ESPU Meeting on Thursday 18, June 2026, 09:40 - 10:35
09:40 - 09:43
S10-1 (CP)
Naima SMEULDERS 1, Florent GUERIN 2, Sheila TERWISSCHA VAN SCHELTINGA 3, Alexander CHO 4, Timothy ROGERS 5, Federica DE CORTI 6, Ross CRAIGIE 7, Gabriela GUILLEN BURRIEZA 8, Patrizia DALL'IGNA 9, Ana L LUIS HUERTAS 10, Beatrice COPPADORO 9, Ilaria ZANETTI 9, Olga SLATER 4, Trung NGUYEN 4, Julia CHISHOLM 11, Veronique MINARD-COLIN 12, Mark GAZE 13, Pei LIM 13, Raquel DAVILA FAJARDO 3, Sophie ESPENEL 12, Cyrus CHARGARI 12, Gianni BISOGNO 9, Hans MERKS 3 and Helene MARTELLI 2
1) Great Ormond Street Hospital NHS Trust, Department of Paediatric Urology, London, UNITED KINGDOM - 2) Public Assistance Hospitals Paris, Paris, FRANCE - 3) Princess Maxima Centrum, Utrecht, NETHERLANDS - 4) Great Ormond Street Hospital for Children, London, Uk, UNITED KINGDOM - 5) Bristol Royal Hospital for Children, Bristol, UNITED KINGDOM - 6) Padua University Hospital, Padua, ITALY - 7) Royal Manchester Children's Hospital, Manchester, UNITED KINGDOM - 8) Hospital Vall d'Hebron, Department of Paediatric Surgery, Bareclona, SPAIN - 9) Universitat degli Studi di Padova, Padua, UNITED KINGDOM - 10) Hospital Universitario La Paz, Madrid, SPAIN - 11) Royal Marsden Hospital, Sutton, UNITED KINGDOM - 12) Institut Gustave Roussy, Paris, FRANCE - 13) University College London Hospitals, London, UNITED KINGDOM
PURPOSE
Salvage of patients with bladder-prostate rhabdomyosarcoma (BP-RMS), who progress or relapse, remains challenging. The EpSSG RMS2005 trial captured all patients with rhabdomyosarcoma without distant spread. This report explores local therapy after local disease progression or relapse (LP/LR).
MATERIAL AND METHODS
All patients with BP-RMS prospectively enrolled in RMS2005 (2005-2016) were reviewed for their first- and second-line treatment. Local therapy (LT) was categorized, differentiating organ-sparing surgery (OSS) from organ-depleting surgery (ODS) and brachytherapy (BT) from external-beam radiotherapy (EBRT). Progressive disease, relapse or death were considered events for progression-free-survival (PFS) and all deaths for overall survival (OS). Statistics: Kaplan-Meier survival probability.
RESULTS
The cohort comprised 199 patients (aged 10days-21.8years; median 2.6years), 181 with localised BP-RMS and 18 with extension to loco-regional nodes (histology: 191-favourable, 8-unfavourable (3xfusion-gene positive); tumour diameter <5cm in 64 and >5cm in135).
5year-PFS was 79.1% (95%CI:72.7-84.2%); 5year-OS was 89.2% (95%CI:84.0-92.9%). Of 42 events, 35 were confined loco-regionally: 32 in localised BP-RMS and 3 in nodal-extension at diagnosis. Patients were aged 10days-21.8yrs (median 2.4yrs; 34-favourable, 1-alveolar histology (fusion-negative); 10 tumours <5cm and 25 >5cm).
Ten events were LP (after 2-7 chemotherapy cycles) before LT had been delivered: 6 achieved complete-clinical-remission (CCR) and 4 died. Twenty-five suffered LR after first-line LT: surgery-alone in 6, OSS+BT in 8, EBRT-alone 4 and any other surgery+radiotherapy combinations in 7: 11 achieved a 2nd-CCR, 1 is alive with LR and 13 died.
LT after LP/LR was none in 2(2 died), chemotherapy-alone in 6(1-CCR,5-died), OSS in 3(1-CCR,2-died), radical ODS in 9(5-CCR,4-died), BT in 1(1-CCR), OSS+BT in 4(4-CCR), ODS+BT in 2(2-CCR), EBRT in 1(1-died), OSS+EBRT in 3(1-CCR,1-alive with LR,1-died), ODS+EBRT in 3(1-CCR,2-died). Timing of LT after LP/LR was at relapse in 5(1-CCR, 1-alive with LR, 3-died) or after relapse chemotherapy cycle-1 in 1(1-CCR), cycle-2 in 5(2-CCR, 3-died), cycle-3 in 2(1-CCR, 1-died), cycle-4 in 7(6-CCR, 1-died), cycle-5 in 1(1-CCR), cycle-10 in 1(died), cycle-12(died).
