ESPU Meeting on Thursday 4, September 2025, 14:00 - 14:50
14:00 - 14:03
S12-1 (OP)
Ashray KAPURIA 1, Karl GODLEWSKI 1, Amelia WILDERMUTH 1, Nathan HYACINTHE 1, Sameer MITTAL 1, Katherine FISCHER 1, Meghan DAVIS 2, Thomas KOLON 1, Mark ZAONTZ 1 and Christopher LONG 1
1) Children's Hospital of Philadelphia, Pediatric Urology, Philadelphia, USA - 2) Children's Hospital of Philadelphai, Pediatric Urology, Philadelphia, USA
PURPOSE
Testosterone (T) has commonly been used by pediatric surgeons as an adjunct in hypospadias repair because of its effects on penile size. Its ability to increase glans width (GW) has been well documented. We hypothesize that testosterone administration significantly increases BMI and growth percentile in infants undergoing hypospadias repair at time of surgery, but the effects are transient in the short to medium term.
MATERIAL AND METHODS
We queried our prospective hypospadias database for patients undergoing primary distal hypospadias repair between 2015 - 2022. Patients were stratified by whether or not they received T prior to surgery. Height, weight, age, BMI, GW, and Z-score were recorded at initial visit, surgery, 0-6 months, 6-12 months and 12-24 months post operatively. Paired T-tests were used to determine significance with a threshold of 0.05.
RESULTS
In total 341 patients were included; 200 no T, 141 T. There was no difference in age, height, weight, BMI or Z-score at initial visit. At surgery height/weight was significantly increased in the T group vs no T (p = 0.02). At 0-6 months post surgery, height, weight and Z-score were significantly increased (p = 0.001, 0.003, 0.01 respectively). At 12-24 months post operatively there were no differences in age, BMI, height, weight or Z-score between groups. GW was significantly smaller in the T group at initial visit mean 12.5mm (IQR = 2.5) vs 14.3mm (IQR = 4), significantly larger at surgery 16.8mm (IQR = 3) vs 14.3mm (IQR = 3), and there was no difference in glans width at 2 years post operatively between group means 16.5mm (IQR = 2) vs 16.6mm (IQR = 2).
CONCLUSIONS
Preoperative T has significant transient effect on height, weight, BMI and Z score at the time of surgery, however these differences quickly normalize by 12-24 months after surgery. Testosterone appears to have a durable effect on GW in the long-term.
14:03 - 14:06
S12-2 (OP)
Amr Kamal SALAMA 1, Assem GHOZLAN 2, Waleed DAWOOD 2, Mohamed YOUSSIF 2, Ahmed FAHMY 2 and Haytham BADAWY 2
1) .Alexandria School of Medicine, Pediatric Urology, .Alexandria, EGYPT - 2) Alexandria School of Medicine, Pediatric Urology, Alexandria, EGYPT
PURPOSE
Hypospadias as a prevalent congenital anomaly, has received a lot of interest from surgeons. Different techniques have been adopted to repair it through the years with continuous modifications to reach an optimum outcome. The aim of our study is to compare the well-known TIP repair to the newly adopted Topographic Guided Repair (TGR) (2021).
MATERIAL AND METHODS
A prospective randomized study was conducted in our hospital (between 2022-2024) including patients presenting with fresh DPH. They were assigned randomly to group A (TGR) , group B (TIP). Outcome variables were assessed in both groups during follow up period.
RESULTS
104 patients were assigned groups A (N=52), Group B (N=52). Age range in both groups (3.68 ± 2.29), (3.80 ± 2.65) respectively. Median (IQR) Urethral plate (UP) width in group A and B were 7.0 (6.0-8.2), 8.2 (6.9-9.3) mm respectively. Median glanular width in both groups 11.2 (10.9 - 13.5), 11.1 (10.6-13.9) respectively. Median (IQR) operative time (min) in both groups was 49.5 (44.2- 51.5) vs. 63.2 (57.0-70.0) mins. Median Follow up duration 15.3 (12.2 - 22.6) months. Complications rate in both groups was comparable (8.4% vs. 6.9%) respectively. Hose score was used to assess outcome on both groups. Average score in group A was 13 compared to 14 in group B.
CONCLUSIONS
TGR is a reliable technique and achieving good cosmetic outcome in DPH repair comparable to the validated TIP repair. More future studies with longer follow up are warranted to validate this technique.
