ESPU Meeting on Friday 5, September 2025, 17:15 - 18:00
17:15 - 17:18
S30-1 (OP)
Nikhil V. BATRA, Kirstan K. MELDRUM, Rosalia MISSERI, Jin Kyu KIM, Mark P. CAIN, Pankaj P. DANGLE, Martin KAEFER, Joshua D. ROTH, Benjamin M. WHITTAM, Richard C. RINK and Konrad M. SZYMANKSI
Riley Hospital for Children at Indiana University Health, Pediatric Urology, Indianapolis, USA
PURPOSE
We sought to review our data to evaluate for changes in estimated glomerular filtration rates (eGFR) and chronic kidney disease (CKD) status in pediatric patients with classic bladder exstrophy (CBE) that have previously undergone staged repairs with primary closure followed by isolated bladder neck repair (BNR).
MATERIAL AND METHODS
Medical records of patients with CBE (1986-2020) were retrospectively reviewed and included if had undergone staged repairs without bladder augmentation with creatinine measurements obtained prior to 18 years of age. Schwartz formula was used to calculate eGFRs and CKD status determined by nephrology evaluations. Non-parametric statistical analysis was performed.
RESULTS
Twenty-two children (68% male) underwent primary closure (94% immediate neonatal) followed by BNR at median age of 5.1 years. At median follow-up after BNR of 16 years, 16 (73%) were augmented or diverted primarily for urodynamic deterioration or upper tract changes (81%). Median preoperative eGFR was 104 ml/min/1.73 m2 at which time no patients had a CKD diagnosis. Ninety-two percent had a decline in eGFR with median change of -22 ml/min/1.73 m2 (p=0.01) observed prior to 18 years of age, corresponding to a -2 ml/min/1.73 m2 (p=0.04) annual rate of decline. At this time point, 5 patients (23%) had any CKD diagnosis and 1 (5%) had CKD3+ with median age at diagnosis of 14 years; all followed with a nephrologist.
CONCLUSIONS
Renal outcomes data following exstrophy repairs continue to be sobering, with nearly a 2-point annual decline in eGFR following isolated BNR. More attention to the early surveillance of renal function following exstrophy repair is needed.
17:18 - 17:21
S30-2 (OP)
Yesica QUIROZ MADARRIAGA 1, Paula IZQUIERDO 2, Rocio JIMENEZ 2, Erika LLORENS 2, Juan Carlos OSORIO 2, Monica FURLANO 3 and Anna BUJONS 2
1) Fundacio Puigvert, Paediatric Urology, Barcelona, SPAIN - 2) Fundacion Puigvert, Paediatric Urology, Barcelona, SPAIN - 3) Fundacion Puigvert, Nephrology, Barcelona, SPAIN
PURPOSE
The exstrophy-epispadias complex (EEC) is a rare spectrum of genitourinary malformations, with treatment evolving from cystectomies and ureterosigmoidostomies to bladder augmentation and bladder plate reconstruction. The long-term impact of these interventions on renal function remains unclear. This study seeks to identify risk factors for renal function deterioration in EEC patients undergoing lower urinary tract reconstructions.
MATERIAL AND METHODS
A prospective database of 176 EEC patients at our institution was retrospectively analyzed. Patients with incomplete follow-up were excluded. Data on demographics, EEC type, renal malformations, glomerular filtration rate (GFR), lower urinary tract reconstruction, UTIs, VUR, urolithiasis, and renal transplantation were collected. Descriptive statistics, logistic regression, and Cox analysis were performed.
RESULTS
124 patients were included, 58% male. 85.5% were born with bladder exstrophy, 12% had epispadias and 2.5% had cloacal exstrophy. 51.6% of patients had urinary reconstruction using segments of the gastrointestinal tract (GT) (enterocistoplasty, ureterosigmoidostomies, colonic conduit), 33.9% had their native bladder and 14.5% had non-continent reservoirs (NCR) such as ureterostomies or ileal conduits. 44.4% of the patients presented a decrease in GFR in an average of 16.9 years with an average decrease of 22ml/min/1.73 m2. In the survival analysis, the median time for deterioration of patients with native bladder, reconstructions with GT and NCR was 36, 27 and 14 years respectively, with a HR of 3.3 (95% CI 1.5-7.03) for NCR, with a statistically significant impact on the decrease in GFR (p 0.0016). Only 6(4.8%) patients required renal transplantation during follow-up.
