Parallel Meeting on Friday 19, June 2026, 10:30 - 11:15
10:30 - 10:35
MWC-1 (SP)
Ahsen KARAGÖZLÜ AKGÜL
Marmara University, Faculty of Medicine, Department of Paedi, Paediatric Urology, Istanbul, TÜRKIYE
SUMMARY
Management of 7 years old boy with PUV, VUR and atrophic right kidney. VUR was managed endoscopically on right side and surgically on left side. Obstruction was observed on both side during follow up. Despite repeated interventions including internal stenting and re-UNC, obstruction could not solved easily. Progression to end-stage renal disease could not be prevented. (I described the details in the word document attached this mail).
LESSONS LEARNED
Bladder rehabilitation is crucial. If it is inadequate or poorly adhered to by patient or parents, the success of surgical interventions may be significantly compromised.
Endoscopic treatment of VUR in patients with PUV may carry a higher risk of obstruction.
Even a subtle mucosal bulge at the ureteral orifice can result in significant obstruction.
Patient compliance is a cornerstone of management; poor adherence can undermine even well-planned treatment strategies.
The underlying mechanism of the polypoid lesions observed within the distal ureter in the submucosal tunnel remains unclear.
10:35 - 10:40
MWC-2 (SP)
Alfredo BERRETTINI
Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Paediatric Urology Unit, Milan, ITALY
ABSTRACT
A boy with born with bladder exstrophy was managed at our center. At birth, he underwent primary bladder closure with pubic bones approximation and application of a spica bandage. He subsequently underwent penile reconstruction using a modified Cantwell technique, along with a series of endoscopic evaluations and intraoperative cystography to assess bladder capacity and urinary continence. At the age of 10, persistent urinary incontinence necessitated further surgical intervention. He underwent robot-assisted Keel plication of the bladder neck with a Mitrofanoff procedure. Due to extensive adhesions from previous surgeries, the procedure was technically challenging and lasted approximately 9 hours. The patient was positioned in gynecological position to facilitate endoscopic access to the bladder. Postoperatively, the prolonged operative time and positioning led to metabolic acidosis and elevated lactate levels, requiring admission to the intensive care unit for monitoring. The development of lower limb swelling and elevated muscle injury markers raised suspicion for compartment syndrome. Further investigations revealed venous thrombosis along with bilateral sciatic and popliteal nerve neuropathy. Anticoagulant and neurotrophic treatment was initiated, and the patient underwent urgent lower limbs fasciotomies on postoperative day (POD) 2, with delayed closure performed three weeks later. The urological outcome was otherwise uneventful and satisfactory. However, recovery was significantly impacted by lower limb neuropathy, necessitating serial nerve conduction studies and intensive rehabilitation with close physiatric support. The venous thrombosis resolved after one month, as confirmed by ultrasonography. The hospital stay was one month. He was discharged after endoscopic assessment of the viability of the Mitrofanoff channel and was maintained on pregabalin for neuropathic pain. Functional recovery of the lower limbs was gradual and required intensive physiotherapy. After an initial period of severe impairment in ambulation, he gradually regained strength and sensation of his lower limbs. He resumed walking with an unstable gait and marked limp but achieved complete functional recovery by four months postoperatively.
SUMMARY
From the reassessment of this case, we highlight the pivotal importance of proper positioning and cushioning during prolonged procedures in position.
Besides, despite adherence to standard protective measures, the complications observed suggest that intermittent repositioning or temporary undocking of the robotic system to relieve pressure on the lower limbs may be beneficial during extremely lengthy procedures.
10:40 - 10:45
MWC-3 (SP)
Martin KAEFER
Riley Hospital for Children, Urology, Indianapolis, USA
SUMMARY
Prior to performing a dismembered pyeloplasty, many urologists will perform a retrograde pyelogram to fully define ureteral and pelvic anatomy. In the case to be presented a three-month-old boy was taken to the operating room and a retrograde pyelogram was performed. A narrow segment was noted at the ureteropelvic junction. As is the surgeon's practice, the ureteral catheter was left in the ureter to allow passive dilation of the ureter during the pyeloplasty.
The patient was then placed in the lateral decubitus position, and a flank incision was made. Upon opening into the renal pelvis, a large segment of tissue was identified that had not been appreciated on retrograde pyelogram. It became evident that the ureter had been avulsed from the bladder and intussuscepted completely into the renal pelvis.
Decision was made to tie the end of the ureter to the stent, make a second incision into the bladder, pull the end of the ureter back into the bladder and secure it circumferentially to the bladder mucosa with interrupted 5-0 sutures . A JJ stent was then placed to bridge between the renal pelvis and bladder. The pyeloplasty was then completed. The stent was removed 12 weeks later. Hydronephrosis is decreased and there is no hydroureter. Differential renal function is unchanged, and the patient remains asymptomatic three years following surgery.
