Li-Yi Lim

• Topic I: General Consideration
  Marcelo ChenTaiwan Moderator

  Seung-Ju LeeKorea (Republic of) Moderator Questionnaires Provide Rapid Diagnosis of uUTI
• Opening Remarks
  Stephen S. YangTaiwan Speaker UTI & Hydronephrosis: What's New and Asian Guideline UpdateHydronephrosis is a common urological condition in both adults and children. It is frequently associated with urinary tract infection (UTI). However, not all hydronephrosis means upper urinary tract obstruction (UUTO). So, differentiating hydronephrosis into pathological or physiological is important. In pathological hydronephrosis or UUTO, risk factors of UTI should be identified. While in physiological UTI, no further study is required. In this lecture, classification of upper urinary tract dilatation will be introduced, including SFU and UTD system. Other than intra-venous pyelourography, diuretic renal scan can be useful in differentiating hydronephrosis into physiological or pathological hydronephrosis. Pitfalls in interpreting diuretic renogram will be discussed. A brief review of risk factors of UTI will be done. Finally, Asian guideline on UTI will be updated.
• Definition of Perioperative Infections and Surgical Classification
  Jun KameiJapan Speaker Definition of Perioperative Infections and Surgical Classification
• Surgical Antibiotic Prophylaxis: Types and Timing
  Wai Kit MaHong Kong, China Speaker Surgical Antibiotic Prophylaxis: Types and Timing
• Optimizing Pre-operative Patient Factors to Reduce Post-Surgical Complications
  Pei-Shan YangTaiwan Speaker Optimizing Pre-operative Patient Factors to Reduce Post-Surgical ComplicationsOptimizing Pre-operative Patient Factors to Reduce Post-surgical Complications Preoperative care • Preoperative documentation • Assessment of physical function and frailty • Cognititve screening • Pulmonary risk • Cardiovascular risk • Elective urological surgery should be delayed for 14 days after coronar balloon angioplsty, 30 days after bare metal stent 1 year after drug-eluting implantation • Atrial fibrillation do not need bridge therapy except for high risk of stroke, venous thrmoembolism <12 wks recent stenting or chronic anticoagulation • Endocrine • Delay elective procedure for HbA1C>6.9% • Longterm steriod dose adjustment for risk of GI bleeding or reactive airway issues • GI • Preoperaive fasting (6hrs befoere GA for solids, 2 hrs for clear liquids) is recommended to reduce the risk of intraoperative aspiration • Renal • ESRD: evaluate for hyperkalemia, acid-base status, anemia • Consider antibiotics covering endocarditis for dialysis patients • Nutrition • Immunonutrition (IMN) • Some equivocal results • lower postop infectious copmlications but no diff in other outcomes • Earlier return to bowel function with IMN but no diff in other outcomes • There was no difference in any grade CD complications by type of nutritional supplement for patients with bladder cancer undergoing RC. • From SWOG s1600 • Endourology • Scoring system • Novel techniques for puncture planning • Prevention of ureteral injury • Stenting •
• Essential Intraoperative Protocols for Infection Prevention
  Kazuyoshi ShigeharaJapan Speaker Essential Intraoperative Protocols for Infection PreventionSurgical site infections (SSIs) represent a significant burden on routine clinical practice and medical costs. Many interventions have been proposed over the past years to minimize the occurrence of SSIs. These interventions are broadly delivered at three stages including preoperative, intraoperative, and postoperative managements. Intraoperative interventions are largely focused on skin and would decontamination, precautions to prevent transfer of microorganisms into incisions, and optimising the patient's own bodily functions to promote best recovery, which can be performed by the surgeons and medical staffs during operation. These interventions include skin cleansing protocols, wound closure procedure, wound lavage and irrigation, and drain placement. In this lecture, I would like to mention summaries of intraoperative managements for the prevention of SSIs based on the Japanese Guidelines for Prevention of Perioperative Infections in Urology, which had been newly revised by 2023.
