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Routh, Jonathan Charles

Positions:

Associate Professor of Surgery

Surgery, Urology
School of Medicine

Associate Professor in Pediatrics

Pediatrics
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2002

M.D. — University of North Carolina at Chapel Hill School of Medicine

Intern, General Surgery

Mayo School of Health Sciences

Resident, Urology

Mayo School of Health Sciences

Fellow, Pediatric Health Services Research

Harvard Medical School

Fellow, Pediatric Urology

Children's Hospital Boston

News:

Duke opens center for transgender adolescents

September 22, 2015 — The News & Observer

Grants:

Comp C -Urologic Management to Preserve Renal Function Protocol - Duke Project

Administered By
Surgery, Urology
AwardedBy
Centers for Disease Control and Prevention
Role
Co Investigator
Start Date
September 09, 2014
End Date
August 31, 2019

Comparative Effectiveness of Vesicoureteral Reflux Treatments in Children

Administered By
Surgery, Urology
AwardedBy
National Institutes of Health
Role
Principal Investigator
Start Date
August 01, 2014
End Date
May 31, 2019

Publications:

Renal medullary carcinoma: A national analysis of 159 patients.

Renal medullary carcinoma (RMC) is an aggressive malignancy seen predominantly in young males with sickle cell trait. RMC is poorly understood, with fewer than 220 cases described in the medical literature to date. We used a large national registry to define the typical presentation, treatments, and outcomes of this rare tumor.The National Cancer Database was queried for patients under 40 years of age diagnosed with RMC from 1998 to 2011. An analysis of patient and tumor characteristics, treatment details, and overall survival (OS) was undertaken, and factors associated with mortality were identified using multivariable regression analysis.In total, 159 patients with RMC were identified, of whom a majority were male (71%), African American (87%), and had metastatic disease (71%). Median tumor size was 6 cm and median survival was 7.7 months. Most patients underwent surgery (60%) and chemotherapy (65%). Few patients received radiation (12%). Patients with metastatic disease had a significantly worse median survival (4.7 vs. 17.8 months, P < 0.001) and were less likely to receive surgery (42% vs. 91%, P < 0.001). Age and tumor size did not appear to impact OS.In the largest cohort to date of patients with RMC, we found a dismal median survival of less than 8 months. Age and tumor size were not associated with OS. Metastatic disease at presentation was the main negative prognostic indicator in RMC and was present in a majority of patients at the time of diagnosis.

Authors
Ezekian, B; Englum, B; Gilmore, BF; Nag, UP; Kim, J; Leraas, HJ; Routh, JC; Rice, HE; Tracy, ET
MLA Citation
Ezekian, B, Englum, B, Gilmore, BF, Nag, UP, Kim, J, Leraas, HJ, Routh, JC, Rice, HE, and Tracy, ET. "Renal medullary carcinoma: A national analysis of 159 patients." Pediatric blood & cancer 64.11 (November 2017).
PMID
28485059
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
64
Issue
11
Publish Date
2017
DOI
10.1002/pbc.26609

Epidemiologic Analysis of Elective Operative Procedures in Infants Less Than 6 Months of Age in the United States.

This study uses publicly available data to analyze the total number of elective, potentially deferrable operative procedures involving infants <6 months of age in the United States. We investigated the factors associated with the performance of these procedures in this population.The State Ambulatory Surgery Database was used to identify patients in California, North Carolina, New York, and Utah during the years of 2007-2010 who were younger than 6 months of age at the time that they underwent outpatient (ambulatory) surgery. Operations that could reasonably be postponed until 6 months of age were classified as potentially deferrable procedures. Hernia repairs were analyzed separately from other deferrable procedures. Primary outcomes included the total number of elective procedures and the number and rates of potentially deferrable procedures per state per year in this population.Over the study period, a total of 27,540 procedures were identified as meeting inclusion criteria; of those, 7832 (28%) were classified as potentially deferrable, 4315 of which were hernia repairs. The average rates of potentially deferrable nonhernia procedures in California, North Carolina, New York, and Utah were 8.3, 43.8, 30.0, and 11.7 per 10,000 person-years, respectively. In multivariable analysis, private insurance (odds ratio [OR] = 1.36), self-pay status (OR = 1.50), and treatment in a different state (OR = 0.48-3.16) were independent predictors of a potentially deferrable procedure being performed on an infant younger than 6 months.Potentially deferrable procedures are still performed in infants <6 months of age. There appears to be significant variation in timing of these procedures among states. Insurance status and geography may be independent predictors of a procedure being potentially deferrable.

Authors
Einhorn, LM; Young, BJ; Routh, JC; Allori, AC; Tracy, ET; Greene, NH
MLA Citation
Einhorn, LM, Young, BJ, Routh, JC, Allori, AC, Tracy, ET, and Greene, NH. "Epidemiologic Analysis of Elective Operative Procedures in Infants Less Than 6 Months of Age in the United States." Anesthesia and analgesia 125.5 (November 2017): 1588-1596.
PMID
28632539
Source
epmc
Published In
Anesthesia and Analgesia
Volume
125
Issue
5
Publish Date
2017
Start Page
1588
End Page
1596
DOI
10.1213/ane.0000000000002185

Readmissions, unplanned emergency room visits, and surgical retreatment rates after anti-reflux procedures.

The choice between endoscopic injection (EI) and ureteroneocystotomy (UNC) for surgical correction of vesicoureteral reflux (VUR) is controversial.To compare postoperative outcomes of EI vs UNC.This study reviewed linked inpatient (SID), ambulatory surgery (SASD), and emergency department (SEDD) data from five states in the United States (2007-10) to identify pediatric patients with primary VUR undergoing EI or UNC as an initial surgical intervention. Unplanned readmissions, additional procedures, and emergency room (ER) visits were extracted. Statistical analysis was performed using multivariate logistic regression using generalized estimating equation (GEE) to adjust for hospital-level clustering.The study identified 2556 UNC and 1997 EI procedures. Compared with patients undergoing EI, those who underwent UNC were more likely to be younger (4.6 vs 6.0 years, P < 0.001), male (30 vs 20%, P < 0.001), and publicly insured (34 vs 29%, P < 0.001). As shown in Summary Figure, compared with EI, UNC patients had lower rates of additional anti-reflux procedures within 12 months (25 (1.0) vs 121 (6.1%), P < 0.001), but a higher rate of 30-day and 90-day readmissions and ER visits. On multivariate analysis, patients treated by UNC remained at higher odds of being readmitted (OR = 4.45; 2.69 in 30 days; 90 days, P < 0.001) and to have postoperative ER visits (OR = 3.33; 2.26 in 30 days; 90 days, P < 0.001); however, EI had significantly higher odds of repeat anti-reflux procedures in the subsequent year (OR = 7.12, P < 0.001).Endoscopic injection constituted nearly half of initial anti-reflux procedures in children. However, patients treated with UNC had significantly lower odds of requiring re-treatment in the first year relative to those treated with EI. By contrast, patients treated with UNC had more than twice the odds of being readmitted or visiting an ER postoperatively. Although the available data were amongst the largest and most well validated, the major limitation was the retrospective nature of the administrative database. The practice setting may not be generalizable to states not included in the analysis.Postoperative readmissions and ER visits were uncommon after any surgical intervention for VUR, but were more common among children undergoing UNC. The EI patients had a more than seven-fold increased risk of surgical re-treatment within 1 year.

Authors
Wang, H-HS; Tejwani, R; Wolf, S; Wiener, JS; Routh, JC
MLA Citation
Wang, H-HS, Tejwani, R, Wolf, S, Wiener, JS, and Routh, JC. "Readmissions, unplanned emergency room visits, and surgical retreatment rates after anti-reflux procedures." Journal of pediatric urology 13.5 (October 2017): 507.e1-507.e7.
PMID
28434635
Source
epmc
Published In
Journal of Pediatric Urology
Volume
13
Issue
5
Publish Date
2017
Start Page
507.e1
End Page
507.e7
DOI
10.1016/j.jpurol.2017.03.016

Editorial Comment.

Authors
Moul, JW
MLA Citation
Moul, JW. "Editorial Comment." The Journal of urology (September 2017).
PMID
28867072
Source
epmc
Published In
The Journal of Urology
Publish Date
2017
DOI
10.1016/j.juro.2017.07.090

The Public Health Burden of Lymphatic Malformations in Children: National Estimates in the United States, 2000-2009.

Describe inpatient resource utilization trends in children with lymphatic malformations using a national database.Kids' inpatient database, years 2000-2009.Subjects included children 18 years and under with International Classification of Diseases (ICD), 9th revision code: 228.1-lymphangioma, any site. Data elements were extracted and used to calculate related inpatient costs and trended over time.No significant increase in admission rates was noted over time, p = 0.5128. Average total charges per admission were $30,995. There is a clear and increasing trend of total charges per admission; even when adjusted for inflation, this has increased disproportionately. In 2009, the mortality rate increased to 2.58%, which was significantly higher than in previous years, p = 0.0346. In multivariate analysis for mortality, the only factor that was noted to be significant was between survey years 2000 and 2009. The odds ratio (OR) for mortality was 2.97, 95% CI: [1.423-6.202], which indicated that there was an almost three times higher likelihood of mortality in 2009 than in 2000.Admission rates appear to remain stable for pediatric inpatients with lymphatic malformations but resource utilization related to charges has been increasing from 2000 to 2009. Controlling for inflation does not explain our observed trend in total charge increases. Previously, surgical resection was the most commonly performed procedure, and now the trend has shifted away from operative intervention. Mortality rates, while low, experienced a rise in 2009. Further investigation may be warranted.

Authors
Cheng, J; Liu, B; Farjat, AE; Routh, J
MLA Citation
Cheng, J, Liu, B, Farjat, AE, and Routh, J. "The Public Health Burden of Lymphatic Malformations in Children: National Estimates in the United States, 2000-2009." Lymphatic research and biology 15.3 (September 2017): 241-245.
PMID
28759318
Source
epmc
Published In
Lymphatic Research and Biology
Volume
15
Issue
3
Publish Date
2017
Start Page
241
End Page
245
DOI
10.1089/lrb.2017.0009

Yellow-Orange Penile Papules.

Authors
Masoud, M; Routh, JC; Bellet, JS
MLA Citation
Masoud, M, Routh, JC, and Bellet, JS. "Yellow-Orange Penile Papules." Pediatric dermatology 34.5 (September 2017): 603-604.
PMID
28884899
Source
epmc
Published In
Pediatric Dermatology
Volume
34
Issue
5
Publish Date
2017
Start Page
603
End Page
604
DOI
10.1111/pde.13186

Bladder Reconstruction Rates Differ among Centers Participating in National Spina Bifida Patient Registry.

We performed an exploratory analysis of data from the NSBPR (National Spina Bifida Patient Registry) to assess variation in the frequency of bladder reconstruction surgeries among NSBPR centers.We queried the 2009-2014 NSBPR to identify patients who had ever undergone bladder reconstruction surgeries. We evaluated demographic characteristics, spina bifida type, functional level, mobility and NSBPR center to determine whether any of these factors were associated with reconstructive surgery rates. Multivariable logistic regression was used to simultaneously adjust for the impact of these factors.We identified 5,528 patients with spina bifida enrolled in the NSBPR. Of these patients 1,129 (20.4%) underwent bladder reconstruction (703 augmentation, 382 continent catheterizable channel, 189 bladder outlet procedure). Surgical patients were more likely older, female, nonHispanic white, with a higher lesion level, myelomeningocele diagnosis, nonambulators (all p <0.001) and nonprivately insured (p=0.018). Bladder reconstruction surgery rates varied among NSBPR centers (range 12.1% to 37.9%, p <0.001). After correcting for known confounders NSBPR center, spina bifida type, mobility, gender and age (all p <0.001) were significant predictors of surgical intervention. Race (p=0.19) and insurance status (p=0.11) were not associated with surgical intervention.There is significant variation in rates of bladder reconstruction surgery among NSBPR centers. In addition to clinical factors such as mobility status, lesion type and lesion level, nonclinical factors such as patient age, gender and treating center are also associated with the likelihood of an individual undergoing bladder reconstruction.

Authors
Routh, JC; Joseph, DB; Liu, T; Schechter, MS; Thibadeau, JK; Wallis, MC; Ward, EA; Wiener, JS
MLA Citation
Routh, JC, Joseph, DB, Liu, T, Schechter, MS, Thibadeau, JK, Wallis, MC, Ward, EA, and Wiener, JS. "Bladder Reconstruction Rates Differ among Centers Participating in National Spina Bifida Patient Registry." The Journal of urology (August 19, 2017).
PMID
28830753
Source
epmc
Published In
The Journal of Urology
Publish Date
2017
DOI
10.1016/j.juro.2017.08.084

Comparing oncologic outcomes after minimally invasive and open surgery for pediatric neuroblastoma and Wilms tumor.

Minimally invasive surgery (MIS) has been widely adopted for common operations in pediatric surgery; however, its role in childhood tumors is limited by concerns about oncologic outcomes. We compared open and MIS approaches for pediatric neuroblastoma and Wilms tumor (WT) using a national database.The National Cancer Data Base from 2010 to 2012 was queried for cases of neuroblastoma and WT in children ≤21 years old. Children were classified as receiving open or MIS surgery for definitive resection, with clinical outcomes compared using a propensity matching methodology (two open:one MIS).For children with neuroblastoma, 17% (98 of 579) underwent MIS, while only 5% of children with WT (35 of 695) had an MIS approach for tumor resection. After propensity matching, there was no difference between open and MIS surgery for either tumor for 30-day mortality, readmissions, surgical margin status, and 1- and 3-year survival. However, in both tumors, open surgery more often evaluated lymph nodes and had larger lymph node harvest.Our retrospective review suggests that the use of MIS appears to be a safe method of oncologic resection for select children with neuroblastoma and WT. Further research should clarify which children are the optimal candidates for this approach.

Authors
Ezekian, B; Englum, BR; Gulack, BC; Rialon, KL; Kim, J; Talbot, LJ; Adibe, OO; Routh, JC; Tracy, ET; Rice, HE
MLA Citation
Ezekian, B, Englum, BR, Gulack, BC, Rialon, KL, Kim, J, Talbot, LJ, Adibe, OO, Routh, JC, Tracy, ET, and Rice, HE. "Comparing oncologic outcomes after minimally invasive and open surgery for pediatric neuroblastoma and Wilms tumor." Pediatric blood & cancer (August 9, 2017).
PMID
28792662
Source
epmc
Published In
Pediatric Blood & Cancer
Publish Date
2017
DOI
10.1002/pbc.26755

The association between caudal anesthesia and increased risk of postoperative surgical complications in boys undergoing hypospadias repair.

Recent reports have suggested that caudal anesthesia may be associated with an increased risk of postoperative surgical complications. We examined our experience with caudal anesthesia in hypospadias repair to evaluate for increased risk of urethrocutaneous fistula or glanular dehiscence.All hypospadias repairs performed by a single surgeon in 2001-2014 were reviewed. Staged or revision surgeries were excluded. Patient age, weight, hypospadias severity, surgery duration, month and year of surgery, caudal anesthesia use, and postoperative complications were recorded. Bivariate and multivariate statistical analyses were performed.We identified 395 single-stage primary hypospadias repairs. Mean age was 15.6 months; 326 patients had distal (83%) and 69 had proximal (17%) hypospadias. Caudal anesthetics were used in 230 (58%) cases; 165 patients (42%) underwent local penile block at the discretion of the surgeon and/or anesthesiologist. Complications of urethrocutaneous fistula or glanular deshiscence occurred in 22 patients (5.6%) and were associated with caudal anesthetic use (OR 16.5, 95% CI 2.2-123.8, P = 0.007), proximal hypospadias (OR 8.2, 95% CI 3.3-20.0, P < 0.001), increased surgical duration (OR 1.01, 95% CI 1.01-1.02, P < 0.001), and earlier year of practice (OR 3.0, 95% CI 1.2-7.9, P = 0.03 for trend). After adjusting for confounding variables via multivariable logistic regression, both caudal anesthetic use (OR 13.4, 95% CI 1.8-101.8, P = 0.01) and proximal hypospadias (OR 6.8, 95% CI 2.7-16.9, P < 0.001) remained highly associated with postoperative complications.In our experience, caudal anesthesia was associated with an over 13-fold increase in the odds of developing postoperative surgical complications in boys undergoing hypospadias repair even after adjusting for urethral meatus location. Until further investigation occurs, clinicians should carefully consider the use of caudal anesthesia for children undergoing hypospadias repair.

Authors
Taicher, BM; Routh, JC; Eck, JB; Ross, SS; Wiener, JS; Ross, AK
MLA Citation
Taicher, BM, Routh, JC, Eck, JB, Ross, SS, Wiener, JS, and Ross, AK. "The association between caudal anesthesia and increased risk of postoperative surgical complications in boys undergoing hypospadias repair." Paediatric anaesthesia 27.7 (July 2017): 688-694.
PMID
28345802
Source
epmc
Published In
Pediatric Anesthesia
Volume
27
Issue
7
Publish Date
2017
Start Page
688
End Page
694
DOI
10.1111/pan.13119

Urinary Anomalies in 22q11.2 Deletion (DiGeorge syndrome): From Copy Number Variations to Single-Gene Determinants of Phenotype.

Authors
Hall, G; Routh, JC; Gbadegesin, RA
MLA Citation
Hall, G, Routh, JC, and Gbadegesin, RA. "Urinary Anomalies in 22q11.2 Deletion (DiGeorge syndrome): From Copy Number Variations to Single-Gene Determinants of Phenotype." American journal of kidney diseases : the official journal of the National Kidney Foundation 70.1 (July 2017): 8-10.
PMID
28456345
Source
epmc
Published In
American Journal of Kidney Diseases
Volume
70
Issue
1
Publish Date
2017
Start Page
8
End Page
10
DOI
10.1053/j.ajkd.2017.03.017

Contemporary Demographic, Treatment, and Geographic Distribution Patterns for Disorders of Sex Development.

This study aimed to describe the demographic characteristics, hospital utilizations, patterns of inpatient surgical management, and the overall state/regional variation in surgery rate among patients with disorders of sex development (DSD). We analyzed the Nationwide Inpatient Sample from 2001 to 2012 for patients younger than 21 years. DSD-related diagnoses and procedures were identified via International Classification of Diseases, Ninth Revision (ICD-9) codes. We identified a total of 43,968 DSD-related admissions. Of these, 73.4% of the admissions were designated as female and 642 (1.9%) were inpatient surgical admissions. Among neonates, less than 1% underwent any type of genital surgery. Nonsurgical admissions were associated with longer length of stay and higher cost. There was no significant regional variation in the rate of DSD surgeries, but we observed higher concentrations of DSD surgeries in states associated with tertiary referral centers.

Authors
Tejwani, R; Jiang, R; Wolf, S; Adkins, DW; Young, BJ; Alkazemi, M; Wiener, JS; Pomann, G-M; Purves, JT; Routh, JC
MLA Citation
Tejwani, R, Jiang, R, Wolf, S, Adkins, DW, Young, BJ, Alkazemi, M, Wiener, JS, Pomann, G-M, Purves, JT, and Routh, JC. "Contemporary Demographic, Treatment, and Geographic Distribution Patterns for Disorders of Sex Development." Clinical pediatrics (July 2017): 9922817722013-.
PMID
28758411
Source
epmc
Published In
Clinical Pediatrics
Publish Date
2017
Start Page
9922817722013
DOI
10.1177/0009922817722013

Open versus minimally invasive surgical approaches in pediatric urology: Trends in utilization and complications.

Minimally invasive surgery (MIS) techniques are anecdotally reported to be increasingly used, but little objective data supports this. Our objective was to assess trends in MIS utilization across various procedures in pediatric urology and to compare postoperative complication rates between MIS and open procedures.We analyzed the 1998-2012 Nationwide Inpatient Sample. We identified children (<18 years old) undergoing open and MIS inpatient procedures and any in-hospital post-operative complications that occurred during that postoperative hospitalization. We utilized propensity score matching and multivariable logistic regression to adjust for confounding factors.We identified 163,838 weighted encounters in the "overall cohort," 70,273 of which were at centers performing more than five MIS procedures over the years studied. Use of MIS techniques increased significantly over time for several procedures, most prominently for nephrectomy (Fig.). The overall rate of complications was lower in patients undergoing MIS compared with open surgery (6% vs. 11%, p < 0.001). Specialized centers had a significantly lower overall rate of complications than unspecialized centers (9% vs. 12%, p < 0.001). Within specialized centers, MIS had lower complication rates than open procedures (7% vs. 9%, p < 0.001); this finding was consistent even after adjusting for other factors (OR 0.71, p = 0.02).Limitations include that these data may not be generalizable to encounters not in the sample pool. As a large, retrospective, administrative database, NIS may be affected by miscoding bias - rendering our analysis sensitive to the accuracy of procedure coding in NIS. Although the accuracy level of NIS is high for an administrative database, it is possible at least some portion of our cohort may be incorrectly coded. Further, the NSQIP complications we identified may represent associated comorbidities and not true postoperative complications, as NIS does not provide temporal relationships between different diagnosis codes. Despite these limitations, we note that the NIS database is rigorously monitored and audited for coding accuracy and, therefore, represents a reasonably reliable panorama of the characteristics of an inpatient surgical cohort. However, it is important to note that the choice of operative modality is, undoubtedly, multifactorial and patient/setting-specific.There is increasing use of MIS for pediatric urology procedures, although utilization rates vary among procedures. MIS was associated with a lower postoperative complication rate than for open procedures. Higher-volume MIS centers have a lower complication rate than lower-volume centers.

Authors
Tejwani, R; Young, BJ; Wang, H-HS; Wolf, S; Purves, JT; Wiener, JS; Routh, JC
MLA Citation
Tejwani, R, Young, BJ, Wang, H-HS, Wolf, S, Purves, JT, Wiener, JS, and Routh, JC. "Open versus minimally invasive surgical approaches in pediatric urology: Trends in utilization and complications." Journal of pediatric urology 13.3 (June 2017): 283.e1-283.e9.
PMID
28344019
Source
epmc
Published In
Journal of Pediatric Urology
Volume
13
Issue
3
Publish Date
2017
Start Page
283.e1
End Page
283.e9
DOI
10.1016/j.jpurol.2017.01.013

A Pediatric Urology Wish List for Spina Bifida Research.

Authors
Routh, JC
MLA Citation
Routh, JC. "A Pediatric Urology Wish List for Spina Bifida Research." The Journal of urology 197.6 (June 2017): 1377-1378.
PMID
28325669
Source
epmc
Published In
The Journal of Urology
Volume
197
Issue
6
Publish Date
2017
Start Page
1377
End Page
1378
DOI
10.1016/j.juro.2017.03.113

Patterns of Performance of Oncologic Surgery by North American Pediatric Urologists: A Report from the Pediatric Urologic Oncology Working Group of the Society for Pediatric Urology.

Objective data on patterns of oncology practice among pediatric urologists are lacking. We reviewed surgical case logs submitted to the American Board of Urology by those self-reporting as pediatric urologists. We hypothesized that logs would reveal a low oncology volume (fewer than 5 cases) and identify orchiectomy as the most common oncology cases, and that less than 25% of logs would show nephrectomy for renal tumor.Case logs submitted for American Board of Urology certification, recertification or pediatric subspecialty certification were reviewed and standardized to represent 12-month practice. Data were collected on pediatric oncologic surgeries as noted by procedure codes linked with oncologic diagnosis codes for patients up to age 30 years.We identified 281 case logs meeting study criteria. A total of 364 oncology cases were logged and 131 logs (46.6%) listed at least 1 oncology case, while 150 (53.4%) contained no oncology cases. The 75th, 90th and 95th percentiles of oncology volume were represented by reporting 2, 3 and 4 cases, respectively. A total of 13 logs (4.6%) accounted for more than a third of all oncology cases (35.9%). The most frequent oncology case logged was orchiectomy, which was documented in 83 logs (29.5%). On Poisson regression surgeon variables associated with higher oncology volume included male gender (IRR 2.8, 95% CI 2.1-3.9), 2010 log year (IRR 2.4, 95% CI 1.3-4.4), 2015 log year (IRR 3.7, 95% CI 2.1-6.4) and nonpediatric subspecialty certification log (IRR 1.6, 95% CI 1.2-2.3).Few pediatric urologists perform a high volume of oncologic surgeries based on surgical case logs submitted to the American Board of Urology. A small cohort of pediatric urologists logged the majority of such cases.

Authors
Cost, NG; Ross, JH; Ferrer, FA; Lorenzo, AJ; Shnorhavorian, M; Routh, JC; Kieran, K; Ritchey, ML
MLA Citation
Cost, NG, Ross, JH, Ferrer, FA, Lorenzo, AJ, Shnorhavorian, M, Routh, JC, Kieran, K, and Ritchey, ML. "Patterns of Performance of Oncologic Surgery by North American Pediatric Urologists: A Report from the Pediatric Urologic Oncology Working Group of the Society for Pediatric Urology." The Journal of urology 197.5 (May 2017): 1349-1354.
PMID
27986529
Source
epmc
Published In
The Journal of Urology
Volume
197
Issue
5
Publish Date
2017
Start Page
1349
End Page
1354
DOI
10.1016/j.juro.2016.12.011

The public health resource utilization impact of airway foreign bodies in children.

Quantify the resource utilization associated with airway foreign bodies in children in the United States using a national database and report observed trends over time.Cross-sectional analysis of national inpatient database with weighted estimates.The KID database (2000-2009).ICD-9-DM codes for foreign body aspiration were used to identify patients to be included for investigation. Admission rates and charges were aggregated and compared among geographic region, location, and teaching hospital status. These factors were then also trended over time.From 2000 to 2009, airway foreign body diagnoses in children accounted for an estimated 4000 to 5000 admissions, resulting in a mean admission rate of 6.6 per 10,000 pediatric patients annually. Charges related to airway foreign bodies in children rose from a total of $93 million to $486 million in the observed period. There is an increasing trend over time of total charges per patient. Charges appear to be higher in urban locations and teaching hospitals.The public health and economic burden of pediatric airway foreign bodies appears to be rising. Further investigation may be helpful to examine factors that may be contributing to increasing charges and creating strategies to improve cost effectiveness, as well as why there seems to be increased resource utilization in urban locations and teaching hospitals.

Authors
Cheng, J; Liu, B; Farjat, AE; Routh, J
MLA Citation
Cheng, J, Liu, B, Farjat, AE, and Routh, J. "The public health resource utilization impact of airway foreign bodies in children." International journal of pediatric otorhinolaryngology 96 (May 2017): 68-71.
PMID
28390617
Source
epmc
Published In
International Journal of Pediatric Otorhinolaryngology
Volume
96
Publish Date
2017
Start Page
68
End Page
71
DOI
10.1016/j.ijporl.2017.03.009

Diagnostic evaluation of ovarian torsion: An analysis of pediatric patients using the Nationwide Emergency Department Sample.

Ultrasonography (US) is the diagnostic modality of choice during work-up for ovarian torsion, although computed tomography (CT) may be used. We examined the utilization of CT in girls with ovarian torsion, and determined which patients are most likely to undergo this study.The Nationwide Emergency Department Sample dataset was searched for patients <18 years who presented with ovarian torsion from 2006 to 2012. Hospitals were categorized by the volume of pediatric patients seen.A total of 1279 patients were identified. Seven hundred twelve (56%) were seen at adult hospitals, 154 (12%) at pediatric privileged, and 413 (32%) at pediatric hospitals. Patients cared for in a pediatric or pediatric privileged hospital had more US alone performed to diagnose ovarian torsion (p < 0.01).Girls seen at pediatric hospitals are more likely to undergo US for work-up of ovarian torsion.

Authors
Rialon, KL; Wolf, S; Routh, JC; Adibe, OO
MLA Citation
Rialon, KL, Wolf, S, Routh, JC, and Adibe, OO. "Diagnostic evaluation of ovarian torsion: An analysis of pediatric patients using the Nationwide Emergency Department Sample." American journal of surgery 213.4 (April 2017): 637-639.
PMID
27890333
Source
epmc
Published In
The American Journal of Surgery
Volume
213
Issue
4
Publish Date
2017
Start Page
637
End Page
639
DOI
10.1016/j.amjsurg.2016.11.021

Risk Factors Associated With Recurrent Urinary Tract Infection in Neurogenic Bladders Managed by Clean Intermittent Catheterization.

To identify risk factors for recurrent urinary tract infection (UTI) in patients who perform clean intermittent catheterization (CIC).A 6-year retrospective chart review of patients with spina bifida or tethered cord who perform clean intermittent catheterization (8 months to 58 years) was conducted. A strict case definition for UTI was applied, and per-subject UTI events, demographic, and clinical data were abstracted. Data were compared between groups defined by no or infrequent UTI (≤1.0 UTI/study year) and frequent UTI (>1.0 UTI/study year).Of 194 total patients, 146 (75%) had no UTIs or infrequent UTIs, and 48 (25%) patients had frequent UTIs. On univariate analysis, only younger age and suprasacral cord lesions were associated with frequent UTIs (P = .002 and P = .007, respectively). Among the 128 patients with urodynamic studies, bladder capacity, compliance, detrusor overactivity, and detrusor leak point pressure were not associated with frequent UTI on univariate analysis. On multivariate analysis, increasing age was found to be associated with decreased odds of UTI by 7% per year (odds ratio 0.93, P = .016).The risk of UTI among individuals with spina bifida or tethered cord declines with increasing age. Bladder function based on urodynamic parameters did not correlate with frequent UTIs.

Authors
Chaudhry, R; Balsara, ZR; Madden-Fuentes, RJ; Wiener, JS; Routh, JC; Seed, P; Ross, SS
MLA Citation
Chaudhry, R, Balsara, ZR, Madden-Fuentes, RJ, Wiener, JS, Routh, JC, Seed, P, and Ross, SS. "Risk Factors Associated With Recurrent Urinary Tract Infection in Neurogenic Bladders Managed by Clean Intermittent Catheterization." Urology 102 (April 2017): 213-218.
PMID
28065810
Source
epmc
Published In
Urology
Volume
102
Publish Date
2017
Start Page
213
End Page
218
DOI
10.1016/j.urology.2016.12.049

Evidence-Based versus Personalized Medicine in Pediatric Urology: The Evidence Supports Evidence-Based Medicine.

Authors
Routh, JC
MLA Citation
Routh, JC. "Evidence-Based versus Personalized Medicine in Pediatric Urology: The Evidence Supports Evidence-Based Medicine." The Journal of urology 197.4 (April 2017): 979-980.
PMID
28268013
Source
epmc
Published In
The Journal of Urology
Volume
197
Issue
4
Publish Date
2017
Start Page
979
End Page
980
DOI
10.1016/j.juro.2017.01.054

Utility Estimation for Pediatric Vesicoureteral Reflux: Methodological Considerations Using an Online Survey Platform.

The advent of online task distribution has opened a new avenue for efficiently gathering community perspectives needed for utility estimation. Methodological consensus for estimating pediatric utilities is lacking, with disagreement over whom to sample, what perspective to use (patient vs parent) and whether instrument induced anchoring bias is significant. We evaluated what methodological factors potentially impact utility estimates for vesicoureteral reflux.Cross-sectional surveys using a time trade-off instrument were conducted via the Amazon Mechanical Turk® (https://www.mturk.com) online interface. Respondents were randomized to answer questions from child, parent or dyad perspectives on the utility of a vesicoureteral reflux health state and 1 of 3 "warm-up" scenarios (paralysis, common cold, none) before a vesicoureteral reflux scenario. Utility estimates and potential predictors were fitted to a generalized linear model to determine what factors most impacted utilities.A total of 1,627 responses were obtained. Mean respondent age was 34.9 years. Of the respondents 48% were female, 38% were married and 44% had children. Utility values were uninfluenced by child/personal vesicoureteral reflux/urinary tract infection history, income or race. Utilities were affected by perspective and were higher in the child group (34% lower in parent vs child, p <0.001, and 13% lower in dyad vs child, p <0.001). Vesicoureteral reflux utility was not significantly affected by the presence or type of time trade-off warm-up scenario (p = 0.17).Time trade-off perspective affects utilities when estimated via an online interface. However, utilities are unaffected by the presence, type or absence of warm-up scenarios. These findings could have significant methodological implications for future utility elicitations regarding other pediatric conditions.

