Journal Of Pediatric Urology[JOURNAL]
Sun
200 papers
Commentary to "Impact of the MAG III protocol (F+0 vs. F+20) used on indication for pyeloplasty, time to surgery and radiation burden in high-grade hydronephrosis".
Hodhod A, Moneir WM
J Pediatr Urol · 2026 Mar · PMID 41916846 · Publisher ↗
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CurvAssist: An AI assisted pipeline for penile shaft segmentation/ curvature measurement in children with hypospadias.
Babu R, A S, Sivakumar D … +4 more , Vijayaraghavan G, Velmurugan M, Sampathkumar K, Shakthi D
J Pediatr Urol · 2026 Mar · PMID 41916845 · Publisher ↗
INTRODUCTION: Accurate assessment of ventral curvature (VC) is critical in determining the type of VC correction. Unaided visual inspection (UVI) remains common but is prone to significant interobserver variability and e...
INTRODUCTION: Accurate assessment of ventral curvature (VC) is critical in determining the type of VC correction. Unaided visual inspection (UVI) remains common but is prone to significant interobserver variability and error. Although smartphone app-based measurement (SAM) offers greater objectivity, it still relies on manual reference point selection. This study describes the development and evaluation of CurvAssist, an AI-assisted pipeline integrating deep learning-based segmentation for accurate, automated penile curvature measurement. METHODS: In step-1, a synthetic dataset of 250 images was generated from 3D phantom penile models with known ground-truth curvatures (0°-90°) under randomized lighting, angle, and background conditions. Penile shaft segmentation was achieved using a U-Net convolutional neural network. Curvature quantification employed a nonlinear least-squares circle-fitting algorithm using the Levenberg-Marquardt optimization to fit arc contours and calculate curvature angles geometrically. In step-2, the circle fitting algorithm's outputs were compared against SAM on clinical photographs (n = 7). Model performance was evaluated using Dice Similarity Coefficient (DSC), Intersection over Union (IoU), Precision, Recall, Mean Absolute Error (MAE), and Intraclass Correlation Coefficient (ICC). RESULTS: U-Net that analysed phantom 3D images (n = 250) achieved high segmentation accuracy with mean DSC 0.925 ± 0.021, IoU 0.910 ± 0.035, Precision 0.958, and Recall 0.947, providing a robust foundation for geometric quantification. The circle-fit algorithm estimated curvature with a MAE of 1.35°, representing a clinically negligible deviation from ground-truth. Comparison of AI-derived versus SAM-measured angles of clinical photographs (n = 7) demonstrated excellent agreement (ICC = 0.981). DISCUSSION: CurvAssist achieved a notable improvement and compares favourably with other emerging computational methods. While the AI-based applications have evolved to match the level of SAM measurements, they are likely to be more consistent when the model becomes robust avoiding human errors/relying on manually selected reference points on SAM. CurvAssist should still be considered as a proof-of concept or technical feasibility study requiring further large-scale validation. The time required for segmentation and computation was not evaluated in this study. CONCLUSION: CurvAssist can provide surgeons with objective, reproducible data to guide intraoperative decision-making, standardize surgical planning, and enhance multi-center research by minimizing interobserver variability. Future research should focus on prospective validation using a large dataset of intraoperative images, expanding the system to perform true 3D measurements from multiple views, and in developing a user-friendly real-time interface for seamless integration into the clinical workflow while addressing regulatory concerns on data handling and privacy.
Response to Letter to the Editor re: "Age-related changes in the urinary microbiome of healthy Japanese children".
Tsuji S, Gonchigsuren U, Akagawa S … +11 more , Yamanouchi S, Kato S, Unishi G, Okano M, Okuda K, Kino J, Araki A, Takaya J, Teraguchi M, Nakamura A, Kaneko K
J Pediatr Urol · 2026 Mar · PMID 41905820 · Publisher ↗
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Letter to the Editor re: "Education and training in hypospadias surgery: Current status, competency assessment, and the role of modern educational tools".
Mishra D, Ahmed SM, Shubham S
J Pediatr Urol · 2026 Mar · PMID 41904050 · Publisher ↗
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Long-term outcomes and risk factors for reoperation after ileal augmentation in children: A single-center study.
Asci A, Altan M, Ayva M … +2 more , Dogan HS, Tekgul S
J Pediatr Urol · 2026 Mar · PMID 41903288 · Publisher ↗
INTRODUCTION: Patients with certain lower urinary tract anomalies may develop high-pressure, low-capacity bladders, risking incontinence and upper urinary tract damage. If conservative treatments fail, augmentation surge...
