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Oh KT, Lim AN, Ibrahim AR, Kim JH. Transitional Urology in Korea: Initial Insights Through a Cross-Sectional Study. Int Neurourol J 2024; 28:162-167. [PMID: 38956776 PMCID: PMC11222824 DOI: 10.5213/inj.2448186.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/15/2024] [Indexed: 07/04/2024] Open
Abstract
PURPOSE In Korea, the field of transitional urology (TU) is in its nascent stages, with its introduction only beginning. This study aims to evaluate the existing state of TU prior to implementing a transition protocol, and to identify key areas of focus for the development of an effective transition protocol. METHODS From June 1, 2021 to May 31, 2023, clinical data were retrospectively collected for patients who visited the adult urology or pediatric urology outpatient departments of this hospital and were aged 10 or older, with medical conditions falling under the category of TU. We analyzed the patient distribution across different disease groups. The transitional stages were categorized from T1, indicating initial care by pediatric urologists, to T4, denoting complete transition to adult care. 'T4x' was used for patients with unknown medical histories, and 'T4only' for those who had never been under pediatric urology care. RESULTS During a 2-year period, a total of 1,484 patients received outpatient care for diseases in TU field. The most prevalent diseases were hypospadias (40.4%), spinal bifida (37.3%), and congenital ureteral anomalies (17.7%), with other conditions accounting for 4.6%. Among 553 spinal bifida patients, only 5.3% completed transitional care (T4), while 80.1% were in the initial phase (T1). For patients introduced to adult urology (T2-T4), 37.7% reached T4, highlighting a marked increase in transition completion within this subset (P<0.001). CONCLUSION TU in Korea is in its nascent stage, with a significant gap in the initiation and completion of transitional care for patients with congenital urologic conditions. Early initiation and active engagement in transitional care are crucial for successful transition. This study highlights the need for structured transition protocols to address the complex needs of this patient population.
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Affiliation(s)
- Kyung Tak Oh
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Avelyn Noble Lim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- Subsection of Urology, Department of Surgery, University of Santo Tomas Hospital, Manilla, the Philippines
| | - Alwadai Raed Ibrahim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- Department of Urology, King Abdullah Hospital, Bishah, Assir, Saudi Arabia
| | - Jang Hwan Kim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Bencic M, Bizic M, Joksic I, Stojanovic B, Djordjevic ML. Isolated Male Epispadias Repair: Long-Term Outcomes. Life (Basel) 2024; 14:446. [PMID: 38672717 PMCID: PMC11050961 DOI: 10.3390/life14040446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Isolated male epispadias is one of the most severe congenital genital anomalies that require surgical correction. The goals of the surgery are to reach good aesthetic and functional outcomes. The aim of this retrospective study was to analyze the long-term outcomes of surgical reconstruction of male epispadias. A total of 31 patients with a mean age of 17 years, who underwent surgical repair of isolated male epispadias from January 2000 to January 2015, were involved. The main outcome measures were defined as: aesthetic outcome, continence, postoperative complications, sexual function, and quality of life. The follow-up period ranged from 8 to 23 years, with an average of 14.4 years. Each patients underwent an average of 2.2 surgical procedures in this period. The most common postoperative complications were urethral fistula and residual curvature, in 22.6% and 12.9%, respectively. Satisfactory aesthetic outcome was reported in 71.4% of cases. The repair of male epispadias usually includes more than two procedures with satisfactory aesthetic outcome. Unsolved urinary incontinence remains a significant issue and has a high impact on the quality of life. Follow-up should be extended even after complete sexual maturity. Comprehensive long-term evaluation is necessary for proper treatment of isolated epispadias.
