Parallel Meeting on Friday 19, June 2026, 17:10 - 18:00
17:10 - 17:13
S26-1 (CP)
Alina PUZKO and Maksym PONOMARENKO
OHMATDYT Children's Hospital, Pediatric Urology, Kyiv, UKRAINE
PURPOSE
Detrusor overactivity in children remains one of the leading causes of progressive renal deterioration in patients with neurogenic bladder. Oxybutynin has traditionally been the mainstay therapy, although its use is frequently associated with adverse effects, while botulinum toxin injections remain financially burdensome for many families. Since 2023, the β3-adrenergic agonist mirabegron has been introduced as an alternative or in combination with oxybutynin.
MATERIAL AND METHODS
Between 2021 and 2025, 618 children aged 3-17 years with neurogenic bladder were evaluated:
• detrusor overactivity — 58% (358 children),
• detrusor underactivity — 39% (241 children),
• detrusor-sphincter dyssynergia — 3% (19 children).
All patients underwent comprehensive urodynamic evaluation before treatment and at 1 and 3 months after therapy initiation.
Before 2023, 208 children were treated with oxybutynin only (0.2-0.3 mg/kg/day). Adverse effects were reported in 18% (~37 children), including headache, nausea, dizziness, excessive sweating, dry mouth, and allergic reactions.
From 2023 onward, patients were divided into two groups:
• Group A (n=104): oxybutynin + mirabegron (1-2 mg/kg/day),
• Group B (n=96): mirabegron monotherapy (1-2 mg/kg/day).
RESULTS
In Group A, oxybutynin dosage was reduced by half, achieving full bladder pressure compensation within 1 month, with no adverse effects reported.
In Group B, mirabegron monotherapy resulted in no adverse reactions, and full pressure compensation was achieved within 3 months.
CONCLUSIONS
The combination of mirabegron with low-dose oxybutynin represents a more effective and safer alternative to standard therapy, providing faster intravesical pressure normalization and eliminating treatment-related adverse effects.
17:13 - 17:16
S26-2 (CP)
Tal MAY 1, Anna BABAOFF 1, Michael FRUMER 2, Avigal LASK 1 and David BEN-MEIR 1
1) Schneider Children's Medical Center, Petach Tikva, ISRAEL - 2) Schneider Children's Medical Center, Urology, Petach Tikva, ISRAEL
PURPOSE
There are two accepted approaches for managing children with Spina Bifida: initiating catheterization immediately after birth or initiating catheterization only when risk factors for upper urinary tract deterioration emerge. Our objective was to evaluate the safety of the latter approach by examining long-term urological outcomes.
MATERIAL AND METHODS
Data were collected retrospectively for children with Spina Bifida treated at our clinic since 2006. We compared urodynamic and nephrological parameters between children who initiated Clean Intermittent Catheterization (CIC) immediately upon neurological diagnosis (Proactive Group) and children who initiated catheterization only if poor bladder compliance, unstable bladder, or infections were detected (Reactive Group).
RESULTS
Seventy-three children were included, of whom 40 were boys (55%). The initial urodynamic study revealed a stable bladder, normal compliance, age-appropriate capacity, normal post-void residual, and absence of reflux in 37 (51%), 40 (55%), 28 (38%), 22 (30%), and 56 (77%) of the children, respectively.
The Proactive and Reactive groups included 14 (19.2%) and 59 (80.2%) children, who initiated catheterization at a median age of 0.3 months (IQR 0.2-0.3) and 30 months (IQR 15-83), respectively. Two children (14%) from the Proactive group ceased catheterization over the years. Eighteen children (30%) from the Reactive group never required catheterization.
At a median follow-up of 10 years (IQR 5-13), no significant differences were found between the Proactive and Reactive groups regarding rates of: stable bladder (71% vs. 78%), normal compliance (57% vs. 68%), age-appropriate capacity (64% vs. 43%), normal post-void residual (28% vs. 14%), absence of reflux (71% vs. 84%), urinary tract infections (14% vs. 10%), Deflux injection to the ureteral orifice (7% in both), Botulinum toxin injection to the bladder (35% vs. 24%), incontinence requiring diapers (21% vs. 40%), or changes from baseline creatinine levels.
