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Journal of pediatric urology 63건

  1. [해외논문]   Urinary antimicrobial peptides: Potential novel biomarkers of obstructive uropathy   SCIE

    Gupta, S. (Pediatric Urology Division, Pediatric Surgery Department at Nationwide Children's Hospital, Columbus, OH, USA ) , Jackson, A.R. (Center for Clinical and Translational Research at the Research Institute of Nationwide Children's Hospital, Columbus, OH, USA ) , DaJusta, D.G. (Pediatric Urology Division, Pediatric Surgery Department at Nationwide Children's Hospital, Columbus, OH, USA ) , McLeod, D.J. (Pediatric Urology Division, Pediatric Surgery Department at Nationwide Children's Hospital, Columbus, OH, USA ) , Alpert, S.A. (Pediatric Urology Division, Pediatric Surgery Department at Nationwide Children's Hospital, Columbus, OH, USA ) , Jayanthi, V.R. (Pediatric Urology Division, Pediatric Surgery Department at Nationwide Children's Hospital, Columbus, OH, USA ) , McHugh, K. (Department of Biomedical Education & Anatomy, Ohio State University Medical School, USA ) , Schwaderer, A.R. (Center for Clinical and Translational Research at the Research Institute of Nationwide Children's Hospital, Columbus, OH, USA ) , Becknell, B. (Center for Clinical and Translational Research at the Research Institute of Nationwide Childre) , Ching, C.B.
    Journal of pediatric urology v.14 no.3 ,pp. 238.e1 - 238.e6 , 2018 , 1477-5131 ,

    초록

    Summary Introduction Antimicrobial peptides (AMPs) have historically been evaluated for their role in protecting against uropathogens. However, there is mounting evidence to support their expression in noninfectious injury, with unclear meaning as to their function. It is possible that AMPs represent urothelial injury. Urinary tract obstruction is known to alter the urothelium; however, AMPs have not been evaluated for expression in this noninfectious injury. Objective A pilot study to compare urinary AMP expression in children undergoing surgical intervention for ureteropelvic junction obstruction (UPJO) with nonobstructed controls. Study design Bladder urine was collected from consenting/assenting pediatric patients with UPJO at intervention. Control bladder urines were obtained from age-matched and sex-matched healthy children without known obstruction or infection. Enzyme-linked immunosorbent assays were run for the following AMPs: β defense 1 (BD-1), neutrophil gelatinase-associated lipocalin (NGAL), cathelicidin (LL-37), hepatocarcinoma-intestine-pancreas/pancreatitis-associated protein (HIP/PAP), and human α defensin 5 (HD-5); and normalized to urine creatinine. Results were analyzed with Student's t -test or Mann–Whitney U test, when appropriate, and receiver operating characteristic curves. A P -value of Results Thirty bladder urine samples were obtained from children with UPJO at the time of decompressive intervention. Mean patient age was 4.7 years (range 0.3–18.4); 20 (67%) patients were male. Fifteen bladder urine samples were obtained from age-matched and sex-matched controls. Urinary AMP levels were significantly higher in UPJO patients than controls for BD-1 ( P = 0.015), NGAL ( P P P = 0.046). Optimal threshold values of these AMPs were determined, with each demonstrating significant odds ratios of predicting urinary obstruction. Discussion Certain urinary AMPs are altered even in noninfectious urinary tract pathology. This represents a novel induction of AMP expression, as the current study is the first to report elevations in BD-1 and HIP/PAP in urinary tract obstruction. This suggests other roles for these AMPs outside of their antimicrobial properties, and likely is a reflection of the urothelial and tubular stress resulting from obstructive uropathy. Conclusions Induction of AMPs BD-1, NGAL, LL-37, and HIP/PAP was found to occur in urinary tract obstruction. Further evaluation of AMP expression as a biomarker of uroepithelial injury outside of infection is indicated. Display Omitted

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

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  2. [해외논문]   Adolescent urology   SCIE

