ESPU Meeting on Friday 10, June 2022, 17:40 - 18:25
17:40 - 17:43
S17-1 (OP)
Carolina BEBI 1, Marco BILATO 1, Michele GNECH 2, Erika Adalgisa DE MARCO 3, Dario Guido MINOLI 3, Irene PARABOSCHI 3, Emanuele MONTANARI 1, Luca BOERI 1, Irene FULGHERI 4, Gianantonio MANZONI 3 and Alfredo BERRETTINI 3
1) Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico - University of Milan, Urology Unit, Milan, ITALY - 2) PhD School in Reproduction and Development Sciences, University of Trieste, Trieste, ITALY - 3) Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Paediatric Urology Unit, Milan, ITALY - 4) Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico - University of Milan, Radiology, Milan, ITALY
PURPOSE
Antegrade sclerotherapy (Tauber) effectively treats varicocele. However, fluoroscopy exposes young males to radiation. We aimed to measure radiation exposure and surgical outcomes after Tauber surgery.
MATERIAL AND METHODS
We retrospectively analysed data from 251 patients. Dose area product (DAP) and fluoroscopy time were recorded. PCXMC software calculated the effective dose. Clinical recurrence was evaluated >6 months post-surgery. Descriptive statistics and linear regression tested the association between clinical predictors and radiation exposure.
RESULTS
Median (IQR) age and body mass index (BMI) were 14 (13-16) years and 20.1 (17.9-21.6) kg/m2. Five (2.1%) patients developed clinical recurrence and 3 (1.2%) developed complications. Median fluoroscopy time and DAP were 38.5 (e27.7-54.0) sec and 89.6 (62.5-143.9) cGy/cm2. Effective dose was 0.25 (0.17-0.42) mSv. Fluoroscopy time was higher in patients with collateral veins [41 (26-49) vs. 36 (31-61) sec, p=0.02]. Median amount of sclerosing agent (SA) used was 3 (3-4) ml. DAP was higher when SA >3ml were used [101.4 (65-183) vs. 80.5 (59-119) cGy/cm2; p<0.01). At Spearman’s correlation, patient’s BMI (rho 0.38, p<0.001) and operative time (rho 0.27, p<0.01) positively correlated with DAP. At univariable linear regression, age, BMI, operative time and SA >3ml were associated with DAP (all p<0.01). At multivariable linear regression, only BMI and operative time emerged as predictors of DAP, after accounting for age and SA >3ml.
CONCLUSIONS
Tauber procedure is safe and associated with low effective dose. Operative time and patient’s BMI independently predict higher radiation dose. Effort to reduce radiation exposure in young males should be made.
17:43 - 17:46
S17-2 (OP)
Aykut AKINCI 1, Murat Can KARABURUN 2, Eralp KUBILAY 2, Mehmet Fatih OZKAYA 2, Tarkan SOYGUR 1 and Berk BURGU 1
1) Ankara University Faculty of Medicine, Pediatric Urology, Ankara, TURKEY - 2) Ankara University Faculty of Medicine, Urology, Ankara, TURKEY
PURPOSE
We aimed to-determine whether elastography could-predict real catch-up-growth and distiguish it from intratesticular-edema after varicocele(VC)repair in-experimental prepubertal-rats.
MATERIAL AND METHODS
In group A&B an experimental-VC-model was successfully established by partially ligating left renal vein.Six-weeks after-surgical induction of-VC-model, all rats underwent second-laparotomy for ligation of the dilated-left-spermatic-vessels.Microscopic lymphatic-sparing- varicocelectomy was performed in Group-A.Patterns of testicular lymphatic drainage were examined using local injection of ink into the testicular parenchyma for each case.For Group B during the varicocele-repair,anastomotic region of the main-lymph trunk toward the testicular artery was also ligated to form a non-lymphatic-sparing varicocelectomy-model.GroupC was sham&each group consisted 25prepubertal Wistar-Albino-rats.Prior to VC-induction, before varicocelectomy and 6-weeks after varicocelectomy, bilateral testicular volumes&testicular elasticity of all were measured by shear-wave-elastography.Contralateral testes were used as control for each case. Orchiectomy&following histopathologic evaluation was done 6-weeks after varicocelectomy.
