Page 9 - CUA2018 Abstracts - Pediatric Urology

Poster session 7: Pediatrics

Introduction: Cryptorchidism (UDT) is a common congenital abnormality but do use antibiotics after hypospadias surgery where catheters/stents
that is managed by pediatric urologists (U) and pediatric surgeons (S). In are left indwelling. The North American PUs demonstrated comparable
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the era of evidence–based medicine, clinical practice guidelines may practice patterns, which often differed significantly from those of the
improve healthcare outcomes by standardizing patient care. Therefore, SPUNZA and BAPU PU. Specifically, a significantly larger proportion of
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this project aims to evaluate whether a guideline is an effective tool of the North American PUs do not use antibiotics for common procedures
influencing practice at institutional and national levels by assessing dif- when compared to Australia, New Zealand, and the U.K.
ferences in the management of UDT between U and S at the institutional Conclusions: Practice patterns in antibiotic usage among PUs vary widely
and national (Canadian) levels of practice. based on geographic location of practice. This may be attributed to local
Methods: To assess the institutional practice patterns, a retrospective ‘culture’ and training. With antibiotic stewardship being a significant
review of the electronic records of patients who underwent primary uni- focus in healthcare, there is a need to understand the reasons for such
lateral or bilateral orchidopexies at our centre between January 2012 and variation and to standardize antibiotic usage based on best evidence.
January 2014 was performed. To assess the national practice patterns, Reference:
active members of Pediatric Urologists of Canada (PUC) and Canadian 1. Wolf JS, Bennett CJ, Dmochowski RR, et al. Best practice policy
Association of Pediatric Surgery (CAPS) were invited to participate in a statement on urologic surgery antimicrobial prophylaxis. J Urol
multiple–choice–type questionnaire with clinical scenarios in manage- 2008;179:1379–90. https://doi.org/10.1016/j.juro.2008.01.068
ment of UDT.
Results: At our institution, 488 patients (616 testes) were identified; 405 UP–7.3
(83.0%) and 83 (17.0%) were managed by U and S, respectively. With
the national survey, there was a 74% response rate among CAPS members An epidemiological overview of a tertiary referral practice for
(54/73) and 79% response rates among PUC members (27/34). Table male pediatric lichen sclerosus
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1(available at https://cua.guide/) outlines the relevant guideline recom- Dylan Hoare , Peter Metcalfe
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mendations and the observed institutional practice patterns and preferred Division of Urology, Department of Surgery, University of Alberta,
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national practice patterns of U and S. Edmonton, AB, Canada; Division of Pediatric Surgery, Department of
Conclusions: Despite some differences, the overall adherence to guideline Surgery, University of Alberta, Edmonton, AB, Canada
recommendation observed from both institutional and national investiga- Introduction: Within the pediatric population, changing patterns of cir-
tions were similar. The difference between the observed age at surgery cumcisions have confounded the epidemiology and presentation of lichen
institutionally and preferred age of surgery nationally may indicate that sclerosus (LS). We sought to evaluate the incidence, demographics, and
despite the ‘preferences,’ actual practice may be different. The high rates clinical features of patients presenting to a single Albertan pediatric urolo-
of preoperative ultrasound use may indicate that current guideline rec- gist with LS.
ommendations are ineffective at influencing established practice patterns Methods: This retrospective, descriptive analysis evaluated all pediatric
based on experience. patients referred for phimosis to a single pediatric urologist in Edmonton,
References: Alberta, Canada. This surgeon routinely delivered foreskin specimens for
1. Sijstermans K, Hack WWM, Meijer RW, et al. The frequency of pathology post–circumcision. Chief complaints/symptoms, date of birth,
undescended testis from birth to adulthood: A review. Int J Androl and date of circumcision were identified. Clinical suspicion of LS and
2008;31:1–11. pathological confirmation of the disease were documented. The primary
2. Kirkpatrick DH, Burkman RT. Does standardization of care through outcome of interest was the proportion of circumcisions with pathologi-
clinical guidelines improve outcomes and reduce medical liabil- cally confirmed LS.
