Parallel Meeting on Friday 19, June 2026, 14:10 - 15:10
14:10 - 14:13
S25-1 (CP)
Stefano CARDIN 1, Christopher DEFRANCESCO 2, Maia REGAN 3, Colby FREEMAN 2, Caroline KIM 2 and David HORN 2
1) Orlando Health Arnold Palmer Hospital for Children, Orthopedic Surgery, Orthopedic Surgery, Orlando, USA - 2) The Children's Hospital of Phialdelphia, Orthopedic Surgery, Philadelphia, USA - 3) Frank H. Netter MD School of Medicine, North Haven, USA
PURPOSE
Bladder exstrophy is a rare disorder involving the urinary, reproductive, and musculoskeletal systems. Published studies suggest that individuals with bladder exstrophy have an increased incidence of hip dysplasia, but these studies included a wide range of ages and patients with both classic bladder exstrophy (CBE) and cloacal exstrophy (CE). Since CE is often accompanied by neurological conditions (such as myelomeningocele and tethered cord) that may themselves cause hip dysplasia, it is not clear if CBE is independently associated with hip dysplasia. This study therefore reports the prevalence of hip dysplasia in infants and toddlers with classic bladder exstrophy.
MATERIAL AND METHODS
A retrospective database of patients with CBE aged 0-17 at a tertiary care pediatric hospital from January 2014 to September 2025 was queried for infants with CBE who had hip ultrasounds (US) within the first six months of life. Historical and imaging records for these patients were reviewed. Patients with incomplete records or imaging studies, and those with a diagnosis of CE or epispadias were excluded.
RESULTS
Sixty patients with CBE were identified; 36 (60%) had an US. Of these, thirteen (36%) were female. Nineteen patients (65%) had normal findings. Nine (25%) had mild dysplasia on US (α angle 43-60° and/or femoral coverage <50%). One male patient had bilateral dislocated hips, which underwent staged open reductions.
Of the nine patients with mild dysplasia, the dysplasia was bilateral in seven and unilateral in two (one right and one left). Eight of these resolved with observation. One patient was successfully treated with a Pavlik Harness.
Of the 36 patients with US studies, twenty-one had radiographic follow-up beyond the age of three (range 36 months to 12 years). These included seven patients with mild dysplasia and the single patient with bilateral dislocated hips. The most recent radiographs for these patients showed all hips to be IHDI grade I, with no residual dysplasia, and a mean acetabular index of 14.3 (range, 8-26).
CONCLUSIONS
Infants and children with CBE have a high rate of hip dysplasia. Most of these can be corrected with observation or nonoperative treatment, and the short-term outcome is good. Infants with CBE should be screened with US and any dysplasia treated according to established protocols. In conclusion, this is the first study reporting the prevalence and treatment of hip dysplasia in infants with CBE (excluding CE), and it provides insight and guidance in the treatment of this rare, complex condition.
14:13 - 14:16
S25-2 (CP)
S N KUREEL 1, Anit PARIHAR 2, Archika GUPTA 1 and Sunil KANOUJIA 3
1) King George's Medical University, Lucknow, India, Department of Pediatric Surgery, Lucknow, INDIA - 2) King George's Medical University, Lucknow, India, Department of Radiodiagnosis, Lucknow, INDIA - 3) Chandan hospital, Lucknow, India, Department of Pediatric Surgery, Lucknow, INDIA
PURPOSE
Bladder plate mobilization is the first step in classic bladder exstrophy (CBE) reconstruction. Process of bladder plate mobilization must ensure the integrity of pelvic autonomic nerves (pelvic splanchnic and hypogastric) to prevent the component of bladder dysfunction secondary to nerve damage during surgery. Preoperative mapping of these nerves could help in preservation of these nerves during bladder plate mobilization and ureteric reimplantation.
This study reports the findings of preoperative imaging of autonomic nerves in CBE by Magnetic resonance (MR) imaging and subsequent confirmation with intraoperative mapping of nerves with nerve locator.
MATERIAL AND METHODS
After taking institutional ethical clearance, this prospective observational study was conducted in two male CBE and one female CBE presenting for surgery beyond adolescent age. The study was conducted using 3 tesla MRI (Philip, Ingenia Elition X). Imaging was done using Dwibs sequence, Vista sequence, heavily t2 weighted sequence, and 3D-PD sequence. Images were obtained using maximum intensity projection (MIP) which was also used to trace the course of nerve. Using same protocol, images from one normal male and normal female were obtained as control.
