ESPU Meeting on Friday 5, September 2025, 16:15 - 17:15
16:15 - 16:18
S29-1 (OP)
Jai MAHAJAN 1, Josy THOMAS 2 and Bikas MEDHI 3
1) Postgraduate instiute of Medical Education and Research, Pediatric Surgery, Chandigarh, INDIA - 2) Postgraduate Institute of Medical Education and Research, Pediatric Surgery, Chandigarh, INDIA - 3) Postgraduate Institute of Medical Education and Research, Pharmacology, Chandigarh, INDIA
PURPOSE
To study the effect of the early administration of oxybutynin in infants with primary fulguration of PUV with abnormal urodynamics.
MATERIAL AND METHODS
Twenty-one consecutive with PUV who underwent primary fulguration and had abnormal urodynamic findings after 3 months of follow up, postfulguration, were enrolled. Three patients were excluded (refusal of consent, expired, UDS not done). The remaining 18 were randomly assigned into two groups, Group A (oxybutynin) and Group B (placebo). The clinical, biochemical, radiological and urodynamic findings were re-assessed after 3-6 months of the intervention.
RESULTS
The mean age of fulguration was 4.3 ± 3.52 months (12 days - 12 months). The mean creatinine at presentation was 0.82±0.25mg% (0.51-1.3 mg%) and the creatinine value at 6-months follow-up was 0.43±0.10mg%(0.25-0.64mg%). Voiding cystourethrography (VCU) showed unilateral VUR in 5 patients and B/L VUR in 6 patients.
The mean age of performing the first UDS was 7 ± 2.7 months (3-15 months) whereas the second UDS was done at a mean age 10.9± 3.3 months (6-18 months). The mean observed/expected (O/E) bladder capacity (BC) in group A was 77.56%± 17.96 (41.6 - 98.1%) which increased significantly to 88.5±9.44% (67.3% -97.1%) (p = 0.029) after the intervention. Mean compliance in group A was 3.05± 1.29ml/cm of H2O before intervention and improved to 5.7 ± 1.3ml/cm of H2O after the intervention (p=0.00). The compliance in group B also improved (2.57±1.37 preintervention to 4.2±1.66 ml/cm of H2O, postintervention(p = 0.003), however the BC did not improve significantly (p value 0.143). Detrusor pressure did not change significantly either in group A (p value 0.103) or group B (p value 0.275) during this short follow up.
CONCLUSIONS
Early administration of oxybutynin to infants with PUV, before the toilet training, showed significant improvements in compliance and bladder capacity. There is spontaneous improvement of compliance as well.
16:18 - 16:21
S29-2 (OP)
Silvia PECORELLI 1, Clara WOLMER 1, Michail AFTZOGLOU 2, Massimo GARRIBOLI 2 and Luke HARPER 3
1) Pellegrin children's hospital, Pediatric urology, Bordeaux, FRANCE - 2) Evelina children's hospital, Pediatric urology, London, UNITED KINGDOM - 3) CHU Pellegrin-Enfants, Pediatric Surgery, Bordeaux, FRANCE
PURPOSE
Several reports have suggested a higher rate of cryptorchidism and inguinal hernia in boys with posterior urethral valves (PUV). Both cryptorchidism and hernia are also supposed to be associated with more severe forms of PUV. We aimed to verify if this was true in two large contemporary cohorts of boys with PUV.
MATERIAL AND METHODS
We looked at the incidence of cryptorchidism and inguinal hernia in two cohorts of boys born with PUV between 2012 and 2022 (France and the UK). We compared renal function between boys with or without cryptorchidism/hernia. We also looked at presence of asymmetrical renal function (<40% DMSA) or high-grade VUR on the side of the cryptorchidism/hernia.
