ESPU Meeting on Thursday 18, June 2026, 16:50 - 17:35
16:50 - 16:55
S14-1 (VP)
Merve DEDE 1, Ayşegül AKBULUT 2, Tuğçe Merve ORBAY 2, Nizamettin KILIÇ 2, Mehmet Ugur YILMAZ 2 and Mehmet Emi̇n BALKAN 2
1) Bursa Uludag University Faculty of Medicine, Pediatric Surgery, Division of Pediatric Urology, Nilufer, TÜRKIYE - 2) Bursa Uludag University Faculty of Medicine, Pediatric Urology, Nilufer, TÜRKIYE
PURPOSE
To present a stepwise surgical video demonstrating the combined use of Kelly bladder neck reconstruction and the modified Cantwell–Ransley technique for epispadias repair in a 1-year-old boy with isolated epispadias and a hypocompliant, low-capacity bladder.
MATERIAL AND METHODS
A 1-year-old male was referred with isolated epispadias. Ultrasonography was normal, while videourodynamics revealed a hypocompliant bladder with approximately half of the expected capacity but without vesicoureteral reflux.
A combined bladder neck and urethral reconstruction was performed.
A midline incision was made from the urethral opening to the umbilicus, and dissection was carried to the pubic symphysis, which was opened to expose the bladder neck. An anterior incision unified the bladder and urethral plate. Both ureters were catheterized and reimplanted using the Cohen technique. The bladder neck and urethral plate were outlined, a bladder-neck incision was made and extended distally, followed by circumferential incision and complete penile degloving. Posterior corporal attachments were released to improve penile mobility. Triangular demucosalization and subsequent approximation sutures, along with pubic symphysis and bladder closure, completed the Kelly reconstruction.
Epispadias repair began with two ventral incisions preserving the ventral neurovascular bundle. A dorsal plate incision at the glans enabled mobilization. Using the modified Cantwell–Ransley technique, the corporal bodies were separated and partial penile disassembly was performed without glans detachment. The urethral plate was mobilized for ventral transposition and tubularized over a catheter to form the proximal neourethra. The corporal bodies were reapproximated in the midline. A preputial graft was tubularized and anastomosed distally to complete urethral reconstruction. A subcoronal catheter was guided into the glans for the glans–urethra anastomosis, followed by glanuloplasty. Penoscrotal angle correction, circumcision closure, and dorsal Z-plasties finalized the procedure.
RESULTS
The combined reconstruction was completed without intraoperative complications. Adequate neo-urethral length, bladder neck configuration, and corporal alignment were achieved. The postoperative course was uneventful. Early follow-up showed appropriate healing and stable catheter drainage. Continence evaluation is ongoing.
CONCLUSIONS
This video demonstrates the feasibility and effectiveness of integrating Kelly bladder neck reconstruction with modified Cantwell–Ransley epispadias repair. The combined approach offers a comprehensive solution for infants with isolated epispadias and bladder dysfunction.
16:55 - 16:58
S14-2 (CP)
Sudhindra JAYASIMHA 1, Kevin CAO 2, Vasileios VASILEIADIS 2, Alya ALBLOOSHI 2, Naima SMEULDERS 2, Imran MUSHTAQ 2 and Nav JOHAL 2
1) Great Ormond Street Hospital, Pediatric Urology, London, UNITED KINGDOM - 2) Great Ormond Street Hospital, Paediatric Urology, London, UNITED KINGDOM
PURPOSE
At our centre, neonatal primary bladder exstrophy (BEX) closure is performed without osteotomy. Historically, closure occurred urgently within the first few days of life. We compared the safety of delayed, elective neonatal primary closure (DNPC)(7–28 days) with early closure (≤6 days).
MATERIAL AND METHODS
We reviewed consecutive infants from our departmental BEX database (2001–2025). Closures beyond 28 days were excluded to avoid confounding by delayed referral or major comorbidities. The primary outcome was dehiscence with bladder extrusion requiring redo-closure. Secondary outcomes included ICU admission, Clavien–Dindo >IIIa complications, and emergency readmission.
Continuous variables were analyzed with Mann–Whitney U test and categorical variables with Chi-square/ Fisher’s exact tests. Multivariable logistic regression was adjusted for sex, gestational age, and birthweight.
RESULTS
Of 225 closures, 175 (77.8%) were early and 50 (22.2%), delayed. Birthweight and creatinine were higher in DNPC. Prematurity and prenatal diagnosis rates were similar. Bladder polyps were more frequent in early closures (54% vs 38%, p=0.06).
