Browsing by Author "Routh, Jonathan C"

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    Bone scan positivity in non-metastatic, castrate-resistant prostate cancer: external validation study.
    (International braz j urol : official journal of the Brazilian Society of Urology, 2020-01) Johnston, Ashley W; Longo, Thomas A; Davis, Leah Gerber; Zapata, Daniel; Freedland, Stephen J; Routh, Jonathan C

    Introduction

    Tables predicting the probability of a positive bone scan in men with non-metastatic, castrate-resistant prostate cancer have recently been reported. We performed an external validation study of these bone scan positivity tables.

    Materials and methods

    We performed a retrospective cohort study of patients seen at a tertiary care medical center (1996-2012) to select patients with non-metastatic, castrate-resistant prostate cancer. Abstracted data included demographic, anthropometric, and disease-specific data such as patient race, BMI, PSA kinetics, and primary treatment. Primary outcome was metastasis on bone scan. Multivariable logistic regression was performed using generalized estimating equations to adjust for repeated measures. Risk table performance was assessed using ROC curves.

    Results

    We identified 6.509 patients with prostate cancer who had received hormonal therapy with a post-hormonal therapy PSA ≥2ng/mL, 363 of whom had non-metastatic, castrate-resistant prostate cancer. Of these, 187 patients (356 bone scans) had calculable PSA kinetics and ≥1 bone scan. Median follow-up after castrate-resistant prostate cancer diagnosis was 32 months (IQR: 19-48). There were 227 (64%) negative and 129 (36%) positive bone scans. On multivariable analysis, higher PSA at castrate-resistant prostate cancer (4.67 vs. 4.4ng/mL, OR=0.57, P=0.02), shorter time from castrate-resistant prostate cancer to scan (7.9 vs. 14.6 months, OR=0.97, P=0.006) and higher PSA at scan (OR=2.91, P<0.0001) were significantly predictive of bone scan positivity. The AUC of the previously published risk tables for predicting scan positivity was 0.72.

    Conclusion

    Previously published risk tables predicted bone scan positivity in men with non-metastatic, castrate-resistant prostate cancer with reasonable accuracy.
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    Causes of death among people with myelomeningocele: A multi-institutional 47-year retrospective study.
    (Journal of pediatric rehabilitation medicine, 2023-12) Szymanski, Konrad M; Adams, Cyrus M; Alkawaldeh, Mohammad Y; Austin, Paul F; Bowman, Robin M; Castillo, Heidi; Castillo, Jonathan; Chu, David I; Estrada, Carlos R; Fascelli, Michele; Frimberger, Dominic C; Gargollo, Patricio C; Hamdan, Dawud G; Hecht, Sarah L; Hopson, Betsy; Husmann, Douglas A; Jacobs, Micah A; MacNeily, Andrew E; McLeod, Daryl J; Metcalfe, Peter D; Meyer, Theresa; Misseri, Rosalia; O'Neil, Joseph; Rensing, Adam J; Routh, Jonathan C; Rove, Kyle O; Sawin, Kathleen J; Schlomer, Bruce J; Shamblin, Isaac; Sherlock, Rebecca L; Slobodov, Gennady; Stout, Jennifer; Tanaka, Stacy T; Weiss, Dana A; Wiener, John S; Wood, Hadley M; Yerkes, Elizabeth B; Blount, Jeffrey

    Purpose

    This study aimed to analyze organ system-based causes and non-organ system-based mechanisms of death (COD, MOD) in people with myelomeningocele (MMC), comparing urological to other COD.

    Methods

    A retrospective review was performed of 16 institutions in Canada/United States of non-random convenience sample of people with MMC (born > = 1972) using non-parametric statistics.

    Results

    Of 293 deaths (89% shunted hydrocephalus), 12% occurred in infancy, 35% in childhood, and 53% in adulthood (documented COD: 74%). For 261 shunted individuals, leading COD were neurological (21%) and pulmonary (17%), and leading MOD were infections (34%, including shunt infections: 4%) and non-infectious shunt malfunctions (14%). For 32 unshunted individuals, leading COD were pulmonary (34%) and cardiovascular (13%), and leading MOD were infections (38%) and non-infectious pulmonary (16%). COD and MOD varied by shunt status and age (p < = 0.04), not ambulation or birthyear (p > = 0.16). Urology-related deaths (urosepsis, renal failure, hematuria, bladder perforation/cancer: 10%) were more likely in females (p = 0.01), independent of age, shunt, or ambulatory status (p > = 0.40). COD/MOD were independent of bladder augmentation (p= >0.11). Unexplained deaths while asleep (4%) were independent of age, shunt status, and epilepsy (p >= 0.47).

    Conclusion

    COD varied by shunt status. Leading MOD were infectious. Urology-related deaths (10%) were independent of shunt status; 26% of COD were unknown. Life-long multidisciplinary care and accurate mortality documentation are needed.
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    Combining adult with pediatric patient data to develop a clinical decision support tool intended for children: leveraging machine learning to model heterogeneity.
    (BMC medical informatics and decision making, 2022-03) Sabharwal, Paul; Hurst, Jillian H; Tejwani, Rohit; Hobbs, Kevin T; Routh, Jonathan C; Goldstein, Benjamin A

    Background

    Clinical decision support (CDS) tools built using adult data do not typically perform well for children. We explored how best to leverage adult data to improve the performance of such tools. This study assesses whether it is better to build CDS tools for children using data from children alone or to use combined data from both adults and children.

