Parallel Meeting on Thursday 18, June 2026, 08:00 - 08:45
08:00 - 08:04
S15-1 (CRP)
Fabrizio VATTA, Nathalie BOTTO, Aline BROCH, Beatrice MONTANARO, Henri LOTTMANN and Thomas BLANC
Hôpital Necker Enfants malades - AP-HP, Department of Pediatric Surgery and Urology, Paris, FRANCE
PURPOSE
Magnetic-end double-J ureteral ureteral stents (MEDJUS) - BlackStar® have become increasingly popular in pediatric urology thanks to its outpatient, cystoscopy-free removal. Although MRI is formally contraindicated because of the magnetic tip, inadvertent MRI may occur in clinical practice. Aim of the study is to describe whether this scenario occurred in our experience with MEDJUS and in such case, if it resulted in any adverse events.
MATERIAL AND METHODS
Retrospective analysis of prospectively collected data of all children who received MEDJUS in our institution from 2016 to 2025. Demographics and surgical indication were collected. Formal contra-indication to perform MRI was explained to the family and noted in the reports. Follow-up imaging was reviewed to identify inadvertent MRI performed while MEDJUS was still inserted.
RESULTS
381 procedures were performed in 346 children (198 boys; median age 6 years, IQR 2.5-11.5). Surgical indications included 157 pyeloplasties (147 robotic, 7 laparoscopic, 3 open), 65 kidney transplantations, 60 ureteral reimplantations, 55 flexible ureteroscopies for urolithiasis, 35 emergency stent placements and 9 uretero-ureteral anastomoses.
Three children underwent inadvertent MRI while the MEDJUS was still inserted.
Two abdominopelvic MRIs were performed in another hospital for the oncologic follow-up
- rhabdomyosarcoma in an 8-year-old boy: MEDJUS for trans uretero-ureteral anastomosis after partial cystectomy
- Ewing sarcoma in an 18-year-old girl: MEDJUS to relieve uretero-hydronephrosis due to tumor compression
A third case involved a cerebral MRI performed for neurosurgical emergency evaluation in a child with hydrocephalus who had previously undergone ureteroscopy for urolithiasis.
No symptoms were reported such as heating sensation or pain. No stent displacement was observed. Imaging artifacts were present in the pelvis.
No child required unplanned hospital admission or secondary intervention and MEDJUS were easily removed in outpatient clinic.
CONCLUSIONS
To our knowledge, this is the first report (adult and children) reporting inadvertent MRI with MEDJUS. In our cohort, no clinical consequences nor stent displacement occurred. Although MRI remains formally contra-indicated, these preliminary findings suggest that accidental exposure may be less hazardous than theoretically feared.
08:04 - 08:08
S15-2 (CRP)
Juan OSORIO 1, Marta LOPEZ 2, Yessica QUIROZ 2, Rocio JIMENEZ 2 and Anna BUJONS 2
1) Fundacion puigvert, Pediatric urology, Barcelona, SPAIN - 2) Fundacion puigvert, Paediatric urology, Barcelona, SPAIN
PURPOSE
The bladder exstrophy-epispadias complex is a rare and highly complex condition that involves a prolonged surgical trajectory from childhood onward. In the literature, cases of patients with primary closure and an excluded bladder are reported; however, such bladders may develop intestinal metaplasia and, exceptionally, adenocarcinoma.
We present the case of a patient with bladder exstrophy and an excluded bladder who developed intestinal-type adenocarcinoma in the bladder remnant.
MATERIAL AND METHODS
It is presented a 53-year-old male patient with a history of bladder exstrophy and duplication of the left renal excretory system, as well as familial colonic polyposis. At birth, he underwent closure of the bladder plate and correction of epispadias. However, follow-up revealed severe bilateral hydronephrosis, requiring reintervention with bilateral cutaneous ureteroureterostomy. Additional reintervention of the external genitalia, including a Bowne-type urethroplasty, was also necessary. Due to recurrent renal ectasia secondary to vesicoureteral reflux and the development of urinary lithiasis, he underwent multiple endoscopic procedures. In parallel, he underwent total colectomy and ileorectal reconstructions because of familial adenomatous polyposis.
