MP29-04 ANNUAL RENAL ULTRASOUND IS ADEQUATE SURVEILLANCE TO SCREEN FOR NEW OBSTRUCTIVE UROPATHY IN ADULT PATIENTS WITH CONGENITAL ANOMALIES OF THE BLADDER

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: External Genitalia Reconstruction and Urotrauma (including transgender surgery) I (MP29)1 Apr 2020MP29-04 ANNUAL RENAL ULTRASOUND IS ADEQUATE SURVEILLANCE TO SCREEN FOR NEW OBSTRUCTIVE UROPATHY IN ADULT PATIENTS WITH CONGENITAL ANOMALIES OF THE BLADDER Madeline Cancian*, Charlotte Wu, Lindsey Hartsell, Edwin Smith, K. Jeff Carney, and Niall Galloway Madeline Cancian*Madeline Cancian* More articles by this author , Charlotte WuCharlotte Wu More articles by this author , Lindsey HartsellLindsey Hartsell More articles by this author , Edwin SmithEdwin Smith More articles by this author , K. Jeff CarneyK. Jeff Carney More articles by this author , and Niall GallowayNiall Galloway More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000868.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with congenital bladder anomalies are surviving into adulthood and transitioning to adult urologic care. Urologists represent a hugely important gate keeper, as traditionally the leading cause of death in patients with spina bifida over 16 years old was renal failure secondary to complications of the urinary tract. Unfortunately, there are no standard guidelines for choosing an appropriate surveillance protocol. The goal of our study was to describe our surveillance patterns and examine renal outcomes in this population. METHODS: We performed retrospective chart review of patients with spina bifida (SB), posterior urethral valves (PUV) and bladder exstrophy (BE) seen from 2008 - 2019 at our institution, a single tertiary referral academic center. We excluded patients who had chronic kidney disease or clinically significant hydronephrosis (HN) upon referral. RESULTS: We identified 103 subjects (83% SB, 1% PUV, 16% BE). [Table 1] Our surveillance protocol involved annual renal ultrasonography. Routine bloodwork or urodynamics was not completed unless prompted by worsening HN. Six (6%) patients developed new or worsening HN during follow up. No patient developed worsening renal function, as measured by creatinine, in the absence of new or worsening HN, and only one patient had a concomitant rise in creatinine. Of the 6 patients, 2 patients were observed for physiologic HN, 3 patients required surgery for obstruction at the level of the stoma (1) or ureter (2), and one patient required transplant. While two (50%) cases of new obstructive uropathy were due to failed urinary diversion, one case was related to poor patient compliance, and the final case resulted from obstruction secondary to metastatic adenocarcinoma of the augmented bladder. CONCLUSIONS: In our patients with congenital bladder anomalies, annual renal ultrasound detected de novo or worsening HN in 6 (6%) patients. As adults, these patients did not develop new kidney failure in the absence of HN. Among those with clinically significant HN, the majority was from an iatrogenic cause and required operative intervention in the form of surgical revision or transplant. Annual renal ultrasonography appears to be an adequate and useful screening protocol in these patients. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e430-e430 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Madeline Cancian* More articles by this author Charlotte Wu More articles by this author Lindsey Hartsell More articles by this author Edwin Smith More articles by this author K. Jeff Carney More articles by this author Niall Galloway More articles by this author Expand All Advertisement PDF downloadLoading ...