Abstracts of the 45th Congress of the Société Internationale d’Urologie

Review Committee

The SIU wishes to extend its gratitude to the urologists who contributed their time to review abstract submissions for the 45th SIU Congress:

Refaat Abusamra, Libya;	Sanjai Addla, India;
Kinju Adhikari, India;	Neeraj Agarwal, United States;
Madhu Agrawal, India;	Sachin Agrawal, United Kingdom;
Thomas Ahlering, United States;	Shusuke Akamatsu, Japan;
Peter Albers, Germany;	Salah Albuheissi, United Kingdom;
Naif Alhathal, Saudi Arabia;	Bedeir Ali-El-Dein, Egypt;
Murtadha Almusafer, Iraq;	Anastasios Anastasiadis, Greece;
Mohamed Arafa, Qatar;	Amandeep Arora, India;
Zeeshan Aslam, United Kingdom;	Hammad Ather, Pakistan;
Widi Atmoko, Indonesia;	Melanie Aubé-Peterkin, QC;
Riccardo Autorino, United States;	Ben Ayres, United Kingdom;
Puskal Kumar Bagchi, India;	Ganesh Bakshi, India;
Mevlana Derya Balbay, Turkey;	Neil Barber, United Kingdom;
John Barry, United States;	Jens Bedke, Germany;
Elisa Berdondini, Italy;	Gajanan Bhat, India;
Amit Bhattu, United States;	Naeem Bhojani, Canada;
N I Bhuiyan, Bangladesh;	Marta Bizic, Serbia;
Damien Bolton, Australia;	Vincenzo Borgna, Chile;
Muhammad Bulbul, Lebanon;	Gian Maria Busetto, Italy;
Ana Gabriela Caballero Garcia, Mexico;	Adam Calaway, United States;
Amparo Camacho, United States;	Kevin Campbell, United States;
Francesco Capelan, Switzerland;	Manuel Castanheira de Oliveira, Portugal;
Christine Joy Castillo, Philippines;	David Castro-Diaz, Spain;
Arun Chawla, India;	Manohar ChikkaMoga Siddaiah, India;
Archil Chkhotua, Georgia;	Sung Yong Cho, Korea, Rep.;
Michael Chua, Canada;	Frederik Claassen, South Africa;
Nicolae Crisan, Romania;	Vito Cucchiara, Italy;
Marc Dall’Era, United States;	Jean de la Rosette, Turkey;
Cosimo De Nunzio, Italy;	Miroslav Djordjevic, Serbia;
Alim Dymov, Russian Federation;	James Eastham, United States;
Haitham Elbardisi, Qatar;	Mohamed Elshazly, Egypt;
Dean Elterman, Canada;	Amr Emara, United Kingdom;
Bhavatej Enganti, India;	Tarik Esen, Turkey;
Masatoshi Eto, Japan;	Christopher Evans, United States;
Papa Ahmed Fall, Senegal;	Jawad Feghali, Lebanon;
Adam Feldman, United States;	Mario Fernandez, Chile;
Margit Fisch, Germany;	Avelino Fraga, Portugal;
Mark Frydenberg, Australia;	Jurgen Futterer, Netherlands;
Seiichi Fuziwara Ruiz, Mexico;	Mauro Gacci, Italy;
Valerie Gan, Singapore;	Syed Mohammed Ghouse, India;
Stilianos Giannakopoulos, Greece;	Scott Gilbert, United States;
Peter Gilling, New Zealand;	Kah Ann Git, Malaysia;
Hemant Kumar Goel, India;	Reynaldo Gomez, Chile;
Paolo Gontero, Italy;	Mariano Sebastian Gonzalez, Argentina;
Jorge de Jesus Gonzalez Moncayo, Mexico;	Ganesh Gopalakrishnan, India;
Michael Grasso III, United States;	Stavros Gravas, Cyprus;
Rahul Gupta, India;	Sakineh Hajebrahimi, Iran;
Rizwan Hamid, Saudi Arabia;	Peter Hammerer, Germany;
Richard Hautmann, Germany;	Wayne Hellstrom, United States;
Andres Hernandez-Porras, Mexico;	Sarah Hillery, United Kingdom;
Sudhir Isharwal, United States;	Mohamed Jalloh, Senegal;
Rohit Joshi, Gujarat;	Amit Joshi, India;
Pankaj Joshi, India;	MD Jahangir Kabir, Dhaka;
Sanjeevan Kalavampara, India;	Ayo Kalejaiye, United Kingdom;
Ganesh Kamath, India;	Nanjappa Kandarthanda, India;
Gokul Vignesh Kandaswamy, United Kingdom;	Bhalchandra Kashyapi, India;
Wassim Kassouf, Canada;	Christof Kastner, United Kingdom;
George Kasyan, Russian Federation;	Aparna Katdare, India;
Samir Khanna, India;	Mohit Khera, United States;
Soo Woong Kim, Korea, Rep.;	Christian Kollmannsberger, Canada;
Badrinath Konety, United States;	Gowtham krishna, India;
Deepak Krishnappa, India;	Raghunath Krishnappa, India;
Sanjay Kulkarni, India;	Nitesh Kumar, India;
Naveen Kumar, India;	Rajeev Kumar, India;
Anup Kumar, India;	Manal Kumar, United Kingdom;
Teele Kuusk, Estonia;	Cheol Kwak, Korea, Rep.;
M. Pilar Laguna Pes, Turkey;	Isiaka Olayinka Lawal, Nigeria;
Bradley Leibovich, United States;	Seth Lerner, United States;
Mohammed Lezrek, Morocco;	Roger Li, United States;
Richard Link, United States;	Vashti Livingston, United States;
Ka Lun Lo, Hong Kong;	Kevin Lu, Taiwan;
Angus Luk, United Kingdom;	Lukas Lusuardi, Austria;
Bill Lynch, Australia;	Petr Macek, France;
Pankaj Maheshwari, India;	Vijayan Manogran, Malaysia;
Sunny Doodu Mante, Ghana;	Guglielmo Mantica, Italy;
Marlon Martinez, Philippines;	Jose Antonio De Jesus Martinez Garcia, Mexico;
Francisco Martins, Portugal;	Timothy Masterson, United States;
Agostino Mattei, Switzerland;	Achille Aurele Mbassi, Cameroon;
Kurt McCammon, United States;	Arturo Mendoza-Valdes, Mexico;
Ramasamy Meyyappan, India;	Maria Carmen Mir, Spain;
Dilip Kumar Mishra, India;	Dionysios Mitropoulos, Greece;
Vaibhav Modgil, United Kingdom;	Ignacio Moncada Iribarren, Spain;
Nicola Mondaini, Italy;	Simone Morra, Italy;
Evelyn Moshokoa, South Africa;	Sherif Mourad, Egypt;
Mohamad Moussa, Lebanon;	Faiz Mumtaz, United Kingdom;
Tony Mundy, United Kingdom;	Shingai Mutambirwa, South Africa;
Gopichand Mutyalapaty, India;	Ghulam Nabi, United Kingdom;
Kushal Narang, India;	Brusabhanu Nayak, India;
Rishi Nayyar, New Delhi;	Medina Ndoye, Senegal;
Rajendra Nerli, India;	Rotimi Nettey, United States;
Anthony C.F. Ng, Hong Kong;	Dmitriy Nikolavsky, United States;
Alexander Nwofor, Nigeria;	Nkemdilim Okonji, Nigeria;
E. Oluwabunmi Olapade-Olaopa, Nigeria;	Tim Oliver, United Kingdom;
Teng Aik Ong, Malaysia;	Karima Oualla, Morocco;
Priya Padmanabhan, United States;	Edgar Paez, United Kingdom;
Mahendra Pal, India;	Karl Pang, United Kingdom;
Athanasios Papatsoris, Greece;	Ashish Pardeshi, Maharashtra;
Manish Patel, Australia;	Abhijit Patil, India;
Prashant Pattnaik, India;	Joe Philip, United Kingdom;
Merycarla Pichardo Garcia, Dominican Republic;	Naveen Pokala, United States;
Gagan Prakash, India;	Sarah Psutka, United States;
Rajveer Purohit, United States;	Vijay Radhakrishnan, India;
Ragu N Ragavan, India;	Weranja Ranasinghe, Australia;
Hassan Razvi, Canada;	Leonardo Reis, Brazil;
Patrick Richard, Canada;	Keith Rourke, Canada;
Leticia Ruiz, Panama;	Ravindra Sabnis, India;
Simpa Salami, Michigan;	Michael Samarinas, Greece;
Saeed Samnakay, Kenya;	Paksi Satyagraha, Indonesia;
Silvia Secco, Italy;	Ugur Selek, Turkey;
Shomik Sengupta, Australia;	John Sfakianos, United States;
Shailesh Kumar SHAH, India;	Isteaq Shameem, Bangladesh;
Ahmad Shamsodini, Qatar;	Anuj Sharma, India;
Mazhar Sheikh, United Kingdom;	Amitabh Singh, India;
Harprit Singh, India;	Amitabh Kumar Sinha, India;
Petros Sountoulides, Greece;	Tarkan Soygur, Turkey;
Pietro Spatafora, Italy;	Philippe Spiess, United States;
Kelly Stratton, United States;	Rajeev T P, India;
Anil Takvani, India;	Vineet Talwar, India;
Simon Tanguay, Canada;	Jeremy Teoh, Hong Kong;
George Thalmann, Switzerland;	Kishore Thekke Adiyat, India;
Manohar Thimme Gowda, India;	Charalampos Thomas, Greece;
Ali Thwaini, United Arab Emirates;	Liliya Tryfonyuk, Ukraine;
Ömer Levent Tuncay, Turkey;	Yüksel Ürün, Turkey;
Chandramohan Vaddi, India;	Suryaprakash Vaddi, India;
Nikhil Vasdev, United Kingdom;	Rajan Veeratterapillay, United Kingdom;
Gonzalo Vitagliano, Argentina;	Adrian Wagg, Canada;
Hazel Warburton, UK;	Nick Watkin, United Kingdom;
Ranga Eshaka Wickramarachchi, Sri Lanka;	Liping Xie, China;
Rahul Yadav, India;	Steffi Kar Kei Yuen, Hong Kong;
Prahara Yuri, Indonesia;	Wen Zhong, China;
Kevin Zorn, Canada;	Ali Ersin Zumrutbas, Turkey.

1. Adrenals

1.1. Moderated Oral ePosters

MP-01.01—Bilateral Adrenalectomy as an Urgent Intervention for Severe ACTH-Dependant Cushing’s Syndrome: A Case Series 

• Agarwal Keshav, Ramachandran Rashmi, Tandon Nikhil, Kumar Rajeev
  All India Institute of Medical Sciences, New Delhi, India

• Introduction and Objectives: Patients with severe metabolic complications of Cushing’s syndrome may require urgent surgery to control cortisol levels, especially when it is not amenable to medical management. We reviewed our experience with urgent bilateral adrenalectomy to assess safety, surgical outcomes and impact on health-related quality of life.
  Materials and Methods: In an IRB approved study, we reviewed our prospective database of patients who underwent urgent bilateral adrenalectomy between 2016 and 2023. Preoperative clinical parameters, operative details and complications were recorded. Patients were followed-up for resolution of symptoms, complications of chronic steroid intake and quality of life using the WHO-QoL BREF questionnaire.
  Results: 8 patients underwent urgent bilateral adrenalectomy for severe ACTH dependant hypercortisolism with poor performance status (ECOG ≥ 3), intractable hypokalemia, uncontrolled diabetes, hypertension and progressive debilitating myopathy. 4 had sepsis, and 2 had acute psychosis (Table 1). 7 patients had transperitoneal laparoscopic surgery, and 1 underwent open surgery (Table 2). All patients had resolution of symptoms post-operatively, 5 became normotensive, 5 had 50% reduction in requirement of insulin, and 2 patients required no oral hypoglycaemics. Episodes of steroid deficiency occurred in 2 patients. 3 patients died, one after 4 weeks due to malignancy, one due to complications of tracheostomy after 7 weeks, one due to sepsis after 1 year. The remaining 5 had satisfactory quality of life in all domains till the time of follow-up.
  Conclusions: Urgent bilateral adrenalectomy is feasible in severe ACTH dependant Cushing’s syndrome when medical management fails to control complications and symptoms of severe hypercortisolism. It results in amelioration of symptoms and comorbidities with satisfactory quality of life.

MP-01.02—Gr Suppression Activates Atf4-Xct Axis to Drive Adrenocortical Carcinoma Progression 

• Wu Kan, Bai Hexiang, Wu Kang, Li Xiang
  West China Hospital, Sichuan University, Chengdu, China

• Introduction and Objectives: Adrenocortical carcinoma (ACC) is a rare, aggressive malignancy with limited treatment options. The glucocorticoid receptor (GR), a key regulator of stress responses, has undefined roles in ACC pathogenesis. This study aimed to (1) characterize GR expression patterns in ACC versus normal/benign tissues; (2) assess GR’s prognostic significance; (3) elucidate GR-regulated molecular mechanisms; and (4) evaluate therapeutic strategies targeting GR-associated pathways.
  Materials and Methods: GR mRNA levels were analyzed using TCGA-ACC (n = 79), GEO datasets (GSE12368, GSE90713), and GTEx normal adrenal tissues (n = 3). GR protein expression was quantified via immunohistochemistry in 78 ACC patients. GR-knockdown (shGR) and overexpressing (OE-GR) ACC cell lines were established for functional assays (proliferation, migration, apoptosis). Subcutaneous xenografts in nude mice assessed tumor growth. Transcriptomics and bioinformatics identified GR-regulated pathways, validated by qPCR/WB. Amino acid metabolism (cystine, GSH/GSSG, ROS) and therapeutic interventions (xCT/PI3K inhibitors) were analyzed.
  Results: GR expression was elevated in ACC versus normal/adenomas (p < 0.001) but paradoxically reduced in cortisol-secreting ACC, correlating with poorer recurrence-free survival (HR = 2.41, p = 0.004) and independent prognostic value (p = 0.016). GR knockdown enhanced cell proliferation (2.3-fold), migration (3.1-fold), and xenograft growth (1.8-fold, p = 0.007), while GR overexpression suppressed malignancy. GR loss activated PI3K-Akt-mTOR signaling, driving ATF4 nuclear translocation and xCT upregulation. This increased cystine uptake (45%, p = 0.002), GSH/GSSG ratio (2.1-fold), and glutamine dependence. ATF4/xCT silencing reversed GR-mediated aggressiveness. Combined xCT inhibitor (erastin) and PI3K inhibitor (LY294002) synergistically suppressed tumor growth (67% volume reduction vs. monotherapy, p < 0.001) without toxicity, restoring redox balance and apoptosis.
  Conclusions: GR suppression promotes ACC progression via PI3K-Akt-mTOR-driven activation of the ATF4-xCT metabolic axis, enhancing cystine metabolism and glutamine dependency. Targeting this pathway with xCT/PI3K inhibitors demonstrates potent anti-tumor synergy, positioning GR as both a prognostic biomarker and therapeutic vulnerability in ACC.

MP-01.03—Pheochromocytoma During Pregnancy: A Series of Four Cases with Varying Management Strategies 

• Toshib GA, Anubhuti Rana, Sharma K Aparna, Ramachandran Rashmi, Tandon Nikhil, Kumar Rajeev
  All India Institute of Medical Sciences, New Delhi, India

• Introduction and Objectives: The occurrence of a pheochromocytoma during pregnancy poses increased maternal and fetal morbidity and mortality if left undiagnosed and untreated. Surgical removal is the definitive treatment and may be performed during the second trimester, concurrent with delivery, or after confinement. We reviewed our experience of four cases with varied presentations and management. The occurrence of a pheochromocytoma during pregnancy poses increased maternal and fetal morbidity and mortality if left undiagnosed and untreated. Surgical removal is the definitive treatment and may be performed during the second trimester, concurrent with delivery, or after confinement. We reviewed our experience of four cases with varied presentations and management.
  Materials and Methods: Case 1: A 26-year lady at 9 weeks of gestation presented with episodic palpitations, sweating, headache and a history of hypertension and diabetes with previous first-trimester spontaneous abortion due to chronic hypertension. Case 2: A 27-year lady was diagnosed with hypertension during a routine antenatal check-up at 15 weeks. Case 3: A 24-year lady at 33 weeks gestation presented with hypertension, headache, sweating and right upper abdominal pain. Case 4: A 26-year lady was detected to have an adrenal lesion on antenatal ultrasound at 24 weeks gestation with a history of hypertension, not on medication. All patients had an adrenal mass on imaging and elevated catecholamines.
  Results: In all patients, blood pressure control was achieved through adrenergic blockade and careful titration of salt and fluid intake. Case 1 underwent laparoscopic adrenalectomy at 15 weeks gestation. Case 2 and 3, both patients were managed with medical therapy and underwent elective caesarean section combined with laparoscopic adrenalectomy at 36 and 37 weeks of gestation respectively. Case 4: The patient was planned for concurrent adrenalectomy but developed accelerated hypertension at 36 weeks and underwent an emergency caesarean section followed by laparoscopic adrenalectomy 6 weeks postpartum. All four mothers and babies are healthy on follow up.
  Conclusions: Diagnosing pheochromocytoma during pregnancy requires a high level of suspicion. Optimal management of blood pressure during pregnancy allows safe delivery. Laparoscopic adrenalectomy is a safe procedure and may be scheduled at varying times depending on the individual patient’s period of gestation and stability.

MP-01.04—The Effect of Primary Tumor Resection on Overall Survival in Metastatic Phaeochromocytoma and Paraganglioma: A Population-Based Study 

• Wu Kan, Wu Kang, Li Xiang, Bai Hexiang
  West China Hospital, Sichuan University, Chengdu, China

• Introduction and Objectives: Primary tumor resection has been suggested as a potential treatment for metastatic pheochromocytoma and paraganglioma (PPGL), but its survival benefits remain unclear. This study evaluated the impact of primary tumor resection on overall survival (OS) in patients with metastatic PPGL and identified subgroups that may derive the greatest benefit from surgery.
  Materials and Methods: Using the Surveillance, Epidemiology, and End
  Results database (2004–2021), 227 patients with metastatic PPGL were analyzed based on whether they underwent primary tumor resection. Kaplan-Meier survival analysis and multivariable Cox regression models were used to evaluate OS. Sensitivity analyses examined outcomes by tumor type (pheochromocytoma [PHEO] vs. paraganglioma [PGL]), metastatic burden, therapeutic exposures, and metastatic site.
  Results: Of 227 patients, 116 (51%) underwent primary tumor resection. Patients undergoing surgery had significantly longer OS compared to those who did not (80 vs. 37 months; p < 0.001). Multivariable analysis confirmed surgery as an independent predictor of survival (hazard ratio [HR]: 0.56; p = 0.002). Subgroup analyses revealed that surgery was particularly beneficial for patients with adrenal PHEO, metastatic PGL (except abdominal tumor), single-site metastases (HR: 0.27; p = 0.001), bone metastases (HR: 0.37; p = 0.010), and liver metastases (HR: 0.33; p = 0.043). In contrast, no survival benefit was seen in patients with lung metastases (p = 0.144) or multiple metastatic sites (p = 0.709). Surgery also improved OS in patients treated with radiation therapy (p = 0.024) but not systemic therapies (p = 0.451).
  Conclusions: Primary tumor resection appears to improve survival in metastatic PPGL, particularly in patients with limited metastases and favorable metastatic sites (bone and liver). Further research is warranted to optimize patient selection.

1.2. Unmoderated Standard ePosters

UP-01.01—Comprehensive Analysis of an ATF/CREB Family-Based Signature with Regard to Prognosis and Immune Feature in Adrenocortical Carcinoma 

• Jia Yige, Wu Kan, Li Xiang
  West China Hospital, Sichuan University, Chengdu, China

• Introduction and Objectives: The ATF/CREB family members have crucial functions in tumorigenesis and immunity across various cancers. However, the patterns of expression and clinical relevance of ATF/CREB family members in adrenocortical carcinoma (ACC) have yet to be determined. The objective of this study was to examine the gene expression profiles of ATF/CREB family members in ACC and develop a prognostic signature based on this family.
  Materials and Methods: Utilizing data from The Cancer Genome Atlas (TCGA), we assessed the expression levels of 21 ATF/CREB genes in ACC. We constructed a prognostic model using Cox regression and Lasso analyses, with the TCGA cohort serving as the training dataset, and further validated using an independent Gene Expression Omnibus (GEO) dataset and ATF4 immunohistochemical data from 78 samples. To verify the accuracy of the prognostic model, we performed Kaplan-Meier and multivariable Cox analyses. Furthermore, we investigated the relationship between the prognostic signature, immune checkpoints, and immune cell populations.
  Results: Our findings revealed that the ATF/CREB family-based signature significantly stratified ACC cases into high- and low-risk groups based on overall survival (OS) in the TCGA dataset. Moreover, the prognostic signature maintained its status as an independent prognostic factor in multivariate analyses, and its clinical significance was well validated across various clinical subgroups and independent validation cohorts. Notably, high-risk signature patients exhibited distinct immune cell proportions and immune-suppressive states. Furthermore, the signature scores exhibited a negative correlation with multiple immunotherapy biomarkers.
  Conclusions: This study presents the first ATF/CREB family-based model for predicting survival outcomes and immune landscapes for ACC patients. Further validation is necessary to confirm the predictive capacity of this signature in terms of prognosis and response to immunotherapy.

UP-01.02—Correlation Between Preoperative Computed Tomographic Parameters and Final Histopathological Report of Resected Adrenal Masses: A Retrospective Single-Center Study 

• Ganpule Arvind, Coelho Victor, Singh Abhishek, Sabnis Ravindra, Desai Mahesh, Patel Saket
  Muljibhai Patel Urological Hospital, Nadiad, India

• Introduction and Objectives: Adrenal masses are found in approximately 5% of patients undergoing cross-sectional imaging. Determining whether an incidental adrenal mass is malignant or benign is a critical part of the diagnostic process. Advanced imaging techniques often reveal adrenal tumors in both symptomatic and asymptomatic patients. Cross-sectional imaging, particularly CT, provides valuable insights into the composition of adrenal masses. However, many large but benign adrenal tumors are surgically removed for pathological diagnosis, while smaller malignant tumors go undetected. This study aims to analyze the accuracy of CT imaging through radiologic-pathologic correlation and to identify new criteria for more effective diagnosis, which can aid in guiding treatment decisions.
  Materials and Methods: This is a retrospective study in which patient data were collected from hospital records in the Departments of Urology and Pathology at Muljibhai Patel Urological Hospital, Nadiad, India. The study encompassed all patients who underwent surgery for adrenal masses over a 24-year period. CT data from 95 adrenalectomy specimens were retrospectively analyzed with various CT parameters. Various parameters were computed to predict histopathological outcomes using SPSS Version 25.
  Results: A comprehensive analysis was conducted using the entire adrenal mass specimen, rather than just a biopsy tissue sample, enabling us to compute new correlational analytics. The distribution of individual phase Hounsfield Unit (HU) values varied significantly across different conditions, limiting the effectiveness of HU values for diagnosing and differentiating lesions. Even using Absolute washout values of 60 provided sensitivity up to 60%. While conventional individual values lacked required sensitivity, using an HU enhancement cutoff of 30 provided a sensitivity up to 70% for classifying lesions as malignant. Combining an HU enhancement cutoff of 30 with absolute washout values of 65, it yielded a sensitivity of 90% and specificity of 85%.
  Conclusions: The diagnostic challenge for adrenal lesions on CT imaging arises from the difficulty in distinguishing benign lesions from potentially malignant tumors due to overlapping imaging characteristics. By combining these computed parameters, specificity for identifying malignancy reaches 85%. This approach can significantly enhance decision-making in managing adrenal lesions promptly. Future directions include leveraging AI-driven analysis to improve diagnostic precision by using advanced computational techniques to enhance lesion characterization and differentiation.

1.3. Unmoderated Video ePosters

UVP-01.01—Is Immediate Robot Assisted Re Exploration in Abandoned Large Adrenal Mass Excision Feasible? Our Experience and Points to Learn 

• Saurabh Nikhil, Rawal Sudhir, Singh Amitabh, Khanna Ashish, Pratihar Sarbartha
  Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

• Introduction and Objectives: Adrenal tumours are rare tumours, and adrenal schwannomas are rarer. Prior to surgery, their functioning status must be evaluated. Adrenal schwannomas arise from Schwann cells in the nerves supplying adrenal medulla and are usually benign. With the rise in minimally invasive technique, laparoscopic or robot assisted laparoscopic surgery are being favoured. Laparoscopic adrenalectomy is considered to be the gold standard technique for benign small- and medium-sized adrenal masses (<6 cm) as it has low morbidity rate, short duration of hospitalization and earlier patient recovery. This case aptly exemplifies role of robot assisted laparoscopic surgery in prior failed robot attempt for left adrenal removal in immediate post operative period.
  Materials and Methods: A 46-year-old female with a BMI of 34.2 was referred to our Centre after an abandoned robot assisted (RA) Left Adrenal Mass excision procedure one day ago at a low volume centre. It was metabolically inactive. On examination, she had an abdominal drain and Foley catheter in situ. She underwent an FDG PET Scan for staging and imaging, which showed a large predominantly necrotic soft tissue mass lesion (7.6 × 5.8 cm, SUV max-2.4) in left suprarenal area with no other metabolically active lesion-localized disease. After preop anaesthetic assessment, counselling and consent, she was posted for Redo robot assisted Left Adrenalectomy next day.
  Results: She underwent the surgery successfully and had left hemi-diaphragmatic injury repaired primarily. Her postoperative period was uneventful, chest x-ray was normal, and was discharged on day 3. Her biopsy came as benign schwannoma. She has been on follow up since 1 year without any recurrence.
  Conclusions: It is better to terminate the procedure and refer to a higher centre in view of unmanageable complications. Even in immediate post operative period, robot assisted approach can be attempted with plan to convert to open if not progressing. First step is the creation of pneumoperitoneum (closed or open method); old port sites can be used. Surgeon’s expertise and experience is an important factor, and good assistant is needed with a good multi department support. Inoperability/abandonment in minimal invasive technique by one surgeon should not be a deciding factor for ruling out another attempt by other surgeon.

UVP-01.02—Laparoscopic Bilateral Adrenalectomy and Inter-Aortocaval Mass Excision for Bilateral Pheochromocytoma and Paraganglioma 

• Kumar Rajeev Kumar, Arulraj Kevin
  All India Institute of Medical Sciences, New Delhi, India

• Introduction and Objectives: The presence of a paraganglioma along with bilateral pheochromocytomas is rare, and management can be challenging. Laparoscopic bilateral surgery can be safely performed in most patients. We describe a step-by-step approach to bilateral adrenalectomy and excision of inter-aortocaval mass as a single procedure.
  Materials and Methods: A 23-year-old male presented with right flank pain, episodic headache, and palpitations for one year. On evaluation, he was found to have bilateral adrenal masses and an inter-aortocaval mass with elevated plasma normetanephrines. Contrast tomography revealed a six centimeter lesion in the right adrenal gland, two nodules in the left adrenal, and a three centimeter inter-aortocaval mass. DOTANOC scan showed uptake in all three lesions, confirming the diagnosis of bilateral pheochromocytoma with paraganglioma. The patient was scheduled for bilateral laparoscopic adrenalectomy with inter-aortocaval mass excision. Left adrenalectomy was performed first in the right lateral position using a standard three-port configuration. The patient was then repositioned in the left lateral position for right adrenalectomy and inter-aortocaval mass excision. After adrenalectomy using four ports, the inter-aortocaval mass was dissected away from the duodenum. Lateral dissection was performed to release the tumor from the inferior vena cava. Feeding vessels from the lateral aspect were ligated. Medial dissection was performed to separate the mass from the aorta. Feeding vessels from the cranial and caudal aspect of the mass were divided, thereby completing the dissection.
  Results: The surgical duration was 180 min with minimal blood loss. The post-operative period was uneventful, and steroid supplementation was initiated. In the last 15 years, we have performed bilateral adrenalectomy in 61 patients, including 58 who had synchronous procedures, 37 for pheochromocytomas and 21 for Cushing’s syndrome. The majority were performed laparoscopically with minimal complications.
  Conclusions: Inter-aortocaval mass excision with total adrenalectomy can be safely performed laparoscopically.

2. Basic Science—Benign Diseases

2.1. Unmoderated Standard ePosters

UP-02.01—Exploring the Association Between Pathogen-Derived Antibodies and Benign Prostatic Disease: Insights from Generalized Summary Data-Based Mendelian Randomization 

• Haipeng Zhou, Jiaxue Han, Ping Tan
  West China Hospital, Sichuan University, Chengdu, Sichuan, China

• Introduction and Objectives: Previous research has suggested that infectious pathogens are associated with benign prostatic disease (BPD). This study employs Generalized Summary data-based Mendelian Randomization (GSMR) to explore causal relationships between pathogen-derived antibodies and benign prostatic disease.
  Materials and Methods: We performed robust statistical methods including a bidirectional GSMR to investigate the causal effects between pathogen-derived antibodies and BPD, and additional MR methods, including IVW random effects (IVW-RE), MR-Egger regression were applied to examine the antibody-disease relationships from the main analysis of GSMR.
  Results: The Epstein-Barr virus (EBNA-1) antibody levels were significantly associated with a higher risk of BPH (OR = 1.08, 95% CI = 1.04–1.13, p-value = 8.2 × 10⁻⁵), similar findings were also observed in the corresponding inverse-variance weighted (IVW) analysis (OR = 1.08, 95% CI = 1.04–1.13, p-value = 0.3 × 10⁻³). Conversely, higher Epstein-Barr virus ZEBRA antibody levels were associated with a potential protective effect of BPH (OR = 0.93, 95% CI = 0.89–0.97, p-value = 1.8 × 10⁻³); the same trend was also evident in the IVW analysis. Furthermore, reverse GSMR and MR indicated that BPH could increase the levels of Helicobacter pylori OMP antibody and the seropositivity of Anti-chlamydia trachomatis IgG.
  Conclusions: This study clarifies the complex role of pathogen antibodies in benign prostate diseases, uncovering substantial implications for translational therapeutic development. The results underscore the need for deeper exploration of pathogen-immune system interactions to guide precision intervention strategies.

3. Bladder Cancer—Basic Science

3.1. Moderated Oral ePosters

MP-03.01—Association of High-Risk Human Papillomaviruses with Tumor Stage and Grade in Urothelial Bladder Carcinomas in a Syrian Cohort 

• Abu Haweeleh Mohannad, Almahdi Hamad
  Qatar University, College of Medicine, Doha, Qatar

• Introduction and Objectives: High-risk human papillomaviruses (HR-HPV) are oncogenic pathogens predominantly spread through sexual contact. These viruses have been implicated in various anogenital malignancies. Although the anogenital tract and bladder are anatomically close, the relationship between HPV and bladder urothelial carcinoma (UC) remains controversial. This study aimed to investigate the presence of specific HR-HPV types in Syrian bladder cancer specimens and to assess their association with tumor stage and grade.
  Materials and Methods: Formalin-fixed, paraffin-embedded tissue samples of primary UC were collected and processed. DNA extraction was performed and used for HPV detection through PCR with specific primers targeting the E6/E7 regions of high-risk HPV types. The PCR products were analyzed with 1.5% agarose gel electrophoresis, using HeLa and SiHa cell lines as positive controls and human uterine endothelial cells as a negative control. Statistical analysis used to assess associations between HPV status and clinical variables.
  Results: 73 Syrian bladder cancer samples were analyzed for HR-HPV types, with 34 samples testing positive. The most common HPV types identified were 45 (18%), 52 (15%), and 58 (14%), while HPV types 16 and 18 were not detected. Co-infections with multiple HPV strains were found in 12 of the HPV-positive samples. Patients’ median age was 64.7 years, with 89% of patients being male. Non-invasive papillary urothelial carcinoma was the predominant subtype (58%). Advanced-stage tumors (pT3/pT4) were more frequent in HPV-positive cases. Logistic regression revealed a possible association with advanced stage and HPV status.
  Conclusions: This study offers new perspectives on the role of detecting HR-HPV and its impact on the pathogenesis of bladder UC, which may have potential implications for diagnostics, therapeutics, and preventive strategies in this cancer type. Further research with larger sample sizes is necessary to clarify these associations and determine the clinical relevance of HR-HPV in bladder cancer.

MP-03.02—Influence of Myeloid-Derived Suppressor Cells on Cancer Stem Cells in Bladder Urothelial Carcinoma 

• Mebroukine Samy, Klein Clément, Robert Gregoire, Larmonier Nicolas, Domblides Charlotte
  University Hospital of Bordeaux, Bordeaux, France

• Introduction and Objectives: Myeloid-derived suppressive cells (MDSCs) contribute to an immunosuppressive tumor microenvironment (TME) that supports the progression of bladder urothelial carcinoma. Beyond their immunosuppressive role, MDSCs directly promote cancer progression through invasion and pre-metastatic niche formation. Preliminary evidence suggest MDSCs may induce cancer stem cells (CSCs), related to poor prognosis through their roles in dissemination, quiescence, and chemoresistance. Also, BCG may induce a modification in MDSC’s activity. This study aims at exploring MDSC-CSC interactions in bladder cancer.
  Materials and Methods: The urothelial carcinoma cell line HTB-4 and an in vitro-generated MDSC model known as Human Monocyte-derived Suppressive Cells (HuMoSC) were used. A 2D co-culture was performed for 72 h. Then, HTB-4 cells were separated from HuMoSC and after sorting, HTB-4 cells were cultured in a selective medium in which only CSCs proliferate into tumorspheres. Tumorspheres with or without co-culture were counted at day 6 to assess CSC induction by HuMoSC. The role of TGF-β signaling pathway and BCG was assessed in this coculture model.
  Results: Our findings suggest that HuMoSC induce CSCs in the HTB-4 cancer cell population (Test t Student, p < 0,0001, n = 10), depending on cellular contact (ANOVA, p < 0,001, n = 4). Moreover, BCG-treated HuMoSCs didn’t decrease their ability to induce CSCs, meaning that cells remained aggressive while BCG was administered. Additionally, the TGF-β signaling pathway through isoforms I and II of the receptors appeared to be involved, as indicated by results obtained with LY2109761, which inhibits these receptors (ANOVA, p < 0,0001 n = 3).
  Conclusions: This is the first study providing proof of concept of the induction of a cancer stem cell phenotype by MDSC in bladder urothelial carcinoma. These data contribute to the understanding of the TME and the identification of potential new therapeutic targets that could enhance the response to systemic immunotherapies in bladder urothelial carcinoma.

3.2. Unmoderated Standard ePosters

UP-03.01—Biomarker Detection for Predicting the Efficacy of Neoadjuvant Rc48-ADC Combined with Immunotherapy in MIBC Patients Using Single-Cell Sequencing 

• Hu Jiao ¹, Liu Jinhui ¹, Yan Luzhe ², Zu Xiongbing ³, Chen Minfeng ²
  ¹ Xiangya Hospital, Changsha, China, ² Central South University, Changsha, China, ³ Hunan Provincial People’s Hospital, Changsha, China

• Introduction and Objectives: Disitamab vedotin (RC48-ADC), an emerging targeted drug, shows promising efficacy and manageable safety in patients with muscle-invasive bladder cancer (MIBC). Antibody drug conjugates (ADCs) can activate the immune microenvironment for immune checkpoint inhibitors (ICIs) combination. However, the lack of efficacy-predicting biomarkers restricts MIBC precision treatment. Thus, we systematically identify and validate novel biomarkers for predicting the efficacy of neoadjuvant RC48-ADC combined with immune checkpoint inhibitors (ICIs) in muscle-invasive bladder cancer (MIBC) patients.
  Materials and Methods: We collected 11 bladder tumor specimens from 10 patients before and after neoadjuvant RC48-ADC plus ICI treatment (6 specimens before treatment and 5 specimens after treatment) and performed single-cell RNA sequencing on them. After quality control, we aligned the FASTQ files to the GRCh38 human reference genome using Cell Ranger software. 45,603 cells remained for further analysis.
  Results: 21,206 bladder cancer (BLCA) epithelial cells were categorized into 4 clusters: C1, C2, C3, and C4 (Figure 1). HSPA1A was significantly overexpressed in all subclusters after treatment. As the target of RC48-ADC, HER2 was specifically highly expressed in C3 before treatment. In the samples that achieved complete response (CR), HER2 was highly expressed in C3 while HSPA1A was not expressed. Notably, HER2 high-expression was unique to C3, and HSPA1A high-expression always included C3. In C3, patients with positive HSPA1A (regardless of the HER2 status) could not achieve CR (Figure 2). Pseudo-time analysis showed an evolutionary path: C3/C4→C1→C2. The expression characteristics of HER2 and HSPA1A originated from the C3 and remained stable during the evolutionary process. Therefore, C3 may determine the sensitivity and resistance of BLCA to RC48-ADC treatment.
  Conclusions: Detecting the expression of HER2 and HSPA1A in C3 subcluster based on single-cell sequencing is expected to serve as a biomarker to predict the efficacy of neoadjuvant RC48-ADC combined with ICIs in the treatment of MIBC.

UP-03.02—Immunohistochemical Profiling of L1cam, NTRK and PD-L1 in Rare Atypically Differentiated Variants of Bladder Carcinoma 

• Struck Julian, Krause Elisabeth, Heinrichs Anna, Al-Sliman Rashid, Reinwald Mark, Günther Marlis, Kalinski Thomas, Nass Norbert, Arndt Katharina, Borgmann Hendrik
  Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 14770 Brandenburg A.d. Havel, Germany

• Introduction and Objectives: Bladder cancer is the second most common malignancy of the urogenital tract. Rare, atypically differentiated variants such as the small cell or plasmacytoid subtypes often exhibit aggressive behavior and are typically diagnosed at advanced stages. Current treatment guidelines do not differentiate between classic and atypical urothelial carcinoma. Immunohistochemical markers such as L1CAM, PD-L1, and NTRK have shown prognostic and predictive relevance in other malignancies. This study investigates their expression patterns and potential clinical significance in rare bladder carcinoma variants.
  Materials and Methods: This retrospective, single-center analysis included 134 patients diagnosed between 2005 and 2023 with a histologically confirmed rare variant of bladder cancer. Immunohistochemical expression of L1CAM, PD-L1, and NTRK was evaluated and correlated with clinicopathological parameters. Poorly differentiated high-grade urothelial carcinoma served as the control group. Survival data and lifestyle factors were collected and are currently under analysis.
  Results: Distinct expression patterns were observed among the different histological subtypes. L1CAM (p = 0.002) and NTRK (p < 0.001) expression was significantly higher in small cell carcinomas compared to squamous cell subtypes. Conversely, PD-L1 expression was significantly elevated in squamous compared to micropapillary subtypes (p = 0.025). Moreover, a strong correlation was identified between L1CAM and NTRK positivity (p < 0.001). Comparative analyses with the control group of high-grade urothelial carcinoma are ongoing.
  Conclusions: Preliminary findings suggest subtype-specific expression patterns of L1CAM, PD-L1, and NTRK in rare bladder cancer variants. These markers may aid in early histopathological differentiation and hold potential prognostic or predictive value. Ongoing analyses aim to evaluate associations between marker expression and overall survival, recurrence, tumor stage, and systemic therapy. Final results, including comparative data with high-grade urothelial carcinoma, will be presented at the 2025 SIU Congress.

UP-03.03—Lactic Acid Bacteria Enhance Antitumor Immunity and Reverse Immune Suppression in Bladder Cancer 

• Bae Woo Kyun
  Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea

• Introduction and Objectives: The microbiome can significantly influence cancer prevalence and recurrence, with probiotic bacteria from fermented foods offering potential therapeutic benefit.
  Materials and Methods: In this study, we identified two lactic acid bacteria Weissella bacteria species, WiKim0164 and WiKim0166, from fermented Kimchi, and evaluated their impact on antitumor immunity and immunotherapy in a bladder cancer model.
  Results: Both strains induced substantial cytotoxic effects on bladder cancer cells, mediated through the ER stress-related apoptosis and immunogenic cell death, leading to significant tumor growth inhibition. Tumor suppression correlated with an increase in tumor-infiltrating lymphocytes (TILs), Natural Killer, CD4 + T and CD8 + T cells, particularly within the effector memory T cell subset. Single cell analysis further confirmed the tumor growth inhibition was associated with the activation of immune responses. Notably, immune evasion mechanisms were counteracted, as evidenced by decreased PD-1 and LAG3 expression on CD8 + T cells and a reduction in the frequency of regulatory T cells and myeloid-derived suppressor cells. Moreover, WiKim0164 and WiKim0166 promoted dendritic cell maturation and activation within tumor-draining lymph nodes.
  Conclusions: These findings highlight the potential of Kimchi-derived lactic acid bacteria, WiKim0164 and WiKim0166, as a novel therapeutic approach for bladder cancer, underscoring their role in enhancing antitumor immunity and reversing immune suppression within the tumor microenvironment.

UP-03.04—Neutrophil Extracellular Traps-Stc1 Positive Feedback Loop Promotes Immune Evasion and Metastasis in Bladder Cancer 

• Cai Tingting, Zhu Yiping, Ye Dingwei
  Fudan University Shanghai Cancer Center, Shanghai, China

• Introduction and Objectives: Muscle-invasive bladder cancer (MIBC) is characterized by poor survival due to frequent metastasis and significant resistance to current immunotherapies. Immune checkpoint inhibitors (ICIs) have improved outcomes for some patients, but primary resistance and severe immune-related adverse events (irAEs) substantially limit clinical efficacy. Neutrophil extracellular traps (NETs) and novel immune checkpoint molecules represent emerging targets in tumor immunotherapy. This study aimed to elucidate the role of NETs and their interaction with the novel “don’t-eat-me” checkpoint molecule STC1, exploring a potential therapeutic target to enhance immunotherapy efficacy and mitigate resistance in MIBC patients.
  Materials and Methods: We utilized integrated methodologies including in vitro assays, genetically engineered mouse models (GEMMs), single-cell RNA sequencing (scRNA-seq), and multi-omics analyses to delineate the interplay between NETs and STC1 within the bladder cancer microenvironment. Additionally, prospective and retrospective clinical cohort studies were employed to validate experimental findings and establish clinical relevance.
  Results: Our results demonstrated significantly elevated NET levels in patients with metastatic MIBC, correlating closely with poor prognosis, immunotherapy resistance, and increased tumor metastasis. Animal models confirmed that NETs enhanced pulmonary metastasis through immune-dependent mechanisms, accompanied by reduced T-cell infiltration and cytotoxic functionality in the tumor microenvironment. Therapeutic intervention with DNAse I (NETs inhibitor) significantly improved the efficacy of anti-PD-1 therapy and decreased associated irAEs. Mechanistically, we identified STC1 as a critical downstream target gene of NETs, functioning as an immune checkpoint by capturing pro-phagocytic signals (calreticulin), thereby impairing antigen-presenting cell (APC) function and promoting immune escape. NET-induced STC1 upregulation occurred via the MAPK-FOSL1 signaling pathway. Critically, secreted STC1 further enhanced NET formation, creating a self-perpetuating immunosuppressive feedback loop.
  Conclusions: Our study uncovered an innovative NETs-STC1 positive feedback mechanism pivotal for immune evasion and metastasis in bladder cancer. Clinically, targeting the NETs-STC1 axis represents a novel, dual-therapeutic strategy with the potential to significantly improve the outcomes and reduce irAEs for MIBC patients receiving ICIs, thereby addressing an urgent unmet clinical need.

UP-03.05—Pir-43452 Suppresses Bladder Cancer Progression and Chemosensitizes via Gtsf1/piwil4-Mediated Lrp1 mRNA Degradation: Mechanistic Insights and Therapeutic Implications 

• Shi Yuchen, Liu Ben
  First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

• Introduction and Objectives: Bladder cancer ranks as the 10th most common malignancy globally, with chemotherapy remaining cornerstone for advanced disease. However, 30–50% of patients develop resistance to first-line gemcitabine regimens, driving disease progression and mortality. Piwi-interacting RNAs (piRNAs) are emerging as critical regulators in carcinogenesis, yet their roles in bladder cancer (BCa) remain underexplored. This study investigates the tumor-suppressive function of piR-43452 in BCa, focusing on its novel mechanism through the GTSF1/PIWIL4 complex to degrade low-density lipoprotein receptor-related protein 1 (LRP1) mRNA and enhance chemosensitivity to gemcitabine. Piwi-interacting RNAs (piRNAs) are emerging as critical regulators in carcinogenesis, yet their roles in bladder cancer (BCa) remain underexplored. This study investigates the tumor-suppressive function of piR-43452 in BCa, focusing on its novel mechanism through the GTSF1/PIWIL4 complex to degrade low-density lipoprotein receptor-related protein 1 (LRP1) mRNA and enhance chemosensitivity to gemcitabine.
  Materials and Methods: In 22 paired BCa tissues and bladder cancer cell lines, piR-43452 expression was quantified via qPCR. RNA immunoprecipitation (RIP) identified PIWI protein interactions. Functional assays (CCK-8, colony formation, Transwell, flow cytometry) and xenograft models evaluated proliferation, migration, apoptosis, and autophagy. RNA-seq and dual-luciferase reporter assays identified downstream targets, validated by RIP-qPCR, co-immunoprecipitation (IP), and Western blotting. LRP1 knockdown/overexpression studies determined its role in piR-43452-mediated effects. Chemosensitivity was assessed through IC50 assays and apoptosis analysis post-gemcitabine treatment.
  Results: piR-43452 was significantly downregulated in BCa tissues and cell lines and specifically bound PIWIL4. piR-43452 overexpression suppressed proliferation, migration, and EMT while inducing caspase-dependent apoptosis and autophagy. piR-43452 recruited the GTSF1/PIWIL4 complex to bind LRP1 mRNA’s 3′UTR, promoting its degradation. LRP1 knockout phenocopied piR-43452 overexpression, whereas LRP1 overexpression reversed its antitumor effects. piR-43452 overexpression or LRP1 knockdown reduced gemcitabine IC50 and synergistically enhanced apoptosis.
  Conclusions: This study delineates a novel piR-43452/GTSF1/PIWIL4/LRP1 axis that suppresses BCa progression and augments gemcitabine efficacy. By mechanistically linking piRNA-driven mRNA degradation to chemosensitivity, these findings propose piR-43452 as a potential biomarker and therapeutic target for BCa precision therapy.

UP-03.06—The Role of Human Papillomavirus (HPV) in Bladder Cancer Carcinogenesis 

• Bouayed Abdelmoula Nouha, Smaoui Walid, Abdelmoula Balkiss
  Medical University of Sfax, Sfax, Tunisia

• Introduction and Objectives: Human papillomavirus (HPV) has been implicated in the development of various cancers, including urogenital cancers. The potential role of HPV in bladder cancer is the subject of ongoing debate, with studies reporting variable associations. This systematic review aimed to assess the prevalence and potential involvement of HPV in bladder cancer.
  Materials and Methods: We conducted a systematic review of the literature, including recent studies and meta-analyses, assessing the prevalence of HPV in bladder cancer patients, its molecular mechanisms and possible correlation with bladder cancer progression. Studies using PCR detection of HPV DNA in bladder cancer tissue samples and immune marker analyses were included.
  Results: The prevalence of HPV in bladder cancer patients varied considerably, ranging from 0% to 64.6%. High-risk HPV types 16 and 18 were most frequently detected in bladder cancer tissues, although the overall association with bladder cancer risk remains weak. Studies also suggest that HPV infection is more common in certain ethnic groups, particularly in Asia and the Arab world. While some studies indicate that HPV may contribute to bladder cancer tumorigenesis, notably through viral integration, other studies report no significant correlation between HPV infection and the development of bladder cancer. The role of HPV in bladder cancer is further complicated by confounding factors such as smoking and immune system status.
  Conclusions: Although there is evidence of a potential role for HPV in bladder cancer, its contribution to tumorigenesis remains uncertain. The variability of HPV prevalence in different populations and study models underscores the need for further research to elucidate molecular mechanisms and the potential causal relationship. Vaccination and early detection strategies targeting HPV may offer preventive benefits in reducing the incidence of HPV-related bladder cancer.

UP-03.07—Tumor-Associated Macrophages in Bladder Cancer: Single-Cell RNA Sequencing Reveals Metabolic and Pro-Tumorigenic Signatures 

• Pavlov Valentin ¹, Enikeeva Kadriya ², Mukhamadeev Radmir ², Kutliyarov Linat ¹
  ¹ Bashkir State Medical University, Ufa, Russian Federation, ² Institute of Urology and Clinical Oncology, Ufa, Russian Federation

• Introduction and Objectives: Bladder cancer remains a significant global health burden, with tumor microenvironment (TME) components playing a pivotal role in disease progression and therapeutic resistance. Tumor-associated macrophages (TAMs) are key immune regulators within the TME, exhibiting plasticity that enables both pro- and anti-tumor functions. This study leverages single-cell RNA sequencing (scRNA-seq) to dissect the transcriptional landscape of TAMs in bladder cancer, aiming to identify critical genes and pathways that underpin their functional adaptation to the tumor microenvironment.
  Materials and Methods: Tumor tissues were isolated from four patients with histologically confirmed bladder cancer. A single-cell suspension was generated using the Tumor Dissociation Kit on the DSC-410 Single Cell Suspension Dissociator. scRNA-seq libraries were prepared using the 10× Genomics Chromium X platform. Raw sequencing data were processed with Cell Ranger for alignment, filtering, and UMI counting. Downstream analysis was conducted in R using the Seurat package. Differential gene expression analysis between TAM clusters was performed using *FindMarkers* (Wilcoxon rank-sum test, adjusted p-value < 0.05).
  Results: Key Findings in Tumor-Associated Macrophages: Highly Expressed Genes in TAMs. NPHS1: Elevated expression of NPHS1, a gene typically associated with podocyte function, was observed in TAMs. This suggests potential reprogramming of macrophages within the tumor microenvironment, possibly reflecting a unique TAM subpopulation adapted to tumor-specific conditions. SLC16A10: This gene, encoding an amino acid transporter, was significantly upregulated. SLC16A10 may facilitate metabolic crosstalk between TAMs and tumor cells, supporting tumor growth through nutrient shuttling and lactate export, which is critical for tumor cell migration and angiogenesis. MIR155HG: The long non-coding RNA MIR155HG, a regulator of inflammatory responses, was overexpressed.
  Conclusions: This study identifies distinct transcriptional profiles in bladder cancer TAMs, underscoring their metabolic adaptability and pro-tumorigenic functions. The overexpression of NPHS1 and SLC16A10 suggests that TAMs contribute to tumor progression by rewiring nutrient transport and acidifying the microenvironment, while MIR155HG implicates inflammatory signaling in macrophage polarization. Notably, MIR155HG emerges as a potential biomarker for predicting immunotherapy efficacy, particularly in patients undergoing immune checkpoint blockade. These findings advocate for targeting TAM-specific pathways (e.g., SLC16A10-mediated metabolism) to disrupt tumor-macrophage crosstalk. Further validation in larger cohorts and functional studies are needed to confirm these mechanisms and their clinical relevance.

4. Bladder Cancer—Clinical

4.1. Moderated Oral ePosters

MP-04.01—Bladder EpiCheck Triggered Photodynamic Diagnosis Biopsies Detect High Grade Recurrences Missed by White Light Cystoscopy 

• Hart-Brooke Jasmin, Sparks Rebecca, Lord-McKenzie Tanya, Mariappan Paramananthan
  Edinburgh Bladder Cancer Surgery (EBCS), The University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom

• Introduction and Objectives: White-light cystoscopy (WLC) has moderate sensitivity (70%) and misses ~50% of CIS recurrences. PhotoDynamic Diagnosis (PDD) guided biopsies detects some of these missed tumours. Bladder EpiCheck (BE) is a urine marker with high HG sensitivity (91%) and specificity (84%) and a strong anticipatory positive signal. We introduced BE into our routine high-risk NMIBC (HR-NMIBC) surveillance and analysed the performance of BE and WLC against PDD-guided biopsy as the diagnostic benchmark.
  Materials and Methods: As part of an NHS Quality Improvement project within our Effectiveness and Efficiency programme, all HR-NMIBC patients on surveillance in a tertiary centre underwent both WLC and BE from Jul’23, to explore an opportunity to replace WLC with BE. Voided urine was collected immediately prior to WLC and sent to a certified lab for BE testing. Cystoscopists were blinded to the BE result. Positive WLC triggered a resection/biopsy under general anesthesia (GA). Negative WLC but positive BE triggered PDD-guided biopsy under GA.
  Results: From 348 HR-NMIBC patients undergoing surveillance Jul’23–Aug’24, 328 were suitable for analysis. 30 (9.1%) patients had a pathologically proven recurrence: 24 (7.3%) HG (10 CIS alone) and 6 (1.8%) LG, 277 (84.5%) were recurrence free (NEG) and 21 (6.4%) are still indeterminate (9 pending GA, the rest unable/unwilling to undergo GA). BE detected 23 (95.8%) HG, 9 (90%) CIS and 6 (100.0%) LG tumours. WLC detected 16 (66.7%) HG, 4 (40%) CIS and 4 (66.7%) LG and was equivocal in 1 (4.2%) HG. Of the 277 NEG patients, BE and WLC were negative in 263 (94.9%) and 270 (97.5%), respectively. BE PPV was 67.4%; both NPV and HG NPV were 99.6%. WLC PPV was 74.1%, NPV was 96.3% and HG NPV was 98.5%.
  Conclusions: BE demonstrated superior sensitivity over WLC with 44% more HG recurrences detected, without compromising specificity. PDD-guided biopsies of BE positive patients who are WLC negative unveil the true performance of BE and WLC, particularly in CIS. Performing BE alone in surveillance visits, followed by PDD-guided biopsy in BE positives, could reduce 95% of unnecessary cystoscopies while detecting 96% of HG disease. This evidence suggests significant utility in surveillance programmes by effectively and efficiently detecting high grade recurrence earlier, particularly CIS, which translates to opportunities for bladder preservation.

MP-04.02—Clinicopathologic Features and Outcomes of Signet Ring Cell Urachal Tumors Using the National Cancer Database 

• Sakthivel Deerush Kannan, Prabhakar Pushan, Pon Avudaiappan Arjun, Raja Iyub Mohamed Javid, Manoharan Murugesan
  Miami Cancer Institute, Baptist Health South Florida, Miami, United States

• Introduction and Objectives: Signet ring cell urachal carcinoma compared to the common urachal adenocarcinoma is an aggressive variant with limited literature on patient outcomes due to a low incidence rate. This study analyses the sociodemographic and clinical treatment outcomes of signet ring cell urachal carcinoma a large-volume national database.
  Materials and Methods: The National Cancer Database was queried for patients with the histology signet ring cell urachal carcinoma between the years 2004–2021. The sociodemographic and clinical variables were compared using descriptive analyses and a Kaplan-Meier survival analysis was done to find the median survival.
  Results: A total of 60 patients had signet ring cell urachal carcinoma on the final pathology. They were predominantly male (65%) and Caucasian (77%). Most of these patients were primarily treated at Academic/Research programs (33%), which are highly skilled centers of care, showing the level of specialized care needed for these patients. A large proportion of these patients also had a Charlson-Deyo comorbidity score of 0 indicating no pre-existing conditions. Looking at the clinical T stage, T3 and T2 tumors were the most common at 18.4% and 16.7% respectively. A small proportion, 13.3% of cases, had distant metastasis clinically (cM1). In the pathological stage, pT3 (36.9%) and pN0 (36.7%) was the most common. A very small subset of patients, approximately 10%, had regional nodal metastasis, indicating an aggressive tumor. Exploring the surgical treatment modalities, partial cystectomy (56.7%) was the most common with only 8.3% undergoing a radical cystectomy. This could be in part due to the location of the tumor, which allowed for a more conservative approach. Multi-agent chemotherapy was given in 31.7% of patients. Looking at the median overall survival, signet ring cell carcinoma had a survival of 30 months compared to 79 months in urachal adenocarcinoma (p < 0.001).
  Conclusions: Signet ring cell carcinoma is an aggressive variant with poor survival outcomes despite multimodal treatments. This study using the National Cancer Database highlights the need for a standardized treatment paradigm while also necessitating further research to improve patients diagnosed with signet ring cell carcinoma.

MP-04.03—Duration of Perioperative Antibiotics in Radical Cystectomy and Urinary Diversion: A Systematic Review and Meta-Analysis 

• Mohamed Tarek ¹, Elhashamy Hamza ², Deameh Mohammad Ghassab ³, Irshid Baha’ Aldeen Bani ⁴, Ramez Mohamed ⁵
  ¹ United Lincolnshire Teaching Hospitals NHS Trust, Lincoln, United Kingdom, ² Assiut University, Assiut, Egypt, Arab Rep., ³ Prince Hamza Hospital, Amman, Jordan, ⁴ Princess Basma Teaching Hospital, Irbid, Jordan, ⁵ University of Texas MD Anderson Cancer Center, Houston, United States

• Introduction and Objectives: To evaluate the impact of extended versus non-extended perioperative antibiotic prophylaxis (PAP) on reducing postoperative complications and hospital stay in patients undergoing radical cystectomy and urinary diversion.
  Materials and Methods: We conducted this systematic review and meta-analysis in accordance with the PRISMA guidelines. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Cochrane Library for studies comparing short-term (≤24 h) and extended (≥24 h) PAP in patients undergoing radical cystectomy and urinary diversion. The primary outcomes were surgical site infections (SSIs), urinary tract infections (UTIs), and length of hospital stay. The statistical analysis was performed using RevMan version 5.3. The results are presented as risk ratios (RR) and mean differences (MD).
  Results: 214 studies were screened. Of them, four studies involving 680 patients were included. No significant differences were observed between short-term and extended PAP in terms of SSIs (RR = 0.71 (95% CI [0.43–1.17]; p = 0.18)), febrile UTIs (RR = 1.19 (95% CI [0.91–1.56]; p = 0.20)), or length of hospital stay (MD = 0.76 days (95% CI [−2.72, 4.25]; p = 0.67)).
  Conclusions: No significant difference was observed between 24-h and extended PAP for reducing postoperative complications after radical cystectomy and urinary diversion. Short-term PAP is a reliable and effective strategy and is recommended as the standard practice for reducing antimicrobial resistance and improving postoperative outcomes.

MP-04.04—Encore Durability Results from BOND-003 Cohort C-Phase 3, Single-Arm Study of Intravesical Cretostimogene Grenadenorepvec for High-Risk BCG-Unresponsive Non-Muscle Invasive Bladder Cancer with Carcinoma In Situ 

• Tyson Mark ¹, Uchio Edward ², Nam Jong-Kil ³, Joshi Shreyas S. ⁴, Bivalacqua Trinity ⁵, Steinberg Gary ⁶, Kitamura Hiroshi ⁷, Tran Ben ⁸, Li Roger ⁹
  ¹ Mayo Clinic, Phoenix, United States, ² University of California Irvine, Irvine, United States, ³ Busan National University Yangsan Hospital, Yangsan, Korea, Dem. Rep., ⁴ Emory University School of Medicine, Atlanta, United States, ⁵ University of Pennsylvania, Philadelphia, United States, ⁶ Rush University Medical Center, Chicago, United States, ⁷ University of Toyama, Toyama, Japan, ⁸ Peter MacCallum Cancer Centre, Melbourne, Australia, ⁹ H. Lee Moffitt Cancer Center, Tampa, United States

• Introduction and Objectives: Considerable unmet medical need exists for clinically effective and well-tolerated bladder-sparing treatment options for patients with High-Risk BCG-Unresponsive (HR BCG-UR) NMIBC with carcinoma in situ (CIS). Cretostimogene grenadenorepvec, an oncolytic immunotherapy, selectively replicates in and lyses cancer cells with Retinoblastoma (Rb)-E2F pathway alterations, releasing antigens that trigger antitumor immune activation, enhanced by the GM-CSF transgene. Cretostimogene has received both US FDA Fast Track and Breakthrough Therapy Designations. BOND-003 (NCT044552591) is a phase-3 study evaluating the efficacy and safety of cretostimogene in patients with HR BCG-UR NMIBC.
  Materials and Methods: 112 adults with histologically confirmed HR BCG-UR NMIBC with CIS were enrolled, with efficacy data from 110 patients. Cretostimogene treatment consisted of 6 weekly doses during induction, followed by maintenance. Patients with persistent HG Ta or CIS at Month 3 were eligible for repeat induction. Response assessments included serial cystoscopy, urine cytology, axial imaging, and mandatory mapping biopsy at month 12, with centralized pathology review. The primary endpoint was Complete Response (CR) at any time. Other secondary and exploratory outcomes were also assessed.
  Results: As of the January 20, 2025 data cutoff, with a median follow-up time of 22.3 months, the CR rate at any time is 75.5% (83/110) (95% CI 66.3–83.2%). The median duration of response is 28 months (95% CI 14.3–NE%) and is on-going. Patients did convert to CR (50%, 14/28) after re-induction, of whom 64.3% (9/14) remain in a durable complete response. Complete responses are consistent across patient subgroups, including those who received prior intervening therapy, re-induction, or presented with higher-risk phenotypes such as CIS+HGT1. A total of 97.3% (107/110) of patients completed all protocol-defined treatments, demonstrating high patient tolerability. At 24 months, 97.3% (107/110) were free from ≥T2 progression during the treatment phase, and 84.5% (93/110) avoided a radical cystectomy. There were with no grade 3+ adverse events related to cretostimogene treatment.
  Conclusions: The consistent and compelling efficacy, safety and tolerability of intravesical cretostimogene for the treatment of HR BCG-UR NMIBC with CIS compares favorably and offers distinct advantages to existing therapies. Ongoing investigation of this promising monotherapy, as well as future combinations, may address a considerable unmet need for bladder cancer patients.

MP-04.05—Evaluating the Need to Biopsy Red Patches in Haematuria Patients: A Selective, Risk-Based Approach 

• Abdelrahman Asem, Anber Ahmed, Nelson Adam, Saeb-Parsy Kasra, Colquhoun Alexandra, Reeves Felicity, Lobo Niyati, Li Xi, Kadhim Hassan
  Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom

• Introduction and Objectives: Red patches observed during flexible cystoscopy in haematuria patients may represent benign or malignant pathology. Many are transient, raising concerns about the necessity of biopsy when high-quality urine cytology and imaging are negative. This study evaluates their clinical significance to determine whether a selective biopsy approach is justified.
  Materials and Methods: A retrospective review was conducted on 2,064 haematuria patients referred via the cancer pathway over 24 months. Patients with red patches/dots on cystoscopy were included, excluding those with prior bladder cancer or overt malignancy.
  Results: Eighty-nine patients met inclusion criteria (mean age: 69 years; range: 48–92; 39 females, 50 males). Seventy-five underwent GA rigid cystoscopy, while 14 had repeat cystoscopy within 2–4 weeks, all showing complete resolution. Fourteen patients in the GA cohort did not require biopsy due to unremarkable intraoperative findings. Bladder biopsies were performed in 61 patients, revealing benign or inflammatory histology in 55. Six had urothelial carcinoma: 2 with CIS, 2 with high-grade tumors (G3 pTa, G3 pT1) confirmed by high-quality urine cytology (100% PPV). Two patients with negative cytology had low-grade carcinoma (G1 pTa), managed with 12-month surveillance.
  Conclusions: Routine biopsy of red patches may be unnecessary, particularly when high-quality urine cytology and imaging are negative. A selective biopsy strategy, integrating these factors, could minimize unnecessary procedures while maintaining diagnostic accuracy.

MP-04.06—Integrating Narrow Band Imaging and Upper Tract Cytology in Non Muscle Invasive Bladder Carcinoma Surveillance: A Prospective Cohort Study from a Tertiary Center 

• Yadav Mithilesh, Nayak Prasant, Muhammad Huzaifa, C. Sabique
  All India Institute of Medical Sciences, Bhubaneshwar, Bhubaneshwar, India

• Introduction and Objectives: Non-Muscle Invasive Bladder Cancer (NMIBC) is characterized by high recurrence and progression rates, necessitating stringent surveillance. Traditional surveillance methods, such as white light cystoscopy and urine cytology, often fail to detect flat or occult lesions and upper tract involvement. Objective: To evaluate the effectiveness of incorporating Narrow Band Imaging (NBI), upper tract cytology, random bladder biopsies (RBB), and prostatic urethral biopsies (PUB) into routine surveillance protocols for early detection of recurrence and extravesical disease in NMIBC patients.
  Materials and Methods: A prospective single-arm cohort study was conducted at AIIMS Bhubaneswar between January 2023 and December 2024, involving 20 patients with NMIBC undergoing adjuvant intravesical BCG therapy. Participants underwent extended surveillance, including NBI-assisted cystoscopy, RBB, PUB, and bilateral upper tract barbotage cytology. Data were analysed for diagnostic yield and correlation with clinical risk factors.
  Results: Of 20 patients (median age 61.5 years), recurrence was detected in one patient via NBI and confirmed by biopsy. NBI identified suspicious lesions in three patients, with one case of invasive urothelial carcinoma. Upper tract cytology showed atypical or malignant cells (Paris category 3–5) in 9 patients, predominantly among those with multifocal tumours (p = 0.013). RBB and PUB were largely negative, except in one patient who had biopsy-proven recurrence. The additional diagnostic yield from extended surveillance was modest but clinically meaningful in select high-risk patients.
  Conclusions: Our findings suggest that incorporating NBI and upper tract cytology into routine surveillance protocols enhances the detection of early recurrence in NMIBC patients, particularly those with multifocal tumours. While random bladder and prostatic urethral biopsies showed limited utility in our cohort, their selective use in high-risk populations may improve surveillance sensitivity. These results align with existing literature indicating that NBI can improve tumour detection rates, though its impact on recurrence reduction remains inconclusive. Tailoring surveillance strategies based on individual risk profiles and utilizing advanced imaging techniques like NBI may optimize patient outcomes in NMIBC management.

MP-04.07—Long-Term Recurrence and Progression Post Tula in NMIBC;  Results from a Large UK Cohort 

• Ho Zelig ¹, Yamada Kohei ², Lim Nicole ¹, Anbazhagan Prasanna ², Collins Charlotte ², Irfan Zaynab ², Syed Hira ¹, Janardanan Sarosh ¹, Agrawal Sachin ¹
  ¹ Ashford & St. Peter’s Hospitals Foundation Trust, Chertsey, United Kingdom, ² Ashford & St. Peter’s Hospitals  NHS Foundation Trust, Chertsey, United Kingdom

• Introduction and Objectives: This study evaluates the recurrence and progression rates of non–muscle-invasive bladder cancer (NMIBC) managed with transurethral laser ablation (TULA) compared to the European Organisation for Research and Treatment of Cancer (EORTC) risk stratification model. The goal is to determine the safety of TULA as a primary management approach in NMIBC.
  Materials and Methods: A prospective analysis was conducted on patients who underwent TULA for bladder transitional cell carcinoma (TCC) between 2017 and 2024. The study included individuals managed exclusively with TULA and those who received TULA following other methods of NMIBC management e.g. TURBT. Patients were categorized by EORTC risk groups based on their risk level at the time of first TULA, with recurrence and progression rates assessed.
  Results: A total of 396 patients (mean age: 81 years) underwent TULA. Overall recurrence rate was 26.8% at one year and 41.2% at five years, while progression rates were 2.5% and 4.5%, respectively. Low-risk group: Recurrence rates (N = 96) were 15.6% at one year and 32.3% at five years (EORTC: 15% and 31%). Progression rates (N = 146) were 2.7% and 1.4% (EORTC: 0.2% and 5.5%). Intermediate-risk group: Recurrence rates (N = 221) were 25.8% and 40.3% (EORTC: 24% and 46%), while progression (N = 166) was 1.2% and 3.0% (EORTC: 1% and 6%). High-risk group: Recurrence rates (N = 73) were 41.1% and 52.1% (EORTC: 38% and 62%), with progression (N = 59) at 6.8% for both intervals (EORTC: 5% and 17%). Very high-risk group: Recurrence (N = 6) was 66.7% and 83.3% (EORTC: 61% and 78%), while progression (N = 25) was 4% and 8% (EORTC: 17% and 45%). A total of 104 patients (91 males, 13 females) died during follow-up, with 19 (4.7%) due to bladder cancer. Other causes of mortality included cardiac, respiratory, cerebrovascular, frailty-related, malignancies, trauma, and unknown factors.
  Conclusions: TULA demonstrates recurrence and progression rates comparable to or lower than those predicted by the EORTC model. These findings suggest that TULA is a viable management option for NMIBC, particularly in the low/intermediate risk groups. It is a feasible option in higher risk groups with clinical frailty.

MP-04.08—Multitarget Urine RNA Test for Urothelial Carcinoma Detection and Surveillance 

• Xu Hua
  Fudan University Shanghai Cancer Center, Shanghai, China

• Introduction and Objectives: Multitarget urine RNA test has been a promising procedure for the detection and surveillance of patients with urothelial carcinoma (UC). However, the current bottleneck in clinical diagnosis of UC lies in the detection of early-stage, low-grade (LG), residual, and recurrent tumors. To develop a multiplex urinary RNA panel for the noninvasive detection and surveillance of UC and prospectively validate its performance externally.
  Materials and Methods: In this prospective, multicenter study conducted between June 2022 and August 2023, 912 eligible participants were recruited from eight centers in China for urine sample collection, including 359 patients with UC and 553 controls. The expression of the eight optimal RNA targets was analyzed and modeled to calculate a risk score, thus categorizing individuals into high or low risk groups. The primary outcome of the study was the diagnostic accuracy, sensitivity, and specificity of the multitarget urine RNA (mt-uRNA) test, followed by a histopathology study on biopsies as the reference standard.
  Results: In a large training set of 267 UCs and 261 controls, we identified eight optimal RNAs (CA9, CCL18, ERBB2, IGF2, MMP12, PPP1R14D, SGK2, and SWINGN) and demonstrated an outstanding performance of this mt-uRNA test with 89.38% accuracy, 90.16% sensitivity, and 88.89% specificity in an intermediate validation study. In the prospective validation phase, the mt-uRNA test achieved an overall accuracy of 92.65%, a sensitivity of 91.92%, and a specificity of 93.13%. Especially for early-stage (below stage T2) and LG diseases, the sensitivity of the test was 100% for stage Ta, 86.67% for stage Tis, 87.30% for stage T1, and 91.25% for LG tumors. In addition, the mt-uRNA test achieved sensitivities of 93.75%, 89.47%, and 88.61%, as well as specificities of 91.30%, 82.61%, and 98.24% in hematuria, residual, and recurrent subpopulations, respectively.
  Conclusions: In this study, a urine-based multitarget RNA test showed high diagnostic accuracy, sensitivity, and specificity for UC, particularly for early-stage and LG tumors. From a clinical perspective, the mt-uRNA test could be a valuable alternative or adjunct to endoscopy in diagnosing UC, potentially reducing unnecessary or overused endoscopies and Re-TURBT in surveillance settings.

MP-04.09—Ongoing Trial: BOND-003 Cohort P—A Multi-National, Single-Arm Study of Intravesical Cretostimogene Grenadenorepvec for Treatment of High-Risk, Papillary only, BCG-Unresponsive Non-Muscle Invasive Bladder Cancer 

• Tyson Mark ¹, Smelser Woodson W ², Dickstein Rian ³, Zainfeld Daniel E. ⁴, Li Roger ⁵, Daneshmand Siamak ⁶, Dinney Colin ⁷
  ¹ Mayo Clinic, Phoenix, United States, ² Washington University, St. Louis, United States, ³ Chesapeake Urology Associates LLC, Hanover, United States, ⁴ Urology San Antonio, San Antonio, United States, ⁵ H. Lee Moffitt Cancer Center, Tampa, United States, ⁶ University of Southern California, Los Angeles, United States, ⁷ University of Texas MD Anderson Cancer Center, Houston, United States

• Introduction and Objectives: Patients with High-Risk BCG-Unresponsive Non-Muscle Invasive Bladder Cancer (HR BCG-UR NMIBC) have limited treatment options. The US FDA has approved treatments for BCG-UR patients with CIS, but additional bladder-sparing treatments are needed, especially for the BCG-UR papillary-only population. Cretostimogene grenadenorepvec, an oncolytic immunotherapy, selectively replicates in and lyses cancer cells with Retinoblastoma (Rb)-E2F pathway alterations. This releases virus- and tumor-specific antigens, initiating antitumor immune activation, further amplified by the GM-CSF transgene. Cretostimogene received US FDA Fast Track and Breakthrough Therapy Designations for BCG-UR HR NMIBC with CIS. The BOND-003 Cohort P study (NCT044552591) is a multi-national, single-arm clinical trial assessing the efficacy and safety of intravesical cretostimogene in HR, papillary-only, BCG-UR NMIBC patients.
  Materials and Methods: Eligibility criteria include age ≥ 18 years, ECOG performance status of 0–2, histologically confirmed BCG-UR HG Ta/T1 papillary disease without CIS within 90 days of study enrollment. Patients who recur with an HG Ta/T1 tumor within six months of the last dose of adequate BCG or who recur with HG T1 after a single induction course of BCG may be eligible. Patients must have no evidence of residual bladder cancer before treatment. Intravesical cretostimogene will be instilled in combination with n-dodecyl-β-D-maltoside (DDM), an excipient that enhances adenoviral delivery, for six weekly doses during the induction phase, followed by three weekly maintenance cycles quarterly through month 12, then every six months through month 36. Re-induction is permitted after the first disease assessment for patients with persistent HG Ta and/or CIS. Primary disease assessments include serial cystoscopy, urine cytology, axial imaging, and mandatory biopsy at Month 12, with centralized review of pathologic samples. The primary outcome measure is all-cause Event Free Survival (EFS). Secondary endpoints include Recurrence-Free Survival, Progression-Free Survival, Cystectomy-Free Survival, Bladder Cancer Specific Survival, safety, and time to next intervention. Exploratory outcome measures include Patient-Reported Quality of Life and biomarker analyses.
  Results: N.A.
  Conclusions: 35+ clinical sites have been selected in the United States and Japan. The study has surpassed 50% enrollment, with interim results expected at the end of 2025.

MP-04.10—Perioperative Outcomes and Complications of Robot-Assisted Radical Cystectomy in Patients Older vs. Younger than 70 Years: Insights from over 20 Years of Experience in a High-Volume Tertiary Robotic Center 

• Morra Simone ¹, Resca Stefano ², Frego Nicola ³, Tamburini Sara ⁴, Ticonosco Marco ², Pissavini Alessandro ⁴, Noya Mourullo Andrea ⁵, Barletta Francesco ⁶, Longo Nicola ⁷, Lambert Edward ⁸, D’Hondt Frederiek ⁸, De Groote Ruben ⁸, De Naeyer Geert ⁸, Mottrie Alexandre ⁸
  ¹ University of Naples “Federico II”, Naples, Italy, ² University of Modena and Reggio Emilia, Modena, Italy, ³ Humanitas Research Hospital, IRCCS, Rozzano, Italy, ⁴ IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy, ⁵ University Hospital of Salamanca, Salamanca, Spain, ⁶ IRCCS Ospedale San Raffaele, Milan, Italy, ⁷ Federico II University of Naples, Naples, Italy, ⁸ Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium

• Introduction and Objectives: Robot-assisted radical cystectomy (RARC) has demonstrated improved perioperative outcomes and enhanced recovery in patients undergoing treatment for bladder cancer (BCa). However, older patients may experience longer operative time (OT), extended length of stay (LOS), and higher complication rates compared to their younger counterparts. Given the increasing prevalence of BCa in the aging population, understanding the impact of age on perioperative outcomes is crucial for optimizing surgical management. This study aims to compare patient and tumor characteristics, OT, LOS, and complication rates between patients ≥70 vs. <70-year-old who underwent RARC at a high-volume tertiary robotic center over 20 years (2003–2024).
  Materials and Methods: Data from 236 consecutive BCa patients who underwent RARC with ileal conduit at Onze-Lieve-Vrouwziekenhuis (OLV) Hospital (Aalst, Belgium) were analyzed. Perioperative outcomes were compared between cohorts (≥70 vs. <70-year-old). Multivariable Poisson regression models identified predictors of longer OT and LOS, while multivariable logistic regression models (MLRMs) assessed predictors of higher complication rates.
  Results: Overall, 236 BCa patients who underwent RARC were identified (62% ≥70 vs. 38% <70-year-old). The ≥70-year-old group had a significantly shorter median OT (330 vs. 365 min; p < 0.001) and statistically significant longer LOS (10 vs. 9 days; p = 0.02) compared to the <70-year-old group. No statistically significant differences were recorded in postoperative complication rates between the two groups (p = 0.7). In multivariable Poisson regression, the ≥70-year-old group was an independent predictor of shorter OT (IRR: 0.93, 95% CI: 0.92–0.94; p < 0.001) and longer LOS (IRR: 1.35, 95% CI: 1.24–1.47; p < 0.001). In MLRMs, the ≥70-year-old group was not associated with a higher risk of complications of any grade (p = 0.2).
  Conclusions: While the ≥70-year-old group undergoing RARC experienced a significantly longer length of stay but a paradoxically shorter operative time compared to younger patients. This difference in operative time may be partially explained by a lower rate of lymphadenectomy in the older cohort. However, age was not an independent predictor of higher postoperative complication rates. These findings suggest that RARC remains a safe and feasible option for older BCa patients, emphasizing the need for individualized surgical planning based on patient characteristics rather than age alone.

MP-04.11—Phase 1 Study of an Anti-PD-L1/IL-15 Fusion Protein (SIM0237) in BCG-Unresponsive Non-Muscle-Invasive Bladder Cancer (NMIBC) 

• Xu Hua ¹, Ye Dingwei ¹, Jiang Shusuan ², Zhang Shudong ³, Niu Haitao ⁴, Cao Yu ⁴, Hu Hailong ⁵, Dai Tao ², Wu Tao ⁶, Xu Jiajia ⁶, Zhang Nating ⁶, Sun Haolin ⁶
  ¹ Fudan University Shanghai Cancer Center, Shanghai, China, ² Hunan Cancer Hospital, Changsha, China, ³ Peking University Third Hospital, Beijing, China, ⁴ The Affiliated Hospital of Qingdao University, Qingdao, China, ⁵ The Second Hospital of Tianjin Medical University, Tianjin, China, ⁶ Simcere Zaiming Pharmaceutical Co., Ltd., Shanghai, China

• Introduction and Objectives: Treatment options for BCG-unresponsive NMIBC are limited. Anti-PD-1 monotherapy and IL-15 agonist in combination with BCG have shown clinical efficacy in BCG-unresponsive carcinoma in situ (CIS) NMIBC. It remains unclear whether targeting both PD-(L)1 and IL-15 has synergistic effect in NMIBC. SIM0237 is an anti-PD-L1/IL-15 variant fusion protein and showed significant anti-tumor activity in human bladder cancer xenograft models.
  Materials and Methods: This phase 1 study includes a dose escalation part to determine the recommended dose (RD) and a dose expansion part to examine the preliminary efficacy of SIM0237. Patients with BCG-unresponsive high-risk NMIBC received intravesical SIM0237 following the standard induction/maintenance treatment schedule. A re-induction course was allowed if the patients had persistent CIS or high-grade (HG) Ta at Month 3. This abstract reported the data from the dose escalation part.
  Results: Between January 23 and December 31 2024, 17 patients (3 CIS, 14 papillary) were enrolled at dose levels of 75 mg, 150 mg and 300 mg with 3, 6 and 8 patients, respectively. Median age was 65 years, with 82% male. The median number of prior BCG doses was 13. TEAEs occurred in 13 (76.5%) patients, with 66.7%, 83.3% and 75.0% at 75 mg, 150 mg and 300 mg, respectively. Five (29.4%) patients had Grade 3 TEAEs, and all were unrelated to SIM0237, no Grade 4 or 5 TEAEs. Grade 1 or 2 TRAEs occurred in 7 (41.2%) patients with the majority limited in the urinary system. Two (11.8%) patients experienced SAEs, and all were unrelated to SIM0237. Four (23.5%) patients had dose interruptions due to AE. No dose-limiting toxicity, immune-related AE or AE leading to SIM0237 discontinuation occurred. PK data showed undetectable systemic exposure of SIM0237. Two CIS/HG Ta patients had post-baseline tumor assessments: one achieved CR at Month 6 and maintained CR at Month 9; the other achieved CR at Month 3. The median DFS in papillary patients was immature, with a 6-month DFS rate of 72.9%. The 300 mg dose was selected as the RD.
  Conclusions: Intravesical SIM0237 was safe and well tolerated with promising anti-tumor activity in patients with BCG-unresponsive NMIBC. The dose expansion part is in progress.

MP-04.12—Preliminary Results from LEGEND: A Phase 2 Study of Detalimogene Voraplasmid, a Novel, Investigational, Non-Viral Genetic Medicine for High-Risk Non-Muscle Invasive Bladder Cancer (NMIBC) 

• Kamat Ashish ¹, Taylor John A. ², Merrill Suzanne ³, Chang Sam S. ⁴, Packiam Vignesh T. ⁵, Joshi Shreyas ⁶, Liu Jen-Jane ⁷, Schuckman Anne ⁸, Salmasi Amir ⁹, Rendon Ricardo ¹⁰, Kassouf Wassim ¹¹, Holzbeierlein Jeffrey ², Tyson Mark ¹², Dickstein Rian ¹³, Satkunasivam Raj ¹⁴, Shore Neal ¹⁵, Luckenbaugh Amy ⁴, Daneshmand Siamak ¹⁶, Tosone Christine ¹⁷, Cheung Anthony ¹⁷, Chan Katherine ¹⁷, Pruthi Raj ¹⁷, Lotan Yair ¹⁸
  ¹ University of Texas MD Anderson Cancer Center, Houston, United States, ² University of Kansas Cancer Center, Kansas City, United States, ³ Colorado Urology, Brighton, United States, ⁴ Vanderbilt University, Nashville, United States, ⁵ Rutgers RWJ Barnabas Health, West Orange, United States, ⁶ Emory University School of Medicine, Atlanta, United States, ⁷ Oregon Health Science University, Portland, United States, ⁸ Keck/USC School of Medicine, Los Angeles, United States, ⁹ UC San Diego, San Diego, United States, ¹⁰ Dalhousie University, Halifax, Canada, ¹¹ McGill University, Montreal, Canada, ¹² Mayo Clinic, Phoenix, United States, ¹³ Cheapeake Urology, Hanover, United States, ¹⁴ Houston Methodist-Weill Cornell Medical College, Houston, United States, ¹⁵ Carolina Urology, Myrtle Beach, United States, ¹⁶ USC Norris Comprehensive Cancer Center, Los Angeles, United States, ¹⁷ enGene Inc., Waltham, United States, ¹⁸ University of Texas Southwestern Medical Center, Dallas, United States

• Introduction and Objectives: Detalimogene voraplasmid (EG-70) is a novel, investigational, non-viral genetic medicine for high-risk NMIBC, including BCG-unresponsive disease. The Phase 1 portion of LEGEND (NCT04752722) demonstrated a promising safety profile and an overall complete response (CR) of 73% at any time. Phase 2 is ongoing; preliminary efficacy results of the pivotal Cohort 1 (BCG-unresponsive NMIBC with CIS) and safety for all cohorts are reported here.
  Materials and Methods: Key eligibility criteria: ≥18 years; ECOG PS 0–2; high-risk NMIBC, ±resected coexisting papillary (Ta/T1) tumors, ineligible for/elected not to undergo cystectomy. Cohorts: BCG-unresponsive with CIS (1; pivotal cohort); BCG-naïve with CIS (2A); BCG-exposed with CIS (2B); BCG-unresponsive with high-grade papillary disease without CIS (3). Patients received four doses, 50 mL intravesically at Weeks 1, 2, 5 & 6 of a 12-week cycle x 4 cycles. Primary endpoint: CR rate at Week 48; safety. Secondary endpoints: PFS; CR rate at Week 12, 24, 36 & 96, % of patients with a durable CR at 12 Months. Patients with a non-CR at 3 Months (pTis or pTa) were eligible for re-treatment with drug (re-induction).
  Results: As of September 13, 2024, 21 patients were evaluable for efficacy in Cohort 1. In the 42 safety-evaluable patients (all cohorts), treatment-related adverse events were observed in 20 (47.6%; all G1/2), most commonly (≥10%): dysuria (21.4%); bladder spasm (19.0%); pollakiuria (11.9%); fatigue (11.9%). Overall CR rate: 71%; CR rate: 67% at 3 Months and 47% at 6 Months.
  Conclusions: Preliminary data from the pivotal Phase 2 portion of LEGEND suggest a promising safety/tolerability profile. Overall, 71% of patients achieved a CR, with 67% achieving a CR at 3 Months and 47% achieving a CR at 6 Months.

MP-04.13—Unveiling Molecular Subtypes in Carcinoma Urinary Bladder: A Study of Molecular Classification and Their Role in Tailoring Bladder Cancer Treatment 

• Mittal Ankur
  All India Institute of Medical Sciences, Rishikesh, Rishikesh, India

• Introduction and Objectives: Bladder cancer, predominantly urothelial carcinoma, is characterized by molecular heterogeneity that impacts clinical outcomes and treatment responses. This study aimed to assess the molecular subtypes of carcinoma urinary bladder using immunohistochemistry (IHC) markers, focusing on luminal and basal subtypes, with the goal of improving prognosis and guiding personalized treatment strategies.
  Materials and Methods: A prospective observational study was conducted at AIIMS Rishikesh, enrolling 67 patients with carcinoma urinary bladder (both non-muscle invasive and muscle-invasive) over one year. IHC markers (GATA3, CK20, CK5/6, and CK14) were used to assess the molecular subtypes, categorizing patients into four groups: luminal, basal, double-positive, and double-negative. Clinical data, including disease stage and nodal involvement, were recorded to correlate with molecular subtypes.
  Results: The cohort was predominantly male (94%) with a high prevalence of smokers/tobacco users (84.3%), reflecting regional risk factors for bladder cancer. 42.2% of the cases had the luminal subtype, with early-stage disease (T1: 57.1%, T2: 40.1%) and low nodal involvement (92.9% node-negative). 12.7% were basal subtype, associated with advanced-stage disease (T4: 45%) and significant nodal involvement (N2: 27.3%, p < 0.01). 36.3% had double-positive tumors, often linked to muscle-invasive disease (T2 or higher: 74.9%). 8.8% had double-negative tumors, with absent GATA3 and CK5/6 expression, associated with advanced disease. CK5/6-positive basal tumors were particularly aggressive but showed complete responses to neoadjuvant chemotherapy in some cases, suggesting a potential predictive biomarker. Additionally, all female patients were CK5/6-positive, suggesting a gender-specific pattern.
  Conclusions: Molecular subtyping is significant for understanding prognosis and guiding treatment in bladder cancer. Luminal and double-positive subtypes were associated with better outcomes, while basal and double-negative subtypes showed a statistically significant association with advanced disease and nodal involvement. CK5/6 positivity, especially in basal subtypes, may predict chemotherapy responsiveness. This study supports further research into subtype-specific therapeutic strategies, considering regional and gender-specific variations.

MP-04.14—Utility of Restaging Transurethral Resection in Patients with Primary High-Grade Ta Bladder Cancer 

• Mebroukine Samy, Klein Clément, Bladou Franck, Bernhard Jean-Christophe, Robert Gregoire
  University Hospital of Bordeaux, Bordeaux, France

• Introduction and Objectives: International guidelines show discrepancies concerning restaging transurethral resection (TURBT) for high-grade (HG) Ta NMIBC. According to the latest European guidelines, restaging TURBT is no longer recommended for HG Ta if the initial TURBT is considered as complete. Recent studies with heterogeneous inclusion criteria reported discordant results on its benefits. Our study aimed to assess the prognostic impact of restaging TURBT in patients with HG Ta fully resected during the initial TURBT.
  Materials and Methods: A single-center retrospective study was conducted between November 2015 and November 2021, including patients diagnosed with HG Ta NMIBC. Exclusion criteria included previous HG Ta or T1 NMIBC, macroscopically incomplete resection, and the absence of detrusor muscle on the pathology report. The decision to use photodynamic diagnosis (PDD) and to perform restaging TURBT was left to the discretion of the urologist. Adjuvant treatment with Bacillus Calmette–Guérin (BCG) or mitomycin (in the event of BCG shortage or intolerance), along with follow-up, was carried out according to European guidelines.
  Results: 181 patients were identified, and 111 were included in the final analysis. Among these patients, 41 underwent restaging TURBT. Patients who underwent restaging TURBT had more frequently multifocal lesions (85% vs. 67.1%, p = 0.03) and were more likely to receive adjuvant therapy (77.5% vs. 55.7%, p = 0.02). Conversely, patients who underwent a single TURBT had a higher prevalence of prior low-grade Ta NMIBC (25.7% vs. 9.8%, p = 0.04). The median time to restaging TURBT was 49 days [41–65]. Residual tumors were detected in 36.4% of restaging TURBT, with 4.6% being diagnosed as pT1. Restaging TURBT did not impact recurrence-free survival (RFS) (p = 0.87). In multivariate analysis, the use of PDD (HR = 0.3, p = 0.03) and adjuvant therapy (HR = 0.5, p < 0.01) were associated with a reduced risk of recurrence. Restaging TURBT did not impact progression-free survival (PFS) (p = 0.87).
  Conclusions: Restaging TURBT did not impact the risk of recurrence or progression in patients with HG Ta NMIBC following a complete initial TURBT. In contrast, PDD was associated with a lower risk of recurrence. These findings could help standardize international guidelines concerning restaging TURBT.

4.2. Moderated Video ePosters

MVP-04.01—Tips for Standardizing the Reconstruction of Orthotopic Intracorporeal Robotic Ileal Neobladder 

• Prabhakar Pushan ¹, Raja Iyub Mohamed Javid ¹, Martinez Orlando Brito ¹, Bokhari Akram ², Eldefrawy Ahmed ¹, Manoharan Murugesan ¹, Sakthivel Deerush Kannan ¹
  ¹ Miami Cancer Institute, Baptist Health South Florida, Miami, United States, ² University of Hai’l, Hai’l, Saudi Arabia

• Introduction and Objectives: Intracorporeal Robotic Ileal Neobladder Reconstruction using the ileal bowel is a technically challenging and complex surgical procedure. So, we demonstrate a few tips that can aid in the standardisation of the reconstruction.
  Materials and Methods: The video illustrates the steps for standardizing the reconstruction.
  Results: Video Clip: Step 1: Apical Fixation. The selected ileal segment for the construction of the neobladder is approximated and sutured posterior to the urethra along the antimesenteric border. This not only aids in tension-free vesicourethral anastomosis along with apical fixation but also facilitates stabilising the bowel by limiting its movement. Step 2: Early Vesicourethral Anastomosis. At the planned anastomosis site on the ileal segment, an opening is made. Subsequently, the vesicourethral anastomosis is done. The apical fixation done in the earlier step aids with the placement of the urinary catheter anastomosis site. Step 3: Stay Sutures to Facilitate Neobladder Reconstruction. Our ileal neobladder will have a 40 cm bowel segment for the pouch and 10–15 cm for the chimney making each wall about 20 cm long. In this step, 4 stay sutures at 5 cm intervals are placed. Subsequently, the distal suture will be held with the robot’s 3rd arm, and the proximal suture is held by the assistant. This traction ensures suturing along a straight line and allows for the neobladder reconstruction in a smooth, easy, and standardized fashion.
  Conclusions: To conclude, the robotic reconstruction of a neobladder is a complex surgical procedure, but the surgical steps mentioned in this video have enabled us to simplify reconstruction by making it more standardised, reproducible, and easy.

4.3. Residents Forum Moderated Oral ePosters

RF-04.01—Evaluation of Cxbladder Compared to the Triple Work-up of Macroscopic Haematuria for the Diagnosis of Urothelial Carcinoma in a Single Australian Tertiary Hospital 

• Lucas Harrison, Wallace Suzanne, Zargar Homi, Corcoran Niall
  Western Health, Melbourne, Australia

• Introduction and Objectives: Macroscopic haematuria is a common presenting symptom of urothelial carcinoma (UC). Traditionally, the “triple work-up”—comprising flexible cystoscopy, urine cytology and imaging is used as the standard diagnostic approach for patients presenting with haematuria. However, this process can be invasive, time-consuming, and costly. Cxbladder utilises a non-invasive, singular urine sample to detect patients who have a low or high risk of UC. This study evaluates the performance of Cxbladder compared to the standard triple work-up in patients presenting with haematuria, in the diagnosis of UC.
  Materials and Methods: We conducted a prospective, observational study at a single Australian tertiary hospital. 257 patients, who presented with macroscopic haematuria from 2020 to 2023, underwent both a Cxbladder test and standard triple work-up with three urine cytology samples, imaging, and a flexible cystoscopy. Results were records of these tests and confirmed histopathological tissue diagnoses of UC, if an additional procedure was indicated. Diagnostic accuracy was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the proportion of missed tumours.
  Results: 5.4% of patients presenting with haematuria were diagnosed with UC (n = 15). Cxbladder demonstrated a sensitivity of 92.9% and an NPV of 98.6%. This was similar to the triple work-up, which showed a sensitivity of 93.1% and an NPV of 97.5%. The difference between the sensitivity and NPV for Cxbladder compared with the triple work-up was not statistically significant, with p-values of 1.00 and 0.48 respectively. The proportion of UC cases missed by Cxbladder was 6.7% (n = 1).
  Conclusions: Cxbladder offers a non-invasive alternative to the traditional work-up of macroscopic haematuria with high accuracy in excluding patients presenting who do not have UC. Cxbladder demonstrates the potential to reduce unnecessary invasive tests and procedures, with an alternative diagnostic workup for UC.

4.4. Unmoderated Standard ePosters

UP-04.01—A Novel Bladder Cancer Diagnostic Technique Based on Urine Multimodal Spectroscopy 

• Manera Alekseja ¹, Morselli Simone ², Sebastianelli Arcangelo ³, Nicoletti Rossella ³, Moscardi Luisa ², Ciaralli Elena ³, Catucci Claudia Lucia ³, Serni Sergio ⁴, Gacci Mauro ³, Li Marzi Vincenzo ⁵, Alberti Andrea ³
  ¹ AOU Senese, Siena, Italy, ² University of Florence, Florence, Italy, ³ Careggi Hospital, University of Florence, Florence, Italy, ⁴ Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy, ⁵ Le Scotte Hospital, University of Siena, Siena, Italy

• Introduction and Objectives: Past studies have demonstrated the effectiveness of multimodal fiber optic spectroscopy (MFOS) to correctly assess Urothelial Cancer (UC) presence in ex vivo tissue, plus providing reliable grading and staging information. Further evolution of the method is the possibility to provide this information from urine samples analysis.
  Materials and Methods: After ethical appraisal, a clinical study began in January 2021 in an academic referral hospital. Patients undergoing urological endoscopic surgical operations were prospectively enrolled, and urine samples were collected from each one before surgery. UC presence was assessed through endoscopy at first and then with confirmatory pathological analysis. To obtain these results, 3 principal components (PC) were extracted from the fluorescence spectra excited at 378 nm, 3 PC from the fluorescence spectra excited at 445 nm, and 4 PC from the Raman spectra excited at 785 nm. The PCs of 280 samples were analyzed using a support vector machine (SVM): 210 samples were used to train the classifier, and 70 samples were used to test it to verify the reliability of MFOS. The remaining 116 samples were classified in a blinded manner.
  Results: A total of 418 patients were enrolled, of whom 8 excluded for incidental prostate cancer, 1 for kidney cancer, and 12 for insufficient sample; therefore, a total of 396 patients were included in the study. Patients with UC were 196 (49.5%), while 200 (50.5%) were negative. In the first 210 patients (calibration), MFOS provided a 49% sensibility and a 100% specificity. In the total count of 396 patients, MFOS provided a 84% sensibility and a 100% specificity. Regarding the technique, the model developed kept a high accuracy (71.4%) in correctly assessing UC presence even in the largest sample, while the discrimination between high and low grade UC slowly dropped in a larger sample.
  Conclusions: Despite being an experimental method, MFOS showed the possibility to correctly assess UC presence at surgery and pathology from just a urine sample. Strength points are the calibration of the method that can be further ameliorated with larger samples and the possibility to predict grading compared to gold standard cytology. However, larger randomized clinical trials are mandatory to verify these results.

UP-04.02—A Viable Alternative to Urine Cytology in Urothelial Cancer Detection: A Non-Inferiority Trial 

• Manera Alekseja ¹, Morselli Simone ², Sebastianelli Arcangelo ³, Nicoletti Rossella ⁴, Moscardi Luisa ², Ciaralli Elena ⁴, Catucci Claudia Lucia ⁴, Serni Sergio ³, Gacci Mauro ⁴, Li Marzi Vincenzo ⁵, Alberti Andrea ⁴
  ¹ AOU Senese, Siena, Italy, ² University of Florence, Florence, Italy, ³ Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy, ⁴ Careggi Hospital, University of Florence, Florence, Italy, ⁵ Le Scotte Hospital, University of Siena, Siena, Italy

• Introduction and Objectives: Multimodal fiber optic spectroscopy (MFOS) has proven effective in detection, grading, and staging of Urothelial Cancer (UC) ex-vivo. A new possible application under evaluation is to test the same technique in UC diagnosis in urine samples, comparing it to current gold standard, urinary cytology.
  Materials and Methods: A prospective non-inferiority case control study trial started in January 2021 in an academic hospital after ethical appraisal. Urine samples were collected before urological endoscopic surgical intervention, from cases (patients with UC) and controls (patients without UC). Patients with kidney or prostate tumors were excluded. Presence/absence of UC was assessed during surgery, combining direct visualization of the mucosa and through biopsy of any suspect area during surgery even in controls. The same urine specimen was then divided and sent to urine cytology and MFOS analysis. Cytologist did the measurement in blind, as well as MFOS was applied in blind after previous calibration of the machine.
  Results: A total of 418 patients were enrolled, of whom 8 excluded for incidental prostate cancer diagnosis, 1 for kidney cancer diagnosis, and 12 for insufficient sample; therefore, a total of 396 patients were included in the study. Patients with UC were 196 (49.5%), while 200 (50.5%) were negative. All cases underwent TURB, while controls were patients who underwent TURP or HOLEP or URS or RIRS. Patients with UC at PPA were in 27 cases low grade UC and in 83 high grade UC of whom 38 with muscle invasive disease and 9 with CIS. In the evaluated sample, cytology yielded sensibility of 21% and specificity of 100%, meanwhile MFOS provided a sensibility of 85% and specificity of 100%. Comparison of the techniques showed a statistical significant difference (p < 0.05), with a superiority of MFOS. Indeed, according to Cubic Support Vector Matrix plus Principal Component Analysis mathematic model, MFOS provided an AUC of 71.4%.
  Conclusions: Despite the experimental nature of the current technique, operator independent MFOS appeared non-inferior to gold standard urine cytology in a direct comparison. Further larger trials might confirm these results.

