ICCS & ESPU-Nurses Meeting on Friday 5, September 2025, 09:25 - 10:13
09:25 - 09:31
ICCS-S02-1 (OP)
Renan Timóteo De OLIVEIRA, Alissa Fernanda De Souza BRITTO, Mateus Batista PEREIRA, Iara Regina Siqueira LUCENA, Fernanda Beretta REIS, Antônio Euclides Pereira De SOUZA JUNIOR, Antônio Rebello Horta GÖRGEN, Patric Machado TAVARES and Tiago ROSITO
Federal University of Rio Grande do Sul - Hospital de Clinicas de Porto Alegre - Brasil, Urology, Porto Alegre, BRAZIL
PURPOSE
In 2006, a study published by the Medical University of Innsbruck, Austria, indicated a reduction in renal damage and the number of surgeries in patients with myelomeningocele (MMC) undergoing an early-onset proactive protocol. That same year, we initiated our protocol at the Hospital de Clínicas de Porto Alegre, a public university hospital in southern Brazil. Now, after nearly 20 years, we present our results.
MATERIAL AND METHODS
Retrospective cohort study since 2000. From 2006 onwards, all patients were submitted to the institutional protocol for paediatric neurogenic bladder. Urodynamic studies were performed on all patients at admission. Ultrasound scans were performed annually and DMSA scans every 5 years. Relative risk for bladder augmentation and DMSA alteration was calculated in a subgroup analysis including patients between 8-20 years old to pair for age. All patients included under 2 years of age were considered exposed to the protocol and the control group was considered those included over 5 years of age.
RESULTS
To date, 190 patients have been included. The current median follow-up time is 10.10 (0-24.72) years. 16.9% underwent intrauterine correction in the historical series, however, the rate is 49.12% in the last 5 years. Urodynamics demonstrated 62.2% with overactivity/low compliance, 28.4% with sphincter incompetence and 33.3% of patients classified as high risk. In the subgroup analysis, there was a 70% reduction in the risk of bladder augmentation (RR 0.300, 95% CI 0.089 - 1.000, p = 0.050) and a 72% reduction in the risk of DMSA alteration (RR 0.288, 95% CI 0.099 - 0.841, p = 0.022).
CONCLUSIONS
A proactive approach to paediatric neurogenic bladder was able to reduce renal damage and the need for bladder augmentation when initiated in MMC patients under 2 years of age. Thus, we reinforce the idea of early intervention for these patients, ideally from birth, to prevent poor outcomes.
09:31 - 09:37
ICCS-S02-2 (OP)
Fernanda Bereta REIS, Renan Timóteo De OLIVEIRA, Patric Machado TAVARES, Antônio Rebello Horta GÖRGEN, Maria Eduarda LIMA, Leonardo FRAGA and Tiago Elias ROSITO
Federal University of Rio Grande do Sul - Hospital de Clinicas de Porto Alegre - Brasil, Urology, Porto Alegre, BRAZIL
PURPOSE
Neurogenic bowel is a condition resulting from malformations in nervous system pathways, commonly associated with myelomeningocele. This condition often manifests symptoms such as constipation and fecal incontinence. Myelomeningocele presents significant neurological challenges, and antenatal surgery has been proposed to improve outcomes, particularly in the orthopedic and neurological domains. While some studies report some improvements in bladder function, evidence regarding its impact on bowel function remains limited.
MATERIAL AND METHODS
This prospective cohort study evaluates bowel symptoms in patients aged 4 to 18 years, with a focus on assessing fecal continence in the pediatric population. We included 75 patients, 16 of whom had undergone antenatal surgery.
RESULTS
The majority of patients had lumbar and sacral lesions. In the postnatal surgery group, 92.8% of patients experienced either constipation or fecal incontinence, with 7.2% remaining asymptomatic. In contrast, 18.2% of patients in the fetal surgery group were asymptomatic, indicating that the likelihood of being asymptomatic more than doubled in the antenatal group. Additionally, urinary tract infections (UTIs) were more common in patients with bowel symptoms in both groups. In the antenatal surgery group, 31% of patients were non-ambulatory, compared to 47% in the post-natal surgery group, where mobility impairments may further exacerbate bowel symptoms.
