5th Joint Meeting of ESPU-SPU - Virtual

S9: ADOLESCENT UROLOGY

Moderators: Lane Palmer (USA)

ESPU-SPU Meeting on Friday 24, September 2021, 13:00 - 13:55


13:00 - 13:03
S9-1 (SO)

GONADAL FUNCTION AND REPRODUCTIVE SYSTEM ANATOMY IN POST- PUBERTAL PRUNE-BELLY SYNDROME PATIENTS

Roberto LOPES, Alessandro TAVARES, Francisco DÉNES and Marcello COCUZZA
University of São Paulo Medical School, Urology, São Paulo, BRAZIL

PURPOSE

Prune belly syndrome (PBS) is characterized by abdominal wall flaccidity, variable urinary tract dilatation and bilateral intra-abdominal cryptorchidism. No spontaneous paternity has been reported to date and infertility is usually taken for granted. Our objective was to gain insight into the causes of infertility in PBS by evaluating reproductive system anatomy and gonadal function in a cohort of post pubertal PBS patients.

MATERIAL AND METHODS

We contacted all PBS patients 14 years-old or older treated and followed at our institution. Age at orchiopexy, type of orchiopexy (with or without ligation of gonadal vessels), testicular volumes and positions. Pelvic MRI to evaluate prostate size, seminal vesicles and vas and hormonal profile were ordered. Sperm analysis and analysis of urine after masturbation were performed after informed consent.

RESULTS

Fifteen patients were included in this study. Mean age was 19.2 years. Mean age at orchiopexy was 18 months. Fourteen patients (93.3%) had normal and topic testes. Mean testicular volume was 6.9 cc. Eight patients collected semen, five of them (62.5%) had spermatozoa in the specimen and motile sperm was found in 4 (50%). Mean hormone levels were LH: 5.3 mg/dl, FSH:6.9 mg/dl, testosterone 531 mg/dl. MRI revealed hypoplastic prostates in 66.6% and unilateral seminal vesicle absence in 66.6%. No vasal abnormality was noted. 

CONCLUSIONS

Patients with PBS may have normal sexual hormonal levels. Motile spermatozoa were found in half of the patients. Our study highlights a high prevalence of prostate and seminal vesicle abnormalities that may represent an important cause for their infertility.


13:03 - 13:06
S9-2 (SO)

OAB PREVALENCE AND RISK FACTORS IN YOUNG ADULTS IN MAINLAND CHINA

Yu LIANG 1, Jian Guo WEN 2, Huijie HU 3, Zhenwei ZHANG 4, Qifeng DOU 5, Cuiping SONG 1, Feng REN 6, Chengbiao LU 6 and Soren RITTING 7
1) First Affiliated Hospital of Xinxiang Medical University, Pediatric Surgery, Xinxiang, CHINA - 2) Xinxiang Medical University, First Affiliated Hospital of Xinxiang Medical University,, Xinxiang, CHINA - 3) Xinxiang Medical University, Nursing School, Xinxiang, CHINA - 4) Third Affiliated Hospital of Xinxiang Medical University, Department of Urology, Xinxiang, CHINA - 5) First Affiliated Hospital of Xinxiang Medical University, Department of Urology, Xinxiang, CHINA - 6) Xinxiang Medical University, School of Basic Medical Sciences, Xinxiang, CHINA - 7) Aarhus University Hospital, Pediatrics and Adolescent Medicine, Aarhus, DENMARK

PURPOSE

The purpose of this study was to investigate the prevalence of overactive bladder (OAB) and its risk factors in Chinese young adults by surveying junior university 

MATERIAL AND METHODS

October 2018 to January 2019, 14,010 anonymous questionnaires were distributed to freshmen in two universities in China. The students were from all over the country. The questionnaire included general items such as sex, date of birth, height, weight, history of urinary tract infection (UTI), bowel symptoms and overactive bladder symptom score (OABSS). The OABSS is used to assess the presence and severity of OAB, which is defined when the score of urgency is ≥ 2, and the total score is ≥ 3. In addition, its relationship with many variables were evaluated.

