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Gnech M, 't Hoen L, Zachou A, Bogaert G, Castagnetti M, O'Kelly F, Quaedackers J, Rawashdeh YF, Silay MS, Kennedy U, Skott M, van Uitert A, Yuan Y, Radmayr C, Burgu B. Update and Summary of the European Association of Urology/European Society of Paediatric Urology Paediatric Guidelines on Vesicoureteral Reflux in Children. Eur Urol 2024; 85:433-442. [PMID: 38182493 DOI: 10.1016/j.eururo.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND AND OBJECTIVE The prescriptive literature on vesicoureteral reflux (VUR) is still limited and thus the level of evidence is generally low. The aim of these guidelines is to provide a practical approach to the treatment of VUR that is based on risk analysis and selective indications for both diagnostic tests and interventions. We provide a 2023 update on the chapter on VUR in children from the European Association of Urology (EAU) and European Society for Paediatric Urology (ESPU) guidelines. METHODS A structured literature review was performed for all relevant publications published from the last update up to March 2022. KEY FINDINGS AND LIMITATIONS The most important updates are as follows. Bladder and bowel dysfunction (BBD) is common in toilet-trained children presenting with urinary tract infection (UTI) with or without primary VUR and increases the risk of febrile UTI and focal uptake defects on a radionuclide scan. Continuous antibiotic prophylaxis (CAP) may not be required in every VUR patient. Although the literature does not provide any reliable information on CAP duration in VUR patients, a practical approach would be to consider CAP until there is no further BBD. Recommendations for children with febrile UTI and high-grade VUR include initial medical treatment, with surgical care reserved for CAP noncompliance, breakthrough febrile UTIs despite CAP, and symptomatic VUR that persists during long-term follow-up. Comparison of laparoscopic extravesical versus transvesicoscopic ureteral reimplantation demonstrated that both are good option in terms of resolution and complication rates. Extravesical surgery is the most common approach used for robotic reimplantation, with a wide range of variations and success rates. CONCLUSIONS AND CLINICAL IMPLICATIONS This summary of the updated 2023 EAU/ESPU guidelines provides practical considerations for the management and diagnostic evaluation of VUR in children. ADVANCING PRACTICE For children with VUR, it is important to treat BBD if present. A practical approach regarding the duration of CAP is to consider administration until BBD resolution. PATIENT SUMMARY We provide a summary and update of guidelines on the diagnosis and management of urinary reflux (where urine flows back up through the urinary tract) in children. Treatment of bladder and bowel dysfunction is critical, as this is common in toilet-trained children presenting with urinary tract infection.
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Affiliation(s)
- Michele Gnech
- Department of Paediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Lisette 't Hoen
- Department of Pediatric Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Alexandra Zachou
- Department of HIV and Sexual Health, Chelsea & Westminster Hospital, London, UK
| | - Guy Bogaert
- Department of Urology, University of Leuven, Leuven, Belgium
| | - Marco Castagnetti
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padua, Italy
| | - Fardod O'Kelly
- Division of Paediatric Urology, Beacon Hospital Dublin & University College Dublin, Ireland
| | - Josine Quaedackers
- Department of Urology, University Medical Center Groningen, Groningen, The Netherlands
| | - Yazan F Rawashdeh
- Department of Urology, Section of Pediatric Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Mesrur Selcuk Silay
- Division of Pediatric Urology, Department of Urology, Biruni University, Istanbul, Turkey
| | - Uchenna Kennedy
- Department of Pediatric Urology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Martin Skott
- Department of Urology, Section of Pediatric Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Allon van Uitert
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Yuhong Yuan
- Department of Medicine, London Health Science Centre, London, Ontario, Canada, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Christian Radmayr
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Berk Burgu
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
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Sforza S, Marco BB, Haid B, Baydilli N, Donmez MI, Spinoit AF, Paraboschi I, Masieri L, Steinkellner L, Comez YI, Lammers RJM, 't Hoen LA, O'Kelly F, Bindi E, Kibar Y, Silay MS. A multi-institutional European comparative study of open versus robotic-assisted laparoscopic ureteral reimplantation in children with high grade (IV-V) vesicoureteral reflux. J Pediatr Urol 2024; 20:283-291. [PMID: 38000950 DOI: 10.1016/j.jpurol.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/27/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Traditionally, open ureteral reimplantation (OUR) has been the standard treatment for primary vesicoureteral reflux (VUR) requiring reimplantation. Robotic-assisted laparoscopic ureteral reimplantation (RALUR) is gaining popularity and high success rates have been reported. OBJECTIVE In this multi-institutional study, we aimed to compare the perioperative and postoperative outcomes of OUR and RALUR for high-grade (IV + V) VUR in children. STUDY DESIGN A retrospective evaluation was performed collecting data from 135 children (0-18 years) who underwent high grade VUR surgical correction at nine European institutions between 01/01/2009 and 01/12/2020, involving either open or robotic approaches. Institutional review board approval was obtained. Patients with lower grades of VUR (≤III), previous history of open or endoscopic ureteral surgery, neurogenic bladder, or refluxing megaureter in need of ureteral tapering were excluded. Pre-, peri- and post-operative data were statistically compared. RESULTS Overall, 135 children who underwent either OUR (n = 68), or RALUR (n = 67) were included, and their clinic and demographic features were collected. The mean age of the open group was 11 months (interquartile range [IQR] 9.9-16.6 months), in the RALUR group it was 59 months (IQR 29-78mo) (p < 0.01); the open cohort had a weight of 11 kg (IQR 9.9-16.6 kg) while the RALUR group had 19 kg (IQR 13-25 kg) (p < 0.01). No significant differences were found for intraoperative (1.5 % vs 7.5 %, p = 0.09) or for postoperative complication rates (7.4 % vs 9 %, p = 0.15). Favorable outcomes were reported in the RALUR group: shorter time to stooling (1 vs 2 days), fewer indwelling urethral catheter days (1 vs 5 days), perioperative drain insertion time (1 vs 5 days) and a shorter length of hospital stay (2 vs 5 days) (p < 0.01). The success rate was 94.0 % and 98.5 % in the open and RALUR groups, respectively. The long-term clinical success rates from both groups was comparable:42 vs 23 months for open and RALUR, respectively. DISCUSSION This study reported a large multicentric experience focusing on high grade VUR. Furthermore, this study compares favorably to OUR in a safety analysis. There was also a trend towards higher success rates with RALUR utilizing an extravesical approach which has not been previously reported. CONCLUSION RALUR is an efficacious and safe platform to use during ureteral reimplantation for high grade VUR. The overall peri-operative and post-operative complication rates are at least equivalent to OUR, but it is associated with a faster functional recovery and time to discharge. Medium to long term success rates are also equivalent to OUR.
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Affiliation(s)
- Simone Sforza
- Department of Pediatric Urology, University of Florence, Meyer Children Hospital, Florence, Italy.
| | - Beatriz Bañuelos Marco
- Department of Urology, Charité University Clinic, Division of Paediatric Urology, Berlin, Germany
| | - Bernhard Haid
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Linz, Austria
| | - Numan Baydilli
- Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Muhammet Irfan Donmez
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Anne-Françoise Spinoit
- Department Urology ERN Centre, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
| | - Irene Paraboschi
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Lorenzo Masieri
- Department of Pediatric Urology, University of Florence, Meyer Children Hospital, Florence, Italy
| | - Lukas Steinkellner
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Linz, Austria
| | - Yusuf Ilker Comez
- Department of Urology, Biruni University, Division of Paediatric Urology, Istanbul, Turkey
| | - Rianne J M Lammers
- Department of Urology, University Medical Center Groningen, 9713 GZ Groningen, the Netherlands
| | - Lisette Aimée 't Hoen
- Department of Paediatric Urology, Sophia Children's Hospital, Erasmus University Medical Center, 3015 GD Rotterdam, the Netherlands
| | - Fardod O'Kelly
- Division of Paediatric Urology, Beacon Hospital, DK18 AK68 Dublin, Ireland
| | - Edoardo Bindi
- Pediatric Surgery Unit, Salesi Children's Hospital, Ancona, Italy
| | - Yusuf Kibar
- Department of Urology, University, Koru Hospital, Ankara, Turkey
| | - Mesrur Selçuk Silay
- Department of Urology, Biruni University, Division of Paediatric Urology, Istanbul, Turkey
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O'Kelly F. Commentary to quantification of vesicoureteral reflux using machine learning. J Pediatr Urol 2024; 20:265-266. [PMID: 38097422 DOI: 10.1016/j.jpurol.2023.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 04/22/2024]
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Sforza S, Marco BB, Haid B, Baydilli N, Donmez MI, Spinoit AF, Paraboschi I, Masieri L, Steinkellner L, Comez YI, Lammers RJM, Aimée 't Hoen L, O'Kelly F, Bindi E, Kibar Y, Silay MS. Response to Editorial Commentary Regarding 'A multi-institutional European comparative study of open versus robotic-assisted laparoscopic ureteral reimplantation in children with high grade (IV-V) vesicoureteral reflux?'. J Pediatr Urol 2024; 20:293-294. [PMID: 38065759 DOI: 10.1016/j.jpurol.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 04/22/2024]
Affiliation(s)
- Simone Sforza
- Department of Pediatric Urology, University of Florence, Meyer Children Hospital, Florence, Italy.
| | - Beatriz Bañuelos Marco
- Department of Urology, Charité University Clinic, Division of Paediatric Urology, Berlin, Germany
| | - Bernhard Haid
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Linz, Austria
| | - Numan Baydilli
- Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Muhammet Irfan Donmez
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Anne-Françoise Spinoit
- Department Urology ERN Centre, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
| | - Irene Paraboschi
- Department of Pediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Lorenzo Masieri
- Department of Pediatric Urology, University of Florence, Meyer Children Hospital, Florence, Italy
| | - Lukas Steinkellner
- Department of Pediatric Urology, Ordensklinikum Linz, Hospital of the Sisters of Charity, Linz, Austria
| | - Yusuf Ilker Comez
- Department of Urology, Biruni University, Division of Paediatric Urology, Istanbul, Turkey
| | - Rianne J M Lammers
- Department of Urology, University Medical Center Groningen, 9713 GZ Groningen, the Netherlands
| | - Lisette Aimée 't Hoen
- Department of Paediatric Urology, Sophia Children's Hospital, Erasmus University Medical Center, 3015 GD Rotterdam, the Netherlands
| | - Fardod O'Kelly
- Division of Paediatric Urology, Beacon Hospital, DK18 AK68 Dublin, Ireland
| | - Edoardo Bindi
- Pediatric Surgery Unit, Salesi Children's Hospital, Ancona, Italy
| | - Yusuf Kibar
- Department of Urology, University, Koru Hospital, Ankara, Turkey
| | - Mesrur Selçuk Silay
- Department of Urology, Biruni University, Division of Paediatric Urology, Istanbul, Turkey
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Baydilli N, Dönmez Mİ, Wilcox DT, Hadziselimovic F, Hayashi Y, Oswald J, Ziylan O, Thorup J, Kapelari K, Soygür T, Favorito LA, Braga LH, 't Hoen LA, O'Kelly F, Sforza S, Lammers R, Bindi E, Paraboschi I, Haid B, Quiroz Madarriaga Y, Banuelos Marco B. Undescended testis: A roundtable discussion based on clinical scenarios - Part 1. J Pediatr Urol 2024; 20:95-101. [PMID: 37845102 DOI: 10.1016/j.jpurol.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 09/14/2023] [Accepted: 09/27/2023] [Indexed: 10/18/2023]
Abstract
Undescended testis (UDT, cryptorchidism) is the most common congenital anomaly of the genital tract. Despite its high incidence, the management of UDT varies between specialties (urology, pediatric surgery, pediatric urology, pediatric endocrinology). Therefore, as the European Association of Urology - Young Academic Urologists Pediatric Urology Working Group, we requested experts around the world to express their own personal approaches against various case scenarios of UDT in order to explore their individual reasoning. We intended to broaden the perspectives of our colleagues who deal with the treatment of this frequent genital malformation.
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Affiliation(s)
- Numan Baydilli
- Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey.
| | - M İrfan Dönmez
- Division of Pediatric Urology, Department of Urology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
| | - Duncan T Wilcox
- Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA.
| | - Faruk Hadziselimovic
- Department of Pediatrics, Children's Day Care Center Liestal, Cryptorchidism Research Institute, Liestal, Switzerland.
| | - Yutaro Hayashi
- Department of Pediatric Urology Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Josef Oswald
- Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria.
| | - Orhan Ziylan
- Division of Pediatric Urology, Department of Urology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
| | - Jorgen Thorup
- Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
| | - Klaus Kapelari
- Department for Children and Adolescent Medicine, Innsbruck Medical University, Tyrol, Austria.
| | - Tarkan Soygür
- Division of Pediatric Urology, Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
| | - Luciano Alves Favorito
- Unidade de Pesquisa Urogenital, Universidade do Estado do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brazil.
| | - Luis H Braga
- Department of Surgery/Urology, McMaster University, Hamilton, Ontario, Canada.
| | - Lisette A 't Hoen
- Department of Pediatric Urology, Erasmus MC University Medical Center, Rotterdam-Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - Fardod O'Kelly
- Division of Paediatric Urology, Beacon Hospital, University College Dublin, Dublin, Ireland.
| | - Simone Sforza
- Paediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy.
| | - Rianne Lammers
- Department of Urology, University Medical Center Groningen, Groningen, the Netherlands.
| | - Edoardo Bindi
- Ospedale Pediatrico G Salesi, Department of Pediatric Urology, G Salesi Paediatric Hospital, Ancona, Italy.
| | - Irene Paraboschi
- Department of Pediatric Urology, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milano, Italy.
| | - Bernhard Haid
- Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria.
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Dönmez Mİ, Baydilli N, 't Hoen LA, O'Kelly F, Sforza S, Lammers R, Bindi E, Paraboschi I, Haid B, Quiroz Madarriaga Y, Banuelos Marco B. Response to letter to the editor re undescended testis: A roundtable discussion based on clinical scenarios - Part 1. J Pediatr Urol 2024; 20:104-105. [PMID: 37919214 DOI: 10.1016/j.jpurol.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 11/04/2023]
Affiliation(s)
- M İrfan Dönmez
- Division of Pediatric Urology, Department of Urology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
| | - Numan Baydilli
- Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey.
| | - Lisette A 't Hoen
- Department of Pediatric Urology, Erasmus MC University Medical Center, Rotterdam-Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - Fardod O'Kelly
- Division of Paediatric Urology, Beacon Hospital, University College Dublin, Dublin, Ireland.
| | - Simone Sforza
- Paediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy.
| | - Rianne Lammers
- Department of Urology, University Medical Center Groningen, Groningen, the Netherlands.
| | - Edoardo Bindi
- Ospedale Pediatrico G Salesi, Department of Pediatric Urology, G Salesi Paediatric Hospital, Ancona, Italy.
| | - Irene Paraboschi
- Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Department of Pediatric Urology, Milano Italy.
| | - Bernhard Haid
- Department of Pediatric Urology, Hospital of the Sisters of Charity, Linz, Austria.
