BACKGROUND: Hydronephrosis due to ureteropelvic junction obstruction (UPJO) is a common cause of paediatric urological morbidity. Split renal function (SRF), a key determinant in management, is traditionally assessed usi...BACKGROUND: Hydronephrosis due to ureteropelvic junction obstruction (UPJO) is a common cause of paediatric urological morbidity. Split renal function (SRF), a key determinant in management, is traditionally assessed using renal dynamic scintigraphy (RDS), which involves ionizing radiation. This feasibility study evaluated whether non-contrast-enhanced MR urography (NCE-MRU) derived split renal volume (SRV) could serve as a radiation-free surrogate for SRF in children with UPJO-type hydronephrosis before pyeloplasty. METHODS: Twenty consecutive children (13 males, 7 females; 40 renal units) with UPJO-type hydronephrosis underwent ultrasound, RDS, and NCE-MRU prior to surgery. Renal volumetry was performed on T2-weighted images using manual segmentation in Horos software (Horos Project, Annapolis, MD, USA), by two independent observers (a paediatric surgeon and a radiologist). SRV was calculated for each renal unit and compared with RDS derived SRF using Pearson's correlation. Interobserver agreement was assessed with intraclass correlation coefficient (ICC) and Bland-Altman analysis. An exploratory threshold-based analysis was performed using an SRF cut-off of 40% to assess the diagnostic performance of MRU-derived SRV for identifying impaired renal units. RESULTS: Of the 40 renal units, 21 (Left 13, Right 6, Bilateral 1) demonstrated obstruction. SRV showed strong correlation with SRF for all renal units (Observer 1: R = 0.948, p < 0.00001; Observer 2: R = 0.919, p < 0.00001). Strong correlations were also observed in obstructed (R = 0.888 and 0.810) and non-obstructed units (R = 0.890 and 0.793). Interobserver agreement was excellent (ICC = 0.932 overall), with minimal median bias on Bland-Altman analysis. In the threshold-based analysis, SRV showed 90.9% sensitivity, 89.7% specificity, 76.9% positive predictive value, 96.3% negative predictive value, and 90.0% overall accuracy for identifying impaired renal units. Threshold-based agreement was 90.0%, with threshold discordance and clinical misclassification in 4/40 and 1/40 renal units respectively. CONCLUSIONS: NCE-MRU-derived SRV demonstrated strong correlation with RDS-derived SRF, excellent interobserver reproducibility, and high agreement with the clinically relevant 40% SRF threshold. These findings support NCE-MRU volumetry as a non-invasive, radiation-free complementary tool for functional assessment in selected cases of UPJO-type hydronephrosis rather than as a routine replacement for RDS. However, larger multicentric studies are needed to validate threshold agreement and define its role in longitudinal follow-up.
BACKGROUND: Gender dysphoria (GD) has been reported in individuals with classic congenital adrenal hyperplasia (CAH), but its frequency and predictors among 46, XX patients raised female remain poorly characterized. Unde...BACKGROUND: Gender dysphoria (GD) has been reported in individuals with classic congenital adrenal hyperplasia (CAH), but its frequency and predictors among 46, XX patients raised female remain poorly characterized. Understanding the influence of androgen exposure, timing of diagnosis, and treatment adherence is essential for sex assignment, surgical planning, and long-term follow-up in pediatric urology. OBJECTIVE: To systematically review published cases of 46, XX CAH patients assigned female who developed GD or changed social gender, focusing on Prader stage, age at diagnosis, and treatment adherence. METHODS: A systematic search of PubMed, Embase, and Cochrane Central was conducted through January 2025 using the terms ("Congenital adrenal hyperplasia" OR "CAH" OR "21-hydroxylase deficiency" OR "adrenogenital syndrome") AND ("gender identity" OR "gender dysphoria" OR "gender incongruence" OR "gender nonconformity"). Inclusion criteria were original articles reporting 46, XX CAH individuals raised as females who presented GD; studies on non-classic CAH, animals, individuals under 12 years, and review articles were excluded. Extracted data included age at diagnosis, Prader classification, CAH type, surgery, medication adherence, GD assessment method, social gender change, sexual orientation, and psychosocial variables. RESULTS: Thirteen studies met the inclusion criteria, describing 19 cases of 46, XX CAH patients assigned female who developed GD and/or transitioned socially to male. Overall, 15/19 cases had at least one of: (a) marked virilization (Prader 4-5 or highly virilized), (b) late diagnosis, or (c) poor/irregular adherence to glucocorticoid therapy. Sexual orientation, when reported, was mainly female-directed, and eleven patients had socially transitioned to male at the time of report. CONCLUSIONS: GD in 46, XX CAH patients raised female appears linked to higher cumulative androgen exposure, delayed diagnosis, and poor treatment adherence. Early diagnosis and consistent therapy may be protective.
