ESPU Meeting on Thursday 9, June 2022, 10:40 - 11:25
10:40 - 10:43
S06-1 (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
Different degrees of urinary tract dysfunction exist in children with Prune Belly Syndrome (PBS) and can be linked to different phenotypes. A specific score called RUBACE was recently published to facilitate phenotype correlation. The aim of this study was to determine if this score could predict the degree of urinary tract dysfunction and the number of urological procedures.
MATERIAL AND METHODS
A national multicentric retrospective study identified all patients with diagnosis of PBS between 1989 and 2020. RUBACE score was retrospectively calculated from the medical record. Patients were classified into two groups: high RUBACE score (HRS) >= 11 and low RUBACE score (LRS) <11. Number and type of urological procedures, number of urinary tract infections(UTI), and renal function were assessed. Statistical analysis: Fisher’s and Student tests.
RESULTS
56 patients from 15 centers were included, with a median (IQR) follow-up of 10.5(7-19) years. 28 patients had a HRS (median=12) and 26 had a LRS (median=8). Median number of urological procedures was higher in HRS patients compared to LRS (5,7 vs. 1,3, p<0.001). UTI were more frequent in the HRS group, with more than 10 UTI in 54% of HRS patients and 7% in LRS(p<0.05). Chronic kidney disease was significantly higher in HRS (33% vs. 0%, p<0.05).
CONCLUSIONS
RUBACE score may be used as a valid score to predict renal and urinary tract prognosis in children with PBS. In our experience, high RUBACE score was associated with a higher number of UTI and urinary tract surgeries, as well as poor renal outcomes.
10:43 - 10:46
S06-2 (OP)
Ali̇ TEKİN 1, Murat PEHLIVAN 2, Si̇bel TİRYAKİ 3, Ömer Bariş YÜCEL 4, Uygar BAĞCI 4, Hasan ÇAYIRLI 1, İlker Zeki̇ ARUSOĞLU 1 and İbrahi̇m ULMAN 1
1) Ege University, Pediatric Surgery and Pediatric Urology, İzmir, TURKEY - 2) Ege University, Department of Biophysics, Izmir, TURKEY - 3) İZMİR HEALTH SCIENCES UNIVERSITY TEPECİK EDUCATION AND RESEARCH HOSPITAL, Pediatric Urology, İzmi̇r, TURKEY - 4) Ege University, Pediatric Urology, Izmir, TURKEY
PURPOSE
To determine the optimal placement of the reference electrode for recording the pelvic floor activity in urodynamic studies.
MATERIAL AND METHODS
Children over six years of age were invited to the study. A test unit was assembled with four identical electromyography amplifier modules, a battery unit, an analog-digital conversion module, and a recording program generated by DASYLab. Surface skin electrodes were used. Active electrodes were placed on the right and left sides near the anus. Reference electrodes were placed over 4 different body sites; the right kneecap, the right inner thigh, the right anterior iliac spine (AIS), and the left gluteal muscles. The subjects were instructed to contract their pelvic floor muscles as strong and long as they could. The recordings were performed twice, in the supine position on the examination table and in the sitting position on the urodynamic chair.
RESULTS
A total of 21 subjects (10M, 11F) were included. The mean age was 10.19±3.20 years. The highest root-mean-square (RMS) values were obtained with the reference electrode on the inner thigh in the supine position and the anterior iliac spine in the sitting position (Table). The minimum RMS values in both positions were obtained with the reference electrode on the knee.
|
Reference Localization |
The mean RMS values in the supine position |
The mean RMS values in the sitting position |
||||
|
N |
Mean |
Std. Deviation |
N |
Mean |
Std. Deviation |
|
|
Knee |
21 |
0.89* |
0.81 |
17 |
0.69* |
0.28 |
|
Thigh |
21 |
0.98 |
0.87 |
17 |
0.76* |
0.29 |
|
AIS |
21 |
0.95 |
0.75 |
17 |
0.79* |
0.30 |
|
Gluteus |
21 |
0.98 |
0.86 |
17 |
0.77* |
0.29 |
*p<0.05
CONCLUSIONS
AIS seems to be the most appropriate location for the reference electrode at the sitting position, and the knee seems to be the least suitable option. This information may help improve EMG recordings during urodynamic studies.
