Patient and Parent Perspectives on Testicular Adrenal Rest Tumors in Congenital Adrenal Hyperplasia.

Background: Testicular adrenal rest tumors (TARTs) increase the risk of infertility in males with classic congenital adrenal hyperplasia (CAH). There is no consensus regarding at what age screening testicular ultrasounds should begin and how often they should be repeated. Furthermore, it is unknown whether patients and parents are aware of the significance of TARTs.

Sociodemographic differences in opioid use and recovery following ambulatory pediatric urologic procedures.

Our aim was to examine associations between sociodemographic factors and postoperative opioid use and recovery among pediatric patients undergoing outpatient urologic procedures. We retrospectively evaluated 831 patients undergoing ambulatory urologic procedures from 2013 to 2017 at an urban pediatric hospital. Patients were evaluated for days of opioid use and days until return to baseline behavior.

The impact of patient age and procedure type on postoperative opioid use following ambulatory pediatric urologic procedures.

Purpose: The aim of this study is to determine whether patient age and procedure type are associated with duration of opioid use in pediatric patients undergoing ambulatory urologic procedures.

Methods: We retrospectively reviewed pediatric patients who underwent outpatient urologic procedures from 2013 to 2017. At postoperative visits, parents reported the number of days their child took opioid pain medication.

The effect of surgeon versus technologist control of fluoroscopy on radiation exposure during pediatric ureteroscopy: A randomized trial.

Background: Fluoroscopy is commonly used during pediatric ureteroscopy (PURS) for urolithiasis, and the most important contributor to overall radiation exposure is fluoroscopy time (FT). One factor that may impact FT is who controls activation of the fluoroscope: the urologist (with a foot pedal) or the radiation technologist (as directed by the urologist). While there are plausible reasons to believe that either approach may lead to reduced FT, there are no systematic investigations of this question.

Melanotic Neuroectodermal Tumor of Infancy Presenting With Fast-Growing Scrotal Swelling: A Case Report and Literature Review.

Testicular melanotic neuroectodermal tumor of infancy (MNTI) is extremely rare, with 2 cases reported in the literature. Its rarity and rapid and infiltrative growth pattern pose a diagnostic challenge. A previously healthy 3-month-old male, presented with a history of worsening left hemiscrotal swelling for 1 week.

Testicular Adrenal Rest Tumors in Boys and Young Adults with Congenital Adrenal Hyperplasia.

Purpose: Testicular adrenal rest tumors are a well-known complication in males who have congenital adrenal hyperplasia with potential infertility in adulthood. We assessed the prevalence of testicular adrenal rest tumors in infants to young men presenting to a congenital adrenal hyperplasia Comprehensive Care Center.

Materials And Methods: A total of 35 males with congenital adrenal hyperplasia due to 21-hydroxylase deficiency underwent scrotal ultrasonography, including 7 younger than 5 years, 9 who were 5 to 12 years old and 19 who were older than 12 years.

Utility Estimation for Pediatric Vesicoureteral Reflux: Methodological Considerations Using an Online Survey Platform.

Purpose: The advent of online task distribution has opened a new avenue for efficiently gathering community perspectives needed for utility estimation. Methodological consensus for estimating pediatric utilities is lacking, with disagreement over whom to sample, what perspective to use (patient vs parent) and whether instrument induced anchoring bias is significant. We evaluated what methodological factors potentially impact utility estimates for vesicoureteral reflux.

Utility scores for vesicoureteral reflux and anti-reflux surgery.

Background: Management of vesicoureteral reflux (VUR) continues to be controversial. In conditions of uncertainty, decision analytic techniques such as cost-utility analysis (CUA) can help to structure the decision-making process. However, CUA analyses require a "utility," a value between 0 (death) and 1 (perfect health) corresponding to the quality of life associated with a health state.

Estimating utility values for vesicoureteral reflux in the general public using an online tool.

Introduction: Cost-utility analyses are useful to study conditions without a widely accepted treatment algorithm; in pediatric urology, one such condition is vesicoureteral reflux (VUR). A necessary component of cost-utility analyses is to accurately calculate the "utility", a numerical surrogate of quality of life, for various health states. Our aims were to determine utility values for representative VUR health states and to verify the feasibility of a novel online platform for utility elicitation in order to reduce the time and expense of such analyses.

New contralateral vesicoureteral reflux after unilateral ureteral reimplantation: predictive factors and clinical outcomes.

Purpose: Although unilateral ureteral reimplantation for vesicoureteral reflux is highly successful, new contralateral reflux will develop postoperatively in some patients. We examined predictors and clinical outcomes of postoperative contralateral vesicoureteral reflux.

Materials And Methods: We reviewed patients who underwent nontapered unilateral reimplantation for primary vesicoureteral reflux graded on a 3-point scale at our institution from January 1990 to December 2002, and identified those with subsequent contralateral vesicoureteral reflux.

Trends in revision circumcision at pediatric hospitals.

Background: We sought to determine the incidence of revision circumcision at freestanding children's hospitals, and examine trends over time.