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Skott M, Gnech M, Hoen LA', Kennedy U, Van Uitert A, Zachou A, Yuan Y, Quaedackers J, Silay MS, Rawashdeh YF, Burgu B, Castagnetti M, O'Kelly F, Bogaert G, Radmayr C. Endoscopic dilatation/incision of primary obstructive megaureter. A systematic review. On behalf of the EAU paediatric urology guidelines panel. J Pediatr Urol 2024; 20:47-56. [PMID: 37758534 DOI: 10.1016/j.jpurol.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Historically, ureteral reimplantation (UR) has been the gold standard for treatment of primary obstructive megaureter (POM) with declining renal function, worsening obstruction, or recurrent urinary tract infections. In infants, open surgery with reimplantation of a grossly dilated ureter into a small bladder, can be technically challenging with significant morbidity. Therefore, less invasive endoscopic management such as dilatation or incision of the ureter-vesical junction, has emerged as an alternative to reimplantation during the last decades. OBJECTIVE To systematically evaluate the effectivity, safety, and potential benefits of endoscopic treatment (dilatation with or without balloon or incision) of POM in comparison to UR. STUDY DESIGN A systematic review was conducted. Randomized controlled trials (RCTs), nonrandomized comparative studies (NRSs), and single-arm case series including a minimum of 20 participants and a mean follow-up more than 12 months were eligible for inclusion. RESULTS Of 504 articles identified, 8 articles including 338 patients were eligible for inclusion (0 RCTs, 1 NRSs, and 7 case series). Age at time of surgery was minimum 15 days to a maximum of 192 months. Indications for endoscopic treatment (ET) included patients with loss of split renal function (>10%) and worsening of hydroureteronephrosis. The studies analysed reported a success rate ranging from 35% to 97%. Success was defined as stabilization of differential renal function without further procedures. A post-operative complication rate of 23-60% was reported (mostly transient haematuria, urinary tract infections and stent migration or intolerance). In 14% of the cases salvage UR following initial ET, was performed due to relapse of symptomatic POM. CONCLUSION Endoscopic treatment for persistent or progressive POM in children is a minimally invasive alternative to UR with a long-term modest success rate. Additionally, it can be performed within a wide age span, with equal success rate and complication rates.
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Affiliation(s)
- Martin Skott
- Department of Urology, Section of Pediatric Urology, Aarhus University Hospital, Aarhus, Denmark.
| | - Michele Gnech
- Department of Paediatric Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Lisette A 't Hoen
- Department of Pediatric Urology, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Uchenna Kennedy
- Department of Pediatric Urology, University Children's Hospital Zurich, Switzerland.
| | - Allon Van Uitert
- Department of Urology, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - Alexandra Zachou
- Department of HIV and Sexual Health, Chelsea & Westminster Hospital, London, United Kingdom.
| | - Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Josine Quaedackers
- Department of Urology and Pediatric Urology, University Medical Center Gronningen, Rijks University Groningen, Groningen, the Netherlands.
| | - Mesrur Selcuk Silay
- Division of Pediatric Urology, Department of Urology, Istanbul Birurni University, Istanbul, Turkey.
| | - Yazan F Rawashdeh
- Department of Urology, Section of Pediatric Urology, Aarhus University Hospital, Aarhus, Denmark.
| | - Berk Burgu
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey.
| | - Marco Castagnetti
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padua, Italy.
| | - Fardod O'Kelly
- Division of Paediatric Urology, Beacon Hospital, Dublin, Ireland, University College Dublin, Ireland.
| | - Guy Bogaert
- Department of Urology, University of Leuven, Leuven, Belgium.
| | - Christian Radmayr
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria.
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O'Kelly F, t'Hoen LA, Banuelos Marco B, Lammers RJM, Sforza S, Hiess M, Bindi E, Baydilli N, Donmez MI, Paraboschi I, Atwa A, Spinoit AF, Haid B, Silay S. Pathways to paediatric urology subspecialisation: a study of casemix, incumbent attitudes and opinions. World J Urol 2024; 42:34. [PMID: 38217728 PMCID: PMC10787691 DOI: 10.1007/s00345-023-04743-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/20/2023] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVE To identify any self-reported differences or attitudes towards certification, publication, or practice patterns between adult urology and paediatric general surgery-trained paediatric urology providers. There are no known published differences in clinical/operative/research outcomes in either group. METHODS An 18-item cross-sectional survey was compiled through the EAU Young Academic Urologists (YAU) office and disseminated to a trans-Atlantic convenience sample of current practising paediatric urologists. This was created using a mini-Delphi method to provide current semi-quantitative data relating to current opinions and attitudes of this cohort. RESULTS A total of 228 respondents completed the survey, with female respondents representing 37% and 34% for urology and paediatric general surgery, respectively. Nearly 90% overall respondents felt that a full 2-year paediatric fellowship program was very important and 94% endorsed a collaborative dedicated paediatric urology on call service, with 92% supporting the joint development of transitional care. Urology managed higher numbers of bedwetting (p = 0.04), bladder bowel dysfunction (p = 0.02), endourological procedures (p = 0.04), and robotics (p = 0.04). Paediatric general surgery managed higher numbers of laparoscopic reconstruction (p = 0.03), and posterior urethral valve ablation (p = 0.002). CONCLUSION This study represents the first time that a cross-sectional cohort of paediatric urologists from different training backgrounds were compared to assess their productivity, practice patterns and attitudes. Paediatric urology is in a unique position to have two contributing specialities, with the ability to provide optimal transitional and lifelong care. We believe that there should be a strong emphasis on collaboration and to remove any historically-created barriers under policies of equity, diversity and inclusivity.
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Affiliation(s)
- F O'Kelly
- Division of Paediatric Urology, Beacon Hospital, University College Dublin, Dublin, Ireland.
| | - L A t'Hoen
- Department of Pediatric Urology, Erasmus MC University Medical Center, Rotterdam-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - B Banuelos Marco
- Department of Urology, University Hospital El Clinico, Madrid, Spain
| | - R J M Lammers
- Department of Urology, University Medical Center Groningen, Groningen, The Netherlands
| | - S Sforza
- Paediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy
| | - M Hiess
- Department of Pediatric Urology, Hospital of the Sisters of Charity Linz, Linz, Austria
| | - E Bindi
- Department of Pediatric Surgery, AOU Delle Marche, Ospedale Pediatrico G Salesi, Ancona, Italy
| | - N Baydilli
- Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - M I Donmez
- Division of Pediatric Urology, Department of Urology, İstanbul University İstanbul Faculty of Medicine, Istanbul, Turkey
| | - I Paraboschi
- Department of Pediatric Urology, IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Atwa
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - A F Spinoit
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - B Haid
- Department of Pediatric Urology, Hospital of the Sisters of Charity Linz, Linz, Austria
| | - S Silay
- Department of Urology, Biruni University, Istanbul, Turkey
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't Hoen LA, O'Kelly F, Lammers RJM, Dönmez Mİ, Baydilli N, Sforza S, Bindi E, Atwa A, Haid B, Quiroz Y, Marco BB. Mobility and Sporting Activity After Renal Trauma: A Survey Regarding Best Clinical Practice During the Recovery Stage. Urology 2024; 183:199-203. [PMID: 37806456 DOI: 10.1016/j.urology.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To evaluate strategies that are followed after pediatric renal trauma during the recovery stage, with an emphasis on mobility and involvement in subsequent sporting activities. Renal trauma is the most common urogenital trauma in children. The American Association for the Surgery of Trauma (AAST) scale is most commonly used to stratify the severity of injury. There is no consensus in the existing literature with respect to the recovery stage following renal trauma. METHODS A survey was constructed by the European Association of Urology (EAU) - Young Academic Urologists (YAU) Pediatric Urology Working Group and then made digitally available on SurveyMonkey. The survey consists of 15 questions exploring relevant factors and timing to start again with mobility and activity. RESULTS In total 153 people responded, of whom 107 completed the entire survey. The presence of pain and severity of trauma were acknowledged as most important factors to commence mobilization, whereas presence of hematuria was identified as an additional factor for sporting activity. Regardless of severity of trauma a minimum of 90% of respondents recommend return to noncontact sports within 12weeks. For contact sports, a minimum of 33% of respondents advised >12weeks minimum before starting again. A small number of respondents would never allow sporting activities again. CONCLUSION The time to allow sporting activity shows high variation among the respondents, some even restricting sporting activities completely. This survey highlights the need for a standardized protocol based on multicenter follow-up data.
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Affiliation(s)
- Lisette A 't Hoen
- Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Fardod O'Kelly
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Rianne J M Lammers
- Department of Urology, University Medical Center Groningen, Groningen, the Netherlands
| | | | | | | | | | - Ahmed Atwa
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Bernard Haid
- Ordensklinikum Linz, Barmherzige Schwestern Hospital, Linz, Austria
| | - Yesica Quiroz
- Department of Urology, Division of Pediatric Urology, Fundació Puigvert, Barcelona, Spain
| | - Beatriz Bañuelos Marco
- Department of Urology, Renal Transplant Division, University Hospital El Clinico, Madrid, Spain
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O'Kelly F, t'Hoen LA, Silay S, Lammers RJM, Sforza S, Bindi E, Baydilli N, Donmez MI, Paraboschi I, Atwa A, Spinoit AF, Marco BB. Neuropsychiatric Developmental Disorders in Children Are Associated With an Impaired Response to Treatment in Bladder Bowel Dysfunction: A Prospective Multi-Institutional European Observational Study. J Urol 2023; 210:899-907. [PMID: 37747130 DOI: 10.1097/ju.0000000000003701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE Bladder and bowel dysfunction is a common but underdiagnosed pediatric entity which may represent up to 47% of pediatric urology consults. The objectives of this observational study were to determine functional 1-year outcomes following standard treatment of bladder and bowel dysfunction in both control and neuropsychiatric developmental disorder groups using validated questionnaires, and to perform an initial cost analysis. MATERIALS AND METHODS This was a prospective observational study conducted across a number of academic European centers (July 2020-November 2022) for new bladder and bowel dysfunction patients. Parents completed a sociodemographic survey, information pertaining to prior neuropsychiatric developmental disorder diagnoses, as well as a number of validated functional scores. RESULTS A total of 240 patients were recruited. In the control bladder and bowel dysfunction group, the baseline Dysfunctional Voiding Scoring System and Childhood Bladder and Bowel Dysfunction Questionnaire scores were 20% and 17.% lower, respectively, after 1 year compared to the neuropsychiatric developmental disorder group. The change in improvement was diminished for the neuropsychiatric developmental disorder cohort in both Dysfunctional Voiding Scoring System and Childhood Bladder and Bowel Dysfunction Questionnaire scores. The odds ratio of full symptom resolution was 5.7 in the control cohort compared to the neuropsychiatric developmental disorder cohort. A cost analysis on prescribed medications at referral led to a total cost of €32,603.76 (US $35,381.00) in the control group and €37,625.36 (US $40,830.00) in the neuropsychiatric developmental disorder group. CONCLUSIONS This study demonstrates that pediatric patients with a neuropsychiatric developmental disorder exhibit more severe bladder and bowel dysfunction at baseline and throughout treatment with a lower overall quality of life, as well as 15.4% higher medication costs at referral. It is also important that parents' and caregivers' expectations are managed regarding higher levels of treatment resistance for functional bladder and bowel issues.
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Affiliation(s)
- F O'Kelly
- Division of Paediatric Urology, Beacon Hospital, University College Dublin, Dublin, Ireland
| | - L A t'Hoen
- Department of Pediatric Urology, Erasmus MC University Medical Center, Rotterdam-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - S Silay
- Department of Urology, Biruni University, Istanbul, Turkey
| | - R J M Lammers
- Department of Urology, University Medical Center Groningen, Groningen, The Netherlands
| | - S Sforza
- Paediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy
| | - E Bindi
- Department of Pediatric Surgery, AOU delle Marche, Ospedale Pediatrico G Salesi, Ancona, Italy
| | - N Baydilli
- Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - M I Donmez
- Division of Pediatric Urology, Department of Urology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - I Paraboschi
- Department of Pediatric Urology, IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Atwa
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - A F Spinoit
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - B Banuelos Marco
- Department of Urology, University Hospital El Clinico, Madrid, Spain
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O'Kelly F. Response to letter to the editor re adapting lean methodology towards surgical tray rationalisation in inguinoscrotal day case surgery in the Republic of Ireland. J Pediatr Urol 2023; 19:678-679. [PMID: 37414649 DOI: 10.1016/j.jpurol.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Fardod O'Kelly
- University College Dublin, Division of Paediatric Urology, Dublin, Ireland.
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Fawaz AS, O'Connell C, Manecksha RP, Redmond EJ, Nason G, Dowling C, O'Kelly F. Women in Irish urology: An examination of female representation amongst attendees of the Irish Society of Urology annual meeting (2008-2020). Surgeon 2023; 21:308-313. [PMID: 36935272 DOI: 10.1016/j.surge.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND There is underrepresentation of women at surgical conferences. We examine the representation of women in Irish urology by looking at gender balance within the Irish Society of Urology (ISU) conference. AIMS ISU programmes over thirteen years from 2008 to 2020 were assessed and female representation in session chairs, guest speakers, poster and oral presentations identified. Gender distributions of authors for each year was examined. To investigate changes in female representation temporally, the period of this study (2008-2020) was subdivided and compared: 2008-2013 and 2014-2020. RESULTS 76 sessions were presided over by 138 chairs, of which 6 (4.3%) were female. Eight conferences had zero female chairs. 62 guest lectures were given, 6 (9.6%) by women. Of total 340 poster and 434 oral presentations, women delivered 24.9% (0-47.5%) of posters and 31.6% (10.3-59.4%) of oral presentations. We found no significant difference in the percentage of female poster presentations between the time periods 2008-2013 (m = 18.2, sd = 13.7) and 2014-2020 (m = 34.3, sd = 17.8), t(11) = -1.4, p > 0.05. However, we found a significant difference in the percentage of female oral presentations between the periods 2008-2013 (m = 18.7, sd = 14.2) and 2014-2020 (m = 40.6, sd = 14.5), t(11) = -2.8, p < 0.05. CONCLUSIONS Our study is the second to examine female representation in Irish urology. Session chairs and guest speakers were grossly overrepresented by males as were oral and poster presentations. Despite lacking female influence overall, in more recent years there was an increased representation of women. Societies should strive to increase female representation, as this perpetuates a positive feedback loop, encouraging future female trainees to pursue urological surgery.
