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Purpose: To determine trends in hypospadias management, including surgical techniques and perioperative care, by pediatric urologists in North America. Methods: An anonymous online survey was devised to assess approaches to hypospadias repair and management, including anesthetic considerations, catheter placement, choice of dressing, and postoperative antibiotic treatment. The survey was sent to all practicing members of the Societies for Pediatric Urology. Results: The survey was completed by 133 (34.5%) respondents. Hypospadias repair was overwhelmingly recommended between ages 6–12 months (89.5%). A local or regional anesthetic block (caudal, penile, pudendal, spinal) is performed nearly universally (96.2%). The majority of surgeons perform distal repairs outpatient (70.7%), while fewer perform outpatient staged repairs (47.4%) or redo surgery (33.8%). Nearly all respondents preferred either VicrylTM/DexonTM (50.4%) or MaxonTM/PDSTM (48.1%) for urethroplasty. All but one respondent leaves a stent for midshaft to proximal repairs whereas stenting for glanular repairs was split with 53.4% leaving a stent. Most surgeons (60.9–70.9%) prescribe postoperative antibiotics regardless of severity and the majority (72.9%) prescribe narcotics for analgesia. Conclusions: Approaches to hypospadias repair are extremely varied such that there is a lack of consensus among pediatric urologists regarding most aspects of hypospadias management. Investigations comparing hypospadias practice patterns are necessary to develop a standard of care for this complex pediatric urologic entity. [ABSTRACT FROM AUTHOR]

In the last decades, a digital revolution has transformed several aspects of people’s lives worldwide. Consequently, many substantial changes have concerned numerous professional environments, including medical ones. Among all the different new instruments available in this field, the metaverse is the most futuristic one and seems to be likewise promising. The metaverse is an emerging resource in healthcare, resulting from the integration of virtual and physical reality. It is particularly valuable in surgical operations, since it allows surgeons to perfectly visualize patients’ anatomy. Metaverse applications even include the pediatric field—in particular, the implementation of children and parents’ shared decision-making processes, as well as prenatal diagnosis and fetal surgery. This resource further represents a rising opportunity in pediatric urology: the development of 3D virtual models and robotic surgery will allow surgeons to explore surgical fields, perfectionating their own professional skills. The metaverse will empower pediatric urologists, patients and their families in many ways, and each one of them deserves to be explored to the fullest. In this work, we aim to discuss the current applications of the metaverse in pediatric urology and its future perspectives.

Bladder blood clots represent an infrequent urinary condition in children. They usually result from hematuria with many underlying causes, such as urinary tract infections and urethral/bladder traumas. Treatment options for clot removal include trans-urethral or suprapubic bladder irrigation and, if unsuccessful, endoscopic management under general anesthesia with a resectoscope. In younger male children, however, the repeated passage of a trans-urethral resectoscope may be challenging and traumatic, due to the small lumen diameter. Eventually, an open surgical approach can be required in many patients. Few anecdotal non-surgical approaches have been proposed for the management of bladder blood clots in children. This review aims to summarize the conservative techniques described in the literature with the instillation of intravesical agents, analyzing the different strategies and their advantages.

The article discusses the challenges associated with percutaneous nephrostomy in infants, focusing on a single-center trial where 75 infants underwent the procedure for various pathologies. The study reported a 100% technical success rate and low major complication rates, but raised questions about radiation dose information, the need for larger cohort studies, and the importance of long-term follow-up and operator experience. The authors commend the study but suggest cautious interpretation of the findings. [Extracted from the article]

Purpose: Pelvoureteric junction obstruction (UPJO) is a common cause of hydronephrosis in children but no previous studies have evaluated differences between boys and girls operated with pyeloplasty. This study aimed to evaluate potential differences between sexes in children operated with pyeloplasty for PUJO in terms of presentation, surgery, and long-term results. Methods: Data was retrospectively collected from all children operated on with pyeloplasty between January 2002 and December 2020. Data contained several variables covering presentation, surgery, and long-term results. Results: In total, 194 patients were included of which 126 (64.9%) were boys. There were no significant differences in prenatal findings, pelvic dilation on ultrasound, function of the affected kidney, surgical method, obstruction type, resolution of hydronephrosis, or improvement of function. Boys presented with pain more often than girls (47.4 vs 25.0%, p < 0.01) while girls were more prone to infections preoperatively (17.2 vs 7.0%, p = 0.04). All nine patients requiring reoperation were boys (p = 0.03). Conclusion: Girls with UPJO seem to experience infections as presenting symptoms more often than boys, while boys significantly more often present with pain. There is also a higher percentage of boys needing reoperation. [ABSTRACT FROM AUTHOR]

To explore private vs public pediatric circumcision insurance coverage and surgeon reimbursement. A telephone survey about circumcision coverage (Current Procedural Terminology codes: 54150, 54161) was conducted in October 2021 with insurance plan representatives from the 12 plans that comprised ≥1% of institutional pediatric urology visits to compare plan characteristics and coverage details. Circumcision billing data were collected at one pediatric hospital to assess surgeon reimbursement (insurance + patient payment) by plan type using bivariate statistics. Ten plans (5 private and 5 public) responded (83.3% response rate). All except one public plan covered newborn circumcision. For non-newborn circumcisions, most public plans (80%) had unrestricted coverage, whereas all private plans required medical necessity. Median reimbursement for newborn circumcision (CPT: 54150) was $484 for private and $78 for public plans, P <.001 while median reimbursement for non-newborn circumcision (CPT: 54161) was $314 for private and $147 for public plans, P <.001. Private insurance plans reimburse significantly more than public plans for newborn circumcision. For non-newborn circumcision, private plans reimburse more than public but the coverage is more restricted, with a smaller differential between newborn and non-newborn circumcision. This coverage and reimbursement structure may indirectly encourage newborn circumcision for privately insured boys and non-newborn circumcision for publicly insured boys. [ABSTRACT FROM AUTHOR]

