ESPU Meeting on Thursday 4, September 2025, 08:50 - 09:50
08:50 - 08:53
S10-1 (OP)
Jin Kyu (Justin) KIM 1, Mandy RICKARD 2, Rosalia MISSERI 1, Benjamin WHITTAM 1, Pramod REDDY 3, Andrew STRINE 3, Brian VANDERBRINK 3, Daryl MCLEOD 4, Rama JAYANTHI 4, Carol DAVIS-DAO 5, Antoine KHOURY 5, Peter WANG 6, Sumit DAVE 6, Timothy BOSWELL 7, Brenton BICKNELL 7, Joana DOS SANTOS 2, Michael CHUA 2, Armando LORENZO 2 and Konrad SZYMANSKI 1
1) Riley Hospital for Children, Urology, Indianapolis, USA - 2) The Hospital for Sick Children, Urology, Toronto, CANADA - 3) Cincinnati Children's Hospital, Urology, Cincinnati, USA - 4) Nationwide Children's Hospital, Urology, Columbus, USA - 5) Children's Hospital of Orange County, Urology, Orange County, USA - 6) Western University, Urology, London, CANADA - 7) Children's of Alabama, Urology, Birmingham, USA
PURPOSE
There are limited means to predict clinically significant renal outcomes in children with posterior urethral valve (PUV). The PURK score uses variables available at initial presentation and was shown to predict progression to renal replacement therapy (RRT). It has been shown that progression to RRT is also associated with serum creatinine nadir in the first year of life (SCN1). Herein, we aim to externally validate the PURK score and to compare it to SCN1 for RRT progression.
MATERIAL AND METHODS
A multi-center review of PUV patients (treated before 90 days of life without progressing to RRT in first 14 days of life) across eight North American centers was performed. PURK scores were calculated (failure-to-thrive, baseline Cr, renal dysplasia, high grade VUR) and prognostic value in predicting progression to RRT was compared to SCN1 using the area under receiver operating characteristics curve (AUROC) and Kaplan-Meier survival curves (KMSC).
RESULTS
Of 402 boys diagnosed with PUV at a median of 12 days (median follow up: 9.5 years, IQR 9.5-13.0), 45 (12.2%) progressed to RRT. RRT risk was 12.5% at 5 years and 24.8% at 10 years. PURK/SCN1 risk groups were: low (PURK 0-1/SCN1 ≤0.4), intermediate (PURK 2-3/SCN1 0.4-0.8), high (PURK ≥4/SCN1 ≥0.8). PURK and SCN1 had similar performance with AUROC of 0.837 (95%CI 0.785-0.890) vs. 0.878 (95%CI 0.809-0.947; p=0.349) at 5-years and of 0.828 (95%CI 0.776-0.880) vs. 0.892 (95%CI 0.837-0.947; p=0.090) at 10-years. KMSC demonstrated better discrimination of risk groups for earlier outcomes5 years for SCN1.
CONCLUSIONS
Both PURK and SCN1 has prognostic value for RRT progression. PURK score can be calculated at the time of initial presentation and provides an earlier prognostic utility comparable to SCN1; however, SCN1 may provide better discrimination of long-term high-risk patients.
