A survey of management preferences for bladder exstrophy and cloacal anomalies among Canadian pediatric surgeons and urologists

Catherine Morgan; Mackenzie C Lees; Dawn L MacLellan; Christopher Blackmore; Rodrigo Lp Romao

doi:10.1016/j.jpedsurg.2021.12.044

A survey of management preferences for bladder exstrophy and cloacal anomalies among Canadian pediatric surgeons and urologists

J Pediatr Surg. 2022 May;57(5):816-823. doi: 10.1016/j.jpedsurg.2021.12.044. Epub 2022 Jan 14.

Authors

Catherine Morgan¹, Mackenzie C Lees², Dawn L MacLellan³, Christopher Blackmore², Rodrigo Lp Romao⁴

Affiliations

¹ Department of Family Medicine, McGill University, Queen Elizabeth Health Complex, 2100 Avenue de Marlowe, Montréal, QC, Canada, H4A 3L5.
² Division of Pediatric General and Thoracic Surgery, Department of Surgery, IWK Health, Dalhousie University, 5850 University Ave, PO BOX 9700, Halifax, NS, Canada, B3H 6R8.
³ Division of Pediatric Urology, Department of Urology, IWK Health, Dalhousie University, 5850 University Ave, PO BOX 9700, Halifax, NS, Canada, B3H 6R8.
⁴ Division of Pediatric General and Thoracic Surgery, Department of Surgery, IWK Health, Dalhousie University, 5850 University Ave, PO BOX 9700, Halifax, NS, Canada, B3H 6R8; Division of Pediatric Urology, Department of Urology, IWK Health, Dalhousie University, 5850 University Ave, PO BOX 9700, Halifax, NS, Canada, B3H 6R8. Electronic address: rodrigo.romao@iwk.nshealth.ca.

PMID: 35105453
DOI: 10.1016/j.jpedsurg.2021.12.044

Abstract

Purpose: This study examined the current referral patterns and preferences of Canadian Association of Paediatric Surgeons (CAPS) and Pediatric Urologists of Canada (PUC) members for management of bladder exstrophy and cloacal anomalies (BECA).

Methods: We invited CAPS and PUC members to participate in an online survey using RedCap. Demographic variables, years in practice, current referral patterns and local expertise at the participants' institution were collected. Participants' preferences towards three distinct referral models were assessed using Likert scales: no centralization of care, centralization in one or two national centres of excellence, or a consortium-based approach.

Results: There were 82 survey respondents (2/3 were CAPS members, 35.4% female, 72% in practice for >10 years). Although >90% of participants agreed/somewhat agreed that surgical volumes impact outcomes, 58% reported not referring out BECA patients for treatment; about 50% recognized the existence of a local dedicated expert. In terms of referral preferences, 84% of participants favoured identification of a few centres with expertise based on geographic location (a consortium-based approach), while only 7% chose a one or two national centres of excellence model. Over half of participants agreed/somewhat agreed with participating in trials of a consortium-based approach in Canada.

Conclusion: Most CAPS and PUC members do not refer BECA patients elsewhere for treatment. Nonetheless, most surgeons recognize the importance of volume to improve outcomes and show willingness to participate in trials to concentrate experience; most participants favour a consortium-based approach through identification of a few centres of excellence based on geographic location.

Keywords: Bladder exstrophy; Cloacal anomalies; Consortium; Survey.

MeSH terms

Bladder Exstrophy* / surgery
Canada
Child
Digestive System Abnormalities*
Female
Humans
Male
Surgeons*
Surveys and Questionnaires
Urogenital Abnormalities*
Urologists