RESULTS

Data of 13,083 (93.4%) subjects (4192 males and 8891 females) (age 19 ± 1.3 years) were eligible for final statistical analysis. The overall prevalence of OAB was 6.0% (788/13,083); 4.3% reported dry OAB, and 1.7% reported wet OAB. The prevalence of mild OAB was 5.6% and moderate OAB was 0.5%; no severe OAB was reported. The prevalence of OAB was more common in females than in males (6.7% vs. 4.7%, P < 0.05), and in subjects with constipation, the rates of anal prolapse, anal fissure, past history of UTI and nocturnal enuresis (NE) were increased (P<0.05).

CONCLUSIONS

OAB is common in Chinese young adults. Female sex, constipation, anal prolapse, anal fissure, past history of UTI and NE were risk factors for OAB.


13:06 - 13:09
S9-3 (SO)

ENLIGHTENING ACTIVITIES FOR TESTICULAR TORSION: RECOGNITION SURVEY AND SCHOOL LECTURE IN JAPANESE HIGH SCHOOL BOYS

Hiroshi ASANUMA, Yu TERANISHI, Kimiharu TAKAMATSU, Ryohei TAKAHASHI, Yota YASUMIZU, Nobuyuki TANAKA, Toshikazu TAKEDA, Kazuhiro MATSUMOTO, Shinya MORITA, Takeo KOSAKA, Ryuichi MIZUNO and Mototsugu OYA
Keio University, Urology, Tokyo, JAPAN

PURPOSE

Testicular torsion (TT) occurs most commonly during adolescence. Patient recognition of this condition could lead to early presentation and intervention, and salvage of the affected testicle.
The purpose of this study is to assess recognition and knowledge of TT in Japanese high school boys. We also evaluated their response to educational lecture of testicular health.

MATERIAL AND METHODS

We planned educational lecture of testicular health including acute scrotum in an urban boy's high school in Japan. An anonymous questionnaire survey for TT was administered before and after the lecture in 765 boys.

RESULTS

Seventy-six boys (9.9%) experienced a scrotal pain, and 48 boys (6.3%) had multiple episodes. One hundred twenty-one boys (15.8%) had a recognition of TT, however, only 48 boys (6.3%) had the knowledge of TT requiring emergent intervention, and 633 boys (82.7%) did not have a recognition of TT at all. If the boys had developed a scrotal pain or swelling, they would have been happy to tell their father (52.0%), close friends (38.8%), mother (37.4%), siblings (13.2%) or teacher (9.9%), however, 82 boys (10.7%) never would have liked to tell anyone because of their embarrassment for genitalia.
After attending the lecture, 724 boys (94.6%) answered to have a good knowledge of TT requiring emergent intervention. If the boys developed a scrotal pain or swelling, they would be happy to tell their family at home or teacher at school (57.5%), or close friends (16.7%) immediately, otherwise they would check it on a book or the Internet (20.7%).

CONCLUSIONS

Approximately 10% of high school boys experienced a scrotal pain, however, more than 80% of them did not have a recognition of TT at all. Enlightening activities for TT are necessary for not only schoolboys, but also their families and teachers. Educational lecture improved recognition and knowledge of TT in high school boys, and could help avoid possible testicular loss.


13:09 - 13:18
Discussion
 

13:18 - 13:21
S9-4 (SO)

LONG TERM FOLLOW-UP ON ADULTS THAT UNDERWENT HYPOSPADIAS REPAIR THROUGH URETHRAL ADVANCEMENT IN CHILDHOOD

Sharmila Devi RAMNARINE SANCHEZ, Alberto PARENTE HERNANDEZ, Alvaro ESCASSI GIL, Veronica VARGAS CRUZ, Maria Rosa IBARRA RODRIGUEZ and Rosa Maria PAREDES ESTEBAN
Reina Sofía University Hospital, Paediatric surgery, Cordoba, SPAIN

PURPOSE

To assess long-term results on voiding, sexual function, cosmetic appearance and psychological impact of adults gone through Urethral Advancement (UA) hypospadias repair in childhood.
 

