Introduction Prune Belly Syndrome (PBS) is a rare congenital disorder characterized by abdominal wall musculature deficiency, cryptorchidism, and urinary tract abnormalities. Clinical presentation is highly variable, with multisystem involvement and a wide range of urologic and renal outcomes. Long-term data from contemporary pediatric cohorts remain limited. Methods We conducted a retrospective review of pediatric patients diagnosed with PBS and followed at a tertiary pediatric urology center between 2002 and 2024. Demographic, clinical, surgical, and urodynamic data were extracted from electronic records. Renal function was assessed by estimated glomerular filtration rate and CKD staging. Comparative analyses were performed between subgroups using Student’s t-test or Fisher’s exact test, where appropriate. Multivariate logistic regression was performed to evaluate predictors of progression to CKD and renal transplant. Results Sixty-four patients (61 males, 3 females) with a median follow-up of 12.6 years were included. Hydronephrosis (87.5%), vesicoureteral reflux (73.4%), and recurrent UTIs (76.6%) were common. Nearly all patients underwent surgical intervention, most frequently orchidopexy (83.6%), vesicostomy (23.4%), and appendicovesicostomy (35.9%). Abdominal wall reconstruction was performed in 45.3% of patients. CIC was utilized by 35.9%, typically via a continent catheterizable channel. Urodynamic studies demonstrated large, compliant bladders with impaired emptying. CKD developed in 48.4% of patients, and 17.2% required renal transplantation, with nadir serum creatinine in infancy predictive of long-term outcomes. Conclusion PBS requires lifelong, multidisciplinary care. Early identification of patients at risk for CKD, proactive bladder management, and coordinated reconstructive surgery are critical to optimizing outcomes. These results reinforce the importance of integrating functional and quality-of-life goals into care planning. Future prospective studies are needed to refine surgical timing, preserve renal function, and better characterize long-term quality-of-life outcomes.

OBJECTIVE:To understand optimal primary management for posterior urethral valve (PUV) by comparing renal outcomes of a uniquely matched cohort of primary valve ablation (PVA) versus vesicostomy, whereby progressive urethral dilation (PUD) was performed to achieve PVA for previously ineligible infants. While PVA is often the preferred treatment, smaller, sicker neonates have historically undergone primary vesicostomy, limiting true comparisons between treatment cohorts. The advent of PUD has made PVA feasible in a broader population, including neonates previously deemed too small for PVA. METHODS:We conducted a retrospective cohort study of neonates treated with either PVA (with or without PUD) or primary vesicostomy at two institutions between 1995 and 2021. Match criteria were creatinine at intervention, gestational age, and age/weight at intervention. The primary outcome was progression to renal replacement therapy (RRT). Secondary outcomes included trends in nadir serum creatinine. RESULTS:Twenty-four neonates met inclusion criteria (12 PVA, 12 vesicostomy). Groups were matched across clinical variables. There was no significant difference in serum creatinine at 6 weeks (P = .74) or 1 year (P = .89). Kaplan-Meier analysis showed no significant difference in time to RRT between groups (HR (95% CI): 1.32 (0.32, 5.45); P = .70). These findings persisted after adjustment for clinical covariates (OR (95% CI): 1.24 (0.10, 15.9); P = .87). CONCLUSION:This study represents a uniquely matched comparison of PVA and vesicostomy following the introduction of PUD, addressing a longstanding treatment selection bias. While renal outcomes were comparable, vesicostomy may impose greater surgical burden and disrupt bladder cycling.

Rhabdomyosarcoma (RMS) treatment involves surgery, chemotherapy, and radiotherapy. A radioprotective space between the bladder/prostate and rectum reduces postradiation complications, as reported in adult patients. Describe pediatric preradiotherapy perirectal hyaluronic acid (HA) spacer injection for bladder/prostate RMS. We present a case of a 17-month-old male with bladder/prostate RMS. Before radiotherapy, an HA spacer was injected peri-rectally. Under general anesthesia, a transrectal ultrasound was positioned and 1 mL of HA spacer was injected into the perirectal space. No complications were reported at 6-month follow-up. This is the first report of pre-radiation therapy spacer injection for pediatric bladder/prostate RMS. UROLOGY 181: 136-140, 2023.(c) 2023 The Authors. Published by Elsevier Inc.