RESULTS
Of 202 patients, 20 (10%) had cryptorchidism, which was bilateral in 4 (2%), and 11 patients (5%) had inguinal hernias that were not associated with cryptorchid testes (rates of cryptorchidism and hernia in the general European population are around 2-3% and 3-4% respectively). There was no difference in nadir creatinine between boys with cryptorchidism/hernia and those without (36 µmol/L (20-61) vs 28 (22-41). The rate of asymmetrical DMSA scan and the rate of high-grade VUR were not different between those with unilateral cryptorchidism/hernia and the rest of the children.
The study did not require formal IRB.
CONCLUSIONS
Our findings suggest cryptorchidism is indeed more frequent in boys with PUV, but less so than previously reported. We did not find a significant increase in rate of inguinal hernias, nor a significant relationship between crytptorchidism and renal function in our population. We did not observe a relationship between unilateral cryptorchidism and homolateral high-grade VUR or decreased renal function.
16:21 - 16:24
S29-3 (OP)
Ramesh BABU 1, Tharanenthran HEERA 2, Dharmalingam ARUN PRASAD 3 and Geminiganesan SANGEETHA 4
1) Sri Ramachandra Institute of Higher Education & Research, Pediatric Urology, Chennai, INDIA - 2) Sri ramachandra Insititute of Higher Education & Research, Department of Pediatric Urology, Chennai, INDIA - 3) SRIHER, Pediatric Urology, Chennai, INDIA - 4) SRIHER, Pediatric Nephrology, Chennai, INDIA
PURPOSE
Young’s classification of posterior urethral valves (PUV) has no direct clinical implication. The aims are to report the long-term outcomes based on RBS (renal & bladder status) grading of PUV.
MATERIAL AND METHODS
Details of antenatal/ postnatal ultrasound, voiding cystourethrography (VCUG), nadir creatinine/ bladder recovery at 3-6months post-valve-ablation were retrospectively reviewed. PUV was graded into: PUV0 – suspicious folds/ kinks on VCUG but on cystoscopy no classical PUV; PUV1 –amniotic fluid index (AFI) >41, normal renal parenchyma, classical PUV (obstructing leaflets at verumontanum) on VCUG/ cystoscopy, normal renal function pre/post treatment; PUV2 –AFI 21-40mm, normal renal parenchyma, recoverable renal function (nadir creatinine <1mg/dl) and bladder contour (VCUG); PUV3 – AFI<20mm, echogenic/cystic kidneys, abnormal renal function pre/post treatment (nadir creatinine >1mg/dl), unimproved bladder contour/ reflux/ hydroureteronephrosis post treatment. During the follow-up progression to chronic kidney disease (>CKD3) and valve bladder on urodynamics were recorded.
RESULTS
A total of 254 PUV cases were radiologically diagnosed over a 20-year period (2003-2023). Among PUV0 (n=97) none deteriorated. Among PUV1 (n=68), CKD progression happenned in 4 (6.25%) and valve bladder in 3 (4.68%); among PUV2 (n=90), CKD progression happenned in 11(12.2%) and valve bladder in 8(8.8%); among PUV3 (n=29), CKD progression happenned in 15 (51.7%) and valve bladder in 12(41.3%). Kaplan-Meier survival analysis revealed increasing renal and bladder function deterioration (p=0.0001) as the grade progressed.
CONCLUSIONS
Unlike Young’s classification, RBS grading of PUV is useful in prognosis and counseling. PUV1/PUV2 with normal/ reversible renal & bladder function have a good prognosis following a prompt intervention. PUV3 has a high-risk of CKD progression despite treatment.
16:24 - 16:27
S29-4 (OP)
Samer MAHER 1, Joana DOS SANTOS 1, Mirriam MIKHAIL 1, Beverly MIRANDA 1, Noreen GORAYA 1, Jin Kyu KIM 1, Adree KHONDKER 1, Michael CHUA 1, Daniel FLANDERS 2, Rodrigo ROMAO 1, Joao Pippi SALLE 1, Armando J. LORENZO 1 and Mandy RICKARD 1
1) SickKids Hospital, Urology, Toronto, CANADA - 2) KinderCare Pediatrics, Pediatrics, Toronto, CANADA
PURPOSE
It has been reported that children with PUV have health-related quality of life (HRQoL) scores comparable to normative healthy control psychometric data. Herein, we aimed to compare the HRQoL of PUV to hydronephrosis (HN) patients and healthy controls seen in a community pediatric urology clinic.
