Page 3 - CUA2019 Abstracts - Pediatric Urology

Poster session 6: Pediatrics

Results: The questionnaire was administrated by 92 children (44 in the MP-6.8
diseased group and 48 in the control group). The age at presentation was Nephrolith-nothing: Clearing-up the ‘possible kidney stone’
similar in both groups (117 months). The mean total score for the dis- conundrum on abdominal ultrasounds in pediatric patients
eased group was 8.7 (3–14) while it was 1.19 (0–5) for the control group Kristen McAlpine 1,2,3 , Raees Cassim , Khaldoun Koujok , Luke T.
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(p<0.001). There was a strong correlation between the total BBDSS score Lavallée 1,3,5 , Carl van Walraven 3,5,6 , Michael Leonard , Luis Guerra ,
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and both groups (r=0.88; p<0.001). Using the ROC curve, the BBDSS Melise Keays 2,3
showed to be an excellent tool in differentiating normal and diseased 1 Division of Urology, The Ottawa Hospital, Ottawa, ON, Canada;
patients (area under the curve [AUC] 0.98; p<0.001) (Fig. 2a). When total 2 Division of Urology, Children’s Hospital of Eastern Ontario, Ottawa,
BBDSS was ≥6, the positive predictive value was 1, while the negative ON, Canada; University of Ottawa, Ottawa, ON, Canada; Department
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predictive value was 0.89. The defecation part of the BBDSS was a good of Diagnostic Imaging, Children’s Hospital of Eastern Ontario, Ottawa,
tool in differentiating OAB from BBD patients (AUC 0.89; p<0.001) (Fig. ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada;
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2b). No patient with OAB had a bowel score >3. 6 Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
Conclusions: The BBDSS is a reliable and valid instrument in BBD/OAB Introduction: Ultrasound (US) is the primary imaging modality to detect
diagnosis. The questionnaire was easily administrated by parents or chil- urolithiasis in children. Small calcifications on US that lack posterior
dren. Moreover, it can differentiate between OAB and BBD. shadowing or twinkling artifact are frequently reported as ‘possible
This paper has figures, which may be viewed online at: stones.’ Little is known regarding the clinical significance of this imaging
https://2019.cua.events/webapp/lecture/160 finding. We sought to determine the radiologic and clinical outcomes of
patients with an US reporting a possible stone to guide future practice.
MP-6.7 Methods: Transcribed radiology reports for all patients at our pediat-
Identifying systems delays in the assessment, diagnosis, and ric tertiary care centre receiving an abdominal US between 2011 and
operative management of testicular torsion at a Canadian 2016 were searched using key terms for kidney stones. Identified stud-
tertiary care centre ies were manually reviewed and studies where a radiologist expressed
Ernest Chan , Zhan Tao (Peter) Wang , Frank Myslik , Hanny Chen , uncertainty regarding the diagnosis of kidney stones were included in
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Sumit Dave 1,2,4 this study. Images of possible stones were reviewed to obtain character-
1 Department of Surgery, Division of Urology, Schulich School of Medicine istics, including size, location, presence of shadowing, or twinkle artifact.
& Dentistry, London, ON, Canada; Department of Surgery, Division of Demographic and clinical information was collected for each patient.
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Paediatric Surgery, Schulich School of Medicine & Dentistry, London, Followup imaging reports and clinical information were reviewed to
ON, Canada; Department of Medicine, Division of Emergency Medicine, determine outcome.
