INTRODUCTION:Artificial intelligence (AI) is increasingly being applied across pediatric urology. We provide a living scoping review and online repository developed by the AI in PEDiatric UROlogy (AI-PEDURO) collaborative that summarizes the current and emerging evidence on the AI models developed in pediatric urology. MATERIAL AND METHODS:The protocol was published a priori, and Preferred Reporting Items for Systematic Review and Meta-analysis Scoping Review (PRISMA-ScR) guidelines were followed. We conducted a comprehensive search of four electronic databases and reviewed relevant data sources from inception until June 2024 to identify studies that have implemented AI for prediction, classification, or risk stratification for pediatric urology conditions. Model quality was assessed by the APPRAISE-AI tool. RESULTS:Overall, 59 studies were included in this review from 1557 unique records. Of the 59 published studies, 44 studies (75 %) were published after 2019, with hydronephrosis and vesicoureteral reflux/urinary tract infection as the most common topics (17 studies, 28 % each). Studies originated from USA (22 studies, 37 %), Canada (10 studies, 17 %), China (8 studies, 14 %), and Turkey (7 studies, 12 %). Neural network (35 studies, 59 %), support-vector-machine (21 studies, 36 %), and tree-based models (19 studies, 32 %) were the most used machine learning algorithms, with 14 studies (24 %) providing useable repositories or applications. APPRAISE-AI assessed 12 studies (20 %) of studies as low quality, 39 studies (66 %) as moderate quality, and 8 studies (14 %) as high quality, with specific improvements noted in model robustness and reporting standards over time (p = 0.03). Findings were synthesized into an online repository (www.aipeduro.com). DISCUSSION:There is an increasing pace of AI model development in pediatric urology. Model topics are broad, algorithm choice is diverse, and the overall quality of models are improving over time. While there is still a lack of clinical translation of the AI models in pediatric urology, the usage of online repositories and reporting frameworks can facilitate sharing, improvement, and clinical implementation of future models. CONCLUSIONS:This living scoping review and online repository will highlight the current landscape of AI models in pediatric urology and facilitate their clinical translation and inform future research initiatives. From this work, we provide a summary of recommendations based on the current literature for future studies.

BACKGROUND:Timely imaging is recommended after febrile UTI (fUTI) in young children to identify treatable urologic conditions. The 2011 American Academy of Pediatrics (AAP) guideline recommends renal bladder ultrasound (RBUS) after fUTI and voiding cystourethrogram (VCUG) after abnormal RBUS or second fUTI. OBJECTIVE:We sought to investigate practice pattern variability and associated factors in pediatric fUTI imaging in primary care clinics. STUDY DESIGN:All children <24 months old with fUTI (temperature ≥38C, positive urinalysis, and >50,000 CFU on urine culture) in a large primary care network in a US Northeast state in 2019 were reviewed. Those with congenital genitourinary anomalies were excluded. We fitted a multivariable logistic regression model with a primary outcome of adherence to the AAP guideline. RESULTS:In total we included118 patients with fUTI. Overall, post-UTI imaging was adherent to the AAP guideline in 82 cases (69.5 %, See Figure). Reasons for non-adherence were: no RBUS (N = 21), VCUG despite normal RBUS (N = 9), no VCUG after abnormal RBUS (N = 4), and no VCUG after a second fUTI (N = 2). In the multivariable logistic regression model, significant predictors of guideline adherence were commercial insurance (OR = 2.82, p = 0.047), more providers in the practice (OR = 1.38, p = 0.05), and younger provider age (OR = 0.96, p = 0.043) after adjusting for patient's age, sex, maximal temperature during fUTI. DISCUSSION:Young children with fUTI received guideline-adherent imaging from their primary care clinician approximately 70 % of the time in this sample, though significant opportunities for improvement exist. Guideline adherence was more likely for commercially-insured patients, providers working in larger offices, and younger providers, suggesting both patient and provider characteristics impact the practice pattern. CONCLUSION:We observed a wide variation of imaging ordering practice for fUTI in primary care clinic network. Further research may seek to examine reasons for non-adherence, thereby guiding efforts to improve it.

