Parallel Meeting on Thursday 4, September 2025, 08:50 - 09:50
08:50 - 08:53
S17-1 (OP)
Sahar EFTEKHARZADEH 1, Neal JACOBSMA 2, Sameer MITTAL 3, Karl GODLEWSKI 3, Jason VAN BATAVIA 3, Christopher LONG 3, Arun SRINIVASAN 3, Aseem SHUKLA 3, Thomas KOLON 3, Stephen ZDERIC 3, Mark ZAONTZ 3 and Katherine FISCHER 3
1) Einstein Jefferson Medical Center, Urology, Philadelphia, USA - 2) Children's Hospital of Philadelphia, Digital And Technology Services, Philadelphia, USA - 3) Children's Hospital of Philadelphia, Urology, Philadelphia, USA
PURPOSE
Same-day surgery cancelation has financial and health consequences, compromises operating room efficiency, and may worsen healthcare disparities.
We hypothesize that identifying patient-related factors linked to same-day cancelations can help develop models for targeted preventive interventions.
MATERIAL AND METHODS
We reviewed all non-emergent urology surgeries scheduled between 1/2023 and 6/2024 at a tertiary pediatric center, excluding patients residing outside of USA, lacking valid address, and weather-related cancelations. Data on demographics, surgery type (elective, non-elective but not time sensitive, non-elective time-sensitive), prior cancelations, distance to hospital or surgical center, and child opportunity index (COI)- a measure of resources and economic stability- were reviewed. Multivariate regression models were utilized to identify factors associated with higher risk of same-day cancelation, and to develop a predictive model.
RESULTS
Of 2835 cases, 195 (7%) were canceled on the day of surgery. Multivariate analysis revealed that non-English speaking, non-white patients, and those with COI < 30 were at significantly higher risk for same day cancelation. A predictive model using 80% of the dataset for training and 20% for testing achieved an accuracy of 0.76, sensitivity of 0.78, and specificity of 0.47 in prediction of cases with 10% chance of cancelation. The model correctly predicted 40% of cancelations and 80% of non-cancelations.
|
Multivariate logistic regression predicting risk of same day cancelation based on patient’s race, preferred language, and Child Opportunity Index (COI) |
||||
|
Independent Variable |
Odds Ratio |
Standard Error |
p-value |
|
|
Race |
Non-White /White |
1.6 |
0.19 |
0.01 |
|
Language |
Non-English speaking /English-speaking |
2.0 |
0.25 |
0.004 |
|
COI |
COI<30 /COI 30 |
1.97 |
0.19 |
<0.001 |
CONCLUSIONS
Models based on race, language, and COI can be utilized to mitigate risk of cancelation by identifying at risk patients prior to surgery. Using this data, a quality improvement intervention can be developed to focus on these patients.
08:53 - 08:56
S17-2 (OP)
Evelyn JAMES, Bruce NDEBANJE, Ethan GRIFFIN and Lily WANG
MaineHealth, Urology, South Portland, USA
PURPOSE
Outpatient no show visits affect patient access to healthcare as well as clinic efficiency. Some studies have shown that there is a higher rate of no show visits in pediatric urology patients. We sought to evaluate factors affecting no show rates in our urology outpatient clinic.
MATERIAL AND METHODS
An IRB-approved retrospective chart review of patient appointments from March to September of 2024 was performed.
RESULTS
We identified 9872 visits with a 6.7% no show rate in the pediatric group (2043 visits) and a 3.5% in the adult group (7829 visits). Pediatric patients tended to live farther from the hospital - 59.1 miles versus 40.2 miles in the adult group. While 47.5% of pediatric visits were new patient visits, only 17.7% of adult visits were new visits. Pediatric families were more likely to prefer non-English languages (7.5%) and be non-white (15.8%) than adult patients (2.3% and 5.6%, respectively). 48.2% of pediatric patients had Medicaid or were uninsured compared with 7% in adults. The only factors significant on multivariate regression for pediatric no show visits was non-commercial insurance with an odds ratio of 3.21 (p-value <0.001) and new patient visits with odds ratio of 0.69 (p-value=0.042).
CONCLUSIONS
Our data confirm that pediatric urology patients have a higher no show rate than adult urology patients. Pediatric patients were more likely to live farther from clinic, have new patient visits, prefer non-English language, be non-white, and have non-commercial insurance. Our data indicate that factors leading to higher no show rate in pediatric patients are driven by socioeconomic status.
