ESPU Meeting on Thursday 18, June 2026, 14:00 - 15:00
14:00 - 14:05
S12-1 (VP)
Pauline LOPEZ 1, Alexis BELGACEM 1, Jenna HOUARI 1, Aurélien DESCAZEAUD 2, Xavier PLAINARD 2, Laurent FOURCADE 1 and Quentin BALLOUHEY 1
1) Hôpital de la Mère et de l'Enfant - Hospital Dupuytren, Paediatric Surgery, Limoges, FRANCE - 2) Hospital Dupuytren, Urology, Limoges, FRANCE
PURPOSE
Vesicovaginal fistula (VVF) is rare in children, often due to the introduction of foreign body into the vagina. Closure techniques are difficult, and the risk of reopening is high, often leading to the abandonment of minimally invasive approaches. We report the first case of robot-assisted laparoscopic transvesical closure of a vesicovaginal fistula.
MATERIAL AND METHODS
Patient: A 14-year-old girl was admitted for urinary incontinence, foul-smelling vaginal discharge, and recurrent urinary tract infections since early childhood. She was being followed by psychiatry after suspected sexual abuse. Initial examinations revealed a 30 mm bladder stone. Cystoscopy found a large infra-trigonal VVF centered on the lithiasis, which was itself aggregated on a plastic ring. All of them were then extracted by bladder suprapubic incision. Because of absence of spontaneous closure of the VVF, surgical closure was considered.
Method: The technique used was robot-assisted laparoscopy (4 robotic trocars and one assistant trocar). After initial endoscopic identification of the ureteral meatuses (JJ stents), closure was performed via a transvesical approach into two planes, vaginal and vesical, with absorbable sutures, with interposition of omentum in between (movie).
RESULTS
The total operative time was 252 minutes. The adolescent weighed 70 kg. No intra- or postoperative complication was reported. The patient was discharged on postoperative day 2. The transurethral catheter was removed after a control cystography on day 22. The JJ stents were removed on day 34, and the cystoscopic examination confirmed that there was no reopening of the fistula. After a follow-up of one year, continence was normal with no urinary leakage, and uroflowmetry was normal.
CONCLUSIONS
Robot-assisted minimally invasive closure of VVF is feasible and optimizes suture quality in a difficult-to-access anatomical region, thus promoting a satisfactory success rate in addition to the already known advantages of minimally invasive surgery.
14:05 - 14:08
S12-2 (CP)
Mohamed ABDELWAHAB, Amr ELKADY, Galal ELSHORBAGY and Mohamed ABDELGHANY
Cairo University, Urology, Cairo, EGYPT
PURPOSE
Although has become familiar, laparoscopic dismembered pyeloplasty is still a demanding procedure with a steep learning curve especially for beginners. Since described, several modifications and technical tricks have been proposed to facilitate laparoscopic dismembered pyeloplasty. Herein, we present a step wise modified technique for dismembered pyeloplasty in which the ureteric continuity remains intact to ensure its splinting and alignment for proper spatulation and precise placement of anastomotic angle's suture before dismembering.
MATERIAL AND METHODS
Between March 2024 and March 2025, 57 children less than 10 years of age candidate for laparoscopic pyeloplasty were included in the study. All cases were done by the same surgeon in our institute. The patients were randomized using closed envelopes into one of two study groups: (Group A) for classic laparoscopic dismembered pyeloplasty and (Group B) for laparoscopic in situ dismembered pyeloplasty. The presence of crossing vessels did not contraindicate in situ spatulation and all cases with aberrant vessels crossing the UPJ were randomized in both groups.
RESULTS
The mean timing of PUJ incision, spatulation, dismembering and re-anastomosis as well as the mean total operative duration were significantly lower in group B compared to group A. The early postoperative period passed smoothly without major complications in all cases of both groups. All patients improved postoperatively except 3 patients (2 patients in group A and one patient in group B) who had worsened hydronephrosis in the follow-up ultrasound and obstructed curves in the renal scan. Open redo pyeloplasty was done for those three patients after 6 month and they improved clinically and radiologically on follow up.