Location of hypogastric and pelvic splanchnic nerves was visualized. In bladder exstrophy patients after bladder plate mobilization, location of these nerves were confirmed using nerve locator.
RESULTS
Results
The location of hypogastric nerves was visualized on both sides crossing the sacroiliac joint going downwards parallel to sacral foramina. Upwards, it was continuous with sympathetic chain. Location of pelvic splanchnic nerves was visualized using Dwib sequence deep in the pelvis going towards bladder base. There was no difference in location of these nerves between male and female.
CONCLUSIONS
Conclusion
Hypogastric nerves in CBE courses anterior to sacroiliac joint, common iliac vessels, medial to ureter and parallel to sacral foramina, while pelvic splanchnic nerves courses from sacrum to bladder base parallel to course of lower ureter. These nerves need to be preserved during bladder plate mobilization and ureteric reimplantation.
14:16 - 14:19
S25-3 (CP)
Nikola STANOJEVIC 1, Yuri CHEKERIDI 2 and Yuri RUDIN 3
1) Urogenital Center - MSB Hospital, Belgrade, Serbia, Urogenital reconstructive surgery, Belgrade, SERBIA - 2) Moscow Regional Children's Clinical Traumatology and Orthopedics Hospital, Traumatology and Orthopedics, Moscow, RUSSIAN FEDERATION - 3) N. A. Lopatkin Research Institute of Urology and Interventional Radiology, Urology, Moscow, RUSSIAN FEDERATION
INTRODUCTION
Bladder exstrophy (BE) is a congenital malformation that involves defects of the genitourinary system, pelvic floor muscles, and pelvic bones. It is characterized by shortening and widening of the pubic bones, external rotation of the pubic bone–hip joint complex on both sides, and external rotation of the iliac wings. Successful closure of the bladder and the anterior abdominal wall is, in most cases, impossible without osteotomy of the iliac bones. Currently known anterior osteotomy techniques are based on Salter’s procedure and differ only in the level and direction of the osteotomy line. They are traumatic, time-consuming, and associated with a risk of neuropathy. The minimally invasive osteotomy described here offers significant advantages.
MATERIAL AND METHODS
From 2002 to 2024, minimally invasive intrapelvic osteotomy of the iliac bones (minimal-access iliac osteotomy) was performed in 152 patients with BE, aged from 6 days to 33 years: 127 underwent primary closure, and 25 underwent repeated bladder neck reconstruction. Access to the isthmus of the ilium was achieved through a transverse incision along the linea interspinalis anterior, without muscle detachment and without periosteal stripping. A transverse osteotomy was performed while preserving a bone–periosteal bridge up to 0.5 cm in length along the inner margin, which served as an axis of rotation and fractured during derotation of the hip joint. After approximation of the pubic bones, fragments of the iliac bones were fixed with Kirschner wires, and a plaster cast was applied. The average duration of the osteotomy on each side was 15 minutes.
RESULTS
Approximation of the pubic bones enabled successful completion of the urological stage of reconstruction in all cases. However, pubic bone diastasis increased with age. In two patients (1.3%) who did not undergo metal osteosynthesis, unilateral vertical displacement of the hip joint by one centimeter was observed, but no corrective intervention was required. No vascular or neurological complications were recorded, and no nonunion along the osteotomy line was observed.
CONCLUSIONS
The proposed minimally invasive intrapelvic osteotomy of the iliac bones is simple to perform, effective, does not damage vascular or neurological structures, and can be carried out quickly, with a low rate of surgical complications.
14:31 - 14:34
S25-4 (CP)
Sudhindra JAYASIMHA 1, Karen RYAN 2, Hazel LEARNER 3, Gunter DE WIN 4, Naima SMEULDERS 2, Imran MUSHTAQ 5 and Nav JOHAL 5
1) Great Ormond Street Hospital, Pediatric Urology, London, UNITED KINGDOM - 2) Great Ormond Street Hospital, Paediatric Urology, London, UNITED KINGDOM - 3) University College Hospital London, Adolescent Gynaecology, London, UNITED KINGDOM - 4) University College Hospital London, Adolescent Urology, London, UNITED KINGDOM - 5) Great Ormond Street Hospital for Children NHS Foundation Trust, Pediatric Urology, London, UNITED KINGDOM
PURPOSE
Müllerian and genital tract anomalies in girls with classic bladder exstrophy (CBE) are thought to be uncommon, with current knowledge based mainly on isolated case reports. Accurate characterisation of reproductive anatomy is crucial for counselling, guiding genital reconstruction, and anticipating risks of obstructed menstruation, sexual dysfunction, and future fertility challenges. Although Müllerian anomalies are well described in cloacal exstrophy, the spectrum in CBE is less clearly defined. This study describes a two-decade single-centre experience focusing on anatomical findings, operative management, and medium-term outcomes.
