Parallel Meeting on Thursday 4, September 2025, 08:00 - 08:50
08:00 - 08:04
S16-1 (CP)
Brooke SPRATTE, Brad FIGLER, Hans ARORA and Richard SUTHERLAND
University of North Carolina, Urology, Chapel Hill, USA
PURPOSE
In neurogenic bladder patients, bladder neck sling procedures treat incontinence with low leak point pressures. Traditional transabdominal approaches require blind posterior dissection, risking bladder neck or rectal injury and suboptimal sling placement. In males, a trans-perineal approach with peri-rectal dissection allows direct visualization of the posterior bladder neck, reducing injury risk and improving sling placement.
MATERIAL AND METHODS
A 9-year-old male with spina bifida and neurogenic bladder presented with persistent incontinence after ileocystoplasty, prompting plans for a Mitrofanoff and bladder neck sling. A trans-perineal peri-rectal dissection was performed simultaneously with a trans-abdominal approach. In high lithotomy, a midline perineal incision was made, perineal body divided, corpus spongiosum mobilized, Denonvilliers’ fascia incised, and the prostate/bladder neck elevated off the rectum to enter the retroperitoneum. A Penrose drain was placed posteriorly and advanced anteriorly around both sides of the bladder neck. Upon abdominal entry, the drain was easily identified. A 10x2cm rectus fascia sling was placed circumferentially around the bladder neck, using the Penrose drain as a guide to ensure precise placement. Cystoscopy confirmed urethral coaptation. The Mitrofanoff procedure was completed, and an 8 French Foley was placed.
RESULTS
At two months, retrograde and antegrade cystoscopy confirmed appropriate urethral coaptation. At one year, urodynamics showed no incontinence, and no leak at a maximal Valsalva pressure of 72mm H2O. At two years, he remains dry between Mitrofanoff catheterizations with rare urethral incontinence.
CONCLUSIONS
A trans-perineal approach with peri-rectal dissection avoids blind posterior bladder neck dissection and enables precise sling placement, which potentially may improve continence outcomes.
08:04 - 08:08
S16-2 (CP)
Ahmed ELKASHEF 1, Mina MELIKAH 1, Mona Kamal GOMMA 2 and Ashraf HAFEZ 1
1) Urology and Nephrology Center, Mansoura University, Egypt, Department of Urology, Mansoura, EGYPT - 2) Urology and Nephrology Center, Mansoura University, Egypt, Department of Radiology, Mansoura, EGYPT
PURPOSE
To report a rare case of iatrogenic uretero-iliac artery fistula post vascular surgery that was repaired by appendiceal interposition ureteroplasty and iliac artery bypass graft.
MATERIAL AND METHODS
A 9-year-old girl, presented with hematuria and clot retention with right flank pain. She had history of repair of right common iliac artery aneurysm using a synthetic graft, which was complicated by right ureteral injury and right resection-ureteral reanastomosis was then performed. Few months later, she underwent balloon dilatation at the site of the arterial graft. Following the arterial dilation, she developed hematuria and clot retention. On examination, her vital signs were within the normal limits. Her hemoglobin level was 9 g/dL. Renal and bladder ultrasound (RBUS) showed right grade III hydronephrosis, with a hematoma occupying the right pelvicalyceal system as well as the urinary bladder. CT angiogram demonstrated right external iliac artery aneurysm measuring 1.7 x 2.6 cm, inseparable from the right iliac ureter, suggesting the presence of right uretero-iliac artery fistula with right pelvicalyceal and bladder hematomas. So, surgical exploration was then performed.
RESULTS
Surgical exploration showed large fistula associated with severe inflammatory reaction. The decision was made to bypass the fistula at both the ureteral and vascular levels. A stented ureteral replacement was conducted using the appendix as a conduit. A right common iliac to external iliac artery bypass graft was also performed using the right superficial femoral vein. Postoperatively, the patient showed resolution of hematuria and viable right lower limb by clinical examination. RBUS and duplex ultrasound also showed resolution of hydronephrosis and intact vascularity of right lower limb, respectively.
CONCLUSIONS
Uretero-iliac artery fistula is an uncommon complication that needs high index of suspicion to diagnose and innovative surgical techniques to treat.