    Methods

    Retrospective cohort using data from 2017 to 2020. Participants include all individuals (adults and children) receiving an elective surgery at a large academic medical center that provides adult and pediatric services. We predicted need for mechanical ventilation or admission to the intensive care unit (ICU). Predictor variables included demographic, clinical, and service utilization factors known prior to surgery. We compared predictive models built using machine learning to regression-based methods that used a pediatric or combined adult-pediatric cohort. We compared model performance based on Area Under the Receiver Operator Characteristic.

    Results

    While we found that adults and children have different risk factors, machine learning methods are able to appropriately model the underlying heterogeneity of each population and produce equally accurate predictive models whether using data only from pediatric patients or combined data from both children and adults. Results from regression-based methods were improved by the use of pediatric-specific data.

    Conclusions

    CDS tools for children can successfully use combined data from adults and children if the model accounts for underlying heterogeneity, as in machine learning models.
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    Correction to: Combining adult with pediatric patient data to develop a clinical decision support tool intended for children: leveraging machine learning to model heterogeneity.
    (BMC medical informatics and decision making, 2022-05) Sabharwal, Paul; Hurst, Jillian H; Tejwani, Rohit; Hobbs, Kevin T; Routh, Jonathan C; Goldstein, Benjamin A
    Following publication of the original article [1], it was reported that part of the ‘Outcome Variable Definition’ and the entirety of the ‘Descriptive statistics’ subsection was missing. These two subsections are given below with the previously missing text highlighted in bold. The original article [1] has been updated. Outcome Variable Definition In the initial development of the CDS tool, we were tasked with predicting four outcomes related to hospital resource utilization: overall length of stay, admission to the intensive care unit (ICU), requirement for mechanical ventilation, and discharge to a skilled nursing facility. Because children are rarely discharged to a skilled nursing facility and evaluating continuous outcomes poses unique challenges, we focused on the two binary outcomes: admission to the ICU and requirement for mechanical ventilation. Statistical Analysis Descriptive statistics We compared the pediatric and adult patient populations. We report standardized mean differences (SMDs) where an SMD > 0.10 indicates that the two groups are out of balance.
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    Delayed presentation of urethrocutaneous fistulae after hypospadias repair.
    (Journal of pediatric surgery, 2020-01-29) Johnston, Ashley W; Jibara, Ghalib A; Purves, J Todd; Routh, Jonathan C; Wiener, John S
    BACKGROUND:Delayed urethrocutaneous fistula (UCF) presentation after hypospadias repair is rarely reported. The aim of this study is to report our experience with delayed UCF presenting more than 5 years after hypospadias repair. METHODS:We conducted a retrospective review of patients who underwent UCF repair (CPT codes 54,340 and 54,344) at our institution between 1997 and 2017. Delayed UCF presentation was defined as a single normal urinary stream after initial hypospadias repair and subsequent presentation of a UCF/s urinary stream more than 5 years after initial hypospadias or UCF repair. Demographic and clinical data were reviewed after approval from our institutional review committee. RESULTS:We identified 12 patients with delayed UCF. The mean age at hypospadias repair was 12.3 months (Range 6-32). The mean time to delayed UCF presentation was 11.5 years (Range 7.1-15.8). Four patients with delayed UCF (33.3%) required additional surgery for UCF recurrence with a mean time to recurrence of 2.2 years (Range < 1-5.6). CONCLUSIONS:Delayed UCF presentation can occur more than 15 years after initial repair. Pubertal penile skin changes and increased genital awareness in older children may be contributing factors as all but one presented at age 10 years or older. LEVEL OF EVIDENCE:III.
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    High Flow Priapism in a Pediatric Patient after Circumcision with Dorsal Penile Nerve Block.
    (Case reports in pediatrics, 2016-01) Granieri, Michael A; Fantony, Joseph J; Routh, Jonathan C
    We report the first documented case of high flow priapism after circumcision with dorsal penile nerve block. A 7-year-old male who had undergone circumcision three years before presented to our institution with a 3-year history of persistent nonpainful erections. Workup revealed a high flow priapism and, after discussion of the management options, the patient's family elected continued observation.
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    Parental Preferences for Vesicoureteral Reflux Treatment: a Crowd-sourced, Best-worst Scaling Study.
    (Urology, 2019-03-13) Dionise, Zachary R; Gonzalez, Juan Marcos; Garcia-Roig, Michael L; Kirsch, Andrew J; Scales, Charles D; Wiener, John S; Purves, J Todd; Routh, Jonathan C
