Consultant Urologists Research Articles

Re: Predicting Grade and Stage at Cystoscopy in Newly Presenting Bladder Cancers-A Prospective Double-Blind Clinical Study.

Objective To assess urologists' ability to predict the grade and stage of new bladder cancers from the cystoscopic features alone. Patients and Methods We conducted a prospective clinical study on consecutive patients who underwent transurethral resection of bladder tumor (TURBT) for new bladder cancers. Using only cystoscopic tumor morphology at the time of initial TURBT, 3 urology consultants predicted the grade and stage, recording these on a proforma along with tumor features. Predictions were compared with assessments by uropathologists, blinded to the clinical prediction. We analyzed the accuracy in (1) predicting the exact grade and stage of the cancer; (2) differentiating between low- and high-grade cancers; and (3) discerning between Ta, T1, and T2 cancers. Results Of 248 patients, 224 were suitable for analysis. The positive predictive values for low- and high-grade cancers were 85.8% and 71.3%, respectively. The overall likelihood of a consultant predicting high-grade cancers as being low grade was 16/83 (19.3%). When tumors were large (>30 mm), this likelihood dropped significantly to 7.3% (4/55) (odds ratio = 3.1, 95% confidence interval = 1.0-9.7, P = .04). Non–muscle-invasive and muscle-invasive cancers were predicted accurately in 93.4% and 85.2% patients, respectively. Six of 161 (3.7%) tumors predicted to be non–muscle-invasive bladder cancer were actually muscle invasive on histology. Conclusion For clinical purposes, in newly presenting patients with bladder cancer, urologists appear to reliably predict lower grade and muscle-invasive disease, confirming widely held belief. This allows for appropriate and efficient use of surgical expertise, available technology, and selection of participants for clinical trials on the basis of prehistology risk categories.

Assessing the role of urologists and general surgeons in the open repair of bladder injuries: Analysis of a large, statewide trauma database

Bladder injuries often occur in the setting of polytrauma, and if severe, may require open surgical repairs. We assess the role of urologists and general surgeons (GS) in the open surgical management of bladder injuries and their outcomes in a traumatic setting. Patients who underwent open bladder injury repair secondary to trauma from 2000 to 2017 by urology or GS were identified in the Pennsylvania Trauma Outcome Study database by International Classification of Diseases-9th Rev.-Clinical Modification procedure codes (57.19-57.93). Patient demographics, initial trauma assessment, length of hospital stay, associated complications, and mortality were evaluated. Urology management of a bladder injury was defined by documentation of a urologist in the operating room or urological consultation during the hospital stay. GS management was defined by documented bladder repair without urology involvement as described previously. Of 624,504 patients in the database, 701 met inclusion criteria (419 managed by urology, 282 by GS). The most commonly performed procedure was suturing of bladder lacerations (80.5%). On univariate analysis, GS was more likely to manage patients with penetrating injuries and those who required exploratory laparotomy less than 2 hours upon arrival. Urology was more likely to manage patients with concomitant pelvic fractures and higher Injury Severity Score (ISS). On multivariate analysis, higher ISS was predictive of urology management (odds ratio, 1.83; 95% confidence interval, 1.17-2.87, p = 0.008), while patients who required urgent exploratory laparotomy was predictive of GS management (odds ratio, 0.34; 95% confidence interval, 0.21-0.55, p < 0.001). Patients with concomitant pelvic fractures (n = 318) were also more likely to have higher ISS (p < 0.001) and were more likely to be managed by urology (odds ratio, 1.52; 95% confidence interval, 1.01-2.30, p = 0.046). Mortality, length of hospital stay, and complication rates were not significantly different between the two specialties and among individual procedures. Our study describes the landscape of traumatic bladder repairs between urology and GS. GS may maintain similar patient outcomes when managing select cases of traumatic bladder injuries in the absence of urologists. Therapeutic, level IV.