UP-04.03—Assessing the Impact of Step Count on the Risk of Post-Operative Ileus Following Robotic Assisted Radical Cystectomy 

• Carey Charles, Malthouse Theo, Sullivan Gabriel, Milton Nicola, Calleja Edward
  East Sussex Healthcare NHS Trust, Eastbourne, United Kingdom

• Introduction and Objectives: There is currently little evidence supporting how much activity should be performed after radical cystectomy to prevent paralytic ileus. This study measured the association between step count and the incidence of ileus after robotic-assisted radical cystectomy (RARC).
  Materials and Methods: Patients who consented to wearing Fitbits after RARC between October 2022–July 2024 were included, and their daily number of steps were measured until discharge. The mean number of steps taken by patients who developed and did not develop ileus were compared using one-tailed t-tests. A Point-Biserial correlation coefficient was also used to measure the correlation between step count and ileus.
  Results: 29 patients were included, and 13 (44.8%) suffered post-operative ileus. Patients who developed ileus had a mean daily (SD) step count of 603.1 (476.7) after three post-operative days. This was significantly lower than the 1,220.0 (1,231.0) taken by those without ileus (p = 0.029). The mean (SD) daily number of steps taken after seven days by patients who suffered ileus was 949.0 (737.5), which was also significantly lower than the 1988.5 (1,530.0) taken by those without ileus. A statistically significant negative Point-Biserial correlation was found between the number of steps taken after seven days and ileus (r = −0.39, p = 0.04). A negative correlation, which was not statistically significant, was also found between the number of steps taken after three days and ileus (r = −0.31, p = 0.13). The mean (SD) length of hospital stay (LOS) for patients who developed ileus was significantly longer than for those who did not suffer ileus (p = 0.001). There were no significant differences between the mean ages and Charlson co-morbidity indexes between patients who developed and did not develop ileus (p = 0.460 and 0.098 respectively).
  Conclusions: Patients who developed ileus took significantly fewer steps during the first three and seven days after RARC and had a significantly longer LOS. The number of steps was also negatively correlated with the incidence of ileus. Encouraging patients to take a similar mean number of steps to those who did not suffer ileus in this study may reduce the risk of this complication after RARC.

UP-04.04—Assessing the Oncological Outcomes for Robotic-Assisted Salvage Cystectomy After Radiotherapy for Muscle-Invasive Bladder Cancer 

• Carbin Joseph Danny Darlington, Ferguson Jonathan, Raderam Giriraj, Antonoglou Georgios, Roodhouse Alison, Swinn Michael, Woodhams Simon, Abou Chedid Wissam, Kusuma Venkata Ramana Murthy, Moschonas Dimitrios, Patil Krishna, Perry Matthew
  Royal Surrey County Hospital, Guildford, United Kingdom

• Introduction and Objectives: Muscle invasive bladder cancer (MIBC) carries poor prognosis, with 5-year survival of 34% for just localised bladder cancer. Radical cystectomy (RC) is considered an optimal treatment for MIBC however conveys significant pre- and post-operative discrepancy in quality of life for patients. Alternative treatment options, such as radical radiotherapy, can provide comparable oncological outcomes. In some cases, salvage radical cystectomy is required if bladder preserving therapies fail to provide satisfactory oncological outcomes. The robotic approach has demonstrated comparable outcomes to open in recent studies, however none providing data for salvage procedures. We aim to demonstrate our experience of salvage RARC oncological outcomes at a single cancer referral centre.
  Materials and Methods: After local audit approval, a retrospective study between 2013–2023 at our hospital was completed. Inclusion criteria were all patients who underwent robotic-assisted salvage cystectomy (RARC) post-radiotherapy treatment for bladder cancer only. Patients undergoing RARC for bladder damage secondary to treatment for peri-bladder disease such as gynaecological or prostatic disease were excluded.
  Results: 25 patients underwent RARC between 2013 and 2023. 2 were excluded for peri-bladder disease, leaving N = 23. 18 patients were male, 5 females. Pre-operative disease was classified as muscle invasive bladder cancer (19 cases), non-muscle-invasive bladder cancer (4 cases). Mean age: 72 years. Mean BMI: 28.13 kg/m ². Neoadjuvant chemotherapy conducted in 6 cases. 2 patients experienced mild hydronephrosis postoperatively (beyond 90 days). Sadly, 13 patients passed away during follow-up, 2 cases from lung cancer, 4 from progression of bladder cancer disease, the remainder not recorded. In total, 7 cases recorded recurrence. For a median follow up of 20 months post-procedure, overall survival (OS) was 43.5% and Recurrence Free Survival (RFS) was 14.6 months. Transitional cell carcinoma showed overall survival of 43.8%; none of the adenocarcinoma, necrosis, or metastatic cases survived. No statistically significant difference found in overall survival between MIBC and non-muscle invasive bladder cancer (NMIBC) cases.
  Conclusions: Common oncological outcomes in RFS and OS have been demonstrated for our cohort at a single centre. Overall survival was not significantly different between MIBC and NMIBC cases.

UP-04.05—Assessing the Success Rate of Implementing Day Case Transurethral Resection of Bladder Tumour (Turbts)—A Quality Improvement Initiative 

• Rajagopal Ragaul, Rddah Mayas, Quraishi Mohammed Kamil, Calleja Edward
  East Sussex Healthcare Trust, Eastbourne, United Kingdom

• Introduction and Objectives: Day Case Transurethral Resection of Bladder Tumour (TURBT) is a surgical approach aimed at reducing inpatient admissions and optimizing healthcare resource utilization. This Quality Improvement Project (QIP 1573) was conducted at Hailsham Ward, Eastbourne District General Hospital, with the objective of increasing same-day discharges while maintaining patient safety and clinical outcomes. The initiative also sought to streamline surgical workflows, improve postoperative care, and promote patient autonomy through strategies like Self-Trial Without Catheter (TWOC).
  Materials and Methods: A structured quality improvement methodology using Plan-Do-Study-Act (PDSA) cycles were employed. Baseline data (February–April 2024) identified key areas for intervention: inconsistent operative documentation, inadequate post-op reviews, poor discharge planning, and limited self-TWOC uptake. Interventions included mentorship for junior surgeons, standardization of operation notes, improved discharge letter training, patient education on self-TWOC, and more consistent post-op ward rounds. Two data collection cycles were completed—Cycle 1 in May 2024 and Cycle 2 in October 2024—with results reviewed at Clinical Governance Meetings in May and November 2024.
  Results: Significant improvements were observed across several metrics. The proportion of day-case TURBTs increased from 53% to 67.4%. GIRFT data reflected a rise from 21% in February 2024 to 51.6% in September 2024, inclusive of Transurethral Laser Ablation (TULA) procedures. Postoperative catheter documentation accuracy improved from 71% to 98%, while fully completed operation notes rose from 58% to 65%. Surgeon-led post-op reviews increased from 75% to 90%, enhancing complication monitoring and discharge safety. Self-TWOC adoption rose from 0% to 10.9%, marking early progress in promoting patient self-management. Readmission rates increased slightly from 5% to 7.2%, highlighting the need for ongoing refinement of discharge protocols.
  Conclusions: This initiative demonstrated that structured quality improvement efforts can successfully increase day-case TURBT rates while improving clinical documentation and patient care. The project optimized resource use and fostered a culture of continuous improvement. Further efforts should focus on expanding self-TWOC programs, strengthening patient education, and implementing real-time feedback systems to sustain progress and further reduce readmissions.

UP-04.06—Assessment of Pioglitazone Use History in Patients Diagnosed with Bladder Cancer: A Case-Control Matched Analysis 

• Cin Hicret ¹, Turan Turgay ¹, Gulmez Hakan ¹, Polat Salih ¹, Efiloglu Ozgur ², Yildirim Asif ², Ahmadzada Javid ¹
  ¹ Izmir Democracy University, Izmir, Türkiye, ² Istanbul Medeniyet University, Istanbul, Türkiye

• Introduction and Objectives: Pioglitazone, a thiazolidinedione approved for type 2 diabetes, is known for its cardiometabolic benefits. However, its potential association with bladder cancer risk remains controversial. The aim of our study is to evaluate the relationship between the presence of type 2 diabetes and pioglitazone use with the recurrence and progression of bladder cancer.
  Materials and Methods: This study is based on the retrospective analysis of prospectively collected data from 943 patients diagnosed with bladder cancer between 2005 and 2024. Initially, patients were categorized into two groups: those without a diagnosis of Diabetes Mellitus (DM) (n = 721) and those with DM (n = 222). Non-diabetic patients had a mean follow-up of 30 months, while diabetic patients were followed for 24 months. Additionally, in patients with DM, the use of pioglitazone was assessed, and those receiving the medication were further stratified into a distinct subgroup (Table 1). Subsequent analyses used a case-control approach to compare tumor recurrence and progression in patients receiving pioglitazone, focusing on the duration of use.
  Results: Patients with diabetes not receiving pioglitazone had significantly higher mean age and CIS presence, while those without diabetes showed higher male predominance and lower BMI (Table 1). Patients were matched for recurrence and progression using a case-control design based on age, BMI, smoking history, tumor stage, grade, number, and CIS presence, as shown in Table 2. No significant differences were observed between groups in terms of recurrence, time to recurrence, progression, or time to progression. There was no significant correlation between pioglitazone duration and recurrence or progression (Table 3). In the recurrence and progression analysis (Table 4), smoking history, T1 stage, and CIS presence predicted recurrence, while CIS and tumor size predicted progression.
  Conclusions: Pioglitazone use and duration were not significantly associated with bladder cancer recurrence or progression, and no meaningful oncologic outcome differences were observed between groups despite case-control matching. These findings suggest that pioglitazone does not independently influence bladder cancer prognosis, and patient-specific tumor characteristics remain the primary determinants of clinical outcomes.

UP-04.07—Clinical Presentation, Management and Follow-up of Urachal Carcinoma: A Large, Tertiary Centre Experience over a 10-Year Period 

• Wang Bingxuan ¹, Ahmed Adham ², McPhee Arthur ²
  ¹ Clinical School of Medicine, University of Cambridge, Cambridge, United Kingdom, ² Cambridge University Hospitals, Cambridge, United Kingdom

• Introduction and Objectives: Urachal carcinoma is a rare and aggressive bladder cancer originating from the urachus, a vestigial structure of the allantois of no residual function after birth. Despite its typical involution, urachal remnants may persist and undergo malignant transformation. This cancer is often diagnosed at advanced stages owing to its anatomical location and is therefore associated with poor prognoses.
  Materials and Methods: A retrospective review of records from a tertiary centre identified 12 patients with urachal carcinoma diagnosed between 2014 and 2023. Data obtained included clinical presentation, investigation findings, stage, treatment modalities and clinical outcome.
  Results: Patients were predominantly male (75%) and over 50 years of age at diagnosis (67%). Haematuria was the most common initial symptom. Pathologically, all tumours were adenocarcinoma of enteric or mucinous subtypes. All patients who underwent surgery had partial cystectomies, with open or laparoscopic approaches. MDT treatment combinations, including chemotherapy and/or radiotherapy in addition to surgery, were used in some patients. Follow-up revealed three deaths due to urachal carcinoma. Median survival time was 20.5 months. Prognoses varied for different tumour stages with greater mortality rates observed in higher Sheldon/TNM tumour stages.
  Conclusions: The management of urachal carcinoma represents a clinical challenge due to the rarity of both the disease itself and the published literature. This study highlights that, whilst surgery and/or chemotherapy form the cornerstone of treatment of urachal carcinoma, international collaboration is needed to formulate consensus, evidence-based management protocols to improve patient outcome.

UP-04.08—Comparison of Image Signal-to-Noise Ratio, Tumor Detection Rate, and Prognostic Outcomes Between Blue Light Cystoscopy and White Light Cystoscopy in Chinese Non-Muscle Invasive Bladder Cancer Patients 

• Li Peng, Qie Yunkai, Lei Mingde, Chen Houyuan, Huang Shiwang, Wang Yinlei, Jia Kaipeng, Wu Zhouliang, Liu Kangkang, Liu Zhiheng, Zhang Zhe, Lin Yuda, Fu Chong, Zhang Tianxiao, Shen Chong, Hu Hailong
  The Second Hospital of Tianjin Medical University, Tianjin, China

• Introduction and Objectives: The high recurrence rate following white light cystoscopy (WLC) raises concerns, but blue light cystoscopy (BLC) appears to offer a promising solution.
  Materials and Methods: From January to June 2023, a total of 223 bladder cancer patients underwent transurethral resection. 40 patients who intended to receive Hexaminolevulinate were included as the experimental group, and comparisons of image signal-to-noise ratio and performance analysis were conducted, along with the evaluation of safety metrics. The remaining patients were assigned to the control group. 12-month follow-up was conducted after excluding those unsuitable for prognostic analysis. Propensity score matching was performed, resulting in BLC group (n = 25) and WLC group (n = 25).
  Results: BLC exhibited a better tumor/adjacent tissue signal-to-noise ratio compared to WLC, regardless of the pathological types (Dysplasia, Ta, T1, or Cis) (p = 0.001, p = 0.001, p < 0.0001, and p = 0.002, respectively). However, WLC provided better image quality compared to BLC, irrespective of pathological type (p < 0.0001). At the lesion level, the detection rates for BLC compared to WLC were 93.10% vs. 41.38%, 100% vs. 93.75%, 100% vs. 87.23%, and 100% vs. 63.64% for Dysplasia, Ta, T1, and Cis, respectively (p = 0.003, p = 0.325, p = 0.012, and p = 0.019). At the patient level, 32.35% of patients (55.88% when combining Dysplasia) had at least one lesion detected only by BLC. Furthermore, the false positive rates for BLC and WLC were 12.5% (16/128) and 3.53% (3/85), respectively. And 45% were observed to experience a total of 30 adverse events, all classified as mild to moderate and unrelated to Hexaminolevulinate. Prognostic analysis revealed that the recurrence rate in the WLC group was significantly higher than in the BLC group (48.00% vs. 20.00%, p = 0.037). Moreover, Kaplan-Meier curves indicated that the 1-year recurrence-free survival rate for the BLC group was significantly better than that for the WLC group (p = 0.034), and further multivariable Cox regression analysis identified BLC as a protective factor (HR 0.210, 95% CI 0.064–0.698, p = 0.011).
  Conclusions: Hexaminolevulinate-induced cystoscopy offers a new method for tumor observation, enhancing tumor discrimination during the procedure. Compared to traditional WLC, BLC enhances tumor detection rates and reduces residual tumors in Chinese NMIBC patients, resulting in a significant decrease in the one-year recurrence rate during follow-up.

UP-04.09—Comparison of Three Different Maintenance Protocols for First-Line Intravesical Gemcitabine in Asian Patients with Non-Muscle-Invasive Bladder Cancer: A Multi-Center Retrospective Cohort Study 

• Nam Jong Kil ¹, Oh Cheol Kyu ², Lee Ki Soo ³, Goh Hyeok Jun ³, Kim Tae Nam ⁴
  ¹ Pusan National University Yangsan Hospital, Yangsan, Republic of Korea, ² Inje University Haeundae Paik Hospital, Busan, Republic of Korea, ³ Dong-A University Hospital, Busan, Republic of Korea, ⁴ Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea

• Introduction and Objectives: Due to the ongoing BCG shortage, intravesical gemcitabine has been increasingly used as first-line therapy for non–muscle-invasive bladder cancer (NMIBC). However, data comparing various intravesical gemcitabine therapies used in real practice are lacking. We compared the oncologic outcomes of patients with NMIBC treated with three different intravesical gemcitabine protocols.
  Materials and Methods: Patients treated at four tertiary hospitals from January 2020 to August 2024 were retrospectively analyzed. A total of 206 patients with intermediate and high-risk, intravesical-treatment-naive NMIBC were included: 64 patients (group I, induction only), 68 patients (group II, induction plus 4-times maintenance), and 74 patients (group III, induction plus 1-year maintenance). These patients received intravesical gemcitabine therapy following complete transurethral resection of bladder tumor (TURBT). Two grams of gemcitabine were administered intravesically once per week for 5–6 weeks. Maintenance regimens at the same dosage were initiated once per month if the patient was disease-free at the first follow-up visit.
  Results: The median (IQR) age and duration of follow-up were 72.0 (65.0–79.0) years and 11.0 (2.0–14.7) months, respectively. A total of 168 patients (81.6%) were male, and all 206 patients (100%) were Asian. Recurrence-free survival (RFS) rates in groups I, II, and III were 83.2%, 90.4%, and 100% at 6 months; 74.9%, 66.2%, and 91.1% at 12 months; and 54.5%, 44.1%, and 78.7% at 24 months. Multivariable Cox regression analyses, controlling for sex, results of repeat TURBT, and total number of intravesical gemcitabine installations revealed that the group III treatment protocol (hazard ratio, 0.28; 95% CI, 0.10–0.63; p = 0.003) and the presence of carcinoma in situ (hazard ratio, 2.49; 95% CI, 1.21–5.12; p = 0.011) were associated with RFS. Three patients experienced disease progression, but progression-free survival did not significantly differ among the three treatment groups (p = 0.151). There were three (1.5%) adverse events greater than grade III and four (1.9%) treatment discontinuations, which were not significantly different among the three treatment groups.
  Conclusions: In this cohort study, the 1-year gemcitabine maintenance protocol was associated with less disease recurrence, along with similar rates of adverse events and treatment discontinuation compared to the other gemcitabine protocols.

UP-04.10—CT-Based Radiomics Signature of Visceral Adipose Tissue for Prediction of Early Recurrence in Patients with NMIBC: A Multicentre Cohort Study 

• Yu Nengfeng, Jin Xiaodong
  Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China

• Introduction and Objectives: The objective of this research is to investigate the predictive ability of abdominal fat features derived from computed tomography (CT) to predict early recurrence within a year following the initial transurethral resection of bladder tumor (TURBT) in patients with non-muscular-invasive bladder cancer (NMIBC). A predictive model is constructed in combination with clinical factors to aid in the evaluation of the risk of early recurrence among NMIBC patients post-initial TURBT.
  Materials and Methods: This retrospective study enrolled 325 NMIBC patients from three centers. Machine learning-based visceral adipose tissue (VAT) radiomics models (VAT-RM) and subcutaneous adipose tissue (SAT) radiomics models (SAT-RM) were constructed for identifying patients with early recurrence. A combined model integrating VAT-RM and clinical factors was further established. The predictive performance of each variable and model was analyzed using the area under the receiver operating characteristic curve (AUC). The net benefit of each variable and model was presented through decision curve analysis (DCA). The calibration was evaluated utilizing the Hosmer-Lemeshow test.
  Results: The VAT-RM demonstrated satisfactory performance in the training cohort (AUC = 0.853, 95% CI 0.768–0.937), test cohort 1 (AUC = 0.823, 95% CI 0.730–0.916), and 2 (AUC = 0.808, 95% CI 0.681–0.935). Across all cohorts, the AUC values of the VAT-RM were higher than that of SAT-RM (p < 0.001). The DCA curves further confirmed that the net profit of VAT-RM was better than that of SAT-RM. In the context of multivariate logistic regression analysis, the VAT-RM emerged as the most significant independent predictor (hazard ratio [HR] = 0.000, p < 0.001). The fusion model exhibited excellent AUC values for 0.938, 0.851, and 0.826 across three cohorts. The fusion model surpassed traditional risk assessment frameworks (EORTC/CUETO) in terms of both predictive efficacy and net clinical benefit.
  Conclusions: VAT serves as a crucial factor of early postoperative recurrence in NMIBC patients. VAT-RM can accurately identify high-risk patients with early postoperative recurrence and has significant advantages over SAT-RM. The new predictive model constructed by combining VAT-RM and clinical factors exhibits excellent predictive performance, net benefits, and calibration accuracy.

UP-04.11—Day Case Thulium Fibre Laser En Bloc Resection for Non-Muscle Invasive Bladder Cancer 

• Pineda Turner Andrew, Karanjia Rustam, Agag Ayman, Brittain James, Abuelnaga Mahmoud, Whiting Danielle, Paramore Louise, Chetwood Andrew, Ali Ahmed
  NHS Frimley Health Foundation Trust, Frimley, United Kingdom

• Introduction and Objectives: Thulium Fibre Laser En Bloc resection of Bladder Tumour (TFLeBT) has been utilised as an alternative to conventional TURBT for non-muscle invasive bladder cancer (NMIBC). At present, no published data exists on its use within the UK and NHS, even though initial results have suggested it provides superior detrusor muscle sampling, reduced complication rates, and reduced rates of 1-year recurrence. We present our initial data to assess the efficacy and feasibility of using TFLeBT for NMIBC.
  Materials and Methods: Between December 2022–November 2024, patients at Frimley Park Hospital with suspected superficial bladder tumours at cystoscopy underwent TFLeBT rather than conventional TURBT. Patient demographics were gathered, including smoking history, performance status, and tumour characteristics at cystoscopy. Primary outcomes were rates of detrusor muscle sampling in High-Grade (HG) disease, Mitomycin C (MMC) instillation rates, day case rates, and 30-day complications (defined as Clavien-Dindo (CD) > 2).
  Results: During this period, 75 patients underwent TFLeBT. The average age was 75 [range 37–93], 58/75 (77%) were male, and 62/75 (83%) were primary resections. 1/75 (1%) was converted intra-operatively to conventional TURBT due to size of tumour. 47/75 (63%) patients were diagnosed with HG disease, of which detrusor muscle was sampled in 38/47 (81%). No intra-operative perforations occurred. MMC was given in 58/64 (91%) when indicated. 59/75 (79%) patients were day-case procedures, excluding social reasons. 5/75 (7%) had CD > 2 complications (two had haematuria requiring irrigation, two developed urinary tract infections, and one had an upper GI Bleed due to oesophagitis post-op).
  Conclusions: Initial results suggest TFLeBT is a safe and feasible day-case alternative to conventional TURBT in the UK, with high rates of detrusor muscle sampling and low risk of complications. Longer term data is needed to assess oncological outcomes.

UP-04.12—Does Bladder Outlet Obstruction Related to Recurrence In Low Risk Ta Low Grade Non Muscle Invasive Bladder Cancer? 

• Dusunus Yunus, Yentur Serhat, Ulus Ismail, Kandirali Ismail
  Bagcilar research and training Hospital, Istanbul, Türkiye

• Introduction and Objectives: Bladder cancer is common in men. The number of recurrences is one of the risk factors for progression and poor prognosis in nonmuscle invasive bladder cancer (NMIBC). We aimed to investigate whether bladder outlet obstruction (BOO) has an effect on bladder cancer recurrence in patients with nonmuscle invasive bladder cancer.
  Materials and Methods: Data from 207 male patients with nonmuscle invasive bladder cancer (NMIBC) diagnosed between November 2008 and March 2023, with low risk Ta Low-Grade tumors were retrospectively reviewed. Patients were divided into 2 groups as bladder outlet obstruction (n:133) and nonobstruction (n:74). We analyzed the results of the effect of obstruction on bladder cancer recurrence.
  Results: Recurrence rates of patients with bladder outlet obstruction were found to be higher in Kaplan-Meier analysis. The log-rank test result of p = 0.034 was statistically significant at 5% significance level. Cox regression analysis revealed that bladder outlet obstruction had an increasing effect on recurrence (p = 0.049), while other variables (smoking, age, postmicturition residual [PMR]) did not create a significant difference in the risk of recurrence.
  Conclusions: The presence of bladder outlet obstruction is a factor that increases the risk of recurrence. In bladder cancer patients, early treatment of bladder outlet obstruction will not only reduce the tumor recurrence rate but also have a positive impact on the patient’s quality of life.

UP-04.13—Efficacy and Safety of Intravesical Hyperthermic Chemotherapy with Mitomycin C in the Management of Non-Muscle-Invasive Bladder Cancer 

• Pelari Lira ¹, Saavedra Centeno Manuel ², Velasco Balanza Clara ², Sanchez Ramirez Ana ², Albers Acosta Eduardo ², Costal Martin ², Celada Luis Guillermo ², Pinazo Rubio Ignacio ², Cogorno Wasylkowski Leopoldo ², Casado Varela Javier ², Quicios Dorado Cristina ², San Jose Manso Luis Alberto ²
  ¹ Hospital Universitario de la Princesa, Madrid, Spain, ² Hospital de la Princesa, Madrid, Spain

• Introduction and Objectives: Non-muscle-invasive bladder cancer (NMIBC) is a neoplasm with high incidence and recurrence risk. Intravesical hyperthermic chemotherapy (HIVEC), combining mitomycin C with local heating, has shown to reduce these recurrence rates, although clear indications and therapeutic protocols have not yet been established. This study analyzes the effectiveness and safety of HIVEC in patients with NMIBC over a three-year period.
  Materials and Methods: This study retrospectively analyzed 40 patients with intermediate and high-risk recurrent NMIBC who had previously undergone BCG treatment and subsequently received HIVEC between January 2021 and December 2024. The analyzed variables included clinical and pathological characteristics, recurrence and progression rates, and treatment-related adverse events. The treatment was administered using mitomycin C (40 mg) via heated intravesical irrigation system (Combat System^®) applied weekly for 6 weeks. Recurrence and progression rates at 12 and 24 months were calculated using the Kaplan-Meier method. Additionally, adverse events were reviewed, and treatment interruptions due to these events were quantified.
  Results: Forty patients were included, 29 men (72.5%) and 11 women (27.5%). The median age was 68 years (range: 32–82). The median follow-up was 30 months (range: 3–48). Eighteen patients (45%) were classified as high risk, and 22 patients (55%) as intermediate risk. Recurrence rates were 17.5% at 12 months and 25% at 24 months. No cases of progression to muscle-invasive disease were observed. The most common adverse events were bladder spasms (12.5%), hematuria (5%), dysuria (2.5%), and dizziness (2.5%). A 12.5% treatment interruption rate was recorded due to toxicity or intolerance.
  Conclusions: HIVEC with mitomycin C is an effective and safe strategy for the treatment of NMIBC, with low recurrence rates and no progression to muscle-invasive disease. Although adverse events were generally mild, 12.5% of patients could not complete the treatment due to toxicity. These findings support HIVEC as a valid option in NMIBC management. However, prospective studies with larger patient cohorts are needed to confirm these results.

UP-04.14—Efficacy of Single-Side Mono Ureterocutaneostomy as a Method of Urine Diversion After Cytoreductive Cystectomy in Patients with Locally Advanced and Metastatic Bladder Cancer (BC) 

• Voylenko Oleg, Pishak Vladyslav, Stakhovskyi Oleksandr, Kononenko Oleksii, Pikul Maksym, Semko Sofiya, Hrechko Bohdan, Tymoshenko Andrii, Koshel Denis, Karkych Oleksandr, Vitruk Yurii, Stakhovsky Eduard
  National Cancer Institute of Ukraine, Kyiv, Ukraine

• Introduction and Objectives: The treatment of patients with locally advanced and metastatic bladder cancer (BC) remains challenging, as many are ineligible for systemic therapy due to complications that significantly reduce both lifespan and quality of life. In such cases, surgical intervention becomes the only available palliative option aimed at symptom control and improving patient comfort. This study aimed to evaluate the efficacy of single-side mono ureterocutaneostomy as a urinary diversion method in patients with locally advanced and metastatic BC, particularly those with low performance status who are poor candidates for more invasive procedures.
  Materials and Methods: A prospective, non-randomized study (01.2015–09.2024) included 328 patients with locally advanced (T3b–T4b) or metastatic (N1–3, M1) BC. All patients provided informed consent, and the study received approval from the local Ethics Committee. The majority had poor functional status, and cytoreductive cystectomy was performed for palliative purposes. The main group (n = 155, 47.2%) underwent single-side mono ureterocutaneostomy, while the control group (n = 173, 52.7%) received Bricker’s urinary diversion. Both groups were comparable in demographic and clinical characteristics, including age, sex, ECOG score, BMI, eGFR, creatinine levels, and comorbidities. Key outcomes included surgical time, blood loss, postoperative complications (Clavien-Dindo), and length of hospital stay. Statistical analysis was conducted using SPSS 22.0.
  Results: Intraoperative blood loss was similar between groups: 400 [300–700] ml in the main group vs. 500 [250–700] ml in the control group (p = 0.16). However, operative time was significantly shorter with mono ureterocutaneostomy (175 [150–180] vs. 210 [190–240] minutes; p < 0.01). Complication rates were lower in the main group (31 cases, 20%) compared to the control group (51 cases, 29.5%; p < 0.05). Five cases (2.9%) of intestinal anastomotic leakage occurred only in the control group, requiring stoma formation. Hospital stay was shorter in the main group (6 [5–7] vs. 8 [7–9] days; p < 0.01).
  Conclusions: Single-side mono ureterocutaneostomy is a safe and effective urinary diversion technique. It offers a valuable alternative to the Bricker procedure, especially for high-risk patients, with fewer complications, reduced operative time, and shorter hospitalization.

UP-04.15—Evaluating the Readability and Quality of Bladder Cancer Information from AI Chatbots: A Comparative Study Between ChatGPT, Google Gemini, Grok, Claude and DeepSeek 

• Patel Kunjan, Radcliffe Robert
  Royal Derby Hospital, Derby, United Kingdom

• Introduction and Objectives: Artificial Intelligence (AI) based chatbots such as ChatGPT are easily available and are quickly becoming a source of information for patients as opposed to traditional Google search. We assessed the quality of information on bladder cancer, provided by various AI chatbots such as ChatGPT 4o, Google Gemini 2.0 flash, Grok 3, Claude Sonnet 3.7 and DeepSeek R1. Their responses were analysed in terms of Readability Indices, and two consultant urologists rated the quality of information provided using the validated DISCERN tool.
  Materials and Methods: Top 10 most frequently asked questions about bladder cancer were identified using Google Trends. These questions were then provided to five different AI chatbots, and their responses were collected. No prompts were used reflecting natural language queries that patients would use. The responses were analysed in terms of their readability using five validated indices: Flesch Reading Ease (FRE), Flesch-Kincaid Reading Grade Level (FKRGL), Gunning-Fog Index, Coleman-Liau Index and SMOG index. Two consultant urologists then independently assessed the responses of various AI chatbots using the DISCERN tool, which rates quality of health information on a five-point LIKERT scale. Interrater agreement was calculated using Cohen’s Kappa and Intraclass correlation coefficient (ICC).
  Results: ChatGPT 4o was the overall winner in readability scores with highest Flesch Reading Ease score (59.4) and the lowest average reading grade level (7.0) required to understand the material. Grok 3 was a close second (FRE 58.3, Grade level 8.7). Claude 3.7 Sonnet used the most complex language in its answers and therefore scored the lowest FRE score of 44.9 with highest grade level (9.5) and also highest complexity on other indices. In the DISCERN analysis, Grok 3 received the highest average score (52.0), followed closely by ChatGPT 4o (50.5). Interrater agreement was highest for ChatGPT 4o (ICC: 0.777; Kappa: 0.437), while it was lowest for Grok 3 (ICC: 0.243, Kappa 0.0).
  Conclusions: All AI chatbots can provide generally good quality answers to questions about bladder cancer with zero hallucinations. ChatGPT 4o was the overall winner with best Readability Metrics, strong DISCERN ratings and highest interrater agreement.

UP-04.16—Evolution of a Bladder Cancer Pathway in a Secondary Care Unit with Transurethral Laser Ablation and ‘Bladder Planning Meetings’ 

• Katz-Summercorn Charles, Pandian Shiv Kumar, Almpanis Stefanos, Hossain Akbar, Carrington Alison
  North Middlesex University Hospital, London, United Kingdom

• Introduction and Objectives: Transurethral Laser Ablation (TULA) is often used for small or recurrent bladder tumours. It offers a safe alternative for patients who are unsuitable for GA or cannot get timely pre-operative assessments for TURBT. Patients are identified for TULA in ‘bladder planning meetings’, and this reduces their cancer waiting time (CWT). Its effectiveness as a diagnostic tool, including complications and costs, has been assessed.
  Materials and Methods: All TULA procedures performed at the trust between August 2023 to November 2024 were studied. Case-notes, operation notes and MDT outcomes were retrospectively reviewed. All procedures were performed with a flexible cystoscope and ‘cold cup’ biopsies, with further ablation and haemostasis using a 1470 nm Diode laser at 4 watts and 400 µm laser fibre.
  Results: During the study period, 61 TULA procedures were performed and followed-up between 8 weeks–1 year. 52 (85.2%) were under LA +/− sedation; 8 had GA (13.1%), and 1 (1.6%) spinal anaesthetic. 5 (8.2%) cases were rebooked for TURBT following insufficient sampling; 1 (1.6%) for repeat TULA. None of the cases were considered to have missed a significant finding. 1 case was complicated with on-going bleeding, requiring bladder washout under GA. Since introducing Bladder Planning Meetings in July 2024, 24 (39%) patients were identified for TULA. Of these, 7 (29%) were originally scheduled for TURBT and were having difficulties getting pre-operative assessment clearance.
  Conclusions: TULA has been implemented with a low complication rate and appropriate sampling. In the next phase, TULA will be rolled out to an out-patient setting. This will lead to a significant cost reduction.

UP-04.17—Evolution of a Rapid, Simple Urine Test for Detecting Volatile Organic Compound (VOC) in Urine by a High Performance Portable Device (Nabil) for Detection of Urinary Bladder Carcinoma 

• Karmakar Saurav ¹, Kanjilal Subir ¹, MANDAL TAPAN ²
  ¹ B R Singh Hospital, Dumdum, India, ² Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India, Kolkata, India

• Introduction and Objectives: Diagnosis of urinary bladder cancer by the presence of volatile organic compounds (VOCs) in the urine has been employed for the past decade. Current clinical diagnostic approaches suffer from many limitations including issues related to accuracy, invasiveness and cost. The use of biomarkers in clinical practice can range from screening of at risk population, risk stratification following diagnosis, to prognostication following therapy. We have done this study jointly in collaboration with DR. S N Bose National Centre for Basic Sciences in Kolkata to develop a portable, non-invasive, real-time, low cost method of detection of bladder carcinoma by detecting urinary biomarkers.
  Materials and Methods: Urine samples from 218 patients and 56 normal volunteers have been taken. 177 patients were reported to have confirmed urinary bladder cancer, 29 subjects revealed to have fresh haematuria, and 15 subjects were reported to have other types of cancers. The samples have been kept in a warm chamber for 15 min, while they will be exposed to indigenously developed sensor strips, which change color on exposure to the specific urinary VOC. The data collected from the strip is then analysed by the inhouse device (NABIL), and the machine learning algorithms being trained using the parameters, to create a model that could estimate the probability of cancer in the urine sample under test. The result has been compared with the histopathological reports.
  Results: When we analyze the data in the algorithms, the probability of cancer in normal control population was found to be 0%. On the other hand probability of cancer in known bladder tumor cases was 85–88%, and probability of cancer among patients who were on BCG was 16%.
  Conclusions: Our present work demonstrates the development of a cost-effective sensitive sensor and rapid detection device, which has great potential applicability in rapid and non-invasive diagnosis of urinary bladder cancer, which can be extremely helpful in screening of at risk population.

UP-04.18—Evolution of Perioperative Outcomes in Robot-Assisted Radical Cystectomy over 20 Years of Experience in a High-Volume Tertiary Robotic Center 

• Morra Simone ¹, Resca Stefano ², Frego Nicola ³, Tamburini Sara ⁴, Ticonosco Marco ², Pissavini Alessandro ⁴, Noya Mourullo Andrea ⁵, Barletta Francesco ⁶, De Angelis Mario ⁶, Longo Nicola ⁷, Lambert Edward ⁸, D’Hondt Frederiek ⁸, De Groote Ruben ⁸, De Naeyer Geert ⁸, Mottrie Alexandre ⁸
  ¹ Federico II University of Naples, Naples, Italy, ² University of Modena and Reggio Emilia, Modena, Italy, ³ Humanitas Research Hospital, IRCCS, Rozzano, Italy, ⁴ IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy, ⁵ University Hospital of Salamanca, Salamanca, Spain, ⁶ IRCCS Ospedale San Raffaele, Milan, Italy, ⁷ University of Naples “Federico II”, Naples, Italy, ⁸ Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium

• Introduction and Objectives: Robot-assisted radical cystectomy (RARC) has demonstrated improved perioperative outcomes and recovery in bladder cancer (BCa) patients. This study compares patient and tumor characteristics, operative time (OT), length of stay (LOS), and complication rates between a historical (2003–2016) and a contemporary cohort (2017–2024) treated at a high-volume robotic center.
  Materials and Methods: Data from 274 BCa patients undergoing RARC at Onze-Lieve-Vrouwziekenhuis (OLV) Hospital (Aalst, Belgium) were analyzed. Perioperative outcomes were compared between cohorts. Multivariable Poisson regression models identified predictors of longer OT and LOS, while multivariable logistic regression models (MLRMs) assessed predictors of higher complication rates.
  Results: Overall, 274 BCa patients who underwent RARC were identified (38% historical cohort vs. 62% contemporary cohort). The contemporary cohort had a significantly shorter median OT (345 vs. 360 min; p = 0.048) and LOS (8 vs. 12 days; p < 0.001) compared to the historical cohort. Postoperative complications were lower in the contemporary group, with more cases experiencing no complications (60% vs. 41%) and fewer grade 3–4 complications (10% vs. 27%; p < 0.001). In multivariable Poisson regression, the contemporary cohort was an independent predictor of shorter OT (Incidence Rate Ratio [IRR]: 0.94, 95% [Confidence Interval] CI: 0.93–0.96; p = 0.04) and shorter LOS (IRR: 0.65, 95% CI: 0.60–0.69; p < 0.001). In MLRMs predicting complications, the contemporary cohort was associated with lower risk (Odds Ratio: 0.42, 95% CI: 0.23–0.76; p = 0.005).
  Conclusions: RARC outcomes improved significantly over time, with reduced OT, LOS, and complication rates in the contemporary cohort, highlighting advancements in surgical techniques, perioperative care, and patient safety. These findings reinforce the role of RARC in optimizing BCa treatment.

UP-04.19—Evolution of Survival Outcomes in Robot-Assisted Radical Cystectomy over 20 Years of Experience in a High-Volume Tertiary Robotic Center 

• Morra Simone ¹, Longo Nicola ², Resca Stefano ³, Frego Nicola ⁴, Tamburini Sara ⁵, Ticonosco Marco ³, Pissavini Alessandro ⁵, Noya Mourullo Andrea ⁶, Barletta Francesco ⁷, Lambert Edward ⁸, D’Hondt Frederiek ⁸, De Groote Ruben ⁸, De Naeyer Geert ⁸, Mottrie Alexandre ⁸
  ¹ University of Naples “Federico II”, Naples, Italy, ² Federico II University of Naples, Naples, Italy, ³ University of Modena and Reggio Emilia, Modena, Italy, ⁴ Humanitas Research Hospital, IRCCS, Rozzano, Italy, ⁵ IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy, ⁶ University Hospital of Salamanca, Salamanca, Spain, ⁷ IRCCS Ospedale San Raffaele, Milan, Italy, ⁸ Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium

• Introduction and Objectives: Radical cystectomy (RC) is the gold standard for muscle-invasive and recurrent high-risk non–muscle-invasive bladder cancer (BCa). Over time, robot-assisted radical cystectomy (RARC) has gained adoption. Despite technological advancements, survival differences may persist between patients treated in earlier versus recent years. This study evaluates temporal variations in overall survival (OS) in patients undergoing RARC at a high-volume tertiary robotic center, comparing a historical cohort (2003–2016) with a contemporary one (2017–2024).
  Materials and Methods: Data from patients undergoing RARC at Onze-Lieve-Vrouw (OLV) Hospital (Aalst, Belgium) between July 2003 and March 2024 were analyzed. Three experienced surgeons performed all procedures. Baseline characteristics were compared, Kaplan-Meier plots illustrated OS, and Cox regression models evaluated overall mortality (OM). An 18-month landmark analysis minimized immortal time bias.
  Results: Overall, 358 BCa patients underwent RARC (53% historical vs. 47% contemporary). The 3-year OS was 85% for the historical cohort vs. 93% for the contemporary cohort (p = 0.001). Multivariable Cox regression showed that treatment in the contemporary cohort was an independent predictor of lower OM (HR: 0.52, 95% CI: 0.34–0.83; p = 0.006), with further reduction after the 18-month landmark analysis (HR: 0.42, 95% CI: 0.19–0.92; p = 0.03). Higher pathological T stage (pT3-4) was associated with increased OM before (HR: 3.9, 95% CI: 2.19–6.95; p < 0.001) and after landmark analysis (HR: 2.25, 95% CI: 1.08–4.68; p = 0.03). Grade 3-4 Clavien-Dindo complications predicted higher OM before (HR: 2.02, 95% CI: 1.27–3.22; p = 0.003) but not after landmark analysis (HR: 2.04; 95% CI: 0.99–4.18; p = 0.052).
  Conclusions: Patients treated between 2017–2024 had significantly lower OM, with a 50% reduction in mortality risk compared to 2003–2016. Advancements in surgical techniques and perioperative care likely contributed to improved OS. However, pathological T stage remained a strong predictor of OM, highlighting the need for enhanced early detection and disease management despite technological progress.

UP-04.20—Exploring the Prognostic Role of HER2 and PD-L1 Expression in Bladder Cancer: Clinical Implications for Targeted and Immunotherapy Approaches 

• Mittal Ankur
  All India Institute of Medical Sciences, Rishikesh, Rishikesh, India

• Introduction and Objectives: Carcinoma urinary bladder is a common malignancy of the genitourinary tract with high rates of recurrence and progression. HER2 and PD-L1 are emerging biomarkers with potential prognostic and therapeutic significance. Analysis of expression of these biomarkers in bladder cancer patients have clinical implications for targeted and immunotherapy approaches. Hence this study aimed to study the incidence of HER2 and PD-L1 in bladder cancer patients and their associations with various clinicopathological parameters.
  Materials and Methods: A retrospective analysis was performed on 250 patients with carcinoma urinary bladder using immunohistochemical staining of tumor tissues (formalin-fixed paraffin blocks). The expression of HER2 and PD-L1 was evaluated, and their associations with clinicopathological features were analyzed statistically
  Results: HER2 overexpression was observed in 40% of cases and was significantly associated with advanced nodal stages (N2 and N3, p value 0.02). HER2/neu positivity was significantly associated with advanced nodal involvement, suggesting a potential role in tumour progression and aggressiveness. Further subgroup analysis of patients less than 40 years of age showed increased T stage (74% patients showed T2 or higher stage) and increased HER2 neu expression in nodal positive disease (61%, p value 0.036), further correlating HER2 neu expression with aggressive disease. PD-L1 positivity was identified in 50% of patients but showed no significant association with nodal involvement (p = 0.882) or other clinicopathological features, including age, gender, tumour type, and stage. Both biomarkers were independent of each other in terms of expression patterns.
  Conclusions: HER2 and PD-L1 play distinct but critical roles in bladder cancer progression, therapeutic response, and prognosis. Their differential expression highlights the need for biomarker-driven strategies to improve patient outcomes. Our study reinforces the distinct but significant roles of HER2/neu and PD-L1 in carcinoma urinary bladder. The findings support the integration of HER2/neu-targeted therapies and immune checkpoint inhibitors in personalized treatment regimens, tailored to the molecular and immunological profiles of bladder cancer patients.

UP-04.21—Higher Preoperative Systemic Inflammatory Biomarkers Remain Prognostic Indicators in Patients Undergoing Radical Cystectomy for Bladder Cancer 

• Doshi Chirag, Zahir Mazyar, Ku Josh, Nayeri Diba, Gevorkyan Rafael, Escobar Domenique, Cai Jie, Miranda Gus, Daneshmand Siamak
  USC/Norris Comprehensive Cancer Center, Los Angeles, United States

• Introduction and Objectives: Currently, there are no reliable biomarkers for predicting the prognosis of patients who undergo radical cystectomy (RC) for bladder cancer. Common blood ratios such as the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) have attracted much attention. The purpose of this study was to investigate the value of NLR, MLR, and PLR in patients with treated with radical cystectomy (RC) in assessing post-operative outcomes.
  Materials and Methods: We queried our prospective, IRB approved cystectomy database for patients who underwent radical cystectomy from 2007 to 2023. Patients who had incomplete or inaccurate CBC data were excluded from analysis. Patients with a NLR greater than 2.75, MLR greater than 0.35, and PLR greater than 140 were considered as indicative of an abnormal value. Associations of NLR with recurrence-free survival (RFS) and overall survival (OS) were assessed with univariable and multivariable Cox regression models.
  Results: Our cohort included 1,655 patients who had complete CBC data within 30 days prior to cystectomy. The 5-year recurrence-free survival (RFS) rate between normal NLR and higher NLR groups were 73 and 67% respectively. The NLR ratio was significantly associated with recurrence-free survival (p = 0.006). With each 1 point increase in the ratio, the risk of recurrence increased by 31% (HR 1.31, p = 0.0061). On multivariable analysis controlling for pathological staging, neutrophil-to-lymphocyte ratio (HR 1.23, p = 0.022) was independently associated with recurrence-free survival. Higher NLR and MLR were also significantly associated with increased 30 day and 90 day complications for patients undergoing radical cystectomy (p = 0.0014, p = 0.0004 respectively).
  Conclusions: NLR and MLR remain strong indicators for complications after radical cystectomy. Patients undergoing radical cystectomy may require further risk stratification based on their systemic inflammatory index scores.

UP-04.22—High-Grade Non-Invasive Urothelial Carcinoma of the Prostatic Urethra: Oncological Outcomes Following Intravesical BCG Treatment 

• Bizzarri Francesco Pio ¹, Terro Khodr ², Anber Ahmed ², Nelson Adam ², Colquhoun Alexandra ², Lobo Niyati ²
  ¹ Policlinico “A-Gemelli”-Gemelli Isola Tiberina, Rome, Italy, ² University of Cambridge-Addenbrooke’s Hospital, Cambridge, United Kingdom

• Introduction and Objectives: Prostatic urothelial carcinoma occurs in 16–39% of patients with non-muscle-invasive bladder cancer (NMIBC). While upfront cystectomy is the standard recommendation for carcinoma in situ involving the prostatic urethra, intravesical bacille Calmette-Guérin (BCG) therapy offers a viable alternative in select cases. We aim to evaluate the oncological outcomes in a contemporary cohort of patients with high-risk non-muscle-invasive bladder cancer and prostatic urethral involvement (PUI) treated with adequate BCG.
  Materials and Methods: We performed a review of patients with PUI and concomitant high-risk NMIBC treated with adequate BCG (as defined by the EAU) at our institution between 2014 and 2023. Recurrence-, progression-, cystectomy- and cancer-free survival were analyzed using Kaplan-Meier methods.
  Results: A total of 22 patients with PUI and concomitant high-risk NMIBC were treated with adequate BCG at our institution. The mean age was 71 years (SD 9). Seventeen (77.3%) patients had CIS of the prostatic urethra, while the remaining 4 patients had (22.7) high grade Ta. The median number of BCG doses received was 16 (IQR11). After a median follow-up of 42 months, 14 (63%) patients were alive, 4 (18%) had died from other causes and 3 (13%) had died of bladder cancer. 5-year recurrence-free, progression-free, cystectomy-free and cancer-specific survival were 45%, 72%, 87% and 86%, respectively.
  Conclusions: To our knowledge, this study represents one of the largest series of prostatic urothelial carcinoma treated with intravesical BCG. We demonstrate favorable outcomes in appropriately selected patients. This is particularly important as bladder-sparing treatments continue to garner increasing interest

UP-04.23—Impact of Animated Video-Based Education on Psychological Outcomes Prior to Cystoscopy: A Prospective Randomized Controlled Trial 

• Agirbasli Abidin, Yorulmaz Enis, Ozcan Serkan, Kose Osman, Gorgel Sacit, Akin Yiğit
  Katip Çelebi University, İzmir, Türkiye

• Introduction and Objectives: Demographic characteristics were statistically similar between the groups. Although all psychological scores showed a downward trend postoperatively, only the Beck Depression Inventory revealed a significant reduction (p = 0.002). No significant pre-post changes were observed for HADS-A, HADS-D, or STAI TX-I across the entire cohort. However, repeated measures ANOVA revealed a significant three-way interaction for HADS-A (Time ✻ Video ✻ Education Level, p = 0.045) and STAI TX-I (p = 0.002), indicating that patients with higher education levels benefited more from the video intervention in terms of reduced anxiety. No significant effects were found for HADS-D or BDI scores based on video use or education level. These findings suggest that the educational background may modulate the effectiveness of video-based education on anxiety reduction.
  Materials and Methods: This randomized controlled trial included 97 first-time cystoscopy patients. The video group (n = 45) received both written consent and an EAU-produced educational video, while the control group (n = 52) received written consent only. Psychological assessments—HADS-A, HADS-D, STAI TX-I, and BDI—were administered before and shortly after the procedure. All procedures were standardized, and appropriate statistical tests, including repeated measures ANOVA, were used to evaluate the data. Statistical analysis included Shapiro–Wilk tests for normality, independent t-tests or Mann–Whitney U tests for group comparisons, and 2 × 2 repeated measures ANOVA for within-subject comparisons. Subgroup analyses by educational and employment status were performed, and p < 0.05 was considered statistically significant.
  Results: Demographics and baseline scores were similar between groups. Overall, only BDI scores significantly declined post-procedure (p = 0.002). Anxiety scores (HADS-A, STAI TX-I) showed no significant overall difference but decreased more in university-educated patients in the video group (HADS-A interaction p = 0.045; STAI TX-I p = 0.002). HADS-D and BDI showed no significant interaction with education or video use.
  Conclusions: Video education alone did not significantly reduce anxiety or depression for the general population. However, it was more effective among patients with higher education levels. These findings highlight the importance of personalized educational strategies based on health literacy in improving patient comfort before procedures like cystoscopy.

UP-04.24—Large-Scale Comparative Analysis of the Survival, Perioperative and Operative Outcomes Between Muscle-Invasive Bladder Cancer Patients Aged <70 and ≥70 Who Underwent Radical Cystectomy: Results from the Korean Bladder Cancer Study Group Database 

• Nam Jongkil, Park Sungwoo, Kim Taenam
  Pusan National University Yangsan Hospital, Yangsan, Republic of Korea

• Introduction and Objectives: Radical cystectomy (RCx) remains the standard of care for muscle-invasive bladder cancer (MIBC). However, it is associated with considerable morbidity and mortality, raising particular concerns for elderly patients. We aimed to compare the survival, perioperative, and operative outcomes between MIBC patients aged <70 and ≥70 who underwent RCx.
  Materials and Methods: We reviewed the Korean Bladder Cancer Study Group Database and identified 3,765 MIBC patients who underwent RCx at 11 medical centers between 2010 and 2019. Cox regression and Kaplan-Meier analyses were conducted. This study was approved by the institutional review board (2405-003-138).
  Results: Of the 3,765 patients, 2,127 (56.5%) were aged <70, and 1,638 (43.5%) were aged ≥70. There were significant differences between 2 groups in terms of hypertension, diabetes, American Society of Anesthesiologists score, clinical N and pathological T stages (all p < 0.05). In patients aged ≥70, a lower rate of neoadjuvant chemotherapy, shorter operative times, and fewer lymph nodes removed were observed (all p < 0.01). Patients aged ≥70 more frequently underwent open RCx, ileal conduit or ureterocutaneostomy urinary diversion, limited or standard lymph node dissection, intraoperative transfusion, and had higher mortality rates within 30 days postoperatively (all p < 0.01). Multivariate Cox regression analysis revealed that age ≥ 70 was a significant risk factor for both cancer-specific mortality and overall mortality, with hazard ratios of 1.43 (95% confidence interval [CI]: 1.22–1.68) and 1.64 (95% CI: 1.45–1.85), respectively (all p < 0.001). In survival analysis, patients aged ≥70 had significantly worse outcomes than their younger counterparts across recurrence-free survival (RFS; 61.0 vs. 91.0 months, log-rank p = 0.009), cancer-specific survival (CSS; not reached in both groups, log-rank p < 0.001), and overall survival (OS; 68.0 vs. 155.0 months, log-rank p < 0.001).
  Conclusions: Patients aged ≥70 who underwent RCx had different perioperative and operative outcomes compared to those aged <70. Furthermore, age ≥ 70 was associated with significantly worse RFS, CSS, and OS.

UP-04.25—LEGEND: A Phase 1/2 Study of Detalimogene Voraplasmid Intravesical Monotherapy for Patients with High-Risk Non-Muscle Invasive Bladder Cancer (NMIBC) 

• Daneshmand Siamak ¹, Satkunasivam Raj ², Lotan Yair ³, Taylor John A. ⁴, Holzbeierlein Jeffrey ⁴, Merrill Suzanne ⁵, Packiam Vignesh T. ⁶, Chang Sam S. ⁷, Joshi Shreyas ⁸, Liu Jen-Jane ⁹, Schuckman Anne ¹⁰, Salmasi Amir ¹¹, Kassouf Wassim ¹², Tyson Mark ¹³, Dickstein Rian ¹⁴, Shore Neal ¹⁵, Luckenbaugh Amy ⁷, Martini Alberto ¹⁶, Tosone Christine ¹⁷, Cheung Anthony ¹⁷, Chan Katherine ¹⁷, Pruthi Raj ¹⁷, Kamat Ashish ¹⁸
  ¹ USC Norris Comprehensive Cancer Center, Los Angeles, United States, ² Houston Methodist-Weill Cornell Medical College, Houston, United States, ³ University of Texas Southwestern Medical Center, Dallas, United States, ⁴ University of Kansas Cancer Center, Kansas City, United States, ⁵ Colorado Urology, Brighton, United States, ⁶ Rutgers RWJ Barnabas Health, West Orange, United States, ⁷ Vanderbilt University, Nashville, United States, ⁸ Emory University School of Medicine, Atlanta, United States, ⁹ Oregon Health Science University, Portland, United States, ¹⁰ Keck/USC School of Medicine, Los Angeles, United States, ¹¹ UC San Diego, San Diego, United States, ¹² McGill University, Montreal, Canada, ¹³ Mayo Clinic, Phoenix, United States, ¹⁴ Cheapeake Urology, Hanover, United States, ¹⁵ Carolina Urology, Myrtle Beach, United States, ¹⁶ University of Cincinnati Cancer Center, Cincinnati, United States, ¹⁷ enGene Inc., Waltham, United States, ¹⁸ University of Texas MD Anderson Cancer Center, Houston, United States

• Introduction and Objectives: Detalimogene voraplasmid (EG-70) is a novel, investigational genetic medicine for high-risk non-muscle invasive bladder cancer (NMIBC) delivered intravesically using a non-viral vector. It is designed to elicit local stimulation of anti-tumor immune responses in the bladder without cellular integration, mitigating the risk of systemic toxicity. The Phase 1 (dose-escalation) portion of the first-in-human, Phase 1/2, open-label, multicenter study of detalimogene (LEGEND; NCT04752722) is complete. The Phase 2 dose was identified, treatment was generally well tolerated, and the overall complete response (CR) rate was 73%. Here we describe the ongoing Phase 2 portion of the study, which opened in May 2023.
  Materials and Methods: Eligibility criteria: age ≥ 18 years; ECOG PS 0–2; NMIBC ± resected coexisting papillary (Ta/T1) tumors, ineligible for/elected not to undergo cystectomy; satisfactory bladder function with ability to retain study drug for ≥60 min. Cohorts: BCG-unresponsive with CIS (Cohort 1; pivotal cohort); BCG-naïve with CIS (Cohort 2A) or BCG-exposed with CIS (Cohort 2B); BCG-unresponsive with high-grade papillary disease without CIS (Cohort 3). Patients receive detalimogene (dose: 0.8 mg/mL) in a volume of 50 mL intravesically, at Weeks 1, 2, 5 & 6 in a 12-week cycle × 4 cycles; patients with CR at end of 4th cycle enter maintenance treatment (2 instillations per cycle, at Weeks 1 & 2 for up to 8 cycles). Phase 2 primary endpoints: efficacy (CR rate at Week 48); safety. Secondary endpoints: PFS; CR rate at Week 12, 24, 36 & 96; % of patients with durable CR at 12 Months.
  Results: The Phase 2 portion of the study is enrolling.
  Conclusions: The study will recruit approximately 300 patients across all cohorts, from sites in the USA, Canada, Europe, and the Asia-Pacific region.

UP-04.26—Long Term Outcome of Outpatient Laser Ablation for Non Muscle Invasive Bladder Cancer 

• Habib Abul, Feflea Dragos, Elsweefy Momen, Zakarian Artaches, Rahman Shahinur, Batura Deepak
  London North West University Healthcare NHS Trust, Harrow, United Kingdom

• Introduction and Objectives: Non muscle invasive bladder cancer (NMIBC) has a high recurrence rate. Repeated transurethral resections under general/regional anaesthesia adds to cost and morbidities. Therefore, outpatient Laser ablation (LA) is getting popularity, but there is lack of long term data in terms of efficacy and safety of this procedure. This study was aimed to evaluate the long-term safety and efficacy of LA as a treatment modality for patients with NMIBC recurrences.
  Materials and Methods: Retrospective study was conducted involving patients diagnosed with NMIBC undergoing laser ablation/resection between 2017 and 2019 in outpatient clinic under local anaesthetic in Northwick Park Hospital, London. Diode Laser 3 W, 1470/980 nm was used. Patients were followed up for five years post-procedure. Patient and disease characteristics, recurrence, progression, and complications were noted. MS Excel was used for data collection and analysis.
  Results: Total 46 patients were included, mean age 81.3 years (range: 70–91), average frailty score 2.9 (range: 1–6), average WHO performance status of 1.6 (range: 0–3). Mean duration of follow up since diagnosis was 9.5 years. 15 (32.6%) patients were of low risk, 21 (45.6%) intermediate risk, and 09 (19.5%) patients were of high risk group. 09/46 had BCG, and 17/46 patients had full course of Mitomycin therapy. 42 (91.3%) patients had one or more recurrence over 5 years; progression was noted in 01 (2.1%) patient who had BCG refractory G3T1 disease. 11 (23.9%) patients died of non cancer related cause. 2 (4.3%) patients came back with haematuria, one of them required hospital admission for washout, another 2 (4.3%) were treated for UTI with oral antibiotics. Average laser energy was 798.5 Joule, and laser time—181.5 s.
  Conclusions: Outpatient laser ablation is safe and effective treatment for NMIBC, offers good long-term oncologic control without disease progression with minimal morbidity. It is particularly useful for elderly, frail group of patients to keep them safe and progression free. Study with Larger sample size and randomised trial would be helpful to compare this with the standard treatment (Transurethral Resection of Bladder Tumor).

UP-04.27—Low Risk Non Muscle Invasive Bladder Cancer (NMIBC)—Are We Safe to Discharge After a Year? 

• Mohammed Lubna Tarranum ¹, Warren Kate ², Mohammed Shah ³, Burden Helena ²
  ¹ North Bristol, Weston Super Mare, United Kingdom, ² North Bristol Trust, Bristol, United Kingdom, ³ UCHL, London, United Kingdom

• Introduction and Objectives: Bladder cancer is the 11th most common in UK. Non-muscle invasive bladder cancer (NMIBC) has a higher prevalence than muscle invasive cancer and presents a unique challenge due to its propensity for recurrence. However, guidance varies as to the appropriate surveillance protocol. For low risk NMIBC, National Institute for Clinical Excellence guidelines suggest patients can be discharged at 1 year; however, alternative guidelines recommend a longer follow-up.
  Materials and Methods: We performed a retrospective analysis of low risk NMIBC patients on our surveillance database, at a tertiary referral centre, between January 2017 to April 2023. As part of our current centre guidance, we perform surveillance cystoscopies up to 3 years. Primary study outcome was recurrence data.
  Results: A total of 193 patients, low risk NMIBC patients, were identified for inclusion (74% male) with a mean age of 71 years (10–99 years). During this study 4.66% (n = 09/193) of the patients had a recurrence. 3 of the 12 patients had a recurrence within 1 year, one had G3 pTa, and two had G2 pTa. While 6 patients had a recurrence within 3 years of follow up, all of these were G2 PTA, and one patient had 3 time recurrences. Within our dataset, no recurrences were seen after 3 years.
  Conclusions: Low risk NMIBC in our dataset demonstrates a significant risk of recurrence occurring after one year of being disease free. In fact, the majority of recurrences have occurred after the first year of surveillance. Therefore, we do not feel discharge at one year is currently justified.

UP-04.28—Naloxegol in Addition to Enhanced Recovery After Surgery (ERAS): A Retrospective Study Comparing the Addition of Naloxegol to ERAS vs. ERAS Alone in Patients Post-Robot-Assisted Radical Cystectomy 

• Heslop Calum, Abdelrahman Aisha, Weston Robin, Hanchanale Vishwanath, Starmer Benjamin
  Liverpool University Hospitals, Liverpool, United Kingdom

• Introduction and Objectives: Post-operative ileus (POI) affects up to 33% of patients following cystectomy and ileal conduit diversion. It is a significant cause of morbidity, prolonged hospital stay and, in rare cases, mortality. On this basis, attempts should be made to reduce ileus as much as possible. μ-opioid receptor antagonists, such as alvimopam, have been used to reduce POI to good effect in randomised controlled trials. Naloxegol is another μ-opioid receptor antagonist and is significantly cheaper than alvimopam; however, data on its effectiveness in reducing POI following cystectomy and ileal conduit diversion is unclear. Furthermore, it remains unclear whether the addition of naloxegol to enhanced recovery after surgery (ERAS) protocols has a beneficial effect compared to ERAS protocols alone.
  Materials and Methods: We retrospectively assessed 96 consecutive patients undergoing robot-assisted radical cystectomy and ileal conduit diversion (RARC), by three surgeons, between 18/10/2021 and 30/09/2024 in a large tertiary teaching hospital. We assessed patients receiving ERAS only (Group A) and those receiving ERAS and naloxegol for up to 7 days (Group B).
  Results: The median age was 71, which included 74 males and 22 females. Median ASA scores and Charlson comorbidity scores were 2 and 5 in Group A and 2 and 6 in Group B, respectively. By intention to treat analysis, 64 patients were in Group A, and 32 patients in Group B. Median length of stay was 7 days in Group A vs. 8 days in Group B (p = 0.7). Median time to first bowels open was 5 days in Group A vs. 6 days in Group B (p = 0.1). Vomiting occurred in 39% in Group A vs. 41% in Group B (p = 0.9). 27% in Group A vs. 22% in Group B underwent Ryles tube insertion (p = 0.7).
  Conclusions: The addition of naloxegol to ERAS does not appear to improve post-operative ileus or length of stay.

UP-04.29—Non-Invasive Evaluation of Muscle Invasion and Survival Prognosis in Bladder Cancer Using Enhanced CT-Based Deep Learning Radiomics: A Multicenter Real-World Cohort Study 

• Hu Jiao ¹, He Yunbo ¹, Liu Yifan ¹, Yan Luzhe ¹, Fan Benyi ¹, Chen Minfeng ¹, Zu Xiongbing ²
  ¹ Central South University, Changsha, China, ² Hunan Provincial People’s Hospital, Changsha, China

• Introduction and Objectives: Bladder cancer (BLCA) is a prevalent malignancy characterized by high recurrence and poor prognosis, particularly in muscle-invasive bladder cancer (MIBC). Histopathology, the gold standard for assessing muscle invasion, often suffers from sampling errors and operator dependency, underscoring the need for non-invasive, accurate preoperative assessment methods. This study aimed to develop and validate a hybrid artificial intelligence (AI) model based on CT radiomics and deep learning to predict MIBC and overall survival (OS) preoperatively in BLCA patients.
  Materials and Methods: A total of 1,452 patients from six academic medical centers were retrospectively included. Preoperative contrast-enhanced CT scans were analyzed to extract radiomic features using machine learning algorithms and deep learning features using ResNet 101. A hybrid model combining radiomic and deep learning features was constructed and validated in internal and external cohorts. Model performance was evaluated using metrics such as the area under the curve (AUC) and Cox proportional hazards analysis for OS predictions.
  Results: The DLRN model demonstrated superior performance with an AUC of 0.807 in the internal validation cohort and 0.783 in the external validation cohort for predicting muscle invasion. The model effectively stratified patients into high- and low-risk groups for OS, showing robust generalizability across diverse clinical settings. AI-assisted diagnostics significantly improved the sensitivity and accuracy of urologists, particularly among less experienced clinicians.
  Conclusions: The DLRN model provides a reliable, non-invasive tool for preoperative assessment of muscle invasion and prognosis in BLCA. By addressing histopathology limitations, it offers valuable insights for personalized treatment strategies, paving the way for precision oncology in real-world clinical applications.

UP-04.30—Oncological Efficacy of Flexible PDD-Guided Transurethral Laser Ablation of Recurrent Non-Muscle Invasive Bladder Cancer (<15 mm) Under Local Anesthesia in an Outpatient Clinic 

• Ozeke Recep, Larssen Kristian S, Baco Eduard
  Oslo University Hospital, University of Oslo, Oslo, Norway

• Introduction and Objectives: Patients with recurrent non-muscle invasive bladder cancer (NMIBC) are most commonly treated with transurethral resection (TURB) in the operating room under general or spinal anesthesia. This study aims to assess the oncological efficacy of flexible photodynamic diagnosis (PDD)-guided transurethral laser ablation (TULA) under local anesthesia in an outpatient setting for patients with recurrent NMIBC following primary TURB, with evaluations at 3 and 12 months post-treatment.
  Materials and Methods: We conducted a prospective, single-institution trial from August 2017 to June 2022, including 177 consecutive patients (137 male, 40 female) with recurrent NMIBC. Selection criteria included patients initially treated with TURB for NMIBC who presented with recurrent tumors measuring less than 15 mm on white-light follow-up cystoscopy. Among the participants: • Seventy-nine patients (44.7%) had low-grade NMIBC as their primary histology. • Fifty-two patients (29.3%) had high-grade NMIBC as their primary histology. • Sixty-seven patients (37.9%) had single recurrences. • Sixty-three patients (35.6%) had multiple recurrences. Histological recurrences following TULA were recorded at 3 and 12 months post-treatment.
  Results: Local recurrence of NMIBC after TULA was observed in: • 27 patients (15%) at 3 months. • 48 patients (27%) at 12 months.
  Conclusions: Flexible PDD-guided TULA of recurrent NMIBC under local anesthesia in an outpatient setting demonstrates good oncological efficacy.

UP-04.31—Predictors of BCG Therapy Complications in Non-Muscle Invasive Bladder Cancer: A Clavien-Dindo-Based Study 

• Ozbek Ozkan ¹, Turan Turgay ², Efiloglu Ozgur ³, Hamid-Zada Ilkin ³, Polat Salih ², Yildirim Asif ³, Ahmadzada Javid ²
  ¹ Urla Governmental Hospital, Urla/İzmir, Türkiye, ² Izmir Democracy University, Izmir, Türkiye, ³ Istanbul Medeniyet University, Istanbul, Türkiye

• Introduction and Objectives: Intravesical Bacillus Calmette-Guérin (BCG) therapy represents the standard adjuvant treatment for non-muscle invasive bladder carcinoma (NMIBC), particularly in cases involving carcinoma in situ, following tumor resection. The primary objective of this study was to evaluate the clinical significance of complications associated with BCG therapy, spanning from mild to severe adverse events, and to analyze the strategies employed for managing patients experiencing these side effects. To facilitate a more comprehensive assessment of the side effect profile, the Clavien-Dindo classification system was utilized as a framework for categorization.
  Materials and Methods: Our retrospective study evaluated 694 bladder cancer patients treated with intravesical BCG therapy between 2004 and 2024. Ethical approval was obtained, and data included comorbidities, demographics, tumor characteristics, and treatment outcomes. Patients received variable BCG regimens, with freeze-dried BCG 12.5 mg administered intravesically. Side effects during induction and maintenance therapy were documented using the Clavien-Dindo classification. With an average follow-up of 34 months, the study assessed complication profiles and their impact on treatment, emphasizing the need for tailored management strategies to enhance safety and efficacy.
  Results: The study cohort comprised 580 (83.6%) male and 114 (16.4%) female patients, with a median age of 65 years (range: 55–75) at bladder cancer diagnosis. Maintenance therapy was administered to 295 (42.5%) patients. Among the 122 documented complications, 118 were classified as Clavien-Dindo grade ≤ 2. Multivariate Cox regression analysis identified age (hazard ratio [HR]: 1.055, 95% confidence interval [CI]: 1.033–1.078, p < 0.001) and tumor grade (HR: 2.473, 95% CI: 1.379–4.436, p = 0.002) as independent predictors of complications.
  Conclusions: This retrospective analysis confirms that intravesical BCG therapy is safe and well-tolerated, with no significant association between instillation frequency and severe complications. However, advanced patient age and higher tumor grade were associated with an increased risk of adverse effects. We recommend careful consideration and tailored management when administering BCG therapy in elderly patients due to their heightened susceptibility to treatment-related complications.

UP-04.32—Preoperative Angioembolization Followed by Transurethral Resection of Bladder Tumor for Large Bladder Tumors: Early Clinical Experiences 

• Bang Sungun, Jeon Jinhyung, Kim Do Kyung, Kwon Jong Kyou, Cho Kang Su
  Yonsei University College of Medicine, Seoul, Republic of Korea

• Introduction and Objectives: Transurethral resection of bladder tumor for large tumors (≥5 cm) is challenging, even for experienced surgeons, due to increased risks of transfusion, bladder perforation, and incomplete resection. We developed a sequential strategy involving preoperative embolization followed by transurethral resection to address these challenges.
  Materials and Methods: This retrospective study evaluated patients who underwent preoperative embolization followed by transurethral resection for non-muscle-invasive bladder cancer at two tertiary hospitals between 2021 and 2024. Potential candidates were patients newly diagnosed with large bladder tumors (longest diameter of the main mass ≥ 5 cm) and suspected non-muscle-invasive bladder cancer on preoperative studies.
  Results: Eleven patients (mean age, 73.2 years) were included in this study. The mean tumor size was 5.78 cm (range, 5.0–8.0 cm). Embolization was performed on the day of surgery in seven cases (63.7%) and 1–4 days before surgery in four cases (36.3%), and complete tumor resection was successfully achieved in all cases. The mean operative time was 78.8 min (range, 33–149 min). No complications related to transurethral resection or embolization, including the need for transfusion or reoperation, were observed. Pathology results revealed Ta in six cases and T1 in five cases. Disease recurrence occurred in six patients (54.5%); however, none demonstrated disease progression during a median follow-up of 18 months (range, 4–38 months).
  Conclusions: Our early experiences demonstrated that preoperative angioembolization followed by transurethral resection for large non-muscle-invasive bladder cancers may be a feasible approach for achieving complete resection without complications.

UP-04.33—Preoperative Sarcopenia as a Predictor of Severe Postoperative Complications After Radical Cystectomy: A Contemporary Cohort Study 

• Sobhi Mohamed Alaa ¹, Hamedoun Larbi ¹, Harchaoui Mohamed Amine ¹, Elghazzaly Anouar ¹, Oukouhou Abdelhakim ¹, Salama Walid ², Jamali Mounir ¹, Tetou Mohamed ¹, Mrabti Mohammed ¹, Elbahri Abdessamad ¹, Alami Mohammed ¹, Ameur Ahmed ¹
  ¹ Mohammed V Military Hospital, Rabat, Morocco, ² m, Ra, Morocco

• Introduction and Objectives: Sarcopenia has emerged as a prognostic indicator of postoperative morbidity and mortality in patients undergoing radical cystectomy (RC) for bladder cancer. Objective: To evaluate sarcopenia as a predictor of 90-day severe postoperative complications and to identify other significant preoperative risk factors.
  Materials and Methods: A retrospective analysis of 83 patients undergoing RC between January 2020 and March 2025 was conducted. Sarcopenia was determined via preoperative CT scans using skeletal muscle index (SMI) at the L3 level. Sarcopenia was defined as SMI < 43 cm²/m² for men with BMI < 25, <53 cm²/m² for men with BMI ≥ 25, and <41 cm ²/m² for women. Complications were classified using the Clavien-Dindo system. Logistic regression analyses assessed predictors of Clavien ≥ 3b complications within 90 days post-RC.
  Results: Among 83 patients (mean age 71.2 years, 65.1% male), 27 (32.5%) were sarcopenic. Overall, 51 (61.4%) experienced postoperative complications; 23 (27.7%) had severe (Clavien ≥ 3b) complications. Sarcopenia was significantly associated with severe complications (48.1% vs. 17.9%, p = 0.006). In multivariable analysis, sarcopenia (OR 2.84, 95% CI 1.12–7.20, p = 0.028), ASA score 3–4 (OR 2.69, 95% CI 1.01–7.16, p = 0.049), and age (OR 1.06 per year, 95% CI 1.01–1.11, p = 0.021) independently predicted severe complications.
  Conclusions: Sarcopenia significantly predicts severe complications within 90 days of RC. Preoperative CT-based assessment may assist in risk stratification. Age and ASA score also independently predict morbidity.

UP-04.34—Prophylactic Mesh Following Radical Cystectomy with Ileal Conduit for the Prevention of Parastomal Hernia—Surgical Technique 

• Raja Iyub Mohamed Javid, Prabhakar Pushan, Martinez Orlando Brito, Manoharan Murugesan, Sakthivel Deerush Kannan
  Miami Cancer Institute, Baptist Health South Florida, Miami, United States

• Introduction and Objectives: One of the standard management for bladder cancer is Radical Cystectomy (RC) with urinary diversion. A well-established complication after Ileal Conduit (IC) is Parastomal Hernia (PH). A prophylactic mesh can be placed for the prevention of PH. Multiple techniques have been illustrated for this.
  Materials and Methods: We explain our steps for the placement of a prophylactic mesh for the prevention of PH in RC with IC patients. As the cruciate flaps come in contact with the stoma, preference is given to a composite mesh for this purpose.
  Results: Step 1: Cruciate incision on mesh. Around 8 × 8 cm of custom mesh is used, and a cruciate incision of size 2 × 2 cm is made at the centre of the mesh. This cruciate incision, plus the flaps that have been created, allows for better conformity of the mesh to the stoma when it is passed through. Step 2: Mesh placement. Between the peritoneum and the posterior rectus sheath, a plane is developed, and the mesh is placed in this preperitoneal plane. This method has been referred to as the sublay-preperitoneal technique. The advantage of the development of this plane for the placement of mesh is the reduced vascularity in this plane compared to the space between the posterior rectus sheath and the rectus muscle. Step 3: Externalization of IC. The mesh is then placed with the cruciate opening lined up for the stoma to be brought through. Sutures are not used in anchoring the mesh. Next, the ileal conduit is brought out through the peritoneum, pre-peritoneal mesh, rectus muscle, subcutaneous tissue, and skin to form the standard stoma.
  Conclusions: The available limited literature reveals that placement of a prophylactic mesh not only decreases the occurrence of PH but is also safe with minimal mesh-related complications. We describe our surgical technique, explaining the specific steps for a sublay pre-peritoneal mesh placement during ileal conduit creation.

UP-04.35—Quality Improvement in TURBT: Experience from One Centre with 45 Years of Prospectively Collected Data 

• Hart-Brooke Jasmin, Mariappan Paramananthan
  Edinburgh Bladder Cancer Surgery (EBCS), The University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom

• Introduction and Objectives: The quality of the initial TURBT is crucial to outcomes as it not only reduces early recurrence but also ensures the utilisation of appropriate adjuvant treatment. In 2005, an Effectiveness and Efficiency programme was introduced into our bladder cancer service through which preceding and subsequent prospectively collected real world data informed performance as well as permitted systematic introduction of evidence-based interventions into clinical practice. We describe the consequent changes to TURBT quality over 45 years.
  Materials and Methods: The Donabedian model of structure-process-outcomes was adopted for continuous quality improvement, and interventions to improve TURBT were implemented and evaluated using the Deming cycle. Interventions included single post-TURBT instillation of Mitomycin-C (SI-MMC), TURBT training with Photodynamic Diagnosis, dedicated TURBT lists and the introduction of Quality Performance Indicators. Data on tumour features, surgery and follow up were collected prospectively on standard proformas with electronic transfer since 1978 in our centre. Continuous audit and feedback evaluated performance, informing subsequent remedial interventions. Primary endpoints representing quality of initial TURBT were recurrence rate at first follow up, cystoscopy (RR-FFC) and residual cancer at reTURBT (R2-6W) for low and high grade NMIBC, respectively. Analysis was undertaken to describe changes to outcomes over the 45 years as snapshot audits.
  Results: From a total of 1,322 consecutive new NMIBC patients, analysed in four separate cohorts where the initial TURBTs were undertaken in the years 1978–84 (n = 152), 1991–96 (n = 196), 2005–08 (n = 310) and 2014–17 (n = 351), provided snapshot audits of TURBT quality, commensurate with specific interventions introduced into our service at those time points. The interventions are listed in the Figure below. From the snapshots, we note a significant reduction in RR-FFC (for patients with new low grade Ta) from 32% to 12% (OR = 3.4, 95%CI = 2.0–5.9, p < 0.001) over 45 years. The rate of residual cancer at re-TURBT (R2–6W) fell from 63% to 23% (OR = 5.6, 95% CI = 3.3–9.6, p < 0.001) over 45 years.
  Conclusions: Our experience suggests that a systematic and dynamic approach to continuous quality improvement with audit, feedback and whole pathway oversight can improve the quality of TURBT and consequent clinical outcomes.

UP-04.36—Rare Case Series of Diagnosis, Management, and Outcomes of Bladder Paraganglioma Cases 

• Jha Prasoon, Mehra Ketan, Madhavan Kumar, Phonde Amrut, Shandilya Shushant
  All India Institute Of Medical Sciences, Bhopal, India, Bhopal, India

• Introduction and Objectives: Bladder paraganglioma is rare neuroendocrine tumour originating from neural crest cells, categorized as functional or non-functional depending on catecholamine secretion. Functional tumours, causing symptoms such as hypertension and “micturition attacks,” are often overlooked because of rarity, leading to possible misdiagnosis and unnecessary surgeries. Objectives—Examine the management and outcomes of patients with bladder paraganglioma, addressing diagnostic challenges and treatment paths followed for each case.
  Materials and Methods: This case series presents 3 patients with bladder masses, diagnosed as bladder paragangliomas through imaging, metabolic workup, and histopathology. Each of these 3 cases were diagnosed at a different timeline on their management journey and underwent a different course of management. We have retrospectively gathered data on their diagnostic journey, followed their medical and surgical management, and analysed short-term outcomes.
  Results: Case 1 (pre-operatively known case): Patient with functional bladder tumor also had gastric gastrointestinal stromal tumor (GIST) i.e., Carney-Stratakis Syndrome. Patient underwent Transurethral resection of bladder tumor (TURBT); histopathological examination (HPE) revealed paraganglioma infiltrating bladder muscle. He then underwent radical cystoprostatectomy with neobladder formation. Patient had SDHB mutation on Nx gen whole exome sequencing. Genetic counselling was done. Patient is recurrence-free at second 3 monthly visit. Case 2 (diagnosed post operatively incidentally): Patient with non-functional tumor underwent TURBT following general management protocol of bladder mass, but HPE reports revealed paraganglioma. Patient has no recurrence at second 3 monthly visit. Case 3 (diagnosed through intra-operative suspicion): Non-functional tumor patient was initially scheduled for TURBT for suspected urothelial carcinoma bladder. Intraop instability raised suspicion, and post-op elevated normetanephrines levels were also noted. She then underwent open partial cystectomy. HPE finding was consistent with paraganglioma. Patient is recurrence free at first 3 monthly visit.
  Conclusions: Bladder paraganglioma is rare tumour without specific preoperative diagnostic indicator, often misdiagnosed as bladder carcinoma. Diagnosis may depend on signs of catecholamine excess if the tumour is functional. Once the diagnosis is confirmed, patients should be started on fluid replacement therapy and adrenergic blockade to abate the disorders associated with catecholamine excess. Optimal treatment planning is based on considerations such as tumour size, extent, and presence of malignancy to achieve the best outcomes.

UP-04.37—Real World Evaluation of ADXBladder and Epicheck Compared to Urine Cytology in Early Recurrence Detection for Patients with Non-Muscle Invasive Bladder Cancer 

• Solano Heranz Pablo ¹, Rodriguez Serrano Andrea ², Duque Alcorta Marta ¹, Rodríguez García Ana ¹, Campuzano Pérez María ¹, Álvarez Maestro Mario ¹, Linares Espinós Estefanía ¹, Ríos González Emilio ¹, Martínez-Piñeiro Luis ¹
  ¹ University Hospital La Paz, Madrid, Spain, ² Toledo University Hospital, Toledo, Spain

• Introduction and Objectives: EAU guidelines recommend periodic citology and cistoscopy as the best surveillance strategy for non-invasive bladder cancer (NMIBC). Seeking for reduction of the number of total cystoscopies, diagnostic tests Epicheck and ADXBladder have been introduced in clinical practice. We aim to determine the diagnostic value of both tests to identify early recurrences in real clinical practice.
  Materials and Methods: We conducted a prospective study of 198 patients diagnosed with NMIBC from November 2020 to May 2024. ADXBladder, Epicheck, cytology and cystoscopy were performed at 3 months follow up. Tumor recurrence was established by combination of cytology, cystoscopy and biopsy in positive/suspected patients. We analyze the Sensibility (S), Specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and false negative rate (FNR) in the whole sample and high-grade tumor subgroup.
  Results: During test assessment at short-term follow-up, 25 patients (12%) had tumor recurrence. Out of these 25 recurred patients, 6 had no biopsy (or fulgurations), 9 were TaG1-G2(LG), 2 TaG2(HG)-3, 4 T1 G2(HG)-G3 and 4 T2G3. Considering ADXBladder, Epicheck and cytology, S/Sp/PPV/NPV were: General: ADXBladder (S 33%, Sp 75%, PPV 15%, NPV 89%) FNR 66% Epicheck (24S %, Sp 91%, PPV 24%, NPV 91%) FNR 75% Citology (S 17% Sp 97%, PPV 44%, NPV 89%) FNR 83% High grade (excluding patients with TaG1 and without AP results): ADXBladder (S 50% Sp 73% PPV 10% NPV 96%) FNR 50% Epicheck (S 38% Sp 91% PPV 19% NPV 96%) FNR 62% Citologia (S 40% Sp 97% PPV 44% NPV 97%) FNR 60%.
  Conclusions: Negative predictive values of ADXBladder and Epicheck tests were similar, around 90% for all, and 96% for high grade tumors. Our data does not show increased value of these tests compared to cytology at 3 months follow-up. Early recurrence of NMIBC should include cystoscopy at 3 months follow up due to the high false negative rate described in our series.

UP-04.38—Renal Function After Cytoreductive Cystectomy in Patients with Metastatic Bladder Cancer 

• Hrechko Bohdan, Voylenko Oleg, Vitruk Yuriy, Tymoshenko Andrii, Koshel Denis, Pishak Vladyslav, Stakhovsky Eduard, Kononenko Oleksii
  National Cancer Institute of Ukraine, Kyiv, Ukraine

• Introduction and Objectives: The role of cytoreductive cystectomy in metastatic bladder cancer (mBC), particularly its impact on renal function, remains insufficiently studied. Preserving or improving renal function is crucial, as it may influence eligibility for systemic chemotherapy. Aim. To assess oncological outcomes and renal function following cytoreductive cystectomy in patients with mBC.
  Materials and Methods: This retrospective single-center study included 37 patients with mBC treated between 2014 and 2022. Renal function was assessed using serum creatinine and estimated glomerular filtration rate (eGFR). Complications were evaluated clinically and radiologically. Follow-up lasted 12 months.
  Results: The cohort consisted predominantly of males (89.2%) with a median age of 69 years and BMI of 27.7 kg/m². Most patients (94.6%) had ECOG 0–1, a median Karnofsky score of 80, and high comorbidity burden (Charlson index = 6; 78.4% ASA III). At surgery, all patients had confirmed metastases. A total of 64.9% (n = 24) had a single metastatic site—most commonly bone (40.5%), lung (24.3%), or liver (10.8%). The remaining 35.1% (n = 13) had two metastatic sites: liver and lung (18.9%), liver and bone (10.8%), or lung and bone (5.4%). All patients with two sites had urgent indications for surgery: massive hematuria (n = 7), refractory pain (n = 4), or progressive bilateral ureterohydronephrosis with renal impairment (n = 2). Ureterohydronephrosis was observed in 73.0% (n = 27), including unilateral (54.1%) and bilateral (18.9%) cases. Postoperative renal function improved significantly: mean eGFR increased from 58 ± 12.7 to 72.2 ± 11.0 mL/min/1.73 m² (p = 0.005). All surgeries were completed without major intraoperative complications. A subset underwent a modified ureterocutaneostomy via extraperitoneal routing of the ureters to the sigmoid mesentery, forming a common channel in the left iliac region. Postoperative morbidity was low: two patients had Clavien-Dindo grade III complications, and four had minor (grade I–II) complications. No 30-day mortality occurred. The 1-year survival rate was 75% (n = 28). All patients received and tolerated first-line chemotherapy.
  Conclusions: Cytoreductive cystectomy may offer clinical benefits in selected mBC patients, including improved renal function, symptom relief, and readiness for systemic treatment. It can be considered a component of multimodal therapy.

UP-04.39—Robot-Assisted Radical Cystectomy with Intracorporeal Neocyst Formation: A Single-Center Analysis of Complications 

• Akinyemi Samuel, Pavlov Valentin, Urmantsev Marat
  Bashkir State Medical University, Ufa, Russian Federation

• Introduction and Objectives: Radical cystectomy combined with pelvic lymphadenectomy is currently regarded as the gold standard for the management of aggressive bladder cancer. The advancement of minimally invasive surgical technologies has facilitated the integration of robot-assisted techniques into urological practice. Robot-assisted radical cystectomy has emerged as a contemporary and effective approach for treating muscle-invasive bladder cancer as well as high-risk non-muscle-invasive bladder cancer. Over the past decade, numerous studies have highlighted the efficacy of robot-assisted cystectomy with intracorporeal urinary diversion. This study aims to evaluate the complications associated with robot-assisted radical cystectomy and intracorporeal urine diversion, utilizing the Clavien-Dindo classification system, based on data from a single institution.
  Materials and Methods: A retrospective analysis was conducted from 2023 to 2025, examining complications arising from robot-assisted radical cystectomies in a cohort of 200 patients diagnosed with bladder cancer. All patients underwent radical Bricker cystectomy with pelvic lymphadenectomy, performed using the Da Vinci^® Si robotic surgical system. Complications were assessed at 30 and 90 days postoperatively, along with corrective measures implemented.
  Results: A total of 35 patients (17.5%) experienced complications within 30 days post-surgery, classified as grade I-III according to the Clavien-Dindo system. Among these, 14 patients (7%) developed grade II or III complications by the 90-day mark. Notably, patients who experienced grade II or III complications within the first 30 days were more likely to encounter further complications by 90 days (p < 0.05). However, there were no statistically significant differences observed in the types of grade II and III complications between the 30-day and subsequent 90-day evaluations (p < 0.05).
  Conclusions: Robot-assisted radical cystectomy represents an effective and technologically sophisticated method for managing aggressive bladder cancer. Our findings indicate a low incidence of surgical complications associated with this procedure, supporting its continued use in clinical practice.

UP-04.40—Robotic Placement of Prophylactic Mesh for Para-Stomal Hernia in Robotic Cystectomy with Intracorporeal Ileal Conduit: A Retrospective Study 

• Carbin Joseph Danny Darlington ¹, Shanmuganathan Sarah ², Rddah Mayas ², Abdallah Mohamed ², Samateh Abdulai ², Sullivan Gabriel ², Milton Nicola ², Callaghan Clare ², Rimington Peter ², Calleja Edward ²
  ¹ Royal Surrey County Hospital, Guildford, United Kingdom, ² East Sussex NHS Trust, Eastbourne, United Kingdom

• Introduction and Objectives: Parastomal hernia is a known complication in cystectomy patients with ileal conduit. This can lead to stomal complications, bowel and ureteric obstruction, leading to acute and chronic morbidity. Prophylactic Biomesh placement to prevent this has been tried in open cystectomies with conduits. We perform robotic placement of DynaMesh in our centre for robotic cystectomy patients.
  Materials and Methods: We aimed to analyse the safety and outcomes of prophylactic DynaMesh placed in robotic cystectomies with intracorporeal ileal conduit in our centre. All robotic cystectomies with intracorporeal ileal conduit (IC) who underwent prophylactic DynaMesh placement in our centre between August 2023 and September 2024 were included. Preoperative, intraoperative and postoperative parameters were recorded. Perioperative and 90-day stomal and mesh complications, radiological and clinical parastomal hernia rates were analysed in follow-up data.
  Results: 22 patients underwent robotic cystectomy with intracorporeal ileal conduit and prophylactic DynaMesh placement in the study period. Of these 41% were females, and 59% were males. 77.3% underwent (robot-assisted radical cystectomy) RARC+IC, 18.1% robotic anterior exenteration, 4.6% underwent RARC+nephro-ureterectomy+IC. One robotic cystectomy was for benign cause, whereas 31.8% had T1, 50% had T2, 9% had T3, and 4.5% had T4 disease. The average operating time was 310 min. There were no mesh/stoma related complications perioperatively. 22% had ileus after the surgery. On a median follow up of 3 months with IQR 4, there was no clinical or radiological parastomal hernia or uretero-enteric anastomotic stricture. One patient succumbed to recurrent disease. The median creatinine was 82 μmol/L with IQR 23 μmol/L.
  Conclusions: Prophylactic placement of DynaMesh for parastomal hernia is feasible and safe with no increased rates of infection. This can be safely done robotically with no immediate complications. Further studies with long term follow-up are needed for proving the long term safety and effectiveness in the prevention of parastomal hernia.

UP-04.41—Spectroscopic Monitoring of Therapeutic Response in Bladder Cancer Patients 

• Daria Ialiukhova, Pavlov Valentin, Ishemgulov Ruslan, Shakirov Albert, Kutliiarov Linat
  Bashkir State Medical University, Ufa, Russian Federation

• Introduction and Objectives: Bladder cancer represents a significant clinical burden due to its high recurrence rate and heterogeneous response to therapy. There is a need for modern diagnostic techniques to evolve rapidly as there is an alarmingly increasing rate of mortality from various conditions, especially oncological disorders. Therefore, a search for new and an optimisation of already existing approaches from other scientific fields becomes especially relevant. One of these methods is application of spectroscopic techniques to clinical diagnostics. The objective of this research is to evaluate the practical usefulness of Raman spectroscopy for monitoring the progression of treatment of bladder cancer patients.
  Materials and Methods: 56 patients with diagnosed and histologically confirmed bladder cancer of various stages (I—11, II—24, III—21). Spectres were recorded before and after the surgical intervention. Inclusion criteria: age ≥ 18 years; histologically verified urothelial carcinoma; absence of prior oncologic treatment; and the ability to provide informed consent. Exclusion criteria: the presence of other malignancies, systemic inflammatory or infectious diseases, end-stage organ dysfunction, and compromised plasma sample integrity. All the spectres were recorded using RamanLife RL785, 785 nm, 30× 4000, LMPlan 20×/0.45 magnification lens.
  Results: Comparative spectral analysis of pre- and post-treatment plasma revealed consistent alterations in biochemical signatures associated with disease state and therapeutic response. Postoperative spectra exhibited a marked decrease in lipid-associated peaks (~1445 cm⁻¹) and a relative increase in protein-associated bands (primary amide peaks at ~1655 cm⁻¹, tertiary amide peaks at ~1260 cm⁻¹), suggesting a reduction in tumour-associated metabolic activity and systemic inflammation. Shifts in the 1000–1050 cm⁻¹ region are likely to be corresponding to phenylalanine and phosphate groups, which can indicate of alterations in protein and nucleic acid content following successful tumour removal.
  Conclusions: Raman spectroscopy can be considered a valuable analytical technique that allows to monitor the progression of the treatment with relative simplicity and minimal invasiveness.

UP-04.42—Streamlined, Patient-Centric Design of the Cretostimogene Grenadenorepvec Expanded Access Program in Patients with Non-Muscle Invasive Bladder Cancer Unresponsive to Bacillus Calmette-Guerin 

• Black Peter ¹, Psutka Sarah ², Lotan Yair ³, Steinberg Gary ⁴, Porten Sima ⁵, Scarpato Kristen ⁶, Westerman Mary ⁷, Schuckman Anne ⁸
  ¹ University of British Columbia, Vancouver, Canada, Vancouver, Canada, ² University of Washington, Seattle, United States, ³ University of Texas Southwestern Medical Center, Dallas, United States, ⁴ Rush University Medical Center, Chicago, United States, ⁵ University of California, San Francisco, United States, ⁶ Vanderbilt University Medical Center, Nashville, United States, ⁷ University of North Carolina, Raleigh, United States, ⁸ University of Southern California, Los Angeles, United States

• Introduction and Objectives: Current guidelines recommend radical cystectomy for High-Risk, BCG-Unresponsive Non-Muscle Invasive Bladder Cancer (HR BCG-UR NMIBC). However, many patients are unwilling or unfit for this intervention due to medical risks. Thus, there is a need for effective, well-tolerated, and accessible bladder-sparing treatments. Cretostimogene, an oncolytic immunotherapy, selectively replicates in and lyses cancer cells with Retinoblastoma (Rb)-E2F pathway alterations, releasing antigens that trigger antitumor immune activation, enhanced by the GM-CSF transgene. Preliminary results from the Phase 3 BOND-003 study led to cretostimogene receiving Fast Track and Breakthrough Therapy Designations by the US FDA for BCG-UR NMIBC. The cretostimogene Expanded Access Program (CRETO-EAP) (NCT06443944), an open-label, expanded access clinical trial, provides cretostimogene to real-world patients who may not qualify for current clinical trials.
  Materials and Methods: Pragmatic real-world eligibility criteria: ECOG performance status of 0–3, pathologically confirmed BCG-UR CIS +/− HG Ta/T1 disease after completion of adequate BCG treatment. The protocol has been amended to improve flexibility and allow patients who received prior therapies for HR BCG-UR NMIBC, including investigational agents. Intravesical cretostimogene will be administered in combination with n-dodecyl-β-D-maltoside (DDM), an excipient that enhances adenoviral delivery for six weekly doses during the induction phase, followed by three weekly maintenance cycles quarterly through Month 12, then every six months through Month 24. Re-induction is permitted. Additionally, patients with partial response, defined as persistent but improved disease at week 25 or subsequent timepoints, may receive continued doses of cretostimogene at the discretion of the investigator. Primary disease assessments include serial cystoscopy, urine cytology, axial imaging, and directed bladder biopsies as clinically indicated with local review of pathologic samples. Co-primary endpoints include safety and complete response at any time. The incidence of adverse events will be reported using Medical Dictionary for Regulatory Activities (MedDRA) and CTCAE v 5.0. Secondary outcomes include Duration of Response, Progression-Free Survival, Cystectomy-Free Survival, Patient Reported Outcomes, and Health-Related Quality of Life measures.
  Results: N.A.
  Conclusions: A broad cross-section of geographically diverse clinical sites in the US and Canada that serve socioeconomically diverse patients has been identified. The study actively recruiting patients.

UP-04.43—The Impact of Transurethral Laser Ablation of Small Bladder Tumors; Single-Centre Analysis and Patient Reported Outcomes 

• Jolie Sheldon, Morton Simon, Shin Je Song
  Glasgow Royal Infirmary, Glasgow, United Kingdom

• Introduction and Objectives: The outpatient management of small bladder tumours has gained increasing attention, particularly in response to the backlog of patients exacerbated by the COVID-19 pandemic. Transurethral LASER ablation (TULA) using a diode LASER under local anaesthesia offers a viable alternative to conventional inpatient procedures. This study evaluates the impact of TULA on reducing inpatient surgical cases and patient-reported outcomes.
  Materials and Methods: Before TULA implementation (April–September 2021), 87 small bladder tumours were managed in an inpatient setting: 24 via cystodiathermy and 63 via bladder biopsies. The combined median age and ASA was 72 and 2 respectively. Among these, 92% of cystodiathermy cases (15 GA, 6 Spinal, 1 LA) and 75% of bladder biopsies (33 GA, 12 Spinal, 2 LA) met the criteria for TULA (recurrence < 1 cm, recurrent G1/2 pTa, large tumours unfit for GA, unable to stop anti-coagulation, post MMC/BCG; not suitable for radical treatment, palliative ablations, post-radiation haematuria). Inpatient stay for these procedures ranged from 0 to 2 days.
  Results: Following TULA implementation (April–September 2023), inpatient cases decreased by 37%, and, in the subsequent year (April–September 2024), there was a further 58% reduction (74% reduction compared to 2021 pre-TULA). A patient questionnaire assessed understanding of TULA, pain perception, and willingness to undergo repeat procedures. Among 79 respondents, 52% reported mild pain (1–2 on a 10-point scale), while 32% reported no pain. Notably, 100% of patients indicated they would opt for TULA again if needed.
  Conclusions: TULA is an effective outpatient alternative that significantly reduces inpatient capacity demands and helps manage long surgical waiting lists for small bladder tumours. Additionally, patient-reported outcomes highlight high levels of satisfaction and underscore TULA’s role in improving both healthcare efficiency and promoting patient-centred approach to bladder cancer management.