14:06 - 14:09
S12-3 (OP)
Mohamed MANSY
.Nile Of Hope Hospital For Congenital Anomalies, Pediatric Surgery and Pediatric Urology, .Alexandria, EGYPT
PURPOSE
Medical Literature describes the use of various tissues such as de‐epithelised overlap skin flap, dartos fascia, corpus spongiosum, tunica vaginalis flap and tunica vaginalis graft to provide cover to neo-urethra in hypospadias surgeries
Platelet-rich plasma (PRP) is an autologous plasma fraction with a high platelet concentration, leading to hemostasis, fibrous connective tissue formation and revascularization.
The aim of our study was to evaluate the use of platelet rich plasma (PRP) versus dartos flap as an intermediate layer in the Snodgrass repair of distal hypospadias.
MATERIAL AND METHODS
A prospective randomized study was conducted from June 2022 to June 2024. Patients were divided in to two groups in which dartos flap was inserted as an intermediate layer in the first group while the PRP gel was applied over the neo-urethra as an additional protective layer without the use of dartos flap.
The 2 groups were compared regarding the incidence of fistula occurrence, meatal stenosis, post operative infection, and incidence of total disruption.
RESULTS
The study included 46 patients in each group with a follow-up period ranged from 6-30 months.
There was no significant difference regarding both early and long-term post-operative complications including urethrocutenous fistula, meatal stenosis, disruption and post-operative infection rates.
CONCLUSIONS
PRP has a potential to prevent early and long-term post-operative complications occurring after hypospadias repair. Moreover, PRP could be a good substitute for dartos flap specially in complicated cases with deficient dartos flap.
14:22 - 14:25
S12-4 (OP)
Galal ELSHORBAGY, Abas MOHAMUD, Hani MORSI and Hesham IBRAHIM
Cairo University, Egypt, Pediatric Urology, Nasr City, EGYPT
PURPOSE
To evaluate the benefit of using platelet rich plasma covering layer in decreasing the occurrence of urethral fistula post STAR technique repair in Distal Penile Hypospadias
MATERIAL AND METHODS
Forty-four children with distal penile hypospadias at Cairo University Specialized Pediatric Hospital were randomized into two groups children underwent distal penile hypospadias repair by Seleim's Topography-Guided Anatomical Reassembly (STAR) with PRP as covering layer (Group A, n=22) and children without PRP covering layer (Group B, n=22). About 5-10 cc of the whole patients' blood were obtained, centrifuged, and a PRP layer was sutured over urethroplasty as a second layer.
RESULTS
There was no significant difference between group A "with PRP" and group B "without PRP" regarding edema (4.5% vs. 0%, p=1.00), meatal stenosis (4.5% vs. 0%, p=1.00), or mean operative time (70.2±16.5 min vs. 61.1±15.7 min, p=0.068), however, they showed significantly lower incidence of Urethrocutaneous fistula (4.5% vs. 27.3%, p=0.039).
CONCLUSIONS
The use of platelet‐rich plasma as covering layer with STAR technique had revealed reliable outcome to decrease occurrence urethrocutaneous fistula.
14:25 - 14:28
S12-5 (OP)
Serhat ÇETİN 1, Fırat Çağlar BUDAK 2, Burak ELMAS 3, Mustafa KABA 1, Mustafa Özgür TAN 1, Hasan BIRI 4, İlker ŞEN 1, Ahmet Bora KÜPELI 1, İbrahim BOZKIRLI 5 and Özdemir Serhat GÜROCAK 1
1) Gazi University Faculty of Medicine, Department of Urology, Ankara, TÜRKIYE - 2) Ankara City Hospital, Department of Urology, Ankara, TÜRKIYE - 3) Kizilcahamam State Hospital, Ankara, Turkey, Department of Urology, Ankara, TÜRKIYE - 4) Koru International Hospital, Department of Urology, Ankara, TÜRKIYE - 5) Mersin system surgery center, Department of Urology, Mersin, TÜRKIYE
PURPOSE
This study evaluates the relationship between surgical success and puberty in children with congenital penile curvature (CPC).
MATERIAL AND METHODS
Records of 64 CPC patients without hypospadias treated with simple plication near the 12 o'clock position from 2012 to 2024 were analyzed. Patients were classified as prepubertal (<13 years) or postpubertal (≥13 years) based on age and pubertal growth. Curvature >30° confirmed by goniometry during surgery was the indication for intervention. Surgical success was defined as a residual curvature of <10° during follow-up.
