Introduction Management of severe antenatally detected oligohydramnios with and without obstruction is improving with the result that more fetuses are surviving with early renal failure. Significant advances have occurred in all specialties involved in the management of these patients. All these specialties working together have resulted in the survival of more patients born with renal failure. Objective The aim of this study is to highlight the medical advances in antenatal management of fetal oligohydramnios and pulmonary hypoplasia and to demonstrate that transplantation into a diverted urinary system is safe and leads to good outcomes. Study design A case series of five patients were presented who, at the study center's respective facilities, recently underwent renal transplantation into bladders drained by cutaneous vesicostomy after extensive bladder evaluation and whose clinical cases highlight the aim of this study. Results A total of 5 patients were reviewed. Renal failure was caused by posterior urethral valves in four patients, and in one patient Eagle-Barrett syndrome. One patient received an amnio-infusion and attempted antenatal bladder shunt. One patient was ventilator dependent until 24 months, and required a tracheostomy, while two patients were ventilator dependent for the first few months of life. Three of five patients were dialysis dependent. Patient age at transplantation ranged from 20 to 61 months. All patients were poorly compliant pre-transplant and had bladder capacities ranging from 10 mL to 72 mL. Months since follow-up ranged from 3 to 64 months. Creatinine levels prior to transplant ranged from 1.9 to 5.6. During the follow up period, this range decreased to 0.13 to 0.53. Two of five patients had UTI episodes since transplantation. Patient A showed Banff Type 1A acute T-cell mediated rejected approximately two months after transplant, but subsequent biopsies have been negative for rejection. Patient A also required a vesicostomy revision approximately two months after transplant and balloon dilation of UVJ anastomosis three months after transplant. Discussion Vesicostomy is an especially attractive option to manage children with small bladders to accommodate the high urinary output that occurs after transplantation in infants who require an adult kidney. Recent advances in antenatal management such as amnioinfusion for oligohydramnios have made significant impacts in pulmonary and renal management of this patient population over recent years. Conclusion This report provides further support for the use of vesicostomy as an option for surgical management of patients with renal failure with oligohydramnios and severe obstructive lesions identified antenatally. It also indicates the need to update the criteria for antenatal management of oligohydramnios in obstructive and anephric patients.

Graves, John Lee BA; Lomboy, Jason R. MD; Hacker, Kathryn E. MD, PhD; Garren, Brandon MD; Wood, Case M. MD; North, Amanda C. MD; McKenna, Patrick H. MD, FACS; Tan, Hung-Jui MD, MSHPM; Pruthi, Raj S. MD, MHA, FACS Author Information

