Stephen S. Yang

• 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.

• Diagnosis of Uncomplicated Urinary Tract Infections
  Seung-Ju LeeKorea (Republic of) Moderator Questionnaires Provide Rapid Diagnosis of uUTI

  Stephen S. YangTaiwan Moderator 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.
• Questionnaires Provide Rapid Diagnosis of uUTI
  Seung-Ju LeeKorea (Republic of) Speaker Questionnaires Provide Rapid Diagnosis of uUTI
• Changes of the Bacterial Resistance from Uncomplicated Cystitis in Japan
  Shingo YamamotoJapan Speaker Changes of the Bacterial Resistance from Uncomplicated Cystitis in JapanThe spread of antimicrobial resistance (AMR) is an increasing threat to all of humanity. Southeast and South Asian countries are among the world's leading AMR-endemic countries, with advanced AMR spreading through various international routes. Considering the mass administration of antibiotics to livestock and pets, and the spread of antibiotics and drug-resistant bacteria in the environment, measures to combat AMR cannot be completed within the human medical field alone. It is necessary to clarify the concept of the One Health approach and for various sectors, including human medical fields (such as veterinary medicine and the environment), to work together toward the same goal. When Japan's infectious disease control guidelines were published in 2011, fluoroquinolones were positioned as the first-choice drug for the treatment of acute uncomplicated cystitis in both pre- and postmenopausal women, because they are highly effective against both gram-negative and gram-positive bacteria. However, quinolone-resistant and ESBL-producing strains of Gram-negative bacteria, mainly E. coli, are increasing year by year, and many ESBL-producing strains are quinolone-resistant. Therefore, it is considered that the use of cephalosporins and quinolones should be severely restricted, and it is necessary to discuss the important issue of appropriate use of antibiotics.
• Integrated Chip Provide Rapid Identification of Uropathogen
  Chia-Hung LiuTaiwan Speaker Integrated Chip Provide Rapid Identification of UropathogenThe present study proposes a unique approach for the quick and cost-effective detection of Escherichia coli (E. coli) in urine samples using disposable gold electrode sensing chips. Spectrophotometry and plate counting demonstrated a significant linear correlation coefficient of 0.98986 between absorbance values and E. coli concentration. The electrochemical detection approach used modified electrodes to increase sensitivity. The method used to address cyclic voltammetry (CV) was not effective in depicting the peaks involved in breaking down the bacterial cell wall barrier using a permeabilizer. Square wave voltammetry (SWV) was used to identify changes in the p-nitrophenyl-β-D-galactopyranoside (p-APG) oxidation peak, which served as evidence of the successful integration and hydrolysis of β-galactosidase (β-gal). Both modified and unmodified gold electrodes showed an inversely proportional oxidation peak at 500 mV for p-PAG in E. Coli experiments employing SWV, with the modified electrodes showing greater sensitivity. During clinical testing, the proposed biosensor successfully detected urine bacterial counts with a sensitivity of about 75 colony-forming units per millilitre (cfu/ml), despite difficulties in detecting extremely low E. coli concentrations. The use of electrochemical techniques resulted in a significant decrease in experimental time, allowing real-time analysis for useful applications in the detection of bacteria in urine.
• Discussion
• Genital Infection
  Marcelo ChenTaiwan Moderator

