ESPU Meeting on Friday 19, June 2026, 17:10 - 18:00
17:10 - 17:13
S24-1 (CP)
Maria Fernanda RUIZ ALBARRAN 1, Isabel CASAL BELOY 2, Sebastian ROLDAN PEREZ 2, Maria Rocio JIMENEZ CORRO 3, Mario CUESTA ARGOS 3, Camila GONZALEZ RUHRNSCHOPF 4, Bernardita TRONCOSO SOLAR 5, Almudena GONZALEZ ARRIAGA 6 and Rosa Maria ROMERO RUIZ 2
1) Virgen del Rocío University Hospital, Pediatric Surgery, Seville, SPAIN - 2) Virgen del Rocío University Hospital, Pediatric Surgery Department, Pediatric Urology Unit,, Seville, SPAIN - 3) Puigvert Foundation, Pediatric Urology Department, Barcelona, SPAIN - 4) Germans Trias i Pujol University Hospital, Pediatric Surgery Department, Pediatric Urology Unit, Badalona, SPAIN - 5) Dr. Luis Calvo Mackenna Hospital, Pediatric Surgery Department, Pediatric Urology Unit, Providencia, CHILE - 6) Donostia University Hospital, Begiristain Doktorea Pasealekua, s/n, San Sebastian, SPAIN
PURPOSE
The interpretation of pediatric urodynamic studies shows high interobserver variability, which may affect clinical decision-making. The incorporation of videourodynamics (VUD), adding voiding cystography, may improve diagnostic uniformity. This study evaluates the impact of VUD on diagnostic concordance both between and within observers.
MATERIAL AND METHODS
Based on the International Children's Continence Society (ICCS) guidelines, a structured 20-item digital questionnaire was developed and accessed via QR code. Forty-five real clinical cases were assessed in two phases: first using conventional urodynamics (without video) and subsequently videourodynamics (with cystography), resulting in a total of 90 evaluations. Seven pediatric urologists completed both questionnaires for each case, yielding 6,300 responses. Fleiss' Kappa was used to assess interobserver agreement for each question, and Cohen's Kappa was used to evaluate intraobserver agreement.
RESULTS
Interobserver concordance was globally low, with marked variability across items. The addition of VUD improved agreement in 9 out of 20 questions, particularly in anatomical and dynamic variables such as cystometric capacity (Kappa 0.52→0.66), bladder compliance (0.22→0.51), detrusor opening pressure, and urethral evaluation during voiding. Worsening was observed in 6 questions, and 5 remained stable. The question regarding "risk of upper urinary tract deterioration" showed only acceptable concordance (≈0.22) in both phases.
Intraobserver concordance was globally good, with most questions showing Kappa >0.60 and several >0.75, indicating stable diagnostic criteria at the individual level even after incorporating imaging.
CONCLUSIONS
VUD partially improves diagnostic concordance among pediatric urologists, particularly for morphofunctional parameters, but does not eliminate interobserver variability. In contrast, intraobserver consistency was good, suggesting that variability may stem from the lack of standardized criteria for interpreting urodynamic parameters. These findings highlight the urgent need for structured clinical guidelines to standardize the interpretation of pediatric urodynamic studies incorporating imaging
17:13 - 17:16
S24-2 (CP)
Yunus Emre GENC 1, Faruk ARSLAN 1, Onur Can OZKAN 2, Osman AKYUZ 3, Raziye ERGUN 4, Ahmet Ozgur GUCTAS 1, Selcuk YUCEL 2, Kamil CAM 1, Tufan TARCAN 5 and Cagri Akin SEKERCI 6
1) Marmara University School of Medicine, Urology, Istanbul, TÜRKIYE - 2) Marmara University School of Medicine, Pediatric Urology, Istanbul, TÜRKIYE - 3) Kanuni Training and Research Hospital, Urology, Trabzon, TÜRKIYE - 4) Kocaeli State Hospital, Pediatric Urology, Kocaeli, TÜRKIYE - 5) Marmara University School of Medicine, Koç University School of Medicine, Urology, Istanbul, TÜRKIYE - 6) Marmara University School of Medicine, Urology/Pediatric Urology, Pendik Istanbul, TÜRKIYE
PURPOSE
Urodynamic studies are the gold standard tool in the diagnosis, treatment, and follow-up of patients with spina bifida. Despite several standardisation studies, interobserver agreement has been reported to be low in adults. To date, no study has systematically the interobserver consistency in pediatric population. The aim of this study was to investigate the consistency of urodynamic interpretations among experienced pediatric urologists.
