ESPU Meeting on Friday 19, June 2026, 08:00 - 08:50
08:00 - 08:03
S19-1 (CP)
Mohamed HUSSINY, Ahmed ELKASHEF, Mohamed DAWABA and Ashraf T. HAFEZ
Urology and Nephrology center - Mansoura University, Urology department, Mansoura, EGYPT
PURPOSE
We studied the safety and efficacy of alpha-1 adrenergic blocker, tamsulosin, on bladder and upper urinary tract outcomes in children following posterior urethral valve (PUV) ablation.
MATERIAL AND METHODS
Patients who had undergone primary endoscopic ablation for PUV at our center were screened for eligibility.
Exclusion criteria included patients with other conditions that affect lower or upper urinary tract functions, patients treated with urinary diversion and contraindications to α blocker treatment.
Study patients were randomized in a 1:1 ratio to either both oxybutynin (0.2 mg/kg 2 times daily) and tamsulosin (0.01 mg/kg once daily) (study group) or oxybutynin alone (control group).
The primary study end points were hydronephrosis (HN) improvement, vesicoureteric reflux (VUR) resolution, calculation of serum creatinine and estimated Glomerular Filtration Rate (eGFR)) and safety of tamsulosin.
The secondary end points included bladder neck hypertrophy (BNH) reduction, change in Shape/Wall/Reflux/Diverticulae (SWRD) score) and febrile UTI recurrence.
This study is registered on ClinicalTrials.gov (NCT06737016).
RESULTS
A total of 47 patients (25 receiving both tamsulosin and oxybutynin and 22 receiving oxybutynin alone) with a median (IQR) age of 22.23 (2.97-51.26) months were enrolled between november 2024 and september 2025 and completed at least 3 months of followup.
Tamsulosin treatment was discontinued in one patient due to treatment-related adverse effects (nasal stiffness and congestion).
Baseline characteristics were similar between both study groups.
After followup of 3 months, median serum creatinine and eGFR were not significantly different between the groups (p=0.460 and p=0.163, respectively).
Right and left HN improved in 11 (45.8%) and 7 (28%) renal units in study group vs. 8 (36.4%) and 13 (59.1%) renal units in control group (p=0.145 and =0.240 respectively) showing no significant difference.
Likewise, right and left VUR improved/ resolved in 5 (20.8%) and 3 (12%) renal units in study group vs. 4 (21.1%) and 4 (21.1%) renal units in control group (p=0.986 and =0.157 respectively) showing no significant difference.
Also, the median (IQR) SWRD score (for study group: 1 (0-2) vs. 2 (1-3) for control group, p=0.079) and the median (IQR) BNH ratio (for study group: 1.27 (1.13-1.5) vs. 1.31 (1.09-1.67) for control group, p=0.599) were not significantly different between the two groups.
As well, febrile UTI (16% vs 18.2%, p=0.843) did not differ significantly between the 2 groups.
CONCLUSIONS
Administration of selective α1 blocker, tamsulosin with anticholinergics after primary endoscopic posterior urethral valve ablation does not offer short-term benefits in terms of improving renal function, hydronephrosis, reflux, bladder neck hypertrophy compared to anticholinergic alone.
08:03 - 08:07
S19-2 (BSP)
M S ANSARI, Priyank YADAV, Naveen GAUTAM, Shivani KUMARI and Aamir USMANI
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Pediatric Urology, Department of Urology and renal transplantation, Lucknow, INDIA
PURPOSE
MATERIAL AND METHODS
RESULTS
CONCLUSIONS
The data indicates that the administration of tadalafil in cases of PUV led to superior outcomes, suggesting its role in attenuating adverse bladder remodelling by reducing inflammation and promoting functional (urodynamic) recovery.
08:07 - 08:10
S19-3 (CP)
Hans BAE 1, Alyssa WONG 1, Falla JIN 1, Harry CHAE 2, Qian ZHANG 1, Abdullah ALSHALAN 3, Douglas MATSELL 4, Jeffrey BONE 1, Kourosh AFSHAR 5, Erik SKARSGARD 5, Andrew MACNEILY 5 and Soojin KIM 5
1) BC Children's Hospital Research Institute, Urology, Vancouver, CANADA - 2) University of British Columbia, Medicine, Vancouver, CANADA - 3) University of British Columbia, Urologic Sciences, Vancouver, CANADA - 4) University of British Columbia, Pediatrics, Vancouver, CANADA - 5) British Columbia Children's Hospital, Surgery, Vancouver, CANADA
PURPOSE
Antibiotic prophylaxis (AP) and circumcision are commonly used to prevent urinary tract infections (UTIs) in children with posterior urethral valves (PUV), but there is insufficient research examining their efficacy when used together. This study compared the effectiveness of AP when used alone and in combination with circumcision in preventing UTIs in PUV patients.