  Satoshi TakahashiJapan Moderator
• HIV Screening through the Nation-Wide Sexual Health Friendly Clinical Network: Taiwan Experiences
  Pin-Hui LeeTaiwan Speaker HIV Screening through the Nation-Wide Sexual Health Friendly Clinical Network: Taiwan ExperiencesAs of the end of 2024, Taiwan has accumulated 45,255 HIV notifications since 1984. The number of people living with HIV has been more than 36000. Analysis by age group highlights that the majority of new HIV cases occur among individuals engaging in unsafe sexual behaviors, accounting for over 90% of transmissions. Despite ongoing efforts, undiagnosed HIV infections remain a public health challenge. Estimates using the CD4 depletion model, recommended by the U.S. CDC, show varying undiagnosed rates across age groups, especially for age of 13-35 years. Taiwan has made considerable progress toward the UNAIDS 95–95–95 targets for 2030. In 2024, estimated 92% of people living with HIV were aware of their status, 96% of those diagnosed were receiving treatment, and 95% of treated individuals had achieved viral suppression. To strengthen early diagnosis, Taiwan has implemented various HIV screening programs especially through the B1 program, which promotes comprehensive HIV screening for individuals with STIs, also including acute viral hepatitis A,B,C, or substance use disorders. Education and promotion of the B1 program through the medical professional societies to organize the sexual health friendly clinical network has substantially increased the accessibility of HIV testing. The diagnostic process involves a combination of antigen/antibody screening, immunochromatographic tests, and nucleic acid testing. Healthcare institutions are incentivized through the reimbursement system. The role of urology specialists is particularly emphasized. Between 2019 and 2024, urology clinics and hospitals contributed significantly to the B1 program of HIV testing. The highest HIV positivity rates in these settings were linked to patients diagnosed with syphilis, chlamydia, and condyloma acuminatum (genital warts). Physicians are encouraged to offer HIV testing and health education to at-risk patients and to invite their partners for screening and treatment. In summary, Taiwan continues to advance in its response to the HIV epidemic by improving diagnostic coverage, optimizing care pathways, and engaging frontline specialties such as urology. Emphasis on integrated care models and proactive partner notification are key strategies moving forward in achieving national and international targets for HIV control.
• HPV Vaccination in Men, Asia and the World
  Sang-Rak BaeKorea (Republic of) Speaker HPV Vaccination in Men, Asia and the WorldHPV Vaccination in Men: Status in Asia and the World Human papillomavirus (HPV) comprises a group of over 200 virus types, among which certain high-risk types are known to cause genital warts and various cancers. Persistent infection with high-risk HPV types is a leading cause of cervical cancer and is also associated with vulvar, vaginal, oral/oropharyngeal, penile, and anal cancers. Approximately 5.2% of all cancers globally—amounting to around 600,000 new cases annually—are attributed to HPV infection. Prophylactic vaccination remains the most effective method to prevent these HPV-related malignancies. In the case of cervical cancer, HPV screening and treatment of precancerous lesions are also recognized as effective preventive strategies. However, due to the absence of reliable screening methods for HPV-related conditions in men, the burden of male HPV infection has often been overlooked. As of 2025, around 149 countries have implemented national HPV vaccination programs, of which 82 offer gender-neutral vaccination (GNV). In Asia, Mongolia, Bhutan, the UAE, Qatar, and Kuwait have adopted GNV, and Taiwan is scheduled to expand vaccination to males starting September 2025. This study aims to emphasize the necessity of expanding HPV vaccination for males in Asia, based on global comparisons and the rationale for male vaccination. 1. History of HPV and HPV Vaccination In the 1970s, HPV infection was first identified as a cause of female genital malignancies. In 1985, HPV DNA was detected in head and neck cancer tissues, and in 1995, HPV types 16 and 18 were officially classified as carcinogenic for genital cancers. The first HPV vaccine was developed in 2006, and in 2007, HPV-16 was acknowledged as a carcinogen for head and neck cancers. As of July 2025, 37 out of 38 OECD countries (excluding Türkiye) have implemented national vaccination programs. Japan and Korea currently only provide government-supported vaccination for females. In Asia, Mongolia, Bhutan, UAE, Qatar, and Kuwait offer vaccination for both sexes, with Taiwan including males starting in September 2025. 