ESPU Meeting on Saturday 6, September 2025, 16:05 - 16:50
16:05 - 16:08
S41-1 (OP)
Mohammed ELIFRANJI 1, Sinead CORNYN 1, Miriam DOYLE 1, Tafadzwa MANDIWANZA 2 and Salvatore CASCIO 3
1) CHI at Temple Street, Paediatric Urology, Dublin, IRELAND - 2) CHI at Temple Street, Paediatric Neurosurgery, Dublin, IRELAND - 3) SCHOOL OF MEDICINE UNIVERSITY COLLEGE DUBLIN AND CHILDREN'S HEALTH IRELAND AT TEMPLE STRETT, PAEDIATRIC SURGERY AND UROLOGY, Dublin, IRELAND
PURPOSE
Closed spinal dysraphism (CSD) refers to a heterogeneous group of skin-covered congenital spinal anomalies caused by incomplete closure of the neural tube and anomalous development of the caudal cell mass during embryogenesis. The aim of this study was to analyse the relationship between CSD and urological anomalies. Secondary outcomes included assessment of urinary continence and uroflow patterns in this cohort.
MATERIAL AND METHODS
A retrospective review was performed of our database of children attending the National CSD Clinic over a 4-and-a-half-year period (since its inception in June 2020, to January 2025). All baseline urinary tract ultrasounds (USS) and uroflows were reviewed by three paediatric surgeons. Continence and Uroflow patterns were assessed according to the International Children’s Continence Society Standardization document.
RESULTS
209 patients attended the CSD Clinic. 16 were excluded (did not meet criteria for CSD). 116(60%) were female. Mean age was 8.6 years. Baseline USS was reviewed in 185(96%). Urological anomalies were detected in 29(15.6%). The most common abnormal USS finding was renal pelvis dilatation in 15(8.1%), followed by ureteric dilatation in 2(1%), horseshoe kidney in 3(1.6%), and crossed fused ectopia in 2(1%). 62(32%) patients had urinary incontinence, with 60(31%) requiring CIC, 40(20.7%) anticholinergic medications and 30(15.5%) rectal washouts. Uroflow was performed in 55% of patients, and was abnormal in 51% of these, with a plateau-shaped curve being the most common abnormality.
CONCLUSIONS
Urological anomalies were identified in 15.6% of children with CSD. 32% of children with CSD are incontinent and require active urological management. Uroflow can be used as a screening test to identify those children with CSD who may require urological management.
16:08 - 16:11
S41-2 (OP)
David CHU 1, Josephine HIRSCH 1, Lynn HUANG 2, Theresa MEYER 1, Danielle HERRERA 1, Cameron ARKIN 3, Ilina ROSOKLIJA 1, Kavita HODGKINS 1, Susan FURTH 4, Diana BOWEN 1, Tamara ISAKOVA 5, Elizabeth YERKES 1 and Earl CHENG 1
1) Ann & Robert H. Lurie Children's Hospital of Chicago, Urology, Chicago, USA - 2) Northwestern University Feinberg School of Medicine, Center for Health Services and Outcomes Research, Chicago, USA - 3) University of Utah, Surgery, Salt Lake City, USA - 4) Children's Hospital of Philadelphia, Pediatrics (Nephrology), Philadelphia, USA - 5) Northwestern University Feinberg School of Medicine, Nephrology, Chicago, USA
PURPOSE
People with myelomeningocele are at high risk for developing chronic kidney disease (CKD). However, current estimated glomerular filtration rate (eGFR) equations are potentially inaccurate in this patient population. We obtained gold-standard measured glomerular filtration rate (mGFR) to identify the best-performing eGFR equations.
MATERIAL AND METHODS
A prospective cohort study was performed from 1/2019 until 12/2024 at a single pediatric center. Participants aged 6 years or older with myelomeningocele completed initial serum laboratory assessment then an iohexol plasma clearance test to calculate eGFR and mGFR, respectively. The performance of fifteen current eGFR equations was compared against mGFR using bias (eGFR-mGFR), accuracy (P30 and P10 reflecting proportions of eGFR within 30 and 10% of mGFR, respectively), correct CKD stage classification, and Bland-Altman plots.
RESULTS
A total of 98 iohexol plasma clearance tests were completed in 77 unique participants. Median age was 15.2 years (range 6.2-32.7), 64% of participants were female, 78% had ventricular shunts, 25% were non-ambulatory, and 23% had a prior bladder augmentation surgery. Median mGFR was 94.3 mL/min/1.73m^2 (IQR 84.5-110.0) with 37% of the cohort having mGFR<90 mL/min/1.73m^2. Of the fifteen eGFR equations, the CKiD U25 cystatin-C equation conferred the lowest bias, highest P30 and P10, highest correct CKD stage classification, and visually best Bland-Altman plots in the overall cohort and in subgroups stratified by mGFR=90 mL/min/1.73m^2.
CONCLUSIONS
In our prospective study with gold-standard mGFR testing, the CKiD U25 cystatin-C equation had the best performance and should be used to assess kidney function in people with myelomeningocele.
