Management and Long-term Follow-up of Vaginal Rhabdomyosarcoma in a 3-Year-Old Female.

We present the case of a 3-year-old female who presented with a vaginal mass and was subsequently diagnosed with intermediate risk, stage I, group III vaginal embryonal rhabdomyosarcoma. She was staged and treated with chemotherapy according to the Children's Oncology Group protocol. Surgical management included initial tumor debulking and subsequent partial vaginectomy with vaginal reconstruction following chemotherapy.

Posterior urethral valves and kidney transplantation: Identifying opportunities for improvement.

Background: Posterior urethral valves (PUV) represents a heterogenous spectrum in which guidelines for management are lacking particularly for those patients facing end-stage kidney disease and transplant. In this study we aim to 1) evaluate our long term PUV pediatric transplant outcomes compared to those without lower urinary tract dysfunction and 2) assess our PUV cohort for trends in bladder management and evaluate outcomes to inform development of institutional guidelines.

Materials And Methods: A retrospective cohort analysis of all patients with a diagnosis of PUV who underwent kidney transplant from 2000 to 2023 was completed.

Preputial pedicle flap ICG blood flow assessment during proximal hypospadias repair: Development of a standardized protocol.

Introduction: Blood supply to preputial flap drives outcomes of hypospadias repair. Unfortunately, we only have surgeon's subjective assessment to evaluate flap perfusion which may not be accurate. Indocyanine green (ICG) has been used in a multitude of surgeries for perfusion assessment, however, no standardized protocol has been described for use of ICG in hypospadias repairs.

Transforming into a Learning Health System: A Quality Improvement Initiative.

Background: The Institute of Medicine introduced the Learning Healthcare System concept in 2006. The system emphasizes quality, safety, and value to improve patient outcomes. The Bellevue Clinic and Surgical Center is an ambulatory surgical center that embraces continuous quality improvement to provide exceptional patient-centered care to the pediatric surgical population.

Enhanced recovery program in ambulatory pediatric urology: A quality improvement initiative.

Background: Enhanced Recovery After Surgery (ERAS) was established in 2001 for adult patients undergoing complex procedures. ERAS in adult ambulatory surgery later followed with similar positive outcomes. For the pediatric population, ERAS implementation has shown promising results in complex surgeries such as bladder reconstruction.

Putting the coach in the game: Current and future state of surgical coaching in pediatric urology.

Background: Surgical coaching has been proposed as a mechanism to fill gaps in proficiency and encourage continued growth following formal surgical training. Coaching benefits have been demonstrated in other surgical fields; however, have not been evaluated within pediatric urology. The aims of this study were to survey members of The Societies for Pediatric Urology (SPU) to assess the current understanding and utilization of surgical coaching while gauging interest, potential barriers and personal goals for participation in a coaching program.

Standardization and Implementation of a Surgical Coaching Model for Pediatric Urology.

To bridge gaps in proficiency and encourage life-long learning following training, coaching models have been utilized in multiple surgical fields; however, not within pediatric urology. In this review of our methodology, we describe the development of a coaching model at a single institution. In our initial experience, the perceived most beneficial aspect of the program was the goal setting process with logistics around debriefs being the most challenging.

Feasibility of Enhanced Recovery After Surgery (ERAS) implementation in Pediatric Urology: Pilot-phase outcomes of a prospective, multi-center study.

Introduction/background: Enhanced Recovery After Surgery (ERAS) is a fundamental shift in perioperative care that has consistently demonstrated an improved outcome for a wide variety of surgeries in adults but has only limited evidence in the pediatric population.

Objective: We aimed to assess the success with and barriers to implementation of ERAS in a prospective, multi-center study on patients undergoing complex lower urinary tract reconstruction.

Study Design: Centers were directed to implement an ERAS protocol using a multidisciplinary team and quality improvement methodologies.

Association between YouTube® videos and health literacy with postoperative healthcare utilization following pediatric urologic surgery: A randomized trial.

Introduction: Limited caregiver health literacy has been associated with poorer health outcomes in pediatric patients and may limit caregiver understanding of printed education resources. Postoperative healthcare utilization may be related to confusion about instructions or complications.

Objective: To correlate caregiver health literacy and educational video intervention with postoperative healthcare utilization following ambulatory pediatric urologic surgery.

Increase in robot assisted operating room efficiency: A quality improvement study.

Introduction: Pyeloplasties are time-sensitive, and the most common robot assisted intervention performed in pediatric urology. Early intervention is intended to avoid permanent loss of renal function with negative long-term effects if surgery is delayed when indicated. A need to increase capacity has become a premium value in patient care.

Reducing post-operative caregiver after-hours phone calls to pediatric urology providers: A quality improvement study.

Introduction: Caregiver phone calls are an important part of caring for pediatric patients. At our institution, residents respond to after-hours caregiver calls. While it is critical for families to be able to reach us for urgent concerns, the ease of access has led to overutilization with many phone calls not meeting the urgent nature that is intended for these calls.