Authors
Tejwani, R; Wang, H-HS; Lloyd, JC; Kokorowski, PJ; Nelson, CP; Routh, JC
MLA Citation
Tejwani, R, Wang, H-HS, Lloyd, JC, Kokorowski, PJ, Nelson, CP, and Routh, JC. "Utility Estimation for Pediatric Vesicoureteral Reflux: Methodological Considerations Using an Online Survey Platform." The Journal of urology 197.3 Pt 1 (March 2017): 805-810.
PMID
27746280
Source
epmc
Published In
The Journal of Urology
Volume
197
Issue
3 Pt 1
Publish Date
2017
Start Page
805
End Page
810
DOI
10.1016/j.juro.2016.09.119

A Society for Pediatric Urology Workforce Survey on the Current Perceptions of Oncology Care by Pediatric Urologists: A Report from the Pediatric Urologic Oncology Working Group of the Society for Pediatric Urology.

Data are lacking on the current perception of oncology care among pediatric urologists. Thus, we developed, pilot tested and administered a survey on this topic to SPU (Society for Pediatric Urology) members.Approval for this proposal was granted by SPU leadership prior to developing or distributing the survey instrument. The survey was developed and pilot tested by the PUOWG (Pediatric Urologic Oncology Working Group). Response data were collected and descriptive statistics were used for analysis. Logistic regression analysis was performed to correlate surgeon reported factors with higher volumes of reported oncology surgery.A total of 426 surveys were distributed via email to SPU members and 212 individual surveys (49.8%) were returned with the background/introduction section completed. Of these surveys 200 (94.3%) were completed by practicing pediatric urologists. Overall, 155 respondents (77.5%) reported performing 5 or fewer oncology related surgeries per year and 74.9% reported that less than 25% of renal tumor surgery at their institution was performed through the pediatric urology service. On multivariate analysis the self-reported factors significantly associated with increased oncology surgical volume (more than 5 cases per year) were greater than 50% attendance at institutional tumor board meetings (OR 4.8, 95% CI 1.4-16.9) and practicing at a hospital with a higher volume of renal tumor surgery (OR 2.6, 95% CI 1.2-5.8).Few surveyed pediatric urologists reported performing a high volume of oncology surgery. Respondents expressed interest in ways to increase pediatric urology involvement in oncology care, including opportunities for increased education. Self-reported factors that correlated with higher volume were regular attendance at the institutional pediatric tumor board and practice at a higher volume institution.

Authors
Cost, NG; Ferrer, FA; Lorenzo, AJ; Shnorhavorian, M; Kieran, K; Routh, JC; Ritchey, ML; Ross, JH
MLA Citation
Cost, NG, Ferrer, FA, Lorenzo, AJ, Shnorhavorian, M, Kieran, K, Routh, JC, Ritchey, ML, and Ross, JH. "A Society for Pediatric Urology Workforce Survey on the Current Perceptions of Oncology Care by Pediatric Urologists: A Report from the Pediatric Urologic Oncology Working Group of the Society for Pediatric Urology." The Journal of urology 197.3 Pt 2 (March 2017): 892-897.
PMID
27837647
Source
epmc
Published In
The Journal of Urology
Volume
197
Issue
3 Pt 2
Publish Date
2017
Start Page
892
End Page
897
DOI
10.1016/j.juro.2016.08.012

Parental Preference Assessment for Vesicoureteral Reflux Management in Children.

Parents of children with vesicoureteral reflux are presented with a variety of management options, which in many cases offer a similar risk-benefit ratio. To facilitate shared decision making, parental preferences regarding vesicoureteral reflux treatment options need to be acknowledged. We aimed to characterize the clinical experience of parents and elicit core themes affecting decision making in regard to managing vesicoureteral reflux in their child.A semistructured, qualitative interview script was developed and vetted by 25 pediatric urologists to discuss treatment options for vesicoureteral reflux. Additional patient interviews were conducted until new themes failed to arise. Content analysis was performed to extract all statements that described treatment options. Similar statements were combined until a final list of unique themes emerged.A total of 26 interviews were performed, yielding 689 statements about overall parent experiences with managing vesicoureteral reflux in the child and 450 statements (65%) pertaining to treatment options. Of the 13 themes that emerged, those most commonly considered were the prevention of future urinary tract infections by 85% of parents, the efficacy rate of treatment options by 85%, the burden of daily maintenance or compliance by 77%, antibiotic resistance by 69%, chronic kidney damage by 62% and invasiveness by 58%.Our study emphasizes that when choosing a treatment option for vesicoureteral reflux in their child, parent preferences regarding risks and benefits are variable. However, their chief concerns include whether a method decreases the risk of urinary tract infections, has an acceptable efficacy rate and aligns itself with the capabilities of the family. These themes help frame discussions between families and clinicians regarding vesicoureteral reflux management, and they can facilitate shared decision making.

Authors
Tran, GN; Bodapati, AV; Routh, JC; Saigal, CS; Copp, HL
MLA Citation
Tran, GN, Bodapati, AV, Routh, JC, Saigal, CS, and Copp, HL. "Parental Preference Assessment for Vesicoureteral Reflux Management in Children." The Journal of urology 197.3 Pt 2 (March 2017): 957-962.
PMID
27974258
Source
epmc
Published In
The Journal of Urology
Volume
197
Issue
3 Pt 2
Publish Date
2017
Start Page
957
End Page
962
DOI
10.1016/j.juro.2016.09.109

Interrater Reliability in Pediatric Urodynamic Tracings: A Pilot Study COMMENT

Authors
Routh, JC
MLA Citation
Routh, JC. "Interrater Reliability in Pediatric Urodynamic Tracings: A Pilot Study COMMENT." JOURNAL OF UROLOGY 197.3 (March 2017): 869-870.
Source
wos-lite
Published In
The Journal of Urology
Volume
197
Issue
3
Publish Date
2017
Start Page
869
End Page
870

Surgical Scar Location Preference for Pediatric Kidney and Pelvic Surgery: A Crowdsourced Survey

Authors
Routh, JC
MLA Citation
Routh, JC. "Surgical Scar Location Preference for Pediatric Kidney and Pelvic Surgery: A Crowdsourced Survey." JOURNAL OF UROLOGY 197.3 (March 2017): 917-918.
Source
wos-lite
Published In
The Journal of Urology
Volume
197
Issue
3
Publish Date
2017
Start Page
917
End Page
918

Editorial Comment.

Authors
Routh, JC
MLA Citation
Routh, JC. "Editorial Comment." The Journal of urology 197.3 Pt 2 (March 2017): 917-918.
PMID
27951406
Source
epmc
Published In
The Journal of Urology
Volume
197
Issue
3 Pt 2
Publish Date
2017
Start Page
917
End Page
918
DOI
10.1016/j.juro.2016.11.106

A Nationwide Assessment of the Emergency Department Management of Acute Urinary Retention Due to Urethral Stricture.

To evaluate the nationwide practice patterns of the management of acute urinary retention (AUR) secondary to urethral stricture (US) in an emergency department (ED) setting.We used the 2006-2010 Nationwide Emergency Department Sample to identify men with US who received treatment for AUR. We excluded patients with benign prostatic hyperplasia, vesicourethral anastomotic stenosis, neurogenic bladder, and bladder cancer. Primary outcome was urethral dilation or suprapubic tube (SPT) placement as initial AUR management. Patient demographics and hospital factors were also examined. Multivariate logistic regression was performed to examine factors associated with initial AUR management.We identified 4794 weighted ED encounters of men with US who underwent urethral dilation or SPT placement for AUR. Mean age was 58.6 ± 0.8 years. A total of 4084 (85%) men received urethral dilation, whereas 710 had SPT (15%) placement. In bivariate analysis, patients who received SPT were likely to be younger (P <.001), treated in recent years (P = .002), and in hospitals in the West region (P = .003). In multivariate analysis, SPT placement was significantly associated with younger age (P = .004), public insurance (P = .03), recent treatment years (P = .02), and hospitals in the West region (P = .02). Income and hospital teaching status did not have significant association with initial treatment choice.Urethral dilation remains the most common urologic intervention in the ED for AUR due to US; however, there is an increasing trend toward SPT placement. Patients who are younger, publicly insured, or who receive care in the West region are more likely to receive a SPT for initial treatment of AUR due to US.

Authors
Granieri, MA; Wang, H-HS; Routh, JC; Peterson, AC
MLA Citation
Granieri, MA, Wang, H-HS, Routh, JC, and Peterson, AC. "A Nationwide Assessment of the Emergency Department Management of Acute Urinary Retention Due to Urethral Stricture." Urology 100 (February 2017): 79-83.
PMID
27658662
Source
epmc
Published In
Urology
Volume
100
Publish Date
2017
Start Page
79
End Page
83
DOI
10.1016/j.urology.2016.08.026

Increased pediatric sub-specialization is associated with decreased surgical complication rates for inpatient pediatric urology procedures.

Increased case volumes and training are associated with better surgical outcomes. However, the impact of pediatric urology sub-specialization on perioperative complication rates is unknown.To determine the presence and magnitude of difference in rates of common postoperative complications for elective pediatric urology procedures between specialization levels of urologic surgeons. The Nationwide Inpatient Sample (NIS), a nationally representative administrative database, was used.The NIS (1998-2009) was retrospectively reviewed for pediatric (≤18 years) admissions, using ICD-9-CM codes to identify urologic surgeries and National Surgical Quality Improvement Program (NSQIP) inpatient postoperative complications. Degree of pediatric sub-specialization was calculated using a Pediatric Proportion Index (PPI), defined as the ratio of children to total patients operated on by each provider. The providers were grouped into PPI quartiles: Q1, 0-25% specialization; Q2, 25-50%; Q3, 50-75%; Q4, 75-100%. Weighted multivariate analysis was performed to test for associations between PPI and surgical complications.A total of 71,479 weighted inpatient admissions were identified. Patient age decreased with increasing specialization: Q1, 7.9 vs Q2, 4.8 vs Q3, 4.8 vs Q4, 4.6 years, P < 0.01). Specialization was not associated with race (P > 0.20), gender (P > 0.50), or comorbidity scores (P = 0.10). Mortality (1.5% vs 0.2% vs 0.3% vs 0.4%, P < 0.01) and complication rates (15.5% vs 11.7% vs 9.6% vs 10.9%, P < 0.0001) both decreased with increasing specialization. Patients treated by more highly specialized surgeons incurred slightly higher costs (Q2, +4%; Q3, +1%; Q4 + 2%) but experienced shorter length of hospital stay (Q2, -5%; Q3, -10%; Q4, -3%) compared with the least specialized providers. A greater proportion of patients treated by Q1 and Q3 specialized urologists had CCS ≥2 than those seen by Q2 or Q4 urologists (12.5% and 12.2%, respectively vs 8.4% and 10.9%, respectively, P = 0.04). Adjusting for confounding effects, increased pediatric specialization was associated with decreased postoperative complications: Q2 OR 0.78, CI 0.58-1.05; Q3 OR 0.60, CI 0.44-0.84; Q4 OR 0.70, CI 0.58-0.84; P < 0.01.Providers with proportionally higher volumes of pediatric patients achieved better postoperative outcomes than their less sub-specialized counterparts. This may have arisen from increased exposure to pediatric anatomy and physiology, and greater familiarity with pediatric techniques.The NIS admission-based retrospective design did not enable assessment of long-term outcomes, repeated admissions, or to track a particular patient across time. The study was similarly limited in evaluating the effect of pre-surgical referral patterns on patient distributions.Increased pediatric sub-specialization among urologists was associated with a decreased risk of mortality and surgical complications in children undergoing inpatient urologic procedures.

Authors
Tejwani, R; Wang, H-HS; Young, BJ; Greene, NH; Wolf, S; Wiener, JS; Routh, JC
MLA Citation
Tejwani, R, Wang, H-HS, Young, BJ, Greene, NH, Wolf, S, Wiener, JS, and Routh, JC. "Increased pediatric sub-specialization is associated with decreased surgical complication rates for inpatient pediatric urology procedures." Journal of pediatric urology 12.6 (December 2016): 388.e1-388.e7.
PMID
27363329
Source
epmc
Published In
Journal of Pediatric Urology
Volume
12
Issue
6
Publish Date
2016
Start Page
388.e1
End Page
388.e7
DOI
10.1016/j.jpurol.2016.05.034

Design and Methodological Considerations of the Centers for Disease Control and Prevention Urologic and Renal Protocol for the Newborn and Young Child with Spina Bifida.

Care of children with spina bifida has significantly advanced in the last half century, resulting in gains in longevity and quality of life for affected children and caregivers. Bladder dysfunction is the norm in patients with spina bifida and may result in infection, renal scarring and chronic kidney disease. However, the optimal urological management for spina bifida related bladder dysfunction is unknown.In 2012 the Centers for Disease Control and Prevention convened a working group composed of pediatric urologists, nephrologists, epidemiologists, methodologists, community advocates and Centers for Disease Control and Prevention personnel to develop a protocol to optimize urological care of children with spina bifida from the newborn period through age 5 years.An iterative quality improvement protocol was selected. In this model participating institutions agree to prospectively treat all newborns with spina bifida using a single consensus based protocol. During the 5-year study period outcomes will be routinely assessed and the protocol adjusted as needed to optimize patient and process outcomes. Primary study outcomes include urinary tract infections, renal scarring, renal function and bladder characteristics. The protocol specifies the timing and use of testing (eg ultrasonography, urodynamics) and interventions (eg intermittent catheterization, prophylactic antibiotics, antimuscarinic medications). Starting in 2014 the Centers for Disease Control and Prevention began funding 9 study sites to implement and evaluate the protocol.The Centers for Disease Control and Prevention Urologic and Renal Protocol for the Newborn and Young Child with Spina Bifida began accruing patients in 2015. Assessment in the first 5 years will focus on urinary tract infections, renal function, renal scarring and clinical process improvements.

Authors
Routh, JC; Cheng, EY; Austin, JC; Baum, MA; Gargollo, PC; Grady, RW; Herron, AR; Kim, SS; King, SJ; Koh, CJ; Paramsothy, P; Raman, L; Schechter, MS; Smith, KA; Tanaka, ST; Thibadeau, JK; Walker, WO; Wallis, MC; Wiener, JS; Joseph, DB
MLA Citation
Routh, JC, Cheng, EY, Austin, JC, Baum, MA, Gargollo, PC, Grady, RW, Herron, AR, Kim, SS, King, SJ, Koh, CJ, Paramsothy, P, Raman, L, Schechter, MS, Smith, KA, Tanaka, ST, Thibadeau, JK, Walker, WO, Wallis, MC, Wiener, JS, and Joseph, DB. "Design and Methodological Considerations of the Centers for Disease Control and Prevention Urologic and Renal Protocol for the Newborn and Young Child with Spina Bifida." The Journal of urology 196.6 (December 2016): 1728-1734.
PMID
27475969
Source
epmc
Published In
The Journal of Urology
Volume
196
Issue
6
Publish Date
2016
Start Page
1728
End Page
1734
DOI
10.1016/j.juro.2016.07.081

Commentary on "Evaluation of ureteral jet dynamics in pediatric kidney stone formers: A cross-sectional study".

Authors
Routh, JC
MLA Citation
Routh, JC. "Commentary on "Evaluation of ureteral jet dynamics in pediatric kidney stone formers: A cross-sectional study"." Journal of pediatric urology 12.6 (December 2016): 382-.
PMID
27650110
Source
epmc
Published In
Journal of Pediatric Urology
Volume
12
Issue
6
Publish Date
2016
Start Page
382
DOI
10.1016/j.jpurol.2016.07.010

Biomarkers for Wilms Tumor: A Systematic Review.

Wilms tumor is the most common childhood renal malignancy and the fourth most common childhood cancer. Many biomarkers have been studied but there has been no comprehensive summary. We systematically reviewed the literature on biomarkers in Wilms tumor to quantify the prognostic implications of the presence of individual tumor markers.We searched for English language studies from 1980 to 2015 performed in patients younger than 18 years with Wilms tumor and prognostic data. The protocol was conducted per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Two reviewers abstracted data in duplicate using a standard evaluation form. We performed descriptive statistics, then calculated relative risks and 95% confidence intervals for markers appearing in multiple level II or III studies.A total of 40 studies were included examining 32 biomarkers in 7,381 patients with Wilms tumor. Studies had a median of 61 patients, 24 biomarker positive patients per series and a median followup of 68.4 months. Median percentages of patients with stages 1, 2, 3, 4 and 5 tumors were 28.5%, 26.4%, 24.5%, 14.1% and 1.7%, respectively, and 10.2% had anaplasia. The strongest negative prognostic association was loss of heterozygosity at 11p15, with a risk of recurrence of 5.00, although loss of heterozygosity at 1p and gain of function at 1q were also strongly linked to increased recurrence (2.93 and 2.86, respectively).Several tumor markers are associated with an increased risk of recurrence or a decreased risk of overall survival in patients with Wilms tumor. These data suggest targets for development of diagnostic tests and potential therapies.

Authors
Cone, EB; Dalton, SS; Van Noord, M; Tracy, ET; Rice, HE; Routh, JC
MLA Citation
Cone, EB, Dalton, SS, Van Noord, M, Tracy, ET, Rice, HE, and Routh, JC. "Biomarkers for Wilms Tumor: A Systematic Review." The Journal of urology 196.5 (November 2016): 1530-1535.
PMID
27259655
Source
epmc
Published In
The Journal of Urology
Volume
196
Issue
5
Publish Date
2016
Start Page
1530
End Page
1535
DOI
10.1016/j.juro.2016.05.100

Open versus minimally invasive ureteroneocystostomy: A population-level analysis.

Open ureteroneocystostomy (UNC) is the gold standard for surgical correction of vesicoureteral reflux (VUR). Beyond single-center reports, there are few published data on outcomes of minimally-invasive (MIS) UNC. Our objective was to compare postoperative outcomes of open and MIS UNC using national, population-level data.We reviewed the 1998-2012 Nationwide Inpatient Sample to identify pediatric (≤18 years) VUR patients who underwent either open or MIS UNC. Demographics, National Surgical Quality Improvement Program (NSQIP) complications, length of stay (LOS), and cost data were extracted. Statistical analysis was performed using weighted, hierarchical multivariate logistic regression (complications) and negative binomial regression (LOS, cost).We identified 780 MIS and 75,976 open UNC admissions. Compared with patients undergoing open UNC, patients who underwent MIS UNC were likely to be older (6.2 versus 4.8 years, p < 0.001), publically insured (43 versus 26%, p < 0.001), and treated in recent years (90 versus 46% after 2005, p < 0.001). MIS admissions were associated with a significantly shorter length of stay (1.0 versus 1.8 days, p < 0.001) and higher cost ($9230 versus $6,304, p = 0.002). After adjusting for patient-level confounders (age, gender, insurance, treatment year, and comorbidity), and hospital-level factors (region, bedsize, and teaching status), MIS UNC was associated with a significantly higher rate of postoperative urinary complications such as UTIs, urinary retention, and renal injury (OR 3.1, p = 0.02), shorter LOS (RR 0.8, p = 0.02), and higher cost (RR 1.4, p = 0.008).Strengths of this study are its large cohort size, long time horizon, national estimation, and cost data. Most prior studies are case-series limited to the size of the institutional cohort. Our analysis of 76,756 operative encounters revealed that open UNC continues to be performed at far greater frequency than MIS UNC, outpacing the latter modality by nearly 100:1. Children treated with MIS UNC had three times greater odds of developing postoperative urinary complications, and MIS UNC patients incurred average costs per admission that were nearly 1.5 times higher than those of children who underwent open UNC. These children were also likely to be older, publically insured, and treated in more recent years. On the other hand, patients treated with MIS UNC required substantially shorter postoperative hospitalization, with an average LOS roughly half that of open UNC cases. Limitations include the retrospective nature of the administrative database, lack of detailed patient-level data, and no available long-term postoperative outcomes. Compared with open surgery, MIS UNC was associated with shorter LOS but higher costs and possibly higher urinary complication rates.

Authors
Wang, H-HS; Tejwani, R; Cannon, GM; Gargollo, PC; Wiener, JS; Routh, JC
MLA Citation
Wang, H-HS, Tejwani, R, Cannon, GM, Gargollo, PC, Wiener, JS, and Routh, JC. "Open versus minimally invasive ureteroneocystostomy: A population-level analysis." Journal of pediatric urology 12.4 (August 2016): 232.e1-232.e6.
PMID
27140001
Source
epmc
Published In
Journal of Pediatric Urology
Volume
12
Issue
4
Publish Date
2016
Start Page
232.e1
End Page
232.e6
DOI
10.1016/j.jpurol.2016.03.014

Is the Economic Impact and Utilization of Imaging Studies for Pediatric Urolithiasis Across the United States Increasing?

To identify longitudinal trends of economic impact and resource utilization for management of pediatric urolithiasis using national databases.We analyzed the 2006-2012 Nationwide Emergency Department Sample and Nationwide Inpatient Sample. We used ICD-9 (International Classification of Diseases) codes to identify patients (≤18 years) diagnosed with urolithiasis. Diagnostic imaging and surgeries were identified using ICD-9 and Current Procedural Technology codes. We abstracted demographic, imaging, procedure, and charge data. Weighted descriptive statistics were calculated to describe the population's demographics and economic expenditures by clinical setting and year.In total, 45,333 inpatient admissions (68% females) and 234,559 emergency department encounters (63% females) were identified. Most patients (84%) were teenagers and the southern region of the United States was the most common geographic region for all encounters (44%). There was no significant trend in number of urolithiasis encounters over the period studied. Utilization of all imaging techniques increased; in particular, computed tomography was used in 23% of encounters in 2006 and 40% in 2012 (P < .0001). The mean charge per emergency department visit increased by 60% from $3645 in 2006 to $5827 in 2012 (P < .0001). The mean charge increased for inpatient admissions by 102%, from $16,399 in 2006 to $33,205 in 2012 (P < .0001). Total charges increased 72% over the study period from $230 million in 2006 to $395 million in 2012 (P < .0001), outpacing medical inflation over the same period.Charges for pediatric urolithiasis management increased by 65% from 2006 to 2012 despite stable frequency of patient encounters. The utilization of computerized tomography in pediatric urolithiasis increased as well.

Authors
Young, BJ; Tejwani, R; Wang, H-HS; Wolf, S; Purves, JT; Wiener, JS; Routh, JC
MLA Citation
Young, BJ, Tejwani, R, Wang, H-HS, Wolf, S, Purves, JT, Wiener, JS, and Routh, JC. "Is the Economic Impact and Utilization of Imaging Studies for Pediatric Urolithiasis Across the United States Increasing?." Urology 94 (August 2016): 208-213.
PMID
27208819
Source
epmc
Published In
Urology
Volume
94
Publish Date
2016
Start Page
208
End Page
213
DOI
10.1016/j.urology.2016.05.019

Outcomes of Shock Wave Lithotripsy and Ureteroscopy for Treatment of Pediatric Urolithiasis.

Shock wave lithotripsy has been commonly used to treat children with renal and ureteral calculi but recently ureteroscopy has been used more frequently. We examined postoperative outcomes from these 2 modalities in children.We reviewed linked inpatient, ambulatory surgery and emergency department data from 2007 to 2010 for 5 states to identify pediatric admissions for renal/ureteral calculi treated with shock wave lithotripsy or ureteroscopy. Unplanned readmissions, additional procedures and emergency room visits were extracted. Multivariate logistic regression using generalized estimating equations to adjust for hospital level clustering was performed.We identified 2,281 admissions (1,087 for shock wave lithotripsy and 1,194 for ureteroscopy). Ages of patients undergoing ureteroscopy and those undergoing shock wave lithotripsy were similar (median 17.0 years for both cohorts, p = 0.001) but patients were more likely to be female (63.4% vs 54.7%, p <0.0001), to be privately insured (69.8% vs 62.2%, p <0.0005) and to have a ureteral stone (81.0% vs 34.8%, p <0.0001). Patients undergoing ureteroscopy demonstrated a lower rate of additional stone related procedures within 12 months (13.6% vs 18.8%, p <0.0007) but a higher rate of readmissions (10.8% vs 6.3%, p <0.0002) and emergency room visits (7.9% vs 4.9%, p <0.0036) within 30 days postoperatively. On multivariable analysis patients undergoing ureteroscopy were nearly twice as likely to visit an emergency room within 30 days of the procedure (OR 1.97, p <0.001) and to be readmitted to inpatient services (OR 1.71, p <0.01).Ureteroscopy is now used more commonly than shock wave lithotripsy for initial pediatric stone intervention. Although repeat treatment rates did not differ between procedures, ureteroscopy patients were more likely to be seen at an emergency room or hospitalized within 30 days of the initial procedure.

Authors
Tejwani, R; Wang, H-HS; Wolf, S; Wiener, JS; Routh, JC
MLA Citation
Tejwani, R, Wang, H-HS, Wolf, S, Wiener, JS, and Routh, JC. "Outcomes of Shock Wave Lithotripsy and Ureteroscopy for Treatment of Pediatric Urolithiasis." The Journal of urology 196.1 (July 2016): 196-201.
PMID
26997313
Source
epmc
Published In
The Journal of Urology
Volume
196
Issue
1
Publish Date
2016
Start Page
196
End Page
201
DOI
10.1016/j.juro.2016.02.2975

Nationwide Trends and Variations in Urological Surgical Interventions and Renal Outcome in Patients with Spina Bifida.

Bladder dysfunction in patients with spina bifida can lead to significant morbidity due to renal insufficiency. Indications for surgery vary among institutions and the impact is unclear. We examined trends and variations in urological interventions and chronic renal insufficiency in patients with spina bifida.We reviewed NIS (Nationwide Inpatient Sample) for all patients with spina bifida treated from 1998 to 2011. We used ICD-9-CM codes to identify urological surgery and chronic renal insufficiency. We calculated the Spearman correlation coefficients between rates of spina bifida related bladder surgeries and rates of chronic renal insufficiency outcomes by state. Linear regression models were fitted to investigate the associations between rates of spina bifida related surgery and chronic renal insufficiency across treatment years.We identified 427,616 spina bifida hospital admissions. Mean patient age was 26 years and 56% of patients were female. Of the admissions 35,249 (8%) were for chronic renal insufficiency and 11,078 (3%) were for surgery. During the study period chronic renal insufficiency rates doubled from 6% to 12% and surgery rates decreased from 2.0% to 1.8%. There was a moderately weak inverse association between surgery and chronic renal insufficiency rates with time (r = -0.3, p = 0.06) and by state (r = -0.3, p = 0.04). On multivariate analysis higher rates of surgery were associated with the state in which the patient was treated (p <0.001), and with younger age (p <0.001) and hospital teaching status (p <0.001). In contrast, chronic renal insufficiency was not associated with spina bifida related surgery (p = 0.67).We observed a temporal and geographic trend toward decreasing urological surgery and increasing chronic renal insufficiency rates in spina bifida and a wide variation in urological surgical rates among states. Further study is needed to determine the factors behind these trends and variations in spina bifida management.

Authors
Wang, H-HS; Lloyd, JC; Wiener, JS; Routh, JC
MLA Citation
Wang, H-HS, Lloyd, JC, Wiener, JS, and Routh, JC. "Nationwide Trends and Variations in Urological Surgical Interventions and Renal Outcome in Patients with Spina Bifida." The Journal of urology 195.4 Pt 2 (April 2016): 1189-1194.
PMID
26926542
Source
epmc
Published In
The Journal of Urology
Volume
195
Issue
4 Pt 2
Publish Date
2016
Start Page
1189
End Page
1194
DOI
10.1016/j.juro.2015.11.033

DISPROPORTIONATE USE OF INPATIENT CARE BY OLDER ADULTS WITH URINARY STONE DISEASE

Authors
Cone, EB; Hammill, B; Kaplan, AG; Dale, J; Routh, JC; Lipkin, ME; Preminger, GM; Schmader, K; Scales, CD
MLA Citation
Cone, EB, Hammill, B, Kaplan, AG, Dale, J, Routh, JC, Lipkin, ME, Preminger, GM, Schmader, K, and Scales, CD. "DISPROPORTIONATE USE OF INPATIENT CARE BY OLDER ADULTS WITH URINARY STONE DISEASE." April 2016.
Source
wos-lite
Published In
The Journal of Urology
Volume
195
Issue
4
Publish Date
2016
Start Page
E1172
End Page
E1172

Incidence of Breakthrough Urinary Tract Infection in Hospitalized Infants Receiving Antibiotic Prophylaxis.

Urinary tract infections (UTIs) are a source of substantial morbidity in children in the neonatal intensive care unit. The incidence of UTIs that occur in critically ill infants during a course of antibiotic prophylaxis (i.e., breakthrough urinary tract infections [BUTIs]) is not known. We investigated the incidence of BUTI in a cohort of infants hospitalized on prophylactic antibiotics in neonatal intensive care units. Predictors of BUTI were evaluated using multivariable Cox regression. Out of 716 787 infants, 631 (0.09%) were prescribed 821 courses of antibiotic prophylaxis. Among this cohort, 60 infants (9.5%) suffered a total of 65 BUTIs. Of all prophylactic antibiotic courses, 65/821 (7.9%) were complicated by BUTI.Klebsiella, Enterobacter, andEscherichia colispecies were the most common causes of BUTI. There was no statistically significant difference (P= .78) in BUTI incidence among the 4 antibiotics assessed (amoxicillin, cephalexin, nitrofurantoin, or trimethoprim-sulfamethoxazole).

Authors
Lloyd, JC; Hornik, CP; Benjamin, DK; Clark, RH; Routh, JC; Smith, PB
MLA Citation
Lloyd, JC, Hornik, CP, Benjamin, DK, Clark, RH, Routh, JC, and Smith, PB. "Incidence of Breakthrough Urinary Tract Infection in Hospitalized Infants Receiving Antibiotic Prophylaxis." Clinical pediatrics (March 21, 2016).
PMID
27006413
Source
epmc
Published In
Clinical Pediatrics
Publish Date
2016

Trends in Sickle Cell Disease-related Priapism in U.S. Children's Hospitals.

To define rates of priapism diagnosis and inpatient admission among males with sickle cell disease (SCD).We retrospectively reviewed the Pediatric Health Information System database for males aged <21 years treated 2004-2012. We identified patients with SCD and priapism based on the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. Logistic regression and generalized estimating equation models were used to control for confounding and to adjust for within-hospital clustering of similar patients.We identified 17,186 males who were admitted 137,710 times during the study period. Of these, 362 (2.1%) were diagnosed with priapism on 748 admissions. There was a significant decrease in the number of priapism admissions among patients with SCD over time (0.81% in 2004 to 0.44% in 2012, P  <  .001). The number of patients diagnosed with SCD-related priapism varied over time without a statistically significant trend (2.3% in 2004, 2.69% in 2008, 1.01% in 2012, P  =  .34). Rates of priapism admissions (0-4.4%) varied widely between hospitals. Older patient age was associated with an increased likelihood of a priapism admission in the multivariate logistic regression model after adjusting for treatment year, hospital region, and for hospital-level clustering of similar patients.From 2004 to 2012, the number of admissions for SCD-related priapism declined whereas the number of individual patients diagnosed with SCD-related priapism did not. Rates of priapism-related admissions in males with SCD vary widely among PHIS hospitals.

Authors
Wang, H-HS; Herbst, KW; Rothman, JA; Shah, NR; Wiener, JS; Routh, JC
MLA Citation
Wang, H-HS, Herbst, KW, Rothman, JA, Shah, NR, Wiener, JS, and Routh, JC. "Trends in Sickle Cell Disease-related Priapism in U.S. Children's Hospitals." Urology 89 (March 2016): 118-122.
PMID
26674747
Source
epmc
Published In
Urology
Volume
89
Publish Date
2016
Start Page
118
End Page
122
DOI
10.1016/j.urology.2015.11.023

Rare variants in tenascin genes in a cohort of children with primary vesicoureteric reflux.

Primary vesicoureteral reflux (PVUR) is the most common malformation of the kidney and urinary tract, and reflux nephropathy is a major cause of chronic kidney disease in children. Recently, we reported mutations in the tenascin XB gene (TNXB) as a cause of PVUR with joint hypermobility.To define the role of rare variants in tenascin genes in the etiology of PVUR, we screened a cohort of patients with familial PVUR (FPVUR) and non-familial PVUR (NFPVUR) for rare missense variants inTNXB and the tenascin C gene (TNC) after excluding mutations in ROBO2 and SOX17.The screening procedure identified 134 individuals from 112 families with PVUR; two families with mutations in ROBO2 were excluded from further analysis. Rare missense variants in TNXB were found in the remaining 110 families, of which 5/55 (9%) families had FPVUR and 2/55 (4%) had NFPVUR. There were no differences in high-grade reflux or renal parenchymal scarring between patients with and without TNXB variants. All patients with TNXB rare variants who were tested exhibited joint hypermobility. Overall we were able to identify causes of FPVUR in 7/57 (12%) families (9% in TNXB and 3% in ROBO2).In conclusion, the identification of a rare missense variant in TNXB in combination with a positive family history of VUR and joint hypermobility may represent a non-invasive method to diagnose PVUR and warrants further evaluation in other cohorts.

