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Kaefer M. Editorial Comment. J Urol 2024:101097JU0000000000004002. [PMID: 38713536 DOI: 10.1097/ju.0000000000004002] [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: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 05/09/2024]
Affiliation(s)
- Martin Kaefer
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
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Binion KE, Perreira KM, Villa Torres L, White JT, Hernandez GC, Kaefer M, Misseri R, Ross S, Chan KH. A multi-site cultural and linguistic adaptation of a hypospadias decision aid for Latinx communities. J Pediatr Urol 2024:S1477-5131(24)00192-X. [PMID: 38688803 DOI: 10.1016/j.jpurol.2024.04.002] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/19/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Latinx, Spanish-speaking (LSS) patients are more likely to experience decisional conflict and regret about healthcare decisions than non-Hispanic, white, English-speaking patients. OBJECTIVE To adapt the Hypospadias Hub (Hub), a rigorously developed and tested web-based decision aid (DA), for LSS parents. METHODS Guided by the Ecological Validity Model (EVM), a heuristic framework was followed to culturally adapt the Hub (see Extended Summary Figure). In stage 1, recommendations were obtained from a focus group with members of the institution's Latinx Community Review Board (Latinx CRB) and semi-structured interviews with pediatricians with Latinx-focused practices. In stage 2, preliminary cultural modifications were made, the Hub was translated into Spanish, and a second focus group with the Latinx CRB was convened to review the revised Hub. In stage 3, semi-structured interviews with LSS parents of healthy boys (i.e., without hypospadias) ≤ 5 years old were conducted to identify any cultural adaptations and/or usability issues regarding the revised Hub. In stage 4, based on parents' feedback, final revisions to the Hub were made. The focus groups and parent interviews were conducted in Spanish; then, the recordings were professionally transcribed in Spanish and translated into English. Interviews with pediatricians were conducted in English; then, the recordings were professionally transcribed. Three coders conducted a qualitative content analysis to identify areas for revision. Changes were applied iteratively. RESULTS Participants included 3 Latinx CRB members (2 women, 1 did not disclose gender; mean age = 48.3, SD = 21.2), 3 non-Latinx pediatricians (2 women, 1 man; mean age = 49.6, SD = 9.1), and 5 Latinx mothers (mean age = 34.0, SD = 1.26). Participants recommended: 1) featuring video testimonials from Latinx families or including Spanish voice-overs/subtitles; 2) diversifying racial/ethnic/geographic representation and including extended families in photographs/illustrations; 3) adding information about health insurance coverage and circumcision, 4) reassuring parents that the condition is not their fault, 5) considering cultural values (e.g., reliance on expert advice), and 6) clarifying medical terminology. Feedback related to seven EVM dimensions: concepts, content, context, goals, language, metaphors, and methods. DISCUSSION Participants perceived the Hub to be informative in guiding parents' treatment decisions. Revisions were reasonable and acceptable for a linguistic and cultural adaptation for LSS parents. CONCLUSIONS We identified and implemented preliminary cultural modifications to the Hub and applied user-centered design methods to test and revise the website. The product is a culturally appropriate DA for LSS parents. Next, English and Spanish-versions of the Hub will be tested in a randomized controlled trial.
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Affiliation(s)
- Kelsey E Binion
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA.
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Laura Villa Torres
- Public Health Leadership Program, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - J Tommy White
- North Carolina Clinical and Translational Sciences Institute, University of North Carolina, Chapel Hill, NC, USA.
| | - Guadalupe C Hernandez
- North Carolina Clinical and Translational Sciences Institute, University of North Carolina, Chapel Hill, NC, USA.
| | - Martin Kaefer
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Rosalia Misseri
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Sherry Ross
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Katherine H Chan
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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Cascio S, Kaefer M, Bagli D, Nelson CP, Nieuwhof-Leppink A, Braga LH, Herbst KW, Garriboli M, Kalfa N, Harper L, Fossum M. The importance of animal specificity in animal experimentation, part II: Physiological challenges and opportunities in relation to pediatric urology. J Pediatr Urol 2024; 20:315-317. [PMID: 38238242 DOI: 10.1016/j.jpurol.2023.12.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 04/22/2024]
Abstract
When performing animal experimentation in Pediatric Urology studies, it is important to be aware of physiological differences between species and to understand when relevant disease models are available. Diseased animal models may be more relevant in many cases, rather than performing studies in healthy and normally developed animals. For example, they may be more appropriate for the study of congenital malformations, to investigate the secondary effects of prenatal urinary obstruction, to study the effect of prenatal exposure to endogenous or exogenous factors which may lead to disease, or in testing bioengineered structures. In this short educational article, we aim to describe some disease models that have been used to simulate human pathologies and how, if properly designed, these studies can lead to important new knowledge for human translation. In addition, we also highlight the importance of formulating a research question(s) before deciding on the animal experimental model and species to choose.
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Affiliation(s)
- Salvatore Cascio
- Department of Pediatric Surgery, School of Medicine, University College Dublin and Children's Health Ireland, Dublin, Ireland
| | - Martin Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Darius Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital and Harvard Medical School, MA, United States
| | - Anka Nieuwhof-Leppink
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - Luis H Braga
- Department of Surgery, Division of Urology, McMaster University, McMaster Children's Hospital, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada
| | - Katherine W Herbst
- Connecticut Children's Research Institute, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Massimo Garriboli
- Department of Pediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Nicolas Kalfa
- Service de Chirurgie Urologique Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France
| | - Luke Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - Magdalena Fossum
- Department of Pediatric Surgery, Surgical Clinic C, Rigshospitalet, Copenhagen University, Clinical Medicine, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Fossum M, Kaefer M, Bagli D, Harper L, Herbst KW, Nelson CP, Braga LH, Nieuwhof-Leppink A, Kalfa N, Garriboli M, Cascio S. The importance of animal specificity in animal experimentation, part I: Anatomy in relation to pediatric urology. J Pediatr Urol 2024; 20:312-314. [PMID: 38199905 DOI: 10.1016/j.jpurol.2023.12.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
Why and when is animal experimentation relevant? The answer to this question depends on the research question. In this short educational article we aim to raise awareness of the importance of formulating a very specific research question before choosing an animal species. An awareness of anatomical and physiological differences vis-a-vis similarities between species, will increase the potential for obtaining data that is relevant for translation to human conditions.
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Affiliation(s)
- Magdalena Fossum
- Department of Pediatric Surgery, Center of Cancer and Organ Diseases, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Martin Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Darius Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Luke Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - Katherine W Herbst
- Division of Urology, Research Institute, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital and Harvard Medical School, MA, United States
| | - Luis H Braga
- Department of Surgery, Division of Urology, McMaster University, McMaster Children's Hospital, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada
| | - Anka Nieuwhof-Leppink
- Department Urotherapy, Wilhelmina Children's Hospital, Part of University Medical Center Utrecht, Netherlands
| | - Nicolas Kalfa
- Department of Pediatric Surgery and Urology, Lapeyronie Hospital, CHU Montpellier, France; UMR1302 Institute Desbrest of Epidemiology and Public Health, INSERM, University Montpellier, Montpellier, France
| | - Massimo Garriboli
- Department of Paediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Salvatore Cascio
- Department of Pediatric Surgery, School of Medicine, University College Dublin and Children's Health Ireland at Temple Street, Dublin, Ireland
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Aichner J, Kaefer M, Zundel S, Jhala T, Szavay P. Surgical simulation of hypospadias repair - High-fidelity, reproducible and affordable animal tissue model. J Pediatr Urol 2024:S1477-5131(24)00090-1. [PMID: 38402079 DOI: 10.1016/j.jpurol.2024.02.010] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/05/2024] [Accepted: 02/13/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION Teaching methods in hypospadias repair are still traditional. Available simulators often lack authenticity in terms of haptic feedback and realistic tissue handling. OBJECTIVE Our aim was to develop a high-fidelity, easily reproducible, and affordable animal tissue model for the advanced surgical simulation of hypospadias repair with realistic haptic feedback and tissue handling. MATERIAL AND METHODS A regular-sized chicken leg and a lamb tenderloin are used to assess the feasibility of simulating hypospadias correction by using the example of a Snodgrass Tubularized Incised Plate-Repair. The model preparation is incorporated into the training process. RESULTS A detailed description of the high-fidelity model is provided. All steps of a hypospadias repair can be trained while providing realistic anatomy, adequate size, and multilayer tissue properties. Haptic conditions highly resemble human tissue properties. Fine tissue handling corresponds to intraoperative conditions. Limitations to this surgical model apply as in other animal tissue models. CONCLUSION We developed a high-fidelity, easily reproducible, and affordable hypospadias animal tissue model. Due to the multilayer animal tissue properties, this model provides realistic haptic feedback and thus an inexpensive and reproducible model for hypospadias simulation. External validation is mandatory prior to implementation into urological training.
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Affiliation(s)
- Jonathan Aichner
- Department for Pediatric Surgery, Lucerne Cantonal Hospital, 6000, Lucerne, Switzerland.
| | - Martin Kaefer
- Department of Surgery, Riley Children's Health, 705 Riley Hospital Dr, Indianapolis, IN 46202, USA.
| | - Sabine Zundel
- Department for Pediatric Surgery, Lucerne Cantonal Hospital, 6000, Lucerne, Switzerland.
| | - Tobias Jhala
- Department for Pediatric Surgery, Lucerne Cantonal Hospital, 6000, Lucerne, Switzerland.
| | - Philipp Szavay
- Department for Pediatric Surgery, Lucerne Cantonal Hospital, 6000, Lucerne, Switzerland.
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Szymanski KM, Roth JD, Szymanski AJ, King SJ, Whittam B, Kaefer M, Rink RC, Cain MP, Misseri R. People with spina bifida use their MACE on long-term follow-up: A single institutional retrospective cohort study. J Pediatr Urol 2023:S1477-5131(23)00123-7. [PMID: 37088620 DOI: 10.1016/j.jpurol.2023.03.035] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE While the Malone antegrade continence enema (MACE) facilitates bowel movements in patients with spina bifida (SB) and neuropathic bowel, little is known about its long-term use. We aimed to assess long-term MACE use and potential risk factors for disuse. METHODS All patients with SB who underwent MACE procedures at our institution were retrospectively reviewed. Main outcome was MACE disuse (no longer catheterizing the MACE for antegrade enemas) based on self-report on a clinic questionnaire, or medical record for patients last seen before introducing the questionnaire 5 years ago. Survival analysis used two timeframes: time after surgery (Analysis 1) and chronological age: accounting for older children reaching adulthood earlier (Analysis 2). RESULTS Overall, 411 patients (54% female, 78% shunted, 65% augmented) underwent a MACE procedure at median 7.9 years old (median follow-up: 8.4 years). Thirty-three (8%) patients no longer used their MACE. Most common reasons for doing so were channel/stomal stenosis (61%) and excision at colostomy or other abdominal surgery (12%). Bowel management afterwards included oral agents ± enemas (55%), Chait tube (30%), colostomy (12%). After correcting for differential follow-up, 90% of participants used their MACE at 10 years and 87% at 15 years after surgery. Based on chronological age, 97% used their MACE at 15 years old, 92% at 20 and 81% at 30 (Summary Figure). On multivariate analysis, umbilical MACEs were 2.4 times more likely to be disused than right lower quadrant MACEs (p = 0.04). Without correcting for chronological age (Analysis 1), patients undergoing MACE surgery at older ages were more likely to stop MACE use (p = 0.03). However, after accounting for chronological age (Analysis 2), patients undergoing a MACE procedure at older ages were no more likely to stop its use (p = 0.47, Figure). Gender, SB type, shunt status, mobility status, bladder augmentation or a urinary catheterizable channel were not associated with stopping MACE use (p ≥ 0.10). COMMENT Participants were regularly followed in multi-disciplinary SB clinics. We did not assess continence, satisfaction or long-term urinary channel use, making it premature to recommend optimal stomal locations. CONCLUSIONS Most patients with SB followed by a multi-disciplinary team continue using their MACE; 1% stopped MACE use annually, particularly after adolescence. This strongly suggests it is an effective bowel management method and transitioning to self-care plays a role in maintaining long-term MACE use. Umbilical MACEs may be at high risk of disuse, but all people with a MACE can benefit from support as they transition to adult care.
