ESPU-Nurses Meeting on Friday 19, June 2026, 10:10 - 10:50
10:10 - 10:20
SN08-1 (NP)
Louiza DALE, Angela DOWNER, Sonia DUGMORE and Kristina DZHUMA
Oxford Children's Hospital, Paediatric Urology, Oxford, UNITED KINGDOM
PURPOSE
Video Urodynamics (VUD) is an invasive diagnostic procedure that measures bladder pressure in children. Optimal study quality requires the child to remain calm and still, as movement can introduce artefacts. We report our experience implementing VR technology as a distraction tool during VUD to improve patient tolerance, reduce anxiety, and enhance study quality.
MATERIAL AND METHODS
VR is an interactive, 3- dimensional, computer stimulated environment, accessed through a head mounted device, precluding the real-world view. Children aged 4-16 years were offered the option to use a VR headset during VUD when deemed appropriate by a Play Specialist. The child and specialist selected the VR program, which included games, mindfulness and incentive breathing activities. The headset was secured prior to the procedure and could be discontinued at any time. Clinical assessment included observation of anxiety levels, cooperation, communication ability, and artefact frequency during the study. Patients' feedback was collected at the end of the procedure.
RESULTS
Over a 3-month period, VR was used in five patients. Clinical assessment demonstrated reduced anxiety and improved compliance with procedural instructions in all cases. Children remained communicative and responsive while immersed in VR. Parents and clinicians reported that VR facilitated tolerance of the procedure. All children responded positively, and all participants expressed willingness to use VR again. Clinicians observed fewer artefacts in pressure recordings and shorter procedure times. No adverse events were reported.
Play Specialists reported that children engaged more readily with the VR environment, demonstrating decreased pre-procedural distress compared to standard distraction techniques. Feedback from the patients was very positive and included one 9-year-old patient willing to come back the following day for the procedure to be performed again.
CONCLUSIONS
VR technology appears to be a valuable adjunct for promoting relaxation and distraction during paediatric VUD. Clinical assessment confirms its role in reducing anxiety, improving procedural compliance, and enhancing study quality. Continued application and evaluation in a larger cohort are warranted.
10:20 - 10:30
SN08-2 (NP)
Çiğdem ARSLAN ALICI 1 and Aykut AYKAÇ 2
1) Eskisehir City Hospital, Pediatric Urology, Eskisehir, TÜRKIYE - 2) Eskişehir City Hospital, Urology, Eskişehir, TÜRKIYE
PURPOSE
The purpose of this study was to evaluate whether artificial intelligence (AI) and natural language processing (NLP) techniques can accurately identify concordance and divergence across pediatric urology guidelines published by the European Association of Urology (EAU), American Urological Association (AUA), and National Institute for Health and Care Excellence (NICE). The study aimed to determine the degree of alignment among recommendations and to characterize terminology variability that may hinder guideline standardization.
MATERIAL AND METHODS
Guidelines from EAU, AUA, and NICE published between 2023 and 2025 were analyzed across four clinical domains: vesicoureteral reflux (VUR), enuresis, hydronephrosis, and imaging. NLP tools (BERT, GPT, and SciSpacy) were employed to extract, categorize, and compare recommendations. Semantic similarity metrics, including Jaccard similarity and cosine similarity, were used to quantify concordance. Expert validation was performed on a randomly selected subset of statements to assess the accuracy of AI-derived classifications. Primary outcomes included guideline concordance, terminology variability, and validation accuracy.
RESULTS
High concordance was observed between EAU and AUA guidelines (Jaccard similarity 0.82; cosine similarity 0.91), while NICE recommendations demonstrated moderate divergence. Agreement was strongest in the VUR domain, with 9 of 12 statements showing alignment. Hydronephrosis guidelines exhibited the greatest heterogeneity. Significant terminology variability—particularly within enuresis recommendations—was noted between AUA and NICE. Expert review confirmed the accuracy of AI-generated classifications in 90% of the evaluated statements. Limitations included the use of only three guideline sources and potential algorithmic bias related to training data.
