Parallel Meeting on Wednesday 3, September 2025, 16:10 - 17:10
16:10 - 16:13
S06-1 (OP)
Catherine ROBEY 1, Michelle HIGGINS 2, Mohammad ELMOJTABA GUMMA 2, Tanisha MARTHESWARAN 2, David HEAP 2, Jason YANG 2, Ming-Hsien WANG 3 and Chad CRIGGER 2
1) John Hopkin University, Robert D. Jeffs Division of Pediatric Urology, Baltimore, USA - 2) Johns Hopkins University, Robert D. Jeffs Division of Pediatric Urology, Baltimore, USA - 3) John Hopkins University, Robert D. Jeffs Division of Pediatric Urology, Baltimore, USA
PURPOSE
Pediatric hemorrhagic cystitis (HC) is an understudied yet highly morbid condition. The lack of identified risk factors for severe cases has contributed to the absence of standardized protocols to assist hematology-oncology providers when to initiate timely consultation. This study identified risk factors for progression to operative intervention in pediatric HC and informed a simple decision-aid to guide early urologic consultation.
MATERIAL AND METHODS
This retrospective review included all inpatients at our institution from 2014-2024 diagnosed with HC grade II or higher. Demographics, primary diagnosis, age at HC onset, urine virology, chemotherapy/radiation exposure, bone marrow transplant (BMT) status, HC grade/duration, and urologic consultation/intervention were collected. Exclusion criteria included patients with concurrent urinary tract infection or upper tract bleeding, as well as those with incomplete data. Chi-square and Fisher’s exact tests were used to identify risk factors necessitating operative management
RESULTS
In our cohort of 65 patients, the median time from HC onset to urologic consultation was 20 days (range 0-38), and from consultation to intervention was 3 days (range 0-36). Patients with prior BMT were more likely to require operative management if they had prior pelvic radiation (p=0.014) or exposure to both busulfan and methotrexate (p=0.018). For patients without BMT, risk factors included positive BK virus (p=0.03) or exposure to 3 or more bladder-toxic chemotherapies (p=0.001).
| History of BMT? | ||||||
| Yes | No | |||||
| Pelvic XRT? | BK Virus? | |||||
| No | Yes | Yes | No | |||
| Busulfan+MTX? | Early Uro Consult (p=0.014) | Early Uro Consult (p=0.03) | 3+ Bladdeer Toxic Chemo? | |||
| No | Yes | Yes | No | |||
| Provider Discretion | Early Uro Consult (p=0.018) | Early Uro Consult (p=0.001) | Provider Discretion |
CONCLUSIONS
This is the first study to suggest a clinical decision-making tool for pediatric HC. Despite a small cohort, this simple framework may be implemented and refined with larger datasets to improve risk stratification.
16:13 - 16:18
S06-2 (VP)
Aisha SIEBERT, Peter CAI and Michael KURTZ
Boston Children's Hospital, Pediatric Urology, Boston, USA
INTRODUCTION
Cystoscopic clot evacuation has a fundamental limitation – once the cystoscope and sheath are positioned, the optical component must be removed to free the sheath lumen. Aspiration is then iterative and blind, guided only by tactile feedback and inspection of the effluent. This risks mucosal injury if the bladder wall is drawn into the sheath by suction, and inefficacy if the clot has moved and aspirations fail to yield clot. We present the first report, in adults or children, of the use of transabdominal ultrasound to guide sheath positioning during clot evacuation.
METHODS
We performed this procedure for two adolescents. Videos from one are shown, featuring technical details around safety and efficiency. We used a curved 5-1 MHz probe to image the bladder continuously. We were able to assess bladder fullness, sheath position, and clot position distinctly.
RESULTS
In both cases the bladders were cleared of clot using this technique. We found that there are important considerations, such as the presence of air at the bladder dome. Bladder imaging of the floor remains distinct. We observed that clots move when the telescope is removed and a small amount of fluid exits. This explains some of the inefficiency with the blind technique, but we could easily pursue these clots with a sheath under ultrasound guidance.
CONCLUSION
We show that use of ultrasound has features that could contribute to patient safety, confirming the presence of fluid and lack of contact with the bladder mucosa, and efficiency, allowing each aspiration to withdraw clot.
