ESPU Meeting on Friday 21, April 2023, 14:25 - 15:10
14:25 - 14:28
S18-1 (OP)
Yuval BAR-YOSEF 1, Addi SHALOM-BRANDNSTETTER 1 and Ronella MAROM 2
1) Tel-Aviv Medical Center, Pediatric Urology, Tel-Aviv, ISRAEL - 2) Tel-Aviv Medical Center, Neonatology, Tel-Aviv, ISRAEL
PURPOSE
Selective serotonin reuptake inhibitors (SSRI) antidepressant usage has risen among pregnant women. These agents, which traverse the placenta, have known implications for neonatal outcomes, such as neurologic, autonomic, respiratory, and gastrointestinal symptoms. The effect of maternal SSRI treatment on the urinary system of neonates, such as time to first micturition, however, has not been investigated.
MATERIAL AND METHODS
This retrospective study was conducted by anonymous data extraction from electronic medical records in a tertiary hospital. Prenatal and neonatal datasets of neonates exposed to maternal SSRI drug usage in-utero (n=157) and neonates who were not exposed (n=157) matched for gestational age, weight, and year of birth with were analyzed. Neonates with a 5-minute Apgar score of <8, CAKUT and other major malformations were excluded. The primary outcome was time to first void.
RESULTS
Time to first void was longer in infants exposed to SSRI treatment (10.9 vs 9.4 hours, p=0.007). The non-SSRI mothers were significantly younger than the SSRI mothers (mean age 32.2±4.8 vs 34.6±4.8 years, p<0.0001). There were no group differences in delivery mode. Exclusive human milk feeding was 1.8 times more prevalent among the unexposed neonates, and the absence of crying immediately after birth was associated with longer time to first micturition.
CONCLUSIONS
Maternal use of SSRI during pregnancy affects time to first micturition in their neonates and should be considered when evaluating delayed urination in neonates. Identification of maternal and fetal characteristics predisposing to delay in first void in neonates exposed to SSRI is warranted.
14:28 - 14:31
S18-2 (OP)
Carla RAMIREZ-AMOROS 1, Maria ALVAREZ BARRIAL 1, Maria SAN BASILIO 1, Francisco De Borja NAVA 2, Virginia AMESTY 2, Susana RIVAS 2, Pedro LOPEZ PEREIRA 2, Maria Jose MARTINEZ URRUTIA 2 and Roberto LOBATO 2
1) La Paz University Hospital, Paediatric surgery, Madrid, SPAIN - 2) La Paz University Hospital, Paediatric urology, Madrid, SPAIN
PURPOSE
Intracytoplasmic sperm injection (ICSI) has become the most commonly used method of fertilization in assisted reproductive technology. Its use has generated considerable controversy over the safety of the procedure for the offspring. We aimed to determine whether ICSI is associated to increased risk of congenital malformations.
MATERIAL AND METHODS
Retrospective cohort study comparing women who underwent ICSI (ICSI group) with women randomly selected among those who naturally conceived (no ICSI group) at our institution in 2017. Cause of infertility, multiple-gestations, mode of delivery, gestational age (GA), sex and birth weight and frequency and type of congenital malformations were analysed. Major birth defects were defined by the US Centres for Disease Control and Prevention guidelines. Chromosomal abnormalities were excluded.
RESULTS
We analysed 700 women, 400 ICSI group and 300 no-ICSI group, aged 35±3.18y vs 34±5.51y respectively. 117 (29.3%) achieved pregnancy after a maximum of 3 cycles of ICSI and male factor represented 50% of all of causes of infertility. ICSI- group presented higher number of multiple gestation (17.2% vs 3.3%, p< 0.01), higher probability of caesarean delivery (47% vs 27.3%, p<0.01), less GA at birth (37± 3.1 vs 38.8±1.83, p<0.01), higher pregnancy loss (7/117 vs 0/300, p<0.01) and a higher incidence of congenital malformations (20.5% vs 11.35%, p=0.018), including urological malformations. There were no differences in sex distribution and birth weight.
CONCLUSIONS
Pregnancies after ICSI are at increased risk of developing urological malformations when compared to similar naturally conceived children. Paediatric surgeon must be aware of the problems associated with this technique.