CONCLUSIONS
our proposed technique offers a feasible manual especially for beginners to a simplified laparoscopic dismembered pyeloplasty in a timely manner with excellent outcomes.
14:08 - 14:11
S12-3 (CP)
Matthieu PEYCELON, Bastien LANDREAT, Amane-Allah LACHKAR, Pauline LOPEZ, Alaa EL-GHONEIMI and Annabel PAYE
Robert-Debré University Hospital, Université Paris Cité, National Reference center for Rare Urinary Tract Malformations (MARVU), ERN eUROGEN, Paediatric Urology, Paris, FRANCE
PURPOSE
Retroperitoneal laparoscopic pyeloplasty (RLP) is an established standard procedure for ureteropelvic junction obstruction (UPJO) in children, including infants weighing less than ten kilograms. Robotic-assisted laparoscopic pyeloplasty (RALP) is increasingly used; however, evidence supporting its feasibility via a retroperitoneal approach in small infants remains limited. This study aims to compare perioperative outcomes, complications, and functional results of retroperitoneal RALP versus standard RLP in infants <10 kg.
MATERIAL AND METHODS
A retrospective single-center review was conducted of all infants <10 kilograms who had retroperitoneal pyeloplasty (2019-2025). All procedures were performed by senior pediatric urologists. RALP in infants < 10 kg was implemented after the primary surgeon had completed 33 robotic pyeloplasties, corresponding to established learning curves for robotic UPJO repair.
Demographics, preoperative parameters, operative details, postoperative course, and follow-up outcomes were collected. Complications were graded according to Clavien-Madadi classification. Surgical success was defined by clinical improvement and radiological evidence of unobstructed drainage. Statistical analyses included descriptive reporting using median (interquartile range) and univariate comparisons.
RESULTS
Thirty-four infants were included (18 RLP; 16 RALP). Groups were comparable regarding median (IQR) weight (RLP, 8.0 kg (7.4-8.8) vs. RALP, 8.6 kg (7.9-9.7), p=0.10) and age at surgery (RLP, 8.1 (5.8-11) months vs. RALP, 10.0 (7-11) months, p=0.11)., Preoperative renal function (RLP, 35% (27-43) vs. RALP, 34% (28-39), p=0.46) and anteroposterior pelvic diameter (APD) (RLP, 27 (25-30) mm. vs. RALP, 32 (26-38) mm, p=0.21) did not differ significantly.
Median operative time was significantly shorter in the RALP group (147 min (129-186) vs. RLP, 200 min (180-209), p=0.001). Hospital stay was similar (RLP, 2 (1-2) days vs. RALP, 2 (2-2) days, p=0.84). No intraoperative complications occurred. Early (<30-day) postoperative complications included one febrile urinary tract infection in each group.
At a median follow-up of 24 (9-35) months in both groups (p=0.72), one recurrence was observed in the RLP group (p>0.20), succesfully treated by a redo UPJO repair using a laparoscopic transperitoneal approach. Postoperative APD values and percentage reduction (RLP, 11 (9-15) mm vs. RALP, 11 (9-13) mm, p=0.94; and RLP, -61% (-53;-73) vs. RALP, -68% (-56;-99), p=0.19, respectively) showed no significant differences. Both techniques demonstrated excellent functional outcomes, with stable renal drainage and symptom resolution.
CONCLUSIONS
Retroperitoneal RALP in infants <10 kg is safe, feasible, and reproductible with perioperative and functional outcomes comparable to standard retroperitoneal laparoscopy. The significant reduction in operative time highlights a potential advantage of the robotic approach in small infants, despite the constraints of the retroperitoneal space. These results support the growing role of retroperitoneal RALP in the management of these technically demanding cases.
