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MP55-07 HISTOPATHOLOGICAL CHANGES ASSOCIATED WITH POLYACRYLATE POLYALCOHOL BULKING COPOLYMER (PPC, VANTRIS) INJECTION FOR PAEDIATRIC VESICOURETERAL REFLUX (VUR)
THE JOURNAL OF UROLOGYâ
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(CAP), with/without associated febrile urinary tract infection (UTI), and 6-weeks post-operatively following open surgery; 2) respondents randomized to answer questions from child, parent, or dyad perspectives on the utility of a single VUR health state in an affected child; and 3) respondents randomized to answer questions from one of three practice scenarios (paralysis, common cold, none) prior to a VUR scenario. Utility estimates and potential predictors were fitted to a generalized linear model to determine what factors most impacted utilities. RESULTS: A total of 1,947 responses were obtained. Mean respondent age was 34-36 years; 48% were female; 37% were married; and 44% had children. Compared to a perfect health state of 1.0, mean VUR utility was 0.87 irrespective of CAP or UTI (p¼0.9). Utility values were uninfluenced by child/personal VUR/UTI history, income, or race. Utilities were higher in the child group (0.27 lower in parent v. child, p<0.001; 0.09 lower in dyad v. child, p<0.001), among single respondents (0.07 higher v. married, p¼0.007), and among older respondents (0.03 lower per 10-year age interval, p¼0.008). VUR utility was not significantly affected by the presence or type of TTO warm-up scenario (p¼0.87). CONCLUSIONS: Online crowd-sourced utility elicitation for pediatric urologic conditions is feasible. VUR utility was viewed as only slightly inferior to perfect health by most respondents. Source of Funding: Grant K08-DK100534, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
MP55-07 HISTOPATHOLOGICAL CHANGES ASSOCIATED WITH POLYACRYLATE POLYALCOHOL BULKING COPOLYMER (PPC, VANTRIS) INJECTION FOR PAEDIATRIC VESICOURETERAL REFLUX (VUR) Boris Chertin*, Stanislav Kocherov, Jerusalem, Israel; Ermelinda Mele, Simona Gerocarni Nappo, Nicola Capozza, Rome, Italy INTRODUCTION AND OBJECTIVES: Endoscopic correction of VUR utilizing Vantris has demonstrated high efficacy not only during a short term period, but also during a long term follow up without VUR recurrence. We have hypothesized that the obstruction following endoscopic correction of VUR is related to the anatomical features of the UVJ rather than the type of material used for endoscopic correction. Therefore, we have retrospectively evaluated all cases of obstruction following endoscopic treatment of VUR in both departments over the last 5 years and have performed clinical and histological review of these patients. METHODS: Study population comprised 2470 patients who underwent endoscopic correction of VUR utilizing Deflux (1790 children) and Vantris (680 patients). 9(0.5%) children (3 F and 6 M) in Deflux group and 8(1.2%) (4 F and 4 M) in Vantris group developed UVJ obstruction and required ureteral re-implantation. Tissue sections were stained with hematoxylin eosin and trichrome and examined under a light microscope. Nine primary obstructive megaureters after ureteral re-implantation served as controls. RESULTS: All children developed obstruction during the period ranging from 2 to 49 months (average 16 months) following endoscopic correction. The primary reflux grade was III in 7, IV in 6 and V in 4 children respectively. The review of pretreatment VCUG demonstrated the presence of refluxing/obstructive ureter in 10(58.8%) out of 17 obstructive ureters showing true obstruction in 7 ureters (1 from Deflux and 6 from Vantris group). Histopathological analysis revealed a pseudocapsule composed of fibrous tissue and foreign body-type giant cells surrounding the Vantris implant in all patients. The distal part of the ureters demonstrated significant ureteral dilatation without ureteral fibrosis. In all patients, additional biopsies from the muscularis propria adjacent to the injection site were examined and showed no significant abnormalities. There was an increased collagen deposition in the juxtavesical segment of the obstructive ureters following Deflux, Vantris injection and also of primary obstructive megaureter. No significant difference was found in the tissue response between Deflux, Vantris patients and controls.
