ESPU Meeting on Saturday 20, June 2026, 11:20 - 12:15
11:20 - 11:25
S30-1 (SP)
Mohan GUNDETI
University of Chicago Medicine, Paediatric Urology, Chicago, USA
BACKGROUNG
Robotic assisted laparoscopic approach for creation of an apppendicovesicostomy is in common practice now. We describe our modifications to the conventional open technique for adopting the Robotic Assisted Laparoscopic Mitrofanoff Appendicovesicostomy (RALMA) and study our long term outcomes.
METHODS
This was a retrospective review of prospectively collected data and EMR review from 2008 to 2024. Children, with failure to empty the bladder with normal bladder capacity who underwent RALMA incorporating our "Gundeti s Salient 10 step modifications" were included. Demographic, clinical, and post operative details were collated and analysed. All children where annually followed up, to monitor continence and redo surgery rates. Success was defined as post procedural stomal continence and failure was considered in those who underwent redo procedures.
RESULTS
27 children were included with a mean age of 9.4 years. Mean hospitalization, estimated blood loss, operative time was 5.27 days, 18.05 ml and 236 minutes. Complications were, supra fascial stenosis (11%), sub fascial stenosis (3.7%) and channel incontinence (7.4%). Three, required redo procedures (11%). The mean follow up was 69.41 months, and all 27 children are continent(100 %) at the last follow up.
CONCLUSIONS
Our proposed modifications, i.e. "Gundeti s Salient 10 step modification" allows a success of 92.6 % for continence and 89% based on redo surgery, thereby proving it to be a safe and feasible option amongst our paediatric population.
11:27 - 11:30
S30-2 (CP)
Jae Min CHUNG 1, Han A LEE 1, Jung Yoon KANG 2 and Sang Don LEE 1
1) Pusan National University Children's Hospital, Urology, Yangsan-Si, REPUBLIC OF KOREA - 2) Eulji General Hospital, Urology, Seoul, REPUBLIC OF KOREA
PURPOSE
Beta-3 adrenergic agonists have emerged as alternatives to antimuscarinic agents for treating overactive bladder (OAB) in children, particularly due to the side-effect profile of antimuscarinics. However, clinical evidence supporting the pediatric use of these agents remains limited. This study aimed to compare the efficacy and safety of vibegron and mirabegron in children with OAB using objective uroflowmetry parameters.
MATERIAL AND METHODS
A retrospective cohort analysis was performed on children diagnosed with OAB who received either mirabegron or vibegron and had complete baseline and follow-up uroflowmetry measurements. A total of 66 patients met inclusion criteria, of whom 35 received mirabegron and 31 received vibegron. Demographic variables (age and BMI) and uroflowmetry parameters—maximum flow rate (Qmax), voided volume (VV), and post-void residual (PVR)—were evaluated. Treatment efficacy was assessed based on within-group changes (baseline vs follow-up) and between-group differences in ΔQmax, ΔVV, and ΔPVR. Safety analysis focused on the presence or absence of medication-related adverse findings.
RESULTS
A total of 66 children were analyzed, with 35 treated with mirabegron and 31 with vibegron. Children receiving mirabegron were slightly older, whereas BMI and baseline uroflowmetry parameters were similar between the two groups. During follow-up, both treatments produced meaningful improvement in bladder function. Voided volume increased significantly in both groups, with mirabegron showing a mean rise of 61.6 mL and vibegron an increase of 45.1 mL, although the magnitude of improvement did not differ significantly between agents.
Qmax remained stable after treatment, with small, non-significant increases observed in both groups (mirabegron +3.1 mL/s; vibegron +0.2 mL/s), and no between-group differences were identified. PVR values were low at baseline and showed no significant changes following treatment. Importantly,no medication-related adverse findings were observed in either group, and no child developed urinary retention or deterioration in uroflow curve patterns.