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making IV1 Apr 2017MP76-10 BURNOUT IN UROLOGY: RESULTS FROM THE 2016 AUA CENSUS Amanda C. North, Patrick H. McKenna, Raymond Fang, Alp Sener, Brian K. McNeil, Julie Franc-Guimond, William Meeks, Steven Schlossberg, Chris M. Gonzalez, and James Q. Clemens Amanda C. NorthAmanda C. North , Patrick H. McKennaPatrick H. McKenna , Raymond FangRaymond Fang , Alp SenerAlp Sener , Brian K. McNeilBrian K. McNeil , Julie Franc-GuimondJulie Franc-Guimond , William MeeksWilliam Meeks , Steven SchlossbergSteven Schlossberg , Chris M. GonzalezChris M. Gonzalez , and James Q. ClemensJames Q. Clemens View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2138AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Physician burnout is linked to decreased job performance as well as increased medical errors, interpersonal conflicts and depression. Two recent multi-specialty studies showed that compared to other physicians in the 29-65 age group, urologists had the highest rate of burnout (54.4% vs. 63.6%); however, these reports were limited by a low sample size for urologists (n=119). We aimed to establish the prevalence of urologist burnout and to determine factors associated with burnout more comprehensively. METHODS In the 2016 AUA Census, Maslach Burnout Inventory (MBI) questions were randomly assigned to half of the respondents. Using matrix sampling, the 1,126 practicing urologists who received and answered the MBI questions represent the entire 2,301 who completed the Census with a sampling weight of 2.04. Burnout was defined as scoring high in either the emotional exhaustion (score≥27) or depersonalization (score≥10) categories. Demographic and practice variables were assessed through both univariate descriptive analysis and multivariate logistic analysis to establish correlating factors to burnout. RESULTS Overall, 38.8% of urologists met the criteria for burnout, of whom 17.2% scored high for emotional exhaustion and 37.1% scored high for depersonalization. Multivariate analysis revealed that urologist burnout is associated with a variety of factors as follows (ranked from most important): greater number of patient visits in a typical week; younger age group; in sub-specialty area other than pediatric or oncology; in either solo or multi-specialty practices; practice size of more than 2; and greater number of work hours in a typical week. (See table.) CONCLUSIONS These results suggest that the burnout rate for urologists, 38.8% overall or 41.3% in urologists ages 29-65, is lower than previously reported and is consistent with rates reported in other medical and surgical specialties. Burnout continues to be an important issue for urologists. Higher workload correlated with increased burnout while other practice patterns, such as being a solo owner of a practice or working in an academic center, appear to be protective. Understanding the causes of burnout in urology will help guide future intervention. It is important to keep all urologists in the workforce to help lessen projected shortages. © 2017FiguresReferencesRelatedDetailsCited byChouhan J, Anwar T, Jones A and Murray K (2020) Burnout in the Urology Workforce: Voluntary Survey Results in the United StatesUrology Practice, VOL. 7, NO. 6, (566-570), Online publication date: 1-Nov-2020. Volume 197Issue 4SApril 2017Page: e1016-e1017 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Amanda C. North More articles by this author Patrick H. McKenna More articles by this author Raymond Fang More articles by this author Alp Sener More articles by this author Brian K. McNeil More articles by this author Julie Franc-Guimond More articles by this author William Meeks More articles by this author Steven Schlossberg More articles by this author Chris M. Gonzalez More articles by this author James Q. Clemens More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

IntroductionThe resolution rate of prenatal urinary tract dilation (UTD) has been documented in several retrospective studies. The present study analyzed prospective observational registry data, with the aim of determining time to resolution among patients prenatally identified with mild postnatal UTD.Materials and methodsA total of 248 subjects, from four centers, were prospectively enrolled from 2008 to 2015. Exclusion criteria included other anomalies (n = 69), fewer than two ultrasounds, and/or <3 months follow-up (n = 26). Resolution was defined as Outcome A (SFU 0) and Outcome B (SFU 0/1). Fisher's exact test, ManneWhitney U or Kruskale-Wallis test and KaplaneMeier were used for analysis.Results/discussionThemedian follow-up for 179 (n = 137males) subjects was 15 months (IQR 7-24), range 0-56 months. VCUG was performed in 100 (57%) and VUR identified in 15 (15%). There was no association with reflux and resolution (P = 0.72). For resolution assessment (n = 153), lower grades were likely to resolve and demonstrated a higher rate in the Outcome B classification. Time ity resolving within 2 years (Figure). Surgical intervention was performed in 14 (8%). It is interesting to note that regardless of grade of UTD, there was no difference in frequency of US or the time that RUS was first performed. Practitioners performed the first RUS of life within a narrow window ranging from 0.27 RUS/month for Grade 1 UTD to 0.30 RUS/month for Grade 4 UTD. It was speculated that this practice pattern occurrence likely reflected the deficiency in knowledge by primary care providers, and identified a potential opportunity for education. The SFU registry substantiates that the vast majority of patients will demonstrate transient UTD and most cases that do not resolve will improve within 2 years of life. This data could be used to further an evidenced-based approach towards the evaluation and management of prenatal UTD, as outlined in the multidisciplinary consensus statement for prenatal urinary tract dilation.ConclusionsThis prospective registry confirms that the majority of prenatal UTD is transient, resolution occurs within the first 3 years of life, and most patients will not need intervention. Redefining SFU 1 as normal increased the resolution rate. A large proportion of patients were not evaluated with a VCUG, therefore impact of VUR could not be determined.

