ESPU Meeting on Thursday 18, June 2026, 08:00 - 08:50
08:00 - 08:03
S08-1 (CP)
Maria ESCOLINO, Maria Sofia CARACÒ, Fulvia DEL CONTE, Vincenzo COPPOLA, Claudia DI MENTO, Francesca CARRATURO, Francesco TEDESCO, Valerio MAZZONE, Roberta GUGLIELMINI, Benedetta CESARO, Maria Luisa PIRONE and Ciro ESPOSITO
Federico II University Hospital, Translational Medical Sciences, Naples, ITALY
PURPOSE
This study aimed to further validate the 3D-printed Fish Tank Simulation Model (FTSM) as a practical and effective training tool for endoscopic bulking agent injection in the management of vesicoureteral reflux (VUR).
MATERIAL AND METHODS
A total of 61 attendees and 11 faculty members completed a post-training questionnaire after using the FTSM during dedicated simulation sessions. A seven-item, 5-point Likert scale survey assessed both face and content validity. Trainee performance metrics included time to complete the injection and quality of the created mound (height and position), rated using a 5-point Likert scale. Participant demographics, training level, and prior procedural experience were also recorded.
RESULTS
Among the 72 participants, 22 (30.5%) were fellows or pediatric surgery specialists, while 50 (69.5%) were residents or surgeons in training. Most defined themselves as novice in endoscopic injection (< 10 procedures/year; 70.8%), with 13.8% intermediate (10-20 procedures per year) and 15.3% expert (> 20 procedures per year). No significant differences emerged between novice and intermediate/expert groups in face or content-validity scoring, confirming the model’s broad applicability. The FTSM was rated as a useful training tool for beginners by 63/72 (87.5%) while it was considered useful for training pediatric surgeons/urologists by 50/72 (69.4%). All attendees made two consecutive attempts, with the median injection-completion time significantly decreasing from 4.17 to 2.84 minutes (p=0.0007). The quality-of-mound score also significantly improved between attempts (3.47 vs 4.42; p=0.0009).
CONCLUSIONS
The 3D-printed FTSM proved to be a high-fidelity, accessible, and cost-effective simulator that enhances technical skills in endoscopic VUR injection across different experience levels. Its realistic setup, ease of use, and measurable performance metrics support its integration into structured training curricula. Future refinements should focus on improving anatomical fidelity and incorporating congenital anatomical variants such as ectopic ureters or duplex systems.
08:03 - 08:06
S08-2 (CP)
Jin Kyu (Justin) KIM 1, Martina BRUNIERA 2, Beverly MIRANDA 2, Mandy RICKARD 2, Mirriam MIKHAIL 2, Konrad SZYMANSKI 1, Martin KAEFER 1, Mark CAIN 1, Richard RINK 1, Joshua ROTH 1, Kirstan MELDRUM 1, Benjamin WHITTAM 1, Pankaj DANGLE 1, Nikhil BATRA 1, Michael CHUA 2, Joana DOS SANTOS 2, Rodrigo ROMAO 2, Joao PIPPI SALLE 2, Armando LORENZO 2 and Rosalia MISSERI 1
1) Riley Hospital for Children, Urology, Indianapolis, USA - 2) The Hospital for Sick Children, Urology, Toronto, CANADA
PURPOSE
Vesicoureteral reflux (VUR) management consists of ureteral bulking agents like Deflux® or surgically via ureteral reimplantation. Bulking agents have historical lower success rates for high-grade VUR compared to reimplantation. This study aims to provide a contemporary comparison of outcomes from preferential Deflux® and reimplantation centers.
MATERIAL AND METHODS
We retrospectively compared VUR patients undergoing reimplantation (institution 1) vs. Deflux® (institution 2). The patients were matched by era (2018-2025) and indication (recurrent urinary tract infections, UTI). Baseline factors and 30-day post-operative outcomes (emergency room visits, readmissions; Clavien-Dindo ≥3 complications, UTIs (culture-proven, symptomatic) and recurrent UTIs (≥2 UTIs in 6 months or ≥3 UTIs in 12 months) were evaluated.
RESULTS
A total of 312 patients (133 reimplant, 179 Deflux®) were identified. Median age at presentation (3.0 vs. 2.4 years, p=0.750), follow-up (23.7 vs. 27.9 months, p=0.106), high-grade VUR (86.4% vs. 87.2%, p=0.859), bilateral interventions (60.9% vs. 54.4%, p=0.386), and bladder and bowel dysfunction (BBD, 39.1% vs. 49.7%, p=0.062) were similar. The reimplant group was more often female (90.2% vs. 74.8%, p<0.001), with duplex systems (30.0% vs. 16.7%, p=0.005), and older at surgery (4.6 vs. 3.4 years, p=0.034).
