ESPU Meeting on Friday 19, June 2026, 11:45 - 12:40
11:45 - 11:48
S22-1 (CP)
Constantijn MEIJSSEN 1, Fred VAN DER TOORN 2, Barbara KORTMANN 3, Jeroen SCHEEPE 2, Piet CALLEWAERT 4, Katja WOLFENBUTTEL 2, Eric VAN DER HORST 5, Martijn STEFFENS 6, Aart KLIJN 1, Keetje DE MOOIJ 1, Josine QUAEDACKERS 7, Rogier SCHROEDER 1, Allon VAN UITERT 3, Martje SCHOTMAN 8 and Ruud WORTEL 1
1) University Medical Center Utrecht - Wilhemina Children's Hospital, Pediatric Urology, Amsterdam, NETHERLANDS - 2) Erasmus Medical Center - Sophia Children's Hospital, Pediatric Urology, Rotterdam, NETHERLANDS - 3) Radboud University Medical Center - Amalia Children's Hospital, Pediatric Urology, Nijmegen, NETHERLANDS - 4) Maastricht University Medical Center, Pediatric Urology, Maastricht, NETHERLANDS - 5) Amsterdam University Medical Center, Pediatric Urology, Amsterdam, NETHERLANDS - 6) Isala Hospital, Urology, Zwolle, NETHERLANDS - 7) University Medical Center Groningen, Pediatric Urology, Groningen, NETHERLANDS - 8) Haga Hospital - Juliana Children's Hospital, Pediatric Urology, Den Haag, NETHERLANDS
PURPOSE
During hypospadias repair, the split ventral prepuce can be reconstructed by incorporation of a preputioplasty. This additional surgical step may potentially increase the risk of complications. This study evaluates the complications related to preputioplasty after hypospadias repair and compares urethroplasty complications (UC) in these boys with a control group in which the preputium was removed and a dartos flap of the prepuce was used to cover the neo-urethra. In addition, parental satisfaction with the post-operative appearance of the penis is assessed.
MATERIAL AND METHODS
This is a substudy of the Dutch Hypospadias Study, a nationwide prospective multicenter cohort study (2008-2016).
In boys with coronal or distal shaft hypospadias, preputial complications after primary hypospadias repair including preputioplasty (n=233) were assessed six months post-operatively and at five years of age (TIPU, MAG-Thieu).
Complications of the urethroplasty in this patient group were compared with a control group (n=402) in which hypospadias repair was performed without preputioplasty (TIPU). In the control group, a vascularized dartos flap from the prepuce was used to cover the neo-urethra in order to reduce the risk of urethral complications. Multivariable regression models were used to analyze factors associated with UC. Parental satisfaction with the post-operative appearance of the penis was compared between the two groups.
RESULTS
In the preputioplasty group, preputial complications (preputial fistula, preputial dehiscence) were observed in 17.6% (41/233 patients). For urethroplasty complications, no statistically significant difference was observed between the two groups (25.8% in the preputioplasty group vs 21.6% in the control group). The overall risk of complications was, however, significantly higher in the preputioplasty group (36.9%) compared to the control group (21.6%). Between pre-operative and at five years of age, the improvement of parental satisfaction with the penile appearance was comparable (2.88 vs 2.86). In the multivariable analysis, only running urethroplasty suture technique (versus interrupted) was associated with a lower relative risk for UC.
CONCLUSIONS
Performing a preputioplasty carries a substantial additional risk of post-operative complications. A preputioplasty has no impact on parental satisfaction with the post-operative appearance of the penis.
11:48 - 11:51
S22-2 (CP)
Jeffrey HUYNH 1, Fred VAN DER TOORN 2, Allon VAN UITERT 3, Josine QUAEDACKERS 4, Piet CALLEWAERT 5, Martijn STEFFENS 6, Eric VAN DER HORST 7, Martje SCHOTMAN 8, Barbara KORTMANN 3, Jeroen SCHEEPE 2, Katja WOLFFENBUTTEL 2, Aart Jan KLIJN 9, Keetje DE MOOIJ 9 and Rogier SCHROEDER 10
1) Univeristy Medical Centre Utrecht - Wilhelmina Children's Hospital, Urology, Utrecht, NETHERLANDS - 2) Erasmus University Medical Center - Sophia Children's Hospital, Pediatric Urology, Rotterdam, NETHERLANDS - 3) Radboud University Medical Center - Amalia Children's Hospital, Pediatric Urology, Nijmegen, NETHERLANDS - 4) University Medical Center Groningen, Urology, Groningen, NETHERLANDS - 5) Maastricht University Medical Center, Urology, Maastricht, NETHERLANDS - 6) Isala Hospital, Urology, Zwolle, NETHERLANDS - 7) Amsterdam University Medical Center, Pediatric Urology, Amsterdam, NETHERLANDS - 8) Haga Hospital - Juliana Children's Hospital, Pediatric Urology, Den Haag, NETHERLANDS - 9) Univeristy Medical Centre Utrecht - Wilhelmina Children's Hospital, Pediatric Urology, Utrecht, NETHERLANDS - 10) University Medical Center Utrecht - Wilhelmina Children's Hospital, Pediatric Urology, Utrecht, NETHERLANDS
PURPOSE
Distal hypospadias accounts for the majority of all hypospadias cases. Achieving a normal penile appearance is an important indication for surgical repair. However, studies comparing parental perception and satisfaction before and after surgery across different repair techniques remain scarce. In this study, we aimed to compare parental perception and level of satisfaction before and after surgery among 4 different techniques for distal hypospadias repair.