08:53 - 08:56
S10-2 (OP)
Jin Kyu (Justin) KIM 1, Konrad SZYMANSKI 1, Rosalia MISSERI 1, Pramod REDDY 2, Andrew STRINE 2, Brian VANDERBRINK 2, Daryl MCLEOD 3, Rama JAYANTHI 3, Priyank YADAV 4, Mohd Sualeh ANSARI 4, Carol-Davis DAO 5, Antoine KHOURY 5, Assia COMELLA 6, Kiarash TAGHAVI 6, Rival KATTANI 6, Christopher BITCON 7, Daniel KEEFE 7, Peter WANG 8, Sumit DAVE 8, Timothy BOSWELL 9, Brenton BICKNELL 9, Paul MERGUERIAN 10, Adree KHONDKER 11, Joana DOS SANTOS 11, Michael CHUA 11, Armando LORENZO 11 and Mandy RICKARD 11
1) Riley Hospital for Children, Urology, Indianapolis, USA - 2) Cincinnati Children's Hospital, Urology, Cincinnati, USA - 3) Nationwide Children's Hospital, Urology, Columbus, USA - 4) Sanjay Gandhi Postgraduate Institute of Medical Sciences, Urology, Lucknow, INDIA - 5) Children's Hospital of Orange County, Orange County, USA - 6) Monash Children's Hospital, Urology, Clayton, AUSTRALIA - 7) IWK Health, Urology, Halifax, CANADA - 8) Western University, Urology, London, CANADA - 9) Children's of Alabama, Urology, Birmingham, USA - 10) Seattle Children's Hospital, Urology, Seattle, USA - 11) The Hospital for Sick Children, Urology, Toronto, CANADA
PURPOSE
The Posterior Urethral Valve Risk of Chronic Kidney Disease (PURK) score, introduced in 2023, is the first prognostic system to identify children with posterior urethral valve (PUV) at high risk for chronic kidney disease (CKD) stage ≥3 at 1- or 5-years of age. The score is calculated based on initial presentation clinical variables (Table), and it showed promise in early external validation studies. We aimed to validate the score's robustness across 11 international academic centers.
| Clinical variable at presentation | Points per variable |
| Baseline Cr >150µmol/L (1.7 mg/dL) | Yes (+2 Points) |
| Failure to thrive | Yes (+2 Points) |
| High grade VUR (≥3) on VCUG | Yes (+1 Points) |
| Renal dysplasia on US | Yes (+1 Points) |
| Total score | /6 |
MATERIAL AND METHODS
We collected data from 11 pediatric centers across Canada (n=3), the United States (n=6), India (n=1), and Australia (n=1). Clinical variables were used to calculate PURK scores, and its prognostic value was assessed using the area under the receiver operating characteristic curve (AUROC).
RESULTS
The prospective internal validation cohort consisted of 51 new patients, while the external validation cohort included 341 patients. In the internal validation cohort, AUROC for predicting CKD ≥3 was 0.897 (95% CI 0.795–0.998) at 1 year (38 patients) and 0.824 (95% CI 0.646–1.002) at 5 years (20 patients). In the external validation cohort, AUROC was 0.844 (95% CI 0.790–0.898) at 1 year (228 patients) and 0.838 (95% CI 0.773–0.903) at 5 years (182 patients). Geographic subgroup analyses (Canada, USA, Australia, India) also confirmed significant prognostic value, with AUROC ranging from 0.827–0.960.
CONCLUSIONS
The PURK score's excellent prognostic value across diverse international cohorts supports its use in clinical settings for counseling and risk stratification. PURK score reporting in publications should also be strongly encouraged to ensure fair outcome comparisons across the spectrum of PUV.