CONCLUSIONS
This study represents an initial analysis within a larger cohort of myelomeningocele patients treated at our institution in Brazil. Neurogenic bowel dysfunction remains underrecognized and undertreated worldwide in this patient population, despite its significant impact on both quality of life and bladder function. The initial findings give us some hope regarding bowel function improvement in antenatal repair to be confirmed in the future.
09:37 - 09:43
ICCS-S02-3 (OP)
Fernanda Bereta Dos REIS, Patric Machado TAVARES, Alissa Fernanda De Souza BRITTO, Antônio Rebello Horta GÖRGEN, Renan Timóteo De OLIVEIRA, Maria Eduarda LIMA, Leonardo Vaccaro DE FRAGA and Tiago Elias ROSITO
Federal University of Rio Grande do Sul - Hospital de Clinicas de Porto Alegre - Brasil, Urology, Porto Alegre, BRAZIL
PURPOSE
Neurogenic bowel and bladder dysfunction are prevalent among patients with myelomeningocele. Existing literature supports the notion that comprehensive bowel management can alleviate urinary incontinence and improve bladder function.
MATERIAL AND METHODS
At our institution, a high-volume referral center in Brazil, we surveyed the families of 75 pediatric patients aged 4 to 18 years regarding neurogenic bowel symptoms, including continence, incontinence, Bristol stool scale classification, and independence in bowel care during their first evaluation by the multidisciplinary team.
RESULTS
Our results reveal that nearly 30% of patients had never been screened for bowel symptoms, resulting in a lack of therapeutic intervention. Among these, 76% reported experiencing bowel-related symptoms, including Bristol stool scale 1, which could potentially be alleviated with basic therapeutic interventions
CONCLUSIONS
Our findings highlight that even within specialized centers, patients with myelomeningocele remain underdiagnosed and undertreated with respect to bowel care. Current evidence suggests that structured bowel management not only improves quality of life but also optimizes bladder dynamics and reduces urinary incontinence when integrated with multimodal treatment strategies. We advocate for systematic screening for bowel symptoms by urologists and recommend the establishment of a multidisciplinary care team, including a bowel care specialist, as the standard of care for these individuals.
09:43 - 09:49
ICCS-S02-4 (OP)
Matheus Batista PEREIRA, Alissa Fernanda De Souza BRITTO, Fernanda Beretta REIS, Antônio Euclides De Souza JUNIOR, Antônio Rebello Horta GOERGEN, Iara Regina Siqueira LUCENA, Patric Machado TAVARES, Renan Timóteo De OLIVEIRA and Tiago ROSITO
Federal University of Rio Grande do Sul - Hospital de Clinicas de Porto Alegre - Brasil, Urology, Porto Alegre, BRAZIL
PURPOSE
Since the 2011 MOMS trial, we have questioned whether intrauterine closure alters urological outcomes. Since 2017, we have initiated a prospective cohort of patients born with myelomeningocele (MMC) at our institution. In this analysis, we compare neonatal urodynamic results in patients with intrauterine versus postnatal closure, all born and evaluated at the same institution.
MATERIAL AND METHODS
Prospective study of patients with MMC initiated in 2017. For this analysis, we selected patients with at least 1 year of follow-up. All patients underwent urodynamic studies and voiding cystourethrograms by 6 months of age. The examinations were performed by the same professionals at the same institution. Urodynamic risk stratification was based on the CDC's Urologic Management to Preserve Initial Renal Function Protocol for Young Children with Spina Bifida (UMPIRE). The urodynamic study followed the guidelines and nomenclature recommended by the ICCS. For comparison, patients were divided into two groups: intrauterine closure and postnatal closure. For statistical analysis, we performed Chi-square and Fisher's exact tests.
RESULTS
This analysis included 53 patients 27 postnatal group / 26 intrauterine group. Urodynamic studies identified detrusor abnormality in 46.1% of the postnatal group versus 61.5% in the intrauterine group (p=0.20). Low/moderate/high urodynamic risk was 29.6%, 44.4% and 26.0% in the postnatal group and 34.6%, 23.0% and 42.4% in the intrauterine group, respectively (p=0.24). There was 77.2% (27/35) agreement between urodynamic studies and voiding cystourethrograms regarding the degree of urodynamic risk and imaging abnormality (p=0.02). The presence of VUR and DMSA alterations was similar between the groups.
