Posterior Cloaca: A Urogenital Rather Than Anorectal Anomaly ‘Persistent Cloaca’ refers to one of the major groups of anorectal anomalies in the female when a single perineal orifice is located at the normal site of the urethra draining both urogenital and alimentary tracts. However, ‘posterior cloaca’ is a new term developed by Pena to describe a unique defect in females in which a common urogenital sinus is deviated posteriorly to open into normally located anorectum (type A) or in the perineum slightly anterior to the anus (type B).
A guide to evaluating survey research methodology in pediatric urology Surveys are one of the most common study designs in healthcare research. They are easy to undertake, have minimal cost and aim to obtain reliable and unbiased information from a population of interest. Surveys in pediatric surgery/urology are an effective tool for gathering information on clinical practices for rare and complex conditions that highlight information on their behavior, institutional disparities, and healthcare paradigms.This education article consists of using a published survey by one of the authors as an example to demonstrate both positive and negative aspects, including limitations, of survey design studies with the purpose of helping pediatric urologists develop a framework to create and critically appraise survey methodology.
A POTPOURRI OF PEDIATRIC UROLOGY I began writing this on December 9, which is the 344th day of this calendar year (though I’m certain that many of us may feel differently). On December 9, 1979, the World Health Organization announced that naturally occurring smallpox had been completely eradicated (one of only two diseases for which this has been accomplished, the other being rinderpest). In the 1700s, variolation with a less-intense variant of the virus (variola minor) was routinely used to protect people against contracting the disease.
Evaluation of Educational Value of YouTube Videos addressing Robotic Pyeloplasty in Children Ureteropelvic junction obstruction (UPJO) is the most frequent obstructive uropathy of the upper urinary tract in children. Video-sharing platforms have become a significant source of visual information for health care providers. Among these platforms, YouTube®, (www.youtube.com), contains a high number of videos free of charge and represents one of the most important and known websites of video-sharing. YouTube® is a widely used open-access video sharing website that allows us to watch an unlimited number of video content, and to upload an infinitive number of videos.
Standardization of penile angle estimation with a semi-automated algorithm Penile curvature (PC) refers to an abnormal bending of the main longitudinal axis of the penis. It is frequently associated to hypospadias. To date, accurate and objective evaluation of PC is not easily reproducible amongst surgeons and there are no stablished protocols on how to measure PC in a standard way and in real-time to guide intraoperative decision making. For this reason, we want to present the results of creating a semi-automated algorithm to establish a reproducible and objective assessment of PC and propose it as a standard protocol for clinical applicability using inanimate 3-D penile models.
Calyx to Parenchymal Ratio (CPR): An unexplored tool and its utility in the follow-up of pyeloplasty Antero-posterior trans pelvic diameter (APD) and renal scintigraphy play a significant role in the diagnosis of pelvi-ureteric junction (PUJ) obstruction and postoperative follow-up following pyeloplasty. However, the APD varies irrespective of improvement, deterioration, or preserved function in a hydronephrotic kidney is not a reliable parameter due to various factors (hydration status, compliance, and reduction pyeloplasty). Calyx to Parenchymal Ratio (CPR) is the ratio of the depth of the calyx and parenchymal thickness measured on ultrasound (USG) in coronal image.
Opioid prescribing is excessive and variable after pediatric ambulatory urologic surgery Acute pain after surgery is one of the most frequent indications for opioid prescribing in children. Opioids are often not stored or disposed of safely after their use, placing children and others in the home at risk for accidental ingestion or intentional misuse. We currently lack evidence-based guidelines for post-operative pain management after common ambulatory pediatric urologic procedures. Thus, each surgeon must decide if and how much opioid to prescribe based on his/her own assumptions of perceived post-operative pain.