16:11 - 16:14
S41-3 (OP)
Amr HODHOD, Abdullah ALSUFIANI, Abdullah ALAGEEL, Wael MONEIR, Abdulwahab ALHAMS, Yasser JAMALALIAL, Fayez ALMODHEN, Tariq BURKI and Ahmed ALSHAMMARI
King Abdullah Specialized Children's Hospital, Pediatric Urology, Riyadh, SAUDI ARABIA
PURPOSE
We evaluated the impact of hydronephrosis (HN) at presentation on the prognosis of renal function and the occurrence of related urinary problems.
MATERIAL AND METHODS
We retrospectively reviewed spina bifida patients’ charts from 2008-2024, who completed at least 10 years of follow-up. Patients’ demographics in addition to ultrasound, voiding cystourethrogram, urodynamic studies, kidney function workup and urodynamic data, were collected. Data was collected at the first and last follow-up. Furthermore, we collected prescribed medications, the incidence of UTI and required surgical intervention. The estimated glomerular filtrations rate (eGFR) was calculated using this formula: GFR= 175×Serum Cr-1.154× age-0.203×1.212 (if patient is black) × 0.742 (if female). Thereafter, eGFR was furtherly categorized.
RESULTS
A total of 115 patients were included in this study (64 had no hydronephrosis at presentation, while 51 patients with HN). Of those with HN, 23 (45%) had unilateral low-grade HN (Grade 1 and 2), 6 (11.8%) had unilateral High-grade HN(grade 3 and 4), 13 (25.5%) had bilateral low-grade-HN, 6 (11.8%) had bilateral high-grade HN while the remaining had bilateral High-grade and Low-grade HN. Those presented with HN had significantly higher high-grade VUR (16 patients) compared to 6 patients in the Non-HN group (p<0.005). Moreover, the occurrence of recurrent UTI was significantly associated with HN (4(6.3%) and 13 (25.5%) respectively, p=0.004). No significant difference between both groups in terms of UDS findings, need for surgical intervention and incidence of renal impairment (Table).
| Parameter |
No-Hydronephrosis n(%) |
Hydronephrosis n(%) |
P |
| UDS_Small_Bladder | 34(53.1) | 23(45.1) | 0.39 |
| Detruroser_Overactivity | 14(21.9) | 17(33.3) | 0.16 |
| Hostile_bladder(DLPP>40cmH2O) | 25(39) | 18(35.2) | 0.68 |
| Poor_compliance | 30(46.9) | 21(41.2) | 0.54 |
| Surgical_intervention | 11(17.2) | 8(15.7) | 0.83 |
| eGFR_(G3a-G5) | 2 (3.2) | 2 (3.8) | 0.81 |
CONCLUSIONS
Patients who had HN at presentation had a higher incidence of high-grade VUR and an elevated risk of recurrent UTI. However, no difference was observed regrading UDS findings or renal impairment risk.
16:26 - 16:29
S41-4 (OP)
Sugandha AGARWAL 1, Delona Treeza JOSEPH 1, Manisha JANA 2, Jitendra Kumar MEENA 3, Ajay VERMA 1, Anjan Kumar DHUA 1, Devendra Kumar YADAV 1, Himalaya KUMAR 1 and Sachit ANAND 1
1) All India institute of Medical Sciences, Department of Paediatric Surgery, Delhi, INDIA - 2) All India Institute of Medical Sciences, Department of Radiodiagnosis and Interventional Radiology, Delhi, INDIA - 3) All India Institute of Medical Sciences, Department of Pediatrics, Delhi, INDIA
PURPOSE
Bladder pathologies including neurogenic bladder (NB) can cause alterations in the tissue elasticity. We aim to evaluate the utility of shear wave elastography (SWE) in children with NB. Also, we intend to evaluate whether SWE measurements correlate with current standard investigations
MATERIAL AND METHODS
This single centre prospective cohort study included patients with NB and healthy controls. During bladder SWE, the Young’s modulus of elasticity (YME) was measured along the anterior wall at full-bladder and post-void states. Median SWE measurements were compared between patients and controls. Also, the median SWE values (at both states) were correlated with different upper and lower urinary tract variables from routine baseline investigations including ultrasound, scintigraphy studies, micturating cystourethrogram and urodynamic study
RESULTS
A total of 42 healthy controls and 44 patients were enrolled in the study. At full-bladder state, the median YME was significantly different between patients vs. controls (9.95 vs. 7.5 kPa; p=0.0006). Similarly, the median YME at post-void state was significantly higher in patients vs. controls (9.3 vs. 6.8 kPa; p=0.023). However, no significant correlation could be established between YME (full-bladder or post-void state) and variables including hydroureteronephrosis, vesicoureteral reflux, kidney scarring, low GFR, bladder capacity, bladder pressure, compliance, uninhibited detrusor contractions
CONCLUSIONS
Children with NB have significantly higher values of YME compared to controls. Therefore, SWE can be a useful screening tool for identifying NB among children with lower urinary tract symptoms. However, the lack of significant correlations between YME and upper or lower-urinary tract variables suggest that SWE cannot replace the current diagnostic and prognostic tools
16:29 - 16:32
S41-5 (OP)
Antonio MACEDO JR, Taiane ROCHA CAMPELO, Sergio LEITE OTTONI, Rafael JORDAN BALLADARES, Debora Laena BARROSO SACOMAN, Jose Renato AZEVEDO ARAUJO, Emanuelle LIMA MACEDO, Ricardo MARCONDES DE MATTOS, Gilmar DE OLIVEIRA GARRONE and Marcela LEAL DA CRUZ
CACAU NUPEP, Department of Urology, São Paulo, BRAZIL
PURPOSE
Lower urinary tract reconstruction represents end-stage bladder function. We assessed a prospective cohort of in-utero operated myelomeningocele patients starting in 2011 to create a Kaplan-Meyer survival curve for non touched bladder versus operated bladder in a timeline according follow up.