PURPOSE:The proportion of women in urology has increased from less than 0.5% in 1981 to 10% today. Furthermore, 33% of students matching in urology are now female. In this analysis we characterize the female workforce in urology compared to that of men with regard to income, workload and job satisfaction.MATERIALS AND METHODS:We collaborated with the American Urological Association to survey its domestic membership of practicing urologists regarding socioeconomic, workforce and quality of life issues. A total of 6,511 survey invitations were sent via e-mail. The survey consisted of 26 questions and took approximately 13 minutes to complete. Linear regression models were used to evaluate bivariable and multivariable associations with job satisfaction and compensation.RESULTS:A total of 848 responses (660 or 90% male, 73 or 10% female) were collected for a total response rate of 13%. On bivariable analysis female urologists were younger (p <0.0001), more likely to be fellowship trained (p=0.002), worked in academics (p=0.008), were less likely to be self-employed and worked fewer hours (p=0.03) compared to male urologists. On multivariable analysis female gender was a significant predictor of lower compensation (p=0.001) when controlling for work hours, call frequency, age, practice setting and type, fellowship training and advance practice provider employment. Adjusted salaries among female urologists were $76,321 less than those of men. Gender was not a predictor of job satisfaction.CONCLUSIONS:Female urologists are significantly less compensated compared to male urologists after adjusting for several factors likely contributing to compensation. There is no difference in job satisfaction between male and female urologists.

Abstract Introduction There is little information on job satisfaction in the extant literature in urology. The purpose of this study is to examine 1) the current state of job satisfaction among urologists in the United States, and 2) the demographic and work place factors that have the greatest influence on satisfaction. Methods We collaborated with AUA (American Urological Association) to query its domestic membership of practicing urologists regarding socioeconomic, work force and quality of life issues. A total of 848 responses were collected for a total response rate of 13%. Linear regression models were used to evaluate bivariable and multivariable associations with job satisfaction scores on a 1 to 5 scale. Results Of providers 70% reported being satisfied, 63% reported that they would choose medicine again and 83% would choose urology again. Age and job satisfaction did not demonstrate a linear association on statistical analysis but rather a U-shaped relationship. On bivariate analysis significant factors associated with higher job satisfaction included younger and older age, higher income (p = 0.047), fewer call days (p = 0.006), fellowship training (p = 0.006) and academic practice (overall p = 0.002). On multivariate analysis age (younger and older ages) and academic practice remained significant predictors of job satisfaction (p = 0.01) as did higher income (p = 0.038). Conclusions The current study helps describe the current state of job satisfaction among American urologists and examined work place factors that influence satisfaction. Income, hours worked, academic practice and age each have a significant impact on job satisfaction for the practicing urologist. Keeping abreast of the drivers of job satisfaction is critical to ensure that urologists continue to care for patients, perform research, educate future physicians and provide service to their communities.