CONCLUSIONS
This study found that the selective approach to initiating catheterization in children with Spina Bifida is safe. Continued follow-up and a larger cohort of patients are required to validate these results.
17:16 - 17:19
S26-3 (CP)
Julian GIESCHE 1, Arndt VAN OPHOVEN 2, Severine BANEK 3, Kristina BECKER 4, Markus HEIBEL 5, Almut HIRSCH 6, Margot KIERUJ 7, Ines KURZE 8, Anja LINGNAU 9, Barbara LUDWIKOWSKI 10, Tobias LUITHLE 11, Fabian QUEISSERT 12, Wolfgang RÖSCH 13, Regina STREDELE 14, Thomas M.K. VÖLKL 15 and Michael GEDAMKE 16
1) Universitätsklinikum Ulm, Urologie und Kinderurologie, Neuro-Urologie, Ulm, GERMANY - 2) Marien Hospital Herne Universitätsklinikum der Ruhr-Universität Bochum ST. ELISABETH GRUPPE GmbH, Neuro-Urologie, Herne, GERMANY - 3) Universitäts Medizin Frankfurt, Klinik für Urologie, Frankfurt Am Main, GERMANY - 4) Haunersches Kinderspital, Kinderchirurgische Klinik und Poliklinik, München, GERMANY - 5) Sauerlandklinik Hachen gGmbH, MS-Spezialambulanz, Sundern‑Hachen, GERMANY - 6) Klinik Hallerwiese-Cnopfsche Kinderklinik, Kinderneurologie, Nürnberg, GERMANY - 7) DRK Kamillus Klinik Asbach, Asbach, GERMANY - 8) Zentralklinik Bad Berka, Neurologie, Querschnittgelähmten-Zentrum/Klinik für Paraplegiologie und Neuro-Urologie, Bad Berka, GERMANY - 9) Charité Universitätsmedizin Berlin, Klinik für Kinderchirurgie mit Arbeitsbereich Kinderurologie, Berlin, GERMANY - 10) Auf der Bult Kinder- und Jugendkrankenhaus, Kinderchirurgie/Kinderurologie, Hannover, GERMANY - 11) Universitätsklinikum Tübingen, Kinderchirurgie und Kinderurologie, Tübingen, GERMANY - 12) Kontinenz- und Beckenbodenzentrum in der Klinik für Urologie am UKM (Universitätsklinikum Münster),, Münster, GERMANY - 13) KUNO Klinik St. Hedwig, Kinderurologie, Regensburg, GERMANY - 14) LMU, Urologische Klinik und Poliklinik, München, GERMANY - 15) KJF Klinikum Josefinum, Klinik für Kinder- und Jugendmedizin, Augsburg, GERMANY - 16) FARCO Pharma GmbH, Medical, Köln, GERMANY
PURPOSE
Neurogenic detrusor overactivity (NDO) is a common symptom in patients with neurogenic spinal cord injuries/diseases (SCI), meningomyelocele (MMC), multiple sclerosis (MS), stroke or Parkinson's disease. EAU guideline for NDO recommends intravesical oxybutynin as 2nd-line treatment in NDO, if oral was insufficient or adverse drug reaction appeared. The dosage of intravesical oxybutynin (IVO) is usually determined by doctors based on their experience. The aim of the UPSIDE study was to identify predictors for a therapeutically satisfactory dosage. Here we focus on paediatric results.
MATERIAL AND METHODS
Prospective, non-interventional study with NDO patients suffering from SCI/D, MMC or MS who had been treated with VESOXX® (IVO) for at least three months. The patients were observed exclusively within the framework of routine clinical practice. Data on dosage, frequency of use, medical history, NDO medication history, concomitant medication and diseases, and paraclinical findings were recorded. Urodynamic and anamnestic factors were examined as predictors.
RESULTS
51 patients were evaluated, 36 had at least one follow-up visit.
A therapeutically satisfactory dosage was achieved in 72.2% (n = 36) of patients.
