Incontinence and Quality of Life in Children With Spina Bifida
NCT ID: NCT03410667
Last Updated: 2025-10-01
Study Results
Results pending
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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Recruitment Status
ACTIVE_NOT_RECRUITING
Clinical Phase
NA
Total Enrollment
67 participants
Study Classification
INTERVENTIONAL
Study Start Date
2019-12-01
Study Completion Date
2026-03-15
Brief Summary
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This study aims to develop an innovative, interactive tool for joint use by spina bifida patients and their urologists to identify patients interested in addressing their urinary and fecal incontinence and establish continence goal(s) they would like to achieve. To date, no such tool exists for use by spina bifida patients or urologists. This represents a major paradigm shift in the urologic care of pediatric SB patients. It will give children and families a voice in setting their personal goals for urinary and fecal incontinence, rather than relying on physicians' traditional clinical targets (e.g., absence of urinary incontinence, 4-hour dry interval). These traditional views fail to reflect the full patient experience of their ailment by underestimating symptoms and prioritizing only the most severe. This study represents the first time that such a process will be formalized before initiating urological therapy in children with SB (Aim 2). Additionally, this tool may help rule out interventions with a low chance of achieving desired goals and allow for a recalibration of unrealistic goals. The app will be useful for any child, regardless of urinary and fecal incontinence treatment history or underlying bladder pathology, as it will help describe personalized clinical treatment goals based on urinary incontinence, a characteristic all these patients share. This study will also capture the health-related quality of life (HRQOL) impact of urinary and fecal incontinence improvement regardless of the treatment, whether behavioral, medical or surgical, many of which are available to patients regardless of age. A systematic therapeutic goal-setting tool will help in bringing precision medicine to the SB population.
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PHASE1/PHASE2
Detailed Description
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Phase 1: Stakeholder Group. The investigators will engage 30 dyads of children and adolescents with spina bifida aged 8-17 years old, who experienced any urinary and fecal incontinence in the past 4 weeks, and their caregivers in the exploration phase. These children and adolescents will be identified from among spina bifida patients receiving care from pediatric urology providers at Riley Hospital for Children, Indiana University Health. As part of the exploration process, it is important to include patients that reflect the varied life experiences of those impacted by spina bifida. Therefore, the investigators will aim to include children and adolescents with a range of physical and cognitive developmental delays. Groups will be separated by gender to facilitate discussion and elicit any gender-specific urinary incontinence goals. The patient engagement core will create a smartphone-based "Day in the Life" diary toolkit that will be provided to the stakeholder group. The stakeholders will be asked to self-report their experiences and perspectives as they relate to being a child or adolescent with spina bifida and urinary and fecal incontinence, or taking care of someone with spina bifida with urinary incontinence. Stakeholders will be asked to respond using video to various prompts such as documenting a typical day in their life, sharing their experiences. After completing the requested tasks, stakeholders will return the toolkit to the patient engagement. These self-reporting tools will be designed to be as usable as possible by as many participants as possible, taking into account common barriers caused by this condition, and relying on caregivers, as needed, to administer the tools. Investigators anticipate that the kit will take approximately 3 hours to complete. Through analysis and translation of the diaries and video, the patient engagement core will identify insights into patient-centered UI goals and areas of opportunity for design solutions. These identified opportunity spaces will inform the work for Phase Two, the creation phase.
Phase 2: In order to achieve a holistic and sustainable intervention, it is crucial that the investigators work with an interdisciplinary team that include designers, researchers, patients, family members, other caregivers, and health care providers in the process of creating the intervention. Therefore, the investigators will invite 8-10 of the dyads from Phase One to participate as members of the Co-Design Panel which will be brought together to participate in a 2-4 hour co-design session. During this session, designers will share the insights gained from Phase One work. Panel participants will be asked to help refine these insights to define domains of patient-centered urinary incontinence goals. From there, the Co-Design Panel will work to generate solutions for a tool to facilitate goal-setting and follow-up related to these domains (i.e., the tool, or app). This will be done through a series of generative, prototyping exercises with participants. For example, the group could work in small teams to generate ideas for their ideal goal-setting tool and then use sketches, storyboards, building materials like foam core, or verbal story-telling to prototype these ideas. The options for prototyping will be diverse to accommodate a spectrum of physical and cognitive abilities. These prototypes can then be used to generate discussion among the Co-Design Panel, which will further refine the ideal aspects of the app from the perspective of children and adolescents with SB and their caregivers.