14:11 - 14:14
S12-4 (CP)
Jenna HOUARI 1, Julien ROD 2, Olivier ABBO 3, Alexis ARNAUD 4, Alice FAURE 5, Thomas BLANC 6, Nathalie BOTTO 7 and Quentin BALLOUHEY 1
1) Limoges University Hospital Centre, Department of Pediatric Surgery, Limoges, FRANCE - 2) Caen University Hospital Center, Caen, FRANCE - 3) Toulouse Hospital University Center, Department of Pediatric Surgery, Toulouse, FRANCE - 4) CHU de Rennes, Rennes, Department of Pediatric Surgery, Rennes, FRANCE - 5) Marseille Universiy Center, Service de Chirurgie Viscérale et Urologie Pédiatrique,, Marseille, FRANCE - 6) Hôpital Necker-Enfants Malades, APHP, Paris, France Université Paris Cité, Paris, France, Service de Chirurgie Viscérale, Urologie et Transplantation Pédiatrique, Paris, FRANCE - 7) Hôpital Necker-Enfants Malades, APHP, Paris, France Université Paris Cité, Service de Chirurgie Viscérale, Urologie et Transplantation Pédiatrique, Hôpital Necker-Enfants Malades, Paris, FRANCE
PURPOSE
Minimally invasive surgery has improved perioperative outcomes in pediatric pyeloplasty, but the use of Magnetic-end double-J ureteral stents (MEDJUS) - BlackStar® may be associated with specific morbidity. This study aimed to compare the feasibility and morbidity of MEDJUS insertion between retroperitoneal and transperitoneal robot-assisted pyeloplasty (RALP).
MATERIAL AND METHODS
We conducted a retrospective multicenter study over the last 10 years (2015–2025) across six French University Hospitals performing pediatric RALP with MEDJUS. Demographics, perioperative variables, MEDJUS insertion feasibility, and stent-related complications were compared between the transperitoneal and retroperitoneal groups.
RESULTS
A total of 289 patients underwent RALP with MEDJUS use, including 120 transperitoneal and 169 retroperitoneal approach. Mean weight was 28 (±6) kg and mean procedure duration was 210 (±21) minutes. There was recorded no mortality nor conversion.
Overall, there were 49 MEDJUS placement failures (17%) that required alternative drainage in 45 cases (smaller none magnetic JJ stent n=33, nephrostomy placement n=12) or no drainage in 4 cases.
Failure and complication rates did not differ between the two approaches (respectively 18% vs. 15%, p=0.7 and 39% vs. 37%, p=0.8). Children in whom MEDJUS placement was successful were significantly older (99.1 ± 56.3 vs. 71.7 ± 51 months, p < 0.001), taller (129 ± 28.7 vs. 116 ± 29.3 cm, p < 0.01), and heavier (29.3 ± 15.6 vs. 26 ± 14.5 kg, p < 0.01); (median 25 (17-40) vs. 16 (13-27); p=0.0007) than those in the failure group; Suggested weight cut-off between success and failure groups was 8.7 kg. No significant differences were observed regarding prior double-J stenting, urological previous history, revision procedures, operated side, gender and operative time.
Misplacement included 13 MEDJUS coiled in the ureter (4.4%) and 30 coiled in the urethra. Removal of MEDJUS in consultation failed in 19 patients (8%) and required general anesthesia for completion. Postoperative pyelonephritis occurred in 19 cases (6.5%), with no inter-group variation.
CONCLUSIONS
Transperitoneal and retroperitoneal RALP showed comparable MEDJUS insertion success and peri-/postoperative morbidity. Use of MEDJUS allowed avoidance of a second general anesthesia in 76% of cases. Lower patient weight and height were associated with higher failure rates. Prospective studies are needed to refine indications and assess long-term safety.
