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Julian Wan

Publications and source records attributed to Julian Wan.

8 recordsLinked to original sources
PubMed2005

The increasing incidence of newborn circumcision: data from the nationwide inpatient sample.

PURPOSE: Newborn circumcision is the most common surgical procedure in the United States, yet there are few contemporary data regarding circumcision rates or the factors that affect these rates. The goal of this study was to determine trends in the national rate of newborn circumcision between 1988 and 2000, and to evaluate patient and hospital factors associated with newborn circumcision. MATERIALS AND METHODS: The Nationwide Inpatient Sample provides information on 5 million to 7 million inpatient stays per year. Newborn male hospitalizations were selected, and those newborns who underwent circumcision were identified using International Classification of Disease-9 procedure codes. Weighted national estimates of circumcision rates were calculated, and patient and hospital characteristics were examined to identify factors associated with newborn circumcision. RESULTS: We identified 4,657,402 newborn male hospitalizations during a 13-year period. Circumcision rates increased significantly with time-48.3% of newborn males underwent circumcision in 1988 to 1991 vs 61.1% in 1997 to 2000 (p <0.0001). In multivariate regression analysis the odds of circumcision increased by 6.8% per year during the study period (p <0.0001). Patient characteristics associated with increased odds of circumcision in the multivariate model included private insurance (p <0.0001), higher socioeconomic status (p <0.0001), fewer co-morbid diagnoses (p <0.0001) and black race (p <0.0001). Hospital factors associated with increased odds of circumcision included Northeast or Midwest geographic region and rural location. CONCLUSIONS: There was a significant increase in the rate of newborn circumcision between 1988 and 2000. The increase may be related to increased recognition of the potential medical benefits of circumcision. However, the increase may also result in a higher incidence of surgical complications of circumcision.

Circumcision, Male↗
PubMed2005

The increasing incidence of congenital penile anomalies in the United States.

PURPOSE: Epidemiologic studies have suggested that the incidence of congenital penile anomalies (CPA), particularly hypospadias, is increasing. This phenomenon has significant biological and socioeconomic implications. We sought further confirmation of the reported trends using a large national database. MATERIALS AND METHODS: The Nationwide Inpatient Sample is a 20% sample of United States hospitals containing data on 5 to 7 million hospital inpatient stays per year. We identified male newborns, used ICD-9 codes to identify newborns with CPA, determined nationally weighted incidence over time and performed multivariate analyses to identify factors associated with CPA. RESULTS: Of the 4.84 million male newborns in the Nationwide Inpatient Sample we identified 37,577 with CPA (weighted incidence rate 7.8/1000 newborns). The weighted incidence increased from 7.0/1000 newborns in 1988 to 1991 to 8.3/1000 in 1997 to 2000 (p <0.0001). The most common diagnosis was hypospadias (68.3%), followed by chordee (8.6%) and hypospadias plus chordee (5%). Unspecified genital or penile anomalies were reported for 14% of the cases. The highest incidence of CPA was in white newborns (9.2/1000), followed by black newborns (7.5/1000), Asians (5.0/1000) and Hispanics (4.7/1000) (p <0.0001). Socioeconomic status (SES) was strongly associated with CPA, with CPA odds 19% higher for the highest SES category versus the lowest (OR 1.18, 95% CI 1.16-1.20). Increasing incidence of CPA over time was observed even after adjusting for race/ethnicity, geographic region, insurance status and SES. CONCLUSIONS: These nationally representative, weighted analyses reveal a significant increase in the incidence of CPA, with striking variation by race, region and SES. Further research into potential causes, as well as the observed disparities in incidence, is needed.

Chi-Square Distribution↗
PubMed2005

Pediatric stone disease: an evolving experience.

PURPOSE: The presentation and management of pediatric stone disease have changed due to early identification and treatment of congenital urological conditions, as well as technological advances. Therefore, we reviewed our 12-year experience. MATERIALS AND METHODS: A total of 123 patients with 158 stones presented from 1991 to 2003. The 46 boys and 77 girls were 8 months to 25 years old, including 5 boys (4%) younger than 3 years, 46 (37%) 4 to 12 years old and 72 (59%) older than 13 years. A 24-hour urine collection was done in 50 patients (41%) and serum chemistry studies were performed in 66 (54%). RESULTS: The seasons of presentation were fall in 41% of cases, summer in 24%, spring in 22% and winter in 13%. Of the patients 94 (76%) had loin pain, 10 (8%) had urinary tract infections, 13 (11%) had a history urinary tract infection, 18 (15%) had gross hematuria, 14 (11%) had structural urological abnormalities and 7 (6%) had neurogenic bladder. Metabolic abnormalities were uncommon and included hypercalciuria in 12%, hyperoxaluria in 2% and cystinuria in 2%. A total of 57 patients (46%) passed the stones and 34 (28%) underwent extracorporeal shock wave lithotripsy, of whom 24 (71%) became stone-free. Ureteroscopy was performed in 10 patients (8%) 6 to 19 years old, percutaneous nephrostolithotomy was done in 4 (3%) and 4 (3%) underwent open surgery. Stone analysis showed calcium based in 88% of the cases, struvite in 7% and cystine in 5%. CONCLUSIONS: The majority of patients had no congenital abnormalities. Early diagnosis of urological abnormalities and urinary infection, and appropriate management of neurogenic bladder may have reduced the incidence in those groups. Most stones are calcium based but occur in the absence of metabolic disturbances. More patients presented in the fall, perhaps reflecting the increased concentration of urine in the summer. Half of the patients passed the stones and shock wave lithotripsy was curative in most others. Ureteroscopy, percutaneous nephrostolithotomy and open surgery were rarely required.

Adolescent↗
PubMed2004

Tethered cord in children: a clinical classification with urodynamic correlation.

