Parallel Meeting on Friday 5, September 2025, 08:00 - 08:45
08:00 - 08:03
S31-1 (OP)
Tomer HASDAI, Maya YOHAN BARAK and David BEN MEIR
Schneider Hospital, Pediatric Urology, Kiryat Ono, ISRAEL
BACKGROUND AND PURPOSE
The "Mic-key" button (MB) is an alternative to intermittent catheterization (IC).
The study purpose is to describe complications associated with MB, and to compare quality of life (QOL) with IC.
MATERIAL AND METHODS
We retrospectively collected demographic and clinical data among MB children during 2015-2023, and administered self-report questionnaires relating to QOL of children who performed IC versus MB.
RESULTS
Our MB cohort included 33 children (24 boys), median age of 4.5 years (range 0.4-19), and median MB duration of 24 months (7 days - 90 months). For the mental well-being data, 37 parents were queried: 18 IC and 19 MB. 18 children aged 7-18 years filled out the questionnaires themselves (5 IC, 13 MB). During follow-up, 22 (68%) of the MB group suffered from symptomatic urinary tract infections, with common pathogens being Pseudomonas (14, 43%) and E. coli (7, 22%). Other complications included cutaneous granulomas (5, 15%), dilation of the opening tract (2, 6%), leaks (2, 6%), and bladder stone formation (2, 6%). Parent reports showed significance in hierarchical regression (F(7,29)= 5.39, p<.001), indicating that as age decreased and difficulty in emptying the bladder lessened, QOL increased. Reports from children showed that QOL of adolescents (M=61.2) was significantly worse compared to that of younger children (M=76.9; T(15)=2.2, P<.05).
CONCLUSIONS
MB use was associated with complications, especially urinary tract infections, but QOL was similar to IC. In terms of QOL, adolescents are more adversely affected by bladder-emptying, and thus should be targeted for intervention.
08:03 - 08:06
S31-2 (OP)
Sajid SULTAN 1, Sadaf ABA UMER KODWAVWALA 1, Bashir AHMED 2 and Syed Adib Ul Hassan RIZVI 1
1) SINDH INSTITUTE OF UROLOGY & TRANSPLANTATION, PHILIP G RANSLEY DEPARTMENT OF PAEDIATRIC UROLOGY, Karachi, PAKISTAN - 2) Sindh Institute of Urology & transplantation, Philips G Rensley Department of Paediatric Urology, Karachi, PAKISTAN
PURPOSE
The purpose is to evaluate the long-term outcome and complications of continent catheteizable urinary channel in children from a developing country setting with low socioeconomic and educational level.
MATERIAL AND METHODS
Retrospective analysis of medical records of children who underwent CCC between 2002 and 2023. For the analysis children are divided into two groups on the basis of channel type i.e. appendi-covesicostomy or Monti. Data was analyzed on SPSS 20. Kaplan Mayer survival graph was used for long term survival (complications)analysis.
RESULTS
228 channels were formed with mean age at surgery 8.6+/-3.4 years. M:F 1.6:1. Diagnoses included Neurogenic bladder-37%, PUV-33% & EEC-19%. Appendix used in 89% and ileal-monti in 19(11%). Stoma was created in right iliac fossa in majority of the cases using VQZ technique. Overall complication rate was 19.5% which were Clevien-Dindo-Grade IIIb. Of them 18/43 required open surgical revision of stoma/channel. No statistically significant differences in complications and surgical revision were noted when comparing appendix and ileal monti (p=0.76 and 0.42 respectively)50 % of all the complications were noted in the first 2 years and 25% after 5 years of follow-up. Difficult catheterization was the most common(17/43). Stoma related complications included stenosis(7) mucosal prolapse(7).Channel related complications included stenosi(8), fistula(4)and incontinence(2). Channel incontinence seen in Monti and channel fistula in appendicovesicostomy. Our survival analysis (Kaplan-Meier)evaluating the whole cohort complication free time was157+/- 6 months(95% CI 145-169.6). On a time to event analysis there were no statistically significant differences in complications rate comparing the use of appendix vs Monti(p=0.32). The mean follow-up period is 8.5+/-4.7 years.
CONCLUSIONS
In a developing country setting with a low socio-economic and educational-level it is possible to successfully perform clean intermittent catheterization using cheap nelaton-catheter through continent catheterizable channel with small complications rate even in the long term.
