ESPU-Nurses Meeting on Thursday 18, April 2024, 10:20 - 11:10
10:20 - 10:30
SN2-1 (OP)
Mandy RICKARD, Armando J LORENZO, Juliane RICHTER, Jin Kyu KIM, Michael CHUA and Joana DOS SANTOS
The Hospital for Sick Children, Urology, Toronto, CANADA
PURPOSE
To explore the impact of PUV on quality of life of families and compare them to healthy controls published in the literature.
MATERIAL AND METHODS
From December 2022-Oct 2023 we distributed the family impact module(FIM) of the PedsQL Inventory, to parents of patients with PUV. The FIM measures the impact of chronic illness on the parent and family as a whole. The maximum score is 100, with higher scores reflecting a lower illness impact. We conducted subgroup analyses to determine family impact based on age, initial surgical intervention, catheterizations (CIC) and CKD
RESULTS
A total of 100 families completed the questionnaire. The mean age of the child with PUV was 7+/-5 years. The overall FIM score was 74+/-19, the impact on parent was 77+/-21 and the family impact 80+/-21. Scores were significantly lower for families with children <2y (63+/-28 vs. 78+/-16; p<0.01) and while not significant, family scores were lower for children on CIC (74+/-23 vs. 83+/-19; p=0.07). The reported FIM score for a community sample was 74+/-14, which was not different from our PUV cohort (p=0.19).
| Total | Parent | Family | |||||||
| Yes | No | p | Yes | No | p | Yes | No | p | |
| CIC (n=26) | 71+/-21 | 77+/-19 | 0.26 | 76+/-22 | 78+/-20 | 0.85 | 74+/-23 | 83+/-19 | 0.06 |
| UTIs (n=42) | 71+/-21 | 80+/-17 | 0.08 | 74+/-22 | 80+/-19 | 0.24 | 76+/-22 | 85+/-17 | 0.08 |
| Urinary Diversion (n=34) | 71+/-21 | 77+/-19 | 0.22 | 74+/-23 | 79+/-19 | 0.31 | 76+/-20 | 82+/-20 | 0.25 |
| CKD (>3) (n=18) | 72+/-16 | 76+/-20 | 0.56 | 74+/-18 | 78+/-21 | 0.53 | 77+/-17 | 80+/-21 | 0.56 |
| Age63+/-2878+/-16<0.0169+/-2680+/-170.0272+/-2783+/-170.03 | |||||||||
CONCLUSIONS
The impact of PUV diagnosis appears to impact families of children less than 2years of age; and, while not significant, those on CIC report lower scores compared those who are not. These data may support additional mental health and social work support for these families.
10:30 - 10:40
SN2-2 (OP)
Cal H ROBINSON 1, Mandy RICKARD 2, Nivethika JEYAKUMAR 3, Graham SMITH 3, Eric MCARTHUR 3, Joana DOS SANTOS 2, Rahul CHANCHLANI 4 and Armando J LORENZO 2
1) The Hospital for Sick Children, Paediatric Nephrology, Toronto, CANADA - 2) The Hospital for Sick Children, Urology, Toronto, CANADA - 3) London Health Sciences Centre, Lawson Health Research Institute, London, CANADA - 4) McMaster University, Pediatric Nephrology, Hamilton, CANADA
PURPOSE
To determine the risk of major adverse kidney events (MAKE) among PUV patients.
MATERIAL AND METHODS
Population-based retrospective cohort study of all males (0-2-years) diagnosed with PUV between 1991-2021 in Ontario, Canada, identified by diagnostic codes in province-wide administrative health databases. Control cohorts were: 1) male general population and 2) male pyeloplasty patients (both 0-2-years, without PUV). The primary outcome was time-to-modified MAKE (death, chronic kidney replacement therapy (KRT; dialysis or kidney transplant), or de novo chronic kidney disease (CKD)). We censored for death, provincial emigration, or Mar 2022.
