Search

Artificial intelligence (AI) is providing novel answers to long-standing clinical problems, and it is quickly changing pediatric urology. This thorough analysis focuses on current developments in AI technologies that improve pediatric urology diagnosis, treatment planning, and surgery results. Deep learning algorithms help detect problems with previously unheard-of precision in disorders including hydronephrosis, pyeloplasty, and vesicoureteral reflux, where AI-powered prediction models have demonstrated promising outcomes in boosting diagnostic accuracy. AI-enhanced image processing methods have significantly improved the quality and interpretation of medical images. Examples of these methods are deep-learning-based segmentation and contrast limited adaptive histogram equalization (CLAHE). These methods guarantee higher precision in the identification and classification of pediatric urological disorders, and AI-driven ground truth construction approaches aid in the standardization of and improvement in training data, resulting in more resilient and consistent segmentation models. AI is being used for surgical support as well. AI-assisted navigation devices help with difficult operations like pyeloplasty by decreasing complications and increasing surgical accuracy. AI also helps with long-term patient monitoring, predictive analytics, and customized treatment strategies, all of which improve results for younger patients. However, there are practical, ethical, and legal issues with AI integration in pediatric urology that need to be carefully navigated. To close knowledge gaps, more investigation is required, especially in the areas of AI-driven surgical methods and standardized ground truth datasets for pediatric radiologic image segmentation. In the end, AI has the potential to completely transform pediatric urology by enhancing patient care, increasing the effectiveness of treatments, and spurring more advancements in this exciting area. [ABSTRACT FROM AUTHOR]

Simple Summary: Diagnosis is the most important step in treating and managing kidney cancer, requiring accurate identification, localization, and classification of tumor regions. The selection of appropriate surgical procedures for malignant cases is further based on tumor volume and relative severity. In recent years, machine-learning-based approaches have been proposed to localize, quantify, and stratify kidney tumors using contrast-enhanced computed tomography (CT) images. However, previous studies have largely neglected the integration of patient metadata with clinical images to better diagnose and guide surgical interventions. In the current study, we developed a combined clinical and image-based approach to classify kidney cancers using a publicly available dataset. We show that the inclusion of clinical features alongside medical images improves the performance of kidney tumor classification. We further used clinical data together with a machine-learning approach to predict the expected surgical procedure employed in individual kidney cancer patients. In addition to cancer stage and tumor volume, some surprisingly common demographic features were revealed to be key determinants of the surgical procedure later selected for nephrectomy. Kidney cancers are one of the most common malignancies worldwide. Accurate diagnosis is a critical step in the management of kidney cancer patients and is influenced by multiple factors including tumor size or volume, cancer types and stages, etc. For malignant tumors, partial or radical surgery of the kidney might be required, but for clinicians, the basis for making this decision is often unclear. Partial nephrectomy could result in patient death due to cancer if kidney removal was necessary, whereas radical nephrectomy in less severe cases could resign patients to lifelong dialysis or need for future transplantation without sufficient cause. Using machine learning to consider clinical data alongside computed tomography images could potentially help resolve some of these surgical ambiguities, by enabling a more robust classification of kidney cancers and selection of optimal surgical approaches. In this study, we used the publicly available KiTS dataset of contrast-enhanced CT images and corresponding patient metadata to differentiate four major classes of kidney cancer: clear cell (ccRCC), chromophobe (chRCC), papillary (pRCC) renal cell carcinoma, and oncocytoma (ONC). We rationalized these data to overcome the high field of view (FoV), extract tumor regions of interest (ROIs), classify patients using deep machine-learning models, and extract/post-process CT image features for combination with clinical data. Regardless of marked data imbalance, our combined approach achieved a high level of performance (85.66% accuracy, 84.18% precision, 85.66% recall, and 84.92% F1-score). When selecting surgical procedures for malignant tumors (RCC), our method proved even more reliable (90.63% accuracy, 90.83% precision, 90.61% recall, and 90.50% F1-score). Using feature ranking, we confirmed that tumor volume and cancer stage are the most relevant clinical features for predicting surgical procedures. Once fully mature, the approach we propose could be used to assist surgeons in performing nephrectomies by guiding the choices of optimal procedures in individual patients with kidney cancer. [ABSTRACT FROM AUTHOR]

