MP11-14 ACHIEVING GOAL CAPACITY FOR CONTINENCE SURGERY: A CUMULATIVE EVENT ANALYSIS OF BLADDER EXSTROPHY PATIENTS

BACKGROUND
Following successful closure of patients with classic bladder exstrophy (CBE), the next major milestone is the establishment of urinary continence. Prior to determining the most appropriate continence surgery, it is imperative to reach an adequate bladder capacity minimum of 100 cc in order to make the decision between bladder neck reconstruction (BNR) or continent stoma, with or without augmentation cystoplasty (AC).


OBJECTIVE
To examine the timing of when patients achieve threshold bladder capacity for BNR eligibility. We hypothesize most patients will achieve an adequate bladder capacity (100 cc) by 7 years old when continence surgeries will begin to be considered.


STUDY DESIGN
An institutional database of 1388 exstrophy patients was retrospectively reviewed for CBE patients after successful primary bladder closure. Bladder capacities were measured via gravity cystography and data presented as descriptive statistics. The cohort was stratified by location, neonatal (≤28 days) or delayed closure period and osteotomy status. The bladder capacities were categorized to either reaching goal or not and a cumulative event analysis was performed. The event being reaching 100 cc capacity or greater and time being the number of years between bladder closure and attainment of goal capacity.


RESULTS
253 patients met inclusion criteria between 1982 and 2019. The majority were of male gender (72.9%), had their closure performed at the authors' institution (52.5%), within the neonatal period (80.7%), and without an osteotomy (51.7%). 64.9% of patients reached goal bladder capacity. There were no significant differences in those who did or did not achieve goal except for clinical follow up. Cumulative event analysis demonstrated a median time of 5.73 years (95% CI 5.2-6.20) corresponded with a 50% event probability of reaching goal capacity. Cox-proportional hazards showed location of closure was significantly associated with hazards of reaching goal bladder capacity (HR = 0.58, CI 0.40-0.85, p = 0.005). Based on this model, the median time to event would be 5.20 years (95% CI 4.76-5.80) for cases done at the authors' hospital and 6.26 years for those performed at an outside hospital (95% CI 5.77-7.24).


CONCLUSIONS
These findings help surgeons counsel families appropriately on the odds of attaining goal capacity at various ages. For those who do not reach 100 cc by five years of age, it helps further characterize the odds of requiring a continent stoma with bladder augmentation and the best timing for reconstructive surgery in order to safely gain urinary continence. Families may also be assured that most patients would have the breadth of surgical options when it comes to continence as more than half of patients reached the bladder capacity threshold.

INTRODUCTION AND OBJECTIVE: Following successful closure of patients with classic bladder exstrophy (CBE), the next major milestone is the establishment of urinary continence. However, prior to determining the appropriate continence surgery, it is imperative to reach an adequate bladder capacity of 100 cc minimum in order to make the decision between bladder neck reconstruction (BNR) and continent stoma with or without augmentation cystoplasty (AC). The authors sought to examine the timing of when patients achieve this threshold bladder capacity to be eligible for BNR.
METHODS: An institutional database of 1388 exstrophy patients was retrospectively reviewed for CBE patients after successful primary bladder closure. Bladder capacities was measured via gravity cystography. The cohort was stratified by location, neonatal ( 28 days) or delayed closure period and osteotomy status. The bladder capacities were categorized to either reaching goal or not and a cumulative event analysis was performed. The event being reaching 100cc capacity or greater and time being the number of years between bladder closure and attainment of goal capacity.
RESULTS: Two hundred fifty-three patients met inclusion criteria from 1982 to 2019. The majority were of male gender (72.9%), had their closure performed at the authors' institution (52.5%), within the neonatal period (80.7%), and without an osteotomy (51.7%). 64.9% of patients reached goal bladder capacity. There were no significant differences in those who did or did not achieve goal except for clinical follow up. The cumulative event analysis demonstrated that a median time of 5.73 years (95% CI 5.2 e 6.20) corresponded with a 50% event probability of reaching goal capacity. Coxproportional hazards showed location of closure was significant associated with hazards of reaching goal bladder capacity (HR [ 0.58, CI 0.40 e 0.85, p [ 0.005). Based on this model, the median time to event would be 5.20 years (95% CI 4.76 e 5.80) for cases done at the authors' hospital and 6.26 years for those performed at an outside (95% CI 5.77 e 7.24).
CONCLUSIONS: These findings help counsel families appropriately on the odds of attaining goal capacity at various ages. For those who do not reach 100cc by 5 years of age, it helps further characterize the odds of requiring bladder augmentation and the best timing for reconstructive surgery in order to safely gain urinary continence. Families may also be assured that most patients would have the breadth of options when it comes to continence surgery as more than half of patients reached the bladder capacity threshold.

MP11-15 PATIENT REPORTED REASONS FOR DELAYED PRESENTATION TO HOSPITAL WITH TORSION AND IMPACT ON TESTICULAR OUTCOMES
Thawatchai Mangonsrisuk, Nicholas Mitsakakis, Luis Guerra, Melise Keays*, Ottawa, Canada INTRODUCTION AND OBJECTIVE: Population based studies demonstrate that over one third of children and teenagers with testicular torsion lose their testicle due to advanced presentation. Validated scores and expedited pathways have been published to decrease hospital (system delays) to definitive OR. While pre-hospital delays tend to be longer than hospital delays in torsion, very little research has focused on patient-centered reasons for delay in seeking care. Objective: Evaluate patient-reported symptoms and reasons for delay to presentation to hospital and assess their impact on testicular torsion viability (based on pathology review or post-operative atrophy).
METHODS: Electronic health records of children <18 years with ICD-9 diagnosis of testicular torsion and ICD-10 procedure of orchiectomy or orchidopexy in a single academic pediatric hospital from 2010 to 2020 were reviewed. Elective orchidopexy cases or confounding diagnoses were excluded. Demographic data, prehospital pain duration, patients' activity at onset, reasons for delayed presentation, system delays (time from ER triage to surgery), and testicular outcomes were extracted. Poor testicular outcomes including non-viability confirmed by pathologic review or when >50% atrophy seen on post-operative follow-up.
CONCLUSIONS: Pre-hospital patient delays are significantly longer than hospital delays to definitive surgical correction for testicular torsion and increase risk of testicular loss or atrophy. While urologists play a key role in increasing awareness of testicular torsion and improving system delays to definitive care, this study highlights the need for broader educational campaigns targeting patients and parents to promote earlier presentation to hospital.