ESPU Meeting on Wednesday 17, June 2026, 13:00 - 13:50
13:00 - 13:03
S01-1 (CP)
Sun-Ouck KIM 1, Yeonwoo JEONG 1, Seong Hyeon YU 1, Ho Seok CHUNG 1, Do Gyeong LIM 1 and Sungchan PARK 2
1) Department of Urology, Chonnam National University Medical School, Urology, Gwangju, REPUBLIC OF KOREA - 2) Ulsan University Hospital, College of Medicine, Department of Urology, Ulsan, REPUBLIC OF KOREA
PURPOSE
To evaluate the incidence and perinatal risk factors associated with cryptorchidism in neonates and to identify predictors of persistent undescended testis at 6 months of age.
MATERIAL AND METHODS
A retrospective cohort study was conducted including 976 male neonates born at Hospital between January 2018 and December 2023. Clinical variables including birth weight, gestational age, Apgar score, delivery mode, urogenital anomalies, maternal age, maternal estrogen exposure, and family history were evaluated. Cryptorchidism was diagnosed at birth, and spontaneous descent was assessed at 6 months. Logistic regression analysis was used to identify significant predictors.
RESULTS
The incidence of cryptorchidism was 8.8% (86/976), with significantly higher prevalence in preterm infants (28.1%) compared to term infants (3.1%) (p<0.001). Risk factors independently associated with cryptorchidism included low birth weight (OR, 3.82;p<0.001), prematurity (OR, 2.75;p=0.001), maternal estrogen exposure (OR, 2.57;p=0.006), and urogenital anomalies (OR, 2.13;p=0.026). Among cryptorchid cases, 72.1% experienced spontaneous descent by 6 months. Factors associated with persistent undescended testis included urogenital anomalies (OR, 0.32;p=0.028), while preterm birth (OR, 2.10;p=0.013), low birth weight (OR, 1.67;p=0.023), and maternal estrogen exposure (OR, 1.85;p=0.024) were positively associated with resolution.
CONCLUSIONS
Cryptorchidism is significantly associated with identifiable perinatal risk factors. Most cases resolve spontaneously within 6 months, particularly in the absence of urogenital anomalies. Early clinical characteristics can be used to guide follow-up and determine the need for surgical intervention.
13:03 - 13:06
S01-2 (CP)
Kiloran METCALFE 1, David KEENE 1, David WILKINSON 2, Alejandro ROSSI 1, Jonathan GORING 2, Baqer SHARIF 2 and Tamas CSERNI 1
1) Royal Manchester Children's Hospital, Paediatric Urology, Manchester, UNITED KINGDOM - 2) Royal Manchester Children's Hospital, Paediatric Surgery, Manchester, UNITED KINGDOM
PURPOSE
Fowler Stephens (FS) is a well-established staged technique for impalpable testis involving division of the main testicular vessels and has a risk of testicular atrophy. Shehata described a two-stage laparoscopic traction orchidopexy (TST) which encourages elongation of the testicular vessels without division. This technique also enables a single stage (SS) approach in selected patients.
We aimed to evaluate size and position outcomes for boys undergoing laparoscopic orchidopexy.
MATERIAL AND METHODS
Retrospective review of all paediatric patients undergoing laparoscopic orchidopexy at a tertiary centre between January 2016 and March 2024. Patients who had excision of their testicular remnant were excluded. Size outcomes were classified as good (> 50% contralateral testis), intermediate (25-50%) and atrophy (<25%). A good position was defined as within the scrotum. Categorical data were analysed using a Chi Square test.
RESULTS
Total of 236 testes (from 204 boys). Median age 22 months (IQR 16-37.5) with follow up of 13 months (IQR 6-19). Outcomes are shown in table 1: atrophy rates were significantly lower in both the TST and SS groups (p<0.001). Atrophy rates were SS 3/29 (10%) and TST 3/70 (4%) compared to FS 29/96 (30%). There was no significant difference in testicular position.
| Outcomes |
Size outcome (based on examination) |
Position outcome (excluding non-palpable testes) |
Good position and size | |||||
| Number | Atrophy (<25%) |
Intermediate (25-50%) |
Good (>50%) | Number | Good position | Any other position | ||
| Single stage | 29 | 3 (10%) | 3 (10%) | 23 (79%) | 28 | 22 (79%) | 6 (21%) | 20/29 (69%) |
| Two stage traction | 70 | 3 (4%) | 18 (26%) | 49 (70%) | 68 | 52 (76%) | 16 (23%) | 40/70 (57%) |
| Fowler Stephens | 96 | 29 (30%) | 16 (17%) | 51 (53%) | 75 | 56 (75%) | 19 (26%) | 44/96 (46%) |
CONCLUSIONS
FS was associated with significantly higher rates of testicular loss compared to traction techniques. Position outcome was the same for both techniques.
