ESPU Meeting on Wednesday 3, September 2025, 15:30 - 16:15
15:30 - 15:33
S03-1 (OP)
Mehmet CETIN 1, Cagri Akin SEKERCI 2, Turker ALTUNTAS 1, Onur Can OZKAN 2, Yiloren TANIDIR 3, Selcuk YUCEL 4, Tufan TARCAN 4 and Kamil CAM 5
1) Marmara University School of Medicine, Urology, Istanbul, TÜRKIYE - 2) Marmara University, Department of Urology, Division of Pediatric Urology, Istanbul, TÜRKIYE - 3) Medicana Atasehir Hospital, Urology, Istanbul, TÜRKIYE - 4) Marmara University, Department of Urology, Division of Pediatric Urology, Urology, Istanbul, TÜRKIYE - 5) Marmara University, Department of Urology, Urology, Istanbul, TÜRKIYE
PURPOSE
Undescended testis is a common congenital anomaly in male newborns. Orchiopexy, the standard treatment, is frequently performed in pediatric urology. Studies suggest that multimedia tools may reduce parental anxiety. However, no studies have evaluated the effect of video-based informed consent on anxiety in parents of children undergoing urological surgery. This study aims to examine the impact of video-based information on anxiety and depression levels in parents of children undergoing orchiopexy.
MATERIAL AND METHODS
Parents of children scheduled for orchiopexy between 15/12/2023 and 15/10/2024 were enrolled. Exclusion criteria included prior urological surgery or additional urological procedures. Children were randomized into two groups: Group 1 received Standard Informed Consent and Verbal Information three days preoperatively, while Group 2 also watched a 6-minute educational video on surgical approaches and procedures (https://youtu.be/9Q60CnlPL0w). HADS, BAI, and STAI scores were obtained preoperatively and one week postoperatively, and compared between groups.
RESULTS
Seventy-four children with a median age of 5.5 (1-13) years were randomized into two groups (37 per group). Orchiopexy was performed on the right (n=34), left (n=23), or bilaterally (n=15). Mothers were primary caregivers in 74.3% of cases. HADS-T, HADSD, HADS-A, BAI, and STAI-I scores significantly decreased postoperatively in both groups, while STAI-II remained unchanged (p=<0.001, p=0.015, p<0.001, p=0.012, p=<0.001). Group 2 had significantly lower preoperative HADS-T (11-6), BAI (3-1), and STAI-I (41-35) scores and lower postoperative HADS-D (4.5-2) and STAI-I (36.5-26.5) scores (p=0.029, p=0.008, p=0.007, p=0.041, p=0.043). Bilateral cases had higher anxiety and depression scores. The use of multimedia was more effective for parents with higher education.
CONCLUSIONS
Preoperative multimedia video information, alongside routine written consent, reduced anxiety and depression in parents of children undergoing orchiopexy, with no adverse effects. Video-based information may strengthen the informed consent process.
15:33 - 15:36
S03-2 (OP)
Jin Kyu (Justin) KIM, Renee SHAVNORE, Pete ARNOLD, Nikhil BATRA, Konrad SZYMANSKI, Benjamin WHITTAM, Martin KAEFER, Mark CAIN, Pankaj DANGLE, Kirstan MELDRUM, Richard RINK, Rosalia MISSERI and Joshua ROTH
Riley Hospital for Children, Urology, Indianapolis, USA
PURPOSE
The American Urological Association (AUA) and European Association of Urology (EAU) recommends urology referral and surgery for undescended testicle (UDT) before 18 months of age, but it has been shown that many referrals occur later, influenced by social factors. This study aims to identify key social factors that impact UDT referral timing and appropriateness.
MATERIAL AND METHODS
Pediatric patients referred to our institution for UDT management from 2018-2023 were analyzed. Referral appropriateness was assessed by whether the child had a true UDT, defined as undergoing orchiopexy. Timeliness was defined as referral before 18 months of age. Demographics and socioeconomic data were gathered, including health literacy index (HLI), area deprivation index (ADI), and provider training (physician vs. advanced practice provider [APP]).
