ESPU Meeting on Wednesday 3, September 2025, 16:15 - 17:10
16:15 - 16:18
S04-1 (OP)
Habib Ullah JOYA, Carlos Hernandez ROSALES, Amani N. ALANSARI and Sheyma Ahmed G AL-ROMAIHI
HAMAD MEDICAL CITY, Pediatric Surgery, Doha, QATAR
PURPOSE
Penile anthropometric measurements vary among children of different ethnicities. To date, there is no local data available on this subject. This study aims to assess the penile anthropometry of local healthy children.
MATERIAL AND METHODS
This prospective cross-sectional study, conducted over one year, included 210 healthy children aged 6 months to 12 years who underwent circumcision. Demographic data were recorded, and body mass index (BMI) was measured. Stretched penile length (SPL), Glans diameter at the coronal sulcus (GDCL), and mid-penile diameter (MPD) were documented. An age-specific nomogram for SPL, GDCL, and MPD was generated. Descriptive statistics were performed using SPSS version 27.
RESULTS
The overall mean values for BMI, SPL, GDCL, and MPD in children aged 6 to 12 months were 18.25 ± 2.5 kg/m², 3.75 ± 0.4 cm, 1.36 ± 0.1 cm, and 1.28 ± 0.1 cm, respectively. In contrast, for children aged 1 to 12 years, the mean values were 17.9 ± 2.9 kg/m², 5.53 ± 0.9 cm, 1.71 ± 0.2 cm, and 1.61 ± 0.21 cm, respectively. The SPL of children increased gradually from 3.75 ± 0.4 cm at ages 6 to 12 months to 5.53 ± 0.9 cm at ages 1 to 12 years, with the most rapid growth occurring during the 11th and 12th years. However, no correlation was found between height, weight, BMI, and SPL.
CONCLUSIONS
A penile anthropometric nomogram for children of our country has been developed. This data can serve as reference values for the assessment and management of disorders of sexual development and hypospadias.
16:18 - 16:21
S04-2 (OP)
Troy LA 1, Aidan BOYNE 1, Nicole WRIGHT 1, Geneva PANTOJA 1, Archer SCHAEFFER 1 and Niccolo PASSONI 2
1) Baylor College of Medicine, Urology, Houston, USA - 2) Texas Children's Hospital, Urology, Houston, USA
PURPOSE
Neonatal circumcision is a common yet controversial pediatric urological procedure in the United States, prompting debate about its benefits, risks, and ethical implications. Although the American Urological Association (AUA) and American Academy of Pediatrics (AAP) have published practice guidelines, medical students’ understanding of current circumcision evidence and their perspectives on its modern practice have not been studied. Thus, our aim was to elucidate these future providers’ viewpoints, which inherently are crucial in the shaping of future clinical practice.
MATERIAL AND METHODS
An IRB-approved survey was administered to medical students at a single institution. The survey assessed students' knowledge of benefits, risks, and guidelines; attitudes including personal, ethical, and cultural factors; and clinical training. This survey included Likert-scale, multiple-choice, and open-ended questions, was pilot-tested, and underwent revision based on feedback. Data was analyzed using descriptive statistics, chi-square testing, and logistic regression.
RESULTS
113 medical students participated in the survey: 20.4% MS1s, 28.3% MS2s, 25.7% MS3s, and 25.7% MS4s. At the time of survey, MS2s had completed the preclinical curriculum, while MS3/MS4s had completed the core clinical curriculum. Despite completing core rotations, 55.4% of MS3/MS4s reported being unaware of either AUA or AAP guidelines. Additionally, only 13% of MS1s, 25.8% of MS2s, and 53.6% of MS3/MS4s knew that universal routine neonatal circumcision was not indicated, with significantly higher rates of uncertainty exhibited by MS1s and MS2s (p<0.004, Figure 1). 80.5% of respondents felt the curriculum did not adequately cover neonatal circumcision, while 77.9% felt unprepared to counsel.
CONCLUSIONS
Widespread misunderstanding of neonatal circumcision among medical students highlights a critical gap in medical education, risking perpetuation of internal biases over evidence-based practice. Addressing these educational deficiencies through revision of curriculum is imperative to ensure future physicians provide informed, evidence-based care.
16:21 - 16:24
S04-3 (OP)
Mohammed ALFAWZAN 1, Parul Rai RAI 2, Mohamed SOLTAN 3, Guolian KANG, 4, Yunus OLUFADI 4, Clifford TAKEMOTO 5 and Marry KILLIAN 1
1) University of Tennessee Health Science Center / St. Jude children's research hospital, Pediatric Urology, Memphis, USA - 2) University of Tennessee Health Science Center / St. Jude children's research hospital, Pediatric Hematology, Memphis, USA - 3) University of Tennessee Health Science Center/ St. Jude children's research hospital, Pediatric Urology, Memphis, USA - 4) St. Jude Children's Research Hospital, Department of Biostatistics, Memphis, USA - 5) St. Jude Children's Research Hospital, Pediatric Hematology, Memphis, USA
PURPOSE
Priapism, a serious complication of sickle cell disease (SCD), is underreported, leading to variable prevalence estimates. This study aimed to determine prevalence of priapism in male children with SCD and to identify associated risk factors.
