ESPU Meeting on Saturday 6, September 2025, 08:50 - 09:40
08:50 - 08:53
S36-1 (OP)
Marie BOUSQUET, Amane-Allah LACHKAR, Alaa EL GHONEIMI, Annabel PAYE JAOUEN and Matthieu PEYCELON
National Reference center for Rare Urinary Tract Malformations (CRMR MARVU), Robert-Debré University Hospital, APHP, GHU North, Université Paris Cité, Department of Pediatric Surgery and Urology, Paris, FRANCE
PURPOSE
Prune-Belly Syndrome[PBS] is a rare congenital disorder characterized by significant clinical heterogeneity, necessitating complex, multidisciplinary management. This study aimed to evaluate functional and quality-of-life[QoL] outcomes in patients with PBS, focusing on nephrological, urological, gonadal, respiratory, and aesthetic dimensions.
MATERIAL AND METHODS
A monocentric, prospective, cross-sectional study was conducted. Multidisciplinary evaluations were performed, including nephrological assessments (glomerular filtration rate[GFR] via serum creatinine and cystatinC), urological analyses (bladder dysfunction assessed by the Dysfunctional Voiding Symptom Score[DVSS] (if≥9) and uroflometry, renal/bladder ultrasound[US], surgical interventions), gonadal evaluations (endocrine markers, testicular volume on US (hypotrophy defined by Z-score<-2), and respiratory assessments (Pulmonary Function Tests[PFT]). QoL was assessed using the Pediatric Quality of Life Inventory[PedsQL™], while the Patient and Observer Scar Assessment Scale[POSAS] and BODY-Q questionnaire evaluated aesthetic outcomes.
RESULTS
12 patients were evaluated at a median (IQR) age of 12.8 years (9.7-15.1). Nephrological assessments revealed significant discrepancies (due to abdominal wall hypoplasia) between creatinine-based and cystatin C-based GFR estimates (97.9 vs. 73.3 mL/min/1.73m2, p<0.01). Consequently, chronic kidney disease[CKD] staging differed considerably (36.4% vs. 90.1% at CKD-stage ≥2, p<0.01). Significant post-void residuals were observed in 5 patients (55.6%), with a median (IQR) DVSS of 11.0 (5.8-12.8). Testicular hypotrophy post-orchiopexy was observed in 63% (N=12), with 44.5% (N=4) showing decreased inhibin B levels (median: 121,9 pg/ml), indicative of impaired Sertoli cell function. Respiratory assessments indicated reduced mobilizable lung volumes in 77.9% (N=7), associated with abdominal muscle hypoplasia. Aesthetic outcomes were moderate, and children reported significantly higher QoL scores than their parents.
CONCLUSIONS
This study underscores the need for enhanced gonadal and, for the 1st time, respiratory monitoring as patients transition into adulthood and highlights importance of addressing QoL disparities between patients and their families.
08:53 - 08:56
S36-2 (OP)
Chad CRIGGER 1, Jason YANG 1, Catherine ROBEY 2, David HEAP 1, Victoria MAXON 1, John GEARHART 1 and Heather DI CARLO 1
1) Johns Hopkins University, Urology, Baltimore, USA - 2) Johns Hopkins University, Baltimore, USA
PURPOSE
We sought to evaluate the postoperative benefits of OnabotulinumtoxinA (Botox) injections in pediatric patients undergoing bladder reconstruction.
MATERIAL AND METHODS
Pediatric patients who underwent bladder reconstruction between 2018-2024 were identified retrospectively from an institutional database. Bladder reconstruction was defined to include any combination of the following procedures - bladder neck reconstruction, bladder neck transection, Mitrofanoff or Monti catheterizable channel creation, and bladder augmentation. Patients were stratified based on concurrent ureteral reimplantation necessitating ureteral stent placement. Data on postoperative course, medications, and complications were collected.
RESULTS
Among 88 bladder reconstruction patients, 43 (48.86%) received Botox and 45 (51.11%) did not. In patients undergoing bladder reconstruction without ureteral reimplantation necessitating ureteral stents, Botox significantly reduced anticholinergic use (0.11 mg/kg/day, IQR 0.07-0.19 vs. 0.16 mg/kg/day, IQR 0.11-0.21, p=0.05). These patients also experienced fewer days to return to feeding (3.00 days, IQR 1.00-4.25 vs. 4.50 days, IQR 3.00-5.75, p=0.05) and return to bowel movement (2.00 days, IQR 2.00-3.50 vs. 4.50 days, IQR 3.00-6.00, p=0.01). In contrast, patients undergoing bladder reconstruction with concurrent ureteral reimplantation necessitating ureteral stents showed no significant differences in anticholinergic use (0.14 mg/kg/day, IQR 0.06-0.31 vs. 0.19, IQR 0.12-0.25, p=0.71). Interestingly, there was a faster return to feeding (4.00 days, IQR 3.00-4.50 vs. 6.00, IQR 4.00-7.75, p=0.02). Complication rates were comparable between Botox and non-Botox groups (all p>0.05).