Objectives: There is an unmet need for preoperative methods that surgeons can use to objectively quantify hypospadias anatomic variables and determine risk of penile curvature. We, therefore, assessed whether Plate Objective Scoring Tool measurements were correlated with degree of ventral curvature in affected children. Methods: Patients undergoing distal hypospadias repair were enrolled into the study between January 2018 and December 2020 and were categorized independently by at least two surgeons using Plate Objective Scoring Tool. Scores were compared statistically to determine the degree of ventral curvature and requirement for correction. Results: Sixty‐five patients with a median age of 18 months (interquartile range 13–26) were enrolled into the study prior to surgery for primary distal hypospadias. Patient probability of significant postoperative curvature (>20°) was determined with moderate confidence using a cutoff Plate Objective Scoring Tool score of 1 (sensitivity 75%, specificity 60%). Presurgery Plate Objective Scoring Tool scores were negatively correlated with subsequent degree of curvature (r = −0.37, P = 0.003), with values <1.0 predicting >20° curvature. Conclusions: Plate Objective Scoring Tool scoring offers a succinct method of describing hypospadias severity and correlates well with postoperative outcomes. The Plate Objective Scoring Tool system can therefore be used to objectively predict the likelihood of penile curvature and aid communication between surgeons and researchers, as well as improving parental counseling. [ABSTRACT FROM AUTHOR]

Penile curvature (PC) is a significant phenotypic anomaly associated with hypospadias that can affect hypospadias repair post-operative outcomes and impact on long-term quality of life as well as psychosexual wellbeing of affected patients. While several previous studies have attempted to define PC assessment criteria, there is still no accurate, reproducible, and reliable tool for quantifying severity. Our goal was to review the pros and cons of the current tools utilized for assessing the degree of PC in children, stressing on both strengths and limitations of each method. A wide and deliberate review of the literature discussing the assessment of PC in hypospadias patients was conducted. We also draw on relevant methods employed in adults with PC and Peyronie's disease where a greater breadth of studies has been conducted. The appraisal outcomes combined with our recommendations were presented in a structured approach discussing the pre-, intra-, and post-operative evaluation of PC in patients with hypospadias. Critical appraisal of the evaluation tools in terms of availability, cost, objectivity, and potential reproducibility was presented. This review reflects on current tools used for assessing the degree of PC in children, highlighting both strengths and limitations of each method. A wide variety of approaches are currently being practiced or investigated, with each method displaying particular utility and reliability characteristics. Several approaches are currently being explored with high potential to overcome the current difficulties encountered when measuring PC both in clinical practice and research studies. [ABSTRACT FROM AUTHOR]

Hypospadias is a common birth defect of the male external genitalia. However, there are conflicting arguments about the optimal classification approach and ideal surgical technique. We have introduced the Plate Objective Scoring Tool (POST) to define critical glanular phenotypic landmarks of the urethral plate. We propose that POST can objectively, reproducibly, and accurately determine urethral plate quality, thus permitting robust comparison between the different surgical techniques commonly utilized in hypospadias repair. Furthermore, the POST scoring system represents a versatile tool that can objectively quantify key variables in hypospadiology that are currently not well defined. Further validation of POST should lead to better identification and management of postoperative complications. [ABSTRACT FROM AUTHOR]

Abstract Prostate cancer rarely metastasis to the rectum. Findings in the patient reported here emphasize the importance of the relationship between urinary and gastrointestinal symptoms in detecting prostatic neoplasms in older male patients.

Background: Pyeloplasty is a common surgical operation with a high success rate. However, significant challenges are to be optimized in the design of stenting systems in order to improve perioperative monitoring of urine drainage and enhance patient and family comfort through easier post-operative care. Materials and Methods: In a preliminary study in six pigs, handling, mechanical and functional features of this stent system were tested. In our main study, six double-lumen stents (230 mm long each) and 6F/9F external diameter were implanted through the ureteric walls of six domestic pigs to allow postoperative drainage and monitoring following ureteroureterostomy. After a 7-day survival period, monitoring with intravenous antibiotic coverage, and pain control, contrast antegrade pyelogram, under valve control, and renal ultrasonography were conducted and stents explanted and the animals were then euthanized. Results: The double-lumen valve-controlled stent supported the healing of the neo anastomoses and helped to monitor perioperative urine drainage and perianastomotic leakage accurately. It also guided a well-controlled more informative radiological contrast-supported imaging before removal of the stents that confirmed the healing of the neo anastomotic site and no leak formation. The double-lumen system demonstrated high feasibility regarding its insertion, functionality, and removal capacities. The excellent flexibility of the individual stents allowed exact anatomically controlled implantation. Conclusion: The double-lumen valve-controlled stent system was studied in a porcine model, which demonstrated its feasibility. Preclinical experience revealed favorable results concerning stent implantation, operability and functionality, in the perioperative management of pyeloplasty or ureteric surgery. [ABSTRACT FROM AUTHOR]