Background Management patterns and outcomes are poorly defined in cases of late PUV diagnosis. Objective To compare post-ablation management and clinical outcomes of patients with infantile (<1 year) versus childhood (>5 year) PUV diagnosis to gain insight into the pathologies at opposite ends of the PUV spectrum. Study design A multicenter retrospective cohort study was con-ducted using the TriNetX research network between 2006 and 2022. TriNetX synthesizes insurance claims and electronic medical record data for over 110 million patients from 92 healthcare organizations. We defined two cohorts: 1) The <1 year arm had an index diagnosis of PUV and cystoscopy with valve ablation within 1 year of life, 2) the >5 year arm had an index diagnosis of PUV and valve ablation after age 5. We report rates and time-to-first use of an-tispasmodics, alpha-blockers, CIC, bladder botox, enterocystoplasty or Mitrofanoff or secondary cuta-neous vesicostomy, and CKD. Results We identified 569 patients (323 <1 year; 246 >5 year). Median age at diagnosis was 1 month (median follow-up 8 years) and 9 years (median follow-up 10 years) for the <1 year and >5 year cohorts, respectively. Following ablation, both arms were primarily managed with antispasmodics, with no difference between groups. The >5 year arm was significantly more likely to receive alpha-blockers or bladder botox. The <1 year arm was significantly more likely to be started on CIC, undergo enter-ocystoplasty, Mitrofanoff or secondary cutaneous vesicostomy, or renal transplantation. The <1 year arm had significantly higher rates and shorter time-to-progression to all stages of CKD. Discussion Despite higher utilization of conservative strategies among patients with a late PUV diagnosis, these patients had superior renal outcomes and low rates of progression to invasive treatments. Limitations include potential inaccuracies in medical coding as well as variations in thresholds to initiate CIC, perform surgical reconstruction, or proceed with renal transplantation at participating centers. Conclusions These findings provide evidence that a late PUV diagnosis reflects an overall milder disease process.

Congenital melanocytic nevi are present at birth or develop within the first few months of life. Giant congenital mela-nocytic nevi are a rare variant and may involve the external genitalia with a confluent "bathing trunk" distribution. Rapid growth of proliferative nodules of melanocytic cells may cause disfigurement and anatomical distortion resulting in psy-chological distress and loss of functionality. We report the case of a neglected 17-year-old nonverbal male who received a resection of a Giant Congenital Melanocytic Nevi (GMN) engulfing the penis and scrotum with final resected dimensions of 36.0 x 20.0 x 8.0 cm. UROLOGY 181: 147-149, 2023.(c) 2023 Elsevier Inc. All rights reserved.