08:08 - 08:12
S16-3 (CP)
Saidanvar AGZAMKHODJAEV 1, Ilia KAGANTSOV 2, Akmal RAKHMATULLAEV 3, Kobiljon ERGASHEV 1 and Kamron KHIDOYATOV 1
1) NATIONAL CHILDREN'S MEDICAL CENTER, DEPARTMENT OF PEDIATRIC UROLOGY, Tashkent, UZBEKISTAN - 2) Almazov National Medical Research Center, PEDIATRIC SURGERY, St.Petersburg, RUSSIAN FEDERATION - 3) TASHKENT PEDIATRIC MEDICAL INSTITUTE, PEDIATRIC SURGERY, Tashkent, UZBEKISTAN
PURPOSE
Chyluria is a rare condition characterized by the presence of chyle in the urine, resulting in a milky or turbid appearance. While parasitic infections are the most common cause of chyluria in endemic areas, non-parasitic or idiopathic cases can also occur. This case report presents an unusual case of long-standing idiopathic chyluria in a young patient, successfully managed with laparoscopic intervention.
MATERIAL AND METHODS
A 12-year-old male patient presented to our clinic with a chief complaint of passing milky urine for more than 10 years. Physical examination revealed no significant abnormalities, and there was no evidence of lymphadenopathy or edema. Laboratory investigations, including parasite examination for Wuchereria bancrofti was negative, ruling out filarial etiology. A cystoscopy was performed, which revealed chyle coming out from the left ureteral orifice, confirming the diagnosis of left-sided chyluria. Laparoscopic left renal pedicle lymphatic ligation was performed.
RESULTS
During the short postoperative period, there were no signs of milky urine. The patient was followed up regularly after the procedure. At the 6-month follow-up, he remained symptom-free with no recurrence of milky urine. There were no postoperative complications, and the patient reported a significant improvement in his quality of life.
CONCLUSIONS
Idiopathic chyluria, though rare, should be considered in the differential diagnosis of milky urine in pediatric patients, even in non-endemic areas. This case demonstrates that a laparoscopic approach for the renal pedicle lymphatic ligation can be a safe and effective treatment option for managing idiopathic chyluria in young patients, offering good outcomes and improved quality of life.
08:12 - 08:16
S16-4 (CP)
Lauren CHEW 1, Kevin PARR 1, Alejandro CALVILLO-RAMIREZ 2, Nannan THIRUMAVALAVAN 1, Matthew DEMASI 1, Pedro-Jose LOPEZ 2 and Juan MOLDES 2
1) University Hospitals Cleveland Medical Center, Urology, Cleveland, USA - 2) University Hospitals Rainbow Babies & Children's Hospital, Pediatric Urology, Cleveland, USA
INTRODUCTION
Rhabdomyosarcoma (RMS) treatment often combines chemotherapy, surgery, and/or radiation. In genitourinary RMS, surgical resection may be unfeasible, requiring radiation that risks gonadal exposure. Testicular transposition is typically performed to preserve gonadal function, but standard techniques may not always be feasible due to extensive radiation fields. We report a five-year-old male with unresectable prostatic RMS who required an alternative approach to testicular preservation.
CASE PRESENTATION
A multidisciplinary team evaluated options for testicular preservation in this patient, as traditional inguinal repositioning was unviable due to the extensive radiation field. The safest site was identified as high on the lateral abdominal wall, beneath the liver and lateral to the spleen. Concerns arose regarding vas deferens mobility, but a fertility specialist advised that the vas deferens could be transected, with potential vasovasostomy if the patient later desired reproduction. After discussing risks and benefits, the parents consented to the procedure.
SURGICAL TECHNIQUE
Bilateral inguinal incisions released the testicles from gubernacular attachments, improving mobility. Laparoscopy enabled precise positioning in the abdominal cavity at the inferior liver and lateral to the spleen. Transection of the vas deferens was not necessary, as there was sufficient length to position the testicles without tension. To maintain blood supply, the peritoneum was released from the spermatic cord at the internal inguinal ring. The testicles were secured laterally with Prolene sutures and marked with metal clips. Postoperative imaging confirmed successful mobilization 18 cm cephalically from the pubic symphysis.
CONCLUSIONS
When traditional testicular transposition is unfeasible, high intra-abdominal placement offers a viable alternative. Laparoscopy allows precise positioning while preserving testicular blood supply. While transection of the vas deferens remains an option for greater mobility, this case demonstrates it may not always be necessary. Protecting gonadal function should remain a priority in such cases.
