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Dalela D, Schlomer B. Antibiotic Prophylaxis in Infants With Grade III, IV, or V Vesicoureteral Reflux. J Urol 2024; 211:620-621. [PMID: 38353206 DOI: 10.1097/ju.0000000000003889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024]
Affiliation(s)
- Deepansh Dalela
- Department of Pediatric Urology, Children's Health Texas University of Texas Southwestern Medical Center, Dallas, Texas
| | - Bruce Schlomer
- Department of Pediatric Urology, Children's Health Texas University of Texas Southwestern Medical Center, Dallas, Texas
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Dalela D, Batie S, Carolan A, Schlomer B, Collins R, Jacobs M. Renal medullary carcinoma: the zebra amongst the horses. Urology 2024:S0090-4295(24)00151-1. [PMID: 38467288 DOI: 10.1016/j.urology.2024.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
A 13-year old Latino male who presented with recurrent gross hematuria, 5-cm right sided poorly defined heterogeneous mass, enlarged retrocaval lymph nodes and 1.2 cm paratracheal lymph node. Given the need for multiple blood transfusions, robot-assisted radical nephrectomy with lymph node dissection was performed. Pathology revealed pT3a high-grade tumor, clear margins, and positive lymph node. Additionally, with multiple sickled RBCs and loss of staining of SMARCB1 in tumor specimen, and hemoglobin electrophoresis suggesting sickle cell trait, diagnosis of metastatic renal medullary carcinoma was confirmed. The patient was enrolled into COG AREN 03B2 trial, and has completed 10 cycles of carboplatin/gemcitabine/bortezomib alternating with cisplatin/gemcitabine/paclitaxel, with no evidence of recurrent disease 9 months post-surgery.
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Affiliation(s)
- Deepansh Dalela
- Pediatric Urology, Children's Medical Center, UT Southwestern Medical Center, Dallas, TX.
| | - Shane Batie
- Pediatric Urology, Children's Medical Center, UT Southwestern Medical Center, Dallas, TX
| | - Alexandra Carolan
- Pediatric Urology, Children's Medical Center, UT Southwestern Medical Center, Dallas, TX
| | - Bruce Schlomer
- Pediatric Urology, Children's Medical Center, UT Southwestern Medical Center, Dallas, TX
| | - Rebecca Collins
- Department of Pathology, Children's Medical Center, UT Southwestern Medical Center, Dallas, TX
| | - Micah Jacobs
- Pediatric Urology, Children's Medical Center, UT Southwestern Medical Center, Dallas, TX
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Schlomer B. Editorial Comment. J Urol 2024; 211:35-36. [PMID: 37948752 DOI: 10.1097/ju.0000000000003763.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023]
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Jacobs M, Schlomer B. Commentary to 'What makes the bladder neck sling procedure a success in a selected population of children and adolescents? A STROBE-compliant investigation'. J Pediatr Urol 2022; 18:199-200. [PMID: 35410805 DOI: 10.1016/j.jpurol.2022.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 01/31/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Micah Jacobs
- Childrens Medical Center - Dallas, Dallas, TX United States.
| | - Bruce Schlomer
- Childrens Medical Center - Dallas, Dallas, TX United States.