Authors
Elahi, S; Homstad, A; Vaidya, H; Stout, J; Hall, G; Wu, G; Conlon, P; Routh, JC; Wiener, JS; Ross, SS; Nagaraj, S; Wigfall, D; Foreman, J; Adeyemo, A; Gupta, IR; Brophy, PD; Rabinovich, CE; Gbadegesin, RA
MLA Citation
Elahi, S, Homstad, A, Vaidya, H, Stout, J, Hall, G, Wu, G, Conlon, P, Routh, JC, Wiener, JS, Ross, SS, Nagaraj, S, Wigfall, D, Foreman, J, Adeyemo, A, Gupta, IR, Brophy, PD, Rabinovich, CE, and Gbadegesin, RA. "Rare variants in tenascin genes in a cohort of children with primary vesicoureteric reflux." Pediatric Nephrology (Berlin, Germany) 31.2 (February 2016): 247-253.
PMID
26408188
Source
epmc
Published In
Pediatric Nephrology
Volume
31
Issue
2
Publish Date
2016
Start Page
247
End Page
253
DOI
10.1007/s00467-015-3203-6

Nephron-sparing surgery for Wilms tumor: A systematic review.

Radical nephrectomy (RN, or total nephrectomy) is the current gold-standard surgical treatment for children with Wilms tumors (WT). However, nephron-sparing surgery (NSS, or partial nephrectomy) has recently been gaining increasing attention. The objective of this systematic review is to compare the effectiveness of NSS as compared with RN for the treatment of children with WT.We searched the Cochrane Controlled Trials Register, clinicaltrials.gov, MEDLINE, EMBASE, Google Scholar, and recently presented meeting abstracts for reports in English. The bibliographies of included studies were then hand-searched for any missed articles. The protocol was prospectively registered. Manuscripts were assessed and data abstracted in duplicate with differences resolved by the senior author. Owing to high heterogeneity among the final included studies, only a qualitative systematic review was performed; no formal meta-analysis was undertaken.We identified 694 articles, 118 of which were selected for full-text review and 66 of which were included in the final analysis. Most studies were single- or multi-institution retrospective case series (60, 91%), with a small number of prospective cohort studies (6, 9%) and 1 administrative database analysis. Most studies were from Europe (27, 41%) or North America (21, 32%). Nearly half (32, 48%) of studies those were included were dated from 2010 or later. In total, data on 4,002 patients were included, of whom 1,040 (26%) underwent NSS and 2,962 (74%) underwent NSS. Reported rupture rates were similar between RN and NSS (13% vs. 7%), as were recurrence rates (12% vs. 11%) and survival rates (85% vs. 88%). However, these comparisons are limited by inherent biases in the design and reporting of most included studies.Most contemporary studies reporting the use of NSS in children with WT report similar long-term outcomes to RN. However, most existing studies are limited by their small numbers, inconsistent reporting, and methodological biases. There are significant opportunities for future research on the use of NSS in children with WT, including issues related to surgical quality, optimal technique, timing and duration of chemotherapy, and variation in the use of NSS among centers.

Authors
Vanden Berg, RNW; Bierman, EN; Noord, MV; Rice, HE; Routh, JC
MLA Citation
Vanden Berg, RNW, Bierman, EN, Noord, MV, Rice, HE, and Routh, JC. "Nephron-sparing surgery for Wilms tumor: A systematic review." Urologic oncology 34.1 (January 2016): 24-32. (Review)
PMID
26254695
Source
epmc
Published In
Urologic Oncology: Seminars and Original Investigations
Volume
34
Issue
1
Publish Date
2016
Start Page
24
End Page
32
DOI
10.1016/j.urolonc.2015.07.003

High Flow Priapism in a Pediatric Patient after Circumcision with Dorsal Penile Nerve Block.

We report the first documented case of high flow priapism after circumcision with dorsal penile nerve block. A 7-year-old male who had undergone circumcision three years before presented to our institution with a 3-year history of persistent nonpainful erections. Workup revealed a high flow priapism and, after discussion of the management options, the patient's family elected continued observation.

Authors
Granieri, MA; Fantony, JJ; Routh, JC
MLA Citation
Granieri, MA, Fantony, JJ, and Routh, JC. "High Flow Priapism in a Pediatric Patient after Circumcision with Dorsal Penile Nerve Block." Case reports in pediatrics 2016 (January 2016): 6976439-.
PMID
27648333
Source
epmc
Published In
Case Reports in Pediatrics
Volume
2016
Publish Date
2016
Start Page
6976439
DOI
10.1155/2016/6976439

Medical expulsive therapy for pediatric urolithiasis: Systematic review and meta-analysis.

Kidney stone disease has become more common among children and young adults. Despite its well-documented success in adults, published success rates of medical expulsive therapy (MET) for pediatric urolithiasis vary widely. Our objective was to determine whether the aggregated evidence supports the use of MET in children.We searched the Cochrane Controlled Trials Register, clinicaltrials.gov, MEDLINE, and EMBASE databases, and recently presented meeting abstracts for reports in any language. In addition, the bibliographies of included studies were then hand-searched. The protocol was prospectively registered at PROSPERO (CRD42013005960). Inclusion criteria were children (aged ≤ 18 years) with urolithiasis treated with medications with the specific goal of increasing spontaneous stone passage rate, including but not limited to alpha-adrenergic blockers (e.g., tamsulosin or doxazosin), calcium channel blockers (e.g., nifedipine), or other adjuvant medications (e.g., steroids or tolterodine). Manuscripts were then assessed and data abstracted in duplicate, with differences resolved by the senior author. Risk of bias was assessed using standardized instruments. Descriptive statistical analyses were performed as appropriate.We identified 11,197 studies, five of which (3 randomized controlled trials, 2 retrospective cohorts) were included in the pooled meta-analysis. Although we found little evidence of significant publication bias, we were unable to assess the likelihood of other forms of bias (allocation, selection) for most included studies due to reporting limitations. The pooled results demonstrate that MET significantly increased the odds of spontaneous stone passage (OR 2.21, 95% CI 1.40-3.49). Between-study heterogeneity was not statistically significant (I(2) = 14%, p = 0.36). Bivariate meta-regression models revealed no significant association between the likelihood of stone passage and study COI (p = 0.9), study country (p = 0.7), patient age (p = 0.4), patient gender (p = 0.4), duration of follow-up (p = 0.3), or stone size (p = 0.7). Side effects of MET were reported to be minimal. Relatively few patients reported any adverse effects at all; the most commonly reported issue was somnolence. Concerns about biases affecting the published outcomes of the included studies exist due to the low quality of the randomized controlled trials reviewed for analysis. However, there was little visual evidence of publication bias noted on the funnel plot, as confirmed by the Begg test (p = 0.5).Consistent with the adult literature, pediatric studies demonstrate that treatment with MET results in increased odds of spontaneous ureteral stone passage and a low rate of adverse events. Although the accumulated literature is limited by inconsistent and/or incomplete reporting, there is nonetheless a clear, cumulative positive effect of MET on stone passage among children. The available evidence thus supports a prominent role for MET in treatment algorithms for pediatric urolithiasis.

Authors
Velázquez, N; Zapata, D; Wang, H-HS; Wiener, JS; Lipkin, ME; Routh, JC
MLA Citation
Velázquez, N, Zapata, D, Wang, H-HS, Wiener, JS, Lipkin, ME, and Routh, JC. "Medical expulsive therapy for pediatric urolithiasis: Systematic review and meta-analysis." Journal of pediatric urology 11.6 (December 2015): 321-327. (Review)
PMID
26165192
Source
epmc
Published In
Journal of Pediatric Urology
Volume
11
Issue
6
Publish Date
2015
Start Page
321
End Page
327
DOI
10.1016/j.jpurol.2015.04.036

Use of patient registries and administrative datasets for the study of pediatric cancer.

Analysis of data from large administrative databases and patient registries is increasingly being used to study childhood cancer care, although the value of these data sources remains unclear to many clinicians. Interpretation of large databases requires a thorough understanding of how the dataset was designed, how data were collected, and how to assess data quality. This review will detail the role of administrative databases and registry databases for the study of childhood cancer, tools to maximize information from these datasets, and recommendations to improve the use of these databases for the study of pediatric oncology.

Authors
Rice, HE; Englum, BR; Gulack, BC; Adibe, OO; Tracy, ET; Kreissman, SG; Routh, JC
MLA Citation
Rice, HE, Englum, BR, Gulack, BC, Adibe, OO, Tracy, ET, Kreissman, SG, and Routh, JC. "Use of patient registries and administrative datasets for the study of pediatric cancer." Pediatric blood & cancer 62.9 (September 2015): 1495-1500. (Review)
PMID
25807938
Source
epmc
Published In
Pediatric Blood & Cancer
Volume
62
Issue
9
Publish Date
2015
Start Page
1495
End Page
1500
DOI
10.1002/pbc.25506

Hospital Surgical Volume and Associated Postoperative Complications of Pediatric Urological Surgery in the United States.

Hospital and provider surgical volume have been increasingly linked to surgical outcomes. However, this topic has rarely been addressed in children. We investigated whether hospital surgical volume impacts complication rates in pediatric urology.We retrospectively reviewed the Nationwide Inpatient Sample (1998 to 2011) for pediatric (18 years or younger) hospitalizations for urological procedures. We used ICD-9-CM codes to identify elective urological interventions and NSQIP® postoperative in hospital complications. Annual hospital surgical volume was calculated and dichotomized as high volume (90th percentile or above) or non-high volume (below 90th percentile).We identified 158,805 urological admissions (114,634 high volume and 44,171 non-high volume hospitals). Of the hospitals 75% recorded fewer than 5 major pediatric urology cases performed yearly. High volume hospitals showed treatment of significantly younger patients (mean 5.4 vs 9.6 years, p < 0.001) and were more likely to be teaching hospitals (93% vs 71%, p < 0.001). The overall rate of NSQIP identified postoperative complications was higher at non-high volume vs high volume hospitals (11.6% vs 9.3%, p = 0.003). After adjusting for confounding effects patients treated at non-high volume hospitals remained more likely to suffer multiple NSQIP tracked postoperative complications, including acute renal failure (OR 1.4, p = 0.04), urinary tract infection (OR 1.3, p = 0.01), postoperative respiratory complications (OR 1.5, p = 0.01), systemic sepsis (OR 2.0, p ≤ 0.001), postoperative bleeding (OR 2.5, p < 0.001) and in hospital death (OR 2.2, p = 0.007).Urological procedures performed in children at non-high volume hospitals were associated with an increased risk of in hospital, NSQIP identified postoperative complications, including a small but significant increase in postoperative mortality, mostly following nephrectomy and percutaneous nephrolithotomy.

Authors
Wang, H-HS; Tejwani, R; Zhang, H; Wiener, JS; Routh, JC
MLA Citation
Wang, H-HS, Tejwani, R, Zhang, H, Wiener, JS, and Routh, JC. "Hospital Surgical Volume and Associated Postoperative Complications of Pediatric Urological Surgery in the United States." The Journal of urology 194.2 (August 2015): 506-511.
PMID
25640646
Source
epmc
Published In
The Journal of Urology
Volume
194
Issue
2
Publish Date
2015
Start Page
506
End Page
511
DOI
10.1016/j.juro.2015.01.096

Utility scores for vesicoureteral reflux and anti-reflux surgery.

Management of vesicoureteral reflux (VUR) continues to be controversial. In conditions of uncertainty, decision analytic techniques such as cost-utility analysis (CUA) can help to structure the decision-making process. However, CUA analyses require a "utility," a value between 0 (death) and 1 (perfect health) corresponding to the quality of life associated with a health state. Ideally, utility values are elicited directly from representative community samples, but utilities have not been rigorously measured for pediatric urology conditions.To elicit utility scores for VUR and open anti-reflux surgery (ARS) from a representative, well-characterized community sample of adults who have been parents.Cross-sectional survey of nationally representative adults who had ever been parents. Each respondent saw one of four descriptions of VUR, with or without continuous antibiotic prophylaxis (CAP) and occurrence of febrile urinary tract infection (UTI). A 6-week postoperative health state following ARS was also assessed. We used the time trade-off (TTO) method to elicit utility scores. Factors associated with utility score were assessed with a multivariate linear regression model.The survey was completed by 1200 individuals. Data were weighted to adjust for demographic differences between responders and non-responders. Mean age was 52 ± 15 years, 44% were male, and 68% were White. In terms of education, 29% had a college degree or higher. The mean utility score for VUR overall was 0.82 ± 0.28. VUR utility scores did not differ significantly based on inclusion of CAP or UTI in the health state description (p = 0.21). The 6-week postoperative period garnered a utility of 0.71 ± 0.43.Our results showed that VUR has a mean utility score of 0.82, which indicates that the community perceives this condition to be a substantial burden. For comparison, conditions with similar utility scores include compensated hepatitis B-related cirrhosis (0.80) and glaucoma (0.82); conditions with higher utilities include neonatal jaundice (0.99) and transient neonatal neurological symptoms (0.95); and conditions with lower utility scores include severe depression (0.43) and major stroke (0.30). Our results suggest that parents consider the burden associated with VUR to be significant, and that the impact of the condition on families and children is substantial.VUR is perceived as having a substantial impact on health-related quality of life, with a utility value of 0.82. However, use of CAP and occurrence of UTI do not seem to affect significantly the community perspective on HRQOL associated with living with VUR.

Authors
Nelson, CP; Routh, JC; Logvinenko, T; Rosoklija, I; Kokorowski, PJ; Prosser, LA; Schuster, MA
MLA Citation
Nelson, CP, Routh, JC, Logvinenko, T, Rosoklija, I, Kokorowski, PJ, Prosser, LA, and Schuster, MA. "Utility scores for vesicoureteral reflux and anti-reflux surgery." Journal of pediatric urology 11.4 (August 2015): 177-182.
PMID
25975732
Source
epmc
Published In
Journal of Pediatric Urology
Volume
11
Issue
4
Publish Date
2015
Start Page
177
End Page
182
DOI
10.1016/j.jpurol.2015.03.008

Factors impacting survival in children with renal cell carcinoma.

Renal cell carcinoma (RCC) is an uncommon tumor in the pediatric population. We examined a large national cancer database to determine outcomes for children with RCC and to identify variables affecting long-term survival.The National Cancer Data Base (NCDB) was queried for patients age 0 to 17 years diagnosed with RCC from 1998-2011. Patient demographics, tumor stage and characteristics, management, and outcomes were evaluated.A total of 304 children met inclusion criteria. Overall, 39% of children had stage I disease, 16% stage II, 33% stage III, and 12% stage IV. One-year and five-year survival for all children was 87% and 70%, respectively. Eighty-six percent of patients underwent surgical resection. In comparison to children who underwent complete nephrectomy, patients undergoing partial nephrectomy had smaller tumors and were of lower clinical stages. Survival following partial resection was 100% at one and five years. Age and gender had no significant impact on survival. Survival was negatively impacted by increasing tumor size (P<0.001), positive nodal status (P=0.001), and higher pathologic stage (P<0.001).Children with renal cell carcinoma who undergo surgical resection have excellent one-year and five-year survival. Overall survival is significantly affected by pathologic stage, tumor size, and nodal status.

Authors
Rialon, KL; Gulack, BC; Englum, BR; Routh, JC; Rice, HE
MLA Citation
Rialon, KL, Gulack, BC, Englum, BR, Routh, JC, and Rice, HE. "Factors impacting survival in children with renal cell carcinoma." Journal of pediatric surgery 50.6 (June 2015): 1014-1018.
PMID
25805005
Source
epmc
Published In
Journal of Pediatric Surgery
Volume
50
Issue
6
Publish Date
2015
Start Page
1014
End Page
1018
DOI
10.1016/j.jpedsurg.2015.03.027

Estimating the nationwide, hospital based economic impact of pediatric urolithiasis.

The incidence of urolithiasis is increasing in children and adolescents but the economic impact of this problem is unclear. We examined 2 large databases to estimate the nationwide economic impact of pediatric urolithiasis.We analyzed the 2009 NEDS and KID, used ICD-9-CM codes to identify children 18 years or younger diagnosed with urolithiasis and abstracted demographic and charge data from each database.We identified 7,348 weighted inpatient discharges in KID and 33,038 emergency department weighted encounters in NEDS. Of the patients 32% and 36% were male, respectively. Inpatients were younger than those who presented to the ED (mean age 13.9 vs 15.7 years). Most patients had private insurance (52.9% to 57.2%) and the South was the most common geographic region (39.5% to 44.4%). The most common procedures were ureteral stent placement in 20.4% to 24.1% of cases, followed by ureteroscopy in 3.8% to 4.4%. Median charges per admission were $13,922 for a weighted total of $229 million per year. Median emergency department charges were $3,991 per encounter for a weighted total of $146 million per year.Each day in 2009 in the United States an estimated 20 children were hospitalized and 91 were treated in the emergency department for upper tract stones. A conservative estimate of 2009 annual charges related to pediatric urolithiasis in the United States is at least $375 million. This is likely a significant underestimate of the true economic burden of pediatric urolithiasis because it accounts for neither outpatient management nor indirect costs such as caregiver time away from work.

Authors
Wang, H-HS; Wiener, JS; Lipkin, ME; Scales, CD; Ross, SS; Routh, JC
MLA Citation
Wang, H-HS, Wiener, JS, Lipkin, ME, Scales, CD, Ross, SS, and Routh, JC. "Estimating the nationwide, hospital based economic impact of pediatric urolithiasis." The Journal of urology 193.5 Suppl (May 2015): 1855-1859.
PMID
25305358
Source
epmc
Published In
The Journal of Urology
Volume
193
Issue
5 Suppl
Publish Date
2015
Start Page
1855
End Page
1859
DOI
10.1016/j.juro.2014.09.116

Untitled

Authors
Routh, JC
MLA Citation
Routh, JC. "Untitled." JOURNAL OF UROLOGY 193.5 (May 2015): 1741-1742.
Source
wos-lite
Published In
The Journal of Urology
Volume
193
Issue
5
Publish Date
2015
Start Page
1741
End Page
1742

Editorial comment.

Authors
Routh, JC
MLA Citation
Routh, JC. "Editorial comment." The Journal of urology 193.5 Suppl (May 2015): 1741-1742.
PMID
25817161
Source
epmc
Published In
The Journal of Urology
Volume
193
Issue
5 Suppl
Publish Date
2015
Start Page
1741
End Page
1742
DOI
10.1016/j.juro.2014.10.132

Complications of surgical management of upper tract calculi in spina bifida patients: analysis of nationwide data.

The management of upper urinary tract stones in patients with spina bifida is challenging but poorly described in the literature. We compared urolithiasis interventions and related complications in patients with spina bifida to those in other stone formers using a national database.We retrospectively reviewed the NIS to identify hospital admissions for renal and ureteral stones from 1998 to 2011. We used ICD-9-CM codes to identify urological interventions, including shock wave lithotripsy, ureteroscopy, percutaneous nephrolithotomy and ureteral stent placement. NSQIP data were used to identify postoperative complications.We identified 4,287,529 weighted stone hospital admissions, including 12,315 (0.3%) of patients with spina bifida. Compared to those without spina bifida the patients with spina bifida who had urolithiasis were significantly younger (mean age 34 vs 53 years), more likely to have public insurance (72% vs 44%) and renal vs ureteral calculi (81% vs 58%), and undergo percutaneous nephrolithotomy (27% vs 8%). After adjusting for age, insurance, comorbidity, treatment year, surgery type, stone location and hospital factors patients with spina bifida were more likely to have urinary tract infections (OR 2.5), urinary complications (OR 3.1), acute renal failure (OR 1.9), respiratory complications (OR 2.0), pneumonia (OR 1.5), respiratory insufficiency (OR 3.2), prolonged mechanical ventilation (OR 3.2), sepsis (OR 2.7), pulmonary embolism (OR 3.0), cardiac complications (OR 2.4) and bleeding (OR 1.6).Compared to those without spina bifida the patients with spina bifida who were hospitalized for urolithiasis were younger, and more likely to have renal stones and undergo percutaneous nephrolithotomy. Urolithiasis procedures in patients with spina bifida were associated with a significantly higher risk of in-hospital postoperative complications.

Authors
Wang, H-HS; Wiener, JS; Ferrandino, MN; Lipkin, ME; Routh, JC
MLA Citation
Wang, H-HS, Wiener, JS, Ferrandino, MN, Lipkin, ME, and Routh, JC. "Complications of surgical management of upper tract calculi in spina bifida patients: analysis of nationwide data." The Journal of urology 193.4 (April 2015): 1270-1274.
PMID
25261805
Source
epmc
Published In
The Journal of Urology
Volume
193
Issue
4
Publish Date
2015
Start Page
1270
End Page
1274
DOI
10.1016/j.juro.2014.09.095

Efficacy of antibiotic prophylaxis in children with vesicoureteral reflux: systematic review and meta-analysis.

Controversy exists regarding the use of continuous antibiotic prophylaxis vs observation in the management of children with vesicoureteral reflux. The reported effectiveness of continuous antibiotic prophylaxis in children with reflux varies widely. We determined whether the aggregated evidence supports use of continuous antibiotic prophylaxis in children with vesicoureteral reflux.We searched the Cochrane Controlled Trials Register, clinicaltrials.gov, MEDLINE(®), EMBASE(®), Google Scholar and recently presented meeting abstracts for reports in any language. Bibliographies of included studies were then hand searched for any missed articles. The study protocol was prospectively registered at PROSPERO (No. CRD42014009639). Reports were assessed and data abstracted in duplicate, with differences resolved by consensus. Risk of bias was assessed using standardized instruments.We identified 1,547 studies, of which 8 are included in the meta-analysis. Pooled results demonstrated that continuous antibiotic prophylaxis significantly reduced the risk of recurrent febrile or symptomatic urinary tract infection (pooled OR 0.63, 95% CI 0.42-0.96) but, if urinary tract infection occurred, increased the risk of antibiotic resistant organism (pooled OR 8.75, 95% CI 3.52-21.73). A decrease in new renal scarring was not associated with continuous antibiotic prophylaxis use. Adverse events were similar between the 2 groups. Significant heterogeneity existed between studies (I(2) 50%, p = 0.03), specifically between those trials with significant risk of bias (eg unclear protocol descriptions and/or lack of blinding).Compared to no treatment, continuous antibiotic prophylaxis significantly reduced the risk of febrile and symptomatic urinary tract infections in children with vesicoureteral reflux, although it increased the risk of infection due to antibiotic resistant bacteria. Continuous antibiotic prophylaxis did not significantly impact the occurrence of new renal scarring or reported adverse events.

Authors
Wang, H-HS; Gbadegesin, RA; Foreman, JW; Nagaraj, SK; Wigfall, DR; Wiener, JS; Routh, JC
MLA Citation
Wang, H-HS, Gbadegesin, RA, Foreman, JW, Nagaraj, SK, Wigfall, DR, Wiener, JS, and Routh, JC. "Efficacy of antibiotic prophylaxis in children with vesicoureteral reflux: systematic review and meta-analysis." The Journal of urology 193.3 (March 2015): 963-969. (Review)
PMID
25196653
Source
epmc
Published In
The Journal of Urology
Volume
193
Issue
3
Publish Date
2015
Start Page
963
End Page
969
DOI
10.1016/j.juro.2014.08.112

Emergent care patterns in patients with spina bifida: a case-control study.

Individuals with spina bifida are typically followed closely as outpatients by multidisciplinary teams. However, emergent care of these patients is not well defined. We describe patterns of emergent care in patients with spina bifida and healthy controls.We reviewed Nationwide Emergency Department Sample data from 2006 to 2010. Subjects without spina bifida (controls) were selected from the sample using stratified random sampling and matched to each case by age, gender and treatment year at a 1:4 ratio. Missing emergency department charges were estimated by multiple imputation. Statistical analyses were performed to compare patterns of care among emergency department visits and charges.A total of 226,709 patients with spina bifida and 888,774 controls were identified. Mean age was 28.2 years, with 34.6% of patients being younger than 21. Patients with spina bifida were more likely than controls to have public insurance (63.7% vs 35.4%, p <0.001) and to be admitted to the hospital from the emergency department (37.0% vs 9.2%, p <0.001). Urinary tract infections were the single most common acute diagnosis in patients with spina bifida seen emergently (OR 8.7, p <0.001), followed by neurological issues (OR 2.0, p <0.001). Urological issues were responsible for 34% of total emergency department charges. Mean charges per encounter were significantly higher in spina bifida cases vs controls ($2,102 vs $1,650, p <0.001), as were overall charges for patients subsequently admitted from emergent care ($36,356 vs $29,498, p <0.001).Compared to controls, patients with spina bifida presenting emergently are more likely to have urological or neurosurgical problems, to undergo urological or neurosurgical procedures, to be admitted from the emergency department and to incur higher associated charges.

Authors
Wang, H-HS; Wiener, JS; Ross, SS; Routh, JC
MLA Citation
Wang, H-HS, Wiener, JS, Ross, SS, and Routh, JC. "Emergent care patterns in patients with spina bifida: a case-control study." The Journal of urology 193.1 (January 2015): 268-273.
PMID
25016137
Source
epmc
Published In
The Journal of Urology
Volume
193
Issue
1
Publish Date
2015
Start Page
268
End Page
273
DOI
10.1016/j.juro.2014.06.085

Editorial comment.

Authors
Moul, JW; Semans, JH
MLA Citation
Moul, JW, and Semans, JH. "Editorial comment." Urology 85.1 (January 2015): 90-.
PMID
25530369
Source
epmc
Published In
Urology
Volume
85
Issue
1
Publish Date
2015
Start Page
90
DOI
10.1016/j.urology.2014.07.073

Editorial Comment

Authors
Routh, JC
MLA Citation
Routh, JC. "Editorial Comment (Accepted)." Journal of Urology (2015).
Source
scopus
Published In
The Journal of Urology
Publish Date
2015
DOI
10.1016/j.juro.2014.10.132

Estimating utility values for vesicoureteral reflux in the general public using an online tool.

Cost-utility analyses are useful to study conditions without a widely accepted treatment algorithm; in pediatric urology, one such condition is vesicoureteral reflux (VUR). A necessary component of cost-utility analyses is to accurately calculate the "utility", a numerical surrogate of quality of life, for various health states. Our aims were to determine utility values for representative VUR health states and to verify the feasibility of a novel online platform for utility elicitation in order to reduce the time and expense of such analyses.A cross-sectional survey of American adults was conducted using the time-trade-off (TTO) method. Respondents were recruited from an online work interface, Amazon's Mechanical Turk (MTurk). Four annualized VUR health states were assessed: VUR treated with/without continuous antibiotic prophylaxis (CAP) and with/without associated febrile urinary tract infection (UTI). A 6-week post-operative scenario following open ureteroneocystostomy was also assessed.We received 278 survey responses (70% response rate). The respondents were largely between the ages of 25 and 44 (59%), female (60%), and Caucasian (76%). Thirty-seven percent had a college degree, and 44% were parents. Compared with a perfect health state of 1.0, we found mean utilities of 0.87 for VUR, regardless of whether CAP was used or whether UTI was present (p=0.9). The immediate post-operative period following ureteroneocystostomy garnered an annualized utility of 0.94.Our data suggest that MTurk-based utility assessment is feasible, and that subjects view the VUR health state as only slightly inferior to perfect health. This includes VUR health states incorporating CAP and febrile UTI.

Authors
Lloyd, JC; Yen, T; Pietrobon, R; Wiener, JS; Ross, SS; Kokorowski, PJ; Nelson, CP; Routh, JC
MLA Citation
Lloyd, JC, Yen, T, Pietrobon, R, Wiener, JS, Ross, SS, Kokorowski, PJ, Nelson, CP, and Routh, JC. "Estimating utility values for vesicoureteral reflux in the general public using an online tool." Journal of pediatric urology 10.6 (December 2014): 1026-1031.
PMID
24766856
Source
epmc
Published In
Journal of Pediatric Urology
Volume
10
Issue
6
Publish Date
2014
Start Page
1026
End Page
1031
DOI
10.1016/j.jpurol.2014.02.014

Commentary to "Cumulative incidence of outcomes and urologic procedures after augmentation cystoplasty".

Authors
Routh, JC
MLA Citation
Routh, JC. "Commentary to "Cumulative incidence of outcomes and urologic procedures after augmentation cystoplasty"." Journal of pediatric urology 10.6 (December 2014): 1050-.
PMID
24916578
Source
epmc
Published In
Journal of Pediatric Urology
Volume
10
Issue
6
Publish Date
2014
Start Page
1050
DOI
10.1016/j.jpurol.2014.03.020

Use of nephron sparing surgery and impact on survival in children with Wilms tumor: a SEER analysis.

Nephron sparing surgery is the standard of care for many adults with renal tumors and has been described in some children with Wilms tumor. However, beyond case series the data concerning nephron sparing surgery application and outcomes in patients with Wilms tumor are scarce. We examined nephron sparing surgery outcomes and factors associated with its application in children with Wilms tumor.We retrospectively reviewed the 1998 to 2010 SEER database. We identified patients 18 years old or younger with Wilms tumor. Clinical, demographic and socioeconomic data were abstracted, and statistical analysis was performed using multivariate logistic regression (predicting use of nephron sparing surgery limited to unilateral tumors smaller than 15 cm) and Cox regression (predicting overall survival) models.We identified 876 boys and 956 girls with Wilms tumor (mean ± SD age 3.3 ± 2.9 years). Of these patients 114 (6.2%) underwent nephron sparing surgery (unilateral Wilms tumor in 74 and bilateral in 37). Median followup was 7.1 years. Regarding procedure choice, nephron sparing surgery was associated with unknown lymph node status (Nx vs N0, p <0.001) and smaller tumor size (p <0.001). Regarding survival, only age (HR 1.09, p = 0.002), race (HR 2.48, p = 0.002), stage (HR 2.99, p <0.001) and lymph node status (HR 2.17, p = 0.001) predicted decreased overall survival. Survival was not significantly different between children undergoing nephron sparing surgery and radical nephrectomy (HR 0.79, p = 0.58).In children with Wilms tumor included in the SEER database nephron sparing surgery has been infrequently performed. Nephron sparing surgery application is associated with smaller, bilateral tumors and with omission of lymphadenectomy. However, there are no evident differences in application of nephron sparing surgery based on demographic or socioeconomic factors. Despite lymph node under staging, overall survival is similar between patients undergoing nephron sparing surgery and radical nephrectomy.

Authors
Wang, H-HS; Abern, MR; Cost, NG; Chu, DI; Ross, SS; Wiener, JS; Routh, JC
MLA Citation
Wang, H-HS, Abern, MR, Cost, NG, Chu, DI, Ross, SS, Wiener, JS, and Routh, JC. "Use of nephron sparing surgery and impact on survival in children with Wilms tumor: a SEER analysis." The Journal of urology 192.4 (October 2014): 1196-1202.
PMID
24735935
Source
epmc
Published In
The Journal of Urology
Volume
192
Issue
4
Publish Date
2014
Start Page
1196
End Page
1202
DOI
10.1016/j.juro.2014.04.003

Resolution rate of isolated low-grade hydronephrosis diagnosed within the first year of life.

Diagnosis of low-grade hydronephrosis often occurs prenatally, during evaluation after urinary tract infection (UTI), or imaging for non-urologic reasons within the first year of life. Its significance in terms of resolution, need for antibiotic prophylaxis, or progression to surgery remains uncertain. We hypothesized that isolated low-grade hydronephrosis in this population frequently resolves, UTIs are infrequent, and progression to surgical intervention is minimal.Children < 12 months old diagnosed hydronephrosis (Society for Fetal Urology [SFU] grade 1 or 2) between January 2004 and December 2009 were identified by ICD9 code. Patients with other urological abnormalities were excluded. Stability of hydronephrosis, UTI (≥ 100,000 CFU/mL bacterial growth) or need for surgical intervention was noted.Of 1496 infants with hydronephrosis, 416 (623 renal units) met inclusion criteria. Of 398 renal units with grade 1 hydronephrosis, 385 (96.7%) resolved or remained stable. Only 13 (3.3%) worsened, of which one underwent ureteroneocystostomy. Of 225 renal units with grade 2 hydronephrosis, 222 (98.7%) resolved, improved or remained stable, three (1.3%) worsened, of which one required pyeloplasty. Only 0.7% of patients in the ambulatory setting had a febrile UTI.Low-grade hydronephrosis diagnosed within the first year of life remains stable or improves in 97.4% of renal units. Given the low rate of recurrent UTI in the ambulatory setting, antibiotic prophylaxis has a limited role in management.