10 patients were paediatric patients, 9 were diagnosed with MMC and one with SCI, age range 6-14 years.
Factors that affected the dosage were glomerular filtration rate (GFR) (p = 0.011) and age (p = 0.059).
Mean starting dose for paediatric group was 0.53 mg/ kg body weight (0.37-0.83 mg/kg).
During the study, all measured urodynamic parameters improved and maximum catheter volume improved statistically significant overall from 304.2 ml to 409.6 ml (p=0.012).
Handling of the syringe was rated easy/very easy in nine of ten patients (one neutral).
Quality of life in the Qualiveen Score improved overall significantly over the course of the study (p=0.0276), as well as in the paediatric subgroup (p=0.019)
Observed side effects corresponded to the anticholinergic effect profile of the substance, in the paediatric group only one patient experienced an AE.
CONCLUSIONS
Predictors for IVO dose determination were age and GFR.
Mean starting dose in paediatric patients was 0.53 mg/ kg body weight.
IVO improved the urodynamic factors and quality of life of patients.
Safety data confirmed reports from the literature.
17:19 - 17:22
S26-4 (CP)
Alice FAURE 1, Jessica PINOL 2, Amane LACHKAR 2, Pauline GASTALDI 2 and Mirna HADDAD 3
1) APHM Hopital La Timone Enfant, National Expert Center for Chiari and rare spinal and spinal cord malformations (C-MAVEM ), Paediatric surgery, Marseille, FRANCE - 2) APHM Hopital La Timone Enfant, Pediatric Surgery, Marseille, FRANCE - 3) APHM Hopital La Timone Enfant, National Expert Center for Chiari and rare spinal and spinal cord malformations (C-MAVEM ), Pediatric surgery, Marseille, FRANCE
PURPOSE
Intravesical botulinum toxin (BTX-A) is an established treatment for neurogenic detrusor overactivity (NDO). However, the potential benefit of targeting the trigone (an area rich in sensory and autonomic receptors) remains unexplored. We evaluated whether including trigonal injections to the classical detrusor pattern could improve clinical and urodynamic outcomes in children.
MATERIAL AND METHODS
Retrospective study including children with NDO and urinary incontinence (UI) inadequately controlled with anticholinergic. All received BTX-A intra-detrusor injections including trigone (6-8U/Kg, max 200U, with 15% of the dose divided into 3 points within the trigone, experimental group, n=14). This cohort was compared with a historical control group (n=19) treated with the classical detrusor-only injection pattern. Primary endpoints: changes in daytime UI episodes and video-urodynamic parameters between baseline and 10 weeks post-injection in both groups. Secondary endpoints: change in urine volume at first morning catheterization (VFMC), 24-hour Pad-test results. Vesicoureteral reflux (VUR) and other adverse effects were recorded. Continuous variables were compared using Student’s t-test or Mann-Whitney U test, and categorical variables using Chi-square or Fisher’s exact test. Statistical significance was defined as p<0.05.
RESULTS
Between 2016 and 2025, 33 children (0.5-18 years) were injected. At Week 10, mean UI episodes decreased by 68% in trigonal-injection group (-3.5 episodes/day) versus 44% in controls (-1.64 episode/day, p=0.01). In the experimental group, the 24-hour Pad-test improved by -77% and VMFC increased by + 200.18mL (+79%); in controls, changes were -51% and +256.07mL (+15%) respectively (p>0.05 for both comparisons).
In the experimental group, from baseline, mean detrusor pressure (Pdet) decreased by -35.5cmH2O (-71%), mean NDO volume increased by +47.5mL (+38%) and maximum cystometric capacity (MCC) increased by + 80.85mL (+35%). In the control group: Pdetchanged by -7.29cmH2O (-23%, p=0.01), NDO increased by +36.54mL (+40%, p>0.05), and MCC by +59.06mL (+24%, p>0.05). In both group, no de novo VUR was detected. Over a median follow-up of 15 months [12-18], no intra- or postoperative complications were reported.
CONCLUSIONS
Combined detrusor-trigone BTX-A injections seems to improve continence outcomes and bladder dynamics in children with NDO, without increasing the risk of adverse events.
