Novel use of contrast enhanced ultrasonography with urodynamics in children: A comparison study to fluoroscopy.

Introduction: Video urodynamics (UDS) has classically been performed using fluoroscopy (fluoro). Contrast enhanced voiding ultrasonography (ceVUS) has rarely been reported for use with UDS. This is the first study to compare the imaging characteristics of ceVUS versus fluoro UDS.

Viability of contrast-enhanced voiding urosonography as an alternative to fluoroscopy during video urodynamics.

Pediatric urodynamic studies are performed to evaluate bladder function, commonly in conjunction with a voiding cystourethrogram (VCUG). Contrast-enhanced voiding urosonography (CeVUS) has been approved in the evaluation of vesicoureteral reflux and has been shown to have equal or superior diagnostic value to VCUG. In this technical innovation, we have shown that ultrasound contrast agent microbubbles are compatible with the equipment used for urodynamic evaluation.

Long-term Outcomes After Gender-Affirming Surgery: 40-Year Follow-up Study.

Background: Gender dysphoria is a condition that often leads to significant patient morbidity and mortality. Although gender-affirming surgery (GAS) has been offered for more than half a century with clear significant short-term improvement in patient well-being, few studies have evaluated the long-term durability of these outcomes.

Methods: Chart review identified 97 patients who were seen for gender dysphoria at a tertiary care center from 1970 to 1990 with comprehensive preoperative evaluations.

Pyeloplasty with ureteral stent placement in children: Do prophylactic antibiotics serve a purpose?

Objectives: Ureteral stents are commonly used during pyeloplasty to ensure drainage and anastomotic healing. Antibiotic prophylaxis is often used due to concerns for urinary tract infection (UTI). Although many surgeons prescribe prophylactic antibiotics following pyeloplasty, practices vary widely due to lack of clear evidence-based guidelines.

Tele-Urology During COVID-19: Rapid Implementation of Remote Video Visits.

Introduction: COVID-19 has brought unprecedented challenges to the delivery of urological care. Following rapid implementation of remote video visits at our tertiary academic medical center serving a large rural population we describe and assess our experience with planned video visits and ongoing scheduling efforts.

Methods: Patients scheduled for video visits between April 14 and April 27, 2020 were included.

Benefits and barriers to pediatric tele-urology during the COVID-19 pandemic.

Introduction: Telemedicine video visits are an under-utilized form of delivering health care. However due to the COVID-19 pandemic, practices are rapidly adapting telemedicine for patient care. We describe our experience in rapidly introducing video visits in a tertiary academic pediatric urology practice, serving primarily rural patients during the COVID-19 pandemic.

Parental perception of bladder spasms and hematuria after surgery for vesicoureteral reflux: A prospective multicenter study.

Introduction: Anti-reflux surgery success has been well-documented in the literature. Little data exists about the characterization of the child's symptoms regarding pain, bladder spasms, and hematuria following these procedures. These symptoms may affect the choice of surgery for families and providers.

Identifying and addressing training deficiencies in the examination of cryptorchidism-a quality improvement study.

Background: Accurate and timely diagnosis of cryptorchidism by primary care providers (PCPs) is critical to oncologic and fertility outcomes. Physical exam is the mainstay of diagnosis, but little is known about PCPs' skills in examining cryptorchid patients. Patients referred to surgeons for cryptorchidism often have normal or retractile testes on exam, and delayed or missed diagnosis of cryptorchidism may contribute to advanced age at surgical intervention.

Complementary and Integrative Management of Pediatric Lower Urinary Tract Dysfunction Implemented within an Interprofessional Clinic.

Lower urinary tract dysfunction in children is a common multifactorial functional problem that often correlates with bowel dysfunction and behavioral disorders. Ideal management combines integrative therapies that optimize bladder and bowel habits, address behavioral issues, foster mind-body connection, and improve pelvic floor muscle dysfunction. Movement therapies that teach diaphragmatic breathing and relaxation, mind-body awareness, and healthy pelvic floor muscle function are vital for long-term symptom improvement in children.

A practice pattern assessment of members of the Society of Pediatric Urology for evaluation and treatment of urinary tract dilation.

Introduction: Over the last decade the literature, including a multidisciplinary consensus statement, has supported a paradigm shift in management of urinary tract dilation, yet the impact on practice patterns has not been well documented.

Objective: This study aims to elucidate specific practice patterns for treatment of prenatal unilateral urinary tract dilation and to assess surgical intervention patterns for ureteropelvic junction obstruction.

Study Design: An online survey was distributed to 234 pediatric urologists through the Society of Pediatric Urology.

Delayed Partial Nephrectomy for Hydronephrosis After Renal Trauma.