Cystourethroscopy in children can be conducted in a significant variety of patient sizes, ranging from newborns to adolescents. In order to have adequate visualization of both the urethra and the bladder, suitable positioning needs to be achieved. We describe a method for positioning the legs of infants for cystoscopy using skin-friendly tape. The benefit of this technique is that it is adaptable and cheap without the requirement for wedges, stirrups or boots. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to explore the normal external urethral meatal and glans closure line in normal boys, and to investigate the correlation between these glans biometrics and the age of the participants. Material and Method: 103 male children were asked to participate in the study during ritual circumcision. Parents of 94 of them (mean age 5.9 years, range 0.6-13) accepted while remaining 9 did not. Glans biometrics were measured using digital calipers. Result: 100% of the study participants had a vertical slit-like meatal opening located at the tip of the glans. The length of the meatal opening was 5.3 (± 1) mm and of ventral glans closure was 4.8 (±1.1) mm. Significant correlation between both the external meatal opening and closure lines lengths and age was observed. Moreover, the meatal opening size was correlated to the glans closure line as well (r = 0.36, confidence interval 0.14-0.54, P < .001). Conclusion: The site and size of the meatus opening in normal male children is consistent, and ventral glans closure is equal to or slightly less than meatal length. These findings could aid in glanular reconstruction configuration during hypospadias surgery. [ABSTRACT FROM AUTHOR]

Current approaches to classifying hypospadias severity are based on meatus position. These classification tools lack precise reflection on the degree of urethral hypoplasia and extent of urethral underdevelopment hence are not good representative of hypospadias severity. Here, an alternative classification system is introduced that objectively reflects the developmental pathology underlying this condition. The study goal was to appraise location of bifurcation in the corpus spongiosum (BCS) relative to the penile shaft as an indicator of hypospadias severity. Patients aged <18 years with primary hypospadias were included in the study. Urethral defect ratio (UDR) was calculated by dividing the extent of urethral defect (distance between the glandular knobs and BCS) relative to stretched penile length (SPL). Hypospadias severity was then categorized into three distinct grades (UDR <0.5, 0.5–0.99, ≥1.0). The Inter-Class Correlation (ICC) was evaluated to assess the intra- and inter-rater agreement between the reviewers of UDC ratio. Linear regression analysis was performed to estimate the correlation between UDC ratios and either plate objective scoring tool (POST) and Curvature degrees. A total of 67 patients aged 12.3 ± 3.7 months with primary hypospadias were enrolled. UDR ranged between 0.2 and 1.3. A significant difference in hypospadias level was observed between UDR grades, which further correlated degree of curvature (P < 0.0001), urethral plate quality (P < 0.0001), and associated anomalies (P < 0.05). The Inter-Class Correlation (ICC) value to examine the intra- and inter-rater agreement between the two reviewers in UDC ratio was 0.998 (95% CI 0.998, 0.999). Regression analysis revealed that UDR and both POST and Curvature degree were significantly associated (P < 0.001). A hypospadias severity scoring system based on embryological etiology and urethral hypoplasia and assessed relative to the penile shaft represents an objective, feasible, and consistent tool. These results clearly indicate that the reviewers have had excellent consistency/reliability across their consecutive readings. This new system can facilitate objective description of hypospadias-spectrum anomalies and thus support precise communication between individual surgeons and centers. [ABSTRACT FROM AUTHOR]

Background: Foreign body (FB) ingestion by children is a common problem worldwide. Management may include endoscopic removal. This paper describes the clinical findings, sites and types of FBs, and outcomes in children who underwent endoscopic management of ingested FBs at our institution. The published literature regarding the management of FB ingestion in children is also reviewed. Methods: We retrospectively reviewed the records of all patients aged <14 years who underwent endoscopic management of gastrointestinal FBs between July 2002 and June 2012 (47 patients) and tracheobronchial FBs between December 2010 and June 2012 (17 patients) at our institution. Patient characteristics, clinical findings, sites and types of FBs, and outcomes were recorded. Results: The 47 patients with gastrointestinal FBs included 29 males and 18 females with a mean age of 3.5 years. The most common symptoms were difficulty with swallowing and vomiting in 16 patients (34%), chest pain in 10 (21%), and coughing and breathing difficulty in 7 (15%). The most common FB site was the esophagus (36 patients). Most gastrointestinal FBs were metallic, with coins being the most common. Endoscopic removal was successful in 43 patients. The 17 patients with tracheobronchial foreign bodies included 9 males and 8 females with a mean age of 3.2 years. The most common symptoms were breathing difficulty in 12 patients (71%) and coughing in 3 (18%). The most common tracheobronchial FBs were nuts (10 patients). Bronchoscopic removal was successful in all 17 patients. Conclusions: Coins were the most common gastrointestinal FBs, and nuts were the most common tracheobronchial FBs. Clinical presentations were variable, and a high index of suspicion is necessary. Endoscopic removal is safe and effective, and early diagnosis and management result in favorable outcomes. [ABSTRACT FROM AUTHOR]