During follow-up for urolithiasis, abdominal CT revealed an excluded bladder with new-onset mural thickening. The patient presented to our institution with symptoms of urethral discharge. Endoscopic evaluation showed exophytic lesions, and transurethral biopsy was performed, yielding a diagnosis of intestinal-type adenocarcinoma in situ. Staging was further expanded with a PET-CT scan, which showed no evidence of lymph node involvement or distant metastases.
RESULTS
After multidisciplinary evaluation, radical cystoprostatectomy of the excluded bladder with bilateral distal ureteral resection and creation of an ileal conduit was performed. There was no intraoperative complications and The immediate postoperative course was satisfactory, with good oral tolerance and preserved renal function. Histopathological examination confirmed a well-differentiated intestinal-type adenocarcinoma, pT2a, with negative surgical margins.
CONCLUSIONS
The presence of an excluded bladder poses a risk for the development of metaplasia and subsequent intravesical adenocarcinoma. Therefore, close follow-up of such patients is required, and current surgical strategies aim to minimize this risk.
08:08 - 08:12
S15-3 (CRP)
Tim LITTLE and Liam MCCARTHY
Birmingham Children's Hospital, Paediatric Urology, Birmingham, UNITED KINGDOM
PURPOSE
The inverted ‘Y’ configuration is the rarest form of ureteral duplication anomaly. The embryological explanation has generally been one of two distal ureteric buds and ureters fusing to form one proximal ureter.
A recent case of a 3-year-old boy with bilateral inverted ‘Y’ duplications prompted us to explore the literature and devise a novel management strategy.
Our aims are two-fold. The first is to categorise the anomaly. The second is to describe our management of this particular case.
PATIENT AND METHODS
The 3-year-old boy was referred with antenatal and postnatal mild right-sided hydronephrosis. On follow-up ultrasound he had developed hydroureteronephrosis. A micturating cystourethrogram demonstrated the inverted ‘Y’ duplication of the left ureter, and grade I vesico-ureteric reflux on the right. An interval scan showed worsening of the right-sided ureteric dilatation and a JJ stent was planned. The retrograde pyelogram demonstrated the inverted ‘Y’ on the right. Stenting improved the dilatation, but it recurred on removal of the stent. He was taken to theatre for excision of the blind-ending duplication and a tapering anastomosis.
A literature search was conducted using Medline with reference lists hand-searched and the cases summarised in an Excel® spreadsheet. The cases were grouped into logical categories determined by logical categories determined by similar anatomical variants.
RESULTS
Post-operative recovery was uneventful. Histology confirmed the excised tissue as ureter. A repeat ultrasound at three months demonstrated stability in the dilatation and the boy has had no urinary tract infections.
The literature search returned detailed descriptions of 30 cases with reference to a further 10 cases. Broadly, the cases could be categorised as per Table 1.
Table 1: Categorisation of inverted ‘Y’ duplications
|
|
Male |
Female |
|
Point of termination of duplicated limb |
Blind-ending |
|
|
Ectopic location in bladder, with or without ureterocele |
||
|
Perianal |
||
|
Seminal vesicle |
Uterus |
|
|
Posterior urethra |
Vagina |
|
CONCLUSIONS
Inverted ‘Y’ duplications of the ureter are rare with the management being determined by the symptoms and precise configuration of the anomaly. We provide a categorisation of the anomaly and one method of treating an obstructing, blind-ending limb.
08:12 - 08:16
S15-4 (CRP)
Mohamed ABDELGHANY 1, Galal ELSHORBAGY 1, Hisham IBRAHIM 1, Mohamed SALAH 2, Ahmed SALEM 1, Ahmed SHOUMAN 1, Ahmed SHOUKRY 1, Mohamed ELGHONEIMY 1 and Hani MORSI 1
1) Cairo University, Paediatric Urology, Cairo, EGYPT - 2) Cairo University, Cairo, EGYPT
PURPOSE
We reported a rare association between exstrophy epispadias complex and complete urethral duplication .