MATERIAL AND METHODS
From December 2022-2024, the PedsQL Inventory and family impact module (FIM) were distributed in our PUV, HN, and community-based urology clinics. Higher scores indicate better HRQoL. Children >13 years self-completed and <13y parent proxies were used. PUV patients were compared to HN patients and healthy controls.
RESULTS
284 patients were included (124 PUV, 54 HN, 106 community). PUV patients scored similarly to HN patients and healthy controls in total HRQoL and FIM scores. However, psychosocial scores were significantly lower in PUV patients compared to HN patients (78 ±17 vs. 85 ±11; p=0.038). When stratifying patients by age, we found PUV patients <3 years scored lower in total pediatric QoL, psychosocial domains, and FIM compared to HN patients of the same age. Demographic and social factors had no significant effect on HRQoL outcomes.
|
Variable |
PUV(n=124) Mean (SD) |
HN(n=54) Mean(SD) |
Community-Clinic(n=106) Mean(SD) |
p-value (HN vs.PUV) |
p-value (Community-Clinic vs.PUV) |
PUV < 3 years (n= 34) Mean(SD) |
HN<3 years (n=52) Mean(SD) |
p-value (HN<3 vs.PUV<3) |
|
PedQL.Total |
82.48(13.79) |
86.52(10.68) |
82.18(13.19) |
0.107 |
0.716 |
79.86(16.08) |
86.54(10.67) |
0.040 |
|
Ped.PsychSoc |
78.42(16.65) |
84.66(11.37) |
79.20(14.43) |
0.038 |
0.937 |
76.29(20.94) |
84.53(11.46) |
0.044 |
|
Family Impact |
78.01(18.78) |
83.12(15.28) |
78.60(16.89) |
0.120 |
0.957 |
72.80(25.70) |
84.60(13.15) |
0.021 |
CONCLUSIONS
PUV patients score similarly to controls, but psychosocial domains are negatively impacted. Children <3years with PUV may also be at increased risk of a negative HRQoL impact. These findings underscore the need for targeted psychosocial support, especially for younger children with PUV.
16:42 - 16:45
S29-5 (OP)
Laura DIAZ MENENDEZ 1, Isabel CASAL BELOY 2, Isabel PLANAS DIAZ 1 and Rosa ROMERO RUIZ 2
1) Hospital Infantil Virgen del Rocio, Pediatric Surgery Department, Sevilla, SPAIN - 2) Hospital Infantil Virgen del Rocio, Pediatric Urology Unit, Sevilla, SPAIN
PURPOSE
Approximately 15-20% of patients with posterior urethral valves (PUV) progress to ESRD. We conducted a study to identify risk factors (RF) for progression to ESRD and the need for renal replacement therapy (RRT) during follow-up in patients with PUV.
MATERIAL AND METHODS
A case-control study was conducted on patients diagnosed with PUV between 1995 and 2024. Two study groups were created: RRT vs. no-RRT. Clinical, laboratory, and radiological variables were collected. A bivariate analysis and binary logistic regression were performed to identify RFs for RRT requirement.
RESULTS
A total of 145 patients were included, of whom 13.7% (n=20) required RRT. The mean follow-up period was 7.8 years.
Antenatal USS high-risk signs (keyhole sign, urinoma, parenchyman cysts, renal dysplasia, oligoamnios) (p=0.006), vesicoureteral reflux (p=0.018), acute kidney injury at diagnosis (p<0.001), elevated NADIR creatinine (p=0.014), and elevated maximum creatinine level in the first year of life (p<0.001) were significantly more frequent in the RRT group.
