30th ESPU Congress - Lyon, France - 2019

S14: ADOLESCENT UROLOGY

Moderators: Gianantonio Manzoni (Italy), Radim Kočvara (Czech Republic)

ESPU Meeting on Friday 26, April 2019, 12:00 - 12:28


12:00 - 12:05
S14-1 (LO)

★ IS THE SUCCESS RATE OF VARICOCELECTOMY DIFFERENT IN ADOLESCENTS WITH NUTCRACKER SYNDROME (NCS)?

Perviz HAJIYEV 1, Cagri AKPINAR 2, Baris ESEN 2, Murat KARABURUN 2, Gunay EKBERLI 1, S. FITOZ 3, Tarkan SOYGUR 1 and Berk BURGU 1
1) Ankara University School of Medicine, Pediatric Urology, Ankara, TURKEY - 2) Ankara University School of Medicine, Urology, Ankara, TURKEY - 3) Ankara University School of Medicine, Pediatric Radiology, Ankara, TURKEY

PURPOSE

We questioned whether Nutcracker(NCS) Etiology etiology for pediatric varicocele is related with special diagnostic features and can predict a lower success rate after surgery in mid-term follow up.

MATERIAL AND METHODS

Records of 17 boys (mean age at diagnosis 158±38 months) with NCS and varicocele were retrospectively evaluated. Age,presenting symptoms and findings were recorded.All patients underwent subinguinal microscopic varicocelectomy and re-examined within last 6months before abstract submission to evaluate the mid-term(33±11months)postoperative status clinically and sonographically for recurrence and testicular volume.Catch-upgrowth was compared also in patients with significant pre-operative asymmetry.Semen analysis was performed in patients with TannerV.The results were compared with the results of 108 adolescents without NCS who underwent subinguinal microscobic varicoselectomy between 2007-2017 with unilateral left sided varicocele with a follow up of 79±28months. Indications for surgery in both groups were asymmetric testicular growth >20%, Peak Retrograde Flow (PRF) >35cm/s and pain with grade3 varicocele.We compared preoperative mean RPF of NCS associated and non-associated varicocele groups and its relation with postoperative recurrence.

RESULTS

Preoperative NCS patients had all grade3 varicocele and significantly higher mean PFR(median: 39 ±13cm/s)when compared to control(28±12cm/s).Whereas presence of testicular asymmetry was comparable in both groups.Recurrence confirmed with a postoperative PFR above 20 cm/s in DUS in NCS group was significantly higher.%of catch-up growth were similar in both groups.Results of postoperative semen analysis from 6 patients in NCS and 28 from control in terms on TMC were comparable.All NCS patients had at least one ofthe accompanying symptoms suchas abdominal pain, micro/macrohematuria, low BMIor orthostatic non-nephrotic-proteinuria.Presence and severity of these were not able to predict the recurrence in this group postoperatively.

CONCLUSIONS

NCS patients admit with a higher grade varicocele and PFR in DUS than a non-NCS group.Testicular asymmetry and catch-up growth are similar.There is a significantly higher postoperative recurrence rate. 


12:05 - 12:10
S14-2 (LO)

POST-PUBERTAL SELF-REPORTED OUTCOMES AFTER DISTAL HYPOSPADIAS TABULARISED INCISED PLATE (TIP) REPAIR COMBINED WITH PREPUTIAL RECONSTRUCTION (PR) VS. CIRCUMCISION: A NORM RELATED STUDY

Ludovica DURANTE 1, Marta BIANCO 2 and Marco CASTAGNETTI 3
1) University Hospital of Padova, Paediatric Urology, Padua, ITALY - 2) University Hospital of Padova, Pediatric Urology, Padua, ITALY - 3) University Hospital of Padova, Section for Paediatric Urology, Padova, ITALY

PURPOSE

We assessed post-puberal self-reported outcomes in patients undergoing TIP repair of primary distal hypospadias in combination with either PR or circumcision, in comparison to normal controls. Our hypotheses were that hypospadias patients had worse outcomes that normal controls, and that hypospadias patients undergoing PR fared better than those undergoing circumcision.

MATERIAL AND METHODS

Between 10/2001 and 09/2012, 498 patients underwent primary distal hypospadias repair. Inclusion criteria were age at surgery >10 years, TIP repair, and Tanner stage 2 or greater.

Validated self-administred questionnaires included 1. the HOSE, the PPPS, and the SIGHT score to asses penile appearance and patient satisfaction; 2. the Stark QoL to assess quality of life; and 3. the RQ to asses interpersonal relationships. 

Results were compared among patients undergoing TIP repair and  PR, those undergoing TIP repair and  circumcision, and normal age-matched controls.

RESULTS

During the study period, 208/498 patients underwent primary TIP distal hypospadias repairs, 83 (39.9%) were eligible for the study, and 41 completed the study (response rate 49,3%). Of these 41, 26 underwent PR and 15 circumcision. Median follow-up was 11.6 (range 5.2-16.2) years. The control group included 45 healthy boys.