RESULTS
At 6-weeks after varcocelectomy,20 rats(%80) in Group-A and 23 rats(%92) in Group-B had statistically significant increase in testicular volume(p<.05). The mean increase in testis(VC-induced)size was measured as 18.7%&20.9%,respectively.In Group-A, the mean elasticity of the testis that underwent varicocelectomy was higher than GroupB. (1,99±0,56kPa vs.1,48±0,37kPa,p:0,019) The mean of divergence of elasticity from the contralateral control testes in Group-A was statistically significantly different than the Group-B. (0,29±0,14kPa vs.0,18±0,11kPa for Group-A and B,respectively).The histological findings showing higher incidence of edema in group-B supported the elastography findings.
CONCLUSIONS
Elastography can distinguish real catch-up-growth from intratesticular-edema&can answer the exact cause of testicular volume increase after prepubertal-varicoselectomy.
17:46 - 17:49
S17-3 (OP)
Adele RAYMO 1, Maria Camila SUAREZ ARBELAEZ 2, Isabella CABRERA 1, Cinthia GALVEZ 1, Daniel E. NASSAU 1, Andrew LABBIE 1, Rafael GOSALBEZ 1, Alireza ALAM 1 and Ranjith RAMASAMY 2
1) Nicklaus Children's Hospital, Pediatric Urology, Miami, USA - 2) University of Miami, Urology, Miami, USA
PURPOSE
Adolescent varicocelectomy is recommended when either an abnormal semen analysis (SA) or testicular volume discrepancy (TVD) ≥20% is present. However, TVD may occur in the healthy pediatric population. We hypothesized that lower than expected ultrasonographic TVD and total testicular volume (TTV) are indicative of poor semen parameters in adolescents with varicocele.
MATERIAL AND METHODS
We retrospectively identified by diagnosis-codes boys
RESULTS
A total of 107 patients were included in the study. The mean age at the time of the SA was 17.8 years (range of 14.2-21.5). TVD<20% was observed in 71 patients and TVD≥20% in 36 patients. TVD was not associated to any of the analyzed variables(table). Of 58 tanner 5 patients, 41 had TTV≥30cc and 17 had TTV<30cc. The mean TMSC and TVD for Tanner 5 boys with TTV≥30cc was 105.8±148.2 million and 10.5±17.3%, compared to 23.5±4.2 million and 16.2±20.3% for boys with TTV
| Variables | TVD<20% n=71 |
TVD≥20% n=36 |
p-value |
| Age at SA (years) | 17.8±1.36 | 17.5±1.31 | 0.22 |
| Varicocele grade 2 3 |
24 47 |
12 24 |
0.96 |
| Sperm-concentration (millions) | 49.2±53.8 | 59.1±86.2 | 0.47 |
| TMSC (millions) | 74.1±120.1 | 72.5±111.2 | 0.47 |
| Varicocelectomy | 18 | 11 | 0.56 |
CONCLUSIONS
In this cohort of Tanner 5 patients with varicocele, TTV
17:49 - 17:52
S17-4 (OP)
Elisa CERCHIA 1, Elisa ZAMBAITI 2, Riccardo GUANA' 2, Giulia GIANNOTTI 3, Dalia GOBBI 4, Valeria BUCCI 5, Maurizio CHELI 3, Paola MIDRIO 4, Pier Giorgio GAMBA 6, Fabio Salvatore CHIARENZA 5, Fabrizio GENNARI 2 and Simona GEROCARNI NAPPO 1
1) Regina Margherita Children's Hospital, Pediatric Urology, Turin, ITALY - 2) Regina Margherita Children's Hospital, Pediatric Surgery, Turin, ITALY - 3) ASST Papa Giovanni XXIII, Pediatric Surgery, Bergamo, ITALY - 4) Ospedale Ca' Foncello, Pediatric Surgery, Treviso, ITALY - 5) Ospedale San Bortolo, Pediatric Surgery, Vicenza, ITALY - 6) University Hospital of Padova, Pediatric Surgery, Padova, ITALY
PURPOSE
During Covid-19 pandemic an alarming delay in diagnosis of non-Covid related diseases has been recorded, even in pediatric patients. Aim of the study was to investigate whether children with a testicular torsion had a delayed presentation and treatment during Covid pandemic.
