5th Joint Meeting of ESPU-SPU - Virtual

S11: NEUROPATHIC BLADDER 1

Moderators: Matthieu Peycelon (France)

ESPU-SPU Meeting on Friday 24, September 2021, 15:10 - 16:04


15:10 - 15:13
S11-1 (SO)

★ A PROSPECTIVE, MULTICENTRIC, RANDOMIZED, DOSE-RANGING STUDY ON INTRADETRUSOR INJECTIONS OF BOTULINUM TOXIN TYPE A (IDIBTX-A) IN CHILDREN WITH NEUROGENIC BLADDER.

Juliette WARTELLE 1, Charline BISCHOFF 1, Nadia BOUDAOUD 1, Francesco LACONI 1, Didier AUBERT 2, Florence BASTIANI 3, Stephan GEISS 4, Remi BESSON 5, Catherine JOLLY 1, Maguelonne PONS 6 and Marie-Laurence POLI-MEROL 1
1) CHU Reims, Pediatric Surgery and Urology, Reims, FRANCE - 2) Centre Hospitalier Universitaire Saint Jacques, Pediatric Surgery and Urology, Besançon, FRANCE - 3) Hôpitaux Pédiatriques de Nice CHU - Lenval, Pediatric Surgery and Urology, Nice, FRANCE - 4) Hopital Louis Pasteur Pasteur, Pediatric Surgery and Urology, Colmar, FRANCE - 5) Centre Hospitalier Universitaire de Lille (CHU) Hôpital Jeanne de Flandre, Pediatric Surgery and Urology, Lille, FRANCE - 6) HOPITAL ESTAING, Pediatric Surgery and Urology, Clermont-Ferrand, FRANCE

PURPOSE

Evaluate the results of IDIBTX-A depending on the dose (full versus half dose) in children with neurogenic bladder.

MATERIAL AND METHODS

After institutional ethics review board approval, patients with confirmed neurogenic bladder were enrolled in the study with the following inclusion criteria: age ≥3 and ≤15 years, urinary incontinence, failure of prolonged oral anticholinergic therapy, and possibility to perform clean intermittent catheterization. The patients were randomized and divided in group 1 and 2, who received full and half dose of botulinum toxin respectively. Maximum detrusor pressure (mDP), Quality of Life, (QoL validated questionnaire) and incontinence (Schulte-Baukhol score) were evaluated before the injections (T0) and 1-4 months after (T1-T2). We performed the Wilcoxon test and we used the NPAR1WAY procedure on SAS/STAT system to compare the results between groups in the different phases of the follow-up.

RESULTS

We collected 29 patients from 5 centers, 14 were included in group 1 and 15 in group 2. No statistically significance in mDP was founded between groups at T0, T1 and T2 (p=0.0632, p=0.0529 and p=0.1048 respectively). Differences in modifications of mDP during the follow-up didn't have statistically significance comparing Group 1 and Group 2 at T1 and T2. (p= 0.7645 and 0.5709). Continence at T1 and T2 improved for all patients (p=0.002, p=0.03) but did not for each group separately (p > 0.05). Finally, all participants declare ameliorations in QoL after the treatment.

CONCLUSIONS

Half and full dose treatment shown same results: it means that risks of side effects and impact on public health cost could be halved.


15:13 - 15:16
S11-2 (SO)

SYSTEMATIC SONOGRAPHIC BLADDER VOLUME MEASUREMENTS AT EVALUATION FOR AND DIRECTLY AFTER FETAL MYELOMENINGOCELE REPAIR - IS BLADDER FUNCTION PREDICTABLE?

Ladina VONZUN 1, Luca MAZZONE 2, Ulrich MOEHRLEN 3, Martin MEULI 4, Roland ZIMMERMANN 5, Nicole OCHSENBEIN-KÖLBLE 5 and Maya HORST 6
1) University Hospital Zürich, Department of Obstetrics, Center for Fetal Diagnosis and Therapy, Zurich, SWITZERLAND - 2) University Children's Hospital Zurich, Surgery, Department of Pediatric Urology, Spina Bifida Center, Zurich, SWITZERLAND - 3) University Children's Hospital Zurich, Department of Pediatric Surgery, Zurich Center for Fetal Diagnosis and Therapy, Zurich, SWITZERLAND - 4) University Children's Hospital Zurich,, Department of Pediatric Surgery, Zurich Center for Fetal Diagnosis and Therapy, Zurich, SWITZERLAND - 5) University Hospital Zurich, Department of Obstetrics, Zurich Center for Fetal Diagnosis and Therapy, Zurich, SWITZERLAND - 6) University Children's Hospital Zurich, Pediatric Urology, Spina Bifida Center, Zurich, SWITZERLAND

INTRODUCTION

Current data suggest a possible benefit in bladder function after fetal myelomeningocele (fMMC) repair compared to the postnatal intervention. However, it is not known what effect the repair has on fetal bladder function and whether there are predictive factors that could be seen sonographically. The aim of this study was to evaluate predictability of fetal bladder function at evaluation for and directly after fMMC repair.