13:06 - 13:09
S01-3 (CP)
Alexander SCHATZKI-LUMPKIN 1, Michael SISCHKA 2, Maryam HOCKLEY 3, Daniel SALEVITZ 4, Nicolette PAYNE 2, Sam DOWELL 5, Stephanie MILLER 6, Cecilia MONTEILH 3 and Gwen GRIMSBY 6
1) University of Arizona, College of Medicine - Phoenix, Phoenix, USA - 2) Mayo Clinic, Urology, Phoenix, USA - 3) Phoenix Children's, Emergency, Phoenix, USA - 4) Seattle Children's, Urology, Seattle, USA - 5) Phoenix Children's, Pediatrics, Phoenix, USA - 6) Phoenix Children's, Urology, Phoenix, USA
PURPOSE
Acute testicular pain is a common pediatric emergency with testicular torsion (TT) requiring immediate surgery and other causes managed conservatively. Distinguishing TT remains difficult and often requires scrotal ultrasound (US). The Testicular Workup for Ischemia and Suspected Torsion (TWIST) score integrates history and physical exam findings to stratify risk of TT. The goal of this study was to prospectively evaluate TWIST in children presenting to the Emergency Department (ED) with acute scrotal pain and to compare the TWIST scores in patients with testicular pain secondary to TT to those with testicular pain due to other sources.
MATERIAL AND METHODS
Prospective TWIST data were collected on 434 patients with acute testicular pain presenting to a quaternary pediatric ED from January to July 2025. TWIST scores were recorded by ED and/or urology providers. Clinical outcomes included US findings and operative results. Age, TWIST components, and total TWIST scores were compared using t-tests and chi-square analysis.
RESULTS
Mean age was 10.2 years (SD 5) with mean TWIST score of 1.6 (SD 1.9). Thirty-five patients (8%) had TT confirmed surgically; 29% underwent orchiectomy. Patients with TT had significantly higher TWIST scores than those without (5.2 vs 1.3, p<0.0001). High-Risk TWIST (≥5) occurred in 77% of TT patients versus 4% of non-TT patients. No patient with a TWIST score of 0 had torsion except one transferred patient after manual detorsion. Among 17 High-Risk TWIST score non-TT patients, all were <12 years old. Diagnoses included epididymal orchitis (n=8), appendix testis torsion (n=3), hernia/hydrocele (n=3), scrotal cellulitis (n=1), and unknown (n=2). Among 37 patients scored by two providers on the same day, mean TWIST scores did not differ (2.7 vs 3.2, p=0.298). Agreement was highest for nausea/vomiting (78%) and lowest for high-riding testis (62%).
CONCLUSIONS
TWIST reliably discriminates TT from non-torsion causes in pediatric patients. High-risk TWIST (≥5) strongly predicted TT and could justify expedited surgical intervention without US, particularly in post-pubertal patients. TWIST of 0 effectively excluded torsion, supporting its use as a rapid triage tool to optimize testicular salvage and perhaps assist in triage of the use of US. Inter-observer variability was modest, underscoring the need for provider education in TWIST application.
13:21 - 13:24
S01-4 (CP)
Marie ANDERSSON 1, Canan YASAR 1, Pia LÖFGREN 1 and Martin SALÖ 2
1) Queen Silvia Children's Hospital, Paediatric Urology, Goteborg, SWEDEN - 2) Skåne University Hospital, Lund, Department of Pediatric Surgery, Lund, SWEDEN
PURPOSE
Scrotal pain is a common condition in the pediatric ER where the most serious cause is testicular torsion (TT) demanding urgent exploration and detorsion. Other causes do usually not require surgery. To aid in evaluation the TWIST-score was developed and a metaanalysis in 2022 deemed the Barbosa stratifications system (0-2, 3-4, 5-7) the most reliable in pediatric patients, with no patients receiving 0, 1 or 2 points having TT. We aimed to evaluate the accuracy of using this stratification in our setting.
MATERIAL AND METHODS
A multicenter prospective study was conducted between 2019-2022 including all boys between 2weeks to16 years of age with less than 5 days of symptoms, excluding those with hernias as a cause. In a second stage, all patients who underwent acute scrotal exploration during the same period were analyzed.
The diagnosis of TT was considered confirmed when detorsion was performed during exploration or the testis was macroscopically ischemic.
RESULTS
317 boys were included prospectively, and 30 boys were retrospectively analyzed.
Median age was 12 years(0.5;16). Ultrasound was performed in 39.1%(124/317)of cases and 35.3% (112/317) had a surgical procedure. Negative exploration rate was 28.6% (32/112), with diagnoses like epididymitis, torsion of Morgagnis hydatid or no pathology found. The other 80 had confirmed TT/ suspected intermittent TT or Bell clapper deformity.