The Physician Panel will then be invited to respond to a prototype of the app and give their input on how it can be improved to best fit into clinic workflow, address physician preferences, and work for a variety of patient-physician scenarios. These responses will be gathered through structured in-person interviews.
Phase 3: The investigators will ask patient/caregiver dyads with spina bifida (N=8), who were not part of the Co-Design Panel in Phase Two, to utilize the tool in conjunction with their pediatric urologist during a pediatric urology clinic visit at Riley Hospital. The investigators will comply with all IRB requirements at the study institution for the inclusion of patients in research, including obtaining the necessary consents/assents.
Testing Process. Following the clinic visit, the patient/caregiver will participate in Cognitive Interviews. They will be asked to describe their impressions of the prototype app through the use of scripted verbal probes ("What do you think is being represented here?" "Describe what you would do next.") and spontaneous probes ("What about this picture/sentence/etc., makes you feel that way?"), the investigators will determine if the prototype app is functioning as expected, or any key elements were missed. The investigators will also ask for feedback from the urologists on how well the tool functioned within the clinic setting to help in this iterative validation process. This will be accomplished by conducting interviews with approximately 6 physicians.
Phase 4: The investigators will recruit children and adolescents with SB (8-17 years old) who are followed at Riley Hospital Pediatric Urology Outpatient Clinic and their primary caregiver. The primary caregiver must be the patient's legal guardian. Well over 200 children and adolescents with SB are seen at this facility annually. Each week, a research assistant (RA) will be given a list of SB patients within the desired age range who have an upcoming appointment in two settings: the Pediatric Urology Clinic or the multidisciplinary Spina Bifida clinic. The RA will approach the patient and their primary caregiver upon arrival at the clinic appointment to gauge their interest in study participation. If the dyad indicates potential interest, the RA will take them to a private area to further discuss the details of the study, determine eligibility, and then obtain consent from the legal caregiver and assent from the patient wishing to enroll in the study. Over a 12-month period, the investigators will enroll 92 children and adolescents with SB and their primary caregivers. After enrollment in the study, the RA will administer the app, and collect baseline data regarding self-reported urinary and fecal incontinence and HRQOL. The patient and their caregiver will then meet with their urologist for the scheduled clinic appointment. After being enrolled at baseline, participants will continue with standard care for 12 months (while completing UI, HRQOL, and other questionnaires), at which point the app is introduced and the goal is set, and then they are followed for another 12 months. The urologist will be provided with the completed app and will utilize this tool to verify/discuss the goal selected, and then discuss plans for treatment in order to achieve this goal. Goal attainment, UI, and HRQOL will be assessed at 6 and 12 months after the app is introduced. Children with SB are typically seen in the outpatient clinic every 6-12 months. Therefore, these follow-up assessments will occur in-person at a clinic appointment, or, if not possible, investigators will contact the participant by telephone to notify them that an email link to a secure website to complete the necessary assessments will be sent. To minimize loss to follow-up, investigators will ask for 3 different phone numbers with at least one being a landline (if available). Investigators will also ask for two email addresses. Up to 3 attempts will be made to reach participants.
Phase 2: In order to achieve a holistic and sustainable intervention, it is crucial that the investigators work with an interdisciplinary team that include designers, researchers, patients, family members, other caregivers, and health care providers in the process of creating the intervention. Therefore, the investigators will invite 8-10 of the dyads from Phase One to participate as members of the Co-Design Panel which will be brought together to participate in a 2-4 hour co-design session. During this session, designers will share the insights gained from Phase One work. Panel participants will be asked to help refine these insights to define domains of patient-centered urinary incontinence goals. From there, the Co-Design Panel will work to generate solutions for a tool to facilitate goal-setting and follow-up related to these domains (i.e., the tool, or app). This will be done through a series of generative, prototyping exercises with participants. For example, the group could work in small teams to generate ideas for their ideal goal-setting tool and then use sketches, storyboards, building materials like foam core, or verbal story-telling to prototype these ideas. The options for prototyping will be diverse to accommodate a spectrum of physical and cognitive abilities. These prototypes can then be used to generate discussion among the Co-Design Panel, which will further refine the ideal aspects of the app from the perspective of children and adolescents with SB and their caregivers.