CONCLUSIONS
Both mirabegron and vibegron significantly increased functional bladder capacity without compromising urinary flow or increasing PVR. No significant differences in treatment response were identified between the two beta-3 agonists, and both were well tolerated with no drug-related adverse findings. Vibegron appears to be an effective and safe alternative to mirabegron for pediatric OAB. Prospective controlled studies with standardized symptom scoring and structured safety monitoring are warranted.
11:30 - 11:33
S30-3 (CP)
Cem AKBAL 1, Yakup Emre TEKİN 2 and Demet ORHAN 1
1) Acıbadem Altunizade Hospitals, Pediatric Urology, Istanbul, TÜRKIYE - 2) Acibadem Mehmet Ali Aydinlar University, Urology, İstanbul, TÜRKIYE
PURPOSE
Lower urinary tract dysfunction characterized by increased voiding frequency (>7/day) and urgency accompanied by elevated post void residual (PVR) is common in pediatric urology. Conventional management often uses anticholinergic agents alongside behavioral measures as first line therapy; however, long term use is associated with side effects and adherence issues. This study evaluated the effectiveness of biofeedback assisted pelvic floor rehabilitation as an initial treatment and assessed whether this approach can obviate the need for anticholinergic medication.
MATERIAL AND METHODS
In this prospective study, 30 children diagnosed with overactive bladder (OAB) and elevated PVR were enrolled. Patients with neurogenic bladder, spinal dysraphism, or anatomical abnormalities were excluded. All participants received standard urotherapy plus a structured biofeedback program targeting pelvic floor muscle rehabilitation. Voiding diaries, uroflowmetry parameters, and PVR volumes were compared before and after therapy. The primary endpoint was avoidance of anticholinergic initiation due to symptom resolution after biofeedback; the secondary endpoint was the need to add anticholinergic therapy for persistent symptoms.
RESULTS
Twenty children (mean age 8.26 years; 13 boys, 17 girls) were included. Post treatment, significant improvements were observed in uroflowmetry parameters and bladder emptying efficiency. Mean maximum flow rate (Qmax) increased from 16.13±10.64 mL/s to 18.58±6.35 mL/s (p=0.16). A more pronounced improvement was noted in mean flow rate (QAve), rising from 6.44±2.63 mL/s to 10.03±3.38 mL/s (p<0.001). Mean PVR decreased from 54.10±33.37 mL to 24.33±9.84 mL (p<0.001). Clinically, 19 patients (63.3%) achieved complete symptom resolution with biofeedback alone and did not require anticholinergics, while 11 patients (36.7%) required addition of an anticholinergic agent due to insufficient symptom improvement.
CONCLUSIONS
Biofeedback assisted pelvic floor rehabilitation is an effective, non invasive first line option for children with OAB and elevated PVR, yielding significant improvements in QAve and PVR. Our findings suggest that a structured biofeedback program can eliminate the need for anticholinergic medication in over 60% of appropriately selected patients.
11:33 - 11:36
S30-4 (CP)
Mawuenyo ATTAWA OYORTE, Joao Luiz PIPPI SALLE, Mandy RICKARD, Usman KAHLOON, Michael CHUA, Samer MAHER, Hamna NAVEED, Abby VARGHESE, Barbara PANNOZZO, Mirriam MIKHAIL, Beverly MIRANDA, Armando LORENZO and Joana DOS SANTOS
The Hospital for Sick Children, Urology, Toronto, CANADA
PURPOSE
Alpha-blockers are used to improve bladder emptying in children with dysfunctional voiding, urinary retention, and neurogenic bladder dysfunction, but most supporting data come from male-predominant studies. Given assumptions that shorter female urethral length and lower α-adrenergic receptor density may reduce benefit, we compared treatment response between males and females receiving alpha-blockers for bladder emptying dysfunction.
MATERIAL AND METHODS
We retrospectively reviewed 83 children treated with tamsulosin or silodosin for neurogenic bladder (without catheterization), dysfunctional voiding, or mixed dysfunction. Baseline characteristics, indications, duration, adverse effects, and treatment discontinuation were recorded. Bladder emptying efficiency was measured as percent change in post-void residual (PVR) relative to bladder volume from baseline to last follow-up. Sex-based comparisons were performed using appropriate parametric and non-parametric tests.
