ESPU Meeting on Saturday 6, September 2025, 09:40 - 10:40
09:40 - 09:43
S37-1 (OP)
Mandy RICKARD 1, Mirriam MIKHAIL 1, Abby VARGHESE 1, Beverly MIRANDA 1, Michael CHUA 1, Rodrigo ROMAO 1, Joao PIPPI SALLE 1, Chia Wei TEOH 2, Armando LORENZO 1 and Joana DOS SANTOS 1
1) The Hospital for Sick Children, Urology, Toronot, CANADA - 2) The Hospital for Sick Children, Nephrology, Toronto, CANADA
PURPOSE
The use of mirabegron in pediatric patients with CKD and kidney transplant (KT) requires caution due to complex comorbidities, potential drug interactions, and hypertension risks. Herein we evaluate safety, tolerability, and outcomes of mirabegron in children with CKD and post-KT with refractory voiding dysfunction (rVD).
MATERIAL AND METHODS
We reviewed pediatric patients receiving mirabegron for rVD. Data collected included demographics, underlying diagnoses, bladder capacity (via uroflowmetry or videourodynamics), lower urinary tract symptoms (LUTS), mirabegron dosing, adverse effects, creatinine, and Tacrolimus levels. Paired t-tests compared pre- and post-treatment outcomes.
RESULTS
Thirteen pediatric patients (mean age 133 ± [MR1] [JR2] 52 months, 61%. female) were included. All received extended-release mirabegron (25-50 mg/day). It was well-tolerated, with no serious adverse effects or hypertension. Two patients with pre-transplant hypertension became normotensive post-transplant. Mirabegron significantly improved LUTS, with 69% reporting partial or complete symptom resolution. Bladder capacity significantly increased, rising from 46.7 ± 24.9% to 84.3 ± 29.5% of the expected bladder capacity for age (% EBC) (p<0.01). No significant changes were observed in eGFR (p = 0.98) or Tacrolimus levels (p = 0.85).
|
CKD stages N (%) 1 2 3a 3b 4 5 |
3 (23) 3 (23) - 1 (7.7) 1 (7.7) 5 (38.6) |
|
Kidney transplant recipients N (%) |
5 (38.6) |
|
Duration of treatment Median (IQR) months |
30.7 (11-40) |
|
|
Pre-Mirabegron |
Post-Mirabegron |
p value |
|
Bladder volume %EBC (mean ± SD) |
46.7 ± 24.9 |
84.3 ± 29.5 |
<0.01 |
|
PVR ml (mean ± SD) |
8.2 ± 17.2 |
6.1± 7.8 |
0.70 |
|
eGFR |
89.5 ± 38.3 |
89.2 ± 38 |
0.98 |
|
Tacrolimus level (N = 5) On target |
5.6 ± 1.2
3/5 |
5.8 ± 1.9
5/5 |
0.85 |
CONCLUSIONS
Mirabegron is safe and well-tolerated in pediatric CKD and post-KT patients with rVD. Early outcomes suggest significant improvements in LUTS and bladder capacity, with low risk of hypertension. Further studies are needed to confirm these findings and assess long-term outcomes.
09:43 - 09:46
S37-2 (OP)
Gabriele VASTA 1, Anne WRIGHT 2, Sara LOBO 1, Anu PAUL 1, Pankaj MISHRA 1, Arash TAGHIZADEH 1, Riccardo MANUELE 2 and Massimo GARRIBOLI 1
1) Evelina London Children's Hospital, Department of Pediatric Urology, London, UNITED KINGDOM - 2) Evelina London Children's Hospital, Children's Bladder Service, London, UNITED KINGDOM
INTRODUCTION AND OBJECTIVE
The use of intravesical Botulinum Toxin (BTX) for the treatment of idiopathic detrusor overactivity has been extensively studied in adults. However, studies involving paediatric populations are limited. The aim of this study is to evaluate the effectiveness of BTX injections in children with non-neurogenic detrusor overactivity (DO) resistant to anticholinergic and to analyze potential predictive factors of success.
MATERIAL AND METHODS
We retrospectively reviewed clinical files of all children affected by non-neurogenic detrusor overactivity resistant to medical therapy, treated with intradetrusor BTX injections between November 2011 and November 2021. All patients failed medical treatment with anticholinergic (oxybutynin, tolterodine, solifenacin) and underwent urodynamic studies before treatment with BTX.
