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Recent Advancements in Pediatric Urology (II)
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Li-Yi LimMalaysia
Speaker
Pediatric Urological SurgeryWhat’s New in Nocturnal Enuresis?
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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.
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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.
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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.
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TICC - 2F 201AF
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