    OBJECTIVE:To quantitatively evaluate parental preferences for the various treatments for vesicoureteral reflux using crowd-sourced best-worst scaling, a novel technique in urologic preference estimation. METHODS:Preference data were collected from a community sample of parents via two best-worst scaling survey instruments published to Amazon's Mechanical Turk online community. Attributes and attribute levels were selected following extensive review of the reflux literature. Respondents completed an object case best-worst scaling exercise to prioritize general aspects of reflux treatments and multi-profile case best-worst scaling to elicit their preferences for the specific differences in reflux treatments. Data were analyzed using multinomial logistic regression. Results from the object-case provided probability scaled values (PSV) that reflected the order of importance of attributes. RESULTS:We analyzed data for 248 and 228 respondents for object and multi-profile case BWS, respectively. When prioritizing general aspects of reflux treatment, effectiveness (PSV=20.37), risk of future urinary tract infection (PSV=14.85) and complication rate (PSV=14.55) were most important to parents. Societal cost (PSV=1.41), length of hospitalization (PSV=1.09), and cosmesis (PSV=0.91) were least important. Parents perceived no difference in preference for the cosmetic outcome of open versus minimally invasive surgery (p=0.791). Bundling attribute preference weights, parents in our study would choose open surgery 74.9% of the time. CONCLUSIONS:High treatment effectiveness was the most important and preferred attribute to parents. Alternatively, cost and cosmesis were among the least important. Our findings serve to inform shared parent-physician decision-making for vesicoureteral reflux.
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    Patterns of inpatient care for prostate cancer in men with spina bifida.
    (Disability and health journal, 2020-04) Johnston, Ashley W; Wolf, Steven; Alkazemi, Muhammad H; Pomann, Gina-Maria; Wood, Hadley; Wiener, John S; Routh, Jonathan C
    BACKGROUND:Advances in medical care have increased the long-term survival of patients with spina bifida. Despite this growing population, limited knowledge is available on age-related illnesses in adults with spina bifida, particularly prostate cancer for which there is no published data. OBJECTIVE:Our aim was to describe inpatient care for prostate cancer in men with spina bifida in the United States. METHODS:We performed a descriptive, retrospective study utilizing the 1998 to 2014 National Inpatient Sample from the Healthcare Cost and Utilization Project. Weights were applied to the sample to make national level inferences. We identified all adult encounters (≥18 years old) with prostate cancer and spina bifida. RESULTS:We identified 253 encounters (mean age 64.9 years). Most were Caucasian (67.5%) and had public insurance (61.6%). 44% of encounters included a major urologic procedure. 38.4% of encounters included prostatectomies, 28.3% included lymph node dissections, and 7.8% included cystectomies. Robotic surgery was performed in 9.4%. Mean length of stay was 5.6 days (95% CI: 3.7, 7.5). The average total cost was $14,074 (95% CI: $8990.3, $19,158.6). CONCLUSIONS:In this first-ever exploration of inpatient care for prostate cancer in men with spina bifida, we found that length of stay and total costs were higher in men with spina bifida. Almost half of encounters included a prostatectomy, cystectomy, and/or lymph node dissection. More detailed investigations are necessary to assess comparative treatment outcomes and complications, including prevalence and mortality rates of prostate cancer among adult men with SB.
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    Pediatric urologic oncology in the 21st century: where we stand and where we're headed.
    (Translational andrology and urology, 2020-10) Routh, Jonathan C; Cost, Nicholas G; Wiener, John S
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    The Importance of Early Diagnosis and Management of Pediatric Neurogenic Bladder Dysfunction.
    (Research and reports in urology, 2021-01) Hobbs, K Tyler; Krischak, Madison; Tejwani, Rohit; Purves, J Todd; Wiener, John S; Routh, Jonathan C
    Neurogenic bladder dysfunction is a major source of urologic morbidity in children, especially in those with spina bifida (SB). Complications from progression of bladder dysfunction can include urinary tract infections (UTIs), urinary incontinence, upper tract deterioration, and renal dysfunction or failure. In these children, there has been a recent trend toward proactive rather than expectant management of neurogenic bladder. However, there is a lack of consensus on how to best achieve the three main goals of neurogenic bladder management: 1) preserving kidney function, 2) achieving continence (if desired by the family/individual), and 3) achieving social and functional urologic independence (if appropriate). Hence, our objective was to perform a narrative literature review to evaluate the approaches to diagnosis and management of pediatric neurogenic bladder dysfunction, with special focus on children with SB. The approach strategies vary across a spectrum, with a proactive strategy on one end of the spectrum and an expectant strategy at the other end. The proactive management strategy is characterized by early and frequent labs, imaging, and urodynamic (UDS) evaluation, with early initiation of clean intermittent catheterization (CIC) and proceeding with pharmacotherapy, or surgery if indicated. The expectant management strategy prioritizes surveillance labs and imaging prior to proceeding with invasive assessments and interventions such as UDS or pharmacotherapy. Both treatment strategies are currently utilized and data have historically been inconclusive in demonstrating efficacy of one regimen over the other. We performed a narrative literature evaluating proactive and expectant treatment strategies as they relate to diagnostics and management of Spina Bifida. From the available literature and our practice, a proactive strategy favors greater benefit in preventative management and may decrease risk of renal dysfunction compared with expectant management.