    Misseri, Rosalia
    Journal of pediatric urology v.14 no.3 ,pp. 239 - 239 , 2018 , 1477-5131 ,

    초록

    Summary Introduction Antimicrobial peptides (AMPs) have historically been evaluated for their role in protecting against uropathogens. However, there is mounting evidence to support their expression in noninfectious injury, with unclear meaning as to their function. It is possible that AMPs represent urothelial injury. Urinary tract obstruction is known to alter the urothelium; however, AMPs have not been evaluated for expression in this noninfectious injury. Objective A pilot study to compare urinary AMP expression in children undergoing surgical intervention for ureteropelvic junction obstruction (UPJO) with nonobstructed controls. Study design Bladder urine was collected from consenting/assenting pediatric patients with UPJO at intervention. Control bladder urines were obtained from age-matched and sex-matched healthy children without known obstruction or infection. Enzyme-linked immunosorbent assays were run for the following AMPs: β defense 1 (BD-1), neutrophil gelatinase-associated lipocalin (NGAL), cathelicidin (LL-37), hepatocarcinoma-intestine-pancreas/pancreatitis-associated protein (HIP/PAP), and human α defensin 5 (HD-5); and normalized to urine creatinine. Results were analyzed with Student's t -test or Mann–Whitney U test, when appropriate, and receiver operating characteristic curves. A P -value of Results Thirty bladder urine samples were obtained from children with UPJO at the time of decompressive intervention. Mean patient age was 4.7 years (range 0.3–18.4); 20 (67%) patients were male. Fifteen bladder urine samples were obtained from age-matched and sex-matched controls. Urinary AMP levels were significantly higher in UPJO patients than controls for BD-1 ( P = 0.015), NGAL ( P P P = 0.046). Optimal threshold values of these AMPs were determined, with each demonstrating significant odds ratios of predicting urinary obstruction. Discussion Certain urinary AMPs are altered even in noninfectious urinary tract pathology. This represents a novel induction of AMP expression, as the current study is the first to report elevations in BD-1 and HIP/PAP in urinary tract obstruction. This suggests other roles for these AMPs outside of their antimicrobial properties, and likely is a reflection of the urothelial and tubular stress resulting from obstructive uropathy. Conclusions Induction of AMPs BD-1, NGAL, LL-37, and HIP/PAP was found to occur in urinary tract obstruction. Further evaluation of AMP expression as a biomarker of uroepithelial injury outside of infection is indicated. Display Omitted

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

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  3. [해외논문]   Long-term urinary symptoms in adolescent and adult women with congenital adrenal hyperplasia   SCIE

    Bogdanska, M. (Gynaecology Department, Royal Children's Hospital, Melbourne, Australia ) , Morris, A. (Gynaecology Department, Royal Children's Hospital, Melbourne, Australia ) , Hutson, J.M. (Department of Paediatrics, University of Melbourne, Melbourne, Australia ) , Heloury, Y. (Urology Department, Royal Children's Hospital, Melbourne, Australia ) , Grover, S.R. (Gynaecology Department, Royal Children's Hospital, Melbourne, Australia)
    Journal of pediatric urology v.14 no.3 ,pp. 240.e1 - 240.e5 , 2018 , 1477-5131 ,