Vol. 195, No. 4S, Supplement, Sunday, May 8, 2016
CONCLUSIONS: Our data show that Vantris injection does not lead to ureteral fibrosis or inflammatory changes and therefore does not seem to increase the incidence of UVJ obstruction. However, patients with high grade VUR and an initial underlying ureteral pathology should receive appropriate counseling upon surgery concerning the possibility of UVJ obstruction and the need in subsequent ureteral re-implantation. Source of Funding: none
MP55-08 PREVALENCE AND RISK FACTORS OF SYMPTOMATIC URINARY TRACT INFECTION AFTER ENDOSCOPIC INCISION FOR THE TREATMENT OF URETEROCELE IN CHILDREN. Kimihiko Moriya*, Michiko Nakamura, Yoko Nishimura, Takeya Kitta, Kanno Yukiko, Hiroki Chiba, Masafumi Kon, Nobuo Shinohara, Sapporo, Japan INTRODUCTION AND OBJECTIVES: Endoscopic incision (EI) is widely accepted as a minimally invasive management for ureterocele (UC). While incidence of inherent or de novo vesicoureteral reflux (VUR) was reported so far, risk of urinary tract infection (UTI) after EI has not been well discussed. In the present study, impact of EI for UC was evaluated focusing on prevalence and risk factors of symptomatic UTI after EI. METHODS: We performed retrospective chart review of children with UC between September 1994 and April 2015. Among them, patients who were observed conservatively without additional surgical management after EI were included in this study. Type of UC was divided into intravesical (I-UC) and ectopic (E-UC) ones. Prevalence and risk factors of symptomatic UTI, which was defined recurrent cystitis or febrile UTI, after EI were evaluated. Statistical analysis was performed using Kaplan-Maier Curve with the generalized Wilcoxon test for evaluation of the prevalence and risk factors for symptomatic UTI. RESULTS: Among 38 children with UC during the study period, 36 children (20 girls and 16 boys) were included. The reason of exclusion in 2 boys with E-UC were that open ureterocystoneostomy was indicated just after EI due to ectopic opening of ureteral orifice into urethra in 1 and due to their guardian’s preference in 1. Surgical indications for EI were symptomatic UTI in 23, hydronephrosis in 8, macrohematuria in 3 and others in 2. I-UC and E-UC was identified in 15 and 21, respectively. Median age at EI was 8.9 months (range; 1.6 to 190). Ten children had symptomatic UTI (febrile UTI in 8 and recurrent cystitis in 2) during median follow of 72.9 months (7.1 to 219). Initial symptomatic UTI in each child occurred at less than 25 months after EI (0.5 to 24.9). Symptomatic UTI was less common in boys (p<0.01) or children with IUC (p <0.05). Symptomatic UTI free rate at 25 months after EI (%) was 91.7/45.1 in boys/girls, 81.8/55.4 in I-UC/E-UC, or 86.7/40.5 in boys or IUC/girls with E-UC. Symptomatic UTI as presenting symptom (p ¼0.148), bilateral/unilateral UC (p ¼0.236), single/duplex system in UC unit (p ¼0.068), age at EI (p ¼0.393), or inherent or de novo VUR after EI (p ¼0.233) did not affect the prevalence of symptomatic UTI. CONCLUSIONS: Symptomatic UTI occurred within 25 months after EI. Boys and children with I-UC were at a lower risk for symptomatic UTI after EI. Our data suggests that conservative management after EI would be a safe option in terms of symptomatic UTI for the management of UC especially in boys or in children with I-UC even though VUR was identified after EI. Source of Funding: none
MP55-09 LONG-TERM RESULTS AND SAFETY OF POLYACRYLAMIDE HYDROGEL FOR THE ENDOSCOPIC TREATMENT OF VESICOURETERAL REFLUX IN CHILDREN Sophie Ramsay*, Anne-Sophie Blais, Fannie Morin, Katherine Moore, phane Bolduc, Quebec City, Canada Ste INTRODUCTION AND OBJECTIVES: Various bulking agents are available for vesicoureteral reflux (VUR) endoscopic treatment, but
