Advances in pediatric urology have transformed once fatal, congenital anomalies into chronic, manageable conditions, creating a growing population of adults living with childhood-onset urologic disorders. Despite interna...Advances in pediatric urology have transformed once fatal, congenital anomalies into chronic, manageable conditions, creating a growing population of adults living with childhood-onset urologic disorders. Despite international transition initiatives, most readiness tools emphasize task completion rather than the acquisition of confidence, motivation, and adaptability required for sustained self-management. This review integrates evidence from behavioral science to propose an enhanced, self-efficacy-driven approach to transitional urology. Drawing on established health behavior change models including Social Cognitive Theory, the Health Belief Model, the Transtheoretical Model, and Health Action Process Approach, we synthesize data showing that self-efficacy, resilience, and motivation are key predictors of durable behavior change. These principles informed the preliminary development of the Uro-TRAQ, a conceptual adaptation of the Transition Readiness Assessment Questionnaire (TRAQ) that adds items designed to incorporate confidence, resilience, motivation, environmental context, and urology-specific skills into readiness assessment. The Uro-TRAQ provides a foundation for action by identifying confidence gaps, barriers, and skill needs. It is embedded within an Individualized Transition Plan (ITP), a structured, clinic-based roadmap that organizes readiness assessment, goal-setting, and longitudinal follow-up. Guided by the ITP, clinicians can support transition readiness through the following complementary strategies: (1) motivational interviewing to elicit confidence ratings and connect real-world strengths to health behaviors; (2) resilience-building through individualized "if-then" plans that anticipate common barriers; and (3) graded mastery pathways that progressively strengthen skill and confidence through supported practice. Additionally, the questionnaire asks specifically about environmental and social barriers so these can be addressed in the context of transition planning. Informed by evidence-based behavioral strategies clinicians can move beyond documenting task performance to actively cultivating confidence, resilience, and autonomy, core determinants of competent lifelong self-management.
BACKGROUND: This study aimed to develop and validate a nomogram for predicting the risk of postoperative fever in pediatric patients undergoing percutaneous nephrolithotomy (PCNL) for upper urinary tract stones, to provi...BACKGROUND: This study aimed to develop and validate a nomogram for predicting the risk of postoperative fever in pediatric patients undergoing percutaneous nephrolithotomy (PCNL) for upper urinary tract stones, to provide a basis for the early identification of high-risk patients and intervention. METHODS: This retrospective study analyzed the clinical data of 219 pediatric patients with upper urinary tract stones who underwent PCNL performed by the same surgeon at two medical centers between October 2019 and October 2024: Hospital A (150 Uyghur patients) and Hospital B (69 Han patients). Univariate and multivariate logistic regression analyses were used to identify independent risk factors for postoperative fever, which were then used to construct a nomogram. The model's performance, accuracy, and clinical utility were comprehensively evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). RESULTS: Multivariate logistic regression analysis identified four independent risk factors: lower preoperative hemoglobin (OR = 0.96, 95%CI: 0.94-0.99, P = 0.003), positive urine culture (OR = 2.26, 95%CI: 1.21-4.22, P = 0.011), multiple stones (OR = 2.01, 95%CI: 1.06-3.81, P = 0.034), and longer operative time (OR = 1.01, 95%CI: 1.01-1.02, P = 0.018). The nomogram based on these factors demonstrated good discrimination, with an area under the ROC curve (AUC) of 0.748. The calibration curve indicated excellent agreement between the predicted risk and actual fever incidence. Decision curve analysis (DCA) showed that using this model for clinical decision-making yielded a higher net benefit than alternative strategies within a threshold probability range of approximately 15%-65%. CONCLUSIONS: In support of our initial hypothesis, we conclude that lower preoperative hemoglobin, a positive preoperative urine culture, increasing operative time, and the presence of multiple stones are independently associated with postoperative fever in pediatric patients undergoing PCNL. Based on these results, we successfully created a predictive nomogram and internally validated its predictive ability. However, as this currently represents a proof-of-concept model, external validation and direct linkage to hard clinical outcomes remain critical next steps before it can be adopted for routine clinical decision-making. CLINICAL TRIAL NUMBER: Not applicable.