CONCLUSIONS
Local therapy is important for salvage after LP/LR for BP-RMS, as chemotherapy alone does not usually suffice. Nevertheless, some chemotherapy at the point of relapse ahead of LT appears beneficial, although delaying LT beyond 4-5 cycles of chemotherapy is not advised.
09:43 - 09:48
S10-2 (VP)
Emma VAN RESPAILLE 1, Letizia CORBI 2, Joris VANGENEUGDEN 1, Mieke WATERSCHOOOT 1 and Nicolaas LUMEN 1
1) University Hospital Ghent, Urology, Ghent, BELGIUM - 2) Bambino Gesù Children's Hospital IRCSS, Pediatric Surgery, Roma, ITALY
PURPOSE
Rhabdomyosarcoma (RMS) with prostatic involvement represents a rare subtype of pediatric soft tissue sarcoma. The golden standard treatment of RMS typically involves a multimodal approach, combining neoadjuvant chemotherapy to reduce tumor size followed by surgical resection. Recent advances in minimally invasive surgery, particularly robot-assisted laparoscopic radical prostatectomy (RALP), have expanded the therapeutic possibilities for deep pelvic tumors However, its application remains controversial and under investigation.
MATERIAL AND METHODS
We document the case of a 19-month-old boy presenting with acute urinary retention. Ultrasound revealed a bladder mass with bilateral hydronephrosis and MRI confirmed the 6×5.6×8 cm mass, originating from the prostate and extending to the bladder base with involvement of the ureteral orifices. Biopsy results confirmed an embryonic, fusion-negative rhabdomyosarcoma. PET-CT-staging showed no distant metastases, thus classifying as a cT2b N0 M0 tumor according to the FaR-RMS-C protocol with standard-risk group.
The patient received neoadjuvant chemotherapy (Ifosfamide-Vincristine-ActinomycinD regimen) resulting in significant tumor size reduction, followed by a robot-assisted radical prostatectomy using Bocciardi Retzius-sparing technique (Galfano et al). The procedure was uneventful, with en-bloc-resection of the tumor and watertight vesico-urethral anastomosis. Histopathological examination revealed no viable tumor cells and negative surgical margins. Adjuvant chemotherapy was continued without complications and follow-up imaging showed no clear evidence of recurrence at three months of follow-up. The functional outcome seems successful: The boy had a sufficient bladder capacity and no need of suprapubic catheter.
RESULTS
This case highlights the potential of robot-assisted surgery in the management of pediatric prostate rhabdomyosarcoma. Although robotic surgery for RMS is still considered experimental and not yet standardized, the IPSO and FaR-RMS protocols have begun to acknowledge its benefits in specific, selected cases. In our patient, youngest of the series, robotic surgery provided the advantage of minimal invasiveness, precise tumor excision, and preservation of surrounding structures, with a favorable oncological outcome so far.
CONCLUSIONS
Robot-assisted radical prostatectomy in a local RMS without invasion of the bladder after neo-adjuvant chemotherapy seems safe and effective in children of 1 year and older. While the technique is still under investigation, early results are promising and further research is necessary to validate its role in pediatric onco-urology.