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Affiliation(s)
- A S Fawaz
- Cork University Hospital, Cork, Ireland.
| | | | | | | | - G Nason
- Mater Misercordiae University Hospital, Dublin, Ireland
| | - C Dowling
- University Hospital Galway, Galway, Ireland
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Finup JL, Bhatia VP, Perry DM, Truscott SJ, Cannon ST, O'Kelly F, Farhat WA. Personalized Pre-clinic Nursing Telemedicine Visit: An Efficient and Efficacious Approach for Bowel and Bladder Dysfunction in Children. Urology 2023; 179:158-163. [PMID: 37348658 DOI: 10.1016/j.urology.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES To evaluate the effectiveness and efficacy of a Registered Nurse (RN) led educational pre-clinic telephone call on compliance and outcomes in children with bowel and bladder dysfunction (BBD). METHODS A retrospective chart review of a prospectively applied protocol in a single academic institution was performed for children aged 4-17 presenting with BBD. All children underwent a pre-clinic RN telemedicine visit where they were educated on pathophysiology of BBD, provided personalized urotherapy and bowel recommendations and instructed to complete pre-clinic questionnaires and voiding diaries. Patients were evaluated by a provider 4weeks following RN call. Data collected included compliance with forms, bowel management and need for imaging/testing, medications, and biofeedback. Patients were considered to improve with urotherapy alone if they were discharged from urology without the need for medications and/or biofeedback. RESULTS In total, 277 patients completed an RN call and 224 patients attended a provider visit between December 2020 and June 2022. Mean age was 9.4years (3:1 Female to Male ratio). During the RN call, 154 (56%) patients had bowel management initiated. Of the 224 patients seen by a provider, 69% (n = 154) had symptom improvement or resolution with urotherapy alone. Thirty-eight patients (17%) enrolled in biofeedback with 7 (3%) completing all 8 sessions. Thirty-two patients (14%) required medication for daytime bladder symptoms. CONCLUSION Our novel RN-led pre-clinic telemedicine visit demonstrates excellent compliance and patient outcomes for children with BBD and can reduce the use of unnecessary imaging, medications, and time-consuming treatments such as biofeedback.
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Affiliation(s)
| | | | - Dana M Perry
- University of Wisconsin Hospitals and Clinics, Madison, WI
| | | | | | | | - Walid A Farhat
- University of Wisconsin Hospitals and Clinics, Madison, WI
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Bañuelos Marco B, 't Hoen L, O'Kelly F, Dönmez MI, Haid B, Baydilli N, Sforza S, Bindi E, Lammers RJ. Primum Non Discernere: Glass Ceilings and Female Representation at the European Association of Urology and European Society for Paediatric Urology Annual Meetings, 2012-2022. EUR UROL SUPPL 2023; 52:60-65. [PMID: 37284042 PMCID: PMC10240511 DOI: 10.1016/j.euros.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 06/08/2023] Open
Abstract
Background The term glass ceiling coined by Loden in 1978 is commonly used to describe difficulties faced by minorities and women when trying to move into senior roles. Objective To analyse trends and patterns for female representation at the European Association of Urology (EAU) and European Society for Paediatric Urology (ESPU) annual general meetings over the past decade. Design setting and participants We used objective data on female representation in the roles of chairs, moderators, and lecture speakers at the EAU and ESPU meetings from 2012 to 2022. Outcome measurements and statistical analysis We evaluated gender based representation in paediatric urology sessions at the EAU and ESPU meetings, collecting data on the overall number of sessions, lectures, symposiums, abstract/poster sessions, and courses, and analysed the male/female ratio. Data were derived from printed and digital programmes for the relevant meetings. Results and limitations During the period from 2012 to 2022, the percentage female representation varied from 0% (2012) to a maximum of 35% (2022) at EUA paediatric urology sessions, and from 13.5% (2014) to a maximum of 32% (2022) at ESPU meetings. Both associations show clear progression towards equality. Conclusions Female representation at EAU and ESPU meetings has risen over the years, reaching 35% and 32%, respectively, in 2022, which is in line with the number of female members. We hope that this motivates a move towards the equality objectives for 2030. A clear and fundamental societal change is needed, with fair and more consistent institutional policies and framework commitments in the areas of science, medicine, and global health. Gender equality and diversity taskforces are essential to achieve these goals. Patient summary We analysed the male/female ratio for participants in annual meetings held by the European Association of Urology and the European Society for Paediatric Urology. From a low level in 2012, the ratio increased to over 30% in 2022, in line with the female membership of the societies. Focus on fair and consistent policies is needed to ensure that women are well represented in medicine.
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Affiliation(s)
- Beatriz Bañuelos Marco
- Department of Urology, Renal Transplant Division, University Hospital El Clinico, Madrid, Spain
| | | | - Fardod O'Kelly
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Bernhard Haid
- Ordensklinikum Linz, Barmherzige Schwestern Hospital, Linz, Austria
| | | | | | | | - Rianne J.M. Lammers
- Department of Urology, University Medical Center Groningen, Groningen, The Netherlands
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15
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O'Kelly F, t'Hoen LA, Burgu B, Banuelos Marco B, Lammers RJM, Sforza S, Hiess M, Bindi E, Baydilli N, Donmez MI, Paraboschi I, Atwa A, Spinoit AF, Haid B, Radmayr C, Silay MS. A cross-sectional analysis of paediatric urologists' current practices, opinions and areas of perceived importance in the delivery of adolescent & transitional care. J Pediatr Urol 2023:S1477-5131(23)00152-3. [PMID: 37173199 DOI: 10.1016/j.jpurol.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/01/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Complex urological anomalies often require continued care as patients reach adulthood. Adequate transition for adolescents with ongoing urological care needs is critical to allow for seamless care in adult hospitals. Studies have shown that this can lead to improved patient and parental satisfaction, and lower utilisation of unplanned inpatient beds and emergency department visits. There is currently no ESPU-EAU consensus on the adequate mechanism and very few individual papers examining the role of urological transition for these patients in a European setting. This study aimed to identify current practice patterns in paediatric urologists providing adolescent/transitional care, to assess their opinions towards formal transition and to look for variations in care. This has implications for long-term patient health and specialist care. METHODS An 18-item cross-sectional survey was compiled and pre-approved through the EAU-EWPU and ESPU board offices prior to dissemination to all registered ordinary members affiliated with the ESPU. This was created using a mini-Delphi method through the EWPU research meetings to provide current semi-quantitative data relating to current opinions and attitudes of this cohort. RESULTS A total of 172 respondents (55% paediatric general surgery; 45% urology) across 28 countries completed the survey. The majority of respondents were in practice >10 years and spent >80% time in paediatric urology. There was no formal transition process according to 50% respondents and over half of those that did have less than 1/month, with <10% using validated questionnaires. More than two-thirds respondents continued to provide care after transition, as >70% units had no designated corresponding adult service. Furthermore, 93% paediatric believe a formal transition service to be very important, using a multidisciplinary framework. A pareto chart demonstrated 10 specific conditions to be of most interest in transition to adulthood. CONCLUSION This is the first study to assess the requirements of paediatric urologists for adequate transitional care, however due to the nature of the survey's distribution, this was a non-scientific poll based on a convenience sample of respondents. It is critical that dual-trained or adult-trained urologists with a specific interest in paediatric urology work with current paediatric urologists in a multidisciplinary fashion to facilitate early transition based on the adolescent's developmental and biopsychosocial requirements. National urological and paediatric surgical societies need to make transitional urology a priority. The ESPU and EAU should collaboratively consider developing transitional urology guidelines to allow a framework by which this can occur.
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Affiliation(s)
- F O'Kelly
- Division of Paediatric Urology, Beacon Hospital, University College Dublin, Dublin, Ireland.
| | - L A t'Hoen
- Department of Pediatric Urology, Erasmus MC University Medical Center, Rotterdam-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - B Burgu
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
| | - B Banuelos Marco
- Department of Urology, University Hospital Clinico San Carlos, Madrid, Spain
| | - R J M Lammers
- Department of Urology, University Medical Center Groningen, Groningen, the Netherlands
| | - S Sforza
- Paediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy
| | - M Hiess
- Department of Pediatric Urology, Hospital of the Sisters of Charity Linz, Austria
| | - E Bindi
- AOU Delle Marche, Ospedale Pediatrico G Salesi, Department of Pediatric Surgery, Ancona, Italy
| | - N Baydilli
- Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - M I Donmez
- Division of Pediatric Urology, Department of Urology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - I Paraboschi
- Department of Pediatric Urology, IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Atwa
- Urology Department, Urology and Nephrology Center, Mansoura University, Egypt
| | - A F Spinoit
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - B Haid
- Department of Pediatric Urology, Hospital of the Sisters of Charity Linz, Austria
| | - C Radmayr
- Department of Urology, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - M S Silay
- Department of Urology, Biruni University, Istanbul, Turkey
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16
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Herlihy E, Antao B, Fawaz A, McDermott J, Patterson K, Nason G, O'Kelly F. Adapting lean methodology towards surgical tray rationalisation in inguinoscrotal day case surgery in the republic of Ireland. J Pediatr Urol 2023:S1477-5131(23)00107-9. [PMID: 37029012 DOI: 10.1016/j.jpurol.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/13/2023] [Accepted: 03/16/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION Lean methodologies have been used successfully in both industry and healthcare to reduce waste. The operating room (OR) and central supplies department (CSD) are areas associated with high hospital costs. The aim of this study was to employ Lean methodologies to support the rationalisation of surgical trays in paediatric inguinoscrotal surgery in order to reduce instrument wastage, processing times and overall costs in a European setting. METHODS This was a prospective, pilot observation and implementation study using Lean methodology including DMAIC (Define, Measure, Analyse, Improve and Control) cycles. Relevant tray set-up included trays for boys ≥12 months age undergoing open elective inguinoscrotal surgery. A comparative analysis of two phases, pre and post-standardization was then carried out with respect to operating times, instrument set-up times, tray weights, and costs. Instruments that were used <40% of the time were eliminated from the surgical tray. RESULTS Rationalization of the inguinoscrotal tray led to a 34.7% reduction in tray size, with a concomitant time-reduction of >2 min per case. The average overall instrument utilisation rate increased from 56% to 80% across users. Cost savings were projected at €5380.40 per annum based on current changes. There were no differences in operative time, or adverse outcomes. DISCUSSION At the hospital level, the reduction in variation, and rationalisation of this single surgical tray could lead to both operational (Tray assembly process; Operating rooms; Ergonomic functionality) as well as economic (Sterilisation; Instrument repair; Purchases) financial and ergonomic improvements for the healthcare system. The reduction in time taken to count and sterilise instruments can lead to a potential manpower saving involving a redistribution of activities to other areas which may require them. CONCLUSION Surgical tray rationalisation is emerging Lean concept with overlap across a number of specialities, and represents a technique by which to manage costs, and improve supply chain efficiency without any adverse effect in patient healthcare outcomes.
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Affiliation(s)
- E Herlihy
- Division of Paediatric Surgical Services, Beacon Hospital and University College Dublin, Ireland
| | - B Antao
- Division of Paediatric Surgical Services, Beacon Hospital and University College Dublin, Ireland; Department of Paediatric Surgery, Childrens Health Ireland, Crumlin, Dublin, Ireland
| | - A Fawaz
- Division of Paediatric Surgical Services, Beacon Hospital and University College Dublin, Ireland
| | - J McDermott
- Division of Paediatric Surgical Services, Beacon Hospital and University College Dublin, Ireland
| | - K Patterson
- Department of Urological Surgery and Renal Transplantation, Beaumont Hospital, Dublin, Ireland
| | - G Nason
- Department of Urological Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - F O'Kelly
- Division of Paediatric Surgical Services, Beacon Hospital and University College Dublin, Ireland; Division of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland.
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Bhatia VP, Wolf J, Farhat WA, Lewis B, Gralnek DR, Eliceiri KW, O'Kelly F. External validation of a low fidelity dry-lab platform to enhance loupes surgical skills techniques for hypospadias repair. J Pediatr Urol 2022; 18:765.e1-765.e6. [PMID: 35644791 DOI: 10.1016/j.jpurol.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/22/2022] [Accepted: 04/30/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Hypospadias repair is an index pediatric urology procedure that requires trainee familiarity with surgical loupes. A previous low-fidelity, 6-step curriculum was proposed that deconstructed the most important steps of loupe surgery. We expanded on this curriculum with an intermediate-fidelity silicone hypospadias model and designed an abbreviated version of the 6-step curriculum to precede the hypospadias repair simulation. OBJECTIVE To assess the validity of our prior, low-fidelity conceptual model using the metric of improved performance on the intermediate-fidelity silicone hypospadias model. STUDY DESIGN A silicone model was first prototyped with the design software Solidworks™, and then fabricated using a cast made of a mixture of silicone rubbers designed to function like skin and soft tissue (Mold Star 20T, Dragon skin FX-pro and Slacker). Casts were used to create the penile shaft model and the dorsal hooded foreskin model. The urethral plate was cast separately on a flat surface. The model was then assembled by hand. The model used for simulation included the penile shaft and urethral plate, while the dorsal-hooded foreskin was prepared to simulate the penile anatomy separately. Trainees were then divided into two groups. Group 1 practiced the low-fidelity curriculum (3 tasks) and then performed dissection of the urethral plate and suturing using the intermediate-fidelity hypospadias model. Group 2 practiced hypospadias repair prior to the low-fidelity curriculum. Both groups' models were scored by 3 blinded urologists. Trainees were then asked to complete a post simulation satisfaction survey. Data analysis was performed in IBM SPSS Statistics for Macintosh (Version 28.0 Armonk, NY: IBM Corp). RESULTS Twenty-two candidates across Wisconsin, USA, and Dublin, Ireland participated in the study. This included 7 s-year residents, 9 third-year residents, 2 fourth-year residents, and 3 fifth-year residents. Both Groups 1 and 2 had a similar distribution of trainees (p = 0.60). Group 1 outperformed group 2 in all tasks (p < 0.05, Table 1). Trainees reported that the platform was very useful (91%). DISCUSSION Our curriculum showed improvement in trainee ability and comfort to perform hypospadias repair. Advantages of such a simulated curriculum include improving current resident training in microsurgery, improving surgical ergonomics for trainees prior to real-time experience, and decreasing the learning curve for trainees pursuing pediatric urology. CONCLUSION An intermediate-fidelity hypospadias platform externally validates the conceptual model implemented in the low-fidelity loupes curriculum. This appears to lead to improvement in loupe surgical skills regardless of trainee level.