We analyzed the following parameters: sex, age at first treatment, urgency before treatment, frequency, comorbidities, bladder capacity vs expected bladder capacity (BC/EBC), post void residual (PCR), and cystometrogram parameters (bladder compliance, cystometric capacity, end fill pressure and max pressure DO). Treatment outcomes were classified as either a complete response or no response.
RESULTS
A total of 69 children were included, 38 girls (55%) and 31 boys (45%); presenting symptoms were day-time urinary incontinence, urgency, frequency in 100%, 97%, 88,4%, respectively.
Median age at first BTX injection was 11.6 years (8-16 years). Age at last follow up was 15,4 years (8-20). Overall success rate was 46/69 (67%) after a median of 2 BTX injections.
No significant differences were found between responders and non-responders in relation to the variables analyzed. No significant associations could also be identified at the multivariate analysis.
CONCLUSIONS
Botox injection is a potentially effective adjuvant therapy in the treatment of children with non-neurogenic, drug-resistant overactive bladder (OAB). None of the variables analyzed proved to be statistically significant. Further studies and multicenter collaboration are needed to draw more meaningful conclusions.
09:46 - 09:49
S37-3 (OP)
Ahmed HASSAN 1, Hayley WYNNE 2, Ella POLLITT 2 and Anju GOYAL 2
1) Manchester University NHS Foundation Trust, Paediatric urology, Manchester, UNITED KINGDOM - 2) Manchester University NHS Foundation Trust, Paedaitric Urology, Manchester, UNITED KINGDOM
PURPOSE
Overactive bladder (OAB) refractory to anti-cholinergics is a challenging condition and requires paediatric urology services and specialist nursing support for years. After transition to adult services, progression remains unclear. This study evaluated long-term outcomes.
MATERIAL AND METHODS
48 patients/parents who had participated in a RCT 10 years earlier and had urodynamically proven refractory OAB with day time wetting were invited to complete a questionnaire.
RESULTS
Median age at presentation with OAB was 7.0 years(range:3.0–15.0). All were refractory to anti-cholinergics and underwent urodynamic study (UDS) a median of 2.0 years later. After confirmation of bladder overactivity, interventions included anti-cholinergics only(5), Botulinum toxin(32), or Mirabegron(11) as a single or combined therapy.
The telephone questionnaire was completed by participants at a current median age of 18.0 years(range:15.0–23.0).
20 patients (41.7%) were symptom-free, and 14 patients (29.2%) had some urgency with no significant impact on quality of life. Another 3(6%) had mild OAB symptoms.
11 had moderate-to-severe OAB symptoms but only 6 were taking medication (4 under adult services). 42 patients (87.5%) were off medication. 39 patients (81.3%) expressed great satisfaction with paediatric urology/nursing services.
CONCLUSIONS
Despite an often long and frustrating journey in refractory OAB, long term outcome is encouraging with 77% patients having complete or near complete symptom resolution. 23% have persistent significant symptoms but half do not seek appropriate help, highlighting the need for a robust transition pathway. Moreover, the high satisfaction rate with our paediatric urology services demonstrates the importance of a patient-centred, multidisciplinary approach.
10:00 - 10:03
S37-4 (OP)
Araz MUSAEV 1, Mehmet Fatih ÖZKAYA 1, Ahmet Furkan ÖZSOY 1, Serhat ERKMEN 2, Bahri Efe TURGUT 3, Yakup Tarkan SOYGÜR 1 and Berk BURGU 1
1) Ankara University Faculty of medicine, Pediatric Urology, Ankara, TÜRKIYE - 2) Ankara University Faculty of medicine, Urology, Ankara, TÜRKIYE - 3) Ankara University Faculty of medicine, Ankara, TÜRKIYE
PURPOSE
We aimed to compare the treatment options for giggle-incontinence (GI) and identify the factors associated with full response (FTR) to a structured treatment.
MATERIAL AND METHODS
The data of patients treated for GI in our outpatient clinic between 2010 and 2024 were evaluated. The patients who did not achieve a FTR and required methylphenidate administration as the next step were analysed in two groups. Patients in Group 1 received standard urotherapy and anticholinergic treatment, while those in Group 2 received standard urotherapy and biofeedback therapy.
