Pei-Shan Yang

Marcelo ChenTaiwan Moderator

Seung-Ju LeeKorea (Republic of) Moderator Questionnaires Provide Rapid Diagnosis of uUTI

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.

Jun KameiJapan Speaker Definition of Perioperative Infections and Surgical Classification

Wai Kit MaHong Kong, China Speaker Surgical Antibiotic Prophylaxis: Types and Timing

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 •

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.

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.

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

Jeong Woo LeeKorea (Republic of) Speaker Transurethral Surgery

Toshiki EtaniJapan Speaker Surgery for Urolithiasis

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.

Li-Yi LimMalaysia Speaker Pediatric Urological SurgeryWhat’s New in Nocturnal Enuresis?

Chang Il ChoiKorea (Republic of) Speaker Renal Transplantation

Yoshiki HiyamaJapan Speaker Prostate Biopsy

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.

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.