ESPU Meeting on Friday 5, September 2025, 08:05 - 08:45
08:05 - 08:08
S23-1 (OP)
Sachit ANAND 1, Gaurav PRASAD 2, Dhruv Satya SAHNI 3 and Mehak SEHGAL 4
1) All India Institute of Medical Sciences, New Delhi, Pediatric Surgery, New Delhi, INDIA - 2) Rajendra Institute of Medical Sciences, Pediatric Surgery, Ranchi, INDIA - 3) NHS Greater Glasgow and Clyde, Urology, Glasgow, UNITED KINGDOM - 4) Great Ormond Street Hospital for Children, NHS Foundation Trust, Pediatric Surgery, London, UNITED KINGDOM
PURPOSE
The utility of postoperative antibiotic prophylaxis in children undergoing pediatric pyeloplasty for ureteropelvic junction obstruction (UPJO) remains unclear, with growing concerns about antimicrobial resistance. This systematic review and meta-analysis aims to investigate the impact of postoperative antibiotic prophylaxis on the incidence of urinary tract infection (UTI) in these children.
MATERIAL AND METHODS
A systematic search of PubMed, Embase, Web of Science, and Scopus databases was conducted to identify studies comparing the incidence of UTI among patients receiving postoperative prophylactic antibiotics vs. those not receiving them. Data on UTI incidence, stent insertion, and surgical approach were extracted. Meta-analysis was performed using RevMan 5.4 and the Mantel-Haenszel method was utilized for the estimation of pooled risk ratio (RR). The methodological quality assessment was performed using the Newcastle-Ottawa Scale.
RESULTS
A total of 13 studies were included in the systematic review, with 4 studies contributing to the meta-analysis. Among total 2,507 pyeloplasties (2.5% without a stent), 1,876 (74.8%) received prophylactic antibiotics, and had a UTI incidence of 7.6%. Contrary to this, 5.5% of the non-antibiotic cases developed UTIs. The meta-analysis showed no incremental benefit of antibiotic prophylaxis in terms of the incidence of UTI (pooled RR=1.34, 95% CI:0.84-2.14, p=0.22), with minimal heterogeneity (I²=0%, p=0.63). Factors like uncircumcised status, pre-operative antibiotic administration, and diaper use were associated with higher UTI risk.
CONCLUSIONS
Routine postoperative antibiotic prophylaxis does not significantly reduce the incidence of UTI after pediatric pyeloplasty. A targeted approach, such as the administration of antibiotics at stent removal, may be more appropriate and align with antibiotic stewardship principles.
08:08 - 08:11
S23-2 (OP)
Michelangelo COBANGBANG 1, Kay RIVERA 1, Mandy RICKARD 2, Joana DOS SANTOS 2, Armando LORENZO 2, Jin Kyu KIM 2, Jessie CUNNINGHAM 2 and Michael CHUA 2
1) St. Luke's Medical Center, Urology, Quezon City, PHILIPPINES - 2) The Hospital for Sick Children, Urology, Toronto, CANADA
PURPOSE
To compare the surgical outcomes between nonreduction and reduction Anderson-Hynes dismembered pyeloplasty in the management of ureteropelvic junction obstruction (UPJO) among pediatric patients, such as postoperative functional and structural outcomes, complication and failure rate, through a meta-analysis of comparative studies.
MATERIAL AND METHODS
Electronic databases, such as PubMed, EMBASE, Scopus, and Cochrane Library, including the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials, were searched to identify published literature containing comparison between reduction and nonreduction pyeloplasty up to December 2023. Data regarding postoperative anteroposterior diameter, differential renal function, and complications were extracted. Data synthesis and statistical analysis were done using ReviewManager. Random-effects model and mean difference were used for calculation of all effect estimates with 95% confidence intervals (CI) for extrapolation. This study was registered with PROSPERO (CRD42021288645).
RESULTS
Five studies were selected for analysis, encompassing 177 renal units, of which 88 (49.72%) cases were reduction pyeloplasty and 89 (50.28%) cases were nonreduction pyeloplasty. Our overall pooled effect estimates show statistically significant difference favoring reduction pyeloplasty in terms of anteroposterior pelvic diameter (APPD) (RR=2.99; 95%CI 1.49, 4.50), differential renal function (DRF) (RR=2.73; 95%CI 0.34, 5.13) and change in anteroposterior pelvic diameter (RR=3.27; 95%CI 2.64, 3.90). Analysis of both groups revealed no significant difference in terms of complication (RR=0.91; 95%CI 0.38, 2.16) and failure rate (RR=1.50; 95%CI 0.28, 8.04).
CONCLUSIONS
The evidence depicted in our study demonstrates that reduction pyeloplasty results in superior APPD, differential renal function and change in APPD over nonreduction pyeloplasty. Complication and failure rates between the two groups are comparable.