MATERIAL AND METHODS
A multicentric retrospective study was conducted in six Paediatric Surgery and Urology Units, in a high COVID19 incidence area. The medical records of all consecutive patients operated for testicular torsion in the period 03.2020- 01.2021 were reviewed. Primary outcomes were time from symptom onset to presentation at Emergency Department (T1), time from diagnosis to surgery (T2) and ischemic time (T3). Secondary outcomes were orchiectomy rate and post-operative testicular atrophy. Data of the first and second pandemic waves were compared with pre-Covid period. Fisher's exact, Mann Whitney and Kruskal Wallis test were used for statistics.
RESULTS
188 patients with acute testicular torsion were included, 89 in the pre-COVID-19 (pC) period and 99 during COVID-19 (dC). T1 was not different among the two populations (pC: 5,5 hours, dC: 6 hours, p 0.374), and similarly T2 (pC: 2,5 hours, dC: 2,5 hours, p 0.970) and T3 (pC: 8,2 hours, dC: 10 hours, p 0.655). T1 was <6 h in 46/99 patients (46%) pC and 45/89 patients (51%) dC (p = 0.88, Fisher's exact test). Subgroup analysis accounting for seasonality, confirm the absence of any difference. Orchiectomies rate was 23% (23/99) dC and 21% (19/89) pC (p = 0.861, Fisher's exact test) and rate of post-operative atrophy was 9% dC (7/76) and 14% pC (10/70), p=0,44, Fisher's exact test.
CONCLUSIONS
Unexpectedly, testicular torsion in a high morbidity pandemic area of Covid19 did not have a delayed referral, nor a delayed treatment. As a consequence, orchiectomy rate and post-operative atrophy were also not significantly increased.
17:52 - 17:55
S17-5 (OP)
Pauline LOPEZ 1, Thomas BLANC 2, Arthur LAURIOT DIT PREVOST 3, Pauline CLERMIDI 4, Alice FAURE 5, Sophie BRANCHEREAU 6, Coralie DEFERT 7, Etienne SUPPLY 8, Sébastien FARAJ 9, Marc CHALHOUB 10, Yann CHAUSSY 11, David LOUIS 12, Marie-Laurence POLI-MEROL 13, Annabel PAYE JAOUEN 1, Matthieu PEYCELON 1 and Alaa EL GHONEIMI 1
1) Department of pediatric surgery and urology, National Reference center for Rare Urinary Tract Malformations (MARVU), University Hospital Robert Debre, APHP, University of Paris, Paris, FRANCE - 2) Department of pediatric surgery and urology, National Reference center for Rare Urinary Tract Malformations (MARVU), University Hospital Necker, APHP, University of Paris, Paris, FRANCE - 3) Department of pediatric surgery and urology, National Reference center for Rare Urinary Tract Malformations (MARVU), University Hospital Lille, University of Lille, Lille, FRANCE - 4) Department of pediatric surgery and urology, National Reference center for Rare Urinary Tract Malformations (MARVU), University Hospital Armand Trousseau, APHP, Sorbonne University, Paris, FRANCE - 5) Department of pediatric surgery and urology, National Reference center for Rare Urinary Tract Malformations (MARVU), University Hospital of Marseille, APHM, Aix-Marseille University, Marseille, FRANCE - 6) Department of pediatric surgery and urology, National Reference center for Rare Urinary Tract Malformations (MARVU), University Hospital Bicêtre, APHP, Paris-Saclay University,, Le Kremlin Bicêtre, FRANCE - 7) Department of pediatric surgery and urology, National Reference center for Rare Urinary Tract Malformations (MARVU), University Hospital Rennes, Rennes1 University, Rennes, FRANCE - 8) Department of pediatric surgery and urology, National Reference center for Rare Urinary Tract Malformations (MARVU), University Hospital La Reunion, La Reunion University,, La Réunion, FRANCE - 9) Department of pediatric surgery and urology, National Reference center for Rare Urinary Tract Malformations (MARVU), University Hospital Nantes, Nantes University, Nantes, FRANCE - 10) Department of pediatric surgery and urology, National Reference center for Rare Urinary Tract Malformations (MARVU), University Hospital Toulouse, Toulouse III Paul Sabatier University, Toulouse, FRANCE - 11) Department of pediatric surgery and urology, National Reference center for Rare Urinary Tract Malformations (MARVU), University Hospital Besançon, Franche-Comté University, Bensançon, FRANCE - 12) Department of pediatric surgery and urology, National Reference center for Rare Urinary Tract Malformations (MARVU), University Hospital Dijon, Dijon Bourgogne University, Dijon, FRANCE - 13) Department of pediatric surgery and urology, National Reference center for Rare Urinary Tract Malformations (MARVU), University Hospital Reims, Reims Champagne-Ardenne University, Reims, FRANCE
PURPOSE
Surgical management of intra-abdominal testis in children with Prune Belly Syndrome (PBS) is challenging. Many controversies exist about the optimal surgical approach and timing for orchiopexy. The aim was to evaluate the long-term outcomes of orchiopexy in a large cohort of PBS patients.
