ESPU Meeting on Friday 19, June 2026, 14:10 - 15:10
14:10 - 14:13
S23-1 (CP)
Lydia HERMANN 1, Morgan BLACK 2, Rosalia MISSERI 3, Martin KAEFER 3, Konrad SZYMANKSI 3, Richard RINK 3, Joshua ROTH 3, Kirstan MELDRUM 3, Benjamin WHITTAM 3, Nik BATRA 3, Mark CAIN 3 and Pankaj P. DANGLE 3
1) Indiana University School of Medicine, Medical Student, Indianapolis, USA - 2) Indiana University School of Medicine, Urology Resident, PGY2, Indianapolis, USA - 3) Indiana University School of Medicine, Pediatric Urology, Indianapolis, USA
PURPOSE
While ureteroceles are well-described in infancy, long-term bladder function outcomes remain limited. In a previous study, our institution observed an increased incidence of lower urinary tract dysfunction (LUTD) among school-aged children (41%). We aimed to describe persistent or new-onset lower urinary tract symptoms (LUTS) during adolescence.
MATERIAL AND METHODS
We retrospectively reviewed for children with ureterocele treated at our institution between 1993 and 2007. Inclusion criteria were presentation before five years old, duplex collecting system with ureterocele, and surgical correction. Charts were assessed for LUTS occurring after age five, defined by the 2015 International Children’s Continence Society, and evaluated during puberty according to National Institute of Child Health and Human Development criteria. Fisher’s exact test was used for univariate analysis.
RESULTS
Forty eligible patients (29, 73% female) were followed to a median 13.3 years old (IQR 5.8-16.8). Thirty-nine (98%) ureteroceles were unilateral—17 (43%) ectopic, 12 (30%) intravesical, and 11 (27%) cecoureterocele. Twenty-two (55%) were diagnosed prenatally with ultrasound. Eighteen (45%) presented postnatally with 17 (94%) diagnosed after urinary tract infections (median 8.6 months old; IQR 2.7-30.3). Median age at first surgery was 10.9 weeks (IQR 4.8-40.2), independent of surgical type. Thirty (75%) had initial puncture/incision (median 8.32 weeks; IQR 4.0-25.6). Of these, twenty-four (80%) had subsequent ureterocele excision and reimplantation (median 2.3 years old; IQR 1.8-4.2). Twenty-one (53%) patients developed new-onset LUTS after surgery. Symptoms appeared a median 6.8 years (IQR 5.6–9.0) after initial surgery, independent of surgical type. Twenty (95%) required intervention—18 (90%) behavioral modification, 7 (35%) medication, and 6 (30%) pelvic floor therapy. Two (10%) required bulking injections for refractory stress incontinence. Eleven (52%) of the 21 patients developed new-onset LUTS during childhood (median 6.63 years old; IQR 5.69-7.09), with 4 (36%) persisting into puberty. Notably, 8 (38%) female patients developed new LUTS around puberty (median 9.9 years old; IQR 9.1-10.4). Their most common symptom was daytime incontinence (5, 63%), followed by urgency (4, 50%) and decreased frequency (4, 50%). Cecoureterocele was a significant risk factor for new-onset LUTS during puberty (p=.025).
CONCLUSIONS
LUTS is common following childhood surgery for ureterocele with renal duplication. New-onset LUTS may occur around puberty—with incontinence being the most common. Those with cecoureterocele appear to be at highest risk.
14:13 - 14:16
S23-2 (CP)
Tyler OVERHOLT DANIEL 1, Kevin HOBBS 1, Esther LIU 1, Brett TEPLITZ 2, Katelyn CARTY 2, Murali KOVVUR 3, Glenn CANNON 1, Francis SCHNECK 1, Omar AYYASH 1 and Rajeev CHAUDHRY 1
1) Children's Hospital of Pittsburgh, Division of Pediatric Urology, Pittsburgh, USA - 2) University of Pittsburgh Medical Center, Department of Urology, Pittsburgh, USA - 3) University of Pittsburgh, School of Medicine, Pittsburgh, USA
PURPOSE
Emerging evidence suggests that ureteroceles may be associated with lower urinary tract dysfunction (LUTD). Validated questionnaire data lacks for this patient population. The primary aim of this analysis was to formally assess LUTD in ureterocele patients.