MATERIAL AND METHODS

Patients over 14 years, who underwent UA hypospadias repair in our center (2000-2010), were evaluated. All patients presented mid-distal hypospadias with subcoronal-penile meatus and mild-moderate chordee. Penis cosmetic appearance, urinary and sexual function, body perception and overall satisfaction were assessed.

RESULTS

143 children underwent UA hypospadias repair (2000-2010). 36 patients, ages 14-27 years were evaluated. Penis cosmetic appearance was assessed using HOPE scale, with an average of 8.76 (SD +/- 0.98), which indicates a good aesthetic result.
Regarding voiding dysfunction symptoms, it was evaluated by the AUASI: 55.6% had mild symptoms and 19.4% moderate symptoms (nocturia, incomplete bladder emptying, polaquiuria). 75% void standing up and 91.7% void through the tip of the penis.
Only 38.9% of patients are sexually active, according the IIEF-15 scale, 2 had slight erectile dysfunction, and 77.8% had satisfactory relationships. The perception of all patients about their erection, was good-very good on 72.2%, but 5.6% considered it unsatisfactory.
Through the GPS, the body perception was assessed, being 88.9% positive-very positive. However, the perception of their genitals was positive-very positive only 77.8%, with a negative correlation between the perception of genitals/body in 13.9%.

CONCLUSIONS

In our series, results of sexual function, voiding, psychological repercussion, and cosmetic appearance, on mid-distal hypospadias patients gone through UA repair are satisfactory. It indicates that UA technique might be a valid option for mid-distal hypospadias repair when indicated


13:21 - 13:24
S9-5 (SO)

ENDOCRINE AND REPRODUCTIVE OUTCOME OF YOUNG ADULTS BORN WITH HYPOSPADIAS

Lloyd TACK 1, Ahmed MAHMOUD 2, Kelly TILLEMAN 2, Alexander SPRINGER 3, Stefan RIEDL 3, Ursula TONNHOFER 3, Manuela HIESS 3, Julia WENINGER 4, Erik VAN LAECKE 5, Piet HOEBEKE 5, Anne-Françoise SPINOIT 6 and Martine COOLS 1
1) Ghent University Hospital, Pediatrics, Gent, BELGIUM - 2) Ghent University Hospital, Andrology, Gent, BELGIUM - 3) Medical University of Vienna, Pediatric Surgery, Vienna, AUSTRIA - 4) Medical University of Vienna, Urology, Vienna, AUSTRIA - 5) Ghent University Hospital, Urology, Ghent, BELGIUM - 6) UNIVERSITY HOSPITAL GHENT, Urology, Ghent, BELGIUM

PURPOSE

An increased risk for reduced fertility and/or impaired testicular hormone synthesis has been seen in severe forms of hypospadias. However, the extent of this phenomenon and if milder forms are also affected, remains unclear. Aim of this study was to assess long-term endocrine and reproductive outcome after hypospadias repair in childhood.

MATERIAL AND METHODS

Prospective cross-sectional assessment of young adult men (16-21 years old) born with all forms of non-syndromic hypospadias as compared to age-matched cohort of healthy controls.

Blood sampling (taken in hospital 8:00-9:00 AM): total and free testosterone, LH, FSH and inhibin B. Two separate spermiograms, according to the WHO 2010 criteria. Statistical analysis: IBM SPSS© 25.0 as appropriate. Approval from ethics board: B670201835984.

RESULTS

Participants: 193 cases and 50 controls. No differences in testosterone and LH levels were seen between cases born with distal and proximal hypospadias, nor compared to controls. In contrast, FSH levels were higher and inhibin B lower in complex hypospadias as compared to isolated hypospadias and controls (FSH: p=0,004 and p<0,001; Inhibin B p<0,001 and p<0,001, respectively). Reduced semen concentration was found in 32 (18,8%) cases and 2 (4,0%) controls. Semen concentrations were similar in distal and proximal hypospadias (p=0,214). However, only proximal and complex hypospadias cases had lower sperm concentrations as compared to controls (p=0,022 and p<0,001, respectively).

