a telephone survey. A total of 4 yes/no questions and an open-ended question was asked to explore domains of the drawbacks and benefits to telemedicine. Categorical responses and associations between parent demographics and telehealth satisfaction were analyzed with descriptive statistics. Open-ended questions were analyzed using a team-based content analysis approach.ResultsResponse rate was 76.7% (376/490). Median patient age was 4 years. 60.9% (229/376) patients were male, and 39.1% (147/376) patients female. 96.5% of parents felt that all their questions were answered by the end of their appointment. 97.8% of parents felt comfortable using telemedicine for future appointments. Patient sex, age, provider type, insurance type, clinic site, distance from clinic site, and visit diagnosis had no significant impact on survey response. Based on open-ended responses, five general themes emerged: issues with accessing technology, time saving logistics, challenging clinical interactions, a positive overall experience, and parents having about a 50/50 split in preference for telemedicine or in person visits. Multiple parents expressed discomfort with a genital exam via telemedicine.ConclusionsOverall, parents found telemedicine to be an acceptable alternative to in-person visits and demonstrated a willingness to continue to use it in the future. Patient diagnosis and insurance type had no effect on parent response. Parents noted that pediatric urology offers unique challenges due to its personal and sensitive treatment, including the need to evaluate the genitalia. As the role of telemedicine continues to expand, consideration of these challenges is needed to ensure that pediatric urology patients and their parents are comfortable with this approach.

MP17-03 COMPLICATION RATES AMONG DIFFERENT TREATMENT MODALITIES FOR THE SURGICAL MANAGEMENT OF VESICOURETERAL REFLUX IN CHILDREN

You have accessJournal of UrologyCME1 May 2022MP17-03 COMPLICATION RATES AMONG DIFFERENT TREATMENT MODALITIES FOR THE SURGICAL MANAGEMENT OF VESICOURETERAL REFLUX IN CHILDREN Andres Guillen Lozoya, Candace Granberg, and Patricio Gargollo Andres Guillen LozoyaAndres Guillen Lozoya More articles by this author , Candace GranbergCandace Granberg More articles by this author , and Patricio GargolloPatricio Gargollo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002550.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Vesicoureteral reflux (VUR) is a commonly encountered problem in pediatric urologic practice, affecting approximately 1% of all children, and up to 70% of those presenting with a febrile UTI. Given this common incidence, the economic impact from VUR has been found to be significant, with care-related charges exceeding $100 million annually in the U.S. Optimal management strategies for this condition are controversial and continue to be debated as our understanding of its pathophysiology, clinical course, and long-term sequelae evolve. Urologists have been quick to embrace robotic technologies and apply them to existing surgical procedures despite the greater cost associated with the robotic procedure and reported lower success rate. It has further been observed that complications associated with robotic assisted procedures tend to be more severe and require a higher rate of intervention than open procedures. METHODS: We retrospectively reviewed United HealthCare Electronic Records of patients treated for VUR from January 2020 to January 2021. Data was clustered based on surgical treatment modality: endoscopic, open, and robotic-assisted surgery. Discrete variables were compared using Fisher’s exact test. Difference between groups was considered as statistically significant if p < 0.05. RESULTS: A total of 1872 patient records were included, with 1,010 endoscopic, 751 open and 111 robotic-assisted surgeries. Mean age at time of procedure was 8.5 months for endoscopic surgery, 10.4 for open surgery and 47.8 for robotic surgery. A majority of patients who underwent endoscopic and open procedures were female (n=858, 85% and n=565, 75.2%, respectively) while males were the majority for robotic procedures (n=62, 55.9%). There was a statistically significant difference in complication rates post-discharge (p < 0.001) with the highest rate in the robotic surgery group (n=21, 18.9%). CONCLUSIONS: Minimally-invasive surgeries comprised the majority of VUR surgeries, with endoscopic procedures utilized most in this cohort. Robotic-assisted surgery had the highest post-discharge complication rate, which was statistically significant. Further study is warranted to assess incremental costs incurred by these complications, which increase the overall cost of robotic procedures even more. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e284 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andres Guillen Lozoya More articles by this author Candace Granberg More articles by this author Patricio Gargollo More articles by this author Expand All Advertisement PDF DownloadLoading ...

Comment on: “Cost comparison of intra-detrusor injection of botulinum toxin versus augmentation cystoplasty for refractory Neurogenic Detrusor Overactivity in Children”

To assess the outcome of treatment for a chronic ailment in pediatric patients is a very complex task. In the case of neurogenic bladder secondary to spinal dysraphism there is one major fundamental endpoint and that is preservation of kidney function. The next important goal is improvement of quality of life by achieving continence and acceptable regular bladder emptying. Two treatment modalities are widely used, augmentation cystoplasty (AC) and intravesical injections of Botulinum toxin A (BTX-A). In many instances the latter is used preceding the augmentation if kidney function is preserved to postpone the more invasive and more definitive augmentation. However, there is no international consensus about when of these modalities may be used or when diversion should be instituted. But in any case, both regimens include lifelong monitoring and frequent new interventions. Cost comparison of intra-detrusor injection of botulinum toxin versus augmentation cystoplasty for refractory neurogenic detrusor overactivity in childrenJournal of Pediatric UrologyVol. 18Issue 3PreviewTreatment options for refractory neurogenic detrusor overactivity (NDO) in children include botulinum toxin type A (BTX-A) and augmentation cystoplasty (AC). Although BTX-A is accepted in contemporary pediatric urologic practice, cost and long-term outcomes data for BTX-A are limited relative to the gold standard, AC. The purpose of this study was to compare the projected 10-year costs of AC versus BTX-A. Full-Text PDF

