ESPU Meeting on Saturday 11, June 2022, 08:30 - 09:25
08:30 - 08:33
S19-1 (OP)
Agnieszka PASTUSZKA 1, Tomasz KOSZUTSKI 1, Anita OLEJEK 2 and Jacek ZAMŁYŃSKI 2
1) Medical University of Silesia in Katowice, School of Medicine in Katowice,, Clinical Department of Children's Surgery, Department of Children's Surgery and Urology,, Katowice, POLAND - 2) Medical University of Silesia in Katowice, School of Medicine with Division of Dentistry in Zabrze, Department of Gyneacology, Obstetrics and Oncological Gyneacology, Bytom, POLAND
PURPOSE
It 's proved that Prenatal myelomeningocele (MMC) closure significantly reduces the need for hydrocephalus shunting, improves bladder and bowel function as wellas improving lower extremities motor function. The aim of study was to evaluate the chance for achieving social continence in children after prenatal and postnatal myelomeningocele repair.
MATERIAL AND METHODS
Clinical data were prospectively collected for all patients who underwent fetal or postnatal MMC repair. Assessments include degree of social urinary continence and constipations as well as renal and bladder ultrasound, VCUG, urodynamic study, occurrence of UTI's.
From the group of 146 patients who underwent prenatal MMC closure from 2005 to 2018, 55 patients with a postnatal follow-up of at least 3 years, were included in this study and compared with age-matched 55 MMC patients who underwent postnatal surgery. All children, regardless of the type of operation, had the same level of spina bifida and were managed according to the same protocol.
RESULTS
Urodynamic and imaging studies showed no differences between the groups.The incidence of neurogenic bladder dysfunction was similar. Children from the prenatal group showed statistically significant better urine contience in all age groups and among the oldest children group 96% achieved social continence. Prenatal group also showed statistically significant lower number of UTI's in all age groups and less frequent constipation when compared to postnatal group(p=0.005).
CONCLUSIONS
Prenatal MMC repair increases the chance of acheving social urine continence as the child grows older. It also reducing the risk of UTI and constipation.
Children operated prenatally can achieve in the future better quality of life, self-esteem and independence.
08:33 - 08:36
S19-2 (OP)
Antonio MACEDO JR 1, Hugo GANCHOZO 2, Paula CAMILATO 2, Gilmar GARRONE 2, Sergio OTTONI 2 and Marcela LEAL DA CRUZ 2
1) Federal University of Sao Paulo, Pediatrics, Sao Paulo, BRAZIL - 2) CACAU/NUPEP, Urology, Sao Paulo, BRAZIL
PURPOSE
In-utero MMC repair is still a topic of debate among different institutions in regards to bladder function.
MATERIAL AND METHODS
Since 2011 we prospectively follow MMC patients operated in utero. We selected patients with a minimum of 8 years of age and at least 2 urological evaluations. We compared the first and last UE and clinical outcomes.
RESULTS
We have identified 48 patients aged > 8 years, but only 34 filled the criteria defined. Our mean follow-up was 55.5 months. A VPS was done in 5.88% of cases. Mean age at first evaluation was 6.06 months. At initial presentation UTI was present in 29.4% and vesicoureteral reflux in 9.38%. High risk bladder pattern was found in 58.82% and incontinent pattern in 35.29% (Leal da Cruz categorization). CIC was initiated at 61.76% of patients. Maximal bladder pressure at cystometry (at peak contractions or baseline) was 62.38 cm H20. Detrusor overactive contractions were found in 79.41%. In follow-up, surgery was performed in 4 patients (11.76%): 3 augmentations, 2 ACE, 1 sling and 1 vesicostomy. Looking only at the 12 patients with sphincteric deficiency (LPP < 40cm H20), 7 remained fully incontinent on diapers (58.8%). None of the patients had renal scars.
CONCLUSIONS
This analysis confirms our statements that fetal MMC surgery offers limited improvement in bladder function compared to postnatal surgery. A secondary observation was that the "low-risk" pattern (incontinent pattern) is high-risk for future major bladder reconstruction to achieve continence.
08:36 - 08:39
S19-3 (OP)
Carlos DELGADO MIGUEL 1, Antonio MUÑOZ-SERRANO 1, Lucas MORATILLA 2, Virginia AMESTY 2, Susana RIVAS 2, Roberto LOBATO 2, María José MARTÍNEZ-URRUTIA 2 and Pedro LÓPEZ-PEREIRA 2
1) La Paz Children's Hospital, Pediatric Surgery, Madrid, SPAIN - 2) La Paz Children's Hospital, Pediatric Urology, Madrid, SPAIN
PURPOSE
Simultaneous performance of artificial urinary sphincter (AUS) placement and bladder augmentation (BA) in patients with neuropathic bladder is currently controversial. The aim of this study is to describe our very long-term results after 27-year experience.
