ESPU Meeting on Thursday 18, June 2026, 11:20 - 12:20
11:20 - 11:25
S11-1 (VP)
Ignacio ARENAS NORTON, Javier RUIZ, Nicolas ROSIERE, Francisco IMAZ, Danel ALBERTI, Leandro ASEN, Otilia BLAIN, Felicitas LÓPEZ IMIZCOZ, Yesica GÓMEZ, Cristian SAGER, Carol BUREK and Santiago WELLER
Hospital Garrahan, Pediatric Urology, Caba, ARGENTINA
INTRODUCTION
Urethral stricture is an uncommon but challenging complication in patients with complex urethral malformations. Paclitaxel inhibits smooth muscle cell proliferation and collagen production, modulating the healing process and reducing the risk of restenosis. Its local application through drug-coated balloons has shown efficacy in animal models, in adults, and more recently in complex pediatric cases.
MATERIAL AND METHODS
We present a video demonstrating the surgical technique of urethral dilation using a paclitaxel-coated balloon in a patient with pan-urethral stricture.
RESULTS
We report the case of a one-year-old male patient with Y-type urethral duplication, under postoperative follow-up after mobilization of the ventral urethra. The patient developed urinary retention due to complete urethral stenosis, leading to the diagnosis of pan-urethral stricture.
Predilation was performed using a 6-mm × 60-mm PTA balloon inflated to 10 atmospheres for 5 minutes. This was followed by dilation with a paclitaxel-coated balloon of the same dimensions, first inflated to 10 atmospheres for 5 minutes and then to 12 atmospheres for 2 minutes. Both dilations were carried out under fluoroscopic guidance. No intraoperative or postoperative complications were observed. The patient subsequently regained normal urethral voiding. The suprapubic catheter was successfully removed two weeks after the procedure. Follow-up ultrasound was normal.
CONCLUSIONS
The use of paclitaxel-coated balloons represents a safe and effective alternative for managing complex pediatric urethral strictures, extending the applicability of protocols already validated in adults to challenging reconstructive scenarios in children.
11:25 - 11:28
S11-2 (CP)
Usman KAHLOON 1, Michael CHUA 1, David LEVIN 2, Samer MAHER 1, Julia LEVIN 3, Lizz BORUTSKI 3, Barbara PANNOZZO 1, Armando LORENZO 1, Mandy RICKARD 1, Abby VARGHESE 1 and Joana DOS SANTOS 1
1) The Hospital For Sick Children, Division of Urology, Toronto, CANADA - 2) The Hospital For Sick Children, Division of Anesthesia, Toronto, CANADA - 3) The Circumcision Clinic, Toronto, CANADA
PURPOSE
Bleeding is the most common early complication of neonatal circumcision despite standardized technique. 2-Octyl cyanoacrylate (2OCA), a topical skin adhesive, may enhance hemostasis, improve wound approximation, and serve as an antimicrobial barrier. The objective of this institutionally approved (REB #1000070281) multi-site double-blinded randomized controlled trial is to evaluate the efficacy and safety of 2OCA compared with standard of care (SOC; petroleum jelly) in reducing post-circumcision complications.
MATERIAL AND METHODS
Healthy neonates (2–60 days) were randomized 1:1 by sealed envelopes to 2OCA or SOC following circumcision using Gomco or Mogen clamps under local anesthesia (0.5% bupivacaine ± 1% lidocaine). The operating physician was blinded to allocation until clamp removal. The primary endpoint was intraoperative bleeding requiring compression dressing, silver nitrate, or suturing. Continuous variables were compared using two-sample t-tests, multi-category variables using Wilcoxon rank-sum tests, and binary categorical variables using Fisher’s exact tests (p<0.05). Bleeding risk was estimated with univariate logistic regression. All analyses followed an intention-to-treat approach.
RESULTS
One hundred neonates were included (2OCA n=42; SOC n=58). Baseline characteristics were comparable between groups (Table 1). Bleeding occurred in 4.8% of 2OCA versus 31.0% of SOC cases (p<0.001). On univariate logistic regression, 2OCA use was associated with an 89% reduction in the odds of bleeding (B=–2.20; SE=0.78; Wald=7.97; p=0.005; OR, 0.11; 95% CI, 0.02–0.51). Subgroup analysis showed significance for Gomco circumcisions (3.7% vs 42.1%; p<0.001) but not for Mogen (6.7% vs 11.1%; p=0.66).