RESULTS
We included 727 PUV, 855 pyeloplasty, and 1,013,052 general pediatric controls with a follow-up time of 16.6 years (IQR 8.6-24.5). Age at PUV diagnosis was 40 days(IQR 10-196). Throughout follow-up, 32.3% PUV patients developed MAKE vs. 0.8%of general controls. The aHR for MAKE among PUV patients was 36.6(95%CI 31.6-42.4,p<0.001) vs. general controls. The risks of CKD, KRT, hypertension, and AKI were all higher among PUV patients(Table).
| Outcome | PUV patients n=727 n(%) |
Pyeloplasty patients n=855 n(%) |
General pediatric controls n=1,013,052 n(%) |
Adjusted HR(95% CI) (PUV vs. general controls) |
| Major adverse kidney event (MAKE) | 235 (32.3) | 50 (5.8) | 8198 (0.8) | 36.6 ( 31.6-42.4) |
| All-cause mortality | 17 (2.3) | Not reported (NR) for privacy due to small cell size | 4355 (0.4) | 2.9 (1.7-4.8) |
| Kidney replacement therapy (dialysis or transplant) | 61 (8.4) | 6 (0.7) | 155 (<0.01) | 130.7 (78.3-218.2) |
| Chronic kidney disease | 198 (27.2) | 44 (5.1) | 4017 (0.4) | 82.0 (70.8-94.9) |
| Hypertension | 133 (18.3) | 48 (5.6) | 29445 (2.9) | 5.7 (4.7-6.8) |
| Acute kidney injury | 145 (19.9) | 32 (3.7) | 4513 (0.4) | 27.9 (22.8-34.2) |
CONCLUSIONS
PUV patients are at increased long-term risks of CKD, KRT, hypertension, and AKI. This justifies greater kidney function and BP surveillance among children and adults with a PUV history
10:40 - 10:50
SN2-3 (OP)
Mandy RICKARD 1, Armando J LORENZO 1, Noreen GORAYA 2, Juliane RICHTER 1, Jin Kyu KIM 1, Michael CHUA 1 and Joana DOS SANTOS 1
1) The Hospital for Sick Children, Urology, Toronto, CANADA - 2) The Hospital for Sick Children, Social Work, Toronto, CANADA
PURPOSE
To evaluate the physical and psychosocial quality of life (QoL) of children with PUV using and compare them to controls reported in the literature.
MATERIAL AND METHODS
From December 2022-Oct 2023, we distributed the PedsQL Inventory, which is a validated tool for assessment of QoL in children. It provides a measure of the impact of chronic illness on physical and psychosocial QoL with a maximum score of 100. Higher scores reflect better QoL. Children >8years completed the tool themselves, otherwise parents did so on behalf of the child. We performed subgroup analyses stratified by age, initial surgical intervention, catheterization (CIC), and CKD.
RESULTS
A total of 103 patients ages 7+/-5years completed the instrument. The total QoL score was 80+/-13, physical score was 88+/-15 and psychosocial was 76+/-16. Children on CIC scored significantly lower in the psychosocial domain compared to those who were not (68+/-22vs. 78+/-16;p=0.03) and age <2years also scored significantly lower in physical and psychosocial domains (79+/-16 vs. 90+/-14;p<0.01 and 67+/-23 vs. 77+/-17; p=0.03). When PUV patients were compared to healthy children, they scored significantly lower overall QoL scores (80+/-13 vs. 84 +/- 12; p<0.01), but when compared to other children with chronic illness, PUV patients scored significantly higher (80+/-13 vs. 74 +/- 15; p<0.01).
