Page 19 - CUA 2020_Pediatric

2020 CUA Abstracts

46. MAUDE Adverse Event Report # 3005099803-2018-01870: 78% and high bladder pressures (dLPP >30 mmH O) was the most com-
2
Boston Scientific - Spencer Lithovue single-use digital flexible mon indication for surgery at 56%. Mean preoperative creatinine was 54
ureteroscope and accessories, Flexible/Rigid. (2018) Available umol/L. Mean short-term postoperative creatinine was 55 umol/L (p=0.66)
at: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/ and mean medium-term postoperative creatinine was 52 umol/L (p=0.64),
Detail.CFM?MDRFOI__ID=7592382&pc=FG B. Accessed April neither of which were statistically significantly elevated from preoperative
27, 2020. creatinine. The portion of patients with hydronephrosis, recurrent UTIs,
47. MAUDE Adverse Event Report # 3005099803-2016-03209: Boston and incontinence all decreased postoperatively. The portion of patients
Scientific - Spencer Lithovue single-use digital flexible uretero- of bladder stones increased postoperatively.
scope and accessories, Flexible/Rigid. (2016). Available at: https:// Conclusions: Ileovesicostomy is an effective tool in the pediatric surgical
www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail. armamentarium in preserving renal function. It is safe procedure and can
CFM?MDRFOI__ID=6047459&pc=FG B. Accessed April 27, 2020. have excellent short- and medium-term urological outcomes.
48. MAUDE Adverse Event Report # 3005099803-2016-01244: Boston
Scientific - Spencer Lithovue single-use digital flexible uretero- MP-12.12
scope and accessories, Flexible/Rigid. (2016). Available at: https://
www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/Detail. A consecutive, single-center, retrospective series of one-stage,
CFM?MDRFOI__ID=5628325&pc=FG B. Accessed April 27, 2020. vessel-preserving laparoscopic orchidopexies: Postoperative
49. Martin C, et al. The economic implications of a reusable flexible testicular atrophy rates and position 1,2
1,2
1
digital ureteroscope: A cost-benefit analysis. J Urol 2017;197:730-5. Adam Forster , Zhan Tao (Peter) Wang , Sumit Dave 2
1
https://doi.org/10.1016/j.juro.2016.09.085 Urology, Western University, London, ON, Canada; Pediatrics, Western
50. Hennessey DB, et al. Single-use disposable digital flexible ure- University, London, ON, Canada
teroscopes: An ex vivo assessment and cost analysis. BJU Int Introduction: Single-stage laparoscopic orchidopexy (SSO) and Fowler-
2018;121:55-61. https://doi.org/10.1111/bju.14235 Stephens orchidopexy (FSO) are accepted standards of care for the treat-
1
51. Taguchi K, et al. Micro-costing analysis demonstrates comparable ment of impalpable undescended testis (IUDT). There is paucity of data to
2
costs for LithoVue compared to reusable flexible fiberoptic ure- suggest superiority of one approach. No defined intraoperative variables
3
teroscopes. J Endourol 2018;32:267-73. https://doi.org/10.1089/ that favor proceeding with one approach exist. In this retrospective, con-
end.2017.0523 secutive case series, we present our results of SSO in patients with IUDT,
52. Ozimek T, et al. Retrospective cost analysis of a single-center reus- regardless of location, treated at a single institution by one surgeon over
able flexible ureterorenoscopy program: A comparative cost simula- a 10-year period.
tion of disposable fURS as an alternative. J Endourol 2017; 31:1226- Methods: Boys with IUDT underwent SSO from 2008–2018. SSO was
30. https://doi.org/10.1089/end.2017.0427 performed by testicular vessel mobilization and translocation to the scro-
53. Geavlete P. Ureteroscopy complications, in Smith’s Textbook of tum medial to the medial umbilical ligament. The peritoneal reflection
Endourology, Third Edition, G.H.B. Arthur D. Smith, Glenn M. between the gonadal vessels and vas was divided after mobilization to
Preminger, Louis R. Kavoussi., Editor. 2012, Blackwell Publishing allow for extra mobility. Outcomes assessed included testicular atrophy
Ltd. https://doi.org/10.1002/9781444345148.ch47 defined as lack of Doppler flow on scrotal ultrasound and postoperative
54. Binbay M, et al. Is there a difference in outcomes between digital testicular location defined by examination at least six months postop-
and fiberoptic flexible ureterorenoscopy procedures? J Endourol eratively. Descriptive statistics summarize demographic variables and
2010;24:1929-34. https://doi.org/10.1089/end.2010.0211 postoperative outcomes.
