Parallel Meeting on Thursday 18, June 2026, 08:45 - 09:55
08:45 - 08:48
S16-1 (CP)
Jonathan AICHNER 1, Martin KAEFER 2, Tobias JHALA 3, Abraham CHERIAN 4, Ganesh VYTHILINGAM 4, Navroop JOHAL 4, Johannes MOLINARO 5, Philipp STRIEDL 5, Luisa HEUER 6, Philipp SZAVAY 7 and Sabine ZUNDEL 5
1) Children's Hospital of Central Switzerland and Great Ormond Street Hospital for Children, Paediatric Urology, London, UNITED KINGDOM - 2) Riley Children's Health, Department of Surgery, Indianapolis, USA - 3) University Hospital of Tuebingen, Department for Pediatric Surgery, Tuebingen, GERMANY - 4) Great Ormond Street Hospital for Children, Pediatric Urology, London, UNITED KINGDOM - 5) Children's Hospital of Central Switzerland, Paediatric Urology, Lucerne, SWITZERLAND - 6) University Children's Hospital Zurich, General Pediatric Surgery, Zurich, SWITZERLAND - 7) Children's Hospital of Central Switzerland, Pediatric Urology, Lucerne, SWITZERLAND
PURPOSE
Teaching in hypospadias repair is traditional. Available simulators lack realistic haptic feedback and tissue handling. A new animal-tissue model addressing these limitations, constructed from chicken skin mounted over lamb loin, was recently introduced (Aichner et al.; JPU 2025, 3:1477-5131). The aim of this study is to validate this new model using a standardised framework for face, content, construct, and concurrent validity.
MATERIAL AND METHODS
A structured, standardised simulation session was developed, teaching materials were produced, and feedback questionnaires were designed, the latter following the recommendations of the framework. Sixty-four paediatric surgeons (PS) and seven medical students (MS) from seven centres around the world participated in the study. Participants were randomized into training groups of six participants per session. Simulation sessions using the model to train the Snodgrass TIP-repair were carried out by the authors. Statistical analysis of data was conducted in a double-blinded fashion.
RESULTS
95.7% of participants rated the model as a good training tool for hypospadias repair and 91.3% recommended training on the model prior to operating on humans. 84.8% of participants rated the presented model as realistic (face validity). The simulation itself was rated as relevant by 95.7% and improved performance in 92.5% of participants. All participants agreed that the skills acquired were transferable to the operating theatre (content validity). PS scored significantly higher scores than MS in Urethral Tubularization and Degloving (p<0.05). Experienced hypospadias surgeons scored significantly higher scores in Dartos Flap preparation and Urethral Tubularization than inexperienced surgeons (p<0.05) (construct validity). In comparison to other models, such as 3D-printed ones, the animal tissue model was rated as the most realistic and suitable available (concurrent validity).
CONCLUSIONS
The animal-tissue model provides realistic, practical training for hypospadias repair. Its comprehensive validation—covering face, content, construct, and concurrent validity—supports its integration into future training programmes. The model outperforms currently available training models.
08:48 - 08:51
S16-2 (CP)
Michail AFTZOGLOU 1, Ionica STOICA 2, Sara LOBO 2, Ketaki GHARPURE 2, Anu PAUL 2, Arash TAGHIZADEH 2, Massimo GARRIBOLI 2, Patrick AZANU 3, Pankaj MISHRA 2 and Sayed KADIR 3
1) Evelina London Children's Hospital, Department of Peadiatric Urology, London, UNITED KINGDOM - 2) Evelina London Children's Healthcare, Department of Paediatric Urology, London, UNITED KINGDOM - 3) King's College, Department of Physics, London, UNITED KINGDOM
PURPOSE
To evaluate the fidelity, realism and perceived educational value of a newly developed high-fidelity silicone model designed to support structured training in distal hypospadias repair.
