ESPU Meeting on Friday 21, April 2023, 08:15 - 08:55
08:15 - 08:18
S14-1 (OP)
Rafael Enrique JORDAN BALLADARES 1, Renata CORRÊA 1, Raphael SANCHES 1, Marcela LEAL DA CRUZ 1, Marcos DEVANIR DA COSTA 2, Sergio CAVALHEIRO 2 and Antonio MACEDO JR. 3
1) CACAU - NUPEP, Pediatric urology, São Paulo, BRAZIL - 2) Federal University of São Paulo, Pediatric Neurosurgery, São Paulo, BRAZIL - 3) CACAU - NUPEP, Federal University of São Paulo, Pediatric urology, São Paulo, BRAZIL
PURPOSE
We want to compare the impact of two techniques of open fetal closure of MMC in bladder categorization parameters
MATERIAL AND METHODS
We evaluated 128 patients that underwent fetal closure of myelomeningocele: 102 with the original technique (OT) and 26 patients with the modified technique that consists of more aggressive dissection of distal nerves of the aponeurosis and non hermetic closure of aponeurosis (MT) to avoid compression of neural canal.
RESULTS
Patients operated in the OT presented with overall good lower limb mobility in 72.54%, regular in 12.2% and poor condition in 7.8, whereas patients operated with the MT presented 88.4%, 3.8%, 7.6% respectively. The incidence of ventriculo peritoneal shunts (VPS) was 9.8% and 3.8% respectively. The onset of febrile UTI was 25.4% (OT) and 3.8% (MT). The incidence of hydronephrosis was 19.6%(OT) and no patient reported using the modified technique. No difference was found in regards to bladder trabeculation: 22.5% (OT) and 23.07% (MT). Vesicoureteral reflux was present in 16.6% (OT) and 23.07% (MT). Mean age at urodynamic evaluation was 7.9 months (OT) and 6.8 months (MT) and patients as high risk in 51.9% (OT) and 38.4% (MT), incontinent in 25.4% (OT) and 23.07%(MT), with underactive bladder in 2.9% (OT), 1.9% (MT) and normal bladder profile 15.6%(OT) and 26.9%(MT) repectively
CONCLUSIONS
We found a trend of improvement of normal bladder profile and reduction of high-risk patterns with the modification in the technique of fetal MMC closure.
08:18 - 08:21
S14-2 (OP)
Luca MAZZONE 1, Ueli MÖHRLEN 2, Beth PADDEN 3, Theres MÖHRLEN 2, Carol MEYER ZU SPRADOW 1, Mirjam HARMS 1 and Maya HORST 1
1) University Children's Hospital Zurich, Pediatric Surgery, Division of Pediatric Urology, Zurich, SWITZERLAND - 2) University Children's Hospital Zurich, Pediatric Surgery, Zurich, SWITZERLAND - 3) University Children's Hospital Zurich, Division of Pediatric Rehabilitation, Zürich, SWITZERLAND
PURPOSE
To investigate urological outcomes after open prenatal spina bifida aperta repair (OPSBAR) at the age of five years.
MATERIAL AND METHODS
Patients with OPSBAR at our center were followed in a standardized program. Data obtained at follow-up visits was collected in a RedCap database. Patients five years or older were considered for this study.
RESULTS
At the 5-years follow-up (mean age 5.0 years), 16% (7/42) had a normal cystometry and were able to void volitionally, six being fully continent and one diaper dependent. 81% (34/42) were on clean intermittent catheterization (CIC) and one patient had a vesicostomy. 24 of the 34 patients on CIC (71%) were on anticholinergics. Reason to start CIC was a hyperactive/high pressure bladder in 28 patients (usually combined with instillation of intravesical anticholinergics) and an acontractile bladder in eight patients. In one patient, CIC could be stopped at the 2 year follow-up visit and in another after vesicostomy placement.
In six patients (14%), CIC became necessary only after neurosurgical resection of inclusion cysts (at a mean age of 28.3 months). Five showed a persistent acontractile bladder and one a hyperactive bladder.
Performed surgeries were Botulinum toxin injection in the detrusor (7), bladder sling with appendicovesicostomy (1) and vesicostomy (1).
CONCLUSIONS
Only a minority of patients with OPSBAR shows a normal bladder function at 5 years. However, the percentage is higher than reported percentages after postnatal repair. A substantial number developed neuropathic bladder dysfunction after inclusion cyst resection.