You have accessJournal of UrologyCME1 May 2022MP11-13 SHORT AND LONG TERM RENAL OUTCOMES IN CLINICALLY MATCHED COHORTS OF NEWBORNS WITH PUV MANAGED BY PRIMARY VESICOSTOMY VERSUS PRIMARY VALVE ABLATION Nora Haney, Shwetha Mudalegundi, Angelica Griggs-Demmin, Tamir Sholklapper, Edwin Smith, and Charlotte Wu Nora HaneyNora Haney More articles by this author , Shwetha MudalegundiShwetha Mudalegundi More articles by this author , Angelica Griggs-DemminAngelica Griggs-Demmin More articles by this author , Tamir SholklapperTamir Sholklapper More articles by this author , Edwin SmithEdwin Smith More articles by this author , and Charlotte WuCharlotte Wu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002533.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Some controversy exists regarding whether primary valve ablation (PVA) or primary vesicostomy (PVES) provides superior drainage in neonates with posterior urethral valves. We previously demonstrated progressive urethral dilation (PUD) as a means to achieve PVA in low birth weight and early gestational age neonates, who otherwise disproportionately require PVES. Management with PUD has provided a novel opportunity for comparative analysis of primary intervention on outcomes between similar cohorts with fewer clinical confounders. In this multi-institutional study, our objectives were to determine the short and long term renal outcomes in clinically matched cohorts of neonates with PVES versus PVA. METHODS: This is a retrospective study. Institution A performs PUD to achieve PVA in all neonates. Institution B performs PVES when PVA is unfeasible. Patients were matched primarily by creatinine at intervention and then by clinical features of gestational age, age at ablation, and weight at ablation. We excluded children who had intervention beyond 9 months of age or with incomplete creatinine data. We included all patients who met criteria over 25 years of follow up. RESULTS: 24 patients (12 PVES, 12 PVA) were included with mean follow up 98.8 (+/- 15.9) months. Clinical demographics were matched similarly between groups (Table 1). Creatinine nadir within 6 weeks and 1 year of intervention was not statistically significantly different between groups at 1.4 and 1.2 mg/dL respectively for PVES and 1.3 and 0.9 mg/dL respectively for PVA. A time to event analysis with Mantel-Cox Log Rank was performed and did not show a statistically significant difference in the long-term distribution of ESRD outcomes over time, p = 0.819). CONCLUSIONS: In these clinically matched cohorts comparing PVA to PVES, there was no statistically significant difference in renal outcomes in the short term as determined by creatinine nadir within 6 weeks and 1 year of primary intervention. Long-term results similarly show no statistically significant difference in ESRD outcomes. Although these are preliminary findings based on a small sample, this is the first study of this kind to provide insight into the effect of primary intervention on renal outcomes while reducing critical biases of inherently heterogeneous cohorts. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e161 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nora Haney More articles by this author Shwetha Mudalegundi More articles by this author Angelica Griggs-Demmin More articles by this author Tamir Sholklapper More articles by this author Edwin Smith More articles by this author Charlotte Wu More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction PUV patients managed with primary vesicostomy instead of primary valve ablation (PVA) historically are preterm, low-birth-weight (LBW) infants with inadequate urethral size. We previously described progressive urethral dilation (PUD) as an effective method of enhancing the likelihood of PVA in these infants, allowing equal access to PVA as an initial management method. Objective We aim to characterize renal outcomes in patients managed with PUD + PVA and compare this to outcomes with PVA alone. We also re-examine the effect of LBW and gestational age on renal outcomes in PUV with a cohort treated uniformly by PVA. Methods We performed retrospective review of 78 neonates with PUV treated with PVA prior to 10 weeks of age with>1 year of follow up. Before valve ablation, boys either underwent PUD (serial upsizing of a smaller bore urethral catheter to an 8Fr catheter; PUD+PVA) or non-dilation (smaller bore catheter was maintained; PVA-only). PUD + PVA versus PVA-only was compared using chi-square and t-test. Logistic regression was performed to assess the effect of PUD, preterm (<37 weeks), LBW (<2.5 kg), and other predictors on the final outcomes of CKD3+ and ESRD. Results 31 of 78 patients underwent PUD + PVA. Mean follow up was 5.2 years (SD 3.4), with no significant difference between PUD + PVA and PVA-only. The PUD + PVA group included significantly lower gestational age infants with lower birth weight and ablation weight. There was no significant effect of PUD on final CKD3+ or ESRD outcome on univariable or multivariable analysis. When adjusted for other variables, only Cr nadir >0.5 remained an independent predictor of CKD3+ (OR 41.2; p < 0.001) and ESRD (OR 18.9; p = 0.015). Discussion We previously demonstrated that PUD is an effective means to achieve PVA in small neonates who might otherwise require vesicostomy. The data herein demonstrates no significant effect of PUD on renal outcomes. In this unique cohort of newborns treated with PVA, only creatinine nadir and not gestational age or an independent predictor of outcomes. Conclusion In small preterm infants who would have been excluded from PVA due to limited urethral size, PUD + PVA confers the same renal outcomes as PVA alone in larger infants. This novel data will assist in the risk-benefit analysis of using PUD before PVA in newborns diagnosed with PUV. When primary intervention is uniformly PVA, preterm birth and LBW are not independent predictors of renal outcomes. [GRAPHICS] .