MATERIAL AND METHODS
We retrospectively reviewed filling cystometry traces and pressure measurements of patients with lower urinary tract dysfunction secondary to spina bifida who underwent urodynamic evaluation between 2020 and 2025. Studies not compliant with the 2016 International Children’s Continence Society (ICCS) guidelines for good urodynamic practice and terminology were excluded. Presence and type of detrusor overactivity (phasic/non-phasic) and bladder compliance were independently assessed by four pediatric urologists, two neuro-urology specialists, and one urologist across three high-volume centers. Interobserver agreement was analyzed using Fleiss’ Kappa test in SPSS.
RESULTS
Of 125 urodynamic studies, 25 were excluded due to non-compliance with good urodynamic practice. The final cohort included 100 children (53 girls, 47 boys) with a median age of 6.5 (1-17) years. Interobserver agreement for detrusor overactivity yielded a Kappa value of 0.59 (moderate agreement), while in compliance assessment, Kappa score was 0.46 (moderate agreement).
CONCLUSIONS
This study demonstrated that interobserver agreement in the interpretation of urodynamic studies is at a moderate agreement level. Given the risk of upper urinary tract deterioration in children with neurogenic lower urinary tract dysfunction, there is a clear need for standardized assessment tools such as nomograms to enhance consistency and reliability of interpretations. Future prospective, multicenter studies involving observers with varying levels of expertise are warranted to validate these results.
17:16 - 17:19
S24-3 (CP)
Anita C. DE JONG 1, Olga E. ARGUEDAS FLORES 2, Job B.M. VAN WOENSEL 1, Kristin KEUNEN 3, Tanja M. DE KRAKER 2 and Jolanda M. MAASKANT 4
1) Amsterdam UMC Location University of Amsterdam, Emma Children's Hospital, Paediatric Intensive Care Unit, Amsterdam, NETHERLANDS - 2) Amsterdam UMC Location University of Amsterdam, Emma Children's Hospital, Paediatric Urology, Amsterdam, NETHERLANDS - 3) Amsterdam UMC Location University of Amsterdam, Emma Children's Hospital, Anaesthesiology, Amsterdam, NETHERLANDS - 4) Amsterdam UMC Location University of Amsterdam, Emma Children's Hospital, Paediatrics, Amsterdam, NETHERLANDS
PURPOSE
Accurate bladder volume assessment in paediatric patients is essential for diagnosing urinary retention. Automated bladder ultrasound devices (ABUD) provide a practical, operator-independent three-dimensional alternative to conventional ultrasonography. However, their accuracy in children remains uncertain. This study evaluated the agreement between ABUD-estimated and catheterized bladder volumes in children in during routine clinical care, and the diagnostic accuracy for detecting urinary retention.
MATERIAL AND METHODS
This cross-sectional diagnostic accuracy study included children under twelve years at a tertiary pediatric hospital. In patients undergoing urethral catheterization or cystoscopy, bladder volumes estimated using the ABUD Cubescan™ BioCon-900S (child or adult mode selected according per manufacturer’s height- and weight-based recommendations) (index test) were compared to catheterized volumes (reference standard). Measurement agreement was assessed using correlation, Intraclass Correlation Coefficient (ICC), mean bias and Limits of Agreement (LoA). Urinary retention was defined as a catheterized volume exceeding the expected bladder capacity. A review of scan quality was performed to support interpretation of measurement variability.
PRELIMINARY RESULTS
Among 183 children, 189 bladder scans were performed in the Paediatric Intensive Care Unit and the Operating Room. The median age was 2.4 years (IQR 0.8-7.0). Agreement results are summarized in Table 1, showing improved measurement agreement above age two. For detecting urinary retention (n=52), diagnostic accuracy also improved above two years (sensitivity 0.62, specificity 0.96, AUC 0.91). The considerable variability in measurement bias was attributable to both observer-related factors (inadequate bladder centering) and device-related factors (under- or overestimation of the bladderwall outlining, particularly in child mode).