Remote consultations in paediatric urology–Not just for pandemics? Although some centres have successfully integrated remote clinics into their paediatric urological practice, for many, remote clinics have developed due to the COVID-19 pandemic. One UK-based institution has integrated remote clinics in their practice for over two years and has developed guidelines considering which conditions may be suitable for remote consultations. These guidelines have been appraised by the European Association of Urology Young Academic Urologists paediatric working group. Through practical experience and anticipated difficulties, we have discussed considerations that paediatric urology departments should ponder when integrating remote clinics into their practice as we move forward from the pandemic.
Gender-dependent bladder response to one-day bladder outlet obstruction BackgroundDevelopment of bladder fibrosis, loss of compliance, and voiding dysfunction are among the severe consequences of various lower urinary conditions, for example, bladder outlet obstruction (BOO), neurogenic bladder, and radiotherapy to the pelvic area. The bladder remodelling results in significant changes in bladder function and architecture, and may ultimately be deleterious for kidney function. The molecular signals underlying pathologic bladder remodelling, as well as the impact of gender, remain poorly understood.
Treatment of obstructive sleep apnea does not treat primary nocturnal enuresis Primary Nocturnal Enuresis (PNE), obesity, and obstructive sleep apnea (OSA) are suggested to share a complex interaction whereby risk for PNE is increased when obesity and airway obstruction are present. We aimed to evaluate whether surgical or medical management of OSA in the treatment of patients with PNE and improves PNE outcomes.
Surveying unmet pediatric urological needs in low- and middle-income countries Access to pediatric urological surgery is low in low-and-middle income countries (LMICs). Pediatric Urological missions have often been undertaken without best practice guidelines. Many strides have been made in pediatric general surgery and other surgery but little in pediatric urology as a component of global surgery.
Barriers in transitioning urologic patients from pediatric to adult care As the advances in medicine continue to emerge, more children with congenital or pediatric-onset chronic urologic conditions are surviving well into adulthood. This imposes an ever rising there is a need for adequate transition of these patients from pediatric to adult care. Despite position statements from multiple heath care organizations and several models proposed in literature, different issues and gaps in urologic transition continue to exist. Major barriers in this transition are adolescence, a challenging time that is characterized by impulsive behavior and risk taking, and the longstanding relation between both patients and paediatric providers.
Sexual function and dysfunction in men with spina bifida Spina bifida is the most common neural tube defect, which can lead to multiple urologic problems stemming from neurogenic bladder including need for lifelong renal monitoring and urinary continence. However, as males with SB age, it is clear that many also start to care about their sexuality, which may also be affected by the disease process.After reviewing the literature, the authors summarize the available information regarding sexual function and sexual dysfunction in adult males with spina bifida, specifically focusing on sexuality education, relationship status/sexual activity, continence, penile rigidity, penile sensation, ability to orgasm, ability to ejaculate, quality of ejaculation and non-genital sexual contact.
Ascending testis: A congenital predetermined condition About 0.8% of boys have undescended testes at 1 year of age. However, the overall rate of orchidopexy is 2.5 times that expected. While studies have shown ascending testes accounting for a proportion of such discrepancy, the aetiology of this ascent remains controversial. In this study, intra-operative findings of patients underwent orchidopexy for ascending testes are evaluated to infer aetiology.
Check cystoscopy in the management of anterior urethral valves in a cohort of pediatric patients Anterior urethral valves (AUV) are a rare cause of lower urinary tract obstruction which could progress to renal damage, Clinical presentation varies according with patient’s age and severity of obstruction, but, in most cases, diagnosis is based on voiding cysto-urethrogram (VCUG). To date, the treatment of choice is endoscopic ablation even if approved guidelines about the overall management of AUVs, including the recognition and treatment of residual valves, are not available.
Challenging proximal hypospadias repairs: An evolution of technique for two stage repairs Proximal hypospadias repair remains challenging. Our approach to the first stage of two-stage proximal hypospadias repairs has evolved from using Byars' flaps to preputial inlay grafts in anatomically suitable cases and pedicled preputial flaps in more complex repairs. We reviewed our outcomes, hypothesizing that inlay grafts and pedicled preputial flaps were associated with lower complication risks than Byars’ flaps.