RESULTS
Of 1821 patients, 45.6% of patients had bilaterally descended testicles, and the median referral age was 2.5 years (IQR: 1.2-6.6), with only 34.7% referred before 18 months. Taken together, 18.1% of referrals were both appropriate and timely. Univariate analysis found inappropriate referrals were associated with provider type, HLI, ADI, median income ratio (geographic income/state income), education level, race, and patient age. Multivariate analysis identified three significant factors for inappropriate referrals: APP referrals (OR 1.37, p=0.028), higher ADI percentile (OR 1.005, p=0.021), and Black race compared to non-Hispanic White (OR 1.80, p<0.001; Figure 1). Late referrals were significantly linked to race and recent local employment rate changes, with Hispanic children more likely to be referred late (OR 1.63, p=0.012).
CONCLUSIONS
Our findings highlight that nearly half of the children referred for UDT have normally descended or retractile testicles not necessitating referral, and two-thirds are referred late. Significant disparities in referral quality and timing are associated with race, socioeconomic factors, and provider type. Targeted educational interventions focusing on APPs, high-ADI communities, non-White populations, or broader campaigns may help address these disparities effectively.
15:43 - 15:46
S03-3 (OP)
Adel ALJUNEIBI 1, Hesham Soliman SAFOURY 1, Mohamed HOBELDIN 1, Saif ABDELSALAM 1, Abdunaser ALSAID 2, Hamdan ALHAZMI 3, Khaled KHALFAN 4, Abdulrahman ALMAGHRABI 5, Sadikullah KHAN 1, Nusheen NASIR 1, Ashhad Ali KHAN 2 and Ahmed Abdelhaseeb YOUSSEF 6
1) Shaikh Khalifa Medical City, Pediatric Surgery, Abu Dhabi, UNITED ARAB EMIRATES - 2) IBN SINA HOSPITAL, PEDIATRIC UROLOGY, Kuwait, KUWAIT - 3) KING SAUD UNIVERSITY HOSPITAL, Pediatric urology, Riyadh, SAUDI ARABIA - 4) ALQASSIMI HOSPITAL, PEDIATRIC SURGERY, Sharjah, UNITED ARAB EMIRATES - 5) MATERNITY HOSPITAL MECCA, PEDIATRIC SURGERY, Mecca, SAUDI ARABIA - 6) Ain-Shams University, Pediatric Surgery, Cairo, EGYPT
PURPOSE
We published earlier our modified testicular traction technique including intracorporeal placed suture, gabernacular preservation and minimal dissection. We used to fix the testis to a mobile part of the abdominal wall to enhance lengthening with respiratory movement rather than fixing near bony landmark. Herein we compare our traction period of 7 days to the classic 6 weeks period adopted earlier
MATERIAL AND METHODS
In five centers in three Arabian-Gulf countries, patients with intra-abdominal testes operated using the intracorporeal placement of traction suture modification of staged traction laparoscopic-orchiopexy were divided into 2 groups. Group 1: the time interval between both stages was 7 days, while group 2: followed the classic approach with a waiting interval of 6 weeks
RESULTS
Group 1 included 92 patients, while group 2 included 58 patients. All patients tolerated both stages of surgery well without complications. Group 2 had 4 testes found detached from the anterior abdominal wall during second stage. Two of whom required redo first stage while the other 2 was found long enough to be positioned in the scrotum without tension. Moreover, mean operative time was slightly longer in group 2. This was attributed to time spent in testicular adhesiolysis. The 1 year follow-up period proved successful outcome in all cases
CONCLUSIONS
The modified staged traction laparoscopic orchiopexy is safe and successful in intra-abdominal testes. Seven days traction period is enough to bring the testis down to the scrotum decreasing the time burden on the family to worry about complications related to traction
15:46 - 15:49
S03-4 (OP)
Hawwa CHAKERA 1, Leandra Sheila STRINGER 2, Adam FORSTER 3, Zhan Tao "Peter" WANG 2 and Sumit DAVE 2
1) Schulich School of Medicine and Dentistry (University of Western Ontario), Medicine, London, CANADA - 2) London Health Sciences Centre, Department of Urology, London, CANADA - 3) London Health Sciences Centre, Division of Nephrology, Department of Medicine, London, CANADA
PURPOSE
Optimal treatment for intra-abdominal undescended testes (IAT) remains debated. Laparoscopic single-stage vessel sparing orchidopexy (LVSO) and one/two stage Fowler Stephens orchiopexy (LFSO) are selected based on surgeon training and preferences rather than objective criterion necessitating vessel division. This study investigates a pre-meditated approach to perform all orchidopexies for IAT using LVSO, irrespective of testis location or any factors that predict the need for LFSO.
