ESPU Meeting on Thursday 4, September 2025, 11:10 - 12:10
11:10 - 11:14
S11-1 (OP)
Irene PARABOSCHI 1, Michela MARINARO 2, Pankaj MISHRA 3, Anu PAUL 3, Arash TAGHIZADEH 3, Charles TURNER 4, Neil R DALTON 5 and Massimo GARRIBOLI 6
1) UNIVERSITY OF MILAN, BIOMEDICAL AND CLINICAL SCIENCE, Milano, ITALY - 2) "V. Buzzi" Chidlren's Hospital, Department of Pediatric Surgery, Milan, ITALY - 3) Evelina London Children's Hospital, Paediatric Urology Department, London, UNITED KINGDOM - 4) Evelina London Children's Hospital, WellChild Laboratory, London, UNITED KINGDOM - 5) Evelina London Children's Hospital, WellChild Laboratory,, London, UNITED KINGDOM - 6) Evelina London Children's Hospital, Department of Paediatric Urology, London, UNITED KINGDOM
PURPOSE
Indication for surgery in Ureteropelvic junction obstruction (UPJO) could be difficult. Proteomic analysis could provide risk stratification, potentially refining clinical decision-making.
MATERIAL AND METHODS
We conducted a prospective study in 50 children undergoing pyeloplasty versus 25 sex-and age-matched healthy controls. Urine was collected preoperatively from the bladder and affected kidney, as well as contralateral and postoperatively from the affected kidney (days 1 and 7) and bladder (at follow-up). Mass spectrometry assessed the expression of biomarker clusters: albumin, retinol-binding protein (RBP), uromodulin, and creatinine. Data were normalized to urinary creatinine and analyzed for predictive patterns.
RESULTS
Preoperatively, albumin UPJO [4.6 mg/mmol (2.3 - 9.1)] was elevated in comparison with controls [1.4 (0.9 - 5.0) mg/mmol; p-value: <0.0001], and in the affected kidney [69.1 (15.1 - 226.7) mg/mmol] vs the contralateral [32.8 (12.6 - 59.6) mg/mmol; p-value: 0.0589]. Levels peaked on postoperative day 1 [945.7 (589.6 - 1,969.0) mg/mmol] before decreasing by day 7 [373.5 (131.5 - 948.3) mg/mmol] and in the follow-up [3.6 (1.3 - 11.1) mg/mmol], suggesting an acute response followed by stabilization. RBP had a similar trend: (0 (0 - 23.7) µg/mmol preoperatively,1,286.8 (491.5 - 2,278.7) µg/mmol on day 1, 790.6 (165.2 - 1,319.3) µg/mmol by day 7 and 0.0 (0.0 - 67.0) µg/mmol at follow-up. Uromodulin remained stable. Creatinine was lower in the preoperative bladder urine (UPJO) compared to controls [2.5 (1.4 - 4.9) vs. 3.4 (2.4 - 5.5) mmol/L, p = 0.2286] and in affected kidneys vs contralateral [1.7 (1.0 - 3.6) vs. 5.9 (3.5 - 7.4) mmol/L, p < 0.0001].
CONCLUSIONS
Proteomic analysis can potentially differentiate UPJO from healthy kidneys and support clinical decision-making.
11:14 - 11:17
S11-2 (OP)
Cayde RITCHIE, Shao TAO, Tianjia GE, Rachelle BALILI, Kritika SHARMA, Aliyah DAVIS, James BROOKS and Kunj SHETH
Stanford University, Department of Urology, Palo Alto, USA
PURPOSE
Hydronephrosis is common in pediatric patients. Decision for surgery relies on differentiating true ureteropelvic junction obstruction (UPJO) from non-obstructive dilation (NOD). Current strategies are suboptimal, relying on subjective interpretation of invasive diagnostics. In this study, we aim to explore the role of urinary biomarkers in non-invasive determination of UPJO.
MATERIAL AND METHODS
Pediatric patients with unilateral hydronephrosis were enrolled. Patients progressing to pyeloplasty were categorized as UPJO, while NOD encompassed those stable on observation. Urine specimens were analyzed for NGAL, MCP-1, CA19-9, IP-10, and RBP4, using enzyme-linked immunosorbent assay (ELISA). Baseline and longitudinal data were collected. Data was analyzed using descriptive statistics, t-test, analysis of variance (ANOVA), and logistic regression modeling.