Table 1. Baseline Characteristics of Participants by Study Group
| a Two-sample t-test. b Wilcoxon rank-sum test. c Fisher’s Exact test. |
|||
|
Baseline Variable |
Intervention (n=42) |
Control (n=58) |
p-value |
|
Age (days), mean ± SD |
38 ± 18 |
35 ± 16 |
0.34a |
|
Weight (kg), mean ± SD |
4.4 ± 0.8 |
4.4 ± 0.8 |
0.89a |
|
Ethnicity, (%) |
0.39b |
||
|
Caucasian/White |
42 |
36 |
|
|
Black |
8 |
3.5 |
|
|
East Asian |
15 |
11 |
|
|
Middle Eastern |
8 |
3.5 |
|
|
Other |
27 |
46 |
|
|
Indication, (%) |
0.46c |
||
|
Elective |
90 |
95 |
|
|
Medically Indicated |
10 |
5 |
|
|
Clamp, (%) |
0.83c |
||
|
Gomco |
65 |
68 |
|
|
Mogen |
35 |
32 |
|
|
Surgeon Experience, (%) |
0.22b |
||
|
Staff (medical) |
21 |
18 |
|
|
Staff (surgical) |
21 |
14 |
|
|
Fellow (2nd year) |
50 |
54 |
|
|
Fellow (1st year) |
7 |
14 |
|
|
Local Anesthetic Used, mean ± SD (mL) |
|||
|
0.5% Bupivacaine |
1.8 ± 0.6 |
2.4 ± 3.5 |
0.24a |
|
1% Lidocaine |
2.0 ± 0.6 |
2.0 ± 0.7 |
0.89a |
CONCLUSIONS
2OCA significantly reduced bleeding compared with standard closure. Moreover, these findings suggest that if using a Gomco clamp, 2OCA should be considered to minimize bleeding risk. These interim findings support 2OCA as a safe and effective hemostatic alternative, with final results forthcoming upon study completion.
11:28 - 11:31
S11-3 (CP)
Shafiea KHAN, Atif SAEED, Murtaza KHANBHAI, Muhammad Ruhul AMIN, Darrel GREGORY and Abdul Rauf KHAN
Thornhill Clinic, Surgery, Luton, UNITED KINGDOM
PURPOSE
Non-Therapeutic Male Circumcision (NTMC) is commonly performed in the community, yet there are no formal national guidelines on the best age for the procedure. Existing evidence indicates that age may directly influence complication rates. This study aims to identify the age for NTMC associated with the lowest complication rate over seven years in a specialist community clinic .
MATERIAL AND METHODS
A retrospective cohort study was conducted on 7633 NTMC procedures performed under local anaesthesia in a community clinic. NTMC utilised either the Circumplast® (n=2074) or Plastibell® (n= 5559) device. The choice of device depended on the doctor' s preference, considering the child' s anatomy and the parents’ choice. Patients were divided into four age groups: Group A (24 months, n=575) All circumcisions were performed by trained doctors and paediatric surgeons. The primary outcome was the overall complication rate, compared across age groups. Surgeon-specific complication rates were also analysed using a chi-square test.
RESULTS
The mean age was 51. 0 days (median 34) in Group A (n= 6071), 257. 0 days (median 250) in Group B (n= 646), 545. 8 days (median 541) in Group C (n= 341), and 1707. 7 days (median 1465) in Group D (n= 575). There was a significant, stepwise increase in the overall complication rate with age: Complications in Group A (6.4% n=387/6071) compared to Group B (13.2% n=85/646 ), Group C (16.1% n=55/341), and Group D (28.2% n=162/575) (p< 0. 0001). For infants under 6 months, there was no significant difference in complication rates between the Circumplast® (6.7%) and Plastibell® (6.0%) devices. Surgeon variability was minimal, and the most experienced surgeon (n=2557) showed significantly fewer complications in Group A (6.0%n=109/1814) compared to Group B (8.8% n=18/204), Group C (16.0% n=20/125), and Group D (27.4% n=104/380). Specific complications such as ring removal, migration, and infection significantly increased with age (p< 0.0001), while adhesions and bleeding did not (p> 0.05). The mean follow- up was 17 ± 1 days (median 6).
CONCLUSIONS
Complication rates following NTMC increase significantly with age. To minimise complications and enhance patient safety, it is recommended to perform NTMC within the first six months of life in a community setting, using either the Circumplast® or Plastibell® device. Future research should explore which specific months within the first six carry the lowest risk.