MATERIAL AND METHODS
We retrospectively reviewed PUV patients managed at our institution from 2000-2019 with a 2-year follow-up period after initial presentation. Treatment exposure was modelled as time-varying. Person-time receiving AP without circumcision was classified as ‘AP only', and person-time receiving AP after circumcision was classified as ‘combined treatment'. UTIs were defined based on patient symptoms, microbiological confirmation, and/or clinical documentation. A multivariable mixed-effects Poisson regression model was used to compare UTI incidence rates between treatment exposures, adjusting for the duration of AP received prior to circumcision for combined treatment, neonatal intensive care unit (NICU) admission status, distance to hospital, and socioeconomic deprivation. Socioeconomic status was assessed using the Canadian Index of Multiple Deprivation (CIMD) scores and quintiles, which include situational vulnerability, residential instability, economic dependency, and ethnocultural composition.
RESULTS
Out of 61 patients with PUV, 32 received AP only (52.5%), 24 received combined treatment (39.3%), 1 received circumcision only (1.6%), and 4 received none of the two interventions (6.6%). Median age at circumcision, AP initiation, and first UTI was 90 days (interquartile range (IQR) 28, 275), 7.5 days (IQR 2, 38), and 46 days (IQR 14, 114), respectively. Among the cohort, 31 patients required NICU admission (50.8%), median distance to hospital was 69.5 km (IQR 22.9, 120), and median CIMD score was 3 (IQR 2.25, 3.31). The incidence rate of UTIs in the AP-only periods was 0.71 per person-year (95% CI 0.53, 0.94), and 0.51 per person-year in the combined treatment periods (95% CI 0.30, 0.79). Multivariable analysis showed that combined treatment was associated with an 80% lower UTI incidence rate compared to AP-only (incidence rate ratio 0.20; 95% CI 0.07, 0.63; p = 0.006). Greater socioeconomic deprivation (p = 0.04) was associated with higher UTI rates, whereas prior AP duration (p = 0.17), patient distance to hospital (p = 0.90), and NICU admission (p = 0.87) were not significant.
CONCLUSIONS
Combined treatment with circumcision and AP may be more effective than AP alone in preventing UTIs in PUV patients. In our cohort, degree of socioeconomic deprivation was predictive of UTI occurrence. Further investigation through implementation of a national, multicenter PUV registry could inform future practices in the management of UTIs in PUV patients.
08:22 - 08:25
S19-4 (CP)
Mahmoud AHMED 1, Matthieu PEYCELON 1, Ugo Maria PIERUCCI 1, Amane-Allah LACHKAR 1, Charlotte DUNETON 2, Hani MORSI 3, Ahmed SHOUKRY 3, Waleed GHONEIMA 3, Hisham IBRAHIM 3, Annabel PAYE 1 and Alaa EL GHONEIMI 1
1) Robert Debré University Hospital (APHP), Université Paris Cité, National Reference Center for Rare Urinary Tract Malformations (MARVU), ERN eUROGEN, Pediatric Urology, Paris, FRANCE - 2) Robert Debré University Hospital (APHP), Université Paris Cité, National Reference Center for Rare Urinary Tract Malformations (MARVU), ERN ORKID, Pediatric Nephrology, Paris, FRANCE - 3) Cairo university Hospitals, Pediatric urology, Giza, EGYPT
PURPOSE
This study aims to evaluate the long-term renal outcomes and progression to ESRD in patients born with PUV with neonatal serum creatinine more than 1 mg/dL, comparing those who had endoscopic valve ablation with those managed by incontinent vesicostomy within the first three months of age. Additionally, we assess lower urinary tract function in these patients to help identify the most appropriate initial management strategy.
MATERIAL AND METHODS
A retrospective bicentric comparative study included children born with PUV and elevated neonatal creatinine > 1 mg/dL, treated at two tertiary centers (2000-2020). Group 1 was managed by endoscopic valve ablation, while Group 2 had incontinent vesicostomy. Renal outcomes were assessed at day 7, 2 years, and 5 years post intervention using serum creatinine levels, estimated glomerular filtration rate (eGFR), and renal ultrasound. Lower urinary tract function was evaluated based on symptoms, febrile UTIs, need for clean intermittent catheterization (CIC), anticholinergics use, and urodynamic parameters. Statiscal analysis: descriptive and univariate comparison.