UP-04.44—The Influence of Female Gender on Disease Stage, Perioperative Trends and Cancer Survival in Patients with Bladder Cancer Undergoing Radical Cystectomy 

• Boztepe Ozlem ¹, Delgiudice Francesco ¹, Gad Mohamed ¹, Clark Calum ¹, Kam Jonathan ¹, Mensah Elsie ¹, Nair Rajesh ¹, Omar Kawa ², Thurairaja Ramesh ¹, Khan Shamim ¹, Abu-Ghanem Yasmin ¹
  ¹ Guy’s and St Thomas’ Hospital, London, United Kingdom, ² King’s College Hospital, London, United Kingdom

• Introduction and Objectives: Female sex in patients undergoing Radical Cystectomy (RC) for urothelial or variant-histology bladder cancer has been previously associated with advanced pT stage and worse oncological survival. We investigated the role of gender on perioperative and Disease-Free Survival (DFS) outcomes at our dedicated tertiary centre.
  Materials and Methods: We reviewed our prospectively maintained database of patients who underwent RC for confirmed urothelial or variant Non-muscle Invasive (NMI) and Muscle Invasive Bladder Cancer (MIBC) at our centre from 2014–2023. Demographics, diagnostics, and pathological data were stratified according to gender distribution to explore the impact of sex on perioperative trends and DFS.
  Results: 640 (72.2%) men and 247 (27.8%) women with a mean age of 68.5 and 68.1 years with diagnosis of urothelial cancer undergoing cystectomy were reviewed. While male sex was associated with worse preoperative baseline co-morbidities, such as Diabetes Mellitus, Chronic Kidney Disease, and Cardiovascular Disease, there were no significant discrepancies in time from primary referral to RC (0.93M vs. 1.03F months, p-value: 0.93), neoadjuvant systemic therapy adoption (21.6M vs. 17.3F %, p-value: 0.25) or surgical approach (ORC: 31M vs. 28F %, RARC: 69M vs. 72F %, p-value: 0.55). This was similarly reflected on final pT status (pT0-1: 44M vs. 50F %; pT2-4 56M vs. 50F %, p-value: 0.13) and Kaplan-Meir DFS analysis (84M, 95% CI: 78–90 vs. 64F, 95% CI: 52–74 months, Log Rank: 0.14).
  Conclusions: Our results would suggest that dedicated bladder cancer pathways at a high volume tertiary centre may overcome pathological and biological survival imbalances traditionally attributed to the gender.

UP-04.45—Transurethral Laser Ablation (TULA) and Biopsy for the Management of Recurrent Bladder Tumours and Red Patches Under Local Anaesthesia in the Urology Investigation Unit 

• Anwar Adeel, Madasu Anshuman, Basu Saurajyoti
  Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom

• Introduction and Objectives: Transurethral laser ablation (TULA) and biopsy under local anaesthesia offer a minimally invasive solution for managing recurrent non-muscle invasive bladder cancer (NMIBC) and biopsying suspicious red patches. TULA enhances tumour targeting precision, reduces procedural risks, and avoids general anaesthesia, making it ideal for medically frail patients or those with significant comorbidities. It provides effective tumour control, fewer complications, and shorter recovery times. This study evaluates TULA’s clinical efficacy, safety, recurrence rates, and potential for disease upgrading. Additionally, it compares TULA’s cost-effectiveness with transurethral resection of bladder tumours (TURBT), highlighting its role in managing high-risk patients.
  Materials and Methods: We conducted a prospective audit of TULA over a 14-month period (November 2023 to December 2024). The audit collected comprehensive data on patient demographics, pain scores, complications, readmission rates, cost analysis, and recurrence rates at three and six months.
  Results: The study included 77 patients, predominantly male (75%), with an average age of 78 years. None of the patients discontinued their anticoagulant therapy. The procedures had an average duration of 3.87 min, totaling 88 procedures. Biopsies were performed in 57% of cases (n = 50), with muscularis propria identified in 7 of these. Among the identified tumours, 46% were classified as low-grade, superficial G1-G2 pTa tumours (n = 23). Red patch biopsies were conducted on 11 out of 13 patients, with 1 case of carcinoma in situ found. The average pain score, as measured on the visual analogue scale, was 3, and the readmission rate was 7%, primarily due to haematuria. Tumour recurrence occurred in 44% of patients at three months and 15% at six months, with no disease upgrading. The average cost of flexible cystoscopy and Transurethral Laser Ablation (TULA) ranged from £250 to £300, significantly lower than the average cost of £1,267.59 for a day-case rigid cystoscopy and bladder biopsy or Transurethral Resection of Bladder Tumour (TURBT) under general or spinal anaesthesia.
  Conclusions: TULA is a safe, well-tolerated, and cost-effective option for managing recurrent NMIBC in frail patients. It also facilitates biopsies of red patches to exclude carcinoma in situ, thus reducing the burden on the waiting list and preventing unnecessary anaesthesia.

UP-04.46—Transurethral Laser Ablation (TULA) for NMIBC: Recurrence, Complications and Patient Reported Outcomes in Our Case Series 

• Pineda Turner Andrew, Giona Simone, Ali Ahmed
  NHS Frimley Health Foundation Trust, Frimley, United Kingdom

• Introduction and Objectives: Bladder cancer has a high impact on health services due to its high risk of recurrence. Many health care providers need to frequently deal with frail, comorbid patients with recurrent non-muscle invasive bladder cancer (NMIBC). Transurethral laser ablation (TULA) is a minimally invasive alternative to transurethral resection of bladder tumour (TURBT), performed under local anaesthesia with fewer complications and lower costs. This study evaluated our TULA case series recurrence and complication rates, alongside post-operative pain and patient satisfaction using validated EORTC questionnaires (QLQ-C30, QLQ-NMIBC24).
  Materials and Methods: From January 2022 to December 2023, we retrospectively collected data on all patients who underwent TULA for NMIBC in our trust, along with prospective data on post-operative pain (VAS score) and patient satisfaction using QLQ-C30 and QLQ-NMIBC24 questionnaires. We recorded demographic variables, Charlson Comorbidity Index, estimated 10-year survival, and anti-coagulation status. Primary outcomes included re-recurrence rates, 30-day complications, and overall patient satisfaction.
  Results: A total of 168 patients underwent TULA, with 81% having a history of TCC and included in the analysis. The average patient age was 73.9 years, with a median Charlson score of 4 and a median estimated 10-year survival of 21%. Among them, 36% were taking anticoagulants. Average number of lesions was 2, and complete ablation rate of 94.9%. The overall re-recurrence rate was 30.7%. Complications were minimal: 5.1% required antibiotics for UTIs, 3.6% experienced haematuria requiring review, and one case required a washout under general anaesthesia. Post-operative pain was low (median VAS score: 2), and quality-of-life assessments indicated minimal impact, with common symptoms such as frequency and urgency resolving within 48 h.
  Conclusions: TULA is a safe, effective, and minimally invasive alternative to TURBT for NMIBC, reduces the need for general anaesthesia, and provides a cost-effective approach to NMIBC management particularly in frail, comorbid patients. It achieves a high rate of complete ablation with a manageable recurrence rate and low complication rates. Its well tolerated by patients, and patient-reported outcomes indicate high satisfaction rate. Further studies are needed to refine patient selection and assess long-term outcomes.

UP-04.47—Transurethral Laser Ablation Management for Bladder Cancer: A Single Centre Experience 

• Miller Alexandra, Gujadhur Rahul, Dowling James, Kuchi Dhriti
  Newcastle University Hospitals Trust, Newcastle, United Kingdom

• Introduction and Objectives: Transurethral laser ablation is used to manage recurrent non muscle invasive bladder cancer. TULA is used for small, recurrent bladder tumours completed as a day case procedure using local anaesthesia. It is safe, effective, and financially viable option for managing patients with higher risk anaesthetic. We will aim to share results with 24 month follow up following TULA.
  Materials and Methods: Retrospective review of patient records who underwent TULA for bladder tumours between Oct 2019–March 2022 (n = 168). Patients were excluded if tumours were too large for TULA/had UTI/ did not tolerate or declined treatment (n = 21). Age, gender, ASA, indications, number of lesions, biopsy results, recurrence, complications, and potential cost savings were reviewed (n = 151). Patients were followed up for 24 months.
  Results: 168 patients underwent TULA for bladder tumours between Oct 2019-March 2022. The average age was 76 years old with an age range of 46–98 yrs (127 males, 41 females). 33 patients were on anticoagulation/antiplatelet treatment. 18 patients were ASA 1, 83 were ASA 2, 63 ASA 3, and 3 were ASA 4. Reason for TULA: Recurrence on flexi (n = 137), visible haematuria (n = 25), imaging proven bladder lesion (n = 3), red patch on flexi and unfit for TURBT (n = 3). The majority of patients only had 1 lesion (n = 84), 39 patients had 2 lesions, 37 patients had 3 or more lesions. Biopsy results showed: benign (n = 41), urothelial dysplasia (n = 7), low grade superficial (n = 81), high grade (n = 12) CIS (n = 3), or no biopsy (n = 12). 5 patients had post-procedural complications, 1 had UTI, 1 had haematuria (required admission), 3 had retention. 42 patients had recurrence at 3 months, 59 patients at 6 months, 78 at 12 months, 84 at 2 years, and 14 patients died prior to 24 month follow up. The potential cost savings are £450 per patient who avoided a formal TURBT, making savings of £67,950 over 24 months.
  Conclusions: TULA is a safe, effective method for managing patients with recurrent non-muscle invasive bladder cancer. The side effect profile is low and an effective way to avoid anaesthetics in patients who are not fit. We have also identified a significant cost saving, making it an attractive option for large patient bases.

UP-04.48—Trial in Progress: PIVOT-006—A Phase 3, Randomized Study of Adjuvant Intravesical Cretostimogene Grenadenorepvec Versus Surveillance for the Treatment of Intermediate-Risk Non-Muscle Invasive Bladder Cancer 

• Preston Mark ¹, Svatek Robert ², Bivalacqua Trinity ³, Shore Neal ⁴, Jayram Gautam ⁵, Josephson David ⁶, Daneshmand Siamak ⁷
  ¹ Department of Urology, Brigham and Women’s Hospital, Boston, United States, ² University of Texas Health San Antonio, San Antonio, United States, ³ University of Pennsylvania, Philadelphia, United States, ⁴ Carolina Urologic Research Center, Myrtle Beach, United States, ⁵ Urology Associates, Nashville, United States, ⁶ Tower Urology, Los Angeles, United States, ⁷ University of Southern California, Los Angeles, United States

• Introduction and Objectives: The AUA/SUO guidelines recommend adjuvant intravesical therapy or surveillance for Intermediate-Risk Non-Muscle Invasive Bladder Cancer (IR NMIBC). Despite this, up to 60% of patients will recur, highlighting a need for improved therapies. Cretostimogene grenadenorepvec, an oncolytic immunotherapy, selectively replicates in and lyses cancer cells with Retinoblastoma (Rb)-E2F pathway alterations, releasing antigens that initiate antitumor immune activation, further amplified by the GM-CSF transgene. Cretostimogene received US FDA Fast Track and Breakthrough Designations for High-Risk, BCG-Unresponsive NMIBC with CIS and has shown a favorable safety profile. The PIVOT-006 (NCT06111235) Phase 3 study is designed to assess the efficacy and safety of adjuvant cretostimogene versus surveillance in patients with IR NMIBC.
  Materials and Methods: Eligibility criteria include histologically confirmed IR NMIBC diagnosis within 90 days of randomization, as defined by AUA/SUO guidelines. Stratification factors include receipt of single-dose perioperative chemotherapy and tumor grade. Patients (N~364) will be randomized 1:1 to undergo surveillance or to receive intravesical cretostimogene following TURBT. If IR-NMIBC recurrence is noted in the surveillance arm, patients will be eligible to receive intravesical cretostimogene. Intravesical cretostimogene is administered in combination with n-dodecyl-β-D-maltoside (DDM), an excipient that enhances adenoviral delivery, for 6 weekly doses during the induction phase, followed by 3 weekly maintenance cycles at Months 3 and 6, and culminating in a single intravesical dose at Months 9 and 12. Primary disease assessments include serial cystoscopy, urine cytology, axial imaging, and centralized review of pathologic samples. The primary outcome measure is Recurrence-Free Survival (RFS). Secondary outcomes include safety, tolerability, Progression-Free Survival, and time to next intervention. Exploratory outcome measures include Health-Related Quality of Life and biomarker analyses.
  Results: N.A.
  Conclusions: PIVOT-006 has received SUO-Clinical Trials Consortium (SUO-CTC) and Bladder Cancer Advocacy Network (BCAN) support. 90+ clinical sites have been selected. Enrollment for PIVOT-006 is ongoing, with approximately one-third of patients already recruited at the time of abstract submission.

UP-04.49—Updates to the CORE-008 Trial Protocol: A Phase 2 Multi-Arm, Multi-Cohort Study to Evaluate Intravesical Cretostimogene Grenadenorepvec in Patients with High-Risk Non-Muscle Invasive Bladder Cancer 

• Bivalacqua Trinity ¹, Steinberg Gary ², Shore Neal ³, Joshi Shreyas S. ⁴, Dinney Colin ⁵, Daneshmand Siamak ⁶
  ¹ University of Pennsylvania, Philadelphia, United States, ² Rush University Medical Center, Chicago, United States, ³ Carolina Urologic Research Center, Myrtle Beach, United States, ⁴ Emory University School of Medicine, Atlanta, United States, ⁵ University of Texas MD Anderson Cancer Center, Houston, United States, ⁶ University of Southern California, Los Angeles, United States

• Introduction and Objectives: Treatment for HR NMIBC includes TURBT followed by intravesical BCG, yet high recurrence rates and the ongoing BCG shortage highlight the need for effective, well-tolerated, and readily available treatment options. Cretostimogene is an oncolytic immunotherapy with a dual mechanism of action. It selectively replicates in and lyses cancer cells with Retinoblastoma (Rb)-E2F pathway alterations, releasing virus- and tumor-specific antigens that initiate antitumor immune activation, further enhanced by the GM-CSF transgene. Cretostimogene received Fast Track and Breakthrough Therapy Designations by FDA for HR BCG-Unresponsive NMIBC. The CORE-008 clinical trial (NCT06567743) was developed as a Phase 2, multi-arm, multi-cohort trial to evaluate the efficacy and safety of cretostimogene in patients with HR NMIBC.
  Materials and Methods: Eligibility criteria include pathologic confirmation of HR NMIBC, CIS containing and papillary only, as defined by the AUA. Cohort A (BCG-naive) includes patients without prior BCG treatment, Cohort B (BCG-exposed) consists of those who recurred after prior BCG, and Cohort CX will evaluate the safety and HG-EFS of cretostimogene with intravesical gemcitabine in BCG-exposed and BCG-unresponsive patients. Intravesical cretostimogene will be instilled in combination with DDM, an excipient that enhances adenoviral delivery, for six weekly doses during the induction phase, followed by three weekly maintenance cycles quarterly through month 12, then every six months through month 36. Re-induction is permitted. The primary endpoint for the CIS population is Complete Response (CR) at any time and High-Grade Event Free Survival (HG-EFS) for patients with papillary-only disease. Secondary endpoints will include Duration of Response, all-cause Event-Free Survival, Bladder Cancer Specific Survival, Cystectomy Free Survival, safety, and tolerability. Exploratory outcome measures include Health-Related Quality of Life, Overall Survival, and biomarker assessments.
  Results: N.A.
  Conclusions: CORE-008 is actively recruiting patients. Enrollment for the CIS containing arms on Cohort A has been successfully completed, with an HG Ta/T1-only arm planned. Cohort B has received collaborative support from the Society of Urologic Oncology Clinical Trials Consortium (SUO-CTC). Additionally, Cohort CX is open for enrollment as of April 2025.

UP-04.50—What Is the Utility of FDG PET-CT in Detecting Lymph Node Involvement Compared with Conventional Imaging in Patients with Bladder Cancer with Variant Histology? 

• Bizzarri Francesco Pio ¹, Abdul Nazar Nafeesa ², Ojo Onaiho ², Nelson Adam ², Colquhoun Alexandra ², Lobo Niyati ²
  ¹ Policlinico “A-Gemelli”-Gemelli Isola Tiberina, Rome, Italy, ² University of Cambridge-Addenbrooke’s Hospital, Cambridge, United Kingdom

• Introduction and Objectives: FDG PET has been increasingly used in bladder cancer staging to improve the detection of lymph node involvement. We evaluate the performance of 18F-FDG PET/CT compared to conventional MRI and CT in patients undergoing radical cystectomy for bladder cancer with variant histology (BCVH).
  Materials and Methods: We performed a retrospective review of patients staged for BCVH using FDG-PET/CT, MRI and CT who then underwent radical cystectomy between 2018 and 2024 at our institution. Pre-operative FDG-PET/CT, MRI and CT results were paired with corresponding histopathology reports.
  Results: Thirty-nine patients with BCVH underwent FDG-PET/CT, CT and MRI prior to radical cystectomy. The mean age was 65 years (SD 13). Clinical stage was in Ta 2%, Tis in 5%, T1 in 21%, T2 in 18%, T3 in 34% and T4 in 13%. The most common variant histology was squamous cell carcinoma (59%), followed by glandular differentiation (15%), plasmacytoid (8%), nested (8%), micropapillary (5%), and adenocarcinoma (5%). Overall, concordance rates between FDG-PET/CT, MRI and CT with final cystectomy specimens in predicting lymph node involvement were 79.5%, 73.5% and 66.7%, respectively. FDG-PET/CT demonstrated higher sensitivity for lymph node detection (66.7%) compared to MRI (40.0%) and CT (8.3%); however, specificity (92.0%) was lower than CT (100.0%) and similar compared to MRI (91.7%).
  Conclusions: In patients with BCVH, FDG-PET/CT demonstrates the highest sensitivity for the detection of lymph node metastases compared to MRI and CT. However, CT exhibited the highest specificity. Further studies with larger cohorts are warranted to confirm these findings.

UP-04.51—Non-Muscle Invasive Bladder Cancer: A Scoping Review of Treatment Efficacy and the Impact of Modifiable Risk Factors 

• George Althea ¹, Nwachukwu Nwachukwu ²
  ¹ The Royal London Hospital/ Barts Health NHS Trust, London, United Kingdom, ² Liverpool John Moores University, Liverpool, United Kingdom

• Introduction and Objectives: Non-muscle invasive bladder cancer (NMIBC) accounts for 75–85% of newly diagnosed bladder cancer cases. Although less invasive, NMIBC has high recurrence and progression rates, posing challenges in management. Standard treatment begins with transurethral resection of bladder tumor (TURBT), often followed by intravesical therapies such as Bacillus Calmette–Guérin (BCG) or chemotherapy. Modifiable risk factors—especially occupational and lifestyle exposures—significantly influence disease onset and recurrence but are often overlooked in clinical strategy. This scoping review compares treatment efficacy and explores the role of modifiable exposures in NMIBC outcomes.
  Materials and Methods: Following the PRISMA-ScR framework, a systematic search of PubMed, Google Scholar, and Cochrane Library was conducted for studies published between 2000 and 2024. Of 240 articles identified, 20 met the inclusion criteria: randomized controlled trials, cohort studies, and systematic reviews in English addressing NMIBC treatment or risk factors. Data on treatment outcomes, recurrence, complications, and exposure risks were extracted and appraised using the Cochrane Risk of Bias Tool and Newcastle–Ottawa Scale.
  Results: TURBT alone had recurrence rates up to 80%, highlighting the need for adjuvant therapy. BCG provided the highest recurrence-free survival in high-risk NMIBC, reducing recurrence and progression by up to 60%. Intravesical chemotherapy (e.g., mitomycin C, gemcitabine) showed 20–40% recurrence reduction in intermediate-risk cases. Complication rates were highest with BCG (up to 30%), while chemotherapy had lower rates (<10%). Occupational exposures—particularly to aromatic amines and polycyclic aromatic hydrocarbons—increased NMIBC risk by 2.5–4 times. Smoking accounted for up to 50% of cases. Additional lifestyle risks included low fluid intake, high red meat consumption, obesity, and chronic infections.
  Conclusions: BCG remains the gold standard for high-risk NMIBC, while chemotherapy benefits intermediate-risk patients. Incorporating occupational and lifestyle risk assessment into NMIBC management could improve outcomes. Further research is needed on patient education, guideline adherence, and post-treatment lifestyle modification.

4.5. Unmoderated Video ePosters

UVP-04.01—Robotic Radical Cystectomy with Intracorporeal Ileal Conduit with Hugo RAS Surgical System 

• Prakash Pradeep, Ali Mujahid
  Yashoda Superspeciality Hospital and Cancer Institute, Ghaziabad, India

• Introduction and Objectives: Radical cystectomy with urinary diversion is standard of care for localized muscle invasive bladder carcinoma. Robotic radical cystectomy with intracorporeal diversion is routinely performed with Da Vinci surgical system, but few reports are available on other systems. We present a successful case of robotic radical cystectomy with intracorporeal ileal conduit with HugoTM RAS system.
  Materials and Methods: 62 year male presented with gross painless hematuria to our hospital. Further evaluation with ultrasound and CT urogram showed a solid, broad based mass on right posterolateral wall of urinary bladder. TURBT was done, which proved it to be high grade muscle invasive bladder cancer. FDG PET-CT was suggestive of localized disease. So patient was planned for robotic radical cystectomy with intracorporeal ileal conduit.
  Results: Operative time was 7 h, and blood loss was 400 mL. There were no intraoperative complications, and no blood transfusion was required. Postoperative recovery was uneventful, and patient was started orally on 2nd day after surgery. Patient was discharged on 6th day on normal diet.
  Conclusions: It is feasible and safe to perform robotic radical cystectomy with intracorporeal ileal conduit with HugoTM RAS, with early postoperative recovery compared to open radical cystectomy. The return to normal diet is earlier, and hospital stay is lesser with robotic radical cystectomy and there is no increase in complication.

5. BPO/LUTS

5.1. Moderated Oral ePosters

MP-05.01—“Clamp” Score: A Novel Scoring System to Predict Acute Urinary Retention in Benign Prostatic Hyperplasia Patients 

• Karmakar Saurav ¹, Mandal Tapan ², Kanjilal Subir ¹
  ¹ B R Singh Hospital, Dumdum, India, ² Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India, Kolkata, India

• Introduction and Objectives: In men older than 50 years, benign prostatic hyperplasia (BPH) is a common disease and progressive disease. Acute Urinary Retention (AUR) is one of the most common and painful long-term outcomes of BPH. Our study aimed at determining the risk factors, which are responsible for developing AUR and formulating a novel scoring system known as “CLAMP Score” (Comorbidities, Lower urinary tract symptoms, Age, Median lobe enlargement, serum PSA) or “Retention Score” to predict the risk of developing AUR in BPH patients in future and manage them in advance.
  Materials and Methods: The present study was a hospital-based comparative study, which was conducted at the department of Urology, Nil Ratan Sircar Medical College and Hospital. Two groups were compared: one ‘with AUR’ and another ‘without AUR. Various risk factors have been studied including age, international prostate symptom score (IPSS), comorbidities like diabetes mellitus, serum PSA etc. From the study we have formulated and validated a simple out-patient based risk scoring known as “Retention Score” by which we can stratify the BPH patients into various risk groups of developing AUR.
  Results: A total of 240 patients have been divided into two groups, with 120 in each group. It was found that majority number of patients with AUR are more than 60 years of age (92.5%) and have comorbidities (84.0%). 68% of these patients have a serum PSA over 1.4 ng/dL and a history of AUR (75%). The mean IPSS was 26.8, and intravesical prostatic projection is more than 12 mm. Our proposed scoring system has a significant association with the patients with AUR group.
  Conclusions: Our study provides valuable insights into the associations between various risk factors and AUR in BPH patients. “CLAMP Score” will be of great help in predicting AUR in BPH patients on out-patient basis and thereby counselling and treating them accordingly in advance.

MP-05.02—Anatomical Endoscopic Enucleation of the Prostate for Treatment of Bladder Outlet Obstruction for Patients on Prostate Cancer Surveillance Protocol: Prospective Controlled Assessment of Functional and Oncological Outcome 

• Hamdi Ashraf, Mosbah Ahmed, Laymon Mahmoud, Elshal Ahmed
  Mansoura Urology & Nephrology Center, Mansoura, Egypt, Arab Rep.

• Introduction and Objectives: Data has shown that, when intervention for patients with low-risk prostate cancer is triggered by bothersome lower urinary tract symptoms (LUTs) only, there is a trivial 10-year cancer-specific mortality benefit. In the current study, symptomatic patients on prostate cancer surveillance protocol were offered anatomical endoscopic enucleation of the prostate (AEEP). Oncological and functional urinary outcomes were prospectively reported.
  Materials and Methods: Since 2016, patients on prostate cancer surveillance protocol in our prostate unit have been screened for bothersome LUTs. After a detailed discussion with the patient-physician, they were prospectively grouped into Gr-1 (AEEP) and Gr-2 (medications). The main endpoint of the study is progression to active cancer treatment. Oncological and functional outcomes using prostate-specific antigen (PSA), magnetic resonance imaging (MRI), repeat biopsy, and voiding parameters were reported and compared. Trial registry: NCT05631080.
  Results: Out of 74 patients, 52 legible patients were included in the study, 27 in Gr-1 and 25 in Gr-2. Baseline median PSA was comparable in the groups; further median PSA changes were reported in Figure 1. Progression (stage &/or grade) and active cancer treatment were recorded in 3 (11%) and 5 (17%) patients (p = 0.4) in Gr-1 and Gr-2 with median (range) years reported for progression 7 (7–8) and 2 (1–6) (p = 0.003) respectively. Median progression-free survival was 96 (95% C.I. 90–106) and 72 (95% C.I. 49–71) months in Gr-1 and Gr-2, respectively (p = 0.003). There was a significant percentage reduction of symptom score (87% and 60%, p = 0.00) from baseline to last follow-up in Gr-1 and Gr-2, respectively. There was a significant percentage increase in peak flow rate (204% and 95%, p = 0.00) from baseline to last follow-up in Gr-1 and Gr-2, respectively.
  Conclusions: Patients on prostate cancer surveillance protocol could safely benefit from relief of LUTs secondary to prostate obstruction by AEEP without negative oncological risk. Furthermore, post AEEP changes in PSA would work as a better predictor for cancer changes that boost time to active cancer treatment.

MP-05.03—Comparison of Clean Intermittent Self-Catheterization and Indwelling Catheterization for the Management of Urinary Retention Before BPH Surgery: A Monocentric Retrospective Study 

• Klein Clement ¹, Denimal Louis ², Capon Gregoire ², Alezra Eric ¹, Bernhard Jean-Christophe ¹, Estrade Vincent ¹, Blanc Peggy ¹, Bladou Franck ¹, Robert Grégoire ¹
  ¹ Bordeaux University Hospital, Bordeaux, France, ² CHU de Bordeaux, Bordeaux, France

• Introduction and Objectives: In case of acute urinary retention (AUR) due to BPH first trial without catheter (TWOC) may fail in about 30% of cases. In this situation most of patients have to keep an indwelling catheter (IDC) or to perform clean intermittent self-catheterization (CISC) until surgery. Although CISC has shown several advantages over IDC in neurologic patients, it is barely proposed in case of acute or chronic urinary retention due to BPH, and comparative data on the outcomes of BPH surgery are very sparse. The aim of this study was to evaluate peri-operative outcomes of BPH surgery depending on the type of urinary drainage in a population of patients with acute or chronic urinary retention and TWOC failure.
  Materials and Methods: We retrospectively analyzed a prospective database to retrieve the records of all men admitted for surgical treatment of BPH following acute or chronic urinary retention with TWOC failure over a one-year period of time (January to December 2022). Two groups were constituted depending on the type of urinary drainage at the time of surgery (IDC or CISC). Peri-operative outcomes were compared between groups regarding pre-operative urine culture, antibiotic consumption, post-operative complications, length of hospital stay, and spontaneous voiding after catheter removal.
  Results: Between January and December 2022, 59 patients underwent BPH surgery after urinary retention and TWOC failure. At the time of surgery, 28 patients were on IDC (47%), and 31 patients were on CISC (53%). Despite a shorter delay between AUR and surgery in the IDC group (42 days vs. 80 days, p < 0,01), patients had a significantly higher rate of pre-operative positive urine culture (100% vs. 51.6%, p < 0.01), received antibiotics more frequently (93% vs. 42%, p < 0.01), had a higher rate of post-operative complications (50% vs. 13%, p < 0.01), stayed longer in the hospital (3 days vs. 2 days, p < 0.01), and had a higher rate of post-operative retention (36% vs. 6.5%, p < 0.01).
  Conclusions: In our experience, the use of CISC before BPH surgery improved peri-operative outcomes as compared to IDC. CISC reduced antibiotic consumption, post-operative complications, length of hospital stay, and improved micturition recovery after catheter removal.

MP-05.04—Expanded Case Series on the Use of Rada16 Self-Assembling Peptide (PuraBond^®) in Holmium Laser Enucleation of the Prostate (HoLEP): A Multi-Patient Analysis 

• Sid Ahmed Momen, Nkwam Nkwam, Tasleem Ali, Martindale Alexander
  Princess Royal University Hospital, King’s College Hospital NHS Trust, London, UK, London, United Kingdom

• Introduction and Objectives: Intraoperative and postoperative bleeding remain major causes of morbidity in urological surgery. Holmium Laser Enucleation of the Prostate (HoLEP) is a gold-standard treatment for benign prostatic hyperplasia (BPH) due to its excellent long-term outcomes, but effective hemostasis is crucial to prevent complications. This study evaluates the safety and feasibility of using PuraBond^®—a synthetic self-assembling peptide hemostatic agent—during HoLEP, particularly in a low-power HoLEP setting, to improve bleeding control.
  Materials and Methods: A prospective case series was conducted on 10 consecutive patients undergoing low-power HoLEP between August 2024 and October 2024 at a teaching hospital in London. Key data included patient age, prostate volume, enucleation and morcellation times, weight of resected tissue, and postoperative urine clarity. PuraBond^® was applied to the prostatic fossa at the end of each enucleation to augment hemostasis. Postoperative outcomes (urine color, catheter removal, complications) were tracked, and, at 3-month follow-up, uroflowmetry (Q_max and post-void residual [PVR]) and International Prostate Symptom Scores (IPSS) were obtained. Descriptive statistics were used to analyze trends.
  Results: The mean patient age was 69.4 years, and the average prostate volume was 109.6 cc. The mean enucleated tissue weight was 74.3 g. Mean enucleation and morcellation times were 49.9 min and 6.7 min, respectively. All patients were discharged on the day of surgery with clear urine in 9 out of 10 cases (one patient had minimally blood-tinged urine at discharge). There were no postoperative complications or readmissions for bleeding within 30 days. At 3-month follow-up, patients demonstrated a high average peak urine flow (Q_max ~32 mL/s) with low residual volumes (mean PVR ~34 mL), and symptom scores improved (mean IPSS 13.5, most patients in the mild symptom range).
  Conclusions: The adjunct use of PuraBond^® in HoLEP was found to be safe and effective in achieving hemostasis, facilitating prompt recovery and same-day discharge. PuraBond^® notably reduced postoperative hematuria and maintained clear urine in the immediate postoperative period. These findings support PuraBond^® as a valuable hemostatic adjunct in HoLEP, particularly in scenarios with higher bleeding risk (such as low-power laser settings or anticoagulated patients). Larger controlled studies are recommended to further validate its efficacy compared to standard hemostatic techniques (e.g., tranexamic acid or diathermy alone).

MP-05.05—First Multi-Center, Real-World Study on the Temporary Implantable Nitinol Device (iTind) for the Management of Lower Urinary Tract Symptoms Related to Benign Prostatic Obstruction 

• Castellucci Roberto ¹, De Nunzio Cosimo ², Secco Silvia ³, Olivero Alberto ³, Al Jaafari Feras ⁴, Khadhouri Sinan ⁴, Faieta Alessio ¹, Lombardo Riccardo ², Morselli Simone ⁵, Elterman Dean ⁶, Cindolo Luca ⁵, Salvaggio Marco ¹
  ¹ Casa di Cura Villa Stuart-Private Hospital, Roma, Italy, ² Sapienza Università di Roma, Roma, Italy, ³ ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy, ⁴ NHS Fife, Scotland, United Kingdom, ⁵ Hesperia Hospital, Modena, Italy, ⁶ University Health Network, Toronto, Canada

• Introduction and Objectives: LUTS due to BPO represent a common condition affecting ageing men. Transurethral resection of the prostate represents the gold standard surgical treatment but is not without complications such as retrograde ejaculation, bleeding and urinary retention. The iTind, is considered a minimally invasive surgical technique, designed to treat LUTS while preserving erectile and ejaculatory function. Herein we report the results of a multi-center, real-world assessment of the iTind procedure.
  Materials and Methods: Data from 5 international centres treating LUTS with the iTind device were collected. We recorded changes in IPSS questionnaire with QoL, IIEF5 questionnaire, antegrade ejaculatory function, QMax, PVR and freedom from repeat intervention.
  Results: A total of 74 subjects were enrolled; median follow-up was 12 months. IPSS and QoL changed from a median of 23 and 4 points at baseline to 11 and 2 points respectively at the last follow-up. A mean improvement in Qmax and PVR from 9 mL/s and 75 mL at baseline to 13 mL/s and 0 mL at the last follow-up. Total median operative time was 10 min, with the median time of iTind indwell time was 7 days. The median device remove time was 5 min. There were no changes in IIEF5 scores and antegrade ejaculation rate. No intra-operative complications were reported, and non-serious post-operative complications occurred in 6 patients (2 urinary retention, 2 mild haematuria, 2 urinary tract infection). Finally, 4 patients underwent reoperation during the follow-up period. All procedures were performed as outpatient day cases.
  Conclusions: Our results confirm that treatment with the iTind is effective and safe in terms of improving urinary symptoms and quality of life without impacting sexual function. Longer follow-up is required to better define the durability of this minimally invasive procedure.

MP-05.06—Flow Rate Improvements Maintained Through 3 Years After Treatment with Optilume BPH 

• Elterman Dean ¹, Kaplan Steven ²
  ¹ University of Toronto, Toronto, Canada, ² Mount Sinai Hospital, Icahn School of Medicine, New York, United States

• Introduction and Objectives: Optilume BPH is a novel minimally invasive surgical therapy (MIST) that combines mechanical dilation with the delivery of paclitaxel for the treatment of lower urinary tract symptoms (LUTS) secondary to BPH. Mechanical dilation with Optilume BPH achieves an anterior commissurotomy, while delivery of paclitaxel is intended to maintain luminal patency during healing. The PINNACLE study was a randomized, sham controlled study evaluating Optilume BPH against a sham procedure, with long-term follow-up limited to the active (Optilume BPH) treatment group.
  Materials and Methods: 148 subjects were randomized in a 2:1 fashion (100 Optilume BPH, 48 sham) at 18 centers in the US and Canada. Subjects and evaluating personnel were blinded to the treatment received through 12-months, subjects randomized to receive treatment with Optilume BPH continued follow-up through 2 years. Symptom improvement was measured utilizing the International Prostate Symptom Score (IPSS), and functional improvement measured by peak urinary flow rate (Qmax). Erectile and ejaculatory function were evaluated utilizing validated questionnaires.
  Results: Seventy-eight subjects have completed the 2-year follow-up in the per-protocol set. A total of 4 subjects (4/100, 4%) have pursued additional surgical management (PAE, TURP (2), laser ablation) through the 3-year timepoint. Improvement in IPSS was maintained through 3 years (23.4 vs. 100). Qmax improved from 8.9 mL/s at baseline to 17.7 mL/s through 3-year follow-up. Paired analysis showed minimal changes in IPSS and Qmax from 12 month to 3-year follow-up. There were no changes in perceived sexual or ejaculatory function.
  Conclusions: Treatment with Optilume BPH results in impressive and durable functional improvements in flow rate and symptomology. Minimal surgical retreatment has occurred in the cohort of patients randomized to receive Optilume BPH as part of the pivotal randomized, sham controlled trial.

MP-05.07—Life Cycle Assessment of HoLEP: Quantifying Environmental Impact and Opportunities for Sustainable Urologic Surgery 

• Klein Clement ¹, Humbert Veronique ², Meune Mathieu ¹, Margue Gaelle ¹, Tubiana-Dussin Françoise ¹, Chabriere Sandrine ¹, Lamouroux Karin ¹, Robert Grégoire ¹, Bladou Franck ¹
  ¹ Bordeaux University Hospital, Bordeaux, France, ² CV Developpement, Canet-en-Roussillon, France

• Introduction and Objectives: The ecological transition of the healthcare sector is a pressing priority in the context of global climate change. In urology, surgery for benign prostatic hyperplasia (BPH) is among the most frequently performed procedures. While Holmium Laser Enucleation of the Prostate (HoLEP) is well established for its clinical efficacy, its environmental impact remains largely unexplored.
  Materials and Methods: We conducted a comprehensive Life Cycle Assessment (LCA) of 20 consecutive HoLEP procedures, in accordance with ISO 14040/44 standards and the European Product Environmental Footprint (PEF) methodology. The analysis covered the entire perioperative timeline—pre-, intra-, and post-operative phases—including medical devices, consumables, energy use, and waste generation. Environmental impacts were modeled using SimaPro^® software (v9.6) and the Ecoinvent database.
  Results: The median PEF score was 5.9 points [IQR: 5.7–6.1], with a carbon footprint of 106 kg CO₂-eq [IQR: 102–118] per procedure. The surgical phase alone accounted for 49% of the total PEF score. The 10-L fluid collection canisters were the primary contributors to the environmental burden of medical devices (48%), particularly in categories related to climate change and fossil resource depletion. Use of the SUPERSHOW fluid management system significantly reduced both the PEF score (–21%) and carbon footprint (–13%) compared to conventional plastic containers (p < 0.001). Environmental impact increased with operative duration, but this increase was significantly less steep when SUPERSHOW was used.
  Conclusions: This is the first study to quantify the environmental footprint of HoLEP using a standardized LCA approach. Our findings highlight the value of LCA in informing sustainable surgical practices. Optimizing surgical workflows and adopting eco-innovative technologies can lead to substantial reductions in resource consumption and waste production. These results support the integration of environmental criteria into decision-making processes and encourage the broader adoption of LCA in surgical innovation and hospital policy.

MP-05.08—Long-Term Efficacy and Safety of Rezūm Water Vapor Therapy for Enlarged Prostates 

• Bitar Mario ¹, Bhojani Naeem ², Zorn Kevin ³, Chughtai Bilal ⁴, Cindolo Luca ⁵, Ferrari Giovanni ⁵, Elterman Dean ¹
  ¹ University of Toronto, Toronto, Canada, ² University of Montreal Hospital Center, Montreal, Canada, ³ BPH Canada, Montreal, Canada, ⁴ Smith Institute of Urology, New York, United States, ⁵ Hesperia Hospital, Modena, Italy

• Introduction and Objectives: Rezūm therapy is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that uses water vapor thermal ablation. This study aimed to evaluate the long-term outcomes of Rezūm therapy by analyzing symptom durability and improvement in Lower Urinary Tract Symptoms (LUTS) in a cohort of patients followed over a three-year period.
  Materials and Methods: A prospective registry was established for Rezūm therapy at two international high-volume centers. We reviewed data for patients followed between April 2019 and October 2021. All patients had baseline medical and BPH history documented along with uroflowmetry (Qmax and PVR) and validated questionnaires (IPSS, IPSS QoL, BPHII, IIEF-15, MSHQ-EjD function and bother).
  Results: In this study, we evaluated 712 patients with a one-year follow-up, analyzing LUTS and sexual function. The mean age at treatment was 67.2 years (SD 8.9) with mean baseline prostate volume was 74.1 cc (SD 34.4). Patient follow-up data for post-void residual (PVR) volumes showed a decline from a baseline mean of 134.9 mL (n = 598) to 47.8 mL at 24 months (n = 145) and 38.5 mL at 36 months (n = 18). Qmax demonstrated improvement, increasing from a baseline mean of 8.6 mL/s (n = 584) to 15 mL/s at 24 months (n = 103), and 12.1 mL/s at 36 months (n = 17). The IPSS showed a notable decrease, with baseline scores averaging 22 (n = 627), then dropping to 9.8 at 36 months (n = 64). The IPSS QoL score improved from a baseline mean of 4.5 (n = 627) to 1.9 at 36 months (n = 64). BPHII improved from a baseline mean of 7.7 (n = 489) to 2.9 at 12 months (n = 210), 2.2 at 24 months (n = 105), and 2.7 at 36 months (n = 51). No statistically significant differences were observed in the IIEF or the MSHQ-EjD function and bother domains.
  Conclusions: The Rezūm procedure resulted in significant improvements with sustained benefits over three years. These findings underscore the treatment’s effectiveness in enhancing patient well-being while maintaining stable sexual function.

MP-05.09—Long-Term Outcomes of Prostatic Artery Embolization: A 10-Year Retrospective Analysis 

• Eragamreddy Sai Kalpitha, Morris Samuel, Dasgupta Ranan, Burfitt Nicholas, Roustampour Samira
  Imperial College Healthcare NHS Trust, London, United Kingdom

• Introduction and Objectives: Prostatic Artery Embolization (PAE) has emerged as a promising minimally invasive treatment for benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS). It offers an alternative to conventional surgical interventions, particularly for patients who may be unfit for surgery or prefer a less invasive approach. This retrospective analysis evaluates the clinical outcomes of PAE performed over a 10-year period, focusing on symptom relief, catheter dependence, and haematuria resolution.
  Materials and Methods: This study included data from 100 patients who underwent PAE between 2016 and 2025. The median age was 76 years. The primary indications for PAE were LUTS (n = 74), urinary retention requiring catheterization (n = 16), and haematuria (n = 10). All of the haematuria cases were also catheterized, contributing to the total of 26 catheterized patients. The outcomes assessed included changes in prostate volume, post-void residual (PVR), and catheter dependence pre- and post-PAE.
  Results: Among the cohort, only 6 patients remained catheter-dependent post-PAE, with a median follow-up of 1 year. The clear successful outcome from PAE for haematuria cases was confirmed, with 70% avoiding the need for further intervention. Among those treated for LUTS (74 patients), 5.4% (4/74) required additional surgical intervention, including 1.4% (1/74) who underwent transurethral resection of necrotic prostate tissue. The median prostate volume reduction was 31%, though symptom relief was noted even in cases with less significant volume reduction. A significant improvement in PVR with median reduction of 50% was observed, supporting the efficacy of PAE in improving urinary function.
  Conclusions: PAE demonstrated effectiveness in reducing LUTS, improving catheter independence, and resolving haematuria. It remains a valuable option for patients who are unfit or unwilling to undergo other surgical interventions.

MP-05.10—Low-Power HoLEP for Large Prostates (≥100 cc): Outcomes Compared to Smaller Glands and Implications for Replacing Open Surgery 

• Sid Ahmed Momen, Nkwam Nkwam
  Princess Royal University Hospital, King’s College Hospital NHS Trust, London, UK, London, United Kingdom

• Introduction and Objectives: Historically, prostates ≥ 100 cc required open prostatectomy due to limitations of standard transurethral techniques. High-power HoLEP (100 W) challenged this paradigm, but evidence with low-power (50 W) HoLEP is limited. We evaluated outcomes of low-power HoLEP by prostate size, hypothesizing comparable effectiveness and safety across gland sizes, thus supporting its role as an alternative to open surgery.
  Materials and Methods: We analyzed 259 consecutive HoLEP procedures performed with a 50 W laser (2020–2025), stratified by prostate volume: Small (≤80 cc, n = 51), Moderate (81–149 cc, n = 138), and Large (≥150 cc, n = 68). Perioperative outcomes (operative/enucleation time, catheterization duration, hospital stay, complications) and functional improvements (IPSS, Qmax, PVR at 3–6 months) were compared using ANOVA, Kruskal-Wallis, and chi-square tests.
  Results: Mean prostate volumes were 60 cc (Small), 120 cc (Moderate), and 178 cc (Large). Enucleation time increased with size (median 31 vs. 50.5 min, p < 0.001), as did operative time (45 vs. 70 min, p < 0.001). However, enucleation efficiency was highest in the Large group (2.5 g/min vs. 1.4 g/min Small, p < 0.001). Safety remained consistent: transfusion rates were low and comparable (0% Small, 1.4% Moderate, 1.5% Large; p = 0.73). Rates of transient incontinence (~8–12%) and urethral stricture (~2%) did not differ by size. Large prostates had slightly longer catheterization (1.5 vs. 1 day, p = 0.02) and hospital stays (1.5 vs. 1 day, p = 0.04), but these differences were clinically minor. Functional outcomes showed uniform IPSS improvement (~17 points, p = 0.56) and substantial Qmax gains (~250%, p = 0.64) across sizes. In extreme cases (≥200 cc; mean 245 cc, max 374 cc, n = 18), enucleation time averaged 82 min with minimal complications, paralleling outcomes from high-power HoLEP and surpassing open prostatectomy in safety and recovery.
  Conclusions: Low-power HoLEP is effective and safe for treating large prostates (100–374 cc), demonstrating excellent outcomes comparable to smaller glands and high-power HoLEP. Our findings strongly support low-power HoLEP as a viable, minimally invasive alternative to open prostatectomy, broadening access to advanced BPH management beyond tertiary centers.

MP-05.11—Management of Post-Endourological Bladder Neck Contracture: Transurethral Resection Combined with Triamcinolone Acetonide Injection Demonstrates Sustained Efficacy 

• Liu Ben, Zheng Xiangyi, Shi Yuchen
  First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

• Introduction and Objectives: Bladder neck contracture (BNC), a prevalent complication following endourological procedures for benign prostatic hyperplasia (BPH), leads to bladder outlet obstruction, debilitating lower urinary tract symptoms, increased healthcare utilization, and reduced quality of life. This study evaluates the safety and efficacy of a dual-modality approach combining transurethral bladder neck scar resection with triamcinolone acetonide injection for post-endourological BNC.
  Materials and Methods: A single-center study included 29 patients diagnosed with BNC after transurethral resection of the prostate (TURP), transurethral vapor enucleation and resection (TVERP), or holmium laser enucleation (HoLEP). Inclusion criteria comprised confirmed BNC diagnosis via cystoscopy and urodynamic obstruction. Under general anesthesia, patients underwent transurethral scar tissue resection followed by submucosal triamcinolone acetonide (800 mg) injections at eight evenly distributed sites of the bladder neck. Follow-up included uroflowmetry, symptom assessment, and cystoscopy at 1 month and longer time. Primary outcome was treatment success (unobstructed voiding without reintervention). Secondary outcomes included postoperative complications.
  Results: Over a median follow-up of 19 months (IQR: 13–32), 86.2% (25/29) of patients achieved durable treatment success, with no instances of recurrent obstruction or need for secondary procedures. Postoperative maximum urinary flow rates improved from 1.0 ± 0.9 mL/s to 9.3 ± 2.2 mL/s (p < 0.001). Minor complications occurred in four patients including epididymitis, UTI, retrograde ejaculation, and hematuria, while no major complications (Clavien-Dindo > IIIa) were observed.
  Conclusions: The integration of transurethral bladder neck scar resection with triamcinolone acetonide injection demonstrates high efficacy and safety in managing post-endourological BNC. This technique addresses both mechanical obstruction and inflammatory scarring, offering a technically reproducible strategy to reduce recurrence. These findings support its adoption as a first-line therapy for refractory BNC, warranting further multicenter validation.

MP-05.13—Rezum Therapy for Management of Frail Patients with Catheter Dependent Urinary Retention Due to Benign Prostate Hyperplasia: A One Year Follow up Study 

• Ali Ahmed ¹, Tayeb Waseem ², Kalantan Suhail ³, Abdelfadel Abdelsalam ¹, Azzam Amr ⁴, Almouhissen Turky ⁵, Othman Basem ³, Albkri Abdullah ⁶, Bakhsh Abdulaziz ⁷, Moalwi Adel ⁸, Alqahtani Ali ⁹, Kasem Mohammed ¹, Mirza Abdulrahim ³, Hassan Ali ¹, Gabr Ahmed ¹⁰
  ¹ Minia University, Minia, Egypt, Arab Rep., ² King Abdullah Medical City, Makkah, Saudi Arabia, ³ Security Forces Hospital, Makkah, Saudi Arabia, ⁴ Damanhur Medical National Institute., Damanhur, Egypt, Arab Rep., ⁵ Jeddah University, College of Medicine, Jeddah, Saudi Arabia, ⁶ Security Forces Medical City, Makkah, Saudi Arabia, ⁷ Taibah University, Madinah Al Monawarah, Saudi Arabia, ⁸ Najran University, Najran, Saudi Arabia, ⁹ Al-Noor Specialist Hospital, Makkah, Saudi Arabia, ¹⁰ NHS GGC, Glasgow, United Kingdom

• Introduction and Objectives: Rezum system uses water vapor thermal energy, which causes irreversible cell necrosis when it comes into contact with the prostatic tissue. This study represents a one-year follow-up for frail patients with catheter-dependent urine retention secondary to BPH treated with Rezum therapy.
  Materials and Methods: All patients enrolled in this study presented with catheter-dependent urinary retention due to benign prostatic hyperplasia with a mean prostate volume of 65 ± 13.1 mL. All patients included in the study are frail patients with a PRISMA-7 questionnaire score of ≥3. Patients with bladder or prostate cancer, previous pelvic irradiation or prostate surgery, neurogenic bladder, urethral stricture, or active urinary tract inflammation were excluded from the study. The procedure was performed under local anaesthesia with possible sedation. Patients were followed up at 1, 3, 9, and 12 months post-operatively. Clinical assessments were conducted using the IPSS score, bladder scans to measure pre- and post-voiding bladder volume and to evaluate the need for re-catheterization.
  Results: Eighty frail patients with PRISMA-7 score ±3 underwent Rezum therapy for urinary retention secondary to BPH. The mean age of the patients was 79 ± 6 years, the mean prostate volume was 65 ± 13.1 mg, and the mean PSA was 3.5 ± 3 ng/mL. Sixty-eight patients were able to void freely after Rezum therapy. The IPSS score and PVR urine volume showed improvement through a one-year postoperative period (IPSS score at 12 months postoperative: 11.3 ± 5.1, PVRU volume at 12 months: 30 ± 13 cc).
  Conclusions: This study demonstrates that Rezum therapy is a feasible treatment option for frail patients with PRISMA-7 questionnaire score of ≥3, presented with catheter-dependent urinary retention. Appreciated postoperative outcomes and improvement of IPSS score up to one year postoperative were reported.

MP-05.14—Safety and Efficacy of Aquablation in Men 80 Years or Older: An Analysis of the International Collaborative Aquablation Research Urology Society (ICARUS) Real-World Database 

• Murad Liam ¹, Bouhadana David ¹, Cabral Joshua ², Hamouda Aalya ¹, Lee Nick ³, Ohana Ilan ⁴, Quintas Juan ⁵, Leathead Anouk ⁶, Saibi Augustin ⁷, Corsi Nicholas ⁸, Chang Cecilia ², Rodrigues Tiago ⁹, Glaser Alexander ², Helfand Brian ², Zorn Kevin ¹⁰
  ¹ McGill University, Montreal, Canada, ² University of Chicago, Evanston, United States, ³ University of Montreal Hospital Center, Montreal, Canada, ⁴ Laval University, Quebec City, Canada, ⁵ HM Hospital Universitario, Madrid, Spain, ⁶ University of Montreal, Montreal, Canada, ⁷ University of Laval, Quebec City, Canada, ⁸ University of Texas, Dallas, United States, ⁹ Hospital Cruz Vermelha, Lisbon, Portugal, ¹⁰ BPH Canada Prostate Surgical Institute, Montreal, Canada

• Introduction and Objectives: Benign prostatic hyperplasia (BPH) is a condition that manifests with increasing age, with many men experiencing lower urinary tract symptoms (LUTS) by their 50s. This is important as older patients face a higher risk of perioperative complications. Given these concerns, this study aims to assess safety and effectiveness of Aquablation in men over 80 by examining real-world data to inform clinical decision-making.
  Materials and Methods: This retrospective, multi-center study includes 2,136 patients who underwent Aquablation between 2018 and 2024. Patients were divided into two cohorts, ≥80 and <80 years of age, consisting of 206 and 1930 men, respectively. Data included baseline demographics and variables, operative characteristics, as well as post-operative functional outcomes, including peak urinary flow rate (Qmax), post-void residual volume (PVR), and the International Prostate Symptom Score (IPSS) and Quality of Life (QoL) questionnaire. Safety metrics, such as transfusion rates and perioperative complications, were also evaluated.
  Results: Men ≥80 had higher rates of anxiety/depression (32% vs. 16%, p = 0.003), 5α-reductase inhibitor use (35% vs. 19%, p = 0.001), and anticoagulation (56% vs. 24%, p < 0.0001). Mean prostate volume was similar between groups (84.5 cc vs. 78.0 cc, p = 0.051), but men ≥80 were less likely to have a median lobe (52% vs. 63%, p = 0.003). Both groups showed similar improvements in PVR, IPSS, and QoL. However, men older than 80 had lower post-operative Qmax (17.57 vs. 21.54, p = 0.0284) and higher IPSS scores at long-term follow up (10.73 vs. 6.83 at 13–24 months, p = 0.0392). Men ≥80 had higher rates of take-back for cystoscopy/clot evacuation (4.4% vs. 1.9%, p = 0.034), transfusions (2.9% vs. 0.5%, p = 0.003), and 30-day readmissions (4.2% vs. 0.7%, p = 0.002). A composite bleeding outcome was associated with age (OR 1.047, p = 0.014) and urinary retention (OR 2.199, p = 0.017). There were no changes in erectile function and no differences in retrograde ejaculation between groups.
  Conclusions: This study is the first to assess Aquablation’s safety and efficacy across all ages. Aquablation offers similar voiding improvements in men aged ≥80 as in younger men, with slightly higher perioperative risks. Thus, Aquablation should be considered for well-selected, elderly patients with significant BPH who wish to preserve sexual function.

MP-05.15—Safety Outcomes of the Robotic Platform for Holmium Laser Enucleation of the Prostate: Primary Results of the ASTRA Study 

• Gilling Peter ¹, Gomez Sancha Fernando ², Ledezma Rodrigo ³, Vermeulen Wikus ¹, Trucco Cristian ⁴, Georgiev Georgi ⁵, Losco Giovanni ⁶
  ¹ Tauranga Hospital, Tauranga, New Zealand, ² ICUA-Clínica CEMTRO, Madrid, Spain, ³ Universidad de Chile, Santiago, Chile, ⁴ Universidad Catolica, Santiago, Chile, ⁵ Hill Clinic, Sofia, Bulgaria, ⁶ Forte Health Hospital, Christchurch, New Zealand

• Introduction and Objectives: Benign Prostatic Hyperplasia (BPH) is one of the most common male conditions. Various medical therapies and surgical approaches are available for treating BPH, but Holmium Laser Enucleation of the Prostate (HoLEP) remains the gold-standard surgical treatment due to its low recurrence and bleeding rates. However, its steep learning curve has resulted in limited adoption. The Beacon platform, developed by Andromeda Surgical, is a robotically assisted surgical device designed to enhance procedural safety and reduce the learning curve associated with complex urological surgeries. These abstract reports interim safety outcomes from the first-in-human ASTRA trial of robotic HoLEP using the Beacon platform.
  Materials and Methods: This multicenter, open-label, prospective pilot study (ASTRA Study) evaluated the safety of the Beacon platform for performing robotic-assisted Holmium Laser Enucleation of the Prostate (RoLEP). Participants included men aged 45 years and older with symptomatic Benign Prostatic Hyperplasia (BPH) indicated for HoLEP. Safety endpoints were assessed systemically at baseline, one week, and one month post-procedure. Adverse events (AEs) were graded using the Clavien-Dindo classification, and device-related complications were tracked. Safety results of initial 15 subjects who completed one-month follow-up are reported.
  Results: Fifteen patients underwent robot-assisted Holmium Laser Enucleation of the Prostate (RoLEP) and were seen at one week and one month after the procedure. There were no significant adverse events (Clavien-Dindo Grade ≥ 3a) during the 30-day postoperative period. Mild to moderate complications (Grades 1–2) were reported, including urgency, dysuria, mild hematuria with clot retention, UTI, urinary incontinence. All adverse events were consistent with those commonly associated with standard HoLEP and were managed conservatively. No device-related malfunctions or safety issues were reported.
  Conclusions: Interim results from the ASTRA study indicate that robot-assisted Holmium Laser Enucleation of the Prostate (RoLEP) using the Beacon platform is safe, with an adverse event profile that is comparable to conventional HoLEP techniques. Complications reported were mild to moderate in severity, transient, and manageable with standard postoperative care, with no serious or device-related adverse events identified. These promising safety outcomes support further investigation and broader clinical adoption of the Beacon robotic platform for HoLEP.

MP-05.16—Slim 22-F Versus Standard 26-F Sheath Holmium Laser Enucleation of the Prostate in the Management of Benign Prostatic Hyperplasia: A Prospective, Randomized Controlled Trial 

• Elmansy Hazem ¹, Mousa Ahmed ¹, Blahitko Oksana ¹, Roos Adam ¹, Hodhod Amr ², Khan Nawsheen ¹, Abdul Hadi Ruba ¹, Alaradi Husain ¹, Alotaibi Khaled ¹, Zakaria Ahmed S. ¹, Alhelal Saud ¹
  ¹ Northern Ontario School of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada, ² King Abdulaziz Medical City, National Guard Hospital Affairs, Riyadh, Saudi Arabia

• Introduction and Objectives: To compare the outcomes of ambulatory miniaturized holmium laser enucleation of the prostate (MiLEP) performed with a slim 22-F sheath versus standard holmium laser enucleation of the prostate (HoLEP) with a 26-F sheath.
  Materials and Methods: We included 82 patients in this ongoing randomized controlled trial (RCT) who underwent endoscopic enucleation of the prostate (EEP) with either 22-F MiLEP or standard 26-F HoLEP between April and September 2024. Patients’ preoperative and prostate data were evaluated. Intraoperative data and perioperative outcomes, including hospital admission and readmission rates, as well as measures such as IPSS, QoL, Qmax, PVR, and postoperative PSA, were collected and analyzed at 1- and 3-month follow-up intervals.
  Results: Of the 82 patients in the study, 41 underwent 22-F MiLEP, and 41 were managed with 26-F HoLEP. There were no statistically significant differences in preoperative characteristics between the two groups. Additionally, no significant differences were observed between the cohorts in terms of enucleation time, morcellation time, resected weight, or enucleation and morcellation efficiency. However, significant differences were observed in favor of the 26-F sheath regarding the duration of postoperative hematuria, catheterization time, and length of hospital stay. Approximately 29.3% of patients in the 22-F sheath group were admitted with immediate postoperative hematuria, compared to 9.8% in the 26-F sheath group (p = 0.026). Patients treated with 26-F HoLEP were more likely to achieve a successful same-day trial of void (TOV), with rates of 89.2% and 62.1% in the 26-F and 22-F groups, respectively (p = 0.009). Postoperative outcomes, including IPSS, QoL, Qmax, PVR, and postoperative PSA, were comparable between the two cohorts up to 3 months after surgery.
  Conclusions: Both the 22-F and 26-F sheaths achieve satisfactory intraoperative and postoperative functional outcomes in EEP. However, 26-F HoLEP facilitates same-day trial TOV and reduces postoperative hospital admission rates.

MP-05.17—Two-Year Efficacy and Safety of Rezūm Water Vapor Thermal Therapy in Large Prostates (≥80 mL) 

• Bitar Mario ¹, Jakubowicz Deborah ¹, Ferreira Roseanne ¹, Bhojani Naeem ², Zorn Kevin ³, Chughtai Bilal ⁴, Cindolo Luca ⁵, Ferrari Giovanni ⁵, Elterman Dean ¹
  ¹ University of Toronto, Toronto, Canada, ² University of Montreal Hospital Center, Montreal, Canada, ³ BPH Canada, Montreal, Canada, ⁴ Smith Institute of Urology, New York, United States, ⁵ Hesperia Hospital, Modena, Italy

• Introduction and Objectives: While initial guidelines recommended Rezūm for prostates less than 80 mL, recent studies have demonstrated its efficacy and safety in larger prostates. Water Vapor Thermal Therapy (WVTT), Rezūm, is a minimally invasive therapy that uses water vapor to ablate benign prostatic tissue. This study aims to present the prospective, multi-center outcomes of the largest cohort of prostates ≥ 80 mL treated with Rezūm.
  Materials and Methods: This study involved a prospective Rezum registry, which collated information from two high-volume centers between April 2019 and August 2024. Baseline medical histories, uroflowmetry (Qmax, PVR), and validated questionnaires (IPSS, IPSS QoL, BPHII, IIEF-15, MSHQ-EjD) were recorded. The main outcomes assessed included symptom scores, functional improvement, and safety at baseline, 6, 12 and 24 months.
  Results: A total of 259 patients with a prostate volume ≥ 80 mL were treated with Rezūm. The median prostate volume was 105 mL, with 207 patients exhibiting a median lobe. A history of urinary retention was noted in 86 patients (33.6%). The IPSS improved from 21.8 (n = 212) at baseline to 9.1 at 6 months (n = 131), 6.6 at 12 months (n = 107), and 5.7 at 24 months (n = 68). At baseline, Qmax was 8.2 mL/s (n = 198), increasing to 14.6 mL/s at 6 months (n = 45), 14.1 mL/s at 12 months (n = 46), and 14.9 mL/s at 24 months (n = 33). Post-void residual (PVR) volume at baseline was 132.5 mL (n = 196), decreasing to 72 mL at 6 months (n = 42), 60 mL at 12 months (n = 93), and 90 mL at 24 months (n = 38). The IPSS QoL score decreased from 4.5 (n = 212) at baseline to 1.4 at 6 months (n = 131), 1.65 at 12 months (n = 107), and 1.1 at 24 months (n = 68). The BPHII decreased from 7.5 at baseline (n = 171) to 3.3 at 6 months (n = 86), 2.9 at 12 months (n = 65), and 2.3 at 24 months (n = 35). There was no significant difference noted in sexual function as measured by IIEF and MSHQ.
  Conclusions: Rezūm therapy is a safe, effective, and minimally invasive treatment for large prostates (≥80 mL), with similar outcomes to those seen in smaller prostates. Significant improvements were observed in urinary symptoms and quality of life, with minimal impact on sexual function.

5.2. Moderated Video ePosters

MVP-05.01—Slim Sheath 22-F Holmium Laser Enucleation of the Prostate (HoLEP) vs. 26-F Sheath HoLEP for the Treatment of Benign Prostatic Hyperplasia (BPH) 

• Alaradi Husain, Blahitko Oksana, Alotaibi Khaled, Abdul Hadi Ruba, Mousa Ahmed, Elmansy Hazem, Alhelal Saud
  Northern Ontario School of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada

• Introduction and Objectives: To compare the outcomes of ambulatory miniaturized holmium laser enucleation of the prostate (MiLEP) using a 22-F slim sheath and standard 26-F sheath holmium laser enucleation of the prostate (HoLEP).
  Materials and Methods: The clips in this video are part of an ongoing randomized controlled trial (RCT) of 90 patients who underwent endoscopic enucleation of the prostate (EEP) with either 22-F MiLEP or 26-F HoLEP between April-October 2024. We utilized the MOSESTM 2.0 system (MOSESTM Pulse 120H) with a 120 W laser from Boston Scientific and a 550-μm MOSESTM laser fiber. All procedures were performed by a single surgeon using the top-down technique with early apical release. The enucleated tissue was morcellated using a Karl Storz^® DrillCutTM morcellator.
  Results: Incisions were performed with great visibility, with both the slim 22-F and 26-F sheath allowing clear view of anatomical landmarks in both procedures. During enucleation, this good visibility was maintained, allowing for smooth tissue handling. Similarly, during hemostasis, clear vision was maintained with both the 22- and 26-F sheaths, ensuring seamless progress. During morcellation, we observed a difference in visibility and irrigation flow between the two instruments. The 26-F sheath provided superior irrigation, resulting in enhanced visibility. There were 4 instances of superficial bladder mucosal injury that occurred during the 22-F slim sheath morcellation. There was no significant difference in the hematuria scale on continuous bladder irrigation (CBI) between the slim 22-F and the 26-F sheath postoperatively. However, we observed significant advantages with the 26-F sheath, including a reduced duration of postoperative hematuria, shorter catheterization time, and decreased hospital stay. In the 26-F group, 90.5% of patients had a successful same-day trial of void (TOV), compared to 73.8% in the slim 22-F group.
  Conclusions: Preliminary RCT results indicate that, apart from a higher rate of bladder mucosal injury with the slim 22-F sheath, scope size had no significant advantage on intraoperative outcomes. The 26-F sheath was associated with significantly shorter postoperative hematuria, catheterization time, and hospital stay. A higher success rate for same-day TOV was observed when using the 26-F sheath. Postoperative outcomes were similar between cohorts up to 3 months. Larger comparative RCTs are warranted.

5.3. Residents Forum Moderated Oral ePosters

RF-05.01—Clinical and Economic Comparison of Surgical Alternatives for the Treatment of Benign Prostatic Hyperplasia in a Tertiary Hospital in Mexico 

• Arguelles Morales Genaro, Toledo Diaz Mario Alberto, Delgado Corral Aarón, Martínez Correa Adrián, Santiago González Rubén Miguel Ángel, Vieyra Valdez Omar, Osornio Sánchez Víctor, Pérez Becerra Rodrigo, Trujillo Ortiz Luis, Saldivar Luna Alberto, Perez Alan, Rufino Cruz Angel, Castro Fuentes Carlos Alberto
  Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, Mexico

• Introduction and Objectives: Benign prostatic hyperplasia (BPH) is one of the most prevalent medical conditions in men and is the most common cause of urological consultation. Current treatment options are: mono and bipolar transurethral resection of the prostate (TURP), vaporization (Green light^®), enucleation transurethral prostate (HoLEP, TuLEP, B-TUEP), adenomectomy (open and laparoscopic), alternative ablative treatments (embolization of prostatic arteries, Rezum^®), and non-ablative (intraprostatic injection, intraurethral devices). The objective is to compare the clinical characteristics and the economic expenses generated between the different therapeutic options available at our institution.
  Materials and Methods: It’s a retrospective, descriptive and transversal study. The clinical records of patients with a diagnosis of BPH undergoing Bipolar TURP, open and laparoscopic adenomectomy were reviewed in the period from January 2021 to December 2023.
  Results: A total of 129 patients were treated; the main reason for care was acute urinary retention (n = 100; 77.5%). Through the IPSS questionnaire, more than 60% (n = 81) of the population were found in a range of 24 to 28 points (severe symptoms). Referent to the physical examination, grade IV was identified by rectal examination in 70% (n = 90) of the studied population, followed by grade III (n = 39; 30%). Prostate volume was measured by ultrasound; a range between 78 to 111 cc was identified in 85.3% (n = 110) of the population. Bipolar TURP was performed in 60.5% (n = 78), followed by open adenomectomy in the 30.2% (n = 39) and laparoscopic adenomectomy in 9.3% (n = 12). Assessing the economic cost (hospital stay, blood units and surgical time), an average of $2,181.22 USD was identified for bipolar TURP; $2,922.42 USD in the case of open adenectomy and $4,436.31 USD for laparoscopic adenomectomy.
  Conclusions: Bipolar TURP is the most used treatment in our institution, followed by open adenomectomy with a 2:1 ratio, being the laparoscopic approach the least used, only in a small group of patients. The treatment with the highest cost was laparoscopic adenomectomy, representing almost double compared to bipolar TURP, which recorded the lowest cost. In our institution has attended patients with advanced disease and large prostate volume. The results concluded that bipolar TURP is the standard of treatment with adequate functional results and lower cost.

5.4. Unmoderated Standard ePosters

UP-05.01—Impact of Acute Urinary Retention on Perioperative and Functional Outcomes Following Transurethral Resection of the Prostate: A Systematic Review 

• Ausaf Husnain
  Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, United Kingdom

• Introduction and Objectives: Acute urinary retention (AUR) is a frequent clinical manifestation in men with benign prostatic hyperplasia (BPH) and is often an indication for transurethral resection of the prostate (TURP). However, the extent to which preoperative AUR influences postoperative outcomes remains a subject of ongoing debate. This systematic review aims to synthesize current evidence on the impact of AUR on perioperative and functional outcomes following TURP, with a focus on postoperative complications, urinary function, and the need for additional surgical interventions.
  Materials and Methods: This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. A literature search was conducted across PubMed, PMC, MEDLINE, Scopus, ScienceDirect, ScienceOpen, MyScienceWork, and Google Scholar over a five-year period. Studies were screened based on inclusion and exclusion criteria, assessing titles, abstracts, full texts, and quality. To minimize bias, appropriate assessment tools were used. The search initially identified 1,251 records, with irrelevant publications removed.
  Results: After evaluation of 30 studies, 11 were included, while 19 were excluded due to poor quality. Evidence suggests that patients with a history of AUR experience prolonged postoperative catheterization, an increased risk of urinary incontinence, and a slower return to normal voiding function compared to those who undergo TURP electively. Additionally, preoperative AUR has been associated with a higher likelihood of requiring repeat TURP within five years.
  Conclusions: The presence of preoperative AUR is associated with poorer postoperative functional outcomes and an increased risk of surgical complications following TURP. Prognostic factors such as prostate volume and the duration of urinary retention appear to influence surgical outcomes. Long-term follow-up studies indicate that patients with AUR are more prone to persistent LUTS postoperatively. These findings underscore the need for perioperative management strategies to optimize surgical success. Further research is warranted to refine treatment protocols and improve patient outcomes.

UP-05.02—Outpatient Urolift Under Local Anesthesia for BPH: A Real-World Evaluation 

• Khalil Waqas, Islam Jawad, Ghosh Dhruba, Sheikh Mazhar
  Blackpool Victoria Hospitals, Blackpool, United Kingdom

• Introduction and Objectives: The Urolift system is a minimally invasive treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPE). NICE guidelines (MIB217) and EAU endorse it as a tissue-preserving alternative to TURP, particularly for high-risk patients unsuitable for general anesthesia. This study evaluates its feasibility as an outpatient procedure. Objectives: This study aimed to evaluate feasibility of Urolift under LA in outpatient settings; assess procedural success against EAU/NICE benchmarks; quantify impact on patient safety, NHS waiting lists and costs; identify anatomical predictors of success per BAUS guidance
  Materials and Methods: Study Design: Retrospective cohort analysis 30 consecutive patients meeting EAU criteria for minimally invasive BPH therapy. Patient Cohort: Inclusion: Men ≥ 50 years with LUTS (IPSS ≥ 12), prostate 40–80 g. Exclusion: Active UTI, bladder stones, or prior prostate surgery, large median/anterior lobes. Intervention: Anesthesia: Lidocaine 2% gel. Device: Urolift P4 implant system (CE-marked). Setting: Dedicated outpatient procedure room (BAUS day-case standards). Outcome Measures: Procedural success (catheter removal at 1 week; IPSS reduction ≥5 at 3 months); VAS pain scores (0–10) intraoperatively; QoL (IPSS-QoL ≤ 2). Data Analysis: Descriptive statistics for demographics; Fisher’s exact test for categorical outcomes;paired t-tests for pre-/post-operative IPSS.
  Results: Mean age: 77.6 years. Success rate: 66.7% (15/24), comparable to EAU-reported rates for minimally invasive therapies. QoL improved in 62% (score ≤ 2), with mean pain of 3.2/10. Catheter-free rate: 40% (4/10), consistent with NICE efficacy criteria. Failures (20.8%) were linked to anatomical challenges (e.g., large median lobe), echoing BAUS technical guidance.
  Conclusions: Urolift under LA meets NICE cost-effectiveness thresholds and EAU safety standards for outpatient BPE management. Its reduced perioperative burden aligns with NHS priorities to shorten waiting lists while avoiding anesthesia risks cited in BAUS audits. Anatomical patient selection remains critical, as emphasized across all guidelines. Takeaways: Guideline-backed: Meets EAU/NICE/BAUS criteria for safety and efficacy. NHS-aligned: Reduces theatre demands and waiting lists. Patient-centric: Avoids general anesthesia risks; preserves sexual function. Scientific Merits: Direct benchmarking against major urological guidelines. Real-world data validating outpatient feasibility. Explicit alignment with healthcare system priorities (patient safety, cost, capacity).

UP-05.03—Audit on the Outcomes of GreenLight Laser Photovaporization of the Prostate at Freeman Hospital 

• Miller Alexandra, Dhondee Ashika, Almond Megan, Veeratterapillay Rajan, Rix David, Tait Campbell, Gujadhur Rahul
  Newcastle Upon Tyne Hospitals, Newcastle, United Kingdom

• Introduction and Objectives: GreenLight laser photovaporization of the prostate (GL PVP) has emerged as a widely accepted, minimally invasive treatment for benign prostatic enlargement (BPE), which was introduced at the Freeman in 2023; this audit assesses patient outcomes and waiting times, following its introduction.
  Materials and Methods: A retrospective audit of GLPVP patient data from March 2023–April 2024 reviewed: (a) waiting times & LOS, (b) complications, (c) TWOC success & (d) symptomatic relief.
  Results: N = 88 GLPVP cases, mean age 70 yrs, 25/88 were anticoagulated. Mean prostate size for GLPVP = 57 cc (range = 20–114 cc). Mean prostate size for TURP = 41 cc (range = 30–75 cc). GLPVP (n = 88), mean wait = 154 days (range 19–461 days). Some were converted from TURP/HoLEP. Patients who had TURP (n = 86), mean wait = 257 days (41–825 days), LOS: 98% same day discharge. 2% LOS = 2 days. Complications: 8% had UTI, 3% had haematuria, 3% urethral stricture, 1% required further procedure, 1% had osteitis pubis, 4.5% had UTI requiring IV antibiotics. 97% had a successful initial TWOC, 1/88 required a long term catheter, the other passed on second TWOC. 71/88 patients have had their follow up. 80% have reported complete symptomatic benefit. Cause for incomplete resolution: 9 = ongoing LUTS, 4 = dribble incontinence, 1 = LTC.
  Conclusions: GLPVP is a safe, effective method of treatment for BPE that can treat larger prostates and convert patients previously booked for TURP. GLPVP has improved overall waiting time for bladder outlet surgery at the Freeman Hospital with excellent symptomatic benefit.

UP-05.04—Bipolar Enucleation Versus Resection for Large-Volume Benign Prostatic Hyperplasia: A Prospective Randomized Trial 

• Selim Mohamed, Eldorey Abdelaleem, Elsherif Eid, Salman Baher, Rokba Mohamed
  Faculty of Medicine, Menoufia University, Shebin El Kom, Menoufia Governorate, Egypt, Arab Rep.

• Introduction and Objectives: This study aimed to compare the safety and efficacy of bipolar transurethral enucleation of the prostate (B-TUEP) with bipolar transurethral resection (B-TURP) in patients with LUTS secondary to BPH exceeding 60 g.
  Materials and Methods: This prospective, randomized study was conducted at the Menoufia Urology Department between June 2022 and December 2024. A total of 104 patients were enrolled and randomly assigned to the B-TUEP group (n = 52) or the B-TURP group (n = 52). We included BPH patients with a prostate volume exceeding 60 mL, IPSS above 19, a urine flow rate (Q-max) less than 15 mL/s, and a post-void residual (PVR) greater than 150 mL. Patients with a history of prostatic surgery, neurogenic bladder, or urinary bladder stones were excluded. Preoperative parameters included age, prostate volume, IPSS, PVR, and Q-max. Patients were assessed before the procedure, then 2 weeks, 3 months, and 6 months postoperatively. Both surgical procedures were performed using a bipolar cutting loop electrode (Lamidey Noury) with energy settings of 100 watts for cutting and 120 watts for coagulation.
  Results: 104 patients were equally randomized into two groups, with no difference in preoperative characteristics. The mean prostate sizes were 99 ± 36 g for the B-TUEP group and 88 ± 17 g for the B-TURP group. Operative time was shorter in the B-TURP group; however, this difference did not reach statistical significance (p = 0.122). The B-TUEP group demonstrated a significantly greater volume of prostatic tissue removed (66.93 ± 29.34 g vs. 38.43 ± 8.34 g, p < 0.001), greater irrigation fluid utilization (52 ± 12 L vs. 38 ± 5 L, p < 0.001), and a less postoperative hemoglobin drop (0.81 ± 0.46 g/dL vs. 1.21 ± 0.51 g/dL, p < 0.021). Additionally, the B-TUEP group had a significantly shorter duration of catheterization and hospital stay (p < 0.001). Both groups demonstrated significant postoperative improvements in IPSS, Q-max, and PVR with no statistically significant intergroup differences at 6 months.
  Conclusions: B-TUEP emerges as an effective and safe surgical option for large-volume BPH, offering superior functional outcomes, comparable efficacy with faster postoperative recovery, and durable treatment success, all while maintaining a satisfactory safety profile.

UP-05.05—Clinical and Oncological Outcomes of HoLEP and Incidental Prostate Cancer Findings 

• Kalpee Amit ¹, Samuel Brayan ¹, Onyeze Chigozie ², Rizaam Fathima-Sumaiya ², Tan Litkiat ², Sivathasan Sailathra ¹
  ¹ University of Dundee, Dundee, United Kingdom, ² Tayside NHS, Dundee, United Kingdom

• Introduction and Objectives: We review the clinical and oncological management outcomes of patients incidentally diagnosed with prostate cancer during HOLEP in a single surgeon series.
  Materials and Methods: Between June 2022 and February 2023, a total of 104 HOLEP procedures were performed. A database was created retrospectively following the histological confirmation of prostate cancer. Data collected included preoperative PSA levels, digital rectal examination findings, histopathology results and postoperative PSA trends. Additional evaluations including imaging (MRI, bone scans) and oncological management were also evaluated.
  Results: Among the patients reviewed, 13 (12.5%) had incidental prostate cancer findings post-HoLEP. Gleason scores ranged from 3 + 3 (4 patients/31%), 3 + 4 (6 patients/46%) and 4 + 5 (2 patients/15%). Preoperative PSA mean was 7.9 ng/dL with PSA range 1.9 ng/dL to 31 ng/dL. Postoperative PSA mean was 3.4 ng/dL with range 0.2 ng/dL to 35 ng/dL. Preoperative PSA was a poor predictor of histological grading and oncological outcome. Postoperative PSA level (<1.5 ng/dL) correlated with a normal post procedural MRI result. Management strategies included active monitoring (53%), watchful waiting (23%), and combination androgen deprivation therapy and external beam radiotherapy (15%). Post HOLEP complications were minimal, with one patient developing bladder neck stenosis requiring a laser bladder neck incision (7.6%).
  Conclusions: HoLEP remains a highly effective and safe intervention for BPH, with the added benefit of detecting incidental prostate cancer. The findings support its role not only in improving urinary symptoms but also in aiding early prostate cancer detection. Further longitudinal studies are recommended to optimize surveillance strategies in patients with incidental prostate cancer post-HoLEP.

UP-05.06—Comparing the Use of a 1000 µm Laser Fiber with the New Pulsed Thulium:YAG (Thulio) Laser Versus a 550 μm Pulse Modulated Holmium:YAG Laser in Endoscopic Enucleation of the Prostate 

• Thiruchelvam Jegathesan, Kwok Jia Lun
  Tan Tock Seng Hospital, Singapore, Singapore

• Introduction and Objectives: Anatomical Endoscopic Enucleation of the Prostate (AEEP) has traditionally been performed with an end-firing laser measuring 500–600 µm, typically a pulsed Holmium:YAG laser. Recent advancements have introduced the pulsed Thulium fiber laser (TFL) and the pulsed Thulium:YAG laser (p-Tm:YAG), both with distinct properties, including decreased peak power and increased water absorption coefficients, that may affect tissue charring and dissection capabilities. This study aims to demonstrate that laser enucleation can be effectively performed using the latest p-Tm:YAG (Thulio, Dornier MedTech Systems GmbH, Weßling, Germany) with a larger reusable 1000 µm inner core fiber.
  Materials and Methods: We conducted a retrospective study of en bloc AEEP procedures performed between January 2024 and March 2025 at a large tertiary institution in Singapore. Two laser systems were compared: a 550 µm Holmium:YAG Lumenis Pulse P120H (Boston Scientific, Marlborough, MA) and a 1000 µm p-Tm:YAG laser. Data collected included laser enucleation time and morcellated tissue weight. Enucleation efficiency was defined as the weight of enucleated tissue divided by enucleation time (g/min). An unpaired t-test was used to assess statistical significance.
  Results: We performed 28 cases using the 550 µm Holmium:YAG laser, followed by 43 cases with the 1000 µm Thulium:YAG laser. Mean enucleation efficiency was significantly higher in the p-Tm:YAG group (0.76 vs. 0.55 g/min, p = 0.01). Mean morcellated weight was significantly higher in the p-Tm:YAG group (62.7 vs. 41.0 g, p = 0.002)
  Conclusions: Our study demonstrates that the novel use of a 1000 µm Thulium-YAG laser fibre in AEEP achieves good enucleation efficiency possibly due to its larger area effect. This is of interest with the current widespread use of 500 µm laser fibres for TFL and p-Tm:YAG lasers. However, we acknowledge that our superior enucleation efficiency may be confounded by factors such as differences in morcellated tissue weight and learning curve. Nonetheless, this does not detract from the novel use of 1000 µm inner core p-Tm:YAG fiber. Further controlled studies are, however, necessary.

UP-05.07—Daylep: A Five Year Multi-Centre Evaluation of HoLEP Outcomes in Berkshire and Wessex UK, the Rise of Day Case Surgery 

• Masiha Erfan ¹, Maynard William ¹, Patel Pretesh ¹, Anand Chanakya ², Phan Yih Chyn ², Ismail Mohamed ², Johnston Max ³, Brewin James ³, Jones Adam ¹, Kumar Sunil ¹, Yang Bob ¹
  ¹ Royal Berkshire NHS Foundation Trust, Reading, United Kingdom, ² Portsmouth Hospitals NHS Trust, Po, United Kingdom, ³ Salisbury NHS Foundation Trust, Salisbury, United Kingdom

• Introduction and Objectives: Holmium-Laser Enucleation of the Prostate (HoLEP) has become the preferred surgical approach in treating bladder outflow obstruction (BOO) secondary to high-volume prostates despite a plethora of new interventions. Despite its reputation for a steep learning curve, it offers excellent haemostatic properties and low complication rates; day-case procedures are increasingly common. An analysis of current practice to determine safety and outcomes of short-stay HoLEP was conducted.
  Materials and Methods: A retrospective analysis of patients’ records undergoing HoLEP between December 2020-April 2024 at three high-volume centres.
  Results: 441 patients, mean age 72 y (range = 53–89 y), mean body mass index 27.3 kg/m² (SD = 4), mean PSA 7.63 ng/mL (SD = 7 ng/mL) and mean prostate volume 111 cc (SD = 27 cc), underwent HoLEP. 20.8% patients were anticoagulated. Indications included lower urinary tract symptoms (32.8%), urinary retention (47.9%), and high-pressure chronic retention (8.5%). Mean operating time: 119 min (SD = 48 min), mean morcellation time: 28 min (SD = 22 min), mean tissue resection: 77 g (SD = 52 g). Mean post-operative stay was 0.6 days (SD = 1 day), with 51% as day-case procedures. Complications include urinary tract infections in 3.1%, bleeding requiring review in 6.8% and return to theatre in 0.9%. Mean post-op QMax was 19.6 mL/s, mean QMax improvement of 113%. 12% noted incontinence at first follow-up (3–6 months, 1 pad/day). 1.8% developed urethral stricture, and 1 patient complained of persistent de-novo erectile dysfunction. Statistical analysis demonstrated anticoagulation, larger prostate volumes (>120 cc) and pre-operative catheterisation were not associated with greater complications or worse outcomes.
  Conclusions: HoLEP is a highly effective treatment for BOO with a low side-effect profile, which can be performed safely as a day-case procedure. Overall complication rates were low. Incontinence rates at first follow-up underpin the importance of commencing pelvic floor exercises pre-operatively.

UP-05.08—Does Postoperative Antibiotic Prophylaxis Reduce Urinary Tract Infection Rates After Holmium Laser Enucleation of the Prostate? A Randomized Prospective Clinical Trial 

• Elmansy Hazem ¹, Mousa Ahmed ¹, Blahitko Oksana ¹, Skogberg Jill ¹, Khan Nawsheen ¹, Hodhod Amr ², Alaradi Husain ¹, Alotaibi Khaled ¹, Abdul Hadi Ruba ¹, Zakaria Ahmed S. ¹, El Tayeb Marawan M. ³, Alhelal Saud ¹
  ¹ Northern Ontario School of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada, ² King Abdulaziz Medical City, National Guard Hospital Affairs, Riyadh, Saudi Arabia, ³ Baylor Scott and White Health, Temple, TX, United States

• Introduction and Objectives: We aimed to evaluate whether a 3-day course of antibiotics following holmium laser enucleation of the prostate (HoLEP) reduces the incidence of postoperative urinary tract infections (UTIs) in a randomized controlled trial (RCT).
  Materials and Methods: We included 89 patients who underwent HoLEP using MOSES™ 2.0 technology between November 2023 and September 2024 in this ongoing RCT. Patients’ preoperative parameters, including prostate characteristics, were assessed, and all had a negative preoperative urine culture. All participants were discharged with a scheduled urine culture to be performed on postoperative day 3 (POD 3), regardless of whether they exhibited UTI symptoms. Intraoperative parameters and perioperative outcomes, including hospital admission and the incidence of postoperative UTIs, were collected and analyzed. Outcome measures, including IPSS, QoL, Qmax, and PVR, were collected and analyzed at 1, 3, and 6 months, with PSA measured at 3 months.
  Results: The antibiotic and no-antibiotic groups consisted of 45 and 44 patients, respectively. There were no statistically significant differences in preoperative characteristics or intraoperative parameters between the two groups. On POD 3, twelve patients (26.7%) in the antibiotic group exhibited UTI symptoms, compared to 14 patients (31.8%) in the no-antibiotic group (p = 0.34). However, only three patients (6.8%) in the antibiotic group had a positive urine culture on POD 3, compared to 6 patients (13.6%) in the no-antibiotic group (p = 0.19). One patient in the no-antibiotic group presented to the emergency room (ER) with acute epididymoorchitis. At one-month follow-up, only one patient in the antibiotic group had a positive urine culture. Postoperative outcomes, including IPSS, QoL, Qmax, PVR, and PSA, were comparable between the two cohorts up to 6 months postoperatively.
  Conclusions: The MOSESTM and TFL laser systems demonstrate comparable efficacy for lithotripsy of renal calculi during f-URS, with neither technology showing a distinct clinical advantage.

UP-05.09—Durability on Patient-Reported Outcomes Two Years After Rezūm Therapy: A Real-World Single-Center Experience 

• Symeonidis Asterios ¹, Bekos Athanasios ¹, Symeonidis Evangelos N. ¹, Sountoulides Petros ², Mykoniatis Ioannis ², Andreou Andreas ¹
  ¹ European Interbalkan Medical Center, Thessaloniki, Greece, ² Aristotle University of Thessaloniki, Thessaloniki, Greece

• Introduction and Objectives: Minimally invasive treatments (MISTs) have emerged in the last decade in the continuum between pharmacotherapy and surgery for lower urinary tract symptoms (LUTS) secondary to Benign Prostatic Obstruction (BPO) in males. Transurethral convective water vapor energy, delivered with the Rezum system, is amongst the most promising and well-studied MISTs. The aim of this study was to assess the efficacy and treatment durability at two-year follow-up after Rezum treatment for LUTS/BPO.
  Materials and Methods: Prospectively collected data from a single-surgeon Rezum database were retrospectively analyzed. The first 129 patients, with moderate to severe LUTS, who underwent Rezum from July 2020 to August 2021, were screened. Treatment durability at 24-months, for patients not surgically or medically retreated, was defined as achieving minimally clinical important difference (MCID) in the International Prostate Symptom Score (IPSS) and Quality of Life score, ≥3 and ≥1-point improvement respectively. Marked ≥ 8 points improvement in the IPSS was also recorded. Objective measurements were also compared between baseline and at two years.
  Results: Of 129 patients treated, 105 completed the 24-month follow-up, and 91 met the inclusion criteria and were analyzed. Mean age was 62.09 ± 8.36 years. 81% of our cohort (74 patients) were categorized as having moderate LUTS, while 18.7% (17 patients) with severe LUTS. Retreatment rate, for both surgical failure and BPH pharmacotherapy re-initiation, was 5.43%. 86 (94.5%) and 82 (90.1%) patients met the primary endpoint of IPSS MCID and IPSS-QoL MCID respectively. 67 (73.6%) patients achieved the stricter criterion of marked IPSS difference. Median changes, at 24 months, in IPSS, IPSS-QoL, IPSS voiding and storage domains were significant, averaging 9.5, 2.0, 5.5, and 4.0 point, respectively (all p < 0.001). Significant improvements were shown in post-void residual volume, prostate volume, peak urinary flow rate (all p < 0.001), and PSA levels (p < 0.005) averaging 46.9 mL (CI: −67.5, −30), 16.16 cm³ (95% CI: −18.9, −13.4), 5.06 mL/s (95% CI: 3.9, 6.2), and 0.32 ng/mL (95% CI: −0.61, −0.09) respectively.
  Conclusions: The results from the first study conducted in the Greek population provided herein, demonstrate that Rezum is a safe, feasible and durable MIST for men seeking relief from LUTS/BPO symptoms.

UP-05.10—Economic Evaluation of Prostatic Urethral Lift: Interim Results of the Ecolift Study 

• Robert Grégoire ¹, Blin Patrick ², Bonnet Hilary ³, Abouelfath Abdelilah ², Ben Boujema Meric ¹, Benard Antoine ¹
  ¹ Bordeaux University Hospital, Bordeaux, France, ² Bordeaux Pharmaco Epidemiology, Bordeaux, France, ³ Bordeaux Pharmaceuticals Epidemiology, Bordeaux, France

• Introduction and Objectives: Transurethral surgery of the prostate (TURP/laser) is the standard treatment for bladder outlet obstruction due to benign prostatic hyperplasia (BPH). Urolift (PUL, Prostatic Urethral Lift) is a minimally invasive alternative with fewer postoperative complications and better preservation of quality of life, although its symptomatic efficacy is lower than that of TURP. The aim of the ECOLIFT study is to assess whether Urolift implants represent a cost-effective strategy for treating BPH compared to surgery.
  Materials and Methods: ECOLIFT is a multicenter observational prospective cohort study comparing two groups: one cohort of patients treated with PUL and another of patients undergoing TURP or laser procedures [Holmium Laser Enucleation (HoLEP)/GreenLight Laser Vaporization (GLV)]. Included patients were men aged 50 or older with symptomatic BPH requiring first-line surgical treatment. The incremental cost-effectiveness ratio (ΔC/ΔE) was expressed as the differential cost per complication avoided with PUL compared to TURP/laser, four months after the intervention. The probability distribution of the incremental cost-effectiveness ratio was obtained using bootstrap resampling (1000 iterations). Costs were calculated for both public and private hospital stays. Mean differentials (ΔC and ΔE) were calculated using a generalized linear model.
  Results: The PUL and TURP/laser cohorts included 74 and 66 patients respectively, all with 4-month follow-up. Patients in the TURP/laser cohort were slightly older, had larger prostate volumes, and more severe urinary symptoms before the procedure. The cost of the surgical intervention per patient, adjusted for age, post-void residual volume, and prostate size, was significantly lower in the PUL cohort, with a mean differential of −€917.14 (95% CI: −€1176.33 to −€657.94; p-value < 0.0001). The proportion of participants with no surgery-related complications before or after hospital discharge also favored the PUL cohort, though the difference was not statistically significant [0.13 (−0.04 to 0.31), p-value = 0.1422]. The incremental cost-effectiveness ratio was -€7055 per additional patient without complications. Bootstrap simulation with 1000 samples indicated that, in 92% of cases, PUL was both less costly and associated with fewer complications.
  Conclusions: Cost-effectiveness at 4 months favors the PUL cohort after adjustment for age, post-void residual volume, and prostate size. However, longer follow-up is needed to confirm these promising findings.

UP-05.11—Efficacy and Safety of Optilume^® Drug-Coated Balloon for Urethral Strictures: A Prospective Single-Center Study 

• Bahbahani Basmah ¹, AlArbeed Abdullah ², Alhajeri Faisal ¹, Alharbi Abdulrahman ³, Salem Shady ³, Aldousari Saad ¹
  ¹ Sabah Alahmad Urology Center, Kuwait, Kuwait, ² Farwaniya hospital, Kuwait, Kuwait

• Introduction and Objectives: Urethral strictures can cause significant morbidity, leading to bothersome lower urinary tract symptoms and potential complications. The Optilume^® drug-coated balloon (DCB) has emerged as a novel therapeutic approach for the management of urethral strictures. This study evaluates the safety and efficacy of Optilume^® DCB in men with urethral strictures.
  Materials and Methods: A prospective cohort study was conducted on male patients who underwent Optilume^® DCB treatment for urethral strictures by an experienced surgeon between May 2023 and May 2024. Follow-up assessments were conducted at 2 weeks, 3 months, and 6 months. The primary efficacy endpoint was symptom improvement, measured using the International Prostate Symptom Score (IPSS) and Quality of Life (QoL) score. Secondary outcomes included functional improvement, assessed through maximum urinary flow rate (Qmax) and post-void residual volume (PVR). The primary safety endpoint was the absence of serious device-related complications.
  Results: Among 35 patients, 11 had no prior treatment, while 24 had undergone endoscopic interventions, including 4 with urethroplasty. Stricture etiology was idiopathic in 18, iatrogenic in 16, and traumatic in 1, with a mean length of 1.3 cm. Significant symptom improvement was observed, with mean IPSS decreasing from 13.2 ± 3.8 at baseline to 5.4 ± 3.9 at 6 months (p < 0.0001). The IPSS QoL score showed substantial improvement from 4.54 ± 0.7 at baseline to 1.65 ± 0.6 at 14 days post-procedure (p < 0.0001), remaining stable at 3 and 6 months (1.62 ± 0.8 and 1.65 ± 0.9, respectively; p < 0.0001). Mean Qmax increased from 9.2 ± 4 mL/s at baseline to 22.3 ± 11.1 mL/s at 14 days (p < 0.0001), with sustained improvement at 3 months (21 ± 8.8 mL/s; p < 0.0001). Mean PVR at 6 months was 22.9 ± 55.2 mL. Functional improvements in urinary flow and symptoms were observed regardless of prior endoscopic treatment history, with no significant differences between treated and untreated patients. No serious device-related complications occurred. However, 6 patients experienced dysuria, 7 had mild hematuria, and 1 developed a urinary tract infection requiring antibiotics.
  Conclusions: Optilume^® DCB is a safe and minimally invasive treatment option for men with urethral strictures, demonstrating immediate improvements in voiding symptoms, urinary flow, and quality of life.

UP-05.12—En Bloc Holmium Laser Enucleation of the Prostate (HoLEP): Initial Experience and Consolidation of the Technique 

• Avalos Ramon Julio, Pineda Murillo Javier, Hernandez Leon Omar, Lugo Garcia Juan
  Hospital Juarez De Mexico, Ciudad De Mexico, Mexico

• Introduction and Objectives: Benign prostatic enlargement has a prevalence of approximately 60% in 60-year-old men. En bloc nucleation and its variants, which emerged in 2010, are a method to enucleate the three lobes of the prostatic capsule completely, maintaining the capsular plane and the urethral sphincter while removing the prostate. The aim of the present study is to analyze the implementation of the surgical technique, considering the learning curve and the experience accumulated in a group of patients before and after its development.
  Materials and Methods: Retrospective study from July 2022 to November 2024, in which 136 patients with lower urinary tract symptoms due to prostate growth with indication for surgical treatment were included. Bleeding, surgical time, hospital stay, enucleated prostate volume, as well as enucleation, morcellation, time and laser energy efficiencies were analyzed.
  Results: The efficacy of the procedure was higher in the post-curve group with a p < 0.0001 compared to the pre-curve group with a coefficient of determination R2 = 0.8091. Enucleation efficiencies, laser time and energy showed a statistically significant difference (p < 0.05) in favor of the post-curve group.
  Conclusions: Holmium laser enucleation of the prostate has proven to be an effective and safe surgical treatment even during the learning curve. The turning point of the procedure will depend on mentoring and an adequate selection of cases in the training process.