11:43 - 11:46
S11-4 (CP)
Erika LÖNNGREN and Martin Jonathan SALO
Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden, Department of Clinical Sciences, Pediatrics, Lund University, Lund, Sweden, Lund, SWEDEN
PURPOSE
Problems with the foreskin in terms of pathological phimosis is a highly prevalent conditions among boys and often a cause of concern for parents. Topical steroids as first line treatment for symptomatic phimosis is recommended by the EAU guidelines and is always the choice in countries where boys are not routinely circumcised. Due to an increase in the number of boys with phimosis referred to our outpatient clinic, leading to increased demand, and longer waiting times for other patients, an assistant-nurse led clinic for management of these boys were started. The aim of this study was therefore to evaluate the implementation, treatment success, and long-term follow-up of an assistant-nurse led clinic for management of boys with phimosis.
MATERIAL AND METHODS
All boys < 15 years referred for treatment of symptomatic phimosis to the assistant-nurse clinic between 2017-2018 were studied. Primary outcome was successful treatment defined as complete or partial response to steroid ointment, and not needing foreskin surgery at long-term follow up. Independent variables were age, duration and type of symptoms, and prior and prescribed treatment with steroid ointment. Factors associated with a successful treatment were evaluated with multiple logistic regression and presented as adjusted odds ratios (aOR) with a 95% confidence interval (95% CI).
RESULTS
A total of 240 boys were included. Follow-up of all boys was 7-8 years. Mean age was 9.3 years, and the median symptom duration was four months. About 1/3 had history of balanitis and 80% had previous been prescribed steroid ointment. About 67% (162) had indication for steroid treatment, 7% (16) got referred for surgery directly, and 26% (62) got expectant management. No child was misdiagnosed at the first visit when retrospectively evaluated. Of the 162 treated with steroid ointment, 78% had successful treatment. The only symptom affecting treatment success was micturition pain at diagnosis (aOR 0.38 95%CI (0.17-0.83), p=0.015).
CONCLUSIONS
The implementation of an assistant-nurse outpatient clinic for management of boys with phimosis has been successful. An estimation of 1000 boys have been managed during the eight years passed. No patients were misdiagnosed and the success rate of steroid ointment is comparable to previous studies.
11:46 - 11:49
S11-5 (CP)
Lena-Maria PROMM 1, Claudia NEISSNER 1, Pirmin I ZÖHRER 1, Christopher GOSSLER 2, Wolfgang H. RÖSCH 1, Wolfgang OTTO 2, Gudula KIRTSCHIG 3, Alba TROCI 4, Corinna BANG 4 and Martin PROMM 5
1) Clinic St. Hedwig, University Medical Center of Regensburg, Department of Pediatric Urology, Regensburg, GERMANY - 2) University of Regensburg, Caritas St. Josef Medical Center, Department of Urology, Regensburg, GERMANY - 3) Medbase Health Centre, Dermatology, Frauenfeld, SWITZERLAND - 4) Christian-Albrechts-University of Kiel, Institute of Clinical Molecular Biology, Kiel, GERMANY - 5) Klinik St. Hedwig, Paediatric Urology, Regensburg, GERMANY
PURPOSE
Lichen sclerosus(LS) is a chronic inflammatory skin disease which can affect the foreskin and lead to a relevant phimosis. The pathogenesis is little understood. The aim of this prospective study was to analyze and compare the microbiota of boys with scarring phimosis with and without histological proof of LS. We compared the bacterial abundance of preoperatively gained urine, an intraoperatively gained swab of the balanopreputial sac as well as the affected foreskin.
MATERIAL AND METHODS
Between 01/2021 and 12/2022 we included 53 boys with scarring phimosis, the study group comprised 24 with and 29 boys without histological proof of LS. Urine, skin swabs and a part of the affected foreskin were obtained for analysis of the microbiota by 16S rDNA sequencing. Subsequently, we analyzed alpha- and beta-diversity of microbiota profiles and performed differential abundance analysis.
RESULTS
In the histological analysis LS was verified for all 24 patients whereas all 29 controls showed no hint for LS. At the time of surgery, median age of patients with LS was 9.5 years(y) (range 5-14y), and controls had a median age of 8y (range 3-14y).
