Page 6 - CUA2019 Abstracts - Pediatric Urology

2019 CUA Abstracts

taking a biopsy is an invasive process for patients, which could result UP-6.3
in comorbidities. To circumvent these issues, induced pluripotent stem Can the urinary tract dilation classification system be more
(iPS) cells could be an alternative cell source. iPS cells are differenti- helpful than the Society of Fetal Ultrasound system for
ated somatic cells reprogrammed to acquire embryonic stem cell-like vesicoureteral reflux patients?
properties. The iPS cells can be indefinitely expanded, providing large Amr Hodhod , J.-P. Capolicchio , Roman Jednak , Mohamed El-Sherbiny 1
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amounts of cells able to differentiate into all lineages needed for tissue- 1 Pediatric Urology, McGill University Health Centre, Montréal, QC,
engineered constructs. Canada
Methods: Reprogrammed iPS obtained either from urine, blood, or skin Introduction: The urinary tract dilation (UTD) classification system was
samples, were treated for five days by a mixture in order to obtain defini- introduced in 2014 to categorize congenital hydronephrosis regarding the
tive endoderm (DE) cells. The expression of markers of DE cells (Sox17 risk of developing complications like febrile urinary tract infection (fUTI)
and FoxA2) was verified. Double-positive cells were then treated for six or surgery. In the current study, we tried to evaluate the ability of the UTD
days with another mixture or with UC-conditioned medium (UCM) to system to categorize vesicoureteral reflux (VUR) according to the risk of
induce the cells into UC progenitors. Expression and localization of K8/18 developing fUTI or undergoing surgical interventions.
were then checked using 2D cultures. Reconstruction of 3D models was Methods: We retrospectively reviewed patients’ charts who had antenatal
done to assess the potential of the induced cells. hydronephrosis from 2008–2016. Only patients who were diagnosed with
Results: The Activin A/Wortmanin mix for five days provided the best VUR were recruited. We collected patients’ characteristics. Moreover, the
results to obtain DE cells. The cells treated with UCM showed high simi- grade of VUR, followup period, fUTI occurrence, and surgical interven-
larity with the original UC culture and presented a high degree of dif- tions were collected. We graded hydronephrosis using both the Society
ferentiation on 3D models. The origin of the iPS did not impact the final for Fetal Urology (SFU) and UTD grading systems. Thereafter, we com-
result, but a larger number of cells were obtained when extracted from pared the ability of both grading systems to categorize VUR regarding the
blood samples. occurrence of fUTI or surgical interventions (clinically significant VUR).
Conclusions: The iPS cells could be used to reconstruct human-derived Results: We recruited 64 patients with 89 refluxing renal units.
3D urological tissues by tissue engineering. Further studies, e.g., graft on Patient demographics are presented in Table 1. Notably, 70.8% (63/89)
animals, are needed to confirm the safety of the technique. of VURs were categorized as UTD P2 or P3 in comparison with 34.8%
(31/89) that were considered as SFU grade 3 or 4 (p<0.001). Of total
UP-6.2 included VURs, 35/89 (39.3%) units had high-grade VUR (HG-VUR).
A tailored surgical approach to the palpable undescended testis Nineteen HG-VURs (54.3%) were considered as SFU grade 3 or 4, while
Amos Neheman , Max Levitt , Zvi Steiner 3 32 HG-VURs (91.4%) were considered UTD P2 or P3 (p<0.001). During
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1 Department of Urology, Division of Pediatric Urology, Assaf Harofeh a median followup of 42.9 months, 29 patients with 44 VUR units devel-
Medical Center, Tzrifin, Israel; Division of Urology, University of Ottawa, oped fUTI. Of these units, 39/44 units (88.6%) were graded as UTD P2
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Ottawa, ON, Canada; Department of Urology, Meir Medical Centre, or P3, while only 18/44 VURs (40.9%) were graded as SFU grade 3 or 4
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Kefar Saba, Israel. (p<0.001) (Table 2). Regarding surgical interventions (23 VURs), 95.7%
Introduction: Orchiopexy for a palpable undescended testis can were either P2 or P3, while only 13/23 (56.5%) VURs were either SFU
be approached through a traditional inguinal incision or trans-scro- grade 3 or 4 (p=0.002) (Table 2). Of surgically managed VURs, 20 units
tally. Despite the possible advantages of the scrotal approach, includ- had surgical interventions due to recurrent fUTI while three units were
ing reduced postoperative pain and shorter recovery, it is not consistently operated due to worsening hydronephrosis.