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Affiliation(s)
- Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA.
| | - Joshua D Roth
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA
| | - Arthur J Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA
| | - Shelly J King
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA
| | - Benjamin Whittam
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA
| | - Martin Kaefer
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA
| | - Richard C Rink
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA
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Szymanski KM, Kaefer M, Fossum M, Kalfa N, Herbst KW, Braga LH, Cascio S, Garriboli M, Nelson CP, Nieuwhoff-Leppink A, Bagli D, Harper L. What are validated questionnaires and which ones measure quality of life? J Pediatr Urol 2023:S1477-5131(23)00121-3. [PMID: 37080794 DOI: 10.1016/j.jpurol.2023.03.034] [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: 03/17/2023] [Accepted: 03/26/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Konrad M Szymanski
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Martin Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Magdalena Fossum
- Department of Pediatric Surgery, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Nicolas Kalfa
- Service de Chirurgie et Urologie Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier; Institut Debrest de Santé Publique IDESP, UMR INSERM - Université Montpellier, France
| | - Katherine W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Luis H Braga
- McMaster University/Department of Surgery/Urology, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Hamilton, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Salvatore Cascio
- Department of Paediatric Urology, Children's Health Ireland at Temple Street, Dublin, Ireland; University College Dublin, Ireland
| | - Massimo Garriboli
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom; Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health, United Kingdom
| | - Caleb P Nelson
- Urology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States
| | - Anka Nieuwhoff-Leppink
- Department Psychology, Urotherapy and Urology Section, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Darius Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Luke Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France.
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Binion KE, Rode AU, Miller AD, Nortey G, Ross S, Misseri R, Kaefer M, Preisser JS, Hu D, Chan KH. Response to letter to the editor re 'A multi-site pilot study of a parent-centered tool to promote shared decision-making in hypospadias care'. J Pediatr Urol 2023:S1477-5131(23)00106-7. [PMID: 37029010 DOI: 10.1016/j.jpurol.2023.03.020] [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: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 04/09/2023]
Affiliation(s)
- Kelsey E Binion
- Department of Communication Studies, Indiana University Purdue University, Indianapolis, IN, USA.
| | - Akash Uday Rode
- Department of Human-Centered Computing, Luddy School of Informatics, Computing, and Engineering, Indiana University, Indianapolis, IN, USA
| | - Andrew D Miller
- Department of Human-Centered Computing, Luddy School of Informatics, Computing, and Engineering, Indiana University, Indianapolis, IN, USA
| | - Gabrielle Nortey
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Sherry Ross
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Rosalia Misseri
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Martin Kaefer
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John S Preisser
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Di Hu
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Katherine H Chan
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Szymanski KM, Roth JD, Hensel DJ, Wiener JS, Younsi N, Stein R, Whittam B, Kaefer M, Rink RC, Cain MP, Misseri R. Sexual activity and function of adult men with spina bifida. J Pediatr Urol 2023:S1477-5131(23)00077-3. [PMID: 36935328 DOI: 10.1016/j.jpurol.2023.03.002] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVE Data on sexual function of men with spina bifida (SB) is limited. We aimed to assess sexual activity and erectile dysfunction (ED) in a large international sample of men with SB. METHODS Men with SB (≥18yo) were recruited in an international online survey via clinics and social media. We collected data on demographics, ambulation (Hoffer classification), penile rigidity (Erection Hardness Score), sexual activity and ED (International Index of Erectile Function). Non-parametric tests were used. RESULTS A total of 162 men (median age 35, 62% shunted, 38% community ambulators) reported sexual desire similar to the general population (p = 0.82), but 55% were dissatisfied with their sex life (Summary Table). Overall, 36% reported full penile rigidity with erections, more commonly with better ambulation (p = 0.01), 69% had ever experienced orgasm and 84% ejaculated. In 44 men (27%) attempting sexual intercourse in the last 4 weeks, 59% had ED (11% severe, 7% moderate, 14% mild-moderate, 27% mild). In this group, 91% of men reporting less than full penile rigidity had ED, compared to 30% with full penile rigidity (p = 0.001). Overall, partnered non-genital contact in the last 3 months was reported by 56%, solo masturbation: 62%, partnered intercourse: 48% (31% vaginal). Of 54 men who used phosphodiesterase type 5 inhibitors (PDE5I), 80% reported improved erections, 56% improved intercourse. Overall, 40% reported non-genital erogenous zones as most pleasurable, especially with poorer ambulation (p = 0.002, chest/nipples: 73%). COMMENT Strengths of this study include anonymous, voluntary, online participation maximizing participation of a heterogenous, international population. Whenever available, we compared findings to published values for the general population. Since romantic and sexual activity is a complex intersection of interest, opportunity and ability, a more comprehensive assessment was beyond the study's scope. Future work will focus on the interplay with issues like incontinence. CONCLUSIONS ED was frequent among men with SB, especially in men with poorer ambulation. PDE5 inhibitors may be beneficial. Partnered sexual activity was reported by half of the men, although it may not involve penetrative intercourse.
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Affiliation(s)
- Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA.
| | - Joshua D Roth
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA
| | - Devon J Hensel
- Department of Pediatrics and Department of Sociology, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - John S Wiener
- Section of Pediatric Urology, Duke University Medical Center, Durham, NC, USA
| | - Nina Younsi
- Department of Pediatric, Adolescent and Reconstructive Urology University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Benjamin Whittam
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA
| | - Martin Kaefer
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA
| | - Richard C Rink
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA
| | - Mark P Cain
- Department of Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA
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Binion KE, Rode AU, Nortey G, Miller AD, Misseri R, Kaefer M, Ross S, Preisser JS, Hu D, Chan KH. A multi-site pilot study of a parent-centered tool to promote shared decision-making in hypospadias care. J Pediatr Urol 2023:S1477-5131(23)00028-1. [PMID: 36801199 DOI: 10.1016/j.jpurol.2023.01.018] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/14/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Using a user-centered design approach, we conducted a two-site pilot study to evaluate a decision aid (DA) website, the Hypospadias Hub, for parents of hypospadias patients. OBJECTIVES The objectives were to assess the Hub's acceptability, remote usability, and feasibility of study procedures, and to evaluate its preliminary efficacy. METHODS From June 2021-February 2022, we recruited English-speaking parents (≥18 years old) of hypospadias patients (≤5 years) and delivered the Hub electronically ≤2 months before their hypospadias consultation. We collected website analytic data using an ad tracker plug-in. We inquired about treatment preference, hypospadias knowledge, and decisional conflict (Decisional Conflict Scale) at baseline, after viewing the Hub (pre-consultation), and post-consultation. We administered the Decision Aid Acceptability Questionnaire (DAAQ) and the Preparation for Decision-Making Scale (PrepDM) which assessed how well the Hub prepared parents for decision-making with the urologist. Post-consultation, we assessed participants' perception of involvement in decision-making with the Shared Decision-making Questionnaire (SDM-Q-9) and the Decision Regret Scale (DRS). A bivariate analysis compared participants' baseline and pre/post-consultation hypospadias knowledge, decisional conflict, and treatment preference. Using a thematic analysis, we analyzed our semi-structured interviews to uncover how the Hub impacted the consultation and what influenced participants' decisions. RESULTS Of 148 parents contacted, 134 were eligible and 65/134 (48.5%) enrolled: mean age 29.2, 96.9% female, 76.6% White (Extended Summary Figure). Pre/post-viewing the Hub, there was a statistically significant increase in hypospadias knowledge (54.3 vs. 75.6, p < 0.001) and decrease in decisional conflict (36.0 vs. 21.9, p < 0.001). Most participants (83.3%) thought Hub's length and amount of information (70.4%) was "about right", and 93.0% found most or everything was clear. Pre/post-consultation, there was a statistically significant decrease in decisional conflict (21.9 vs. 8.8, p < 0.001). PrepDM's mean score was 82.6/100 (SD = 14.1); SDM-Q-9's mean score was 82.5/100 (SD = 16.7). DCS's mean score was 25.0/100 (SD = 47.03). Each participant spent an average of 25.75 min reviewing the Hub. Based on thematic analysis, the Hub helped participants feel prepared for the consultation. DISCUSSION Participants engaged extensively with the Hub and demonstrated improved hypospadias knowledge and decision quality. They felt prepared for the consultation and perceived a high degree of involvement in decision-making. CONCLUSION As the first pilot test of a pediatric urology DA, the Hub was acceptable and study procedures were feasible. We plan to conduct a randomized controlled trial of the Hub versus usual care to test its efficacy to improve the quality of shared decision-making and reduce long-term decisional regret.
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Affiliation(s)
- Kelsey E Binion
- Department of Communication Studies, Indiana University Purdue University, Indianapolis, IN, USA.
| | - Akash Uday Rode
- Department of Human-Centered Computing, Luddy School of Informatics, Computing, and Engineering, Indiana University, Indianapolis, IN, USA.
| | - Gabrielle Nortey
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Andrew D Miller
- Department of Human-Centered Computing, Luddy School of Informatics, Computing, and Engineering, Indiana University, Indianapolis, IN, USA.
| | - Rosalia Misseri
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Martin Kaefer
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Sherry Ross
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - John S Preisser
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - Di Hu
- Department of Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - Katherine H Chan
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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Kaefer M, Rink R, Misseri R, Winchester P, Proctor C, Ben Maamar M, Beck D, Nilsson E, Skinner MK. Role of epigenetics in the etiology of hypospadias through penile foreskin DNA methylation alterations. Sci Rep 2023; 13:555. [PMID: 36631595 PMCID: PMC9834259 DOI: 10.1038/s41598-023-27763-5] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 01/06/2023] [Indexed: 01/13/2023] Open
Abstract
Abnormal penile foreskin development in hypospadias is the most frequent genital malformation in male children, which has increased dramatically in recent decades. A number of environmental factors have been shown to be associated with hypospadias development. The current study investigated the role of epigenetics in the etiology of hypospadias and compared mild (distal), moderate (mid shaft), and severe (proximal) hypospadias. Penile foreskin samples were collected from hypospadias and non-hypospadias individuals to identify alterations in DNA methylation associated with hypospadias. Dramatic numbers of differential DNA methylation regions (DMRs) were observed in the mild hypospadias, with reduced numbers in moderate and low numbers in severe hypospadias. Atresia (cell loss) of the principal foreskin fibroblast is suspected to be a component of the disease etiology. A genome-wide (> 95%) epigenetic analysis was used and the genomic features of the DMRs identified. The DMR associated genes identified a number of novel hypospadias associated genes and pathways, as well as genes and networks known to be involved in hypospadias etiology. Observations demonstrate altered DNA methylation sites in penile foreskin is a component of hypospadias etiology. In addition, a potential role of environmental epigenetics and epigenetic inheritance in hypospadias disease etiology is suggested.
