ESPU Meeting on Saturday 20, June 2026, 08:00 - 08:45
08:00 - 08:05
S27-1 (VP)
Nicole KYE, Suhaib ABDULFATTAH, Sanjay AIYAR, Meghan DAVIS, Arun SRINIVASAN, Sameer MITTAL and Aseem SHUKLA
Children's Hospital of Philadelphia, Urology, Philadelphia, USA
INTRODUCTION
Ureteroplasty is performed to repair ureteral strictures and restore proper urine flow, preserving kidney function, and preventing long-term complications such as hydronephrosis. We present a case of a 16-year-old female with ulcerative colitis and prior ileostomy/J-pouch who developed a mid-ureteral stricture with significantly reduced left kidney function.
METHODS
The patient underwent preoperative cystoscopy and retrograde pyelogram, confirming a 3 cm mid-ureteral stricture, and a double-J stent was placed. She was positioned in lithotomy and Trendelenburg, and robotic ports were inserted for minimally invasive access. Adhesions from prior surgeries were carefully dissected to expose the ureter, which was opened longitudinally. A 3 × 1.5 cm buccal mucosal graft was harvested from the cheek and sutured onlay to the ureter to widen the narrowed segment, and a drain was placed for postoperative management.
RESULTS
The patient had a 4-day hospital stay, and the stent was removed 13 weeks postoperatively. At 1-year follow-up, renal ultrasound showed no hydronephrosis or ureteral dilation, indicating successful reconstruction and preserved renal function.
CONCLUSION
Buccal graft onlay ureteroplasty is a safe and effective option for complex ureteral strictures.
08:05 - 08:08
S27-2 (CP)
Karl BODENSCHATZ
Clinic of Pediatric Surgery and Urology, Klinikum Nuremberg, Nuremberg, GERMANY
PURPOSE
The therapeutic goals in children with ureterocele are to preserve kidney function, rule out or eliminate significant obstruction, and prevent urinary tract infections and bladder dysfunction. But how can these goals be best achieved?
MATERIAL AND METHODS
Based on 5 cases, the diagnostic and therapeutic approach to the treatment of ureterocele was queried by 11 experienced paediatric urologists (PU) (5 paediatric surgeons, 5 urologists, 1 both), including 8 FEAPUs.
RESULTS
Case 1: Full-term boy with ureterocele of a dysplastic kidney (8% function): Assuming an unremarkable clinical course, the treatment spectrum ranges from "don't touch" - no prophylaxis, no further diagnostics, no therapy, or topical therapy of the prepuce, to ureterocele incision/puncture (laser/ELRES/cold) alone to ureterocele resection + bladder floor reconstruction + ureteral reimplantation (URI) (open) or nephroureterectomy (DaVinci/LSK/open) ± ureterocele resection.
Case 2/3: Full-term girls with a duplex kidney, hydronephrotic upper moiety, and associated ureterocele: Some PU follow their principle, that girls must always undergo ureterocele resection, bladder floor reconstruction, and ureteral reimplantation (URI). Other PU choose to simply puncture the ureterocele and, if the findings are unremarkable, take no further action. In the third group, further diagnostic testing (VCUG/DMSA) is performed after ureterocele incision, and the decision is made, based on the findings (1st: ureterocele resection + bladder floor reconstruction + URI, 2nd laparoscopic Lich-Gregoir ± laparoscopic upper heminephroureterectomy, 3rd laparoscopic ureteroureterostomy. 2nd and 3rd leaving the ureterocele untouched).
Case 4: A 5-month-old female infant with a obstructet and infected lower moiety in a case of duplex kidney and ureterocele of the upper moiety.: Agreement on immediate decompression (PCN, ureterocele incision, ureterocutaneostomy of one or both ureters).
All PU plan to perform ureterocele resection + bladder floor reconstruction + URI at 1-2.5 years of age. DMSA/VCUG are optional.