    초록

    Summary Background Congenital adrenal hyperplasia (CAH) is an autosomal recessive condition resulting in excess androgen production. Females are typically born with ambiguous genitalia and often undergo feminising genitoplasty in infancy or childhood. Recently, there has been considerable international debate as to whether distressing urinary symptoms in CAH patients are truly present and, if so, whether these urinary problems are a consequence of the feminising genitoplasty. Objective To identify and assess any urinary symptoms in an Australian cohort of adolescent and adult women with CAH who have undergone feminising genitoplasty in infancy, childhood or adolescence as a part of their management. Study design Females with CAH aged 12–40 years, who had undergone feminising genitoplasty, and were identified from a hospital database ( n = 72). Those aged 12–15 years were assessed using the Paediatric Incontinence Symptom Index questionnaire in conjunction with sections of the Bristol Female Lower Urinary Tract Symptoms Scored Form questionnaire. Those aged 16–40 years were assessed using the Bristol Female Lower Urinary Tract Symptoms Scored Form questionnaire. Uroflowmetry studies and post-void residual volume ultrasounds were also conducted. Previously published normative data were used for the control population. Results Responses to the questionnaire indicated that CAH patients had a higher incidence of urgency, frequency, urge incontinence, unexplained incontinence and nocturnal incontinence, when compared to previously published control data. Average and maximum urine flow rates measured by uroflowmetry were within normal range; however, the 16–40-year-old age group had significantly increased mean post-void residual volumes ( P Discussion The presence of lower urinary tract symptoms in these patients has previously been interpreted as a direct outcome of feminising genitoplasty; however, these results could also be accounted for by the virilisation of pelvic floor musculature. Androgens have been shown to increase skeletal muscle mass, but their exact impact on the pelvic floor musculature requires further research. Three previous studies have measured post-void residual volumes in patients with CAH, all of which found it them be raised. Conclusions Patients with CAH appeared to have overall normal urinary flow but increased post-void residual volumes. The data suggested that this population of patients has an increased probability of incontinence, urgency, and frequency when compared to a control population. These results confirmed findings of other small studies; however, it remains unclear if these changes reflected the underlying diagnosis or were a consequence of management. Summary table . Frequency of urinary symptoms as reported by congenital adrenal hyperplasia patients compared to previously reported control population data. Symptom type Congenital adrenal hyperplasia patients Control population P -value Incontinence symptoms Frequency of incontinence episodes 59% (10/17) 15% (3/20) 0.008* Stress incontinence 41% (7/17) 25% (5/20) 0.48 Urge incontinence 59% (10/17) 5% (1/20) 0.001* Unexplained incontinence 47% (8/17) 5% (1/20) 0.005*

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  4. [해외논문]   Urinary incontinence among adolescent female athletes   SCIE

    Logan, Bridget Linehan (Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA ) , Foster-Johnson, Lynn (Geisel School of Medicine at Dartmouth College, Hanover, NH, USA ) , Zotos, Eleni (University of New Hampshire School of Nursing, Durham, NH, USA)
    Journal of pediatric urology v.14 no.3 ,pp. 241.e1 - 241.e9 , 2018 , 1477-5131 ,

    초록

    Summary Background A collection of studies have demonstrated that approximately one-third of female nulliparous athletes experience urinary incontinence during their athletic activities. Contributing factors of incontinence that have thus far been the focus of study include type of sport, duration and intensity of athletic activity, use of hormonal contraception, and weight. There has, as yet, been a notable underemphasis on several other factors which influence incontinence, including bowel pattern, urinary habits, and menstrual status. The purpose of this pilot study was to describe the urinary habits and frequency of incontinence among adolescent female athletes. A secondary purpose was to identify factors associated with incontinence. Methods To investigate these factors, a questionnaire was completed by 44 female high school athletes. Descriptive statistics were used, including means and percentages to answer the first purpose of our study. Chi-square tests and effect sizes were employed to determine the magnitude and statistical significance of the differences. The second research purpose was tested using correlations and logistic regression. Approval was obtained for this study from the Dartmouth Hitchcock Medical Center Committee for the Protection of Human Subjects. Results There is an even higher rate of athletic incontinence (34.15%) among high school female athletes surveyed in this study than in previous studies of college age athletes. The more seasons athletes are engaged in vigorous exercise, the higher the rate of incontinence in athletics as well as during laughter and activities of daily living (ADLs). A habit of voiding more than six times per day was associated with incontinence. Conclusions Athletic incontinence is common among adolescent female athletes. Athletes who compete four seasons of the year have higher rates of all types of incontinence (athletic, laughter, and during ADLs) than athletes who compete during fewer seasons of the year. Avid participation in vigorous exercise may be a risk factor not only for athletic incontinence but also incontinence during laughter and ADLs. Several areas of findings warrant further research, including the impact of hot weather on incontinence and increased incontinence with particular body positions or athletic maneuvers.