PATIENTS AND METHODS

We retrospectively analyzed the sonographic bladder volume measurements of 28 fetuses at evaluation for and directly after fMMC repair. Statistical analysis was performed comparing two groups: group 1 (N=11) with neuropathic bladder dysfunction (NBD) and group 2 (N=17) children with normal bladder function postnatally. Data is presented as mean+/-SD. Statistical significance was indicated at p <0.05.

RESULTS

At evaluation for fMMC repair the fetal bladder volume was significantly lower in group 1 compared to group 2: 0.5±0.5 ml vs. 1.0±0.6ml (p =0.03) with comparable fetal weights: 555±134g vs. 620±190g (p=0.34). Directly after surgery the fetal bladder volume was still smaller in group 1 compared to group 2: 2.5±1.9ml vs. 4.5±2.5ml (p=0.05) with comparable fetal weights: 681±126 vs. 709±152g (p=0.6). No patient developed urinary retention.

CONCLUSIONS

The presented data show a predictability of fetal bladder function by ultrasound at evaluation for and directly after fMMC repair thereby adding an extremely valuable information to the counseling of the parents. Nevertheless, this cohort is small and reproducibility has to be proven in bigger cohorts.


15:16 - 15:19
S11-3 (SO)

IMPLEMENTING AN ENHANCED RECOVERY PATHWAY IN CHILDREN UNDERGOING BLADDER RECONSTRUCTION

Yvonne Y. CHAN 1, Soojin KIM 2, Nicholas E BURJEK 3, Megan A. BROCKEL 4, Josephine HIRSCH 1, Ilina ROSOKLIJA 1, Mehul V. RAVAL 5, Kyle O. ROVE 6, Elizabeth B. YERKES 1, Abbey STUDER 7 and David I. CHU 1
1) Ann & Robert H. Lurie Children's Hospital of Chicago, Urology, Chicago, USA - 2) University of British Columbia, Urologic Sciences, Vancouver, CANADA - 3) Ann & Robert H. Lurie Children's Hospital of Chicago, Anesthesia, Chicago, USA - 4) Children's Hospital Colorado, Anesthesiology, Aurora, USA - 5) Ann and Robert H. Lurie Children's Hospital of Chicago, Surgery, Chicago, USA - 6) Children's Hospital Colorado, Urology, Aurora, USA - 7) Ann & Robert H. Lurie Children's Hospital of Chicago, Clinical Effectiveness and IMP, Chicago, USA

PURPOSE

Implementation of an enhanced recovery pathway (ERP) is a safe and effective way to improve the recovery of children undergoing bladder reconstruction. However, it has not been widely adopted in pediatric urology. To improve the post-surgical recovery process of children undergoing bladder reconstruction, we implemented an ERP as a quality improvement initiative at a single, free standing children's hospital. Herein we report our approach to implementation and preliminary results.

PATIENTS AND METHODS

We first met with pediatric practitioners with ERP experience to understand potential implementation barriers. We then held stakeholder meetings to engage anesthesiologists, nurses, case managers, and other ancillary staff in drafting our institution-specific pathway. We generated a standardized order set to improve pathway adherence. The pathway has been continuously refined with stakeholder feedback and audit results before and after implementation.

RESULTS

We implemented ERP in seventeen patients undergoing bladder reconstruction (median age 10.6 years, range 4-21). Median LOS was 4 days (range 4-30). A median of 14 (range 11-19) of 20 elements were implemented for each patient. The median LOS is decreased compared to a historical cohort (n=17, median age 10.2 years, range 3.5-25) with median LOS of 9 days after surgery.

CONCLUSIONS

Open communication and early stakeholder involvement were critical to implementation. Integration of resources of the electronic medical record improves ease in implementation. Early pathway adherence is encouraging and has positively impacted LOS. Further follow-up is necessary to evaluate the impact on patient-centered and patient-reported outcomes. Audit results and stakeholder feedback will continue to improve future adherence.


