Parallel Meeting on Wednesday 19, April 2023, 17:40 - 18:15
Ziggy VAN UYTVEN 1, Matthew PETERS 1, Stefan DE WACHTER 2, Alexandra VERMANDEL 2, Karen DE BAETS 3, Lola BLADT 4 and Gunter DE WIN 2
1) University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk, BELGIUM - 2) University Hospital Antwerp & University of Antwerp, Urology Department & Faculty of Medicine and Health Sciences, Edegem, BELGIUM - 3) University Hospital Antwerp, Department of Urology, Edegem, BELGIUM - 4) University of Antwerp, Product Development, Antwerpen, BELGIUM
INTRODUCTION AND AIM
Although we regularly perform uroflow tests in our patients, little is known about the change in flowrates during pubertal development.
MATERIAL AND METHODS
33 boys (age 11-15) were recruited in a secondary school. Based on drawings, photos and a description of each stage, a Tanner self-assessment tool for pubertal development was created. After each boy assessed his tanner stage, an objective evaluation was undertaken by a blinded medical assessor. Next, the boys returned to their classroom and were instructed to drink 300ml of water. When they felt an urge to empty their bladder, a uroflow test was performed and their urge was assessed based on the ICS criteria. Boys with voiding issues, non-bell-shaped curves, history of urethral surgery or urge 0/4 were excluded.
No statistical difference between age and objective Tanner stages was found. Subjective and objective Tanner agreement was 14% for stage 1 and 76% for the higher Tanner stages. For uroflow statistics 6 boys were excluded. There was no statistical difference in Qmax based on their age (p=0.381) however a significant difference was noted based on tanner stage (p<0.001) with mean values ranging from 19.8 (+/- 2.32) in Tanner 1 to 34.2 (+/- 5.07) ml/s in Tanner 4. There was no difference in Qmax between Tanner 1 and 2.
During pubertal development, it is better to evaluate Qmax in relation to Tanner stage instead of age. Apart from stage 1, Tanner self-assessment before uroflow is feasible and correlates well with objective assessment.
Amelia PANTAZIS 1, Jordan GITLIN 1, Spencer SHANE 1, Alexander FANG 2 and Israel FRANCO 3
1) NYU Langone Hospital - Long Island, Mineola, NY, USA, Pediatric urology, New Hyde Park, USA - 2) NyU Langone Hospital - Long Island, Mineola, NY, USA, Department of Pediatric Urology, New Hyde Park, USA - 3) Yale School of Medicine, Pediatric urology, New Haven, USA
Traditionally, erectile dysfunction (ED) has been considered a disease of older men. A review of the literature reveals a paucity of information about adolescent ED. Our aim was to gain a further understanding on ED in this population to help guide evaluation and treatment.
MATERIAL AND METHODS
We performed retrospective chart review of a single practice over an 8-year period which included 129 males between the ages of 14 and 21 who presented with ED. We evaluated mental health status, medications, lab work, testicular exam, ED setting, ED severity, medical history, surgical history, BMI, number of visits, referrals to other providers, ejaculation success, and problem resolution. Statistics were performed using SPSS, which included descriptive statistics, Chi-square, ROC, and logistic regression analysis where applicable.
129 adolescent males with mean age of 16.89 ± 1.41 were identified with a mean number of visits of 1.2 ± 0.53 and a mean BMI of 23.5 ± 3.90. Erection quality was described as longer to achieve 9(7%), difficult to maintain 26(20%), partial 50(39%), and failed to erect 15(12%). Erection problems were present during intercourse 38(30%), masturbation 29(23%), and in both settings 14(11%). 56% of patients that had a neuropsychiatric problem reported an issue with intercourse. Neuropsychiatric conditions associated with ED were anxiety 10(8%), depression 9(7%), both 5(4%), and psychosis 1(0.7%). There was a statistically significant association between testicular hypotrophy and ED severity by chi square analysis (p=0.048), unfortunately we do not have the laboratory data to potentially link the presence of hypotrophy to an endocrine or organic cause of the ED. 14(37%) of patients had elevated prolactin level many were on psychiatric medications.
There is a high incidence of psychogenic ED ranging from 18-77%. Organic causes do exist and blood work should be ordered on all adolescent males presenting with erectile dysfunction which includes Testosterone, LH, FSH, Prolactin, and TSH.
Gabriel MONTEIRO, Bruna VENTURINI, Ana BRAGA, Maria CALASANS and Ubirajara BARROSO
Bahiana School of Medicine and Public Health, Uropediatrics, Salvador, BRAZIL
The aim of this study is to evaluate the quality of life (QoL), urinary continence, sexual function, self-esteem, genital self-image and sexual positioning preferences in adults patients who have undergone surgical correction for exstrophy-epispadia complex (EEC) in childhood.
