ESPU Meeting on Thursday 4, September 2025, 16:30 - 17:30
16:30 - 16:34
S15-1 (OP)
Putu Angga Risky RAHARJA 1, Ponco BIROWO 1, Lisnawati RACHMADI 2, Heri WIBOWO 3, Aria KEKALIH 4, Gede Wirya Kusuma DUARSA 5, Tariq ABBAS 6 and Irfan WAHYUDI 1
1) Cipto Mangunkusumo National Hospital, Department of Urology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, INDONESIA - 2) Cipto Mangunkusumo National Hospital, Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Jakarta Pusat, INDONESIA - 3) Faculty of Medicine, Universitas Indonesia, Department of Parasitology, Jakarta Pusat, INDONESIA - 4) Faculty of Medicine, Universitas Indonesia, Department of Community Medicine, Jakarta Pusat, INDONESIA - 5) Prof. Dr. I.G.N.G Ngoerah Hospital, Department of Urology, Faculty of Medicine, Universitas Udayana, Bali, Indonesia, Bali, INDONESIA - 6) Sidra Medicine, Doha, Qatar, Pediatric Urology Section, Doha, QATAR
PURPOSE
The role of dartos fascia in hypospadias-associated chordee remains unclear, with structural differences potentially varying by location. This study compared the histopathological profiles of proximal and distal ventral dartos in hypospadias patients.
MATERIAL AND METHODS
This prospective case-control study included 50 hypospadias patients (25 proximal, 25 distal) and 50 age-matched circumcision controls. Dartos tissue samples were collected from proximal and distal ventral locations and analyzed using hematoxylin and eosin and Masson's trichrome staining. Collagen and muscle densities were quantified using annotation in QuPath, with statistical comparisons among groups.
RESULTS
Significant differences were observed in collagen density (p=0.001) and muscle density (p<0.001) among proximal dartos, distal dartos, and control samples. Proximal dartos exhibited significantly higher collagen (46.9±8.2% vs. 41.8±10.1%; p=0.004) and muscle density (24.9±9.4% vs. 14.7±6.4%; p<0.001) compared to controls. Distal dartos tissue had a comparable collagen density (40.7±7.2% vs. 41.8±10.1%; p=0.501) but a significantly higher muscle density (18.2±7.7% vs. 14.7±6.4%; p=0.027). In distal hypospadias, distal dartos tissue resembled normal dartos. In proximal hypospadias, distal dartos had increased muscle density but normal collagen levels.
CONCLUSIONS
Dartos fascia exhibits location-dependent differences, with proximal dartos having increased collagen and muscle density, potentially contributing to chordee. In contrast, distal dartos in distal hypospadias closely resembles normal tissue, suggesting that its preservation during hypospadias repair may be beneficial. These findings support the removal of proximal dartos to correct chordee, while a ventral dartos flap approach could simultaneously eliminate chordee tissue and provide a coverage layer for urethroplasty, potentially improving surgical outcomes.
16:34 - 16:38
S15-2 (OP)
Hüseyin ÖZBEY 1 and Burak MAŞALI 2
1) Art Hypospadias, Istanbul, TÜRKIYE - 2) University of Barcelona, Biomedical Engineering, Barcelona, SPAIN
PURPOSE
This study uses the analogy of multi-layered flexible pipes to provide a biomechanical explanation for why the penis is flexible when flaccid and rigid when erect, aiming to guide penile surgery.
MATERIAL AND METHODS
The hypothesis uses an energy-based hyperelastic multi-layered model to explain how the layers of the penile shaft respond to internal pressure and friction forces, enabling flexibility and rigidity. Structural differences in layers such as the tunica albuginea, Buck's fascia, dartos fascia and skin, along with energy losses, particularly those involving internal pressure transmission, were considered. For this purpose, a non-linear model was developed based on the Mooney-Rivlin model, hyperelasticity theory, and Coulomb's law of friction.
RESULTS
The results show that the inner layers are subjected to higher pressure, and as pressure increases, they become stiffer and more resistant to expansion, contributing to rigidity during erection. Increased internal pressure also raises friction forces between the layers, limiting longitudinal expansion and supporting rigidity. This model explains that in addition to the veno-occlusive mechanism, higher internal pressure increases friction between the layers of the penis, making it more difficult to glide, reducing flexibility, and raising temperature due to energy loss.
