Challenges in e-Health: The effect of digitalisation of frequency voiding charts on compliance in paediatric patients. Randomised controlled trial comparing digital and versus paper frequency voiding charts.

Objective: Frequency voiding charts are commonly used to gain better insight into the voiding and drinking behaviours of patients with voiding symptoms. Non-compliance when filling out a chart is known to be high. The use of a digital application might increase adherence, but little research has been conducted on this topic. The aim of this study is to compare the quality (number of correctly filled out charts) and quantity (number of complete charts) of digital versus paper frequency voiding charts among children and their parents. Methods: A multi-centre parallel randomised controlled trial was conducted. Participants were assigned either a 48-h digital frequency voiding chart or a 48-h paper frequency voiding chart. Completion rates were scored based on a predefined scoring method and transcribed into a percentage. Secondary objectives included user friendliness, feasibility, degree of the child's participation, and attractiveness. Trail registry data: NTR NL9383. Results: Ninety-seven patients were randomised to either a digital (N = 53) or paper (N = 44) frequency voiding chart. No significant difference in complete and accurately filled out frequency voiding charts was seen between the groups, with 35% (N = 18) for digital and 50% (N = 22) for paper, p = 0.12. Subjects considered the digital application more appealing, more educative, and more inviting compared to the paper chart (p < 0.05). Conclusions: In this underpowered study, no significant difference appeared between the groups in the number of complete and accurately filled out frequency voiding charts. Implementation of e-health did not seem to improve compliance. In daily practice, personal preference might offer the best solution.

Development of a prediction model for postoperative complications after primary hypospadias correction.

PURPOSE: To develop a prediction model for postoperative complications after primary one-stage hypospadias correction to improve preoperative parental counseling. MATERIALS AND METHODS: In this retrospective cohort study, data were collected from 356 patients with anterior or middle hypospadias who had a one-stage hypospadias correction from 2003 onwards. Potential treatment- and patient-related factors were selected and used to develop a prediction model for postoperative complications within one year (wound-related complications, urinary tract infections, fistulas, stenosis, and prepuce-related complications). Multivariable logistic regression analysis with stepwise backward selection and a p-value of 0.20 was used to select the final model, which was internally validated using the bootstrap procedure. RESULTS: Complications within one year postoperatively occurred in 66 patients (19%), of which 13% and 37% were seen in anterior and middle type of hypospadias, respectively. Hypospadias phenotype, surgical technique, chordectomy, and surgeon's experience were included in the final prediction model, whereas none of the patient-related factors were. The final model had a good discriminative ability (bias corrected C statistic 0.70) and calibration. CONCLUSION: Using easily obtainable information, this model showed good accuracy in predicting complications within one year after hypospadias surgery. It is a first step towards individualized risk prediction of postoperative complications for anterior and middle hypospadias and can assist in preoperative parental counseling. TYPE OF STUDY: Prognostic study. LEVEL OF EVIDENCE: Level II.

Level of agreement on postoperative complications after one-stage hypospadias correction comparing medical records and parent reports.

PURPOSE: To analyze agreement on postoperative complications after hypospadias surgery according to medical records and parents' reports. MATERIALS & METHODS: In this retrospective cohort study, data were collected from 409 children who received an initial one-stage hypospadias correction in the Radboudumc, The Netherlands. Postoperative complications according to medical records were compared with parent-reported complications in an online questionnaire. Main complications studied were wound-related complications, urinary tract infections, fistulas, stenosis, and prepuce-related complications. Agreement was determined by Cohen's kappa coefficient. RESULTS: Slightly less complications were mentioned in medical records (37%) compared to parents' reports (42%). Overall agreement was moderate (κ = 0.50, 95% confidence interval (CI):0.41-0.59), but poor for some specific complications. Agreement was higher for complications that needed reoperation compared to when no reoperation was performed (κ = 0.53, 95% CI: 0.43-0.62 and κ = 0.18, 95% CI: 0.06-0.31) and for patients with recent surgery (<5 years before questionnaire completion) compared to less recent surgeries (κ = 0.69, 95% CI: 0.55-0.84 and κ = 0.43, 95% CI: 0.33-0.54). CONCLUSIONS: Agreement on complications according to medical records and parents' reports was poor to moderate, but better after reoperation and more recent surgery. Some complications mentioned in medical records were missing from parents' reports and the other way around. Better agreement will give physicians and parents a more reliable view on postoperative outcome after hypospadias surgery. TYPE OF STUDY: Diagnostic test. LEVEL OF EVIDENCE: Level III.