Applying the Adaptive Leadership Framework for Chronic Illness to understand how American and British men navigate the infertility process.

In this article, we sought to understand the adaptive challenges and work faced by men with male factor infertility. Using a prospective qualitative study in private (the United States) and academic (the United Kingdom) urology clinics, we recruited seven American and five British men with primary infertility after their urology consultation for male factor infertility between December 2015 and April 2017. Individual in-depth qualitative interviews were conducted shortly after male factor infertility urology consultation and then two additional interviews at about 3 and 6 months. We found three themes related to adaptive challenges faced during fertility treatment: avoidance (not disclosing, avoided social network), uncertainty (about ability to have a child, fertility-related information, and male factor infertility status), and affective symptoms (sadness, shock, disbelief, denial, about not achieving fatherhood, and poor outcomes). Four themes about adaptive work included focusing on goal (having clear, actionable steps; knowledge received from urologist; exhausted all options; focus on parenthood), support from partner (relationship and communication), support from health care team (provision of emotional support, increased comfort with staff over time, disclosure of knowing others with same condition), and acquired information (understanding issue, support from urologist, seeking information). We concluded that men with male factor infertility face adaptive challenges including avoidance, uncertainty, and affective symptoms. To manage during the treatment process, they use adaptive work including focusing on the goal, receiving support from their partner and health care team, and acquiring information. Although qualitative results cannot be generalized to larger populations, they might be applicable to men with male factor infertility during infertility treatment.

Impact of the Timing of Ureteral Stent Placement on Outcomes in Patients with Obstructing Ureteral Calculi and Presumed Infection.

Objective: To understand how time to stent placement impacts outcomes in patients with obstructing ureteral stones and concern for infection. Materials and Methods: Using a prospective urology consult institutional database (2011-2016), we identified patients who presented to the emergency department (ED) with an obstructing ureteral stone, met two or more systemic inflammatory response syndrome (SIRS) criteria (temperature [T] >38°C or <36°C, heart rate >90 beats per minute, respiratory rate >20 breaths per minute, white blood cell count >12 k/μL or <4 k/μ), and underwent stent placement. The primary outcome of interest was impact of stent timing on intensity of care (need for intensive care unit [ICU]) as well as overall length of stay (LOS). Results: Forty-eight patients were identified who met the study criteria. Overall, 58.3% had positive urine cultures. There was no difference between groups with across a range of clinical variables. While the need for ICU admission did not differ between groups, those patients who had a ureteral stent placed within 6 and 10 hours of ED arrival had a significantly decreased LOS (35.6 hours vs 71.6 hours, p = 0.01; 45.7 hours vs 82.4 hours, p = 0.04) relative to those patients who were stented outside these intervals. Conclusion: In patients with an obstructing ureteral calculus and concern for infection, there is a beneficial effect to timelier stent placement in the form of decreased overall LOS.

Urological knowledge among primary health care physicians in Saudi Arabia.

Objectives:To evaluate the general knowledge among primary health care (PHC) physicians regarding the management of common urological problems in Saudi Arabia.Methods:This is an observational prospective study, where a self-administered questionnaire was distributed to practicing PHC physicians in the western region of Saudi Arabia on January 2017. The questionnaire consisted of 21-item questions, inquiring about demographics and general urological knowledge and skills. The management of common urological problems was assessed by case scenarios for specific urological condition, including urethral catheterization, definition and evaluation of hematuria, recognition of age-specific increase in prostatic specific antigen (PSA), and management of lower urinary tract symptoms.Results:A total of 148 questionnaires were distributed, with a response rate of 75.7%, where 112 respondents completed the questionnaires, including 54.3% residents, 39% general practitioners, and 5.4% specialists. Fifty-seven percent of respondents were males and 68% were Saudi practitioners. A higher number of respondents expressed that they were able to catheterize a male than female patient (56.5% versus 34.3%). Only 6.4% of respondents defined microscopic hematuria accurately. Knowledge about hematuria, serum prostate specific antigen and overactive bladder was low in all groups. Apart from hematuria, seeking urological consultations was less than 35% for all other disease entities.Conclusion:Urological knowledge among PHC physicians seems to be insufficient. Significant percentages of the participants were unable to catheterize a female patient, did not know the definition of hematuria; and whether to ask for urological consultations in cases of hematuria, increased PSA, and overactive bladder.