RESULTS
132 patients were prospectively analyzed. In hydronephrotic patients, baseline levels of NGAL, CA19-9, IP-10, and RBP4 were significantly elevated in patients with UPJO, compared to NOD. Levels of NGAL and IP-10 were significantly higher in patients with differential renal function <40%. On logistic regression analysis, the combination of IP-10 and RBP4 was the best predictor of surgery (sensitivity 76%, specificity 91%, AUC 0.94). In UPJO patients four months post-pyeloplasty, there was a 51% decrease in IP-10 levels and 49% decrease in RBP4. In NOD patients, levels remained stable.
CONCLUSIONS
While NGAL, CA19-9, IP-10, and RBP4 were able to differentiate UPJO from NOD, the combination of IP-10 and RBP4 emerged as the strongest predictor of surgery, with levels decreasing postoperatively. Early longitudinal data demonstrated stable levels in patients with NOD, indicating a potential role for a predictive algorithm at the time of initial presentation.
11:17 - 11:20
S11-3 (OP)
Tanvi LUTHRA 1, Devasenathipathy KANDASAMY 2, Ajay VERMA 1, Devendra YADAV 1 and Sachit ANAND 1
1) All India Institute of Medical Sciences (AIIMS) New Delhi, Paediatric Surgery, New Delhi, INDIA - 2) All India Institute of Medical Sciences (AIIMS), New Delhi, Radio diagnosis, New Delhi, INDIA
PURPOSE
Split renal function (SRF) is one of the major factors for decision-making in children with ureteropelvic junction obstruction (UPJO)-type hydronephrosis and is commonly measured using renal dynamic scan (RDS). This study aims to investigate the accuracy of using non-contrast-enhanced magnetic resonance urography (NCE-MRU) as an alternative to RDS to estimate SRF in children with UPJO-type hydronephrosis.
MATERIAL AND METHODS
Twenty consecutive children (M:F= 13:7) with UPJO-type hydronephrosis were included in this feasibility study. All patients underwent NCE-MRU and RDS. Renal parenchyma volume were obtained on NCE-MRU by drawing the volume of interest to cover all the kidney parenchyma layer by layer. The values of split renal volume (SRV) for left renal units, right renal units and total renal units on NCE-MRU were compared with the values of SRF determined on RDS using Pearson’s correlation coefficient.
RESULTS
Out of forty renal units from twenty patients, twenty-one (Left-13, Right-6, Bilateral-1) exhibited obstruction. In our overall assessment, the values of SRV showed a significant positive correlation with SRF for all forty renal units (R=0.9483, R2=0.8993, P<0.00001). In an independent analysis for the twenty-one obstructed renal units, the values of SRV also demonstrated a significant positive correlation with SRF (R=0.8912, R2=0.7942, P<0.00001).
CONCLUSIONS
NCE-MRU is an accurate non-invasive alternative to RDS for estimating SRF in children with UPJO-type hydronephrosis. However, the findings need to be tested in a larger cohort of patients and further validation will also require comparison of postoperative NCE-MRUs and RDS before any definite conclusions are drawn.
11:20 - 11:23
S11-4 (OP)
Henry CHAUVEAU 1, Antoine GIRARD 2, Denis CHATELAIN 3 and Xavier DELFORGE 4
1) Amiens University Hospital, Urology, Amiens, FRANCE - 2) Amiens University Hospital, Nuclear Medicine, Amiens, FRANCE - 3) Amiens University Hospital, Department of Pathology, Amiens, FRANCE - 4) Amiens University Hospital, Paediatric Surgery, Amiens, FRANCE
PURPOSE
Surveillance is the standard approach for most patients presenting with hydronephrosis (HN). Predictive markers of HN non-progression may lighten the medical follow-up. For MAG3 renograms, the Cortical Transit Time (CTT) shows promising results in predicting HN progression.
We aim to assess the risk of progression to surgery based on CTT in patients with ureteropelvic junction obstruction (UPJO).
MATERIAL AND METHODS
Retrospective study including patients born between 2008 and 2020 who presented with HN and obstruction on MAG3 renogram. A senior physician reviewed all renograms. The primary outcome was the occurrence of surgery. We compared CTT values, differential renal function, and pelvic dilation between operated and non-operated renal units.