08:56 - 08:59
S10-3 (OP)
Timothy C. BOSWELL 1, Mandy RICKARD 2, Alireza ALAM 3, Kevin BLAINE 4, Gabriel CARRENO 5, David A. CHAMBERLIN 6, Joshua D. CHAMBERLIN 6, Kai-Wen CHUANG 7, Laura CORNWELL 8, Sumit DAVE 9, Carol DAVIS-DAO 7, Joana R. DOS SANTOS 2, Nicholas FERNANDEZ 10, Janelle A. FOX 11, Joshua HARVEY 12, Kathy H. HUEN 13, Jin Kyu KIM 2, Armando J. LORENZO 2, Paul A. MERGUERIAN 10, Heidi A. STEPHANY 7, Juanita VELASQUEZ OSPINA 14, Zhan Tao Peter WANG 9, Elias J. WEHBI 7 and Antoine E. KHOURY 7
1) Children's of Alabama, University of Alabama Birmingham, Division of Pediatric Urology, Birmingham, USA - 2) Hospital for Sick Children, Department of Urology, Toronto, CANADA - 3) University of Miami, Miller School of Medicine, Department of Urology, Miami, USA - 4) Children's Hospital of Orange County, Research Institute, Orange, USA - 5) University of Louisville, Department of Urology, Louisville, USA - 6) Loma Linda University Health, Department of Urology, Loma Linda, USA - 7) Children's Hospital of Orange County, Division of Pediatric Urology, Orange, USA - 8) Norton Children's Hospital; University of Louisville, Department of Urology, Louisville, USA - 9) Western University; London Health Sciences Centre, Department of Urology, London, CANADA - 10) Seattle Children's Hospital, Division of Urology, Seattle, USA - 11) Children's Hospital of the King's Daughters, Division of Urology, Norfolk, USA - 12) Children's Hospital of the King's Daughters; Eastern Virginia Medical School, Division of Urology, Norfolk, USA - 13) University of California Los Angeles, Department of Urology, Los Angeles, USA - 14) Nicklaus Children's Hospital, Division of Pediatric Urology, Miami, USA
PURPOSE
Nadir creatinine is the best-established predictor of chronic kidney disease (CKD) in PUV. However, it can take months to determine the nadir Cr. Therefore, earlier predictors of CKD are needed for guiding early management. We evaluated the utility of creatinine velocity (Cvel) over the first 5 days after presentation for predicting CKD in PUV.
MATERIAL AND METHODS
PUV patients from 10 institutions were retrospectively reviewed and those presenting under 72 hours of life with minimum 1 year follow-up were included. Cvel was calculated as the slope of Cr values over 5 days after initial bladder drainage. The outcome was CKD stage 2+ (eGFR<90 mL/min/1.73m2) at one and/or five years.
RESULTS
Of 427 PUV patients identified, 118 were eligible (Table 1). At 1 year, 55% (56/102) had CKD 2+, as did 67% (48/72) at 5 years. Cvel correlated with CKD 2+ at 1 year with AUC of 0.72, compared to nadir Cr AUC of 0.88, with significant difference on test of equality (p=0.002). At 5 years, the Cvel AUC was 0.82, similar to nadir Cr AUC of 0.83 (p=0.85). 63% of those with eGFR>90 at 5 years had a Cvel with a decreasing slope. 90% of patients with eGFR<15 at 5 years had Cvel with a rising slope.
| Table 1: PUV Patient Characteristics (n = 118) | |
| Median gestational age (weeks) | 37 (IQR 35-38) |
|
Oligohydramnios Anhydramnios |
47 (40%) 12 (10%) |
|
Dysplasia on ultrasound None Unilateral Bilateral |
41 (35%) 5 (4%) 72 (61%) |
|
High-grade VUR None Unilateral Bilateral |
45 (39%) 41 (35%) 31 (26%) |
| Median age at initial surgery (days) | 8 (IQR 5-16) |
CONCLUSIONS
In a multicenter study of PUV patients with prompt care after birth, Cvel was predictive of 1- and 5-year CKD2+ and was indistinguishable from nadir Cr for 5-year outcomes. Cvel may provide critical early risk stratification for PUV management within the first days of life.
09:11 - 09:14
S10-4 (OP)
Zeynep Merve GÖKBUGET 1, Ali̇ Ekber HAKALMAZ 1, Elçi̇n GÜLBAL 1, Ayşe KALYONCU UÇAR 2, Ayşe AĞBAŞ 3, Yunus SÖYLET 4, Mehmet ELİÇEVİK 4 and Haluk EMİR 4
1) Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Pediatric Surgery, İstanbul, TÜRKIYE - 2) Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Radiology, Division of Pediatric Radiology, İstanbul, TÜRKIYE - 3) Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, İstanbul, TÜRKIYE - 4) Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Pediatric Surgery, Division of Pediatric Urology, İstanbul, TÜRKIYE
INTRODUCTION
Voiding cystourethrography (VCU) is an invasive diagnostic tool for posterior urethral valve (PUV) cases, associated with risks such as radiation exposure, urethral injury, and urinary tract infections (UTIs). This study evaluates the necessity of VCU in PUV management.
