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MP-11.01 Laparoendoscopic Single-Site Surgery (LESS) In Paediatric Patients less than 5 Years of Age
MODERATED POSTER SESSIONS
Moderated Poster Session 11: Pediatric Urology Tuesday, October 18 13:15-14:45 MP-11.01 Laparoendoscopic Single-Site Surgery (LESS) In Paediatric Patients less than 5 Years of Age Ganpule A, Sinha L, Mishra S, Sabnis R, Desai M Muljibhai Patel Urological Hospital, Nadiad, India Introduction and Objective: There is paucity of literature regarding application of LESS in infants. We present our experience with LESS in the patients less than 5 years of age. Material and Methods: Ten patients (11 renal units) less than 5 years of age underwent LESS. Seven patients underwent nephrectomy (simple nephrectomy, n⫽3) and nephroureterectomy (n⫽4). Three patients underwent pyeloplasty. One pyeloplasty was done bilaterally, simultaneously—this was a 4-month-old infant. In all patients R-port™ was used through an umbilical incision. All procedures were done with straight instruments. The coaxial endoeye™camera was used in all cases. The hilum in all cases was secured with vascular clips, except one case in which a EndoGIA™stapler was used. For the pyeloplasty cases renogram is scheduled at 6 months. Results: In 10 patients (11 renal units) mean age was 3.14⫾1.9yrs (0.3-5years) The mean weight was 10.8⫾ 3.4 kg. In nephrectomy patients (n⫽7) operating room time (OR time) was 97.5⫾12.54min, mean age was 3.5⫾1.7yrs.Hospital stay was 3.83⫾1.69 days. No peroperative or postoperative complications were encountered. In pyeloplasty patients (n⫽3), OR time was192⫾47.16min, mean age was 2.43⫾2.3yrs, hospital stay was 7⫾3 days. In bilateral pyeloplasty OR time was 360min. The follow up renogram is awaited. Conclusion: LESS is safe and feasible in the paediatric population age less than 5 years. We feel improvement in port design and further miniaturization of instruments will help the progress of LESS in this group of patients. Subjectively, this technique has better cosmesis; however, this needs to be proven in further randomized studies.
S110
MP-11.02 The Role of Urodynamical Findings in the Management of Children’s Overactive Bladder Martha O1, Duicu C2, Kiss E2 1 Dept. ofUrology, UMPh Tg. Mures, Tirgue Mures, Romania; 2Clinic of Pediatric Nephrology, UMPh Tg. Mures, Tirgue Mures, Romania Introduction and Objectives: Overactive bladder (OAB): this filling phase dysfunction shows an increasing incidence. The aim of this retrospective study is to present, based on urodynamical findings, our experience concerning management possibilities and difficulties in children’s OAB. Materials and Methods: In a two-year period (between 2008 and June 2010) in the Urodynamic Unit of the Clinic of Urology Tg-Mures there were 107 flowmetries performed in 48 cases of children presenting OAB: 28 girls and 20 boys, 6.5 years (3.2-14 years). Besides urodynamics the diagnosis of OAB was based on: history taking (questionnaire), voiding diary, clinical examination, urine analysis and urine culture, ultrasound. In cases resistant to initial treatment we performed invasive urodynamics also. Results: Our findings showed increased micturition frequency in 4 (over 20 micturition), and 5 cases (15-20) reduced bladder capacity in a total of 29 cases (volume less than 100 ml), 6 patients (100-150 ml) , postvoid residual urine in 7 cases, urge incontinence in 22 cases (15 girls), nocturnal enuresis 5 patients (4 girls), urogenital congenital disorders in 5 cases (congenital hydronephrosis, low grade VUR). Regarding the values there were differences caused by age, but we found real high values of Qmax (30 ml/sec.) in cases of 8 girls (), in 10 cases the Qmax was on limit (values age and gender specific after Abrams). As of the shape of the curve our results revealed normal shape in 7 () cases, interrupted and irregular curves in 3 () cases.As the treatment modalities: urotherapy in all of the cases, 11 cases alfa blocking agents, 38 cases treated with anticholinergics (18 children-Oxybutinin, 10-Trospium chloride,10 caes-Solifenacin Succinate). Conclusions: Urodynamics are very useful in defining lower urinary tract conditions in children, and also in the proper management of these conditions, especially OAB. Although different anticholinergics, alfa blocker agents are used because of the fact that the level of evidence is low, new drugs and even randomized controlled trials (mainly for children under the age of 8) are needed.