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  5. [해외논문]   Caring for urologic transition patients: Current practice patterns and opinions   SCIE

    Zillioux, J.M. (Department of Urology, University of Virginia, Charlottesville, VA, USA ) , Jackson, J.N. (Department of Urology, University of Virginia, Charlottesville, VA, USA ) , Herndon, C.D.A. (Department of Urology, Virginia Commonwealth University, Richmond, VA, USA ) , Corbett, S.T. (Department of Urology, University of Virginia, Charlottesville, VA, USA ) , Kern, N.G. (Department of Urology, University of Virginia, Charlottesville, VA, USA)
    Journal of pediatric urology v.14 no.3 ,pp. 242.e1 - 242.e5 , 2018 , 1477-5131 ,

    초록

    Summary Introduction Congenitalism is an emerging field that recognizes the complex needs of adult patients with congenital urologic issues. Despite the onset of transitional care clinics, these patients remain difficult to care for due to resource availability, insurance coverage, and multi-disciplinary needs. Objective The current study sought to characterize practice patterns and opinions regarding care for urologic transition patients. Design An anonymous 20-question survey was sent to members of the Society of Pediatric Urology listserv. Questions pertained to physician background, practice demographics, clinic structure, and quality. Five-point Likert scales were used to assess quality markers (5 = most/best). Data were analyzed in R, and subgroup analyses were performed. Subgroups included presence of formal transition clinic, city size, and practice type. Results The response rate was 53%, with 124 respondents. A formal transition clinic was reported by 32%. Those with formal clinics reported higher enthusiasm (3.9 vs 3.4, P P P = 0.13). The majority (64%) felt that transition patients are best cared for by specialized adult providers; however, these formalized clinics found to be staffed primarily by pediatric providers (54%). Discussion This study supported the general consensus in the literature that transition clinics improve care for urologic transition patients, while underlining discordance between current practice patterns and recommendations for optimal care. Conclusion The majority of practices appeared to lack a formal transition clinic, and there was variation in their structure. Those with formal clinics tended to rate themselves as providing higher-quality care. The majority of respondents believed that adult specialists in either reconstructive or neuro-urology are best suited to care for these complex patients. Summary Table Formal transition clinic practice patterns. Characteristics % (N) Formal clinic 32% (39) Staffed by Adult urologist 16% (6) Pediatric urologist 55% (21) Both on separate visits 16% (6) Both on same visit 13% (5) If staffed by adult urologist, what fellowship? Reconstructive urology 58% (10) Female reconstructive 12% (2) Neuro-urology/Reconstructive 12% (2) Andrology/Infertility 6% (1) None 12% (2) Dedicated nurse coordinator 75% (28) Multispecialty same day clinic 30% (11) Number of patients seen annually 10–50 54% (61) 50–100 6% (7) ≥100 12% (14) On a scale of 1–5, how would you rate the coordination of your clinic? 1 (worst) 5% (2) 2 21% (8)

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  6. [해외논문]   Active surveillance for antenatally detected ureteroceles: Predictors of success   SCIE

    Andrioli, V. (Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada ) , Guerra, L. (Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada ) , Keays, M. (Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada ) , Keefe, D.T. (Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada ) , Tang, K. (Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada ) , Sullivan, K.J. (Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada ) , Garland, K. (Faculty of Medicine, University of Ottawa, Ottawa, Canada ) , Rafikov, M. (Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada ) , Leonard, M.P. (Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada)
    Journal of pediatric urology v.14 no.3 ,pp. 243.e1 - 243.e6 , 2018 , 1477-5131 ,

