Parallel Meeting on Wednesday 17, June 2026, 15:55 - 16:55
15:55 - 15:58
S06-1 (CP)
Agnieszka WIERNIK, Paulina BRAUNER, Tomasz KOSZUTSKI, Lidia HYLA-KLEKOT and Grzegorz KUDELA
Medical University of Silesia, Department of Pediatric Surgery and Urology, Katowice, POLAND
PURPOSE
Urolithiasis in children is a multifactorial disease influenced by genetic, metabolic, and environmental factors. The Klotho protein, a regulator of calcium-phosphate metabolism and oxidative stress, has emerged as a potential player in the pathogenesis of this condition. This study aimed to evaluate serum Klotho levels in children with urolithiasis and investigate their association with clinical features and laboratory findings.
MATERIAL AND METHODS
This case-control study included 40 children with urolithiasis and 40 controls. Serum Klotho levels were measured along with calcium-phosphate metabolism parameters, including calcium, phosphorus, magnesium, 1,25-(OH)₂D₃, parathyroid hormone (PTH), and others. A 24-hour urine collection assessed the excretion of electrolytes and metabolites. Modifiable (e.g., physical activity, fluid intake) and non-modifiable (e.g., family history) risk factors were analyzed. Statistical analysis was performed to evaluate differences between groups and correlations between variables, with a p-value <0.05 considered statistically significant.
RESULTS
Children with urolithiasis had significantly lower serum Klotho levels than healthy controls. Lower levels were associated with a positive family history, recurrent urolithiasis, and the need for repeated surgical interventions for renal colic. A positive correlation was observed between Klotho levels and serum phosphorus. Lower Klotho levels were noted in obese children, while higher physical activity was linked to increased Klotho levels.
CONCLUSIONS
Low Klotho levels may serve as a biomarker for pediatric urolithiasis, reflecting disease severity and recurrence risk. Identifying high-risk children using Klotho measurements could improve early intervention and long-term management strategies, protecting kidney health in pediatric patients.
15:58 - 16:01
S06-2 (CP)
Judy Ws HUNG
Hong Kong Children's Hospital, Surgery, Hong Kong, HONG KONG
PURPOSE
The incidence of paediatric urolithiasis is rising, but data on children with concurrent malignancies is limited. This study compares the clinical characteristics of urolithiasis in paediatric patients with and without cancer.
MATERIAL AND METHODS
A retrospective review (Jan 2018-Aug 2025) was conducted on patients under 18 diagnosed with urolithiasis at our tertiary oncology centre. Inclusion criteria were children less than 18 years old, diagnosed with kidney, ureteral, bladder or urethral stone identified from a prospective regional database. Patients without information available were excluded. Data extracted included demographics, malignancy type, stone details (location, size, composition), presentation, and interventions. Continuous and categorical data were analysed with independent t test and chi-square test using SPSS version 29.0.2.0.
RESULTS
Of 63 patients (36 male, 85 renal units, 97 stones), 24 stones were associated in patients with malignancy (Group A) and 73 without (Group B). Mean age at diagnosis was 10.7 years (SD 5.1). Malignant diagnosis were acute lymphoblastic leukaemia(76.9%), medulloblastoma (15.4%), and Ewing's sarcoma (7.7%). Group A patients were significantly younger (9.7 SD 4.7 vs 11 SD 5.3, p<0.05), and more likely male (82.6% vs. 52.7%, p<0.05). Their presentation differed markedly: they less frequently presented with loin pain (4.3% vs. 43.3%, p<0.05) and more often with haematuria (69.6% vs. 25.7%, p<0.05). A causative drug, most commonly steroids, was more frequently identified in Group A (34.8% vs. 12.2%, p<0.05), as was immobilisation (52.2% vs. 14.9%, p<0.05). While surgical intervention rates were similar (60.9% vs. 48.6%, p=0.35), Group A more often required only double J stent placement without further surgery (39.1% vs. 6.8%, p<0.05). All analysed stones in Group A were carbonate apatite. No statistical significant difference was seen regarding laterality, mean stone size, stone location, lucency on plain films and Hounsfield unit between the two groups.
CONCLUSIONS
Paediatric urolithiasis patients with malignancy present with distinct demographics and symptoms. They are younger, more likely male, present with haematuria rather than pain, and have stronger associations with drug causes and immobilisation. Stone composition also appears unique, consistently featuring carbonate apatite.
