Parallel Meeting on Wednesday 17, April 2024, 16:20 - 17:00
16:20 - 16:23
S04-1 (OP)
Aysegul AKBULUT 1, Esi̇n AVCİ 2, Nazli̇ ÇİL 3 and Özkan HEREK 4
1) ULUDAG UNIVERSITY SCHOOL OF MEDİCİNE, PAEDIATRIC SURGERY /DIVISION OF PAEDIATRIC UROLOGY, Bursa, TURKEY - 2) PAMUKKALE UNİVERSİTY FACULTY OF MEDİCİNE, DEPARTMENT OF BIOCHEMISTRY, Deni̇zli̇, TURKEY - 3) PAMUKKALE UNİVERSİTY SCHOOL OF MEDİCİNE, DEPARTMENT OF HISTOLOGY AND EMBRYOLOGY, Deni̇zli̇, TURKEY - 4) PAMUKKALE UNİVERSİTY SCHOOL OF MEDİCİNE, PEDİATRİC SURGERY, Deni̇zli̇, TURKEY
PURPOSE
In this study, we aimed to investigate protective effect of ibuprofen on experimental ovarian torsion.
MATERIAL AND METHODS
Thirty female, Wistar-Albino rats were used for the study. The animals were divided into two main groups as early (n =15) and late ischemia reperfusion groups (n = 15). Group 1 Early Sham ES (n=5), Group 2 Early ischemia reperfusion EIR (n=5) and Group 3 Early ischemia reperfusion ibuprofen EIRİ (n=5). Group 4 late sham GS (n=5), Group 5 Late ischemia reperfusion injury GIR (n=5), Group 6 Late ischemia reperfusion injury ibuprofen (40mg/kg) GIRİ (n=5). All blood samples taken from early and late groups were evaluated for serum Superoxide Dismutase (SOD), Xanthine Oxidase (XO), Glutathione (GSH) and Malondialdehyde (MDA) levels. Also tissue samples were histopathologically evaluated.
RESULTS
Serum SOD level was found to be lower in Group 2 (0,48 ± 0,02), higher in Group 3 (0,52 ± 0,0). Statistically significant difference was detected (p<0,05). Median serum XO levels were found higher in Group 2 (1,49 ± 0,19) and lower in Group 1 (1,15 ± 0,27). Statistically significant difference was detected (p<0,05). Median serum MDA levels were found higher in Group 5 (0,13±0,05), and lower in Group 6 (0,040±0,03). Statistically significant difference was detected (p<0,05). Histopathological evaluation by edema, follicular cell damage, vascular congestion, hemorrhage, neutrophil infiltration and cohesion lossSignificant decrease in total cell damage was found in the groups treated with ibuprofen (p<0,05).
CONCLUSIONS
According to biochemical findings and histopathologic evaluation ibuprofen treatment is effective in preventing lipit peroxidation by reducing MDA level in early stage and increasing antioxidant enzyme SOD level in late stage ischemia / reperfusion injury. Ibuprofen may has a protective effect on ischemia reperfusion injury.
16:23 - 16:26
S04-2 (OP)
Aurora GRUTMAN 1, Courtney STEWART 2, Corey ABLE 2, Pranjal AGRAWAL 1, Ahmad HAFFAR 3, Logan GALANSKY 3, Andrew GABRIELSON 3, Nora HANEY 3, Taylor KOHN 3 and Chad CRIGGER 3
1) Johns Hopkins, School of Medicine, Baltimore, USA - 2) University of Texas Medical Branch at Galveston School of Medicine, Urology, Galveston, USA - 3) Johns Hopkins, Urology, Baltimore, USA
PURPOSE
To assess the risk of persistent opioid use following various urologic procedures in adolescents and young adults.
MATERIAL AND METHODS
The TriNetX LLC Diamond Network was queried for patients aged 13-21years who underwent pyeloplasty, hypospadias repair, inguinal hernia repair, inguinal orchiopexy, hydrocelectomy, or circumcision. Cohorts of patients prescribed and not prescribed postoperative opioids were created and propensity-matched for age, race/ethnicity, psychiatric diagnoses, and preoperative pain diagnoses. The primary outcome was new persistent opioid use, defined as new opioid use 3-9months after index procedure without another surgery requiring anesthesia during the postoperative timeframe.
RESULTS
Of 32,789 patients identified, 66.0% received a postoperative opioid prescription. After propensity score matching for each procedure, 18,416 patients were included: 197 for pyeloplasty, 469 for hypospadias repair, 1818 for inguinal hernia repair, 2664 for inguinal orchiectomy, 534 for hydrocelectomy, and 3526 for circumcision. Overall, 0.41% of patients who did not receive postoperative opioids developed new persistent opioid use, whereas 1.69% of patients who received postoperative opioids developed new persistent opioid use (P < .05). Patients prescribed postoperative opioids had statistically higher odds of developing new persistent opioid use for hypospadias repair (RR: 17.0; 95% CI: 2.27-127.2), inguinal orchiectomy (RR: 3.46; 95% CI: 1.87-6.4), inguinal hernia repair (RR: 2.18; 95% CI: 1.07-4.44), and circumcision (RR: 4.83; 95% CI: 2.60-8.98).