RESULTS
92 renal units were included: 60 operated and 32 non-operated. The initial CTT was 209 seconds in the Operated group, significantly higher than in the Non-Operated group, 147 seconds (p=0.023). The optimal CTT threshold was 180 seconds, with 50% of sensitivity and 81% of specificity. The proportion of initially obstructive CTT values was significantly higher in the Operated group (p<0.01). In a multivariate analysis, the model combining CTT, differential renal function, and pelvic dilation at one month was significantly predictive of the risk of surgery (p<0.001).
CONCLUSIONS
Measuring CTT on MAG3 renogram is a useful tool for predicting the progression of HN to surgery. A CTT below 180 seconds may be a favourable predictor of a non-progressive course in HN. Combining CTT with renal function and pelvic dilation at 1 month could reduce surveillance.
11:35 - 11:38
S11-5 (OP)
Zeynep Merve GÖKBUGET 1, Vefa SALT 2, Ayşe KALYONCU UÇAR 3, Haluk Burçak SAYMAN 4, Mehmet ELIÇEVIK 5, Yunus SÖYLET 5 and Haluk EMIR 5
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, İstanbul, TÜRKIYE - 3) Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Radiology, Division of Pediatric Radiology, İstanbul, TÜRKIYE - 4) Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Nuclear Medicine, İstanbul, TÜRKIYE - 5) Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Pediatric Surgery, Division of Pediatric Urology, İstanbul, TÜRKIYE
INTRODUCTION
This study evaluates the diagnostic accuracy of serial ultrasonography (dynamic ultrasonography, DUSG) when performed concurrently with dynamic renal scintigraphy (DRS) in detecting obstructive hydronephrosis (HN) in children undergoing DRS for suspected urinary obstruction.
PATIENTS AND METHODS
Thirty-five patients with unilateral HN requiring DRS between June 2022 and August 2024 were included. Standardized DUSG measurements were obtained at predefined time points: 30 minutes before DRS (USG1), at DRS initiation (USG2), at DRS completion (USG3), and one hour after furosemide administration (USG4). Prospective data from both modalities were analyzed and compared.
RESULTS
DRS showed radiotracer clearance half-life (t½) <10 minutes in 19 patients, 10-20 minutes in 6 patients, and >20 minutes with no response in 10 patients.
DUSG revealed persistent HN in 17 patients at USG4, while APD returned to baseline or decreased further in 18 patients. Although DRS and DUSG demonstrated consistent graphical patterns, their timing varied. The regression of t½ and APD occurred at different time points.
When comparing APD values between USG3 and USG4, the average reduction rate (emptying percentage) was found to be 20%. In the non-responsive group, the emptying percentage was 4.63%, indicating a significant difference compared to the remaining patients.
CONCLUSIONS
Integrating DRS and DUSG improves diagnostic accuracy for ureteropelvic junction obstruction. While nuclear clearance and anatomical regression are correlated, they occur at different time points. The APD emptying percentage on DUSG serves as a predictor of obstruction on DRS. Further large-scale, multicenter studies are needed to validate these findings.
11:38 - 11:41
S11-6 (OP)
Amr HODHOD 1, Wael MONEIR 2, Abdulwahab ALHAMS 1, Yasser JAMALALIAL 1, Fayez ALMODHEN 1, Tariq BURKI 1, Abdullah ALSUFIANI 1, Ali ALMALKI 1, Omar ALSALEM 1 and Ahmed ALSHAMMARI 1
1) King Abdullah Specialized Children's Hospital, Pediatric Urology, Riyadh, SAUDI ARABIA - 2) King Abdullah Specialized Children's Hospital, Riyadh, SAUDI ARABIA
PURPOSE
Isolated hydronephrosis (IH) is the most common cause of congenital hydronephrosis. Although voiding cystourethrogram (VCUG) is one of the main tools in hydronephrosis workup, there is debate about performing it routinely in all cases. In this study, we evaluated the role of VCUG in the assessment of bilateral IH in terms of its utility and potential complications.
MATERIAL AND METHODS
A retrospectively review of patients’ charts who presented with postnatal hydronephrosis from 2012 to 2023 was conducted. We collected patients’ demographics, grade of hydronephrosis and anteroposterior renal diameter (APD). VCUG results were reviewed and grade of vesicoureteric reflux (VUR) was documented. Additionally, any encountered VCUG-related complications were collected. The fate of hydronephrosis was assessed at the last follow up including ultrasound scans and need for surgical intervention.