MATERIAL AND METHODS
This is a cross-sectional study. Seven self-administered questionnaires were used. Participants were divided into two groups: Those who operated for EEC (31 participants) and a control group of individuals without any urogenital malformation (30 participants).
QoL scores were lower in the EEC for the domains of general health (p=0,006), social aspects (p=0,023) and mental health (0,012). Regarding self-esteem, no statistically significant difference was found (p=0,051). Urinary incontinence scores were worse in the exstrophics in the comparison between groups (p<0,001) and between exstrophic and non-exstrophic women (p=0,01). Erictile function did not differ in general between groups (p=0,392), however, male sexual function scores were worse for the domain of general satisfaction (p=0,015). For women, sexual function scores were worse for the pain domain (p=0,034). Self-image was significantly impaired in both sexes (p<0,001).
Adults patients with EEC have in some aspects impairement of QoL. Males with EEC are generely less satisfied with the sexual function and the main complain of the women was pain during the intercourse. Self image was impared in both genders with EEC.
Ashley W. JOHNSTON, Konrad SZYMANSKI, Rosalia MISSERI and Joshua D. ROTH
Riley Hospital for Children, Indiana University, Pediatric Urology, Indianapolis, USA
To assess decision regret (DR) among adults with spina bifida (SB) regarding Malone antegrade continence enema channel (MACE) creation in childhood
MATERIAL AND METHODS
We surveyed consecutive adult patients (>/=18 years old [y]) who underwent MACE creation at <18y (6/2018-1/2020). Utilizing the Decision Regret Scale, DR was categorized as: none (0), mild (1-25), moderate (26-50), strong (51-75), very strong (76-100). We analyzed whether bowel management habits, bowel symptoms, or symptom bother impacted DR.
Of the 71 patients (52% male, 90% White), the median ages at survey participation was 24y and MACE creation at 7y. Median DR score was 0 with 58% without any DR. Of those with some DR, the majority were mild (28%) and moderate (11%) with few strong (1%) or very strong (1%).
The majority, 73%, were independently flushing a median 7 times/week and spending a median 1 hour on the toilet. DR was significantly associated with both time on the toilet >1 hour (p=0.02, OR 3.7, 95%CI [1.3-10.8]) and bother waiting for stool evacuation (p=0.02, OR 3.2, 95%CI [1.2-8.5]). Difficulty catheterizing was also associated with DR (p=0.02, OR=3.3, 95%CI [1.2-9.5]). On multivariate logistic regression, only catheterization difficulty was significantly associated with DR (p=0.05, OR 3.3, 95%CI [0.99-10.9]). Fecal incontinence, MACE leakage, and demographics weren't associated with increased DR (p>0.3).
The majority of adults with SB do not regret undergoing MACE creation as children. Those with DR have mild to moderate levels. Time on the toilet, bother associated with flushing time, and catheterization issues were associated with higher levels of DR.
Rosalia MISSERI 1, Ashley W. JOHNSTON 1, Devon J. HENSEL 2, Joshua ROTH 1, John S. WIENER 3 and Konrad M. SZYMANSKI 1
1) Riley Hospital for Children, Indiana University, Pediatric Urology, Indianapolis, USA - 2) Riley Hospital for Children, Indiana University, Pediatrics, Indianapolis, USA - 3) Duke University Medical Center, Urology, Durham, USA
To evaluate the frequency and risk factors of sexual abuse (SA) and intimate partner violence (IPV) in adults with spina bifida (SB)
MATERIAL AND METHODS
We conducted an anonymous cross-sectional online survey in adults (>/=18 years old [y]) with SB from across the world. Participants were asked about a history of SA (“sexual contact that you did not want”) and IPV (“hit, slapped, kicked, punched or hurt physically by a partner”).
Median age of the 405 participants (61% female) was 35y. Most self-identified as heterosexual (85%) and were in a romantic relationship (66%).
A total of 19% reported a history of SA (78% no SA, 3% preferred not to answer). Women reported SA more frequently than men (27% vs. 5%, p<0.001). Adults reporting non-heterosexual sexual orientation were more likely to report SA than heterosexual adults (41% vs. 15%, p<0.001). On multivariate analysis, female gender and non-heterosexual orientation were independently associated with SA (p<0.001 for both).
Twelve percent reported a history of IPV (86% no IPV, 2% preferred not to answer). IPV was more frequently reported by women compared to men (14% vs. 9%, p=0.02), non-heterosexuals compared to heterosexuals (26% vs. 10%, p=0.002), and adults with a history of sexual activity versus those without (14% vs. 2%, p=0.01). On multivariate analysis, only non-heterosexual orientation was independently associated with IPV (p=0.002). Age, ambulatory status, presence of ventriculoperitoneal shunt, and bladder emptying management were not associated with SA or IPV (p>0.15).
People with SB are vulnerable to SA and IPV. Women and non-heterosexuals are at highest risk of SA and IPV.