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Can Regular Bladder Washouts and Acetylcysteine Instillation Prevent Stone Formation and Reduce Incidence of Urine Infections in the Augmented Bladder?
S92
ESPUN Programme 2008
# S1-5 (O) CAN REGULAR BLADDER WASHOUTS AND ACETYLCYSTEINE INSTILLATION PREVENT STONE FORMATION AND REDUCE INCIDENCE OF URINE INFECTIONS IN THE AUGMENTED BLADDER? Craig TAYLOR, Ramnath SUBRAMANIAM St.James University Hospital, Paediatric Urology, Leeds, UNITED KINGDOM
To monitor the effects of regular bladder washout regime and use of acetylcysteine in te prevention of stones and frequency of symptomatic urine infections in children post bladder augmentation.
any time for the management of severe mucous production. The clinical nurse specialists in our department have extended outdoor role with liaison in the community. The children and families are contacted regularly to ensure compliance and providing support to them as needed.
MATERIAL AND METHODS
RESULTS
19 children, 8 boys and 11 girls (mean age 13.54 years) who underwent augmentation cystoplasty with a mean followup of 37 months (11-98)were included. All of them were contacted with questionnaires. Information requested included frequency of bladder washouts both in the first three months after surgery and presently to date, type of solution used and whether acetylcysteine solution was prescribed ay
Frequency of bladder washouts varied considerably from once daily upto four times a day in the first 3 months. Following that the ferquency reduced significantly to once daily to not at all. All chldren used saline for the washouts. Wsahout dwell time was less tha 5 mins in 17 ans 5-10 mins in 2. 7 children used acetylcysteine in the 1st six weeks postoperatively. 13 children were taking prohylactic antibiotics. The incidence of
PURPOSE
bladder stones formation to date is zero. Incidence of symptomtic urine infection was less than 1 episode in a 6 month period in these children.
CONCLUSIONS Adhering strictly to postoperative bladder washout regimes indicates that NO children in this study have any evidence of bladder stone formation and the incidence of symptomatic urine infections was significantly reduced. The services of a clinical nurse specialist with outdoor liaison duties is invaluable to provision of such excellent standards of clinical care and outcomes and also in achieving good compliance from the children after major bladder reconstruction.
# S1-6 (O) CONTROL OF POST-OPERATIVE PAIN IN CHILDREN UNDERGOING HYPOSPADIAS AND PENILE CURVATURE SURGERY: QUASI-EXPERIMENTAL STUDY Donata DINI, Leonardo BUSSOLIN*, Dante Alfredo DANTIy, Antonio MESSINEOz, Filippo FESTINIz University of Florence, Dpt. of Paediatrics, Firenze, ITALY - *Meyer Children Hospital, Dept. of Anesthesiology, Florence, ITALY yMeyer Children Hospital, Dept. of Surgery, Florence, ITALY - zUniversity of Florence, Dept. of Pediatrics, Florence, ITALY
PURPOSE
MATERIAL AND METHODS
Hypospadias and penile curvature (HPC) are common congenital anomalies. If not surgically corrected they may negatively affect the quality of life of adolescents. Surgery is invasive and the post-operative phase is very painful. To obtain a good control of post-operative pain, the use of an epidural catheter to administer analgesia continuously was introduced. No studies are available about the efficacy of this method compared to the use of rectal and oral analgesia in children undergoing HPC surgery. Aim: To verify if in children undergoing HPC surgery, post-operative continuous analgesia with epidural catheter is more effective in controlling pain than traditional treatment.
Quasi-experimental controlled study. Convenience sample of children undergoing HPC surgery, admitted to the Surgical Department of Meyer Children Hospital (Florence, Italy) from January to April 2007.Children were divided into two groups: Group A was treated with tunneled epidural catheter and Group B treated with rectal analgesia at fixed time plus oral analgesia on demand. Nurses measured pain using VAS and FLACC scales (scores 0 to 10) for 72h after surgery.
Mean pain score of Group A was 0.13 (SD 0.8) and 0.42 (SD 1.4) in Group B, T-test p ¼ 0.02. Median duration of the epidural catheter was 65h, the mean 51.8 h (SD 24.3). 93 pain recordings during medication. During the first medication mean pain score in Group A was 1.5 (SD 1.8), 3.2 (SD 1.8) in Group B Ttest p¼0.01.
CONCLUSIONS RESULTS 41 children observed (mean age 64.1 months, SD 47.3), 332 post-operative pain recordings (Group A n¼161, Group B n¼171).
