Page 20 - CUA 2020_Pediatric

Moderated Posters 12: Pediatric Urology

MP-12.13 MP-12.14
Randomized controlled trial of scrotal vs. inguinal orchidopexy Demystifying the diagnosis and treatment of vaginal yolk sac
on postoperative pain: The EXPRESSO trial tumors in children: A comprehensive review of 127 cases
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Melissa Mcgrath 1,2,3 , John Kim , Luis H. Braga 1,2,3 Bruce Li , Adib Shamsuddin , Catherine Anne Lovatt , Luis H. Braga 1,2,3
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1 Department of Surgery, Pediatric Urology, McMaster University, Hamilton, 1 Michael G. DeGroote School of Medicine, McMaster University, Hamilton,
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2
ON, Canada; McMaster Pediatric Surgery Research Collaborative, ON, Canada; Division of Urology, McMaster University, Hamilton, ON,
McMaster University, Hamilton, ON, Canada; Clinical Urology Research Canada; McMaster Pediatric Surgical Research Collaborative, McMaster
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3
Enterprise (CURE), McMaster University, Hamilton, ON, Canada University, Hamilton, ON, Canada
Introduction: We aimed to compare the impact of orchidopexy approach Support: McMaster Surgical Associates Grant. McMaster Children’s
(scrotal [SO] vs. inguinal [IO]) on analgesic requirements, postoperative Hospital Foundation
(PO) pain, and complication rates. Introduction: Vaginal yolk sac tumors (vYSTs) are rare malignant germ
Methods: A superiority randomized control trial (RCT) including boys cell tumors of infancy. While current literature is comprised of several
10–95 months of age at sx, diagnosed with palpable undescended testicles
(UDT) was conducted. Patients with non-palpable or bilateral previous
orchidopexies and concurrent procedures were excluded. Block random- MP-12.14. Table 1. Summary of vaginal yolk sac tumors in
ization with 1:1 allocation ratio was employed, as was standardized anes- published literature
thesia protocol with peri/postoperative analgesia. The primary outcome Characteristics
was PO pain and analgesic use in hospital and at home using validated
pain scales (FLACC, CHEOPS, PPPM, TPPPS). FLACC and CHEOPS were Total number of cases reported 127
used by two independent nurses to assess pain in the PACU and SDSU. Presentation
TPPPS and PPPM were used by parents to assess pain at home within the
first 24 hours postoperatively. Secondary outcomes included operative Age of presentation (months)
time (OpT), conversion and success rates, and complications at 6–8- Mean 12.34
weeks. An intention-to-treat protocol (ITT)was followed. Standard deviation 6.38
Results: Of 1093 patients, 173 (15.8%) were considered eligible and
enrolled, with 14 patients withdrawing or being lost to followup. Of Presenting complaint,¹ n (%)
the159 patients who completed follow up, 81 had IO and 78 had SO (Fig. Vaginal bleeding 121 (95.2)
1). No significant difference in mean operative time, pain score imme- Passage of tissue 3 (1.6)
diately following the surgery, and in-home administration of analgesic.
PACU ibuprofen administration (p<0.05) and SDSU administration of both Fever 4 (3.2)
morphine and Tylenol (p<0.05) and TPPPS scores were significantly higher Urinary symptoms 2 (1.6)
in patients who received inguinal orchidopexy (p<0.05). The conversion Not stated 15 (11.8)
rate was 29.5%, with 18 of 79 SO requiring an additional incision. Of
those converted SO, 13 of 18 (72%) occurred in canalicular testes. The Diagnosis
overall complication rate was 3.14%, with one testicular atrophy, three AFP (ng/mL)
re-ascents, and two wound infections. Mean 10040.41
Conclusions: SO is superior to IO on PO pain and analgesic consump-
tion during the immediate recovery period but not in terms of OpT (ITT) Standard deviation 18715.93
or complications. However, SO may not be a suitable approach for all Not stated 45
patients with canalicular testes. Diagnostic methods, n (%)
Biopsy 125 (98.4)
CT 43 (33.9)
MRI 35 (27.6)
Tumor characteristics
Primary tumor location, n (%)
Distal third of vagina 7 (5.5)
Middle third of vagina 10 (7.9)
Proximal third of vagina 17 (13.4)
Two thirds of vagina or greater 6 (4.7)
Other 2 14 (11.0)
Not stated 73 (57.5)
Tumor length (cm)
Mean 3.73
Standard deviation 1.56
Extra-vaginal spread,¹ n (%)
Pelvic spread 30 (23.6)
Lymphatic involvement 15 (11.8)
Distal metastasis 6 (4.7)
None 90 (70.9)
¹ Some cases presented with multiple features described. 2 Includes anterior or posterior
MP-12.13. Fig. 1. Eligibility and enrollment. wall of the vagina.

CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S157