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Research

The CHOC Children’s Urology Center is dedicated to providing patients and their families the most up-to-date, state-of-the-art, research-based diagnoses and treatments. We are proud to be participating in these ongoing clinical research projects:

  • Multi-Center Study for Constructing a Nomogram for Prediction of Resolution of Vesicoureteral Reflux
  • Randomized Control Trial of using On-Q Pump® for Urological Post-Operative Pain Management
  • Determining the Value of Early Prophylactic Treatment with Clean Intermittent Catheterization and Anti-Cholinergic Medication in the Spina Bifida Population
  • Determining the Value of Home Pressure Monitoring in Patients Performing Regular Catheterization for Neurogenic Bladders
  • Two Multi-Centered Randomized Controlled Trials of New Medications for the Treatment of Neurogenic Bladder

As we continue researching and finding new and innovative treatments for pediatric urology conditions, disorders and diseases, we proudly share our findings to the world. Below are some of our recently published findings:

Development, Reliability and Validation of a Neurogenic Bowel Dysfunction Score in Pediatric Patients with Spina Bifida

Authors: Maryellen S Kelly, Margaret Hannan, Brenda Cassidy, Guy Hidas, Blake Selby, Antoine E Khoury, Gordon McLorie

Objective: To develop a reliable and valid questionnaire to monitor neurogenic bowel symptoms in children.

Subjects: 34 children aged 6-18 with neurogenic bowel and their caregivers. 18 control patients.

Methods: Expert panel generated a domain of observables and formative/reflective content. Response options were scaled following Likert-type items. Key informant interviews revised the measures. Final questionnaire was given to subjects twice to calculate intra-rater reliability using Cohen’s Kappa Coefficient (k) and paired t-test. Blinded interviews were conducted after physical examination and health assessment and questionnaires completed by a nurse to determine construct validity and inter-rater reliability using k and Spearman’s rank-order correlation. Control patients completed the questionnaire once, their results were used to determine discriminate validity and a receiver operating characteristic (ROC) curve.

Results: Intra-rater reliability showed 85% of the questionnaires having k>0.6. Paired t-test results of t(33)=1.997, p=0.054, d=0.53, confirmed there was not a significant difference between the scores of the two completed questionnaires. Inter-rater reliability showed 97% of the questionnaires having k>0.6 between the nurse and the patient/caregiver responses. Scores had a strong positive correlation at rs(32)=0.943, p<0.0005. Mean score with neurogenic bowel was 15.18(STD±5.77) and control group 4.68(STD±2.98). ROC analysis showed an area under the curve of 0.9. A score of 8.5 correlated with presence of neurogenic bowel with sensitivity of 94% and specificity of 87%.

Conclusion: Questionnaire shows positive reliability and validity when used for pediatric neurogenic bowel patients. The questionnaire differentiates between normal and neurogenic patients. Larger studies are necessary to conduct further validation. Copyright © 2014 Journal of Pediatric Surgery. Published by Elsevier Inc. All rights reserved.

Application of continuous incisional infusion of local anesthetic after major pediatric urological surgery: Prospective randomized controlled trial

Authors: Guy Hidas, Maryellen S Kelly, Blake (Selby) Watts, Zeev N Kain, Antoine E. Khoury

Purpose: The aim of the study was to determine efficacy of continuous incisional infusion of local anesthetic, ON-Q® pain relief system (Kimberly-Clark, Georgia), in improving postoperative pain, reducing narcotic requirement, and shortening recovery time after major pediatric urological surgery. Material and methods: Prospective open-labeled randomized controlled trial comparing the ON-Q® pain relief system to standard of care pain management. Pain was assessed by nurses using the Visual Analog Scale or the Face, Legs, Activity, Cry, Consolability Scale depending on the child’s age. Information regarding analgesic consumption and recovery parameters such as temperature, start of oral nutrition, and length of hospitalization were prospectively collected.