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Affiliation(s)
- V P Bhatia
- Division of Pediatric Urology, Women and Children's Hospital, University of Wisconsin School of Medicine and Public Health, USA.
| | - J Wolf
- Department of Biomedical Engineering, University of Wisconsin-Madison College of Engineering, USA; Morgridge Institute for Research, Madison, WI, USA
| | - W A Farhat
- Division of Pediatric Urology, Women and Children's Hospital, University of Wisconsin School of Medicine and Public Health, USA
| | - B Lewis
- Division of Pediatric Urology, Women and Children's Hospital, University of Wisconsin School of Medicine and Public Health, USA
| | - D R Gralnek
- Division of Pediatric Urology, Women and Children's Hospital, University of Wisconsin School of Medicine and Public Health, USA
| | - K W Eliceiri
- Department of Biomedical Engineering, University of Wisconsin-Madison College of Engineering, USA; Morgridge Institute for Research, Madison, WI, USA
| | - F O'Kelly
- Division of Pediatric Urology, Women and Children's Hospital, University of Wisconsin School of Medicine and Public Health, USA; Division of Paediatric Urology, Beacon Hospital, University College Dublin, Ireland
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Yadav P, Erlich T, Zlotnik M, Khondker A, O'Kelly F, Traubici J, Chua ME, Koyle MA. Ultrasonographical features of perinatal testicular torsion: an assessment of interobserver variability among radiologists and pediatric urologists. Pediatr Surg Int 2022; 38:2053-2058. [PMID: 36261731 DOI: 10.1007/s00383-022-05260-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To retrospectively compare interpretations of Doppler ultrasound (US) in newborns with confirmed perinatal testicular torsion (PTT) by an experienced faculty (staff) pediatric radiologist (SPR), pediatric radiology fellow (PRF), pediatric urology fellow (PUF) and staff pediatric urologist (SPU). METHODS US images of 27 consecutive males with PTT between May 2000 and July 2020 were retrieved. The testicles were classified as affected or non-affected by PTT. We performed a blinded comparison of interpretation by four assessors (SPR, PRF, PUF, SPU), with respect to the US features of PTT. Paired inter-rater agreement was calculated using Cohen's Kappa (κ) and overall agreement was assessed using Fleiss' kappa. RESULTS Overall comparison using Fleiss' kappa found fair agreement for most features except testicular echogenicity and echogenic foci at interface for which there was poor agreement. Paired comparisons revealed better agreement between the SPR and PRF compared to the remaining two pairs, suggesting a need for the pediatric urologists (PUF and SPU) to acquaint themselves with testicular ultrasonography as this may have an impact on patient risk stratification and the quality of information given to parents. CONCLUSION This study highlights the need for focused training program for pediatric urologists to attain similar agreement as the radiologists, suggesting a need for the pediatric urologists (PUF and SPU) to acquaint themselves with testicular ultrasonography as this may have an impact on patient risk stratification and the quality of information given to parents.
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Affiliation(s)
- Priyank Yadav
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. .,Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| | - Tomer Erlich
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Margalit Zlotnik
- Division of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Adree Khondker
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Fardod O'Kelly
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Pediatric Urology, Beacon Hospital, Dublin, and School of Medicine, University College Dublin, Dublin, Ireland
| | - Jeffrey Traubici
- Division of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Michael E Chua
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines
| | - Martin A Koyle
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Das A, O'Kelly F, Wolf J, Hermes G, Wang M, Nemr C, Truscott S, Finnup J, Farhat W, Su R. Biofeedback therapy for children: What is the maximum number of sessions we should offer? J Pediatr Urol 2022:S1477-5131(22)00534-4. [PMID: 36944560 DOI: 10.1016/j.jpurol.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/02/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Biofeedback therapy is an effective but resource intensive treatment for pediatric dysfunctional voiding. Based on our center's experience, we evaluated the rate of clinical improvement from biofeedback in order to identify the maximum number of sessions to offer patients. METHODS We reviewed 490 pediatric patients who underwent at least 6 sessions of biofeedback from 2013 to 2021. At each session, patients and their parents documented their urinary symptoms (urgency, frequency, pain, and difficulties with stream), incontinence, medications, and stool pattern. This longitudinal data was abstracted, and the log odds of urinary symptoms or incontinence was modelled with number of sessions as a predictor using generalized estimating equations and robust standard errors in SAS v9.4. Gender and bowel dysfunction were included as interactions terms. A logistic regression using absence of urinary symptoms at last biofeedback session as a dependent variable was done to further explore differences between genders. RESULTS Patients were predominantly female (324/490, 66%) with a mean age of 8.9 years (SD 3.3 years). Most common symptoms at presentation were urinary urgency (389/490, 79%) and urinary incontinence (413/490, 84%). Medication use was common at the time of the first session (191/490, 39%) with males more likely to be on alpha-blockers (54/166 vs 1/324, p < 0.001) and females more likely to be on antibiotic prophylaxis (68/324 vs 2/166, p < 0.001). The probability of having urinary symptoms or incontinence decreased up to session 11 (9 months from initial visit). There was slower rate of improvement after session 8 (3 months). Controlling for age, symptoms, and medication use at initial visit, male patients were less likely to report symptom resolution at the time of the last session (OR 0.55, 95% CI 0.33, 0.89). The nadir for reporting symptoms occurred by session 22 for male patients, compared to session 10 for female patients. CONCLUSIONS Clinical improvement from biofeedback for pediatric patients with dysfunctional voiding may take up to 9 months of therapy, but most cases that improve do so by 3 months. The effect of gender on biofeedback efficacy requires further study, but males may have slower response to biofeedback. Our data provides guidance on when maximum benefit from biofeedback can be expected before considering re-evaluation or other therapies for lower urinary tract symptoms.
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Affiliation(s)
- Arighno Das
- Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Fardod O'Kelly
- Department of Urology, University College Dublin, Dublin, County Dublin, Ireland
| | - Josiah Wolf
- Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gabriella Hermes
- Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Muen Wang
- Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Clara Nemr
- Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sarah Truscott
- Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jennika Finnup
- Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Walid Farhat
- Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ruthie Su
- Division of Pediatric Urology, Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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20
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Erlich T, Ghazzaoui AE, Pokarowski M, O'Kelly F, Lorenzo AJ, Bagli DJ, Koyle MA. Perinatal testicular torsion: The clear cut, the controversial, and the "quiet" scenarios. J Pediatr Surg 2022; 57:288-297. [PMID: 34753560 DOI: 10.1016/j.jpedsurg.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/17/2021] [Accepted: 10/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perinatal testicular torsion (PTT) is a catastrophic event that occurs in utero or up to 30 days postnatally, with testicular loss being the most common outcome. OBJECTIVE To assess clinical evaluation, surgical management and clinical outcomes in patients with PTT in a quaternary referral pediatric center, to determine testicular salvageability and propose future management options. METHODS We retrospectively reviewed a cohort of males born outside the quaternary center with a diagnosis of PTT, from May 2000 to July 2020. Data collection included mode of delivery, gestational age, birth weight, testicular examination at birth, clinical presentation, ultrasound results at diagnosis, surgical management and findings, perioperative complications, and follow-up. RESULTS 62 patients, including 2 patients with bilateral asynchronous PTT, were identified. Median (IQR) gestational age and birth weight were 39 (38-39.4) weeks and 3.4 (3.1-3.72) kg, respectively. Abnormal testicular examination at birth was found in 69% (Table 1). Doppler ultrasound was performed in all but 1 patient. 59 patients underwent surgery, 21 within 4 h, with bilateral exploration in 44 cases. Affected and non-affected testicles were explored in 76% and 98% of cases, respectively. 3 "nubbins" were found, of which 2 were excised. 3 nonsurgical complications were identified. During a median (IQR) follow-up of 3 (3-3) months, 63 testicles were removed or found to be non-functional, with compensatory hypertrophy in 38% of patients. CONCLUSION Given that 3% of our patients presented with asynchronous bilateral PTT, as well as the safety of general anesthesia in a referral pediatric hospital, early bilateral scrotal exploration of PTT is recommended. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tomer Erlich
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Surgery, University of Toronto, Toronto, Canada.
| | - Ali El Ghazzaoui
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | - Martha Pokarowski
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
| | - Fardod O'Kelly
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Pediatric Urology, Beacon Hospital, Dublin, and School of Medicine, University College Dublin, Ireland
| | - Armando J Lorenzo
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | - Darius J Bagli
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Surgery, University of Toronto, Toronto, Canada
| | - Martin A Koyle
- Division of Pediatric Urology, The Hospital for Sick Children, SickKids, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Surgery, University of Toronto, Toronto, Canada
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21
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Haid B, Tack LJW, Spinoit AF, Weigl C, Steinkellner L, Gernhold C, Banuelos B, Sforza S, O'Kelly F, Oswald J. Being born small for gestational age (SGA) might be associated with a higher reoperation rate in proximal hypospadias. J Pediatr Urol 2022; 18:609.e1-609.e11. [PMID: 36075827 DOI: 10.1016/j.jpurol.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 07/16/2022] [Accepted: 08/16/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Being born small for gestational age (SGA) is associated with a higher frequency and more severe forms of hypospadias as well as with potential developmental differences. This study aims to characterize operative outcomes in SGA boys compared to boys born with normal weight and length for gestational age (appropriate/large for gestational age, AGA/LGA). METHODS Demographic data, hypospadias characteristics, associated pathologies and operative outcomes of boys who underwent hypospadias repair at a single center (10/2012-10/2019) were evaluated. Boys were categorized into SGA and non-SGA, which were then compared using unpaired t-tests and chi square tests. To examine the effect of SGA on reoperative risk, a logistic regression model was applied integrating surgical technique, meatal localization and complex hypospadias (narrow glans/plate, curvature, micropenis, bilateral cryptorchidism). RESULTS SGA boys accounted for 13.7% (n = 80) of the total cohort (n = 584) and 33% of all proximal hypospadias (n = 99, SGA vs. non-SGA 41.3% vs. 13%, p < 0.001). After a mean follow-up of 18.6 months the reoperation rate for all hypospadias was 17.9% (n = 105). In distal hypospadias there was no difference in reoperation rate between SGA and AGA/LGA boys (p = 0.548, multivariate regression model). For each meatal localization in proximal hypospadias SGA was a significant, independent factor predicting higher reoperation rates (p = 0.019, OR 3.21) in a logistic regression model (Figure ROC). DISCUSSION Hypospadias surgery carries a substantial risk for unplanned reinterventions. Apart from meatal localization, there are only a few factors (urethral plate quality, glandular diameter, curvature) reported in literature to be associated with reoperative risk. Intrauterine growth retardation associated with SGA might lead to not only a higher probability of proximal hypospadias but also contribute to a higher risk for complications mediated by developmental differences. Whether these findings could help to tailor surgical strategies or adjuvant measures, as for example the application of preoperative hormonal stimulation remains to be determined in future studies. This study is limited by being a single-center series with limited follow-up resulting in some complications probably not yet detected - however, in the same extent in both groups. CONCLUSION Based on this study, 33% of all proximal hypospadias cases occur in boys born SGA. While the reoperation rate in boys with distal hypospadias was not influenced by SGA status, SGA proved to be an independent predictor of a higher risk of reoperation in those with proximal hypospadias. After validation of these findings in other centers, this could be integrated into counseling and risk-stratification.
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Affiliation(s)
- Bernhard Haid
- Department of Paediatric Urology, Ordensklinikum Linz Hospital of the Sisters of Charity, Linz, Austria.
| | - Lloyd J W Tack
- Department of Internal Medicine and Paediatrics, Division of Paediatric Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Anne-Françoise Spinoit
- Division of Paediatric Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Chiara Weigl
- Department of Paediatric Urology, Ordensklinikum Linz Hospital of the Sisters of Charity, Linz, Austria
| | - Lukas Steinkellner
- Department of Paediatric Urology, Ordensklinikum Linz Hospital of the Sisters of Charity, Linz, Austria
| | - Christa Gernhold
- Department of Paediatric Urology, Ordensklinikum Linz Hospital of the Sisters of Charity, Linz, Austria
| | - Beatriz Banuelos
- Department of Urology, Charite Universitätsmedizin, Berlin, Germany
| | - Simone Sforza
- Department of Pediatric Urology, University of Florence, Meyer Children Hospital, Florence, Italy
| | - Fardod O'Kelly
- Departments of Urology and Pediatric Surgery, Beacon Hospital, Dublin, Ireland; University College Dublin, School of Medicine and Medical Science, Dublin, Ireland
| | - Josef Oswald
- Department of Paediatric Urology, Ordensklinikum Linz Hospital of the Sisters of Charity, Linz, Austria
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22
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Zu'bi F, O'Kelly F, Farhat WA, Chua M, Shiff M, Gao B, Kim JK, Kutbi RA, Pokarowski M, Koyle MA. Recurrent UPJ obstruction following paediatric pyeloplasty is associated with an initial <2.5cm incision open surgical approach. Urology 2022:S0090-4295(22)00721-X. [PMID: 36002089 DOI: 10.1016/j.urology.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 07/12/2022] [Accepted: 08/08/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To determine the risk factors that affect surgical outcomes for pediatric pyeloplasty, and whether this may be related to the choice of operative approach. METHODS A retrospective cohort study was performed to evaluate clinicodemographic and operative characteristics of children undergoing dismemberment pyeloplasty by 2 senior pediatric urologists in our tertiary institution between Jan 2008 - Dec 2017. Outcomes included overall complications, re-stenosis, and revision pyeloplasty based on clinic-radiological parameters. Bivariate analysis with Chi-square and Mann-Whitney U test followed by multivariate logistic regression with backward likelihood analysis determined an adjusted effect estimate of the identified significant indicators for inferior peri-operative outcomes related to management. RESULTS A total of 185 (93 open, 92 Laparoscopic) cases with an average follow-up of 31.3±27.4 months were analyzed. Complications occurred in 21 (11.4%) patients. 12 (6.5%) experienced recurrent UPJ obstruction with 10 (5.4%) undergoing redo-pyeloplasty. Of these, 9 were performed open and 1 laparoscopically. Multivariate logistic regression identified open pyeloplasty as an independent predictor for overall complications (HR 3.29, 95%CI 1.14, 9.51), recurrent UPJ obstruction (HR 49.8, 95%CI 3.09, 803.2) and redo-pyeloplasty (HR 9.75, 95%CI 1.21, 78.6) compared to a laparoscopic approach. Missed crossing vessels were identified in seven redo-cases, which all were from prior open pyeloplasty. CONCLUSIONS An initial open approach was identified as an independent predictor of future complications due to a higher incidence missed crossing vessels at initial repair. Surgeons need to remain especially mindful of this phenomenon when working in a confined open field.
