Page 5 - CUA2018 Abstracts - Pediatric Urology

Poster session 7: Pediatrics

visualized ureter behind the bladder. Units with resolved hydronephrosis, 2. Malone PR. Urethrocutaneous fistula: Preserve the tract and turn it
under conservative management, were evaluated in terms of fUTI, age at inside out: The PATIO repair. BJU Int 2009;104:550–4. https://doi.
resolution, and final diagnoses. org/10.1111/j.1464–410X.2009.08350.x
Results: We included 428 patients with 552 renal units. The median fol- 3. Nerli RB, Metgud T, Bindu S, et al. Solitary urethrocutaneous fistula
lowup was 36.4 months (3–109.5). Nearly all UTD P1 were diagnosed managed by the PATIO repair. J Pediatr Urol 2011;7:166–9. https://
as isolated hydronephrosis. Fifty–one percent of UTD P1 (148 units) doi.org/10.1016/j.jpurol.2010.04.016
were assessed using voiding cystourethrograms. Of them, only nine units
(6.1%) were diagnosed as vesicoureteral reflux (VUR) (eight low–grade, MP–7.5
one high–grade). Globally, most of diagnosed VURs (59%) were UTD P2,
with 64% of them low–grade. In comparison, 70% of VURs that were Assessment of risk factors for surgical complications in neonatal
associated with UTD P3 were high–grade. UTD P1 had significant low circumcision clinic 2,3 2 2
1,2
risk for surgical and UTI incidence in comparison with the other groups. Jin Kyu (Justin) Kim , Martin Koyle , Michael Chua , Jessica Ming , Min
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2
2
2
Notably, none of UTD P1 renal units had surgical interventions during Joon Lee , Amre Kesavan , Megan Saunders , Joana Dos Santos
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followup, in comparison to 71% of UTD P3. There was no difference in 2 Faculty of Medicine, University of Toronto, Toronto, ON, Canada;
the terms of fUTI incidence and recurrent infection between UTD P2 3 Division of Urology, Hospital for Sick Children, Toronto, ON, Canada;
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and UTD P3 (p=0.53). The median time to resolution was about double Surgery, University of Toronto, Toronto, ON, Canada; School of
for UTD P3 in comparison to the other groups (p=0.007). The risk of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
surgical interventions was significantly higher in the UTD P3 than UTD Introduction: Thirty percent of male newborns are circumcised annually
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P2 (p<0.001). Regarding hydronephrosis resolution, only 9.9 % (10/97) in Canada. Circumcision, however, carries risks, as well as potential
2,3
resolved UTD P3 units received conservative management in comparison benefits. Despite this, there is limited data on risks for complications
to 78.2% (226/289) of UTD P1. of neonatal circumcision without clinically relevant quantification of risk
Conclusions: Most UTD P1 units resolved or improved on conservative factors. Herein, we aim to assess potential risk factors contributing to
management with no risk of surgical intervention and least risk of fUTI. complications of neonatal circumcision.
Units with VUR and UTD P1 were mostly resolved during followup (8/9). Methods: A retrospective review was performed on all males who under-
went a neonatal circumcision in our institution’s pediatric urology clinic
between January 2015 and June 2017. Parameters collected included age
MP–7.4 (corrected for pre–maturity), weight, circumcision technique, comorbidi-
Urethrocutaneous fistula repair following hypospadias repair ties, indications for circumcision, complications (early <24–hour, long–
using the “preserve the tract and turn it inside out” technique: term >24–hour), return to operating room (OR), and post–circumcision
A single–centre experience communications. Age and weight were dichotomized to determine a
Jas Singh , Karen Psooy , Nafisa Dharamsi 1 clinically relevant cutoff value.
1
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1 Department of Surgery, Section of Urology, University of Manitoba , Results: A total of 277 patients were identified. The mean age and weight
Winnipeg, MB, Canada were 28.4 days and 4.3 kg; 93.1% of cases were elective and 12.3%
Introduction: Urethrocutaneous fistula (UCF) development following of patients had comorbidities (Table 1; available at https://cua.guide/).
primary hypospadias repair is a common complication that creates Circumcisions were performed using Mogen (61.4%) or Gomco clamps
functional and cosmetic issues. Fistula repair has entailed local exci- (39.6%) under local anesthesia. There were 18 patients (6.5%) with bleed-
sion and multilayered closure, however, fistula recurrence is high. A ing requiring sutures. Twenty–six patients (9.4%) experienced long–term
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novel technique for management of these fistulas, the PATIO (preserve complications, with most being penile adhesions (84.6%). One of these
the tract and turn it inside out) repair, has been described and has shown patients required surgical intervention (Table 2; available at https://cua.
encouraging outcomes in previous reports. The aim of this study was to guide/). One patient visited the emergency room due to postoperative
2,3
evaluate fistula repair success in patients undergoing the PATIO technique bleeding from the circumcised area, which was managed conservatively.
compared with traditional repairs. Weight >5.1 kg was identified as a risk factor for bleeding requiring
Methods: A retrospective chart review was performed for patients under- sutures (odds ratio [OR] 4.15; 95% confidence interval [CI] 1.25–13.80)
going UCF repair from January 2005 to July 2017. Data, including age, fol- and long–term complications (OR 3.74; 95%CI 1.36–10.31) (Tables 3, 4;
lowup, hypospadias and fistula repair surgeon, meatal location, meatal available at https://cua.guide/).
stenosis, number of fistulas and repairs, UCF location, complications, Conclusions: This investigation revealed low rates of complication, regard-
and outcomes, was obtained. All fistula repairs were performed by two less of whether Mogen or Gomco was used. Patients weighing >5.1 kg
pediatric urologists. Cases were categorized into PATIO repair, traditional may be at higher risk of bleeding and long–term complications, such as
repair, and a combination. The primary outcome was freedom from fistula adhesions, suggesting that weight, rather than age, might be identified
recurrence on ongoing followup. as a limit for safe circumcision.
Results: In total, 36 patients underwent 38 UCF repairs during this References:
period. Mean age at repair was 19 months. Median followup time was 34 1. Sorokan ST, Finlay JC, Jefferies AL. Newborn male circumcision.
months. For PATIO repair alone, 10/12 had success. For traditional repair Paediatr Child Heal 2015;20:311–5. https://doi.org/10.1093/
alone, 8/18 had success, 8/18 had failed, and 2/18 were lost to followup. pch/20.6.311
For traditional repair followed by PATIO repair, 7/7 had success. Failure 2. Weiss HA, Larke N, Halperin D, et al. Complications of circumci-
following PATIO repair was found in cases where the procedure was early sion in male neonates, infants, and children: A systematic review.
in implementation and experience was limited. BMC Urol 2010;10:1–13. https://doi.org/10.1186/1471–2490–10–2
Conclusions: UCF repair using the PATIO technique has shown encour- 3. American Academy of Pediatrics. Circumcision policy statement.
aging results in the short–term, with a majority of patients achieving a Pediatrics 2012;130:585–6. https://doi.org/10.1542/peds.2012–1989
successful outcome. As this procedure continues to be used and experi-
ence develops, a larger sample of cases will become available for analysis
and longer followup will prove necessary in examining the long–term
outcomes of this procedure.
References:
1. Srivastava R, Tandale MS, Panse N, et al. Management of urethrocuta-
neous fistula after hypospadias surgery — An experience of 35 cases.
Indian J Plast Surg 2011;44:98–103. https://doi.org/10.4103/0970–
0358.81456
S102 CUAJ • June 2018 • Volume 12(6Suppl2)