CONCLUSIONS
AI-assisted and NLP-based analysis provides an effective method to identify consensus and variation across major pediatric urology guidelines. This approach has the potential to enhance guideline harmonization and contribute to the development of evidence-based clinical decision-support systems. Further validation across broader guideline sets and clinical contexts is warranted to strengthen generalizability and real-world applicability.
10:30 - 10:40
SN08-3 (NP)
Usman KAHLOON 1, Michael CHUA 1, David LEVIN 2, Samer MAHER 1, Julia LEVIN 3, Lizz BORUTSKI 3, Barbara PANNOZZO 1, Armando LORENZO 1, Mandy RICKARD 1, Abby VARGHESE 1 and Joana DOS SANTOS 1
1) The Hospital For Sick Children, Division of Urology, Toronto, CANADA - 2) The Hospital For Sick Children, Division of Anesthesia, Toronto, CANADA - 3) The Circumcision Clinic, Toronto, CANADA
PURPOSE
Bleeding is the most common early complication of neonatal circumcision despite standardized technique. 2-Octyl cyanoacrylate (2OCA), a topical skin adhesive, may enhance hemostasis, improve wound approximation, and serve as an antimicrobial barrier. The objective of this institutionally approved (REB #1000070281) multi-site double-blinded randomized controlled trial is to evaluate the efficacy and safety of 2OCA compared with standard of care (SOC; petroleum jelly) in reducing post-circumcision complications.
MATERIAL AND METHODS
Healthy neonates (2–60 days) were randomized 1:1 by sealed envelopes to 2OCA or SOC following circumcision using Gomco or Mogen clamps under local anesthesia (0.5% bupivacaine ± 1% lidocaine). The operating physician was blinded to allocation until clamp removal. The primary endpoint was intraoperative bleeding requiring compression dressing, silver nitrate, or suturing. Continuous variables were compared using two-sample t-tests, multi-category variables using Wilcoxon rank-sum tests, and binary categorical variables using Fisher’s exact tests (p<0.05). Bleeding risk was estimated with univariate logistic regression. All analyses followed an intention-to-treat approach.
RESULTS
One hundred neonates were included (2OCA n=42; SOC n=58). Baseline characteristics were comparable between groups (Table 1). Bleeding occurred in 4.8% of 2OCA versus 31.0% of SOC cases (p<0.001). On univariate logistic regression, 2OCA use was associated with an 89% reduction in the odds of bleeding (B=–2.20; SE=0.78; Wald=7.97; p=0.005; OR, 0.11; 95% CI, 0.02–0.51). Subgroup analysis showed significance for Gomco circumcisions (3.7% vs 42.1%; p<0.001) but not for Mogen (6.7% vs 11.1%; p=0.66).
Table 1. Baseline Characteristics of Participants by Study Group
| a Two-sample t-test. b Wilcoxon rank-sum test. c Fisher’s Exact test. |
|||
|
Baseline Variable |
Intervention (n=42) |
Control (n=58) |
p-value |
|
Age (days), mean ± SD |
38 ± 18 |
35 ± 16 |
0.34a |
|
Weight (kg), mean ± SD |
4.4 ± 0.8 |
4.4 ± 0.8 |
0.89a |
|
Ethnicity, (%) |
0.39b |
||
|
Caucasian/White |
42 |
36 |
|
|
Black |
8 |
3.5 |
|
|
East Asian |
15 |
11 |
|
|
Middle Eastern |
8 |
3.5 |
|
|
Other |
27 |
46 |
|
|
Indication, (%) |
0.46c |
||
|
Elective |
90 |
95 |
|
|
Medically Indicated |
10 |
5 |
|
|
Clamp, (%) |
0.83c |
||
|
Gomco |
65 |
68 |
|
|
Mogen |
35 |
32 |
|
|
Surgeon Experience, (%) |
0.22b |
||
|
Staff (medical) |
21 |
18 |
|
|
Staff (surgical) |
21 |
14 |
|
|
Fellow (2nd year) |
50 |
54 |
|
|
Fellow (1st year) |
7 |
14 |
|
|
Local Anesthetic Used, mean ± SD (mL) |
|||
|
0.5% Bupivacaine |
1.8 ± 0.6 |
2.4 ± 3.5 |
0.24a |
|
1% Lidocaine |
2.0 ± 0.6 |
2.0 ± 0.7 |
0.89a |
CONCLUSIONS
2OCA significantly reduced bleeding compared with standard closure. Moreover, these findings suggest that if using a Gomco clamp, 2OCA should be considered to minimize bleeding risk. These interim findings support 2OCA as a safe and effective hemostatic alternative, with final results forthcoming upon study completion.
