Page 2 - CUA2019 Abstracts - Pediatric Urology

2019 CUA Abstracts

Results: Twenty-nine patients were enrolled in this pilot study. Fifteen UTIs post-CAP-DC were females and had more frequent bladder bowel
patients were assigned to the control group and 14 to the treatment dysfunction and dilating VUR.
group. Neither the FLACC scale or NRS displayed statistical significance. This paper has figures, which may be viewed online at:
Post-discharge, the PPPM for the control group was 4.0 (0–8) and for the https://2019.cua.events/webapp/lecture/158
treatment group was 1.0 (0–2.5) (p=0.010).
Conclusions: With just a single dose of ketorolac given intraoperatively, MP-6.5
parental perception of pain was significantly lower in the ketorolac group
when compared to the control. To better delineate these results, we are Voiding cystourethrograms for infants with isolated high-grade prenatal
moving forward with enrollment for a randomized controlled at Alberta hydronephrosis and hydroureteronephrosis without a history of previous
Children’s Hospital, aiming to further evaluate the use of ketorolac as an urinary tract infection: Is it really necessary? 1 1
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adjunct analgesic in pediatric patients. 1 George Goucher , Melissa McGrath , Alanna Webster , Luis H. Braga
References Urology, McMaster University, Hamilton, ON, Canada
1. American Society of Anesthesiologists Task Force on Acute Pain Introduction: Several guidelines have been published in an attempt to
Management. Practice guidelines for acute pain management standardize the use of voiding cystourethrogram (VCUG) to identify those
in the perioperative setting: An updated report by the American at a higher risk of recurrent urinary tract infections (UTI). There remains
Society of Anesthesiologists Task Force on Acute Pain Management. a lack of uniformity in this practice, particularly in infants without prior
Anesthesiology 2012;116: 248-73. https://doi.org/10.1097/ history of UTI. Here, we evaluate the yield of vesicoureteral reflux (VUR)
ALN.0b013e31823c1030 detection on VCUG and determine the risk of subsequent febrile UTIs and
2. Ketorolac compound summary. Pubchem Substance Website. the need for surgical intervention to assess the clinical utility of this test.
National Center for Biotechnology, US National Library of Medicine. Methods: We reviewed our prospectively collected prenatal hydrone-
Available at: http://pubchem.ncbi.nlm.nih.gov/compound/3826. phrosis database of patients 0–12 months from 2008–2018, including
Accessed June 24, 2015. those with Society of Fetal Ultrasound (SFU) III/IV or urinary tract dila-
tion (UTD) grade II/III without a previous history of UTI who underwent
VCUG. Rates of subsequent febrile UTI and surgical intervention were
MP-6.4 compared between those in whom VUR was detected and those in whom
Challenging the status quo: A prospective study of early it was absent. Results were stratified between those with isolated HN and
discontinuation of continuous antibiotic prophylaxis in children those with hydroureteronephrosis (HUN).
with vesicoureteral reflux Results: A total of 306 patients were included for analyses: 193 (63.1%)
Catherine Lovatt , Melissa McGrath , Smruthi Ramesh , Alanna Webster , with isolated HN and 113 (36.9%) with HUN. VUR was detected on
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Kornelia Palczek , Luis H. Braga 1,2 VGUG more often in patients with HUN (28.3%) than int hose with
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1 Surgery, McMaster Children’s Hospital, Hamilton, ON, Canada; Surgery, isolated HN ( 9.3%) (p<0.001). The overall rate of febrile UTI was low
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McMaster University, Hamilton, ON, Canada (7.1%); however, those with VUR detected on VCUG with HUN were
Introduction: Continuous antibiotic prophylaxis (CAP) has been recom- more likely to experience febrile UTIs then those without VUR (12.5%
mended for children with vesicoureteral reflux (VUR) until toilet-training vs. 3.7%; p=0.015). This association was not found in the isolated HN
to prevent urinary tract infections (UTI). We had the chance to investigate group. Patients in the isolated HN group were more likely to require
this concept at our institution by prospectively following two cohorts surgical intervention (40.8% vs. 20.3%).