MATERIAL AND METHODS
The authors queried the electronic medical record system (EMR) at a tertiary center for patients with ureterocele history from 01/01/2002-12/31/2021. Proper institutional review board approval was obtained. Families were prospectively contacted to complete the Dysfunctional Voiding Symptom Score (DVSS), a 10-question survey validated to assess LUTD. The EMR was reviewed for additional history data. Patients were excluded if they were less than 3 years old or if families declined participation. Significant LUTD was defined as total DVSS score>9. The primary outcome was LUTD rate. Secondary outcomes included ureterocele location and surgical history data.
RESULTS
Of 123 eligible patients, 70 (57%) completed the DVSS. Median age at time of survey completion was 10.5 years (interquartile range 7-16). The majority were female gender (67.1%). There were 27 respondents (38.6%) with DVSS scores consistent with significant LUTD. Individual items with the highest scores were holding urine, pushing to defecate, and stressful life circumstances. Most patients (87.1%) underwent a transurethral incision of ureterocele for initial management at median age 3 months (IQR 0 – 9.5). There were 25 respondents (35.7%) with urinary tract infections (UTIs) and 38 (54.3%) with vesicoureteral reflux (VUR) after initial management. Thirty respondents (42.9%) had subsequent surgery, most commonly ureteral reimplantation (83.3%) at median age 17 months (IQR 13 – 32). There were no differences in DVSS scores between genders (p=0.149), ureterocele location (p=0.39), UTI status (p=0.742), VUR status (p=0.866), or number of surgeries performed (p=.277).
CONCLUSIONS
The rate of LUTD in ureterocele patients is high, affecting 38.6% of patients in this analysis over a 20-year period. Patients of all ages and genders were affected, and most common areas of dysfunction included holding and straining symptoms. Patients and families should be counseled about this association and screened accordingly to minimize LUTD morbidity.
14:16 - 14:19
S23-3 (CP)
Michael DE SOUSA AMARAL, Antonia Alexandra DAN, Thomas BLANC, Aline BROCH, Fabrizio VATTA, Beatrice MONTANARO, Henri LOTTMANN and Nathalie BOTTO
Hopital Necker-Enfants-Malades, Service de Chirurgie viscérale, urologie et transplantation pédiatrique, Paris, FRANCE
PURPOSE
Clean intermittent catheterization (CIC) is a therapeutic option for managing bladder dysfunction, particularly neurogenic bladder. In children with normal urethral and perineal sensation, CIC can be challenging, and a continent cystostomy may be required. The aim of this study is to determine the failure rate and identify risk factors for failure in children.
MATERIAL AND METHODS
We conducted a retrospective, single-center study including 40 children followed between 2015 and 2025 who required CIC for non-neurogenic elimination disorders. Demographic and clinical data were extracted from medical records. CIC failure was defined as discontinuation of catheterization or the use of an alternative management strategy. Analyses were mainly descriptive, with univariate comparisons between success and failure groups.
RESULTS
The study included 40 children (27 boys), with a median age of 67 months at CIC initiation. Diagnoses included posterior urethral valves (n=14, 35%), non-neurogenic bladder-sphincter dyssynergia (n=5, 13%), bladder exstrophy (n=3), Prune-Belly syndrome (n=2), and other complex urological malformations (e.g., cloaca, aphallia, obstructive ureterocele). CIC was successful in 27 children (68%). Failure to perform CIC for bladder emptying occurred in 13 children (32%), including 8 within the first 6 months. CIC failure was more common in older children at initiation (median 88 vs 62 months). Pain during CIC was strongly associated with failure (11 out of 13 in the failure group; none in the success group (p < 0.05). An initial refusal of CIC was also significantly more frequent in the failure group (7 vs 1 case; p < 0.01). Lack of regular medical and paramedical follow-up, procedure-related anxiety, and a history of traumatic medical experiences were additional factors associated with CIC failure (p < 0.05).