RESULTS
The cohort included 40 males and 43 females. Age, diagnosis distribution, reasons for initiating therapy, treatment duration, and discontinuation patterns were similar between sexes. Both boys and girls demonstrated significant improvement in bladder emptying after alpha-blocker therapy (males p=0.03; females p<0.001). Median percent reduction in PVR did not differ between sexes (60.1% vs. 50.4%, p=0.38). Adverse effects were uncommon and comparable (10% vs. 11.6%).
|
Baseline Variable |
Male (n=40) |
Female (n=43) |
p-value |
|
Age (months), mean ± SD |
115 ± 44 |
125 ± 53 |
0.36a |
|
Duration (months), median (IQR) |
13.9 (8.1–26.3) |
7.4 (3.4–17.8) |
0.06a |
|
Diagnosis, N (%) |
|
|
0.68b |
|
Neurogenic bladder |
13 (32.5) |
16 (37.2) |
|
|
Reason to start, N (%) |
|
|
0.38b |
|
High PVR |
29 (72.5) |
27 (62.8) |
|
|
Reason to stop, N (%) |
|
|
0.18b |
|
Not discontinued |
31 (77.5) |
27 (62.8) |
|
|
% change in PVR, median (IQR) |
60.0 (-0.31–85.5) |
50.4 (2.3–94.2) |
0.38a |
|
Adverse effects, N (%) |
|
|
0.85c |
|
Yes |
4 (10) |
5 (12) |
|
ᵃ Independent t-test.
ᵇ Mann Whitney U test.
c Fisher’s Exact test.
CONCLUSIONS
Alpha-blockers improve bladder emptying in children regardless of sex, with similar efficacy and tolerability in boys and girls. Despite anatomical and receptor-density differences, clinical response appears sex-independent. These findings support the use of alpha-blockers in appropriately selected female patients and emphasize the need for prospective, sex-stratified studies.
11:51 - 11:54
S30-5 (CP)
Ruiz Albarran RUIZ ALBARRAN 1, Isabel CASAL BELOY 2, Rosa Maria ROMERO RUIZ 2, Ana ACEMEL 2 and Ana FERNANDEZ GOMEZ 2
1) Virgen del Rocío University Hospital, Pediatric Surgery, Seville, SPAIN - 2) Virgen del Rocío University Hospital, Pediatric Surgery Department, Pediatric Urology Unit,, Sevilla, SPAIN
PURPOSE
Giggle incontinence (GI) is an uncommon clinical entity within lower urinary tract dysfunctions, characterized by a complete involuntary voiding triggered by intense laughter. It is a poorly understood condition with no established standard treatment. Few studies have evaluated the effectiveness of methylphenidate (M group, M-G) or biofeedback (BFB group, BFB-G) as therapeutic options. The aim of this study was to compare the effectiveness of both approaches in patients with GI.
MATERIAL AND METHODS
Prospective study of patients with GI treated between 2023 and 2025. Two cohorts were compared based on the treatment received: M-G or BFB-G. Methylphenidate was administered in an extended-release formulation (18 mg/24 h), with dose adjustments according to clinical response, for an average of 6 months. BFB (pelvic floor strengthening) was delivered over 6-7 sessions lasting 30-40 minutes each, spaced 1-3 weeks apart, and supplemented with home exercises. Response was classified as complete (resolution or ≤1 episode/month), partial (50-99% reduction), or absent (<50%), according to the definitions proposed by the International Children's Continence Society (ICCS). Relapse was defined as >1 weekly episode after initial improvement.