CONCLUSIONS
The use of postoperative opioids after urological procedures in adolescents and young adults is associated with a significant risk of developing new persistent opioid use.
16:26 - 16:29
S04-3 (OP)
Mohamed ABDELRAHMAN 1, Youssef IBRAHIM 1, Shimaa IBRAHIM 1, Anu PAUL 1 and Massimo GARRIBOLI 2
1) Evelina London Children's Hospital, Paediatric Urology, London, UNITED KINGDOM - 2) Evelina London Children's Hospital - Guy's and St Thomas NHS Foundation Trust, Paediatric Urology, London, UNITED KINGDOM
PURPOSE
Coverage of existing antimicrobials is shrinking with ongoing pressure on minimising their use as single prophylaxis dose could be associated with increased resistance. Prophylaxis prior to urological procedures varies among clinicians and is common practice for many aiming to reduce the risk of post-procedure UTI.
We aimed to evaluate the reliability of intraoperative urine dip-stick in predicting culture-proven bacteriuria to determine need for treatment post-cystoscopy
MATERIAL AND METHODS
Prospective study of children undergoing a cystoscopy (diagnostic or interventional). A urine sample has been collected at the beginning of the cystoscopy, dipped and sent for culture. Data regarding indication for the procedure, underlying condition, history of previous UTI and antibiotic status were collected. A 13-point score (Dip score) generated giving 1 point for each 1+ blood or LE or proteins, and 3 points for positive nitrites was used and sensitivity and specificity of several cut-off were calculated
RESULTS
Samples were collected from 123 patients (median age 2 years); 30 were on intermittent catheterization and 51 on antibiotic prophylaxis. Dip-stick was positive for nitrites in 25(20%) leukocyte esterase (LE) in 35(29%), and blood in 69(57%). Culture was positive in 16%. Good sensitivity can be obtained using 3 points cut-off but at the expense of a poor specificity (90% and 68%, respectively). Using 9 points cut-off provides good specificity while sensitivity is low (97% and 15%, respectively). When cut-off of 7/13 is used Dip score showed sensitivity and specificity of 40% and 93%
CONCLUSIONS
Nitrites, leukocyte esterase, and blood detected on dipstick when used together would represent more reliable screening tool for predicting bacteriuria compared to each parameter alone. The 7 points cut-off provides a good balance between sensitivity and specificity and can be used as a simple, easy and cheap screening tool to stratify children undergoing cystoscopy, particularly identifying those with sterile urine and at low risk to develop post-procedure UTI
16:29 - 16:32
S04-4 (OP)
Wouter VAN DORT, Aart KLIJN and Laetitia DE KORT
UMC Utrecht, Urology, Ens, NETHERLANDS
PURPOSE
Urodynamic study (UDS) is a commonly used diagnostic tool for assessing the function of the lower urinary tract. However, a UDS is invasive and may cause anxiety in the child. To reduce the effects of this uneasiness, a second run in the same session can be performed, as the child will probably void in a more representative manner the second time. The goal of this study was to compare urodynamic parameters between two consecutive runs of pressure flow studies (PFS’s) in the same urodynamic session.
MATERIAL AND METHODS
1501 high-quality PFS’s of children (mean age 9.5 years), consisting of two runs, were included. Maximum flow rate (Qmax), voiding time detrusor pressure at maximum flow rate, average flow rate and voided volume were compared between the runs.
RESULTS
In 60% of the second runs an improvement of Qmax was found, with an improvement of >20% in 29% of the cases. Overall, all assessed parameters, except the voiding time, slightly improved in the second run, see Table 1.
Table 1: Overview of results.All differences are significant, with Wilcoxon p <0.001.
|
Urodynamic parameter |
Mean difference (second run-first run)[Standard Deviation] |
|
Maximal flow [Qmax] (ml/s) |
1.0 [4.1] |
|
Voiding time [Tvoid] (s) |
0.8 [10.6] |
|
Detrusor pressure at Qmax [pdetQmax] (cmH2O) |
-3.4 [29.5] |
|
Average flow [Qavg] (ml/s) |
0.7 [2.6] |
|
Voided volume [Vmain] (ml) |
21 [81] |
CONCLUSIONS
As urodynamic parameters of the second PFS in the same UDS session showed improved values, we recommend to perform a second PFS in all children as a routine.
