Search

ObjectiveTo assess self-perceived planned retirement patterns among urologists by using the American Urological Association Census Data. With an expanding elderly population and an aging urologic workforce, concerns regarding increased demand and decreased supply of urologists have been raised.Materials and methodsWe analyzed data from the 2014 American Urological Association Census, which is a specialty representative survey distributed to the urologists who practice in the United States. A total of 2204 census samples were weighted to represent 11,703 urologists who practiced in the United States in 2014. We compared urologists who are nearing retirement (within 5 years of their planned retirement) with the rest of urologists on their demographic, geographic, and practice characteristics.ResultsOf the 11,703 practicing urologists in the United States, 3181 (95% confidence interval: 2884-3479) or 27% (95% confidence interval: 25%-30%) are nearing planned retirement. The mean age (standard deviation [SD]) of urologists nearing retirement (69, SD = 8.2) was older than nonretiring urologists (48, SD = 10.3), P

Objective. There has been a major increase in the incidence of hypospadias in infants in the 1990s, but the risk factors are not known. Although there are scattered reports in the literature regarding the association of low birth weight and hypospadias, this has not been systematically studied. The objective of this study was to determine the association between early gestation intrauterine growth and hypospadias, Methods. A retrospective review of 13 years of admissions to 2 tertiary care neonatal intensive care units (NICUs) in Connecticut (1987-2000) showed that 112 (1.66%) of 6746 male infants had any degree of hypospadias. Of these, 8 were part of a genetic syndrome and were excluded. A retrospective cohort analysis of these 6738 infants was performed. Infant growth parameters at birth (weight, head circumference, and length) were analyzed along with maternal risk factors known to be associated with changes in fetal growth, including maternal age, race, diagnosis of preeclampsia, gestational diabetes, and maternal use of alcohol or tobacco or substance abuse during pregnancy. Results. The incidence of hypospadias in the NICU population increased 10-fold from 0.4% in 1987 to 4% in the first quarter of 2000. Hypospadias was significantly more common in infants who had uniformly poor intrauterine growth ( Conclusions. The incidence of hypospadias in our NICU population has increased 10-fold during the 13-year period of study. There was a significant association of hypospadias with poor intrauterine growth. The growth restriction was probably of early gestational cause as there was proportionate involvement of somatic (weight and length) and brain growth (head circumference). The increasing frequency of hypospadias and its association with poor intrauterine growth originating in early gestation suggests that common environmental factor(s) that have an impact on both conditions may be involved. Pediatrics 2002;109:473-478; hypospadias, SGA, intrauterine growth, temporal trend, risk factors., ABBREVIATIONS. SGA, small for gestational age; AGA, appropriate for gestational age; LGA, large for gestational age; NICU, neonatal intensive care unit; UCHC, University of Connecticut Health Center; GA, gestational age; [...]

Background: A genitourinary abnormality is detected antenatally in approximately 1% of pregnancies. Pediatric urologists are increasingly becoming involved in decisions regarding antenatal intervention (AI). Currently, there are no written guidelines when AI is indicated. A survey of pediatric urologists was undertaken to evaluate current practice patterns and recommendations regarding AI. Materials and Methods: A two-sided survey instrument was mailed to all members of the Society for Fetal Urology (SFU). The survey included 7 case scenarios that addressed critical decision points in patients with antenatally detected GU abnormalities. A second mailing was sent to initial non-responders. All data was tabulated at one center. A chi-square analysis was used for statistical analysis. Results: A total of 112 of 188(60%) members (99 North American(NA), 13 Non-North American(NNA)) completed the survey. The first two case scenarios involved near term fetuses with fetal lung maturity: There was almost uniform agreement in delaying intervention for a 32 week fetus with a suspected UPJ obstruction (99%). For a 36 week fetus with suspected PUV without oligohydramnios most respondents (69%) elected no intervention while a minority would have induced early delivery (27%). When comparing (NNA) to (NA) respondents, 46% of NNA would have induced early delivery compared to 26% of NA. (p-value=.01) Three cases involved fetuses with low to normal amniotic fluid without fetal lung maturity: Most respondents(86%) recommended serial ultrasounds to follow an 18-week fetus with suspected PUV when amniotic fluid was normal but decreasing. Almost all respondents agreed with some type of Al for a 28 week fetus with a solitary kidney and a suspected UPJ(76% renal shunt, 13% induce delivery as soon as lung maturity, 6% aspirate left renal pelvis now, 6% aspirate left renal pelvis prior to delivery). Most respondents agreed with no intervention(55% serial ultrasounds, 27% no intervention) for a 20 week fetus with suspected bilateral renal cystic disease. Finally, two cases involved scenarios with lung immaturity and available bladder and/or renal electrolytes: For a 23-week-old fetus with suspected PUV and oligohydramnios with normal bladder electrolytes, most respondents agreed with some form of AI(71% vesicoamniotic shunt, 7% serial aspiration, 7% amnioinfusion). For a 20 week fetus with suspected PUV, oligohydramnios and renal and bladder electrolytes indicating a non-functioning right kidney, there was no clear consensus with 55% favoring AI(47% vesicoamniotic shunt, 5% serial aspirations, 3% right pelvis shunt) and 38% recommending no Al because of anticipated fetal demise. Conclusion: There is a general consensus among pediatric urologists regarding Al for specific GU abnormalities. Intervention is indicated by this group in cases with proven renal function and oligohydramnios with fetal viability. In cases with normal amniotic fluid Al is not recommended by a majority of practitioners regardless of the detected abnormality. There is a trend favoring early delivery of fetuses with severe GU abnormalities and proven lung maturity even in the absence of oligohydramnios., C.D. Anthony Herndon, MD, Patrick H. McKenna, MD, FAAP, Andrew L. Freedman, MD, FAAP, Los Angeles, CA, Fernando A. Fetter, MD. Dept. of Pediatric Urology, Connecticut Children's Medical Center, Hartford, [...]

