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Photogrammetric point clouds offer immense potential for various applications, especially for the AEC industry and "as-built" BIM. However, despite many advantages such as time and cost efficiency, image based point clouds of indoor environments mostly suffer from inhomogeneous and strongly fluctuating point-wise uncertainties. This lack of area-filling geometric reliability represents a strong barrier for innovations and further development of image based applications for as-built BIM, regarding both software and hardware. Therefore, this paper presents a method for the geometric verification of indoor BIMs by images and uncertainty management in order to unleash the potential of photogrammetry in context of professional building documentation heading towards "digital twinning". Individual 3D point accuracies, object's surface characteristics and BIM related uncertainties according to the Level of Accuracy (LOA) specification are assessed and taken into account. The final decision of whether or not a photogrammetric point cloud confirms a given model within its associated level of accuracy results from a combined reasoning pipeline based on Dempster–Shafer evidence theory. The novel Pho-to-BIM verification method is demonstrated on three real indoor construction sites, each 3D mapped with different image sensors. Based on the experiments it is shown how to set up belief functions for evidence based reasoning individually, depending on the measurement and site characteristics. [ABSTRACT FROM AUTHOR]

Differences of sex development (DSD) are congenital conditions in which there is atypical chromosomal, gonadal and/or phenotypic sex. A phenotype of severe genital atypia in patients raised as male is a relatively rare occurrence and standards for management are lacking. Decision making for early surgical planning in these rare cases includes, but is not limited to, degree of atypia, location of testes, and presence of Mϋllerian remnants. In this study we describe surgical approaches and short-term outcomes for masculinizing genitoplasty in moderate to severe genital atypia in young patients raised male, for whom parents opted for early surgery. This NIH-sponsored study is an ongoing, observational, multicenter investigation assessing medical, surgical and psychological outcomes in children and their parents affected by atypical genitalia due to DSD. Participants were prospectively enrolled from 12 children's hospitals across the United States that specialize in DSD care. Criteria for child enrollment were a Quigley score of 3–6 in those with a 46, XY or 45,X/46, XY chromosome complement, age <3 years with no previous genitoplasty; patients were included independent of whether genitoplasty was performed. Cosmesis was graded according to a 4-point Likert scale and complications per the Clavian-Dindo classification. Of the 31 participants, 30 underwent hypospadias repair and 1 patient did not undergo a genitoplasty procedure. The majority of participants (22) received a staged hypospadias repair. Seventeen complications were identified in 12 of the 31 children (41%) at 12 months of follow up. Glans dehiscence and urethrocutaneous fistula were the most common complications. Orchiopexy was performed in 14 (44%) and streak gonads were removed in 4 (13%) participants. Both parents and surgeons reported improved cosmesis after surgery when compared to baseline. Genitoplasty was chosen by parents for the majority of children eligible for study. No single surgical approach for masculinizing moderate to severe genital ambiguity in young patients with 46, XY or 45,X/46, XY DSD was adopted by all surgeons. Complications occurred in 41% of those who underwent genitoplasty for severe hypospadias. Overall, appearance of the genitals, as determined by parents and surgeons, improved following genitoplasty. Outcomes of early genitoplasty are needed to guide families when making decisions about such procedures for their young children. [Display omitted] [ABSTRACT FROM AUTHOR]

Disorders/differences of sex development (DSD) are congenital conditions in which there is atypical chromosomal, gonadal and/or phenotypic sex. While there remains controversy around the traditionally binary concept of sex, most patients with DSD are reared either male or female depending on their genetic sex, gonadal sex, genital phenotype and status of their internal genital tract. This study uses prospective data from 12 institutions across the United States that specialize in DSD care. We focused on patients raised female. Eligible patients had moderate to severe genital atypia (defined as Prader score >2), were ≤2 years of age at entry, and had no prior genitoplasty. The aim of this study is to describe early post operative complications for young patients undergoing modern approaches to feminizing genitoplasty. Of the 91 participants in the cohort, 57 (62%) were reared female. The majority had congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (n = 52), 1 had ovo-testicular syndrome, 2 had mixed gonadal dysgenesis and 2 had partial androgen insensitivity syndrome (PAIS). Of the 50 participants who received early genitoplasty, 43 (86%) had follow-up at 6–12 months post-surgery. Thirty-two participants (64%) received a clitoroplasty, 31 (62%) partial urogenital mobilization and 4 (8%) total urogenital sinus mobilization. Eighteen percent (9/50) experienced post-surgical complications with 7 (14%) being rated as Clavien-Dindo grade III. Both parents and surgeons reported improved satisfaction with genital appearance of participants following surgery compared to baseline. This information on post-operative complications associated with contemporary approaches to feminizing genitoplasty performed in young children will help guide families when making decisions about whether or not to proceed with surgery for female patients with moderate to severe genital atypia. Summary Figure River diagram of mother's cosemsis rating over time in DSD patients undergoing early feminizing genitoplasty Summary Figure [ABSTRACT FROM AUTHOR]