IntroductionRisk factors for urinary tract infection (UTI) in children with prenatal hydronephrosis (PNH) are not clearly defined. Our study aim was to describe incidence and identify factors associated with UTI among a cohort of children diagnosed with PNH.Material and methodsPatients with confirmed PNH from four medical centers were prospectively enrolled in the Society for Fetal Urology (SFU) hydronephrosis registry between 9/2008 and 10/2015. Exclusion criteria included enrollment because of UTI, associated congenital anomalies, and less than 1-month follow-up. Univariate analysis was performed using Fisher's Exact test or Mann-Whitney U. Probability for UTI was determined by Kaplan-Meier curve.ResultsMedian follow-up was 12 (IQR 4-20) months in 213 patients prenatally diagnosed with hydronephrosis. The majority of the cohort was male (72%), Caucasian (77%), and 26% had high grade (SFU 3 or 4) hydronephrosis. Circumcision was performed in 116/147 (79%) with known status, 19% had vesicoureteral reflux (VUR), and 11% had ureteral dilatation. UTI developed in 8% (n = 18), 89% during their first year of life. Univariate analysis found UTI developed more frequently in females (p < 0.001), uncircumcised males (p < 0.01), and the presence of parenchymal renal cyst (p < 0.05). Logistic regression found renal cyst to no longer be significant, but female gender a significant risk factor for development of UTI (p < 0.001). Regression analysis stratified by gender found neither hydronephrosis grade nor parenchymal renal cyst to be significant risk factors for UTI development among females. However, hydronephrosis grade and circumcision status were significant risk factors for development of UTI among males (p < 0.05 and p < 0.01, respectively).ConclusionIdentification of factors associated with UTI in patients with PNH is still progressing; however, several observational studies have identified groups that may be at increased risk of UTI. Use of prophylactic antibiotics (PA), degree of kidney dilation, gender, and circumcision status all have been reported to have some degree of impact on UTI. A previous study identified risk factors for UTI as female gender, uncircumcised status, hydroureteronephrosis, and VUR, and reported that prophylaxis provided a protective effect on prevention of UTI. Our data mirror those in some respect, identifying an association of UTI with female gender and, among males, uncircumcised status, and high grade hydronephrosis. However, we were unable to demonstrate an association between UTI and the use of PA, presence of VUR, dilated ureter, or renal duplication in this observational registry.

OBJECTIVE To assess self-perceived planned retirement patterns among urologists by using the American Urological Association Census Data. With an expanding elderly population and an aging urologic workforce, concerns regarding increased demand and decreased supply of urologists have been raised.MATERIALS AND METHODS We analyzed data from the 2014 American Urological Association Census, which is a specialty representative survey distributed to the urologists who practice in the United States. A total of 2204 census samples were weighted to represent 11,703 urologists who practiced in the United States in 2014. We compared urologists who are nearing retirement (within 5 years of their planned retirement) with the rest of urologists on their demographic, geographic, and practice characteristics.RESULTS Of the 11,703 practicing urologists in the United States, 3181 (95% confidence interval: 28843479) or 27% (95% confidence interval: 25%-30%) are nearing planned retirement. The mean age (standard deviation [SD]) of urologists nearing retirement (69, SD = 8.2) was older than nonretiring urologists (48, SD = 10.3), P <.01. Nearly double the proportion of nearing retirement urologists is found in nonmetropolitan compared to nonretiring urologists, 534 (17%) vs 782 (9%), P <.01, respectively. Urologists nearing retirement are more likely to practice general urology compared to nonretiring urologists, 2341 (74%) vs 5072 (60%), P <.01. Among urologists nearing retirement, 2155 (68%) of them still perform inpatient operations.CONCLUSION More than one-fourth of existing practicing urologists plan to retire in the next 5 years. General urology and urology practices outside of metropolitan areas will be impacted the most by the planned retiring workforce. (C) 2016 Elsevier Inc.