CONCLUSIONS
When compared to healthy controls, PUV patients score significantly lower on overall QoL assessment. In addition children <2y of age experience lower scores across both physical and psychosocial domains and CIC negatively impacts the emotional well-being. These data can be used to advocate for better mental health supports and social work for these children
10:50 - 11:00
SN2-4 (OP)
Eeke VAN LEERSSEN 1, Sanne LINDEBOOM 1, Rafal CHRZAN 2, Tariq ABBAS 3, Mirjam GARVELINK 4 and Rogier Paul Joseph SCHROEDER 1
1) UMC utrecht, Urology, Utrecht, NETHERLANDS - 2) Jagiellonian University Medical College, Pediatric Urology, Cracow, POLAND - 3) Sidra Medicine, Urology, Ar-Rayyan, QATAR - 4) Antonius Nieuwegein, Value-Based Health Care, Nieuwegein, NETHERLANDS
PURPOSE
Anatomical infravesical obstruction in boys is a common form of pathology in pediatric urology. Patients may present with various symptoms and signs at different ages. Accurate objective diagnostic modalities to diagnose anatomical infravesical obstruction in boys are lacking.
This study aims to reach a consensus on the diagnostic determinants that are important to assess the likelihood of an anatomical infravesical obstruction in boys.
MATERIAL AND METHODS
A Delphi method was used to establish a list of diagnostic determinants that might lead to the diagnosis of an anatomical infravesical obstruction in boys. Consensus was reached among an international and interdisciplinary panel of seventeen experts through sequential electronic questionnaires. Rounds one and two were used to define diagnostic determinants. Round 3 was used to differentiate these regarding age.
RESULTS
Both rounds received a response rate of 100%. In round one, a consensus was achieved on 44 of the total 79 items. In round two, extra consensus was achieved on 19 of the total 51 items. There was agreement that a toddler obstruction needs more additional diagnostics than a neonate. The final third round of this study used to differentiate the importance of determinants based on these age groups. Both neonates and toddlers require information from history, clinical presentation and (prenatal) ultrasound. For toddlers additionally flowmetry and urodynamics are considered relevant.
CONCLUSIONS
An international group of experts agreed that a risk assessment tool on the likelihood of an anatomical infravesical obstruction in boys would be beneficial for both clinical practice and research. Using a Delphi study method, a consensus was reached on a whole set of diagnostic determinants that should be employed for such a tool. This study paves the way for future research validating the determinants in a (prospective) clinical setting.
11:00 - 11:10
SN2-5 (OP)
Catrin GRIFFITH, Fiona MARKS, Claire FOSTER, Ellen BULLMAN, Eleanor PAGE, Abdelrahman MOHAMED and Massimo GARRIBOLI
Evelina London Children's Hospital, Paediatric Urology, London, UNITED KINGDOM
PURPOSE
Posterior Urethral Valves (PUV) is a common cause of urinary tract obstruction in male patients. Early bladder management is essential to avoid progressive damage to both the upper and lower urinary tract. A 4-hour voiding observation study allows investigating bladder function as early as a few days old and can detect any unsafe parameters that requires intervention to ensure the bladder is kept safe. We aimed to review our experience and outcomes in boys with PUV
MATERIAL AND METHODS
We retrospectively reviewed patients born with PUV who undergone 4-hour voiding observation study between 2021 and 2023. Parameters evaluated were voiding frequency, bladder capacity and emptying and clinical decisions following the assessment.
RESULTS
A total of 37 patients were reviewed. Age ranged from 6 months to 3 years. Number of voids completed during the four-hour assessment ranged between 1-8 (average 4.5). Bladder capacity (compared to expected bladder capacity) was small in 5, normal in 24 and large in 7. Post-void residuals ranged between 0-188 ml (average 23 ml). Following the assessment, an intervention was recommended in 14 boys (38%): start or continue with toilet training with the aim of better control bladder emptying with routine double voiding (n=9), Clean Intermittent Catheterisation to commence (n=3) or continue (n=1) and laxatives (n=1). No intervention was considered required in 23 (62%) patients.
CONCLUSIONS
Our experience highlights the importance of investigating bladder function in infancy in boys with PUV. The 4-hour voiding observational study is a simple and reproducible test that can be important for ensuring the safety of their bladder and urinary tracts