09:06 - 09:09
S17-3 (OP)
Lissoune CISSÉ 1, Faty Balla LO 2, Ndèye Aby NDOYE 3, Mohamed JALLOH 4, Médina NDOYE 4, Oumar NDOUR 5, Gabriek NGOM 3 and Ameth FALL 6
1) Centre Hospitalier National de Pikine, Pediatric surgery, Dakar, SENEGAL - 2) National Hospital of Pikine, Dakar, Senegal, Pediatric surgery, Dakar,, SENEGAL - 3) Albert Royer Children's Hospital, Pediatric surgery, Dakar,, SENEGAL - 4) Grand Yoff General Hospital, Urology, Dakar, SENEGAL - 5) Aristide LeDantec National Hospital, Pediatric surgery, Dakar, SENEGAL - 6) Dalal Jam Hospital, Urology, Dakar, SENEGAL
INTRODUCTION
Pediatric urology in low-income settings faces significant challenges. In Senegal, children represent 48% of the population, resulting in an increasing demand for specialized pediatric care, including pediatric urology. This study aims to assess the current state of pediatric urology by evaluating equipment availability and human resource capabilities.
MATERIAL AND METHODS
Information was gathered from the directories of the Senegalese Society of Pediatric Surgery and the Senegalese Society of Urology. Online surveys were distributed to 120 practitioners across the country, focusing on training, experience, challenges in pediatric urology, and equipment availability. Data were collected from October 2024 to January 2025. Descriptive analysis was performed using Excel.
RESULTS
Two surgeons have completed degree-level pediatric urology training (1.7%), and 13 have undertaken internships abroad in pediatric urology departments (10.8%).
Ninety percent of surgeons practice pediatric urology. Both the exstrophy-epispadias complex and hypospadias were reported as challenging to manage by 25% of practitioners. Access to pediatric urology equipment was identified as the primary obstacle by 84.4% of practitioners.
Half of the regions in Senegal have access to pediatric urology equipment. Functional cystoscopes were available in 29.6% of facilities. Lasers and extracorporeal lithotripsy were present in 11.1% of facilities. Nephroscopes and flow meters were found in 7.4% of facilities. All recorded cystomanometers were out of service.
CONCLUSIONS
This study highlights the deficit in pediatric urology equipment and lack of specialized training. International partnerships could help address equipment shortages, support knowledge exchange, and improve access to quality care for pediatric patients across the country.
09:09 - 09:12
S17-4 (OP)
Isabel PLANAS DÍAZ 1, Isabel CASAL BELOY 2, Laura DÍAZ MENÉNDEZ 1, María MOLINA MATA 3, Ana Edith HERNÁNDEZ CALVARRO 4 and Rosa ROMERO RUÍZ 2
1) Hospital Infantil Virgen del Rocío, Pediatris Surgery Department, Sevilla, SPAIN - 2) Hospital Infantil Virgen del Rocío, Pediatric Urology, Sevilla, SPAIN - 3) Hospital Infantil Virgen del Rocío, Pediatric Surgery Department, Sevilla, SPAIN - 4) Hospital Universitario Son Espases, Mallorca, Pediatric Urology, Mallorca, SPAIN
PURPOSE
The Clavien Dindo Classification (CDC) is the most widely used tool for standardized analysis of surgical morbidity; however, it has significant limitations in pediatric urology. The Comprehensive Complication Index (CCI) is base do nathorough analysis of unexpected events according to CDC. The study aims to compare CDC and CCI tools for grading morbidity in patients undergoing urological surgery at our institution.
MATERIAL AND METHODS
A retrospective study analyzed patients who underwent urological surgery from March 2022 to September 2024. Demographic variables and morbidity occurring within the first 30 postoperative days were collected from medical records.
Morbidity events were analyzed with CDC and CCI. Cohen’s Kappa coefficient was used to assess concordance between both tools. Events were categorized as mild, moderate or severe, and the McNemar test was applied in a bivariate analysis.
RESULTS
A total of 971 children who underwent urological surgery were included. Morbid events were identified in 129 patients (13,3%). Kappa analysis showed substantial concordance between CDC and CCI (k=0,715, p<0,001). Events were categorized using CDC (Mild: 99; Moderate: 27; severe: 3) and CCI (Mild: 92; Moderate: 26; Severe: 11). The McNemar test demostrated that CCI identified more severe events, which were categorized as moderate by the CDC tool (p<0,01) (Table 1).
| CD | CCI | p (McNemar) | |
|
Mild morbidity Moderate morbidity Severe morbidity |
76,7% (99) 20,9% (27) 2,3% (3) |
71,3% (92) 20,2% (26) 8,5% (11) |
<0.001 |
CONCLUSIONS
Although both the CDC and CCI showed substantial concordance overall, CCI demonstrated superiority in grading severe complications in paediatric urology.