16:24 - 16:27
S06-3 (OP)
Naima SMEULDERS 1, Florent GUERRIN 2, Tim ROGERS 3, Federica DE CORTI 4, Sheila TERWISSCHA VAN SCHELTINGA 5, Gabriela GUILLEN BURRIEZA 6, Mark GAZE 7, Pei S LIM 7, Ilaria ZANETTI 8, Beatrice COPPADORA 8, Olga SLATER 9, Trung NGUYEN 9, Veronique MINARD-COLIN 10, Julia CHISHOLM 11, Hans MERKS 5, Gianni BISOGNO 12 and Helene MARTELLI 2
1) Great Ormond Street Hospital NHS Trust, Department of Paediatric Urology, London, UNITED KINGDOM - 2) Hopital Bicetre, Chirurgie Pediatrique, Paris, FRANCE - 3) Bristol Royal Hospital for Children, Department of Paediatric Surgery, Bristol, UNITED KINGDOM - 4) University Hospital of Padua, Paediatric Surgery Unit, Padua, ITALY - 5) Princess Maxima Centrum, Department of Paediatric Surgery, Utrecht, NETHERLANDS - 6) Hospital Infantil Universitari Vall d'Hebron, Department of Paediatric Surgery, Barcelona, SPAIN - 7) University College London Hospitals, Department Clinical Oncology, London, UNITED KINGDOM - 8) Universitat degli Studi di Padova, Department for Women and Children, Padova, ITALY - 9) Great Ormond Street Hospital for Children, Department of Paediatric Oncology, London, UNITED KINGDOM - 10) Institut Gustave Roussy, Department of Pediatric and Adolescent Oncology, Paris, FRANCE - 11) Royal Marsden Hospital, Department of Paediatric Oncology, Sutton, UNITED KINGDOM - 12) Universitat degli Studi di Padova, Department of Women and Children, Padova, ITALY
PURPOSE
During the EpSSG’s RMS2005 trial, organ-sparing-surgery with brachytherapy became the local-therapy (LT) of choice for suitable patients with bladder-prostate rhabdomyosarcoma (BP-RMS), offering a first opportunity to compare this to traditional LT modalities for BP-RMS, namely surgical-resection and/or radiotherapy.
MATERIAL AND METHODS
With consent, all patients with BP-RMS without nodal/metastatic-spread prospectively enrolled on RMS2005 (October2005-December2016) were categorized by their LT, differentiating organ-sparing from organ-depleting surgery (OSS vs ODS) and brachytherapy (BT) from external-photon/proton-beam-radiotherapy (EBRT). Statistics: survival-probability calculated by Kaplan-Meier; patient-demographics, tumour-characteristics, treatment, outcomes explored by univariate and multivariate analysis(SAS9.4). Tumour-progression(tumour-growth or <1/3 tumour-reduction to first-line chemotherapy), relapse or death were considered events for progression-free-survival(PFS) and all deaths for overall-survival(OS).
RESULTS
The 176 patients were aged 10days-21.8years, median 2.5years, 4 alveolar-histology. Follow-up extended to 12.5years(median 6.5years). 5yr-PFS was 80.3%(95%CI:73.6-85.5%; 34events) and 5yr-OS was 90.7%(95%CI:85.3-94.2%, 17deaths).
5yr-PFS was similar(p=0.56) for patients offered BT+/-OSS [n=54, 2(3.7%) aged≥10years, 57.4%tumours ≤5cm-diameter], surgery alone [n=40, all aged<10years, 67.5%tumours confined to bladder], EBRT alone [n=22, 4(18.2%) aged≥10years, 63.6%tumours >5cm-diameter, 31.8%prostate-location] and any other surgery+radiotherapy [n=48, 7(14.6%) aged≥10years, 87.5%tumours >5cm-diameter, 37.5%prostate-location].
5yr-OS was significantly affected by LT(p=0.019), being highest in patients suitable for surgery alone (100%) or BT+/-OSS (98.1%;95%CI:87.4-99.7%). Those with local tumour progression/relapse after EBRT failed to re-achieve complete remission: 5yr-OS 81.8%(95%CI:58.5-92.8%) for EBRT alone, 85.3%(95%CI:71.6-92.7%) for surgery+radiotherapy.