RESULTS
A total of 104 patients,83 males and 21 females, with bilateral IH were included. Patients presented at amedian age of 0.13 month (0.1-10.2). Only 5 patients (4.8%) had VUR; all of them were unilateral and low-grade ( 1 as grade 1, 2 as grade 2 and 2 as grade 3 VUR) . Of these refluxing patients, only one had UTI during follow up. All refluxing units were managed conservatively. During follow up, 11 patients (10.6%) had UTI, 5 patients (4.8%) had VCUG related UTI; all were on Abx prophylaxis. Of these 5 patients, 4 had no further UTI. No other procedure-related complications were reported. Notably, 8.7% of units (28 units) had surgical intervention as pyeloplasty whereas none had any anti-reflux procedures.
CONCLUSIONS
Less than 5% of patients were diagnosed with VUR that question the importance of routine VCUG studies in bilateral HN, particularly as only one of them developed UTI. We recommend preforming VUG in patients, with bilateral IH, who develop UTI only to rule out VUR.
11:41 - 11:44
S11-7 (OP)
Mandy RICKARD 1, Joana DOS SANTOS 1, Samer MAHER 1, Jin Kyu KIM 1, Adree KHONDKER 1, Beverly MIRANDA 1, Mirriam MIKHAIL 1, Nithiakishna SELVATHESAN 2, Rodrigo ROMAO 1, Joao PIPPI SALLE 1, Michael CHUA 1 and Armando J. LORENZO 1
1) SickKids, Urology, Toronto, CANADA - 2) SickKids, Nephrology, Toronto, CANADA
PURPOSE
Published guidelines suggest that all infants with SFU 3-4 hydronephrosis (HN) be placed on continuous antibiotic prophylaxis (CAP) and investigated with a VCUG and diuretic renal scintigraphy (DRS). Over the last decade, we have reduced routine VCUGs, DRS and CAP for all isolated HN, regardless of severity and selected hydroureteronephrosis (HUN)patients. We aimed to determine the impact on UTIs and time to surgery with this modified approach.
MATERIAL AND METHODS
Patients <24 months with HN/HUN after 2015 were included. Known VUR or other anomalies were excluded. Variables included VCUG and DRS rates, CAP use, UTIs, and surgeries. Patients were divided into groups by year of presentation: Group 1(2015–2018), Group 2(2019–2021), and Group 3(2022–2025). UTIs were defined as pyuria and positive culture from a catheter specimen in a febrile child.
RESULTS
985 patients were included. Baseline characteristics were comparable(Table). There was a reduction in VCUG(52%, 31%, 29%,p<0.01), DRS rates(57%, 43%, 30%,p<0.01) and CAP duration(12 ± 9 vs. 7 ± 6 vs. 5 ± 4 months,p<0.01)for groups 1, 2 and 3, respectively. UTI rates remained stable(4%, 3%, 3%;p=0.74), and surgical age was younger(11 ± 13 vs. 7 ± 7 vs. 6 ± 5months;p<0.01).
CONCLUSIONS
Selective monitoring resulted in reduced radiation exposure, CAP duration and earlier age at surgery, without increased UTIs. These findings support revisiting current HN guidelines and may aid in identifying patients who would benefit from earlier surgical intervention.