CONCLUSIONS
The Cubescan™ BioCon-900S demonstrated very strong correlation with catheterized bladder volumes in children aged two to twelve years. Both agreement and diagnostic accuracy for detecting urinary retention also improved from age two. Substantial variability in bias was observed, attributable to both operator- and device-related errors.
Table 1: Measurement agreement of ABUD-estimated versus catheterized bladder volumes in children
| Age | 0 to 12 year (n = 189) |
0 to 2 year |
over 2 to 12 year |
| Spearman’s rho | 0.86 (95% CI 0.78-0.91) |
0.64 (95% CI 0.45-0.80) |
0.92 (95% CI 0.87-0.96) |
| ICC | 0.88 (95% CI 0.84-0.91) |
0.79 |
0.86 (95% CI 0.80-0.90) |
| Absolute mean bias (mL) | 2.1 (SD 47.4; 95% LoA -90.7 to 95.0) | 5.8 (SD 28.2; 95% LoA -49.6 to 61.1) |
-1.0 (SD 59.2; 95% LoA -117.1 to 115.0) |
| Relative mean bias (%) | 50.4 (SD 137.0; 95% LoA -218.0 to 319.0) | 70.3 (SD 176.4; 95% LoA -275.4 to 416.0) |
33.3 (SD 88.1; 95% LoA -139.3 to 206.0) |
17:19 - 17:22
S24-4 (CP)
Kyeong KIM 1, Kwanjin PARK 2 and Young Jae IM 2
1) Chungbuk National University Hospital, 776 1st Circular Road, Seowon-gu, Cheongju-Si, REPUBLIC OF KOREA - 2) Seoul National University Children's Hospital, Pediatric Urology, Seoul, REPUBLIC OF KOREA
PURPOSE
An accurate assessment of bladder capacity is important in planning treatment for nocturnal enuresis. In particular, a decrease in functional bladder capacity can be expected in non-monosymptomatic nocturnal enuresis (NMNE) with overactive bladder (OAB). Two commonly used diagnostic tools for evaluating functional bladder capacity are voiding diaries and uroflowmetry, each with its own strengths and limitations. We compared bladder capacity measurements obtained from 48-hour voiding diaries and uroflowmetry in children with nocturnal enuresis, evaluating discrepancies between these methods.Furthermore, we investigated the concordance between bladder capacity measured by two methods and voiding symptoms.
MATERIAL AND METHODS
In this retrospective cohort study, we compared bladder capacity measurements obtained by a 48-hour voiding diary and uroflowmetry in children with nocturnal enuresis who visited a single institution between 2020 and 2022. Factors such as age, sex, and nocturnal enuresis type (monosymptomatic nocturnal enuresis (MNE) and NMNE were considered. We enrolled 157 patients with available data for assessment, which was obtained by reviewing their clinical records and voiding diaries. Statistical analysis included paired t-tests for comparing bladder capacity measurements between methods and assessment of concordance between the two methods in categorizing bladder capacity as low or normal.
RESULTS
Uroflowmetry showed lower bladder capacity compared to 48-hour voiding diaries in the entire study population (p<0.001). This difference was observed in patients with MNE (p = 0.007) and NMNE (p<0.001) when comparing bladder capacity measurements between the two methods. Age-stratified analysis showed discrepancies between the diagnostic methods in the 5–6-year-old (p = 0.003) and 7–11-year-old (p<0.001) age groups, but not in the group aged 12 years and older (p = 0.61). Gender-based analysis revealed a difference between the two methods in the boy group (mean age = 7.2; SD = 2.3, p<0.001) but not in the girl group (mean age = 7.9; SD = 3.0, p = 0.078). Concordance in the categorization of bladder capacity between the two methods was observed in 60.5% (95/157) of the total population, 57.1% (49/84) of NMNE patients, and 67.1% (49/73) of MNE patients. In the NMNE group, uroflowmetry detected a higher proportion of low bladder capacity (65.5%) compared to voiding diaries (40.5%), with 27 out of 48 patients having normal capacity on diaries but low capacity on uroflowmetry.