MATERIAL AND METHODS
This study used data from the multicenter, prospective Dutch Hypospadias Study. Eligible patients had (sub)coronal or distal penile shaft hypospadias and underwent primary repair via tubularized incised plate urethroplasty (TIPU), meatal advancement and glanuloplasty (MAGPI), urethral advancement (UA), or a modified Mathieu (MM) technique. Parents rated penile appearance pre- and 6 months postoperatively using the parent perception score (PPS), mirroring the 5 HOPE-score items (meatal position, meatal shape, glans shape, skin shape, torsion) with a single normal reference photo for shape-related items. Additionally, parents rated their level of satisfaction on a 10-point scale, referred to as the Parent Satisfaction Rate (PSR). Statistical analyses tested pre- to postoperative PPS and PSR differences among the 4 techniques.
RESULTS
In total, 394 patients had both pre- and postoperative complete PPS and PSR. Of these, 300 underwent TIPU, 41 MAGPI, 10 UA and 43 MM. Median age at surgery was 12.0 months. Median PPS improved from 8 preoperatively to 9 postoperatively across all techniques, with no significant differences between techniques at either timepoint. This held true for individual PPS items as well. Median PSR similarly increased from 6 to 8 postoperatively, without inter-technique differences. No significant differences appeared in PPS or PSR improvements across the 4 techniques.
CONCLUSIONS
We found no significant differences in short-term parental perception and satisfaction among 4 commonly used techniques for (sub)coronal and distal penile shaft hypospadias repair techniques. Parental satisfaction improved from a 6 to 8. Future research in the Dutch Hypospadias Study will assess improvement in penile perception and level of satisfaction from the boys themselves at age 15 to 16, evaluating their own preoperative photographs.
11:51 - 11:54
S22-3 (CP)
Yannis BONNIN 1, Aurelie CAZALS 2, Lola ANGOT 2, Sarah GARNIER 1, Benoit TESSIER 1 and Nicolas KALFA 1
1) CHU de Montpellier, Département de Chirurgie Infantile, Service de Chirurgie Viscérale et Urologie Pédiatrique, Montpellier, FRANCE - 2) CHU de Montpellier, Centre de Référence Maladies Rares DEVGEN Constitutif Sud, Montpellier, FRANCE
PURPOSE
Anterior hypospadias can benefit from surgery or conservative approach depending on phenotype, urinary consequences and family’s choice. The aim of this study was to assess the proportion of patients who require surgery and to identify predictive factors for this.
MATERIAL AND METHODS
Retrospective comparative study that enrolled patients with anterior hypospadias from 2010 to 2025. Data included type of hypospadias, associated anomalies, operative or non-operative management and type of surgery.
RESULTS
830 patients (mean age 13 months at first consultation) were included. Mean follow-up was 4.02 years (up to 18.8). The overall rate of surgery was 52%. This rate declined in the last 6 years while the number of children with anterior hypospadias remained stable. Urethroplasty was the most frequent surgery, but it was needed in only 34.5% of cases (n=310). Other surgeries without urethroplasty included meatoplasty (n=70, 7.8%), straightening of the penis (n=35, 3.9%), circumcision (n=26, 2.9%). An event-free curve for children not yet operated at 2 years of age showed that 1-only 1/3 will finally require surgery later during infancy, 2-the surgery is mainly done before or around the school age 3- surgery is rarely needed after 12 years if the patient wase closely followed before. Predictive factors for the need of a urethroplasty were the position of the meatus under the sulcus (p<0.01), a deflected urinary stream (p= 0,025), the absence of congenital syndrome (p=0,036).
CONCLUSIONS
Only half of patients with anterior hypospadias patients need surgery during infancy. Urethroplasty is the most frequent approach but meatoplasty and penis straightening may be sufficient in a significant number of patients. Children who are still non-operated at 2 years of age will require surgery in less than 1/3 case mainly around school age. A meatus below the sulcus, a deflected stream and the absence of congenital syndrome are risk factors for urethroplasty. A close and step-by-step follow-up to determine the patient’s needs at each age may reduce the risk of unnecessary surgery.