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Affiliation(s)
- Martin Kaefer
- grid.257413.60000 0001 2287 3919Department of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indiana University, Indianapolis, IN 46202-5201 USA
| | - Richard Rink
- grid.257413.60000 0001 2287 3919Department of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indiana University, Indianapolis, IN 46202-5201 USA
| | - Rosalia Misseri
- grid.257413.60000 0001 2287 3919Department of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indiana University, Indianapolis, IN 46202-5201 USA
| | - Paul Winchester
- grid.257413.60000 0001 2287 3919Department of Pediatrics, St. Franciscan Hospital, School of Medicine, Indiana University, Indianapolis, IN 46202-5201 USA
| | - Cathy Proctor
- grid.257413.60000 0001 2287 3919Department of Pediatrics, St. Franciscan Hospital, School of Medicine, Indiana University, Indianapolis, IN 46202-5201 USA
| | - Millissia Ben Maamar
- grid.30064.310000 0001 2157 6568Center for Reproductive Biology, School of Biological Sciences, Washington State University, Pullman, WA 99164-4236 USA
| | - Daniel Beck
- grid.30064.310000 0001 2157 6568Center for Reproductive Biology, School of Biological Sciences, Washington State University, Pullman, WA 99164-4236 USA
| | - Eric Nilsson
- grid.30064.310000 0001 2157 6568Center for Reproductive Biology, School of Biological Sciences, Washington State University, Pullman, WA 99164-4236 USA
| | - Michael K. Skinner
- grid.30064.310000 0001 2157 6568Center for Reproductive Biology, School of Biological Sciences, Washington State University, Pullman, WA 99164-4236 USA
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12
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Fossum M, Kaefer M, Herbst KW, Harper L, Beckers GMA, Nelson CP, Garriboli M, Nieuwhof-Leppink A, Bagli D, Kalfa N. The orchestration of gene expression and the editing role of microRNA. J Pediatr Urol 2022:S1477-5131(22)00631-3. [PMID: 36653199 DOI: 10.1016/j.jpurol.2022.12.016] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Abstract
In this short educational communication the ESPU Research Committee presents the role of non-coding RNA and how these can affect gene expression. In particular we discuss the role of microRNA on post transcriptional changes and how these may cause pathological conditions within Pediatric Urology and how microRNA could be useful in future clinical practice.
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Affiliation(s)
- M Fossum
- Department of Pediatric Surgery, Rigshospitalet, Dept of Medical Sciences, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - K W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - L Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | | | - C P Nelson
- Department of Urology, Boston Children's Hospital and Department of Surgery, Harvard Medical School, Harvard University, Boston, MA, USA
| | - M Garriboli
- Department of Paediatric Urology, Evelina Children's Hospital, Guy's and St. Thomas NHS Foundation Trust, London, United Kingdom
| | - A Nieuwhof-Leppink
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - D Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - N Kalfa
- Service de Chirurgie Urologique Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France; Institut Debrest de Santé Publique IDESP, UMR INSERM - Université Montpellier, Montpellier, France
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13
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Kaefer M, Saad K, Gargollo P, Whittam B, Rink R, Fuchs M, Bowen D, Reddy P, Cheng E, Jayanthi R. Intraoperative laser angiography in bladder exstrophy closure: A simple technique to monitor penile perfusion. J Pediatr Urol 2022; 18:746.e1-746.e7. [PMID: 36336625 DOI: 10.1016/j.jpurol.2022.10.012] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 09/13/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The successful repair of Bladder Exstrophy remains one of the biggest challenges in Pediatric Urology. The primary focus has long been on the achievement of urinary continence. Historically there has been less focus on early penile outcomes. To this end we have incorporated penile perfusion testing using intraoperative laser angiography in to our operative approach. OBJECTIVE We hypothesize that assessment of penile perfusion at various points in the procedure is a feasible technique that may assist in decision making during the repair of this complex condition. This will reduce the risk of tissue compression and potential loss of penile tissue that has been reported to occur as a complication of the procedure. STUDY DESIGN Consecutive patients presenting with bladder exstrophy were evaluated at four stages of their operation (i.e. following induction of anesthesia, after bladder mobilization, following internal rotation of the pubis and at the end of the procedure) by infusing indocyanine green (ICG) at a dose of 1 mg per 10 kg body weight. Measurements were taken at 80 s post infusion and the medial thigh served as the reference control. Postoperative penile viability was evaluated by visual inspection and palpation three months following the procedure. RESULTS Eight consecutive patients were included in this study. Perfusion was easy to measure and posed no significant technical difficulties. Penile perfusion increased slightly following bladder dissection. Internal rotation of the hips with apposition of the symphysis pubis resulted in an average 50% reduction in penile blood flow. Patients undergoing CPRE experienced an additional mean 33% drop in blood flow. In all eight cases the penis was symmetric and healthy with no sign of tissue loss at three months follow up. CONCLUSIONS This pilot study demonstrates that the measurement of penile perfusion utilizing intraoperative laser angiography is easy to employ and should be considered a reasonable adjunct to tissue assessment in this complex condition. Marked reduction in penile blood flow may occur without any outward clinical signs. Penile perfusion is markedly reduced by apposition of the symphysis pubis and, in the immediate postoperative period, there may be further reduction in penile blood flow with CPRE as opposed to a staged repair. Future correlation with measures of penile viability and function are needed to define the clinical utility of this modality.
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Affiliation(s)
- Martin Kaefer
- Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Kahlil Saad
- Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Benjamin Whittam
- Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard Rink
- Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Molly Fuchs
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Diana Bowen
- Lurie Children's Hospital, Northwestern University, Chicago, IL, USA
| | - Pramod Reddy
- Cincinatti Children's Hospital, Cincinnati, OH, USA
| | - Earl Cheng
- Lurie Children's Hospital, Northwestern University, Chicago, IL, USA
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14
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Bagli D, Fossum M, Harper L, Herbst K, Nieuwhof-Leppink A, Beckers GMA, Kalfa N, Kaefer M. Epigenetics: Through the pediatric urology looking glass. J Pediatr Urol 2022; 18:464-465. [PMID: 35798630 DOI: 10.1016/j.jpurol.2022.05.018] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Darius Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Magdalena Fossum
- Department of Pediatric Surgery, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Luke Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - Katherine Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Anka Nieuwhof-Leppink
- Department Psychology, Urotherapy and Urology Section, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | | | - Nicolas Kalfa
- Service de Chirurgie et Urologie Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, and Institut Debrest de Santé Publique IDESP, UMR INSERM - Université Montpellier, France; Institut Debrest de Santé Publique IDESP, UMR INSERM - Université Montpellier, France
| | - Martin Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
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15
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Binion K, Miller A, Misseri R, Kaefer M, Longtin K, Carroll A, Wiehe SE, Chan KH. Ask the parents: Testing the acceptability and usability of a hypospadias decision aid. J Pediatr Urol 2022; 18:170.e1-170.e9. [PMID: 35131196 PMCID: PMC9167211 DOI: 10.1016/j.jpurol.2022.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/16/2021] [Revised: 12/16/2021] [Accepted: 01/10/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION In previous work, we engaged key stakeholders to create a web-based decision aid (DA) prototype to facilitate shared decision making about hypospadias. OBJECTIVE The study's objective was to use a human-centered design approach to assess the DA's acceptability and usability and revise it prior to pilot testing. METHODS We recruited English-speaking parents (≥18 years old) of sons with hypospadias (≤5 years) for a two-phase process of semi-structured phone/video interviews to obtain feedback about our DA prototype. DA webpages included: "Hypospadias," "Surgery Basics," "No Surgery," "Family Stories," "Help Me Decide," and "FAQs." In both phases, participants viewed the DA using the "think aloud" technique and completed several validated scales to evaluate its acceptability and usability. In phase 1, we collected feedback about the "Homepage" organization, values clarification methods (VCM), and webpage content. In phase 2, participants searched the DA for answers to hypospadias-related questions, provided feedback on testimonial videos and VCM, and shared their preferences about data visualizations. All interviews were audio recorded. After each phase, transcripts were qualitatively analyzed to identify key areas for revision. Revisions were made between phase 1 and 2 to improve the DA's acceptability and usability. RESULTS We interviewed 20 participants (10/phase): median age 33.7 years, 60% female, 80% White. Mean score on the Preparation for Decision Making Scale: 86.8 (out of 100). We revised: 1) VCM, focusing on pros/cons of surgery and question prompts, 2) "Homepage," adding webpage descriptions (Extended Summary Figure), 3) menu organization, 4) "Surgery Day" webpage, adding general anesthesia risk information, and 5) "Hypospadias" webpage, adding an icon bar graph to help participants visualize statistics. Participants thought the testimonial videos were relatable and the VCMs would prepare them for their visit with their child's urologist. DISCUSSION Ours is the first parent-centered DA developed and pre-tested for hypospadias. Using validated usability and acceptability scales, participants highly rated the DA in helping them arrive at a decision about surgery. Study limitations include the sample's lack of diversity (i.e., educated, health literate) and participants already decided about their son's hypospadias management before enrolling. To learn more about the DA's usability and acceptability, we plan to pilot test it in a clinical setting. CONCLUSIONS Participants found our DA informative in understanding hypospadias. There was a high perceived level of preparation for hypospadias decision making. Participatory research methods, such as "think aloud," may be helpful when testing DAs as they privilege the patient's experience.
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Affiliation(s)
- Kelsey Binion
- Department of Communication Studies, Indiana University Purdue University, Indianapolis, IN, USA.
| | - Andrew Miller
- Department of Human-Centered Computing, Indiana University Purdue University, Indianapolis, IN, USA.
| | - Rosalia Misseri
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Martin Kaefer
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Krista Longtin
- Department of Communication Studies, Indiana University Purdue University, Indianapolis, IN, USA.
| | - Aaron Carroll
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Sarah E Wiehe
- Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana; Research Jam, Indiana Clinical and Translational Sciences Institute, Indianapolis, IN, USA.
| | - Katherine H Chan
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Urology, University of North Carolina, Chapel Hill, NC, USA.
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Kaefer M, Bagli D, Kalfa N, Beckers GMA, Harper L, Herbst K, Nieuwhof-Leppink A, Fossum M. Genetics: The diagnostic frontier in pediatric urology. J Pediatr Urol 2021; 17:803-804. [PMID: 34607751 DOI: 10.1016/j.jpurol.2021.09.011] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
In the course of human history few scientific breakthroughs can rival the importance of the discovery of DNA. Our ever increasing ability to unravel the secrets contained in this molecule allow new insight in to the etiology and eventual treatment of human conditions ranging from congenital structural disorders to cancer. It is the focus of this article to touch upon sequencing technologies and their potential to provide information that can revolutionize healthcare.