Self- and proxy-reported outcomes after surgery in people with disorders/differences of sex development (DSD) in Europe (dsd-LIFE) Surgery is performed in many individuals with disorders/differences of sex development (DSD). Irreversibility of some surgical procedures, lack of information about the procedures, and lack of follow-up care for physical and psychological outcomes, lead to wish for more knowledge from both surgeons and patients. After the consensus conference in 2006, multidisciplinary care is provided to a higher degree with psychological support and more restricted surgical procedures. Outcome studies after genital surgery often lack of patient's perspective.
Letter to the Editor: “Protective effect of hydrogen sulﬁde on experimental testicular ischemia reperfusion in rats” Gains and troubles of an experimental study I have just read a previously published article in Journal of Pediatric Urology with great interest which is corresponded by Bozkurt et al. . In this study, the authors investigated protective effect of hydrogen sulﬁde on testicular ischemia-reperfusion (I/R) with an experimental animal model. The study is well designed and I would like to congratulate the authors. While reading the mentioned article, I have identified some limitations and troubles that may lead misunderstood at the readers. Therefore, I would like to make some contributions in order to make this study more valuable and to reveal the issues that need more attention at future for experimental studies.
Correspondence to “Duplex systems: Top-Down or bottom-up approach?” We read with interest the article titled “Duplex systems: Top-down or bottom-up approach?”  The authors preferred the upper tract approach for duplex systems during their initial years of practice (2003–2009) but decided to shift the approach to the lower tract approach (after 2009) because they noted that a significant number of patients required bladder level surgery following a top down approach. The authors attempt to compare outcomes following upper tract and lower tract approach in surgical management of duplex systems.
Preclinical studies of testicular ischemia-reperfusion treatment Testicular torsion occurs annually in appr. 3.8/100.000 under the age of 18 years The condition has a bimodal incidence pattern with peaks in infancy and early adolescence (1). If retorsion is performed within the first few hours, there might be a chance of preservation of testicular function, but when the time period from onset of symptoms exceeds 12 hours, the testicular function is lost. So acute surgery is mandatory, but could it be possible to get a higher success rate with supplementary measures? This is the topic of the preclinical study by ???? (2) where they explore the effect of famotidine, a competitive inhibitor of histamine H2 receptors, normally used to reduce gastric acid, to counteract the reperfusion damages to the testicular tissue?
Metabolic risk factors and the role of prophylaxis in pediatric urolithiasis Suppose that the recurrence in pediatric urolithiasis has a close relationship with metabolic abnormalities and is affected by residual burden and prophylaxis. If so, the recurrence rates could be reduced with effective surgery and appropriate prophylaxis. Here we retrospectively evaluate the metabolic risk factors data of 148 children who were operated on between January 2005 and March 2013 due to kidney stones. All patients underwent percutaneous nephrolithotomy (PCNL), and all were children. Thirteen children had a history of surgery performed to treat urological anomalies.
24-Hour Urine Collection for First Time Pediatric Stone Formers: Is it Worth it? 24-hour urine collections are recommended for motivated first-time stone formers. Given that children have a lifetime potential for recurrences, metabolic work-up has been recommended. 24-hour urine collections can be problematic, especially in children. We sought to study the benefits of 24-hour urine collections in children with stones.
Evaluating quality of patient-reported outcome measures in patients with hypospadias There is growing recognition of the importance of patient-reported outcomes (PROs) in pediatric hypospadias. We have previously presented a conceptual framework for Hypospadias-Specific Health-Related Quality of Life (HRQoL), which posited 5 domains of HRQoL in this population. The framework components (domains) included penile appearance, voiding function, social function, psychological/behavioral function, and pubertal/sexual health. In this work, we investigated the established validity and relevance of PROs within each of these domains for patients with hypospadias.
