IP70-17 EVALUATING PATTERNS IN OPIOID PRESCRIPTION AT DISCHARGE POST OUTPATIENT PEDIATRIC UROLOGY PROCEDURES

The Journal of Urology · 2026-04-27

The PKIDS Study: Comparative Effectiveness of Surgical Interventions for Pediatric Patients With Kidney Stones

2025-06-02

Pediatric Voiding Dysfunction: Definitions and Management

Medicina · 2025-03-26

The prevalence of lower urinary tract symptoms or voiding dysfunction is significant in pediatric patients. Severe voiding dysfunction can cause serious medical issues, including impacting renal function. This review article aims to help provide an understanding of the variable presentations of voiding dysfunction and the different methods of treatment in children. The symptoms vary widely and can often be associated with constipation. Etiologies vary from behavioral/habits to anatomic to psychological or neurologic. Occasionally, imaging is used in the workup, with ultrasound being the most common. Behavior changes are often employed first in treatment before introducing pharmacotherapies or other interventions. Given the variety of presentations and severities, along with the significant number of children who present with lower urinary tract complaints, it is important for all pediatric providers to be familiar with this common diagnosis and some management options.

Ureteroscopy vs Shockwave Lithotripsy to Remove Kidney Stones in Children and Adolescents

JAMA Network Open · 2025-08-07 · 1 citations

Importance: Most children and adolescents with kidney and ureteral stones are treated with ureteroscopy, despite the uncertainty and equal weight of guideline recommendations for ureteroscopy or shockwave lithotripsy. Objective: To compare stone clearance and patient-reported outcomes among children and adolescents after ureteroscopy or shockwave lithotripsy. Design, Setting, and Participants: This nonrandomized clinical trial enrolled patients between March 16, 2020, and July 31, 2023, at 31 medical centers in the US and Canada. Patients aged 8 to 21 years with kidney stones, ureteral stones, or both were included. Follow-up was completed on October 15, 2023. Interventions: Ureteroscopy or shockwave lithotripsy. Main Outcomes and Measures: The primary outcome was stone clearance assessed by standardized ultrasonography 6 (±2) weeks after surgery. Using inverse probability weighting and random intercepts for site, stone clearance was evaluated per kidney or ureter using logistic regression and estimated stone clearance rates were generated for each procedure. Results: This study included 1142 patients (690 females [60.4%]), with a median age of 15.6 years (IQR, 12.6-17.3 years). In terms of race and ethnicity, 41 patients (3.6%) were Black, 130 (11.4%) were Hispanic, and 884 (77.4%) were White. A total of 124 urologists treated 1069 and 197 kidneys or ureters with ureteroscopy and shockwave lithotripsy (n = 953 and n = 189 patients), respectively, with a median stone size of 6.0 mm (IQR, 4.0-9.0 mm). Ureteral stents were placed at time of index surgery for 841 procedures for 767 patients (80.4%) receiving ureteroscopy and for 6 procedures for 5 patients (2.6%) receiving shockwave lithotripsy. Stone clearance occurred in 474 patients who underwent ureteroscopy (71.2% [95% CI, 63.8%-78.5%]) and in 105 patients who underwent shockwave lithotripsy (67.5% [95% CI, 61.0%-74.1%]), a difference that was not statistically significant (risk difference, 3.6% [95% CI, -6.2% to 13.5%]). Compared with shockwave lithotripsy, ureteroscopy resulted in greater pain interference (T-score difference, 5.0 [95% CI, 2.3-7.8]) and urinary symptoms (symptom score difference, 3.9 [95% CI, 1.2-6.7]) 1 week after surgery. Patients who had ureteroscopy missed more school (risk difference, 21.3% [95% CI, 9.7%-32.8%]) and caregivers missed more work (risk difference, 23.0% [95% CI, 11.0%-35.0%]) in the week after surgery. Conclusions and Relevance: In this study of 1142 children and adolescents with kidney and ureteral stones, there was no clinically meaningful difference in stone clearance with ureteroscopy vs shockwave lithotripsy. Shockwave lithotripsy was associated with better patient-reported outcomes. These findings raise questions about the preference for ureteroscopy in practice. Trial Registration: ClinicalTrials.gov Identifier: NCT04285658.