BACKGROUND: Posterior urethral valves (PUV) remain an important contributor to childhood chronic kidney disease. After endoscopic valve ablation, residual valves may perpetuate obstruction and worsen renal and bladder ou...BACKGROUND: Posterior urethral valves (PUV) remain an important contributor to childhood chronic kidney disease. After endoscopic valve ablation, residual valves may perpetuate obstruction and worsen renal and bladder outcomes. The posterior: anterior urethral ratio (PAR) on postoperative micturating cystourethrogram (MCUG) is a simple quantitative measure that may help detect residual valves, but reported thresholds and accuracies vary widely. We aimed to evaluate the diagnostic performance of PAR on postoperative MCUG for detecting residual PUV, using cystoscopy as the reference standard. METHODS: This review was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline extension for diagnostic test accuracy reviews and a protocol was a priori registered in PROSPERO (CRD420251010994). PubMed, Scopus, EMBASE and Web of Science were searched on 23 June 2025 for English-language studies in which PAR on postoperative MCUG was used to diagnose residual valves after ablation, with check cystoscopy as reference standard. The risk of bias among the included studies was assessed using QUADAS-2 tool. Two reviewers independently performed data extraction and constructed 2 × 2 tables for each study. Pooled sensitivity and specificity were estimated, and a summary receiver operating characteristic (sROC) curve was constructed using a bivariate random-effects model (Stata 'midas'). RESULTS: Seven studies (n = 565; 398 PUV, 167 controls) met the inclusion criteria for the systematic review; six were included in the meta-analysis. Reported PAR cut-offs for residual valves ranged from 1.2 to 3.5. Pooled sensitivity was 0.77 (95% credible interval [CrI] 0.54-0.90), pooled specificity was 0.95 (95% CrI 0.78-0.99), and the sROC area under the curve was 0.91 (95% CrI 0.88-0.93), with high specificity but only moderate sensitivity. Among the included studies, the majority had low risk of bias for the index test (six out of seven studies) and reference standard (all seven studies), but two studies had high risk in the patient selection and three studies had high risk in flow/timing domains. Also, the risk of applicability was low for all studies in most of the domains. CONCLUSION: Postoperative PAR on MCUG demonstrates a specificity of 95% and a sensitivity of 77% for detecting residual PUV. Given the wide variation in PAR thresholds and heterogeneity among the included studies, the pooled estimates are promising, yet hypothesis-generating. Interpretation of these results should be cautious and cannot be construed as prescriptive. Further high-quality multicentric studies are needed to validate these results.
We describe an abdominal wall closure device (AWCD)-assisted minimally invasive cutaneous ureterostomy (CU) for young infants who require urgent, low-pressure diversion due to markedly dilated ureters (e.g., duplex-syste...We describe an abdominal wall closure device (AWCD)-assisted minimally invasive cutaneous ureterostomy (CU) for young infants who require urgent, low-pressure diversion due to markedly dilated ureters (e.g., duplex-system ureterocele with high-grade reflux or other severe reflux/obstructive scenarios). Under laparoscopic vision, the AWCD is used to deliver and retrieve a suture loop beneath the markedly dilated ureter, enabling controlled elevation of the ureter along an extraperitoneal trajectory to a small skin incision with minimal ureteral mobilization. This "loop-lift" maneuver simplifies ureteral exposure, reduces tissue handling, and provides a reproducible pathway for rapid diversion prior to definitive reconstruction.