MATERIAL AND METHODS
A retrospective review identified all genetically female patients with CBE born from 2001 onwards and aged ≥12 years (to allow assessment around menarche). Patients with incomplete follow-up were excluded. Demographic data, imaging and operative findings, reconstructive procedures, complications, and adolescent/adult functional outcomes were analysed and presented as number (percentage) and/or median (IQR).
RESULTS
Of 88 girls with CBE, 52 were ≥12 years and 38 (73%) had complete follow-up. Median age at last review was 16.9 years (IQR 14.6–18.9); median age at menarche was 13 years (12–13.2). Imaging and/or intra-operative documentation of Müllerian structures was available in 30 patients. Concomitant urinary tract anomalies were rare, with only one unilateral duplex kidney identified.
Müllerian anomalies were present in 10/38 (26%), including arcuate uterus (n=2), bicornuate uterus (n=3), septate uterus (n=1), uterus didelphys (n=1), and hydrocolpos (n=3). Genital anomalies were more frequent (26/35; 74%) and included narrow introitus (n=23), longitudinal vaginal septum (n=2), and excessive labial skin (n=1).
Twenty-three girls underwent genital reconstructive procedures at a median age of 15.4 years. Operations included introitoplasty (n=9), perineal flap vaginoplasty (n=8), combined labioplasty or monsplasty (n=4), and abdominal scar revision (n=2). Median post-operative follow-up was 24.5 months (16.2–48.7). One urethral fistula occurred after introitoplasty; all other recoveries were uncomplicated. Vaginal dilatation was routinely continued following introital or vaginal reconstruction.
Sixteen patients were followed into adulthood. Sexual activity data were available in eight, of whom six were sexually active. Two women achieved four term pregnancies, all delivered by caesarean section.
CONCLUSIONS
In girls with CBE, genital anomalies are common, while Müllerian anomalies occur less frequently but may have important clinical implications. Systematic anatomical assessment and timely, individualised reconstructive surgery support favourable sexual function and reassuring reproductive potential into adulthood.
14:34 - 14:37
S25-5 (CP)
Arianna MARIOTTO 1, David J B KEENE 1, Gail BUSBY 2 and Raimondo M CERVELLIONE 1
1) Manchester University NHS Foundation Trust, Paediatric Urology, Manchester, UNITED KINGDOM - 2) Manchester University NHS Foundation Trust, Obstetrics and Gynaecology, Manchester, UNITED KINGDOM
PURPOSE
Female patients with cloacal exstrophy often present with Müllerian structures (MS) that lack continuity with the perineum. Following puberty, these obstructed MS can become a significant source of morbidity. This study reports a 25-year institutional experience in the management of obstructed MS in this population.
MATERIAL AND METHODS
A prospectively maintained institutional database was reviewed to identify all female patients with cloacal exstrophy who underwent primary treatment between 2000 and 2024. Only patients who had reached puberty at last follow-up were included. The following variables were evaluated: initial diagnosis (classic cloacal exstrophy vs. cloacal exstrophy variant), surgical management during infancy, symptoms at puberty, medical and surgical management of obstructed MS, and clinical outcomes.
RESULTS
| PUBERTAL PATIENTS (7/19) | CLOACA VARIANT | CLASSIC CLOACA |
| n. | 3 | 4 |
| Perineal orifice/Spontaneous menstruation | 3 | 0 |
| Symptoms at presentation: | ||
| Abdominal Pain | 0 | 4 |
| Hydronephrosis | 0 | 2 |
| Success of COCs | na | 0/4 |
| Surgical drainage with perineal aproach | na | 2 |
| Laparotomy+formation of perineal outlet | na | 2 |
| Recurrence of symptoms: | ||
| Abdominal Pain | na | 2 |
| Hydrosalpinx+ovarian abscess | na | 1 |
Nineteen female patients with cloacal exstrophy were treated during the study period, of whom seven had reached puberty. Three patients with cloacal exstrophy variants had a perineal orifice that permitted spontaneous menstruation. Four patients developed severe, prolonged abdominal pain at puberty due to bilateral obstruction of the MS. Two of these patients also developed significant hydronephrosis secondary to ureteric compression, and hydrosalpinx was noted in two cases. Medical management with combined oral contraceptives (COCs) was ineffective in all four patients. Two underwent perineal drainage of the Müllerian remnants at ages 13 and 15, while two required laparotomy (ages 11 and 15) to anastomose the separated MS and establish a perineal outlet. Surgical intervention resulted in immediate and complete resolution of symptoms and hydronephrosis. However, one patient experienced recurrent pain that subsequently improved with COCs, and another developed hydrosalpinx and an ovarian abscess requiring drainage.
