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Psychosocial needs, which encompass behavioral health and social determinants of health (SDOH), are important mediators of the patient experience and health outcomes. However, many practices have limited experience with systematically assessing the non-billable psychosocial services provided to patients and families. To characterize the non-billable activities of three psychosocial providers in a pediatric urology practice at a freestanding children's hospital. Following Institutional Review Board approval, an adapted version of the Care Coordination Measurement Tool (CCMT) was used to collect data prospectively on non-billable activities performed by a psychologist, social worker (SW), and certified child life specialist (CCLS) in a pediatric urology department. Variables included activity type, time spent per activity, and outcomes affected. Demographic data included age, sex, race, state, zip code, insurance type, and language. From April to October 2022, 3096 activities were performed in support of psychosocial needs over 947 encounters for 527 patients. The median patient age was 9.2 years (IQR 4.8–12.4); 48.4 % were male. The psychosocial providers most commonly identified care coordination needs related to delivery of urologic care (73.4 %), mental/behavioral/developmental health (29.1 %), and referral and appointment management (19.9 %). The largest proportion of time was spent on providing direct psychosocial support (45.9 %), consisting of psychosocial assessments, education, and other behavioral health interventions. A large proportion of time was also spent on care coordination activities, namely logistics and navigation support (35.9 %). Relative time allocation across activities varied by provider type (p < 0.001); care coordination constituted 64.2 % of non-billable activities for the psychologist, 57.8 % for the SW, and 12.3 % for the CCLS. Activities were associated with treatment plan modification in 37.7 % (n = 357), outpatient coordination in 22.5 % (n = 213), and treatment plan adherence in 19.0 % (n = 180) of encounters. This study enhances our understanding of psychosocial needs of patients in a pediatric urology practice by assessing non-billable psychosocial services not otherwise captured in the clinical workflow. In addition to direct psychosocial support, care coordination activities constitute a large proportion of such services. These data provide valuable insight into the range of activities necessary for the provision of specialty pediatric medical care. Psychosocial providers in a pediatric urology practice perform many non-billable care coordination and psychosocial support activities. Characterizing these activities is important for beginning to understand patients' psychosocial needs and informing resource deployment. [Display omitted] [ABSTRACT FROM AUTHOR]

False-positive urine pregnancy screening tests (UPST) have been reported among patients with bowel-containing urinary reconstruction (BCUR). However, the true frequency of such inaccurate results, which have been attributed to urinary mucous or other proteins interfering with or mimicking the binding of beta-HCG in the assay, is unknown in this population. We sought to determine the incidence of false-positive pregnancy screening tests among this patient population at our institution. Using existing databases of patients with spina bifida, bladder exstrophy, and genitourinary rhabdomyosarcoma, we identified female patients with BCUR who had UPST over a 10-year period as screening prior to procedures or imaging. Patient and test result information was recorded. A total of 120 patients with a history of BCUR were identified: 33 with spina bifida, 73 within the exstrophy-epispadias complex (EEC), and 14 with genitourinary rhabdomyosarcoma. Of this group, 46 patients (38%) had at least one UPST during the study period; 15 had 1 UPST, 6 had 2 UPSTs, 4 had 3 UPSTs, and 21 had greater than 3 UPSTs, for a total of 244 UPST in this cohort. UPSTs used at our institution included Sure-Vue brand and Alere brand (HCG sensitivity 20 mIU/ml). Types of BCUR included ileal enterocystoplasty in 25 patients, colon enterocystoplasty in 6, stomach enterocystoplasty in 5, composite enterocystoplasty in 7, and continent catheterizable channel alone (e.g. Yang-Monti, appendicovesicostomy) in 3 patients. Of the 244 UPSTs in patients with BCUR, zero (0%) were positive. Despite reports in the literature that false-positive UPST are common among patients with bowel-containing urinary diversions, we found no positive UPST among patients with BCUR in the healthcare setting. False-positive UPST in the home setting may be due to variability in sensitivity thresholds, binding agents , technical errors in test technique, kit quality control, or other factors. Summary Table Characteristics and results of urine pregnancy screening tests (UPST) in a hospital setting, among female patients with bowel-containing urinary reconstruction (BCUR), over a 10-year period. Spina Bifida (n = 16) Exstrophy Complex (n = 29) GU RMS (n = 1) Total (n = 46) Age at BCUR Repair (years, median, IQR) 13.5 (8.5–25) 4 (1.5–9.5) 2 8 (2–14.25) Type of BCUR (%) Augment, ileum 11 (69) 14 (48) 0 25 (54) Augment, colon 5 (31) 0 1 (100) 6 (13) Augment, stomach 0 5 (17) 0 5 (11) Augment, compound a 0 7 (24) 0 7 (15) Continent Channel only 0 3 (10) 0 3 (7) Time from BCUR to first UPST (months, median, IQR) 14.5 (4–31) 139 (77.5–202.5) 147 54 (13–149.25) Number of UPST per patient (%) One 6 (38) 9 (31) 0 15 (33) Two 2 (13) 4 (14) 0 6 (13) Three 1 (6) 3 (10) 0 4 (9) Greater than Three 7 (44) 13 (45) 1 (100) 21 (46) Total Positive UPST 0 0 0 0 a stomach/ileum (4), colon/ileum (1), colon/stomach (1), other (1). [ABSTRACT FROM AUTHOR]