The Physician Panel will then be invited to respond to a prototype of the app and give their input on how it can be improved to best fit into clinic workflow, address physician preferences, and work for a variety of patient-physician scenarios. These responses will be gathered through structured in-person interviews.
Phase 3: The investigators will ask patient/caregiver dyads with spina bifida (N=8), who were not part of the Co-Design Panel in Phase Two, to utilize the tool in conjunction with their pediatric urologist during a pediatric urology clinic visit at Riley Hospital. The investigators will comply with all IRB requirements at the study institution for the inclusion of patients in research, including obtaining the necessary consents/assents.
Testing Process. Following the clinic visit, the patient/caregiver will participate in Cognitive Interviews. They will be asked to describe their impressions of the prototype app through the use of scripted verbal probes ("What do you think is being represented here?" "Describe what you would do next.") and spontaneous probes ("What about this picture/sentence/etc., makes you feel that way?"), the investigators will determine if the prototype app is functioning as expected, or any key elements were missed. The investigators will also ask for feedback from the urologists on how well the tool functioned within the clinic setting to help in this iterative validation process. This will be accomplished by conducting interviews with approximately 6 physicians.
Phase 4: The investigators will recruit children and adolescents with SB (8-17 years old) who are followed at Riley Hospital Pediatric Urology Outpatient Clinic and their primary caregiver. The primary caregiver must be the patient's legal guardian. Well over 200 children and adolescents with SB are seen at this facility annually. Each week, a research assistant (RA) will be given a list of SB patients within the desired age range who have an upcoming appointment in two settings: the Pediatric Urology Clinic or the multidisciplinary Spina Bifida clinic. The RA will approach the patient and their primary caregiver upon arrival at the clinic appointment to gauge their interest in study participation. If the dyad indicates potential interest, the RA will take them to a private area to further discuss the details of the study, determine eligibility, and then obtain consent from the legal caregiver and assent from the patient wishing to enroll in the study. Over a 12-month period, the investigators will enroll 92 children and adolescents with SB and their primary caregivers. After enrollment in the study, the RA will administer the app, and collect baseline data regarding self-reported urinary and fecal incontinence and HRQOL. The patient and their caregiver will then meet with their urologist for the scheduled clinic appointment. After being enrolled at baseline, participants will continue with standard care for 12 months (while completing UI, HRQOL, and other questionnaires), at which point the app is introduced and the goal is set, and then they are followed for another 12 months. The urologist will be provided with the completed app and will utilize this tool to verify/discuss the goal selected, and then discuss plans for treatment in order to achieve this goal. Goal attainment, UI, and HRQOL will be assessed at 6 and 12 months after the app is introduced. Children with SB are typically seen in the outpatient clinic every 6-12 months. Therefore, these follow-up assessments will occur in-person at a clinic appointment, or, if not possible, investigators will contact the participant by telephone to notify them that an email link to a secure website to complete the necessary assessments will be sent. To minimize loss to follow-up, investigators will ask for 3 different phone numbers with at least one being a landline (if available). Investigators will also ask for two email addresses. Up to 3 attempts will be made to reach participants.
Conditions
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Spina Bifida
Myelomeningocele
Study Design
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Allocation Method
NON_RANDOMIZED
Intervention Model
PARALLEL
Primary Study Purpose
TREATMENT
Blinding Strategy
NONE
Study Groups
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Standard Care
Standard of care arm
Group Type
OTHER
Phase One: Exploration
Intervention Type
BEHAVIORAL
Spina Bifida patients from the pediatric urology clinic at Riley Hospital and their caregivers will participate in discussions of UI goals. These patients will self report their experiences and perspectives using a "Day in the Life" diary tool-kit.