10:46 - 10:49
S06-3 (OP)
Sibel TIRYAKI 1, Oguz EGIL 2, Ahmet Ziya BIRBILEN 2 and Ayse BUYUKCAM 2
1) Gaziantep Children's Hospital, Division of Pediatric Urology, Gaziantep, TURKEY - 2) Gaziantep Children's Hospital, Gaziantep, TURKEY
PURPOSE
SARS-COV-2 is associated with unexpected symptoms. Several studies in adults reported urinary frequency with COVID-19. The aim of this study is to reveal lower urinary tract symptoms associated with COVID-19 (CALUTS) in children.
PATIENTS AND METHODS
All children diagnosed with COVID-19 and associated multisystem inflammatory syndrome in children (MIS-C) between November 2020-June 2021 in our hospital were reviewed and asked for urinary symptoms at the time of or following their disease. The ones reporting symptoms were invited for further evaluation. Parents were inquired for their child’s former bladder and bowel function, their symptoms after the diagnosis of COVID-19 or MIS-C, onset and duration of the symptoms, and their current state.
RESULTS
In total 20 patients (18/216 with acute disease and 2/36 with MIS-C) reported CALUTS. Age and sex distribution were not significantly different from the patients without urinary symptoms (p=0.777 and p=0.141 respectively). All parents described a sudden onset of extremely increased urinary frequency (more than twice an hour) and urgency lasting for weeks which disappeared gradually. Median bladder and bowel dysfunction questionnaire (BBDQ) score before COVID-19 was 2.5 (1-18) which increased to a median of 22 (15-29) at the time of the symptoms (p<0.001). The timing of onset and duration of symptoms were variable and not associated with symptom severity (p=0.306 and p=0.450 respectively). All patients with symptoms at the time of inquiry were followed and returned to their baseline toilet habits at a maximum duration of six months.
CONCLUSIONS
Our study, for the first time, revealed that SARS-COV-2 can be associated with lower urinary tract symptoms also in children both during the acute phase and MIS-C. Further studies are necessary to understand the etiopathogenesis and prevalence of this unexpected aspect of COVID-19.
10:49 - 10:52
S06-4 (OP)
Borko STOJANOVIC 1, Marta BIZIC 1, Marko BENCIC 1, Vladimir MILOVANOVIC 2 and Miroslav DJORDJEVIC 1
1) University Children's Hospital Belgrade, Urology, Belgrade, SERBIA - 2) University Children's Hospital Belgrade, Cardiothoracic surgery, Belgrade, SERBIA
PURPOSE
Iatrogenic urethral strictures in children are rare, but their management is very challenging in terms of long-term outcome. We present a series of severe urethral strictures in children shortly after they underwent cardiac surgery, focusing on stricture repair.
MATERIAL AND METHODS
From October 2014 until December 2020, 14 male patients with mean age of 39 months (ranged from 11 to 84 months) underwent treatment of urethral stricture. All patients had previously undergone surgery for congenital heart disease, and had indwelling urethral catheter for the mean period of 12 days. Onset of symptoms was 3-6 months after cardiac surgery and included decreased stream, urinary tract infection, straining to void and retention. Urethrography and urethroscopy revealed ten bulbomembranous, two penile and two combined bulbar and penile strictures. One-stage augmentation urethroplasty using buccal mucosa graft and/or penile skin flap, stricture excision with "end-to-end" anastomosis and internal urethrotomy were performed in 8, 4 and 2 cases, respectively.
RESULTS
The mean follow-up was 45 months (ranged from 13 to 86 months). Twelve patients (86%) were symptom free, with normal voiding patterns. One patient had straining to void and dysuria, without evidence of restricture or diverticulum. One patient developed restricture after internal urethrotomy, and underwent open surgical repair. There was no penile shortening or curvature.
CONCLUSIONS
Urethral stricture after cardiac surgery may be a result of indwelling urethral catheter combined with ischemia of the urethra. These strictures can be successfully managed using appropriate urethral reconstruction, with good long-term outcome. Internal urethrotomy has a small role in urethral stricture repair, for selected cases.