14:31 - 14:34
S18-3 (OP)
Simona GEROCARNI NAPPO 1, Dalia GOBBI 2, Erika Adalgisia DE MARCO 3, Elisa CERCHIA 1, Camilla PAGLIARA 2, Irene PARABOSCHI 3, Andrea SCIARRONE 4, Fulvia PAMPO 5, Nicola PERSICO 5, Gabriella BRACALENTE 6, Alfredo BERRETTINI 3 and Paola MIDRIO 2
1) OIRM-Città della salute e della scienza di Torino, Paediatric Urology Unit, Torino, ITALY - 2) Ospedale Ca' Foncello, Paediatric Surgery Unit, Treviso, ITALY - 3) Fondazione IRCSS Cà Granda, Ospedale Maggiore Policlinico, Paediatric Urology Unit, Milan, ITALY - 4) City of Health and Science, S. Anna Hospital, Obstetrics-Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and Gynecology, Torino, ITALY - 5) Fondazione IRCSS Cà Granda, Ospedale Maggiore Policlinico, Fetal Medicine and Surgery Unit, Milan, ITALY - 6) Osp. Cà Foncello Treviso, Italy, Fetal Medicine Unit, Department of Obstetrics and Gynecology, Treviso, ITALY
PURPOSE
Hypospadias is the most common genital anomaly of the male fetus, occurring in 1:300 male newborns. Reports of prenatal diagnosis of hypospadias are only scattered. Aim of the paper is to assess accuracy and postnatal outcome of hypospadias diagnosed prenatally, and give suggestions for prenatal counselling.
MATERIAL AND METHODS
A retrospective study was conducted in three referral centers of Pediatric Urology and Pediatric Surgery, with tertiary level prenatal diagnosis. Included in the study were all fetuses with a prenatal suspicion of short phallus/ hypospadias. Prenatal findings, genetics, associated malformations and neonatal outcome were recorded
RESULTS
25 fetuses were observed, at a mean gestional age of 23 weeks (range 18-39 w), 16/25 (64%) within 22 weeks. 5/25 gestations (20%) occurred after IVF. Cariotype was assessed in 18/22 pregnancies, showing 46 XY in 14 and cariotype anomalies in 4, 3 of which underwent TOP. After birth, a genital anomaly was confirmed in 21/22 newborns (95.4%): 14 proximal hypospadias (6 with penoscrotal transposition), 2 severe chordee without hypospadias, 2 midshaft and 1 distal hypospadias, 1 hidden penis, 1 epispadias. Associated anomalies were 3 IUGR, 1 ARM, 2 cardiac malformations, 3 hydronephrosis, 2 renal ectopia, 5 undescended testis (1 bilateral),1 sindactilia.
CONCLUSIONS
Our series confirms the high accuracy of prenatal diagnosis of hypospadias (78- 91%in the literature), and also shows that the majority of hypospadias diagnosed during pregnancy are at the very severe end of the spectrum, associated with a high rate of chromosomal anomalies and non-genital malformations. Genetic diagnosis and counselling are mandatory in these cases. Prenatal counselling can be demanding, since isolated hypospadias cannot be distinguished from more complex conditions of DSD.
14:45 - 14:48
S18-4 (OP)
Juliane RICHTER 1, Hayley GOOD 2, Jin K. KIM 1, Patrick SHANNON 3, Joana DOS SANTOS 1, Natasha BROWNRIGG 1, Michael CHUA 1, Armando J. LORENZO 1, Mandy RICKARD 1, Tim VAN MIEGHEM 4 and Shiri SHINAR 4
1) The Hospital for Sick Children, Division of Urology, Toronto, CANADA - 2) University of Toronto, Faculty of Medicine, Toronto, CANADA - 3) Mount Sinai Hospital, Department of Laboratory Medicine & Pathobiology, Toronto, CANADA - 4) Mount Sinai Hospital, Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Toronto, CANADA
PURPOSE
A prenatal diagnosis of lower urinary tract obstruction (LUTO) often results in pregnancy termination due to the suspected poor prognosis. The aim of this study was to assess the autopsy findings of these terminated fetuses.
MATERIAL AND METHODS
We retrospectively reviewed all patients referred to a high-risk fetal center for a suspected LUTO diagnosis from 2009 to 2022 and whose pregnancies were terminated. We assessed ultrasound features, gestational age at termination, genetic investigations, autopsy and placental findings and distribution of diagnoses within the terminated fetuses.