PURPOSE: Tethered cord was classified based on clinical presentation and correlated with urodynamic and uroradiographic findings. MATERIALS AND METHODS: A total of 54 children underwent cord untethering from 1993 through 2000. Preoperative magnetic resonance imaging, fluorourodynamics and renal ultrasound were performed in all cases, and postoperative (mean 16 months) fluorourodynamics was done in 33. The conus was at L-2 or lower, with or without a thickened filum in 51 patients and 3 older children with voiding dysfunction had normal cords. RESULTS: Children were classified into group 1-19 with orthopedic deformities (scoliosis or lower limb abnormalities, group 2-16 with cutaneous back lesions, group 3-13 with voiding dysfunction (VD) or urinary tract infection without cutaneous lesions and group 4-6 with associated syndromes. In group 1, 3 patients (16%) had preoperative hyperreflexia (HR) which improved postoperatively in 2, HR developed in 1, none had hydronephrosis or reflux (VUR), 5 (26%) had voiding dysfunction (VD) and 4 improved postoperatively. In group 2, 4 patients (25%) had preoperative HR and all improved postoperatively, and 5 (31%) had VUR and 2 improved postoperatively. In group 3, 11 patients (85%) had HR and 2 (15%) were areflexic preoperatively and 6 (areflexic 1, HR 5) improved postoperatively, 3 (23%) had VUR and 2 improved postoperatively, and 7 (54%) had improved VD but 5 (71%) were on anticholinergics. All 3 patients with VD/normal cords had preoperative HR, and 1 improved, 1 had preoperative VUR which resolved and 1 clinically improved but was on anticholinergics. In group 4, 5 patients (83%) had HR and 2 improved, 2 (33%) had VUR and both improved, and 3 (50%) had VD and 1 improved. CONCLUSIONS: Older children who present with orthopedic problems have rare neurourological abnormalities many of which resolve after surgery. Similarly, infants who are diagnosed early with a cutaneous back lesion can have urodynamic abnormalities, which also have a high rate of resolution. Older children who present with VD have the highest incidence of urodynamic abnormalities. While many seem improved clinically after surgery, they require anticholinergics. All patients with VATER's syndrome should be evaluated prospectively for tethered cord.

Child↗
PubMed2003

Kidney and testicle injuries in team and individual sports: data from the national pediatric trauma registry.

PURPOSE: We define the risk of kidney or testicle injury in children who play contact sports. MATERIALS AND METHODS: National Pediatric Trauma Registry data from 50 United States pediatric trauma centers for 1990 to 1999 were analyzed. The data were from age groups 5 to 11, 12 to 14 and 15 to 18 years. Major abdominal injuries, injuries due to team and individual contact sports, and the site of injury were examined. RESULTS: Of the 81,923 cases 5,439 were sports related. Abdominal injuries occurred in 459 patients (0.56%), and were due to contact sports in 191. Team sports were involved in 184 cases, including football in 44%, hockey in 19%, baseball in 15%, soccer in 12% and basketball in 6%. Abdominal injury rate by age was 16% for 5 to 11-year olds, 42% for 12 to 14-year-olds and 42% for 15 to 18-year-olds. Most common was splenic injury at 50% of cases, kidney injuries occurred in 22% and no testicle injuries were reported. Football accounted for the most kidney injuries (62%). Kidney injuries were more common among older teenagers. No injuries led to nephrectomy. CONCLUSIONS: Abdominal injuries are rare in children who play team and individual contact sports. No testicular injuries were reported. Kidneys are most at risk in football. Splenic injuries are most common overall, although the risk to kidney and spleen is equal in basketball. No kidneys were reported as lost. These data should help families and schools when assessing risk to genitourinary organs during these activities.

Abdominal Injuries↗
PubMed2002

Experience with varicoceles in children and young adults.

PURPOSE: Varicocele ligation in children and adolescents has been advocated for left testicular growth arrest. We report our experience with this population as well as the results of the microscopic inguinal technique. MATERIALS AND METHODS: Between 1994 and 1999, 184 children and young adults presented with unilateral left varicoceles. At presentation 171 patients were asymptomatic and 13 had pain. Testicular measurement was assessed with calipers in 158 cases and ultrasound in 26. Surgery was performed using a microscopic inguinal technique in 58 patients and loupes in 16 of those who presented with left testicular growth arrest initially or who had growth arrest while under observation. Only one child underwent surgery for pain alone. RESULTS: Patient age at presentation ranged from 5 to 22 years, and 70% presented between the ages of 12 and 16 years. Of the 13 patients with pain ages ranged from 13 to 22 years and 6 (46%) also had left testicular growth arrest. Initially, 109 (60%) boys were found not to have left testicular growth arrest and were followed, while 56 (30%) with left testicular growth arrest (ages 9 to 22 years) underwent surgery and 19 were lost to followup. Left testicular growth arrest developed in 17 (15%) of the followed group (ages 11 to 17 years) after 6 to 41 months (average 22) of observation and they underwent surgery. Postoperatively, varicocele disappeared in 66 (89%) patients and it was smaller in 8, in whom 8 loupes were used in 2 and the microscope was used in 6. Of the 36 patients who returned for postoperative measurement 30 (83%) had catch-up growth, while 6 did not. No hydroceles were noted. CONCLUSIONS: Varicoceles can be found in boys as young as 5 years and left testicular growth arrest as early as 9 years. As left testicular growth arrest can develop if not present initially, these boys must be followed with serial testicular measurements before and after puberty until late adolescence. Microscopic inguinal ligation results in complete resolution of the varicocele in almost 90% of patients with no complicating hydroceles. Left testicular catch-up growth can be expected in more than 80% of patients at any age.

Adolescent↗