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Affiliation(s)
- Martin Kaefer
- Riley Hospital for Children, Pediatric Urology, Indiana University, Indianapolis, IN, United States.
| | - Darius Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Nicolas Kalfa
- Service de Chirurgie Urologique Pediatrique, Hopital Lapeyronie, CHU de Montpellier, Universite de Montpellier, France
| | - Goedele M A Beckers
- Department of Urology, Pediatric Urology Section, Amsterdam University Medical Centre Location VUmc, Amsterdam, the Netherlands
| | - Luke Harper
- Service de Chirurgie Pediatrique, Hopital Pellegrin-Enfants, CHU de Bordeaux, France
| | - Katherine Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Anka Nieuwhof-Leppink
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - Magdalena Fossum
- Department of Pediatric Surgery, Surgical Clinic C, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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17
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Karmazyn B, Salama A, Jennings SG, Kaefer M. Ultrasound of retained gonads in children and young women with androgen insensitivity syndrome. J Pediatr Urol 2021; 17:797-802. [PMID: 34556411 DOI: 10.1016/j.jpurol.2021.09.005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/02/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Gonadal management in androgen insensitivity syndrome (AIS) patients has been controversial due to low risk of testicular cancer. Our study evaluated the role of ultrasound (US) in screening for malignancy in retained gonads in AIS patients. METHODS This was a retrospective study (2001-2020) of gonadal US in patients with AIS. Demographics and clinical information were retrieved from the medical records. US studies were reviewed for nodule presence, size, echotexture, and change on follow-up studies. When available, pathology correlation was performed. Two-tailed t-test was used to compare age and development of nodules clinically or on US examination. RESULTS 13 patients were included with a median age was 9.9 years (range 3.8-18.4 years). In 11 patients, gonads were in the inguinal canals on either initial or follow-up US. No nodules were palpable on physical examination, but nodules were detected in ten testicles by US in five of 13 patients (41.7%). Presence of nodules was significantly (p = 0.0038) associated with older age. The largest nodule size varied from 0.4 to 2.2 cm (average 0.9 ± 0.5 cm) and most (7/10, 70%) were hypoechoic. Finding testicular nodules on US led to change in management in three patients; bilateral gonadectomies, unilateral gonadectomy, and gonadal excisional biopsies (Figure). Pathology demonstrated Sertoli hamartoma in these patients, and in an additional two patients who underwent post-puberty gonadectomy. No malignancy was found in any specimen. DISCUSSION Preservation of the gonads in children with AIS is associated with low risk for malignant transformation. The role of US surveillance of the gonads is unknown. In our series on 13 patients, most of the visualized 24 gonads (22/24, 91.7%) were localized in the groins in either the first or follow-up US studies. Nodules were detected in ten gonads in five of 13 patients (41.7%). Most of these gonads (8/10) had numerous nodules, most (7/10) were hypoechoic with average diameter of the largest nodule of 0.9 ± 0.5 cm. Pathology in 5 patients demonstrated Sertoli hamartomas in all of the gonads. No malignancy was found. In our series, gonadal nodules led to either gonadectomies or excisional biopsies in three patients. Our study has several limitations, related to the retrospective nature of the study and the small size of our series. CONCLUSION Multiple testicular nodules were commonly detected by US in AIS patients and were not associated with malignancy. Therefore, we are concerned that US screening can lead to unnecessary excisional biopsies and orchiectomies.
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Affiliation(s)
- Boaz Karmazyn
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Riley Hospital for Children, 705 Riley Hospital Drive, Room 1053, Indianapolis, IN, 46202, USA.
| | - Amr Salama
- Division of Pediatric Urology, Urology Department at Alexandria School of Medicine, Alexandria University, Egypt
| | - S Gregory Jennings
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 950 W. Walnut Street, Room E124, Indianapolis, IN, 46202, USA
| | - Martin Kaefer
- Department of Urology, Indiana University School of Medicine, Riley Hospital for Children, 705 Riley Hospital Drive, Room 4230, Indianapolis, IN, 46202, USA
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Adams CM, Misseri R, Rink RC, Kaefer M, Whittam BM, Chan KH, Szymanski KM. Split appendix catheterizable urinary channels are at no higher risk of undergoing revision compared to channels made with the intact appendix. J Pediatr Urol 2021; 17:703.e1-703.e6. [PMID: 34366250 DOI: 10.1016/j.jpurol.2021.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/26/2020] [Revised: 05/24/2021] [Accepted: 06/24/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess long-term APV and split-appendix MACE durability and to compare split and intact appendix APVs in a large patient cohort. METHODS This retrospective cohort study included consecutive patients ≤21 years old undergoing an APV at our institution (1990-2019). Main outcomes were stomal and subfascial revisions. Kaplan Meier survival and Cox proportional hazards analysis were used. RESULTS A total of 339 patients underwent APV creation at a median 7.4 years old (41% female vs. 59% male; 37% umbilical stoma vs. 63% other). In total, 36 patients underwent a stomal revision and 19 a subfascial revision (median channel follow-up 6.3 years). On survival analysis, the risk of stomal revision of the APV was 9.1% at 5 years, 12.6% at 10 years and 16.5% at 15 years. Risk of subfascial revision of the APV was 5.1% at 5 years, 7.0% at 10 years and 8.2% at 15 years. A split-appendix APV was performed in 118 (34.8%) of 339 patients. They had a shorter follow-up compared to those with an intact APV (5.1 vs. 7.0 years, p = 0.03). After correcting for differential follow-up time, there was no significant difference between groups for stomal revisions (HR 1.11, p = 0.76) or subfascial revisions (HR 0.80, p = 0.67, Figure). Risk of APV stomal revision was independent of stomal location and age at surgery (p ≥ 0.37). Similarly, risk of subfascial APV revision was independent of stomal location and age at surgery (p ≥ 0.18). Risk of stomal revision for split-appendix MACE channels was 16.2% at 5, 10 and 15 years (similar to split-appendix APV and all APVs, p ≥ 0.26). Risk of MACE subfascial revision was 5.5% at 5 years, 5.5% at 10 years and 14.7% at 15 years (similar to split-appendix APV and all APVs, p ≥ 0.36). COMMENT We focused on surgical complications, as these entail the highest morbidity, however, we did not assess non-surgical, percutaneous or endoscopic management which also impact long-term outcome and patient quality of life. We did not compare the outcomes of the split-appendix MACE to an intact-appendix MACE cohort, as this patient population was not captured in this review. CONCLUSIONS The split-appendix technique has durable long-term results for both the APV and MACE channels, which are comparable to the technique utilizing the intact appendix. Channel complications occur over the channel's lifetime, as 1 in 8 APVs in the entire cohort underwent a stomal revision and 1 in 14 APVs underwent a subfascial revision at 10 years after surgery.
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Affiliation(s)
- Cyrus M Adams
- Riley Children's Hospital at IU Health, Indianapolis, IN, USA.
| | - Rosalia Misseri
- Riley Children's Hospital at IU Health, Indianapolis, IN, USA
| | - Richard C Rink
- Riley Children's Hospital at IU Health, Indianapolis, IN, USA
| | - Martin Kaefer
- Riley Children's Hospital at IU Health, Indianapolis, IN, USA
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Harper L, Bagli D, Kaefer M, Kalfa N, Beckers GMA, Nieuwhof-Leppink AJ, Fossum M, Herbst KW. COVID-19 and research in pediatric urology. J Pediatr Urol 2021; 17:569-570. [PMID: 33966999 PMCID: PMC8053218 DOI: 10.1016/j.jpurol.2021.04.004] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/11/2021] [Indexed: 11/07/2022]
Abstract
COVID-19 began in December 2019 then spread worldwide. Providers, including pediatric urologists, had to adapt their clinical processes, and many non-covid research activities were suspended. COVID-19 impacts how research is financed, performed, and published, and is itself the subject of intense research. We present current research and publications specifically related to the urinary tract and the pediatric population.
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Affiliation(s)
- L Harper
- Department of Pediatric Urology and Pediatric Surgery, Hopital Pellegrin-Enfants, CHU Bordeaux, France.
| | - D Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada.
| | - M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States.
| | - N Kalfa
- Department of Pediatric Urology and Pediatric Surgery, Hopital Lapeyronie, CHU de Montpellier et Université de Montpellier, France and Institut Desbrest d'Epidemiologie et de Santé Publique IDESP, Université de Montpellier, France.
| | - G M A Beckers
- Department of Urology, Section of Pediatric Urology, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands.
| | - A J Nieuwhof-Leppink
- Department of Medical Psychology and Social Work, Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO box 85090, 3508 AB, Utrecht, the Netherlands.
| | - M Fossum
- Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, DK-2100, Denmark; Department of Women's and Children's Health, Bioclinicum, Floor 10, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
| | - K W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, USA.
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Affiliation(s)
- Martin Kaefer
- Indiana University School of Medicine, Indianapolis, Indiana 46202.
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Salama AK, Misseri R, Hollowell N, Hahney B, Whittam B, Kaefer M, Cain MP, Rink RC, Szymanski KM. Incidence of nephrolithiasis after bladder augmentation in people with spina bifida. J Pediatr Urol 2021; 17:521.e1-521.e7. [PMID: 33867288 DOI: 10.1016/j.jpurol.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/22/2020] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Risks of nephrolithiasis after bladder augmentation in people with spina bifida (SB) remain unclear. Annual incidence of nephrolithiasis in the general population is 0.01% for 10-14 years old, 0.07% for 15-19 years old and 0.2% for 20-24 years old. Our aim was to assess the incidence and risk factors of nephrolithiasis in SB patients after augmentation. METHODS Patients with SB and augmentation followed at our institution were retrospectively reviewed (born ≥1972, surgery 1979-2019). Patients were screened annually with renal bladder ultrasound and abdominal radiograph. Main outcome was nephrolithiasis treatment. Kaplan-Meier survival and Cox proportional hazards analysis were used. Possible predictors were assessed using stepwise forward selection (variables with p < 0.1 on univariate analysis included in multivariate analysis). RESULTS 427 patients with SB and augmentation were included (51.8% female, 74.9% shunted). Median age at augmentation was 8.5 years (median follow-up: 12.4 years, ileum segment: 81.0%, bladder neck procedure: 60.7%, urinary channel: 74.2%) and 28.8% developed bladder stones. Overall, 47 (11.0%) patients were treated for nephrolithiasis. After correction for differential follow-up, nephrolithiasis was treated in 7.3% at 10 years, 13.2% at 15 years, and 18.0% at 20 years (Figure). Patients presented with either a urinary tract infection (46.8%), on screening (44.7%), or pain (8.5%). Stones were treated percutaneously, endoscopically or by ESWL (63.8%/34.0%/10.7%, respectively). Most were calcium stones (58.3%). On multivariate analysis, compared to younger patients, patients augmented at ≥10 years of age had 1.84 times the risk of nephrolithiasis (p = 0.01). Nephrolithiasis was more common in those who developed bladder stones (HR = 3.00, p < 0.0001). Among those with both renal and bladder stones, bladder stones typically preceded nephrolithiasis (55.2%), were treated concurrently (31.0%) and 13.8% occurred after nephrolithiasis. Gender, wheelchair use, bowel segment used, MACE and skeletal fractures were not associated with higher nephrolithiasis risk (p ≥ 0.11). DISCUSSION This study of a large cohort of SB patients with long-term follow-up highlights that the risk of nephrolithiasis is cumulative and related to bladder stone formation, age at augmentation and time since augmentation. An association with bladder stones suggests potential shared metabolic causes. The study's retrospective design likely led to underestimating the risk of nephrolithiasis by not capturing spontaneously passed stones. CONCLUSION Approximately 1% of patients with SB develop nephrolithiasis annually after augmentation. Close long-term surveillance after augmentation is strongly indicated, as nephrolithiasis incidence in augmented patient with SB is at least 10 times higher than general population. Patients with bladder stones are especially at risk.
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Affiliation(s)
- Amr K Salama
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA; Division of Pediatric Urology, Urology Department at Alexandria School of Medicine, Alexandria University, Egypt.
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA.
| | - Nathan Hollowell
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA.
| | - Brittany Hahney
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA.
| | - Benjamin Whittam
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA.
| | - Martin Kaefer
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA.
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA.
| | - Richard C Rink
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA.
| | - Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA.
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Riggs A, Kaefer M. Treatment of a high output nephrocutaneous urine leak following treatment of a giant calyceal diverticulum in a child. Urol Case Rep 2020; 33:101287. [PMID: 32514404 PMCID: PMC7267703 DOI: 10.1016/j.eucr.2020.101287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/27/2020] [Indexed: 12/02/2022] Open
Abstract
Calyceal diverticula are non-secretory transitional-epithelium lined cavities that are connected to the collecting system through a small ostium. They are rarely seen in young children. Although most remain asymptomatic, the presence of stagnant urine can result in infection, stone formation and pain. Treatment may consist of percutaneous ablation or open surgical excision. Failure of the ostium to completely seal can result in a persistent leak. We present a case of a massive calyceal diverticulum in a child who developed a postsurgical nephrocutaneous fistula recalcitrant to conservative management that was successfully managed with injection of fibrin glue.