08:21 - 08:24
S14-3 (OP)
Lisa Karin Elisabet ÖRTQVIST 1, Gundela HOLMDAHL 1, Helena BORG 2, Kristine BJORNLAND 3, Helen LILJA 1, Pernilla STENSTRÖM 4, Niels QVIST 5, Trinae SAETHER HAGEN 6, Mikko PAKARINEN 7, Tomas WESTER 8 and Risto RINTALA 7
1) Karolinska University Hospital, Pediatric Surgery department, Stockholm, SWEDEN - 2) Drottning Silvia's Children's Hospital, Pediatric surgery department, Gothenburg, SWEDEN - 3) Oslo University Hospital, Department of Pediatric Surgery, Oslo, NORWAY - 4) Children's hospital, Skåne University Hospital, Department of Pediatric surgery, Lund, SWEDEN - 5) University of Southern Denmark, Research Unit for Surgery, Centre of Excellence in Gastrointestinal Diseases, Malformations in Infancy and Children, Odense, DENMARK - 6) Oslo University Hospital, University of Oslo, Department of Pediatric Surgery, Oslo, NORWAY - 7) The New Children's Hospital, University of Helsinki and Helsinki University Hospital, Section of Pediatric Surgery, Pediatric Liver and Gut Research Group, Helsinki, FINLAND - 8) Karolinska Institutet, Department of Women's and Children's Health, Stockholm, Karolinska University Hospital, Department of Pediatric Surgery, Stockholm, SWEDEN
PURPOSE
Long-term outcomes of cloacal malformations remain unclear. We aimed to evaluate postoperative
bowel control, bladder function and quality of life in patients under 18 years of age with cloaca.
MATERIAL AND METHODS
This was a multi-center cross-sectional observational study accomplished by the Nordic Pediatric Surgery Research Consortium. Patients with a cloacal malformation, 4 to 17 years of age, were eligible. Data including patient characteristics, surgical procedures, and complications were retrieved from case records. Established questionnaires with normative control values evaluating bowel function, bladder function, and health-related quality of life (HRQoL) were sent to the patients and their caregivers. The study was approved by the participating center's Ethics Review Authorities.
RESULTS
Twenty-six (67%) of 39 eligible patients with median age 9.5 (range, 4-17) years responded.
Twenty-one (81%) patients had a common channel ≤ 3 cm. Imaging confirmed sacral anomalies in 11 patients and spinal cord abnormalities in nine. Excluding patients with stoma (n=5), median bowel function score was 12 (7-19), and 5 patients (20%) reported a bowel function score >17, approaching normal bowel control level. Bowel management increased the proportion of socially continent school-aged children to 52%. Six (23%) patients had a permanent urinary diversion or used clean intermittent catheterization (CIC), while majority (70%) of the remaining patients were urinary continent. The reported HRQoL was comparable to healthy Swedish children.
CONCLUSIONS
Whilst well-preserved spontaneous bowel control was rare, a majority of patients were dry for urine without any additional procedures. Few patients experiences social problems or negative impact on HRQoL due to bladder or bowel dysfunction.
08:35 - 08:38
S14-4 (OP)
Reuben BEN-DAVID 1, Moti IFLAH 1, Noam BAR-YAAKOV 1, Haim HERZBERG 1, Emmanuel KORNITZER 2, Fred CARROLL 2 and Yuval BAR-YOSEF 1
1) Tel-Aviv Medical Center, Pediatric Urology, Tel-Aviv, ISRAEL - 2) ALYN Hospital, Pediatric Rehabilitation Center, Jerusalem, ISRAEL
PURPOSE
To assess whether antibiotic therapy before urodynamic studies should be empiric or culture-guided in children with neurogenic bladder who require clean intermittent catheterization (CIC).
MATERIAL AND METHODS
Urine cultures collected before urodynamic studies between 2010-2018 were retrospectively analyzed. Urine samples had been collected from asymptomatic children with neurogenic bladder who require CIC before undergoing a urodynamic study. Resistance to commonly prescribed periprocedural antibiotic treatments was documented. The probability of antibiotic resistance according to sex, vesicoureteral reflux status, consumption of prophylactic antibiotics, and self- or caregiver-performed CIC was determined by a χ2 test.
RESULTS
A total of 278 urine cultures were collected from 185 children (median age 8 years [interquartile range 5-12]) with neurogenic bladder. The most common etiology for neurogenic bladder was spinal dysraphism (n = 146, 77%). Bacterial growth was detected in 216 (78%) cultures, and the most commonly detected bacterial species was Escherichia.coli (n = 155, 72%). Thirty-six (19%) children had, and 14 of them received continuous prophylactic antibiotics. The probability of resistance to oral antibiotics among urine cultures was amoxicillin (22%), cephalexin (21%), cefuroxime-axetil (14%), ciprofloxacin (10%), nitrofurantoin (21%) sulfamethoxazole/trimethoprim (23%), and for intramuscular/intravenous antibiotics it was ceftriaxone (17%) and gentamycin (8%). There was no significant difference in the probability of resistance to antibiotics according to sex, vesicoureteral reflux status, continuous antibiotic prophylaxis, or self/caregiver-performed CIC (χ2 test).