CONCLUSIONS
The urinary reconstruction in patients with EEC significantly impacts long-term renal function. It is important to maintain rigorous surveillance, particularly in those with NCR as they are the most prone to upper urinary tract deterioration. Multicenter studies with larger cohorts are necessary to identify more reliable prognostic factors in this population.
17:29 - 17:32
S30-3 (OP)
Logan GALANSKY, Andrew GABRIELSON, Joseph CHEAIB, Victoria MAXON, Catherine ROBEY, Chad CRIGGER, John GEARHART and Heather DI CARLO
Johns Hopkins, Urology, Baltimore, USA
PURPOSE
Transitional care for bladder-exstrophy epispadias complex (BEEC) includes genital reconstruction to improve sexual function and cosmesis as patients mature into adulthood. We evaluated our institutional experience with vaginoplasty for female patients with BEEC.
MATERIAL AND METHODS
We conducted a retrospective review of BEEC patients undergoing vaginoplasty from 2000-2024. Post-operative outcomes analyzed included vaginal stenosis requiring re-operation (VS), urinary tract infection (UTI), surgical site infection (SSI), dehiscence, rectal injury, fistula, and pelvic organ prolapse (POP).
RESULTS
We identified 240 female BEEC patients with 54 (22.5%) undergoing vaginoplasty. Median age was 15.6 years old. Median follow-up was 55.2 months. The majority of cases were perineal flap vaginoplasty (88.9%). Nylon suture was most commonly used (46.3%), with PDS used in 22.2% of cases. Post-operative complication rates were VS 14.8%, UTI 3.7%, SSI 7.4%, dehiscence 3.7%, rectal injuries 0%, fistula 0%, and POP 12.9%. The 90-day post-operative complication rate was 20.4% and the lifetime complication rate was 33.3% (Table 1). There was no significant association between reconstruction method and VS (p=0.2) or between perineal flap vaginoplasty and any complication outcome (OR 1.87, 95% CI [0.26-13.7], p=0.5). PDS use was significantly associated with VS on univariable analysis (OR 4.75, 95% CI [1.02-23.1], p=0.042) and multivariable analysis when adjusting for reconstruction method (OR 5.83, 95% CI [1.06-32.3], p=0.043) (Table 2).
CONCLUSIONS
We believe this is the largest reported cohort of BEEC patients undergoing vaginoplasty to date. While perineal flap reconstruction can achieve excellent functional and cosmetic outcomes, VS is the most common complication. Use of PDS was associated with VS, suggesting that other suture types may be more advantageous for successful surgical outcomes, but further investigation into the clinical significance of this finding is warranted.
17:32 - 17:35
S30-4 (OP)
Jason YANG, David HEAP, Victoria MAXON, Catherine ROBEY, Mahir MARUF, Chloe MICHEL, Heather DI CARLO, John GEARHART and Chad CRIGGER
Johns Hopkins University, Urology, Baltimore, USA
PURPOSE
Exstrophy-epispadias complex (EEC) patients often present with attenuated fascia. Currently, there is no direct comparison of outcomes between percutaneous cystolitholapaxy and open cystolithotomy in this specific patient population. Thus, we sought to evaluate the therapeutic efficacy and associated morbidity of both surgical approaches in EEC patients.
MATERIAL AND METHODS
Patients who underwent either their first percutaneous cystolitholapaxy or open cystolithotomy between 2003-2023 were retrospectively identified using an IRB-approved institutional database. Data were collected on operative times, length of stay, stone-free rates, stone size, recurrence rates, and both intraoperative and postoperative complications.
RESULTS
Among 66 patients, 39 (57.58%) underwent percutaneous cystolitholapaxy, and 27 (42.42%) underwent open cystolithotomy. Median stone sizes were comparable between groups (4.00 vs. 4.50 cm, p=0.36). The percutaneous approach resulted in significantly shorter operative times (126.00 vs. 203.00 minutes, p<0.0001) and reduced hospital stays (1.00 vs. 3.00 days, p=0.0003) relative to the open approach. Notably, both techniques achieved a 100% stone-free rate (p>0.99). There were no differences in recurrence (p=0.11) and cumulative incidence (HR 0.76, 95% CI 0.39-1.48, p=0.38) between groups. Postoperative complications revealed a significantly higher incidence of vesicocutaneous fistulas in the open surgery group, with a rate of 22.22% compared to 0.00% in the percutaneous group (p=0.0038).