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Affiliation(s)
- Fadi Zu'bi
- Department of Urology, Rambam Health Care Campus, Haifa, Israel; Department of Urology, The Nazareth Hospital EMMS, Nazareth, Israel.
| | - Fardod O'Kelly
- Division of Paediatric Urology, Beacon Hospital, Royal College of Surgeons in Ireland & University College Dublin, Ireland.
| | - Walid A Farhat
- Division of Pediatric Urology, Department of Urology, University of Wisconsin, Madison, USA.
| | - Michael Chua
- Division of Urology, Department of Surgery, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
| | - Mitchell Shiff
- Division of Urology, Department of Surgery, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
| | - Bruce Gao
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
| | - Jin Kyu Kim
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
| | - Rusul Al Kutbi
- Division of Urology, Department of Surgery, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
| | - Martha Pokarowski
- Division of Urology, Department of Surgery, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
| | - Martin A Koyle
- Division of Urology, Department of Surgery, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
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23
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Sherrer R, Su R, O'Kelly F, Borza T, Byrne A, Finup J, Farhat W. A Prospective Analysis of Opioid Use Following Outpatient Pediatric Urologic Surgery. Urology 2022; 168:183-188. [PMID: 35853508 DOI: 10.1016/j.urology.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To examine our outpatient urologic surgery cohort for trends in opioid consumption, given the lack of consensus on opioid prescription after outpatient urologic procedures. While opioids have a role in multimodal post-operative analgesia, there is emerging data that they may not be routinely required after pediatric surgery. METHODS Data on opioid use was prospectively collected over 16 months via post-operative telephone calls to caregivers of patients undergoing outpatient urologic surgery. Patient characteristics, surgery type, analgesia, and opioid prescription and usage information were recorded. Patients were prescribed as needed oxycodone and scheduled acetaminophen and ibuprofen for 48 hours, then as needed. The relationships between the log mean of the number of opioid doses used and age, type of surgery, race, and opioid prescription were modelled using negative binomial regression with robust standard errors. RESULTS 265 patients were included. They were predominantly male with median age 2.6 years. The mean number of opioid doses prescribed per patient was 5.8 (SD 2.8, range 3-20). Over half of patients used no opioids, and mean opioid use was one dose. Those prescribed >5 doses took on average 3.4 times more doses compared to those prescribed >5 (p=0.0003), and this was the only factor significantly associated with amount of opioid used. CONCLUSIONS Our findings suggest that opioids are over-prescribed after outpatient pediatric urologic surgery, with 95% of patients having leftover medication and 54% not using any opioids at all. While opioid requirements were low across all sub-cohorts, patients who were prescribed more opioid doses used significantly more doses.
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Affiliation(s)
- Rachael Sherrer
- Department of Urology, University of Wisconsin, Madison, WI.
| | - Ruthie Su
- Department of Urology, University of Wisconsin, Madison, WI.
| | - Fardod O'Kelly
- Division of Paediatric Urology, Beacon Hospital Dublin & University College Dublin, Ireland.
| | - Tudor Borza
- Department of Urology, University of Wisconsin, Madison, WI; Wisconsin Surgical Outcome Research Program, Madison, WI.
| | - Ann Byrne
- Department of Urology, University of Wisconsin, Madison, WI.
| | - Jennika Finup
- Department of Urology, University of Wisconsin, Madison, WI.
| | - Walid Farhat
- Department of Urology, University of Wisconsin, Madison, WI.
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24
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O'Sullivan NJ, Nason G, Manecksha RP, O'Kelly F. The unintentional spread of misinformation on 'TikTok'; A paediatric urological perspective. J Pediatr Urol 2022; 18:371-375. [PMID: 35331640 DOI: 10.1016/j.jpurol.2022.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/26/2022] [Accepted: 03/01/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION 'TikTok' is a social media application based on the publication of short videos that has accumulated over 1.1 billion users worldwide since its launch in 2016. With the use of 'TikTok' on the rise, there is an increasing tendency for patients or family members to seek medical information online. OBJECTIVE We aim to assess the authenticity of information being spread on 'TikTok' on common paediatric urological presentations by comparison to current up to date guidelines provided by the European Association of Urology (EAU). MATERIALS AND METHODS A search for a variety of paediatric urology conditions was performed on 'TikTok'. Videos were subsequently screened based on strict pre-defined criteria. The content and claims of each video were compared to up-to-date guidelines to reveal whether or not they complied with standards set by the European Association of Urology (EAU). Information that correlated with that of the guidelines was then further classified by Oxford levels of evidence. RESULTS 27 videos met our criteria with a combined total of 6,578,863 views, 308,700 likes and 5782 comments. Only 22.2% of videos contained information that can also be found in guidelines provided by the EAU. None of the included videos contained any cited evidence to reinforce statements that were being made. DISCUSSION Misinformation lacking scientific evidence has been reported has been reported for various conditions on 'TikTok'. Patients, family members or caregivers without a medical background can have difficult verifying and ensuring the credibility of information posted on social media. CONCLUSION The evolution of 'TikTok' has allowed the layperson to create content that can potentially reach millions of users worldwide. This study demonstrated that 'TikTok' can be used as a resource for health information, however is currently a pit of misinformation with the potential to cause harm to the user.
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Affiliation(s)
| | - Greg Nason
- Dept. of Urology, Mater Misericordae University Hospital, Dublin, Ireland
| | - Rustom P Manecksha
- Dept. of Urology, Tallaght University Hospital, Dublin, Ireland; Dept. of Urology, Beacon Hospital, Dublin, Ireland; Dept. of Surgery, Trinity College Dublin, Dublin, Ireland
| | - Fardod O'Kelly
- Dept. of Urology, Beacon Hospital, Dublin, Ireland; Dept. of Surgery, University College Dublin, Dublin Ireland
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25
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O'Kelly F, T' Hoen L, Banuelos B, Lammers R, Radford A, Sforza S, Hiess M, Bindi E, Spinoit AF, Silay M, Haid B. Pathways and perceived barriers to paediatric urology subspecialisation: A study of incumbent attitudes and opinions. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01140-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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26
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Carmen Mir M, Greenwell T, O'Kelly F, Proietti S, Laukhtina E, Mertens L, Morgenstern S, Ouzaid I. Reply to Laurence Klotz's Letter to the Editor re: Jeremy Yeun-Chun Teoh, Daniele Castellani, Claudia Mercader, et al. A Quantitative Analysis Investigating the Prevalence of "Manels" in Major Urology Meetings. Eur Urol 2021;80:442-9. Eur Urol 2021;80:e100: Reply from the European Association of Urology Equity, Diversity, and Inclusion Task Force. Eur Urol 2021; 81:e26-e27. [PMID: 34772550 DOI: 10.1016/j.eururo.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/06/2021] [Indexed: 11/30/2022]
Affiliation(s)
- M Carmen Mir
- Department of Urology, Fundacion Instituto de Valenciano Oncologia, Valencia, Spain.
| | | | - Fardod O'Kelly
- Division of Paediatric Urology, Beacon Hospital & University College Dublin, Dublin, Ireland
| | - Silvia Proietti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Laura Mertens
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Saskia Morgenstern
- Department of Urology, Agaplesion Markus-Krankenhaus, Frankfurt, Germany
| | - Idir Ouzaid
- Department of Urology, Hôpital Bichat-Claude Bernard, Paris, France
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27
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Serrell EC, Su R, O'Kelly F, Semanik M, Farhat WA. The utility of native ureter in the management of ureteral complications in children after renal transplantation. Pediatr Transplant 2021; 25:e14051. [PMID: 34056809 DOI: 10.1111/petr.14051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/26/2021] [Accepted: 03/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ureteral complications after renal transplantation in children are a major source of morbidity. Management is complex and variable. METHODS With IRB approval, health records were retrospectively reviewed of patients who: were <18 years, underwent kidney transplant between 1997 and 2017, had at least 2 years of follow-up, and underwent interventions due to post-transplant ureteral complications. RESULTS Of 136 patients, seventeen (13%) required ureteral intervention due to stricture (n = 3), reflux (n = 12), or both (n = 2). Transplant occurred at median 10.5 years (3.1-14.7). Reconstruction occurred at median 10 months (7-15) after transplant. Pre-existing bladder pathology was present in 6 (35%) patients. Four of five patients with strictures had at least one endoscopic balloon dilation. Ultimate management included reimplantation, ureteroureterostomy of native to transplant ureter, pyeloureterostomy to native ureter, multiple endoscopic interventions followed by a Boari flap, or multiple failed endoscopic interventions. Fourteen patients with VUR underwent reimplantation (n = 5), ureteroureterostomy of native to transplant ureter (n = 4), pyeloureterostomy to native ureter (n = 4), and one underwent endoscopic injection with Deflux of the transplant ureter. Only one patient had a non-functioning graft due to ureteral complication. All patients were alive at follow-up (median 17 years [12-19]). CONCLUSIONS Transplant ureteral reflux and stricture are significant complications following pediatric renal transplantation and may require surgical management. In our population, reflux or stricture requiring ureteral reconstruction occurred in 10% and 4%, respectively. Endoscopic interventions were rarely successful. Native ureters were used for ureteral reconstruction in more than two thirds of patients should be considered in management of ureteral complications.
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Affiliation(s)
| | - Ruthie Su
- University of Wisconsin, Madison, WI, USA
| | - Fardod O'Kelly
- University of Wisconsin, Madison, WI, USA.,University College Dublin, Dublin, Ireland
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28
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O'Kelly F, Lorenzo AJ, Zubi F, De Cotiis K, Farhat WA, Koyle MA. The impact of multiple donor renal arteries on perioperative complications and allograft survival in paediatric renal transplantation. J Pediatr Urol 2021; 17:541.e1-541.e11. [PMID: 33883096 DOI: 10.1016/j.jpurol.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 01/21/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The impact of using allografts with multiple renal arteries in paediatric kidney transplantation has not been clearly established. The aim of this study was to determine whether kidney grafts with multiple arteries pose any adverse effects upon perioperative surgical outcomes, and graft survival up to 12 months post-transplant. OBJECTIVE The objective of this study was to perform a comparative analysis of a minimum of 12-month graft survival and transplant renal function in paediatric renal transplant recipients receiving single versus multiple donor arteries, and to assess perioperative and early post-operative surgical outcomes. STUDY DESIGN A retrospective divisional chart review of 379 transplants performed (2000-2018), of which 90 (23.7%) contained multiple donor arteries. The number of arteries of the graft, donor type, vascular reconstruction technique, occurrence of urological and vascular complications, estimated GFR and graft survival up to 12 months post-transplantation, graft loss and mortality were analysed. Comparisons in baseline characteristics and outcome measures were made between both groups. RESULTS No significant differences were found in age (p = 0.42), BMI (p = 0.39), estimated intraoperative blood loss (p = 0.14), overall (p = 0.63) or warm ischaemic time (p = 0.37). 51.3% patients with multiple donor arteries underwent an ex vivo reconstruction. There were no differences in the site of arterial anastomosis (aorta, external iliac, internal iliac), or anastomotic type (end-side; end-end). Whilst there was a significantly higher post-operative lymphocoele rate in the multiple vessel cohort (p = 0.024), there was no increase in post-transplant urine leaks, rejection episodes, graft loss (1.1% multiple vs 2.1% single), perioperative complications (p = 0.68), or estimated GFR at 1 month (p = 0.9) or at 1 year (p = 0.67). DISCUSSION We demonstrated in this study that there was no significant difference in postoperative complications up to 3 months, eGFR and renal function up to 1 year, and graft survival up to 4 years post transplantation irrespective of allograft type or reconstruction technique. There was however, a higher rate of lymphocoeles in the multiple artery cohort. The results seen here broadly mirror trends seen in adult studies, however, there is little data available from paediatric series. CONCLUSION Our study demonstrates that multiple renal artery allografts - previously been considered to carry a high complication risk - can be safely used for paediatric renal transplantation with equivalent perioperative complications and graft outcomes to single artery allografts.
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Affiliation(s)
- F O'Kelly
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada; Division of Paediatric Urology, Beacon Hospital, University College, Dublin, Ireland.
| | - A J Lorenzo
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada
| | - F Zubi
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada
| | - K De Cotiis
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada; Division of Pediatric Urology, Neymours/duPont Childrens Hospital, Delaware, USA
| | - W A Farhat
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada; Division of Pediatric Urology, American Family Childrens Hospital, Wisconsin, USA
| | - M A Koyle
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada
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Rebullar K, O'Kelly F, Koyle MA, Kirsch A, Al-Kutbi R, Zu'bi F. A systematic review of outcomes of Deflux® treatment for vesicoureteral reflux following pediatric renal transplantation. J Pediatr Urol 2021; 17:589.e1-589.e6. [PMID: 34364813 DOI: 10.1016/j.jpurol.2021.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 06/26/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Vesicoureteral reflux (VUR) after renal transplant in the pediatric population may be associated with an increased incidence of urinary tract infection (UTIs) leading to increased morbidity, including graft dysfunction and graft loss. The non-orthotopic location of the transplanted ureter, and lack of submucosal tunnel may pose challenges in correcting the VUR using endoscopic injection techniques. Herein we report the results of a systematic review evaluating the outcomes of endoscopic treatment of VUR using Deflux® in this population. METHODS Pubmed and Embase databases were searched from October 2001 to April 2019. Full-text English articles involving patients less than 18 years old at the time of transplant, with a diagnosis of VUR post-transplantation, who underwent Deflux® treatment were included. Figure 1 outlines our PRISMA-compliant search strategy. RESULTS We found 6 eligible studies describing Deflux® treatment outcomes in 67 pediatric patients with post-transplant VUR where voiding cystourethrogram (VCUG) confirmed the diagnosis and resolution of VUR. The mean success rate was 36.8%. Ureteral obstruction occurred in 7/67 cases (10.4%). In all these 7 cases of obstruction, ureteric stenting was the initial management, but was only successful in 1 patient. Open ureteroneocystostomy (UNC) was performed in 4/7 cases, while 2/7 were managed expectantly (unknown outcomes). Persistent VUR with UTI despite Deflux® were reported in 20 out of 67 cases. Of these, 7 were managed with prophylactic antibiotics, and 13 with UNC. Success rates were consistently low for UNC after failed Deflux® in comparison to redo UNC in transplant ureters without prior injection. CONCLUSION Low success rates are seen following injection techniques for VUR after pediatric renal transplant. Although an appealing option, Deflux® may prove counterintuitive due to the high rate of obstruction and suboptimal results if open reimplantation is required. A multi-institutional prospective study with a larger population size may further elucidate these results.
