دورية أكاديمية
Management of urachal anomalies in pediatric patients: A comparison of treatment strategies between pediatric urology and general surgery.
| العنوان: | Management of urachal anomalies in pediatric patients: A comparison of treatment strategies between pediatric urology and general surgery. |
|---|---|
| المؤلفون: | Gelikman DG; University of Central Florida College of Medicine, Orlando, FL, USA., Ibanez KR; University of Central Florida College of Medicine, Orlando, FL, USA., Ghattas YS; University of Central Florida College of Medicine, Orlando, FL, USA., Craver EC; Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL, USA., Casas-Melley AT; University of Central Florida College of Medicine, Orlando, FL, USA; Department of Surgery, Division of Pediatric Surgery, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL, USA., Ellsworth P; University of Central Florida College of Medicine, Orlando, FL, USA; Department of Surgery, Division of Urology, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL, USA., Seth A; University of Central Florida College of Medicine, Orlando, FL, USA; Department of Surgery, Division of Urology, Nemours Children's Health System/Nemours Children's Hospital, Orlando, FL, USA. Electronic address: abhishek.seth@nemours.org. |
| المصدر: | Journal of pediatric urology [J Pediatr Urol] 2024 Feb; Vol. 20 (1), pp. 75.e1-75.e8. Date of Electronic Publication: 2023 Sep 22. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: England NLM ID: 101233150 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-4898 (Electronic) Linking ISSN: 14775131 NLM ISO Abbreviation: J Pediatr Urol Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Kidlington, Oxford, UK : Elsevier, c2005- |
| مواضيع طبية MeSH: | Urology* , Urachus*/surgery , Urachus*/abnormalities , Urachal Cyst*/diagnosis , Urachal Cyst*/surgery, Child ; Humans ; Male ; Female ; Retrospective Studies ; Conservative Treatment ; Urologists |
| مستخلص: | Introduction: Persistence of embryonic urachal structures due to a failure of the urachus to involute into the median umbilical ligament is known as a urachal anomaly (UA). UAs may remain asymptomatic or lead to abdominal pain and recurrent infections. Management of UAs in pediatric patients has historically lacked a clear consensus between conservative and surgical management. While both urologists and general surgeons manage this pathology, a comparison of management style and outcomes between these specialties has not been published to our knowledge. Objective: To (1) evaluate trends in management of UAs among pediatric urologists and general surgeons across three tertiary care children's hospitals and (2) identify factors that place patients at higher risk for requiring surgery. Study Design: All patients diagnosed with a UA from 2016 to 2020 at our multi-site institution were identified by ICD-10 code Q64.4 "malformation of the urachus" and retrospectively reviewed. Patient demographics, treatment specialty, remnant subtype, and management strategy were recorded. Data was dichotomized between both urology and general surgery as well as between surgical and nonsurgical intervention to identify and compare management strategies. Results: Overall, 143 patients diagnosed with UAs were identified. Of these patients, 74 were treated by urology and 69 were treated by general surgery. Patients who were treated by urology were significantly more likely to receive conservative treatment (66.2% treated conservatively vs. 33.8% treated surgically), while patients treated by general surgery were significantly more likely to undergo surgery (84.1% treated surgically vs. 15.9% treated conservatively, p < .0001). Though, urology was more likely to treat patients who presented incidentally (p < .01), and general surgery was more likely to treat patients who presented with an infected remnant (p < .01). Patients of male sex were more likely overall to receive surgery compared to female patients (p < .01). Discussion: Management of UAs by urologists was more conservative than general surgeons. However, both specialties treat distinctly different patient presentations, with urology managing more incidental remnants and general surgery operating on more emergent, infected urachi. Limitations of the study included its retrospective nature and the insufficient reporting of urachal remnant subtypes and presence of infection among patients. Conclusions: Management strategies of UAs differ among urology and general surgery, but surgical and conservative treatments are necessary to appropriately treat their distinct patient populations. This study provides valuable insight into current practices of UA management and may help to inform future treatment. Competing Interests: Conflict of interest The authors have no conflict of interest to declare. (Copyright © 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Infection; Management; Pediatric; Retrospective review; Urachal anomalies; Urachus |
| تواريخ الأحداث: | Date Created: 20231006 Date Completed: 20240214 Latest Revision: 20240314 |
| رمز التحديث: | 20240314 |
| DOI: | 10.1016/j.jpurol.2023.09.013 |
| PMID: | 37802719 |
| قاعدة البيانات: | MEDLINE |
Full Text via ClinicalKey 
Full Text Finder | تدمد: | 1873-4898 |
|---|---|
| DOI: | 10.1016/j.jpurol.2023.09.013 |