RESULTS
A total of 123 patients were included in the study, Group 1 n=61 and Group 2 n=62
Initially characteristics of patients with full response with partial and non-responders, multivariate analysis revealed that admission at post pubertal age (p < 0.05), female gender (p < 0.001), and a positive family history (p < 0.05) were significantly associated with full response for both Group 1&2. However, no significant association was found with BMI, IBSS, constipation or nocturnal enuresis.
As the second outcome, response to methylphenidate treatment were evaluated for both groups, no significant differences were observed in the percentage of full responders between the two groups at 1, 3, and 6 months. However, at the 12-month follow-up, the percentage of full responders in Group 2 was significantly higher compared to Group 1 (p < 0.01).
CONCLUSIONS
For treatment of GI, postpubertal age, female gender, and a positive family history were found to be associated with a complete treatment response both for anticholinergics and biofeedback.
In refractory GI cases where methylphenidate was added to the treatment, a history of biofeedback therapy was associated with long-term full treatment response.
10:03 - 10:06
S37-5 (OP)
Eliza SZWARCBERG, Chris KIMBER and Kiarash TAGHAVI
Monash Children's Hospital, Department of Paediatric Urology, Clayton, AUSTRALIA
PURPOSE
Giggle incontinence is a bladder storage disorder characterized by uncontrolled voiding during or immediately after laughter. The study aimed to determine the efficacy of intravesical Botox injections in the management of children with giggle incontinence.
MATERIAL AND METHODS
A retrospective review was performed of children who received intravesical botulinum toxin-A for giggle incontinence over a six-year period. All children experienced complete bladder emptying during/immediately after laughter, with or without the presence of related voiding disorders. Severity was classified as: mild (more than once monthly, less than twice per week), moderate (more than once per week, not daily), severe (at least daily). Outcomes were characterised as: “no response” (0-49% reduction in number of episodes), “partial response” (50-99% reduction), “complete response” (100% reduction).
RESULTS
The study analysed 17 children who underwent 34 injection procedures. Median age at first treatment was 11 years (range 6-17). Mean number of treatment cycles was 2.1 (range 1-5 injection procedures). Median time between treatment cycles was 14 months (IQR 7-24). Breakdown of treatment response according to severity and associated symptoms are presented below.
|
Pre-op Severity |
No response |
Partial response |
Complete response |
|
|
Moderate |
3 (23%) |
2 (15%) |
8 (62%) |
13 |
|
Severe |
0 |
1 (25%) |
3 (75%) |
4 |
|
|
3 (18%) |
3 (18%) |
11 (65%) |
17 |
Table 1: Treatment response according to severity of giggle incontinence prior to initial injection procedure
|
|
No response |
Partial response |
Complete response |
|
|
No related voiding disorder |
2 (50%) |
0 |
2 (50%) |
4 |
|
Presence of related voiding disorder |
1 (8%) |
3 (23%) |
9 (69%) |
13 |
|
|
3 (18%) |
3 (18%) |
11 (65%) |
17 |
Table 2: Treatment response according to presence of a related voiding disorder
CONCLUSIONS
The present study is the first case series to confirm intravesical Botox injection as an effective, well-tolerated management option for children with giggle incontinence.
10:15 - 10:18
S37-6 (OP)
Aslı ÖZTÜRK 1, Rabia AŞIK 1, Canan SEYHAN 1, Hasan Cem IRKILATA 2 and Murat DAYANÇ 1
1) Private Dayanc Pediatric Urology Center, Ankara, TÜRKIYE - 2) Lokman Hekim Istanbul Hospital, Urology, Istanbul, TÜRKIYE
PURPOSE
Lower urinary tract dysfunction(LUTD) is common in children.Pelvic floor muscle(PFM) function contributes to its pathophysiology. This study aimed to investigate the effectiveness of an individualized pelvic floor muscle rehabilitation(PFMR) program on symptoms,uroflowmetry parameters and pelvic floor muscle activity(PFMA) in children with LUTD.
MATERIAL AND METHODS
The study included 145 children(73 girls/72 boys, mean age 8,77) diagnosed with LUTD through non-invasive evaluations. Children were evaluated with the Dysfunctional Voiding and Incontinence Symptom Score(DVISS),uroflowmetry and PFMA measurement before and after treatment. All patients received an individualized PFMR program combined with standart urotherapy.