MATERIAL AND METHODS
The assessed following parameters: MMC in-utero repair, urodynamic pattern (normal, hypocontractile, incontinent and high risk), initial and final treatment and age at surgical indication. The probability of surgery (event/record) was calculated using the Kaplan-Meier survival curve. The surgical procedure was considered a “census”. A “censored case” was considered one in which the surgical approach did not occur.
RESULTS
We found 103 patients with the first evaluation occurring below 12 months of age. Mean age at first evaluation was 3 months and mean follow-up was 39 months. Initial clinical evaluation showed hydronephrosis (n=20 : 19,4%), vesicoureteral reflux (n=18 : 17,5%). Bladder pattern according to the Leal da Cruz classification was: high-risk in 51 (49,5%), incontinent in 23 (22,3%), hypocontractile in 8 (7,8%) and normal in 21 (20,4%). Surgery was performed in 13 patients. The Kaplan-Meyer bladder survival curve showed the average time to be treated by surgery was 42,8 months.
CONCLUSIONS
Despite treatment, we found a high incidence of patients with a high risk pattern (39.8%), an incidence of 12.6% surgery at 42.8 months. After 80 months of follow-up we observed a drop in the survival of untouched bladder to less than 50% at 100 months of follow-up
16:32 - 16:35
S41-6 (OP)
Salvatore CASCIO 1, Gabrielle KELLY 2, Costanza CASCIO 3, Miriam DOYLE 4, Ilona ALOVA 5, Nathalie BOTTO 5, Marcello DELLA CORTE 5 and Henri LOTTMANN 5
1) SCHOOL OF MEDICINE UNIVERSITY COLLEGE DUBLIN AND CHILDREN'S HEALTH IRELAND AT TEMPLE STRETT, DEPARTMENT OF PAEDIATRIC SURGERY AND UROLOGY, Dublin, IRELAND - 2) UNIVERSITY COLLEGE DUBLIN, SCHOOL OF MATHEMATICS AND STATISTICS, Dublin, IRELAND - 3) SCHOOL OF MEDICINE UNIVERSITY OF DUNDEE, Dundee, UNITED KINGDOM - 4) CHILDREN'S HEALTH IRELAND AT TEMPLE STREET, DEPARTMENT OF PAEDIATRIC SURGERY AND UROLOGY, Dublin, IRELAND - 5) NECKER UNIVERSITY HOSPITAL FOR SICK CHILDREN, DIVISION OF PAEDIATRIC SURGERY AND UROLOGY, Paris, FRANCE
PURPOSE
A recent systematic review has demonstrated that detrusorectomy enhances bladder compliance in pediatric neurogenic bladders. The primary aim of this study was to review the long-term results of the procedure. Secondary aims were to compare the pre and post-operative video-urodynamics (VUDs), renal function and use of anticholinergics.
MATERIAL AND METHODS
Between 10/2004-3/2024, 51 patients, age at surgery 9.6 y (mean), underwent either detrusorectomy (15) or detrusorotomies (36) in two tertiary pediatric urology departments. There were 34 females. All patients had neurogenic bladders, 28(55%) due to myelomeningocele. The procedures were performed by either a sagittal myotomy (29) or sagittal + coronal (22) with an open technique (45) or robotic (6).
RESULTS
Pre and post operative VUD were available in 48 patients. Compliance – (ΔV/ΔP 80% at 80% of bladder filling) and bladder capacity were pre-operatively 10 ml/cm H2O and 190 mls respectively, post-operatively 15.8 ml/cm and 346 mls. Detrusorectomy failed in 12(24%) patients requiring ileocystoplasty and one patient had bladder perforation on two occasions. 46(90%) of the patients were on anticholinergic pre and 41(80%) post-operatively Most common complications included intra-op mucosal perforation 24(47%), post-op bladder perforation (2), haematoma (2), stones (1), vesicovaginal fistula (1), bleeding (1). Creatinine was normal in 47 patients.
CONCLUSIONS
Detrusorotomy improves bladder compliance and capacity in neurogenic bladders. Intraoperative mucosal perforation occurs in 47% of patients. Other complications may occur in 14% of the patients. A quarter of the patients will require bladder augmentation while 80% of the patients still need anticholinergic medication in the long term.