Authors
Madden-Fuentes, RJ; McNamara, ER; Nseyo, U; Wiener, JS; Routh, JC; Ross, SS
MLA Citation
Madden-Fuentes, RJ, McNamara, ER, Nseyo, U, Wiener, JS, Routh, JC, and Ross, SS. "Resolution rate of isolated low-grade hydronephrosis diagnosed within the first year of life." Journal of pediatric urology 10.4 (August 6, 2014): 639-644.
PMID
25185821
Source
epmc
Published In
Journal of Pediatric Urology
Volume
10
Issue
4
Publish Date
2014
Start Page
639
End Page
644
DOI
10.1016/j.jpurol.2014.07.004

Variation in use of nephron-sparing surgery among children with renal tumors.

Given the negative long-term effects of renal insufficiency, nephron-sparing surgery (NSS) is increasingly discussed for the treatment of pediatric renal tumors. We sought to examine variation in practice patterns of NSS among children with renal tumors.We performed a retrospective cohort analysis of claims data for pediatric inpatient admissions captured by the Kids Inpatient Database (1997-2009). We identified children with renal tumors who underwent surgery, including radical nephrectomy (RN) and NSS. We used multivariable logistic regression to assess the relationship between use of NSS and various clinical, demographic, and geographic predictors of interest.We identified 10,108 pediatric inpatient admissions for renal tumors. Of these, 1657 were surgical admissions, with 1501 patients (90.5%) undergoing RN and 156 (9.5%) undergoing NSS. On multivariable analysis, NSS was associated only with a concomitant diagnosis of renal insufficiency (relative ratio [RR] 3.37, p = 0.01) and surgery in the Northeastern USA (RR 3.07, p = 0.03). Race/ethnicity, age, payer type, procedure year, and other non-clinical factors were not significantly associated with NSS.In a large, nationwide pediatric cohort, RN remains the most common surgical intervention for renal tumors. NSS is significantly associated with a diagnosis of renal insufficiency, but not non-clinical factors such as patient gender or race. © 2014 Published by Elsevier Ltd on behalf of Journal of Pediatric Urology Company.

Authors
Chu, DI; Lloyd, JC; Balsara, ZR; Wiener, JS; Ross, SS; Routh, JC
MLA Citation
Chu, DI, Lloyd, JC, Balsara, ZR, Wiener, JS, Ross, SS, and Routh, JC. "Variation in use of nephron-sparing surgery among children with renal tumors." Journal of pediatric urology 10.4 (August 2014): 724-729.
PMID
24517904
Source
epmc
Published In
Journal of Pediatric Urology
Volume
10
Issue
4
Publish Date
2014
Start Page
724
End Page
729
DOI
10.1016/j.jpurol.2013.12.019

Evaluation of cold ischemia for preservation of testicular function during partial orchiectomy in the rat model.

We hypothesized that cold ischemia during partial orchiectomy would lead to higher serum testosterone levels and preservation of testicular architecture than warm ischemia in a prepubescent rat model.Eighteen prepubescent male Sprague-Dawley rats were randomized to three different surgical groups: sham surgery, bilateral partial orchiectomy with 30 min of cord compression with cold ischemia, or bilateral partial orchiectomy with 30 min of cord compression with warm ischemia. Animals were killed at puberty, and serum, sperm, and testicles were collected. Histological tissue injury was graded by standardized methodology.Mean serum testosterone levels were 1445 ± 590 pg/mL for the sham group, 449 ± 268 pg/mL for the cold ischemia group and 879 ± 631 pg/mL for the warm ischemia group (p = 0.12). Mean sperm counts were 2.1 × 10(7) for sham, 4.4 × 10(6) for cold ischemia, and 9.9 × 10(6) for the warm ischemia groups (p = 0.48). Histological evaluation revealed significant difference in tissue injury grading with more injury in the cold ischemia than in the warm ischemia group (p = 0.01).In our preclinical rat model, we found no benefit for cold ischemia over warm ischemia at 30 min.

Authors
McNamara, ER; Madden-Fuentes, RJ; Routh, JC; Rouse, D; Madden, JF; Wiener, JS; Rushton, HG; Ross, SS
MLA Citation
McNamara, ER, Madden-Fuentes, RJ, Routh, JC, Rouse, D, Madden, JF, Wiener, JS, Rushton, HG, and Ross, SS. "Evaluation of cold ischemia for preservation of testicular function during partial orchiectomy in the rat model." Journal of pediatric urology 10.4 (August 2014): 593-597.
PMID
25128916
Source
epmc
Published In
Journal of Pediatric Urology
Volume
10
Issue
4
Publish Date
2014
Start Page
593
End Page
597
DOI
10.1016/j.jpurol.2014.06.005

Editorial Comment

Authors
Routh, JC
MLA Citation
Routh, JC. "Editorial Comment." Urology 84.1 (July 2014): 195-196.
Source
crossref
Published In
Urology
Volume
84
Issue
1
Publish Date
2014
Start Page
195
End Page
196
DOI
10.1016/j.urology.2014.02.031

Editorial comment.

Authors
Routh, JC
MLA Citation
Routh, JC. "Editorial comment." Urology 84.1 (July 2014): 195-196.
PMID
24857276
Source
epmc
Published In
Urology
Volume
84
Issue
1
Publish Date
2014
Start Page
195
End Page
196
DOI
10.1016/j.urology.2014.02.031

Congenital Spigelian hernia and ipsilateral cryptorchidism: Raising awareness among urologists

Spigelian hernias (SHs) are rare in the pediatric population. Although pediatric general surgeons often treat this defect, the increased association between a congenital SH and an ipsilateral undescended testis suggests that urologists may be the first provider encountering this entity. Knowledge of this condition is therefore important. We report one such case of a male infant referred to urology for an undescended testicle. Further investigation revealed the testicle to be within a congenital SH sac. Herein, we additionally review the literature concerning SHs associated with ipsilateral undescended testicles. © 2014 Published by Elsevier Inc.

Authors
Balsara, ZR; Martin, AE; Wiener, JS; Routh, JC; Ross, SS
MLA Citation
Balsara, ZR, Martin, AE, Wiener, JS, Routh, JC, and Ross, SS. "Congenital Spigelian hernia and ipsilateral cryptorchidism: Raising awareness among urologists." Urology 83.2 (February 1, 2014): 457-459.
Source
scopus
Published In
Urology
Volume
83
Issue
2
Publish Date
2014
Start Page
457
End Page
459
DOI
10.1016/j.urology.2013.09.032

Response to "Reputation rankings for pediatric urology moderately".

Authors
Lloyd, JC; Madden-Fuentes, RJ; Nelson, CP; Kokorowski, PJ; Wiener, JS; Ross, SS; Kutikov, A; Routh, JC
MLA Citation
Lloyd, JC, Madden-Fuentes, RJ, Nelson, CP, Kokorowski, PJ, Wiener, JS, Ross, SS, Kutikov, A, and Routh, JC. "Response to "Reputation rankings for pediatric urology moderately"." J Pediatr Urol 10.1 (February 2014): 201-202. (Letter)
PMID
24076378
Source
pubmed
Published In
Journal of Pediatric Urology
Volume
10
Issue
1
Publish Date
2014
Start Page
201
End Page
202
DOI
10.1016/j.jpurol.2013.08.011

Evaluation of the contralateral inguinal ring in clinically unilateral inguinal hernia: A systematic review and meta-analysis

Purpose: The management of the contralateral inguinal canal in children with clinical unilateral inguinal hernia is controversial. Our objective was to systematically review the literature regarding management of the contralateral inguinal canal. Methods: We searched MEDLINE, EMBASE, and Cochrane databases (1940-2011) using 'hernia' and 'inguinal' and either 'pediatric,' 'infant,' or 'child,' to identify studies of pediatric (age ≤21 years) patients with inguinal hernia. Among clinical unilateral hernia patients, we assessed the number of cases with contralateral patent processus (CPP) and incidence of subsequent clinical metachronous contralateral hernia (MCH). We evaluated three strategies for contralateral management: expectant management, laparoscopic evaluation or pre-operative ultrasound. Pooled estimates of MCH or CPP were generated with random effects by study when heterogeneity was found (I 2 > 50 %, or Cochrane's Q p ≥ 0.10). Results: We identified 2,477 non-duplicated studies, 129 of which met our inclusion criteria and had sufficient information for quantitative analysis. The pooled incidence of MCH after open unilateral repair was 7.3 % (95 % CI 6.5-8.1 %). Laparoscopic examination identified CPP in 30 % (95 % CI 26-34 %). Lower age was associated with higher incidence of CPP (p < 0.01). The incidence of MCH after a negative laparoscopic evaluation was 0.9 % (95 % CI 0.5-1.3 %). Significant heterogeneity was found in studies and pooled estimates should be interpreted with caution. Conclusions: The literature suggests that laparoscopically identified CPP is a poor indicator of future contralateral hernia. Almost a third of patients will have a CPP, while less than one in 10 will develop MCH when managed expectantly. Performing contralateral hernia repair in patients with CPP results in overtreatment in roughly 2 out of 3 patients. © 2013 Springer-Verlag.

Authors
Kokorowski, PJ; Wang, HHS; Routh, JC; Hubert, KC; Nelson, CP
MLA Citation
Kokorowski, PJ, Wang, HHS, Routh, JC, Hubert, KC, and Nelson, CP. "Evaluation of the contralateral inguinal ring in clinically unilateral inguinal hernia: A systematic review and meta-analysis." Hernia 18.3 (January 1, 2014): 311-324. (Review)
Source
scopus
Published In
Hernia
Volume
18
Issue
3
Publish Date
2014
Start Page
311
End Page
324
DOI
10.1007/s10029-013-1146-z

The Publication Ranking Score for pediatric urology: quantifying thought leadership within the subspecialty.

OBJECTIVES: Clinical care parameters are frequently assessed by national ranking systems. However, these rankings do little to comment on institutions' academic contributions. The Publication Ranking Score (PRS) was developed to allow for objective comparisons of scientific thought-leadership at various pediatric urology institutions. METHODS: Faculty lists were compiled for each of the US News & World Report (USNWR) top-50 pediatric urology hospitals. A list of all faculty publications (2006-2011) was then compiled, after adjusting for journal impact factor, and summed to derive a Publication Ranking Score (PRS). PRS rankings were then compared to the USNWR pediatric urology top-50 hospital list. RESULTS: A total of 1811 publications were indexed. PRS rankings resulted in a mean change in rank of 12 positions, compared to USNWR ranks. Of the top-10 USNWR hospitals, only 4 were ranked in the top-10 by the PRS. There was little correlation between the USNWR and PRS ranks for either top-10 (r = 0.42, p = 0.23) or top-50 (r = 0.48, p = 0.0004) hospitals. CONCLUSIONS: PRS institutional ranking differs significantly from the USNWR top-50 hospital list in pediatric urology. While not a replacement, we believe the PRS to be a useful adjunct to the USNWR rankings of pediatric urology hospitals.

Authors
Lloyd, JC; Madden-Fuentes, RJ; Nelson, CP; Kokorowski, PJ; Wiener, JS; Ross, SS; Kutikov, A; Routh, JC
MLA Citation
Lloyd, JC, Madden-Fuentes, RJ, Nelson, CP, Kokorowski, PJ, Wiener, JS, Ross, SS, Kutikov, A, and Routh, JC. "The Publication Ranking Score for pediatric urology: quantifying thought leadership within the subspecialty." J Pediatr Urol 9.6 Pt B (December 2013): 1108-1113.
PMID
23622970
Source
pubmed
Published In
Journal of Pediatric Urology
Volume
9
Issue
6 Pt B
Publish Date
2013
Start Page
1108
End Page
1113
DOI
10.1016/j.jpurol.2013.03.012

The effect of dietary sodium and fructose intake on urine and serum parameters of stone formation in a pediatric mouse model: a pilot study.

PURPOSE: Dietary factors have a role in stone disease in adults but little is known about the relationship in children. We tested whether diet could alter urine and serum parameters in a pediatric mouse model. MATERIALS AND METHODS: We randomized 30 female BALB/c mice at age 3 weeks to mouse chow, a complex carbohydrate Western diet or a high fructose, high sodium Western diet. Body weight was measured twice weekly. Urine was periodically collected and mice were sacrificed on day 30. Samples were pooled to analyze serum and urine electrolyte factors. RESULTS: There was no significant difference in body weights among the groups at any time or in kidney weight at sacrifice (each p >0.15). There was no observable increase in urine stone forming analytes across the arms except uric acid, which tended to be higher in the Western diet and high fructose, high sodium Western diet groups. There was a substantial decrease in urinary stone inhibitors (magnesium and citrate), a decrease in urinary potassium and an increase in serum calcium in the 2 Western diet groups. CONCLUSIONS: This pilot study suggests that consuming a Western diet, especially one composed of high fructose and sodium, may alter parameters that predispose to stone formation in children by decreasing stone inhibitors. Results require validation in larger studies and ultimately in humans.

Authors
Ross, SS; Masko, EM; Abern, MR; Allott, EH; Routh, JC; Wiener, JS; Preminger, GM; Freedland, SJ; Lipkin, ME
MLA Citation
Ross, SS, Masko, EM, Abern, MR, Allott, EH, Routh, JC, Wiener, JS, Preminger, GM, Freedland, SJ, and Lipkin, ME. "The effect of dietary sodium and fructose intake on urine and serum parameters of stone formation in a pediatric mouse model: a pilot study." J Urol 190.4 Suppl (October 2013): 1484-1489.
PMID
23473903
Source
pubmed
Published In
The Journal of Urology
Volume
190
Issue
4 Suppl
Publish Date
2013
Start Page
1484
End Page
1489
DOI
10.1016/j.juro.2013.02.3199

Reviewing definitions of urinary continence in the contemporary spina bifida literature: a call for clarity.

BACKGROUND: Urinary continence is a common goal for children with spina bifida and their physicians. However, definitions of urinary continence vary widely across published studies. We systematically assessed the utilization of common definitions of urinary continence in the spina bifida literature. METHODS: We searched library databases for reports (2000-2012) describing urinary continence outcomes in children with spina bifida. We assessed various patient-level factors such as age, lesion level, surgical history, and use of additional therapies, as well as study-level factors such as study design, country of origin, continence definition(s), and method of data collection. RESULTS: Of 473 identified articles, 105 met inclusion criteria, comprising a total of 3209 patients. Of these, 1791 patients (56%) were deemed continent by the study authors. Only 60 studies (57%) clearly defined what they considered to be "continent". The most common definition, used in 24% of all reports, was "always dry". There was no association between journal of publication (p = 0.13), publication year (p = 0.86), study size (p = 0.26), or study country (p = 0.43) and likelihood of a continence definition being included in the manuscript. CONCLUSIONS: The most frequent definition of urinary continence in the spina bifida literature is "always dry". However, definitions were highly variable, and many authors did not define continence at all. Clinicians and researchers alike would be better able to apply research findings toward improving patient care if continence definitions were more explicitly reported and less variable.

Authors
Lloyd, JC; Nseyo, U; Madden-Fuentes, RJ; Ross, SS; Wiener, JS; Routh, JC
MLA Citation
Lloyd, JC, Nseyo, U, Madden-Fuentes, RJ, Ross, SS, Wiener, JS, and Routh, JC. "Reviewing definitions of urinary continence in the contemporary spina bifida literature: a call for clarity." J Pediatr Urol 9.5 (October 2013): 567-574.
PMID
23507290
Source
pubmed
Published In
Journal of Pediatric Urology
Volume
9
Issue
5
Publish Date
2013
Start Page
567
End Page
574
DOI
10.1016/j.jpurol.2013.02.006

Contemporary epidemiological trends in complex congenital genitourinary anomalies.

PURPOSE: Anecdotal evidence suggests that complex congenital genitourinary anomalies are occurring less frequently. However, few epidemiological studies are available to confirm or refute this suggestion. MATERIALS AND METHODS: The Kids' Inpatient Database (KID) is a national, all payer database of several million inpatient pediatric hospitalizations per year, including complicated and uncomplicated in-hospital births. We reviewed the 1997 to 2009 KID to determine the birth prevalence of spina bifida, posterior urethral valves, bladder exstrophy, epispadias, prune belly syndrome, ambiguous genitalia and imperforate anus. For posterior urethral valves and prune belly syndrome we limited our search to newborn males only. RESULTS: During the study period, there was a diagnosis of spina bifida in 3,413 neonates, bladder exstrophy in 214, epispadias in 1,127, ambiguous genitalia in 726, prune belly syndrome in 180, posterior urethral valves in 578 and imperforate anus in 4,040. We identified no significant change in the birth prevalence of spina bifida (from 33.9 new spina bifida births of 100,000 uncomplicated births to 29.0/100,000, p = 0.08), posterior urethral valves (from 10.4/100,000 to 11.0/100,000, p = 0.51), prune belly syndrome (from 4.8/100,000 to 3.3/100,000, p = 0.44) or ambiguous genitalia (from 5.82/100,000 to 5.87/100,000, p = 0.38). There was a significant decrease in the birth prevalence of bladder exstrophy (from 2.4/100,000 to 1.6/100,000 uncomplicated births, p = 0.01) and a significant increase in epispadias (from 8.0/100,000 to 11.6/100,000) and imperforate anus (from 33.6/100,000 to 35.0/100,000, each p = 0.04) during the study period. CONCLUSIONS: The birth prevalence of spina bifida, posterior urethral valves and prune belly syndrome appears to have been stable in the last 12 years. Epispadias, ambiguous genitalia and imperforate anus diagnoses in newborns became more common in the same period, while bladder exstrophy diagnoses became less common.

Authors
Lloyd, JC; Wiener, JS; Gargollo, PC; Inman, BA; Ross, SS; Routh, JC
MLA Citation
Lloyd, JC, Wiener, JS, Gargollo, PC, Inman, BA, Ross, SS, and Routh, JC. "Contemporary epidemiological trends in complex congenital genitourinary anomalies." J Urol 190.4 Suppl (October 2013): 1590-1595.
PMID
23791903
Source
pubmed
Published In
The Journal of Urology
Volume
190
Issue
4 Suppl
Publish Date
2013
Start Page
1590
End Page
1595
DOI
10.1016/j.juro.2013.04.034

Re: Effect of Extracorporeal Shock Wave Lithotripsy on Kidney Growth in Children

Authors
Tasian, G; Routh, JC
MLA Citation
Tasian, G, and Routh, JC. "Re: Effect of Extracorporeal Shock Wave Lithotripsy on Kidney Growth in Children." JOURNAL OF UROLOGY 190.3 (September 2013): 1140-1141.
PMID
23583860
Source
wos-lite
Published In
The Journal of Urology
Volume
190
Issue
3
Publish Date
2013
Start Page
1140
End Page
1141

Variation in definitions of urinary tract infections in spina bifida patients: a systematic review.

OBJECTIVE: Urinary tract infections (UTIs) are a common source of morbidity among children with spina bifida (SB) and are a frequently reported outcome in studies of this patient population. However, the criteria for a diagnosis of UTI are often not stated. We evaluated the literature on SB patients for the criteria that authors use to define parameters in reporting UTI outcomes. METHODS: Embase and Medline were queried with the medical subject heading terms “spinal dysraphism,” “myelomeningocele,” “infection,”and “urinary tract infection.” A second search with the exploded term“spina bifida” and “urinary tract infection” was performed. Original research studies reporting a UTI outcome in SB patients were included and evaluated by 2 independent reviewers for the presence of a UTI definition and diagnostic criteria. RESULTS: We identified 872 publications, of which 124 met inclusion criteria. Forty-five of 124 (36.3%) studies reporting UTI as an outcome provided a definition of UTI. Of 124 studies, 28 (22.6%) were published in pediatric journals and 69 (55.6%) in urology journals. A definition of UTI was provided in 11 (39.3%) and 26 (37.7%) studies, respectively. “Fever,culture, and symptoms” defined a UTI in 17 of 45 studies. Journal category and presence of UTI definitions did not correlate (P = .71). CONCLUSIONS: Explicit definitions for UTI are heterogeneous and infrequently applied in studies of SB patients, limiting study reliability and estimates of true UTI rates in this population. Future studies will benefit from the development and application of a standard definition for UTI in this population.

Authors
Madden-Fuentes, RJ; McNamara, ER; Lloyd, JC; Wiener, JS; Routh, JC; Seed, PC; Ross, SS
MLA Citation
Madden-Fuentes, RJ, McNamara, ER, Lloyd, JC, Wiener, JS, Routh, JC, Seed, PC, and Ross, SS. "Variation in definitions of urinary tract infections in spina bifida patients: a systematic review." Pediatrics 132.1 (July 2013): 132-139. (Review)
PMID
23796735
Source
pubmed
Published In
Pediatrics
Volume
132
Issue
1
Publish Date
2013
Start Page
132
End Page
139
DOI
10.1542/peds.2013-0557

B7-h1 as a biomarker for therapy failure in patients with favorable histology Wilms tumor.

PURPOSE: A minority of children with Wilms tumor will experience tumor recurrence. In a previous pilot study we found an association between expression of an immune costimulatory molecule, B7-H1, and tumor recurrence in favorable histology Wilms tumor. We sought to verify the prognostic value of B7-H1 as a biomarker in favorable histology Wilms tumor. MATERIALS AND METHODS: We performed a nested case-control study of tumors from the Fifth National Wilms Tumor Study. We randomly selected 44 children unsuccessfully treated (cases) and 49 who were successfully treated for favorable histology Wilms tumor (controls). Cases and controls were matched based on tumor stage, and the analysis was restricted to children who underwent initial resection. We excluded patients with stage IV or V disease and those treated with chemotherapy or radiation. Tumor specimens were stained for B7-H1 expression. RESULTS: Of the 93 total samples analyzed 60 (65%) demonstrated B7-H1 staining, with staining diffusely present in 13 (22%) and blastema predominant in 34 (57%). B7-H1 expression was associated with failure of initial therapy (p = 0.006). Patients with tumors showing less than 20% B7-H1 positive cells were at lower risk for treatment failure, while those with tumors exhibiting greater than 60% B7-H1 positive cells were at greater risk for treatment failure. This association appeared to be independent of tumor stage. CONCLUSIONS: B7-H1 expression by favorable histology Wilms tumor is associated with an increased risk of failure of initial therapy.

Authors
Routh, JC; Grundy, PE; Anderson, JR; Retik, AB; Kurek, KC
MLA Citation
Routh, JC, Grundy, PE, Anderson, JR, Retik, AB, and Kurek, KC. "B7-h1 as a biomarker for therapy failure in patients with favorable histology Wilms tumor." J Urol 189.4 (April 2013): 1487-1492.
PMID
23154206
Source
pubmed
Published In
The Journal of Urology
Volume
189
Issue
4
Publish Date
2013
Start Page
1487
End Page
1492
DOI
10.1016/j.juro.2012.11.012

Urological complications and vesicoureteral reflux following pediatric kidney transplantation.

PURPOSE: Ureteral complications of renal transplantation can dramatically impact renal outcomes. We studied whether complications are associated with preexisting genitourinary pathology or transplant using a deceased donor allograft. MATERIALS AND METHODS: We retrospectively reviewed all patients undergoing renal transplantation at our institution between 2000 and 2010. We abstracted patient demographic details, donor type (living vs deceased), end-stage renal disease etiology, reimplant technique, stent use, preoperative and postoperative imaging, history of lower genitourinary pathology and postoperative complication management. RESULTS: A total of 211 kidneys were transplanted into 206 patients (mean age 13.7 years, mean followup 4.6 years). Most patients (89%) underwent extravesical ureteroneocystostomy without stenting (97%), with roughly half (47%) of transplants being from living donors. Preexisting urological pathology was present in 34% of cases. Postoperative obstruction or extravasation occurred in 16 cases (7.6%), of which 15 were acute. Complications were not associated with donor type, preexisting urological pathology other than posterior urethral valves, surgical technique, etiology of end-stage renal disease or patient age. However, posterior urethral valves or other preexisting genitourinary pathology was not associated with an increased likelihood of genitourinary complications. Posterior urethral valves were associated with development of postoperative vesicoureteral reflux (OR 6.7, p = 0.004) but were not associated with stent placement, surgical technique, donor type or etiology of end-stage renal disease. CONCLUSIONS: Patients with posterior urethral valves undergoing renal transplantation are at increased risk for postoperative vesicoureteral reflux but not for other acute surgical complications. There is no association between donor type, etiology of end-stage renal disease, surgical technique or patient age and increased complications.

Authors
Routh, JC; Yu, RN; Kozinn, SI; Nguyen, HT; Borer, JG
MLA Citation
Routh, JC, Yu, RN, Kozinn, SI, Nguyen, HT, and Borer, JG. "Urological complications and vesicoureteral reflux following pediatric kidney transplantation." J Urol 189.3 (March 2013): 1071-1076.
PMID
23022008
Source
pubmed
Published In
The Journal of Urology
Volume
189
Issue
3
Publish Date
2013
Start Page
1071
End Page
1076
DOI
10.1016/j.juro.2012.09.091

Commentary to 'Selective endoscopic treatment of the non-refluxing contralateral ureter prevents new contralateral vesicoureteral reflux'.

Authors
Routh, JC
MLA Citation
Routh, JC. "Commentary to 'Selective endoscopic treatment of the non-refluxing contralateral ureter prevents new contralateral vesicoureteral reflux'." J Pediatr Urol 9.1 (February 2013): 55-56.
PMID
22264625
Source
pubmed
Published In
Journal of Pediatric Urology
Volume
9
Issue
1
Publish Date
2013
Start Page
55
End Page
56
DOI
10.1016/j.jpurol.2011.12.014

Experience with glycerin for antegrade continence enema in patients with neurogenic bowel.

PURPOSE: Malone antegrade continence enemas are used in the management of neurogenic bowel to attain fecal continence. Several different irrigation solutions have been described but glycerin, an osmotic laxative that promotes peristalsis, has rarely been mentioned or studied. We assessed clinical outcomes in our patients with a Malone antegrade continence enema using glycerin based irrigation. MATERIALS AND METHODS: We retrospectively reviewed patients with neurogenic bowel who underwent a Malone antegrade continence enema procedure between 1997 and 2011. Glycerin diluted with tap water followed by a tap water flush is our preferred irrigation protocol. Bowel regimen outcomes examined included fecal continence, emptying time, leakage from stoma, enema volume, frequency and independence. RESULTS: Of the 23 patients with followup greater than 6 months 19 used glycerin based irrigation. Average age at surgery was 8.8 years. Patients using glycerin instilled a median of 30 ml (mean 29) glycerin and 50 ml (131) tap water. Fecal continence rate was 95% and stoma leakage rate was 16%, and only 16% of patients required daily irrigation. CONCLUSIONS: Glycerin is a viable and effective alternative irrigant for antegrade enemas of neurogenic bowel, with an excellent fecal continence rate. The volume of irrigant needed is typically less than 90 ml, which is much less than in published reports using tap water alone.

Authors
Chu, DI; Balsara, ZR; Routh, JC; Ross, SS; Wiener, JS
MLA Citation
Chu, DI, Balsara, ZR, Routh, JC, Ross, SS, and Wiener, JS. "Experience with glycerin for antegrade continence enema in patients with neurogenic bowel." J Urol 189.2 (February 2013): 690-693.
PMID
22986031
Source
pubmed
Published In
The Journal of Urology
Volume
189
Issue
2
Publish Date
2013
Start Page
690
End Page
693
DOI
10.1016/j.juro.2012.08.209

Editorial comment.

Authors
Routh, JC
MLA Citation
Routh, JC. "Editorial comment." J Urol 189.2 (February 2013): 669-670.
PMID
23260546
Source
pubmed
Published In
The Journal of Urology
Volume
189
Issue
2
Publish Date
2013
Start Page
669
End Page
670
DOI
10.1016/j.juro.2012.09.187

p53 Immunohistochemistry Expression in Wilms Tumor: A Prognostic Tool in Detection of Tumor Aggressiveness EDITORIAL COMMENT

Authors
Routh, JC
MLA Citation
Routh, JC. "p53 Immunohistochemistry Expression in Wilms Tumor: A Prognostic Tool in Detection of Tumor Aggressiveness EDITORIAL COMMENT." JOURNAL OF UROLOGY 189.2 (February 2013): 669-670.
Source
wos-lite
Published In
The Journal of Urology
Volume
189
Issue
2
Publish Date
2013
Start Page
669
End Page
670

Quality Assessment of Economic Analyses in Pediatric Urology Reply

Authors
Kokorowski, PJ; Routh, JC; Nelson, CP
MLA Citation
Kokorowski, PJ, Routh, JC, and Nelson, CP. "Quality Assessment of Economic Analyses in Pediatric Urology Reply." UROLOGY 81.2 (February 2013): 268-268.
Source
wos-lite
Published In
Urology
Volume
81
Issue
2
Publish Date
2013
Start Page
268
End Page
268
DOI
10.1016/j.urology.2012.08.100

Quality Assessment of Economic Analyses in Pediatric Urology

Authors
Kokorowski, PJ; Routh, JC; Nelson, CP
MLA Citation
Kokorowski, PJ, Routh, JC, and Nelson, CP. "Quality Assessment of Economic Analyses in Pediatric Urology." UROLOGY 81.2 (February 2013): 263-267.
PMID
23374775
Source
wos-lite
Published In
Urology
Volume
81
Issue
2
Publish Date
2013
Start Page
263
End Page
267
DOI
10.1016/j.urology.2012.08.071

Trends in revision circumcision at pediatric hospitals

Background. We sought to determine the incidence of revision circumcision at freestanding children's hospitals, and examine trends over time. Methods. We searched the Pediatric Health Information Systems database to identify boys undergoing revision circumcision (RC), primary non-newborn circumcision (PC), or lysis of penile adhesions (LPA) from 2004 to 2009. Rates of RC procedures were calculated by dividing the incidence of procedures by the total male ambulatory surgical volume. Results. We identified 34 568 patients of whom 5632 underwent RC, 25 768 PC, and 3168 LPA. The rate of RC increased 119%, which was significantly more than PC (19%; P <.001) or LPA (37%; P <.001). Urologists performed 76% of RC and 12% were performed with other genitourinary procedures. Boys undergoing RC were predominately white (60%) and publicly insured (61%). Conclusions. There was a disproportionate increased rate of RC performed at Pediatric Health Information Systems hospitals compared with PC or LPA. Wide variation exists in rate increases among hospitals. © 2013 The Author(s).

Authors
Kokorowski, PJ; Routh, JC; Hubert, K; Graham, DA; Nelson, CP
MLA Citation
Kokorowski, PJ, Routh, JC, Hubert, K, Graham, DA, and Nelson, CP. "Trends in revision circumcision at pediatric hospitals." Clinical Pediatrics 52.8 (2013): 699-706.
PMID
23820002
Source
scival
Published In
Clinical Pediatrics
Volume
52
Issue
8
Publish Date
2013
Start Page
699
End Page
706
DOI
10.1177/0009922813492878

Partial orchiectomy for bilateral synchronous testicular masses in a prepubescent boy: a case report.

Testicular masses in prepubescent children are typically benign. Most masses are mature teratomas, epidermoid cysts, and stromal tumors. Synchronous bilateral testicular masses in children are rare. The etiology of these includes synchronous primary testicular masses, lymphoma, leukemia, and adrenocortical rest hyperplasia. Partial orchiectomy, or testis-sparing surgery, is now preferred in the management of testicular masses deemed to be benign. We present a case of benign bilateral testicular masses managed with testis-sparing surgery. Six-month follow-up revealed no residual tumor, normal contour of the testes, and no evidence of atrophy.

Authors
Madden-Fuentes, R; Wiener, JS; Ross, SS; Routh, JC
MLA Citation
Madden-Fuentes, R, Wiener, JS, Ross, SS, and Routh, JC. "Partial orchiectomy for bilateral synchronous testicular masses in a prepubescent boy: a case report." Urology 80.5 (November 2012): 1144-1146.
PMID
22743256
Source
pubmed
Published In
Urology
Volume
80
Issue
5
Publish Date
2012
Start Page
1144
End Page
1146
DOI
10.1016/j.urology.2012.04.056

How dry is dry? A review of definitions of continence in the contemporary exstrophy/epispadias literature.