Microbiota analysis: In general, we detected microbial species from the phyla Actinobacteria, Bacteroidetes, Firmicutes, Fusobacteria and Proteobacteria in all three different sample types (urine, skin swabs and biopsies). Whereas a significantly increased bacterial richness (alpha-diversity) for patients with LS could be observed in the swabs(p=0.002), we couldn't find significant differences for biopsies(p=0.61) and significantly less diverse bacterial communities in the urine samples(p=0.05).Beta-diversity also revealed that the bacterial microbiota compositions of urine(p=0.05), swab(p=0.01) and biopsy(p=0.008) differ significantly between the two groups. Subsequently performed differential abundance analysis for each sample type demonstrated more bacterial Amplicon Sequence Variant(ASVs) to be increased in patients with LS (PFDR<0.05). Interestingly, we observed several ASVs from the genera Prevotella, Porphyromonas, Peptoniphilus, Ezakiella and Varibaculum to be consistently increased in all tested sample types of the patients with histological proof of LS.
CONCLUSIONS
In this study, significant differences in respect to the bacterial diversity and composition could be shown between patients with and without histologically proved LS. The identified relevant abundance shifts of several bacterial species in patients with LS warrants further studies to understand their potential role in disease etiology or progression.
11:49 - 11:52
S11-6 (CP)
Zafar ABDULLAEV, Kobiljon ERGASHEV, Kamron KHIDOYATOV, Askar SOLIEV, Sarvar ESHANKULOV and Saidanvar AGZAMKHODJAEV
National Children's Medical Center, Pediatric urology, Tashkent, UZBEKISTAN
PURPOSE
Postoperative complications after concealed penis repair include severe edema, wound problems, and skin damage, which may persist for a long time. This prospective study evaluated the efficiency of a minimally invasive concealed penis repair technique.
MATERIAL AND METHODS
This prospective comparative cohort study included 34 consecutive patients operated on between 2023 and 2025.
Patients were divided into two groups: Group A included 12 patients (35.2%) who underwent the minimally invasive (MI) technique, and Group B consisted of 22 patients (64.7%) in the control group who underwent the standard repair. Early and late postoperative outcomes were assessed over one year. Data were analyzed using Pearson's chi-square, Fisher's exact test, and independent t-tests with Welch's correction for continuous data (p < 0.05).
RESULTS
The median age at surgery was 60 ± 36 months in both groups. The duration of surgery was significantly shorter in Group A (63.3±4.5 minutes) compared with Group B (88.5±11.3 minutes). No significant differences were observed in wound dehiscence (p = 0.676) or scar formation (p = 0.228). The MI technique showed a significantly lower rate of postoperative edema (p = 0.046) compared with the standard technique. Additionally, the incidence of skin complications was significantly lower in Group A (p = 0.032).
CONCLUSIONS
The minimally invasive technique for the correction of concealed penis demonstrated lower early postoperative morbidity, particularly in terms of edema and skin complications, compared with the traditional method. The technique appears safe, effective, and suitable for broader clinical application. Further prospective studies with larger cohorts are recommended.
11:52 - 11:57
S11-7 (VP)
Mustafa KABA, Murat Yavuz KOPARAL, Mustafa Ozgur TAN and Serhat GUROCAK
Gazi University, School of Medicine, Department of Urology, Ankara, TÜRKIYE
PURPOSE
To describe the surgical technique and clinical outcomes of ventral onlay urethroplasty using a preputial skin graft for the treatment of a recurrent bulbar urethral stricture in a pediatric patient with a history of multiple catheterizations and prior major abdominal surgery.
MATERIAL AND METHODS
A 10-year-old boy with a history of multiple urethral catheterizations following liver transplantation surgery and repeated endoscopic interventions presented with persistent voiding symptoms and ineffective intermittent self-catheterization. Ventral onlay urethroplasty using a preputial skin graft was planned. Preoperative uroflowmetry demonstrated a Qmax of 7.6 mL/s, a Qave of 6 mL/s, and a voided volume of 153 mL. Operative duration, postoperative course, and functional outcomes were prospectively recorded.
RESULTS
The procedure was successfully completed with an operative time of 112 minutes. The patient was discharged on postoperative day 2, and the urethral catheter was removed on day 10. Self-catheterization was no longer required. At the one-year follow-up, uroflowmetry revealed marked improvement, with a Qmax of 23 mL/s, a Qave of 14.6 mL/s, and a voided volume of 200 mL. No postoperative complications or stricture recurrence were observed.
CONCLUSIONS
Ventral onlay urethroplasty using a preputial skin graft is a safe, feasible, and effective option for managing bulbar urethral strictures in pediatric patients, particularly those without prior circumcision and with a history of repeated urethral instrumentation. This case demonstrates excellent one-year functional outcomes and supports the use of preputial skin as a reliable graft material in pediatric urethral reconstruction.