09:56 - 09:59
S10-3 (CP)
Johana PAEZ 1, Naeem SAMNAKAY 2, Andres GOMEZ 3, Camilo ORJUELA 4, Yair CADENA 4, Javier RUIZ 5, Imran MUSHTAQ 6, Jose ESCALA 7, Sonia PEREZ 8, Luis GARCIA-APARICIO 9, Beatriz FERNANDEZ 10, Carlos LARIOS 11, Sibel TIRYAKI 12, Dana OBERY 13, Eman CHAUDHRI 13, Juan MOLDES 1 and Pedro-José LOPEZ 1
1) University Hospitals Rainbow Babies and Children's, Pediatric urology, Cleveland, USA - 2) Institute for Paediatric Perioperative Excellence, The University of Western Australia, Surgery, Perth, AUSTRALIA - 3) Hospital 12 Octubre, Pediatric urology, Madrid, SPAIN - 4) Fundación Cardioinfantil, Pediatric urology, Bogotá, COLOMBIA - 5) Hospital de pediatría J. P. Garrahan, Pediatric urology, Cuidad De Buenos Aires, ARGENTINA - 6) Great Ormond Street Hospital, Paediatric urology, London, UNITED KINGDOM - 7) Clinica Las Condes, Pediatric urology, Santiago, CHILE - 8) Hospital Sant Joan de Déu, Pediatric Urology Unit, Barcelona, SPAIN - 9) Hospital Sant Joan de Déu, Pediatric urology, Barcelona, SPAIN - 10) Hospital General Universitario Gregorio Marañón, Pediatric urology, Madrid, SPAIN - 11) Clínica infantil Santa Maria del lago, Pediatric urology, Bogotá, COLOMBIA - 12) Ege University, Department of Pediatric Surgery, Division of Pediatric Urology, Izmir, TÜRKIYE - 13) University Hospitals, Urology institute, Cleveland, USA
PURPOSE
Nephrogenic adenoma (NA) is an uncommon benign epithelial lesion of the urinary tract, most frequently arising in the bladder. Pediatric cases are rare and typically occur in the setting of chronic mucosal irritation related to infection, surgery, trauma, or stones. Given its overlapping morphologic features with malignant processes, accurate diagnosis in children can be challenging, and the available literature remains limited. This study looks to describe presentation, management, and outcomes of NA in the pediatric population.
MATERIAL AND METHODS
After institutional review board approval, we performed a retrospective descriptive study of pediatric patients under 18 years with histologically confirmed NA. Cases were collected through international collaboration with the European Society for Pediatric Urology (ESPU) and the Iberoamerican Society of Pediatric Urology (SIUP). Patients aged ≥18 years or those with insufficient clinical data were excluded. Demographic, clinical, histologic, treatment, recurrence, and follow-up outcomes were analyzed descriptively.
RESULTS
Sixteen pediatric cases of NA were identified across 11 centers in 7 countries. The mean age at diagnosis was 7.6 years (median 6; range 2.5-17), and 9 (56%) were female. Management included seven transurethral resections (44%), three partial cystectomies (19%), two transurethral fulgurations (13%), two intravesical sodium hyaluronate instillations (13%), one laparoscopic-to-open cystectomy (6%), and one surveillance (6%). The predominant histologic subtype was mixed tubular-papillary (63%); no malignant transformation. Recurrence developed in 5 patients (31%) after a mean of 12 months; 2 were managed with repeat resection, 2 with fulguration, and 1 with open bladder mucosectomy, who also received intravesical sodium hyaluronate. None of the NA recurrences had malignant pathology. Mean follow-up was 4.9 years; 10 (63%) were disease-free at last visit.
CONCLUSIONS
NA in children is a rare benign lesion characterized by bladder predominance, potential multifocality, and notable recurrence rates. This study represents the largest pediatric multicenter cohort reported to date and further delineates its clinical and histopathologic profile. Transurethral resection remains the most frequently used initial treatment and provides durable control for most patients, although approximately one-third experience recurrence without malignant progression. Ongoing international collaboration is essential to improve recognition, standardize management, and develop evidence-based follow-up strategies for this rare entity.
09:59 - 10:02
S10-4 (CP)
Sajid SULTAN 1, Bashir AHMED 2, Sadaf ABA UMER KODAVWALA 1, Muhammad Shamvil ASHRAF 1, Hira IRSHAD 1, Tahir HUSSAIN 1 and Syed Adeeb UL HASSAN RAZVI 1
1) SINDH INSTITUTE OF UROLOGY AND TRANSPLANTATION, Philips G Ransley Department of Paediatric Urology, Karachi, PAKISTAN - 2) Sindh Institute of Urology & transplantation, Philips G Rensley Department of Paediatric Urology, Karachi, PAKISTAN
PURPOSE
To assess the clinical features, management, and outcomes of children with CCSK treated at a single center using SIOP and umbrella protocols.
MATERIAL AND METHODS
We reviewed prospectively collected data of all children with histopathologically confirmed CCSK from 2007–2024, analyzing demographics, presentation, biopsy findings, radiological staging–based treatment, surgical details, and follow-up outcomes. Overall and event-free survival were calculated. Statistical analysis was performed using SPSS (version 20, 2011). For numerical data, percentages were calculated.