RESULTS
Thirty patients were included (15 per group). Median age at last follow-up was 7.0 years (5.0-9.0 y). All patients had bilateral hydroureteronephrosis with reduced renal parenchyma at baseline. High-grade bilateral VUR was more frequent in Group 2 (53% vs. 31%, p<0.001). At day 7 post-intervention, creatinine levels were similar (Group 1, 2.0 mg/dL vs. Group 2, 2.2 mg/dL, p=0.32). Renal function improved in both groups two years after neonatal intervention, with significant improvement after valve ablation. At 5 years, renal function was stable and comparable (Group 1, 0.8 mg/dL vs. Group 2, 1.2 mg/dL, p=0.08). Persistent upper urinary tract dilatation at 5 years was more frequent after vesicostomy, but did not correlate with CKD progression. However, no significant differences were observed regarding febrile UTIs, urodynamic parameters, or CIC requirement. Bladder compliance and capacity were preserved in both groups.
CONCLUSIONS
In neonates born with PUV and with elevated creatinine (more than 1 mg/dL), both primary valve ablation and vesicostomy achieve comparable long-term renal and bladder outcomes. Persistent upper tract dilatation does not necessarily predict progression to ESRD. Importantly, vesicostomy does not compromise bladder function compared with primary valve ablation.
08:25 - 08:28
S19-5 (CP)
Carla RAMIREZ-AMOROS 1, Laura GARCIA-ESPINOSA 2, Maria LOPEZ 3, Virginia AMESTY 1, Roberto LOBATO 1, Susana RIVAS 1, Maria Jose MARTINEZ-URRUTIA 1 and Pedro LOPEZ-PEREIRA 1
1) Hospital Universitario La Paz, Paediatric Urology, Madrid, SPAIN - 2) Hospital Universitario La Paz, Paediatric Nephrology, Madrid, SPAIN - 3) Hospital Universitario La Paz, Paediatric Surgery, Madrid, SPAIN
PURPOSE
Long-term outcomes and quality of life in patients with posterior urethral valves (PUV) remain poorly defined, particularly after transition to adult care. We aimed to assess renal function, bladder status, and sexual health in a mature PUV cohort.
MATERIAL AND METHODS
We retrospectively reviewed PUV patients treated between 1995-2005 at a tertiary reference centre. Renal, bladder, and sexual function were analysed through clinical history, laboratory data, urodynamic studies, and validated questionnaires.
RESULTS
Forty patients were included, with a median current age of 25.5 (19-29) years and a median follow-up of 26 (19-29) years, representing one of the longest reported PUV cohorts. Thirteen (35%) patients underwent initial ureterostomy and 27 (65%) primary valve resection. Ureterostomy patients had significantly higher initial creatinine (2.5 (0.9-2.8) mg/dL) compared to the primary resection group (1.1 (0.5-2.1) mg/dL), p<0.05. They also had higher transplantation rates, 61% versus 22% in the primary resection patients (p<0.05), although median age at transplant was comparable. At follow-up, 65% of patients maintained normal eGFR without renal transplantation.
Bladder dysfunction was present in 42.5% of patients. Among these, detrusor overactivity accounted for 53%, low compliance for 29%, and myogenic underactivity for 18%. Bladder dysfunction was strongly associated with worse renal outcomes: 57% of transplant recipients exhibited bladder dysfunction, and all patients with myogenic underactivity or low-compliance bladders ultimately required renal transplantation. Only 12% of patients reported current voiding symptoms in adulthood.
Thirty-one patients completed the sexual function questionnaire, with 6.4% reporting mild erectile dysfunction and 9.6% delayed ejaculation, indicating generally preserved sexual health in adulthood.
CONCLUSIONS
PUV continues to impact renal and bladder function into adulthood. Early urinary diversion in patients with worse baseline renal function may achieve comparable long-term renal outcomes to primary valve ablation. In addition to renal dysplasia, low compliance and myogenic failure remain a determinant of adverse renal outcomes. Despite this, most patients maintained normal eGFR, with minimal voiding or sexual dysfunction. Structured transition to adult care remain key to preserving lifelong health.
08:28 - 08:31
S19-6 (CP)
Claire, Lan LO 1, Jeanne GOULIN 1, Céline GROSOS 1, Thomas LOPPINET 2, Aurélie PORTEFAIX 2, Delphine DEMEDE 1 and Valeska BIDAULT 1
1) Hôpital Femme Mère Enfant, Paediatric surgery/urology, Bron, FRANCE - 2) Centre d'investigation clinique, CIC1407, Bron, FRANCE
PURPOSE
Posterior urethral valves (PUV) are a major cause of long-term renal and urinary dysfunction despite advances in healthcare. The impact of PUV and their multidisciplinary follow-up on health-related quality of life (HRQoL) has been scarcely reported in children. This study aimed to evaluate generic HRQoL of school-aged children treated for PUV during infancy.