Melanoma is a highly aggressive tumor of the skin. The clinical outcome is determined by the presence or absence of metastases, and the liver is a common site of distant metastases. Hepatic metastasis is causing activation of hepatic stellate cells (HSC), which form the stroma of hepatic metastases and are increasingly recognized as a crucial component of the pro- metastatic liver microenvironment. Most studies have focused on the effects of HSC on (metastasizing) tumor cells. Here, we aimed to analyze functional in vitro effects of conditioned medium (CM) of twelve different human melanoma cell lines on LX2 cells and HSC htert cells, two well established human activated HSC cell lines. CM from melanoma cells significantly induced HSC proliferation and acted as chemoattractant for HSC in Boyden chamber assays. The CM effects significantly varied between different HSC as well as melanoma cells. Interestingly, CM from melanoma cell lines derived from melanoma metastases (WM239A, WM9, WM1158, WM1232, 451Lu and 1205Lu) had a stronger effect on proliferation of HSC htert cells than CM derived from primary melanoma tumors (SbCl2, WM3211, WM35, WM278, WM1366 and WM793). Moreover, we observed a significant correlation between the chemoattractive effects of CM from the different melanoma cells on HSC htert and LX2 cells. In contrast, the melanoma CM effects on the proliferation of the two HSC lines did not show a significant correlation. In summary, our data indicate that melanoma cells metastasizing to the liver have the potential to attract HSC and to induce HSC proliferation, respectively. Still, it appears that melanoma effects on HSC migration and proliferation are mediated via different soluble factors indicating the complexity of melanoma-HSC interaction. Furthermore, the intensity of at least some functional effects varies between different human tumor cells and HSC which may point to mechanisms explaining diverse hepatic metastasis in melanoma patients. [ABSTRACT FROM AUTHOR]

While our institution has historically obtained a urine culture (UCx) from every child at the time of urodynamics (UDS), no consensus exists on UDS UCx utility, and practice varies widely. This study aims to prospectively study our symptomatic post-UDS UTI rate before and after implementing a targeted UCx protocol. A 2-part prospective study of patients undergoing UDS at one pediatric hospital was undertaken, divided into Phase 1 (7/2016-6/2017) with routine UCx at the time of UDS and Phase 2 (7/2019-6/2020) after implementation of a protocol limiting UCx at the time of UDS to only a targeted subset of patients. The primary outcome was symptomatic post-UDS UTI, defined as positive UCx ≥10ˆ4 CFU/mL and fever ≥38.5 °C or new urinary symptoms within seven days of UDS. A total of 1,154 UDS were included: 553 in 483 unique patients during Phase 1 and 601 in 533 unique patients during Phase 2. Age, sex, race, ethnicity, and bladder management did not differ significantly between phases. All 553 UDS in Phase 1 had UCx at the time of UDS, compared to 34% (204/601) in Phase 2. The rate of positive UCx decreased from 39% in Phase 1–35% in Phase 2. Three patients developed symptomatic post-UDS UTI in each study period, resulting in a stable post-UDS UTI rate of 0.5% (3/553) in Phase 1 and 0.5% (3/601) in Phase 2. These patients varied in age, sex, UDS indication, and bladder management. Four of the six (67%) patients had positive UCx at the time of UDS, one had a negative UCx, and one had no UCx under the targeted UCx protocol. Predictors of symptomatic post-UDS UTI could not be evaluated. In the largest prospective study to date, we found that symptomatic post-UDS UTI was <1% and that UCx at the time of UDS can safely be limited at our hospital. This reduction has important implications for cost containment and antibiotic stewardship. We will continue iterative modifications to our protocol, which may eventually include the elimination of UCx at the time of UDS in all groups. This 2-part prospective evaluation at one pediatric hospital determined that the symptomatic post-UDS UTI rate remained <1% with no identifiable predictors after limiting previously universal UCx at the time of UDS to only a targeted subset of patients. Summary Table Urine cultures during urodynamics and antibiotic treatment by protocol. Summary Table Retrospective [ 11 ] Prospective: Phase 1 Prospective: Phase 2 Time period 1/2013–1/2015 7/2016–6/2017 7/2019–6/2020 UDS urine culture protocol No protocol, routine urine cultures UDS protocol with universal urine cultures UDS protocol with limited urine cultures Urine culture with UDS 993/1057 (94%) 553/553 (100%) 204/601 (34%) Positive culture 402/993 (40%) 218/553 (39%) 72/204 (35%) Received antibiotic treatment after UDS, either based on culture protocol or symptoms 23/1057 (2%) 44/553 (8%) 36/601 (6%) Symptomatic post-UDS UTI 15 (1.4%) 3 (0.5%) 3 (0.5%) [ABSTRACT FROM AUTHOR]