Case 5: Full-term female infant with duplex kidney, small ureterocele and mildly dilated upper moiety: There is agreement on an observational, sonographically controlled approach ± prior MAG-III scintigraphy.
CONCLUSIONS
In both diagnosis and therapy, different approaches are evident regardless of the specialist title (paediatric surgeon/urologist) often shaped by training and individual experience.
08:08 - 08:11
S27-3 (CP)
Kevin KANG 1, Yong Seung LEE 1, Sang Woon KIM 1, Beom Yong RHO 2 and Sang Won HAN 3
1) Yonsei University College of Medicine, Urology, Seoul, REPUBLIC OF KOREA - 2) Inha University College of Medicine, Department of Urology, Incheon, REPUBLIC OF KOREA - 3) CHA Gangnam Medical Center, Urology, Seoul, REPUBLIC OF KOREA
PURPOSE
High-pressure balloon dilatation (HPBD) has shown promising results in managing primary non-refluxing megaureter (PMU). Whether HPBD can be considered as an alternative treatment option to ureteral reimplantation remains unanswered. We compared the clinical outcome of two surgical techniques.
MATERIAL AND METHODS
Medical records of pediatric patients who underwent HPBD or ureteral reimplantation for PMU between 2005 and 2025 were reviewed. Pre- and postoperative grade of hydronephrosis, and retrovesical ureter diameter at sagittal view of bladder, and SRF were collected. A secondary analysis was performed to investigate predictive factors for HPBD failure. A ureter tortuosity index (TI) was incorporated as a novel parameter to quantify the severity of tortuosity by calculating the ratio between the actual ureteral length on the RGP and the shortest distance if the ureter were to follow its normal course.
RESULTS
114 patients who underwent HPBD (n=47, group A) or reimplantation (n=67, group B) were included in the analysis with median follow-up of 68.5 (IQR: 20.0-127.0) months. The median age at surgery was 33.0 months in group A and 10.0 months in group B (p<0.001). There was no baseline difference in preoperative grade of hydronephrosis (p=0.074) and ureter diameter (A: 17.4±10.0mm, B: 16.8±6.2mm, p=0.721). The average preoperative SRF was lower in group B compared to group A (A: 38.5±11.7%, B: 47.5±13.0%, p<0.001). After surgical intervention, significant improvements were observed within each group: grade of hydronephrosis (A & B, p<0.001) and ureter diameter (A: 7.7±5.5mm, p<0.001, B: 2.4±4.2mm, p<0.001). However, the functional recovery was not evident (A: 46.5±13.0%, p=0.879, B: 38.6±12.1%, p=0.595). The reimplantation was more effective in reducing hydronephrosis and ureter diameter (both p<0.001). Only in group A required further surgical intervention in 8 (17.0%) patients. The median time from HPBD to secondary intervention was 8.0 (IQR: 5.5-13.5) months; and the median age was significantly lower in HPBD failure group (15.0 months vs. 4.0 months, p<0.001). The average preoperative ureter diameter and TI of patients with successful HPBD was significantly lower (15.7mm vs. 22.6mm, and 1.15 vs. 1.65, p=0.046, p<0.001, respectively). Finally, there was no difference in the number of febrile UTI events between HPBD and reimplantation (p=0.122).
CONCLUSIONS
HPBD can be a less invasive option for select PMU patients, especially too young and technically challenging to perform reimplantation. The preoperative ureter diameter combined with TI may serve as a guidance in making a final decision on treatment option between HPBD and reimplantation.