2. Global Status of HPV-Related Cancers To reduce the incidence of cervical cancer to fewer than 4 cases per 100,000 women by 2030, the WHO has launched the "A World Without Cervical Cancer" initiative, targeting 90% vaccination coverage, 70% screening uptake, and 90% treatment rates. Globally, 87–96% of cervical cancers are HPV-related, with 92% in Asia alone. Additionally, head and neck cancers—the fifth most common cancer—are associated with HPV in 20–40% of cases. Penile cancer is linked to HPV in up to 90% of HGSIL cases and approximately 33% of invasive penile cancers. In total, HPV is associated with over 730,000 cancers worldwide, representing over 5% of all malignancies. 3. Rationale for HPV Vaccination in Males HPV vaccination in males is often underprioritized, as the burden of prevention is traditionally placed on females. Unlike cervical cancer in females, there is no organized screening program for HPV-related non-cervical cancers in men, limiting secondary prevention benefits. Men also show lower awareness of HPV-related diseases, increasing their vulnerability to infection. Due to insufficient vaccine coverage, populations such as MSM and unvaccinated females remain inadequately protected despite herd immunity. Males act as a significant reservoir of HPV. Transmission from female to male occurs at a rate of 5.6 per 100 person-months, while male-to-female transmission is also substantial at 3.5. HPV-infected sperm demonstrates reduced motility and increased DNA fragmentation, potentially affecting fertility. In the U.S., the incidence of HPV-related oropharyngeal cancer in men has surpassed that of cervical cancer in women since the mid-2010s. 4. HPV Vaccination for Males in Asia Asia is home to approximately 60% of the global population. However, the two most populous countries—China and India—do not include HPV vaccination in their national immunization programs. Among the Asian countries offering vaccination, only Mongolia, Bhutan, UAE, Qatar, Kuwait, and now Taiwan (from September 2025) provide GNV. There is significant variability in vaccination coverage across nations. According to GLOBOCAN data, 58% of global cervical cancer cases—around 352,000 new diagnoses—occur in Asia. Given Asia’s population size and disease burden, expanding HPV vaccination programs, particularly for males, is a critical public health priority. 5. Recommendations To prevent HPV-related diseases—including cervical cancer, oropharyngeal cancer, and benign HPV-related conditions—HPV vaccination is recommended for both males and females aged 9–26. Individuals aged 9–14 should receive two doses at 0 and 6 months; those aged 15–26 should receive three doses at 0, 1, and 6 months. The optimal age for vaccination is 11–12 years. Women aged 27 and above may receive the vaccine based on individual clinical decision-making. 6. Conclusion HPV affects both sexes, contributing significantly to disease burden in males through cancers and anogenital warts. The lack of organized screening for HPV-related diseases in men makes gender-neutral vaccination (GNV) a fair and effective public health strategy. GNV may also accelerate cervical cancer elimination and increase program resilience against future disruptions. In particular, the high burden of HPV-related diseases in Asia underscores the urgency and importance of expanding vaccination coverage across the region.
• Antimicrobial Resistance on Neisseria Gonorrhoeae and Mycoplasma Genitalium
  Koichiro WadaJapan Speaker Antimicrobial Resistance on Neisseria Gonorrhoeae and Mycoplasma GenitaliumSexually transmitted diseases, in which Neisseria gonorrhoeae and Mycoplasma genitalium are the pathogenic microorganisms, have become a social problem also in Japan. Drug resistance has been increasing, especially among penicillins, macrolides, and fluoroquinolones in Neisseria gonorrhoeae. Mycoplasma genitalium was originally not highly susceptible to tetracyclines, but has recently become resistant to macrolides and fluoroquinolones. N. gonorrhea can be treated with a 1g single-dose of ceftriaxone, but urethritis caused by M. genitalium sometimes requires sequential/combination therapy, and many cases are difficult to treat. In my presentation, I would like to discuss diagnosis and treatment, especially drug resistance in Japan.
• Discussion