Management of obstructing ureterocele often includes endoscopic transurethral incision (TUI) that can be challenging secondary to uncertainty in anatomic landmarks with risk of serious complications. To this end, we innovated a technique using predictable landmarks that begins endoscopic incision at the ureterocele orifice and extends retrograde proximal to the bladder neck (Figure). With over 15 years of experience in performing this retrograde incision from orifice (RIO) technique, we aimed to examine post-operative outcomes and risk of surgical failure after RIO compared to traditional TUI techniques for ureteroceles. We hypothesized that clinical outcomes after RIO would be superior to traditional endoscopic approaches to decompression of obstructing ureterocele in infants. A retrospective study of patients ≤12 months old who underwent TUI ureterocele at our institution between 2007 and -2021 was conducted. Pre-, intra- and post-operative characteristics were compared between patients who underwent RIO vs non-RIO TUI. Primary outcome was post-incision febrile urinary tract infection (fUTI). Secondary outcome was a composite failure measure of fUTI, secondary surgery, de novo bladder outlet obstruction, or vesicoureteral reflux. Multivariable Cox proportional hazard models were fitted to compare the time-to-event risk of primary and secondary outcomes between groups. Ninety patients with 92 ureteroceles were included (49 RIO, 43 non-RIO). Median follow-up from TUI was 33 months. RIO had a shorter median operative duration (27 vs 35 min, p = 0.021). Primary and secondary outcomes were similar between groups (fUTI: 29% RIO vs 19% non-RIO, p = 0.27; composite failure 54% RIO vs 69% non-RIO, p = 0.15). In multivariable Cox proportional hazard models, there was no significant difference in risk of fUTI (RIO aHR 0.98, 95% CI 0.38–2.54, p = 0.97) or composite failure (RIO aHR 0.80, 95% CI 0.45–1.44, p = 0.46) between TUI techniques. RIO technique for TUI ureterocele is attractive in that it uses predictable anatomic landmarks making it simple to perform. In analyzing this 15-year institutional experience of TUI ureterocele, RIO showed similar success to non-RIO endoscopic incisions. This study is a retrospective, non-randomized, single-institutional study over 15 years and is therefore subject to change in surgeon practice over time and variable practices between providers. Given comparable success and durability over time to other TUI ureterocele techniques, and with the advantage of operator ease using consistent anatomic landmarks, RIO is a worthy option for endoscopic ureterocele decompression. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to determine if health literacy is associated with health-related quality of life (HRQOL) in adolescents and young adults (AYAs) with spina bifida.Study Design: Between June 2019 and March 2020, the Patient-Reported Outcome Measurement Information System Pediatric Global Health-7 (PGH-7), a measure of HRQOL, and the Brief Health Literacy Screening Tool (BRIEF) were administered to patients ≥12 years old with a diagnosis of spina bifida seen in our multidisciplinary spina bifida center. Questionnaires were completed at scheduled clinic visits. The primary outcome was the PGH-7 normalized T-score. The primary exposure was the BRIEF score. Demographic and clinical characteristics were obtained from the medical record. Nested, multivariable linear regression models assessed the association between health literacy and the PGH-7 score.Results: Of 232 eligible patients who presented to clinic, 226 (97.4%) met inclusion criteria for this study. The median age was 17.0 years (range: 12-31). Most individuals were female (54.0%) and had myelomeningocele (61.5%). Inadequate, marginal, and adequate health literacy levels were reported by 35.0%, 28.3%, and 36.7% of individuals. In univariable analysis, higher health literacy levels were associated with higher PGH-7 scores. In nested, sequentially adjusted multivariable linear regression models, a higher health literacy level was associated with a stepwise increase in the PGH-7 score. In the fully adjusted model, adequate health literacy and marginal health literacy, compared with inadequate health literacy, were associated with increases in a PGH-7 score of 3.3 (95% CI: 0.2-6.3) and 1.1 (95% CI: -2.0 to 4.2), respectively.Conclusions: Health literacy was associated with HRQOL after adjusting for demographic and clinical factors. Strategies incorporating health literacy are needed to improve HRQOL in AYAs with spina bifida. [ABSTRACT FROM AUTHOR]

Acrylonitrile styrene acrylate (ASA) plastic and stamp sand are both waste materials that impose a significant burden on the environment. This study investigates the potential of using stamp sand and ASA plastic composite as the pavement structure. It should be noted that this new material does not use the asphalt binder. A series of lab tests usually used for asphalt pavement materials were employed for the stamp sand and ASA plastic composite material. The high-temperature properties were analyzed by the Hamburg wheel tracking device (HWTD), while the low-temperature performance was measured by the disc-shaped compact tension (DCT) test. The tensile strength ratio (TSR) was used to determine the moisture susceptibility and the dynamic modulus was used to assess the deformation characterize under various loads and frequencies, the coefficient of permeability was estimated by the water permeability test, and the mass loss of aggregate was estimated by the Cantabro loss test. The dynamic modulus results showed that the ASA mixtures have improved high-temperature deformation resistance as compared to the asphalt mixtures. The ASA mixture with 40% sand showed higher stiffness than the ASA mixture with 30% sand. The ASA mixtures have excellent rutting resistance and moisture damage resistance. The fracture energy of the asphalt mixture is 42–77% higher than the ASA mixture. The tensile strength ratio of the ASA and asphalt mixture are all larger than 0.8 and therefore satisfy the Superpave specification. The average coefficient of permeability of the ASA mixture is 6–10 times higher than the asphalt mixture in the same air void level. The average aggregate loss percent of the ASA mixtures is 9.2–10.8 times higher than asphalt mixtures. In summary, the implementation of stamp sand and ASA plastic mixtures may be a successful solution to mitigate the environmentally harmful effects of waste plastic and stamp sand, as well as assist in offsetting the cost and negative effects of the asphalt mixtures typically used for road surfaces. [ABSTRACT FROM AUTHOR]