Objective: Nocturnal enuresis (NE) is one of the most common disorders in pediatric urology, and patients often turn to family physicians (FP) and pediatricians (P) initially. The aim of this study was to understand the awareness, self-confidence and suggestions of physicians regarding the management of NE. Materials and Methods: In this study, 360 FP and family medicine residents (FMR), as well as 280 P and pediatrics residents (PR), were contacted through a cellular phone texting system. A simple multiple-choice questionnaire (Surveymonkey®) consisting of 10 questions was used to gather data. The survey included questions about their experience, training, evaluation, and management of NE. Results: A total of 119 FPs and Ps (18.5%) filled the questionnaire. Thirty (25.21%) of the participants were P, 27 (22.69%) PR, 3 (2.52%) FP and 59 (49.58%) FMR. The rate of physicians who encounter at least 5 children with NE per month is 31.33%. The mean self-confidence in the management of NE was 4.5 out of 10. The self-confidence of pediatricians was significantly higher than that of PR and FMR (p<0.001, p<0.001). Most (n=78, 65.55%) of the participants stated that they received training on EN during medical faculty and 62 (52.10%) during residency. Psychological problems (89.92%), sleep disorders (78.15%), and excessive fluid intake (75.63%) were the most frequently considered factors in etiology. While most responders (75.63%) considered dietary regulation and behavioral interventions as the first-line treatment, 25.21% consult a pediatric urologist and only 1.6% recommend medical treatment. Conclusion: Although FP and P admit they had training on NE, they mostly felt incompetent to manage NE and exclusively avoided pharmacological treatment. [ABSTRACT FROM AUTHOR]

Objectives: Telemedicine for pediatric lower urinary tract symptoms (pLUTS) is a relatively new mode of delivering bladder health education with scant evidence supporting current practice. We aim to examine the safety of pLUTS‐related telemedicine visits surrounding the COVID‐19 pandemic. Methods: We conducted a retrospective cohort study of new pLUTS referral diagnoses to our institution's pediatric urology clinics. Demographics, wait times, and referral diagnoses were captured and compared before and after March 2020 using χ2/Fisher exact tests and t‐tests. A retrospective chart review was performed for an initial telemedicine visit followed by an in‐person visit to identify missed radiology, lab, or physical exam findings. Results: Six hundred twelve patients were included from September 2018 to August 2021. Most were 5–10 years old (62.3%), female (56.2%), English speaking (86.5%), White (39.4%), and had private insurance (67.2%). Wait times were shorter for telemedicine versus in‐person visits (t190 = −3.56, p <.001). After March 2020, patients with a urinary tract infection (UTI) and females utilized in‐person visits more often (p <.001). After chart review (11 patients, mean = 10.4 years), 9 (81.8%) had comorbid conditions and/or family history of lower urinary tract symptoms. None had missed clinical findings that changed management. Conclusions: pLUTS care can be delivered via telemedicine without a significant change in patient volume and population, though additional investigations will clarify the needs of patients with specific referral diagnoses and comorbid conditions. The in‐person exam can be omitted safely with proper clinical history taking, supporting future virtual programs that address delays in care within local communities. [ABSTRACT FROM AUTHOR]

Purpose of Review: As patients with spina bifida are living longer, more long-term outcomes are being reported. Today, the conversation surrounding neurogenic bladder care has evolved from reducing mortality to enhancing quality of life, namely, reducing urinary incontinence while still preserving upper tract function. In this paper, we seek to review risks of bladder malignancy in neurogenic bladder patients with history of augmentation or chronic catheters. Recent Findings: Recent data has demonstrated that cancers in bladders with prior augmentation or chronic catheters tend to be advanced, aggressive, and occur at a younger age. However, bladder cancer in this population is difficult to predict and difficult to diagnose before it is too late. Summary: Screening protocols and early diagnostic tools remain elusive as these cancers may present with symptoms that can be easily overlooked or attributed to other disease processes. Current work with biomarkers may yield better diagnostic tools than cystoscopy or cytology. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to explore how patients treated for endometrial cancer (EC) with robotic surgery are affected in symptoms of anxiety and depression and HRQoL in the long term. Methods: Women scheduled for primary robotic surgery for EC were included (n = 64), in this single-center study. Socioeconomic variables were obtained at baseline. The European Organization for Research and Treatment of Cancers Quality of Life Questionnaire Core 30 (QLQ-C30), its module for EC (EN24), the Generalized Anxiety Disorder Scale (GAD-7), and the Patient Health Questionnaire Depression Scale (PHQ-9) were followed prospectively from baseline to 2 weeks, 3 months and 1 year postoperatively. Results: The number of patients scoring above the clinical threshold for anxiety decreased from 17 (27.0%) at baseline to 4 (7.0%) at 2 weeks (p = 0.012). Depressive symptoms were reported in 20% of patients at baseline and did not change significantly during the one-year follow-up (p = 0.58). A significant decrease in Global health status was seen at 2 weeks (from 69.8 to 62.7; p = 0.048), with return to baseline levels after 3 months (68.5; p = 0.32) and stable at 1 year. Unemployment, low income, and adjuvant therapy correlated with lower Global health status at 3 months. Conclusion: The significant proportion of patients with anxiety symptoms preoperatively reduced prompt after surgery, while the proportion with depression remained constant, indicating that the primary treatment has no long-term negative effect on patients' mental health. At 3 months, there is no obvious remaining negative impact on patients' HRQoL, and these results are consistent after 1 year. [ABSTRACT FROM AUTHOR]