CONCLUSIONS
Urine cultures of neurogenic children who undergo CIC apparently carry a high risk of resistance to commonly administered oral antibiotics. be culture-guided periprocedural antibiotic prophylaxis before urodynamics are recommended.
08:38 - 08:41
S14-5 (OP)
Deniz UGURLU 1, S. Kerem OZEL 2, Arzu CANMEMIS 3, Ferruh Kemal ISMAN 4, Ibrahim ALATAS 5 and Cigdem ULUKAYA DURAKBASA 1
1) Istanbul Medeniyet University Faculty of Medicine, Pediatric Surgery, Istanbul, TURKEY - 2) Istanbul Medeniyet University Faculty of Medicine, Pediatric Surgery Division of Pediatric Urology, Istanbul, TURKEY - 3) Ministry of Health Göztepe City Hospital, Pediatric Surgery Division of Pediatric Urology, Istanbul, TURKEY - 4) Istanbul Medeniyet University Faculty of Medicine, Biochemistry, Istanbul, TURKEY - 5) Spina Bifida and Fetal Surgery Center, Pediatric Neurosurgery, Istanbul, TURKEY
PURPOSE
Aim of this study was to delineate the relation between urodynamic decreased bladder compliance and urinary, serum fibrosis markers.
PATIENTS AND METHODS
Spina bifida (SB) patients with no renal scar, no recurrent urinary tract infection with low bladder compliance formed study group (LC). SB patients with normal bladder compliance were defined as NC group. Patients without the diagnosis of SB formed control group (C). Age, gender, urodynamic parameters, urine density, blood urea and creatinine levels were noted. Urinary collagen type 1, collagen type 3 and its metabolite procollagen 3 and serum collagen type 1 and collagen type 3 were examined with ELISA method.
RESULTS
72 patients were included (LC n:31, NC n:24, C n:17, 31 girls and 41 boys , mean age, 7,39±1,24 years). There was no difference in age, gender, urodynamic parameters, urine density, serum urea and creatinine. In LC group urinary collagen type 1 was higher than C (11,71±3,02 ng/ml vs 9,45±1,97 ng/ml, p=0,03). Urinary procollagen 3 was also higher in LC than C (103,15±24 ng/ml vs 82,42±22,26 ng/ml, p=0,016). In prediction of low bladder compliance higher than 9,20 ng/ml was 80,6% sensitive and 70,6% specific for collagen type 1. Procollagen 3 over 78 ng/ml was 87% sensitive and 70,6% specific to predict same condition.
CONCLUSIONS
Determination of urinary fibrosis markers may indicate decreased bladder compliance in neuropathic bladder dysfunction. It is plausible to say that with the development of new noninvasive markers, urodynamic studies may be less preferred in the diagnosis of decreased bladder compliance in the future.
08:41 - 08:44
S14-6 (OP)
Zachary CULLINGSWORTH 1, Benjamin PRESS 2 and Israel FRANCO 3
1) Randolph-Macon College, Department of Engineering, Ashland, USA - 2) Yale School of Medicine, Department of Urology, New Haven, USA - 3) Yale School of Medicine, Pediatric urology, New Haven, USA
PURPOSE
Low amplitude rhythmic bladder contractions (LARC) are commonly noted during UDS studies. The presence of these contractions can be indicative of underlying pathology but little is known about these contractions and their relationships with other urodynamic parameters. The aim of our study is to identify there is a relationship with urodynamic work (UW) and LARC.
MATERIAL AND METHODS
IRB approval was obtained for the use of deidentified urodynamic data. Urodynamic data was exported from UDS machine into a text delimited format and analyzed using Python to perform frequency analysis during the beginning, middle, and end of the studies. UW was determined by measuring the area under the urodynamic curve (AUC) on a pressure/volume graph and theoretical pressure (Pdet th) derived from the work. UDS graphs were reviewed by one author for the presence of LARC. Statistics were performed using Xlstat and SPSS.
RESULTS
There were 42 urodynamic studies in which UW, frequency data and actual UDS curves were available for review from 25 patients. All studies were performed in children ((mean=6.3 yr.). logistic regression was performed and revealed that the effect of the Pdet th was significant, B = -0.20, OR = 0.82, p = .037, indicating that a one-unit increase in Pdet th decreases the odds of observing visual contractions of the bladder by approximately 18.27%. Total work, Lowest common frequency and highest amplitude frequency had no effect on the presence of LARC. ROC analysis reveals that Pdet th>13.4 cm H2O was the cutoff value for contractions with an AUC of 0.842, sens=0.882, specificity=0.714 and ACC=0.854. Highest amplitude Frequency had an AUC of 0.744 at a cutoff of 3.538 and snes=0.586 but spec =1 and PPV=1, similarly total work had an AUC=0.729 at a cutoff of 956 with a sens=0.5 and spec=1 and ppv=1.0.
CONCLUSIONS
The findings indicate that Pdet th is the most important determinant of the presence of LARC on UDS.