The development of surgical ability during pediatric urology fellowship and its evolution in the early years of practice.

Background: North American Pediatric Urology fellowship programs underwent a structural change in 2021 that allows more flexibility in training. Given this opportunity as well as widespread concern about the development of contemporary surgical trainees, it is prudent to understand in detail the current state of preparedness of pediatric urology fellowship graduates for independent practice.

Objective: The study aimed to determine recent pediatric urology graduates' reported levels of comfort both at graduation and following the start of clinical practice in performing select index procedures.

Third-Line Therapeutic Interventions for Non-Neurogenic Bladder Dysfunction in Children.

Purpose Of Review: The aim of this article is to review considerations and efficacy of third-line treatments for pediatric non-neurogenic bladder dysfunction, including Botulinum toxin A (BoTNA), Posterior Tibial Nerve Stimulation (PTNS), and Sacral Neuromodulation (SNM).

Recent Findings: Federal Drug Administration approval for use of beta-3-agonists in overactive detrusor activity in pediatric patients may provide an additional step prior to third-line therapies. New long-term data on pediatric SNM efficacy, complications, and revision rates will provide valuable information for counseling families.

Sacral nerve stimulation leads to long-term improvement in fecal incontinence and quality of life for children with functional and organic defecation disorders.

Background: Our objective was to evaluate long-term outcomes of sacral nerve stimulation (SNS) for children with functional and organic defecation disorders.

Methods: We performed a prospective study of children <21 years of age who started SNS treatment between 2012 and 2018. We recorded demographics, medical history, and diagnostic testing.

Settings and effectiveness of the revised probe compared to the original probe for micropulse transscleral cyclophotocoagulation.

Purpose: The goal of this study was to compare the settings and effectiveness of the original P3 and revised P3 probes for micropulse transscleral cyclophotocoagulation.

Methods: This retrospective cross sectional study includes a total of 56 patients with glaucoma who received micropulse transscleral cyclophotocoagulation. 32 patients received treatment with the original P3 probe and 24 received treatment with the revised P3 probe.

Outcomes after dextranomer/hyaluronic acid bladder neck injection in patients with urethral incontinence following bladder neck repair.

Introduction: Many patients who undergo surgery for bladder neck (BN) incompetence may still experience incontinence postoperatively. Dextranomer/hyaluronic acid (Dx/HA) is widely used for endoscopic treatment of vesicoureteral reflux in children; however, few studies have reported its use in treating incontinence after BN surgery.

Objective: The aim of this study was to evaluate outcomes after Dx/HA bladder neck injection in patients with persistent outlet incompetency following BN Repair.

Caregiver disclosure of common early childhood pediatric urologic surgeries.

Background: Certain pediatric urologic diagnoses can have serious long-term adverse health outcomes. As a result, it is important for a child to be aware of their diagnosis and a prior surgery. When children have surgery prior to the age of memory formation, it is incumbent upon their caregiver to disclose this surgery.

Reducing Opioid Prescriptions after Common Outpatient Pediatric Urologic Surgeries: A Quality Improvement Assessment.

Unlabelled: Pediatric patients undergoing outpatient surgeries often receive prescriptions for postoperative pain, including opioid medications. As a result, the American Academy of Pediatrics formally challenged all pediatric surgeons to decrease opioid prescribing for common specialty-specific outpatient procedures at discharge. To meet this challenge, we designed a quality improvement project to decrease the average number of opioid doses administered to pediatric patients undergoing 3 common outpatient urologic surgeries: circumcision, orchiopexy, and inguinal hernia repair (IHR).

Prolonged Opioid Use and Pain Outcome and Associated Factors after Surgery under General Anesthesia: A Prospective Cohort Association Multicenter Study.

Background: There is insufficient prospective evidence regarding the relationship between surgical experience and prolonged opioid use and pain. The authors investigated the association of patient characteristics, surgical procedure, and perioperative anesthetic course with postoperative opioid consumption and pain 3 months postsurgery. The authors hypothesized that patient characteristics and intraoperative factors predict opioid consumption and pain 3 months postsurgery.

A survey of pediatric urology fellowship applicants: past priorities to guide future possibilities.

Background: The number of applicants to pediatric urology fellowships is often lower than the available positions (chart), giving applicants significant influence over where they ultimately match. Historically, interviews were conducted at individual hospitals, in-person, with residents bearing most costs. The objective of this study was to understand the factors associated with where applicants decide to apply, interview, and match for fellowship, as well as barriers within this process.

Effectiveness of a Practical, At-Home Regimen of Parasacral Transcutaneous Electrical Nerve Stimulation in Pediatric Overactive Bladder.

Objective: To describe and evaluate efficacy of a more practical, at-home regimen of parasacral transcutaneous electrical nerve stimulation (TENS) for pediatric overactive bladder (OAB).

Methods: We prospectively enrolled patients with OAB.

Inclusion Criteria: age 5-13 years and willingness to try TENS.