ity? Obstet Gynecol 2010;116:1022–6. https://doi.org/10.1097/ Results: From July 2006 to March 2016, 4163 patients were seen for
AOG.0b013e3181f97c62 phimosis of the approximate 12 000 new referrals. One hundred phimosis
patients had clinically suspected LS. Unfortunately, 17 (10.5%) patients
were missing pathology specimens. Of those adequately reported, 81
UP–7.2 (81/83) were microscopically confirmed to be LS, with a mean age of 9.6
Practice variation on use of antibiotics: An international survey years and median age of 8.9 years (range 4.1–16.1). This cohort repre-
among pediatric urologists sented 2.0% of phimosis referrals and approximately 0.7% of all referrals
Jin Kyu (Justin) Kim , Michael Chua , Jessica Ming , Luis Braga , Grahame to our pediatric urologist. When compared to physiological phimosis,
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Smith , Christopher Driver , Martin Koyle 2,6 these patients had higher rates of dysuria (n=28, 34.6% vs. n=1, 1.0%;
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1 Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Division p<0.0001) and urinary retention (n=18, 22.2% vs. n=1, 1.0%; p<0.0001)
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of Urology, Hospital for Sick Children, Toronto, ON, Canada; Urology, as presenting complaints. The remainder of the patients presented due to
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McMaster Children’s Hospital and McMaster University, Hamilton, ON, painful erections (n=2, 2.5%), balanitis (n=2, 2.5%), and the inability to
Canada; Urology, The Sydney Children’s Hospital, Sydney, Australia; retract their foreskin (n=24, 29.6%), among other reasons (n=7, 8.6%).
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5 Surgical Pediatrics, Royal Aberdeen Children’s Hospital, Aberdeen, Conclusions: LS of the pediatric male genitalia is an uncommon, albeit
United Kingdom; Surgery, University of Toronto, Toronto, ON, Canada clinically significant disease entity. For the trained practitioner, the clinical
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Introduction: The evidence for antibiotic prophylaxis after common pedi- diagnosis is very accurate.
atric urological procedures is limited and current practices on post–proce-
dure prophylaxis may be variable among pediatric urologists (PU), without UP–7.4
evidence–based support. We aimed to evaluate the current practice pat-
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tern on antibiotic usage for common interventions among PUs practicing A pilot study using magnetic stents in pediatric patients
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in four English–speaking, geographic sectors of the world. Navraj Dhaliwal , Bruce Gao , Ravneet Dhaliwal , Mutaz Farhad , Carolina
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Methods: A survey using multiple–choice options based on seven scenar- 1 Fermin–Risso , Anthony Cook , Bryce Weber
ios, primarily on clinical situations where a tube/catheter/stent is inserted Undergraduate Medical Education, University of Calgary, Calgary, AB,
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and/or left indwelling, was disseminated to practicing members of the Canada; Faculty of Medicine, University of Calgary, Calgary, AB, Canada;
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Pediatric Urologists of Canada (PUC) and Society of Pediatric Urology of Urology, University of Calgary, Calgary, AB, Canada ©
Australia and New Zealand (SPUNZA), and all PUs attending the 2016 Introduction: Ureteral stents with magnetic tips (Blackstar ) were recently
British Association of Pediatric Urology (BAPU) and 2017 American approved for use in Canada. Traditionally, pediatric stent insertion and
Association of Pediatric Urology (AAPU) meetings. removal is done under general anesthetic. Unfortunately, general anes-
Results: A total of 126 respondents completed the survey (68.5% response thetic has been associated with potential learning difficulty and devel-
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rate) with ≥65% response rate from each sector. Across the groups, pre– opmental issues. With magnetic stents shown to be safe and effective
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incision prophylactic antibiotics were administered for J–J stent place- in adults and removable without general anesthetic, these stents have
ment and before hypospadias surgery. Most PUs do not use continuous potential to reduce anesthetic–associated morbidity in pediatric patients.
prophylactic antibiotics for indwelling urethral and suprapubic catheters,
S106 CUAJ • June 2018 • Volume 12(6Suppl2)