A Quality Improvement Collaborative to Improve the Discharge Process for Hospitalized Children.

Objective: To assess the impact of a quality improvement collaborative on quality and efficiency of pediatric discharges.

Methods: This was a multicenter quality improvement collaborative including 11 tertiary-care freestanding children's hospitals in the United States, conducted between November 1, 2011 and October 31, 2012. Sites selected interventions from a change package developed by an expert panel.

Factors influencing rate of testicular salvage in acute testicular torsion at a tertiary pediatric center.

Introduction: Studies have demonstrated that variables other than duration of symptoms can affect outcomes in children with acute testicular torsion. We examined demographic and logistical factors, including inter-hospital transfer, which may affect outcomes at a tertiary pediatric referral center.

Methods: We reviewed charts of all pediatric patients with acute testicular torsion during a five-year period.

Children with spinal abnormalities have an increased health burden from upper tract urolithiasis.

Objective: To examine the epidemiology and health care burden of upper tract urolithiasis in children with spinal abnormalities using a large, national database. Children with spinal dysraphism are predisposed to urolithiasis for many reasons, including immobility, bacteriuria, and urinary stasis. No large epidemiologic studies exist regarding stones in this specific group.

Obstructive complications of lichen sclerosus.

Objective: Young males with lichen sclerosus (LS) commonly present with phimosis; complete urinary obstruction has also been described in this population, but is much rarer. We present the case report of a boy with acute renal failure secondary to urethral obstruction caused by LS, with a review of the literature regarding the occurrence of complete urinary obstruction and renal failure associated with this disease process.

Materials And Methods: A comprehensive review of the literature was conducted using MEDLINE and EMBASE to characterize the association of lichen sclerosus with significant obstructive complications of the urinary tract.

Lack of defects in androgen production in children with hypospadias.

Formation of the male urethra requires the synthesis of testosterone, its activation to dihydrotestosterone (DHT) in genital skin, and binding of DHT to the androgen receptor. Defects in any of those steps can cause hypospadias. To determine whether defects exist in the production of androgens in individuals with hypospadias, we examined enzymatic function of 3beta-hydroxysteroid dehydrogenase (3betaHSD), P450c17 (17alpha-hydroxylase and 17,20 lyase activity), and type 3 17betaHSD.

Is bladder dysfunction and incontinence associated with ureteroceles congenital or acquired?

Purpose: Bladder dysfunction (a disorder often characterized by incontinence, urgency, patterns of dysfunctional voiding, incomplete emptying and so forth) in association with ureteroceles has been attributed to surgical intervention. A previous study suggested that patients with ectopic ureteroceles may have bladder dysfunction as part of this disorder regardless of the type of surgical intervention. We reviewed all types of ureteroceles (ectopic versus intravesical, simple versus duplex) to characterize the patterns of bladder dysfunction and its association with prior surgical treatments.