ESPU Meeting on Saturday 22, April 2023, 11:45 - 12:30
11:45 - 11:48
S26-1 (OP)
Alejandra RIOS 1, Pedro Jose LOPEZ 1, Francisco REED 1, Nelly LETELIER 1, Ricardo ZUBIETA 1, Carlos FINSTERBUSCH 1 and Francisca YANKOVIC 2
1) Hospital exequiel gonzalez cortes, Paediatric urology, Santiago De Chile, CHILE - 2) Hospital exequiel Gonzalez Cortes & Clinica Santa Maria, Paediatric Urology, Santiago De Chile, CHILE
PURPOSE
In previous studies, awareness has been made regarding female involvement in scientific meetings, notifying less participation considering female physicians overall. However, no reports about gender participation in pediatric urology congress have been made. Our aim is to evaluate the gender gap in the main pediatric urology meetings worldwide.
MATERIAL AND METHODS
Main available paediatric urology meetings from around the world from 2019-2021 were included (table 1). Retrospective reviewed regarding female participation and type of participation divided into; clinical moderator, clinical lecturer, clinical round table participant, clinical round table moderator and investigation/basic science moderator. T-Student with 95% interval confidence was done. Female participation in organizational committees, sponsored symposium or pre-congress courses was not analysed.
RESULTS
A total of 15 programmes and 691 lecturers of six major paediatric urology meetings where reviewed. Of this, male participation represents a 73% of all lectures. As for analysing total participation in all the reviewed programmes, except for the basic science moderators, we observed statistical difference in all types of participations as shown in table 1: moderators of lectures (p=0.04), lecturers (p=0.029), panel participants (p=0.009) and panel/round table moderators (p=0.033).
CONCLUSIONS
Despite gender-gap consciousness has been noticed more often, there is still lack of equal gender participation of women in paediatric urology meetings. This is especially significant for the keynote sessions of the meeting (lectures and panel participation) where female participation is extremely underrepresented
11:48 - 11:51
S26-2 (OP)
Logan GALANSKY, Andrew GABRIELSON, Ahmad HAFFAR, Tamir SHOLKLAPPER, Chad CRIGGER, Nora HANEY, Kelly HARRIS, Hiten PATEL, Ming-Hsien WANG, Charlotte WU, John GEARHART and Heather DI CARLO
Johns Hopkins, Urology, Baltimore, USA
PURPOSE
Despite increased adoption of opioid-sparing protocols in pediatric outpatient urologic surgery, older children may still be sent home with an opioid prescription. Yet, patients are infrequently provided instructions on safe disposal methods of surplus opioids. As part of the Baby ORIOLES trial, we evaluated the impact of opioid disposal instructions with parental education versus standard postoperative care instructions on surplus opioid disposal rates.
MATERIAL AND METHODS
In this IRB-approved prospective, single-blinded factorial randomized controlled trial, pediatric patients 6 years or older undergoing ambulatory urology procedures either received the FDA opioid disposal best practices worksheet plus nursing education or routine postoperative instructions alone. A standardized short-term rescue opioid prescription of 3-5 doses of 0.1 mg/kg of Oxycodone was given. Patients were called at 10-14 days post-procedure to determine opioid use and disposal practices.
RESULTS
A total of 52 (28 experimental, 24 control) patients have been enrolled. Demographics, procedure performed, and adjunct analgesia used were similar between groups. There was no difference in rate of filling the opioid prescription (82% vs 83%, p=0.91). Among patients who filled the prescription, a greater number of patients in the opioid disposal instruction cohort disposed of their medication appropriately compared to those who did not receive instructions, but this was not statistically significant (48% vs 27%, p=0.20). There was no difference in percentage of patients using opioids post-discharge (43% vs 46%, p=0.83). However, the cohort receiving disposal instructions had more surplus pills at 10-14 days post-discharge, although this was not statistically significant (57% vs 46%, p=0.42).
CONCLUSIONS
Results from this study found that providing formal opioid disposal literature with parental education did not affect post-discharge opioid utilization and disposal practices to a statistically significant degree. However, based on the trends observed, these findings may show significance on formal assessment pending further trial accrual.
11:51 - 11:54
S26-3 (OP)
Katie CLEARY, Ganesh VYTHILINGAM, Kevin CAO and Navroop JOHAL
Great Ormond Street Children's Hospital, Urology, London, UNITED KINGDOM
PURPOSE
Enhanced Recovery After Surgery (ERAS) improves clinical outcomes in adults. We previously presented similar outcomes and cost reduction using ERAS for ileocystoplasy in children. New efficiency models must maintain high quality, safe, patient experience satisfying care. We present herein a quality of life (QoL) assessment to analyse ERAS impact and describe the cost effectiveness for paediatric urology.
