Parallel Meeting on Thursday 4, September 2025, 16:30 - 17:30
16:30 - 16:33
S22-1 (OP)
David KEENE 1, Arianna MARIOTTO 1, Mohamed KENAWEY 2, Emmanouil MORAKIS 2 and Raimondo CERVELLIONE 1
1) Royal Manchester Children's Hospital, Paediatric Urology, Manchester, UNITED KINGDOM - 2) Royal Manchester Children's Hospital, Paediatric Orthopaedics, Manchester, UNITED KINGDOM
PURPOSE
Despite pelvic osteotomy helps to secure the closure of the anterior abdominal wall, its role remains controversial because pubic diastasis (PD) partially recurs within 6 months in most patients. Aim: to assess allograft symphyseal reconstruction (ASR) for maintaining pubic approximation post iliac osteotomies in bladder exstrophy (BE) repair.
MATERIAL AND METHODS
Fifteen consecutive patients had ASR with modified oblique iliac osteotomies at delayed exstrophy repair. Tendon allografts were tunnelled subperiosteally around the pubic bones, passed through the obturator foramina and reinforced by anterior chondro-periosteal vicryl sutures. A control group (C) of 24 patients underwent delayed exstrophy repair with osteotomy but no ASR. Postop external fixator and mermaid dressings prevented leg abduction. PD assessed pre-operatively CT scan (A), post-operatively pelvic x-ray before fixator removal (B) x-ray at latest follow-up (C). Data collection was prospective, and is presented as median (IQ range), t-test for groupwise statistical analysis.
RESULTS
All patients had successful bladder closure with no dehiscence or neurological sequaelae. Post-op PD stayed the same in ASR group (<3mm difference) in 12/15(80%) at follow up, compared to 1/24(4%) control group.
| Allograft symphseal reconstruction (ASR) | Control (C) | P-value | ||
| Number patients | 15 | 24 | ||
| Age BLEX closure(months) | 12(10-16) | 7.8(4-12) | ||
| Underlying condition |
11 classic exstrophy 2 cloacal exstrophy 2 exstrophy variant |
24 classic exstrophy | ||
| Gender | 4M,11F | 17M,7F | ||
| Pubic diastasis (mm) |
A –pre-op | 50(47-53) | 51(44-54) | P=0.11 |
| B –post-op (exfix removal) | 22(17-24) | 21(18-23) | P=0.27 | |
| C –post-op latest follow-up | 23(19-27) | 34(32-42) | P<0.00001 | |
| Follow-up period (months) | 6 (4-9) | 64 (24-90) | ||
CONCLUSIONS
Pubic approximation post-iliac osteotomy and allograft symphyseal reconstruction is maintained in the majority of exstrophy patients at median follow-up of 6 months.
16:33 - 16:36
S22-2 (OP)
Dana WEISS 1, Michael FRANCAVILLA 2, Martin KIDD 3, Mohamed ELSINGERGY 4, John WEAVER 5, B. David HORN 6, Aseem SHUKLA 7, Joseph BORER 8, Ted LEE 8, John KRYGER 9, Elizabeth ROTH 10, Travis GROTH 10, Michael MITCHELL 10 and Susan BACK 4
1) Children's Hospital of Philadelphia, Surgery, Division of Urology, Philadelphia, USA - 2) University of South Alabama, Whiddon College of Medicine, Department of Radiology, Mobile, USA - 3) University of Stellenbosch, Centre for Statistical Consultation, Stellenbosch, SOUTH AFRICA - 4) Children's Hospital of Philadelphia, Department of Radiology, Philadelphia, USA - 5) Cleveland Clinic, Department of Urology, Cleveland, USA - 6) Children's Hospital of Philadelphia, Division of Orthopedic Surgery, Philadelphia, USA - 7) Children's Hospital of Philadelphia, Division of Urology, Philadelphia, USA - 8) Boston Children's Hospital, Department of Urology, Boston, USA - 9) Children's Hospital of Wisconsin, Division of Urology, Milwaukee, USA - 10) Children's Hospital of Wisconsin, Department of Urology, Milwaukee, USA
PURPOSE
Bladder exstrophy-epispadias complex (BEEC) involves osseous pelvic defects and a wide pubic diastasis (PD). We aimed to assess how using a standard pelvic measurement of posterior inferior iliac spine distance (dPIIS) as a growth metric within a ratio, PD/dPIIS or “M-factor,” accounts for overall pelvic size compared to PD alone.
