- Email: [email protected]
Continent Appendicovesicostomy in the Management of Valve Bladder Syndrome
S48 CONCLUSIONS Short-term Mitrofanoff drainage of bladders in PUV boys reduces renal dilatation by 40%,
ESPU Programme 2010 but doesn’t change renal function. Longterm Mitrofanoff drainage significantly delays the onset of ESRF in PUV boys by 5 years.
# DP02-2 (DP) CONTINENT APPENDICOVESICOSTOMY IN THE MANAGEMENT OF VALVE BLADDER SYNDROME Mohamed YOUSSIF1, Haytham BADAWY1, Samir SHABAAN2, Ibrahim MOKHLESS2 and Ahmed HANNO2 1
Alexandria University, Urology Department, Alexandria, EGYPT, 2Alexandria University, Urology Dept., Alexandria, EGYPT
PURPOSE Clean intermittent catheterization (CIC) is a cornerstone in the management of VBS. Sometimes, there is difficulty or pain during performing CIC per urethra which might affect patient compliance. Using appendicovesicostomy might allow better patient compliance and have a positive impact in the management of VBS.
MATERIAL AND METHODS Appendicovesicostomy was performed in 10 boys with VBS to allow better implementation of CIC (group I). Other 10 boys with VBS performing CIC per urethra were used as a control group (group II). Both groups were followed regarding complications of
catheterization (pain, difficulty, and false passage), rate of UTI, compliance and effect on upper tract dilatation. Stomal complications in addition to continence status were recorded in group I.
RESULTS Age range in both groups was 3-9 years and the follow up period is 2 years. No complications of catheterization encountered in group I. Pain was present in 6, false passage in 2 and difficulty in 3 boys in group II. As regards UTI, documented upper tract infection was present in one case in group I and in 4 cases in group II. Lower tract infection was present in 2 cases in group I and in 7 cases in group II. Two cases in group
II had recurrent epididymitis. Compliance to CIC was 100% in group I while in group II was 70 %. At the last follow up, there was improvement in upper tract dilatation in 4 cases in group I compared to its status before performing the appendicovesicostomy. Only one case in group I had stomal stenosis that needed surgical revision. All stomas were continent in between the period of CIC.
CONCLUSIONS Continent appendicovesicostomy is a valid procedure in the management of VBS when compliance in CIC is equivocal. It is a safe and easy procedure with long term success that obviates problems of urethral catheterization.
# DP02-3 (DP) RESIDUAL VALVE AND STRICTURE AFTER POSTERIOR URETHRAL VALVE ABLATION: WHEN AND WHOM TO EVALUATE? Tayfun OKTAR, Emre SALABAS, Arda ATAR, Ismet NANE, Haluk ANDER and Orhan ZIYLAN Istanbul Faculty of Medicine, Istanbul University, Department of Urology, Division of Pediatric Urology, Istanbul, TURKEY
PURPOSE It might be diffucult to evaluate the clinically significant residual valve remnants and strictures, and make a judgement for the re-operation after the ablation of posterior urethral valve. In this research, clinical and radiological parameters are examined in cases with residual valve remnants.
MATERIAL AND METHODS Between 1986-2009, a total of 127 valve patients were treated in our clinic and the records of 101 patients, who had regular follow-up, were included to the study. Of these 101 children, the records of 10 patients, who were found to have residual
valve or stricture after ablation, were reviewed retrospectively.
RESULTS Endoscopic intervention due to the residual valve remnants or stricture was performed after a mean period of 7.254.7 months following the first ablations. In 2 (20%) of the cases, urethra has been found to be normal in the first radiological evaluation (voiding cystourethrography). Of these 2 children, urethroscopy was conducted due to the recognition of the valve remnants in the follow-up of vesicoureteral reflux in one case and during evaluation of persistent hydroureteronephrosis in the other case. Two out of 8 cases who had the radiological appearance of obstruction in the early period, were found to have strictures. In the
other 6 cases, the residual valve remnants were incisized. In the follow-up, endoscopy was re-conducted on the 2 out of 8 cases due to strictures.
CONCLUSIONS In our series, almost 10% of the cases were found to have residual valve or strictures. Although about one fifth of the cases were seen to be normal in the first radiological examination, valve remnants were found in the clinical follow-up evaluations due to the persistent hydrourethronephrosis and vesicoureteral reflux. For this reason, the operation decision should be given in the light of the clinical and radiological evaluations together to find the significant valve remnants and strictures following valve ablation.