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Edwards A, Hammer M, Artunduaga M, Peters C, Jacobs M, Schlomer B. Renal ultrasound to evaluate for blunt renal trauma in children: A retrospective comparison to contrast enhanced CT imaging. J Pediatr Urol 2020; 16:557.e1-557.e7. [PMID: 32446678 DOI: 10.1016/j.jpurol.2020.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/13/2020] [Accepted: 04/18/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The standard imaging modality for hemodynamically stable blunt abdominal trauma patients is a contrast enhanced CT scan, which is reflected in the current AUA urotrauma guidelines. This comes, however, with radiation exposure and the potential sequalae of IV contrast administration in the pediatric patient. OBJECTIVE We hypothesize that ultrasound imaging would be able to diagnose and rule out clinically significant renal injuries when compared to the gold standard of CT scan in the setting of pediatric blunt abdominal trauma. STUDY DESIGN All children <18 years of age who were evaluated for blunt abdominal trauma who had a CT scan and ultrasound imaging of kidneys were identified. The ultrasound images were reviewed by four reviewers who were blinded to CT results and all clinical information. The ability of ultrasound to diagnose and rule out clinically significant renal injury was evaluated by diagnostic test performance characteristics including sensitivity, specificity, negative predictive value and positive predictive value. RESULTS There were 76 patients identified, 24 of which had a renal injury (1 bilateral) diagnosed by CT scan for a total of 25 injuries in 152 renal units. There were six grade I-II injuries and 19 grade III-V injuries. The sensitivity of the four blinded reviewers by ultrasound alone to detect the 19 grade III-V injuries ranged from 79 to 100% with NPV between 97 and 100%. Three of the four reviewers identified all 19 grade III-V injuries by ultrasound. When combined with significant hematuria, all 19 grade III-IV injuries were identified. Of note, all patients with a grade III-V injury of the kidney had significant hematuria. Of the grade I-II renal injuries, all reviewers identified 1/5 or 2/5 by ultrasound alone. DISCUSSION The limitations of this study include: its retrospective nature, limited number of patients and reviewers, quality of the ultrasound machine. and experience of technologist, radiologist and urologist. A major limitation is the inability to assess other solid organ injuries during this initial study. CONCLUSIONS When compared to a CT scan as the gold standard, kidney ultrasound images had a sensitivity of 79-100% to detect grade III-V injuries and NPV of 97-100% by four blinded reviewers. All grade III-V injuries had either an episode of gross hematuria or microscopic hematuria >50 RBC/hpf. A prospective study that includes full abdominal imaging is needed to confirm that ultrasound can safely be used in place of CT scan for evaluation of hemodynamically stable blunt trauma patients.
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Affiliation(s)
| | - Matthew Hammer
- University of Texas Southwestern Department of Radiology, USA
| | | | - Craig Peters
- University of Texas Southwestern Department of Urology, USA
| | - Micah Jacobs
- University of Texas Southwestern Department of Urology, USA
| | - Bruce Schlomer
- University of Texas Southwestern Department of Urology, USA.
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Passoni N, Edwards A, Schlomer B, Stanasel I, Baker L, Peters C, Jacobs M. Urethral injury in the setting of blunt pelvic fracture: Does age matter? EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33233-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Schlomer B, Keays M, Grimsby G, Granberg C, DaJusta D, Bergu B, Ostrov L, Sheth K, Hill M, Sanchez E, Huang R, Harrison C, Jacobs M, Hennes H, Baker L. MP40-03 TRANS-SCROTAL NEAR INFRARED SPECTROSCOPY IN THE EMERGENCY DEPARTMENT TO DIAGNOSE TESTICULAR TORSION IN PEDIATRIC PATIENTS PRESENTING WITH ACUTE SCROTUM. J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schlomer B, Rodriguez E, Baskin L. Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome should be redefined as ipsilateral renal anomalies: cases of symptomatic atrophic and dysplastic kidney with ectopic ureter to obstructed hemivagina. J Pediatr Urol 2015; 11:77.e1-6. [PMID: 25797857 DOI: 10.1016/j.jpurol.2014.12.