MATERIAL AND METHODS
3 months old presented with bladder exstrophy epispadias complex. Under general anesthesia, during epispadias repair as a part of classic complete primary exstrophy repair, a tubular structure ventral to the epispadic urethra and both corpora cavernosum noticed . This tubular structure ended at conical shaped Glans penis ventral to the epispadic urethra with a urethral meatus . Upon passage of urethral naelton catheter through this opening , it passed to the exstrophy patch . urethroscopy was done to discover a normal ventral urethra with Verumontanum and bladder neck ended with the exstrophy patch.
RESULTS
The dorsal epispadic urethra excised and classic primary exstrophy repair with osteotomy was done. Post operative course was unremarkable
CONCLUSIONS
Despite being rare, exstrophy epispadias complex may associated with complete urethral duplication . High index of suspicion is need to detect these rare exstrophy variant .
08:16 - 08:20
S15-5 (CRP)
Ji Yong HA 1, Hye Jin BYUN 1, Teak Jun SHIN 1, Hyeon Chan JANG 1, Wonho JUNG 1, Byung Hoon KIM 1 and Dong-Gi LEE 2
1) Keimyung university school of medicine, Dongsan Hospital, Urology, Daegu, REPUBLIC OF KOREA - 2) Kyung Hee University Hospital, Urology, Seoul, REPUBLIC OF KOREA
PURPOSE
Scrotal agenesis is an extremely rare congenital anomaly, with only a few cases reported in the literature. It is often associated with undescended testes, hypospadias, and other congenital anomalies. Optimal surgical management remains debated due to concerns regarding flap viability and timing of orchiopexy.
MATERIAL AND METHODS
We report the case of an 11-month-old male who presented with an empty scrotum. Physical examination revealed bilateral undescended testes palpable in the inguinal canal, balanic hypospadias with chordee, and complete scrotal agenesis. His past medical history included pachygyria with seizure episodes, developmental delay, thrombocytosis under hematologic evaluation, and planned cochlear implantation for hearing loss.
RESULTS
A single-stage scrotal reconstruction was performed using a penile preputial flap combined with bilateral orchiopexy and chordectomy. The postoperative course was uneventful, and follow-up at 6 months demonstrated good scrotal formation and satisfactory testicular position.
CONCLUSIONS
This case highlights the feasibility of single-stage scrotal reconstruction with bilateral orchiopexy in patients with scrotal agenesis. Although some authors recommend a staged approach due to the risk of flap necrosis or infection, our experience suggests that a one-stage repair can be safely performed with favorable outcomes.
08:20 - 08:24
S15-6 (CRP)
Mohamed HUSSINY and Ashraf T. HAFEZ
Urology and Nephrology center - Mansoura University, Urology department, Mansoura, EGYPT
PURPOSE
Urinary leakage post PCNL is a significant complication which affects quality of life and may promote uro-sepsis. Leakage occurs due to obstructing residual ureteric stone, ureteric wall edema or inadequate drainage. Here, we present a rare cause of leakage post PCNL in a patient with augmented bladder and its management.
MATERIAL AND METHODS
20- year-old male patient presented with multiple left renal stones. He is a known case of classic bladder exstrophy who underwent delayed complete primary repair at age of 3 months. For achieving urinary continence, he tried endoscopic injection then bulbourethral sling operations with no success. Finally, he underwent bladder neck closure with augmentation ileocystoplasty with appendicovesicostomy continent cutaneous catheterizable channel (CCCC). PCNL was done after fixation of direct ultrasound-guided percutaneous nephrostomy tube (PCN). The procedure was uneventful. Control radiology revealed no residual stones. After removal of PCN, the patient developed urinary leakage from its site. Despite indwelling catheter drainage through CCCC and no evidence of any obstructing residual ureteric stones, the leakage persist for 4 days.
