ESPU Meeting on Friday 5, September 2025, 14:15 - 15:10
14:15 - 14:18
S28-1 (OP)
Abdelwahab HASHEM 1, Ahmed ELKASHEF 1, Doaa Elsayed SHARAF 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 assess the correlation between post-operative diuretic scintigraphic and ultrasonographic parameters in children who underwent pyeloplasty.
MATERIAL AND METHODS
In a single arm registered 'ClinicalTrials ID: NCT03939091', prospective cohort study, children who underwent open Anderson-Hynes pyeloplasty were included. While, those who had bilateral pyeloplasty, pyeloplasty in a solitary or anomalous kidney were excluded. At six months after surgery, follow-up ultrasound was performed in a supine position by a single senior experienced radiologist. Diuretic scintigraphy was also done according to an international standardized protocol.
RESULTS
A total of 83 patients were included in the study. The median (IQR) age was 3 (0.95, 7.0) years with 14 children (16.8%) were between 3-6 months. Fifty-seven (68.7%) of them were boys, while the remaining 26 (31.3%) were girls. Post-operative delayed cortical transit time (CTT) showed significant correlation with post-operative antero-posterior diameter (APD) (Spearman rho 0.323, p=0.003), post-operative calyceal dilatation (Spearman rho 0.246, p=0.04), parenchymal thickness (Spearman rho -225, p=0.025), post-operative calyx to parenchyma ratio (Spearman rho 0.274, p=0.012), post-operative cortex to pelvis ratio (Spearman rho 0.358, p=0.001) and post-operative half-time (T ½) (Spearman rho 0.497, p <0.001). Whereas, post-operative CTT showed insignificant correlation with APD change (Spearman rho 0.115, p=0.229). Post-operative T ½ also showed significant correlation with post-operative APD (Spearman rho 0.265, p=0.015), parenchymal thickness (Spearman rho -727, p <0.001), post-operative calyx to parenchyma ratio (Spearman rho 0.342, p=0.002), post-operative cortex to pelvis ratio (Spearman rho 0.383, p <0.001) and post-operative T ½ (Spearman rho 0.497, p <0.001). While, post-operative T ½ showed insignificant correlation with APD change (Spearman rho 0.114, p=0.304) and post-operative calyceal dilatation (Spearman rho 0.202, p=0.067).
CONCLUSIONS
Post-operative delayed CTT may correlate with post-operative ultrasonographic parameters apart from APD change.
14:18 - 14:21
S28-2 (OP)
Dogancan DORUCU 1, Kader Ada DOGAN 1, Onur Can OZKAN 2, Cagri Akin SEKERCI 3, Yiloren TANIDIR 4, Tufan TARCAN 2 and Selcuk YUCEL 2
1) Marmara University, Department of Urology, Istanbul, TÜRKIYE - 2) Marmara University, Department of Urology, Division of Pediatric Urology, Istanbul, TÜRKIYE - 3) Marmara University, Paediatric Urology, Division of Pediatric Urology, Pendik Istanbul, TÜRKIYE - 4) Medicana Atasehir Hospital, Istanbul, TÜRKIYE
INTRODUCTION
The renal pelvis anteroposterior diameter (RPAPD) is an important parameter used in indication and follow-up of ureteropelvic junction obstruction (UPJO). We hypothesized that kidney dimensions namely, longitudinal length (LL) and transverse width (TW) may have an easier similar validity to RPAPD measurement in the diagnosis of UPJO and follow-up after pyeloplasty.
MATERIAL AND METHODS
Children who underwent pyeloplasty (January 2012- January 2024) were retrospectively evaluated. Exclusion criteria included megaureter, vesicoureteral reflux, urinary stones, duplicated systems, abnormal contralateral kidneys, secondary interventions, and incomplete data. The RPAPD, hydronephrosis grade, LL, and TW measured by US before and 6 months after pyeloplasty were compared.
RESULTS
Among 64 children (14 girls, 35 boys; age range: 6 months to 17 years) who underwent pyeloplasty were studied. A significant reduction in RPAPD and LL was observed in affected kidneys 6 months after pyeloplasty compared to preoperative US measurements. (p<0.0001, p=0.005, respectively) but not in TW (p=0.19). Similarly, the ratio of LL of the affected kidney to contralateral kidney significantly decreased after pyeloplasty (p=0.026) but not the ratio of TW (p=0.357). A positive correlation between RPAPD and LL is revealed (correlation efficient=0.619).
