Page 5 - CUA2019 Abstracts - Pediatric Urology

Poster session 6: Pediatrics

diagnosed and treated at the primary care level. While BBD has been minutes (53–77) (p< 0.0001). The CR in phase 1 was significantly higher
recently defined in the literature, research and education at the primary than in phase 2 (27.5% vs; 11.4%; p<0.0001). Seemingly, there was no
care level are sparse. The purpose of this study is to assess the nature of correlation between the OT and CR in phase 2. Hence, decreasing OT
BBD referrals to pediatric urologists and determine what proportion of had no impact on the outcome.
these referrals could be appropriately dealt with at the primary care level. Conclusions: Despite a standardized approach by a single surgeon, com-
Methods: Retrospective review of all new referrals to a tertiary care urol- plications after TIP repair do occur. In this study, the lowest achievable
ogy practice was conducted from January 1, 2018 to June 30, 2018. All complication rate after distal hypospadias repair, after the learning curve
cases of BBD in children aged 4–12 years were identified on the basis of had been achieved, was 11.4%. It is evident that as surgeon experiences
ICD-10 code K59.04 after history, physical exam, and Vancouver ques- increases, OT decreases, but in our hands, complications continue and
tionnaire. Primary outcome variables included: 1) overt identification of are not as low as reported.
BBD at time of referral; 2) pre-referral initiation of bowel treatment; and This paper has a figure, which may be viewed online at:
3) the need for specialty intervention. Other data included the referral https://2019.cua.events/webapp/lecture/168
provider type, setting, and diagnosis, as well as the presence of essential
BBD evaluation criteria in the referring provider’s note (see essential ele- MP-6.15
ments, Table 1).
Results: A total of 190 patients met our criteria (Fig. 1), none of whom 1000 hypospadias repairs: Have we been overlooking important
were identified at the time of referral as having BBD; 77% had not extrinsic risk factors? 1 1 1
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received any form of bowel treatment, and only 7% required specialist Fadi Zu’bi , Michael Chua , Mitchell Shiff , Mandy Rickard , Ali El
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intervention. Referral provider type and setting were not predictive of the 1 Ghazzaoui , Anne Sophie Blais , Walid Farhat
pre-referral initiation of bowel treatment or the need for specialist inter- Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada
vention (Table 2). Thoroughness of the pre-referral evaluation was the only Introduction: Hypospadias repair is considered the trademark of pedi-
factor that predicted the initiation of bowel treatment (p<0.001). The odds atric urology, however, there continues to be controversy surrounding
of receiving bowel treatment increased by 3.2X and 8.7X, respectively, techniques and causes of complications. Extrinsic risk factors, including
when three or four of the essential evaluation criteria were met. In terms of surgeons’ experience, trainee factors (early vs. late in academic year),
specialty intervention, 11 patients required voiding cystourethrogram and and even time of day (early vs. late or fatigue factor) that could impact
two meatotomy. For specialty intervention, the only predictive factor was outcomes are less clear. Herein, we examine the impact of these potential
referral diagnosis; a non-voiding dysfunction diagnosis was 35X more extrinsic risk factors on the outcome of hypospadias.
likely to require specialist intervention (p<0.001), and dysuria 7X more Methods: We reviewed our single-surgeon cohort of children undergoing
likely (p=0.01) than a voiding dysfunction diagnosis. primary hypospadias repair from 2001–2017. The following variables were
Conclusions: In addition to the high prevalence of BBD in referrals to extracted: age, severity, curvature, surgical technique, type of sutures, aca-
pediatric urologists, there appears to be a lack of association between demic period, time of day (AM vs. PM), use of skin glue, type of regional
urinary symptoms and constipation, the cornerstone of the BBD diagnosis. block, type of urethral stent, and postoperative outcomes. Complications
While a thorough pre-referral evaluation can result in constipation treat- were defined as any outcome necessitating a surgical reintervention.
ment, this is likely system-based rather than recognition of underlying Patients were divided into five equal clusters in a chronological manner.
cause and effect. The vast majority (>90%) of BBD patients do not require We performed univariate analysis, and multivariate logistic regression was
specialized care. These conclusions necessitate more comprehensive BBD done for the significant variables noted on univariate analysis.
education for primary care providers. Results: A total of 1021 children underwent primary hypospadias repair;
This paper has figures, which may be viewed online at: we excluded 69 who were lost to followup. Age at surgery was 12 months
https://2019.cua.events/webapp/lecture/167 (interquartile range [IQR] 9.0–19), and followup was 20 months (IQR
3–48). Patient characteristics are summarized in Table 1. Multivariable
analysis showed that hypospadias severity and the presence of curvature
MP-6.14 were the only factors associated with re-operation. Re-operation rate was
Tubularized incised plate repair complications: How low can not different among children who underwent hypospadias repair at the
we go? start vs. end of the academic year, nor whether it occurred in the AM vs.
Fadi Zu’bi , Michael Chua , Mitchell Shiff , Ali El Ghazzaoui , Mandy PM cases (Table 2).
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Rickard , Anne Sophie Blais , Walid Farhat 1 Conclusions: Our data suggest that despite inevitable practice changes,
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1 Division of Urology, The Hospital for Sick Children, Toronto, ON, Canada hypospadias severity and the presence of curvature are the only indepen-
Introduction: Hypospadias complications has been a heavily published dent predictive factors for reoperation, which is in keeping with previous
topic, resulting in many well-known contributing classic risk factors. A studies. In our series, the evolution of surgical technique had no impact
seemingly obvious contributing factor would be the experience of the on outcomes, nor did trainee and fatigue factors.
surgeon, hypothesizing that more complications occur with less surgeries This paper has figures, which may be viewed online at:
performed. Herein, we review the experience of a single surgeon with https://2019.cua.events/webapp/lecture/169
distal tubularized incised plate (TIP) repairs in an academic institution.
Our objective was to determine the number of cases, operative time (OT), UP-6.1
and complications, and identify the lowest achievable complication rate
(CR), hypothesizing that complication rates and duration of cases would Induced pluripotent stem cells as an alternative source of
be lower with higher volumes. epithelial and mesenchymal cells for reconstruction of urological
Methods: We reviewed all distal TIP repairs of a single surgeon from tissues by tissue engineering 1 1
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2001–2017. Collected data included: age, meatal location, OT, develop- Christophe Caneparo , Stéphane Chabaud , Geneviève Bernard ,
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ment of complications, and followup duration. A cumulative sum control Stéphane J. Bolduc
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chart was used to determine trends in the CR and OT over the study Surgery, CHU de Québec-Université Laval Research Centre, Québec
period. In order to account for surgical experience with time, the highest City, QC, Canada
peak in both OT and CR was identified on the plot and was set as the CUA-Astellas Research Grant
transition point between learning phase (1) and experienced phase (2). Introduction: To reduce complications resulting from enterocystoplasties,
Results: During the study period, 571 children underwent distal TIP we generated a bladder mucosa model where bladder fibroblasts secrete
repairs. Patient characteristics are summarized in Table 1. The peak for and assemble their own scaffold. The uroepithelial cells (UC) seeded
OT and CR was at the 239th and 273rd cases, respectively (Fig. 1). The on this construct differentiate appropriately, creating a barrier function.
median OT in phase 1 was 74 minutes (interquartile range [IQR] 61–88), Nevertheless, we used cells from healthy patients while tissue-specific
which was significantly higher than phase 2, where the median OT was 62 primary cells may be absent or diseased in some patients. Moreover,
CUAJ • June 2019 • Volume 13, Issue 6(Suppl5) S127