Redo closure was required in 17/175 (9.7%) early and 2/50 (4%) DNPC (p=0.26). After adjustment, DNPC remained non-inferior with no predictors of dehiscence. Secondary outcomes—ICU use, major complications, transfusion, emergency readmissions—were similar.
DNPC procedures were longer (180 vs. 120 minutes, p<0.00001) although epidural use, transfusion rates, and peri-operative stability were similar:
Table 1
|
|
≤6 days |
7–28 days |
p |
|
Demographics |
|||
|
N(Male/Female) |
175(113/62) |
50(32/18) |
1.00 |
|
Age at closure(days) |
3(2,4) |
10(8,17) |
<0.00001 |
|
Preterm(<37weeks) |
18(10.3%) |
5(10%) |
1.00 |
|
Weight(g) |
3180 (2800,3500) |
3400 (3173,3668) |
0.01 |
|
Prenatal diagnosis |
39(22.3%) |
13(26%) |
0.57 |
|
|
|||
|
Clinical |
|||
|
Resistant organisms bladder culture |
10(5.7%) |
0(0.0%) |
0.12 |
|
Creatinine(µmol/L) |
58.5(38,72.2) |
71(45.3,79.8) |
0.052 |
|
Bladder polyps |
93(53.8%) |
19(38%) |
0.06 |
|
|
|||
|
Operation |
|||
|
Duration(min) |
120(90,150) |
180(120,181) |
<0.00001 |
|
Epidural |
142(81.1%) |
38(77.6%) |
0.55 |
|
Transfusion |
4(2.3%) |
1(2%) |
1.00 |
|
|
|||
|
Primary outcome |
|||
|
Dehiscence requiring redo-closure |
17(9.7%) |
2(4%) |
0.26 |
|
|
|||
|
Secondary outcomes |
|||
|
ICU care |
25(14.3%) |
6(12%) |
0.82 |
|
Clavien >IIIa complication |
22(12.6%) |
9(18.0%) |
0.35 |
|
Emergency readmission |
7(4%) |
4(8%) |
0.27 |
CONCLUSIONS
Elective DNPC without osteotomy is a safe and effective alternative to urgent early closure. Although not statistically significant, DNPC was associated with a 50% reduction in redo-closure rate without increased morbidity.
Given comparable complication profiles and a trend toward fewer dehiscences, DNPC may be considered a preferable default approach in experienced centres, reserving urgent early closure for select scenarios.
16:58 - 17:01
S14-3 (CP)
Naif ALQARNI
King Faisal Specialist Hospital and Research Center, Riyadh, Pediatric Urology Section, Urology Department, Riyadh, SAUDI ARABIA
PURPOSE
This study presents our experience comparing early versus delayed repair of bladder exstrophy, focusing on perioperative and postoperative parameters, clinical outcomes and the approximate impact on healthcare costs.
MATERIAL AND METHODS
We retrospectively reviewed patients diagnosed with bladder exstrophy who underwent staged repair between 2017 and 2025. Patients were categorized into two groups; early repair - surgery performed between 1 and 6 weeks of age with a mean age of 4 weeks - and 'delayed repair - surgery performed beyond 3 months with a mean age 5.2 months -.
All cases were managed with staged repair, and osteotomy was performed in all.
Key parameters assessed included hospital length of stay, postoperative ICU admission, blood transfusion requirement, postoperative complications, overall outcomes and approximate healthcare costs.
RESULTS
A total of 31 patients were included: 18 underwent early repair, and 13 underwent delayed repair.
ICU admission was required in 100% of early repair patients , compared to 15% in the delayed group; with an average ICU stay of 5 days postoperatively.
Average hospital stay was 22 days in the early group versus 8 days in the delayed group.
Postoperative complications - including urinary tract infection, hospital acquired pneumonia, and surgical site infection - were significantly higher in the early group.
Blood transfusion rates and overall outcomes were similar between both groups.
ICU admission and hospital stay were approximately calculated for each group, revealing a significantly higher average cost per patient in the early repair group compared to the delayed group.
No significant gender-based differences were observed across the assessed parameters.
CONCLUSIONS
While final outcomes were comparable, delayed repair of bladder exstrophy was associated with significantly reduced ICU admission, shorter hospital stay, and fewer postoperative complications. These findings also suggested a significant reduction in the overall healthcare cost.
