Commentary to "Barriers to participation in surgical randomized controlled trials in pediatric urology: A qualitative study of key stakeholder perspectives".
As pediatric urologists and active clinical investigators, it is with great interest that we read the recently published paper “Barriers to participation in surgical randomized controlled trials in pediatric urology: a qualitative study of key stakeholder perspectives” by Vemoulakonda and Jones [1] in the Journal. This is a unique, single-center study providing qualitative perspectives in the typically quantitatively dominated field of pediatric urology research. The authors provide an important basis to understand potential parental and healthcare provider barriers to enroll children in randomized controlled trials (RCTs). With these perceived obstacles in mind, investigators may be able to modify recruitment strategies in such a way that it may facilitate enrollment and increase participation. While this is undoubtedly a significant contribution to the literature, the authors base their study [1] on the assumption that pediatric urology surgical trials suffer from similarly low recruitment rates as those seen in adult surgical oncology trials [2]. Although reasonable, this simply may not always be the case. A clear example of high recruitment within pediatric urology surgical trials can be seen in the currently ongoing “Expertise-Based Randomized Controlled Trial of Scrotal Versus Inguinal Orchidopexy on Post-operative Pain” (NCT02158780), where, to date, 41 of 50 (82%) eligible patients have been recruited to participate [3]. Another example of reasonably high recruitment rate is seen in the challenging setting of a placebo control versus antibiotic prophylaxis for infants with highgrade prenatal hydronephrosis [4]. A 57% recruitment rate has been achieved thus far, providing further proof that RCTs are a feasible (and needed) study design in pediatric