Robotic pyeloplasty has become a natural progression from the development of open, then laparoscopic procedures to treat pediatric patients with ureteropelvic junction obstruction (UPJO). Robotic-assisted pyeloplasty (RALP) is now considered a new gold standard in pediatric MIS. A systematic review of the literature retrieved from PubMed and published in the last 10 years (2012–2022) was performed. This review underlines that in all children except the smallest infants, where the open procedure has benefits in terms of duration of general anesthetic and there are limitations in the size of instruments, robotic pyeloplasty is becoming the preferred procedure to perform in patients with UPJO. Results for the robotic approach are extremely promising, with shorter operative times than laparoscopy and equal success rates, length of stay and complications. In case of redo pyeloplasty, RALP is easier to perform than other open or MIS procedures. By 2009, robotic surgery became the most used modality to treat all UPJO and continues to grow in popularity. Robot-assisted laparoscopic pyeloplasty in children is safe and effective with excellent outcomes, even in redo pyeloplasty or challenging anatomical cases. Moreover, robotic approach shortens the learning curve for junior surgeons, who can readily achieve levels of expertise comparable to senior practitioners. However, there are still concerns regarding the cost associated with this procedure. Further high-quality prospective observational studies and clinical trials, as well as new technologies specific for the pediatric population, are advisable for RALP to reach the level of gold standard. [ABSTRACT FROM AUTHOR]

Aim: The voiding diary (VD) yields crucial insights into voiding volumes (VV), voiding frequency (VF), and management habits in children with lower urinary tract (LUT) dysfunction. It is recommended to be conducted for a minimum of 2 days. Nevertheless, certain studies have indicated similarities in voided volumes between days in a three-day VD. This study aims to compare VV and VF values across days based on bladder capacity and symptom scores. Materials and Methods: Children who applied to the pediatric urology clinic due to LUT symptoms between 2022 and 2023 were included in the study. Retrospective evaluation was conducted on the records. Children with neurological deficits and incomplete data were excluded from the study. All children were assessed following the guidelines of ICCS and EUA and underwent a 3-day voiding diary. Mean VV and VF values of the whole group for each day were compared and subgroup analyzes were performed in terms of gender, Voiding Dysfunction Symptom Score (VDSS), bladder capacity (BC), and diagnoses. Results: A total of 109 (53 girls (48.6%), 56 boys (51.4%)) children with a median age of 8 (3-17) were included in the study. 77 (70.6%) children were diagnosed with overactive bladder, 8 (7.4%) with dysfunctional voiding, and 24 (22%) with monosymptomatic enuresis nocturne. The mean VVs between days were similar in the whole group (p = 0.759). Moreover, the mean VV of the first day was similar to the average of both the first two days and the three days (p = 0.021, p = 0.490). Also, the maximum and minimum VVs were similar between days (p = 0.942, p = 0.160, respectively). In subgroup analyses based on gender, bladder capacity, and symptom score, mean VV was also found to be similar. VF values were found to be significantly different between days. There was also a difference between VF values in children with VDSS > 8.5 (p = 0.012) and BC/EBC (%) > 65 (p = 0.030). In subgroup analysis for diagnoses, mean and maximum VV and VF were similar between the groups, except for VF (p = 0.026) in OAB. Conclusion: While the voided volumes of children with non-neurogenic LUT dysfunctions appear to be consistent across the days of the VD, variations in VF might arise, especially among children with a VDSS of > 8.5 and normal bladder capacity. As a result, we believe that using a VD spanning at least two days could enhance diagnostic accuracy and help prevent unnecessary treatment. [ABSTRACT FROM AUTHOR]

Background: Due to the great importance of the face in social interaction, minimally invasive treatments can—besides their ability to rejuvenate and enhance beauty—also change the way facial impressions of a person are perceived. In recent literature, three main character traits (attractiveness, trustworthiness, and competence) and subdomains essential for facial perception were described. Objective: To investigate whether minimally invasive procedures truly influence different character traits when evaluated by independent, objective observers. Methods: Photographs of n = 34 female faces before and after treatment with injectable fillers and botulinum toxin were rated by 393 individuals without aesthetic background with regards to different character traits on a 7‐point Likert scale. Tests for dimensionality were performed, and composite scores of the impressions underlying each of the three dimensions were created and compared using within‐subjects t tests. Results: Treatments statistically significantly improved the overarching character trait domains attractiveness, trustworthiness, and competence in posttreatment photographs compared with pretreatment. Posttreatment ratings of the respective subdomains also showed a statistically significant difference compared with pretreatment photographs, with the exception of the subdomain dominance which failed to reach statistical significance. Conclusion: Impressions of facial attractiveness, trustworthiness, and competence can be improved by injectables while the naturalness of the face is left intact. An implication is that the improvement of traits highly relevant to social interaction will accommodate the patient's desires for beautification and rejuvenation. [ABSTRACT FROM AUTHOR]

Introduction Cystinuria is often diagnosed by large renal stone for pediatric patients. The patients suffer from recurrence of stone disease, develop the chronic kidney disease and fall into end‐stage renal failure. Total removal of stone at the first intervention and prevention of recurrence are essential. Although, it is difficult to treat the pediatric stone patients for their anatomical feature. Case presentation We report three cases of pediatric cystine stone patients (two 4‐year‐old boys and a 9‐year‐old girl) successfully treated by mini‐percutaneous nephrolithotripsy and antegrade ureteroscopy. We could remove stones completely in all three cases, and the patients did not suffer from major complications. Conclusion It is essential to select the surgical approach, the endourological device, and the patient's position which is suitable for the age, the body size, and the condition of stones at the initial intervention of pediatric cystine stone.

Objectives: The 2021 European Association of Urology–European Society for Paediatric Urology guidelines on Pediatric Urology recommended testis‐sparing surgery (TSS) as the primary approach to treat prepubertal testicular tumors exhibiting favorable preoperative ultrasound diagnoses. However, prepubertal testicular tumors are rare and clinical data regarding them is limited. Here, we analyzed the surgical management of prepubertal testicular tumors based on cases observed over approximately 30 years. Methods: Data were retrospectively reviewed from medical records of consecutive patients aged <14 years with testicular tumors who received treatment at our institution between 1987 and 2020. We compared patients by their clinical characteristics, namely, those who underwent TSS versus radical orchiectomy (RO) and those who received surgery in 2005 onward versus prior to 2005. Results: We identified 17 patients, with a median age at surgery of 3.2 years (range 0.6–14.0) and a median tumor size of 15 mm (range 6–67). The tumor size was significantly smaller in patients who underwent TSS than in those who underwent RO (p = 0.007). Patients treated in 2005 onward were more likely to undergo TSS than those treated prior to 2005 (71% vs. 10%, respectively), without significant differences in tumor size or the rate of preoperative ultrasound. No TSS cases required conversion to RO. Conclusions: Recent improvements in ultrasound imaging technology allow for more accurate clinical diagnosis. Therefore, the indications of TSS for prepubertal testicular tumors can be judged based not only on the tumor size but also on the diagnosis of benign tumors by preoperative ultrasound. [ABSTRACT FROM AUTHOR]