• Opening
  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.
• Debate: To Do or Not to Do Surgery for High Grade (IV-V) Vesicoureteral Reflux
  Grahame SmithAustralia Moderator

  Yu-Chen ChenTaiwan Moderator What We Should Know about Sexual Development Disorders Disorders of Sexual Development (DSDs) represent a spectrum of congenital conditions involving atypical development of chromosomal, gonadal, or anatomical sex. Early identification and accurate diagnosis are essential for guiding clinical management and psychosocial support. This talk will provide an overview of the classification of DSDs, including 46,XX DSD, 46,XY DSD, and sex chromosome DSDs, and highlight key diagnostic steps such as hormonal profiling, genetic testing, and imaging studies. Common conditions such as congenital adrenal hyperplasia (CAH), androgen insensitivity syndrome (AIS), and gonadal dysgenesis will be discussed, with emphasis on a multidisciplinary approach involving pediatric endocrinologists, geneticists, surgeons, and psychologists. Practical considerations in gender assignment, surgical timing, and long-term follow-up will also be addressed. This session aims to equip urology residents with the essential knowledge to recognize and contribute to the care of patients with DSDs.
• Proposition for VUR Surgery
  Kentaro Mizuno Japan Speaker Proposition for VUR Surgery
• Opposition to VUR Surgery
  Shin-Mei WongTaiwan Speaker Opposition to VUR SurgeryVesicoureteral reflux (VUR) is closely associated with urinary tract infections (UTIs) and renal scarring in neonates and children. Primary VUR attributes its pathogenesis to a congenitally short submucosal ureteral tunnel, resulting in inadequate ureterovesical junction resistance. This concept has informed the development of various surgical techniques aimed at increasing ureteral resistance. However, emerging evidence suggests that surgical correction does not consistently offer superior long-term renal outcomes compared to continuous antibiotic prophylaxis (CAP). This raises important concerns regarding the role of surgery as the treatment for high-grade VUR. Given the heterogeneity of VUR, underlying factors such as elevated detrusor pressure, increased urethral resistance, or persistently low ureteral resistance must be thoroughly evaluated and addressed prior to surgical intervention. As VUR remains one of the most debated conditions in pediatric urology, further studies are essential to improve risk stratification and refine treatment algorithms to optimize both infection control and renal preservation.
• Challenges from the Floor
• Advancement in the Management of Pediatric Hydronephrosis and UPJO
  Yoshiyuki KojimaJapan Moderator

  Yu-Hua FanTaiwan Moderator Updates on Vesicoureteral RefluxVesicoureteral reflux (VUR) remains a critical topic in pediatric urology, with ongoing debates surrounding its diagnosis, management, and long-term outcomes. This presentation will provide an updated overview of the current understanding of VUR, including recent advances in imaging techniques, risk stratification, and non-surgical versus surgical treatment options. Emerging evidence on the natural history of VUR, the role of continuous antibiotic prophylaxis, and evolving criteria for surgical intervention will be discussed. The session will also highlight recent guideline updates, innovations in endoscopic injection materials, and strategies for individualized patient care. By integrating recent clinical data and expert consensus, this talk aims to provide practical insights into optimizing VUR management in contemporary practice.
• Postnatal Hydronephrosis: How to D/D Obstructive from Non-Obstructive Hydronephrosis
  Jae-Min Chung Korea (Republic of) Speaker Postnatal Hydronephrosis: How to D/D Obstructive from Non-Obstructive Hydronephrosis
• Which Surgical Treatment is Best for UPJO in Infants: Open, Laparoscopic, Robotic Assisted
  Shang-Jen ChangTaiwan Speaker 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.
• How I do It: Laparoscopic and Robotic Assisted Pyeloplasty
  Sujit ChowdharyIndia Speaker How I do It: Laparoscopic and Robotic Assisted Pyeloplasty aim is to present the technical points with illustrative cases on the learning experience of over 600 newborn / open / laparoscopic / robotic pyeloplasties for Pelviureteric junction obstruction along with long term follow up and management approach to complications over a twenty year follow up .
• Discussion
• Closing

• UTI & Hydronephrosis: What's New and Asian Guideline Update
  Hio Fai LaoMacau, China Moderator

  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.
• Prostate Cancer Nomograms and Their Application in Asian Men
  Samuel Vincent G. YrastorzaPhilippines Moderator

  Rajeev KumarIndia Speaker Troubleshooting in Endoscopic Stone Surgery: How to Handle Unexpected Challenges in RIRS and ECIRSProstate Cancer Nomograms and Their Application in Asian MenNomograms help to predict outcomes in individual patients rather than whole populations and are an important part of evaluation and treatment decision making. Various nomograms have been developed in malignancies to predict and prognosticate clinical outcomes such as severity of disease, overall survival, and recurrence-free survival. In prostate cancer, nomograms were developed for determining need for biopsy, disease course, need for adjuvant therapy, and outcomes. Most of these predictive nomograms were based on Caucasian populations. Prostate cancer is significantly affected by race, and Asian men have a significantly different racial and genetic susceptibility compared to Caucasians, raising the concern about the generalizability of these nomograms. There are very few studies that have evaluated the applicability and validity of the existing nomograms in in Asian men. Most have found significant differences in the performance in this population. Thus, relying on such nomograms for treating Asian men may not be appropriate and collaborative efforts are required within Asian countries to develop locally relevant nomograms.What Is Critical Appraisal?Critical appraisal is the process of systematically evaluating research studies to assess their validity, relevance, and trustworthiness. The goal is to determine whether a study’s results are credible and useful for clinical decision-making, research, or policy. This has become increasingly important as there has been a massive increase in the number of scientific journals and not all published research is of equal quality. Critical appraisal helps healthcare professionals avoid being misled by poor-quality studies, make evidence-based decisions and improve patient outcomes. The key purposes are to assess validity of the study and its results and determine applicability to the specific population. It involves assessing the study design, methodological quality, completeness of reporting, potential sources of bias and potential for misconduct. There are number of reporting guidelines that can be used for performing critical appraisal. Additionally, being aware of essential reporting standards and common problems with studies can help readers make informed decisions.Scientific Misconduct and PitfallsNo abstractExample of the “Ideal” AbstractNo Abstract
• BJUI Lecture: The ProtecT Trial and Its Impact in 2025
  Yeong-Shiau PuTaiwan Moderator