CONCLUSIONS
In this cohort, four of seven post pubertal patients with cloacal exstrophy experienced substantial morbidity due to obstructed MS, and all required surgical intervention. Symptoms recurred in two patients. These findings provide important guidance for surgeons caring for girls with cloacal exstrophy and suggest that prophylactic removal of obstructed MS prior to puberty may warrant consideration.
14:45 - 14:48
S25-6 (CP)
Emanuela GALLO, Fabrizio VATTA, Aline BROCH, Nathalie BOTTO, Henri LOTTMANN and Thomas BLANC
Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France., Department of Paediatric Urology, Paediatric Surgery & Transplantation, Paris, FRANCE
PURPOSE
Isolated female epispadias is a rare congenital malformation. Due to the rarity of this condition, treatment relies on surgeon's preferences and capacities. Thus, it is difficult to define the continence rate of each surgical approach, with some studies equating continence outcomes to bladder exstrophy. The aim of this study is to report long term continence results of a large cohort of female epispadias.
MATERIAL AND METHODS
Retrospective monocentric study. Clinical records of girls operated on between 1996-2021 in the same tertiaty care center were analyzed. Girls aged ≤5 years(n= 1), or with incomplete records/follow-up(n=14) were excluded. Data are reported as absolute numbers and percentages (qualitative variables), as medians and IQR (quantitative variables). Comparisons were realized with χ²test, Fisher's exact or Mann-Whitney test. All p-values were two-tailed, with significance at p < 0.05.
RESULTS
Twenty-four isolated incontinent female epispadias were included. 3 subgroups based on the initial surgical technique:
- Group 1 : single-stage perineal urethrocervicoplasty (PUC)(n=17-71%),
- Group 2 : Young-Dees suprapubic cervicoplasty (YD)(n=5 -21%),
- Group 3 : bladder neck injection of bulking agents (n=2 -8%).
Median follow-up of 13.6 years (IQR 4.8-18.3), median age at follow-up of 14.5 years (IQR 9.9-17.7).
Total continence was 67% (n=16), rising to 92% including the 6(25%) girls with stress incontinence. Seven girls (29%) practice clean intermittent self-catheterisation (CIC), 13 (54.1%) take oxybutynin.
Flowmetries : normal bladder volume in 60% of cases, curves bell-shaped in 60%, flattened in 13%, and polyphasic/staccato in 27%, significant post-void residual in 13%.
Comparative analysis between group1 and 2 showed : median number of surgeries 1(IQR 1-3) vs 3(IQR 2-3) p=0.19 ; total continence 64.7% vs 80% (p=0.61) ; a significant difference was the presence of renal ultrasound abnormalities, 5.8% vs 60% (p=0.009), consistent with the higher prevalence of vesico-ureteral reflux in group2 (29.4% vs 100%, p=0.023). Bladder augmentation was more frequent in patients operated on before the age of 1 year (33.3%vs14.1%, p=0.193).
CONCLUSIONS
Long-term outcomes of incontinent female epispadias repair are good, with comparable continence rates across techniques. Differences in renal abnormalities likely reflect underlying patient characteristics rather than procedure-specific effects. These findings highlight the need for tailored management and extended follow-up to monitor bladder function and upper tract status.
14:48 - 14:51
S25-7 (CP)
Erin MAYEUX 1, Margaux JOHNSON 2, Alexander RADAOUI 1, Heather DICARLO 2, John GEARHART 2 and Chad CRIGGER 2
1) Johns Hopkins, Department of Pediatric Urology, Baltimore, USA - 2) Johns Hopkins Hospital, Department of Pediatric Urology, Baltimore, USA
INTRODUCTION
Female epispadias (FE) represents a misplacement or incomplete fusion of the dorsal urethra, with varying degrees of urethral abnormality with or without coexisting abnormalities of the bladder neck. Patients often display a bifid clitoris, depressed mons pubis, and ill-defined labia minora. It occurs in 1:400,000 live female births and is more rare than other bladder exstrophy diagnoses including isolated male epispadias. Like all pathologies within the Bladder Exstrophy-Epispadias Complex (BEEC), FE is associated with varying degrees of a widened pubic diastasis. This study sought to evaluate continence outcomes in females with epispadias as well as investigate the correlation between width of diastasis and continence outcomes.