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 12/01/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome is a rare syndrome characterized by mullerian and renal anomalies. Renal agenesis is classically considered to be part of the definition of OHVIRA syndrome. There are increasing reports that the lack of an ipsilateral kidney on imaging studies is not from true renal agenesis but renal dysplasia and atrophy. We have observed cases where this ipsilateral dysplastic and atrophic kidney leads to clinical symptoms. The objective of this study is to report cases of OHVIRA syndrome where an ipsilateral dysplastic and atrophic kidney led to clinical symptoms, and to raise awareness in the pediatric urology community of this variant of OHVIRA syndrome. MATERIAL AND METHODS All cases of OHVIRA syndrome with an ipsilateral dysplastic and atrophic kidney were identified from January 2010 to June 2013. The patient's presentation, clinical course, surgical management, radiologic findings, and pathologic finding were reviewed. RESULTS There were three cases of OHVIRA syndrome with a symptomatic ipsilateral dysplastic and atrophic kidney identified. All three of these dysplastic and atrophic kidneys had an ectopic ureter to the obstructed hemivagina and led to persistent vaginal drainage after resection of the vaginal septum. These dysplastic and atrophic kidneys were not visualized on any imaging studies. Laparoscopic removal of the dysplastic and atrophic kidney led to cessation of vaginal drainage in all cases. CONCLUSION This study reports additional cases to the literature that do not fit the classic definition of OHVIRA syndrome. In the cases in this study, there was no ipsilateral renal agenesis, but an ipsilateral dysplastic and atrophic kidney with an ectopic ureter to the obstructed hemivagina. In addition, these cases demonstrate that the dysplastic and atrophic kidney may cause symptoms such as persistent vaginal drainage after resection of vaginal septum. The dysplastic and atrophic kidneys may not be detected by any imaging modality including MRI and DMSA scan and may be ectopic in location. All three of our cases had persistent vaginal drainage after resection of the vaginal septum which was cured by removal of the dysplastic and atrophic kidney ipsilateral to the obstructed hemivagina. The limitations of this study include the small number of patients and retrospective nature. While the classic definition of OHVIRA syndrome includes ipsilateral renal agenesis, there is increasing evidence that the absence of a kidney on imaging is due to renal dysplasia and atrophy and not true renal agenesis. In addition, we have observed that this dysplastic and atrophic kidney may cause clinically significant issues such as persistent vaginal drainage through an ectopic ureter to the ipsilateral hemivagina after resection of vaginal septum. This small dysplastic and atrophic kidney may not be visualized on imaging studies and laparoscopy can be diagnostic and therapeutic if indicated. Ipsilateral renal anomalies, not ipsilateral renal agenesis, should be considered part of the definition of OHVIRA syndrome. Pediatric urologists need to be aware of the spectrum of renal anomalies in OHVIRA syndrome.
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Affiliation(s)
- Bruce Schlomer
- University of Texas Southwestern and Children's Medical Center, Dallas, TX, USA.
| | | | - Laurence Baskin
- University of California San Francisco, Department of Urology, San Francisco, CA, USA
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Sheth KR, Keays M, Grimsby G, Granbery C, DaJusta DG, Ostrov L, Hill M, Sanchez E, Harrison C, Jacobs M, Huang R, Burgu B, Hennes H, Schlomer B, Baker L. MP40-05 DOES NEAR INFRARED SPECTROSCOPY IMPROVE TWIST SCORE IN THE DIAGNOSIS OF TESTICULAR TORSION? J Urol 2015. [DOI: 10.1016/j.juro.2015.02.1187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chen MJ, Karaviti LP, Macias CG, Roth DR, Gunn S, Sutton VR, Schlomer B. State of the art review in hypospadias: challenges in diagnosis and medical management. Pediatr Endocrinol Rev 2014; 12:46-54. [PMID: 25345085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hypospadias is a common congenital malformation in males, the cause of which may be genetic, hormonal, or environmental, although it usually is idiopathic or possibly multifactorial. Determining the optimal diagnostic testing and management remains a challenge. Hypospadias is corrected with surgery, and androgen therapy often is used preoperatively as an adjunctive therapy, although its use, timing, and effectiveness are unclear. No standardized approach has been established for the diagnostic testing for hypospadias or for preoperative androgen therapy. We reviewed current literature and used the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence and provide recommendations for a diagnostic testing algorithm from an endocrine and genetic perspective and for the optimal use of preoperative androgen therapy. These recommendations are an important step towards standardizing the use of diagnostic testing and the management of patients with hypospadias.