MATERIAL AND METHODS
A 3D-printed, anatomically accurate silicone penis model was developed through close collaboration between paediatric urologists and simulation engineers. Particular attention was given to replicating operative conditions: silicone firmness was adjusted to optimise needle purchase, suture resistance was calibrated to minimise cut-through, and the urethral plate and surrounding tissues were contoured to mimic real operative planes. A hooded foreskin was incorporated to reflect contemporary reconstructive practice and allow trainees to perform full foreskin reconstruction. During each session, trainees of varying experience performed two-layer urethroplasty, glanuloplasty and foreskin reconstruction using microsurgical instruments. At the end of the course, all participants completed a validated 24-item questionnaire assessing model fidelity, task realism, technical challenge, relevance to clinical surgery and overall educational value.
RESULTS
Thirty-three trainees participated across the training sessions, representing a wide spectrum of clinical experience (novice <10 cases; intermediate <20: 46%; senior 20–30: 23%; expert >30: 23%). Engagement was strong, with all participants reporting that their primary motivation for attending was to enhance their technical skills and refine their understanding of hypospadias repair. Overall, 92% rated the simulator as high fidelity. Needle handling (4.5/5) and tissue-cutting realism (4.8/5) were highly rated, and the reproducibility of inverting sutures with fine handling of fragile tissue received the highest score (4.9/5). Glanuloplasty scored lower (4.1/5), mainly due to tissue tension during approximation, identifying a clear area for iterative refinement. Participants consistently highlighted the opportunity to perform the entire operative sequence—from plate tubularisation to foreskin reconstruction—as a major advantage of the model. Importantly, 100% felt that training with this simulator would improve their performance in the operating theatre.
CONCLUSIONS
This novel, high-fidelity silicone hypospadias model accurately reproduces the key reconstructive steps required for distal repair and offers a realistic, safe and reproducible platform for skills development. Its strong educational value, demonstrated across all trainee levels, supports its integration into formal hypospadias training pathways and justifies further refinement and wider implementation.
08:51 - 08:54
S16-3 (CP)
Alexis LUBET 1, Mariette RENAUX-PETEL 1, Hugo DUPUIS 2, Laurent DELBREILH 3 and Agnès LIARD-ZMUDA 1
1) University Hospital of Rouen, France, Pediatric surgery, Rouen, FRANCE - 2) University Hospital of Rouen, France, Urology, Rouen, FRANCE - 3) GPM, Groupe de Physique des matériaux CNRS, Rouen, FRANCE
PURPOSE
Flexible ureteroscopy is increasingly performed in children for the management of upper urinary tract stones, but training opportunities remain limited due to the cost, fragility, and restricted access to high-fidelity simulators. Existing models often lack the anatomical realism, reproducibility and affordability required for widespread pediatric training. The aim of this study was to develop and validate an inexpensive, anatomically accurate, 3D-printed simulator (Space Child Ureteroscopic Trainer, SCUT) to support progressive training in flexible ureteroscopy, including stone extraction and laser fragmentation.
MATERIAL AND METHODS
An anonymized CT urogram of a healthy children was segmented and digitally modified to replicate pediatric upper urinary tract proportions while enabling safe manipulation of flexible ureteroscopes. The urinary tract model was 3D-printed using low-cost polylactic acid (PLA), with a total material cost under ten euros per unit. Artificial stones were produced using dental cement. The simulator was evaluated during structured training sessions involving junior residents and senior surgeons. Participants performed standardized tasks: navigation of the collecting system, stone location, stone extraction using a basket device, and laser fragmentation under fluoroscopic control. After each session, participants completed a Likert-scale questionnaire assessing anatomical fidelity, ergonomics, maneuverability, and educational value. Performance during laser exercises was assessed using a structured scoring system adapted from validated technical skill assessment tools (Martin et al. Br J Surg 1997; 84: 273–8).
RESULTS
Thirty-nine participants completed the full evaluation. The overall appreciation score was 8.21 out of 10 (standard deviation 0.86). Senior surgeons consistently rated anatomical realism, ergonomics, and endoscope maneuverability higher than trainees (p less than 0.05). Realism of the renal cavities reached 8.46 out of 10. The simulator withstood repeated use of laser energy without structural degradation. In the laser fragmentation subgroup (n = 10), senior surgeons achieved significantly higher performance scores than trainees (mean 34.0 vs. 23.83; p = 0.031), demonstrating discriminative validity. Internal consistency was excellent for the performance score (Cronbach alpha 0.98) and good for the satisfaction questionnaire (Cronbach alpha 0.80).