UP-05.13—Enhanced Earlier Recovery Outcomes Following Aquablation 

• Ng Keng, Darwazeh Hashem, Barber Neil
  Frimley Park Hospital, Camberley, United Kingdom

• Introduction and Objectives: Aquablation prostate surgery has gained popularity as treatment of choice for lower urinary tract symptoms due to benign prostatic enlargement. Improvements in urinary flows and symptoms coupled with minimal sexual dysfunction rates are largely due to the precise robotic waterjet prostate ablation while preserving bladder neck and verumontanum integrity. Most of our patients recover quicker and return to normal activities sooner following aquablation.
  Materials and Methods: 75 prospective patients who were undergoing aquablation were consented preoperatively and participated in our questionnaire study. Validated questionnaires were given to patients at two weeks, one month, and three months following aquablation. The questionnaires included IPSS, IIEF and recovery assessment questionnaires (e.g., pain scores, satisfaction scores, interference with activities).
  Results: Preoperatively, the mean IPSS was 23/35, QoL 4.5/6 with average Qmax at 8.3 mL/s and mean prostate volume of 87.3 cc. Post op IPSS score at 2 weeks was reduced to 15.2, 10.1 at 1 months and 8.8 at end of 3 months post aquablation. Similarly, the QoL scores improved to 2.9 (at 2 weeks), and, at end of 3 months, it was recorded at 1.6. 72.5% of patients were very satisfied/satisfied with the quality of recovery post surgery at 2 weeks following surgery and improved to 85% at 3 months. 90% of patients rated the overall experience to be very happy/happy, having received the procedure at 2 weeks post op and this was maintained till 3 months on follow up. Two thirds of men were very satisfied/satisfied about urinary symptoms at 2 weeks, which then improved to 79.5% at 1 month. At 2 weeks following aquablation, 78% described little/none of the time with interference with activities at home at 2 weeks and majority (90.0%) at 3 months. In terms of interference with outdoor activities, 70% reported none/little of time interference at 1 month, and this improved to 90% at 3 months.
  Conclusions: This initial study highlights the efficacy of aquablation but also enhances our belief that patients recover quicker and return to normal activities earlier following aquablation. Reasons behind this success are probably due to the precision of waterjet ablation and minimal thermal effect from aquablation.

UP-05.14—Exploring Factors Influencing Length of Hospital Stay Following Holmium Laser Enucleation of the Prostate (HoLEP) 

• Javed Muhammad Usman, Rahman Enamur, Bhatti Irtiza Ahmed, Penev Branimir, Henderson Alastair, Cynk Mark
  Maidstone and Tunbridge Wells NHS UK, Maidstone, United Kingdom

• Introduction and Objectives: Holmium Laser Enucleation of the Prostate (HoLEP) has been shown to significantly reduce postoperative length of stay (LOS). However, LOS remains variable among patients. This study aimed to identify and analyse factors influencing LOS following HoLEP to improve patient selection and optimize hospital resource utilization.
  Materials and Methods: A retrospective review was conducted of 219 patients who underwent HoLEP at our centre. Patients were excluded for social admissions, return travel time exceeding one hour, ASA score > 3, or inability to discontinue anticoagulants preoperatively. The primary outcome was LOS, defined as the time from surgery to hospital discharge. Patients were categorized as same-day discharge (DS) or next-day stay (NDS), and comparisons were made between the two groups.
  Results: A total of 185 patients met the inclusion criteria: 91 (49.1%) were discharged on the same day, and 94 (50.8%) required overnight admission. NDS patients were significantly older than DS patients (mean age 73.8 vs. 71.7 years, p = 0.01). Longer operative time was associated with NDS (105.2 vs. 85.4 min, p = 0.0023), as were larger prostate volumes (114.9 cc vs. 86.3 cc, p < 0.0001) and greater resected tissue weight (61.7 g vs. 44.6 g, p = 0.0005). ASA scores and Charlson Comorbidity Index were not significantly associated with LOS. Among anticoagulated patients, 64% (12/19) of DOAC users and 50% (10/20) of antiplatelet users were in the NDS group.
  Conclusions: Same-day discharge post-HoLEP is more likely in younger patients with smaller prostates and shorter operative times. ASA score and comorbidity burden did not significantly impact LOS. These findings may aid in patient selection and procedural planning; further large-scale studies are recommended to support and refine criteria for same-day discharge in HoLEP.

UP-05.15—Exploring the Association Between Restless Legs Syndrome and Overactive Bladder 

• Hajebrahimi Sakineh ¹, Salehi-Pourmehr Hanieh ², Kalarastaghi Niloofar ³, Aletaha Reza ⁴, Nejati Negin ⁴, Hajebrahimi Reyhaneh ⁴
  ¹ Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Rep., ² Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Rep., ³ Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Rep., ⁴ Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Rep.

• Introduction and Objectives: This study aimed to investigate the potential association between Restless Legs Syndrome (RLS) and Overactive Bladder (OAB).
  Materials and Methods: This cross-sectional study recruited 135 patients diagnosed with RLS based on the Persian version of the Cambridge-Hopkins RLS diagnostic questionnaire (CHRLSq). Participants provided informed consent and completed the International Consultation on Incontinence Questionnaire Overactive Bladder Module (ICIQ-OAB) to assess the presence and severity of OAB symptoms, including urinary frequency, nocturia, urgency, and urgency urinary incontinence (UUI). Demographic data, including age and gender, as well as information on pre-existing medical conditions and medication use, were collected.
  Results: The study cohort comprised predominantly women (57.8%). The mean age of participants was 40.12 ± 16.47 years, and the mean age of RLS onset was 28.60 ± 17.34 years. Diabetes mellitus and hypertension were the most frequently reported underlying medical conditions. Among the 135 RLS patients, 25.9% reported urinary frequency, 45.9% experienced nocturia, 65.2% reported urgency, and 32.6% had UUI. Of the RLS patients who reported discomfort while seated or reclined (n = 109), a high proportion (82.6%) also reported at least one OAB symptom. Similarly, among those with at least one OAB symptom (n = 93), 78.8% reported a frequent need to move their legs. While Fisher’s Exact Test showed no significant difference in the overall prevalence of OAB symptoms between groups based on discomfort or leg movement urge, a statistically significant association was found between nocturia (p = 0.015) and UUI (p = 0.011) with the presence of discomfort while seated or reclined. Pearson correlation analysis revealed a statistically significant positive correlation between patient age and RLS onset age (r = 0.778, p < 0.0001), as well as a significant positive correlation between RLS onset age and the OAB score (r = 0.301, p = 0.001).
  Conclusions: The findings suggest a notable co-occurrence of urinary symptoms, indicative of potential OAB, in individuals with RLS. The significant associations observed between nocturia and UUI with discomfort during rest suggest a possible link between the sensory-motor disturbance characteristic of RLS and bladder function.

UP-05.16—Holmium Laser Enucleation Versus Bipolar Enucleation for Large Volume (>80 mL) Prostates: A Systematic Review of Prospective Clinical Trials 

• Kourouklidis Ioannis ¹, Haidich Anna-Bettina ², Liakos Aris ², Lusuardi Lukas ³, Roidos Christos ², Papathanasiou Konstantinos ², Baniotis Panagiotis ², Sountoulides Petros ²
  ¹ General Hospital of Florina, Florina, Greece, ² Aristotle University of Thessaloniki, Thessaloniki, Greece, ³ Paracelcus Medical University, Salzburg, Austria

• Introduction and Objectives: Benign prostatic enlargement (BPE) in men over 60 is the most common cause of obstructive lower urinary tract symptoms (LUTS). Anatomical Endoscopic Enucleation of the Prostate (AEEP) by either Holmium laser (HoLEP) or bipolar enucleation (BipolEP) is considered as first line surgical option. However for patients with large prostates (PV > 80 mL) the existing bibliography does not offer enough evidence whether one technique is superior to the other. The main aim of this systematic review and meta-analysis is to investigate if HoLEP achieves better International Prostate Symptom Score (IPSS) than BipolEP. Apart from that, secondary outcomes (Qmax, hospitalization, catheterization, hemoglobin drop and operative time) were also examined to detect any difference.
  Materials and Methods: We searched in databases, grey literature and trial registries for RCTs that compared these two methods by measuring preoperative and postoperative IPSS and included patients with BPE and PV > 80 mL, who satisfied the criteria for surgical treatment. RCTs with patients with prostate cancer or neurogenic bladder were excluded. The RoB2 tool was used to assess risk of bias in studies. R Studio was utilized to synthesize data, perform the meta-analysis, conduct the heterogeneity tests and illustrate the forest plots. GRADE approach was used to examine the certainty of evidence.
  Results: Three RCTs were included with a total number of 274 participants. No significant differences were found in IPSS, Qmax, hospitalization, catheterization and hemoglobin drop. Conversely, operative time was found 11.36 min significantly shorter in HoLEP (MD:-11.36 95% CI:-20.32;-2.40). Limitations of our review derive from the small number of included RCTs and from the low certainty of evidence in three out of six outcomes (hospitalization, catheterization, hemoglobin drop). Further future relative RCTs are needed with stratified PV.
  Conclusions: In patients with BPE and large prostate size (PV > 80 mL), IPSS, Qmax, hospitalization, catheterization and hemoglobin drop seem to be equivalent among the two operations, while HoLEP procedures have shorter operative times.

UP-05.17—Impact of Radiation on Artificial Urinary Sphincter Success in Post-Prostatectomy Patients: A Long-Term Retrospective Analysis 

• Ghonaimy Ahmed, Stephenson Jennifer, Lopolito Adriana, Fulford Simon, Nadeem Mehwash
  James Cook University Hospital, South Tees NHS Trust, Middlesbrough, United Kingdom

• Introduction and Objectives: The artificial urinary sphincter (AUS) is considered the gold standard for managing post-prostatectomy stress urinary incontinence (PP-SUI) with generally favourable outcomes. However, prior radiation therapy can adversely impact surgical success. This study aimed to review and assess outcomes, including success and complication rates, comparing long-term results in irradiated versus non-irradiated patients.
  Materials and Methods: We conducted a retrospective review of patients who underwent bulbar AUS placement for urodynamically confirmed PP-SUI from 2014 to 2023. Patients who had bladder neck AUS placement or bulbar AUS for conditions other than PP-SUI were excluded. Data collected included patient demographics, intraoperative details, short- and long-term complications, and revision rates. Outcomes between irradiated and non-irradiated patients were compared, and postoperative urinary symptom scores (0–6) were used to assess quality of life (QoL).
  Results: A total of 180 patients were identified, but 88 patients were included for final analysis in line with the inclusion criteria. The mean age was 69 years (±7.2 SD), were included. Mean follow-up duration was 18.4 months (±4.48 SD) with minimum 12 months follow up. Twenty-six patients had received radiation therapy (22 salvage radiotherapy post-radical prostatectomy and 6 radical radiation therapy followed by prostatectomy). Overall, device revision was required in 18 patients (20%): 11 due to mechanical failure and 7 due to urethral cuff erosion or infection necessitating staged replacement. Complication rates were higher in the irradiated group, with urethral erosion occurring in 7 (31%) irradiated patients compared to 3 (5%) in the non-irradiated group. Device infection occurred in 4 irradiated patients compared to 3 in the non-irradiated group. Interestingly, new onset overactive bladder symptoms, urethral strictures, and scrotal hematomas were more common in non-irradiated patients (3 vs. 2, 2 vs. 0, and 2 vs. 0, respectively). All patients reported improved QoL post-procedure (score 0–1), with 80% considering the operation life-changing and willing to recommend it to others. All patients who experienced device failure opted for revision surgery and were satisfied with the outcomes.
  Conclusions: Bulbar AUS placement is a safe and effective treatment for PP-SUI with high patient satisfaction. Although irradiated patients showed a slightly higher complication rate, long-term outcomes were satisfactory across the cohort.

UP-05.18—Impact of Sheath Size on HoLEP Outcomes: A Comparative Study Between 22f and 26f Sheaths 

• Alshammari Abdulaziz ¹, Alhajeri Faisal ², Boualbanat Mariam ², Alghadouri Saad ², Alrefai Abdullah ², Alenezi Saad ³, Alkandari Abdulrahman ⁴
  ¹ Kuwait Board of Urology, Kuwait Institute for Medical Specialisation, Kuwait City, Kuwait, ² Kuwait Board of Urology, Kuwait City, Kuwait, ³ Jaber Alahmad Hospital, Kuwait City, Kuwait, ⁴ Adan Hospital, Kuwait City, Kuwait

• Introduction and Objectives: Benign prostatic hyperplasia (BPH) is a common condition in aging men that often requires surgical intervention when symptoms become severe. Holmium Laser Enucleation of the Prostate (HoLEP) is a well-established treatment with proven safety and efficacy. However, postoperative complications such as temporary stress incontinence and urethral stricture remain concerns. The 22 French (F) sheath is a novel tool designed to reduce urethral trauma compared to the traditional 26F sheath. To compare the incidence of urethral stricture, functional outcomes, and complications in patients undergoing HoLEP using either the 22F or 26F sheath.
  Materials and Methods: This retrospective analysis included prospectively collected data from patients who underwent HoLEP between July 2023 and September 2024. Patients were randomized into two groups: Group 1 (22F sheath) and Group 2 (26F sheath). Outcomes assessed included the incidence of urethral stricture, Qmax, International Prostate Symptom Score (IPSS), and post-void residual (PVR) at 1, 3, and 6 months postoperatively. Statistical analysis was performed using the Julius.ai platform. Independent-sample t-tests and chi-square tests were used, with a p-value of < 0.05 considered statistically significant.
  Results: A total of 122 patients were included (62 in Group 1 and 60 in Group 2). baseline parameters. There was no statistically significant difference in urethral stricture rates between the groups (3.2% vs. 6.7%; p = 0.64). Transient stress incontinence was lower in the 22F group at all time points, with a significant difference at 3 months (p = 0.049). Both groups showed improvement over time, with incontinence rates approaching zero at 6 months. Group 1 demonstrated significantly greater improvement in mean IPSS scores at all follow-up intervals (p = 0.026). Improvements in Qmax and PVR favored the 22F group but did not reach statistical significance. Two patients from each group were readmitted for clot retention; no blood transfusions were required. No major complications were reported aside from urethral strictures.
  Conclusions: The use of a smaller 22F sheath in HoLEP showed promising results in improving early IPSS scores without a statistically significant difference in postoperative urethral stricture. Larger studies are needed to validate these findings.

UP-05.19—Impact of Verbal Compared to Structured Information on Patient’s Anxiety and Satisfaction Undergoing Uroflowmetry—A Randomized Control Trial 

• Nadeem Ramna, Faruqui Nuzhat, Ather Hammad
  Aga Khan University Hospital, Karachi, Pakistan

• Introduction and Objectives: Uroflowmetry (UFM) is a non-invasive, initial, simple, and widely performed first-line investigation for the evaluation of this condition. Despite its non-invasive nature, uroflowmetry can provoke anxiety and affect satisfaction, often due to misunderstandings about the procedure. Objective: This randomized control trial aimed to compare the effects of structured versus verbal education on anxiety and satisfaction in patients undergoing uroflowmetry.
  Materials and Methods: A single-blind, parallel-arm study was conducted with 148 patients, which were randomized into structured (brochure) and verbal counseling groups. The modified Amsterdam Preoperative Anxiety and Information Scale (APAIS-M) assessed anxiety, while satisfaction was measured using a questionnaire adapted from Dogun et al. Descriptive statistics, chi-square, and independent t-tests were employed for data analysis.
  Results: The structured education group demonstrated significantly lower anxiety scores, with less worry in structured education group 2.87 ± 0.135 versus 3.49 ± 0.142 (p = 0.028), and less thoughts with 2.90 ± 0.150 versus 3.25 ± 0.155 (p = 0.044). Satisfaction scores showed that the structured group had a higher satisfaction for knowledge provided (1.21 ± 0.04 vs. 1.08 ± 0.036, p = 0.035) and ease of using Uroflowmetry equipment (4.51 ± 0.11 vs. 4.05 ± 0.118, p = 0.047), more satisfied with related to privacy (4.68 ± 0.112 vs. 4.20 ± 0.115, p = 0.04).
  Conclusions: Structured education significantly improved patient understanding, comfort, and expectations in terms of privacy while reducing anxiety compared to only verbal counseling. Integrating structured education before uroflowmetry could enhance patient experience and satisfaction.

UP-05.20—Introduction of Same-Day Discharge HoLEP in a District General Hospital (DGH) 

• Chan Kimberley, Hsu Ray, Gan Christine
  East and North Hertfordshire NHS Trust, Stevenage, United Kingdom

• Introduction and Objectives: In 2018, Getting It Right First Time (GIRFT) published its national report for Urology surgery, supporting the recommended 80% day-case rate made by British Association of Day Surgery for HoLEP. We describe our discharge protocol for day-case HoLEP. Our objective was to determine its feasibility and safety.
  Materials and Methods: All patients listed for HoLEP between September 2023–June 2024 were considered for same-day discharge (SDD). We developed specific post-operative instructions and discharge protocols. Patients all had meticulous laser haemostasis, 22Fr 3-way catheter inserted, 50 mL in catheter balloon and light traction towards end of procedure. All had irrigation titrated to urine colour for an hour post-operatively, stopped once urine clear. If urine remained clear for 30 min, the catheter balloon was deflated by 20 mL, observed for another 30 min, and patients discharged with spiggoted 3-way catheter. Most patients were reviewed by surgeon before discharge, with nurse-led discharge guided by urine-colour charts provided.
  Results: 78 cases of HoLEP (median age/ASA:73/2) with mean (range) prostate volume of 107 (50–220) mL were performed using the Lumenis Pulse™ 120H Holmium Laser System. 74.4% (58/78) had planned SDD. Planned SDD was not possible due to lack of social cover (8/20), surgical reasons (6/20) and anaesthetic concerns (6/20). 82.8% (48/58) of planned SDD was discharged same-day, with no re-admissions with haematuria within 30-day follow-up period. Haematuria (5/10) was the main reason for unplanned admission post-op.
  Conclusions: Day-case HoLEP is feasible and safe. It can be implemented on most patients. Pre-op counselling on day-case nature of procedure and performing case early during the day will improve our day-case rate.

UP-05.21—Is Water Vapor Thermal Therapy Feasible in an Octogenarian Population? A Multicentric Long Term Follow up Evaluation 

• Minore Antonio ¹, Ferrari Giovanni ², Cacciatore Loris ¹, Siena Giampaolo ³, Balsamo Raffaele ⁴, Morselli Simone ², Castellucci Roberto ², Varvello Francesco ⁵, Cindolo Luca ², Salvaggio Marco ⁶
  ¹ Fondazione Policlinico Campus Bio Medico di Roma, Roma, Italy, ² Hesperia Hospital, Modena, Italy, ³ Università di Firenze, Firenze, Italy, ⁴ AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy, ⁵ Michele e Pietro Ferrero Hospital, Alba Di Cuneo, Italy, ⁶ Casa di Cura Villa Stuart-Private Hospital, Roma, Italy

• Introduction and Objectives: Water vapor thermal therapy is one of the latest developed minimally invasive surgical treatments for benign prostatic hyperplasia. More elderly people refer to urologists asking for a surgical option that provides low invasiveness and frees them from drug assumption or indwelling catheter. We focused on functional outcomes of WVTT in an octogenarian cohort.
  Materials and Methods: We retrospectively queried our multicentric prospectively maintained database including only over 80 years patients. We collected baseline and demographic data. Preoperative as 12-month follow up assessment included PSA, uroflowmetry, ultrasonographic evaluation of prostate volume, international prostatic symptoms and quality of life scores (IPSS and QoL), international index of erectile function (IIEF5) and the question yes/no assessing ejaculatory dysfunction. Prostate cancer was ruled out when suspected. Complications were classified according to the Clavien-Dindo Classification. Continuous variables were reported as median and interquartile range, categorical variables as percentages. T-test and chi-square assessed the difference between continuous and categorical variables respectively. A significance level was set at p < 0.05.
  Results: 26 patients were included, with a median age of 82 years old (IQR 81–84). Baseline and perioperative data are reassumed in Table 1. Median baseline prostate volume was 64 mL. A median of 9 injections were performed (6–12), and the catheter was maintained in situ for 14 days. Despite the high comorbidity load, no major complications were reported, but 27% of acute urinary retentions occurred that were treated putting the catheter in situ for 7 more days. Furthermore we proved a Qmax improvement from 8 to 14 mL/s (p = 0,03) and PVR drop from 140 mL to 40 (p = 0,02). Comparisons are reassumed in Table 2. Moreover patients experienced a significant reduction of symptoms burden at IPSS assessment (p < 0.01) with an improvement in terms of QoL (p < 0.01). 11.5% of patients experienced urinary tract infections treated with antibiotic administration according to urine culture results.
  Conclusions: WVTT is a safe and effective procedure in octogenarian patients. Due to its low invasiveness, it may be considered in routine clinical practice in patients willing to discontinue BPH drugs who are unfit for conventional surgery due to high comorbidity load.

UP-05.22—Men’s Health Quality of Life Before Surgical BPH Treatment for Lower Urinary Tract Symptoms 

• Sürmeli Bahattin ¹, Güzelburç Vahit ¹, Çalık Gökhan ¹, Horuz Rahim ¹, Albayrak Selami ¹, Koçak Mehmet ², Laguna Pilar ¹, De La Rosette Jean ¹
  ¹ Istanbul Medipol Mega University Hospital, Istanbul, Türkiye, ² Multi-Omics Design and Analysis Studie (MODAS-SABITA), Istanbul Medipol University, İstanbul, Türkiye

• Introduction and Objectives: Benign Prostatic Hyperplasia (BPH) is a prevalent medical condition characterized by the enlargement of the prostate, impacting around 50–80% of males aged 50 and older, with its occurrence rising with age. It is associated with burdensome symptoms, such as Lower Urinary Track Symptoms (LUTS), Erectile Dysfunction and Ejaculatory Dysfunction, which have a major impact on patients’ quality of life (QoL) by affecting their psychological and social wellbeing, work productivity and sexual health. We assess Men’s Health Quality of life before surgically treated for Lower Urinary Tract Symptoms (LUTS) because of Benign Prostatic Hyperplasia (BPH).
  Materials and Methods: 28 University and Community hospitals from Turkiye participated in the study and performed various BPH surgeries based on their own preference or equipment availability. International Index of Erectile Function (IIEF-5) and Male Sexual Health Questionnaire-short form (MSHQ-EjD-SF) were used to assess the sexual functions, and Short Form Quality of Life Survey was used to measure the general quality of life including mental and physical health (SF-12). Categorical variables were presented as frequencies and percentages, and continuous variables were presented as mean and standard deviation.
  Results: From April 2020 through January 2023, we treated 1808 patients. The mean age (64.9 years), prostate volume (68.6 cc), IPSS score (23.1), SF12 score (36.8), MSHQ score (7.4) and IIEF score (13.6) were calculated for the 1303 patients enrolled with spontaneous voiding. 504 patients were in urinary retention and were not included in this analysis. Patients with a baseline MSHW < 9 were older (p < 0.0001), had a smaller voided volume (p < 0.0001), a higher IPSS score (p < 0.0003), a lower IPSS-QoL score (p < 0.006), lower SF12 score (p < 0.0001), and a lower total IIEF score (p < 0.0001). Patients with an IIEF score <17 were older (p < 0.0001), had a lower voided volume (p < 0.0009), a lower SF 12 score (p < 0.0001) and lower MSHQ score (p < 0.0001).
  Conclusions: Patients treated for LUTS because of BPH may experience impaired sexual functions. Patients with Sexual Health dysfunction were older and presented with lower mental and physical health. The voiding parameters are only slightly impaired though.

UP-05.23—One-Year Follow-up of a Randomized Prospective Clinical Trial Comparing Holmium MOSES Versus Thulium Fiber Laser Enucleation of the Prostate for the Treatment of Benign Prostatic Hyperplasia 

• Elmansy Hazem ¹, Mousa Ahmed ¹, Blahitko Oksana ¹, Kelly Ryan ¹, Hodhod Amr ², Abdul Hadi Ruba ¹, Alaradi Husain ¹, Alotaibi Khaled ¹, Zakaria Ahmed S. ¹, Alhelal Saud ¹
  ¹ Northern Ontario School of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada, ² King Abdulaziz Medical City, National Guard Hospital Affairs, Riyadh, Saudi Arabia

• Introduction and Objectives: We sought to compare intraoperative and one-year postoperative outcomes of patients treated for benign prostatic hyperplasia (BPH) with either holmium laser enucleation of the prostate using MOSESTM technology (M-HoLEP) or thulium fiber laser enucleation of the prostate (ThuFLEP).
  Materials and Methods: We included 104 patients who underwent endoscopic enucleation of the prostate (EEP) using either MOSESTM technology or thulium fiber laser (TFL) between June 2022 and January 2024 in this randomized controlled trial (RCT). Patients’ preoperative and prostate data were evaluated. Intraoperative data and perioperative outcomes, including hospital admission, perioperative complications, readmission rates, and measures such as IPSS, QoL, flow rate, PVR, PSA, and TRUS-size reduction, were collected and analyzed over a 12-month follow-up period.
  Results: Of the 104 patients in the study, 52 underwent M-HoLEP, and 52 were managed with ThuFLEP. There were no statistically significant differences in preoperative characteristics between the two groups. Patients in the M-HoLEP group had a shorter median enucleation time (50 vs. 57.5 min, p < 0.001) and demonstrated significantly higher enucleation efficiency than the ThuFLEP group (1.97 vs. 1.49 g/min, p < 0.001). Furthermore, significant differences were observed in favor of M-HoLEP regarding continuous bladder irrigation (CBI) time, hematuria scale, duration of postoperative hematuria, catheterization time, and length of hospital stay. Approximately 30.8% of ThuFLEP patients were admitted with immediate postoperative hematuria compared to 7.7% in the M-HoLEP group, p = 0.003. Postoperative outcomes, including IPSS, QoL, Qmax, PVR, PSA and TRUS-size reduction, were comparable between the two cohorts up to 12 months postoperatively. Two patients (3.8%) from the ThuFLEP group had bladder neck contractures until the final follow-up visit.
  Conclusions: Both TFL and MOSESTM technology achieved satisfactory intraoperative and postoperative functional outcomes in EEP. However, MOSESTM technology demonstrated superior results in terms of enucleation time, enucleation efficiency, catheterization time, and hospital stay. M-HoLEP facilitates same-day trial of void (TOV) and reduces the rate of postoperative hospital admissions.

UP-05.24—Optilume^® Drug-Coated Balloon Treatment for BPH: A 12-Month Follow-Up Study 

• Bitar Mario ¹, Patel Premal ², Elmansy Hazem ³, Bhojani Naeem ⁴, Meskawi Malek ⁵, Matsumoto Edward ⁶, Elterman Dean ⁷
  ¹ University of Toronto, Toronto, Canada, ² Men’s Health Clinic, Manitoba, United States, ³ Thunder Bay Regional Health Sciences Centre, Thunder Bay, United States, ⁴ University of Montreal Hospital Center, Montreal, Canada, ⁵ Centre de Recherche du CHUM, Montreal, Canada, ⁶ St Joseph Hospital, Hamilton, Canada, ⁷ University Health Network, Toronto, Canada

• Introduction and Objectives: The Optilume^® drug-coated balloon (DCB) offers a novel treatment approach for lower urinary tract symptoms (LUTS), combining mechanical dilation for immediate symptom relief with a paclitaxel-coated drug delivery system. This study provides an overview of the safety and functional outcomes associated with the Optilume BPH catheter system.
  Materials and Methods: This prospective, single-arm, multi-center, open-label study will be conducted at Canadian centers with 24 patients to evaluate the safety of the endoscopic Optilume BPH drug-coated balloon procedure for LUTS due to BPE from July 2022 to January 2025. The study will assess the complication rate at 90 days and evaluate functional outcomes at baseline, 3, 6, and 12 months.
  Results: Out of 24 patients, 17 (70.8%) experienced a total of 42 adverse events (AEs), the majority of which were mild (Grade I: 70.8%). The most reported side effects were hematuria (41.6%), dysuria (16.6%), urinary tract infection (UTI) (8.4%), and urinary urgency (8.4%). Significant symptomatic improvement was observed over time. IPSS scores decreased from 22.5 ± 5.1 at baseline to 11 ± 6.6 at 12 months, while QoL scores improved from 4.6 ± 1.3 to 1.9 ± 1.4 over the same period. Qmax increased from 9.4 ± 3.6 mL/s to 15.7 ± 4.9 mL/s at 3 months, remaining stable at 15.3 ± 7.7 mL/s at 12 months. Post-void residual (PVR) volume decreased from 96.3 ± 83.9 mL to 68.1 ± 43.9 mL at 12 months, reflecting sustained improvements in urinary function. No significant differences were observed in sexual function scores, including IIEF, MSHQ function, and bother scores, indicating that the procedure did not negatively impact sexual health.
  Conclusions: The Optilume BPH drug-coated balloon procedure demonstrated significant symptomatic and functional improvements while maintaining a favorable safety profile over 12 months. Most adverse events were mild and self-limiting, with no serious complications or need for surgical intervention. Improvements in IPSS, QoL, Qmax, and PVR were sustained over time, and sexual function remained stable. These findings support Optilume BPH as an effective and well-tolerated minimally invasive treatment for BPH-related LUTS.

UP-05.25—Outcomes of Low-Power Holmium Laser Enucleation of the Prostate Performed as Elective Day Surgery by a Single Surgeon at a UK Tertiary Centre 

• Sid Ahmed Momen ¹, Nkwam Nkwam ¹, Pherwani Siddhant ², Spazzapan Martina ², Tai Justina ¹, Hallchurch Philippa ², Kassem Kassem ²
  ¹ Princess Royal University Hospital, King’s College Hospital NHS Trust, London, UK, London, United Kingdom, ² Urology, Princess Royal University Hospital, King’s College Hospital NHS Trust, London, UK, London, United Kingdom

• Introduction and Objectives: Benign prostatic hyperplasia (BPH) significantly impacts quality of life in aging men, often requiring surgical intervention. Holmium Laser Enucleation of the Prostate (HoLEP) has become a size-independent gold standard for surgical management. This study aimed to evaluate the perioperative safety, functional outcomes, and feasibility of elective day-case HoLEP using a low-power holmium laser performed by a single surgeon in a UK tertiary hospital.
  Materials and Methods: A retrospective analysis was conducted on patients who underwent HoLEP from February 2020 to February 2025. All procedures used a low-power (≤50 W) holmium:YAG laser and were intended as elective day-case surgeries. Data collected included demographic details, preoperative assessments (IPSS, QoL score, Qmax, PVR, PSA), perioperative parameters (operative time, enucleation efficiency, morcellation time, blood loss), and postoperative outcomes (IPSS, Qmax, PVR, continence status, complications, and pathology findings). Patients with incomplete outcome data were excluded from functional analysis.
  Results: A total of 259 patients were included. The median prostate volume was 119 mL, and 49.8% presented with urinary retention. En bloc enucleation was performed in 80% of cases. Median enucleation and morcellation times were 38 and 9 min respectively, with a median tissue removal of 83 g and enucleation efficiency of 2.1 g/min. Same-day discharge was achieved in 46%, and 73% were discharged within 24 h. Significant improvements were noted in symptom scores and uroflowmetry parameters: median IPSS dropped from 22 to 7, Qmax increased from 9 to 25 mL/s, and PVR decreased from 138 to 18 mL. Early transient stress incontinence occurred in 9.7%, with persistent incontinence in 7.0%. Complication rates were low, and 14% of patients had incidental prostate cancer.
  Conclusions: Low-power HoLEP is a safe and effective procedure for BPH, demonstrating excellent symptom relief and minimal morbidity. It allows for efficient adenoma removal even in large prostates and supports a day-case surgery model. These results affirm that lower laser power does not compromise outcomes, making HoLEP accessible and sustainable in varied healthcare settings.

UP-05.26—Pilot Validation of Sonocurve, a Machine-Learning Sound-Based Uroflowmetry Algorithm, in a Symptomatic Patient Population 

• Sinha Rajan ¹, Mukherjee Subhabrata ², Maynard William ³, Rynne Cormac ⁴, Khoo Christopher ²
  ¹ Kidney Stone & Urology Clinic, Bhagalpur, India, ² Charing Cross Hospital, London, United Kingdom, ³ Royal Berkshire Hospital, Reading, United Kingdom, ⁴ King’s College London, London, United Kingdom

• Introduction and Objectives: One in four men will develop benign prostatic hyperplasia within their lifetime, which often manifests as lower urinary tract symptoms (LUTS). International guidelines recommend uroflowmetry in the evaluation of male LUTS. However, traditional in-clinic uroflowmeters are costly, may malfunction, and provide only a one-off reading, which may not represent the patient’s typical voiding behaviour, especially under the stress of a clinical setting. SonoCurve is a novel machine-learning algorithm developed to provide uroflowmetry metrics and a flow curve from the sound of the urinary void. If deployed in a patient’s smart device, potential advantages include lower cost, serial at-home testing (in a more physiological environment), and remote assessment. This pilot validation study aims to compare SonoCurve with conventional uroflowmetry in a symptomatic patient population.
  Materials and Methods: After obtaining institutional approval, we conducted a prospective, within person comparative study in male patients recruited from a specialist LUTS clinic (Mar/May 24). Men unable to void spontaneously, with catheters in situ, or with neurogenic bladders were excluded. Participants voided into a gravimetric uroflowmeter (Status Medical Equipment) from standing. To simulate a toilet bowl, 500 mL of water was placed into the urine receptacle at baseline. Uroflowmetry metrics (maximum flow rate, average flow rate, voided volume, and voiding time) and raw flow data were recorded. Simultaneously, high-fidelity waveform audio recordings were made using a smartphone (Galaxy M14, Samsung) fixed 80 cm above and 40 cm behind the receptacle. Data from voids of <150 mls or with significant artefact were excluded. Audio data were analysed using the SonoCurve algorithm to obtain sonouroflowmetry outputs. Paired outputs were compared using Lin’s concordance correlation coefficient (Python 3.12).
  Results: Flows from 42 men were included (mean age: 54.9 years, range 19–85). Moderate correlations were observed for max flow rate (0.69, 95% CI 0.49–0.83) and average flow rate (0.71, 95% CI 0.54–0.83). Strong correlations were found for voided volume (0.92, 95% CI 0.84–0.96) and voiding time (0.95, 95% CI 0.87–0.98).
  Conclusions: This pilot study demonstrates that SonoCurve provides comparable results to conventional uroflowmetry in men with symptomatic LUTS. Large-scale patient evaluation is planned.

UP-05.27—Preliminary Experience with REZUM System in the Treatment of Bladder Outlet Obstruction Secondary to Benign Hyperplasia of Prostate (BPH) 

• Chandra Shoubhik ¹, Nerli Rajendra ², Ghagane Shridhar ³
  ¹ Shriram Care Hospital Bilaspur, Chhattisgarh, India, Bilaspur, India, ² J N Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belagavi, India, ³ KLE Academy of Higher Education and Research (Deemed-to-be-University), Belagavi, India

• Introduction and Objectives: An enlarging prostate causes bladder outflow obstruction (BOO), which results in lower urinary tract symptoms (LUTS). These LUTS have a significant impact on quality of life (QoL). Several minimally invasive procedures have been developed to provide alternative surgical strategies to the transurethral resection of prostate (TURP). The Rezum system, a novel ablative procedure, has been one of the recently introduced surgical options in the management of a symptomatic enlarged prostate. This paper aims to report our preliminary experience with the use of the Rezum system for prostatic ablation.
  Materials and Methods: We prospectively included patients with bladder outlet obstruction (BOO) secondary to BPH for treatment with the Rezum system. Elderly males (>55 years of age) with LUTS secondary to BOO due to BPH, with moderate to severe IPSS score, Qmax < 15 mL/s and prostate volume of 40–80 cc were included into the study.
  Results: Fifty-two patients with a mean age of 62 ± 2.24 years underwent Rezum therapy during the study period. The pre-operative mean Qmax was 7.3 ± 0.73 mL/s, and the mean post-void residual (PVR) was 86.5 ± 21.2 mL. The mean pre-operative international prostate symptom score (IPSS) was 24.8 ± 2.77. The mean operative time was 13.2 ± 2.17 min. The mean post-operative Qmax was 14.38 ± 0.48 mL/s (p < 0.0001), and the mean (post-op) post-void residual urine was 21 ± 10.25 mL (p 0.003), which was assessed 45 days after the procedure. The mean post-op IPSS score was 8.4 ± 0.89 (p < 0.0001).
  Conclusions: Our short-term results show that the outcomes such as post-operative Q-max, post-void residual urine and post-operative IPSS score were significantly improved. Sexual and ejaculatory functions were also preserved.

UP-05.28—Promising Outcomes of Optilume Treatment for Recurrent Bulbar Urethral and Post-Robotic Prostatectomy Anastomotic Strictures 

• Anwar Adeel, Gkikas Christos
  Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom

• Introduction and Objectives: Urethral stricture affects 16,000 men in the UK each year, with recurrence rates of 50% for urethral dilation (UD), 60% for optical (OU) urethrotomy, and 2–36% for urethroplasty. Optilume, a drug-coated balloon that delivers paclitaxel to reduce the urethral stricture recurrence, costs £1,550 per unit—higher than dilation (£937) but lower than urethroplasty (£4,300). We review its initial outcomes at our NHS trust.
  Materials and Methods: Between June 2024 and March 2025, 17 patients underwent Optilume dilatation for recurrent strictures and post-robotic-assisted laparoscopic prostatectomy (RALP) bladder neck stenosis. The mean age was 61 years (range, 29–88). Sixteen patients (94%) had the procedure under general anaesthesia and one under local anaesthesia. A 30 Fr, 5 cm drug-coated balloon was used, with an average stricture length of 2.1 cm (range, 0.6 cm–5.0 cm). The mean number of prior endoscopic treatments was 3.2. Sixty percent had urethral dilatation (UD), and 40% underwent optical urethrotomy (OU). Follow-up was scheduled at 2 weeks, 3 months, 9 months, and annually. A prospective database was maintained. A trial without catheter (TWOC) was conducted within 3–5 days. Follow-up included assessments of urine flow rate (Qmax), International Prostate Symptom Score (IPSS), and Sexual Health Inventory for Men (SHIM) scores.
  Results: Functional treatment success is defined as a ≥50% improvement in IPSS without re-treatment. After 9 months of Optilume treatment, IPSS improved from 20.6 to 5.5, indicating significant symptom reduction, and quality of life increased from 5 (unhappy) to 3 (mixed). Qmax rose from 6.2 to 11.8 mL/s. Erectile function remained unaffected, with the SHIM score improving from 19.7 to 21. No patients required intermittent self-dilatation. No serious adverse events or non-urinary complications occurred. Common complaints included dysuria and minor bleeding, with no cases of acute urinary retention or headaches.
  Conclusions: Optilume offers an effective intermediate treatment for recurrent anterior urethral strictures, bridging the gap between urethral dilation, optical urethrotomy, and urethroplasty. It provides a minimally invasive option for patients who prefer to avoid the waiting time and risks associated with urethroplasty. With sustained improvement in voiding parameters, Optilume drug-coated balloon dilatation is a safe and cost-effective alternative.

UP-05.29—Prostatic Stone Burden and Intravesical Prostatic Protrusion as Predictors of Voiding Function Recovery Following Endoscopic Prostatic Enucleation 

• Chang Ruei-Je
  Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan

• Introduction and Objectives: Prostatic calculi (PC) are commonly detected in aging men with benign prostatic hyperplasia (BPH), aided by advanced imaging tools such as transrectal ultrasound (TRUS) and CT. Emerging studies suggest that PC are associated with lower urinary tract symptoms (LUTS), chronic pelvic pain, erectile dysfunction, and potentially with impaired bladder function. Intravesical prostatic protrusion (IPP) has also been identified as a significant anatomical predictor of bladder outlet obstruction and treatment response. This study aimed to evaluate the impact of prostatic stone burden and IPP on urinary flow outcomes following anatomical endoscopic enucleation of the prostate (AEEP).
  Materials and Methods: This retrospective study included men aged 45–95 who underwent AEEP for symptomatic BPH between 2019 and 2020 at a single tertiary referral center. All surgeries were performed by a single surgeon. Prostatic calculi were identified on TRUS and categorized into two groups based on the proportion occupying the boundary between peripheral and transitional zones (>50% vs. <50%). IPP was also measured on imaging. Voiding volume (VV) and peak flow rate (PFR) were recorded preoperatively and 1.5 months postoperatively. Statistical analysis was performed using paired t-tests and Fisher’s exact test.
  Results: Among 245 patients who underwent AEEP, 175 had detectable prostatic calculi on TRUS. Of these, 117 patients had complete pre- and post-operative urodynamic data. Patients with a higher burden of prostatic calculi showed significantly lower VV both before and after surgery. Postoperative improvement in PFR was significantly greater in those with fewer calculi. Additionally, patients with more prominent IPP exhibited less improvement in both VV and PFR compared to those with smaller IPP.
  Conclusions: Higher prostatic stone burden and greater IPP are associated with less improvement in voiding parameters following AEEP. These anatomical characteristics may impact postoperative bladder function and should be considered during preoperative evaluation for patients undergoing surgical treatment of BPH.

UP-05.30—Real World Outcomes Following Convective Water Vapour Energy Ablation (REZUM) for Benign Prostatic Hyperplasia (BPH) with Obstructing Median Lobe 

• Benjamin Lim Tze Ying, Sundaram Palaniappan, Lee Lui Shiong, Lim Yong Wei
  Sengkang General Hospital, Singapore, Singapore

• Introduction and Objectives: REZUM has been proposed as a treatment option for prostate volume of 30–80 g including patients with obstructing median lobes. We aim to report the real world outcomes of REZUM in men with obstructing median lobe in a tertiary hospital in Singapore.
  Materials and Methods: 79 men had undergone REZUM from July 2021 to July 2024 at Sengkang General Hospital, Singapore. Patient characteristics and outcome measures were collected from time of enrolment. They were prospectively followed up, and outcomes were measured at 1 month, 3 months and 12 months post-operatively. Failure of treatment is defined as need to restart BPH medication or required surgery for symptomatic BPH.
  Results: Group A consists of patients with significant obstructing median lobe, which is defined as intravesical prostatic protrusion (IPP) measuring ≥10 mm on ultrasound. Group B patients are those with no IPP measuring 1 to 9 mm. There was no difference when comparing Group A vs. Group B in terms of successful trial of catheter at one week, overall complication rates, clot retention rates, and rates of rehospitalisation. At 3 months follow up, there was no difference when comparing Group A vs. Group B in terms of improvement of Qmax (5.8 mL/s vs. 4.1 mL/s, p = 0.184), improvement in IPSS (11.6 vs. 11.8, p = 0.205) and improvement of QOL scores (4.4 vs. 4.6, p = 0.493). Total patients who failed treatment is 14 pts (17.7%). The failure rate is higher in Group A, 11 patients (26.2%) vs. 3 patients (8.1%) in Group B, p = 0.036. In Group A, 9 patients (21.4%) restarted medications due to worsening of symptoms compared to 1 patient (2.7%) in Group B, p = 0.012. Group A had higher rates of patients undergoing subsequent TURP, 4 patients (9.6%) vs. 2 patients (5.4%) in Group B, although the difference is not clinically significant, p = 0.491.
  Conclusions: REZUM has excellent short-term outcomes for symptomatic BPH. However, in patients with obstructing median lobes, failure of treatment is high within 2 years post treatment. 21.4% of patients were restarted on BPH medication, and 9.6% of patients required subsequent TURP. This will help guide treatment options and management of patient expectations.

UP-05.31—Real-World Outcomes of Aquablation for Benign Prostatic Hyperplasia: A Comparative Analysis of the International Collaborative Aquablation Research Urology Society (ICARUS) Database, WATER and WATER-II Trials 

• Lee Nick ¹, Murad Liam ², Bouhadana David ², Sioufi Jeffrey ³, Chakraborty Anindyo ⁴, Marhamati Shawn ⁵, Rodrigues Tiago ⁶, Helfand Brian ⁷, Quintas Juan ⁸, Corsi Nicholas ⁹, Elmansy Hazem ¹⁰, Glaser Alexander ⁷, Zorn Kevin ¹¹
  ¹ University of Montreal, Montreal, Canada, ² McGill University, Montreal, Canada, ³ University of Vermont Medical Center, Burlington, United States, ⁴ University of Laval, Quebec City, Canada, ⁵ Potomac Urology, Alexandria, United States, ⁶ Hospital Cruz Vermelha, Lisbon, Portugal, ⁷ University of Chicago, Evanston, United States, ⁸ HM Hospital Universitario, Madrid, Spain, ⁹ University of Texas, Dallas, United States, ¹⁰ Northern Ontario School of Medicine, Thunder Bay, United States, ¹¹ BPHCanada Prostate Surgical Institute, Montreal, Canada

• Introduction and Objectives: The WATER and WATER-II clinical trials of Aquablation demonstrated effectiveness for treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) in men with prostate volumes (PV) 30–80 and 80–150 mL, respectively. In this study, we compare real-world Aquablation outcomes of men with similar PVs to results from WATER/WATER-II.
  Materials and Methods: We retrospectively analyzed 1,946 consecutive men from the International Collaborative Aquablation Research Urology Society (ICARUS) database between 2018 and 2024 with PV ≤ 150 mL who underwent Aquablation at one of four international centers. Baseline characteristics, functional outcomes, and complications were compared to data from WATER/WATER-II using ANOVA and Kruskal-Wallis tests.
  Results: From the ICARUS database, 1,069 men (PV ≤ 80 mL) were compared to 116 men (WATER), and 877 men (PV 80–150 mL) were compared to 101 men (WATER-II). As expected, there were slight differences in baseline characteristic between cohorts. Quality of Life and International Prostate Symptom Scores (IPSS) were slightly higher at some timepoints in the real-world (e.g., IPSS at 3-months: ICARUS-I 9.9 ± 6.9 vs. WATER 7.0 ± 5.7, p < 0.001). Anejaculation rates, Qmax flow rates, and post-void residuals at 3 months were consistent across cohorts. Transfusion rates were significantly lower in the real-world large prostate dataset (ICARUS-II 1.3% vs. WATER-II 5.9%, p = 0.01).
  Conclusions: Real-world outcomes of Aquablation are broadly comparable to those observed in the pivotal WATER/WATER-II trials. These findings support its generalizability and sustained effectiveness beyond the rigorous selection criteria of WATER/WATER-II, validating its role as a viable treatment for BPH in routine clinical practice.

UP-05.32—REZUM Water Vapour Therapy for Benign Prostatic Hyperplasia: A Single-Centre Experience 

• Jacob Dayan
  James Cook University Hospital, Middlesbrough, United Kingdom

• Introduction and Objectives: The provision of REZUM therapy started in April 2021 in our Trust. It is currently being performed as a day case procedure through one short appointment. Through this study we aimed to assess treatment outcomes among our patients who underwent REZUM procedure in the first 2 years of service initiation.
  Materials and Methods: A retrospective-cohort study was conducted to assess treatment outcomes among patients who underwent REZUM procedure from April 2021–2023 with at least 6-month post-procedure follow up data available. The data variables collected include patient age, prostate volume, number of injections given, pre-treatment and post treatment International Prostate Symptom Score (IPSS) and Quality of Life (QoL) score.
  Results: 45 patients (mean age 71.24, range 57–93 years) who underwent REZUM therapy were included. Mean prostate volume was 51.8 cc (range 20–98 cc). The mean number of injections given was 4.5. There were no re-admissions for complications post procedure. 1 (2.2%) patient presented to SDEC with urinary infection needing oral antibiotics. IPSS and QoL scores’ data were available for 37 patients, of which 33 (89%) patients showed improvement in both IPSS and QoL scores on undergoing REZUM (Figure 1). 2 (4.4%) patients required repeat REZUM procedures in view of recurrence of symptoms. 36 (80%) patients were discharged back to primary care at the 6-month follow up with improved symptoms.
  Conclusions: REZUM has proven to be an efficient and safe minimally invasive treatment option in our patient cohort. It is a good alternative to more invasive surgical procedures for BPH in appropriately selected patient population.

UP-05.33—Safety of Holmium Laser Enucleation of the Prostate (HoLEP) in Patient with Large Prostate Volume 

• Tan Lit Kiat, Sivathasan Sailantra, Henderson Sarah, Kalpee Amit
  NHS Tayside, Dundee, United Kingdom

• Introduction and Objectives: To evaluate the safety of Holmium Laser Enucleation of the Prostate (HoLEP) in patients with large prostate volume (>100 cm³), focusing on intraoperative and postoperative outcome.
  Materials and Methods: A cohort of 104 patients underwent HoLEP between May 2022 and May 2024 in NHS Tayside. SPSS v25 was used to carry out statistical analysis on preoperative and postoperative data and patient demographics. chi-square test used for comparison of categorical variables, and independent t test for continuous variables.
  Results: The mean preoperative prostate volume was 109.3 cm³ including 38/104 (38.5%) patients with prostate volume of >100 cm³ and 17/104 (16.3%) patients with prostate volume >150 cm³. 13/104 patients (12.0%) experienced postoperative haematuria. Of those 13 patients, only 1/13 patient (7.7%) required blood transfusion. 7/104 patients (6.5%) experienced postoperative infection. Only 1/104 (1.0%) patient required surgery postoperatively due to complications. The mean prostate volume in patient who experienced complications was 120.7 cm³, while it is 105.8 cm³ in patient with no complication. However, there is no statistical significance to indicate a correlation between prostate volume and complication rate (prostate volume > 100 cm³, p = 0.2697).
  Conclusions: This study demonstrates a favourable safety profile of HoLEP in patients with large prostate volume compared to other studies within the literature. Our study results also demonstrate favourable safety profile of HoLEP compared to traditional surgical options for men with large prostate volumes such as TURP and open prostatectomy recorded within the literature. Our results argue the case that HoLEP should be seen as a viable option and first line treatment modality for men with large prostate volumes.

UP-05.34—Safety and Efficacy of Holmium Laser Enucleation of the Prostate (HoLEP): A Single Centred Retrospective Study 

• Tan Lit Kiat, Sivathasan Sailantra, Henderson Sarah, Kalpee Amit
  NHS Tayside, Dundee, United Kingdom

• Introduction and Objectives: This retrospective study evaluates postoperative outcomes, complication rates, and identifies patient factors influencing recovery in patient who had Holmium Laser Enucleation of the Prostate (HoLEP) for bladder outlet obstruction (BOO) caused by benign prostatic enlargement (BPE).
  Materials and Methods: 104 patients underwent HoLEP between 2022 and 2024 in NHS Tayside. SPSS v25 was used for statistical analysis on preoperative and postoperative data and patient demographics. Chi square test used for comparison of categorical variables and independent t test for continuous variables.
  Results: Postoperative functional improvements were significant, with a 109% increase in mean Qmax (11.3 mL/s preoperatively, 23.7 mL/s postoperatively); only 2 patients were still catheter dependent 30 day postoperatively (1.9%). Complications were reported in 18.5% of patients. 13/104 patients (12.0%) experienced postoperative haematuria. 7/104 patients (6.5%) experienced postoperative infection. Only one patient had a Clavien-Dindo score of IIIb or higher and required further surgery. Patients with advanced age (over 80 years, p = 0.0141) were significantly associated with higher complication rates for this procedure. Patients on anticoagulants did not have a higher postoperative complication rate (anticoagulated, p = 0.5546).
  Conclusions: HoLEP is a safe and effective surgical option for patients with BPE. However, advanced age is associated with a higher risk of complications, underscoring the need for careful patient selection. Our result is on par with available literature on safety of HoLEP with a superior outcome for patients on anticoagulants. It underlines the safety of HoLEP in patients on anticoagulation and is a viable alternative to the current gold-standard TURP procedure.

UP-05.35—Serial Evaluation of Sonocurve, a Machine-Learning Sound-Based Uroflowmetry Algorithm, in Healthy Male Volunteers 

• Khoo Christopher ¹, Maynard William ², Rynne Cormac ³
  ¹ Charing Cross Hospital, London, United Kingdom, ² Royal Berkshire Hospital, Reading, United Kingdom, ³ King’s College London, London, United Kingdom

• Introduction and Objectives: Benign prostatic hyperplasia affects approximately a third of men aged > 50 years, frequently causing lower urinary tract symptoms (LUTS). Uroflowmetry is a standard diagnostic tool for male LUTS, but conventional in-clinic uroflowmeters are expensive, prone to malfunction, and provide only one-off readings. To overcome these limitations, we developed a novel machine-learning algorithm (SonoCurve) that provides uroflowmetry outputs and a flow curve from the sound of the urinary void. If deployed on the patient’s smart device, this approach would permit serial at-home testing. This has the potential to streamline patient pathways and reduce burden on healthcare systems. This study aimed to compare the performance of SonoCurve against traditional uroflowmetry in healthy males.
  Materials and Methods: Two healthy male volunteers (both abstract authors, aged 35) performed serial voids into a gravimetric uroflowmeter from a standing position (Jan/Mar 24). To simulate a toilet bowl, 500 mL of water was placed into the urine receptacle before each void. Uroflowmetry outputs (max flow rate, average flow rate, voided volume, and voiding time), along with raw flow data, were exported. Simultaneously, high-quality waveform audio file (WAV) recordings were captured using a smartphone (Galaxy S8+, Samsung) placed at a fixed distance 80 cm above and 40 cm behind the urine receptacle to simulate placement on the toilet cistern. Voids with significant sound artefact were excluded. The SonoCurve algorithm was used to analyse audio files. Paired uroflowmetry and SonoCurve urinary flow metrics were compared using Lin’s concordance correlation coefficient. Analyses were conducted using Python 3.12. This non-invasive self-experimental study was conducted in accordance with all principles of the Declaration of Helsinki.
  Results: 41 paired urinary flows were included. Moderate correlation was observed in maximum flow rate (0.85, 95% CI 0.75–0.9). Strong correlation was observed in average flow rate (0.92, 95% CI 0.86–0.95), voided volume (0.91, 95% CI 0.85–0.95), and voiding time (1, 95% CI 0.99–1).
  Conclusions: Our findings demonstrate the feasibility of SonoCurve in predicting uroflowmetry metrics from smartphone audio recordings of the urinary void in healthy male volunteers. Patient evaluation has been initiated.

UP-05.36—Single Setting Monopolar Transurethral Resection of Prostate in Massively Enlarged Prostate (>100 g), an Unconventional Approach 

• Tariq Muhammad Nauman, Hanif Muhammad Shahbaz
  Fg Polyclinic Hospital, Islamabad, Pakistan, Islamabad, Pakistan

• Introduction and Objectives: Symptomatic benign prostatic hyperplasia is initially managed with medications and by surgery in later stages. In massively enlarged prostates (>100 g), majority surgeons prefer open prostatectomy, laser enucleation or bipolar TURP rather than monopolar TURP.
  Materials and Methods: This case series study was conducted to evaluate the outcome of monopolar TURP in massively enlarged prostates in terms of IPSS improvement, hospital stay, blood loss and post-operative complications. Malignant Ca prostates were excluded. Per op urethral dilation till 28Fr was done, followed by resection using 26Fr resectoscope, strictly keeping the resection under 60 min. Post operative IPSS was calculated at 3 monthly follow up and 9 monthly follow up. One investigation of urine flowmetry (UFM) was done at 3 monthly follow up, and Qmax of less than 10 mL/s was considered as urethral stricture.
  Results: The prostate size ranged from 110 g to 264 g with average size being 152.7 g. Pre op, the lowest IPSS score was 21, and highest IPSS score was 32 with average score being 25.9. On 3 month follow up, post-operative lowest IPSS score was 3, and highest IPSS score was 10 with average score being 5.85. 17 out of 20 patients were discharged on the 1st post operative day (POD) and 3 on the second POD. Post operative irrigation was continued till 24 h in 17 patients, 36 h in 2 patients and, only in one patient, the irrigation was continued till 48 h. Only one patient required post operative blood transfusion. No patient failed the trial of void performed on the 5th POD. No patient post operatively developed secondary hemorrhage, clot retention, TUR syndrome or urethral stricture on follow up.
  Conclusions: Single setting monopolar TURP in massively enlarged prostate has comparable results to other new techniques with almost negligible complications, provided we follow strict protocols of resection time, per operative dilatation, antibiotic selection, resectoscope and catheter size.

UP-05.37—Star-P—Suprapubic Transvesical Adenoma Resection of the Prostate—Functional Data from an Expanded Patient Cohort 

• Gobbi Luca Matteo ¹, Basile Greta ¹, Bucca Bruno ¹, Dalpiaz Orietta ², Gozzi Christian ³
  ¹ Sapienza University of Rome, Rome, Italy, ² Hochsteiermark Hospital, Leoben, Austria, ³ City Clinic, Bolzano, Italy

• Introduction and Objectives: The suprapubic approach to minimally invasive surgery for BPH remains a relatively unexplored area. In this context, STAR-P (Suprapubic Transvesical Adenoma Resection of the Prostate), whose technique was recently described and published, represents a completely original innovation. We present updated functional data from our case series.
  Materials and Methods: This single-center single-operator study involved a retrospective analysis of prospectively collected data from 80 consecutive patients who underwent the STAR-P procedure. Data were gathered in a dedicated database and analyzed using descriptive statistical methods. The procedure involved a dedicated 42 Fr bipolar resectoscope designed specifically for suprapubic prostate resection. The suprapubic approach offers substantial freedom of movement, and the large caliber of the instrument allows for the resection of a significant tissue volume within a relatively short time frame. A urinary catheter is placed at the end of the procedure.
  Results: No intraoperative complications occurred. No patients developed complications related to the suprapubic access; on the contrary, all potential complications associated with the transurethral approach were avoided. The median operative time was 100 min, with a median resection time of 60 min. All patients experienced a significant improvement in their flowmetric indices, with a high level of satisfaction. The median preoperative maximum flow rate (Qmax) was 10.85 mL/s, while the postoperative Qmax was 22.5 mL/s. The postoperative post-void residual volume recorded a median of 0 mL, with a mean of 4.34 mL. The median postoperative IPSS score was 3.0. This study examined patients with a median prostate volume of 85 mL (ranging from 20 mL to 160 mL). Three out of 80 patients (3.75%) experienced symptoms of urinary urgency, which resolved within 60 days.
  Conclusions: STAR-P is confirmed as a valid and safe technique for the surgical treatment of BPH and should be discussed with patients as one of the currently available options. The dedicated instrumentation allows for the treatment of larger prostate volumes while maintaining reasonable costs.

UP-05.38—The HoLEP Learning Curve: Improvement in Efficiency and Outcomes over 259 Low-Power Enucleation Cases 

• Sid Ahmed Momen, Nkwam Nkwam
  Princess Royal University Hospital, King’s College Hospital NHS Trust, London, UK, London, United Kingdom

• Introduction and Objectives: Holmium Laser Enucleation of the Prostate (HoLEP) is an effective surgical technique for benign prostatic hyperplasia but has a recognized learning curve. We aimed to characterize the learning curve and operative performance evolution of a surgeon already proficient in transurethral resection and previously trained in HoLEP, focusing specifically on low-power (50 W) laser use. Our objectives were to quantify improvements in surgical efficiency, complication rates, and patient outcomes across 259 consecutive HoLEP cases and to assess the impact of transitioning from multi-lobar to en bloc enucleation.
  Materials and Methods: A retrospective analysis was performed on operative metrics from 259 consecutive low-power HoLEP procedures (2020–2025) conducted by a single surgeon experienced in both TURP and HoLEP. Procedures were grouped chronologically (in 20-case blocks and annually). Primary metrics included enucleation and morcellation times, total operative time, efficiency (grams per minute), complications, catheterization duration, and postoperative incontinence rates. Statistical analyses involved Mann–Whitney U, ANOVA, and cumulative sum (CUSUM) analyses to identify significant improvements.
  Results: A clear learning curve was evident despite the surgeon’s prior HoLEP training. Median enucleation time significantly reduced from 46.5 min (first 50 cases) to 35.0 min (last 50 cases, p = 0.04). Enucleation efficiency doubled from 1.3 g/min initially to 2.6 g/min in later cases (p < 0.001), with notable improvement after adopting the en bloc technique around the 30th case. CUSUM analysis demonstrated substantial gains by case 30, reaching a plateau around case 120. Morcellation times modestly improved (median 10.5 to 8.0 min, p = 0.2) despite larger prostate volumes in later procedures. Complication rates decreased over time, with fewer capsular perforations and transient stress incontinence episodes beyond the initial cohort. Clavien ≥ III complications occurred exclusively in early cases. Functional outcomes remained consistently excellent throughout.
  Conclusions: Even among surgeons proficient in HoLEP and TURP, adopting low-power HoLEP involves a noticeable learning curve, with significant efficiency and safety improvements observed within approximately 30 cases. Optimal proficiency is typically achieved by about 50 cases, particularly after transitioning to an en bloc approach. These findings provide practical benchmarks for surgeons transitioning to or optimizing low-power HoLEP practice.

UP-05.39—Thulium Fiber Laser Compared to Holmium Laser with Moses Technology for Prostate Enucleation: A Prospective Study 

• Almousa Saud, Siron Nicolas, Guennoun Abbas, Levitt Max, Meskawi Malek, Bhojani Naeem
  University of Montreal, Montreal, Canada

• Introduction and Objectives: Benign prostatic hyperplasia (BPH) is a common condition in men where the prostate enlarges and can lead to lower urinary tract symptoms. A procedure called laser enucleation of the prostate is a modern treatment that reduces urinary obstruction by resecting a significant portion of the prostate. The study aims to compare the safety profile and clinical outcomes of Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP).
  Materials and Methods: In a prospective, non-randomized, multicenter study conducted between September 2021 and December 2023, 61 patients aged 54 to 90 with BPH underwent either HoLEP (n = 30) or ThuLEP (n = 31). All procedures were performed by experienced surgeons in two centers, with follow-up at 3 months. The primary endpoints were non-inferior IPSS and quality of life (QoL) scores at 3 months. Secondary endpoints included post-operative complications, peak flow (Qmax), post-void residual (PVR), erectile function (IIEF), incontinence (ICIQ-SF), and procedural outcomes like operation, catheterization, and hospitalization times.
  Results: In the study, the mean operative time was 127 min for HoLEP and 100.17 min for ThuLEP (p = 0.70), with comparable specimen weights (96.32 cc vs. 92.35 cc, p = 0.75). At 3 months, there were no significant differences between the two groups in terms of IPSS (6.25 vs. 5.42, p = 0.52), QoL (1.21 vs. 1.27, p = 0.88), IIEF (10.05 vs. 13.23, p = 0.27), or ICIQ-SF (5.65 vs. 5.65, p > 0.9). Uroflowmetry also showed no significant differences in Qmax (18.13 mL/s vs. 14.52 mL/s, p = 0.16) and PVR (26.80 mL vs. 30.60 mL, p = 0.79). Catheterization duration was shorter in the HoLEP group (84% had <24 h), while 80% in the ThuLEP group had catheterization between 24–48 h. Hospitalization was longer for HoLEP (17.52 h vs. 12.08 h, p = 0.15). The complication rate was higher in HoLEP (13%) than in ThuLEP (3%), with one HoLEP patient requiring a transfusion.
  Conclusions: Both ThuLEP and HoLEP relieve lower urinary tract symptoms with comparable results in terms of functional outcome.

UP-05.40—Thulium vs. Holmium Laser Enucleation: Who Wins in Hemostasis, Function and Continence Recovery? 

• Boualbanat Mariam ¹, Alshammari Abdulaziz ¹, Alhajeri Faisal ¹, Alghadouri Saad ¹, Alenezi Saad ², AlYousef Yaqoub ¹, Mohammed Sameh ³, Alrefai Abdullah ¹, Alkandari Abdulrahman ⁴
  ¹ Kuwait Board of Urology, Kuwait Institute for Medical Specialisation, Kuwait, Kuwait, ² Jaber Al-Ahmed Hospital-Ministry of Health, Kuwait, Kuwait, ³ Alseef Hospital -Ministry of Health, Kuwait, Kuwait, ⁴ Aladan hospital-Ministry of Health, Kuwait, Kuwait

• Introduction and Objectives: Benign prostatic hyperplasia (BPH) frequently requires surgical management when medical therapy fails. Thulium fiber laser (TFL) has gained popularity among endourologists for its hemostatic precision in soft tissue surgery. This study compares the clinical outcomes of thulium fiber laser enucleation of the prostate (ThuFLEP) and holmium laser enucleation of the prostate (HoLEP), with attention to perioperative safety, functional outcomes, and postoperative stress urinary incontinence over time.
  Materials and Methods: This retrospective cohort study included patients who underwent laser enucleation between October 2021 and August 2024. Group 1 (n = 68) underwent HoLEP using the Moses™ 1.0 system (Lumenis), while Group 2 (n = 94) underwent ThuFLEP using the Sirius™ laser (Rocamed). Primary outcomes included hemoglobin drop, blood transfusion, and failed trial of void. Secondary outcomes included transient stress urinary incontinence at 1, 3, and 6 months, and functional parameters such as maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and quality of life (QoL). Statistical analyses were conducted using Julius.ai, including independent-sample t-tests, chi-square tests, and correlation analysis. A p-value < 0.05 was considered statistically significant.
  Results: The mean hemoglobin drop was significantly lower in the ThuFLEP group compared to the HoLEP group (14.07 ± 10.57 g/L vs. 18.48 ± 13.40 g/L; p = 0.044). Functional outcomes, including Qmax, IPSS, and QoL, were significantly better in the Group 1. No blood transfusions or major complications were reported in either group. The rate of failed trial of void was significantly higher in the ThuFLEP group (10.26% [8/94] vs. 1.06% [1/68]; p = 0.0187). Additionally, a significant correlation was observed between increased surgical experience and a reduction in early postoperative stress urinary incontinence, regardless of the laser modality used.
  Conclusions: ThuFLEP provided better perioperative hemostasis with fewer drops of hemoglobin. HoLEP superior in success trial of void. The learning curve was significantly associated with reduced temporary stress urinary incontinence, highlighting the impact of surgical experience on continence recovery.

UP-05.41—Transperineal Laser Ablation Under Local Anaesthetic in an Outpatient Setting: A Novel Approach for Treating Benign Prostatic Enlargement—First UK Experience from a Single-Centre Prospective Cohort Study 

• Maddan Asyraf ¹, Kostyuk Mykhaylo ¹, Qalawena Muhamed ¹, Croitoru Radu ¹, Ormanov Dimitar ¹, Richardson Fiona ², Carrie Anne ³, Lersakrussamee Nonthaphat ¹, Smith Lee ⁴, Ilie Petre-Cristian ¹
  ¹ Queen Elizabeth Hospital King’s Lynn, Norfolk and Norwich University Hospitals NHS Foundation Trust, King’s Lynn, United Kingdom, ² The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, King’s Lynn, United Kingdom, ³ Norfolk and Norwich University Hospital, Norfolk and Norwich University Hospitals NHS Foundation Trust, King’s Lynn, United Kingdom, ⁴ Anglia Ruskin University, Cambridge, UK., Cambridge, United Kingdom

• Introduction and Objectives: Benign prostatic enlargement is a prevalent condition affecting ageing men, primarily caused by benign prostatic hyperplasia. In recent years, minimally invasive alternatives have become favourable with transperineal laser ablation (TPLA) emerging as a novel ultra-minimally invasive technique for treating BPE. This work aims to evaluate the feasibility, efficacy and safety profile of TPLA for BPE treatment in an outpatient setting.
  Materials and Methods: This prospective study involved 17 consecutive patients operated between August 2023 and October 2024 who presented with severe LUTS and treated for BPE. Specific tools used to measure the outcome including IPSS and non-invasive uroflowmetry. The outcome comparison measured between pre-intervention and three months post-TPLA recorded in Healthium^®. The procedure performed in an outpatient setting under local anaesthetic, utilising the continuous-wave diode EchoLaser^® device.
  Results: The mean flow rate improved significantly from 7.29 mL/s to 13.18 mL/s (+80.8%, p = 0.001), and the mean for post-void residual volume reduced from 205 mL to 113.12 mL (−44.82%, p = 0.06). 6 out of 17 patients presented with baseline PVR more than 200 mL. This may suggest the presence of a hypotonic bladder (revised p = 0.03). The mean IPSS decreased from 24.59 to 11.65 (−52.62%, p < 0.001), indicating a substantial reduction in symptom severity. The mean score for quality of life (QoL) as part of the IPSS similarly improved from 4.88 to 2.82 (-42.21%, p < 0.001).
  Conclusions: TPLA is a safe and effective ultra-minimally invasive treatment that significantly improves lower urinary tract symptoms and quality of life. However, further long-term studies are necessary to validate these findings.

UP-05.42—Unveiling the Effects of Transrectal Prostate Biopsy on Lower Urinary Tract Symptoms and Erectile Function: A Prospective Analysis 

• Cheqboub Mohamed, Azarg Ayoub, Oubihi Mohamed, Chatar Achraf, Lakmichi Mohamed Amine, Dahami Zakaria, Sarf Ismail
  Arrazi Hospital, Mohammed Vi University Hospital Center-Marrakech, Marrakech, Morocco

• Introduction and Objectives: Transrectal prostate biopsy is essential for diagnosing prostate cancer, but its effects on urinary symptoms and erectile function are still not well understood. Some studies suggest a temporary increase in urinary symptoms, while the impact on sexual function remains uncertain. The aim of this study was to assess the evolution of LUTS, erectile function, and other clinical parameters after prostate biopsy.
  Materials and Methods: We conducted a prospective study including 288 patients who underwent a transrectal prostate biopsy between June 2021 and June 2024. Collected clinical data included age, medical history, PSA levels, prostate volume, and biopsy results. LUTS were assessed using the IPSS, and erectile function was evaluated using the IIEF-5 before the biopsy and one month later. Other parameters, such as the number of biopsy cores and the rate of immediate complications.
  Results: The mean age was 69.3 years. Among them, 61 patients (21.2%) were diabetic, and 70 patients (24.3%) had hypertension. The prostate volume was 48.7 cm³. Before the biopsy, 256 patients (88.9%) had LUTS, with a mean IPSS score of 15.2 (interquartile range 6–22). In terms of erectile function, 104 patients (36.1%) had a normal IIEF-5 score, with a mean score of 16.4. One month after the biopsy, there was a significant increase in the IPSS score, with a mean of 19.1 (p < 0.001). Regarding erectile function, the IIEF-5 score slightly decreased to 15.7, but this difference was not statistically significant (p = 0.65). Immediate complications such as moderate hematuria were reported in 31 patients (10.8%), and febrile episodes occurred in 13 patients. Additionally, 22 patients developed acute urinary retention requiring catheterization, with successful catheter removal after alpha-blocker treatment in 20 patients (90.9%).
  Conclusions: This study confirms that transrectal prostate biopsy can lead to a short-term worsening of urinary symptoms, likely due to local inflammation following the procedure. The results also indicate that erectile function remains largely unaffected after the biopsy. In addition to LUTS, moderate complications such as hematuria and urinary retention may occur. It is therefore essential to inform patients of the temporary risks associated with this procedure while emphasizing its importance for diagnosing prostate cancer.

UP-05.43—Update on Daycase Aquablation Cases from Frimley Park Hospital, UK 

• Ng Keng, Uthayanan Leshanth, Barber Neil
  Frimley Park Hospital, Camberley, United Kingdom

• Introduction and Objectives: Aquablation has gained popularity as one of the modalities of choice for surgical treatment of benign prostatic enlargement in men with LUTS. In our centre, majority of our patients have undergone aquablation as daycase procedures with same day discharge with catheter and outpatient TWOC a few days later.
  Materials and Methods: Patients were counselled for daycase aquablation and, following informed consent, were included in our study. Exclusion criteria were—living outside locality (>50 miles), living alone or refused the daycase proposal. Aquablation was performed under general anaesthesia with 2 aquablation passes protocol followed by spot diathermy at bladder neck. 3 way urinary catheter was then inserted, and continuous bladder irrigation maintained for 2–3 h post op in recovery. Following bedside assessment, irrigation was stopped, and patients were then discharged with catheter and returned 3 days later for TWOC.
  Results: From January 2023 till October 2024, 122 patients have undergone aquablation as daycases in our institution. Preoperatively, mean prostate volume was 82.3 cc (range 30–180 cc, 62% trilobar prostatomegaly), with IPSS of 23, QoL 5, Qmax rate 8.3 mL/s with mean psa of 4.7. 88% (108 out of 122 patients) patients were discharged as daycase following aquablation. 14 patients had inpatient stay—6 cases of haematuria, which required further irrigation overnight, 2 patients had nausea/vomiting due to anaesthesia and 6 patients were due to social reasons. All patients had successful outpatient TWOC at 3 days post op. There were no admissions to ED prior to outpatient TWOC. At 3 months, IPSS reduced to 9.4 with QoL 1.8 and mean post op prostate volume reduction of 65%. The feasibility and reproducibility of these daycases are due to close adherence to systematic technique—precise aquablation treatment planning with particular attention at bladder neck and verumontanum regions, two passes of aquablation, spot diathermy at bladder neck with completion, limited resection of anterior prolapsing portion of prostate within bladder neck region.
  Conclusions: Our results prove that aquablation can be done safely and effectively as daycase procedures. This has led to better utilisation of theatre list, less burden on nursing workload and ever increasing limited NHS hospital beds.

UP-05.44—Urodynamic Outcomes Following Photovaporization of the Prostate for Benign Prostatic Hyperplasia: Diminished Detrusor Voiding Pressure Preserves Function After Surgery 

• Hossaini Chaimaa ¹, Liou Louis ², Kim Jonathan ³
  ¹ AOA Urological Associates, Boston, MA, United States, ² Emerson Hospital, Concord, MA, United States, ³ Drexel University College of Medicine, Philadelphia, PA, United States

• Introduction and Objectives: Photovaporization of the prostate (PVP) is a minimally invasive procedure for benign prostatic hyperplasia (BPH) that is effective and has fewer complications than standard transurethral resection of the prostate. However, its precise effect on bladder function remains unclear. This study examines urodynamic changes underlying subjective improvements seen after PVP.
  Materials and Methods: In this single-center prospective study, patients with BPH and lower urinary tract symptoms scheduled for PVP underwent pre- and post-op urodynamic studies (UDS) and International Prostate Symptom Score (IPSS). UDS parameters assessed included average flow rate (Qavg), max flow rate (Qmax), detrusor pressure at max flow (Pdet@Qmax), and max detrusor pressure (max Pdet). The bladder outlet obstruction index (BOOI) was calculated as Pdet@Qmax − 2Qmax. Each patient’s pre-op subjective (IPSS score) and objective (UDS) data were compared to post-op and were compared using the Wilcoxon signed-rank test.
  Results: A total of 50 patients were studied with mean age of 71.3 years (SD = 10.2). The IPSS score decreased from pre-op (18.8) to post-op (13.1) (p < 0.01). Max Pdet decreased from pre-op (97.4) and post-op (75.1) (p < 0.01). Pdet@Qmax also decreased (pre-op, 49.3 vs. post-op, 27.7) (p = 0.04). Qavg increased from pre-op (4.1) to post-op (5.3) (p < 0.01), while Qmax showed no change (pre-op, 38.2 vs. post-op, 29.1). The BOOI post-op (20.1) decreased from pre-op (43.1) (p = 0.01). This real-world data study provides insights into the urodynamic effects of PVP in BPH patients. Decreases in max PDet and Pdet@Qmax reflect improved bladder outlet dynamics and reduced obstruction post-PVP. By allowing for lower pressure voiding, the workload of the detrusor muscle to sustain flow decreases, enhancing voiding efficiency. Increased average flow rates post-op, despite unchanged max flow rates, are likely due to more sustained flow with lower detrusor pressure and greater efficiency.
  Conclusions: UDS is infrequently performed in men undergoing BPH procedures; however, it can be feasibly done. Urodynamics provide objective insights into bladder voiding dynamics that account for the subjective improvements seen after BPH surgery, and its implementation is the goal for BPH surgeries.

UP-05.45—Outcomes of Prostatic Artery Embolization in Treating Urinary Retention: Single Centre Results 

• Elhammadi Moustafa, Antara Faria, Irfan Zaynab, Tadtayev Sergey
  Ashford and St Peter’s Hospital NHS Foundation Trust, Chertsey, United Kingdom

• Introduction and Objectives: Prostatic artery embolization (PAE) has demonstrated effectiveness in treating lower urinary tract symptoms (LUTS) but lacks robust evidence for treating urinary retention due to prostate enlargement. PAE is particularly useful in older, frail patients with questionable fitness for general anaesthesia and those on long-term anticoagulation, as it is performed under local anaesthesia. However, challenges like arterial atherosclerosis and complex pelvic vasculature can complicate this technically demanding procedure. This review evaluates the success rate and predictors of successful trial without catheter (TWOC) in urinary retention patients after PAE, along with re-treatment rates and delays in patients who failed TWOC.
  Materials and Methods: We conducted a retrospective review of electronic medical records of patients with long-term catheters, who had previously failed TWOC before undergoing PAE at our institution between January 2019 and March 2024.
  Results: We included 45 patients with a mean age of 78 years and median prostate volume of 130 cc (105, 160). Of these, 26 (57.7%) underwent bilateral embolization and 19 (42.2%) unilateral embolization. A total of 24 patients (53.3%) successfully passed TWOC with a mean follow-up of 26.7 months. Three patients experienced retention again within one year post-TWOC. Thirteen patients (28.3%) required re-treatment after failed TWOC, with 10 (76.9%) passing TWOC after re-treatment. Re-treatment delay averaged 8.9 months. Regression analysis showed no statistically significant results due to small sample size; however, the success group tended to be younger, have larger prostates, and undergo bilateral embolization.
  Conclusions: With a success rate exceeding 50%, PAE is a viable option for older, frail patients with larger prostates, particularly those at high risk for anaesthesia and those on long-term anticoagulation.

5.5. Unmoderated Video ePosters

UVP-05.01—Novice 30-amp MOSES Versus MOSES 2.0 Technology in Endoscopic Enucleation of the Prostate: Initial Experience 

• Alaradi Husain, Blahitko Oksana, Alotaibi Khaled, Abdul Hadi Ruba, Mousa Ahmed, Elmansy Hazem, Alhelal Saud
  Northern Ontario School of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada

• Introduction and Objectives: The 120 W MOSES 1.0 and 2.0 laser systems require a dedicated 50-amp power supply, which often necessitates costly upgrades to the electrical infrastructure of operating rooms. To address this barrier, a new 30-amp MOSES system was introduced. In this video, we describe our initial experience performing holmium laser enucleation of the prostate (HoLEP) using the novel 30-amp MOSES system, compared to MOSES 2.0 technology.
  Materials and Methods: We captured intraoperative video footage of our institution’s inaugural HoLEP procedure using the 30-amp MOSES technology, performed in October 2024, along with a HoLEP procedure utilizing the MOSES 2.0 system on the same operative day. Both MOSES systems were developed by Boston Scientific. A 550-µm MOSES laser fiber was used in each procedure. The MOSES 2.0 system was set to a maximum optical power of 120 W, using 2 J and 40 Hz for enucleation and 2 J and 20 Hz for hemostasis. In comparison, the 30-amp MOSES technology was set to a maximum of 80 W, with enucleation settings of 2 J and 35 Hz and hemostasis settings of 2 J and 20 Hz. The MOSES 2.0 system has a maximum optical power of 120 W. In our study, we used settings of 2 J and 40 Hz for enucleation and 2 J and 20 Hz for hemostasis. In comparison, the 30-amp MOSES technology, with a maximum optical power of 80 W, was set to 2 J and 35 Hz for enucleation and 2 J and 20 Hz for hemostasis. The procedures were performed by a single surgeon using the top-down technique with early apical release.
  Results: The intraoperative video captured precise and efficient incisions achieved with the MOSES 2.0 and 30-amp MOSES technologies, allowing clear identification of proper anatomical landmarks. Both systems consistently maintained enucleation efficiency, demonstrating smooth tissue handling and separation throughout the procedures. Effective hemostasis was achieved by each technology, as shown in the recorded clips.
  Conclusions: Our preliminary results indicate that the MOSES 2.0 and 30-amp MOSES technologies demonstrate efficient tissue interaction and separation with enhanced hemostasis. For institutions without a dedicated 50-amp power supply, the 30-amp MOSES system may be a viable and effective alternative. Large comparative RCTs with extended follow-up are warranted.

6. Female Urology

6.1. Moderated Oral ePosters

MP-06.01—A Single Tertiary Center Experience of Intravaginal Mesh Slings and Complications: Is It the Summit of an Iceberg? 

• Sharifiaghdas Farzaneh ¹, Rostaminejad Niloofar ²
  ¹ Shahid Beheshti University of Medical Sciences, Labbafinejad Medical Center, Tehran, Iran, Islamic Rep., ² Iran University of Medical Sciences, Hasheminejad Medical Center, Tehran, Iran, Islamic Rep.

• Introduction and Objectives: Pelvic floor disorders negatively affect quality of life of million sufferers. Ever since synthetic mesh was introduced for these conditions, there has been a debate about its benefits and disadvantages. Although some mesh related complications are asymptomatic, in some cases, debilitating adverse events have been reported. In this report we share our experience in the management of mesh related complications who failed the first line conservative management and referred to our tertiary center.
  Materials and Methods: 128 from total number of 152 referred patients between October 2017 to October 2022 have been included in our study. The cases were divided in 4 groups of A to D according to invasion to the bladder, urethra, vagina or de novo incomplete voiding. Physical examinations were done, and surgical and medical histories were obtained. Based on patient’s chief complaints, relevant surgical approaches were performed and post operative follow up planned.
  Results: Data analysis revealed significant decrease in pain after reconstructive surgeries. 84.61% of patients in group A, 66.6% of group B, 67.9% of group C and 91.6% of group D were completely cured. At first surgical attempt after 36 months. One patient in group B complains of urinary incontinence, and one patient in group B and D is on Clean Intermittent self-catheterization.
  Conclusions: Intravaginal mesh sling incision and or partial removal was successful in 98.43% of our patients. 37 patients underwent more than one session of surgical repair. The most complicated patients were those with bladder neck and urethral involvement or loss. The longest interval between the initial mesh sling procedure and mesh associated complications was 20 years, raising concerns over the safety of the non-absorbable foreign material in the vaginal and pelvic area. Perhaps mandating physical examination at regular intervals for those with history of intra vaginal mesh sling surgery would be one solution.

MP-06.02—Bilateral Tailoring, Dorsal Folding: A Simple Approach for Short Urethra and Incompetent Bladder Neck in Female Patients 

• Sharifiaghdas Farzaneh ¹, Rostaminejad Niloofar ²
  ¹ Shahid Beheshti University of Medical Sciences, Labbafinejad Medical Center, Tehran, Iran, Islamic Rep., ² Iran University of Medical Sciences, Hasheminejad Medical Center, Tehran, Iran, Islamic Rep.

• Introduction and Objectives: According to Poiseuille’s law a hypothesis was established that narrowing the urethral lumen and folding it will increase the intra luminal resistance of the urethra in Incompetent Bladder Neck. The surgical technique was performed in a small group of female patients with total urinary incontinence and the short term results evaluated.
  Materials and Methods: We selected bladder-neck incompetent and incontinent female patients with wide open urethra. The exclusion criteria included neurogenic bladder dysfunction. A baseline physical examination, urinary tract ultrasound imaging, urine analysis and urine culture, conventional standard urodynamic study, voiding cystourethrography and cystourethroscopy confirmed a wide open bladder neck and short urethra. Surgery: under general anesthesia and dorsal lithotomy position, a supra meatal mucosal incision was made at the 12 o’clock position, extending to the laterals to make a semilunar incision between 5 and 7 o’clock. The dissection went as close as possible to the urethra and advanced to the bladder neck beneath the pubic symphysis to release the dorsal surface of the urethra. Then, two parallel rows of separate stitches were made from the meatus to the bladder neck with 4.0 Vicryl material involving dorsal and ventral wall of the urethra at each side with 2–3 mm intervals. Finally there was one main urethral lumen located between 2 smaller urethral lumens. In the next step, these two lateral lumens were approximated with simple separated sutures at the 12 o’clock position to reinforce the urethra.
  Results: From August 2021 to September 2022, eight patients (age range: 11–28 years) were eligible to enter the study. One of the patients had a prior history of ureter reimplantation due to ectopic ureter in the urethra. The mean operation time was 48.6 min (range: 42–64). No adverse events were appreciated. At 3 and 6 months follow up, 7 out of 8 patients (87.5%) were continent, and one patient remained totally incontinent and was scheduled for bladder neck reconstruction for definite treatment.
  Conclusions: The current study illustrates a novel and less invasive approach for bladder neck incompetence treatment in female patients. It may be adopted as an alternative to more definite bladder reconstruction treatment in selected cases.

MP-06.03—Optimizing Bladder Neck Incision for PBNO: A Comparative Study on Long-Term Outcomes 

• R Bharath, Kalra Sidhartha, Bolar Siddhant, Mudhol Rajat, L N Dorairajan, K S Sreerag, Ghorai Rudra, Pal Atanu
  Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

• Introduction and Objectives: Bladder neck incision (BNI) and bladder neck resection (BNR) are the primary surgical approaches for Primary Bladder Neck Obstruction (PBNO), though concerns over complications and limited data hinder widespread use (1,2). Complications like bladder neck contracture, incontinence, vesico-vaginal fistula, and recurrences require further investigation. Additionally, optimal BNI techniques are debated, with variation in incision depth, location, and tools. This study evaluates the long-term effectiveness, reoperation rates, complications, and impact of technique modifications on surgical outcomes.
  Materials and Methods: This retrospective study analyzed 41 PBNO patients who underwent BNI and BNR from 2018–2024. The patients’ clinical features, renal function tests, ultrasonography, uroflowmetry, and video-urodynamic study (VUDS) data were assessed. Initially, 10 patients had BNI at the 5 and 7 o’clock positions, while 31 others had modified BNI at 3 and 9 o’clock with resection of interposing tissue. Perioperative parameters and complications were evaluated during follow-up.
  Results: Patients presented with lower urinary tract symptoms (LUTS) including chronic retention, acute retention, and hydroureteronephrosis. The mean serum creatinine and IPSS were 2.8 ± 1.9 mg/dL and 21.8 ± 10.7, respectively. The mean Qmax, pdet@Qmax, and PVR were 6.7 ± 3.08 mL/s, 58.2 ± 14.2 cm H₂O, and 280 ± 80 mL, respectively. The mean operating time and blood loss were 20.7 ± 6.4 min and 28.6 ± 10.5 mL. Follow-up averaged 41.6 ± 13.2 months. After one year follow-up, the mean IPSS, Qmax, and PVR were 6.2 ± 1.5, 22.6 ± 6.8 mL/s, and 29.5 ± 12.7 mL respectively. Of the initial 10 patients, four had inadequate resection and required re-resection, while modified technique resulted in only one recurrence after two years. Two patients developed incontinence, with one resolving spontaneously. There were no instances of bladder neck contracture or urethrovaginal fistula.
  Conclusions: Bladder neck muscle fibers shift towards the bladder as it fills, causing the incision site to migrate towards the urethra, which can increase the risk of SUI and fistulas. Regular bladder emptying and incision reassessment are crucial as surgeons gain depth perception with experience. Immediate symptom relief may not occur in all cases, and re-resection may be necessary. A modified BNI and BNR approach at the 3 and 9 o’clock positions significantly improves PBNO outcomes, with no long-term complications like bladder neck contracture.

MP-06.04—Sacral Neuromodulation: Outcomes from a Tertiary Referral Centre 

• Seguí Moya Elena, Russell Josephine, Hina Saddaf, Alhasso Ammar, Granitsiotis Voula, Uguzova Sabine
  Western General Hospital. NHS Lothian., Edinburgh, United Kingdom

• Introduction and Objectives: Sacral neuromodulation (SNM) is an option for voiding dysfunction (VD) or detrusor overactivity (DO) when conservative treatments have failed. If the patient’s symptoms improve by more than 50% during the test phase, the patient is qualified for the implant. We evaluated the results of the implant in a tertiary referral centre.
  Materials and Methods: 141 patients who underwent PNE between 2019 and 2024 were prospectively collected. Gender, age, diagnosis (VD or DO), psychiatric condition, adverse events (AEs), and implant success were analysed. Fisher exact and logistic regression tests were used for statistical analysis with R Studio program.
  Results: Of 141 patients, 126 (89.4%) were female and 15 (10.6%) male, with a median age of 47.8 (16–80). Eighty-two (58.2%) had diagnosis of VD and 59 (41.8%) DO. Sixty-eight patients (48.22%) were deemed to have successful PNE. There was no correlation between PNE success and gender (p = 0.102) or diagnosis (VD n = 41, DO n = 27; p = 0.619). There was no statistically significant association between psychiatric comorbidity and the distribution of VD and DO (p = 0.834), but there was a strong correlation between PNE success and reported psychiatric comorbidity (p < 0.001). Logistic regression analysis demonstrated that increasing age was associated with treatment failure with OR 0.97 (0.95–0.99, p = 0.003) with age cut off at 50% probability being 45.1 (AUC 0.645). Sixty-four females (94.1%) and four males (6.9%), with median age 46 (SD 16.4), received the implant. Five patients were excluded as they had less than 6 months of follow-up. Thirty-nine (61.9%) had diagnosis of VD and twenty-four (38.1%) DO. In fifty-one (81%) patients, the implants worked well according to the patient’s subjective assessment. In 15 patients, pain was the main AE. In twelve (19%) patients, the implant did not work. The main reason was pain with three devices removed. There was no statistical correlation between SNS success and diagnosis type (p = 0.510) or psychiatric comorbidity (p = 0.110). There was no association between patient age and treatment outcome (B = −0.019, SE = 0.021, p = 0.375).
  Conclusions: We have demonstrated an overall permanent implant success of 81%. Patients with a psychiatric condition or age below 45 are more successful in proceeding for a permanent implant. Patient selection is key to the success of the outcome.

MP-06.05—Validity and Reliability of the Persian Version of the Contilife Questionnaire for Urinary Incontinence 

• Hajebrahimi Sakineh ¹, Salehi-Pourmehr Hanieh ¹, Tayebi Sona ², Mohammadpour Amir ³, Amiri Elaheh ⁴, Jabraeili-Siahroud Shaghaiegh ³, Fakhraie Sara ³, Hatami Aynaz ³, Mostafaei Helia ³
  ¹ Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Rep., ² Iran University of Medical Sciences, Tehran, Iran, Islamic Rep., ³ Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Rep., ⁴ Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Rep.

• Introduction and Objectives: Stress urinary incontinence (SUI) significantly impacts quality of life. The CONTILIFE questionnaire is a specific tool to measure this impact. This study aimed to culturally adapt the CONTILIFE questionnaire into Persian and determine its psychometric properties (validity and reliability) in Iranian women with urinary incontinence.
  Materials and Methods: This methodological study involved the cultural adaptation and psychometric evaluation of the CONTILIFE questionnaire. The original English version was translated into Persian using the forward-backward translation method. Two hundred and fifty-five women with symptoms of SUI participated and completed the Persian CONTILIFE. Content validity was assessed using the Content Validity Index (CVI) and Content Validity Ratio (CVR) based on expert review of the questionnaire’s content, clarity, and simplicity. Test-retest reliability was determined by calculating the Intraclass Correlation Coefficient (ICC). Internal consistency was assessed using Cronbach’s alpha coefficient for each factor and the entire instrument.
  Results: The Persian version of CONTILIFE was reviewed and completed by 255 women with urinary incontinence (mean age 52.95 ± 0.81 years). The CVR was above the acceptable threshold of 0.62, and the CVI was above the acceptable threshold of 0.70, indicating good content validity. The ICC value for test-retest reliability was 0.952, demonstrating very high stability of the measurements over time. The Cronbach’s alpha coefficient for the internal consistency of the entire questionnaire was 0.955, indicating excellent internal consistency and reliability.
  Conclusions: The Persian version of the CONTILIFE questionnaire demonstrates good content validity and excellent reliability, as evidenced by high ICC and Cronbach’s alpha values in Iranian women with urinary incontinence. These findings suggest that the translated questionnaire accurately and consistently measures the impact of urinary incontinence on health-related quality of life in this population.

RF-06.01—Evaluating Perioperative Outcomes in Robotic and Open Repair of Genitourinary Fistulas: A Retrospective Comparative Study 

• Patel Saket, Coelho Victor, Patel Pratik, Singh Abhishek, Ganpule Arvind, Sabnis Ravindra, Desai Mahesh
  Muljibhai Patel Urological Hospital, Nadiad, India

• Introduction and Objectives: Genitourinary fistulas involve abnormal connections between the urinary or genital tract and surrounding structures. Surgical repair is often required to restore normal function and improve the patient’s quality of life. In recent years, robotic-assisted surgery has gained popularity due to its potential advantages, such as improved visualization, precise instrumentation, and shorter recovery times. This study aimed to compare the outcomes of robotic-assisted genitourinary fistula repair with traditional open surgery.
  Materials and Methods: A retrospective analysis was conducted using medical records of patients who underwent genitourinary fistula repair over a 10-year period. Patients were divided into two groups: the robotic group (N = 26) (patients who underwent robotic-assisted repair) and the open group (N = 24) (patients who underwent open surgical repair). Surgical success rates, defined as the absence of fistula recurrence, along with postoperative complications, length of hospital stay, and patient-reported outcomes, were compared.
  Results: A total of 50 patients were included in the study, with (N = 26) in the robotic group and (N = 24) of patients in the open group. The surgical success rate was 96.15% in the robotic group [1 recurrence out of 26] and 95.83% [1 recurrence out of 24] in the open group. Although the success rate was higher in the robotic group, this difference was not statistically significant (p > 0.05). The blood loss was higher in the robotic group compared to the open approach and statistically significant (p = 0.024). In addition to the repair, a flap repair was done in 17 of the 26 robotic cases and 3 of the 24 cases in the open group (p ≤ 0.001). The median length of hospital stay was 8 days in the robotic group and 6 days in the open group, favoring the open approach (p < 0.041).
  Conclusions: This retrospective study suggests that both robotic-assisted and open surgical approaches are viable options for genitourinary fistula repair, with comparable surgical success rates and post operative complications. The robotic approach had a longer hospital stay, potentially due to the early learning curve. However, the decision to choose one approach over the other should be individualized, considering factors such as surgeon expertise, patient preferences, and available resources.

6.2. Unmoderated Standard ePosters

UP-06.01—Factors Associated with Urological Complications After Abdominal Hysterectomy at the Yaoundé Gynaecological Obstetric and Paediatric Hospital 

• Mbouche Landry Oriole ¹, Fouda Jean Cedrick ¹, Frantz Guy Epoupa Ngalle ²
  ¹ Faculty of Medicine and Biomedical Sciences, Yaounde, Cameroon, ² Faculty of Medicine and Biomedical Sciences, Douala, Cameroon

• Introduction and Objectives: Hysterectomy (HRT) is a surgical procedure performed for a variety of specific indications and is one of the most common surgical procedures performed in gynaecology. It is therefore very often subject to complications which may be haemorrhagic, infectious, digestive or urological. The aim of this study was to evaluate urological complications after abdominal hysterectomy in Cameroon.
  Materials and Methods: This was an analytical case-control study covering ten years. For the case type, we included the records of women who had a urological complication secondary to HRT and, for the controls, the records of women who had HRT without urological complications. Data were collected using a survey form and analysed using IBM-SPSS version 26.0 software. A univariate analysis and then a multivariate analysis using the binary logistic regression method were carried out to identify the factors associated with urological complications after HRT.
  Results: During the study period, we included 100 cases, including 34 cases and 66 controls. The prevalence of urological complications was 5.1%. The mean age was 47.05 ± 9.9 years. Ureteral lesions were the most common (n = 21). The main complaint was urinary incontinence (n = 13). The median time to diagnosis was 5 [0; 15] days. Ultrasound examination of the urinary tract and a methylene blue test were the most frequently performed tests. Management was dominated by surgical treatment. Reconstructive surgery was complicated in 20.59% (n = 7) of cases. In univariate analysis, the factor increasing the risk of urological injury after HRT was discovery of haemoperitoneum intraoperatively. Multivariate analysis revealed that being a housewife, working in the informal sector, having a FIGO 7 myoma and having an operation lasting between 240 and 520 min were independent risk factors for urological complications.
  Conclusions: Our study of the factors associated with urological complications after abdominal hysterectomy enabled us to say that the occurrence of urological complications after hysterectomy depends on several factors. We found a significant incidence of urological complications (5.1%). The management of these urological lesions was essentially ureterovaginal reimplantation. We note that the independent clinical characteristics at risk of urological complications were FIGO 7 myoma, operation duration more than 240 min, altered general condition.

UP-06.02—Augmented Urethroplasty from Lower Lip for Female Urethral Stricture 

• Sharifiaghdas Farzaneh ¹, Rostaminejad Niloofar ²
  ¹ Shahid Beheshti University of Medical Sciences, Labbafinejad Medical Center, Tehran, Iran, Islamic Rep., ² Iran University of Medical Sciences, Hasheminejad Medical Center, Tehran, Iran, Islamic Rep.