Background: Recently we have documented the expression of an important angiogenic factor, IL-8 and its receptors, in ex-vivo and in-vitro human neuroblastoma (NB) cells. Currently, little is known about the regulation of IL-8 expression by NB tumor cells. IL-1[Beta] and TNF[Alpha] are known to be important inducers of IL-8 in-vivo. We hypothesized that IL-1[Beta] and TNF[Alpha] are present in NB microenvironment and that they control IL-8 expression by NB cells. To begin to address this question we performed immunohistochemical (IHC) analysis of NB specimens and in-vitro stimulation studies on cultured NB cells. Methods: To demonstrate the presence of IL-1[Beta] and TNF[Alpha] in the tumor microenvironment archival human NB specimens (n=7) were evaluated for IL-1[Beta] and TNF[Alpha] expression by standard IHC. To determine if IL-1[Beta] and TNF[Alpha] can regulate IL-8 expression in NB we performed cell culture stimulation studies using the SK-N-MC NB cell line. Specifically, SK-N-MC cells were stimulated with 10ng/ml of IL-1[Beta], TNF[Alpha] or control media (total n each group = 15). Supernatants were harvested at 24 and 48 hrs and evaluated for IL-8 by ELISA. Results: IHC analysis revealed expression of IL-1[Beta] in the tumor stroma and fibroblasts in NB. TNF[Alpha] was prominently expressed in both the tumor stroma and on NB cells themselves. Stimulation studies demonstrated that both IL-1[Beta] and TNF[Alpha] significantly stimulated IL-8 production in NB cells at 24 and 48hr time points when compared to control media (see fig). Specific mean levels [[+ or -] SEM] for control media at 24 and 48hrs were: 26.23 pg/ml [[+ or -] 0.88] and 38.31pg/ml [[+ or -] 3.14], IL-1[Beta] stim. levels at 24 and 48 hrs were 107.97 pg/ml [[+ or -] 31.01] and 348.93 pg/ml [[+ or -] 61.40]. TNF[Alpha] stim. levels at 24 and 48hrs were 198.48 pg/ml [[+ or -] 18.22] and 411.42 [[+ or -] 23.22]. Conclusions: Our studies demonstrate that IL-1[Beta], TNF[Alpha] and IL-8 are all present in the NB tumor microenvironment. Additionally we have shown IL-1[Beta] and TNF[Alpha] upregulate IL-8 expression in cultured NB tumor cells. As IL-1[Beta] and TNF[Alpha] appear to be present in the NB microenviroment they may contribute to the in-vivo regulation of IL-8 in NB. Understanding the regulatory cascade promoting angiogenesis in NB may lead to the development of effective anti-angiogenic therapy., Fernando A. Ferrer, Laud J. Miller, Patrick H. McKenna and Donald L. Kruetzer. Dept. Ped. Urology. Connecticut Childrens Medical Center. The University of Connecticut Health Center, Hartford, CT. ---------- Please [...]