MATERIAL AND METHODS
This retrospective cohort study analyzed data from 461 male SCD patients (ages 2-18) within our institution Sickle Cell patient's database. Priapism cases were identified using ICD-9/10 codes and a language modeling algorithm. A 1:3 age-matched case-control analysis compared priapism patients to controls, assessing demographics, genotype, treatment history, hematologic parameters, associations with vaso-occlusive crises (VOC), acute chest syndromes (ACS), pulse oximetry (PO), and tricuspid regurgitation velocity (TRV). Statistical comparisons used two-sample t-tests/Wilcoxon rank sum tests for quantitative variables and Chi-square tests for categorical variables.
RESULTS
Of the 461 patients, 92 (20%) experienced at least one episode of priapism. Compared to controls, patients with priapism were significantly older (mean age 14.7 vs. 12.5 years, P=4×10-5), had elevated bilirubin levels (p=0.02) and more frequent VOC (p= 2×10-88) and ACS events (p=1×10-4). Furthermore, higher fetal hemoglobin level (p=0.04) and earlier initiation of hydroxyurea (p=0.003) appeared to protect from having priapism events. However, after matching for age, only higher number of total VOC and ACS events were the only variables that showed significant association with priapism (p=5×10-5 and p=0.0018).
CONCLUSIONS
This study reveals a significant prevalence of priapism in children with SCD, identifying older age, frequent VOCs, and ACSs as risk factors. Proactive monitoring is crucial, and further research on hydroxyurea's preventative role is warranted.
16:34 - 16:37
S04-4 (OP)
M S ANSARI, Dr Priyank YADAV and Dr Raj KUMAR
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Pediatric Urology, Department of Urology and renal transplantation, Lucknow, INDIA
PURPOSE
In present study, we have reviewed our surgical experience managing pediatric pelvic fracture urethral injuries (PFUI) via a transperineal approach, identifying preoperative and intraoperative predictors of pubectomy and reporting long-term outcomes. Gapometry index was used as preoperative predictive tool for the need of pubectomy.
MATERIAL AND METHODS
Gapometry index was calculated as bulbo-prostatic urethral gap divided by length of bulbar urethra (G/L). The patients were divided into two groups: Group I (simple perineal) and Group II (extended perineal with ancillary procedures). Group II was further divided as IIa: Inferior pubectomy only, IIb: Total pubectomy and IIc: perineo-abdominal transpubic approach including inferior/total pubectomy or perineo-abdominal transpubic approach). Success was defined as restoration of urethral continuity with urethral caliber equal or greater to 6 + age X 0.6 and normal voiding (Pdet Qmax >10 ml/sec, PVR < 20%).
RESULTS
85 patients with PFUI were treated at our institution. The median age at definitive surgery was 8.8 years. Mean distraction defect length was 2.1 cm (range 1.3 to 2.7) in Group I vs 3.5 cm (range 3.1 to 4.2) in Group II . The difference was highly statistically significant (p < 0.001). This correlated with the mean index of Gapometry Index which was 0.43 in Group I vs 0.70 in Group II. The difference was highly statistically significant (p < 0.001). However, the mean bulbar urethral length was not much different in both the groups i.e. 4.8 cm (range 4.3 to 5.5) and 5.0 (4.5-5.1) cms in Group I and II respectively. A positive correlation was observed between urethral gap length i.e. Gapometry Index.
CONCLUSIONS
Most pediatric posterior urethral injuries(PFUI) can be successfully managed through a perineal approach, reserving extended approach for more complex cases. Increased urethral gap length and Gapometry Index correlated with the need for more complex surgical approaches like pubectomy.
16:37 - 16:40
S04-5 (OP)
Sajid SULTAN 1, Philip G RANSLEY 1, Bashir AHMED 2, Sadaf ABA UMER KODWAVWALA 1 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
To compare the indications and voiding outcome of boys who underwent single stage End to End (SSEE) Bulboprostatic Uretheroplasty performed by Progressive Perineal Approach VS Combined Abdominoperineal Approach.
MATERIAL AND METHODS
Record are reviewed of 145 boys who underwent SSEE Bulboprostatic Uretheroplasty between 2005-2024 divided as Group I, VS APA Group II and compared for nature of trauma, H/O Failed Uretheroplasty. Findings of Antegrade and Retrograde cystouretherogram and scopy, operative findings, voiding outcome as urinary symptoms, VCUG, uroflowmetery, post urethroplasty surgical intervention and follow up period. Mean and SD is calculated for continuous variable Chi square test for categorical variables. P-value <0.05 will be considered as significant.