14:14 - 14:17
S12-5 (CP)
Aneta PIOTROWSKA-GALL 1, Marcin POLOK 2 and Rafał CHRZAN 1
1) Jagiellonian University Medical College, Krakow, Department of Pediatric Urology, University Children's Hospital, Krakow, Krakow, POLAND - 2) Collegium Medicum, University of Zielona Góra, Department of Pediatric Surgery and Urology, University Hospital in Zielona Gora, Zielona Góra, POLAND
PURPOSE
Robotic assisted laparoscopic pyeloplasty (RALP) became widely accepted procedure in pediatric ureteropelvic junction obstruction. Most surgeons operating with robotic assistance have prior laparoscopic experience. In this study we aimed to test whether greater prior laparoscopic experience is associated with shorter baseline times in robotic cases.
MATERIAL AND METHODS
A uniform protocol for collecting data on robotic assisted procedures has been approved by the Ethical Committee. A prospective, two-center study on three pediatric urologists: most-experienced (S1), experienced (S2) and novice (S3) was conducted. Consecutively performed unilateral RALP were included into this study.
RESULTS
There was a total of 68 RALP during the period of 05.2024-11.2025. The first 13 procedures performed by each pediatric urologist were included (median age was 8,4 years, ranged from 0,6 to 17,6 years). There were 27 left-sided pyeloplasties, all cases were elective. The median duration of the surgery was 171 minutes (SD 50), console time 127 minutes (SD 44), dissection time 83minutes (SD 40) and anastomosis time 43 minutes (SD 12). There was one case of conversion to open due to complex case with nephrolithiasis.
On log-transformed times, the omnibus ANOVA no difference in overall surgery duration (p=0.47). For console time, the omnibus was initially significant (p = 0.04), however after endpoint-wise multiplicity correction across four endpoints became non-significant (Holm-adjusted p=0.08). Suturing and dissection times showed significant omnibus differences (p=0.003 for each). Post-hoc Tukey on log-suturing time showed no significant pairwise differences (RGM, 95% CI, p_adj): S2 vs S1 1.04 (0.80–1.35, 0.935); S3 vs S1 0.94 (0.73–1.20, 0.798); S3 vs S2 0.90 (0.70–1.17, 0.604). For log-dissection time, Tukey test identified S3 vs S2 as significant RGM = 1.82 (1.22–2.73; p_adj = 0.0023), indicating ~82% longer dissection for S3; other pairs were not significant (S2 vs S1 0.73; 0.49–1.09; 0.142; and S3 vs S1 1.33; 0.90–1.95; 0.185).
CONCLUSIONS
Prior laparoscopic experience in performing complex urological cases like pyeloplasty does not seem to be associated with significantly shorter times in robotic procedures.
14:32 - 14:35
S12-6 (CP)
Thomas LOUBERSAC 1, Annabel PAYE JAOUEN 2, Marie-Aimée PERROUIN-VERBE 3, Delphine DEMEDE 4, Marc-David LECLAIR 5, Amane Allah LACHKAR 2, Thibault PLANCHAMP 6, Alice FAURE 7, Alaa EL GHONEIMI 2 and Matthieu PEYCELON 2
1) University Hospital of Nantes, Nantes Université, Paediatric Urology, Nantes, FRANCE - 2) Department of Pediatric Surgery and Urology, National Reference Center for Rare Urinary Tract Malformations (CRMR MARVU), ERN eUROGEN, Robert-Debré University Hospital, APHP, Pediatric urology, Paris, FRANCE - 3) University Hospital of Nantes, Nantes Université, Urology Department, Nantes, FRANCE - 4) CHU Lyon, Pediatric urology, Lyon, FRANCE - 5) University Hospital of Nantes, Nantes Université, Pediatric urology, Nantes, FRANCE - 6) Department of Pediatric Surgery and Urology, National Reference Center for Rare Urinary Tract Malformations (CRMR MARVU), ERN eUROGEN, Robert-Debré University Hospital, APHP, Paediatric Urology, Paris, FRANCE - 7) APHM Marseille, Pediatric urology, Marseille, FRANCE
PURPOSE
Robot-assisted laparoscopic continent cutaneous urinary diversion (RALCCUD) according to the Mitrofanoff principle has gained increasing adoption in pediatric urology. However, outcomes fromlow-volume robotic centers(<1 CCUD a year) remain poorly documented. This study aimed to evaluate the safety, feasibility, and functional outcomes of RALCCUD performed across four low-volume institutions.