15:19 - 15:28
Discussion
 

15:28 - 15:31
S11-4 (SO)

CAUSES OF DEATH AMONG PEOPLE WITH SPINA BIFIDA DUE TO MYELOMENINGOCELE: A MULTI-INSTITUTIONAL INTERNATIONAL RETROSPECTIVE STUDY

Konrad SZYMANSKI 1, Cyrus M. ADAMS 1, Mohammad ALKAWALDEH 2, Paul F. AUSTIN 3, Robin M. BOWMAN 4, Heidi CASTILLO 5, Jonathan CASTILLO 5, David I. CHU 6, Carlos R., Jr. ESTRADA 2, Michele FASCELLI 7, Dominic C. FRIMBERGER 8, Patricio C. GARGOLLO 9, Dawud G. HAMDAN 10, Sarah L. HECHT 11, Betsy HOPSON 12, Douglas A. HUSMANN 9, Micah A. JACOBS 13, Andrew E. MACNEILY 14, Daryl J. MCLEOD 15, Peter D. METCALFE 16, Theresa MEYER 6, Rosalia MISSERI 1, Joseph O'NEIL 17, Adam J. RENSING 8, Jonathan C. ROUTH 18, Kyle O. ROVE 11, Bruce J. SCHLOMER 13, Isaac SHAMBLIN 12, Rebecca L. SHERLOCK 2, Gennady SLOBODOV 8, Jennifer STOUT 18, Stacy T. TANAKA 19, Dana A. WEISS 10, John S. WIENER 18, Hadley M. WOOD 7, Elizabeth B. YERKES 6 and Jeffrey BLOUNT 12
1) Riley Hospital for Children at IU Health, Division of Pediatric Urology, Indianapolis, USA - 2) Boston Children's Hospital, Department of Urology, Boston, USA - 3) Texas Children's Hospital, Division of Urology, Houston, USA - 4) Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Neurosurgery, Chicago, USA - 5) Texas Children's Hospital, Section of Developmental Pediatrics, Houston, USA - 6) Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Urology, Chicago, USA - 7) Glickman Urological and Kidney Institute Cleveland Clinic Foundation, Department of Urology, Cleveland, USA - 8) Oklahoma University Medical Center, Department of Urology, Oklahoma City, USA - 9) Mayo Clinic, Department of Urology, Rochester, USA - 10) Children's Hospital of Philadelphia, Division of Urology, Philadelphia, USA - 11) Children's Hospital Colorado, Department of Pediatric Urology, Aurora, USA - 12) University of Alabama at Birmingham, Department of Neurosurgery, Birmingham, USA - 13) University of Texas Southwestern Medical Center, Department of Urology, Dallas, USA - 14) University of British Columbia, Department of Urologic Sciences, Vancouver, CANADA - 15) Nationwide Children's Hospital, Section of Pediatric Urology, Columbus, USA - 16) University of Alberta, Department of Surgery, Edmonton, CANADA - 17) Riley Hospital for Children at IU Health, Section of Developmental Pediatrics, Indianapolis, USA - 18) Duke University, Division of Urologic Surgery, Durham, USA - 19) Vanderbilt University Medical Center, Division of Pediatric Urologic Surgery, Nashville, USA

PURPOSE

To analyze causes of death in people with myelomeningocele (MMC).

MATERIAL AND METHODS

Retrospective review at 16 institutions in Canada and United States of a non-random convenience sample of people with MMC (born >=1972).  Data were obtained from medical records, families, obituaries, death certificates.  “Unexplained deaths” were defined as unexpected deaths while asleep, without attributable known cause.  Non-parametric tests were used.

RESULTS

Over 47 years, 316 deaths were identified at participating institutions (85.1% shunted hydrocephalus/8.2% unshunted/6.6% unknown, 10.4% community ambulators).  Deaths occurred in infancy (15.2%), in later childhood (35.8%), adulthood (49.0%).  Causes of death were documented in 74.1%.

 

Leading causes of death for 269 people with shunted MMC were infections (33.1%, including shunt infections: 4.1%), non-infectious shunt malfunction (15.2%), non-infectious pulmonary disease (6.3%).  For 26 people with unshunted MMC, deaths were due to infections (23.1%), non-infectious pulmonary disease (15.4%), congenital and non-congenital cardiovascular disease (11.5% each).  For 21 people with unknown shunt status, 42.9% of deaths were due to infections.

 

Deaths from infections were more common among adults than children (40.0% vs. 26.1%, p=0.01).  Overall, 4.4% of deaths were unexplained.  These were not significantly associated with age, shunt status or epilepsy (p>=0.57).  Urology-related deaths (grouping causes: urosepsis, renal failure, hematuria, bladder perforation, bladder cancer) occurred in 9.5%.

CONCLUSIONS

While causes of death varied by shunt status in people with MMC, infections were the leading cause of mortality.  About 10% of deaths were urology-related and 26% of deaths had an unknown cause.  These findings underline the need for life-long multidisciplinary care and accurate documentation of mortality data.