MATERIAL AND METHODS
A retrospective single-center case-control study was performed in patients with neuropathic bladder treated in our institution between 1994-2020, in whom AUS placement and BA were performed simultaneously (SIM group) or sequentially at different times (SEQ group). Demographic variables, hospital length of stay (LOS), long-term outcomes and postoperative complications were compared between both groups.
RESULTS
A total of 39 patients (21 males, 18 females) were included, with a median age of 14.3 years. BA and AUS were performed simultaneously in 27 patients at the same surgical time, and in 12 cases in different interventions, with a median of 18 months between both surgeries. No demographics differences were observed. SIM group had a shorter median LOS when compared to SEQ group, considering the two sequential procedures (10 vs. 15 days; p=0.032). Median follow-up was 17.2 years (interquartile range 10.3-23.9). Four postoperative complications were reported, 3 patients in SIM group and 1 case in SEQ group, with no statistically significant differences between them (p=0.758). Adequate urinary continence was achieved in more than 90% of patients, without differences between both groups.
CONCLUSIONS
Simultaneous BA and AUS placement appears safe and efficacious in children with neuropathic bladder, with shorter LOS and no differences in postoperative complications or long-term outcomes when compared to performing the two procedures sequentially at different times.
08:39 - 08:42
S19-4 (OP)
Carlos DELGADO MIGUEL 1, Antonio MUÑOZ-SERRANO 1, Lucas MORATILLA 1, Susana RIVAS 2, Roberto LOBATO 2, María José MARTINEZ-URRUTIA 2 and Pedro LÓPEZ-PEREIRA 2
1) La Paz Children's Hospital, Pediatric Surgery, Madrid, SPAIN - 2) La Paz Children's Hospital, Pediatric Urology, Madrid, SPAIN
PURPOSE
Augmentation cystoplasty (AC) is a useful alternative for the treatment of neuropathic bladder, although there are scarce studies reporting very long-term results to date. Our aim is to report our experience in patients with at least 20 years of follow-up.
MATERIAL AND METHODS
A retrospective study was conducted in patients with neuropathic bladder in whom AC was performed in our institution between 1990-2000. Demographics, pre- and post- AC urodynamic studies, long-term outcomes and postoperative complications were collected.
RESULTS
A total of 55 patients (27 males and 28 females) underwent AC surgery with a median age of 11.9 years (interquartile range 7.5-14.3) and a median follow-up of 26.1 years (interquartile range 23.4-27.5). Bladder augmentation was performed with ileum in 41 cases (74.5%), sigma in 9 cases (16.4%) and ureter in 5 cases (9.1%). In 17 patients an artificial urinary sphincter (AUS) was placed at the same intervention. Mean preoperative bladder capacity was 116 ml (SD 35), which was increased to 452 ml (SD 64) one year after surgery, being this difference statistically significant (p<0.001). Vesico-ureteral reflux improved after AC in 70.1% patients with no other surgical interventions. Five mechanical complications associated with AUS were observed. Bladder lithiasis was reported in 5 patients. No bladder perforations were described. One patient developed bladder squamous cell carcinoma 16 years after AC, requiring radical cystectomy and Hautmann neobladder.
CONCLUSIONS
The very long-term results of this study demonstrate that AC is an effective treatment in neuropathic bladder children. Due to the risk of developing bladder squamous cell carcinoma, close follow-up is essential.
09:00 - 09:03
S19-5 (OP)
Can Utku BAKLACI 1, Aykut AKINCI 2, Tarkan SOYGUR 2 and Berk BURGU 2
1) Ankara University Faculty of Medicine, Urology, Ankara, TURKEY - 2) Ankara University Faculty of Medicine, Pediatric Urology, Ankara, TURKEY
PURPOSE
Sedoanalgesia is given to children who have intermittently undergone invasive urodynamic examination for the evaluation of neurogenic bladder in order to limit movement during the procedure for an optimal test. In this study,it was aimed to show that the use of VR technology reduces the need of sedoanalgesia by maintaining optimal test conditions.
MATERIAL AND METHODS
A total of 66children who were followed up with neurogenic bladder,applying CIC and underwent routine filling cystometry between August2020 and December2021,were included in the study.All patients were older than age of 6.The patients were randomized into three groups as sedoanalgesia,TV and VR groups.Filling cystometry was performed to sedoanalgesia group under sedoanalgesia,while the children in the TV group were watching TV and while the patients in the VR group were using VR glasses.Age, gender,number of artifacts during the procedure, maximum bladder capacity,and successful termination of the study were compared.