RESULTS
A total 160 fetuses with suspected LUTO were included in this study, of which 72 (45%) were terminated. We excluded 31 for declined autopsy/missing data, resulting in 41 cases for final analysis (4 females, 37 males). Pregnancies were terminated at a mean GA of 22.1 +/- 4.7 weeks. A LUTO diagnosis was confirmed in 85.4% of fetuses (35/41) with 41.5% posterior urethral valves, 24.4% urethral atresia, 19.5% urethral stenosis/stricture and other pathologies in the remaining ones. Pulmonary hypoplasia or cystic kidneys were found in 57.1% (20/35) and 62.9% (22/35) and placental pathologies in 57.1% of confirmed LUTO, respectively. Only 22 fetuses had prenatal genetic investigations with detected Trisomy 8, microdeletion and a gene mutation, only in fetuses with confirmed LUTO diagnosis (n=3/22;13.6%).
CONCLUSIONS
Our data show that almost half of prenatally-suspected LUTO pregnancies are terminated and 15% of fetuses with antenatal suspicion of LUTO have other conditions, stressing the importance of autopsy. Given overlapping ultrasound findings, posterior urethral valves cannot be differentiated from urethral atresia or urethral stricture prenatally.
14:48 - 14:51
S18-5 (OP)
F. Juliane RICHTER 1, Shiri SHINAR 2, Lauren ERDMAN 3, Hayley GOOD 4, Jin K. KIM 1, Joana DOS SANTOS 1, Natasha BROWNRIGG 1, Adree KHONDKER 1, Priyank YADAV 1, Michael CHUA 1, Tim VAN MIEGHEM 2, Mandy RICKARD 1 and Armando J. LORENZO 1
1) The Hospital for Sick Children, Division of Urology, Toronto, CANADA - 2) Mount Sinai Hospital, Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Toronto, CANADA - 3) The Hospital for Sick Children, Centre for Computational Medicine, The Hospital for Sick Children, Toronto, ON, Canada, Toronto, CANADA - 4) University of Toronto, Faculty of Medicine, Toronto, CANADA
PURPOSE
LUTO is a chronic condition with a spectrum of outcomes. It is usually suspected prenatally based on ultrasound features(USF). Given the unknown postnatal trajectory and the potential for significant morbidity and mortality, many families choose termination of pregnancy(TOP), often based on USF alone. We sought to develop a tool that can be used to predict postnatal outcomes based on combinations of USF to aid with prenatal counselling and parental decision making.
MATERIAL AND METHODS
We reviewed a LUTO database from a high-risk fetal center and tertiary pediatric center and collected USF and postnatal need for urinary diversion and renal replacement therapy(RRT). USFs from a gestational age(GA) of 13-26 weeks for TOPs were collected and matched to fetuses who were not terminated to build a random forest model.Each predictor was assessed independently with combined importance when accounting for other predictors.The model was used to predict the most likely postnatal outcomes for TOPs had the pregnancy been continued.
RESULTS
USF from 37 TOPs and 30 livebirths with postnatally confirmed LUTO were included with a follow up time of 1599 days.There were 4 postnatal deaths. Dialysis was predicted with the highest accuracy of 81%(63%sensitivity,89%specificity),with transplant second highest(69%,43%sensitivity,79%specificity), and diversion the least well predicted (50%accuracy).For TOPs, had the pregnancies continued,the model predicted dialysis in 16/37(43%), transplant in 7/37(19%) cases, and urinary diversion in 17/37(46%).All TOPs predicted to receive transplant were predicted to receive diversion and/or dialysis, with the majority receiving both(5/7).This is similar to the postnatal LUTO cases in which 6/7 transplanted cases received both diversion and dialysis.
CONCLUSIONS
Our data suggests that it is possible to predict postnatal renal replacement therapy from USFs in TOPs had the pregnancy been continued. Predictive accuracy will improve with continued follow-up of more patients, enabling more personalized prenatal counseling and allowing for more informed decision making for families.