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(CAP), with/without associated febrile urinary tract infection (UTI), and 6-weeks post-operatively following open surgery; 2) respondents randomized to answer questions from child, parent, or dyad perspectives on the utility of a single VUR health state in an affected child; and 3) respondents randomized to answer questions from one of three practice scenarios (paralysis, common cold, none) prior to a VUR scenario. Utility estimates and potential predictors were fitted to a generalized linear model to determine what factors most impacted utilities. RESULTS: A total of 1,947 responses were obtained. Mean respondent age was 34-36 years; 48% were female; 37% were married; and 44% had children. Compared to a perfect health state of 1.0, mean VUR utility was 0.87 irrespective of CAP or UTI (p¼0.9). Utility values were uninfluenced by child/personal VUR/UTI history, income, or race. Utilities were higher in the child group (0.27 lower in parent v. child, p<0.001; 0.09 lower in dyad v. child, p<0.001), among single respondents (0.07 higher v. married, p¼0.007), and among older respondents (0.03 lower per 10-year age interval, p¼0.008). VUR utility was not significantly affected by the presence or type of TTO warm-up scenario (p¼0.87). CONCLUSIONS: Online crowd-sourced utility elicitation for pediatric urologic conditions is feasible. VUR utility was viewed as only slightly inferior to perfect health by most respondents. Source of Funding: Grant K08-DK100534, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
MP55-07 HISTOPATHOLOGICAL CHANGES ASSOCIATED WITH POLYACRYLATE POLYALCOHOL BULKING COPOLYMER (PPC, VANTRIS) INJECTION FOR PAEDIATRIC VESICOURETERAL REFLUX (VUR) Boris Chertin*, Stanislav Kocherov, Jerusalem, Israel; Ermelinda Mele, Simona Gerocarni Nappo, Nicola Capozza, Rome, Italy INTRODUCTION AND OBJECTIVES: Endoscopic correction of VUR utilizing Vantris has demonstrated high efficacy not only during a short term period, but also during a long term follow up without VUR recurrence. We have hypothesized that the obstruction following endoscopic correction of VUR is related to the anatomical features of the UVJ rather than the type of material used for endoscopic correction. Therefore, we have retrospectively evaluated all cases of obstruction following endoscopic treatment of VUR in both departments over the last 5 years and have performed clinical and histological review of these patients. METHODS: Study population comprised 2470 patients who underwent endoscopic correction of VUR utilizing Deflux (1790 children) and Vantris (680 patients). 9(0.5%) children (3 F and 6 M) in Deflux group and 8(1.2%) (4 F and 4 M) in Vantris group developed UVJ obstruction and required ureteral re-implantation. Tissue sections were stained with hematoxylin eosin and trichrome and examined under a light microscope. Nine primary obstructive megaureters after ureteral re-implantation served as controls. RESULTS: All children developed obstruction during the period ranging from 2 to 49 months (average 16 months) following endoscopic correction. The primary reflux grade was III in 7, IV in 6 and V in 4 children respectively. The review of pretreatment VCUG demonstrated the presence of refluxing/obstructive ureter in 10(58.8%) out of 17 obstructive ureters showing true obstruction in 7 ureters (1 from Deflux and 6 from Vantris group). Histopathological analysis revealed a pseudocapsule composed of fibrous tissue and foreign body-type giant cells surrounding the Vantris implant in all patients. The distal part of the ureters demonstrated significant ureteral dilatation without ureteral fibrosis. In all patients, additional biopsies from the muscularis propria adjacent to the injection site were examined and showed no significant abnormalities. There was an increased collagen deposition in the juxtavesical segment of the obstructive ureters following Deflux, Vantris injection and also of primary obstructive megaureter. No significant difference was found in the tissue response between Deflux, Vantris patients and controls.