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making II1 Apr 2016PD17-03 IMPACT OF APOLOGY LAWS ON LITIGATION LENGTH Patrick H McKenna, Thomas W Bentley, and Christina J Sauder Patrick H McKennaPatrick H McKenna More articles by this author , Thomas W BentleyThomas W Bentley More articles by this author , and Christina J SauderChristina J Sauder More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1168AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Thirty-eight states have apology laws which allow defendants to exclude statements or expressions of sympathy regarding medical errors in liability lawsuits. Most states with apology laws simply protect physicians from expressions of sympathy (partial apology law), while a few go further and protect physicians against admission of fault (full apology law). Apology laws are meant to improve communication between patient and physician regarding medical errors. This should reduce patient anger, decrease litigation, and speed up settlements. We assessed whether state apology laws impact litigation length using data from the National Practitioner Databank Public Use Data File (NPDB), which contains information on all malpractice cases from 1991 to 2014. METHODS Using data from the NPDB, litigation length was compared between states with and without apology laws. In states with apology laws, litigation length was compared before and after the laws were enacted and between states with partial and full laws. RESULTS Litigation length was 3.3 ± 2.0 years in states with (N=38,940) and 5.6 ± 3.7 years in states without (N=102,528) apology laws (p<.001). In states with apology laws, litigation length was 4.4 ± 3.3 years before the law was enacted (N=165,556) and 3.3 ± 2.0 years afterwards (N=38,940) (p<.001). Litigation length was 2.6 ± 1.4 years in states with full apology laws (N=2281) and 3.3 ± 2.0 in states with partial laws (N=36,659) (p<.001). CONCLUSIONS Apology laws appear to expedite resolution of medical malpractice cases. Full apology laws appear to be more effective at this than partial laws. States benefit the most with implementation of full apology laws. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e399-e400 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Patrick H McKenna More articles by this author Thomas W Bentley More articles by this author Christina J Sauder More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Objective Pediatric genitourinary rhabdomyosarcoma (RMS) accounts for 25 % of all pediatric soft tissue sarcomas. The treatment of these tumors has shifted over time from debilitating radical exenteration to organ-sparing techniques using multimodal therapy. Our review aims to summarize recent relevant literature regarding the current treatment practices of pediatric genitourinary RMS and how these practices have shifted over time. Methods PubMed database search was utilized to identify relevant literature from 1997 to 2015 relating to the treatment of pediatric genitourinary RMS with emphasis on organ preservation and maintaining organ function. Results A total of 31 articles from 1997 through 2015 were identified relating to current management concepts in pediatric genitourinary sarcomas. Relevant articles were reviewed in detail and discussed. Conclusion The treatment of pediatric genitourinary RMS has shifted from debilitating pelvic exenteration to a multimodal treatment approach involving surgery, chemotherapy, and radiation therapy in an effort to preserve genitourinary organs and reduce treatment morbidity. Continued research is required to improve post-treatment organ function. Further studies utilizing objective urodynamic evaluation are necessary to better characterize bladder function after treatment for RMS. Exciting recent developments in RMS research of fusion proteins that induce cell transformation and inhibit apoptosis and myogenic differentiation may result in future management changes to treatment protocols.

No AccessJournal of UrologyEditorial1 Jan 2015Current Role of Biofeedback for Pediatric Lower Urinary Tract Symptoms Patrick H. McKenna Patrick H. McKennaPatrick H. McKenna View All Author Informationhttps://doi.org/10.1016/j.juro.2014.10.058AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Current Role of Biofeedback for Pediatric Lower Urinary Tract Symptoms." The Journal of Urology, 193(1), pp. 14–15 References 1 : Pelvic-floor therapy and toilet training in young children with dysfunction voiding obstipation. BJU Int2000; 85: 889. Google Scholar 2 : Interactive computer games for treatment of pelvic floor dysfunction. J Urol2001; 166: 1893. Link, Google Scholar 3 : Biofeedback therapy expedites the resolution of reflux in older children. J Urol2002; 168: 1699. Link, Google Scholar 4 : Pelvic floor muscle retraining for pediatric voiding dysfunction using interactive computer games. J Urol1999; 162: 1056. Link, Google Scholar 5 : Lower urinary tract dysfunction in childhood. Urol Clin North Am2010; 37: 215. Google Scholar 6 : Biofeedback for nonneuropathic daytime voiding disorders in children: a systematic review and meta-analysis of randomized controlled trials. J Urol2014; 193: 274. Google Scholar 7 : Animated biofeedback: an ideal treatment for children with dysfunctional elimination syndrome. J Urol2011; 186: 2379. Link, Google Scholar 8 : Home uroflowmetry biofeedback in behavioral training for dysfunctional voiding in school-age children: a randomized controlled study. J Urol2006; 175: 2263. Link, Google Scholar 9 : Voiding dysfunction in children. Pelvic-floor exercises or biofeedback therapy: a randomized study. Pediatr Nephrol2006; 21: 1858. Google Scholar 10 : Management of abnormal postvoid residual urine in children with dysfunctional voiding. Urology2010; 75: 1472. Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 1January 2015Page: 14-15 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patrick H. McKenna More articles by this author Expand All Advertisement PDF downloadLoading ...