RESULTS
A total of 33 patients were included. Most presented with an abdominal mass (30/33, 90%), abdominal pain (12/33, 36%), or hematuria (5/33, 15%); two had a history of trauma. The cohort included 26 males and 7 females, with mean age of 4.0 ± 2.4. Tru-cut biopsy was performed in 28 (84%): 20 (60%) confirmed CCSK, 5 (15%) were inconclusive, 2 (6%) were reported as round blue cell tumors, and 2 (6%) as necrotic tissue. Neoadjuvant chemotherapy was given to 22 (66%): VAD in 9 (40%), VAD with high-risk modification in 3 (13%), and high-risk protocols in 5 (22%). Two received VA and one VAC for inconclusive pathology.
Of the 33 patients, upfront nephrectomy was performed in 11 (33%), and in 22 (66%) radical nephrectomy followed neoadjuvant chemotherapy. Postoperative staging showed stage I in 13 (39%), stage III in 12 (36%), and stage IV in 8 (24%). Among stage III cases, lymph-node involvement occurred in 5 (41%), thrombus in 3 (25%), and positive margins in 4 (33%). Of stage IV patients, 4 (50%) had local stage I and 4 (50%) local stage III tumors; all (100%) had pulmonary metastasis. In stage I (10/13), there was one relapse, one lost to follow-up at 4 months, one lost after 2 years post-treatment, and one expired. In stage III (9/12), two were lost to follow-up for 3.5 years, two relapsed (one with positive margins and LNs), and one expired. In stage IV (8 patients; local stage I = 4 [50%], local stage III = 4 [50%]), all had LNs, and one patient (local stage I) died after relapse. Overall and event-free survival were favorable, 90% and 87% respectively, approaching outcomes of Wilms tumor.
CONCLUSIONS
CCSK shows favorable outcomes with standardized multimodal therapy under SIOP-based management with survival comparable to Wilms tumor
10:10 - 10:13
S10-5 (CP)
Judy Ws HUNG
Hong Kong Children's Hospital, Surgery, Hong Kong, HONG KONG
PURPOSE
Haemorrhagic cystitis (HC) is a known complication of hematopoietic stem cell transplant (HSCT) with an incidence of 10-20%. While acute morbidity is significant, no study has evaluated long-term bladder function in this cohort. We aimed to characterize the long-term urological outcomes of paediatric HSCT survivors who developed HC.
MATERIAL AND METHODS
A retrospective cohort study (Jan 2018-Dec 2023) was conducted on patients under 18 who underwent HSCT at a tertiary oncology centre.Inclusion criteria were all patients with HSCT done identified from aprospective regional database.Data such as age, gender, diagnosis, types of HSCT, conditioning regime and presence of concurrent graft versus host disease (GVHD) and veno-occlusive disease (VOD) were collected. Bladder function of patients who had hemorrhagic cystitis were objectively assessed by International Consultation on Incontinence Questionnaire (ICIQ) and uroflowmetry. Parent and patient score, uroflowmetry parameters such as bladder capacity, maximum flow rate, residual urine and shape of curve was analyzed. Continuous and categorical, data were analyzed using Mann Whitney-U test and Chi square test with SPSS version 29.0.2.0.
RESULTS
HSCT was performed on 108 patients (64 male) with a median age of 9.5 years (IQR 4.6-12.9). HC was diagnosed in 21 patients (Group A, 19.4%). Significant risk factors for development of HC included older age (12.9 yrs [IQR 7.7-15.2] vs. 8.1 yrs [IQR 4.1-12.5], p<0.05), GVHD (81% [17/21] vs. 36% [31/87], p<0.05), and VOD (67% [14/21] vs. 12% [10/87], p<0.05). At a median follow-up of 34 months(IQR 29.5 to 52), 13 HC survivors underwent assessment. The median ICIQ score was 12 (IQR 11-14), indicating moderate-severe symptoms. Uroflowmetry abnormalities were present in 84.6%, with reduced bladder capacity being the most common finding.
CONCLUSIONS
Hemorrhagic cystitis after paediatric HSCT is associated with older age, GVHD, and VOD. Despite survivors potentially adapting to their symptoms, standardized questionnaires revealed a significant burden of moderate subjective incontinence. This, combined with a high prevalence of objective uroflowmetry abnormalities, underscores the necessity for structured long-term urological follow-up.