On univariate analysis, survival was also significantly impacted by patient age≥10yrs and a prostatic tumour-location. On multivariate Cox-modelling only a prostate-location remained significant (5yr-PFS:p=0.020;5yr-OS:p=0.0018). Delaying LT to after cycle 7 of chemotherapy did not significantly impact 5yr-PFS(p=0.59) or 5yr-OS(p=0.29).
CONCLUSIONS
Different LT modalities for BP-RMS without nodal/metastatic spread carry a similar risk of events, poor salvage of tumour progression/relapse after EBRT significantly impacting 5yr-OS. Organ-sparing techniques, such as BT+/-OSS, should be favoured and may be delayed for chemotherapy-responsive tumours.
16:27 - 16:30
S06-4 (OP)
Naima SMEULDERS 1, Sheila TERWISSCHA VAN SCHELTINGA 2, Florent GUERRIN 3, Tim ROGERS 4, Federica DE CORTI 5, Gabriela GUILLEN BURRIEZA 6, Ross CRAIGIE 7, Patrizia DALL'IGNA 8, Mark GAZE 9, Pei S LIM 9, Raquel DAVILA FAJARDO 10, Ilaria ZANETTI 11, Beatrice COPPADORA 11, Olga SLATER 12, Trung NGUYEN 12, Veronique MINARD-COLIN 13, Helen REES 14, Julia CHISHOLM 15, Hans MERKS 16, Gianni BISOGNO 11 and Helene MARTELLI 17
1) Great Ormond Street Hospital NHS Trust, Department of Paediatric Urology, London, UNITED KINGDOM - 2) Princess Maxima Centrum, Department of Paediatric Surgery, Utrecht, NETHERLANDS - 3) Hopital Bicetre, Chirurgie Pediatrique, Paris, UNITED KINGDOM - 4) Bristol Royal Hospital for Children, Department of Paediatric Surgery, Bristol, UNITED KINGDOM - 5) University Hospital of Padua, Department of Paediatric Surgery, Padua, ITALY - 6) Hospital Infantil Universitari Vall d'Hebron, Department of Paediatric Surgery, Barcelona, SPAIN - 7) Royal Manchester Children's Hospital, Department of Paediatric Surgery, Manchester, UNITED KINGDOM - 8) Universitat degli Studi di Padova, Department of Paediatric Surgery, Padua, ITALY - 9) University College London Hospitals, Department Clinical Oncology, London, UNITED KINGDOM - 10) Princess Maxima Centrum, Department Clinical Oncology, Utrecht, NETHERLANDS - 11) Universitat degli Studi di Padova, Department for Women and Children, Padova, ITALY - 12) Great Ormond Street Hospital for Children, Department of Paediatric Oncology, London, UNITED KINGDOM - 13) Institut Gustave Roussy, Department of Paediatric Oncology, Paris, FRANCE - 14) Bristol Royal Hospital for Children, Department of Paediatric Oncology, Bristol, UNITED KINGDOM - 15) Royal Marsden Hospital, Department for Women and Children, Sutton, UNITED KINGDOM - 16) Princess Maxima Centrum, Department of Paediatric Oncology, Utrecht, NETHERLANDS - 17) Hopital Bicetre, Department of Paediatric Surgery, Paris, FRANCE
PURPOSE
Risk stratification of patients to treatment algorithms for rhabdomyosarcoma (RMS) requires accurate staging, with histological nodal assessment of critical importance for specific tumour sites. This report explores the value of surgical nodal staging in bladder-prostate rhabdomyosarcoma (BP-RMS).
MATERIAL AND METHODS
With consent, all patients with BP-RMS prospectively enrolled in EpSSG’s RMS2005 and MTS2008 trials (October 2005-December 2016) were reviewed for the staging methodology and outcome. Statistics: survival-probability calculated by Kaplan-Meier; Fisher’s exact testing explored differences between independent variables.