CONCLUSIONS
This study provides new insights into the biomechanics of penile flexibility. Impaired penile flexibility and ventral curvature in hypospadias and other penile malformations can be considered as an indication of impaired multi-layered mechanics of the penis.
16:38 - 16:41
S15-3 (OP)
Luca DANTE, Fausto NEGRI, Arianna LESMA and Andrea SALONIA
IRCCS Ospedale San Raffaele, Urology, Milan, ITALY
PURPOSE
Pediatric urology surgeries often address anatomic pathologies that may cause dysfunction in adulthood, with hypospadias being one of the most common. This study evaluates postoperative outcomes, focusing on urological and sexual function, and their impact on mood disturbances.
MATERIAL AND METHODS
Data from men with hypospadias managed between 1972 and 2007 at tertiary referral center were collected. At follow-up, patients completed the International Prostate Symptoms Score (IPPS) and IPPS-Quality of Life (QoL), the Beck's Depression Inventory (BDI), and the International Index of Erectile Function [IIEF, divided into 5 domains: erectile function (EF), orgasmic function (OF), intercourse satisfaction (IS), sexual desire (SD), overall satisfaction (OS)]. Patients were classified into two groups: distal (Group 1) and proximal (Group 2) hypospadias. Descriptive statistics and logistic regression tested association between surgical characteristics and IPSS-QoL.
RESULTS
Of 354 patients, 41 (12.7 %) had complete data at a median (IQR) follow-up of 25 (21-29) yrs. Median age (IQR) at surgery was 22 (12-54) months in Groups 1 and 16.5 (11-33) months in Group 2. Complications were significantly higher in Group 2 (67.9% vs. 24.1%; P<0.001), with fistula being the most common (69.4% vs. 47.4%). Erectile dysfunction was reported by 13 (38.2%) men in Group 1 and 3 (42.9%) in Group 2, with the other IIEF domains similar between groups. Median (IQR) IPSS-QoL were significantly worse in Groups 2 [3 (2-4) vs. 1 (0-1), P=0.004]. Multivariable logistic regression analyses showed the presence of complications as the only independent predictor of IPSS-QoL (OR 0.11; 95%CI 0.005-0.85; P=0.06), after adjusting for possible confounders. No significant differences were found in IPPS and BDI scores between groups.
CONCLUSIONS
The presence of complications was the strongest predictor of poor IPPS-QoL, highlighting the need of tailored long-term follow-up in this sub-cohort of patients to ensure unmet need.
16:53 - 16:56
S15-4 (OP)
Suzanne OOSTLAND 1, Floor ROZEMEIJER 1, Fred VAN DER TOORN 2 and Rogier SCHROEDER 3
1) Wilhelmina Kinderziekenhuis Utrecht, Pediatric Urology, Utrecht, NETHERLANDS - 2) Erasmus MC, Pediatric Urology, Rotterdam, NETHERLANDS - 3) UMC Utrecht, Pediatric Urology, Utrecht, NETHERLANDS
PURPOSE
In pediatric distal hypospadias repair, varying catheter diameters are employed for neourethral reconstruction. The longterm impact of the intra-operative catheter diameter on postoperative outcomes are not well studied. This study aims to investigate the correlation between intraoperative catheter diameter and the incidence of complications and reoperations at the age of five.
MATERIAL AND METHODS
This study is part of the prospective multi-centered observational cohort study, the Dutch Hypospadias Study. 728 pediatric patients were included. Inclusion criteria were restricted to patients requiring neo-urethral construction during the hypospadias surgery. Subjects were stratified by urethral catheter diameter used in urethroplasty into two cohorts: smaller-caliber catheters (Ch 6, Ch 8) and larger-caliber catheters (Ch 10, Ch 12). Outcome measures were assessed at six months and five years postoperatively (mean follow up 3.8 years). The primary outcome measures included the incidence of postoperative complications; wound dehiscence, meatal stenosis and fistula formation. The need for surgical revision was evaluated as the secondary outcome.
RESULTS
No significant differences were observed in the incidence of intracutaneous fistula formation or meatal stenosis between the two groups. Significantly more patients had a wound dehiscence in the larger-caliber cohort (15.2% vs. 7.0% in the smaller-caliber cohort). Also the larger-caliber cohort showed significantly more reoperations (21.0% vs. 8.7% in the smaller-caliber cohort).