PURPOSE: Definitions of continence following surgery in children with exstrophy-epispadias complex vary widely. We assessed the most common definitions of continence and evaluated the clinical significance of usage patterns for those definitions. MATERIALS AND METHODS: We searched MEDLINE and EMBASE (2000 to 2011) for English language reports describing postoperative continence outcomes in children with exstrophy-epispadias complex. Articles were evaluated and data were abstracted by 2 reviewers. We assessed patient level factors such as age, preoperative diagnoses and use of additional therapies, as well as study level factors such as continence definition(s), country of origin and method of data collection. RESULTS: We identified 884 articles, of which 87 met inclusion criteria. In total these studies included continence outcomes data on 2,681 patients (57% male). Only 59 studies (68%) clearly defined the term "continence." The most common definition of continence was dry with voiding/catheterization every 3 hours (used in 23 studies, or 39%, defining continence). There was no association between publication date (p = 0.17), study location (p = 0.47) or study size (p = 0.81) and continence definition. There was a trend toward improved reporting of methods for continence ascertainment in more recent years (p = 0.02). Of the 2,681 children included 1,372 (51%) were dry by the definition used in their study. CONCLUSIONS: The most frequent definition of continence was "dryness with voiding or catheterization at 3-hour intervals." However, definitions were highly variable and many authors did not define continence at all. To better define outcomes, we recommend that a standardized definition of continence be established and used in future reports.

Authors
Lloyd, JC; Spano, SM; Ross, SS; Wiener, JS; Routh, JC
MLA Citation
Lloyd, JC, Spano, SM, Ross, SS, Wiener, JS, and Routh, JC. "How dry is dry? A review of definitions of continence in the contemporary exstrophy/epispadias literature." J Urol 188.5 (November 2012): 1900-1904.
PMID
22999699
Source
pubmed
Published In
The Journal of Urology
Volume
188
Issue
5
Publish Date
2012
Start Page
1900
End Page
1904
DOI
10.1016/j.juro.2012.07.017

COST- AND RADIATION DOSE-AWARENESS AMONG UROLOGY RESIDENTS: A SURVEY OF ATTITUDES AND EDUCATIONAL NEEDS

Authors
Goldsmith, ZG; Lipkin, ME; Wang, AJ; Ferrandino, MN; Ross, SS; Wiener, JS; Kokorowski, PJ; Preminger, GM; Routh, JC; Neisius, A
MLA Citation
Goldsmith, ZG, Lipkin, ME, Wang, AJ, Ferrandino, MN, Ross, SS, Wiener, JS, Kokorowski, PJ, Preminger, GM, Routh, JC, and Neisius, A. "COST- AND RADIATION DOSE-AWARENESS AMONG UROLOGY RESIDENTS: A SURVEY OF ATTITUDES AND EDUCATIONAL NEEDS." September 2012.
Source
wos-lite
Published In
Journal of Endourology
Volume
26
Publish Date
2012
Start Page
A418
End Page
A418

EFFECTS OF SODIUM AND FRUCTOSE INTAKE ON PEDIATRIC STONE FORMATION

Authors
Masko, EM; Lipkin, ME; Abern, MR; Allott, EH; Gaines, AR; Routh, JC; Wiener, JS; Preminger, GM; Ross, SS
MLA Citation
Masko, EM, Lipkin, ME, Abern, MR, Allott, EH, Gaines, AR, Routh, JC, Wiener, JS, Preminger, GM, and Ross, SS. "EFFECTS OF SODIUM AND FRUCTOSE INTAKE ON PEDIATRIC STONE FORMATION." September 2012.
Source
wos-lite
Published In
Journal of Endourology
Volume
26
Publish Date
2012
Start Page
A111
End Page
A111

Shock wave lithotripsy vs ureteroscopy: variation in surgical management of kidney stones at freestanding children's hospitals.

PURPOSE: Although shock wave lithotripsy has long been considered the gold standard for treatment of kidney stones in children, ureteroscopy has become increasingly common. The factors determining procedure choice at individual centers are unclear. We sought to identify patient and hospital factors associated with the choice between shock wave lithotripsy and ureteroscopy. MATERIALS AND METHODS: We searched the Pediatric Health Information System hospital database to identify patients with renal calculi who underwent inpatient or outpatient shock wave lithotripsy or ureteroscopy between 2000 and 2008. We used multivariate regression to evaluate whether procedure type was associated with hospital level factors, including treating hospital, region, size and teaching status, or patient level factors, including age, race, gender and insurance type. RESULTS: We identified 3,377 children with renal stones, of whom 538 (16%) underwent surgery (shock wave lithotripsy in 48%, ureteroscopy in 52%). Procedures in 445 patients at hospitals performing both procedures were included. The relative proportion of ureteroscopy increased during the study period (24% from 2000 to 2002 vs 50% from 2006 to 2008, p=0.0001). Procedure choice was not significantly associated with patient age (p=0.2), gender (p=0.1), race (p=0.07), insurance (p=0.9), hospital size (p=0.6) or teaching status (p=0.99). Procedure choice varied significantly by geographical region (p=0.05), regional population (p=0.002) and stone location (p<0.0001). On multivariable analysis controlling for stone location, gender and treatment year the treating hospital was still highly associated with procedure choice. CONCLUSIONS: There is wide variation in procedure choice for children with kidney stones at freestanding children's hospitals in the United States. Treatment choice depends significantly on the hospital at which a patient undergoes treatment.

Authors
Wang, H-HS; Huang, L; Routh, JC; Nelson, CP
MLA Citation
Wang, H-HS, Huang, L, Routh, JC, and Nelson, CP. "Shock wave lithotripsy vs ureteroscopy: variation in surgical management of kidney stones at freestanding children's hospitals." J Urol 187.4 (April 2012): 1402-1407.
PMID
22341283
Source
pubmed
Published In
The Journal of Urology
Volume
187
Issue
4
Publish Date
2012
Start Page
1402
End Page
1407
DOI
10.1016/j.juro.2011.12.010

Vesicoureteral reflux: current trends in diagnosis, screening, and treatment.

CONTEXT: Vesicoureteral reflux (VUR) is present in approximately 1% of children in North America and Europe and is associated with an increased risk of pyelonephritis and renal scarring. Despite its prevalence and potential morbidity, however, many aspects of VUR management are controversial. OBJECTIVE: Review the evidence surrounding current controversies in VUR diagnosis, screening, and treatment. EVIDENCE ACQUISITION: A systematic review was performed of Medline, Embase, Prospero, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, clinicaltrials.gov, and the most recent guidelines of relevant medical specialty organizations. EVIDENCE SYNTHESIS: We objectively assessed and summarized the published data, focusing on recent areas of controversy relating to VUR screening, diagnosis, and treatment. CONCLUSIONS: The evidence base for many current management patterns in VUR is limited. Areas that could significantly benefit from additional future research include improved identification of children who are at risk for VUR-related renal morbidity, improved stratification tools for determining which children would benefit most from which VUR treatment option, and improved reporting of long-term outcomes of VUR treatments.

Authors
Routh, JC; Bogaert, GA; Kaefer, M; Manzoni, G; Park, JM; Retik, AB; Rushton, HG; Snodgrass, WT; Wilcox, DT
MLA Citation
Routh, JC, Bogaert, GA, Kaefer, M, Manzoni, G, Park, JM, Retik, AB, Rushton, HG, Snodgrass, WT, and Wilcox, DT. "Vesicoureteral reflux: current trends in diagnosis, screening, and treatment." Eur Urol 61.4 (April 2012): 773-782. (Review)
PMID
22264440
Source
pubmed
Published In
European Urology
Volume
61
Issue
4
Publish Date
2012
Start Page
773
End Page
782
DOI
10.1016/j.eururo.2012.01.002

Prospective measurement of patient exposure to radiation during pediatric ureteroscopy.

PURPOSE: Few data have been reported regarding radiation exposure during pediatric endourological procedures, including ureteroscopy. We measured radiation exposure during pediatric ureteroscopy and identify opportunities for exposure reduction. MATERIALS AND METHODS: We prospectively observed ureteroscopy procedures as part of a quality improvement initiative. Preoperative patient characteristics, operative factors, fluoroscopy settings and radiation exposure were recorded. Our outcomes were entrance skin dose and midline dose (both mGy). Specific modifiable factors were identified as targets for potential quality improvement. RESULTS: Direct observation was performed in 54 consecutive ureteroscopy procedures. Mean±SD patient age was 14.8±3.8 years (range 7.4 to 19.2), with 9 children being younger than 12 years. Mean±SD entrance skin dose was 46.4±48 mGy. Mean±SD midline dose was 6.2±5.0 mGy. The most important major determinant of radiation dose was total fluoroscopy time (mean±SD 2.68±1.8 minutes) followed by dose rate setting, child anteroposterior diameter and source to skin distance (all p<0.01). Analysis of factors affecting exposure levels revealed that use of ureteral access sheaths (p=0.01) and retrograde pyelography (p=0.04) were significantly associated with fluoroscopy time. We also found that dose rate settings were higher than recommended in up to 43% of cases and ideal C-arm positioning could have reduced exposure by 14% (up to 49% in some cases). CONCLUSIONS: Children receive biologically significant radiation doses during ureteroscopy procedures. Several modifiable factors contribute to dose and could be targeted in efforts to implement dose reduction strategies.

Authors
Kokorowski, PJ; Chow, JS; Strauss, K; Pennison, M; Routh, JC; Nelson, CP
MLA Citation
Kokorowski, PJ, Chow, JS, Strauss, K, Pennison, M, Routh, JC, and Nelson, CP. "Prospective measurement of patient exposure to radiation during pediatric ureteroscopy." J Urol 187.4 (April 2012): 1408-1414.
PMID
22341275
Source
pubmed
Published In
The Journal of Urology
Volume
187
Issue
4
Publish Date
2012
Start Page
1408
End Page
1414
DOI
10.1016/j.juro.2011.12.013

Economic and radiation costs of initial imaging approaches after a child's first febrile urinary tract infection.

BACKGROUND. The traditional initial imaging approach following pediatric urinary tract infection is the "bottom-up" approach (cystogram and renal ultrasound). Recently, the "top-down" approach (nuclear renal scan followed by cystogram for abnormal scans only) has gained increasing attention. The relative cost and radiation doses of these are unknown METHODS. The authors used a decision model to evaluate these imaging approaches. Cost and effective radiation dose estimates, including sensitivity analyses, were based on one-time imaging only. RESULTS. Comparing hypothetical cohorts of 100 000 children, the top-down imaging approach cost $82.9 million versus $59.2 million for the bottom-up approach. Per-capita effective radiation dose was 0.72 mSv for top-down compared with 0.06 mSv for bottom-up. CONCLUSIONS. Routine use of nuclear renal scans in children following initial urinary tract infection diagnosis would result in increased imaging costs and radiation doses as compared to initial cystogram and ultrasound. Further data are required to clarify the long-term clinical implications of this increase.

Authors
Routh, JC; Grant, FD; Kokorowski, PJ; Nelson, CP; Fahey, FH; Treves, ST; Lee, RS
MLA Citation
Routh, JC, Grant, FD, Kokorowski, PJ, Nelson, CP, Fahey, FH, Treves, ST, and Lee, RS. "Economic and radiation costs of initial imaging approaches after a child's first febrile urinary tract infection." Clin Pediatr (Phila) 51.1 (January 2012): 23-30.
PMID
21868595
Source
pubmed
Published In
Clinical Pediatrics
Volume
51
Issue
1
Publish Date
2012
Start Page
23
End Page
30
DOI
10.1177/0009922811417294

The best take-home messages from the 2012 American Urological Association annual meeting in Atlanta

Authors
Kader, AK; Ophoven, AV; Gutiérrez-Aceves, J; Goldstein, M; Elliott, S; Khera, M; O'Donnell, PD; González, RR; Sung, GTM; Routh, JC; Krishnamurthi, V; Guru, K; Clarke, HS; Jarrard, DF; Veale, JL
MLA Citation
Kader, AK, Ophoven, AV, Gutiérrez-Aceves, J, Goldstein, M, Elliott, S, Khera, M, O'Donnell, PD, González, RR, Sung, GTM, Routh, JC, Krishnamurthi, V, Guru, K, Clarke, HS, Jarrard, DF, and Veale, JL. "The best take-home messages from the 2012 American Urological Association annual meeting in Atlanta." Urology Times 40.7 (2012).
Source
scival
Published In
Urology Times
Volume
40
Issue
7
Publish Date
2012

Patient and family impact of pediatric genitourinary diagnostic imaging tests

Purpose: The impact of diagnostic genitourinary imaging on patients and families is poorly understood. We measured patient and family reaction to commonly performed genitourinary imaging studies using a standardized measurement tool. Materials and Methods: We surveyed families undergoing genitourinary imaging (renal ultrasound, voiding cystourethrography, radionuclide cystogram, static renal scintigraphy and diuretic renal scintigraphy) using a Likert scaled 11-item survey to assess impact across 4 domains (pain, anxiety, time, satisfaction). Survey scores were analyzed using ANOVA and linear regression. Results: A total of 263 families were surveyed (61 renal ultrasound, 52 voiding cystourethrogram, 55 radionuclide cystogram, 47 mercaptoacetyltriglycine dynamic renal scintigraphy, 48 dimercaptosuccinic acid static renal scintigraphy). Mean patient age was 2.1 years old. Of the patients 45% were male and 77% were white. Patient age, gender and prior genitourinary imaging experience varied by study type. Study type was significantly associated with total and weighted scores on the genitourinary imaging survey (both p <0.0001). Renal ultrasound was scored as better and mercaptoacetyltriglycine dynamic renal scintigraphy was worse than voiding cystourethrogram, radionuclide cystogram and dimercaptosuccinic acid static renal scintigraphy, which did not differ from each other. Other factors associated with worse total scores included patient age 1 to 3 years (p <0.001) and nonwhite race (p = 0.04). Gender, prior testing history, wait time and parent education were not associated with total scores. In the multivariate model renal ultrasound remained the best and mercaptoacetyltriglycine dynamic renal scintigraphy the worst (p <0.0001). In a direct comparison dimercaptosuccinic acid static renal scintigraphy and voiding cystourethrogram total scores did not differ (p = 0.59). Conclusions: There were significant differences among genitourinary imaging studies regarding the patient/family experience, but there was no overall difference between dimercaptosuccinic acid static renal scintigraphy and voiding cystourethrogram. These findings may be useful to aid decision making when considering genitourinary imaging for children. © 2012 American Urological Association Education and Research, Inc.

Authors
Nelson, CP; Chow, JS; Rosoklija, I; Ziniel, S; Routh, JC; Jr, BGC
MLA Citation
Nelson, CP, Chow, JS, Rosoklija, I, Ziniel, S, Routh, JC, and Jr, BGC. "Patient and family impact of pediatric genitourinary diagnostic imaging tests." Journal of Urology 188.4 SUPPL. (2012): 1601-1607.
PMID
22910271
Source
scival
Published In
The Journal of Urology
Volume
188
Issue
4 SUPPL.
Publish Date
2012
Start Page
1601
End Page
1607
DOI
10.1016/j.juro.2012.02.026

Association of urolithiasis with systemic conditions among pediatric patients at children's hospitals

Purpose: Urolithiasis is associated with systemic medical conditions in adults but associations have not been well studied in children. We investigated the association of urolithiasis with diabetes mellitus, hypertension and obesity among children with and without urolithiasis. Materials and Methods: We performed a matched case-control study using the PHIS (Pediatric Health Information System) database. ICD-9 codes identified urolithiasis cases from 2004 to 2009. Four randomly selected controls were matched by age, hospital, patient care setting and year of treatment. Diagnoses from all hospital encounters were ascertained for comorbid conditions. Univariate and multivariable conditional logistic regression was used to assess the associations of urolithiasis with diabetes mellitus, hypertension and obesity. Results: We identified 9,843 urolithiasis cases and 39,047 controls. On univariate analysis stone formers had significantly higher odds of obesity (OR 1.44, 95% CI 1.27-1.64) and hypertension (OR 2.12, 95% CI 1.88-2.40) compared to controls. The odds of type I diabetes mellitus was lower among cases compared to controls (OR 0.38, 95% CI 0.30-0.48). After adjusting for gender, race, insurance type and number of visits using logistic regression, children with urolithiasis still had higher odds of obesity (AOR 1.30, 95% CI 1.12-1.51) and hypertension (AOR 1.61, 95% CI 1.40-1.86) as well as lower odds of type I diabetes mellitus (AOR 0.32, 95% CI 0.25-0.41) compared to controls. Conclusions: Among pediatric patients at freestanding children's hospitals, urolithiasis is associated with higher odds of obesity and hypertension and lower odds of type I diabetes mellitus. These findings may be helpful in further elucidating the etiology of pediatric urolithiasis. © 2012 American Urological Association Education and Research, Inc.

Authors
Kokorowski, PJ; Routh, JC; Hubert, KC; Graham, DA; Nelson, CP
MLA Citation
Kokorowski, PJ, Routh, JC, Hubert, KC, Graham, DA, and Nelson, CP. "Association of urolithiasis with systemic conditions among pediatric patients at children's hospitals." Journal of Urology 188.4 SUPPL. (2012): 1618-1622.
PMID
22906655
Source
scival
Published In
The Journal of Urology
Volume
188
Issue
4 SUPPL.
Publish Date
2012
Start Page
1618
End Page
1622
DOI
10.1016/j.juro.2012.02.019

Racial variation in timing of pyeloplasty: prenatal versus postnatal diagnosis.

PURPOSE: We have previously shown that nonwhite patients with ureteropelvic junction obstruction undergo pyeloplasty at a younger age than white patients. The mechanisms behind this finding are unclear, since there is no known racial variation in the natural history of ureteropelvic junction obstruction. We used a detailed clinical database to explain this phenomenon. MATERIALS AND METHODS: We retrospectively reviewed all patients undergoing primary pyeloplasty at our institution between 1992 and 2008. More than 360 data points were abstracted for each patient, including self-reported race, socioeconomic status, symptom duration and presentation. RESULTS: Of 847 patients undergoing pyeloplasty during the study period 741 met inclusion criteria. Nonwhite patients underwent surgery at a younger age (0.6 years) than whites (2.6 years, p <0.0001). When stratified by timing of clinical presentation (prenatal vs postnatal), there was no significant difference in race among patients presenting prenatally (0.37 vs 0.36 years, p = 0.22). Nonwhite patients presenting postnatally were significantly younger than white patients (6.3 vs 8.2 years, p = 0.03). This finding appeared to be due to differences in age at initial clinical presentation (5.4 vs 7.0 years, p = 0.03) and in time from initial clinical presentation to urological evaluation (0.6 vs 3.2 months, p = 0.03). These differences persisted after correcting for other factors, including markers of socioeconomic status. CONCLUSIONS: Consistent with previous studies, we found that nonwhite patients underwent primary pyeloplasty at a younger age than whites. This difference is limited to patients presenting after birth. Prenatally diagnosed patients underwent surgery at similar ages regardless of race.

Authors
Routh, JC; Pennison, M; Rosoklija, I; Dobbins, S; Kokorowski, PJ; Hubert, KC; Huang, L; Nelson, CP
MLA Citation
Routh, JC, Pennison, M, Rosoklija, I, Dobbins, S, Kokorowski, PJ, Hubert, KC, Huang, L, and Nelson, CP. "Racial variation in timing of pyeloplasty: prenatal versus postnatal diagnosis." J Urol 186.6 (December 2011): 2386-2391.
PMID
22014821
Source
pubmed
Published In
The Journal of Urology
Volume
186
Issue
6
Publish Date
2011
Start Page
2386
End Page
2391
DOI
10.1016/j.juro.2011.07.111

Vesicoureteral reflux in children with urachal anomalies.

OBJECTIVE: We report the largest known series of vesicoureteral reflux (VUR) in children with urachal anomalies (UA). METHODS: Two institutions' records were reviewed for children with UA (1951‒2007). RESULTS: Of 30 girls and 36 boys with UA (34 urachal cysts, 14 patent urachus, 10 urachal diverticula, 7 urachal sinuses, and 1 unknown), 57 (86%) underwent surgical resection or drainage. A voiding cystourethrogram was obtained in 22 (33%). VUR was demonstrated in 14 of the 22 children (64%), and rates were similar among the various types of UA. The median age with versus without VUR was not different (1.3 vs 1.7 years, P=0.97). Of 24 refluxing renal units, classification was grade≤3 in 71%, 4‒5 in 12%, and unspecified in 17%. Four children (26%) underwent ureteroneocystostomy and 10 observed patients resolved spontaneously. CONCLUSION: To our knowledge, this is the first series of VUR associated with UA. The increased incidence of VUR (64%) in this small subset of patients warrants prospective studies to determine if there is a positive correlation with UA. We believe thorough genitourinary and family histories are important when evaluating children with UA to help detect clinically significant VUR.

Authors
Fox, JA; McGee, SM; Routh, JC; Granberg, CF; Ashley, RA; Hutcheson, JC; Vandersteen, DR; Reinberg, YE; Kramer, SA
MLA Citation
Fox, JA, McGee, SM, Routh, JC, Granberg, CF, Ashley, RA, Hutcheson, JC, Vandersteen, DR, Reinberg, YE, and Kramer, SA. "Vesicoureteral reflux in children with urachal anomalies." J Pediatr Urol 7.6 (December 2011): 632-635.
PMID
21565560
Source
pubmed
Published In
Journal of Pediatric Urology
Volume
7
Issue
6
Publish Date
2011
Start Page
632
End Page
635
DOI
10.1016/j.jpurol.2011.04.001

Screening for malignancy after augmentation cystoplasty in children with spina bifida: a decision analysis.

PURPOSE: Augmentation cystoplasty is the mainstay of surgical treatment for medically refractory neurogenic bladder in patients with spina bifida. Concerns regarding an increased risk of malignancy have prompted many centers to consider routine postoperative screening. We examine the potential cost-effectiveness of such screening. MATERIALS AND METHODS: A Markov model was used to compare 2 screening strategies among patients with spina bifida after cystoplasty, namely annual screening cystoscopy and cytology and usual care. Model parameters were informed via a systematic review of post-augmentation malignancy and cost estimates from published reports or government sources. RESULTS: In a hypothetical cohort the individual increase in life expectancy for the entire cohort was 2.3 months with an average lifetime cost of $55,200 per capita, for an incremental cost-effectiveness ratio of $273,718 per life-year gained. One-way and two-way sensitivity analyses suggest the screening strategy could be cost effective if the annual rate of cancer development were more than 0.26% (12.8% lifetime risk) or there were a greater than 50% increase in screening effectiveness and cancer risk after augmentation. After adjusting for multiple levels of uncertainty the screening strategy had only an 11% chance of being cost effective at a $100,000 per life-year threshold or a less than 3% chance of being cost effective at $100,000 per quality adjusted life-year. CONCLUSIONS: Annual screening for malignancy among patients with spina bifida with cystoplasty using cystoscopy and cytology is unlikely to be cost effective at commonly accepted willingness to pay thresholds. This conclusion is sensitive to a higher than expected risk of malignancy and to highly optimistic estimates of screening effectiveness.

Authors
Kokorowski, PJ; Routh, JC; Borer, JG; Estrada, CR; Bauer, SB; Nelson, CP
MLA Citation
Kokorowski, PJ, Routh, JC, Borer, JG, Estrada, CR, Bauer, SB, and Nelson, CP. "Screening for malignancy after augmentation cystoplasty in children with spina bifida: a decision analysis." J Urol 186.4 (October 2011): 1437-1443.
PMID
21855939
Source
pubmed
Published In
The Journal of Urology
Volume
186
Issue
4
Publish Date
2011
Start Page
1437
End Page
1443
DOI
10.1016/j.juro.2011.05.065

Use of the ureteral access sheath during ureteroscopy in children.

PURPOSE: The use of ureteral access sheaths during ureteroscopy is common but there are sparse data on the safety and outcomes of ureteral access sheath use in children. We compared the outcomes of ureteroscopy with vs without a ureteral access sheath in children. MATERIALS AND METHODS: We retrospectively reviewed all ureteroscopy procedures for urolithiasis in patients younger than 21 years at our hospital from 1999 to 2009. The primary outcome was intraoperative complications. Secondary outcomes were postoperative hydronephrosis, emergency room visit/hospital readmission within 90 days, stone-free status and need for re-treatment. We analyzed associations of a ureteral access sheath with outcomes. RESULTS: A total of 34 boys and 62 girls with a mean age of 13 years underwent ureteroscopy. A ureteral access sheath was used in 40 of the 96 patients (42%). The mean stone burden was 9.6 mm. Median followup was 11 months (range 0.2 to 110). Intraoperative complication occurred in 7 cases, including perforation/extravasation in 4, a submucosal wire in 2 and stent migration in 1. Intraoperative complications were more common when a sheath was used (15% vs 2%, adjusted OR 8.2, 95% CI 1.3-50.9, p = 0.02). Postoperative hydronephrosis was observed in 7 of 73 cases (10%) but it was not significantly more common when a sheath was used. No ureteral stricture was identified. Sheath use was not associated with postoperative telephone calls, emergency room visits or rehospitalization. Although the stone-free rate tended to be higher in cases without a sheath (78% vs 59%, p = 0.09), this association was not significant in a multivariate model (p = 0.6). CONCLUSIONS: Although intraoperative complications occur more commonly during ureteroscopy with a ureteral access sheath, no increase in longer term adverse effects were observed. Future prospective studies of ureteral access sheath use in children with longer followup are warranted.

Authors
Wang, H-H; Huang, L; Routh, JC; Kokorowski, P; Cilento, BG; Nelson, CP
MLA Citation
Wang, H-H, Huang, L, Routh, JC, Kokorowski, P, Cilento, BG, and Nelson, CP. "Use of the ureteral access sheath during ureteroscopy in children." J Urol 186.4 Suppl (October 2011): 1728-1733.
PMID
21855908
Source
pubmed
Published In
The Journal of Urology
Volume
186
Issue
4 Suppl
Publish Date
2011
Start Page
1728
End Page
1733
DOI
10.1016/j.juro.2011.03.072

Editor's comment.

Authors
Bhattacharya, S
MLA Citation
Bhattacharya, S. "Editor's comment." Indian J Plast Surg 44.3 (September 2011): 526-.
PMID
22279297
Source
pubmed
Published In
Indian Journal of Plastic Surgery
Volume
44
Issue
3
Publish Date
2011
Start Page
526

Evaluation of the United States pediatric urology workforce and fellowships: a series of surveys performed in 2006-2010.

OBJECTIVE: In the US, there has been an evolution in the practice of pediatric urology from a primary academic sub-specialty focused on reconstruction of major congenital genitorurinary abnormalities to a mixed academic and private practice that serves as the primary care giver for all pediatric urologic concerns. The estimated manpower needs were unable to be resolved, due to our inability to determine the impact of sub-specialty certification on referral patterns, along with the failure to embrace the use of physician extenders. Here, we review a series of surveys performed in 2006-2010 regarding the sub-specialty of pediatric urology. MATERIALS AND METHODS: The four surveys focused on workforce needs, appraised the financial impact of educational debt on the pediatric urology community, and evaluated concerns of the current fellows in training. RESULTS: The median financial income for a pediatric urologist, the resident's educational debt load, and a desire of the fellows to have an open dialog with the urologic community regarding the merits of the research year are revealed. CONCLUSION: We have identified that the ability to recruit fellows into our field is dependent upon a combination of factors: interest in the field, job availability in relationship to geographic locations, mentoring, concerns regarding financial/familial hardships encountered during a 2-year fellowship, and the lack of increased financial reimbursement for the extra training required.

Authors
Husmann, DA; Routh, JC; Hagerty, JA; Cannon, GM; Gomez, P; Cheng, EY; Skoog, S
MLA Citation
Husmann, DA, Routh, JC, Hagerty, JA, Cannon, GM, Gomez, P, Cheng, EY, and Skoog, S. "Evaluation of the United States pediatric urology workforce and fellowships: a series of surveys performed in 2006-2010." J Pediatr Urol 7.4 (August 2011): 446-453.
PMID
21324750
Source
pubmed
Published In
Journal of Pediatric Urology
Volume
7
Issue
4
Publish Date
2011
Start Page
446
End Page
453
DOI
10.1016/j.jpurol.2010.12.009

Contemporary use of nephron-sparing surgery for children with malignant renal tumors at freestanding children's hospitals.

OBJECTIVE: It is widely accepted that, when feasible, nephron-sparing surgery (NSS) is preferable to radical nephrectomy (RN) for treatment of renal tumors in adults. However, RN is more frequently used in children. We sought to compare in-hospital outcomes after NSS and RN for malignant pediatric renal tumors. MATERIAL AND METHODS: The pediatric health information system (PHIS) combines data from more than 40 North American pediatric hospitals. We queried PHIS to identify children with malignant renal tumors who underwent surgery from 2003 to 2009. We examined whether outcomes (complication rates, cost, and length of stay) differed by procedure type. Multivariate regression models were used to adjust for confounding, and generalized estimating equations were used to adjust for hospital clustering. RESULTS: We identified 1235 children with renal tumors who underwent RN (91%) or NSS (9%). Patients undergoing RN and NSS had similar median comorbidity scores (P = .98), hospital lengths of stay (each 6.0 days, P = .54), in-hospital charges, ($25,700 vs $37,000, P = .11), and surgical complication rates (16.4 vs 20.5%, P = .24). These outcomes remained similar after adjusting for other patient and hospital factors. CONCLUSIONS: Most children with malignant renal tumors treated at children's hospitals undergo RN. RN and NSS use were not significantly different in terms of their length of hospital stay, in-hospital charges, and complication rates. Although oncological outcomes are lacking, these data suggest that NSS may be performed in selected children with malignant renal tumors without significantly increasing their hospital charges, length of stay, or surgical complication rates.

Authors
Routh, JC; Graham, DA; Estrada, CR; Nelson, CP
MLA Citation
Routh, JC, Graham, DA, Estrada, CR, and Nelson, CP. "Contemporary use of nephron-sparing surgery for children with malignant renal tumors at freestanding children's hospitals." Urology 78.2 (August 2011): 422-426.
PMID
21689846
Source
pubmed
Published In
Urology
Volume
78
Issue
2
Publish Date
2011
Start Page
422
End Page
426
DOI
10.1016/j.urology.2010.12.048

Does a controversial topic affect the quality of urologic information on the internet?

Objective: Increasingly, patients seek medical information via the Internet, despite highly variable information quality. We sought to determine whether controversial urological topics are associated with decreased content quality or search characteristics. Methods: We systematically searched the Internet for 5 noncontroversial (cryptorchidism, testicular torsion, urethral stricture, testicular cancers, renal cancers) and 5 controversial (disorders of sexual differentiation, circumcision, penile elongation, interstitial cystitis, testosterone therapy) conditions. Number of total hits, sponsored links, page owner and author, accreditation, updates, advertising, readability, and content quality were assessed for each topic. Content quality was determined on a 5-point scale for accuracy and completeness of 3 domains: diagnosis, natural history, and treatment. Results: In total, 100 websites were evaluated. Noncontroversial topics had more hits (1,610,000 vs 475,000) and more sponsored links (30% vs 10%) than controversial topics. Noncontroversial web pages were more likely to have government or medical owners (58% vs 30%, P =.009) than controversial web pages. Website quality was significantly different between noncontroversial and controversial topics. In regard to accuracy, noncontroversial topics had higher scores for diagnosis (4.6 vs 3.8, P <.0001), natural history (4.5 vs 3.2, P <.0001), and treatment (4.6 vs 3.3, P <.0001). Similarly, noncontroversial topics had higher completeness scores for diagnosis (3.8 vs 3.0, P =.001), natural history (3.7 vs 3.0, P =.003), and treatment (3.6 vs 3.0, P =.006). Conclusion: Web pages dedicated to controversial urological topics have lower quality content in regard to diagnosis, natural history, and treatment. Such quality issues may contribute to ongoing public confusion and misinformation regarding these challenging topics. © 2011 Elsevier Inc. All Rights Reserved.

Authors
Routh, JC; Gong, EM; Jr, GMC; Nelson, CP
MLA Citation
Routh, JC, Gong, EM, Jr, GMC, and Nelson, CP. "Does a controversial topic affect the quality of urologic information on the internet?." Urology 78.5 (2011): 1051-1056.
PMID
21945281
Source
scival
Published In
Urology
Volume
78
Issue
5
Publish Date
2011
Start Page
1051
End Page
1056
DOI
10.1016/j.urology.2011.06.050

Editorial comment

Authors
Routh, JC
MLA Citation
Routh, JC. "Editorial comment." Urology 78.1 (2011): 152-153.
PMID
21712119
Source
scival
Published In
Urology
Volume
78
Issue
1
Publish Date
2011
Start Page
152
End Page
153
DOI
10.1016/j.urology.2011.01.058

The gatekeeper disparity-Why do some medical schools send more medical students into urology?