To measure our opioid prescription rate, determine if our rate has decreased since 2019, and identify areas for future interventions to further decrease our opioid prescription rate. We retrospectively reviewed all pediatric urology patients (age..±18 years) who underwent a procedure between October 1, 2020 and October 22, 2021. We collected data on opioid prescribing, age, sex, surgeon, procedure, ethnicity, and race. We grouped procedures into 6 categories: circumcision, cystoscopy with the removal of foreign body/stone/stent, scrotal surgery, hypospadias repair/penile surgery, pyeloplasty/ureteral reimplant, and others. We analyzed 821 operative cases. Only 2.2% (18/821) of discharges included an opioid prescription. The prescription rate of 1 pediatric urologist was 4.6% (17/369), which was higher than the other 2 practitioners... (0.40%, 1/250%, and 0%, 0/202) (P.ß<.ß.001). The median age of patients who received an opioid prescription was older than patients without an opioid prescription (16.5 vs.ß5.0 years, P.ß<.ß.001). Surgery performed in an inpatient setting was more likely to result in an opioid prescription (9.7%, 3/31) than in the outpatient setting (1.9%, 15/790) (P.ß=.ß.03). No adverse effects of reduced opioid usage were noted. From October 2020 to October 2021, our institution had an opioid prescription rate of 2.2%. This represented a decrease from our previously reported rate of 8% in 2019. At the same time, we found no significant pain issues in our post-operative patients. Seventeen out of 18 prescriptions were written under 1 provider. Though heightened awareness has made a difference, targeted feedback is needed if we wish to reduce opioid usage further. [ABSTRACT FROM AUTHOR]

In the field of pediatric medicine, as patients grow and mature from adolescence to adulthood, it is necessary to transition from protective medical care that has been provided by parents and medical professionals to autonomous adult medical care that patients have the right to determine by themselves. Recently, the transition of urologic patients that require lifelong medical management, such as those with spina bifida, has been discussed more frequently. In order to achieve a better transition process, it is necessary to prepare for transition before the patient reaches puberty, and it is desirable to establish a multidisciplinary transition support clinic. Many kinds of diseases are dealt with by pediatric urologists, so cooperation with various pediatricians (nephrologists, endocrinologists, etc.) is required when the patients transition to adult care. Especially in patients with mental development problems, respiratory/cardiovascular problems, gastrointestinal surgical problems, orthopedic problems, etc. such transition requires detailed attention. In addition, at present, there are many social restrictions surrounding patients, and the development of social systems is desired. The importance of transitional medicine is expected to increase further in the future, and we will discuss the current situation, recognition and future prospects of how to smoothly transition so that patients can receive the medical care they want even after reaching adulthood. [ABSTRACT FROM AUTHOR]

Bladder blood clots represent an infrequent urinary condition in children. They usually result from hematuria with many underlying causes, such as urinary tract infections and urethral/bladder traumas. Treatment options for clot removal include trans-urethral or suprapubic bladder irrigation and, if unsuccessful, endoscopic management under general anesthesia with a resectoscope. In younger male children, however, the repeated passage of a trans-urethral resectoscope may be challenging and traumatic, due to the small lumen diameter. Eventually, an open surgical approach can be required in many patients. Few anecdotal non-surgical approaches have been proposed for the management of bladder blood clots in children. This review aims to summarize the conservative techniques described in the literature with the instillation of intravesical agents, analyzing the different strategies and their advantages. [ABSTRACT FROM AUTHOR]

Background: Children awaiting transplantation face a high risk of waitlist mortality due to a shortage of pediatric organ donors. Pediatric donation consent rates vary across Organ Procurement Organizations (OPOs), suggesting that some OPOs might utilize more effective pediatric‐focused donor recruitment techniques than others. An online survey of 193 donation requestor staff sheds light on the strategies that OPO staff utilize when approaching potential pediatric deceased organ donors. Methods: In collaboration with the Association of Organ Procurement Organizations, the research team contacted the executive directors and medical directors of all 57 of the OPOs in the US. Of these, 51 OPOs agreed to participate, and 47 provided contact information for donation requestor staff. Of the 379 staff invited to participate in the survey, 193 provided complete responses. Results: Respondents indicated more comfort approaching adult donors than pediatric donors, and they endorsed approach techniques that were interpersonal and emotional rather than professional and informative. Respondents were accurate in their perceptions about which donor characteristics are associated with consent. However, respondents from OPOs with high consent rates (according to data from the Scientific Registry of Transplant Recipients), and those from OPOs with low consent rates were very similar in terms of demographics, training, experience, and reported techniques. Conclusions: Additional research is needed to better determine why some OPOs have higher consent rates than others and whether the factors that lead to high consent rates in high‐performing OPOs can be successful when implemented by lower‐performing OPOs. [ABSTRACT FROM AUTHOR]

Aim: To investigate the potential benefits of medical clowns (MCs) in reducing anxiety and pain during paediatric urinary catheter insertion. Methods: In this prospective pilot study, 51 children who required urinary catheter insertion were randomised into two groups; the first group (n = 29) underwent the procedure in the presence of a MCs, and the second control group (n = 22) underwent the procedure using sedation. Pain and anxiety levels as well as procedural duration were recorded. All procedures were filmed and evaluated for anxiety level by a paediatric psychiatrist. General satisfaction questionnaires were filled by the medical team and parents in the clown group. Results: There were no differences in pain scores or anxiety levels between the two groups. Procedure duration and total hospital stay were significantly shorter in the MC group (p < 0.001). One hundred percent of the parents and the medical team were in favour of incorporating MCs during urinary catheter insertion. Conclusion: MCs are as good as sedation in lowering anxiety and pain levels in children undergoing urinary catheter insertion. In addition, MCs reduce the duration of the procedure and elicit a high degree of overall satisfaction from the parents and medical team. [ABSTRACT FROM AUTHOR]