14:51 - 14:54
S18-6 (OP)
Mandy RICKARD 1, Juliane RICHTER 1, Joana DOS SANTOS 1, Natasha BROWNRIGG 1, Armando J. LORENZO 1, Tim VAN MIEGHEM 2 and Shiri SHINAR 2
1) The Hospital for Sick Children, Urology, Toronto, CANADA - 2) Mount Sinai Health System/ Ontario Fetal Centre, High Risk Obstetrics, Toronto, CANADA
PURPOSE
Termination of pregnancy(TOP) is a decision that some women will have to face. Be it personal choice, social circumstances or medical events for the woman or fetus, consideration of TOP requires thought and deliberation. Recently, because of legislative changes in the UnitedStates, access to abortion has been restricted. In pediatric urology, we are involved in pre-and-postnatal care of fetuses with kidney anomalies. In this context, we present a Canadian experience of fetuses with LUTO and describe their long-term outcomes.
MATERIAL AND METHODS
We reviewed a LUTO database from a fetal-centre and-associated pediatric-center from2009-2022. We included all fetuses with LUTO and collected pre and postnatal data. Pregnancy outcomes included TOP, fetal demise, autopsy findings, and live-births. Neonatal outcomes included respiratory compromise, dialysis, and deaths. Long-term outcomes included transplant.
RESULTS
A total of 157 fetuses were referred at a GA of 19±4weeks. Of these,27(17%) were excluded due to a non-LUTO diagnosis. Of the 130LUTO cases, 71(55%) underwent TOP at a GA of22.1+/-4.7weeks. Autopsy data for 41fetuses, confirmed LUTO in 35(85%). For those who continued the pregnancy, 6(5%) had intrauterine demise, and 14(11%) had neonatal death. 42(32%) survived, born at GA of 37+/-2 weeks, birthweight was 3111±635gr and 19(46%) had urinary diversions. 14(35%) required intubation, 5(12%) had urinomas, and 22(52%) had an acute kidney injury. At a follow-up of 5+/-3.5years, 20(47%) had UTIs, 16(38%) were on CIC, 22(52%) had CKD, 8(19%) required dialysis at 1.2+/-2years and 11(26%) had a transplant at 4.3+/-2.7years.
CONCLUSIONS
Unfortunately, in some jurisdictions, TOP has become a political argument instead of a personal choice. We comment on one aspect of a fetal diagnosis with lifelong implications for mother and baby and associated with significant morbidity and mortality. The presented challenging outcomes highlight that women deserve the right to access lawful and safe TOP given the short and long-term sequalae of LUTO.
14:54 - 14:57
S18-7 (OP)
Jules KOHAUT 1, Ingo GOTTSCHALK 2, Grigore CERNAIANU 1, Christoph BERG 2 and Martin DÜBBERS 1
1) University Hospital of Cologne, Division of Pediatric Surgery, Cologne, GERMANY - 2) University Hospital of Cologne, Department of Obstetrics and Prenatal Medicine, Cologne, GERMANY
PURPOSE
Early intrauterine vesicoamniotic shunting (VAS) using a Somatex® Shunt has proven to be effective on survival of male fetuses with lower urinary tract obstruction (LUTO). We assessed the impact on neonatal surgical management.
MATERIAL AND METHODS
We retrospectively reviewed all male fetuses that underwent intrauterine VAS in our institution during first or second trimester of pregnancy. We have evaluated outcomes regarding survival and neonatal surgical management, especially the removal of the shunt.
RESULTS
Between 2016 and 2022, 20 VAS in fetuses with LUTO between 13 and 17 weeks of gestation were performed. The shunt had to be re-implanted in utero in five fetuses due to dislocation. There were two terminations of pregnancy, one intrauterine fetal death and one neonatal death. Of the 16 living births, there were five premature births. Seven shunts could be removed without further anesthesia at the bedside. Nine patients required surgical shunt removal under general anesthesia due to migration (56%). We performed laparoscopic shunt extraction in seven cases. The most frequent location was the detrusor in six cases and removal of the shunt required a bladder suture in two patients. In two cases the shunt was located in the abdominal wall and in one case in the colonic wall. Postoperative course in all patients was uneventful. Due to the presence of an anorectal malformation, we performed a colostomy at the same surgical procedure in three patients.
CONCLUSIONS
In our recent experience, more than half of the LUTO newborns require shunt removal surgery after early VAS. The orientation of these children at birth and the information given to families should be adapted accordingly.