Pd31-07 patients With Limited Genital Tissue Achieve Optimal Dilation Outcomes in Primary Robotic Peritoneal Flap Vaginoplasty

Abstract

INTRODUCTION AND OBJECTIVE: Hypertension (HTN) has a reported incidence of around 4% after pediatric renal trauma. Risk factors for long-term HTN include medial parenchymal lacerations, high AAST injury grade, and HTN in the acute postinjury period. Little is known about BP trends over time to guide decision-making on the duration of monitoring. We hypothesized that most postinjury HTN spontaneously resolves, with an incidence of sustained HTN similar to the general population.METHODS: We retrospectively reviewed records of all pediatric renal trauma patients (<18 years) who presented to our Level 1 trauma center from 2010-2019 for demographic, injury characteristics and follow-up data. Only routine follow-up visits were included. BPs were graded based on age-, sex-and height-normalized data to identify normotension, elevated BP (EBP), and HTN per age-appropriate guidelines. HTN is a subset of EBP. At least 3 follow-up BP readings was required for inclusion criteria.RESULTS: From a total of 179 patients, 97 met inclusion criteria. No patients were discharged on antihypertensives. Median follow-up duration was 32 (IQR 6-65) months. On follow-up, 67% were always normotensive and 33% had EBP. 23% had HTN. Of those with EBP, 41% had onset at injury with persistence, 31% had late onset after initial normotension, and 28% had initial EBP that later spontaneously resolved. The time to late onset or resolution of EBP/HTN was variable, occurring at respective means of 50 (SD 41) and 18.6 (SD 37.5) months. The incidence of postinjury EBP was significantly higher in males (p[0.003). No other variables had a statistically significant relationship with long-term EBP (Table 2). Four patients (11.4%) with EBP had this finding addressed at an outpatient visit. Two patients were started on antihypertensives by an outpatient provider in follow-up.CONCLUSIONS: Postinjury HTN is more common than previously reported, and is not routinely recognized or addressed when present in follow-up. Up to 1/3 of those with early HTN will have spontaneous resolution, but HTN can also develop in a delayed manner in some patients. Patient/parent counseling is important to raise awareness and encourage routine monitoring after discharge. Further work is necessary to determine risk factors for chronic HTN, and indications for long-term follow-up and medical intervention.