ESPU-Nurses Meeting on Friday 19, April 2024, 08:50 - 09:30
08:50 - 09:00
SN6-1 (OP)
Ellen BULLMAN, Eleanor PAGE, Fiona MARKS, Griffith CATRIN, Kay RUTH, Claire FOSTER, Keisha HEPBURN and Massimo GARRIBOLI
Evelina London Children's Hospital, Paediatric Urology, London, UNITED KINGDOM
PURPOSE
Electromyography (EMG) electrodes are used during Bladder Function Assessments (BFA) to analyse pelvic floor and abdominal EMG activity during voiding. This can indicate dysfunctional voiding, underactive bladder and obstruction. EMG can be associated with discomfort, embarrassment and dislike. We aimed to explore patients' expectations and feelings about having the EMG electrodes applied and worn throughout the assessment.
MATERIAL AND METHODS
A questionnaire was prospectively given to all patients attending for a BFA. Patients were asked to rate on a scale of 0-10 (0 being the weakest and 10 being the strongest) how embarrassed, happy, worried, scared and okay they felt about having the electrodes applied. We also explored whether they felt the EMG influenced their void. Finally, we explored how the experience met their expectations. Results are presented as median (range).
RESULTS
Data was collected from 7 patients. Embarrassment scored 4 (0-5), happiness 8 (0-10), worry 3 (0-7), fear 1 (0-10) and okay 9 (5-10). Only 1 patient found having the electrodes applied bad and 5 found the electrodes uncomfortable once they had been applied. Only 1 patient felt their void was not representative because of the electrodes. 3 patients found the experience worse than expected, 2 as expected and 2 found it better than expected.
CONCLUSIONS
EMG electrodes are generally well tolerated during a BFA and do not influence the void. This small cohort did not allow significant conclusions to be generated but emphasizes the importance of adequate preparation. This study is ongoing to capture a larger cohort.
09:00 - 09:10
SN6-2 (OP)
Christina HEUBERGER 1, Thomas BÄUMLER 1, Wolfgang RÖSCH 1 and Aybike HOFMANN 2
1) Clinic St. Hedwig in Cooperation with University Regensburg, Pediatric Urology, Regensburg, GERMANY - 2) Clinic st. Hedwig in Cooperation with University Regensburg, Paediatric Urology, Regensburg, GERMANY
PURPOSE
The aim of this study is to evaluate the benefits of urotherapeutically guided standardized instructions for clean intermittent self-catheterization (CISC) after the creation of a continent stoma in patients with bladder exstrophy, using a questionnaire-based approach.
MATERIAL AND METHODS
43 bladder exstrophy patients who received CISC instruction after the creation of a continent stoma between 2008 and 2023 were included in the study. Participants were asked to complete a customized questionnaire consisting of 10 questions regarding inpatient CISC instruction.
RESULTS
A total of 27 (62.79%) questionnaires were returned. CISC instruction for 3 patients was not provided by a urotherapist as it was conducted before the establishment of structured guidance. The majority (96%) of patients perceived the instructions to be appropriate for both children and parents. 93% consider a pre-catheterization discussion with a urotherapist to be extremely important, while nearly the half of patients desire additional standardized follow-up training. However, this follow-up should occur as needed and not at a fixed time point. 67% would find additional instructional videos beneficial, particularly those patients who did not receive urotherapeutic instruction.81% also desired a designated urotherapist as a point of contact, especially for any subsequent inquiries and emergencies.
CONCLUSIONS
Patients appear to benefit significantly from urotherapeutically supported CISC instruction. Therefore, these services should be adequately represented and reimbursed in the care of these patients.