MP-11.03 Screening for Mutations in Id2 Gene in Familial Hydronephrosis Aoki Y1,2, Sakai K3, Arai Y4, Yokoyama O1, Yokota Y2 1 Dept. of Urology, University of Fukui Faculty of Medical Sciences, Matsuoka, Japan; 2Dept. of Molecular Genetics, University of Fukui Faculty of Medical Sciences, Matsuoka, Japan; 3Dept. of Urology, Miyagi Children’s Hospital, Sendai, Japan; 4Dept. of Urology, Tohoku University School of Medicine, Sendai, Japan Introduction and Objectives: Among the gene-deficient mouse lines with hydronephrosis, Id2 mutant mice exhibit a battery of features more similar to that of human cases of ureteropelvic junction obstruction (UPJO) such as unilaterality and male preponderance. Furthermore, it is intriguing that haploinsufficiency of Id2 can cause hydronephrosis. These observations raise the possibility that Id2 is a gene responsible for the pathogenesis of congenital hydronephrosis in humans. To test this hypothesis, we investigated the Id2 gene locus of familial cases of hydronephrosis. Materials and Methods: After written informed consent was obtained, 28 individuals in 7 families with the history of hydronephsrosis were analyzed, including 7 bilateral UPJO, 6 unilateral UPJO, 1 ureterocelce, 1 refluxing megaureter. DNA purified from peripheral blood was subjected to PCR to amplify the genomic regions covering the exons and the 500 kb upstream promoter of the Id2 gene. PCR products were directly sequenced using ABI Prism BigDye® Terminator Cycle Sequencing Kit (Applied Biosystem, USA). The obtained sequences were compared with those deposited in the GenBank using BLAST search at National Center for Biotechnology Information. This study has been approved by an ethics committee of the University of Fukui. Results: Our analysis revealed no sequence alterations in the exons and the promoter region of Id2 gene in familial cases of hydronephrosis. Conclusions: The present study failed to detect a mutation in the genomic sequence of the Id2 gene. In previous studies, several genes have been nominated as a cause of human congenital hydroneprosis. More investigations should be carried out for unraveling the etiology of human congenital hydronephrosis.
UROLOGY 78 (Supplement 3A), September 2011
Moderated Poster Session 11: Pediatric Urology Tuesday, October 18 13:15-14:45 MP-11.01 Laparoendoscopic Single-Site Surgery (LESS) In Paediatric Patients less than 5 Years of Age Ganpule A, Sinha L, Mishra S, Sabnis R, Desai M Muljibhai Patel Urological Hospital, Nadiad, India Introduction and Objective: There is paucity of literature regarding application of LESS in infants. We present our experience with LESS in the patients less than 5 years of age. Material and Methods: Ten patients (11 renal units) less than 5 years of age underwent LESS. Seven patients underwent nephrectomy (simple nephrectomy, n⫽3) and nephroureterectomy (n⫽4). Three patients underwent pyeloplasty. One pyeloplasty was done bilaterally, simultaneously—this was a 4-month-old infant. In all patients R-port™ was used through an umbilical incision. All procedures were done with straight instruments. The coaxial endoeye™camera was used in all cases. The hilum in all cases was secured with vascular clips, except one case in which a EndoGIA™stapler was used. For the pyeloplasty cases renogram is scheduled at 6 months. Results: In 10 patients (11 renal units) mean age was 3.14⫾1.9yrs (0.3-5years) The mean weight was 10.8⫾ 3.4 kg. In nephrectomy patients (n⫽7) operating room time (OR time) was 97.5⫾12.54min, mean age was 3.5⫾1.7yrs.Hospital stay was 3.83⫾1.69 days. No peroperative or postoperative complications were encountered. In pyeloplasty patients (n⫽3), OR time was192⫾47.16min, mean age was 2.43⫾2.3yrs, hospital stay was 7⫾3 days. In bilateral pyeloplasty OR time was 360min. The follow up renogram is awaited. Conclusion: LESS is safe and feasible in the paediatric population age less than 5 years. We feel improvement in port design and further miniaturization of instruments will help the progress of LESS in this group of patients. Subjectively, this technique has better cosmesis; however, this needs to be proven in further randomized studies.