08:16 - 08:20
S16-5 (CP)
Marie HEYNE-PIETSCHMANN 1, Sibylle TSCHUMI 2 and Mazen ZEINO 1
1) University of Bern, Pediatric Urology, Department of Pediatric Surgery, Bern, SWITZERLAND - 2) University of Bern, Pediatric Nephrology, Children Hospital, Bern, SWITZERLAND
PURPOSE
Bilateral renal agenesis is a rare fetal anomaly, which is historically described as almost universally fatal in the neonatal period due to severe pulmonary hypoplasia. Over the last decades, survival rates have increased due to the innovation of fetal amnio-infusions and development of dialysis in premature infants. But morbidity remains high, and the management remains challenging with slender chances of long-term survival.
MATERIAL AND METHODS
We present the case of a male neonate with bilateral renal agenesis and bladder agenesis. Initially, he was a dizygotic twin pregnancy with intrauterine death of the twin between the 8th-9th weeks of gestation. Between the 20th-24th weeks of pregnancy anhydramnios was recognised and no kidneys could be identified. The parents declined fetal amnio-infusions.
RESULTS
e was born prematurely (GA 36 2/7 weeks) and peritoneal dialysis was initiated on the 3rd day of life. A neobladder from ileum and sigmoid with a Mitrofanoff stoma was reconstructed at nearly 3 years of age. Five months later, renal transplantation was carried out successfully. In a short follow up of six months after transplantation, the renal function remains stable with a good outcome of the reconstructed neobladder. High-frequency oscillation was necessary during the first week of life, but now he needs only intermittent high-flow support during the night.
CONCLUSIONS
In the last few years, there have been an increasing number of reports about survivors with bilateral renal agenesis due to serial amnioinfusions, but morbidity and mortality remain very high. In our case, it remains mysterious how the patient survived without fetal intervention.
08:20 - 08:24
S16-6 (CP)
Sudhindra JAYASIMHA 1, David COX 2, Premal PATEL 3, Ciaran HUTCHINSON 4, Giuseppe BARONE 5, Claire MCCAHILL 6, Naima SMEULDERS 7 and Navroop JOHAL 7
1) Great Ormond Street Hospital, Pediatric Urology, London, UNITED KINGDOM - 2) Great Ormond Street Hospital for Children NHS Foundation Trust, Neonatology, London, UNITED KINGDOM - 3) Great Ormond Street Hospital for Children NHS Foundation Trust, Interventional Radiology, London, UNITED KINGDOM - 4) Great Ormond Street Hospital for Children NHS Foundation Trust, Pathology, London, UNITED KINGDOM - 5) Great Ormond Street Hospital for Children NHS Foundation Trust, Oncology, London, UNITED KINGDOM - 6) Great Ormond Street Hospital for Children NHS Foundation Trust, Anaesthesia, London, UNITED KINGDOM - 7) Great Ormond Street Hospital for Children NHS Foundation Trust, Urology, London, UNITED KINGDOM
PURPOSE
Rupture of congenital mesoblastic nephroma(CMN) during caesarean section has not been previously reported in literature. This case report describes the crucial role of a multidisciplinary approach in achieving an optimal clinical outcome.
MATERIAL AND METHODS
A male neonate was born at 36 weeks by caesarean for reduced foetal movements. His birthweight was 2.7 kg and Apgar scores were 8 and 9. Subsequently, he was noted to be tachycardic, hypotensive with abdominal distention and haemoglobin dropped from 93 to 34g/L. He required significant resuscitation before transfer. Imaging showed a large, right-sided, intra-abdominal mass with solid and cystic areas, and haemoperitoneum. A multidisciplinary team (Neonatology, Interventional Radiology, Urology, Vascular Surgery) was assembled to formulate a management plan.
Under general anaesthesia, a 5X2 mm Saber balloon was placed in the supracoeliac aorta via the umbilical artery. Balloon-inflation was planned if there was major haemorrhage during laparotomy. A transperitoneal right radical nephrectomy was completed for a large, ruptured right renal tumour.
Post-operatively, he was managed on the neonatal intensive-care for shock, sepsis, acute kidney injury, low sensorium and congenital hypothyroidism, with multidisciplinary input.