16:01 - 16:04
S06-3 (CP)
Sadaf ABA UMER, Bashir AHMED, Sajid SULTAN and Adeeb Ul Hassan RIZVI
SINDH INSTITUTE OF UROLOGY AND TRANSPLANTATION (SIUT), PHILIP G.RANSLEY DEPARTMENT OF PAEDIATRIC UROLOGY, Karachi, PAKISTAN
PURPOSE
Calculus anuria is a life-threatening emergency in which timely prediction of renal recovery is crucial for clinical decision-making. This study aimed to evaluate the impact of age groups and associated clinical, biochemical, and perioperative variables on short-term outcomes in children presenting with calculus anuria.
MATERIAL AND METHODS
A retrospective review was conducted of children ≤5 years who presented with calculus anuria between 2016 and 2021 and underwent emergency renal decompression by double-J (DJ) stenting or percutaneous nephrostomy (PCN). Demographic data, anuria duration, clinical and laboratory parameters, operative details, postoperative complications, and outcomes were analyzed. Patients were categorized into three age groups: Group I (≤1 year), Group II (1.1–2 years), and Group III (2.1–5 years). Logistic regression was used to identify predictors of renal recovery. Chi square test used for categorical variables. ANOVA or Kruskal–Wallis tests were used for numerical variables. Statistical significance was set at p<0.05.
RESULTS
A total of 128 children were included (Group I: 48; Group II: 39; Group III: 41). Median anuria duration at presentation was 3 days across groups (p=0.70). Mean serum creatinine was 4.8 ± 3.0, 6.2 ± 2.8, and 5.8 ± 2.5 mg/dL in Groups I, II, and III, respectively (p=0.05). Severe malnutrition was noted in 15% (p=0.36). Twenty-three children had small kidneys for age (p=0.12), and 21 had a solitary functioning kidney. Nineteen patients required hemodialysis pre-decompression (p=0.10). DJ stenting was performed in 85% (Group I=38, II=35, III=36), PCN in 8% (Group I =6, II = 01, III=03), and combined DJ/PCN in 7% (Group I=04, II=03, III= 02) p= 0.8.
Overall, 92% achieved complete renal recovery, with mean discharge creatinine 0.72 ± 0.7 mg/dL (median 0.42 mg/dL)P=0.16. Ten children had eGFR <60 mL/min/1.73 m² at 3 months. Recovery rates varied across age groups (Group I: 98%, Group II: 92%, Group III: 85%; p=0.08). Postoperative complications were infrequent (p=0.71). None of the evaluated risk factors—including age, anuria duration, malnutrition, illness severity, pre-operative hemodialysis, or postoperative urosepsis—significantly predicted incomplete recovery.
CONCLUSIONS
Calculus anuria in young children is a critical emergency frequently associated with severe metabolic derangements. Prompt decompression—particularly via retrograde DJ stenting—results in excellent short-term renal recovery. In this pediatric cohort, no clinical, biochemical, or perioperative parameters significantly predicted poor recovery.
16:19 - 16:22
S06-4 (CP)
Rostyslav NAKONECHNYY 1, Andrii NAKONECHNYI 2, Dmytro SHEVCHUK 3 and Taras VIVCHARIVSKYI 3
1) SNPE «Danylo Halytskyi Lviv National Medical University», Surgery and Transplantology, Lviv, UKRAINE - 2) SNPE «Danylo Halytskyi Lviv National Medical University», Pediatric surgery, Lviv, UKRAINE - 3) First Lviv Territorial Medical Union, «Saint Nicholas Hospital», Pediatric Urology, Lviv, UKRAINE
PURPOSE
Accurate preoperative assessment is critical for optimizing the surgical management of pediatric urolithiasis. Conventional linear measurements of stone size often fail to reflect fragmentation complexity. Advanced imaging techniques enable quantitative volumetric and densitometric analyses, potentially improving prognostic accuracy. Our objective was to assess the predictive value of preoperative 3D stone volume, mean and maximum stone density, and patient age for achieving stone-free status after a single session of extracorporeal shockwave lithotripsy (ESWL) in children.