INTRODUCTION: Patients with certain lower urinary tract anomalies may develop high-pressure, low-capacity bladders, risking incontinence and upper urinary tract damage. If conservative treatments fail, augmentation surgery aims to improve bladder capacity, maintain continence, and protect the upper urinary tract. Long-term follow-up is vital, as over half of patients may require reoperations, making identification of risk factors and optimal management important. AIM: To evaluate factors influencing the risk of reoperation, upper urinary tract deterioration (UUTD), and incontinence in children undergoing ileal augmentation (IA). PATIENTS AND METHODS: A retrospective analysis was conducted on 131 patients who underwent IA surgery between July 1991 and January 2023 at a single center. Data included demographics, etiology, vesicoureteral reflux (VUR), preoperative renal function, anti-reflux surgery, bladder neck procedures, and catheterizable stoma procedures (CSP; Mitrofanoff/Monti). Factors affecting postoperative incontinence, UUTD, and reoperation rates were analyzed. RESULTS: The mean age at operation was 9.5 ± 4.95 years, with 55 males and 76 females. Over a median follow-up of 65 months, new-onset UUTD was observed in 33 patients (25.2 %). Anti-reflux surgery (p = 0.033) and preoperative chronic renal disease (CRD) (p = 0.045) were significant in univariate analysis. A total of 91 reoperations were performed on 45 patients (34.3 %). Multivariate analysis identified bladder exstrophy-epispadias complex (BEEC, p = 0.013) and CSP (p = 0.022) as significant risk factors for reoperation. Postoperative incontinence occurred in 34 patients (25.9 %), with BEEC being significant in multivariate analyses (p < 0.001). Patients with follow-up exceeding 10 years had higher reoperation risk (48.3 % vs. 30.4 %, p = 0.081), though not statistically significant. Incontinence (27.6 % vs. 23.5 %, p = 0.633) and UUTD (27.6 % vs. 24.5 %, p = 0.809) rates were similar. DISCUSSION: BEEC is associated with higher postoperative incontinence and reoperation risks. CSP was associated with higher reoperation risks. Longer follow-up periods did not seem to affect incontinence and UUTD rates, but reoperation rates seem to be higher. CONCLUSION: IA is a complex surgery requiring long-term follow-up. Certain patient groups are under higher risk for incontinence and reoperation. Longer follow-up periods may lead to higher reoperation rates. CLINICAL APPLICABILITY: Given the pediatric nature of this patient group and their long life expectancy, better knowledge of the long-term outcomes, complications, and the need for reoperations will aid in management of these complications and provide useful information for families towards the prognosis of this surgery.
Impact of transfer status, time to operation, and orchiectomy rates in pediatric testicular torsion: A retrospective cohort analysis.
Erpenbeck SP, Moturu A, Ko CY … +3 more , Saito JM, Finkelstein JB, Ellison JS
J Pediatr Urol · 2026 Mar · PMID 41895038 · Publisher ↗
INTRODUCTION: Testicular torsion is a time-sensitive pediatric emergency, with delays in care potentially leading to testicular loss (i.e., orchiectomy). Transfer to pediatric specialty hospitals may prolong time to oper...
INTRODUCTION: Testicular torsion is a time-sensitive pediatric emergency, with delays in care potentially leading to testicular loss (i.e., orchiectomy). Transfer to pediatric specialty hospitals may prolong time to operation. The National Surgical Quality Improvement Program - Pediatric (NSQIP-Ped) collects process measures for time-sensitive operations, including transfer status, defined as whether a patient was transferred to the operating hospital. Several NSQIP-Ped hospitals additionally participated in a Testicular Torsion Collaborative convened to improve torsion care processes. In this study, we sought to evaluate the association between patient transfer and testicular salvage. PATIENTS AND METHODS: This retrospective cohort analysis included non-neonate pediatric patients (0-17 years) from the NSQIP-Ped database who underwent non-elective surgery for testicular torsion between January 2022 and May 2024. Patients with symptom duration >24 h and unknown transfer status were excluded. Orchiectomy was modeled using mixed-effects logistic regression, clustering by institution and comparing on transfer status. Median time to mobilize a patient to operative intervention was compared across transfer status and Testicular Torsion Collaborative participation using nonparametric tests. RESULTS: Among 2801 included cases from 74 institutions, 51.0 % (1415/2801) presented directly to NSQIP-Ped hospitals, 88.0 % (2467/2801) had time to operation <4 h, and 8.7 % (244/2801) underwent orchiectomy. Testicular Torsion Collaborative institutions performed 54.0 % (1514/2801) of operations. Transfer status was not associated with orchiectomy (OR: 1.2, 95 % CI: 0.9-1.6). Non-Testicular Torsion Collaborative institutions were associated with higher odds of orchiectomy (OR: 2.3, 95 % CI: 1.5-3.4). Among transferred patients, there was no difference in median time to mobilize between transferred versus non-transferred patients (111 vs 117 min, p = 0.23). However, among Testicular Torsion Collaborative institutions, the median time to mobilize was shorter than non- Testicular Torsion Collaborative institutions (102 vs 118 min, p < 0.01). CONCLUSION: While transfer status was not associated with differences in testicular salvage, Testicular Torsion Collaborative participation was independently associated with a reduced likelihood of orchiectomy. These results emphasize opportunities to improve testicular salvage for testicular torsion through collaboration.
An international multicenter cohort study of management and outcomes of undescended testis in German-speaking countries.