Trafik Kazası Sonrası Erektil Disfonksiyon Gelişen Olguya Adli Tıbbi Yaklaşım

Erektil disfonksiyon, cinsel ilişki için yeterli ereksiyonun elde edilememesi veya sürdürülememesidir. Bu olgu sunumunda; trafik kazasına bağlı multitravmalı olguda gelişen erektil disfonksiyonu adli-tıbbi açıdan değerlendirmek ve yaralama suçlarının adli tıp açısından değerlendirilmesi amacıyla kullanılan kılavuza katkıda bulunmak amaçlandı.&#x0D; Tıbbi evrakta; olaya bağlı pelvik kırıklar, mesane ve üretra rüptürü ve diğer yaralanmaları olduğu kayıtlıydı. Olgunun Anabilim Dalımıza başvurusu sonrası istenen Üroloji konsültasyonu sonucunda; mevcut bulgularla ereksiyonu gerçekleştirmek için organik açıdan yeterli olmadığı anlaşıldı.&#x0D; Travmanın erektil disfonksiyona yol açtığı belirlenen olguda, yaralanmanın ürolojik açıdan kişinin organlarından birinin işlevinin sürekli yitirilmesine yol açtığı sonucuna varıldı.Erektil disfonksiyonun, cinsel fonksiyon bozuklukları başlığı altında ilgili kılavuzda yer almasının, adli rapor düzenleme sürecine yardımcı olacağı düşünülmektedir.

641 - Implementation of a ureteric colic phone consult clinic reduces unnecessary outpatient urology consults

641 - Implementation of a ureteric colic phone consult clinic reduces unnecessary outpatient urology consults

Interactive virtual 3D models of renal cancer patient anatomies alter partial nephrectomy surgical planning decisions and increase surgeon confidence compared to volume-rendered images

PurposeTo determine whether the interactive visualisation of patient-specific virtual 3D models of the renal anatomy influences the pre-operative decision-making process of urological surgeons for complex renal cancer operations.MethodsFive historic renal cancer patient pre-operative computed tomography (CT) datasets were retrospectively selected based on RENAL nephrectomy score and variety of anatomy. Interactive virtual 3D models were generated for each dataset using image segmentation software and were made available for online visualisation and manipulation. Consultant urologists were invited to participate in the survey which consisted of CT and volume-rendered images (VRI) for the control arm, and CT with segmentation overlay and the virtual 3D model for the intervention arm. A questionnaire regarding anatomical structures, surgical approach, and confidence was administered.ResultsTwenty-five participants were recruited (54% response rate), with 19/25 having > 5 years of renal surgery experience. The median anatomical clarity score increased from 3 for the control to 5 for the intervention arm. A change in planned surgical approach was reported in 19% of cases. Virtual 3D models increased surgeon confidence in the surgical decisions in 4/5 patient datasets. There was a statistically significant improvement in surgeon opinion of the potential utility for decision-making purposes of virtual 3D models as compared to VRI at the multidisciplinary team meeting, theatre planning, and intra-operative stages.ConclusionThe use of pre-operative interactive virtual 3D models for surgery planning influences surgical decision-making. Further studies are needed to investigate if the use of these models changes renal cancer surgery outcomes.