INTRODUCTION: Hypospadias repair is a common pediatric urological procedure often requiring urinary diversion to minimize postoperative complications. The optimal diversion technique-transurethral versus suprapubic diver...INTRODUCTION: Hypospadias repair is a common pediatric urological procedure often requiring urinary diversion to minimize postoperative complications. The optimal diversion technique-transurethral versus suprapubic diversion -remains debated. The aim of this study is to systematically review and compare outcomes of transurethral versus suprapubic diversion following hypospadias repair in pediatric patients. METHODS: A systematic review and meta-analysis were performed in accordance with PRISMA guidelines. PubMed, Scopus, Web of Science, and Cochrane Library were searched through December 2024. Eligible studies included randomized controlled trials and comparative observational studies reporting outcomes of transurethral versus suprapubic diversion. Main outcomes included urethrocutaneous fistula, meatal stenosis, and bladder spasms. RESULTS: Five studies including 680 patients were analyzed. Initial pooled analysis showed no significant difference between transurethral and suprapubic diversion in fistula incidence (RR 1.21, 95% CI 0.75-1.96; p = 0.42). Sensitivity analysis excluding one study suggested a potential reduction in fistula risk with suprapubic diversion (RR 0.35, 95% CI 0.16-0.78; p = 0.01). Meatal stenosis rates were comparable between groups (RR 1.25, 95% CI 0.60-2.59; p = 0.55). For bladder spasms, pooled analysis showed no difference (RR 0.81, 95% CI 0.55-1.20; p = 0.29), but sensitivity analysis favored suprapubic diversion (RR 0.08, 95% CI 0.02-0.32; p = 0.0003). CONCLUSION: Both methods yield comparable outcomes with some potential advantages of suprapubic diversion in some outcomes only after sensitivity analysis. While SPT may offer a viable alternative to traditional urinary catheterization in select cases of hypospadias repair, the current evidence base does not support definitive conclusions about its superiority or inferiority. Given the variability in study quality, small sample sizes, and heterogeneity in reported outcomes, no definitive recommendation can yet be made. Future RCTs are essential to guide practice.
Dr. Israel Franco is Adjunct Professor of Clinical Urology at Yale School of Medicine. Previously he was Professor of Urology at New York Medical College and Yale School of Medicine. He has held multiple leadership posit...Dr. Israel Franco is Adjunct Professor of Clinical Urology at Yale School of Medicine. Previously he was Professor of Urology at New York Medical College and Yale School of Medicine. He has held multiple leadership positions in the International Children's Continence Society (ICCS) and on September 5, 2025, he delivered the Kelm Hjalmas lecture at the ICCS meeting in Vienna, Austria. He has long advocated for improved understanding of pediatric urinary continence by looking at the central control of the bladder and urethral sphincter. We took this opportunity to further discuss how this view affects his clinical approach and where he thinks this will lead us in our treatment of pediatric urinary incontinence.