There were 21.8% (69/317) confirmed TT as defined in methods. Among these, 17 (24.6%) had a low-risk score (0-2), (table 1) , 17 (24.6%) had intermediate risk score and 35 (50.7%) had a high-risk score.
Additionally in the retrospective group 16/30 TT (53.3%) were identified. Among these 1 (6.3%) had a low-risk score.
In the the low-risk group, ultrasound was performed in 4/17 and surgical descision was based on the pain characteristics in 15 and on ultrasound finding in 2.
CONCLUSIONS
The TWIST-score can be useful when utilized as intended: to minimize unnecessary ultrasounds in low-score patients and unnecessary delay of surgery in high-score patients. However, it should be stressed that low scores should not be interpreted as “no risk of TT”. If used as such, almost a third of the TT in this cohort would have been missed. Other parameters, such as characteristics of pain, and history of similar previous episodes must be taken into account in the decision of exploration or not.
13:24 - 13:27
S01-5 (CP)
Dacia DI RENZO 1, Valentina CASCINI 1, Elisa MUSSUTO 1, Maria Enrica MISCIA 1, Gabriele LISI 2 and Giuseppe LAURITI 2
1) "Santo Spirito" Hospital of Pescara, Pediatric Surgery Unit, Pescara, ITALY - 2) University "Gabriele d'Annunzio" of Chieti-Pescara and "Santo Spirito" Hospital of Pescara, Department of Medicine and Aging Science and Pediatric Surgery Unit, Chieti, ITALY
PURPOSE
Introduction. Management of pediatric testicular torsion (TT) has recently shifted from orchiectomy to a conservative strategy (i.e. prompt detorsion and orchiopexy, even in grossly necrotic testes). Nevertheless, concerns persist regarding its potential detrimental effects, including disruption of the hormonal axis and autoantibody formation. The literature contains limited reports on the use of contrast-enhanced ultrasound (CEUS) in TT, mostly focused on diagnostic applications and adult populations. This prospective study aims to assess the utility of CEUS in monitoring testicular viability after conservative management of TT, in order to guide selective delayed orchiectomy. Primary endpoint was the correlation between CEUS findings and histology of removed testes. Secondary endpoints were the correlation between CEUS findings with pre- and intra-operative data.
MATERIAL AND METHODS
Materials and Methods. All patients admitted with TT from November 2024 were prospectively enrolled. Surgical management included detorsion and bilateral septal orchiopexy. Data regarding duration of symptoms, degree of torsion and bleeding-test were collected. At 3-4 weeks post-event, CEUS was performed. CEUS findings were correlated with histopathology of removed testes, duration of symptoms, degree of torsion and bleeding-test results.
RESULTS
Results. Twelve patients were enrolled. CEUS demonstrated normal perfusion in 7 cases, full but heterogeneous perfusion in 1, full but delayed perfusion in 1, and complete absence of perfusion in 3. Orchiectomies were performed in these 3 patients. Histology demonstrated a complete necrosis in all cases. Significant correlation was found between CEUS findings and pre- and intra-operative data. Decreased gonadal perfusion at CEUS significantly correlates with duration of symptoms (p<0.001) and intra-operative bleeding test (p<0.05). Moreover, heterogeneous gonadal structures at CEUS significantly correlates with duration of symptoms (p<0.01) and intra-operative bleeding test (p<0.05).
CONCLUSIONS
Conclusions. These preliminary findings indicate strong concordance between CEUS and histopathology, supporting CEUS as a valuable tool for assessing post-detorsion testicular viability. CEUS may assist in identifying testes requiring delayed orchiectomy, hence supporting clinician in the prevention of possible negative effects on the contralateral gonad.
13:27 - 13:30
S01-6 (CP)
David KEENE and Raimondo CERVELLIONE
Royal Manchester Children's Hospital, Paediatric Urology, Manchester, UNITED KINGDOM
PURPOSE
Current indications for varicocele repair in adolescents include pain, testicular asymmetry, and possibly abnormal semen parameters. However, when managed conservatively according to these criteria, up to 20% of adolescents with symmetrical testicular volumes develop subfertility by 18 years of age. This study aimed to determine whether surgical intervention in adolescents with idiopathic varicocele and symmetrical testes confers a fertility benefit compared with observation alone.