Purpose There is no robust evidence for the efficacy of intraoperative antibiotics in preventing infections in testicular torsion surgery, the incidence of which is reported to be <0.2 %. In the absence of clear guidelines regarding the appropriate use of antibiotic prophylaxis, the factors influencing these differences in practice patterns remain unclear. Our study aimed to identify both patient and institution-level factors affecting whether a pediatric patient undergoing emergency testicular detorsion (orchiopexy or orchiectomy) will receive antibiotic prophylaxis. Materials and methods We utilized the Pediatric Health Information System (PHIS) database to identify patients<18 years old who underwent testicular septopexy or orchiectomy with the diagnosis of torsion of the testis between 2015 and 2021. Patient visits for repeated presentations of torsion were excluded from the analysis. We used multivariate logistic regression to evaluate if pre-procedural antibiotic prophylaxis was associated with hospital-level factors (treating hospital) or patient-level factors (case complexity, concurrent orchiectomy, age category, race/ ethnicity, income quintile, insurance). Results We included 5313 children who underwent surgeries for testicular torsion. Median age was 13 (IQR 10-15 years). 74.0 % patients received antibiotic prophylaxis. Compared to no antibiotic prophylaxis, those who received antibiotic prophylaxis were significantly older (p < 0.001). After adjusting for race/ethnicity, orchiectomy vs septopexy, income quintiles, insurance, and comorbidities, older age (12-18 years compared to the 0-12 age group, OR Z 1.6 (95 % CI 1.4-1.9, p < 0.001) and hospital (p < 0.001) remained significantly associated with choice of antibiotic prophylaxis for testicular torsion surgeries. Discussion There is wide variation in antibiotic prophylaxis use for patients undergoing testicular detorsion at freestanding children's hospitals in the United States. Older patients (age 12-18) are more likely to receive antibiotic prophylaxis prior to testicular torsion surgery. On the other hand, no obvious benefit in reducing subsequent hospital readmission rate was found associated with antibiotic prophylaxis. This study was limited by an inherent reliance on accurate documentation of antimicrobial-associated allergic reaction(s) and readmission rates in this PHIS database. Conclusions Given the risks associated with excessive antibiotic use, an understanding of the factors and proper standardization is warranted. Significant variation in antibiotic prophylaxis demonstrates the need for clearer guidelines and evidence-based practice. Future work may illustrate the potential impact on standardized protocols on reducing unwarranted antibiotic use.

Introduction Intra-detrusor botulinum toxin (Botox) injection is a minimally invasive alternative to augmentation cystoplasty in patients with refractory neurogenic bladder. Botox was first used for neurogenic bladder children two decades ago. However, there are no existing guidelines on indications or use among patients with spina bifida. Furthermore, there are little data regarding its use relative to bladder augmentation and patient volume on a national scale. Objective We sought to investigate the contemporary trends of intra-detrusor Botox injection and augment cystoplasty in free-standing children's hospitals. Study design We queried the Pediatric Health Information System database to identify spina bifida patients from 2016 to 2019 who underwent intra-detrusor Botox injection and augment cystoplasty based on CPT and ICD10 codes. Total spina bifida population under care in the free-standing children's hospitals was estimated by all inpatient and ambulatory surgery encounters as denominators to calculate frequency by time for both intra-detrusor Botox injections and augmentation cystoplasty. Results In total, we included 1924 intra-detrusor Botox injections and 842 augmentation cystoplasties. 1413 (51.1%) patients were female. Median age at surgery was 10.0 (interquartile range 6.98-13.5) years. There was a significant increase in intra-detrusor Botox injection frequency (p < 0.001). While there was an overall decreasing, but not significant, trend for augmentation cystoplasty, there was a significant increase in this procedure during the summer months compared to the rest of the year (p < 0.001, Figure 1). Sensitivity analysis using only first intradetrusor Botox injection per patient demonstrated similarly significant increasing trend. Discussion Use of intra-detrusor Botox injection for the management of neurogenic bladder has significantly increased among patients with spina bifida while augmentation cystoplasty has slightly decreased, but not significantly. Conclusions Over time, practice patterns for the treatments of neurogenic bladder among spina bifida children have favored minimally invasive Botox injections while augmentation cystoplasty use has not significantly changed.