16:43 - 16:46
S04-5 (OP)
Mandy RICKARD 1, Armando J LORENZO 1, Dan FLANDERS 2, Malsha KARUNAGODA 2, Natasha BROWNRIGG 3, Darius BAGLI 3, Michael CHUA 3 and Joana DOS SANTOS 3
1) The Hospital for Sick Children, Urology, Toronto, CANADA - 2) KinderCare Pediatrics, Pediatrics, Toronto, CANADA - 3) SickKids, Urology, Toronto, CANADA
PURPOSE
The COVID-19 worldwide pandemic has resulted in significant clinical and surgical backlogs, resulting in long wait times for patients to be seen. To address this waitlist in a tertiary hospital pediatric urology clinic, a community pediatric urology clinic was implemented. This clinic is staffed by a pediatrician with specialized training in medical pediatric urology and two pediatric urology nurse practitioners. We hypothesized that the community-based clinic would help identify and streamline surgical cases, decrease wait times for non-surgical visits, protect hospital appointments for complex cases, and provide similar level of care and patient satisfaction in both settings.
MATERIAL AND METHODS
Referrals to a tertiary hospital were screened for penile issues, undescended testes(UDT), and bladder and bowel dysfunction(BBD) and redirected to the community clinic. Patient experience surveys were sent to the community clinic Sept2020-Jan 2023 and the hospital urology clinic from January-March 2021.
RESULTS
In the community, 642 surveys resulted in a 37%response rate, an 18%surgical booking rate, and 97%patient satisfaction. In the hospital clinic, 1004 surveys achieved a41% response rate, with 91 patient satisfaction(table 1). Significant differences in wait times were noted between the community and hospital clinics for all diagnoses (table 2).
| Community(n=212) | Hospital(n=216) | p | |
| Wait time(days) | 53+/-36 | 194+/-108 | <0.01 |
| Surgical | 38(18%) | 35(16%) | 0.89 |
|
Diagnosis -Phimosis -Hypospadias -Other penile problem -UDT -BBD |
41(19) 27(12) 34(16) 83(39) 27(14) |
31(14) 24(11) 15(7) 25(12) 121(56) |
n.s. <0.01 |
| Satisfied with care | 232(97) | 373(91) | <0.01 |
| Community | Hospital | p | |
| Phimosis | 43+/-15 | 214+/-116 | <0.01 |
| Hypospadias | 52+/-17 | 245+/-108 | <0.01 |
| Other penile problem | 57+/-7 | 252+/-141 | <0.01 |
| UDT | 56+/-48 | 154+/-72 | <0.01 |
| BBD | 55+/-24 | 160+/-95 | <0.01 |
CONCLUSIONS
A community-based medical pediatric urology clinic is feasible, reducing wait times for similar diagnoses while maintaining patient satisfaction in both settings.
16:49 - 16:52
S04-7 (OP)
Jin Kyu (Justin) KIM, Michael CHUA, Adree KHONDKER, Mandy RICKARD and Armando LORENZO
The Hospital for Sick Children (SickKids), Urology, Toronto, CANADA
PURPOSE
GPT-4 is the latest large language model (LLM) from OpenAI with 1.76 trillion parameters. This new model allows users to input images along with the prompt and the model can provide an output while evaluating the image features. While there have been numerous efforts to evaluate the performance of ChatGPT for word-based questions, including those in urology, there has been limited efforts in evaluating its efficacy in answering questions requiring visual recognition. We aim to evaluate the GPT-4’s performance on visual recognition questions from Pediatric Self-Assessment Study Program (PSASP) from Societies for Pediatric Urology (SPU), and FEAPU.
MATERIAL AND METHODS
Twenty sample FEAPU questions and 100 PSASP questions were obtained. ChatGPT-4 model (https://chat.openai.com/) was utilized to input word-based question along with images provided in the question for visual recognition. The answers were evaluated and compared to the answers provided by SPU and FEAPU.
RESULTS
A total of 18 questions were identified (17 PSASP, 1 FEAPU). One question was excluded as GPT-4 was unable to recognize the question and image. Of 16 questions evaluated, only 5 questions were answered correctly (29.4%). There was no trend to which images were the most likely to be interpreted correctly, as abdominal x-ray (1/2), ultrasound (1/4), clinical photo (hypospadias; 1/3), MAG3 and ultrasound (1/1), and VCUG (1/3) questions were answered correctly (Table 1).
| Type of Image | Correctly Answered | Incorrectly Answered |
| Abdominal X-ray | 1 | 1 |
| VCUG | 1 | 2 |
| US | 1 | 3 |
| US + RUG | 0 | 1 |
| US + VCUG | 0 | 1 |
| US + MAG3 | 1 | 0 |
| UDS | 0 | 1 |
| CT scan | 0 | 2 |
| clinical photos | 1 | 2 |
CONCLUSIONS
GPT-4 model does not perform well on imaging-based questions. While it hold tremendous promise for word-based questions and clinical scenarios, it is unreliable as a clinical or educational aid for visual recognition at this time.