Objective Children with occult spinal dysraphism represent a wide spectrum of patients. Previous studies assessing urologic outcomes have in part been deficient due to the inability to appropriately categorize these patients and gather long-term follow-up data. In this study, a uniform set of patients that had occult spinal dysraphism with magnetic resonance imaging findings of a fatty filum terminale (FF) and/or low-lying cord (LLC) was identified. Utilizing long-term follow-up data, predictors for achieving urinary continence following tethered cord release (TCR) were determined. Methods A retrospective chart review of pediatric patients with a diagnosis of tethered cord who underwent TCR from 1995 to 2005 was performed. Analysis was limited to patients who had primary TCR by one of two neurosurgeons within our multidisciplinary spina bifida clinic, who had greater than 1-year follow-up, and who were old enough to have continence status assessed (age > 6 years unless definitively toilet trained earlier). Patients with other associated forms of spinal dysraphism (lipomyelomeningeocele, spinal lipomas, sacral agenesis), anorectal malformations, and genitourinary anomalies were excluded. Pre- and post-TCR urodynamics, radiographic studies, functional orthopedic status, and urologic outcomes were assessed. Urodynamic results were categorized by three blinded urologists into one of three urodynamic patterns: (1) normal, (2) indeterminate, and (3) high risk. Results A total of 147 patients with FF and/or LLC that underwent TCR were reviewed. 51 patients were excluded because of another associated spinal dysraphism (15/51 patients) or an anorectal/genitourinary anomaly (36/51 patients). Fifty-nine of the remaining 96 patients had adequate long-term follow-up data to be included in the study. 20 patients were asymptomatic at the time of TCR while 39 presented with orthopedic and/or urologic symptoms. The average age at surgery was 59.3 months (range 2–277 months) with an average follow-up of 7.0 years (range 1–16 years). At latest follow-up, 47 (80%) patients were continent while 12 (20%) were either incontinent or utilizing clean intermittent catheterization (CIC). Statistical analysis revealed that age of untethering, type of cutaneous lesion, level of conus, presence of hydronephrosis, and high-grade vesicoureteral reflux (VUR) were not independent predictors of continence. In patients with a cutaneous lesion who were asymptomatic, 19/20 obtained continence post-TCR (* p = 0.036). In patients who were old enough to assess continence pre-TCR, 14/25 patients were continent pre-TCR and 11/25 were incontinent. Of the 14 who were continent pre-TCR, all remained continent post-TCR (* p = 0.002). Of the 11 who were incontinent pre-TCR, five (45%) eventually became continent post-TCR. Assessment of urodynamic data revealed that neither pre- nor post-TCR urodynamics predicted continence status. Conclusion Isolated cutaneous lesions and preoperative continence status are positive predictors for post-TCR continence. While pre- and post-TCR urodynamics do not predict continence status, their utility in preoperative work-up, monitoring for retethering, and long-term urologic follow-up requires further examination. [ABSTRACT FROM AUTHOR]

