ESPU Meeting on Friday 19, April 2024, 08:30 - 09:00
08:30 - 08:34
S14-1 (LOP)
Rachel PENNEY 1, Danny MATTI 2, Jessica PRODGER 2, Jeremy BURTON 2, Peter Zhantao WANG 2 and Sumit DAVE 3
1) LONDON HEALTH SCIENCES CENTRE, SURGERY, London, CANADA - 2) LONDON HEALTH SCIENCES CENTRE WESTERN UNIVERSITY, SURGERY/UROLOGY, London, CANADA - 3) London Health Sciences Centre, Western University, Surgery and Pediatrics (Division of Urology), London, CANADA
PURPOSE
Male circumcision (MC) is performed for religious reasons, treatment of pathological phimosis and for congenital anomalies associated with recurrent UTI's. This prospective cohort study aims to identify the changes to the foreskin microbiota before and after MC.
MATERIAL AND METHODS
We conducted a longitudinal study of pediatric patients undergoing MC and collected penile swabs during surgery and 6 weeks after MC (n=74). Patients were divided into 3 cohorts based on MC indication: pathological phimosis, religious elective MC, and MC for medical reasons. The microbiota before and after MC was characterized using 16S rRNA gene sequencing analysis for the different groups.
RESULTS
The penile microbiota was found to be significantly different between the cohorts prior to MC (p=0.014). After MC, the composition of the penile microbiota changes drastically (p=0.009) and the microbial diversity decreases. Data analysis suggests a preponderance of Prevotella sp. in uncircumcised boys, associated with higher T cell and dendritic cell density in the inner foreskin, which are markers for inflammation. The outer foreskin in boys with pathological phimosis showed a higher density of Langerhans cells and Natural killer cells.
CONCLUSIONS
These results suggest a change in the microbiota of the penile skin following MC and a correlation between inflammatory markers and the foreskin phimosis status. This information will increase the understanding of the relationship between the penile microbiota and the host in children and aid further studies to investigate the mechanism underlying the benefits of MC in patients undergoing circumcision electively or for pathological phimosis.
08:34 - 08:37
S14-2 (OP)
Alkan OKTAR 1, Mehmet Fatih ÖZKAYA 2, Aykut AKINCI 3, Ezel AYDOĞ 2, Efe Semetey OĞUZ 4, Murat Can KARABURUN 5, Tarkan SOYGÜR 2 and Berk BURGU 4
1) Ankara Üniversitesi Tıp Fakültesi, Üroloji, Ankara, TURKEY - 2) Ankara University, Urology, Ankara, TURKEY - 3) Denizli State City Hospital, Pediatric Urology, Denizli, TURKEY - 4) Ankara University, Pediatric Urology, Ankara, TURKEY - 5) Denizli Acipayam State Hospital, Urology, Denizli, TURKEY
PURPOSE
Bacterial colonization of the preputial and perimeatal skin is a natural occurrence in children and may play a role in maintaining genital health.This study aims to compare the impact of circumcision and probiotic use on bacterial colonization in uncircumcised children.
MATERIAL AND METHODS
We prospectively investigated children aged 0-3 years between August 2018- June 2019.Bacterial cultures were analysed, results were categorized by non-uropathogenic and uropathogenic bacteria,and compared within and between groups.irrelevant results were excluded.The subjects were categorized into three groups:Group 1 (n=31),uncircumcised children without probiotic supplementation;Group 2 (n=45),circumcised children;and Group 3 (n=33),consisting of uncircumcised children prescribed with probiotics (Bifidobacterium animalis,SSP lactis B9) before admitting to our institution for routine check up.Mean age was similar with each group.These children were initially evaluated every 3 months in the first year of life,with subsequent follow-up examinations every six months.Bacterial colonization in the periurethral meatal and glanular sulcus regions was examined during each follow-up visit.Cultures were obtained from both periurethral meatal and glanular sulcus areas by adhering strictly to the rules of obtaining bacterial culture to avoid false-positive or negative culture results.Chi square test was used for statistical analysis.
