Abstract:
BACKGROUND:Elevated body mass index (BMI) is a well-known risk factor for perioperative complications in adults, but has not been investigated in children undergoing urologic procedures. Given the low rate of complications associated with urologic surgery, a large sample is required for their characterization, but BMI is frequently not available in administrative databases. Here we report results from the first nationally based, prospectively assembled cohort analyzed with respect to the association of BMI with 30-day postoperative events for pediatric urologic procedures. OBJECTIVE:To determine the association of elevated BMI with overall 30-day postoperative events and wound complications in a large national sample of children undergoing urologic procedures. STUDY DESIGN:We queried the 2012 Pediatric National Surgical Quality Improvement Program database (NSQIP), defining obesity as a BMI above the 95th percentile and overweight above the 85th percentile, per CDC definitions. We used BMI <85th percentile as a referent group. Complications were collected within 30 days of the procedure. Comorbidity was classified on a linear scale using a validated pediatric-specific comorbidity score, and procedures were classified as genital, abdominal without bowel involvement, or abdominal with bowel involvement. Univariate and multivariate logistic models were used to test significance of associations. RESULTS:2871 patients aged 2-18 years were analyzed. Of these, 420 (14.6%) were overweight and 440 (15.3%) were obese. A summary of 30-day events and complications is shown in the structured abstract table. On multivariate analysis adjusting for age, gender, class of procedure, and comorbidity, BMI remained a significant risk factor for 30-day events when comparing BMI ≥85th percentile to BMI <85th percentile (OR 1.36, 95% CI 1.03-1.8, p = 0.035). An exploratory subgroup analysis examining the rate of wound complications demonstrated an odds ratio of 2.36 (95% CI 1.28-4.35, p = 0.006) for BMI >85th percentile on multivariate analysis. DISCUSSION:Overweight/obese status increased the odds of overall complications by 36%, and of wound complications by 140%. In adults there is a known profound effect of body composition on wound complications, but in children this association is less clear, and has not been studied in the pediatric urologic literature on a large scale. The mechanisms linking BMI to pediatric postoperative complications are unclear, but cytokine mechanisms or changes in the response to inflammation have been postulated. Limitations of this study include restriction to those urologic procedures included in ACS-NSQIPP and sorted into broad general categories. We did not control for secondary procedures. BMI/BMI percentile may not be appropriate measures of body composition in patients with atypical body habitus or proportions (e.g. myelomeningocele). CONCLUSION:BMI in the pediatric NSQIP urologic population was found to be associated with overall complication after adjustment for case type and preoperative comorbidity in a large national sample assembled for assessment of perioperative outcomes. An exploratory analysis uncovered more than two-fold increase in odds of wound complication in obese/overweight patients compared with a normal weight referent population. These results may be useful in preoperative counseling patients regarding perioperative risk.
journal_name
J Pediatr Uroljournal_title
Journal of pediatric urologyauthors
Kurtz MP,McNamara ER,Schaeffer AJ,Logvinenko T,Nelson CPdoi
10.1016/j.jpurol.2015.04.014subject
Has Abstractpub_date
2015-08-01 00:00:00pages
224.e1-6issue
4eissn
1477-5131issn
1873-4898pii
S1477-5131(15)00157-6journal_volume
11pub_type
杂志文章abstract::We report an extremely rare case of a female neonate with antenatally diagnosed bilateral moderate hydronephrosis and appropriate postnatal follow up who presented at 6 weeks of life with sudden onset of anuria secondary to bilateral pelvi-ureteric junction obstructions. While most antenatally diagnosed hydronephrosis...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2005.10.010
更新日期:2006-10-01 00:00:00
abstract:BACKGROUND:Acute pyelonephritis is associated with renal scarring in up to 30% of patients. Renal scarring may cause significant long-term morbidity. The pathogenesis of acute pyelonephritis remains unclear, although it involves interaction among uroepithelium, the immune system cells, and the locally produced cytokine...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2017.05.025
更新日期:2017-12-01 00:00:00
abstract:INTRODUCTION:Stomal stenosis is the most common complication after the creation of a continent catheterizable channel (CCC), but is challenging to treat. OBJECTIVE:To describe early experience with triamcinolone injection for the treatment of stomal stenosis. MATERIALS AND METHODS:A retrospective review was performed...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2017.06.007
更新日期:2017-08-01 00:00:00
abstract:INTRODUCTION:In 2006, nomenclature referencing atypical sex development (i.e., 'intersex') was updated, and the term disorder of sex development (DSD) was formally introduced. Clinicians, patients, and parents, however, have not universally accepted the new terminology, and some continue to use different nomenclature. ...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2018.08.009
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVE:To evaluate outcomes of desmopressin treatment in monosymptomatic enuresis (ME) and nonmonosymptomatic enuresis (NME). MATERIALS AND METHODS:PubMed was searched for all studies investigating enuresis, up to July 2009, in which desmopressin was administered alone or combined with other treatments. Each study ...