No difference in ED visits within 30 days (5.3% vs. 6.1%, p=0.422), readmissions (3.0% vs. 1.7%, p=0.474), redo surgeries (2.3% vs. 3.9%, p=0.403) or any post-operative UTIs (21.1% vs. 22.9%, p=0.697) was observed. Reimplant patients had fewer recurrent UTIs (5.3% vs. 12.3%, p=0.035; NNT 14). Multivariate regression adjusting for procedure, age, sex/circumcision, VUR grade, BBD, duplex systems, and follow-up confirmed Deflux® patients were more likely to have recurrent UTI (OR 3.2, 95% CI 1.3-8.2). Similar results were seen with ≥12-month follow-up (7.2% vs. 15.6%, OR 2.8, 95% CI 1.1-7.2; NNT 12).
CONCLUSIONS
Compared to reimplantation, Deflux® carries higher short-term recurrent UTI risk. However, as a minimally invasive procedure, post-operative pain, length of stay, cost, patient/parental preference must also be weighed, highlighting need for counseling and risk-stratification.
08:06 - 08:09
S08-3 (CP)
Ermelinda MELE 1, Gaia BRUNETTI 2, Benedetta MARINO 2, Giuseppe COLLURA 2, Ana Ludy LOPES MENDEZ 2, Michele INNOCENZI 2 and Marco CASTAGNETTI 2
1) Bambini Gesu Pediatric Hospital, Paediatric Urology, Rome, ITALY - 2) Bambino Gesù Hospital, Urology, Roma, ITALY
PURPOSE
Reportedly, ureteral obstruction after endoscopic treatment (ET) of vesicoureteral reflux (VUR) can occur in 1 to 5% of patients.
Aim of present study was to assess the characteristics of patients requiring ureteral reimplantation for ureteral obstruction after ET of VUR.
MATERIAL AND METHODS
Retrospective analysis of patients undergoing ureteral reimplantation for ureteral obstruction after ET of VUR at our institution between 2006 and 2023. During this period ET was performed with dextranomer/hyaluronic acid (Dx/HA) or polyalcolic polyacrylate copolymer (PPC) based on surgeon preference.
Age, sex, laterality, renal scarring, injected material, injection volume and endoscopic technique were assessed.
RESULTS
Over the 17-year study period, 40 patients underwent ureteral reimplantation for ureteral obstruction after ET of VUR. Reimplantation was performed at a median (range) of 19 (range 1-88) months after ET. Of the patients undergoing reimplantation, 26 (65%) were males; 13 (32.5%) on the left side and 24 (60%) bilateral; 39 (97.5%) had high-grade VUR and 15 (37.5%) renal scan abnormalities before ET. Injected material was Dx/HA in 23 (57.5%) and PPC in 17 (42.5%). Median (range) injected volume was 0.5 (0.3-1) ml for Dx/HA and 0.5 (0.1-1.2) ml for PPC. The injection technique was sub-ureteral in 23 (57%), intra-ureteral in 3 (7.5%) and unknown in 14.
At a median follow-up of 102.5 months (range: 14 - 176 months) after reimplantation, all patients were asymptomatic and improved radiologically. Five (13%) patients experienced loss of renal function (median drop in differential renal function 19%, range 6-29%).
CONCLUSIONS
Our experience confirms that ureteral obstruction after ET of VUR is rare, but reimplantation can be required up to 7 years after the ET. Obstruction can occur with any material and injection technique. Reimplantation is generally effective fixing the obstruction, but 13% of cases experienced loss of renal function.
08:21 - 08:24
S08-4 (CP)
Emanuela GALLO 1, Girolamo MATTIOLI 1, Mohan S. GUNDETI 2, Boris CHERTIN 3, Leon CHERTIN 3, Stanislav KOCHEROV 4, Ciro ANDOLFI 5, Filippo GHIDINI 5, Alfredo BERRETTINI 6, Federica FANTI 1, Venusia FIORENZA 1, Francesca BAGNASCO 7 and Marcello CARLUCCI 1
1) University of Genova - Giannina Gaslini Institute, Department of Pediatric Surgery, Genova, ITALY - 2) Comer Children's Hospital, The University of Chicago, Chicago, IL, USA, Department of Pediatric Surgery, Chicago, USA - 3) Department of Pediatric Urology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel, Department of Pediatric Surgery, Jerusalem, ISRAEL - 4) Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel, Department of Pediatric Surgery, Tel-Aviv, ISRAEL - 5) Service de Chirurgie Pédiatrique, Hôpitaux Civils de Colmar, Colmar, France, Department of Pediatric Surgery, Colmar, FRANCE - 6) Department of Paediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy., Department of Pediatric Surgery, Milan, ITALY - 7) University of Genova - Giannina Gaslini Institute, Statistics and Epidemiology Department, Genova, ITALY
PURPOSE
Even though robotic surgery is well described in simple vesico-ureteral reflux (VUR), few studies explore its role in complex uretero-vesical junction (UVJ) anomalies or reiterative surgery. This study assesses the role of different robotic surgical procedures and clinical features that can impact the result of complex robotic ureteral reimplantation in children.