ABSTRACT Objective The urinary tract dilation (UTD) classification system provides objective assessment relevant to hydronephrosis management for children. However, the lack of uniform language regarding UTD in radiology reports leads to significant difficulty in both clinical management and research. We seek to develop a unified multi-task/multi-class model that can effectively extract UTD components and classifications from early postnatal ultrasound (US) reports. Methods Radiology records from our institution were reviewed to identify infants aged 0-90 days undergoing early ultrasound for antenatal UTD. The report and images were reviewed by the study team to create the ground truth of UTD classification and components (primary outcome). Bio_ClinicalBERT, a variant of the Bidirectional Encoder Representations from Transformers (BERT) model, was used as the embedding layers of the classification model. The model was fine-tuned with 11 linear classification layers. All but the last BERT layer were frozen during the fine-tuning process. The model performance was evaluated with five-fold cross-validation with an 80:20 train-test ratio. Results 2460 early (0-90 days) US reports were included. The five-fold cross-validated model performance is satisfactory (Weighted F1 > 0.9 for all UTD components). We report the weighted F1 scores, accuracies, and standard deviations for all 11 tasks and their average performance. Conclusions By applying deep state-of-the-art NLP neural networks, we developed a high-performing, efficient, and scalable solution to extract UTD components from unstructured ultrasound reports using one single multi-task model. This can potentially help standardize and facilitate large-scale computer vision research for pediatric hydronephrosis. Key Words: machine learning, efficiency, ambulatory care, forecasting

The urinary tract dilation (UTD) classification system provides objective assessment relevant to hydronephrosis management for children. However, the lack of uniform language regarding UTD in radiology reports leads to significant difficulty in both clinical management and research. Human error is also prevalent due to these inconsistencies and the heavy workload involved in reviewing and interpreting the reports. We seek to develop a unified model that can effectively extract UTD components and classifications from early postnatal ultrasound reports via multi-task and multi-class learning, with the potential to reduce human errors and improve the consistency and accuracy of UTD assessments. Radiology records from our institution were reviewed to identify infants aged 0-90 days who underwent early ultrasound for antenatal UTD. The reports and images were reviewed by the study team to establish the ground truth for UTD classification and components (primary outcome). Our multi-task multi-class model utilizes embedding layers from ClinicalBERT, a variant of the Bidirectional Encoder Representations from Transformers (BERT) model, along with 11 linear classification layers with SoftMax functions. The model's performance was evaluated using five-fold cross-validation with an 80:20 train-test split for each round. After each round, predictions that were inconsistent with the initial labeling were reviewed and corrected by human reviewers, and the model was retrained accordingly. Additionally, we compared the model's performance to GPT-3.5-Turbo in both 3-shot and 0-shot settings. A total of 2,460 early (0-90 days) ultrasound reports were included. The five-fold cross-validated model demonstrated satisfactory performance, with a weighted F1 score greater than 0.9 for all UTD components. The model effectively identified human labeling errors, and its performance improved after correcting uncertain cases. It outperformed GPT-3.5-Turbo in all task predictions by 20%-30% in terms of accuracy. By applying deep state-of-the-art NLP neural networks, we developed a high-performing, efficient, and scalable solution to extract UTD components from unstructured ultrasound reports using one single multi-task model. This can potentially help standardize and facilitate large-scale computer vision research for pediatric hydronephrosis. N/A

Background and objective A urodynamic study (UDS) is a routine clinic procedure that can cause significant discomfort for certain patients, with no satisfactory analgesic alternatives currently available. Our aim was to evaluate the effectiveness of low-dose self-adjusted nitrous oxide (SANO), titrated to the patient’s desired effect, on standard metrics for bladder function and on patient-reported pain and anxiety. Methods We conducted a single-institution, double-blind, randomized crossover trial in adults undergoing UDS. Each patient underwent two consecutive UDS runs, randomized to receive oxygen during the first run followed by SANO during the second run, or vice versa. UDS outcomes (capacity, detrusor strength, residual volume) and patient subjective outcomes (Visual Analog Scale for pain and anxiety, operator assessment of verbal feedback) were compared between the two runs. Secondary analyses were performed to compare outcomes during the first UDS run and adjust for treatment order. A paired Wilcoxon signed rank-sum test and McNemar’s χ2 test were used to compare continuous and categorical variables, respectively. Adverse events were recorded. Key findings and limitations Nineteen patients were randomized (10 to oxygen for the first run, 9 to SANO for the first run). UDS outcomes did not differ between the two arms. Patients reported significantly less pain during the SANO run than during the oxygen run (p = 0.046). Verbal feedback was significantly better with SANO (p = 0.001). Most patients (15/19, 79%) stated that they would prefer to receive SANO during future UDS. There were no significant complications. Conclusions and clinical implications SANO oxide is a safe and effective means of preserving standard adult UDS metrics while significantly reducing patient-reported pain. Patient summary Urodynamic tests (UDS) for evaluation of lower urinary tract symptoms can cause discomfort and pain. Our study shows that nitrous oxide gas self-adjusted by patients had no effect on UDS test outcomes or on verbal feedback during the procedure, and reduced discomfort and pain in comparison to oxygen. Nitrous oxide may an attractive option for patients who are reluctant to undergo UDS.