RESULTS
The average number of sessions was 11,81(range 3-27). Treatment started with twice-weekly sessions for 3 weeks, then weekly for 4 weeks, followed by monthly sessions until full recovery.Significant improvements were seen in PFM functions(relaxation, contraction, and functional contraction amplitudes)(p=0.0001)(Table). The average DVISS dropped from16,52 to 1,41(p=0,0001) and average postvoiding residual urine(PVR) decreased from 29,86 ml to 7,17 ml after treatment(p= 0.0001).
The average resting activity of the PFM before treatment was positively correlated with higher PVR(p=0,0001). Children with higher average functional contraction amplitude before treatment had lower PVR values both before and after treatment(p=0,030;p=0,031). Children with higher pre-treatment DVISS scores required more sessions(p=0.048).
|
Table:Comparison of parameters before and after treatment |
|
|
Before Treatment |
After Treatment |
p value |
|
PFM rest average(µV) |
3,09±1,73 |
1,17±0,68 |
0,0001 |
|
PFM work average(µV) |
5,32±2,62 |
9,46±3,55 |
0,0001 |
|
PFM functional contraction amplitude(µV) |
2,20±2,52 |
8,30±3,55 |
0,0001 |
|
Total DVISS score |
16,52±7,01 |
1,41±2,88 |
0,0001 |
|
PVR(ml) |
29,86±37,36 |
7,17±8,70 |
0,0001 |
CONCLUSIONS
Individualized PFMR is an effective method for improving symptoms, PFMA and reducing PVR in children with LUTD. Increased pelvic floor resting activity before treatment may contribute to higher PVR. PFM functions determined by PFMA measurement should guide rehabilitation program selection.
10:18 - 10:21
S37-7 (OP)
Hannah BACHTEL 1, Keridan MORGAN 2, Neil MAZZONE 2, Taylor SHARK 2, Yianni KANTZOS 2, Brittany SWIGER 1 and Justin BAKER 2
1) Akron Children's Hospital, Pediatric & Adolescent Urology, Akron, USA - 2) The University of Akron, Biomedical Engineering, Akron, USA
PURPOSE
Biofeedback is a successful treatment option for pediatric patients with urinary issues secondary to pelvic floor dysfunction. Ambulatory biofeedback sessions pose a hefty time commitment for patients and caregivers, especially for those who must repeatedly travel long distances for care. Unfortunately, this prohibits many patients from attempting biofeedback therapy. The goal was to develop an intuitive, portable, non-invasive pediatric biofeedback device with ability to communicate data in real-time to a web-based application for at-home use.
MATERIAL AND METHODS
An engineering and clinical team jointly produced a novel biofeedback device for pediatric patients by developing design specifications and system diagrams for the device. We identified eight user need components and eleven engineering design requirements. Considerations for portability, reliability, technical complexity, form factor, responsivity, cost, and clinical accuracy were prioritized.
RESULTS
A high-fidelity, fully functioning device prototype was developed that addressed our key design components. Verification of eleven engineering requirements was performed, as was validation of eight user needs, all of which passed. The final prototype design included a portable, simple, cost-efficient housing unit integrated with a responsive, kid-friendly user interface. The housing unit was printed with PLA resin and encompassed a microcontroller, signal processor, Bluetooth chip and battery. A downloadable, web-based, executable file was designed to consolidate EMG electrode data transmitted via Bluetooth into an interactive game for children.
CONCLUSIONS
We developed a novel pediatric biofeedback device consisting of a portable housing unit and web-based user-friendly interface. Our device has the potential to augment ambulatory biofeedback sessions as well as expand access to biofeedback therapy for children who may benefit. Future studies will assess patient usability and treatment efficacy of the device in both clinical and at-home settings.
10:21 - 10:24
S37-8 (OP)
Aslı ÖZTÜRK 1, Canan SEYHAN 1, Rabia AŞIK 1, Hasan Cem IRKILATA 2 and Murat DAYANÇ 1
1) Private Dayanc Pediatric Urology Center, Ankara, TÜRKIYE - 2) Lokman Hekim Istanbul Hospital, Urology, Istanbul, TÜRKIYE
PURPOSE
The absence of any action of pelvic floor muscle is called non-functional pelvic floor (NFPF). It can be detected by physical examination or electromyographic measurements of pelvic floor muscle activity (PFMA). We investigated the clinical characteristics of children with lower urinary tract dysfunction (LUTD) and NFPF.