Robotic versus laparoscopic urological surgery: incidence of reoperation and complications

Objective: To report the introduction of minimum invasive surgery in Denmark with focus on the reoperation and complication rates.Materials and methods: Data were prospectively collected at the national UroLap database. The database was established in 2003 in Denmark to register all laparoscopic urological procedures as well as their peri- and post-operative outcomes. In the period from 2009–2014, 10,843 patients were registered with the database, of which 10,546 (97%) had a complete Clavien-Dindo score within the first 30 postoperative days.Results: The mean age of patients was 60.5 years (S.D. = 16.2), and 415 patients (4%) were under the age of 17 years. The male-to-female ratio was 4:1. At the end of 2010, 25% of surgeries used the robotic technique, but the frequency of robotic surgeries increased to 56% in 2014. No complications were reported in 74.6% of the urological procedures. The mortality rate was reported at only 0.27% of all patients. Patients who underwent a urological procedure performed by consultant urologists had a lower rate of complication compared to procedures performed by trainees (p = 0.03) but not staff doctors (p = 0.9). There were no significant differences in complication rates between staff doctors and trainee (p = 0.2).Conclusion: Robotic and laparoscopic urological procedures are associated with low serious complication rates. Postoperative complications were more common among surgeries performed by trainees. The robotic approach is associated with a shorter L.O.S. compared to the laparoscopic approach and linked to lower reoperation rates.

Unusual Cause of Nephrolithiasis: Cystinuria

Cystinuria is a rare hereditary disease in which excretion of detectable amount of cysteine, lysine, ornithine and arginine amino acids in the urine is present leading to cysteine nephrolithiasis. Over 100 mutations for SLC3A1 and SLC7A9 genes were identified for this disease. 47 years old male patient suffering from recurrent nephrolithiasis analysis of which revealed L-cysteine type stone for the last 12 years applied to our hospital with the complaint of flank pain. Obesity, hyperglycemia, hypertriglyceridemia, microscopic hematuria, macroalbuminuria, multiple stones in the urinary tract with the diameter of 1 cm and hypercystinuria were detected. Urology consultation for stone removal, alkalization and increasing the volüme of urine, life style modifications in order to lose body fat, potassium citrate and tiopronine were adviced to the patient. If Stones passed through urinary tract are not analysed, diagnosis of cystinuria will be missed out. With this case, an unlucky but common state for patients with cystinuria is discussed.

Propofol-Associated Priapism in a Prepubescent Pediatric Patient.

Introduction. Propofol is a commonly used sedative medication for procedural sedation with a limited side effect profile. Although well tolerated with minimal adverse reactions, uncommon side effects have been reported. Methods. Case report of priapism in a 9-year-old male following the use of propofol for sedation in the pediatric intensive care unit (PICU) setting. The patient was admitted to the PICU for postoperative management following laryngotracheal reconstruction. On postoperative day 2, our patient was initiated on continuous infusion of propofol and he developed priapism. Propofol was then immediately discontinued, and the priapism quickly resolved without any medical or surgical interventions. Results. Priapism is a low-flow state and is considered a urological emergency requiring prompt recognition, withdrawal of suspected offending agents, and possible need for urologic consultation to alleviate complications. Although rare, priapism with propofol has been reported but never in a prepubescent male. The mechanism of propofol-associated priapism is not well understood, but it is thought that it may result from an autonomic system imbalance, leading to an increase in parasympathetic activity. In addition, propofol has been shown to affect nitric oxide–mediated smooth muscle relaxation. In our patient, we suspected propofol to be contributing factor to his priapism based on the temporal relationship between the initiation of the medication and symptoms and resolution of symptoms after propofol discontinuation. Discussion. Given the expansive use of propofol in pediatrics for sedation and anesthesia, pediatric clinicians should be cognizant of this rare adverse effect in pediatric patients with potentially disastrous complications.

Effect of diuresis on bother related to lower urinary tract symptoms.