  Freddie HamdyUnited Kingdom Speaker BJUI Lecture: The ProtecT Trial and Its Impact in 2025Introduction
• Active Surveillance for Early Prostate Cancer
  Eddie ChanHong Kong, China Moderator How to Escape Surgical ComplicationsSurgical complications can significantly impact patient outcomes and healthcare resources. This talk will focus on practical strategies to minimize complications in urologic surgery, tailored specifically for urology fellows. Real-life case examples will illustrate how thoughtful preparation and proactive communication can prevent or mitigate complications. Additionally, we will discuss structured approaches to managing complications when they arise, including communication with the patient and team, documentation, and timely intervention. Through real-life case examples, this session aims to enhance surgical judgment, promote patient safety, and build confidence in complication management.

  Mikio SugimotoJapan Speaker Active Surveillance for Early Prostate CancerActive surveillance for early prostate cancer The global incidence of prostate cancer is steadily increasing. While the prevalence has historically been lower in Asia compared to Western countries, recent trends suggest a significant rise in prostate cancer cases across the region. This increase is likely attributed to the Westernization of dietary habits and the aging population. The widespread use of prostate-specific antigen (PSA) screening has led to an increase in the detection of early-stage prostate cancer, which is a positive development. However, this has also resulted in the identification of a substantial number of low-grade, indolent cancers that are unlikely to impact life expectancy, raising concerns about overdiagnosis and overtreatment. Active surveillance has emerged as a practical and effective strategy to address overtreatment in the PSA era. Although the adoption of active surveillance has increased dramatically in Western countries, its implementation in Asia remains limited. In Japan, a large-scale prospective observational study, PRIAS-JAPAN, has been underway since 2010, with over 1,400 patients enrolled to date. In this report, we briefly present the findings of PRIAS-JAPAN and explore strategies to promote the broader and more effective use of active surveillance in clinical practice.
• PSA Kinetics Following PADT in mHSPC. Is It a Real-World Tool for Predicting Oncologic Outcome?
  Yen-Ta ChenTaiwan Moderator

  Bannakij LojanapiwatThailand Speaker PSA Kinetics Following PADT in mHSPC. Is It a Real-World Tool for Predicting Oncologic Outcome?PSA Kinetics following Primary Androgen Deprivation Therapy (PADT) in mHSPC. Is it a Real-world Tool for Prediction Oncologic Outcome? Bannakij Lojanapiwat, M.D. Professor of Urology, Chiang Mai University, Thailand. Of recent guidelines, upfront primary androgen deprivation monotherapy or combination therapy (PADT) is recommended for the treatment of metastatic hormone sensitive prostate cancer (mHSPC). Limitation of real-world treatment such as culture difference, financial barrier, geographic access to treatment and high operation/ radiation risks associated with medical comorbidity led to underutilization of combination therapy as the standard guideline. Prognostic factors are important in clinical practice which can predict the clinical outcome that offer the pre-treatment counseling for patients to select the optimal treatment. Prostate specific antigen (PSA) levels is one of the important key prognostic markers. PSA kinetics of nadir PSA level and time to nadir PSA following the treatment are the important role for progression to CRPC and oncologic outcome. Our study and the previous studies reported better oncologic outcome especially overall survival, cancer specific survival and time to developed CRPC in mHSPC patients received upfront PADT who decline PSA≥95% (deep responder), PSA nadir ≤ 0.2 ng/ml (low PSA nadir level), time to PSA nadir ≥ 6 month and PSA decline velocity <11 ng/ml/month. PSA Kinetics following Primary Androgen Deprivation Therapy (PADT) is one of a real-world tool for prediction oncologic outcome in the treatment of mHSPC.
• The Potential Role of Urinary Microbiome in Benign Prostate Hyperplasia/Lower Urinary Tract
  Horie ShigeoJapan Moderator