08:06 - 08:09
S31-3 (OP)
Sherif M. SOLIMAN 1, Moustafa M. BAYOUMI 1, Mostafa M. ELGHANDOUR 1, Mahmoud S. ABOL KHER 2 and Hany E. ELHADY 1
1) Children's Hospital & Faculty of Medicine, Ain Shams University, Division of Paediatric Urology, Department of Paediatric Surgery, Cairo, EGYPT - 2) Children's Hospital & Faculty of Medicine, Sohag University, Department of Paediatric Surgery, Sohag, EGYPT
PURPOSE
Intractable Leakage is a frustrating complication after construction of MC. Even after multiple sessions, unsatisfactory outcomes are often reported with endoscopic injection of bulking agents. Herein, we present diverse surgical tactics envisioned as a definitive solution to this problem, as dictated by the conduit length, girth, trajectory, blood supply, reservoir nature and local tissue conditions, and further optimized by intraoperative testing for leakage and ease of catheterization.
MATERIAL AND METHODS
Twenty-two patients (age range 1.5-15.5 years, median 10.88) with 22 Leaking MC (11 appendix, 8 Monti, 3 tapered ileum, prior 13 failed attempts of endoscopic injection in 9) were operated after assuring patient compliance, reservoir/bladder low-pressure status, and adequate capacity by a catheterization diary and urodynamic testing. Following cystoscopy/mitrofanoffscopy and intraoperative assessment of the conduit-reservoir unit, The anti-reflux tactics culminated in MC reimplantation in the intestinal portion of the reservoir and customized as: simple Shanfield reimplant(3/22), seromuscular trough-enforced Shanfield(9/22), reservoir wrap-enforced Shanfield(7/22) and Y-V advancement with a seromuscular/ detrusor trough in(3/22). Concurrent procedures involved, MC remodeling(1), skin revision/relocation for stomal stenosis (3), and add-on patch augment(1). Success was defined by an easy, non-painful catheterization with leak-proof intervals more than 4 hours and no upper tract deterioration sustained beyond 6 months after the procedure.
RESULTS
Follow-up ranged 0.5-7.5 years(median 2.88,IQR 3.25). Successful outcome was achieved in 19/22 children (86%). Two re-developed leakage (2 and 7 months), while one developed a proximal long stricture (3 months) necessitating take-down of MC in all, and replacement by tapered ileum MC implanted in a serosal-lined trough created partially by an add-on ileal patch evantually reaching dryness in all.
CONCLUSIONS
The diverse tactics employed herein for rescue of leaking MC, strictly customized for each conduit-reservoir unit, were robust and durable in attaining a leak-proof status in most children following a single intervention with significant enhancement of their lifestyle.
08:19 - 08:24
S31-4 (VP)
Mohamed HUSSINY 1, Tamer HELMY 1, Mohamed DAWABA 1, Antoine KHOURY 2 and Ashraf T. HAFEZ 1
1) Urology and Nephrology center - Mansoura University, Urology department, Mansoura, EGYPT - 2) University of California Irvine, Department of Urology, Orange, USA
PURPOSE
Leaking CCCC is a significant and frustrating complication which may need more than one revisional surgery for management. Moreover, some patients are still incontinent after these surgeries. Total channel substitution is required in case of complete disruption of the continence mechanism. However, treatment options are limited. The aim of this video is to illustrate a new outlet mechanism suitable for correction of incontinence post appendicovesicostomy CCCC in children. Initially it was described for urinary conversion in cases of urethral recurrence following cystectomy and orthotopic urinary diversion for bladder cancer.
MATERIAL AND METHODS
We present a case of 11-year-old boy with diagnosis of neuropathic bladder due to meningomyelocele. At age of 6 years old, He underwent augmentation ileocystoplasty and bladder neck reconstruction with appendicovesicostomy CCCC which was done outside our institution for a complaint of total urinary incontinence. He presented to us with urinary incontinence via the urethra with a leaking CCCC. Pouchogram revealed accepted capacity. The operative decision was bladder neck closure with revision of CCCC. Key surgical steps are described in the video. Bladder neck closure was done through transvesical approach. Total channel substitution was done using spiral monti tube with serous lined extramural tunnel continence mechanism through longitudinal opening of anterior wall of pouch only. A 6 cm. ileal segment was used.
