1
|
Kong L, Sevick C, Beltran G, Rove K, Wilcox D, Hecht S. Caregiver decisional regret following reconstructive bladder surgery in children with neurogenic bladder. J Pediatr Urol 2024:S1477-5131(24)00441-8. [PMID: 39278765 DOI: 10.1016/j.jpurol.2024.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 08/22/2024] [Accepted: 08/25/2024] [Indexed: 09/18/2024]
Abstract
BACKGROUND Surgical management for neurogenic bladder requires complex decision-making by physicians, patients, and caregivers. Assessing decisional regret (DR) as a patient-reported outcome among caregivers could inform future counseling and shared decision-making. OBJECTIVE To assess DR among caregivers of children with neurogenic bladder following reconstructive bladder surgery. STUDY DESIGN A questionnaire including a validated DR survey was distributed to English-speaking caregivers of children with neurogenic bladder who had undergone reconstructive bladder surgery at Children's Hospital Colorado. DR scores range from zero to 100, with higher numbers indicating higher regret. Wilcoxon rank sum test and Spearman correlation were performed to assess differences in DR scores by patient demographic factors or disease factors. RESULTS Forty-five of 210 English-speaking caregivers completed the DR survey. The median DR score was 5, with 40% of subjects reporting with a DR score of zero and 24% of subjects with a DR score of 30 or higher. Patient sex and Mitrofanoff leakage were found to be associated with DR, with caregivers of male patients reporting significantly higher DR. Surgical procedure did not have a statistically significant impact on DR scores. DISCUSSION Sparse existing data exploring DR among patients with neurogenic bladder suggest DR following reconstructive bladder surgery is low, with few identifiable predictors of regret. While the majority of caregivers in our study report little or no DR, one quarter of caregivers report moderate to high DR. The limitations of this study include small cohort size, low response rate, exclusion of non-English speaking patients, and the potential for recall bias due to the survey design of the study. CONCLUSION Caregiver DR following bladder reconstruction in children with neurogenic bladder is generally low, however a subset of caregivers reports significant DR. This study suggests that caregivers of male children may have higher DR, a finding that merits further investigation.
Collapse
Affiliation(s)
- Lily Kong
- University of Colorado Anschutz Medical Campus 13001 E 17th Pl., Aurora, CO 80045, USA; Pediatric Urology Research Enterprise, Children's Hospital Colorado 13123 E 16th Ave., Aurora, CO 80045, USA.
| | - Carter Sevick
- University of Colorado Anschutz Medical Campus 13001 E 17th Pl., Aurora, CO 80045, USA; Pediatric Urology Research Enterprise, Children's Hospital Colorado 13123 E 16th Ave., Aurora, CO 80045, USA; Adult and Child Center for Outcomes Research and Delivery Science 1890 N Revere Ct., 3rd Fl., Aurora, CO 80045, USA.
| | - Gemma Beltran
- University of Colorado Anschutz Medical Campus 13001 E 17th Pl., Aurora, CO 80045, USA; Pediatric Urology Research Enterprise, Children's Hospital Colorado 13123 E 16th Ave., Aurora, CO 80045, USA.
| | - Kyle Rove
- Pediatric Urology Research Enterprise, Children's Hospital Colorado 13123 E 16th Ave., Aurora, CO 80045, USA; Children's Hospital Colorado 13123 E 16th Ave., Aurora, CO 80045, USA.
| | - Duncan Wilcox
- Pediatric Urology Research Enterprise, Children's Hospital Colorado 13123 E 16th Ave., Aurora, CO 80045, USA; Children's Hospital Colorado 13123 E 16th Ave., Aurora, CO 80045, USA.
| | - Sarah Hecht
- Doernbecher Children's Hospital 700 SW Campus Dr., Portland, OR 97239, USA.
| |
Collapse
|
2
|
Oamen E, Lowrey T, Tran H, Patel S, Rensing A. Robot-assisted Laparoscopic Urethral Diverticulectomy in a Pediatric Patient. Urology 2023; 177:181-183. [PMID: 37044311 DOI: 10.1016/j.urology.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023]
Abstract
Urethral diverticula are rare in children, especially in the absence of trauma. We present a case of a 9-year-old girl with pain with micturition, incontinence, and recurrent urinary tract infections. Diagnosis of urethral diverticulum was made by magnetic resonance imaging. A robot-assisted transabdominal laparoscopic diverticulectomy was performed without complication. The patient experienced a significant improvement in symptoms.
Collapse
Affiliation(s)
| | - Thomas Lowrey
- OU College of Medicine Department of Urology, Oklahoma City, OK
| | - Hanh Tran
- Oklahoma Children's Hospital OU Health, Oklahoma City, OK
| | - Sanjay Patel
- OU College of Medicine Department of Urology, Oklahoma City, OK
| | - Adam Rensing
- OU College of Medicine Department of Urology, Oklahoma City, OK; Oklahoma Children's Hospital OU Health, Oklahoma City, OK.