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Affiliation(s)
- Marko Bencic
- Belgrade Center for Genitourinary Reconstructive Surgery, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marta Bizic
- Belgrade Center for Genitourinary Reconstructive Surgery, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivana Joksic
- Department of Genetics, Gynecology and Obstetrics Clinic “Narodni Front”, 11000 Belgrade, Serbia
| | - Borko Stojanovic
- Belgrade Center for Genitourinary Reconstructive Surgery, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Miroslav L. Djordjevic
- Belgrade Center for Genitourinary Reconstructive Surgery, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Örtqvist L, Holmdahl G, Borg H, Bjornland K, Lilja H, Stenström P, Qvist N, Hagen TS, Pakarinen M, Wester T, Rintala R. Bowel Control, Bladder Function, and Quality of Life in Children with Cloacal Malformations. J Pediatr Surg 2023; 58:1942-1948. [PMID: 36635159 DOI: 10.1016/j.jpedsurg.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/22/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Long-term outcomes of cloacal malformations remain unclear. We evaluated postoperative bowel control, bladder function and quality of life in patients under 18 years of age with cloaca. MATERIALS AND METHODS This was a multi-center cross-sectional observational study accomplished by the Nordic Pediatric Surgery Research Consortium. Patients with a cloacal malformation, 4-17 years of age, were eligible. Data including patient characteristics, surgical procedures, and complications were retrieved from case records. Established questionnaires with normative control values evaluating bowel function, bladder function, and health-related quality of life (HRQoL) were sent to the patients and their caregivers. The study was approved by the participating center's Ethics Review Authorities. RESULTS Twenty-six (67%) of 39 eligible patients with median age 9.5 (range, 4-17) years responded. Twenty-one (81%) patients had a common channel ≤3 cm. Imaging confirmed sacral anomalies in 11 patients and spinal cord abnormalities in nine. Excluding patients with stoma (n = 5), median bowel function score was 12 [7-19], and 5 patients (20%) reported a bowel function score ≥17, approaching normal bowel control level. Bowel management increased proportion of socially continent school-aged children to 52%. Six (23%) patients had a permanent urinary diversion or used clean intermittent catheterization (CIC), while majority (70%) of the remaining patients were urinary continent. The reported HRQoL was comparable to healthy Swedish children. CONCLUSION Whilst well-preserved spontaneous bowel control was rare, a majority of patients were dry for urine without any additional procedures. Few patients experienced social problems or negative impact on HRQoL due to bladder or bowel dysfunction. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Lisa Örtqvist
- Karolinska Institutet, Department of Women's and Children's Health, Stockholm, Sweden; Karolinska University Hospital, Department of Pediatric Surgery, Stockholm, Sweden.
| | - Gundela Holmdahl
- Karolinska Institutet, Department of Women's and Children's Health, Stockholm, Sweden; Karolinska University Hospital, Department of Pediatric Surgery, Stockholm, Sweden
| | - Helena Borg
- Department of Pediatric Surgery, Drottning Silvia's Children's Hospital, Göteborg, Sweden
| | - Kristine Bjornland
- Department of Pediatric Surgery, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Helene Lilja
- Karolinska Institutet, Department of Women's and Children's Health, Stockholm, Sweden; Karolinska University Hospital, Department of Pediatric Surgery, Stockholm, Sweden
| | - Pernilla Stenström
- Department of Pediatric Surgery, Children's Hospital, Skåne University Hospital Lund, Lund University, Sweden
| | - Niels Qvist
- Research Unit for Surgery, and Centre of Excellence in Gastrointestinal Diseases and Malformations in Infancy and Childhood (GAIN), Odense University Hospital, Odense, Denmark, University of Southern Denmark, Odense, Denmark
| | - Trine Sæther Hagen
- Department of Pediatric Surgery, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Mikko Pakarinen
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, The New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tomas Wester
- Karolinska Institutet, Department of Women's and Children's Health, Stockholm, Sweden; Karolinska University Hospital, Department of Pediatric Surgery, Stockholm, Sweden
| | - Risto Rintala
- Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, The New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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O'Kelly F, t'Hoen LA, Burgu B, Banuelos Marco B, Lammers RJM, Sforza S, Hiess M, Bindi E, Baydilli N, Donmez MI, Paraboschi I, Atwa A, Spinoit AF, Haid B, Radmayr C, Silay MS. A cross-sectional analysis of paediatric urologists' current practices, opinions and areas of perceived importance in the delivery of adolescent & transitional care. J Pediatr Urol 2023:S1477-5131(23)00152-3. [PMID: 37173199 DOI: 10.1016/j.jpurol.2023.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/01/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Complex urological anomalies often require continued care as patients reach adulthood. Adequate transition for adolescents with ongoing urological care needs is critical to allow for seamless care in adult hospitals. Studies have shown that this can lead to improved patient and parental satisfaction, and lower utilisation of unplanned inpatient beds and emergency department visits. There is currently no ESPU-EAU consensus on the adequate mechanism and very few individual papers examining the role of urological transition for these patients in a European setting. This study aimed to identify current practice patterns in paediatric urologists providing adolescent/transitional care, to assess their opinions towards formal transition and to look for variations in care. This has implications for long-term patient health and specialist care. METHODS An 18-item cross-sectional survey was compiled and pre-approved through the EAU-EWPU and ESPU board offices prior to dissemination to all registered ordinary members affiliated with the ESPU. This was created using a mini-Delphi method through the EWPU research meetings to provide current semi-quantitative data relating to current opinions and attitudes of this cohort. RESULTS A total of 172 respondents (55% paediatric general surgery; 45% urology) across 28 countries completed the survey. The majority of respondents were in practice >10 years and spent >80% time in paediatric urology. There was no formal transition process according to 50% respondents and over half of those that did have less than 1/month, with <10% using validated questionnaires. More than two-thirds respondents continued to provide care after transition, as >70% units had no designated corresponding adult service. Furthermore, 93% paediatric believe a formal transition service to be very important, using a multidisciplinary framework. A pareto chart demonstrated 10 specific conditions to be of most interest in transition to adulthood. CONCLUSION This is the first study to assess the requirements of paediatric urologists for adequate transitional care, however due to the nature of the survey's distribution, this was a non-scientific poll based on a convenience sample of respondents. It is critical that dual-trained or adult-trained urologists with a specific interest in paediatric urology work with current paediatric urologists in a multidisciplinary fashion to facilitate early transition based on the adolescent's developmental and biopsychosocial requirements. National urological and paediatric surgical societies need to make transitional urology a priority. The ESPU and EAU should collaboratively consider developing transitional urology guidelines to allow a framework by which this can occur.
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Affiliation(s)
- F O'Kelly
- Division of Paediatric Urology, Beacon Hospital, University College Dublin, Dublin, Ireland.
| | - L A t'Hoen
- Department of Pediatric Urology, Erasmus MC University Medical Center, Rotterdam-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - B Burgu
- Department of Pediatric Urology, Ankara University School of Medicine, Ankara, Turkey
| | - B Banuelos Marco
- Department of Urology, University Hospital Clinico San Carlos, Madrid, Spain
| | - R J M Lammers
- Department of Urology, University Medical Center Groningen, Groningen, the Netherlands
| | - S Sforza
- Paediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy
| | - M Hiess
- Department of Pediatric Urology, Hospital of the Sisters of Charity Linz, Austria
| | - E Bindi
- AOU Delle Marche, Ospedale Pediatrico G Salesi, Department of Pediatric Surgery, Ancona, Italy
| | - N Baydilli
- Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - M I Donmez
- Division of Pediatric Urology, Department of Urology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - I Paraboschi
- Department of Pediatric Urology, IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Atwa
- Urology Department, Urology and Nephrology Center, Mansoura University, Egypt
| | - A F Spinoit
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - B Haid
- Department of Pediatric Urology, Hospital of the Sisters of Charity Linz, Austria
| | - C Radmayr
- Department of Urology, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - M S Silay
- Department of Urology, Biruni University, Istanbul, Turkey
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Morlacco A, Bianco M, Dal Moro F. Transitional care in urology: the road to independence. Nat Rev Urol 2022; 19:691-692. [PMID: 36068352 DOI: 10.1038/s41585-022-00653-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alessandro Morlacco
- Pediatric Urology Unit, Azienda Ospedale-Università di Padova, Padova, Italy.