08:18 - 08:21
S23-3 (OP)
Ismail SELVI 1, M. İrfan DÖNMEZ 2, Numan BAYDILLI 3, Yesica Quirroz MADARRIAGA 4, Rianne LAMMERS 5, Edoardo BINDI 6, Simone SFORZA 7, Fardod O'KELLY 8, Bernhard HAID 9, Beatriz Banuelos MARCO 10 and Li̇sette Ai̇mee T'HOEN 11
1) İstanbul University, İstanbul Faculty of Medicine, Department of Pediatric Urology, Istanbul, TÜRKIYE - 2) İstanbul University, İstanbul Faculty of Medicine, Department Pediatric Urology, Istanbul, TÜRKIYE - 3) Erciyes University Faculty of Medicine, Department of Pediatric Urology, Kayseri, TÜRKIYE - 4) Fundació Puigvert, Department of Pediatric Urology, Barcelona, SPAIN - 5) University Medical Center Groningen, Department of Pediatric Urology, Groningen, NETHERLANDS - 6) Ospedale Pediatrico G Salesi Paediatric Hospital, Department of Pediatric Urology, Ancona, ITALY - 7) University of Florence, Meyer Children Hospital, Department of Pediatric Urology, Florence, ITALY - 8) University College Dublin, Department of Pediatric Urology, Dublin, IRELAND - 9) Hospital of the Sisters of Charity, Department of Pediatric Urology, Linz, AUSTRIA - 10) University Hospital Clinico San Carlos, Department of Pediatric Urology, Madrid, SPAIN - 11) Erasmus MC University Medical Center, Rotterdam-Sophia Children's Hospital, Department of Pediatric Urology, Rotterdam, NETHERLANDS
PURPOSE
Vesicoureteral reflux (VUR) may have long lasting effects on affected individuals, especially in females. Its intertwined relationship with urinary tract infection (UTI) has been well documented and there is a further risk during pregnancy where UTIs are more problematic. In this systematic review, we aimed to analyze existing data within the literature to identify factors associated with pregnancy-related complications in women with a history of VUR in childhood.
MATERIAL AND METHODS
PubMed, MEDLINE, Embase, and the Cochrane Library databases were searched to identify all published reports of pregnancy outcomes in women with a history of VUR in childhood up to January 2024 (PROSPERO Registration ID: CRD42024550470). Selection criteria included all English-language original articles reporting pregnancy outcomes (maternal and fetal morbidities) in pregnant patients with a history of VUR in childhood.
RESULTS
The search yielded 1060 papers, and 17 articles met the PICO inclusion criteria after screening and eligibility assessment. This systematic review assessed 2349 women with a history of VUR in childhood,1167 pregnant women and a total of 2206 pregnancies. Compared with the general obstetric population, the results showed an increased rate of pregnancy-related complications (particularly febrile urinary tract infection, gestational hypertension, pre-eclampsia) in the presence of renal scarring, even if the women had undergone anti-reflux surgery in childhood, but not persistent low-grade VUR. Due to the methodological and clinical heterogeneity of the included articles, conduction of a meta-analysis was inappropriate. Therefore, a narrative synthesis of the data was performed.
CONCLUSIONS
Despite the lack of larger prospective randomized controlled trials with long-term follow-up, based on the findings of this systematic review, we conclude that close monitoring during pregnancy should be recommended in the presence of persistent high-grade VUR or in women with renal scarring, even if VUR has resolved. However, persistent low-grade VUR is not associated with an increased pregnancy-related complications.
08:21 - 08:24
S23-4 (OP)
Matthew FORMSTONE 1, Rosie CRESNER 2, George BETHELL 3 and Ewan BROWNLEE 2
1) University of Southampton / University Hospital Southampton, School of Medicine / Paediatric Urology, Marlow, UNITED KINGDOM - 2) University Hospital Southampton, Paediatric Urology, Southampton, UNITED KINGDOM - 3) University Hospital Southampton, Academic Paediatric Surgery, Southampton, UNITED KINGDOM
PURPOSE
Multiple endoscopic treatments for vesico-ureteric junction obstruction (VUJO) have been reported. This systematic review aimed to determine the effectiveness of these techniques for treating primary obstructive megaureter.
MATERIAL AND METHODS
A systematic review of Medline, Embase, PubMed, and Cochrane Library databases was conducted following PRISMA guidelines (PROSPERO: CRD42024536020). Studies reporting outcomes of endoscopic VUJO treatment in children were included. Outcomes assessed included procedural success (ability to complete the procedure), treatment success, and complications. Bias risk was evaluated using ROBINS-I, and pooled success rates (95% CI) were calculated using random-effects models.