55. Somani BK, et al. Outcomes of flexible ureterorenoscopy and laser Results: Thirty-seven boys underwent surgery for IUDT (mean age
fragmentation for renal stones: comparison between digital and 2.58±1.72 years) with 47 SSO procedures. Mean followup dura-
conventional ureteroscope. Urology 2013;82:1017-9. https://doi. tion was 2.89±2.32 years. Forty-six of 47 (97.8%) SSO testes showed
org/10.1016/j.urology.2013.07.017 Doppler flow and were palpable on followup six months post SSO, con-
56. Legemate JD, et al. Durability of flexible ureteroscopes: A prospec- firming lack of testicular atrophy. Forty-five of 47 (95.4%) were palpable
tive evaluation of longevity, the factors that affect it, and dam- in the scrotum; two were located outside the scrotum at the level of the
age mechanisms. Eur Urol Focus, 2019;5:1105-11. https://doi. pubic tubercle.
org/10.1016/j.euf.2018.03.001 Conclusions: In this series, we demonstrate that a majority of boys with
IUDT can undergo SSO without FSO; our data demonstrate a low atro-
phy rate (2.2%) and minority of extra-scrotal testes in SSO (4.6%). A
MP-12.11 limitation of our study design is that variables predictive of achieving an
Surgical outcomes in patients undergoing ileovesicostomy in ideal scrotal location in SSO could not be elucidated. These hypothesis-
Edmonton over the past 12 years generating findings indicate a need for prospective studies to investigate
Steven Tong , David W. Chapman , Peter D. Metcalfe 1 the intraoperative indications for SSO vs. FSO.
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1 Urology, University of Alberta, Edmonton, AB, Canada References
Introduction: Children born with spina bifida and other congenital abnor- 1. Braga LH, Lorenzo AJ, Romao RL. Canadian Urological Association-
malities are suspect to significant urological complications, such as Pediatric Urologists of Canada (CUA-PUC) guideline for the diagno-
kidney injury, recurrent urinary tract infection (UTI), and incontinence. sis, management, and followup of cryptorchidism. Can Urol Assoc J
Management of these patients is challenging, and surgical diversion 2017;11:E251-60. https://doi.org/10.5489/cuaj.4585
offers a possible solution. Our objective was to assess overall short- and 2. Esposito C, Vallone G, Savanelli A, et al. Long-term outcome of
medium-term outcomes of an incontinent ileovesicostomy in this complex laparoscopic Fowler-Stephens orchiopexy in boys with intra-
pediatric and adult patient population. abdominal testis. J Urol 2009;181:1851-6. https://doi.org/10.1016/j.
Methods: We reviewed postoperative outcomes of all patients who under- juro.2008.12.003
went an ileovesicostomy from 2006–2018. The primary outcome was 3. Penson D, Krishnaswami S, Jules A, et al. Effectiveness of hormonal
preservation of kidney function based on pre- and postoperative creati- and surgical therapies for cryptorchidism: A systematic review.
nine. The change in creatinine was evaluated with repeated-measures Pediatrics 2013;131:e1897-907. https://doi.org/10.1542/peds.2013-
ANOVA. Secondary outcomes included change in hydronephrosis, recur- 0072
rent UTIs, incontinence, and development of bladder stones.
Results: A total of 18 patients underwent an ileovesicostomy through the
specified time frame by a single surgeon. The median age at surgery was
18 (range 8–42) and the median duration of followup was 27 months
(range 0–80). Spina bifida was the most common underlying diagnosis at
S156 CUAJ • June 2020 • Volume 14, Issue 6(Suppl2)