- Department of Surgical, Oncological and GE sciences (DISCOG), Università degli Studi di Padova, Padova, Italy.
| | - Marta Bianco
- Pediatric Urology Unit, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Fabrizio Dal Moro
- Pediatric Urology Unit, Azienda Ospedale-Università di Padova, Padova, Italy
- Department of Surgical, Oncological and GE sciences (DISCOG), Università degli Studi di Padova, Padova, Italy
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Voiding Dysfunction in Transitional Urology Patients: Common Issues and Management Strategies. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00671-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Wood D. A potpourri of pediatric urology. J Pediatr Urol 2022; 18:698-699. [PMID: 36503844 DOI: 10.1016/j.jpurol.2022.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Dan Wood
- University College London Hospitals, Adolescent Urology, London W1G8PH, United Kingdom.
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Psychosocial aspects of sports medicine in pediatric athletes: Current concepts in the 21 st century. Dis Mon 2022:101482. [PMID: 36100481 DOI: 10.1016/j.disamonth.2022.101482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Behavioral aspects of organized sports activity for pediatric athletes are considered in a world consumed with winning at all costs. In the first part of this treatise, we deal with a number of themes faced by our children in their sports play. These concepts include the lure of sports, sports attrition, the mental health of pediatric athletes (i.e., effects of stress, anxiety, depression, suicide in athletes, ADHD and stimulants, coping with injuries, drug use, and eating disorders), violence in sports (i.e., concepts of the abused athlete including sexual abuse), dealing with supervisors (i.e., coaches, parents), peers, the talented athlete, early sports specialization and sports clubs. In the second part of this discussion, we cover ergolytic agents consumed by young athletes in attempts to win at all costs. Sports doping agents covered include anabolic steroids (anabolic-androgenic steroids or AAS), androstenedione, dehydroepiandrostenedione (DHEA), human growth hormone (hGH; also its human recombinant homologue: rhGH), clenbuterol, creatine, gamma hydroxybutyrate (GHB), amphetamines, caffeine and ephedrine. Also considered are blood doping that includes erythropoietin (EPO) and concepts of gene doping. In the last section of this discussion, we look at disabled pediatric athletes that include such concepts as athletes with spinal cord injuries (SCIs), myelomeningocele, cerebral palsy, wheelchair athletes, and amputee athletes; also covered are pediatric athletes with visual impairment, deafness, and those with intellectual disability including Down syndrome. In addition, concepts of autonomic dysreflexia, boosting and atlantoaxial instability are emphasized. We conclude that clinicians and society should protect our precious pediatric athletes who face many challenges in their involvement with organized sports in a world obsessed with winning. There is much we can do to help our young athletes find benefit from sports play while avoiding or blunting negative consequences of organized sport activities.
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Streur CS, Floody EA, Lapham ZK, Sandberg DE. The transition to independence and adult care for women with Turner syndrome: Current status and priorities of 1338 women and parents. Am J Med Genet A 2022; 188:400-413. [PMID: 34773722 PMCID: PMC8758527 DOI: 10.1002/ajmg.a.62564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/31/2021] [Accepted: 10/15/2021] [Indexed: 02/03/2023]
Abstract
Transitioning to adult health care and functioning is crucial for youth and young adults with special health care needs, such as those with Turner syndrome (TS). The International Turner Syndrome Consensus Group developed clinical practice guidelines to improve this transition. This study sought to evaluate how effectively they have been implemented and whether they align with the priorities of women with TS and families of girls and women with TS. A web-based survey was offered to those affiliated with major TS support organizations, with 1338 successfully responding (n = 543 women [≥18 years]; n = 232 parents of a woman [≥18 years]; and n = 563 parents of a girl with TS [<18 years]). Findings demonstrated that while most women transitioned to adult primary care providers, follow-up with key specialists was lacking. Women and families prioritized flexibility in appointments and designating one provider to oversee all their TS-related care. They identified health care coverage as a barrier to receiving care. The transition process to adult care and independence commonly occurred after girls become legal adults. Together, these findings serve to inform strategies to improve the delivery of transitional care for girls and women with TS.
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Affiliation(s)
- Courtney S. Streur
- Division of Pediatric Urology, Department of Urology, University of Michigan,Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan
| | | | - Zoe K. Lapham
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan
| | - David E. Sandberg
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan,Division of Pediatric Psychology, Department of Pediatrics, University of Michigan
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Affiliation(s)
- Dan Wood
- University College London Hospitals, London, NW1 2BU, UK.
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