11:54 - 11:57
S22-4 (CP)
Maria ESCOLINO, Claudia DI MENTO, Francesca CARRATURO, Fulvia DEL CONTE, Francesco TEDESCO, Vincenzo COPPOLA, Maria Sofia CARACÒ, Benedetta CESARO, Maria Luisa PIRONE and Ciro ESPOSITO
Federico II University Hospital, Translational Medical Sciences, Naples, ITALY
PURPOSE
This study aimed to evaluate anatomical and intraoperative risk factors predicting complications following distal hypospadias repair with foreskin reconstruction in pediatric patients.
MATERIAL AND METHODS
A prospective analysis was conducted on all patients with distal hypospadias undergoing tubularized incised plate urethroplasty (TIPU) with foreskin reconstruction over a 2-year period. Intraoperative measurements—stretched penile length, glans width, glans groove width, meatal position, ischemic time and preputial symmetry—were recorded. Postoperative complications and reoperations were analyzed through multivariate logistic regression to determine independent predictors.
RESULTS
The patient cohort included 71 operated boys. Median patient age was 2.4 years (range 1-9.1), and median follow-up was 12.8 months. The most frequent complications were foreskin dehiscence (12.7%), non-retractile foreskin (12.7%), meatal/urethral stenosis (11.3%), and urethrocutaneous fistula (7.0%). Prolonged ischemic time (>60 min) independently predicted foreskin dehiscence (p=0.03) and reoperation (p=0.003). Shorter PL (≤3 cm) was associated with higher stenosis rates, while more proximal distal meatal position (subcoronal/midpenile) increased the risk of foreskin dehiscence (p=0.0006), fistula (p=0.007), and reoperation (p=0.02). Age > 2 years significantly predicted meatal/urethral stenosis (p=0.01) and reoperation (p=0.001). Preputial asymmetry correlated with foreskin dehiscence (p=0.006), whereas glans width and groove width showed no significant associations (p>0.05).
CONCLUSIONS
Prolonged ischemic time, shorter penile length, more proximal distal meatal position, asymmetric prepuce and older age at surgery are independent predictors of postoperative complications and reoperations after distal hypospadias repair with foreskin reconstruction. Careful preoperative assessment, minimizing intraoperative ischemic duration, and considering earlier surgery before 2 years of age may improve both functional and cosmetic outcomes.
12:12 - 12:15
S22-5 (CP)
Maksym PONOMARENKO
National Children's Specialized Hospital « Ohmatdyt», Paediatric Urology, Kiev, UKRAINE
PURPOSE
Meatal stenosis remains one of the most relevant postoperative complications after distal TIP urethroplasty. Conventional techniques involve forming the neourethra directly over the postoperative catheter, which may result in a narrow final lumen once the catheter is removed. The aim of this study was to determine whether intraoperative urethral calibration using a larger catheter, followed by postoperative downsizing, reduces the incidence of meatal and neourethral stenosis.
MATERIAL AND METHODS
A retrospective comparative analysis was performed in boys who underwent distal TIP urethroplasty between 2021 and 2024. All patients received suprapubic urinary diversion, which was therefore not a variable of comparison. Two groups were evaluated. Group 1 (n = 340) underwent neourethral tubularization directly over the postoperative drainage catheter (8 Ch in prepubertal and 10 Ch in postpubertal patients). Group 2 (n = 480) underwent neourethral formation over a larger calibration catheter, with postoperative downsizing: 10 Ch to 8 Ch in prepubertal boys and 12 Ch to 10 Ch in postpubertal patients. Follow-up was conducted at 1, 6, and 12 months, focusing on meatal and neourethral stenosis as the primary outcomes.
RESULTS
A significant difference in postoperative stenosis was observed. In Group 1, meatal stenosis occurred in 20 patients (6%). In Group 2, no cases of stenosis were identified. Two patients in Group 2 (0.4%) experienced minor postoperative complications unrelated to stenosis; both resolved with conservative management. No increase in fistulas, wound dehiscence, or discomfort was observed when the upsizing-downsizing technique was used.
CONCLUSIONS
Intraoperative urethral calibration using a catheter of larger caliber, followed by postoperative downsizing, significantly reduces the risk of meatal and neourethral stenosis after distal TIP urethroplasty. This technique is simple, safe, and easily adopted into routine surgical practice. The results demonstrate that controlled upsizing during tubularization provides a more stable neourethral lumen and offers an effective strategy for preventing stenosis in distal hypospadias repair.