BACKGROUND: Primary vesicoureteral reflux (VUR) is a congenital urinary system condition that can lead to renal impairment. While the laparoscopic Lich-Gregoir anti-reflux surgery is an established treatment, previous re...BACKGROUND: Primary vesicoureteral reflux (VUR) is a congenital urinary system condition that can lead to renal impairment. While the laparoscopic Lich-Gregoir anti-reflux surgery is an established treatment, previous research has primarily focused on reflux recurrence and urinary tract infection (UTI) rates. The postoperative recovery of the frequently associated ureteral dilation remains an under-investigated area, which is crucial for understanding ureteral functional restoration. OBJECTIVE: To investigate the resolution timeline of ureteral dilation following laparoscopic Lich-Gregoir anti-reflux surgery in children and to identify factors influencing this recovery. STUDY DESIGN: A retrospective analysis was conducted on 92 children (139 ureters) with primary VUR and ureteral dilation who underwent the laparoscopic Lich-Gregoir procedure. The primary outcome was the time from surgery to the resolution of ureteral dilation, defined as a diameter of <7 mm on ultrasonography. RESULTS: Postoperative ureteral diameter and renal pelvis dilation significantly decreased. Overall, 90% of ureteral dilations resolved within 6 months post-surgery. Grade IV-V VUR, a history of preoperative UTI, and bilateral surgery were identified as independent risk factors for significantly delayed resolution. DISCUSSION: The identified risk factors reflect more severe initial anatomical impairment and greater surgical complexity. Establishing this resolution timeline provides a data-driven reference for clinicians to effectively manage postoperative expectations. CONCLUSION: Laparoscopic Lich-Gregoir anti-reflux surgery is effective in resolving VUR-caused ureteral dilation 6 months postoperatively. Grade IV-V VUR, bilateral surgery, and a history of preoperative UTI are risk factors for delayed resolution.
OBJECTIVE: To evaluate the long-term incidence of urethral stricture intervention following hypospadias repair, a procedure for a common urogenital birth defect in which the urethral meatus is repositioned to the penile...OBJECTIVE: To evaluate the long-term incidence of urethral stricture intervention following hypospadias repair, a procedure for a common urogenital birth defect in which the urethral meatus is repositioned to the penile tip, as long-term outcomes are not well studied. METHODS: A retrospective, population-based cohort study of males born in Ontario, Canada from April 1994-March 2023, was conducted using healthcare administrative databases. Cases undergoing hypospadias repair were matched to four controls by birthdate. Primary outcome was urethral stricture requiring intervention, assessed using Cox proportional hazards models. Secondary exposure was hypospadias location (distal vs proximal). Models were adjusted for baseline and secondary covariates. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated. RESULTS: A total of 9130 cases and 36,520 controls were analyzed. The mean and median age at surgery was 26.9 months and 19 months, respectively. Distal hypospadias accounted for 68.9% of cases, 9% required multi-stage repair, and 7% had post-operative complications. Urethral stricture requiring intervention developed in 169 cases (1.85%), versus 24 controls (0.06%). The risk of stricture was significantly higher in cases compared to controls (HR 26.80, 95% CI 17.43-41.20). Proximal repairs carried higher risk than distal repairs (HR 3.20, 95% CI 1.60-6.41). Mean follow-up was 13.5 years. CONCLUSIONS: Although absolute risk is low, patients with hypospadias repair are more likely to develop urethral strictures that require intervention compared with controls, particularly following proximal repair. These findings suggest that clinicians should maintain a high index of suspicion for urethral strictures in this population, even many years after the initial surgery.