MATERIAL AND METHODS
A retrospective analysis was conducted on patients who underwent LVSO between January 2008 and December 2023. All patients in this series are consecutive patients except 2, excluded due to Prune belly syndrome. Data collected included age at surgery, laterality and post-operative Doppler ultrasound findings, testicular resistive index (RI), volume and location of the testis, at minimum 6 months following LVSO. All testes were extensively mobilized and brought into the scrotum medial to the medial umbilical ligament.
RESULTS
This single surgeon series includes 54 patients with 63 testes undergoing LVSO at a mean age of 2.3 years. Doppler ultrasounds conducted post-orchiopexy showed testicular atrophy (no flow), in 2/63 testis (3%). 87% (55/63) of testicles were successfully positioned in the scrotum post-surgery (Mean follow-up 2.2 years). Testicular RI was comparable in the majority of patients, when documented.
CONCLUSIONS
This study highlights the effectiveness of LVSO in managing IAT. LFSO guarantees scrotal location of the testis with a higher risk of atrophy, while LVSO reduces the need for a second operation and is associated with a lower atrophy rate. These findings support the need for a standardized definition of atrophy post-orchiopexy.
15:56 - 15:59
S03-5 (OP)
Sarah ERPENBECK 1, Anoosha MOTURU 2, Clifford KO 2, Jacqueline SAITO 3, Julia FINKELSTEIN 4 and Jonathan ELLISON 1
1) Medical College of Wisconsin, Department of Urology, Milwaukee, USA - 2) American College of Surgeons, Department of Research and Optimal Patient Care, Chicago, USA - 3) Children's National Hospital, Department of Surgery, Washington, USA - 4) Boston Children's Hospital, Department of Urology, Boston, USA
INTRODUCTION
Testicular torsion is a time-sensitive pediatric emergency, with delays in care potentially leading to testicular loss. Transfer to pediatric specialty hospitals may prolong care pathways. The National Surgical Quality Improvement Program - Pediatric (NSQIP-Ped) collects process measures for time-sensitive operations, including initial presentation site (NSQIP-Ped vs. transfer). A Testicular Torsion Collaborative (TTC) of 29 NSQIP-Ped sites was convened to improve torsion care processes. This study evaluates the association between initial presentation site and orchiectomy rates, as well as the impact of TTC participation and time to operation under four hours (TTOR<4).
MATERIAL AND METHODS
This retrospective cohort analysis included non-neonate pediatric patients (0-17 years) from the NSQIP-Ped database who underwent urgent surgery for testicular torsion between January 2022 and September 2024. Patients with symptom duration >24 hours were excluded. Orchiectomy was modeled using mixed-effects logistic regression, clustering by institution and controlling for initial presentation site. Sensitivity analyses assessed associations with TTC participation and TTOR<4.
RESULTS
Among 2,802 included cases from 74 institutions, 51% (1415/2802) presented directly to NSQIP-Ped hospitals, 54% (1514/2802) were performed at TTC sites, 88% (2467/2802) had TTOR<4, and 8.7% (244/2802) underwent orchiectomy. Initial presentation site was not associated with orchiectomy (OR: 1.2, 95% CI: 0.9-1.6). On sensitivity analysis, non-TTC sites were associated with higher odds of orchiectomy (OR: 2.3, 95% CI: 1.5-3.4).
CONCLUSIONS
Presentation site did not affect orchiectomy rates. However, TTC participation was associated with a significantly reduced orchiectomy likelihood, highlighting the potential of collaborative efforts to improve testicular salvage for transferred patients.