    초록

    Summary Introduction Historically, ureteroceles were surgically treated, as patients were diagnosed after developing symptoms. However, with the advance of fetal medicine, antenatal detection has provided an opportunity to look at the natural history of ureteroceles. Objectives With data derived from a retrospective chart review of patients with ureteroceles that were detected antenatally, the current study aimed to determine which group of children would be at risk for failure on active surveillance. It was hypothesized that single system ureteroceles (SSU) and male patients with duplex system ureteroceles (DSU) would be ideal for observation. Methods Outcomes were assessed by descriptive statistics. Kaplan–Meier curves were utilized to estimate median duration on active surveillance in both single and duplex cohorts. Breakthrough febrile urinary tract infection (fUTI) and surgery were determined by Cox regression in the duplex system cohort. Surgery was considered surveillance failure. Results A total of 102 patients (64 females/38 males) met the criteria: 78 (76.5%) had DSU and 24 (23.5%) SSU. The overall median observation was 1.2 years (range 0.7–3.1). Follow-up ranged from 0.3 to 11.7 years for SSU, and from 0.02 to 17.3 years for DSU. The predictors of failure of active surveillance (AS) in DSU (surgical intervention) were male gender (HR 1.8, 1.0–3.3, P = 0.037), or fUTI (HR 3.1, 1.7–5.8, P = 0.002). Predictors of fUTI were contralateral hydroureter or ipsilateral hydronephrosis ± hydroureter (OR 9.5, 1.2–71.7, P = 0.028). Interestingly, vesicoureteral reflux (VUR) was not a predictor of fUTI. The SSU patients were ideal for AS, while in DSU, surveillance was successful in 30% of patients who were primarily females without contralateral hydroureter or ipsilateral hydronephrosis ± hydroureter. However, in contradiction to the hypothesis, males were at higher risk for surgical intervention in the DSU cohort. Conclusion Active surveillance is an option for patients with antenatally detected ureteroceles, but careful long term follow up is mandatory. Parents should be advised that surgical intervention may still be necessary, particularly in males with DSU. Summary table Patient characteristics Total, n = 102 SSU, n = 24 DSU, n = 78 Gender Female 6 58 Male 18 20 Circumcision Yes 5 4 No 11 13 Not reported 2 3 Interval on AS 252 days to 3.1 years 100 days to 11.2 years 7 days to 17.2 years Hydronephrosis of the lower moiety (ipsilateral to ureterocele) No N/A 11 Hydronephrosis only N/A 47 Hydroureteronephrosis N/A 20 Ipsilateral reflux (any grade) 4 34 Surgery Male 5 17 Female 0 36 AS, active surveillance; SSU, single system ureterocele; DSU, duplex system ureterocele; N/A, not available.

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  7. [해외논문]   The evaluation of three comorbidity indices in predicting postoperative complications and readmissions in pediatric urology   SCIE

    Jiang, Ruiyang (Division of Urology, Duke University Medical Center, Durham, NC, USA ) , Wolf, Steven (Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA ) , Alkazemi, Muhammad H. (School of Medicine, Duke University Medical Center, Durham, NC, USA ) , Pomann, Gina-Maria (Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA ) , Purves, J. Todd (Division of Urology, Duke University Medical Center, Durham, NC, USA ) , Wiener, John S. (Division of Urology, Duke University Medical Center, Durham, NC, USA ) , Routh, Jonathan C. (Division of Urology, Duke University Medical Center, Durham, NC, USA)
    Journal of pediatric urology v.14 no.3 ,pp. 244.e1 - 244.e7 , 2018 , 1477-5131 ,