INTRODUCTION: Hypospadias is a common congenital malformation with a complex etiology involving genetic susceptibility and environmental factors. MicroRNAs (miRNAs), as epigenetic modulators, are hypothesized to bridge t...INTRODUCTION: Hypospadias is a common congenital malformation with a complex etiology involving genetic susceptibility and environmental factors. MicroRNAs (miRNAs), as epigenetic modulators, are hypothesized to bridge these factors by regulating genes essential for urogenital development. The aim of this study was to investigate the expression profiles of specific miRNAs associated with AR, ESR1, and FGFR2 genes in both tissue and systemic circulation (blood) of children with hypospadias compared to healthy controls, to evaluate their potential as epigenetic footprints. METHODS: The study included 20 boys undergoing surgical repair for isolated hypospadias and 20 age-matched healthy boys undergoing routine circumcision. Preoperative venous blood and intraoperative foreskin tissue samples were collected from all participants. The expression levels of miR-203a-3p, miR-210, miR-218-5p, miR-22-3p, miR-302c-3p, miR-355-5p, and miR-488-5p were analyzed using quantitative Real-Time PCR (qRT-PCR). RESULTS: In tissue samples, no statistically significant differences were observed in miRNA expression between the hypospadias and control groups. However, significant dysregulation was detected in blood samples. miR-203a-3p was significantly upregulated, while miR-210, miR-218-5p, miR-22-3p, miR-302c-3p, miR-355-5p, and miR-488-5p were significantly downregulated in the hypospadias group compared to controls. Furthermore, a significant source-dependent difference (tissue vs. blood) was observed exclusively within the patient group, whereas tissue and blood levels were similar in healthy controls. DISCUSSION: The discrepancy between tissue and blood results suggests that while local tissue expression may normalize postnatally, the systemic circulation retains a distinct profile of these epigenetic modulators. These findings demonstrate that circulating miRNAs are significantly dysregulated in hypospadias patients, suggesting a potential association with systemic responses to developmental disruptions, rather than establishing a direct etiology. CLINICAL/TRANSLATIONAL APPLICABILITY: This study demonstrates that specific circulating miRNA profiles are altered in hypospadias, suggesting a potential association with systemic epigenetic modulations rather than localized defects. These preliminary data provide a foundation for future comprehensive studies to explore their roles in developmental anomalies.
BACKGROUND: Primary Monosymptomatic Nocturnal Enuresis (PMNE) remains a common and distressing condition in pediatric practice. Imipramine, a tricyclic antidepressant, is an established therapy but has limitations relate...BACKGROUND: Primary Monosymptomatic Nocturnal Enuresis (PMNE) remains a common and distressing condition in pediatric practice. Imipramine, a tricyclic antidepressant, is an established therapy but has limitations related to safety and relapse. Sulbutiamine, a lipophilic thiamine derivative with central neuromodulatory cholinergic and dopaminergic activity, may offer a novel therapeutic approach by modulating arousal and micturition control. OBJECTIVE: To compare the efficacy and safety of sulbutiamine and imipramine in the management of PMNE in children. METHODS: A total of 450 children aged 6-18 years with PMNE were prospectively randomized into three equal groups: Group A, imipramine alone (25 mg/day); Group B, sulbutiamine alone (100 mg/day); and Group C, combined imipramine plus sulbutiamine at the same doses. Patients were followed for six months. The primary outcomes were treatment response (complete, partial, or none) and relapse rate; secondary outcomes included duration to achieve dryness and adverse events. RESULTS: Baseline characteristics did not differ significantly among groups. The mean duration to achieve successful therapy was shorter with sulbutiamine (3.2 ± 1.9 months) and combination therapy (3.3 ± 1.8 months) than with imipramine alone (3.8 ± 1.9 months; p = 0.017). After six months, complete response occurred in 60% of the combination group, 52.7% of the sulbutiamine group, and 37.3% of the imipramine group (p = 0.003). Relapse rates were markedly lower with sulbutiamine (28.7%) and combination therapy (24.8%) compared with imipramine (43.6%) (p = 0.01). Adverse effects were significantly less frequent with sulbutiamine (4.7%-6%) than with imipramine (12%-14%) (p = 0.017). CONCLUSIONS: Sulbutiamine, either as monotherapy or combined with imipramine, produced faster and more sustained improvement in PMNE with fewer adverse effects and lower relapse rates than imipramine alone. These findings suggest that sulbutiamine may represent a safe and effective alternative or adjunct in the pharmacologic management of primary nocturnal enuresis.