Validation of the modified Bosniak classification system to risk stratify pediatric cystic renal masses: An international, multi-site study from the pediatric urologic oncology working group of the societies for pediatric urology.

Background: Pediatric cystic renal lesions are challenging to manage as little is known about their natural course. A modified Bosniak (mBosniak) classification system has been proposed for risk stratification in pediatric patients that takes ultrasound (US) and/or computed tomogram (CT) characteristics into account. However, literature validating this system remains limited.

Lichen simplex chronicus of the eyelid: A case report and literature review.

Purpose: To report a case of lichen simplex chronicus (LSC) of the eyelid and to perform a literature review on this topic.

Observations: A 59-year-old African American man presents with chronic and recalcitrant recurrent chalazion of both upper eyelids despite aggressive medical management. An incision and drainage procedure was performed along with biopsy of the eyelid, which was found to be consistent with LSC.

Broadening candidate office circumcision patients: A comparison of outcome in children based on age and weight.

Introduction: Office circumcision with a clamp or Plastibell device is often restricted in practice by patient age and size. This is thought to ensure the patient fits appropriately on the restraining device and limit complications.

Objective: To compare the outcomes of office circumcision in children ≤3 months of age and ≤5.

Treatment outcomes on neovascularization after CRAO treated with hyperbaric oxygen.

Central retinal artery occlusion (CRAO) is a condition that causes sudden vision loss due to obstruction of the retinal artery, typically from a thrombotic or embolic source. It is often associated with atherosclerotic risk factors, including cardiovascular disease, diabetes, hyperlipidemia, and a history of cerebrovascular disease. CRAO often leads to a poor visual outcome as well as neovascularization of the iris, retina, and optic disc, which can exacerbate vision loss and cause pain.

Gomco vs. plastibell office circumcision: No difference in overall post-procedural complications and healthcare utilization.

Introduction: Gomco clamp and Plastibell ring are common methods of office circumcision. While they possess similar features, the Plastibell is retained after the procedure which could impact perceived and true outcomes of the procedure.

Objective: This study evaluated differences in complications, interventions, and healthcare utilization between Gomco and Plastibell office circumcision techniques.

Surgical outcomes are equivalent after pure laparoscopic and robotic-assisted pyeloplasty for ureteropelvic junction obstruction.

Introduction: Minimally invasive (robotic and pure laparoscopic) pyeloplasty has been increasingly used for treatment of ureteropelvic junction obstruction (UPJO). However, few large-scale studies have compared these two modalities directly.

Methods: We performed a retrospective single-center review of all patients who underwent pure laparoscopic (LP) or robotic pyeloplasty (RALP) between 2007 and 2018.

Self-retained cryopreserved amniotic membrane for treating severe corneal ulcers: a comparative, retrospective control study.

To compare the effectiveness of self- retained cryopreserved AM as an adjuvant therapy for infectious corneal ulcers. Retrospective, case-control study of 24 eyes of 24 consecutive patients with central and paracentral corneal infectious ulcers and initial visual acuity worse than 20/200. Among them, 11 eyes of 11 patients received additional placement of self-retained cryopreserved AM.

An Observational Study of the Pharmacokinetics of Surgeon-Performed Intercostal Nerve Blockade With Liposomal Bupivacaine for Posterior-Lateral Thoracotomy Analgesia.

Background: Intercostal nerve blocks with liposomal bupivacaine are commonly used for thoracic surgery pain management. However, dose scheduling is difficult because the pharmacokinetics of a single-dose intercostal injection of liposomal bupivacaine has never been investigated. The primary aim of this study was to assess the median time to peak plasma concentration (Tmax) following a surgeon-administered, single-dose infiltration of 266 mg of liposomal bupivacaine as a posterior multilevel intercostal nerve block in patients undergoing posterolateral thoracotomy.

Self-retained cryopreserved amniotic membrane in treating acute ocular graft-versus-host-disease (oGVHD).

Purpose: To report successful management of acute ocular graft-versus-host disease (oGVHD) by self-retained cryopreserved amniotic membrane (AM).

Observations: A 69-year-old male developed acute oGVHD following hematopoietic stem cell transplantation (HSCT) with severe dryness, pain, photophobia, and blurred vision, the right eye worse than the left eye. Despite topical artificial tears, corticosteroids, and bandage contact lens (BCL) for two weeks, his right eye deteriorated with increasing redness and blurred vision and presented with diffuse conjunctival inflammation, severe superficial punctate keratitis, and corneal and limbal epithelial defect.

Severe Inflammation and Hyphema After Micropulse Diode Transscleral Cyclophotocoagulation.

Purpose: To describe vision-threatening complications after micropulse diode transscleral cyclophotocoagulation (MP-TSCPC).

Methods: Retrospective case series. Medical charts of patients who underwent MP-TSCPC and developed visually significant inflammation and hyphema after the procedure were reviewed.