10:13 - 10:16
S10-6 (CP)
Irene IJGOSSE 1, Aart J. KLIJN 2, Ruud WORTEL 2, Leendert LOOIJENGA 1, Rogier SCHROEDER 2, Ralph OUDE OPHUIS 3, Margreet VEENING 1, Lideke VAN DER STEEG 1, Sruthi SRIRAM 1 and Marianne VAN DE WETERING 1
1) Prinses Maxima Centrum voor kinderoncologie, Pediatric oncology, Utrecht, NETHERLANDS - 2) UMC Utrecht, Pediatric urology, Utrecht, NETHERLANDS - 3) UMC Utrecht, Voortplantings geneeskunde, Utrecht, NETHERLANDS
PURPOSE
Pediatric cancer survival now exceeds 80%, yet gonadotoxic chemotherapy causes high risk for infertility in 25-35% of male survivors. While semen cryopreservation is established for pubertal boys, prepubertal patients require preservation of the spermatogonal precurser cells, the stem cells. We present outcomes from a systematic national oncofertility program integrating testicular tissue cryopreservation into routine prepubertal cancer care.
MATERIAL AND METHODS
Between 2021-2025, newly diagnosed male oncology patients were risk-stratified according to international PanCareLIFE guidelines. All high-risk patients (n=410) received structured counseling by a multidisciplinary team including pediatric oncologists, a fertility nurse practitioner, and pediatric urologists. Of patients choosing fertility preservation (n=234, 57%) 152 (post)pubertal boys opted for semen preservation. 82 prepubertal boys agreed on unilateral open trans-scrotal testicular biopsy during general anesthesia scheduled for port-a-cath placement. With informed consent, 15% of tissue was allocated for spermatogonial stem cell (SSC) research; 85% was cryopreserved. Tissue viability and histopathology were assessed for research samples. Surgical complications were systematically evaluated immediately post-operatively and at structured follow-up intervals
RESULTS
All 82 testicular biopsies yielded tissue suitable for cryopreservation with volumes correlating to testicular size. Histological examination confirmed presence of spermatogonial stem cells in all samples allocated for research. No intra-operative complications occurred. Post-operatively, one patient (1.2%) developed a self-limiting scrotal hematoma requiring no intervention. No testicular atrophy, infection, delayed wound healing, or long-term adverse events were documented. The procedure added minimal time to anesthesia, and cancer treatment initiation was not delayed in any case.
CONCLUSIONS
Systematic implementation of a multidisciplinary oncofertility program successfully counseled 57% of high-risk patients. Unilateral testicular tissue biopsy in prepubertal boys is safe (1.2% complication rate), achieves 100% cryopreservation success, and does not delay cancer treatment. This standardized approach demonstrates feasibility of fertility preservation and supports SSC cryopreservation as standard-of-care in pediatric oncology centers.
10:16 - 10:19
S10-7 (CP)
Reut SHASHAR, Valentin SHABATAEV, Akram ASSADI and Sergiu BISTRITCHI
RAMBAM HEALTH CARE CAMPUS, HAIFA, ISRAEL, UROLOGY, Haifa, ISRAEL
PURPOSE
The improvement in survival rates among children with oncological diseases poses a urological challenge due to the need for fertility preservation, as the absence of such preservation may leave these children with significant disabilities later in life. Electroejaculation is a technique that uses electrical pulses through the rectum to obtain sperm for children who are unable to produce sperm on their own. The aim of this study is to describe our experience in electroejaculation, examine the success rates and to recognize predictive factors for success in these children.
MATERIAL AND METHODS
A retrospective study of children with oncological diseases who underwent electroejaculation between 2016 and 2024. Data were collected regarding their illness, Tanner stage, hormonal function, information about the procedure, and success rates. Success was defined as the production of fluid containing sperm from which at least one sample was frozen and stored in a sperm bank.
RESULTS
A total of 27 children were included, of which 14 (51.9%) had hematological malignancies, 8 (29.6%) had sarcomas, and 5 (18.5%) had other solid tumors. Seven children (25.9%) received chemotherapy prior to the procedure. The median age was 14.9 years (12.4-18). The procedure was performed under general anesthesia, with 6 children (22.2%) undergoing the procedure as part of another surgery. The success rate was 51.9% (14/27 children), with the youngest child who had success was 12.9 years old. Among the children whose attempts were unsuccessful, 5 also underwent TESE following the procedure, and all attempts were unsuccessful and did not produce any viable sperm. A comparison between children who succeeded in the procedure and those who did not showed that the median testosterone levels were higher: 9.32 compared to 3.39. The median Tanner stage was similar – 4 (3-5). In children who received chemotherapy prior to the procedure, the success rates were particularly low – 28.6% compared to 60%.
CONCLUSIONS
Electroejaculation can lead to sperm production in pediatric oncology patients, with success rates of approximately 51.9%. Children with higher testosterone levels who have not yet received chemotherapy are the best candidates. The efficacy of TESE following the failure of electroejaculation is questionable.