ESPU Programme 2010 but doesn’t change renal function. Longterm Mitrofanoff drainage significantly delays the onset of ESRF in PUV boys by 5 years.
# DP02-2 (DP) CONTINENT APPENDICOVESICOSTOMY IN THE MANAGEMENT OF VALVE BLADDER SYNDROME Mohamed YOUSSIF1, Haytham BADAWY1, Samir SHABAAN2, Ibrahim MOKHLESS2 and Ahmed HANNO2 1
Alexandria University, Urology Department, Alexandria, EGYPT, 2Alexandria University, Urology Dept., Alexandria, EGYPT
PURPOSE Clean intermittent catheterization (CIC) is a cornerstone in the management of VBS. Sometimes, there is difficulty or pain during performing CIC per urethra which might affect patient compliance. Using appendicovesicostomy might allow better patient compliance and have a positive impact in the management of VBS.
MATERIAL AND METHODS Appendicovesicostomy was performed in 10 boys with VBS to allow better implementation of CIC (group I). Other 10 boys with VBS performing CIC per urethra were used as a control group (group II). Both groups were followed regarding complications of
catheterization (pain, difficulty, and false passage), rate of UTI, compliance and effect on upper tract dilatation. Stomal complications in addition to continence status were recorded in group I.
RESULTS Age range in both groups was 3-9 years and the follow up period is 2 years. No complications of catheterization encountered in group I. Pain was present in 6, false passage in 2 and difficulty in 3 boys in group II. As regards UTI, documented upper tract infection was present in one case in group I and in 4 cases in group II. Lower tract infection was present in 2 cases in group I and in 7 cases in group II. Two cases in group
II had recurrent epididymitis. Compliance to CIC was 100% in group I while in group II was 70 %. At the last follow up, there was improvement in upper tract dilatation in 4 cases in group I compared to its status before performing the appendicovesicostomy. Only one case in group I had stomal stenosis that needed surgical revision. All stomas were continent in between the period of CIC.
CONCLUSIONS Continent appendicovesicostomy is a valid procedure in the management of VBS when compliance in CIC is equivocal. It is a safe and easy procedure with long term success that obviates problems of urethral catheterization.
# DP02-3 (DP) RESIDUAL VALVE AND STRICTURE AFTER POSTERIOR URETHRAL VALVE ABLATION: WHEN AND WHOM TO EVALUATE? Tayfun OKTAR, Emre SALABAS, Arda ATAR, Ismet NANE, Haluk ANDER and Orhan ZIYLAN Istanbul Faculty of Medicine, Istanbul University, Department of Urology, Division of Pediatric Urology, Istanbul, TURKEY
PURPOSE It might be diffucult to evaluate the clinically significant residual valve remnants and strictures, and make a judgement for the re-operation after the ablation of posterior urethral valve. In this research, clinical and radiological parameters are examined in cases with residual valve remnants.
MATERIAL AND METHODS Between 1986-2009, a total of 127 valve patients were treated in our clinic and the records of 101 patients, who had regular follow-up, were included to the study. Of these 101 children, the records of 10 patients, who were found to have residual
valve or stricture after ablation, were reviewed retrospectively.
RESULTS Endoscopic intervention due to the residual valve remnants or stricture was performed after a mean period of 7.254.7 months following the first ablations. In 2 (20%) of the cases, urethra has been found to be normal in the first radiological evaluation (voiding cystourethrography). Of these 2 children, urethroscopy was conducted due to the recognition of the valve remnants in the follow-up of vesicoureteral reflux in one case and during evaluation of persistent hydroureteronephrosis in the other case. Two out of 8 cases who had the radiological appearance of obstruction in the early period, were found to have strictures. In the
other 6 cases, the residual valve remnants were incisized. In the follow-up, endoscopy was re-conducted on the 2 out of 8 cases due to strictures.
CONCLUSIONS In our series, almost 10% of the cases were found to have residual valve or strictures. Although about one fifth of the cases were seen to be normal in the first radiological examination, valve remnants were found in the clinical follow-up evaluations due to the persistent hydrourethronephrosis and vesicoureteral reflux. For this reason, the operation decision should be given in the light of the clinical and radiological evaluations together to find the significant valve remnants and strictures following valve ablation.