ESPU Meeting on Saturday 6, September 2025, 15:25 - 16:05
15:25 - 15:28
S40-1 (OP)
Than Soe KYAW 1, Debbie GOLDBERG 2, Lindsay HAMPSON 3 and Hillary COPP 3
1) University of California San Francisco, Medical Scientist Training Program, San Francisco, USA - 2) University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, USA - 3) University of California San Francisco, Department of Urology, San Francisco, USA
PURPOSE
Spina Bifida (SB) is a common congenital condition often requiring frequent antibiotic use, but cumulative antibiotic exposure in pediatric SB population remains underexplored.
MATERIAL AND METHODS
This retrospective cohort study utilized MarketScan insurance claims data (2013 - 2021) to compare cumulative antibiotic exposure in SB patients (ages 0-17) with age-matched controls. Cohort selection criteria included a diagnosis of SB in cases with 5:1 age-matched controls. Infections linked to antibiotic use were categorized by organ systems.
RESULTS
The cohort of 11,478 SB cases and 50,852 controls included 47% males in the SB group and 50% in controls. SB patients had 1.4 times higher antibiotic use than controls (mean: 8.1 vs. 6.0 prescriptions; p < 0.0001) and 1.6 times higher repeat courses within one week (2.8 vs. 1.8; p < 0.0001). Among prescriptions, 95 - 96% were tied to documented infections. SB patients were more likely to receive antibiotics for urinary system infections (32% vs. 8%; p < 0.0001), while controls more frequently received antibiotics for upper respiratory infections (64% vs. 55%, p < 0.0001) and otitis media (32% vs. 29%, p < 0.0001). Antibiotics for SB patients were more commonly prescribed in non-urgent ambulatory care settings (18% vs. 2%; p < 0.0001), whereas controls more frequently received antibiotics in urgent care settings (5% vs. 1%; p < 0.0001).
CONCLUSIONS
Pediatric SB patients experience significantly higher antibiotic exposure, primarily for urologic infections, and are at increased risk for repeat dosing. Future work will evaluate variabilities in antibiotic utilization and identify improvement strategies.
15:28 - 15:31
S40-2 (OP)
Nora BROADWELL, Catherine NGUYEN and Albert S LEE
Texas Children's Hospital, Pediatric Urology, Houston, USA
PURPOSE
To evaluate the incidence of symptomatic urinary tract infection (sUTI) and antibiotic usage in video urodynamics (VUDS) compared to voiding cystourethrogram (VCUG) alone.
MATERIAL AND METHODS
VCUG and VUDS studies between 1/2017 to 12/2022 in patients < 18 years of age were included. Urine culture (UCx) was obtained pre-procedure in all VCUG and VUDS studies. Demographic data, comorbidities, antibiotic usage, and UCx results were collected and analyzed. sUTI was defined as lower urinary tract symptoms with positiveUCx.
RESULTS
A total of 1709 patients were included. 245/1709 (14.4%) patients had VUDS. Of those, 111/245 (45.3%) had positive UCx compared to 317/1464 (21.7%) of the VCUG cohort (p<0.001). A higher percentage of VUDS patients 34/245 (13.9%) received post-imaging antibiotics compared to VCUG alone 144/1464 (9.8%) (p<0.001). sUTIs were less common in the VUDS cohort compared to VCUG alone 7/245 (2.9%) v 59/1464 (4.0%) (p<0.001). Rates of hospitalization and fever within 14 days was not significantly different between the two cohorts. On logistic regression, urinalysis parameters of white blood cell count (p<0.001), nitrites (p<0.001), leukocyte esterase (p=0.001), and concomitant urodynamics (p<0.001) were predictive of positive UCx but not sUTIs.
CONCLUSIONS
We found VUDS had a higher rate of asymptomatic bacturia and post-imaging antibiotic usage, however, it had a lower rate of sUTI compared to VCUG alone. Additionally, there was no difference in fever nor hospitalization rates. Overall low rate of sUTI in both groups and high post-imaging antibiotic usage suggest routine UCx is not necessary and can lead to overtreatment.
15:31 - 15:34
S40-3 (OP)
Brendan FRAINEY 1, Seth REASONER 2, Alexandra BORDEN 3, Megan STOUT 1, Mason GRAHAM 1, Cyrus ADAMS 1, Maryellen KELLY 3, Maria HADJIFRANGISKOU 2 and Douglass CLAYTON 1
1) Vanderbilt University Medical Center, Pediatric Urology, Nashville, USA - 2) Vanderbilt University Medical Center, Pathology, Microbiology, and Immunology, Nashville, USA - 3) Duke University Medical Center, Urology, Durham, USA
PURPOSE
Improving care for urinary tract infections (UTI) in spina bifida (SB) patients requires a better understanding of the resident microbiome. This study aims to characterize the composition and diversity of the urinary and intestinal microbiomes in patients with SB.