Methods: We searched the Pediatric Health Information Systems database to identify boys undergoing revision circumcision (RC), primary non-newborn circumcision (PC), or lysis of penile adhesions (LPA) from 2004 to 2009. Rates of RC procedures were calculated by dividing the incidence of procedures by the total male ambulatory surgical volume.

The Publication Ranking Score for pediatric urology: quantifying thought leadership within the subspecialty.

Objectives: Clinical care parameters are frequently assessed by national ranking systems. However, these rankings do little to comment on institutions' academic contributions. The Publication Ranking Score (PRS) was developed to allow for objective comparisons of scientific thought-leadership at various pediatric urology institutions.

Prospective systematic intervention to reduce patient exposure to radiation during pediatric ureteroscopy.

Purpose: After prospective measurement of radiation exposure during pediatric ureteroscopy for urolithiasis, we identified targets for intervention. We sought to systematically reduce radiation exposure during pediatric ureteroscopy.

Materials And Methods: We designed and implemented a pre-fluoroscopy quality checklist for patients undergoing ureteroscopy at our institution as part of a quality improvement initiative.

Quality assessment of economic analyses in pediatric urology.

Objective: To describe and evaluate economic analyses or economic evaluations in pediatric urologic literature, including study types such as cost-effectiveness analysis, which are increasingly common in the medical literature.

Methods: We performed a systematic literature review of the MEDLINE, EMBASE, and Cochrane databases (1990-2011) to identify economic analyses of pediatric urologic topics. Studies were evaluated using published quality metrics.

In utero closure of myelomeningocele does not improve lower urinary tract function.

Purpose: Recent data comparing prenatal to postnatal closure of myelomeningocele showed a decreased need for ventriculoperitoneal shunting and improved lower extremity motor outcomes in patients who underwent closure prenatally. A total of 11 children whose spinal defect was closed in utero were followed at our spina bifida center. We hypothesized that in utero repair of myelomeningocele improves lower urinary tract function compared to postnatal repair.

Association of urolithiasis with systemic conditions among pediatric patients at children's hospitals.

Purpose: Urolithiasis is associated with systemic medical conditions in adults but associations have not been well studied in children. We investigated the association of urolithiasis with diabetes mellitus, hypertension and obesity among children with and without urolithiasis.

Materials And Methods: We performed a matched case-control study using the PHIS (Pediatric Health Information System) database.

Clinical outcomes and long-term resolution in patients with persistent vesicoureteral reflux after open ureteral reimplantation.

Purpose: Success rates of ureteral reimplantation for primary vesicoureteral reflux are high. Few studies document the natural history of children with persistent vesicoureteral reflux. We reviewed their clinical outcomes and long-term resolution.

Prospective measurement of patient exposure to radiation during pediatric ureteroscopy.

Purpose: Few data have been reported regarding radiation exposure during pediatric endourological procedures, including ureteroscopy. We measured radiation exposure during pediatric ureteroscopy and identify opportunities for exposure reduction.

Materials And Methods: We prospectively observed ureteroscopy procedures as part of a quality improvement initiative.

Long-term incidence of urinary tract infection after ureteral reimplantation for primary vesicoureteral reflux.

Objective: To determine the incidence of urinary tract infection (UTI) after ureteral reimplantation (UR) for primary vesicoureteral reflux (VUR).

Materials And Methods: In this retrospective review, the pyelonephritis-free survival of patients with primary VUR who underwent open UR from January 1990 to December 2002 was assessed using a Cox proportional hazards analysis.

Results: 1076 patients underwent open UR for primary VUR.

Durability of antireflux effect of ureteral reimplantation for primary vesicoureteral reflux: findings on long-term cystography.

Objective: To evaluate the long-term durability of successful ureteral reimplantation (UR) for vesicoureteral reflux (VUR) through a review of late cystography (LC) findings.

Materials And Methods: We performed a retrospective chart review of all children with primary VUR who underwent successful open UR (grade 0 VUR into the reimplanted ureter[s] on initial cystogram) at our institution from January 1990 to December 2002. We identified successful UR patients who underwent LC ≥ 1 year after UR and reviewed the results for the presence of recurrent VUR into the reimplanted ureter(s).

Racial variation in timing of pyeloplasty: prenatal versus postnatal diagnosis.

Purpose: We have previously shown that nonwhite patients with ureteropelvic junction obstruction undergo pyeloplasty at a younger age than white patients. The mechanisms behind this finding are unclear, since there is no known racial variation in the natural history of ureteropelvic junction obstruction. We used a detailed clinical database to explain this phenomenon.

Economic and radiation costs of initial imaging approaches after a child's first febrile urinary tract infection.

BACKGROUND. The traditional initial imaging approach following pediatric urinary tract infection is the "bottom-up" approach (cystogram and renal ultrasound). Recently, the "top-down" approach (nuclear renal scan followed by cystogram for abnormal scans only) has gained increasing attention.

Screening for malignancy after augmentation cystoplasty in children with spina bifida: a decision analysis.

Purpose: Augmentation cystoplasty is the mainstay of surgical treatment for medically refractory neurogenic bladder in patients with spina bifida. Concerns regarding an increased risk of malignancy have prompted many centers to consider routine postoperative screening. We examine the potential cost-effectiveness of such screening.