Parallel Meeting on Wednesday 3, September 2025, 15:30 - 16:10
15:30 - 15:34
S05-1 (CP)
Jovelino Quintino De Souza LEAO 1, Fernanda Ghilardi LEAO 1, Priscila Cardoso Braz ASCAR 1, Giselle Machado Campos OLIVEIRA 1, Luciano Silveira ONOFRE 1 and Marc-David LECLAIR 2
1) Hospital Infantil Darcy Vargas, Pediatric Urology, São Paulo, BRAZIL - 2) CHU NANTES, Pediatric Urology, Nantes, FRANCE
PURPOSE
Penile anatomy in cloacal exstrophy could be severely compromised. In hypoplastic penis, including intravesical phallus, some atypical surgical procedures become necessary. The aim of this study is to describe three cloacal exstrophy patients treated by penile surgical reconstruction using parascrotal flaps for neophaloplasty and Kelly's procedure. Long and short-term follow-up were compared.
MATERIAL AND METHODS
Case #1
Sixtenn-year-old boy with severely compromised penis undergone neophaloplasty, using parascrotal flaps (Bianchi), at age of 7 years. By 14 years, he was submitted to Kelly's procedure to mobilize two hypoplastic hemiphallus, put them inside of cutaneous neophalus. Penis development and appearance are satisfactory; buccal mucosal graft was used to resurface the glans. He has regular erections, and is under psychological support.
Case #2
Ten-year-old boy with intravesical phallus undergone Kelly's procedure by two years, mobilizing ectopic phallus displaced on caudal bladder plate. Phallic repositioning on abdominal surface, penile coverage was done using parascrotal flaps (Bianchi). With hormonal stimulation, penile development and appearance are satisfactory, he is on psychological support.
Case #3
Two-year-old boy with intravesical phallus undergone Kelly's procedure by one and half years. Phallic repositioning achieved on abdominal surface, penile coverage using skin flaps from neophalus constructed on neonatal closure, with redundant abdominal skin. His family is satisfied with penile appearance.
RESULTS
Parascrotal flaps combined with radical soft tissue mobilization are unique to achieve reasonable cosmetic and functional penile results. All patients had phallic appearance improved. Outcomes on short-term and long-term are maintainable. Two adolescents are very satisfied with their penile appearance.
CONCLUSIONS
Neophaloplasty in cloacal exstrophy patients represents a significant surgical challeng. Short-term and long-term outcomes have successfully improved. A multidisciplinary approach with physical, psychological, and social aspects of care is essential for outcomes and the quality of life for these individuals.
15:34 - 15:38
S05-2 (CP)
Edison Daniel SCHNEIDER-MONTEIRO, Marcio Dias GUILHERME FILHO, Lucas Henrique CAVALHEIRO SANCHES, João Vitor LUGUI CARVALHO, Andre Meirelles DOS SANTOS and Tiago Moura RODRIGUES
PUC CAMPINAS, UROLOGY, Campinas, BRAZIL
INTRODUTION
Traumatic penile amputation is a rare surgical emergency and, therefore, poses a challenge for surgeons due to the limited number of cases, the delicate surgical technique required, and the lack of a standardized postoperative care protocol.
PATIENT
A 9-year-old patient was treated at our tertiary care center following a genital trauma caused by a sharp object. The accident occurred at home when the patient fell and came into direct contact with shattered toilet fragments. Initial care was provided at an external facility, where clinical stabilization and bleeding control were performed. A severe injury was identified, with an incomplete amputation at the base of the penis, maintaining only a small cutaneous tissue attachment. Microsurgical penile reimplantation was performed eight hours after the accident.
Postoperatively, the patient underwent daily hyperbaric oxygen therapy. Intravenous alprostadil, oral acetylsalicylic acid, tadalafil, and topical vitamin E were administered as part of the treatment.
RESULTS
Postoperative care was provided over 17 days of hospitalization. After 27 days, a postectomy was performed to remove edematous fibrotic tissue, ensuring an adequate esthetic outcome. The patient’s clinical evolution has been satisfactory thus far, with proper urinary function and satisfactory nocturnal erections.