Dr Jean McIldowie Smellie Image 1Dr Jean Smellie who died at the age of 93 was a paediatrician who specialised in the management of children with urinary infection. Her meticulous research was enormously important in developing our current understanding of the condition and significantly reducing the number of investigations and operations to which children were subjected.
Recurrent ventral curvature after proximal TIP hypospadias repair Most boys with proximal hypospadias have ventral curvature (VC) which must be straightened while preserving the urethral plate to use TIP repair. That is usually done by dorsal plication (DP). However, we reported recurrent VC was commonly found after DP in boys with proximal urethroplasty complications, and have diagnosed VC in patients similarly straightened by WS. We reviewed our proximal TIP patients and now report their recurrent VC.
Nerve-sparing circumcision: Myth or reality? Circumcision is a common procedure. Recently, tissue-sparing approaches have become a matter of interest, and a nerve-sparing approach is described in adults. Although circumcision is common in the practice, the nerve-sparing approach has not been evaluated in the pediatric age group.
Clinical outcomes after increasing bladder outlet resistance without augmentation cystoplasty in neurogenic bladder Patients with neurogenic bladder (NGB) and urinary incontinence (UI) due to low bladder outlet resistance may require bladder neck procedures (BNPs) to achieve continence. These patients may also have reduced bladder capacity and or elevated detrusor storage pressures that require augmentation cystoplasty (AC). AC is not without complications that include risks for bladder rupture, urolithiasis, urinary tract infections and metabolic issues. Avoidance of AC would be helpful in patients with neurogenic urinary incontinence that have safe bladder parameters in the setting of low bladder outlet resistance.
Timing of inguinal hernia following complete primary repair of bladder exstrophy Introduction/background: Bladder exstrophy patients have a high prevalence of inguinal hernia that often become clinically evident following bladder closure. Understanding when the bladder exstrophy patient is under greatest risk of developing an inguinal hernia following bladder closure is important, since incarceration resulting in strangulation of intra-abdominal contents can lead to significant morbidity if not addressed in a timely fashion. Although the incidence and risk factors of inguinal hernia have been reported, the timing of occurrence is not well understood.
Structural and Chemical Heterogeneities of Primary Hyperoxaluria Kidney Stones from Pediatric Patients Calcium oxalate stones are the most common type among stone-forming patients and, in some cases result from predisposed genetic conditions. In this work, we examined the differences in structure and chemical composition between oxalate stones from patients from three groups: 1) pediatric patients that were genetically predisposed (primary hyperoxaluria) to form stones (PPH); 2) control pediatric patients that did not have such genetic predisposition (PN-PH); 3) adult patients that formed oxalate stones without the genetic predisposition (A-CaOx).
Additional VCUG-related parameters for predicting the success of endoscopic injection in children with primary vesicoureteral reflux Prediction of vesicoureteral reflux (VUR) prognosis and decision for treatment are usually made according to the reflux grading classification. But the management of VUR is still controversial since there are difficulties in distinguishing reflux grade due to inter- and intra-observer variations. Previous studies have demonstrated that the distal ureteral diameter ratio (UDR) on voiding cystourethrography (VCUG) may be more predictive for clinical prognosis than reflux grade. We aimed to predict the success of endoscopic injection in primary VUR by creating new models that include other additional parameters (timing of reflux, delayed post-voiding contrast drainage of the upper urinary tract) as well as UDR.
Parental preferences for vesicoureteral reflux treatment: Profile case best-worst scaling Vesicoureteral reflux is a common pediatric urologic condition that often has several reasonable treatment options depending on condition severity. In order to choose the best treatment for their child, parents are expected to make judgements that weigh attributes such as treatment cost, effectiveness, and complication rate. Prior research has shown that factors such as treating hospital and surgeon also influence patient treatment choice.
