ㅤTake-home message from RIVUR Trial Investigators 2014, published in New England Journal of Medicine:
In children with urinary tract infections due to vesicoureteral reflux (VUR), antibiotic prophylaxis with trimethoprim-sulfamethoxazole compared to placebo:
Reduced the risk of recurrent urinary tract infections. This effect was more evident in children whose index infection was febrile, as well as in those with bladder and bowel dysfunction
Did not reduce the occurrence of renal scarring
Increased resistance of Escherichia coli to trimethoprim-sulfamethoxazole
ㅤTake-home message from Ulf Jodal 2006, published in Pediatric Nephrology:
This trial compared outcomes of children with severe VUR managed medically (antibiotics) and surgically (ureteric reimplantation).
Renal growth and UTI recurrence rates were similar, however medically treated patients had more febrile infections.
There was no difference in somatic growth, radionuclide imaging or renal function.
ㅤTake-home message from Per Brandström 2010, published in Journal of Urology:
In girls with grade III-IV vesicoureteral reflux (VUR) antibiotic prophylaxis and endoscopic treatment decreased the febrile urinary tract infection (UTI) recurrence rate compared to surveillance. Reflux severity at study entry did not predict recurrence.
Boys with dilating VUR who were older than 1 year old showed few recurrences and did not benefit from active treatment.
ㅤTake-home message from Paediatric Surgical Trainees Research Network (PSTRN) 2021, published in BJS Open:
No increased risk of post-operative testicular atrophy, reoperation rates and anaesthetic complications with early orchidopexy <1 year of age compared to orchidopexy on older boys.
Higher wound infection rate in boys that underwent early orchidopexy <1 year of age compared to older boys aged >1 year.
Further research remains needed to illustrate non-inferiority of early orchidopexy to orchidopexy in older boys aged over 1 year.
ㅤTake-home message from D Singh-Grewal 2004, published in Archives of Disease in Childhood:
This meta-analysis shows circumcision reduces the risk of UTI in boys who have a history of recurrent UTI or vesicoureteric reflux. The data does not support the routine circumcision of normal boys to prevent UTI.
ㅤTake-home message from Visser 2003, published in BJU International:
The two most important factors determining testicular salvage after torsion are the duration and the degree of testicular rotation.
To salvage the testis three factors are needed: prompt presentation, prompt diagnosis and referral, and immediate surgery.
Saving the ipsilateral testis requires prompt presentation by the patient, prompt diagnosis, and immediate surgery.
Subfertility found in 36-39% patients after torsion
ㅤTake-home message from PH ter Meulen 2001, published in European Urology:
Twice daily application of 0.05% clobetasol propionate cream for one month allowed the majority of boys referred for a circumcision to treat phimosis to avoid surgery and should therefore be considered as first-line treatment.
ㅤTake-home message from J Oster 1968, published in Archives of Disease in Childhood:
Phimosis (inability to retract the foreskin with gentle manipulation) is physiological and common in school-age boys, resolving in 99% by the age of 16-17 years. Preputial adhesions are also very common, and equally resolve in the majority of boys by the age of 16-17 years without intervention.
ㅤTake-home message from Mellick 2019, published in Paediatric Emergency Care:
This systematic review provides useful data on testicular viability after different time intervals from a testicular torsion event. Testicular salvage is greatest when presentation and treatment is within 0 to 6 hours of symptom onset (96%). Beyond this, survival decreases with increasing time from presentation, however a proportion (10%) remains viable after >48 hours of symptoms.
ㅤTake-home message from Pettersson 2007, published in New England Journal of Medicine:
Treatment for undescended testis before puberty decreases the risk of testicular cancer.
Age at orchidopexy matters
Age <13y RR 2.2x (testes ca)
13 RR 5.4x
ㅤTake-home message from Claude Kollin 2007, published in The Journal of Urology:
Early orchiopexy leads to better outcomes for testicular growth in unilateral undescended testis.
Orchiopexy at 9 months is better than orchiopexy at 3 years.
Partial catch-up of testicular growth in the retained testis compared to scrotal testis was seen for orchiopexy at 9 months and not orchiopexy at 3 years.