ESPU Meeting on Thursday 20, April 2023, 15:15 - 15:55
15:15 - 15:18
S12-1 (OP)
Lauren DOVAL 1, Annabel PAYE-JAOUEN 1, Pauline LOPEZ 1, Amane LACHKAR 1, Anca TANASE 2, Marianne ALISON 2, Alaa EL GHONEIMI 1 and Matthieu PEYCELON 3
1) National Reference center for Rare Urinary Tract Malformations (MARVU), University Hospital Robert-Debre, APHP, Université Paris Cité, Pediatric Urology, Paris, FRANCE - 2) National Reference center for Rare Urinary Tract Malformations (MARVU), University Hospital Robert-Debre, APHP, Université Paris Cité, Pediatric Radiology, Paris, FRANCE - 3) National Reference center for Rare Urinary Tract Malformations (MARVU), University Hospital Robert-Debre, APHP, Université Paris Cité, Paediatric Urology, Paris, FRANCE
PURPOSE
Post-procedural urinary tract infections (ppUTI) rates after voiding cystourethrography (VCUG) vary in the literature (0-42%), but more recent studies report on rates lower than 5%. The main objective of this study was to determine the 7-day ppUTI rate after VCUG without the verification of urine sterility beforehand. The secondary aim was to determine risk factors associated with ppUTI.
MATERIAL AND METHODS
A monocentric retrospective review of VCUG performed on children < 3-year-old was conducted between January 2020 and December 2021. Exclusion criteria included: neuropathic bladder, bladder exstrophy, any urine culture prior to the VCUG, and loss of follow-up < 30 days. We hypothesized that a ppUTI rate < 5% was the cut-off for a reasonably safe practice of VCUG done without urine culture. Statistical analysis: univariate and multivariate tests.
RESULTS
A total of 318 VCUG was performed in 300 children (248 (78%) males (circumcision status: 8%) at a median (IQR) age of 5 (1–11) months. 107 (33.6%) were on antibiotics before the VCUG (94 on antibioprophylaxis and 13 on therapeutic doses), 212 (66.4%) had hydronephrosis, and 219 (69%) had history of UTI. VCUG results were abnormal in 134 children (43%): 114 children (85%) vesicoureteral reflux (VUR), 14 (10%) posterior urethral valves (PUV), 28% other abnormalities. The 7-day ppUTI rate was 3.8% (N=12). No variable (age, gender, retrograde VCUG, PUV, high grade VUR, history of UTI, MDR bacteria, non-circumcised status) was identified as risk factor for ppUTI in statistical analysis.
CONCLUSIONS
No systematic urine culture before performing a VCUG was not associated with a high ppUTI rate.
15:18 - 15:21
S12-2 (OP)
Saidul KABIR 1, Muhammad E. H. CHOWDHURY 2, Jl Pippi SALLE 3 and Tariq Osman ABBAS 3
1) University of Dhaka, Department of Electrical and Electronic Engineering, Dhaka, BANGLADESH - 2) Qatar University, Department of Electrical Engineering, Doha, QATAR - 3) Sidra Medicine, Urology Division, Doha, QATAR
PURPOSE
The international method for radiographic grading of voiding cystourethrogram (VCUG) pictures in patients with vesicoureteral reflux (VUR) is well-established for predicting and deciding the clinical course and treatment, but yet very subjective. We aimed to create a supervised machine learning model that could automatically and quantitatively provide a VUR grade to VCUG images.
MATERIAL AND METHODS
A total of 113 VCUG images were gathered from publicly accessible sources to compile the dataset for the experiment. Clinicians then assigned scores 1 to 5 to each image. The ground truth for each image was assigned as the majority grade diagnosed by the experts. The grades were then sub-categorized into low and high severity, with low severity corresponding to grades 1-3 and high severity to grades 4-5. Each VCUG image was annotated with nine features to be extracted. Using leave-one-out cross-validation, four classical machine learning models (MLPClassifier, CatBoost, Extra Trees, and Random Forest classifiers) were trained, validated, and evaluated. Models were trained on the highest-ranked features, and all features were compared and contrasted.
RESULTS
Four pediatric radiologists and three pediatric urologists rated the severity of the VUR. Using the best features, the F1-Scores for the Extra Tree and MLPclassifier were 85.84% and 84.95%, respectively, whereas they were 90.26% and 89.38%, respectively, using all features
CONCLUSIONS
Our results indicate that a distorted pattern of renal calyces is a highly accurate and explicable predictor of high-grade VUR. In the future, machine learning techniques can be perfected to provide objective grading of VUR.