• Coffee Break
• Topic II: Specific Topics
  Dong Hoon LimKorea (Republic of) Moderator

  Shang-Jen ChangTaiwan Moderator Which Surgical Treatment is Best for UPJO in Infants: Open, Laparoscopic, Robotic AssistedAbstract Ureteropelvic junction obstruction (UPJO) in infants is a condition that can significantly impair renal function and requires timely surgical intervention when certain criteria are met, such as decreased split renal function, poor drainage on diuretic renography, or recurrent urinary tract infections. The three main surgical approaches for treating UPJO are open pyeloplasty (OP), laparoscopic pyeloplasty (LP), and robot-assisted laparoscopic pyeloplasty (RALP). Each technique has its own benefits and limitations, especially when applied to infants. Minimally invasive surgery (MIS), including LP and RALP, has gained popularity in pediatric urology due to advantages such as shorter hospital stays, reduced postoperative pain, faster recovery, and better cosmetic outcomes. However, the small working space in infants, the steep learning curve, and higher costs are significant limitations. In particular, the utility of MIS in infants remains controversial due to undefined benefits and technical challenges, including limited space for trocar placement and difficulty in intracorporeal suturing. Current guidelines from the European Association of Urology (EAU) indicate that while RALP is considered the gold standard for older pediatric patients, its role in infants remains less defined due to anatomical and logistical constraints. Open surgery continues to be the mainstay for infantile UPJO due to its well-established success rate and lower cost. Several studies have addressed the learning curve associated with these techniques. Laparoscopic pyeloplasty requires about 30 cases for a surgeon to achieve proficiency, while RALP demands approximately 18–31 cases depending on the metrics used. Simulation-based training, dry labs, and multicenter collaboration are proposed solutions to accelerate skill acquisition and ensure patient safety. Cost is another critical consideration. Although RALP generally incurs higher upfront costs, especially in low-volume centers, innovations such as magnetic stents have helped offset some of these expenses by eliminating the need for anesthesia during stent removal. Moreover, the availability of pediatric-specific robotic instruments remains limited and necessitates ongoing development to fully support MIS in smaller patients. In conclusion, while RALP is increasingly recognized as the standard for pediatric UPJO, its application in infants should be considered selectively, depending on surgeon experience, institutional resources, and patient anatomy. Open pyeloplasty remains a safe and effective option, particularly in very young children. Advances in surgical training, cost reduction strategies, and instrument development will be key to expanding the use of minimally invasive techniques in this population.
• Endoscopic Examination
  Tze-Chen ChaoTaiwan Speaker Prevention of Surgical Site Infection: Endoscopic examinations and drainage tube related proceduresThe presentation outlines antibiotic prophylaxis in urologic examinations and drainage tube-related procedures. For diagnostic examinations like urodynamics and cystoscopy without manipulation, prophylactic antibiotics are generally not required in low-risk patients without UTI risk factors. Ureteroscopy has increased infection risk due to potential mucosal trauma, increased intrarenal pressure, and therefore requires antibiotic prophylaxis. For drainage procedures, DJ stent placement typically warrants prophylaxis except in carefully selected low-risk patients, as colonization rates increase with duration and certain risk factors such as diabetes, chronic kidney disease, malignancy, female gender, pregnancy, and emergency procedures. First-time nephrostomy placement requires single-dose prophylaxis due to renal parenchymal injury and bacteremia risk. On the other hand, routine exchanges of nephrostomy generally don't need prophylaxis unless tube obstruction occurs. The key principle is individualized risk assessment. Current evidence supports selective rather than universal prophylaxis to prevent infection and minimize bacterial resistance.Transurethral Surgery
• Transurethral Surgery
  Jeong Woo LeeKorea (Republic of) Speaker Transurethral Surgery
• Surgery for Urolithiasis
  Toshiki EtaniJapan Speaker Surgery for Urolithiasis
• Surgery Using Foreign Bodies
  Chi-Fang ChenTaiwan Speaker Antibiotic prophylaxis for surgery using foreign bodiesWhile existing guidelines offer important frameworks for antibiotic prophylaxis in AUS and penile prosthesis surgeries, they are insufficiently comprehensive and sometimes inconsistent, particularly regarding coverage of all relevant pathogens, duration of antibiotic use, and tailoring to patient risk profiles. This underscores the need for further high-quality research to refine prophylaxis protocols and improve infection prevention outcomes in these prosthetic surgeries.