09:12 - 09:15
S17-5 (OP)
Jack ELDER 1, Andrew CHEN 2 and Chang LIU 3
1) Massachusetts General Hospital, Pediatric Urology, Boston, USA - 2) Warren Alpert Medical School of Brown University, Providence, USA - 3) Massachusetts General Hospital, Pediatric Anesthesia, Boston, USA
PURPOSE
Spinal anesthesia (SA) is an alternative to general anesthesia (GA) for infraumbilical surgery in infants. Benefits include avoidance of airway instrumentation and opioid administration. SA with intrathecal bupivacaine allows analgesia for 60 minutes and adding clonidine can extend the analgesia to 80-90 minutes. We hypothesized that an indwelling caudal catheter (CC) might allow longer procedures to be performed with regional anesthesia.
MATERIAL AND METHODS
In a retrospective analysis of a prospective database, healthy infants less than 10 months and less than 10 kg who were scheduled for an infraumbilical urologic procedure that was anticipated to last longer than 80 minutes underwent SA with 0.5% bupivacaine 1 mg/kg and clonidine 1 ug/kg. No preoperative sedation was administered. After intravenous access was obtained, a CC was inserted through a 20-gauge angiocath. During the surgical procedure, when the infant appeared to arouse, the CC was activated with an infusion of 1 mL/kg 2% chloroprocaine with 1:200,000 epinephrine over 15 minutes followed by 1 ml/kg/hr infusion.
RESULTS
A total of 28 patients (corrected age 27 +/- 9 months) underwent CSC and one patient had unsuccessful SA. 25/28 infants had complex hypospadias repairs. Average time from entering the OR to surgery start was 27 +/- 6 minutes. The average time to CC activation was 77+/-18 minutes with a 68 +/- 35 minutes average extension in surgical anesthesia duration. Total average surgical duration was 109+/-20 minutes. Longest surgical duration was 148 minutes. Four patients (14.2%) completed the surgical procedure without CC activation. 25% received sedation and none received opioid. None showed signs of systemic local anesthetic toxicity and no adverse events were observed.
CONCLUSIONS
CSC provides effective regional anesthesia for selected infants less than 10 kg and less than 10 months undergoing an infraumbilical urologic operation with long expected surgical duration.
09:28 - 09:31
S17-6 (OP)
Roberto VAGNI 1, Pedro MERCADO 1, Maria ORMAECHEA 1, Agustina OLIVA 1, Francisco DE BADIOLA 1, Pedro-Jose LOPEZ 2, Alejandro CALVILLO-RAMIREZ 2 and Juan MOLDES 2
1) Hospital Italiano de Buenos Aires, Pediatric Surgery, Buenos Aires, ARGENTINA - 2) University Hospitals Rainbow Babies and Children's, Urology, Cleveland, USA
INTRODUCTION
Kidney transplantation (KT) is the treatment of choice for children with end-stage kidney disease. When the donor's kidney is right-sided, the graft can be placed ipsilaterally using an inverted kidney allograft (IKA) technique, facilitating the anastomosis of a shorter renal vein, and an ideal spatial orientation of the renal hilum with anterior positioning of the urinary tract. However, IKA is rarely employed, with existing limited evidence. We aimed to compare the safety and efficacy of IKA and standard anatomical position (AP) in pediatric KT.
MATERIAL AND METHODS
A retrospective study of patients aged up to 18 years who underwent KT at our institution from January 2010 to December 2021 was conducted. The primary outcome was the incidence rates of urologic and vascular complications. Secondary outcomes were mortality, 1-year graft survival, and creatinine clearance.
RESULTS
Overall, 157 KT were performed: 61 were IKA, and 96 in the AP. There was no significant difference in urologic (16.4% vs 13.5%, p=0.79) or vascular complication rates (1.2% vs 5.2%, p=0.47). Median 1-year creatine clearance was 73.1 ml/min/m2 in the IKA group and 75.3 ml/min/m2 in AP individuals, with no significant difference. Graft survival at 1-year follow-up and overall mortality were comparable between the groups.
CONCLUSIONS
IKA technique is a safe and non-inferior approach for pediatric KT when standard AP is not feasible. This method did not increase the risk of urologic or vascular complications and provided comparable graft survival and 1-year creatine clearance results. Larger clinical trials are necessary to draw definitive conclusions and support broader adoption of this technique.
09:31 - 09:34
S17-7 (OP)
Jin Kyu (Justin) KIM, Renee SHAVNORE, Jeremy KOEHLINGER, Christy HEGEL, Konrad SZYMANSKI, Rosalia MISSERI, Nikhil BATRA, Martin KAEFER, Mark CAIN, Richard RINK, Joshua ROTH, Kirstan MELDRUM, Benjamin WHITTAM and Pankaj DANGLE
Riley Hospital for Children, Urology, Indianapolis, USA
PURPOSE
Non-E.coli urinary tract infections (UTI) have been associated with genitourinary abnormalities and it has been recommended that non-E.coli UTIs undergo imaging and work-up to assess for urologic abnormalities. However, little is known about how Non-E.coli UTI differ from E.coli UTI in degree of antibiotic resistance. Herein, we compare the prevalence, risk factors, and resistance patterns between E.coli and non-E.coli UTIs in children.