MATERIAL AND METHODS
The Pediatric Quality of Life Inventory (PedsQL 4.0) questionnaires were mailed to families of children aged 6-17 years treated for PUV within their first year of life. HRQoL was evaluated using both child self-report and parent proxy-report, while the familial impact of the disease was also assessed. Higher scores indicate better HRQoL and lower impact on family. Clinical data were collected regarding surgical history, medications, urinary continence and renal function. Results are expressed as mean ± SD, and comparisons use Spearman’s correlation test. Psychometric scores were compared with an age-matched healthy reference population.
RESULTS
Thirty-four (58.6%) patients completed the questionnaires, with a median age of 10 years (IQR 8-13). The mean child self-reported PedsQL score was 77.5 ± 16.6, indicating good overall HRQoL, similar to healthy controls. Psychosocial score was lower than physical score (73.3 ± 18.8 vs 85.4 ± 15.5), reflecting the impact of PUV on emotional and school functioning. No significant differences were found between age groups (6-7 years, 8-12 years and 13-17 years). Children with chronic kidney disease had significantly lower HRQoL scores (63.0 ± 12.8) than those with normal renal function (82.7 ± 14.8; p<0.01), showing a moderate positive correlation with GFR (ρ=0.5). Urinary incontinence was associated with markedly lower HRQoL (65.6 ± 15.5 vs. 83.2 ± 14.2; p < 0.01), with a strong negative correlation between HRQoL and incontinence severity (ρ=-0.8). Parents reported lower PedsQL scores across all domains, but PUV did not appear to affect family quality of life.
CONCLUSIONS
School-aged children treated for PUV in infancy reported overall satisfactory HRQoL when compared to healthy controls. Chronic kidney disease and urinary incontinence are major factors of reduced HRQoL. This first standardized European HRQoL evaluation in PUV provides further insights to support parental counseling and emphasizes the need for adequate expert management, particularly for voiding disorders. The impact of socio-economic status on HRQoL in children with PUV remains to be assessed in further studies.
08:31 - 08:34
S19-7 (CP)
Mehak SEHGAL 1, Mohammed ELRAYES 1, Kevin CAO 1, Divyesh DESAI 1, Matko MARLAIS 2 and Navroop JOHAL 1
1) Great Ormond Street Hospital for Children, NHS Foundation Trust, London, Paediatric Urology, London, UNITED KINGDOM - 2) Great Ormond Street Hospital for Children, NHS Foundation Trust, London, Paediatric Nephrology, London, UNITED KINGDOM
PURPOSE
Children with Trisomy 21 (T21) have a significantly higher prevalence of congenital renal and urinary tract anomalies, including an increased risk of obstructive uropathy such as posterior urethral valves (PUV). Despite this recognised association, the clinical course, valve anatomy, bladder phenotype and long-term renal outcomes in T21-PUV remain poorly defined, as existing literature consists mainly of small series with limited follow-up. This gap in evidence hampers early recognition and optimal management in a population already predisposed to renal morbidity. This study aimed to characterise presentation patterns, cystoscopic morphology, bladder function and long-term renal outcomes in children with T21 and PUV managed at a national paediatric referral centre, representing the largest and most comprehensive cohort reported to date.
MATERIAL AND METHODS
A retrospective review was conducted for all children with T21 and endoscopically confirmed PUV managed between 2004-2024. Extracted variables included age and serum creatinine at presentation, nadir creatinine, valve morphology, operative interventions, bladder and urodynamic parameters, continence, and estimated glomerular filtration rate (eGFR) at final follow-up. Statistical analysis using correlation analyses assessed predictors of long-term renal outcome.
RESULTS
Seventeen children with T21-PUV were identified. Delayed diagnosis was frequent: 56% presented beyond the neonatal period, with a mean age of 3.9 years (0-12). Mean presenting creatinine was 173.6 µmol/L, with subsequent renal recovery reflected in stable nadir values. Atypical or variant valve morphology was observed in 50% at cystoscopy. Bladder assessments demonstrated reduced capacities, elevated post-void residuals and persistent lower urinary tract dysfunction; only 50% achieved full toilet training at last follow-up. Despite these challenges, long-term renal outcomes were broadly comparable to published non-T21 PUV cohorts. A moderate negative correlation was seen between age at presentation and final eGFR (r = -0.467), suggesting earlier detection is associated with improved renal preservation.
CONCLUSIONS
Children with T21 and PUV form a distinct clinical subgroup characterised by delayed presentation, variant valve anatomy and significant bladder dysfunction. Nevertheless, with multidisciplinary management, their long-term renal outcomes approximate those of non-T21 PUV patients. These findings strengthen the case for early renal ultrasonography and timely voiding cystourethrography in infants with T21 to facilitate prompt diagnosis and minimise progression to chronic kidney disease.