RESULTS
Significant differences in 5-year overall (5yr-OS) and progression-free survival (5yr-PFS) were observed for the 224 patients with BP-RMS of different Tumour-Nodal-Metastatic (TNM) stages(p=<0.0001).
|
|
N |
Events |
5-yr PFS (95%CI) |
Deaths |
5-yr OS (95%CI) |
|
N0 M0 |
181 |
36 |
79.8 (73.1-85.0) |
18 |
90.4 (85.0-93.9) |
|
N0 M1 |
9 |
2 |
77.8 (36.5-93.9) |
2 |
77.8 (36.5-93.9) |
|
N1 M0 |
18 |
6 |
72.2 (45.6-87.4) |
5 |
77.8 (51.1-91.0) |
|
N1 M1 |
16 |
11 |
37.5 (15.4-59.8) |
11 |
35.2 (13.3-58.2) |
|
Total |
224 |
55 |
p<0.0001 |
36 |
p<0.0001 |
Almost all nodal staging was by imaging, with only 7 patients undergoing surgical nodal assessment at presentation and 48 at delayed surgery (no sampling despite a laparotomy/other surgery in 120). Six patients considered N0 by imaging had RMS in nodes sampled after 5-6 cycles of chemotherapy (triggering post-operative EBRT for 5); eight patients deemed N1 had negative nodal pathology after 4-8 cycles of chemotherapy. Surgical nodal assessment did not impact the occurrence of loco-regional events (12/55, 21.8%) as compared to those staged by imaging alone (28/166 16.9%, Fisher’s exact p=0.423). Adding FDG-PET imaging to explore nodal and/or metastatic spread did not significantly reduce subsequent disease-related events: 12/66 (18.2%) compared to 42/156 (26.9%) not imaged by FDG-PET (Fisher’s exact p=0.176).
CONCLUSIONS
In contrast to other sites, surgical nodal sampling, undertaken in 24.6% overall and only 3.1% at presentation, does not significantly impact outcome of BP-RMS.
16:36 - 16:39
S06-5 (OP)
Raymond YONG 1, David HINOJOSA-GONZALEZ 1, Troy LA 2, Soham DATAR 2, Allan ZHANG 2, Nora BROADWELL 1 and Niccolo PASSONI 1
1) Texas Children's Hospital, Urology, Houston, USA - 2) Baylor College of Medicine, Urology, Houston, USA
PURPOSE
Following serum tumor marker normalization after chemotherapy for Stage III non-seminomatous germ cell tumors (NSGCT), resection of residual disease is recommended to rule out teratoma. Low pathology concordance between retroperitoneal (RP) and other metastatic sites supports this approach. Adolescents often present with more advanced disease and worse outcomes than adults, highlighting the need for refined management. This study compares residual mass resection rates and pathology findings between adolescents and adults with Stage III NSGCT.
MATERIAL AND METHODS
A retrospective review of 194 NSGCT patients treated from 2000 to 2024 was conducted. Patients aged ≥11 years were analyzed, stratified into adolescents (11–18 years) and adults (>18 years). Statistical significance was assessed using chi-square tests.
RESULTS
Of 194 patients, 62 (32%) were adolescents, and 109 (56%) were adults. Stage III disease was found in 23% of adolescents and 77% of adults. Recurrence occurred in 15% of adults but none in adolescents (p=0.17). Residual mass resection was performed in 40.9% of Stage III patients, more frequently in adolescents (63.6%) than adults (33.3%, p=0.2). RPLND pathology showed necrosis (44.4%), viable tumor (27.8%), and teratoma (27.8%). Necrosis was more common in adolescents (57.1%) than adults (36.4%, p=0.5). All extra-RP resections involved adolescents including three lung resections and one partial hepatectomy, primarily identifying teratoma.
CONCLUSIONS
Adolescents underwent more frequent residual mass resections and surgeries than adults, with a trend toward higher necrosis and teratoma rates. These findings suggest adolescents may present with more aggressive disease, warranting tailored surgical strategies and improved risk assessment.
16:39 - 16:42
S06-6 (OP)
Raymond YONG 1, David HINOJOSA-GONZALEZ 1, Angel OTTO 2, Nora BROADWELL 1 and Niccolo PASSONI 1
1) Texas Children's Hospital, Urology, Houston, USA - 2) Baylor College of Medicine, Urology, Houston, USA
PURPOSE
Understanding demographic disparities in germ cell tumors (GCTs) is crucial for timely diagnosis and treatment. Recent SEER data suggests race and ethnicity may influence cancer-specific mortality in males with GCTs.
