ICCS & ESPU-Nurses Meeting on Thursday 4, September 2025, 08:20 - 09:08
08:20 - 08:26
SN04-1 (OP)
Maryellen KELLY 1, Mandy RICKARD 2 and Azadeh WICKHAM 3
1) Duke University, Urology, Durham, USA - 2) The Hospital for Sick Kids, Urology, Toronto, CANADA - 3) Mercy Children's, Urology, Kansas City, USA
PURPOSE
The burden of pediatric urologic disease has been increasing, and the current and projected supply of urologists will unlikely be able to meet the needs of patient access. Advanced practice providers (APPs) have become increasingly common in surgical practices, such as urology, to help fill this growing gap. The Pediatric Urology Nurses and Specialists (PUNS) organization represents many APPs in pediatric urology in the US. This study aimed to conduct a census survey of PUNS members to understand better the training and roles of APPs in pediatric urology.
MATERIAL AND METHODS
This descriptive survey, developed by the research special interest group of PUNS was conducted among PUNS fall meeting attendees in 2023. The electronic survey collected information on demographics, professional settings, the degree of independence in practice versus physician-supervised roles, procedures and diagnoses managed, and engagement in research.
RESULTS
There were 112 respondents, predominantly female (97.9%). 46.3% were between 31-40 years, followed by the 41-50 years group (27.4%), those aged 51 years and older (15.8%), and the 20-30 years (10.5%). 90% of the respondents work in urban centers, with 98.7% based in university settings or academic institutions. Respondents were highly educated, with many having advanced degrees such as MSN (71.4%), DNP (9.8%), and PhDs (1.8%). Most respondents see patients independently of physicians (94.7%). 58% are involved with research with their roles, 24.1% assisted with patient recruitment and consenting, another 24.1% were co-investigators, and 8.9% were primary investigators, 8.9% of respondents had published in peer-reviewed journals over the past two years.
CONCLUSIONS
This survey revealed a well-educated, predominantly female membership primarily working in urban academic environments and exhibiting high clinical independence. Less than half of the membership participates in research, those who do are significantly involved across various capacities.
08:26 - 08:32
SN04-2 (OP)
Fatih OZKAYA, Aykut AKINCI, Bahri Efe TURGUT, Aylin DOĞAN, Sercan SAĞLIK, Berk BURGU and Tarkan SOYGUR
Ankara University Faculty of Medicine, Paediatric Urology, Ankara, TÜRKIYE
PURPOSE
Ochoa syndrome is a rare autosomal recessive disorder characterized by abnormal facial expressions and severe urinary dysfunction. Patients often present with vesicoureteral reflux (VUR), hydronephrosis, and recurrent urinary tract infections (UTIs), leading to renal impairment if untreated. This study evaluates the clinical course, treatment strategies, and long-term outcomes of 28 patients diagnosed with Ochoa syndrome over a 62-month follow-up period
MATERIAL AND METHODS
A total of 28 patients (16 males, 12 females; mean age 9.6 years) were included. Genetic analysis identified HPSE2 mutations in 19 patients and LRIG2 mutations in 9. All patients underwent intermittent catheterization (CIC), pharmacologic therapy (anticholinergics, alpha-blockers, desmopressin), and surgical intervention where necessary. Clinical data, renal function, and ocular findings were monitored throughout follow-up.
RESULTS
CIC was initiated in 20 patients (71%), with 15 (75%) maintaining adherence by 62 months. Anticholinergic therapy was used in 21 (75%), and 10 (36%) underwent endoscopic ureteral injection for VUR. Urinary incontinence, present in 24 patients (86%), improved in 14 (50%). UTIs decreased from 78% to 43%, but three (11%) developed end-stage renal disease. Ocular findings included optic atrophy in 6 (21%) and retinal changes in 4 patients.
CONCLUSIONS
Regular CIC use and pharmacologic therapy improved bladder function, reducing hydronephrosis and UTI incidence. Surgical intervention contributed to better renal outcomes. However, three patients progressed to renal failure, emphasizing the need for early intervention and lifelong follow-up in Ochoa syndrome.
08:32 - 08:38
SN04-3 (OP)
Shelly KING
Riley Childrens's Hospital/ Indiana University, Pediatric urology, Fishers, USA
PURPOSE
Ensuring that nurses are well-educated in catheterization techniques, risks, and complications is crucial for patient safety and high-quality care. This study aims to evaluate nursing knowledge and confidence in pediatric urinary catheterization before and after a comprehensive presentation by an experienced pediatric urology nurse practitioner with the goal to improve patient care.
MATERIAL AND METHODS
A comprehensive presentation on safe catheterization was delivered to 39 operating room (OR) nurses by an experienced pediatric urology nurse practitioner following routine hospital catheterization education. The session covered principles of safe catheterization, proper procedures, equipment, and identifying potential complications. Pre- and post-education surveys assessed the nurses' comfort level in performing pediatric catheterization, requesting urology assistance and their opinions on including this training in orientation.