CONCLUSIONS
The SCUT simulator is a low-cost, realistic and reproducible tool that allows detailed training in pediatric flexible ureteroscopy, including navigation, stone extraction, and laser lithotripsy. Its affordability and validated educational performance support its integration into pediatric urology training programs.
09:06 - 09:09
S16-4 (CP)
Hachem ZIADEH 1, Eman CHAUDHRI 1, Lauren CHEW 2, Johana PAEZ CORTES 1, Mercedes STREMMLER 3, Lorena LLOBENES 4, Pedro-Jose LOPEZ 1 and Juan MOLDES 1
1) University Hospitals Cleveland Medical Center/Case Western Reserve University, Urology, Cleveland, USA - 2) University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, USA - 3) Aquietar, Buenos Aires, ARGENTINA - 4) Motivacion Compasiva, Buenos Aires, Buenos Aires, ARGENTINA
PURPOSE
Compassion is increasingly recognized as a core clinical competency in healthcare, yet it remains underemphasized within surgical environments where time pressure, technical focus, and emotional restraint often take precedence. Incorporating compassion-based practices may improve surgeon well-being, team dynamics, and patient-centered care. This pilot study sought to evaluate the feasibility and psychological impact of a structured 6-week compassion training program tailored for surgeons, integrating three perioperative "Surgical Pauses": Awareness, Compassion, and Integration.
MATERIAL AND METHODS
Surgeons from a urology department participated in a 6-week curriculum consisting of weekly 90-minute sessions involving mindfulness, self-compassion training, and guided reflection. The three Surgical Pauses were introduced as brief, replicable steps designed to embed compassion directly into operative routines. Validated quantitative scales and qualitative questionnaires were administered pre- and post-training. Paired-sample t-tests assessed changes in psychological measures.
RESULTS
Fifteen surgeons completed the pre-training questionnaire, and ten completed both pre- and post-assessments. Participants showed significant improvement in self-compassion (p=0.0455) and significant reductions in fear of compassion (p=0.0204), most notably fear of expressing compassion to others (p=0.00388). Mindfulness demonstrated a trend towards improvement (p=0.0655). Although changes in overall well-being and burnout were not statistically significant, qualitative responses highlighted meaningful perceived benefits. Surgeons described the Awareness Pause as enhancing preoperative focus and emotional grounding. The Compassion Pause, the most frequently cited impactful component, was associated with improved team cohesion, communication, and patient-centered intention-setting. The Integration Pause was described as promoting postoperative reflection, gratitude, and emotional closure. Collectively, these pauses were viewed as feasible and easily incorporated into existing workflow without disrupting operative efficiency.
CONCLUSIONS
This pilot study demonstrates feasibility, acceptability, and psychological relevance of compassion training for surgeons. The structured program improved self-compassion and reduced fear of compassion while offering a simple, reproducible framework for integrating compassion and reduced fear of compassion while offering a simple, reproducible framework for integrating compassion into perioperative practice. The three Surgical Pauses, namely the Compassion Pause, provided a practical reproducible method for embedding compassion directly into surgical routines. Larger, multi-institutional studies are warranted to validate these findings and explore the broader impact of compassion-based interventions within surgical teams.
09:09 - 09:12
S16-5 (CP)
Paul MERGUERIAN and Nicolas FERNANDEZ
Seattle Children's Hospital, Division of Urology, Seattle, USA
PURPOSE
Systematic literature reviews (SLRs) and meta-analysis are generally considered to be among the most robust forms of evidence; their adherence to strict methodological guidelines helps negate bias. Conducting SLRs can be quite labor-intensive, requiring extensive manual efforts from researchers to identify and screen large volumes of published literature. With the recent boom in Artificial Intelligence technologies, the way SLRs will be conducted may be changing. We aim to evaluate current research software (Elicit AI) in its accuracy in performing SLRs and compare the results with those published in the pediatric urology literature.