    초록

    Summary Introduction The surgical comorbidity assessment is important for patient risk stratification, counseling, and research. In adults, risk assessment indices, such as the Charlson Co-morbidity Score (CCS) or Van Walraven Index (VWI), are well established. In pediatrics, however, risk assessment indices are scarce. Recently, a pediatric-specific risk assessment index, the Rhee index, was developed to discriminate mortality for pediatric general surgery patients. Currently, there is no validated risk assessment tool in pediatric urology. Objective We compared the performance of the CCS, VWI, and Rhee Index in discriminating postoperative complications and readmissions to the emergency room/inpatient unit after pediatric urological procedures. Methods We analyzed the Nationwide Readmissions Database (NRD), State Inpatient Databases (SID), and State Emergency Department Databases (SEDD). We included patients ( This protocol was reviewed by our Institutional Review Board and deemed to be exempt. Results We identified a total of 8006 patients in NRD and 6236 patients in SID/SEDD. The Rhee index had the best performance for discriminating postoperative complications (AUC = 0.67, 95% CI 0.64–0.70) compared to CCS (AUC = 0.62, 95% CI 0.60–0.65) and VWI (AUC = 0.62, 95% CI 0.59–0.65); p p p = 0.5 (see Table). Discussion The Rhee Index had the best performance for discriminating postoperative complications, while the CCS was superior for discriminating inpatient readmissions among the three indices. Limitations to our study include inpatient-only procedures, inability to identify complications managed in clinics, omission of secondary operations, accounting for parental anxiety, and the generalizability of SID. Conclusions The three comorbidity indices evaluated are poor discriminators for postoperative complications, 30-day inpatient readmissions or 30-day ER admissions. A new index is needed for pediatric urology patients. Table Results summary. 30-day inpatient readmission 30-day ER admission Postoperative complication CCS AUC = 0.63 (95% CI 0.61–0.66) AUC = 0.52 (95% CI 0.50–0.54) AUC = 0.62 (95% CI 0.58–0.66) VWI AUC = 0.54 (95% CI 0.52–0.56) AUC = 0.51 (95% CI 0.49–0

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  8. [해외논문]   Risk factors for repeat surgical intervention in pediatric nephrolithiasis: A Pediatric Health Information System database study   SCIE

    Ellison, Jonathan S. (Correspondence to: J.S. Ellison, Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA) , Shnorhavorian, Margarett , Oron, Assaf , Kieran, Kathleen , Lendvay, Thomas S. , Merguerian, Paul A.
    Journal of pediatric urology v.14 no.3 ,pp. 245.e1 - 245.e6 , 2018 , 1477-5131 ,

    초록

    Summary Introduction Successful surgical therapy for pediatric upper urinary tract calculi (UUTC) minimizes the need for repeat surgical interventions. However, staged procedures, whether planned or unplanned, are sometimes necessary. We assessed predictors of repeat intervention for children with UUTC using a nationwide administrative dataset. Methods Using the Pediatric Health Information System (PHIS) dataset, we assessed children with UUTC undergoing shock wave lithotripsy (SWL) or ureteroscopy (URS) for an index stone from January 2010 to June 2015. Primary outcome was additional treatment for nephrolithiasis within 90 days. Patient and procedural variables were assessed as potential risks for retreatment. Multivariable logistic regression models were used to compare the risk of retreatment adjusting for potential confounding factors. Results A total of 2788 patients undergoing URS (2,216, 79.5%) and SWL (572, 20.5%) were identified. SWL, stenting at the index operation without pre-index stenting, chronic comorbidities, renal calculi, and age Conclusions Adjusting for measured confounders, SWL is associated with a 2.6-fold higher risk of repeat stone-related interventions. Additional patient-related factors also increase likelihood of retreatment. Intra-operative stent placement is a strong predictor of retreatment, perhaps serving as a marker for complex cases or planned staged procedures. Prospective studies are needed to assess comparative effectiveness of SWL and URS and improve mono-therapeutic success for children with UUTC. Display Omitted

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

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  9. [해외논문]   The implications of fellowship expansion on future pediatric urologist surgical volumes   SCIE

    Groth, Travis W. (Department of Pediatric Urology, Children's Hospital of Wisconsin, Milwaukee, WI, USA ) , See, William A. (Department of Urology, Medical College of Wisconsin, Milwaukee, WI, USA ) , Ramsay, Sophie (Centre de Recherche Du CHU de Québec-Université) , Cooper, Christopher S. (Laval, Québec, Canada ) , Kryger, John V. (Director of Pediatric Urology, Iowa City, USA )
    Journal of pediatric urology v.14 no.3 ,pp. 246 - 250 , 2018 , 1477-5131 ,