CONCLUSIONS

Almost 20% of men born with hypospadias have a reduced semen quality. In contrast to previous studies, proximal and distal hypospadias cases had similar semen concentrations. No difference in testosterone or LH levels was found between cases and controls.


13:24 - 13:27
S9-6 (SO)

PSYCHOSEXUAL OUTCOME OF ADULT MEN FOLLOWING CHILDHOOD HYPOSPADIAS REPAIR

Lloyd TACK 1, Eline VAN HOECKE 2, Alexander SPRINGER 3, Stefan RIEDL 3, Ursula TONNHOFER 3, Manuela HIESS 3, Julia WENINGER 4, Erik VAN LAECKE 5, Piet HOEBEKE 5, Anne-Françoise SPINOIT 5 and Martine COOLS 1
1) Ghent University Hospital, Pediatrics, Gent, BELGIUM - 2) Ghent University Hospital, Pediatric Psychology, Gent, BELGIUM - 3) Medical University of Vienna, Pediatric Surgery, Vienna, AUSTRIA - 4) Medical University of Vienna, Urology, Vienna, AUSTRIA - 5) Ghent University Hospital, Urology, Ghent, BELGIUM

PURPOSE

Few studies have been performed on the long-term patient satisfaction or psychosexual outcome following hypospadias surgery.  The aim of this series was to assess the psychosexual outcome of men who underwent hypospadias repair in childhood.

MATERIAL AND METHODS

Prospective cross-sectional assessment of young adult men (16-21 years old) born with all forms of non-syndromic hypospadias as compared to age-matched healthy controls. Participants filled in five questionnaires: the Decision Regret Scale (DRS), Penile Perception Score, Sexual Quality of Life – Male, International Index of Erectile Function and a custom-made questionnaire. The DRS and custom-made questionnaires were also completed by the participants’ parents. Genital examination using the Hypospadias Objective Penile Evaluation (HOPE). Statistical analysis: IBM SPSS© 25.0 as appropriate. Approval from ethics board: B670201835984.

RESULTS

Participants: 193 hypospadias cases and 50 controls. Satisfaction regarding their penile appearance and the number of penile surgeries were significantly associated with the opinion of cases and their parents about hypospadias repair and the psychosexual outcome. No associations with erectile function were found. Based on HOPE, most men are more satisfied about their penile appearance than the physician (p=0,033). Eighty percent of men were satisfied with having had childhood hypospadias repair, even though they had not been able to consent to surgery themselves. Erectile and ejaculation problems were present in approximately 10% of cases.

CONCLUSIONS

Very few patients regret having had hypospadias surgery in childhood. Uncomplicated hypospadias surgery results in equal psychosexual outcome as controls and in high satisfaction rates; multiple surgeries are a risk factor for poorer outcomes. Addressing erectile and sexual function should be considered at the postpubertal follow-up.


13:27 - 13:30
S9-7 (SO)

UROLOGICAL OUTCOME OF YOUNG ADULTS FOLLOWING CHILDHOOD HYPOSPADIAS REPAIR

Lloyd TACK 1, Manuela HIESS 2, Alexander SPRINGER 3, Stefan RIEDL 3, Ursula TONNHOFER 3, Julia WENINGER 4, Erik VAN LAECKE 5, Anne-Françoise SPINOIT 6, Martine COOLS 1 and Piet HOEBEKE 5
1) Ghent University Hospital, Pediatrics, Gent, BELGIUM - 2) Medical University of Vienna, Vienna, AUSTRIA - 3) Medical University of Vienna, Pediatric Surgery, Vienna, AUSTRIA - 4) Medical University of Vienna, Urology, Vienna, AUSTRIA - 5) Ghent University Hospital, Ghent, BELGIUM - 6) Ghent University Hospital, Urology, Ghent, BELGIUM

PURPOSE

There is a general paucity of data regarding the long-term outcome of adults who had childhood hypospadias repair. The aim of this study was to evaluate long-term urological outcome of adult men who unerwent hypospadias repair during childhood.