PATIENTS AND METHODS
A retrospective review was conducted on 43 newborns and infants diagnosed with PUV confirmed by cystoscopy (2013-2024). Thirty-six had prenatal ultrasound suspicion, while others presented with clinical symptoms (UTI). Patients were divided into two groups: Group1 (n=22) underwent VCU before cystoscopy, while Group2 (n=21) proceeded directly to cystoscopy. Clinical, ultrasound, and follow-up data were compared.
RESULTS
The mean age at cystoscopy was 55.2days (Group1) and 41days (Group2). All patients had increased bladder wall tichkness, in both groups together with bilateral hydronephrosis/hydroureteronephrosis (HN/HUN) (18 in Group1, 19 in Group2) or unilateral HUN and patient with bilateral urinoma. VCU confirmed PUV in 12 (54%) of Group1.
However, cystoscopy identified PUV in all cases, including those with negative VCU. PUV types: TypeI (n=33; 14 in Group2), TypeIII (n=8; 7 in Group2), and TypeI+III (n=2, Group1). Valve ablation was performed using a cold knife.
During follow-up (mean 5years), seven Group2 patients required delayed VCU (mean 5months), with one needing surgery for persistent HN.
HN/HUN regressed in 30 patients (15 in Group2), remained stable in 11 (4 in Group2), progressed in 2 (one per group).
CONCLUSIONS
Diagnosing and treatment of PUV are multifactorial processes. Our clinical results support; cystoscopic evaluation and treatment of suspected PUV without preoperative VCU is a safe method, especially in newborn and infants.
09:14 - 09:17
S10-5 (OP)
Mandy RICKARD 1, Armando J. LORENZO 1, Mirriam MIKHAIL 1, Beverly MIRANDA 1, Noreen GORAYA 2, Jin Kyu KIM 3, Adree KHONDKER 1, Rodrigo ROMAO 1, Joao PIPPI SALLE 1, Nithiakishna SELVATHESAN 4, Michael CHUA 1 and Joana DOS SANTOS 1
1) SickKids, Urology, Toronto, CANADA - 2) SickKids, Social Work, Toronto, CANADA - 3) Riley Children's Hospital, Urology, Indianopolis, USA - 4) Sickkids, Nephrology, Toronto, CANADA
PURPOSE
Post-obstructive diuresis(POD) may develop following relief of obstruction in children with PUV. Herein, we aim to identify risk factors associated with the development of POD and associated outcomes.
MATERIAL AND METHODS
Retrospective review of database from 2018-2024, including children <2 yearswith complete urine output recordings. We collected data on age at presentation, duration of initial catheterization, surgery, length of stay(LOS), urine outputs, ultrasounds, serum creatinine(sCr) and progression to CKDand KRT. POD was defined as urine output of >5cc/kg/hr for more than 2 consecutive hours.
RESULTS
A total of 67 patients were included, 30with POD. Age at presentation, and oligohydramnios were similar, but POD patients had longer LOS and catheter duration. POD cases had higher sCr at baseline(135 [86] vs. 66 [48];p<0.01) and SFU 3-4 hydronephrosis(54% vs. 46%;p=0.02); however, post interventional sCr and US parameters were similar as was CKD and KRT rates(Table). Maximum urine output post-catheterization/post-diversion was significantly higher in the POD group(10.4cc/kg vs. 2.1cc/kg/hr; p<0.01). POD occurred at 8 days of age and was post diversion in53%, in contrast to 40% with bladder decompression and 7% after anticholinergics(p=0.03).