Percutaneous Nephrolithotomy vs Ureteroscopy for Kidney Stones in Children

JAMA Network Open · 2025-06-20 · 7 citations

Importance: Based on expert opinion, clinical guidelines recommend percutaneous nephrolithotomy or shockwave lithotripsy for children and adolescents with kidney stones 20 mm or larger, without mention of ureteroscopy as an alternative. Objective: To compare clinical and patient-reported outcomes for percutaneous nephrolithotomy vs ureteroscopy in children and adolescents with kidney and/or ureteral stones. Design, Setting, and Participants: This prospective cohort study was performed at 31 medical centers in the US and Canada. Participants included patients aged 8 to 21 years undergoing surgery for kidney and/or ureteral stones between March 16, 2020, and July 31, 2023. Exposures: Percutaneous nephrolithotomy vs ureteroscopy. Main Outcomes and Measures: Stone clearance assessed by ultrasonography 6 (±2) weeks postoperatively. Secondary outcomes included patient-reported outcomes 1 week after surgery. Results: The study enrolled 1039 eligible patients (median age, 15.6 [IQR, 12.5-17.3] years; 629 female [60.5%]; 40 Black [3.8%]; 128 Hispanic [12.3%]; and 792 White [76.2%]). One hundred twenty-six urologists performed percutaneous nephrolithotomy for 98 kidneys and/or ureters and ureteroscopy for 1069, including 36 undergoing percutaneous nephrolithotomy and 43 undergoing ureteroscopy for stones larger than 15 mm. Stone clearance was 67.2% (95% CI, 46.0%-88.4%) for percutaneous nephrolithotomy and 73.4% (95% CI, 69.4%-77.4%) for ureteroscopy, a difference that was not statistically significant (risk difference, -6.2%; 95% CI, -27.7% to 15.4%). For stones larger than 15 mm, stone clearance was 94.0% (95% CI, 83.3%-100%) for percutaneous nephrolithotomy and 55.0% (95% CI, 32.9%-77.1%) for ureteroscopy, a statistically significant difference (risk difference, 39.0%; 95% CI, 14.4%-63.5%). Compared with ureteroscopy, percutaneous nephrolithotomy had significantly lower pain intensity (T score difference, -5.42; 95% CI, -10.38 to -0.46), pain interference (T score difference, -5.88; 95% CI, -11.02 to -0.75), anxiety (T score difference, -5.74; 95% CI, -9.26 to -2.22), psychological stress experiences (T score difference, -7.90; 95% CI, -13.13 to -2.67), sleep disturbance (T score difference, -5.57; 95% CI, -8.56 to -2.58), and urinary symptoms (symptom score difference, -6.37; 95% CI, -11.71 to -1.03) 1 week after surgery. Conclusions and Relevance: Compared with ureteroscopy, percutaneous nephrolithotomy had similar stone clearance and better lived experiences for children and adolescents and was associated with greater stone clearance of kidney stones larger than 15 mm. A future adequately powered prospective clinical trial is needed to reaffirm these results.

V05-04 SUPINE TUBELESS MINI-PCNL IN A PEDIATRIC PATIENT

The Journal of Urology · 2024-04-15

You have accessJournal of UrologyPediatrics (V05)1 May 2024V05-04 SUPINE TUBELESS MINI-PCNL IN A PEDIATRIC PATIENT Jordan M. Smith, Rani Ashouri, Marc Abboud, Cynthia Sharidan, Romano DeMarco, Christopher E. Bayne, and John M. DiBianco Jordan M. SmithJordan M. Smith , Rani AshouriRani Ashouri , Marc AbboudMarc Abboud , Cynthia SharidanCynthia Sharidan , Romano DeMarcoRomano DeMarco , Christopher E. BayneChristopher E. Bayne , and John M. DiBiancoJohn M. DiBianco View All Author Informationhttps://doi.org/10.1097/01.JU.0001009516.84627.21.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We describe a novel technique for treatment of pediatric nephrolithiasis. METHODS: We present a case of a 12 year old female with cystinuria who was found on surveillance imaging to have a left lower pole stone burden of 1.7 centimeters. After discussion of management options with the patient and parents, they elected to proceed with miniaturized PCNL. She was pre-stented. For our equipment, we typically utilize the Storz MIPS set with the 16 french outer sheath. For lithotripsy, we typically utilize the High Powered Holmium Laser with pulse modulation due to increased efficiency. Patients are typically positioned in the modified supine split leg, or Valdivia, position. Access is accomplished as previously described by Giusti et al with retrograde pyelogram performed to delineate the anatomy and the relationship of the calyces' to the stone for puncture site and trajectory. Once access is obtained, we proceed with antegrade and retrograde pyeloscopy and lithotripsy for complete stone removal. RESULTS: Operating room time was 2 hours and 26 minutes with a total fluoroscopic radiation usage of 0.56 gray. Estimated blood loss was minimal. She was observed overnight with an indwelling foley, which was removed the following day. She was discharged on post operative day 1 to follow up in 2 weeks with stent removal. Postoperative imaging is typically accomplished with ultrasound given our concern for radiation. There was no evidence of obstruction or significant stone burden. CONCLUSIONS: Mini PCNL techniques have been shown to have lower postoperative pain, higher tubeless rates, and lower complications with similar stone free rate in adults. These advantages are also attractive in the pediatric population, especially in children with genetic pre-dispositions for stone formation who might require multiple lithotripsy procedures throughout their lifetime. In this technique video, we demonstrate a safe, effective approach to large stone volume lithotripsy in a pediatric patient with cystinuria. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e269 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Jordan M. Smith More articles by this author Rani Ashouri More articles by this author Marc Abboud More articles by this author Cynthia Sharidan More articles by this author Romano DeMarco More articles by this author Christopher E. Bayne More articles by this author John M. DiBianco More articles by this author Expand All Advertisement PDF downloadLoading ...