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Schulich School of Medicine & Dentistry, London, ON, Canada; Results: Of 51 518 abdominal US performed during the study period, 124
4 Department of Pediatrics, Schulich School of Medicine & Dentistry, reports were flagged for possible sto nes (0.2%). Inclusion criteria were met
London, ON, Canada; Schulich School of Medicine & Dentistry, London, by 98 reports representing 93 patients. Mean size of possible stones was
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ON, Canada 3 mm. Mean and median patient age were 2 and 5.8 years, respec-
Introduction: Testicular torsion (TT) is a common pediatric urological tively. Followup imaging was available for 85% of patients. Resolution
emergency. Management of TT is time-sensitive, and often confirmed of the possible calculus was seen in 61% by an average of 13 months.
on Doppler ultrasound (DUS). Acquiring DUS, however, can result in Twenty-two patients (24%) had followup US with persistent possible
delays in the management of TT, affecting testicular salvage rates. The stones. Most patients had seen a urologist and/or nephrologist (77%).
objective of this study was to identify delays in the assessment and diag- None required intervention.
nosis for patients presenting with TT to a Canadian academic hospital Conclusions: In our series, radiologists commented on a possible kidney
using patient flow analysis. stone in 1/500 abdominal US. More than half of the possible stones
Methods: A retrospective review was performed for patients presenting to resolved, indicating stone passage or resolution of an insignificant finding.
our emergency department (ED) who received a scrotal DUS to rule out Given the high rate of persistence on US, we suggest a one-year followup
possible TT from 2012–2017. Our primary outcome measured cycle-time US for possible stones.
measurements (median time) between different points along the clinical
flow pathway for a patient with suspected TT. The secondary outcome MP-6.9
assessed diagnostic sensitivity and specificity, as well as positive (PPV) Validation of hydronephrosis severity score in a larger prospective
and negative predictive values of standard scrotal DUS. database
Results: A total of 609 patients presented with an acute scrotum war- Smruthi Ramesh , Melissa McGrath , Kornelia Palczek , Catherine Lovatt ,
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ranting DUS to rule out TT, of which 46 underwent scrotal exploration. Luis H. Braga 1,2
Testicular salvage rate was 82.6% (38 testes were salvaged, eight under- 1 Surgery, McMaster University, Hamilton, ON, Canada; Surgery,
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went orchiectomy). Median time from onset of symptoms to presentation McMaster Children’s Hospital, Hamilton, ON, Canada
to the ED for patients with possible TT was four hours. Following triage, Introduction: The hydronephrosis severity score (HSS), which relies on
a median of 79.8 minutes was required for emergency physician assess- Society for Fetal Urology (SFU) hydronephrosis (HN) grades, differential
ment and an additional 48 minutes for DUS to be performed. Absence renal function (DRF), and drainage curve patterns, was previously described
of Doppler flow on scrotal DUS had a 97.4% PPV for diagnosing TT to assess the severity of ureteropelvic junction obstruction (UPJO)-like cases
confirmed during scrotal exploration. and the likelihood of surgical intervention. Herein, we sought to validate
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Conclusions: Patient flow delays to surgical intervention for patients with this scoring system in our prenatal hydronephrosis (PHN) population with
TT represents a preventable cause of orchiectomy in young men. This UPJO-like cases, specifically looking at identifying better cutoffs to predict
study identifies intervention points in patient care flow pathways where which patients would be more likely to undergo pyeloplasty.
delays to surgical intervention can be up to two hours. This represents Methods: A prospectively collected PHN database was reviewed to
an opportunity for use of point-of-care ultrasound (POCUS), a previously extract UPJO-like patients. Children with vesicoureteral reflux (VUR),
validated tool that can aid in the earlier diagnosis of TT. Our findings primary megaureter, bilateral HN, and other associated anomalies were
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support the need for further investigation of POCUS to replace DUS to excluded. Only patients who had ultrasound and MAG-3 renal scan at
expedite the diagnosis of TT. a minimum of two time points were included. HSS was calculated at
Reference the initial, interim, and last followup clinic visits. Scores were analyzed
1. Yagil Y, Naroditsky I, Milhem J, et al. Role of Doppler ultraso- regarding its usefulness to predict which patients would be more likely
nography in the triage of acute scrotum in the emergency depart- to undergo pyeloplasty.
ment. J Ultrasound Med 2010;29:11-21. https://doi.org/10.7863/ Results: Of 167 patients, 131(78%) were male, 119 (71%) had left UPJO-
jum.2010.29.1.11 like, and 113 (67%) had a pyeloplasty. The median age at baseline was
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S125