Kidney transplantation is the predominant treatment option in patients with end-stage renal disease. The aim of this study was to evaluate the effect of the presence of a psychiatric disorder on the quality of life in children and adolescents after kidney transplantation. A total of 43 patients aged 6 to 18 years were included in the study. All participants and their parents were asked to complete the Pediatric Quality of Life Inventory (PedsQL), and families only, the Strengths and Challenges Questionnaire. Psychiatric symptoms and disorders of the patients were evaluated according to the Schedule for Mood Disorders and Schizophrenia for School-Age Children/Now and Lifetime Turkish Version. Patients were divided into 2 groups according to psychiatric symptoms and disorders. The most common psychiatric disorder was attention deficit and hyperactivity disorder (26%). The questionnaires filled out by the patients revealed a lower Total PedsQL Score (P =.003), PedsQL Physical Functionality Score (P =.019), and PedsQL Social Functioning Score (P =.016) in patients with psychiatric disorders. When the parents filled out the questionnaires, the Total PedsQL Score was similar in both groups. The PedsQL Emotional Functionality Score (P =.001) and PedsQL School Functionality Score (P =.004) were significantly lower in patients with psychiatric disorders. The Strengths and Difficulties Questionnaire revealed significantly higher total (P =.014) and hyperactivity/inattention subscale scores (P =.001) in those with a psychiatric disorder. Psychiatric disorders in kidney transplant patients adversely affect the quality of life. [ABSTRACT FROM AUTHOR]

Precision Medicine holds promise for helping us manage specific phenotypes of common diseases. For rare diseases such as hypospadias, DSD, and pediatric solid tumors, it can also reveal underlying risk factors and pathogenesis. Professors Ann Nordgren and Anna Lindstrand share their experiences in the development and ongoing initiatives of the Swedish national project on Precision Medicine and how it could change the care of pediatric urology patients. [ABSTRACT FROM AUTHOR]

Background: Urinary tract infection (UTI) represents one of the most common infectious diseases and a major cause of antibiotic prescription in children. To prevent recurrent infections and long-term complications, low-dose continuous antibiotic prophylaxis (CAP) has been used. However, the efficacy of CAP is controversial. The aim of this document was to develop updated guidelines on the efficacy and safety of CAP to prevent pediatric UTIs. Methods: A panel of experts on pediatric infectious diseases, pediatric nephrology, pediatric urology, and primary care was asked clinical questions concerning the role of CAP in preventing UTIs in children. Overall, 15 clinical questions were addressed, and the search strategy included accessing electronic databases and a manual search of gray literature published in the last 25 years. After data extraction and narrative synthesis of results, recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Results: The use of CAP is not recommended in children with a previous UTI, with recurrent UTIs, with vesicoureteral reflux (VUR) of any grade, with isolated hydronephrosis, and with neurogenic bladder. CAP is suggested in children with significant obstructive uropathies until surgical correction. Close surveillance based on early diagnosis of UTI episodes and prompt antibiotic therapy is proposed for conditions in which CAP is not recommended. Conclusions: Our systematic review shows that CAP plays a limited role in preventing recurrences of UTI in children and has no effect on its complications. On the other hand, the emergence of new antimicrobial resistances is a proven risk. [ABSTRACT FROM AUTHOR]

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Purpose: To present our experience with robot-assisted laparoscopic varicocelectomy in a pediatric population. Methods: We reviewed 49 consecutive cases performed by the same experienced surgeon. One-to-four veins were ligated at the internal ring of the inguinal canal, while the testicular artery and lymphatics were spared. Information on patient characteristics, surgical time, complications, and recurrences were collected. Results: Median patient age was 14 (range 10–17) years. Forty-eight had left-sided varicoceles and one had a bilateral varicocele. Forty-five were grade 3. All patients were referred due to discomfort/pain and 20 also had reduced testicular size. The median operating time from skin incision was 48 min (31–89 min) and the median console time was 18 min (7–55 min). Forty-seven patients were discharged the same day. Two patients experienced pain and problems urinating, respectively. These issues had resolved by the first post-operative day. There were no other complications, but at 6 months, eight recurrences were noted (16%). Scrotal complaints had subsided in all patients. Catch-up growth of the affected testicles was seen in 19/20 cases. Conclusion: Robot-assisted laparoscopic varicocelectomy is feasible and safe in a pediatric population but with a relatively high recurrence rate. [ABSTRACT FROM AUTHOR]

Objective: To examine and critique current international clinical practice guidelines (CPGs) on management of paediatric neurogenic lower urinary tract dysfunction (NLUTD) and assess the applicability of these guidelines to clinical practice. Materials and Methods: We conducted a systematic review of all CPGs on NLUTD published in English from the year 2010 to 2022. Six reviewers independently used the Appraisal of Guidelines and Research Evaluation (AGREE) II instrument to appraise all eligible CPGs. This instrument is comprised of 23 items organised into six quality domains. The scores for each item and domain were tabulated for each reviewer and interrater reliability was assessed for each domain using the intraclass correlation coefficient (ICC). Results: Six CPGs were appraised and these included: National Institute for Health and Care Excellence (NICE), European Society for Paediatric Urology, International Children's Continence Society, Irish, Spina Bifida Association (SBA), and International Brazilian Journal of Urology guidelines. They had high mean standardised scores in the domain on 'scope and purpose' and 'clarity of presentation' but had low scores in the domain of 'applicability'. The top three CPGs based on overall score were the NICE, Irish and SBA guidelines and the reviewers had high degree of interrater reliability (ICC 0.912, P < 0.001). The mean scores in various domains for the top three guidelines were 95.8 (scope and purpose), 87.5 (stakeholder involvement), 69.1 (rigour of development), 94.0 (clarity of presentation), 68.4 (applicability), and 59.7 (editorial independence). The diagnostic and treatment recommendations of the top three guidelines were presented. Conclusion: The existing CPGs on paediatric NLUTD provide high‐quality evidence based recommendations. The NICE, Irish and SBA guidelines were the top three CPGs identified. They scored high on most domains except applicability and editorial independence. These domains need to be considered for future updates to improve the utility. [ABSTRACT FROM AUTHOR]