advocated. The objective of this study was to present the experience with Conclusions: The UTD system was able to classify more than 90% of
a tailored approach to orchiopexy based on physical findings. HG-VUR as moderate or high-risk hydronephrosis (P2 or P3). Moreover,
Methods: The mobility of the testis as described at examination under either UTD P 2 or 3 were the hydronephrosis grade for 88.6% of VURs
anesthesia informs the choice of surgical approach. If a ‘low’ palpa- that experienced fUTI and 95.7% that underwent surgical interventions.
ble testis (defined as the testis that can be manipulated to the scrotum) This paper has figures, which may be viewed online at:
was found, a scrotal approach was used. In cases of ‘high’ palpable testis https://2019.cua.events/webapp/lecture/171
(the testis that cannot be manipulated to scrotum), the inguinal approach
was used. Success was defined by location and size of the testis three UP-6.4
months after surgery. How far are they coming from?
Results: A total of 259 orchiopexies were performed in 181 boys (78 Samuel Otis-Chapados , Karolane Coderre , Stéphane J. Bolduc ,
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bilateral). Scrotal approach was used in 125 (48%) and inguinal in 134 Katherine Moore 1
(52%) orchiopexies. Operative time was significantly shorter for the 1 Urology, CHU de Québec - Université Laval, Québec City, QC, Canada
scrotal approach, 25 minutes vs. 40 minutes for inguinal orchiopexy Introduction: In the province of Québec, eight pediatric urologists prac-
(p<0.05). The overall success rate was 98% with no statistical difference tice in three tertiary centres. Each centre covers a large territory. As part of
between the groups. Three children from the inguinal group and two an effort to improve the availability of pediatric urology to distant families
from the scrotal group required an additional procedure for persistent and reduce the economic burden on those families, we examined the
undescended testis. The rates of testicular atrophy and hypotrophic testis chart of all patients attending the pediatric urological outpatient clinic in
were higher in the inguinal group than the scrotal group (5/134 vs. 0/125; a one-year period. Our objectives were to evaluate the distance travelled
p<0.05 and 17/134 vs. 6/126; p<0.05, respectively). by each pediatric patient visiting the outpatient urology clinic and to
Conclusions: This tailored approach to a palpable undescended testis report the most frequent urological referral complains.
appears simple, safe, and effective, providing high success rate with mar- Methods: From July 2016 to June 2017, we retrospectively reviewed the
ginal complications. It is considered a preference in cases of low unde- charts of all the 3609 pediatric patients seen in the outpatient urologi-
scended testis, whereas the standard two-incision inguinal orchiopexy cal clinic in CHU de Québec. We specifically focused on the travelling
may better serve those with high undescended testis. distance covered by families and the purpose of referral.
Results: Most patients were boys (78%) and the mean age was 7.2
years. The average one-way distance traveled by each family was 69 km.
The patients came more frequently from Capitale-Nationale (64%) and
Chaudière-Appalaches (22%), the closest regions. In smaller proportions,
124 patients (3,46%) came from Saguenay-Lac-St-Jean and about 200 chil-
dren came from either Bas-St-Laurent-Gaspésie (3,67%) or Mauricie (3%).
The most common reasons for consultations were postoperative followups
(15%), phimosis and adherence (14%), enuresia (14%), hydronephrosis
S128 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)