Aubert O, Föller J, Beume JS … +18 more , Brinkmann O, Degener S, Drießler C, Eckoldt F, Fennell S, Hirsch-Koch K, Meyer J, Promm M, Radmayr C, Riechardt S, Rosellen J, Schroeder JT, Sommer J, Weingaertner K, Yiakoumos T, Zundel S, Stein R, Younsi N
J Pediatr Urol · 2026 Mar · PMID 41895037 · Publisher ↗
BACKGROUND: Undescended testis (UDT) is the most common congenital genitourinary anomaly in boys. Guidelines recommend orchidopexy by 12-18 months to optimize fertility and reduce malignancy risk, but adherence is often...
BACKGROUND: Undescended testis (UDT) is the most common congenital genitourinary anomaly in boys. Guidelines recommend orchidopexy by 12-18 months to optimize fertility and reduce malignancy risk, but adherence is often poor. The objectives of this study were to asses institutional management for UDT and evaluate surgical practices and long-term patients outcomes following orchidopexy. METHODS: We conducted a multicenter observational study in German-speaking countries using a standardized questionnaire on UDT management and collected retrospective data on all patients who underwent orchidopexy in 2009, allowing ≥10 years of follow-up. Clinical records and patient/parent questionnaires were analyzed for perioperative data, complications, and long-term outcomes. RESULTS: Twenty-seven departments completed the questionnaire, and 18 provided patient data on 419 testicular units. Palpation was nearly universal, ultrasound use varied (≈50% for palpable, >80% for non-palpable), and MRI was rarely performed. For palpable testes, the combined inguinal-scrotal approach was most common, while laparoscopy was preferred for non-palpable testes. About one-third of departments reported changes in management practices over the past decade, often driven by institutional or policy shifts. Surgery was frequently delayed: 6.9% of patients underwent orchidopexy before 12 months and 27.2% before 18 months. Significant differences between pediatric surgeons and urologists were noted in sonography use, operative access, fixation technique, and suture material (all p < 0.001). However, complication rates, reoperation, testis position, and growth did not differ. At follow-up, 1.7% of testes were not in scrotal position, 5.4% did not have age-appropriate growth with no follow-up data in 12.9% of patients for testis position and in 20.6% for growth respectively. Parent-reported satisfaction was high. CONCLUSION: In German-speaking countries, various techniques are used for orchidopexy with some changes in the daily practice over time. Late orchidopexy may be related to delayed referral or secondary ascent. Nevertheless, long-term outcomes for testis position, growth, and satisfaction remain favorable with a low complication rate.
Prophylactic antibiotic in pubertal testicular torsion: Is it Justified?
Arenas Hoyos J, Dalela D, Schlomer BJ … +5 more , Stanasel I, Carolan AM, Batie SF, Jacobs MA, Peters CA
J Pediatr Urol · 2026 Mar · PMID 41895036 · Publisher ↗
BACKGROUND: There is insufficient evidence to support the effectiveness of preoperative antibiotic prophylaxis in reducing surgical site infections (SSI) during urgent testicular torsion (TT) surgeries. OBJECTIVE: The pr...
BACKGROUND: There is insufficient evidence to support the effectiveness of preoperative antibiotic prophylaxis in reducing surgical site infections (SSI) during urgent testicular torsion (TT) surgeries. OBJECTIVE: The primary objective was to determine the incidence of SSI in patients undergoing surgery for testicular torsion and to assess the impact of antibiotic prophylaxis on SSI rates. STUDY DESIGN: Retrospective study, including patients with acute scrotum who underwent urgent surgery for clinically confirmed testicular torsion, including orchiectomy, tunica vaginalis flap, and orchiopexy. Exclusion criteria included neonatal or prepubertal testicular torsion, delayed or elective surgical intervention, and lack of follow-up after surgery. Population characteristics were described in patients with and without antibiotic prophylaxis, and a case-control analysis was conducted. Risk ratios and the number needed to prevent SSI were analyzed, along with univariate and multivariate analyses to identify risk factors and assess the effectiveness of antibiotic prophylaxis. RESULTS: 448 patients met the inclusion criteria. The mean age of diagnosis was 14.07 years, with a median pain duration of 8.77 h. Pre-operative prophylactic antibiotics were administered to 75.67 % of patients. The overall prevalence of SSI was 3.12 %. SSIs occurred in 2.36 % of patients in the prophylaxis group versus 5.55 % in the non-prophylaxis group (p = 0.1). The absolute risk reduction with the use of antibiotic prophylaxis was 3.14 %. Univariate analysis identified obesity and experiencing less than 12 h of pain before surgery as potential factors associated with SSI, whereas multivariate analysis found no significant association between the pre-selected variables and SSI. DISCUSSION: The study demonstrated a low incidence of SSI following testicular torsion surgery, with no significant difference between patients receiving antibiotic prophylaxis and those who did not. Based on our analysis, there is no demonstrable benefit of administering antibiotic prophylaxis in reducing the risk of surgical site infections (SSI) in this population. While there is clearly no benefit among patients who experienced less than 12 h of pain prior to the operation, we were unable to demonstrate a significant benefit in those with more than 12 h of pain; however, there may be some potential benefit in this subgroup. CONCLUSION: Based on our study, there is no demonstrable benefit of administering antibiotic prophylaxis in reducing the overall risk of surgical site infections (SSI) in this population.