MATERIAL AND METHODS
Elicit software was used for the AI research assistant to perform the systematic reviews. Elicit is able identify papers relevant to a research question across multiple databases. Elicit identifies the most relevant papers, then generates a summary of the question through analysis of each abstract. We compared the Elicit generated reports with 4 systematic reviews published in the pediatric urology literature. Filters were applied to refine the search based on article type and publication according to the inclusion criteria of the original published review. Three Elicit reports were generated for each SLR. Elicit reports were assessed based on repeatability, reliability and accuracy.
RESULTS
Elicit was accurate in repeating the same publications in the 3 trials for each of the SLRs. The number of articles screened by Elicit was lower than the ones screened in the published SLR, though Elicit added relevant articles that were not included in the published SLR. The reports were accurate and came to the same conclusions as the published systematic reviews.
CONCLUSIONS
Our findings suggest that AI research assistants, like Elicit, are complementary when designing or writing SLRs. However, AI tools have several limitations and in their current state cannot replace the human element. They have the ability to complement and enhance the SLR process making it more time efficient and accurate.
09:12 - 09:15
S16-6 (CP)
Jin Kyu (Justin) KIM 1, Rosalia MISSERI 1, Martin KOYLE 2, Armando LORENZO 3, Mandy RICKARD 3 and Michael CHUA 3
1) Riley Hospital for Children, Urology, Indianapolis, USA - 2) University of Toronto Temerty Faculty of Medicine, Institute of Health Policy Management and Evaluation, Toronto, CANADA - 3) The Hospital for Sick Children, Urology, Toronto, CANADA
PURPOSE
Clinical practice guidelines are central to evidence-based practice, yet their quality varies. The AGREE II instrument is the international standard for appraisal but is resource-intensive. Large language models (LLMs) may provide a scalable alternative, though their reliability compared with human reviewers is uncertain. This study assessed the reliability of LLMs in appraising pediatric urology guidelines using AGREE II.
MATERIAL AND METHODS
We conducted a methodological comparison study. Human AGREE II scores were obtained from three prior studies (2015–2023). LLM appraisals were performed in 2025 using a structured web-based workflow with standardized prompts. Eighteen international pediatric urology guidelines were included (undescended testis = 4, neurogenic bladder = 5, circumcision = 9), each with ≥4 human evaluations. Policy statements, retired guidelines, and American Urological Association guidelines were excluded. Three proprietary LLMs (GPT-4.1, Gemini Flash 2.5, Claude Sonnet 4) each appraised all guidelines three times. Agreement was assessed using intraclass correlation coefficients (ICCs), Bland–Altman analyses, and consistency indices.
RESULTS
LLMs showed excellent internal consistency (ICC 0.868–0.986) and inter-model agreement (ICC 0.895–0.932), similar to human–human agreement (ICC 0.732–0.929). Agreement between LLMs and humans was lower but acceptable (ICC 0.646–0.743). Consistency indices were ≥0.70 except for Claude Sonnet 4 on undescended testis guidelines. Bland–Altman analysis indicated LLMs scored lower than humans by an average of -12.7%, ranging from -1.3% (circumcision) to -24.5% (undescended testis).
CONCLUSIONS
LLMs provided reliable AGREE II appraisals of pediatric urology guidelines, with performance comparable to human evaluators. While scoring slightly lower, their consistency supports use as adjuncts to expert appraisal, potentially reducing evaluation burden. Broader studies across diverse clinical domains are needed to confirm generalizability.
09:15 - 09:18
S16-7 (CP)
Aneta PIOTROWSKA-GALL 1, Julia BADZIŃSKA 2, Maria GRUBA 3, Bartosz BOGUSZ 3, Joanna GODLEWSKA 3, Wojciech GÓRECKI 3 and Rafał CHRZAN 1
1) Jagiellonian University Medical College, Department of Pediatric Urology, University Children's Hospital, Krakow, POLAND - 2) Jagiellonian University, Institute of Psychology, Doctoral School in the Social Sciences, Institute of Psychology, University of the National Education Commission, Krakow, POLAND - 3) Jagiellonian University Medical College, Department of Pediatric Surgery, University Children's Hospital, Krakow, POLAND
PURPOSE
Performance in robotic surgery depends on a combination of technical skills, cognitive abilities, and individual characteristics. The aim of our study was to identify experiential and psychological factors associated with better performance on a DaVinci® robotic surgery simulator.
