ESPU-Nurses Meeting on Friday 19, April 2024, 11:40 - 12:00
11:40 - 11:47
SN9-1 (PP)
Rebecca DAVIES, Hazem MOSA, Azad MATHUR and Ashish MINOCHA
Jenny Lind Children's Hospital, Paediatric urology, Norwich, UNITED KINGDOM
PURPOSE
Hair thread tourniquet syndrome (HTTS) is a rare phenomenon where a thread of hair wraps tightly around an area of tissue impending blood flow. Genital HTTS often occur in circumcised boys. We aimed to describe the presentation in a boy with an intact foreskin and review the literature.
MATERIAL AND METHODS
A 6-month-old boy presented to their local Emergency Department (ED) with one week history of foreskin swelling. An adult urologist attempted removal of a constricting hair tourniquet in ED and was unsuccessful due to baby’s irritability. The baby was transferred to a tertiary paediatric urology centre for further management. Examination revealed a distal foreskin hair tourniquet with mild waisting, and a ventral granuloma. Parental wish was foreskin preservation. Under General anaesthesia and penile block, release of the hair tourniquet was performed. Ventral granuloma was excised and sent for histopathological assessment. Ventral foreskin was reconstructed transversely to widen the preputial opening and improve foreskin retractility. This was performed using interrupted 6-0 polydioxanone. Examination of the glans and distal urethra revealed no concomitant injury.
RESULTS
The patient had an uneventful recovery and was discharged the next day. Literature review of male genital HTTS revealed only 5 reports of foreskin HTTS to date. 54 reports described HTTS affecting the penile shaft and 12 reports of urethral or meatal involvement and no cases of scrotal HTTS.
CONCLUSIONS
Foreskin HTTS is a very rare cause of foreskin swelling. A high index of suspicion and thorough examination can help prevent strangulation and tissue loss. Foreskin preservation can be achieved according to parental preference.
11:47 - 11:54
SN9-2 (PP)
Eleanor PAGE 1, Jo CLOTHIER 2, Pankaj MISHRA 1 and Massimo GARRIBOLI 1
1) Evelina London Children's Hospital, Paediatric Urology, London, UNITED KINGDOM - 2) Evelina London Children's Hospital, PAEDIATRIC NEPHRO-UROLOGY, London, UNITED KINGDOM
PURPOSE
Posterior urethral valves (PUV) is the most common cause of bladder outlet obstruction in males and it accounts for one quarter of all paediatric renal transplants in the United Kingdom. Patients have a range of severity of symptoms, from LUTS to renal failure.
Waiting lists for hospital appointments and procedures are becoming a real concern lately and delayed appointments can increase the risk of complications.
In order to avoid missing appointment for fragile/at risk children, we categorised them to prioritise those with higher clinical risk factors.
MATERIAL AND METHODS
We reviewed charts of our current cohort of 275 patients under active follow up and categorised them according to the following traffic light system, based upon kidney and bladder function:
1. Red - less than one year from diagnosis, a glomerular filtration rate (GFR) of less than 50ml/min/1.73m2, an indwelling suprapubic catheter or ostomy.
2. Amber - a GFR of 50-80ml/min/1.73m2, solitary kidney, high grade vesicoureteral reflux (VUR), recurrent UTIs, clean intermittent catheterisation or bladder medication.
3. Green - normal kidney function, not on bladder management.
RESULTS
Based on the above system, 64 patients were classified as red, 114 amber and 97 green. Taking this forward, we are ensuring that all red and amber patients are made a priority for investigations and follow up.
CONCLUSIONS
Using the proposed traffic lighting system, we can identify patients with risk factors for developing bladder and kidney damage. This allows us to prioritise their investigations and follow up which can influence their prognosis.