Pediatric Sedation Unit: A Safe, Effective, and Satisfactory Alternative to Outpatient Pediatric Urological Procedures Under Anesthesia.

INTRODUCTION: The operating room is an increasingly expensive and limited resource. The aim of this study was to evaluate the efficacy, safety, cost, and parental satisfaction of transitioning minor pediatric urology procedures from an operating room setting to a pediatric sedation unit. METHODS: Minor urological procedures were transitioned from the operating room to the pediatric sedation unit if they could be completed in 20 minutes using minimal instrumentation. Information regarding patient demographics, procedure characteristics, rates of success and complications, and cost were collected from urology procedures performed in the pediatric sedation unit between August 2019 and September 2021. Patient demographics and cost data from the most common urology procedures performed in the pediatric sedation unit were compared to data from historical controls of cases occurring in the operating room. Parent surveys were performed following the completion of procedures in the pediatric sedation unit. RESULTS: A total of 103 patients, ranging from 6-207 months old (mean 72 months), underwent procedures in the pediatric sedation unit. The most common procedures were lysis of adhesions and meatotomy. All procedures were successfully completed with procedural sedation, and no procedure was complicated by serious sedation adverse events. The cost reduction for lysis of adhesions in the pediatric sedation unit was 53.5% compared to the operating room, and meatotomy was 27.9%, leading to approximately $57,000 cost savings per year. Fifty families completed a follow-up satisfaction survey, and 83% of parents were satisfied with the care their family received. CONCLUSIONS: The pediatric sedation unit can provide a successful and cost-efficient alternative to the operating room while preserving safety and high rates of parental satisfaction.

Biofeedback therapy for children: What is the maximum number of sessions we should offer?

BACKGROUND: Biofeedback therapy is an effective but resource intensive treatment for pediatric dysfunctional voiding. Based on our center's experience, we evaluated the rate of clinical improvement from biofeedback in order to identify the maximum number of sessions to offer patients. METHODS: We reviewed 490 pediatric patients who underwent at least 6 sessions of biofeedback from 2013 to 2021. At each session, patients and their parents documented their urinary symptoms (urgency, frequency, pain, and difficulties with stream), incontinence, medications, and stool pattern. This longitudinal data was abstracted, and the log odds of urinary symptoms or incontinence was modelled with number of sessions as a predictor using generalized estimating equations and robust standard errors in SAS v9.4. Gender and bowel dysfunction were included as interactions terms. A logistic regression using absence of urinary symptoms at last biofeedback session as a dependent variable was done to further explore differences between genders. RESULTS: Patients were predominantly female (324/490, 66%) with a mean age of 8.9 years (SD 3.3 years). Most common symptoms at presentation were urinary urgency (389/490, 79%) and urinary incontinence (413/490, 84%). Medication use was common at the time of the first session (191/490, 39%) with males more likely to be on alpha-blockers (54/166 vs 1/324, p < 0.001) and females more likely to be on antibiotic prophylaxis (68/324 vs 2/166, p < 0.001). The probability of having urinary symptoms or incontinence decreased up to session 11 (9 months from initial visit). There was slower rate of improvement after session 8 (3 months). Controlling for age, symptoms, and medication use at initial visit, male patients were less likely to report symptom resolution at the time of the last session (OR 0.55, 95% CI 0.33, 0.89). The nadir for reporting symptoms occurred by session 22 for male patients, compared to session 10 for female patients. CONCLUSIONS: Clinical improvement from biofeedback for pediatric patients with dysfunctional voiding may take up to 9 months of therapy, but most cases that improve do so by 3 months. The effect of gender on biofeedback efficacy requires further study, but males may have slower response to biofeedback. Our data provides guidance on when maximum benefit from biofeedback can be expected before considering re-evaluation or other therapies for lower urinary tract symptoms.