10:45 - 10:50
MWC-4 (SP)
Bashir AHMED
Sindh Institute of Urology & transplantation, Philip G. Ransley Department of Paediatric Urology, Karachi, PAKISTAN
SUMMARY
A 9-year-old boy presented in January 2026 with intermittent right flank pain, fever, nausea and anorexia. On examination, he was febrile and a enlarge, tender, palpable right kidney. Ultrasound KUB demonstrated a grossly enlarged pyonephrotic right kidney with thick echoes, a 16*13 mm pelvic stone, and an 80 ml perinephric collection. Laboratory evaluation revealed severe anemia, leukocytosis, electrolyte imbalance, and urine culture grew Klebsiella species, targeted antibiotic was given.
Following initial stabilization, an ultrasound-guided right percutaneous nephrostomy was performed. However, the kidney contained organized pus that could not be adequately drained. A DMSA scan demonstrated a normal left kidney and non-functioning, infected pyonephrotic right kidney and ongoing infection, right open nephrectomy was performed. Intraoperatively, we found an enlarged pyonephrotic kidney with perinephric collection, densely adherent to surrounding structures, including duodenum; therefore, a subcapsular nephrectomy was performed medially to avoid duodenal injury. On survey of wound, no leak of bilious contents was observed.
On postoperative day 2, bilious drainage (230 ml/day) raised suspicion of concealed duodenal injury. Two options of management were under consideration: surgical or conservative. A multidisciplinary team opted for conservative management, including total parenteral nutrition, octreotide, and supportive care. Gradual reduction in fistula output was observed. At 14 postoperative day, nasojejunal tube was introduced to transition to enteral feeding. By postoperative day 24, the fistula resolved completely, the drain and nasojejunal tube were removed. Histopathology confirmed xanthogranulomatous pyelonephritis and pyonephrosis.
This case highlights that conservative management can be effective in selected cases of postoperative duodenal injury, emphasizing the importance of nutritional support, fluid-electrolyte balance, and close monitoring.
10:50 - 10:55
MWC-5 (SP)
Sibel TIRYAKI
Ege University Department of Pediatric Surgery, Division of Pediatric Urology, Izmir, TÜRKIYE
SUMMARY
A 3-month-old male infant with antenatal bilateral hydroureteronephrosis and high-grade VUR presented with pyelonephritis following a cystoscopy at an external center. I started to follow him after this incident. The mother reported intermittent inability to void, and my ultrasound during the outpatient visit showed more urine to the upper system while voiding, which I misattributed (and assured the mom) to be massive reflux filling the ureters. Then, during the COVID carantina, mom called stating that he had not passed urine for the last 24-hours. Despite my initial skepticism, catheterization drained 600 cc of urine. Re-evaluation of imaging and a subsequent cystoscopy revealed giant bilateral diverticula located near the bladder neck, with the ureteral orifices opening directly into them. Due to the pandemic constraints and the patient's age, I trained the mom to drain with CIC if he fails to pass enough urine, maintaining the child infection-free until the age of one. Then, I performed bilateral lower urinary tract reconstruction (ureteral reimplantation and diverticulectomy). On postoperative day 3, removing the stents triggered immediate anuria and massive bilateral hydroureteronephrosis. While the right side stabilized with anti-inflammatory treatment, the left required a JJ stent.
Three months later, hydronephrosis recurred and I saw that the lower end of the JJ stent migrated into the ureter. I decided to perform an open exploration and during the operation, I encountered a major diagnostic dilemma: with the bladder open, active urine jets were clearly visible from both ureters, ureterorenoscope easily passed to the ureter, and retrograde pyelography showed no ureteral kinking. Relying on these ""reassuring"" signs, I closed the bladder without further intervention.
However, the hydronephrosis on left persisted, leading to severe cortical thinning. I eventually referred the patient to another center, where re-exploration revealed that the submucosal tunnel was too long. It was commented that this ureter's possibly poor peristalsis (due to opening in a giant diverticula) could not overcome the resistance of a standard tunnel. The complication was resolved by shortening the tunnel, finally allowing the kidney to drain and hydronephrosis to resolve.
Why this complication is worth sharing:
• At the initial presentation, I misidentified the diverticula as severely tortuous ureters.
• A 'logical' explanation (massive VUR) led me to ignore the mother's accurate observation of urinary retention
• I managed a complex reconstruction candidate with CIC during the global pandemic
And I think most importantly,
• Intraoperative visualization of a urine jet does not exclude obstruction. In possibly dysplastic ureters (opening in a giant diverticula), a standard anti-reflux tunnel can act as a high-pressure barrier.
10:55 - 11:00
MWC-6 (SP)
M S ANSARI
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Pediatric Urology, Department of Urology and renal transplan, Lucknow, INDIA
SUMMARY
A 10-month-old infant undergoing robotic-assisted right nephrectomy and left pyeloplasty suffered an intraoperative, inadvertent ligation of the contralateral (left) renal vein due to anatomical distortion. Immediate recognition of the error allowed for swift, open reconstruction, including re-anastomosis of the vein and proactive peritoneal dialysis for acute tubular necrosis. The infant recovered fully with normal renal function by day seven, highlighting the necessity of vigilant vascular identification and rapid, effective management of surgical complications.