30th ESPU Congress - Lyon, France - 2019

S4: MISCELLANEOUS

Moderators: Jens Larsson (Sweden), Hanny Cobussen (Netherlands)

ESPU-Nurses Meeting on Friday 26, April 2019, 09:35 - 10:35


09:35 - 09:45
S4-1 (LO)

NURSING CARE AFTER CONGENITAL ADRENAL HYPERPLASIA (CAH) SURGERY: A RETROSPECTIVE EVALUATION OF 28 CASES.

Mathilde BRANDAO DOS SANTOS, Fatiha BACHIR, Marion GOUJET, Marie-Flore LECOINTRE, Chloé FIX, Tatiana BERNA, Marion BOUCAUD MAITRE, Marine GRONLIER, Anne-Claire BOUVIER, Daniela GORDUZA and Pierre MOURIQUAND
Hospices Civils de Lyon- Hopital Femme Mere Enfants, Service Urologie Pédiatrique, Bron Cedex, FRANCE

PURPOSE

To describe and evaluate a post-operative nursing care for genital surgery in CAH patients.

MATERIAL AND METHODS

Twenty eight patients with CAH, whose average age was 6 months, were submitted to genital reconstruction between 2008 and 2018 including: vaginoplasty, clitoral reduction for some and perineoplasty. All patients had a mermaid immobilization of the legs keeping a good access to the wound. A CH8 Foley bladder catheter was left in place for 10 days. Nursing care using aqueous chlorhexidine and saline was repeated 4 times daily. Antibiotic prophylaxis with Trimethoprim was maintained for 10 post-operative days.

RESULTS

All patients achieved a complete healing of the wound although a short dehiscence of the tip of the labia major was common, but without late consequences. Mid-term and late outcome was evaluated in all cases.

CONCLUSIONS

Informing parents on the current managements of CAH and accompany parents through this critical period with a team of paediatric nurses experienced in genital surgery along with a multidisciplinary medical team, is one essential part of this post-operative follow-up.


09:45 - 09:55
S4-2 (LO)

EFFECT OF CASTOR OIL AND PENILE PUMP ON COMPLICATION RATES IN CHILDREN UNDERGOING TWO-STAGE HYPOSPADIAS SURGERY

Halil TUĞTEPE 1, Arzu CANMEMIŞ 1, Ahsen KARAGÖZLÜ AKGÜL 1, Zeynep ÇALIKLI 2, Nicat VALIYEV 2, Tülay GÜRAN 3, Abdullah BEREKET 3 and Tolga DAĞLI 2
1) Marmara Pendik eğitim araştırma, Department of Paediatric Surgery-Division of Paediatric Urology, Istanbul, TURKEY - 2) Marmara Pendik eğitim araştırma, Department of Paediatric Surgery, Istanbul, TURKEY - 3) Marmara Pendik eğitim araştırma, Department of Paediatrics, Division of Paediatric Endocrinology, Istanbul, TURKEY

PURPOSE

Two-staged free preputial graft has recently increased in popularity for use in severe hypospadias repair. In this study, the aim was to evaluate the effect on complications of using castor oil and penile pump after 1st stage of two-stage repair with free preputial graft.

MATERIAL AND METHODS

Patients undergoing two-stage hypospadias repair between April 2013 and August 2018 were included in the study prospectively. In the study group, 14 days after 1st stage, castor oil was applied on the graft 3 times a day until 2nd stage in addition to use of penile pump. castor oil and pump was not used in the control group. Complications were compared between the two groups and Odds ratio was calculated.

RESULTS

There were 30 patients in study group and 21 patients in control group. The average age in study group at 1st and 2nd stage was 21.7months and 28.7months,and in control group  31.3 months and 39 months respectively. There were 3 patients with midshaft, 27 with penoscrotal, 18 with scrotal and 2 with perineal hypospadias. There was no statistical difference between ages, follow up times and hypospadias types between the two groups. Complications were seen in 11 patients (55%) in the control and 8 patients (26.6%) in the study group (p=0.07). Use of Indian Oil and penile pump had an Odds ratio of 0.38 (%95 CI 0.10-1.35).

CONCLUSIONS

Use of castor oil and penile pump in patients undergoing two-staged hypospadias repair reduces the complication rates. and protects from complications but this outcome did not reach statistical significance. Further studies with larger population are required.