BACKGROUND: Hypospadias is a common congenital anomaly seen in newborn males. The phenotypic spectrum is wide, and complication rates are high, particularly in severe cases. Multi-stage approaches to surgical management...BACKGROUND: Hypospadias is a common congenital anomaly seen in newborn males. The phenotypic spectrum is wide, and complication rates are high, particularly in severe cases. Multi-stage approaches to surgical management have gained traction over recent years. However, a comprehensive understanding of national practice patterns is limited. OBJECTIVE: To perform a contemporary analysis of hypospadias repair patterns and complication rates in the United States, with a focus on surgical staging. MATERIALS & METHODS: The Pediatric Health Information System (PHIS) database was queried to create a cohort of pediatric patients under 5 years of age who underwent single- or multi-stage hypospadias repair between January 1, 2016 and June 30, 2025. ICD-10 and CPT codes were used for cohort creation. Patients with inconsistent coding were excluded. Patient demographics and features of hypospadias phenotype were explored. Comparisons between single- and multi-stage patients, longitudinal trends in staging, and factors impacting complication rates were analyzed. RESULTS: We identified 25,989 patients at 45 children's hospitals. Overall, 96.5% of patients underwent single-stage repair at a median age of 9.3 months, while 3.5% underwent multi-stage repair, starting at 15.4 months. For proximal cases, 35.5% were managed in a multi-stage fashion. On longitudinal analysis, rates of multi-stage repair for proximal hypospadias have significantly increased over time (p = 0.003). Compared to single-stage patients, multi-stage patients were more likely to be non-White, receive care in the Northeast or Midwest, have a proximal meatus and associated chordee, and undergo grafting or complex scrotoplasty. On multivariate analysis of multi-stage patients, increasing age was a significant predictor of complications (p < 0.0001), while Midwest region (p = 0.003) and non-Hispanic Black (p = 0.02) and Hispanic race-ethnicity (p = 0.01) were protective. Meatal location was not a significant factor impacting complications after multi-stage repair (p = 0.28); however, in single-stage patients, complication rates did increase with a more proximal meatus (p < 0.0001). CONCLUSIONS: Use of multi-stage repairs for proximal hypospadias has increased over the past decade in the United States. Single- and multi-stage patients differ in terms of hypospadias phenotype, demographics, and factors associated with complication rates.
BACKGROUND: Routine antibiotic prescription is commonly practiced in pediatric circumcision, despite limited evidence supporting its benefit in clean elective procedures. This study aimed to determine whether withholding...BACKGROUND: Routine antibiotic prescription is commonly practiced in pediatric circumcision, despite limited evidence supporting its benefit in clean elective procedures. This study aimed to determine whether withholding routine antibiotics is non-inferior to standard postoperative administration in preventing surgical site infections (SSIs) in healthy children undergoing elective circumcision. METHODS: This single-center, randomized, non-inferiority trial enrolled boys aged 5-15 years scheduled for elective circumcision. Participants were allocated to receive either standard postoperative oral antibiotics or no antibiotics. The primary outcome was an SSI within 21 days, assessed by blinded evaluators, with non-inferiority defined as an upper limit of the 95% confidence interval (CI) for the risk difference of <5%. RESULTS: Of 175 screened patients, 155 were included in the per-protocol analysis (80 antibiotics; 75 no antibiotics). SSIs occurred in one patient in each group (1.3% vs. 1.3%), yielding a risk difference of 0.0% (95% CI -3.8% to 3.8%), which met the non-inferiority criterion. Secondary outcomes were comparable between the groups, and no serious adverse events were observed. CONCLUSION: Withholding antibiotics in healthy children undergoing elective circumcision is non-inferior to routine postoperative use with respect to infection risk and supports an antibiotic-sparing approach consistent with antimicrobial stewardship principles. TRIAL REGISTRATION: Thai Clinical Trials Registry (TCTR20250818001).
BACKGROUND: Augmentation cystoplasty (AC) remains the standard reconstructive option for children with refractory lower urinary tract dysfunction (LUTD) and high-risk urodynamic patterns threatening renal function. Howev...BACKGROUND: Augmentation cystoplasty (AC) remains the standard reconstructive option for children with refractory lower urinary tract dysfunction (LUTD) and high-risk urodynamic patterns threatening renal function. However, postoperative morbidity and long-term renal outcomes remain clinically relevant concerns. OBJECTIVE: To characterize postoperative complications following AC, evaluate functional and renal outcomes, and identify risk factors associated with intermediate and late adverse events. STUDY DESIGN: Retrospective cohort study including patients ≤18 years with neurogenic or congenital bladder dysfunction refractory to optimized medical and endoscopic therapy, who underwent AC between 2003 and 2017 at a tertiary pediatric center. Minimum follow-up was 12 months. Pre- and postoperative assessment included standardized urodynamics, renal ultrasound, DMSA scintigraphy, and estimated glomerular filtration rate (eGFR). Complications were categorized by timing (early <30 days; intermediate 1-12 months; late >12 months) and by type (surgical or clinical). Kaplan-Meier analysis was performed for lithiasis-free survival. RESULTS: A total of 128 patients (mean age 11 years) were included; myelomeningocele and anorectal malformations were the predominant etiologies. Preoperatively, approximately 50% presented with urinary incontinence, recurrent urinary tract infections (UTIs), hydronephrosis, and elevated detrusor leak point pressure (>40 cmHO). Sigmoid colon was used in 78% of augmentations. At one year, mean maximum cystometric capacity increased by 142%, and mean end-detrusor pressure decreased to 23 cmHO. Early surgical complications occurred in 12.5% of cases. During follow-up, UTIs were the most frequent clinical event. Bladder lithiasis developed in 20%, with a cumulative incidence of 20% at 70 months, and was significantly associated with constipation, irregular bladder irrigation, wheelchair dependence, and recurrent UTIs. At five years, renal function remained stable in 70.7%, improved in 11.1%, and worsened in 18.2%, without significant overall decline. DISCUSSION: Despite functional improvements post-AC, intermediate-term postoperative morbidity remains considerable and is influenced by modifiable clinical factors. Interpretation of long-term renal and metabolic outcomes is limited by the retrospective design and heterogeneous follow-up duration. CONCLUSION: Augmentation cystoplasty provides substantial and sustained improvements in bladder dynamics in children with severe LUTD. Nevertheless, intermediate-term morbidity-particularly UTIs and bladder lithiasis-remains frequent and is strongly influenced by modifiable postoperative management factors. Structured long-term follow-up focused on adherence to catheterization and irrigation protocols is essential to optimize urinary tract preservation.