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Affiliation(s)
- Karla Rebullar
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Fardod O'Kelly
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Martin A Koyle
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Andrew Kirsch
- Department of Pediatric Urology, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Rusul Al-Kutbi
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Fadi Zu'bi
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Urology, Rambam Health Care Campus, Haifa, Israel; Department of Urology, The Nazareth Hospital EMMS, Nazareth, Israel.
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Affiliation(s)
- Fardod O'Kelly
- Division of Pediatric Urology, The Hospital for Sick Children, Toronto, Ontario, Canada; Departments of Urology and Pediatric Surgery, Beacon Hospital, Dublin, Ireland; University College Dublin, School of Medicine and Medical Science, Dublin, Ireland
| | - Martin A Koyle
- Division of Pediatric Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Koven A, O'Kelly F, El-Ghazzaoui A, Langer JC, Levin D, Diamond A, Goldstein Y, Reichman E, Koyle MA. Bringing Jewish Ritual circumcision (Brit Milah) Into the Operating Room: An Analysis of Surgical Outcomes and Satisfaction Across Families and Society of Pediatric Urology members. Urology 2021; 154:243-248. [PMID: 33482127 DOI: 10.1016/j.urology.2020.12.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/30/2020] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess caregiver satisfaction, procedural outcomes and practitioner opinion regarding a novel program designed for patients to undergo a deferred Jewish ritual circumcision (Brit Milah) in the operating room (OR), combined with other indicated surgical procedures. METHODS All patients undergoing Brit Milah in the OR at our institution between 2013 and 2019 were included. Surveys were administered to assess caregiver satisfaction and Society for Pediatric Urology member practice patterns. A retrospective case-control series was completed to compare complication rates and operative times for procedures with and without Brit Milah. RESULTS Forty-four intraoperative Brit Milah patients were identified. The mean procedure time for a distal hypospadias repair with Brit Milah was 66.0 minutes, compared to 62.4 minutes without (P = .57). No complications were attributable to the addition of Brit Milah. The caregiver survey had a 100% response rate. The modal response for satisfaction with the perioperative experience was 5 of 5 (ie, highly satisfied), with 100% of respondents very likely to recommend the program. 132 active Society for Pediatric Urology members responded to the survey (34.1% response rate) with 44% regularly allowing Brit Milah in the OR at their institution. 90.5% received positive caregiver feedback and 64% believe it is important to offer. CONCLUSION This novel program incorporating Brit Milah into the OR yields high caregiver satisfaction, no additional OR time or postoperative complications, and provides an opportunity to combine family-centered care with cultural competence.
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Affiliation(s)
- Alexander Koven
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| | - Fardod O'Kelly
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ali El-Ghazzaoui
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jacob C Langer
- Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David Levin
- Department of Anesthesiology and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aubie Diamond
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Ontario, Canada; Abraham Diamond Medicine Professional Corporation, Toronto, Ontario, Canada
| | - Yisroel Goldstein
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Ontario, Canada; Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ezriel Reichman
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Ontario, Canada; Division of General and Thoracic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Martin A Koyle
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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O'Kelly F, Pokarowski M, DeCotiis KN, McDonnell C, Milford K, Koyle MA. Structured opioid-free protocol following outpatient hypospadias repair - A prospective SQUIRE 2.0-compliant quality improvement initiative. J Pediatr Urol 2020; 16:647.e1-647.e9. [PMID: 32713791 DOI: 10.1016/j.jpurol.2020.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/29/2020] [Accepted: 06/12/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prescription opioids have been extensively to manage postoperative pain in children. A growing body of evidence from the adult literature, suggests however, that healthcare providers may be prescribing far more opioids than required, with some studies demonstrating equivalent post-operative pain and clinical outcomes with their omission. OBJECTIVE The objectives of this prospective study were to assess the current heterogeneity of practice in post-operative opioids prescription following day case hypospadias surgery, to establish a streamlined discharge protocol, and to reduce the use of post-operative opioid prescription by 30% within a 4 month period through the use of systemic forcing functions and education. STUDY DESIGN This prospective study was approved by the Quality Improvement (QI) sub-committee of the hospital's Research and Ethics Board (REB) and was compliant with the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines. Recruited parents (n = 84) were contacted for telephone interview following a combined intervention of education and omission of post-operative opioids from the discharge prescription. A mixture of qualitative and quantitative techniques were employed including an initial process analysis to assess current opioid use, the creation of balancing measures, and the creation of Plan-Do-Study-Act cycles. Age, procedure, post-operative outcomes and opioid prescription data were recorded over a period of 6 months in 2019. RESULTS Initial measures in our process analysis demonstrated significant institutional practice variation amongst our 84 post-intervention patients. Our process and fidelity measures confirmed 100% information provision. Following the point of intervention, there was a significant and sustained drop in opioid prescription, with an absolute reduction of 35%, and a relative reduction of 56%. There was no significant difference in patient age, pain scores, or outcomes pre- and post-intervention. DISCUSSION We have shown in this study that a sustainable decrease in post-operative opioid prescriptions following hypospadias surgery is possible. We managed to achieve a relative reduction 56% which is comparable to other specialties, however, did it within a quality improvement framework to ensure fidelity and no adverse balancing measures. We also managed to reduce the number of doses prescribed in those receiving opioids post-intervention at week 9. CONCLUSION Our study demonstrates opioids can be safely omitted in hypospadias cohorts without any adverse clinical outcomes or balancing measures. We recommend that opioids be used extremely judiciously in this population in order to minimize exposure in children.
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Affiliation(s)
- F O'Kelly
- Division of Pediatric Urology, The Hospital for Sick Children, Toronto, Canada; Centre for Quality Improvement and Patient Safety (C-QuIPS), University of Toronto, Toronto, Canada.
| | - M Pokarowski
- Division of Pediatric Urology, The Hospital for Sick Children, Toronto, Canada
| | - K N DeCotiis
- Division of Pediatric Urology, The Hospital for Sick Children, Toronto, Canada; Centre for Quality Improvement and Patient Safety (C-QuIPS), University of Toronto, Toronto, Canada
| | - C McDonnell
- Department of Anaesthesiology and Pain Medicine, The Hospital for Sick Children, Toronto, Canada
| | - K Milford
- Division of Pediatric Urology, The Hospital for Sick Children, Toronto, Canada; Department of Anaesthesiology and Pain Medicine, The Hospital for Sick Children, Toronto, Canada
| | - M A Koyle
- Division of Pediatric Urology, The Hospital for Sick Children, Toronto, Canada; Centre for Quality Improvement and Patient Safety (C-QuIPS), University of Toronto, Toronto, Canada
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O'Kelly F, Sparks S, Seideman C, Gargollo P, Granberg C, Ko J, Malhotra N, Hecht S, Swords K, Rowe C, Whittam B, Spinoit AF, Dudley A, Ellison J, Chu D, Routh J, Cannon G, Kokorowski P, Koyle M, Silay MS. A survey and panel discussion of the effects of the COVID-19 pandemic on paediatric urological productivity, guideline adherence and provider stress. J Pediatr Urol 2020; 16:492.e1-492.e9. [PMID: 32680626 PMCID: PMC7334656 DOI: 10.1016/j.jpurol.2020.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/12/2020] [Accepted: 06/19/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has led to an unprecedented need to re-organise and re-align priorities for all surgical specialties. Despite the current declining numbers globally, the direct effects of the pandemic on institutional practices and on personal stress and coping mechanisms remains unknown. The aims of this study were to assess the effect of the pandemic on daily scheduling and work balances, its effects on stress, and to determine compliance with guidelines and to assess whether quarantining has led to other areas of increased productivity. METHODS A trans-Atlantic convenience sample of paediatric urologists was created in which panellists (Zoom) discussed the direct effects of the COVID-19 pandemic on individual units, as well as creating a questionnaire using a mini-Delphi method to provide current semi-quantitative data regarding practice, and adherence levels to recently published risk stratification guidelines. They also filled out a Perceived Stress Scale (PSS) questionnaire to assess contemporary pandemic stress levels. RESULTS There was an 86% response rate from paediatric urologists. The majority of respondents reported near complete disruption to planned operations (70%), and trainee education (70%). They were also worried about the effects of altered home-lives on productivity (≤90%), as well as a lack of personal protective equipment (57%). The baseline stress rate was measured at a very high level (PSS) during the pandemic. Adherence to recent operative guidelines for urgent cases was 100%. CONCLUSION This study represents a panel discussion of a number of practical implications for paediatric urologists, and is one of the few papers to assess more pragmatic effects and combines opinions from both sides of the Atlantic. The impact of the pandemic has been very significant for paediatric urologists and includes a decrease in the number of patients seen and operated on, decreased salary, increased self-reported stress levels, substantially increased telemedicine usage, increased free time for various activities, and good compliance with guidelines and hospital management decisions.
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Affiliation(s)
- Fardod O'Kelly
- Division of Paediatric Urology, The Hospital for Sick Children, Toronto, Canada.
| | - Scott Sparks
- Division of Pediatric Urology, Children's Hospital of Los Angeles, CA, USA
| | - Casey Seideman
- Division of Pediatric Urology, OHSU Doernbecher Children's Hospital, Portland, OR, USA
| | | | | | - Joan Ko
- Division of Pediatric Urology, Children's Hospital of Los Angeles, CA, USA
| | | | - Sarah Hecht
- Division of Pediatric Urology, Children's Hospital Colorado, USA
| | - Kelly Swords
- Division of Pediatric Urology, Rady Children's Hospital, San Diego, CA, USA
| | - Courtney Rowe
- Division of Pediatric Urology, Connecticut Children's Hospital, USA
| | - Ben Whittam
- Division of Pediatric Urology, Riley Children's, Indianapolis, IN, USA
| | | | - Anne Dudley
- Division of Pediatric Urology, Connecticut Children's Hospital, USA
| | | | - David Chu
- Division of Pediatric Urology, Lurie Children's Chicago, IL, USA
| | - Jonathan Routh
- Division of Urologic Surgery, Duke University Medical Centre, NC, USA
| | - Glenn Cannon
- Division of Pediatric Urology, University of Pittsburgh Medical Centre, PA, USA
| | - Paul Kokorowski
- Division of Pediatric Urology, Children's Hospital of Los Angeles, CA, USA
| | - Martin Koyle
- Division of Paediatric Urology, The Hospital for Sick Children, Toronto, Canada
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Milford K, O'Kelly F, Koyle MA. Dr. Robert Douglas Jeffs (1924-2006) - A founding father of North American pediatric urology. Can Urol Assoc J 2020; 14:E169-E172. [PMID: 32369011 PMCID: PMC7197970 DOI: 10.5489/cuaj.6573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Karen Milford
- Division of Pediatric Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Fardod O'Kelly
- Division of Pediatric Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Martin A Koyle
- Division of Pediatric Urology, The Hospital for Sick Children, Toronto, ON, Canada
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O'Kelly F, DeCotiis K, Aditya I, Braga LH, Koyle MA. Assessing the methodological and reporting quality of clinical systematic reviews and meta-analyses in paediatric urology: can practices on contemporary highest levels of evidence be built? J Pediatr Urol 2020; 16:207-217. [PMID: 31917158 DOI: 10.1016/j.jpurol.2019.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/03/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Systematic reviews and meta-analyses provide a comprehensive summary of research studies and are used to assess clinical evidence, form policy and construct guidelines. This is pertinent to childhood surgery with issues of consent and condition prevalence. The aims of this study were to evaluate the methodological and reporting quality of these reviews and to identify how these reviews might guide clinical practice amongst those conditions most commonly encountered and managed by practicing paediatric urologists. METHODS A systematic search of the English literature was performed to identify systematic reviews and meta-analyses focusing on clinical paediatric urology (1/1/1992-1/12/2018) to include common paediatric urological conditions managed by paediatric urology residents/fellows. To these reviews, Assessing the Methodological Quality of Systematic Reviews (AMSTAR)-2 and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) scores were applied. Univariate linear regression and descriptive statistical methods were performed. RESULTS From an initial literature review of 1723 articles, 227 were included in the analysis. Inter-reviewer agreement was high amongst 3 independent reviewers (κ = 0.92). Eighty-four percent of systematic reviews and meta-analyses were published since 2009 following publication of the PRISMA guidelines. The overall impact factor was 3.38 (0.83-17.58), with adherence to AMSTAR-2 criteria 48.46% and PRISMA criteria 70.1%. From a methodological perspective, 15% of reviews were of moderate quality, 65% were of low quality and 20% reviews were of critically low quality, with none found to have good quality reporting. CONCLUSIONS Despite the continued increase of systematic reviews and meta-analyses in paediatric urology from which many guidelines are based, a significant number of reviews contain poor methodology and, to a lesser extent, poor reporting quality. Journals should consider having specific 'a priori' criteria based on checklists before publication of manuscripts to ensure the highest possible reporting quality.