RESULTS
We included 20 patients (65% girls): 11 in BFB-G and 9 in M-G. Mean age was 11.8 years. Twenty-five percent had a family history of GI. Therapeutic adherence was higher with BFB-G (90.9% vs. 66.7%, p=0.28). The overall response rate (complete + partial) was significantly higher in BFB-G (100% vs. 50%; p=0.02), as was the complete response rate (60% BFB vs. 0%). Adverse effects were more frequent in the M-G(22.2% vs. 0%, p<0.05). At mid-term follow-up, 50% of patients treated with BFB discontinued home exercises, and relapse occurred in two of them.
CONCLUSIONS
BFB is a safe and effective treatment for pediatric GI and should be considered first-line therapy. Relapses occurred exclusively in patients who discontinued home exercises, underscoring the importance of long-term adherence.
11:54 - 11:57
S30-6 (CP)
Mohammad BADER 1, Naeem IQBAL 2, Madhavan HENNESSEY 2, Louiza DALE 2, Angela DOWNER 2, Anas FAGELNOR 3, Reesha RANAT 3, Bridie BEESELL 3, Tammy BARRY 3, Laura JACKSON 3, Mohamed SHALABY 3, Mark WOODWARD 3 and Karim AWAD 4
1) Children's Hospital Oxford, Urology, Abu Dhabi, UNITED ARAB EMIRATES - 2) Children's Hospital Oxford, PAEDIATRIC UROLOGY, Oxford, UNITED KINGDOM - 3) Bristol Royal Hospital for Children, PAEDIATRIC UROLOGY, Bristol, UNITED KINGDOM - 4) Bristol Royal Hospital for Children, Urology, Bristol, UNITED KINGDOM
PURPOSE
Lower urinary tract dysfunction, particularly refractory overactive Bladder syndrome (OAB), can be a distressing and challenging condition for children, families and treating physicians. We aim to evaluate the impact of percutaneous tibial nerve stimulation (PTNS) on OAB symptoms in children who have not responded to standard medical therapy.
MATERIAL AND METHODS
All children (n=94), aged 18 and under, were identified from a prospectively collected database at two tertiay centres in UK between 2010 and 2021. Children, who failed basic urotherapy and medical management for OAB were offered 12 sessions of PTNS treatment. Experienced urology nurse specialists provided these sessions. The data was retrospectively analyzed to ascertain the effectiveness of therapy. Success was defined as symptom control to the extent that no further medical intervention was needed for the management of the OAB.
RESULTS
Mean age of our cohort was 9.7 years. Following primary course of PTNS 71 (76%) children experienced symptom improvement. The children were further analyzed for recurrence post PTNS therapy. These children had a median duration of symptoms of 36 months. 21(30%) had recurrence of symptoms after 12 sessions of PTNS. Of the children who did not improve after first course of PTNS, 75% improved after a subsequent course of PTNS. Bladder capacity pre and post PTNS was insufficient to draw a reliable conclusion. Median follow-up duration was 16 months after PTNS therapy.
CONCLUSIONS
PTNS is effective and well tolerated in children with refractory overactive bladder. However, further courses can be offered in case of recurrence of symptoms initial PTNS course which can be effective in 75% of the children.
11:57 - 12:00
S30-7 (CP)
Gokhan DEMIRTAS 1, Gunay EKBERLI 2 and Huseyın Tugrul TIRYAKI 1
1) ANKARA BILKENT CITY HOSPITAL, PEDIATRIC UROLOGY, Ankara, TÜRKIYE - 2) ANKARA BILKENT CITY HOSPITAL, DEPARTMENT OF PEDIATRIC UROLOGY, Ankara, TÜRKIYE
PURPOSE
Primary monosymptomatic nocturnal enuresis (PMNE) is a common condition in childhood, with age, sex, and body mass index (BMI) proposed as potential predictors of treatment response. However, data on the relationship between BMI and treatment outcomes remain limited. This study aimed to evaluate the impact of age, sex, and BMI on treatment success in children with PMNE.