RESULTS
99 chidren completed the study The results revealed compelling findings.Bacterial colonization positivity during follow ups are %84 (n=26),%31 (n=14),%50 (n=17) for groups 1,2 and 3 respectively.Group 2 and Group 3 exhibited similar bacterial colonization patterns,with both groups demonstrating lower colonization of gram negative pathogens compared to Group 1 after the initial 6 months.(p value 0.001 and 0.006 respectively.
CONCLUSIONS
These findings suggest that circumcision and probiotic
supplementation in uncircumcised children may contribute to a reduction in
uropathogenic bacterial colonization. The potential clinical implications of
these differences in colonization warrant further exploration.
08:37 - 08:40
S14-3 (OP)
Tomer BASHI 1, Hadas RORMAN 2, Ziv SAVIN 1, Jacob BEN-CHAIM 1 and Yuval BAR-YOSEF 1
1) Tel-Aviv Medical Center, Pediatric Urology, Dana-Dwek Children's Hospital, Tel Aviv, ISRAEL - 2) Tel-Aviv Medical Center, Pediatric Urology, Dana-Dwek Children's Hospital., Tel Aviv, ISRAEL
PURPOSE
The reasons for performing a circumcision among male children after the neonatal period are characteristically cultural or medical. The aim of this study was to evaluate parental regret and identify factors associated with such regret.
MATERIAL AND METHODS
Included were male patients aged 6 months to 18 years who underwent circumcision under general anesthesia at a single center between 2/2017 and 01/2023. Those who underwent additional surgical procedures during the same session were excluded. Parents responded to the Decision Regret Scale (DRS) questionnaire via telephone. Regret was classified as none (0), mild (1-25), or moderate-to-strong (26-100). Surgical and demographic data were retrieved from the departmental database for comparison to DRS scores.
RESULTS
201 of the 265 suitable patients met the inclusion criteria. Parents of 130 patients (65%) with an average age of 5.06(IQR 1.58,7.53) years completed the DRS questionnaire. The average time since surgery was 41.8(IQR 25.4,59.3) months. Forty parents reported that the surgery was undertaken for cultural reasons, and 90 for medical considerations. Eighteen parents reported regret for the performance of circumcision (15 mild and 3 moderate-to-strong). Time since surgery was the only
significant variable in the DRS, with a gap of 33 months since surgery predicting no regret (p=0.02 compared to shorter gaps). The reasons for circumcision did not significantly differ between the regret and the no-regret groups (p=0.23).
CONCLUSIONS
Post-neonatal circumcision was regretted by 13.8% of parents, and the passage of time since surgery was found to significantly influence reduction of parental negative attitudes.
08:40 - 08:43
S14-4 (OP)
Aykut AKINCI 1, Murat Can KARABURUN 2, Mehmet Fatih OZKAYA 3, Tarkan SOYGUR 3 and Berk BURGU 3
1) Denizli State Hospital, Paediatric Urology, Denizli, TURKEY - 2) Acıpayam State Hospital, Urology, Denizli, TURKEY - 3) Ankara University, Pediatric Urology, Ankara, TURKEY
PURPOSE
Meatal stenosis can be seen frequently after circumcision. In this study, we aimed to compare the results of patients who received only steroid cream and patients who received steroid cream applied to the catheter.
MATERIAL AND METHODS
Between January 2020 and June 2023, patients who presented at the outpatient clinic with suspicion of meatal stenosis following circumcision and abnormal uroflowmetry findings were included in the study. Patients with neurogenic diseases, hypospadias, or a history of trauma were excluded from the study. The patients were randomly assigned to two groups. In the first group, Clobetasol propionate 0.05% was applied twice daily for four weeks. In the other group, in addition to this treatment, parents applied a steroid, which had been applied to the tip of an 8F catheter, into the distal urethra once daily. Uroflowmetry evaluation was conducted before and after the procedure, and the rates of referral for meatoplasty surgery were compared. For the evaluation of categorical data, the chi-square test was employed, and for the comparison of numerical values, the Student's t-test was used, all analyzed using SPSS 25.0.