RESULTS
Non contrast CT revealed evidence of hour-glass deformity in the augmented bladder, so the catheter was not in the bladder and the drainage was not optimum. Flexible cystoscopy through appendicovesicostomy CCCC was done, bypassing the narrow neck into the bladder. Wide pore catheter was fixed over guidewire and kept for 1 week. The leakage stopped completely after 2 days and the patient was discharged safely. Correction of hour-glass deformity with reconfiguration of ileal pouch was recommended later on.
CONCLUSIONS
Hour-glass deformity is a rare cause of persistent urinary leakage post PCNL in patients with augmented bladder. Optimal drainage with wide pore catheter is crucial for urgent management. It must be a cystoscopic-guided procedure.
08:24 - 08:28
S15-7 (CRP)
Gabriela Marianna GROCHOWSKA 1, Karina FELBERG 2 and Piotr GASTOŁ 2
1) Children's Memorial Health Institute, Paediatric Urology, Warsaw, POLAND - 2) Children's Memorial Health Institute Warsaw/Poland, Paediatric Urology, Warsaw, POLAND
PURPOSE
Psychogenic polydipsia in children is uncommon and can lead to severe urological complications. We present a 8-year-old boy with massive bilateral hydroureteronephrosis and complex voiding dysfunction secondary to compulsive water drinking.
MATERIAL AND METHODS
The patient began compulsive water intake at 12 months, consuming up to 3000 ml daily. Multidisciplinary evaluation at age 2.5 years excluded organic causes including diabetes insipidus. Water restriction tests were normal without electrolyte imbalances. Despite failure to thrive (<3rd percentile) and low growth hormone levels, brain MRI was unremarkable. Psychogenic polydipsia secondary to ADHD was diagnosed, with initial improvement following behavioral therapy and fluid restriction.
At 7.5 years, he presented with nocturnal enuresis and daytime incontinence after starting school. Fluid intake had escalated to 5000 ml/day with 4000 ml diuresis. Ultrasound revealed severe bilateral hydroureteronephrosis with renal cortical atrophy. VCUG excluded VUR but demonstrated a pathologically enlarged, trabeculated bladder with multiple diverticula. Cystoscopy confirmed no anatomical obstruction. Urodynamics showed large bladder capacity with significant post-void residual, necessitating CIC.
RESULTS
After 6 months of strict fluid restriction (reduced to 2300 ml/day), psychological support, and CIC, marked improvement occurred. Diuresis decreased to 1750 ml/day, ultrasound showed reduced upper tract dilation, nocturnal enuresis decreased, and daytime continence was achieved. The patient successfully self-administers CIC due to persistent post-void residual.
CONCLUSIONS
1. Psychogenic polydipsia can cause severe urological damage mimicking obstructive uropathy.
2. Early multidisciplinary diagnosis is essential, with pediatric urologists playing a critical role.
3. Effective management requires combined psychiatric and behavioral therapy with proactive urological intervention including CIC to preserve renal function and mitigate long-term bladder dysfunction.
08:28 - 08:32
S15-8 (CRP)
Mark NINOMIYA, William TABAYOYONG and David DIAMOND
University of Rochester Medical Center, Department of Urology, Rochester, USA
PURPOSE
Inflammatory myofibroblastic tumors (IMTs) are rare, benign neoplasms of myofibroblastic and fibroblastic spindle cells that typically arise from the mesentery and mucosal surfaces, including the genitourinary system. These may occur in children and young adults with a female predominance. Here, we describe a unique case of an adolescent female who presented with bladder fullness and intermittent clot retention found to have an intravesical IMT.
MATERIAL AND METHODS
The patient was a 14-year-old otherwise healthy female who initially presented to her community hospital with progressive dysuria, urgency, and lower abdominal pain. She was started on empiric oral antibiotics for presumed urinary tract infection with no improvement in her symptoms. Her finalized urine culture was negative. Over the following weeks, she passed clots with intermittent urinary retention between clot passages. She therefore re-presented to the emergency department where urgent MRI showed a heterogeneously enhancing bladder mass (4.7cm x 5.1cm x 4.1cm), prompting transfer to a tertiary care center for pediatric urology care.