15:21 - 15:24
S12-3 (OP)
Sofia SJÖSTRÖM 1, Ulla SILLÉN 2, Sverker HANSSON 2 and Per BRANDSTRÖM 2
1) The Queen Silvia Children Hospital Gothenburg, Paediatric Surgery- Peadiatric Urology, Gothenburg, SWEDEN - 2) The Queen Silvia Children's Hospital, Paediatric Urology and Nephrology Center, Gothenburg, SWEDEN
PURPOSE
The coexistence of vesicoureteral reflux (VUR) and bladder bowel dysfunction (BBD) in children is well established but whether this dysfunction remains in the long term is not yet known. This study revisited children who participated in the Swedish Reflux Trial (SRT) with primary aim to re-evaluate BBD and secondary aims to evaluate subgroup of dysfunction and relation to recurrent urinary tract infections (UTI).
MATERIAL AND METHODS
In 73 (38% boys) of the children who participated in the SRT (VUR grade 3 in 62% and grade 4 in 38% at inclusion in original study); bladder function was prospectively evaluated using a standardized validated dysfunction questionnaire (BBDQ) and uroflowmetry ten years after study-end. Comparison with bladder function data at study-end of SRT was done. BBD was diagnosed from the BBDQ score (cut-off ≥7), and overactive bladder (OAB) and dysfunctional voiding (DV) sub-diagnoses were calculated from symptom scores.
RESULTS
BBD was diagnosed in 37% at the end of the SRT (Mean age 3.7 (0.43) years) and decreased to 23% at 10-year follow-up (Mean age 15.7 (0.43) years). DV and OAB subgroups were equally common at the end of SRT, but only DV remained at the last follow-up of the present study (p=0.0008). Recurrent UTI's were seen in 17% at ten year follow-up and were more common in patients with BBD (p=0.038). The gender distribution of BBD also changed, from equally common at the end of SRT to mainly adolescent girls in the last follow-up (p=0.022). Similarly, during follow-up girls were in the majority regarding the number of UTI's.
CONCLUSIONS
In this follow-up of BBD in children with VUR, the number of children with BBD decreased with age. In adolescence, both DV and recurrent urinary tract infections affected mainly girls.
15:35 - 15:38
S12-4 (OP)
Ezel AYDOĞ, Khaled OBAID, Araz MUSAEV, Doruk GÜLER, Tarkan SOYGÜR and Berk BURGU
Ankara University School of Medicine, Urology, Ankara, TURKEY
PURPOSE
We aim to investigate the use of contralateral PIC cystogram with the subsequent injection for the intraoperatively detected de-novo contralateral reflux during the endoscopic correction of unilateral VUR.
MATERIAL AND METHODS
From Apr-2019 to Dec-2020, 174 patients who were diagnosed with unilateral G2-4 reflux on VCUG after a febrile UTI episode were randomized (matched pairs for reflux grade) into 2 groups, prospectively. There was no significant difference between two groups for the prevalence of renal scar, potty training and LUTD. Among the 87 pairs, there were 20, 43, 24 pairs of; G2, G3, G4 unilateral VUR on patients, respectively. None of the patients had any prior surgical interference. On PIC-group, during the unilateral sting, a PIC cystogram was performed on the contralateral side, and if de-novo VUR was detected it was subsequently treated. On the control group, no additional diagnostic test was used other than the initial VCUG. All patients were followed up 1 year after the operation. Paired-T test was used for statistical comparisons.
RESULTS
During follow-up, febrile UTI rates decreased in both groups with no statistically significant difference. Non-febrile rates on 1-year follow-up for PIC-group and control group were respectively; 75% (n = 66) and 87% (n = 72). For the subgroup of potty trained patients, however, value of PIC cystogram increases as this group of patients had better non-febrile rates during the follow-up. (PIC-group: 80% (n = 8) vs. control group: 41% (n = 5), p < 0.05). The same phenomenon is similarly observed in patients with prior LUTD and/or contralateral renal scars.
CONCLUSIONS
Simultaneous contralateral PIC cystogram is a valuable tool during the endoscopic treatment of unilateral VUR patients. It decreases postoperative febrile UTIs, thus unnecessary postoperative VCUGs, especially in the subgroup of potty trained patients with contralateral scars and/or LUTD.