RESULTS
The demographic data of the patients were similar.10/22 patients in the TV group and in3/22 patients in the VR group could not adapt to the test and sedoanalgesia was given and the procedure was performed in this way.The examination was successfully terminated in all patients in the sedoanalgesia group. The success of the sedoanalgesia and VR groups were found to be higher than the TV group(p<0.05).There was no significant difference between the sedoanalgesia and VR groups(p=0,77). The mean number of artifacts was 0.59 in the sedoanalgesia group,1.31 in the TV group and 0.89 in the VR group.The count of artifacts was significantly lower in both the sedoanalgesia and VR groups compared to the TV group(p=0.001, p=0.025).There was no significant difference between the sedoanalgesia and VR groups in terms of artifact counts(p=0,77).
CONCLUSIONS
It is a known subject that VR technology can be helpful and facilitate painful and invasive procedures in children. In this study, it was shown that the use of VR during the urodynamics procedure in pediatric urology, reduces the need for sedoanalgesia.
09:03 - 09:06
S19-6 (OP)
Ganesh VYTHILINGAM, Susan MAESTRI, Josie COLEMEADOW, Neetu KUMAR, Navroop JOHAL and Divyesh DESAI
Great Ormond Street Children Hospital, Urology, London, UNITED KINGDOM
PURPOSE
Children born with myelomeningocele require specialized care and follow up. An audit of renal outcomes in 2006 at our institution identified a 17% incidence of new scarring during follow up. Risk factors were identified that led to the establishment of a protocol, with its objectives to protect the upper tract, control urinary tract infection and achieve continence. In this study we reviewed the urological outcomes following establishment of the protocol.
MATERIAL AND METHODS
Outcomes were analysed from a prospective database of patients starting in 2006 to 2021 (167 patients’ 84 males and 83 females) under our care including patients referred from other centres after neurosurgery. Renal scarring was determined using DMSA renogram and urinary continence was assessed using non-invasive and invasive urodynamics for patients above 5 years of age.
RESULTS
Mean follow up in this cohort was 56 months. 24 patients suffered recurrent urinary tract infection. Renal scarring was documented in 20 patients. 9 had scarring at presentation, 6/26 developed scarring during out of protocol follow up. 5/ 141 patients developed scarring on the protocol. 9 patients needed nephrology care. 2 patients developed hypertension and 1 patient required renal transplant. Urinary continence was achieved in 73 patients out of 108 patients at last follow up.
CONCLUSIONS
3.5% of our patients developed scarring following implementation of the protocol compared to 23 % scarring in out of protocol follow up. Continence is addressed throughout childhood and surgical intervention is considered based on the maturity and desire of both the child and family.
09:06 - 09:09
S19-7 (OP)
Alice FAURE 1, Mirna HADDAD 2, Thierry MERROT 2, Jean-Michel GUYS 2 and Gilles KARSENTY 3
1) Hopital La Tirone enfant, Paediatric surgery, Marseille, FRANCE - 2) Aix-Marseille University APHM, Pediatric Urology, Marseille, FRANCE - 3) Aix-Marseille University APHM, Urology, Marseille, FRANCE
PURPOSE
- To assess the feasibility and describe the periuretral balloons (ACT™, Uromedica) placement technique
- To assess the early functional outcomes and complications of ACT
MATERIAL AND METHODS
Prospective non-randomized pilote study aiming to treat children with intrinsic sphincter deficiency (ISD) with ACT (2 balloons below the bladder neck in girls and at the level of the membranous urethra in boys). Treatment was considered successful if patient wear no pad or just one “security”/day and improved if daily pad use was reduced by ³50%.
RESULTS
Since April 2018, 13 children (6 girls, 7 boys) were implanted at median age of 12years (5-16). Seven (54%) patients had neurogenic bladder (NB) and 6 (46%) had exstrophy/epispadias complex.
After ACT placement, continence was achieved in 9 (69%, 5/7 from the NB group, one with bladder exstrophy and 3 with epispadias) and improved in 3 (23%, 2 with NB and 1 with EE complex) with a daily pad use decreased from 4 to 2 (67% reduction) and 24hours Pad-test reduction from 615g to 106g.
Mean final balloon volume was 2.89 ml (+/-0.85) with a median of 3 fillings. Balloon infection occurred in one continent patient. Median follow-up was 21 months(4-43). One exstrophic girl had bladder erosion, after the second filling. Two children with NB had cutaneous erosion. All these patients underwent explanation and a replacement is scheduled. Neither degradation of the kidneys nor cystomanometric changes have been observed postoperatively.
CONCLUSIONS
This is the first report of ACT use in a complex pediatric population. Placement was feasible and early results were encouraging. In children, ACT could be a minimally invasive and effective alternative to bladder neck reconstruction or AUS without urethra or bladder neck dissection. Larger cohorts are needed.