MATERIAL AND METHODS
A multicenter retrospective analysis was conducted using prospectively maintained databases (2017–2024). Children undergoing RALCCUD with umbilical stoma creationwithout concomitant augmentation cystoplastywere included. Collected parameters included 30-day postoperative complications according to Clavien-Madadi classification, stomal stenosis, stomal continence (Schulte-Baukloh score), revision procedures, and urodynamic findings. All patients underwent standardized preoperative and postoperative urodynamic evaluation; functional outcomes were assessed at 3 months, then annually. Continence was defined as complete absence of stomal or urethral leakage. Statistical analysis: descriptive.
RESULTS
Twenty-two children were included (median (IQR) age: 13.0 years (8–13.5)). Median follow-up was 43 months (18–49), with no loss to follow-up. All procedures were completedrobotically, with a median operative time of 226 minutes (173–244) and a median hospital stay of 7 days (6–9). Two patients developed Clavien–Madadi grade III complications (obstructive catheter malfunction requiring change under general anesthesia; one bowel obstruction). Importantly,no stomal stenosis occurred in the cohort. Stomal incontinence was observed in three patients; all were successfully treated (Deflux® injection n=1, redo surgery n=1, conservative management n=1). The two-year revision rate was 22.3%. At final follow-up,all patients were able to self-catheterize, andno patient exhibited stomal or urethral leakage. Overall stomal continence and channel patency rates were100%.
At the final follow-up, all patients could self-catheterize through the tube, and the stomal and urethral continence rates were 100%.
CONCLUSIONS
Robot-assisted laparoscopic continent cutaneous urinary diversion can be performed safely and effectively in children even within low-volume robotic centers (who create less that one channel a year), yielding excellent long-term continence and patency results. With increasing experience, revision and complication rates improved. These results support the broader adoption of robotic Mitrofanoff creation in appropriately selected patients.
14:35 - 14:38
S12-7 (CP)
Thibault PLANCHAMP, Annabel PAYE, Ugo-Maria PIERUCCI, Mahmoud AHMED, Matthieu PEYCELON, Alaa EL-GHONEIMI and Amane-Allah LACHKAR
Robert-Debré University Hospital, APHP, GHU Nord, Université Paris Cité, Department of Pediatric Surgery and Urology, National Reference Center for Rare Urinary Tract Malformations (CRMR MARVU), ERN eUROGEN Accredited Center, Paris, FRANCE
PURPOSE
Continent catheterizable channels (CCCs) offer an alternative route for clean intermittent catheterization in children unable to catheterize via the urethra.
With the increasing adoption of laparoscopy and robotic surgery, comparative long-term outcome data remain limited.
This study compares the long-term continence outcomes of CCCs and evaluates complication and revision rates between three surgical approaches: open, laparoscopic, and robotic.
MATERIAL AND METHODS
A retrospective single-center study identified patients under 20 years of age who had a CCC creation performed via open or mini-invasive (MIS) (laparoscopic and robotic) surgeries between 1997 and 2025.
Demographic variables, indications, channel type, association with bladder augmentation, complications, revisions, and channel’s continence outcomes were analyzed.
Statistical analysis : descriptive (median and range), univariate comparison, Kaplan-Meier survival rates.
RESULTS
126 patients (91 males) were included with a median follow-up of 5.7 years [0.08 - 19.8]. Median age at surgery was 7.6 years [0.8 - 19.1], and median BMI was 15.7 [11.7 - 39.4]. Indications included neurogenic bladder (34%), bladder exstrophy-epispadias complex (30%), and posterior urethral valves (18%).