MATERIAL AND METHODS
Patients ages 0-30 with SB were enrolled prospectively between 10/2023 to 1/2025 from two SB clinics. Catheterized urine and stool samples were obtained. Expanded quantitative urine culture (EQUC) and 16S rRNA amplicon sequencing were performed on these specimens. Descriptive analyses of demographic, clinical and EQUC data were performed. Sequencing reads were bioinformatically decontaminated prior to analysis.
RESULTS
Ninety-nine subjects met inclusion with a mean age of 7.1 (range 0-27) years old. Fifty-one (50.5%) subjects were male and 91 (92%) had a diagnosis of myelomeningocele. Fifty-four (54.5%) participants performed clean intermittent catheterization and 23 (23%) had a culture-proven UTI within the past year. Of the 128 urine samples obtained, 104 (84.4%) had bacterial growth on EQUC. Bacterial DNA was detectable in 28/30 (97%) urine specimens and 28/28 (100%) stool samples on amplicon sequencing. Escherichia genera was present in 20/30 (67%) of urine specimens and was the dominant genera in 50% of samples. Subjects with a history of prior UTI had greater abundance of Escherichia in the stool than those without a history of UTI (p < 0.05). Subjects on CIC had greater abundance of Staphylococcus spp. in the urine relative to those not on CIC (p < 0.05).
CONCLUSIONS
Individuals with SB have high rates of bacteria present on both EQUC (84%) and amplicon sequencing (97%), but little diversity in their urobiome. Escherichia is abundant within the urine of individuals with SB and significantly more abundant in the stool of individuals with prior UTI.
15:44 - 15:47
S40-4 (OP)
Luca A MORGANTINI 1, Danielle HERRERA 1, Josephine HIRSCH 1, Theresa MEYER 1, Lynn Wei HUANG 2, Ilina ROSOKLIJA 1, Diana K BOWEN 1, Earl Y CHENG 1, Elizabeth B YERKES 1 and David I CHU 1
1) Lurie Children's Hospital of Chicago, Urology, Chicago, USA - 2) Northwestern University, Feinberg School of Medicine, Chicago, USA
PURPOSE
Spina bifida (SB) can cause neurogenic bladder dysfunction and renal deterioration. Guidelines recommend renal ultrasound (RUS) for surveillance, but its utility in predicting bladder hostility remains uncertain. We evaluated the diagnostic test characteristics of RUS findings for bladder hostility in youth with SB.
MATERIAL AND METHODS
We conducted a retrospective cohort study of patients with myelomeningocele followed at a pediatric SB clinic who had a RUS within three months of urodynamic studies (UDS). Equal-sized groups of urodynamic-RUS dyads were created by randomly selecting ~100 from each of four UDS risk categories. RUS parameters included hydronephrosis, thinned parenchyma, hypoplasia, and scarring. Bladder hostility was defined as end-fill pressures/detrusor leak point pressures 40cmH2O or greater. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy (AUC) of RUS parameters for bladder hostility were calculated with adjustment for patient clustering. Sensitivity/subgroup analyses were performed.
RESULTS
397 urodynamic-RUS dyads were included from 205 unique patients. Median age was 8.1 years; 70% had ventricular shunts. Any hydronephrosis demonstrated an overall sensitivity/specificity/PPV/NPV/AUC of 51/56/26/80/54%, respectively, and a sensitivity/specificity/AUC of 67/50/60% in non-ambulatory patients. In sensitivity analyses, high-grade hydronephrosis (SFU 3-4) had a sensitivity/specificity/AUC of 10/94/50%. The presence of any RUS abnormality yielded a sensitivity/specificity/AUC of 50/52/54%. In those with RUS-bladder volume >75% of UDS-bladder capacity, any hydronephrosis conferred a sensitivity/specificity/AUC of 83/47/63%.
CONCLUSIONS
RUS should not be used alone as a screening tool to identify bladder hostility in youth with SB due to limited sensitivity and diagnostic utility. UDS remains an essential tool for surveilling at-risk bladders.
15:47 - 15:51
S40-5 (OP)
Alexandra BAIN 1, Alexandra LINGEL 1, Shivam JOSHI 2, Janae PREECE 3, Sudipti GUPTA 4, Brian BECKNELL 5 and Christina CHING 1
1) Nationwide Children's Hospital, Pediatric Urology, Columbus, USA - 2) Nationwide Children's Hospital, Kidney and Urinary Tract Center, Columbus, USA - 3) Children's Hospital of Michigan, Pediatric Urology, Detroit, USA - 4) Nationwide Children's Hospital, The Kidney and Urinary Tract Center, Columbus, USA - 5) Nationwide Children's Hospital, Pediatric Nephrology, Columbus, USA
PURPOSE
Our objective was to evaluate if certain urine biomarkers could predict future urinary tract deterioration or infection progression in a neurogenic bladder population.
