Growth in Newborn Circumcisions Performed by Pediatric Urologists and Advanced Practice Providers Between 2010 and 2021 in the United States.

Objective: To characterize changes in the proportion of newborn circumcisions performed by pediatric urologists and advanced practiced providers (APPs) in the United States over the last decade.

Methods: The Merative MarketScan Commercial Database was queried for newborn circumcision private health insurance claims (Common Procedural Terminology 54150) between 2010 and 2021. Setting (inpatient/outpatient), US Census Bureau region, clinician specialty, and patient age (days) were determined for the full study time period, and by study year.

Streamlining surgical trays for common pediatric urology Procedures: A quality improvement initiative.

Introduction: Procedures involving the external genitalia are the most common pediatric urologic operations. Our group identified excess instrumentation for these cases to be a potential cause of operating room (OR) inefficiency at our large, freestanding pediatric hospital. This quality improvement (QI) initiative aimed to streamline surgical instrumentation for the most-performed pediatric urologic procedures at our hospital.

Randomized trial of prophylactic antibiotics vs. placebo after midshaft-to-distal hypospadias repair: the PROPHY Study.

Background: Use of prophylactic antibiotics after stented hypospadias repair is very common, but most research has not identified any clinical benefits of this practice. Only one study has found that postoperative prophylaxis reduces symptomatic urinary tract infections (UTIs). Data from the same trial suggested that prophylaxis may also reduce urethroplasty complications.

Assessment of distal ureteral and ureterovesical junction visualization on contrast-enhanced voiding urosonography.

Background: Contrast-enhanced voiding urosonography (CEVUS) uses intravesically administered microbubble contrast to detect vesicoureteral reflux (VUR) and urethral anomalies with ultrasound. Multiple studies have suggested CEVUS can replace voiding cystourethrogram (VCUG) as a radiation-free alternative. Analysis of the ureterovesical junction and ureters on VCUG documenting the ureterovesical junction position, ureteral duplication, periureteral diverticula and ureteroceles is important as anatomical variations may affect management and surgical approach.

Association between intra-operative meatal mismatch and urethrocutaneous fistula development in hypospadias repair.

Introduction: The Glans-Meatus-Shaft (GMS) Score is a pre-operative phenotypic scoring system used to assess hypospadias severity and risk for post-operative complications. The 'M' component is based on pre-operative meatal location, but meatal location sometimes changes after penile degloving, resulting in 'meatal mismatch.'

Objective: To identify: 1) the incidence and clinical predictors of meatal mismatch, and 2) the association of meatal mismatch with post-operative urethrocutaneous fistula development.

Are pressure pop-offs beneficial to the bladder in boys with posterior urethral valves?

Background: Pressure pop-offs, such as high-grade vesicoureteral reflux with renal dysplasia, have historically been considered beneficial for renal and bladder outcomes in boys with posterior urethral valves (PUV). Recent longer-term studies have called into question the beneficial effects of pop-offs on renal function.

Objective: To evaluate how pop-offs affect bladder outcomes in boys with PUV.

Caregiver Reported Reasons for Delay of Neonatal Circumcision.

Objectives: To determine caregiver-reported reasons for delay of desired neonatal circumcision.

Methods: Caregivers requesting elective outpatient circumcision at two urban tertiary care hospitals were surveyed from 1/2017 to 12/2018. Boys >3 years and those with abnormal penile anatomy were excluded.

Frequency and Variability of Advice Given to Parents on Care of the Uncircumcised Penis by Pediatric Residents: A Need to Improve Education.

Objective: To understand the extent to which pediatricians are providing advice on care of the uncircumcised penis and the advice they are providing. We hypothesized that pediatric residents lack preparedness to offer parents advice on caring for the uncircumcised penis and as such are unlikely to offer such advice.

Methods: An IRB approved, anonymous survey was administered to 244 pediatric residents in 5 urban training programs (Appendix).

Advising on the care of the uncircumcised penis: A survey of pediatric urologists in the United States.

Background: Parents of uncircumcised boys often report confusion regarding the proper care and hygiene practices for the uncircumcised penis. The lack of guidance from healthcare providers may be due to a lack of consensus on the proper care of the prepuce.

Objective: The aim of this study was to determine whether or not there exists consensus among pediatric urologists on the care of the uncircumcised penis and on the advice they provide to parents.

Robot-Assisted Laparoscopic Reoperative Repair for Failed Pyeloplasty in Children: An Updated Series.

Purpose: Reoperative pyeloplasty is commonly used in children with recurrent obstruction after pyeloplasty. We previously reported on reoperative robot-assisted laparoscopic repair for failed pyeloplasty in 16 children and concluded that short-term and intermediate outcomes were comparable to open reoperative repair. In this updated series we describe longer term outcomes from an extended study.