BACKGROUND & OBJECTIVE: Children with Developmental Coordination Disorder (DCD) face significant, yet often overlooked, challenges beyond motor impairments, including difficulties with toilet training and bladder and bow...BACKGROUND & OBJECTIVE: Children with Developmental Coordination Disorder (DCD) face significant, yet often overlooked, challenges beyond motor impairments, including difficulties with toilet training and bladder and bowel dysfunctions (BBD). This study aims to explore whether children with DCD exhibit greater difficulties in these areas compared to typically developing children (TDC). METHOD: This cross-sectional case-control study included 84 children aged 5-8 years (42 DCD, 42 TDC), matched by school-grade and sex (33 boys and 9 girls per group). Parents completed the Vancouver Symptom Score for Dysfunctional Elimination Syndrome (VSSDES) to assess BBD symptoms, the Dutch DCD-questionnaire (DCD-Q) to evaluate motor coordination, and additional questions regarding toilet training, elimination diagnosis, and co-occurring conditions. Correlations and exploratory group differences were analysed. RESULTS: Parents of children with DCD reported significantly more toilet training difficulties than parents of controls (p < 0.001), including persistent accidents (47.6% vs. 9.5%), prolonged training (45.2% vs. 4.8%), and difficulties recognizing urination urgency (40.5% vs. 2.4%). The parental report of delayed attainment of bowel and bladder control (p < 0.05) and BBD rates (p < 0.001) was also significantly higher in children with DCD. Exploratory analyses indicated that the prevalence of these outcomes was not significantly different between children with DCD with and without co-occurring ADHD or autism, suggesting a possible primary association with DCD. Additionally, across both children with DCD and TDC, poorer motor skills were associated with more BBD symptoms (r = -0.474, p < 0.001). CONCLUSION: Children with DCD have a higher prevalence of toilet training difficulties and BBD compared to TDC, potentially affecting their psychosocial well-being. Greater awareness is crucial for timely and targeted care. Notably, the study's design, directly comparing children diagnosed with DCD to matched TDC, provides new insights into the prevalence of elimination difficulties in this population.
OBJECTIVE: To compare the surgical and functional outcomes of PSARVUP and TUM in a contemporary cohort of patients with cloacal malformations, with particular emphasis on urological results and the influence of individua...OBJECTIVE: To compare the surgical and functional outcomes of PSARVUP and TUM in a contemporary cohort of patients with cloacal malformations, with particular emphasis on urological results and the influence of individual patient anatomy on these outcomes. METHODS: A retrospective cohort study of patients with cloacal malformations who underwent definitive repair between 2020 and 2023. Inclusion criteria were confirmed cloacal malformation with prior colostomy and definitive repair by PSARVUP or TUM, whilst cases with complex sacral and spinal anomalies were excluded. Preoperative workup included cystoscopy, pelvic and spinal MRI, renal ultrasound, and voiding cystourethrography. Outcome measures included postoperative complications, ability to void spontaneously, requirements for clean intermittent catheterization (CIC), status of urinary continence, incidence of febrile urinary tract infections (UTIs), and urodynamic findings. RESULTS: A total of 27 patients with confirmed cloacal malformations were included. Of these, 16 patients (59.3%) underwent PSARVUP and 11 patients (40.7%) underwent TUM. Within the PSARVUP cohort, wound dehiscence represented the most frequent complication compared to vaginal stenosis in TUM group. As regards recurrent frequent UTIs, the overall incidence of infection was lower in PSARVUP as compared to TUM. Overall, approximately two-thirds of all evaluated patients demonstrated abnormal findings on urodynamic assessment with neurogenic bladder patterns were the most common. CONCLUSION: PSARVUP and TUM are effective techniques for repairing long common channel cloaca, each with distinct advantages and limitations. TUM offers an improved cosmetic outcome but can result in long-term urological complications. On the other hand, PSARVUP yields an improved functional outcome despite a more complex operative course and higher rates of vesicourethral fistulas. Longer follow-up and multicenter studies are required to refine surgical planning and optimize outcomes.