• Pediatric Urological Surgery
  Li-Yi LimMalaysia Speaker Pediatric Urological SurgeryWhat’s New in Nocturnal Enuresis?
• Renal Transplantation
  Chang Il ChoiKorea (Republic of) Speaker Renal Transplantation
• Prostate Biopsy
  Yoshiki HiyamaJapan Speaker Prostate Biopsy
• Urethroplasty for Urethral Stenosis
  Seung-Kwon ChoiKorea (Republic of) Speaker Urethroplasty for Urethral StenosisUrethroplasty is a definitive treatment for urethral stricture disease. Despite its high success rate, surgical site infections (SSIs) and urinary tract infections (UTIs) remain notable postoperative complications. Antibiotic prophylaxis practices vary significantly among reconstructive urologists, ranging from single-dose perioperative regimens to prolonged courses until catheter removal. However, there is limited high-quality evidence to guide optimal antibiotic duration in this context. Recent prospective cohort studies demonstrated no significant reduction in UTI or wound infection with extended antibiotic prophylaxis versus limited regimens. Moreover, prolonged antibiotic use was associated with a significantly higher incidence of multidrug-resistant (MDR) organisms. Additional studies confirmed the lack of correlation between bacteriuria and stricture recurrence or wound complications. Prolonged postoperative antibiotic prophylaxis offers no clear benefit in preventing SSIs or UTIs following urethroplasty. In contrast, it may promote the development of MDR organisms. Current evidence support a practice shift toward single-dose perioperative antibiotics. These strategies enhance antibiotic stewardship while maintaining clinical safety.
• Closing Remarks
  Stephen S. YangTaiwan Speaker UTI & Hydronephrosis: What's New and Asian Guideline UpdateHydronephrosis is a common urological condition in both adults and children. It is frequently associated with urinary tract infection (UTI). However, not all hydronephrosis means upper urinary tract obstruction (UUTO). So, differentiating hydronephrosis into pathological or physiological is important. In pathological hydronephrosis or UUTO, risk factors of UTI should be identified. While in physiological UTI, no further study is required. In this lecture, classification of upper urinary tract dilatation will be introduced, including SFU and UTD system. Other than intra-venous pyelourography, diuretic renal scan can be useful in differentiating hydronephrosis into physiological or pathological hydronephrosis. Pitfalls in interpreting diuretic renogram will be discussed. A brief review of risk factors of UTI will be done. Finally, Asian guideline on UTI will be updated.

• What’s New in Enuresis and Varicocele Treatment for Children and Adolescents
  Thawatchai MankongsrisukThailand Moderator

  Yung-Shun JuanTaiwan Moderator
• What’s New in Nocturnal Enuresis?
  Li-Yi LimMalaysia Speaker Pediatric Urological SurgeryWhat’s New in Nocturnal Enuresis?
• What's New in Adolescent Varicocele?