CONCLUSIONS
The measurement of RPAPD is operator-dependent and requires experience. We think reliable measurements requiring less time and expertise can contribute to effective follow-up. Our findings indicate that LL is elevated in affected kidneys compared to contralaterals, and significantly decreases after pyeloplasty. The present study shows that the decrease in LL may be an alternative straightforward and reliable measurement to predict the success of pyeloplasty.
14:21 - 14:24
S28-3 (OP)
Zita HORNOK 1, Vvs CHANDRASEKHARAM 2, R SATYANARAYANA 3 and Khyati KIRAN J 4
1) Semmelweis University, Budapest, HUNGARY - 2) Ankura Hospitals for Women and Children, Hyderabad, India, Pediatric Surgery, Pediatric Urology and MAS, Hyderabad, INDIA - 3) Ankura Hospitals for Women and Children, Hyderabad, India, Surgery, Pediatric Urology, Hyderabad, INDIA - 4) Ankura Hospitals for Women and Children, Hyderabad, India, Pediatric Surgery, Hyderabad, INDIA
PURPOSE
Post-pyeloplasty follow-up includes multiple ultrasonograms (USG) and diuretic renograms (DR), but the optimal follow up method remains debated. This study analyzes pre- and postoperative renal pelvic anteroposterior diameter (APD) changes on USG to predict surgical success.
MATERIAL AND METHODS
A single-center retrospective review included 464 patients of which 359 patients (323 primary, 36 redo pyeloplasties) with pre- and postoperative APD and at least one DR were included. Success was defined as symptom resolution, APD reduction, and unobstructed DR. APD changes at 3, 6, and 12 months postoperatively were analysed, with ROC analysis performed on 3-month APD improvement.
RESULTS
Maximum APD reduction occurred at 3 months. ROC analysis determined an optimal cutoff of 41.71% APD reduction for predicting success (AUC: 0.973, 95% CI: 0.958-0.987, p < 0.001), with 91.0% sensitivity and 100.0% specificity. An APD Percent Improvement (PI) <15% strongly predicted early failure (100%), while PI between 15-41.7% was associated with late failures (44.2%).
CONCLUSIONS
In most cases, a 41.7% APD reduction at 3 months accurately predicts pyeloplasty success, potentially eliminating the need for routine diuretic renograms. Patients with <15% reduction require close follow-up due to early failure risk, while those with 15-42% reduction should be monitored for late failure.
14:33 - 14:36
S28-4 (OP)
Lorenzo ANEZ-BUSTILLOS, Camila MORENO BENCARDINO, Catalina SANCHEZ-BASTO, Joana DOS SANTOS, Mandy RICKARD and Armando LORENZO
The Hospital for Sick Children, Pediatric Urology, Toronto, CANADA
PURPOSE
The optimal age for the management of ureteropelvic joint obstruction (UPJO) remains a topic of debate, with concerns about unfavorable outcomes when pyeloplasty is performed in younger infants. Herein, we compared postoperative outcomes stratified by age at surgery.
MATERIAL AND METHODS
We reviewed our hydronephrosis database and selected children < 24 months of age who underwent open pyeloplasty from 2008 to 2024 by a single surgeon. Clinical preoperative and postoperative variables were collected. Patients were grouped in cohorts by age at surgery.
RESULTS
A total of 238 patients were included. Preoperative renal pelvic anteroposterior diameter (APD) was slightly higher in younger infants. Postoperative outcome variables were similar across groups. Although younger infants had a slightly higher frequency of re-do pyeloplasty, the occurrence is rare and insignificant.
| 0-3m (n=63) | 4-6m (n=72) | 7-12m (n=66) | 13-24m (n=37) | p | |
| Age (months) (IQR) | 2.2 (1) | 5 (2) | 9 (2) | 18 (6) | <0.01 |
| Pre-op APD (mm) (IQR) | 26 (12) | 24 (14) | 21 (11) | 23 (6) | 0.03 |
| Immediate post-op APD | 14 (15) | 15 (10) | 12 (7) | 13 (8) | 0.48 |
| APD last follow up | 9 (9) | 10 (7) | 8 (7) | 7 (9) | 0.67 |
| APD % improvement (%) (IQR) | 65 (37) | 53 (51) | 57 (32) | 67 (42) | 0.32 |
| OR time (mins) (IQR) | 144 (88) | 140 (82) | 122 (67) | 166 (55) | 0.10 |
| Length of stay (hours) | 25 (46) | 23 (22) | 25 (35) | 23 (25) | 0.26 |
| ER visits within 30 days | 10 (19) | 10 (15) | 6 (10) | 3 (9) | 0.39 |
| Readmissions | 2 (3) | 4 (6) | 0 (0) | 2 (5) | 0.28 |
| Redo pyeloplasty | 4 (6) | 2 (3) | 1 (2) | 1 (3) | 0.47 |
| Follow up (months) (IQR) | 38 (35) | 30 (26) | 33 (44) | 29 (52) | 0.51 |
CONCLUSIONS
Pyeloplasty is a safe and effective procedure for managing UPJO in young babies. Regardless of the age at which the surgery is performed, outcomes do not differ significantly between younger infants and toddlers.
