Page 7 - CUA2018 Abstracts - Pediatric Urology

Poster session 7: Pediatrics

MP–7.9 Conclusions: In this followup of detailed geospatial analysis of hypospa-
A prospective cohort study on the safety and success of pediatric dias and cryptorchidism prevalence in an area with stable population,
robot–assisted laparoscopic ureteric reimplantation in the we did not confirm the previous findings of high clustering in areas of
Canadian healthcare system intense agricultural activity. Furthermore, our analysis did not find high
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Noah Stern , Roderick Clark , Zhan Tao (Peter) Wang , Sumit Dave 1 clustering of the congenital malformations in areas near toxic industries
1 Urology, London Health Sciences Centre, London, ON, Canada to support an environmental role in their development.
Introduction: Concerns have been raised regarding the safety and success References:
of pediatric robotic assisted extravesical ureteric reimplantation (RUR). 1. Lane C, Boxall J, MacLellan D, et al. A population–based study
Based on the IDEAL framework for surgical innovation, RUR is currently of prevalence trends and geospatial analysis of hypospadias and
at the exploratory phase (Stage 2a). This study explores the safety and cryptorchidism compared with non–endocrine mediated congenital
outcomes of RUR in the first Canadian series to date. anomalies. J Ped Urol 2017;13:284.e1–7. https://doi.org/10.1016/j.
Methods: This prospective cohort study includes all RUR procedures jpurol.2017.02.007
performed between July 2013 and June 2017 by a single surgeon using 2. ESRI, Redlands, CA, USA.
a standard three–port technique, without ureteric stenting. The primary
indication for surgery was recurrent breakthrough urinary tract infections MP–7.11
(UTIs) or UTIs after cessation of antibiotic prophylaxis (ABP), despite A comparison of the incidence and clinico–demographics of
adequate treatment for bladder–bowel–dysfunction. Success was defined pediatric epididymal cysts
for patients who had at least six months’ followup as resolution of UTIs Fardod O’Kelly , Kristen McAlpine , Nishard Abdeen , Melise Keays , Luis
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off ABP or a negative voiding cystourethrogram (VCUG) (in those who Guerra , Michael Leonard 1
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had UTIs after surgery). 1 Pediatric Urology, Children Hospital of Eastern Ontario, Ottawa, ON,
Results: A total of 21 RURs were performed on 19 females and two males. Canada; Pediatric Diagnostic Imaging, Children Hospital of Eastern
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The average age at surgery was 5.4 years (range 12–129 months). RUR Ontario, Ottawa, ON, Canada
complications included one intraoperative acute kidney injury treated Introduction: With only a small number of studies in modern literature per-
conservatively and one delayed distal thermal ureteric injury, which taining to epididymal cysts, with an average of 32 patients per study (median
required stenting. Post–stent removal, this patient remained asymptom- n=1), it remains unknown whether any risk factors exist for these children or
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atic with no evidence of obstruction. Twelve patients remained UTI–free what the best method of management is. The cysts are thought to regress
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off ABP after surgery, while nine who had persistent UTIs (≥2) postop- in children. The aim of this study was to assess the incidence, clinico–
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eratively underwent a VCUG, which showed no evidence of persistent demographics, and outcomes of epididymal cysts in a pediatric cohort.
vesicoureteric reflux in all. Three of these nine patients remain on ABP. Methods: Our institutional ultrasound (US) database was searched for all
Conclusions: RUR remains a technically challenging procedure that needs scrotal US. From these, a filtered, IRB–approved search was performed
further investigation in a systematic manner before universal adoption. for any reports containing the word “cyst.” These were then cross–refer-
Despite a comparable success rate to open ureteric reimplantation, enced with a retrospective chart review (October 2006–September 2017).
robotic dissection techniques have to be standardized and improved to Clinico–demographics, cyst characteristics, and outcomes were analyzed
prevent ureteric injury. for both pre– and post–pubertal boys using descriptive and non–parametric
statistical methods.
