TeleBBD: Telehealth management of bladder bowel dysfunction - A provider survey of benefits and limitations.

INTRODUCTION: Bladder bowel dysfunction (BBD), defined by the International Children's Continence Society (ICCS) as a spectrum of lower urinary tract and bowel symptoms, represents to up to 40% of pediatric urology consults. Management of BBD involves strict behavioral management with frequent follow ups by urology advanced practice providers (APPs). If left untreated, patients may develop secondary comorbidities that impact their renal and/or bladder function, bowel function, and psychosocial well-being. Previous studies have reported feasibility for virtual post-operative visits and prenatal consultations, however, telehealth management of BBD, or TeleBBD, has not yet been studied. The goal of this study is to survey APPs in pediatric urology to understand how TeleBBD compares to in-person visits, and identify benefits and limitations of TeleBBD. STUDY DESIGN: An online survey via Qualtrics was designed based on current practice guidelines for BBD management and telehealth considerations. Survey was distributed in September 2020 via the Pediatric Urology Nurses & Specialists listserv. Group qualitative coding was completed by the authors to generate themes that emerged from the results. RESULTS/DISCUSSION: A total of 53 APPs from across 21 states in the US completed the online survey, with 49 (92%) APPs reporting currently providing TeleBBD. Those who did not provide TeleBBD typically do not manage BBD patients. Summary Table shows the comparison of TeleBBD with in-person visits, with many elements of TeleBBD better or the same as in-person visits. APPs reported that TeleBBD has been most beneficial in increasing access and overall improvement in follow up which is significant for management of this chronic condition. Barriers include access to technology/internet and inability to perform full physical exams via televisit. Limitations of the study include lack of validated survey and small sample size. Overall increased access and improved patient adherence and resolution from BBD is significant for this patient population for prevention of secondary comorbidities. CONCLUSION: This is the first study to survey APPs across the US specifically exploring indication of TeleBBD as well as comparison of TeleBBD with in-person visits. The perception of improved access to care and less no-show rates is significant especially during the pandemic in providing continuity of care and prevent secondary comorbidities. Additionally, TeleBBD was felt to be just as effective as in-person visits for patient adherence to treatment, and other components of care, with the exception of ability to provide physical exams. Providers leveraged the benefits of TeleBBD and shared strategies for best practices.

Scar acceptance after pediatric urologic surgery.

INTRODUCTION: Patients undergo pediatric urologic surgery as infants and young children. OBJECTIVE: The purpose of the study was to evaluate the evolution of surgical scars over several years in order to inform parents and surgeons on the true cosmetic impact of pediatric surgery and evaluate patient scar satisfaction. STUDY DESIGN: This was a cross-sectional study where patients who have undergone urologic surgery at a young age are evaluated years later for scar satisfaction via an abbreviated validated questionnaire. Scar length currently was measured and compared with immediate postoperative scar length to assess for growth. RESULTS: Eighty-two children were evaluated with a median age (interquartile range) at the time of surgery and at the time of the study of 1 year (0.6-3 years) and 7 years (3-11 years), respectively. Pyeloplasty (48.8%), ureteral reimplantation/ureterocele reconstruction (41.5%) and other (9.8%) surgical techniques were included. No bother was reported in 84.0% of families. Surgical approach (robotic/laparoscopic vs. open) did not influence whether families reported very pleased/pleased versus neutral/somewhat bothered attitudes (p = 0.094). At time of surgery median scar length for all open surgical approaches (N = 65) was 4 cm (IQR 4-4.5 cm) and at time of the study scars were 6 cm (IQR 5-8 cm). For laparoscopic incisions, median length at time of surgery was 0.8 cm (IQR 0.8-1.1 cm) and at a mean follow up time of 2.3 years median scar length was 1.1 cm (IQR 1-1.5 cm). By race, Asian experienced the lowest percent change in scar length 0.3%, then Caucasian 0.8%, Latino 1.4% and self-described other ethnicity 2.0%. DISCUSSION: As predicted, scars grow in length over time in either open or minimally surgical approaches. Depending on patient race, scar growth varied. Regardless, survey results did not vary based on surgical approach, type of surgery or race of survey taker Summary figure. CONCLUSIONS: The majority of families are pleased with overall scar appearance after undergoing major pediatric urologic surgery. Scars tend to grow in length overtime with less growth noted in Asian children and flank incisions.

Complete androgen insensitivity syndrome: an anatomic evaluation and sexual function questionnaire pilot study.

PURPOSE: To further characterize the anatomy and sexual function of women with CAIS compared to normal females, and assess the utility of magnetic resonance imaging (MRI) to distinguish anatomical differences. MATERIALS AND METHODS: In a prospective cohort pilot study, five individuals with androgen insensitivity syndrome and six, normal, nulliparous women underwent an interview, physical examination, questionnaire completion and MRI of the pelvis. Statistical analysis was performed with emphasis on determining significant differences in anatomical findings and sexual satisfaction. RESULTS: MRI demonstrated statistically significant differences in vaginal depth and size that were not confirmed on physical exam. MRI and physical exam demonstrated a non-significant difference in average phallic thickness between the two groups, although the CAIS group clitoral width tended to be smaller. Physical exam demonstrated a higher average erect height and longer arm span in the CAIS patients but this was not statistically significant. No significant differences were noted in categories designed to assess satisfaction with ability to achieve orgasm, vaginal appearance and frequency of sexual intercourse between the two groups. CONCLUSIONS: The women with CAIS were as satisfied with sexual function as were the women within the control group. Physical exam and MRI did not find any statistically significant clinically relevant differences between the two groups.