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Bägli D, Beckers G, Fossum M, Harper L, Herbst K, Kaefer M, Kalfa N, Nieuwhof-Leppink A. To: Adult and pediatric urology department/division chairs and pediatric urology fellowship programme directors. J Pediatr Urol 2020; 16:731-732. [PMID: 32830061 DOI: 10.1016/j.jpurol.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/29/2022]
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Herbst KW, Beckers GMA, Harper L, Bägli DJ, Nieuwhof-Leppink AJ, Kaefer M, Fossum M, Kalfa N. Don't be mean, be above average: Understanding data distribution and descriptive statistics. J Pediatr Urol 2020; 16:712. [PMID: 33011086 DOI: 10.1016/j.jpurol.2020.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
- K W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States.
| | - G M A Beckers
- Department of Urology, Section of Pediatric Urology, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - L Harper
- Department of Pediatric Urology and Pediatric Surgery, Hopital Pellegrin-Enfants, CHU Bordeaux, France
| | - D J Bägli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - A J Nieuwhof-Leppink
- Department of Medical Psychology and Social Work, Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, the Netherlands
| | - M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - M Fossum
- Department of Pediatric Surgery, Surgical Clinic C, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - N Kalfa
- Service de chirurgie et urologie pédiatrique, hôpital Lapeyronie, CHU de Montpellier et Université de Montpellier, France
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Affiliation(s)
- L Harper
- Department of Pediatric Urology and Pediatric Surgery, Hopital Pellegrin-Enfants, CHU Bordeaux, France.
| | - N Kalfa
- Service de chirurgie et urologie pédiatrique, hôpital Lapeyronie, CHU de Montpellier et Université de Montpellier, France.
| | - G M A Beckers
- Department of Urology, Section of Pediatric Urology, AmsterdamUMC, Location VUmc, Amsterdam, the Netherlands.
| | - M Kaefer
- Indiana University, 702 Barnhill Drive, Suite 4230, Indianapolis, IN, USA.
| | - A J Nieuwhof-Leppink
- Department of Medical Psychology and Social Work, Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO box 85090, 3508 AB, Utrecht, the Netherlands.
| | - Magdalena Fossum
- Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, DK-2100, Denmark; Department of Women's and Children's Health, Bioclinicum, Floor 10, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
| | - K W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, USA.
| | - D Bagli
- Hospital for Sick Chidlren, Univeristy of Toronto, Canada.
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Kaefer M, Kalfa N, Herbst KW, Harper L, Beckers GM, Bagli D, Fossum M. How to more effectively determine what is true: The limits of intuition. J Pediatr Urol 2020; 16:495-496. [PMID: 32493668 DOI: 10.1016/j.jpurol.2020.05.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 11/18/2022]
Abstract
The plethora of scientific data and explosion of published materials often leave it challenging to develop a clear and concise overview of many scientific topics. A number of factors may contribute to our misunderstanding. It is the focus of this article to describe primary reasons for failure to establish a clear, factual and functional understanding regarding scientific areas of inquiry.
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Affiliation(s)
- Martin Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Nicolas Kalfa
- Service de Chirurgie Urologique Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France
| | - Katherine W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Luke Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - Goedele Ma Beckers
- Department of Urology, Pediatric Urology Section, Amsterdam University Medical Centre Location VUmc, Amsterdam, the Netherlands
| | - Darius Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Magdalena Fossum
- Department of Pediatric Surgery, Surgical Clinic C, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Chan KH, Misseri R, Cain MP, Whittam B, Szymanski K, Kaefer M, Rink R, Cockrum B, Moore C, Wiehe S. Provider perspectives on shared decision-making regarding hypospadias surgery. J Pediatr Urol 2020; 16:307-315. [PMID: 32307325 PMCID: PMC8562057 DOI: 10.1016/j.jpurol.2020.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/07/2020] [Accepted: 03/19/2020] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Many parents experience decisional conflict and decisional regret around hypospadias surgery. The utilization of a shared decision-making (SDM) process may mitigate these issues, however addressing the principal components of the SDM process is a complex task that requires the investment of providers. OBJECTIVE The purpose of this study was to facilitate a discussion about SDM anchored on hypospadias with pediatric urology and general pediatric providers to explore perspectives, clinical applications and barriers to adopting SDM in clinical practice. STUDY DESIGN We conducted two focus groups in order to engage pediatric urology and general pediatric providers in guided discussions about SDM anchored on hypospadias. All activities were audio recorded and professionally transcribed. The transcripts were analyzed by three coders using directed qualitative content analysis techniques to identify themes and relationships between themes to inform the development of an affinity diagram (Extended Summary Figure). RESULTS Two focus groups were held; one with seven pediatric urology providers in November 2018 and one with ten general pediatric providers in January 2019 (median age 51 years, 88.2% Caucasian, 58.8% female, 70.6% physicians and 29.4% nurse practitioners). Both groups identified some of the key components of SDM including engaging families in decision-making, informing them about treatment options and clarifying values/preferences (Extended Summary Figure). They thought that SDM was useful for discussing preference-sensitive conditions (e.g. hypospadias) and addressing parental compliance. General pediatric providers also suggested that SDM helped them avoid unnecessary referrals to specialists. Both groups identified parental, provider and systemic barriers to the adoption of SDM: a) desire for paternalism, b) misperceptions about medical evidence, c) completion of parental decision-making prior to the clinical visit, d) provider bias/lack of interest and e) time constraints/productivity pressures. DISCUSSION Providers who care for hypospadias patients are knowledgeable about SDM and its potential clinical applications. They identified several potentially modifiable barriers to the adoption of a SDM process about hypospadias surgery in a pediatric clinical setting. CONCLUSIONS Based on feedback from providers, we plan to implement a hypospadias decision aid early in the parental decision-making process about hypospadias such as in the postpartum unit and at well-child visits in the newborn period and provide a provider training session about SDM to address the identified knowledge gaps.
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Affiliation(s)
- Katherine H Chan
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Pediatrics, Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Rosalia Misseri
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Mark P Cain
- Department of Urology, University of Washington, Seattle, WA, USA.
| | - Benjamin Whittam
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Konrad Szymanski
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Martin Kaefer
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Richard Rink
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Brandon Cockrum
- Research Jam, Indiana Clinical and Translational Sciences Institute, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Courtney Moore
- Research Jam, Indiana Clinical and Translational Sciences Institute, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Sarah Wiehe
- Research Jam, Indiana Clinical and Translational Sciences Institute, Indiana University School of Medicine, Indianapolis, IN, USA.
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Harper L, Herbst KW, Bagli D, Kaefer M, Beckers GMA, Fossum M, Kalfa N. The battle between fake news and science. J Pediatr Urol 2020; 16:114-115. [PMID: 32094094 DOI: 10.1016/j.jpurol.2019.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/03/2019] [Indexed: 11/18/2022]
Affiliation(s)
- L Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France.
| | - K W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - D Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - G M A Beckers
- Department of Urology, Pediatric Urology Section, Amsterdam University Medical Centre Location VUmc, Amsterdam, the Netherlands
| | - M Fossum
- Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - N Kalfa
- Service de Chirurgie et Urologie Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France
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Bagli D, Herbst KW, Harper L, Beckers G, Kaefer M, Kalfa N, Fossum M. Further medical experience will be required to validate these results: How experience -based medicine shapes the validity of medical evidence. J Pediatr Urol 2020; 16:112-113. [PMID: 31836435 DOI: 10.1016/j.jpurol.2019.10.022] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 10/23/2019] [Indexed: 11/16/2022]
Abstract
This communication contextualizes the importance of clinical experience or experience-based medicine within the current paradigm of evidence-based medicine, complementing our previously published series of five short educational articles on evidence-based medicine. Previously we focused on optimizing medical decisions using publications of well-conducted research. Previous commentaries included a backgrounder, the hierarchy of evidence, data acquisition, tools for critical appraisal, and clinical use of evidence based medicine.
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Affiliation(s)
- Darius Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Katherine W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Luke Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - Goedele Beckers
- Department of Urology, Pediatric Urology Section, Amsterdam University Medical Centre Location VUmc, Amsterdam, the Netherlands
| | - Martin Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Nicolas Kalfa
- Chirurgie et Urologie Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université, de Montpellier, France
| | - Magdalena Fossum
- Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Fossum M, Herbst KW, Kaefer M, Harper L, Castagnetti M, Beckers G, Kalfa N, Bagli D. Evidence-based medicine V: how to use in clinical practice. J Pediatr Urol 2019; 15:568-569. [PMID: 31519481 DOI: 10.1016/j.jpurol.2019.07.025] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 11/30/2022]
Abstract
In this penultimate installment in the educational series on evidence-based medicine, the Research Committee of the European Society of Pediatric Urology will focus on clinical application. In previous communications, optimizing medical decisions was focused on through the use of well-conducted research publications, and the topics of background, hierarchy of evidence, information acquisition, and critical appraisal tools were covered. The goal is to guide the clinician in using evidentiary tools for setting up a clinical question, finding appropriate information, searching appropriate databases, and evaluating the results with the patient in mind.
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Affiliation(s)
- Magdalena Fossum
- Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Kathrine W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Martin Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Luke Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - Marco Castagnetti
- Section of Pediatric Urology, Department of Surgical, Oncological and Gastroeneterological Sciences, University Hospital of Padova, Padua, Italy
| | - Goedele Beckers
- Department of Urology, Pediatric Urology Section, Amsterdam University Medical Centre Location VUmc, Amsterdam, the Netherlands
| | - Nicolas Kalfa
- Service de Chirurgie et Urologie Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France
| | - Darius Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
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Kaefer M, Castagnetti M, Herbst K, Bagli D, Beckers GMA, Harper L, Kalfa N, Fossum M. Evidence-based medicine III: level of evidence. J Pediatr Urol 2019; 15:407-408. [PMID: 31130505 DOI: 10.1016/j.jpurol.2019.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 11/17/2022]
Abstract
The present article is the third installment in a five-part series related to evidence-based medicine (EBM) provided by the European Society for Paediatric Urology Research Committee. It will present the different levels of evidence (i.e. systematic review, randomized controlled trial, cohort study) available to clinicians and researchers and describe the strengths of each study type. While EBM provides a valuable construct to aid in medical decision-making, it remains imperative that this information be interpreted and applied in the clinical context with a good dose of common sense.
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Affiliation(s)
- M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - M Castagnetti
- Section of Pediatric Urology, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, Padua, Italy
| | - K Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - D Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - G M A Beckers
- Department of Urology, Pediatric Urology Section, Amsterdam University Medical Centre Location VUmc, Amsterdam, the Netherlands
| | - L Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - N Kalfa
- Service de Chirurgie et Urologie Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France
| | - M Fossum
- Division of Pediatric Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Beckers GMA, Herbst K, Kaefer M, Harper L, Castagnetti M, Bagli D, Kalfa N, Fossum M. Evidence Based Medicine IV: how to find an evidence-based answer to a clinical question? Make a critically appraised topic! J Pediatr Urol 2019; 15:409-411. [PMID: 31266683 DOI: 10.1016/j.jpurol.2019.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 05/08/2019] [Indexed: 02/04/2023]
Abstract
This manuscript is the fourth in a five part series related to evidence based medicine (EBM) provided by the European society of pediatric urology (ESPU) research committee. It will present a way to come to a quick and critical appraisal of available evidence on a specific topic: a CAT (critically appraised topic). The way how to write a cat is described for interventions to be compared to a control group, and for other, more generalized clinical questions. While systematic reviews provide a throughout overview of all evidence available, a CAT provides a shorter way to come to quick insights based on EBM.
