226 / 238
226
29
th
CONGRESS OF THE ESPU
MATERIAL AND METHODS
Single-centre retrospective case-note and imaging review of patients managed with SPB drainage
between 2007 and 2017. A 12 Fr MINI
TM
gastrostomy button (off-licence use) was inserted primarily
or following a pre-existent supra-pubic catheter/ vesicostomy, and changed 6-monthly in an out-
patient setting. Bladders were cycled 2–3 hourly by day and overnight drainage.
RESULTS
Eighteen patients had an SPB inserted at a median age of 47 (0.1–142) months. Diagnoses were
PUV (4), urethral atresia (1), triad syndrome (1), cloacal anomaly (3), anorectal malformation (2),
intestinal failure/ hypocontractile bladder (4), neuropathic bladder (3). Indications were failure to
CIC urethrally (11) or anatomic anomaly precluding CIC (5). Complications were colonisation/ urine
infection (10), leakage (7), bladder spasm (2) and false passage (1). At a median 5 (0.7–10) year
follow-up, the button was removed in 4 (2 replaced by Mitrofanoff and 2 neuropaths voiding nor-
mally). Upper tract dilatation improved in 5, deteriorated in 2 and stabilised in 11. Only one patient
with high-grade VUR developed a new scar on follow-up DMSA.
CONCLUSIONS
SPB bladder drainage is a safe second-line option to urethral CIC fails. It avoids the social and skin
problems associated with a vesicostomy and effectively tides patients over until more definitive
surgery is required. The main disadvantages are cost (although less than that of CIC catheters for
6 months) and risk of colonisation/ infection.
12:30–12:40
S2-4 (LO)
SAFETY AND EFFICACY OF INTRAVESICAL GENTAMICIN
THERAPY IN PAEDIATRIC PATIENTS WITH COMPLEX
UROLOGICAL CONDITIONS
David KEENE
1
, Beverley WHITNALL
2
and Liz EDWARDS
2
1) Royal Manchester Children's Hospital, Paediatric Urology, Manchester, UNITED KINGDOM - 2) Royal Manchester
Children's Hospital, Department of Paediatric Urology, Manchester, UNITED KINGDOM
PURPOSE
Intra-vesical gentamicin therapy (IGT) has been used in adult cystitis patients and paediatric pa-
tients with complex urological conditions (Defoor, J.Urol.2006;175(5):1861–4). The authors aimed
to compare the safety and efficacy data with published literature.
MATERIAL AND METHODS
A prospective study was performed in a single institution between 2016 and 2017. A treatment
course was twice a day for 7 days. A prophylactic course was 3 times a week for up to 6 months.
Gentamicin 40 mg was added to 100 mls urotainer and instilled into an empty bladder by gravity
over 5 minutes. The bladder was emptied after 1 hour. Gentamicin levels were performed 1 hour
after the IGT on days 1, 3 and 7. Chi-squared test was used to compare the outcomes (elevated
gentamicin level and breakthrough UTI) between this cohort and published literature.
RESULTS
17 patients were commenced on IGT for recurrent urinary tract infections (10 treatment courses
for current symptomatic UTIs and 11 prophylactic courses). Underlying conditions included neuro-
pathic bladder (6), bladder exstrophy (4), posterior urethral valves (3), cloacal anomaly (1), revision
pyeloplasty (1), severe overactive bladder (1). 4 patients stopped IGT early (2 breakthrough UTIs,
1 developed diarrhoea, 1 gentamicin resistance).