Antenatal biological models in the characterization and research of congenital lower urinary tract disorders Congenital lower urinary tract disorders are a family of diseases affecting both urinary storage and voiding as well as upstream kidney function. Current treatments include surgical reconstruction but many children still fail to achieve urethral continence or progress to chronic kidney disease. New therapies can only be achieved through undertaking research studies to enhance our understanding of congenital lower urinary tract disorders. Animal models form a critical component of this research, a corner of the triangle composed of human in-vitro studies and clinical research.
Response to letter to the editor Re: Device outcomes in pediatric sacral neuromodulation: A single center series of 187 patients We appreciate the thoughtful comments from the letter writers concerning our study. The primary goal of our study was to address the repeat surgery rate in pediatric SNM, not to address pediatric SNM efficacy. The latter has been previously addressed and supported by multiple studies. Admittedly, ours is a retrospective study over a long period of time (2002–2019) during which the horizon of treatment options for pediatric BBD was expanding. Likewise, guidelines defining the sub-types of LUTD have been under development over the course of our study period.
What the Editors are Reading – Quality improvement and patient safety Covid-19 continues to impact all of us in so many ways. At the time of this writing, Great Britain is now enduring a prolonged lockdown and both Canada and the USA are experiencing unprecedented numbers of patients infected and dying of the virus. It certainly is a time for reflection. There has been much more time afforded to me to scan the literature relating to quality improvement and patient safety (QIPS). Pertinent to QIPS is leadership development and equality, as evidenced in the 4 articles reviewed in this volume of What the Editors Are Reading.
Urodynamics in Posterior Urethral Valve: Pursuit of prognostication or optimisation Detrusor dysfunction is known to persist in several patients of Posterior Urethral Valve (PUV) after successful fulguration leading to progressive deterioration of renal function. Persistent bladder outlet obstruction (BOO) in the form of bladder neck hypertrophy, residual valves or strictures may contribute to progressive detrusor dysfunction. These are assessed radiologically or cystoscopically and are managed variedly by anticholinergics, alpha-adrenergic blockers or even bladder neck incision.
Stretched penile length and anogenital distance in Egyptian boys aged one month to five years In children with isolated unilateral undescended testis mechanical anomalies are commonly implicated and a diagnosis of simple hypospadius implies that the rest of the external genitalia are normal. Patients with disorders of sexual development, by contrast, have other associated genital anomalies including micropenis and should be referred to the endocrinologist for hormonal assessment before surgical correction of undescended testis or hypospadius. Early diagnosis of abnormal penile size is important but proper assessment begins with defining the normal population-specific age-appropriate reference range.
Assisted reproductive technologies and the risk of congenital urogenital tract malformations: A systematic review and meta-analysis A systematic review was conducted to evaluate the relationship between ART and the risk of urogenital tract malformations, especially hypospadias and cryptorchidism. Thirty-three papers were selected. Meta-analysis showed that ART was correlated with an increased risk of urogenital tract malformation in offspring (odds ratio (OR) = 1.61, 95% confidence interval (CI): 1.41–1.85), hypospadias (OR = 1.87, 95% CI: 1.47–2.40) and cryptorchidism (OR = 1.83, 95% CI: 1.54–2.18). Among offspring conceived by ART, multiple pregnancies appeared to result in a higher risk of urogenital tract malformation than singleton pregnancies (OR = 1.42, 95% CI: 0.99–2.04; P = 0.058).
Laparoscopic ureteral reconstruction in infant with congenital mid ureteric valve Congenital mid ureteric valve (MUV) stenosis is a very rare cause of ureteric obstruction and hydronephrosis (HN) in children. We describe how we manage laparoscopically one case of a patient with congenital MUV.We describe a 6-month-old boy born with antenatal left HN, with an anteroposterior diameter (APD) of 1,5 cm. Follow-up renal ultrasound at 3 months of age showed an increase in left kidney HN, approximately 2.5 cm below the PUJ associated with distal stenosis. Renal scintigraphy with DTPA showed an obstructive pattern.