• Introduction and Objectives: Urethral strictures in females are uncommon but challenging for reconstructive surgeons. Although different surgical methods have been introduced, the optimal option is still deliberated. In the present study we describe our experience with a new and feasible method to address the female urethral stricture.
  Materials and Methods: From March 2021 until December 2022, 28 women with anatomical urethral strictures were entered to our study. A lower lip buccal mucosal graft (BMG) was harvested. The urethra was incised, and an augmented dorsal onlay urethroplasty was performed. The graft was sutured bilaterally to the borders of the native urethra. The outcomes were assessed 3,6 months and one year later by physical examination, urine analysis and culture, urinary tract ultrasound scan, simple uroflowmetry and AUA questionnaire.
  Results: Surgical intervention was successful in 96% of patients (28 out of 29 patients). Only one case required an emergent urethral catheter placement due to obliterative symptoms as a result of remaining poor absorbed suture materials in the urethral lumen, which eventually required no further intervention. Post operative AUA symptoms score survey and post void residual urine (PVR) measurement indicated improvement of obstructive features in the study group. Two patients of the study group experienced “scattered voiding” instead of normal voiding stream however without any other urinary symptoms.
  Conclusions: The female augmented urethroplasty from lower lip BMG with a dorsal approach is novel and highly successful with favorable results, minimal risk of fistula formation, donor site complications at short term follow up.

UP-06.03—Laparoscopic Approach to Incontinence Mesh Removal: A Surgical Challenge 

• Fernandes Cláudia ¹, Velasco Clara ², Ramírez Ana ², Saavedra Manuel ², Casado Javier ², Vale Luís¹, Silva Carlos ¹, José Luis ², Lavalle Luis ²
  ¹ São João Local Health Unit, Porto, Portugal, ² La Princesa University Hospital, Madrid, Spain

• Introduction and Objectives: Stress urinary incontinence (SUI) affects approximately 30–50% of women aged 49–59. The introduction of suburethral slings in the 1990s revolutionized the management of SUI. Nevertheless, this treatment is not without complications, and the most common are vaginal extrusion, bladder or urethral extrusion, dyspareunia, recurrent urinary tract infections, lithiasis, and chronic pelvic pain. We present a video of an extruded suburethral sling within the bladder neck removal, associated with bladder lithiasis, via a transperitoneal laparoscopic approach.
  Materials and Methods: A 55-year-old woman with a history of SUI underwent retropubic TVT placement in 2002. In 2003, vaginal removal was required due to infravesical obstruction. Post-removal, she developed urgency-predominant mixed UI. Examination showed no sling extrusion or urethral hypermobility. Urodynamics revealed reduced cystometric capacity and detrusor overactivity. Cystoscopy identified a 1.5 cm bladder stone adherent to the right sling arm, eroding near the bladder neck. Transvaginal ultrasound confirmed this. She was scheduled for transperitoneal laparoscopic sling removal with intraoperative rigid cystoscopy. Procedure: The patient was positioned in lithotomy and Trendelenburg. Urethrocystoscopy was performed, identifying the bladder stone and the suburethral sling arm. The procedure began with the pneumoperitoneum creation with the Hasson technique. Then dissection of the Retzius space, identifying and isolating the left arm of the sling. The right arm was then identified and similarly isolated. A cystotomy was performed to release the sling, which was found to be intra-detrusor, along with bladder stone extraction. An iatrogenic perforation of the anterior vaginal wall was noted. The sling and the bladder stone were removed using an organ retrieval bag. The vaginal and bladder defects were closed, and bladder watertightness was confirmed at the end. A drain was placed, and abdominal incisions were closed.
  Results: The patient was discharged on the 1st postoperative day with a urinary catheter in free drainage for four weeks. A voiding cystourethrogram was performed before catheter removal, without urinary fistula or significant post-void residual volume. The patient experienced resolution of urgency symptoms but persistent SUI.
  Conclusions: Suburethral slings should be carefully placed, ideally by experienced urologists, to avoid complications. A transperitoneal approach is recommended for suburethral sling excision when placed at the bladder neck.

UP-06.04—Laparoscopic Pelvic Organ Prolapse Mesh Removal: A Surgical Nightmare 

• Fernandes Cláudia ¹, Velasco Clara ², Ramírez Ana², Saavedra Manuel ², Casado Javier ², Vale Luís ¹, Silva Carlos ¹, José Luis ², Lavalle Luis ²
  ¹ São João Local Health Unit, Porto, Portugal, ² La Princesa University Hospital, Madrid, Spain

• Introduction and Objectives: Pelvic organ prolapse (POP) affects nearly 50% of women, though only 3–6% are symptomatic and require treatment. Surgical intervention is the only option to restore normal anatomy, using either vaginal or abdominal approaches, sometimes with mesh support. However, transvaginal meshes have been associated with complications such as infections, fistulas, and vaginal or bladder extrusion, some requiring surgical intervention. In 2019, the FDA banned transvaginal meshes for POP repair in the U.S.A. We present a video of the laparoscopic transperitoneal removal of a mesh used for anterior POP correction complicated by vaginal extrusion.
  Materials and Methods: Case Description: A 55-year-old woman, smoker, with a history of Crohn’s disease and Von Willebrand disease, presented with urinary urgency refractory to treatment and significant constipation. She had a hysterectomy for uterine fibroids and underwent a retropubic suburethral sling (TVT) for stress urinary incontinence in 2007. Due to vaginal extrusion, the TVT was removed in 2008. She later had anterior POP correction with a vaginal mesh. Physical examination revealed grade III posterior prolapse, no anterior or apical prolapse, and a negative stress test. Vaginal extrusion of the POP mesh was observed. Cystoscopy showed no abnormalities. Videodefecography revealed pathological rectal ampulla descent, severe rectocele, and enteroceles. Pelvic MRI confirmed severe middle and posterior compartment insufficiency, colpoceles and rectoceles. A multidisciplinary pelvic floor team recommended mesh removal with possible pelvic floor repair. A transperitoneal access was established using the Hasson technique. Sigmoid colon and rectal adhesions were released. The peritoneum was incised, and the vesicovaginal space was dissected to identify the POP mesh. A longitudinal vaginal incision allowed excision of the central vaginal component, with bilateral paravaginal dissection and partial resection of the lateral mesh branches. The mesh was removed vaginally. Anterior colporrhaphy was performed using a biplanar V-Loc 3/0 suture.
  Results: The patient was discharged on day 1 post-operatory without complications. After 3 months, the patient reported no urinary urgency and improved constipation.
  Conclusions: The use of POP meshes should not be placed via the vaginal approach. When surgical treatment for POP is required using meshes, it should be performed via the abdominal route by experienced professionals to prevent long-term complications.

UP-06.05—Management of Patients with Pelvic Dysfunctions: A Cross-Sectional Prospective Study 

• Ausheva Bella, Kasyan George, Pushkar Dmitry
  Russian University of Medicine, Moscow, Russian Federation

• Introduction and Objectives: Pelvic disorders involve a variety of different conditions such as bladder and bowel dysfunctions along with pain or sexual problems. Urinary incontinence is one of the most common manifestations of pelvic disorders. The aim of this observational study was to analyze patient`s profile and the structure of surgical interventions in these patients in real life practice.
  Materials and Methods: A study was conducted from March to October 2024 in the female urology department of a tertiary public University center. A total of 150 patients admitted for the pelvic surgery were screened, data of 105 patients were collected and analyzed. All patients completed questionnaires prior to surgery.
  Results: The total number of patients operated was 105, with an average age of 55.7 years (±12.6). Coital urinary incontinence was reported in 41.7% cases, 17.1% had difficulty voiding, 42.3%—intermittent urination, and 31.4% experienced constipation. Stress urinary incontinence was detected in 44.8% of the patients during the examination, while 41.0% had a mixed incontinence. 26.7% of the patients had pelvic organ prolapse: 13% with rectocele, 65,2% with cystocele, 7.1% with a combination of cystocele and rectocele. In 46 patients (43.8%), frequency of urination was more than 7 times. A total of 85 patients (80.9%) had urge to urinate at night, and 44 women (51.7%) had urge to urinate 2 or more times per night. The urge to urinate was not felt by 16 patients (15.2%). In 83 patients (79.0%), urine was not delayed due to strong urge to urinate. Suburethral sling operations (n = 77.73%) and combined surgical interventions (n = 19.18%) were most often performed. Transobturator approach was most commonly used for sling urethropexy (n = 54, 70%), while retropubic approach was used in 26% of patients (n = 20).
  Conclusions: Pelvic disorders limit female patients in their choice of professional activities, force them to leave their workplaces, and significantly restrict them in daily activities. Surgeons should take into account the patient’s expectations and lifestyle, her age, which is a determining factor in choosing the optimal approach, as well as risk factors for relapse.

UP-06.06—Predictive Factors for Percutaneous Nerve Evaluation Outcomes in Treating Detrusor Overactivity in Women 

• Mazhar Farah, Fletcher Nicholas, Phillips Alice, Telford Nicola, Gray Struan, Foster Emma
  Salford Care Organisation, Northern Care Alliance, Manchester, United Kingdom

• Introduction and Objectives: Sacral neuromodulation (SNM) has been performed for detrusor overactivity (DO) and premenopausal female retention since 1999. SNM is an expensive treatment with imperfect long-term results. This study was performed to identify referral factors that may assist in predicting local anaesthetic performed percutaneous nerve evaluation (LA PNE) single-stage trial results in patients referred with DO who were then offered SNM insertion.
  Materials and Methods: We carried out a retrospective study of 131 females with DO referred for SNM, between 2018 and 2023. The variables recorded were age; BMI; neurological diagnoses; psychiatric diagnoses; cardiac disease; smoking history; hypertension; cerebral vascular accident; migraine; peripheral neuropathy; diabetes; urge incontinence; gynaecological surgery and presence of pain symptoms. Information was obtained from our electronic patient records. Treatment success was defined as a positive subjective and objective response to single-stage LA PNE leading to semi-permanent SNM insertion listing. Univariate and multivariate logistical regression analysis was performed using R Studio.
  Results: Univariate analysis identified psychiatric diagnoses at referral to be significantly associated with successful PNE trial (OR: 6.666, 95% CI: 2.129–29.476, p = 0.00343). This retained significance on multivariate analysis (OR: 2.158, 95% CI: 3.543–431.881, p = 0.0263). The multivariate analysis highlighted a significant association between neurological history and negative PNE outcomes (OR: 3.360, 95% CI: 1.021–0.626, p = 0.00618). There are no significant associations demonstrated with other clinical factors, such as age, diabetes, BMI and cardiac history, which have previously been published.
  Conclusions: Women with DO referred for SNM who have a history of psychiatric illness have been demonstrated to have improved responses to PNE as part of the work-up for SNM in this cohort. Patients with a neurological history could be considered for a 2-stage trial in preference to the LA PNE trial. However, this would have significant cost and resource implications. This analysis does not demonstrate older age or a history of gynaecological surgery to have a significant impact on PNE trial success. Further research is required to identify if psychiatric illness is predictive of SNM response for patients with DO.

UP-06.07—Predictors of De Novo Pelvic Dysfunctions After Vaginal Reconstructive Surgery: A Prospective Cohort Study 

• Ausheva Bella, Kasyan George, Pushkar Dmitry
  Russian University of Medicine, Moscow, Russian Federation

• Introduction and Objectives: Pelvic dysfunctions are a common problem in the world, significantly reducing the quality of life of patients. Vaginal reconstructive surgery is aimed at correcting these disorders. However, there is a proportion of patients who, after undergoing surgical treatment, experience new symptoms. The aim of our prospective cohort study was to identify predictors of de novo pelvic dysfunction after vaginal reconstructive surgery while monitoring patients for 12 months.
  Materials and Methods: We conducted a prospective cohort study with patients who were admitted to the Department of Urogynecology with a request for surgery from March to October 2023. Criteria for inclusion in the study: patients with symptomatic pelvic organ prolapse, urinary incontinence with no effect from conservative therapy. Prior to surgery, the patients completed validated questionnaires—ICIQ-SF (International Conference on Incontinence Questionnaire Short Form), PFDI-20 (Pelvic Floor Distress Inventory), PFIQ-7 Pelvic Floor Impact Questionnaire), PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire). After surgical correction, the patients were invited for a follow-up visit after 3, 6, and 12 months to assess their postoperative condition by re-filling out the questionnaire.
  Results: The study included 159 people who were admitted to the Department of Urogynecology with a request for surgery from March to October 2023. The following groups of factors can be mentioned as possible predictors of postoperative urinary incontinence: higher score of the general ICIQ-SF questionnaire before surgery (p = 0.045, OR 1.62, 95% CI 1.01–2.59); higher BMI (p = 0.042, OR 1.21, 95% CI 1.01–1.46). The scores of the preoperative PFDI-20 questionnaire are a predictor of recurrence/occurrence of pelvic organ prolapse. At the same time, the low overall score of this questionnaire is a risk factor. These data require further investigation as the number of patients and follow-up time increase.
  Conclusions: The results of our study have important clinical significance. By identifying patients at higher risk of developing new symptoms of pelvic dysfunction after surgery, doctors can adapt their preoperative counseling and management strategies to reduce these risks. Improving the treatment and monitoring of patients with pelvic dysfunctions creates favorable conditions for reducing the number of postoperative complications and de novo symptoms.

UP-06.08—Results of Modified Transvesical Repair of Vesicovaginal Fistula 

• Hashmi Saadat
  Rawalpindi Medical University, Rawalpindi, Pakistan

• Introduction and Objectives: Review the outcomes of modified transvesical repair of vesicovaginal fistula (VVF) without bivalving the bladder in a series of 50 patients.
  Materials and Methods: This prospective study was conducted from March 2018 to March 2024, including 50 patients selected by purposive sampling technique. Average age was 38.7 ± 7.5 years. Etiology included post obstetric fistula in 88% and 12% having previous surgeries. Average fistula size ranged from 1.5 to 3 cm. Patients with multiple fistulas, size of >4 cm, complex fistulas with involvment of ureter, bladder neck, radiation induced or malignant fistulas were excluded. A modified transvesical approach was used involving limited cystostomy incision without complete bivalving of bladder. A circum fistula incision was given, vaginal and bladder flaps raised by meticulous dissection without excising the fistulous tract. Primarily vaginal layer was closed in double layer by continuous suturing using 3/0 round body Vicryl suture followed by double layer closure of bladder flap. Suprapubic and urethral catheters were placed. In certain cases omental flap was placed to support vaginal layer before closure of bladder layer. Primary outcome measures included fistula closure rates, hospital stay, intraoperative and postoperative complications, operative time, catheterization duration, and postoperative continence status.
  Results: Mean operative time was 74.6 ± 12.3 min, mean blood loss was 120 ± 20 mL; mean catheterization duration was 15 ± 2 days. Overall success rate was 94 percent, recurrence rate was 6% (n = 3), post operative UTI rate was 8% (n = 4), and average hospital stay was 5 ± 2 days. Postoperative complications were minimal, with urinary retention in 6% of patients and mild transient urgency in 8%. Recurrence rate of 6% was observed during a mean follow-up period of six months, but neither of them developed urinary incontinence. Continuous variables like hospital stay, operative time were statistically evaluated by using T-tests, and categorical variables including recurrence rates and success rates were compared using chi-square test. SPSS version 26 was used for statistical analysis.
  Conclusions: Modified transvesical VVF repair without bivalving the bladder is effective and minimally invasive approach, demonstrating high success rates with reduced morbidity and recovery times. This technique may serve as valuable alternative to conventional surgical methods.

UP-06.09—Surgical Treatment for Obesity Is Able to Cure Urinary Incontinence 

• Persu Cristian, Ciofu Irina, Cartas Remus, Chirca Narcis Marian, Popescu George, Jinga Viorel
  “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Bucharest, Romania

• Introduction and Objectives: There is enough evidence to support weight loss in order to improve urinary incontinence. Nevertheless, weight loss and maintaining a lower weight are not easy to achieve in general population. Our study aims to evaluate whether bariatric surgery has a positive effect on the symptoms of urinary incontinence in female patients.
  Materials and Methods: We performed a prospective study on obese female patients before and after bariatric surgery, over a period of 9 years. Patients with a BMI ≥ 33 kg/m² were included if they described involuntary loss of urine and no previous surgery for urinary incontinence was performed. The patients underwent bariatric laparoscopic surgery. Our evaluation collected data on age, time since onset of symptoms, pad usage, number and way of deliveries, concomitant conditions and medications. Our objective defined change in incontinence as cure, improved, no change and worse.
  Results: Our study included 54 women in which initial data and at least 18 months of follow up were available. We observed that about 50% of all women undergoing bariatric surgery have some degree of urinary incontinence. The ICIQ score improved from 13.31 ± 5.18 before to 8.30 ± 4.49 points after surgery (p < 0.0001). Before surgery, 38 patients (70%) described severe incontinence, compared to only 20 patients (37%) after surgery. 16 women (31%) report complete cure of urinary incontinence after bariatric surgery. Data from the VAS questionnaire shows improvement in 46 cases (85%). Pad usage improved from 7.04 ± 2.79 to 3.42 ± 2.77 (p < 0.001) per day. The number of patients using more than one pad per day decreased from 35 (65%) to 9 (17%). The type of incontinence doesn’t seem to be relevant, but our sample size was too small to lead to statistically significant results. There is no impact on the outcome of incontinence of number/type of delivery, age or BMI.
  Conclusions: Our data shows that bariatric surgery is able to cure urinary incontinence in one of three obese women. Significant improvement is obtained in more than two thirds of the patients, regardless the type of incontinence. For an obese female with urinary incontinence, the treatment for obesity should prevail, and incontinence should be treated only if symptoms remain.

UP-06.10—The Relationship Between Sarcopenia and Urinary Conditions in the Elderly in Rural Taiwan 

• Ho Yung, Huang Wei-Chun, Chou Chieh-Lung
  China Medical University Hospital, Taichung, Taiwan

• Introduction and Objectives: Sarcopenia has significant impacts on other organ diseases, and its severity also reduces patients’ ability to perform daily activities, leading to a decline in quality of life and disability. At the same time, lower urinary tract symptoms (LUTS) were also associated with age, but few literature discussed the association between sarcopenia and LUTS in women. In this research, we assumed that sarcopenia also caused dysfunction of bladder muscles, including detrusor muscle, external sphincter, and this situation would eventually increase the prevalence of urinating dysfunction.
  Materials and Methods: Data were sourced from 64 participants, including 48 sarcopenia patients and 16 individuals in the control group, from long-term care communities in Yunlin County, Taiwan, between 10/01/2023 and 03/30/2025. Females aged 65 years and older, living in southwestern Taiwan, were invited to participate in this study. Patients with the following conditions were excluded: mobility impairment, bedridden status, severe dementia, or cognitive impairment. Bioelectrical impedance analysis, IPSS score, OABSS score, uroflowmetry, quality of life, Patient Perception of Bladder Condition (PBCC), and demographic data were collected and analyzed using SPSS statistical software.
  Results: Among the 64 participants, the median age of the sarcopenia group (n = 48) was 80 years old, while the median age of the control group (n = 16) was 74 years old. LUTS symptoms were common in sarcopenia patients (18 cases had an IPSS > 7, and 3 cases had an IPSS > 20). The prevalence of overactive bladder in the entire cohort was 78.1%. The PBCC score was significantly higher in the sarcopenia group. The median IPSS score and OABSS score in the sarcopenia group were higher but not significantly so. The median voided volume on uroflowmetry was 196.75 mL, the residual urine volume was 11.07 mL, and the maximum flow rate was 20.65 mL/s.
  Conclusions: In this study, we discovered the high prevalence of LUTS or overactive bladder in old female sarcopenia patients. Although only PPBC showed significance, patients with sarcopenia appeared to be more severe in urinating problems, and a trend of storage symptoms over voiding symptoms was noted. Larger and multicenter studies should be conducted to decrease the bias.

UP-06.11—The Use of a Hybrid Sling for the Surgical Treatment of Female Urinary Incontinence 

• Le Tkhu Chang, Pavlov Valentin, Vardikian Andranik, Papoyan Anushavan
  Bashkir State Medical University, Ufa, Russian Federation

• Introduction and Objectives: Currently, more than 40 different types of synthetic slings are used to treat stress urinary incontinence (SUI). However, mesh-associated complications related to the use of polypropylene nets have been accumulating in recent years. A promising solution is hybrid slings, in which biological component is placed in the most vulnerable middle part of the implant. The presence of allogaft “Alloplant” in hybrid slings allow carry out standard technique of transobturator sling operation without increasing time duration. The aim of our work is to improve the results of the operative treatment of female SUI with the use of hybrid allogeneic-synthetic suburethral slings and prevention implant-associated complications.
  Materials and Methods: This prospective study included 100 female patients with SUI hospitalized at the Clinic of Bashkir State Medical University. Patients were categorized into two groups: Group I included 50 patients whom a midurethral sling procedure using hybrid tape is implanted; Group II included 50 patients whom a synthetic transobturator tape was implanted during transobturator sling operation (in both groups). Patients completed the PGI and UDI-6 questionnaires and underwent urodynamic studies before surgery and six months after surgery.
  Results: Both groups showed comparable and significant improvements in the questionnaires. The average operation time of Group 1 and 2 was 28.33 ± 6.1 min and 22.7 ± 3.5 min respectively. The cure rate was 98% in Group 1 and 96% in Group 2, which was not statistically significant. Serious intraoperative complications were not observed. Vaginal erosion was observed in one case in Group 2, which was treated by sling removal. One case of bladder hyperactivity de novo was observed in Group 2. According to the MRI of the small pelvic organs, there were signs of remodeling and biological transformation of allogeneic material in Group 2, which indicates the formation of functionally complete connective tissue structure on the recipient site, which is able to withstand static and dynamic loads.
  Conclusions: The fixation properties of the synthetic mesh for better tension control are preserved, while the periurethral contact zone is maintained with an allogeneic graft. However, it is still necessary to conduct long-term research of a large group of patients.

UP-06.12—Fascial Mild Urethral Sling or Artificial Urinary Sphincter in the Neurological Women Population, a Multicenter Study 

• Blondeau Alicia ¹, Mazeaud Charles ¹, Khavani Rose ², Ong M. ², Debois Alexandre ³, Pitout Alice ⁴, Peyronnet Benoit ⁵
  ¹ CHRU Nancy, Nancy, France, ² Houston Methodist Hospital, Houston, United States, ³ University of Rennes, Rennes, France, ⁴ Nancy University Hospital, Nancy, France, ⁵ Rennes University Hospital, Rennes, France

• Introduction and Objectives: Continence for neurological bladder patients is a challenging goal, especially for the female population. Two techniques have the surgeon’s preference according to their country’s regulation but have never been compared: the Artificial Urinary Spincter (AUS) or the fascial pubovaginal sling (PVS). The aim of the present study was to compare the outcomes of AUS and PVS in female neurogenic patients.
  Materials and Methods: This retrospective international multicenter study was conducted from October 1st, 2014, to March 31st, 2023. We included all women with a past medical history of neurogenic bladder who underwent surgery for AUS or a fascial sling (cadaveric or fascia lata) at three centers. All three centers were offering the two different surgical options to patients, and the decision to perform depended upon the surgeon’s preference, the era, and/or the shared-decision making process with patients. The primary endpoint was the PGII at 3 months and at last follow-up.
  Results: Thirty-five patients were included: 16 AUS and 19 PVS. The PVS patients were significantly younger (median: 30 vs. 53 years; p = 0.008) and had less history of previous anti-incontinence procedures (10.5% vs. 43.8%; p = 0.02). There were more spinal cord injuries in the PVS group (52.6% vs. 12.5%; p = 0.01), and the maximum cystometric capacity was significantly higher in the AUS group (364.1 vs. 252.8 mL; p = 0.03). All the perioperative outcomes were comparable in both groups (see Table 2) with only two major postoperative complications in each group (12.5% vs. 10.5%; p = 0.99). Many functional outcomes favored AUS but with no statistically significant difference, notably for PGII at 3 months (p = 0.08) and at last follow-up (p = 0.10).
  Conclusions: AUS and fascial MUS are two procedures surgeons must consider in the female neurogenic SUI population with similar morbidity. The functional outcomes may be more favorable for AUS. This choice remains complex and requires further investigation.

UP-06.13—Treatment of Stress Urinary Incontinence in Women with Polycaprolactone-Based Bulking Agent (Urolon™): Efficacy and Need for Additional Treatment 

• Samarinas Michael ¹, Antoniadis Georgios ², Milad Ziad ³, Theodorou Tasos ³, Kyriakides Andreas ³, Nikolaou Nikos ³, Pavlou Antonis ³, Karaolides Theocharis ³, Gravas Stavros ⁴
  ¹ Aristotle University of Thessaloniki, Thessloniki, Greece, ² General Hospital of Larissa, Larissa, Greece, ³ General Hospital of Nicosia, Nicosia, Cyprus, ⁴ Medical School, University of Cyprus, Nicosia, Cyprus

• Introduction and Objectives: Stress urinary incontinence (SUI) significantly impairs quality of life in women, and urethral bulking agents are increasingly used as minimally invasive alternatives to surgery. Urolon™, a newer polycaprolactone-based bulking agent, has shown promising results in initial trials, but real-world evidence remains limited. This study evaluated the Urolon™ efficacy in terms of incontinence improvement in women with SUI and assessed the duration of improvement.
  Materials and Methods: A retrospective analysis was conducted on 44 women with SUI who received Urolon™ injections. Patient age, improvement in symptoms (no or fewer incontinence episodes), and any subsequent treatments were recorded. Duration of improvement was categorized into four groups: improvement up to 6 months, up to 1 year, up to 2 years, and over 2 years. Additional interventions were classified as no further treatment, overactive bladder (OAB) medications, mid-urethral sling placement, or repeat Urolon™ injection. Statistical analysis included descriptive statistics.
  Results: The mean age of participants was 65.7 years (range 44–86). Symptom improvement following Urolon™ injections was reported by 27 (61.4%) of patients. From those 27 patients, 12 (44.4%), 5 (18.5%), 3 (11.1%), and 7 (25.9%) patients experienced relief up to 6 months, 1 year, 2 years, and beyond 2 years, respectively. No improvement was reported by 17 out of 44 patients (38.6%). Patients with no improvement or symptom recurrence were treated with repeat Urolon™ injections (36.4%), mid-urethral sling surgery (20.5%), or OAB drugs (13.6%). In total, 29.5% of the patients required no additional therapy.
  Conclusions: Our series found that Urolon™ provided a symptomatic benefit in more than 60% of women with SUI, with over 50% reporting an improvement for at least 12 months. However, additional treatment was required in 70% of patients on long-term. These findings may be useful for the counseling of patients about the efficacy of the treatment and the potential need for repeat procedures or additional therapies.

UP-06.14—Urethral Leiomyoma—A Rare Benign Tumour of Female Urethra 

• Thogaru Tejaswi
  Osmania General Hospital, Hyderabad, India

• Introduction and Objectives: Urethral Leiomyoma is exceedingly rare tumour, with fewer than 45 cases reported in literature till now. They are benign mesenchymal tumours that arise from the smooth muscle cells, seen most commonly in uterus but can occur in unusual sites like ovaries, urethra, or bladder. It is often seen in females of 30 to 50 years of age group and appears to be hormone dependent.
  Materials and Methods: This is a case of 45-year-old female presenting with complaints of obstructive LUTS and urethral mass since 6 months. On physical examination, 4 × 6 cm non tender, firm mass with well defined margins was noted in periurethral region. Cystoscopy revealed normal urethral mucosa. MRI pelvis was done, which was showing a lesion of 5.6 × 4.5 × 7.2 cm in anterior urogenital triangle in periurethral region with indistinct interphase with urethra. Under spinal anaesthesia, complete surgical resection of tumour was done by transvaginal route. The rent in urethral mucosa was repaired with absorbable sutures in interrupted fashion. Patient was discharged with urethral catheter in situ. HPE report showed spindle shaped cells arranged in interlacing bundles suggestive of urethral leiomyoma. Patient had complete resolution of symptoms after urethral catheter removal, and there was no recurrence noted in six months follow up.
  Results: Urethral leiomyomas are an unusual type of deep soft tissue leiomyomas. These tumours are most commonly seen in females of reproductive age group. Some studies suggest a correlation with estrogen levels in the body, and their size may increase rapidly during pregnancy. Approximately 25% of cases remain asymptomatic, and others may present with symptoms such as urethral/vaginal mass, hematuria, LUTS such as frequency, urgency, poor stream, recurrent UTIs and sometimes with acute urinary retention. Postoperative pathological examination can only provide definitive diagnosis. Complete surgical excision is usually recommended to minimize the risk of recurrence. There is no documentation of malignant transformation till date.
  Conclusions: Urethral leiomyoma is a rare benign tumour, which requires histopathological examination for definitive diagnosis despite being a benign entity. Complete surgical excision typically results in good outcomes. The management of urethral leiomyomas remains challenging due to their rarity and no standardized treatment protocol.

6.3. Unmoderated Video ePosters

UVP-06.01—Robotic TOT Sling Removal and Ureteral Reimplantation 

• Blondeau Alicia, Pitout Alice, Decombe Ophélie, Eschwege Pascal, Mazeaud Charles
  CHRU Nancy, Nancy, France

• Introduction and Objectives: The removal of suburethral slings does not always allow for complete excision of the mesh. The robotic approach helps address this issue while also enabling ureterovesical anastomosis according to the Lich-Gregoir technique. The objective of this video is to describe a technique for TOT removal and ureteral reimplantation using the X DA VINCI robot. The removal of suburethral slings does not always allow for complete excision of the mesh. The robotic approach helps address this issue while also enabling ureterovesical anastomosis according to the Lich-Gregoir technique. The objective of this video is to describe a technique for TOT sling removal and ureteral reimplantation using the X DAVINCI robot.
  Materials and Methods: A 38-year-old female patient presented with recurrent pain and pyelonephritis. She has a history of TOT sling placement for several years. She presents with dysuria and a history of recurrent pyelonephritis. CT and MRI scans reveal a bilateral double collecting system, with the left ureter of the superior system abnormally implanting into the urethra. Additionally, there is dilation of the left upper pole. Scintigraphy shows no significant functional difference between the left and right upper poles.
  Results: The procedure was performed under general anesthesia using the X Da Vinci robot via a transperitoneal approach. The upper-system left ureter was quickly identified and placed on traction. It was dissected up to its crossing with the lower ureter and subsequently transected. A ureterovesical anastomosis was performed according to the Lich-Gregoir technique, with the placement of a JJ stent. In the second stage, the Retzius space was dissected down to the endopelvic fascia. The arms of the TOT sling were easily identified and cut at the level of the endopelvic facia. Careful dissection of the sling was performed on both sides of the urethra, allowing for its complete removal. Peritoneal closure was achieved using a V-Loc suture. The bladder catheter was removed on postoperative day 7, and the JJ stent was removed after three weeks.
  Conclusions: The robotic approach enables effective removal of the TOT sling while allowing simultaneous ureterovesical reimplantation.

UVP-06.02—Autologous Fascial Sling: Tips and Tricks 

• Ausheva Bella, Kasyan George, Pushkar Dmitry
  Russian University of Medicine, Moscow, Russian Federation

• Introduction and Objectives: The current protocols for the surgical management of stress urinary incontinence (SUI) advocate for a collaborative decision-making process between healthcare professionals and patients, considering all available surgical approaches, including and excluding the use of mesh. Unfortunately, there are some complicated cases of urinary incontinence that occur due to damage to the urethra following previous surgical procedures. One treatment option for these patients is to install an autologous fascia sling. The purpose of this video is to provide information about the process of installing a sling following urethral reconstruction.
  Materials and Methods: The patient is a 57-year-old woman with a history of midurethral sling implantation for urinary incontinence. However, the protrusion of the sling caused destruction of the urethra and urethra-vaginal fistula. A year ago, the urethrolysis with the sling removal was performed followed by urethral reconstruction. After the surgery, the patient reported complaints of severe stress urinary incontinence. An autologous fascial sling was chosen as a treatment option for this patient.
  Results: The patient has an autologous fascial sling. In the long-term postoperative period, the cough test was negative at the follow-up examination. Patient can continence the urine.
  Conclusions: An autologous fascial sling has demonstrated high efficacy after urethrolysis in a patient with urethral destruction.

7. History of Medicine

7.1. Unmoderated Standard ePosters

UP-07.01—Antonio Scarpa: Architect of Modern Surgical Anatomy 

• Gibson John, Pearce Ian
  Manchester University NHS Foundation Trust, Manchester, United Kingdom

• Introduction and Objectives: Antonio Scarpa (1752–1832) was an Italian anatomist and surgeon whose life and work laid foundations for modern surgical anatomy and urology. Among his many discoveries, Scarpa’s fascia remains one of the most significant anatomical descriptions, providing critical insights into the structure of the anterior abdominal wall. This study explores Scarpa’s life, the discovery of Scarpa’s fascia, and his contributions to urology.
  Materials and Methods: A comprehensive literature review and analysis of historical archives was conducted using peer-reviewed journal articles, historical texts, and primary sources, including Scarpa’s original works.
  Results: Born into humble beginnings in Lorenzaga, Italy, Scarpa’s talent was evident at an early age. He entered the University of Padua at 15 and earned his medical degree at 18. His rapid academic ascent led to his appointment as a professor at the University of Modena and subsequently to the prestigious chair at the University of Pavia. Here he established a school of anatomy and the “Aula Scarpa”—an anatomical theatre. He was also a talented artist renowned for his detailed anatomical illustrations; he personally drew and engraved many of the plates for his textbooks. He gained recognition in 1772 for his detailed descriptions of the structures of the ear and later studied the anatomy of the inner ear, the accessory spinal nerve and innervation of the heart. Scarpa’s fascia was first described in his anatomical studies. It is clinically relevant because it forms a distinct layer in the lower anterior abdominal wall that serves as an important surgical landmark useful in urological procedures such as cystolithotomy. The fascia also forms fascial planes that limit fluid extravasation, relevant to the bladder and perineum, particularly in relation to urinary extravasation. His pioneering work in urology also included the recto-vesical approach for bladder stone removal.
  Conclusions: Antonio Scarpa was a pioneer of his time, and his contributions to anatomy and urology have profoundly influenced modern-day surgical understanding and practice, particularly his discovery of Scarpa’s fascia. This comprehensive review underscores the importance of his contributions and offers valuable insights for modern clinical practice and medical education.

UP-07.02—Bladders Don’t Discriminate: A Brief History of Women in Urology 

• Djoudi Assia
  Queen Elizabeth University Hospital, Glasgow, United Kingdom

• Introduction and Objectives: Urology is a specialty that, quite literally, flows through all of us—kidneys, ureters, bladders, urethras. But historically, it flowed through departments that had little room for women. For much of the 20th century, urology was a male-dominated field, where female practitioners were few and often met with resistance when they tried to scrub in. To explore the overlooked history of women in urology, spotlight the trailblazers who paved the way, and reflect on how their contributions continue to shape the specialty.
  Materials and Methods: This talk takes a narrative historical approach, tracing key milestones and stories—both recorded and rediscovered—of women in urology, from early pioneers to modern leaders. Particular attention is paid to figures in the UK and US, where documentation and progress have taken different forms.
  Results: Results: Dr. Elisabeth Pauline Pickett, the first woman elected to the American Urological Association in 1951, spent much of her career being the only woman in the room. In the UK, the early history is more elusive—perhaps because it was never fully recorded—but a quiet revolution has been underway, reflected in the steady rise of female trainees. Later figures like Dame Professor Clare Fowler redefined subspecialties like female urinary dysfunction. Yet today, women still make up just 12% of consultant urologists in the UK—a reminder that representation remains a work in progress.
  Conclusions: The urinary tract may not care about gender—but the systems built around it historically did. This presentation recognises the women who stepped into a field that wasn’t always built for them and, in doing so, quietly reshaped it. Their contributions continue to influence the direction of urology today, reminding us that progress often begins with those willing to go first.

UP-07.03—From Toxin to Therapy: The Transformative Journey of Botulinum Toxin in Medicine 

• Ghonaimy Ahmed, Hanna George, Fulford Simon, Nadeem Mehwash
  James Cook university Hospital, South Tees NHS Trust, Middlesbrough, United Kingdom

• Introduction and Objectives: Botulinum toxin (BTX), a neurotoxin produced by Clostridium botulinum, has transitioned from a cause of foodborne illness to a widely used therapeutic agent. Its history includes significant medical, industrial, and regulatory milestones, solidifying its role in neurology, dermatology, and urology.
  Materials and Methods: A historical review of BTX, using keywords such as Botulinum Toxin and Botox, highlighted its discovery, clinical uses, and regulatory approvals. Key developments included the first observations of botulism, toxin isolation, and its eventual medical applications
  Results: BTX’s history began with the 1793 botulism outbreak and its 1895 isolation by Dr. Ermengem. Initially investigated as a chemical weapon during WWII, its medical potential emerged when Dr. Scott used it for strabismus in 1977. FDA approvals expanded from ocular conditions (1989) to cosmetic and therapeutic uses, such as cervical dystonia (2000), chronic migraines (2010), and urge urinary incontinence (2011). Various formulations, including Botox™️, Dysport™️, and Xeomin™️, have distinct regulatory standards. In urology, BTX applications began in 1988 for detrusor-sphincter dyssynergia, later addressing conditions like voiding dysfunction and neurogenic detrusor overactivity.
  Conclusions: The journey of BTX from a lethal toxin to a therapeutic agent exemplifies its transformative impact on medicine. Ongoing research and development promise continued advances in its clinical applications.

UP-07.04—Gurdon Buck: Pioneer of Buck’s Fascia and Surgical Innovation 

• Gibson John, Pearce Ian
  Manchester University NHS Foundation Trust, Manchester, United Kingdom

• Introduction and Objectives: Dr Gurdon Buck (1807–1877) is recognised as a pioneering figure in 19th-century surgery, whose innovative contributions span urology, plastic surgery, and orthopaedics. Notably, his description of the deep fascia of the penis (Buck’s fascia), first documented in 1848, has had an enduring impact in urological practice. This study aims to examine Buck’s life and his legacy.
  Materials and Methods: A literature review was conducted, and a synthesis of peer-reviewed literature and biographical sources was used. This study involved a review of Buck’s life and original publications to evaluate his surgical innovations and their influence on subsequent clinical practices.
  Results: Buck graduated from Columbia University College of Physicians and Surgeons in 1830 and completed his internship at the New York Hospital. He went on to work and continue his training in Europe (Paris, Berlin, London and Vienna). Buck was instrumental in pioneering several surgical techniques that have become foundational in modern practice. His 1848 description of Buck’s fascia provided an anatomical basis for improved urological and reconstructive procedures. It is crucial in hypospadias repair, penile fracture repair and serves as a key anatomical landmark. Its integrity influences erectile function, and it can limit the spread of infections and haematomas, making it key to urological practice. His contributions to fracture management in orthopaedics highlight his innovative approach across specialties. Furthermore, his early use of clinical photography set a precedent for surgical documentation. The findings confirm that Buck’s work not only advanced 19th-century surgery but also laid the groundwork for contemporary surgical techniques.
  Conclusions: Dr Gurdon Buck’s multidisciplinary contributions have left an indelible mark on the fields of urology, plastic surgery, and orthopaedics. His pioneering work on Buck’s fascia and other innovative surgical practices emphasises the lasting relevance of historical surgical methods to modern clinical applications. This study reinforces the value of historical analyses in understanding the evolution of surgical innovation and provides a framework for appreciating how past advancements continue to influence current medical practice.

UP-07.05—Historical Perspectives on Male Genital Surgery: Contributions from Islamic Scholars and Ayurvedic Medicine a Millennium Ago 

• Al Dayel Adel ¹, Al Zuhair Naheda ²
  ¹ Men’s Health Clinic, Dammam, Saudi Arabia, ² Men’s Health Society, Dammam, Saudi Arabia

• Introduction and Objectives: Historical medical literature provides substantial insights into early understandings and treatments of male genital disorders. Islamic scholars, particularly Abu Al-Qasim Al-Zahrawi, Abu Bakr Muhammad ibn Zakariya Al-Razi, and Ali ibn Abbas Al-Majusi, significantly advanced surgical practices related to male genital conditions. Concurrently, Ayurvedic medicine offered a parallel understanding through comprehensive surgical and herbal treatments. The objective is to investigate and document the contributions of those scholars to the understanding and surgical management of scrotal and penile disorders 1000 years ago, alongside the Ayurvedic perspectives and treatments of similar disorders.
  Materials and Methods: Primary source textbooks reviewed included Al-Zahrawi’s “Al-Tasrif,” Al-Razi’s “Al-Hawi,” and Al-Majusi’s “Kitab al-Maliki,” each examined in their original Arabic language. Ayurvedic contributions were assessed through the “Sushruta Samhita” and related classical texts, reviewed in their English translations. A systematic literature review methodology was employed, comparing surgical techniques, diagnostic criteria, therapeutic recommendations, and postoperative care instructions across these texts.
  Results: All three named Arabic textbooks provided detailed information on the diagnosis and surgical procedures on male genitalia. Al-Zahrawi notably advanced the surgical management of varicocele and hydrocele and standardized circumcision methods, significantly influencing future surgical practices. Al-Razi provided crucial differential diagnoses, clearly distinguishing benign swellings from testicular tumors, and outlined therapeutic strategies. Al-Majusi enriched diagnostic precision and procedural accuracy in testicular disorders and varicocele surgery. Ayurvedic medicine, through the “Sushruta Samhita,” detailed sophisticated surgical and herbal treatments for scrotal disorders, underscoring holistic patient management.
  Conclusions: These historical texts collectively reflect substantial advancements in the surgical management of male genital disorders, indicating an early, intricate understanding and systematic approach to urological care, which profoundly impacted subsequent medical practices globally.

UP-07.06—The History of the Genitourinary Trauma and Its Management 

• Gibson John
  Manchester University NHS Foundation Trust, Manchester, United Kingdom

• Introduction and Objectives: Genitourinary (GU) trauma has presented unique challenges in military medicine, with advancements often driven by the unique injuries encountered during advancing warfare. This study examines the evolution of GU trauma and its management from the American Civil War to modern conflicts.
  Materials and Methods: A comprehensive literature search was conducted using PubMed and the Cochrane Library to identify papers detailing the injuries and management of GU trauma in military settings across different eras.
  Results: During the American Civil War, GU injuries from musket and cannon fire were managed with basic surgical techniques, often resulting in high infection and mortality rates. World Wars I and II saw improvements with the introduction of aseptic methods, Foley catheters, and early reconstructive approaches for pelvic and bladder injuries caused by high-velocity munitions. In the Iraq and Afghanistan conflicts, IED-related injuries accounted for a significant proportion of GU trauma, including pelvic trauma, testicular rupture, and urethral disruption. Management included damage control surgery, temporary urinary diversion, and reconstructive techniques such as microvascular repair and urethral reconstruction. Recent innovations, such as portable ultrasound and penile prosthetics, have improved both functional outcomes and long-term quality of life.
  Conclusions: The evolution of GU trauma management reflects the intersection of military needs and medical advancements, highlighting the importance of continued innovation to address the unique challenges of warfare.

8. Infections and Inflammatory Diseases

8.1. Moderated Oral ePosters

MP-08.01—Adjuvant Immunomodulation for the Prevention of Recurrent Urinary Tract Infections. (AIPIRUTI Pilot Study) 

• Trujillo-Santamaría Hegel
  Hospital D’Maria, Veracruz, Mexico

• Introduction and Objectives: Recurrent urinary tract infections (rUTIs) are a common challenge, often requiring repeated antibiotic use and significantly impacting quality of life. This study aimed to evaluate the impact of adding immunomodulation with an oral formulation of inactivated bacterial lysates (contains inactivated lysates of 14 types of bacteria) to standard antibiotic regimens and adjunctive therapies in patients with rUTIs, assessing recurrence reduction, symptom improvement, and quality of life.
  Materials and Methods: This ambispective cohort study included 25 patients (87.5% female; age 38–78) with documented rUTIs. All had received repeated antibiotic therapy plus D-mannose (2100 mg/day) and phytonutrient, symbiotic, immunonutrient over 18 months. In March 2024, immunomodulation with inactivated bacterial lysates was initiated and continued for 5 months. Patients were hospitalized for two days for intravenous antibiotic initiation, followed by 5 days of oral therapy, then transitioned to outpatient care with immunomodulation and adjunctive therapy. Evaluations before and after immunomodulation included UTI frequency, disuria, lower urinary tract symptoms (LUTS), urinalysis (nitrites, leukocyturia, bacteriuria), urine culture results, hospitalizations, and quality of life (ICIQ-UI SF). Statistical analysis included McNemar tests for categorical variables and paired t-tests for continuous outcomes.
  Results: After 5 months of immunomodulation: Mean UTI episodes dropped from 4 to 0.5 per patient (p < 0.001). Disuria decreased from 80% to 20% (p = 0.004). LUTS fell from 85% to 15%. Urine culture positivity reduced from 88% to 16% (p < 0.0001), mainly involving E. coli (68%) and K. pneumoniae (20%). Abnormal urinalysis decreased from 76% to 24%. Quality of life improved in 80% of patients (vs. 28% before; p < 0.001). Hospitalizations fell from 32% to 4%.
  Conclusions: The introduction of immunomodulation with inactivated bacterial lysates significantly reduced rUTI episodes, improved urinary symptomatology, and enhanced quality of life in this patient cohort. These findings suggest that immunomodulatory therapy is a promising adjunct to standard care and may represent a shift in the management paradigm of rUTIs. Further randomized controlled trials are warranted to confirm these results.

MP-08.02—Clinical Efficacy of Intravesical Injections of Autologous Plasma-Rich Plasma Versus Bladder Hydrodistension in the Treatment of Interstitial Cystitis/ Bladder Pain Syndrome: A Comparative Study 

• Kosova Inga ¹, Kolbasov Dmitry ², Grigoriev Nikolay ³, Loran Oleg ¹, Barsegian Vagan ³
  ¹ Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation, ² Demikhov City Clinical Hospital, branch #2, Moscow, Russian Federation, ³ European Medical Center, Moscow, Russian Federation

• Introduction and Objectives: The pathophysiology of interstitial cystitis/bladder pain syndrome (IC/BPS) involves neurogenic inflammation, urothelial dysfunction, mast cell activation and autoimmunity. Platelet-rich plasma (PRP) is rich in cytokines and platelet-derived growth factors that modulate tissue inflammation and promote regeneration. The study aimed to assess the clinical efficacy of intravesical injections of plasma-rich plasma compared to bladder hydrodistension in the treatment of IC/BPS.
  Materials and Methods: Intravesical PRP injections with preliminary bladder hydrodistension were performed in 15 IC/BPS patients. A single high-dose (20 mL) autologous PRP injection was administered into suburothelium at 20 sites on the posterior and lateral bladder walls. Clinical outcomes were assessed at baseline, 1, 3 and 6 months post-treatment using ICSI, VAS pain score, 3-day voiding diary and global response assessment (GRA). Uroflowmetry was performed at baseline and 6 months after treatment. These outcomes were compared with retrospective data from 20 IC/BPS patients who received bladder hydrodistension alone.
  Results: The baseline clinical variables were not significantly different in both groups. At 6 months after single high-dose PRP intravesical injection, statistically significant improvements in ICSI (5.13 ± 0.98 vs. 10.47 ± 1.59; p < 0.01), VAS pain score (2.8 ± 1.11 vs. 5.07 ± 0.82; p < 0.01) and daily frequency (9.93 ± 0.99 vs. 11.67 ± 0.83; p = 0.01) were observed. Changes in other assessed parameters were insignificant (p ≥ 0.05). Compared to bladder hydrodistension alone, PRP injections resulted in better improvements at 6 months in ICSI (5.13 ± 0.98 vs. 8.45 ± 1.22; p < 0.01), VAS pain (2.8 ± 1.11 vs. 4.1 ± 0.82; p = 0.04) and GRA (2 [0.5; 2] vs. 0.5 [0; 1]; p = 0.02) scores. However, only 60% of patients had GRA ≥ 2 at both 3 and 6 months after PRP injections. No complications were registered.
  Conclusions: Intravesical PRP injections seem to be a promising treatment for IC/BPS, demonstrating superior symptom improvement compared to bladder hydrodistension alone. Further studies are required to confirm long-term efficacy and safety.

MP-08.03—Intravesical Hyaluronic Acid Instillations Versus Amitriptyline for Improving Bladder Compliance in Interstitial Cystitis/Bladder Pain Syndrome 

• Apostolidi Theodora-Paisia ¹, Antoniadis Georgios ², Galanoulis Konstantinos ², Bousdroukis Nikolaos ², Karatzas Anastasios ³, Samarinas Michail ⁴
  ¹ University of Thessaly, Nursing, Larissa, Greece, Larissa, Greece, ² Urology Department, General Hospital of Larissa, Greece, Larissa, Greece, ³ Urology Department, University Hospital of Larissa, Greece, Larissa, Greece, ⁴ 2nd Urology Department, Aristotle University of Thessaloniki, Greece, Thessaloniki, Greece

• Introduction and Objectives: Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is a chronic disorder characterized by pelvic pain and urinary symptoms, significantly affecting quality of life. Managing IC/BPS is challenging, with diverse treatment strategies under exploration. This study compares the efficacy of intravesical hyaluronic acid (HA) instillations and oral amitriptyline in enhancing bladder compliance and relieving symptoms.
  Materials and Methods: This prospective, comparative study involved adult women (>18 years) diagnosed with IC/BPS using bladder diaries, cystoscopy, bladder biopsies, and urodynamic tests. Exclusion criteria included neurological disorders, pelvic surgeries, antidepressant use, or urological conditions such as bladder lithiasis or recurrent urinary tract infections. Participants were divided into two groups: Group A received intravesical HA instillations weekly for 6 weeks, followed by monthly sessions for 6 months, while Group B was treated with 50 mg/day of amitriptyline for 6 months. Bladder compliance, capacity, and symptoms were assessed using the O’Leary/Sant questionnaires at baseline and 6 months.
  Results: Of 24 participants (mean age: 38.5 years), 12 were assigned to each group. Baseline assessments showed no significant differences between groups in bladder capacity, compliance, or urinary frequency. At baseline, Group A’s mean maximum voided volume (MVV) was 120 mL, compliance 17.5, and frequency 11, while Group B had an MVV of 110 mL, compliance of 16.5, and frequency 13. After 6 months, Group A exhibited significant improvement in MVV (210 mL, p = 0.04) and compliance (24.5, p = 0.03), along with a reduction in frequency (8, p = 0.09). Group B showed minimal changes in bladder capacity (125 mL, p = 0.743), compliance (16, p = 0.912), and frequency (14, p = 0.845). Symptom scores for voiding and pain improved modestly in both groups, but only Group B demonstrated significant pain reduction (p = 0.03).
  Conclusions: Intravesical HA instillations significantly enhance bladder compliance and capacity compared to amitriptyline in women with IC/BPS, suggesting superior efficacy for managing bladder dysfunction in this population.

MP-08.04—Psychosocial Influences on Pain Experience in Bladder Pain Syndrome: The Mediating Role of Social Support 

• Dağlı İsa, Canbolat Muhammed, Öztürk Erdem, Uzel Tuncel
  University of Health Sciences, Dr.Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Türkiye

• Introduction and Objectives: Bladder Pain Syndrome (BPS), also known as Interstitial Cystitis, is a chronic and distressing condition characterized by persistent pelvic pain, urinary urgency, and frequency. The syndrome can significantly impair patients’ physical, psychological, and social well-being. While biological mechanisms underlying pain in BPS are frequently recognized, recent studies suggest that psychosocial factors—particularly social support—may also influence the pain experience. Social support, comprising emotional, instrumental, and informational components, has been associated with improved adjustment in various chronic pain conditions.
  Materials and Methods: This study included 75 participants diagnosed with BPS, categorized into two groups based on perceived social support (Support: n = 37; Non-support: n = 38), as measured by the Multidimensional Scale of Perceived Social Support (MSPSS). Pain intensity and symptom burden were assessed using the Brief Pain Inventory (BPI), Interstitial Cystitis Symptom Index (ICSI), and Interstitial Cystitis Problem Index (ICPI). Pre- and post-treatment scores were compared using appropriate parametric and non-parametric statistical tests.
  Results: Post-treatment BPI scores were significantly lower in the support group (median = 20.00) compared to the non-support group (median = 26.50, p < 0.001). Pain reduction (BPI change) was also greater in the support group (median = 19.00 vs. 13.00, p = 0.002). MSPSS scores confirmed significantly higher perceived support across all subscales in the support group. No significant differences were observed between groups in ICPI and ICSI scores.
  Conclusions: These findings indicate that perceived social support may contribute to improved pain outcomes in individuals with BPS. While symptom-specific indices did not differ significantly, the presence of social support appears to be associated with greater pain relief following treatment, underscoring the potential benefit of integrating psychosocial support into BPS management strategies.

MP-08.05—Zinc Hydrogel for Intravesical Treatment of Urinary Tract Infections via Enhanced Antimicrobial and Mitophagy Modulation 

• Tan Zhimin, He Qiyu, Liu Yu
  West China Hospital, Sichuan University, Chengdu, China

• Introduction and Objectives: Urinary tract infections (UTIs) are common and recurrent. Intravesical hydrogel delivery enables controlled drug release, enhancing local efficacy and minimizing systemic exposure. We report a zinc-based hydrogel for antimicrobial delivery in recurrent bacterial and fungal UTIs.
  Materials and Methods: Zn²⁺-hydrogels were synthesized by mixing hyaluronic acid and N,O-carboxymethyl chitosan (2:8) with Zn²⁺ coordination to form a stable 3D network. Injectability, mechanical strength, and in vivo stability were assessed by rheometry, swelling ratio, and mass retention. Antimicrobial activity was evaluated via inhibition zones, OD600 curves, and MICs; biocompatibility and migration by flow cytometry and scratch assays. Acute bacterial or fungal UTI was induced in female C57BL/6 mice via intravesical E. coli or C. albicans instillation. At 24 h, mice received drug-loaded hydrogel, free drug, blank gel, or vehicle. Infection burden and inflammation were assessed by bladder and kidney CFU counts, voiding tests, peripheral leukocyte levels, TEM for tissue pathology, immunohistochemistry for IL-6 and TNF, and serum ELISA for IL-6, LCN2, and CRP. Mitophagy and repair pathways were analyzed via transcriptomics, Western blotting, flow cytometry, and mitochondrial assays.
  Results: The hydrogel showed thermoresponsive rheology and sustained dual-drug release (>50% at 48 h; prolonged beyond 7 days). It exhibited enhanced antimicrobial activity against E. coli and C. albicans, with reduced MICs and enlarged inhibition zones. Cytocompatibility assays confirmed minimal toxicity and preserved epithelial cell function. Intravesical drug-loaded hydrogel significantly reduced bladder and renal microbial loads (>2 log₁₀), alleviated urinary symptoms, and restored body weight in acute UTI mice within 4 weeks. Compared with free drugs, it reduced systemic inflammatory markers (IL-6, LCN2, CRP) by >40%, and suppressed TNF-α and IL-6 in urothelial and renal tissues. Ultrastructural analysis revealed preserved mitochondrial integrity, reduced inflammation, and enhanced autophagy. Transcriptomic profiling showed upregulation of mitophagy pathways, notably PINK1/Parkin signalling, corroborated by functional and pharmacological assays, supporting hydrogel-mediated activation of mitophagy promotes tissue repair and resolution of infection.
  Conclusions: The zinc-functionalised hydrogel provides local antimicrobial delivery and mitophagy activation, offering dual infection control and repair in complicated UTIs, informing regenerative biomaterial design.

8.2. Unmoderated Standard ePosters

UP-08.01—Antibacterial and Antibiofilm Efficacy of Juniper Essential Oil-Infused Polycaprolactone Nanofibers Against ESKAPE Pathogens 

• Abu Haweeleh Mohannad, Hamdan Ahmad, Zughaier Susu
  Qatar University, College of Medicine, Doha, Qatar

• Introduction and Objectives: Infectious diseases are a major cause of morbidity and mortality, particularly in low- and middle-income countries, with antimicrobial resistance (AMR) posing a significant global threat. The World Health Organization has identified AMR as one of the top 10 global public health threats due to the misuse and overuse of antimicrobials, leading to drug-resistant pathogens. This crisis is particularly severe with ESKAPE pathogens, which are notorious for causing nosocomial infections. In response, there has been a renewed interest in plant-derived antimicrobial therapeutics, such as essential oils.
  Materials and Methods: Juniper essential oil (EO) was extracted from Juniperus communis berries and tested for antibacterial activity against ESKAPE pathogens. The antibacterial efficacy was assessed using bacterial growth curves, where clinical isolates were cultured and treated with varying concentrations of Juniper EO. Antibiofilm activity was evaluated using crystal violet staining in microtiter plates. Additionally, polycaprolactone (PCL) nanofibers impregnated with Juniper EO were fabricated to test their antibacterial efficacy against MRSA. The PCL nanofibers were prepared using air-jet spinning and tested for their structural integrity and antibacterial activity. The antibacterial activity was measured by observing the zone of inhibition on agar plates inoculated with MRSA.
  Results: Juniper EO demonstrated significant antibacterial activity against both Gram-positive and Gram-negative bacteria, including Staphylococcus aureus, MRSA, Klebsiella pneumoniae, and Enterobacter cloacae. The EO also showed dose-dependent antibiofilm activity against S. aureus and E. coli, with higher doses being more effective. PCL nanofibers impregnated with Juniper EO maintained their structural integrity and showed antibacterial activity against MRSA, with the largest zone of inhibition observed at 8% EO concentration. The study also found that Juniper EO significantly reduced biofilm formation by S. aureus and E. coli.
  Conclusions: Juniper essential oil exhibits promising antibacterial and antibiofilm properties against ESKAPE pathogens, and its incorporation into PCL nanofiber bandages could be beneficial for treating surgical site infections and skin ulcers. Further studies are required to develop suitable pharmaceutical formulations for clinical use. The study highlights the potential of Juniper EO in combating AMR, particularly against ESKAPE pathogens, which are notorious for forming biofilms and causing nosocomial infections.

UP-08.02—Antimicrobial Resistance in WHO Aware Classified Antibiotics for Treating Urinary Tract Infections in Diabetic Women 

• Abu Haweeleh Mohannad, Alremawi Izzaldin, Hamdan Ahmad, Zughaier Susu
  Qatar University, College of Medicine, Doha, Qatar

• Introduction and Objectives: Women with diabetes have a higher likelihood of developing urinary tract infections (UTIs), often requiring repeated antibiotic treatments. Frequent antibiotic use can lead to antimicrobial resistance (AMR), a significant public health concern that can result in treatment failures. This study explored the prevalence of AMR and related factors in women with UTIs, comparing those with diabetes to those without.
  Materials and Methods: A cross-sectional study design was conducted using data from the Physionet database, involving 116,902 female participants treated for UTIs. The analysis included their antibiotic use, diabetes status, other health conditions, and hospital admission details. Antibiotics were categorized based on the WHO’s AWaRe criteria. The primary outcome was AMR identified in urine cultures, with its association with diabetes status assessed using multivariable logistic regression.
  Results: The average age of women without diabetes was 52 years (SD = 23), while, for those with diabetes, it was 68 years (SD = 14). The highest resistance rates were observed for cefazolin and levofloxacin within the Access and Watch antibiotic categories, with ciprofloxacin being the most commonly prescribed antibiotic. AMR was found in 35.7% of women with diabetes and 21.3% of those without. Adjusted analyses showed significant associations between AMR and both uncomplicated diabetes (OR 1.14, 95% CI 1.08–1.21) and complicated diabetes (OR 1.54, 95% CI 1.45–1.64), as well as with an increased number of prescribed antibiotics (OR 277.39, 95% CI 253.79–303.17).
  Conclusions: The study highlights the urgent need for targeted antimicrobial stewardship programs for women with diabetes to combat rising AMR rates. Given their increased risk of UTIs and frequent antibiotic use, these patients are particularly vulnerable to AMR. Implementing tailored stewardship initiatives will optimize antibiotic use, improve patient outcomes, and reduce AMR. Educating healthcare providers and supporting policies that promote effective stewardship are essential steps in addressing this public health challenge.

UP-08.03—Bacterial Colonization of Ureteral Stents: Lessons from Real-Life Culture Data 

• Othmane Mouslim, Taha Zariouh, Achraf Chatar, Mohammed Amine Lakmichi, Zakaria Dahami, Ismail Sarf
  University Hospital Center (CHU), Marrakech, Morocco

• Introduction and Objectives: Double-J ureteral stents are indispensable tools in modern urology, widely used for temporary relief of upper urinary tract obstruction. While their clinical utility is well recognized, extended indwelling durations are associated with bacterial colonization, posing a risk for local and systemic infections, including urosepsis.
  Materials and Methods: We conducted a prospective study over an 18-month period (August 2018–January 2020) at the Department of Urology, Mohammed VI University Hospital in Marrakech, Morocco. Fifty-four patients who underwent elective stent removal were included. Extracted stents were processed under sterile conditions and cultured using a standardized laboratory protocol. Patient demographics, comorbidities, indication for stent placement, stent type, and duration of implantation were documented. Statistical analysis was performed to assess correlations between colonization and patient/stent characteristics.
  Results: Colonization was observed in 61.1% of the retrieved stents. Gram-negative bacilli accounted for a large proportion of isolates, with Klebsiella pneumoniae, Enterobacter cloacae, and Pseudomonas aeruginosa being most prevalent. Gram-positive cocci, particularly coagulase-negative Staphylococcus and Enterococcus faecalis, were also frequently detected. Concerning antimicrobial susceptibility, notable resistance to third-generation cephalosporins and carbapenems was found among Gram-negative organisms, including multidrug-resistant strains. Among the studied variables, the duration of stent placement emerged as the only statistically significant factor correlated with colonization (mean duration: 323 vs. 161 days, p = 0.041). No significant associations were identified regarding age, sex, diabetes, or chronic kidney disease.
  Conclusions: Our findings indicate that bacterial colonization of ureteral stents is common, particularly when indwelling times are prolonged. The microbial spectrum is diverse, with a significant presence of antibiotic-resistant pathogens. These results underscore the necessity of timely stent removal and reinforce the role of microbiological surveillance in guiding prophylactic and therapeutic decisions. In the context of rising antimicrobial resistance, minimizing stent duration appears to be a simple yet crucial strategy to reduce infection risk in urological patients.

UP-08.04—Clinical Spectrum, Diagnostic Approaches, and Surgical Management of Genitourinary Tuberculosis: A Retrospective Study from a Tertiary Care Center 

• Patel Aquib Javed, Navriya Shiv, Panugothu Leela Madhav, Choudhary Gautam, Singh Mahendra, Bhirud Deepak, Sandhu Arjun
  All India Institute Of Medical Sciences, Jodhpur, Rajasthan, India, Jodhpur, India

• Introduction and Objectives: Genitourinary tuberculosis (GUTB) continues to pose significant public health challenges, especially in endemic regions. It presents with varied clinical features, complicating both diagnosis and treatment. This study aims to analyze the clinical presentations, diagnostic approaches, surgical interventions, and outcomes of GUTB based on a retrospective study from a tertiary care center.
  Materials and Methods: A retrospective analysis of GUTB cases managed in a tertiary teaching hospital’s urology department was conducted from January 2021 to July 2024. Patient demographics, clinical symptoms, diagnostic tools, and surgical interventions were reviewed. Surgical procedures, including nephrectomy, ureteric reimplantation, and augmentation cystoplasty, were used based on disease severity alongside standard anti-tubercular therapy (ATT). Data were analyzed using SPSS.
  Results: The study included patients aged 10–76 years (mean age 39), with a slight female predominance (57.6%). Storage lower urinary tract symptoms (LUTS) were the most frequent complaint (66.6%), with urinary frequency being the most common. Hematuria (27.2%) and flank pain (21.2%) were also observed. Eleven patients (33.3%) had multiple symptoms. The kidney was the most commonly affected organ (54.5%), followed by the ureter (45.4%) and bladder (42.4%), with multi-organ involvement in 57.6% of cases. Radiological imaging was the most common diagnostic modality (42.4%), followed by CBNAAT (30.3%). Urine AFB was positive in 21.2% and mycobacterial culture in only 6% of cases. Major surgeries included augmentation cystoplasty (15.1%) and ureteric reconstruction (9.09%). Among minor procedures, DJ stenting was most frequent (24.24%), followed by PCN and stent replacement (15.15% each).
  Conclusions: Timely diagnosis, a multidisciplinary approach, and individualized surgical management are key to optimizing outcomes in GUTB. While surgical reconstruction can be complex and resource-intensive, it significantly improves quality of life when paired with ATT.

UP-08.06—Delayed Presentation of Genito-Urinary Tuberculosis as Scrotal Abscess 

• Sofi Junaid, Hellawell Giles
  LNWH, Harrow, United Kingdom

• Introduction and Objectives: England remains a low-incidence TB country. People born outside the UK account for most TB notifications in England (76.4%), with most (86%) occurring more than 2 years after UK entry. TB has been described as the second great mimicker (after syphilis), complicating diagnosis and treatment. Genitourinary tuberculosis (GUTB) is the second most common form of extrapulmonary tuberculosis after lymph node involvement. GUTB is known to present itself after prolonged latent period ranging up to 5 decades. Epididymis is the second most common GU site of hematogenous seeding after the kidney, and one third of the patients have bilateral involvement, having consequent effects on fertility.
  Materials and Methods: We present a case of a 31 year male, with an initial diagnosis of epididymo-orchitis progressing to scrotal abscess not improving with two courses of antibiotics. The patient was not immunocompromised, reported no fever or night sweats or dysuria but reported weight loss for last 2 months. He had been in the UK for more than 8 years by this time. On examination there was fluctuant swelling of right scrotal wall draining pus. Lower pole of right testicle felt tense, irregular, hard, and epididymis tense and hard. Left testicle felt unusually firm with irregular surface. No inguinal/ axillary/supraclavicular lymphadenopathy was felt. Initial concern of malignancy led to an urgent Ultrasound showing significant enlargement and heterogeneity of the epididymal tail, which appears predominantly hypoechoic with increased vascularity. Hypoechoic material extends to and indents the lower pole of the right testicle and through a fistulous tract to the scrotal wall and skin surface. Large heterogeneous collections demonstrating predominantly peripheral vascularity are seen within the left testicular parenchyma, continuous with the enlarged heterogeneous, hypoechoic, hypervascular left epididymal tail.
  Results: Chest X-ray was clear. PUS PCR & Urine Culture for AFB was positive for TB. On review of medical history it was discovered that a chest X-ray done as part of contact tracing in 2017 had shown unilateral pleural effusion after a positive Montaux test.
  Conclusions: It was felt that this was a delayed presentation of untreated TB, and antitubercular drugs were commenced. Long term effects on fertility will need to be monitored.

UP-08.07—Diagnostic and Therapeutic Yield of Cystoscopy and Prostatic Massage in Chronic Prostatitis: A Retrospective Review of 200 Cases 

• Asif Muhammad, Khan Muhammad
  Lady Reading Hospital, Peshawar, Pakistan

• Introduction and Objectives: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has been a challenging condition regarding its diagnosis and approach towards its treatment. This retrospective study reviews the outcome of 200 cases with chronic prostatitis who underwent cystoscopy and prostatic massage, in terms of its diagnostic utility and potential therapeutic implications.
  Materials and Methods: A total of 200 patients with CP/CPPS underwent cystoscopy for evaluation and cystoscopy guided prostatic massage. Cystoscopic findings were noted in all patients, and at the same time prostatic massage was performed to test the expressed prostatic secretions (EPS) for inflammatory cells and bacterial cultures. Patients were evaluated in terms of clinical outcome, improved symptomatology and correlation between cystoscopic and microbiological findings.
  Results: Cystoscopy revealed bladder mucosal abnormalities such as erythema (55%), trabeculation (28%), and prostatic urethral changes (45%). Prostatic massage led to symptom improvement in 35% of cases, while 20% reported transient symptom exacerbation. EPS analysis showed inflammatory cells in 55% of cases, and bacterial growth was identified in 10% patients, guiding targeted antibiotic therapy. Patients with abnormal cystoscopic findings were more likely to have persistent symptoms compared to those with normal cystoscopic results (p < 0.05).
  Conclusions: Cystoscopy plays a vital role in identification of bladder mucosal changes, prostatic urethral abnormalities associated with CP/CPPS, but its role in guiding the treatment for chronic prostatitis is still unclear. Cystoscopy guided prostatic massage helps in diagnosis through EPS analysis and provides symptomatic relief in some of the patients. Further prospective studies are needed to establish the clinical utility of these procedures in diagnosing and managing CP/CPPS.

UP-08.08—Emergent Ureteric Stent Versus Percutaneous Nephrostomy Tube Placement in Patients with Urosepsis: A Real-World Population-Based Study in Ontario, Canada 

• Elmansy Hazem ¹, Savage David W. ², Cerasuolo Joshua O. ³, Lalva Tasneem ³, Mckay Rachel ⁴, Berjaoui Mohamad B. ⁵, Zakaria Ahmed S. ¹, Alhelal Saud ¹
  ¹ Northern Ontario School of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada, ² Northern Ontario School of Medicine, Thunder Bay Regional Health Centre, Institute for Clinical Evaluative Sciences (ICES) North, Health Sciences North Research Institute, Sudbury, ON, Canada, ³ Institute for Clinical Evaluative Sciences (ICES) North, Health Sciences North Research Institute, Sudbury, ON, Canada, ⁴ Queen’s University, Kingston, ON, Canada, ⁵ University of Toronto, Toronto, ON, Canada

• Introduction and Objectives: We aimed to examine a population-based cohort of patients diagnosed with urosepsis secondary to urolithiasis, comparing mortality rates between those treated with emergent ureteric stents versus percutaneous nephrostomy tubes (NT) during hospitalization and within 90 days post-discharge.
  Materials and Methods: We conducted a retrospective cohort study of adult patients hospitalized in Ontario, Canada, between April 2010 and December 2022, with an admitting diagnosis of urosepsis secondary to obstructive urolithiasis. Patients with sepsis who had no concurrent urolithiasis or a history of dialysis, end-stage renal disease or transplant, cystectomy, or genitourinary cancers were excluded. We compared all-cause mortality during hospitalization and at 90 days post-discharge between those who underwent decompression via a percutaneous NT versus a ureteric stent, using generalized linear and Cox regression models, respectively. Confounders were balanced using propensity weighting to ensure a fair and unbiased comparison and minimize treatment selection bias risk. Furthermore, our 90-day analysis accounted for definitive management received after the initial hospitalization.
  Results: Among the 4,573 patients included in the study, 620 underwent NT placement, and 3,953 received a ureteric stent. After adjusting for confounders, patients who received an NT had a 2.84-fold higher risk of all-cause in-hospital mortality (RR: 2.84 [1.98, 3.92]) and 1.52-fold higher risk of 90-day post-discharge mortality (HR: 1.52 [1.01, 2.30]) compared to those who received a ureteric stent. Furthermore, patients who received definitive management had a 62% lower risk of all-cause mortality than those who did not (HR: 0.38 [0.23, 0.63]).
  Conclusions: While both interventions aim to relieve obstruction and facilitate the resolution of infection, they differ in terms of invasiveness and complication rates. NTs, however, are linked to a higher risk of all-cause in-hospital mortality and an increased risk of 90-day post-discharge mortality. Understanding the differences in outcomes can inform clinical decision-making and optimize treatment strategies for patients with urosepsis. Randomized controlled trials are warranted.

UP-08.09—Evaluation of Sysmex UF-5000 Bacterial Count for UTI Diagnosis: A Multicenter Study 

• Choi Seung-Kwon ¹, Lee Jeong Woo ², Choi Jin Bong ³
  ¹ Seoul Medical Center, Seoul, Republic of Korea, ² Kyung Hee University College of Medicine, Seoul, Republic of Korea, ³ The Catholic University of Korea College of Medicine, Seoul, Republic of Korea

• Introduction and Objectives: Urinary tract infections (UTIs) are among the most common bacterial infections. Rapid and accurate diagnosis is essential for guiding appropriate antimicrobial treatment. The Sysmex UF-5000, an automated urine flow cytometer, provides bacterial counts through flow cytometry. This multicenter study aimed to evaluate the diagnostic performance of UF-5000 in detecting UTIs based on bacterial count, stratified by clinical subtype.
  Materials and Methods: Urine samples were retrospectively collected from three hospitals. All specimens were analyzed with the UF-5000 within 2 h of collection. UTI diagnosis was based on standard urine culture. Diagnostic performance of the UF-5000 bacterial count was assessed using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Subgroup analysis was conducted for cystitis, uncomplicated acute pyelonephritis (APN), and complicated APN.
  Results: Out of 556 cases, 468 (84.2%) were culture-positive. Gram-negative bacteria were predominant (69.7%), with E. coli as the most common pathogen. The UF-5000 bacterial count demonstrated strong diagnostic accuracy for UTI (AUC 0.81, cut-off 463.7). By UTI subtype, the diagnostic performance of bacterial count was as follows: Cystitis (n = 223, AUC 0.81, Sensitivity 71.1%, Specificity 80.8%, PPV 96.6%); Uncomplicated APN (n = 289, AUC 0.81, Sensitivity 81.0%, Specificity 76.9%, PPV 94.1%); Complicated APN (n = 44, AUC 0.85, Sensitivity 75.8%, Specificity 90.9%, PPV 96.2%); Overall: (n = 556, Sensitivity 76.2%, Specificity 79.8%, PPV 95.2%, NPV 39.0%). Bacterial count distribution significantly differed among UTI subtypes (p = 0.046 for cystitis, p = 0.024 for complicated APN).
  Conclusions: The UF-5000 bacterial count shows high sensitivity and specificity in detecting UTI, with excellent positive predictive values across all clinical subtypes. These findings support the utility of UF-5000 as a rapid and reliable tool for UTI screening in clinical practice.

UP-08.10—Exploring AI Applications in the Control of Bacterial Infections 

• Abu Haweeleh Mohannad, Hamdan Ahmad, Rajha Humam
  Qatar University, College of Medicine, Doha, Qatar

• Introduction and Objectives: Artificial intelligence (AI) has become an invaluable tool in healthcare, significantly advancing the diagnosis, treatment, monitoring, prevention, and testing of diseases. Despite its broad adoption, the role of AI in infection control, particularly bacterial infections, lacks clinical consensus. This scoping review seeks to explore the characteristics of AI applications in bacterial infection control.
  Materials and Methods: Utilizing the Arksey and O’Malley framework, a comprehensive search was conducted across PubMed, Embase, and Web of Science, yielding 1165 articles. Of these, 54 articles met the eligibility criteria and were analyzed. The review identified five thematic scopes: countries, aim, type of AI, advantages, and limitations.
  Results: The analysis revealed a concentration of studies from high-income countries, particularly the USA, indicating a geographic imbalance in AI research and application. The primary objectives of these studies were pathogen identification and infection risk assessment, underscoring AI’s potential for early detection and proactive management of infections. Machine learning emerged as the most commonly used AI technology, valued for its ability to handle complex datasets and deliver predictive insights. The advantages of AI applications were most evident in predictive modeling and risk assessment, assisting healthcare professionals in anticipating infection trends and optimizing resources. However, a notable limitation was the generalizability of AI models, which often faced challenges when applied to diverse populations or healthcare settings, highlighting the need for more adaptable models. Additionally, while high-income countries lead AI research, extending these technologies to low-income regions is crucial, where they could significantly enhance infection control efforts.
  Conclusions: Strengthening AI applications in infection control is essential, particularly in low-income countries. Investing in AI models with proven efficacy is vital to maximize their utility and address existing challenges. This review enhances understanding of AI’s role in bacterial infection control, advocating for broader adoption and refinement to improve global health outcomes.

UP-08.11—Infection Rates of Trans-Perineal Versus Trans-Rectal Prostate Biopsy: A Middle Eastern Tertiary Center Experience: Time for a Change? 

• Nasrallah Oussama, Nasr Rami, Herrera Maya, Fawaz Mohammad, Watfa Mohamad, El Mir Mohamad, El Hajj Albert, Bachir Bassel, Bulbul Muhammad, Khouzami Riad
  American University of Beirut Medical Center, Beirut, Lebanon

• Introduction and Objectives: Prostate cancer is the most diagnosed cancer in men with transrectal ultrasound-guided (TRUS) biopsy being the most frequently used method of tissue diagnosis in the past. With the introduction of the new modality of trans-perineal (TP) ultrasound-guided prostate biopsy, urologists and radiologists adopted this new technique for the decreased rate of complications such as urinary tract infections, bacteremia, sepsis and the avoidance of antimicrobial prophylaxis.
  Materials and Methods: Retrospective data was collected on patients from our medical records from May 2019 till December 2023 at the American University of Beirut Medical Center. The data included adult male patients aged 18 years and above undergoing TP or TRUS prostate biopsy. Patients with positive urine culture before biopsy were excluded. Electronic medical records, pathology and laboratory reports were reviewed to collect patient related data including age, BMI, smoking, alcohol consumption, medical history and comorbidities. In addition, variables related to the procedure type, the target lesion location, antibiotic prophylaxis, bowel preparation, number of cores taken, and laterality of the tumor were included.
  Results: A total of 745 patients underwent an ultrasound guided prostate biopsy performed by 6 attending urologists at AUBMC. 157 (21.1%) patients underwent TRUS biopsy, while 588 (78.9%) underwent TP biopsy. 13 patients (1.7%) developed UTI within one month of the biopsy. 6 of them had TRUS (4.1%), and 7 had TP (1.2%) with p = 0.03. Four patients required hospital admission for fever and bacteremia, all of which had undergone TRUS biopsy with hospital stay from 2–5 days receiving meropenem, ciprofloxacin, cefixime or Bactrim.
  Conclusions: TP prostate biopsy carries a lower risk of infectious complications and requires no antibiotic prophylaxis compared to TRUS biopsy of the prostate. These results advocate the superiority of the use of TP biopsy over TRUS biopsy.

UP-08.12—Intravesical Glycosaminoglycan Replenishment Therapy: A Targeted Approach to Managing Chronic Bladder Pain Conditions 

• Khan Hira, Jacob Dayan, Ekpeno Inyang, Chitteti Pragnitha, Nadeem Mehwash
  James Cook University Hospital, Middlesbrough, United Kingdom

• Introduction and Objectives: Intravesical glycosaminoglycan replenishment therapy (iGRT) is designed to restore the bladder’s epithelial barrier function, thereby reducing exposure to urinary irritants and mitigating chronic inflammation. This study aimed to assess the clinical outcomes of iAluRil^®, a formulation containing hyaluronic acid and chondroitin sulfate, in patients with chronic bladder pain syndromes, including bladder pain syndrome (BPS), recurrent urinary tract infections (UTIs), and cystitis secondary to radiation or Bacillus Calmette–Guérin (BCG) therapy.
  Materials and Methods: This research analyzed a prospectively maintained database of patients treated with iGRT between August 2019 and February 2023. Comprehensive demographic and clinical data were collected, including patients’ age, gender, clinical diagnosis, co-morbidities, indications for therapy, and diagnostic workup. Treatment outcomes were assessed using the Patient Global Impression of Improvement (PGI-I) scale and changes in quality of life (QoL) metrics before and after therapy. Statistical analysis was performed using SPSS version 22 to identify significant associations and trends.
  Results: Sixty patients met the inclusion criteria, with a median age of 51 years (range: 18–85) and a male-to-female ratio of 1:5. Indications for treatment included BPS (57%), recurrent UTIs (35%), and radiation/BCG-induced cystitis (8%). There were no statistically significant differences between diagnostic groups based on age, gender, or comorbidities (p = 0.6). After a mean follow-up of 16 months (minimum 6 months for all participants), 80% (48/60) of patients reported improvement per the PGI-I scale. The BPS subgroup demonstrated the highest response rate, with 85% reporting improved QoL. A statistically significant association was observed between female gender and chronic bladder pain syndromes (p < 0.001), though no correlations were found between age and PGI-I scores or comorbidity and treatment response.
  Conclusions: Intravesical therapy with iAluRil® appears to be effective in improving symptoms and patient-reported outcomes among individuals with chronic bladder pain, especially in those with BPS. These findings support the role of iGRT as a valuable targeted approach in symptom management for this challenging urological cohort.

UP-08.13—Investigating the Therapeutic Mechanism of Uro-Vaxom^® (Om-89) in a Murine Model of Bacterial Cystitis 

• Lim Donghoon ¹, Choi Hae Woong ²
  ¹ Chosun University Hospital, Gwangju, Republic of Korea, ² Korea University, Seoul, Republic of Korea

• Introduction and Objectives: Uro-Vaxom^® (OM-89) is a non-antibiotic immunomodulator clinically proven effective for preventing recurrent urinary tract infections (UTIs). Despite substantial clinical evidence supporting its efficacy, the precise immunological and therapeutic mechanisms of Uro-Vaxom^® remain poorly understood. This study aims to clarify the underlying mechanisms through which Uro-Vaxom^® exerts its beneficial effects in a murine model of bacterial cystitis.
  Materials and Methods: A well-established murine model of bacterial cystitis was employed, in which female C57BL/6 mice were intravesically infected with uropathogenic Escherichia coli (UPEC). Following infection, mice received oral administration of Uro-Vaxom. The therapeutic efficacy was assessed by evaluating the following parameters: (1) Bacterial load, measured by counting colony-forming units (CFUs) of UPEC in bladder tissue. (2) Pain response, evaluated by assessing mechanical allodynia using von Frey filament tests. (3) Bladder function, determined by voiding spot analysis (VSA) to examine changes in micturition patterns. (4) Histopathological changes, examined through immunohistochemical analysis of nociceptive nerve expression in bladder tissue. (5) Immune response, assessed by flow cytometry to quantify bladder infiltration of CD11b+ Ly6G+ neutrophils and CD11b+ Ly6C+ monocytes.
  Results: Treatment with Uro-Vaxom^® significantly decreased bladder bacterial load compared to untreated controls (p < 0.05). Additionally, Uro-Vaxom^®-treated mice exhibited significantly reduced pain sensitivity (mechanical allodynia; p < 0.01). Improvements in voiding patterns indicative of better bladder function were also observed. Histological analyses showed marked decreases in nociceptive nerve expression in the bladder tissues of treated mice. Flow cytometry revealed significantly reduced infiltration of CD11b+ Ly6G+ neutrophils and CD11b+ Ly6C+ monocytes, suggesting an immunomodulatory effect of Uro-Vaxom^® treatment.
  Conclusions: Uro-Vaxom^® treatment significantly reduced bacterial load and modulated immune responses in a murine model of bacterial cystitis. Notably, this study provides novel evidence that Uro-Vaxom^® also alleviates pain sensitivity and improves bladder function, aspects which have previously been underexplored. These findings broaden our understanding of the therapeutic benefits of Uro-Vaxom^® beyond infection prevention, supporting its clinical potential in managing symptomatic UTIs.

UP-08.14—Mixed Growth in Urine Before Urological Operation—Antibiotic or No Antibiotic? 

• Habib Abul, Choudhury Sadiq, Rahman Shahinur, Kavia Rajesh
  London North West University Healthcare NHS Trust, Harrow, United Kingdom

• Introduction and Objectives: It is a standard practice to treat positive urine culture before urological operation. However, there is no uniformity of practice among urologists, also no clear recommendation regarding mixed growth in urine culture before operation. This study was aimed to audit the prescription of perioperative antibiotic in those patients and to check if that reduces the risk of postoperative infection.
  Materials and Methods: A retrospective analysis was conducted on patients undergoing various urological operations and had mixed growth in urine culture before operation. Patients were identified from consecutive operating lists from December 2024 to February 2025 under Urology, Northwick Park Hospital, London. Incidence of infections was checked for up to one month after the operation. Urine microscopy and culture, use of perioperative antibiotic, associated comorbidities, type of operations were noted. Data were compiled and analysed using MS Excel; chi-square test was performed for statistical significance at 95% confidence interval.
  Results: Total 100 patients were included in the study. All patients had standard antibiotic prophylaxis—one to three doses depending on the nature of operation. 46 (46%) patients were treated with antibiotic before operation, and 54 (54%) patients did not have any preoperative course of antibiotic. 36 (36%) patients also had a full course of antibiotic after operation, but 64 (64%) patients did not continue antibiotic apart from standard prophylaxis. Postoperative infections were reported in 17 (17%) patients. 9/17 (53%) patients with infection received preoperative antibiotic—showing no significant (p > 0.05) impact of preoperative antibiotic on infection. 8/17 (47%) patients had infection despite continuing full course of antibiotic after operation, also statistically not significant (p > 0.05). 13/17 (76.5%) patients with infection had Pyuria in preoperative urine. Also, 12/17 (70.5%) patients had comorbidities, Diabetes, metastatic cancer, renal failure—either one or in combination. Both were statistically significant (p < 0.05).
  Conclusions: Prolonged perioperative course of antibiotic does not seem to reduce the risk of infection in patients having mixed growth in preoperative urine cultures. However, extra precaution should be taken if associated pyuria and certain comorbidities. Study with larger sample size or randomised trial would be helpful to make a powerful recommendation.

UP-08.15—Predictors of Treatment Failure in Recurrent UTIs: Implications for Urological Practice 

• Jacob Dayan, Khan Hira, Chitteti Pragnitha, Morris-laverick Jayne, Bezemer Stephanie, Nadeem Mehwash
  James Cook University Hospital, Yarm, United Kingdom

• Introduction and Objectives: Recurrent urinary tract infections (rUTIs) remain a complex clinical challenge, particularly when standard treatments fail. Both patient-specific (e.g., comorbidities, immune status) and disease-related factors (e.g., multidrug-resistant organisms) are suspected to influence outcomes. This study aims to identify predictors of treatment failure in patients managed for rUTIs within a specialist urology setting.
  Materials and Methods: We reviewed our prospectively maintained Complex UTI Clinic database to identify the patients who were referred to us between April 2021 to March 2023. Patient demographics and comorbidities, urine culture and antibiotic sensitivities, investigations and intervention performed, hospital admission with urosepsis, treatment received with its outcome {symptomatic and Quality of life (QoL)} were recorded. Statistical analysis was performed using SPSS^® 26. Univariate and multivariate analyses were performed using chi-square and Linear regression model respectively.
  Results: 211 patients (male: 22 & female: 189) included with mean age of 58.3 ± 16 years. 185 (87.7%) patients had UTI resolution while 26 (12%) failed treatment at a mean follow-up of 10 months. On univariate analysis, source of referral (GP vs. Specialist), immunosuppression, hospital admission with urosepsis, and non-E. Coli growth on urine culture and sensitivity, multi drug resistance, abnormal cystoscopy, and need for tertiary treatment (failure to 1st and second-line treatment) were found to be statistically significant (p < 0.05). On corrected general linear regression model, source of referral, hospital admission with urosepsis, and need for tertiary treatment reached the statistical significance (p < 0.05).
  Conclusions: This study highlights key clinical and microbiological predictors of treatment failure in patients with rUTIs. Early identification of high-risk individuals—particularly those referred from primary care, hospitalized with urosepsis, or requiring escalation beyond second-line therapy—may enable more personalized care pathways and improve outcomes in urological practice.

UP-08.16—Preliminary Experience with Uromune^® in Cornwall Aimed at Decreasing the Frequency of Urinary Tract Infections (UTIs) in Patients with Recurrent UTIs: A Two-Year Follow-Up 

• Iqbal Nadeem ¹, Hotston Matthew ²
  ¹ Newham University Hospital, London, United Kingdom, ² Royal Cornwall Hospital, Truro, United Kingdom

• Introduction and Objectives: Recurrent urinary tract infection (UTI) has been posing a significant challenge to urologists worldwide. It has adverse impact on mental health of patient and an additional economic burden on national health systems. Till now there has been no consensus or clarity in follow up protocols and treatments strategies of such difficult to treat UTIs. This study was first of its kind in our county to assess the efficacy of Uromune in reducing frequency of UTIs.
  Materials and Methods: We reviewed records of all 33 patients who had failed all treatment options for recurrent urinary tract infections (UTIs) and then received Uromune vaccine between 2021 and 2023. Their mean age was 59.73 years. They were subjected to Uromune sublingual vaccine for period of three months. They were followed up for 12 months after treatment. Number of UTIs before and after Uromune intervention was recorded, and paired t-test was utilised to determine statistical significance of decrease in number of UTIs post Uromune.
  Results: There were 4 males and 29 ladies in the study. Twenty-three of the women were post-menopausal. One patient could not continue Uromune treatment due to side effects. Mean number of UTIs before and after Uromune treatment were 4.24 and 1.94 respectively (p value < 0.001). Eleven patients (34.37%) felt subjectively better post Uromune treatment. Twelve (36.36%) patients had to restart long term antibiotics even after Uromune.
  Conclusions: In our experience Uromune showed significant decrease in frequency of UTIs. More research is needed on longer follow ups and adjunct treatments internationally.

UP-08.17—Seasonality of Urinary Tract Infections in Arid Regions—Southern Morocco’s Example 

• Guebbas Salim, Chatar Achraf, Lakmichi Mohamed Amine, Dahami Zakaria, Sarf Ismail, Bajji Yassir
  Mohamed VI University Hospital, Marrakech, Morocco

• Introduction and Objectives: Urinary tract infections present a significant public health concern due to their impact on health, mortality rates, and the associated costs of treatment. Various risk factors contribute to the development of these infections. This study seeks to assess how seasonal changes influence the risk of UTIs.
  Materials and Methods: A retrospective analysis was carried out on all urine cultures (ECBU) conducted in our department from January 2022 to December 2023. The data were classified by month and season of testing, taking into account patient gender and age range as clinical variables. Additionally, monthly average temperatures in our region were recorded. Data analysis was conducted using SPSS version 21.0.
  Results: A total of 1388 urine cultures were analyzed. Among these, 60.7% of patients were male, resulting in a sex ratio of 1.54. The average age was 58.6 years. Within the samples, 38.7% (n = 538) were sterile, 30.1% (n = 418) were polymicrobial, and 18.66% (n = 258) tested positive. A notable increase in positive cultures was noted during the summer months (June, July, and August each year) (p = 0.003) compared to autumn and winter, peaking at 27.78% positive cultures in the summer of 2022 (Positive culture rates: Winter 2022: 22.92%, Spring: 26.4%, Summer: 27.7%, Autumn: 13.51%, Winter 2023: 12.8%, Spring: 22.5%, Summer: 22.5%, Autumn: 15.2% of seasonal totals). However, seasonal variations did not impact the rate of sterile cultures (p = 0.428). The most frequently identified organism was Escherichia coli (31.7%, n = 82), showing a significant rise in prevalence during the summer months (p = 0.005). During the study period of 2022–2023, an analysis of the monthly average temperatures in the Marrakech-Safi region revealed a notable connection between temperature and culture outcomes (p = 0.014). Similarly, there was a significant correlation between temperature and E. coli positivity (p = 0.011). Notably, when temperatures exceeded 40 °C, 22% of positive urine cultures were linked to E. coli, compared to a mere 1.9% when temperatures were below 20 °C.
  Conclusions: High temperatures during the summer season pose a significant risk factor for urinary infections, especially in our region. In an arid climate, poor hygiene conditions, recent sexual activity, dehydration, and metabolic diseases during this time could exacerbate their morbidity.

UP-08.18—Urological Manifestations of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis and Their Management: A Scoping Review 

• Williams Zoe, Kim Paul, Canagasingham Ashan, Kovacic James, Shepherd Andrew, Dhar Ankur, Chung Amanda
  North Shore Urology Research Group, Sydney, Australia

• Introduction and Objectives: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, potentially fatal immunological conditions affecting the skin and mucosa. Urological manifestations of SJS/TEN are uncommon, and preventative measures are unclear. This scoping review identifies the spectrum of urological manifestations of SJS/TEN and describes management and prevention strategies.
  Materials and Methods: MEDLINE and Embase via Ovid were searched for keywords and MeSH terms relevant to urological manifestations of SJS/TEN. Two reviewers independently screened 307 abstracts. Summary articles, clinical guidelines, case reports/series, and comparative studies published in English were included if they addressed the nature, outcomes, management, and prevention strategies of urological manifestations of SJS/TEN.
  Results: Eighty-four studies were included in the review. Male genital involvement occurs in up to two thirds of patients with SJS/TEN. Urological manifestations of SJS/TEN include cutaneous lesions of the penis and scrotum, mucositis, erosion and ulceration, haematuria with clot retention, phimosis, and balanitis. Urethral sequelae are present in 5.7% and 9.6% of patients with SJS and TEN respectively and include urethritis, strictures, and synechiae. Isolated reports of ureteric strictures are described. Outcomes include re-epithelialisation of lesions, secondary infection, chronic balanitis, phimosis, urinary obstruction, sexual dysfunction and septic shock. General SJS/TEN management principles of ceasing causative agents, initiating fluid resuscitation and high dose immunosuppressant therapy, and monitoring for skin changes should be implemented in a tertiary centre with multidisciplinary involvement. Cross-sectional imaging and monitoring of renal function should be performed to detect upper urinary tract manifestations. Indwelling catheterisation is recommended to manage and prevent urethral strictures. Early examination of uncircumcised male patients for preputial retractability is recommended to risk-stratify adhesional phimosis. Adhesions at the external urethral orifice should be lysed with paraffin ointment. Patients should be reviewed for up to 12 months post-recovery with physical examination, anatomical and/or functional assessments to monitor for long-term manifestations.
  Conclusions: SJS/TEN has the potential to affect a range of urological structures and cause significant harm. This review serves as a resource to inform care practices of urological manifestations of SJS/TEN. Early urological referral and consideration of urinary catheterisation, manual lysis of adhesions, foreskin retractability, and investigation for ureteric involvement are recommended.

UP-08.19—Validation of the Persian Version of the Acute Cystitis Symptom Score (ACSS) in Women with Uncomplicated Acute Cystitis 

• Hajebrahimi Sakineh ¹, Sharifzadeh Nasim ², Salehi-Pourmehr Hanieh ³, Hassanzadeh Kamaleddin ⁴, Naber Kurt ⁵, Alidjanov Jakhongir ⁶, Mohammad Rahimi Mohsen ⁴
  ¹ Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Rep., ² Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Rep., ³ Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Rep., ⁴ Department of Urology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran, Islamic Rep., ⁵ Department of Urology, Technical University of Munich, Munich, Germany, ⁶ Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany

• Introduction and Objectives: This study aimed to translate and validate the Acute Cystitis Symptom Score (ACSS) into the Persian (Farsi) language in accordance with international guidelines.
  Materials and Methods: This prospective, cross-sectional, observational cohort study involved 100 Persian-speaking women: 50 patients diagnosed with uAC based on clinical symptoms and microbiological confirmation (≥10⁵ CFU/mL of uropathogens) and 50 age-matched control participants without suspected urinary tract infection. The linguistic validation of the ACSS followed international guidelines, including forward and backward translations, reconciliation, and expert review. Participants completed the Persian ACSS. UAC patients completed the questionnaire at baseline (BL) and post-treatment follow-up (FU). Control participants completed it only at BL. Statistical analyses assessed internal consistency (Cronbach’s alpha, split-half reliability), diagnostic performance (sensitivity, specificity, accuracy, Youden’s index, ROC curve analysis), and compared ACSS domain and item scores between groups (Student’s t-test, Welch correction, Mann-Whitney U test, chi-square test). Changes in symptom severity and quality of life in uAC patients from BL to FU were also evaluated. Statistical significance was set at p < 0.05.
  Results: The Persian ACSS demonstrated good internal consistency across its domains. The receiver operating characteristic (ROC) curve analysis of the “Typical” domain summary score revealed high diagnostic accuracy for uAC (Figure 1). Using a cut-off score > 6, the Persian ACSS achieved a sensitivity of 97% and a specificity of 96% for diagnosing uAC. Significant differences (p < 0.05) were observed in the “Typical,” “Differential,” and “Quality of Life” domain scores, as well as most individual item scores, between uAC patients at baseline and control participants. Among the 40 uAC patients who completed the FU assessment, significant improvements (p < 0.05) were noted in symptom severity and quality of life across most ACSS items and domain scores compared to their baseline. However, at follow-up, some “Typical” and “Quality of Life” item scores remained significantly different (p < 0.05) from those of the control group at baseline. The “Dynamics” domain at FU indicated that 75.0% of patients reported feeling “back to normal” or “much better” post-treatment.
  Conclusions: The Persian version of the ACSS demonstrated excellent psychometric properties, including high reliability and validity for the diagnosis of uAC in Persian-speaking women.

UP-08.20—Volcanic Eruption of Pus: A Dramatic Case of Prostate Abscess Successfully Treated with Transurethral Resection 

• Khalil Waqas, Islam Jawad, Sheikh Mazhar
  Blackpool Teaching Hospitals, Blackpool, United Kingdom

• Introduction and Objectives: Prostate abscess is a rare but serious complication of bacterial prostatitis, predominantly caused by Gram-negative organisms like *Klebsiella pneumoniae* and *Escherichia coli*. Risk factors include diabetes, immunosuppression, and advanced age. The European Association of Urology (EAU) and British Association of Urological Surgeons (BAUS) emphasize prompt imaging (CT/MRI) and a combination of antibiotics and drainage for management, with surgical intervention reserved for refractory cases (EAU Guidelines 2023, BAUS 2022).
  Materials and Methods: Case Presentation: A 65-year-old male with type-II diabetes presented with sepsis on November 1, 2024. Initial CT (November 4) revealed a prostate abscess. Despite broad-spectrum antibiotics, his condition deteriorated, and a repeat CT (November 8) showed abscess progression into the left internal obturator muscle and anorectal fossa, alongside a 1.2 cm right vesicoureteric junction (VUJ) stone. Per NICE guidelines (NG111), his direct oral anticoagulant was withheld for 48 h. Transperineal drainage was attempted but failed, prompting urgent transurethral resection of the prostate (TURP) for abscess drainage and right JJ stent insertion. Intraoperatively, a “volcanic eruption” of pus was observed, confirming successful decompression.
  Results: Postoperatively, the patient improved rapidly, with normalized inflammatory markers and resolved sepsis. Cultures identified *Klebsiella pneumoniae*, guiding targeted antibiotic therapy. He was discharged in stable condition, underscoring the efficacy of surgical drainage when minimally invasive methods fail.
  Conclusions: This case highlights the critical role of timely surgical intervention in complicated prostate abscesses, as endorsed by EAU and BAUS. The dramatic intraoperative finding of pus eruption underscores the urgency of drainage in such cases. Early imaging, multidisciplinary input, and adherence to guidelines are pivotal for optimal outcomes.