This study presents a novel endoscopic laser internal drainage technique for pediatric endophytic simple renal cysts. Tailored to anatomy using flexible ureteroscopy or needle-perc approaches, it creates a cyst-collectin...This study presents a novel endoscopic laser internal drainage technique for pediatric endophytic simple renal cysts. Tailored to anatomy using flexible ureteroscopy or needle-perc approaches, it creates a cyst-collecting system fistula via holmium laser for durable decompression. With a high success rate and minimal invasiveness, it offers a safe and effective alternative to traditional methods for problematic pediatric cysts.
INTRODUCTION: Pediatric urolithiasis is often associated with metabolic alterations and urinary malformations, leading to a higher risk of recurrence. Effective management requires minimally invasive procedures that achi...INTRODUCTION: Pediatric urolithiasis is often associated with metabolic alterations and urinary malformations, leading to a higher risk of recurrence. Effective management requires minimally invasive procedures that achieve high stone-free rate (SFR). Identifying risk factors that affect SFR is essential for selecting the most suitable surgical approach for each patient. This study aims to identify variables associated with reduced SFR in pediatric patients undergoing RIRS to support pediatric urologists' clinical decision-making. MATERIAL AND METHODS: This retrospective study included patients under 18 years of age with renal stones <20 mm treated with RIRS between August 2021 and August 2023. All patients underwent preoperative computed tomography scanning. Stone volume was calculated using the ellipsoid formula. In cases of multiple stones (≥2), diameters and volumes were calculated for each stone individually and then summed to determine the total stone burden. SFR was defined as the absence of stones >3 mm on ultrasound performed at the third postoperative month. Receiver operating characteristic (ROC) curves were generated to determine cut-off points for continuous variables to support clinical decision-making and to evaluate the predictive capacity of stone burden variables. RESULTS: A total of 62 RIRS were analyzed. The average patient age was 10 years, with 37% having multiple stones and 56.4% with stones located in the lower calyx. Mean stone diameter, volume and density were 11.2 mm, 438 mm, and 872 HU, respectively. The overall SFR was 82%. Significant predictors of reduced SFR included multiple stones (p = 0.001), lower calyx location (p = 0.017), stone density (p = 0.019), volume (p = 0.001), and diameter (p = 0.001). ROC analyses identified key cut-off values for stone burden. A stone volume ≥1000 mm and a stone diameter ≥15 mm were associated with RIRS failure, showing high specificity (98% and 92%, respectively) and markedly increased risks of residual stones (107-fold and 18-fold, respectively). Although both stone burden variables demonstrated high predictive capacity for success on ROC curves, stone volume showed a significantly higher AUC (p = 0.032). CONCLUSIONS: RIRS is a safe and effective treatment for pediatric renal stones <20 mm, achieving high success rates with a low incidence of complications. Several factors were associated with SFR, including stone number, location, density, diameter and volume. However, stone volume demonstrated the highest predictive accuracy and was the only independent predictor of surgical success in multivariable analysis. A stone volume ≤1000 mm may therefore represent a practical and clinically meaningful threshold for selecting RIRS as first-line therapy in pediatric renal lithiasis.