Purpose To describe fertility preservation (FP) utilization by transgender adolescents within a pediatric gender clinic between July 2013 and July 2016. Methods A retrospective chart review was conducted to abstract demographic and clinical information among adolescents initiating gender-affirming hormones, including patient age at initial FP consultation, birth-assigned sex, race/ethnicity, and outcome of FP consultation. Results In our sample of 105 transgender adolescents, a total of 13 (seven transgender men and six transgender women) between the age of 14.2 and 20.6 years were seen in formal consultation for FP before initiating hormones. Of these adolescents, four completed sperm cryopreservation and one completed oocyte cryopreservation. Conclusions Rates of FP utilization among transgender youth were low, which is consistent with a recently published report of FP utilization among transgender youth at another pediatric institution. Identified barriers to FP in our sample included cost, invasiveness of procedures, and desire not to delay medical transition.

No abstract

Pediatric fertility preservation is an emerging, evolving field. Fertility preservation options for prepubertal patients with fertility altering conditions such as cancer and differences/disorders of sex development are currently limited. However, multiple lines of active research hold promise for the future. Key considerations include establishing a multidisciplinary team to provide pediatric fertility preservation services, an appreciation for relevant ethical issues and cost.

No abstract

TGNC adolescents expressed interest in multiple family building options, including adoption and biological parenthood, and identified a need for more information about these options. Thus, clinicians working with adolescents should be aware of the unique fertility and reproductive health needs of TGNC youth.

WHAT'S KNOWN ON THIS SUBJECT: Current guidelines recommend renal ultrasound as a screening test after febrile urinary tract infection, with voiding cystourethrogram (VCUG) only if the ultrasound is abnormal. Few studies have evaluated the accuracy of ultrasound as a screening test for VCUG-identified abnormalities. WHAT THIS STUDY ADDS:This study shows that ultrasound is a poor screening test for genitourinary abnormalities identified on VCUG, such as vesicoureteral reflux. Neither positive nor negative ultrasounds reliably identify or rule out such abnormalities. Ultrasound and VCUG provide different, but complementary, information.abstract BACKGROUND: The 2011 American Academy of Pediatrics guidelines state that renal and bladder ultrasound (RBUS) should be performed after initial febrile urinary tract infection (UTI) in a young child, with voiding cystourethrogram (VCUG) performed only if RBUS shows abnormalities. We sought to determine test characteristics and predictive values of RBUS for VCUG findings in this setting. METHODS:We analyzed 3995 clinical encounters from January 1, 2006 to December 31, 2010 during which VCUG and RBUS were performed for history of UTI. Patients who had previous postnatal genitourinary imaging or history of prenatal hydronephrosis were excluded. Sensitivity, specificity, and predictive values of RBUS for VCUG abnormalities were determined. RESULTS:We identified 2259 patients age ,60 months who had UTI as the indication for imaging. RBUS was reported as "normal" in 75%. On VCUG, any vesicoureteral reflux (VUR) was identified in 41.7%, VUR grade .II in 20.9%, and VUR grade .III in 2.8%. Sensitivity of RBUS for any abnormal findings on VCUG ranged from 5% (specificity: 97%) to 28% (specificity: 77%). Sensitivity for VUR grade .III ranged from 18% (specificity: 97%) to 55% (specificity: 77%). Among the 1203 children aged 2 to 24 months imaged after a first febrile UTI, positive predictive value of RBUS was 37% to 47% for VUR grade .II (13% to 24% for VUR grade .III); negative predictive value was 72% to 74% for VUR grade .II (95% to 96% for VUR grade .III).CONCLUSIONS: RBUS is a poor screening test for genitourinary abnormalities. RBUS and VCUG should be considered complementary as they provide important, but different, information. Dr Nelson conceptualized and refined the study design, performed a substantial portion of data collection and interpretation, and drafted the initial manuscript; Dr Johnson contributed substantially to data collection and interpretation, critically reviewed the manuscript, and incorporated revisions from all the authors; Dr Logvinenko performed data analysis and critically reviewed the manuscript; Dr Chow contributed to conceptualization and refinement of the study design and data interpretation and critically reviewed the manuscript; and all authors approved the final manuscript as submitted. Although the new guidelines do not explicitly frame RBUS as a screening test, the guidelines do suggest that the decision to perform VCUG after a first febrile UTI...

PURPOSE We performed a population-based study comparing trends in perioperative outcomes and cost for open (OP), laparoscopic (LP), and robotic (RP) pediatric pyeloplasty. Specific billing items contributing to cost were also investigated. MATERIALS AND METHODS Using the Premier Perspective database, we identified 12,662 pediatric patients who underwent open, laparoscopic and robotic pyeloplasty (ICD-9 55.87) in the United States from 2003 – 2010. Univariate and multivariate statistics were used to evaluate perioperative outcomes, complications, and costs for the competing surgical approaches. Propensity weighting was employed to minimize selection bias. Sampling weights were used to yield a nationally representative sample. RESULTS A decrease in OP and a rise in minimally invasive pyeloplasty (MIP) was observed. All procedures had low complication rates. Compared to OP, LP and RP had longer median operating room (OR) times (240 minutes, p<0.0001 and 270 minutes, p<0.0001, respectively). There was no difference in median length of stay (LOS). The median total cost was lower among patients undergoing OP versus RP ($7,221 vs $10,780, p<0.001). This cost difference was largely attributable to robotic supply costs. CONCLUSIONS During the study period, OP made up a declining majority of cases. LP utilization plateaued, while RP increased. OR time was longer for MIP, while LOS was equivalent across all procedures. A higher cost associated with RP was driven by OR use and robotic equipment costs, which abrogated low room and board cost. This study reflects an adoption period for RP. With time, perioperative outcomes and cost may improve.

Gender and sex diverse individuals—transgender individuals and those with disorders of sex development (DSD)—both face medical treatments that may impair biological fertility potential. Young DSD patients also often have abnormal gonadal development. Fertility preservation for these populations has historically been poorly understood and rarely addressed. Future fertility should be discussed with gender and sex diverse individuals, particularly given recent advances in fertility preservation technologies and evolving views of fertility potential. Key ethical issues include parental proxy decision-making and uncertainty regarding prepubertal fertility preservation technologies. Many opportunities exist for advancing fertility-related care and research for transgender and DSD patients.