CONCLUSIONS
There was no significant difference in urodynamic risk between the two groups. The moderate risk grading proposed by UMPIRE may be a confounding factor in this analysis. There was good agreement between urodynamic studies and voiding cystourethrograms, reinforcing the value of video-urodynamics.
09:49 - 09:55
ICCS-S02-5 (OP)
Tuğçe ATALAY 1, S. Kerem OZEL 2 and İbrahim ALATAŞ 3
1) PelvicKids Pelvic Rehabilitation Center, Pediatric Physiotherapy, İstanbul, TÜRKIYE - 2) Demiroğlu Bilim University Faculty of Medicine, Pediatric Surgery, Istanbul, TÜRKIYE - 3) İstanbul Beykent University Faculty of Medicine, Pediatric Neurosurgery, İstanbul, TÜRKIYE
PURPOSE
Aim of the study was to delineate the clinical effects of kinesiotape application during pelvic floor rehabilitation (PFR) in children with neurogenic bladder dysfunction (NBD) due to spina bifida.
MATERIAL AND METHODS
Children with the diagnosis of NBD due to spina bifida were studied. Patients received behavioral therapy, diaphragmatic breathing, core stabilization exercises, and perineal sensory training in PFR. Two groups were formed; patients who received kinesiotape application with PFR or only PFR. Age, gender, patient satisfaction scores, no of diaper change, maximum voluntary voided volume, voluntary defecation, urinary tract infection (UTI) episodes, constipation status, dry periods after catheterization and pelvic floor EMG activities were noted. Results were analyzed statistically.
RESULTS
There was a total of 36 children (9,8±4,3 years) with NBD due to spina bifida. 11 patients (5 boys, 6 girls) received kinesiotape application added to standard PFR and 25 patients (13 boys, 12 girls) received only PFR. There was no difference in terms of age, gender, diaper change, maximum voluntary voided volume, voluntary defecation, UTI episodes, constipation, dry periods between groups. Patient satisfaction scores of those who received kinesiotape was significantly higher than standard PFR (7,63±0,8 vs 5,84±1,86, p=0,006). Pelvic floor EMG activity was significantly higher after kinesiotape application (5,47±1 mV vs 4,89±2,73 mV, p=0,011).
CONCLUSIONS
Standard pelvic floor rehabilitation with kinesiotape application may help to improve patient satisfaction and pelvic floor EMG activity during pelvic physiotherapy in children with neurogenic bladder dysfunction due to spina bifida. Studies with larger cohorts are necessary to evaluate the clinical outcome in these patients.
09:55 - 10:01
ICCS-S02-6 (OP)
Cristian SAGER, Yesica GOMEZ, Carol BUREK, Javier RUIZ, Felicitas LOPEZ IMIZCOZ, Nicolas ROSIER, Otilia BLAIN, Danel ALBERTI, Leandro ASEN, Ignacio ARENAS and Santiago WELLER
Garrahan Hospital, Urology, Buenos Aires, ARGENTINA
PURPOSE
Congenital neurogenic lower urinary tract dysfunction (NLUTD) carries high uronephrological morbidity with the time, so early evaluation and close follow up is essential. The objective is to present outcomes of NLUTD and determine risk factors.
PATIENTS AND METHODS
This retrospective cohorte included newborns with bifida spina, specifically myelomeningocele with postnatal closure. A proactive approach was implemented in the first days of life: early initiation of CIC in neonatology, videourodynamic evaluation since 3th month, anticholinergics drugs according the urodynamic data and renal function monitoring. Follow up to 5 years. Non-parametric tests and categorical variables were analyzed using the Chi-square test or Fisher’s test. Stata.18 was used.
RESULTS
128 children with spina bifida were studied, 50% boys, with a mean follow-up of 5.5 years. Initially, 44%, 4% and 20% of them had UTI, hydronephrosis and VUR respectively. Hyperactivity and pdetmax >20 cm of H2O were: 65 and 36%. Abnormal DMSA scintigraphy was 24%. With a proactive approach, UTI, VUR and hiperactivity decreased in: 12%, 10% and 46% respectively. On the contrary, hydronephrosis, cystometric capacity and pdetmax >20 cm of H2O increased to 25%, 35% and 43% respectively. There were no significant differences with other urodynamic variables. The resolution rate of VUR was 58.3% in 1.8 years (range: 7- 49 months). Premature and neurosurgical closure beyond 24 hours were identified as predisposing factors for VUR (p < 0.001). At the end of follow-up, DMSA scintigraphy was associated with RVU in 23% (p: 0.03). With abnormal Microalbuminuria/Creatinine in 27%, we identified CKD: Chronic kidney disease in 39%.