15:31 - 15:34
S11-5: Withdrawn (author request)
 
15:34 - 15:37
S11-6: Withdrawn (video presentation not uploaded)
 

15:37 - 15:40
S11-7 (SO)

RISK FACTORS PREDICTING UPPER URINARY TRACT DETERIORATION IN CHILDREN WITH SPINAL CORD INJURY

Bulent ONAL 1, Elif Altinay KIRLI 1, Berin SELCUK 1, Derya BUGDAYCI 2, Gunay CAN 3 and Bulent CETİNEL 4
1) Istanbul University-Cerrahpaşa Cerrahpaşa School of Medicine, Urology, Istanbul, TURKEY - 2) Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Physical Medicine and Rehabilitation, Istanbul, TURKEY - 3) Istabul University-Cerrahpasa Cerrahpasa School of Medicine, Public Health, Istanbul, TURKEY - 4) Istanbul University-Cerrahpasa Cerrahpasa School of Medicine, Urology, Istanbul, TURKEY

PURPOSE

The aim of this study is to determine the risk factors predicting upper urinary tract (UUT) deterioration in children with spinal cord injury (SCI). 

MATERIAL AND METHODS

Medical records of 108 children with SCI who referred to our unit between 1996 and 2018 were retrospectively reviewed. The data included general patient demographics, SCI characteristics, bladder management methods, serum creatinine level, presence of urinary tract infection, indwelling catheter time, radiological findings of the upper and lower urinary tract (LUT), and video-urodynamic (VUD) findings. The univariate and multivariate analyses were used to determine the risk factors predicting UUT deterioration. ROC analysis was done to determine the cutoff values of maximum detrusor pressure during filling and bladder volume ratio (BVR) to predict UUT deterioration. 

RESULTS

Complete data were available on 76 children. The median patient age was 15 years (2-17). The leading causes of SCI were motor vehicle accidents (44%) and fall (33%). UUT deterioration was determined in 33 patients (43%). Iatrogenic SCI etiology, abnormal radiological LUT findings, and detrusor pressures greater than 70 cmH2O were found to be independent risk factors for UUT deterioration in logistic regression analysis. Additionally, ROC analysis revealed that BVR less than 0.7 were cutoff values for UUT deterioration in children with SCI. 

CONCLUSIONS

Abnormal radiological LUT findings, iatrogenic SCI etiology, detrusor pressures greater than 70 cmH2O, and BVR less than 0.7 were risk factors predicting UUT deterioration in children with SCI.


15:40 - 15:43
S11-8 (SO)

UROLOGICAL COMPLICATIONS IN CHILDREN WITH MENKES DISEASE: A CHALLENGING MANAGEMENT FOR PEDIATRIC UROLOGIST

Giovanni MOSIELLO 1, Diego MARTINELLI 2, Elsa BEVIVINO 2, Maria Luisa CAPITANUCCI 1, Alberto LAIS 1, Antonio ZACCARA 1 and Carlo DIONISI VICI 2
1) BAMBINO GESU' PEDIATRIC HOSPITAL, UROLOGY- NEURO-UROLOGY, Rome, ITALY - 2) BAMBINO GESU' PEDIATRIC HOSPITAL, PEDIATRIC METABOLIC DISEASE, Rome, ITALY

PURPOSE

Menkes Disease (MD)  is a very rare X-linked recessive disorder of copper (Cu) metabolism, incidence 1:254000 live born babies. The clinical spectrum is wide and complications are related to complications in Cu transports, resulting in progressive neurodegeneration , connective tissue abnormalities.In natural history death occurs mainly from 3 years of age, longer survival is now described reflecting improvements in medical and nutritional management. Because urological complications are commonly reported, aim of our paper is retrospectively review our urological management and outcome in survival.

PATIENTS AND METHODS

15 children with MD have been evaluated in our centre . All patients have been evaluated for age at diagnosis, urological complications, urological surgical procedure, surgical complications, follow-up.

RESULTS

Mean age at diagnosis was 11 months. Bladder diverticula have been described in 11, bladder dysfunction in 9, urinary tract infection in 9, hydronephrosis in 5, vesicoureteral reflux in 4. CIC has been suggested in 9, only. 2 regularly performe. Button cistostomy has been the most common surgical procedure , 5 cases, well effective in 3 ( percutaneous access) ,  1 patient reported button dislocation and 1 wound dehiscence (open access). 2 patients were operated with surgical cistostomy, 1 with nephrostony. In 2 Diverticula excision have been performed. 4 patients have been lost at follow-up, 2 died for MD, 9 are still alive, mean 7.3years.

CONCLUSIONS

Our series is the largest describing urological complications in MD. Urological complications are very common  presenting early in life, 1yrs, always increasing with  during  time. Bladder diverticulae is the most common finding. Urological imaging is mandatory , including serial renal US control and VCUG, for an adequate urological treatment preserving renal function. Early bladder management using CIC must be the first line treatment, when CIC is no effective button cistostomy or vesicostomy coils be useful in all, while surgical treatment of diverticula is required in very selected cases .


15:43 - 15:46
S11-9: Withdrawn (author request)
 
15:46 - 16:04
Discussion