CONCLUSIONS
Several studies have suggested a six-hour window following amputation as the golden period for achieving a favorable surgical outcome. However, procedures performed beyond 24 hours post-injury have also demonstrated success. Therefore, all efforts should be directed toward the management of this condition, including the appropriate preservation of the amputated organ until reimplantation, the meticulous execution of the microsurgical procedure, and comprehensive postoperative care for the reimplanted organ.
15:38 - 15:42
S05-3 (CP)
M. Firat OZERVARLI 1, Ismail SELVI 1, M. Irfan DONMEZ 1, Nezihe Seden KUCUCUK 2, Tayfun OKTAR 1 and Orhan ZIYLAN 1
1) Istanbul University Istanbul Faculty of Medicine, Department of Urology, Fatih/İstanbul, TÜRKIYE - 2) Istanbul University Istanbul Faculty of Medicine, Department of Radiation Oncology, Fatih/İstanbul, TÜRKIYE
PURPOSE
Keloid formation along the incision line is a very rare complication of circumcision. Various treatments, including surgery, radiation, topical corticosteroids, and intralesional triamcinolone injections, have been used, but no standardized protocol exists. Half of the cases may recur within 6-12 months. On the other hand, brachytherapy has gained popularity in recent years as an adjunctive treatment due to its high recurrence-free survival rates in keloid scars.
This case report discusses the novel use of brachytherapy+hyperbaric oxygen therapy in conjunction with surgery for a child with a recurrent circumcision line keloid.
MATERIAL AND METHODS
An 11-year-old male with no co-morbidities presented with recurrent keloid formation along his circumcision incision line. He had undergone circumcision at age 2 and developed a keloid two months later. Despite two surgical keloid excisions at ages 6 and 8, recurrence occurred within 3 months after both surgeries. His examination revealed a large circular keloid extending from the coronal sulcus to the penile shaft. No other urological abnormalities were found.
RESULTS
During excision, six brachytherapy tubes were placed—three on each side of the corpus cavernosum. Brachytherapy started within 24 hours, delivering 2.5 Gy over two days in four fractions. The patient also received 20 days of hyperbaric oxygen therapy of which each session lasted 120 minutes (with 5-minute breaks every 20 minutes) at a pressure of 2.4 ATA (1 ATA = 760 mmHg).
At the 8-month follow-up, there was no recurrence, and the incision line appeared natural.
CONCLUSIONS
Keloid formation along the circumcision incision line is rare and has a high recurrence rate despite various treatments. In this case, a combination of brachytherapy, hyperbaric oxygen and surgical excision led to complete regression, with no recurrence at 8 months.
15:42 - 15:46
S05-4 (CP)
Ionica STOICA 1, Simon FILSON 2, Pankaj MISHRA 1 and Arash TAGHIZADEH 1
1) Evelina Children's Hospital, Paediatric Urology, London, UNITED KINGDOM - 2) Evelina Children's Hospital, Paediatric Plastic Surgery, London, UNITED KINGDOM
PURPOSE
Congenital prepubic sinus (CPS) is a rare anomaly with a midline opening in the prepubic area or dorsum of the penis. The embryological origins are unclear, with some suggesting it may be a form of urethral duplication, while others proposing a localized aberration of midline fusion. We reviewed our experience and the literature to identify the more plausible origin theory.
MATERIAL AND METHODS
We conducted a retrospective case note review, including clinical, radiological, surgical and histological findings. Additionally, we performed an extensive literature review to identify all published cases.
RESULTS
Between 2012 and 2024, three cases (all males) were identified, aged 10-14 years, presenting with intermittent sinus discharge. Examination, radiology and cystoscopy found no communication with the urinary tract, including the urethra. In one patient, MRI revealed an intraabdominal component. Sinus excision was performed in all cases. In one patient the pelvic/intraabdominal element extending to the umbilicus was also excised. We observed that the sinus trajectory was very close and densely adherent to the pubis in all cases. Failure to excise the entire tract has resulted in a persistent, yet asymptomatic, cyst.
Histology demonstrated the presence of squamous and transitional epithelium confirming a relationship to the urinary tract.
Since the first CPS report in 1987, 81 cases (almost equal gender distribution) have been reported, with presentation age ranging from 2 days to 22 years. The majority presented with prepubic sinuses and intermittent discharge. Only 6% had a connection to the urinary tract and 4% had other genital anomalies.