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Affiliation(s)
- G M A Beckers
- Department of Urology, Pediatric Urology Section, Amsterdam University Medical Centre Location VUmc, Amsterdam, the Netherlands.
| | - K Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - L Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - M Castagnetti
- Section of Pediatric Urology, University Hospital of Padova, Padua, Italy
| | - D Bagli
- Division of Urology, Department of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - N Kalfa
- Service de Chirurgie Urologique Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France
| | - M Fossum
- Division of Pediatric Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Szymanski KM, Whittam B, Monahan PO, Kaefer M, Frady H, Cain MP, Rink RC. Validation and Preliminary Results of the Parental Assessment of Children's External Genitalia Scale for Females (PACE-F) for Girls With Congenital Adrenal Hyperplasia. Urology 2019; 130:132-137. [PMID: 31071351 DOI: 10.1016/j.urology.2019.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/23/2019] [Accepted: 04/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To validate a parental assessment of children's external genitalia scale for females (PACE-F) for girls with congenital adrenal hyperplasia (CAH) by adapting the validated adult female genital self-image scale. METHODS PACE-F was administered to parents of girls (Tanner 1, 2 months-12 years) with and without CAH. Final questions were determined by clinical relevance and psychometric properties (scores: 0-100). A reference range was established using 95% confidence interval among controls. Age-matched controls were compared to girls with CAH (1) <4 years old before and after female genital reconstruction surgery (FGRS), and (2) 4-12-year olds after FGRS. Nonparametric statistics were used. RESULTS Participants included 56 parents of 41 girls with CAH (median 3.9 years old, 97.6% FGRS) and 139 parents of 130 girls without CAH. Face and content validity was established by families, experts, and factor analysis. Internal consistency was high (Cronbach's alpha: 0.83). Population reference score range was 66.7-100. Ten consecutive girls had pre- and post-FGRS PACE-F scores. All scores improved at 4 months after surgery and all preoperative scores were below reference range and lower than controls (P = .0001). All postoperative scores were within reference range, no different from controls (P = .18). Scores for girls with CAH after FGRS aged 4-12 years were no different from controls (100.0 vs 88.9, P = .77) and 90.0% were in reference range, as expected (P = .99). CONCLUSION We present a validated instrument for parental assessment of genital appearance in girls with CAH. We demonstrate improved parent-reported appearance after FGRS, with scores similar to age-matched controls.
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Affiliation(s)
- Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN.
| | - Benjamin Whittam
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Patrick O Monahan
- Department of Biostatistics, Indiana University School of Medicine and School of Public Health, Indianapolis, IN
| | - Martin Kaefer
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Heather Frady
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Richard C Rink
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
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Castagnetti M, Herbst KW, Bagli D, Beckers GMA, Harper L, Kaefer M, Kalfa N, Fossum M. EBM II: How to perform a literature search. J Pediatr Urol 2019; 15:268-269. [PMID: 30956125 DOI: 10.1016/j.jpurol.2019.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 03/05/2019] [Indexed: 11/30/2022]
Abstract
The present article is a second part related to evidence based medicine (EBM) in a series of five by the European society for paediatric urology (ESPU) research committee. It will present the different databases/search engines available to clinicians and researchers and describe strategies to focus the search to one's particular needs. Indeed, databases/search engines used and search strategy should vary according to the goal of the research. If the aim is to address a clinical problem, the search should allow to identify a small number of most pertinent articles (high specificity); if the search is for research purposes, instead, it should ensure no meaningful articles are overlooked (high sensitivity).
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Affiliation(s)
- M Castagnetti
- Section of Pediatric Urology, University Hospital of Padova, Padua, Italy
| | - K W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - D Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - G M A Beckers
- Department of Urology, Pediatric Urology Section, Amsterdam University Medical Centre Location VUmc, Amsterdam, the Netherlands
| | - L Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - N Kalfa
- Service de Chirurgie Urologique Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université, de Montpellier, France
| | - M Fossum
- Division of Pediatric Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Szymanski KM, Whittam B, Kaefer M, Frady H, Cain MP, Rink RC. What about my daughter's future? Parental concerns when considering female genital restoration surgery in girls with congenital adrenal hyperplasia. J Pediatr Urol 2018; 14:417.e1-417.e5. [PMID: 30126743 DOI: 10.1016/j.jpurol.2018.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 07/12/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE The parental decision-making process regarding female genital restoration surgery (FGRS) for girls with congenital adrenal hyperplasia (CAH) is controversial and poorly understood. The aim of the study aim was to evaluate parental concerns related to their child's future and parental plans about disclosure prior to FGRS. MATERIALS AND METHODS The authors performed an online survey of consecutive parents presenting at a tertiary referral center for consultation regarding FGRS for their daughter with CAH before 3 years of age (2016-2018). Twenty issues initially identified by three families and six clinicians were rated on a 6-point Likert scale of importance ('not at all' to 'extremely'). RESULTS Sixteen consecutive families participated (Prader 3/4/5: 43.8%/43.8%/12.5%). Fourteen girls (87.5%) subsequently underwent FGRS at a median age of 8 months. Most issues (19/20, 95.0%) were ranked 'quite a bit' to 'extremely' important (Table). Top issues were not surgical: Normal physical/mental development, adrenal crisis and side-effects of medications. Surgery-related and self-image concerns followed in importance. Least prioritized issues were multiple genital exams ('quite a bit' important) and the child not being involved in the decision to proceed with FGRS ('somewhat' important). On average, no issues were considered 'not at all' or 'a little' important. Disclosure of FGRS to their daughter was the 15th prioritized issues. Almost all families (93.8%, 1 unsure) planned to disclose the surgery to their daughter, although many were unsure when and how to do it (33.3% and 37.5%, respectively). COMMENT Initial efforts to understand the complex process of parental decision-making regarding FGRS in the context of CAH, a complex, multifactorial disease, are presented. Parents of infant girls with CAH simultaneously weigh multiple life-threatening concerns with a decision about FGRS. While issues of genital ambiguity and surgery are important, they are not overriding concerns for parents of girls with CAH. Parents report significant uncertainty about appropriate timing and approach to disclosing FGRS to their daughters. Unfortunately, best practice guidelines for this process are lacking. The findings are not based on actual history of disclosure but on parents' anticipated behavior. Further data are need from parents, children, and women with CAH about successful disclosure. Being a single-center series, these data may not correspond to the wider CAH community. CONCLUSIONS Parental decision-making regarding FGRS is multifactorial. Even when considering FGRS, parents' largest concerns remain focused on the life-threatening and developmental effects of CAH and side-effects of its medical treatment. The disclosure process deserves further attention.
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Affiliation(s)
- K M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA.
| | - B Whittam
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
| | - M Kaefer
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
| | - H Frady
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
| | - M P Cain
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
| | - R C Rink
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
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Kaefer M, Beckers G, Gobet R, El-Ghoneimi A, Fossum M. How the ESPU grades clinical abstracts. J Pediatr Urol 2018; 14:451-452. [PMID: 30181100 DOI: 10.1016/j.jpurol.2018.07.009] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
The ability to consistently review abstracts in an unbiased and objective fashion is a skill that most academics hope to master. However, robust standardized rating systems are sparse, with most scientific boards leaving the task of rating abstracts poorly defined and at the whim of the reviewer. In an effort to bring consistency to this process, in 2013, the ESPU board adopted an abstract rating system that has been previously used in the field of plastic surgery and orthopedics. (van der Steen et al., 2004; Poolman et al., 2007). The aim of this manuscript is to outline this practice.
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Affiliation(s)
- Martin Kaefer
- Department of Pediatric Urology, Riley Children's Hospital, Indiana University, Indianapolis, IN, USA
| | - Goedele Beckers
- Department of Urology, VU University Medical Center, Amsterdam, The Netherlands
| | - Rita Gobet
- Department of Pediatric Urology, Kinderspital, Zürich, Switzerland
| | | | - Magdalena Fossum
- Department of Pediatric Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Dept. of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Chan KH, Shah A, Moser EA, Szymanski K, Whittam BM, Misseri R, Kaefer M, Rink R, Cain MP. Author Reply. Urology 2018; 118:170-171. [PMID: 30077313 DOI: 10.1016/j.urology.2017.08.065] [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]
Affiliation(s)
- Katherine H Chan
- Division of Pediatric Urology, Department of Urology, Indiana University School of Medicine, Indianapolis, IN; Center for Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Aali Shah
- Department of Anesthesiology, Indiana University School of Medicine, Indianapolis, IN
| | - Elizabeth A Moser
- Department of Biostatistics, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indianapolis, IN
| | - Konrad Szymanski
- Division of Pediatric Urology, Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Benjamin M Whittam
- Division of Pediatric Urology, Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Rosalia Misseri
- Division of Pediatric Urology, Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Martin Kaefer
- Division of Pediatric Urology, Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Richard Rink
- Division of Pediatric Urology, Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Mark P Cain
- Division of Pediatric Urology, Department of Urology, Indiana University School of Medicine, Indianapolis, IN
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Szymanski KM, Whittam B, Kaefer M, Frady H, Casey JT, Tran VT, Cain MP, Rink RC. Parental decisional regret and views about optimal timing of female genital restoration surgery in congenital adrenal hyperplasia. J Pediatr Urol 2018; 14:156.e1-156.e7. [PMID: 29330019 DOI: 10.1016/j.jpurol.2017.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 09/12/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The role of female genital restoration surgery (FGRS) in girls with congenital adrenal hyperplasia (CAH) is controversial, with no long-term parent-reported outcomes available. Decisional regret (DR) affects most parents after their children's treatment of pediatric conditions, including hypospadias. We aimed to assess parental DR after FGRS in infancy or toddlerhood and explore optimal timing for surgery. MATERIALS AND METHODS One-hundred and six parents of females with CAH undergoing FGRS before 3 years old and followed at our institution (1999-2017) were invited to enroll online. Higher Decision Regret Scale (DRS) scores indicated greater DR (range 0-100). Participants also reported preferred FGRS timing relative to their surgery (earlier, same, later/delayed). Non-parametric statistical tests were used. RESULTS Thirty-nine parents (median 4.4 years after FGRS) participated (36.8% response rate). Median age at FGRS was 9 months. Median DRS score was 0 (mean: 5.0). Overall, 20.5% of parents reported some regret (all mild-moderate) (Figure). Fewer parents reported DR after FGRS compared with published DR after hypospadias repair (50-92%, p ≤ 0.001) or adenotonsillectomy (41-45%, p ≤ 0.03). No parent preferred delayed FGRS. Seven parents (18.1%) preferred earlier surgery, especially when performed after birthday (80.0% vs. 8.8%, p = 0.004). DISCUSSION We present the first report of validated long-term parent-reported outcomes after FGRS in infant and toddler girls with CAH. One limitation is that this is largely a single surgeon series. Reasons for the observed low levels of DR are likely multifactorial. Far from a definitive study, we aimed to provide parents willing to share about their experience an opportunity to do so. For that reason, selection bias may exist in our study. While parents with higher DR were potentially less likely to participate because of mistrust of the medical establishment, those with a negative experience may in fact be more likely to voice their opinions. A low participation rate was likely a result of the sensitive nature of FGRS, a desire for privacy, and inability to locate parents. A larger study will be required to assess how DR is affected by sexual function, genital appearance and complications, and DR among women with CAH. CONCLUSIONS Parents of females with CAH report low levels of DR after FGRS in infancy and toddlerhood. This appears to be lower than after other genital and non-genital pediatric procedures. When present, parental DR is usually mild. No parents preferred delayed surgery, even among those with DR. Some preferred earlier surgery.