MATERIAL AND METHODS
PD and dPIIS were measured on 268 radiographs (134 of BEEC patients paired with age and gender matched controls) at 4 timepoints: preoperative, intraoperative, early post-operative and late post-operative.
RESULTS
Following BEEC repair with osteotomies and pubic bone approximation, PD and the M-factor decreased significantly. (See Table for measures). Due to early spreading of the bones as well as infant growth, there was no statistical difference between pre-operative and early post-operative PD, however there was a significant difference in the M-factor. With gradual increase in PD over time, there was a significant difference between early and late post-operative PD measurements, but not in the M-factor.
|
Time point |
PD (mm) (mean ± std) |
p-value |
M Factor (mean ± std) |
p-value |
||||
|
Pre-operative |
35.2 ± 8.6 |
<0.01* |
0.08 |
|
0.89 ± 0.23 |
<0.01* |
<0.01* |
|
|
Intra-operative |
24.3 ± 13.5 |
0.54 ± 0.21 |
||||||
|
Early post-operative |
34.1 ± 9.8 |
|
0.03* |
0.73 ± 0.2 |
|
0.45 |
||
|
Late post-operative |
39.8 ± 9.9 |
|
0.75 ± 0.17 |
|
||||
CONCLUSIONS
PD in patients with BEEC changes over time due to surgery as well as growth, while a ratio of PD to an internal reference (dPIIS), does not. This M-Factor ratio can better determine the initial extent of PD within the context of the size of the child, as well as standardize assessment of changes after surgery and during growth and development.
16:36 - 16:39
S22-3 (OP)
David HEAP, Alex SIMPKINS, Jason YANG, Catherine ROBEY, Tamir SHOLKLAPPER, Alexander HIRSCH, Ahmed HAFFAR, Heather DI CARLO, John GEARHART and Chad CRIGGER
Johns Hopkins University School of Medicine, Robert D. Jeffs Division of Pediatric Urology, James Buchanan Brady Urological Institution, Baltimore, USA
PURPOSE
Isolated male epispadias (IME) presents as an abnormal dorsal opening of the urethral meatus. It occurs in 1:120,000 live male births. Like all pathologies within the Bladder Exstrophy-Epispadias Complex (BEEC), this condition is associated with varying degrees of widened pubic diastasis. This study sought to investigate the correlation between width of diastasis and continence outcomes.
MATERIAL AND METHODS
An IRB-approved, prospectively maintained, single-institutional BEEC database was utilized to identify male patients with isolated epispadias. Electronic medical records were reviewed for data pertaining to patient demographics, their original epispadias revision surgeries, and continence procedures and outcomes. Width of pubic diastasis was recorded through measurements obtained in imaging or physical exam. Continence was described in terms of social continence or >3 hours of daytime dry intervals between voids. These factors were assessed for their impact on continence outcomes.
RESULTS
Of the 150 male epispadias cases reported in the database, 63 patients with complete data were identified. Of the 63 patients, 32 (51%) achieved social continence while the remainder are incontinent. Decreasing trends in mean width of pubic diastasis were observed in the continent group (2.13 cm, SD 1.36 vs. 2.65 cm, SD 1.18) when compared to the incontinent cohort. 15 of 32 continent patients did not require additional surgery to achieve continence while the remainder received 1-3 surgeries to achieve dryness. The 17 that required surgery had a significantly wider pubic diastasis (3.0 cm, SD 1.25 vs. 1.2 cm, SD 0.69) when compared to the nonsurgical group (p<0.001).