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Affiliation(s)
- F O'Kelly
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - K DeCotiis
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - I Aditya
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - L H Braga
- Division of Urology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - M A Koyle
- Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Kim JK, Koyle MA, Lee MJ, Nason GJ, Ren LY, O'Kelly F. A systematic review of genitourinary injuries arising from rugby and football. J Pediatr Urol 2020; 16:130-148. [PMID: 32029358 DOI: 10.1016/j.jpurol.2019.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 12/25/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Genitourinary injuries in athletes engaging in high-impact sports such as football and rugby may have catastrophic consequences, especially in individuals with pre-existing urologic concerns, such as a solitary kidney. OBJECTIVE To summarize the current literature on football-related or rugby-related genitourinary organ injuries in both adult and pediatric populations in an effort to risk stratify the likelihood of these injuries. METHODS An independent systematic literature search for records reporting football-related or rugby-related injuries was conducted by a certified librarian and reviewer in March 2019. The search electronic databases included Medline, EMBASE, Scopus, and Web of Science. All studies reporting football-related or rugby-related genitourinary injuries were included. RESULTS Twenty-two records (11 research studies, 11 case reports) were identified. In the pediatric population, the reported football-related kidney injuries were 0.1-0.7% of all football-related injuries, 0.07-0.5% of all sports-related injuries, and 1.5-37.5% of all sports-related genitourinary injuries, with incidence ranging from 0.00000084 to 0.0000092 injuries per exposure (five studies). Pediatric football-related testicular injuries were reported to be 0.11% of all football injuries, 0-0.07% of all sports-related injuries, and 0-37.5% of all sports-related genitourinary injuries; injury per exposure was 0.0000092 (four studies). In adults, there was no proportion of genitourinary injuries that could be determined, and football-related kidney injury incidence was 0.000012 injuries per exposure (one study). No adult literature investigated testicular injuries. Eleven case reports were additionally identified. Review of the case reports suggests that patients with previously existing urologic abnormalities such as ureteropelvic junction obstruction may predispose an individual to kidney injuries. CONCLUSION There is little to suggest that those engaged in football or rugby have a significant risk of genitourinary injury; therefore, future guidelines should reflect this.
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Affiliation(s)
- Jin K Kim
- Department of Surgery, University of Toronto, Toronto, Canada; Division of Urology, The Hospital for Sick Children, Toronto, Canada.
| | - Martin A Koyle
- Department of Surgery, University of Toronto, Toronto, Canada; Division of Urology, The Hospital for Sick Children, Toronto, Canada
| | - Min Joon Lee
- Division of Urology, The Hospital for Sick Children, Toronto, Canada; Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Gregory J Nason
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Lily Yuxi Ren
- Hospital Library and Archives, The Hospital for Sick Children, Toronto, Canada
| | - Fardod O'Kelly
- Department of Surgery, University of Toronto, Toronto, Canada; Division of Urology, The Hospital for Sick Children, Toronto, Canada
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O'Kelly F, DeCotiis K, Zu'bi F, Farhat WA, Koyle MA. Increased hand digit length ratio (2D:4D) is associated with increased severity of hypospadias in pre-pubertal boys. Pediatr Surg Int 2020; 36:247-253. [PMID: 31748946 DOI: 10.1007/s00383-019-04600-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Hypospadias is a common congenital male disorder, with much research focusing on prenatal androgen exposure as a causative factor. Whilst digit length ratios were apparent in sexual dimorphism since the nineteenth century, their role in hypospadias remains unknown. The objective of our study was to determine the correlation between digit length (2D:4D) ratio, hypospadias severity, and anogenital distance. METHODS Pre-pubertal boys (<3 years old) seen intra/postoperatively following hypospadias repair (June 2018-January 2019 inc.) were included. These were age-matched to non-hypospadias controls. Anthropomorphic measurements of digit lengths, penile/glans width, and anogenital distance were measured using digital calipers. RESULTS Data measurements were collected for 105 boys with hypospadias (60 distal; 45 proximal) and 55 controls. There were significant differences in 2D:4D ratios in each hand (p < 0.001), as well as individual digits (p < 0.001), and a reduced anogenital distance (p < 0.001), when comparing the proximal group with distal or control groups. There were no significant differences in glans width, or between term- and preterm births. CONCLUSIONS This study is the first to demonstrate increased 2D:4D ratios with proximal hypospadias, which also correlate with a shortened anogenital distance. This may provide a non-invasive, potentially antenatal, anthropomorphic measurement, as an indirect indicator of aberrant urogenital development.
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Affiliation(s)
- Fardod O'Kelly
- Division of Urology, The Hospital for Sick Children, Toronto, ON, M5G1X8, Canada.
| | - Keara DeCotiis
- Division of Urology, The Hospital for Sick Children, Toronto, ON, M5G1X8, Canada
| | - Fadi Zu'bi
- Division of Urology, The Hospital for Sick Children, Toronto, ON, M5G1X8, Canada
| | - Walid A Farhat
- Division of Urology, The Hospital for Sick Children, Toronto, ON, M5G1X8, Canada
| | - Martin A Koyle
- Division of Urology, The Hospital for Sick Children, Toronto, ON, M5G1X8, Canada
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Dos Santos J, Marcon E, Pokarowski M, Vali R, Raveendran L, O'Kelly F, Amirabadi A, Elterman D, Foty R, Lorenzo A, Koyle M. Assessment of Needs in Children Suffering From Refractory Non-neurogenic Urinary and Fecal Incontinence and Their Caregivers' Needs and Attitudes Toward Alternative Therapies (SNM, TENS). Front Pediatr 2020; 8:558. [PMID: 33014941 PMCID: PMC7509042 DOI: 10.3389/fped.2020.00558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/31/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Non-neurogenic urinary and fecal incontinence (UI, FI) affects approximately 6% of North American children with 1% of cases becoming refractory (nonresponsive to standard therapies). Incontinence has major potential long-term physiological and psychological implications for patients and their families. While Sacral Neuromodulation (SNM) and Transcutaneous Nerve Stimulation (TENS) are alternative therapies available for the treatment of refractory UI/FI, these are not approved for use in children in Canada. The present study assessed participants' perception of current treatments, incontinence burden, and attitudes toward novel therapies in a single pediatric institution. Methods: Multiple validated questionnaires including Dysfunctional Voiding Scoring System (DVSS), Bristol Stool Chart (BSC), Pediatric Incontinence measurement (PinQ), and Time-Driven Activity Based Costing were used to perform a needs assessment for patients with non-neurogenic refractory incontinence, and to determine patients' and caregivers' attitudes toward alternative therapies. Results: 75% of patients and 89% of caregivers reported a moderate to severe impact of incontinence on QoL with diminished social interactions among the primary concerns. Caregivers were frustrated with current treatments and were open to trying alternative therapies (SNM and TENS), which, at least in the case of SNM, seems to be less expensive, possibly less burdensome and more effective than current surgical options. Conclusion: Pediatric refractory UI/FI has a large impact on patients' and caregivers' QoL and alternative therapies with the potential to improve QoL of patients and caregivers should be further investigated as a substitute for surgery.
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Affiliation(s)
- Joana Dos Santos
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.,Translational Research Program, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Edyta Marcon
- Translational Research Program, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Donnelly Centre, University of Toronto, Toronto, ON, Canada
| | - Martha Pokarowski
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Reza Vali
- Translational Research Program, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lucshman Raveendran
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Fardod O'Kelly
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Afsaneh Amirabadi
- Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Dean Elterman
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Richard Foty
- Translational Research Program, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Armando Lorenzo
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Martin Koyle
- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Hannick JH, O'Kelly F, Wolfstadt JI, Ward SE, Koyle MA. Improving care in pediatric urology-A primer on quality improvement methodology and how to apply it to pediatric urology. J Pediatr Urol 2019; 15:503-512. [PMID: 31648888 DOI: 10.1016/j.jpurol.2019.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/12/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Jessica H Hannick
- Division of Pediatric Urology, UH Rainbow Babies and Children's Hospital, Cleveland, OH, USA; Division of Pediatric Urology, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Fardod O'Kelly
- Division of Pediatric Urology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jesse Isaac Wolfstadt
- Granovsky Gluskin Division of Orthopedic Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Sarah E Ward
- Department of Surgery, University of Toronto, Toronto, ON, Canada; Division of Orthopedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Martin A Koyle
- Division of Pediatric Urology, The Hospital for Sick Children, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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O'Kelly F, McAlpine K, Abdeen N, Keays MA, Guerra LA, Leonard MP. The futility of continued surveillance of epididymal cysts - A study of the prevalence and clinico-demographics in pre- vs. post-pubertal boys. Can Urol Assoc J 2019; 13:E398-E403. [PMID: 31039113 DOI: 10.5489/cuaj.5667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The first description of epididymal cysts in children appears from a 1976 case study. Since then, there have been a total of 24 indexed publications relating to pediatric epididymal cysts. Risk factors that may exist for children presenting with epididymal cyst remain unknown, as has the best method of management. And there have not been any studies looking at the cost implications of this diagnosis. The aim of this study was to assess the incidence, clinico-demographics, outcomes, and costs of epididymal cysts in pre-pubertal boys compared with a post-pubertal epididymal cyst cohort, and to assess whether this cohort requires continued surveillance METHODS:: Our institutional ultrasound (US) database was searched for all scrotal US. From these, a filtered, institution review board-approved search was performed for any reports containing the word "cyst." These were then cross-referenced with a retrospective chart review (October 2006 to September 2017). Clinico-demographics, cyst characteristics, and outcomes were analysed for both pre- and post-pubertal boys using descriptive and non- parametric statistical methods RESULTS:: Of 4508 boys undergoing scrotal US during the study period, 191 were indicated to contain cysts. This was manually reduced to 109 scans (2.4%) that met inclusion criteria (85 pre-pubertal; 24 post-pubertal). Thirty-one scans were ordered by urology, including all those with abnormal testicular echotexture (n=5). The average age of the post-pubertal cohort was 15.8 years, compared with 3.8 years in the pre-pubertal cohort. Most (70.5%) epididymal cysts were incidental. There was no difference between the pre- and post-pubertal cohorts in terms of presence of hydrocoeles (p=0.9), symptoms (p=0.9), ordering service (p=0.61), rate of resolution (4.2% vs. 8.2%; p=0.68), or length of followup (4 vs. 4.5 years; p=0.44). Pre- pubertal cysts were significantly smaller in size (3.35 vs. 14.52 mm; p=0.025) and more likely to trigger repeat scanning (67 vs. 10; p=0.008). There were no operative interventions and no subsequent clinical deterioration occurred with observation. At a cost of $71.10 CAD per US, $15 002.10 CAD was expended on epididymal cyst surveillance in direct cost to the healthcare system. CONCLUSIONS Epididymal cysts are comparable in both pre- and post-pubertal boys and can be safely managed non-operatively without the use of continued US surveillance or urological referral. The higher than expected rate of detection may be a result of the improved ultra-resolution of modern scanners. These children should not require continued followup with repeat surveillance imaging solely for epididymal cysts and could be managed in the primary care setting as part of routine clinical examination.
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Affiliation(s)
- Fardod O'Kelly
- Division of Pediatric Urology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - Kristen McAlpine
- Division of Pediatric Urology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - Nishard Abdeen
- University of Ottawa, Ottawa, ON, Canada.,Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Melise A Keays
- Division of Pediatric Urology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - Luis A Guerra
- Division of Pediatric Urology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - Michael P Leonard
- Division of Pediatric Urology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
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O'Kelly F, Koyle MA. Response to editorial commentary: predatory publishing or a lack of peer-review transparency?-a contemporary analysis of indexed open and non-open access articles in paediatric urology. J Pediatr Urol 2019; 15:161. [PMID: 30606636 DOI: 10.1016/j.jpurol.2018.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 11/18/2022]
Affiliation(s)
- F O'Kelly
- Division of Paediatric Urology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, ON M5G 1X8, Canada.
| | - M A Koyle
- Division of Paediatric Urology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, ON M5G 1X8, Canada
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O'Kelly F, Fernandez N, Koyle MA. Predatory publishing or a lack of peer review transparency?-a contemporary analysis of indexed open and non-open access articles in paediatric urology. J Pediatr Urol 2019; 15:159.e1-159.e7. [PMID: 30867116 DOI: 10.1016/j.jpurol.2018.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 08/21/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The advent of open access publishing has allowed for unrestricted and rapid knowledge dissemination and can generate higher citation levels. However, the establishment of predatory journals exploits this model and may lead to publication of non-peer reviewed work. OBJECTIVE The objective of this study was to compare the characteristics and trends of indexed publications in paediatric urology. The primary outcomes were to compare open access vs non-open access publishing. The secondary outcome was to assess whether any open access publications in this cohort could be classified as predatory based on journal data basing and external peer review policies. METHODS PubMed, MEDLINE and Embase reviews were carried out for any publication using the terms 'p(a)ediatric urology' over a 5-year period (October 2012-2017). These publications were individually accessed, assessed for relevance and cross-checked using the ISI Web of Knowledge Journal Citation Report. Bibliometric data, journal type and access model were all individually assessed, ranked and compared using descriptive and non-parametric statistical methods. RESULTS From an initial total of 4075 indexed publications, 2244 journal publications across 51 countries were included based on relevance, of which 611 were open access. Open access journals were significantly more likely to publish basic science/laboratory versus clinical publications (10.9% vs 3.3%). They were more likely have higher average citations/publication (17 vs. 8), but there was no difference between open and closed journal impact factors (3.1 vs. 2.7). The overall rate of open access, indexed publications that were not peer reviewed and/or included in open access databases was 6.5% DISCUSSION: The overall numbers of paediatric urological articles appearing on PubMed between 2012 and 2017 have increased by approximately 75%, while the number of open access articles has remained relatively static (25%). Researchers may prefer to publish in specific journals to disseminate results to a particular audience or fear in the current climate that an open access journal may not be considered legitimate, and possibly even predatory, thus having a negative impact on the data and the author's reputation. The impact factor status and route/method of publication may be less important. CONCLUSIONS Open access, peer reviewed publishing allows rapid international knowledge dissemination. The exact objective definition of what constitutes a predatory journal remains controversial. We have identified a time-stable prevalence of 6.5% open access publications that could meet proposed criteria for a 'borderline/predatory journal'; however, this should not influence the decision to publish in open access journals.
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Affiliation(s)
- F O'Kelly
- Division of Paediatric Urology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - N Fernandez
- Division of Paediatric Urology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
| | - M A Koyle
- Division of Paediatric Urology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
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O'Kelly F. Featuring: Renal cyst evolution in childhood: a contemporary observational study. J Pediatr Urol 2019; 15:112-113. [PMID: 31103192 DOI: 10.1016/j.jpurol.2019.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 04/14/2019] [Indexed: 11/16/2022]
Affiliation(s)
- F O'Kelly
- Division of Paediatric Urology, The Hospital for Sick Children (Sick Kids), Toronto, Canada.