The Glans-Meatus-Shaft (GMS) Score is a pre-operative phenotypic scoring system used to assess hypospadias severity and risk for post-operative complications. The 'M' component is based on pre-operative meatal location, but meatal location sometimes changes after penile degloving, resulting in 'meatal mismatch.' To identify: 1) the incidence and clinical predictors of meatal mismatch, and 2) the association of meatal mismatch with post-operative urethrocutaneous fistula development. We performed a retrospective cohort study on patients who underwent primary hypospadias repair at a single center from 2011 to 2018. Meatal mismatch was defined as: upstaging (meatus moving more proximally after degloving), downstaging (moving more distally after degloving), or none. Covariates included: pre-degloving meatal location, chordee severity, penoscrotal anatomy, pre-operative testosterone, and number of stages for repair. To test the association between meatal mismatch and fistula development, we constructed two, nested, multivariable Cox proportional hazards regression models with and without meatal mismatch and compared them with the likelihood ratio test. A sensitivity analysis excluded patients with <6 months of follow-up. Of 485 patients, 99 (20%) exhibited meatal mismatch, including 75 (15%) with upstaging and 24 (5%) patients with downstaging (Figure). Meatal mismatch was significantly associated with penoscrotal webbing, number of stages for repair, and pre-degloving meatal location, with downstaging being associated with more proximal meatal location. Over a median follow-up of 7.3 months (interquartile range 2.0–20.9), fistulae developed in 56 (12%) patients. On multivariable analysis, meatal upstaging was associated with a 3-fold increased risk of fistula development (Hazards Ratio [HR]: 3.04, 95% Confidence Interval [CI]: 1.44–6.45) compared to no mismatch. Meatal downstaging had similar risk of fistula development compared to no mismatch (HR: 0.99, 95% CI: 0.29–3.35). Multi-stage compared to single-stage repair was associated with reduced risk of fistula development (HR: 0.24, 95% CI: 0.09–0.66). The likelihood ratio test favored the model that included meatal mismatch. The sensitivity analysis showed similar findings. Our short-term results suggest that meatal mismatch may be an important additional consideration to the GMS score as a tool to assess hypospadias severity, counsel families, and predict outcomes. Longer-term studies are needed to enhance the precision of risk stratification in hypospadias. Meatal mismatch occurred in 20% of patients undergoing hypospadias repair. Among this cohort, meatal upstaging was associated with a 3-fold increased risk of post-operative urethrocutaneous fistula development. [Display omitted] Summary Table 1 Sensitivity Analysis (restricted to patients with ≥6 months of follow-up, N=275) multivariable Cox regression models with and without meatal mismatch. Likelihood ratio test showed better fit with full model (p=0.04). Summary Table 1 Variable Base Model HR (95% CI), p-value Full Model HR (95% CI), p-value Pre-degloving Meatal Location Glanular Referent Referent Coronal 0.54 (0.09–3.24), p = 0.50 0.58 (0.10-3.53), p = 0.56 Distal/Midshaft 1.61 (0.38-6.91), p = 0.52 2.24 (0.50-10.03), p = 0.29 Proximal 3.33 (0.69-16.18), p = 0.14 7.18 (1.21-42.52), p = 0.001 Chordee Severity (n = 457) None (0°) Referent Referent Mild (1–29°) 3.41 (0.43-26.80), p = 0.24 3.90 (0.50-30.50), p = 0.20 Moderate (30–60°) 3.91 (0.48-31.66), p = 0.20 3.61 (0.45-29.01), p = 0.23 Severe (≥61°) 4.11 (0.50-34.02), p = 0.19 3.95 (0.48-32.51), p = 0.20 # of Stages of Repair Single-stage Referent Referent Multi-stage 1.97 (1.01-3.84), p = 0.047 1.76 (0.89-3.47), p = 0.11 Pre-operative Testosterone No Referent Referent Yes 1.65 (0.92–2.98), p = 0.10 1.43 (0.78–2.62), p = 0.25 Meatal Mismatch No mismatch – Referent Meatal downstaging – 0.88 (0.25-3.01), p = 0.84 Meatal upstaging – 3.04 (1.34-6.88), p = 0.007 [ABSTRACT FROM AUTHOR]

Land-use conflicts created by the growth of solar photovoltaics (PV) can be mitigated by applying the concept of agrivoltaics, that is, the co-development of land for both PV and agricultural purposes, to commercial-scale solar installations. In this study, we present a conceptual design for a novel agrivoltaic system based on pasture-fed rabbit farming and provide the technical, environmental and economic analyses to demonstrate the viability of the concept. Included in our analysis are the economic advantages to the PV operator of grazing rabbits at a density sufficient to control vegetative growth, thus reducing the economic and environmental costs of mowing; the dual-revenue stream from the sale of both rabbits and electricity, contrasted with estimates of the capital-investment costs for rabbits co-located with, and also independent of, PV; and the economic value to the rabbit farmer of higher colony-growth rates (made possible by the shading and predator protection provided by the PV arrays and of reduced fencing costs, which are the largest capital cost, by being able to leverage the PV systems for rabbit fencing. We also provide an environmental analysis that suggests that rabbit-PV farming is a pathway to a measurable reduction in agriculturally-generated greenhouse-gas emissions. Our calculations indicate that the co-location of solar and rabbit farms is a viable form of agrivoltaics, increasing overall site revenue by 2.5%–24.0% above projected electricity revenue depending on location and rental/ownership of rabbits, while providing a high-value agricultural product that, on a per weight basis, has significantly less environmental impact than cattle. • Agrivoltaics avoids land-use conflicts between photovoltaics (PV) and agriculture. • Developed novel pasture-fed rabbit farming for agrivoltaics. • Rabbits cut O&M costs by grazing. • Location dependent rabbits increase revenue 2.5–24% from ownership/land rental fees. [ABSTRACT FROM AUTHOR]

