ESPU Meeting on Friday 21, April 2023, 09:40 - 10:20
09:40 - 09:43
S15-1 (OP)
Ranveer VASDEV 1, Sydney MCSOLEY 2, Kenneth SOFTNESS 3, Erin MCNAMARA 4, Carlos ESTRADA 4 and Hsin-Hsiao Scott WANG 4
1) University of Minnesota, Department of Urology, Rochester, USA - 2) Simmons University, Division of Mathematics, Computing, and Statistics, Boston, USA - 3) Beth Israel Deaconess Medical Center, Division of Urologic Surgery, Boston, USA - 4) Boston Children's Hospital, Department of Urology, Boston, USA
PURPOSE
Ureteral reimplantation is the gold-standard surgical treatment for vesicoureteral reflux (VUR). However, this procedure can result in significant perioperative complications, especially in patients with neurogenic bladder (NB). Our study aims to compare the surgical outcomes for patients undergoing ureteral reimplantation with and without neurogenic bladder (NB).
MATERIAL AND METHODS
We queried the Pediatric Health Information System (PHIS) database using ICD-10 and CPT codes to identify patients < 18 years old who underwent ureteral reimplantation between 2015 and 2022. Multivariate models were used to evaluate if NB children undergoing reimplant were associated with longer length of stay (LOS, >2d) or two surgical complication markers: PHIS-flagged surgical complications or National Surgical Quality Improvement Program (NSQIP) complications identified by ICD-10 codes. Multivariable logistic regression was fitted to adjust for potential confounders.
RESULTS
We included 4793 children who underwent ureteral reimplantation. The median (IQR) age was 3.84 (1.60-6.95) years. 1961 (40.9%) were male. 1858 (38.76%) had LOS >2d, 255 (5.32%) had a PHIS-flagged surgical complication, and 115 (2.40%) had an NSQIP surgical complication. Compared to no NB, NB was significantly associated with older age (p<0.001) and open approach (p=0.001). After adjusting for age, sex, race, hospital reimplant volume quintile, region, insurance type, surgical approach (open vs lap), and patient complexity, NB patients remained significantly associated with longer LOS >2d (OR 3.70 (95%CI=2.67-5.22), p< 0.001), higher risk of PHIS-flagged surgical complications (OR 2.76 (95%CI=1.88-4.02), p<0.001), and NSQIP surgical complications (OR 2.33 (95%CI=1.33-3.96), p= 0.002).
CONCLUSIONS
Compared to patients without NB, patients with NB were found to be significantly and independently associated with extended LOS and surgical complications.
09:43 - 09:46
S15-2 (OP)
Salvatore CASCIO 1 and Henri LOTTMANN 2
1) Children's Health Ireland at Temple Street, Paediatric Urology, Dublin, IRELAND - 2) University Hospital Necker Enfants Malades, Paediatric Urology, Paris, FRANCE
PURPOSE
Contradictory results have been published over the years for detrusorectomy. However, recent studies have shown encouraging results. The aim of this study was to systematically review the published literature on detrusorectomy.
MATERIAL AND METHODS
In October 2022 a search of PubMed and Embase for studies evaluating the outcome of detrusorotomy, detrusorectomy and or autoaugmentation was carried out. Inclusion criteria included original publication in English language with more than 10 patients. Outcome measures used by the reviewed studies included measurement of bladder capacity (BCa) and compliance (BCo). Secondary aim was to correlate patients selection, technical modifications and post operative instructions to clinical outcome
RESULTS
In total 25 studies were identified using the search terms outlined. Eleven studies were reviewed comprising a total of 236 patients with a mean age of 9.8 years and a median follow up of 6.1 years. Bladder capacity remained the same or increased in 65% of patients (mean) and bladder compliance improved in 55%. Technical modifications associated with better outcomes included hitching the detrusor to the recti and the urachus to anterior abdominal wall. Studies with better outcomes are associated with immediately post operative bladder cycling. Finally patients with a capacity of more than 50% of the expected bladder capacity (EBC) appear to experience better clinical and urodynamic outcomes.
CONCLUSIONS
Bladder capacity remain the same or improves in approximately 2/3 of patients after detrusorectomy while compliance improves in half of children with neurogenic bladder. For the success of the procedure accurate patients selection, precise post-op instructions and long term follow up are required.