Postobstructive diuresis and its biochemical characteristics in children undergoing pyeloplasty for unilateral pelviureteric junction obstruction - a prospective observational study.
Pokharkar AD, Meshram RB, Yadav C … +2 more , Gupta A, Chadha R
J Pediatr Urol · 2026 Mar · PMID 41895035 · Publisher ↗
BACKGROUND: The characteristics of postobstructive diuresis (POD) following relief of unilateral ureteric obstruction (UUO) has been studied in animals, but there is scarcity of literature on translation of these finding...
BACKGROUND: The characteristics of postobstructive diuresis (POD) following relief of unilateral ureteric obstruction (UUO) has been studied in animals, but there is scarcity of literature on translation of these findings in human pediatric patients with unilateral pelviureteric junction obstruction (PUJO) following pyeloplasty. OBJECTIVE: The primary objective was to assess the biochemical characteristics of the POD from the operated kidney. Our secondary objective was it's clinical implications and identifying predisposing factors. STUDY DESIGN: A prospective observational study was conducted on pediatric patients who underwent pyeloplasty for unilateral PUJO. Post-operative differential urine output (UO) from the operated kidney (OK) was compared with the normal contralateral kidney (NCK). Patients were divided into two groups: Group-1 with POD [n = 32; 60.4%] and Group-2 without POD [n = 21; 39.6%]. Data was collected for the occurrence of POD, urine biochemistry and postoperative electrolyte derangement requiring nephrology consultation. RESULTS: POD occurred in Group-1 patients within 48-h after surgery. They had statistically significant lower median renal parenchymal thickness and higher median renal pelvis antero-posterior diameter (APD), differential ratio of kidney size and proportion of grade-4 hydronephrosis (HN) than Group-2 patients. None of the kidneys with PUJO were small in size. The abnormal biochemistry of POD from OK matched with experimental animal studies except the FeK excretion which was significantly higher [13,14,15]. Four patients in Group-1 required nephrology consultation for prolonged POD with electrolyte derangement: one concomitant pyelonephritis in NCK and other three with past history of renal injury. Predisposing factors for POD were parenchymal thinning in enlarged kidneys with SFU grade-4 hydronephrosis and higher renal pelvis APD. DISCUSSION: Urine biochemistry in human pediatric subjects matches animal studies to a large extent except FeK excretion and suggests compensation by NCK to maintain homeostasis during POD. Besides the predisposing factors in OK, concomitant or pre-existing (subclinical) functional injury to NCK despite normal appearance on preoperative imaging may limit the compensation resulting in electrolyte derangement. CONCLUSIONS: High UO from OK mainly contributes to POD. Larger hydronephrotic kidneys with parenchymal thinning are more predisposed to POD. Our observations reveal that concomitant or prior subclinical injury to NCK may not be apparent on preoperative imaging and it could be a warning signal to the clinician for occurrence of electrolyte derangement with prolongation of POD and such patients should be monitored closely during post-operative period.
Factors influencing timely management and outcomes in testicular torsion.
Wang D, Arroyave Villada JS, Kim E … +6 more , Connors C, Snyder J, Friedman L, Levy M, Stock JA, Palese MA
J Pediatr Urol · 2026 Mar · PMID 41895034 · Publisher ↗
INTRODUCTION: Testicular torsion (TT) is a surgical emergency in which prompt intervention is critical for testicular salvage. Delays in care remain common and may occur both before and after hospital presentation. OBJEC...
INTRODUCTION: Testicular torsion (TT) is a surgical emergency in which prompt intervention is critical for testicular salvage. Delays in care remain common and may occur both before and after hospital presentation. OBJECTIVE: To identify clinical and non-clinical predictors of orchiectomy in patients with TT and determine whether pre-hospital or in-hospital delays have the greater impact on testicular salvage. STUDY DESIGN: We retrospectively reviewed all TT cases from 2017 to 2024 at a metropolitan tertiary care center. Demographic and process variables were collected, including time intervals throughout emergency and operative management. Univariate and multivariate logistic regression were used to identify predictors of orchiectomy, and a logistic regression spline model was constructed to characterize the relationship between time to presentation and orchiectomy risk. RESULTS: Among 109 patients, 34 % underwent orchiectomy. On multivariate analysis, only pre-hospital symptom duration predicted orchiectomy: 6-24 h (OR 11.7, 95 % CI 2.1-94.0, p = 0.009) and >24 h (OR 430.7, 95 % CI 21.9-21031.6, p < 0.001). The spline model estimated a 50 % probability of orchiectomy at approximately 23 h after symptom onset. Weekend or nighttime admissions, hospital transfer, and triage-to-OR time were not associated with orchiectomy. Median in-hospital time from ED triage to OR start was 4.1 h (IQR 3.2-4.8) and there was no significant differences between orchiopexy and orchiectomy groups (p = 0.068). DISCUSSION: Pre-hospital delay was the primary driver of orchiectomy risk, whereas in-hospital workflow factors had no statistically significant impact on outcomes. While continued efforts to optimize triage efficiency for patients with suspected TT remain important, our findings suggest that educational initiatives promoting early symptom recognition and prompt emergency department presentation may offer greater potential for improving testicular salvage than further in-hospital process refinements. CONCLUSION: Although streamlining in-hospital triage for patients with suspected TT remains important, targeting pre-hospital delays through patient, parental, and provider education may offer even greater opportunities to improve testicular salvage.