MATERIAL AND METHODS
A national multicentric retrospective study identified all patients with a diagnosis of PBS between 1989 and 2020. Data were collected regarding type of surgical management (open versus laparoscopy), technique (one or 2-stage), age at surgery, and abdominoplasty timing. Main outcomes included testicular size and position. Statistical analysis: Fisher's test.
RESULTS
56 patients were included from 15 centers. 87 orchiopexies were performed at a median (IQR) age of 22(14-40) months. 71% of testes were pulled-down using a one-stage technique; 66% without spermatic vessels section. At a median follow-up of 10(6-18) years, 78% of patients had non-atrophic testes and 75% were palpable in the scrotum. There were no significant differences between one and two-stage procedures in terms of rate of non-atrophic testes (74% versus 88%) and of intra-scrotal position (73% versus 84%), p>0.05. Orchiopexy was performed during abdominoplasty in 33% and was not associated with worse outcomes (p>0.05).
CONCLUSIONS
This study shows that surgical procedures to correct intraabdominal testes of PBS patients are associated with comparable outcomes of orchiopexy in the general population. Of note, orchiopexy was performed at an older age than recommended by ESPU/AUA guidelines. To the best of our knowledge, this is the largest national cohort reporting surgical management of intra-abdominal testis in children with PBS. Further studies are required to assess testicular function in post-pubertal patients.
17:55 - 17:58
S17-6 (OP)
Anna MORANDI 1, Maria FANJUL 2, Barbara Daniela IACOBELLI 3, Inbal SAMUK 4, Dalia AMINOFF 5, Paola MIDRIO 6, Ivo DE BLAAUW 7, Eberhard SCHMIEDEKE 8, Alessio PINI PRATO 9, Wout FEITZ 10, Herjan VAN DER STEEG 7, Dario Guido MINOLI 11, C.E.J. Pim SLOOTS 12, Francesco FASCETTI LEON 13, Igor MAKEDONSKY 14, Araceli GARCIA 15 and Pernilla STENSTROM 16
1) Fondazione IRCCS Ca Granda -Ospedale Maggiore Policlinico, Paediatric Surgery, Milan, ITALY - 2) Hospital Gregorio Maranon, Paediatric Surgery, Madrid, SPAIN - 3) Bambino Gesù Children's Hospital-Research Institute, Rome, Italy, Medical and Surgical Neonatology Department, Newborn Surgery Unit, Rome, ITALY - 4) Schneider Children's Medical Center, Petah Tikva, affiliated with Sackler Faculty of Medicine,, Pediatric and Adolescent Surgery Department, Tel Aviv, ISRAEL - 5) Aimar, Italian Patients' and Parents' Organization for Anorectal Malformation, Rome, ITALY - 6) Cà Foncello regional Hospital, Paediatric Surgery, Treviso, ITALY - 7) Radboudumc Amalia Children's Hospital, Paediatric Surgery, Nijmegen, NETHERLANDS - 8) Klinikum Bremen Mitte, Clinic for Paediatric Surgery and Paediatric Urology, Bremen, GERMANY - 9) The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo,, Paediatric Surgery, Alessandria, ITALY - 10) Radboudumc Amalia Children's Hospital, Urology Department, Division of Paediatric Urology, Nijmegen, NETHERLANDS - 11) Fondazione IRCCS Ca Granda -Ospedale Maggiore Policlinico, Paediatric Urology, Milano, ITALY - 12) Erasmus MC-Sophia Children's Hospital, Paediatric Surgery, Rotterdam, NETHERLANDS - 13) University of Padua, Pediatric Surgery Unit, Women's and Children's Health Department, Padova, ITALY - 14) Rudnev Dnipropetrovsk Specialized Clinical Medical Center for Mother and Child Health, Paediatric Surgery, Dnipro, UKRAINE - 15) University Hospital 12 de Octubre, Paediatric Surgery, Madrid, SPAIN - 16) Lund University, Skane University Hospital,, Paediatric Surgery, Lund, SWEDEN
PURPOSE