Results: Patient’s demographic, clinical, and surgical characteristics were similar in both groups. The ON-Q® group experienced significantly lower scores of maximal daily pain episodes compared to the control on the day of surgery (1.9±1.8vs.4.2±2.2p=0.009)and first postoperative day(2.28±3.2vs.5.47±2.45p=0.004). Mean number of narcotic doses was significantly lower in treatment group compared to control [Total (2.21 vs. 4.6 p=0.02), POD0 (0.7 vs. 1.7 p=0.02) and POD1 (1.3 vs. 2.8 p=0.04)]. Conclusion: The ON-Q® system is a viable option for postoperative pain management in children undergoing urological surgeries. This technology significantly decreases the amount of maximal pain, and the need for systemic narcotic consumption. Copyright © 2014 Journal of Pediatric Surgery. Published by Elsevier Inc. All rights reserved.

Application of continuous incisional infusion of local anesthetic after major pediatric urological surgery.

Guy Hidas, Hak J Lee, Blake (Selby) Watts, Maryellen S Pribish (Kelly), Edwin T Tan, Zeev N Kain, Antoine Khoury.

Objectives: To determine the efficacy of the locally infused anesthetic, ON-Q® pain relief system (Kimberly-Clarke, GA-USA), in improving postoperative pain, reducing narcotic requirement, and shortening recovery time after major pediatric urological surgery.

Material and Methods: A case-control analysis comparing 20 patients undergoing major urological procedures who were treated postoperatively with the ON-Q system was compared to 20 patients treated with current hospital standard of care intravenous and oral analgesics. Pain was assessed in both groups by staff nurses using the different validated scales depending on the child’s age. Information regarding analgesic consumption along with recovery parameters such as temperature, start of oral nutrition, and length of hospitalization (LOH) were collected.

Results: The ON-Q group experienced significantly lower ratings of maximal pain on the first postoperative day as compared to the control group (3 vs. 5.2, p = 0.03) and a trend toward lower mean of maximal pain score on postoperative day two (1.8 vs. 3.5, p = 0.055). Systemic intravenous and oral analgesics were significantly lower on the day of surgery and the first postoperative day for the ON-Q group (p = 0.014; and p = 0.046 respectively). No differences in frequency of fever, start of oral nutrition and LOH were found between the study groups.

Conclusion: Continuous incisional infusion of local anesthetic with the ON-Q system is a viable option for postoperative pain management in children undergoing major urological surgeries. This technology significantly decreases the need for systemic analgesic consumption. Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved

Is the appearance of the dextranomer/hyaluronic acid mound predictive of reflux resolution?

Guy Hidas, Tandis Soltani, Blake (Selby) Watts, Maryellen Pribish (Kelly), Antoine E Khoury.

Purpose: After endoscopic correction of vesicoureteral reflux, we correlated the appearance of the Deflux® mound with the outcome.

Material and Methods: We created an online survey based on 11 primary vesicoureteral reflux cases, including 6 failed and 9 successful procedures in a total of 15 renal units. Cases were selected randomly from our video library. All cases were performed by a single surgeon using the double hydrodistention implantation technique until a satisfactory mound was achieved and corrected. An online survey questionnaire was e-mailed to 234 members of the Society for Pediatric Urology. Each survey question contained a preoperative voiding cystourethrogram image as well as images of the ureteral orifice before and after injection. Respondents were asked to predict whether they thought that the appearance of the Deflux mound would be associated with successful reflux resolution on voiding cystourethrogram 3 months postoperatively. We analyzed the percent of correctly answered questions as well as the sensitivity, specificity and predictive value of the ability of experts to predict the outcome.

Results: A total of 104 pediatric urologists responded to the survey. Overall, 66.4% of respondents predicted reflux resolution based on mound appearance, including 66% and 67% who correctly predicted success and failure, respectively. Mean outcome predictability per respondent was 66% (range 26% to 86%).

Conclusion: The appearance of the Deflux mound and lack of hydrodistention at the completion of the procedure are not reliable predictors of outcome. Based on this experience, postoperative voiding cystourethrogram is still required to truly determine reflux resolution. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

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