How I do it: Single-port serpentine-arm robot in infants pyeloplasty.
Liu P, Zou X, Hou Y … +6 more , Xing X, Bai K, Shen H, Ma Z, Xie H, Sun J
J Pediatr Urol · 2026 Mar · PMID 41880683 · Publisher ↗
This article presents the clinical experience of our center with the SHURUI Single-Port Serpentine-Arm Robotic System for pyeloplasty in infants with ureteropelvic junction obstruction.
This article presents the clinical experience of our center with the SHURUI Single-Port Serpentine-Arm Robotic System for pyeloplasty in infants with ureteropelvic junction obstruction.
Utility and challenges of flexible and navigable suction ureteral access sheath (FANS) vs. suction mini-PCNL in children: A comparative analysis.
Lim EJ, Yuen SKK, Somani BK … +16 more , Herrmann TRW, Sarica K, Bujons Tur A, Madarriaga YQ, Kalathia J, Ragoori DR, Tak GR, Fong KY, Teng RZS, Tursunkulov AN, Tanidir Y, Joshi R, Vaddi CM, Traxer O, Castellani D, Gauhar V
J Pediatr Urol · 2026 Jun · PMID 41880674 · Publisher ↗
INTRODUCTION: Pediatric kidney stone disease presents unique challenges, necessitating minimally invasive techniques. Suction-assisted mini-percutaneous nephrolithotomy (SM-PCNL) is a well-established treatment, while fl...
INTRODUCTION: Pediatric kidney stone disease presents unique challenges, necessitating minimally invasive techniques. Suction-assisted mini-percutaneous nephrolithotomy (SM-PCNL) is a well-established treatment, while flexible ureteroscopy using a flexible and navigable suction ureteral access sheath (FANS-UAS) is an emerging technique. Both integrate suction to improve stone clearance, reduce intrarenal pressure, and enhance visualization. However, comparative evidence in children remains limited. OBJECTIVE: This study hypothesized that FANS-UAS would demonstrate comparable stone-free rates (SFR) and perioperative outcomes to SM-PCNL in children with renal stones ≤2 cm, while potentially offering advantages in operative efficiency and patient recovery. We aimed to compare the perioperative outcomes and SFR of FANS-UAS versus SM-PCNL across multiple international centers. METHODS: A prospective, multicenter study analyzed 96 pediatric patients (50 FANS-UAS, 46 SM-PCNL) from eight centers. Inclusion criteria were age ≤16 years, normal renal anatomy, and stone burden ≤2 cm. Outcomes included SFR (assessed via 30-day non-contrast CT scan), operative time, complications, and hospital stay. RESULTS: FANS-UAS demonstrated comparable SFR to SM-PCNL (66.0 % vs. 58.7 % for zero fragments) but with shorter operative times (42.5 vs. 82.5 min, p = 0.025) and hospital stays (2 vs. 3 days, p < 0.001). FANS-UAS was preferred for multiple stones (28 % vs. 0 %, p = 0.005). Complication rates were similar (12.0 % vs. 8.7 %, p = 0.845). Notably, all FANS-UAS patients required pre-stenting, and a lower body mass index (BMI) was associated with FANS-UAS selection (14.0 vs. 19.0 kg/m, p < 0.001). DISCUSSION: FANS-UAS offers advantages in operative duration and utility for multiple stones, though it requires pre-stenting and careful sheath handling. SM-PCNL remains a reliable option with a strong safety record. Study limitations include its non-randomized design, small sample size, and short-term follow-up. The findings suggest that while stone burden is not the sole determinant, factors like BMI and the presence of multiple stones may influence the choice of approach. CONCLUSIONS: FANS-UAS and SM-PCNL are both suitable for managing renal stones up to 2 cm in children. FANS-UAS offers benefits in operative efficiency and managing multiple stones. The choice of technique may be influenced by patient characteristics such as BMI, and ultimately, surgeon experience and comfort remain crucial for procedural success and complication rates.
Neurophysiological correlates of vitamin D, B, and folate deficiency in children with primary nocturnal enuresis.