09:55 - 10:05
S4-3 (LO)

THE IMPACT OF URINARY DIVERSION ON OUTCOMES IN PEDIATRIC RENAL TRANSPLANTATION PATIENTS WITH POSTERIOR URETHRAL VALVES

Mandy RICKARD 1, Fadi ZUBI 2, Martin KOYLE 2, Armando LORENZO 2 and Walid FARHAT 2
1) The Hospital for Sick Children, Division of Urology, Toronto, CANADA - 2) The Hospital for Sick Children, Toronto, CANADA

PURPOSE

Up to one third of patients with posterior urethral valves (PUV) will require a renal transplant (RT), however bladder function may be unpredictable. Assuring bladder drainage via a continent catheterizable (Mitrofanoff) channel may be indicated. Herein we review our series of patients with PUV and RT, comparing those with and without a Mitrofanoff.

MATERIAL AND METHODS

We reviewed our transplant database and extracted PUV patients(n=37) from 1995-2018, excluding 15 who underwent RT at our institution but were followed elsewhere. Variables included: late(>6m) vs.early presentation, symptomatic presentation (SP)(after urinary tract infection [UTI]), management of PUV, incontinence, UTIs, dialysis, donor type, and Mitrofanoff. Posttransplant variables included graft function, eGFR, creatinine, incontinence and UTIs.

RESULTS

Most children (77%) had an early/prenatal diagnosis and 23%a SP. Most(59%) were managed with ablation, 15% vesicostomy and27% with ablation+vesicostomy. Follow up was63+/-45 months, 36% developed a pretransplant UTI and 14%had incontinence. Mitrofanoff was performed in38%, all prior to RT and22% had an augmentation. When patients were divided into those with vs. without Mitrofanoff, we found significantly more SP children developed UTI and had a Mitrofanoff (67%)vs. 15% of prenatal patients (p=0.03), however there was no difference in posttransplant UTIs(Table 1)

Mitrofanoff (n=9) No Mitrofanoff (n=13) p value
Age (years) 12 +/- 4 9 +/- 6 .30
BSA 1.19 +/- 0.30 1.08 +/- 0.46 .52

PUV management

Ablation

Vesicostomy

Ablation+vesicostomy

4 (44)

1 (12)

4 (44)

9 (70)

2 (15)

2 (15)
.32
LateDx 3(33) 2(15) .61
SP 6(67) 2(15) .03
PreTx UTI 6(67) 2(15) .03
PostTx UTI 4(44) 1(8) .12
Dialysis 5(56) 7(54) 1.00

CONCLUSIONS

More PUV patients with SP required Mitrofanoff regardless of age at presentation, however posttransplant outcomes were the same. This finding may suggest that symptom development prior to diagnosis may have a more detrimental effect on bladder function.


10:05 - 10:15
S4-4 (LO)

COMMUNICATION ABOUT SEXUAL HEALTH IN RADBOUD AMALIA UNIVERSITY CHILDREN'S HOSPITAL

Jacqueline KNOLL, Karen KWAK, Barabara KORTMANN and Wout FEITZ
University hospital Radboud, Pediatric urology, Nijmegen, NETHERLANDS

PURPOSE

The aim of our project was to describe the current situation concerning communication with youngsters with a chronic disorder about sexual health (SH) and to study how it can be improved

MATERIAL AND METHODS

Qualitative research; data were collected by:

  1. Online focus groups  with youngsters and parents

  2. Interviews with healthcare professionals (HP)  in our and other Dutch hospitals, online questionnaires for pediatric nurses and  nurse practitioners

  3. Literature review

RESULTS

Youngsters and parents:

Both have the need to communicate and to receive information about SH in relation to the chronic disorder. They don’t receive information about SH on a regular base. They search on the internet, but there is less information available of SH in relation to the disorder. They expect that the HP will take the initiative, both don’t feel comfortable to initiate a conversation on the subject. Parents are aware of the influence of a chronic disorder on SH, but they find medical issues more important to discuss.

Healthcare professionals:

HC are aware that there’s a need to talk about SH , but don’t discuss it on a regular base. They like to pay more attention, but some find it a taboo, feel uncomfortable and irresponsible to discuss it and some are not always aware of the expectations of youngsters and parents.

CONCLUSIONS

Youngsters with a chronic disorder have the need to discuss SH and parents and HP's are aware of it, but there appear to be obstructing factors for implementation of regular communication about SH.  Tools are needed to resolve these factors.