CONCLUSIONS
This study demonstrates significant discrepancies between bladder capacity measurements obtained from 48-hour voiding diaries and uroflowmetry in children with nocturnal enuresis. The findings suggest that uroflowmetry consistently underestimates bladder capacity compared to voiding diaries, particularly in younger age groups and boy group. Furthermore, in approximately 25% of cases, there was a discordance between bladder capacity measured by the two methods and the type of enuresis (MNE and NMNE).Therefore, meticulous attention to measuring and interpreting bladder capacity is crucial in the treatment of nocturnal enuresis.
17:37 - 17:40
S24-5 (CP)
Kourosh AFSHAR 1, Mary CONNOLLY 2, Caitlin MOHSENI DOWNING 1, Daniel AMINBAKHSH 1 and Maryam NOPARAST 1
1) The University of British Columbia, Urologic Sciences, Vancouver, CANADA - 2) The University of British Columbia, Pediatrics, Vancouver, CANADA
PURPOSE
Bladder and bowel dysfunction (BBD) is one of the most common indications for referral to Pediatric Urology and is associated with significant clinical and quality-of-life consequences. Although several neuropsychiatric conditions are known to be linked with BBD, limited data exist regarding its relationship with epilepsy. The objective of this study was to determine the prevalence of BBD, using a validated instrument (Vancouver BBD Questionnaire), in children with epilepsy.
MATERIAL AND METHODS
We conducted a cross-sectional study with prospective data collection. Participants were recruited from a tertiary-care pediatric epilepsy clinic, and controls from the same institution were used for comparison.
Inclusion criteria:
• Diagnosis of epilepsy or an epilepsy syndrome confirmed by a pediatric neurologist
• Stable antiseizure medication dose for ≥1 month prior to recruitment
• Ability to communicate in English
• Capacity and willingness to provide consent or assent
Exclusion criteria:
• Developmental age <5 years
• Severe intellectual disability or autism spectrum disorder
• Neurogenic bladder
• Lower urinary tract abnormalities (except primary vesicoureteral reflux)
• History of urological or neurosurgical interventions
• New neurological regression
• Active urinary tract infection
Data collected:
1. Demographics
2. Epilepsy characteristics (duration, type, seizure control, medications, comorbidities)
3. Medication history
4. Vancouver BBD Questionnaire scores
RESULTS
50 pediatric epilepsy patients were recruited, with a mean (SD) age of 11.0 (3.7) years. 50 controls were used for comparison.
The prevalence of BBD in the epilepsy cohort was 34%, compared with 10% in controls. This difference was statistically significant (Fisher's Exact Test, p = 0.007).
There were no significant differences in demographics, epilepsy type or severity, or comorbidities between epilepsy patients with BBD and those without BBD.
CONCLUSIONS
Children with epilepsy demonstrate a significantly higher prevalence of bladder and bowel dysfunction compared with controls. These findings highlight the need for routine screening and early identification of BBD in pediatric epilepsy clinics to optimize management and prevent long-term complications.
17:40 - 17:43
S24-6 (CP)
Murali KOVVUR 1, Brett TEPLITZ 2, Karen KENYON 2, Kevin HOBBS 2, Glenn CANNON 2, Michael OST 2, Francis SCHNECK 2, Omar AYYASH 2 and Rajeev CHAUDHRY 2
1) University of Pittsburgh School of Medicine, Pittsburgh, USA - 2) University of Pittsburgh Medical Center, Department of Urology, Division of Pediatric Urology, Pittsburgh, USA
INTRODUCTION
Bladder function depends on bladder wall compliance, which can be altered in connective tissue disorders such as Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorders (HSD). We suspect this may increase the rate of voiding dysfunction, which could be detected on assessment of bladder and bowel dysfunction (BBD). Regional studies report a baseline BBD prevalence of 21% in the general pediatric population. We hypothesize increased BBD prevalence in EDS/HSD patients versus the general pediatric population, with a high proportion having prior pediatric urology referral.