Pruthi, Nicholas; Lyons, Matthew D. MD; Kirby, Will E. MD; Langston, Joshua P. MD; McKibben, Maxim J. MD; Gonzalez, Chris M. MD, FACS; McKenna, Patrick H. MD, FACS, FAAP; Nielsen, Matthew E. MD, FACS; Smith, Angela B. MD; Pruthi, Raj S. MD, FACS Author Information

Pruthi, Nicholas; Spencer, Sophie E. MD; Langston, Joshua P. MD; Kirby, Will E. MD; Gonzalez, Chris M. MD, FACS; McKenna, Patrick H. MD, FACS, FAAP; McKibben, Maxim J. MD; Nielsen, Matthew E. MD, FACS; Smith, Angela B. MD; Pruthi, Raj S. MD, FACS Author Information

Diagnosis, decision making, and counseling for patients with disorders of sexual development pose challenges for physicians and families. Accurate antenatal evaluation combined with effective communication between the family and multidisciplinary team is important to provide the best patient outcome. We reviewed 2 cases from our institution that illustrate the complexity of antenatal and postnatal management in Turner Syndrome patients who have 45,X mosaicism. We concluded that because of the complexity involved in providing appropriate care to these individuals, it is critical that accurate and universally accessible counseling materials are available to providers and families at the time of diagnosis and management decision making. (C) 2014 Elsevier Inc.

Lower urinary tract dysfunction (LUTD) and associated constipation are common and challenging problems facing the general practitioner and the pediatric urologist. The underlying problem may be non-neuropathic, neuropathic, anatomic, or a combination of any of the three. Neuropathic, anatomic, and certain non-neuropathic causes require prompt recognition and appropriate referral to prevent possible permanent renal and lower urinary tract damage. Constipation often occurs with LUTD and must be recognized and addressed concomitantly. Evaluation for non-neuropathic LUTD rarely involves invasive studies, relying instead on flow rates and surface muscle electromyography (EMG) measurements. Management of LUTD and associated constipation has changed in recent years. Currently the first line of therapy involves education, hydration, and treatment of constipation with bulking agents. These steps may be started by the primary care physician if a more serious underlying cause is not suspected. After referral to a pediatric urologist, most children will receive continued conservative management with some starting biofeedback and pelvic floor muscle retraining (PFMR). Medications such as anticholinergics and α-blockers should not be started until a patient has been evaluated by a specialist. More invasive management strategies such as catheterization and surgery are only indicated for anatomic or neurologic abnormalities or for severe cases that do not respond to more conservative measures. Well-coordinated care involving patients, families, primary care physicians, and specialists is needed to ensure the best outcomes for children with LUTD and associated constipation.

