Page 4 - CUA2019 Abstracts - Pediatric Urology

2019 CUA Abstracts

two months (interquartile range [IQR] 1–4). According to initial (first clinic determined to be $51.97 per case, while the cost-effectiveness for those
visit) HSS, 5/36 (14%) patients with a 0–4 score, 93/116 (80%) with a managed by S was significantly higher at $1025.58 per case.
5–8 score, and 15/15 (100%) with a 9–12 score underwent pyeloplasty, Conclusions: Compared to U, many S submitted hernia sacs for pathology
respectively (p<0.01) (Table 1). When HSS cutoff values were changed to examination despite significant costs and predominantly non-significant
mild (0–3), moderate (4–6), and severe (7–12), the modified mild group findings with pediatric IHH repair. Hernia sac evaluation should, there-
was more representative of a true low-risk category, with no patients fore, be reserved for patients with a high clinical suspicion of injuries
requiring surgery, and the new severe group included 98% of patients or abnormalities.
who had pyeloplasty (Table 2). The modified risk categories allowed for
proper discrimination between patients who can be discharged, those who MP-6.12
require monitoring, and those who would undergo pyeloplasty (p<0.01)
(Fig. 1). A case-control study on the first reported successful use of
Conclusions: The new proposed HHS system for UPJO-like patients is magnetic stents in pediatric populations 2 1
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reproducible; however, cutoff values need to be reassessed to accu- Alec Mitchell , Stéphane J. Bolduc , Katherine Moore , Anthony J. Cook ,
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rately reflect true risk categories, as the purpose of this system is to dif- Carolina Fermin Risso , Bryce A. Weber
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ferentiate those who have UPJO severe enough to require intervention 2 Division of Urology, Alberta Children’s Hospital, Calgary, AB, Canada;
from those who can be managed conservatively. Changing risk groups Division of Urology, CHU de Québec-Université Laval, Québec City,
to mild (0–3), moderate (4–6), and severe (7–12) allowed for better dis- QC, Canada
crimination between patients who would undergo surgical intervention Introduction: Ureteral stents with magnetic tips were recently approved for
from those who no longer needed monitoring. use in Canada. To our knowledge, this is the first published evidence of their
This paper has figures, which may be viewed online at: use in pediatric patients. Traditionally, pediatric stent insertion and removal
https://2019.cua.events/webapp/lecture/163 are performed under general anesthetic (GA). However, there exists debate
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Reference as to the safety of using GA in pediatric populations. As well, operating
1. Babu R, Venkatachalapathy E, Sai V. Hydronephrosis severity score: room (OR) costs are continually rising; it’s been estimated at over $62/
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An objective assessment of hydronephrosis severity in children — a minute. Therefore, magnetic stents have three main benefits in pediatric
preliminary report. J Pediatr Urol 2019;15:68.e1-68.e6. https://doi. patients: reduced GA exposure, cost savings, and decreased OR time.
org/10.1016/j.jpurol.2018.09.020 Methods: This study was a proof of concept pilot, and ran from May
2017 to May 2018 to demonstrate the safety and efficacy of magnetic
stents in pediatric patients. Patients undergoing ureteroscopy, ureteric
MP-6.11 re-implantation, and pyeloplasty with simultaneous magnetic stent inser-
Healthcare resource utilization: Cost associated with the tion were included. Forty patients had regular double J stents removed
variability among Canadian pediatric urologists and pediatric under anesthesia and served as control cases. Forty patients had magnetic
surgeons in the rate of hernia sac submission for pathology double J stents at initial surgery at two different sites, CHU de Québec
examination and Alberta Children’s Hospital.
Min Joon Lee , Jin K. Kim , Martha Pokarowski , Patricia Mitton , Results: Overall, 39 magnetic stents were successfully retrieved with-
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Andreea Popescu , Amre Kesavan , Mitchell Shiff , Catherine Chung , out general anesthetic, representing a retrieval failure rate of only 2.5%.