  Sungchan ParkKorea (Republic of) Speaker What's New in Adolescent Varicocele?Varicocele is defined as an abnormal dilatation of testicular veins in the pampiniformis plexus caused by venous reflux. It is unusual in boys under ten years of age and becomes more frequent at the beginning of puberty. It is found in 14-20% of adolescents, with a similar incidence during adulthood. In 70% of patients with grade II and III varicocele, left testicular volume loss was found. Abnormal reproductive hormonal levels (increased serum levels of FSH and LH, and decreased levels of inhibin B) and semen quality were reported in varicocele patients and were directly related to varicocele severity. In about 20% of adolescents with varicocele, fertility problems will arise. The adverse influence of varicocele increases with time. Surgical indications 1. The recommended indication criteria for varicocelectomy in children and adolescents - varicocele associated with a small testis (volume difference > 20%) This should be confirmed on two subsequent visits six months apart 2. Additional treatment can be considered on a case by case - additional testicular condition affecting fertility - bilateral palpable varicocele - pathological sperm quality (in older adolescents) - symptomatic varicocele (pain, 2-10%) - cosmetic reasons related to scrotal swelling - Repair of a large varicocele, causing physical or psychological discomfort, may also be considered. --> Other varicoceles should be followed-up until a reliable sperm analysis can be performed. Natural progression of testicular growth Surgical treatment Based on ligation or occlusion of the internal spermatic artery. Ligation is performed at different levels. - inguinal (or subinguinal) approach with or without microsurgical or macroscopic (loupe) assistance - suprainguinal ligation, using open or laparoscopic techniques (few report using robotic system) - Sclerosing therapy using retrograde or antegrade approach. For surgical ligation, some form of optical magnification (microscopic or laparoscopic) should be used because the internal spermatic artery is 0.5 mm in diameter at the level of the internal ring. In supra-inguinal approach, an artery sparing varicocelectomy may not offer any advantage in regards to catch-up growth and is associated with a higher incidence of recurrent varicocele. The success rates of the treatment (disappearance of varicocele) were between 85.1% and 100%. Whereas the complication rates were between 0% and 29% in the included studies. The most common complication reported was hydrocele. Resolution of pain after treatment was more than 90% in the reported series.
• Discussion
• Urolithiasis
  Chia-Cheng SuTaiwan Moderator

  Sajid SultanPakistan Moderator Urolithiasis in Pediatric Patients
• Complex Renal Stone: PCNL or RIRS or Combination?
  Yi-Yang LiuTaiwan Speaker Complex Renal Stone: PCNL or RIRS or Combination?Mini-percutaneous nephrolithotomy (mini-PCNL) provides stone-free rate (SFR) 85 to 95 % in children with complex burdens, and recent systematic reviews report overall complications < 7 % and transfusion requirements ≈3 % when tracts ≤18 Fr are used. Its drawbacks are the need for percutaneous access, risk of bleeding, and potential parenchymal scarring, especially when multiple tracts are required. Retrograde intrarenal surgery (RIRS) avoids renal puncture and shows the lowest incidence of high-grade complications (<1 %); contemporary series in preschool children describe initial SFRs of 60–78 %, with secondary procedures needed in up to one-third of cases because of narrow, tortuous ureters. Pre-stenting, staged dilation and longer operative time can offset its minimally-invasive appeal for stones ≥2 cm. Endoscopic combined intrarenal surgery (ECIRS) merges an antegrade mini-PCNL channel with simultaneous flexible ureteroscopy. The first multicenter pediatric series and a 2024 comparative study confirm SFRs of 75–92 %, shorter hospital stay and lower fluoroscopy or transfusion risk than standalone PCNL despite treating more complex stones. Its limitations are the need for two skilled teams, specialized equipment and the Galdakao-modified supine Valdivia position, which lengthen setup and raise costs. In summary, mini-PCNL remains the most efficient monotherapy for large or staghorn calculi; RIRS is ideal when bleeding risk or unfavorable percutaneous windows predominate; ECIRS offers the best compromise between clearance and morbidity where resources and expertise allow. Individualized, anatomy-based algorithms and further pediatric RCTs are still required. ECIRSIn this session, we will demonstrate the technique about Totally-X-ray free ultrasound guided endoscopic combind intrarenal surgery