PATIENTS AND METHODS
This is a cross-sectional study evaluating the prevalence of voiding dysfunction in patients diagnosed with EDS or HSD compared to the general pediatric population and age-matched controls screened from our institutional Emergency Department. Eligible patients 22 years old or younger were identified from institutional records and recruited by phone. Patients with concomitant neurogenic disorders were excluded. We utilized the validated Dysfunctional Voiding Scoring System (DVSS) survey to assess BBD symptoms and performed retrospective chart review to capture contributing demographic factors. BBD was defined as DVSS score greater than or equal to 6 (females) and greater than or equal to 9 (males).
RESULTS
Of 104 eligible patients, 52 completed the DVSS survey (50%). Respondents included 26 females and 26 males, with a mean age of 13.0 years. Mean overall DVSS score was 10.8; 11.4 for females compared to 10.2 for males (p = 0.4). BBD criteria were met in 79% of patients; 23/26 females (89%) compared to 18/26 males (69%) (p = 0.2). Among those with BBD, urinary urgency (71%), holding (66%), and constipation (76%) occurred half the time or more, with 49% having reported a stressful event within the prior month. Of 18 age-matched controls (recruitment ongoing), 4 met BBD criteria (22%). The BBD prevalence in EDS/HSD patients was significantly higher than the previously reported regional prevalence of 21% and preliminary controls of 22% (p < 0.001). 23 EDS/HSD patients (36%) had a prior urology referral for a genitourinary complaint.
CONCLUSION
We observed a significantly elevated prevalence of BBD and a high proportion with prior pediatric urology referral among patients with EDS or HSD. These findings may help raise clinical awareness, guide appropriate counseling, and identify young patients who would benefit from early screening and treatment for voiding dysfunction.
17:43 - 17:46
S24-7 (CP)
Maria Fernanda RUIZ ALBARRAN 1, Cristina Marcela MARÍN RODRÍGUEZ 2, Rosa María ROMERO RUIZ 2, Maria Jose MOYA JIMÉNEZ 1, Rocío GRANERO CENDÓN 1, Ana ACEMEL ACEMEL 1 and Isabel CASAL BELOY 2
1) Virgen del Rocío University Hospital, Pediatric Surgery, Seville, SPAIN - 2) Virgen del Rocío University Hospital, Pediatric Surgery Department, Pediatric Urology Unit,, Seville, SPAIN
PURPOSE
The use of electrotherapy is increasingly common in pediatrics to treat urinary dysfunction, intestinal dysfunction, and pain. Its benefits are well documented, but there is limited information regarding its adverse effects. The aim of this study is to describe the complications observed.
MATERIAL AND METHODS
We conducted a retrospective review of all patients treated with sacral electrotherapy (TENS-S), tibial electrotherapy (T-TENS), and suprapubic electrotherapy (SS-TENS) during the 2023-2024 period. Demographic data, diagnoses, and adverse effects were analyzed. The therapy was applied either in the hospital or at home. Complications were classified according to the CTCAE (Common Terminology Criteria for Adverse Events).
RESULTS
We included 175 patients (mean age 12.3 years). Patients were categorized based on the indication for therapy: pelvic, perineal, or genital pain (7 patients); intestinal dysfunction (32 patients); and bladder dysfunction (136 patients). Adverse effects were reported in 12.5% of patients with intestinal dysfunction (n=4, urinary urgency and incontinence, CTCAE 1-2), in 10.3% of those with bladder dysfunction (n=14, fecal urgency, CTCAE 1-2), and in 14% of children treated for pain (n=1, fecal urgency, CTCAE 1-2). Additionally, 3 patients developed dermatitis at the site of transcutaneous patch application (CTCAE 1). No severe adverse effects were recorded. No patient had to discontinue TENS therapy due to adverse events. Among the total number of patients with fecal urgency (15), 3 presented associated fecal incontinence. In 2 of these cases, symptoms resolved by reducing the frequency of TENS sessions. In the third case, in addition to reducing TENS frequency (3 times per week), transanal irrigations were initiated before device use. Urinary urgency was not associated with incontinence and was managed with standard urotherapy guidelines.
CONCLUSIONS
Despite the advantages of TENS, it is essential to recognize and monitor its potential adverse effects. TENS applied to one system may affect another. Understanding these effects is crucial to provide comprehensive management and adequately inform patients about the benefits and risks of the therapy. Further studies are needed to optimize the safety and effectiveness of TENS.