Purpose Urology continues to be a highly desirable specialty despite decreasing exposure of students to urology in American medical schools. We assessed how American medical schools compare to each other in regard to the number of students that each sends into urological training. We evaluated the reasons why some medical schools consistently send more students into urology than others. Materials and Methods We obtained American Urological Association Match data for the 5 match seasons from 2005 to 2009. We then surveyed all successful participants. The survey instrument was designed to determine what aspects of the medical school experience influenced students to specialize in urology. Bivariate and multivariate analysis was then done to assess which factors correlated with more students entering urology from a particular medical school. Results Between 2005 and 2009 a total of 1,149 medical students from 130 medical schools successfully participated in the urology match. Of the 132 allopathic medical schools 128 sent at least 1 student into urology (mean ± SD 8.9 ± 6.5, median 8). A few medical schools were remarkable outliers, sending significantly more students into urology than other institutions. Multivariate analysis revealed that a number of medical school related variables, including strong mentorship, medical school ranking and medical school size, correlated with more medical students entering urology. Conclusions Some medical schools launch more urological careers than others. Although the reasons for these findings are multifactorial, recruitment of urological talent pivots on these realities. © 2011 American Urological Association Education and Research, Inc.

Authors
Kutikov, A; Bonslaver, J; Casey, JT; Degrado, J; Dusseault, BN; Fox, JA; Lashley-Rogers, D; Richardson, I; Smaldone, MC; Steinberg, PL; Trivedi, DB; Routh, JC
MLA Citation
Kutikov, A, Bonslaver, J, Casey, JT, Degrado, J, Dusseault, BN, Fox, JA, Lashley-Rogers, D, Richardson, I, Smaldone, MC, Steinberg, PL, Trivedi, DB, and Routh, JC. "The gatekeeper disparity-Why do some medical schools send more medical students into urology?." Journal of Urology 185.2 (2011): 647-652.
PMID
21168862
Source
scival
Published In
The Journal of Urology
Volume
185
Issue
2
Publish Date
2011
Start Page
647
End Page
652
DOI
10.1016/j.juro.2010.09.113

Editorial comment

Authors
Routh, JC; Nelson, CP
MLA Citation
Routh, JC, and Nelson, CP. "Editorial comment." Urology 77.1 (2011): 199--.
PMID
21195840
Source
scival
Published In
Urology
Volume
77
Issue
1
Publish Date
2011
Start Page
199-
DOI
10.1016/j.urology.2010.07.457

Costs and consequences of universal sibling screening for vesicoureteral reflux: decision analysis.

OBJECTIVE: Our objective was to evaluate screening for vesicoureteral reflux (VUR) among siblings of patients with VUR, in terms of cost, radiation exposure, and number of febrile urinary tract infections (fUTIs) averted. METHODS: We constructed a Markov model to evaluate 2 competing management options, that is, universal screening (cystographic evaluation of all siblings without symptoms) and usual care (cystographic evaluation of siblings only after fUTIs). Published data were used to inform all model inputs. Costs were estimated by using a societal perspective. RESULTS: Universal screening yielded 2980 fUTIs, whereas usual care yielded 6330. Therefore, universal screening for VUR in a cohort of 100,000 siblings 1 year of age without symptoms resulted in the prevention of 1 initial fUTI per 3360 siblings, at an excess cost of $55,600 per averted fUTI, in comparison with usual care. These estimates were heavily dependent on screening age and the effectiveness of antibiotic prophylaxis; prevention of a single fUTI would require screening of 166 siblings 5 years of age and 694 siblings 10 years of age. Similarly, if prophylaxis was ineffective in preventing fUTIs, then up to 10,000 siblings would need to be screened for prevention of a single fUTI. CONCLUSIONS: Prevention of a single fUTI would require screening of 30 to 430 siblings 1 year of age without symptoms, at an estimated excess cost of $56,000 to $820,000 per averted fUTI. These estimates are heavily dependent on screening age and the effectiveness of antibiotic prophylaxis.

Authors
Routh, JC; Grant, FD; Kokorowski, P; Lee, RS; Fahey, FH; Treves, ST; Nelson, CP
MLA Citation
Routh, JC, Grant, FD, Kokorowski, P, Lee, RS, Fahey, FH, Treves, ST, and Nelson, CP. "Costs and consequences of universal sibling screening for vesicoureteral reflux: decision analysis." Pediatrics 126.5 (November 2010): 865-871.
PMID
20956427
Source
pubmed
Published In
Pediatrics
Volume
126
Issue
5
Publish Date
2010
Start Page
865
End Page
871
DOI
10.1542/peds.2010-0744

Trends in imaging and surgical management of pediatric urolithiasis at American pediatric hospitals.

PURPOSE: Little is known of current practice patterns for pediatric urolithiasis. We examined recent trends in imaging and surgical management. MATERIALS AND METHODS: The Pediatric Health Information System database is a national database collected at American pediatric hospitals. We searched the database from 1999 to 2008 to identify children diagnosed with urolithiasis. Inpatient hospital admissions, and emergency department and outpatient medical/surgical short stay visits were included. We examined imaging and surgical management trends during the study period using bivariate and multivariate logistic regression models. RESULTS: We identified 7,921 children diagnosed with urolithiasis during the study period, of whom 1,712 (22%) underwent stone related surgery and 6,318 (80%) underwent stone related diagnostic imaging. The surgery rate remained stable during the study period (p = 0.15), as did the overall imaging rate (p = 0.2). However, computerized tomography use increased (26% to 45%) and plain x-ray of kidneys, ureters and bladder plus excretory urogram use decreased (59% to 38%) during the study period (each p <0.0001). Surgery was associated with older patient age, female gender, white race and private insurance. Computerized tomography use was associated with older patient age, nonwhite race and public insurance. After adjusting for other factors, including hospital region, the treating hospital was most important for predicting surgery or computerized tomography (each p <0.0001). CONCLUSIONS: Surgery and imaging for pediatric urolithiasis remained stable at pediatric hospitals in the last decade, although computerized tomography use has increased. The hospital where a patient receives treatment is the single most important feature driving computerized tomography and surgery use. Patient age, race and insurance status have a smaller but significant role.

Authors
Routh, JC; Graham, DA; Nelson, CP
MLA Citation
Routh, JC, Graham, DA, and Nelson, CP. "Trends in imaging and surgical management of pediatric urolithiasis at American pediatric hospitals." J Urol 184.4 Suppl (October 2010): 1816-1822.
PMID
20728146
Source
pubmed
Published In
The Journal of Urology
Volume
184
Issue
4 Suppl
Publish Date
2010
Start Page
1816
End Page
1822
DOI
10.1016/j.juro.2010.03.117

Predicting renal outcomes in children with anterior urethral valves: a systematic review.

PURPOSE: Prognostic information is limited on children with congenital anterior urethral valves or a diverticulum. We reviewed the literature and examined our clinical database to identify clinical features predicting a poor renal outcome, defined as azotemia, renal failure or death. MATERIALS AND METHODS: We reviewed 97 English language studies of patients 18 years old or younger. Seven patients from our institutions were also included in analysis. After data abstraction we used multivariate models to define factors associated with outcomes of interest. RESULTS: We identified 239 male patients with anterior urethral valves, of whom 139 had adequate data available for study inclusion. Of these patients 108 (78%) had normal renal function after treatment. On bivariate analysis vesicoureteral reflux (OR 22.4, p <0.0001), pretreatment azotemia (OR 17.1, p <0.0001), urinary tract infection (OR 3.3, p = 0.006), hydronephrosis (OR 10.0, p = 0.0004) and bladder trabeculation (OR 7.3, p = 0.01) were associated with renal failure or death while treatment method (p = 0.9), obstruction type (valve vs diverticulum, p = 0.4) and valve location (p = 0.6) were not. After adjusting for other factors only pretreatment azotemia (p = 0.0005) and vesicoureteral reflux (p = 0.01) remained associated with renal failure and/or death with a trend toward significance for urinary tract infection (p = 0.06). When all 3 factors were present, the odds of a poor renal outcome increased 25-fold (p = 0.005). CONCLUSIONS: Congenital anterior urethral obstruction in children has a generally good prognosis but may occasionally result in a poor renal outcome. The combination of pretreatment azotemia, vesicoureteral reflux and urinary tract infection is highly predictive of a poor renal outcome.

Authors
Routh, JC; McGee, SM; Ashley, RA; Reinberg, Y; Vandersteen, DR
MLA Citation
Routh, JC, McGee, SM, Ashley, RA, Reinberg, Y, and Vandersteen, DR. "Predicting renal outcomes in children with anterior urethral valves: a systematic review." J Urol 184.4 Suppl (October 2010): 1615-1619. (Review)
PMID
20728183
Source
pubmed
Published In
The Journal of Urology
Volume
184
Issue
4 Suppl
Publish Date
2010
Start Page
1615
End Page
1619
DOI
10.1016/j.juro.2010.03.119

Epidemiological trends in pediatric urolithiasis at United States freestanding pediatric hospitals.

PURPOSE: Anecdotal and lay press reports suggest that the incidence of pediatric urolithiasis is increasing but reliable data are lacking. The objective of this study was to examine trends in the epidemiology of urolithiasis at pediatric hospitals nationwide. MATERIALS AND METHODS: The Pediatric Health Information System database is a national database covering 42 freestanding United States pediatric hospitals that captures inpatient admissions, and emergency department and outpatient surgery visits. We searched the Pediatric Health Information System database to identify children (18 years old or younger) treated for urolithiasis between 1999 and 2008. Patients with urolithiasis were measured as a proportion of the total number of patients seen per hospital annually. Trends were verified by comparing results to 2 other common pediatric diagnoses-appendicitis and viral bronchiolitis. RESULTS: We identified 7,921 children diagnosed with urolithiasis during the study period. The total number of children with urolithiasis seen in Pediatric Health Information System hospitals increased from 125 in 1999 to 1,389 in 2008. Mean number of stone cases per hospital per year increased from 13.9 to 32.6. Compared to total hospital patients, the proportion of patients with pediatric urolithiasis increased from 18.4 per 100,000 in 1999 to 57.0 per 100,000 in 2008, an adjusted annual increase of 10.6% (p <0.0001). Urolithiasis also increased compared to appendicitis (p <0.0001) and bronchiolitis (p <0.0001). CONCLUSIONS: Even after correcting for increases in total patient volume at Pediatric Health Information System hospitals, there has been a significant increase in the number of children diagnosed with and treated for urolithiasis at these hospitals in the last decade.

Authors
Routh, JC; Graham, DA; Nelson, CP
MLA Citation
Routh, JC, Graham, DA, and Nelson, CP. "Epidemiological trends in pediatric urolithiasis at United States freestanding pediatric hospitals." J Urol 184.3 (September 2010): 1100-1104.
PMID
20650479
Source
pubmed
Published In
The Journal of Urology
Volume
184
Issue
3
Publish Date
2010
Start Page
1100
End Page
1104
DOI
10.1016/j.juro.2010.05.018

Variations in timing of surgery among boys who underwent orchidopexy for cryptorchidism.

OBJECTIVE: Current clinical guidelines recommend that orchidopexy be performed by the age of 1 in patients with congenital undescended testis. We sought to examine trends in surgical timing and to determine what factors are associated with age at surgery. METHODS: The Pediatric Health Information System (PHIS) is a national database of >40 freestanding children's hospitals. We searched the PHIS to identify boys with cryptorchidism who underwent orchidopexy between 1999 and 2008. Patient age at orchidopexy was evaluated, and we used multivariate models to determine factors associated with timing of surgery. RESULTS: We identified 28 204 children who underwent orchidopexy at PHIS hospitals. Of these, 14,916 (53%) were white, and 17,070 (61%) had public insurance. Only 5031 patients (18%) underwent orchidopexy by the age of 1 year; only 12,165 (43%) underwent orchidopexy by the age of 2 years. These figures remained stable over time (P=.32). After adjusting for patient clustering, race (P<.001) and insurance status (P<.001) remained associated with patient age at orchidopexy; however, the treating hospital (P<.001) was the most important factor in predicting the timing of the procedure. CONCLUSIONS: Only 43% had surgery by 2 years of age, which suggests that either significant numbers of boys with congenital cryptorchidism do not undergo surgery in a timely fashion or late-onset testicular ectopy is more common than generally recognized. Factors associated with the timing of orchidopexy include patient race, insurance status, and the hospital in which surgery is performed.

Authors
Kokorowski, PJ; Routh, JC; Graham, DA; Nelson, CP
MLA Citation
Kokorowski, PJ, Routh, JC, Graham, DA, and Nelson, CP. "Variations in timing of surgery among boys who underwent orchidopexy for cryptorchidism." Pediatrics 126.3 (September 2010): e576-e582.
PMID
20732947
Source
pubmed
Published In
Pediatrics
Volume
126
Issue
3
Publish Date
2010
Start Page
e576
End Page
e582
DOI
10.1542/peds.2010-0747

Contemporary epidemiology and characterization of newborn males with prune belly syndrome.

OBJECTIVES: Prune belly syndrome (PBS) is a rare condition characterized by the congenital absence or deficiency of the abdominal wall musculature, with associated abnormalities of the genitourinary tract, including hydronephrosis and cryptorchidism. Few population-based epidemiology or mortality data are available. METHODS: We retrospectively reviewed the Kids' Inpatient Database to evaluate PBS among newborn infants during their initial hospitalization in 2000, 2003, and 2006. The International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify patients and to determine the comorbidity status. The PBS incidence, demographics, comorbid conditions, and disposition were assessed. RESULTS: A total of 133 newborn male infants diagnosed with PBS were identified of 1,420,991 live male births, for a weighted incidence estimate of 3.8 cases/100,000 live births. Of the newborns with PBS, 50% were white, 31% black, and 10% were Hispanic. In-hospital mortality was high (39 of 133, 29%). Of the 133 patients with PBS, 55 (41%) were discharged home and 39 (29%) required inpatient transfer or home nursing care. Fifty-seven patients (43%) were born premature; 56% of the PBS deaths occurred in premature infants. Mechanical ventilation was required in 64 newborns (48%), and 33 (24%) had coexisting congenital cardiovascular anomalies. Renal failure was uncommon, occurring in only 5 newborns (4%); none required dialysis. Only 13 patients (10%) underwent urinary diversion (vesicostomy or ureterostomy). CONCLUSIONS: The incidence of PBS was 3.8 cases/100,000 live births. Despite advances in care for children with PBS, this condition continues to be associated with high perinatal mortality, likely related to the associated prematurity and pulmonary complications. Renal failure was rare, as was immediate urinary diversion.

Authors
Routh, JC; Huang, L; Retik, AB; Nelson, CP
MLA Citation
Routh, JC, Huang, L, Retik, AB, and Nelson, CP. "Contemporary epidemiology and characterization of newborn males with prune belly syndrome." Urology 76.1 (July 2010): 44-48.
PMID
20381841
Source
pubmed
Published In
Urology
Volume
76
Issue
1
Publish Date
2010
Start Page
44
End Page
48
DOI
10.1016/j.urology.2009.12.072

Predicting success in the endoscopic management of pediatric vesicoureteral reflux.

Vesicoureteral reflux is a common cause of pediatric morbidity. Though traditionally managed using a limited number of therapeutic modalities, the last decade has witnessed countless surgical innovations for treating reflux. A major force behind this innovation is the increasing use of endoscopic injection, which currently constitutes nearly half of all anti-reflux procedures performed in the United States. However, published success rates for injection vary dramatically. Despite a relative lack of comparative data, multiple studies have attempted to define the most important prognostic factors for injection success. This article is an attempt to summarize these findings.

Authors
Routh, JC; Reinberg, Y
MLA Citation
Routh, JC, and Reinberg, Y. "Predicting success in the endoscopic management of pediatric vesicoureteral reflux." Urology 76.1 (July 2010): 195-198.
PMID
19931896
Source
pubmed
Published In
Urology
Volume
76
Issue
1
Publish Date
2010
Start Page
195
End Page
198
DOI
10.1016/j.urology.2009.09.017

Dextranomer/hyaluronic acid for pediatric vesicoureteral reflux: systematic review.

OBJECTIVE: Published success rates of dextranomer/hyaluronic acid (Dx/HA) injection for pediatric vesicoureteral reflux (VUR) vary widely. Our objective of this study was to assess whether underlying patient or study factors could explain the heterogeneity in reported Dx/HA success rates. METHODS: We searched the Cochrane Controlled Trials Register and Medline, Embase, and Scopus databases from 1990 to 2008 for reports in any language, along with a hand search of included study bibliographies. Articles were assessed and data abstracted in duplicate, and differences were resolved by consensus. Conflict of interest (COI) was determined by published disclosure. Meta-regression was performed to adjust for patient as well as study-level factors. RESULTS: We identified 1157 reports, 89 of which were reviewed in full with 47 included in the pooled analysis. Of 7303 ureters that were injected with Dx/HA, 5633 (77%) were successfully treated according to the authors' definition. Injection success seemed to vary primarily on the basis of the preoperative reflux grade. After adjustment for VUR grade, other factors, such as the presence or absence of COI disclosure, were not significant. Studies were markedly heterogeneous overall. CONCLUSIONS: The overall per-ureter Dx/HA success rate was 77% after 3 months, although success rates varied widely among studies. Increased VUR grade negatively affected success rates, whereas COI, patient age, and injected Dx/HA volume were not significantly associated with treatment outcome after adjustment for VUR grade. There is a significant need for improved reporting of VUR treatments, including comparative studies of Dx/HA and other VUR treatments.

Authors
Routh, JC; Inman, BA; Reinberg, Y
MLA Citation
Routh, JC, Inman, BA, and Reinberg, Y. "Dextranomer/hyaluronic acid for pediatric vesicoureteral reflux: systematic review." Pediatrics 125.5 (May 2010): 1010-1019. (Review)
PMID
20368325
Source
pubmed
Published In
Pediatrics
Volume
125
Issue
5
Publish Date
2010
Start Page
1010
End Page
1019
DOI
10.1542/peds.2009-2225

Variation in surgical management of vesicoureteral reflux: influence of hospital and patient factors.

OBJECTIVE: Controversy exists over surgical procedure choice for vesicoureteral reflux (VUR) in children. Either ureteral reimplantation (UR) or a newer procedure, endoscopic injection (EI), may be chosen; however, the factors that determine procedure choice for any individual patient are unclear. The objective of this study was to identify patient and hospital factors associated with the choice of EI for children undergoing antireflux surgery. PATIENTS AND METHODS: We searched the Pediatric Health Information System, a national database collected by freestanding children's hospitals. We identified children aged <18 years with primary VUR who underwent surgery (UR or EI) between 2003 and 2008. We used multivariate logistic regression models to evaluate whether the type of procedure performed was associated with hospital-level factors including individual hospital, hospital region, size, and teaching status, as well as patient features including age, race, gender, and insurance type. RESULTS: We identified 15026 children with primary VUR who underwent antireflux surgery between 2003 and 2008. Of these, 3611 children (24%) were treated at hospitals that performed reimplant only. Among children treated at institutions offering both procedures, 5562 (49%) underwent injection and 5853 (51%) underwent reimplant. Patients who received EI were significantly older and more likely to be girls, white, and publicly insured than those who had UR. They were more likely to have been treated at hospitals that were larger, were teaching hospitals, or were located in larger metropolitan areas or the South rather than the Northeast. After adjusting for other covariates, the treating hospital was the most important factor predicting procedure choice. CONCLUSIONS: The hospital at which a patient receives treatment is the single most important feature that drove procedure choice for children with primary VUR. The patient's age, gender, insurance status, and disease severity played a smaller, although significant, role.

Authors
Routh, JC; Nelson, CP; Graham, DA; Lieu, TA
MLA Citation
Routh, JC, Nelson, CP, Graham, DA, and Lieu, TA. "Variation in surgical management of vesicoureteral reflux: influence of hospital and patient factors." Pediatrics 125.3 (March 2010): e446-e451.
PMID
20142292
Source
pubmed
Published In
Pediatrics
Volume
125
Issue
3
Publish Date
2010
Start Page
e446
End Page
e451
DOI
10.1542/peds.2009-1237

Management strategies for mayer-rokitansky-kuster-hauser related vaginal agenesis: A cost-effectiveness analysis

Purpose The optimal method for neovagina creation in patients with vaginal agenesis is controversial. Progressive perineal dilation is a minimally invasive method with high success rates. However, the economic merits of progressive perineal dilation compared to surgical vaginoplasty are unknown. Materials and Methods We performed a Markov based cost-effectiveness analysis of 3 management strategies for vaginal agenesisprogressive perineal dilation with and without subsequent vaginoplasty, and up-front vaginoplasty. Cost data were drawn from the Pediatric Health Information System database (2004 to 2009) for inpatient procedures and from governmental cost data (2009) for outpatient procedures and clinical followup. Other model parameters were derived from a systematic literature review and comparison with other congenital and acquired pediatric and/or adolescent gynecologic conditions. Bounded and probabilistic sensitivity analyses were used to assess model stability. Results Including all procedures, equipment and physician visits, progressive perineal dilation had a mean cost of $796, while vaginoplasty cost $18,520. Up-front vaginoplasty was strongly dominated at any age, ie was more expensive but no more effective than other options. In cases of progressive perineal dilation failure the incremental cost-effectiveness ratio of progressive perineal dilation with subsequent vaginoplasty was $1,564 per quality adjusted life-year. Only the utility weights of life after treatment impacted model outcomes, while frequency of followup and probability of treatment success did not. Conclusions Initial progressive perineal dilation followed by vaginoplasty in cases of dilation failure is the most cost-effective management strategy for vaginal agenesis. Initial vaginoplasty was less cost-effective than initial progressive perineal dilation in 99.99% of simulations. © 2010 American Urological Association Education and Research, Inc.

Authors
Routh, JC; Laufer, MR; Jr, GMC; Diamond, DA; Gargollo, PC
MLA Citation
Routh, JC, Laufer, MR, Jr, GMC, Diamond, DA, and Gargollo, PC. "Management strategies for mayer-rokitansky-kuster-hauser related vaginal agenesis: A cost-effectiveness analysis." Journal of Urology 184.5 (2010): 2116-2121.
PMID
20850825
Source
scival
Published In
The Journal of Urology
Volume
184
Issue
5
Publish Date
2010
Start Page
2116
End Page
2121
DOI
10.1016/j.juro.2010.06.133

Ketorolac is underutilized after ureteral reimplantation despite reduced hospital cost and reduced length of stay

OBJECTIVES To examine patterns of ketorolac use and its association with hospital outcomes. Although ureteral reimplantation (UR) reliably corrects vesicoureteral reflux, postoperative pain and bladder spasm often occur. Multiple studies show that ketorolac markedly reduces postoperative pain after UR, but there is no information on whether ketorolac is routinely used. METHODS The Pediatric Health Information System is a national database collected by over 40 US children's hospitals. We identified children with primary vesicoureteral reflux who underwent UR between 2003 and 2008. Billing data were reviewed to identify patients who received ketorolac during hospitalization. Multivariate models were used to examine ketorolac use and postoperative outcomes including complication rates, length of stay, and hospital costs. RESULTS We identified 12 239 children undergoing UR, 6362 (52%) of whom received ketorolac postoperatively. Factors associated with ketorolac use include older age, female gender, and decreased disease severity (all P <.0001). Ketorolac use was associated with reduced length of stay (2 vs 3 days, P <.0001) and decreased hospital costs ($14 223 vs $16 382, P <.0001). Complication rates were slightly higher in patients not receiving ketorolac (4% vs 3%). After adjusting for confounding factors, ketorolac use remained highly associated with decreased length of stay (P = .01) and decreased costs (P = .002), with no significant differences in complication rates (P = .4). CONCLUSIONS In a contemporary nationwide sample, only half of children undergoing UR received ketorolac. Ketorolac use is independently associated with reduced procedure costs and reduced length of stay after UR, without increased complications. This suggests underutilization of ketorolac after UR. © 2010 Elsevier Inc.

Authors
Routh, JC; Graham, DA; Nelson, CP
MLA Citation
Routh, JC, Graham, DA, and Nelson, CP. "Ketorolac is underutilized after ureteral reimplantation despite reduced hospital cost and reduced length of stay." Urology 76.1 (2010): 9-13.
PMID
20138342
Source
scival
Published In
Urology
Volume
76
Issue
1
Publish Date
2010
Start Page
9
End Page
13
DOI
10.1016/j.urology.2009.10.062

Regional variations in small intestinal submucosa evoke differences in inflammation with subsequent impact on tissue regeneration in the rat bladder augmentation model

Objective To examine the histological differences in the inflammatory response and regenerative outcomes of distal vs proximal porcine small intestinal submucosa (SIS) grafts in the rat bladder, as SIS from distal small intestine yields reliable and reproducible bladder regeneration, while SIS from proximal portions of small intestine does not provide similar Results. Materials and Methods In all, 30 Sprague-Dawley rats underwent hemi-cystectomy followed by anastomosis of a bladder patch of SIS prepared from either distal or proximal small intestine. After bladder harvest, immunohistochemistry was used to quantify mast cells, eosinophils, macrophages, and neutrophils (PMNs). Total cell count per unit area was compared across the time course in univariate and logistic regression modelling. RESULTS There were more eosinophils and mast cells in proximal SIS grafts, while there were more macrophages and PMNs in distal SIS grafts (all P < 0.05). Trichrome analysis showed increased collagen deposition in proximal SIS grafts and little smooth muscle regeneration. There was also significant graft contracture in proximal SIS grafts compared with distal SIS grafts (P < 0.05). Conclusions We conclude that the location of SIS origin may evoke different inflammatory responses, which Results in altered bladder tissue regeneration. © 2009 BJU INTERNATIONAL.

Authors
Ashley, RA; Roth, CC; Palmer, BW; Kibar, Y; Routh, JC; Fung, K-M; Frimberger, D; Lin, H-K; Kropp, BP
MLA Citation
Ashley, RA, Roth, CC, Palmer, BW, Kibar, Y, Routh, JC, Fung, K-M, Frimberger, D, Lin, H-K, and Kropp, BP. "Regional variations in small intestinal submucosa evoke differences in inflammation with subsequent impact on tissue regeneration in the rat bladder augmentation model." BJU International 105.10 (2010): 1462-1468.
PMID
19863527
Source
scival
Published In
Bju International
Volume
105
Issue
10
Publish Date
2010
Start Page
1462
End Page
1468
DOI
10.1111/j.1464-410X.2009.08965.x

Variation Among Internet Based Calculators in Predicting Spontaneous Resolution of Vesicoureteral Reflux

Purpose: An increasing number of parents and practitioners use the Internet for health related purposes, and an increasing number of models are available on the Internet for predicting spontaneous resolution rates for children with vesicoureteral reflux. We sought to determine whether currently available Internet based calculators for vesicoureteral reflux resolution produce systematically different results. Materials and Methods: Following a systematic Internet search we identified 3 Internet based calculators of spontaneous resolution rates for children with vesicoureteral reflux, of which 2 were academic affiliated and 1 was industry affiliated. We generated a random cohort of 100 hypothetical patients with a wide range of clinical characteristics and entered the data on each patient into each calculator. We then compared the results from the calculators in terms of mean predicted resolution probability and number of cases deemed likely to resolve at various cutoff probabilities. Results: Mean predicted resolution probabilities were 41% and 36% (range 31% to 41%) for the 2 academic affiliated calculators and 33% for the industry affiliated calculator (p = 0.02). For some patients the calculators produced markedly different probabilities of spontaneous resolution, in some instances ranging from 24% to 89% for the same patient. At thresholds greater than 5%, 10% and 25% probability of spontaneous resolution the calculators differed significantly regarding whether cases would resolve (all p <0.0001). Conclusions: Predicted probabilities of spontaneous resolution of vesicoureteral reflux differ significantly among Internet based calculators. For certain patients, particularly those with a lower probability of spontaneous resolution, these differences can significantly influence clinical decision making. © 2010 American Urological Association Education and Research, Inc.

Authors
Routh, JC; Gong, EM; Jr, GMC; Yu, RN; Gargollo, PC; Nelson, CP
MLA Citation
Routh, JC, Gong, EM, Jr, GMC, Yu, RN, Gargollo, PC, and Nelson, CP. "Variation Among Internet Based Calculators in Predicting Spontaneous Resolution of Vesicoureteral Reflux." Journal of Urology 183.4 (2010): 1568-1573.
PMID
20172550
Source
scival
Published In
The Journal of Urology
Volume
183
Issue
4
Publish Date
2010
Start Page
1568
End Page
1573
DOI
10.1016/j.juro.2009.12.042

Radiation dose and screening for vesicoureteral reflux

Authors
Routh, JC; Lee, RS; Chow, JS
MLA Citation
Routh, JC, Lee, RS, and Chow, JS. "Radiation dose and screening for vesicoureteral reflux." American Journal of Roentgenology 194.2 (2010): w243-.
PMID
20093582
Source
scival
Published In
AJR. American journal of roentgenology
Volume
194
Issue
2
Publish Date
2010
Start Page
w243
DOI
10.2214/AJR.09.3384

Editorial comment

Authors
Routh, JC; Reinberg, Y
MLA Citation
Routh, JC, and Reinberg, Y. "Editorial comment." Journal of Urology 184.2 (2010): 689--.
PMID
20561646
Source
scival
Published In
The Journal of Urology
Volume
184
Issue
2
Publish Date
2010
Start Page
689-
DOI
10.1016/j.juro.2010.03.163

Editorial Comment

Authors
Routh, JC
MLA Citation
Routh, JC. "Editorial Comment." Journal of Urology 183.2 (2010): 718--.
PMID
20022038
Source
scival
Published In
The Journal of Urology
Volume
183
Issue
2
Publish Date
2010
Start Page
718-
DOI
10.1016/j.juro.2009.10.104

Nonoperative management of nonvascular grade IV blunt renal trauma in children: meta-analysis and systematic review.

OBJECTIVES: To evaluate nonoperative management of grade IV blunt renal trauma in pediatric patients by performing a systematic review and meta-analysis of published studies. METHODS: MEDLINE, EMBASE, Cochrane, and Scopus databases were searched between January 1992 and June 2008 for studies of pediatric renal trauma management. Inclusion criteria were patient age

Authors
Umbreit, EC; Routh, JC; Husmann, DA
MLA Citation
Umbreit, EC, Routh, JC, and Husmann, DA. "Nonoperative management of nonvascular grade IV blunt renal trauma in children: meta-analysis and systematic review." Urology 74.3 (September 2009): 579-582. (Review)
PMID
19589574
Source
pubmed
Published In
Urology
Volume
74
Issue
3
Publish Date
2009
Start Page
579
End Page
582
DOI
10.1016/j.urology.2009.04.049

Sacral neuromodulation in children with dysfunctional elimination syndrome: description of incisionless first stage and second stage without fluoroscopy.

OBJECTIVES: To detail a percutaneous technique of sacral nerve neuromodulation (SN) that eliminates the first-stage incisions and the need for second-stage fluoroscopy. Our group has previously described the results of SN in children with medically refractory dysfunctional elimination syndrome. The drawbacks to SN include the use of fluoroscopy and the need to reopen recent skin incisions during the second stage. This results in increased radiation exposure, poor cosmesis, and possible wound infection. METHODS: The incisionless first stage consisted of percutaneously tunneling the temporary external appliance to the contralateral axillary line at the buttock after localization of the S3 nerve root and placement of a quadripolar tined lead under fluoroscopic guidance. A subcutaneous bolus of methylene blue marked the lead connector site, obviating the need for later fluoroscopic localization to place the implantable pulse generator at the second stage. RESULTS: A total of 27 children with refractory dysfunctional elimination syndrome underwent SN using the InterStim device. Of the 27 patients, 19 underwent our modified technique. The operative time for our modified tunneling and placement technique was < or = 2 minutes. The mean hospital stay was 0.6 day, with no patient requiring postoperative intravenous narcotics. At a mean follow-up of 35.9 months, no wound infections had occurred in the incisionless cohort compared with 1 postoperative wound infection requiring device explantation in the conventional lead placement group. CONCLUSIONS: The incisionless technique of SN device implantation is technically simple, quick to perform, and results in decreased radiation exposure, excellent pain control, and improved cosmesis without compromising the outcomes.