(088) TRENDS IN VARICOCELE SURVEILLANCE AND SURGICAL INTERVENTION IN CHILDREN AND ADOLESCENTS

The Journal of Sexual Medicine · 2024-08-12

Abstract Introduction Varicocelectomy is often recommended in the setting of abnormal semen analyses, testicular atrophy, or associated testicular discomfort. Managing varicoceles in the adolescent populations is less clear because of the unknown impact on fertility. Expert consensus recommends adolescent patients diagnosed with varicocele undergo further evaluation to assess testicular growth. Varicocele surveillance trends including prevalence, length of follow-up, and indications for intervention are underreported. We report our experience with varicocele surveillance and the triggers for surgical intervention in the pediatric population at our institution. Objective We aim to characterize the selection of adolescent patients with varicocele participating in surveillance and the triggers for proceeding to varicocelectomy. Methods A single institutional retrospective review of electronic medical records from a tertiary referral center was performed. We evaluated pediatric patients ≤18 years old diagnosed with varicocele from 5/1/1993 to 5/31/2023. Varicocele diagnosis was identified using ICD 9 and 10 codes. Surveillance was defined as having at least one additional encounter for varicocele evaluation following the initial diagnosis. Testicular volumes were obtained by scrotal ultrasound and clinical assessment. Results 96% of patients (380 of 395) had no varicocelectomy. 209 (53%) patients participated in surveillance. 9 of these patients eventually had a varicocelectomy. Indications for surgery in patients being surveilled included testicular pain (n = 4), testicular volume difference (n = 3 with a median testicular volume difference of 2.7 mL), and 2 patients with no reported indication. 186 (47%) patients had no surveillance period, 6 of which had a varicocelectomy. Indications for surgery in these patients included testicular pain (n = 2), testicular volume difference (n = 3 with a median testicular volume difference of 2.4 mL), and bilateral testicular hypotrophy (n = 1) with a total testicular volume of 10 mL. The median age at diagnosis was 15.05 years in the surveillance group and 15.5 years in the non-surveillance group. Conclusions Following diagnosis, only half of children and adolescent patients participated in surveillance of their varicocele. Rates of boys proceeding to varicocelectomy were very low and did not differ between patients seen at the primary visit and those who were followed for their varicocele. Our findings highlight the importance of maximizing patient counseling about varicoceles at diagnosis. Surveillance of young males with varicoceles requires patient, guardian, and provider education to counsel patients who may not otherwise undergo evaluation until infertility is encountered. Disclosure No.

Single-Port (SP) Robotic Nephroureterectomy in a Pediatric Patient

JU Open Plus · 2023-01-01 · 5 citations

The da Vinci SP (single port) robotic surgical platform has expanded surgical options for single-incision, minimally invasive surgery in the pediatric population. Challenges to SP use include mastering an expected learning curve, less fine instrument movement compared with multiport da Vinci surgery, and ensuring optimal camera length from target anatomy. If these challenges can be overcome, single-port robotic surgery offers the advantage of a single incision for minimally invasive pediatric surgery, both extirpative and reconstructive. We present our experience with an SP robotic nephroureterectomy in a 9-year-old patient.