Abstract: While intermittent ureteropelvic junction obstruction is well recognized clinically, intermittent obstruction at the ureterovesical junction has not been previously described. We herein present a case report of intermittent ureterovesical junction obstruction, characterized by intermittent hydroureteronephrosis on ultrasonography and symptoms of flank/abdominal pain, nausea and vomiting. [Copyright &y& Elsevier]

Purpose: The ideal biomaterial for bladder tissue engineering remains elusive. Silk has been utilized in vascular and orthopedic applications, and possesses physical and biological properties well suited for urologic applications. We hypothesize that silk scaffolds can be utilized for bladder tissue engineering. Methods: Silk fibroin solution from Bombyx mori silkworm cocoons were woven into patches using gel spinning. Bladder augmentations were performed in 25 CD-1 female mice with non-cell seeded silk, PGA, or SIS patches (0.5 cm2). Sham procedures of cystotomy only were performed. Postoperative assessment at 1, 3, 6, and 10 weeks included: 1) voiding stain on paper (VSOP) testing for qualitative and quantitative assessment of voiding, 2) ultrasound to assess bladder and renal appearance, 3) pathological analysis including Masson trichrome and immunofluorescence of smooth muscle (alpha actin) and urothelial (uroplakin IIIa) markers, and 4) Urodynamics (bladder capacity, voided volume, urinary flow rate, and bladder compliance). Statistical analysis was performed by ANOVA with post-hoc Bonferroni testing. Results: VSOP revealed normalization of voiding pattern in silk-augmented mice at 1 week that persisted to 10 weeks. Renal and bladder ultrasound demonstrated normal kidneys and gradual bladder remodeling over 10 weeks. Histological analysis of silk-augmented bladders revealed complete organized bladder tissue formation without fibrosis around the silk scaffolds by 10 weeks. The new tissue stained robustly for alpha actin (Figure 1) and uroplakin IIIa (Figure 2). 10 weeks after augmentation, mean capacity of silk-augmented bladders was 207 (mcL) v. 51 for controls (p<0.0001). Mean compliance for silk-augmented bladders was 12.0 (mcL/cm H2O) v. 8.4 for controls (p=0.023), 3.9 for PGA-augmented bladders (p=0.0001), and 5.5 for SIS-augmented bladders (p<0.0001). Conclusions: Unseeded silk scaffolds promote formation of organized and functional bladder tissue in mice. In addition, silk produces superior compliance compared to conventional biomaterials. This represents a new option for urologic tissue engineering applications. [Copyright &y& Elsevier]