Vol. 195, No. 4S, Supplement, Sunday, May 8, 2016
CONCLUSIONS: Our data show that Vantris injection does not lead to ureteral fibrosis or inflammatory changes and therefore does not seem to increase the incidence of UVJ obstruction. However, patients with high grade VUR and an initial underlying ureteral pathology should receive appropriate counseling upon surgery concerning the possibility of UVJ obstruction and the need in subsequent ureteral re-implantation. Source of Funding: none
MP55-08 PREVALENCE AND RISK FACTORS OF SYMPTOMATIC URINARY TRACT INFECTION AFTER ENDOSCOPIC INCISION FOR THE TREATMENT OF URETEROCELE IN CHILDREN. Kimihiko Moriya*, Michiko Nakamura, Yoko Nishimura, Takeya Kitta, Kanno Yukiko, Hiroki Chiba, Masafumi Kon, Nobuo Shinohara, Sapporo, Japan INTRODUCTION AND OBJECTIVES: Endoscopic incision (EI) is widely accepted as a minimally invasive management for ureterocele (UC). While incidence of inherent or de novo vesicoureteral reflux (VUR) was reported so far, risk of urinary tract infection (UTI) after EI has not been well discussed. In the present study, impact of EI for UC was evaluated focusing on prevalence and risk factors of symptomatic UTI after EI. METHODS: We performed retrospective chart review of children with UC between September 1994 and April 2015. Among them, patients who were observed conservatively without additional surgical management after EI were included in this study. Type of UC was divided into intravesical (I-UC) and ectopic (E-UC) ones. Prevalence and risk factors of symptomatic UTI, which was defined recurrent cystitis or febrile UTI, after EI were evaluated. Statistical analysis was performed using Kaplan-Maier Curve with the generalized Wilcoxon test for evaluation of the prevalence and risk factors for symptomatic UTI. RESULTS: Among 38 children with UC during the study period, 36 children (20 girls and 16 boys) were included. The reason of exclusion in 2 boys with E-UC were that open ureterocystoneostomy was indicated just after EI due to ectopic opening of ureteral orifice into urethra in 1 and due to their guardian’s preference in 1. Surgical indications for EI were symptomatic UTI in 23, hydronephrosis in 8, macrohematuria in 3 and others in 2. I-UC and E-UC was identified in 15 and 21, respectively. Median age at EI was 8.9 months (range; 1.6 to 190). Ten children had symptomatic UTI (febrile UTI in 8 and recurrent cystitis in 2) during median follow of 72.9 months (7.1 to 219). Initial symptomatic UTI in each child occurred at less than 25 months after EI (0.5 to 24.9). Symptomatic UTI was less common in boys (p<0.01) or children with IUC (p <0.05). Symptomatic UTI free rate at 25 months after EI (%) was 91.7/45.1 in boys/girls, 81.8/55.4 in I-UC/E-UC, or 86.7/40.5 in boys or IUC/girls with E-UC. Symptomatic UTI as presenting symptom (p ¼0.148), bilateral/unilateral UC (p ¼0.236), single/duplex system in UC unit (p ¼0.068), age at EI (p ¼0.393), or inherent or de novo VUR after EI (p ¼0.233) did not affect the prevalence of symptomatic UTI. CONCLUSIONS: Symptomatic UTI occurred within 25 months after EI. Boys and children with I-UC were at a lower risk for symptomatic UTI after EI. Our data suggests that conservative management after EI would be a safe option in terms of symptomatic UTI for the management of UC especially in boys or in children with I-UC even though VUR was identified after EI. Source of Funding: none
MP55-09 LONG-TERM RESULTS AND SAFETY OF POLYACRYLAMIDE HYDROGEL FOR THE ENDOSCOPIC TREATMENT OF VESICOURETERAL REFLUX IN CHILDREN Sophie Ramsay*, Anne-Sophie Blais, Fannie Morin, Katherine Moore, phane Bolduc, Quebec City, Canada Ste INTRODUCTION AND OBJECTIVES: Various bulking agents are available for vesicoureteral reflux (VUR) endoscopic treatment, but