CONCLUSIONS
The intraoperative catheter size in hypospadias surgery significantly affects the postoperative outcomes wound dehiscence and leads to a higher reoperation rate. Careful preoperative planning and consideration of catheter size appears of the essence. However, additional studies are required to evaluate its correlation with long-term functional outcomes.
16:56 - 16:59
S15-5 (OP)
Amelia WILDERMUTH, Christopher LONG, Nathan HYACINTHE, Katherine FISCHER, Meghan DAVIS, Sameer MITTAL, Arun SRINIVASAN, Aseem SHUKLA, Thomas KOLON, Mark ZAONTZ and Karl GODLEWSKI
Children's Hospital of Philadelphia, Urology, Philadelphia, USA
PURPOSE
Uroflowmetry is a commonly used tool in postoperative evaluation of hypospadias patients, however, interpretation of uroflow is difficult. Factors including time since surgery, initial meatus location, age, voided volume and complication type have been shown to influence uroflowmetry results. We hypothesized that Tanner stage is associated with improved postoperative uroflowmetry results after hypospadias repair and aimed to determine at which Tanner stage improvements in max flow rate (Qmax) could be expected.
MATERIAL AND METHODS
Distal (DH) and proximal (PH) hypospadias patients >13 years old, with >10 years of follow-up and at least one uroflow were included. First, we evaluated patients with no complications and recorded Qmax values. The data were stratified by time since surgery 0-5 years, 5-10 years, 10+ years and Tanner stage (I-V). We also analyzed Qmax in patients who underwent surgical repair of urethral stricture. Flows <50mL were excluded.
RESULTS
177 patients were included (91 DH and 86 PH). 63/177 of these patients (49 DH/14 PH) had no complication and mean Qmax (cc/s) increased with time since surgery (Mean Qmax cc/sec DH: 0-5 yr = 8.7, 5-10 yr = 12.2, 10+ yr = 19.8. PH: 0-5 yr = 11.8, 5-10 yr = 11, 10+ yr = 19.7). Improvement in Qmax for DH patients without complication began at Tanner III versus Tanner IV for PH patients. Patients with a urethral stricture had a mean Qmax of 4ml/sec which was similar regardless of Tanner stage or meatus location. Mean Qmax for patients with uroflow >10yrs from surgery were; DH 17.9cc/sec, PH 15.2cc/sec.
CONCLUSIONS
Uroflow Qmax gradually increases with time from surgery for both DH and PH patients who did not have a surgical complication. Tanner stage may be a better predictor of expected uroflow improvement than time from surgery. PH patients may have delayed Qmax improvement compared to DH patients.
16:59 - 17:02
S15-6 (OP)
Araz MUSAEV 1, Mehmet Fatih ÖZKAYA 2, Ahmet Furkan ÖZSOY 2, Elif İpek AKSOY 2, Timur Kürşad ÜLGEN 2, Atakhan MUSAYEV 2, Hüzeyfe Yusuf ŞAHİN 2, Atakan ATAKLI 2, Yakup Tarkan SOYGÜR 2 and Berk BURGU 2
1) Ankara University Faculty of medicine, Urology, Ankara, TÜRKIYE - 2) Ankara University Faculty of medicine, Pediatric Urology, Ankara, TÜRKIYE
PURPOSE
In this study, we aimed to compare preoperative and postoperative structured information forms.
MATERIAL AND METHODS
Between 01/12/2023 and 01/12/2024, the parents of patients scheduled for hypospadias surgery were divided into two groups. Preoperatively, both Group 1 and Group 2 received structured audiovisual information about the surgery, and theState-Trait Anxiety Inventory Form - State Anxiety (STAI-I)was completed. In the postoperative period, Group 1 received a structured written information document, including intraoperative images related to the surgery, whereas Group 2 was provided with standard verbal information. On the 10th postoperative day, participants were asked to complete the STAI-I again.
RESULTS
A total of 210 parents were included in the study, with Group 1 (n=105) and Group 2 (n=105). The preoperative STAI-I scores were 46.7 ± 4.5 for Group 1 and 45.4 ± 4.9 for Group 2, with no statistically significant difference between the groups (p=0.8). Postoperative STAI-I scores were recorded as 51.3 ± 3.9 in Group 1 and 58.4 ± 4.5 in Group 2. The postoperative anxiety levels were significantly lower in Group 1 compared to Group 2, and this difference was found to be statistically significant (p=0.001).