UP-08.21—Who Benefits from Uromune? A Retrospective Clinical Audit 

• Sim Simone ¹, Kujawa Magda ²
  ¹ Manchester Royal Infirmary, Manchester, United Kingdom, ² Stepping Hill Hospital, Manchester, United Kingdom

• Introduction and Objectives: Urinary tract infections (UTIs) are common and recurrent UTIs cause considerable morbidity and are a major contributor to antibiotic-resistant infections. Therefore, non-antibiotic preventative approaches are encouraged. Uromune (MV-140) is an immunomodulator drug that has shown efficacy in preventing recurrent UTIs, but studies are mainly focused on uncomplicated UTIs. We aim to assess the efficacy of Uromune stratified by patient complexity.
  Materials and Methods: A retrospective audit was conducted in a regional tertiary hospital. Twenty-five patients were prescribed Uromune from August 2019 to March 2024 for recurrent UTIs. Patient details were collated via case notes, family doctor records and laboratory results. Uromune efficacy was determined by the patient’s experience, documented via clinic letters; through acute prescriptions for antibiotics to treat UTIs; and comparing the number of positive MSUs 12 months pre- and post-Uromune.
  Results: Twenty-three patients completed the 3-month Uromune course. The majority (78%, n = 18) had complicated recurrent UTIs. Common factors for complicated UTIs were multidrug-resistant bacteria, immunosuppression, patients dependent on intermittent self-catheterisation (ISC) and anatomical abnormality. Additionally, these patients are generally older with an average age of 68.8 years. On average, patients had tried and failed 3–4 different preventative treatments before. All patients had culture-proven recurrent UTIs with causative agents that were predominantly E. coli and Klebsiella. Despite Uromune, 76% (n = 17) of patients did not benefit and suffered multiple UTIs within 12 months of treatment. Most (88%, n = 15) of these patients who did not benefit had complicated UTIs. Of those who benefited, majority of them (75%, n = 3) had uncomplicated UTIs.
  Conclusions: Despite the promising results of Uromune in uncomplicated UTIs, we question its benefit and use in complicated UTIs. Due to the small sample size of the audit, a larger cohort is required to further analyse the risk factors for complicated UTIs and how this might impact Uromune efficacy. Overall, it is not clear which demographic of patients would benefit.

9. Infertility

9.1. Unmoderated Standard ePosters

UP-09.01—A Very Rare Tumor of the Spermatic Cord Found During an Infertility Consultation: The Malignant Fibrous Histiocytoma 

• Bannowsky Andreas ¹, Bannowsky Sabine ¹, Ückert Stefan ²
  ¹ Hospital Diepholz, Diepholz, Germany, ² Hannover Medical School, Hannover, Germany

• Introduction and Objectives: Primary spermatic cord tumors are rare, and most of them are benign in 75% of the cases. Malignant fibrous histiocytoma arise mainly in the deep soft tissues of the extremities (70%), retroperitoneum (16%) and, occasionally, in the inguinal region; it rarely involves the spermatic cord. Only 33 cases of spermatic cord malignant fibrous histiocytoma have been reported in the literature. Aim of this study was to present one very rare case of a malignant fibrous histiocytoma found in our fertility clinic and provide a literature review.
  Materials and Methods: We report a case of a 48 year-old-man who entered our fertility clinic and complained about infertility since the last 4 years. The physical examination revealed a hydrocele and small firm mass in the right spermatic cord. Blood chemistry and tumor markers were within normal limits. Ultrasonography revealed a hypoechoic mass; the testes and epididymides were of normal appearance. The patient underwent right inguinal exploratory surgery, a tumor involving the spermatic cord was identified, and a frozen section was considered to be malignant. Right radical orchiectomy was subsequently performed.
  Results: Histopathology and immunohistochemistry showed an extremely rare malignant fibrous histiocytoma (myxoid subtype) of the spermatic cord. Surgical margins were noted to be negative, and postoperative recovery was uneventful. Postoperative staging CT-scan showed no evidence of metastasis, and we recommended adjuvant radiotherapy. The patient and his family refused any further treatment. He was followed up regularly for 16 months, with no evidence of recurrence or metastasis.
  Conclusions: Primary malignant fibrous histiocytoma of the spermatic cord is extremely rare, and the optimal treatment strategy is radical orchiectomy with wide excision of surrounding soft tissue structures, followed by radiation therapy. Our case demonstrates an unusual finding of one of these tumors in “routine” infertility consultation.

UP-09.02—Development of a Web-Based Male Infertility Screening System Using Hormonal Analysis, without Semen Analysis 

• Kobayashi Hideyuki ¹, Fujieda Masashi ², Ishida Kazuhiro ², Nakaniwa Iori ²
  ¹ Toho University, Tokyo, Japan, ² CreaTact, inc, Mito, Japan

• Introduction and Objectives: Semen analysis is considered essential for the diagnosis of male infertility, but at present it can only be performed at specialized infertility centers, and there is not a sufficient testing system in place. Therefore, we have created a new tool for screening for male infertility using AI predictive analysis based on hormonal analysis results, without semen analysis.
  Materials and Methods: This study was conducted with the approval of the Ethics Committee of Toho University Medical Center Omori Hospital using case data from 3,627 patients who visited our hospital between 2011 and 2020 and underwent hormone and semen examinations. Based on the WHO 2010 guidelines, a total motility sperm count of 9.0 × 10⁶/mL was set as the lower limit of normal. Based on this value, each case was assigned to a “normal (0)” or “abnormal (1)” group. The differences in the distributions of age, LH, FSH, PRL, testosterone, and E2 between the normal and abnormal groups were analyzed, the data were classified into 14 subgroups, and trends in the data were analyzed. LightGBM, a decision tree-based gradient boosting algorithm, was used to construct a web-based system for use in screening for male infertility.
  Results: Significant differences were found in the distributions of LH, FSH, and testosterone between the normal and abnormal groups. Eight subgroups with LH and FSH above the upper or lower limits had more cases in the abnormal group than in the normal group. The AUC of the AI model constructed using the 3,627 cases was 68.6%, and, in the provisional evaluation, the AUC of groups 1–13, with abnormal LH, FSH, or testosterone (1,165 cases), had an AUC of 78.7%. In contrast, group 14 (2,462 cases), in which LH, FSH, and testosterone were all within the normal range, had an AUC of 64%.
  Conclusions: We developed an AI model using the LightGBM algorithm and were able to construct a screening system that predicts the risk of male infertility with high accuracy using only hormonal analysis data. We found that the risk of male infertility could be determined with about 80% accuracy in cases where LH, FSH, or testosterone were outside the normal range.

UP-09.03—Ethical and Religious Issues Surrounding Gamete and Embryo Donation: Islamic Perspectives and the Case for Prohibition 

• Cheqboub Mohamed, Azarg Ayoub, Oubihi Mohamed, Chatar Achraf, Lakmichi Mohamed Amine, Dahami Zakaria, Sarf Ismail
  Arrazi Hospital, Mohammed VI University Hospital Center-Marrakech, Marrakech, Morocco

• Introduction and Objectives: Gamete and embryo donation are widely used in assisted reproductive technology (ART), offering infertile couples a chance at parenthood. However, these practices raise ethical and religious concerns, especially within Islam, which strictly prohibits third-party gamete and embryo donation. This prohibition is grounded in the protection of family lineage, avoidance of confusion in genealogical ties, and the prevention of exploitation. This article aims to explore the ethical, religious, and pathological aspects of gamete and embryo donation, emphasizing the Islamic rationale for prohibition.
  Materials and Methods: The study employs a literature review, analyzing scientific, ethical, and Islamic theological sources. The study incorporates both Islamic jurisprudence, focusing on the Qur’an and Hadith, and academic research concerning the psychological and pathological consequences for children born from gamete and embryo donations.
  Results: Anonymity and Identity: Donor anonymity conflicts with children’s right to know their biological origins. In Islam, lineage is sacred, and the introduction of third-party gametes violates this principle. Commodification and Exploitation: Islam prohibits the sale or donation of gametes, considering it a form of commodification and exploitation of the human body, especially for egg donors. Pathological and Psychological Effects: Research suggests that children born from donations may face psychological identity issues and possible pathological risks. These outcomes align with Islamic concerns about the disruption of family harmony. Islamic law prohibits gamete and embryo donation to preserve clear lineage and prevent the commodification of the human body. This strict stance contrasts with secular approaches that allow for regulated donation. The prohibition in Islam protects the family structure, promotes ethical medical practices, and prevents potential psychological and pathological consequences for donor-conceived children.
  Conclusions: Islam’s prohibition on gamete and embryo donation is rooted in strong ethical and religious principles, aiming to protect lineage, prevent exploitation, and ensure family stability. This precautionary stance safeguards the well-being of children and maintains moral clarity in reproduction, aligning with broader Islamic values.

UP-09.04—Evaluating the Association of Periconceptional Paternal Exposures and in-Vitro Fertilization (IVF) Success Rates: A Cross-Sectional Study 

• Haghpanah Abdolreza, Heidari Mehdi
  Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Rep.

• Introduction and Objectives: In vitro fertilization (IVF) has revolutionized reproductive medicine, providing hope to couples facing infertility challenges. While IVF has significantly increased pregnancy success rates, understanding the impact of periconceptional paternal exposures on IVF outcomes remains critical. Factors such as lifestyle choices, environmental influences, and medical conditions can affect sperm quality and DNA integrity. Exploring the association between these paternal exposures and IVF success rates can help tailor interventions and optimize fertility treatments. This study examines the relationship between periconceptional paternal exposures and IVF success rates among couples undergoing treatment at a tertiary center in Shiraz in 2022.
  Materials and Methods: This retrospective cross-sectional study investigated IVF outcomes among couples at a Shiraz tertiary center from 2022–2023. The calculated sample size was 300 participants. Data were collected from medical records, IVF databases, and participant questionnaires regarding paternal exposures. Key IVF metrics, such as pregnancy and live birth rates, were analyzed using SPSS version 26, with appropriate statistical tests and ethical safeguards.
  Results: A total of 300 IVF participants (average age 40.7 years, SD = 5.4) were studied. Among them, 79.7% (n = 239) did not achieve pregnancy, while 20.3% (n = 61) did. The analytic methods revealed that some exposures such as smoking habits displayed a notable association, with never-smokers having a lower pregnancy rate compared to occasional or regular smokers (p < 0.001). Besides that, logistic regression analysis revealed that each additional year of age increased the odds of IVF failure by 1.41 (p < 0.001). Petrochemical workers had a 22.02-fold higher risk of IVF failure (p = 0.021). Reduced physical activity was associated with increased odds of failure (p < 0.001, OR = 0.29), and chemical exposure increased the odds of failure by 4.04 times (p = 0.005).
  Conclusions: The study emphasizes that factors such as increasing paternal age, employment in the petrochemical sector, reduced physical activity, and chemical exposure significantly contribute to a low IVF success rate of 20.3%. These findings underscore the need for clinicians to consider paternal influences and recommend personalized interventions and lifestyle changes to improve IVF outcomes.

UP-09.05—Familial Male Infertility Associated to Copper Homeostasis Dysregulation 

• Bouayed Abdelmoula Nouha
  Medical University of Sfax, Sfax, Tunisia

• Introduction and Objectives: Both copper increase and deficiency lead to a significant reduction in male fertility, spanning the entire spectrum of abnormalities at the sperm level, testis tissue, gamete production, hormone production and distribution of other trace elements (zinc-iron). Here, we report a Tunisian familial pedigree in which many cases of male infertility were recorded in association to toxic levels of copper.
  Materials and Methods: Clinical characteristics of male infertile patients were collected, and molecular analyses were carried out for all coding exons and intron/exon junctions of ATP7B (ATPase copper-transporting beta) gene.
  Results: Semen analysis confirmed severe oligo-astheno-teratozoospermia for the three members of the family with normal male karyotype and AZF status. Molecular genetic testing revealed a familial compound heterozygote status with the p.H1069Q and the p.D642H substitution.
  Conclusions: The first mutation c.3207C>A of exon 14 is the most common mutation in Wilson disease in Europe. It is associated with the late onset of the neurological condition and is characterized by the loss of ATPase activity as well as decreased copper transport activity and stability, whereas the second c.1924G>C missense mutation is located in the cytoplasmic region at 64 amino acids after the last copper binding domain, transforming a negatively charged residue (Asp) to a positive charged one (His). It is much less common than the first mutation, and it affects the domain’s affinity to copper.

UP-09.06—Histopathological Evaluation of the Orchiectomy Specimens for Adult Unilateral Cryptorchidism 

• Albalawi Khalid, Alzahrani Turki, Alanazi Mshari, Alanazi Abdulaziz, Ismail Fakherelddin, Abolhasan Anas, Almutairi Nura, Almuzaini Omar, Khan Amjad, Kamal Ahmed, Elbahnasawy MAGDY
  King Salman Armed Forces Hospital, Tabuk, Saudi Arabia

• Introduction and Objectives: Clinicians generally believe that adult testicles that have not descended do not affect fertility. Furthermore, 10% of testicular malignancies are believed to originate from undescended testicles, and carcinoma in situ is observed in undescended testicles at a ratio of 1–4%. The AUA and EUA guidelines recommend orchiectomy for post-pubertal UDT with normal contralateral testes. For this reason, it is critical to fully inform all post-pubertal UDT patients of risks and potential advantages of orchidopexy vs. orchiectomy; to find out the histopathological characteristics of the adult UDT removed by orchiectomy regarding the presence of any degree of spermatogenesis up to possible sperms; to find out if there are any detected pre-malignant or malignant changes.
  Materials and Methods: This retrospective study included 14 patients with mean age of 24.7 (16–47), who were subjected to simple orchiectomy for UDT from 2012 to 2021. Out of them, 10 testes were inguinal, 3 pelvic and 1 abdominal. Removed testes were examined by 2 expert histopathology consultants for the presence of spermatogenesis, malignant or pre-malignant changes.
  Results: Out of the 14 none showed any sperms in the examined specimens. Histopathology showed 11 patients with Sertoli only, 2 with infrequent hypospermatogenesis and 1 with testicular atrophy. No single case showed ITGCN or overt malignancy.
  Conclusions: None of our cases showed any sperms in the orchidectomized adult UDT supporting the consensus of orchiedectomy of adult unilateral cryptorchidism. No malignant lesions were detected in our cases as most of them were inguinal testes.

UP-09.07—Long-Term Fertility Outcomes Following Orchiectomy for Testicular Cancer: Conception Rates and Key Predictive Factors (2010–2022) 

• Cheqboub Mohamed, Oubihi Mohamed, Azarg Ayoub, Chatar Achraf, Lakmichi Mohamed Amine, Dahami Zakaria, Sarf Ismail
  Arrazi Hospital, Mohammed Vi University Hospital Center-Marrakech, Marrakech, Morocco

• Introduction and Objectives: Patients undergoing orchiectomy due to testicular cancer face potential risks of long-term reduced fertility, influenced by the surgery and additional treatments like chemotherapy or radiotherapy. This study aims to assess fertility following orchiectomy, the use of assisted reproductive technology (ART), and the predictive factors associated with subsequent pregnancies.
  Materials and Methods: The study involved 39 patients who underwent orchiectomy for testicular cancer between 2010 and 2022. Clinical data, medical history, and preoperative fertility information were collected for each patient. Postoperative fertility was evaluated through telephone surveys, and variables influencing pregnancy occurrence were statistically analyzed.
  Results: The median age of patients at the time of orchiectomy was 32 years. Among the 39 patients, 14 had pure seminoma, while 25 had a non-seminomatous or mixed germ cell tumor. The tumor stage was T1 for 30 patients, T2 for 5 patients, and T3 for 4 patients. Ten patients presented with lymph node or pulmonary metastases, and 29 received additional treatments, including 15 with radiotherapy and 14 with chemotherapy. The median follow-up duration was 5 years. At the end of the follow-up, 12 patients had children, 5 of whom used ART. Age, history of paternity, and the completion of additional treatments were not significantly associated with post-treatment pregnancies. However, a significant correlation was observed between the duration of follow-up and conception rates (p < 0.05). These findings indicate that the probability of conception following orchiectomy for testicular cancer increases with the length of follow-up, suggesting a possible gradual recovery of fertility after treatment. Treatments such as radiotherapy or chemotherapy were not statistically linked to reduced chances of conception, potentially explained by the increased use of ART to counteract treatment effects on fertility.
  Conclusions: About one-third of patients who underwent orchiectomy for testicular cancer had children in the years following treatment, with a 40% rate of ART use. Prolonged follow-up appears to be the most influential factor on post-treatment fertility. To improve fertility outcomes, regular reproductive health monitoring over several years post-treatment is recommended, incorporating ART as an option when early signs of decreased sperm quality appear.

UP-09.09—Prevalence of Chromosomal Abnormalities Among 170 Non-Obstructive Azoospermic Patients 

• Alzahrani Turki, Abdelfatah Mohamed, Ismail Fakherelddin, Abolhasan Anas, Albalawi Khalid, Elbahnasawy Magdy
  King Salman Armed Forces Hospital, Tabuk, Saudi Arabia

• Introduction and Objectives: Amongst the several causes of male factor infertility, genetic causes play an important role. Chromosomal aberrations in the general population are approximately 0.6%. Males presenting with infertility have karyotype abnormalities in the range of 2–14%. Chromosomal aberrations have been clearly demonstrated to increase with the severity of the infertility (19% in non-obstructive azoospermic NOA). The most common numerical genetic abnormality is Klinefelter syndrome (KS), with 5% and 10% prevalence in men with severe oligozoospermia and azoospermia, respectively. Our aim is to define the prevalence of chromosomal anomalies among our azoospermic patients evaluated at our tertiary referral hospital.
  Materials and Methods: All NOA patients evaluated in our hospital from 2010 until 2024 were subjected to chromosomal analysis after full clinical, laboratory and radiologic work up (scrotal US). Patients with iatrogenic causes of azoospermia as those post-chemotherapy or vasectomy as well as cases of obstructive azoospermia were excluded. Results: Out of 170 NOA patients, 20 (11.76%) showed chromosomal anomalies. Klinefelter syndrome was detected in 11 (6.47%) and Y-chromosome microdeletions in 5 cases (2.94%). Other detected, more rare anomalies were Robertsonian translocation between chromosome 13 and 14, abnormal chromosome 16, 46xx male syndrome and Prader Willi syndrome in one patient each.
  Conclusions: Chromosomal abnormalities were detected in significant numbers of our NOA patients. Klinefelter syndrome was the more prevalent chromosomal anomaly followed by Y chromosome microdeletions. All these patients need genetic counselling before TESE due to lower sperm retrieval rat. Preimplantation Genetic Diagnosis (PGD) is essential for this group of patients.

UP-09.10—Subinguinal Microdenervation of the Spermatic Cord (MDSC) for Refractory Chronic Orchialgia 

• Chu Cheng ¹, Huang William J. ²
  ¹ Department of Urology, Taipei Veterans General Hospital, Yuan-Shan and Su-Ao Branches, Yilan, Taiwan, ² Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan

• Introduction and Objectives: Microdenervation of the spermatic cord has been demonstrated to be an effective method for managing chronic orchialgia, a persistent pain condition that can profoundly affect patients’ quality of life. In this video, we present our standardized protocol for the treatment of chronic orchialgia, with a particular focus on the procedural details of microdenervation.
  Materials and Methods: A 25-year-old man presented with refractory chronic scrotal pain that had persisted for five years, significantly impacting his daily activities. He had previously undergone bilateral laparoscopic varicocelectomy to alleviate scrotal pain, but this intervention was unsuccessful. Subsequently, a bilateral epididymectomy was performed at another hospital; however, the pain persisted despite these and other conservative treatments. Seeking further management, the patient visited our outpatient department. Physical examination and Duplex scrotal ultrasound ruled out structural abnormalities, including torsion, hydrocele, and spermatocele. A spermatic cord block was then administered in the high scrotal region using 10 mL of 2% lidocaine. Given his positive response, demonstrated by temporary pain reduction following the cord block, the patient was considered a suitable candidate for microdenervation of the spermatic cord. Microdenervation of the spermatic cord was performed by subinguinal approach following the ‘Trifecta Nerve Complex’ template, targeting key denervation sites as follows: the Intra-Cremasteric Complex, the Peri-Vasal Complex, and the Posterior Peri-Arterial/Lipomatous Complex.
  Results: Bilateral microdenervation of the spermatic cord was successfully completed. Postoperatively, the patient reported a numerical rating scale (NRS) pain score of 0, indicating complete resolution of scrotal pain.
  Conclusions: Microdenervation of the spermatic cord (MDSC) offers a reliable and effective method for managing chronic orchialgia, particularly in cases where pain affects multiple scrotal structures, such as the testis, epididymis and spermatic cord. MDSC should be regarded as the primary surgical option for alleviating pain while preserving the testicle.

UP-09.11—The Impact of Hematospermia on IVF Success Rates in Infertile Couple: A Retrospective Cohort Study 

• Haghpanah Abdolreza, Shamohammadi Iman, Mahmoodi Meysam, Dehghani Anahita
  Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Rep.

• Introduction and Objectives: Infertility is a serious health issue with significant psychological and social impacts on infertile couples. Hematospermia, the presence of blood in semen, is a rare but typically benign condition that may impair male fertility. This study investigates the effect of hematospermia on the success rate of in vitro fertilization (IVF) in infertile couples.
  Materials and Methods: This retrospective cohort study included all men who visited the infertility center at the Mother and Child Hospital in Shiraz from 2018 to 2023. Data were collected from medical records at the center and analyzed using statistical tests.
  Results: Of the 2,340 participants, 570 (24%) had hematospermia. Among those with hematospermia, 39% achieved successful pregnancy. The results indicated that men with hematospermia and additional sperm disorders were 22% less likely to achieve successful IVF outcomes compared to men without such disorders, though this difference was not statistically significant.
  Conclusions: Hematospermia cannot serve as an important indicator in the assessment of male fertility for IVF. Resultantly, proper evaluation and management of associated conditions such as sperm morphology, count, and movement could enhance the success rate of assisted reproductive technologies such as IVF.

10. Kidney and Ureter, Benign Diseases

10.1. Moderated Oral ePosters

MP-10.01—AI-Based Automatic Estimation of Single-Kidney Glomerular Filtration Rate and Split Renal Function Using Non-Contrast CT 

• Wang Yiwei
  Ninth People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

• Introduction and Objectives: The split renal function (SRF) represents the relative contribution of single-kidney GFR to overall GFR and is important for decision-making in urological surgery. The single-photon emission computed tomography (SPECT) is the gold standard for measuring SRF. Compared with SPECT, computed tomography (CT) is more commonly used due to its lower cost, faster imaging speed, and reduced radiation exposure. Artificial intelligence (AI) methods, including deep learning and radiomics, play an important role in medical image processing. Using deep learning algorithms, organ segmentation can be accomplished in an efficient fully automated manner. In this study, we aimed to develop and validate an AI-based automatic estimation method of single-kidney GFR and SRF using non-contrast CT for patients with hydronephrosis and atrophic kidney.
  Materials and Methods: 245 patients with atrophic kidney or hydronephrosis were included from two centers (Training set: 128 patients from Center I; Test set: 117 patients from Center II). The renal parenchyma and hydronephrosis regions in non-contrast CT were automatically segmented by deep learning. Radiomic features were extracted and combined with clinical characteristics using multivariable linear regression (MLR) to obtain a radiomics-clinical-estimated GFR (rcGFR). The relative contribution of single-kidney rcGFR to overall rcGFR, the percent renal parenchymal volume, and the percent renal hydronephrosis volume were combined by MLR to generate the estimation of SRF (rcphSRF). The Pearson correlation coefficient (r), mean absolute error (MAE), and Lin’s concordance coefficient (CCC) were calculated to evaluate the correlations, differences, and agreements between estimations and SPECT-based measurements, respectively.
  Results: Compared to manual segmentation, the deep learning-based automatic segmentation could reduce the average segmentation time by 434.6 times to 3.4 s. Compared to single-kidney GFR measured by SPECT, the rcGFR had a significant correlation of r = 0.75 (p < 0.001), MAE of 10.66 mL/min/1.73 m², and CCC of 0.70. Compared to SRF measured by SPECT, the rcphSRF had a significant correlation of r = 0.92 (p < 0.001), MAE of 7.87%, and CCC of 0.88.
  Conclusions: For patients with atrophic kidney or hydronephrosis, the non-contrast CT and artificial intelligence methods can be used to estimate single-kidney glomerular filtration rate and split renal function, which may minimize the radiation risk, enhance diagnostic efficiency, and reduce costs.

MP-10.02—Do Delays on Benign Surgery Impact Outcomes of Robotic-Assisted Pyeloplasty?—A Single-Centre Study 

• Douglas Alexandra ¹, Shin Je Song ², Hendry Jane ², Qureshi Khaver ², Oades Grenville ²
  ¹ University of Glasgow, Glasgow, United Kingdom, ² Queen Elizabeth University Hospital, Glasgow, United Kingdom

• Introduction and Objectives: Robotic-assisted pyeloplasty is a standard treatment for pelviureteric junction obstruction (PUJO). However, extended waiting times for benign surgical procedures in the NHS —exacerbated by prioritisation of cancer surgeries and COVID-19-related backlogs—raise concerns about potential impacts on surgical and clinical outcomes.
  Materials and Methods: Retrospective data from 63 PUJO patients treated at a single tertiary referral centre were analysed. Parameters included waiting times, pre- and post-operative renal function (MAG3/DMSA renograms), symptomatic outcomes, and complications. Patients were stratified by waiting time (<6 months, 6–12 months, 12–24 months, >24 months), and outcomes were compared.
  Results: Of the 63 patients, 43 underwent pyeloplasty, and 36 completed follow-up. The average waiting time was 19 months. Post-operative symptomatic improvement was reported in 82% of patients, with 42% showing improved renograms. Longer waiting times did not correlate with worse renograms, but there was a minor decline in symptomatic improvement, albeit not statistically significant. Symptomatic improvements often occurred independently of renogram changes, demonstrating the limited utility of renograms as a sole outcome measure.
  Conclusions: Surgical delays due to extended benign waiting times do not significantly compromise symptomatic outcomes in pyeloplasty patients. Most patients still experience substantial symptomatic relief, even after prolonged delays. These findings underscore the viability of delayed pyeloplasty in constrained healthcare settings but highlight the need for prospective studies to optimise surgical prioritisation.

MP-10.03—Efficacy of Allium Ureteral Stents for Treatment of Various Causes of Ureteral Stricture 

• Moon Du Geon, Ahn Sun Tae, Cho Sun Beom
  Korea University Guro Hospital, Seoul, Republic of Korea

• Introduction and Objectives: Treatment for ureteral stricture has not yet been established. One treatment option is using endoscope and placing ureteral stent. Recently, efficacy of self-expanding large caliber stent (Allium, Allium LTD, Israel) for ureteral stricture related to surgery, radiation or malignancy was reported. We performed this study to assess the efficacy of Allium stent on various causes of ureteral stricture.
  Materials and Methods: From July 2018 and April 2025, 178 Allium stent were inserted under ureteroscopic balloon dilation under intraoperative x-ray guidance after dilation of the stricture and removed in 115 patients by single surgeon. All patients showed hydronephrosis before the stenotic lesion and pain. Self-expanding Allium ureteral stent of 12 cm, 12 cm bladder anchor or 20 cm length were used as single or dual as needed. The primary outcome was immediate improvement in pain and improvement in hydronephrosis. The secondary outcome was stricture resolution rates following stent removal. All patients were followed through ultrasound examination for hydronephrosis, KUB for stone formation on the stent, U/A, BUN/Cr at 1, 3, 6 and every 6 months until stent removal.
  Results: Of 115 patients, 20 cm stent in 47 patients, 12 cm stent in 7 and dual stent of 20 cm stent intussuscepted 12 cm with bladder anchor were used to avoid stent migration in 61 patients. After median follow-up period of 29.5 months, 64.3% (74/115) of patients are stent free. Median indwelling time was 16.68 months (range 1–37), and stent migration was observed in 18.5% (12/65) of single stent, 6% (3/50) in dual stent, respectively. In patients of idiopathic stricture and ureteral stone, mean stent time of 13.7 months resolved hydronephrosis in 95.7% of patients. In patients of ureteral disease and extrinsic obstruction, stent removal time was 23.5 months (4–45).
  Conclusions: Self-expanding Allium ureteral stent showed high efficacy in relieving pain and improving hydronephrosis in various ureter stricture with minimal risk of complication. Overall success rate after stent removal was associated with causative disease.

MP-10.04—Pilot Study on the Impact of Low-Intensity Extracorporeal Shockwave Therapy (ESWT) of the Kidneys on Hypertension and Creatinine Levels in Chronic Kidney Disease Stage 3a and 3b Patients 

• Bulaong Sheldon Marllow, Mercado Gavino, Tan Karl Marvin, Madrona Eli Paulino
  Veterans Memorial Medical Center, Quezon City, Philippines

• Introduction and Objectives: Low Intensity Extracorporeal Shock Wave Therapy (LI-ESWT) has been shown to enhance renal perfusion and stimulate cellular repair and angiogenesis. These mechanisms indicate that LI-ESWT may serve as a valuable adjunctive treatment for managing hypertension in patients with stage 3a and 3b chronic kidney disease (CKD). By improving blood flow and promoting kidney health, LI-ESWT could help regulate blood pressure and preserve or enhance renal function in this patient population.
  Materials and Methods: This study included adult patients diagnosed with CKD stage III a/b, characterized by an estimated glomerular filtration rate (eGFR) of 30–59 mL/min/1.73 m², and hypertension defined as a blood pressure of 130/80 mm Hg or greater. Eligible patients were those receiving treatment with one to three classes of antihypertensive medications. Selected patients underwent six sessions of LI-ESWT, delivered with an energy density of 0.1 to 0.3 mJ/mm² and a frequency of 1 to 3 Hz. Sessions were scheduled twice a week for three weeks. Blood pressure, creatinine levels, and eGFR were measured at baseline (pre-LI-ESWT) and at the 4th, 12th, 24th, and 48th weeks post-treatment.
  Results: The study enrolled 24 patients, predominantly male (23 males and 1 female), aged 60 to 77 years. Significant improvements were noted following LI-ESWT, with systolic blood pressure decreasing from a baseline range of 136–141 mm Hg to 121–125 mm Hg (p < 0.001), averaging a reduction of 15 mm Hg. Diastolic blood pressure also improved, dropping from 86–89 mm Hg to 79–84 mm Hg (p < 0.001), with a similar average decrease of 15 mm Hg. Furthermore, creatinine levels significantly decreased, from a baseline range of 142–173 mmol to 104–111 mmol (p < 0.001), with all patients achieving normal creatinine levels by the end of the study.
  Conclusions: Preliminary findings indicate that LI-ESWT is an effective intervention for managing hypertension and improving renal function in patients with stage III a/b CKD. Further research with a larger and more diverse cohort is recommended to validate these results.

MP-10.05—Renal Hydatid Disease: Spectrum of Presentation, Diagnostic and Treatment Dilemma and Our Experience 

• Aggarwal Nitish, Jain Siddharth, Seth Amlesh, G.A Toshib
  AIIMS, New Delhi, India

• Introduction and Objectives: Hydatid disease is an infectious disease that affects several organs. Isolated renal involvement is very rare. The treatment for renal hydatid cyst ranges from minimally invasive percutaneous aspiration techniques to laparoscopic and open techniques. We describe seven cases of isolated renal hydatidosis with varied presentations, which were treated successfully with an open approach.
  Materials and Methods: A retrospective analysis of the Department of Urology Database was done regarding isolated renal hydatids over the last 5 years. A thorough review of records was done, and follow-up was taken via teleconsultation.
  Results: The presenting symptoms included incidental, flank pain, mass abdomen, and hydaturia (descending order). In 6 patients, the diagnosis of a hydatid cyst was known preoperatively, but one patient with a preoperative diagnosis of a simple cyst was found to harbor hydatidosis intraoperatively. Eosinophilia as a marker for the active disease was present in two patients only, while echinococcal serology was positive in only 25%. All cases were approached via open technique. Two patients were treated with nephrectomy due to bulky disease, while the other three underwent renal preserving surgeries. Renal preservation cases used Aarons’s surgical suction cone, which decreased spillage of cyst content. All patients had an uneventful post-operative period. The mean duration of post-operative stay was two days. On mean follow-up of 1 year, all patients were doing well.
  Conclusions: Early diagnosis is imperative to start preoperative albendazole and take measures to prevent spillage. Mainstay of treatment is surgery with adequate medical therapy. Meticulous technique to avoid pillage during surgery is necessary to avoid anaphylaxis and prevent recurrence. Aim should be to preserve the renal function and opt for nephrectomy only in case of a non-functional kidney.

MP-10.06—Role of Lidocaine and Dexmedetomidine Containing Irrigation Fluid in Prevention of Post Operative Catheter Related Bladder Discomfort in Patients Undergoing Percutaneous Nephrolithotomy (PCNL) and Ureteroscopic Lithotripsy (URSL): A Double Blinded Randomized Controlled Trial 

• Mavuduru Ravimohan ¹, Sachdeva Sahil ², Singh Ajay ², Devana Sudheer ², Saini Vikas ², Bora Girdhar ²
  ¹ PGIMER, Chandigarh, India, ² Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

• Introduction and Objectives: Catheter-related bladder discomfort (CRBD) is a common postoperative complication, often affecting patients after urological surgeries. Symptoms, such as urgency and suprapubic burning, significantly impact patient comfort and recovery. Current treatments, including anticholinergics and analgesics, offer limited relief and may have adverse effects. This study evaluates the effectiveness of intravesical lidocaine, dexmedetomidine, and normal saline in reducing CRBD in patients undergoing PCNL and URSL.
  Materials and Methods: A prospective, randomized, double-blind trial included 105 patients aged 20–60 years, who were randomly assigned to three groups: Group L (lidocaine 0.01%), Group D (dexmedetomidine 0.5 μg/kg), and Group N (normal saline). The primary outcome was the incidence of moderate-to-severe CRBD at 0-, 1-, 2-, and 6-h post-surgery. Secondary outcomes included bladder, suprapubic, or urethral pain, use of rescue medications, side effects, and patient satisfaction. Intravesical irrigation was administered for 30 min post-surgery, followed by assessment in the post-aesthetic care unit.
  Results: The study showed that the incidence of CRBD decreased over time in all groups, with Group D demonstrating the most significant reduction, from 22.9% severe CRBD at 0 h to 0% at 6 h. Group L also showed a decrease in CRBD severity but to a lesser extent. Group N exhibited persistent moderate CRBD. Pain management was most effective in Group D, with the lowest median pain scores (NRS 4.0) and the least need for rescue medications (8.6%). Patient satisfaction was highest in Group D, followed by Group L, and then Group N with no side effects.
  Conclusions: Intravesical lidocaine and dexmedetomidine effectively reduce CRBD and postoperative pain in patients undergoing PCNL and URSL, with dexmedetomidine providing superior efficacy. These findings support the use of intravesical agents as an effective strategy for improving postoperative outcomes, reducing reliance on rescue medications, and enhancing patient satisfaction in urological procedures.

10.2. Unmoderated Standard ePosters

UP-10.01—A Case of Ureteropelvic Junction Obstruction Developing After Partial Nephrectomy 

• Doria Glenys Mae
  Veterans Memorial Medical Center, Manila, Philippines

• Introduction and Objectives: Hydronephrosis caused by ureteropelvic junction obstruction (UPJO) may be caused by intrinsic stenosis or valves, ureteral insertional anomaly, fibrous bands/adhesions, crossing vessels, or even renal mobility. We report a case of UPJO that developed after open partial nephrectomy for renal cell carcinoma.
  Materials and Methods: A 67-year-old female underwent open partial nephrectomy for an exophytic 4.8 cm renal mass located in the inferior pole of the right kidney. 9 months postoperatively, the patient presented with right flank pain and UTI. CT urogram was done, which revealed hydronephrosis and luminal narrowing of the right proximal ureter and passage of contrast to the rest of the right ureter. The patient opted for conservative management and underwent DJ stent insertion on the right, which was replaced every 3 months for 1 year. In the interim, the patient experienced recurrent dysuria and flank pain. RGP was done, and drain films showed that the right pelvicalyceal system still had inadequate drainage; hence, the patient underwent reconstructive procedure. There was note of a dilated extrarenal pelvis and fibrous adhesive bands at the area of the UPJ causing kinking of the proximal ureter.
  Results: Adhesiolysis and spiral flap pyeloplasty reconstruction was done ensuring a funneled ureter. DJ stent was inserted, and nephropexy was done. The DJ stent was removed 1 month postoperatively. The patient had no recurrence of flank pain, dysuria, and UTI.
  Conclusions: UPJO and subsequent hydronephrosis is an under-reported complication of partial nephrectomy. Reyes et al. (2011) found that tumor complexity, mid-/lower pole tumors, urinary leak, and hemorrhage are associated with development of delayed ureteral stricture typically diagnosed at 7 to 10 weeks postoperatively. Injuries caused during dissection of inferior pole mass and removal of perinephric fat may contribute to stricture formation. There must be a high index of suspicion for this complication on follow up of patients who undergo partial nephrectomy. Culp deWeerd pyeloplasty is suitable for cases where there is a large extrarenal pelvis in management of UPJO.

UP-10.02—A Single Centre Series of Robotic Uretero-Ureterostomy to Treat Renal Duplication 

• Waley Laura, Malik Tom, Keeley Francis
  Bristol Urological Institute, Bristol, United Kingdom

• Introduction and Objectives: In the paediatric setting, ipsilateral uretero-ureterostomy is a recognised intervention for symptomatic vesicoureteric reflux, or upper tract obstruction resulting from renal duplication. To our knowledge, there are no published reports of this procedure for abnormalities in duplex kidneys in adults. We have previously published our outcomes from lower pole heminephrectomy and shown that the procedure is associated with significant morbidity, and therefore changed our practice to robotic ipsilateral uretero-ureterostomy.
  Materials and Methods: We include patients from our centre who have undergone an ipsilateral uretero-ureterostomy for complete duplex ureters. Since 2020 we have performed 4 robotic assisted uretero-ureterostomies in adults ranging from 25 to 34 years old. All presented in childhood—initially with recurrent urinary tract infections (UTIs) that became more problematic in adulthood with all reporting episodes of pyelonephritis associated with scarring of the lower pole moiety. All had the lower pole ureter anastomosed to the upper pole ureter in an end-to-side fashion.
  Results: Three have undergone single-side robotic uretero-ureterostomy, and one has had the procedure done bilaterally. All have been completed robotically. Mean operating time per kidney was 170 min. Length of stay ranged from 1 to 3 days. Two have completed long-term follow up—both had reduced pain and reduced frequency of UTIs. The latter two remain in the early stages of follow-up.
  Conclusions: Robotic uretero-ureterostomy has gained popularity in the paediatric setting as an alternative to more traditional approaches, such as injection of bulking agents, ureteric reimplantation or heminephrectomy. Furthermore, robot-assisted uretero-ureterostomy is becoming increasingly used and has shown promising results in comparison with laparoscopic or open techniques. Our early cases are suggesting that this is also a viable option for adults and should be considered as an alternative to ureteric reimplantation or heminephrectomy.

UP-10.03—Challenges of Surgical Management of Patients with Autosomal Dominant Polycystic Kidney Disease—Series of Cases Bilateral Nephrectomies 

• Silva Pedro, Pinheiro Luis, Gil Miguel, Cunha João, Caceiro Rui, Gomes Alexia, Lanca Miguel, Pereira Patricia, Meireles Ana
  Central Lisbon University Hospital Centre, Lisboa, Portugal

• Introduction and Objectives: Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common genetic kidney disorders, characterized by progressive cyst enlargement that can impair renal function and lead to end-stage renal disease (ESRD). Advanced ADPKD is frequently complicated by cyst infections, hemorrhage, and chronic pain, with recurrent infections in ESRD patients often necessitating surgical intervention. This case series aims to highlight the surgical challenges associated with bilateral nephrectomies in ADPKD patients with recurrent cyst infections.
  Materials and Methods: This case series describes two patients with ADPKD who underwent bilateral nephrectomy due to recurrent cyst infections unresponsive to medical treatment. The first patient, a 56-year-old female on hemodialysis, presented with severe, recurrent cyst infections and biliary duct compression leading to jaundice. Imaging revealed multiple infected cysts, prompting a multidisciplinary decision for bilateral nephrectomy. The second patient, a 49-year-old male with ESRD and prolonged hospitalizations due to recurrent cyst infections, also underwent bilateral nephrectomy following failed medical management.
  Results: The first patient’s surgery was complicated by the large cystic kidneys and significant adhesions, but the procedure was successfully completed, leading to infection resolution and an uneventful recovery. The second patient also had significantly enlarged polycystic kidneys with extensive adhesions, but the nephrectomy was performed without intraoperative complications. Postoperatively, both patients remained infection-free and demonstrated stable clinical progress.
  Conclusions: Bilateral nephrectomy in ADPKD patients with recurrent cyst infections presents notable surgical challenges, including managing massively enlarged kidneys, dense adhesions, and intraoperative stability. Despite these complexities, both cases resulted in favorable postoperative outcomes, with resolution of infections and improved quality of life. This case series underscores the importance of a multidisciplinary approach in optimizing surgical outcomes for ADPKD patients requiring nephrectomy.

UP-10.04—Comparative Study of Mono J Single-Step Versus Two-Step Balloon Nephrostomy Placement for Urinary Tract Obstruction: Efficiency, Tolerability, and Complication Rates 

• Giannakodimos Ilias ¹, Akrivou Dimitra ², Adamos Konstantinos ¹, Kaltsas Aris ¹, Mitakidi Evangelia ³, Karagiannis Dimitrios ², Chrisofos Michael ¹, Scriapas Konstantinos ², Kratiras Zisis ¹
  ¹ Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece, ² General Hospital of Larissa, Larissa, Greece, Larissa, Greece, ³ General Hospital of KAT, Athens, Greece, Athens, Greece

• Introduction and Objectives: Urinary tract obstruction can lead to severe renal impairment if not managed effectively. Nephrostomy placement is a critical intervention to relieve such obstructions. Several techniques of nephrostomy tube placement have been described in the literature. This study aims to compare the mono J single-step nephrostomy and the two-step balloon nephrostomy techniques in terms of procedural efficiency, patient tolerability, and complication rates.
  Materials and Methods: A prospective randomized observational design was employed, including patients requiring nephrostomy placement due to oncological conditions, urinary tract lithiasis, or functional disorders. Patients were randomized into two groups: one receiving the mono J single-step method and the other the two-step balloon method. The primary metrics evaluated were the average placement time and the accuracy of the tube placement, verified through immediate post-procedural imaging. Patient pain levels were assessed using the Visual Analogue Scale (VAS), and complications were monitored at 3, 6, 9, and 12 months. For the statistical analysis, chi-square test was performed for binary variables and Wilcoxon-Mann-Whitney test for continuous variables.
  Results: The mono J single-step method had a significantly shorter average placement time (Mann-Whitney, W = 367.5, p = 0.006445; t-test, t = −2.7202, p = 0.008399), while the two-step method demonstrated better early tube stability, as evidenced by fewer dislocations at 3 months (chi-square, χ² = 4.828, p = 0.028, Cramer’s V = 0.28) and 6 months (chi-square, χ²(1) = 5.198, p = 0.023, Cramer’s V = 0.29). Patients tolerability, as measured by VAS score, did not differ significantly between the two methods (Z-1.39, p = 0.165).
  Conclusions: These findings suggest that, while the mono J single-step technique is more time-efficient, the two-step balloon method offers advantages in early tube stability, providing valuable insights for optimizing clinical decision-making in nephrostomy placement.

UP-10.05—Comparison of Risk Factors Between Nephrectomy and Angioembolization of Kidney Due to Renal Angiomyolipoma in Patients with Tuberous Sclerosis: A Retrospective Study 

• Haghpanah Abdolreza, Sadeghi Fatemeh, Dehghani Anahita
  Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Rep.

• Introduction and Objectives: This study aimed to investigate the risk factors and predictors associated with the occurrence of spontaneous rupture or the need for angioembolization in patients with renal angiomyolipoma associated with tuberous sclerosis. The purpose was to aid in predicting and preventing advanced and severe stages of the disease and to improve the screening and treatment process for these patients.
  Materials and Methods: This retrospective case-control study was conducted with two subgroups in the case group, consisting of tuberous sclerosis patients with renal symptoms and destructive manifestations who underwent either angioembolization (16 patients) or nephrectomy (19 patients). The control group included 17 tuberous sclerosis patients without renal clinical manifestations. Demographic information (age and gender), tumor size, number and location of tumors, as well as extrarenal involvement, including neurological and dermatological symptoms, were collected using standard questionnaires and medical record reviews. Data were analyzed using IBM SPSS Statistics 26, with statistical tests including chi-square, Fisher’s exact test, ANOVA, and post-hoc analyses. A significance level of less than 0.05 was considered for all tests.
  Results: Among 52 patients studied, the findings revealed the following: 1. The mean age of the control group (24.2 years) was significantly lower than that of the angioembolization group (51.2 years) and the nephrectomy group (38.3 years) (p < 0.0001). 2. There was a significant difference in tumor size between the groups; the tumors in the control group were smaller (mean: 33.4 mm) compared to the case groups (62.7 mm in the angioembolization group and 70.4 mm in the nephrectomy group) (p < 0.0001). 3. Neurological disorders and dermatological involvement were significantly more common in the control group (p < 0.0001). 4. The increase in hemoglobin levels following intervention was greater in the nephrectomy group compared to the angioembolization group (p = 0.012).
  Conclusions: The study demonstrated that patients with renal manifestations (case group) were generally older, had larger tumor sizes, lower initial hemoglobin levels, and higher creatinine levels. In contrast, patients without renal manifestations (control group) were mostly younger, and their initial disease manifestations appeared as dermatological and neurological involvement. These findings underscore the importance of timely monitoring and treatment to prevent disease progression and the need for invasive interventions.

UP-10.06—Deep Learning-Based Kidney Disease Detection from CT and MRI Images Using Convolutional Neural Networks 

• Negara Edvin ¹, Daryanto Besut ¹, Seputra Kurnia ¹, Budaya Taufiq ¹, Irmawati Irmawati ², Pratiwi Monica ²
  ¹ Universitas Brawijaya, Malang, Indonesia, ² Indonesia International Institute for Life Science, Jakarta, Indonesia

• Introduction and Objectives: Kidney disease remains a critical global health challenge, demanding precise diagnostics and timely interventions. In the era of Industry 6.0, marked by the synergy of human expertise, artificial intelligence (AI), and big data analytics, advanced technologies are revolutionizing medical workflows. Convolutional Neural Networks (CNNs), a specialized deep learning class, have emerged as pivotal tools in medical imaging, excelling at detecting subtle radiological patterns with accuracy rivaling or surpassing human capabilities. This study proposes a CNN-based framework to enhance renal tumor diagnosis and clinical decision-making, leveraging multimodal imaging data to optimize therapeutic workflows.
  Materials and Methods: The methodology employs a dataset of radiologist-annotated CT and MRI scans, augmented by clinical imaging data from PACS Bangladesh and Saiful Anwar Hospital. The CNN model undergoes three phases: (1) preprocessing and normalization of imaging data, (2) architecture optimization for renal pathology detection, and (3) validation using accuracy, sensitivity, and specificity metrics. The goal is to develop a high-precision tool for classifying renal tumor subtypes while refining interpretative frameworks for radiological assessments.
  Results: Experimental results demonstrate exceptional performance: the CT-based model achieves 99.97% validation accuracy, outperforming Vision Transformer (ViT), Data-efficient Image Transformer (DeiT), and Swin Transformer models on MRI data, which attain 97.44%, 99.43%, and 99.72% accuracy, respectively. These models not only excel in tumor detection but also enhance the interpretability of imaging data, a critical factor for clinical adoption. Their integration into diagnostic workflows holds transformative potential, enabling scalable, data-driven strategies to accelerate therapeutic interventions.
  Conclusions: In conclusion, deep learning models like CNNs and transformer architectures achieve diagnostic precision rates of 97–99% for renal tumors, underscoring their viability in clinical settings. The incorporation of spatial localization data further refines surgical planning, bridging the gap between imaging analysis and actionable clinical decisions. By combining AI-driven accuracy with workflow optimization, this research advances precision oncology, offering a paradigm shift in kidney disease management. The findings highlight the potential of AI to democratize access to high-quality diagnostics, particularly in resource-constrained regions, while setting a benchmark for future innovations in medical imaging technologies.

UP-10.07—Dietary Index for Gut Microbiota, a Novel Protective Factor for the Prevalence of Chronic Kidney Diseases in the Adults: A Population Based Cross-Sectional Study 

• Xiao Yunfei ¹, Yang Yaqing ², Lin Tao ²
  ¹ Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, ² West China Hospital, Sichuan University, Chengdu, China

• Introduction and Objectives: This study explores the association between the dietary index for gut microbiota (DI-GM) and the prevalence of chronic kidney disease (CKD).
  Materials and Methods: A cross-sectional study of participants aged ≥20 years using the data drawn from NHANES (2007–2018). DI-GM is comprised 14 dietary components (10 beneficial and 4 unfavorable). CKD diagnosis based on uACR and eGFR. Logistic regression models were employed to evaluate the relationship between DI-GM and CKD while controlling for various covariates. Additionally, a spline smooth analysis was performed. Subgroup and interaction analyses were conducted to investigate whether any factors modified this relationship.
  Results: A total of 28,843 participants were eligible for the study, of whom 5,461 were diagnosed with CKD, while 23,382 were not. Patients with CKD exhibited significantly lower DI-GM scores compared to healthy individuals. A negative association between DI-GM and the prevalence of CKD was observed across all models, with the relationship being more pronounced in individuals with DI-GM scores greater than 5 compared to those with scores ≤ 3. Beneficial components, such as dietary fiber, whole grains, and coffee, were identified as protective factors. Moreover, gender make an effect on this relationship, with stronger effects noted in women.
  Conclusions: Higher DI-GM scores correlate with reduced CKD prevalence, and the effect appears to be more pronounced in women than in men. These findings suggest that enhancing gut health through diet may serve as a viable strategy for the prevention and management of CKD, with particular attention to sex-based differences in prevention.

UP-10.08—Does the Innovative Single Pigtail Jfil^® Stent Improve Patient’s Tolerability? A Pilot Study 

• Chin Yew Fung ¹, Allam Mazen ¹, Farah Mohamed ¹, Hughes Tom ², Mahmalji Wasim ¹
  ¹ Hereford County Hospital, Wye Valley Trust, Hereford, United Kingdom, ² Birmingham Heartland Hospital, Urology, United Kingdom

• Introduction and Objectives: Ureteric stent-related symptoms represent a major issue and impair the patients’ quality of life. To minimise stent-related symptoms, a newly single pigtail suture stent was developed, where the distal part of the stent is a 0.3 Fr suture that terminates in the bladder. We aimed to compare the single pigtail suture stent (JFil^®, Rocamed) with the conventional double-J stent in relation to stent-related symptoms.
  Materials and Methods: The inclusion criteria were patients with pelvi-ureteric junction obstruction or benign upper ureteric strictures, who were managed with long-term stents and complained strongly of stent symptoms. Patients with urinary stones or strictures were excluded from the study. Seven women with a median age of 64 ± 24 years were included and underwent replacement of their long-term double-J stents with JFil stents measuring 7.0 Fr in diameter and 8 or 16 cm in specified length. All patients completed the ureteral stent symptoms questionnaire (USSQ) prior to replacement (baseline) and day 90 post-replacement. We followed these patients over the next 12 months and compared the means of each USSQ domain between the two stent types.
  Results: The urinary symptom index score (37.5 vs. 24.4, p = 0.019), body pain index score (21.1 vs. 8.4, p = 0.04) and general health index score (18.2 vs. 9.6, p = 0.014) were significantly in favour of JFil pigtail-suture stent. No difficulty in the placement of JFil stent was encountered. No stent failure and no calcification were observed 12 months after stenting. Stent suture migration to the ureter occurred in one patient and required a ureteroscopy to exchange the stent.
  Conclusions: JFil stent is a potentially beneficial option to minimize stent-related symptoms. We are planning to conduct a multi-centre study to shed more insight on symptom response to this stent design.

UP-10.09—Endoscopic Management of Eight Large Ureteral Fibroepithelial Polyps: A Single-Center Case Series 

• Simforoosh Nasser, Sharifiaghdas Farzaneh, Dadpour Mehdi, Rabani Hossein
  Shahid Beheshti University of Medical Sciences, Labbafinejad Medical Center, Tehran, Iran, Islamic Rep.

• Introduction and Objectives: Fibroepithelial polyps (FEPs) of the ureter are rare benign tumors. They originate from mesodermal tissue. As reported in the literature, these lesions are more frequently found on the left side and usually measure less than 5 cm in length. In this study, we report eight consecutive cases of huge ureteral FEPs that were managed using endoscopic techniques.
  Materials and Methods: This retrospective study included eight patients with ureteral polyps, treated between December 2016 and March 2024 at a tertiary care center. CT urogram and intravenous pyelography (IVP) were used for diagnosis. All patients were treated with ureteroscopy using laser, cautery and grasping. Patients were followed by imaging and symptoms monitoring.
  Results: This study included eight patients (all of them were female) with a mean age of 35.68 ± 8.65 years. Patients presented with flank pain (n = 8), hematuria (n = 3), and intermittent protrusion of a mass from the urethral meatus (n = 1). Polyps were located in the proximal ureter in six patients and in the mid-ureter in two. All polyps were located in the right ureter. The mean polyp length was 15 ± 2.68 cm. All patients underwent ureteroscopic removal of the polyps, performed using Holmium:YAG laser (n = 6) or cautery and grasping (n = 2). The mean operative time was 20 ± 3.86 min. The mean postoperative hemoglobin decrease was approximately 0.2 g/dL. No patients experienced Clavien–Dindo grade 3 or higher complications. The mean follow-up was 1 year. All patients reported full relief from their symptoms, and no cases of recurrence or ureteral obstruction in imaging were noted during the follow-up.
  Conclusions: Endoscopic resection of ureteral fibroepithelial polyps using various techniques proved safe and effective in all patients. Every patient showed complete recovery, with no recurrence or complications observed.

UP-10.10—Healthy Eating Index-2015, a Protective Factor for Mitochondria-Derived Methylmalonic Acidemia in the Low Poverty Income Ratio with Chronic Kidney Diseases 

• Xiao Yunfei ¹, Yang Yaqing ², Lin Tao ²
  ¹ Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, ² West China Hospital, Sichuan University, Chengdu, China

• Introduction and Objectives: To explore the relationship between the Healthy Eating Index-2015 (HEI-2015) and the prevalence of methylmalonic acidemia (MMA) among low-poverty income ratio (PIR) patients with chronic kidney disease (CKD).
  Materials and Methods: We conducted a cross-sectional study of participants aged ≥20 years using the data drawn from the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2014. Individuals under low PIR suffering from CKD were included. HEI-2015 was calculated to evaluate diet quality. Multivariate logistic regression models were applied to examine the association between HEI-2015 and MMA prevalence with age, gender, body mass index, race, education, marital, alcohol, smoke, hypertension, cardiovascular disease, cancer, diabetes, moderate activity, and vigorous activity adjusted. Stratified and interaction analyses were performed to explore whether some variables modified the relationship.
  Results: A total of 582 CKD patients with low PIR were enrolled. The logistic analysis showed that higher HEI-2015 was significantly associated with a lower prevalence of MMA (OR 0.970, 95% CI 0.954–0.986, p < 0.001). Patients in the highest quartile of HEI-2015 scores (>61.17) showed a 57.8% reduction in MMA prevalence compared to those in the lowest quartile (OR 0.422, 95% CI 0.222–0.801, p = 0.008). The subgroup and interaction analysis revealed that the negative association could be modified by alcohol. Sensitive analysis indicated the result robust.
  Conclusions: The protective role of high-quality diets, as reflected by HEI-2015, in reducing the prevalence of MMA in low PIR CKD patients. Improving diet quality in this population could potentially mitigate the risks associated with MMA and CKD progression.

UP-10.11—Magnetic Black-Star^® for Short-Term Ureteric Stenting After Stone Surgery: The Future of Stent Removal? A Pilot Study 

• Chin Yew Fung ¹, Allam Mazen ¹, Farah Mohamed ¹, Hughes Tom ², Mahmalji Wasim ¹
  ¹ Hereford County Hospital, Wye Valley Trust, Hereford, United Kingdom, ² Birmingham Heartland Hospital, Urology, United Kingdom

• Introduction and Objectives: Ureteric stenting is common after ureteroscopy, but cystoscopic removal of them can be unpleasant for patients and costly. Ureteric stents with extraction strings risk premature dislodgement and increased urinary symptoms due to string irritation. We aimed to evaluate the feasibility of a novel ureteric stent that incorporates a small magnet at its distal-end (Magnetic Black-Star^®, Urotech).
  Materials and Methods: In this pilot study, the magnetic stent was inserted following ureteroscopy for stone removal in 10 consecutive patients, who had previously undergone ureteroscopy with standard DJ stent insertion. We compared the patient experience, using the Ureteral Stent Symptom Questionnaire (USSQ), as well as the cost and time for removal.
  Results: All 20 stents were removed within 2 weeks of insertion. The USSQ did not show statistically significant differences between magnetic and non-magnetic stents in any domain. In contrast, patients with magnetic stents experienced significantly less pain during removal compared with cystoscopy (mean VAS score 2.2 vs. 4.9; p < 0.001). All magnetic removals were performed within less than 30 s. 90% of the patients preferred to have their stents removed by this method in the future. On average the estimated cost of removing a Black-Star stent is £90 cheaper than single use cystoscopy and £120 cheaper than reusable cystoscopy; however, stent on strings is still the cheapest option.
  Conclusions: Magnetic stents have a similar morbidity to standard ureteric stents. However, magnetic stent removal is preferable to patients, causing less pain and can be rapidly performed in an outpatient setting, avoiding the need for cystoscopy.

UP-10.12—Multi-Centre Audit of Renal Angiomyolipoma Surveillance in Women of Childbearing Age Referred From Primary Care 

• Williams Omoremi ¹, Muruganandham Madhunesha ¹, Black Boada Rebecca ², Tsang Derrick ¹, Green James ¹, Peters John ¹
  ¹ Barts Health NHS Trust, London, United Kingdom, ² Queen Mary University of London, London, United Kingdom

• Introduction and Objectives: Surveillance of renal angiomyolipomas (AML) in females of childbearing age is widely recommended due to the risk of growth and spontaneous bleeding; yet, current practices often do not align with recommendations. Although there is no global consensus on monitoring criteria for AML, some institutions advise that at-risk groups should have annual imaging surveillance for 5 years. This audit aims to evaluate the surveillance and referral practices in a large multi-centre UK trust for female patients of childbearing age found to have AML on imaging.
  Materials and Methods: A retrospective audit was conducted on all patients referred from primary care for ultrasound imaging over a 12-month period (January to December 2024) with a finding of AML. Female patients of childbearing age (18–52 years old) were identified from the Trust’s imaging database with the following keywords: “AML”, “angiomyolipoma”. The audit compared clinical practice against the local urology guidelines for surveillance and treatment of AML.
  Results: A total of 163 female patients with AML were identified; 25 patients (15.3%) were referred for repeat imaging in accordance with local guidelines. 34 patients (20.8%) were referred to urology, and, of these, 9 (26%) were on the suspected cancer pathway. 4 patients (2.5%) had AML ≥ 3 cm, of which 2 were referred to urology, and only 1 had repeat imaging. 31 patients (19%) with AML < 3 cm were also referred to urology, but only 13 (8%) had repeat imaging. 11 patients (6.8%) were inappropriately referred to nephrology, and only 5 were subsequently referred to urology. No AML-related complications were identified, and no patients were referred for treatment.
  Conclusions: This audit reveals that clinical practice is not concordant with local guidelines of the management of AML in this population, as demonstrated by the low proportion of follow-up imaging and review. Though it is not possible to comment on long-term outcomes in this cohort or any potential complications arising from decreased surveillance rates, there is an obvious discrepancy in the clinical management of AML. This underscores the need to explore the factors contributing to low adherence to the local guidelines to ensure appropriate management in this at-risk group.

UP-10.13—Retrospective Single Centre Analysis of Long Term Follow-Up and Outcomes of Laparoscopic vs. Robot Assisted Pyeloplasty 

• Desai Viraj, Singh Abhishek, Tayal Harshit, Patel Deep, Pathak Niramya, Ganpule Arvind, Sabnis Ravindra
  Muljhibhai Patel Urological Hospital, Nadiad, India

• Introduction and Objectives: Historically, open pyeloplasty was the standard treatment option for Pelviureteric Junction obstruction (PUJO). During the last four decades, minimally invasive modalities have been in spotlight. In this study, we aim to compare long-term functional and surgical outcomes of laparoscopic (LP) and robotic pyeloplasty (RP).
  Materials and Methods: Retrospective analysis and follow-up of patients with PUJO, who underwent RP or LP during the period from 2010 to 2015, were done. Patients were evaluated preoperatively using CT-Urography, diuretic-renogram and biochemistry. All patients were followed-up with clinical examination, diuretic-renogram and sonography in post-op period (6 months-2 years) and subsequently after 8–10 years of surgery. The mean operative time, post-operative drain removal day, hospital stay and long term outcomes were compared. Exclusion criteria involved primary redo procedures and PUJO with obstructing calculus. Recurrence was defined as need for post-operative intervention, persistent symptoms or non-draining renogram with increasing hydronephrosis.
  Results: Total 189 patients underwent pyeloplasty during the study period, 89 patients underwent LP and 100 underwent RP. 92 (48.6%) patients were in the paediatric age group, of which 41 were in LP group (mean-age 6.96 ± 5.05 years) and 51 were in RP group (mean-age 9.04 ± 5.47 years) (p = 0.064). 11 patients were excluded from the study. 16 patients lost to follow-up. The mean operation time, drain removal day and hospital stay were comparable in LP and RP group. The maximum follow-up period was 167 months in LP and 159 months in RP group. Immediate post-operative complication rates were 10.11% in LP and 12% in RP group. 4 patients had recurrence in LP group and 5 in RP group (p = 0.92). 9 patients had surgery in solitary functioning kidney.
  Conclusions: Both modalities can be successfully utilized for benefits of patients with PUJO. Long term follow-up results are convincing for comparable outcomes of both the modalities.

UP-10.14—Safety and Efficacy of Ureteroscopic Lithotripsy and RIRS Under Regional Anesthesia at a Primary Clinic 

• Na Joon Chae, Min Seung Ki
  Goldman Urology Clinic, Seoul, Republic of Korea

• Introduction and Objectives: Despite the prevalence of ureteroscopic lithotripsy and RIRS for ureteral and kidney stones primarily in secondary and tertiary hospitals, its adaptation in primary care settings remains limited. This study aims to demonstrate the safety and efficacy of conducting ureteroscopic stone surgeries under regional anesthesia in a primary care setting, challenging the traditional hospital-centric model.
  Materials and Methods: We conducted a retrospective review of 195 cases of ureteroscopic surgery for ureteral and kidney stones at our primary care clinic from July 2020 to December 2023. All procedures were performed under regional anesthesia by the same urologist. Data collected included patient demographics, stone characteristics, operative time, complications, and postoperative recovery.
  Results: Among 195 cases, 106 (54.4%) cases consisted of stones located in the upper ureter or kidney. Patients were anesthetized under spinal block in 172 (88.2%) cases, caudal block in 7 (3.6%) cases, and no regional block in 11 (5.6%) cases. Sedation was done in 51 (26.2%) cases. Operation time was <1.0 h in 60 (30.8%) cases, 1.0~2.0 h in 44 (22.6%) cases, and 2.0~3.0 h in 31 (15.9%) cases. The procedure was successfully completed in all cases. No severe complications requiring transfer to a higher-level facility occurred.
  Conclusions: Our findings suggest that ureteroscopic lithotripsy and RIRS under regional anesthesia can be safely and effectively performed in a primary care setting. This approach may allow for broader access to essential urologic procedures, reducing the need for referrals and the burden on secondary hospitals. Further studies are recommended to validate these results and explore the potential for primary care facilities to adopt more advanced urological procedures.

UP-10.15—Does Quality of Life Matter in Patients with Ureteral Stent After Ureteroscopy? 

• Azli Mohsen ¹, Sadki Reouane ¹, Bouhnik Abdelhalim ², Benrabah Rabah ¹
  ¹ Kouba Hospital, Algiers, Algeria, ² Kouba Hospital, Algiers, Algeria

• Introduction and Objectives: To evaluate the prevalence of the side effects associated with ureteral stents and their impact on sexual function and quality of life of patients.
  Materials and Methods: From March 2022 to April 2024, 100 patients (66 men and 44 women; mean age: 41,3 years [range: 18–74]) with unilateral ureteral stents were included in this study. Stents were placed for various etiologies, urolithiasis (66 cases), infection diseases (14 cases), ureteroplasty (08 cases), renal transplantation (06 cases) and cancer diseases (06 cases). 28 cm 7F polyurethane stents, double J. The safety of stents and their impact on sexual function and quality of life of patients were evaluated on the day of removal by a questionnaire, USSQ.
  Results: The mean duration of stenting was 5,6 weeks [range: 3–12]. Of the 100 individuals in the final study, 100% reported one or more urinary symptoms after stent removal. Dysuria, urinary frequency, hematuria and urgency were reported by 21%, 50%, 52% and 90% of the patients respectively. Flank pain 68%, the mean score on the VAS was 3,6 [0–10] for global impression, for bladder pain 75% and for low back pain during micturition 50%. More than 22% of patients experienced stent related pain affecting daily activities, 32% reported sexual dysfunction, and 16% reported reduced work capacity and negative economic impact. At the end of the study, all patients did not want to renew the experience.
  Conclusions: Double J stents are associated with high morbidity and significant impact on patient quality of life. Our study confirms that the duration of stenting must be as short as possible in order to improve patient’s quality of life.

10.3. Unmoderated Video ePosters

UVP-10.01—Hybrid Renorrhaphy with Selective Inner Layer Clipping Under AI-Assisted 3D Navigation System in Robotic Partial Nephrectomy 

• Bang Sungun, Jeon Jinhyung, Kim Do Kyung, Kwon Jong Kyou, Cho Kang Su
  Yonsei University College of Medicine, Seoul, Republic of Korea

• Introduction and Objectives: Compared to traditional double-layer renorrhaphy, single-layer renorrhaphy shortens ischemic time and may reduce damage to healthy tissue, though it could raise the risk of leakage. We introduce our hybrid approach during robot assisted partial nephrectomy (RAPN), combining selective inner layer clipping (SILC) during resection, guided by AI-assisted 3D navigation and Doppler ultrasonography. This enables simultaneous resection and inner layer closure, reducing ischemic time and preserving renal function by sparing critical vasculature. The outer layer closure provides added support, addressing leak concerns.
  Materials and Methods: We present the case of a 50-year-old man who underwent left RAPN. Arterial, portal, and delayed phase images were obtained at 1 mm cuts, and an RUS™ AI-based 3D kidney model was reconstructed (Hutom, South Korea). Intraoperatively, the Da Vinci surgeon identified vascular supply using robotic ultrasonography and the AI 3D model. We performed enucleoresection combined with inner cortical clipping of feeding vessels using Click’aV^® polymer ligating clips (Grena, UK), Challenger^® Ti-P (B.Braun, UK), or Small or Medium-large clip applier (Intuitive Surgical Da Vinci, US). After resection, outer layer renorrhaphy was performed using Vicryl 2–0, Click’aV^® clips, and LAPRA-TY™ Suture Clip Applier (Ethicon, US).
  Results: The patient presented with a 5.6 cm cystic mass in the upper pole of the left kidney. Color Doppler ultrasound revealed one arteriole, and the AI 3D model identified one arteriole and one venule. Three cysts were completely excised: a Bosniak III main mass, a Bosniak II cyst adjacent to the renal mass, and a small simple cyst. During enucleoresection, the two aforementioned vessels were identified. The feeding vessels were ligated and cut using SILC. The warm ischemic time was 23 min. Pathology revealed the main mass as clear cell renal cell carcinoma with extensive cystic change, with a clear resection margin. The adjacent renal cyst was diagnosed as a multilocular cystic renal neoplasm of low malignant potential, with a clear resection margin. The other cyst was a simple cortical cyst.
  Conclusions: Our experience with SILC and hybrid renorrhaphy for RAPN demonstrates that concise tumor resection and renorrhaphy are feasible without complications. Larger studies are warranted to validate these findings.

11. Kidney and Ureteral Cancer—Basic Science

11.1. Moderated Oral ePosters

MP-11.01—Multi-Omics Uncovers the Molecular Machinery Underlying Autophagic Regulation Leading to Metastasis in Chromophobe Renal Cell Carcinoma 

• Lu Jiayi, Zhai Wei
  Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

• Introduction and Objectives: The rare incidence of chromophobe renal cell carcinoma (ChRCC) makes its pathogenesis and metastatic mechanisms poorly understood, and effective treatments for ChRCC are lacking. To address this, we performed multi-omics analysis of ChRCC to identify potential therapeutic targets.
  Materials and Methods: Tissues from 68 ChRCC patients diagnosed over the past 7 years, including frozen tumor and normal tissues from 52 cases, and FFPE samples of primary, recurrent, and metastatic lesions from 16 metastatic cases were analyzed through multi-omics including WES, RNA, proteomics, phospho-proteomics, and metabolomics. Western blot, immunohistochemistry, and multiplex fluorescence staining were conducted, and immortalized cell lines from primary cultures were established and characterized as in vitro models.
  Results: ChRCC with higher somatic mutation burden is associated with poorer prognosis, whereas those characterized by elevated mitochondrial DNA (mtDNA) mutations exhibit better outcomes, demonstrating a significant negative correlation between mtDNA and somatic mutations. Integrative analysis of CNV, RNA, and protein profiles in non-metastatic ChRCC highlights positive correlations with macroautophagy, supported by the presence of autophagic vesicles in ChRCC cell lines and WB, IHC validation, while metastatic ChRCC displays autophagy suppression. SLC38A1, a highly expressed amino acid transporter, positively correlates with autophagy (cor = 0.80), whereas mitochondrial-related proteins show a strong negative correlation (cor = −0.65). Impaired expression of mitochondrial electron transport chain complexes suggests OXPHOS dysfunction due to mtDNA mutations, indicating oxidative stress in ChRCC cells. Metabolomic analysis reveals downregulation of amino acid metabolites in tissues with high SLC38A1 expression, suggesting that non-metastatic ChRCC fulfills its heightened metabolic demands through increased amino acid uptake and protective autophagy. Conversely, in metastatic ChRCC, phospho-proteomic kinase profiling identifies enhanced ULK1-SDCBP/Syntenin kinase-substrate activity, with SDCBP/Syntenin phosphorylation inhibiting cytotoxic autophagy. Elevated SDCBP/Syntenin expression at both RNA and protein levels contributes to tumor metastasis and invasion by mediating cell adhesion, membrane trafficking, endocytosis and autophagy inhibition.
  Conclusions: The evolutionarily conserved autophagy acts as a “double-edged sword” in ChRCC, balancing cell protection and cytotoxicity. These findings underscore autophagy’s critical role in ChRCC survival and support targeting SLC38A1/ULK1/SDCBP as therapeutic strategies.

11.2. Unmoderated Standard ePosters

UP-11.01—Circulating Succinate Modifying Metabolites Accurately Classify and Monitor Fumarate Hydratase Deficient Renal Cell Carcinoma 

• Xu Yunze
  Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

• Introduction and Objectives: Fumarate hydratase–deficient (FH-deficient) renal cell carcinoma (RCC) represents a particularly aggressive form of kidney cancer. Early detection can be curative, but there are no biomarkers, and, in the sporadic setting, establishing a diagnosis of FH-deficient RCC is challenging. Therefore, finding noninvasive plasma biomarkers suitable for rapid diagnosis, screening, and surveillance would improve clinical outcomes.
  Materials and Methods: We performed untargeted mass spectrometry metabolomic analyses of human plasma from a testing cohort of patients with FH-deficient RCC (n = 10), sporadic RCC (clear cell RCC [ccRCC], papillary RCC, etc.) (n = 10), and healthy adults (n = 10). We compared the levels of these candidate biomarker metabolites in a second validation cohort of patients with FH-deficient RCC (n = 83), patients with sporadic RCC (n = 77), and healthy adults (n = 78). Candidate biomarker metabolites were further evaluated using a cell line and patient-derived xenograft (PDX).
  Results: We identified two robust circulating biomarkers, succinic-cysteine (suc-cys) and succinyl-adenosine (suc-ado), which can sensitively and specifically report FH status and tumor burden. We separately validated the superior screen and diagnostic power with receiver operating characteristic (ROC) under the curve (AUC), ROCAUC = 0.98 to assigning FH mutant (FH-MT) RCC from no-tumor normal control (NC) or FH-wildtype (FH-WT) RCC. Suc-ado and suc-cys blood levels increased proportionally with the growth of an FH-deficient PDX in mice but not with a ccRCC PDX. Finally, via longitudinal assessment of these plasma biomarker dynamics, we demonstrated the powerful capacity to monitor real-time treatment efficacy and identify recurrent or metastatic tumors.
  Conclusions: Our data demonstrated how disrupted metabolism caused by FH deficiency leads to unique metabolic traits that produce stable circulating metabolites that can serve as sensitive and specific biomarkers for early diagnosis and prognosis of FH-deficient RCC. Suc-ado and suc-cys should be evaluated in prospective trials before they are routinely incorporated in the clinic.

UP-11.02—Schwann Cell-Mediated Mechanisms in Renal Cell Carcinoma Metastasis at the Tumor Border Microenvironment 

• Song Qiang, Zhai Wei
  Shanghaijiaotong University, Shanghai, China

• Introduction and Objectives: Renal cell carcinoma (RCC) exhibits aggressive metastasis, with poor prognosis in advanced stages. This study investigates the role of Schwann cells (SCs) in RCC metastasis, focusing on tumor border microenvironment interactions and molecular mechanisms.
  Materials and Methods: Using spatial transcriptomics (Decoder-seq), single-cell RNA sequencing (scRNA-seq), and deep learning (Cancer-Finder algorithm), we analyzed 9 RCC samples (I–IV stages) with tumor core and border regions. Functional validation included in vitro co-culture models (RCC cells and SCs), ELISA, protein assays, and pharmacological inhibition (Milatuzumab, ISO-1). Immunohistochemistry and multiplex fluorescence staining were performed on RCC tissue microarrays.
  Results: Single-cell and spatial transcriptomics revealed enriched Schwann cells (SCs) in advanced renal cell carcinoma (RCC) borders (stages III–IV vs. I–II, p < 0.01), with SC markers (S100B, SOX10) localized within 200 μm of invasive tumor margins. Metastatic RCC cells exhibited enhanced MIF-CD74 signaling to SCs via elevated MIF secretion (2.1-fold vs. monoculture, p = 0.003), driving SC migration (43%↓ with CD74/MIF inhibition, p = 0.01) and proliferation (37%↓, p = 0.02). Activated SCs secreted IL8 (4.8-fold↑, p = 0.004), promoting RCC cell migration (2.3-fold↑) and angiogenesis (68%↑ tube formation, p = 0.005), reversible by IL8 blockade. IL8 upregulated HMGA1 in RCC cells (3.1-fold↑, p = 0.001), linked to EMT/angiogenesis signatures, while HMGA1 knockdown reduced invasion by 52% (p = 0.008).
  Conclusions: SCs at the tumor border microenvironment promote RCC metastasis via MIF-CD74 signaling, driving IL8 secretion and HMGA1-mediated transcriptional reprogramming. Targeting this axis (e.g., MIF/CD74 inhibitors, IL8-neutralizing therapies) may offer novel strategies to suppress RCC progression.

UP-11.03—Spatial and Molecular Analysis of PSMA-Positive Peritumoral Vessels in Renal Cell Carcinoma 

• Watanabe Ryuta ¹, Kagimoto Keito ¹, Chousei Mami ², Sakaue Tomohisa ², Kurata Mie ², Miura Noriyoshi ², Kitazawa Riko ³, Kikugawa Tadahiko ², Higashiyama Shigeki ⁴, Takashi Saika ²
  ¹ Ehime University, Toon, Japan, ² Ehime University Graduate School of Medicine, Toon, Japan, ³ Ehime University Hospital, Toon, Japan, ⁴ Osaka International Cancer Institute, Chuouku, Japan

• Introduction and Objectives: Prostate-specific membrane antigen (PSMA) is a type II transmembrane glycoprotein known for its expression in prostate cancer, but recent studies have identified its expression in the tumor vasculature of other malignancies, including renal cell carcinoma (RCC). Our previous findings demonstrated that PSMA expression in peritumoral vessels of RCC correlates with recurrence and enhanced angiogenic activity. However, the molecular characteristics of PSMA-positive vessels and their spatial distribution within the tumor microenvironment remain unclear. This study aimed to investigate the spatial gene expression profiles associated with PSMA-positive vessels in RCC and assess their angiogenic potential.
  Materials and Methods: Formalin-fixed paraffin-embedded tissue samples from RCC surgical specimens were analyzed using high-resolution spatial transcriptomics (Visium HD, 10× Genomics). Tissue sections including the tumor, peritumoral region, and adjacent normal tissue were evaluated. Clustering and gene expression analyses were performed to identify angiogenesis-related pathways in PSMA-positive areas. Gene Set Enrichment Analysis (GSEA) was conducted using the Space Ranger pipeline and GRCh38 reference genome. In vitro, human umbilical vein endothelial cells (HUVECs) were treated with conditioned medium (CM) derived from RCC cell lines (Caki1, ACHN), and changes in PSMA expression and tube formation capacity were assessed using Western blotting, immunofluorescence, and tube formation assays.
  Results: Spatial transcriptomic analysis revealed that regions with high PSMA expression were enriched for pro-angiogenic pathways. PSMA-positive vessel clusters demonstrated distinct gene expression profiles compared to adjacent normal vasculature. In vitro, HUVECs treated with RCC-derived CM showed increased PSMA expression and enhanced tube formation. RNA sequencing confirmed the upregulation of angiogenesis-related genes in these treated cells. Immunohistochemical analysis of 45 RCC specimens showed that the intensity of PSMA expression in tumor vessels correlated significantly with tumor recurrence.
  Conclusions: PSMA-positive peritumoral vessels in RCC exhibit elevated angiogenic potential and distinct molecular signatures. Their expression correlates with tumor recurrence, suggesting that PSMA may serve as a prognostic biomarker and potential therapeutic target for anti-angiogenic strategies in RCC.

UP-11.04—Spatial Profiling of Fibroblast Activation Protein-α (FAP) in Clear Cell Renal Cell Carcinomas Using Multiplex Immunoanalysis of the Tumor Microenvironment 

• Riaza Montes María ¹, Redrado Miriam ², Loizaga-Iriarte Ana ³, Pérez-Fernández Amparo ³, Santos-Martín Aída ³, Angulo Cuesta Javier ⁴, Fernández José Andrés ⁵, Calvo González Alfonso ², López José Ignacio ⁶, Larrinaga Gorka ⁵
  ¹ Galdakao-Usansolo University Hospital, Galdakao, Spain, ² University of Navarra, Pamplona, Spain, ³ Basurto University Hospital, Bilbao, Spain, ⁴ University Hospital of Getafe, Madrid, Spain, ⁵ University of The Basque Country, Leioa, Spain, ⁶ Biobizkaia Basque Health Research, Barakaldo, Spain

• Introduction and Objectives: Clear cell renal cell carcinoma (ccRCC) is a clinically challenging neoplasm due to its phenotypic variability and marked intratumoral heterogeneity. Given this complexity, ccRCC provides a valuable platform for testing innovative technological approaches aimed at uncovering its underlying biological mechanisms. Multiplex immunofluorescence (mIF) is an emerging technique that enables the simultaneous and comprehensive evaluation of tumor and stromal cell subpopulations within a single tissue section. This study seeks to explore the spatial distribution of cancer-associated fibroblasts expressing fibroblast activation protein-α (FAP+CAFs) alongside lymphoid (CD4, CD8, FOXP3, CD20) and myeloid (CD68) immune cells in CCRCC, using multiplex immunofluorescence (mIF) to assess the tumor microenvironment.
  Materials and Methods: In this study, we characterized the spatial distribution of cancer-associated fibroblasts expressing fibroblast activation protein-α (FAP+CAFs) alongside lymphoid (CD4, CD8, FOXP3, CD20) and myeloid (CD68) cell populations in CCRCC tissue sections (n = 88). Both the central and peripheral regions of the primary tumor were analyzed using mIF.
  Results: FAP+CAFs and TILs were significantly more concentrated at the tumor periphery. A higher percentage of FAP+CAFs was correlated with larger tumor sizes and the presence of synchronous metastases. Moreover, increased levels of CD68+ macrophages and FOXP3+ regulatory T cells (above the 75th percentile) were associated with poorer 5 year cancer-specific survival (CSS). Correlation analyses revealed significant interactions between FAP+CAFs, TILs, and CD68+ macrophages. The co-occurrence of elevated FAP+CAFs, cytotoxic T cells (CD8+), regulatory T cells (FOXP3+), and macrophages (CD68+) in the tumor center was independently associated with worse CSS.
  Conclusions: These findings suggest that FAP+CAFs play a pivotal role in driving CCRCC aggressiveness, likely through the promotion of an immunosuppressive tumor microenvironment.

12. Kidney and Ureteral Cancer—Clinical

12.1. Moderated Oral ePosters

MP-12.01—A Propensity Matched Cohort Study Evaluating Long-Term Oncologic Outcomes in Patients Who Underwent Percutaneous Microwave Ablation vs. Robot-Assisted Partial Nephrectomy for Stage I Renal Cell Carcinoma 

• Giannakodimos Ilias ¹, Chlorogiannis David-Dimitris ², Moulavasilis Napoleon ³, Evgenia Efthymiou ⁴, Nikolaos Kelekis ¹, Chrisofos Michael ¹, Filippiadis Dimitrios ¹, Stravodimos Konstantinos ³, Kratiras Zisis ¹
  ¹ Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece, ² Brigham and Womens Hospital, Boston, United States of America, Boston, United States, ³ National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece, ⁴ Medical School, National and Kapodistrian University of Athens, “Attikon” University General Hospital, Athens, Greece

• Introduction and Objectives: There has been a noteworthy increase in the incidence of Stage I renal cell carcinoma (RCC) in recent years, primarily due to incidental detection on cross-sectional imaging. In terms of treatment, Partial Nephrectomy (PN) is the standard of care for these patients. Percutaneous Microwave Ablation (MWA) has demonstrated comparable short-term efficacy. However, there is a lack of literature regarding its long term oncological outcomes. The aim of our study was to evaluate the oncologic outcomes of microwave ablation in comparison to the standard of care, Robot-Assisted Partial Nephrectomy, for the treatment of Stage 1 RCC.
  Materials and Methods: This single-center, institutional board–approved retrospective observational review study recruited 160 consecutive patients with T1 RCC, who underwent either Robot-Assisted PN (RAPN) or MWA. A 1:1 inverse probability propensity score-matched analysis to account for the selection bias between the treatments. Kaplan-Meier log-rank test analyses and Cox proportional hazard regression models were used to compare the primary outcomes of recurrence-free survival, metastasis-free survival and overall survival.
  Results: After propensity score matching, 142 patients were included in the final analysis. 71 patients underwent percutaneous MWA (mean age, 70 ± 10 years) and 71 underwent RAPN (mean age, 60 ± 9) with the mean tumor size being 3.1 cm (±1.4 cm). At 8 years follow-up, the estimated survival rates for the MWA patients were 98% (95% confidence interval [CI]: 95–100%) for overall survival, 97% (95% CI: 93–100%) for progression-free survival, and 97% (95% CI: 93–100%) for metastasis-free survival. The matched cohorts that underwent RAPN exhibited survival rates of 100% (95% CI: 100–100%) for overall survival, 98% (95% CI: 94–100%) for progression-free survival, and 98% (95% CI: 94–100%) for metastasis-free survival. After performing log-rank testing, these rates were not significantly different (p-values of 0.44, 0.67, and 0.67 respectively).
  Conclusions: In this observational study there were no significant differences regarding the long-term oncologic outcomes between percutaneous MWA and RAPN at 8 years of follow up. Thus, for Stage 1, RCC percutaneous MWA could be a valuable therapeutic option.

MP-12.02—Are Benign Kidney Tumour Resections Avoidable? A Tertiary Care Center Experience over Decade 

• C Sivaraman ¹, Bhat Ritu ², Mete Uttam ², Kakkar Nandita ², Bora Girdhar ², Devana Sudheer ², Sharma Aditya ², Kumar Santosh ², Singh Shanky ², Mavuduru Ravimohan ²
  ¹ Postgraduate Institute of Medical Education and Research, Chandigarh, India, ² PGIMER, Chandigarh, Chandigarh, India

• Introduction and Objectives: Enhancing renal masses are considered as malignant until proven otherwise. Since the last decade there is increase in renal resections all over the world. Studies suggest that one third of patients are overtreated with nephrectomies. This study was done to evaluate the prevalence of avoidable benign kidney tumor resections and clinical parameters predicting benign kidney tumor resections.
  Materials and Methods: This is a retrospective study done at a tertiary care center where hospital records of patients who underwent nephrectomies with the intent of cure were collected from 2015 to 2024. Total of 1461 patients (n = 1314 in malignant and n = 147 in benign) were included for final analysis. Statistical analysis was done using SPSS v21 software.
  Results: Out of 1461 patients, 147 patients (10.1%) had benign pathology. Most common pathology in benign resections was oncocytoma (30.6%) followed by angiomyolipoma (23.1%). Median age of patients in benign group is significantly less than malignant group (47 years (IQR: 36–57) vs. 54 years (IQR: 43–63), p = 0.001). Mean tumor size also significantly lesser in benign group than malignant group (p = 0.002). Female sex was more prevalent in malignant group than benign (66.4% vs. 55.8% p = 0.011). Symptomatically, pain was significantly presented in benign group (51% vs. 36.5% p = 0.001), and hematuria was presented in malignant group (20.1% vs. 4.8% p = 0.001). On univariate analysis, tumor size, age, sex, pain, hematuria, type of surgery (radical vs. partial) are significantly different in benign and malignant group. On multivariate analysis, age (p = 0.01 OR: 0.9), sex (p = 0.042 OR: 1.4), hematuria (p = 0.01 OR: 0.35), type of surgery (p = 0.001 OR: 3.9) are significantly different in benign and malignant group.
  Conclusions: Young male patients of small renal mass presenting without hematuria are more likely to be benign. More prospective studies are needed for further conclusions.

MP-12.03—Enhancing Postoperative Care: Implementation of Telemonitoring in Robot-Assisted Partial Nephrectomy (UroCCR N°229) 

• Margue Gaëlle ¹, Ricard Solène ¹, Geshkovska Arna ¹, Callede Emmanuelle ¹, Dubernet Caroline ¹, Picard Françoise ¹, Herman Guillaume ¹, Autheman Maximilien ², Morichau-Beauchant Pierre ², Alezra Eric ¹, Capon Grégoire ¹, Estrade Vincent ¹, Bladou Franck ¹, Robert Grégoire ¹, Bernhard Jean-Christophe ¹
  ¹ Bordeaux University Hospital, Bordeaux, France, ² Resilience Care, Paris, France

• Introduction and Objectives: Effective postoperative monitoring is critical for patient safety and recovery, especially after complex surgical procedures like robot-assisted partial nephrectomy (RAPN). Since September 2021, we’ve used the UroConnect^® telemonitoring tool for pre- and postoperative support, providing information, communication with the coordination team, and PROMs (Patient Reported Outcome Measures) questionnaires. This study aims to evaluate UroConnect^®’s impact and adoption in RAPN care pathways.
  Materials and Methods: The UroConnect^® app was offered to all patients scheduled for RAPN in our department. Features included a preoperative callback request questionnaire and PROMs surveys administered on postoperative days 2, 7, 14, 21, and 30. Clinical data and patient questionnaire responses were securely stored in the UroCCR network database. We analyzed the tool’s acceptance rate, the demographic and clinical characteristics of users vs. non-users, and the response rates to PROMs questionnaires.
  Results: From September 13, 2021, to April 15, 2024, 413 RAPNs were performed on 407 patients. Of these, 58 (14%) opted out of using UroConnect^®. The characteristics of both populations are displayed in Table 1. Non-users were generally older and had more comorbidities. Among users, adherence was high, with response rates exceeding 80% to all ePROMs questionnaires. Notably, 27.1% of patients utilized the callback request feature preoperatively, indicating strong engagement with the tool. UroConnect Users (n = 355) Non-users (n = 58) Non-utilization Reasons, n (%) Foreign patient Not proposed Incompatible phone Refusal Other (illiterate…) 4 (6.9) 25 (43.1) 23 (39.7) 1 (1.7) 5 (8.6) Sex, n (%) Male Female 233 (65.6) 122 (34.4) 34 (58.6) 24 (41.4) 0.37 History of cancer, n (%) 61 (17.2) 15 (25.9) 0.16 Family history of kidney cancer, n (%) 21 (5.9) 4 (6.9) 0.46 Solitary kidney, n (%) 16 (4.5) 3 (5.2) 0.73 cTNM, n (%) T1a T1b T2a T2b T3a T3b 176 (49.6) 133 (37.5) 26 (7.3) 11 (3.1) 8 (2.2) 1 (0.3) 24 (41.4) 25 (43.1) 4 (6.9) 3 (5.2) 1 (1.7) 1 (1.7) 0.39 Age, mean [SD] 60.2[14.2] 67.4[12.0] <0.001 ASA score, n (%) 1 2 ≥ 3 58 (16.3) 194 (54.6) 103 (29.0) 2 (3.45) 30 (51.7) 26 (44.8) 0.009 Indication for NSS, n (%) Elective Imperative Relative 271 (76.3) 41 (11.5) 43 (12.1) 41 (70.7) 13 (22.4) 4 (6.9) 0.047.
  Conclusions: UroConnect^® improves communication and follow-up in RAPN patients. High adherence and frequent use of callback request highlight its value in pre and postop care, supporting broader telemonitoring adoption to enhance outcomes and streamline care.

MP-12.04—Molecular Correlates of Clinical Response to Combination Immunotherapy in Advanced Fumarate Hydratase Deficient Renal Cell Carcinoma 

• Xu Yunze
  Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

• Introduction and Objectives: Fumarate hydratase (FH)-deficient renal cell carcinoma (RCC) is an aggressive subtype of RCC most often seen in the context of hereditary leiomyomatosis and RCC (HLRCC) syndrome. Immune checkpoint inhibitor (ICI)-based treatment improves survival in a subset of patients with FH-deficient RCC. However, potential predictive biomarkers and mechanisms of response and resistance remain less well understood. We aimed to analyze the genomic and tumor immune microenvironment features of FH-deficient RCC underpinning anti-PD-1 response using bulk and single-cell approaches.
  Materials and Methods: We integrated prospective clinical sequencing of 109 primary and recurrent tumors from FH-deficient RCC patients with clinical and treatment phenotypes (ClinicalTrials.gov identifier: NCT05243173). Next-generation sequencing (NGS) of DNA damage response and repair (DDR) genes and single-cell RNA sequencing, immunohistochemistry staining integrated with multiplexed immunofluorescence (mIF) analysis were performed on FH deficient RCCs to uncover the immunogenomic determinants of therapeutic response.
  Results: While degree of PD-L1 expression was not associated with clinical response, conventional genomic markers (deleterious DDR gene alterations and tumor mutation burden) were associated with median systemic treatment overall survival (OS) with ICI-based treatment. Moreover, trajectory analysis indicated gradually upregulated exhausted markers and an increased apoptotic trend of CD8+ tumor infiltrating cells (TIC) despite continuous exposure to ICI-based treatment. Clinical data of mIF further demonstrated that high levels of CD8+ TIC expressing PD-1 but not Tim3 had higher ORR (p = 0.0423), longer median systemic treatment OS (p = 0.0261) and longer median first-line PFS.
  Conclusions: Deleterious DDR gene alterations and T-cell exhaustion molecules are associated with better clinical outcomes to combination immunotherapy in FH-deficient RCC.

MP-12.05—Predicting Oncological and Functional Outcomes by Nephrectomy Type for T1 Renal Tumors Using Machine Learning Models: Internal and External Validation 

• Puig Lucia ¹, Song Maisy ¹, Seo Seong Il ², Song Cheryn ¹, Shin Dongrul ¹, Kang Minyong ²
  ¹ Asan Medical Centre, Seoul, Korea, Dem. Rep., ² Samsung Medical Center, Seoul, Korea, Dem. Rep.

• Introduction and Objectives: While partial nephrectomy (PN) is the standard for T1 renal cell carcinoma (RCC), patients for whom benefits must be scrutinized are frequently encountered. We aimed to develop a machine learning (ML)-based model to simultaneously predict oncological and functional outcomes according to nephrectomy type.
  Materials and Methods: Demographic, tumor-related preoperative and renal functional data of 1,448 patients who underwent partial or radical nephrectomy (RN) for cT1N0M0 RCC between 2007 and 2019 at two academic institutions was collected and analyzed. In the training set (78.4%), five ML models were developed using preoperative variables and evaluated through area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC), root mean squared error (RMSE) and R2. The primary outcomes were recurrence probability and estimated glomerular filtration rate (eGFR) at postoperative 5 years according to nephrectomy type. Selecting the best fitting model, an online interface was constructed and validated using 313 (21.6%) patients.
  Results: The analytical cohort included 684 (60.2%) T1a cases, 79.9% of which underwent PN, and 451 (39.7%) T1b cases, 41% of which underwent PN. The median age was 54 years, and 68.9% of the cohort were male. Histological subtype was assumed to be clear cell in 81.5%. Recurrence was observed in 1.1% of T1a and 3.7% of T1b cases, while the median 5-year eGFR was 93.2 mL/min/1.73 m² after PN and 73.2 mL/min/1.73 m² after RN. Among the ML models, the XGBoost model demonstrated the highest performance for predicting 5-year recurrence, with AUROC of 0.861 and AUPRC of 0.095. For renal function prediction, GBM model showed the highest accuracy with R2 0.604 and RMSE of 11.714. External validation confirmed the robustness, presenting AUROC of 0.758, AUPRC of 0.200 with XGBoost model for recurrence, and RMSE of 15.9 with GBM model for eGFR.
  Conclusions: We developed an ML-based interface predicting 5-year recurrence and eGFR after PN or RN for T1 RCC using preoperative parameters. External validation corroborates the usefulness of the model and its potential for routine implementation.

MP-12.06—Preoperative Role of Systemic Immune Indices in the Differential Diagnosis Between Chromophobe Renal Cell Carcinoma and Oncocytoma 

• Aktas Semih ¹, Besiroglu Huseyin ², Sevinc Ahmet ³, Bozkurt Muammer ⁴, Kadihasanoglu Mustafa ²
  ¹ Istanbul Training and Research Hospital, İstanbul, Türkiye, ² Istanbul University-Cerrahpaşa Faculty of Medicine, İstanbul, Türkiye, ³ Kartal Training and Research Hospital, İstanbul, Türkiye, ⁴ Okmeydani Training and Research Hospital, İstanbul, Türkiye

• Introduction and Objectives: Chromophobe renal cell carcinoma (chRCC) is a subtype of RCC with a better prognosis than clear cell renal cell carcinoma, while oncocytoma is known to be a typically benign lesion. Both tumors may present with similar clinical features, making accurate diagnosis challenging. The aim of this study is to explore the role of systemic immune indices (systemic immune inflammation index and systemic inflammatory response index) in the differential diagnosis between chRCC and oncocytoma.
  Materials and Methods: The medical records of 162 patients with chromophobe RCC and 90 patients with oncocytoma, who underwent surgery for renal masses between June 2006 and August 2024, were reviewed retrospectively. Inflammatory indices of NLR, PLR, MLR, SII, and SIRI were calculated. The patient characteristics and immune indices were compared between two groups. The sensitivity and specificity of immune indices were further analyzed by ROC curve.
  Results: NLR, MLR, PLR, SII and SIRI values were significantly lower (p < 0.001) in the oncocytoma group compared to those with chromophobe RCC. SII and SIRI values also showed significant diagnostic efficiency, with AUC values of 0.72 (0.653–0.788) and 0.68 (0.609–0.750), respectively.
  Conclusions: Inflammation indices might be valuable tools in the preoperative diagnostic differentiation of chRCC and oncocytoma to optimize treatment strategies.