To explore and objectify the impact of diuresis on the presence of daytime and nighttime LUTS, and associated bother. Participants (healthy volunteers and patients referred to our hospital for a urologic consultation) were asked to complete a 72-hour bladder diary and also had to fill in a Likert scale (0: no bother; 10: maximal bother) to evaluate the LUTS-associated bother during daytime and nighttime. Three groups were defined: no/mild bother (Bother ≤2), moderate bother (3≤Bother≤6), and strong bother (Bother ≥7). Questionnaires in order to assess LUTS (ICIQ MLUTS and ICIQ FLUTS), quality of life (SF-36, NqOL), and quality of sleep (PSQI) were completed. During daytime and nighttime, the study of participants with a strong bother associated with LUTS revealed a statistically significant higher fluid intake than those without bother (1640mL vs 1800mL during daytime, P=0.007). Also, those with higher diuresis rate had more bother related to LUTS than the others (71.3mL/h in group 1 vs 87.3mL/h in group 3 (P<0.001) during daytime). As might be expected, lower urinary tract such as bladder, for example, studied through maximal voided volume does play a role. The lower the maximal voided volume is, the more bother the participants described. This study pointed out the implication of diuresis in bother related to LUTS. Our findings showed that there was an increase in bother by 1 when diuresis increased by 100mL/h.

Bilateral orchidopexies: synchronous or metachronous? Survey of BAPS and BAPU members and single-centre comparison

Background/AimApproximately 20% of undescended testes (UDT) are bilateral. It is unclear whether bilateral orchidopexy (BO) should be undertaken synchronously (SBO) or metachronously (MBO). Our aim was to investigate current UK practice and the complications of SBO vs MBO. Materials & methodsFollowing approval of BAPS and BAPU ethics committee, a survey was circulated to UK consultant pediatric surgeons and urologists regarding practice. A departmental retrospective review was additionally carried out for patients undergoing BO between 2005 and 2017. ResultsForty-three consultant surgeons from 20 centres completed the survey. Overall, SBO was preferred by 70% for bilateral palpable UDT versus 30% for bilateral impalpable UDT. When one side was palpable and the other impalpable, 70% preferred SBO. Pediatric urologists were significantly more likely to undertake SBO than pediatric general surgeons. One hundred eighty-eight patients (376 testicular units) were identified who had undergone BO with a median follow up of 9 months. 144/188 (76.6%) underwent SBO, while 44 had MBO. There was no statistical difference in the complication rate between the two groups (7.6% in SBO vs 9.1% in MBO; p = 0.66). ConclusionsThe majority of the responding UK consultants, in particular pediatric urologists, favor SBO. This potentially offers a reduction in cost, more rapid completion of treatment, and is not associated with additional complications by comparison to MBO. We recommend SBO to be standard practice for bilateral UDT whenever possible. Level of EvidenceLevel III, Retrospective Comparative Study.

Determination of Contributing Risk Factors to Adult Nephrolithiasis Patients

Objectives: To determine the contributing risk factors to adult nephrolithiasis patients.Methodology: A descriptive study was conducted to determine the contributing risk factors toAdults nephrolithiasis starting from December 2007 to September 2008. A purposive "nonprobability"sample of (100) patients with nephrolithiasis was selected of those who wereadmitted to the hospitals, attending the Urology Consultation Clinic and Extracorporeal ShockWave Lithotripsy Department. The study instrument consists of two parts. The first part isrelated to the patients' demographic variables and the second part is constructed to serve thepurpose of the study. The total number of items in the questionnaire was (85) ones.Content Validity of the instrument was determined through the use of a panel of (12) expert inthe field of the study. Reliability of the instrument was estimated through the pilot study. Datawere analyzed through descriptive data analysis and the inferential data analysis approaches.