| 2015-18(n=303) | 2019-21(n=381) | 2022-25(n=301) | p | |
| Age(months) | 4+/-4 | 4+/-5 | 3+/-3 | 0.05 |
| IsolatedHN | 227(75) | 313(82) | 230(77) | 0.05 |
|
Uncircumcised Circumcised Female |
130(43) 114(38) 59(19) |
209(55) 106(28) 65(17) |
149(50) 96(32) 56(18) |
0.03 |
| High-gradeHN | 206(68) | 210(55) | 181(60) | 0.03 |
| VCUG | 157(52) | 119(31) | 86(29) | <0.01 |
| DRS | 173(57) | 164(43) | 91(30) | <0.01 |
| CAP duration(months) | 12+/-9 | 7+/-6 | 5+/-4 | <0.01 |
| Age at surgery(months) | 11+/-3 | 7+/-7 | 6+/-5 | <0.01 |
11:53 - 11:56
S11-8 (OP)
Ugo Maria PIERUCCI 1, Amane-Allah LACHKAR 1, Irene PARABOSCHI 2, Annabel PAYE-JAOUEN 1, Michele GNECH 3, Thibault PLANCHAMP 1, Federica FANTI 3, Dario Guido MINOLI 3, Alaa EL-GHONEIMI 1, Alfredo BERRETTINI 3 and Matthieu PEYCELON 1
1) National Reference center for Rare Urinary Tract Malformations (CRMR MARVU), ERN eUROGEN, Robert-Debré University Hospital, APHP, GHU North, Université Paris Cité, Department of Pediatric Surgery and Urology, Paris, FRANCE - 2) University of Milano, Department of Biomedical and Clinical Science, Milan, ITALY - 3) Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Pediatric Urology, Milan, ITALY
PURPOSE
According to Crooks et al., giant hydronephrosis (GH), often caused by ureteropelvic junction obstruction, is defined as a kidney occupying the hemiabdomen, crossing the midline, and spanning five vertebral bodies. This study compares antenatal/postnatal findings, surgical management, and long-term renal outcomes in children with GH versus non-GH hydronephrosis.
MATERIAL AND METHODS
A retrospective analysis was conducted on children with hydronephrosis treated by pyeloplasty at two European centers (2013-2024). Patients were stratified into GH and no-GH groups. Data collected included prenatal detection, imaging results, renal function, surgical approaches, and postoperative outcomes.
RESULTS
Among 428 children, 38 had GH and 390 no-GH. Prenatal detection was more frequent in GH (76.3% vs. 68.7%, p=0.15). Median age at surgery was younger in GH [8(2-61) vs. 19(7-103) months, p=0.004]. Open, laparoscopic, and robot-assisted pyeloplasty were performed in 148 [15.8%(GH) vs. 36.4%(no-GH)], 142 [63.2% vs. 30.3%], and 134 [18.4% vs. 32.6%] cases, respectively (p<0.001). Complication rates were 7% intraoperatively and 34.1% postoperatively, with laparoscopic pyeloplasty in GH associated with higher intraoperative (18.4%) and postoperative (73.0%) complications. Redo surgery was more frequent in GH (10.5% vs. 2.8%, p<0.05). Median renal function improvement was 4% (-10.5 to 14.0) in GH and 1.5% (-2.0 to 8.0) in no-GH (p=0.86). Logistic regression showed no significant difference in long-term [36(18-60) months] renal function (p=0.34).
CONCLUSIONS
Despite a significant reduction in pelvic dilation, GH is associated with higher complication rates regardless of surgical approach. However, long term renal function is not affected by this severe presentation/malformation
11:56 - 12:01
S11-9 (VP)
Rebecca FRANKS 1, Nora BROADWELL 1, Raymond YONG 2, Sara KOH 1, Scott KOH 2, Danielle SWEENEY 2, Andrea BALTHAZAR 2, Albert LEE 1, Jacob SMITH 2 and Chester KOH 2
1) TCH-BCM, Pediatric Urology, Houston, USA - 2) TCH - BCM, Pediatric urology, Houston, USA
PURPOSE
Previous studies in adult patients demonstrated that buccal mucosa graft (BMG) ureteroplasty is an effective surgical option for patients with recurrent ureteropelvic junction obstructions (UPJOs) who failed prior pyeloplasty, and especially among those with long ureteral strictures. However, there has been limited reported experiences with robot-assisted redo pyeloplasty with BMG in the pediatric population.
MATERIAL AND METHODS
In this video, we describe a redo robotic-assisted left pyeloplasty with BMG in a 13-year-old male with a history of bilateral congenital hydronephrosis and recurrent UPJO with persistent narrowing of the left proximal ureter following two previous robotic-assisted pyeloplasties that resulted in persistent flank pain.
RESULTS
Retrograde pyelography showed a long strictured segment of the left proximal ureter (4 cm). A 4cm x 1 cm segment of BMG was harvested from the left inner cheek. After spatulating the ureter on its anterior aspect, the BMG was placed as an onlay graft. A well vascularized omental flap was placed over the graft. At 4 months post-op, the patient was asymptomatic with decreased hydronephrosis and calyceal dilation.
CONCLUSIONS
Similar to adults, BMG ureteroplasty is a viable alternative to more invasive re-operative strategies such as auto-transplantation and nephrectomy for pediatric patients with recurrent ureteral strictures.