MATERIAL AND METHODS
A retrospective cohort analysis included 72 pediatric patients (age 1–17 years) with solitary urinary tract stones treated at the at a single center between January 2023 and June 2025. Stone volume and density (Hounsfield units, HU) were quantified using CT imaging and 3D Slicer software. Participants were classified into two outcome groups based on post-ESWL ultrasound at 1–3 months: Stone-Free (n=55, complete stone clearance) and Residual Fragment (n=17). Preoperative parameters were analyzed by receiver operating characteristic (ROC) curves to determine area under the curve (AUC), optimal cut-off values, sensitivity, specificity, and Youden’s index.
RESULTS
Stone volume was the strongest independent predictor of stone-free status following ESWL. The optimal volumetric threshold was 185 mm³ (AUC=0.829, 95% CI: 0.72–0.91, p<0.001), with a specificity of 92.7% and sensitivity of 64.7%. A stone volume above 185 mm³ was associated with greater risk of residual fragments (positive likelihood ratio=8.9). Maximum stone density provided additional predictive value (AUC=0.704, p=0.011); a cut-off >934 HU predicted residual fragments with 76.5% sensitivity and 63.6% specificity. Mean density (AUC=0.655, p=0.071) and patient age (AUC=0.554, p=0.5) were not statistically significant predictors.
CONCLUSIONS
Preoperative 3D stone volume is a robust predictor of ESWL outcomes in children, with volumes exceeding 185 mm³ indicating elevated risk for residual fragments. Maximum stone density above 934 HU further stratifies risk, suggesting consideration for alternative or adjunctive treatment strategies. Patient age does not independently influence ESWL outcomes, supporting the modality’s efficacy across the pediatric age spectrum.
16:22 - 16:25
S06-5 (CP)
Mathilde CAMOUS 1, Thomas LOUBERSAC 2, Annabel PAYE 3, Matthieu PEYCELON 3, Xavier DELFORGE 4, Valeska BIDAULT 5, Delphine DEMEDE 5, Arthur LAURIOT DIT PREVOST 6, Camille RENAULT 6, Alexis ARNAUD 7, Pauline CLERMIDI 8, Sebastien FARAJ 8, Nathalie BOTTO 9, Thomas BLANC 9, Quentin BALLOUHEY 10, Sarah GARNIER 11, Olivier ABBO 12, Daniela GORDUZA 13, Luke HARPER 14, Julien ROD 15, Jean-Baptiste MARRET 15, Amane LACHKAR 1 and Alice FAURE 1
1) Hôpital La Timone Enfants , Assistance Publique des Hôpitaux de Marseille (APHM), Pediatric surgery, Marseille, FRANCE - 2) Centre Hospitalier Universitaire de Nantes, Pediatric surgery, Nantes, FRANCE - 3) Hôpital Universitaire Robert-Debré, AP-HP, Université Paris Cité, National Expert Center for Rare Urinary Tract Malformations (MARVU), ERN eUROGEN, Pediatric Urology, Paris, FRANCE - 4) Centre Hospitalier Universitaire d'Amiens, Pediatric Surgery, Amiens, FRANCE - 5) Hospices Civiles de Lyon, Hopital Femme Mere Enfants, Pediatric surgery, Bron, FRANCE - 6) Centre Hospitalier Universitaire Lille, Pediatric surgery, Lille, FRANCE - 7) Centre Hospitalier Universitaire Rennes, Pediatric surgery, Rennes, FRANCE - 8) Hôpital Armand-Trousseau, AP-HP, Pediatric surgery, Paris, FRANCE - 9) Hôpital Necker - Enfants Malades, AP-HP, Pediatric Surgery, Paris, FRANCE - 10) Centre Hospitalier Universitaire de Limoges, Pediatric Surgery, Limoges, FRANCE - 11) Centre Hospitalier Universitaire de Montpellier, Pediatric surgery, Montpellier, FRANCE - 12) Centre Hospitalier Universitaire de Toulouse, Pediatric Surgery, Toulouse, FRANCE - 13) Centre Hospitalier Universitaire Saint-Étienne, Pediatric surgery, Saint-Priest-En-Jarez, FRANCE - 14) Centre Hospitalier Universitaire de Bordeaux, Pediatric surgery, Bordeaux, FRANCE - 15) Centre Hospitalier Universitaire de Caen, Pediatric surgery, Caen, FRANCE
PURPOSE
Caliceal diverticulum (CD) is a rare pediatric condition that can be difficult to diagnose and manage. This study aimed to describe contemporary imaging practices and treatment strategies for pediatric CD across multiple tertiary pediatric urology centers.
