Skills or Pills: Randomized Trial Comparing Hypnotherapy to Medical Treatment in Children With Functional Nausea.

BACKGROUND & AIMS: The potential effectiveness of gut-directed hypnotherapy (HT) is unknown for pediatric chronic nausea. This randomized controlled trial compared HT with standard medical treatment (SMT). METHODS: One hundred children (ages, 8-18 y) with chronic nausea and fulfilling functional nausea (FN) or functional dyspepsia (FD) criteria were allocated randomly (1:1) to HT or SMT, with a 3-month intervention period. Outcomes were assessed at baseline, at the halfway point, after treatment, and at the 6- and 12-month follow-up evaluation. Children scored nausea symptoms in a 7-day diary. The primary outcome was treatment success, defined as a reduction in nausea of 50% or more, at the 12-month follow-up evaluation. Secondary outcomes included adequate relief of nausea. RESULTS: After treatment and at the 6-month follow-up evaluation, there was a trend toward higher treatment success in the HT group compared with the SMT group (45% vs 26%, P = .052; and 57% vs 40%, P = .099, respectively). At 12 months, treatment success was similar in both groups (60% in the HT group and 55% in the SMT group; P = .667). In the FN group, significantly higher success rates were found for HT, but no differences were found in patients with FD. Adequate relief was significantly higher in the HT group than in the SMT group at the 6-month follow-up evaluation (children: 81% vs 55%, P = .014; parents: 79% vs 53%; P = .016), but not at the 12-month follow-up evaluation. CONCLUSIONS: HT and SMT were effective in reducing nausea symptoms in children with FN and FD. In children with FN, HT was more effective than SMT during and after the first 6 months of treatment. Therefore, HT and SMT, applied separately or in combination, should be offered to children with FN as a treatment option (Clinical trials registration number: NTR5814).

New reference charts for testicular volume in Dutch children and adolescents allow the calculation of standard deviation scores.

AIM: Accurate calculations of testicular volume standard deviation (SD) scores are not currently available. We constructed LMS-smoothed age-reference charts for testicular volume in healthy boys. METHODS: The LMS method was used to calculate reference data, based on testicular volumes from ultrasonography and Prader orchidometer of 769 healthy Dutch boys aged 6 months to 19 years. We also explored the association between testicular growth and pubic hair development, and data were compared to orchidometric testicular volumes from the 1997 Dutch nationwide growth study. RESULTS: The LMS-smoothed reference charts showed that no revision of the definition of normal onset of male puberty - from nine to 14 years of age - was warranted. In healthy boys, the pubic hair stage SD scores corresponded with testicular volume SD scores (r = 0.394). However, testes were relatively small for pubic hair stage in Klinefelter's syndrome and relatively large in immunoglobulin superfamily member 1 deficiency syndrome. CONCLUSION: The age-corrected SD scores for testicular volume will aid in the diagnosis and follow-up of abnormalities in the timing and progression of male puberty and in research evaluations. The SD scores can be compared with pubic hair SD scores to identify discrepancies between cell functions that result in relative microorchidism or macroorchidism.

Long-term testicular volume after orchiopexy at diagnosis of acquired undescended testis.

PURPOSE: We studied long-term outcomes of orchiopexy at diagnosis of acquired undescended testes using ultrasound to determine testicular volume. MATERIALS AND METHODS: Patients who had undergone orchiopexy for acquired undescended testis at diagnosis were recruited to assess testicular volume. Testis volume was measured by ultrasound and compared with recently developed normative values for testicular size. For young adults (older than 18 years) volumes were grouped and compared to normative values reported in the literature. In all unilateral cases testicular volume was compared with its counterpart. RESULTS: A total of 155 patients 5.1 to 26.6 years old (181 acquired undescended testes) were included in the study. Mean ± SD followup was 6.6 ± 3.8 years (range 1.4 to 15.5). For all patients 18 years old or younger (125 patients, 143 testes) operated testis volume was 0.1 to 12.7 ml (mean ± SD 2.5 ± 2.9), which was significantly smaller than the normative values (50th percentile) for the same age (p <0.001). Mean ± SD testis volume in young adults (38 testes) was 8.1 ± 3.7 ml, compared to a mean volume of 13.4 ml reported in the literature (p <0.001). In unilateral cases the mean volume of the testes fixed by orchiopexy differed significantly from their counterparts (3.4 ± 3.3 ml vs 4.6 ± 4.6 ml, p <0.001). CONCLUSIONS: The long-term volumes at diagnosis of acquired undescended testes after orchiopexy were significantly less than the normative values at all ages. In unilateral cases the volumes were also significantly less compared to the contralateral testes.