BACKGROUND: An effective treatment strategy is essential for metastatic Wilms tumor (WT) management. To improve prognostic accuracy, this study examined metastatic patterns and key prognostic factors. METHODS: Children d...BACKGROUND: An effective treatment strategy is essential for metastatic Wilms tumor (WT) management. To improve prognostic accuracy, this study examined metastatic patterns and key prognostic factors. METHODS: Children diagnosed with WT from 2010 to 2021 were identified from the SEER database. All patients underwent chemotherapy and surgical resection. Metastatic patterns, metastasis-related predictors, and prognostic factors were evaluated. RESULTS: Of the 1040 patients analyzed, 226 (21.7%) experienced lung metastasis, 31 (3.0%) liver metastasis, 6 (0.6%) bone metastasis, and 220 (21.2%) regional lymph node metastasis. Distant metastasis was associated with a higher incidence of lymph node metastasis (OR = 1.506, 95% CI 1.346-1.685, p < 0.001). Age 3-17 years (OR = 1.933, 95% CI 1.406-2.680, p < 0.001), left-sided (OR = 1.383, 95% CI 1.016-1.890, p = 0.040), bilateral (OR = 2.303, 95% CI 1.215-4.243, p = 0.009), and tumor size ≥135 mm (OR = 2.020, 95% CI 1.481-2.749, p < 0.001) were identified as predictors of metastasis. Both lymph node (p < 0.001) and lung metastasis (p < 0.001) were high-risk factors for WT. Radiotherapy provided long-term survival benefits for the metastatic population (p = 0.027), while postoperative chemotherapy showed better outcomes than preoperative or other strategies (p < 0.001). Further analysis demonstrated that the concurrent lung and lymph node metastasis group benefited more from postoperative chemoradiotherapy, with HRs of 0.226 (p = 0.028) for overall survival and 0.255 (p = 0.048) for cancer-specific survival. CONCLUSION: WT with concurrent lung and lymph node metastasis represents a distinct and aggressive metastatic phenotype associated with a significantly poor prognosis. Postoperative chemoradiotherapy may provide superior survival benefits for this high-risk population.
OBJECTIVE: Testicular torsion in childhood and adolescence is a urological emergency that may necessitate orchiectomy. The long-term impact of orchiectomy on psychological well-being, body image, and fertility concerns r...OBJECTIVE: Testicular torsion in childhood and adolescence is a urological emergency that may necessitate orchiectomy. The long-term impact of orchiectomy on psychological well-being, body image, and fertility concerns remains poorly defined. This study aimed to evaluate the psychosocial and sexual consequences of orchiectomy following torsion, compared with patients who underwent orchiopexy alone. METHODS: A retrospective single-center study included 54 men, who underwent surgery for torsion between 2013 and 2023. Participants were healthy, with no prior psychiatric history. Validated questionnaires, DASS-21 (Depression, Anxiety, Stress Scale), IIEF-5 were administered. Subgroup analysis assessed the impact of testicular prosthesis placement. RESULTS: Twenty-seven patients had undergone orchiectomy and 27 orchiopexy. Mean (±S.D.) age at surgery was 16.8 ± 7.1 and 16.9 ± 4.2 years, respectively. Mean follow-up age was 27.6 ± 5.9 years. Orchiectomy was associated with significantly higher anxiety (11.9 ± 3.0, p< 0.001) and stress scores (18.4 ± 4.5, p< 0.001). All orchiopexy patients were within normal range on all DASS-21 subscales. Sexual function (IIEF-5) showed no significant difference (29.4 ± 2.2 vs. 30.0 ± 0.0, p= 0.15). Body image dissatisfaction was reported by 89% (24/27) of orchiectomy patients, all explicitly attributing it to testicular loss. The most frequent concern was fear of future infertility. Prosthesis implantation improved self-perceived body image but did not significantly mitigate anxiety or stress. CONCLUSIONS: Orchiectomy for torsion exerts a measurable and enduring psychosocial burden, manifesting as moderate anxiety, mild stress, and high rates of body image dissatisfaction. Testicular prosthesis placement enhances appearance-related satisfaction but does not normalize emotional distress. Comprehensive post-torsion care should include psychological and fertility counselling to address the multidimensional impact of testicular loss.