Aim: The aims of the study are to audit the default rate of the provisional date of elective surgery in pediatric urology private practice and to study the factors involved in the postponement of elective operation dates by patients. Patients and Methods: The audit involved analysis of reasons behind patients defaulting from elective pediatric urology procedures between January 2019 and December 2019 at a tertiary private teaching hospital in South India. The details were obtained from the outpatient register kept for elective booking. The details of actual procedures performed were obtained from OT records. From the defaulters, the reasons for postponement were obtained through personal/telephonic interview. Results: A total of 289 patients were given dates for elective procedures. Among this, 72 (24.9%) defaulted, leaving 217 patients who underwent elective surgery. Among those who underwent surgery, 90 (41%) were elective day case (DC) procedures, whereas 127 (59%) were inpatient (IP) procedures. The default rate was 26/116 (22.4%) for DC procedures, whereas 46/173 (26.6%) for IP procedures, with no significant difference between them (P = 0.64). Among the 72 defaulters, the reasons for cancellation were as follows: financial factors (FFs) 22 (30.6%), lack of family support 19 (26.4%), function/grievance in house 10 (13.9%), respiratory illness 14 (19.4%), and treatment at a different center 7 (9.7%). FF (insurance denial) was significantly higher (P = 0.001) in crucial IP procedures at 19/46 (41%) compared to DC procedures at 3/26 (12%). The various diagnoses denied insurance were UPJO (7), VUR (6), hypospadias (4), UDT (3), and PUV (2). Conclusions: FFs were mainly responsible for parents postponing their children's elective pediatric urology procedures in India. Universal insurance coverage for congenital anomalies might help overcome this most important cause of cancellations. [ABSTRACT FROM AUTHOR]

Rationale: The number of pediatric surgeries is constantly increasing. Evaluating anxiety levels in pediatric surgical patients is highly important in terms of preventing complications. Aims and Objectives: The purpose of this study is to cross‐culturally adapt to the Turkish version, and to test the validity and reliability of Children's Perioperative Multidimensional Anxiety Scale (CPMAS). Method: This methodological study was carried out with 50 children aged 7–10 years who underwent surgery at Bartın Obstetrics and Pediatrics Hospital between September 2021 and May 2022. The self‐reported CPMAS and Children's Anxiety Meter‐State (CAM‐S) were administered before the surgery, on the day of the surgery, and 1 month after the surgery to collect data. The internal consistency, test–retest reliability, parallel forms reliability, content validity, and construct validity of CPMAS were tested. Results: Children's Perioperative Multidimensional Anxiety Scale showed a high level of internal consistency (Cronbach's alpha = 0.858, 0.916, 0.864). The item‐total correlation values of CPMAS were found to be 0.58–0.71 before the surgery, 0.77–0.83 on the day of the surgery, and 0.60–0.80 1 month after the surgery. CPMAS was found to be a single‐factor scale explaining 65% of the variance in the examined variable. The correlations between CPMAS and CAM‐S (parallel forms) were found to be 0.474 before the surgery, 0.528 on the day of the surgery, and 0.599 1 month after the surgery. Conclusion: The CPMAS, which was developed by Chow et al. in English, had high validity and reliability levels for Turkey. It is recommended that the scale be used by healthcare professionals in Turkey in the assessment of surgery‐related anxiety in children. [ABSTRACT FROM AUTHOR]

Background: In the last twenty-five years, Onabotulinum Toxin A (BTX-A) has gained increasing popularity for neurogenic lower urinary tract dysfunction (NLUTD) treatment. To maintain its efficacy, repeated BTX-A intradetrusor injections are required over time, with unknown effects on the bladder wall in children. The aim of this paper is to report long-term effects on the bladder wall in children treated with BTX-A. Methods: Children with NLUTD not responsive to anticholinergics were treated with BTX-A, according to our protocol, with bladder wall control using endoscopic cold-cup biopsy. Specimens were evaluated considering edema, chronic inflammation, and fibrosis. Results: Of the 230 patients treated from 1997 to 2022, we considered only specimens obtained in patients who had received ≥5 treatments (36 children), considered as the threshold to evaluate clinical effectiveness on long-term treatment with BTX-A. Most of them had congenital NLUTD (25 patients) and detrusor overactivity (27 patients). In all, increased edema and chronic inflammation with reduced fibrosis over time was reported; these data were not statistically significant. No difference was observed between patients with congenital and acquired diseases. Conclusions: Repeated intradetrusor BTX-A injections are not related to significant histological alterations in children, similarly with adults, and repeated injections could be considered safe. [ABSTRACT FROM AUTHOR]

Luciano Giuliani was born near Arezzo, in Tuscany (Italy) in 1928. After taking his Degree cum Laude in Medicine and Surgery at the University of Florence in 1951, he became a voluntary assistant at the Institute of General Clinical Surgery and Surgical Therapy. He then took a diploma in Urology and General Surgery, having demonstrated his great technical and surgical ability, and was subsequently appointed assistant in charge and then extraordinary assistant. Endowed with uncommon surgical skills and a forceful personality, Giuliani tirelessly carried out his clinical and surgical activity, covering several roles and rapidly earning profound esteem and recognition in the field of urology. As a pupil of the great luminary of Italian surgery, Ulrico Bracci, Dr Giuliani keenly followed his master, embracing his teachings and surgical techniques, until 1969, when he was appointed to run the 2nd Urology Division at San Martino Hospital in Genoa. He subsequently took up the chair of Urology at the University of Genoa and became Director of the Specialty School in Urology. Within a few years, he earned a solid reputation both nationally and internationally through his innovative surgical techniques. He also gave considerable impetus to the Genoese School of Urology, reaching the highest echelons of the Italian and European Societies of Urology. At the beginning of the 1990s, he designed and founded a new urology clinic in Genoa; this imposing, avant-garde building was subdivided into four floors and equipped with 80 beds. In July 1994, he won the prestigious "Willy Grégoir Medal", an accolade awarded to eminent personalities in European urology. In August of the same year, he died in the Institute that he himself had created at San Martino Hospital in Genoa. [ABSTRACT FROM AUTHOR]