Cost comparison of intra-detrusor injection of botulinum toxin versus augmentation cystoplasty for refractory neurogenic detrusor overactivity in children

Treatment options for refractory neurogenic detrusor overactivity (NDO) in children include botulinum toxin type A (BTX-A) and augmentation cystoplasty (AC). Although BTX-A is accepted in contemporary pediatric urologic practice, cost and long-term outcomes data for BTX-A are limited relative to the gold standard, AC. The purpose of this study was to compare the projected 10-year costs of AC versus BTX-A. We performed a cost analysis from the payer perspective by computationally modeling treatment sequences by a Markov model. In the model, we used probabilities derived from published sources, and costs obtained at a tertiary medical center. The base case was a pediatric patient with refractory NDO. In the model, we assumed biannual BTX-A treatments. Treatment costs over 10 years were compared between immediate AC versus bridging therapy with BTX-A. Using the computational model, we simulated 100,000 instances of 10-year treatment cost for each of the two treatment modalities. The costs for the two treatment approaches were then compared using t-test and Wilcoxon test. The projected median and mean 10-year cost of immediately AC were $51,798.72 (95% CI [$51,798.72, $327,483.80]) and $123,473.4 (SD: $98,085.23) respectfully, while the projected median and mean 10-year cost of bridging therapy with BTX-A prior to proceeding to AC as needed were $74,552.46 (95% CI [$53,188.56, $309,913.07]) and $124,858.80 (SD: $84,495.35) (p<0.001). For a typical index pediatric patient with NDO, bridging therapy with intravesical BTX-A is associated with an increased cost compared to immediate AC over a ten-year period.

Indocyanine green (ICG) assessment of ureteral perfusion during pediatric robotic surgery

Vascular preservation is a tenet of successful ureteral reconstruction. Near-infrared fluorescence (NIRF) imaging with indocyanine green (ICG) provides real-time identification of tissue perfusion during robotic surgery. Here, we present our utilization of NIRF with ICG to ensure adequate ureteral perfusion during robotic reconstruction in 3 pediatric patients. Between July 2019 and May 2020, we utilized NIRF with ICG during 3 consecutive robotic ureteral reconstructive cases in an academic pediatric urology practice. Patients were 3-, 14-, and 17-years-old and presented with congenital ureteral stricture, mid-ureteral polyp disease, and distal-ureteral polyp disease, respectively. Following surgical reconstruction of each patient's underlying pathology, ICG doses of 0.039–0.086 mg/kg IV were used to elucidate blood supply to the affected segment of ureter prior to closing. In all 3 cases, NIRF with da Vinci Xi endoscope's Firefly® technology confirmed perfusion proximal and distal to target anatomy within 60 seconds of administration. Use of ICG appears to be low-cost, safe, and useful during pediatric urologic robotic surgery. This technology may be helpful to confirm satisfactory blood supply to the ureter following robotic ureteral reconstruction, as demonstrated in our case series of 3 pediatric patients.

Referral patterns for undescended testis: A 7 year comparative analysis of primary care providers

Cryptorchidism, or undescended testis (UDT), is identified in 1% of boys by one year of age and carries long term risks of infertility and testicular neoplasia. In 2014, the American Urological Association (AUA) released a guideline statement stating that patients with UDT should be referred to a urologist by 6 months of age in order to facilitate timely surgical correction. This study is the follow-up to a 2010 study assessing referral patterns to our university center from primary care providers. In this new study, we aim to identify changes in referral patterns in response to the establishment of the 2014 AUA guidelines and to understand how our referring physicians stay abreast of current knowledge regarding UDT. A 9 question anonymous survey regarding UDT referral patterns was sent to providers who had previously referred a patient to our pediatric urology practice. The results were categorized by specialty and were compared to the similar survey from 2010. Surveys were sent to 500 physicians with 138 (27.6%) responses received. Less than half of respondents reported that they would refer a boy with unilateral or bilateral palpable UDT by 6 months of age (37.0% and 38.4% respectively). This was not significantly different than the 2010 survey (p=0.68 and 0.27 respectively). Two-thirds of physicians would refer a patient with unilateral nonpalpable UDT within the recommended time frame (68.8%); this was also unchanged from 2010 (p=0.87). There was an improvement in respondents who would refer immediately for bilateral nonpalpable testes from 49.8% in 2010 to 53.6% in 2017 (p=0.01). Residency training was most commonly cited as the primary source of knowledge regarding UDT although 89.3% of respondents citing this were >5 years removed from residency training. Delayed referral patterns were reported by the majority of providers for palpable UDT and by greater than one-third of providers for nonpalpable UDT. There was minimal change in referral patterns between 2010 and 2017 despite the release of the AUA cryptorchidism guidelines in 2014. In both 2010 and 2017, residency training was identified as the primary source of knowledge regarding management of UDT. These findings suggest an unmet need for education regarding contemporary management of UDT for the primary care physicians in our community.