10:15 - 10:25
S4-5 (LO)

CAN THE GASTROCOLIC REFLEX FACILITATE TOILET TRAINING FOR STOOL IN DIAPER DEPENDENT TODDLERS?

Tinne VAN AGGELPOEL 1, Hedwig NEELS 1, Stefan DE WACHTER 2 and Alexandra VERMANDEL 1
1) University Hospital Antwerp, Urology - Pelvic Floor Physiotherapy, Edegem, BELGIUM - 2) University Hospital Antwerp, Urology, Edegem, BELGIUM

PURPOSE

The aim of this study was to make use of the gastrocolic reflex in toddlers to facilitate defecation on the potty.

MATERIAL AND METHODS

Parents signed an informed consent and filled in a questionnaire about the health of the child and the progress of toilet training. During two weeks, once a day, parents were asked to let their toddler sit on a potty for 15 minutes after a randomly chosen meal.

RESULTS

29 toddlers (18 boys and 11 girls) participated, with a mean age of 24 months (SD=4). Parents tried on average 12 days to keep their child on the potty. Defecation happened on average 13 minutes after the meal (SD=8). All the attempts considered, only 41% (n=12) of the children defecated on the potty, on average 3 times (SD = 2,0). If a child had already defecated earlier that day, a significant relation with ‘not making stool' during the attempt on the potty was found (p=0,032). The most frequent shape of the feces was Bristol stool scale type 4. The odds of defecating were 0,45 less if the child was tested after dinner compared to breakfast and lunch.

CONCLUSIONS

Training the child after breakfast increases the chances of defecating on the potty. It is recommended to put the child 5 to 20 minutes after the meal on the potty in order to use the gastrocolic reflex. Introducing the potty to the child at an earlier age could facilitate the toilet training process for stool, but the moment of training needs to be chosen according to the moment that their child defecates mostly, not when parents have time. Testing the toddler after breakfast was favourable. Parents must be educated that eating or drinking could provoke the gastrocolic response in some toddlers and be informed about stool withholding behaviour, stool toileting refusal and functional constipation so toilet training can proceed smoothly.


10:25 - 10:35
S4-6 (LO)

CELL PHONE CAMERA URINE COLORIMETRIC ANALYSIS TO ESTIMATE HYDRATION STATUS: PILOT STUDY OF A POTENTIAL INEXPENSIVE, WIDELY AVAILABLE, ON-DEMAND TOOL

Mandy RICKARD 1, Jessica HANNICK 2, Darius BAGLI 1, Anne-Sophie BLAIS 1, Kristine TOMCZYK 1 and Armando LORENZO 1
1) The Hospital for Sick Children, Urology, Toronto, CANADA - 2) McMaster University, Surgery, Hamilton, CANADA

PURPOSE

Increased fluid intake has been shown to have a prophylactic effect against recurrent urine infections. In the pediatric population, however, it is difficult to measure and enforce adequate hydration. Herein we present pilot data using cell phone technology to assess pediatric hydration status.

MATERIAL AND METHODS

Random urine samples (n=12) obtained in a pediatric urology clinic from healthy individuals were placed in identical sterile containers. Equal volumes were photographed with a 12MP f/1.8 aperture 28mm camera at a standardized distance with a white background. RGB values were captured with a free app (BoxColor) in triplicate and converted to CIELAB color space values (www.nixsensor.com). Color difference (dE) between samples and reference (water) were calculated based on the 2000 International Commission on Illumination formula (brucelindbloom.com). Values were correlated with specific gravity (SG) determined by dipstick (Clinitek-50).

RESULTS

Sample specific gravity ranged 1005 – 1025, with minimal variation on repeat measures (equal RGB and CIELAB values). There was a strong positive correlation between SG and dE (correlation coefficient = 0.95). When compared to water, dE values were lowest with dilute urine (0.37-2.58; SG=1005) and largest with concentrated specimens (22-24.1; SG=1025). Average sample analysis took 57 seconds.

CONCLUSIONS

The use of free, widely-available software may allow health care providers and patients to employ cell phones to analyze body fluids for specific goals. This pilot study provides evidence that urine colorimetric assessment correlates with SG, which can be used as a surrogate for hydration status. If independently confirmed, these findings may generate innovative options to target recurrent infections in children.