RESULTS
Pre-education surveys showed 43% of nurses were very comfortable and 17% were comfortable with pediatric catheterization, 43% felt inadequately trained during nursing school. Fifty percent were comfortable asking urology for help if needed.
Post-presentation, 46% felt very comfortable and 44% felt comfortable with pediatric catheterization. All participants agreed the presentation should be part of their orientation. Additionally, 62% reported feeling more confident in reaching out to the urology team for assistance.
CONCLUSIONS
The study underscores gaps in nursing training, with many nurses desiring more hands-on education in urinary catheterization. Following the presentation, nurses reported greater confidence in catheterization and a stronger willingness to seek urology support, highlighting the need for additional training and resources in catheterization techniques.
08:38 - 08:44
SN04-4 (OP)
Ruthie YOUSSEFI, Brittany SWIGER, Eric MASSANYI, Daniel MCMAHON, Curtis CLARK and Hannah BACHTEL
Akron Children's Hospital, Pediatric and Adolescent Urology, Akron, USA
PURPOSE
Parental concern about their child after surgery often results in unnecessary utilization of health care resources. The aim of this quality improvement initiative was to decrease preventable postoperative phone calls and return visits after ambulatory pediatric urologic surgery by 30% in six months.
MATERIAL AND METHODS
Project scope focused on the most common ambulatory procedures: inguinal/scrotal, laparoscopic, and non-hypospadias penile surgery. Standardized postoperative instructions were developed and implemented for all surgeons across multiple various locations. Telephone encounters, MyChart messages, clinic, and ER visits within 2 weeks of surgery were classified as preventable if no immediate action was required apart from caregiver education and reassurance. Primary outcome was proportion of preventable phone calls and return visits within 2 weeks of surgery. Impact was measured using a statistical process control P-chart. In addition to run chart rules, a two-sample t-test was used to compare the proportion of preventable calls and visits from the preintervention period to the postintervention period.
RESULTS
564 patients underwent ambulatory urologic surgery performed over 42 weeks from December 2023 to September 2024. In our preintervention phase (weeks 1-11), the median proportion of preventable postoperative calls and return visits was 16%. Following implementation of standardized discharge instructions, preventable postoperative phone calls and return visits decreased to 10%, representing a 37% decrease from baseline (p < 0.05). The center-line shift occurred at week 26 and was sustained for 17 weeks.
CONCLUSIONS
Parent and caregiver anxiety can be decreased significantly by having standardized postoperative instructions, therefore decreasing preventable phone calls and visits. Future directions include the use of preoperative videos to enhance caregiver education and continued standardization of discharge instructions for commonly performed urologic procedures (i.e., endoscopy, hypospadias repair).
08:44 - 08:50
SN04-5 (OP)
Maryellen KELLY 1, Tatyana SYSOEVA 2 and Lisa KARSTENS 3
1) Duke University, Urology, Durham, USA - 2) University of Alabama, Huntsville, Microbiology, Huntsville, USA - 3) Oregon Health and Science University, Portland, USA
PURPOSE
Urinary tract infections (UTIs) are the most common outpatient infections in the US and Europe and pose a serious risk to children, with a recurrence rate of up to 50% and potential life-long health consequences. The presence of specific microbes in the adult urobiome suggest UTI development. Initial studies suggest UTI history affects pediatric urobiome development. This pilot study aimed to evaluate the temporal stability of the urobiome in children and assess the feasibility of longitudinal urine sampling in the pediatric population.
MATERIAL AND METHODS
Fourteen children were provided voided urine samples on days 1-5, 14, 21, 28, and 60. Seven delivered their urine samples daily for same-day processing, while the other seven stored their samples in their home freezers for later batch processing. Urine specimens were filtered through a 0.22m membrane to collect biomass, and total DNA was extracted and sequenced using a short-16S-rRNA gene V4 amplicon via IlluminaMiSeq protocols.
RESULTS
Daily drop-off samples resulted in adequate data for all but four samples. The at-home storage resulted in the poor recovery of amplified 16S RNA gene fragments, which did not produce sufficient quality sequencing data in the majority of the samples, with only four samples producing >10,000 reads. The daily drop-off samples were further analyzed to assess the stability of the pediatric urobiome.
CONCLUSIONS
This data revealed a relatively stable microbial composition of voided urine in children for up to two months. At-home collection with conventional home freezer storage was unsuccessful without chemical preservatives, calling for further research to develop better at-home sampling methods.
08:50 - 08:56
SN04-6 (OP)
Mehmet Ugur YILMAZ
Bursa City Hospital, Paediatric Urology, Bursa, TÜRKIYE
PURPOSE
Urethral foreign bodies, while uncommon, are a serious concern that can cause complications such as UTI(urinary tract infection)s. Causes include insertion due to mental disorders, broken catheter pieces, and iatrogenic reasons. This report describes successful management of a child with a UTI caused by a Hordeum Murinum (false barley) plant pushed into the urethra, likely by the child himself.
