Journal of pediatric urology
-
Over the past 25 years, Pediatric Urology fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) have more than doubled. This increase may lead to a significant decrease in the number of operative cases per surgeon and therefore impact the current practice of pediatric urology. ⋯ This exercise, even with its inherent limitations, is still sufficient to demonstrate that fellowship expansion warrants thoughtful discussion.
-
Multicenter Study
Variation in the use of laparoscopy with inguinal hernia repairs in a sample of pediatric patients at children's hospitals.
Metachronous contralateral inguinal hernias (MCH) occur in approximately 10% of pediatric patients following unilateral inguinal hernia repairs (UIHR). Laparoscopic evaluation of the contralateral internal ring is a method of identifying high-risk individuals for prophylactic contralateral exploration and repair. ⋯ Variation existed in the use of laparoscopy during inguinal hernia repairs and associated costs within the current sample from children's hospitals in the United States. The additional costs of laparoscopic evaluation must be considered against the clinical utility and therapeutic consequences of identifying individuals with a higher risk of metachronous contralateral inguinal hernia.
-
There is growing interest in the general activities of a pediatric urologist, whose specialty remains young in the spectrum of modern, organized medicine. Unplanned activities, which are more commonly referred to as consultations, can represent significant additional workload for the urologist seeing scheduled clinic patients or completing elective operative cases. ⋯ The pediatric urology service averaged about one formal consultation per day, with the most common diagnoses being hydronephrosis, urinary tract infection, urolithiasis, testicular torsion, and retention. One third of consults required intervention. Improved understanding of pediatric urology consultation would be helpful to facilitate physician education and improve service efficiency in the hospital setting.
-
Parasacral transcutaneous electrical nerve stimulation (TENS) has emerged as an effective treatment for overactive bladder (OAB) in view of its high success rates in improving lower urinary tract symptoms and constipation, with no direct side effects. However, the clinical characteristics associated with the outcomes remain to be established. ⋯ Nocturnal enuresis was the only symptom associated with a poor outcome following parasacral TENS treatment in children with OAB.
-
Children who require clean intermittent catheterization (CIC) frequently have positive urine cultures. However, diagnosing a urinary tract infection (UTI) can be difficult, as there are no standardized criteria. Routine urinalysis (UA) has good predictive accuracy for UTI in the general pediatric population, but data are limited on the utility of routine UA in the population of children who require CIC. ⋯ Routine UA had limited sensitivity, but moderate specificity, in predicting UTI in children who required CIC. The composite UA and moderate or large leukocyte esterase both had good negative predictive values for the outcome of UTI.