These findings need to be confirmed by prospective randomized controlled trial with a larger number of patients.
17:37 - 17:40
S26-5 (CP)
Rach MENA 1, Gloria Fatou ROYO 2, Montserrat AGUILERA-PUJABET 2, Carmen LÓPEZ 1, Romy GANDER 2, Malina Daniela BUHNILA 1 and Marino ASENSIO 2
1) Vall d'Hebron University Hospital, Pediatric Surgery, Barcelona, SPAIN - 2) Vall d'Hebron University Hospital, Pediatric Urology, Barcelona, SPAIN
PURPOSE
Intrauterine repair of myelomeningocele (MMC) has been standardized over the last 40 years with dramatic changes in survival and quality of life outcomes in these patients, mostly regarding neurological and motor function. But improvement of urological outcomes after fetal repair still remain uncertain. The aim of this study is to describe urological, urodynamic and clinical outcomes of fetal MMC repair at our center.
MATERIAL AND METHODS
A retrospective study from 2012-2024 of patients undergoing fetal MMC repair followed by Pediatric Urology at our center was performed. Patients with no functional urodynamic study were excluded. Follow-up protocols were designed after European recommendations for neurogenic bladder (NB), classifying urodynamic patterns in: stable bladder (<20mmHg), intermediate risk (<40mmHg), high risk (>40mmHg), hypocontractile and bad accommodation. Incontinence was only evaluated in patients over 2 years old or performing intermittent clean catheterization (ICC).
RESULTS
Out of 83 prenatal MMC surgeries, 38 patients met the inclusion criteria. 24,3% prenatal ultrasounds were altered, as were 67,5% MCUGs, performed at an average age of 12,1 ± 10,7 months. Only 25,3% patients with high-risk bladders presented abnormal findings on ultrasound.
The first urodynamic study was performed at 11,6 ± 5,1 months old on average, and 90,5% patients presented hyperactive bladder patterns. Out of them, 45,6% were considered high-risk and ICC was initiated.
Average follow-up was 6,2 ± 3,4 years. Currently, 70,2% of them perform ICC, which was started at an average age of 21,5 ± 10,9 months. 38,5% have received detrusor botulinum toxin infiltrations, at an average age of 5 ± 1,25 years. 4 patients required urologic surgery: 2 robotic augmentation enterocystoplasties, one non-absorbable polymer bladder neck injection and one utererostomy. On last follow-up, urodynamic patterns were pathological in 71,4% patients (25,7% of them being high-risk) and 47,2% present clinical incontinence.
CONCLUSIONS
Patients with prenatal MMC closure present a higher index of high-risk NB and incontinence compared to previous literature. It may be possible that it entails a new entity with poorer response to the treatments used until now that needs a more aggressive approach.
17:40 - 17:43
S26-6 (CP)
Renan TIMÓTEO DE OLIVEIRA 1, Catharina ACCORSI 2, Manoela GUIMARÃES 2, Alissa FERNANDA DE SOUZA BRITTO 3, Patric MACHADO TAVARES 4, Antônio REBELLO HORTA GOERGEN 4 and Tiago ELIAS ROSITO 5
1) Hospital de Clínicas de Porto Alegre, Urology, Porto Alegre, BRAZIL - 2) Universidade Luterana do Brasil, Faculdade de Medicina, Canoas, BRAZIL - 3) Hospital de Clínicas Porto Alegre, Serviço de Urologia, Porto Alegre, BRAZIL - 4) Hospital de Clínicas de Porto Alegre, Serviço de Urologia, Porto Alegre, BRAZIL - 5) Universidade Federal do Rio Grande do Sul, Serviço de Urologia, Porto Alegre, BRAZIL
PURPOSE
Since the advent and popularisation of intrauterine repair for myelomeningocele (MMC), the improvements in neurological outcomes, including a reduction in the need for ventricular shunts and better motor function in the lower limbs, have been undeniable. However, the urological outcomes still remain equivocal, and few high-quality studies have been dedicated to comparing the functional results of neurogenic bladders in children who underwent intra- and post-natal repair. Our objective was to compare urological outcomes in the first 5 years of children who underwent intrauterine versus postnatal repair, who were subjected to a proactive protocol based on neonatal urodynamic staging to define risk and early intervention.