journal_title:Journal of pediatric urology
pub_type: 杂志文章,评审
doi:10.1016/j.jpurol.2010.04.014
更新日期:2011-02-01 00:00:00
abstract:OBJECTIVE:In principle, the prepuce can be reconstructed during hypospadias repair, but the procedure has not gained wide acceptance and preputial reconstruction (PR) is surrounded by several controversies. MATERIAL AND METHODS:A review is provided of the technique for PR, how PR combines with the other steps of hypos...
journal_title:Journal of pediatric urology
pub_type: 杂志文章,评审
doi:10.1016/j.jpurol.2016.07.018
更新日期:2017-02-01 00:00:00
abstract::Laparoendoscopic single-site surgery (LESS), a minimally invasive procedure, is gaining widespread acknowledgment in pediatric urology. We report the case of a 7-year-old girl with Turner's syndrome with 45,XO/46,XY mosaicism, for whom bilateral prophylactic gonadectomy using LESS was performed. Histopathological find...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2012.02.010
更新日期:2012-08-01 00:00:00
abstract:BACKGROUND:It is extremely important to not only address the short-term success following endoscopic correction of vesicoureteral reflux (VUR) but also the long-term efficacy and safety of the tissue augmenting substance utilized for endoscopic correction. OBJECTIVE:This study retrospectively evaluated all cases of ur...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2018.04.021
更新日期:2018-12-01 00:00:00
abstract::The Mitrofanoff procedure, first described in 1980, has been widely adopted for pediatric continent urinary diversion to increase patient independence and continence, decrease morbidity and infections, and preserve renal function. Although this principle employs the appendix primarily, numerous other tissue conduits h...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2005.02.001
更新日期:2005-10-01 00:00:00
abstract::Ureteropelvic junction (UPJ) stenosis is the most common cause of pathological neonatal hydronephrosis. UPJ obstruction may be treated conservatively in some cases, but surgery is indicated if symptoms occur or renal function deteriorates. Pyeloplasty is the procedure of choice for UPJ stenosis. Pyeloplasty can be per...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2019.03.022
更新日期:2019-08-01 00:00:00
abstract: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 iatro...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2008.08.004
更新日期:2009-02-01 00:00:00
abstract:PURPOSE:There is limited evidence that prophylactic antibiotics prevent surgical site infection in stented, distal hypospadias repair. Our hypothesis is that the use of prophylactic antibiotics does not affect the rate of surgical site infection in this setting. METHODS:We conducted a retrospective study of consecutiv...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2020.11.033
更新日期:2020-11-30 00:00:00
abstract:INTRODUCTION:There is ongoing debate about whether nocturnal enuresis (NE) is affected by the presence of attention deficit hyperactivity disorder (ADHD) in children. Clarifying this relationship could categorize them as a separate entity, potentially requiring a different management from enuretic children without ADHD...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2017.07.002
更新日期:2018-02-01 00:00:00
abstract::Single incision, single port, or single site surgery for retro-peritoneoscopic nephrectomy and nephro-ureterectomy in paediatric practice using an advanced access platform (GelPOINT Mini) is described in two patients. One patient had bilateral synchronous nephrectomy. The technique, advantages, and challenges are repo...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2013.12.018
更新日期:2014-06-01 00:00:00
abstract:INTRODUCTION:'Transition' not only involves finding an adult healthcare provider, but also includes the process of developing the patient's ability to care for him/herself. Recent literature states that 40% of young adults with special healthcare needs are receiving the tools needed for transition. Pediatric urologists...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2016.04.015
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:To compare and evaluate dissection and Plastibell(®) circumcision techniques for the treatment of phimosis. METHODS:In 2006-2007, 125 children were submitted to circumcision by the same surgeon. The children were randomly divided into two groups (PD: Plastibell(®) and DC: dissection). In both groups the surg...
journal_title:Journal of pediatric urology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jpurol.2010.01.005
更新日期:2010-12-01 00:00:00
abstract:INTRODUCTION:Bladder calculi are a known complication of bladder augmentation. Open cystolithotomy remains the preferred option for treating large or multiple stones. Increasingly, however, minimal access techniques have been used. Reports of Mitrofanoff cystolitholapaxy are rare and have been limited to adults. This s...