CONCLUSIONS
Intraoperative Botox significantly reduced anticholinergic use among pediatric patients who underwent bladder reconstruction without ureteral reimplantation requiring ureteral stents. This demonstrates its potential as an effective adjunct for postoperative recovery in patients undergoing select reconstruction.
08:56 - 08:59
S36-3 (OP)
Ainhoa LOMBARDERO 1, Oriol MARTÍN SOLE 1, Isabel CASAL 2, Sonia PEREZ 1, Paula SALCEDO 1, Leopoldo TAPIA 1, Xavier TARRADO 1 and Luis GARCÍA APARICIO 1
1) Sant Joan de Deu Hospital, Pediatric surgery, Esplugues De Llobrega, SPAIN - 2) Virgen del Rocío Hospital, Pediatric surgery, Sevilla, SPAIN
INTRODUCTION
Some surgeons avoid ureteral reimplantation under 1y of age due to concerns about irreversible damage to bladder function, although no studies support this. We evaluate whether patients who underwent Cohen’s reimplantation for vesicoureteral reflux (VUR) or primary obstructive megaureter (POM) before the age of 1y have increased lower urinary tract dysfunction (LUTD) compared to those operated on later.
MATERIAL AND METHODS
LUTD were assessed in patients operated on between 2000 and 2015 using PLUTSS, ICIQ-SF, and CACV questionnaires. The prevalence of LUTD was compared between the two groups, including a gender-stratified analysis.
RESULTS
We assessed 319 patients, excluding 76. Eighty-three patients were operated on under 1y and 160 after 1y. Mean follow-up was 16y (range:8-25y). Patients operated on under 1y included more males (71%vs45%, p<0.01), VUR grade V (59%vs19%, p<0.01) and POM (27%vs11%, p<0.01), while patients who underwent surgery after 1y showed more pathological results in PLUTSS (11.3%vs2.4%, p=0.02) and ICIQ-SF (14%vs6%, p=0.085). Females showed higher scores in PLUTSS (13%vs4%, p<0.01), ICIQ-SF (18%vs5%, p<0.01) and CACV (65%vs44%, p<0.01). When stratifying by gender, gender was found to be a confounding factor, with patients who underwent surgery after the age of 1y having higher LUTD due to the higher proportion of women. In multivariate analysis, voiding postponement and low-grade VUR were identified as risk factors for higher PLUTSS scores.
CONCLUSIONS
Cohen ureteral reimplantation before the age of one year does not increase the risk of LUTD. Women have a higher percentage of LUTD than men, regardless of age at reimplantation.
08:59 - 09:02
S36-4 (OP)
Ching Man Carmen TONG 1, Betsy HOPSON 2, Brandon ROCQUE 3, Sandeep VEJANDLA 4, Inmaculada ABAN 4 and Stacy TANAKA 1
1) University of Alabama at Birmingham, Department of Urology, Birmingham, USA - 2) University of Alabama at Birmingham, Department of Medicine, Birmingham, USA - 3) University of Alabama at Birmingham, Department of Neurosurgery, Birmingham, USA - 4) University of Alabama at Birmingham, Department of Biostatistics, Birmingham, USA
PURPOSE
Bowel substitution in bladder augmentation surgery can lead to metabolic abnormalities and bone demineralization in individuals with spina bifida (SB). The aim of this study is to understand whether patients with SB who had bladder augmentation surgery before 10 years old have higher likelihood of fractures compared to those who had surgery age 10 and after.
MATERIAL AND METHODS
Data was queried from the National Spina Bifida Patient Registry (2009-2021). Demographics, ambulation status and orthopedic data were collected. Patients were split into the young group (age less than 10) and the old group (age 10 and older). Statistical analysis includes chi-square test for comparing fracture percentages, univariable logistic regression for calculating odds ratios, and Kaplan-Meier analysis for time from surgery to fracture.
RESULTS
1167 patients were included; 646 were in the young group and 521 were in the old group (mean age 6.1 vs 14.4 years, respectively). There was statistical difference in ambulation status (p=0.029) and preoperative rate of fractures (10% in old group vs. 5% in young group, p=0.001). The young group had more fractures after surgery (8.82%) vs. old group (4.8%, p=0.01). Odds of fracture are 1.92 times higher in the young group (95% CI : (1.2, 3.17). In time-to-fracture analysis, there is not enough evidence to show a difference between the two groups (p=0.07).
CONCLUSIONS
There is potential association of younger age at time of augmentation surgery with fracture in individuals with SB. This suggests that preoperative counseling for augmentation surgery should include discussions regarding postoperative surveillance of bone health.