CONCLUSIONS
POD is more frequent with higher sCr, severe hydronephrosis and primary diversions, aligning as an indicator of urinary obstruction severity. POD is not associated with worse long-term kidney function. POD is an important consideration in the early management of PUV, potentially guiding surgical decisions.
| POD (n=30) | No POD (n=37) | p | |
| Age at presentation (days) (IQR) | 2 (7) | 4 (30) | 0.25 |
| Oligo/anhydramnios | 11 (37%) | 11 (30) | 0.43 |
| LOS | 16 (20) | 9 (8) | <0.01 |
| SFU 3-4 initial | 26 (54) | 22 (46) | 0.02 |
| Initial creatinine | 135 (86) | 66 (48) | <0.01 |
|
Diversion |
22 (73) | 12 (33) | <0.01 |
| Creatinine 1 year | 26 (15) | 25 (7) | 0.17 |
| CKD >3 | 4 (13) | 6 (13) | 1.00 |
| KRT | 0 (0) | 4 (11) | 0.12 |
| Follow up time | 1079 (1496) | 1260 (956) | 0.09 |
09:17 - 09:20
S10-6 (OP)
Patricia BUGEDA GÓMEZ 1, Isabel CASAL BELOY 2, Laura DÍAZ MENÉNDEZ 3 and Rosa ROMERO RUIZ 2
1) Complejo Hospitalario Universitario Insular Materno infantil, Pediatric Surgery Department, Las Palmas De Gran Canaria, SPAIN - 2) Hospital Infantil Virgen del Rocío, Pediatric Surgery Department, Pediatric Urology Unit, Sevilla, SPAIN - 3) Hospital Infantil Virgen del Rocío, Pediatric Surgery Department, Sevilla, SPAIN
PURPOSE
The value of follow-up cystoscopy after posterior urethral valve (PUV) ablation has not been demonstrated. In 2017, routine check-cystoscopy (CC) 2-3 months after initial valve ablation was included as part of the posterior urethral valves (PUV) protocol to check and treat valve remnants. We aim to evaluate the impact of CC medium-term outcomes.
MATERIAL AND METHODS
Retrospective cohort study analyzing medical records of PUV patients from 1995 to 2023. The cohort was divided into two groups: Group 1, patients with CC as part of their management, and Group 2, without CC. We excluded patients with urinary diversion due to its potential influence on bladder function. We compared renal function, bladder function, and urinary tract infections (UTIs) between groups.
RESULTS
A total of 127 patients were included (type I n=126 and type 3 n=1). In Group 1, 63 patients (52.8%) were included. At initial cystoscopy, incomplete valve ablation was suspected in only 11 patients (17.5%). However, at CC, 33 patients (52.4%) had a repeat transurethral resection. Baseline demographic and clinical variables were comparable between groups. With a mean follow-up of 5 years (1-22), Group 1 showed lower rates of voiding dysfunction requiring clean intermittent catheterization (CIC) (8.1% vs 22.5%, p<0.005) and postoperative UTIs (28.6% vs 47.5%, p<0.005) compared to Group 2.
CONCLUSIONS
Check-cystoscopy in patients with PUV demonstrates a higher-than-expected rate of valve remnants. Routine CC in the management of children with PUV may lead to better functional and clinical outcomes, as they experience less voiding dysfunction requiring CIC and UTIs.
09:32 - 09:35
S10-7 (OP)
Mandy RICKARD 1, Joana DOS SANTOS 1, Mirriam MIKHAIL 1, Beverly MIRANDA 1, Noreen GORAYA 2, Jin Kyu KIM 3, Adree KHONDKER 1, Rodrigo ROMAO 1, Joao PIPPI SALLE 1, Nithiakishna SELVATHESAN 4, Michael CHUA 1 and Armando J. LORENZO 5
1) SickKids, Urology, Toronto, CANADA - 2) SickKids, Social Work, Toronto, CANADA - 3) Riley Children's Hospital, Urology, Indianapolis, USA - 4) SickKids, Nephrology, Toronto, CANADA - 5) 555 University Ave, Urology, Toronto, CANADA
PURPOSE
Urinary extravasation in PUV patients (urinomas/ascites), are thought to be related to high detrusor pressures secondary to infra-vesical obstruction. If so, it is reasonable to expect VUR on the side of the leak. We explored characteristics and outcomes in urinomas and ascites with and without VUR to test this hypothesis.