Timing and outcomes of testicular torsion during the COVID-19 crisis During the COVID-19 crisis, there has been widespread reporting that non-COVID-19-related medical care has been delayed, even for emergent conditions. Testicular torsion is an emergent condition with higher risk of testicular loss with longer ischemic times. We sought to investigate whether patients with testicular torsion had longer time from symptom onset to initial presentation, longer total ischemic time, and higher rate of orchiectomy during the pandemic.
The value of an additional scrotal suture during orchidopexy Undescended testes present in 3–5% of male infants at birth. Orchidopexy is indicated to improve fertility and reduce the risk of testicular tumors. Guidelines recommend orchidopexy as early as six months of age, treatment should be finished within the age of 18 months. So far, no unequivocal proof demonstrated the superiority of one of the different surgical techniques.
Editorial Comment on “Management and outcome in Dehisced Exstrophy with a simplified bladder re-closure and further reconstruction” Management of failed exstrophy closure remains a challenging endeavor, and efforts continue to find a single strategy to achieve the outcomes of abdominal wall reconstruction, bladder closure, and possible eventual voided continence. Unfortunately, as most surgeons, taking on these complex and difficult repairs realize, the potential variations in anatomy (preexisting, or modified due to prior reconstruction) are only limited by the numbers of patients that are evaluated. Management therefore should be individualized, based on the presenting anatomy and the availability of resources at the particular treating institution.
A novel approach in the intraoperative management of ovotesticular DSD Ovotesticular disorder of sex development (OTD) management remains challenging. In OTD, cautious gonadal evaluation and separation of ovarian and testicular components might be required to avoid virilization of a patient with female identity. Herein we report our minimal invasive approach in this very rare condition. The gonads are externalized under laparoscopic control through trocar openings. Intraoperative ovotesticular ultrasonography (US) is used for clear identification of ovarian and testicular tissue which can then be safely separated.
Urological profile of children with microcephaly and congenital Zika syndrome An outbreak of Zika virus disease, a self-limiting arbovirus infection involving skin rash and fever, occurred in Brazil in 2015 and was followed by an increase in newborns with microcephaly and brain malformations. Although two recent studies reported neurogenic bladder in children with microcephaly and congenital Zika syndrome (CZS), urologic evaluation is not yet routine. Objective: To investigate the urological profile of children with microcephaly and CZS.
Standardized protocol for voiding cystourethrogram: Are recommendations being followed? Voiding cystourethrogram (VCUG) images the urethra and bladder during filling and emptying, as well as ureters and kidneys when vesicoureteral reflux (VUR) is present, providing detailed information about both anatomical and functional status of the urinary tract. Given the importance of information obtained, and the varying quality depending on VCUG technique and radiology reporting, the American Academy of Pediatrics Sections on Urology and Radiology published a joint standardized VCUG protocol in 2016.
Intravascular extension of Wilms tumor: Characteristics of tumor thrombus and their impact on outcomes Studies describing intravascular involvement in Wilms tumor have focused on illustrating individual institutional experience and the elements of surgical management. Thrombus characteristics like extent, patterns of regression, and correlation with the surgical findings, intraluminal adhesion, and viable tumor in the thrombus, and patency of the inferior vena cava (IVC) have not been systematically described.
Benefits and barriers to pediatric tele-urology during the COVID-19 pandemic 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.
Correspondence to “the usefulness of ultrasound examination in detecting testicular nubbin in Japanese boys with non-palpable testes” The authors report the usefulness of ultrasound (US) examination in detecting testicular nubbin (TN) in boys with non-palpable testis. They used US in detecting the testicular nubbin and choice was offered to the patients to either opt for follow-up or testicular nubbin excision. None of these patients underwent diagnostic laparoscopy to look for intra-abdominal testis. This approach deviates from the standard practice of diagnostic laparoscopy in all cases of impalpable testis. The American Urological Association and European Society for Pediatric Urology also do not recommend any radiological imaging for impalpable undescended testis (UDT).