Phase Two: Creation
Intervention Type
BEHAVIORAL
Patients, caregivers and providers will work to create a goal setting tool to help patients and physicians appropriately address the issue of UI in patients with spina bifida.
Phase Three: Reflection
Intervention Type
BEHAVIORAL
This is a validation step to test whether the goal-setting tool is widely applicable and functional in a clinic setting. There will be cognitive interviews after the tool is completed to gather patient impressions.
Intervention Arm
Intervention arm
Group Type
EXPERIMENTAL
Aim 3
Intervention Type
BEHAVIORAL
This will be a large scale validation of the app, with assignment to standard care for the first year of enrollment.
Interventions
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Phase One: Exploration
Spina Bifida patients from the pediatric urology clinic at Riley Hospital and their caregivers will participate in discussions of UI goals. These patients will self report their experiences and perspectives using a "Day in the Life" diary tool-kit.
Intervention Type
BEHAVIORAL
Phase Two: Creation
Patients, caregivers and providers will work to create a goal setting tool to help patients and physicians appropriately address the issue of UI in patients with spina bifida.
Intervention Type
BEHAVIORAL
Phase Three: Reflection
This is a validation step to test whether the goal-setting tool is widely applicable and functional in a clinic setting. There will be cognitive interviews after the tool is completed to gather patient impressions.
Intervention Type
BEHAVIORAL
Aim 3
This will be a large scale validation of the app, with assignment to standard care for the first year of enrollment.
Intervention Type
BEHAVIORAL
Other Intervention Names
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Prospective Assessment of Patient-Centered Goals and HRQOL
Eligibility Criteria
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Inclusion Criteria
* Spina bifida
* 8-17 years old
* Followed at Riley Hospital Pediatric Urology Outpatient Clinic
* Primary caregiver is patient's legal guardian
* Urinary incontinence in the past 4 weeks
* Fecal incontinence in the past 4 weeks
* Normal to mildly impaired cognitive development
* English language literacy
* Intent to receive care at the Riley Pediatric Urology Clinic for th extent of the study
The physician panel will be composed of pediatric urologists.
* 8-17 years old
* Followed at Riley Hospital Pediatric Urology Outpatient Clinic
* Primary caregiver is patient's legal guardian
* Urinary incontinence in the past 4 weeks
* Fecal incontinence in the past 4 weeks
* Normal to mildly impaired cognitive development
* English language literacy
* Intent to receive care at the Riley Pediatric Urology Clinic for th extent of the study
The physician panel will be composed of pediatric urologists.
Exclusion Criteria
* Children with significant cognitive impairment, as they will not be able to express their urinary and fecal incontinence goals.
* Patients who underwent a genitourinary procedure or a bowel procedure in the past 4 weeks, since these patients are often temporarily catheterized and therefore not experiencing their typical level of urinary and fecal incontinence.
* Patients who underwent a genitourinary procedure or a bowel procedure in the past 4 weeks, since these patients are often temporarily catheterized and therefore not experiencing their typical level of urinary and fecal incontinence.
Minimum Eligible Age
8 Years
Eligible Sex
ALL
Accepts Healthy Volunteers
No
Sponsors
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
NIH
Sponsor Role
collaborator
Indiana University
OTHER
Sponsor Role
lead
Responsible Party
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Konrad Szymanski
Assistant Professor of Urology
Responsibility Role
PRINCIPAL_INVESTIGATOR
Locations
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Riley Hospital for Children
Indianapolis, Indiana, United States
Site Status
Countries
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United States
References
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Szymanski KM, Cain MP, Hardacker TJ, Misseri R. How successful is the transition to adult urology care in spina bifida? A single center 7-year experience. J Pediatr Urol. 2017 Feb;13(1):40.e1-40.e6. doi: 10.1016/j.jpurol.2016.09.020. Epub 2016 Nov 9.