10:52 - 10:55
S06-5 (OP)
Amr SALEH 1, Alexander CHO 1, Kanchan RAO 2, Naima SMEULDERS 1, Prem PATEL 3, Alex BARNACLE 3 and Abraham CHERIAN 1
1) Great Ormond Street Hospital, London, UK, Department of Paediatric Urology, London, UNITED KINGDOM - 2) Great Ormond Street Hospital, London, UK, Department of Paediatric Bone Marrow Transplant, London, UNITED KINGDOM - 3) Great Ormond Street Hospital, London, UK, Department of Paediatric Interventional Radiology, London, UNITED KINGDOM
PURPOSE
Refractory haemorrhagic cystitis (HC), with large on-going transfusions and/or symptomatic clot-retention causing urinary-obstruction despite maximum medical-management, is a rare complication of allogenic-haematopoietic-stem-cell-transplantation (HSCT) and of oxazaphosphorine-alkylating-agents. The efficacy of selective-superior-vesical-artery-embolisation (SSVAE) for refractory-HC in children was assessed.
MATERIAL AND METHODS
Retrospective-review of paediatric-patients (<17-years) with refractory-HC undergoing SSVAE (2009-2019). Outcomes included: peri-procedural complications, change in transfusion requirements and bladder complications. Statistical analysis: T-Test. SSVAE via the common-femoral-artery using Gelfoam(4) or Contour-PVA 355-500 micron-particles (6); bilateral (7) or Unilateral (due to arterial-spasm 3), was undertaken.
RESULTS
7-pts underwent SSVAE (3M:4F); mean-age at SSVAE:7.2yrs(Range:4.5-16.5yrs); 6-pts were post-HSCT;1-pt treated with cyclophosphamide-chemotherapy for desmoplastic-round-cell-tumour-of-retroperitoneum. All urine-analyses were BK-virus-positive.
Pre-SSVAE-Interventions:
7 primary procedures; 3 repeat-SSVAE-procedures. Median-time to IR-intervention from HC-onset was 30d(13-57d). One complication occurred (puncture-site oozing, managed with compression and topical tranexamic acid). Indications for repeat-embolization: increased blood requirements after temporary improvement(23d & 30d) or inability to embolise one side due to arterial-spasm(3d).
Blood-transfusion requirements significantly-reduced post-SSVAE compared to pre-SSVAE (p<0.05) however the platelet-requirements after the 1st week post-SSVE remained unchanged.
| Median RBC units/week | t-test | Median platelet bag/week | t-test | |
| 1-week Pre-SSVAE | 8 | 13 | ||
| 1st-week Post-SSVAE | 3 | P=0.002 | 11 | P=0.04 |
| 2nd-week Post-SSVAE | 4 | P=0.005 | 13 | P=0.23 |
| 3rd-week Post-SSVAE | 2 | P=0.015 | 10 | P=0.13 |
| 4th-week Post-SSVAE | 2 | P=0.03 | 4 | P=0.001 |
4-patients died within 2-8 weeks post-SSVAE due to adenovirus-virus hepatic failure(1), pulmonary emboli(1), CMV pneumonitis(1), or sepsis and acute kidney injury(1). 3-patients survived with HC-resolution within 9-70 days with no urinary symptoms at follow-up.
CONCLUSIONS
Refractory HC is associated with a high mortality rate. SSVAE seems to be an effective minimally-invasive option to reduce transfusion-requirements in these difficult cases.
10:55 - 10:58
S06-6 (OP)
Sadaf ABA UMER KODWAVWALA 1, Sajid SULTAN 2 and Bashir AHMED 2
1) Sindh Institute of Urology & Transplantation, Philip G. Ransley Department of Paediatric Urology, Karachi, PAKISTAN - 2) SINDH INSTITUTE OF UROLOGY AND TRANSPLANTATION, PHLIP G.RANSLEY DEPARTMENT OF PAEDIATRIC UROLOGY, Karachi, PAKISTAN
PURPOSE
The purpose is to evaluate the long-term outcome and complications of continent catheteizable urinary channel in children from a developing country setting with low socioeconomic and educational level.
MATERIAL AND METHODS
Retrospective analysis of medical records of children who underwent CCC between 2002 and 2018. For the analysis children are divided into two groups on the basis of channel type i.e.appendicovesicostomy or Monti.Data was analyzed on SPSS 20.Kaplan Mayer survival graph was used for long term survival (complications)analysis.