RESULTS
Of 145 patients 95(65.5 %) were Group-I(PA) as compared to 50(34.5%) Group-II(APA). Age in years, Group I(PA)10.02+/-2.38 VS Group-II(APA) 10.04+/-3.22. Nature of trauma group I RTA 59(62.1%), fall 22(23.1 %) crush injury 14(14.7%) whereas in group II RTA 43 (86 %), crush 6(12%) and fall 1(2 %). In Group-II 35(70%) were started as Abdominal approach first, of them 17 were with short posterior urethra and veru not completely visualized, 13 were Redo urethroplasty. However 15(30%) started as PA and converted to APA intraoperatively for too much fibrosis, unable to feel bougie from above 8(16%) and unable to perform anastomosis in high up bladder and posterior urethra in 7(14%).
Voiding outcome showed normal per urethral voiding in 88(92.6%) Q max 17.2+5.8 ml/sec in Group-I vs 47(94%) Q max 16.6+/-3.2 ml/sec in Group II(p=0.94). 12 patient(8.2%) were unable to void per urethra, and required cystoscopy and optical urethrotomy and mitrofinoff in 1 only 8 patient with incontinence required anticholinergics and bulking agent at bladder-neck. Mean-follow up period was 1250+/-1130 days.
CONCLUSIONS
Majority 65.5% of our patients could be managed by progressive perineal approach only. However others required Abdominoperineal approach. Therefore both expertise are essential. In both group majority >90% achieved normal voiding.
16:40 - 16:43
S04-6 (OP)
Luisa WEIL 1, Raimund STEIN 1, Marietta JANK 2 and Nina YOUNSI 1
1) University of Mannheim, Pediatric, adult and reconstructive urology, Mannheim, GERMANY - 2) University of Mannheim, Pediatric and adult surgery, Mannheim, GERMANY
PURPOSE
As pediatric urologists, we are encountering an increasing number of patients receiving vesico-amniotic shunts (VAS). Consequently, we are seeing more boys with an impassable, hypoplastic urethra. Herein, we report our management of these patients in a tertiary center.
MATERIAL AND METHODS
Between October 2015 and December 2024, we reviewed our congenital LUTO patients. Out of 120 patients (63 with VAS), 22 had a hypoplastic urethra, where we were unable to confirm a urethral valve via cystoscopy.
RESULTS
We included 22 male patients (median follow-up of 4.5 years, ranging from 1 month to 9 years) with prenatally suspected lower urinary tract obstruction who received a VAS between 12 and 21 weeks of gestation (median 14 weeks). Only those with a diagnosed hypoplastic or atretic urethra via VCUG or cystoscopy were included in the follow-up.
In 10 out of 22 cases, urethral reconstruction was performed using foreskin (plus buccal mucosa in one case). Seven patients are voiding through the reconstructed urethra, while three could not void due to a neurogenic bladder (VACTERL in two cases, unknown syndrome in one case). Seven patients still have their vesicostomy due to young age, three have a Mitrofanoff stoma, one is on a temporary suprapubic catheter awaiting urethral reconstruction, and one patient died.
CONCLUSIONS
Following VAS, we are increasingly seeing patients with a hypoplastic urethra. Urethral reconstruction has been successfully performed in those without neurogenic bladder dysfunction. However, the timing of urethral reconstruction and the correct indication remain challenging. Currently, there is no comparable data in the literature concerning urethral function after early VAS.