MATERIAL AND METHODS
We conducted a prospective study including medical students and surgeons at different stages in their career. Eligible participants were adults who provided informed consent and Da Vinci®-certified surgeons were excluded. All participants performed the same three exercises on a DaVinci simulator, each exercise repeated once within a 20-minute session. The practical session was repeated four times per participant within a 6-8days intervals. Simulator-derived metrics included overall performance score, task completion time and economy of motion.
Participants completed online questionnaires assessing self-rated skills and interests (e.g. hobbies, previous virtual reality (VR) experience), basic demographic data, and personality/temperament traits using a validated psychological inventory.
RESULTS
A total of 62 participants were enrolled in the study; 26 took part in the practical sessions (20 fully completed). The mean age was 28.11 years (range 20-54, SD 8.2). Simulator performance improved significantly across the first two practice sessions(p<.001), with no further significant improvement between session 3 and 4.
Higher endurance scores were associated with higher total performance scores(p=.001) and shorter task completion times(p<.001). No clear or consistent associations with the performance indicators were observed for briskness, sensory sensitivity, perseverance, emotional reactivity, activity, rhythmicity, nor for neuroticism, extraversion, openness to experience, agreeableness, or conscientiousness.
Professional status, prior laparoscopic experience, hobby, and previous VR experience were not significantly associated with overall performance in this sample. In one exercise, participants without prior laparoscopic experience showed a more favorable learning pattern compared with those with such experience. Prior VR experience was associated with faster completion of one exercise, but not with overall performance nor economy of motion.
CONCLUSIONS
Performance in robotic surgery simulation improves rapidly during early training, with subsequent plateau after a few practice sessions. Persistence emerged as a significant predictor of superior overall simulator performance. Prior laparoscopic experience, gaming, or VR exposure did not improve training outcome. Further studies are warranted to confirm these associations.
09:33 - 09:36
S16-8 (CP)
Khaled ABOUKHALAF 1, Jo BLAIR 2, Dan HAWCUTT 3 and Harriet CORBETT 4
1) Royal Liverpool University Hospital, Liverpool, UNITED KINGDOM - 2) Alder Hey Children's NHS Foundation Trust, Department of Endocrinology, Liverpool, UNITED KINGDOM - 3) University of Liverpool, Institute of Life Course & Medical Sciences, Liverpool, UNITED KINGDOM - 4) Alder Hey Children's NHS Foundation Trust, Regional Department of Urology, Liverpool, UNITED KINGDOM
PURPOSE
Anticholinergics are linked to dementia in older adults; beta-3-agonists may also pose a risk. In children and young people (CYP) there are concerns about neurocognitive side effects: long-term safety data remain limited. Patients and healthcare providers can report suspected adverse drug reactions (ADRs) via https://yellowcard.mhra.gov.uk; summarised data can be reviewed. The study aim was to characterise reports of ADRs involving anticholinergic and beta-3 agonists in CYP.
MATERIAL AND METHODS
The website was accessed on 26/11/2025. Filters were applied: male, female, 0-9 years, 10-19 years. Reports for trospium (n = 2), fesoterodine (1), unknown sex and age were excluded. Data for ≥20 years was reviewed for comparison. Outcomes were categorised by MedDRA System Organ Class (SOC). No prescribing denominator was available, findings represent signal proportions, not incidence. Comparison of proportions was with "N-1" Chi2, p<0.05 was considered significant (www.medcalc.org).
RESULTS
Oxybutynin had the highest number of reports in CYP: 224 (≥20 yrs 966) vs. tolterodine: 36 (≥ 20 yrs 742), solifenacin: 20 (≥20 yrs 952) and mirabegron: 17 (≥20 yrs 1041). No reports had been made for vibegron. Many reports involved multiple SOC categories, the 5 most frequently reported are given in the table.
The proportion of psychiatric disorder reports was significantly higher for oxybutynin compared to tolterodine (63% vs. 33%, p=0.0008) and solifenacin (63% vs. 20%, p=0.0002) but comparable for mirabegron (60% vs. 59%, p=0.737). When compared to data for ≥20 yrs, reports for 0-19 yrs were significantly higher for oxybutynin (63% vs.17%, p<0.0001) and mirabegron (59% vs. 14%, p<0.0001) though comparable for tolterodine & solifenacin.