  Seung Il JungKorea (Republic of) Speaker The Potential Role of Urinary Microbiome in Benign Prostate Hyperplasia/Lower Urinary TractHistorically, urine in the urinary tract was considered “sterile” based primarily on culture-dependent methods of bacterial detection. However, the advent of enhanced quantitative urine culture (EQUC) and 16S ribosomal RNA gene sequencing has revealed the presence of bacterial DNA and live bacteria in the urinary tract, fundamentally changing our understanding of the urogenital microbiome. Recent studies have demonstrated that healthy men, like women, possess distinct urinary tract microbiota. While evidence linking the urinary microbiota to lower urinary tract symptoms (LUTS) in women is accumulating, the association between urinary microbiota and LUTS in men, particularly those with benign prostatic hyperplasia (BPH), remains under investigation. Emerging evidence suggests that dysbiosis of the urinary microbiota may contribute to BPH development and symptom severity through mechanisms such as chronic prostatic inflammation, inflammasome activation (e.g., NLRP3), and microbial-driven DNA damage in prostate epithelial cells. Notably, organisms like Escherichia coli and Burkholderia spp. have been implicated in intraprostatic inflammation and progression of BPH. Additionally, the gut–prostate axis has gained attention as gut microbiota composition—particularly a high Firmicutes/Bacteroidetes ratio—has been associated with BPH via metabolic and immunological pathways. These findings open new avenues for microbiome-targeted therapies, including probiotics and modulation of intestinal microbiota, to prevent or manage male LUTS/BPH. This lecture reviews current evidence linking the urogenital microbiome to BPH pathogenesis and symptomatology in men. Despite promising findings, clinical translation remains limited due to heterogeneity in sampling methods and lack of robust, large-scale studies. Further research is required to validate microbial biomarkers and develop evidence-based, noninvasive strategies for prevention and treatment of male LUTS/BPH.

• Opening
  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.
• The Japanese Nationwide Surveillance for UTIs and the JAID/JSC Guide to Clinical Management of Infectious Diseases 2023: The Usefulness of the Urinary Flow Cytometry Method (uFCM)
  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.

  Koichiro WadaJapan Speaker Antimicrobial Resistance on Neisseria Gonorrhoeae and Mycoplasma GenitaliumSexually transmitted diseases, in which Neisseria gonorrhoeae and Mycoplasma genitalium are the pathogenic microorganisms, have become a social problem also in Japan. Drug resistance has been increasing, especially among penicillins, macrolides, and fluoroquinolones in Neisseria gonorrhoeae. Mycoplasma genitalium was originally not highly susceptible to tetracyclines, but has recently become resistant to macrolides and fluoroquinolones. N. gonorrhea can be treated with a 1g single-dose of ceftriaxone, but urethritis caused by M. genitalium sometimes requires sequential/combination therapy, and many cases are difficult to treat. In my presentation, I would like to discuss diagnosis and treatment, especially drug resistance in Japan.
• Current Trend of Antibiotic Use for Urological Disease in South Korea
  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.

