ESPU-Nurses Meeting on Friday 21, April 2023, 10:50 - 11:25
10:50 - 10:57
SN8-1 (PP)
Eleanor PAGE
Evelina London Children's Hospital, Paediatric Urology, London, UNITED KINGDOM
PURPOSE
Bladder dysfunction is common in boys born with posterior urethral valves (PUV) and they often require medical intervention in order to preserve upper tract function. We aimed to evaluate the incidence of bladder intervention required prior to the onset of puberty.
MATERIAL AND METHODS
A retrospective review of a prospectively maintained database of boys born with PUV looked after in our institution. Inclusion criteria were pre-pubertal boys (between 9 and 13 years old) who underwent a non-invasive bladder function assessment (BFA). We collected data on any of the following interventions: medication, clean intermittent catheterisation (CIC), surgical procedures or a combination.
RESULTS
116 patients were included. At the time of their pre-pubertal BFA a total of 40 patients (34.5%) had had some form of bladder intervention. 25 boys were on bladder medication (of which 24 were anticholinergic and 1 alpha blocker), 15 were performing clean intermittent catheterisation and 13 had undergone a surgical intervention: botox injections to the bladder in 2, formation of Mitrofanoff channel in 8 formations (6 with an ileocystoplasty), insertion of suprapubic catheter in 2 and formation of vesicostomy in 1. Of these, 11 boys had more than 1 intervention.
CONCLUSIONS
Our data suggest that around one third of boys born with PUV would have required a medical intervention for controlling or supporting their bladder function before the onset of puberty. This underpins the importance of patients having regular investigations and assessments to monitor the impact of PUV of their bladder and kidney function.
10:57 - 11:04
SN8-2 (PP)
Fiona MARKS 1, Kay RUTH 2, Jane THOMAS 2, Janet WOOTTON 2 and Massimo GARRIBOLI 2
1) Evelina Children's Hospital, Guy's and St Thomas' Trust, Paediatric Urology, London, UNITED KINGDOM - 2) Evelina London Children's Hospital, Paediatric Urology, London, UNITED KINGDOM
PURPOSE
A nurse-led foreskin clinic with consultant support was established in our hospital in 2016. We share our experience with managing the caseload.
MATERIAL AND METHODS
A prospective analysis of new referrals between July 2016 and July 2018 was conducted. Reason for referral was categorised. The appropriateness of referrals was analysed, along with outcomes and interventions undertaken. Circumcision for cultural reasons is not available on the NHS therefore these referrals are not accepted.
RESULTS
In total, 128 new patients were seen. The mean age was 6 years (range 4 months- 16 y). The indications for referral are listed below (Table 1). The commonest reason for referral was phimosis (54%) followed by balanitis (15%).
Table 1
|
Category |
Number |
|
Phimosis |
69 |
|
Balanitis |
19 |
|
Balanitis Xerotica Obliterans (BXO) |
5 |
|
Voiding problems |
5 |
|
Surgical problems |
5 |
|
Hypospadias |
4 |
|
Preputial adhesions |
4 |
|
Foreskin pain |
4 |
|
Smegma cyst |
3 |
|
Buried penis |
3 |
|
Others |
3 |
|
Paraphimosis |
2 |
|
UTIs |
1 |
|
Preputial ring |
1 |
65 (51%) patients were discharged after the first appointment. 31 (24%) patients were given a follow-up appointment, with conservative instructions such as daily retraction or steroid cream application. 25 (20%) patients were listed for surgery, of which 19 were circumcisions. The remaining patients required alternative follow-up with other specialties. The commonest indications for circumcision were scarring secondary to balanitis or BXO.
CONCLUSIONS
The majority of cases referred to foreskin clinic are physiological phimosis requiring no intervention. This study endorses a role for a safe nurse-led foreskin clinic and highlights the need for educating primary care colleagues
11:04 - 11:11
SN8-3 (PP)
Eleanor PAGE
Evelina London Children's Hospital, Paediatric Urology, London, UNITED KINGDOM
PURPOSE
Posterior urethral valves (PUV) is a congenital condition that requires multiple surgical treatment and medical intervention which can be incredibly overwhelming for the child and family. On top of this, patients and carers often require logistical and moral support. Our aim is to review and reflect on the role of the clinical nurse specialist (CNS) within the PUV service at our tertiary referral hospital.
MATERIAL AND METHODS
We look after a population of more than 300 boys with PUV from birth to transition to adult services at 17 years of age. Patients attend hospital for elective surgical intervention, radiological tests and emergency admissions as well as outpatient appointments. Our CNS team is involved in undertaking assessments and counselling families as well as answering queries and providing education and support to schools and other healthcare providers. Since 2020 the role of "PUV CNS" has been introduced in our team with the aim to have a more robust control of the patients and their appointments.