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Roth JD, Misseri R, Cain MP, Szymanski KM. Mobility, hydrocephalus and quality of erections in men with spina bifida. J Pediatr Urol. 2017 Jun;13(3):264.e1-264.e6. doi: 10.1016/j.jpurol.2016.12.004. Epub 2017 Jan 11.
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Szymanski KM, Misseri R, Whittam B, Large T, Cain MP. Current opinions regarding care of the mature pediatric urology patient. J Pediatr Urol. 2015 Oct;11(5):251.e1-4. doi: 10.1016/j.jpurol.2015.05.020. Epub 2015 Jun 21.
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Strine AC, Misseri R, Szymanski KM, Kaefer M, Rhee AC, Hillier K, Rink RC, Cain MP. Assessing health related benefit after reconstruction for urinary and fecal incontinence in children: a parental perspective. J Urol. 2015 Jun;193(6):2073-8. doi: 10.1016/j.juro.2014.12.089. Epub 2015 Jan 3.
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Szymanski KM, Misseri R, Whittam B, Kaefer M, Rink RC, Cain MP. Quantity, Not Frequency, Predicts Bother with Urinary Incontinence and its Impact on Quality of Life in Adults with Spina Bifida. J Urol. 2016 Apr;195(4 Pt 2):1263-9. doi: 10.1016/j.juro.2015.07.108. Epub 2016 Feb 28.
Reference Type
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Szymanski KM, Cain MP, Whittam B, Kaefer M, Rink RC, Misseri R. All Incontinence is Not Created Equal: Impact of Urinary and Fecal Incontinence on Quality of Life in Adults with Spina Bifida. J Urol. 2017 Mar;197(3 Pt 2):885-891. doi: 10.1016/j.juro.2016.08.117. Epub 2017 Jan 26.
Reference Type
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Snow-Lisy DC, Yerkes EB, Cheng EY. Update on Urological Management of Spina Bifida from Prenatal Diagnosis to Adulthood. J Urol. 2015 Aug;194(2):288-96. doi: 10.1016/j.juro.2015.03.107. Epub 2015 Apr 1.
Reference Type
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Metcalfe PD, Cain MP, Kaefer M, Gilley DA, Meldrum KK, Misseri R, King SJ, Casale AJ, Rink RC. What is the need for additional bladder surgery after bladder augmentation in childhood? J Urol. 2006 Oct;176(4 Pt 2):1801-5; discussion 1805. doi: 10.1016/j.juro.2006.03.126.
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Whittam B, Szymanski K, Misseri R, Carroll A, Kaefer M, Rink R, Cain M. Long-term fate of the bladder after isolated bladder neck procedure. J Pediatr Urol. 2014 Oct;10(5):886-91. doi: 10.1016/j.jpurol.2013.12.022. Epub 2014 Jan 25.
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Szymanski KM, Oliveira LM, Silva A, Retik AB, Nguyen HT. Analysis of indications for ureteral reimplantation in 3738 children with vesicoureteral reflux: a single institutional cohort. J Pediatr Urol. 2011 Dec;7(6):601-10. doi: 10.1016/j.jpurol.2011.06.002. Epub 2011 Jul 7.
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Szymanski KM, Wei JT, Dunn RL, Sanda MG. Development and validation of an abbreviated version of the expanded prostate cancer index composite instrument for measuring health-related quality of life among prostate cancer survivors. Urology. 2010 Nov;76(5):1245-50. doi: 10.1016/j.urology.2010.01.027. Epub 2010 Mar 28.
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Szymanski KM, Bitzan M, Capolicchio JP. Is retroperitoneoscopy the gold standard for endoscopic nephrectomy in children on peritoneal dialysis? J Urol. 2010 Oct;184(4 Suppl):1631-7. doi: 10.1016/j.juro.2010.04.019. Epub 2010 Aug 21.
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Azhar RA, Szymanski KM, Lemercier E, Valenti D, Andonian S, Anidjar M. Visceral organ-to-percutaneous tract distance is shorter when patients are placed in the prone position on bolsters compared with the supine position. J Endourol. 2011 Apr;25(4):687-90. doi: 10.1089/end.2010.0547. Epub 2011 Mar 25.