Early Experience With Pediatric Single-port Robotic Pyeloplasty Compared to Multiport Robotic Cohorts

The Journal of Urology · 2023-05-17 · 18 citations

No AccessJournal of UrologyJU Forum1 Aug 2023Early Experience With Pediatric Single-port Robotic Pyeloplasty Compared to Multiport Robotic Cohortsis corrected byEarly Experience With Pediatric Single-port Robotic Pyeloplasty Compared to Multiport Robotic Cohorts Jordan M. Smith, Alexandra D. Hernandez, Romano T. DeMarco, and Christopher E. Bayne Jordan M. SmithJordan M. Smith Department of Urology, University of Florida College of Medicine, Gainesville, Florida , Alexandra D. HernandezAlexandra D. Hernandez Department of Urology, University of Florida College of Medicine, Gainesville, Florida , Romano T. DeMarcoRomano T. DeMarco Department of Urology, University of Florida College of Medicine, Gainesville, Florida , and Christopher E. BayneChristopher E. Bayne *Correspondence: Department of Urology, University of Florida College of Medicine, PO Box 100247, Gainesville, FL 32610 telephone: 352-273-6815; E-mail Address: [email protected] Department of Urology, University of Florida College of Medicine, Gainesville, Florida View All Author Informationhttps://doi.org/10.1097/JU.0000000000003551AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail REFERENCES 1. . Single port robotic surgery in urology. Curr Urol Rep. 2021; 22(4):22. Crossref, Medline, Google Scholar 2. . Single-port robotic pyeloplasty in a pediatric patient. Videourology. 2021; 10.1089/vid.2020.0112. Crossref, Google Scholar 3. . Single-port robotic Mitrofanoff in a pediatric patient. J Pediatr Urol. 2021; 17(3):424-425. Crossref, Medline, Google Scholar 4. . Comparison of intraoperative and short-term postoperative outcomes between robot-assisted laparoscopic multi-port pyeloplasty using the da Vinci Si system and single-port pyeloplasty using the da Vinci SP system in children. Investig Clin Urol. 2021; 62(5):592-599. Crossref, Medline, Google Scholar 5. . Hidden incision endoscopic surgery: description of technique, parental satisfaction and applications. J Urol. 2011; 185(4):1425-1431. Link, Google Scholar 6. . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-213. Crossref, Medline, Google Scholar 7. . Early diuresis renogram findings predict success following pyeloplasty. J Urol. 2001; 165(6 Pt 2):2311-2315. Link, Google Scholar 8. Single-port versus multi-port robotic-assisted procedures from the patient's perspective: a retrospective cohort study. Urol Pract. 2022; 9(6):574-579. Google Scholar 9. . Single-port robot-assisted laparoscopic pyeloplasty in a pediatric cohort using a mini-Pfannenstiel incision. Abstract presented at The Societies for Pediatric Urology Fall Congress; October 20-23, 2022; Las Vegas, Nevada. Google Scholar 10. . Single-port (SP) robotic nephroureterectomy in a pediatric patient. JU Open Plus. 2023; 1(1):e00005. Crossref, Google Scholar Support: None. Conflict of Interest: The Authors have no conflicts of interest to disclose. Ethics Statement: This study received Institutional Review Board approval (IRB No. IRB202201351). Author Contributions: Conceptualization: JMS, RTD, CEB; Data curation: JMS, ADH, CEB; Analysis: JMS, CEB; Writing—original draft: JMS, CEB; Writing—review and editing: all authors © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byBayne C and Smith J (2023) Early Experience With Pediatric Single-port Robotic Pyeloplasty Compared to Multiport Robotic Cohorts. Reply.Journal of Urology, VOL. 210, NO. 5, (733-733), Online publication date: 1-Nov-2023.Nikolinakos P, Sapountzis D, Donkov I, Bishara S, Charitopoulos K, Ellis D, Ali M, Velaoras K, Alexandrou I, Zavras N and Norris J (2023) Early Experience With Pediatric Single-port Robotic Pyeloplasty Compared to Multiport Robotic Cohorts. Letter.Journal of Urology, VOL. 210, NO. 5, (732-733), Online publication date: 1-Nov-2023.Related articlesJournal of Urology9 Aug 2023Early Experience With Pediatric Single-port Robotic Pyeloplasty Compared to Multiport Robotic Cohorts Volume 210Issue 2August 2023Page: 236-238 Peer Review Reports Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.Keywordschildadolescentkidney pelvisureteral obstructionrobotic surgical proceduresMetrics Author Information Jordan M. Smith Department of Urology, University of Florida College of Medicine, Gainesville, Florida More articles by this author Alexandra D. Hernandez Department of Urology, University of Florida College of Medicine, Gainesville, Florida More articles by this author Romano T. DeMarco Department of Urology, University of Florida College of Medicine, Gainesville, Florida More articles by this author Christopher E. Bayne Department of Urology, University of Florida College of Medicine, Gainesville, Florida *Correspondence: Department of Urology, University of Florida College of Medicine, PO Box 100247, Gainesville, FL 32610 telephone: 352-273-6815; E-mail Address: [email protected] More articles by this author Expand All Support: None. Conflict of Interest: The Authors have no conflicts of interest to disclose. Ethics Statement: This study received Institutional Review Board approval (IRB No. IRB202201351). Author Contributions: Conceptualization: JMS, RTD, CEB; Data curation: JMS, ADH, CEB; Analysis: JMS, CEB; Writing—original draft: JMS, CEB; Writing—review and editing: all authors Advertisement PDF downloadLoading ...