In children undergoing HPC surgery the use of continuous analgesia in epidural catheter seems to reduce pain compared to the use of traditional analgesic treatment.
ESPUN Programme 2008
# S1-5 (O) CAN REGULAR BLADDER WASHOUTS AND ACETYLCYSTEINE INSTILLATION PREVENT STONE FORMATION AND REDUCE INCIDENCE OF URINE INFECTIONS IN THE AUGMENTED BLADDER? Craig TAYLOR, Ramnath SUBRAMANIAM St.James University Hospital, Paediatric Urology, Leeds, UNITED KINGDOM
To monitor the effects of regular bladder washout regime and use of acetylcysteine in te prevention of stones and frequency of symptomatic urine infections in children post bladder augmentation.
any time for the management of severe mucous production. The clinical nurse specialists in our department have extended outdoor role with liaison in the community. The children and families are contacted regularly to ensure compliance and providing support to them as needed.
MATERIAL AND METHODS
RESULTS
19 children, 8 boys and 11 girls (mean age 13.54 years) who underwent augmentation cystoplasty with a mean followup of 37 months (11-98)were included. All of them were contacted with questionnaires. Information requested included frequency of bladder washouts both in the first three months after surgery and presently to date, type of solution used and whether acetylcysteine solution was prescribed ay
Frequency of bladder washouts varied considerably from once daily upto four times a day in the first 3 months. Following that the ferquency reduced significantly to once daily to not at all. All chldren used saline for the washouts. Wsahout dwell time was less tha 5 mins in 17 ans 5-10 mins in 2. 7 children used acetylcysteine in the 1st six weeks postoperatively. 13 children were taking prohylactic antibiotics. The incidence of
PURPOSE
bladder stones formation to date is zero. Incidence of symptomtic urine infection was less than 1 episode in a 6 month period in these children.
CONCLUSIONS Adhering strictly to postoperative bladder washout regimes indicates that NO children in this study have any evidence of bladder stone formation and the incidence of symptomatic urine infections was significantly reduced. The services of a clinical nurse specialist with outdoor liaison duties is invaluable to provision of such excellent standards of clinical care and outcomes and also in achieving good compliance from the children after major bladder reconstruction.
# S1-6 (O) CONTROL OF POST-OPERATIVE PAIN IN CHILDREN UNDERGOING HYPOSPADIAS AND PENILE CURVATURE SURGERY: QUASI-EXPERIMENTAL STUDY Donata DINI, Leonardo BUSSOLIN*, Dante Alfredo DANTIy, Antonio MESSINEOz, Filippo FESTINIz University of Florence, Dpt. of Paediatrics, Firenze, ITALY - *Meyer Children Hospital, Dept. of Anesthesiology, Florence, ITALY yMeyer Children Hospital, Dept. of Surgery, Florence, ITALY - zUniversity of Florence, Dept. of Pediatrics, Florence, ITALY
PURPOSE
MATERIAL AND METHODS
Hypospadias and penile curvature (HPC) are common congenital anomalies. If not surgically corrected they may negatively affect the quality of life of adolescents. Surgery is invasive and the post-operative phase is very painful. To obtain a good control of post-operative pain, the use of an epidural catheter to administer analgesia continuously was introduced. No studies are available about the efficacy of this method compared to the use of rectal and oral analgesia in children undergoing HPC surgery. Aim: To verify if in children undergoing HPC surgery, post-operative continuous analgesia with epidural catheter is more effective in controlling pain than traditional treatment.
Quasi-experimental controlled study. Convenience sample of children undergoing HPC surgery, admitted to the Surgical Department of Meyer Children Hospital (Florence, Italy) from January to April 2007.Children were divided into two groups: Group A was treated with tunneled epidural catheter and Group B treated with rectal analgesia at fixed time plus oral analgesia on demand. Nurses measured pain using VAS and FLACC scales (scores 0 to 10) for 72h after surgery.
Mean pain score of Group A was 0.13 (SD 0.8) and 0.42 (SD 1.4) in Group B, T-test p ¼ 0.02. Median duration of the epidural catheter was 65h, the mean 51.8 h (SD 24.3). 93 pain recordings during medication. During the first medication mean pain score in Group A was 1.5 (SD 1.8), 3.2 (SD 1.8) in Group B Ttest p¼0.01.
CONCLUSIONS RESULTS 41 children observed (mean age 64.1 months, SD 47.3), 332 post-operative pain recordings (Group A n¼161, Group B n¼171).
In children undergoing HPC surgery the use of continuous analgesia in epidural catheter seems to reduce pain compared to the use of traditional analgesic treatment.