ESPU Meeting on Saturday 20, June 2026, 08:45 - 09:40
08:45 - 08:50
S28-1 (VP)
Thomas LOUBERSAC 1, Hortense ALLIOT 2, Marc-David LECLAIR 3 and Marie-Aimée PERROUIN-VERBE 4
1) CHU Nantes, Paediatric Urology, Nantes, FRANCE - 2) University Hospital of Nantes, Nantes Université, Nantes, FRANCE - 3) University Hospital of Nantes, Nantes Université, Pediatric urology, Nantes, FRANCE - 4) University Hospital of Nantes, Nantes Université, Urology Department, Nantes, FRANCE
PURPOSE
The artificial urinary sphincter (AUS) is one of the tools used to manage neurogenic stress urinary incontinence. The open approach is considered the gold standard. There are few cases of R-AUS placement around the bladder neck in girls. Here, we present a step-by-step video of a bladder neck R-AUS procedure performed on a 12-year-old girl with total neurogenic stress urinary incontinence. This case is part of a series of four children who underwent R-AUS procedures at our centre.
MATERIAL AND METHODS
Our patient was a 12-year-old girl with sacral agenesia, a small non-contractile bladder, and incontinence due to intrinsic sphincter deficiency. At the age of six, she underwent bladder augmentation with clean intermittent catheterisation (CIC) and the insertion of a peri-urethral ProACT balloon, which resulted in improved continence.
However, at the age of twelve, she began puberty, and as she grew, the left periurethral balloon migrated posteriorly.
She became completely incontinent due to neurogenic stress urinary incontinence secondary to intrinsic sphincter deficiency. Preoperative investigations included renal and bladder ultrasonography and urodynamics which showed normal results. An AUS was chosen at the bladder neck to reduce the risk of cuff erosion with clean intermittent catheterisation (CIC) while maintaining continence between catheterisations. A robotic approach was chosen to provide a minimally invasive alternative to open surgery.
RESULTS
A transperitoneal five-port approach was performed using a standard four-armed da Vinci® robot (Intuitive Surgical, Sunnyvale, California, USA) in a 20° reverse Trendelenburg position. The artificial urinary sphincter (AUS) cuff was placed around the bladder neck in a circumferential manner, the reservoir was left in an intra-abdominal lateral vesical space, and the pump was placed in the classic position. The AUS was deactivated at the end of the procedure.
The total operative time was 240 minutes. Estimated blood loss was minimal. The catheter was removed on day 2.. The AUS was reactivated six weeks later.
At the 12-month follow-up, the girl had made a full recovery and remained completely dry between voids.
In our series of four children, the median age was 12.5 (IQR: 11.75–14.25), of whom two were girls. No post-operative complications above Clavien grade 3 occurred. The median follow-up period was 16 months (IQR: 6–37). At the final follow-up, all patients were dry with their AUS in place. No sphincters were explanted and the first child (a girl) underwent sphincter revision at 65 months.
CONCLUSIONS
Placing a bladder neck AUS in a girl can be challenging. The robotic approach offers advantages when performing deep pelvic surgery.
08:50 - 08:53
S28-2 (CP)
Jonathan XU, Konrad SZYMANSKI, Rosalia MISSERI, Richard RINK, Mark CAIN, Martin KAEFER and Joshua ROTH
Riley Hospital for Children, Urology, Indianapolis, USA
PURPOSE
Since the 1980s, the artificial urinary sphincter (AUS) has been implanted in children with neurogenic bladder and urinary incontinence to bolster bladder outlet resistance. However, long-term outcomes regarding bladder neck AUS durability and continence in this population remains unknown. Thus, we reviewed our institutional series of patients with bladder neck AUS to investigate these outcomes as these patients have transitioned into adulthood.
MATERIAL AND METHODS
We queried our institutional database on 148 patients who underwent initial bladder neck AUS placements from 1980 to 2004. Following chart review, 107 patients (75 males and 32 females) were included in our analysis. At the time of last urologic follow-up, data on the presence of AUS, functionality, and continence were collected.