CONCLUSIONS
Percutaneous cystolitholapaxy provided significant advantages for EEC patients, including shorter operative times and reduced hospital stays, with equivalent stone clearance. Moreover, open cystolithotomy carried a higher risk of vesicocutaneous fistula formation. These findings suggest percutaneous approaches may offer a safer and more efficient alternative for managing bladder stones in EEC patients.
17:35 - 17:38
S30-5 (OP)
Victoria MAXON, Carolyn IM, Catherine ROBEY, Chad CRIGGER, Heather DI CARLO and John GEARHART
Johns Hopkins University, Baltimore, USA
PURPOSE
To determine risk factors for complications after augmentation cystoplasty (AC) with continent catheterizable channel (CCC) in the EEC.
MATERIAL AND METHODS
An IRB approved institutional database of 1515 exstrophy-epispadias patients was reviewed retrospectively. Patients that had primary augmentation performed at our institution between 2003-2023 were included. Gender, race, primary closure outcome, bowel segment choice for augmentation and stoma, preoperative bladder capacity, bladder neck status, age at augmentation, 30- and 90-day complications, number of stomal revisions, and length of longer term follow-ups were reviewed.
RESULTS
157 patients met final inclusion criteria. The patients included 148 (94.3%) classic bladder exstrophy, 6(3.8%) male epispadias and 3(1.9%) female epispadias. The mean age at time of AC was 11.3 years with a median follow up of 6.46 years. There was no significant difference in the length of bowel harvested by the ileum and colon groups (p=0.0836) or closure outcome (p=0.3013). There was increased usage of Monti stoma in patients with an ileum AC (p=0.0117). Closure outcome did not influence the rate of 30- and 90-day complications (p=0.9607, p=0.5085) or stoma choice (p=0.7364). There was no significant difference between the ileum and colon augment groups in terms of 30- and 90-day complications (p=0.6419, p=0.8889 respectively). Patients with a history of primary successful closure had a shorter hospital stay (p=0.0042) but there was no difference in hospital stay between the ileum and colon groups (p=0.6632).
CONCLUSIONS
Bowel segment choice for augmentation cystoplasty does not influence the risk for complications in the EEC population. History of a failed primary closure leads to a longer hospital stay after AC, but there is no increased risk for complications.
17:50 - 17:55
S30-6 (VP)
Hortense ALLIOT 1, Sadaf KODWAVWALA 2, Thomas LOUBERSAC 1, Bachir AHMED 2, Sajid SULTAN 2, Philip RANSLEY 2 and Marc-David LECLAIR 3
1) University Children Hospital, Pediatric Surgery and Urology, Nantes, FRANCE - 2) Sindh Institute of Urology and Transplantation, Pediatric Urology, Karachi, PAKISTAN - 3) Hôpital Mère-Enfant, Chirurgie Infantile, Nantes, FRANCE
PURPOSE
Bladder exstrophy (BE) represents one of the most complex congenital anomalies encountered in pediatric urology. Its management demands a meticulous balance between achieving urinary continence, preserving renal function, and providing an acceptable cosmetic and functional outcome. The surgical approach to BE has evolved significantly over decades, yet the challenges remain profound.
In the late 1970s, Justin Kelly introduced a radical soft-tissue reconstruction technique (RSTM), emphasizing meticulous dissection and reconstruction of pelvic musculature to support urinary continence and anatomical alignment. While widely regarded as a cornerstone in bladder exstrophy management, the technique requires exceptional surgical precision and expertise, limiting its adoption to select centers worldwide.
There has also been a recent worldwide trend toward delayed closure of BE (as opposed to immediate neonatal closure) recognizing the haemodynamic, hormonal, metabolic, and psychologic advantages.
Building on Kelly’s foundational principles, our team has developed a novel strategy that incorporates a delayed closure approach in combination with Kelly’s RSTM.
MATERIAL AND METHODS
A 10 week-old boy with primary bladder exstrophy underwent a Single-stage reconstruction, combining delayed closure with Kelly RSTM. The technique includes ureters reimplantation, corpora and soft-tissue release from the pelvic bones, and bladder closure, cervicoplasty and urethroplasty, and penile reconstruction.
In this video, we present a step-by-step demonstration of our approach, highlighting key technical modifications with drawings and figures.
RESULTS
The follow-up was uneventful, with normal healing at 21 months portoperatively with no bladder nor abdominal wall dehiscence.
CONCLUSIONS
Combination of Kelly RSTM with the concept of delayed closure represents a new paradigm in BE reconstruction, aiming to optimize bladder growth, enhance tissue compliance, and improve long-term functional outcomes while addressing the limitations of immediate neonatal closure.