MATERIAL AND METHODS
In 2014, catheterized urine samples were obtained from patients with neurogenic bladders at the time of routine urodynamics or renal ultrasound. These samples were separated into colonized and sterile groups based on lack of symptoms and culture results. ELISAs were performed for BD-1, HIP/PAP, DEF5, LL37, NGAL, IL-6, and Upk3a. Patient demographics from 2015 – 2024 were collected and included progression of infection (incidence of urinary infections, complicated infections requiring hospitalization) and urinary tract deterioration (bladder medication changes, need for surgical intervention, worsening of urodynamics or upper tract imaging).
RESULTS
A total of 86 urine samples were collected and analyzed by ELISA —48 were colonized and 38 were sterile. There was a significantly higher rate of UTIs between the time of urine collection and last follow-up in the colonized group (67% vs 42%, p=0.014). In the sterile group, BD-1 was significantly elevated in patients who had infection progression (671.7 ng/mg vs 298.2 ng/mg, p=0.039) or urinary tract deterioration (397.2 ng/mg vs 139.9 ng/mg, p=0.004). In the colonized group, BD-1 was higher in patients with both infection and bladder progression compared to those without, but not significantly.
| Sterile Urine | AMP | Overall | No | Yes | P-value | Metrics |
|
Bladder progression |
BD-1 | 307.33 (123.07, 671.7) | 139.97 (37.17, 316.12) | 397.20 (303.39,1061.62) | 0.004 | Median (Q1, Q3) |
| Infection Progression | 307.33 (123.07, 671.7) | 298.20 (89.94, 397.20) | 671.70 (315.82, 1061.62) | 0.039 |
CONCLUSIONS
This is the first study to our knowledge that shows the potential power of a biomarker to predict infection and progression of bladder dysfunction in patients with a neurogenic bladder. Specifically, we found BD-1 could potentially be used as a prognostic marker of long-term urinary tract outcomes.
15:51 - 15:54
S40-6 (OP)
Lisa JANG 1, Stephanie COLLINS 2, Myron ALLUKIAN 2, Prasanna KAPAVARAPU 3, Carolyn FAZZINI 2, Kirsten WALASKI 3, Joy KERR 4, Keely MCCLATCHY 4 and Jason VAN BATAVIA 4
1) The Children's Hospital of Philadelphia, General Surgery - NEBULA Program, Philadelphia, USA - 2) The Children's Hospital of Philadelphia, General Surgery, Philadelphia, USA - 3) The Children's Hospital of Philadelphia, Gastroenterology, Philadelphia, USA - 4) The Children's Hospital of Philadelphia, Urology, Philadelphia, USA
PURPOSE
Successful management of bladder and bowel dysfunction (BBD) in children with congenital/neurological disorders is critical for quality of life. In most institutions, BBD management is fragmented, requiring separate visits involving colorectal surgeons, urologists, and GI/motility. Siloed care leads to multiple appointments and lacks coordination amongst teams, leaving families unsure of who to contact with issues. We hypothesized that creation of a trans-disciplinary clinic for children with BBD would lead to fewer office visits (OV) and ED visits per year.
MATERIAL AND METHODS
A monthly trans-disciplinary clinic Neuromodulation, Bowel, and Urology Alliance (NEBULA) was started with funding from our hospital. NEBULA consisted of attending physicians (colorectal surgeon, urologist, gastroenterologist), nurse practitioners and a nurse coordinator.
We reviewed data from all NEBULA patients seen within the first year of the program. We recorded OVs, ED visits, patient/family phone calls and messages in the year prior to establishing care with the NEBULA program and the year following. Pre-NEBULA and post-NEBULA values were analyzed using Wilcoxon signed-rank test.
RESULTS
Thirty patients were seen in NEBULA. The median number of OVs per year prior to NEBULA was 3 and decreased significantly to 1.7 while in the NEBULA program (p<0.001). The mean number of ED visits pre-NEBULA was 1 which significantly decreased to 0.4 (p=0.03). The median of calls/messages was 7.5 per year pre-NEBULA and this significantly increased to 31 (p<0.001).
CONCLUSIONS
With a dedicated team, coordinated care and resources, the number of patient visits can be decreased. With proper triaging and communication, the frequency of yearly ED visits was decreased.