journal_title:Journal of pediatric urology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jpurol.2018.02.024
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of VQZ plasty, we analyzed our experience with continent catheterizable urinary stomas using VQZ plasty and V-flap techniques. PATIENTS AND METHODS:We retrospectively reviewed the records of 25 patients who underwent Mitrofanoff procedures in 2000-2009. All stomas were created i...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2010.05.012
更新日期:2011-08-01 00:00:00
abstract:OBJECTIVES:It has been suggested that infants with dilating vesicoureteral reflux (VUR) often have lower urinary tract (LUT) dysfunction. Signs such as high voiding pressure levels, low bladder capacity and dyscoordination at voiding have previously been thought to be indicative of dysfunction. However, these findings ...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2014.08.010
更新日期:2015-02-01 00:00:00
abstract:INTRODUCTION:Complications remain the top evaluation priority subsequent to hypospadias repair. Complications vary in further management, and usually require one or more reoperations. Patients and/or their parents concern not only with the success rate of reoperation, but also with the risk of numerous reoperations. O...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2020.11.010
更新日期:2020-11-12 00:00:00
abstract:INTRODUCTION:Childhood enuresis is common, but the prevalence and factors associated with childhood enuresis in Africa have been poorly described. Furthermore, most studies from the continent have not provided data distinguishing monosymptomatic from non-monosymptomatic enuresis. This distinction is important as it gui...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2015.06.009
更新日期:2015-12-01 00:00:00
abstract:OBJECTIVE:To evaluate the correction of different degrees of penile torsion following a ladder step so that simpler steps are used whenever possible. This can avoid the morbidity and complications of complex procedures. PATIENTS AND METHODS:Cases of congenital and acquired penile torsion were repaired on a ladder step...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2014.05.009
更新日期:2014-12-01 00:00:00
abstract:PURPOSE:We conducted a cross-sectional study to evaluate whether the different positions during urination influence the electrical activity of the abdominal and perineal musculature, as well as the uroflowmetric parameters of children with lower urinary tract dysfunction (LUTD). MATERIALS AND METHODS:Ninety-four child...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2014.03.013
更新日期:2014-12-01 00:00:00
abstract::The ability to consistently review abstracts in an unbiased and objective fashion is a skill that most academics hope to master. However, robust standardized rating systems are sparse, with most scientific boards leaving the task of rating abstracts poorly defined and at the whim of the reviewer. In an effort to bring...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2018.07.009
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVE:To report a novel cause of nocturnal enuresis (NE) and highlight the literature giving insight into this novel mechanism. PATIENT:A 12-year-old morbidly obese female with 2-year history of nightly secondary monosymptomatic NE. RESULTS:On evaluation, a history of severe sleep disturbed breathing was elicited...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2009.08.009
更新日期:2010-06-01 00:00:00
abstract:BACKGROUND:Repair of distal hypospadias is one of the most common pediatric urology procedures in the US. However, the risk of postsurgical complications has been reported primarily from single-institution and tertiary center studies, with short duration of patient follow-up. OBJECTIVE:The aim of the study was to exam...
journal_title:Journal of pediatric urology
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jpurol.2019.06.012
更新日期:2019-10-01 00:00:00
abstract::Hyponatremic hypertensive syndrome is a combination of renovascular hypertension and hyponatremia. Although reported in adults, it is rare in children. We report a 7-year-old boy having renal artery stenosis associated with hyponatremic hypertensive syndrome. ...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2008.01.204
更新日期:2008-10-01 00:00:00
abstract::Metanephric adenoma is an extremely rare tumor of the kidney. The clinical and anatomic characteristics are not yet well defined, but it is currently considered to be a benign tumor with a good prognosis, although recently two metastatic cases have been reported. Around 50% of cases are incidental findings, and sympto...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2006.10.003
更新日期:2007-08-01 00:00:00
abstract::Laparoscopy is an increasingly popular choice for treatment of the impalpable testis. There are many anatomical variants that may be found at operation. We present a case of a 1-year-old boy who presented with an impalpable right testis and absent right kidney, and at laparoscopy was found to have a persistent mesonep...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2006.05.012
更新日期:2007-04-01 00:00:00
abstract:INTRODUCTION:Pediatric robot-assisted laparoscopic (RAL) pyeloplasty has become a viable minimally invasive surgical option for ureteropelvic junction obstruction (UPJO) based on its efficacy and safety. However, RAL pyeloplasty in infants can be a challenging procedure because of the smaller working spaces. The use of...
journal_title:Journal of pediatric urology
pub_type: 杂志文章
doi:10.1016/j.jpurol.2018.06.010
更新日期:2018-12-01 00:00:00