Open surgery was performed in 69%, laparoscopy in 20%, and robotic surgery in the most recent 11% cases. Channels were constructed using appendix (79%), ileum (13%) or ureter (8%). Bladder augmentation was associated in 45% of cases (using robotics in 8.8%).
Overall complications rate was 27.8%, occurring at a median time of 7.9 months [0.03 - 105.2]. Leakage (17.2% open vs. 28.2% MIS, p=0.20) and granulomas (2.3% vs. 2.6%, p>0.99) did not differ significantly between approaches. Stomal stenosis never occurred in MIS group and thus occurred significantly more often after open surgery (11.5% vs 0%, p=0.03). Most stenoses were suprafascial (70%). Revision surgery was required in 26% (N=33) of patients at a median of 6.5 months [2.3 - 105.2]. Complication rates were similar whether CCC was isolated or combined with bladder augmentation (p=0.70). At final follow-up, 91% of functioning CCCs were fully continent.
CONCLUSIONS
Although CCC-related complications and revisions remain common, long-term functional outcomes are excellent.
MIS (laparoscopic and robotic) is associated with a significantly lower risk of stomal stenosis, supporting their increasing use in pediatric urology.
14:38 - 14:41
S12-8 (CP)
Amane-Allah LACHKAR 1, Alexis ARNAUD 2, Camille DUCHENNE 2, Matthieu PEYCELON 1, Florence JULIEN-MARSOLLIER 3, Annabel PAYE 1 and Alaa EL GHONEIMI 1
1) Hôpital Robert Debré, University Hospital, Pediatric Urology, Paris, FRANCE - 2) University Hospital of Rennes, Pediatric Surgery and Pediatric Urology department, Rennes, FRANCE - 3) Hôpital Robert Debré, University Hospital, Pediatric Anesthesiology, Paris, FRANCE
PURPOSE
Robot-assisted bladder augmentation in children is rarely utilized across Europe. Doing robotically this procedure with an ileal loop configuration in a “W” shape is innovative. We analyzed the preliminary results of our experience in robotic-assisted laparoscopic W-shaped ileocystoplasty (RALAWI) in children.
MATERIAL AND METHODS
A prospective bicentric study included all patients who had RALAWI since 2020. The procedures were performed using DaVinci Xi© robot, with a detubularized ileal segment reconfigured in W-shape, combined, if necessary, with extraserosal appendicovesicostomy (APV). Statistical analysis: descriptive (median (range)) and comparative.
RESULTS
Thirteen patients were included at a median age of 9.5 years (5-16) and a median weight of 31 kg (19-99), and followed up for 11.8 months (6 months – 4 years).. Etiologies included: neuropathic bladder (9), bladder exstrophy (2), rhabdomyosarcoma (1), and bilateral ectopic ureters (1). Five patients had previously multiple abdominal surgeries including APV (2). All procedures were done intra-abdominally without conversion. Median operative time and length of stay were 670 min (450-930) and 12 days (6-30). Associated procedures were: APV (8), bladder neck reconstruction (6), bladder neck closure (1), bilateral vesicoureteral reimplantation (2). A complication was reported before 30 days for four patients: urinary anastomotic leakage (N=2, IIIB according to Clavien-Dindo), prevesical abscess (N=1, IIIA), ventriculoperitoneal shunt dysfunction (N=1, IIIB). Nine complications occurred after 30 days in five patients: stoma leakage (N=3, IIIB), bladder stone (N=1, IIIB), difficult catheterizations (N=2, IIIB), ileocystoplasty perforation (N=1, IIIB; N=1, IVA). No APV stenosis was reported. Postoperative bladder capacity was significantly higher (170 vs. 350 mL; p<0.01) .All patients achieved continence.
CONCLUSIONS
To our knowledge, this is the first report of robot-assisted ileocystoplasty in children with a W-shape reconfiguration. It is feasible even after multiple surgeries, offering potential benefits for patients with a fragile abdominal wall. The technique requires further refinements to minimize operative time and early postoperative complications.