MATERIAL AND METHODS

Prospective Cross-sectional assessment of young adult men (16-21 years old) born with all forms of non-syndromic hypospadias as compared to age-matched healthy controls. Urological examinations: uroflow, postmictional and testicular ultrasound and genital examination using the Hypospadias Objective Penile Evaluation. Statistical analysis: IBM SPSS© 25.0 as appropriate. Approval from ethics board: B670201835984.

RESULTS

Participants: 193 hypospadias cases and 50 controls. Approximately 20% had an abnormal miction curve compared to 4,1% of controls. However, only 2,6% of cases and 2,0% of controls had a clinically relevant postmictional residue. Eleven (5,7%) cases had a fistula, which was correlated with the total number of penile surgeries (ρ=0,209, p<0,001). A quarter of cases had residual hypospadias with no difference between proximal and distal hypospadias (p=0,311). Grade II or higher varicocele was over three times more frequent in cases than controls (p=0,021). Stretched penile length strongly correlated with the number of penile surgeries (ρ=-0,407, p<0,001). Testicular ultrasound revealed similar rates of microlithiasis in HS and controls (p=0,189). Testicular volume was only smaller in complex hypospadias cases (right: p=0,002; left: p<0,001).

CONCLUSIONS

Suboptimal urological outcome is a point of concern in young adults, who underwent hypospadias repair in childhood and warrants routine postpubertal urological revision. Frequent occurrence of high grade varicocele was found, though its cause remains unclear.


13:30 - 13:33
S9-8 (SO)

LONG-TERM FOLLOW-UP AFTER TREATMENT OF HYPOSPADIAS: RESULTS ON URINARY FUNCTION, SEXUALITY AND FERTILITY IN ADULTHOOD

Noemie BECQUART 1, Xavier DELFORGE 2, Philippe BUISSON 3 and Elodie HARAUX 3
1) CHU Amiens, Service d'urologie adulte et de transplantation, Amiens, FRANCE - 2) CHU Amiens, Chirurgie de l'enfant, Amiens, FRANCE - 3) CHU Amiens, Service de chirurgie de l'enfant, Amiens, FRANCE

PURPOSE

To evaluate the urinary function, sexuality and fertility of adults operated on for hypospadias in childhood. To compare the results according to the severity of hypospadias

MATERIAL AND METHODS

A single-center study evaluating prospectively men operated on for hypospadias at between January 1, 1980 and December 31, 1995. Clinical and auto-questionnaires data (IPSS, IIEF-15, SEAR) were collected in consultation. Urine flow, hormonal assessment, seminogram were performed.

RESULTS

Thirty-six men (32.7±6.5 years, 80.6% distal) were evaluated. Mean age of surgery was 3,9±3 ans. The complications on the foreskin were frequent (52%). The total rate of uretro-cutaneous fistula was 44.4% and 10 adults had a fistula. Half of the men described a spraying stream with seated urination, 42% had latent drops. Only 5 men (20%) wanted a revision. Three men (9%) had an obstructive profile on the IPSS and /or recurrent urinary tract infections.

None had erectile dysfunction, 48.6% complained of "dribbling" ejaculations. Satisfaction of sexual intercourse was better in distal forms (SEAR score: 81 vs 62 p<0,05). A residual curvature was frequent (55.6%) annoying in 1 case. Half of the men were satisfied with the appearance of their penis and their urination.

Nineteen men (54%) were fathers (1/ICSI). Hormonal assessment (18) were all normal. Minor seminogram abnormalities were found in 59% (0 azoospermia). A transition consultation would have been beneficial (67%).

CONCLUSIONS

Only the satisfaction of sexual intercourse was better for distal forms. The many complications (fistulas, curvature, deviated jet, ejaculation disorder) were often trivialized, and few men wanted care. However, a majority would have liked a transition consultation.


13:33 - 13:36
S9-9: Withdrawn (video presentation not uploaded)
 
13:36 - 13:54
Discussion