CONCLUSIONS
Although the proactive approach reduces UTI, vesicoureteral reflux and detrusor hyperreflexia, other variables have not improved, such as endovesical pressures and the progression of chronic kidney disease. This opens a more complex scenario for improving the management strategies.
10:01 - 10:07
ICCS-S02-7 (OP)
Melise A. KEAYS 1, Manraj N KAUR 2, Lillian C HAYES 3, Katherine SHEEHAN 3, Erin MCNAMARA 3 and Stuart BAUER 3
1) Boston Children's Hospital, Pediatric Urology, Boston, USA - 2) Brigham and Womens' Hospital, Boston, USA - 3) Boston Children's Hospital, Boston, USA
PURPOSE
Clean Intermittent Catheterization (CIC) is essential for managing urinary retention and lower urinary tract dysfunction, reducing infection risks, preventing incontinence, and preserving kidney health. Despite its benefits, no standardized CIC teaching framework exists, leading to variability in education and support that affects adherence and outcomes. This quality improvement (QI) initiative at a high-volume pediatric medical center aims to identify facilitators and barriers to effective CIC education, evaluate workflows, and propose strategies to improve patient and caregiver experiences.
MATERIAL AND METHODS
Using a QI approach grounded in interpretive description methodology, we engaged 14 healthcare providers from our Pediatric Urology clinics through three one-on-one interviews and three focus groups. Discussions explored CIC educational processes, clinician and nursing workflows, barriers, and improvement opportunities. Data were transcribed, thematically analyzed, and summarized in workflow diagrams.
RESULTS
Patients initiating CIC had variable diagnoses and prognoses. CIC educators reported improved outcomes when clinicians pre-communicated rationale for CIC, expected duration, and recovery potential to patients, caregivers, and educators. Facilitators included pre-reading educational materials, involvement of an additional caregiversduring teaching, and early follow-ups for reassurance. Barriers included limited health literacy, supply challenges, teaching non-English-speaking families, and workflow inconsistencies. Gaps in caregiver engagement and lack of standardized protocols were also identified. Proposed solutions included integrating health literacy tools, expanded interpreter services, and patient-centered materials. Workflow mapping revealed opportunities to enhance communication and coordination.
CONCLUSIONS
This initiative highlights key areas for improvement in CIC education and support. Standardized workflows, pre-education materials, and patient-centered protocols will be implemented to improve adherence, outcomes and satisfaction.
10:07 - 10:13
ICCS-S02-8 (OP)
Anna PAGE 1, Jo CLOTHIER 1, Riccardo MANUELE 1, Arash TAGHIZADEH 2 and Anne WRIGHT 1
1) EVELINA LONDON CHILDREN'S HOSPITAL, PAEDIATRIC NEPHROUROLOGYBLADDER, London, UNITED KINGDOM - 2) EVELINA LONDON CHILDREN'S HOSPITALPAED, PAEDIATRIC NEPHROUROLOGYBLADDER, London, UNITED KINGDOM
PURPOSE
It is known that children with cerebral palsy (CP) suffer from bladder dysfunction and abnormal UD findings. CP presents with a spectrum of severity classified by GMFCS. For the first time, we address LUTS solely in severe CP (class 4/5) where children rely on carer observation.
MATERIAL AND METHODS
Single institution retrospective review (2006-2024) of all patients with CP GMFCS 4/5 with carer-reported LUTS correlated with VUD investigation. All parameters quoted as percentages, medians (with range). ICCS/ICS definitions/standards used.