There are indeed numerous variables to take into consideration with performance and interpretation of a VCUG, especially with the diagnosis of posterior urethral valves. In the current study, the ratios were measured under specific filling and voiding circumstances to reduce the possibility of an erroneous calculation on account of these dynamic factors. We agree that such calculations leave room for variability and can be vulnerable to lack of precision. If the VCUG fails to demonstrate adequate conditions to properly assess the ratios, a fallacious ratio will result. Editorial comment on “Posterior urethral morphology on initial voiding cystourethrogram correlates to early renal outcomes in infants with posterior urethral valves”Journal of Pediatric UrologyVol. 18Issue 6PreviewIn this interesting paper, the authors have studied the bladder height to width ratio (HW-B), posterior urethral height to width ratio (HW-PU), posterior-anterior urethral ratio (PA-UR) and bladder trabeculation grade on initial voiding cystourethrogram (VCUG) of children with posterior urethral valve (PUV) and found that only HW-PU significantly correlated with a higher nadir creatinine at one-year of age [1]. Niyogi [2] proposed that in children with PUV increasingly distorted bladder shape was associated with poor bladder dynamics and proposed shape, wall, reflux and diverticuli (SWRD) score. Full-Text PDF

B cells can become activated in germinal center (GC) reactions in secondary lymphoid tissue and in ectopic GCs in rheumatoid arthritis (RA) synovium that may be tumor necrosis factor (TNF) and lymphotoxin (LT) dependent. This study was undertaken to characterize the peripheral B cell compartment longitudinally during anti‐TNF therapy in RA.

Purpose: Primary valve ablation is preferred to vesicostomy in the initial management of posterior urethral valves. However, some neonates have a prohibitively small urethra. We describe our experience with a preoperative urethral catheter regimen to enhance the likelihood of neonatal valve ablation. Materials and Methods: We performed a retrospective review of 126 neonates with posterior urethral valves treated between 2003 and 2019 with valve ablation prior to 10 weeks of age. The preoperative indwelling catheter either was gradually upsized to an 8Fr (progressive urethral dilation), was not upsized (nondilated) or was initially larger bore (8Fr only). The primary outcome was the ability to perform primary ablation by neonatal resectoscope. The secondary objective was to establish the parameters for considering progressive urethral dilation as well as its associated risks. Results: Overall 97% could be ablated. The progressive urethral dilation group had the lowest mean weight (p <0.001). Only a larger catheter at the time of ablation was significantly associated with feasible ablation (p <0.001) and not urethral dilation, the infant’s weight or his gestational age. Progressive urethral dilation was associated with a longer duration of catheterization as well as double the rate of febrile urinary tract infections (8.5%) over the nondilated group (3.6%). Conclusions: A much higher rate of primary ablation is feasible (97%) than previously reported (82%). More important than the infant’s weight is whether a 6Fr to 8Fr catheter is in place at ablation. If an initial 6Fr to 8Fr catheter cannot be placed, urethral dilation to 8Fr should be performed before attempting ablation. This is both a technique and preoperative assessment that is useful for operative planning.

Inflammatory myofibroblastic tumors (IMT) are rare and poorly understood inflammatory neoplasms. Most commonly occurring in the liver and gastrointestinal tract, cases of bladder involvement have been rarely reported. Bladder IMT generally presents with gross hematuria and can be differentiated from other bladder tumors by expression of anaplastic lymphoma kinase. We report the occurrence of an Bladder IMT detected following lower urinary tract reconstruction with bladder augmentation. (C) 2021 Elsevier Inc.

Posterior urethral valve (PUV) is a leading cause of chronic kidney failure in children. Studies have shown that a creatinine nadir above historical cutoff values of 0.8 or 1.0 mg/dL correlates with worse kidney outcomes. The ability to use nadir creatinine more discriminately as a test of kidney outcomes is otherwise limited. We performed a retrospective review of 102 infants treated with primary valve ablation prior to 1 year of age. Patient factors including creatinine at presentation (Cr-P), nadir within 6 weeks after ablation (Cr-6 W), and nadir within 1 year after ablation (Cr-1Y) were assessed as predictors of final chronic kidney disease (CKD) severity. An optimal threshold for four CKD levels was defined in incremental fashion using binary outcome with receiver operating characteristic (ROC). Multivariable logistic regression models compared Cr-P, Cr-6 W, and Cr-1Y while adjusting for patient factors. Boys were ablated at mean age of 36.3 days and followed for 6.6 years (± 3.7). When compared to other demographics, only creatinine remained independently predictive of CKD outcomes on multivariable analysis. ROC analysis demonstrated excellent diagnostic accuracy for Cr-6 W and Cr-1Y (p < 0.001) and acceptable accuracy for Cr-P (p < 0.005). Using the Cr-6 W and Cr-1Y models, high sensitivity and specificity creatinine nadir cutoffs were determined to predict each CKD outcome. The severity of childhood CKD can be predicted with high accuracy using the creatinine nadir within 6 weeks of ablation. The cutoff values described can be incorporated into a clinical setting for patient counseling and individual risk stratification.