MATERIAL AND METHODS
A 3-year-7-month-old male child presented with recurrent urinary tract infection symptoms (dysuria, hematuria, purulent discharge) resistant to 2 months of various antibiotic treatments and hospitalizations. Urine tests showed sterile pyuria. Ultrasound revealed normal kidneys and a small mucosal protrusion near the bladder neck. Voiding cystourethrography was normal. Given the lack of definitive findings on conventional imaging, urethrocystoscopy was planned. Urethrocystoscopy revealed a splinter-like, yellowish foreign body (approximately 10x2mm) embedded in the posterior urethra near the verumontanum, surrounded by a polyp-like tissue reaction. The foreign body was removed with a basket catheter, the surrounding polyp resected, and both sent for pathological examination.
RESULTS
Initially, the object appeared to be a fragment of urethral stone during cystoscopy. However, upon extraction, it was identified as a piece of false barley plant.The procedure was documented with video of urethroscopy and photographs of the extracted plant material and resected tissue. Pathology reported the foreign body as organic material and the polyp as inflammatory granulation tissue. Post-operative recovery was uneventful, and the patient remained symptom-free after 6 months of follow-up.
CONCLUSIONS
The case highlights the importance of considering foreign bodies in the differential diagnosis of UTIs, especially when unresponsive to standard treatments. It should be kept in mind that preschool children may not be able to give a clear anamnesis. Cystoscopy is crucial for diagnosis and removal in such cases.
08:56 - 09:02
SN04-7 (OP)
Lola BLADT 1, Tinne VAN AGGELPOEL 2, Gunter DE WIN 2, Stefan DE WACHTER 2, Lukas VAN CAMPENHOUT 1 and Alexandra VERMANDEL 2
1) University of Antwerp, Product Development, Antwerp, BELGIUM - 2) University Hospital Antwerp, Urology, Edegem, BELGIUM
PURPOSE
Elimination signals–cues a child displays before, during and after urination or defecation–are key in toilet training. In recent decades, there has been a trend of postponed toilet training in Western countries, often linked to the widespread use of highly absorbent disposable diapers. This is the first prospective study to evaluate their impact on urination elimination signals in normally developing children aged 18 to 36 months who are not yet toilet trained.
MATERIAL AND METHODS
A prospective observational study with a crossover design was conducted in non-toilet-trained children under two conditions, presented in a fixed order: first without a diaper, then with a diaper. Trained researchers conducted unblinded observations at daycare centers or private homes, observing children individually or in small groups in real-time and through video recordings. A predefined checklist based on the latest systematic review was used to record the presence of urination elimination signals. Differences between the conditions were analyzed using the McNemar test for paired data.
RESULTS
Out of 40 recruited children, 23 were analyzed (10 boys, 13 girls, mean age 24 months, SD 3.1 months, range 19-30 months). Across all ten predefined urination elimination signals, more children displayed these signals without a diaper, with statistically significant differences in five signals. Before urination, (i) lower limb movement and (ii) looking at or touching the genital area were only observed without diaper in 52% and 44% of children. Additionally, (iii) ceasing current activity, (iv) looking at or touching the genital area during urination, and (v) interest in the void were only observed without a diaper in 52%, 64% and 44% of children, respectively.
CONCLUSIONS
Disposable diapers reduce the display of urination elimination signals, which are essential for assessing a child’s readiness for toilet training. This suggests that prolonged diaper use may delay the natural maturation of bladder control.
09:02 - 09:08
SN04-8 (OP)
Ellie ADAMS 1, Claire FOSTER 2 and Tammy HUNG 3
1) Evelina London Children's Hospital, Urology, London, UNITED KINGDOM - 2) Evelina London Children's Hospital, U, London, UNITED KINGDOM - 3) Evelina London Children's Hospital, Paediatric psychology, London, UNITED KINGDOM
PURPOSE
Clean Intermittent Catheterisation is a skill regularly taught to patients in our department. Learning and performing catheterisation can have a big impact on a patient and their family. This was recognised by the multidisciplinary team and we decided to organise a support day for patients and their families. This was organised and run by a team of urology clinical nurse specialists, psychologists, a play specialist and bladder consultant. The aim was to create a space for patients and their families to connect with others who catheterise and to learn from each other and clinicians in an informal environment.
MATERIAL AND METHODS
We organised a support day and invited patients who catheterise and their parents. All patients had already completed catheterisation training. The patient cohort included those who are highly compliant with catheterisation and those who experience difficulties. Activity sessions were offered, alongside question and answer sessions with the clinical team. Feedback was collected through a questionnaire given to participants at the end of the day.
RESULTS
8 female patients aged between 9-13 years attended along with 9 parents/guardians. The feedback was overwhelmingly positive, with all attendees expressing enjoyment of the event. Nearly all reported finding it either very helpful or somewhat helpful in managing catheterisation. All parents indicated that they learned new strategies to support their child with catheterisation and all but one patient reported learning new coping mechanisms.
CONCLUSIONS
This support day provided a valuable opportunity for participants to share experiences, enhance understanding and gain emotional and practical support in managing catheterisation.