33rd ESPU Congress in Lisbon, Portugal

SN3: MISCELLANEOUS 1

Moderators: Louiza Dale (UK), Tinne van Aggelpoel (BE)

ESPU-Nurses Meeting on Thursday 20, April 2023, 11:00 - 11:50


11:00 - 11:10
SN3-1 (OP)

TUBULARIZED INCISED PLATE REPAIR FOR DISTAL AND MIDPENILE HYPOSPADIAS

Nishant SETYA 1, Rajendra NERLI 2, Ashwin BOKARE 1, Abhinay JOGULA 1 and Ramana SRIPATHI 1
1) JN Medical College, KLE Academy of Higher Education and Research, Pediatric Urology, Pediatric Urology, Belagavi, INDIA - 2) JN Medical College, KLE Academy of Higher Education and Research, Pediatric Urology, Belagavi, INDIA

PURPOSE

The TIP (Tubularized incised plate) repair is the most commonly used procedure to repair the distal and midshaft hypospadias. We report our experience with the TIP procedure in the treatment of distal and midshaft hypospadias over a 15 year period.

MATERIAL AND METHODS

We retrospectively reviewed the inpatient and outpatient records of all children (≤18 years) who underwent TIP (Tubularized incised plate) repair for distal/mid penile hypospadias between Jan 2005 and 2019.

RESULTS

A total of 107 children with the mean age of 34.34±16.41 months presenting with either a distal or a mid penile hypospadias underwent primary tubularized incised plate hypospadias repair during the study period. A total of 31 (28.97%) children had complications needing intervention. Complications included urethrocutaneous fistula in 24 (22.4%), Glans dehiscence in 3 (2.8%), and Meatal stenosis in 4 (3.73%). Urethrocutaneous fistula was more common in those repairs which involved single layer urethroplasty closure as compared to two layer urethroplasty closure (p 0.0302 ) , whereas the fistula rates were similar when dartos flap or tunica vaginalis flap was used (p 0.839).

CONCLUSIONS

The Tubularized incised plate repair of distal/mid penile hypospadias with two layer urethroplasty closure and use of barrier flap decreased the fistula rate. By not extending the plate incision to the neomeatus site and using of a free preputial graft whenever necessary within the incised plate the incidence of meatal stenosis could be reduced.


11:10 - 11:20
SN3-2 (OP)

THE TRUE INCIDENCE OF URINARY TRACT INFECTIONS AMONG INFANTS WITH ISOLATED HYDRONEPHROSIS

Margarita CHANCY 1, Jin K KIM 1, Michael CHUA 1, Joana DOS SANTOS 1, Natasha BROWNRIGG 1, Juliane RICHTER 1, Adree KHONDKER 1, Tim VAN MIEGHEM 2, Armando J LORENZO 1 and Mandy RICKARD 1
1) The Hospital for Sick Children, Urology, Toronto, CANADA - 2) Mount Sinai Hospital/ Ontario Fetal Centre, High Risk Obstetrics, Toronto, CANADA

PURPOSE

The rate of urinary tract infection(UTI) in healthy febrile infants is 7%. Isolated hydronephrosis(HN) refers to dilation of the renal pelvis and has been associated with an increased risk of UTI resulting in continuous antibiotic prophylaxis(CAP)use. Our goal was to determine the overall rate of UTI stratified by type, CAP, concurrent vesicoureteral reflux (VUR) and surgical/procedural instrumentation.

MATERIAL AND METHODS

A HN database from 2015-2022 was examined. Included patients were less than 24months with isolated HN. Those with other abnormalities were excluded. Captured variables included age, sex, circumcision status, HN severity and VUR status. UTI was strictly defined as fever, pyuria and positive culture from catheterized specimens. UTIs were categorized as "index"(pre-presentation), "surveillance"(while being followed), and post-procedural(associated with surgery/tests).

RESULTS

We included689 patients. The median age at baseline was 2 months(0-24m), follow-up was 23m(6-195). A total of52% were prescribed CAP for 6months(0-53). The overall UTI rate was 9% at 5months(0-32m) of age. UTIs were index in32(5%), surveillance in11(2%) and post-procedural in20(3%). After excluding procedural UTIs, the actual rate is 7%. Most patients were male(81%) 62% were uncircumcised. Uncircumcised males comprised 77%, 64% and 63% of index, surveillance and post-procedural UTI respectively. 96% had isolated HN and 53%had high grade(SFU 3-4) with APD of 11mm(0-60). There were 1% of patients with concomitant UPJ+UVJ obstruction and 3% were known to have VUR, however only 30% were investigated with VCUG. When comparing surveillance UTI to none, the only significant finding was 18% VUR in the surveillance group vs. 2% in the no infection group(p<0.01).

CONCLUSIONS

The overall incidence of UTI in children with isolated HN is low. We demonstrated that the rate of UTI is similar to the general population, generating controversy regarding the necessity of CAP. This presents an opportunity to limit exposure to antibiotics to children with isolated HN.


11:20 - 11:30
SN3-3 (OP)

OUTCOME FOLLOWING REPAIR OF GIANT HYDRONEPHROSIS : PYELOPLASTY VERSUS URETEROCALICOSTOMY.

Ashwin BOKARE, Rajendra NERLI, Abhinay JOGULA, Nishant SETYA and Ramana SRIPATHI
JN Medical College, KLE Academy of Higher Education and Research, Pediatric Urology, Belagavi, INDIA

PURPOSE

A giant hydronephrosis (GH) is defined as a gigantic dilatation of the pelvicalyceal system. The cause of GH in children is usually secondary to congenital anomalies such as uretero-pelvic junction (UPJ) obstruction, duplex system or megaureter. A kidney with a split renal function of greater than 10% is considered salvageable. The objective of this study was to assess the outcome of repair of unilateral GH secondary to UPJ obstruction and at the same time to evaluate the results of primary Anderson Hynes pyeloplasty with primary Uretero-calicostomy.