Authors
McGee, SM; Routh, JC; Granberg, CF; Roth, TJ; Hollatz, P; Vandersteen, DR; Reinberg, Y
MLA Citation
McGee, SM, Routh, JC, Granberg, CF, Roth, TJ, Hollatz, P, Vandersteen, DR, and Reinberg, Y. "Sacral neuromodulation in children with dysfunctional elimination syndrome: description of incisionless first stage and second stage without fluoroscopy." Urology 73.3 (March 2009): 641-644.
PMID
19167048
Source
pubmed
Published In
Urology
Volume
73
Issue
3
Publish Date
2009
Start Page
641
End Page
644
DOI
10.1016/j.urology.2008.10.067

Iatrogenic ureteral injury: can adult repair techniques be used on children?

OBJECTIVE: Iatrogenic ureteral injury in children is a rare occurrence, with sparse literature available regarding optimal repair techniques. We reviewed our experience in the management of iatrogenic pediatric ureteral injuries, particularly with respect to initial versus delayed diagnoses. METHODS: All pediatric iatrogenic ureteral injuries repaired by a single surgeon during 1986-2007 were reviewed. RESULTS: Ten injuries were repaired over 20 years. Median patient age was 12 years. Injuries occurred during five open tumor resections, three laparoscopic procedures and two ureteroscopies. Diagnosis was immediate in four patients. Median ureteral defect length was 4 cm (range 2-5). All underwent ureteral reimplantation and psoas hitch Boari flap. Median follow up was 1 year, with no obstruction noted. Diagnosis was delayed in six patients by a median of 21 days. Five children (83%) were managed by temporary percutaneous nephrostomy tube and one (17%) by ureteral stent. Delayed repair was performed 1-3 months later. In the patients with laparoscopic or ureteroscopic injuries the median ureteral defect length was 4 cm (range 3-6). All underwent ureteral reimplantation and psoas hitch Boari flap. Median follow up was 1 year, with no obstruction noted. One child had a proximal ureteral defect 8 cm long; delayed ileal ureter was performed with good results 4 years postoperatively. CONCLUSIONS: Pediatric iatrogenic ureteral injuries are rare and may be repaired by both immediate and delayed techniques as circumstances demand. Standard techniques used in the adult population may be employed in children with the expectation of good long-term results.

Authors
Routh, JC; Tollefson, MK; Ashley, RA; Husmann, DA
MLA Citation
Routh, JC, Tollefson, MK, Ashley, RA, and Husmann, DA. "Iatrogenic ureteral injury: can adult repair techniques be used on children?." J Pediatr Urol 5.1 (February 2009): 53-55.
PMID
18945640
Source
pubmed
Published In
Journal of Pediatric Urology
Volume
5
Issue
1
Publish Date
2009
Start Page
53
End Page
55
DOI
10.1016/j.jpurol.2008.08.004

Leukocyte inflammatory response in a rat urinary bladder regeneration model using porcine small intestinal submucosa scaffold

Small intestinal submucosa (SIS) is a biodegradable scaffold that supports bladder regeneration after partial cystectomy. We sought to define the inflammatory response present in a rat bladder augmentation model using distal ileal SIS. Fifteen Sprague-Dawley rats underwent hemi-cystectomy followed by anastomosis of a bladder patch of SIS. Bladders were excised after days 2, 7, 14, 28, and 56. Tissue regeneration was evaluated by standard hematoxylin and eosin. Immunohistochemical staining was used to quantify neutrophils, macrophages, eosinophils, and mast cells. Total cell counts per unit area were compared between native and graft portions of the bladder for each cell type across the entire time course. Statistical analyses were conducted with the Wilcoxon Rank-Sum and Kruskal-Wallis tests. All tests were two-sided with significance set at p<0.05. These inflammatory responses evolved consistently across all bladders over time. Neutrophil and eosinophil numbers were highest at day 2 and decreased over the 56-day period. In contrast, macrophage and mast cell numbers were low at days 2, 7, and 14; peaked at day 28; and decreased once again at day 56. Cell counts at native and graft sites were equivalent for all cell types, except neutrophils, which were more commonly found in the graft (124 vs. 24cells/mm2, p=0.009). Thus, the inflammatory processes change over time during SIS-mediated bladder regeneration. Similar cell densities are present between the native and SIS portions of the bladder, but neutrophils predominate in the graft areas. © 2009 Mary Ann Liebert, Inc.

Authors
Ashley, RA; Palmer, BW; Schultz, AD; Woodson, BW; Roth, CC; Routh, JC; Fung, K-M; Frimberger, D; Lin, H-K; Kropp, BP
MLA Citation
Ashley, RA, Palmer, BW, Schultz, AD, Woodson, BW, Roth, CC, Routh, JC, Fung, K-M, Frimberger, D, Lin, H-K, and Kropp, BP. "Leukocyte inflammatory response in a rat urinary bladder regeneration model using porcine small intestinal submucosa scaffold." Tissue Engineering - Part A 15.11 (2009): 3241-3246.
Source
scival
Published In
Tissue Engineering, Part A
Volume
15
Issue
11
Publish Date
2009
Start Page
3241
End Page
3246
DOI
10.1089/ten.tea.2008.0699

Editorial comment

Authors
Routh, JC
MLA Citation
Routh, JC. "Editorial comment." Journal of Urology 182.4 SUPPL. (2009): 1706-1707.
PMID
19692060
Source
scival
Published In
The Journal of Urology
Volume
182
Issue
4 SUPPL.
Publish Date
2009
Start Page
1706
End Page
1707
DOI
10.1016/j.juro.2009.03.011

Pediatric Urology and the Internet-Does an Uncommon Topic Decrease Content Quality?

Purpose: The Internet has become a widely used resource for patients and families to obtain medical information but the quality of information available is highly variable. We sought to determine if Web pages addressing common and uncommon pediatric urology topics differ in terms of quality or characteristics. Materials and Methods: We performed an Internet search using 5 common conditions (vesicoureteral reflux, hypospadias, prenatal hydronephrosis, cryptorchidism, enuresis) and 5 uncommon conditions (exstrophy, prune belly, posterior urethral valves, Wilms tumor, ureterocele). We recorded total hits, presence of sponsored links, page owner and author type, last update, content quality, readability, accreditation and advertising. Content quality was graded on a 5-point scale for accuracy and completeness of natural history, diagnosis and treatment. Results: We evaluated 100 sites on 10 topics. Common topics had more hits (980,000 vs 194,000) and were more likely to have sponsored advertisements (40% vs 0%) than uncommon topics. No difference was seen between topics in time from last update, owner/author type, financial disclosure, accreditation or advertising. Median quality grade was 4.0. Common topics had higher quality grades for disease natural history and diagnosis. Reading grade level was high and was similar between the groups. Conclusions: Web sites devoted to common pediatric urology topics have higher quality information for disease diagnosis and natural history. Otherwise, the quality of pediatric urology information on the Internet is high for common and uncommon topics. A high reading level is required to use these resources. © 2009 American Urological Association.

Authors
Routh, JC; Gong, EM; Nelson, CP
MLA Citation
Routh, JC, Gong, EM, and Nelson, CP. "Pediatric Urology and the Internet-Does an Uncommon Topic Decrease Content Quality?." Journal of Urology 182.4 SUPPL. (2009): 1569-1574.
PMID
19683756
Source
scival
Published In
The Journal of Urology
Volume
182
Issue
4 SUPPL.
Publish Date
2009
Start Page
1569
End Page
1574
DOI
10.1016/j.juro.2009.06.056

Re: Evidence-Based Medicine in Urology: Hope and Peril. C. Niederberger J Urol 2009; 181: 1528-1529

Authors
Routh, JC; Nelson, CP
MLA Citation
Routh, JC, and Nelson, CP. "Re: Evidence-Based Medicine in Urology: Hope and Peril. C. Niederberger J Urol 2009; 181: 1528-1529." Journal of Urology 182.3 (2009): 1236-1237.
PMID
19625043
Source
scival
Published In
The Journal of Urology
Volume
182
Issue
3
Publish Date
2009
Start Page
1236
End Page
1237
DOI
10.1016/j.juro.2009.05.059

Increasing Prevalence and Associated Risk Factors for Methicillin Resistant Staphylococcus Aureus Bacteriuria

Purpose: Infections due to methicillin resistant Staphylococcus aureus are becoming increasingly prevalent in hospitals and in the community. We reviewed our institutional experience to determine whether methicillin resistant S. aureus is becoming a more common cause of bacteriuria and to determine if there are specific risk factors that may predict the development of methicillin resistant S. aureus bacteriuria. Materials and Methods: We reviewed all urine cultures with a pure growth of a single organism obtained at our institution from 1997 and 2007. Patients with urine cultures positive for methicillin resistant S. aureus were compared to a cohort with cultures positive for methicillin sensitive S. aureus, and to a third cohort with cultures positive for Escherichia coli to determine patient characteristics and associated risk factors. Results: We identified 7,100 and 9,985 positive urine cultures performed in 1997 and 2007, respectively. The most common urinary organism was E. coli. The number of patients with methicillin resistant S. aureus bacteriuria increased from 18 (0.3%) to 74 (0.8%) (p <0.001). On multivariate analysis older age (p = 0.004), catheter use (p = 0.004), hospital exposure (p <0.001) and patient comorbidity (p <0.001) were associated with methicillin resistant S. aureus bacteriuria compared with E. coli bacteriuria. Conclusions: Methicillin resistant S. aureus remains rare as a cause of bacteriuria but its incidence has increased during the last decade. Risk factors for methicillin resistant S. aureus bacteriuria include increased age, patient comorbidity, hospital exposure and catheter use. For patients with these risk factors and new onset urinary symptoms, methicillin resistant S. aureus should be considered a possible cause of urinary tract infection. © 2009 American Urological Association.

Authors
Routh, JC; Alt, AL; Ashley, RA; Kramer, SA; Boyce, TG
MLA Citation
Routh, JC, Alt, AL, Ashley, RA, Kramer, SA, and Boyce, TG. "Increasing Prevalence and Associated Risk Factors for Methicillin Resistant Staphylococcus Aureus Bacteriuria." Journal of Urology 181.4 (2009): 1694-1698.
PMID
19233426
Source
scival
Published In
The Journal of Urology
Volume
181
Issue
4
Publish Date
2009
Start Page
1694
End Page
1698
DOI
10.1016/j.juro.2008.11.108

Minimal contamination of the human peritoneum after transvesical incision

Background and Purpose: The recent literature has questioned the infectious risk of natural orifice translumenal endoscopic surgery (NOTES). The need for a clean portal of entry may be important to minimize peritoneal contamination after NOTES. Our study examines the resultant microbial contamination of the human peritoneum after transvesical incision and exposure of the abdomen to bladder contents during robot-assisted laparoscopic prostatectomy (RALP) to better understand the potential for infection in transvesical NOTES. Patients and Methods: Sixty consecutive men undergoing RALP for clinically localized prostate adenocarcinoma from January to May 2008 were prospectively studied as part of a database approved by an Institutional Review Board. The patient's preoperative urine microscopy values, complete blood cell count, and prostate-specific antigen (PSA) levels were recorded, along with the total length of time the cystotomy was open to the peritoneum. Intraoperative samplings of peritoneal fluid were collected before and after transvesical incision and sent for anaerobic, aerobic and fungal cultures. Results: Patients undergoing RALP had peritoneal exposure after transvesical incision for an average of 118 minutes. Five of 60 (8.3%) patients had evidence of novel aerobic bacterial contamination of the peritoneum after RALP. No patient had a positive anaerobic culture or fungal culture from the peritoneum. Preoperative serum leukocyte and PSA levels were elevated in patients with peritoneal contamination P<0.05). Remaining clinicopathologic features, total operative time, or open cystotomy time did not predict peritoneal contamination. Conclusion: Prolonged peritoneal exposure to bladder contents demonstrates minimal contamination of the abdominal cavity and is without postoperative infectious significance. This study may overestimate bacterial contamination via the bladder during RALP, because the specific bacteria seen may have originated from the seminal or prostatic fluid during prostatectomy. Transvesical incision would effectively be a clean portal of entry for NOTES with its low rate of peritoneal contamination. Copyright 2009, Mary Ann Liebert, Inc.

Authors
McGee, SM; Routh, JC; Pereira, CW; Gettman, MT
MLA Citation
McGee, SM, Routh, JC, Pereira, CW, and Gettman, MT. "Minimal contamination of the human peritoneum after transvesical incision." Journal of Endourology 23.4 (2009): 659-663.
PMID
19335214
Source
scival
Published In
Journal of Endourology
Volume
23
Issue
4
Publish Date
2009
Start Page
659
End Page
663
DOI
10.1089/end.2008.0418

Superficial genitourinary abscesses in children: emergence of methicillin resistant Staphylococcus aureus.

PURPOSE: The prevalence of methicillin resistant Staphylococcus aureus is increasing. However, little is known about methicillin resistant S. aureus in the genitourinary tract, particularly in children. We assessed the incidence of pediatric genitourinary methicillin resistant S. aureus superficial abscess requiring surgical intervention. MATERIALS AND METHODS: We reviewed the records of all children undergoing surgical debridement of superficial abscess at a single institution between 1995 and 2007. We assessed surgical site, organism identity, patient comorbidity, methicillin resistant S. aureus risk factors, number of procedures and patient outcome. RESULTS: Surgical debridement of a superficial genitourinary abscess was performed in 60 children. Patient age ranged from 29 days to 17 years (median 3 years). A single debridement was generally curative, with only 5 patients (8.3%) requiring more than 1 procedure. One patient (1.7%) died of sepsis postoperatively due to Pseudomonas infection. One patient had myelomeningocele, 1 had undergone renal transplant and 2 were undergoing chemotherapy at the time of debridement. None of these 3 patients had a methicillin resistant S. aureus infection. Methicillin resistant S. aureus was more common in the groin/genitalia and less common in the perineum (p = 0.007). The incidence of methicillin resistant S. aureus increased during the study period, accounting for none of 40 infections between 1995 and 2003, and 8 of 20 (40%) from 2004 to 2007 (p <0.001). CONCLUSIONS: Methicillin resistant S. aureus has become the predominant organism causing pediatric superficial genitourinary abscesses at our institution, accounting for three-quarters of all surgically managed infections in the last 2 years. Methicillin resistant S. aureus was more common at the groin and genitalia. One debridement was generally curative, and patient morbidity was low with aggressive treatment.

Authors
Alt, AL; Routh, JC; Ashley, RA; Boyce, TG; Kramer, SA
MLA Citation
Alt, AL, Routh, JC, Ashley, RA, Boyce, TG, and Kramer, SA. "Superficial genitourinary abscesses in children: emergence of methicillin resistant Staphylococcus aureus." J Urol 180.4 (October 2008): 1472-1475.
PMID
18710758
Source
pubmed
Published In
The Journal of Urology
Volume
180
Issue
4
Publish Date
2008
Start Page
1472
End Page
1475
DOI
10.1016/j.juro.2008.06.055

Unilateral vesicoureteral reflux: does endoscopic injection based on the cystoscopic appearance of the ureteral orifice decrease the incidence of de-novo contralateral reflux?

OBJECTIVE: In patients with unilateral vesicoureteral reflux (VUR), it has been suggested that injection of a non-refluxing but cystoscopically abnormal contralateral ureteral orifice (UO) with dextranomer/hyaluronic acid (Dx/HA) should be performed to prevent the development of de-novo contralateral VUR. We evaluate the effectiveness of this practice. PATIENTS AND METHODS: Patients with primary unilateral VUR undergoing injection of Dx/HA from 2002 to 2005 at two institutions were eligible. Patients with unilateral VUR with cystoscopically abnormal contralateral UOs were injected with Dx/HA, while patients with normal appearing UOs received no treatment. Multivariate logistic regression models were used to estimate the impact of prophylactic injection on the development of de-novo contralateral VUR. RESULTS: In total, 101 patients with unilateral VUR and an abnormal appearing contralateral UO underwent prophylactic injection of Dx/HA while 45 patients with a normal appearing contralateral UO were untreated. In patients receiving prophylactic Dx/HA, 9% (9/101) of the previously non-refluxing ureters developed de-novo VUR. Similarly, 13% (6/45) of patients with a normal appearing UO treated by observation alone developed de-novo VUR (P=0.55). The overall incidence of 10% (15/146) de-novo contralateral VUR matches published results where this protocol was not followed. CONCLUSIONS: Our findings suggest that cystoscopic assessment and prophylactic treatment of an abnormal appearing, non-refluxing contralateral UO with Dx/HA is of little clinical benefit and should be abandoned.

Authors
Routh, JC; Inman, BA; Ashley, RA; Vandersteen, DR; Reinberg, Y; Wolpert, JJ; Kramer, SA; Husmann, DA
MLA Citation
Routh, JC, Inman, BA, Ashley, RA, Vandersteen, DR, Reinberg, Y, Wolpert, JJ, Kramer, SA, and Husmann, DA. "Unilateral vesicoureteral reflux: does endoscopic injection based on the cystoscopic appearance of the ureteral orifice decrease the incidence of de-novo contralateral reflux?." J Pediatr Urol 4.4 (August 2008): 260-264.
PMID
18644526
Source
pubmed
Published In
Journal of Pediatric Urology
Volume
4
Issue
4
Publish Date
2008
Start Page
260
End Page
264
DOI
10.1016/j.jpurol.2007.12.008

Reassessing the diagnostic yield of saturation biopsy of the prostate.

OBJECTIVE: Prostate biopsy remains the gold standard for detection of prostate cancer (PCa). This study was performed to determine whether saturation biopsy (>or= 24 cores) detects more prostate cancer than a standard 12-18 core office biopsy technique. METHODS: We conducted a nonrandomized cohort study of a consecutive series of prostate biopsies. The primary outcome assessed by both univariate and multivariate analysis was the detection of PCa, whereas the secondary outcomes of HGPIN (high-grade prostatic intraepithelial neoplasia) and ASAP (atypical small acinar proliferation) were also analyzed. RESULTS: From September 2005 to June 2006, a total of 469 patients undergoing prostate biopsy were included in this study. A standard office prostate biopsy was performed in 301 men, whereas 168 underwent a saturation biopsy. Age, body mass index (BMI), prostate volume, and family history of PCa were similar. However, patients in the saturation biopsy cohort were more likely to have had prior biopsies, higher prebiopsy PSA, longer PSA doubling times, and to carry more frequent diagnoses of HGPIN or ASAP (all p<0.05). After adjusting for covariates, saturation biopsy did not detect more abnormal pathology than standard office prostate biopsy, including PCa (OR, 1.2; p=0.339), HGPIN (OR, 1.4; p=0.368), or ASAP (OR, 2.2; p=0.201). CONCLUSIONS: Saturation biopsy does not appear to detect more abnormal prostate pathology than standard office biopsy of the prostate. This procedure may be associated with increased cost and patient morbidity.

Authors
Ashley, RA; Inman, BA; Routh, JC; Mynderse, LA; Gettman, MT; Blute, ML
MLA Citation
Ashley, RA, Inman, BA, Routh, JC, Mynderse, LA, Gettman, MT, and Blute, ML. "Reassessing the diagnostic yield of saturation biopsy of the prostate." Eur Urol 53.5 (May 2008): 976-981.
PMID
17997028
Source
pubmed
Published In
European Urology
Volume
53
Issue
5
Publish Date
2008
Start Page
976
End Page
981
DOI
10.1016/j.eururo.2007.10.049

Utility of dextranomer/hyaluronic acid injection in setting of bladder and ureteral anomalies.

OBJECTIVES: Previous studies have shown that the cure rates after dextranomer/hyaluronic acid (Dx/HA) injection can be decreased in patients with neurogenic bladder, previous ureteroneocystostomy, duplicated ureters, or periureteral diverticula. We attempted to determine whether these factors reduce the efficacy of Dx/HA injection compared with that in otherwise normal patients. METHODS: All children with vesicoureteral reflux (VUR) undergoing Dx/HA injection from April 2002 to March 2006 at two institutions were eligible for this study. Multivariate logistic regression models were built to assess the effect of bladder/ureteral anomalies on the success of Dx/HA injection. We adjusted for previously described predictors of injection success, including VUR grade, sex, age, surgeon experience, and injection technique. RESULTS: A total of 543 refluxing ureters (373 patients) were included, of which 145 (27%) had persistent VUR on postoperative voiding cystourethrography; 86 ureters (16%) had anatomic anomalies. On univariate analysis, the most important predictors of injection failure were increasing VUR grade, male sex, younger age, subureteral injection, ureteral duplication anomaly, increasing Dx/HA volume, and surgeon experience. On multivariate analysis, however, the only significant predictors of injection failure were increasing VUR grade, subureteral injection technique, and surgeon experience. No anatomic or functional abnormalities, considered individually or grouped, significantly affected the probability of injection failure. CONCLUSIONS: In our experience, children with functional and anatomic bladder/ureteral anomalies were no more likely to have Dx/HA injection fail than were children with uncomplicated VUR. The most important predictors of Dx/HA success remained VUR grade, injection technique, and surgeon experience. Dx/HA injection in patients with complex bladders could be a reasonable therapeutic option.

Authors
Routh, JC; Kramer, SA; Inman, BA; Ashley, RA; Wolpert, JJ; Vandersteen, DR; Husmann, DA; Reinberg, Y
MLA Citation
Routh, JC, Kramer, SA, Inman, BA, Ashley, RA, Wolpert, JJ, Vandersteen, DR, Husmann, DA, and Reinberg, Y. "Utility of dextranomer/hyaluronic acid injection in setting of bladder and ureteral anomalies." Urology 71.3 (March 2008): 435-438.
PMID
18342182
Source
pubmed
Published In
Urology
Volume
71
Issue
3
Publish Date
2008
Start Page
435
End Page
438
DOI
10.1016/j.urology.2007.10.043

Re: Endoscopic treatment of vesicoureteral reflux associated with paraureteral diverticula in children. W. H. Cerwinka, H. C. Scherz and A. J. Kirsch. J Urol 2007; 178: 1469-1473.

Authors
Routh, JC; Inman, BA; Reinberg, Y
MLA Citation
Routh, JC, Inman, BA, and Reinberg, Y. "Re: Endoscopic treatment of vesicoureteral reflux associated with paraureteral diverticula in children. W. H. Cerwinka, H. C. Scherz and A. J. Kirsch. J Urol 2007; 178: 1469-1473." J Urol 179.3 (March 2008): 1205-. (Letter)
PMID
18206165
Source
pubmed
Published In
The Journal of Urology
Volume
179
Issue
3
Publish Date
2008
Start Page
1205
DOI
10.1016/j.juro.2007.10.098

Editorial Comment

Authors
Routh, JC; Reinberg, Y
MLA Citation
Routh, JC, and Reinberg, Y. "Editorial Comment." Journal of Urology 180.4 SUPPL. (2008): 1592-1593.
Source
scival
Published In
The Journal of Urology
Volume
180
Issue
4 SUPPL.
Publish Date
2008
Start Page
1592
End Page
1593
DOI
10.1016/j.juro.2008.04.170

Editorial Comment

Authors
Routh, JC
MLA Citation
Routh, JC. "Editorial Comment." Journal of Urology 180.4 SUPPL. (2008): 1604--.
Source
scival
Published In
The Journal of Urology
Volume
180
Issue
4 SUPPL.
Publish Date
2008
Start Page
1604-
DOI
10.1016/j.juro.2008.03.261

Editorial Comment

Authors
Routh, JC
MLA Citation
Routh, JC. "Editorial Comment." Journal of Urology 180.4 SUPPL. (2008): 1599--.
Source
scival
Published In
The Journal of Urology
Volume
180
Issue
4 SUPPL.
Publish Date
2008
Start Page
1599-
DOI
10.1016/j.juro.2008.03.248

How long is too long? The effect of the duration of anaesthesia on the incidence of non-urological complications after surgery

OBJECTIVE: To examine the association between the duration of anaesthesia and non-urological complication (NUC) rates after surgery, as the increasing complexity of minimally invasive and laparoscopic procedures in urology has resulted in longer surgery and anaesthesia, and information on the effect of this on NUC rates is limited. PATIENTS AND METHODS: We identified 2196 patients who had open radical nephrectomy or nephron-sparing surgery at our institution between 1989 and 2002. Patients were subdivided into groups I, II, and III according to the duration of general anaesthesia (<4, 4-6 and ≥6 h, respectively). NUCs after surgery, and mortality during and after surgery, were evaluated. RESULTS: There were 1340, 723, and 133 patients in groups I, II and III, respectively. The incidences of any NUC were 3.1%, 5.8% and 13.5%, respectively. The odds ratios for the likelihood of a NUC were 1.91 (P = 0.004) and 4.84 (P < 0.001) for groups II and III, respectively. These differences remained significant even after adjusting for patient and tumour characteristics. Perioperative mortality was highest in group III, at 2.3%, vs 0.4% in groups I and II. CONCLUSIONS: Longer anaesthesia is associated with an increase in the incidence of perioperative complications and mortality, especially when the duration of anaesthesia is >6 h. This increase appears to be independent of patient's preoperative health status, tumour extent and blood loss. © 2008 The Authors.

Authors
Routh, JC; Bacon, DR; Leibovich, BC; Zincke, H; Blute, ML; Frank, I
MLA Citation
Routh, JC, Bacon, DR, Leibovich, BC, Zincke, H, Blute, ML, and Frank, I. "How long is too long? The effect of the duration of anaesthesia on the incidence of non-urological complications after surgery." BJU International 102.3 (2008): 301-304.
PMID
18410433
Source
scival
Published In
Bju International
Volume
102
Issue
3
Publish Date
2008
Start Page
301
End Page
304
DOI
10.1111/j.1464-410X.2008.07663.x

B7-H1 Expression in Wilms Tumor: Correlation With Tumor Biology and Disease Recurrence

Purpose: Despite tremendous gains in improving prognosis, 10% of patients with Wilms tumor will ultimately experience disease recurrence. The identification of novel prognostic markers and tumor associated targets for patients at risk could enable clinicians to treat recurrences more aggressively and, thus, optimize outcomes. We have previously shown that tumor expression of the T cell coregulatory ligand B7-H1 portends a poor prognosis for adults with renal cell carcinoma and represents a promising target to improve therapy. We hypothesize that this finding may be true for Wilms tumor. Materials and Methods: We identified 81 patients with Wilms tumor treated at 1 institution between 1968 and 2004. Histopathological features, including Wilms tumor B7-H1 expression, were correlated with clinical observations and outcome. Results: Tumor recurrences were noted in 22% of patients with Wilms tumor and 14% died. B7-H1 was expressed in 11 tumors (14%) and was more likely to occur in anaplastic Wilms tumor (p = 0.03). Tumor B7-H1 expression was associated with a 2.7-fold increased risk of recurrence, although this difference did not achieve statistical significance (p = 0.06). However, in favorable histology tumors B7-H1 expression was associated with a 3.7-fold increased risk of recurrence (p = 0.03). Conclusions: B7-H1 is expressed by Wilms tumor, correlates with tumor biology and is associated with an increased risk of recurrence in patients with favorable histology tumors. B7-H1 may prove useful in identifying high risk patients who could benefit from more aggressive initial treatment regimens, and may represent a promising therapeutic target. Multi-institutional studies to elucidate the role of B7-H1 in the treatment of Wilms tumor are warranted. © 2008 American Urological Association.

Authors
Routh, JC; Ashley, RA; Sebo, TJ; Lohse, CM; Husmann, DA; Kramer, SA; Kwon, ED
MLA Citation
Routh, JC, Ashley, RA, Sebo, TJ, Lohse, CM, Husmann, DA, Kramer, SA, and Kwon, ED. "B7-H1 Expression in Wilms Tumor: Correlation With Tumor Biology and Disease Recurrence." Journal of Urology 179.5 (2008): 1954-1960.
PMID
18355839
Source
scival
Published In
The Journal of Urology
Volume
179
Issue
5
Publish Date
2008
Start Page
1954
End Page
1960
DOI
10.1016/j.juro.2008.01.056

Re: Tunneled tunica vaginalis flap is an effective technique for recurrent urethrocutaneous fistulas following tubularized incised plate urethroplasty

Authors
Routh, JC; Wolpert, JJ; Reinberg, Y; Chatterjee, US; Basak, D; Chakraborty, SC; Mandal, T; Bhaumik, K
MLA Citation
Routh, JC, Wolpert, JJ, Reinberg, Y, Chatterjee, US, Basak, D, Chakraborty, SC, Mandal, T, and Bhaumik, K. "Re: Tunneled tunica vaginalis flap is an effective technique for recurrent urethrocutaneous fistulas following tubularized incised plate urethroplasty." Journal of Urology 179.2 (2008): 790-791.
PMID
18082822
Source
scival
Published In
The Journal of Urology
Volume
179
Issue
2
Publish Date
2008
Start Page
790
End Page
791
DOI
10.1016/j.juro.2007.09.099

Preventing pain during office biopsy of the prostate: a single center, prospective, double-blind, 3-arm, parallel group, randomized clinical trial.

BACKGROUND: A prospective, double-blind, 3-arm, parallel group, randomized clinical trial was performed to compare 3 anesthetic techniques for preventing pain during prostate biopsy. METHODS: A total of 243 men undergoing a 12-core prostate biopsy were randomized to 1 of 3 anesthetic methods: 1) seminal vesical-prostatic base blockade, 2) intraprostatic blockade, and 3) apical-rectal blockade. Pain was estimated with the 10-point visual analog scale. Multivariate logistic regression evaluated factors predictive of pain. The Kruskal-Wallis test analyzed overall group comparisons and the Steel-Dwass test assessed between-group comparisons in pain scores. Proportional odds ordinal logistic regression quantified the ability of covariates and treatment arms to predict biopsy pain. These values are presented as odds ratios with confidence intervals (OR, 95% CI). RESULTS: From November 2005 to June 2006, 81 men were randomized to 3 study arms. Lidocaine administration was the most painful element of the procedure, while probe insertion was the least. Apical biopsies were routinely more painful than mid-gland biopsies, which were more painful than base biopsies. The apical-rectal blockade was the most painful to administer, but has lasting effects and led to better pain control than the prostatic base-seminal vesicle blockade. Similarly, the intraprostatic blockade was more effective than the prostatic base-seminal vesicle blockade. Besides pain reported at the time of anesthetic injection, no difference was identified between the intraprostatic and apical-rectal blockades. CONCLUSIONS: Mid and apical biopsies of the prostate are more painful than base biopsies. The seminal vesicle-prostatic base blockade is less effective than intraprostatic and apical-rectal blockade at controlling pain.

Authors
Ashley, RA; Inman, BA; Routh, JC; Krambeck, AE; Siddiqui, SA; Mynderse, LA; Gettman, MT; Blute, ML
MLA Citation
Ashley, RA, Inman, BA, Routh, JC, Krambeck, AE, Siddiqui, SA, Mynderse, LA, Gettman, MT, and Blute, ML. "Preventing pain during office biopsy of the prostate: a single center, prospective, double-blind, 3-arm, parallel group, randomized clinical trial." Cancer 110.8 (October 15, 2007): 1708-1714.
PMID
17724727
Source
pubmed
Published In
Cancer
Volume
110
Issue
8
Publish Date
2007
Start Page
1708
End Page
1714
DOI
10.1002/cncr.22973

Multivariate comparison of the efficacy of intraureteral versus subtrigonal techniques of dextranomer/hyaluronic acid injection.

PURPOSE: Numerous factors have been postulated to increase success rates for dextranomer/hyaluronic acid injection for vesicoureteral reflux. Ureteral hydrodistention combined with intraureteral injection reportedly improves injection success rates. We combined the results of 5 pediatric urologists to evaluate the efficacy of this technique compared to that of subtrigonal-only injection in relation to other factors. MATERIALS AND METHODS: Patients with primary vesicoureteral reflux undergoing dextranomer/hyaluronic acid injection from April 2002 to December 2005 at 2 institutions were eligible. Only patients with primary vesicoureteral reflux were included in the study. Injection success was defined as the complete absence of reflux on followup voiding cystourethrogram or radionuclide cystogram. Predictors of a successful outcome were analyzed statistically with logistic regression. Factors included in our analysis were gender, age, vesicoureteral reflux grade, dysfunctional voiding, amount of injected dextranomer/hyaluronic acid, injection technique (intraureteral vs subureteral) and surgeon. RESULTS: A total of 301 patients (453 ureters) with a median age of 5.5 years met inclusion criteria, of whom 199 (66%) were cured at 3 months of followup. Of the patients 145 (48%) underwent subureteral injection and 156 (52%) underwent ureteral hydrodistention combined with intraureteral injection. On multivariate analysis only vesicoureteral reflux grade (p <0.001) and surgeon (p = 0.01) were significantly predictive of injection success. There was a trend toward significance with ureteral hydrodistention combined with intraureteral injection (p = 0.056). CONCLUSIONS: In our multivariate model only vesicoureteral reflux grade and surgeon were independently predictive of injection success in patients with primary, uncomplicated vesicoureteral reflux. There was a trend toward improved results with ureteral hydrodistention combined with intraureteral injection, although this did not achieve statistical significance.