RESULTS
No major complications were recorded. Patient was discharged after 3 days. The pouch was kept drained for 3 weeks before training by intermittent catheter clamping. After one year of follow up, the channel is still continent with normal upper tract sonographically.
CONCLUSIONS
The proposed technique is a feasible option for management of a leaking appendicovesicostomy CCCC in children. It is a simple procedure, time saving and allows using a short ileal segment in this challenging cohort of patients.
08:24 - 08:27
S31-5 (OP)
Kyle O. ROVE 1, Andrew C. STRINE 2, David I. CHU 3, Duncan T. WILCOX 1, Darren HA 1, Gino J. VRICELLA 4, Douglas E. COPLEN 5, Erica J. TRAXEL 5, Austin ACKS 5, Rajeev CHAUDHRY 6, Brian VANDERBRINK 2, Elizabeth B. YERKES 3, Yvonne Y. CHAN 7, Nicholas E. BURJEK 8, Rebecca S. ZEE 9, C. D. Anthony HERNDON 9, Jennifer J. AHN 10, Paul A. MERGUERIAN 10, Bhalaajee MEENAKSHI-SUNDARAM 11, Adam J. RENSING 11, Dominic FRIMBERGER 11 and Megan A. BROCKEL 12
1) Children's Hospital Colorado, Department of Pediatric Urology, Aurora, USA - 2) Cincinnati Children's, Division of Pediatric Urology, Cincinnati, USA - 3) Ann & Robert H. Lurie Children's Hospital of Chicago, Division of Urology, Chicago, USA - 4) Mercy Children's Hospital, Department of Pediatric Urology, Overland Park, USA - 5) St. Louis Children's Hospital, Division of Pediatric Urology, St. Louis, USA - 6) Children's Hospital of Pittsburgh, Division of Pediatric Urology, Pittsburgh, USA - 7) University of California Davis, Department of Urologic Surgery, Sacramento, USA - 8) Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Anesthesiology,, Chicago, USA - 9) Children's Hospital of Richmond at VCU, Division of Urology, Richmond, USA - 10) Seattle Children's Hospital, Department of Urology, Seattle, USA - 11) Oklahoma Children's Hospital at OU Health, Department of Urology, Oklahoma City, USA - 12) Children's Hospital Colorado, Department of Anesthesiology, Aurora, USA
PURPOSE
Enhanced recovery after surgery (ERAS®) is a multidisciplinary framework to standardize perioperative care. Pediatric Urology Recovery After Surgery Endeavor (PURSUE) is a multi-center study of ERAS in patients undergoing complex lower urinary tract reconstruction. We hypothesized ERAS in this population would achieve ≥75% compliance while reducing length of stay and opioid use without an increase in complications or other balancing measures.
MATERIAL AND METHODS
From 2017-2022, 8 centers implemented ERAS for pediatric patients undergoing catheterizable channel creation, bladder augmentation, and/or bladder neck procedures. The uniform ERAS protocol contained 20 process measures covering pre-, intra-, and postoperative phases of care. Prospectively enrolled patients were propensity matched to recent historical controls prior to ERAS implementation and outcomes were compared.
RESULTS
153 ERAS patients and 153 historical controls were matched successfully and included with a median age of 10.2 (IQR 7.6–13.7) and 10.4 (IQR 8.0-14.6) years, respectively (p=0.49). Median protocol compliance increased from 8 to 16 measures between historical and ERAS cohorts (p<0.001). Median length of stay decreased from 8.0 to 5.3 days (p<0.001). Postoperative opioid use decreased 74% without an increase in maximum pain scores. Complication rates at the patient level decreased from 72.5% to 60.1% (p=0.011) with no differences in 90-day emergency room visits, readmissions, or reoperations.
CONCLUSIONS
ERAS is a highly effective at standardizing perioperative care in pediatric urology patients undergoing complex lower urinary tract reconstruction. ERAS was associated with better outcomes of reduced length of stay, lower postoperative opioid use, and lower complication rates.