MATERIAL AND METHODS

Children presenting with giant hydronephrosis secondary to UPJ obstruction formed the study group. Ultrasonography was repeated every three months in the first year following surgery to note the parenchymal thickness as well as anterio-posterior diameter of the renal pelvis. Postoperative CT (computed tomography) was repeated at 12 months to assess the renal parenchymal thickness. A diuretic renogram was repeated 3 months following removal of double J stent, to note the function and drainage.

RESULTS

During the study period a total of 17 children ≤ 18 years of age (11 male and 6 female) underwent surgery for giant hydronephrosis secondary to ureteropelvic junction obstruction . The renal parenchymal thickness increased significantly in the post-operative ultrasonography and CT done at 12 months , so also the AP diameter of the renal pelvis decreased significantly as seen on CT films. There was marginal improvement noticed in the split renal function , however it was not significant. When outcomes were analysed , it appeared that the outcomes were better with the primary uretero-calicostomy as compared to primary pyeloplasty.

CONCLUSIONS

Surgical outcomes following repair of UPJ in children with GH are satisfactory, safe and reliable. The repair significantly improves renal parenchymal thickness and reduces AP diameter of the renal pelvis. Primary ureterocalicostomy shows better drainage as compared to primary pyeloplasty following repair of GH.


11:30 - 11:40
SN3-4 (OP)

RENAL TRANSPLANTATION IN A CHILD WITH TURNER SYNDROME

Nishant SETYA, Rajendra NERLI and Ramana SRIPATHI
JN Medical College, KLE Academy of Higher Education and Research, Pediatric Urology, Belagavi, INDIA

PURPOSE

Turner syndrome (TS) is a rare genetic disorder. Turner syndrome, affects only females, results when one of the X chromosomes is missing or partially missing. However, the prevalence of end-stage renal disease (ESRD) in TS appears to be less common. Some types of glomerulonephropathies are also known to be associated with TS, including membranoproliferative glomerulonephritis and focal segmental glomerulosclerosis. We report a child with TS and ESRD who underwent a successful renal transplantation.

MATERIAL AND METHODS

A 16-year-old female child, a known patient of chronic renal failure and end stage renal disease was admitted to our hospital for live related renal transplantation. She was a known case of hypothyroidism on treatment and had minor cardiac abnormalities. Chromosomal analysis had revealed 45 XO pattern. Genital examination revealed labia majora, labia minora, a long anogenital distance of 53 mm and a single opening of urogenital sinus. Genitoscopy revealed a normal urethra and a blind ending vagina

RESULTS

Renal transplantation was performed using donor's left kidney. During the surgery, it was noticed that the diameter of the common iliac and external iliac arteries in the recipient was 5 mm. The donor's kidney was anastomosed to the recipient's common iliac artery end to side. The post-operative period was uneventful and discharged from the hospital on 8th post-operative day. The serum creatinine settled to 0.6 mg%. The recipient has been on close follow-up.

CONCLUSIONS

Turner syndrome is a rare genetic disorder. Children with Turner syndrome have a number of renal, cardiac, vascular and endocrinal abnormalities. Renal transplantation is feasible and is associated with favourable outcome in patients with Turner syndrome.


11:40 - 11:50
SN3-5 (OP)

COMPARISON BETWEEN ELIMINATION SIGNALS IN HEALTHY NON-TOILET TRAINED CHILDREN AGED 18-24 MONTHS WHEN WEARING A DISPOSABLE DIAPER VERSUS WEARING UNDERWEAR: A PILOT STUDY

Alexandra VERMANDEL 1, Jean Jeacques WYNDAELE 2, Stefan DE WACHTER 2, Gunter DE WIN 2, Silke VERBRAECKEN 3, Eline VAN STOKKUM 3, Latifa EL HANDOUZ 3 and Tinne VAN AGGELPOEL 1
1) University Hospital Antwerp, Urology - Pelvic Floor Physiotherapy, Edegem, BELGIUM - 2) University Hospital Antwerp, Urology, Edegem, BELGIUM - 3) Antwerp University, Faculty of Medicine and Health Sciences - MOVANT, Wilrijk, BELGIUM

PURPOSE

Literature described elimination signals (ES) that non-toilet trained children can demonstrate when voiding. No research has been conducted to determine the possible influence of wearing diapers on the displayed ES. The purpose of this observational pilot study is to review the used protocol and identify the differences in ES with diapers and underwear in healthy, non-toilet trained children aged 18-24 months.

MATERIAL AND METHODS

Fifteen children were observed during two micturitions in underwear and two in diaper with urine indicator, in daycare centers or at home. The ES before, during and after voiding were listed.

RESULTS

Group analyses showed that when wearing underwear, children manipulated (p=0.031) and looked at (p<0.001) their intimate area significantly more often. Interrupting the activity (p=0.021) and not showing ES (p=0.017), occurred significantly more often with diaper. Telephonic contact and recruitment through social media obtained more participants. The more children observed simultaneously, the more circumstantial work. The use of diapers with urine indicators presented challenges in terms of visibility and a latency period. The preconceived list of ES facilitated the observations. Due to daily routine, observations in daycare centers lasted longer compared to home observations.

CONCLUSIONS

ES were significantly less detectable when wearing diapers. Wearing underwear might increase the number of displayed ES. Continuation of the established protocol is encouraged in future research, but with recruitment through telephone or social media. A maximum of three children per observation, the advice of a professional and the use of cameras is advisable.