Testicular volume and testicular microlithiasis in boys with Down syndrome.

PURPOSE: Studies have suggested that testicular microlithiasis and Down syndrome are linked, yet a correlation remains unclear. We investigated the prevalence of testicular microlithiasis in patients with Down syndrome. We hypothesized that testicular microlithiasis is present at a higher rate in these patients. We further hypothesized that patients with Down syndrome have lower testicular volumes than normal age matched boys. We tested our hypothesis by ultrasound investigation in boys 0 to 18 years old with Down syndrome. MATERIALS AND METHODS: Testicular ultrasound was performed in 79 boys with Down syndrome. Mean patient age was 8.8 years (range 0.4 to 18.3). Testicular microlithiasis was assessed and testicular volume was measured according to the formula, π/6 × length × width × height. RESULTS: Testicular microlithiasis was present in 18 boys (22.8%). It was diagnosed in 6 of 28 boys younger than 7 years (21.4%), in 6 of 28 boys 7 to 12 years (21.4%) and in 6 of 23 boys 12 years or older (26.1%). No significant difference was found in the prevalence of testicular microlithiasis between these 3 groups. Mean testicular volumes in patients with Down syndrome (2.19 ml) were significantly smaller than the normative values. CONCLUSIONS: This study demonstrated a 22.8% prevalence of testicular microlithiasis in boys with Down syndrome, which is significantly increased compared to normative values. In addition, testis volume is significantly smaller in boys with Down syndrome compared to normative values.

Current treatment practice of functional abdominal pain disorders in children: A multicenter survey.

BACKGROUND: Approximately 90% of the children with chronic abdominal pain are diagnosed as having functional abdominal pain disorder (FAPD). The Dutch guideline "functional abdominal pain" provides a stepwise approach to treat FAPD. The aim of this survey was twofold first, to determine adherence to the Dutch guideline, and second to determine current management of FAPDs in clinical practice. METHODS: A multicenter survey was designed. The survey was sent to pediatricians and pediatric residents in December 2020. The study ran from October 2020 until March 2021. Participants in ten hospitals in the western region of The Netherlands were invited to complete this survey. Respondents who indicated not to treat children with FAPDs or respondents who completed less than 3 steps of the survey were excluded. RESULTS: In total, 85/174 (48.9%) respondents completed the survey. We included 80 respondents, 68 pediatricians and 12 pediatric residents, for analysis. Overall, self-reported guideline adherence was 85%. Self-reported adherence was higher than actual adherence. Only 50% of all respondents followed the first three steps of the guideline. The reported non-pharmacological and pharmacological treatments were diverse and varied between different age groups. The average follow-up duration was between 2 and 6 months, and the most regularly used outcome measures were attendance at school, quality of life, and adequate pain relief/reassurance. CONCLUSION: We reportedly observed a large variation in the management of children with FAPDs, due to low guideline adherence among clinicians. Improved guideline adherence may be accomplished by updating the guideline with specific recommendations per subtype, follow-up and outcome measures as well measures to improve guideline implementation.

Testicular microlithiasis in boys and young men with congenital or acquired undescended (ascending) testis.