MATERIAL AND METHODS
An IRB-approved, prospectively maintained, single-institutional BEEC database was utilized to identify female patients with isolated epispadias. Electronic medical records were reviewed for data including patient demographics, epispadias repair and genital reconstruction surgeries, and continence procedures and outcomes. Width of pubic diastasis measurements were obtained from radiographic imaging. Continence was described in terms of social continence or at least 3 hours of daytime dry intervals between voids. These factors were assessed for their impact on continence outcomes.
RESULTS
Of the 35 patients identified, 18 (51%) achieved continence and 17 (49%) remained incontinent. Mean pubic diastasis width in the continent group (3.05 cm, SD 1.03 vs. 3.13 cm, SD 0.74) was not statistically different from the incontinent group (p=0.5928). Method of voiding was statistically different when comparing the continent group [4 (22.2%) void per urethra, 13 (72.2%) catheterize per stoma, 1 (5.6%) voids per rectum] to the incontinent group [16 (94.1%) void per urethra, 1 (5.9%) catheterizes per stoma] (p<0.0001). Each of the 18 continent patients required at least one additional continence surgery to achieve continence [3 (16.7%) received one, 8 (44.4%) received two, 7 (38.9%) received three or more]. Within those surgical groups, those that received an increasing number of continence surgeries had a significantly wider pubic diastasis [2.17 cm, SD 0.34 vs 2.54 cm, SD 0.64 vs 4.09 cm, SD 0.90] (p=0.0047).
CONCLUSIONS
This study evaluates the possible correlation of continence status in female epispadias patients with pubic diastasis as a predictor. When it comes to clinical decision making that involves surgical consideration and managing patient expectations, these findings need to be considered. Unfortunately, this subset of BEEC remains severely understudied when compared to bladder and cloacal exstrophy.
14:51 - 14:54
S25-8 (CP)
Ahmed HASSAN, David KEENE, Arianna MARIOTTO and Maximilian CERVELLIONE
Manchester University NHS Foundation Trust, Paediatric Urology, Royal Manchester Children's Hospital, Manchester, UNITED KINGDOM
PURPOSE
Cloacal exstrophy is a severe congenital malformation associated with multiple anomalies. We have adopted a staged reconstruction to minimize morbidity in this particularly fragile group of patients. The aim of this study is to present the outcomes and safety of this standardized approach.
MATERIAL AND METHODS
Patients with cloacal exstrophy treated since 2011 were identified from a prospective database. A standardized staged approach was utilized. Stage 1 (neonatal) included initial laparotomy with Ladd procedure (if required), separation of the cecum from bladder templates, distal ileostomy, tubularization of the cecum with formation of a mucous fistula, hemi-bladder approximation, and omphalocele reduction. Stage 2 was performed when the child reached approximately 8 kg. This stage involved bladder and abdominal closure with combined anterior oblique and vertical iliac osteotomies, with external fixation. Data are presented as median (range).
RESULTS
Twenty-five patients were included in the study. Three patients died preoperatively due to severe comorbidities (pulmonary hypoplasia in two, severe cardiac anomaly in one). Nineteen patients underwent Stage 1 at a median age of 9 days (range 2 to 161). Postoperative complications following Stage 1 included omphalocele dehiscence in one patient and ileostomy issues in two patients. Sixteen patients underwent Stage 2 at a median age of 15 months (range 5 to 27). Of these, eight underwent combined osteotomy and closure in the same operation (median pubic diastasis 5 cm, range 4 to 7). The remaining eight required osteotomy 6 days (range 4 to 14) prior to bladder closure (median pubic diastasis 7 cm, range 4 to 10). No major complications were recorded after the second stage. Median follow-up was 5 years (range 3 to 6).
CONCLUSIONS
The staged approach to managing cloacal exstrophy is safe, reproducible, and effective. It is associated with a relatively low complication rate and prevents life-threatening complications. The use of staged osteotomy in cases with wider pubic diastasis contributes to successful closure.