  Sang-Rak BaeKorea (Republic of) Speaker HPV Vaccination in Men, Asia and the WorldHPV Vaccination in Men: Status in Asia and the World Human papillomavirus (HPV) comprises a group of over 200 virus types, among which certain high-risk types are known to cause genital warts and various cancers. Persistent infection with high-risk HPV types is a leading cause of cervical cancer and is also associated with vulvar, vaginal, oral/oropharyngeal, penile, and anal cancers. Approximately 5.2% of all cancers globally—amounting to around 600,000 new cases annually—are attributed to HPV infection. Prophylactic vaccination remains the most effective method to prevent these HPV-related malignancies. In the case of cervical cancer, HPV screening and treatment of precancerous lesions are also recognized as effective preventive strategies. However, due to the absence of reliable screening methods for HPV-related conditions in men, the burden of male HPV infection has often been overlooked. As of 2025, around 149 countries have implemented national HPV vaccination programs, of which 82 offer gender-neutral vaccination (GNV). In Asia, Mongolia, Bhutan, the UAE, Qatar, and Kuwait have adopted GNV, and Taiwan is scheduled to expand vaccination to males starting September 2025. This study aims to emphasize the necessity of expanding HPV vaccination for males in Asia, based on global comparisons and the rationale for male vaccination. 1. History of HPV and HPV Vaccination In the 1970s, HPV infection was first identified as a cause of female genital malignancies. In 1985, HPV DNA was detected in head and neck cancer tissues, and in 1995, HPV types 16 and 18 were officially classified as carcinogenic for genital cancers. The first HPV vaccine was developed in 2006, and in 2007, HPV-16 was acknowledged as a carcinogen for head and neck cancers. As of July 2025, 37 out of 38 OECD countries (excluding Türkiye) have implemented national vaccination programs. Japan and Korea currently only provide government-supported vaccination for females. In Asia, Mongolia, Bhutan, UAE, Qatar, and Kuwait offer vaccination for both sexes, with Taiwan including males starting in September 2025. 2. Global Status of HPV-Related Cancers To reduce the incidence of cervical cancer to fewer than 4 cases per 100,000 women by 2030, the WHO has launched the "A World Without Cervical Cancer" initiative, targeting 90% vaccination coverage, 70% screening uptake, and 90% treatment rates. Globally, 87–96% of cervical cancers are HPV-related, with 92% in Asia alone. Additionally, head and neck cancers—the fifth most common cancer—are associated with HPV in 20–40% of cases. Penile cancer is linked to HPV in up to 90% of HGSIL cases and approximately 33% of invasive penile cancers. In total, HPV is associated with over 730,000 cancers worldwide, representing over 5% of all malignancies. 3. Rationale for HPV Vaccination in Males HPV vaccination in males is often underprioritized, as the burden of prevention is traditionally placed on females. Unlike cervical cancer in females, there is no organized screening program for HPV-related non-cervical cancers in men, limiting secondary prevention benefits. Men also show lower awareness of HPV-related diseases, increasing their vulnerability to infection. Due to insufficient vaccine coverage, populations such as MSM and unvaccinated females remain inadequately protected despite herd immunity. Males act as a significant reservoir of HPV. Transmission from female to male occurs at a rate of 5.6 per 100 person-months, while male-to-female transmission is also substantial at 3.5. HPV-infected sperm demonstrates reduced motility and increased DNA fragmentation, potentially affecting fertility. In the U.S., the incidence of HPV-related oropharyngeal cancer in men has surpassed that of cervical cancer in women since the mid-2010s. 4. HPV Vaccination for Males in Asia Asia is home to approximately 60% of the global population. However, the two most populous countries—China and India—do not include HPV vaccination in their national immunization programs. Among the Asian countries offering vaccination, only Mongolia, Bhutan, UAE, Qatar, Kuwait, and now Taiwan (from September 2025) provide GNV. There is significant variability in vaccination coverage across nations. According to GLOBOCAN data, 58% of global cervical cancer cases—around 352,000 new diagnoses—occur in Asia. Given Asia’s population size and disease burden, expanding HPV vaccination programs, particularly for males, is a critical public health priority. 5. Recommendations To prevent HPV-related diseases—including cervical cancer, oropharyngeal cancer, and benign HPV-related conditions—HPV vaccination is recommended for both males and females aged 9–26. Individuals aged 9–14 should receive two doses at 0 and 6 months; those aged 15–26 should receive three doses at 0, 1, and 6 months. The optimal age for vaccination is 11–12 years. Women aged 27 and above may receive the vaccine based on individual clinical decision-making. 6. Conclusion HPV affects both sexes, contributing significantly to disease burden in males through cancers and anogenital warts. The lack of organized screening for HPV-related diseases in men makes gender-neutral vaccination (GNV) a fair and effective public health strategy. GNV may also accelerate cervical cancer elimination and increase program resilience against future disruptions. In particular, the high burden of HPV-related diseases in Asia underscores the urgency and importance of expanding vaccination coverage across the region.