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Affiliation(s)
- Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA.
| | - Benjamin Whittam
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
| | - Martin Kaefer
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
| | - Heather Frady
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
| | - Jessica T Casey
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
| | - Vi T Tran
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
| | - Richard C Rink
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, IN, USA
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Weatherly DL, Szymanski KM, Whittam BM, Bennett WE, King S, Misseri R, Kaefer M, Rink RC, Cain MP. Comparing inpatient versus outpatient bowel preparation in children and adolescents undergoing appendicovesicostomy. J Pediatr Urol 2018; 14:50.e1-50.e6. [PMID: 28917602 DOI: 10.1016/j.jpurol.2017.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 05/23/2017] [Accepted: 07/08/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE The need for mechanical inpatient bowel preparation (IBP) in reconstructive pediatric urology has come under scrutiny, secondary to literature demonstrating little benefit regarding outcomes. Starting in 2013, a majority of patients undergoing reconstructive procedures at our institution no longer underwent IBP. We hypothesized that outpatient bowel preparation (OBP) would reduce length of stay (LOS) without increasing postoperative complications after appendicovesicostomy surgery. MATERIALS AND METHODS An institutional database of patients undergoing lower urinary tract reconstruction between May 2010 and December 2014 was reviewed. Starting in 2013, a departmental decision was made to replace IBP with OBP. Patients undergoing an augmentation cystoplasty or continent ileovesicostomy were excluded because of insufficient numbers undergoing OBP. Patients undergoing IBP were admitted 1 day prior to surgery and received polyethylene glycol/electrolyte solution. A personalized preoperative OBP was introduced in 2013. Cost data were obtained from the Pediatric Health Information System. RESULTS Sixty-seven patients met the inclusion criteria, with 30 (44.8%) undergoing IBP. There were no differences with respect to gender, age, presence of ventriculoperitoneal shunt, body mass index, glomerular filtration rate, preoperative diagnosis, operative time, and prior or simultaneous associated surgeries (p ≥ 0.07). Patients undergoing an IBP had a longer median LOS (7 vs. 5 days, p = 0.0002) and a higher median cost (US$4,288, p = 0.01). Postoperative complications in both groups were uncommon and were classified as Clavien-Dindo grade 1-2, with no statistical difference (IBP 20.0% vs. OBP 5.4%, p = 0.13). No serious postoperative complication occurred, such as a dehiscence, bowel obstruction, or shunt infection. DISCUSSION This is the first analysis of hospitalization costs and IBP, showing a higher median cost of US$4288 compared with OBP. The LOS was shorter with an OBP (figure), similar to a previous report. Similar complication rates between the groups add to the growing body of literature that avoidance of IBP is safe in pediatric lower urinary tract reconstruction. Being a retrospective review of a practice change, differences in care that influenced cost and LOS may be missing. Also, as the surgeons do not know if a usable appendix is initially present, our data may not extrapolate to all patients. Despite these potential limitations, our data support the safety of utilizing OBP in patients with a high likelihood of a usable appendix, including those undergoing a synchronous Malone antegrade continence enema via a split-appendix technique. CONCLUSION In patients undergoing an appendicovesicostomy, preoperative IBP led to longer LOS and higher costs of hospitalization. OBP was not associated with increased risks of postoperative complications.
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Affiliation(s)
- David L Weatherly
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA.
| | - Benjamin M Whittam
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - William E Bennett
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Shelly King
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Martin Kaefer
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Richard C Rink
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
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Affiliation(s)
- G M A Beckers
- Department of Urology, Pediatric Urology Section, VU University Medical Center, Amsterdam, The Netherlands.
| | - M Fossum
- Department of Pediatric Surgery, Section of Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - M Kaefer
- Indiana University, 702 Barnhill Drive, Suite 4230, Indianapolis, IN, USA
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Roth JD, Casey JT, Whittam BM, Szymanski KM, Kaefer M, Rink RC, Schubert FP, Cain MP, Misseri R. Complications and Outcomes of Pregnancy and Cesarean Delivery in Women With Neuropathic Bladder and Lower Urinary Tract Reconstruction. Urology 2018; 114:236-243. [PMID: 29305940 DOI: 10.1016/j.urology.2017.11.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 11/11/2017] [Accepted: 11/14/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To determine the outcomes of pregnancy and cesarean delivery (CD) in women with neuropathic bladder (NB) and pediatric lower urinary tract reconstruction (LUTR) as these women often have normal fertility and may become pregnant. METHODS We reviewed consecutive patients with NB due to spinal dysraphism who underwent LUTR, became pregnant, and had a CD at our institution from July 2001 to June 2016. We collected data on demographics, hydronephrosis, symptomatic urinary tract infection, continence, and catheterization during pregnancy. CD data included gestational age, abdominal or uterine incisions, and complications. RESULTS We identified 18 pregnancies in 11 women. Fifteen live newborns were delivered via CD (53.3% term births). Thirteen of 15 patients (86.7%) developed new (10) or worsening (3) hydronephrosis. Six of 13 patients (46.2%) underwent nephrostomy tube placement. Eight of 15 patients (53.3%) developed difficulty catheterizing (66.7% via native urethra, 44.4% via catheterizable channel); 50.0% of patients required an indwelling catheter. Five of 15 patients (33.3%) developed urinary incontinence during pregnancy. Ten of 15 patients (66.7%) had a urinary tract infection (30.0% febrile). A urologist was present for all CDs: 5 were scheduled, 10 occurred emergently. Complications occurred in 40.0% (5 cystotomies, 1 bowel deserosalization, 1 vaginal laceration). All cystotomies occurred during emergent CD. Three patients (20.0%) developed urinary fistulae after emergent CD. CONCLUSIONS Women with NB and LUTR have high rates of complications during pregnancy and CD, despite routine involvement of urologists. Women with prolonged labor, previous CD, or those with a history of noncompliance developed the worst complications. Based on our experience, a urologist should always be present and participate in the CD.
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Affiliation(s)
- Joshua D Roth
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Jessica T Casey
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Benjamin M Whittam
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Konrad M Szymanski
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Martin Kaefer
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Richard C Rink
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | | | - Mark P Cain
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Rosalia Misseri
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN.
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Beckers GMA, Kaefer M, Fossum M. Construction of a scientific abstract. J Pediatr Urol 2017; 13:639-640. [PMID: 29042109 DOI: 10.1016/j.jpurol.2017.08.010] [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: 07/27/2017] [Accepted: 08/08/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Goedele M A Beckers
- VU University Medical Center, Department of Urology, Division of Pediatric Urology, Amsterdam, Netherlands
| | - Martin Kaefer
- Indiana University Medical School, Pediatric Urology, Indianapolis, Indiana, USA
| | - Magdalena Fossum
- Department of Pediatric Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
| | -
- Department of Pediatric Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
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Chan KH, Shah A, Moser EA, Szymanski K, Whittam BM, Misseri R, Kaefer M, Rink R, Cain MP. Comparison of Intraoperative and Early Postoperative Outcomes of Caudal vs Dorsal Penile Nerve Blocks for Outpatient Penile Surgeries. Urology 2017; 118:164-171. [PMID: 29122625 DOI: 10.1016/j.urology.2017.08.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 05/03/2017] [Revised: 08/10/2017] [Accepted: 08/15/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare intraoperative and 1-hour postoperative outcomes in caudal vs dorsal penile nerve block (DPNB) patients undergoing penile surgeries. MATERIALS AND METHODS We performed a retrospective cohort study of boys <10 years old undergoing penile procedures (2013-2015) using the Pediatric Regional Anesthesia Network, Pediatric Health Information System databases, and our medical records. The primary outcome was a maximum Faces Limbs Activity Crying Consolability pain score of >3. Secondary outcomes were intraoperative-postanesthesia care unit (PACU) narcotics, preincision anesthesia time, adjusted operating room charges, and complications. We performed bivariate and multivariable analyses controlling for demographic and procedural characteristics and clustering by surgeon. RESULTS Of 738 patients (mean age 2.1 years), 74.1% had a caudal block. DPNB patients were more likely to have a maximum pain score of >3 (19.5% vs 8.1%, P <.0001), receive intraoperative (33.0% vs 2.9%, P <.0001) and PACU (15.7% vs 7.5%, P = .0009) narcotics, and had shorter preincision anesthesia times (19.5 vs 27.9 minutes, P <.0001) and lower adjusted operating room charges ($9,402 vs $12,760, P <.0001). In a bivariate logistic regression, DPNB patients had 2.7 times the odds of a maximum pain score of >3 (95% confidence interval 1.7-4.4, P <.0001) and 5.2 times the odds of intraoperative and PACU narcotic administration (95% confidence interval 3.3-8.1, P <.0001). In multivariable analyses, caudal patients had longer preincision anesthesia times (27.9 ± 7.4 vs 19.5 ± 6.6 minutes, P <.0001) and higher adjusted operating room charges ($12,760 ± 4077 vs $9,402 ± 3741, P = .01). CONCLUSION Caudal blocks may offer a small advantage in the immediate postoperative period, although cost-effectiveness is unproven.
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Affiliation(s)
- Katherine H Chan
- Division of Pediatric Urology, Department of Urology, Indiana University School of Medicine, Indianapolis, IN; Center for Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.
| | - Aali Shah
- Department of Anesthesiology, Indiana University School of Medicine, Indianapolis, IN
| | - Elizabeth A Moser
- Department of Biostatistics, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indianapolis, IN
| | - Konrad Szymanski
- Division of Pediatric Urology, Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Benjamin M Whittam
- Division of Pediatric Urology, Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Rosalia Misseri
- Division of Pediatric Urology, Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Martin Kaefer
- Division of Pediatric Urology, Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Richard Rink
- Division of Pediatric Urology, Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Mark P Cain
- Division of Pediatric Urology, Department of Urology, Indiana University School of Medicine, Indianapolis, IN
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Affiliation(s)
- Martin Kaefer
- Department of Urology, Indiana University, Indianapolis, Indiana
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Szymański KM, Misseri R, Whittam B, Casey JT, Yang DY, Raposo SM, King SJ, Kaefer M, Rink RC, Cain MP. Validation of QUALAS-T, a health-related quality of life instrument for teenagers with spina bifida. Cent European J Urol 2017; 70:306-313. [PMID: 29104796 PMCID: PMC5656361 DOI: 10.5173/ceju.2017.1195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/10/2017] [Accepted: 05/28/2017] [Indexed: 12/04/2022] Open
Abstract
Introduction We aimed to develop and validate a self-reported QUAlity of Life Assessment in Spina bifida for Teenagers (QUALAS-T). Material and methods We drafted a 46-question pilot instrument using a patient-centered comprehensive item generation/refinement process. A group of 13–17 years olds with spina bifida (SB) was recruited online via social media and in person at SB clinics (2013–2015). Healthy controls were recruited during routine pediatrician visits. Final questions were identified based on clinical relevance, factor analysis and domain psychometrics. Teenagers with SB completed the validated generic Kidscreen-27 instrument. Results Median age of 159 participants was 15.2 years (42.0% male, 77.4% Caucasian), similar to 58 controls (p ≥ 0.06). There were 102 online and 57 clinic participants (82.8% of eligible). Patients, parents and an expert panel established face and content validity of the 2-domain, 10-question QUALAS-T. Internal consistency and test-retest reliability were high for the Family and Independence and Bladder and Bowel domains (Cronbach's alpha: 0.76–0.78, ICC: 0.72–0.75). The Bladder and Bowel domain is the same for QUALAS-T , QUALAS-A for adults and QUALAS-C for children. Correlations between QUALAS-T domains were low (r = 0.34), indicating QUALAS-T can differentiate between distinct HRQOL components. Correlations between QUALAS-T and Kidscreen-27 were also low (r ≤0.41). QUALAS-T scores were lower in teenagers with SB than without (p <0.0001). Conclusions QUALAS-T is a short, valid HRQOL tool for adolescents with SB, applicable in clinical and research settings. Since the Bladder & Bowel domains for all QUALAS versions are the same, Bladder and Bowel HRQOL can be measured on the same scale from age 8 through adulthood.