MATERIAL AND METHODS
This is a prospective, single-centre, trial of ERAS from February 2019. Historical controls were propensity matched. Costing data from financial years 2008-2022 was used. 7 cost saving domains were identified. QoL values were generated utilising EQ-5D-5L (EuroQoL) healthcare questionnaire from 6-months post-operation. Scores in five domains: mobility, self-care, activity, pain and anxiety/depression, were computed into a single index metric of QoL, based on UK population indices (Devlin et al. 2018), to generate quality-adjusted life years (QALYs) and cost-effectiveness figures.
RESULTS
Average ERAS LoS was 6 days and 11 days for traditional management. Total cost of ileocystoplasty using ERAS was £20,078 versus £26,147 for traditional care, a total saving of £6069. Average index scores for QoL under ERAS were 0.86 (0.48-1.0) and (0.6-1.0, p = 0.27, not significant). ERAS generated 58.5 QALYs, at a cost-effectiveness of £362 per QALY. Traditional care generated 63 QALYs, at a cost-effectiveness of £427.
CONCLUSIONS
ERAS for ileocystoplasty reduced mean LOS and therefore the average unit cost per patient. ERAS for paediatric ileocystoplasty is cost-effective and generates a comparable QoL measurements 6 months post-operatively
11:54 - 11:57
S26-4 (OP)
Berk HAZIR 1, Halime Tuna ÇAK 2, Kemal SARUHAN 2, Serdar TEKGUL 1 and Hasan Serkan DOĞAN 1
1) Hacettepe University School of Medicine, Urology, Ankara, TURKEY - 2) Hacettepe University School of Medicine, Child and Adolescent Psychiatry, Ankara, TURKEY
PURPOSE
While most studies in pediatric urology investigate the clinical results, very few explore the relationship between surgery and quality of life and psychosocial well-being in pediatric urology practice. The determination of the spiritual effects of the surgical method is of increasing importance. This study investigated the effect of surgery type on the postoperative quality of life (QoL) and psychological well-being of pediatric urological surgery patients.
MATERIAL AND METHODS
A total of 151 children and adolescents (4-18 years old) undergoing elective urological surgery between September 2020 and July 2021 were evaluated preoperatively; those with current psychiatric disorders were excluded. Of the 98 patients undergoing subsequent detailed preoperative assessment using standardized instruments to evaluate QoL and depressive and anxiety symptom levels, only 63 could be re-evaluated postoperatively at 6 months follow-up. Additionally, preoperative parental psychiatric symptom load was assessed using standardized self-report forms.
RESULTS
The patients were classified into two categories for analysis-open versus endourological surgery and major versus minor surgery. In the latter category, there was a significant increase in the postoperative QoL in children undergoing minor urological surgery (p = 0.037). Furthermore, regression analysis showed that higher parental preoperative psychiatric symptom load, a greater number of previous surgeries, and female gender were predictors for lower postoperative QoL (p < 0.001, adjusted R2 = 0.304).
CONCLUSIONS
Postoperative QoL of children/adolescents undergoing pediatric urology surgery relies more on the preoperative medical condition and psychological status of themselves and their parents rather than the surgical method opted for.
12:12 - 12:15
S26-5 (OP)
Frank-Jan VAN GEEN 1, Anka NIEUWHOF-LEPPINK 2, Aart KLIJN 3, Laetitia DE KORT 1 and Rafal CHRZAN 4
1) UMC Utrecht, Urology, Utrecht, NETHERLANDS - 2) Wilhemina's Childrens Hospital UMC Utrecht, Medical Psychology, Utrecht, NETHERLANDS - 3) Wilhemina's Childrens Hospital UMC Utrecht, Pediatric Urology, Utrecht, NETHERLANDS - 4) Jagiellonian University Medical College UCHC, Pediatric Urology, Kraków, POLAND
PURPOSE
Previously, we presented promising results on a Burch-type colposuspension (BC) as last resort option in a heterogenous group of girls with daytime urinary incontinence (DUI). We assume that a small group of girls with DUI based on stress-urinary incontinence (SUI) might also benefit from a BC in an earlier stage of treatment. Up to date however, we have not determined strict criteria for surgical intervention in these girls. The objective of this study is therefore to assess the (long-term) effect of BC on refractory DUI in girls with SUI, find predictors for a successful surgical intervention and to evaluate patient satisfaction
MATERIAL AND METHODS
First, a retrospective chart study including all girls with refractory DUI and SUI who underwent an open or laparoscopic BC at our tertiary referral center between between 2003-2017 (n=34) was performed. The main outcome measurement was continence, expressed as the percentage of continent children at post-surgical follow-up without any additional treatment (complete response 4-6 months after surgery). Additionally, a cross-sectional follow-up was carried out to assess the long-term effect of BC on DUI and patient satisfaction.