CONCLUSIONS
This study demonstrates that CIC is feasible even in children with a sensitive urethra, with a success rate of 67.5%. Failure occurred predominantly in the early phase of initiation. Early detection of warning signs, such as initial refusal, pain, or traumatic prior medical experiences is essential. Reinforced nursing and psychological support, as well as a multidisciplinary approach from the start, may help improve adherence and reduce the risk of CIC discontinuation.
14:19 - 14:22
S23-4 (CP)
Mandy RICKARD 1, Joana DOS SANTOS 1, Samer MAHER 1, Jin Kyu KIM 1, Adree KHONDKER 1, Nithiakishna SELVATHESAN 2, Rodrigo ROMAO 1, Michael CHUA 1 and Armando J. LORENZO 1
1) SickKids, Urology, Toronto, CANADA - 2) SickKids, Nephrology, Toronto, CANADA
PURPOSE
Males with posterior urethral valves (PUV) and inefficient voiding often require catheterizable channels to allow for catheterization, yet many continue to attempt volitional Valsalva voiding per urethra. We hypothesized that high abdominal pressures generated by this predispose these patients to stoma complications, particularly prolapse.
MATERIAL AND METHODS
We reviewed our PUV database and identified patients managed with a Mitrofanoff channel, comparing them with males with neurogenic bladder (NGB). Demographic and clinical characteristics, stoma complications (prolapse, stenosis, leakage), urodynamic parameters, vesicoureteral reflux (VUR), medications, onabotulinumtoxinA use, and frequency of clean intermittent catheterization (CIC) were analyzed. Bladder capacity was categorized as small (<65% expected bladder capacity [EBC]), normal (66–149%), or large (>150%).
RESULTS
Sixty patients were included (39 PUV; 21 NGB). The mean age at surgery was younger for PUV (83 ± 39 mo) vs. NGB (114 ± 50 mo, p = 0.01). Overall complication rates were similar (67% vs 48%, p = 0.18). Leakage and stenosis were comparable between groups. However, stoma prolapse occurred exclusively in the PUV group (36% vs 0%, p < 0.01). Volitional voiding was more common in PUV patients (62% vs 33%, p = 0.06). Medication, onabotulinumtoxinA, and stoma revision rates were similar. Urodynamic capacity, compliance, and VUR distribution did not differ significantly. (Table)
| PUV (n=39) (%) | NGB (n=21) (%) | p | |
| Age at Mitrofanoff creation (months) (SD) | 83+/-39 | 114+/-50 | 0.01 |
| Any complication | 26 (66) | 10 (48) | 0.18 |
| Prolapse | 14 (36) | 0 (0) | <0.01 |
| Stenosis | 1 (3) | 2 (10) | 0.28 |
| Leak | 11 (53) | 8 (38) | 0.29 |
| Anticholinergics | 31 (80) | 19 (91) | 0.47 |
| onabotulinumtoxinA | 14 (36) | 6 (29) | 0.78 |
| Alpha-blockers | 22 (56) | 0 (0) | <0.01 |
| Mitrofanoff revision | 10 (26) | 5 (24) | 1.00 |
|
CIC Frequency - Day - Night -Both |
2 (5) 7 (18) 30 (77) |
2 (10) 1 (5) 18 (85) |
0.31 |
| Volitional voiding | 24 (62) | 7 (33) | 0.058 |
| VUDS | 26 (67) | 18 (86) | 0.14 |
|
Capacity: - Small - Normal - Large |
6 (23) 15 (58) 5 (19) |
5 (28) 12 (67) 1 (5) |
0.43 |
| Compliance (normal) | 19 (73) | 11 (61) | 0.70 |
| VUR | 22 (58) | 6 (33) | 0.09 |
| Follow-up (months) | 70 +/- 48 | 69 +/- 43 | 0.46 |
CONCLUSIONS
The consistent observation of prolapse exclusively in PUV patients raises awareness of a potentially pressure-related complication pattern, leading to mucosal prolapse at the stoma. These findings warrant further study yet can be used to inform families that children with PUV may face different risks after Mitrofanoff creation, particularly if they continue to try to Valsalva void per urethra.