MATERIAL AND METHODS
A retrospective multicentric observational study included children diagnosed and treated for CD between 2015 and 2025. Data collected encompassed clinical presentation, imaging, operative techniques, and outcomes. Descriptive statistics used medians and ranges were performed.
RESULTS
Thirty patients (16 girls, 14 boys) were identified in 15 pediatric surgery centers. Median age at diagnosis was 11 years (0-17). Flank pain (n=9) and recurrent urinary tract infections (n=9) were most common; 23% were incidental findings. Ultrasound was performed in 97%, CT in 50%, and MRI in 47%; with MRI first-line in 23%. One patient had intravenous urography. Diverticula were described as a thin-walled structure in 76.7%, with mobile echogenic debris in 36.7%. Median size of the CD was 34.4 mm (15-130); 36.7% contained calculi. Left kidney was affected in 53%, mostly upper calyx (40%).
Retrograde intrarenal surgery (RIRS) was preferred in 73.3%; 22.7% had laparoscopic or robotic decortication, and one had percutaneous nephrolithotomy (PCNL). Median age at surgery was 13 years (2-20). During RIRS, the diverticular neck was identified in 86.4% using contrast instillation, enabling Ho:YAG laser infundibulotomy. Intradiverticular stones were all treated at the same time by laser (88.9%) or extracorporeal shock wave lithotripsy (ESWL).
Median operative time was shorter with RIRS (125 min) than laparoscopic/robotic surgery (240 min). Morbidity was low (one conversion; 10% postoperative complications, mostly Clavien-Madadi IB except one IIIA). Median hospital stay was 2 days (1-5) after RIRS and 3 days (2-17) after surgery. Follow-up imaging showed residual diverticula in 60%, with a median size reduction of 50%. Two stone recurrences occurred after median follow-up of 22 months (1-84).
CONCLUSIONS
Though uncommon, pediatric CD is reliably diagnosed with ultrasound, contrast-enhanced imaging; especially MRI which improves confidence without radiation. RIRS is the preferred minimally invasive treatment, offering symptom relief, effective stone clearance, low morbidity, and shorter operative time. Laparoscopic/robotic decortication remains useful for complex cases. This multicenter snapshot reflects current real-world management and may guide future algorithms.
16:25 - 16:28
S06-6 (CP)
Yesica QUIROZ MADARRIAGA 1, Numan BAYDILLI 2, Halil TOSUN 2, Deniz DEMIRCI 2, Deepak RAGOORI 3, Steffi YUEN 4, Chandra Mohan VADDI 5, Soundarya GANESAN 5, Olivier TRAXER 6, Daniele CASTELLANI 7, Bhaskar Kumar SOMANI 8, Demetra FULIGNI 8, Vineet GAUHAR 9 and Anna BUJONS 1
1) Fundacio Puigvert, Paediatric Urology, Barcelona, SPAIN - 2) Erciyes University Medical Faculty, Kayseri, TÜRKIYE - 3) Asian Institute of Nephrology and Urology, Telengana, INDIA - 4) North District Hospital, Hong Kong, HONG KONG - 5) Preeti Urology and Kidney Hospital, Telangana, INDIA - 6) Hôpital Tenon 4 Rue de la Chine,, Paris, FRANCE - 7) Azienda ospedaliero-universitaria Ospedali riuniti di Ancona, Ancona, ITALY - 8) University Hospital Southampton NHS Foundation Trust, Southampton, UNITED KINGDOM - 9) Ng Teng Fong General Hospital , Singapore, Singapore, SINGAPORE
PURPOSE
The management of lower pole (LP) stones in paediatric patients remains challenging due to anatomical limitations that may affectstone clearance. This multicentre study aimed to evaluate the impact of stone location (LP vs non-LP) on perioperative parametersand stone-free outcomes following flexible ureteroscopy (fURSL), and to identify independent predictors of procedural success
MATERIAL AND METHODS
A retrospective analysis was conducted on 548 paediatric patients who underwent fURSL for urolithiasis between September 2015and May 2025 across four tertiary referral centres. Demographic, radiological, intraoperative, and postoperative data were collected.Patients were divided into LP and non-LP groups, according to stone location. Stone-free rate (SFR) represented the primaryoutcome, and was defined as the absence of residual fragments on post-operative ultrasonography. Comparisons were performedusing the Mann–Whitney U test, Student's t-test, and Chi-square/Fisher's exact test, as appropriate. Multivariate logistic regressionanalyses were used to identify independent predictors of LP location and SFR. Statistical significance was set at p value < 0.05.