CONCLUSIONS
This is the first study to suggest that width of pubic diastasis is directly correlated to achieving continence in the IME population. These findings can assist in clinical decision making when considering the need for continence surgery in these patients, while also helping to manage patient and parent expectations.
16:51 - 16:54
S22-4 (OP)
Hilmican ULMAN 1, Sumeyye SOZDUYAR 1, Derya CANARSLAN 2, Sibel TIRYAKI 1, Ibrahim ULMAN 1 and Ali TEKIN 1
1) Ege University, Department of Pediatric Surgery - Division of Pediatric Urology, İzmir, TÜRKIYE - 2) Ege University, Department of Pediatric Surgery, İzmir, TÜRKIYE
PURPOSE
To expose the changing trends in bladder neck repair in bladder exstrophy cases in our center, and to compare the long-term outcomes of different methods.
MATERIAL AND METHODS
Medical records of the cases that underwent bladder neck repair due to bladder exstrophy between 2004-2023 were retrospectively reviewed. The cases that underwent Modified Young-Dees-Leadbetter (YDL) and Kelly radical soft tissue mobilization (KLY) procedures were contacted. Long-term urinary continence and additional surgeries were compared between groups. Cases >4 years-of-age were evaluated for continence, and those who voided voluntarily or remained dry with CIC were considered continent.
RESULTS
Before 2019, YDL was performed, and after 2019, KLY was the procedure of choice. Of the total 66 cases, 50 (15F/35M) underwent YDL and 16 (3F/13M) underwent KLY. Mitrofanoff stoma, ileocystoplasty, bladder neck closure (BNC), and continence rates of the YDL and KLY groups are compared (Table). Excluding BNC cases, urethral continence comparison revealed that the KLY group had a higher rate of continence (p=.01) and less need for a BNC (p=.03) compared to the YDL group. Additionally, within the KLY group, 50% (3/6) of cases operated primarily were able to void spontaneously, whereas only 23% (2/9) of cases operated secondarily could void spontaneously (p=.26), one remained dry with CIC, and one required a BNC.
|
|
YDL (n=50),(%) |
KLY (n=16),(%) |
p |
|
Mitrofanoff stoma |
33 (66%) |
4 (25%) |
.03 |
|
Ileocystoplasty |
31 (62%) |
3 (19%) |
.02 |
|
Bladder neck closure |
20 (40%) |
2 (12%) |
.04 |
|
Continence (total)(>4 years) |
32/50 (60%) |
9/10 (90%) |
>.05 |
|
Continence (urethral)(>4 years) |
12/50 (24%) |
7/10 (70%) |
.004 |
CONCLUSIONS
In the long-term, continence after the Kelly method was superior, and the need for BNC was lower compared to the YDL method. Future reevaluation with larger patient numbers is planned.
16:54 - 16:57
S22-5 (OP)
Maia REGAN 1, Divya MUDUNDI 2, Roni ROBINSON 1, Karl GODLEWSKI 2, Lauren LEVEY 3, Aseem SHUKLA 2, Dana WEISS 2 and David HORN 1
1) The Children's Hospital of Philadelphia, Department of Orthopaedics, Philadelphia, USA - 2) The Children's Hospital of Philadelphia, Department of Urology, Philadelphia, USA - 3) Boston Orthotics & Prosthetics, Philadelphia, USA
PURPOSE
Spica casts are traditionally used for immobilization after bladder exstrophy repair. We have evolved our practice to use a custom-fabricated, removable, hip spica brace for postoperative immobilization and hypothesized that this brace would function as well as a spica cast in children undergoing bladder exstrophy repair.