09:17 - 09:20
S36-5 (OP)
Mohamed ABDELGHANY, Galal ELSHORBAGY, Hesham I MOHAMED, Mohamed SALAH, Waseem NABIL ABOULELA, Waleed GHONEIMA, Ahmed SHOUMAN, Ahmed I SHOUKRY, Mohamed N EL GHONEIMY, Hany MORSI and Ahmed SALEM
Cairo University, Urology department, Cairo, EGYPT
PURPOSE
To study the impact of the baseline renal function on the outcome of AC in children with normal renal function and those children with various degrees of renal function impairment
MATERIAL AND METHODS
A prospective study on 75 children aged from 2 to 14 years old with refractory bladder dysfunction indicated for AC with baseline GFR >30 ml/min for whom augmentation ileocystoplasty were performed between Aug. 2018 and Aug. 2020. GFR was assessed before AC and at 6 to 12 months post AC. Renal function deterioration was defined as progression to a lower CKD stage.
RESULTS
GFR improved in 53 children (74.6%) and deteriorated in 18 children (25.4%). Most of children who had low pre AC GFR (80% of CKD stage IIIa and 100% of CKD stage IIIb) had improved renal function after AC (P= 0.033, 0.01). Children with CKD stages I and II had lower rates of renal function improvement (55% and 73.9 % respectively) (P= 0.008 ,0.168).
The minimum pre AC GFR in the improvement group was 30 ml/min. There was no statistically significant difference in post operative complications rate between each CKD stage apart from metabolic acidosis rate (Higher in CKD II (P=0.009)) and hyperchloremia (Higher in CKD IIIb (P=0.018).
CONCLUSIONS
Augmentation ileocystoplasty didn't lead (on short term follow up) to further renal function impairment in patients with CKD stage III as was previously assumed. Augmentation ileocystoplasty may be considered safe in pediatric population with GFR as low as 30 ml/min.
09:20 - 09:23
S36-6 (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
Robotic bladder neck procedures may have unique benefits including improved visualization and suturing dexterity when compared to an open approach. We aimed to compare the peri-operative and post-operative outcomes of patients who underwent robotic versus open bladder neck reconstruction with slings over a 10—year period.
MATERIAL AND METHODS
A retrospective review was completed of all patients with neurogenic bladders who underwent robotic and open bladder neck reconstruction with sling 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 59 patients were identified (22 robotic and 37 open), with a median age at time of surgery of 6.7 years (IQR 5.5-10.2 years) and median length of follow up of 5.5 years (IQR 2.7-7.5 years). There were no significant differences in patient demographics between the two groups. The robotic group had a significantly shorter length of admission even when excluding those that underwent concurrent enterocystoplasty (5.0 vs 8.0 days, p=0.037). There was no significant difference in 30-day complication rates (40.9% vs 37.8%, p=1.00), surgical revision rates (22.7% vs 27.0% p=0.77), continence rates at 6 months (81.8% vs 73.0% p=0.54) or at last follow up (86.4% vs 89.2% p=1.00) for robotic versus open bladder neck reconstruction with slings.
CONCLUSIONS
Robotic bladder neck reconstructions are a safe alternative to an open approach as they offer similar short and long-term continence rates with significantly shorter hospital stays.
09:23 - 09:28
S36-7 (VP)
Rocio JIMENEZ CORRO 1, David CARRACEDO 2, Erika LLORENS 3, Yesica QUIROZ 3, Juan OSORIO 3 and Anna BUJONS 3
1) Fundacion PUIGVERT, PEDIATRIC UROLOGY, Barcelona, SPAIN - 2) HOSPITAL REY JUAN CARLOS, UROLOGY, Mostoles, SPAIN - 3) FUNDACIO PUIGVERT, PEDIATRIC UROLOGY, Barcelona, SPAIN
INTRODUCTION
AUS is commonly used for neurogenic sphincter insufficiency in pediatric patients, but it has also been successfully applied in congenital conditions like bladder exstrophy or anorectal malformations, with effectiveness rates of 90-87% respectively.
MATERIAL AND METHODS
We present the case of a 16-year-old female with bilateral ureteral ectopia and four prior surgeries. She suffered from severe stress incontinence (SI), requiring 7 pads per day. A robotic AUS placement was decided. The procedure involved opening the bladder-vaginal space and performing a detailed dissection to place the cuff around the bladder neck. A 2cm suprapubic incision allowed for the insertion of a 5mm trocar and externalization of the cuff and balloon tubes. The peritoneum was closed, and a pocket was created in the right labium maiora for the activation pump.
RESULTS
The surgery was successful without complications. The catheter was removed after 6 days, and the AUS was activated after 6 weeks. Post-surgery, the patient no longer had SI and experienced normal voiding without post-void residuals (PVR).
CONCLUSIONS
AUS is an effective treatment for severe SI in pediatric patients. The robotic approach enhances visualization, reduces the risk of injury, and minimizes complications.