Delayed sequelae following conservative management of renal trauma in the pediatric population are uncommon. Reports of delayed operations to manage these sequelae are even less common. Here we present the case of a 16-year-old male patient who had delayed development of upper urinary tract obstruction with recurrent infections following high-grade renal trauma managed conservatively.

11 Years Later-Isolated Testicular Relapse of ALL After Stem Cell Transplantation Treated With Surgery Only: A Case Report and Review of the Literature.

Despite advances in therapy for childhood acute lymphoblastic leukemia (ALL), relapses continue to occur and are associated with significant morbidity and mortality. Individuals who relapse after stem cell transplantation (SCT) have an especially poor prognosis and typically require intensive systemic therapy to provide any chance of cure. The majority of relapses occur within 2 years following SCT; relapses later than 4 years post SCT are rare.

Bi-Institutional Comparison of Robot-Assisted Laparoscopic Versus Open Ureteroureterostomy in the Pediatric Population.

Purpose: Ureteroureterostomy (UU) is a useful surgical option for the management of duplication anomalies as well as obstructed single system ureters for children. We aimed to evaluate the safety, efficacy, and outcomes of robot-assisted laparoscopic UU (RALUU) compared with open UU (OUU) in the pediatric population.

Patients And Methods: A retrospective review was performed at two institutions including six surgeons' experience with all cases of RALUU and OUU from January 2005 to June 2014.

Laparoscopic percutaneous inguinal hernia repair in children: review of technique and comparison with open surgery.

Introduction: Minimally-invasive approaches for inguinal hernia repair have evolved from conventional laparoscopy requiring placement of three ports and intracorporeal suturing to simple, one and two port extraperitoneal closure techniques. We utilize a single port laparoscopic percutaneous repair (LPHR) technique for selected children requiring operative intervention for inguinal hernia. We suspect that compared to open surgery, LPHR offers shorter operative duration with comparable safety and efficacy.

Identification of adolescent and adult patients receiving pediatric urologic care and establishment of a dedicated transition clinic.

Introduction: Pediatric patients with chronic urologic conditions frequently require lifelong evaluation and treatment. Transition to adult urologic care is critically important as these patients mature and the goals of care shift to include sexual function, fertility, and reconstruction.

Objective: Our objectives are to (1) quantify and describe the population of young adult patients with congenital or childhood-acquired urologic problems who continue to be followed in pediatric urology clinic, to (2) discuss the numerous obstacles to successful care transition, and to (3) outline the design features of the dedicated transition clinic we established in response to the identification of a sizeable population in need.

Minimally invasive techniques for management of the ureterocele and ectopic ureter: upper tract versus lower tract approach.

The optimal management approach for children with ureterocele and complete pyeloureteral duplication, especially in the setting of high-grade ipsilateral vesicoureteral reflux, remains unclear. Trends in surgical management reflect a shift from single-stage open reconstruction toward conservative management and minimally invasive approaches. This article reviews lower tract approaches (endoscopic ureterocele incision and ipsilateral ureteroureterostomy), and upper tract approaches (ureterocele moiety heminephrectomy) in terms of selected operative techniques, patient selection, published outcomes, postoperative care, and follow-up.

The role of regulatory proteins and S-nitrosylation of endothelial nitric oxide synthase in the human clitoris: implications for female sexual function.

Introduction: During female sexual arousal, clitoral blood flow is controlled by endothelial nitric oxide synthase (eNOS) and its product, nitric oxide (NO). The mechanisms regulating eNOS activity and NO bioavailability in the clitoris are largely unknown.

Aim: To identify proteins involved in regulation of eNOS activity within the clitoris and to evaluate the effects of S-nitrosoglutathione reductase (GSNO-R) and eNOS nitrosylation/denitrosylation on clitoral blood flow.

Variability in use of voiding cystourethrogram during initial evaluation of infants with congenital hydronephrosis.

Objective: To identify geographic variability in the imaging of infants with congenital hydronephrosis at initial pediatric urologic evaluation.

Methods: We performed a retrospective review of infants aged ≤ 12 months with congenital hydronephrosis seen as new patients from October 2010 to September 2011 at 3 regionally diverse pediatric urology practices: University of Virginia Hospital, Rady Children's Hospital, and Children's Hospital Colorado. Primary outcomes measured were the type and number of tests ordered at initial evaluation.

Adolescent pelvic pain: interstitial cystitis.

Interstitial cystitis (IC) is a syndrome characterized by urinary urgency and frequency, dysuria, nocturia, and suprapubic pain. Patients are often difficult to treat due to the phenotypic heterogeneity of the disease and the limited efficacy of the treatment options. Treatment regimens must be individualized and tailored through a process of trial and error.