MATERIAL AND METHODS
Children with classic bladder exstrophy who underwent consecutive repairs with concurrent pelvic osteotomies at a single center tertiary care children’s hospital between 2018-2024 were included. Post-operative immobilization was initially with a bivalved spica cast until 2021 and switched to a custom spica brace in 2022. Medical records and radiographs were reviewed.
RESULTS
A total of 26 patients (13 male) with a mean age at surgery of 3.7±2 months were included. Fourteen (53.8%) were immobilized in a bivalved spica cast and12 (46.2%) in a spica brace. Duration of immobilization was 5.5±0.74 weeks with no difference between the groups (p=0.917). Skin irritation occurred in 7/14 (50%) of the spica cast group and only 3/12 (25%) in the brace group (p=0.20). There was no difference in the pubic diastasis between the two groups when assessed at 6–8-weeks, 3-8 months and 10-14 months after surgery (p=0.089, 0.479, 0.651 respectively) There were no patients with abdominal or orthopedic wound complications or dehiscence in either group.
CONCLUSIONS
A custom removable spica brace is a useful alternative for post-operative immobilization in children undergoing bladder exstrophy reconstruction. The spica brace is well tolerated and may ultimately have improved skin integrity, while maintaining the strength and efficacy of a spica cast.
16:57 - 17:00
S22-6 (OP)
Zafar ABDULLAEV 1, Kobiljon ERGASHEV 1, Kamron KHIDOYATOV 1, Askar SOLIEV 1, Davronbek KHALTURSUNOV 2, Akmal RAKHMATULLAEV 3 and Saidanvar AGZAMKHODJAEV 1
1) National Children's Medical Center, Pediatric urology, Tashkent, UZBEKISTAN - 2) Tashkent Pediatric Medical Institute, Pediatric urology, Tashkent, UZBEKISTAN - 3) Tashkent Pediatric Medical Institute, Pediatric surgery, Tashkent, UZBEKISTAN
PURPOSE
The most frequent complication following bladder exstrophy repair is fistula formation in the penopubic area. Platelet-rich fibrin (PRF) is an autologous, growth factor-rich biomaterial. This prospective study evaluated the efficiency of using an autologous PRF membrane in cases of bladder exstrophy.
MATERIAL AND METHODS
Twelve male patients with primary classical bladder exstrophy, operated between 2022 and 2024, were prospectively included. Patients were divided into two groups: Group A included 7 patients (58.3%) where PRF was used, and Group B consisted of 5 patients (41.6%) in the control group where standard wound closure was performed without using PRF. During surgery, 5-10 ml of the patient's blood was collected and immediately centrifuged at 3000 rpm for 13 minutes to produce a PRF clot, which was transformed into a dense fibrin membrane. This membrane was applied to the bladder neck area before surrounding tissue approximation. The whole procedure was performed under complete sterilization. Anterior osteotomy was performed in all patients with external fixation.
RESULTS
The median age at surgery was 14±9 months in both groups. Postoperative penopubic fistula formation occurred in 2 patients (40%) from group B, with one case resolving spontaneously and another requiring repair after 8 months. In Group A, one patient developed compartment syndrome intraoperatively, which required penile tissue release.
CONCLUSIONS
PRF is feasible and an alternative tissue for covering the neobladder neck, particularly when additional layers for defect coverage are insufficient. Further randomized comparative studies will be necessary to assess the true benefit of the autologous membrane
17:12 - 17:15
S22-7 (OP)
Cristina TORDABLE 1, Daniel CABEZALÍ 1, Marta MARÍ 1, Ester FERNÁNDEZ 1, Jesús VARA 2, María Josefa SÁNCHEZ 3 and Andrés GÓMEZ 1
1) Hospital 12 de Octubre, Cirugía pediátrica. Sección Urología pediátrica, Madrid, SPAIN - 2) Hospital 12 de Octubre, Rehabilitación, Madrid, SPAIN - 3) Hospital 12 de Octubre, Physiotherapy, Madrid, SPAIN
PURPOSE
The bladder exstrophy-epispadias complex (BEEC) represents an anatomical and
functional challenge, affecting various organs and systems, including the genitourinary
and musculoskeletal systems, among others.