09:10 - 09:20
SN6-3 (OP)
Frank-Jan VAN GEEN 1, Anka NIEUWHOF-LEPPINK 2, Ruud WORTEL 3 and Laetitia DE KORT 1
1) University Medical Center Utrecht, Department of urology, Utrecht, NETHERLANDS - 2) Wilhelmina Children's Hospital, University Medical Center Utrecht, Department of Medical Psychology and Urology, Utrecht, NETHERLANDS - 3) Wilhelmina Children's Hospital, University Medical Center Utrecht, Department of Pediatric Urology, Utrecht, NETHERLANDS
PURPOSE
Achieving urinary continence in children with the bladder exstrophy-epispadias complex (BEEC) is a key goal. Unfortunately, this goal is only moderately achieved by extensive surgical treatment. Undergoing repeated hospitalization and extensive operations may consequently negatively impact quality of life.
We therefore believe that other, conservative treatment options should be explored in an earlier stage of incontinence treatment in BEEC patients. As part of this, an intensive urotherapy program was offered to patients with persistent incontinence after reconstructive surgery for BEEC. The purpose of this study is to evaluate the additional benefits of intensive urotherapy on incontinence after reconstructive surgery in children with BEEC.
MATERIAL AND METHODS
A retrospective chart study included 33 children enrolled in an intensive urotherapy program for persistent incontinence after BEEC reconstructive surgery. Urotherapy consisted of a ten-day inpatient program with extensive supervision by experienced urotherapists. The main outcome measurement was continence based on the ICCS definition, as the percentage of children achieving continence (good result) or improvement after treatment and during follow-up.
RESULTS
In 61% of cases (20/33) an improved or good result was reported on incontinence after urotherapy. Children with classic bladder exstrophy more often achieved a good or improved result (13/16; 81%), compared to children with epispadias (6/16; 38%). From the group of patients with persistent incontinence, 75% (12/16) reported that the complaints were socially acceptable at the end of follow-up.
CONCLUSIONS
The study outcomes reveal that 61% of BEEC patients who participated in our urotherapy program for persistent incontinence after reconstructive surgery achieved either complete or improved continence. Furthermore, 75% of patients who did not achieve complete continence reported that the remaining incontinence was manageable. These findings strongly advocate counselling patients with BEEC to consider exploring more conservative treatment options before opting for further surgery.
09:20 - 09:30
SN6-4 (OP)
Kay RUTH, Claire FOSTER, Fiona MARKS, Keisha HEPBURN, Eleanor PAGE, Ellen BULLMAN, Catrin GRIFFITH, Sharon MOHAN, Arash TAGHIZADEH and Massimo GARRIBOLI
Evelina London Children's Hospital, Paediatric Urology, London, UNITED KINGDOM
PURPOSE
Undergoing a bladder reconstruction represents a major burden, for patients and family. The introduction of Enhanced recovery after surgery (ERAS) protocols intends to achieve shorter hospital stays and faster recovery times. A fundamental pillar of the ERAS protocol is represented by the preparation, postoperative and post-discharge phases delivered by clinical nurse specialists (CNS).
We are responsible for making sure the family are effectively educated and supported throughout this event. Our aim is to reflect on the role of the CNS in the care of these patients within the ERAS pathway.
MATERIAL AND METHODS
From April 2021 to September 2023, 14 patients have undergone bladder reconstruction surgery in our department. Patients and families were counselled and prepared for surgery through a series of appointments with a CNS. Post-operative reviews and post discharge appointments were also planned according to ERAS pathway. During the appointments the CNS takes a holistic approach; taking in to consideration clinical, social, psychological and educational factors.
RESULTS
Patients had an average of 4.28 pre-admission contacts with the CNS. From day 3-4 post op the CNS visited patients daily while post discharge they made weekly phone calls. Median length of stay was 7 days. CIC was started at week 5 and catheters completely removed at week 6 post op. No surgical complications were observed and all patients successfully established CIC post-operatively.
CONCLUSIONS
Bladder reconstruction is a huge and overwhelming experience for families. The role of the CNS is significant for implementing the ERAS pathway and ensuring a successful outcome for these patients.