Robot-assisted laparoscopic transplant-to-native ureteroureterostomy of an intraperitoneal renal allograft.

Objective: The objective is to describe our experience with robot-assisted laparoscopic transplant-to-native ureteroureterostomy (UU) in a pediatric patient with an intraperitoneal renal allograft. We have previously demonstrated this technique for an extraperitoneal allograft.

Methods: The patient is a 17-year-old female who had undergone a deceased donor renal transplant at 5 years of age.

The Correlation between Serial Ultrasound and Diuretic Renography in Children with Severe Unilateral Hydronephrosis.

Purpose: While serial renal ultrasound is often used as an alternative to functional renal imaging in children followed for hydronephrosis, it is unclear whether a lack of hydronephrosis progression safeguards against loss of renal function. In this study we characterize the association between findings on serial renal ultrasound and diuretic renography in children with severe unilateral hydronephrosis.

Materials And Methods: We retrospectively reviewed imaging among patients younger than 18 years old with a history of severe unilateral hydronephrosis, 2 renal ultrasounds and 2 diuretic renograms.

Robot-assisted laparoscopic megaureter tapering with ureteral reimplantation: Tips and tricks.

Objective: The aim was to demonstrate surgical techniques used in pediatric robot-assisted laparoscopic megaureter tapering (RALMT) with ureteral reimplantation. We report on our preliminary experience.

Methods: We reviewed video of patients who underwent RALMT with ureteral reimplantation between August 2012 and November 2015.

Early vs. late-presenting urethroplasty complications after hypospadias repair: A retrospective analysis of patient follow-up.

Introduction: Complications after primary hypospadias repair often present late, that is, more than 1 year postoperatively. This has important implications for clinical practice and prospective research protocols. Follow-up regimen-or lack thereof-may contribute to delayed diagnosis of complications.

Use of Pediatric Open, Laparoscopic and Robot-Assisted Laparoscopic Ureteral Reimplantation in the United States: 2000 to 2012.

Purpose: We characterize the use of pediatric open, laparoscopic and robot-assisted laparoscopic ureteral reimplantation in the United States from 2000 to 2012.

Materials And Methods: We used the Kids' Inpatient Database to identify patients who underwent ureteral reimplantation for primary vesicoureteral reflux. Before 2009 laparoscopic ureteral reimplantion and robot-assisted laparoscopic ureteral reimplantation were referred to together as minimally invasive ureteral reimplantation.

Teaching of the Society for Fetal Urology grading system for pediatric hydronephrosis is improved by e-Learning using Computer Enhanced Visual Learning (CEVL): A multi-institutional trial.

Introduction: It is unclear how clinicians learn to grade pediatric hydronephrosis (HN) and how effective their training has been. We sought to: 1. Assess how clinicians learn to grade HN and their confidence in their training and abilities and 2.

Hydronephrosis: prenatal and postnatal evaluation and management.

Antenatal hydronephrosis (ANH) is one of the most frequently detected abnormalities found on routine prenatal ultrasounds, affecting 1% to 4.5% of all pregnancies. Despite its prevalence, there continues to be uncertainty regarding the clinical impact after birth.

Contemporary national comparison of open, laparoscopic, and robotic-assisted laparoscopic pediatric pyeloplasty.

Objective: We sought to determine current and longitudinal trends in the usage of open (OP), laparoscopic (LP), and robotic pyeloplasties. (RALP) Furthermore, we aimed to describe patient and hospital level characteristics associated with the use of minimally invasive pyeloplasties (MIP) and to compare basic utilization metrics for each approach.

Materials/methods: The 2000, 2003, 2006, and 2009 Kid's Inpatient Databases (KID) were used to determine current and longitudinal trends.

Survey of pediatric urologists on the preoperative use of testosterone in the surgical correction of hypospadias.

Objective: To better characterize the current state of testosterone use in the surgical correction of hypospadias among pediatric urologists.

Methods: An email was sent via the pedsurology research listserv through the American Academy of Pediatrics, inviting members to participate in an anonymous survey regarding their use of preoperative testosterone in hypospadias correction.

Results: Twenty-seven responses were obtained for a response rate of 53%.

A novel method of teaching surgical techniques to residents--computerized enhanced visual learning (CEVL) with simulation to certify mastery of training: a model using newborn clamp circumcision.

Objective: To assess the learning process of combining a web-based video of a simulated surgical procedure with a step-by-step checklist of the same procedure in achieving competency of the simulated technique, in this case a newborn clamp circumcision. Fundamental to this particular learning process is immediate mentor step-by-step feedback which specifically follows the procedure's step-by-step checklist.

Materials And Methods: Pediatric residents naïve to newborn circumcision were enrolled (n = 7).