RESULTS
We included 27 studies with 790 children (845 renal units). Techniques identified:
i) Stent alone
ii) Sequenced dilatation with stent
iii) VUJ incision with stent
iv) Balloon dilatation with stent
v) Balloon dilatation with double stent
vi) Cutting balloon with stent
vii) Balloon dilatation alone
Reported procedural and treatment success ranged from 36–100% and 26–100%, respectively (Table). The most common definition of treatment success was “no evidence of obstruction at follow-up” (n=12), though nine definitions were identified overall. Re-intervention and ureteric reimplantation were most frequently required for stent alone (23% and 53.7%). Pooled meta-analysis demonstrated 95% (87–100%) success for balloon dilatation with stent (iv) and 95% (85–99%) for VUJ incision with stent (iii).
|
|
Studies (n) |
Patients; Renal units (n) |
Successful procedures (% range) |
Successful treatment (% range) |
|
Stent alone |
3 |
66; 72 |
36-100 |
26-75 |
|
Sequenced dilator with stent |
2 |
63; 67 |
94-100 |
97* |
|
VUJ Incision with stent |
4 |
67; 79 |
90-100 |
90-100 |
|
Balloon with stent |
16 |
489; 521 |
58-100* |
71-100* |
|
Balloon with double stent |
2 |
27; 27 |
100* |
80-100* |
|
Cutting balloon with stent |
3 |
14; 14 |
100 |
100 |
|
Non-cutting balloon alone |
2 |
64; 65 |
72-100 |
35-81 |
Table: Successful procedure and treatment rate per intervention. N.b. some studies reported multiple techniques. VUJ = Vesico-Ureteric Junction.
CONCLUSIONS
Endoscopic techniques appear effective for managing VUJO. Data from this study may assist surgeons when counselling families of affected children. However, the wide variation in outcome definitions limits meaningful comparisons between techniques. Addressing this inconsistency through a standardized core outcome set could enhance future research comparability.
08:31 - 08:34
S23-5 (OP)
Mukhlis AKMAL TAHER 1, Nicholas WIJAYA 2, Arnold KEANE 2, Putu Angga RAHARJA 2 and Tariq Osman ABBAS 3
1) Universitas Indonesia,, Department of Urology,, Jakarta, INDONESIA - 2) Universitas Indonesia, Department of Urology,, Jakarta, INDONESIA - 3) Sidra Medicine, Urology, Doha, QATAR
PURPOSE
To compare the efficacy, complication rates, and patient outcomes of various surgical techniques for hypospadias repair in male infants with an unfavorable urethral plate. The study aims to determine which surgical approach offers the best long-term outcomes and fewer complications in this challenging subset of hypospadias cases.
MATERIAL AND METHODS
This systematic review and network meta-analysis followed PRISMA guidelines. A comprehensive search of PubMed, Cochrane Library, Embase, and ScienceDirect was conducted through May 2024. Studies were screened using the Cochrane Risk of Bias 2.0 tool. A random-effects meta-analysis was performed using R-Studio to synthesize effect estimates. Eligible studies included randomized controlled trials, prospective cohort studies, retrospective studies, and case series involving male patients with hypospadias and an unfavorable urethral plate.
RESULTS
Twenty studies involving 1,483 patients were included, with four studies contributing to the network meta-analysis. Meatal stenosis and narrow meatus were more common with TIP urethroplasty, while glans dehiscence was less frequent with flaps. TIP and GTIP procedures had a lower incidence of diverticulum compared to flaps. No significant differences in fistula complications were observed. However, the GTIP approach was associated with fewer overall complications (OR 0.37; 95% CI [0.19-0.75]).
CONCLUSIONS
Flap and GTIP techniques may offer lower complication rates than TIP for patients with an unfavorable urethral plate, with GTIP showing modest superiority. Further high-quality comparative studies are needed to confirm these findings.
08:34 - 08:37
S23-6 (OP)
Randy CASALS 1, Kimberly WAGGENER 1, Marc COLACO 1, John WIENER 2 and Hooman SADRI 1
1) Atrium Wake Forest Baptist Health, Urology, Winston-Salem, USA - 2) Duke University Medical Center, Pediatric Urology, Durham, USA
PURPOSE
As males with spina bifida (SB) live longer and become sexually active, fertility is becoming an increasing priority. This has had little investigation compared to renal preservation and infection prevention in this population. This review seeks to analyze the available data regarding paternity rates and factors contributing to infertility in men with SB.
MATERIAL AND METHODS
We searched Pubmed using the following terms: "spina bifida AND infertility"; "spina bifida AND erectile dysfunction"; "spina bifida AND ejaculatory dysfunction'; "spina bifida AND spermatogenesis"; "myelomeningocele AND infertility". There were no filters for publication year or language. Results were compiled with additions from searching references of included articles. Articles were excluded if they were only available in a non-English language, the full-text article was unavailable, if they were reviews, case reports, guidelines, or editorials, or if deemed irrelevant to the search topic.
RESULTS
70 manuscripts were compiled with an additional 3 obtained from searching references. After excluding results meeting exclusion criteria, 10 remained which included 529 subjects. 2/10 manuscripts addressed paternity rates and 56% of the males reported to attempt to father children were successful. 57% of participants reported erectile dysfunction, 42% reported ejaculatory dysfunction, and 35% of participants with semen analyses were found to have azoospermia.
CONCLUSIONS
Few studies exist that examine fertility in men with SB and in this review, only about half of the males were successful in fathering children. The etiology of infertility in this population is likely multifactorial as there were significant rates of erectile dysfunction, ejaculatory dysfunction, and low sperm counts reported in multiple studies. Individuals with SB have differing degrees of sexual dysfunction, often correlating to the level of lesion and ambulatory status. Further investigation is needed to elucidate the causes of impaired fertility in men with SB and perhaps better understand male factor infertility overall.