MATERIAL AND METHODS
Data of children who underwent robotic reimplantation between 2017-2023 in case of reiterative surgery or complex UVJ anatomy across six centers were retrospectively analyzed. Reimplantation techniques included: dismembered and non-dismembered Lich-Gregoire(D-RALUR, ND-RALUR), Dismembered Extravesical Cross-Trigonal reimplantation(RADECUR). Descriptive statistics were reported in terms of absolute frequencies and percentages for categorical data, and the Pearson's chi- square test or Fisher's exact test, if appropriate, was applied to compare proportions. Quantitative data were described in terms of median values, range, and interquartile range (IQR) due to their non- normal (Gaussian) distribution. Accordingly, comparisons between groups were made by the non-parametric Mann-Whitney U- test or the Kruskal Wallis test.
RESULTS
The study included 134 patients, median age 4 years (IQR 2.1-6.6; range: 0.5-17.4), median weight 15.2 Kg(IQR 13.1-22.0; range: 6.7-80.0). Reiterative surgery(48, 35.8%), duplex systems(38, 28.4%), obstructive megaureter(29, 21.6%) and others(27, 20.1%). D-RALUR 65 (48.5%), ND-RALUR 56(41.8%), RADECUR 13(9.7%). Early post-operative complication rate was 1.4%(six grade 3B-Clavien-Dindo requiring surgical intervention -2 incisional hernia, 4 UVJ stenosis).
At a median follow-up of 21.2 months (IQR 11.7-33.3; range 6.0-80.1) the resolution was 82.2%. The comparative analysis found no significant difference in resolution respect to pathology (p=0.179), technique (p=0.331), age (p=0.937) and weight (p=0-495). There was no statistical difference in resolution rate when stratifying on weight ≤ 10Kg (p=0.633) and ≤15kg (p=0.586). We recorded 9 UVJ obstruction: 5(9%)D-RALUR, 4(8%)ND-RALUR; 11 VUR: 2(15%)RADECUR, 7(12%) D-RALUR, 2 (4%)ND-RALUR and 1 recurrent febrile UTI without VUR or obstruction: 1(D-RALUR).
CONCLUSIONS
Robotic reimplantation is a valid option in case of complex pediatric UVJ pathologies, with good results also in children with a <10kg body weight.
08:24 - 08:27
S08-5 (CP)
Abdulnasser ALSAID, Mamdouh AHMED, Ashhad Ali KHAN and Jad DEGHEILI
Ibn Sina Hospital, Division of Pediatric Urology, Department of Pediatric Surgery, Sabah Medical Region, KUWAIT
PURPOSE
Various surgical options have emerged for the treatment of vesicoureteric reflux (VUR) over the past years. The trend now is shifted toward mini invasive approaches. We adopted laparoscopic bilateral extravesical ureteric re-implantation (LBEUR) starting from November 2022. Our current study is to assess the outcome(s) of LBEUR for the management of VUR in children.
MATERIAL AND METHODS
This prospective study was conducted from 06.11.2022 to 22.07.2025. Total 16 consecutive patients underwent LBEUR after complete history taking and investigations. Patient’s pre/ postoperative data were recorded and analyzed. We evaluated the technique and outcome of surgery, including symptoms and imaging. We used 5mm camera and 3mm working ports.
RESULTS
Total 16 patients underwent LBEUR. 15 were females and 1 male patient, with grade 3 and above bilateral VUR. Age ranged from 10 months to 12 years (mean 6.4years); operative time ranged from 2.3 to 6 hours (mean 3.5 hours). No indwelling catheter was kept postoperatively, except in 1 case kept for 2 days as a minute mucosal perforation closure was done during surgery. Hospital stay was 1 to 2 days (mean 29.5 hours). Follow-up ranged from 3 to 32 months (mean 21 months). Post-operatively, all patients had excellent functional results, without urinary retention/ voiding dysfunction or urinary tract infection. Follow-up ultrasounds showed no significant post void residue.
CONCLUSIONS
Laparoscopic bilateral extra vesical ureteric reimplantation is safe, feasible, and effective in expert hands, exhibiting short hospital stay, minimal morbidity with no evidence of voiding dysfunction/urine retention. Our study is relatively small; further studies from various centers is essentially needed.
08:27 - 08:30
S08-6 (CP)
Selvin Theodore Jayanth DANIEL EZHILARASU 1, Joshua WATSON 2 and Christina CHING 1
1) Nationwide Children's Hospital, Pediatric Urology, Columbus, USA - 2) Nationwide Children's Hospital, Infectious Diseases, Columbus, USA
PURPOSE
To determine whether changing the CAP agent after an initial BT-UTI would alter the risk of a subsequent UTI compared with maintaining the original agent.
