ESPU-Nurses Meeting on Thursday 18, April 2024, 11:40 - 12:20
11:40 - 11:50
SN3-1 (OP)
Fiona MARKS 1, Sharon MOHAN 2, Abdelrahman MOHAMED 2 and Massimo GARRIBOLI 2
1) Guys and St. Thomas' Trust, Urology, London, UNITED KINGDOM - 2) Guys and St Thomas' Trust, Urology, London, UNITED KINGDOM
PURPOSE
Hypospadias repair can be performed as a single-stage or two-stage procedure. There is currently no standardised protocol for the use of analgesia post-operatively. We assessed patients' pain and analgesia requirement in the acute post-operative period after either a single-stage or the first of a two-stage hypospadias repair.
MATERIAL AND METHODS
A patient questionnaire was devised and prospectively issued to patients upon discharge. The questionnaire comprised of five questions answered daily, assessing:
• Pain frequency
• Pain duration
• Pain severity
• Doses of paracetamol administered
• Doses of ibuprofen administered
The questionnaires were filled by the patients' caregivers and returned at their dressing and catheter removal admission for analysis.
RESULTS
Ten questionnaires were returned. Seven patients underwent a single-stage procedure. All patients received caudal block during the operation and were discharged with oxybutynin (0.1mg/kg TDS) to reduce bladder spasms.
Age range was 13-27 months with a mean age of 20.3 months. Collectively, post-operative pain occurred most frequently on day three, although pain episodes lasted longer and were more severe on day two.
Patients undergoing the first-stage procedure experienced nearly twice as many pain episodes (mean 16) compared with their single-stage counterparts. They also experienced longer duration of pain (peak mean of 66mins vs 22mins), higher pain severity and required more analgesia (both paracetamol and ibuprofen).
CONCLUSIONS
Based on the findings, we propose a strategy of as-required analgesia for patients undergoing a single-stage procedure and a protocol of regular paracetamol and ibuprofen combined on discharge for 72 hours before stepping down to an as-required basis for a first-stage hypospadias repair.
11:50 - 12:00
SN3-2 (OP)
Ellen BULLMAN 1, Hazem MOSA 2, Massimo GARRIBOLI 1, Anu PAUL 1, Arash TAGHIZADEH 1 and Pankaj MISHRA 1
1) Evelina children's Hospital London, Paediatric urology, London, UNITED KINGDOM - 2) Jenny Lind Children's Hospital, Paediatric urology, Norwich, UNITED KINGDOM
PURPOSE
Hypospadias is a common penile congenital anomaly that affects 1:200 boys. Hypospadias surgery has both short- and long-term complications. A significant nursing contribution is often required in the first post operative week. We aimed to improve the nursing knowledge and confidence about providing care to patients who recently underwent hypospadias surgery.
MATERIAL AND METHODS
A 7 question Questionnaire identifying staff nurses experience and knowledge of hypospadias nursing using a 5-point Likert scale. A structured nursing-centred workshop with emphasis on two clinical scenarios: hypospadias dressing removal and receiving a phone call from a parent of a hypospadias patient asking for advice. Training was delivered to band 5 (newly qualified) nurses on the nephro-urology ward of a tertiary paediatric urology centre over the period of 2 weeks.
RESULTS
15 nurses participated in the hypospadias training workshop. Questionnaire responses pre and post training were collected. Statistical analysis was performed using an independent t-test to compare responses pre and post training. A significant improvement in responses to the 7 questions was noted (table 1). An instructional video demonstration of hypospadias dressing removal by a paediatric urology clinical nurse specialist was produced to ensure continuity of the quality improvement initiative. A flow chart of the dressing removal procedure was also produced.
|
Pre-training |
Post-training |
P value |
Question theme |
|
|
Question 1 |
1.5 |
4.5 |
0.00 |
Types of hypospadias |
|
Question 2 |
1.5 |
4.4 |
0.00 |
Hypospadias operations |
|
Question 3 |
2.8 |
3.9 |
0.01 |
Dressing removal |
|
Question 4 |
2.1 |
4.2 |
0.00 |
Short-term complications |
|
Question 5 |
2.3 |
4.2 |
0.00 |
Managing postoperative complications |
|
Question 6 |
2.3 |
4.2 |
0.00 |
Giving phone advice |
|
Question 7 |
2.2 |
4 |
0.00 |
Hypospadias referral for escalation |
|
Free text response |
0.1 |
0.8 |
0.00 |
CONCLUSIONS
A focused nursing-centred training can increase nursing staff knowledge and confidence about managing patients with hypospadias. A sustainable mode of training delivery is needed to ensure training of newly qualified nurses.