17:13 - 17:16
S14-4 (CP)
Hortense ALLIOT 1, Sajid SULTAN 2, Nicolas KALFA 3, Delphine DEMEDE 4, Alice FAURE 5, Alaa EL GHONEIMI 6, Thomas BLANC 7, Luke HARPER 8, Raphael MOOG 9, Pauline CLERMIDI 10, Xavier DELFORGE 11, Julien ROD 12, Alfredo BERRETTINI 13, Thomas LOUBERSAC 14, Philip RANSLEY 2 and Marc-David LECLAIR 14
1) Mother and Children's Hospital - University Hospital of Nantes, Paediatric Urology, Nantes, FRANCE - 2) Sindh Institute of Urology and Transplantation (SIUT), Philip G. Ransley Department of Paediatric Urology, Karachi, PAKISTAN - 3) Arnaud de Villeneuve Hospital, Montpellier University Hospital Center and University of Montpellier, Pediatric Surgery Service, Department of Pediatrics, Montpellier, FRANCE - 4) Women Mothers Children's Hospital, University of Lyon 1, Department of Pediatric Surgery and Urology, Bron, FRANCE - 5) La Timone Children's Hospital, Marseille University Hospital, Department of Pediatric Surgery, Marseille, FRANCE - 6) Robert-Debré University Hospital, Paediatric Visceral Surgery and Urology Department, Paris, FRANCE - 7) Necker-Enfants Malades Hospital APHP, Department of Pediatric Surgery and Urology, Paris, FRANCE - 8) Pellegrin Children's Hospital, Bordeaux University Hospital, Department of Pediatric Urology, Bordeaux, FRANCE - 9) Hautepierre Hospital, Strasbourg University Hospital, Department of Pediatric Surgery, Strasbourg, FRANCE - 10) Armand Trousseau Hospital, Pediatric and Neonatal Surgery, APHP, Department of Pediatric Urology, Paris, FRANCE - 11) Amiens University Hospital, Department of Pediatric Surgery, Amiens, FRANCE - 12) University Hospital of Caen, Department of Pediatric Surgery, Caen, FRANCE - 13) Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Pediatric Urology Unit, Milan, ITALY - 14) Mother and Children's Hospital - University Hospital of Nantes, Department of Pediatric Urology, Nantes, FRANCE
PURPOSE
To evaluate bladder dehiscence after one-stage delayed closure of bladder/cloacal exstrophy combining bladder plate closure with Kelly radical soft-tissue mobilization, with or without osteotomy.
MATERIAL AND METHODS
We performed a multicenter retrospective study of children with bladder exstrophy or cloacal exstrophy who underwent single-stage closure with Kelly mobilization (October 2015-June 2025). Procedures were performed by one surgical team, in France and tertiary centers abroad. Primary endpoint was bladder dehiscence within 3 months. Secondary endpoints were early (<3 months) complications. Outcomes were analyzed separately for primary repairs and redo cases after failed closure.
RESULTS
A total of 112 patients (101 bladder exstrophy, 11 cloacal exstrophy; 63% male) were included. Median age at surgery was 5 months [2-15]; median follow-up was 58 months [30-87]. Primary repair was performed in 96/112 (86%); 16/112 (14%) were redo closures. No bladder dehiscence occurred. Early complications arose in 17/112 patients (19 events; 15%): wound infection/dehiscence 3%, bladder-neck fistula 5% (all but one resolved with drainage), hernia 2%, bowel obstruction 1%, evisceration 0.9% (reoperated), glans necrosis 0.9%, dialysis 1.8%, isolated fungal/septic events 2.7%. Most were Clavien-Madadi grade-II (12.4%); grade-III 0.9%; grade-IV 1.8%. Obturator osteotomy was not associated with closure complication, rectus abdominis transposition had a 25% complication rate.
CONCLUSIONS
Single-stage delayed closure with Kelly mobilization achieved reliable bladder closure with zero early dehiscence in bladder/cloacal exstrophy, including redo cases. Early morbidity was acceptable and mostly low grade. When pubic approximation is difficult, bilateral obturator osteotomy appears to offer favorable early parietal outcomes.
17:16 - 17:19
S14-5 (CP)
Guy HIDAS 1, Amit SHEMESH 2, Ezekiel H LANDAU 2, Leonid BOYARSKY 2, Yuval BAR-YOSEF 3, Jacob BEN-CHAIM 4 and Peter CUCKOW 5
1) Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem,, Pediatric urology, Department of Urology, Jerusalem, ISRAEL - 2) Hadassah and Hebrew University Medical Center, Pediatric urology, Department of Urology, Jerusalem, ISRAEL - 3) Tel Aviv Sourasky Medical Cente, Paediatric UroIogy Unit, Department of Urology, Tel Aviv, ISRAEL - 4) Tel Aviv Sourasky Medical Center, Paediatric UroIogy Unit, Department of Urology, Tel Aviv, ISRAEL - 5) Nationwide Children's Hospital, Pediatric Urology, London, UNITED KINGDOM
PURPOSE
Radical soft-tissue mobilization, also known as Kelly’s operation, is performed for reconstruction of the bladder exstrophy–epispadias complex. Its primary goals are to achieve urinary continence and optimize genital appearance and function. This study assesses the long-term outcomes of the salvage Kelly procedure performed after challenging cases of failed bladder exstrophy repair.