RESULTS
A total of 548 procedures were analysed (mean age 8.7 ±5.1 years). LP stones were smaller (9.5 ±2.9 vs 10.5 ±3.2 mm, p<0.001)and had lower volume (480.6 ±575.2 vs 710.8 ±984.9 mm³, p=0.003) compared to other stone localization. Operative time wassignificantly longer for LP procedures (p=0.005), with a mean difference of 12.98 minutes compared with non-LP cases. Despite ahigher rate of visually stone-free procedures intraoperatively (71.0% vs 52.2%, p<0.001), the ultrasound SFR was lower in LP cases(67.2% vs 81.5%, p<0.001). LP procedures were also associated with more complications (21.5% vs 13.3%, p=0.013), highersecond procedure rates (12.9% vs 4.1%, p<0.001), and longer hospital stay (1.6 ±0.7 vs 1.3 ±0.7 days, p<0.001). In multivariateanalysis, pre-operative stenting (OR 3.80, 95%CI 1.90–7.59, p<0.001) and longer operative time (OR 1.04/min, 95%CI 1.03–1.05,p<0.001) independently predicted stone-free status, whereas LP location was not an independent predictor for SF status (OR 0.44,95%CI 0.14–1.22, p=0.13).
|
OR |
p-value |
||
|
Location (LP vs non-LP) |
0.44 |
0.134 |
0.14-1.22 |
|
Stone Diameter |
0.97 |
0.53 |
0.89-1.06 |
|
HU |
1.00 |
0.26 |
0.99-1.00 |
|
Age |
1.01 |
0.78 |
0.95-1.07 |
|
stent* |
3.80 |
0.00014* |
1.90-7.59 |
|
UAS |
1.24 |
0.64 |
0.52-3.24 |
|
Operative time* |
1.04 |
<0.001* |
1.03-1.05 |
CONCLUSIONS
In paediatric fURSL, LP stones tend to be smaller but require longer procedures. However, stone location does not represent anindependent predictor of SFR. In contrast, preoperative stenting and longer operative times are independently associated withimproved stone clearance, suggesting that optimal preoperative preparation and meticulous intraoperative management mayovercome the anatomical challenges of LP stones.
16:28 - 16:33
S06-7 (VP)
Mustafa KABA 1, Cihat AYTEKIN 2, Ahmet Eren DEMIRTOLA 1, Ender Cem BULUT 1, Mustafa Ozgur TAN 1 and Ozdemir Serhat GUROCAK 1
1) Gazi University, School of Medicine, Department of Urology, Ankara, TÜRKIYE - 2) Polatlı State Hospital, Department of Urology, Ankara, TÜRKIYE
PURPOSE
To outline the perioperative strategy and evaluate the clinical efficacy of mini-percutaneous nephrolithotomy (mini-PCNL) for the treatment of a sizable lower calyceal stone in a pediatric patient with a horseshoe kidney after an unsuccessful retrograde intrarenal surgery (RIRS) and to emphasize the technical considerations specific to this complex anatomical configuration.
MATERIAL AND METHODS
A 9-year-old male presented with a 20 × 10.5 × 13.8 mm lower calyceal calculus (calculated volume 1282 mm³; mean attenuation 1040 HU) in the left moiety of a horseshoe kidney. Following a failed RIRS attempt at an external institution (during which a ureteral double-J stent was placed), the patient was referred for definitive management. Mini-PCNL was performed using a standardized pediatric percutaneous access technique and a miniaturized endoscopic system. Perioperative variables, including total operative time, endoscopic manipulation time, and fluoroscopy exposure, were prospectively recorded. Stone-free status was assessed intraoperatively and confirmed postoperatively.