S110
MP-11.02 The Role of Urodynamical Findings in the Management of Children’s Overactive Bladder Martha O1, Duicu C2, Kiss E2 1 Dept. ofUrology, UMPh Tg. Mures, Tirgue Mures, Romania; 2Clinic of Pediatric Nephrology, UMPh Tg. Mures, Tirgue Mures, Romania Introduction and Objectives: Overactive bladder (OAB): this filling phase dysfunction shows an increasing incidence. The aim of this retrospective study is to present, based on urodynamical findings, our experience concerning management possibilities and difficulties in children’s OAB. Materials and Methods: In a two-year period (between 2008 and June 2010) in the Urodynamic Unit of the Clinic of Urology Tg-Mures there were 107 flowmetries performed in 48 cases of children presenting OAB: 28 girls and 20 boys, 6.5 years (3.2-14 years). Besides urodynamics the diagnosis of OAB was based on: history taking (questionnaire), voiding diary, clinical examination, urine analysis and urine culture, ultrasound. In cases resistant to initial treatment we performed invasive urodynamics also. Results: Our findings showed increased micturition frequency in 4 (over 20 micturition), and 5 cases (15-20) reduced bladder capacity in a total of 29 cases (volume less than 100 ml), 6 patients (100-150 ml) , postvoid residual urine in 7 cases, urge incontinence in 22 cases (15 girls), nocturnal enuresis 5 patients (4 girls), urogenital congenital disorders in 5 cases (congenital hydronephrosis, low grade VUR). Regarding the values there were differences caused by age, but we found real high values of Qmax (30 ml/sec.) in cases of 8 girls (), in 10 cases the Qmax was on limit (values age and gender specific after Abrams). As of the shape of the curve our results revealed normal shape in 7 () cases, interrupted and irregular curves in 3 () cases.As the treatment modalities: urotherapy in all of the cases, 11 cases alfa blocking agents, 38 cases treated with anticholinergics (18 children-Oxybutinin, 10-Trospium chloride,10 caes-Solifenacin Succinate). Conclusions: Urodynamics are very useful in defining lower urinary tract conditions in children, and also in the proper management of these conditions, especially OAB. Although different anticholinergics, alfa blocker agents are used because of the fact that the level of evidence is low, new drugs and even randomized controlled trials (mainly for children under the age of 8) are needed.
MP-11.03 Screening for Mutations in Id2 Gene in Familial Hydronephrosis Aoki Y1,2, Sakai K3, Arai Y4, Yokoyama O1, Yokota Y2 1 Dept. of Urology, University of Fukui Faculty of Medical Sciences, Matsuoka, Japan; 2Dept. of Molecular Genetics, University of Fukui Faculty of Medical Sciences, Matsuoka, Japan; 3Dept. of Urology, Miyagi Children’s Hospital, Sendai, Japan; 4Dept. of Urology, Tohoku University School of Medicine, Sendai, Japan Introduction and Objectives: Among the gene-deficient mouse lines with hydronephrosis, Id2 mutant mice exhibit a battery of features more similar to that of human cases of ureteropelvic junction obstruction (UPJO) such as unilaterality and male preponderance. Furthermore, it is intriguing that haploinsufficiency of Id2 can cause hydronephrosis. These observations raise the possibility that Id2 is a gene responsible for the pathogenesis of congenital hydronephrosis in humans. To test this hypothesis, we investigated the Id2 gene locus of familial cases of hydronephrosis. Materials and Methods: After written informed consent was obtained, 28 individuals in 7 families with the history of hydronephsrosis were analyzed, including 7 bilateral UPJO, 6 unilateral UPJO, 1 ureterocelce, 1 refluxing megaureter. DNA purified from peripheral blood was subjected to PCR to amplify the genomic regions covering the exons and the 500 kb upstream promoter of the Id2 gene. PCR products were directly sequenced using ABI Prism BigDye® Terminator Cycle Sequencing Kit (Applied Biosystem, USA). The obtained sequences were compared with those deposited in the GenBank using BLAST search at National Center for Biotechnology Information. This study has been approved by an ethics committee of the University of Fukui. Results: Our analysis revealed no sequence alterations in the exons and the promoter region of Id2 gene in familial cases of hydronephrosis. Conclusions: The present study failed to detect a mutation in the genomic sequence of the Id2 gene. In previous studies, several genes have been nominated as a cause of human congenital hydroneprosis. More investigations should be carried out for unraveling the etiology of human congenital hydronephrosis.
UROLOGY 78 (Supplement 3A), September 2011