16:53 - 16:57
S04-7 (OP)
Ganesh VYTHILINGAM 1, Ruth MARTELL 2, Kevin BIRCHER 3, Elif VARDAR 2, Hans LARSSON 4, Eva ENGELHARDT 4, Yau CH'NG 5, Ilaria LUCCA 6, Nuno GRILO 6, Kalitha PINNAGODA 4, Edoardo MAZZA 3, Wei YEOH 7, Saiful MOHD ZAINUDDIN 8, Anand SANMUGAM 5, Teh XUAN 5, Yi FOONG 5, Muhd Khairul Akmal WAK HARTO 5, Hui Cheng CHEN 9, Rozanaliza RADZI 9, Mark HIEW 9, Nurul Hayah KHAIRUDDIN 9, Retnagowri RAJANDRAM 5, Selvalingam SOTHILINGAM 7, Thambidorai CONJEEVARAM RAJENDRARAO 5, Tunku Kamarul Zaman TUNKU ZAINOL ABIDIN 10, Pankaj JOSHI 11, Sanjay KULKARNI 11, Jeffrey HUBBELL 12, Teng ONG 7 and Peter FREY 2
1) Great Ormond Street Hospital, Paediatric Urology, London, UNITED KINGDOM - 2) Swiss Federal Institute of Technology Lausanne, Lausanne, Switzerland, Institute of Bioengineering, Lausanne, SWITZERLAND - 3) ETH Zurich, Institute of Mechanical Systems, Zurich, SWITZERLAND - 4) Regenosca S.A Lausanne, Laussane, SWITZERLAND - 5) Universiti Malaya, Surgery, Kuala Lumpur, MALAYSIA - 6) Lausanne University Hospital, Urology, Lausanne, SWITZERLAND - 7) Universiti Malaya, Urology, Kuala Lumpur, MALAYSIA - 8) Hospital Serdang, Urology, Kajang, MALAYSIA - 9) Universiti Putra Malaysia, Faculty of Veterinary Medicine, Selangor, MALAYSIA - 10) Universiti Malaya, Orthopaedics, Kuala Lumpur, MALAYSIA - 11) Urokul Hospital, Urology, Pune, INDIA - 12) University Chicago, Pritzker School of Molecular Engineering, Chicago, USA
PURPOSE
A bioengineered mesh for urethral and bladder reconstruction has not replaced current surgical practice of harvesting autologous tissue grafts. A multidisciplinary team has worked on realizing this objective and the patented TissueSpan technology mesh is the final prototype that has transitioned from research setting to a first in human study.
MATERIAL AND METHODS
Various bovine collagen mesh generations underwent in-vitro testing, mechanical analyses, and bench testing by surgeons over a period of 10 years.
| Urethral Reconstruction |
Rabbits |
Dogs |
First in Human |
| Engineering Refinement | N=69 | N=0 | N=0 |
| Final Prototype |
|
N=2 (1 month) |
N=5 (24 months) |
| Total | 78 | 6 | 5 |
| Bladder Reconstruction |
Rats |
Rabbits |
Mini Pigs |
| Engineering Refinement | N=8 | N=0 | N=0 |
| Final Prototype | - |
N=3 (3 month) |
N=2 (6 months) |
| Total | 8 | 7 | 2 |
Functional outcome was examined, and biopsies of repaired sites were subjected to histology and immunohistochemistry. Manufacturing compliant to regulatory standards for the clinical study were undertaken. All in-vivo experiments and first in man trial were approved by the relevant ethics committees.
RESULTS
Voiding post urethral reconstruction and increase in bladder capacity post augmentation was demonstrated. Spontaneous urothelial coverage and smooth muscle cell migration was seen. No immediate or delayed rejection was observed observed locally or systemically in all 5 patients. 2 patients have now completed 24 months and 3 patients are 16 months post-surgery.
CONCLUSIONS
The final engineered mesh still requires a large clinical trial to further confirm safety, performance, and patient benefit. Clinical translation takes time and requires a multidisciplinary collaboration.
16:57 - 17:02
S04-8 (VP)
Afonso BENTO, Rafael VILARES, Roberto IGLESIAS LOPES, Francisco TIBOR DÉNES and Bruno NICOLINO CEZARINO
Hospital das Clínicas FMUSP, Pediatric Urology, São Paulo, BRAZIL
PURPOSE
Penile agenesis is an exceptionally rare congenital anomaly, posing significant challenges in urological reconstruction and functional outcomes. The appendix, with its consistent vascular anatomy and motility, provides a promising option for complex urethral reconstructions (Chen et al., 2012; Koshima et al., 1999). Early studies highlighted its feasibility in urethral substitution, demonstrating its potential for addressing reconstructive needs (Büyükünal et al., 1995). Clinical applications have utilized pedicled or free appendix flaps for tailored reconstructions in cases of severe urethral and genital anomalies (Hiradfar et al., 2015; Aggarwal et al., 2002; Gupta et al., 2017). This case report describes the urethral reconstruction of a 10-year-old male with penile agenesis.
MATERIAL AND METHODS
The patient underwent early perineal urethrostomy and colostomy, followed by surgical interventions including neophalloplasty. Initial reconstruction involved scrotal flap-based neophalloplasty and Vantris injections to enhance neophallus volume.
RESULTS
A robotic-assisted harvest of a pedicled appendix graft was performed, meticulously preserving vascularity, and the graft was implanted in the neophallus position using advanced microsurgical techniques. The procedure was successful, and the patient awaits the next stage for an end-to-end anastomosis of the perineal urethrostomy with the proximal appendix ostium.
CONCLUSIONS
Penile agenesis remains a significant challenge in reconstructive urology. Considering patient’s desire to urinate standing, we present a minimally invasive technique where a neourethra was created using a free appendix flap. This approach integrates functional and cosmetic goals, offering a novel solution to this complex condition.