RESULTS
In the last couple of years the CNS team recorded approximately 600 hospital contacts with PUV patients. This has included patients attending for assessments, planned admissions for surgery and investigations, training and contact over email and telephone with parents.
CONCLUSIONS
PUV can be an overwhelming and logistically challenging diagnosis for families. The role of a PUV CNS is important to council and support parents through their sons' childhood. CNS' represent a vital point of contact and ensure a smooth journey from the moment of PUV diagnosis through the transition to adult services.
11:11 - 11:18
SN8-4 (PP)
Lola BLADT 1, Gunter DE WIN 2, Alexandra VERMANDEL 2 and Lukas VAN CAMPENHOUT 1
1) University of Antwerp, Product Development, Antwerp, BELGIUM - 2) University Hospital Antwerp, Urology, Edegem, BELGIUM
PURPOSE
Urotherapy is the recommended first-line treatment for children with lower urinary tract dysfunctions (LUTD). However, therapy compliance and motivation are low, contributing to its low success rate of 40-56%. Urotherapy is often supported by simple paper-based solutions and the little technology used, can be perceived as outdated by children today. Our goal was to map the various innovation strategies aimed at improving the patient pathway of children with LUTD.
MATERIAL AND METHODS
We conducted a scoping review in March 2022, by searching in Web of Science, Pubmed and Cochrane Library using no date limits. A combination of four search concepts were used: (i) dysfunction descriptors, (ii) therapy descriptors, (iii) innovation strategy descriptors and (iv) pediatric population descriptors.
RESULTS
The search retrieved 2030 articles. After screening and eligibility assessment, 66 articles were included in the review. A range of innovation strategies was found to support diagnosis, therapy and/or self-management, including smartphone apps, software programs, video and multimedia, gamified therapy, reminder tools, redesigns and new technology. The majority of innovation strategies targeted children with nocturnal enuresis (N=19) and urinary incontinence generally (N=12). Most studies were randomized controlled trials (N=14) and validation studies (N=13), followed by quasi-experiments (N=9), experimental studies with no control group (N=8) and qualitative or mixed methods study designs (N=8). A mean sample size of 82 subjects with a standard deviation of 83 (range 14-353) was found for the RCTs, quasi-experiments and experimental studies (no control), indicating a large variation in sample size. 37.8% of studies evaluated outcomes related to patient experience, such as satisfaction, motivation and usability.
CONCLUSIONS
This review offers insight into the various innovation attempts in pediatric LUTD management, which can offer guidance for researchers and designers considering to improve this.
11:18 - 11:25
SN8-5 (PP)
Lola BLADT 1, Gunter DE WIN 2, Stefan DE WACHTER 2, Lukas VAN CAMPENHOUT 1 and Alexandra VERMANDEL 2
1) University of Antwerp, Product Development, Antwerp, BELGIUM - 2) University Hospital Antwerp, Urology, Edegem, BELGIUM
PURPOSE
2.3 billion people worldwide – among which a large group of children – suffer from Lower Urinary Tract Symptoms (LUTS). However, only few seek care because of several barriers, such as embarrassment, anxiety and unawareness. We organized a taboo-breaking LUTS awareness campaign at ‘Nerdland festival’, a popular Belgian science festival. We informed and educated visitors about LUTS by means of a uroflowmetry test on the festival toilets. Herein, we describe the uroflow parameters collected on festival toilets of pediatric volunteers.
MATERIAL AND METHODS
Participants voided voluntarily and at their discretion on a portable uroflowmeter (Minze Uroflow) placed on festival toilets. We classified the uroflow curves using (i) the ICCS descriptors, (ii) the Franco-Yang flow index, (iii) ratio of Qave and Qmax and (iv) time to Qmax. A Qmax vs. Vvoid plot was created and compared to the Miskolc nomograms for girls and boys with a body surface area of 0.92-1.42m2 (≈6–12y).
RESULTS
89 measurements were obtained from children aged 3–13 years (mean 9.8y, SD 2.4y, M:47 and F:42). They were enthusiastic to see their uroflow curve and learn more about LUTS. 60.7% of uroflow curves were classified as normal, bell-shaped. However, 62.9% of measurements had a Vvoid smaller than 50% of EBC, which may change the uroflow curve. Mean Vvoid was 137.7 ml (SD 98.4 ml, range 12-497 ml) and mean Qmax was 19.4 ml/s (SD 7.8 ml/s, range 5.4–39.5 ml/s). Most measurements (88.7%) fell within the normal percentiles of the Miskolc nomograms with few outliers. About three-quarters of measurements fell below the 50th percentile and 75th percentile for girls and boys, respectively.
CONCLUSIONS
The uroflow parameters of pediatric volunteers collected on festival toilets were largely normal but with a small Vvoid compared to EBC. A portable, toilet-based uroflowmeter can be used as an engaging informational and screening tool for LUTS.