Chad Crigger

Purpose: To assess the quality and engagement of bladder exstrophy content on YouTube using validated assessment tools, with the goal of identifying gaps in accessible, high-quality online education. These findings also have broader implications for the interplay of online information and rare conditions. Methods: We reviewed the first 300 YouTube videos relevant to the term “bladder exstrophy” published prior to March 2025. Video quality was assessed using the Patient Education Materials Assessment Tool (PEMAT) and JAMA benchmark criteria. Engagement (views, likes, comments), presenter credentials, and targeted audience were extracted. Spearman correlation coefficients were used to examine the relationship between viewer engagement and quality scores. Results: 133 videos met inclusion criteria. Academic institutions produced 60% of videos. The median video length was 5 min with a median view count of 204. Patient-created videos had the highest Video Power Index (VPI), however this was not statistically significant ( p = 0.11). Median understandability (PEMAT-V) was high (89), while actionability (PEMAT-A) was low (0). Academic videos had significantly higher PEMAT-V ( p = 0.002) and JAMA benchmark scores ( p < 0.001) compared to patient, layperson content. No significant correlations were found between video quality scores and user engagement metrics. Conclusion: Content on bladder exstrophy garners limited viewership and engagement but remains an important educational resource. Videos produced by academic institutions demonstrated the highest quality scores, however, lacked actionable guidance. Higher quality was not associated with increased engagement, highlighting a critical gap in the availability of educational, user-friendly videos that support both understanding and anticipatory guidance for the management of bladder exstrophy.

Background: Patients with exstrophy–epispadias complex (EEC) often present with attenuated fascia. Currently, there is no direct comparison of outcomes between percutaneous cystolitholapaxy and open cystolithotomy in this specific patient population. Thus, we sought to evaluate the therapeutic efficacy and associated morbidity of both surgical approaches in patients with EEC. Methods: Patients who underwent either their first percutaneous cystolitholapaxy or open cystolithotomy between 2003 and 2023 were identified using an IRB-approved institutional database of 1512 patients with EEC. Results: Among 66 patients, 8 (12.12%) underwent percutaneous cystolitholapaxy without augmentation, 31 (46.97%) underwent percutaneous cystolitholapaxy with augmentation, 11 (16.67%) underwent open cystolithotomy without augmentation, and 16 (24.24%) underwent open cystolithotomy with augmentation. Compared with the open approach, the percutaneous approach resulted in shorter operative times: 123 (interquartile ranges [IQR]: 81–151) vs 218 minutes (IQR: 142–281) for patients with augmentation, and 131 (IQR: 115.5–141) vs 196 minutes (IQR: 176.5–287.3) for those without augmentation ( p = 0.0002). Hospital stays were shorter with the percutaneous approach: 1 (IQR: 1–1) vs 3 days (IQR: 1–4) with augmentation, and 1.5 (IQR: 1–2) vs 3 days (IQR: 1–4) without augmentation ( p = 0.0044). Notably, the percutaneous group had smaller stone volumes (7.15 cm ³ , IQR: 2.73–24.31 vs 31.04 cm ³ , IQR: 10.77–107.40, p = 0.0011). Both techniques achieved a 100% stone-free rate ( p > 0.99). There were no differences in recurrence ( p = 0.20) and cumulative incidence (HR 0.76, 95% confidence interval: 0.39–1.48, p = 0.38) between groups. Postoperative complications revealed that vesicocutaneous fistulas were most common in open surgery without augmentation ( n = 5, 45.45%), followed by open with augmentation ( n = 1, 6.25%), and none in the percutaneous groups ( p = 0.0002). Conclusion: Percutaneous cystolitholapaxy provided significant advantages for patients with EEC, including shorter operative times and reduced hospital stays, with equivalent stone clearance. Moreover, open cystolithotomy carried a higher risk of vesicocutaneous fistula formation. These findings suggest percutaneous approaches may offer a safer and more efficient alternative for managing bladder stones in patients with EEC.

Strategies and techniques for minimally invasive pyeloplasty in the pediatric population will be reviewed. Included in this will be a thorough assessment and evaluation as well as technical considerations for multiport and emerging single port robotic-assisted surgery. As the robotic platform adopts more widespread usage, the minimal threshold at which a robotic approach may be attempted trends lower, allowing surgeons to use this surgical advantage in the properly selected patient. Challenges with port placement or redo pyeloplasty require careful consideration and will be explored in this most up-to-date chapter synthesizing the existing literature and providing a roadmap for pyeloplasty in the future.

Purpose After complex reconstruction, bladder exstrophy requires unique considerations for long-term surveillance that may arise through the natural history of the condition. A known long-term risk in exstrophy patients is urolithiasis which is a challenge to both treat, and prevent. The authors sought to provide an updated review on the management, prevention, and available interventions in the exstrophy patient population. Methods A literature review was performed through PubMed database, maintained by the United States National Library of Medicine (USNLM) at the National Institutes of Health to survey the existing body knowledge. After rigorous review, those articles included were synthesized in a concise fashion. Results 151 articles were initially identified that covered “stones in exstrophy.” After careful review, 54 were excluded leaving 97 articles included in the final analysis. These articles were then crafted to answer for key questions pertaining to workup, techniques for intervention, and mitigation measures. Conclusion Exstrophy patients are at an increased risk for urolithiasis given several factors ranging from metabolic derangements secondary to augmentation cystoplasty and relatively increased urinary stasis. Increased volume of irrigation and adjuncts in irrigation materials may be used to minimize future stone formation. Ultimately, if stone intervention is required, there are growing options available to the reconstructive urologist.