RESULTS
41 patients (GMFCS 4=16, male=20, age at VUD 12.3y(2.92-21y) had presenting features (PF) of: discomfort/pain related to bladder function(34%), incontinence(19.5%), UTIs(14.6%), retentive episodes(14.6%), abnormal urinary stream(9.75%) other(7.3%). Fluid intake and constipation were adequately addressed in 71%(gastrostomy) and 90% respectively. All were in diapers. Bladder capacity, PF and UD parameters are detailed in Table 1. Only one child had normal UD storage and voiding. Small BC and all LUTS are associated with high rates of abnormal UD storage and voiding. 64% of children complaining of discomfort had associated abnormal UD events. 54% had UTIs. 22% had abnormal upper tracts on US.
| Presenting feature | CC %* | Abnormalstorage % | DO % | Lowcompliance % |
Abnormalvoiding % |
DSD % | >PVR % | VUR % |
Normalupper tracts % |
|
Discomfort n=14/34% |
Small42.9 Normal50 Large7.1 |
57.1 | 35.7 | 7.1 | 83.3 | 50 | 66.6 | 25 | 92.9 |
|
Incontinence n=8/19.5% |
Small62.5 Normal25 Large12.5 |
75 | 25 | 12.5 | 100 | 50 | 100 | 0 | 100 |
|
UTIs n=6/14.6% |
Small0 Normal66.6 Large33.3 |
50 | 50 | 0 | 80 | 40 | 60 | 0 | 80 |
|
Retention n=6/14.6% |
Small16.6 Normal66.6 Large16.6 |
66.6 | 16.6 | 33.3 | 66.6 | 50 | 66.6 | 33.3 | 66.6 |
|
Abnormalstream n=4/9.75% |
Small25 Normal75 Large0 |
50 | 25 | 25 | 100 | 66.6 | 100 | 25 | 75 |
| Miscn=3/3.1% | Small100 | 100 | 33.3 | 66.6 | 100 | 100 | 100 | 33.3 | 66.6 |
Table 1.
Small<65% Normal65-150% Large>150%
CONCLUSIONS
Bladder dysfunction is a significant source of comorbidity in severe cerebral palsy, including a cause of unexplained discomfort and pain. Education will enable improved quality of life in these highly vulnerable children.
10:13 - 10:19
ICCS-S02-9 (OP)
Kwanjin PARK 1, Sang Woon KIM 2, Jae Min JUNG 3, Ji Yong HA 4, Sang Hoon SONG 5 and Min-Ki BAEK 6
1) Seoul National University Children's Hospital, Urology, Seoul, REPUBLIC OF KOREA - 2) Severance Hospital, Yonsei University, Urology, Seoul, REPUBLIC OF KOREA - 3) Pusan National University Hospital, Urology, Yangsan Si, REPUBLIC OF KOREA - 4) Dongsan Hospital, Keimyung University, Urology, Daegu, REPUBLIC OF KOREA - 5) Asan Medical Center, Ulsan University, Urology, Seoul, REPUBLIC OF KOREA - 6) Samsung Medical Center, Urology, Seoul, REPUBLIC OF KOREA
PURPOSE
This multicenter study tried to show time course of toilet training (TT), urinary/ fecal control of patients with closed spinal dysaraphism (SD) who received untethering at their infancy.
MATERIAL AND METHODS
Data were gathered from 6 tertiary care centers in Korea. Those who completed follow-up at least 10 years of follow-up were eligible for study. Patients who presented tight filum terminale and whose level of conus higher than L2 were excluded from analysis. Baseline demographics, SD related features, age of completing TT, urinary and fecal continence at the age of 5, 7 and 10 years were included in the analysis. Difference in time courses between those doing CIC and spontaneous voiding and factors affecting continence outcome were assessed.
RESULTS
Data of 217 patients were eligible for review. Median follow-up period was 12 (10-22) years and lipomeningomyelocele accounted for 155 (71%) of pathology. CIC was required in 86 (40%) patients. Median age of TT in those with spontaneous voiding and CIC were 8.5 and 12 years, respectively. While the analysis was limited to spontaneous voiders, urinary/fecal incontinence and the lack of TT was not infrequent and this slowly improved from 5 to 10 years of age. Presence of urinary incontinence and/or fecal incontinence were significantly associated with this delayed TT.
| 5 years | 7 years | 10 years | |
| Urinary incontinence | 31 (23%) | 20 (15%) | 13 (10%) |
| Fecal incontinence | 16 (12%) | 10 (8%) | 9 (7%) |
| Toilet training | 109 (83%) | 115 (88%) | 119 (91%) |
CONCLUSIONS
Substantial number of SD patients showed delayed TT even for the spontaneous voider. This did not promptly improved in early elementary school years. Active control of fecal and urinary problem, though prompt response may not be achieved, may be beneficial to achieve timely TT which facilitates early adaptation to school life.