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Affiliation(s)
- Konrad M Szymański
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Benjamin Whittam
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jessica T Casey
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - David Y Yang
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sonia-Maria Raposo
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Shelly J King
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Martin Kaefer
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Richard C Rink
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Szymanski KM, Whittam B, Misseri R, Chan KH, Flack CK, Kaefer M, Rink RC, Cain MP. A case of base rate bias, or are adolescents at a higher risk of developing complications after catheterizable urinary channel surgery? J Pediatr Urol 2017; 13:184.e1-184.e6. [PMID: 28159526 DOI: 10.1016/j.jpurol.2016.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/27/2016] [Accepted: 12/05/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Adolescents are considered to be at high risk of developing complications after lower genitourinary tract reconstruction. This perception may be due to base rate bias, where clinicians favor specific information (adolescents with complications), while ignoring more general information (number of total adolescents being followed). The goal of this study was to assess whether age was a true risk factor for subfascial and stomal revisions after continent catheterizable urinary (CCU) channel procedures. MATERIALS AND METHODS Consecutive patients aged <21 years and who underwent appendicovesicostomy and Monti surgery at the present institution were retrospectively reviewed; demographic and surgical data were collected. Time to subfascial or stomal revision was stratified by age at initial surgery (child: <8, preteen: 8-12, adolescent: 13-17, adult: ≥18 years old) and analyzed with Cox proportional-hazards regression. Secondary analyses included: different age categories at initial surgery (<8, 8-11, 12-15, 16-19, ≥20 years), analyzing age as a continuous and a time-varying covariate. RESULTS Of the 510 patients with CCU channels (median age at surgery: 7.9 years), 63 (12.4%) had subfascial and 53 (10.4%) had stomal revision (median follow-up: 6.8 years). Median age at subfascial and stomal revision was 11.3 and 10.3 years, respectively. Preteens contributed 33.0% and adolescents contributed 29.3% of the total follow-up time (3263.9 person-years). Over 80% of revisions occurred within 5 years of surgery, regardless of age at initial surgery (P ≥ 0.57) (Summary table). On multivariate analysis, age at initial surgery was not associated with undergoing subfascial (P ≥ 0.62) or stomal revisions (P ≥ 0.69). Montis were 2.1 times more likely than appendicovesicostomies to undergo a subfascial revision (P = 0.03). No other variables were associated with the risk of subfascial or stomal revision (P ≥ 0.11). Secondary analyses provided similar results. DISCUSSION Since the median age at surgery was 8 years old and most complications occurred within the first 5 years of follow-up, it is not surprising that most revisions occurred in 8-13 year olds. Pediatric urologists appear to base their impression of adolescents being "high risk" on specific information (adolescents having complications), while subconsciously ignoring more general information (adolescents represent a large proportion of patients in follow-up). This study had several limitations: channel complications treated non-surgically (e.g. prolonged catheterization) were not included. The findings may not be generalizable to other genitourinary reconstructive procedures or clinical settings. CONCLUSIONS While complications were twice as high in Monti channels than appendicovesicostomies, no single age group was at increased risk. The impression that adolescents are a high-risk group appears to represent a base rate bias.
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Affiliation(s)
- K M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA.
| | - B Whittam
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA
| | - R Misseri
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA
| | - K H Chan
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA
| | - C K Flack
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA
| | - M Kaefer
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA
| | - R C Rink
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA
| | - M P Cain
- Division of Pediatric Urology, Riley Hospital for Children at IU Health, 705 Riley Hospital Dr., Suite 4230, Indianapolis, IN 46202, USA
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Kaefer M. Commentary to 'Outcomes of Seromuscular Bladder Augmentation versus Standard Ileocystoplasty: A Single Institution Experience over 14 years'. J Pediatr Urol 2017; 13:201. [PMID: 28274700 DOI: 10.1016/j.jpurol.2016.05.030] [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: 05/26/2016] [Accepted: 05/26/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Martin Kaefer
- Indiana University, 702 Barnhill Drive, Suite 4230, Indianapolis, IN 46202, USA.
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Casey JT, Chan KH, Hasegawa Y, Large T, Judge B, Kaefer M, Misseri R, Rink RC, Ueoka K, Cain MP. Long-term follow-up of composite bladder augmentation incorporating stomach in a multi-institutional cohort of patients with cloacal exstrophy. J Pediatr Urol 2017; 13:43.e1-43.e6. [PMID: 27889222 DOI: 10.1016/j.jpurol.2016.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 06/15/2016] [Accepted: 09/20/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Composite bladder augmentation, incorporating gastric and bowel segments, has the theoretical advantage of metabolic neutrality while potentially avoiding the morbidities of gastrocystoplasty, such as hematuria-dysuria syndrome. The most common indication for this operation is a paucity of bowel, such as in cloacal exstrophy. Despite several early descriptive studies of this technique, there are no reports, to date, of long-term follow-up in this population. OBJECTIVE To describe the outcomes of composite bladder augmentation utilizing stomach in a cohort of cloacal exstrophy patients. MATERIALS AND METHODS A retrospective review of cloacal exstrophy patients who underwent composite bladder augmentation from 1984 to 2006 at two institutions was performed. The incidence of mortality and morbidities related to augmentation was evaluated. RESULTS Eleven patients with cloacal exstrophy underwent composite bladder augmentation. Median age at initial augmentation was 6.4 years (interquartile range (IQR) 4.4-9.1). Median follow-up was 13.2 years (IQR 11.2-24.6). The Summary table describes the types of composite bladder augmentations. Of the three patients with pre-operative metabolic acidosis, two improved with composite bladder augmentation and one developed metabolic alkalosis. Three developed hematuria-dysuria syndrome: one improved with staged ileocystoplasty, and two had persistent symptoms successfully treated with H2 receptor blockers. Two of 11 developed symptomatic bladder stones. There were no reported bladder perforations, bladder malignancies, conversions to incontinent urinary diversions, or deaths. CONCLUSION With long-term follow-up, very few patients developed metabolic acidosis/alkalosis after composite bladder augmentation. The composite bladder augmentation will continue to be used in patients with cloacal exstrophy, in order to minimize the impact on the pre-existing short gut in these patients.
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Affiliation(s)
- J T Casey
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - K H Chan
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Y Hasegawa
- Division of Urology, Department of Surgical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - T Large
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - B Judge
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M Kaefer
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - R Misseri
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - R C Rink
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - K Ueoka
- Division of Urology, Department of Surgical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - M P Cain
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
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Large T, Szymanski KM, Whittam B, Misseri R, Chan KH, Kaefer M, Rink RC, Cain MP. Ambulatory patients with spina bifida are 50% more likely to be fecally continent than non-ambulatory patients, particularly after a MACE procedure. J Pediatr Urol 2017; 13:60.e1-60.e6. [PMID: 27614699 DOI: 10.1016/j.jpurol.2016.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 04/29/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION While fecal incontinence (FI) affects many patients with spina bifida (SB), it is unclear if it is associated with ambulatory status. OBJECTIVE To determine if ambulatory status is associated with FI, and a potential confounding variable, in patients with and without a Malone antegrade continence enema (MACE). STUDY DESIGN This study retrospectively reviewed of patients aged ≥8 years with SB who were enrolled in an international quality of life study at outpatient visits (January 2013 to September 2015). Patients reported FI over the last 4 weeks (strict criteria: any FI/accidents vs no FI). Patients unable to self-report FI due to developmental delay were excluded. Those who were ambulating outdoors with/without braces/crutches were considered community ambulators. Non-parametric tests and logistic regression were used for analysis. RESULTS A total of 115 patients with a MACE and 57 without a MACE were similar in gender (P = 0.99), ventriculoperitoneal status (P = 0.15) and age (16.0 vs 15.4 years, P = 0.11). Median ages at MACE procedure and follow-up were 7.0 and 8.2 years, respectively, and all used the MACE ≥3x/week. They were less likely to be ambulators (54.8 vs 71.9%, P = 0.03). In patients with a MACE, 64 (55.7%) had total fecal continence, compared with 29 (50.9%) without a MACE (P = 0.62). In the MACE group, ambulators were more likely to be continent compared with non-ambulatory patients (65.1 vs 44.2%, P = 0.04) (Table). Although not statistically significant, a similar difference was observed in the non-MACE group (56.1 vs 37.5%, P = 0.25). In the MACE group, continent and incontinent patients, regardless of ambulatory status, had similar rates of MACE use, additive use and time for MACE completion (P ≥ 0.43). MACE ambulators were more likely to be continent than MACE non-ambulators on multivariate analysis (OR 3.26, P = 0.01). DISCUSSION This study reported higher than typical FI rates since: (1) it used a stringent definition of total fecal continence; (2) patients without FI were perhaps less likely to participate; and (3) it relied on patient-reported rather than clinician-reported outcomes. This cross-sectional study should not be interpreted as "MACE procedure is ineffective;" this would require a longitudinal study. The present findings may not apply to young children or those with significant developmental delay (patients excluded from the study). CONCLUSIONS Ambulatory patients with SB are 50% more likely to have total fecal continence on long-term follow-up, particularly after a MACE procedure. Ambulatory status is a significant confounder of FI and should be considered in future analyses.
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Affiliation(s)
- T Large
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - K M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - B Whittam
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - R Misseri
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - K H Chan
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M Kaefer
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - R C Rink
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | - M P Cain
- Division of Pediatric Urology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
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Szymanski KM, Cain MP, Whittam B, Kaefer M, Rink RC, Misseri R. All Incontinence is Not Created Equal: Impact of Urinary and Fecal Incontinence on Quality of Life in Adults with Spina Bifida. J Urol 2017; 197:885-891. [PMID: 28131501 DOI: 10.1016/j.juro.2016.08.117] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE We previously reported that the self-reported amount of urinary incontinence is the main predictor of lower health related quality of life in adults with spina bifida. In this study we sought to determine the impact of fecal incontinence on health related quality of life after correcting for urinary incontinence. MATERIALS AND METHODS An international sample of adults with spina bifida was surveyed online in 2013 to 2014. We evaluated fecal incontinence in the last 4 weeks using clean intervals (less than 1 day, 1 to 6 days, 1 week or longer, or no fecal incontinence), amount (a lot, medium, a little or none), number of protective undergarments worn daily and similar variables for urinary incontinence. Validated instruments were used, including QUALAS-A (Quality of Life Assessment in Spina bifida for Adults) for spina bifida specific health related quality of life and the generic WHOQOL-BREF (WHO Quality of Life, short form). Linear regression was used (all outcomes 0 to 100). RESULTS Mean age of the 518 participants was 32 years and 33.0% were male. Overall, 55.4% of participants had fecal incontinence, 76.3% had urinary incontinence and 46.9% had both types. On multivariate analysis fecal incontinence was associated with lower bowel and bladder health related quality of life across all amounts (-16.2 for a lot, -20.9 for medium and -18.5 for little vs none, p <0.0001) but clean intervals were not significant (-4.0 to -3.4, p ≥0.18). Conversely, health related quality of life was lower with increased amounts of urinary incontinence (-27.6 for a lot, -18.3 for medium and -13.4 for little vs none, p <0.0001). Dry intervals less than 4 hours were not associated with lower health related quality of life (-4.6, p = 0.053) but the use of undergarments was associated with it (-7.5 to -7.4, p ≤0.01). Fecal incontinence and urinary incontinence were associated with lower WHOQOL-BREF scores. CONCLUSIONS Fecal incontinence and urinary incontinence are independent predictors of lower health related quality of life in adults with spina bifida. Health related quality of life is lower with an increasing amount of urinary incontinence. Fecal incontinence has a more uniform impact on health related quality of life regardless of frequency or amount.
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Affiliation(s)
- Konrad M Szymanski
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.
| | - Mark P Cain
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Benjamin Whittam
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Martin Kaefer
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Richard C Rink
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Rosalia Misseri
- Division of Pediatric Urology, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
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