ESPU Congress 2018 - Abstract Book

123

11–14 APRIL, 2018, HELSINKI, FINLAND

S15: OBSTRUCTION &

HYDRONEPHROSIS 2

Moderators: Anthony Herndon (USA), Alex Turner (UK)

ESPU Meeting on Friday 13, April 2018, 10:16–10:50

10:16–10:19

S15-1 (PP)

OUTCOMES FOLLOWING PRIMARY ENDOSCOPIC

DECOMPRESSION OF DUPLEX SYSTEM URETEROCELE

AND PREDICTORS OF LONGTERM SYMPTOMOLOGY

Caroline Mary MACDONALD

, Robert SMALL

, Martyn FLETT

, Salvatore

CASCIO

and Stuart O'TOOLE

1) The Royal Hospital for Children, Paediatric Surgery, Glasgow, UNITED KINGDOM - 2) The Royal Hospital

for Children, Paediatric Urology, Glasgow, UNITED KINGDOM

PURPOSE

Advocates of primary endoscopic decompression (PED) and upper tract or primary reconstructive

surgeries for duplex system ureterocele (DSU) quote rates of reoperation as evidence to support

surgical preference. We aim to report long-term functional and symptomatic outcomes following

PED and perform analysis to predict outcomes.

MATERIAL AND METHODS

We performed a retrospective review of all children with DSU between 2004–2014, with minimum

2.5 years follow up. We perform ‘selective’ PED and follow up surgery based on symptomology.

Demographic and diagnostic variables were collected including: antenatal diagnosis, age at pres-

entation and surgery, weight, comorbidity, VUR status, bladder dysfunction, intra/extravesicular,

hydroureteronephrosis and upper pole function. Primary outcomes were: successful PED, worsen-

ing moiety function, further surgery indicated (FSI), voiding dysfunction (VD) and treatment free

status (TFS). Demographic and diagnostic variables were compared with primary outcomes to test

association (chi

and spearman rho correlation).

RESULTS

We identified 41 cases of DSU, with a 77 % successful PED decompression rate. At mean follow

up 6 years (range 2.5–10.2): 17.1 % showed worsened renal function, 63.4 % required FSI and

36.6 % had some VD but overall 61.5 % were treatment free.

We compared the data before and after 2011, when routine fetal anomaly scanning was introduced,

and showed association only with improved TFS (42 % vs 80 % p=0.02) at 8.5 and 4.1 years follow

up respectively. Presentation in urosepsis was associated with later VD, female sex with FSI (OR

13.7 p=0.001) and lower TFS, and earlier age of intervention with VD and lower TFS.

CONCLUSIONS

DUS is associated with long-term ongoing treatment in 38.5 % but this improves with time.

Predictors of symptomology include female sex, presenting in urosepsis and earlier age of surgical

intervention.