Increased creatinine level in the first week of life (OR: 4.422; 95% CI: 1.044-8.724) was the only independent RF for predicting RRT requirement. Delayed diagnosis and urinary tract infections were not predictive factors for final RRT risk.
CONCLUSIONS
Functional renal reserve at birth was the only predictor of ESRD risk in patients with PUV.
16:45 - 16:48
S29-6 (OP)
Mandy RICKARD 1, Joana DOS SANTOS 1, Mirriam MIKHAIL 1, Beverly MIRANDA 1, Noreen GORAYA 2, Jin Kyu KIM 3, Adree KHONDKER 1, Rodrigo ROMAO 1, Joao PIPPI SALLE 1, Nithiakishna SELVATHESAN 4, Michael CHUA 1 and Armando J. LORENZO 5
1) SickKids, Urology, Toronto, CANADA - 2) SickKids, Social Work, Toronto, CANADA - 3) Riley Children's, Urology, Indianopolis, USA - 4) 555 University Ave, Nephrology, Toronto, CANADA - 5) 555 University Ave, Urology, Toronto, CANADA
PURPOSE
In October 2019, a dedicated clinic and care pathway were implemented at our pediatric center. Herein, we present a comparative analysis of 5-year kidney function outcomes.
MATERIAL AND METHODS
Review of our PUV database, focusing on patients <2years. Patients were segregated into before(BPUV) and after(APUV) clinic, capturing serum creatinine(sCr) values(nadir, time to nadir, one year), initial surgical intervention, progression to CKD>3 and KRT. BPUV patients were censored at 1900 days to ensure equivalent follow-up.
RESULTS
There were 132 BPUV and 57 APUV patients, with similar rates of prenatal presentation(Table). More APUV patients underwent primary diversions as their initial surgical intervention(55% vs. 11%; p<0.01). APUV patients were significantly younger, had shorter time to nadir sCr and had lower sCr at one year of age. Despite similar baseline PURK scores, 28% of BPUV had CKD>3 vs. 12% APUV (p=0.02). In the BPUV group 15 patients (11%) progressed to KRT vs. 2 (3%) (p=0.10) APUV at 247 (IQR 1437) vs. 99 days respectively (p=0.25).
CONCLUSIONS
Care standardization and proactive management appears to delay progression to CKD. The lower proportion of patients progressing to KRT is clinically significant, with clear evidence of a trend towards less KRT at 5 years. These data are evidence of the favorable impact of proactive management on PUV kidney function outcomes.
| bPUV (n=132) | aPUV (n=57) | p | |
| Age at presentation (days) (IQR) | 8 (22) | 3 (16) | <0.01 |
| PURK >3 | 63 (48%) | 20 (35%) | 0.15 |
| Age at initial surgery (days) (IQR) | 16 (30) | 10 (18) | 0.05 |
| SCr at 1-year (IQR) | 31 (12) | 24 (10) | <0.01 |
| Time to nadir SCr (days) (IQR) | 189 (175) | 148 (146) | 0.03 |
| SCr at censored follow-up | 44 (38) | 27 (16) | <0.01 |
| eGFR | 93.90 (61) | 110.30 (63) | <0.01 |
| High grade hydronephrosis at follow up | 52 (39%) | 7 (12%) | <0.01 |
| CKD >3 | 37 (28%) | 7 (12%) | 0.02 |
| KRT | 15 (11%) | 2 (3%) | 0.25 |
16:48 - 16:51
S29-7 (OP)
Rahim DHALLA 1, Adree KHONDKER 2, Joana DOS SANTOS 3, Mandy RICKARD 4 and Armando LORENZO 3
1) Schulich School of Medicine and Dentistry, London, CANADA - 2) University of Toronto, Division of Urology, Department of Surgery, Toronto, CANADA - 3) The Hospital for Sick Children, Division of Urology, Department of Surgery, Toronto, CANADA - 4) The Hospital for Sick Children, Divison of Urology, Department of Surgery, Toronto, CANADA
PURPOSE
Neonatal serum creatinine is closely monitored in boys with PUV, where nadir creatinine is a key prognostic indicator. Creatinine typically declines after urinary decompression; we assessed whether this decay predicts 1-, 3-, and 5-year kidney function.