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Ghane Sharbaf F, Bitzan M, Szymanski KM, Bell LE, Gupta I, Tchervenkov J, Capolicchio JP. Native nephrectomy prior to pediatric kidney transplantation: biological and clinical aspects. Pediatr Nephrol. 2012 Jul;27(7):1179-88. doi: 10.1007/s00467-012-2115-y. Epub 2012 Feb 26.
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Mansure JJ, Nassim R, Chevalier S, Szymanski K, Rocha J, Aldousari S, Kassouf W. A novel mechanism of PPAR gamma induction via EGFR signalling constitutes rational for combination therapy in bladder cancer. PLoS One. 2013;8(2):e55997. doi: 10.1371/journal.pone.0055997. Epub 2013 Feb 8.
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Violette P, Abourbih S, Szymanski KM, Tanguay S, Aprikian A, Matthews K, Brimo F, Kassouf W. Solitary solid renal mass: can we predict malignancy? BJU Int. 2012 Dec;110(11 Pt B):E548-52. doi: 10.1111/j.1464-410X.2012.11245.x. Epub 2012 May 22.
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Violette PD, Szymanski KM, Anidjar M, Andonian S. Factors determining fluoroscopy time during ureteroscopy. J Endourol. 2011 Dec;25(12):1837-40. doi: 10.1089/end.2011.0204. Epub 2011 Sep 9.
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Szymanski KM, Misseri R, Whittam B, Raposo SM, King SJ, Kaefer M, Rink RC, Cain MP. QUAlity of Life Assessment in Spina bifida for Adults (QUALAS-A): development and international validation of a novel health-related quality of life instrument. Qual Life Res. 2015 Oct;24(10):2355-64. doi: 10.1007/s11136-015-0988-5. Epub 2015 Apr 12.
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Szymanski KM, Misseri R, Whittam B, Yang DY, Raposo SM, King SJ, Kaefer M, Rink RC, Cain MP. Quality of Life Assessment in Spina Bifida for Children (QUALAS-C): Development and Validation of a Novel Health-related Quality of Life Instrument. Urology. 2016 Jan;87:178-84. doi: 10.1016/j.urology.2015.09.027. Epub 2015 Oct 9.
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Szymanski KM, Misseri R, Whittam B, Adams CM, Kirkegaard J, King S, Kaefer M, Rink RC, Cain MP. Mortality after bladder augmentation in children with spina bifida. J Urol. 2015 Feb;193(2):643-8. doi: 10.1016/j.juro.2014.07.101. Epub 2014 Jul 27.
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Szymanski KM, Misseri R, Whittam B, Amstutz S, Kaefer M, Rink RC, Cain MP. Cutting for stone in augmented bladders-what is the risk of recurrence and is it impacted by treatment modality? J Urol. 2014 May;191(5):1375-80. doi: 10.1016/j.juro.2013.11.057. Epub 2013 Dec 5.
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Szymanski KM, Keenan A, Cain MP, Waseem S, Kaefer M. A novel colonoscopic approach for the management of a Malone antegrade continence enema channel, which cannot be catheterized in the immediate postoperative period: a case report. Urology. 2014 Dec;84(6):1490-1. doi: 10.1016/j.urology.2014.07.047. Epub 2014 Oct 11.
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Calaway AC, Whittam B, Szymanski KM, Misseri R, Kaefer M, Rink RC, Karymazn B, Cain MP. Multicystic dysplastic kidney: is an initial voiding cystourethrogram necessary? Can J Urol. 2014 Oct;21(5):7510-4.
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Whittam BM, Calaway A, Szymanski KM, Carroll AE, Misseri R, Kaefer M, Rink RC, Karmazyn B, Cain MP. Ultrasound diagnosis of multicystic dysplastic kidney: is a confirmatory nuclear medicine scan necessary? J Pediatr Urol. 2014 Dec;10(6):1059-62. doi: 10.1016/j.jpurol.2014.03.011. Epub 2014 May 2.