CONCLUSIONS
The absence of communication between the CPS and the urinary tract in our cases, as well in 94% of cases reported in the literature, combined with extension to the umbilicus, suggests CPS is a distinct entity, more consistent with an aberration of midline fusion than urethral duplication. We concur that the intraabdominal component requires resection.
15:46 - 15:50
S05-5 (CP)
Hilmican ULMAN 1, Hatice DONBALOGLU 2, Sumeyye SOZDUYAR 1, Sibel TIRYAKI 1, Ali TEKIN 1 and Ibrahim ULMAN 1
1) Ege University, Department of Pediatric Surgery - Division of Pediatric Urology, İzmir, TÜRKIYE - 2) Ege University, Department of Pediatric Surgery, İzmir, TÜRKIYE
INTRODUCTION
Acute Lymphoblastic Leukemia (B-ALL) is a common pediatric malignancy treated with intensive chemotherapy. Complications such as hemorrhagic cystitis and urinary retention due to clots can arise, particularly in patients with risk factors like BK-virus infection. Treatment options for clot removal include trans-urethral or suprapubic bladder irrigation and, if unsuccessful, endoscopic management under general anesthesia with a resectoscope. This report describes a non-operative approach to managing intravesical clots in a pediatric patient.
CASE
A 15-year-old boy with pancytopenia, undergoing chemotherapy for B-ALL was consulted for gross hematuria and urinary retention. Ultrasound revealed a large intravesical clot obstructing the urinary outlet. Initial management with catheter placement and saline irrigation failed the next day, due to clot blocking the catheter. Repeated catheter changes and irrigation attempts were also ineffective.
TECHNIQUE
As a final intervention, after platelet transfusion, 10mg of alteplase was instilled into the bladder through an 18Fr. 3-way Foley catheter and retained for 15 minutes with the catheter clamped. Subsequent saline irrigation disintegrated the clot and removal of the catheter enabled spontaneous voiding of debris.
Post-intervention ultrasound showed a mass reduction in clot burden, with only minimal residue. Despite ongoing hematuria for a few days, the patient gradually recovered without further urinary retention or massive bleeding. His urine sample tested positive for BK-virus, likely causing hemorrhage.
CONCLUSION
Intravesical alteplase, a fibrinolytic agent, was effective in dissolving persistent clots unresponsive to standard measures in a child with B-ALL. This strategy may decrease the need for cystoscopy and invasive clot removal, procedures that could exacerbate bleeding in thrombocytopenic patients.
15:50 - 15:54
S05-6 (CP)
Josefin NORDENSTRÖM
Queen Silvia Children's Hospital, Paediatric Urology, Göteborg, SWEDEN
PURPOSE
To present a case of a young girl with severe painful bladder disorder and a TP63 mutation.
MATERIAL AND METHODS
Girl born in November 2020 with polydactyly/syndactyly and cleft lip. From 2 months of age increasing stomach pain, disturbed sleep. At 1 year, more clearly related to micturition. Due to painful bladder filling, cystometry was performed in anaesthesia in April 2022 which showed reduced BC and normal raise in pressure, but signs of pain already at 60 mL. Cystoscopy showed severe interstitial cystitis and a vesicostomy button was placed. Between 2-3 years of age: daily bladder irrigations due to recurrent cystitis, Oxybutynin instillations twice daily for 6 weeks with no actual improvement, regularly bladder instillation with condroitin sulphate (Gepan®) (1-2x/week) with temporary pain releif, Coeliaci diagnosis. Due to hereditary (aunt and grandmother with chronic cystitis) a genetic analysis was performed wich showed a mutation in TP63 (Ectrodactyly, ectodermal dysplasia, and cleft lip/palate syndrome-3 - EEC3 syndrome), associated with split hand/foot, cleft lip/palate and micturition difficulties. Father has the same mutation. An attemption with Botox injection was also performed with a temporary pain releif, but still a desparate, unsustainable situation with daily severe pain. Therefore, in April 2024 we disconected the bladder from the urinary system by performing bilateral cutaneous ureterostomies.
RESULTS
After surgery the patient is completely painfree. She is growing and thriving. We have performed cystoscopy with bladder irrigation every 2nd months and dilated one ureterostomy that became stenotic.