MP–7.10 Results: Of 4508 boys undergoing scrotal US during this period, 191
A followup geospatial analysis of hypospadias and cryptorchidism were indicated to contain cysts. Of these, 109 scans (2.4%) met inclu-
prevalence rates in a Canadian province with a stable population sion criteria (85 pre–pubertal; 24 post–pubertal); 70.5% of epididymal
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Kiana Mahboubi , Beau Ahrens , Ciaran Lane , Dawn MacLellan , cysts were incidental. There was no difference between cohorts in terms
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Peter Anderson , Rodrigo Romao 1,2 of presence of hydrocoele (p=0.9), symptoms (p=0.9), ordering service
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1 Pediatric Urology, IWK Health Centre, Halifax, NS, Canada; Urology, (p=0.61), rate of resolution (4.2% vs. 8.2%; p=0.68), or length of fol-
Dalhousie University, Halifax, NS, Canada; Faculty of Graduate Studies, lowup (4 vs. 4.5 years; p=0.44). Pre–pubertal cysts were smaller in size
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Dalhousie University, Halifax, NS, Canada (3.35 vs. 4.62 mm; p=0.025), and more likely to trigger repeat scanning
Study Groups: Division of Pediatric Urology, IWK Health Centre, (n=67 vs. n=10; p=0.008). There were no operative interventions, and no
Department of Urology, Dalhousie University. subsequent clinical deterioration occurred with observation.
Introduction: Our group has reported significant clustering of hypospadias Conclusions: Epididymal cysts are comparable in pre– and post–pubertal
and cryptorchidism at the county level in areas of intense agricultural boys, and can be safely managed using a conservative approach. The
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activity in Nova Scotia (NS). The goals of this followup study were: 1) to higher–than–expected rate of detection may be a result of the improved
perform a granular geospatial analysis at the postal code level; and 2) to ultra–resolution of modern scanners. These children should not require
determine whether there is spatial correlation between these conditions repeat surveillance imaging solely for epididymal cysts, and could be
and industries linked to toxic output. managed in a primary care setting with clinical examination.
Methods: Cases of hypospadias and cryptorchidism were identified based References:
on ICD–10 codes from the ATLEE Perinatal Database with records of all 1. Fiogbé MA, Gbénou AS, Metchihoungbé S, et al. [Epidemiological
live births in NS between 1988 and 2013. Data were geocoded and and clinical aspects of visible urogenital malformations among
mapped based on the three first digits of the maternal postal code (Forward adolescent’s schoolboys at Cotonou]. Prog Urol 2013;23:1428–34.
Sortation Area [FSA]) using ArcGIS 10.5. Regional prevalence of congeni- https://doi.org/10.1016/j.purol.2013.04.015
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tal anomalies was calculated for each of the 77 FSAs. To identify statisti- 2. Erikci V, Hoşgör M, Aksoy N, et al. Management of epididymal
cally significant high and low prevalence clusters for each anomaly, Local cysts in childhood. J Pediatr Surg 2013;48:2153–6. https://doi.
Morans I was used on the spatial data. In addition, geospatial point data org/10.1016/j.jpedsurg.2013.01.058
was created for industries linked to toxic output and correlation between 3. Niedzielski J, Miodek M, Krakós M. Epididymal cysts in childhood —
clusters of malformations and proximity to these industries was assessed. conservative or surgical approach? Pol Przegl Chir 2012;84:406–10.
Results: During the study period, there were 1045 cases of hypospadias https://doi.org/10.2478/v10035–012–0068–2
and 993 cases of cryptorchidism. Both hypospadias (five high– and one 4. Homayoon K, Suhre CD, Steinhardt GF. Epididymal cysts in children:
low cluster; p<0.036) and cryptorchidism (three high– and one low–clus- Natural history. J Urol 2004;171:1274–6. https://doi.org/10.1097/01.
ter; p<0.013) demonstrated statistically significant areas of high and low ju.0000110322.87053.99
prevalence clusters (Figs. 1, 2). There was no apparent spatial correlation 5. Posey ZQ, Ahn HJ, Junewick J, et al. Rate and associations of epidid-
between the local clustering of the congenital malformations and proxim- ymal cysts on pediatric scrotal ultrasound. J Urol 2010;184:1739–42.
ity to toxic industries. https://doi.org/10.1016/j.juro.2010.03.118
S104 CUAJ • June 2018 • Volume 12(6Suppl2)