10:40 - 10:50
SN08-4 (NP)
Lydia HERMANN 1, Morgan BLACK 2, Rosalia MISSERI 3, Martin KAEFER 3, Konrad SZYMANKSI 3, Richard RINK 3, Joshua ROTH 3, Kirstan MELDRUM 3, Benjamin WHITTAM 3, Nik BATRA 3, Mark CAIN 3 and Pankaj P. DANGLE 3
1) Indiana University School of Medicine, Medical Student, Indianapolis, USA - 2) Indiana University School of Medicine, Urology Resident, PGY2, Indianapolis, USA - 3) Indiana University School of Medicine, Pediatric Urology, Indianapolis, USA
PURPOSE
While ureteroceles are well-described in infancy, long-term bladder function outcomes remain limited. In a previous study, our institution observed an increased incidence of lower urinary tract dysfunction (LUTD) among school-aged children (41%). We aimed to describe persistent or new-onset lower urinary tract symptoms (LUTS) during adolescence.
MATERIAL AND METHODS
We retrospectively reviewed for children with ureterocele treated at our institution between 1993 and 2007. Inclusion criteria were presentation before five years old, duplex collecting system with ureterocele, and surgical correction. Charts were assessed for LUTS occurring after age five, defined by the 2015 International Children’s Continence Society, and evaluated during puberty according to National Institute of Child Health and Human Development criteria. Fisher’s exact test was used for univariate analysis.
RESULTS
Forty eligible patients (29, 73% female) were followed to a median 13.3 years old (IQR 5.8-16.8). Thirty-nine (98%) ureteroceles were unilateral—17 (43%) ectopic, 12 (30%) intravesical, and 11 (27%) cecoureterocele. Twenty-two (55%) were diagnosed prenatally with ultrasound. Eighteen (45%) presented postnatally with 17 (94%) diagnosed after urinary tract infections (median 8.6 months old; IQR 2.7-30.3). Median age at first surgery was 10.9 weeks (IQR 4.8-40.2), independent of surgical type. Thirty (75%) had initial puncture/incision (median 8.32 weeks; IQR 4.0-25.6). Of these, twenty-four (80%) had subsequent ureterocele excision and reimplantation (median 2.3 years old; IQR 1.8-4.2). Twenty-one (53%) patients developed new-onset LUTS after surgery. Symptoms appeared a median 6.8 years (IQR 5.6–9.0) after initial surgery, independent of surgical type. Twenty (95%) required intervention—18 (90%) behavioral modification, 7 (35%) medication, and 6 (30%) pelvic floor therapy. Two (10%) required bulking injections for refractory stress incontinence. Eleven (52%) of the 21 patients developed new-onset LUTS during childhood (median 6.63 years old; IQR 5.69-7.09), with 4 (36%) persisting into puberty. Notably, 8 (38%) female patients developed new LUTS around puberty (median 9.9 years old; IQR 9.1-10.4). Their most common symptom was daytime incontinence (5, 63%), followed by urgency (4, 50%) and decreased frequency (4, 50%). Cecoureterocele was a significant risk factor for new-onset LUTS during puberty (p=.025).
CONCLUSIONS
LUTS is common following childhood surgery for ureterocele with renal duplication. New-onset LUTS may occur around puberty—with incontinence being the most common. Those with cecoureterocele appear to be at highest risk.