Importance:Increased use of the emergency department (ED) creates strain on the single-payer public health care system in Canada. Objective:To evaluate trends in ED visits and hospital admission rates for urologic conditions in Ontario, Canada, and to determine trends and associated factors for wait times to see a urologist among patients presenting to the ED. Design, Setting, and Participants:This population-based, retrospective cohort study used health administrative data from all EDs and acute care hospitals in Ontario for all adult patients presenting to the ED with a primary urological diagnosis between January 1, 2007, and December 31, 2022. Analyses were performed from January 2023 to April 2024. Main Outcomes and Measures:The main outcome was the rate of ED visits with new urologic diagnoses over time. Crude, age-standardized, and sex-standardized annual rates were estimated for index ED visits and hospital admissions. Wait times to see a urologist after ED visit were also determined. Results:A total of 2 192 213 unique visits to the ED with a main diagnosis of a urologic disorder were identified (mean [SD] patient age, 52.1 [21.2] years; 66.5% female). Of these, 1 732 356 visits represented a new urologic diagnosis (no visits in the prior 2 years). Age- and sex-standardized ED visit rates rose annually from 2007 (0.91 visits per 100 people) to 2015 (1.0 visits per 100 people) (rate ratio [RR], 1.10; 95% CI, 1.09-1.11), then decreased until 2020 (RR, 0.88; 95% CI, 0.87-0.88), before rising again until 2022 (RR, 0.91; 95% CI, 0.90-0.91). Among people seen in the ED with a urologic diagnosis, 10.0% were admitted to the hospital during the study period. The crude rate of admission rose annually (RR, 1.04; 95% CI, 1.03-1.05; P < .001), from 0.07 (95% CI, 0.07-0.08) admissions per 100 people in 2007 to 0.09 (95% CI, 0.09-0.09) in 2022. Patients with greater continuity of outpatient care had lower odds of being admitted. The mean (SD) wait time to see a urologist after an ED visit increased from 62.5 (80.3) days in 2007 to 84.8 (89.3) days in 2014. It subsequently decreased annually until 2022, to 71.1 (70.6) days. Increased comorbidity was associated with lower risk of outpatient urology visit. Conclusions and Relevance:In this cohort study, the annual ED visit rates for new urologic diagnoses, hospital admissions, and wait times to see urologists significantly increased over the study period. These trends were associated with decreasing continuity of care. This increasing burden of acute urologic disease necessitates investment in health care.

Importance With improved medical care, patients with spina bifida are living longer, making kidney morbidity an increasingly important source of disease burden. Objective To measure the incidence rate, age of onset, and clinical factors associated with kidney morbidity among a pediatric cohort of patients with spina bifida. Design, Setting, and Participants This cohort study included all publicly insured individuals born in Ontario, Canada, between April 1, 1992, and March 31, 2023, stratified by those with and without spina bifida. Data was sourced from inpatient and outpatient administrative health record databases. Patients were followed up from birth until August 31, 2023, termination of health insurance, or death. Exposure Patients with spina bifida were identified and compared with the general population born within the same time frame. Main Outcomes and Measures Incidence rate and age of onset of chronic kidney disease (CKD) and end-stage renal disease (ESRD) (ie, long-term dialysis and/or kidney transplant), captured through administrative diagnosis codes. A multivariate Cox proportional hazards model identified clinical factors associated with the development of CKD among patients with spina bifida. Results A total of 4 380 749 individuals were included: 12 868 with spina bifida (median [IQR] age at diagnosis, 1 [0-8] years) and 4 367 881 without spina bifida. The median (IQR) follow-up was 15 (7-23) years. Among patients with spina bifida, the incidence rate of CKD was 2.7 (95% CI, 2.5-2.9) per 1000 person-years compared with 0.3 (95% CI, 0.3-0.3) per 1000 person-years among the general population. The incidence rates of ESRD were 0.3 (95% CI, 0.2-0.4) and 0.01 (95% CI, 0.01-0.01) per 1000 person-years for patients with and without spina bifida, respectively. Patients with spina bifida were diagnosed with CKD earlier than controls (median [IQR], 5 [1-13] years vs 10 [2-18] years; P < .001; standardized difference = 0.411) and progressed to ESRD at a younger age as well (median [IQR], 8 [2-15] years vs 15 [7-22] years; P < .001; standardized difference = 0.614). Earlier birth year, male sex, higher comorbidity score, history of diabetes, upper tract calculi, recurrent complex urinary tract infections, and urologic surgery were significantly associated with CKD among patients with spina bifida. Conclusions and Relevance In this cohort study, pediatric patients with spina bifida faced a higher risk of CKD and ESRD, with onset about 5 to 7 years earlier compared with the general population. Several identified clinical factors were associated with kidney decline, warranting close pediatric surveillance.

Vesicovaginal fistula (VVF) surgical repair can be done transvaginal or transabdominal, laparoscopic, or robotic. Controversy exists regarding optimal approach, especially in those who have had prior radiation treatment, and those with prior VVF repair. We aimed to review our large fistula cohort to determine the success of transvaginal VVF repair. Between 1995 and 2022, 83 women with VVF underwent transvaginal VVF repair. All data were captured in a prospective database. Transvaginal approach involved multi-layer closure with monofilament absorbable sutures and local flap interposition. Success was cystogram evidence of fistula closure and freedom from re-operation. Mean patient age was 47 (median 49, range 24–81). 96

OBJECTIVE:To evaluate the long-term incidence of urethral stricture intervention following hypospadias repair, a procedure for a common urogenital birth defect in which the urethral meatus is repositioned to the penile tip, as long-term outcomes are not well studied. METHODS:A retrospective, population-based cohort study of males born in Ontario, Canada from April 1994-March 2023, was conducted using healthcare administrative databases. Cases undergoing hypospadias repair were matched to four controls by birthdate. Primary outcome was urethral stricture requiring intervention, assessed using Cox proportional hazards models. Secondary exposure was hypospadias location (distal vs proximal). Models were adjusted for baseline and secondary covariates. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated. RESULTS:A total of 9130 cases and 36,520 controls were analyzed. The mean and median age at surgery was 26.9 months and 19 months, respectively. Distal hypospadias accounted for 68.9% of cases, 9% required multi-stage repair, and 7% had post-operative complications. Urethral stricture requiring intervention developed in 169 cases (1.85%), versus 24 controls (0.06%). The risk of stricture was significantly higher in cases compared to controls (HR 26.80, 95% CI 17.43-41.20). Proximal repairs carried higher risk than distal repairs (HR 3.20, 95% CI 1.60-6.41). Mean follow-up was 13.5 years. CONCLUSIONS:Although absolute risk is low, patients with hypospadias repair are more likely to develop urethral strictures that require intervention compared with controls, particularly following proximal repair. These findings suggest that clinicians should maintain a high index of suspicion for urethral strictures in this population, even many years after the initial surgery.

ABSTRACT The American Association for the Surgery of Trauma initially published the organ injury scaling for the kidney in 1989, which was subsequently updated in 2018. This current American Association for the Surgery of Trauma kidney organ injury scaling update incorporates the latest evidence in diagnosis and management of renal trauma and is based upon a multidisciplinary consensus. These changes reflect the near universal use of computed tomography for renal trauma evaluation and the widespread adoption of conservative management across all grades of renal trauma.