RESULTS
Histopathology revealed cellular CMN with weak Cyclin D1 staining, INI-1 expression and ETV6-NTRK3 fusion. He made a full recovery and MRI at two months showed no recurrence. He was planned for close surveillance without adjuvant chemotherapy.
CONCLUSIONS
This case highlights the successful, multidisciplinary management of a rare presentation of CMN, and the innovative use of transumbilical aortic balloon for potential haemorrhage control.
08:24 - 08:28
S16-7 (CP)
Sadaf ABA UMER 1, Bashir AHMED 1, Shamvil ASHRAF 1, Sajid SULTAN 1 and Adeeb Ul Hassan RIZVI 2
1) SINDH INSTITUTE OF UROLOGY AND TRANSPLANTATION (SIUT), PHLIP G.RANSLEY DEPARTMENT OF PAEDIATRIC UROLOGY, Karachi, PAKISTAN - 2) SINDH INSTITUTE OF UROLOGY AND TRANSPLANTATION (SIUT), PHILIP G.RANSLEY DEPARTMENT OF PAEDIATRIC UROLOGY, Karachi, PAKISTAN
PURPOSE
Botryoid WT is a rare entity and bilateral is extremely rare. We present the case of bilateral botryoid WT presented with oligo-anuria and acute renal failure.
MATERIAL AND METHODS
Two and a half-year-old boy presented with vomiting, oligo anuria and generalized edema.
RESULTS
Investigations showed Hb=5.4gm% and renal failure, Creatinine=5.25mg%). An ultrasound showed bilaterally enlarged kidneys with moderate hydroureteronephrosis and echogenic material filling the pelvicalyceal system (PCS). Non-contrast CT scan confirmed these findings of hyperdense material inside the PCS with streak of left perinephric collection. After two sessions of hemodialysis bilateral percutaneous nephrostomies were placed to relieve the obstruction.No urine output and no renal function improvement seen therefore decided for unilateral exploration. On exploration, polypoidal growth protruded on incising the pelvis of Right kidney, and extending down to mid-ureter without obvious ureteric wall attachment.Complete enucleation of the growth is performed and tissue was sent for histopathology which showed the features of “Classic Wilms’ tumour”.After the right debulking surgery,urine output and renal function slightly improved.Postoperative CT scan showed no mass or hyperdense material on the right side however, left remained the same and there was no chest metastasis. Hence, the diagnosis of bilateral localized botryoid WT is established and he was started on chemotherapy. After four cycles of chemotherapy, planned for left debulking surgery.
CONCLUSIONS
This is an extremely rare case of bilateral botryoid WT presented with acute renal failure. Botryoid WT should be included in the differential diagnosis of a young child presented with oliguria and renal failure with echogenic/hyperdense material on ultrasound and CT scan.
08:28 - 08:32
S16-8 (CP)
Joaquín Andrés RISSETTI VILLALOBOS 1, Francisca Victoria YANKOVIC BARCELÓ 2 and Francisco REED LÓPEZ-GUEREÑA 2
1) University of Concepción, Department of Public Health, Concepción, CHILE - 2) Hospital Dr. Exequiel González Cortés, Department of Pediatric Urology, San Miguel, CHILE
INTRODUCTION
Standard management of recurrent urinary tract infections (RUTI) includes antibiotic prophylaxis. Sublingual immunotherapy, a strategy for immune modulation, has substantial evidence for prevention in adult women but has not been studied in pediatric populations. This study describes the initial experience of a 3-month sublingual immunotherapy for RUTI in five girls.
PATIENTS AND METHODS
Case 1: A 4-year-old girl with vesicoureteral reflux (VUR) grade 4 and detrusor-sphincter dyssynergia. After treatment, Uromune® was initiated for 3 months. At 9-month follow-up, she remained infection-free.
Case 2: An 8-year-old girl with VUR grade 2 and recurrent infections despite prophylaxis. After starting Uromune®, she remained asymptomatic for 11 months.
Case 3: An 8-year-old girl with normal imaging and persistent RUTI. Urpo® was initiated, and after 12 months, no infections were reported.
Case 4: A 1-year-old girl with Schinzel-Giedion syndrome, epilepsy, and recurrent febrile UTIs. Uromune® reduced severity, but three infections occurred within four months. Despite this, her overall condition improved.