Backgrounds Urinary Tract Dilation (UTD) classification has been designed to be a more objective grading system to evaluate antenatal and post-natal UTD. Due to unclear association between UTD classifications to specific anomalies such as vesico-ureteral reflux (VUR), management recommendations tend to be subjective. Objective We sought to develop a model to reliably predict VUR from early post-natal ultrasound. Study design Radiology records from single institution were reviewed to identify infants aged 0-90 days undergoing early ultrasound for antenatal UTD. Medical records were reviewed to confirm diagnosis of VUR. Primary outcome defined as dilating (>Gr3) VUR. Exclusion criteria include major congenital urologic anomalies (bilateral renal agenesis, horseshoe kidney, cross fused ectopia, exstrophy) as well as patients without VCUG. Data were split into training/ testing sets by 4:1 ratio. Machine learning (ML) algorithm hyperparameters were tuned by the validation set. Results In total, 280 patients (540 renal units) were included in the study (73 % male). Median (IQR) age at ultrasound was 27 (18-38) days. 66 renal units were found to have >= grade 3 VUR. The final model included gender, ureteral dilation, parenchymal appearance, parenchymal thickness, central calyceal dilation. The model predicted VUR with AUC at 0.81(0.73-0.88) on out-of-sample testing data. Model is shown in the figure. Discussion We developed a ML model that can predict dilating VUR among patients with hydronephrosis in early ultrasound. The study is limited by the retrospective and single institutional nature of data source. This is one of the first studies demonstrating high performance for future diagnosis prediction in early hydronephrosis cohort. Conclusions By predicting dilating VUR, our predictive model using machine learning algorithm provides promising performance to facilitate individualized management of children with prenatal hydronephrosis, and identify those most likely to benefit from VCUG. This would allow more selective use of this test, increasing the yield while also minimizing overutilization.

PURPOSE:Genitourinary rhabdomyosarcoma (GU-RMS) often requires multimodal therapy treatment including radiation, chemotherapy, and radical surgery for disease control. The long-term effects of the disease and associated treatments are unclear. We sought to investigate the long-term genitourinary quality of life for adult survivors of pediatric GU-RMS. MATERIALS AND METHODS:In total, 14 participants (43% female, median age = 32.5 years [IQR = 23.25-39.25], range = 20-52 years, 2 bladder, 1 cervical, 5 paratesticular, 3 vaginal, 2 pelvic, and 1 prostate RMS) agreed to interview about impact of GU-RMS treatment during childhood on quality of life. A semistructured interview guide based on the long-term service and support quality-of-life model and grounded in known GU-RMS experiences was created. Two coders independently coded using thematic analysis methodology. RESULTS:Six themes emerged: (1) unknown fertility status; (2) lack of education; (3) relationships and difficult communication; (4) incontinence, clean intermittent catheterization, and a bag; (5) lifestyle and learned adaptation; and (6) threats to body image. Across these themes, participants reported insufficient knowledge regarding GU-RMS treatment and its impact on function. Participants were principally concerned with anatomical changes, fertility, pregnancy expectations, and survivorship challenges such as communication with romantic partners. CONCLUSIONS:Survivors of GU-RMS have significant urinary and sexual function concerns that are important to address in long-term survivorship. Clinicians can potentially improve survivors' quality of life through open and honest age-appropriate education on expectations for treatment, fertility preservation options, and long-term effects of treatment.

Background Artificial intelligence (AI) and machine learning (ML) methods are increasingly being applied in pediatric urology across a growing number of settings, with more extensive databases and wider interest for use in clinical practice. More than 30 ML models have been published in the pediatric urology literature, but many lack items required by contemporary reporting frameworks to be high quality. For example, most studies lack multi-institution validation, validation over time, and validation within the clinical environment, resulting in a large discrepancy between the number of models developed versus the number of models deployed in a clinical setting, a phenomenon known as the AI chasm. Furthermore, pediatric urology is a unique subspecialty of urology with low frequency conditions and complex phenotypes where clinical management can rely on a lower quality of evidence. Objective To establish the AI in PEDiatric UROlogy (AI-PEDURO) collaborative, which will carry out a living scoping review and create an online repository (www.aipeduro.com) for models in the field and facilitate an evidence synthesis of AI models in pediatric urology. Methods and analysis The scoping review will follow PRISMA-ScR guidelines. We will include ML models identified through standardized search methods of four databases, hand-search papers, and user-submitted models. Retrieved records will be included if they involve ML algorithms for prediction, classification, or risk stratification for pediatric urology conditions. The results will be tabulated and assessed for trends within the literature. Based on data availability, models will be divided into clinical disease sections (e.g. hydronephrosis, hypospadias, vesicoureteral reflux). A risk assessment will be performed using the APPRAISE-AI tool. The retrieved model cards (brief summary model characteristics in table form) will be uploaded to the online repository for open access to clinicians, patients, and data scientists, and will be linked to the Digital Object Identifier (DOI) for each article. Discussion and conclusion We hope this living scoping review and online repository will offer a valuable reference for pediatric urologists to assess disease-specific ML models' scope, validity, and credibility to encourage opportunities for collaboration, external validation, clinical testing, and responsible deployment. In addition, the repository may aid in identifying areas in need of further research.