CONCLUSIONS
This study indicates thatstructured written postoperative information, including intraoperative images, is associated with lower parental anxietycompared to standard verbal information.
Postoperative information is just as important as preoperative information in reducing parental anxiety and enhancing understanding of the surgical process
17:13 - 17:16
S15-7 (OP)
Michele GNECH 1, Alfredo BERRETTINI 1, Waifro RIGAMONTI 2, Giorgio SAGGIONETTO 2, Sara PAVANELLO 3, Fabrizio DAL MORO 2 and Alessandro MORLACCO 4
1) Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Pediatric Urology, Milano, ITALY - 2) Azienda Ospedale-Università di Padova, Pediatric Urology, Padova, ITALY - 3) Padova University, Padova Medical School, Padova, ITALY - 4) Urology Clinic, Urolgy, Padova, ITALY
PURPOSE
Surgical correction of hypospadias is often performed during childhood. This study aims to assess the degree of adolescent and adult patient satisfaction using patient-reported outcome measures.
MATERIAL AND METHODS
Male patients aged at least sixteen, operated during childhood for hypospadias in two reference centres and without prior treatments at other hospitals, were contacted for this study. Those who agreed to participate received a questionnaire via email containing single questions and the H.O.S.E., P.P.S., and S.I.G.H.T. tests. A descriptive analysis of the responses was followed by statistical analysis using Pearson's Chi-square test and Fisher's exact test, with significance set at p<0.05, to determine if there was a correlation between patient satisfaction and the type of hypospadias or the need for reintervention due to complications.
RESULTS
184 patients answered the questionnaire. 82.9% of these had distal and 17.1% proximal hypospadias. Global sexual satisfaction outcomes range from 70% to 80,4%, urinary satisfaction 66,2% and cosmetic satisfaction from 62,3% to 83,9%. Median HOSE score was 14 (IQR), median PPS 8 (IQR) and median SIGHT 33 (IQR). Stratification for distal VS non-distal hypospadias produced a statistically significant difference in three items: satisfaction with the appearance of penis, shape of the external urethral meatus, sexual activity. Only HOSE score showed a significant difference between distal and non-distal hypospadias (14 vs 13), while SIGHT score was significantly lower in patients who underwent reintervention (33 vs 28).
CONCLUSIONS
Adolescent and young adults who underwent surgical correction of hypospadias in childhood report acceptable long-term outcomes. Very long-term follow-up and standardized outcomes reporting, possibly in large and multicentre studies, will help confirm these results.
17:16 - 17:19
S15-8 (OP)
Annaleena ANTTILA, Niklas PAKKASJÄRVI and Seppo TASKINEN
NEW CHILDREN'S HOSPITAL, HELSINKI UNIVERSITY HOSPITAL - HELSINKI, FINLAND, Pediatric surgery, Hus, FINLAND
PURPOSE
This study evaluated sexual outcomes in post-pubertal patients after hypospadias repair in early childhood.
MATERIAL AND METHODS
The hypospadias patients born between 1991 and 2003 completed a sexual function questionnaire including the Erection Hardness Score (EHS) during the last control visit. We included all 171 patients who answered the premailed questionnaire. Curvature, when present, was corrected with dorsal Nesbit plication in 64 patients. Results were compared to previously published controls.
RESULTS
All patients were operated on before the age five (98 distal, 20 midshaft and 53 proximal hypospadias) and the median age at last visit was 16.2 years (15-21.2). Self-reported penile straightness was noted in 159 (93.0%) cases (in 92/96 (97%) of distal, in 19/20 (95%) of midshaft and in 48/51 (94%) of proximal cases (p=0.90) and in 103/106 (97%) cases without and in 56/60 (93%) cases with Nesbit plicature (p=0.24)). EHS grade 4 was achieved in 119/161 (73.9%) patients (in 64/93 (69%) of distal, in 17/20 (85%) of midshaft and in 38/48 (79%) of proximal cases (p=0.20) and in 77/103 (75%) patients without and in 42/57 (74%) with Nesbit plicature, (p>0.99)). EHS grade 4 was even more common than in the controls from the literature (p<0.01). Ejaculation was reported in 95% of patients. No patient reported pain during erection, but one patient had pain during ejaculation.
CONCLUSIONS
This study demonstrates favorable sexual outcomes, comparable to controls, in most adolescents following hypospadias repair. The severity of hypospadias or the history of Nesbit plicature had no significant influence on the outcome.