RESULTS
Complete continence after surgery was achieved in 12% (4/34) of cases. Patients with an abnormal flow pattern and substantial amount of urinary loss more often failed complete cure. After a mean duration of 8 years, 84% (16/19) still experienced DUI. The majority however, would undergo the BC again
CONCLUSIONS
Although complete continence after BC was only achieved in 12% (4/34) of girls with SUI, most patients indicate not to regret the operation. Therefore, when providing information to patients and caretakers, it is important to discuss a clear expectation of success in order to enable proper shared decision making. In our view, BC should only be performed as a last resort treatment in well informed patients.
12:15 - 12:18
S26-6 (OP)
Bade TOKER KURTMEN 1, Bengisu KARBUZOĞLU 1 and Sibel TIRYAKI 2
1) Tepecik Training and Research Hospital, Pediatric Surgery, Izmir, TURKEY - 2) Tepecik Research and Training Hospital, Division of Pediatric Urology, Izmir, TURKEY
PURPOSE
A 3-phase Computed Tomography (CT) is required to visualize post-traumatic urinary tract injuries in children. An X-ray following single-phase CT is performed to evaluate urinary tract to reduce the radiation exposure in our center. The aim of this study was to designate an optimal duration between CT and X-ray to plan validation studies of the technique in imaging the collecting system.
MATERIAL AND METHODS
Records of pediatric trauma patients who admitted to our hospital and underwent a CT scan were analyzed. CT and X-ray images were evaluated and the time between two modalities was calculated. The success of X-ray in visualizing bilateral renal pelvises, ureters and bladder was evaluated.
RESULTS
There were 190 patients of with a male predominance (72.6%). The median age was 9 years (2 months - 17.9 years). The median duration between the CT and X-ray was 60 minutes (7-775). The median duration in which the entire collecting system was visualized (37.9%) was 40 minutes (11-210). Duration was significantly longer in unsuccessful images (73-minutes) than the successful ones (p<0.001). Age (p=0.722), gender (p=0.203) and type of trauma (p=0.796) had no effect on success. When the patients were grouped according to the duration as between 10 – 30 minutes (Group 1) and others (Group 2), the ratio of patients with optimal X-rays was significantly higher in Group 1 (p=0.001). Visualization of both ureters and pelvises was found to be significantly higher in Group 1 than in Group 2 (p<0.001 and p=0.011).
CONCLUSIONS
CT is often a part of diagnostic imaging in trauma. Urinary tract injuries are rare and mostly cannot be evaluated with single-phase CT-scans, but a three-phase scan increases the radiation burden especially for children. Our plan is to validate our technique using an X-ray following CT-scan for evaluating the urinary tract in trauma, and this preliminary retrospective study confirmed 10-30 minutes as an appropriate timing for further studies.
12:18 - 12:21
S26-7 (OP)
Abhinay JOGULA, Rajendra NERLI, Nishant SETYA, Ashwin BOKARE and Ramana SRIPATHI
JN Medical College, KLE Academy of Higher Education and Research, Pediatric Urology, Belagavi, INDIA
PURPOSE
Management of renal injuries has progressively shifted towards a nonoperative approach. Blunt trauma accounts for 80% to 90% of all renal injuries. Most renal injuries are low-grade (American Association for the Surgery of Trauma [AAST] grades I and II), expectantly managed with observation, and have minimal morbidity. Even today nephrectomy remains a common intervention for high-grade renal trauma (HGRT).
MATERIAL AND METHODS
We prospectively gathered data on all children (≤18 years of age) patients presenting with high grade blunt renal trauma (grade IV & V). A centralized database platform was used for data collection. Computed tomography scan findings was used to grade the renal injuries.
RESULTS
A total of 78 children presented to our hospital with grade IV and V blunt renal injuries during the period Jan 2016 - Dec 2020. The overall mean age was 15.42±6.43 years and 64/78 (82.05%) patients were male. Fifty of the 78 patients had grade IV and the remaining 28 had grade V renal injuries. Thirty eight (48.71%) of the patients with HGRT had concomitant abdominal organ injuries. Forty (51.28%) of the 78 patients needed blood transfusions and 16 (20.5%) needed platelets transfusions within the first 24 hours following admission. Renal angiography with angioembolization was performed in 12 patients. Surgical exploration of abdomen was performed in 16 (20.5%) patients for renal injuries and/or other abdominal injuries . Nephrectomy was performed in 3 patients with grade IV and 6 patients with grade V injuries .
CONCLUSIONS
Eighty percent of the children with grade IV & V can be managed safely and successfully with expectant/conservative management . Nearly 20% do require surgical exploration for renal or other abdominal causes and nephrectomy rate is still significant (11.53%). Renal vascular causes remain the most common reason for nephrectomy.