Application of artificial intelligence (AI) is one of the hottest topics in medicine. Unlike traditional methods that rely heavily on statistical assumptions, machine learning algorithms can identify highly complex patterns from data, allowing robust predictions. There is an abundance of evidence of exponentially increasing pediatric urologic publications using AI methodology in recent years. While these studies show great promise for better understanding of disease and patient care, we should be realistic about the challenges arising from the nature of pediatric urologic conditions and practice, in order to continue to produce high-impact research.

Purpose: Identifying factors associated with emergency visits that could be delivered at lower cost sites may help guide population health strategies for pediatric patients with spina bifida. Materials and Methods: Emergency department encounters (2016-2023) by patients with spina bifida (younger than 18 years) in the Pediatric Health Information System were identified. Absence of clinical and imaging charges was defined as low-value emergency visit. We used a control population of patients (younger than 18 years) with obstructive/reflux uropathy who presented for emergency department encounters (2016-2023). Mixed-effects (with repeated individual measurements as random effect) logistic regression was fitted to model odds of low-value emergency visit. Results: In total, we included 22,672 emergency visits by patients with spina bifida. Of these, 20.7% of emergency visits were low value vs 17.7% in controls (P < .001). Costs related to low-value emergency visits account for 3.8% of all costs for emergency visit-related encounters in patients with spina bifida. Low-value emergency visits were associated with younger age (odds ratio [OR], 1.05 [1.04-1.06] per year younger), Hispanic/Latino ethnicity (OR, 1.21 [1.06-1.39] compared with non-Hispanics), Black race (OR, 1.35 [1.16-1.58] compared with White), public insurance (OR, 1.14 [1.01-1.29] compared with private insurance), and genitourinary encounter diagnosis (OR, 1.16 [1.04-1.30]). Using a standard patient, we found that the odds of low-value emergency visit across hospitals ranged from 0.31 to 5.36. Conclusions: Younger age, Hispanic/Latino ethnicity, Black and other race, public insurance, and genitourinary encounter diagnosis were associated with higher odds of low-value emergency visits in pediatric patients with spina bifida. There was wide variation across hospitals, which warrants further investigation to elucidate best practices.

BACKGROUNDS:New methods such as machine learning could provide accurate predictions with little statistical assumptions. We seek to develop prediction model of pediatric surgical complications based on pediatric National Surgical Quality Improvement Program(NSQIP). METHODS:All 2012-2018 pediatric-NSQIP procedures were reviewed. Primary outcome was defined as 30-day post-operative morbidity/mortality. Morbidity was further classified as any, major and minor. Models were developed using 2012-2017 data. 2018 data was used as independent performance evaluation. RESULTS:431,148 patients were included in the 2012-2017 training and 108,604 were included in the 2018 testing set. Our prediction models had high performance in mortality prediction at 0.94 AUC in testing set. Our models outperformed ACS-NSQIP Calculator in all categories for morbidity (0.90 AUC for major, 0.86 AUC for any, 0.69 AUC in minor complications). CONCLUSIONS:We developed a high-performing pediatric surgical risk prediction model. This powerful tool could potentially be used to improve the surgical care quality.