You have accessJournal of UrologyPediatric Urology III (MP47)1 Sep 2021MP47-16 WWW.NEOCIRC.ORG IS A USEFUL MULTIDISCIPLINARY KNOWLEDGE RESOURCE FOR NEONATAL CIRCUMCISION PROVIDERS Max Maizels, Max Maizels, Emily Blum, Edwin A. Smith, Paola Fliman, Elizabeth Goetz, and Walid Farhat Max MaizelsMax Maizels More articles by this author , Max MaizelsMax Maizels More articles by this author , Emily BlumEmily Blum More articles by this author , Edwin A. SmithEdwin A. Smith More articles by this author , Paola FlimanPaola Fliman More articles by this author , Elizabeth GoetzElizabeth Goetz More articles by this author , and Walid FarhatWalid Farhat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002068.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: On average, 5% of boys having neonatal circumcision have surgical repair of complications. Such repairs cause parents unexpected financial and emotional burdens as well as drain our healthcare system. As there has not yet been a systematic effort to reduce the incidence of complications, our research is to reduce this incidence. We begin by hypothesizing that complications are rooted in differences in circumcision knowledge across specialties. Therefore, we built a model, www.NeoCirc.org, to promote consistency in knowledge, shared it online across multiple specialties, and tested it for usefulness. Usefulness, defined broadly, is user opinions which regard model content is beneficial. METHODS: Model design and build began by holding focus groups with multidisciplinary circumcision providers who gave data by survey. We combined survey data with authors’ opinions to create www.NeoCirc.org. The model presents knowledge interactively as a single method, applicable to diverse clamp types. The knowledge is applied before (i.e., assess anatomy for clearance), at (i.e., mark the circumcision site), and after (i.e., provide home care instructions) circumcision. Finally, model was launched and its usefulness assessed by survey (Likert rating). RESULTS: Design/Build. Beginning in April, 2020 we acquired 46 focus group members specializing in: Pediatrics/Neonatology (24). Obstetrics (14), and Pediatric Urology (8). They contributed insights and assessed model content as “very valuable”: before (19/19), at (22/31), and after circumcision (21/27). Launch. There were 332 users who made 747 logins to access content: pediatricians (482), obstetricians (122), pediatric urologists (112), nurses (21) and trainees (10). Of this group 66/332 (20%) provided opinions on model usefulness from specialists in: Pediatrics (31), Obstetrics (24), Family Practice (6), or Urology (5). They indicated the model benefited them as it: was “effective” (63/66), made understanding of circumcision “significantly better” (62/65), and was worthy so “would recommend to a colleague” (63/66). This represents an overall usefulness of 95% (188/197). CONCLUSIONS: www.NeoCirc.org is a new resource of knowledge important to circumcision providers across multiple disciplines. Model usefulness is shown in that 95% of responses indicate benefit: effective learning tool, increases understanding, and would recommend. We expect sharing this model will promote consistency in knowledge across specialties and thereby systematically lead to reduce incidence of complications. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e829-e830 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Max Maizels More articles by this author Max Maizels More articles by this author Emily Blum More articles by this author Edwin A. Smith More articles by this author Paola Fliman More articles by this author Elizabeth Goetz More articles by this author Walid Farhat More articles by this author Expand All Advertisement Loading ...