Salikhova S, Salikhova K
J Pediatr Urol · 2026 Feb · PMID 41876308 · Publisher ↗
BACKGROUND: Primary nocturnal enuresis (PNE) is a prevalent pediatric disorder often associated with delayed cortical maturation and autonomic dysregulation. Growing evidence suggests that metabolic deficiencies, particu...
BACKGROUND: Primary nocturnal enuresis (PNE) is a prevalent pediatric disorder often associated with delayed cortical maturation and autonomic dysregulation. Growing evidence suggests that metabolic deficiencies, particularly in vitamin D, vitamin B, and folate, may influence neuronal development and the neural circuits regulating micturition. OBJECTIVE: To investigate the association between serum levels of vitamin D, vitamin B, and folate and neurophysiological parameters in children with PNE. METHODS: A cross-sectional study was conducted in 68 children aged 5-14 years with PNE and 20 age-matched healthy controls. All participants underwent clinical assessment, electroencephalography (EEG), magnetic resonance imaging (MRI), and computerized attention testing (TOVA). Serum concentrations of 25-hydroxyvitamin D, vitamin B, folate, ferritin, and hemoglobin were measured using immunoassay methods. RESULTS: Children with PNE demonstrated significantly lower serum levels of vitamin D (16.4 ± 2.8 ng/mL vs 26.7 ± 3.1 ng/mL; p < 0.01), vitamin B (198 ± 41 pg/mL vs 283 ± 33 pg/mL; p = 0.001), and folate (4.1 ± 0.8 ng/mL vs 13.6 ± 1.2 ng/mL; p = 0.001) compared with controls, whereas ferritin and hemoglobin showed no significant difference. EEG revealed delayed cortical maturation in 66 % of cases, and MRI demonstrated minor, non-specific structural variants in 34 % of children with PNE. CONCLUSIONS: Lower serum levels of vitamin D, vitamin B, and folate were associated with neurophysiological markers of delayed cortical maturation in children with PNE. Given the cross-sectional design, these findings should be interpreted as exploratory and hypothesis-generating. The observed associations warrant further longitudinal and interventional studies to determine whether micronutrient status is independently related to neurophysiological maturation or clinical outcomes in children with PNE.
Children with enuresis - are they more constipated than others?
Borgström M, Tunebjer M, Skogman BH … +1 more , Nevéus T
J Pediatr Urol · 2026 Jun · PMID 41875672 · Publisher ↗
INTRODUCTION: The bowel-bladder interaction is well established, as is the fact that constipation can lead to daytime incontinence and/or recurrent urinary tract infections. However, the link between constipation and enu...
INTRODUCTION: The bowel-bladder interaction is well established, as is the fact that constipation can lead to daytime incontinence and/or recurrent urinary tract infections. However, the link between constipation and enuresis is less clear. The bowel's influence on enuresis is possibly important even though fecal disimpaction by itself will not make the child dry at night. Furthermore, parents and patients may be unaware of the child's constipation until the enuresis is evaluated. The same should apply to healthy children. The hypothesis that a full bowel affects bladder function appears to be logical; however, this may not be applicable in enuresis. A crucial question is if constipation is more common among children with enuresis than in the general population. AIM: To evaluate the prevalence of constipation in children with enuresis as compared to children without bladder problems. SUBJECTS AND METHODS: In this case-control study the former group was recruited from a pediatric clinic and the latter from the general population in the same geographic area. All children had their horizontal rectal diameter measured via abdominal ultrasound. Their bowel movements over two weeks and bladder function over two days were recorded at home. RESULTS: We recruited 66 children with enuresis and 58 healthy controls. The ages ranged from 6 to 11 (mean 7.3 ± 1.3) years and 50 (40 %) of them were girls. The groups had no difference in rectal diameter (28.9 ± 7.7 vs 28.2 ± 10.1 mm, P = 0.672) and they had a similar prevalence of constipation according to the Rome IV criteria. The children with enuresis had fewer bowel movements per two weeks (11.2 ± 4.1 vs 14.8 ± 6.9, P < 0.001) than controls, but they had no more constipation symptoms. However, bladder diaries showed that children with enuresis had smaller voided volumes (87.1 ± 31.8 vs 127.5 ± 44.5 % of expected bladder capacity; P < 0.001) than controls. CONCLUSION: We did not find support for constipation being more prevalent among children with enuresis than controls. But we did find decreased functional bladder capacity in patients with enuresis which may be an indirect sign of detrusor overactivity.
Letter to the Editor re: "Assessing inter-rater reliability of objective renal sonographic measurements for identification of clinically significant ureteropelvic junction obstruction".
Li J
J Pediatr Urol · 2026 Jun · PMID 41864842 · Publisher ↗
Abstract loading — click title to view on PubMed.
Pediatric urology in low-income settings: A nationwide assessment of equipment availability and human resources in Senegal.
Cissé L, Lo FB, Ndoye M … +6 more , Guèye D, Ndoye NA, Jalloh M, Ndour O, Ngom G, Fall PA
J Pediatr Urol · 2026 Mar · PMID 41864841 · Publisher ↗
BACKGROUND: Pediatric urology in low-income countries is expanding due to demographic and epidemiological factors, yet data on workforce capacity and equipment availability remain limited. This study provides a nationwid...