RESULTS
Of the 64 patients, 23 (35.9%) were prepubertal and 41 (64.1%) were postpubertal. Mean ages were 97,4 months (prepubertal) and 168 months (postpubertal). There was no significant difference in preoperative curvature degree between groups (p>0,05). Follow-up was 65.8 months (prepubertal) and 91.6 months (postpubertal). Residual curvature ≥10° occurred in 2 (8,6%) of prepubertal and 4(9,7%) of postpubertal patients. No patients reported sensory loss or erectile dysfunction. Overall success rates were 91,4 % in the prepubertal group and 90,3% in the postpubertal group, with no significant difference (p>0,05).
CONCLUSIONS
Penile plication demonstrates comparable success rates in both prepubertal and postpubertal CPC patients. However, further studies with larger sample sizes are needed to clarify the impact of age on outcomes.
14:28 - 14:31
S12-6 (OP)
Niklas PAKKASJÄRVI 1, Annaleena ANTTILA 2 and Seppo TASKINEN 3
1) New Children's Hospital Helsinki University, Paediatric urology, Helsinki, FINLAND - 2) New Children's Hospital, Pediatric Surgery, Helsinki, FINLAND - 3) New Children's Hospital Helsinki University, Pediatric Surgery, Helsinki, FINLAND
PURPOSE
Long-term outcomes of early surgical correction for isolated ventral penile curvature, particularly patient-reported outcomes and complication rates, are scarce. We aim to fill this gap.
MATERIAL AND METHODS
Twenty-four pediatric patients treated for isolated ventral penile curvature (born 1991-2003). Median age at surgery was 1.6 years (IQR 1.2-2.6), median preoperative curvature was 60° (IQR 30-75), and median follow-up was 14 years. Surgery included degloving alone (12 patients) or degloving with Nesbit-like dorsal tunical plications (12 patients). Post-pubertal outcomes were assessed using the Danish Prostatic Symptom Score (DAN-PSS), Erection Hardness Score (EHS), and Penile Perception Score (PPS), with a 75% response rate. Complications were graded using the Clavien-Madadi classification. Results were compared to published controls and a matched DAN-PSS control group.
RESULTS
Short-term outcomes were favorable, with no grade III or higher complications within three months. Long-term reoperations were required in 16.7%: one patient for residual curvature (grade IIIb) and three for cosmetic revisions (grade IIIa). Two underwent cystoscopy for uroflowmetry issues (grade II). Functional outcomes showed 87.5% achieved EHS4, and 93.8% reported successful ejaculation, with PPS scores comparable to published data. Compared to the DAN-PSS control group, urinary symptom scores were similar. No participants expressed decisional regret, and 88.9% endorsed appropriate timing of surgery. Dissatisfaction was minimal, related to penile skin appearance or residual curvature.
CONCLUSIONS
Early surgical correction of isolated ventral penile curvature achieves favorable long-term outcomes with a low rate of grade III complications. Functional and patient-reported outcomes were comparable to controls, supporting early intervention to address technical and patient-centered goals.
14:31 - 14:34
S12-7 (OP)
Bo YANG, Yun-Man TANG and Yu MAO
Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Department of Pediatric Surgery, Chengdu, CHINA
PURPOSE
Dorsal midline plication (DMP) corrects residual penile curvature after degloving and urethral plate transection (UPT) in hypospadias repair. This study introduces a data-driven DMP technique for Tanner Stage I hypospadias, achieving effective curvature correction with minimal shortening.
MATERIAL AND METHODS
Tanner I hypospadias patients treated from October 2020 to April 2024 were retrospectively analyzed. All underwent penile degloving and DMP, with UPT performed for urethra-related curvature. Sutures were placed along the dorsal midline at the curvature apex, with proximal and distal distances of 2-4 mm and a middle distance of (curvature angle/10) mm. Curvature angles and stretched penile lengths were measured preoperatively, post-degloving, post-UPT (if applicable), and post-DMP.
RESULTS
Among 381 patients (270 with UPT, 111 without), preoperative curvature (29.59 ± 32.53°) was corrected to 0°. In UPT cases, post-DMP length was shorter than post-UPT (48.47 ± 5.94 vs. 49.29 ± 6.02 mm, p<0.001), but the postoperative length was longer than preoperative one (47.49 ± 5.70 mm vs. 46.66 ± 5.74 mm, p < 0.001). In non-UPT cases, post-DMP length was shorter than post-degloving (53.03 ± 5.93 vs. 53.64 ± 5.83 mm, p<0.001), but postoperative length was not changed significantly from preoperative length (52.34 ± 5.80 mm vs. 52.14 ± 5.82 mm, p = 0.244).
CONCLUSIONS
The data-driven DMP technique effectively corrects curvature in Tanner I hypospadias with minimal shortening. Penile degloving and UPT contribute to lengthening, ensuring that postoperative penile length is preserved or even increased.