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Mahawong P, Sinclair A, Li Y, Schlomer B, Rodriguez E, Ferretti MM, Liu B, Baskin LS, Cunha GR. Prenatal diethylstilbestrol induces malformation of the external genitalia of male and female mice and persistent second-generation developmental abnormalities of the external genitalia in two mouse strains. Differentiation 2014; 88:51-69. [PMID: 25449352 PMCID: PMC4254634 DOI: 10.1016/j.diff.2014.09.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/04/2014] [Accepted: 09/19/2014] [Indexed: 11/28/2022]
Abstract
Potential trans-generational influence of diethylstilbestrol (DES) exposure emerged with reports of effects in grandchildren of DES-treated pregnant women and of reproductive tract tumors in offspring of mice exposed in utero to DES. Accordingly, we examined the trans-generational influence of DES on development of external genitalia (ExG) and compared effects of in utero DES exposure in CD-1 and C57BL/6 mice injected with oil or DES every other day from gestational days 12 to 18. Mice were examined at birth, and on 5-120 days postnatal to evaluate ExG malformations. Of 23 adult (>60 days) prenatally DES-exposed males, features indicative of urethral meatal hypospadias (see text for definitions) ranged from 18% to 100% in prenatally DES-exposed CD-1 males and 31% to 100% in prenatally DES-exposed C57BL/6 males. Thus, the strains differed only slightly in the incidence of male urethral hypospadias. Ninety-one percent of DES-exposed CD-1 females and 100% of DES-exposed C57BL/6 females had urethral-vaginal fistula. All DES-exposed CD-1 and C57BL/6 females lacked an os clitoris. None of the prenatally oil-treated CD-1 and C57BL/6 male and female mice had ExG malformations. For the second-generation study, 10 adult CD-1 males and females, from oil- and DES-exposed groups, respectively, were paired with untreated CD-1 mice for 30 days, and their offspring evaluated for ExG malformations. None of the F1 DES-treated females were fertile. Nine of 10 prenatally DES-exposed CD-1 males sired offspring with untreated females, producing 55 male and 42 female pups. Of the F2 DES-lineage adult males, 20% had exposed urethral flaps, a criterion of urethral meatal hypospadias. Five of 42 (11.9%) F2 DES lineage females had urethral-vaginal fistula. In contrast, all F2 oil-lineage males and all oil-lineage females were normal. Thus, prenatal DES exposure induces malformations of ExG in both sexes and strains of mice, and certain malformations are transmitted to the second-generation.
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Affiliation(s)
- Phitsanu Mahawong
- Division of Pediatric Urology, University of California, San Francisco, CA 94143, United States
| | - Adriane Sinclair
- Division of Pediatric Urology, University of California, San Francisco, CA 94143, United States
| | - Yi Li
- Division of Pediatric Urology, University of California, San Francisco, CA 94143, United States
| | - Bruce Schlomer
- Division of Pediatric Urology, University of California, San Francisco, CA 94143, United States
| | - Esequiel Rodriguez
- Division of Pediatric Urology, University of California, San Francisco, CA 94143, United States
| | - Max M Ferretti
- Division of Pediatric Urology, University of California, San Francisco, CA 94143, United States
| | - Baomei Liu
- Division of Pediatric Urology, University of California, San Francisco, CA 94143, United States
| | - Laurence S Baskin
- Division of Pediatric Urology, University of California, San Francisco, CA 94143, United States
| | - Gerald R Cunha
- Division of Pediatric Urology, University of California, San Francisco, CA 94143, United States.
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Mahawong P, Sinclair A, Li Y, Schlomer B, Rodriguez E, Ferretti MM, Liu B, Baskin LS, Cunha GR. Comparative effects of neonatal diethylstilbestrol on external genitalia development in adult males of two mouse strains with differential estrogen sensitivity. Differentiation 2014; 88:70-83. [PMID: 25449353 PMCID: PMC4254630 DOI: 10.1016/j.diff.2014.09.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/27/2014] [Accepted: 09/19/2014] [Indexed: 11/28/2022]
Abstract
The effect of neonatal exposure to diethylstilbestrol (DES), a potent synthetic estrogen, was examined to evaluate whether the CD-1 (estrogen insensitive, outbred) and C57 (estrogen sensitive, inbred) mouse strains differ in their response to estrogen disruption of male ExG differentiation. CD-1 and C57BL/6 litters were injected with sesame oil or DES (200 ng/g/5 μl in sesame oil vehicle) every other day from birth to day 10. Animals were sacrificed at the following time points: birth, 5, 10 and 60 days postnatal. Neonatally DES-treated mice from both strains had many ExG abnormalities that included the following: (a) severe truncation of the prepuce and glans penis, (b) an abnormal urethral meatus, (c) ventral tethering of the penis, (d) reduced os penis length and glans width, (e) impaired differentiation of cartilage, (f) absence of urethral flaps, and (g) impaired differentiation of erectile bodies. Adverse effects of DES correlated with the expression of estrogen receptors within the affected tissues. While the effects of DES were similar in the more estrogen-sensitive C57BL/6 mice versus the less estrogen-sensitive CD-1 mice, the severity of DES effects was consistently greater in C57BL/6 mice. We suggest that many of the effects of DES, including the induction of hypospadias, are due to impaired growth and tissue fusion events during development.