INTRODUCTION AND OBJECTIVES: Primary tethered cord syndrome (TCS) can lead to neurological and urologic dysfunction. While postoperative urodynamic studies (UDS) are standard for evaluating bladder function after spinal...INTRODUCTION AND OBJECTIVES: Primary tethered cord syndrome (TCS) can lead to neurological and urologic dysfunction. While postoperative urodynamic studies (UDS) are standard for evaluating bladder function after spinal cord detethering (SCD), the role of preoperative UDS remains unclear, particularly in non-toilet trained (NTT) infants and children. This study assesses the utility of preoperative UDS by 1) comparing pre- and postoperative findings and risk stratification, and 2) examining correlations with long-term urologic outcomes. STUDY DESIGN: We retrospectively reviewed records of children who underwent SCD between 2009 and 2022 and had UDS within one year before and after surgery. Patients were included if they were not toilet trained at time of preoperative UDS. Exclusion criteria included secondary SCD, incomplete UDS documentation, and prior urinary diversion. UDS tracings were independently reviewed by two pediatric urologists categorized as low-, intermediate-, and high-risk based on end-fill pressure (EFP) and detrusor overactivity (DO). RESULTS: Forty-eight children met inclusion criteria. Median (IQR) age at preoperative UDS, SCD, and postoperative UDS was 7.7 (4.2-11.1), 8 (5-12), and 16.1 (12.7-20.5) months, respectively. Neurosurgeons had scheduled or definitively recommended surgery for 81.3% of patients prior to preoperative UDS. One child started CIC prior to SCD based on UDS findings of large capacity bladder and poor emptying; 97% of children had no preoperative change in urologic management. There was no significant difference in any individual urodynamic parameter pre- and postoperatively. Preoperatively, 34 (70.8%) children were low-risk, 14 (29.2%) intermediate-risk, and none high-risk. Change in risk categorization was observed in 16 (33.3%) children-11 (22.9%) improved and 5 (10.4%) worsened. At median follow-up of 5.4 years, children with intermediate- or high-risk postoperative UDS were 23.3 times more likely to require CIC at most recent follow-up than low-risk children (p = 0.010); no such association was found with preoperative risk status. CONCLUSION: Among NTT infants and young children with TCS, preoperative UDS findings did not differ significantly from postoperative findings and were not associated with long-term bladder outcomes. These data suggest limited utility of routine baseline preoperative UDS and support reserving preoperative UDS for select cases where results are expected to provide clinically actionable information. Interdisciplinary collaboration is needed to refine testing protocols and promote high-value, patient-centered care.
OBJECTIVE: To evaluate whether nighttime centralization of pediatric acute scrotum management improves timeliness of care and surgical outcomes in a rural regional network. METHODS: We conducted a retrospective cohort st...OBJECTIVE: To evaluate whether nighttime centralization of pediatric acute scrotum management improves timeliness of care and surgical outcomes in a rural regional network. METHODS: We conducted a retrospective cohort study of 215 pediatric acute scrotum cases managed between 2003 and 2024 in Yamanashi Prefecture, Japan. Nighttime centralization was implemented in October 2018, designating a single receiving institution during off-hours. Outcomes before (2003-2017) and after (2018-2024) centralization were compared. Time intervals were analyzed when complete timestamps were available and restricted to ≤1440 min. Continuous variables were compared using the Mann-Whitney U test. RESULTS: A total of 215 cases were included (Before n = 103; After n = 112). Baseline characteristics, including age distribution and proportion of confirmed torsion among surgical cases, were comparable between periods. Following centralization, annual case volume increased, while surgical and salvage proportions remained stable. Of the total cohort, 195 cases were included in the onset-to-consultation analysis, and 68 cases were included in the consultation-to-surgery analysis after exclusion of intervals >24 h. Median onset-to-consultation time did not differ between eras (300 vs 296 min, p = 0.708). Among surgically treated cases, median consultation-to-surgery time showed no significant difference (133 vs 143 min, p = 0.107). Among cases with complete onset and surgery timestamps (n = 52), orchiectomy was associated with longer onset-to-surgery intervals compared with salvaged testes (630 vs 416 min, p = 0.068). CONCLUSIONS: Nighttime centralization increased case capture without worsening in-hospital delay or compromising testicular salvage. Pre-hospital delay remained unchanged. These findings suggest that nighttime centralization functions as a capacity-preserving system reorganization, maintaining in-hospital timeliness despite increased case volume, rather than directly reducing pre-hospital delays.