MATERIAL AND METHODS
We retrospectively identified boys (2002-2024) with PUV at our institution. An exponential decay model, y = A*e^(-bx) + C, was fit to creatinine from the first 90 days. Patients with poor fits (R^2<0.70) were excluded. 1-, 3-, and 5-year creatinine values were evaluated as outcome measures. The area-under-the-curve (AUC) was derived from integrating the decay function. We compared predictive performance of model parameters vs nadir creatinine using the c-index.
RESULTS
Ninety-nine patients met the inclusion criteria; median serum creatinine at 1, 3, and 5 years is described in Table 1. On multivariate regression, the horizontal asymptote (C) was associated with 5-year creatinine (OR 3.46, p < 0.001); the scaling factor (A) and decay rate (b) were not significant. Nadir creatinine alone was associated with 5-year creatinine (OR 10.66, p < 0.001) and showed consistently higher c-indices than AUC in predicting creatinine at 1 year (0.87 vs 0.74), 3 years (0.83 vs 0.80), and 5 years (0.76 vs 0.73).
Table 1: Median serum creatinine and data availablility at 1, 3, and 5 years of age.
| 1 year | 3 years | 5 years | |
| Median Serum Creatinine, umol/L (IQR) | 30 (25-41) | 36 (31-53) | 43 (38-64) |
| Number of Patients with Available Creatinine Data (%) | 79 (80) | 48 (49) | 35 (35) |
CONCLUSIONS
Although decay parameters were associated with long-term kidney function in boys with PUV, nadir creatinine was superior in prediction. Study limitations include retrospective design, limited data, and lack of inclusion of further risk factors. This study does contribute that decay parameters may be meaningful for future prediction in this population, while corroborating the importance of nadir creatinine.
16:51 - 16:54
S29-8 (OP)
Ashley TALTON 1, Kavita HODGKINS 2, Sophia KAMANZI 1, David CHU 1, Ilina ROSOKLIJA 1 and Edward GONG 1
1) Ann & Robert H Lurie Children's Hospital of Chicago, Pediatric Urology, Chicago, USA - 2) Ann & Robert H Lurie Children's Hospital of Chicago, Pediatric Nephrology, Chicago, USA
PURPOSE
The current best predictor of long-term renal function in boys with posterior urethral valves (PUV) is the nadir creatinine level within the first year of life. The role of cystatin C as a secondary renal marker is not well established. We present pilot data on the trends of creatinine and cystatin C in patients with PUV.
MATERIAL AND METHODS
We identified all patients who underwent valve ablation before 5 months of age at a single pediatric institution. Patients were followed in a multidisciplinary clinic, with at least yearly measurements of creatinine and cystatin C. eGFR was calculated at 12 and 24 months using creatinine alone and combined creatinine and cystatin C (CKiD U25 equations). Descriptive statistics are presented.
RESULTS
Fourteen patients were included. The median age at valve ablation was 12 days (range 3-127) and median age at last follow-up was 3.01 years (range 1.03-6.73). In all but one patient, creatinine nadir occurred before a year of life. While creatinine increased in the first two years after nadir, cystatin C continued to decrease, with a nadir between 16 and 30 months (median 25.1 months). Combined eGFR improved between 12 months and 24 months. Combined eGFR was lower than using creatinine alone.
CONCLUSIONS
Creatinine nadir occurs in the first year, while cystatin C declines through the second year. Combined eGFR may provide a more accurate estimate of renal function. Creatinine alone eGFR may overestimate renal function. Further research is needed to understand the implication for long-term kidney function prognosis.