ESPU-Nurses Meeting on Friday 19, April 2024, 11:10 - 11:40
09:55 - 10:05
SN8-1 (OP)
Njomza ZENUNI 1, Veronika WALDBOTH 2 and Brigitte SELINER 3
1) University Children's Hospital, Zurich, Switzerland., Urology, Zürich, SWITZERLAND - 2) ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland, Health, Winterthur, SWITZERLAND - 3) Division of Urology, University Children's Hospital, Zurich, Switzerland., Urology, Zürich, SWITZERLAND
PURPOSE
Background: The insertion of long-term suprapubic catheter (LSBK) is considered a non-standard medical intervention in paediatrics and is only used in rare cases for children with complex chronic conditions or disabilities. Due to the rarity of the situation, health professionals often lack knowledge to support parents in decision-making around LSBK.
Aim: To describe the experiences and support needs of parents of children with LSBK while focusing on the decision-making process and lived experience of LSBK.
MATERIAL AND METHODS
Methods: An embedded single case study with semi-structured interviews (September to December 2022) was conducted with parents of four children with LSBK and three health professionals from different settings. In addition, patient documentation was analysed in detail. The within-case analysis was based on a structured content analysis of the interviews, supplemented with the description of the individual medical histories, followed by a comparative cross-case analysis.
RESULTS
Results: The in-depth analysis of the four units of analysis resulted in four categories with two subcategories: Experiences of the decision-making process and support needs in this process, additionally the challenges and the benefits of living with an LSBK and support needs regarding self-management.
CONCLUSIONS
Conclusion: The LSBK was the best possible option for longer-term urinary diversion for all families. The children's well-being was paramount for the parents in decision-making. The families and professionals emphasized the need for support in the decision-making process and in long-term self-management Important aspects are patient- and family-centred decision-making, holistic support in self-management and good interprofessional cooperation.
10:05 - 10:15
SN8-2 (VP)
Thomas LOUBERSAC 1, Hortense ALLIOT 1, Flavie SADONES 2, Fabrizio VATTA 1, Sebastien FARAJ 1 and Marc-David LECLAIR 1
1) University Hospital of Nantes, Paediatric Urology, Nantes, FRANCE - 2) University Hospital of Nantes, Paediatric Radiology, Nantes, FRANCE
PURPOSE
We report here the case of a 12-year-old female patient who underwent robotic-assisted laparoscopic surgery for a vesico-urethro-vaginal fistula.
MATERIAL AND METHODS
The girl underwent a left nephro-ureterectomy at the age of one year for a symptomatic non-functioning kidney with ureterohydronephrosis. At the age of three she developed total urinary incontinence. Endoscopy revealed a ceco-ureterocele with a vesico-vaginal fistula. Reconstructive surgery was performed with transvesical closure of the vesico-vaginal fistula and urethro-cervicoplasty. Total urinary incontinence recurred at the age of five years. Endoscopy confirmed the recurrence of the vesico-vaginal fistula. Further surgery was performed at the onset of puberty for vulvovaginitis secondary to the fistula. A uro-MRI revealed a vesico-urethrovaginal fistula. Robotic laparoscopic repair of the fistula with omentum interposition was proposed.
RESULTS
The operation was performed under general anaesthesia in the lithotomy position with tredelenburg of 20°. The operation began with a urethrocystoscopy which revealed the fistulous orifice between the vagina, urethra and bladder. A 13F Cystodrain was placed through the fistula between the vagina and the bladder then a 14F urethral catheter.
We began by laparoscopy, dissecting between the bladder and the vagina to the fistula. The fistula was easily found with the cystodrain. The cystic cavity and fistulous tract are resected. The posterior surface of the urethra, bladder and vagina were closed. The robot was placed in the upper abdominal position to free the omentum, which is then interposed between the urethra and vagina. The operation lasted 241 minutes and the patient was discharged on D2. The urethrovesical catheter was removed at D14 after cystography had checked that there was no residual fistula. At 6 months, there was no recurrence of the fistula or urine leakage.
CONCLUSIONS
The cure of vesico-urethro-vaginal fistula by robot-assisted laparoscopy, even after urethro-cervicoplasty, seems possible in children.
10:15 - 10:25
SN8-3 (OP)
Maria Laura SOLLINI 1, Maria Luisa CAPITANUCCI 2, Chiara PELLEGRINO 2, Giada GERVASI 2, Tiziana LORETI 2, Tiziana SERANI 2 and Giovanni MOSIELLO 2
1) University of Rome Tor Vergata, Clinical Sciences and Translational Medicine, Department of Physical and Rehabilitation Medicine, Rome, ITALY - 2) Bambino Gesù Children Hospital, Department of Neuro-Urology and Continence Surgery, Rome, ITALY
PURPOSE
Transanal Irrigation (TAI) is a valid treatment in children with bowel dysfunction, but it is not always well accepted. We evaluated the role of pelvic floor (PF) exercises in TAI practice.
MATERIAL AND METHODS
We report a case of an 11-year-old girl, affected by Anorectal Malformation (MAR) surgical treated at birth, performing bowel management with enema until 9 years old. She referred pain and poor results and TAI proposed as an alternative to classical bowel management. TAI has been refused by the patient due to referred difficulties to catheter insertion in absence of anal stenosis. A new management protocol has been proposed associating TAI training with 3 sessions (15/ days, 1 hour/session) of PF re-education, using a fitball. During sessions we explained anatomy, function of PF and mechanism of TAI, a PF evaluation was performed using an external PC test and PF exercises have been practiced using a fitball. Child simulated a self-administration of TAI too.
RESULTS
During the first session, she was scared and rejected treatment. Evaluation of PF highlighted a failure to selectivity recruit of muscles. PC test was 1/5 and a difficult to relax PF was present. During third evaluation selectivity of PF had improved, PC test was 2/5 and she was able to maintain PF contraction between 2 and 5 seconds; relaxation of PF was improved, too. She successfully tried to self-administrate TAI and the mother referred the execution at home.
CONCLUSIONS
PF muscle training can help all people practicing manoeuvres at the perineal level.