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Affiliation(s)
- Phitsanu Mahawong
- Division of Pediatric Urology, University of California, San Francisco, CA 94143, USA
| | - Adriane Sinclair
- Division of Pediatric Urology, University of California, San Francisco, CA 94143, USA
| | - Yi Li
- Division of Pediatric Urology, University of California, San Francisco, CA 94143, USA
| | - Bruce Schlomer
- Division of Pediatric Urology, University of California, San Francisco, CA 94143, USA
| | - Esequiel Rodriguez
- Division of Pediatric Urology, University of California, San Francisco, CA 94143, USA
| | - Max M Ferretti
- Division of Pediatric Urology, University of California, San Francisco, CA 94143, USA
| | - Baomai Liu
- Division of Pediatric Urology, University of California, San Francisco, CA 94143, USA
| | - Laurence S Baskin
- Division of Pediatric Urology, University of California, San Francisco, CA 94143, USA
| | - Gerald R Cunha
- Division of Pediatric Urology, University of California, San Francisco, CA 94143, USA.
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Schlomer B, Breyer B, Copp H, Baskin L, DiSandro M. Do adult men with untreated hypospadias have adverse outcomes? A pilot study using a social media advertised survey. J Pediatr Urol 2014; 10:672-9. [PMID: 24613143 PMCID: PMC4153791 DOI: 10.1016/j.jpurol.2014.01.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 01/05/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Hypospadias is usually treated in childhood. Therefore, the natural history of untreated mild hypospadias is unknown. We hypothesized that men with untreated hypospadias, especially mild, do not have adverse outcomes. MATERIALS Facebook was used to advertise an electronic survey to men older than 18 years. Men with untreated hypospadias identified themselves and indicated the severity of hypospadias with a series of questions. Outcomes included: Sexual Health Inventory for Men (SHIM), penile curvature and difficulty with intercourse, International Prostate Symptom Score (IPSS), Penile Perception Score (PPS), psychosexual milestones, paternity, infertility, sitting to urinate, and the CDC HRQOL-4 module. RESULTS 736 men completed self-anatomy questions and 52 (7.1%) self-identified with untreated hypospadias. Untreated hypospadias participants reported worse SHIM (p < 0.001) and IPSS scores (p = 0.05), more ventral penile curvature (p = 0.003) and resulting difficulty with intercourse (p < 0.001), worse satisfaction with meatus (p = 0.011) and penile curvature (p = 0.048), and more sitting to urinate (p = 0.07). When stratified by mild and severe hypospadias, severe hypospadias was associated with more adverse outcomes than mild hypospadias. CONCLUSION Men with untreated hypospadias reported worse outcomes compared with non-hypospadiac men. Mild untreated hypospadias had fewer adverse outcomes than severe hypospadias. Research is needed to determine if treatment of childhood hypospadias improves outcomes in adults, especially for mild hypospadias.
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Affiliation(s)
- Bruce Schlomer
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA; University of California San Francisco, San Francisco, CA, USA.
| | - Benjamin Breyer
- University of California San Francisco, San Francisco, CA, USA
| | - Hillary Copp
- University of California San Francisco, San Francisco, CA, USA
| | - Laurence Baskin
- University of California San Francisco, San Francisco, CA, USA
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McCann-Crosby B, Mansouri R, Dietrich JE, McCullough LB, Sutton VR, Austin EG, Schlomer B, Roth DR, Karaviti L, Gunn S, Hicks MJ, Macias CG. State of the art review in gonadal dysgenesis: challenges in diagnosis and management. Int J Pediatr Endocrinol 2014; 2014:4. [PMID: 24731683 PMCID: PMC3995514 DOI: 10.1186/1687-9856-2014-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 03/14/2014] [Indexed: 11/25/2022]
Abstract
Gonadal dysgenesis, a condition in which gonadal development is interrupted leading to gonadal dysfunction, is a unique subset of disorders of sexual development (DSD) that encompasses a wide spectrum of phenotypes ranging from normally virilized males to slightly undervirilized males, ambiguous phenotype, and normal phenotypic females. It presents specific challenges in diagnostic work-up and management. In XY gonadal dysgenesis, the presence of a Y chromosome or Y-chromosome material renders the patient at increased risk for developing gonadal malignancy. No universally accepted guidelines exist for identifying the risk of developing a malignancy or for determining either the timing or necessity of performing a gonadectomy in patients with XY gonadal dysgenesis. Our goal was to evaluate the literature and develop evidence-based medicine guidelines with respect to the diagnostic work-up and management of patients with XY gonadal dysgenesis. We reviewed the published literature and used the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) system when appropriate to grade the evidence and to provide recommendations for the diagnostic work-up, malignancy risk stratification, timing or necessity of gonadectomy, role of gonadal biopsy, and ethical considerations for performing a gonadectomy. Individualized health care is needed for patients with XY gonadal dysgenesis, and the decisions regarding gonadectomy should be tailored to each patient based on the underlying diagnosis and risk of malignancy. Our recommendations, based on the evidence available, add an important component to the diagnostic and management armament of physicians who treat patients with these conditions.