14:37 - 14:40
S23-5 (CP)
Marietta JANK 1, Nina YOUNSI 2, Luisa WEIL 2, Raimund STEIN 2 and Malin NIENTIEDT 2
1) University Medical Center Mannheim, Pediatric Surgery, Mannnheim, GERMANY - 2) University Medical Center Mannheim, Center for Pediatric, Adolescent and Reconstructive Urology, Mannheim, GERMANY
PURPOSE
Fetal stenting for suspected lower urinary tract obstruction (LUTO) aims to preserve renal function and improve perinatal outcomes but carries considerable risks and necessitates postnatal surgical management. Knowledge of postnatal stent location and removal strategies is crucial to guide decision-making and optimize long-term urological outcomes.
MATERIAL AND METHODS
This retrospective study (2013–2024) included all live-born neonates who underwent intrauterine shunting for prenatally suspected LUTO. Collected variables included gestational age at stenting, number of fetal procedures, stent type, and intrauterine complications. Postnatal data comprised perinatal characteristics, stent location, timing and technique of removal, associated procedures, and neonatal complications. Early removal was defined as thirty days or less after birth; late removal as more than thirty days.
RESULTS
Fifty-one live-born patients with prenatal stenting were evaluated; twenty-seven neonates were managed shortly after birth. Five infants receiving palliative care, three transferred for neonatal dialysis, and sixteen managed elsewhere postnatally were excluded. In total, fifty-two intrauterine stenting procedures were performed. The first intervention occurred at a mean gestational age of 19.3 weeks (range 12.7 -34.4), with 55.5 % conducted before seventeen weeks. Stent types included forty-seven Somatex and five Pigtail devices. Intrauterine dislocation occurred in twelve fetuses. Mean birth weight was 2609 grams (1540 to 4060 grams), and mean gestational age at delivery was 35.2 weeks (29.3 to 40.1 weeks). Median APGAR scores were 7.5; 8.3 and 8.8. Bedside removal was achieved in seven cases. Postnatal stent-associated complications occurred in 44.4%, including unintended vesicoperitoneal drainage or skin closure over the stent, often necessitating timely removal. Overall, 62.9 % underwent early and 37.1 % late removal, typically requiring one to three interventions. Stent extraction was frequently combined with procedures securing temporary or long-term urinary diversion such as vesicostomy, cystoscopy, or ureterocutaneostomy. No complications occurred during postnatal surgical removal.
CONCLUSIONS
Most urinary tract shunts were removed within thirty days due to postnatal stent-related problems. Late removal carried no increased risk. Surgical extraction was safe at all time points and could be effectively combined with procedures establishing mid- or long-term urinary diversion.
14:40 - 14:43
S23-6 (CP)
Michael SISCHKA 1, Alexander SCHATZKI-LUMPKIN 2, Kelly PARKER 3, Anjali NAYAK 4 and Gwen GRIMSBY 3
1) Mayo Clinic, Urology, Phoenix, USA - 2) University of Arizona, College of Medicine - Phoenix, Phoenix, USA - 3) Phoenix Children's, Urology, Phoenix, USA - 4) Phoenix Children's, Nephrology, Phoenix, USA
PURPOSE
Urinary tract infections (UTIs) pose a risk of graft loss in patients who have undergone kidney transplants. It is critical to understand who is at higher risk of UTI within the first year after transplant so bladder management strategies and antibiotic prophylaxis can be considered. The goal of this study was to characterize which pediatric kidney transplant patients were at high risk for UTI in the first year after renal transplant.