MP-12.07—Recurrence-Free Survival and Upstaging Risk Following Biopsy in T1 RCC: A Large Single-Center Propensity Score-Matched Analysis 

• Yoo Jun Hyeok, Song Maisy, Song Cheryn, Sung Joung Won
  University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea

• Introduction and Objectives: Concerns persist regarding the potential adverse oncological impact of renal mass biopsy (RMB) in patients with small renal cell carcinoma (RCC), particularly regarding tumor recurrence and upstaging due to tumor seeding or capsule disruption. We evaluated the impact of preoperative RMB on recurrence-free survival (RFS) and upstaging to perinephric fat invasion in patients with cT1 renal cell carcinoma.
  Materials and Methods: We conducted a retrospective cohort study of 386 patients who underwent preoperative RMB and 772 propensity score matched controls who proceeded directly to surgery for T1 RCC between 2004 and 2022, evaluating recurrence-free survival using Kaplan-Meier analysis and Cox proportional hazards regression, and assessing perinephric fat invasion upstaging through multivariable logistic regression.
  Results: Final cohort comprised 882 (76.2%) T1a and 276 (23.8%) T1b patients, with 684 (59.1%) after partial nephrectomy and 474 (40.9%) after radical nephrectomy. During a median follow-up of 58 months (IQR 39–77), RFS showed no statistically significant difference between two groups (5Y RFS 96.7% vs. 97.8%, p = 0.35). Multivariable analysis confirmed RMB was not associated with recurrence (HR = 0.71, 95% CI 0.34–1.46, p = 0.35). Independent predictors of recurrence included the tumor size (HR 1.65, 95% CI 1.23–2.21, p < 0.001), nuclear grade (HR 2.22, 95%CI 1.16–4.24, p = 0.016), high RENAL nephrometry E-score (HR 4.12, 95% CI 1.35–12.56, p = 0.013) and perinephric fat invasion (HR 3.5, 95%CI 1.01–12.12, p = 0.048). Similarly, RMB was not associated with upstaging to perinephric fat invasion (OR 1.64, 95%CI 0.78–3.36, p = 0.182). On multivariable analysis, nephrometry E-score was the only significant predictor of perinephric fat invasion, with higher E-scores showing lower risk.
  Conclusions: Preoperative biopsy in T1 RCC did not adversely impact oncologic outcomes, providing reassurance regarding its safety and supporting its role in diagnostic evaluation and management planning for patients with small renal masses.

12.2. Moderated Video ePosters

MVP-12.01—Robotic Salvage Partial Nephrectomy and Vena Cava Thrombectomy on a Horseshoe Kidney 

• Margue Gaëlle, Yacoub Mokrane, Gross-Goupil Marine, Boulenger De Hauteclocque Astrid, Jambon Eva, Capon Grégoire, Alezra Eric, Estrade Vincent, Bladou Franck, Robert Grégoire, Bernhard Jean-Christophe
  Bordeaux University Hospital, Bordeaux, France

• Introduction and Objectives: The objective of this video is to demonstrate the feasibility of a complex renal surgery involving a robotic-assisted salvage partial nephrectomy with vena cava thrombectomy on a horseshoe kidney.
  Materials and Methods: The surgery was performed using the Da Vinci Xi surgical robot (Intuitive Surgical). We employed three operative arms, a 30° optical lens, and two trocars (5 mm and 12 mm) for surgical assistance. The procedure was guided by intraoperative ultrasonography (Hitachi©). A 3D model of the kidney, its vasculature, the tumor, and the vena cava thrombus was created from the preoperative CT scan using Synapse 3D software (Fujifilm) to guide the surgery.
  Results: The patient was an 85-year-old male in excellent general condition, who underwent laparoscopic partial nephrectomy converted to open surgery in November 2021 for a clear cell renal carcinoma, ISUP grade 3, pT1b on a horseshoe kidney. He presented with a 6 cm recurrence in the anteroinferior right hemikidney with thrombotic extension to multiple draining veins and the vena cava (Novick grade 2, 12 cm). The metastatic workup was negative, and renal function was impaired (serum creatinine 155 µmol/L = GFR 35 mL/min). The surgery was extremely challenging due to the complex venous anatomy and numerous adhesions from the previous intervention. It lasted 10 h and 40 min, successfully excising a clear cell renal carcinoma, ISUP grade 3, pT3b, pN0, R0. The patient was discharged on the 10th postoperative day. Three months post-surgery, he had fully recovered with stable renal function and a GFR of 36 mL/min.
  Conclusions: Horseshoe kidneys represent complex situations where performing nephron-sparing surgery is crucial. Proper preoperative planning is essential to accurately understand the renal and vascular anatomy, enabling ischemic-sparing surgeries that preserve healthy parenchyma. This work was supported by the French government under the 3rd Investment in the Future Program, as part of France 2030, managed by the National Research Agency (ANR) and referenced as ANR-21-RHUS-0015.

12.3. Residents Forum Moderated Oral ePosters

RF-12.01—Integrating Artificial Intelligence for Predicting Oncological and Functional Outcomes in Partial Nephrectomy: A Retrospective Cohort Study 

• Ajzajian Jirayr, Mohammed Mahmoud, Obudi Sara, Makar Adel
  Worcestershire Acute Hospitals NHS, Birmingham, United Kingdom

• Introduction and Objectives: Artificial intelligence (AI) is emerging as a valuable tool in enhancing clinical decision-making across various cancer care pathways. In the context of partial nephrectomy, accurately predicting oncological recurrence and postoperative renal function remains a significant challenge. While traditional risk stratification systems, such as the RENAL nephrometry score, offer important guidance, their predictive capacity can be limited. AI and machine learning techniques have the potential to provide more individualized, data-driven insights. In this study, we assessed the performance of AI-based models in forecasting both oncological and functional outcomes following partial nephrectomy, using data from a single-institution retrospective cohort.
  Materials and Methods: A retrospective study was conducted on 324 renal tumor cases (including metachronous bilateral tumors in six patients) from 2003 to 2020 at the Department of Urology, Worcestershire Acute Hospitals NHS Trust, UK. Machine learning (ML) models including Random Forest and Gradient Boosting were trained using demographic, clinical, and tumor-specific variables to predict recurrence, renal function decline, and margin positivity. The RENAL nephrometry score was reconstructed from imaging and included in the analysis. Model accuracy and feature importance were analyzed and benchmarked against traditional statistical methods.
  Results: AI models achieved high performance in predicting recurrence and functional outcomes. Age, preoperative creatinine, and tumor size were the top predictors of recurrence, while RENAL score had stronger association with renal function decline. Margin positivity showed limited predictive correlation. Subgroup analysis revealed worse outcomes in tumors > 4 cm. Figures include model performance metrics, feature importance plots, confusion matrices, and subgroup bar charts.
  Conclusions: AI-enhanced prediction models demonstrate superior prognostic capabilities for recurrence and renal function outcomes in partial nephrectomy compared to conventional scoring systems alone. Integration of these tools into clinical workflows may enhance individualized patient care.

12.4. Unmoderated Standard ePosters

UP-12.01—A Multicenter Survey on the Current Status of Quality Control in the Diagnosis and Treatment of Renal Cell Carcinoma in China 

• Du Yicong ¹, RCC Quality Control Committee Working Group China NCQCC ²
  ¹ Peking University First Hospital, Beijing, China, ² China National Cancer Quality Control Center, Beijing, China

• Introduction and Objectives: This study aims to comprehensively evaluate the quality control status in the diagnosis and treatment of renal cell carcinoma (RCC) across different medical institutions in China, providing evidence-based support for establishing a standardized RCC diagnosis and treatment system.
  Materials and Methods: A multicenter survey was conducted from September to October 2024, and physicians with RCC experience across 26 provinces or municipalities were invited online. The questionnaire included six core dimensions: physician characteristic, hospital quality control systems, RCC surgical practices, advanced RCC treatment, follow-up management, and multidisciplinary team (MDT) collaboration. Descriptive statistics were used to analyze the collected data.
  Results: A total of 141 valid questionnaires were collected, all from tertiary hospitals. Key findings include: (1) Quality control systems: 77.3% of institutions have established RCC diagnosis and treatment quality control processes. (2) Diagnostic quality: The median proportion of RCC who underwent clinical TNM staging before initial treatment was 92% (80%, 100%). Meanwhile, the median proportion of patients who completed pathological diagnosis before initial non-surgical treatment was 82% (12%, 100%). (3) Surgical quality: Among patients undergoing surgical treatment, the median proportion of those receiving minimally invasive surgery was utilized in 94% (89%, 97%). For T1a stage patients, the median proportion receiving partial nephrectomy reached 91% (82%, 98%). The perioperative mortality rate was 0%. The median proportion of patients requiring intraoperative or postoperative blood transfusion was only 5% (2%, 10%). The median incidence of surgical complications was 5% (2%, 8%). (4) Systemic therapy: Among advanced RCC patients, the median proportion receiving systemic therapy was 81% (60%, 92%); TKI combined with PD-1/L1 inhibitors as first line treatment was accounted for 31.9%. The median proportion of patients who completed efficacy assessment after non-surgical treatment was 79% (40%, 95%); completed adverse reaction assessment was 68% (24%, 90%). (5) Follow-up management: The follow-up rate for treated inpatients after discharge reached 90% (80%, 100%). Additionally, 83.7% of physicians reported that their hospitals routinely implement MDT for RCC diagnosis and treatment.
  Conclusions: Quality control systems for RCC diagnosis and treatment in Chinese tertiary hospitals are preliminarily established, with significant achievements in surgical quality and diagnostic accuracy.

UP-12.02—Arterial Pseudoaneurysm Following Partial Nephrectomy: A Serious but Preventable Complication 

• Ouajnati Mohamed, Damouny Yassine, Chatar Achraf, Lakmichi Mohamed Amine, Dahami Zakaria, Sarf Ismail
  Centre Hospitalo-Universitaire Mohammed VI de Marrakech, Marrakech, Morocco

• Introduction and Objectives: Partial nephrectomy has become the gold standard in the management of localized renal tumors (T1 stage), offering nephron-sparing benefits with effective oncologic control. Despite its minimally invasive nature, it carries a risk of rare but potentially life-threatening vascular complications, such as renal arterial pseudoaneurysm, which often presents in a delayed and hemorrhagic fashion. The objective of this case is to illustrate this complication through a representative clinical scenario and to discuss its risk factors, diagnostic modalities, and preventive strategies.
  Materials and Methods: We report the case of a 77-year-old male patient with no significant medical history who underwent laparoscopic right partial nephrectomy for a T1b upper pole renal tumor. The warm ischemia time was 40 min, and intraoperative blood loss was estimated at 300 mL. The immediate postoperative course was uneventful.
  Results: On postoperative day 11, the patient developed isolated gross hematuria and a drop of 3 g/dL in hemoglobin levels. An abdominal CT angiography revealed an image consistent with an intrarenal pseudoaneurysm. Digital subtraction angiography confirmed an 18 × 30 mm mid-renal pseudoaneurysm. The patient underwent successful selective arterial embolization using 1 mL of 600 µm hydropearl microparticles. The outcome was favorable, with no recurrence at 6-month follow-up.
  Conclusions: Renal arterial pseudoaneurysm is an uncommon (1–5%) but potentially severe complication of partial nephrectomy. Diagnosis relies on contrast-enhanced imaging, and selective embolization is the treatment of choice, allowing lesion control while preserving renal function. Risk factors include hilar tumors, size > 4 cm, prolonged ischemia time, laparoscopic or robotic approach, and intraoperative bleeding. Prevention relies on meticulous surgical dissection and hemostasis. This case emphasizes the need for careful postoperative surveillance and highlights the critical role of collaboration between urologists and interventional radiologists.

UP-12.03—Bacillus Calmette Guerin (BCG) Instillations Versus Radical Nephroureterectomy for the Treatment of Carcinoma in Situ (CIS) of the Upper Urinary Tract: A Systematic Review and Meta-Analysis 

• Alexopoulou Sofia ¹, Lazari Eleni ², Karagiannis Thomas ³, Goulis Dimitrios ³, Memmos Dimitrios ³, Mykoniatis Ioannis ³, Roidos Christos ³, Papathanasiou Konstantinos ³, Sountoulides Petros ³, Langas George ³
  ¹ Sankt Vinzentius Krankenhaus Speyer, Klinik fur Urologie and Kinderurologie, Speyer, Germany, ² Univeritatsklinikum Essen, Zentrum fur Kinder-und Jugendmedizin, Essen, Germany, ³ Aristotle University of Thessaloniki, Thessaloniki, Greece

• Introduction and Objectives: Primary carcinoma in situ of the upper urinary tract (UT-CIS) without papillary component is a rare entity that accounts for less than 1% of urological cancers. Radical nephroureterectomy (RNU) is the standard of care based on the high progression rate of UT-CIC to muscle invasive urothelial carcinoma; however, studies involving these patient are scarce. The favorable response of CIS to Bacillus Calmette-Guérin (BCG) instillations provides the additional benefit of preserving renal function and avoiding the complications of RNU. The objective of the study was to examine whether conservative management with BCG instillations is comparable to RNU regarding safety and oncological efficacy for patients with UT-CIS without concomitant papillary tumors.
  Materials and Methods: A systematic review and meta-analysis were performed concerning the oncological efficacy and safety of BCG instillation therapy versus RNU in patients with UT-CIS. MEDLINE, Scopus and Cochrane databases were searched.
  Results: The systematic review included three retrospective cohort studies (103 patients). 65 received BCG, and 34 underwent RNU. The mean follow-up was 51.1 ± 27.8 months. No significant difference was noted in 5-year overall survival (odds ratio [OR] 1.56, 95% confidence interval [CI] 0.22 to 11.28, I2 = 67%), 5-year cancer-specific survival (OR 0.86, 95% CI 0.15 to 4.28, I2 = 2%) or 5-year relapse-free survival (OR 1.57, 95% CI 0.40 to 6.15, I2 = 0%). The incidence of severe adverse events was comparable between the two treatments (OR 2.61, 95% CI 0.55 to 13.67, I2 = 0%). Of the 65 patients treated with BCG, 49 (75.4%) achieved complete response after completing the therapeutic scheme, and 34 (52.3%) maintained it until the end of follow-up. Persistence or recurrence was observed in 24 (36.9%) patients who received BCG and 15 (44.1%) who underwent RNU. To evaluate the risk of bias, we used the ROBINS-I tool for non-randomized studies; all three studies were at moderate risk of bias.
  Conclusions: BCG instillation therapy for primary UT-CIS without papillary tumor is not inferior to RNU and could be considered as first-line treatment for patients unfit for surgery or at risk of chronic kidney disease following RNU. The role of BCG instillation therapy as first-line treatment for all cases of primary UT-CIS should be prospectively verified.

UP-12.04—Causal Association of Alanine and Alanine Transaminase with Kidney Cancer: Insights from Mendelian Randomization 

• Xie Yu, Chen Lei
  Hunan Cancer Hospital, Changsha, China

• Introduction and Objectives: Previous reports have suggested an association between alanine and alanine aminotransferase (ALT) with various diseases, including cancer. However, these observational studies are susceptible to bias and confounding factors, lacking robust evidence of causality. This study aims to employ Mendelian randomization (MR) analysis using two-sample MR to systematically investigate the causal link between genetically predicted high blood urea nitrogen levels and bladder cancer.
  Materials and Methods: Inverse variance weighted (IVW) analysis was primarily used to assess the causal relationship between circulating alanine and ALT with kidney cancer. Sensitivity analyses, including simple median method, weighted median method, weighted mode method, and leave-one-out analysis, were conducted to enhance result reliability. MR-Egger intercept and Cochran’s Q test were utilized to evaluate heterogeneity and pleiotropy. MR-PRESSO was applied to detect outliers, and multivariable MR analysis was performed to mitigate confounding factors.
  Results: High levels of circulating alanine and ALT showed a significant causal relationship with kidney cancer. IVW analysis revealed an odds ratio (OR) of 1.0016 (95% CI, 1.0001–1.0031) for alanine and kidney cancer. Sensitivity analyses, including weighted median method (OR: 1.0015, 95% CI, 0.9994–1.0036), weighted mode method (OR: 1.0026, 95% CI, 0.9993–1.0058), and simple median method (OR: 1.0028, 95% CI, 0.9994–1.0062), supported the main analysis results. Additionally, ALT showed an OR of 1.0013 with kidney cancer. MR-Egger (OR: 1.0032, 95% CI, 1.0004–1.0060), weighted median method (OR: 1.0017, 95% CI, 0.9997–1.0037), simple median method (OR: 1.048, 95% CI, 1.0003–1.0092), and weighted mode method (OR: 1.0027, 95% CI, 1.0003–1.0052) were also indicative of this association. Cochran’s Q test indicated no heterogeneity in the risk of kidney cancer associated with alanine and ALT, while MR-PRESSO analysis showed no outliers or pleiotropy.
  Conclusions: This MR analysis demonstrates a positive causal relationship between high circulating alanine and ALT levels and kidney cancer, increasing the risk of kidney cancer. Therefore, increased attention should be given to kidney cancer screening and prevention in patients with elevated circulating alanine and ALT levels.

UP-12.05—Clinical Validation of UROCAD Test for Upper Tract Urothelial Carcinoma Detection: Results from a Prospective Multi-Center Study (Nct05043662) 

• Yang Guoliang ¹, Zeng Shuxiong ², Liu Mengyao ¹, Cao Min ¹, Zhang Lianhua ¹, Xue Wei ¹
  ¹ Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, ² Department of Urology, Changhai Hospital, Shanghai, China, Shanghai, China

• Introduction and Objectives: Upper tract urothelial carcinoma (UTUC) presents significant diagnostic challenges due to its anatomical location and limited accessibility. This prospective, multi-center study (NCT05043662) aimed to validate the diagnostic performance of the UROCAD test, a non-invasive assay analyzing chromosomal copy number variations in urinary cell-free DNA, for UTUC detection.
  Materials and Methods: Between 2021 and 2023, 143 patients with suspected UTUC were enrolled across two tertiary centers. The UROCAD test was evaluated for diagnostic accuracy, with pathological diagnosis as the reference standard. Chromosomal alterations were analyzed using a bioinformatics pipeline, and post-surgical monitoring was conducted to assess treatment response.
  Results: The UROCAD test demonstrated high diagnostic accuracy, with a sensitivity of 82.1% (95% CI: 73.2–88.8%) and specificity of 100% (95% CI: 92.5–100%). Positive predictive value (PPV) was 100% (95% CI: 95.3–100%), and negative predictive value (NPV) was 73.8% (95% CI: 61.9–83.2%). The test performed consistently across tumor locations (renal pelvis: 80.8% sensitivity, ureter: 83.7% sensitivity) and tumor grades (high-grade: 85.7% sensitivity, low-grade: 72.0% sensitivity). Characteristic chromosomal alterations were identified, with frequent amplifications in 1q (45.2%), 8q (42.3%), and 3q (38.1%) and deletions in 9p (45.3%), 10q (42.1%), and 6q (40.2%). Post-surgical monitoring revealed complete chromosomal normalization in 60% of cases, with chr1q and chr9p emerging as key biomarkers for recurrence.
  Conclusions: The UROCAD test offers robust diagnostic performance for UTUC detection with high specificity and sensitivity, supporting its integration into clinical practice for both diagnosis and treatment monitoring. These findings highlight the potential of chromosomal copy number variation analysis as a valuable tool in UTUC management.

UP-12.06—Digital Collection of Patient-Reported Outcome Measures (PROMs) Using the UroConnect Application: Insights into Patient Experiences Following Robot-Assisted Partial Nephrectomy (UroCCR N°229) 

• Capon Grégoire ¹, Ricard Solène ¹, Geshkovska Arna ¹, Callede Emmanuelle ¹, Dubernet Caroline ¹, Picard Françoise ¹, Herman Guillaume ¹, Autheman Maximilien ², Morichau-Beauchant Pierre ², Alezra Eric ¹, Estrade Vincent ¹, Bladou Franck ¹, Robert Grégoire ¹, Bernhard Jean-Christophe ¹, Margue Gaëlle ¹
  ¹ Bordeaux University Hospital, Bordeaux, France, ² Resilience Care, Paris, France

• Introduction and Objectives: Since September 2021, our department has deployed the UroConnect^® telemonitoring application for postoperative follow-up, especially for patients undergoing robot-assisted partial nephrectomies (RAPN) in outpatient and ERAS (enhanced recovery after surgery) pathways. It collects PROMs (Patient Reported Outcome Measures) while facilitating and securing the return home. Our objective was to describe RAPN postoperative recovery by analyzing PROMs from the UroConnect^® application.
  Materials and Methods: The UroConnect^® application (Resilience) was offered to all eligible patients undergoing RAPN in our department who were French-speaking and had internet access. Questionnaires evaluating the resumption of activity and the evolution of postoperative symptoms (pain, nausea, scars, etc.) were sent on D2, D7, D14, D21, and D30. All patients were included and followed prospectively, and their clinical data stored in the UroCCR network database (NCT03293563).
  Results: Between September 2021 and April 2024, out of over 414 patients who underwent RAPN, 364 benefited from telemonitoring via the UroConnect^® application. The responses to the various questionnaires are summarized in Table 1. The average level of fatigue progressively decreased during the first 2 weeks postoperatively before stabilizing from D+14 (Figure 1). Similarly, pain decreased mainly in the first two weeks, with 92% of patients expressing a notable improvement in their general condition by D+7 and less than 20% of patients reporting taking painkillers on D+14 postoperatively. D+2 D+7 D+14 D+21 D+30 Request to be recontacted 58 (18.9) 76 (23.9) 61 (18.6) 52 (16.2) 29 (9.3) Pain level (0–10) Mean [SD] 4.2 (2.1) 2.8 (2.0) 1.7 (1.7) 1.5 (1.6) 1.0 (1.5) Nausea, n (%) 54 (17.6) Vomiting, n (%) 10 (3.3) Resumption of bowel movement, n (%) 257 (83.9) 307 (96.5) Fatigue level (0–10) Mean [SD] 5.3 (2.2) 4.5 (2.2) 3.5 (2.4) 3.2 (2.4) 2.7 (2.3) Use of painkillers, n (%) 290 (94.7) 230 (72.3) 101 (30.8) 64 (19.9) 42 (13.5) Hematuria, n (%) 9 (2.8) 11 (3.4) Inflammatory wounds, n (%) 90 (28.3) 89 (27.1) 76 (23.7) Activity level, n (%) Very limited Fairly limited Slightly limited Not limited 89 (27.9) 126 (39.6) 94 (29.6) 9 (2.9) 45 (13.7) 122 (37.2) 139 (42.4) 22 (6.7) 26 (8.1) 102 (31.7) 155 (48.3) 38 (11.9) 19 (6.1) 56 (17.9) 166 (53.2) 71 (22.8).
  Conclusions: This study represents the largest international series of patient-centered evaluations conducted using a telemonitoring application following RAPN. Within 2 weeks following surgery, the majority of patients reported a notable improvement in their health condition.

UP-12.07—Dual Renal Pathology in Tuberous Sclerosis Complex with Situs InVersus Totalis 

• Soni Jaideep, Navriya Shiv, Bhirud Deepak, Singh Mahendra, Choudhary Gautam, Sandhu Arjun
  AIIMS Jodhpur, Lucknow, India

• Introduction and Objectives: Renal angiomyolipomas (AMLs) are benign tumors common in tuberous sclerosis complex (TSC), an autosomal dominant disorder (1 in 6,000) caused by TSC1/TSC2 mutations, with AMLs in up to 80% of cases versus 0.3–3% sporadically. Giant AMLs (>4 cm) risk hemorrhage, while TSC-related renal cell carcinoma (RCC) occurs in 2–4% of patients. This case report details a rare TSC presentation with bilateral renal pathology—a right giant AML and left RCC—complicated by situs inversus totalis, highlighting tailored diagnostic and therapeutic strategies.
  Materials and Methods: A 70-year-old female with TSC, diagnosed via cutaneous signs (angiofibromas, adenoma sebaceum), presented with acute bilateral flank pain and hematuria. Imaging (ultrasound, CECT abdomen, CT thorax, MRI brain) revealed a right giant AML (14.2 cm) with pseudoaneurysm, a left complex renal mass (12.9 cm), situs inversus, and TSC features (lung cysts, brain tubers). Transarterial embolization (TAE) with coils addressed the AML’s hemorrhage, followed by left partial nephrectomy for the suspected RCC. Genetic screening confirmed TSC2 mutation. A multidisciplinary team (radiology, urology, genetics) guided management.
  Results: TAE successfully controlled hemorrhage from the right AML, preventing nephrectomy. Histopathological analysis of the left renal mass confirmed two distinct tumors: a classic AML and RCC (pT2bN1). Postoperative recovery was uneventful, with stable renal function and no immediate complications.
  Conclusions: This case underscores the importance of genetic evaluation, advanced imaging, and a multidisciplinary approach in TSC-associated renal pathology. TAE effectively managed AML-related hemorrhage, while nephrectomy addressed RCC. The presence of situs inversus totalis emphasizes the need for individualized surgical planning to optimize patient outcomes.

UP-12.08—Effectiveness and Safety of Adjuvant Tislelizumab with TKI in Very High-Risk Clear-Cell Renal Cell Carcinoma: A Retrospective, Real-World Study 

• Zhang Shun, Ji Changwei, Liu Guangxiang, Guo Hongqian
  Nanjing Drum Tower Hospital, Nan Jing, China

• Introduction and Objectives: PD-1/PD-L1 inhibitors combined with vascular endothelial growth factor (VEGF) inhibitors have shown survival benefits in advanced renal cell carcinoma (RCC). However, the potential role of perioperative application in localized RCC remains unclear. The KEYNOTE-564 trial demonstrated that adjuvant pembrolizumab improved disease-free survival (DFS) in high-risk clear cell RCC (ccRCC) patients, though subgroup analyses suggested that not all patients derived benefit. Therefore, this study investigates the efficacy and safety of adjuvant tislelizumab in combination with TKI in ccRCC patients with a very high risk of recurrence after nephrectomy.
  Materials and Methods: This retrospective study included 15 patients with very high-risk ccRCC (pT3/pT4Nx/N0M0, pTanyN+M0, or pT2Nx/N0M0 with nuclear grade ≥ 3, or stage M1 with no evidence of disease [NED]) who received adjuvant tislelizumab with TKI post-surgery from August 2021 to September 2024. Data on demographics, clinical characteristics, surgical outcomes, prognostic factors, and safety were collected and analyzed. The primary endpoint was DFS, with secondary endpoints including overall survival and safety.
  Results: The 15 patients had a median age of 57 years (interquartile range 32–71), with 10 (67%) male. Most patients had pT3 (73%) and pN0 (60%) disease, and 13% had M1 NED status. After a median follow-up of 15.5 months (range 5–36), the primary efficacy endpoint of DFS was not reached. The median treatment duration was 9.5 months (range 3–14) for tislelizumab and 6 months (range 3–8) for TKI. The 2-year and 1-year DFS rates were 93.8% (95% CI: 63.2–99.01%) and 84.4% (95% CI: 49.3–96%), respectively. Treatment-related adverse events (TRAEs) occurred in 92% of patients, with grade 3–4 TRAEs in 30%. The most common grade 3–4 TRAEs were leukopenia and hypertension. No treatment-related deaths were reported.
  Conclusions: Adjuvant tislelizumab combined with TKI showed promising antitumor activity and a manageable safety profile in very high-risk ccRCC patients.

UP-12.09—Evaluating the Efficacy and Safety of Active Surveillance for Small Renal Masses in Routine Clinical Practice 

• Morales Pinto Stalin ¹, Herrera Imbroda Bernardo ², García Góngora Beatriz ¹, Alberca Arcos Fernando ¹
  ¹ Virgen de la Victoria University Hospital, Málaga, Spain, ² University Hospital Virgen de la Victoria Málaga-España, Málaga, Spain

• Introduction and Objectives: Active surveillance (AS) of small renal masses (SRMs) is increasingly utilized, particularly in elderly or comorbid patients. However, standardized AS protocols for the general population are lacking. Most SRMs exhibit indolent behavior with low metastatic potential, provided their radiological characteristics remain stable over time.
  Materials and Methods: A retrospective observational study was conducted including 74 patients diagnosed with SRMs (<4 cm), suspected of being renal cell carcinoma based on contrast-enhanced imaging, between January 2016 and April 2024. Patients were followed clinically and radiologically every 6 months. Clinical, demographic, and radiological variables were analyzed. Statistical analysis was performed using SPSS v21.
  Results: Seventy-four patients were included in the AS protocol. The median age was 68 years (IQR25–75; 54–76 y); 56.8% were male. Comorbidities included diabetes mellitus (31.1%), obesity (40.5%), chronic kidney disease (18.9%), and smoking (55.4%). Most SRMs were incidentally discovered (87.8%). ECOG performance status was 0 in 91.9% of patients. Diagnostic modalities included contrast-enhanced CT (71.6%), ultrasound (24.3%), and MRI (4.1%). Right kidney involvement was seen in 55.4%, with masses predominantly located in the mid-renal region (37.8%). Posterior localization was observed in 59.5%. The median follow-up period was 30.5 months (IQR25–75; 6.2–36.5 m). The mean tumor size was 21 mm (SD ± 8), with an average growth rate of 1.75 mm/year. No patients developed metastatic disease during follow-up. Ten patients (14.9%) exited AS, 8 due to accelerated tumor growth and 2 by personal choice. The mean tumor size at the time of AS discontinuation was 26 mm, with a mean growth rate of 2.15 mm/year.
  Conclusions: Active surveillance of small renal masses is a feasible and safe approach in the general population. Accelerated growth may be a variable to consider when determining a change in therapeutic strategy.

UP-12.10—Impact of Capsular Breach on Recurrence Rates After Laparoscopic Partial Nephrectomy: A Retrospective Analysis of Prospectively Maintained Data 

• Rathod Vivek, Nayak Prasant, Muhammad Huzaifa, Yadav Mithilesh
  All India Institute of Medical Sciences, Bhubaneshwar, Bhubaneshwar, India

• Introduction and Objectives: Laparoscopic partial nephrectomy (LPN) preserves renal function but raises concerns about oncological safety, particularly with positive surgical margins (PSMs), tumour spillage, and capsular breech. This study evaluates their impact on recurrence and progression in renal cell carcinoma (RCC), clarifying their significance and refining surgical strategies for improved patient outcomes.
  Materials and Methods: A retrospective analysis of a prospectively maintained database was conducted from September 2019 to October 2024. Patients undergoing LPN with histopathological confirmed RCC were included. Cases converted to radical nephrectomy and patients lost to follow-up were excluded. Oncological outcomes were assessed through standardized postoperative surveillance, including cross-sectional imaging and laboratory investigations at regular intervals. Data were analyzed regarding oncological outcomes, tumor characteristics, and recurrence rates.
  Results: A total of 65 patients were included, with a mean tumour size of 4.8 ± 3.4 cm and a median follow-up of 17 months (range: 5–47 months). PSMs were present in 5 patients, intraoperative tumour capsule breach in 8 cases, and tumor spillage in 3 cases. Two patients experienced recurrence: one local recurrence at 12 months and one nodal metastasis at 17 months, both with ISUP Grade 3 tumors. No recurrence was observed in cases with capsular breech, tumor spillage, or PSMs.
  Conclusions: Capsular breech and tumor spillage did not impact short-term oncological outcomes. The absence of recurrence in these groups suggests that isolated intraoperative complications may not necessarily translate to worse outcomes if managed appropriately. Tumor grade appeared to be a more significant predictor of recurrence and progression. Further long-term studies with larger cohorts are needed to validate these findings and guide surgical decision-making.

UP-12.11—Impact of the CMR Versius Robotic System on the Nephrectomy and Nephroureterectomy Service, an Early Experience 

• Albnhawy Ahmed, Veer Sachin, Hossain Asmita, Das Shweta, Hussain Eslam, Hanna George, Henderson James, Khan Shahid, Rane Abhay
  Surrey and Sussex Healthcare NHS Trust, Redhill, United Kingdom

• Introduction and Objectives: Radical nephrectomy, nephroureterectomy, and simple nephrectomy are common urology procedures. Laparoscopic renal surgery has become the standard of care. The robotic-assisted surgery is the advanced version of the minimally invasive surgery. In April 2022, we introduced the CMR Versius robotic system in our practice. The aim of this study is to assess the impact of the CMR Versius robotic system on our service.
  Materials and Methods: Patients who underwent radical nephrectomy, nephroureterectomy, and simple nephrectomy in the period between 2018 and 2024 were recruited to the study. Patients were reviewed retrospectively for preoperative, operative, and postoperative records, and then the CMR Versius robotic-assisted cases were compared to laparoscopic cases in each parameter.
  Results: Adoption of the CMR Versius robotic system in the nephrectomy and nephroureterectomy service has improved the length of stay; it also has lower rates of intraoperative complications and positive surgical margins. In addition, it showed a reduction in the CDC grade >/= 3 in the NU cases, while there were similar rates in the RN and SN cases. On the other hand, there were no significant differences in blood loss or need for blood transfusion.
  Conclusions: The CMR Versius robotic system has improved the service in multiple aspects. However, the longer operative time with the new system can be explained by the early experience with the system, which would improve with time. Also, the small number of the NU and SN cases would make the result not very accurate for this type of surgery.

UP-12.12—Investigating the Histopathological and Radiological Features of Tubulocystic Renal Cell Carcinoma 

• Abu Haweeleh Mohannad ¹, Khalil Ibrahim ², Abuhayeh Nada ³
  ¹ Qatar University, College of Medicine, Doha, Qatar, ² Urology Department, Hamad Medical Corporation, Doha, Qatar, ³ Qatar University, College of Pharmacy, Doha, Qatar

• Introduction and Objectives: Tubulocystic renal cell carcinoma (TC-RCC) is a rare subtype of renal cell carcinoma with distinct histopathological and immunohistochemical features. Due to its rarity, data on its clinicopathological profile, prognosis, and tumor behavior remain limited. This study aims to analyze reported TC-RCC cases, focusing on tumor characteristics, prognosis, and immunohistochemical findings to improve understanding and management strategies.
  Materials and Methods: A systematic review of 30 published TC-RCC cases was conducted. Data on tumor laterality, site, size, focality, concurrent malignancies, staging, and immunohistochemistry were extracted and analyzed. Tumor extent, lymph node involvement, vascular invasion, and metastatic potential were assessed to determine prognosis. Immunohistochemical markers were evaluated for diagnostic and prognostic significance.
  Results: TC-RCC showed a left-sided predominance (63.3%) and was primarily unifocal (40%). The upper pole was the most affected site (36.7%). Tumor sizes varied widely, ranging from 0.8 cm to 37 cm. Concurrent malignancies were identified in 26.7%, with papillary renal cell carcinoma (PRCC) being the most frequent (20%). Tumor extension beyond the kidney occurred in 16.7%, and distant metastases were observed in 16.7%. Lymphatic or vascular invasion was rarely reported (6.7%). Immunohistochemistry showed AMACR positivity in 66.7%, followed by CD10 (46.7%) and Vimentin (43.3%). CK7 was positive in 30% and negative in 36.7%. CK20, TFE-3, and CEA were negative in all cases. FH retention was noted in 13.3% of cases. CK19 was strongly positive in intracytoplasmic vacuolated areas, and RCC positivity was seen in poorly differentiated areas. Several cases exhibited co-expression of AMACR and E-cadherin.
  Conclusions: TC-RCC is a rare entity with diverse presentations. Many cases exhibit concurrent malignancies and extrarenal extension. Immunohistochemistry highlights AMACR and CD10 positivity. While early-stage tumors are common, advanced cases emphasize the need for standardized management. Further studies are necessary to establish prognostic markers and optimize treatment strategies

UP-12.13—Is Radiofrequency Ablation of Renal Cancer Metastases a Suitable Alternative to Surgical Metastectomy: A Systematic Review 

• Dexter Eloise, McNicholas Daniel, Hampson Alexander, Evans Jonathan, Venugopal Suresh
  Royal Liverpool Hospital, Liverpool, United Kingdom

• Introduction and Objectives: Percutaneous ablative procedures such as radiofrequency ablation (RFA) are recognised as safe and effective treatment for small renal masses. These techniques are routinely used for metastases of other cancers such as lung or colorectal cancer. They are not commonly used to treat metastases from RCC. We performed a systematic review to assess the feasibility and safety of these treatments for metastatic RCC.
  Materials and Methods: A systematic review of the literature was performed, searching for primary papers reporting outcomes on percutaneous ablative procedures such as RFA or cryoablation for the treatment of metastases of RCC. The study is registered with PROSPERO and is conducted in line with PRISMA guidelines.
  Results: Seven studies were identified with a total of 752 patients undergoing 961 radiofrequency ablation sessions for 1423 metastases were included in this systematic review. Of the seven studies, 4 were single centre retrospective cohort studies, 2 were multi-centre retrospective cohort studies, and 1 was monocentric prospective study. The mean age of patients in this study is 63.74 years, and 34.4% were female. Mean follow up ranged from 10–61 months. Mean tumour size ranged from 12–79 mm. Overall survival ranges from 50–100% from 5 years onwards post RFA. Overall, we report a 30% risk of pneumothorax, 1.2% risk of non-pneumothorax complication, and 0.1% risk of death per metastases treated.
  Conclusions: This is the first systematic review on this subject. We have shown that RFA can be safely used for metastatic RCC, like it is used for metastases from other cancers such as liver, lung and bone metastases. It also demonstrates acceptable oncological outcomes, comparable to surgical metastectomy. We have also highlighted the sparsity of evidence for this treatment and emphasise the importance of further research in the form of randomised control trials, which are required to give level 1 evidence.

UP-12.14—Minimally Invasive Management of Small Renal Tumours: A Comparative Analysis of Ablation Techniques with over a Decade of Clinical Experience 

• Sanchez-Pedreno Jimenez Mercedes, Garcia Juarranz Cristina, Bermudez Rodriguez Julio, Donis Canet Francisco, Serret De Troya Carlos, Tellez Martinez-Fornes Miguel
  Severo Ochoa University Hospital, Madrid, Spain

• Introduction and Objectives: Partial nephrectomy is the standard of care for small, localised renal tumours. However, image-guided percutaneous ablation represents a minimally invasive alternative with comparable oncological outcomes in selected patients. This study aims to evaluate the long-term results of radiofrequency (RFA), microwave (MWA), and irreversible electroporation (IRE) in a series of 90 cases.
  Materials and Methods: A retrospective study was conducted from 2010 with follow-up until 2024, including patients with cT1a renal masses treated with percutaneous ablation. The technique was selected based on tumour location and imaging characteristics. All patients had a minimum follow-up of two years. Primary efficacy was defined as complete tumour ablation after a single session; secondary efficacy referred to cases requiring an additional ablation. Complication rates, renal function impairment, recurrence rates, and time to recurrence were recorded. Overall survival and disease-free survival were analysed at 2 years and at the end of follow-up.
  Results: A total of 90 patients were included: 41 treated with MWA, 39 with RFA, and 10 with IRE. Median follow-up was 66 months. Mean tumour size was 2.27 cm. Complete ablation was achieved in 94.4% of cases, with a primary efficacy rate of 81.1%. Disease-free survival rate was 93.3% at two years and 78.9% at the end of follow-up. Recurrence rates were 4.4% and 16.7%, respectively, with no statistically significant differences found between techniques. The overall complication rate was 18.9%, with 83% of events classified as Clavien-Dindo I. Tumour size and location were determining factors for complications, with no statistically significant differences observed between the ablative techniques used. No clinically significant deterioration in renal function was observed.
  Conclusions: In our experience, percutaneous ablation is a safe alternative to partial nephrectomy for the treatment cT1a renal tumours, with comparable oncologic outcomes in selected patients. When appropriately indicated based on tumour location and characteristics, no statistically significant differences were found between the ablative techniques.

UP-12.15—NBI-Assisted Versus Standard White Light Flexible Ureteroscopy in Non-Invasive Upper Urinary Tract Transitional Cell Carcinoma—An Evidence-Based, Prospective, Single-Center Diagnostic Accuracy Comparison 

• Iordache Valentin, Georgescu Dragos, Multescu Razvan, Popescu Razvan, Geavlete Petrisor, Ene Cosmin, Bulai Catalin, Geavlete Bogdan
  ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

• Introduction and Objectives: The primary objective of the study was to evaluate in a prospective, single-center clinical setting the impact of narrow band imaging (NBI) assisted flexible ureteroscopy (fURS) concerning the diagnostic accuracy in upper urinary tract transitional cell carcinoma (UUTTCC) cases by comparison to standard white light ureteroscopic evaluation of the pyelo-caliceal urothelium.
  Materials and Methods: A prospective, single-center clinical trial was performed involving a total of 87 patients suspected of non-invasive UUTTCC malignancy. The inclusion criteria consisted of contrast CT-detected pyelo-caliceal system filling defects, unilateral hematuria observed during diagnostic cystoscopy and malignant urinary cytology associated with negative cystoscopic evaluation. Standard white light fURS was initially completed, followed by NBI-assisted ureteroscopy. All suspected lesions were thoroughly biopsied by grasping forceps sampling, resulting in pathologically confirmed UUTTCC cases.
  Results: Central pathology review confirmed 62 non-invasive UUTTCC patients (113 tumors—104 pTa and 9 CIS). In 56 cases, urothelial lesions were similarly apparent in both white light and NBI, 5 cases were exclusively diagnosed in narrow band imaging mode and 1 patient was solely identified during standard ureteroscopy. 96 UUTTCC tumors were found in both endoscopic vision modes (89 pTa and 7 CIS), 15 lesions were only discovered while using NBI-assisted fURS (13 pTa and 2 CIS) and 2 pTa tumors were solely detected in white light. Consequently, the overall UUTTCC (98.2% versus 86.7%), pTa (98.1% versus 87.5%) and CIS (100% versus 77.8%) lesions’ detection rates were significantly improved (p < 0.05) for NBI based retrograde intrarenal surgery by comparison to the white light conventional evaluation. On a case related basis, a significantly improved detection rate was emphasized for NBI-fURS by comparison to white light ureteroscopy (98.3% versus 91.9%, p < 0.05). The rate of false-positive results was significantly increased among NBI targeted biopsy specimens (17.5% versus 10.1%, p < 0.05).
  Conclusions: In a single-center, prospective clinical setting, NBI was determined to enhance the fURS related non-invasive UUTTCC diagnostic accuracy on a lesion’s as well as cases’ established basis in a statistically significant proportion when compared to the white light flexible ureteroscopic assessment of the pyelo-caliceal mucosa, regardless of tumor stage, at the cost of decreased specificity.

UP-12.16—Optimization of Postoperative Care for Nephrectomy Patients Using the UroConnect Telemonitoring Tool (UroCCRn°129) 

• Margue Gaëlle ¹, Ricard Solène ¹, Geshkovska Arna ¹, Callede Emmanuelle ¹, Dubernet Caroline ¹, Picard Françoise ¹, Herman Guillaume ¹, Autheman Maximilien ², Morichau-Beauchant Pierre ², Alezra Eric ¹, Capon Grégoire ¹, Estrade Vincent ¹, Bladou Franck ¹, Robert Grégoire ¹, Bernhard Jean-Christophe ¹
  ¹ Bordeaux University Hospital, Bordeaux, France, ² Resilience Care, Paris, France

• Introduction and Objectives: Since September 2021, our department has implemented the UroConnect^® telemonitoring tool to enhance nursing coordination for nephrectomy patients (partial—PN or radical—RN). The app sends regular PROMs (Patient-Reported Outcome Measures) questionnaires postoperatively. Abnormal responses trigger alerts, prompting the team to contact the patient and offer appropriate care.
  Materials and Methods: The app was offered to all French-speaking nephrectomy patients with internet access. Questionnaires on activity resumption and symptom evolution (pain, nausea, etc.) were sent on days 2, 7, 14, 21, and 30 post-op. All patients were prospectively included and monitored, with data stored in the UroCCR database (NCT03293563).
  Results: From September 2021 to April 2024, 454 of 562 consecutive nephrectomy patients (364 PN, 90 RN) used UroConnect^®. During the 30 days follow-up period, the average number of alerts per patient was 2 (±1.5). Alert distribution: 85 (18.7%) none, 111 (24.4%) one, 99 (21.8%) two, 159 (35%) three or more. Figure 1 shows alert rates by surgery type and age; symptoms are detailed in Table 1. Younger patients, particularly under 45 years old, had significantly more alerts on Day 2, although this difference disappeared over time. Regardless of age or type of surgery, the proportion of patients with alerts progressively decreased from 43.8% at Day 7 to 8.9% at Day 30.
  Conclusions: The UroConnect^® telemonitoring tool enhances the timely detection of abnormal postoperative developments after nephrectomy. This ensures a safe home transition for patients and optimizes nursing care coordination by effectively identifying those requiring additional follow-up.

UP-12.17—Outcomes of Cytoreductive Nephrectomy in the Contemporary Era of Systemic Treatment 

• Abdellatif Mohamed, Han Linaung, Pillai Praveen, George Jefferson
  SaTH, Coventry, United Kingdom

• Introduction and Objectives: Role of cytoreductive nephrectomy (CN) becomes controversial since CARMENA trail re-sult became public in 2017. Randomized trials and large, retrospective studies came out to address the role and future of CN in the care of metastatic renal cell carcinoma. This is an observational study of demographic data, perioperative outcomes and overall survival of CN cases in a district hospital.
  Materials and Methods: The database of 17 cytoreductive nephrectomy cases in RSH was compiled and analyzed from 2019 to 2023. Then Kaplan–Meier analysis with log-rank test was used to assess pre-dictors of overall survival. Outcome measures were: preoperative comorbidities, size and TNM staging of primary tumour including metastatic burden, resection margin clearance, intraoperative haemoglobin drop, intraoperative creatinine rise & eGFR drop transfusion requirement, Intra- and postoperative complications assessed by Clavien–Dindo score, and 30-day mortality.
  Results: 17 CN (1 hand-assisted laparoscopic and 16 open) were done in Royal Shrewsbury Hospital since 2019. Most (14 cases, 82.35%) were male patients, and majorities (9 cases, 52.94%) had one or more comorbidities. u13 cases (76.47%) had PS 0. Mean tumour size was 9.68 ± 3.49 cm, and there were two cases (11.76%) with more than one metastatic site. Fuhrman grade 4 was given for 8 cases (47.06%), and 5 cases (29.41%) were assigned a Leibovich score of 8. Mean intraoperative haemoglobin drop was 17.76 ± 16.12 g/L. Mean creatinine rise (umol/L) and eGFR drop (mL/min/1.73 m²) were 30.41 ± 30.53 and 16.29 ± 14.13 respectively. Complications of Clavien–Dindo grade ≥ III occurred in 23.53% 23.53% of patients required a perioperative transfusion. There was one case of 30-day mortality (5.88%), and 9 cases (52.94%) received immunotherapy after surgery. Kaplan–Meier analysis with log-rank test, 5 perioperative parameters were associated with overall survival: Intraoperative haemoglobin drop (p = 0.0033), Resection margin (p = 0.0387), Metastatic burden (p < 0.0001), Tumour stage (p = 0.0003) and Preoperative comorbidities (p = 0.0003). Longest overall survival after surgery was 49 months.
  Conclusions: Risk factors for overall survival include preoperative comorbidities, initial metastatic burden, presenting T stage, resection margin clearance, and intraoperative HB drop. For future counselling and analysis of cytoreductive nephrectomy outcome, consideration of above factors should be made.

UP-12.18—Quality of Care and Outcomes of Patients Who Underwent Radical or Partial Nephrectomy for Renal Cell Carcinoma at the Philippine General Hospital 

• Lapitan Marie Carmela, Uy Norwin, Montemayor Jon-Alexis
  Philippine General Hospital, Manila, Philippines

• Introduction and Objectives: The study aims to describe the timelines from symptom onset to surgery, assess compliance to benchmarks and targets in surgical cancer care and describe short-term outcomes of renal cell carcinoma (RCC) patients who underwent radical or partial nephrectomy in a tertiary university hospital in the Philippines. The study aims to describe the timelines from symptom onset to surgery, assess compliance to benchmarks and targets in surgical cancer care and describe short-term outcomes of renal cell carcinoma patients who underwent radical or partial nephrectomy in a tertiary university hospital in the Philippines.
  Materials and Methods: A retrospective descriptive study was conducted among RCC patients who underwent radical or partial nephrectomy from January to June 2024. Time intervals between first symptom, cancer diagnosis, first surgical consult, and surgery were determined. A quality of care audit on timely diagnosis, timely referral, performance of appropriate test for diagnosis and staging, provision of multidisciplinary care, nutritional assessment and management, recording of ECOG status, attainment of adequate surgical margins, timely release and completeness of pathology reports was done by assessing compliance against established guidelines.
  Results: A review of 28 RCC patients who underwent radical or partial nephrectomy revealed a mean age of 55.7 years and male-to-female ratio of 3.7:1. 75% were Stage I and II RCC. Half were diagnosed incidentally. The median time from symptom onset to consult and diagnosis was 22 and 78 days, respectively, while surgery occurred at a median of 202 days. One patient had emergent surgery. Postoperative complications occurred in 10.4%, with one requiring ICU care. All patients were alive at 30 days post-op. Only 39.3% had timely referrals. All patients had pre-operative staging CT scan. ECOG status was recorded in only 89.3%. Nutritional assessment was done in 50%, yet only 2 high-risk patients received intervention. Oncology referrals were low (28.6%), and no cases were discussed preoperatively. Positive margins occurred in 14.3%. Pathology reports exceeded the 14-day target in 29.6%, with 21.4% lacking key elements.
  Conclusions: Delays in diagnosis and treatment, gaps in standard preoperative practices, and incomplete pathology reporting reflect areas for institutional improvement. Strategies addressing these issues are critical to enhancing RCC care quality and aligning with global evidence-based standards.

UP-12.19—Renal Surgical Planning with OneView Renal Angio: A Multimodal Deep Learning Approach 

• Addla Sanjai ¹, Ragavan Narasimhan ¹, Azeez Syed ², KR Akhila ², Sabri Mohammed ²
  ¹ Apollo Cancer Center, Hyderabad, India, ² Biocliq, Bangalore, India

• Introduction and Objectives: Surgical planning for procedures such as partial nephrectomy and kidney transplantation relies on precise visualization of renal anatomy. Traditional imaging modalities, including standard CT and MRI scans, while useful, often fall short in providing a comprehensive anatomical understanding necessary for accurate preoperative assessment. To address this challenge, we have used OneView Renal Angio, an AI-powered software tool designed to generate high-resolution 3D reconstructions from contrast-enhanced abdominal CT scans.
  Materials and Methods: The system utilizes a multimodal deep learning approach, incorporating 3D UNet architectures alongside image registration techniques to process multiphase CT scans. Through this framework, the software can accurately segment key renal structures, including kidneys, tumors, lesions, arteries, veins, and the pelvicalyceal system. These segmented structures are then rendered into high resolution 3D models, providing surgeons with an intuitive and interactive anatomical representation. Beyond visualization, OneView Renal Angio also integrates quantitative renal complexity scoring, assessing tumor burden, vascular involvement and overall renal function. These automated complexity scores help in stratifying surgical risk and optimizing operative planning. These features are particularly beneficial for nephron-sparing procedures and for kidney transplant evaluations.
  Results: We are able to generate a 3-D virtual model image, which can be viewed either on a smart phone or computer and can be manipulated to visualise in 360 degrees. These have been validated by comparison to the per-operative findings. Addition and subtraction of individual components (e.g.: artery, vein, ureter) can be made to better understand anatomy. Additional information in the form of nephrometry score and other useful information, including the estimated loss of kidney volume, is provided.
  Conclusions: OneView Renal Angio represents a significant advancement in renal surgical planning by combining deep learning with multimodal imaging to generate precise anatomical reconstructions and actionable insights. This AI-data-driven approach to preoperative decision-making holds strong potential for improving surgical outcomes, ultimately contributing to more precise, efficient, and patient-centric renal care.

UP-12.20—Role of Serum VEGF Levels in Predicting Resistance to Tyrosine Kinase Inhibitors in Patients with Metastatic Clear Cell Renal Cell Carcinoma 

• Nayak Brusabhanu, Kevin A, Karmakar Subhradip, Seth Amlesh, Kaushal Seema
  All India Institute of Medical Sciences, New Delhi, India

• Introduction and Objectives: Metastatic renal cell carcinoma (mRCC) comprises 30% of all RCC cases. Treatment of metastatic clear cell RCC (mcRCC) includes tyrosine kinase inhibitors (TKI), immune checkpoint inhibitors (ICI), and cytoreductive nephrectomy in select cases. Current guidelines recommend ICI+TKI as first-line therapy, with TKI monotherapy as an alternative for those who are unable to receive ICI. Response rates can be as low as 40%, and, for this reason, early detection of progression and sequencing therapies are crucial for optimal management. Serum vascular endothelial growth factor (VEGF) has been shown to increase in RCC and may serve as a potential biomarker for early detection of progression.
  Materials and Methods: This prospective cohort study assessed the role of serial VEGF levels in identifying TKI response in mcRCC. Conducted from January 2022 to June 2024, the study included patients diagnosed with mcRCC on TKI. Patients with prior targeted therapy and non-clear cell histopathology were excluded. The primary outcome was to evaluate VEGF as a biomarker for TKI response, measured at baseline and at 3-month intervals.
  Results: Among 25 enrolled patients, eight had partial response (PR), seven had progressive disease (PD), and ten had stable disease (SD) at 3 months based on imaging. VEGF levels increased in all patients with PD over time (9% to 139%). In partial responders, VEGF decreased by >25% (28% to 76%). Among the ten patients with SD, VEGF levels decreased by ≤25% (10% to 25%) in 8, while two with increasing VEGF levels progressed at 6 and 9 months. Notably, four SD patients with initially stable VEGF levels experienced progression at 9 months, preceded by rising VEGF levels at 6 months.
  Conclusions: These findings suggest that serial VEGF monitoring can identify TKI non-responders early, even when imaging appears stable. An early switch to ICI therapy in these patients may prevent unnecessary treatment delays, improve decision-making, and potentially extend survival. VEGF could serve as a valuable biomarker for guiding therapeutic strategies in mRCC management.

UP-12.21—Survival Outcomes and Predictive Factors in T2-T3 Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy 

• Saavedra Centeno Manuel, Sánchez Ramírez Ana, Velasco Balanza Clara, Pelari Mici Lira, Márquez Güemez Carlos, Celada Luis Guillermo, Costal Martin, Cogorno Wasylkowski Leopoldo, Albers Acosta Eduardo, Casado Varela Javier, López-Fando Lavalle Luis, Quicios Dorado Cristina, San José Manso Luis Alberto
  La Princesa University Hospital, Madrid, Spain

• Introduction and Objectives: Upper tract urothelial carcinoma (UTUC) is an uncommon malignancy for which radical nephroureterectomy (RNU) remains the standard treatment. However, prognostic factors remain a matter of debate. This study evaluates overall and disease-free survival, along with clinical, analytical, and surgical prognostic variables in a cohort of patients with unfavorable pathology undergoing RNU, with particular focus on the impact of adjuvant therapy.
  Materials and Methods: A retrospective study was conducted on patients with UTUC staged pT2–T3 who underwent RNU at a tertiary hospital between 2015 and 2024. Palliative surgeries were excluded. Clinical variables (age, sex, hypertension, diabetes mellitus, smoking status) and laboratory parameters (renal function, neutrophil-to-lymphocyte ratio [NLR], lymphocyte-to-monocyte ratio [LMR]) were analyzed. Overall survival (OS) and disease-free survival (DFS) at 1 and 2 years were assessed. Statistical analysis was performed using Student’s t test and Kaplan-Meier curves (p < 0.05).
  Results: A total of 76 radical nephroureterectomies were performed during the study period, of which 31 corresponded to pT2–T3 tumors and were included in the analysis (mean age: 73.1 years; 64.5% male). Hypertension was present in 70.9%, diabetes in 16.1%, and 61.3% were current or former smokers. One- and two-year OS rates were 67.7% and 51.7%, respectively, while DFS at ≥2 years was 33.3%. No statistically significant differences were observed based on comorbidities, cytology, prior ureteroscopy, renal function, or NLR/LMR values (p > 0.05). Adjuvant therapy was administered to 42% of patients and showed a trend toward improved 1-year survival (83.3% vs. 57.8%), though not statistically significant (p = 0.12). Tumor location significantly influenced prognosis: patients with renal pelvis tumors had better survival than those with ureteral tumors (1-year OS: 82.3% vs. 41.7%, p = 0.032; 2-year OS: 73.3% vs. 25%, p = 0.011).
  Conclusions: In patients with T2–T3 UTUC, tumor location emerged as a key prognostic factor, with renal pelvis tumors showing more favorable survival outcomes than ureteral tumors. Comorbidities and inflammatory markers did not appear to significantly influence prognosis. While adjuvant therapy showed a positive trend, the benefit was not statistically significant—possibly due to the limited sample size.

UP-12.22—The Impact of Preoperative HTN, DM, and Cardiac Disease on Postoperative eGFR After Unilateral Nephrectomy and Nephroureterectomy: A Retrospective, Comparative Cohort Study 

• Albnhawy Ahmed, Hussain Eslam, Hossain Asmita, Das Shweta, Hanna George, Veer Sachin, Khan Shahid
  Surrey and Sussex Healthcare NHS Trust, Redhill, United Kingdom

• Introduction and Objectives: Unilateral nephrectomy or nephroureterectomy will result in a reduction in the functional renal tissue, which will decrease the total kidney function expressed as glomerular filtration rate. Low preoperative GFR, age, male sex, and high BMI are all risk factors for a lower GFR after nephrectomy. This study aimed to assess the effect of HTN, DM, and cardiac disease on postoperative kidney function after unilateral nephrectomy and nephroureterectomy.
  Materials and Methods: Patients who underwent nephrectomy or nephroureterectomy between 2019 and 2022 were recruited to the study. Patients’ records were reviewed retrospectively for preoperative HTN, DM, and cardiac disease; preoperative eGFR; and postoperative eGFR at 3 months, 6 months, 1 year, and 2 years.
  Results: 47 patients were included. The postoperative eGFR in the patient group with these diseases was lower than in the other group at 3 months, 6 months, 1 year, and 2 years postoperatively (47.9, 47, 52.8, 52.1 vs. 54.88, 55.6, 56.9, 55.46 mL/min/1.73 m²). Patients without these diseases had lower reductions in the eGFR and higher eGFR in comparison to the overall postoperative median eGFR.
  Conclusions: This series showed that the patients with these diseases are liable for more decline in the eGFR within the first 2 years postoperative. The eGFR in this group of patients showed to be lower than patients without these diseases preoperatively by 3.36: 8.6 mL/min/1.73 m² within the first 2 years postoperatively. Further assessment of a larger patient number and longer follow-up will help to determine more details about the effect of these diseases.

UP-12.23—Young Adult Renal Cell Carcinoma: Experience at a Tertiary Care Hospital in a Developing Country 

• Tareen Saffa, Ather Hammad, Saeed Aniqa, Maqbool Nargis
  Aga khan University Hospital, Karachi, Pakistan

• Introduction and Objectives: To assess the radiological and histological features of renal cell carcinoma (RCC) in patients 18–45 years old who were surgically treated for renal cell carcinoma. To determine the relationship of predefined radiological and histological features to outcomes (overall survival at 1 year and documented disease recurrence/progression within 1 year).
  Materials and Methods: All patients aged 18–45 who were surgically treated for RCC between January 2006 and January 2023 were included. Patients with incomplete records or imaging performed outside the institution were excluded. Radiological and histological features were correlated with recurrence and one-year survival using chi-square or Fisher’s exact test.
  Results: The study included 132 patients of RCC. The vast majority (81%) had clear cell grade 2 RCC. Cancer recurrence occurred in 31%, while first-year survival was 87%. Most tumours were exophytic (19%), with 19% showing vascular involvement. Assessment of the histological features, 12% and 23.5%, had positive surgical margins and lymphovascular invasion, respectively. Key prognostic factors for disease progression included lymphovascular invasion, positive lymph nodes, T3 disease, grade 2 RCC, and positive surgical margins (p < 0.05). For one-year survival, positive surgical margins and partially exophytic tumours were significant predictors (p < 0.05).
  Conclusions: Specific radiological and histological features significantly impact the prognosis in young adults with RCC. Tailored postoperative management based on specific tumour features is recommended for young adult RCC.

UP-12.24—Endoscopic en-Bloc Resection of Intrarenal Tumours Using Thulium Laser: A Renal-Sparing Approach 

• Yamada Kohei ¹, Lim Nicole ², Deacon Matthew ¹, Janardanan Sarosh ², Agrawal Sachin ²
  ¹ Ashford & St. Peter’s Hospitals NHS Foundation Trust, Chertsey, United Kingdom, ² Ashford & St. Peter’s Hospitals Foundation Trusts, Chertsey, United Kingdom

• Introduction and Objectives: Endoscopic management of upper urinary tract tumours has emerged as a valuable alternative to nephroureterectomy (NU) in select patients, particularly those with significant comorbidities. We utilised an endoscopic en-bloc resection technique for this intrarenal tumour.
  Materials and Methods: Patient A, 79-year-old male with a background of spinal stenosis, chronic obstructive pulmonary disease (COPD), prostate cancer (managed with hormones and radiotherapy), ureteric strictures, hypertension, asthma, rectal cancer, was selected for this case. CT for haematuria workup demonstrated a filling defect in the left renal pelvis, which led to a ureterorenoscopy + laser en-bloc resection of upper transitional cell carcinoma based on comorbidities and patient choice to avoid nephrectomy. Method: The procedure was performed using a Storz Flex X2 flexible ureterorenoscope, along with SAPS and an 11/13F navigator placed in the upper ureter. A pulsed Thulium YAG 270-micron fibre laser and a Segura basket were used for tumour enucleation and retrieval. Renal calyces were mapped, and the tumour location was confirmed. A circumferential incision was made around the tumour to define the resection boundaries. A combination of scope rotation and controlled advancement facilitated precise dissection. Once fine fibrous attachments were identified, the tumour’s weight was used to aid medial displacement. Blunt dissection with scope pressure and irrigation flow mobilised the tumour, leaving it suspended on a narrow pedicle for final detachment. This en-bloc resection technique allows for complete tumour removal while preserving surrounding structures.
  Results: Histological analysis confirmed a Grade 1/low-grade non-invasive papillary urothelial carcinoma (pTa) with muscle in the sample. A follow-up ureteroscopy at six weeks showed no evidence of recurrence, and biopsies were negative for malignancy. A subsequent relook ureteroscopy has been scheduled for ongoing surveillance.
  Conclusions: Endoscopic en-bloc resection of intrarenal tumours presents a promising alternative technique to ablation or NU in patients with significant comorbidities. In this case, complete tumour removal was achieved with a precise, minimally invasive approach.

12.5. Unmoderated Video ePosters

UVP-12.01—Robot-Assisted Left Nephroureterectomy in a Patient with Previous Radical Cystectomy and Ileal Conduit Diversion: Surgical Technique 

• Haddad Ra’ed, Hemmant Joshua, Dudley James, Weston Robin, Starmer Benjamin
  Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom

• Introduction and Objectives: Patients with urothelial cancer of the bladder who were managed with radical cystectomy and ileal conduit urinary diversion remain at higher risk of developing upper tract urothelial cancer. While some of these are managed with endourological approach, nephroureterectomy remains the best approach for high-risk upper tract urothelial cancer. This procedure has always been more challenging in patients with an ileal conduit due to adhesions from previous surgery and the need for revision of the ileal conduit, including safely managing the contralateral ureter. This procedure (in particular the lower ureter part) is usually performed with an open approach due to its complexity, especially on the left side. A laparoscopic approach has also been described. We report here the surgical technique using video recording of a robot-assisted left nephroureterectomy in a patient with high-risk left upper ureteric recurrence, 2 years post-radical cystoprostatectomy and ileal conduit.
  Materials and Methods: The Da Vinci Xi robot was employed to perform the procedure entirely. Instillation of indocyanine green (ICG) into the ileal conduit was performed to intraoperative identification of the conduit and both ureter.
  Results: The operative time was approximately 6 h. Minimal blood loss of less than 50 mL was recorded, and the postoperative period was smooth with no immediate or late complications. Histopathology revealed G3T1 urothelial cancer with carcinoma in situ involving the left upper ureter with negative margins.
  Conclusions: Robot-assisted nephroureterectomy can be safely performed in patients with a previous history of an ileal conduit. ICG instillation in the conduit facilitates ureter identification. This is a video description of the operative steps.

UVP-12.02—Robotic Non-Ischemic Sutureless Retroperitoneal Partial Nephrectomy: A Video Case Presentation 

• Berk Batuhan, Yilmaz Kayhan, Durak Hasan, Demir Yiğit, Ateş Mutlu, Kiliç Şahin
  Antalya Training and Reasearch Hospital, Antalya, Türkiye

• Introduction and Objectives: Renal masses frequently necessitate surgical intervention, with retroperitoneal partial nephrectomy being one of the preferred approaches for such cases. In recent years, the adoption of minimally invasive techniques and sutureless surgical methods has improved patient outcomes and reduced complication rates. Herein, we present a detailed case of a non-ischemic, sutureless retroperitoneal partial nephrectomy performed on a 39-year-old female patient.
  Materials and Methods: Case Presentation: The patient presented with a localized 4 cm renal mass in the right kidney, which was suspicious for renal cell carcinoma (RCC) on imaging studies. The surgery was performed using a robotic-assisted retroperitoneal approach with a sutureless technique. By avoiding renal hilar clamping (a non-ischemic approach), the renal parenchyma sustained minimal trauma, and renal function was preserved, thereby optimizing the surgical outcome. The accompanying video demonstrates in detail the techniques utilized during tumor excision, including the use of angiographic imaging and strategies for preserving renal tissue.
  Results: No intraoperative complications were observed. The patient’s postoperative course was uneventful, with renal function remaining within normal limits. Operative time was 120 min, and the estimated blood loss was approximately 200 mL, achieved with zero ischemia time.
  Conclusions: The patient’s postoperative course was uneventful, with renal function remaining within normal limits. In summary, non-ischemic sutureless retroperitoneal partial nephrectomy stands out as an effective, safe, and minimally invasive surgical option offering significant benefits in the management of small renal tumors.

UVP-12.03—Sutureless Robot-Assisted Partial Nephrectomy: Feasibility and Surgical Technique (UroCCR N°158) 

• Margue Gaëlle, Capon Grégoire, Bladou Franck, Robert Grégoire, Bernhard Jean-Christophe, Blanco Alexandre, Khaddad Abderrahmane, Estrade Vincent, Alezra Eric
  Bordeaux University Hospital, Bordeaux, France

• Introduction and Objectives: The aim of this video was to present the technique of sutureless robot-assisted partial nephrectomy (without renorrhaphy).
  Materials and Methods: Surgery was performed using the Da-Vinci Xi surgical robot (intuitive surgical). We used 3 operating arms, a 30° optic and 2 trocars (5 and 12 mm) for the assistant. Tumor limits were assessed using intraoperative ultrasound (Hitachi).
  Results: Our patient was a 53-year-old man diagnosed with a 6.5 cm left renal lesion in a context of microscopic haematuria. The extension work-up was negative. Surgery began with minimal dissection of the kidney. The tumorectomy was performed without clamping, following the plane of enucleation, thus limiting bleeding. Coagulation was performed progressively using monopolar scissors in “spray” mode. After testing the excretory tract, elective repair of a small caliceal leak was carried out. No renorrhaphy was performed. The rationale for the sutureless technique is based on the possible impairment of renal function resulting from ischaemic necrosis of the sutured parenchyma and an increased risk of pseudoaneurysms. One-hundred and twelve patients underwent sutureless robot assisted partial nephrectomy in our hospital (Table 1). Table 1—Patients’ and surgeries’ characteristics n = 112 Age (years), mean [SD] 60.3 [13.2] Sex, n (%) Female Male 76 (67.9) 36 (32.1) ASA score, n (%) 1 2 ≥ 3 19 (17.0) 64 (57.1) 29 (25.9) Preoperative GFR (ml/min/M2), mean [SD] 84.6 [19.7] Tumor size (cm), mean [SD] 3.7 [1.7] RENAL score, mean [SD] 7.1 [1.8] RENAL score, n (%) Low Intermediate High 43 (38.4) 59 (52.7) 10 (8.9) NSS indication, n (%) Elective Relative Imperative 86 (76.8) 15 (13.4) 11 (9.8) Multiple tumorectomy, n (%) 6 [5.4] Operating time (min), mean [SD] 144.6 [54.6] Blood loss (mL), mean [SD] 103.2 [135.2] Intraoperative complications, n (%) 1 (0.9) Postoperative complications, n (%) Including severe (Clavien ≥3) 15 (13.4) 1 (0.9) Length of hospital stay (days), mean [SD] 1.2 [1.8]. Postoperative GFR (ml/min/m2), mean [SD] 67 [23.7].
  Conclusions: Sutureless partial nephrectomy is a feasible and safe technique. It simplifies the surgical procedure and reduces the operating time. It requires good preoperative planning to ensure optimal management of haemostasis and to allow for any repair of the excretory tract.

UVP-12.04—Vena Cava Thrombectomy and Robot Assisted Radical Nephrectomy Using Augmented Reality Guidance: Technique and Experience Sharing 

• Margue Gaëlle ¹, Pitout Alice ¹, Desternes Julie ², Chandelon Kilian ², Bourdel Nicolas ³, Bartoli Adrien ⁴, Bernhard Jean-Christophe ¹
  ¹ Bordeaux University Hospital, Bordeaux, France, ² Surgar Surgery, Clermont-Ferrand, France, ³ CHU de Clermont Ferrand, Clermont-Ferrand, France, ⁴ TGI-EnCoV, Clermont Ferrand, France

• Introduction and Objectives: Virtual reality, involving 3D modeling from preoperative CT scans, has been used for several years to guide robot-assisted kidney cancer surgeries. Our objective is to develop an augmented reality solution that superimposes this modeling onto the intraoperative view to provide real-time surgical guidance. This video presents the initial trials of augmented reality during robot assisted radical nephrectomies with vena cava thrombectomy.
  Materials and Methods: The surgeries were performed using the Da Vinci Xi surgical robot (Intuitive Surgical). We utilized three operative arms, a 30° optical lens, and two trocars (5 mm and 12 mm) for surgical assistance. The procedure was guided by intraoperative ultrasonography (Hitachi^©). 3D models of the kidneys, their vasculature, tumors, and vena cava thrombi were created from the preoperative CT scans using Synapse 3D software (Fujifilm). Initially, manual alignment of the modeling with the intraoperative view was performed to enable subsequent automated organ tracking.
  Results: Tests were conducted during two robot-assisted vena cava thrombectomy surgeries in February 2024 (Novick grade 2 thrombus). Augmented reality was implemented and visible on a computer outside the robotic console. It was then transferred to the robot’s TilePro display at key moments of the surgery and compared to visual and ultrasound landmarks. Satisfactory results were achieved, with good organ tracking and coherent thrombus alignment during both surgeries.
  Conclusions: Augmented reality surgical guidance is a technique still under development, particularly concerning the deformation of 3D models. However, these initial trials in the operating room were promising. In situations involving vena cava thrombectomy, augmented reality could facilitate the identification of thrombus limits and venous anatomy, especially improving visualization of lumbar veins to be controlled before cavotomy. This work was supported by the French government under the 3rd Investment in the Future Program, as part of France 2030, managed by the National Research Agency (ANR) and referenced as ANR-21-RHUS-0015.

13. Minimally Invasive Surgery/Robotics

13.1. Moderated Oral ePosters

MP-13.01—Are Minimally Invasive Techniques the New Gold Standard for Middle Volume Prostates? A Comparative Multicentre Prospective Randomized Study 

• Pastore Antonio Luigi ¹, Fuschi Andrea ¹, Valenzi Fabio Maria ¹, Suraci Paolo Pietro ¹, Sequi Manfredi Bruno ¹, Balsamo Raffaele ², Bozzini Giorgio ³, Al Salhi Yazan ⁴, Carbone Antonio ¹
  ¹ Sapienza University of Rome, Faculty of Pharmacy and Medicine Dept. of Medico-Surgical Sciences and Biotechnologies Urology Unit, ICOT Latina, Latina, Italy, ² Monaldi Hospital, Dept. of Urology, Napoli, Italy, ³ ASST Lariana, Como, Italy, ⁴ Sapienza University of Rome, Faculty of Pharmacy and Medicine, Latina, Italy

• Introduction and Objectives: TURP is still considered the gold standard therapy for mid volume prostate glands (30–80 mL). In the last few years, other minimally invasive treatments have been introduced with the aim to reduce the TURP related morbidity, such as: convective water vapor energy (Rezum) and water-jet ablation (Aquablation). The aim of this prospective randomized study is to compare the perioperative and functional outcomes between these techniques.
  Materials and Methods: Patients with non-neurogenic Lower Urinary Tract Symptoms (LUTS) secondary to mid volume benign prostatic enlargement (30–80 mL), non-responders to medical therapy for at least 6 months, were prospectively randomized to the three surgical procedures. The study was approved by the Ethical Committee (IRB no. UNIVLTURO/DSBMC 0131–2021), and all patients signed the informed consent. All patients were preoperatively evaluated with digital rectal examination (DRE), PSA, prostate volume was evaluated by trans abdominal ultrasound. Preoperatively, 6-, and 9-months postop, all subjects were investigated with: Uroflowmetry (Qmax and Qave) with postvoid residual (PVR), International Prostatic Symptoms Score (IPSS), Male Sexual Health Questionnaire (MSHQ) and International Index of Erectile Function (IIEF-5). In all patients, urodynamics was performed. Exclusion criteria were established as: prostate volume < 30 and >80 mL, previous pelvic surgery, urethral strictures, urothelial or prostatic malignancies, neurogenic LUTS, and urinary stones.
  Results: 387 patients with mean age of 63.6 years old (56–74 years) were prospectively randomized to the following treatment groups: 132 subjects underwent Rezum (group A), 128 patients Aquablation (group B), and 127 patients bipolar TURP (group C). Postoperative IPSS resulted lower in patients underwent TURP and AQUABEAM (2 and 3, respectively) than Rezum (5; p < 0.001). The antegrade ejaculation was spared in most of Rezum and Aquablation subjects (95%), whereas all TURP patients reported retrograde ejaculation. At post-operative urodynamics we observed a significant increase of flowmetry parameters (Qmax and Qave) as well as the Pdet values in all subjects.
  Conclusions: This is the first study to compare new minimally invasive approaches to TURP in the treatment of BPO for mid prostate volumes. Postoperative outcomes were more effective in the AQUABEAM and Rezum groups in terms of sexual function and overall satisfaction, especially when evaluating the antegrade ejaculation sparing.

MP-13.02—From Segmentation to Surgical Storytelling: A Multi-Stage Framework for Vision-Language Data 

• Balakrishnan Shidin ¹, AbuHaweeleh Mohannad ², Ahmed Mariam ², Ahmed Fatmaelzahraa ¹, Al Jalham Khalid ¹, Aly Kareem ³, Al Maslamani Ahmed ²
  ¹ Hamad Medical Corporation, Doha, Qatar, ² Qatar University, Doha, Qatar, ³ Weill Cornell Medicine Qatar, Doha, Qatar

• Introduction and Objectives: The rapid evolution of surgical practice calls for data-driven, AI-enabled tools that can interpret laparoscopic images in real time. Such “vision–language” systems could provide valuable insights for training, documentation, and intraoperative decision-making. However, current approaches often rely on transcribed audio, introducing irrelevant or incorrect information and missing crucial spatial cues. To address these issues, we propose a five-stage pipeline that harnesses existing segmentation data—color-coded outlines of instruments and anatomy—to generate clinically coherent captions for surgical images and short video clips. Our objective is to produce a high-quality, structured source of vision–language data suitable for tasks like phase recognition and action triplet extraction.
  Materials and Methods: We applied our pipeline to the EndoVis18 dataset, extracting segmentation masks per frame (Stage 1). Subsequent stages introduced absolute positions (Stage 2), relative positions (Stage 3), proximity-based interactions (Stage 4), and temporal dynamics (Stage 5). Each stage’s output was turned into concise prompts for large language models (LLMs). To assess caption quality, three medical experts rated outputs from GPT-4o, DeepSeek V3, and Llama 3 70B using a five-point Likert scale based on how well each caption met the stage-specific objectives.
  Results: Across all stages and models, 95% of captions scored 3 or higher, demonstrating strong alignment with clinical expectations. Captions for object listing and basic positioning (Stages 1–3) consistently performed well. Despite a dip at Stage 4 (interaction proximity), scores recovered in Stage 5, suggesting that incorporating temporal context clarifies ambiguous interactions. GPT-4o consistently achieved the highest average rank, although differences from DeepSeek V3 were not statistically significant.
  Conclusions: Our five-stage approach generates rich, high-fidelity captions from segmentation data, offering clinicians and researchers a more reliable alternative to noisy transcribed audio. By capturing precise spatial and temporal details, the framework can support advanced surgical intelligence applications, ultimately enhancing patient care and surgical training.

MP-13.03—Patient-Centred Recovery: Enhancing Patient Experience: Comparing Suprapubic and Urethral Catheterisation After Robotic Prostatectomy 

• Ralston Charlotte ¹, Ibrahim Ibrahim ¹, Dutto Lorenzo ², Ahmed Imran ²
  ¹ Glasgow Royal Infirmary, Glasgow, United Kingdom, ² Queen Elizabeth University Hospital, Glasgow, United Kingdom

• Introduction and Objectives: Patients typically require at least one week of bladder catheterization following robot-assisted radical prostatectomy (RARP). Traditionally, this was achieved via urethral catheterization (UC). Recently, suprapubic catheterization (SPC) has been trialed to enhance patient experience following major cancer surgery. This study evaluates and compares Patient Reported Experience Measures (PREMs) regarding patient satisfaction with UC and SPC.
  Materials and Methods: A prospective study was conducted at Queen Elizabeth University Hospital from January 2023 to March 2024 on prostate cancer patients undergoing RARP. Patients received either a UC or SPC, with each surgeon exclusively using one method. A patient preference questionnaire assessed comfort, ease of care, and the quality of pre-/post-operative information. Scoring was based on a visual analogue scale (1–10), categorized as very good (1–3), ok (4–7), or very poor (8–10). Demographic and BMI data were collected. Statistical analysis was performed using chi-squared tests.
  Results: A total of 204 patients were included, with 102 receiving UC and 102 SPC. Discomfort levels significantly differed between groups, with 37.3% of UC patients reporting ‘very good’ comfort versus 87% of SPC patients (p < 0.001). SPC patients also reported significantly higher convenience in care (95.1% vs. 63.7% for UC, p < 0.001). Catheter-associated urinary tract infections were minimal (2% for both groups), while 4% of UC patients presented to the emergency department with blocked catheters.
  Conclusions: SPC greatly improves patient experience following RARP and has become the standard practice in our department. Additional research is required to establish the optimal duration of SPC use.

MP-13.04—Pioneering Telesurgery in Urogynecology: Early Experience with the SSI Mantra Surgical Platform 

• Pratihar Sarbartha, Singh Amitabh, Khanna Ashish, Saurabh Nikhil, Kumar Bhuwan, Malla Ishan, Ali Mujahid, Tomar Devendra, Jain Vandana, Rawal Sudhir
  Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

• Introduction and Objectives: Past two decades have witnessed remarkable advancement in robotic surgery. With the advancement in telecommunications, telesurgery has emerged as a promising solution to deliver advanced healthcare, particularly in underserved areas. Telesurgery enables surgeons to perform complex procedures/train multiple surgeons remotely, utilizing minimally invasive systems combined with telecommunications technology. Here, we present our initial experience with telesurgery for complex urogynecological procedures using the SSI Mantra surgical platform.
  Materials and Methods: For the telesurgery procedures, dual console SSI Mantra Surgical Robotic System (Made in India) was used. The study was conducted between two centers—SSI Headquarters and our institute, located approximately 40 km apart. A dedicated fiber-optic network telecommunication was established between the centers through Bharti Airtel (Indian Telecommunications Service). Following a successful animal trial to validate the setup’s safety, ethical clearance was obtained from institution’s ethics committee, with prospective trial registry under Clinical Trials Registry of India (CTRI-2024-06-068361). Written informed consent was obtained from each patient. Data collected included demography, intraoperative and perioperative outcomes, mean transmission latency time (MTT), data packet loss.
  Results: Between June 2024 and March 2025, 7 patients underwent surgery as part of this trial. Four male patients received radical cystoprostatectomy with bilateral extended lymph node dissection and extracorporeal ileal conduit for muscle-invasive bladder cancer. One female patient underwent a simple hysterectomy, and two male patients underwent radical nephrectomy for renal cell carcinoma. All procedures were completed robotically without intraoperative complications or need for conversion to open/laparoscopic surgery. All patients had usual postoperative course. The MTT ranged from 40–50 ms, with data packet loss below 0.10%.
  Conclusions: Our initial experience with robotic telesurgery has been promising. However, further research across greater distances, telesurgery across geographical boundaries is required to take this technology forward. Source of Funding: SS Innovations Pvt Ltd provided all required monetary or material support.

MP-13.05—Preliminary Experience with a 3D Digital Fluorescence Microscope and Indocyanine Green Angiography in Subinguinal Varicocelectomy 

• Yan Jiasheng ¹, Wang Junlong ¹, Yin Yu ¹, Yang Fei ¹, Liu Yao ², Jin Xiaodong ¹
  ¹ The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China, ² Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China

• Introduction and Objectives: This study reports the application and preliminary experience of a three-dimensional (3D) fluorescent digital external-viewing microscope platform using indocyanine green (ICG) fluorescence angiography in subinguinal varicocelectomy and explores its impact on surgical outcomes and postoperative recovery.
  Materials and Methods: Twenty-six microscope-assisted subinguinal varicocelectomy procedures were performed on 23 patients between 1 September 2024 and 25 October 2024 using this technology. During each surgery, 3 mL of ICG dye was administered via peripheral intravenous injection for angiography. Under fluorescence mode, the arterial and venous structures were visualized; the arteries were marked and preserved, and the veins were ligated.
  Results: All operations were completed successfully, with an average operative time of 52.65 ± 8.48 min per procedure. The mean time from ICG injection to arterial fluorescence was 45.88 ± 2.10 s, and the mean time to venous fluorescence was 81.61 ± 3.61 s. On average, 2.1 ± 0.84 arteries (range 1–4) were preserved per patient, and several capillary reticular arteries were observed in most patients’ spermatic vessels.
  Conclusions: The 3D fluorescent digital external microscope platform using ICG angiography demonstrates promising potential in subinguinal varicocelectomy. It may become a reliable adjunctive technique in microscope-assisted varicocelectomy, aiding surgeons in accurately identifying and locating arterial branches at all levels, thereby preventing arterial injury during surgery.

13.2. Moderated Video ePosters

MVP-13.01—Functional and Oncological Outcomes of Robotic Radical Prostatectomy with First Indian Surgical Robot (SSI Mantra): Initial Experience of First Seventy Seven Cases 

• Singh Amitabh
  Rajiv Gandhi Cancer Institute & Research Centre, Delhi, India

• Introduction and Objectives: Recently several new surgical robotic systems have been launched by various countries. SSI Mantra is the first Indian robotic system, which has been used in India for the last 2 years. It is a multiarm modular system and has been used for several surgical procedures across specialties like uro-oncology, surgical oncology, gastrosurgical procedures, and gynae-oncology. Here, I am presenting a video of robotic radical prostatectomy with bilateral intrafascial nerve sparing with SSI Mantra and peri-operative and oncological outcomes of radical prostatectomy patients with SSI Mantra.
  Materials and Methods: A total of 77 patients were operated for robotic radical prostatectomy with SSI Mantra from July 2022 to September 2023. Data were collected retrospectively from prospectively maintained data. Continence was defined as 0–1 pad use per 24 h and was recorded at 6 weeks and 12 weeks. Biochemical recurrence rates are defined as post-operative prostate-specific antigen (PSA) levels of >0.2 ng/mL.
  Results: Median PSA and median age were 14.8 (7.9–33.5 ng/mL) and 65.0 (60.0–68.5 yrs) respectively. The cohort included post-transferral resected prostate (7.8%), post neoadjuvant hormone therapy (29.9%), and oligometastatic patients (6.5%) as well, apart from localized disease. The majority of patients underwent a combined anterior and posterior approach (n = 75, 97.4%). Retzius sparing radical prostatectomy was done in only 2 patients. Median docking and console time were 8 min (6–10 min), 242 (200–280 min) respectively. Nerve-sparing has been done in only 11 patients. One patient underwent open conversion due to system malfunction, and one patient had a pelvic vessel injury, managed intraoperatively. Positive surgical margins were positive in 17.2% of cases of localized disease and 31.2% of cases of locally advanced disease. The continence at 6 weeks and 3 months was in 49.3% and 82.2% of patients respectively.
  Conclusions: SSI Mantra surgical robot, which is the first made-in-India robotic platform, displays its safety and technical robustness in radical prostatectomy with acceptable peri-operative and oncological outcomes.

MVP-13.02—Retzius Repairing Technique During Robotic Radical Prostatectomy and Early Outcomes 

• Balbay Derya ¹, Kiliç Mert ¹, Madendere Serdar ²
  ¹ Koç University, Istanbul, Türkiye, ² VKV American Hospital, Istanbul, Türkiye

• Introduction and Objectives: We present our new Retzius-repairing technique during robotic radical prostatectomy with early outcomes concerning continence.
  Materials and Methods: Our new technique has been utilized in ten robotic radical prostatectomy cases. After completing urethro-vesical anastomosis, the anterior bladder wall was suture-fixed to the inner surface of the symphysis pubis with a 3/0 barbed suture to stabilize the level of urethro-vesical anastomosis stays above the pelvic floor. Firstly, a bite from the anterior bladder neck was taken, the level of vesical-urethral anastomosis was confirmed, and a corresponding bite at the inner surface of the symphysis pubis was taken. Additional sutures were placed between the anterior bladder neck and the inner surface of the symphysis pubis to complete the repair of the Retzius space. On the 7th day, a cystogram was performed, and the urinary catheter was removed after complete healing of bladder neck-urethral anastomosis. Continence status was evaluated on the day of catheter removal, in the first and third months, respectively.
  Results: Considering the 7th day of catheter removal, 10/39 (25.6%) patients were fully continent. According to postoperative first and third-month outcomes, 14/37 (37.8%) and 23/31 (74.2%) patients were fully continent, respectively. Out of 8 patients who had incontinence in the 3rd month, 7 patients (87.5%) described stress incontinence, and 6/7 patients were using >1 safety pad/day.
  Conclusions: Our experience with this novel technique of Retzius-repairing robot-assisted radical prostatectomy seems promising regarding early continence rates, especially in the post-operative third month.

MVP-13.03—Robotic Assisted Pyeloplasty for Management of Pelviureteric Junction Obstruction (PUJO) in Patients with Anomalous Kidney Configurations—A Point of Technique 

• Shah Chaitya, Singh Abhishek, Pathak Niramya, Batra Rohan, Patil Abhijit, Ganpule Arvind, Sabnis Ravindra, Desai Mahesh
  MPUH, Nadiad, Nadiad, India

• Introduction and Objectives: Concomitant PUJO with renal anomalies poses a unique challenge to the operating urologists. Open pyeloplasty has been a standard of care for surgical correction in these patients, but, recently, robotic assisted pyeloplasty (RAP) has gained popularity worldwide. In this video, we demonstrate our technique and experience of performing RAP for PUJO in anomalous kidneys.
  Materials and Methods: Patients with anomalous kidneys who were diagnosed to have PUJO and underwent robotic assisted pyeloplasty (RAP) were studied. This video demonstrates 4 different case scenarios, which include (i.) an 11-yr-old male who presented with right flank pain and was diagnosed with left to right crossed fused ectopia with left (inferior) PUJO, (ii.) an 18-yr-old male who presented with left flank pain and was diagnosed with B/L PUJO with horseshoe kidney, (iii.) a 4-yr-old male, who presented with right flank pain and was found to have right duplex kidney with lower moiety PUJO, and (iv.) a 37-yr-old gentleman who presented with left iliac fossa pain and was detected with left pelvic ectopic kidney with PUJO. All of these patients were assessed pre-operatively with routine lab investigations and functional evaluation with DTPA renogram. Port placement was guided by the location of the renal pelvis, marked pre-procedurally using Retrograde Pyelogram. Robotic surgery was performed using Intuitive Surgical’s Da Vinci Xi system.
  Results: Our experience includes 12 RAPs done in 11 patients having anomalous kidneys with PUJO, including one patient operated bilaterally. There were 4 patients with a duplex system, 3 patients with horseshoe kidney, one with crossed fused ectopia and 3 patients with ectopic kidney. Above demonstrated cases were followed up, and symptom relief was noted in all of them with minimal to mild residual hydronephrosis seen without any alteration in renal function.
  Conclusions: Robotic assisted pyeloplasty (RAP) is associated with favorable outcomes in these patients. Pre-operative planning is crucial in these patients, owing to distorted pelvicalyceal architecture, aberrant vasculature and altered relationships with adjacent structures. Basic principles include making pyelotomy incision parallel to the long axis of the kidney and spatulation directed towards the lower pole of the kidney. Transmesocolic approach may be opted, based on intraoperative findings.

MVP-13.04—Robotic Retroperitoneoscopic RPLND for Post Chemo Therapy Testicular Seminoma 

• Patel Aquib Javed, Navriya Shiv, Singh Mahendra, Bhirud Deepak, Sandhu Arjun, Soni Jaideep, Rathor Jitendra, Choudhary Gautam
  All India Institute Of Medical Sciences, Jodhpur, Rajasthan, India, Jodhpur, India

• Introduction and Objectives: Clinical stage IIC testicular seminoma is treated with induction chemotherapy, post-chemotherapy masses are managed based on their size; if the mass is larger than 3 cm, an FDG PET scan is performed to assess the likelihood of viable tumor in the residual retroperitoneal mass. Post-chemotherapy retroperitoneal lymph node dissection (RPLND) poses significant challenges due to desmoplastic reactions and substantial perioperative morbidity. Despite these challenges, RPLND is crucial if the FDG-PET scan indicates activity in the post-chemotherapy mass. Here, we present a case of robot-assisted total retroperitoneoscopic left-sided modified lymph node dissection for clinical stage IIC post-chemotherapy left testicular seminoma, to explore the feasibility of this approach in such cases.
  Materials and Methods: Following general anaesthesia, the patient was positioned in the right lateral decubitus position. Retroperitoneal access was achieved, and space was created using a two-glove finger balloon dissection technique. A 12 mm working port was placed, and all three robotic ports (8 mm) were inserted under direct vision in a linear arrangement. The surgical procedure was carried out as demonstrated in the accompanying video.
  Results: Although orientation took some time—primarily because we aimed to lift the peritoneum from the anterior part of the aorta to dissect up to the inter-aortocaval area—we successfully reoriented and performed the modified RPLND along with the removal of the full-length cord structure.
  Conclusions: This robotic retroperitoneoscopic approach for RPLND is feasible, offering quick recovery and the inherent advantages of the retroperitoneoscopic method over the transperitoneal approach.

MVP-13.05—Telesurgery with SSI Mantra Robotic Surgical System: Radical Cystoprostatectomy and Early Clinical Experience 

• Pratihar Sarbartha ¹, Rawal Sudhir ², Singh Amitabh ², Khanna Ashish ², Saurabh Nikhil ², Kumar Bhuwan ², Tomar Devendra ², Malla Ishan ²
  ¹ Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, New Delhi, India, ² Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

• Introduction and Objectives: The advent of new surgical robotic systems has revolutionized the era of robotic surgery. With the advancement in telecommunications, telesurgery has emerged as a promising solution to deliver advanced healthcare particularly in underserved areas. Telesurgery enables surgeons to perform complex procedures/train multiple surgeons remotely, utilizing minimally invasive systems combined with telecommunications technology. We present this index case of a telesurgical robotic radical cystoprostatectomy performed using the SSI Mantra platform (an indigenously developed Indian surgical robotic system), along with our clinical experience using this system for telesurgical procedures.
  Materials and Methods: For the telesurgery procedures, dual console SSI Mantra Surgical Robotic System was used. The index case was performed between two centers—SSI Headquarters and our institute, located approximately 40 km apart. A dedicated fiber-optic network telecommunication was established between the centers through Bharti Airtel (Indian Telecommunications Service). Following a successful animal trial to validate the setup’s safety, ethical clearance was obtained from institution’s ethics committee, with prospective trial registry under Clinical Trials Registry of India (CTRI-2024-06-068361). Following successful completion of seven urogynecological procedures, telesurgery was performed in another two centers situated 286 km and 2000 km respectively. Written informed consent was obtained from each patient. Data collected included demography, intraoperative and perioperative outcomes, mean transmission latency time (MTT), data packet loss.
  Results: Between June 2024 and March 2025, 7 patients underwent surgery as part of this trial. Four male patients received radical cystoprostatectomy with extracorporeal ileal conduit for muscle-invasive bladder cancer. One female patient underwent a simple hysterectomy, and two male patients underwent radical nephrectomy for renal cell carcinoma. At another cardiac center (286 km), 3 internal mammary artery harvestings, one mitral valve replacement and one totally endoscopic coronary artery bypass surgery were done. At 3rd center (2000 km), one esophagectomy and one posterior exenteration were done. All procedures were completed robotically without intraoperative complications or need for conversion to open/laparoscopic surgery. All patients had usual postoperative course. The MTT ranged from 40–50 ms, with data packet loss below 0.10%.
  Conclusions: Our initial experience with robotic telesurgery has been promising. However, further research across greater distances, telesurgery across geographical boundaries are required to take this technology forward.

13.3. Residents Forum Moderated Oral ePosters

RF-13.01—Adopting the Hugo RAS Robot System for Robotic-Assisted Radical Prostatectomy: Insights from a Single Surgeon’s Experience 

• Liu Pin-Chun, Lin Yi-Sheng, Hsu Chao-Yu, Ou Yen-Chuan, Tung Min-Che
  Tungs’ Taichung Metroharbor Hospital, Taichung City, Taiwan

• Introduction and Objectives: Several new robotic platforms have been announced in recent years. The Hugo RAS (Medtronic, Minneapolis, MN, USA) was approved for urologic surgery in Taiwan in May 2023. This study aims to explore the surgical outcomes of robotic-assisted radical prostatectomy (RARP) between the novel Hugo robotic system and the Da Vinci system.
  Materials and Methods: We retrospectively collected data on patients who underwent RARP (using either the Hugo or Da Vinci system) from May 2023 to August 2024, performed by a single surgeon. Baseline characteristics and preoperative PSA level as well as perioperative outcomes (surgical time, blood loss, number of lymph nodes retrieved and positive surgical margins) were collected and analyzed using T tests and chi-squared test.
  Results: This study analyzed data from 155 patients who underwent RARP, with 59 procedures performed using the Hugo system and 96 using the Da Vinci system. RARP with the Hugo system tended to involve a younger patient population (66.8 vs. 69.8, p = 0.015) compared to procedures performed with the Da Vinci system. However, factors such as BMI, estimated blood loss, surgical duration, length of hospital stay, number of retrieved lymph nodes, and positive margin rate did not demonstrate statistical significance between the two systems.
  Conclusions: Hugo RARP had similar surgical outcomes, such as estimated blood loss, operative time, the rate of positive surgical margin, and days in hospital were noted when compared with Da Vinci RARP. This study demonstrated that the Hugo RAS is a safe and feasible platform for RARP.

RF-13.02—Learning Curve of Aquablation for Enlarged Prostate: A Single Center’s Initial Experience 

• Liu Pin-Chun, Lin Yi-Sheng, Hsu Chao-Yu, Ou Yen-Chuan, Tung Min-Che
  Tungs’ Taichung Metroharbor Hospital, Taichung City, Taiwan

• Introduction and Objectives: Aquablation (Aquabeam, PROCEPT BioRobotics, CA, USA) is a new technology that utilizes machine-controlled water jets to ablate prostate tissue. Aquablation was approved for urologic surgery in Taiwan in March 2024. This study aims to explore the initial surgical outcomes of aquablation in patients with enlarged prostates.
  Materials and Methods: We retrospectively collected data on patients who underwent aquablation from March 2024 to July 2024 and were diagnosed with an enlarged prostate with lower urinary tract symptoms. Baseline characteristics, including age and preoperative prostate size, were recorded. The IPSS questionnaire and uroflowmetry were performed before and after aquablation for symptom evaluation. The data were collected and analyzed using paired t-tests with SPSS software.
  Results: This study analyzed data from 15 patients. The pre- and post-aquablation IPSS total scores and quality of life scores showed statistically significant improvements (from 18.3 to 5.16, p = 0.003; and from 3.8 to 1.33, p = 0.013, respectively). The Qmax (from 10.63 to 26.01 mL/s, p < 0.0001), Qmean (from 4.72 to 10.82 mL/s, p < 0.0001), and post-void residual volume (from 132 to 25.5 mL, p = 0.001) also showed significant improvements. Following aquablation surgery, the patient’s hemoglobin levels decreased by an average of 1.76 g/dL, with three patients requiring blood transfusions. Three cases experienced complications from postoperative bleeding at bladder neck, requiring return to the operating room for surgical intervention.
  Conclusions: Our study presents the initial surgical results from Taiwan regarding the treatment of an enlarged prostate with aquablation. This study demonstrates that aquablation is feasible therapy option for an enlarged prostate. However, postoperative rebleeding is a noteworthy complication for surgeons new to the technique.