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Affiliation(s)
- Bonnie McCann-Crosby
- Division of Pediatric Endocrinology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Roshanak Mansouri
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Jennifer E Dietrich
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Laurence B McCullough
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - V Reid Sutton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Elise G Austin
- Department of Molecular and Human Genetics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Bruce Schlomer
- Division of Pediatric Urology, Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - David R Roth
- Division of Pediatric Urology, Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Lefkothea Karaviti
- Division of Pediatric Endocrinology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Sheila Gunn
- Division of Pediatric Endocrinology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - M John Hicks
- Department of Pathology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
| | - Charles G Macias
- Evidence-Based Outcomes Center, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA
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Schlomer B, Rodriguez E, Weiss D, Copp H. Parental beliefs about nocturnal enuresis causes, treatments, and the need to seek professional medical care. J Pediatr Urol 2013; 9:1043-8. [PMID: 23608323 PMCID: PMC4648250 DOI: 10.1016/j.jpurol.2013.02.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 02/18/2013] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To better understand parental beliefs regarding the etiology and treatment of nocturnal enuresis (NE). METHODS A self-administered survey queried parental NE beliefs including perceived etiologies and home behavioral treatments. We assessed for associations between demographic characteristics and propensity to seek medical care for NE. RESULTS Of 216 respondents, 78% were female. The most common causes for NE reported were: deep sleeper (56%), unknown (39%), and laziness (26%). Popular home behavioral therapies included: void prior to sleep (77%) and limiting fluid intake at night (71%). Few reported they would use a bedwetting alarm (6%). Fifty-five percent reported they would seek medical care for NE and 28% reported awareness of effective treatments. On multivariable analysis, females (OR 2.3, 95% CI 1.04-5.0) and those with graduate level education (OR 4.8, 95% CI 1.5-15.7) were more likely to seek medical care for their child with NE. CONCLUSIONS General parental knowledge of the causes and effective treatments for NE is lacking. Only 55% reported they would seek medical care for their child with NE and only 28% reported awareness of effective treatments. Counseling should focus on dispelling common misconceptions about causes and treatments of NE and focus on proven effective treatments.
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Affiliation(s)
- Bruce Schlomer
- University of California San Francisco, 400 Parnassus Avenue, Suite A-633, San Francisco, CA 94143, United States.
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Schlomer B, Saperston K, Copp H. 487 CUMULATIVE INCIDENCE OF COMPLICATIONS AND UROLOGIC PROCEDURES AFTER AUGMENTATION CYSTOPLASTY IN CHILDREN. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Schlomer B, Rodriguez E, Patel N, Weiss D, Copp H. 602 PARENTAL BELIEFS ABOUT NOCTURNAL ENURESIS: CAUSES, TREATMENTS, AND WHETHER A PROVIDER CAN HELP. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Schlomer B, Ferretti M, Rodriguez E, Cunha G, Baskin L. 717 SEXUAL DIFFERENTIATION IN MALE MOUSE FROM DAY 0 TO 10 A DETAILED AND NOVEL MORPHOMETRIC DESCRIPTION. J Urol 2012. [DOI: 10.1016/j.juro.2012.02.802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cost N, Lubahn J, Penn H, Granberg C, Schlomer B, Wickiser J, Rakheja D, Gargollo P, Leonard D, Baker L, Margulis V. 1376 ONCOLOGIC OUTCOMES OF PARTIAL (PN) VERSUS RADICAL NEPHRECTOMY (RN) FOR UNILATERAL WILMS TUMOR (UWT). J Urol 2011. [DOI: 10.1016/j.juro.2011.02.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Raj GV, Karavadia S, Schlomer B, Arriaga Y, Lotan Y, Sagalowsky A, Frenkel E. Contemporary use of perioperative cisplatin-based chemotherapy in patients with muscle-invasive bladder cancer. Cancer 2010; 117:276-82. [DOI: 10.1002/cncr.25429] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Revised: 01/11/2010] [Accepted: 01/19/2010] [Indexed: 11/11/2022]