MATERIAL AND METHODS
A retrospective review was performed of all patients who underwent a kidney transplant at a quaternary children’s hospital from 2006 to 2023. Patient demographics, urologic history, type of ureteral anastomosis for kidney transplant, and any diagnosis of UTI within the first year after transplant were reviewed. Demographic factors of patients who had any UTIs in the first year after transplant were compared with those who did not have any UTIs with t test and Fischer’s exact tests.
RESULTS
133 patients were reviewed. 40 (30%) of the patients underwent a living donor kidney transplant. The mean age at transplant was 12.1 years old (SD 5.4) and 68 (51%) were male. Patients with history of neurogenic bladder, patients who performed clean intermittent catheterization, and patients who had prior bladder surgery were significantly more likely to have a UTI diagnosed in the first year after transplant (all p<0.0001). 75% of neurogenic bladder patients, 80% of CIC patients, and 70% of patients with a history of prior bladder surgery were diagnosed with a UTI in the first year after transplant. Type of transplant (deceased or living donor), age at transplant, sex, race, type of ureteral anastomosis at transplant, and a history of constipation were not significantly associated with UTIs in the first year after kidney transplant.
CONCLUSIONS
This review highlights important characteristics that are associated with higher risk for developing UTIs in the first year after kidney transplant in pediatric patients. Additional surveillance, antibiotic prophylaxis, or implementation of bladder management strategies should be considered in these patients to mitigate the risk of graft loss.
14:43 - 14:46
S23-7 (CP)
Cristian SAGER, Yesica GOMEZ, Carol BUREK, Nicolas ROSIER, Javier RUIZ, Felicitas LOPEZ IMIZCOZ, Danel ALBERTI, Ignacio ARENAS, Francisco IMAZ, Otilia BLAIN and Santiago WELLER
Garrahan Hospital, Urology, Buenos Aires, ARGENTINA
PURPOSE
Augmentation cystoplasty (AC) remains a central reconstructive option for children with severe lower urinary tract dysfunction (LUTD) unresponsive to medical therapy. Although it improves bladder storage and continence, long-term complications and renal vulnerability remain concerns. This study describes the functional, renal and complication profile of reconstructed lower urinary tracts in a large paediatric cohort.
MATERIAL AND METHODS
A retrospective review of 128 children who underwent AC (excluding ureterocystoplasty) between 2003 and 2017 was performed. Postoperative variables included urodynamics, renal-bladder ultrasound, urinary tract infections (UTIs), and surgical and long-term complications. Urodynamic studies followed ICCS standards. Complications were classified as early (<30 days) or long-term. Statistical analysis included chi-squared tests, t-tests and significance set at p < 0.05.
RESULTS
Sigmoid colon was used in 78% and ileum in 22%. Concomitant procedures included continent catheterisable channels (58.5%), bladder neck resistance augmentation (24%) and ureteral reimplantation (14.8%).
Early complications were infrequent: urinary fistula (5.5%), bowel obstruction (4.0%), wound infection (3.1%) and prolonged ileus (2.3%). There were no early graft losses or deaths.
Long-term complications were more common. Reservoir lithiasis occurred in 20% and was significantly associated with UTIs during the first postoperative year (p = 0.019), irregular bladder irrigations at years 3 and 5 (p = 0.001; p = 0.024), and constipation (p = 0.044). Stomal complications included channel stenosis (12.5%), difficult catheterisation (9.3%) and leakage (4.6%). Mucus obstruction requiring intervention occurred in 6.2%. Bladder perforation was rare (1.5%) but required surgery.
Renal outcomes remained stable or improved in most patients, with significant reductions in hydronephrosis and vesicoureteral reflux at 12 months (both p < 0.01). Only 2.3% developed renal deterioration, largely associated with poor adherence to catheterisation or irrigations.