The proportions of nervous system disorders reports were comparable for all medications but the proportion of reports for oxybutynin for 0-19 yrs was significantly higher than for ≥20 years (37% vs.26%, p=0.001).
|
Drug Total number of reports (% female) |
Oxybutynin 224 (52%) |
Tolterodine 36(56%) |
Solifenacin 20 (50%) |
Mirabegron 17 (88%) |
|
Year of first report (average report rate per year) |
1991 (6.6) |
1998 (1.3) |
2007 (1.1) |
2014 (1.5) |
|
Proportion categorised as serious, % |
52 |
47 |
55 |
65 |
|
Total no of SOC reactions reported |
513 |
75 |
41 |
38 |
|
|
|
|
|
|
|
Psychiatric disorders |
141 |
12 |
5 |
10 |
|
Nervous system disorders |
83 |
11 |
7 |
6 |
|
Gastrointestinal disorders |
67 |
15 |
12 |
1 |
|
Skin and subcutaneous tissue disorders |
59 |
6 |
4 |
3 |
|
General disorders and administration site conditions |
38 |
9 |
1 |
6 |
CONCLUSIONS
Oxybutynin is associated with a high number of ADR reports in CYP, significantly more reports fall into neuropsychiatric categories than in adults. The data reveals an underappreciated neurocognitive safety burden of bladder medications. Further epidemiological studies are warranted to quantify long-term neurodevelopmental risks.
09:36 - 09:41
S16-9 (VP)
Nicolas I. ROSIERE, Leandro ASEN, Ignacio ARENAS NORTON, Francisco IMAZ, Danel ALBERTI, Otilia BLAIN, Felicitias LOPEZ IMIZCOZ, Yesica GOMEZ, Carol BUREK, Cristian SAGER, Javier RUIZ and Santiago WELLER
Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan", Urología, Capital Federal, ARGENTINA
PURPOSE
Surgical complications after pediatric kidney transplantation are infrequent. Urinary fistula occurs in 1-5% of cases and is initially managed with urinary diversion. When conservative treatment fails, surgical repair is challenging due to intense inflammation around the graft. Fluorescence imaging has proven useful in complex pelvic surgery, although its use in kidney transplantation remains limited. The aim of this video is to describe the technical aspects of a fluorescence-guided laparoscopic urological reconstruction in a pediatric patient with a post-transplant surgical complication.
MATERIAL AND METHODS
Video case presentation of a pediatric kidney transplant recipient undergoing fluorescence-guided laparoscopic urinary tract reconstruction.
RESULTS
A 17-year-old patient with chronic kidney disease secondary to vasculitis received a deceased-donor transplant. Postoperatively, he developed a retroperitoneal hematoma requiring drainage, then urinary fistula and wound dehiscence. Initial management included negative pressure therapy. Two months later, after removal of the double J stent, antegrade pyelography demonstrated a small fistula and stenosis at the neoureterocystostomy. A nephrostomy was placed. To avoid relaparotomy, a laparoscopic approach was chosen.
In Valdivia-Galdakao position, a stent was placed in the native ureter for identification. Under laparoscopy, severe inflammation impaired visualization. To better identify the graft ureter, a 1.25 mg/mL indocyanine green solution was injected through the nephrostomy tube. Fluorescence with Storz Power LED Rubina safely identified the graft ureter, allowed dissection, avoided ureteral injury and vascular bleeding, and enabled us to perform a wide side-to-side ureteroureterostomy. A double J stent was placed transanastomotically. Postoperative recovery was uneventful. At 2 months, pyelography confirmed patency and the stent was removed. At 4 months ultrasound showed mild pelvic ectasia with normal perfusion.
CONCLUSIONS
Fluorescence enhances identification of the urinary tract in complex reconstructive scenarios, reducing risk of iatrogenic injury and intraoperative bleeding. The native ureter is a useful reconstructive option in post-transplant complications. Laparoscopy approach is safe and avoids the morbidity of relaparotomy in inflamed tissue.