Our aim is to evaluate the effectiveness of pelvic floor rehabilitation as a complementary
approach to surgical management in pediatric patients with BEEC.
MATERIAL AND METHODS
Thirteen BEEC patients underwent pelvic floor rehabilitation between 2018 and 2024.
For analysis, patients were divided into two groups based on their surgical stage: those
without cervicourethroplasty (closure of the bladder plate and epispadias) (n=6) and
those with cervicourethroplasty (n=7). Data were collected from medical records and
cystomanometries.
RESULTS
The mean age of the group without cervicourethroplasty was 8.6 years (3.5–10). In this
group, the average bladder capacity increased by 32.5 ml (p<0.05), and the average
dry time improved by 20 minutes (p>0.05) after an average of 5.5 sessions. The mean
age of the group with cervicourethroplasty was 11 years (7–13). These patients
presented with stress incontinence, and all showed improvement, with their absorbent
pads being dry or less wet after an average of 4.7 sessions. All patients reported
subjective improvement after treatment.
CONCLUSIONS
Pelvic floor rehabilitation is an effective tool to complement the surgical management
of BEEC. It promotes urinary continence, optimizes pelvic floor functionality, and
improves patients’ quality of life. Early rehabilitation should be considered in
comprehensive treatment protocols.
17:15 - 17:18
S22-8 (OP)
Mehak SEHGAL, Alya ALBLOOSHI, Satej MHASKAR, Karen RYAN, Naima SMEULDERS, Navroop JOHAL and Imran MUSHTAQ
Great Ormond Street Hospital for Children, NHS Foundation Trust, Paediatric Urology, London, UNITED KINGDOM
INTRODUCTION
To evaluate the continence outcomes of patients with bladder exstrophy managed exclusively on the Kelly pathway.
MATERIAL AND METHODS
This was a retrospective review of patients managed on the Kelly pathway between 2002 to 2019, with a minimum 5-year follow-up. The pathway includes a neonatal bladder closure, without osteotomy, followed by the Kelly procedure at 12-24 months of age, in all patients. Operative and follow-up data was collected, including the need for urethral CIC and bladder augmentation. Variables studied were continence, status of upper tracts, and functional bladder capacity. Statistical analysis performed included Chi-Square test.
RESULTS
A total of 194 patients were managed on this pathway, of which 159 had a minimum 5-year follow-up and were included in the study. The median age at Kelly procedure was 1.95 years (IQR 1.4-2.5 years). The male:female ratio was 1.96:1, with continence at 10-years post-Kelly higher for girls (56.4% girls vs 48.7% boys(p=0.4)). There was no significant increase in the upper tract dilatation at 10 years compared to 5 years post the Kelly procedure (p=0.9).
| 5 years post Kelly procedure | 10 years post Kelly procedure | |
|
Actual/expected bladder capacity (%) (Median, IQR) |
47.15% (23.7-59.7) | 54.29% (38.57-71.43) |
| Augmentation | 8/159 (5%) | 30/121 (24.7%) |
| Continence Score | ||
| 0- Incontinent | 30/159 (18.8%) | 4/121 (3.3%) |
| 1- Dry intervals, but incontinent |
51/159 (32%) (2 on CIC) |
26/121 (21.4%) |
| 2- Dry by day |
47/159 (29.5%) (4 on CIC) |
28/121 (23.1%) (8 on CIC) |
| 3- Dry day and night | 22/159 (13.8%) |
34/121 (28%) (5 on CIC) |
CONCLUSIONS
Ten years after a Kelly procedure, a child has a 50% chance of being dry by day. Augmentation cystoplasty is required in 25% patients to achieve continence.