Date of Presentation
5-4-2023 12:00 AM
College
School of Osteopathic Medicine
Poster Abstract
Background: It is estimated that 20-30% of congenital anomalies involve the kidney and ureter, and these rates are even higher in infants with low birth weights. Vesicoureteral reflux (VUR) occurs when there is a backflow of urine from the bladder to the kidney. Depending on severity, this condition may require surgical correction with ureteroneocystostomy (UNC). The impact of premature birth and presence of urogenital comorbidities on outcomes of UNC is not known. The objective of this study is to determine the relationship between premature birth and urogenital comorbidities with operative outcomes of UNC for VUR.
Methods: The 2020 American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database was analyzed for patients undergoing UNC for VUR. 1742 patients were evaluated with 1623 meeting inclusion criteria. The patients were divided into full term (>37 weeks gestation at birth) and preterm (birth). Patient demographics, comorbid conditions, urogenital comorbidities, and outcomes were evaluated. Further analysis of factors associated with ectopic ureter was performed.
Results: Out of 1623 UNC patients analyzed, 8.6% were preterm and 91.4% were full term. In basic statistics, bronchopulmonary dysplasia, esophageal/gastric/intestinal disease, developmental delay, structural CNS abnormality, neuromuscular disorder, nutritional support, congenital malformation, cardiac risk factors, ASA classification, gestational age, and urogenital comorbidities were significantly associated with prematurity. Univariate and multivariate analysis revealed that congenital malformation (p=0.007), major cardiac risk factors (p=0.002), and gestational age of 35-36 weeks are significantly associated with risk of ectopic ureter (p<0.001).
Conclusion: While prematurity alone is not associated with incidence of VUR, preterm patients undergoing UNC have a significantly higher risk of postoperative complications despite no differences in operative approach, VUR disease severity, and prior VUR procedure compared to full term patients undergoing this procedure. Preterm patients tend to have more comorbidities which may contribute to this finding. Ectopic ureter is associated with prematurity and factors such as congenital malformations and major cardiac risk factors may increase the risk for ectopic ureter in this population.
Keywords
Vesico-Ureteral Reflux, Premature Birth, Urogenital Abnormalities, Treatment Outcome, Postoperative Complications
Disciplines
Congenital, Hereditary, and Neonatal Diseases and Abnormalities | Medicine and Health Sciences | Pediatrics | Surgery | Surgical Procedures, Operative | Urogenital System | Urology
Document Type
Poster
Included in
Congenital, Hereditary, and Neonatal Diseases and Abnormalities Commons, Pediatrics Commons, Surgery Commons, Surgical Procedures, Operative Commons, Urogenital System Commons, Urology Commons
Association of Prematurity and Urogenital Comorbidities with Postoperative Outcomes of Ureteroneocystostomy for Vesicoureteral Reflux
Background: It is estimated that 20-30% of congenital anomalies involve the kidney and ureter, and these rates are even higher in infants with low birth weights. Vesicoureteral reflux (VUR) occurs when there is a backflow of urine from the bladder to the kidney. Depending on severity, this condition may require surgical correction with ureteroneocystostomy (UNC). The impact of premature birth and presence of urogenital comorbidities on outcomes of UNC is not known. The objective of this study is to determine the relationship between premature birth and urogenital comorbidities with operative outcomes of UNC for VUR.
Methods: The 2020 American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database was analyzed for patients undergoing UNC for VUR. 1742 patients were evaluated with 1623 meeting inclusion criteria. The patients were divided into full term (>37 weeks gestation at birth) and preterm (birth). Patient demographics, comorbid conditions, urogenital comorbidities, and outcomes were evaluated. Further analysis of factors associated with ectopic ureter was performed.
Results: Out of 1623 UNC patients analyzed, 8.6% were preterm and 91.4% were full term. In basic statistics, bronchopulmonary dysplasia, esophageal/gastric/intestinal disease, developmental delay, structural CNS abnormality, neuromuscular disorder, nutritional support, congenital malformation, cardiac risk factors, ASA classification, gestational age, and urogenital comorbidities were significantly associated with prematurity. Univariate and multivariate analysis revealed that congenital malformation (p=0.007), major cardiac risk factors (p=0.002), and gestational age of 35-36 weeks are significantly associated with risk of ectopic ureter (p<0.001).
Conclusion: While prematurity alone is not associated with incidence of VUR, preterm patients undergoing UNC have a significantly higher risk of postoperative complications despite no differences in operative approach, VUR disease severity, and prior VUR procedure compared to full term patients undergoing this procedure. Preterm patients tend to have more comorbidities which may contribute to this finding. Ectopic ureter is associated with prematurity and factors such as congenital malformations and major cardiac risk factors may increase the risk for ectopic ureter in this population.