in Galdakao modified supine Valdivia position.A Critical Appraisal on Percutaneous NephrolithotripsyPercutaneous nephrolithotripsy (PCNL) has evolved from a uniform prone, fluoroscopy-guided, large-tract technique into a precision endourological platform that emphasizes patient-tailored positioning, radiation-free puncture, miniaturized tracts, energy-efficient lasers and nascent robotic–AI augmentation. Contemporary evidence affirms that stone-free rates now approach a plateau, making safety metrics—bleeding control, infection prevention and intrarenal pressure modulation—the key differentiators among modern approaches. Miniaturized optics, suction-regulated sheaths and thulium-fiber or dual-wavelength laser consoles have collectively reduced hemoglobin loss and postoperative sepsis while preserving clearance efficacy. Future success will hinge on harmonizing technological innovation with rigorous evidence so that every incremental advance translates into measurable gains for both efficacy and safety in stone surgery.Echo guide Puncture in Supine PCNL: Tips and Tricks for an Efficient and Safe ProcedureMastery of ultrasound-guided supine PCNL begins with precise anatomical orientation. Color-Doppler mapping pinpoints the target calyx, which is punctured transpapillary with an echogenic-tip needle after artificial hydronephrosis is produced by retrograde ureteroscopic irrigation. A hydrophilic, floppy-tip yet stiff-shaft guidewire is then advanced through the needle, allowing atraumatic navigation of the collecting system under ureteroscopic visualization. Balloon dilation—used in place of sequential dilators—prevents guidewire dislodgement. When necessary, a through-and-through guidewire from flank skin to urethral meatus may be created to secure renal access. Finally, antegrade nephroscopy along this coaxial tract confirms unobstructed entry, provides panoramic inspection, and optimizes lithotripsy efficiency—all without fluoroscopy. Collectively, these steps deliver reliable access, eliminate radiation, and streamline stone clearance in a single, ergonomically favorable supine position.
• Guideline for Urolithiasis in Children
  Michael E. ChuaPhilippines Speaker Guideline for Urolithiasis in Children
• Discussion
• Hypospadias
  Hong-Lin ChengTaiwan Moderator

  Mitsui TakahikoJapan Moderator
• Distal Hypospadias: To Do or Not to Do Surgery?
  Jesun Lin Taiwan Speaker Distal Hypospadias: To Do or Not to Do Surgery? Distal hypospadias repair: To do? Or Not to do Surgery? Jesun Lin, M.D., Ph.D., M.H.A. The definition of Distal Hypospadias: The patients who had glanular, coronal, and subcoronal meatus, were accepted as distal hypospadias cases. This is a retrospective study. In this study, 638 consecutive patients that had been undergone the operation for distal hypospadias repair in the department of pediatric urology of Changhua Christian Pediatric Hospital and Changhua Christian Hospital between September 1980 and December 2024. The ratio of distal type is 53% in the total hypospadias patients. The timing of operation is from infancy to adult according to the individual condition of the patients. The reasons of operation and not to do surgery are according to the variation of the types of distal hypospadias and family members expectations. Distal hypospadias repair has several operative strategies such as Meatoplasty and Glanuloplasty (MAGPI), tubularized incised plate (TIP); Transverse preputial onlay flap (TPOF) and Modified Flip-Flap Procedure (Mathieu, Horton and Devine). Complications developed in 68 (11.0%) patients: 49 urethral fistulas, 11meatal stenosis with bifid urine stream, and 8 anastomotic stenosis. There are literatures talking about stent and non-stent for the reconstruction. A systematic review to assess the complication rates of non-stented compared to the stented distal hypospadias repair is likely no outcome difference. We performed double-tube stent for eliminating stent-related bladder spasm, prevention of dysuria and obstruction after surgery. IN my personal experience, the formation of neo-urethra corpus spongiosum improves the success rate regardless of the surgical methods. Although the current evidence of low to moderate quality suggests that there is likely no outcome difference between non-stented and stented distal hypospadias repair. The final consents are the chordee correction, nature urination with satisfied urine stream and appearance of the penis. We have to follow up the patient with photo and video after discharge periodically.
• Proximal Hypospadias: One Stage or Two Stage Repair? Or How I Do It?
  Kwanjin ParkKorea (Republic of) Speaker Proximal Hypospadias: One Stage or Two Stage Repair? Or How I Do It?
• Discussion