Page 8 - CUA2018 Abstracts - Pediatric Urology

Poster session 7: Pediatrics

MP–7.12 a lower Fragility Index, and thus a more fragile result (r=0.50; p<0.001).
Increasing retrospective detection of pediatric nephrolithiasis in Linear regression models demonstrated a statistically significant associa-
children undergoing abdominal imaging at a Canadian pediatric tion between the presence of a biostatistician and the Fragility Index.
tertiary care centre Study design, allocation concealment, participant blinding, percent lost
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Raees Cassim , Carl van Walraven , Luke Lavallee , Kristen McAlpine , to followup, and level of evidence failed to show a statistically significant
Luis Guerra , Michael Leonard , Melise Keays 1 association with Fragility Index (Table 1; available at https://cua.guide/).
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1 Division of Urology, Department of Surgery, Children’s Hospital of Conclusions: The Fragility Index complements the p value and helps iden-
Eastern Ontario, Ottawa, ON, Canada; Department of Medicine, The tify less robust results. The statistically significant results of the pediatric
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Ottawa Hospital, Ottawa, ON, Canada; Institute for Clinical Evaluative urology studies reviewed appear to be quite fragile.
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Sciences, Toronto, ON, Canada; Division of Urology, Department of
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Surgery, The Ottawa Hospital, Ottawa, ON, Canada MP–7.14
Introduction: There are very few studies evaluating the prevalence of Current practice patterns for simple renal cysts among pediatric
nephrolithiasis in pediatric patients in Canada. Our objective was to urologists
estimate the prevalence of nephrolithiasis in patients undergoing abdomi- Zhan Tao (Peter) Wang , Roderick Clark , Irene McAleer , Elias Wehbi ,
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nal ultrasound (US) or computerized tomography (CT) at the Children’s Kai–Wen Chuang , Antoine Khoury 2
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Hospital of Eastern Ontario (CHEO) using textual analysis of abdominal 1 Surgery, Western University, London, ON, Canada; Urology, University
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imaging reports. of California, Irvine, CA, United States
Methods: Radiology reports for all patients under 18 years of age hav- Introduction: Simple renal cysts (SRC) are rare in the pediatric popula-
ing abdominal US or CT between January 1, 2011 and December 31, tion, with incidences ranging between 0.22–0.55%. In practice, the
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2016 were retrieved. Using SAS, reports were flagged if they contained management of SRC is widely variable, with no consensus on the fre-
keywords (Table 1; available at https://cua.guide/) potentially indicating quency, duration, or criteria for further intervention. The aim of this study
nephrolithiasis present. All flagged reports, as well as 10% of unflagged is to explore the current international practice patterns for SRC amongst
reports, were manually reviewed to confirm the presence or absence of pediatric urologists.
a stone. Patient– and stone–related clinical data was extracted. Methods: An online survey was developed and administered using
Results: A total of 2449 of 53 235 imaging reports cited at least one of SurveyMonkey comprising 21 questions and four clinical scenarios.
the keywords. Initial manual review of reports identified 622 studies as Content and face validation of the survey was performed by five pediatric
potentially indicating stones. Of these, 498 studies had confirmed stones urologists. This survey collected both quantitative (Likert scale) and quali-
(275 unique patients). The prevalence of imaging reports reporting index tative data (open–ended questions) aimed at assessing optimal imaging
stones increased from 488 to 1010 per 100 000 reports between 2011 modality, followup period, and management. The survey was adminis-
and 2015 (Fig. 1; available at https://cua.guide/). One hundred sixty– tered to members of the European Society of Pediatric Urology, American
five (60%) patients were first–time stones formers. The median age of Association of Pediatric Urologists, and Pediatric Urologists of Canada. A
new stone patients was 0.65 years (interquartile range [IQR] 0.32–13.4) total of 128 pediatric urologists responded, with a completion rate of 84%.