    초록

    Summary Introduction Over the past 25 years, Pediatric Urology fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) have more than doubled. This increase may lead to a significant decrease in the number of operative cases per surgeon and therefore impact the current practice of pediatric urology. Objective The objective in conducting this study is to try and predict the effect of the current number of pediatric urology fellowship training positions on future case volume per surgeon using a mathematical model and to discuss future management of the pediatric urology workforce. Design The current study employed a mathematical model to predict the effect of the number of fellowship graduates on future “case volume per surgeon”. We incorporated population growth rates, to calculate incidence rates of key procedures/conditions and the anticipated retirement rate of the current pool of pediatric urologists to help calculate this. Results There is a possibility to increase the number of practicing board-certified pediatric urologists in the next 30 years from approximately 325 to 900 (figure). There will be a twofold reduction in case volume per surgeon compared to the present in model 1. In model 2 the decrease in case volumes is less significant. The annual number of fellows needed to obtain a future-to-current ratio equal to 1 is 16 for model 1, and 26 for model 2. Discussion Our study demonstrates, by using two different models that the current number of pediatric urology fellowship training positions in the United States will ultimately lead to a significant decrease in the case volume per surgeons. Our model has limitations as it relies on multiple assumptions. We are assuming that all fellowship positions would be filled every year and that all fellows would graduate, establish their practices in the United States, and devote 100% of their assumed 30-year professional career to pediatric urology. We also made assumptions of disease occurrence and need for surgical correction. The final assumption we made was that the birth rate would stay static over the next 30 years even though it has been declining for many decades. Conclusion This exercise, even with its inherent limitations, is still sufficient to demonstrate that fellowship expansion warrants thoughtful discussion. Display Omitted

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  10. [해외논문]   Commentary to “The implications of fellowship expansion on future pediatric urologist surgical volumes”   SCIE

    Merguerian, Paul (Correspondence to: P. Merguerian, Department of Urology, Seattle Children's Hospital, 4800 Sandpoint Way, Seattle, WA 98105, USA. Tel.: +1 206 987 1623)
    Journal of pediatric urology v.14 no.3 ,pp. 251 - 251 , 2018 , 1477-5131 ,

    초록

    Summary Introduction Over the past 25 years, Pediatric Urology fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) have more than doubled. This increase may lead to a significant decrease in the number of operative cases per surgeon and therefore impact the current practice of pediatric urology. Objective The objective in conducting this study is to try and predict the effect of the current number of pediatric urology fellowship training positions on future case volume per surgeon using a mathematical model and to discuss future management of the pediatric urology workforce. Design The current study employed a mathematical model to predict the effect of the number of fellowship graduates on future “case volume per surgeon”. We incorporated population growth rates, to calculate incidence rates of key procedures/conditions and the anticipated retirement rate of the current pool of pediatric urologists to help calculate this. Results There is a possibility to increase the number of practicing board-certified pediatric urologists in the next 30 years from approximately 325 to 900 (figure). There will be a twofold reduction in case volume per surgeon compared to the present in model 1. In model 2 the decrease in case volumes is less significant. The annual number of fellows needed to obtain a future-to-current ratio equal to 1 is 16 for model 1, and 26 for model 2. Discussion Our study demonstrates, by using two different models that the current number of pediatric urology fellowship training positions in the United States will ultimately lead to a significant decrease in the case volume per surgeons. Our model has limitations as it relies on multiple assumptions. We are assuming that all fellowship positions would be filled every year and that all fellows would graduate, establish their practices in the United States, and devote 100% of their assumed 30-year professional career to pediatric urology. We also made assumptions of disease occurrence and need for surgical correction. The final assumption we made was that the birth rate would stay static over the next 30 years even though it has been declining for many decades. Conclusion This exercise, even with its inherent limitations, is still sufficient to demonstrate that fellowship expansion warrants thoughtful discussion. Display Omitted

    원문보기

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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