14:36 - 14:39
S28-5 (OP)
Nikhil V. BATRA 1, Hannah DILLON 2, Rosalia MISSERI 1, Pankaj P. DANGLE 1, Joshua D. ROTH 1, Kirstan K. MELDRUM 1, Mark P. CAIN 1, Martin KAEFER 1, Richard C. RINK 1, Konrad M. SZYMANKSI 1 and Benjamin M. WHITTAM 1
1) Riley Hospital for Children at Indiana University Health, Pediatric Urology, Indianapolis, USA - 2) Indiana University School of Medicine, Pediatric Urology, Indianapolis, USA
PURPOSE
We sought to review our experience with the postoperative use of ureteral stents with and without extraction strings in a large series of patients following robotic pyeloplasty.
MATERIAL AND METHODS
All robotic pyeloplasty at our institution from 2012 – present were retrospectively reviewed. Patients with < 60 days of follow-up were excluded. Statistical analysis was performed with Fisher’s exact testing.
RESULTS
A total of 218 patients underwent robotic pyeloplasty: 188 (86%) had ureteral stents with extraction strings and 30 (14%) patients had internalized stents. Study groups were similarly weighted with regards to demographics and perioperative characteristics.
A total of 13 (6%) patients in our series required treatment for UTI following discharge within 60 days: 4 outpatient (3 string (1.6%) vs 1 non-string (3.4%), p=0.45) and 9 inpatient (9 string (4.8%) vs 0 non-string (0%), p=0.26). Complications were not statistically different between the two groups (22 vs. 4, p=0.50). A total of 11 (5.8%) Clavien 3b complications were noted in the group with extraction strings (5 percutaneous nephrostomy tube placement, 5 ureteral stent replacement). No Clavien 3b complications were noted in the internal stent group. Gender was not associated with an increased risk of complications (p=0.19) or UTI (p=0.59) on subgroup analysis.
Fourteen (7.4%) patients with extraction strings came to the office for ureteral stent removal; seven (3.7%) required stent removal in the operating room under anesthesia.
CONCLUSIONS
Ureteral stents with extraction strings were not associated with an increased risk of complications or postoperative UTI in our series.
14:39 - 14:42
S28-6 (OP)
Alejandro CALVILLO-RAMIREZ 1, Lauren CHEW 2, Seyed Sajjad TABEI 2, Hachem ZIADEH 2, Juan MOLDES 1 and Pedro-Jose LOPEZ 1
1) University Hospitals Rainbow Babies and Children's, Urology, Cleveland, USA - 2) University Hospitals Cleveland Medical Center, Urology, Cleveland, USA
PURPOSE
One of the most common and immediate postoperative complications following pyeloplasty is urinary tract infections (UTI), posing significant morbidity in children. This prompts post-procedure prophylactic antibiotics (pAbx) prescription among many pediatric urologists. We hypothesized that children who did not receive pAbx would have higher febrile UTI (fUTI) rates as those who did.
MATERIAL AND METHODS
Using the TriNetX database, we conducted a retrospective study including patients up to 18 years old, who underwent open or minimally invasive pyeloplasty from November 2004 to November 2024. Patients were stratified into two groups, those who received pAbx and those who did not. Propensity score-matching (PSM) was performed to control for demographics (age at surgery), comorbidities (acute upper respiratory tract infection), and procedures (circumcision, frenulotomy). Primary outcome was 30- and 60-day postoperative fUTI (ICD-10 N39 + ≥100.4F) rates. Odds ratios (OR) with 95% confidence intervals (CI) were calculated.