MATERIAL AND METHODS
A total of 250 children (147 male/103 female,mean age 8,6) with LUTD were evaluated using non-invasive methods. When PFMA was measured, if the EMG value did not change when relaxation and contraction were asked, that is, the average contraction(work-avg) and relaxation(rest-avg) activities were equal and there was no pelvic floor muscle movement in the physical examination, NFPT was diagnosed. Patients were categorized by their voiding patterns. Patients were divided into two groups as those with average rest/work activity above and below 2 µV in PFMA measurement.
RESULTS
NFPF was detected in 79 patients(31,6%). The mean DVISS was 16,2 for patients with NFPF and 14,7 for those without NFPF(p=0,041). The frequency of NFPT was %52,5 in intermittent, %42,9 in staccato and %18,8 in continuous voiding pattern. Rest/work avg. was below 2 µV in 19 of these patients(24,1%) and above 2 µV in 60(75,9%). Pelvic floor muscle rehabilitation(PFMR) was planned starting with manuel approaches and relaxation exercises for patients with rest/work activity above 2 µV. Patients with rest/work activity below 2 µV were directly included in the program to gain functionality.
CONCLUSIONS
NFPF is common in children with LUTD. As the voiding pattern worsens,the frequency of NFPF increases. The majority of these patients need a rehabilitation program that begins with a focus on relaxation,while some need a rehabilitation program that directly focuses on gaining functionality.It should be diagnosed through pelvic floor muscle evaluation and treated with an individualized PFMR program based on the evaluation results. We recommend that these cases be defined as “Frozen Pelvic Floor”.
10:24 - 10:27
S37-9 (OP)
Adree KHONDKER, Lisa WANG, Mandy RICKARD, Mirriam MIKHAIL, Abby VARGHESE, Beverly MIRANDA, Michael CHUA, Rodrigo ROMAO, Joao PIPPI SALLE, Max FREEMAN, Armando LORENZO and Joana DOS SANTOS
The Hospital for Sick Children, Urology, Toronto, CANADA
PURPOSE
Urotherapy and constipation management are primary treatments for BBD, but 20-50% of children remain symptomatic despite treatment (refractory BBD [rBBD]). Herein, we aim to identify predictors of symptom improvement and evaluate supplementary strategies for managing rBBD.
MATERIAL AND METHODS
We reviewed children with rBBD from 2020 to 2024. Data on baseline characteristics, interventions (urotherapy, conservative adjuncts [pelvic floor physiotherapy and biofeedback], bowel and urological medications), and symptom improvement (≥50% reduction) were collected. Multivariable logistic regression analyzed the association between each treatment and symptom improvement, adjusting for age, sex, mental health comorbidities, and toilet-training age.
RESULTS
130 patients (61% female, median age 11 years were included, with a median follow-up of 5 months[MR3] . Most patients adhered to urotherapy (55%) or conservative adjuncts (56%). Symptom improvement was observed in 62 patients (48%). In adjusted analyses, both urotherapy (OR 2.4, 95% CI 1.2-5.1) and conservative adjuncts (OR 2.2, 95% CI 1.0-4.5) were associated with symptom improvement. Early toilet training (<2 years) was linked to an increased risk of refractory BBD (OR 1.25, 95% CI 0.53–2.90), though not statistically significant.
|
Variable (N = 130) |
Value (Median, IQR or N, %) |
|
Age at toilet training (months) |
36 (24, 36) |
|
Comorbid Mental Health (%) |
51 (39%) |
|
Symptom Improvement |
62 (48%) |
|
Treatment |
Adjusted Odds Ratio |
p-value |
|
Urotherapy (alone) |
2.4 (1.2, 5.1) |
0.02 |
|
Conservative Management Adjuncts (physiotherapy, biofeedback, home education, neurostimulation) |
2.2 (1.0, 4.5) |
0.04 |
|
Bowel Medications (PEG, Ex-Lax, Enema, Bisacoydl) |
1.0 (0.4, 2.2) |
0.93 |
|
Urological Medications (Solifenacin, Oxybutynin, Mirabegron, Tamsulosin) |
0.6 (0.2, 1.4) |
0.56 |
CONCLUSIONS
Adherence to urotherapy and timely use of conservative adjunctive therapies significantly improve outcomes in children with refractory BBD, emphasizing the importance of early, personalized treatment.