RESULTS
Mini-PCNL was completed successfully with a total operative time of 72 minutes, including 48 minutes of endoscopic working time and 98 seconds of fluoroscopy exposure. No intraoperative or perioperative complications occurred. Complete stone clearance was achieved, and the postoperative course was entirely uneventful without the need for any auxiliary procedures. Stone analysis revealed a composition of whewellite (calcium oxalate monohydrate) and weddellite (calcium oxalate dihydrate).
CONCLUSIONS
Mini-PCNL is a highly effective and technically feasible treatment option for relatively large renal stones in pediatric patients with anatomical anomalies such as horseshoe kidney, particularly when prior endoscopic interventions have failed. It ensures high stone-free rates with minimal radiation and efficient operative performance, supporting its use as a first-line option in complex pediatric cases.
16:33 - 16:36
S06-8 (CP)
Yaacov FRISHBERG 1, Wesley HAYES 2, Efrat BEN-SHALOM 1, Hadas SHASHA-LAVSKY 3, David J. SAS 4, Mini MICHAEL 5, Anne-Laure SELLIER-LECLERC 6, Julien HOGAN 7, Weiming DU 8, John M. GANSNER 8, Daniela BAGNATO 8 and Daniella MAGEN 9
1) SHAARE ZEDEK MEDICAL CENTER, Jerusalem, ISRAEL - 2) GREAT ORMOND STREET HOSPITAL FOR CHILDREN NHS, London, UNITED KINGDOM - 3) GALILEE MEDICAL CENTER, Nahariya, ISRAEL - 4) MAYO CLINIC, Rochester, USA - 5) TEXAS CHILDREN'S HOSPITAL, Houston, USA - 6) HÔPITAL FEMME MÈRE ENFANT, Bron, FRANCE - 7) ROBERT DEBRÉ HOSPITAL, APHP, Paris, FRANCE - 8) ALNYLAM PHARMACEUTICALS, Cambridge, USA - 9) PEDIATRIC NEPHROLOGY INSTITUTE, Haifa, ISRAEL
PURPOSE
Primary hyperoxaluria type 1 (PH1) is a genetic disease that causes oxalate overproduction. Lumasiran is the first RNA interference therapeutic approved for PH1 in infants and children aged <6 years. In ILLUMINATE-B (NCT03905694), lumasiran showed sustained efficacy and a consistent safety profile through 30 months. We present the final 60-month ILLUMINATE-B results.
MATERIAL AND METHODS
This Phase 3, open-label, single-arm study enrolled patients with PH1 aged <6 years, eGFR >45 mL/min/1.73 square meters (age at least 12 months) or serum creatinine at or below upper limit of normal (ULN) for age (age <12 months), and urinary oxalate:creatinine ratio (UOx:Cr) above the ULN for age. Lumasiran was administered subcutaneously with weight-based dosing.
RESULTS
All enrolled patients (N=18) completed the 60-month study. Mean spot UOx:Cr (mmol/mmol) decreased from 0.63 at baseline to 0.11 at Month 60 (74% mean reduction). Mean reduction from baseline in plasma oxalate was 25% at Month 60. Mean eGFR (mL/min/1.73 square meters) was 112.8 at baseline and 109.8 at Month 60. Annual rate of change (slope) in mean eGFR was +0.26 mL/min/1.73 square meters/year. Medullary nephrocalcinosis grade improved in 12/14 (86%) patients with nephrocalcinosis at baseline and worsened in none. All 4 patients without medullary nephrocalcinosis at baseline remained nephrocalcinosis-free at Month 60. The overall rate of kidney stone events was 0.11/person-year (95% CI, 0.06-0.21) over 60 months. The most common lumasiran-related adverse events were mild, transient injection site reactions (3 [17%] patients). Mean change in height z-score from baseline to Month 60 was −0.116. Mean annual height growth rates over the study period by baseline age group (age at screening) were 8.6 cm/year (age <12 months), 7.5 cm/year (age 12 to <24 months), 6.0 cm/year (age 24 to <48 months), and 5.5 cm/year (age at least 4 years).
CONCLUSIONS
Final 60-month ILLUMINATE-B results demonstrate that lumasiran treatment in infants and children aged <6 years with PH1 results in rapid, sustained reductions in urinary oxalate, stable eGFR, and a normal, expected linear growth rate. Medullary nephrocalcinosis grade improved in most patients, kidney stone event rates were low, and safety remained consistent.