Large Peri-Renal Fluid Collection Involving Gerotaʼs Fascia After Acute Pancreatitis

A 19-year-old male presented with third episode of recurrent idiopathic acute pancreatitis. Upon presentation, a CT scan of the abdomen was notable for acute fluid collection formation at the tail of the pancreas (figure 1). The patient was medically managed with aggressive hydration and pain control and was discharged in good health. He presented again after 4 weeks with left flank pain, nausea and vomiting. A repeat CT scan of the abdomen demonstrated a peri-renal fluid collection beneath the Gerota's fascia of the left kidney. The patient was afebrile with stable vital signs. Urinanalysis was unremarkable. Complete blood counts and basic metabolic profile were normal. Urology consultation was obtained for concern for renal compromise from compression effects given the size of the fluid collection, and possible hemorrhage into the peri-renal space from an undetected renal angiolipoma. The patient denied any history of trauma. Urology deemed the fluid not consistent with the kidney origin given no trauma history and no visible tumor on the imaging. MRI of the abdomen performed after four days revealed increasing size of the encapsulated renal fluid collection measuring 17 cm x 12 cm x 12 cm (figure 3). A CT guided drainage of the fluid collection was performed and one liter of dark green non-turbid fluid was drained (figure 4). Investigation of the fluid demonstrated white blood cell count of 4070, amylase of >13000, and lipase of >30000 consistent with pancreatic fluid. Acute and chronic pancreatitis are known to have complications which include the development of a pseudocyst. Pseudocysts occur weeks after the onset of pancreatitis and account for an incidence rate of nearly 5-15%.However, Pseudocysts which have involved the Gerota's fascia of the magnitude seen in our case have very rarely been reported in English literature.In majority of the cases, ultrasonographic or CT guided aspirations were the main stay of therapy which demonstrated definitive resolution. It is postulated that the autolytic nature of pancreatic enzymes allows the fluids to dissect through fascial planes leading to distant pseudocyst formation. Pancreatic pseudocysts with atypical locations such as the peri-renal space are radiologically challenging to diagnose as they often mimic an underlying malignant process or traumatic history. These atypical locations pose and therapeutic challenges which may encompass surgical, percutaneous, or transgastric intervention.1314_A.tif Figure 1: A computed tomography (CT) coronal view image of the abdomen was notable for acute fluid collection “phlegmon” formation at the tail of the pancreas1314_B.tif Figure 2: A computed tomography (CT) abdomen axial image revealing development of peri-renal subcapsular fluid accumulation1314_C.tif Figure 3: Magnetic resonance cholangiopancreatography image demonstrating peri-renal fluid collection involving the Gerota's fascia of the left kidney and measured 17 cm x 12 cm x 12 cm.

EP22.02: Incidental bladder images during a routine pelvic ultrasound

During a routine pelvic ultrasound, the operator can look at the surrounding structures to seek other features. A 45-year-old lady, G2 P2 with two prior Caesareans complained of pelvic discomfort and urge incontinence. She is an occasional smoker with no urological prior history. During her routine check-up, ultrasound showed a thickened bladder mucosa of about 3.2 mm. This image did not show any vascularisation and did not move upon probe movements. No other adnexal pathology was seen and Douglas was free of fluid. The patient was referred for urology consultation and she underwent later on a cystoscopy that showed a suspicious image that was resected. Pathology showed a urothelial superficial tumour. Routine pelvic ultrasound done at the gynecologist's clinic can be a good opportunity to detect a suspicious image at the level of the bladder. Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Simulation in urology to train non-technical skills inward rounds.