RESULTS
Of 107 patients followed, 57 patients had retained AUS at time of last follow-up with median total device utility time of 25.2 years. 50 of 107 patients without their AUS at last follow-up had undergone surgical explantation most commonly for device erosion. 32 of 57 patients (56%) underwent surgical revision of their AUS at some point, most commonly for device malfunction and/or outgrowing their previous sphincter cuff. 23 of 57 patients (40%) with AUS were completely dry from below. 10 of 31 patients (32%) who continue to cycle their AUS are completely dry; 13 of 26 patients (50%) who do not cycle their AUS are completely dry.
CONCLUSIONS
Our results demonstrate that bladder neck AUS continues to assist with voiding function, continence, and dryness well into adulthood (median follow-up 28.1 years). While 53% of patients still cycle their AUS for voiding as adults, an additional 28% of patients who no longer cycle their AUS still retain them for functional dryness. We anticipate our results will better help clinicians counsel patients and families on expectations of function, continence, and dryness of the bladder neck AUS over time.
08:53 - 08:56
S28-3 (CP)
Alice FAURE 1, Mirna HADDAD 2, Amane LACHKAR 3, Floriane MICHEL 4 and Gilles KARSENTY 4
1) APHM Hopital La Timone Enfant, Paediatric surgery, Marseille, FRANCE - 2) APHM Hopital La Timone Enfant, Pediatric surgery, Marseille, FRANCE - 3) APHM Hopital La Timone Enfant, Pediatrc Surgery, Marseille, FRANCE - 4) APHM Hopital La Conception, Urology, Marseille, FRANCE
PURPOSE
To evaluate the outcomes of adjustable continence therapy (ACT™ implantatble balloons) for the treatment of urinary incontinence in patients with neurogenic bladder, incontinent epispadias, or bladder exstrophy.
MATERIAL AND METHODS
We conducted a prospective, non-randomized study of periurethral ACT™ balloon implanted from April 2018 to December 2025. ACT™ were offered to patients presenting with involuntary urinary leakage, a leak point pressure <45 cmH₂O, and a low-pressure, normal-capacity bladder (obtained with botulinum toxin injection in 8 and bladder augmentation in 2). The implantation was performed via a perineal approach under general anaesthesia. Accurate positioning was ensured using both realtime fluoroscopic and endoscopic guidance.
Treatment efficacy was defined as wearing 0–1 safety pad per day. Improvement was defined as a decrease of ≥50% in the number of daily pads.
RESULTS
In total, 17 patients (8 boys-9 girls), median age of 13 Y.O. (5-21) were included; 47% (n=8) had neurogenic bladder, 35% (n=6) had incontinent epispadias and 17% (n=3) bladder exstrophy. The median (range) follow-up time was 54 (12–91) months. The success and improvement rates at M12 were 71% and 21%, respectively (M24: 60% and 15%, M36: 60% and 20%). At the last follow-up, 88% of patients still had their balloon in place. Forty-seven per cent (n=8) experienced at least one complication, mainly cutaneous erosion (41.7%), all treated in outpatient clinic or day case surgery. Definitive explantation occurred in 11.7% (n=2). Higher rate of complications was observed in wheelchair bound girls with neurogenic bladder. Neither degradation of the upper urinary tract nor cystomanometric changes have been observed during follow-up.
CONCLUSIONS
Our series of complex congenital UI patients treated with peri-urethral ACT™ followed over 7 years showed good long-term functional results on these highly challenging situations. ACT devices are more effective than bladder neck injections. In case of failure, no worsening of the initial situation was observed even after removal. Minimal invasive nature of both implantations and complication management preserve local anatomy for future AUS implantation. The ideal candidates would be neurogenic patients (better if walking or having perineal sensation if wheelchair bound) with mild to moderate UI (<400g) or incontinent epispadias regardless of age.