Epididymo-orchitis (EO) may affect patients with anorectal malformations (ARM) leading to potential serious complications. Etiology in these patients is undefined, with no practical guidelines. The aim of our study was to investigate the current experience of the ARM-Net Consortium in the management of EO in patients with ARM, in order to identify specific risk factors and propose a diagnostic algorithm
MATERIAL AND METHODS
We retrospectively collected data of EO in patients with ARM between 2015 and 2019. Data on urological aspects, ARM type, surgical approach, associated anomalies, diagnosis, and treatment of EO were collected and analysed
RESULTS
Twenty-nine patients were reported by 12 Centers. Twenty-six patients with EO (90%) had ARM with rectourinary fistula. Median age at first EO was two years (range 15 days-27 years). Twenty patients (69%) experienced multiple EO, and 70% of recurrences were ipsilateral. Associated urological anomalies included vesicoureteral reflux (48%), urethral anomalies (41%), neurogenic bladder (41%), and ectopic vas (10%). A positive urine culture during EO was present in 69%. EO was treated with antibiotics (90%), limiting surgical exploration to 14%. Prevention of recurrences included surgery (bulking agents 15%, vasectomy 15% and orchiectomy 5%), and antibiotic prophylaxis (20%).
CONCLUSIONS
EO may occur and recur in ARM patients, with a high frequency of positive urine culture. An appropriate urologic work-up for most ARM-patients is necessary to identify and treat underlying risk factors. A practical scheme for the work-up is suggested for a close collaboration between Pediatric Surgeons and Urologists
17:58 - 18:01
S17-7 (OP)
Wang HUI 1, Huang YICHEN 1, Zhang YUE 2, Hu HUIYONG 3, Xie HUA 1, Lv YIQING 1, Li XAOXI 1 and Chen FANG 1
1) Shanghai Children's Hospital, Shanghai Jiaotong University, Department of Urology, Shanghai, CHINA - 2) Shanghai Jiao Tong University, School of Life Sciences and Biotechnology, Shanghai, CHINA - 3) Shanghai Children's Hospital, Shanghai Jiaotong University, Department of Ultrasound, Shanghai, CHINA
PURPOSE
To explore the predictive factors and establish a predictive model for the malignant testicular tumors in children.
MATERIAL AND METHODS
We retrospectively analyzed data for 120 consecutive patients with unilateral testicular tumors treated at a single institution from June 2014 to July 2020.The patients were divided into the benign (n=90) and the malignant (n=30) tumor groups based on the pathological diagnosis. Age, serum markers (serum alpha-fetoprotein (AFP), human chorionic gonadotropin) and tumor ultrasonic findings (maximum diameter, ultrasonic echo, blood flow signal) were recorded. Predictive factors were identified using descriptive statistical methods. A nomogram was established for preoperative prediction.
RESULTS
Patients with malignant tumors were younger (median age 14.5 vs. 34.0 months, P=0.017) and had higher incidence of the elevated AFP (90.0% vs. 2.2%, P<0.001). The ultrasonography indicated the malignant tumors tended to have larger maximum diameters (27.1±11.4 vs. 16.6±9.2 cm, P<0.001), more proportion of the hypoechoic masses (46.7% vs. 8.9%, P<0.001), and the high blood flow signal masses (93.4% vs. 5.6%, P<0.001). A nomogram based on age, AFP, and ultrasound blood flow signals effectively predicted the probability of malignant testicular tumors in children with an accuracy of 0.98 (95% confidence interval: 0.984-1.003).
CONCLUSIONS
A nomogram based on the age, AFP and ultrasound blood flow signal can effectively predict the probability of the malignant testicular tumors in children.