Evidence map›Paper›PMID 37322171›Full record

ArticlePediatric nephrology (Berlin, Germany)2023

Implementation of a standardized clinical pathway in a dedicated posterior urethral valves clinic: short-term outcomes.

Mandy Rickard, Armando J Lorenzo, Juliane Richter, Natasha Brownrigg, Jin K Kim, Michael Chua, Noreen Goraya, Adree Khondker, Priyank Yadav, Daniel T Keefe and 2 more

Abstract read
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In one paragraph

Article in Pediatric nephrology (Berlin, Germany), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
11.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 19 citations in OpenAlex.

  1. Article
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  4. Article
  5. Review
  6. Article
  7. Use of prenatal ultrasound findings to predict postnatal outcome in fetuses with lower urinary tract obstruction.Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology · 2024
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 5 institutions in 3 countries.

Mandy RickardDivision of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada. mandy.rickard@sickkids.ca.ORCID http://orcid.org/0000-0003-0598-1824
Armando J LorenzoDivision of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada.
Juliane RichterDivision of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada.
Natasha BrownriggDivision of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada.
Jin K KimDivision of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada.
Michael ChuaDivision of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada.
Noreen GorayaDepartment of Social Work, The Hospital for Sick Children, Toronto, ON, Canada.
Adree KhondkerDivision of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Priyank YadavDepartment of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Renal Sciences, Lucknow, India.
Daniel T KeefeDepartment of Urology, Dalhousie University, Halifax, NS, Canada.
Shiri ShinarOntario Fetal Center, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
Joana Dos SantosDivision of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, 555 University Avenue, Toronto, ON, Canada.
University of Toronto · CADalhousie University · CAHospital for Sick Children · CAMount Sinai Hospital · CASanjay Gandhi Post Graduate Institute of Medical Sciences · IN

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTo determine if the implementation of a posterior urethral valves (PUV) clinic and standardized management pathway improves the short-term kidney outcomes of infants with PUV.

methodsFrom 2016-2022, 50 consecutive patients were divided into groups after the implementation of the clinic (APUV, n = 29) and before (BPUV, n = 21) during a comparable timeframe. Assessed data included age at initial visit, timing and type of surgery, frequency of follow-up visits, medications, nadir creatinine, and development of CKD/kidney failure. Data are shown as median with interquartile range (IQR) and odds ratios (OR) with 95% confidence interval (CI).

resultsAPUV had higher rates of prenatal diagnoses (12/29 vs. 1/21; p = 0.0037), earlier initial surgical intervention (8 days; IQR 0, 105 vs. 33 days; IQR 4, 603; p < 0.0001), and higher rates of primary diversions (10/29 vs. 0/21; p = 0.0028). Standardized management led to earlier initiation of alpha blockers (326 days; IQR 6, 860 vs. 991; IQR 149, 1634; p = 0.0019) and anticholinergics (57 days; IQR 3, 860 vs. 1283 days; IQR 477, 1718; p < 0.0001). Nadir creatinine was reached at earlier ages in APUV (105 days; IQR 2, 303 vs. 164 days; IQR 21, 447; p = 0.0192 BPUV). One patient progressed to CKD5 in APUV compared to CKD3, CKD5 and one transplant in BPUV.

conclusionImplementing the PUV clinic with standardized treatment expedited postnatal management and resulted in a higher number of cases detected prenatally, a shift in primary treatment, younger ages at initial treatment, reduced time to nadir creatinine, and timely initiation of supportive medications. A higher resolution version of the Graphical abstract is available as Supplementary information.

Indexed as

UrethraUrethral ObstructionCreatinineCritical PathwaysFemaleHumansInfantPregnancyRetrospective StudiesCreatinineClinical pathwayLower urinary tract obstructionPediatricsPosterior urethral valvesProactive management

Identifiers

PMID37322171
OpenAlexW4380739477

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.