title: Surgical Scar Location Preference for Pediatric Kidney and Pelvic Surgery: A Crowdsourced Survey.
abstract: The benefits of minimally invasive surgery in pediatric urology, such as reduced length of hospital stay and postoperative pain, are less predictable compared to findings in the adult literature. We evaluated the choices that adult patients make for themselves and their children regarding scar location.
  
  
  
  We surveyed the preference for scar location/size based on surgery for bladder and kidney procedures with additional questions assessing the impact of a hidden incision, length of hospital stay and pain. The survey was posted to Amazon® Mechanical Turk®.
  
  
  
  We analyzed a total of 954 completed surveys. Surgical history was reported in 660 surveys (69%) with scar bother reported in 357 (54.2%). For pelvic surgery the initial choice was a Pfannenstiel incision for 434 respondents (45.5%), laparoscopy port incisions for 392 (41.1%) and no preference for incision location for 126 (13.2%). When incisions were illustrated relative to undergarments, 718 respondents (75.3%) chose Pfannenstiel. For kidney surgery 567 respondents (59.4%) initially chose the dorsal lumbotomy incision, 170 (17.8%) chose a flank incision, 105 (11.0%) chose laparoscopy ports and 110 (11.5%) had no preference. Respondents were told that minimally invasive surgery might result in less pain/length of hospital stay and were asked to restate the incision choice. For pelvic surgery 232 of 434 respondents (53.5%) who had chosen Pfannenstiel and 282 of 394 (71.6%) who had chosen laparoscopy remained consistent (p <0.001). For kidney surgery 96 respondents (56.5%) who chose a flank incision, 322 (56.8%) who chose dorsal lumbotomy and 68 (64.2%) who chose laparoscopy remained consistent (p = 0.349). Agreement between the incision choice by respondent as a child and for a child was 82% (κ = 0.69) for pelvic surgery and 84.6% (κ = 0.75) for kidney surgery.
  
  
  
  The smallest incision is not always the patient preferred incision, particularly in childhood when pain, length of hospital stay and blood loss may be equivocal among approaches. Discussion of surgical treatment options should include scar length, location and relationship to undergarments.
authors.affiliation: Department of Pediatric Urology, Emory University and Children's Healthcare of Atlanta and Biostatistics Core, Atlanta, Georgia; Department of Pediatrics (CT, CM), Emory University, Atlanta, Georgia.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Garcia-Roig
authors.affiliation: Department of Pediatric Urology, Emory University and Children's Healthcare of Atlanta and Biostatistics Core, Atlanta, Georgia; Department of Pediatrics (CT, CM), Emory University, Atlanta, Georgia.
authors.forename: Curtis
authors.initials: C
authors.lastname: Travers
authors.affiliation: Department of Pediatric Urology, Emory University and Children's Healthcare of Atlanta and Biostatistics Core, Atlanta, Georgia; Department of Pediatrics (CT, CM), Emory University, Atlanta, Georgia.
authors.forename: Courtney
authors.initials: C
authors.lastname: McCracken
authors.affiliation: Department of Pediatric Urology, Emory University and Children's Healthcare of Atlanta and Biostatistics Core, Atlanta, Georgia; Department of Pediatrics (CT, CM), Emory University, Atlanta, Georgia.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Cerwinka
authors.affiliation: Department of Pediatric Urology, Emory University and Children's Healthcare of Atlanta and Biostatistics Core, Atlanta, Georgia; Department of Pediatrics (CT, CM), Emory University, Atlanta, Georgia.
authors.forename: Jared M
authors.initials: JM
authors.lastname: Kirsch
authors.affiliation: Department of Pediatric Urology, Emory University and Children's Healthcare of Atlanta and Biostatistics Core, Atlanta, Georgia; Department of Pediatrics (CT, CM), Emory University, Atlanta, Georgia. Electronic address: akirschmd@gmail.com.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kirsch
mesh_terms: D000328:Adult; D000367:Age Factors; D002921:Cicatrix; D063045:Crowdsourcing; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D057240:Patient Preference; D010388:Pelvis / Q000601:surgery*
keywords: cicatrix; kidney; minimally invasive surgical procedures; surgical wound; urinary bladder