managed by two surgeons with differing practices regarding the age of Conclusions: The rate of VUR detection was significantly higher in patients
CAP discontinuation (CAP-DC). Our objective was to compare febrile with HUN compared to HN, and only in infants with HUN was VUR
(f) UTI rates between these two cohorts. We hypothesized that UTI rates detection correlated with an increased risk of febrile UTI. This study
would be similar for both cohorts, with the early CAP-DC group having would suggest that the clinical utility of VCUG was greater in those with
a more favourable antibiotic resistance profile. HUN compared to those with HN. Reviewing current guidelines could
Methods: We prospectively followed two cohorts of patients with primary prevent unnecessary testing, radiation exposure, and lead to costs savings.
VUR (0–18 years) from 2009–2018 (n=275): CAP-DC occurred at 12–18
months of age in cohort 1 and at toilet-training age (24–36 months) in MP-6.6
cohort 2. Age at and mode of presentation, gender, VUR and hydronephro-
sis (HN) grades, ureteral dilation, UTI and surgery rates, and followup time Bladder Bowel Dysfunction Scorings System (BBDSS): A new
were collected. Our primary outcome was development of fUTI post-CAP- questionnaire for evaluation of voiding dysfunction in children
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DC in both groups. We performed subgroup analyses to determine risk Amr Hodhod , Tuan Hoang , Mohamed El-Sherbiny , J.-P. Capolicchio ,
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factors for UTI post-CAP-DC in both cohorts. Statistical analyses consisted Roman Jednak
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of Chi-square for categorical data and t-tests for continuous variables. Pediatric Urology, McGill University Health Centre, Montréal, QC,
Results: Of 275 patients, 174 (63%) (cohort 1) stopped CAP at a mean age Canada
of 16 months interquartile range [IQR] 11) and 101 (37%) (cohort 2) at 27 Introduction: Most published questionnaires are long and time-consum-
months (IQR 25). Patient characteristics are shown in Table 1. The median ing, and constipation is evaluated by one or a few questions that may
ages at presentation were 10.4 (IQR 7) and 7 (IQR 16) months for cohort be considered vague for many parents. Poor information about a child’s
1 and 2, respectively. Followup was 40+26 months for cohort 1 vs. 54+34 bowel habits could lead to inappropriate management of the underlying
months for cohort 2 (p<0.01). There were more patients with dilating VUR problem. We evaluated the reliability and validity of a newly illustrated
(3–5) (152/174, 87%) in cohort 1 vs. cohort 2 (80/101, 79%) (p=0.05). questionnaire (Bladder Bowel Dysfunction Symptom Score [BBDSS) in
A total of 32 patients developed UTI post-CAP-DC (19/174 [11%] vs. the assessment of overactive bladder (OAB)/bladder bowel dysfunction
13/101 [13%]; p=0.63] and the mean time to the development of UTI (BBD) (Fig. 1).
post-CAP-DC was 7+8 months for cohort 1 vs. 14+20 months for cohort Methods: The BBDSS questionnaire consisted of 12 structured questions.
2 (p=0.19) (Table 2). Both groups had similar rates of VUR-correcting The questionnaire is designed with two groups of questions: one to evalu-
surgery (25% vs. 24% for cohort 1 and 2, respectively). ate the bladder symptoms and the other to assess the bowel dysfunction
Conclusions: Stopping CAP in VUR children at a median age of 16 (according to ROME criteria 4) during the last month. Every answer had a
months did not result in more UTIs when compared to the traditional specific score related to the condition severity. We prospectively collected
approach. By adopting such a strategy, duration of antibiotic exposure may untreated patients who were referred to our voiding dysfunction clinic for
be decreased without adversely increasing UTI rates. Discontinuation of the first time. A control group of healthy children was recruited to assess
CAP early may be more beneficial for males, as 75% of patients who had the reliability of the BBDSS. The provisional diagnosis was collected from
patients’ charts at the time presentation.
S124 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)