Long term renal outcome and risk of elevated blood pressure in children undergoing complete primary repair of bladder exstrophy (CPRE).

Introduction: Since the initiation of staged reconstruction for bladder exstrophy (BE), hypertension has been a known complication of the procedure. Hypertension is a well-established risk factor for chronic kidney disease (CKD) progression and associated with cardiovascular/cerebrovascular morbidity and mortality. Few studies exist evaluating the risk of developing hypertension among patients with bladder exstrophy who underwent CPRE.

Completion of an Enhanced Recovery Program in a Pediatric Ambulatory Surgery Center: A Quality Improvement Initiative.

Background: Enhanced Recovery After Surgery (ERAS) was first established in 2001 focusing on recovery from complex surgical procedures in adults and recently expanded to ambulatory surgery. The evidence for ERAS in children is limited. In 2018, recognized experts began developing needed pediatric evidence.

Caregiver distress: A mixed methods evaluation of the mental health burden of caring for children with bladder exstrophy.

Introduction: Caring for children with bladder exstrophy-epispadias complex (BEEC) exacts a long-term emotional toll on caregivers. Previous studies leave a gap in understanding the impact that caring for a child with BEEC has on caregivers in low- and middle-income countries (LMIC). We hypothesize that families and caregivers experience psychological distress that has long gone unaddressed.

Kidney function outcomes in patients after complete primary repair of bladder exstrophy and penopubic epispadias: Results from the international bladder exstrophy consortium.

Introduction: Historically, repair of bladder exstrophy (BE) is associated with compromise to the upper tracts; the single stage repair of BE was considered to exacerbate risks of kidney impairment.

Objective: We aim to evaluate the risk of upper urinary tract deterioration or chronic kidney disease after the complete primary repair of exstrophy (CPRE).

Study Design: As part of the U.

Short term reoperation rates after artificial urinary sphincter placement in pediatric patients.

Introduction: Artificial urinary sphincters (AUS) have demonstrated good functional outcomes in pediatric populations. We sought to examine the nationwide short term reoperation rates in pediatric patients after AUS placement.

Materials And Methods: An observational cohort study was designed utilizing claims from the Truven MarketScan Commercial Claims and Encounters database from 2007 to 2018.

Racial and ethnic disparities in the timing of orchiopexy for cryptorchidism.

Introduction: Many children do not undergo surgery for cryptorchidism in a timely fashion, increasing risk of infertility and malignancy. Racial and ethnic disparities in surgery timing has been suggested in other specialties, but has not been well-explored in Pediatric Urology.

Objectives: Our aim was to investigate the association of race and ethnicity with age at orchiopexy.

Recovering from COVID - Improving operating room capacity.

Introduction: COVID-19 pandemic required that health systems made great efforts to mitigate the impact of high demands of patients requiring treatment. Triaging surgical cases reduced operating room capacity. Immunizations, massive testing, and personal protective equipment enabled re-activation of operating rooms.

Understanding why caregivers call after ambulatory pediatric urologic surgery.

Introduction: To uncover factors associated with an increased likelihood of a postoperative triage phone call from caregivers after pediatric ambulatory urologic surgery with a focus on social determinants of health.

Materials And Methods: This was a retrospective cohort study from July 2014-January 2020. Patients undergoing ambulatory urologic surgery by three different pediatric urologists were included.

Engagement of common pediatric urologic conditions on social media.

Introduction: As social media use continues to increase, parents and caregivers report using social media platforms as a source of health information. However, there are minimal regulations for social media content and health misinformation has been shared for various medical issues and urologic conditions. While internet content related to pediatric urology has been previously described, social media engagement for various pediatric urologic conditions have yet to be described.

Urinary continence disparities in patients with anorectal malformations.

Purpose: While fecal incontinence is a primary concern for many children with anorectal malformations (ARM), urinary incontinence is also prevalent in this population. Racial, ethnic, and socioeconomic disparities in urinary continence have been observed in other conditions, but have not been previously evaluated in ARM. We aimed to evaluate urinary continence and associated demographic and socioeconomic characteristics in individuals with ARM.

Long-term urological and gynecological outcomes following complete primary repair in females with bladder exstrophy.

Introduction: Long-term continence outcomes in patients undergoing complete primary repair of exstrophy (CPRE) have shown that a subset of patients do not achieve continence until after puberty. We aim to update the continence outcomes as well as describe gynecological outcomes for females having undergone CPRE.

Materials And Methods: This was a retrospective review between 1989 and 2019 at a single institution.

Experiences and attitudes of young adults with congenital bowel and bladder conditions.

Introduction: Young adults with complex congenital bowel and bladder anomalies are a vulnerable population at risk for poor health outcomes. Their experiences with the healthcare system and attitudes towards their health are understudied.

Objective: Our objective was to describe how young adults with congenital bladder and bowel conditions perceive their current healthcare in the domains of bladder and bowel management, reproductive health, and transition from pediatric to adult care.