Background: Omental cysts are the least common variety of intraabdominal cystic lesions encountered in children. They are often identified incidentally, although they may also cause acute abdominal pain. Case Report: We describe here two girls with omental cysts with very unusual clinical presentations. Conclusion: The majority of omental cysts are discovered incidentally. Overall results in pediatric patients are favourable. Optimal surgical management mandates complete excision. [ABSTRACT FROM AUTHOR]

Aim: Hypospadias is a relatively common male genital anomaly that may be caused by anomalies in maternal hormone levels and/or blood glucose levels as well as nutritional deficiencies. Maternal obesity, which increases the risk of diabetes, may alter hormone levels, and may thereby be associated with risk of hypospadias. This study was designed to determine the impact of these risk factors on hypospadias in boys born at the largest tertiary hospital in Qatar. Methods: This population-based, case-control study used linked birth-hospital discharge data from Hamad General Hospital in Doha, Qatar, from January 2007 to December 2012. Boys with hypospadias were identified, and risk factors were determined. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for hypospadias were estimated by multivariable logistic regression models adjusted for maternal age, parity and body mass index (BMI). Results: Seventy-three newborn male infants with hypospadias and 100 without the condition, with birth weight above 2500 g, were compared. Maternal obesity (BMI ≥ 30 kg/m²) was not associated with risk of hypospadias (aOR 1.07; 95% 0.95 - 1.21), and no trend in risk with increasing maternal BMI was observed. Conclusion: Although the causes of male genital malformation are multifactorial, the present data do not support the hypothesis that gestational maternal obesity is a cause of hypospadias in male infants. [ABSTRACT FROM AUTHOR]

Diabetes mellitus (DM) can lead to plantar ulcers, amputation and death. Plantar foot thermogram images acquired using an infrared camera have been shown to detect changes in temperature distribution associated with a higher risk of foot ulceration. Machine learning approaches applied to such infrared images may have utility in the early diagnosis of diabetic foot complications. In this work, a publicly available dataset was categorized into different classes, which were corroborated by domain experts, based on a temperature distribution parameter—the thermal change index (TCI). We then explored different machine-learning approaches for classifying thermograms of the TCI-labeled dataset. Classical machine learning algorithms with feature engineering and the convolutional neural network (CNN) with image enhancement techniques were extensively investigated to identify the best performing network for classifying thermograms. The multilayer perceptron (MLP) classifier along with the features extracted from thermogram images showed an accuracy of 90.1% in multi-class classification, which outperformed the literature-reported performance metrics on this dataset. [ABSTRACT FROM AUTHOR]

Background: Although laparoscopy is rapidly becoming the abdominal surgical modality of choice in adults, there are obstacles to its use in children. We analyzed our experience with pediatric laparoscopic surgery over the past 5 years, with particular emphasis on emergency procedures. Findings: We retrospectively evaluated the records of patients aged <14 years who had undergone laparoscopic procedures for non-trauma emergency conditions at our institution from January 2006 to December 2010. The clinical parameters evaluated included operation time, total length of hospital stay, and postoperative complications. During the 5-year study period, 482 laparoscopic procedures were performed on patients aged <14 years, comprising 300 emergency and 182 elective operations. The majority of procedures were laparoscopic appendectomies, with most of the others being resections of ovarian cysts or Meckel's diverticulae, or adhesiolyses. We observed an improvement in outcomes over the 5-year period, as shown by shorter operation times and shorter postoperative hospital stays. The numbers of laparoscopic procedures performed increased over time. Conclusions: Pediatric laparoscopic surgery for emergency conditions provides excellent results, including better exposure and cosmetic outcomes than laparotomy. At our institution, the numbers and types of laparoscopic procedures performed have increased over time, and the outcomes of laparoscopic procedures have improved. [ABSTRACT FROM AUTHOR]