MATERIAL AND METHODS
This retrospective study analyzed GCT incidence and outcomes in U.S. males aged 0-26 from 1975-2021 using the SEER database. Data was stratified by race/ethnicity, urban/rural status, income, and pubertal stage. Incidence rates were calculated per million.
RESULTS
GCT incidence increased significantly across income levels but showed no statistical differences between income categories. Urban (p<0.0001) and rural (p=0.04) populations also had significant incidence increases. Pubertal (10-18 years) and post-pubertal (19-26 years) males experienced rising rates (p<0.0001), while infants (0-3 years) and pre-pubertal males (4-9 years) did not. Hispanic and NH Asian pubertal males saw the highest increases (p<0.0001, p=0.002), while NH Black and NH White males experienced decreases (p=0.03, p=0.01). Hispanic and NH Asian post-pubertal males also showed rising incidence (p<0.0001, p=0.001). NH Black males had significantly lower survival rates than all other groups.
CONCLUSIONS
Significant sociodemographic disparities exist in GCT incidence and survival outcomes. These findings underscore the need for targeted clinical strategies and further research into environmental and genetic factors contributing to rising incidence rates. Cancer registries play a vital role in advancing our understanding of GCT epidemiology and guiding better care for affected populations.
16:48 - 16:51
S06-7 (OP)
Mathilde GLENISSON 1, Giammarco LA BARBERA 2, Cécile LOZACH 3, Aurore PIRE 4, Julien GROSMAN 4, Daniel ORBACH 5, Véronique MINARD 6, Sabine SARNACKI 4 and Thomas BLANC 4
1) Hôpital Necker-Enfants Malades, Department of Pediatric Surgery and Urology, Paris, FRANCE - 2) Institut Imagine, Paris, France, IMAG2, Université PAris Cité, Paris, FRANCE - 3) Hôpital Necker-Enfants Malades, Pediatric Radiology, Paris, FRANCE - 4) Hôpital Necker-Enfants Malades, Pediatric surgery and Urology, Paris, FRANCE - 5) Institut Curie, Pediatric and Adolescent Oncology, Paris, FRANCE - 6) Institut Gustave Roussy, Pediatric and Adolescent Oncology, Paris, FRANCE
PURPOSE
Despite the growing application of MIS in paediatric oncology, open radical nephrectomy (ORN) remains the gold standard for Wilms tumor (WT). Umbrella Protocol criteria for laparoscopic nephrectomy have been challenged by many studies. Based on our previous experience in paediatric oncology, we reported criteria for the robotic approach in WT.
We aimed to redefine more precise criteria for robotic assisted radical nephrectomy (RARN) for presumptive WT in the light of our single-center experience.
MATERIAL AND METHODS
A prospective institutional analysis was performed including children operated on radical nephrectomy (RN) with presumptive diagnosis of WT from 2016 to 2023. To describe the proportion between the preoperative tumor volume and the patient's age, we calculated a ratio between a 3D-slicer volumetry of (tumor + normal kidney) over estimated patient blood volume.
RESULTS
60 RN were performed, including 23 RARN (38%) and 37 ORN. Tumor volume at surgery was smaller in the RARN group (p<0,0004). There was no difference between groups regarding oncological outcomes. One child (R=0,51) with liver infiltration had positive margins and developed pleural metastasis. All the other robotic cases were performed with a volumetry ratio under 0,35 and without conversion unless thrombus or midline crossing. Among the ORN with a volumetry ratio <0,35, open approach was preferred due to organizational issues in three children.
CONCLUSIONS
Large tumor with a volumetry ratio > 0,35, despite the absence of renal vein thrombus, midline crossing or liver infiltration are formal contraindications for a robotic approach. Almost 40% of presumptive WT can be safely operated with robotic approach.