OBJECTIVE:To determine the most pressing issues facing academic urology training centers. The supply of urologists per capita in the United States continues to decrease. Stricter resident requirements, restriction of resident duty hours, and a Graduate Medical Education (GME) funding cap on resident education has led to significant challenges for academic centers. METHODS:A 32-question survey was sent to Society of University Urologists members. Respondents defined themselves as academic faculty tenure track, program director, academic chair, program director and academic chair, clinical faculty nontenure track, and community faculty member. RESULTS:A total of 143 of 446 members(32%) responded. A lack of funding was indicated as an obstacle to adding new residency positions (65% respondents) and recruiting new faculty (60% respondents). Residency positions not funded by GME (40% respondents) required either clinical or hospital dollars to support these slots. Most respondents (51%) indicated resident research rotations are funded with clinical dollars. Surgical skills laboratories are commonly used (85% respondents) and are supported mostly with hospital or clinical dollars. The majority of respondents (84%) indicated they would expand simulation laboratories if they had better funding. Other than urodynamics and ultrasound, urology residency training programs reported little income from ancillary dollars. CONCLUSION:There is a significant workforce shortage within urology training programs. Clinical revenue and hospital funding seem to be the main financial support engines to supplement the GME funding shortage, proficiency training, and faculty salary support for teaching. The current system of GME funding for urology residency programs is not sustainable.

PURPOSE:Many options are available for repairing mid shaft to distal hypospadias. Reported complications include poor cosmesis, persistent chordee, meatal stenosis and fistula. We hypothesized that advancing the intact native urethra would facilitate chordee correction and minimize complications.MATERIALS AND METHODS:We retrospectively reviewed our records of all 248 hypospadias repairs done from July 2003 to May 2009 and identified patients younger than 18 years with distal or mid shaft hypospadias who underwent repair by urethral mobilization. The outcomes recorded were patient satisfaction, bladder scan volume, and the rate of fistula, meatal stenosis or other complications.RESULTS:Of the patients 83 met study inclusion criteria, including 5 (6%) treated with previous failed hypospadias operations. The hypospadias site was the distal, mid shaft and megameatal intact prepuce variant in 69 (83.1%), 11 (13.3%) and 3 patients (3.6%), respectively. Chordee was present in 80 patients (96.4%). The mean degree of chordee was 61.5 degrees, mean age at operation was 35.7 months and mean followup was 18 months (range 0.25 to 79). Of parental responses 94% were pleased or very pleased. Mean bladder volume on bladder scan was 9.7 ml (range 0 to 81). Fistula developed in 1 patient (1.2%). There were no meatal stenosis cases.CONCLUSIONS:Urethral mobilization results in excellent cosmesis and a low complication rate. This technique is especially well suited to patients with prior operations or deficient preputial skin. Using the native urethra with its blood supply is our preferred method of repairing distal and mid shaft hypospadias with chordee.

Purpose: Worldwide, uroflowmetry without simultaneous electromyography is often the only testing performed during the initial assessment of children with lower urinary tract symptoms. Various alterations in uroflow pattern are thought to indicate particular types of lower urinary tract conditions, specifically staccato uroflow indicating dysfunctional voiding and intermittent/fractionated uroflow indicating detrusor underactivity. We determined how reliable uroflow pattern alone is as a surrogate for simultaneously measured pelvic floor electromyography activity during voiding, and how well staccato and interrupted uroflow actually correlate with the diagnoses they are presumed to represent.Materials and Methods: We reviewed uroflow/electromyography studies performed during the initial evaluation of 388 consecutive neurologically and anatomically normal patients with persistent lower urinary tract symptoms. We identified those with staccato, interrupted/fractionated and mixed uroflow based on current International Children's Continence Society guidelines.Results: A total of 69 girls (58.5%) and 49 boys (41.5%) met inclusion criteria. Staccato uroflow was noted in 60 patients, interrupted/fractionated uroflow in 28 and a combination in 30. An active electromyography during voiding confirmed the diagnosis of dysfunctional voiding in 33.3% of patients with staccato, 46.4% with interrupted/fractionated and 50% with mixed uroflow patterns.Conclusions: Diagnoses based on uroflow pattern appearance without simultaneous electromyography to support them can be misleading, and reliance on uroflow pattern alone can lead to overdiagnoses of dysfunctional voiding and detrusor underactivity. When assessing patients with uroflow, an accompanying simultaneous pelvic floor electromyography is of utmost importance for improving diagnostic accuracy and thereby allowing for the most appropriate therapy.