08:23 - 08:26
S27-4 (CP)
Rajesh YERRA
YERRAS SUPER SPECIALITY HOSPITALS PRIVATE LIMITED, PAEDIATRIC SURGERY and PEDIATRIC UROLOGY, Guntur, INDIA
MANAGEMENT AND OUTCOMES OF URINARY TRACT DILATION IN ECTOPIC KIDNEYS: AN 18-YEAR RETROSPECTIVE REVIEW FROM A TERTIARY PEDIATRIC CENTER
Ectopic kidneys are congenital anomalies frequently accompanied by malrotation, aberrant vasculature, and an increased risk of urinary tract dilation (UTD). Anomalous anatomy complicates decision-making for UTD management. We present an 18-year retrospective review of presentation, management, and outcomes of children with UTD in ectopic kidneys at a tertiary referral center
MATERIAL AND METHODS
We retrospectively analyzed pediatric patients (0-18 years) diagnosed with UTD in an ectopic kidney and managed under the author's care between March 2008 and November 2025. Patients with incomplete records were excluded. Data collected included demographics, imaging (ultrasound, micturating cystourethrography, renal scintigraphy), etiology of UTD, management (conservative, medical, sYY'urgical), and outcomes. Indications for surgery followed standard institutional guidelines.
RESULTS
Of 1,100 children with UTD presenting to the outpatient department, 230 (21%) underwent surgery and 870 (79%) were managed conservatively with spontaneous resolution in many. Sixty-five children had ectopic kidneys (predominantly pelvic); 52/65 (80%) of these had associated UTD. Etiology among the 52 was ureteropelvic junction obstruction (PUJO) in 35 (67%) and vesicoureteral reflux (VUR) in 17 (33%). At initial evaluation, 30 patients underwent surgery and 22 were managed conservatively. Ten patients (20%) experienced spontaneous resolution; 12 initially managed conservatively required delayed surgery for progression. Overall, 42/52 (80%) required surgical intervention. Procedures included Anderson-Hynes dismembered pyeloplasty for PUJO (n=27), ureteric reimplantation for VUR (n=6), and nephrectomy for non functioning kidneys (n=9). Tailored surgical approaches accounting for anomalous anatomy achieved an overall success rate of ≈83% over the 18-year study period.
CONCLUSIONS
UTD in ectopic kidneys mandates individualized assessment and long-term follow-up due to complex anatomy and variable natural history. Early diagnosis, comprehensive imaging, functional assessment, and timely, anatomy-tailored interventions optimize renal preservation and clinical outcomes in this challenging cohort.
08:26 - 08:29
S27-5 (CP)
Florin Bogdan DJENDOV 1, Abraham CHERIAN 1, Divyesh DESAI 1, Imran MUSHTAQ 1, Naima SMEULDERS 1, Navroop JOHAL 1, Neetu KUMAR 1, Marina EASTY 2, Lorenzo BIASSONI 2, Riwa MESHAKA 2, Melanie HIORNS 3 and Alexander CHO 1
1) Great Ormond Street Hospital, Paediatric Urology, London, UNITED KINGDOM - 2) Great Ormond Street Hospital, Paediatric Nuclear Medicine, London, UNITED KINGDOM - 3) Great Ormond Street Hospital, Paediatric Radiology, London, UNITED KINGDOM
PURPOSE
To define the incidence of concurrent paediatric pelvi-ureteric junction obstruction (PUJO) and vesico-ureteric junction obstruction (VUJO), and to identify if pre-operative imaging or intra-operative findings suggest the presence of synchronous pathology.
MATERIAL AND METHODS
Single-centre retrospective review, with institutional approval, of unilateral pyeloplasties performed from April 2019 to April 2024.
RESULTS
Two hundred fifty-four patients were identified: 16 (6%) had concurrent PUJO-VUJO, while 238 required pyeloplasty alone.
PUJO-VUJO:
- 11/16 underwent pyeloplasty first, and the concurrent VUJO was proven by postoperative nephrostogram (10/11) or worsening hydroureter on US (1/11). All underwent subsequent endoscopic cutting balloon.
- 3/16, despite hold-up at the PUJ on the MAG-3 and distal ureteric dilatation on US scan prompted retrograde studies that identified VUJO and this was addressed first; all required a later pyeloplasty due to persistent hydronephrosis and slow PUJ drainage.
- 2/16 had synchronous PUJO-VUJO surgery.