09:08 - 09:13
S28-4 (VP)
Antonio MACEDO JR, Sergio LEITE OTTONI and Debora Laena BARROSO SACOMAN
CACAU NUPEP, Department of Pediatric Urology, São Paulo, BRAZIL
PURPOSE
Bladder neck closure is an even more common procedure performed in our practice. We discuss with the family about the alternatives of plasty x closure and show them results of continence of both techniques to help in the decision making process. We always do this surgery in association with bladder augmentation. We want to demonstrate here the longitudinal insideout approach, which is easier and more comfortable than the transverse approach popularized by Khoury et al (Khoury AE, Agarwal SK, Bägli D, Merguerian P, McLorie GA. Concomitant modified bladder neck closure and Mitrofanoff urinary diversion. J Urol. 1999 Nov;162(5):1746-8. PMID: 10524928.).
MATERIAL AND METHODS
We initially open the bladder in midline to gain exposure to the trigonal area and bladder neck. We place a Foley tube and two 4Fr plastic tubes in both ureters to secure the transection of bladder neck from inside-out without injuring them, making a circumcision of the bladder neck. This incision will produce two bladder flaps. We perform a dissection of the posterior wall of both bladder flaps, separating them from the rectum in males and the vagina is females. The dissection of the posterior wall of the bladder neck is done by a combination of electrocautery and blunt dissection. It is important to have the bladder flaps fully elevated up to the skin level, to close them in two layers: PDS 5.0 for the mucosa and Vycril 4.0 for seromuscular layers. We produce a longitudinal wound closing the bladder neck instead of a transverse one. The advantage of this procedure is that the surgeon has full control and access to the lowest parts of the bladder to be closed. The bladder is prepared for bladder augmentation and creation of a pouch with a continent catheterizable channel. We drain the bladder by two Foley tubes for 3 weeks (ostomy and safety cystostomy)
RESULTS
Patients had an excellent outcome and is full continent between CIC at 4 hours intervals.
CONCLUSIONS
We personally believe that bladder neck closure should be more indicated in cases of complex bladder reconstruction because of better expectancy of continence. The technique we are using is simpler than other ones according to our expertise.
09:13 - 09:16
S28-5 (CP)
Kristina GAM 1, Alexandra BAIN 1, Renee CARPENTER WELLS 2, Megan READ 3, Joshua BRICKER 4, Alexandra REHFUSS 5, Richard WOOD 3, Molly FUCHS 1, Eric SRIBNICK 2 and Christina CHING 1
1) Nationwide Children's Hospital, Urology, Columbus, USA - 2) Nationwide Children's Hospital, Neurosurgery, Columbus, USA - 3) Nationwide Children's Hospital, Center for Colorectal & Pelvic Reconstruction, Columbus, USA - 4) Nationwide Children's Hospital, General Surgery, Columbus, USA - 5) Albany Medical Center, Urology, Albany, USA
PURPOSE
Spinal cord detethering has been shown to improve urodynamic parameters. We sought to investigate factors that may be associated with this improvement and whether it was associated with improvement in clinical outcomes of urologic symptoms or imaging.
MATERIAL AND METHODS
A single-institution retrospective review of patients who underwent tethered cord release between 2011-2024 and had available records of pre- and postoperative urodynamics was completed. Urodynamic improvement was defined by increased bladder capacity or compliance, or improvement in detrusor overactivity. Variables were compared between groups using Chi-squared or Fisher’s exact tests for categorical data and the Wilcoxon rank-sum test for continuous variables, with p<0.05 considered significant
RESULTS
98 patients were included. The median age at detethering was 3.9 years. 48% were female. 45% had anorectal malformation. 4% had occult tethered cord, 62% had fibrolipoma of filum terminale or intraspinal lipoma, and 34% had myelomeningocele or lipomyelomeningocele. The most common indication for cord detethering was worsening urodynamics (44%).