MATERIAL AND METHODS
Retrospective review of a prospectively maintained database(2001–2024) focusing on patients<24months. We included patients with postnatal urinomas/ascites and collected data on demographics, VUR, serum creatinine(SCr) parameters, CKD and kidney replacement therapy(KRT). PUV patients without urinomas/ascites served as a comparison group.
RESULTS
A total of 27 patients had a postnatal urinoma(n=22) or ascites(n=5), and 4 had both. Only 30% of urinomas had ipsilateral VUR and most had severe hydroureteronephrosis, suggesting a functional obstruction at the UVJ. The urinoma/ascites group had higher baseline SCr, likely related to urine reabsorption. However, this was similar at follow-up (Table). There were no differences in CKD >3 or KRT between urinoma/ascites vs.not.
CONCLUSIONS
While there does not appear to be any long-term impact on kidney function in PUV patients with urinoma/ascites, the low incidence of VUR in this population suggests that urinomas/ascites are related to the severity of obstruction and not high-pressure voiding/VUR. These findings should be considered when selecting the best initial surgical intervention in children with PUV.
| Urinoma/Ascites(n=27) |
None(n=162) |
p | |
| Age at presentation (days) | 5(13) | 5(25) | 0.64 |
| PURK >3 | 15(56%) | 67(42%) | 0.21 |
| Length of stay (days) (IQR) | 20(16) | 10(15) | <0.01 |
| VUR |
15 (56%) 8 (30%) to urinoma |
93 (57%) | 1.00 |
| Baseline Scr (IQR) | 141 (87) | 83 (115) | <0.01 |
| SCr at time of surgery (IQR) | 79.5 (97.5) | 63 (121) | 0.52 |
| eGFR last follow up (IQR) | 87.39 (40.49) | 91.60 (62.13) | 0.83 |
| CKD >3 | 7 (26%) | 44 (27%) | 1.00 |
| KRT | 2 (7%) | 26 (16%) | 0.38 |
| Primary Ablation |
18 (68%) |
124 (77) |
0.33 |
| Follow up (years) (IQR) | 12.6 (12) | 8.2 (20.4) | 0.15 |
09:35 - 09:38
S10-8 (OP)
Kadir Emre BALTACI, Ali Cansu BOZACI, Mesut ALTAN, Gokhan KARAKURT, Kamranbay GASIMOV, Berk HAZIR, Serdar TEKGUL and Hasan Serkan DOGAN
Hacettepe University, Urology Department, Çankaya, TÜRKIYE
PURPOSE
To evaluate the protective role of unilateral reflux on renal function in PUV patients. Various protective mechanisms have been proposed in patients with posterior urethral valves (PUV). The role of unilateral reflux as a protective factor is debated.
MATERIAL AND METHODS
A retrospective analysis was conducted on 128 PUV patients treated between January 1986 and July 2023. Unilateral VUR patients and ipsilateral renal function <15% were classified as having valve unilateral reflux dysplasia (VURD) syndrome. Data from 92 patients with documented renal scintigraphy were analyzed. Renal function was considered abnormal if serum creatinine levels exceeded age-specific reference values. Univariate and multivariate analyses assessed various parameters.
RESULTS
The median age at primary surgery was 5 months, with a median follow-up of 26 months. Bilateral VUR patients (44.4%, 16/36) had worse renal outcomes than those with no VUR (19.2%, 10/52) or unilateral VUR (17.5%, 7/40; p = 0.011). Thirteen of 31 patients with unilateral VUR had VURD. Abnormal renal function distribution was similar between unilateral VUR patients, regardless of VURD status. Nadir creatinine and 1-yr creatinine values were independent risk factors for abnormal renal function.
CONCLUSIONS
Although some studies suggest unilateral reflux protects the contralateral kidney, others indicate worse outcomes due to dysplasia. Our findings show that renal outcomes in unilateral VUR patients are comparable with those without VUR, implying a protective effect regardless of severity of ipsilateral dysplasia.
Patients with unilateral VUR exhibit similar outcomes to those without VUR. Nephrectomy should be cautiously considered due to potential protective effects.