MATERIAL AND METHODS
Patients who had previously undergone bladder exstrophy repair and subsequently developed total urinary incontinence underwent a salvage Kelly procedure and were included in the study. This was a single-surgeon cohort analysis from 2014-2025. postoperative complications were documented. Continence outcomes were categorized based on the postoperative dry interval as follows: (1) total incontinence (≤1-hour dry interval), (2) partial continence (>1-hour dry interval), (3) daytime continence, and (4) full day-and-night continence. Changes in continence status before and after surgery were analyzed using the Wilcoxon signed-rank test, with statistical significance set at p < 0.05.
RESULTS
Fourteen patients (13 males, 2 female) with a median surgery age of 7 years were included. All had undergone one to four deferent previous operations, all involving osteotomy. The median follow-up duration was 58months (IQR 38–97), and the median postoperative bladder capacity was 100ml (IQR 80-170.5). Most patients achieved a measurable dry interval, demonstrating a significant improvement in continence (p=0.002): Five patients (33.3%) attained total continence, one (6.7%) achieved daytime continence, six (40%) had partial continence, and two (13.3%) showed no improvement. A trend of increasing bladder capacity with improving continence was observed. whereas patients with persistently small bladders did not improve. Early complications included one urinary tract infection. One patient with severe bladder fibrosis had urinary retention with upper tract dilatation that eventually required cystoplasty. Penile length was universally improved although the creation of hypospadias was usual. In one patient post-operative corporal asymmetry and persistent chordee has required further correction
CONCLUSIONS
Long-term follow-up after Salvage Kelly operation Following Failed Primary Repair of Bladder Exstrophydemonstrates low complication rates and a significant improvement in urinary continence. No
17:19 - 17:22
S14-6 (CP)
Carolina BEBI, Julie LOONEY, Karen RYAN, Divyesh DESAI, Naima SMEULDERS, Imran MUSHTAQ and Navroop JOHAL
Great Ormond Street Hospital for Children, Urology, London, UNITED KINGDOM
PURPOSE
The Kelly procedure is an established continence-restoring technique for children with classic bladder exstrophy; however, postoperative continence remains difficult to achieve, largely due to intrinsically reduced bladder capacity and the challenges of optimizing detrusor-sphincter coordination. Pelvic floor biofeedback (BF) therapy has demonstrated efficacy in improving voiding dynamics in children with dysfunctional voiding and other voiding disorders. Despite its widespread use in paediatric functional urology, its potential role in children who have undergone reconstruction for bladder exstrophy has not previously been explored. In this study we aim to evaluate whether pelvic floor BF is associated with measurable improvements in bladder capacity in children following the Kelly procedure, using standardised age-adjusted bladder capacity measurements.
MATERIAL AND METHODS
We prospectively collected data from children with classic bladder exstrophy who underwent structured BF therapy following the Kelly procedure at our institution. Bladder capacity was calculated using the Koff formula and derived from uroflowmetry, with values expressed as a percentage of the expected capacity for age to control for physiological growth over time. BF sessions were delivered by an experienced continence nurse specialist using perineal surface electromyography electrodes linked to an interactive video game platform designed to teach pelvic floor awareness, relaxation, and coordinated voiding. Demographic variables, number of BF sessions, and pre- and post-therapy capacity measurements were analysed. Paired t-tests were used to compare baseline and post-BF capacities.
RESULTS
Sixty-one patients (39 males, 22 females) were included. The median age at initiation of BF was 6 years (IQR 5-8). Patients completed a median of 8 BF sessions (IQR 5-15) over a median follow-up of 49 months (IQR 17-74). Mean (SEM) baseline bladder capacity was 31.95% (3.07) of the expected age-adjusted value. Following BF, mean capacity increased to 50.11% (3.74), yielding a mean improvement of 18.16% (2.83). This increase was statistically significant (p<.001).
CONCLUSIONS
Pelvic floor biofeedback appears to be associated with a clinically meaningful and statistically significant increase in bladder capacity post Kelly reconstruction for classic bladder exstrophy. These findings suggest that BF may serve as a valuable adjunct to postoperative functional rehabilitation. Further controlled studies are needed to delineate its mechanisms, long-term benefits, and the characteristics of children most likely to respond.