RESULTS
After PSM, 1,082 patients from 97 healthcare organizations were included, yielding 541 patients in each cohort. Age at surgery and comorbidities were comparable between groups. 30-day postoperative fUTI rates were similar between pAbx and non-pAbx groups (9.7% vs 9.6%, OR 0.79, 95% CI 0.65-1.46). Similarly, 60-day postoperative fUTI rates remained similar between groups (12.7% vs 11.2%, OR 0.86, 95% CI 0.60-1.25).
CONCLUSIONS
Our findings suggest that pAbx does not lower fUTI rates. At 30 and 60 days post-pyeloplasty, the rates of fUTI were similar between the pAbx and non-pAbx groups. Future randomized studies are needed to validate the role of pAbx in children after pyeloplasty.
14:42 - 14:47
S28-7 (VP)
Ignacio ARENAS NORTON 1, Ruiz JAVIER 1, Otilia BLAIN 1, Agustina OLIVA 2, Danel ALBERTI 1, Leandro ASEN 1, Felicitas LÓPEZ IMIZCOZ 1, Nicolás ROSIERE 1, Gómez YESICA 1, Cristian SAGER 1, Carol BUREK 1, Edurne ORMAECHEA 2, Roberto VAGNI 2 and Santiago WELLER 1
1) Hospital de Pediatría J.P Garrahan, Urología, Caba, ARGENTINA - 2) Hospital Italiano de Buenos Aires, Urología, Caba, ARGENTINA
INTRODUCTION
Ureterocalicostomy is a surgical alternative for managing severe hydronephrosis secondary to failed pyeloplasty or in primary cases with a small intrarenal pelvis and significant lower calyceal dilatation.
This video presents a step-by-step demonstration of key surgical techniques and insights gained from a decade of experience with laparoscopic ureterocalicostomy at two high-volume centres.
MATERIAL AND METHODS
All patients were positioned in a modified Valdivia-Galdakao position. A retrograde pyelogram was performed, followed by the placement of a ureteral stent in the proximal ureter. A transperitoneal approach was utilised, with dissection of the lower renal pole. In selected cases, a haemostatic manoeuvre similar to the Pringle technique was applied to minimise intraoperative bleeding.
The uretero-calyceal anastomosis was performed in an end-to-side or side-to-side fashion using two continuous 5-0 PDS sutures. A ureteral stent was left in place postoperatively.
RESULTS
A total of 11 patients (median age: 9.8 years) underwent laparoscopic ureterocalicostomy. The median operative time was 173 minutes. A urinary catheter and ureteral stent were maintained for 48 hours and 60 days, respectively. One patient required a redo ureterocalicostomy
CONCLUSIONS
Laparoscopic ureterocalicostomy is a viable option for selected patients with severe hydronephrosis. Careful patient selection and surgical planning are essential. Haemostatic compression techniques can be helpful to reduce intraoperative bleeding and facilitate a successful anastomosis in selected cases.
15:00 - 15:05
S28-8 (VP)
M S ANSARI, Dr Priyank YADAV, Dr Raj KUMAR and Sanchit RUSTGI
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Pediatric Urology, Department of Urology and renal transplantation, Lucknow, INDIA
PURPOSE
Image enhancement techniques are used to improve the visual quality of an image, making it easier for a robot to interpret and help surgeons to navigate the complex surgical anatomy specially in the setting of multiple vessels. The author here in used real time image fusion for augmented surgical navigation in case of multiple vessels in nephron sparing surgery in a child.
MATERIAL AND METHODS
An 8-yr-old boy presented with 6x 6 cm renal mass in right kidney involving upper and mid polar region. He underwent laparoscopic assisted robotic nephron sparing surgery (NSS) using the DaVinci Xi. The digital subtraction angiography (DSA) showed 3 arteries clearly. Under the guidance of image fusion model (Figure 1), we first attempted to find out the upper most vessel. The enhanced imaging system assisted to get down to the targeted vessel more efficiently. Next, we searched for the lower most vessel and image guided navigation was again helpful to dissect this vessel. On 3-dimensional DSA reconstruction it was observed that the middle vessel was placed at a little deeper plane. The image fusion guided search directed us further more confidently to this deeply located vessel. To remain selective, we clamped only the upper two vessels mainly feeding to the tumour area.
RESULTS
The NSS procedure took a total of 210 minutes including the docking time. The procedure went uneventful with a blood loss of 80 ml. The real time image fusion technique guided us to efficiently search and dissect out all the three vessels safely.
CONCLUSIONS
Real time image fusion technique allows surgeon to take advantage of additional information to navigate safely and efficiently during robotic surgery specially in the setting of the complex surgical anatomy or multiple vessels.