You have accessJournal of UrologyPediatric Urology IV (MP51)1 Sep 2021MP51-01 COMPARATIVE ANALYSIS OF CREATININE NADIR CUTOFFS FOR PREDICTING CHILDHOOD RENAL OUTCOMES IN POSTERIOR URETHRAL VALVES Charlotte Wu, Emily Blum, Dattatraya Patil, Stella Shin, and Edwin Smith Charlotte WuCharlotte Wu More articles by this author , Emily BlumEmily Blum More articles by this author , Dattatraya PatilDattatraya Patil More articles by this author , Stella ShinStella Shin More articles by this author , and Edwin SmithEdwin Smith More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002077.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Posterior urethral valves (PUV) are a leading cause of chronic renal failure in childhood. A consistently validated prognostic indicator of renal outcomes is the creatinine nadir. Higher nadirs above historical cutoff values of 0.8 or 1.0 mg/dL correlate with worse renal outcomes. The ability to distinguish early creatinine values more elaborately for patient counseling remains otherwise limited. METHODS: Children with PUV treated by primary valve ablation before 12 months old and followed >2 years were identified. Patient factors including creatinine at presentation (Cr-P), nadir at 6-weeks after ablation (Cr-6W), and nadir at 1 year after ablation (Cr-1Y) were assessed as predictors of final chronic kidney disease (CKD) stage. An optimal threshold for four CKD levels was defined in incremental fashion using binary outcome with receiver operating characteristic (ROC), then multivariable logistic regression models compared Cr-P, Cr-6W, and Cr-1Y while adjusting for patient factors. RESULTS: A total of 102 boys were ablated at a mean age of 36.3 (range 0-334) days and followed for 6.6 (±3.7) years. Overall progression to ESRD was 17%. Univariate analysis demonstrated a significant association between lower gestational age and higher Cr-P, Cr-6W, Cr-1Y with incrementally higher CKD stages. On multivariable analysis, when compared to other demographics, only creatinine remained independently, significantly predictive of CKD outcomes. ROC analysis of creatinine for predicting CKD demonstrated excellent diagnostic accuracy for Cr-6W and Cr-1Y (p<0.001) and acceptable accuracy for Cr-P (p<0.005). Using the Cr-6W and Cr-1Y models, high sensitivity and specificity creatinine nadir cutoffs were determined to predict each CKD outcome (Table 1). CONCLUSIONS: Cr-6W and Cr-1Y are both excellent predictors of childhood CKD outcomes and are superior to Cr-P. A Cr-6W cutoff of 1.0 mg/dL and Cr-1Y cutoff of 0.8 mg/dL are highly specific and sensitive for ESRD. Children with nadir below historic cutoffs of 0.8 or 1.0 mg/dL do not universally experience a benign renal course. The threshold for concern for CKD3 or higher, for which medical treatment is typically initiated, should start at a Cr-6W nadir > 0.5 mg/dL or Cr-1Y nadir >0.3 mg/dL. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e896-e896 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Charlotte Wu More articles by this author Emily Blum More articles by this author Dattatraya Patil More articles by this author Stella Shin More articles by this author Edwin Smith More articles by this author Expand All Advertisement Loading ...

Structural anomalies of the female reproductive tract, known as Mullerian anomalies, can occur in isolation or in association with anomalies of other organ systems. Due to shared embryology, the most common association in up to 40% of patients is with renal, ureteral, and bladder anomalies. Affected girls can have a wide range of genitourinary symptoms with urologists playing an integral role in their diagnosis and treatment. To facilitate the recognition and management of these conditions, we provide a review of Mullerian anomalies including the embryology, classifications, syndromes, evaluation, and treatments with attention to their urologic applicability.

Objectives: Neonatal circumcision is a common practice. We believe that adverse neonatal circumcision outcomes (ANCOs) may occur owing to a lack of standardized knowledge of circumcision. The goal of this study was to determine if a single tool could provide multiple specialties with increased knowledge of neonatal circumcision. Methods: The authors used insight from multidisciplinary circumcision providers to build the educational model. It was made available online, and a user survey assessed its usefulness. Knowledge of pediatricians in a teaching hospital was assessed before and after using www.neocirc.org, and the scores were compared using a paired t-test. Results: www.neocirc.org was found to be 95% useful by multidisciplinary users. Pediatricians significantly increased knowledge after using www.neocirc.org from intake correct answers (18/30, 60%) to exit (23/30, 77%), respectively (p<0.0001). Conclusion: www.neocirc.org provides a tool to increase pediatrician knowledge about neonatal circumcision. Future research is indicated to assess if the use of www.neocirc.org may reduce the incidence of ANCOs.