15:38 - 15:41
S12-5 (OP)
Ezel AYDOĞ, Araz MUSAEV, Efe Semetey OĞUZ, Elif İpek AKSOY, Tarkan SOYGÜR and Berk BURGU
Ankara University School of Medicine, Urology, Ankara, TURKEY
PURPOSE
There are several management options for bilateral VUR with one side being grade 4/5 and contralateral being 2/3. We conducted a randomized prospective study to compare postoperative outcomes and success rate of commonly used surgical management types.
MATERIAL AND METHODS
90 patients whom, after a febrile UTI episode, were diagnosed with unilaterally dilating bilateral reflux on VCUG (G1-3 on one side, G4-5 on the other side) were randomized into 3 groups. Choice of surgery for groups were; bilateral sting regardless of reflux-grade (Group 1), unilateral extravesical UNC (Lich-Gregoir) to dilated and sting to non-dilating side (Group 2), bilateral intravesical UNC (Cohen) (Group 3). Clinical success (CS) and postoperative parameters (length of stay, hospital costs and complications) were documented for each group. CS was defined as; no episode of febrile UTI during 1 year of follow-up. ANOVA and logistic regression were used to determine differences between ordinal variables.
RESULTS
CS for Group 1 was markedly low (23%) compared to other groups (p < 0.05). Between Groups 2 and 3, however, no statistical difference on CS was found in that regard. Clavien-1 complications were reported in Group 1, 2 and 3 were; 3%, 23% and 36%, respectively. 8 patients in group-2 and 11 patients in group-3 needed postoperative IV antibiotics (Clavien-2). 1 patient in group-3 needed blood transfusion (Clavien-2). 2 patients in Group-3 were reoperated after unilateral ureteric obstruction on follow-up (Clavien-3). Compared to group-3 average length of stay and hospital costs were significantly lower in group-2 (p <0.05).
CONCLUSIONS
Bilateral sting is inferior to the other 2 techniques for the treatment of reflux on dilated system as subsequent VCUG demonstrated. Unilateral UNC with the addition of sting for the nondilated contralateral ureter seems comparable to bilateral intravesical UNC for the clinical success, while maintaining a better postoperative safety and cost profile.
15:41 - 15:44
S12-6 (OP)
Young SON 1, Julia SCALI 2, Shana SANTARELLI 2 and Gregory DEAN 3
1) Jefferson New Jersey, Urology, Philadelphia, USA - 2) Jefferson New Jersey, Philadelphia, USA - 3) Urology For Children, Vorhees, USA
PURPOSE
Ureteroneocystostomy (UNC) is considered the gold standard treatment for vesicoureteral reflux (VUR) in pediatrics. The most common causes of emergency department (ED) visits following any urologic procedure are UTIs and catheter/drain concerns. The objective of this study is to identify predictive factors at the time of post-UNC discharge that predict subsequent unplanned ED visits.
MATERIAL AND METHODS
The 2020 American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP) data was analyzed for patients undergoing ureteroneocystostomy for VUR. The patients were divided into 2 groups: ED visits within 0-30 days following anti-reflux procedure and no ED visits after reflux procedure.
RESULTS
Among the 1495 patients, 11.0% reported postoperative ED visits while 89% of those that did not. Patients returning to ED postoperatively were more likely to have been of Hispanic ethnicity, have increased structural pulmonary abnormalities, higher gastrointestinal diseases, ostomy presence, minor cardiac risk factors, or born prematurely between 35-36 weeks. Additionally, patients that required an ED visit following UNC were more likely to have had a longer mean operative time, surgical site infection, post operative UTI, post operative sepsis, prior readmission, renal insufficiency, unplanned reoperation, blood transfusion, as well as placement of an unplanned urinary catheter. Univariate and multivariate analysis showed postoperative UTI (p<0.001), superficial surgical site infection (p=0.022), unplanned procedure (p<0.001), unplanned urinary catheter (p<0.001), and 35-36 weeks gestation (p=0.004) as independent risk factors for postoperative ED visits.
CONCLUSIONS
Post operative ED visits are feared complications after ureteroneocystostomy. Utmost caution is taken prior to discharge after surgery to ensure adequate postoperative course. We show that UTI, surgical site infection, unplanned reoperation, unplanned urinary catheter, and prematurity can lead to more ED visits.