MATERIAL AND METHODS
Favourable ethical approval was obtained in 2009. In 2012, the Hospital became the study sponsor and recruitment commenced. Post-pubertal boys with a clinically visible or palpable varicocele and spontaneous venous reflux on Doppler ultrasound, but symmetric testicular volumes on ultrasound, were enrolled. Randomised participants were asked to provide semen samples at study entry and at age 17. Patients allocated to surgery underwent antegrade sclerotherapy or laparoscopic selective vein ligation. Surgical success was defined as resolution of the varicocele and abolition of continuous venous reflux on Doppler. Changes in sperm concentration from baseline to study completion were analysed using the chi-square test (p < 0.05)
RESULTS
Ninety-three patients were recruited; 46 were randomised to conservative management and 47 to surgery. Demographic variables (age, abstinence interval) did not differ significantly between groups at baseline or study completion. Three patients experienced varicocele recurrence after initial surgery and underwent successful repeat antegrade sclerotherapy. Of the 93 participants, 37 (40%) provided complete semen data (initial and final samples), 38 (41%) provided either the baseline or final sample, and 18 (19%) were unable to provide a sample. Among patients with complete semen data, 16/19 (84%) in the surgical group showed improved sperm concentration compared with 9/18 (50%) in the conservative group (p = 0.026). The median magnitude of improvement was 18 million/mL in the surgery group.
|
Parameters |
Conservative group |
Surgery group |
|
|
Total numbers |
46 |
47 |
|
|
Start |
Age start (years) |
15.6(15.0-15.9) |
15.4(14.5-15.9) |
|
Abstinence interval(days) |
3.0(3.0-4.8) |
3.5(3.0-5.0) |
|
|
End |
Age(years) |
17.4(17.0-17.7) |
17.3(16.9-18.0) |
|
Abstinence interval(days) |
3.5(3.0-4.0) |
4.0(3.0-5.0) |
|
|
Complete sperm data (paired) |
Number of patients |
18 |
19 |
|
Change in sperm concentration from start to end (millions/ml) |
-0.05(-9-21) |
18.1(9.5-34.8) |
|
|
Improved sperm concentration over study |
9/18(50%) |
16/19(84%)** |
|
|
Incomplete sperm data |
Number of patients |
20 |
18 |
|
No sperm data |
Number of patients |
8 |
10 |
CONCLUSIONS
A significantly greater proportion of adolescents with symmetrical testes undergoing early varicocele repair demonstrated improvement in sperm concentration compared with those managed conservatively. Although limited by incomplete data capture and modest sample size, these findings support consideration of early surgical intervention in post-pubertal patients with varicocele and symmetric testes, particularly when abnormal semen parameters are present.
13:30 - 13:35
S01-7 (VP)
Agustina Rene OLIVA, Carolina KORZIN, Nicolas DIAZ BERTILLER, Brenda MALATINI KOZAC, Pedro Luis MERCADO, Juan Manuel MOLDES, Maria Nieves ORMAECHEA, Francisco Ignacio DE BADIOLA, Javier RUIZ and Roberto Luis VAGNI
Hospital Italiano de Buenos Aires, Pediatric Urology, Buenos Aires, ARGENTINA
INTRODUCTION
The prostatic utricle is a rare urogenital anomaly, considered a Müllerian remnant. Its intimate anatomical relationship with the urethra, bladder, and rectum makes surgical excision technically challenging.
The aim of this video is to demonstrate the technical details and key surgical tips acquired over 13 years of experience in the minimally invasive management of this condition.
MATERIALS AND METHODS
It is a retrospective analysis of paediatric patients undergoing minimally invasive utricle excision between 2012 and 2025.
Surgical technique:
All procedures were performed with the patient in the modified Lloyd-Davies position to allow simultaneous endoscopic and abdominal access.
Initial cystoscopic identification and stenting of the utricle were performed using either a guidewire or flexible ureteroscope.
Dissection was carried out from the distal end of the utricle to its origin at the posterior urethra. Transparietal bladder suspension sutures facilitated exposure. The utricle was opened to allow internal closure, with the stent serving as a landmark. Postoperative endoscopy confirmed complete resection. This approach allowed safe, precise dissection while minimising risk to adjacent structures.
RESULTS
Nine patients were initially evaluated; three were excluded —two due to a perineal approach and one who only underwent enlargement of the utricle opening with laser— leaving six patients for analysis: four laparoscopic and two robotic.
Median patient age was 13 years (IQR 10-15). Three patients (50%) were symptomatic, presenting with post-void urine leakage or recurrent urinary tract infections. The most frequent associated diagnoses were gonadal dysgenesis and hypospadias. Median utricle size was 6 cm (IQR 5-7). Median operative time was 240 minutes. Symptomatic patients demonstrated complete clinical improvement. Minor leakage through the abdominal drain occurred in one patient and resolved spontaneously. One residual remnant was detected postoperatively without functional impairment. No major complications were recorded.
CONCLUSIONS
The combined use of intraoperative endoscopy with a laparoscopic or robotic approach optimises identification of the prostatic utricle and enables precise, controlled dissection.
In this cohort, minimally invasive excision of the prostatic utricle proved to be a safe and effective technique.
Nevertheless, larger patient series are required to draw statistically robust conclusions and to further validate these findings.