BACKGROUND: Pediatric urology in low-income countries is expanding due to demographic and epidemiological factors, yet data on workforce capacity and equipment availability remain limited. This study provides a nationwide assessment of pediatric urology resources in Senegal. OBJECTIVE: To evaluate human resources, training exposure, clinical practice patterns, and availability of pediatric urology equipment across Senegal. STUDY DESIGN: A nationwide cross-sectional survey was conducted from October 2024 to January 2025 using national directories of pediatric surgeons and urologists. An online survey collected data on training background, clinical practice, perceived challenges, and access to pediatric urology equipment. Descriptive statistical analysis was performed. RESULTS: Ninety practitioners responded, including all pediatric surgeons practicing nationally and 60 % of registered urologists. Active involvement in pediatric urology was reported by 88.9 % of respondents. Formal degree-level pediatric urology training was completed by 2.2 %, while 20 % reported international training experience. Equipment availability varied markedly across regions: functional cystoscopes were available in 34.3 % of facilities, laser lithotripsy in 20 %, nephroscopes in 11.4 %, and no functional cystomanometers or bladder scanners were identified. Limited access to equipment was the most frequently reported challenge. DISCUSSION: These findings are consistent with reports from other low-resource settings and highlight persistent gaps in subspecialty training and access to essential pediatric urology infrastructure. The study is limited by self-reported data and incomplete response among urologists. CONCLUSION: This nationwide survey identifies critical gaps in pediatric urology capacity in Senegal. The findings provide a data-driven foundation to inform workforce planning, equipment allocation, and the development of context-appropriate strategies to strengthen pediatric urology services in similar low-resource settings.
First-stage procedure for proximal hypospadias with penile encasement/scrotal transposition (PEST) deformity.
Babu R, Shajini N
J Pediatr Urol · 2026 Mar · PMID 41864840 · Publisher ↗
We hereby report Curvature correction, Lateral foreskin Approximation & Scrotal Switch (CLASS) procedure as a first-stage of Penile encasement/scrotal transposition (PEST) deformity & proximal-hypospadias. At first stage...
We hereby report Curvature correction, Lateral foreskin Approximation & Scrotal Switch (CLASS) procedure as a first-stage of Penile encasement/scrotal transposition (PEST) deformity & proximal-hypospadias. At first stage, the encased penis was released by making two inverted "U" shaped incisions on either side of two hemi scrota; the dorsal foreskin was left attached to glans; lateral foreskin flaps, straightened at the coronal sulcus, were approximated in the midline after chordee correction. Fifteen patients with perineal hypospadias & PEST deformity underwent CLASS procedure and second stage with good success. Further large prospective studies are essential to validate this procedure.
Urinary NGF and BDNF as biomarkers of voiding dysfunction in children of mothers with overactive bladder.
Akarken I, Tarhan H, Saruhan E … +4 more , Aydın EC, Uyar BŞ, Güngördük K, Sahin H
J Pediatr Urol · 2026 Jun · PMID 41863954 · Publisher ↗
OBJECTIVES: We investigated the association between maternal overactive bladder (OAB) and voiding dysfunction (VD) in their children, and evaluated urinary nerve growth factor (NGF) and brain-derived neurotrophic factor...
OBJECTIVES: We investigated the association between maternal overactive bladder (OAB) and voiding dysfunction (VD) in their children, and evaluated urinary nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) levels as potential biomarkers for early identification of VD. METHODS: This prospective cross-sectional study included 196 participants: mothers with OAB (n = 39), their children with VD (n = 36), their children without VD (n = 41), healthy mothers (n = 40), and healthy children of healthy mothers (n = 40). Maternal OAB was diagnosed using the OAB-V8 questionnaire, while VD in children was assessed using the Dysfunctional Voiding Symptom Score (DVSS). Urinary NGF and BDNF levels were measured via ELISA. Receiver operating characteristic (ROC) analyses were performed to assess the diagnostic accuracy of these biomarkers. RESULTS: NGF and BDNF levels were significantly higher in mothers with OAB compared to controls (p < 0.001 for both). Children of OAB mothers with VD demonstrated markedly elevated DVSS scores, NGF, and BDNF levels compared to both healthy children of OAB mothers and children of healthy mothers (all p < 0.001). ROC analysis showed strong diagnostic performance for NGF (AUC = 0.828, cut-off 267.7 pg/ml, 75 % sensitivity, 99 % specificity) and acceptable performance for BDNF (AUC = 0.754, cut-off 3.06 ng/ml, 64 % sensitivity, 93 % specificity). CONCLUSION: Urinary NGF and BDNF levels were significantly elevated in mothers with OAB and their affected children. NGF demonstrated superior diagnostic accuracy for identifying VD in children, while BDNF may provide complementary value. These findings support the role of neurotrophin-related mechanisms in intergenerational transmission of lower urinary tract dysfunction.