After detethering, 52% of patients had improved urodynamics. The cohort with improved urodynamics, compared to those without improvement, had a significantly higher proportion of male patients (63% vs 40%, p = 0.04) and a significantly lower rate of bowel symptoms as an indication for detethering (4% vs 23%, p=0.012) The cohort with improved postoperative UDS had a significantly higher rate of detrusor overactivity and a significantly higher end fill pressure on pre-operative UDS (Table 1). Regarding impact on clinical and imaging outcomes, there was no change in findings of hydronephrosis, urinary retention, or UTI between cohorts, while incontinence improved in significantly more patients with improved UDS (32% vs 10%, p=0.02).
| Preoperative UDS findings |
UDS improved N = 51 |
UDS not improved N = 47 |
p-value |
| % expected bladder capacity, Mdn [IQR] | 81 [56, 130.5] | 83 [46.5, 112.5] | 0.38 |
| DLPP, cm H2O, Mdn [IQR] | 44 [16.5, 68] | 27 [14, 43] | 0.4 |
| Overactivity, n (%) | 41 (80.4%) | 28 (59.6%) | 0.04 |
| End fill pressure, cm H2O, Mdn [IQR] | 30 [15, 44.3] | 16 [6, 25] | <0.001 |
| Compliance, mL/cm H2O, Mdn [IQR] | 5.27 [3.3, 10.1] | 7 [3.8, 16.4] | 0.14 |
| PVR, mL, Mdn [IQR] | 35 [8, 150] | 25 [8.5, 60] | 0.48 |
| Reflux, n (%) | 15 (33.3%) | 9 (27.3%) | 0.75 |
| Bladder trabeculations, n (%) | 16 (35.6%) | 10 (30.3%) | 0.81 |
CONCLUSIONS
In our review of patients with perioperative UDS around spinal cord detethering, we found variables of male gender, high preoperative end fill pressure, and preoperative detrusor overactivity significantly associated with post-operative UDS improvement. Presence of bowel symptoms as an indication for detethering may also predict UDS response to detethering. Improvement in urodynamics may contribute to improved urinary incontinence outcomes post-detethering.
09:16 - 09:19
S28-6 (CP)
Giovanni MOSIELLO 1, Rebecca PULVIRENTI 1, Kate ABRAHAMSSON 2, Rafal CHRZAN 3, Michaela DELLENMARK-BLOM 4, Ferdinand DHOMBRES 5, Rien NIJMAN 6, Michal MATERNIK 7, Christian RADMAYR 8, Sylvia ROOZEN 9 and Jean-Marie JOUANNIC 10
1) Bambino Gesù Children's Hospital IRCCS, NEURO-UROLOGY, Rome, ITALY - 2) The Queen Silvia Childrens Hospital, Sahlgrenska University Hospital, Gotheburg, Sweden., PEDIATRIC UROLOGY, Gotheburg,, SWEDEN - 3) Jagiellonian University Medical College, Department of Pediatric Urology, Krakow, POLAND - 4) Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, PEDIATRIC UROLOGY, Gotehnburg, SWEDEN - 5) Armand Trousseau Hospital, APHP Sorbonne University, CRMR SPIN@, Fetal Medicine Department, Paris, FRANCE - 6) University Medical Centre Groningen,, Urology and Paediatric Urology, Groningen, NETHERLANDS - 7) Medical University of Gdansk, Poland,, Department of Pediatrics, Nephrology and Hypertension, Gdansk, POLAND - 8) Medical University Innsbruck, Paediatric Urology, Innsbruck, AUSTRIA - 9) INTERNATIONAL FEDERATION FOR SPINA BIFIDA AND HYDROCEPHALUS, Bruxelles, BELGIUM - 10) Fetal Medicine Department, Armand Trousseau Hospital, APHP Sorbonne University, CRMR SPIN@ and INSERM Limics, Paris, FRANCE
PURPOSE
European Reference Network (ERN) have been estabilished to improve and standardized the care of patients across Europe. Spina Bifida and other Dysraphysms (SBoD) are at risk for life-long comorbidities, as Lower Urinary tract dysfunction (LUTD) and chronic kidney disease (CKD) and should be managed by a multidisciplinary team as recommended by ESPU guidelines. anyway despite medical advances, the care and management of this complex congenital malformations, are still heterogeneous across Europe. This study aimed to map SB healthcare providers (HCPs) activities in Europe, for assessing the real availability of dedicated care pathways and follow-up programs.
MATERIAL AND METHODS
Different specialist (pediatric urologist, pediatric nephrologist, gynecologist, specialized nurses, etc) developed a 18 items multiple choice online questionnaire focusing on SB care and the availability of dedicated facilities and follow-up programs. The survey was distributed among HCP involved in SB management of ERNs ITHACA, eUROGEN, and ERKNET,. Responses were collated, analyzed, and summarized using descriptive statistic.