Objectives: To assess the viability of a hybrid clinic model combining in-person examination with video-based consultation to minimize viral transmission risk. Methods: Data were collected prospectively in a pediatric urology clinic for in-person visits from January to April 2018 ("classic") and hybrid visits from October to December 2020 of the COVID-19 pandemic ("hybrid"). Variables included provider, diagnosis, patient type, time of day, prior surgery, postoperative status, and decision-making for surgery. The primary outcome was "room time" or time in-person. The secondary outcome was "total time" or visit duration. Proportion of visits involving close contact (room time ≥15 min) was assessed. Univariate analyses were performed using the Wilcoxon rank-sum test and Fisher's exact test. Mixed models were fitted for visit approach and other covariates as fixed effects and provider as random effect. Results: Data were collected for 346 visits (256 classic, 90 hybrid). Hybrid visits were associated with less room time (median 3 min vs. 10 min, p < 0.001) but greater total time (median 13.5 min vs. 10 min, p = 0.001) as compared with classic visits. On multivariate analysis, hybrid visits were associated with 3 min less room time (95% confidence intervals [CIs]: -5.3 to -1.7, p < 0.001) but 3.8 min more total time (95% CI: 1.5-6.1, p = 0.001). Close contact occurred in 6.7% of hybrid visits, as compared with 34.8% of classic visits (p < 0.001). Conclusions: Hybrid clinic visits reduce room time as compared with classic visits. This approach overcomes the examination limitations of telemedicine while minimizing viral transmission, and represents a viable model for ambulatory care whenever close contact carries infection risk.

You have accessJournal of UrologyCME1 Apr 2023MP70-07 HIGH-PERFORMING SCALABLE EXTRACTION OF ELEMENTS OF URINARY TRACT DILATION CLASSIFICATION USING NATURAL LANGUAGE PROCESSING ALGORITHMS FOR NEONATAL ULTRASOUND REPORTS Hsin-Hsiao Wang, Andrew Zhang, Caleb Nelson, Anudeep Mukkamala, Michael Li, and Carlos Estrada Hsin-Hsiao WangHsin-Hsiao Wang More articles by this author , Andrew ZhangAndrew Zhang More articles by this author , Caleb NelsonCaleb Nelson More articles by this author , Anudeep MukkamalaAnudeep Mukkamala More articles by this author , Michael LiMichael Li More articles by this author , and Carlos EstradaCarlos Estrada More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The urinary tract dilation (UTD) classification system provides objective assessment for hydronephrosis in young children. However, the lack of specificity regarding UTD categorization in radiology reports causes difficulty in both clinical management and research. We seek to extract UTD elements and classification from early postnatal ultrasound (US) reports using the cutting-edge natural language processing (NLP) machine learning algorithms. METHODS: Radiology records from our institution were reviewed to identify infants age 0-90 days undergoing early ultrasound for antenatal UTD. The report and images were reviewed by the study team physicians to create the ground truth of UTD classification and components (primary outcome). Data were split into training/testing sets by 85:15 ratio. Bidirectional Encoder Representations from Transformers (BERT) language representation models were used as the basis of classification model. The model was fine-tuned with a head consisting of a drop layer, a fully connected layer and a binary classification layer. The model performance was evaluated with out-of-sample testing set. RESULTS: 2500 early (0-90 days) US reports were included. The model performance for the out-of-sample testing dataset is very high (AUC>0.9 for all). Accuracy, F1 score and AUC for UTD features in out-of-sample testing dataset are listed in Table 1. CONCLUSIONS: By applying deep state-of-the-art NLP neural networks, we developed a high-performing and scalable solution to extract UTD components from unstructured ultrasound reports. This can potentially help reduce miscommunications and facilitate large-scale computer vision research for children with hydronephrosis. Source of Funding: Internal © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1005 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hsin-Hsiao Wang More articles by this author Andrew Zhang More articles by this author Caleb Nelson More articles by this author Anudeep Mukkamala More articles by this author Michael Li More articles by this author Carlos Estrada More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyCME1 Apr 2023PD37-11 LONG-TERM URINARY AND SEXUAL OUTCOMES IN PEDIATRIC GENITOURINARY RHAMDOMYOSARCOMA SURVIVORS: A QUALITATIVE STUDY Christopher Jaeger, Andrea Balthazar, Rachel Saunders, Monah Javidan-Nejad, Candace Chung, Judith Vessey, Richard Lee, and Hsin-Hsiao Wang Christopher JaegerChristopher Jaeger More articles by this author , Andrea BalthazarAndrea Balthazar More articles by this author , Rachel SaundersRachel Saunders More articles by this author , Monah Javidan-NejadMonah Javidan-Nejad More articles by this author , Candace ChungCandace Chung More articles by this author , Judith VesseyJudith Vessey More articles by this author , Richard LeeRichard Lee More articles by this author , and Hsin-Hsiao WangHsin-Hsiao Wang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003335.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Genitourinary Rhabdomyosarcoma (GU-RMS) often requires multimodal therapy including radiation, chemotherapy, and radical surgery to maximize disease control. The long-term effects of the disease and associated treatments are unclear. We sought to investigate the long-term genitourinary quality of life (QoL) for adult survivors of pediatric GU-RMS, including urinary function, fertility, sexual function, and associated QoL. METHODS: In total, 14 (43% female, median age=32.5 years [IQR=23.25–39.25], 2 bladder, 1 cervical, 5 paratesticular, 3 vaginal, 2 pelvic, 1 prostate RMS) agreed to interview about impact of childhood GU-RMS treatment on current QoL. A semi-structured interview guide based on a Long-Term Service and Support QoL conception model (LTSS HRQOL), and grounded in GU-RMS experiences was created. Categories included urinary function, sexual function, general health, mental health, and social dynamics. Two coders independently coded using thematic analysis. RESULTS: Three themes specific to genitourinary functions emerged: fertility preservation, sexual health communication with partners, and education of GU-RMS impact during and after treatment. Participants discussed an interest in better understanding fertility preservation options, and post-treatment effects on their anatomy. They noted that knowledge of their ability to conceive impacted their desire to have children. Participants also had challenges related to if, when or how to communicate details of their sexual health with a partner. Across these themes, participants reported insufficient knowledge regarding GU-RMS treatment and its impact on current and future functions. Specific areas of concern were anatomical changes, fertility and pregnancy expectations, and survivorship. CONCLUSIONS: For survivors of GU-RMS, significant urinary and sexual function concerns would be important to address with long-term survivorship. Clinicians can potentially improve survivors’ QoL by educating on expectations for treatment, fertility preservation options, and long-term effects of treatment, at relevant stages in a patient’s life. Source of Funding: Internal © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e992 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Jaeger More articles by this author Andrea Balthazar More articles by this author Rachel Saunders More articles by this author Monah Javidan-Nejad More articles by this author Candace Chung More articles by this author Judith Vessey More articles by this author Richard Lee More articles by this author Hsin-Hsiao Wang More articles by this author Expand All Advertisement PDF downloadLoading ...