CONCLUSIONS
EEC3 syndrome has a varable clinical manifestation and micturition difficulties have been described in the litterature. Although our patient was presenting with severe symtoms at an earlier age than previously acknowledged. We have shown that bypassing the bladder can acheive complete pain releif in these rare cases with severe pain and interstitial cystitis.
15:54 - 15:58
S05-7 (CP)
Pia Kristina LÖFGREN 1, Marie ANDERSSON 2, Sofia SJÖSTRÖM 2, Erik AXMAN 2 and Kate ABRAHAMSSON 2
1) Queen Silvia Children's Hospital, Paediatric Urology, Goteborg, SWEDEN - 2) Queen Silvias Childrens hospital, Pediatric surgery and urology, Gothenburg, SWEDEN
PURPOSE
Patients with bladder augmentation and bladder neck repair have a high risk of developing bladder stones. Treatment options are endoscopic lithotripsy or open lithotomy. Our 15-year-old patient with Lipo-Myelomeningocele had bladder augmentation, Mitrofanoff, and bladder neck repair in 2019. Five years later, cystoscopy due to haematuria and painful CIC revealed a 3 cm bladder stone.
MATERIAL AND METHODS
Open lithotomy at the bowel part of the bladder, with a double layer closure, was performed. The bladder was drained postoperatively. Unfortunately, the catheter obstructed on the third night after surgery which caused a bladder filling of 800 ml. A few days later urinary leakage through the surgical incision was noticed. Despite an attempt to close the bladder, a vesicocutaneous fistula developed.
RESULTS
Even with two open catheters, most urine drained through the 2 mm fistula, macerating the skin around the opening. Learning from bowel fistula experiences, we initiated Vacuum Assisted Closure (VAC) 10 days after the second operation. This kept the skin dry, improving healing conditions. After 3 months of VAC treatment (50 -100mmHg), with change of dressings in the policlinic twice a week, the fistula shrank, and leakage reduced to 30 ml/24 hours. It increased if VAC was removed. After injecting bulking agent via cystoscopy close to the fistula neck, the leakage completely stopped one week later.
CONCLUSIONS
VAC for vesicocutaneous fistula can be successful in difficult-to-treat cases. It also allows patients to be at home in between change of dressings. The combination with Deflux from inside the bladder proved to be a winning concept.
15:58 - 16:02
S05-8 (CP)
Michał GOGOLEWSKI, Karina FELBERG, Kinga KOWALCZYK and Piotr GASTOŁ
The Children's Memorial Health Institute, Pediatric Urology, Warsaw, POLAND
PURPOSE
To present cases of 3 girls with cervical polyps treated in 2024.
MATERIAL AND METHODS
We retrospectively analyzed the medical records, histopatology results and the follow-up plan.
RESULTS
Case 1: 5-month old girl with OHVIRA syndrome. Cystoscopy and vaginoscopy was performed due to urogenital defect. Polyp of left uterine cervix was found accidentaly and was removed. Histopatological examination revealed radical resection of Mullerian papilloma. Follow-up period - 3 months. Control vaginoscopy is planned.
Case 2: 11-year old menstruating girl was admitted to hospital due to prolapse of patological mass from vagina orifice. Oncological evaluation with abdomen MRI was performed. Giant cervical polyp without metastases was found. Vaginoscopy with polyp removal was performed. Endocervical polyp was diagnosed in histopatology. Follow-up period - 2 months. Control vaginoscopy is planned.
Case 3: 9-year old girl with previous history of biopsy of cervical polyp (Mullerian papilloma) at the age of 15 months, subjected only to ultrasound observation in follow-up. Admitted to hospital due to vaginal bleeding and polyp prolapse. Giant cervical polyp was removed during vaginoscopy. Histopatological examination revealed adenocarcinoma, HPV-independent, clear cell type. No metastases were revealed on MRI and PET-CT. Amputation of uterine cervix and ilio-obturator lymph nodes biopsy was performed and no malignant changes were found. Follow-up period - 13 months. Vaginoscopy performed every 3 months doesn't reveal malignant changes.
CONCLUSIONS
Mullerian papilloma polyps should be removed radically due to risk of malignancy. Monitoring including vaginoscopy of girls after removing benign cervical polyps is mandatory.