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O'Kelly F, Koyle MA. Response to Editorial commentary: predatory publishing or a lack of peer-review transparency?-a contemporary analysis of indexed open and non-open access articles in pediatric urology. J Pediatr Urol 2019; 15:163. [PMID: 30772243 DOI: 10.1016/j.jpurol.2018.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/13/2018] [Indexed: 11/28/2022]
Affiliation(s)
- F O'Kelly
- Division of Paediatric Urology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - M A Koyle
- Division of Paediatric Urology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
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Fernandez N, Puerto A, Azuero A, O'Kelly F, Hannick J, Rickard M, Kirsch A, Caldamone A, Koyle M. Historical bibliometric analysis of the top cited articles on vesicoureteral reflux 1950-2016, and incorporation of a novel impact index. J Pediatr Urol 2018; 14:446.e1-446.e9. [PMID: 29776870 DOI: 10.1016/j.jpurol.2018.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/06/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES Vesicoureteral reflux (VUR) has been one of the defining conditions unique to pediatric urology since its inception. The clinical implications of this disease process depend on intrinsic patient factors such as age, genetics, epigenetics, voiding habits, anatomic anomalies, and extrinsic factors such as the pathogenicity of infectious agents. Knowledge about its natural history, the implications of conservative and surgical management, and their associated outcomes have evolved dramatically over time. This study aimed to use bibliometric analyses to summarize the evolution of VUR management over time. In order to accomplish this, the most referenced articles for VUR since 1950 were identified, and a comprehensive analysis of their impact on the management and understanding of VUR was performed by creating a novel impact index. METHODS A reference search was carried out for indexed citations through the portal 'Science Citation Index' in the subsection 'Web of Science Core Collection' using 'vesicoureteral reflux' as a MeSH term. References were analyzed and subcategorized according to various subtopics. A unique impact index was developed to adjust the number of publications for the time since publication, in order to define the impact of the paper amongst the most frequently cited papers. Articles were analyzed and data were tabulated according to the number of citations, country and institute of origin, journal of publication, impact factor, and first authorship. RESULTS Citation counts ranged from 43 to 510, and the mean number of citations per publication was 101.43. The most discussed topic was 'treatment'. The impact index showed that more recent publications have a higher impact. The author with the highest index impact had 271 citations in a period of 5 years. The top 150 articles were published across 23 countries, the majority being from the USA (Summary fig.). The most frequently cited institution had 12 publications. The journal with the highest publication referencing rate was the Journal of Urology. CONCLUSION The most cited articles were valuable sources of information to describe the historical evolution of the pathophysiology and management of VUR. After adjusting for time since publication, the most recent publications (i.e. those published after 1990) had a higher impact index. Combining traditional bibliometric analysis with this novel impact index may allow researchers to optimize future literature analyses, while also assisting clinicians in understanding best practices for patient management based on the available literature.
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Affiliation(s)
- N Fernandez
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada; Division of Pediatric Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Colombia.
| | - A Puerto
- Division of Pediatric Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Colombia
| | - A Azuero
- Division of Pediatric Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogota, Colombia
| | - F O'Kelly
- Department of Paediatric Urology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - J Hannick
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada
| | - M Rickard
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada
| | - A Kirsch
- Department of Pediatric Urology, Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta GA, USA
| | - A Caldamone
- Department of Pediatric Urology, Hasbro Children's Hospital, Brown University, Providence RI, USA
| | - M Koyle
- Division of Pediatric Urology, Hospital for Sick Children, Toronto, Canada
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Stoica I, O'Kelly F, McDermott MB, Quinn FMJ. Xanthogranulomatous pyelonephritis in a paediatric cohort (1963-2016): Outcomes from a large single-center series. J Pediatr Urol 2018; 14:169.e1-169.e7. [PMID: 29233628 DOI: 10.1016/j.jpurol.2017.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 10/25/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Xanthogranulomatous pyelonephritis (XGP) is an uncommon chronic destructive granulomatous inflammation of the kidney. It was first described in 1916, and is thought to affect 6/1000 cases of pyelonephritis. Its manifestations are varied, and with a limited number of cases in the literature, the optimal diagnosis and management of XGP in the paediatric cohort is still unknown. MATERIAL AND METHODS The medical records of children who were diagnosed and treated for XGP at the current unit during the period 1963-2016, inclusive, were retrospectively reviewed. Information pertaining to each patient was recorded, including: demographic data, past medical history, clinical and biochemical characteristics, diagnostic procedures, treatment methods, histopathologic diagnosis of the removed specimen, and outcome. RESULTS A total of 66 children with a median age of 4.84 years (range 1.1-14.81), with an M:F ratio 1.35:1 underwent nephrectomy for XGP and had a median follow-up of 7.19 years (range 0.11-17.45). The most common presentations were systemic illness (62.1%), pain (60.6%), urinary tract infections (54.5%) and an abdominal mass (39.4%); pyrexia was present in 53%. Biochemical abnormalities included anaemia (86.3%), thrombocytosis (80.3%) and hypomagnesemia (65.1%). There was an 83.3% concordance between intraoperative cultures and positive mid-stream urines. Index kidneys were significantly larger than the contralateral side (mean 1.32 cm; P = 0.002). Staging of XGP demonstrated extension beyond the kidney in 79% of kidneys. Computed tomography (CT) was performed in 11 cases (Summary figure). Dimercaptosuccinic acid (DMSA) scan showed 0-10% function in 90.47% of cases. Surgical procedures included nephrectomy (n = 63) and partial nephrectomy (n = 3). Perioperative complications included colonic resections (n = 5) and abscess formation in 18%. CONCLUSIONS This is the largest series to date of XGP in a paediatric cohort. XGP should be included in the differential diagnosis of all children presenting with perirenal or psoas abscesses, renal masses and/or non-functioning kidneys with/or without associated urolithiasis. Clinical awareness and a high index of suspicion is required to achieve the correct pre-operative diagnosis and appropriate management.
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Affiliation(s)
- I Stoica
- Department of Surgery, Division of Paediatric Urology, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
| | - F O'Kelly
- Department of Surgery, Division of Paediatric Urology, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
| | - M B McDermott
- Department of Pathology, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
| | - F M J Quinn
- Department of Surgery, Division of Paediatric Urology, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
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O'Kelly F, Nason GJ, Manecksha RP, Cascio S, Quinn FJ, Leonard M, Koyle MA, Farhat W, Leveridge MJ. The effect of social media (#SoMe) on journal impact factor and parental awareness in paediatric urology. J Pediatr Urol 2017; 13:513.e1-513.e7. [PMID: 28483467 DOI: 10.1016/j.jpurol.2017.03.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Social media (SoMe) comprises a number of internet-based applications that have the capability to disseminate multimodal media and allow for unprecedented inter-user connectivity. The role of Twitter has been studied in conferences and education; moreover, there is increasing evidence that patients are more likely to use social media for their own health education. OBJECTIVE The aim of this study was to assess the impact of social media platforms on the impact factor of both urological and paediatric journals that publish on paediatric urology, and to assess parental awareness of social media in paediatric urology. STUDY DESIGN A filtered Journal of Citation Reports (JCR) search was performed for the period 2012-16 for journals that published articles on paediatric urology. Journals were ranked according to impact factor, and each individual journal website was accessed to assess for the presence of social media. Parents in paediatric urology clinics and non-paediatric urology patients also filled out a questionnaire to assess for awareness and attitudes to social media. All statistical analysis was performed using Prism 6 software (Prism 6, GraphPad Software, California, USA). RESULTS Overall, there were 50 urological journals and 39 paediatric journals with a mean impact factor of 2.303 and 1.766, respectively. There was an overall average increase in impact factor across all urological journals between 2012 and 16. The presence of a Twitter feed was statistically significant for a rise in impact factor over the 4 years (P = 0.017). The cohort of parents was statistically more likely to have completed post-secondary education, to have and access to a social media profile, use it for health education, and use it to access journal/physician/hospital social media accounts. DISCUSSION This study examined, for the first time, the role of social media in paediatric urology, and demonstrated that SoMe use is associated with a positive influence in impact factor, but also a parental appetite for it. Limitations included a non-externally validated questionnaire. There may also have been bias in larger journals that generate and maintain social media platforms such as Twitter, which may then in turn have an influence on impact factor. CONCLUSIONS Social media use within paediatric urology was associated with a higher impact factor, which remained significant after 4 years of analysis. Parents were more likely to use a wide variety of social media to search for conditions and physicians/healthcare providers; therefore, journals and institutions need to embrace and endorse SoMe as a potential source of important clinical information.
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Affiliation(s)
- F O'Kelly
- Department of Paediatric Urology, Our Lady's Children' Hospital, Dublin, Ireland.
| | - G J Nason
- Department of Paediatric Urology, Our Lady's Children' Hospital, Dublin, Ireland
| | - R P Manecksha
- Department of Urological Surgery, Tallaght Hospital (AMNCH), Dublin, Ireland
| | - S Cascio
- Department of Paediatric Urology, Our Lady's Children' Hospital, Dublin, Ireland
| | - F J Quinn
- Department of Paediatric Urology, Our Lady's Children' Hospital, Dublin, Ireland
| | - M Leonard
- Division of Paediatric Urology, Childrens' Hospital of Eastern Ontario, Ottawa, Canada
| | - M A Koyle
- Department of Paediatric Urology, The Hospital for Sick Children, Toronto, Canada
| | - W Farhat
- Department of Paediatric Urology, The Hospital for Sick Children, Toronto, Canada
| | - M J Leveridge
- Department of Urological Surgery, Kingston General Hospital, Ontario, Canada
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O'Connor EM, Nason GJ, O'Kelly F, Manecksha RP, Loeb S. Newsworthiness vs scientific impact: are the most highly cited urology papers the most widely disseminated in the media? BJU Int 2017; 120:441-454. [PMID: 28418091 DOI: 10.1111/bju.13881] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess whether a correlation exists between newsworthiness (Altmetric score) and scientific impact markers, such as citation analysis, impact factors, and levels of evidence. METHODS The top five most cited articles for the year 2014 and 2015 from the top 10 ranking urology journals (Scientific Impact Group) were identified. The top 50 articles each in 2014 and 2015 were identified from Altmetric support based on media activity (Media Impact Group). We determined the number of citations that these articles received in the scientific literature, and calculated correlations between citations with Altmetric scores. RESULTS In the Scientific Impact Group, the mean number of citations per article was 37.6, and the most highly cited articles were oncology guidelines. The mean Altmetric score in these articles was 14.8. There was a weak positive correlation between citations and Altmetric score (rs = 0.35, 95% confidence interval 0.16-0.52, P < 0.001). In the Media Impact Group, the mean Altmetric score was 121.1 and most widely shared articles all related to sexual medicine. In this group, the mean number of citations was 9.7 and there was a weak negative correlation between Altmetric score and citations (rs = -0.20, P = 0.046). CONCLUSION The top articles based on Altmetric scores were not highly cited, suggesting that publications receiving the most media attention may not be the most scientifically rigorous, or that this audience places greater value on different subjects than the scientific community.
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Affiliation(s)
- Eabhann M O'Connor
- Department of Urology, St Vincent's University Hospital, Dublin, Ireland
| | - Gregory J Nason
- Department of Urology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Fardod O'Kelly
- Department of Urology, Our Lady's Childrens' Hospital, Crumlin, Dublin, Ireland
| | - Rustom P Manecksha
- Department of Urology, Tallaght Hospital, Dublin, Ireland.,Department of Urology, St James' Hospital, Dublin, Ireland
| | - Stacy Loeb
- Department of Urology, Population Health, and Laura & Isaac Perlmutter Cancer Center, New York University, New York, NY, USA
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Browne E, O'Malley K, Connolly S, O'Kelly F, Lundon D, Daly P, Galvin D, Hegarty N. The Hidden Burden of Outpatient Repeat PSA Testing in a Prospective Cohort. Ir Med J 2017; 110:564. [PMID: 28737305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PSA testing is widespread throughout Europe for diagnostic purposes and follow up. We performed a prospective outpatient cohort study of 250 men (2013-2015) in two hospital sites. Included were those men being followed up by urology with PSA blood testing. First appointments and those men in whom non-PSA tests were ordered by urology were excluded. The median age was 67.2yrs (46-88). Eighty-one point two percent of samples had a combination of 21 different serology tests at an added cost of >€18,000. Abnormal serology resulted in 53 referrals. Twenty-six-six percent of correspondence referenced abnormal serology other than PSA. Follow up of non-PSA test results poses a challenge in an outpatient setting with failure to appropriately follow-up on abnormal results, increased costs, and medico-legal implications. There is currently no Irish legislature in place to safeguard hospital physicians. This study quantifies the levels of expenditure, resources and risk associated with ambulant PSA testing.
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Affiliation(s)
- E Browne
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7
| | - K O'Malley
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7
| | - S Connolly
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7
| | - F O'Kelly
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7
| | - D Lundon
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7
| | - P Daly
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7
| | - D Galvin
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7
| | - N Hegarty
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7
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Lonergan PE, Nic An Riogh A, O'Kelly F, Lundon DJ, O'Sullivan D, O'Connell M, Hegarty PK. Dynamic sentinel node biopsy for penile cancer: an initial experience in an Irish Hospital. Ir J Med Sci 2017; 186:841-845. [PMID: 28102480 DOI: 10.1007/s11845-017-1558-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 01/11/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The presence of nodal metastases is the single most important prognostic factor in penile cancer. However, reliable assessment of nodal status in clinically node-negative (cN0) patients poses a challenge. Approximately 20% of these patients harbour occult nodal metastases. Currently available non-invasive radiological investigations are unreliable in excluding micrometastatic disease. AIM Dynamic sentinel node biopsy (DSNB) is a minimally invasive procedure for assessing lymph node involvement. We report our initial experience with DSNB in assessing the status of regional lymph nodes in cN0 penile cancer patients. METHODS DSNB was performed in penile cancer patients with at least one cN0 groin. All patients undergoing DSNB at our institution were included. Lymphoscintigraphic images were obtained from all patients, after intradermal, peritumoral injection of a Technetium-99m nanocolloid. The sentinel nodes were defined as the nodes identified on lymphoscintigraphy, which were also radioactive intraoperatively using a gamma probe. RESULTS In total, 18 groins from 11 patients underwent DSNB. Of these, 11 patients underwent bilateral DSNB and 4 had unilateral DSNB. The mean (range) age of patients at the time of presentation of their primary tumour was 63 (39-78) years. A mean of 1.2 nodes per groin was retrieved. One lymph node was positive in one patient, who subsequently underwent a bilateral inguinal lymph node dissection. Overall, the median (range) follow-up was 12.8 (2.7-31.3) months with no local or regional recurrences. CONCLUSION Further cases and longer follow-up will define the accuracy of this technique in the Irish population.
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Affiliation(s)
- P E Lonergan
- Department of Urology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - A Nic An Riogh
- Department of Urology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - F O'Kelly
- Department of Urology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - D J Lundon
- Department of Urology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - D O'Sullivan
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - M O'Connell
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - P K Hegarty
- Department of Urology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.,Mater Private Hospital, Dublin, Ireland.,Mater Private Hospital, Cork, Ireland
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