15:59 - 16:02
S03-6 (OP)
Furkan OZSOY 1, Araz MUSAEV 1, Abdulrahman JAFAROV 1, Emre ERDEM 1, Mehmet Erol MARAŞ 1, Murat Can KARABURUN 2, Mustafa Alkan OKTAR 3, Berk BURGU 4, Tarkan SOYGÜR 4 and Aykut AKINCI 5
1) Ankara university, Urology, Ankara, TÜRKIYE - 2) Etlik Şehir Hastanesi, Urology, Ankara, TÜRKIYE - 3) Pursaklar Governmental Hospital, Urology, Ankara, TÜRKIYE - 4) Ankara University, Pediatric Urology, Ankara, TÜRKIYE - 5) Denizli Government Hospital, Pediatric Urology, Denizli, TÜRKIYE
PURPOSE
Delayed presentation of testicular torsion(TT) can lead to increased intratesticular pressure, which may require additional T.albuginea incision, complicating the choice between salvage&orchiectomy. Conventional macroscopic evaluation may introduce subjectivity, resulting in uncertainty in clinical decision-making. Assessing the efficacy of elastography in conjunction with indocyaninegreenfluorescence to establish a more objective basis for decision-making could be beneficial. We aimed to enhance outcomes of decision making (salvage with/without albuginea incision or orchiectomy) in delayed TT through evaluation of testicular viability.
MATERIAL AND METHODS
Total of 30 postpubertal rats were categorized into 3 groups of varying periods of TT: Group1 (2-4 hours), Group2 (6-8 hours) and Group3 (10-12 hours). Initially,all cases were blinded to standard macroscopic examination, followed by ICGfluorescence and elastography to determine testicular viability. Consequently, orchiectomy was performed on all cases.The decision-making process was further evaluated by the histological TUNELassay(apoptosis)on all orchiectomy tissues(early/late).
RESULTS
In all cases except 1 in Groups1&3 were in concordance with ICG/elastography combination. In Group2(6-8 hours), the decision for orchiectomy based on macroscopic observation was significantly higher(60%)(p<0.05) compared to the ICG/elastographypathway(35%). The apoptosis rate in the tunnel test histopathologically validated the ICG/elastography decision-making process in group 2.
CONCLUSIONS
ICG and elastography demonstrate a higher predictive value for testicular viability, leading to greater salvage rates compared to evaluation based on macroscopic appearance. This approach, particularly in cases of relatively delayed presentation, may facilitate a more objective assessment, thereby increasing the likelihood of successful testicular salvage.
16:02 - 16:05
S03-7 (OP)
Jae Min CHUNG 1, Han A LEE 1, Sungchan PARK 2 and Sang Don LEE 1
1) Pusan National University Children's Hospital, Urology, Yangsan-Si, REPUBLIC OF KOREA - 2) Ulsan University Hospital, University of Ulsan College of Medicine, Department of Urology, Ulsan, REPUBLIC OF KOREA
PURPOSE
Childhood obesity is increasingly recognized as a factor influencing endocrine function, including testicular health. However, the impact of obesity on testicular size and function in children with micropenis, without other endocrine disorders or congenital abnormalities, remains unclear.
This study investigates the effect of obesity on testicular function and size in children with micropenis, excluding those with other endocrine or congenital abnormalities.
MATERIAL AND METHODS
A retrospective review was conducted on 112 children diagnosed with micropenis who visited our institution (mean age: 91.8 ± 25.8 months). Patients were divided into non-obese (36) and obese (76) groups. Penile and testicular size were assessed and compared between the groups. Testicular function was evaluated using hCG stimulation tests. Levels of testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were also measured.
RESULTS
Obese group were significantly older than their non-obese group. The stretched penile length (SPL) showed no significant difference between the groups (non-obese: 3.4 ± 0.5 cm vs. obese: 3.5 ± 0.5 cm, p = 0.221). Testicular size was significantly larger in the obese group (2.1 ± 0.6 cc vs. 1.9 ± 1.3 cc, p = 0.001). However, testicular function tests revealed impaired function in 5.6% (2/36) of the non-obese group and 23.7% (18/76) of the obese group (p = 0.02). There were no significant differences in baseline testosterone, LH, or FSH levels between the groups.
CONCLUSIONS
This study shows the complex relationship between obesity and testicular function in children with micropenis. Obesity in children with micropenis is associated with impaired testicular function, highlighting the need for addressing obesity to prevent testicular dysfunction. The absence of differences in baseline hormonal levels suggests that obesity-related testicular dysfunction may not be detectable through routine hormone testing alone.