To report our experience of an exercise designed to train newly appointed urology trainees in non-technical skills on ward rounds as a part of a simulation 'boot camp', through a qualitative analysis of participant feedback on the utility of this method of training. The simulations took place in a high-fidelity simulated ward bay. Forty-eight doctors with formal urology training ranging between 2 and 60months (mean 19.1 ± 11.6months) took part. Thirty-one participants were on a formal urology specialty training pathway. The remaining participants were core (pre-specialty) surgical trainees. The entry requirement was that participants must be junior-level urologists, ideally at the beginning of specialty training. Participants individually led a simulated ward round, which was devised using actors to play patients and a simulated 'switchboard' for telephone conversations. Distractions were introduced deliberately for participants to manage an emergent urology-related scenario. 'Freeze-frames' were used to 'pause' the ward round, whereby observing consultants provided feedback on performance. After the simulated exercises, a whole-group structured debriefing took place. Non-Technical Skills for Surgeons (NOTSS) scores were generated for participants by seven consultant urologists. Participants completed a two-part feedback form. Part one involved nine questions scored on a Likert scale, and part two required free-text responses. The mean (±sd) itemized NOTSS scores for situational awareness, decision-making, communication and teamwork, and leadership were 3.01 (±0.15), 2.95 (±0.16), 3.05 (±0.19), and 2.98 (±0.15), respectively. From the thematic analysis, participants commented positively on the number of scenarios per participant, the use of actors as patients and real staff, and the use of freeze-frames for immediate feedback. Residents also provided suggestions for distractions to be considered in the future. This simulated ward round was generally well received by participants, and the obtained feedback provides an insight into how this can be adapted to maximize the benefits for new specialty residents. The mean NOTSS scores indicated that non-technical skills performances could be improved. This supports our rationale to train non-technical skills in a safe environment to bolster career transition into positions of greater decision-making autonomy.

271 Social deprivation trends in operative penile cancer

Penile cancer is a rare disease and accounts for less than 1% of total cancers diagnosed. Scotland has a higher incidence of penile cancer compared to many parts of the world and can have serious functional and sexual consequences for patients. Does social deprivation play a role in presentation, grade, stage and ultimate treatment of penile cancer? All cases of penile cancer in Glasgow, Scotland, an area of centralized NHS service, were identified over a 10-year period. Patients identified from operative notes performed by two consultant urologists from 2007 – 2017 were included. Social deprivation was determined using the Scottish Index of Multiple Deprivation (SIMD), the Scottish Government’s official tool to identify areas of multiple deprivation in Scotland. 200 patients were identified with an age range of 27 – 91 (mean = 63). The most deprived areas have a significantly higher number of cases of penile cancer. Moreover, histologically, a higher proportion of aggressive grade 3 cancers were diagnosed in the most deprived population and also more advanced staging. There is a significantly higher rate of penile amputation in the more socially deprived population. Patients took an average of 6 months to present to primary care and although there was no correlation in the number of missed appointments and social deprivation, a total of 200 appointments were missed.

Urologic Phenotype and Patterns of Care in Patients With Megacystis Microcolon Intestinal Hypoperistalsis Syndrome Presenting to a Major Pediatric Transplantation Center

To describe the phenotype, referral pattern, and trends of urologic management for children with megacystis microcolon intestinal hypoperistalsis syndrome. We performed a retrospective review of all patients with megacystis microcolon intestinal hypoperistalsis syndrome treated at a large tertiary children's medical center over a 14-year period. Our primary outcomes included the rate of urology referral, urodynamic characteristics of bladder function, and the proportion of patients managed with clean intermittent catheterization. Twenty-six patients were evaluated at our institution with a median age at presentation of 1.3 years (73% female, 19 of 26). Most patients presented for intestinal transplantation evaluation and were dependent on parenteral nutrition. Megacystis was diagnosed prenatally in 15 patients and postnatally in 11 patients. Twenty patients (77%, 20 of 26) were evaluated by a pediatric urologist. Six patients (23%, 6 of 26) had varying degrees of vesicoureteral reflux. Early bladder management consisted of clean intermittent catheterization in 13 patients and vesicostomy in 8 patients. Megacystis microcolon intestinal hypoperistalsis syndrome is a severe form of intestinal failure and bladder atony with substantial urologic morbidity. Parents should be counseled accordingly and prompt urologic consultation should be included in the multidisciplinary approach to these complex patients.

PUK22 - A Comparison of the Treatment Recommendations for Neurogenic Bladder in the National Institute for Health and Care Excellence, European association of Urology and International Consultations on Incontinence Guidelines

PUK22 - A Comparison of the Treatment Recommendations for Neurogenic Bladder in the National Institute for Health and Care Excellence, European association of Urology and International Consultations on Incontinence Guidelines