RESULTS
53 patients were included in the study (27 steroid/26 steroid+catheter). The steroid and steroid+catheter groups were similar in terms of age (7.89±1.71 vs 8.50±1.42 p 0.16). Qmax at presentation (6.63±1.47 vs 7.00±0.56 p 0.23) and postvoid residual (29.81±5.63 vs 32.12±6.80 p 0.18) were similar. Post-treatment qmax (7.89±1.65 vs 8.54±2.28 p 0.24) and postvoid residual (23.52±9.58 vs 19.42±7.78 p 0.09) were similar between the groups. Meatoplasty surgery was required in 20 patients (74%) in the steroid group and 16 patients (61%) in the steroid+catheter group due to poor uroflowmetry results (p 0.32).
CONCLUSIONS
Steroid administration may reduce the need for surgery in post-circumcision meatal stenosis. Although steroid and catheter administration gave numerically better results, it was not reflected in the statistical result.
08:43 - 08:46
S14-5 (OP)
Alaa CHEIKHELARD 1, Marc GALIANO 2, Bruno D'ACREMONT 3, Frédéric GIRARD 3, Bertrand GIOVANSILLI 3, Jean-Marc CASANOVA 3 and Pierre DESVAUX 4
1) AP-HP Hôpital NECKER (and Clinique Saint-Jean de Dieu - GCS Oudinot Cognac-Jay), Paediatric Surgery & Urology, Paris, FRANCE - 2) Clinique de l'Alma, Urology, Paris, FRANCE - 3) Clinique Saint-Jean de Dieu - GCS Oudinot Cognac-Jay, Urology, Paris, FRANCE - 4) AP-HP Hôpital COCHIN AND UNIVERSITE PARIS CITE, Andrology / Sexology, Paris, FRANCE
PURPOSE
Phimosis is a narrowing of the preputial orifice that hinders complete and painless foreskin retraction onto the glans. It is physiological in children but should be resolved at puberty. Some men reach adulthood with a persistent congenital phimosis (PCP) that can impair their sexuality. The literature is abundant on circumcision, but little attention is paid to phimosis.
We aimed to evaluate the impact of PCP on sexuality in early adulthood.
MATERIAL AND METHODS
Inclusion criterae: men over 18 years of age who reached adulthood with PCP.
Methods: Descriptive study based on an online questionnaire (37 questions) adressing medical history, emotional experience and sexual function (including a personal adaptation of the Sexual Complaint Screener for Males).
RESULTS
435 men were contacted, 80 completed the questionnaire, 67 were included.
79% had impaired sexual onset, 69% had significant anxiety, 66% avoided sex, and 46% avoided a romantic relationship. Desire and arousal were impaired in only 20% and 15%. Sexual function was more impaired during penetration than during masturbation, in the domains of arousal (erectile dysfunction 36% vs 13%) and orgasm (rapid ejaculation 28% vs 20%, delayed ejaculation 18% vs 3%). 67% were dyspareunic.
60% realized they had a problem before 18 years, but 82% did not seek medical advice until after 20, half of them after 25. The mode of revelation was comparison with others (porn and peers) (36%), selfobservation (33%), sexual encounter (28%).
There was no traumatic experience of foreskin retraction in childhood and 55% recommended prevention in adolescents.
CONCLUSIONS
Despite heterogeneity of the population, declarative nature of the data and absence of a control population, this descriptive study is the first to report that unresolved PCP in adolescence alters penetrative but not masturbatory sexuality, leads to avoidance of romance and penetration, with delay in seeking treatment. Preventive systematic andrological consultation should be proposed to adolescents.