Anterograde Stenting Concerns:
For 139/254, a 4.7F-JJ-stent was the preferred stenting method following pyeloplasty. There was difficulty passing the JJ stent across the VUJ in 25/139 (18%) of children, of which 11/25 (44%) had a concurrent VUJO confirmed.
Distal ureteric dilatation:
Distal ureteric dilatation was only demonstrated on pre-operative ultrasound in 5/16 (45%) of the PUJO-VUJO group compared to 5/238 (2%) in the pyeloplasty alone group (p<0.05).
Concurrent PUJO-VUJO Outcomes:
Only one patient required a revision endoscopic procedure for VUJO. All 16 showed subsequent improvement in hydronephrosis on US, and 14/14 showed improved drainage on MAG3, with 7/14 (50%) showing improved differential function ≥5%. Median follow-up time was 33 months (range: 11-56 months).
CONCLUSIONS
Concurrent unilateral PUJO and VUJO occur in only 6% of all children with PUJO. Absence of distal ureteric dilatation does not exclude concurrent VUJO. If an anterograde 4.7F JJ stent cannot be passed across the VUJ, there is a 44% chance of a concurrent VUJO.
08:29 - 08:32
S27-6 (CP)
Adree KHONDKER 1, Eviatar FIELDS 2, Ali HAMADE 3, Ihtisham AHMAD 1, Samer MAHER 1, Michael CHUA 1, Innocent NZEYIMANA 1, Mandy RICKARD 1 and Armando LORENZO 1
1) The Hospital for Sick Children, Toronto, CANADA - 2) McGill University, Montreal, CANADA - 3) Dalhousie University, Halifax, CANADA
PURPOSE
Ureteropelvic junction obstruction (UPJO) in patients with concurrent renal anomalies such as duplex, malrotation, ectopic location, horseshoe configuration and concurrent ureterovesical junction obstruction (UVJO) can introduce surgical complexity. We explore if these cases have an increased risk of surgical complications and re-do pyeloplasty.
MATERIAL AND METHODS
We reviewed children who underwent pyeloplasty at our institution between 2008 and 2025 and identified children who had a concurrent renal anomaly. Data was abstracted regarding demographics, surgical details, pre- and post-operative imaging findings. The primary outcome were surgical complications and procedures for failed pyeloplasty. Additionally, we performed a 1:1 propensity matched comparison against children without complex renal anomalies, matching by demographics, surgical approach, pre-operative anteroposterior diameter (APD). We used Fishers' exact test for dichotomous outcomes and Mann-Whitney U for continuous variables.
RESULTS
Among 816 patients undergoing pyeloplasty, 60 (7%) had a concurrent anomaly (Table 1). Forty-one patients (68%) were male, and median age at surgery was 12 months (IQR 5, 52). The most common among this was a duplex system (15 patients), followed by horseshoe and concurrent UVJO (13 patients each). Twelve patients (20%) were symptomatic prior to operation. Fifty-five (92%) of patients underwent open pyeloplasty, median operative time was 159 min (IQR 122, 188), and 8 patients (13%) had complications (3 infections, 2 hematuria, 2 stent concerns). Three patients (5%) required re-operation for worsening hydronephrosis. On comparison, there were no difference in pre-operative APD, immediate post-operative APD, or re-do pyeloplasty rates between these complex groups. In comparison against a matched uncomplicated pyeloplasty group, there was no significant difference in post-operative APD, length of stay, surgical complications, or rates of re-operation, but there was a significantly increased operating time (159 vs. 139 min, p = 0.048). Of note, 35 had presence of double-J stent (58%) in the anomalies group while 18 (30%) had double-J in the matched cohort (p = 0.01).
CONCLUSIONS
Pyeloplasty in the setting of complex renal anatomy is safe, feasible, and achieves early outcomes comparable to those in standard UPJO. Despite presumed surgical difficulty, complication and re-do rates remained low and aligned with widely accepted benchmarks. These findings reassure clinicians and families that anatomic complexity alone should not deter timely surgical repair, while underscoring the importance of attentive postoperative imaging in this unique population.