16:51 - 16:54
S06-8 (OP)
Matthijs FITSKI 1, Guus BÖKKERINK 2, Sophie VAN PEER 3, Caroline HULSKER 1, Sheila TERWISSCHA VAN SCHELTINGA 1, Cornelis VAN DE VEN 1, Marc WIJNEN 1, Aart KLIJN 4, Marry VAN DEN HEUVEL-EIBRINK 3 and Alida VAN DER STEEG 1
1) Princess Máxima Center for pediatric oncology, Pediatric surgery, Utrecht, NETHERLANDS - 2) Princess Máxima Center for pediatric oncology, Utrecht, NETHERLANDS - 3) Princess Máxima Center for pediatric oncology, Solid tumors, Utrecht, NETHERLANDS - 4) University Medical Center Utrecht/Wilhelmina Children's Hospital, Pediatric urology, Utrecht, NETHERLANDS
PURPOSE
In this retrospective single center cohort study, we report the surgical outcomes of nephron-sparing surgery (NSS) for Wilms' tumor (WT) patients since centralization of pediatric oncology care in the Netherlands, and implementation of technological advancements. Therewith we describe the influence of experience and innovations for this type of surgery.
METHODS
We retrospectively assessed all NSS procedures from January 1st 2015 until January 1st 2024 for patients who underwent surgery for a renal tumor at the Princess Máxima Center for Pediatric Oncology. Data were gathered on patient characteristics, diagnostic information, radiological characteristics, surgical technique and use of innovations, postoperative outcome, administered treatment and surgical follow-up.
RESULTS
36 patients (58% female, 42% male) were included with a total of 43 NSS procedures. Mean (SD) age at diagnosis was 33.3 (23.1) months. 16 procedures were performed without 3D models, of which 3 (18.8%) resulted in an unexpected positive margin. 27 procedures were preoperatively planned with a 3D model with one (3.7%) unexpected anticipated positive margins (p = 0.101). Six (13.9%) procedures had post-operative complications including five urine leakages, one chyle leakage and two (reversible) acute kidney insufficiency. Four patients received a re-intervention (JJ-stent or drain).
CONCLUSIONS
In this retrospective single center cohort study, we show a good surgical outcome after NSS for children with renal tumors after the implementation of 3D models. This study can act as a baseline cohort to harmonize preoperative assessment, intraoperative technique and implementation of innovative surgical technology for further expansion of NSS for WT patients.
16:54 - 16:57
S06-9 (OP)
Suhaib ABDULFATTAH 1, Julia M. MORALES 2, Kayla MEYER 1, Kathryn DOHERTY 1, Nora BROADWELL 2, Raymond YONG 2, Sameer MITTAL 1, Chester KOH 2 and Arun SRINIVASAN 1
1) Children's Hospital of Philadelphia, Urology, Philadelphia, USA - 2) Baylor College of Medicine, Urology, Houston, USA
PURPOSE
Retroperitoneal lymph node dissection (RPLND) is a critical surgical procedure for staging and managing paratesticular rhabdomyosarcoma (PT-RMS) in pediatric patients. While minimally invasive surgical (MIS) approaches, including laparoscopic and robot-assisted techniques, are well-documented in adult cases, their utilization in pediatric populations remains limited. This study evaluates the outcomes of MIS RPLND in pediatric patients with PT-RMS across two tertiary care centers
MATERIAL AND METHODS
A retrospective analysis was conducted on patients who underwent MIS RPLND for PT-RMS between 2012 and 2024. Data collected included demographics, tumor characteristics, neoadjuvant chemotherapy, operative details, and postoperative outcomes. Descriptive statistics were used to summarize findings.
RESULTS
Eight patients (median age 12.6 years, IQR: 11.6, 13.8) underwent MIS RPLND, with equal distribution between laparoscopic and robot-assisted approaches. One patient (12.5%) received neoadjuvant chemotherapy. The median operative time was 436 minutes (IQR: 418, 450), with a median lymph node yield of 13 nodes (IQR: 11, 18). Three patients had positive lymph nodes. The median hospital stay was 2.5 days (IQR: 2, 3), with no postoperative complications reported. Over a median follow-up of 71.5 months (IQR: 41.3, 119), no recurrences were observed.
CONCLUSIONS
MIS RPLND is a safe and effective surgical option for managing PT-RMS in pediatric patients. Broader adoption and further research involving larger cohorts are warranted to validate these findings and refine surgical practices.