12:00 - 12:10
SN3-3 (OP)
Abdurrahman ONEN
Dicle University Medical Faculty, Pediatric Surgery and Urology, Sur, TURKEY
PURPOSE
The clinical indication of a specific dressing is based upon the protective function and mechanical barrier of the tissues against contamination and reduction of infection in children underwent genital surgery. The correct choice of dressing is still challenging. The most important point is to prevent contamination of the surgical area with stool. We developed a special noval pad to prevent stool contamination in infant under go hypospadias repair.
MATERIAL AND METHODS
It is specially designed for infants who has not toilette training and wear diaper. The size of the this noval pad is 15 x 10 cm and has two adhesive wings each 10 cm. One adhesive wing is attached to perineum and distal part of scrotum, while the opposit wing is attached to the diaper. The adhesive long side of the pad is attached to each leg. We have educated and participated parent regarding this pad. Indications of our hypospadias pad is all kind of genital surgeries include hypospadias, epispadias, bladder exstrophy, burried penis, circumcision etc.
RESULTS
We prospectively used this special genital pad in 221 infants; 124 hypospadias, 13 epispadias, 16 burried penis, 5 bladder exstrophy and 63 circumsicion. We compared this group with 214 control infants who we did not use this pad that underwent a genital surgery. Stool contamination was observed in 4/221(1.8%) special pad group while it observed in 37/214(17.3%) control group.
CONCLUSIONS
The proposed material (hypospadias pad) seems to be a highly satisfactory alternative in improving post-operative care after hypospadias surgery. Its use is adequate for prevention of stool contamination after all kind of genital surgeries.
12:10 - 12:20
SN3-4 (OP)
Mehmet Ugur YILMAZ 1 and Tubanur BALTA SARI 2
1) Diyarbakir Children's Hospital, Paediatric Urology, Diyarbakir, TURKEY - 2) Gazi Yasargil Training and Research Hospital, Underwater and Hyperbaric Medicine, Diyarbakir, TURKEY
PURPOSE
We aimed to present the hyperbaric oxygen therapy(HBOT) results of five patients who were operated for distal hypospadias and developed glans ischemia.
MATERIAL AND METHODS
Five patients who received HBOT after hypospadias surgery between October 2022 and April 2023 were included in this study. HBOT protocol was carried out in 2.4 ATA(atmosphere absolute)/45 fsw(feet sea water) and treatment time was 120 minutes. The number of sessions were determined individually for each patient. Before and after therapy penile shaft and glans of the patients were photographed.
| Patients | Age(years old) | Diagnosis | Surgical Method | HBOT Initiation Date(Postoperative) | Number of HBOT Sessions Received | Additional Intervention |
| 1 | 10 | Coronal Hypospadias | TIP(Tubularized Incised Plate) Repair | 7th Day | 14 | One Session of Urethral Bougie Dilation |
| 2 | 1 | Coronal Hypospadias | MAGPI(Meatal Advancement and Glanuloplasty ) | 1st Day | 9 | |
| 3 | 3 | MIP(Megameatus and Intact Preputium) | Duplay | 4th Day | 5 | Two Sessions of Urethral Bougie Dilation |
| 4 | 3 | MIP | Duplay | 1st Day | 9 | |
| 5 | 2.5 | Glanular Hypospadias and Concealed Penis | MAGPI and Concealed Penis Corrrection | 1st Day | 6 |
RESULTS
Patients who developed glans ischemia were treated for the formation of necrosis demarcation line and to support wound healing. It was observed that the ischemic status improved in all patients from the first session of treatment. All patients were discharged when the wound epithelisation started after the ischemia line was demarked. Wound healing was better in patients with early detection of glans ischemia and whose sessions were started more quickly. Urethral strictures requiring urethral dilation developed in patients who started their sessions later than others.
CONCLUSIONS
We believe that HBOT treatment in the early period is important to prevent progression to necrosis and reduces early and late complications in cases of postoperative glans ischemia after hypospadias surgeries.