Background. Undescended testis is one of the most common urological problems in children, affecting about 1%of boys at age of 1 year. Of these, about 20% have a nonpalpable testis with a very high probability that the testis is absent. This may have a significant impact on the possibility of malignancy in these testes, as well as on the later fertility of these subjects. Methods. We retrospectively analyzed the demographic and clinical findings, as well as immediate and 6-month outcomes, in 91 patients diagnosed with impalpable undescended testes between January 2006 and December 2010. Results. Of the 91 patients, 9 had bilateral and 82 had unilateral impalpable testes. All 100 testes were managed laparoscopically. The largest group of intra-abdominal testes in this series, 42 testes, was entering the internal ring; in these, laparoscopic exploration and standard open orchiopexy resulted in a 66% success rate. The total success rate was 63.3%. Conclusion. Laparoscopy is extremely useful in both the diagnosis and treatment of impalpable testes. Objectively measured mobility of the testis towards the contralateral internal inguinal ring is an excellent intraoperative indicator for type of orchiopexy. Standardization of management may increase the success rate of orchiopexy. [ABSTRACT FROM AUTHOR]

Simple Summary: We have conducted a systematic review to investigate the quality of reporting in preclinical experiments exploring tissue engineering approaches for urethral repair. This was performed based on the Animal Research: Reporting of In Vivo Experiments (ARRIVE) guidelines in a total of 28 articles from 2014 to 2020. Inadequate reporting of the essential points of research experiments was observed that could remarkably affect clarity, reproducibility, and translatability. A complete statement of the ethical review permission and guidelines followed was missing in 54% of the studies. Details to ensure reproducibility of the studies, such as animal housing, husbandry, and anesthetics, were infrequently reported. No paper stated the sample size estimation methodology. The quality of reporting improved marginally over the study period. We encourage the utilization of the ARRIVE checklist items when reporting preclinical studies to help the publication of manuscripts that would allow a precise judgment of their scientific merit. Preclinical research within the area of urethral tissue engineering has not yet been successfully translated into an efficient therapeutic option for patients. This gap could be attributed, in part, to inadequate design and reporting of the studies employing laboratory animals. In this study, a systematic review was conducted to investigate the quality of reporting in preclinical studies utilizing tissue engineering approaches for urethral repair. The scope was on studies performed in rabbits, published between January 2014 and March 2020. Quality assessment of the data was conducted according to the Animal Research: Reporting of in Vivo Experiments (ARRIVE) guidelines by the scoring of a 38-item checklist in different categories. A total of 28 articles that fulfilled the eligibility criteria were included in the study. The range of ARRIVE score was from 0 to 100, taking into consideration having reported the item in question or not. The mean checklist score was 53%. The items that attained the highest scores included the number of animals utilized, the size of control and experimental groups, and the definition of experimental outcomes. The least frequently reported items included the data regarding the experimental procedure, housing and husbandry, determination and justification of the number of animals, and reporting of adverse events. Surprisingly, full disclosure about ethical guidelines and animal protocol approval was missing in 54% of the studies. No paper stated the sample size estimation. Overall, our study found that a large number of studies display inadequate reporting of fundamental information and that the quality of reporting improved marginally over the study period. We encourage a comprehensive implementation of the ARRIVE guidelines in animal studies exploring tissue engineering for urethral repair, not only to facilitate effective translation of preclinical research findings into clinical therapies, but also to ensure compliance with ethical principles and to minimize unnecessary animal studies. [ABSTRACT FROM AUTHOR]

Background: Although open Ramsted's pyloromyotomy is the gold standard for the surgical management of infantile hypertrophic pyloric stenosis, laparoscopic pyloromyotomy has been found highly successful. Various factors, however, can affect the outcomes of surgical interventions in these patients. We observed a relationship between the number of ports used and outcome in patients undergoing laparoscopic pyloromyotomies. Method: We retrospectively assessed the medical records of selected group of patients who underwent laparoscopic pyloromyotomy in our institution. Factors analyzed included operation time, length of hospital stay, postoperative complications, and time to postoperative full feeding. Results: We observed failure of myotomy in both two patients who underwent laparoscopic pyloromyotomy using only two working ports compared to successful myotomies in the remaining patients. Conclusion: Laparoscopy provides good results in terms of intraoperative exposure and cosmesis. However, standardized surgical technique with two working ports is advisable and this can trigger further research to be ascertained. [ABSTRACT FROM AUTHOR]