RESULTS
76 HCPs across 23 European countries completed the questionnaire. The majority of centres were academic (62/76:81%). Patient referral was mainly related with pediatricians (57/76:75%), general practitioners (45/76:59%), and gynecologists (38/76:50%). Prenatal diagnostic services are available in 70/76:92% , while fetal surgical repair in 15/76(19%). Specifically, prenatal open repair in 13/76, fetoscopic repair in 9/76 and stem cells therapy in 2/76. A standardized pathway for pregnant women is established in 42/76.55%. 57/76:75% offer a specific outpatient consultation service and 72/76:94%) have a dedicated multidisciplinary team. Pediatric urologist is part of the team in 65/76:90%, urodynamic services in available in 73/76:96%, a dedicated urotherapists team for clean intermittent catheterization training is present in 66/76 :86%. A structured transition-of-care pathway from pediatric to adult services reported in 57/76:75%,). Participation in SB studies confirmed by 42/76:55%, while collaboration with patient association was reported in 36/76:47%. Only 30/76:39% are listed as SB treating centers on ORPHANET website.
CONCLUSIONS
This European survey highlights considerable variation in the organization and provision of SB care, despite widespread access to multidisciplinary teams and key urological services. Important disparities remain particularly in the composition of multidisciplinary team, consistency of structured pathways,either in admission process, either in transition.Informations for patients are lacking as suggested by scant collaboration with patient's association. These findings underscore the need, first of all, to harmonize into ERN , and related HCP, the organization in order to optimize care models and establish standardized patient-centered pathways.
09:19 - 09:22
S28-7 (CP)
Romy GANDER, Gloria Fatou ROYO and Marino ASENSIO
University Hospital Vall d'Hebron, Pediatric Surgery. Pediatric Urology and Renal Transplant Unit, Barcelona, SPAIN
PURPOSE
To describe the surgical technique of laparoscopic (LA) and robot-assisted appendicovesicostomy (RA) and to analyze the results and benefits of this technique.
MATERIAL AND METHODS
Prospective study of children undergoing LA-RA between January2018-October 2025. Criteria for surgery were patients with indication of clean intermittent catheterization (CIC) unable to perform urethral catheterization or with intact urethral sensation. Data were collected regarding surgical technique,operative time, intraoperative and postoperative complications and outcomes. A transperitoneal approach was used and the appendix was implanted in the bladder by a modified Shanfield technique.
RESULTS
Out of 35 patients who underwent appendicovesicostomy (26 males,9 females),21 were LA and 14 RA. Mean age at intervention was 9.28 years (SD:4.30). Indication for surgery was pain during CIC in 24 (68.5%) and difficulty for CIC in 11 (31.4%). Sixteen patients (45.71%) presented with end-stage renal disease (ESRD), of those 8 underwent kidney transplantation (KT).
There were 4 (11%) intraoperative complications: technical difficulties were encountered in maintaining the appendix within the bladder during suturing in 2, and challenges in advancing the catheter in the remaining 2, necessitated completion of the procedure by extending the umbilical incision, without need for full conversion. Median operative time was 220.6 minutes (SD:85). In 12, additional procedures were performed (7 MACE). Three patients (8.5%) experienced early postoperative complications: ileus (1) and internal hernia over the mesoappendix with subsequent intestinal obstruction (2). Eight patients (22.8%) experienced late postoperative stoma related complications: stomal stenosis (3), granuloma (4) and inability to catheterize (1). Mean hospital stay was 6.5 days (SD: 2.8), prolonged mainly by 4 patients with ESRD who required dialysis and/or underwent evaluation for KT.
With a mean follow-up of 46.42 months (SD: 24.5) all except one who presented the internal hernia and lost the conduit, are on CIC. Two patients experience leakage through the channel and the urethra (both Ochoa syndrome), and are currently awaiting bladder augmentation.
CONCLUSIONS
LA by this technique is effective, safe and reproducible, and is associated with good short and mid-term results.