Page 1 - CUA2019 Abstracts - Pediatric Urology

2019 CUA AbstrACts

Poster Session 6: Pediatrics

July 1, 2019 0730-0900

MP-6.1 overcome these shortcomings, we developed a modified, more objective
Revisiting risk factors for febrile urinary tract infection in infants GMS (mGMS) scoring system to grade hypospadias severity and sought to
with prenatal hydronephrosis investigate its association with urethralcomplications (UC) post-tubularized
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Luis H. Braga , Smruthi Ramesh , Melissa McGrath , Anthony Herndon 2 incised plate (TIP) repair.
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1 Surgery, McMaster University, Hamilton, ON, Canada; Urology, VCU, Methods: A total of 680 patients of a prospective, single-centre hypospa-
Richmond, VA, United States dias database were graded preoperatively using the mGMS score. Patients
Introduction: Risk factors for febrile urinary tract infection (fUTI) in infants with followup <3 months, redos, and staged repairs were excluded. Age at
with prenatal hydronephrosis (HN), such as female gender, uncircumcised surgery, preoperative testosterone, glans groove depth, glans width (mm),
status, high-grade HN, and non-refluxing primary megaureter (NRPM), have meatal location, ventral curvature (VC), and complications (fistula, glans
been consistently documented in several small sample size series; however, dehiscence, and meatal stenosis) were collected. Primary outcome was to
the same cannot be said regarding continuous antibiotic prophylaxis (CAP). objectively describe the mGMS scoring system (4–12) (Table 1). Secondary
Herein, we revisit this clinically important outcome using a large, single- outcome was to investigate the association of mGMS severity score groups
centre database to confirm or refute these previous findings. (mild: 4–5; moderate: 6–7; severe: 8–10) with UC. Chi-square and Fisher’s
Methods: Since 2009, we have prospectively followed 876 consecutive exact tests were used to compare UC between groups.
prenatal HN infants <12 months of age with the following conditions: ure- Results: UC developed in 40/445 (9%) patients, most commonly fistulas
teropelvic junction obstruction (UPJO)-like, NRPM and vesicoureteral reflux (47%). Median age at surgery was 16 months (interquartile range [IQR]
(VUR). Patients with <6 months followup were excluded. A priori collected 8) and mean followup was 21 months (3–104). Mean mGMS score was
variables included: HN Society of Fetal Urology (SFU) grade (low: I/II vs. 6.3. UC rates according to the three mGMS severity scores categories are
high: III/IV), HN etiology, CAP, gender, and circumcision status. Primary shown in Table 2. Patients in the severe group had a significantly higher
outcome was catheter specimen fUTI. Time to event curves (hazard ratio complication rate vs. those in the mild category (19% vs. 5%; p<0.01).
[HR]) were analyzed by Cox proportional regression to adjust for confound- Conclusions: We have found the mGMS scoring system to be an objec-
ers. Analyses were done with and without VUR patients. tive, easy to standardize, and statistically useful instrument for describing
Results: Of 848 included patients, 632(75%) were male and 36% were the severity of hypospadias phenotypes and for quantifying the risk of UC.
circumcised. Seventy-three (9%) had a fUTI at a median age of six months We have also identified an association between mGMS severity scores
(interquartile range [IQR] 9). Mean followup was 30 months (6–120). High- groups and UC rates. Boys in the severe mGMS score category had a four-
grade HN was seen in 467 (55%) infants and CAP prescribed for 450 (53%). fold higher complication rate than those with mild hypospadias phenotype.
VUR (68% grades IV–V) was detected in 168/572 (29%) patients who had a This information can be useful for managing parental expectations during
voiding cystourethrogram (VCUG). Upon univariate analysis, a significantly discussion of surgical risks at preoperative consultation.
higher fUTI rate was seen in females, uncircumcised males, patients with This paper has figures, which may be viewed online at:
NRPM, and those with high-grade HN (Table 1). In the Cox proportional https://2019.cua.events/webapp/lecture/156
regression model, NRPM (HR 4.8; p<0.01), VUR (HR 7.0; p<0.01), uncir-
cumcised male (HR 2.3; p=0.03), females(HR 2.5; p=0.02), and lack of MP-6.3
CAP (HR 3.7; p<0.01), were significantly associated with fUTI (Table 2). Pain outcomes in pediatric circumcision patients after
HN grade was not found to be associated with fUTI. Kaplan-Meier curves administration of ketorolac as a preoperative adjunct therapy
for fUTI risk factors are shown in Fig. 1. Alec Mitchell , Adam Spencer , Andrew Walker , Mary Brindle , Anthony
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Conclusions: This study validates previous findings, confirming NRPM, J. Cook , Carolina Fermin Risso , Bryce A. Weber 1
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VUR, uncircumcised status, and female gender as important risk factors 1 Division of Urology, University of Calgary, Calgary, AB, Canada
for fUTI. According to our large dataset analysis, CAP significantly reduced Introduction: Circumcision is a common surgical intervention in children.
fUTIs and should be offered to these high-risk HN patients. Controlling postoperative pain is essential to decrease patient morbidity and
This paper has figures, which may be viewed online at: improve patient and parent satisfaction. With current analgesia practices,
https://2019.cua.events/webapp/lecture/155 pediatric surgical patients are often at risk of being undertreated for postop-
erative pain. Ketorolac is an effective non-steroidal anti-inflammatory drug
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MP-6.2 (NSAID) that is able to provide an analgesic effect comparable to opioids,
Scoring system for grading hypospadias severity and quantifying without postoperative nausea and vomiting. 2
risk of postoperative complications Methods: We conducted a prospective, randomized, single-blinded study
Melissa McGrath , James Elmore , Melise Keays , Farough Farrokhyar , from February 2017 to July 2018. Patients with planned circumcision sur-
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Luis H. Braga 1,4 gery were initially identified by the surgeon and randomized into treatment
1 Surgery, McMaster University, Hamilton, ON, Canada; Urology, Emory (perioperative ketorolac) or control groups (no ketorolac). The anesthesi-
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University, Atlanta, GA, United States; Surgery, Urology, Children’s Hospital ologist injected the study medication (ketorolac vs. normal saline) prior
of Eastern Ontario, Ottawa, ON, Canada; Epidemiology and Biostatistics, to surgical incision. Patients in the treatment group received a 0.5 mg/kg
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McMaster University, Hamilton, ON, Canada (maximum 30 mg) intravenous dose of ketorolac. Postoperative pain was
Introduction: In the original Glans-Urethral Meatus-Shaft (GMS) score evaluated through the use of the Face, Legs, Activity, Cry, Consolability
description, quality of the urethral plate (UP) and glans size were sub- (FLACC) or numeric rating scale (NRS). Parents were contacted 24 hours
jectively classified into four categories, potentially creating difficulty for following their surgery to complete the Parents’ Postoperative Pain Measure
reproducibility of study results and research collaboration. Aiming to (PPPM).
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S123
© 2019 Canadian Urological Association