Objectives: To assess the viability of a hybrid clinic model combining in-person examination with video-based consultation to minimize viral transmission risk. Methods: Data were collected prospectively in a pediatric urology clinic for in-person visits from January to April 2018 ("classic") and hybrid visits from October to December 2020 of the COVID-19 pandemic ("hybrid"). Variables included provider, diagnosis, patient type, time of day, prior surgery, postoperative status, and decision-making for surgery. The primary outcome was "room time" or time in-person. The secondary outcome was "total time" or visit duration. Proportion of visits involving close contact (room time ≥15 min) was assessed. Univariate analyses were performed using the Wilcoxon rank-sum test and Fisher's exact test. Mixed models were fitted for visit approach and other covariates as fixed effects and provider as random effect. Results: Data were collected for 346 visits (256 classic, 90 hybrid). Hybrid visits were associated with less room time (median 3 min vs. 10 min, p < 0.001) but greater total time (median 13.5 min vs. 10 min, p = 0.001) as compared with classic visits. On multivariate analysis, hybrid visits were associated with 3 min less room time (95% confidence intervals [CIs]: −5.3 to −1.7, p < 0.001) but 3.8 min more total time (95% CI: 1.5–6.1, p = 0.001). Close contact occurred in 6.7% of hybrid visits, as compared with 34.8% of classic visits (p < 0.001). Conclusions: Hybrid clinic visits reduce room time as compared with classic visits. This approach overcomes the examination limitations of telemedicine while minimizing viral transmission, and represents a viable model for ambulatory care whenever close contact carries infection risk. [ABSTRACT FROM AUTHOR]

Objective: At present, the most commonly used filler polymethyl methacrylate (PMMA) has the disadvantages of monomer toxicity, heat and leakage, and cannot be applied in young people. Therefore, finding a minimally invasive and good tissue‐compatible alternative material has been a research hotspot in spine surgery in recent years. The aim of this study is to explore whether the memory alloy stent can avoid the complications of bone cement or not. Methods: Four non‐adjacent vertebral bodies of the thoracic and lumbar spine in the 18 10‐month‐old pigs were selected as the surgical site and were randomly divided into the scaffold group and the bone cement group. The memory alloy scaffold and PMMA (polymethyl methacrylate) bone cement were placed via percutaneous puncture, and intraoperative fluoroscopy and micro‐CT were used to observe the changes in the height of scaffolds and bone cement in the vertebral body immediately, 6 weeks, and 12 weeks after operation, the microstructural parameters of the bone trabeculae (bone volume fraction, bone surface volume ratio, bone trabeculae number) were also measured. Results: The memory alloy stent could expand in the vertebral body, and its height gradually increased with time; additionally, the height of the bone cement mass did not change with time (p = 0.00). New bone trabeculae could grow into the scaffold along the gap, and the volume fraction of bone, the volume ratio of bone surface area, and the number of bone trabeculae increased gradually (p = 0.00). However, the volume fraction of bone, the volume ratio of bone surface area, and the number of trabeculae in the cement block decreased gradually (p = 0.00). Conclusions: Memory alloy scaffolds have dynamic expansion characteristics in vivo, which can effectively avoid the complications of bone cement. Thus, it is beneficial to explore this minimally invasive treatment for vertebral compression fractures. [ABSTRACT FROM AUTHOR]

To determine the normal vertical urethral meatus length (ML), maximum glanular width (MGW), the glanular seam length (between the lowest edge of urethral meatus and the glans closure line corona) (GSL) and GSL/ML ratio in all age groups. Consecutive patients presented to urology and pediatric urology outpatient clinics were included in the study. Penile abnormalities, known endocrinological disorders, history of penile/urethral surgery were excluded. MGW, ML, and GSL were measured with a caliper. Glanular and meatal measurements were compared according to ages. A total of 1398 boys and men (380 (27.18%) prepubertal (1-12), 203 (14.52%) adolescent (13-19), and 815 (58.30%) postpubertal (19-93)) with a median age of 31 years (range: 1-93) were included in the study. In consecutive age groups, ML and GSL gradually increased and became steady between 16-19 & 20-30 age groups and 10-12 & 13-15 age groups, respectively. On the other hand, MGW gradually increased until 20 years of age and became steady at median of 35 mm over 20 years of age. Another interesting finding was a rather stable GSL/ML ratio in all age groups. Pairwise comparison of different age groups seemed to be similar and suggests a fixed ratio of 1.33 (IQR: 0.6). The normal glanular and meatal measurements may guide the surgeons for better cosmetic results during hypospadias repair. The GSL/ML ratio appears to be a stable measure for all ages to achieve better cosmetic results. [ABSTRACT FROM AUTHOR]