Neurogenic bladder (NB) affects people of all ages. Electric impedance myography (EIM) assesses localized muscle abnormalities. Here, we sought to investigate whether unique detrusor EIM signatures are present in NB due to spinal cord injury (SCI). Twenty-eight, 8–10 weeks old, C57BL/6J female mice were studied. Twenty underwent spinal cord transection; 8 served as controls. Cohorts were euthanized at 4 and 6 weeks after spinal cord transection. Each bladder was measured in-situ with EIM with applied frequencies of 1 kHz to 10 MHz, and then processed for molecular and histologic study. SCI mice had greater bladder-to-body weight ratio ( p < 0.0001), greater collagen deposition ( p = 0.009), and greater smooth-muscle-myosin-heavy-chain isoform A/B ratio ( p < 0.0001). Compared with the control group, the SCI group was associated with lower phase, reactance, and resistance values ( p < 0.01). Significant correlations ( p < 0.001) between bladder-to-body weight ratios and EIM measurements were observed across the entire frequency spectrum. A severely hypertrophied phenotype was characterized by even greater bladder-to-body weight ratios and more depressed EIM values. Our study demonstrated distinct EIM alterations in the detrusor muscle of mice with NB due to SCI. With further refinement, EIM may offer a potential point-of-care tool for the assessment of NB and its response to treatment.

AIM:To explore the association between presence and severity of lower limb spasticity (LLS) and risk of orchidopexy for cryptorchidism among people with cerebral palsy (CP) and to further define the cremasteric muscle spasticity theory. METHOD:We queried the Pediatric Health Information System database for male patients with CP, stratified patients into those with/without LLS, and compared groups for orchidopexy occurrence. Comparative statistics were performed using χ2 and Mann-Whitney U tests for categorical and continuous variables respectively. The association between orchidopexy and spasticity type was investigated using logistic regression. RESULTS:In total, 44 561 males with CP were identified. Of these, 1.6% underwent orchidopexy (median age: 7 years 8 months [interquartile range: 4 years 6 months-11 years 4 months]). LLS presence was significantly associated with higher orchidopexy rate compared to spasticity absence (odds ratio [OR] = 1.33 [1.10-1.59], p = 0.003). Among 7134 patients with LLS, intervention was significantly associated with higher orchidopexy rate (injection procedures: OR = 2.47 [2.27-6.39], p = 0.034; surgical procedure: OR = 2.60 [1.22-6.76], p = 0.026). LLS groin proximity was significantly associated with higher orchidopexy rate (OR = 2.52 [1.42-4.96], p = 0.003). INTERPRETATION:A strong association exists between LLS presence and severity and orchidopexy risk among people with CP. These findings support a cremasteric spasticity hypothesis as an important factor of cryptorchidism in CP. Providers should continue to examine for cryptorchidism in males with CP as they age. WHAT THIS PAPER ADDS:Lower limb spasticity (LLS) is associated with higher orchidopexy rate in cerebral palsy. Orchidopexy rate was higher in more severe LLS. Orchidopexy rate was higher in more proximal LLS.