Case 5: A 12-year-old girl with tethered cord syndrome, neurogenic bladder, and prior Mitrofanoff procedure. Uromune® initially reduced infections, but frequency increased after six months. Intravesical Botox led to only one non-febrile infection in the following months.
RESULTS
Most patients remained infection-free, while two had reduced infection severity. Families reported high satisfaction, and adherence was excellent.
CONCLUSIONS
This is the first report of sublingual immunotherapy for RUTI in girls in Chile. It appears to be a promising alternative to long-term antibiotics in pediatric patients, warranting further research into its effectiveness and long-term outcomes.
08:32 - 08:36
S16-9 (CP)
Bilge TUREDI SEZER 1 and Ali SEZER 2
1) Konya City Hospital, Paediatric Urology, Konya, TÜRKIYE - 2) Konya City Hospital, Pediatric Urology, Konya, TÜRKIYE
PURPOSE
We aimed to present a case of bilateral nephrolithiasis treated with simultaneous bilateral endoscopic surgery (SBES). This pediatric case is unique for the use of flexible and navigable suction ureteral access sheath (FANS-UAS), Thulium-fiber laser (TFL), and the procedure being performed under spinal anesthesia (SA) in the supine position.
MATERIAL AND METHODS
A 16-year-old girl with restrictive lung disease requiring continuous oxygen support (ASA-4) was referred with bilateral nephrolithiasis causing acute kidney injury. Bilateral DJ-stents were inserted, normalizing creatinine levels. Anesthesia recommended SA for elective surgery, and SBES was planned: Flexible-ureterorenoscopy for the right (lower stone burden side) and endoscopic combined retrograde intrarenal surgery (ECIRS) for the left multiple calyceal stones.
RESULTS
In the left flank-free supine position, a 5Fr ureteral catheter was placed on the left and FANS-UAS on the right. A 12Fr nephroscope was introduced into the left kidney through a 15Fr percutaneous sheath, while a 7.5Fr flexible-ureterorenoscope was used on the right. Stone disintegration was achieved simultaneously using a 30W Holmium laser and 60W TFL. After aspirating the stone fragments on the right side and achieving complete stone clearance, the flexible ureteroscope was retrogradely placed on the left side over a guidewire. The procedure, initially performed using a percutaneous approach on the left side, was subsequently continued with ECIRS, resulting in a stone-free status bilaterally. A left 8Fr nephrostomy and a right 4.7Fr DJ-stent with string were placed. The procedure lasted 90 minutes without complications, and ultrasound at three months showed no residual stones.
CONCLUSIONS
Supine SBES using FANS-UAS and TFL may help reduce operation time and the need for additional sessions. Spinal anesthesia can be considered in older children with significant comorbidities who are high-risk candidates for general anesthesia.
08:36 - 08:40
S16-10 (CP)
Martin KAEFER
Riley Hospital for Children, Urology, Indianapolis, USA
PURPOSE
Urachal cysts have a reported incidence of 1/5000 children. Although most are identified incidentally on imaging studies, symptoms may include infraumbilical pain, dysuria and constipation. We report a rare presentation of a prepubertal boy who was referred to our clinic with an expanding fluid collection in the inguinal canal. The steps leading up to his referral, eventual diagnosis and cure are described.
MATERIAL AND METHODS
An 11-year-old male presented to his local emergency unit with a chief complaint of an expanding mass in the inguinal region. Ultrasound revealed this to be subcutaneous and fluid filled. Treatment at the outside hospital consisted of draining 300 ml of straw-colored fluid. Three months later the patient returned with a similar presentation and was referred to our hospital. Abdominal CT demonstrated the subcutaneous fluid collection. A small supravesical fluid collection with marked inflammation was also appreciated.
RESULTS
Surgical exploration revealed a ruptured urachal remnant with fluid exiting through an open internal ring and tracking out the inguinal canal into the subcutaneous space. Excision of the urachus, neighboring bladder wall and drainage tract was undertaken. The patient recovered with no complications. Pathology returned as inflamed urachal cyst with no evidence of malignancy.
CONCLUSIONS
A ruptured urachal cyst can drain through the inguinal canal and into the subcutaneous tissue. A high index of suspicion is required to make the diagnosis and abdominal imaging assists in clarifying the etiology.