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Szymanski KM, Tabib CH, Idrees MT, Cain MP. Synchronous perivesical and renal malignant rhabdoid tumor in a 9-year-old boy: a case report and review of literature. Urology. 2013 Nov;82(5):1158-60. doi: 10.1016/j.urology.2013.04.050. Epub 2013 Jul 3.
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Chan KH, Szymanski KM, Li X, Ofner S, Flack C, Judge B, Whittam B, Misseri R, Kaefer M, Rink RC, Cain MP. Effect of baseline obesity and postoperative weight gain on the risk of channel revision following continent catheterizable urinary channel surgery. J Pediatr Urol. 2016 Aug;12(4):249.e1-7. doi: 10.1016/j.jpurol.2016.05.021. Epub 2016 Jun 11.
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Whittam BM, Szymanski KM, Flack C, Misseri R, Kaefer M, Rink RC, Cain MP. A comparison of the Monti and spiral Monti procedures: A long-term analysis. J Pediatr Urol. 2015 Jun;11(3):134.e1-6. doi: 10.1016/j.jpurol.2014.12.013. Epub 2015 Mar 25.
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Szymanski KM, Whittam B, Misseri R, Flack CK, Hubert KC, Kaefer M, Rink RC, Cain MP. Long-term outcomes of catheterizable continent urinary channels: What do you use, where you put it, and does it matter? J Pediatr Urol. 2015 Aug;11(4):210.e1-7. doi: 10.1016/j.jpurol.2015.05.002. Epub 2015 May 30.
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Casey JT, Zhang M, Chan KH, Szymanski KM, Judge B, Whittam B, Kaefer M, Misseri R, Rink RC, Cain MP. Does endoscopy of difficult to catheterize channels spare some patients from formal open revision? J Pediatr Urol. 2016 Aug;12(4):248.e1-6. doi: 10.1016/j.jpurol.2016.04.030. Epub 2016 May 26.
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Szymanski KM, Whittam B, Misseri R, Chan KH, Flack CK, Kaefer M, Rink RC, Cain MP. A case of base rate bias, or are adolescents at a higher risk of developing complications after catheterizable urinary channel surgery? J Pediatr Urol. 2017 Apr;13(2):184.e1-184.e6. doi: 10.1016/j.jpurol.2016.12.002. Epub 2017 Jan 11.
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Large T, Szymanski KM, Whittam B, Misseri R, Chan KH, Kaefer M, Rink RC, Cain MP. Ambulatory patients with spina bifida are 50% more likely to be fecally continent than non-ambulatory patients, particularly after a MACE procedure. J Pediatr Urol. 2017 Feb;13(1):60.e1-60.e6. doi: 10.1016/j.jpurol.2016.06.019. Epub 2016 Aug 24.
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Szymanski KM, Misseri R, Whittam B, Lingeman JE, Amstutz S, Ring JD, Kaefer M, Rink RC, Cain MP. Bladder stones after bladder augmentation are not what they seem. J Pediatr Urol. 2016 Apr;12(2):98.e1-6. doi: 10.1016/j.jpurol.2015.06.021. Epub 2015 Sep 25.
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Hubert KC, Large T, Leiser J, Judge B, Szymanski K, Whittam B, Kaefer M, Misseri R, Rink R, Cain MP. Long-term renal functional outcomes after primary gastrocystoplasty. J Urol. 2015 Jun;193(6):2079-84. doi: 10.1016/j.juro.2014.12.088. Epub 2015 Jan 3.
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Szymanski KM, Rink RC, Whittam B, Ring JD, Misseri R, Kaefer M, Cain MP. Long-term outcomes of the Kropp and Salle urethral lengthening bladder neck reconstruction procedures. J Pediatr Urol. 2016 Dec;12(6):403.e1-403.e7. doi: 10.1016/j.jpurol.2016.06.011. Epub 2016 Jul 26.
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Related Links
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https://dschool.stanford.edu/resources/the-bootcamp-bootleg
Hasso Plattner Institute of Design. bootcamp bootleg Accessed March 24, 2015.
Other Identifiers
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1707207063
Identifier Type: -
Identifier Source: org_study_id
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