PURPOSE: We assessed the prevalence of testicular microlithiasis by ultrasound in boys and young men with congenital or acquired undescended (ascending) testis. MATERIALS AND METHODS: During followup for testicular growth patients with congenital or acquired undescended (ascending) testis were also screened by ultrasound for testicular microlithiasis, which was defined as echogenic foci without shadowing within the testis parenchyma. Classic microlithiasis was defined as 5 or more echogenic foci in either or both testes and limited microlithiasis as fewer than 5 foci. RESULTS: We performed 181 ultrasounds in 181 patients (199 congenital undescended testes) with a mean age of 12.6 years (range 2.6 to 28.6) and 636 ultrasounds in 320 patients (350 acquired undescended/ascending testes) with a mean age of 12.4 years (4.1 to 24.1). Age in both patient groups was equivalent. Median followup was 1.34 years (range 0 to 3.2). Testicular microlithiasis was found in 14 patients (2.8%), of whom 11 (2.2%) displayed classic testicular microlithiasis and 3 (0.6%) exhibited limited testicular microlithiasis. Among these 14 patients 5 had congenital undescended testes, which demonstrated classic microlithiasis. Of these 5 patients 4 had chromosomal deformities. The remaining 9 patients had acquired undescended (ascending) testis, which exhibited classic microlithiasis in 6 instances and limited microlithiasis in 3. CONCLUSIONS: The prevalence of testicular microlithiasis in patients with undescended testis is 2.8%. There is no difference in the prevalence of testicular microlithiasis between congenital and acquired undescended (ascending) testes.

Natural history and long-term testicular growth of acquired undescended testis after spontaneous descent or pubertal orchidopexy.

OBJECTIVE: To assess prospectively the natural history and long-term testicular growth of acquired undescended testis (UDT) after spontaneous descent or pubertal orchidopexy in case of nondescent. PATIENTS AND METHODS: From 1996 until 2008, 391 boys with 464 acquired UDT were included in the study. In accordance with Dutch consensus on non-scrotal testes, spontaneous descent at puberty was awaited; if this did not take place, orchidopexy was performed at puberty. Acquired UDT was defined as a testis previously residing in the scrotum that can no longer be manipulated into a stable scrotal (high scrotal) or nonscrotal (inguinal, impalpable) position. After referral, testis position, testis volume and puberty stage were monitored annually until adolescence. Testis volume was assessed using an orchidometer and compared with the Dutch standard. All investigations were carried out by the same physician (W.H.). Of these boys, 84 (mean age 12.9 years, range 6.4-21.3) were also clinically assessed by a second physician (J.G.), unaware of the results of the first examination. In addition, these boys were assessed with testicular ultrasonography, carried out by both physicians. RESULTS: Currently the mean (range) follow-up is 4.7 (0.1-12.0) years, and 253 acquired UDT have reached the scrotum. In 196 of these 253 cases (77.5%), there was spontaneous descent at puberty (mean age at descent 12.9 years, range 9.8-16.9); in the other 57 cases (22.5%), pubertal orchidopexy was required due to nondescent; five cases required orchidectomy. Of the 494 testis volume measurements after spontaneous descent, 458 (92.7%) were at ≥10th centile for age, of which 311 (63.0%) were ≥50th centile, and 107 (21.7%) ≥90th centile. After pubertal orchidopexy for nondescent, of the 85 measurements, 79 (92.9%) were at ≥10th centile, 53 (62.4%) ≥50th centile and 12 (14.1%) ≥90th centile. In unilateral cases, after spontaneous descent 174 of the 294 (59.2%) retained testes were found to be smaller than their counterpart and 90 of 294 (30.6%) were equal in size. After pubertal orchidopexy in unilateral cases, 40 of the 51 (78.4%) testes were smaller, and nine (17.6%) were equal in size. There was a strong correlation between both investigators for the measurement of testicular volume by orchidometer, and for the main investigator (W.H.) between his measurements by ultrasonography and the Prader orchidometer. CONCLUSION: Acquired UDT has a 77.5% tendency of spontaneous descent at puberty. In nearly all cases, after spontaneous descent as well as after pubertal orchidopexy, long-term testicular growth is within the normal range.

Gut-directed hypnotherapy versus standard medical treatment for nausea in children with functional nausea or functional dyspepsia: protocol of a multicentre randomised trial.