09:46 - 09:49
S15-3 (OP)
Ozge OZDEMIR AYLA 1, S. Kerem OZEL 2, Gonul ACAR 3 and Ibrahim ALATAS 4
1) Demiroglu Bilim University Faculty of Health Sciences, Physiotherapy and Rehabilitation, Istanbul, TURKEY - 2) Istanbul Medeniyet University Faculty of Medicine, Pediatric Surgery Division of Pediatric Urology, Istanbul, TURKEY - 3) Marmara University Faculty of Health Sciences, Physiotherapy and Rehabilitation, Istanbul, TURKEY - 4) Spina Bifida and Fetal Surgery Center, Pediatric Neurosurgery, Istanbul, TURKEY
PURPOSE
There is no consensus on the principles of pelvic floor rehabilitation (PFR) in children with neuropathic bladder dysfunction (NBD). The aim of this study was to delineate the clinical effect of electrical stimulation during PFR in children with overactive NBD.
MATERIAL AND METHODS
Medical records of patients with NBD were evaluated. Those patients with overactive detrusor activity were selected with simple randomization. Patients were groupped as standard PFR with parasacral TENS and PFR without TENS. Patients were evaluated with eight different quality of life and continence evaluation tests, detrusor pressures, bladder capacities and residual urine before and after treatment.
RESULTS
A total of 28 spina bifida patients, 15 (8 boys, 7 girls) treated with PFR with TENS and 13 children (10 boys, 3 girls) PFR without TENS (over 5 years and mean age 8,1±2,36 years) were evaluated. There was no difference in terms of age, gender, use of anticholinergics and ambulation levels between groups. In seven of the eight symptom scoring and quality of life evaluations, there was significant clinical response after PFR both with and without TENS. Only in PFR with TENS, there was a significant decrease in maximum detrusor pressures after treatment (before 86,15±16,19 cmH2O, after 58,07±11,05 cmH2O, p=0,018). There was no difference in other urodynamic parameters.
CONCLUSIONS
In a homogeneous subset of children with overactive NBD, TENS with PFR seems to improve clinical condition. Even though, the urodynamic benefit of PFR is minimal, TENS may be helpful in decreasing bladder pressures in these patients. No significant decrease in need for catheterization was observed in this cohort. Physiotherapeutic modalities for selected patients should be tailored for children with this condition.
10:00 - 10:03
S15-4 (OP)
Valentina FORLINI 1, Federica LENA 1, Chiara PELLEGRINO 1, Maria Luisa CAPITANUCCI 1, Antonio ZACCARA 1 and Giovanni MOSIELLO 2
1) Bambino Gesù Children's Hospital, Division of Neuro-Urology and Surgery for Continence, Rome, ITALY - 2) Bambino Gesù Pediatric Hospital, Surgery, Rome, ITALY
PURPOSE
Onabotulinum toxin A (BONTA ) (Botox, Irvin USA) changed completely the management of neurogenic bladder dysfunction (NBD)as in adults as in children. In adults approximately 40% of the patients discontinue treatment over time, for a lack of clinical response or because the patients preference. Pediatric data on long-term safety, efficacy, adherence are lacking.
MATERIAL AND METHODS
We reviewed the data of all patients who had received BONTA intradetrusor injections in the past 25 years, using a specific protocol for selection, injections, control approved by our Ethical Committe and still used. We considered success when patients reported personal satisfaction plus amelioration of 50% between : leaking episodes per day, Number of pads replaced per day, CIC, UTI frequency reduction, monitoring Kidney ultrasound, UD, serum creatine. Regarding outcome measurement we considered discontinuation and failure rates, reason for discontinuation.
RESULTS
230 patients aged 1-18 yrs (mean 8,5) at first injection have been treated, 112males/118females, untill 2021. 70 pts have been injected more then 5 Times. Lapse between injections has been 6-13 months (mean 8.9). 127 pts presented Spina Bifida (SB), 18 SCI, 11 iatrogenic injury, 8 post oncological, 9 myelitis, 46 cerebral palsy, 11 valve bladder. Safety: in 916 procedures performed, no severe complications have been reported, only in 20/916 discharge has been postoponed due to fever or hematuria.Focusing on patients on long-term (>5) effectiveness was 70% (78% in SCI and SB). Adherence the highest rate has been observed in SCI, 50%, then SB 33%, with the low data in CP (20%).
CONCLUSIONS
On long-term BONTA demonstrated to be safe and effective in pediatrics, but an high percentage of patients discontinued treatment over time, higher then in adults, often requiring major surgery, despite satisfacory outcome. In presence of clinical response the reason could be related to avoid repeated anesthesia. Adolescence's low adherence (then a lack of correct information) could be present.