Comparing the three groups, there was no statistically significant difference in cosmetic results, patient perception of penile appearance, and quality of life. Patients tended to perceive the aspect of their genitalia as embarrassing compared to normal controls (p=0.023) irrespective of preputial management. However, they showed less difficulties in starting social relationships compared to the control group (p=0,016).

CONCLUSIONS

Patients revaluated post-pubertally after TIP repair in childhood of primary distal hypospadias did not show a statistically significant difference in cosmetic results, patient perception of penile appearance, and quality of life compared to normal controls irrespective of preputial management. Gential appearance was perceived as a reason for embarrassment, but it did not seem to interfere with social skills.


12:10 - 12:13
S14-3 (PP)

PERSISTING COMPLICATIONS IN MEN TREATED FOR HYPOSPADIAS DURING CHILDHOOD

Sébastien FARAJ 1, Olivier BOUCHOT 2, Thomas LOUBERSAC 2 and Marc-David LECLAIR 3
1) Hôpital Mère-Enfant, Pediatric Surgery, Nantes, FRANCE - 2) CHU de NANTES, Adult Urology Dpt, Nantes, FRANCE - 3) Hôpital Mère-Enfant, Chirurgie Infantile, Nantes, FRANCE

PURPOSE

Hypospadias surgery during childhood may lead to persisting or recurring complications at adult age. We aimed to describe complications observed and treated in a cohort of adults with previously treated hypospadias.

METHODS

All patients referred from 2004 to 2016 to a adult urology university center for late or persisting urethral complications requiring surgical intervention were included. Anatomical, clinical and surgical history data from both childhood and postpubertal period were retrospectively reviewed.

RESULTS

A total of 31 patients underwent redo surgery for hypospadias complications at a median age of 36 years [19-87]. Initial position of meatus was anterior in 18, penile in 10 and posterior in 3. Several different procedures had been performed as initial surgical repair, with a majority of TIP. Fourteen patients (45%) had already required multiple redo-surgery during childhood.
Complications at adult age included distal (n=22) or proximal (at the level of bulbar urethra, n=6) urethral stenoses, residual chordee (n=2), urethral fistula, and urethrocele.
Various surgical procedures were performed at this stage. Recurring complications were observed in almost half of the patients (14/31, 45%), with a median delay of 4 years [1-7], including 13 uni- or bifocal stenoses in 11 men, fistulas (n=2), or stone on urethral hair (n=1). In total, stenosis of the bulbar urethra was observed in 8/31 men, either at initial adult presentation or as a complication of surgery at adult age. Of. note, 6/8 were initially distal hypospadias, and 5/8 had already undergone multiple procedures before puberty.

CONCLUSIONS

Persistent urethral strictures are not uncommon at adult age after childhood history of hypospadias. We observed an unexpected high number of proximal stenoses even in distal hypospadias, raising the suspicion that multiple surgeries and repeated urethral catheterizations may contribute to progressive proximal injury and acquired stricture upstream to the urethroplasty


12:13 - 12:16
S14-4 (PP)

SEXUAL AND PREGNANCY KNOWLEDGE AMONG TRANSITIONAL SPINA BIFIDA WOMEN: A PATIENT-BASED SURVEY ANALYSIS

Anna BUJONS 1, Guilherme LANG MOTTA 2, José Maria GARAT BARREDO 3 and Joan PALOU REDORTA 4
1) Fundació Puigvert Barcelona, Paediatric Urology, Barcelona, SPAIN - 2) Hospital de Clínicas de Porto Alegre, Porto Alegre, BRAZIL - 3) Fundació Puigvert Barcelona, Urology Department, Barcelona, SPAIN - 4) Fundació Puigvert Barcelona, Barcelona, SPAIN

PURPOSE

Pregnancy remains under-investigated and debated among spina bifida (SB) patients. Some studies present data associating gestation in SB patients with higher rates of urinary complication. Thus, we performed this study to assess the educational status of SB young women about intimate care and pregnancy.

MATERIAL AND METHODS

A multicenter cross sectional survey based on personal interview among 253 SB patients was conducted at the Spanish SB Association centers on the cities of Barcelona, Madrid and Malaga. Among these, 126 female patients were asked about sexual and obstetrical themes and its relationship with their chronic condition.

RESULTS

Patients presented mean age of 25 years (range from 18 to 40) and 35.2% reported at least one sexual experience, which occurs regularly in 58.2%. However, only 50% of sexually active patients use a birth-control method and, among these, the preferences were: 58.8% condom, 23.5% hormonal contraceptives, 13.7% coitus interruptus or 3.9% calendar-based method. Besides, 37.2% claims that never had a gynecological evaluation, 8% did not know that they could have intercourse and 18% were uninformed about possibility of pregnancy. Among those who received sexual information, only 16.7% report that obtained it during their medical visits.

CONCLUSIONS

Our survey demonstrates the need to improve communication between health professionals and SB patients about sexuality and the gestacional risks. Since most of these patients follow regularly a transitional urological clinic, we believe that urologists are the most trained professionals to treat and counsel patients about this issue, yet many still don't discuss it with patients.


12:16 - 12:28
Discussion