12:15 - 12:18
S22-6 (CP)
Dilşad DERELI, Akin KARAGÖZOĞLU, Hasan TURAN, Çiğdem ARSLAN ALICI, Araz HÜSEYİNOV and Baran TOKAR
ESKISEHIR OSMANGAZI UNIVERSITY FACULTY OF MEDICINE, PEDIATRIC UROLOGY DEPARTMENT, Eskişehir, TÜRKIYE
PURPOSE
The optimal duration of urethral stent placement after distal hypospadias repair remains a matter of controversy, and current guidelines provide no clear recommendation. This study aimed to compare postoperative complication rates in distal hypospadias patients undergoing tubularized incised plate urethroplasty (TIPU) in whom the urethral stent was removed on postoperative day 3 versus day 7.
MATERIAL AND METHODS
We retrospectively reviewed 639 patients who underwent TIPU for distal hypospadias at our pediatric urology clinic between April 2002 and May 2025. Group A included 278 patients operated on between April 2002 and December 2010, in whom the stent was removed after 7 days. Group B included 361 patients operated on between January 2011 and May 2025, in whom the urethral stent was removed on postoperative day 3. In all cases, a 6 Fr or 8 Fr feeding tube was used as a urethral stent and secured to the glans with sutures. The urethral meatus location ranged from subcoronal to midpenile. Postoperative complications and outcomes were recorded, and patients were scheduled for follow-up at 1 week, 1 month, 3 months, 1 year, and 5 years postoperatively.
RESULTS
In Group A (n = 278), meatal stenosis occurred in 13 patients (4%), urethrocutaneous fistula in 12 patients (4%), and HSE in 5 patients (1%), yielding an overall complication rate of 9%. In Group B (n = 361), postoperative complications included meatal stenosis in 17 patients (4%), urethrocutaneous fistula in 9 patients (2%), and hematoma and/or significant edema (HSE) in 3 patients (0.8%), with an overall complication rate of 8%. The overall rates and distribution of complications were comparable between the two groups.
CONCLUSIONS
There is considerable variability in the literature regarding the duration of the stent. While some studies suggest stentless follow-up, others advocate maintaining the stent for one week or longer. Our analysis shows a comparable complication rate between the two groups following TIPU. This might suggest that reducing the holding time of the stent to 3 days could decrease stent and dressing-related discomfort and help reduce the cost and time required for prolonged follow-up.
Keywords: Distal hypospadias, urethral stent, hypospadias complication
12:18 - 12:21
S22-7 (CP)
Anthony KALLAS CHEMALY 1, Tariq ABBAS 2, Nabil DAOUD 3, Carla HABER 4 and Ghazi SAKR 3
1) Hôtel-Dieu de France University Hospital/ Mount Lebanon University Hospital, Paediatric Urology, Beirut, LEBANON - 2) Sidra Medicine, Pediatric Urology, Doha, QATAR - 3) Mount Lebanon University Hospital, Pediatric Urology, Beirut, LEBANON - 4) Hôtel-Dieu de France University Hospital, Pediatric, Beirut, LEBANON
PURPOSE
Plate Objective Scoring Tool (POST) has been proven accurate for the study configuration of the urethral plate in distal hypospadias. Here we assessed whether POST score correlates with the cosmetic outcome after surgical repair.
MATERIAL AND METHODS
Between 2019 and 2025, 82 children with primary distal hypospadias were propsectively enrolled. We excluded cases with ventral curvature of more than 30 degrees and those with DSD or previous hormonal treatment. All cases had a TIP repair by a single surgeon. POST score was established by an independent experienced surgeon kept blinded from the post-operative results. Cosmetic outcome was determined after at least 6 months from the surgery by two distinct surgeons using a validated questionnaire, Hypospadias Objective Scoring Evaluation (HOSE).
RESULTS
During this 6 year follow-up, 61 children were included with a mean age of 35 months. Coronal, distale penile and midshaft cases were respectively seen in 16.4%, 67.2%, and 16.4%. Median POST score was 1.15 with nearly significant variation across hypospadias type (p=0.003). Median HOSE score was 15.00 with statistically significant variation among hypospadias type (p=0.003). Bivariate correlation analysis indicates that POST score is strongly correlated with the HOSE score and thus can accurately predict postoperative cosmetic outcome (Pearson correlation coefficient r=0.53, 95% CI [0.38, 0.71], P < 0.001). The POST cut-off of 1.1 provided the best compromise, with the highest sensitivity (76.92%) and specificity (66.67%) for identifying patients with acceptable (HOSE>=14) and unacceptable results.
CONCLUSIONS
The present study confirms that POST is a highly accurate and objective tool to predict cosmetic results of primary TIP hypospadias repair using the HOSE score .The power of the study relies on its prospective nature, the presence of one single operator, and distinct surgeons analysing the outcomes. However, a larger number of patients is still required to prospectively determine the best cut-off of the POST Score.