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Jacob Langer , Joseph Milner , Armando J. Lorenzo , Martin A. Koyle 1 Additionally, the rate of complications between the control group and
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1 Department of Urology, Hospital for Sick Children, Toronto, ON, Canada; the treatment group was not statistically different. Lastly, as seen in the
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2 Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Rotman control group, each retrieval took 30 minutes of OR time, which is saved
School of Management, University of Toronto, Toronto, ON, Canada; in magnetic retrieval.
4 Department of Pathology, Hospital for Sick Children, Toronto, ON, Canada; Conclusions: This study represents the first report of successful use of
5 Department of Surgery, Hospital for Sick Children, Toronto, ON, Canada magnetic stents in pediatric patients. Thirty-nine of our 40 patients were
Introduction: Inguinal hernia and hydrocele (IHH) are among the most able to avoid OR time, translating to 2.5 days of freed-up OR. Additionally,
common pediatric conditions that are surgically managed by both pedi- as the cost of OR time has been estimated at $62/minute, this means over
atric urologists (U) and pediatric surgeons (S). Despite extensive studies $1800 is saved per stent removal. Lastly, as the developmental effects of
on surgical approaches and outcomes, little is known about how U and GA are not fully understood, additional exposure is avoided.
S approach healthcare resource utilization when treating pediatric IHH. References
Here, we assessed the variability in the rate of submission of hernia sacs 1. Mellon RD, Simone AF, Rappaport BA. Use of anesthetic agents
for pathological evaluation among U and S following IHH repair at a in neonates and young children. Anesth Analg 2007;104:509-20.
tertiary pediatric referral centre. The value of routine hernia sac examina- https://doi.org/10.1213/01.ane.0000255729.96438.b0
tion was evaluated using a cost-effectiveness analysis for each physician 2. Dimaggio C, Sun LS, Kakavouli A, et al. A retrospective cohort
group practice to optimize the use of medical resources. study of the association of anesthesia and hernia repair surgery
Methods: A retrospective chart review was performed for patients who with behavioural and developmental disorders in young children.
underwent unilateral or bilateral inguinal hernia (IH) and/or hydrocele (H) J Neurosurg Anesthesiol 2009;21:286-91. https://doi.org/10.1097/
repair at the Hospital for Sick Children, Toronto, Canada, between January ANA.0b013e3181a71f11
2015 and January 2018. Descriptive statistical analysis was performed for 3. Chang RS, Liang HL, Huang JS, et al. Fluoroscopic guidance of ret-
all the variables collected for the study. Multiple linear regressions were rograde exchange of ureteral stents in women. AJR Am J Roentgenol
performed to evaluate the factors associated with hernia sac submissions 2008;190:1665-70. https://doi.org/10.2214/AJR.07.3216
and abnormal findings.
Results: A total of 1074 IH patients were identified, from which 922 MP-6.13
(86%) and 152 (14%) were managed by S and U, respectively. Younger
patients (p<0.001) and more females (p=0.005) were seen by S than Bowel bladder dysfunction: Should primary care providers be
U. A total of 157 H patients were identified, from which 95 (61%) and doing more? 1 2 2
62 (39%) were managed by S and U, respectively. A greater number of Jonathan V. Riddell , Melanie P. Fortin , Lawrence J. Becht , John F.
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patients operated by S (n=441) underwent hernia sac analysis than those Buczek , Ranya A. Hamdan , Matthew D. Mason
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by U (n=5) (p<0.001). Of 531 specimens evaluated, 97% were normal. Pediatric Urology, SUNY - Upstate Medical University, Syracuse, NY,
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No malignancy was detected, and other findings did not change clinical United States; Physician Assistant Program, LeMoyne College, Syracuse,
management. The total direct cost of analyzing specimens during the NY, United States
study period was approximately $30 798 CAD, an average cost of $10 Introduction: Bowel-bladder dysfunction (BBD) accounts for up to 40%
266 CAD annually. The cost-effectiveness for patients managed by U was of referrals to pediatric urology; however, this entity can be reasonably
S126 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)