Browsing by Author "Dangle, Pankaj P."

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    Analgesic Efficacy of Quadratus Lumborum Block in Infants Undergoing Pyeloplasty
    (MDPI, 2021) Chisolm, Paul F.; Singh, Nikhi P.; Cummins, Ian; Oster, Robert A.; Cox, Damon; Dangle, Pankaj P.; Urology, School of Medicine
    Post-operative analgesic management is challenging in infants and opioids have been the standard of care. However, they are associated with adverse effects which may negatively impact infants. In this retrospective cohort study, we sought to explore the postoperative analgesic efficacy of quadratus lumborum (QL) block in the infant population undergoing dorsal lumbotomy pyeloplasty. Chart review of 34 infants (≤12 months) who underwent dorsal lumbotomy pyeloplasty between 2016–2020 was performed. Post-operative pain was assessed using externally validated pain scales (CRIES & FLACC) and monitored hemodynamics (pulse and blood pressure). Opioid doses were standardized by using morphine milligram equivalency (MME). The Prescription Database Monitoring Program (PDMP) was utilized to determine if discharge opioid prescriptions were filled. Of 34 patients, 13 received the QL block. Mean age at the time of surgery was 6.2 months ± 3.2 months. The QL group received 0.8 MME postoperatively, whereas the non-QL group received 0.9 MME (p = 0.82). The QL group (20%) filled their discharge opioid prescription less frequently compared to non-QL group (100%) (p = 0.002). There were no observed differences between pain scale or hemodynamic variables. Further studies are warranted to explore QL block’s efficacy for post-operative infant pain management.
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    Effect of age, BMI, and gender on urinary risk factors in pediatric idiopathic stone formers
    (Elsevier, 2021) Fang, Andrew M.; Gibson, Elena; Oster, Robert A.; Dangle, Pankaj P.; Urology, School of Medicine
    Introduction: The incidence of pediatric urolithiasis has been increasing over the years; however, the etiology of this increase is not well understood. Age, body mass index, and gender have been examined as possible risk factors for stone disease, but with inconsistent and variable associations. Objective: We aim to investigate the urine chemistry factors, as assessed by 24-h urinary parameters, in pediatric stone formers at a large volume tertiary referral center in the highest areas in the United States, the Southeast, based on age, body mass index, and gender. Study design: We retrospectively reviewed all pediatric stone formers who completed a 24-h study between 2005 and 2016. Patients were stratified by age (3-10 versus 11-18 years of age), overweight status (above versus below the 85th percentile for body mass index), and gender (male versus female) (Summary Figure). Statistical analysis included analysis of variance and logistic regression. Results: 243 patients were included in our analysis. Patients in the first decade of life were found to have greater numbers of urinary risk factors than those in the second decade. Non-overweight patients were more likely to have hyperoxaluria and hyperuricosuria, while overweight patients were more likely to have hypocitraturia. Female patients were more likely to have higher hyperoxaluria, while male patients were more likely to have hypercalciuria. Discussion: In contrast to prior publications, obesity is not linked to increased risk of urolithiasis with non-overweight individuals having a greater number of risk factors than the overweight cohort. Despite stone disease being more prevalent in adolescents, the greatest number of risk factors were present in the first decade of life. Lastly, female children had more urinary risk factors than males. Further understanding of the underlying causes of stone disease in various pediatric populations is warranted. Conclusion: While more urinary risk factors were identified in younger, non-overweight, and female patients, there remains no consensus on the urinary risk factors for pediatric urolithiasis. Further study is needed to elucidate the risk factors and pathophysiology of pediatric stone disease.
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    Is There an Association between Childhood Obesity and Pediatric Kidney Stone Disease? A Literature Review
    (MDPI, 2021) Paiste, Henry J.; Moradi, Luke; Assimos, Dean G.; Wood, Kyle D.; Dangle, Pankaj P.; Urology, School of Medicine
    Objectives: To examine the most recent literature and published science in determining any and all possible associations between pediatric obesity and pediatric urolithiasis. Methods: Retrospective literature review of pediatric stone formers with diagnosed stone disease and all associated risk factors. Peer-reviewed, published manuscripts from the past several decades were analyzed for risk factors associated with pediatric obesity such as diet, hypertension, and renal diseases. Comparing the pediatric obesity literature with the pediatric stone forming literature, any associations and correlations were derived and analyzed. Results: Despite the existing evidence that obesity is linked to stones in adults, the evidence remains unclear whether obesity plays a role in children. Nutritional discrepancies, in the setting of the obesity epidemic, have been shown to alter the risk profile of pediatric patients. Consistent with the published literature, and lack of consistent correlation with obesity and stone disease, is the knowledge that age, gender, geography, and climate may all play a role in the onset of pediatric obesity and may also be on the causal pathway toward pediatric urolithiasis. Conclusion: The manuscript demonstrates that there are a number of risk factors, congenital or acquired, that are associated with pediatric obesity. The mechanisms responsible for these associations may be on the causal pathway toward childhood urolithiasis. These mechanisms that underlie these associations need to be further investigated.
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    Pediatric urology amidst SARS-CoV-2 pandemic: Building the future with current knowledge
    (Elsevier, 2021) Lombardo, Alyssa M.; Andolfi, Ciro; Deshpande, Abhishek P.; Aizen, Joshua M.; Dangle, Pankaj P.; Gundeti, Mohan S.; Urology, School of Medicine
    Introduction: The COVID-19 pandemic has ripped around the globe, stolen family members and forced healthcare systems to operate under an unprecedented strain. As of December 2020, 74.7 million people have contracted COVID-19 worldwide and although vaccine distribution has commenced, a recent rise in cases suggest that the pandemic is far from over. Methods: This piece explores how COVID-19 has explicitly impacted the field of pediatric urology and its patients with a focus on vulnerable subpopulations. Results: Various medical and surgical associations have published guidelines in reaction to the initial onset of the pandemic in early 2020. Discussion and conclusion: As the number of patients with COVID-19 increases, long-term recovery and future preparedness are imperative and should be cognizant of patient subpopulations that have been subject to disproportionate morbidity and mortality burden. Development of a dedicated response team would aid in achieving preparedness by drafting and implementing plans for resource allocation during scarcity, including logistic and ethical considerations of vaccine distribution.