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Terlecki R, Steele M, Valadez C, Schlomer B, Morey A. 33 POSTOPERATIVE IMAGING IS UNNCESSARY AFTER ANASTOMOTIC URETHROPLASTY. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schlomer B, Figenshau RS, Yan Y, Venkatesh R, Bhayani SB. Pathological Features of Renal Neoplasms Classified by Size and Symptomatology. J Urol 2006; 176:1317-20; discussion 1320. [PMID: 16952619 DOI: 10.1016/j.juro.2006.06.005] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2005] [Indexed: 11/19/2022]
Abstract
PURPOSE We examined the relationship between tumor size and pathological findings in a contemporary series of surgical renal lesions and we characterized the relationship of incidental and symptomatic tumors to pathological findings. MATERIALS AND METHODS We retrospectively reviewed the records of patients treated surgically for renal lesions suspicious for malignancy between March 2000 and May 2005. Specimens were examined for a gross and microscopic description. Statistical analysis was used to determine the correlation of size and symptomatology. RESULTS A total of 349 renal masses from 331 patients were identified. Of the 349 renal masses 56 (16.0%) were benign, 289 (82.8%) were renal cell carcinoma and 4 (1.1%) were other malignancies. The percent of malignant tumors increased from 72.1% for those less than 2 cm to 93.7% for those greater than 7 cm (OR 1.39, 95% CI 1.17 to 1.65). Of the 349 renal masses 258 (73.9%) were discovered incidentally and 91 (26.1%) were symptomatic. Mean size of incidental and symptomatic tumors was 3.7 and 6.2 cm, respectively (p < 0.001). When comparing T1 incidental and symptomatic tumors, there was no significant difference in the overall frequency of malignancy. When comparing T2 incidental and symptomatic tumors, the groups had similar malignancy rates (90.9% and 100%, respectively, p = 0.16). However, symptomatic lesions showed an increased incidence of high grade malignancy (78.4% vs 40.9%, p = 0.012). CONCLUSIONS Smaller renal tumors are more likely to be benign or be a lower grade of malignancy. T1 renal tumors are more likely to be detected incidentally than T2 tumors. When T1 incidental and symptomatic tumors were compared, there was no difference between the malignancy rates. However, when T2 incidental and symptomatic tumors were compared, symptomatic tumors were more likely to be high grade malignancy.
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Affiliation(s)
- Bruce Schlomer
- Division of Urology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Schlomer B, Figenshau RS, Yan Y, Bhayani SB. How does the radiographic size of a renal mass compare with the pathologic size? Urology 2006; 68:292-5. [PMID: 16904439 DOI: 10.1016/j.urology.2006.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2005] [Revised: 01/16/2006] [Accepted: 03/03/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To investigate the relationship between the radiographic size on computed tomography and the pathologic size of renal tumors. METHODS The records of 126 patients with a renal lesion suspicious for malignancy and with preoperative computed tomography performed 60 days or less before surgery at our institution were reviewed. The clinical size was defined as the largest diameter of the tumor seen on computed tomography and the pathologic size was defined as the largest diameter seen at pathology. The clinical and pathologic sizes were compared by size range and primary tumor stage. RESULTS A total of 133 tumors from 126 patients were identified. Of the 133 tumors, 120 (90.2%) were renal carcinoma. The clinical and pathologic size for all 133 tumors was not significantly different (4.5 versus 4.1 cm, P = 0.35). The average clinical tumor size was larger than the pathologic tumor size for all sizes, except for 7 cm and greater. The difference reached statistical significance in all ranges from 1 to 5 cm. The largest size difference was seen for tumors 4 to 5 cm, for which the average clinical size was 0.87 cm larger than the average pathologic size (P = 0.025). CONCLUSIONS Preoperative computed tomography imaging may slightly overestimate the pathologic size of renal tumors in certain size ranges. In pathologic Stage T1a tumors, the clinical tumor size was significantly larger than the pathologic stage (P = 0.009). The difference between the clinical and pathologic tumor size was greatest for tumors 4 to 5 cm. These results may affect decisions to perform nephron-sparing surgery in certain patients.
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Affiliation(s)
- Bruce Schlomer
- Division of Urology, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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