MP70-10 PEDIATRIC SINGLE PORT ROBOTIC PYELOPLASTY COMPARED TO OPEN AND MULTIPORT COHORTS

The Journal of Urology · 2023-03-23

You have accessJournal of UrologyCME1 Apr 2023MP70-10 PEDIATRIC SINGLE PORT ROBOTIC PYELOPLASTY COMPARED TO OPEN AND MULTIPORT COHORTS Jordan Smith, Alexandra Hernandez, Brian Wiseman, Christopher Bayne, and Romano Demarco Jordan SmithJordan Smith More articles by this author , Alexandra HernandezAlexandra Hernandez More articles by this author , Brian WisemanBrian Wiseman More articles by this author , Christopher BayneChristopher Bayne More articles by this author , and Romano DemarcoRomano Demarco More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Da Vinci SP® (single port) surgical system has been used widely in adult urology with comparable peri-operative outcomes compared to multi-port (MP) robotic surgery. However, reports in pediatric urology are limited. We sought to compare operative outcomes in a single pediatric urologist’s open, MP, and SP pyeloplasty experience. METHODS: A retrospective review was performed of all pyeloplasties by a single pediatric urologist in patients <18 y at a tertiary academic center from January 2021 to July 2022. Cases were categorized by approach: open, multiport (MP), or single port (SP). The primary outcomes were entire operative time (OT; defined as cystoscopy to incision close), length of hospital stay (LOS), inpatient opioid use, and post-operative complications (≤30 days). Surgical success (defined as improved nuclear renography drainage or improved renal collecting system dilatation on ultrasonography with resolution of pain) was evaluated as a secondary outcome. RESULTS: During the study period, 6 open, 5 MP, and 11 SP cases were performed. Open cases were performed via flank incision. MP cases were performed via mix of midline port placement and hidden incision endoscopic surgery (HIdES) approach with 3 or 4 trocars. Technique for SP cases evolved during the period. The SP cohort included older children (median 16 y) and larger children (60.1 kg) than open (2.3 mo; 5.7 kg) and MP (4 mo; 6.6 kg) cases. There was no difference in LOS, opioid use, or complications between groups. SP cases were notably longer (median 390 min [376–480 min]) than both open (240 min [240–360 min]) and MP (300 min [200–258 min]) cases. OT for SP cases improved over the last 5 cases (median 388 min) versus the initial 6 (median 405 min). All cases have continued to show a successful repair at a minimum 3 months. Due to sample size, inferential statistics were not able to be performed. CONCLUSIONS: In this single-surgeon experience during early adoption of the SP robot in pediatric urology, SP pyeloplasty cases took substantially longer. This may represent the early learning curve of developing a novel technique. There was no noted difference in other outcomes or complications. Multicenter collaboration of open, MP, and SP data would help account for individual surgeon differences and generate robust samples sizes for inferential statistical analysis. Knowledge of patient-centered opinions regarding the SP incision is warranted to justify SP pyeloplasty over current MP techniques. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1007 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jordan Smith More articles by this author Alexandra Hernandez More articles by this author Brian Wiseman More articles by this author Christopher Bayne More articles by this author Romano Demarco More articles by this author Expand All Advertisement PDF downloadLoading ...