MATERIAL AND METHODS
We conducted a retrospective review of children aged 0-12 months diagnosed with radiologically confirmed high-grade (Grade 4 and 5) primary VUR and a BT-UTI while on CAP between January 2015 and January 2025. Data collected included demographics, BT-UTI characteristics, CAP agents used, and pathogen susceptibility patterns. The primary outcome was the relative risk of a second BT-UTI in patients with a CAP agent changed after the initial BT-UTI versus those with an unchanged agent. The secondary outcome was to investigate the impact on antibiotic susceptibilities and pathogen type of subsequent BT-UTIs based on the CAP strategy.
RESULTS
Forty-six patients experienced a total of 94 episodes of BT-UTIs. Fourteen episodes were excluded due to an interruption in the CAP, leaving 80 for analysis (12 patients had >= 2 episodes, median 2(range 2-5)). After 28 episodes (35%) of BT-UTIs, the CAP was changed, and after 52 episodes (65%), it remained unchanged. A subsequent BT-UTI developed in 19/28 episodes (67%) with CAP changed and in 38/52 episodes (73%) with CAP unchanged. The relative risk of a subsequent BT-UTI when CAP was changed (versus unchanged) was 0.91 (95% confidence interval [0.76, 1.101], p = 0.35). Of the 80 episodes, E.Coli was the causative organism in 45 (56%), and the remaining were non-E.Coli species. A new species of bacteria at BT-UTI was isolated in 11 (39%) versus 14 (26%) of patients in the changed versus unchanged CAP groups, respectively (p=0.06); bacterial resistance to the original CAP agent was 32% and 15% in the changed and unchanged CAP groups, respectively (p = 0.072).
CONCLUSIONS
Changing CAP after an initial BT-UTI did not significantly change the risk of a subsequent BT-UTI compared to leaving CAP unchanged. It was, however, associated with a higher risk of antibiotic resistance. This data supports not changing CAP after BT-UTI.
08:30 - 08:33
S08-7 (CP)
Walker BAILEY 1, Alice XIANG 2, Hunter FLORES 3, Thuytien TO 1, Mustafa SAEED 1, Carlos GARCIA-GONZALEZ 1 and Kyle ROVE 3
1) University of Colorado, School of Medicine, Aurora, USA - 2) University of Colorado, Children's Hospital Colorado, Aurora, USA - 3) University of Colorado, Urology, Aurora, USA
PURPOSE
Post-operative urinary tract infections (UTIs) commonly occur in patients after ureteral reimplantation for vesicoureteral reflux (VUR), and a portion of these patients develop pyelonephritis. While post-operative continuous antibiotic prophylaxis (CAP) intends to reduce UTI recurrence, the principles of antibiotic stewardship compete for priority in management. No guidelines regarding CAP after ureteral reimplantation for VUR currently exist. Accordingly, practice patterns vary widely by surgeon preference and clinical setting.
This study aims to evaluate the influence of postoperative CAP on UTI rates after ureteral reimplantation surgery in children. A secondary aim is to evaluate the optimal duration of postoperative CAP to prevent UTIs, UTI related ED visits, and readmissions.
MATERIAL AND METHODS
This single-center retrospective study examined pediatric patients <18 years old who underwent ureteral reimplantation from 2010-2025. Patients with genitourinary anomalies (neurogenic bladder, cloaca, anorectal malformation), prior or concomitant urologic reconstructive procedures, or known immunodeficiency were excluded. Patients were stratified based on postoperative CAP use and duration of CAP use. Primary outcomes included postoperative UTI, UTI-related ED visits, and UTI-related readmissions within 90 days of surgery.
RESULTS
Of 480 patients screened, 240 met inclusion criteria. 174 of these patients (72.5%) were maintained on CAP postoperatively. Both postoperative UTI rates and UTI related ED visits were higher in the no CAP group when compared to patients receiving CAP of any duration (21.8% vs 9.8%, p = 0.03 and 16.4% vs 4.9%, p =0.01, respectively). When stratified by postoperative CAP duration, patients receiving no CAP or CAP for ≤2 weeks had higher rates of UTI (20%) and ED visits (14%), whereas UTI and ED visit rates were lowest in the 1–3 month CAP groups (~5%). UTI-related readmissions were infrequent across all groups with no clear association to CAP use or duration.
CONCLUSIONS
Postoperative CAP was associated with significantly lower rates of UTI and UTI-related ED visits following ureteral reimplantation. CAP duration of 1 month or longer was associated with the lowest complication rate. UTI-related readmission was rare regardless of prophylaxis. These findings support the consistent use of CAP post-reimplantation and suggest that a duration of ≥1 month may confer optimal benefit.