To evaluate how urologists in various subspecialties view the climate for female urologists, comparing perceptions of gender inequity based on characteristics including gender, subspecialty training, faculty status, parental status, and years in practice. Despite growth in female representation in urology, gender inequalities in career opportunities and compensation continue to exist. An IRB approved survey was sent out to the following list-serves: Society of Urological Oncology (SUO), Society of Endourology (ENDO), Genitourinary Reconstructive Surgeons (GURS), Society of Pediatric Urology (SPU), Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), and American Urogynecologic Society (AUGS). A validated study, the Culture Conducive to Women's Academic Success (CCWAS) was used, and scores analyzed using Wilcoxon Rank-Sum and Kruskal-Wallace tests. There were 430 survey responses (35.3% female, 64.7% male). There was a statistically significant difference in CCWAS score for gender, parental status, and society. On multiple regression analysis controlling for gender, parental status and society were not statistically significant. Years in practice and practice type were not significant. Male urologists perceived practice culture toward women as more equitable than their female colleagues, (median [interquartile range] CCWAS score, 203.5 [184.25, 225.0] vs 162.5 [130.75, 188.0]; P <.0001). This discrepancy in perception between genders was consistent across all subcategories; equal access, work-life balance, freedom of gender bias, and leadership support. This study suggests that there are gender-based differences in how gender inequities are perceived and experienced in urology. Acknowledgment of these differences is the first step in identifying opportunities for improvement. [ABSTRACT FROM AUTHOR]

Biodegradable shape memory polymers provide unique regenerative medicine approaches in minimally invasive surgeries. Once heated, thermally responsive shape memory polymer devices can be compressed, programmed to fit within a small profile, delivered in the cold programmed state, and expanded when heated to body temperature. We have previously developed a biodegradable shape memory elastomer (SME), poly(glycerol dodecanedioate) (PGD), with transition temperatures near 37°C exhibiting nonlinear elastic properties like numerous soft tissues. Using SMEs in the clinic requires disinfection and sterilization methods that conserve physiochemical, thermomechanical, and shape recovery properties. We evaluated disinfection protocols using 70% ethanol and UV254 nm for research applications and ethylene oxide (EtO) gas sterilization for clinical applications. Samples disinfected with ethanol for 0.5 and 1 min showed no changes in physiochemical material properties, but after 15 min showed slower recovery rates than controls (p <.05). EtO sterilization at 54.4°C decreased transition temperatures and shape recovery rate compared to EtO sterilization at 37.8°C (p <.01) and controls (p <.05). Aging samples for 9 months in a vacuum desiccator significantly reduced shape recovery, and the recovery rate in EtO sterilized samples compared to controls (p <.001). Cytotoxicity testing (ISO‐10993.5C:2012) revealed media extractions from EtO sterilized samples, sterilized at 37.8°C, and high‐density polyethylene negative control samples exhibit lower cytotoxicity (IC50) than Ethanol 1 min, UV 2 h, and EtO 54.4°C. Cell viability of NIH3T3 fibroblasts on sterilized surfaces was equivalent on EtO 37.7°C, EtO 54.4°C and Ethanol sterilized substrates. Finally, chromogenic bacterial endotoxin testing showed endotoxin levels were below the FDA prescribed levels for devices contacting blood and lymphatic tissues for ethanol 1 min, UV 120 min, EtO 37.7°C, EtO 54.4°C. These findings outline various disinfection and sterilization processes for research and pre‐clinical application and provide a pathway for developing custom sterilization cycles for the translation of biomedical devices utilizing PGD shape memory polymers. [ABSTRACT FROM AUTHOR]

Lost objects and equipment malfunctions during robotic and laparoscopic cases can lead to an increase in operating time and potential risk to the patient. The literature on the management of foreign bodies during pediatric robotic-assisted surgery is limited. The purpose of the video is to review proper instrument handling to prevent loss of an object and to propose our technique for retrieving lost objects through two pediatric case examples. The first case is a robotic-assisted laparoscopic left pyeloplasty in a 6-week-old male with congenital uteropelvic junction obstruction during which a needle was lost. In the video, we describe our techniques for safe needle passage, proper suturing technique, and recovering a lost needle. The second case is a robotic-assisted right upper pole heminephrectomy in a 14-month-old female with a duplicated renal collecting system and hydroureteronephrosis. We present the management of a rare case during which a harmonic scalpel jaw malfunctioned leading to a lost foreign body. We describe our technique for retrieving the lost fragment. All objects were safely removed, and patients were discharged post-op day one without complication. Our video presents two case examples of foreign bodies lost during pediatric robotic surgeries and approaches to manage each of these incidents. [ABSTRACT FROM AUTHOR]

To explore and document the life and urologic contributions of Dr. Frank B. Bicknell. We researched the life of Dr. Bicknell via his publications, archived documents from the Didusch Museum and through the description of his life and accomplishments by his colleagues including John K. Lattimer and Frank Hinman Jr. Frank B. Bicknell (1907-1999) attended the University of Michigan (1925-1928) and Universityof Michigan Medical School (1928-1932) prior to his internship and urology residency at the Receiving Hospital, Detroit, Michigan (1932-1936). He served in the Merchant Marine in the 1930s, sailing around the world. He was a major in World War II and served as Professor of Urology at Wayne State University. In 1951 Dr. Bicknell got together a small group of eight urologists interested in pediatric urology during the AUA Annual Meeting. Drs. Campbell, Barber, Johnson, Mertz, Hinman Jr., Spence and Lattimer all met in Dr. Bicknell's Chicago hotel room and would form The Society for Pediatric Urology. At the time, Dr. Bicknell's brother-in-law had just become president of the American Academy of Pediatrics (AAP). Dr. John Lattimer with the help of Dr. Bicknell's brother-in-law was able to get a room at the AAP meeting which he filled with 2500 people, thought to be the largest collection of urologists in one room at the time. The success of the session led the AAP to develop a Section of Urology and impressed upon the AUA the magnitude of interest in pediatric urology. This allowed pediatric urologists to secure an exclusive session on the day before the main AUA meeting which has persisted since that time.Dr. Bicknell founded the History Forum in 1966 and chaired this very popular event during its first decade. The forum now occupies an entire afternoon during the AUA annual meeting, with papers presented on historic urologic topics. The highlight of this assembly is the annual lecture on the history of medicine. In 2000, this oration was renamed the Frank Bicknell History of Urology Oration to honor the founder of the History Forum. Dr. Frank Bicknell was an early leader in pediatric urology and urologic history who helped found The Society of Pediatric Urology and the AUA History Forum. [ABSTRACT FROM AUTHOR]