INTRODUCTION: The treatment of chronic functional nausea or nausea due to functional dyspepsia in children is generally symptomatic. Moreover, these disorders pose a risk for worse psychosocial and health outcomes in children. Hypnotherapy (HT), by its ability to positively influence gastrointestinal and psychosocial functioning, may be an effective treatment for chronic nausea. METHODS AND ANALYSIS: To test efficacy, this multicentre, parallel, randomised controlled, open label trial evaluates whether gut-directed HT is superior to standard medical treatment (SMT) for reducing nausea. The study will be conducted at eleven academic and non-academic hospitals across the Netherlands. A total of 100 children (8-18 years), fulfilling the Rome IV criteria for chronic idiopathic nausea or functional dyspepsia with prominent nausea, will be randomly allocated (1:1) to receive HT or SMT. Children allocated to the HT group will receive six sessions of HT during 3 months, while children allocated to the SMT group will receive six sessions of SMT+supportive therapy during the same period. The primary outcome will be the difference in the proportion of children with at least 50% reduction of nausea, compared with baseline at 12 months' follow-up. Secondary outcomes include the changes in abdominal pain, dyspeptic symptoms, quality of life, anxiety, depression, school absences, parental absence of work, healthcare costs and adequate relief of symptoms, measured directly after treatment, 6 and 12 months' follow-up. If HT proves effective for reducing nausea, it may become a new treatment strategy to treat children with chronic functional nausea or functional dyspepsia with prominent nausea. ETHICS AND DISSEMINATION: Results of the study will be publicly disclosed to the public, without any restrictions, in peer-reviewed journal and international conferences. The study is approved by the Medical Research Ethics Committees United (MEC-U) in the Netherlands. TRIAL REGISTRATION NUMBER: NTR5814.

High prevalence of intratesticular varicocele in a post-orchidopexy cohort.

PURPOSE: Intratesticular varicocele (ITV) is an uncommon sonographic finding. A prevalence of up to 2% has been reported in men with testicular problems. In a cohort of men who had undergone prepubertal orchidopexy for acquired undescended testis, several cases of ITV were found. The aim of this study was to analyse the prevalence and clinical aspects of ITV in this cohort. METHODS: In a long-term follow-up study of position and growth of undescended testis after prepubertal orchidopexy, ultrasonography was used to identify men with ITV. Data on clinical presentation, testicular volume, and the location, size and Doppler aspects of intratesticular varicocele were collected and analysed. RESULTS: Of the 105 men, 9 were identified with ITV (8.6%). In all patients, the side of orchidopexy correlated with the side of the ITV, and all were left-sided. The testis with ITV had a smaller volume than the testis without ITV (p = 0.026). CONCLUSIONS: A remarkably high prevalence of ITV (8.6%) was found as well as a smaller volume of the testes with ITV in a cohort of men who had undergone prepubertal orchidopexy for acquired undescended testis.

Testicular microlithiasis in two boys with a chromosomal abnormality.

A nine and 13-year-old boy, previously diagnosed with 18q syndrome and an 11q deletion, respectively were diagnosed with testicular microlithiasis (TM). Both cases demonstrate that TM occurs in patients with various chromosomal abnormalities.

Long-term testicular position and growth of acquired undescended testis after prepubertal orchidopexy.

PURPOSE: The aim of the study was to determine long-term testicular position and growth of acquired undescended testis (UDT) after prepubertal orchidopexy. METHODS: Patients who had undergone prepubertal orchidopexy for acquired UDT at our hospital between 1986 and 1999 were recruited to assess long-term testicular position and volume. Testis position was assessed by physical examination. Testis volume was measured with Prader orchidometry and ultrasound and was compared with normative values reported in the literature. RESULTS: A total of 105 patients (aged 14.0-31.6 years) were included with 137 acquired UDT (32 bilateral, 33 left sided, and 40 right sided). All but 1 of the orchidopexied testes (99.3%) were in low scrotal position. The mean volume of the orchidopexied testes in unilateral UDT (n = 73, 10.57 ± 3.74 mL) differed significantly from the size of the testes at the contralateral side (14.11 ± 4.23 mL) (P = .000). The operated testes (10.28 ± 3.45 mL) were smaller than the mean adult testis volume reported in the literature (13.4-13.6 mL; cutoff, 13.2 mL). CONCLUSION: Testis position after prepubertal orchidopexy for acquired UDT was nearly always low scrotal. The volume of the orchidopexied testes was smaller than both the volume of the contralateral testes and the normative values reported in the literature.