for asymptomatic patients and 9.6 years (IQR 0.69–14.1) overall. One Results: The most commonly used imaging modality for followup was renal
hundred eighteen stone patients (42.9%) were symptomatic, with pain ultrasound (100%) performed, on average, every six months (50.7%). The
(73%), hematuria (26%), urinary tract infection (24%), dysuria (11%), indications for changing followup frequency were mass effect (89.6%),
and/or nausea/vomiting (8%). Stone size was similar in symptomatic vs. gross hematuria (88.7%), worsening renal function (75%), and urinary
asymptomatic stones (6.4 vs. 5.8 mm; p>0.05). tract infection (43.9%). Most respondents followed asymptomatic children
Conclusions: The prevalence of radiologically identified stones in children with stable SRC for 2–5 years before discharging them from their care
undergoing abdominal imaging at a Canadian pediatric tertiary care cen- (32%). Two respondents found malignancies during followup imaging.
tre is increasing significantly over time. Despite the incidental nature of Conclusions: This is the first study to explore international practice
over half of the stones, a basic urological assessment, metabolic workup, patterns for the management of SRC in the pediatric population. The
and imaging until stone resolution are recommended for pediatric stone intervention rate of these SRC is currently are unknown, however, the
formers. socioeconomic burden of the surveillance regime shown in this study
is not trivial. In addition, although common themes were found for fol-
MP–7.13 lowup and treatment, practice patterns remain heterogeneous; as such,
Evaluating the robustness of the pediatric urology literature: A prospective studies or consensus from a working group are required for
role for the Fragility Index optimal management.
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Derek Bos , Andrew Stokl , Luis Braga 2 References:
1 Division of Urology, McMaster University, Hamilton, ON, Canada; 1. McHugh K, Stringer DA, Hebert D, et al. Simple renal cysts in chil-
2 McMaster Children’s Hospital, McMaster University, Hamilton, ON, dren: Diagnosis and followup with US. Radiology 1991;178:383e5.
Canada 2. Laucks Jr SP, McLachlan MS. Aging and simple cysts of the kidney.
Introduction: The use of threshold p values has been criticized as an Br J Radiol 1981;54:12e4.
overly simple concept to determine the true existence of a treatment
effect. To better communicate the limitations of the p value is to report UP–7.1
an additional metric that demonstrates how easily statistical significance A comparison of institutional and national differences in
based on a threshold p value may be exceeded (Fragility Index). management of cryptorchidism among Canadian pediatric
Methods: We reviewed all studies published in high–impact pediatric jour- surgeons and pediatric urologists
nals within the last five years that reported a statistically significant result Jin Kyu (Justin) Kim , Jacob Langer , Luis Braga , B.J. Hancock , Armando
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for at least one dichotomous or time–to–event outcome. In the group with Lorenzo , Walid Farhat , Darius J. Bagli , Michael Chua , Jessica Ming ,
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the smallest number of events, we changed the status of patients without Min Joon Lee , Amre Kesavan , Martin Koyle 2,3
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an event to an event until the p value exceeded 0.05. The number of addi- 1 Faculty of Medicine, University of Toronto, Toronto, ON, Canada;
tional events was labelled the Fragility Index, smaller values representing 2 Surgery, University of Toronto, Toronto, ON, Canada; Division of
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a more fragile result. Linear regression models were employed to evaluate Urology, Hospital for Sick Children, Toronto, ON, Canada; Division of
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associations between the Fragility Index and trial characteristics. General & Thoracic Surgery, Hospital for Sick Children, Toronto, ON,
Results: Of 609 abstracts reviewed, 92 studies were included in the final Canada; School of Medicine, Royal College of Surgeons in Ireland,
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analysis, with a median patient sample size of 89.5 (range 15–6000). The Dublin, Ireland; Urology, McMaster Children’s Hospital, Hamilton, ON,
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mean Fragility Index was 3 (range 0–135); 60% of studies had a Fragility Canada; Surgery & Pediatrics and Child Health, Children’s Hospital,
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Index of 3 or less. A strong correlation was found between sample size Winnipeg, MB, Canada
and Fragility Index, meaning a smaller sample size was associated with
CUAJ • June 2018 • Volume 12(6Suppl2) S105