Authors
Routh, JC; Reinberg, Y; Ashley, RA; Inman, BA; Wolpert, JJ; Vandersteen, DR; Husmann, DA; Kramer, SA
MLA Citation
Routh, JC, Reinberg, Y, Ashley, RA, Inman, BA, Wolpert, JJ, Vandersteen, DR, Husmann, DA, and Kramer, SA. "Multivariate comparison of the efficacy of intraureteral versus subtrigonal techniques of dextranomer/hyaluronic acid injection." J Urol 178.4 Pt 2 (October 2007): 1702-1705.
PMID
17707019
Source
pubmed
Published In
The Journal of Urology
Volume
178
Issue
4 Pt 2
Publish Date
2007
Start Page
1702
End Page
1705
DOI
10.1016/j.juro.2007.03.174

Traumatic obliterative urethral strictures in pediatric patients: failure of the cut to light technique at long-term followup.

PURPOSE: The cut to light procedure or antegrade and retrograde urethroscopy with endoscopic incision of obliterative urethral strictures is an accepted method of treating posterior urethral distraction injuries. We report long-term followup on 22 pediatric patients treated with this technique. MATERIALS AND METHODS: The records of all pediatric patients with a posterior urethral distraction injury treated from 1986 through 2006 were reviewed. The cut to light procedure was performed for obliterative strictures less than 1 cm via a cold knife or laser in 11 patients each. A urethral catheter was left in situ for 3 weeks. Patients were then followed a minimum of 2 years. RESULTS: A total of 22 patients at a median age of 11 years (range 3 to 16) were treated. Followup revealed stricture recurrence in all patients. Median time to recurrence was 3 months after catheter removal (range 5 days to 1 year). Although intermittent catheterization to maintain patency was attempted in all patients, the development of impassable urethral strictures in 16 (73%) and complaints of chronic pain with catheterization in 4 (18%) led to end-to-end urethroplasty. Successful reconstruction with open surgery was achieved in 19 of 20 patients (95%). Two patients (9%) maintained urethral patency with intermittent catheterization. CONCLUSIONS: In children with obliterative posterior urethral distraction injuries a cut to light procedure had a long-term success rate of 0%. All patients required daily intermittent catheterization (9%) or formal urethral reconstruction (91%) to maintain patency. We would strongly recommend against treating pediatric obliterative urethral strictures with a cut to light procedure.

Authors
Tollefson, MK; Ashley, RA; Routh, JC; Husmann, DA
MLA Citation
Tollefson, MK, Ashley, RA, Routh, JC, and Husmann, DA. "Traumatic obliterative urethral strictures in pediatric patients: failure of the cut to light technique at long-term followup." J Urol 178.4 Pt 2 (October 2007): 1656-1658.
PMID
17707030
Source
pubmed
Published In
The Journal of Urology
Volume
178
Issue
4 Pt 2
Publish Date
2007
Start Page
1656
End Page
1658
DOI
10.1016/j.juro.2007.03.182

Histopathological changes associated with dextranomer/hyaluronic acid injection for pediatric vesicoureteral reflux.

PURPOSE: Few studies have examined the medium and long-term histological changes associated with periureteral injection of dextranomer/hyaluronic acid copolymer (Deflux(R)). We present the results of a histological review of a series of distal ureteral excisions in patients undergoing ureteroneocystostomy after failed dextranomer/hyaluronic acid injection. MATERIALS AND METHODS: All patients undergoing ureteroneocystostomy after failed dextranomer/hyaluronic acid injection(s) at 1 institution were eligible for this study. Excised ureteral segments were histologically examined by a single urological pathologist. An immunohistochemical battery was used for each specimen, including hematoxylin and eosin, CD3, CD20, MIB-1 and trichrome stains. Pathological criteria included the presence, location and intensity of fibrosis, giant cell reaction, chronic inflammation, free dextranomer/hyaluronic acid, and CD3, CD20 and MIB-1 staining. Pathological features were correlated with the time from injection to surgical excision. RESULTS: The ureters of 16 children with a mean age of 4.5 years were examined. Median time from injection to implant excision was 8 months. Giant cell reaction was present in 94% of patients and it was typically located in the serosa. No histological or immunophenotypical feature correlated with the duration of implantation except CD3+ and CD20+ lymphocyte counts, which increased with time from injection (p = 0.06 and 0.02, respectively). CONCLUSIONS: Dextranomer/hyaluronic acid appears to be stable and safe for use after 3 to 22 months of followup of subureteral injection. The periureteral inflammatory reaction increases with time, although no increases in nuclear turnover or fibrosis were detected.

Authors
Routh, JC; Ashley, RA; Sebo, TJ; Vandersteen, DR; Slezak, J; Reinberg, Y
MLA Citation
Routh, JC, Ashley, RA, Sebo, TJ, Vandersteen, DR, Slezak, J, and Reinberg, Y. "Histopathological changes associated with dextranomer/hyaluronic acid injection for pediatric vesicoureteral reflux." J Urol 178.4 Pt 2 (October 2007): 1707-1710.
PMID
17707018
Source
pubmed
Published In
The Journal of Urology
Volume
178
Issue
4 Pt 2
Publish Date
2007
Start Page
1707
End Page
1710
DOI
10.1016/j.juro.2007.03.165

Urachal anomalies: a longitudinal study of urachal remnants in children and adults.

PURPOSE: Urachal anomalies are often recognized in children but they may persist into adulthood and cause considerable morbidity. We reviewed the clinical findings associated with these embryological structures and evaluated risk factors for cancer to define the optimal timing for intervention. MATERIALS AND METHODS: We examined the medical records of 176 patients diagnosed with a urachal anomaly between 1951 and 2005. Association of clinicopathological features with malignancy for adults was evaluated using univariate and multivariate logistic regression studies. RESULTS: Urachal remnants were identified in 46 children and 130 adults. Of the 46 children 20 (43%) presented with umbilical drainage and 23 (50%) could be diagnosed by physical examination. A total of 34 children (74%) underwent simple excision. In contrast, 65 of the 130 adults (50%) presented with hematuria, 78 (60%) required cystoscopy and 53 (41%) required computerized tomography. A total of 66 adults (51%) required more extensive surgical intervention with partial or radical cystectomy. Of adult urachal anomalies 66 (51%) were malignant. Patient age 55 years or older and hematuria were the strongest predictors of urachal malignancy (each p <0.001). Cancer risk increased with advancing adult age. CONCLUSIONS: Urachal anomalies present and progress differently in pediatric and adult populations. Adults are at high risk for urachal cancer but children usually incur lower morbidity. Urachal lesions noted early in childhood should be excised to prevent problems in adulthood.

Authors
Ashley, RA; Inman, BA; Routh, JC; Rohlinger, AL; Husmann, DA; Kramer, SA
MLA Citation
Ashley, RA, Inman, BA, Routh, JC, Rohlinger, AL, Husmann, DA, and Kramer, SA. "Urachal anomalies: a longitudinal study of urachal remnants in children and adults." J Urol 178.4 Pt 2 (October 2007): 1615-1618.
PMID
17707039
Source
pubmed
Published In
The Journal of Urology
Volume
178
Issue
4 Pt 2
Publish Date
2007
Start Page
1615
End Page
1618
DOI
10.1016/j.juro.2007.03.194

Long-term continence outcomes after immediate repair of pediatric bladder neck lacerations extending into the urethra.

PURPOSE: Traumatic bladder neck lacerations extending into the urethra are devastating injuries that occur more commonly in children than in adults. It is unclear whether immediate repair of these injuries decreases long-term complications, such as urinary incontinence. We report our long-term results with immediate operative repair of these injuries. MATERIALS AND METHODS: Since 1986, we have primarily repaired all individuals sustaining traumatic longitudinal bladder neck lacerations extending into the urethra within 24 hours of injury. All patients were followed a minimum of 2 years. RESULTS: A total of 12 patients 2 to 16 years old sustained longitudinal bladder neck lacerations extending into the proximal urethra. Median followup was 7 years (range 2 to 13). Postoperatively none of the 12 patients recovered complete urinary continence. Periurethral bulking agents were attempted in all 12 patients with no long-term improvement. Eight patients (75%) pursued additional surgery. Three boys underwent artificial urinary sphincter placement, of which all subsequently eroded. Three girls underwent bladder neck reconstruction with fascial sling procedures, of whom 2 became continent but experienced urinary retention, while 1 became partially continent. Five patients, including the 3 boys with artificial urinary sphincter erosion, ultimately underwent bladder neck closure and continent diversion. CONCLUSIONS: Traumatic longitudinal bladder neck and proximal urethral lacerations are devastating injuries fraught with long-term complications and the need for additional surgery despite immediate surgical repair. Bladder neck closure and continent diversion should be considered in girls with substantial traumatic urethral loss and in boys with persistent urinary incontinence following primary repair.

Authors
Routh, JC; Husmann, DA
MLA Citation
Routh, JC, and Husmann, DA. "Long-term continence outcomes after immediate repair of pediatric bladder neck lacerations extending into the urethra." J Urol 178.4 Pt 2 (October 2007): 1816-1818.
PMID
17707005
Source
pubmed
Published In
The Journal of Urology
Volume
178
Issue
4 Pt 2
Publish Date
2007
Start Page
1816
End Page
1818
DOI
10.1016/j.juro.2007.05.094

Editorial Comment on: The Role of Endoscopic Treatment in the Management of Grade V Primary Vesicoureteral Reflux

Authors
Routh, JC; Reinberg, Y
MLA Citation
Routh, JC, and Reinberg, Y. "Editorial Comment on: The Role of Endoscopic Treatment in the Management of Grade V Primary Vesicoureteral Reflux." European Urology 52.5 (2007): 1509--.
PMID
17517469
Source
scival
Published In
European Urology
Volume
52
Issue
5
Publish Date
2007
Start Page
1509-
DOI
10.1016/j.eururo.2007.04.083

Editorial comment

Authors
Routh, JC
MLA Citation
Routh, JC. "Editorial comment." International Braz J Urol 33.2 (2007): 213--.
Source
scival
Published In
International braz j urol : official journal of the Brazilian Society of Urology
Volume
33
Issue
2
Publish Date
2007
Start Page
213-

Single center experience with endoscopic management of vesicoureteral reflux in children.

PURPOSE: Dx/HA copolymer was approved by the Food and Drug Administration in 2001 for the treatment of VUR in children. Published results have varied widely, prompting us to report our single center experience with 300 consecutive patients. MATERIALS AND METHODS: All patients undergoing Dx/HA injection (300 children, median age 5.4 years) at our institution were eligible for this study. We examined several parameters to determine which variables influence the success of Dx/HA injection, including preoperative reflux grade, bladder diverticula, neurogenic bladder, ureteral duplication, perioperative urinary tract infection, dysfunctional voiding, laterality of reflux and amount of Dx/HA injected. RESULTS: A total of 225 patients (75%) underwent postoperative studies, and, thus, were eligible for study inclusion. Reflux was cured in 144 patients (64%) and improved in 44 (20%). A total of 20 patients had ureteral duplication anomalies. Cure rates in this subgroup were significantly decreased compared to nonduplicated cases (40% vs 66%). Injection in low grade (I to II) reflux was significantly more successful than in high grade (III to IV) reflux (72% vs 54%). A total of 10 patients (8.3%) with unilateral reflux had development of de novo contralateral reflux. Of the patients who failed initial injection 10 (4%) underwent repeat injection, of whom 5 (50%) were cured after the second injection. Two patients (0.9%) had development of temporary ureteral obstruction. CONCLUSIONS: We report a large short-term single center experience with endoscopically injected Dx/HA. Although our cure rate of 64% was less than published rates for open surgery, the minimal morbidity and low complication rate of endoscopic treatment make it an attractive first line therapy for patients with VUR. Longer followup is required to better evaluate this technique.

Authors
Routh, JC; Vandersteen, DR; Pfefferle, H; Wolpert, JJ; Reinberg, Y
MLA Citation
Routh, JC, Vandersteen, DR, Pfefferle, H, Wolpert, JJ, and Reinberg, Y. "Single center experience with endoscopic management of vesicoureteral reflux in children." J Urol 175.5 (May 2006): 1889-1892.
PMID
16600790
Source
pubmed
Published In
The Journal of Urology
Volume
175
Issue
5
Publish Date
2006
Start Page
1889
End Page
1892
DOI
10.1016/S0022-5347(05)00926-2

Postoperative Ureteral Obstruction After Subureteral Injection of Dextranomer/Hyaluronic Acid Copolymer

Purpose: Subureteral injection of dextranomer/hyaluronic acid copolymer is widely accepted for the treatment of primary vesicoureteral reflux. Few studies document the incidence of surgically relevant postoperative obstruction or the characteristics of patients at risk. Materials and Methods: Four institutions had reported surgically relevant postoperative obstruction to representatives of Q-Med Scandinavia, the manufacturers of Deflux® (dextranomer/hyaluronic acid). All children undergoing dextranomer/hyaluronic acid injection at these institutions were evaluated in this study. Patients requiring postoperative stenting were retrospectively reviewed for pertinent history, volume injected, technique of injection, duration of symptoms before intervention, duration of intervention and final outcome. Results: A total of 745 patients (1,155 ureters) underwent injection. Five patients (6 renal units, 7 ureters) required stenting for obstructive symptoms and hydronephrosis, of whom 4 immediately became symptomatic. All patients had been injected with up to 1 ml dextranomer/hyaluronic acid. Four patients (80%) had either a neurogenic bladder or dysfunctional voiding. All stents were placed and removed without complications, with complete resolution of symptoms in all patients. Length of stenting ranged from 2 to 6 weeks. No patient required open surgery. One of 2 patients undergoing postoperative voiding studies had development of recurrent vesicoureteral reflux. Conclusions: Dextranomer/hyaluronic acid injection is associated with a small risk of postoperative ureteral obstruction requiring endoscopic intervention, with an overall incidence of less than 0.7% of patients injected. Patients with voiding dysfunction or neurogenic bladder may be at increased risk. Intervention with temporary ureteral stenting is effective, technically simple and curative. © 2006 American Urological Association.

Authors
Vandersteen, DR; Routh, JC; Kirsch, AJ; Scherz, HC; Ritchey, ML; Shapiro, E; Wolpert, JJ; Pfefferle, H; Reinberg, Y
MLA Citation
Vandersteen, DR, Routh, JC, Kirsch, AJ, Scherz, HC, Ritchey, ML, Shapiro, E, Wolpert, JJ, Pfefferle, H, and Reinberg, Y. "Postoperative Ureteral Obstruction After Subureteral Injection of Dextranomer/Hyaluronic Acid Copolymer." Journal of Urology 176.4 (2006): 1593-1595.
PMID
16952696
Source
scival
Published In
The Journal of Urology
Volume
176
Issue
4
Publish Date
2006
Start Page
1593
End Page
1595
DOI
10.1016/j.juro.2006.06.101

Tunneled Tunica Vaginalis Flap is an Effective Technique for Recurrent Urethrocutaneous Fistulas Following Tubularized Incised Plate Urethroplasty

Purpose: In the last several years the use of the tubularized incised plate hypospadias repair has greatly increased. The most significant complication after this mode of urethroplasty is urethrocutaneous fistula development. Tunneled tunica vaginalis flap is a well described technique for repair of urethrocutaneous fistula. However, to our knowledge its use after tubularized incised plate repair has not yet been described. We present our results with this technique. Materials and Methods: We retrospectively reviewed all patients undergoing repair of urethrocutaneous fistula after initial tubularized incised plate repair between January 2001 and December 2005. We analyzed the initial number and location of fistulas, number of previous urethrocutaneous fistula repairs, duration of surgery, and intraoperative and postoperative complications. Results: A total of 16 boys (median age 2.2 years) underwent tunica vaginalis flap repair at our institution for urethrocutaneous fistula following initial failed tubularized incised plate repair. Of these patients 4 had not previously undergone urethrocutaneous fistula repair and 12 had undergone 1 to 4 failed repair attempts. All boys had a subcoronal fistula and 8 had additional fistulas along the penile shaft, 4 each with 3 and 4 fistulas, including 1 penoscrotal fistula. Mean surgical time was 45 minutes, and no intraoperative or postoperative complications occurred. After a mean followup of 18 months (range 4 to 36) no patient had recurrence of urethrocutaneous fistula. Conclusions: Tunneled tunica vaginalis flap repair is a highly successful technique for the treatment of urethrocutaneous fistula after initial failed tubularized incised plate repair. The technique is technically simple to perform, and we encountered no complications. Tunneled tunica vaginalis flap repair should be considered for treating urethrocutaneous fistula following initial failed tubularized incised plate hypospadias surgery, particularly in a repeat surgical setting. © 2006 American Urological Association.

Authors
Routh, JC; Wolpert, JJ; Reinberg, Y
MLA Citation
Routh, JC, Wolpert, JJ, and Reinberg, Y. "Tunneled Tunica Vaginalis Flap is an Effective Technique for Recurrent Urethrocutaneous Fistulas Following Tubularized Incised Plate Urethroplasty." Journal of Urology 176.4 (2006): 1578-1581.
PMID
16952688
Source
scival
Published In
The Journal of Urology
Volume
176
Issue
4
Publish Date
2006
Start Page
1578
End Page
1581
DOI
10.1016/j.juro.2006.06.032

Impact of Parkinson's disease on continence after radical prostatectomy

Objectives: It is widely believed that men with idiopathic Parkinson's disease (PD) should not undergo prostate surgery because of the prohibitively high risk of incontinence. However, the data supporting this conclusion were based on cohorts undergoing prostate surgery for voiding dysfunction, not for cancer control. Because both prostate cancer and PD are predominantly diseases of the elderly, it is likely that some men are concurrently diagnosed with both disorders who would otherwise be good candidates for radical prostatectomy (RP). However, the urinary outcomes in men with PD undergoing RP are unknown. Thus, it is possible that men with PD have been denied a potentially curative surgery only on the basis of long-standing assumptions. We addressed this issue by examining a cohort of men with PD who underwent RP at our institution. Methods: We retrospectively reviewed a cohort of men who had undergone RP at our institution from 1990 to 2000. These men were surveyed 1 year after their surgery to determine their continence status, and their records were reviewed to determine whether any men had been preoperatively diagnosed with PD. Results: Of the 8415 men undergoing RP during the study period, 20 had PD and were included in our study. Their de novo incontinence rate at 1 year was 24%, with no patient requiring more than one to two pads per day. Conclusions: Most men with PD undergoing RP remained continent 1 year after surgery. Additional studies with longer follow-up are required to determine whether this remains true over time. © 2006 Elsevier Inc. All rights reserved.

Authors
Routh, JC; Crimmins, CR; Leibovich, BC; Elliott, DS
MLA Citation
Routh, JC, Crimmins, CR, Leibovich, BC, and Elliott, DS. "Impact of Parkinson's disease on continence after radical prostatectomy." Urology 68.3 (2006): 575-577.
PMID
16979722
Source
scival
Published In
Urology
Volume
68
Issue
3
Publish Date
2006
Start Page
575
End Page
577
DOI
10.1016/j.urology.2006.03.025

In reply [8]

Authors
Routh, J
MLA Citation
Routh, J. "In reply [8]." Mayo Clinic Proceedings 81.1 (2006): 132-133.
Source
scival
Published In
Mayo Clinic Proceedings
Volume
81
Issue
1
Publish Date
2006
Start Page
132
End Page
133

Adenocarcinoma of the prostate: Epidemiological trends, screening, diagnosis, and surgical management of localized disease

Prostate cancer is a leading cause of mortality and morbidity worldwide. Despite years of study and effort, certain key questions remain unanswered, including how prostate cancer is best detected and diagnosed, how it is best treated, and how best to minimize the complications of treatment. The aim of this article is to briefly address these topics to shed light on the current best practices in prostate cancer screening, diagnosis, and surgical treatment of localized disease. We examine current trends in prostate cancer epidemiology and screening, including genetic and dietary risk factors and the newer prostate-specific antigen-derived screening modalities. Methods of diagnosis, including an overview of prostate biopsy technique and indications, and a brief review of relevant pathologic findings are provided. An in-depth analysis of traditional prostate cancer surgical management high-lights the relevant advantages and disadvantages of radical retropubic and perineal prostatectomy. Complications of surgery, prognostic factors, and the many risk prediction models currently available are discussed. In all, this article aims to give the reader a broad overview of the basic elements of prostate cancer diagnosis and surgical treatment in the modern era. © 2005 Mayo Foundation for Medical Education and Research.

Authors
Routh, JC; Leibovich, BC
MLA Citation
Routh, JC, and Leibovich, BC. "Adenocarcinoma of the prostate: Epidemiological trends, screening, diagnosis, and surgical management of localized disease." Mayo Clinic Proceedings 80.7 (2005): 899-907.
Source
scival
Published In
Mayo Clinic Proceedings
Volume
80
Issue
7
Publish Date
2005
Start Page
899
End Page
907

Epididymo-orchitis and testicular abscess due to Nocardia asteroides complex

Nocardia asteroides complex is a rare human pathogen chiefly affecting immunosuppressed patients. We present the sixth case of epididymo-orchitis attributable to this organism. A 78-year-old man presented to the Mayo Clinic with fever and weight loss after being treated with cyclophosphamide and prednisone for an immune-mediated vasculitis. He was found to have a testicular abscess, and orchiectomy was performed. N. asteroides complex was identified on the wound cultures. Sulfa therapy was begun. In previous case reports, this condition carried a 50% mortality rate. Patients who survive seemed to benefit from aggressive surgical debridement and long-term sulfa therapy. © 2005 Elsevier Inc.

Authors
Routh, JC; Lischer, GH; Leibovich, BC
MLA Citation
Routh, JC, Lischer, GH, and Leibovich, BC. "Epididymo-orchitis and testicular abscess due to Nocardia asteroides complex." Urology 65.3 (2005): 591.e4-591.e5.
PMID
15780388
Source
scival
Published In
Urology
Volume
65
Issue
3
Publish Date
2005
Start Page
591.e4
End Page
591.e5
DOI
10.1016/j.urology.2004.09.008

Nephron-sparing surgery and renal cell carcinoma [5] (multiple letters)

Authors
Routh, JC; Leibovich, BC; Zincke, H; Blute, ML; Curti, BD
MLA Citation
Routh, JC, Leibovich, BC, Zincke, H, Blute, ML, and Curti, BD. "Nephron-sparing surgery and renal cell carcinoma [5] (multiple letters)." Journal of the American Medical Association 292.14 (2004): 1684--.
PMID
15479931
Source
scival
Published In
Journal of the American Medical Association
Volume
292
Issue
14
Publish Date
2004
Start Page
1684-

Lactobacillus gasseri causing Fournier's gangrene

Fournier's gangrene is characterized as an aggressive necrotizing process caused by a polymicrobial infection that includes virulent organisms. We report the first case of Fournier's gangrene caused by a low-virulence organism, Lactobacillus gasseri.

Authors
Tleyjeh, IM; Routh, J; Qutub, MO; Lischer, G; Liang, KV; Baddour, LM
MLA Citation
Tleyjeh, IM, Routh, J, Qutub, MO, Lischer, G, Liang, KV, and Baddour, LM. "Lactobacillus gasseri causing Fournier's gangrene." Scandinavian Journal of Infectious Diseases 36.6-7 (2004): 501-503.
PMID
15307582
Source
scival
Published In
Scandinavian Journal of Infectious Diseases
Volume
36
Issue
6-7
Publish Date
2004
Start Page
501
End Page
503
DOI
10.1080/00365540410015916

Six-year molecular analysis of Burkholderia cepacia complex isolates among cystic fibrosis patients at a referral center for lung transplantation

Over a 6-year period, Burkholderia cepacia complex species were isolated from cystic fibrosis (CF) patients receiving care at The University of North Carolina Hospitals (clinic CF patients) and from those referred from other treatment centers. Fifty-six isolates collected from 30 referred patients and 26 clinic CF patients were characterized by pulsed-field gel electrophoresis (PFGE) and were assayed by PCR to detect the cable pilin gene, cblA. PFGE results indicated that six separate clusters (clusters A to F) were present among the 56 isolates and that three clusters (clusters A, B, and E) consisted only of isolates from referred patients infected with B. cepacia complex isolates prior to referral. However, one cluster (cluster C) consisted of isolates from four CF patients, and hospital records indicate that this cluster began with an isolate that came from a referred patient and that spread to three clinic CF patients. Cluster D consisted of two isolates from clinic CF patients, and hospitalization records are consistent with nosocomial, patient-to-patient spread. cblA was present in only 4 of the 56 isolates and included isolates in cluster E from the referred patients. Our results indicate a lack of spread of a previously characterized, transmissible clone from referred patients to our clinic CF population. Only two instances of nosocomial, patient-to-patient spread could be documented over the 6-year period. An additional spread of an isolate (cluster F) from a referred patient to a clinic patient could not be documented as nosocomial and may have been the result of spread in a nonhospitalized setting. The majority (36 of 56) of our B. cepacia complex-infected CF patients harbor isolates with unique genotypes, indicating that a diversity of sources account for infection. These data suggest that CF patients infected with B. cepacia complex and referred for lung transplantation evaluation were not a major source of B. cepacia complex strains that infected our resident CF clinic population.

Authors
Heath, DG; Hohneker, K; Carriker, C; Smith, K; Routh, J; LiPuma, JJ; Aris, RM; Weber, D; Gilligan, PH
MLA Citation
Heath, DG, Hohneker, K, Carriker, C, Smith, K, Routh, J, LiPuma, JJ, Aris, RM, Weber, D, and Gilligan, PH. "Six-year molecular analysis of Burkholderia cepacia complex isolates among cystic fibrosis patients at a referral center for lung transplantation." Journal of Clinical Microbiology 40.4 (2002): 1188-1193.
PMID
11923329
Source
scival
Published In
Journal of Clinical Microbiology
Volume
40
Issue
4
Publish Date
2002
Start Page
1188
End Page
1193
DOI
10.1128/JCM.40.4.1188-1193.2002

Lung transplantation for cystic fibrosis patients with Burkholderia cepacia complex: Survival linked to genomovar type

The number of cystic fibrosis (CF) patients undergoing lung transplant has risen over the past decade, because of a clear-cut survival benefit. However, patients with Burkholderia cepacia complex are often excluded from transplantation because of increased mortality. To determine the influence of B. cepacia complex genomovar type on transplant outcome, we undertook a retrospective study in 121 CF patients transplanted at UNC. Twenty-one and three patients, respectively, were infected pre- or postoperatively with B. cepacia complex. All posttransplant acquisitions were successfully treated. However, excess mortality occurred over the first 6 postoperative months in those infected preoperatively with B. cepada complex compared with those not infected (33% versus 12%, p = 0.01). The 1-, 3-, and 5-yr survival were significantly lower in the B. cepacia complex cohort. Of the patients infected preoperatively, genomovar III patients were at the highest risk of B. cepacia complex-related mortality (5 of 12 versus 0 of 8, one isolate not typed; p = 0.035). Each of the B. cepacia complex-related deaths was caused by a unique genotype as determined by pulsed-field gel electrophoresis. All isolates were negative for the cable pilin gene. These results warrant a multicenter analysis of B. cepacia complex-infected patients with genomovar-typing to confirm that genomovar III patients are at highest risk for post-transplant complications.

Authors
Aris, RM; Routh, JC; Lipuma, JJ; Heath, DG; Gilligan, PH
MLA Citation
Aris, RM, Routh, JC, Lipuma, JJ, Heath, DG, and Gilligan, PH. "Lung transplantation for cystic fibrosis patients with Burkholderia cepacia complex: Survival linked to genomovar type." American Journal of Respiratory and Critical Care Medicine 164.11 (2001): 2102-2106.
PMID
11739142
Source
scival
Published In
American journal of respiratory and critical care medicine
Volume
164
Issue
11
Publish Date
2001
Start Page
2102
End Page
2106

Editorial comment

Authors
Zhong, P
MLA Citation
Zhong, P. "Editorial comment." Journal of Endourology 15.8 (2001): 826--.
PMID
27936382
Source
scival
Published In
Journal of Endourology
Volume
15
Issue
8
Publish Date
2001
Start Page
826-
Show More

Research Areas:

  • Abnormalities, Multiple
  • Adenocarcinoma
  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Ambulatory Care Facilities
  • Anastomosis, Surgical
  • Anesthesia, Local
  • Anesthetics, Local
  • Animals
  • Anus, Imperforate
  • Biological Markers
  • Biopsy
  • Bladder Exstrophy
  • Child
  • Child, Preschool
  • Cohort Studies
  • Congenital Abnormalities
  • Controlled Clinical Trials as Topic
  • Cost of Illness
  • Cryptorchidism
  • Cystoscopy
  • Data Collection
  • Debridement
  • Decision Support Techniques
  • Dextrans
  • Diagnosis, Differential
  • Diagnostic Techniques, Urological
  • Disease Models, Animal
  • Disorders of Sex Development
  • Diverticulum
  • Double-Blind Method
  • Early Diagnosis
  • Electric Stimulation Therapy
  • Electrolytes
  • Endoscopy
  • Enema
  • Epidemiology
  • Epidermal Cyst
  • Epispadias
  • Equipment Design
  • Evidence-Based Medicine
  • Faculty, Medical
  • Female
  • Female Urogenital Diseases
  • Follow-Up Studies
  • Glycerol
  • Guideline Adherence
  • Health Status
  • Healthcare Disparities
  • Hernia
  • Hospitals
  • Hospitals, Pediatric
  • Humans
  • Hyaluronic Acid
  • Immunohistochemistry
  • Incidence
  • Infant
  • Infant, Newborn
  • Infants
  • Injections
  • Injury Severity Score
  • Intraoperative Complications
  • Ischemia
  • Kidney
  • Kidney Calculi
  • Kidney Diseases
  • Kidney Failure, Chronic
  • Kidney Transplantation
  • Leadership
  • Lidocaine
  • Lithotripsy
  • Living Donors
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Male Urogenital Diseases
  • Markov Chains
  • Mass Screening
  • Middle Aged
  • Morbidity
  • Multifactorial Inheritance
  • Multivariate Analysis
  • Neoplasm Recurrence, Local
  • Pain
  • Pain Measurement
  • Pediatrics
  • Physician's Practice Patterns
  • Physicians
  • Pilot Projects
  • Postoperative Complications
  • Predictive Value of Tests
  • Prevalence
  • Probability
  • Prognosis
  • Program Evaluation
  • Prospective Studies
  • Prostate
  • Prostate-Specific Antigen
  • Prostatic Neoplasms
  • Prostheses and Implants
  • Prosthesis Implantation
  • Prune Belly Syndrome
  • Public Health
  • Publications
  • Quality Improvement
  • Quality of Health Care
  • Radiation Dosage
  • Radiation Injuries
  • Reconstructive Surgical Procedures
  • Remission Induction
  • Renal Insufficiency, Chronic
  • Reoperation
  • Reproducibility of Results
  • Retrospective Studies
  • Risk
  • Risk Factors
  • Sensitivity and Specificity
  • Sex Distribution
  • Siblings
  • Sodium, Dietary
  • Spina bifida
  • Spinal Dysraphism
  • Testicular Diseases
  • Testicular Neoplasms
  • Therapeutic Irrigation
  • Time Factors
  • Transplantation, Homologous
  • Treatment Outcome
  • United States
  • Unnecessary Procedures
  • Urachal Cyst
  • Urachus
  • Ureter
  • Ureteral Diseases
  • Ureteroscopy
  • Urethra
  • Urethral Diseases
  • Urinary Bladder
  • Urinary Bladder Diseases
  • Urinary Bladder, Neurogenic
  • Urinary Sphincter, Artificial
  • Urinary Tract Infections
  • Urination Disorders
  • Urodynamics
  • Urogenital Abnormalities
  • Urolithiasis
  • Urologic Neoplasms
  • Urologic Surgical Procedures
  • Urology
  • Utility theory
  • Vesico-Ureteral Reflux
  • Wilms Tumor
  • Wounds, Nonpenetrating