MATERIAL AND METHODS
An institutional database of culture-proven UTIs between 2022 and 2024 in children(<18 years) was evaluated. Clinical characteristics were compared between cultures with non-E.coli UTI and E.coli UTI. Resistance patterns to five oral antibiotics were captured (penicillin-class, cephalosporin-class, nitrofurantoin, sulfa-based, fluoroquinolones). Risk factors were identified on univariate analysis and confirmed on binomial multivariate logistic regression.
RESULTS
A total of 393 infections were noted among 185 unique patients (78% female cases; median age at UTI 6.7 years [IQR 3.6-9.5]). Predictors of non-E.coli infections on multivariate analysis included male sex (OR 3.4, p<0.0001), congenital abnormalities of kidney and urinary tract (CAKUT; OR 1.8. p=0.038), spinal abnormalities (including myelomeningocele; OR 9.0, p=0.038), non-febrile presentation (OR 1.7, p=0.044), active antibiotic prophylaxis (OR 2.3, p=0.009), and number of prior positive cultures (OR 1.4 with each positive culture, p<0.0001). There was a higher degree of antibiotic resistance to ≥3 oral antibiotics for those with E.coli infections (20.3% vs. 8.2%, p<0.0001). Non-E.coli cultures were more likely to harbor resistance for nitrofurantoin and cephalexin but less likely to harbor resistance to amoxicillin, amoxicillin-clavulanate, TMP-SMX, and ciprofloxacin.
CONCLUSIONS
Children with urologic disorders and antibiotic prophylaxis are at risk of non-E.coli UTIs, which appear to have different resistance patterns to E.coli UTIs. This should be considered in clinical practice in prescribing empiric antibiotic therapy for UTI.
09:34 - 09:37
S17-8 (OP)
Rahel MOSER 1, Katharina STAHLBERG-GLATZ 2, Ulrike SUBOTIC 2, David KRONTHALER 3, Ulrike HELD 3, Maya HORST 1, Kerstin RUOSS 4, Alice HÖLSCHER 1 and Uchenna KENNEDY 1
1) University Children's Hospital of Zurich, Pediatric Surgery, Urology, Zurich, SWITZERLAND - 2) University Children's Hospital of Basel, Pediatric Surgery, Basel, SWITZERLAND - 3) University of Zurich, Division of Clinical Research Methods, EBPI, Biostatistics Department, Zurich, SWITZERLAND - 4) University Children's Hospital of Zurich, Pediatric and Adolescent Gynocology, Zurich, SWITZERLAND
PURPOSE
Simple ovarian cysts in girls are common during hormonally active phases. Surgical intervention is required in cases of cyst growth or complications. The most common laparoscopic ovarian-sparing methods are cyst enucleation and cyst deroofing. Adult studies show lower recurrence rates and a reduction in ovarian reserve following cyst enucleation. However, no such literature exists in girls. We aimed to compare laparoscopic cyst enucleation with cyst deroofing regarding postoperative recurrence rates and postoperative ovarian reserve in girls.
MATERIAL AND METHODS
We conducted a retrospective multicenter study at two institutions, analyzing pre- and postoperative demographic, clinical, and sonographic parameters. Recurrence was defined as an ipsilateral ovarian cyst present within 3 months postoperatively, while ovarian reserve was assessed via sonographic ovarian volume and adnexal ratio. Descriptive statistics were performed. Endpoints were analyzed using unadjusted risk differences, odds ratios, and linear regression models.
RESULTS
From 2012-2022, 107 patients underwent surgery for simple ovarian cysts (enucleation: n=42, deroofing: n=65). Mean age was 13.6 years, mean preoperative cyst size was 54 mm. Postoperative recurrence rates were similar (deroofing: 8.1%, enucleation: 7.8%, p=0.952). However, ipsilateral ovarian volume and adnexal ratio were lower after cyst enucleation, indicating a potential reduction in postoperative ovarian reserve.
CONCLUSIONS
We demonstrated that both methods showed no difference in postoperative recurrence rates. Laparoscopic cyst enucleation appeared to impact postoperative ovarian volumes more negatively. Based on our findings a prospective study is planned to address ovarian reserve more concisely. Our studies will help standardize surgical management of simple ovarian cysts in girls, with the goal of preserving ovarian reserve.