Her physical exam was unremarkable including no protruding urethral masses or external bleeding and voided clear yellow urine. Hematocrit was 31%. MRI of the abdomen and pelvis showed no lymphadenopathy. CT of the chest showed no lymphadenopathy or metastatic disease, and PET MR showed no local or distal findings of metastatic disease. She underwent urgent TURBT, where a large, lobular mass was identified on the right lateral wall superior to the trigone and ureteral orifices and was subsequently resected to the muscle layer of the bladder. She was discharged on post-operative day two, voiding clear, yellow urine.
RESULTS
Final pathology showed IMT with ALK-gene positivity based on FISH analysis. Re-staging TURBT at four months post-operatively showed well-healed surgical scar with random tissue biopsies confirming no residual tumor. Repeat bladder ultrasound at six months post-resection shows no sonographic evidence of residual tumor or recurrence.
CONCLUSIONS
IMT is a rare tumor, especially within the bladder. Here, we present a case of an IMT with the initial appearance on imaging of an aggressive malignancy in a pediatric patient who underwent successful endoscopic resection of this benign tumor without evidence of disease recurrence.
08:32 - 08:36
S15-9 (CRP)
Nicola FAZAA 1, Reut SHASHAR 1, Maxim LEIDERMAN 2 and Akram ASSADI 1
1) Rambam health care campus, Urology, Haifa, ISRAEL - 2) Rambam health care campus, Interventional radiology, Haifa, ISRAEL
PURPOSE
Partial bulbar urethral injuries in children are usually managed with urinary diversion and interval reassessment. Recurrent delayed urethrorrhagia is uncommon and should raise suspicion for a vascular source. We describe a pediatric case of persistent, high-volume urethrorrhagia caused by a bulbar artery pseudoaneurysm following partial urethral disruption, successfully treated with direct ultrasound-guided percutaneous embolization, offering an alternative to conventional endovascular techniques.
MATERIAL AND METHODS
A previously healthy 13-year-old boy sustained a perineal straddle injury resulting in partial bulbar urethral disruption confirmed by retrograde urethrography. Initial management consisted of suprapubic urinary diversion and cystoscopic assessment with placement of a urethral catheter. Two weeks after discharge, he developed recurrent severe urethrorrhagia with progressive hemoglobin decline, necessitating readmission and close hemodynamic monitoring in a pediatric intensive care unit. Conservative measures, including perineal compression, tranexamic acid, bed rest, and simultaneous suprapubic and urethral drainage, provided only transient improvement. CT angiography demonstrated a pseudoaneurysm arising from a left-sided bulbar artery adjacent to the injury site. Written informed consent for treatment and publication was obtained from the patient’s parents. Following multidisciplinary discussion, direct percutaneous embolization was selected. Under sedation and lithotomy positioning, a 25-gauge needle was advanced into the pseudoaneurysm under real-time ultrasound and fluoroscopic guidance. A mixture of Glubran-2 and Lipiodol (1:2) was injected until complete angiographic stasis was achieved.
RESULTS
Hemostasis was immediate and sustained, with no procedural complications. Follow-up Doppler ultrasound confirmed complete thrombosis of the pseudoaneurysm. Four weeks later, repeated urethrography demonstrated intact urethral continuity without contrast extravasation, allowing removal of the suprapubic catheter. At six-week follow-up, the patient voided spontaneously with uroflowmetry showing a peak flow of 23 mL/s and a post-void residual of 9 mL, and documented normal nocturnal erections, indicating preserved urinary and erectile function.
CONCLUSIONS
Bulbar artery pseudoaneurysm is a rare but clinically significant cause of delayed recurrent urethrorrhagia after pediatric urethral trauma. Direct ultrasound-guided percutaneous embolization provides a minimally invasive, artery-targeted, organ-preserving therapeutic option that may avoid open surgery or formal endovascular access while maintaining excellent urinary and erectile outcomes.