parameters (capacity, compliance, abdominal leak point pressure), and surgical factors (injection technique/volume) did not affect success. Multivariate analysis revealed that prior bladder neck sling (OR 0.3, 95% CI 0.1-0.9) was associated with failure, with a success rate of only 30.5%. Non-ambulatory status trended towards treatment success (OR 2.6, 95% CI 0.98-7.1). CONCLUSIONS: EI in patients with bladder outlet incompe- tence demonstrates increased success rates in non-ambulatory patients. Previous bladder neck sling is associated with higher treatment failure. Other factors (surgical technique, injection volume) did not affect treatment success. Despite a relatively low success rate (50%), EI represents a reasonable low morbidity alternative to other surgical therapy for management of pediatric UI. Prospective studies are necessary to resolve disparate outcomes reported in the literature. versus the current technique (from April 2018 to June 2020). Statistics were performed using Fisher's exact test, with p-values < 0.05 considered signi fi cant. RESULTS: The historical cohort is comprised of 74 patients (97 stomas) while 18 patients (22 stomas) underwent the current stomal creation technique. There were no signi fi cant differences in demographics between the 2 cohorts. The historical cohort included 69 ACE procedures (62 appendix, 5 small bowel, and 2 colon) and 28 Mitrofanoff procedures (3 appendix, 19 small bowel, and 6 colon). Among the current technique patients, there were 17 ACE procedures (15 appendix, 1 small bowel, and 1 colon) and 5 Mitrofanoff procedures (1 appendix, 3 small bowel, and 1 colon). Stenosis occurred in 19 of 97 stomas (19.6%) after undergoing either an ACE or Mitrofanoff proced- ure using the historical techniques (13 occurring in ACE cases and 6 occurring in Mitrofanoff cases). There were no cases of stomal stenosis in the current technique group (p [ 0.022). CONCLUSIONS: Our novel suturing technique for stomal cre- ation signi fi cantly reduced the incidence of stomal stenosis. The current, modi fi ed technique is straightforward and fl exible as it can be applied to any stoma placed in any position. None of the patients in the current technique cohort have manifest any of the early fi ndings we saw in the historical stomas that ultimately stenosed. However, further follow-up will be necessary to assess the long-term reliability of this approach.

Purpose: The initial imaging approach to children with urinary tract infection (UTI) is controversial. Along with renal/bladder ultrasound, some advocate voiding cystourethrogram (VCUG), ie a bottom-up approach, while others advocate dimercaptosuccinic acid (DMSA) scan, ie a top-down approach. Comparison of these approaches is challenging. In the RIVUR/CUTIE trials, however, all subjects underwent both VCUG and DMSA scan. Our objective was to perform a comparative effectiveness analysis of the bottom-up vs top-down approach. Materials and Methods: We simulated 1,000 hypothetical sets of 500 children using RIVUR/CUTIE data. In the top-down approach, patients underwent initial DMSA scan, and only those with renal scarring underwent VCUG. In the bottom-up approach, the initial study was VCUG. We assumed all children with vesicoureteral reflux (VUR) received continuous antibiotic prophylaxis (CAP). Outcomes included recurrent UTI, number of VCUGs and CAP exposure. We assumed a 25% VUR prevalence in children with initial UTI with sensitivity analysis using 40% VUR prevalence. Results: Median age of the original RIVUR/CUTIE cohort was 12 months. First DMSA scan was performed at a median of 8.2 weeks (IQR 5-11.8) after the index UTI. In the simulated cohort, slightly higher yet statistically significantly recurrent UTI was associated with the top-down compared with the bottom-up approach (24.4% vs 18.0%, p=0.045). On the other hand, the bottom-up approach resulted in more VCUG (100% vs 2.4%, p<0.001). Top-down resulted in fewer CAP-exposed patients (25% vs 0.4%, p<0.001) and lower overall CAP exposure (5 vs 162 days/person, p<0.001). Sensitivity analysis was performed with 40% VUR prevalence with similar results. Conclusions: The top-down approach was associated with slightly higher recurrent UTI. Compared to the bottom-up approach, it significantly reduced the need for VCUG and CAP.