Urodynamics showed sustained improvement: median bladder capacity increased by 197%, mean detrusor pressure decreased from 47 to 22 cmH₂O, and leak point pressures normalised in 86% at one year. During transition follow-up, anticholinergic use decreased (49%, p < 0.0001) and continence improved (29%, p = 0.0023).
CONCLUSIONS
Paediatric AC provides durable functional improvement and renal stability with low early morbidity. Stone formation is the predominant late complication and requires structured preventive care. Lifelong multidisciplinary follow-up remains essential.
14:46 - 14:49
S23-8 (CP)
Camila ROCHET-CAPELLAN 1, Berenice TULELLI 2, Jérome MASSARDIER 1, Axel FICHEZ 1, Mona MASSOUD 1, Jordan TEOLI 3, Delphine DEMEDE 2 and Valeska BIDAULT JOURDAINNE 2
1) Hospices Civils de Lyon, Prenatal Diagnosis and Obstetrics, Bron, FRANCE - 2) Hospices Civils de Lyon, Pediatric urovisceral, thoracic and transplantation surgery, Bron, FRANCE - 3) Hospices Civils de Lyon, Laboratoire de Biochimie et Biologie Moléculaire multi-sites, Bron, FRANCE
PURPOSE
Fetal megacystis (FM) is associated with a wide range of conditions beyond posterior urethral valves (PUV). This study aimed to describe the pre- and postnatal outcomes of FM excluding confirmed PUV, in order to improve prenatal counseling and prognostic assessment.
MATERIAL AND METHODS
Retrospective multicenter cohort study, conducted between 2009 and 2023, including pregnant women referred for suspected FM across three fetal medicine units. Cases with confirmed PUV, either pre- or postnatally, were excluded. FM was defined as a longitudinal bladder diameter ≥ 7 mm between 10 and 14 gestational weeks (GW) or, after 14 GW, as a persistently enlarged bladder failing to empty for at least 40 minutes. Maternal characteristics, ultrasound findings, genetic testing , final diagnoses and follow-up data were analyzed. Descriptive statistics for categorial variables and univariate analysis using Fisher's and Wilcoxon's tests were performed.
RESULTS
Among 170 referrals, 96 cases of FM without PUV were confirmed. The outcomes included 31 live births (32.3%), 49 medical terminations of pregnancy (MToP, 51%), and 16 intrauterine fetal deaths (IUFD, 16.7%). Most cases (69.8%) were referred during the first trimester. Among live-born infants, the male-to-female ratio was 6.75.
Earlier gestational age at diagnosis strongly correlated with adverse outcomes (p < 0.001), even after excluding MToP cases (p<0 .001). All IUFD occurred after first-trimester diagnosis, with 12.5% presenting chromosomal anomalies. 83.7% of MToP followed a first-trimester diagnosis. Only one vesicoamniotic shunt was placed, complicated by membrane rupture and chorioamniotitis, leading to MToP.
Among the 31 live-born children, four were 46,XX: two had polymalformative syndromes leading to neonatal death, one transient urinary retention, and one bilateral vesicoureteral reflux (VUR) requiring surgery.
Of the 27 males, one neonatal death occurred. Of the 26 survivors, 9 (34.6%) had no urinary sequelae, 12 (46%) had uni- or bilateral VUR, 1 (3.8%) chronic intestinal pseudo-obstruction, 1 (3.8%) a high anorectal malformation within a VACTERL sequence (3.8%), and 3 (11.5%) neurogenic bladder, one of whom required kidney transplantation. Postnatal VUR was significantly associated with third-trimester pelvicalyceal dilatation (p = 0.047).
CONCLUSIONS
This 15-year multicenter study confirms the heterogeneity of diagnoses and prognoses of FM when PUV are excluded. Early prenatal diagnosis is strongly associated with poor prognosis. Detailed prenatal phenotyping may help identify cases with a favorable postnatal outcome, while postnatal imaging and renal assessment remain essential.