Pressure pop-offs, such as high-grade vesicoureteral reflux with renal dysplasia, have historically been considered beneficial for renal and bladder outcomes in boys with posterior urethral valves (PUV). Recent longer-term studies have called into question the beneficial effects of pop-offs on renal function. To evaluate how pop-offs affect bladder outcomes in boys with PUV. At a single-center, the electronic medical records of boys with PUV who underwent valve ablation from 2000 to 2014 were retrospectively reviewed for bladder and continence outcomes. Patients were excluded due to presentation after one year of age, age at last follow-up <1 year, lack of urodynamic study (UDS), lack of voiding cystourethrogram, or concomitant prune belly syndrome. Between patients with and without pop-offs, the following outcomes were compared: prevalence of significant hydronephrosis (Society for Fetal Urology grade 3 or 4) prior to valve ablation and at last follow-up, nadir creatinine level, classification of initial UDS, type of medical and/or surgical interventions, dryness during the day and toilet-training status at last follow-up (among patients ≥4 years), and age at toilet-training. For patients with multiple UDS, initial and latest UDS were compared. 48 patients met inclusion criteria, of whom 31 (65%) had pop-offs and 17 (35%) did not. Median age at last follow-up was 5.9 years (range: 1.0–12.2 years). Patients with pop-offs were more likely to have unsafe initial UDS (26% vs. 12%, p = 0.15) but less likely to have high voiding pressures at their latest UDS (15% vs. 50%, p = 0.03). Patients with pop-offs were more likely to have used clean intermittent catheterization (26% vs. 0%, p = 0.04) and were less likely to be toilet-trained by age 4 (76% vs. 100%, p = 0.15) or dry during the day at last follow-up (56% vs. 92%, p = 0.06). Toilet-trained patients with pop-offs were toilet-trained by an earlier age than patients without pop-offs (3 vs 4 years, p = 0.04). The results of the present retrospective study show that patients with pop-offs required more extensive interventions to achieve continence, and achieved continence and toilet-training less frequently than patients without pop-offs. Additionally, our results demonstrated that patients with pop-offs had worse bladder dynamics initially, which may suggest that pop-offs are a manifestation of more excessive pressure build-up prior to valve ablation. Among boys with posterior urethral valves who present in the first year of life, pop-offs do not appear to impart significant benefit to bladder outcomes and may indicate more severe bladder dysfunction. Summary fig. Study design and key differences between patients with and without pop-offs. Summary figure [ABSTRACT FROM AUTHOR]

To compare differences in bowel-specific quality of life (QOL), overall qQOL, and neurogenic bowel dysfunction (NBD) severity by bowel management program in patients with spina bifida (SB). We performed a retrospective cross-sectional study of patients ≥12 years old at our multidisciplinary SB center who completed both a modified Peristeen NBD questionnaire (assessing bowel symptom severity and bowel-specific QOL) and the Patient-Reported Outcomes Measurement Information System Pediatric Global Health questionnaire (assessing overall QOL). Nested, multivariable models were fit for associations between outcomes and bowel management program (enemas, conservative management, and none). A total of 173 patients, 56.1% female and 64.6% with myelomeningocele, were included in our analysis. Median age was 18.2 years old. Patients reported using enemas (n = 42), conservative management (n = 63), and no bowel program (n = 68). When adjusting for covariates, there was no significant association between bowel-specific QOL nor overall QOL across bowel management programs. However, the use of conservative management compared to enemas was associated with worse bowel symptoms severity (adjusted beta = 2.58, 95%CI = [0.09,5.06]). Additionally, greater bowel symptom severity was significantly associated with lower overall QOL (adjusted beta = − 0.33, 95%CI = [− 0.57,− 0.10]). NBD symptom severity in SB is more strongly associated with QOL than the individual bowel program being utilized. Our findings suggest that different degrees of NBD require different invasiveness of bowel programs, but it is the outcome of the bowel management program and not the specific program itself that is most associated with QOL. [ABSTRACT FROM AUTHOR]

Objective: To examine the variability of estimated glomerular filtration rate (eGFR) in emerging adults with spina bifida (SB) by comparing multiple equations across the transitional age period, hypothesizing that creatinine (Cr)-based equations show greater variability than cystatin-C (CysC)- or combination-based equations.Methods: A retrospective cohort study was performed from 2012 to 2017 at a multidisciplinary SB clinic. Emerging adults were defined as patients ages 18-28 years old. Four pediatric, 3 adult, and 3 averaged eGFR equations were considered. Cross-sectional variability in eGFR data was assessed using coefficients of variation, chronic kidney disease (CKD) stage classification, and pairwise percent relative difference in eGFR between analogous pediatric and adult equations based on included lab values. Longitudinal changes in eGFR over time were compared across equations using a covariance pattern model accounting for repeated measures.Results: Seventy-five emerging adults with SB (median age 21.8 years; 55% female; 83% with myelomeningocele) were included in cross-sectional analyses. Adult equations gave higher median eGFRs by 22%-27% and generally milder CKD stage classification than analogous pediatric equations. In longitudinal analyses (median follow-up of 22 months), all equations conferred negative eGFR changes over time (range -1.9 to -4.3 mL/min/1.73m2 per year) that were not significantly different.Conclusion: In emerging adults with SB, adult equations demonstrated higher median eGFRs by 22%-27% compared to analogous pediatric equations, even with Cystatin-C, and generally downstaged CKD stage classification. The same eGFR equation should be used for serial kidney function monitoring in emerging adults with SB who transition care from pediatric to adult services. [ABSTRACT FROM AUTHOR]