RESULTS
185 channels were formed with mean age at surgery 8.9+-3.4 years.M:F 1.8:1.Diagnoses included Neurogenic bladder-39%,PUV-31% & EEC-17%.Appendix used in 90% and ileal monti in 19(10%).Stoma was created in right iliac fossa in majority of the cases using VQZ technique.Overall complication rate was 19.5%which were Clevien Dindo Grade IIIb.Of them 20/36 required open surgical revision of stoma/channel.No statistically significant differences in complications and surgical revision were noted when comparing appendix and ileal monti (p=0.76 and 0.42 respectively).50% of all the complications were noted in the first 2 years and 25% after 5 years of follow-up.Difficult catheterization was the most common (15/36).Stoma related complications included stenosis (7)and granulation tissue prolapse(5).Channel related complications included stenosis(8),fistula(2)and incontinence(2).Channel incontinence seen in Monti and channel fistula in appendicovesicostomy.Our survival analysis (Kaplan- Meier) evaluating the whole cohort complication free time was 157+- 6 months (95% CI 145-169.6).On a time to event analysis there were no statistically significant differences in complications rate comparing the use of appendix vs.Monti (p=0.32).The mean follow-up period is 7.5+- 4.7years.
CONCLUSIONS
In a developing country setting with a low socio-economic and educational level it is possible to successfully perform clean intermittent catheterization using cheap nelaton catheter through continent catheterizable channel with small complications rate even in the long term. Limitation of the study is small number of children with Monti channel.
10:58 - 11:01
S06-7 (OP)
Sajid SULTAN 1, Philip G. RANSLEY 1, Bashir AHMED 2, Sadaf ABA UMAR 1 and Adib-Ul-Hassan RIZVI 1
1) Sindh Institute of Urology & transplantation, Philip G Ransley Department of Paediatric Urology, Karachi, PAKISTAN - 2) Sindh Institute of Urology & transplantation, Philips G Rensley Department of Paediatric Urology, Karachi, PAKISTAN
PURPOSE
To compare the indications and voiding outcome of boys who underwent single stage End to End(SSEE) Bulboprostatic Urethroplasty performed by progressive perineal approach(PA) vs combined Abdominoperineal approach(APA).
MATERIAL AND METHODS
Records are reviewed of 131 boys who underwent SSEE Bulboprostatic Urethroplasty between 2005-2020 divided as PA Group I, V/S APA group II and compared for nature of trauma ,H/O Failed Urethroplasty .Findings of Antegrade + Retrograde cystourethrogram and scopy, operative findings, voiding outcome as urinary symptoms,VCUG, uroflometry, Post Urethroplasty surgical intervention and follow up period. Mean and SD is calculated for continuous variable
Chi square test for categorical variables.P value <0.05 will be considered as significant.
RESULTS
Of 131 patients 86(66%) were Group I (PA) as compared to 45 (34)% Group II (APA). Age in years, Group I (PA) 10.32 +- 2.38 vs Group II(APA) 10.44 +- 3.22(p=0.95).Nature of trauma group I RTA 56 (65%) ,fall 19(22%) crush injury 11 (13%) whereas in group II RTA 41(91%) and crush 4 (9%).
In Group II 30 (66%) were started as Abdominal approach first ,of them 17 were with short posterior urethra and veru not completely visualized, 13 were Redo urethroplasty. However 15 (33%) started as PA and converted to APA intraoperatively for too much fibrosis ,unable to feel bougie from above 8(18%) and unable to perform anastomosis in high up bladder and posterior urethra in 7(16%).
Voiding outcome showed normal per urethral voiding in 78(91%) Q max 19.2+5.8 ml/sec in Group I vs 43(96%) Q max 16.6+-3.2ml/sec in Group II(p=0.94). 8 patient (9%) were unable to void per urethra,and required cystoscopy and optical urethrotomy .2 patient with incontinence in APA group required anticholinergics and bulking agent at bladder neck. Mean follow up period was 1292.95 +- 1300.46 days.
CONCLUSIONS
Majority 66% of our patients could be managed by progressive perineal approach only.However others required Abdominoperineal approach.Therefore both expertise are essential. In both group majority >90% achieved normal voiding.