| |
Collapse
|
3
|
Recently Described Innovative Reconstruction in Neurogenic Bladder: a Review. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00656-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
4
|
Bowen DK, Cheng EY, Hirsch J, Huang J, Meyer T, Rosoklija I, Chu DI, Yerkes EB. A fresh "slant" on modified Mitchell bladder neck reconstruction: A contemporary single-institution experience. Front Pediatr 2022; 10:933481. [PMID: 36120660 PMCID: PMC9478545 DOI: 10.3389/fped.2022.933481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Patients with neurogenic urinary incontinence due to an incompetent outlet may be offered bladder neck reconstruction, but the quest for the perfect surgical-outlet procedure continues. Our aim was to characterize continence and complications after modified Mitchell urethral lengthening/bladder neck reconstruction (MMBNR) with sling and to introduce a modification of exposure that facilitates subsequent steps of MMBNR. METHODS A single-institution, retrospective cohort study of patients who underwent primary MMBNR between May 2011 and July 2019 was performed. Data on demographics, urodynamic testing, operative details, unanticipated events, continence, bladder changes, and additional procedures were collected. A 2013 modification that permits identification of the incompetent bladder neck prior to urethral unroofing was applied to the last 17 patients. The trigone and bladder neck are exposed via an oblique low anterolateral incision on the bladder. Ureteral reimplantation is not routinely performed. Focal incision of the endopelvic fascia after posterior plate creation limits breadth of blunt dissection for sling placement. Descriptive statistics were utilized. RESULTS A total of 25 patients (13 females) had MMBNR with sling at a median age of 10 years [interquartile range (IQR) 8-11]. Bladder augmentation was performed concurrently in 14/25 (56%) patients. At a median of 5.0 (IQR 3.9-7.5) years follow-up after MMBNR, 9/11 (82%) without bladder augmentation and 13/14 (93%) with bladder augmentation had no leakage per urethra during the day without further continence procedures. Of the three patients with persistent incontinence, two achieved continence with bladder wall Botox injection (overall continence 24/25, 96%). New and recurrent vesicoureteral reflux was noted in five patients and one patient, respectively. Two patients required subsequent bladder augmentation for pressures and one other will likely require it. None have required bladder neck closure or revision. CONCLUSION MMBNR with sling provides promising continence per urethra in neurogenic bladder with low need for secondary continence procedures. Ongoing modifications may achieve elusive total continence.
Collapse
Affiliation(s)
- Diana K Bowen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Earl Y Cheng
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Josephine Hirsch
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Jason Huang
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Theresa Meyer
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Ilina Rosoklija
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - David I Chu
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Elizabeth B Yerkes
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| |
Collapse
|
5
|
Esposito C, Autorino G, Castagnetti M, Cerulo M, Coppola V, Cardone R, Esposito G, Borgogni R, Escolino M. Robotics and future technical developments in pediatric urology. Semin Pediatr Surg 2021; 30:151082. [PMID: 34412879 DOI: 10.1016/j.sempedsurg.2021.151082] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Minimally invasive surgery (MIS) has represented the main innovation in the field of pediatric surgery and urology over the last 30 years. Pediatric MIS is a wide field, ranging from the standard laparoscopic surgery using 3-mm ports to robotics mainly adopted for pediatric urology indications. The aim of this paper was to summarize the current status of robotic surgery in pediatric urology and to evaluate possible future technical developments for this technique. In pediatric urology, many procedures are challenged by the narrow working space available in smaller children, the difficulty to perform complex and long suture lines to repair complex urinary malformations, and the challenge to remove renal or adrenal tumors. The main characteristic of robotic surgery is that the robotic instruments inserted into the abdominal cavity are remotely controlled by the surgeon, who is sitting at a console next to the patient or even far away, avoiding human tremor during complex suturing. Due to the magnification of the operative field view and the six degrees of freedom of the robotic instruments compared to conventional laparoscopic instruments, providing enhanced 3D vision and improved surgeon ergonomics, robot-assisted surgery appears to be beneficial over conventional MIS, especially in complex reconstructive procedures. Currently, there are two robotic systems available on the market and certified for robotic surgery in children: the DaVinci (Intuitive Surgical, since 2001) and Senhance (Transenterix, since 2020). However, almost the totality of papers published in the international literature are focused on robotic procedures using the DaVinci platform. Analyzing the current literature, there is no evidence about the indications where robotics are preferable to conventional MIS approaches. Currently, the main indications of robotic surgery in pediatric urology are: pyeloplasty for ureteropelvic junction obstruction (UPJO), ureteral reimplantation according to Lich Gregoire technique, Mitrofanoff procedure, nephrectomy or partial nephrectomy for oncological indications, removal of renal cysts, bladder neck reconstruction or removal of urinary tract stones. The future developments in this field are certainly represented by intraoperative use of indocyanine green (ICG) fluorescence imaging that permits to have a better vision of vascular anatomy or clearly identify nodes in case of tumors, and by development of 5G technology. The main limitation of robotic surgery today remains the excessive cost of the machine itself and the limited lifespan of robotic instruments. We believe that robotic surgery will surely represent the new field of development in pediatric surgery, but its widespread application will depend on the introduction of new robotic platforms in the market, that will certainly low the costs, and also to the development of smaller size instruments more suitable for pediatric use.
Collapse
Affiliation(s)
- Ciro Esposito
- Pediatric Surgery Unit, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy.
| | - Giuseppe Autorino
- Pediatric Surgery Unit, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Marco Castagnetti
- Division of Pediatric Urology, Medical University of Padua, Padua, Italy
| | - Mariapina Cerulo
- Pediatric Surgery Unit, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Vincenzo Coppola
- Pediatric Surgery Unit, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Roberto Cardone
- Pediatric Surgery Unit, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Giorgia Esposito
- Pediatric Surgery Unit, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Rachele Borgogni
- Pediatric Surgery Unit, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Maria Escolino
- Pediatric Surgery Unit, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| |
Collapse
|
6
|
Silay MS. The sky is clear: robotic surgery is now a valuable player in pediatric urology practice. World J Urol 2020; 38:1819-1820. [PMID: 32621029 DOI: 10.1007/s00345-020-03336-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Mesrur Selcuk Silay
- Division of Pediatric Urology, Department of Urology, School of Medicine, Biruni University, Istanbul, Turkey.
| |
Collapse
|