08:27 - 08:30
S31-6 (OP)
Alexandra BAIN 1, Stephen WERTHEIMER 2, Cody CLARK 1, Brenna RACHWAL 3, Molly FUCHS 1 and Daniel DAJUSTA 1
1) Nationwide Children's Hospital, Pediatric Urology, Columbus, USA - 2) Allegheny Health Network, Urology, Pittsburgh, USA - 3) Nationwide Children's Hospital, Center for Childhood Health Equity and Outcomes Research, Columbus, USA
PURPOSE
Recent literature has demonstrated the feasibility of robotic catheterizable channel creation as it offers reduced morbidity with equivalent clinical outcomes and complication rates compared to traditional open techniques. Our aim was to compare the outcomes of robotic versus open catheterizable channel creation over a 10—year period.
MATERIAL AND METHODS
A retrospective review was completed of all patients with neurogenic bladders who underwent robotic and open catheterizable channel creation from 2014 - 2024. Baseline patient demographics were collected and intra-operative and post-operative outcomes were compared using Fischer's exact and Wilcoxon rank-sum tests.
RESULTS
A total of 189 patients were identified (64 robotic and 125 open), with a median follow-up time of 4.0 years (IQR 1.8-6.8 years). Patients who underwent robotic channel creation were significantly older (9.3 vs 6.1 years, p=0.0001) and had lower rates of previous abdominal surgery (29.7% vs 69.6%, p<0.0001). Patients who underwent a robotic channel creation had a significantly longer median operative time (340.0 vs 214.5 minutes, p=0.007). There was no significant difference in 30-day complication rates (32.8% vs 39.5%, p=0.37), or surgical revision rates (28.1% vs 19.2%, p=0.16) for robotic versus open channel creation. Patients who received robotic channel creation had significantly lower post-operative narcotic usage (0.4 vs 0.7mg/kg morphine equivalents, p=0.049), and shorter hospital stays even when excluding patients who underwent a concurrent augment or Monti creation (5.0 vs 7.0 days, p=0.015).
CONCLUSIONS
Robotic catheterizable channel creation is a safe and feasible option compared to the open technique with significantly shorter hospital stays and similar functional outcomes and complication rates.
08:30 - 08:33
S31-7 (OP)
Tatjana HEISINGER-HEIDLER, Ilina ROSOKLIJA, Theresa MEYER and Elizabeth B. YERKES
Ann & Robert H. Lurie Children's Hospital of Chicago, Pediatric Urology, Chicago, USA
PURPOSE
Stenosis is a common complication of cutaneous, catheterizable channels. Conservative management can address intermittent skin level concerns, but persistent difficulties or discomfort may require revision. When surrounding skin is suboptimal, oral mucosa grafts are a valuable alternative. We aim to describe our experience, postoperative observations and outcomes with this technique.
MATERIAL AND METHODS
A single institution, retrospective case series of patients with suprafascial channel revisions incorporating oral mucosa inlays between 2007 and 2024 was done.Patient and stomal characteristics were reviewed and longitudinal clinical and surgical outcomes were assessed.
RESULTS
We identified 11 patients who received oral mucosa inlay following: Mitrofanoff appendicovesicostomy(5),Monti-Yang ileovesicostomy(3),appendicocecostomy(3). 9 were female with a median age of 11.1 years (range 4.6-17.2 years) at the time of surgery. All had stenosis or hooding that limited ease of access to the channel, one patient had a sinus tract from catheter trauma. Stomas were in the right lower quadrant(6),umbilicus(4),and midline incision(1). As experience progressed, we incorporated one or more of the following: deep radial incision through the scar into healthy channel; excision of surrounding scar; mobilization of the suprafascial channel. Postoperatively, a bolster dressing was used for one week and the catheter stayed for 2 more weeks. Patients were told to apply bland ointment and massage the tissue daily. With a median follow-up of 38 months (range 14-193 months) post-grafting, 3 patients (27%) required additional procedures due to persistent catheterization difficulties, while 2 (18%) experienced transient challenges, managed conservatively with stent and steroids. At most recent follow-up,all catheterized without issues.
CONCLUSIONS
In our experience, oral mucosa inlay is a viable option for stoma revision. Autologous grafting of non-keratinized and highly vascularized mucosa is ideal,especially with poor surrounding skin. Full excision of hypertrophic scar, as well as wider grafts and scar excision in the umbilicus may enhance success.