10:03 - 10:06
S15-5 (OP)
Hortense ALLIOT, Toussaint TAPSOBA, Annabel PAYE-JAOUEN, Yaqoub ASHKANANI, Christine GRAPIN, Matthieu PEYCELON and Alaa EL GHONEIMI
National Reference center for Rare Urinary Tract Malformations (MARVU), University Hospital Robert-Debre, APHP, Université Paris Cité, Pediatric Urology, Paris, FRANCE
PURPOSE
To evaluate the long-term outcome of the serous lined extramural continent catheterizable outlet procedure (SLECCOP) associated with ileal bladder augmentation (BA) in children.
MATERIAL AND METHODS
This monocentric retrospective study identified all children (<18 years) who underwent SLECCOP associated with W-shaped ileocystoplasty (Abol-Enein/Ghoneim procedure) (2002-2021). Exclusion: other type of BA or ileocystoplasty without catheterizable channel. Patient records were reviewed for demographics, surgical data, longterm outcomes for continence and redo surgery. Statistical analysis: univariate (Fisher's exact test).
RESULTS
47 children (30 boys, median (IQR) age: 7.5 (5-10) years) were included: 24 Exstrophy-Epispadias (BEEC), 11 neuropathic bladders, 12 others. Two patients had total bladder substitution. Thirty-one (66%) patients had BNR. All stomas were umbilical, associated with omphaloplasty in BEEC. 36 channels were with the appendix (76.6%) 11 Monti tubes (23.4%). Stoma complications included cutaneous stricture (n=2, 4.3%) and leaking (n=10, 21.3%). Leaking occurred in 22.2% of appendix channels (n=8/36) and 18.2% of Monti tubes (n=2/11) (p-value>0.2). Channels leaks remained in 2 patients (4.3%) at a median (IQR) follow-up of 4.1 (1.2-9.6) years. Redo surgery was required only in 2 patients (4.3%): extra-serosal wrapping for persistent leaking after failed endoscopic injection in one, and surgical revision of Monti in 1. Three patients (6.4%) needed dilatation for transient stoma stenosis at skin level. Strictures were reported in 2.8% of appendix channels (n=1/36) vs. 9.1% of Monti tubes (n=1/11) (p-value>0.2).
CONCLUSIONS
Ileal cystoplasty with SLECCOP is an efficient procedure to manage children with incontinence. We have particularly observed a low stenosis rate of the Mitrofanoff channel in this specific complex group of patients regardless their initial pathology or the type of channel.
10:06 - 10:09
S15-6 (OP)
Hila NOYMAN 1, Ofer GOFRIT 1, Shachar AHARONI 2, Yuval BAR-YOSEF 3, Emmanuel KORNITZER 3 and Guy HIDAS 4
1) Hadassah Medical Center Hebrew University Hospital, Urology, Jerusalem, ISRAEL - 2) Rabin Medical Center, Urology, Tel Aviv, ISRAEL - 3) ALYN Hospital, Jerusalem, ISRAEL - 4) Hadassah and Hebrew University Medical Center. Jerusalem, Israel., Pediatric Urology, Jerusalem, ISRAEL
PURPOSE
In Recent decades, with improvement of therapy, men with spina bifida (myelomeningocele) live longer and reach adulthood. This raises the question whether they also develop age-related benign prostatic hyperplasia (BPH). A recent study found that low acquired spinal cord injuries stop and reverse increase in prostate volume, which suggests that continuous support of some parts of the nervous system is essential for sustaining BPH. This study is aimed to further examine prostate growth in congenital spinal cord injured population – spina bifida patients.
MATERIAL AND METHODS
This is a retrospective and prospective multi-center study. Prostate volume (PV) of 24 men over the age of 35 suffering from spina bifida was documented from recent available imaging. If no imaging found – the patient was invited for an ultrasound testing including PV. Each patient’s measured volume was then compared to expected age-adjusted average volumes of healthy men using available nomograms, and the ratio of measured-expected PVs was calculated. Additional clinical variables were collected, including urinary bladder, neurosurgery, and orthopedic functions.
RESULTS
Patients median age was 46 years, with a range of 35-61. Prostate volume of spina bifida patients was averagely 18% smaller than age expected volume (P<0.005). Most common level of injury was lumbar; however, no significant correlation was found between level of injury and PV. Non-parametric statistical tests did not show a significant correlation between PV and other clinical variables, probably due to the small sample size.
CONCLUSIONS
Spina bifida patients have smaller PV than age expected, and seemingly do not commonly develop BPH. This information is important for the urologist treating these patients when they reach older age. Moreover, the study provides additional evidence of the need for continuous support of the nervous system for developing BPH and raises the possibility of finding a non-hormonal pharmacological intervention for reversing BPH.