Summary Background Self-report (SR) is an efficient data collection method. However, SR data have been shown to be discrepant with medical record (MR) documentation, which raises questions about using SR to supplement retrospective chart review in research. In this study, pediatric spina bifida (SB) patients who completed SR interviews about continence status and personal bladder/bowel management were identified. We examined agreement between SR data and Urology provider notes in MRs. Objective This study aimed to (1) identify demographic, medical, or methodological factors that might contribute to SR/MR disagreement; (2) postulate how these findings might be significant clinically; and (3) recommend improvements to SR data collection and MR documentation. Study design Our institution participates in the National Spina Bifida Patient Registry (NSBPR). NSBPR-enrolled subjects typically complete annual interviews about their urologic outcomes; we consider this to be a form of SR. After identifying patients who interviewed within 1 month of an encounter with a urology provider, we systematically reviewed and compared their SR responses to the MR. Overall SR/MR agreement (no. of agreeing data pairs/no. of complete data pairs) and strength of agreement (kappa, κ ) were assessed. Agreement about daytime continence status was assessed for children ≥5 years or in younger children who were toilet trained. Analyses were also stratified by diagnosis, type of bladder management, and ethnicity. Results Eleven urologic domains were analyzed for 176 patients. Overall SR/MR agreement was ≥90% for nine out of 11 domains (figure). Daytime urinary and stool incontinence (DUSI) domains demonstrated the lowest overall agreement, at 69% and 74% respectively. Patients with myelomeningocele (MM) and those on clean intermittent catheterization demonstrated twice as much SR/MR disagreement about DUSI than patients without MM and those who void. There was no significant difference in rates of SR/MR agreement about DUSI when analyzed by ethnicity, race, and ambulatory function status. Among cases of SR/MR disagreement about DUSI, the SR and MR had a roughly equal percentage of better outcomes reported for both UI and SI. Discussion There was strong SR/MR agreement for the majority of urologic data we analyzed. Medically complex patients faced lower SR/MR agreement, which is consistent with findings in other patient populations. Biased reporting by patients/families or providers was not found. Conclusion Minimizing SR/MR disagreement through standardized data collection methods and tools, improved definitions of patient outcomes, and documentation of respondent identity will improve large, multisite studies that utilize SR and MR concurrently. Figure Overall SR/MR agreement by urologic domain. Figure [ABSTRACT FROM AUTHOR]

Summary Introduction There is no consensus regarding use of periprocedural antibiotics or routine urine cultures during urodynamics study (UDS) in children. At our hospital, we historically have obtained urine cultures during UDS. However, even with positive cultures, few patients require treatment. Most are successfully managed with increased hydration and frequent bladder emptying. Purpose To evaluate clinical characteristics, antibiotic treatment, and outcomes in patients undergoing UDS to identify (1) risk factors for urinary tract infection (UTI) after UDS, and (2) patients who may benefit from routine urine culture. Study design Retrospective review of 769 patients who underwent 1057 UDS between January 2013 and January 2015. Positive urine culture was defined as ≥10 4 colony forming units/ml. Afebrile UTI was defined as new symptoms within 7 days. Febrile UTI was new symptoms with fever (≥38.5 °C). Fisher's exact test was used for comparative analyses. Results Nearly all patients had a urine culture taken immediately prior to UDS (94%, 993/1057). Patients on clean intermittent catheterization (CIC) were more likely to be on pre-UDS antibiotics, 22.8% (106/464) vs. 17.9% of those not on CIC (106/593) (p = 0.04). Of patients who had a urine culture, it was positive in 40% (402/993) with more positive cultures in patients on CIC vs. not (72.0%, 316/439 vs. 15.5%, 86/554, p < 0.0001). Factors significantly associated with clinical/possible post-UDS UTI included clinical UTI within 30 days before UDS, immunosuppression, overnight Foley catheter use, febrile UTI as indication, and symptoms on day of procedure (Table). Fifteen patients (1.4%, 95% confidence interval 0.7–2.1%) developed a clinical/possible post-UDS UTI, of which 40% (6/15) were febrile, with one requiring hospitalization. Of patients with post-UDS UTIs, 33% (5/15) had negative cultures at the time of UDS. Discussion If urine cultures were obtained selectively based on our study findings, 78% of pre-UDS urine cultures could be eliminated, while “missing” clinically relevant cultures in only 0.4% (4/1057). Study limitations include the retrospective design. However, prospective data collection will now be possible by using standardized, templated UDS and post-UDS follow-up notes with extractable data elements that automatically populate a database. Conclusion Post-UDS UTI is uncommon (1.4%), even in the setting of bacteriuria. This finding calls into question the utility of routine pre-UDS urine culture. Data from this study and a future prospective study will be used to refine a new working protocol, with the goal of targeting future urine cultures to a high-risk subset of patients. Table Factors associated with post-UDS clinical/possible urinary tract infection (UTI) or initiation of antibiotic treatment for other reasons. Table Patient characteristics Entire cohort ( N = 1057) Antibiotic treatment ( N = 10) p Clinical UTI/possible UTI ( N = 15) p Bladder management Clean intermittent catheterization 44% (464/1057) 40% (4/10) >0.9 70% (10/15) 0.1 Foley catheter overnight 6% (62/1057) 10% (1/10) 0.5 20% (3/15) 0.05 Symptoms on day of procedure Any urinary symptoms 6% (65/1057) 10% (1/10) 0.4 20% (3/15) 0.04 Personal history Immunosuppression 2% (24/1057) 10% (1/10) 0.2 13% (2/15) 0.04 Clinical UTI within 30 days prior to procedure 8% (87/1057) 10% (1/10) 0.5 40% (6/15) 0.0007 Indication for procedure Febrile UTI 3% (27/1057) 10% (1/10) 0.2 13% (2/15) 0.05 The antibiotic treatment group was defined as patients with initiation of antibiotic treatment within 7 days post-procedure without UTI symptoms. [ABSTRACT FROM AUTHOR]