MATERIAL AND METHODS
A prospective cohort study with the inclusion of patients at birth since 2017. All patients were subjected to urodynamic staging in the 1st year of life and exposed to the same therapeutic protocol. We separated the included patients into two groups (intra- and post-natal closure). Clinical, urodynamic, ultrasound, and glomerular function (DMSA) results were compared at the 1st and 5th years of life. The Mann-Whitney U Test and Student's t-Test were used for comparison between the groups.
RESULTS
89 patients were included in this analysis: 49 (54.4%) post-natal and 40 (43.6%) intrauterine. The mean gestational age at birth was 36.7 in the post-natal group and 34.9 in the intrauterine group. The need for VP shunts was 22.5% in the intrauterine group versus 73.4% in the post-natal group (p 0.001), and 66% with mobility in the post-natal group versus 100% in the intrauterine group (P < 0.05). 47.5% of neonatal high-risk urodynamics were found in the intra-uterine group versus 25% in the post-natal group (P < 0.03) and trabeculated bladder in 3.4% in the intrauterine group versus 6.8% in the post-natal group. RVU was found in 25.3% in the intra-uterine group versus 30.9% in the post-natal group. At the end of 5 years, 16.7% presented with renal scarring in the intra-uterine group versus 41.2% in the post-natal group.
CONCLUSIONS
Despite presenting a higher neonatal urodynamic risk, intrauterine closure appears to demonstrate better urological outcomes in the medium and long term.
17:43 - 17:46
S26-7 (CP)
Betsy HOPSON 1, Carmen TONG 1, Ethan WAN 2 and Stacy TANAKA 1
1) University of Alabama at Birmingham, Urology, Birmingham, USA - 2) University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, USA
PURPOSE
Individuals with spina bifida (SB) frequently require lifelong bladder management, most often through clean intermittent catheterization (CIC). Although prior research shows that people with disabilities face an elevated risk of sexual abuse, the relationship between bladder management methods and this risk remains poorly understood. The aim of this study was to examine associations between sexual abuse, CIC use, and sex among adults with SB to inform targeted screening and prevention strategies in clinical care.
MATERIAL AND METHODS
We analyzed responses from a validated sexual and reproductive health survey of adults with SB distributed through the national Spina Bifida Association (United States). Sexual abuse was defined as any non-consensual or unwanted sexual experience; "none of these things have ever happened to me" was coded as no abuse. Childhood sexual abuse was defined as occurring before age 18. Sex was defined by sex assigned at birth, and CIC use included any urethral or channel-based catheterization. Associations between CIC use, sex, and sexual abuse were assessed using chi-square or Fisher's exact tests when expected cell counts were <5. Odds ratios (ORs) with 95% confidence intervals (CIs) quantified associations, and frequencies and percentages were calculated using non-missing responses as denominators.
RESULTS
Among 137 respondents (102 females, 46 males; mean age = 40.8 ± 13.2 years), 46.0% reported a history of sexual abuse, and 57.4% of those experienced abuse before age 18. Females reported higher lifetime abuse than males (56.8% vs. 19.5%, p < 0.01) and more childhood abuse (59.2% vs. 40.0%, p = 0.22).
Among males, lifetime abuse did not differ by CIC use (16.1% CIC vs. 30.0% non-CIC, p = 0.39). Among females, prevalence was higher for CIC users (62.0% vs. 41.7%, p = 0.13). Females had over fivefold higher odds of lifetime abuse than males (OR 5.43, 95% CI 2.27-13.00), and female CIC users had more than double the odds compared with non-CIC females (OR 2.28, 95% CI 0.89-5.85).
CONCLUSIONS
Sexual abuse is highly prevalent among individuals with SB, with over half experiencing abuse before age 18. Females were over five times more likely to be abused than males. Although CIC use was not associated with abuse among males, it trended toward significance among females, who had more than double the odds of lifetime abuse. These findings highlight the need for targeted screening and prevention, particularly for females using CIC.