MATERIAL AND METHODS
A total of 560 children with PMNE were retrospectively evaluated. Patients were classified according to sex, age groups (6-8, 8-10, 10-12, >12 years), and BMI (normal, overweight, obese; WHO percentiles). Clinical data included treatment duration, initial response (within 2 months), and success rates. Treatment success was defined as ≤1 wet night per week at the end of therapy. Statistical analysis included Chi-square/Fisher's exact tests and multivariate logistic regression.
RESULTS
A total of 560 children were analyzed. Treatment success was highest in the 6-8 age group (98.1%) and progressively decreased in older children (91.3% in 8-10 years; 79.4% in 10-12 years; 57.9% in ≥12 years; p<0.0001). Early response (0-2 months) similarly declined with age, from 23.2% in the 6-8 group to 2.6% in those ≥12 years. Across BMI categories, overall treatment success was 88.6% in normal-weight children, 96.1% in overweight, and 91.9% in obese patients (p=0.038), while early response decreased from 22.5% to 15.6% and 10.8%, respectively. Six-month dryness rates were 90.9%, 96.6%, and 97.3% across the same BMI groups.
CONCLUSIONS
Younger age was the strongest predictor of treatment success, with older children showing delayed early response due to the accumulation of naturally resistant, non-remitting cases in higher age groups. Although higher BMI was associated with slower early improvement and longer treatment duration, final treatment success at 6 months remained comparable across BMI categories. These findings emphasize the need for age- and BMI-aware management strategies and support early initiation of therapy to improve outcomes.
12:00 - 12:03
S30-8 (CP)
Harriet CORBETT 1 and Rachel ISBA 2
1) Alder Hey Children's NHS Foundation Trust, Regional Department of Urology, Liverpool, UNITED KINGDOM - 2) Alder Hey Children's NHS Foundation Trust, Liverpool, UNITED KINGDOM
PURPOSE
Ketamine induced uropathy (KUI), typically seen in young adults with chronic high volume recreational use, was first described in 2007. The majority of sufferers are males in their mid-20s. Recreational use has increased in the UK, with a shift in demographic to those with greater social deprivation. Unfortunately, age of use has fallen, necessitating a dedicated clinic in association with a paediatrician with addiction expertise for children & young people (CYP) < 16 years in Merseyside. Our aim is to report our experience of managing this patient cohort to date.
MATERIAL AND METHODS
Analysis of a database of demographics and investigation results for all referrals for KIU. The database has been maintained prospectively since May 2025 with retrospective data entry for prior patients.
RESULTS
A single patient was referred in 2023, nine in 2024 and 47 in 2025; 70% were female. Median age at referral was 14.5 years, range 13-15. 39 patients have attended to date, two refused. Data re volume of ketamine use is poor, the CYP have poor recall or are reluctant to say. Age at first use (known in 25/41) was predominantly 12-13 years. 35/41 (85%) have a history of adverse childhood experiences and/or ADHD/ASD. Symptoms are predominantly pain and storage related with extreme nocturia, frequency and urgency, making urinary tract ultrasound scan (USS) poorly tolerated. 47 have had at least one USS, median bladder volume 86mLs (IQR 55-212); 16 have had 2 or more USS to monitor bladder wall thickening/hydronephrosis/very low capacity. Three who had stopped use have improved capacity and symptoms, the remainder have median capacity 69 mL (IQR 47-116) on most recent USS. Three with severe symptoms/USS have had cystoscopy and urodynamics: maximum capacity ranged from 50-120mLs, associated with extreme pain. 3/10 reported benefit from anticholinergics, 4/10 reported benefit from mirabegron, 2/6 reported benefit from pentosan-polysulphate. Five have been discharged due cessation of use and symptom resolution.
CONCLUSIONS
KIU in CYP is an emerging problem and strongly associated with adverse life experiences and/or neurodiversity. USS of the bladder is difficult to tolerate which subjectively correlates with symptoms. In those most severely affected support is vital to help break the ‘bladder pain – take more ketamine’ cycle. Bladder symptoms may recover with cessation, but longer-term data is needed.