The INSIDE-OUT longitudinal technique for bladder neck closure in children: A simplified and innovative approach.
Macedo A, Ottoni SL, Sacoman DLB … +3 more , Balladares RJ, Oliveira Holanda VJ, Leal da Cruz M
J Pediatr Urol · 2026 Jun · PMID 41863953 · Publisher ↗
INTRODUCTION: The article presents the INSIDE-OUT longitudinal technique for bladder neck closure in children, a simplified approach aimed at improving outcomes in pediatric patients, particularly those with myelomeningo...
INTRODUCTION: The article presents the INSIDE-OUT longitudinal technique for bladder neck closure in children, a simplified approach aimed at improving outcomes in pediatric patients, particularly those with myelomeningocele. Traditionally, these patients undergo bladder neck plasty or sling procedures, which, while potentially preserving bladder function, achieve continence rates of approximately 50 %. In contrast, the new INSIDE-OUT technique boasts a success rate exceeding 90 %. METHODS: The method begins with a midline incision of the bladder, allowing for internal exposure of the bladder neck. A Foley catheter is inserted and traction applied while plastic tubes are positioned in the ureters to facilitate transection of the bladder neck. The technique involves circumferential dissection of the bladder neck from the inside, creating flaps that are elevated to skin level. Closure occurs in two layers, using specific sutures for mucosal and seromuscular layers. DISCUSSION: Results show a continence rate exceeding 95 % after over a decade of implementation. We believe that the INSIDE-OUT technique should be more widely considered in complex bladder reconstructions, emphasizing the need to educate patients about the risks associated with improper catheterization. This innovative approach promises better outcomes for children facing complex urinary issues.
How do we counsel patients on short- and long-term complications after hypospadias repair? - A survey study.
Bhatia V, Guckien Z, Patel AN … +3 more , Rose A, Cannon S, Dangle PP
J Pediatr Urol · 2026 Feb · PMID 41862313 · Full text
INTRODUCTION: Hypospadias correction remains one of the most performed pediatric urologic procedures, affecting up to 1/150 males born in the United States. Current studies suggest that surgical counseling has a signific...
INTRODUCTION: Hypospadias correction remains one of the most performed pediatric urologic procedures, affecting up to 1/150 males born in the United States. Current studies suggest that surgical counseling has a significant impact on shared decision making, decisional regret, and long-term follow-up. However, no set paradigm currently exists for long-term follow-up or counseling. We sought to obtain consensus from established pediatric urologists the optimal content and potential short, intermediate, and long-term complications to be considered when counseling patients and parents of patients with hypospadias. METHODS: We conducted an IRB-approved survey study, which sampled the responses of Pediatric Urologists from National and International listservs. A google scholar search was performed using key words including "hypospadias" and "long-term complications." Descriptions of pertinent short, intermediate and long-term complications were identified and compiled from existing patient handouts. Survey items were then developed asking respondents to rate proposed descriptions, provide potential edits, and describe their overall approach to counseling. RESULTS: A total of 290 surgeons were contacted with 120 (41 %) responding. In total, 89 respondents (74 %) identified as male and 105 (88 %) had undergone a pediatric urology fellowship. Most surgeons described a reliance on verbal counseling (95 %) with the assistance of hand-drawn diagrams (75 %) to explain long-term care, rather than electronic or audiovisual materials (3-12 %). Of note, fewer surgeons endorsed routine discussion of long-term complications (Range 29.2 %-50.8 %) than shorter-term complications (56.7 %-89.2 %). On a Likert scale, physicians reported that they were mostly satisfied (72 %) with their current approaches to counseling. DISCUSSION: Perioperative counseling has an important yet often overlooked role in surgical care. The aim of this study was to better understand current counseling practices in pediatric hypospadias to identify gaps in urologic care and areas for improvement as one of the most common conditions treated by pediatric urologists. Our results suggest that surgeons who perform hypospadias repairs have potential to include more comprehensive discussion during post-operative follow-up. We proposed a preliminary counselling guide for these concerns which incorporates language from the most commonly selected complication description by survey respondents. Future studies will involve expert consensus and patient input to confirm the adequacy of the content, the method of delivery, content appearance, and accommodations for health literacy. Limitations of the study include small sample size and response bias. The results are reflective of the summed responses of participants and are not reflective of individual providers or practices. Importantly, this study omits the input of other advanced practice providers (nurse practitioners, physician assistants, etc.), nurses, and ancillary staff who are also crucial to hypospadias care. The proposed counseling guide represents a first attempt at creating standardization of hypospadias counseling. CONCLUSION: Surgeons who perform hypospadias repair do not routinely discuss long-term complications after repair, though are overall satisfied with their counseling practices. Better tools, such as improved multimodal counseling guides, could be used to deliver this counseling efficiently and accurately to ensure patients receive optimal long-term care. Future studies will focus on developing educational materials for short, intermediate, and long-term counseling on complications after hypospadias repair with input from patients and clinicians.
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