Management and outcome in dehisced exstrophy with a simplified bladder re-closure and further reconstruction The traditionally accepted method of bladder re closure in dehisced exstrophy involves osteotomy assisted pubic bone approximation (PBA). Continent voluntary voiding is achieved in a small proportion of children sometimes after many operative procedures. We propose a simple yet reliable method of repair of the dehisced bladder using Rectus abdominis muscle flap (RAM) instead of PBA to bridge the inter-pubic gap, followed by concomitant or subsequent bladder augmentation (BA).
Meeting report on the NIDDK/AUA Workshop on Congenital Anomalies of External Genitalia: challenges and opportunities for translational research Congenital anomalies of the external genitalia (CAEG) are a prevalent and serious public health concern with lifelong impacts on the urinary function, sexual health, fertility, tumor development, and psychosocial wellbeing of affected individuals. Complications of treatment are frequent, and data reflecting long-term outcomes in adulthood are limited. To identify a path forward to improve treatments and realize the possibility of preventing CAEG, the National Institute of Diabetes and Digestive and Kidney Diseases and the American Urological Association convened researchers from a range of disciplines to coordinate research efforts to fully understand the different etiologies of these common conditions, subsequent variation in clinical phenotypes, and best practices for long term surgical success.
Evaluation of parental sociocultural background and education level in response to pediatric testis torsion Acute scrotal pain (ASP) remains one of the most common male urologic emergencies in the pediatric age group. The most concerning outcome of testicular torsion (TT) is the need for orchiectomy, which has a negative impact on the child's development in general and on sexual development and psychology in particular. Time is the most important factor in the treatment of TT. Parental awareness of ASP indicating the possibility of TT is a significant factor in children's hospital admission time. Sociocultural background may be an indicator in parental awareness.
How geneticists think about Differences/Disorders of Sexual Development (DSD): A conversation A multidisciplinary DSD clinic offers the opportunity for different specialties to learn from each other, as each provides their own perspective and expertise to the management of these complex patients, leading to collaborative care. For the patient, a multi-disciplinary clinic can improve access to care and decrease stress, as patients see all of the specialists on one day. For urologists seeing patients with DSD within a multi-disciplinary DSD clinic as well as independently, understanding what other specialists provide can help facilitate care and referral.
Acute urinary retention in children Acute urinary retention is a common emergency in adult patients, foremost in older men. In childhood urinary retention is a rare entity with only sparse literature on the etiology.
Adjuvant pharmacological and surgical therapy for testicular torsion: Current state of the art Although the consequences of testicular torsion (TT) have been recognized for centuries, little progress has been made to improve outcomes beyond those seen with timely scrotal exploration. Even with testicular salvage, ischemia/reperfusion injury cause significant atrophy and functional impairment. Recent efforts have sought to identify adjuvant pharmacological or surgical interventions that may attenuate these consequences. In this review, we assess the evidence supporting clinical use of these nascent interventions.
WITHDRAWN: Introductory editorial – Basic science The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.jpurol.2016.01.009. The duplicate article has therefore been withdrawn.The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
CME credits for reviews The Editorial Board of the Journal of Pediatric Urology is pleased to announce that starting in 2021, reviewers will be able to claim pediatric specific CME credits for manuscript reviews. This is made possible through a generous grant from the Journal of Pediatric Urology Company. The CME accreditation will be done through the Warren Alpert Medical School of Brown University. We would like to thank Maria Sullivan and Andrea Goldstein for their guidance, patience, and expertise in bring this to fruition.
Editorial “There are decades where nothing happens; and there are weeks where decades happen”Vladimir Ilyich Lenin
Aviso para pacientes:
Esta página contiene información urológica dirigida a profesionales de la sanidad.
Si tiene algún problema relacionado con esta patología,
consulte con su urólogo o médico de familia.
Si desea información diseñada para pacientes y público general. puede visitar:
Portal de Información Urológica para Pacientes