Summary Background The birth of a child with a disorder of sex development (DSD) and atypical genitalia can be traumatizing and isolating for families. Parents of children with DSD are at risk for increased levels of psychological distress, including depression, anxiety, illness uncertainty (IU), post-traumatic stress symptoms (PTSS), and impairments in quality of life (QOL). Our previous report indicated that although the majority of parents of children with atypical genitalia were coping well prior to the child's genitoplasty, approximately 25% of them reported experiencing some type of psychological distress. Objective The current study sought to examine the trajectory of parental psychological distress prior to, and 6 months after their child underwent genitoplasty. Methods Parents were recruited as part of an ongoing, prospective, multi-site study involving 10 pediatric hospitals with specialized care for children with atypical genitalia. Results from 49 parents (27 mothers, 22 fathers) of 28 children (17 female sex of rearing, 11 male sex of rearing) born with atypical genitalia (Prader rating of 3–5 in 46,XX DSD or by a Quigley rating of 3–6 in 46,XY DSD or 45,XO/46,XY) were included in the study. Results There were no significant changes in level of depressive or anxious symptoms or quality of life between baseline and 6-month post-operative follow-up, although mothers continued to report significantly higher levels of depressive symptoms than fathers, and as a group, these parents reported lower QOL than published norms. The level of PTSS significantly decreased for all parents, suggesting that parents may have come through the acute stress phase associated with their child's diagnosis. Finally, while there were no significant changes in IU over the time period, the level of IU for parents of boys actually increased, while parents of girls reported no change (Figure). Conclusion Six months after their child has undergone genitoplasty, the majority of parents report minimal levels of psychological distress. However, a subset of these parents continue to experience significant distress related to their child's diagnosis. Specifically, parents of boys appear to be at increased risk for difficulties, which may be related to either the lack of clinical diagnosis for almost half of these children or the necessity of two-stage surgeries for the majority of them. We will continue collecting data on these families to better understand the trajectory of these adjustment variables. Figure Graphs of significant changes. Figure [ABSTRACT FROM AUTHOR]

Objectives: To examine whether vesicourethral reflux diagnosed by positioned instillation of contrast (PIC-VUR) shows clinical importance by comparing the incidence rates of febrile urinary tract infection (FUTI) before and after treatment of PIC-VUR. Methods: Beginning in 2001 we used a multi-institutional registry to prospectively enroll consecutive pediatric patients with a history of FUTI without VUR according to voiding cystourethrogram (VCUG) and yet who show PIC-VUR. Treatment of PIC-VUR was with prophylactic antimicrobials or antireflux surgery. The post-treatment occurrence of FUTI was tracked. Results: A total of 14 centers enrolled 118 patients (mean age, 7.2 years; range, 0.5 to 20 years). Parents self-selected the treatment of PIC-VUR as endoscopic injection (104), ureteral reimplantation (3), or antimicrobial prophylaxis (11). Study intervals surveying for FUTI before PIC (mean, 12 months; range, 1 to 17 years) and after PIC treatment (mean, 11 months; range, 0 to 3 years) were not significantly different. Overall the incidence rate for FUTI decreased significantly from 0.16 per patient per month before PIC-VUR treatment to 0.008 per patient per month after treatment (rate ratio 20; 95% confidence interval 11 to 36). The post-treatment rate of FUTI in patients treated with antibiotics versus surgery was not significantly different (rate ratio 2.5; 95% confidence interval 0.33 to 27). Conclusions: The diagnosis of PIC-VUR is clinically important because children treated for PIC-VUR with either antimicrobial prophylaxis or surgery show a significant reduction in the incidence rate of FUTI. This is the basis for a current prospective study randomizing patients with PIC-VUR to treatment or observation. [Copyright &y& Elsevier]