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The megasurvey: International survey on the current practices in surgical management of primary obstructed megaureter
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
741
The megasurvey: International survey on the current practices in surgical management of primary obstructed megaureter Eur Urol Suppl 2017; 16(3);e1283
Sanchez O.1, Lumpkins K.2, Silay S.3, Peycelon M.4, Gopal M.5, Smith C.6, Radford A.6, Tonnhofer U.7, Haid B.8, Spinoit A-F.9 1
Geneva University Hospital, Dept. of Pediatric Surgery, Geneva, Switzerland, 2University of Maryland School of Medicine, Dept. of Pediatric Surgery and Urology, Baltimore, United States of America, 3 Istanbul Medeniyet University, Dept. of Pediatric Urology, Dept. of Urology, Istanbul, Turkey, 4Hopital Robert Debré, APHP, Dept. of Pediatric Urology, Paris, France, 5The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Dept. of Pediatric Urology, Newcastle, United Kingdom, 6Leeds Children’s Hospital, Dept. of Pediatric Urology, Leeds, United Kingdom, 7Vienna General Hospital, Dept. of Pediatric Urology, Dept. of Pediatric Surgery, Vienna, Austria, 8Sisters of The Charity Hospital, Dept. of Pediatric Urology, Linz, Austria, 9Ghent University Hospital, Dept. of Urology, Ghent, Belgium INTRODUCTION & OBJECTIVES: Most published guidelines (EAU, ESPU, BAPU consensus statement) advocate ureteral re-implantation with possible tapering as the definitive surgical treatment in patients presenting with a primary obstructive megaureter(POM). These guidelines mostly consider stenting only as a temporising procedure in younger patients. A growing body of literature is advocating for minimally invasive approaches in POM. The aim of this study is to assess current practice. MATERIAL & METHODS: A scenario-based questionnaire built to assess intervention criteria and surgical options was sent out to paediatric urologists directly or through national societies mailing lists thanks to the Young Paediatric Urologists network. Two cases presented worsening dilation and loss of function and third case presented an infection secondary to POM. Responders where asked to choose between minimally invasive surgical (MIS) techniques (endoscopic, laparoscopic or robotic), ureteroneocystostomy or ureterocutaneostomy. RESULTS: 123 answers were collected from pediatric urologists practising in 30 countries all over the world, mostly from Europe (59%) and North America (28%). 77% of responders were consultant or professor grade urologists, and 2/3 working in centres with at least 4 full time pediatric urologists. In contrast with current published recommendations, 18% and 62% of North American and European responders respectively would consider endoscopic or minimally invasive approches as a primary treatment option for POM. 34% of all hypothesised cases would receive either a temporary or definitive minimally invasive treatment. CONCLUSIONS: Although recently published guidelines describe transvesical ureteroneocystostomy as the main surgical option for POM, about a third of responders would offer MIS approach to their patients.
Eur Urol Suppl 2017; 16(3);e1283 Powered by TCPDF (www.tcpdf.org)
741
The megasurvey: International survey on the current practices in surgical management of primary obstructed megaureter Eur Urol Suppl 2017; 16(3);e1283
Sanchez O.1, Lumpkins K.2, Silay S.3, Peycelon M.4, Gopal M.5, Smith C.6, Radford A.6, Tonnhofer U.7, Haid B.8, Spinoit A-F.9 1
Geneva University Hospital, Dept. of Pediatric Surgery, Geneva, Switzerland, 2University of Maryland School of Medicine, Dept. of Pediatric Surgery and Urology, Baltimore, United States of America, 3 Istanbul Medeniyet University, Dept. of Pediatric Urology, Dept. of Urology, Istanbul, Turkey, 4Hopital Robert Debré, APHP, Dept. of Pediatric Urology, Paris, France, 5The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Dept. of Pediatric Urology, Newcastle, United Kingdom, 6Leeds Children’s Hospital, Dept. of Pediatric Urology, Leeds, United Kingdom, 7Vienna General Hospital, Dept. of Pediatric Urology, Dept. of Pediatric Surgery, Vienna, Austria, 8Sisters of The Charity Hospital, Dept. of Pediatric Urology, Linz, Austria, 9Ghent University Hospital, Dept. of Urology, Ghent, Belgium INTRODUCTION & OBJECTIVES: Most published guidelines (EAU, ESPU, BAPU consensus statement) advocate ureteral re-implantation with possible tapering as the definitive surgical treatment in patients presenting with a primary obstructive megaureter(POM). These guidelines mostly consider stenting only as a temporising procedure in younger patients. A growing body of literature is advocating for minimally invasive approaches in POM. The aim of this study is to assess current practice. MATERIAL & METHODS: A scenario-based questionnaire built to assess intervention criteria and surgical options was sent out to paediatric urologists directly or through national societies mailing lists thanks to the Young Paediatric Urologists network. Two cases presented worsening dilation and loss of function and third case presented an infection secondary to POM. Responders where asked to choose between minimally invasive surgical (MIS) techniques (endoscopic, laparoscopic or robotic), ureteroneocystostomy or ureterocutaneostomy. RESULTS: 123 answers were collected from pediatric urologists practising in 30 countries all over the world, mostly from Europe (59%) and North America (28%). 77% of responders were consultant or professor grade urologists, and 2/3 working in centres with at least 4 full time pediatric urologists. In contrast with current published recommendations, 18% and 62% of North American and European responders respectively would consider endoscopic or minimally invasive approches as a primary treatment option for POM. 34% of all hypothesised cases would receive either a temporary or definitive minimally invasive treatment. CONCLUSIONS: Although recently published guidelines describe transvesical ureteroneocystostomy as the main surgical option for POM, about a third of responders would offer MIS approach to their patients.
Eur Urol Suppl 2017; 16(3);e1283 Powered by TCPDF (www.tcpdf.org)