RF-13.03—Sexual-Sparing Radical Cystectomy in the Robot-Assisted Era: A Review on Functional and Oncological Outcomes 

• Sequi Manfredi Bruno ¹, Fuschi Andrea ², Pastore Antonio Luigi ², De Nunzio Cosimo ³, Valenzi Fabio Maria ², Suraci Paolo Pietro ², Lombardo Riccardo ³, Al Salhi Yazan ⁴, Carbone Antonio ², Introini Carlo ⁵
  ¹ Urology Unit, Department of Medico-Surgical Sciences & Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy, ² Sapienza University of Rome, Faculty of Pharmacy and Medicine Dept. of Medico-Surgical Sciences and Biotechnologies Urology Unit, ICOT Latina, Latina, Italy, ³ Sapienza University of Rome, Faculty of Psychology and Medicine, Sant’Andrea Hospital, Dept. of Urology, Rome, Italy, ⁴ Sapienza University of Rome, Faculty of Pharmacy and Medicine, Latina, Italy, ⁵ Ente Ospedaliero OSPEDALI GALLIERA-GENOVA, Department of Urology and Minimally Invasive Robotic Surgery, Genova, Italy

• Introduction and Objectives: Radical cystectomy (RC) is the standard treatment for muscle-invasive and high-risk non-muscle-invasive bladder cancer, but it often results in significant functional impairments, including sexual and urinary dysfunction, adversely affecting quality of life (QoL). Sexual-sparing robotic-assisted radical cystectomy (RARC) has been introduced to mitigate these effects. This review evaluates the oncological and functional outcomes of sexual-sparing RARC in male and female patients.
  Materials and Methods: A systematic literature search identified 15 studies including 793 patients who underwent sexual-sparing RARC using techniques such as nerve-sparing, capsule-sparing, and pelvic organ-preserving approaches. Data on oncological and functional outcomes were analyzed.
  Results: Sexual-sparing RARC achieves oncological outcomes comparable to open RC, with negative surgical margin (NSM) rates exceeding 95% in most studies. RFS and CSS rates were robust, often surpassing 85% at intermediate follow-ups. Functional outcomes were also favorable, with continence rates exceeding 90% and erectile function recovery surpassing 70% in well-selected male patients. Female patients undergoing pelvic organ-preserving techniques demonstrated improved continence, preserved sexual function, and enhanced QoL. Patient selection emerged as critical, favoring those with organ-confined disease and good baseline function.
  Conclusions: Sexual-sparing RARC offers a promising balance between oncological control and functional preservation, making it an effective option for selected patients. Further research is needed to refine techniques and establish standardized protocols for broader adoption.

13.4. Unmoderated Video ePosters

UP-13.01—Robotic Repair of a Case of Uretero Sciatic Hernia 

• Raut Namisha, Raina Shailesh, Bahadur Madan Mohan, Mehendale Alap, Shingare Ashay
  Jaslok Hospital and Research Centre, Mumbai, Mumbai, India

• Introduction and Objectives: The objective of this case report is to discuss indications of operative management in a case of ureterosciatic hernia. Open/laparoscopic/robotic approaches for reduction of ureter and hernia repair are indicated when stenting does not relieve the obstructive uropathy.
  Materials and Methods: Type of study: Case report 67 YR/F, known case of Type 2 diabetes. Hypertension came with complaints of recurrent fever with UTI and rising serum creatinine. No c.o abdominal pain/generalized oedema/facial puffiness/decreased urine output. Examination findings were normal. Investigations showed raised serum Creatinine: 1.63 mg/dL Plain CT KUB showed left sided ureterosciatic hernia with proximal hydroureteronephrosis with the curlicue sign i.e. ureteric obstruction with U-shaped tortuosity through the sciatic foramen. EC scan showed severely reduced left renal cortical function and obstructed drainage. Patient underwent multiple attempts at DJ stenting; however, there was no improvement in serum creatinine and renal function. Hence decision taken for operative management, i.e., reduction of ureterosciatic hernia with uretero-vesical anastomosis. Follow up post operative showed reduced creatinine with improved renal function.
  Results: Follow up post operative showed reduced creatinine with improved renal function.
  Conclusions: Uretero-sciatic hernia consists of herniation of ureter in the supra-piriformis compartment of the greater sciatic foramen. Etiologies: partial loss of pelvic fascia, atrophy of the piriformis, adhesions or congenital deformity. Patients may be incidentally diagnosed with raised creatinine or present with recurrent UTI or symptoms of obstructive uropathy. i.e. complain of flank pain. CT scan may show the curlicue sign i.e. ureteric obstruction with U-shaped tortuosity through sciatic foramen: pathognomonic of uretero-sciatic hernia. It is reducible in nature hence might be asymptomatic or only present as intermittent loin pain. Long-term management should be planned due to recurrent nature. Surgical correction is indicated in raised serum creatinine, deteriorating renal function, urosepsis septic and acutely unwell patients. Management options include: decompressing the system using nephrostomies/ureteral stenting in acutely septic patients. Open, laparoscopic, and robotic approaches for the reduction of ureter and hernia repair in conditions where stenting does not relieve the obstructing ureteric deformity.

UP-13.02—3D—Image Guided Robot Assisted Partial Nephrectomy for Non-Oncological Reasons 

• Rubat Baleuri Federico
  CHU de Bordeaux, Bordeaux, France

• Introduction and Objectives: We evaluated the safety and effectiveness of the 3D Image-Guided Robot-Assisted Partial Nephrectomy (3D IGRAPN) technique in two patients undergoing surgery for non-oncological renal indications: (1) excision of a left anterior mid-pole caliceal diverticulum containing a 15 mm calculus and (2) upper heminephrectomy for hydronephrosis secondary to major calyceal stenosis and repeated pyelonephritis with segmental parenchymal destruction.
  Materials and Methods: In both cases, detailed 3D reconstructions of the kidney and intrarenal structures were created using Synapse 3D software. These models were used for preoperative planning and intraoperative navigation, confirmed by real-time ultrasound. A complete hilar dissection and clampless technique were employed in both surgeries. The first case involved diverticulectomy with elective calyceal repair using 4-0 PDS sutures and a sutureless coagulative hemostasis approach. In the second case, an anatomical devascularization of the upper pole was achieved, followed by upper heminephrectomy, deep vessel and calyceal suturing, and capsular renorrhaphy under tension maintained by Hem-o-Lok clips.
  Results: The first patient, a 43-year-old woman, was discharged on postoperative day 1 with preserved renal function (GFR 96.9 mL/min, creatinine 67 μmol/L) and showed stable function at 3-month follow-up. The second patient, aged 59, experienced postoperative pyelonephritis managed with antibiotics and was discharged on day 5 with preserved renal function (GFR 95.1 mL/min, creatinine 62 μmol/L). Renal function remained stable at the 3-month follow-up. No excretory drainage was required in either case. Histopathological analysis confirmed benign lesions in both patients.
  Conclusions: 3D IGRAPN is a feasible and effective surgical option for selected non-oncological renal conditions. The use of a 3D model enables enhanced intraoperative navigation, precise anatomical devascularization, and accurate elective suturing of renal structures, contributing to optimal parenchymal preservation and reduced ischemic injury. This technique may reduce postoperative complications such as urinary leakage and support excellent functional outcomes.

UP-13.03—3-D Laparoscopic Versus Robotic Assisted Nephron Sparing Surgery for Renal Tumours: A Propensity Score-Based Analysis from a Tertiary Care Center 

• Navriya Shiv, Jain Jaydeep, Chaudhary Gautam, Singh Mahendra, Bhirud Deepak, Sandhu Arjun
  AIIMS Jodhpur, Jodhpur, India

• Introduction and Objectives: Nephron sparing surgery (NSS) has become an established surgical treatment for renal tumours, particularly when patients at risk for chronic kidney disease. We aim to compare perioperative and oncological outcomes as well as post operative renal functions after 3-D Laparoscopic and Robotic assisted Nephron sparing surgery (NSS) for renal tumours.
  Materials and Methods: We analysed prospectively maintained data of patients who underwent either lap or robotic assisted NSS from January 2021 to Dec 2023. Propensity score matching (1:1) was performed to match potential baseline confounders. Key metrics such as operative time, blood loss, hospital stay, complication rates, and oncological outcomes were compared.
  Results: Out of total 139 patients, 57 patients underwent laparoscopic and 82 patients underwent robotic assisted NSS. 18 patients had preexisting comorbidities including diagnosed syndromes (Tuberous Sclerosis-1, Von Hippel Lindau—3 patients), 15 patients had abnormal vascular anatomy, and mean RENAL Score was 7.8 (range 4–11 p). In RAPN group, shorter warm ischemia times (22.5 min vs. 40.0 min), and less blood loss (190.2 mL vs. 260.3 mL) were seen compared to LPN (p-value 0.001). However, RAPN has a longer operation time (282.1 min vs. 205.9 min). The duration of hospital stay was similar between the two groups (p = 0.383). A higher percentage of LPN patients had Clavien-Dindo grade I complications (94.3% vs. 78.8%), which were easily managed (p = 0.019). In both groups no statistically significant difference was seen in renal functions, most common pathological tumour stage was T1b (74%), and most common histopathology was clear cell (62%). One VHL patient had positive margin after LPN; no recurrence was seen in both groups.
  Conclusions: LPN and RAPN provide comparable oncological and functional outcomes after NSS. Decision for NSS and surgical modality should depend on technical feasibility and availability of expertise. RAPN has lower minor complication rates, with potential advantages in warm ischemia time and inferior morbidity profile.

UP-13.04—Barbed Versus Non-Barbed Sutures in Laparoscopic Dismembered Pyeloplasty 

• Ghoneima Waleed, Rammah Ahmed, Mekki Mohamed, Aboelftoh Mohamed, Kasem Ayman, Sharawy Ahmed
  Kasr Alainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt, Arab Rep.

• Introduction and Objectives: Laparoscopic & robot-assisted dismembered pyeloplasty has become the preferred surgical approach for treating Pelvi-Ureteric Junction Obstruction (PUJO) due to its minimally invasive nature, reduced postoperative pain, and faster recovery compared to open surgery. Technical difficulties usually happen during intracorporeal suturing with standard absorbable non-barbed sutures due to the need for sustained traction of the running suture to avoid loosening of the suture line, which may lead to leakage and surgery failure. The use of barbed sutures has the benefit of being knotless and distributes the tension equally across the suture line, which eventually decreases suturing time and provides a more water-tight anastomosis. We aimed to study the feasibility and safety of using barbed sutures versus conventional non-barbed sutures in minimally invasive dismembered pyeloplasty in the adult population.
  Materials and Methods: We conducted a randomized controlled clinical trial in Cairo University Hospitals from November 2023 to February 2025 on a total of 40 patients. Patients were randomized into two groups: group A used absorbable barbed sutures, whereas group B (control) used the conventional PGA sutures. Preoperative clinical examination and investigations were noted, as well as the intraoperative total operative time and suturing time. Early postoperative data and follow-up data were also recorded.
  Results: The median age for group A was 26.85 (14), whereas for group B was 28.90 (14). Operative time (OT) & suturing time (ST) were significantly shorter (OT: p = 0.000 A: 145.40 ± 27.23 min; B: 181.50 ± 30.83 min. ST: p = 0.000 A: 70.90 ± 20.65 min; B: 101.75 ± 28.99 min). There has been a significant difference in peri-operative renal scan parameters such as split GFR, split percentage, T-Max within each group. Two patients experienced complications; one of them required open redo-pyeloplasty in group A, whereas, in group B, six patients experienced complications. Two of them required auxiliary procedures (open redo-pyeloplasty; PCN fixation; and the need for endopyelotomy) [p = 0.114].
  Conclusions: The use of barbed sutures seemed to be safe and efficient in terms of suture handling and perioperative outcomes, yet further research and meta-analyses are still needed.

UP-13.05—Direct Transmesocolic Approach to Renal Hilum in Laparoscopic Radical Nephrectomy for Large Renal Mass 

• Karmakar Saurav ¹, Gopalakrishna R K ²
  ¹ B R Singh Hospital, Dumdum, India, ² Fortis Kidney Institute, KOLKATA, India

• Introduction and Objectives: Accessing the renal artery and vein is a crucial first step in laparoscopic radical nephrectomy. Performing laparoscopic radical nephrectomy for large renal masses presents challenges due to difficulties in accessing the renal hilum, as well as the risk of excessive bleeding caused by neovascularization and collateral vessels. Traditional approaches to access the renal pedicle involve mobilizing the colon and elevating the lower pole of the kidney to visualize the left renal pedicle. However, for renal masses 10 cm or larger (cT2b or higher), this initial step often results in excessive hemorrhage and lengthens the operative time. In such cases, it can be difficult to reach the renal hilum during laparoscopic radical nephrectomy. We present a novel approach for direct access to the renal artery and vein through the root of the mesentery during laparoscopic radical nephrectomy. This technique provides a quick and early means of controlling the renal pedicle when treating large renal masses, without the need for extensive mobilization of the colon and kidney at the outset. This approach offers two major advantages: it reduces operative time and minimizes hemorrhage, and it allows for early pedicle control, making the tumor relatively avascular. This facilitates quicker and easier mobilization of the kidney later in the procedure.
  Materials and Methods: We report on 70 cases of large renal masses (all larger than 10 cm, with an average size of 12.5 cm), where the transmesocolic approach was used for early pedicle control.
  Results: The average operative time was 2 h and 15 min, with no conversions to open surgery. Five patients required blood transfusion, and no major complications were reported.
  Conclusions: Direct vascular pedicle access through the mesocolic root in laparoscopic radical nephrectomy for large renal masses, without the need to mobilize the colon, offers clear advantages. It significantly reduces operative time and hemorrhage while making both the colon and kidney mobilization relatively avascular and easier. This innovative technique may reduce the barriers to performing laparoscopic radical nephrectomy in patients with large renal masses.

UP-13.06—Efficacy of Various Modalities in Flexible Ureteroscopy; A Single-Centers Experience 

• Bhatti Kamran
  HMC, Alkhor, Qatar

• Introduction and Objectives: Urolithiasis refers to the development of calculi in the urinary system. Globally there is an increase in the prevalence and recurrence rates of urolithiasis. Worldwide 12% of people experience urolithiasis at some point in their lifetime (1–3). Multiple risk factors may contribute to developing urinary stones. Factors: age, gender, ethnicity, eating habits, occupation, local climate, and physical activity. Comorbidities such as diabetes, uncontrolled hypertension, and obesity are other major factors (4,5). Many options are available for the management of renal stones with the innovation of technology.
  Materials and Methods: The study was conducted retrospectively; 1750 patients with renal stones ≤ 2 cm treated with a flexible ureteroscope. Among them, 950 patients underwent dusting, and 800 patients underwent fragmentation with basketing. All patients followed up for 3 months. The operating time, access sheath usage, lasing time, hospital stay, stone-free rate (SFR), and complication rate were compared.
  Results: The mean operative time was significantly lower in the dusting group than in the basketing group, 45.1 ± 10.8 min vs. 63.5 ± 13.8 min, four patients in the dusting group and two patients in the basketing group were admitted to the intensive care unit (ICU) due to septic shock and were successfully treated. The immediate SFR after surgery was significantly higher in the basketing group (78.7%) compared with the dusting group (62.7%, p = 0.001). The SFR was also higher in the basketing group, 86.4% vs. 76.3% (p = 0.001), after 1 month postoperatively. However, the SFR was 87.8% in the dusting group vs. 90.2% in basketing group, during the follow-up period of 3 months postoperatively.
  Conclusions: Conclusion: Our data suggests that single-use fURS represent a safe alternative to reusable fURS. Both devices are associated with similar stone-free rates and complication rates. Future well-designed studies with longer follow-ups may be required to compare these two techniques and both types of flexible ureteroscopes for better results and improved recommendations.

UP-13.07—Evaluation of Clinical Research on Novel Multiport Robotic Platforms for Urological Surgery According to the Ideal Framework: A Systematic Review of the Literature 

• Ficarra Vincenzo ¹, Lo Giudice Arturo ², Vigano Silvia ², Giannarini Gianluca ³, Simonato Alchiede ⁴, Bartoletti Riccardo ⁵, Maravigna Debora ¹, Foti Mauro ², Rossanese Marta ²
  ¹ University of Messina, Messina, Italy, ² Department of Human and Pediatric Pathology “Gaetano Barresi”, Urologic Section, Messina, Italy, ³ Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy, ⁴ Urology unit, University of Palermo, Palermo, Italy, ⁵ Urology Unit, University of Pisa, Pisa, Italy

• Introduction and Objectives: The objective of this systematic review is to examine the evolution status of novel robotic platforms approved for clinical use in urological surgery, evaluated according to the IDEAL framework.
  Materials and Methods: A systematic review was conducted up to 5th January 2024, using Medline and Scopus databases, following the updated PRISMA guidelines. The protocol was registered in PROSPERO (CRD42024503227). Comparative or non-comparative studies on any urological procedure using new robots (Hugo RAS, Versius, Kangduo, Senhance, REVO-I, Avatera, Hinotori, Dexter, and Toumai) were selected. The clinical research stage of each platform was assessed using the IDEAL framework.
  Results: Seventy-five eligible studies were included. Of these, 67 (89.3%) were non-comparative surgical series, classified as development or exploratory studies under IDEAL criteria. Only two Randomized Controlled Trials were identified: one comparing Kangduo robot-assisted partial nephrectomy (RAPN) vs. Da Vinci RAPN, and the other comparing Toumai robot-assisted radical prostatectomy (RARP) vs. Da Vinci RARP. Both trials reported similar perioperative outcomes. Four studies analyzed clinical outcomes using REVO-I (1 study on RARP), Senhance (1 on RARP, 1 on sacrocolpopexy), and Hinotori (1 on RAPN), using matched Da Vinci controls. All showed comparable results. However, these comparative studies were underpowered and limited by small sample sizes. Moreover, most comparisons involved first-generation new platforms versus the fourth-generation Da Vinci system. No direct comparisons between novel robotic platforms have been conducted to date.
  Conclusions: Few and low-quality studies have compared new robotic systems to the Da Vinci platform, with results showing overall similarity. Most existing studies fall into the development or exploration phases, indicating early stages of clinical research. Comparative evaluation with the Da Vinci system is still ongoing. Novel platforms could help reduce the costs of robotic urological surgery and challenge Intuitive’s monopoly. Nevertheless, robust, multicenter studies are required to determine whether these new systems can offer benefits beyond cost reduction

UP-13.08—Evaluation of the Catheter Related Symptoms Between Suprapubic and Standard Catheter in Retzius Sparing Robot-Assisted Radical Prostatectomy 

• Lilly Eddy ¹, Papadopoulos Dimitrios ¹, Joseph Danny ², Casson Helen ¹, Innes Maria ¹, Adamos Konstantinos ¹, Patil Krishna ¹, Moschonas Dimitrios ¹, Hicks James ¹, Perry Matthew ¹, Kusuma Venkata ¹, Abou Chedid Wissam ¹
  ¹ Royal Surrey Foundation Trust, Guildford, United Kingdom, ² Ashford and St Peter’s Hospitals NHS Foundation Trust, Lyne, United Kingdom

• Introduction and Objectives: This study was conducted to compare catheter-related symptoms and ease of self-removal between suprapubic catheters (SPC) and standard urethral catheters (UC) in patients undergoing Retzius-sparing robot-assisted radical prostatectomy (RS-RARP).
  Materials and Methods: This prospective study enrolled 70 patients who underwent RS-RARP performed by a single surgeon between October 2023 and April 2024. 26 patients had a UC and 44 had an SPC. Catheters were removed on postoperative day 7, and patient feedback was obtained via a structured questionnaire evaluating their experience with the urinary drainage device.
  Results: Patients with SPC reported a more favorable overall experience, with less discomfort and a lower perceived burden. Penile pain was significantly greater in the UC group (p = 0.002). Bladder spasms were reported at similar rates between groups (p = 0.752). The overall catheter burden was significantly higher for UC users (p = 0.025), indicating they found it more problematic. The self-removal process was perceived as equally manageable across both groups (p = 0.755). While home removal was common in both, a significant difference was seen in removal location (p = 0.021): all UC users (100%) removed theirs at home, whereas 18.2% of SPC users underwent hospital removal. This suggests that, although SPC users were open to home removal, some still required or preferred hospital-based removal. Correlation analysis showed UC was associated with a more distressing pain experience—pain over the last 7 days (p = 0.039) and penile pain (p < 0.01) strongly correlated with higher perceived burden. In contrast, SPC users did not show a significant correlation between pain (overall: p = 0.117; cramps: p = 0.959) and burden (p = 0.455), implying that any challenges stemmed more from maintenance, psychological concerns, or functional issues. This highlights the need to address not only pain relief but also education, support, and practical guidance for SPC users to enhance their experience.
  Conclusions: Our study reinforces that, while both catheters achieve the fundamental goal of postoperative urinary drainage, SPCs offer distinct advantages in reducing localized pain and perceived burden. Given these findings, a patient-centered approach should be adopted, considering individual preferences, tolerance to discomfort, and readiness to manage the device.

UP-13.09—Focal Therapy for Prostate Cancer with Cryoablation and Irreversible Electroporation: A Single-Surgeon Descriptive Study 

• Kim Jonathan ¹, Hossaini Chaimaa ², Liou Louis ³
  ¹ Drexel University College of Medicine, Philadelphia, PA, United States, ² AOA Urological Associates, Boston, MA, United States, ³ Emerson Hospital, Concord, MA, United States

• Introduction and Objectives: Focal therapy has gained traction in the management of localized prostate cancer (PCa) based on the promise of equivalent oncologic outcomes with minimal adverse effects compared to whole gland therapy. Among available focal modalities, cryoablation and irreversible electroporation (IRE) are two commonly utilized techniques. We present a single-surgeon experience on clinical outcomes with each treatment type.
  Materials and Methods: We retrospectively reviewed 67 patients who underwent focal therapy for localized prostate cancer between September 2008 and July 2024. 56 were treated with cryoablation and 11 with IRE. Urinary function via International Prostate Symptom Score (IPSS), and erectile function via International Index of Erectile Function (IIEF) were recorded at baseline and serially at 1, 6, and 12 months postoperatively. Cancer recurrence was defined by histopathologic confirmation on follow-up biopsy. Recurrences were further categorized as in-field or out-of-field relative to the treatment zone, and Gleason scores were analyzed. Prostate-specific antigen (PSA) levels pre- and post-treatment were also investigated.
  Results: For cryotherapy, mean IPSS decreased from 10.16 to 4.93 at 12 months, and mean IIEF decreased from 16.02 to 13.96. For IRE, mean IPSS decreased from 13.00 to 3.2, and IIEF from 16.23 to 12.80. Overall recurrence rates were found to be 23.2% (13/56) for cryoablation and 36.3% (4/11) for IRE. Among cryoablation recurrences, 46.1% (6/13) were out-of-field. For IRE, 50.0% (2/4) of recurrences were out-of-field. Median PSA decreased from 7.15 ng/mL to 1.18 ng/mL for cryotherapy and from 7.13 ng/mL to 2.39 ng/mL in the IRE group. In patients with recurrence, decline in PSA was less pronounced (7.65 to 1.92).
  Conclusions: Both cryoablation and IRE demonstrated notable biochemical responses with improved urinary function and slightly decreased erectile function, with vast majority of patients not requiring PDE-5 inhibitors. These treatment modalities appear to control cancerous lesions with minimal side effects. However, further evaluation with larger patient cohorts and extended follow-up are needed.

UP-13.10—Inadvertent Injuries During Uro-Laparoscopic Procedures and Their Management 

• Naser Md. Fazal ¹, Haider Mominul ², Afroz Roksana ³, Dey Sudip ², Islam Khan ¹, Hossain Md. Shohrab ⁴
  ¹ National Institute of Kidney Diseases and Urology (NIKDU), Dhaka, Bangladesh, ² Sir Salimullah Medical College Hospital, Dhaka, Bangladesh, ³ Central Police Hospital, Dhaka, Bangladesh, ⁴ Advanced Centre for Kidney and Urology (ACKU), Dhaka, Bangladesh

• Introduction and Objectives: A variety of laparoscopic procedures are regularly performed for urological cases. With increasing laparoscopic surgical experience, the incidence and magnitude of complications increase because more complex procedures are increasingly tackled laparoscopically. Here we summarized the inadvertent injuries we faced in our practice in the last 10 years and how we managed them.
  Materials and Methods: Medical records of laparoscopic procedures performed in the urology operation theater from 2014 to 2024 were systematically reviewed to identify peroperative complications and inadvertent injuries, and their management was noted and later analyzed.
  Results: Total 984 laparoscopic surgeries were performed in last 10 years. In 29 (2.9%) cases, inadvertent injury to surrounding structures was recorded. Among these vascular injury in 19 cases, bowel injury in 5 cases, diaphragmatic injury in 2 cases, splenic injury in 2 cases and liver injury in 1 case. Among the vascular injuries, most common was IVC injury (11); others included external iliac vein injury (4), renal vein injury (2), contralateral renal artery injury (1) and inferior epigastric artery injury (1). All these vascular injuries were repaired laparoscopically except one case of laparoscopic partial nephrectomy (LPN), where renal vein injury led to nephrectomy. The injured inferior epigastric artery was ligated. Among the bowel injuries, colon injury was in 4 cases, and duodenum injury was in 1 case. All of the bowel injuries were repaired immediately by laparoscopic suturing, and none had any postoperative complications. Splenic injuries were dealt with bipolar cautery and bio-absorbable Surgicel^® (Johnson and Johnson, Somerville, NJ, USA). Diaphragmatic injuries were repaired by intracorporeal suturing, and none needed a chest tube.
  Conclusions: Despite the low incidence of complications during laparoscopic surgery, vascular injury is the most serious complication in laparoscopic urological surgery. Rapidly identifying the cause and strictly adhering to standardized management practices to overcome such adverse situations is most important. Almost all injuries can be dealt with laparoscopically without the need for conversion.

UP-13.11—Initial Experience Using the Gelport Device with a Wireless Ultrasound Probe During Laparoscopic Partial Nephrectomy 

• Kapogiannis Filippos, Antoniou Christos, Karydakis Panagiotis, Xatzigianni Olympia-Evaggelia, Mantelos Evangelos, Galopoulou Anabella, Lappas Georgios, Kalogeropoulos Theodoros
  Hippokrateion General Hospital, Athens, Greece

• Introduction and Objectives: Intraoperative ultrasonography (IOUS) constitutes an important auxiliary tool in the treatment of endophytic renal masses since it allows the demarcation of the tumor position and definition of the relationship between the tumor and the vessels of the renal hilum and the pyelocaliceal system. Nevertheless, the purchase cost of specially designed probes could be considerable if not prohibitive. In the absence of a laparoscopic or robotic probe during partial nephrectomy, we used a high-definition, wireless ultrasound probe as a cheap and affordable method to help with a precise delineation of the size, depth, and boundaries of renal masses.
  Materials and Methods: For hand-assisted laparoscopy we used the Gelport, a hand-assist device that permits free and direct insertion and withdrawal of the surgeon’s hand and 5 mm-instruments from the abdomen while maintaining an intact pneumoperitoneum. For IOUS, we used an ultra-portable, handheld ultrasound with a convex transducer (Konted C10T, 3.5/5 Mhz) enclosed in a layer of sterile latex sheath and covered with adhesive and gel, with real-time display of the images on a tablet screen.
  Results: The advantage of this technique is that the surgeon regains direct tactile feedback and acquires improved hand-eye coordination, thereby providing better surgeon autonomy and precision. The margins and depth of the tumor, as well as its distance from the capsule and the renal sinus, were measured after adequate mobilization of Gerota’s fascia of the kidney. Before excision the tumor was outlined circumferentially and demarcated using a monopolar scalpel, as performing ultrasonography and simultaneously carrying out excision is impossible with an endocavitary ultrasound probe in comparison with a robotic probe. None of the patients required surgical conversion. There were no cases of infection at the site of probe entry.
  Conclusions: The use of IOUS via the Gelport is proposed as a simple, and cost-effective method for ensuring surgical margins during laparoscopic PN with a moderate increase in operation time. We believe that this approach could represent a safe alternative for the excision of endophytic tumors in medical centers of developing countries where neither robotic nor laparoscopic probes are available.

UP-13.12—Innovative Multi-Port Trans-Vesical Robotic Radical Prostatectomy: Technique, Challenges, and Oncological Outcomes with the Da Vinci Xi System 

• Usmani Aamir, Pathak Abhishek, Singh Uday
  Sanjay Gandhi Postgraduate Institute, Lucknow, India

• Introduction and Objectives: We aim to describe an innovative technique, its challenges, and the oncological outcomes of multi-port trans-vesical robotic radical prostatectomy in patients with localized prostate carcinoma using the Da Vinci Xi surgical system.
  Materials and Methods: To date, we have performed this innovative technique on eight patients (n = 8). Four underwent the trans-vesical transabdominal approach, while four underwent the transvesicoscopic approach. The prostate volumes of these patients were 76 cc, 70 cc, 20.5 cc, 22 cc, 30 cc, 34 cc, 56 cc, and 50 cc, respectively. In the conventional trans-vesical technique, the prostate was accessed transabdominally after bivalving the urinary bladder. In the transvesicoscopic technique, a pneumovesicum was created using a 12 mm intravesical port, placed under direct vision with cystoscopic guidance. Subsequently, three 12 mm robotic ports were inserted. The surgical steps were nearly identical in both methods and included: posterior bladder neck dissection, vas deferens and seminal vesicle dissection, posterior dissection, anterior bladder neck and prostate dissection, pedicle and neurovascular bundle dissection, posterior reconstruction and urethrovesical anastomosis. The specimen was retrieved in an endo-bag through a separate skin incision.
  Results: The mean age of the patients was 63 years, with a mean preoperative PSA level of 20.5 ng/mL. The average operative time was 288 min, with a mean estimated blood loss of 85 mL. The median hospital stay was 4 days, and the median duration of Foley catheterization post-surgery was 21 days. All four patients achieved early continence following catheter removal. Histopathological examination of the resected specimens revealed negative surgical margins in all cases.
  Conclusions: Both the trans-vesical transabdominal and transvesicoscopic techniques are viable options for patients with localized carcinoma of the prostate. These approaches offer the precision of Retzius-sparing robotic surgery with additional advantages, particularly in challenging cases such as those with a large median lobe or post-TURP conditions, where ureteric orifice identification is crucial. The expedited return to urinary continence without compromising oncological efficacy has led to increased adoption of these techniques in our clinical practice.

UP-13.13—Laparoscopic Bilateral Ureteral Reimplantation in a Frozen Pelvis—A Nightmare Scenario 

• Jin Ye André ¹, Cunha João ², Butticè Salvatore ³, Castillo Geraldini ⁴, Bollens Renaud ⁵
  ¹ Unidade Local de Saúde-Santa Maria, Lisbon, Portugal, ² Unidade Local de Saúde-São José, Lisbon, Portugal, ³ Paulo Borsellino Hospital, Marsala, Italy, ⁴ Clínica Gómez Patiño, Santo Domingo, Dominican Republic, ⁵ Centre Hospitalier de Wallonie picarde, Tournai, Belgium

• Introduction and Objectives: Ureteral iatrogenic lesions are a recognized complication in pelvic surgery, particularly in patients with a history of prior surgeries and pelvic adhesions. Managing such injuries in the presence of a frozen pelvis, characterized by extensive fibrosis and anatomical distortion, presents a significant surgical challenge. Traditional treatment options include ureteroureterostomy, ureteral reimplantation, or urinary diversion using bowel segments. This case report highlights the feasibility of laparoscopic bilateral ureteral reimplantation in a complex scenario where open surgery would traditionally be preferred. This study aims to present a challenging case of laparoscopic bilateral ureteral reimplantation in a patient with distal ureteral iatrogenic injuries within a frozen pelvis, demonstrating the technical feasibility and clinical outcomes of this minimally invasive approach.
  Materials and Methods: A 65-year-old male underwent anterior rectal resection, which was complicated by anastomotic dehiscence requiring a Hartmann’s procedure. A subsequent attempt to restore bowel continuity was performed but required conversion to an open approach due to a frozen pelvis. Postoperatively, a CT scan revealed a distal urinary leak from both ureters. An attempt to place double J stents was unsuccessful, necessitating bilateral percutaneous nephrostomies. The patient was then scheduled for laparoscopic ureteral reimplantation.
  Results: The procedure was performed in a supine position with leg abduction and Trendelenburg tilt. Five trocars were placed strategically. Extensive adhesiolysis was required, complicated by rectal laceration necessitating colorectal anastomosis disassembly and rectal stump closure. The ureters were dissected, spatulated, and reimplanted into the bladder using the Lich-Gregoir technique with double J stent placement. Postoperatively, the patient developed a drain site infection requiring IV antibiotics. He was discharged after 21 days, and the stents were removed six weeks later. Follow-up at three months was uneventful.
  Conclusions: This case demonstrates that laparoscopic bilateral ureteral reimplantation is a viable option for patients with iatrogenic ureteral injuries in a frozen pelvis. Despite the technical complexity, this approach can achieve successful outcomes while minimizing the morbidity associated with open surgery, reinforcing its role in modern urological reconstruction.

UP-13.14—Laparoscopic Modified Hellstrom Technique for Uretero-Pelvic Junction Obstruction Caused by Aberrant Vessels: Long Term Follow Up 

• Simforoosh Nasser, Dadpour Mehdi
  Shahid Beheshti University of Medical Sciences, Labbafinejad Medical Center, Tehran, Iran, Islamic Rep.

• Introduction and Objectives: To investigate the effectiveness of laparoscopic modified Hellstrom techniques in patients with uretero-pelvic junction obstruction (UPJO) caused by aberrant vessels, and to evaluate long-term outcomes.
  Materials and Methods: This study included 18 patients with a mean age of 19.5 ± 6.6 years, treated between 2010 and 2014. All patients underwent laparoscopic surgery for UPJO, during which aberrant vessels were identified as the cause of the obstruction. In this approach, the vein was typically coagulated using bipolar cautery, and the separated artery was buried in the pelvis. Pyeloplasty was not performed in any of the cases. Intravenous pyelogram (IVP) or DTPA scan was conducted since 6 months to 10 years post-surgery to assess short-term and long-term outcomes, respectively.
  Results: The mean operative time was 54.6 ± 11.4 min. Estimated blood loss was 20.5 ± 3.6 mL, and the average hospitalization duration was 2.4 ± 0.2 days. No cases required packed cell transfusion, conversion to open surgery, or resulted in Clavien-Dindo grade 3 or higher complications. Symptoms disappeared in all 18 patients following surgery. Short-term and long-term IVP studies or DTPA scans confirmed the significant improvement of UPJO in all patients.
  Conclusions: Laparoscopic Hellstrom technique is a safe and feasible minimally invasive procedure for patients with UPJO caused by aberrant vessels. Both short-term and long-term follow-ups revealed significant improvements in patients’ symptoms and imaging results.

UP-13.15—Laparoscopic Radical Cystectomy in Patients with Muscle-Invasive Bladder Cancer: Lessons Learnt with Respect to Technical Improvisation over a Period of 6 Years 

• Sharma Amit, RT Raghavendra
  All India Institute of Medical Sciences, Raipur, CG, India

• Introduction and Objectives: We present a retrospective observational study of Laparoscopic Radical Cystectomy (LRC) in patients with Muscle-invasive Bladder Cancer with minimal incision for conduit-formation.
  Materials and Methods: Case records of all MIBC and very high-risk non-MIBC patients managed at a tertiary care centre in central India over a period of 6 years from January 2019 to December 2024 with 2 years follow-up (telephonic and physical). All patients underwent LRC and bilateral PLND as per standard 5 port technique, with ileal conduit and total intracorporeal urinary diversion or orthotopic urinary diversion (Studer technique). Extracorporeal anastomosis was done with a large lower midline laparotomy incision initially from 2019 to 2020. From 2021 onwards, the size of the laparotomy incision was reduced to 6 cm midline incision (mini laparotomy incision), with small bowel scored laparoscopically and specimens with ureters were held with graspers separately, easing the delivery of specimens through small wound. The data was analysed with respect to demographic profile, intra- and post-operative events and complications, hospital stay and follow-up.
  Results: Amongst 228 included patients, there were more males than females, smoking was the commonest risk factor (65.35%) and painless haematuria was the commonest symptom. 200 patients had MIBC, 18 patients had NMIBC and 10 patients underwent Palliative Cystectomy. The operative duration increased in the later 4 years, but there was reduction in blood loss and incision size, because of additional time taken to mark bowel and ureters, reducing incision size and wound-related complications. TCC was the commonest histopathology (92.98) and pT3-T4 disease was the commonest (65%). Nodal involvement was seen in 22% of patients; lympho-vascular and perineural invasion was seen in 11.8% of patients. 87.2% (n = 199) required adjuvant chemotherapy, and 5 received neo-adjuvant chemotherapy before LRC. 5 patients had recurrence, and 3 were dead at follow-up of 2 years.
  Conclusions: Laparoscopic Radical Cystectomy with the minimal incision is feasible, reproducible and gives similar oncological results with less wound-related complications; especially in developing countries which don’t have Surgical Robotic system installed in all the hospitals.

UP-13.16—Laparoscopic Vascular Hitch vs. Dismembered Pyeloplasty in Adult Ureteropelvic Junction Obstruction Caused by Crossing Vessels: A Prospective Observational Clinical Trial 

• Ghoneima Waleed, Rammah Ahmed, Sherif Mohamed, Sharawy Ahmed, Zamel Samih, Torad Hesham
  Kasr Alainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt, Arab Rep.

• Introduction and Objectives: Lower pole crossing vessels are responsible for 40–58% of uretero-pelvic junction obstruction (UPJO) in adults. The gold standard treatment for the repair of UPJO is the dismembered pyeloplasty (DP). Vascular hitch (VH) is an alternative procedure to treat the pure extrinsic UPJO. The VH could eliminate the technical difficulties linked to the intracorporeal laparoscopic sutures. Therefore, we aimed to evaluate the outcome of both laparoscopic techniques for UPJO with crossing vessels: vascular hitch and dismembered pyeloplasty.
  Materials and Methods: This is a prospective clinical trial. All adult patients presented with UPJO were evaluated with CT angiography and renal isotopic DTPA study. Those patients with recurrent UPJO, secondary renal stones, non-functioning ipsilateral renal unit and UPJO without crossing vessel were excluded. Intraoperative laparoscopic assessment was done for the crossing vessels and dissecting it from the UPJ. If clear visible peristalsis and collapsed renal pelvis were noticed, VH was performed by caudal translocation of the crossing vessels away from the UPJ using invaginating 3/0 Vicryl sutures through the renal pelvis, while absent peristalsis and distended renal pelvis were indications to proceed to stented DP with posterior translocation of the crossing vessels. Intraoperative parameters as operative time were documented. 6-months follow up was performed using abdomen and pelvis ultrasound (AP pelvis diameter) and renal isotope DTPA study (GFR split function difference and T1/2).
  Results: 35 patients with UPJO were included in the study with mean age 27.97 ± 8.38 years. 13 patients underwent VH, while 22 patients had DP. No significant difference between both groups as regard the age, affected side, anteroposterior renal pelvis diameter or GFR split function differences. Mean operative time was significantly shorter in VH patients compared to DP, 45.32 ± 5.22 vs. 70.67 ± 9.23 respectively (p < 0.001). Moreover, there was no significant difference as regard the hospitals stay. 6 month follow up revealed no evidence of UPJO recurrence in both groups except one patient in VH group who had dilated renal pelvis and rising curve in DTPA study with T1/2 more than 20 min for which redo DP was required.
  Conclusions: Laparoscopic vascular hitch could be effective and safe alternative for dismembered pyeloplasty in adult UPJO caused by crossing vessels.

UP-13.17—Methods of Prevention of Early Post-Surgical Complications and Improvement of Distant Functional Results After Robot-Assisted Radical Prostatectomy 

• Papoian Anushavan, Ialiukhova Daria, Pavlov Valentin, Urmantsev Marat, Deneiiko Anton
  Bashkir State Medical University, Ufa, Russian Federation

• Introduction and Objectives: Nowadays prostate cancer is the second most common neoplasm in men, and one of the most commonly diagnosed types of cancer worldwide. More than 85% of radical prostatectomies in the world are performed using robotic techniques as it is considered the gold standard. The aim of the study is to develop a method of robot-assisted radical prostatectomy (RARP) with total muscular-fascial reconstruction of pelvic organs.
  Materials and Methods: 80 patients with histologically confirmed localised prostatectomy without distant metastases who underwent RARP with total reconstruction of pelvic structures (group I) using da Vinci surgical system and 80 patients who received RARP surgical treatment without reconstruction (group II); procedure consisted of suturing the tissue along the neurovascular bundle with the tissue in the retrotrigonal layer of the bladder and suturing together the muscular portion of the fascia Denonvillies and the superficial detrusor fibers of the posterior bladder and periurethral tissues below the urethra. A vesicourethral anastomosis (VUA) is then placed. Anterior reconstruction involved suturing the muscle fibers of the bladder to the parietal sheets of the intrapelvic bladder; tissues in the bladder neck region were sutured to the puboprostatic ligaments and tissues of the dorsal venous complex.
  Results: The mean duration of the surgery in group II was 67.3 min and 105.8 min in group I with the mean weight of the prostate changing from 50.8 to 53.7 g. The estimated blood loss in group II was 111 mL, whereas in group I it was 70 mL. The percentage of haemotransfusion in group I was 0%, and in group II it was 2%. The mean VUA application time was 20.9 and 25.7 min in group I and II respectively, and the VUA. There were also 4 cases of congenital haematomas in group II.
  Conclusions: Total muscular-fascial reconstruction of anatomical structures after RARP is a safe and effective method of bleeding from neurovascular bundles, dorsal venous complex and posterior urethral haematomas and urinoma in case of vesicourethral anastomosis failure. It promotes early urinary retention without affecting oncological outcomes.

UP-13.18—Renal Cell Carcinoma in Pelvic Ectopic Kidney Managed by Laparoscopic Partial Nephrectomy 

• Sharma Amit, Goel Saryu, RT Raghavendra, Biswal Deepak
  All India Institute of Medical Sciences, Raipur, CG, India

• Introduction and Objectives: Renal cell carcinoma of ectopic kidney is not common and has been reported less in literature. We present a case of renal cell carcinoma in a female with right pelvic kidney who was managed by laparoscopic partial nephrectomy.
  Materials and Methods: A 74 year-old female presented with right abdominal mass in Urology OPD. She was a known case of right pelvic kidney and also had hypertension and hypothyroidism, which were being treated. There was no history of abdominal pain and haematuria. She was investigated. Contrast-enhanced Computed Tomography suggested right ectopic (pelvic) and malrotated right kidney with a well-defined heterogeneously enhancing mass lesion arising from upper and mid pole of size 4.3 × 4 × 5.4 cm. She was admitted and planned for laparoscopic right partial nephrectomy.
  Results: The patient underwent laparoscopic right partial nephrectomy. There were no intra-operative and post-operative complications. Post operative period was uneventful. The final histopathology report showed clear cell carcinoma grade-1with TNM-T2a Nx staging. The patient is asymptomatic on follow-up.
  Conclusions: Laparoscopic partial nephrectomy is feasible and should be tried for polar masses.

UP-13.19—Retroperitoneoscopic Surgical Experience in Renal, Adrenal, and Retroperitoneal Pathology in University Hospital Jimenez Diaz Foundation 

• Gonzalez Raul ¹, Amaruch Nasser ², Coloma Lidia ², Perez Xabier ², Tufet Jaime ², Matta Jose ², Osorio Felipe ², Ruiz De Castroviejo Joaquin ², Yanes Beatriz ², Jimenez Juan ², Cabello Ramiro ², Gonzalez Enguita Carmen ², Hernando Alberto ¹, Cuello Leslie ¹, Cañadas Maria ¹
  ¹ Hospital Universitario Fundación Jímenez Díaz, Madrid, Spain, ² Jiménez Díaz Foundation University Hospital, Madrid, Spain

• Introduction and Objectives: Retroperitoneoscopic surgery has gained increasing relevance in recent years for the management of renal, adrenal, and retroperitoneal pathologies due to its lower morbidity and mortality rates and faster recovery. Our center has accumulated extensive experience in this technique, with over 150 procedures performed since its introduction in 2016, consolidating its application across various conditions. Objective: To present our experience with retroperitoneoscopic surgery for renal, adrenal, and retroperitoneal pathologies, evaluating its indications, surgical technique, and associated complications.
  Materials and Methods: We present a summary of the most frequently performed retroperitoneoscopic procedures since 2016: Renal Pathology: partial and radical nephrectomy, cyst marsupialization, nephropexy; Adrenal Pathology: total or partial adrenalectomy; Retroperitoneal Pathology: biopsy/excision of lymph nodes in suspected lymphoproliferative disease.
  Results: From 2016 to 2024, over 150 retroperitoneoscopic procedures were performed, with adrenal pathology being the most common indication, followed by renal conditions. A standardized surgical approach was employed in all cases, including anatomical landmark identification, trocar placement, and retroperitoneal space creation using a Gaur balloon. Blood loss was minimal in all cases (100 mL ± 50). The rate of major complications was below 3%. Notable complications included diaphragmatic injury, hematoma at the surgical site, Petit triangle herniation, and urinary fistula. No conversions to open surgery were required, and the average hospital stay was 2.5 days (±1).
  Conclusions: Our experience confirms that retroperitoneoscopic surgery is a safe and effective technique for the treatment of renal, adrenal, and retroperitoneal conditions, with a low complication rate and rapid recovery. This approach minimizes surgical impact and offers consistent outcomes, establishing itself as the preferred option in selected patients at our center.

UP-13.20—Retrospective Cohort Study: Efficacy, Feasibility, and Safety of Aquablation After Previous Urolift Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostate Hyperplasia 

• Darwazeh Hashem, Ng Keng, Barber Neil
  Frimley Park Hospital NHS Foundation Trust, Camberley, United Kingdom

• Introduction and Objectives: The influence of a previous Urolift treatment on the outcomes of prostate Aquablation is still controversial. Therefore, we performed a retrospective cohort study to evaluate the perioperative outcomes, efficacy, feasibility, and safety of Aquablation after previous Urolift treatment.
  Materials and Methods: The charts of patients with Benign prostate hyperplasia (BPH) complicated by storage and voiding symptoms, who were previously treated with Urolift followed by Aquablation, between January 2022 and July 2024, were retrospectively reviewed and analyzed for changes in International Prostate Symptom Score (IPSS), maximum urinary flow rates (Qmax), and postvoid residual volume (PVR) from baseline (pre-Aquablation) to the mean of three months postoperatively. Day-case surgery was performed in 75% of the cases. The feasibility of Aquablation as a day-case procedure was evaluated conjointly.
  Results: The study subjects comprised 40 patients with a mean age of 68 (SD ± 8.91) years with moderately enlarged prostates (mean volume 81.56 mL, [SD ± 25.32), median PSA 3.2 ng/dL). After Aquablation, the mean IPSS improved from 24.7 (SD ± 7.63) at baseline to 9.8 (SD ± 2.55) (p < 0.0001), the mean Qmax increased from 9.6 mL/s (SD ± 5.76) at baseline to 20.8 mL/s (SD ±6.28) (p < 0.0001), and the mean PVR decreased from 143 mL (SD ± 104.89) at baseline to 36 mL (SD ± 30.63 ) (p < 0.0001). The hospital stay for patients admitted ranges from 1 to 2 days. Moreover, there were no intra-operative difficulties or a significant increase in operative time removing dislodged Urolift clips with loop resectoscope at the end of the procedure, while non-dislodged clips were left in situ with no complications. None of the patients had postoperative bleeding that required hospital admission or blood transfusion following discharge.
  Conclusions: Prostate Aquablation is an effective, safe, feasible, and reliable surgical procedure for BPH patients who have had previous Urolift treatment.

UP-13.21—Robot-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion Versus Open Radical Cystectomy: Oncological and Morbidity Outcomes in a Retrospective Cohort 

• Morales Pinto Stalin, Amores Vergara Carmen, Alberca Arcos Fernando, Herrera Imbroda Bernardo
  Virgen de la Victoria University Hospital, Málaga, Spain

• Introduction and Objectives: The increasing adoption of minimally invasive surgical techniques has led to a rise in robot-assisted radical cystectomy (RARC). This study evaluates the oncological outcomes and perioperative morbidity associated with RARC compared to open radical cystectomy (ORC).
  Materials and Methods: A retrospective cohort study was conducted including 350 patients who underwent radical cystectomy between September 2014 and September 2024 at Hospital Universitario Virgen de la Victoria, Málaga. Demographics, perioperative parameters, oncological outcomes, and complications were compared between patients undergoing RARC and ORC.
  Results: Median patient age was 67.4 years (SD ± 9.4), with 84.9% males. Neoadjuvant chemotherapy was administered in 48.3% of cases, with comparable distribution between groups (RARC: 50.9% vs. ORC: 47.8%, p = 0.7). Median follow-up was 48.1 months for ORC and 14.6 months for RARC. Among the RARC group, 53 patients underwent intracorporeal ileal conduit diversion, including 3 orthotopic neobladders. Oncological outcomes: Positive surgical margins were significantly lower in the RARC group (1.9%) compared to the ORC group (15.2%, p = 0.01). No significant difference was found in the median number of lymph nodes retrieved (RARC: 14 vs. ORC: 15, p = 0.6). Perioperative outcomes: RARC was associated with a lower transfusion rate (22.6% vs. 44.8%, p = 0.02), shorter hospital stay (7.0 vs. 13.2 days, p < 0.001), but a longer operative time (371 vs. 300 min, p < 0.001). There was no statistically significant difference in the rate of major complications (Clavien–Dindo ≥ III) between groups (RARC: 24.5% vs. ORC: 36.4%, p = 0.6).
  Conclusions: RARC offers comparable oncological outcomes to ORC, with the added advantages of reduced blood transfusion rates and shorter hospital stays, despite longer operative times. These findings support the continued integration of robotic approaches in the management of muscle-invasive bladder cancer.

UP-13.22—Robotic Assisted Laparoscopic Pyeloplasty: Is a Postoperative Drainage Still Necessary? 

• Al Omeyr Bander ¹, Alenizi Abdullah ¹, AlDayhani Abdulrahman ¹, Alhassan Abdullatif ¹, Alharbi Moaz ²
  ¹ Security Forces Hospital Program, Riyadh, Saudi Arabia, ² Al-Iman General Hospital, Ministry of Health, Riyadh, Saudi Arabia., Riyadh, Saudi Arabi

• Introduction and Objectives: Robotic-assisted laparoscopic pyeloplasty is a minimally invasive surgical technique for the treatment of ureteropelvic junction obstruction. The use of postoperative drains is still controversial and may have implications for clinical outcomes. This study aims to compare perioperative outcomes between patients who had Postoperative drain vs. those who didn’t post robotic-assisted laparoscopic pyeloplasty. The intent is to assess if a routine drain insertion is really needed.
  Materials and Methods: Retrospective analysis of 63 patients who underwent robotic-assisted laparoscopic pyeloplasty, divided into two groups: postoperative drainage (Drainage Group, n = 49) and no drainage (No Drainage Group, n = 14). The demographic characteristics, perioperative factors, and functional outcomes were compared between the groups. The statistical analyses used were Mann-Whitney U, Fisher’s exact test, and Spearman’s correlation with a threshold of significance of p < 0.05.
  Results: Demographically, there were a few statistically significant differences observed between the two groups. The mean age was 17.45 ± 12.3 years in the drainage group and 15.93 ± 15.4 years in the no-drainage group (p = 0.67). The percentage of male patients was higher in the no-drainage group (93%) compared to the drainage group (47%, p = 0.51). Estimated blood loss was significantly lower in the no-drainage group (34.3 ± 15.2 mL) compared to the drainage group (51.02 ± 10.5 mL, p = 0.001). Hospital stays were significantly shorter in the no-drainage group (5.0 ± 1.4 days) compared to the drainage group (5.9 ± 1.5 days, p = 0.03). Operative time, postoperative complications, narcotic use, and ER visit rates were comparable between the groups (p > 0.05). Functional outcomes were also similar, as the resolution of hydronephrosis (HDN) was achieved in 85.7% of patients in the drainage group and 90% in the no-drainage group (p = 0.74).
  Conclusions: Our results demonstrated that robotic-assisted laparoscopic pyeloplasty without drainage was comparable in functional and surgical outcomes to drainage, with the added benefits of shorter hospital stays. This may suggest that omitting drainage in selected patients may be safe and effective, and prospective studies are needed to validate these findings.

UP-13.23—Self-Removal of Suprapubic Catheter Post Retzius Sparing Robotic Assisted Radical Prostatectomy: Feasibility and Patient Outcomes 

• Lilly Eddy ¹, Papadopoulos Dimitrios ¹, Joseph Danny ², Innes Maria ¹, Casson Helen ¹, Adamos Konstantinos ¹, Moschonas Dimitrios ¹, Kusuma Venkata ¹, Hicks James ¹, Patil Krishna ¹, Perry Matthew ¹, Abou Chedid Wissam ¹
  ¹ Royal Surrey Foundation Trust, Guildford, United Kingdom, ² Ashford and St Peter’s Hospitals NHS Foundation Trust, Lyne, United Kingdom

• Introduction and Objectives: We conducted a prospective study to evaluate the feasibility of suprapubic catheter (SPC) self-removal and what factors can interfere with the decision of self-removal, in post RS-RARP patients.
  Materials and Methods: 44 patients had an SPC inserted following an RS-RARP from January 2024 until May 2024; 36 of them opted for self-removal. Feedback was obtained four weeks post operatively regarding catheter related symptoms and the complexity of self-removal procedure.
  Results: Most patients reported minimal overall pain (median = 2), with penile pain most frequently rated as none (mode = 1). Bladder cramps and overall problem perception were also low (median = 1); 65.9% of patients reported no bladder cramps, and 61.4% had no issues with SPC management. Factors such as overall pain (p = 0.234), penile pain (p = 0.286), and overall problem perception (p = 0.643) did not significantly influence the decision of SPC self-removal. However, bladder cramp frequency had significantly impacted the self-removal decision (p = 0.029). Interestingly, many patients who experienced cramps still opted for home removal, while some without cramps chose hospital removal, suggesting that factors like anxiety, perceived difficulty, or clinical recommendation played a stronger role than symptom severity. This highlights the importance of preoperative counseling and improved educational materials to support patient confidence in self-removal decision. The majority (80.6%) found self-removal easy, with only 11.1% considering it complicated. Most patients also recommended self-removal, reinforcing its overall feasibility. The perceived complexity of self-removal strongly correlated with likelihood to recommend the procedure (p < 0.001). Additionally, penile pain correlated with bladder cramps (p = 0.006) and overall problem perception (p = 0.003), suggesting discomfort in one area may reflect a broader negative experience affecting patients’ decision making regarding self-removal, as patients with higher bladder cramps were less likely to recommend self-removal (p = 0.008).
  Conclusions: SPC self-removal after RS-RARP is a feasible and well-tolerated approach, with most patients experiencing minimal symptoms and reporting a positive experience. With appropriate education and support, this method offers a sustainable, patient-centred model that reduces hospital burden and empowers patients in their postoperative care.

UP-13.24—Suprapubic Transvesical Adenoma Resection of the Prostate (Star-P) to Treat Glands≧ 80 mL: Early Surgical Outcomes Compared with Robot-Assisted Simple Prostatectomy (RASP) 

• Bucca Bruno ¹, Brassetti Aldo ², Basile Greta ¹, Gobbi Luca Matteo ¹, Bove Alfredo Maria ², Leonardo Costantino ², Flammia Rocco Simone ², Proietti Flavia ², Licari Leslie Claire ², Bologna Eugenio ², Gozzi Christian ³, Simone Giuseppe ²
  ¹ Sapienza University of Rome, Rome, Italy, ² IRCSS Istituto Nazionale Tumori Regina Elena, Rome, Italy, ³ City Clinic, Bolzano, Italy

• Introduction and Objectives: STAR-P is a minimally invasive procedure for the treatment of benign prostatic obstruction (BPO). Utilizing a trans-vesical resectoscope with a bipolar loop (Gozzi System 42Ch by Tontarra), this approach allows for the resection of adenomas exceeding 80 g via a mini-laparotomic suprapubic access, with the aim of preserving the urethra and the external sphincter.
  Materials and Methods: A dataset was created by combining prospectively collected data on STAR-P and RASP procedures, from the 2 participating institutions. Only patients with a prostate volume (PV) ≥ 80 mL were included. Demographics, perioperative factors, and early outcomes up to 1 month were compared between the two cohorts. Differences between the groups were assessed using chi-square tests for categorical variables and Wilcoxon tests for continuous ones. Surgical quality was evaluated using the Trifecta (postoperative maximum flow rate [Qmax] >15 mL/s, IPSS score < 8, and absence of complications) composite outcome.
  Results: Overall, 26 patients underwent STAR-P, and 35 had RASP. Patients in the former cohort were older (69 years vs. 64 years; p = 0.02) and more symptomatic (preoperative IPSS: 25 vs. 29; p = 0.005), but prostate volume and Qmax at baseline were comparable in the two groups (all p > 0.35) (Table 1). At 1 month follow-up, no significant difference in terms of Trifecta rate was observed between the two cohorts (42% vs. 54%; p = 0.35) (Figure 1), although the rate of patients with Qmax >15 mL/s was significantly higher after robotic surgery (87% vs. 42%; p < 0.001), while the percentage of patients with postoperative IPSS < 8 was significantly higher in the STAR-P group (100% vs. 67%; p = 0.001). No major perioperative complications occurred in either group. No cases of stress urinary incontinence or bladder-neck contracture were reported.
  Conclusions: STAR-P appears to be an effective and safe treatment for patients with large prostates. Though the obstruction relief may not match robotic enucleation, the overall surgical outcomes are similar. Further data with larger patient populations and long-term follow-up are needed to confirm these findings.

UP-13.25—Ureteral Meatus Injuries in Holmium Laser Enucleation: Proposal for Classification and Treatment 

• Garcia Ocampo Fatima ¹, Rubi Lopez Bruno ¹, Bautista Luviano Alexa ¹, Trujillo Santamaria Hegel ²
  ¹ Centro Quirurgico Angelopolis, Puebla, Mexico, Puebla, Mexico, ² Hospital D’Maria, Veracruz, Mexico, Veracruz, Mexico

• Introduction and Objectives: Ureteral meatus injury during holmium laser enucleation of the prostate (HoLEP) is rarely reported in the literature. We propose a classification system and standardized treatment approach.
  Materials and Methods: A retrospective, descriptive, and cross-sectional study was conducted on 516 patients with benign prostatic hyperplasia (BPH) (IPSS > 20, Qmax < 15) who underwent HoLEP between 2021 and 2024 in private hospitals in Mexico. Cases of ureteral meatus injury were analyzed, including demographic characteristics, surgical time, prostate volume, and therapeutic approach.
  Results: Intraoperative ureteral meatus injury occurred in eight patients (1.5%). The mean age was 68 years (range: 59–76), with a mean enucleation time of 47 min (range: 34–75) and an average prostate volume of 105.6 cc (range: 76–153). In all cases, intraoperative cystoscopy did not allow visualization of the ureteral meatus before enucleation. A classification system was proposed based on injury severity and required treatment: Grade I (50%): Managed with intravenous dexamethasone. Grade II (12.5%): Placement of an open-end ureteral catheter. Grade III (25%): Placement of a double-J stent. Grade IV (12.5%): Antegrade cannulation using a vesicoureteral reflux technique without the need for nephrostomy.
  Conclusions: Reports on ureteral meatus injury in HoLEP are limited. A prominent median lobe obstructing visualization of the ureteral meatus represents a key risk factor. The lack of a standardized classification has hindered intraoperative and postoperative decision-making. The proposed classification provides a structured approach to managing ureteral meatus injuries in HoLEP, optimizing postoperative outcomes, and minimizing clinical impact.

UP-13.26—Are Jackson-Pratt Drains Essential in Robotic-Assisted Laparoscopic Pyeloplasty? 

• George Althea, Adhoni Mohammed, Lee Minwook, Nagle Amy, Patki Prasad, Almushatat Ahmad
  The Royal London Hospital/ Barts Health NHS Trust, London, United Kingdom

• Introduction and Objectives: Robotic-Assisted Laparoscopic Pyeloplasty (RALPyelo) is the standard surgical treatment for ureteropelvic junction obstruction due to its high success rate and minimally invasive nature. Commonly, Jackson–Pratt (JP) drains are placed post-operatively to monitor for urinary leaks or fluid collections. However, routine use in uncomplicated cases may be unnecessary, delaying discharge or causing discomfort. The objective is to evaluate outcomes of RALPyelo in a high-output center, with a focus on necessity of JP drain placement, drain output patterns, and postoperative complications.
  Materials and Methods: A retrospective analysis of the RALPyelo database (2018–2024) was performed to identify patients who underwent RALPyelo. Data regarding demographics, JP drain insertion, output, dwell duration, reasons for prolonged dwell duration, and complications such as urinoma formation were collected.
  Results: A total of 116 patients were included, with a median age of 35 years (interquartile range [IQR]: 23). The cohort consisted of 63 females and 53 males. JP drains were routinely placed in 115 patients (99.1%). Among these, 103 patients (89.6%) had their drains removed on postoperative day 1 (POD1). The median total drain output was 10 mL (IQR: 24 mL). Prolonged drain placement beyond POD1 occurred in 12 patients (10.4%), most commonly due to output exceeding 50 mL (n = 5; 4.3%). Other reasons included unspecified factors (n = 4), fever (n = 2), and postoperative pain (n = 1). Only one patient (0.86%) developed a urinary leak with subsequent urinoma formation.
  Conclusions: The retrospective analysis of RALPyelo in our high output centre demonstrates a low rate of postoperative drain output beyond 50 mL and an extremely low rate of urinoma formation at 0.86%. This suggests that drainless RALPyelo can be considered in selected patients, potentially facilitating same-day discharges. However, these findings should be validated by prospective studies.

13.5. Unmoderated Video ePosters

UVP-13.01—Robotic Prostate Sparing Radical Cystectomy and Total Intracorporeal Neobladder Diversion 

• Sürmeli Bahattin ¹, Sabuncu Kubilay ², Horuz Rahim ²
  ¹ Medipol University, İstanbul, Türkiye, ² İstanbul Medipol University, İstanbul, Türkiye

• Introduction and Objectives: Robotic radical cystectomy with total intracorporeal neobladder reconstruction has emerged as a feasible and effective minimally invasive alternative to open surgery for selected bladder cancer patients. This approach offers reduced blood loss, shorter hospital stays, and improved cosmetic outcomes. Prostate-sparing cystectomy, although still considered controversial, may preserve sexual and urinary function in appropriately selected patients without compromising oncologic safety. In this case, we present our first clinical experience and surgical technique in a patient who underwent prostate-sparing robotic radical cystectomy and total intracorporeal neobladder reconstruction.
  Materials and Methods: A 49-year-old male patient was diagnosed with a clinical T3 bladder tumor based on preoperative imaging and pathology findings. He had received neoadjuvant chemotherapy prior to surgery. As there was no evidence of prostatic involvement and no family history of prostate cancer, and due to the patient’s strong desire to preserve erectile and ejaculatory function, a prostate-sparing robotic radical cystectomy was planned and performed. The total operative time was approximately 9 h and 15 min, with a console time of 6 h and 35 min. The procedure was completed without intraoperative complications, and estimated blood loss was 180 cc. Bowel function returned on postoperative day 2, as indicated by the passage of gas. Final pathology revealed a downstaged tumor, reported as high-grade (HG) T1 transitional cell carcinoma (TCC), with negative surgical margins. At the 3-month postoperative follow-up, the patient demonstrated full urinary continence, both during the day and night. He also reported adequate erectile function sufficient for sexual intercourse, although ejaculation was absent.
  Results: This case demonstrates favorable early functional outcomes following prostate-sparing robotic radical cystectomy with intracorporeal neobladder. The patient regained complete urinary continence and reported preserved erectile function. No perioperative complications occurred, and oncologic outcomes were satisfactory with organ-confined disease and negative margins. Early functional preservation suggests that selected patients may benefit from this approach.
  Conclusions: Prostate-sparing robotic radical cystectomy with intracorporeal neobladder reconstruction is a technically demanding but feasible procedure in carefully selected patients. This approach may offer the advantage of functional preservation without compromising early oncological outcomes. Further studies with longer follow-up are needed to validate its long-term safety and efficacy.

UVP-13.02—360 Degree Reconstruction of Bladder Neck in Robotic Simple Prostatectomy 

• Desai Viraj, Singh Abhishek, Desai Rasesh, Ganpule Arvind, Sabnis Ravindra
  Muljhibhai Patel Urological Hospital, Nadiad, India

• Introduction and Objectives: ENUCLEATION is the “gold standard” surgical intervention for large prostate glands > 100 g. Per-urethrally: Holmium laser enucleation of Prostate (HOLEP), thulium laser enucleation of prostate (THULEP), bipolar enucleation of prostate (BipolEP). Open: Millins Prostatectomy or Freyers prostatectomy. Minimally invasive: Laparoscopic Assisted Simple Prostatectomy (LASP) Robotic Assisted Simple Prostatectomy (RASP). Open techniques: Complications: prolonged catheterization time (7–14 days), increased blood loss (500–1000 mL) with transfusion rate of 25%, prolonged hospital stay due to wound infection, urinary incontinence HOLEP, THULEP & BipolEP: need for morcellation of enucleated prostate, bladder injury risk during morcellation, risk of urethral strictures in gland > 150 g due to prolonged time. Urinary incontinence LASP & RASP were developed to address the shortcomings of these techniques.
  Materials and Methods: Between the years 2022–2024, this technique was done in 8 patients over 3 years for prostates sizes of 110–200 g, with close follow-up. All cases were performed with the DaVinci Xi Robotic Platform. Bipolar energy settings kept at ‘6’.
  Results: 1. Decreases postoperative bleeding, especially secondary and tertiary. 2. Obviates blood transfusion & continuous bladder irrigation postop. 3. Facilitates early PUC removal. 4. 360 degree bladder neck reconstruction leaves no raw area, and this minimizes postoperative dysuria and irritative urinary symptoms. 5. Good retrigonization prevents bladder neck stenosis. 6. Minimizes postvoid urine dribbling by preventing prostate capsule outpouching.
  Conclusions: Therefore, this technique is a safe and viable option for complete continence, decreased catheter time, and faster recovery from a morbid procedure

UVP-13.03—Challenging Anatomy in RARP: A Case of Bilateral Ureteric Injury Linked to a Prominent Median Lobe 

• Singh Abhishek, Paharwar Vivek, Parikh Deval, Ganpule Arvind, Sabnis Ravindra, Desai Mahesh
  Muljibhai Patel Urological Hospital, Nadiad, India

• Introduction and Objectives: A technically challenging situation when dealing with prostate cancer is having large median lobes. Patients with large median lobes often have larger prostates, which makes it difficult to visualize anatomical planes during robot-assisted radical prostatectomy (RARP). Ureteric injuries are rare, most commonly secondary to iatrogenic injury with a reported rate of up to 0.3% following radical prostatectomy (RARP). The management of a ureteral orifice injury occurring during robotic radical prostatectomy (RARP) represents a challenge for urologists. Both the above situation requires expert hands to deal properly and uneventfully.
  Materials and Methods: Here we demonstrate a 65 year male with localized Ca prostate with a large protruding median lobe. During posterior dissection, bilateral ureteric orifices weren’t identified and got incorporated in the incision. Here, we demonstrate how a median lobe leads to a dangerous complication and ways to overcome this situation by prompt identification of the complication and dealing with it with bilateral DJS stent, relocation of ureteric opening and ureteric orifice-plasty (new ureteric opening made).
  Results: Patient was well post op. Catheter removed after 10 days, DJS removed after 4 weeks. There was no hydrouretero-nephrosis on serial follow up, with serum creatinine of <1 mg/dL.
  Conclusions: Ureteric injuries are rare (0.3%) after RARP. Preoperative planning with good imaging and Cystoscopy is mandatory. Intraoperative identification of ureteric injury, prompt detection and dealing with B/L DJ stenting, ureteric orifice-plasty is the key for successful management.

UVP-13.04—Impact of Anterior Suspension of Rocco Suture to Improve Early Continence After Robotic Radical Prostatectomy: A Retrospective Cohort Study 

• Addla Sanjai, Singh Ravinder, Tiwari Abhishek
  Apollo Cancer Center, Hyderabad, India

• Introduction and Objectives: Urinary incontinence following robotic-assisted radical prostatectomy (RARP) continues to be a distressing postoperative complication, often impairing quality of life. Various technical modifications have been proposed to accelerate continence recovery. One such technique—the anterior suspension stitch—aims to stabilize the bladder neck and support the vesicourethral anastomosis. This study evaluates its impact on the timeline to continence recovery in patients undergoing RARP.
  Materials and Methods: We conducted a retrospective review of patients with carcinoma prostate who underwent RARP at our institution. Two age-matched cohorts were formed based on surgical technique: Group 1 (n = 40): RARP with anterior suspension stitch, Group 2 (n = 40): RARP without anterior suspension stitch. Baseline characteristics, including age, BMI, prostate volume, nerve-sparing status, and perioperative variables, were recorded. The primary outcome was time to continence recovery, defined as using no pads or one safety pad per day. Kaplan-Meier time to event analysis and log-rank testing were used to compare continence recovery between groups. A multivariate Cox regression model was applied to adjust for potential confounders.
  Results: Both groups were comparable in terms of pelvic floor muscle training, catheter duration, postoperative complications, and operative time. The median time to continence recovery was significantly shorter in the suspension group versus the non-suspension group. Kaplan-Meier analysis demonstrated a faster return to continence in the suspension group (log-rank p < 0.001). After adjusting for age, BMI, prostate volume, and nerve-sparing status, multivariate Cox regression showed the anterior suspension stitch to be an independent predictor of earlier continence recovery (Hazard Ratio: 2.5; 95% CI: 1.8–3.5; p < 0.001).
  Conclusions: Our findings suggest that the anterior suspension of Rocco suture offers a meaningful advantage in expediting urinary continence after RARP. Given its simplicity and potential benefit, this technique deserves consideration in routine surgical practice. Prospective validation in larger, multi-institutional cohorts is warranted.

UVP-13.05—Robotic Multiorgan Resection in Synchronous Bladder and Ileal Tumors 

• Patel Aquib Javed, Choudhary Gautam, Navriya Shiv, Singh Mahendra, Bhirud Deepak, Sandhu Arjun, Rathor Jitendra, Soni Jaideep
  All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

• Introduction and Objectives: Muscle-invasive bladder cancer (MIBC) in females frequently requires anterior pelvic exenteration (APE) for definitive management. The coexistence of a gastrointestinal malignancy such as an ileal neuroendocrine tumor (NET) further complicates the surgical approach, traditionally necessitating separate procedures. However, advances in robotic surgery have enabled safe, minimally invasive multiorgan resections. This case highlights a single-stage robotic APE combined with right hemicolectomy for simultaneous management of MIBC and a synchronous ileal NET, emphasizing feasibility, technical considerations, and outcomes.
  Materials and Methods: A 42-year-old female with no comorbidities and a history of tubal ligation presented with a 3-year history of lower urinary tract symptoms (LUTS) and hematuria. Imaging and biopsy confirmed a muscle-invasive bladder tumor (pT2 high-grade) involving the right posterolateral wall with right external iliac lymph node metastases, along with a distal ileal NET (Grade 1, 19 × 14 mm, 5.7 cm from the ileocecal junction) and a left adnexal mass. After TURBT and six cycles of dose-dense MVAC chemotherapy, PET imaging showed residual disease. The patient underwent a single-stage robotic procedure using the Da Vinci Xi platform: APE including cystectomy, hysterectomy, bilateral salpingo-oophorectomy, anterior vaginal wall resection, and super-extended bilateral pelvic lymph node dissection with intracorporeal ileal conduit urinary diversion. A concurrent robotic right limited hemicolectomy with ileocolic anastomosis was performed for the ileal NET.
  Results: The total operative time was 7 h with an estimated blood loss of 300 mL. No intraoperative complications occurred. The patient tolerated the procedure well, resumed oral intake by postoperative day 4, and was discharged on day 6. Final histopathology showed a pathological complete response in the bladder tumor (ypT0N0) and a Grade 2, moderately differentiated ileal NET (pT3N1M0).
  Conclusions: Robotic multiorgan resection provides a safe and effective minimally invasive option for managing synchronous pelvic and gastrointestinal malignancies. A single-stage approach using robotic APE and right hemicolectomy minimized surgical burden, optimized recovery, and demonstrated favourable oncologic outcomes. This case underscores the potential role of robotic platforms in complex oncologic surgeries and supports further research into long-term outcomes and broader application.

UVP-13.06—Sequential Bilateral Robot-Assisted Enucleation of Renal Tumours in a Patient with Von Hippel-Lindau Disease 

• Banerjee Avijit, Gautam Gagan
  Medanta, Gurugram, Gurugram, India

• Introduction and Objectives: Renal cell carcinoma is a leading cause of death in individuals with Von Hippel–Lindau (VHL) syndrome, typically presenting with multiple bilateral lesions that often require several renal surgeries. To reduce the risk of renal dysfunction, preserving adequate functional parenchyma is a priority, which is achieved through nephron-sparing surgery.
  Materials and Methods: In this video, we demonstrate staged robotic enucleation of renal tumours in a 27-year-old man. His DTPA scan showed good bilateral renal function. The procedure was performed using the Da Vinci Xi robotic system. To save warm ischaemia time and prevent ischaemic damage to the kidney, several cysts were enucleated “off the clamp”, and hemostasis was achieved using various methodologies including cautery, compression, and suturing. Solid and cystic masses were removed, and, during the removal of one such cystic mass, there was bleeding, which required clamping of the renal artery to proceed with the larger tumours. We planned on the right robotic enucleation of renal tumours 2 months after the first surgery. DTPA scan showed more than 40% preservation of renal function in the left kidney. The patient was positioned in the left lateral kidney position. Da Vinci Xi was docked, and conventional ports were made. We aimed to preserve as much renal function as possible and proceed with enucleation of tumours “off-clamp”. The largest mass was tackled at last, and all the enucleation and excision of tumours were done “off-clamp”, ensuring we preserved the maximal renal function. Following Internal renorhaphy, we applied a Veriset hemostatic patch.
  Results: For the left partial nephrectomy, the warm ischemia time was 42 min with approximately 1200 mL blood loss. On postoperative day 4, he was discharged in stable condition. The histopathology report suggested clear cell carcinoma, WHO/ISUP G2. For the right partial nephrectomy, there was approximately 200 mL of blood loss, and the patient went home on postop day 4. The histopathology report suggested clear cell carcinoma, WHO/ISUP G1.
  Conclusions: In patients with VHL and multiple bilateral renal masses, an advanced technique such as the “off-clamp” surgery method is safe and can enhance functional outcomes, making it a viable option when technically and anatomically appropriate.

UVP-13.07—Shanghai to Kuwait Telesurgery: Robotic Assisted Radical Prostatectomy 

• Bahbahani Basmah, Aldousari Saad, Almarzouq Ahmad, Hassan Abdulkareem, Shahin Ahmad, Bubishate Saleh
  Sabah Alahmad Urology Center, Kuwait, Kuwait

• Introduction and Objectives: To show the feasibility of performing human telesurgery robotic-assisted radical prostatectomy (RARP) between two countries using low-latency ultra-long-distance connectivity.
  Materials and Methods: This study described the outcomes of performing RARP on a man in his 60s with localized intermediate-risk prostatic adenocarcinoma located in Kuwait City, while the surgeon (SA) was approximately 7000 kilometers (Km) away at Toumai robotic surgical system (TRSS) headquarters in Shanghai. Operative and connectivity details were reported.
  Results: RARP was performed in December 2024. There were no major clinical or technical problems encountered during the procedure. The average round-trip latency (RTL) was 181.4 milliseconds (ms) using fiber optic broadband network with 5G network as back-up. On the Shanghai end two wired broadband networks were employed as back-up to ensure patient safety. There was an experienced fellowship-trained robotic surgeon (AA) in the operating room in Kuwait capable of taking over in case of clinical or connectivity issues. There were no reported complications. The patient was discharged on postoperative day (POD) 2. Final pathology described Gleason score 7 (3 + 4), ISUP 2, and negative surgical margins (pT2Nx). The catheter was removed on POD 9, and the patient was continent a week later. His serum prostate specific antigen (PSA) was undetectable seven weeks post-operatively.
  Conclusions: This study described the feasibility of human RARP telesurgery between two countries using low-latency, long-distance fiber optic broadband network with 5G network as back-up with successful clinical outcomes. There is a need to establish robust legal and regulatory framework to allow wider international expansion of telesurgery.

UVP-13.08—Single-Port Laparoscopic Radical Prostatectomy: True Minimally Invasive Surgery with Simplified Technique 

• Trujillo-Santamaría Hegel, Martínez Liahut Diego Rafael, Rojas Ramirez Diana Carolina, Herndez Cruz Michael Efrain, Mendo Blanca
  Hospital D’Maria, Veracruz, Mexico

• Introduction and Objectives: Single-port laparoscopic radical prostatectomy (spLRP) represents a genuine advancement in minimally invasive surgery. We present a 7-min video demonstrating a simplified and reproducible single-port technique using conventional laparoscopic instruments, highlighting its feasibility, safety, and functional outcomes in low- and favorable intermediate-risk prostate cancer patients.
  Materials and Methods: The procedure is performed via a transperitoneal approach through a transverse infraumbilical incision, using a single port with two 10 mm and two 5 mm channels. A 5 mm 30° lens is employed. Curved single-port instruments improve intracorporeal maneuverability. No Hem-o-lok clips, staplers, or synthetic sutures are used during most of the dissection. Hybrid energy (bipolar and harmonic) is applied for tissue control, with cold-cut dissection at the bladder neck and urethra to preserve oncological and functional integrity. A suprapubic stitch passed through a needle is used to retract the Foley catheter and expose seminal vesicles. Vesicourethral anastomosis is performed only when needed, typically when the bladder neck is wide, using V-Loc™ 2-0 (15 cm). The technique was applied to patients with low- and favorable intermediate-risk prostate cancer. Higher-risk patients underwent a standard 3-port approach.
  Results: All patients were managed under ERAS protocols. Hospital discharge at 24 h was achieved in all cases. No intraoperative or postoperative complications were reported. Catheter removal was done on postoperative day 10 without incident. Transient incontinence lasted 4–6 weeks, with 90–95% continence recovery following pelvic floor rehabilitation. Oncological control was satisfactory in all cases, with final pathology consistent with preoperative risk assessment.
  Conclusions: This video demonstrates a cost-effective, low-technology, and highly reproducible single-port laparoscopic technique for radical prostatectomy. It preserves functional outcomes without compromising oncologic control. The approach is ideal for centers aiming to democratize minimally invasive prostate cancer surgery, requiring no robotic systems or advanced stapling technologies.

UVP-13.09—Star-P—Suprapubic Transvesical Adenoma Resection of the Prostate—Step-by-Step Technique 

• Bucca Bruno ¹, Gobbi Luca Matteo ¹, Basile Greta ¹, Dalpiaz Orietta ², Gozzi Christian ³
  ¹ Sapienza University of Rome, Rome, Italy, ² Hochsteiermark Hospital, Leoben, Austria, ³ City Clinic, Bolzano, Italy

• Introduction and Objectives: STAR-P technique is a surgical method developed by Prof. Christian Gozzi and recently published. Over the years, the technique has been refined, and its steps have been codified. We present a step-by-step description of the technique.
  Materials and Methods: The patient is positioned supine. A Dufour silicone catheter 16 or 18 Fr is placed. The bladder is filled with saline solution, positioning the bags approximately 60 cm above the neutral level. A transverse skin incision of 2–4 cm is made at the suprapubic level, and dissection proceeds through layers until reaching the fascia, which is incised longitudinally. The bladder is accessed using two suture points, and an opening is created with an electrocautery. Once access to the bladder lumen is achieved, a 15 mm trocar is introduced, through which a dedicated 42 Fr bipolar resectoscope is inserted. The ureteral orifices are marked with distal coagulation. A circular delineation is performed using coagulation to outline the prostate. Under direct visualization, the balloon of the catheter is deflated, and its tip is retracted to the verumontanum. In the initial phase, a medium or large loop is utilized. If present, resection begins from the third lobe. Subsequently, resection is performed from 12 o’clock position down to the base, completing the resection of each lateral lobe. A small or medium loop is then used to refine the anterior wall and the apex. At the end of the procedure, chips are evacuated using an Ellik evacuator or individually with the resectoscope. Careful hemostasis of the prostatic fossa is conducted. A Dufour catheter 16 Fr or 18 Fr is cuffed under direct visualization in the bladder lumen. Closure of the layers is performed in multiple layers.
  Results: No intraoperative complications were observed. Two patients (4.5%) experienced urinary urgency symptoms after catheter removal that resolved within 90 days. Median operative time was 105 min for overall procedure and 65 min for resection. All patients showed an improvement in voiding quality.
  Conclusions: STAR-P is a safe, feasible and cost-effective procedure that spares bulbomembranous and penile urethra and external urethral sphincter and should be discussed with patients as a possible treatment for BPO.

14. Miscellaneous

14.1. Moderated Oral ePosters

MP-14.01—“One Single Visit”: An Integrated and Sustainable Urological Care Model to Reduce the Carbon Footprint and Optimize the Evaluation and Management of Common Prostatic Conditions 

• Trujillo-Santamaría Hegel ¹, Martínez Liahut Diego Rafael ², Mendo Blanca ²
  ¹ Hospital D’Maria | Urología Santamaría, Veracruz, Mexico, ² Hospital D’Maria, Veracruz, Mexico

• Introduction and Objectives: Fragmented urological care contributes to increased healthcare costs, treatment abandonment, and a larger environmental footprint due to repeated visits and travel. This study evaluates the implementation of a “One Single Visit” model—an integrated and sustainable urological care protocol designed to diagnose and manage common prostatic conditions (benign and malignant) in a single day, improving efficiency, reducing costs, and minimizing the carbon footprint.
  Materials and Methods: A prospective cohort of 750 first-time male patients aged 45–84 years (mean age 66.3) was evaluated over twelve months. All presented with lower urinary tract symptoms or elevated prostate-specific antigen (PSA) levels. Each patient underwent a standardized same-day protocol: initial clinical interview (15 min), blood and urine tests (3-h turnaround), hydration and dynamic evaluation including uroflowmetry and prostate ultrasound (pre- and post-void; 45 min), second consultation (15 min) to discuss results and define treatment. Patients with suspected benign prostatic hyperplasia received medical therapy or were scheduled for minimally invasive surgery. Those with suspicious PSA levels were risk-stratified and prepared for prostate biopsy.
  Results: Of the 750 patients, 563 (75.1%) were diagnosed with benign prostatic hyperplasia, and 187 (24.9%) were clinically suspected of having prostate cancer. Of the benign cases, 427 (75.8%) received pharmacological treatment, and 136 (24.2%) were scheduled for minimally invasive surgery (e.g., Rezum, GreenLight, or enucleation). Among the 187 patients with suspicion of malignancy, all were protocolized for biopsy with appropriate preparation. Cost analysis showed an average patient savings of $120–$280 USD. Scaled to the cohort, this represents a total potential savings of $90,000 to $210,000 USD in travel, lost work time, and fees. The carbon footprint was reduced by an estimated 3.1 kg to 93.2 kg of CO₂ per patient, depending on travel distance (5 km to 150 km), with a cumulative reduction of approximately 64,000 kg of CO₂ over twelve months. Patient satisfaction remained high, with 93.7% rating the experience as “very good” or “excellent,” citing time efficiency and clarity of diagnosis.
  Conclusions: The “One Single Visit” model proves to be an effective, scalable, patient-centered, and environmentally responsible approach to urological care—streamlining diagnostics while significantly reducing economic and ecological burdens.

MP-14.02—Investigating Non Visible Haematuria (NVH), Is Positive Urine Dipstick Enough or Is the Microscopy Necessary? 

• Gaur Ashwini, Naushad Naufal, Mahmood Tanveer
  University Hospitals of North Tees and Hartlepool NHS Foundation Trust, Stockton On Tees, United Kingdom

• Introduction and Objectives: NVH is a common presentation in urological practice. Unlike USA, in the UK, the referral to NHS Hospital from primary care is based on the positive urine dipstick results. In our hospital trust significant microscopic haematuria is considered as >45 RBC/μL. However some studies suggest time to analysis can affect the integrity of the RBC. Because immediate microscopy is not feasible in primary care, the accuracy of quantitative RBC microscopy is questionable. Aim of this study was to see if 2 positive urine dipsticks sufficient to investigate NVH or should it be based only on microscopy results.
  Materials and Methods: Prospectively kept data of all patients who underwent flexible cystoscopy for NVH was reviewed retrospectively. Those with significant pathology of cancer or stones were identified. All patients had ≥1+ blood on 2 dipsticks in the absence of UTI. Of these 3, groups were created based on urine microscopy results. Group A with >45 RBC/μL, Group B with 10–45 RBC/μL, and Group C with 0–9 RBC/μL.
  Results: 5846 flexible cystoscopy were performed from Jan 2017 till December 2022. 590/5846 (10.09%) were done for NVH. Of these males were 300 and females were 290. Mean age was 66.91 ± 14.63, range (18–97). 60/590 (10.16%) patients were found to have different pathology with NVH; of these, 2 did not have microscopy therefore excluded. 28/590 (4.7%) had cancer; of these, 25 (4.2%) were bladder cancer, 2 RCC, 1 prostate cancer and 30/590 (5.08%) had stones. Of those who had bladder cancer, 19/25 (76%) were high grade, and 6/25 (24%) were low grade. In Group A, overall, 40/58 (68.96%) patients were included, 19/40 (47.5%) were cancer; of these, 14 were high grade bladder cancer, 1 had RCC, and 21/40(52.5%) were stones. In Group B, 11/58 (18.9%) patients were included, 8 had cancer, and 3 had stones. In Group C, 7/58 (12.06%) were included, and all were found to have stones and no cancer.
  Conclusions: 2 positive urine dipstick tests are enough to investigate NVH. Cancer/stones can be missed if investigated based only on significant microscopic haematuria.

MP-14.03—Neural Regulation of the Lower Urinary Tract: A Functional MRI Study on the Dynamics of Spinal Cord Activity 

• Santoso Anugrah ¹, Salazar Betsy ², Hoffman Kristopher ², Stampas Argyrios ³, Khavari Rose ², Mazeaud Charles ⁴
  ¹ Dr. Soetomo General Academic Hospital/ Universitas Airlangga, Surabaya, Indonesia, ² Houston Methodist Hospital, Houston, United States, ³ The University of Texas Health Sciences Center at Houston, Houston, United States, ⁴ Nancy University Hospital, Nancy, France

• Introduction and Objectives: Regulation of lower urinary tract (LUT) functions involves intricate neural interactions between the brain and spinal cord. While functional MRI (fMRI) studies have advanced our understanding of brain-bladder network, spinal cord regulation of LUT function remains neglected. This study aimed to develop and validate an fMRI protocol to assess spinal cord activity in humans.
  Materials and Methods: We included twenty healthy subjects (9 males, 11 females, mean age: 31 ± 7.6 years). Before imaging, participants consumed water for natural bladder filling, followed by immediate voiding and PVR measurement to ensure complete emptying. Imaging was acquired on a 3T scanner. Anatomical imaging was obtained using either a T1-FLAIR sequence (subjects 1–10) or T2-weighted sequence (subjects 11–20). Functional imaging included resting-state and task-based fMRI in empty and full bladder states, followed by a scan during an attempt to void. Task-based fMRIs involved suprapubic tapping with an MRI-compatible device designed to elicit a simulated bulbocavernosus reflex (sBCR). Stimulation followed a block design with four cycles of 40 s of tapping (1 tap/s) alternating with 40 s of rest. Data were pre-processed and analysed using FSL and Spinal Cord Toolbox. Functional data were modelled on a block design (tap > rest), with second-level fixed-effect analysis for empty and full bladder states. Threshold for statistical images was set at Z > 5, with a corrected cluster significance of p = 0.005.
  Results: Due to preprocessing limitations, only data from subjects with anatomical T2-weighted imaging could be analysed, necessitating a mid-study protocol adjustment. Additionally, five of these ten participants were excluded due to artifacts and signal dropouts intersecting the spinal cord. These challenges highlight the steep learning curve encountered in spinal fMRI assessments. Significant activation was observed in spinal cord regions during sBCR stimulation in both empty and full bladder states, specifically around the ventral horn (approximating Onuf’s nucleus) to intermediolateral region (approximating sacral parasympathetic nucleus) (Figure 1). While activation appeared stronger in the full bladder state, the difference was not statistically significant.
  Conclusions: Here we developed and implemented an fMRI protocol to assess spinal cord activity associated with LUT function. Despite the challenges, our protocol demonstrates feasibility and lays the groundwork for future studies aimed at refining neuromodulation strategies.

MP-14.04—Surgical Ergonomics for Urologists: A Review of Challenges and Evidence-Based Practices 

• Mustafa Mohamed ¹, Verma Saurabh ², Elajnaf Mohamed ³
  ¹ United Lincolnshire Teaching Hospitals NHS Trust, Lincoln, United Kingdom, ² Jame Paget University Hospital, Great Yarmouth, United Kingdom, ³ Ipswich Hospital NHS Trust, Ipswich, United Kingdom

• Introduction and Objectives: Musculoskeletal disorders (MSDs) are a significant occupational hazard in urology, affecting up to 90% of surgeons during their careers. Prolonged static postures, repetitive motions, and suboptimal ergonomic environments during open, laparoscopic, robotic-assisted, and endoscopic procedures contribute to chronic pain, burnout, and early retirement. This review explores ergonomic challenges and strategies to enhance surgeon well-being and performance.
  Materials and Methods: A scoping review of literature was conducted, focusing on ergonomic risks and interventions across urological surgical modalities. Studies examining operating room design, instrument ergonomics, robotic systems, posture training, and physical conditioning programs were analyzed. Data on MSD prevalence, contributing factors, and outcomes of ergonomic modifications were synthesized.
  Results: Open surgery frequently causes neck, back, and shoulder strain due to deep operative fields. Laparoscopic and endoscopic procedures exacerbate upper extremity strain from the fulcrum effect and repetitive movements, while robotic surgery, though advantageous, poses risks of neck and trunk discomfort due to prolonged sitting. Effective interventions include adjustable operating tables, ergonomic instrument designs, robotic systems with improved adjustability, posture training, and intraoperative microbreaks. Ergonomic training remains underutilized, with less than 20% of urologists receiving formal education.
  Conclusions: Ergonomic interventions tailored to urology reduce MSDs, improve surgical performance, and extend career longevity. Ergonomic education in training programs and implementing well-being guidelines across institutions are critical. Integrating ergonomics into surgical practice will protect surgeon well-being, enhance patient outcomes, and support long-term workforce sustainability. Further research is needed to drive innovation in ergonomic solutions for urological surgery.

MP-14.05—The Role of Artificial Intelligence in Urological Cancer Diagnosis and Management: An Overview of Systematic Reviews 

• Sakalis Vasileios ¹, Chatzigriva Eftichia ², Pang Karl ³, Rai Bhavan ⁴, Moris Lisa ⁵, Chalkidou Maria ², Yuan Yuhong ⁶, Bussman Michael ⁷, Koukourikis Periklis ⁸, Papanikolaou Dimitrios ⁸, N’Dow James⁹, Omar Muhammad Imran ¹⁰
  ¹ Hippokrateion General Hospital of Thessaloniki, Urology, Thessaloniki, Greece, ² Hippokrateion Hospital of Thessaloniki, Urology, Thessaloniki, Greece, ³ University College London Hospitals NHS Foundation Trust, Urology, London, United Kingdom, ⁴ Freeman Hospital the Newcastle upon Tyne Hospitals NHS Foundation Trust, Urology, Newcastle Upon Tyne, United Kingdom, ⁵ University Hospitals Leuven, Urology, Leuven, Belgium, ⁶ Medicine Health Sciences Center, Hamilton, Ontario, Canada, ⁷ Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiation Physics, Dresden, Germany, ⁸ Hippokrateion Hospital of Thessaloniki, Urology, Thessaloniki, Greece, ⁹ University of Aberdeen, Aberdeen, United Kingdom, ¹⁰ University of Aberdeen, Aberdeen, United Kingdom

• Introduction and Objectives: Artificial Intelligence (AI) has enormous potential for improving patient care. AI technologies, namely machine learning (ML) and deep learning (DL), analyze images and big data to improve diagnostic accuracy and therapeutic effectiveness. We aim to review the current evidence of AI in urological malignancies.
  Materials and Methods: A systematic search was performed in major databases from 1974 to October 2024 for systematic reviews (SRs) on AI models in urological cancers. We followed the Cochrane methodology of Overviews of Reviews. The outcomes are presented as ranges of AUC-ROC, accuracy, sensitivity, and specificity.
  Results: Sixty-seven SRs of 1166 primary studies were included. The RoB were considered low in 21, high in 41 and unclear in 5 SRs. Forty-four SRs investigated AI in prostate cancer (PCa). AI-models recognized benign from malignant cases (AUC: 0.55–0.99, Accuracy: 88–93%, sensitivity: 59–95%, specificity: 58–87%), improved accuracy compared to human-reading alone in clinically-significant PCa (AUC: 0.933 vs. AUC: 0.82–0.87), characterize Gleason score (AUC: 0.72–0.99, Accuracy: 70.8–93.0%) and predict survival outcomes (AUC: 0.7–0.9, Accuracy: 60.0–84.0%). Seventeen SRs assessed AI in Renal carcinoma (RCa). AI-models characterized RCa lesions from radiology images (AUC: 0.52–0.97, Accuracy: 70.0–94.7%) and predicted RCa grade (AUC: 0.78–0.84, Accuracy: 73.0–88.0%). AI-enhanced reading improved accuracy (77–94% vs.69–80%) and reduced inter-rater variability. Sixteen SRs evaluated AI in Bladder Cancer (BCa) for recurrence (AUC: 0.69–0.92), progression (AUC: 0.80–0.97), and survival (Accuracy: 85.6–96.9%) prediction. Limitations of this overview are the differences in validation techniques and oversampling due to the overlap of primary studies or the use of synthetic data.
  Conclusions: Integrating AI models in urological oncology represents a significant advancement with important implications for patient care. The impact of AI in this field is multi-faceted, ranging from early detection and precise diagnostics to personalized treatment strategies. AI models can analyze extensive datasets and uncover subtle patterns within complex medical information. AI-driven personalized treatment plans could transform therapeutic approaches by integrating patient-specific data, including genomics, clinicopathological and imaging data, to optimize treatment and minimize adverse effects. AI literacy should be integrated into medical training to prepare future healthcare professionals to work with AI, understand its potential, and appreciate its limitations.

14.2. Residents Forum Moderated Oral ePosters

RF-14.01—Ethical Evaluation of Artificial Intelligence Applications in Prostate Cancer Care 

• Shah Aishwarya
  University College London (UCL) Medical School, London, United Kingdom

• Introduction and Objectives: The use of artificial intelligence (AI) in the prostate cancer (PCa) care pathway is a rapidly evolving field which has demonstrated significant potential to advance diagnostic accuracy, treatment planning, and outcomes. However, this integration raises important ethical considerations which are critical to understand for optimal deployment. This study aimed to evaluate the various ethical topics that exist within this realm.
  Materials and Methods: A narrative literature review was conducted following the guidelines proposed by Green et al., with motivation for this methodology being enhancement of qualitative interpretive approaches and a more nuanced exploration of complex topics. Searches were performed in March 2025 on three databases: Medline, Embase and Scopus, using relevant synonyms of ‘Artificial Intelligence’, ‘Ethics’ and ‘Prostate Cancer’. Eligible studies constituted PCa-related articles that focused on AI and had adequate ethical discussion.
  Results: The literature revealed four key ethical themes: accountability, transparency, patient-centred care, and bias. The most commonly discussed ethical concern for AI was bias, and non-maleficence (avoiding harm) was the most frequently cited ethical principle. The phenomenon of data drift, whereby changes in data distributions cause AI models to become outdated, was one such apprehension raised, thus highlighting the necessity for diverse, representative training datasets. Additionally, another discussion point raised was black box issues, whereby the processes within the AI remain unknown, causing difficulty in deciphering how the outcome of the AI was derived. This exacerbated concerns around trust. Utilitarian perspectives and statements based on the ethical principle of beneficence provided more positive acceptance of AI use in the PCa pathway.
  Conclusions: The ethical implications surrounding the integration of AI in PCa care are constantly evolving and complex. However, few attempts have been made to gauge this with key stakeholders, including patients. Consequently, the incorporation of such technology demands continuous ethical discussion to facilitate synergy between technological advancement and patient safety and dignity.

RF-14.02—Ketamine Uropathy: Presentation and Specialty Referrals 

• Stimler Batya ¹, Chibuzo Ijeoma ¹, McKnight Rebecca ², Myton Tracey ², Lee Ling ¹
  ¹ Royal Bolton Hospital, Greater Manchester, United Kingdom, ² Greater Manchester Mental Health NHS Foundation Trust, Greater Manchester, United Kingdom

• Introduction and Objectives: The prevalence of Ketamine use disorder (KUD) with its associated uropathy is rising. Early identification of KUD is key in providing effective, holistic treatment and mitigating sequelae.
  Materials and Methods: We undertook a retrospective analysis on the characteristics of adult patients referred to our Urology Department in 2024 with known Ketamine use. Electronic hospital records and routes of referral were reviewed.
  Results: Nine patients were referred to Urology in 2024 with Ketamine use. Eight were male and one female with a median age of 24 years. Routes of referral included Accident and Emergency (A&E) [56%], General Practice [22%] and the Addiction Care Teams [22%]. Patients most commonly presented with cystitis-type symptoms and haematuria. Average Ketamine usage was >4g daily for a median duration of 12 months. Three patients had Stage 3 Ketamine Uropathy (KU)—bilateral hydronephrosis/reflux. One had deranged renal function, whilst seven (78%) had abnormal liver function tests (LFTs). In 62.5% of patients, KU was diagnosed following multiple A&E attendances (median = 2) with lower urinary tract symptoms (LUTS). Referral to Urology was initiated after an average of 5 months. Delays to referral were due to misdiagnosis (44%) and indirect referral (22%). The analysis showed a low rate of referral from A&E to ACT (28%). Two patients remain abstinent (2 and 4 months) from Ketamine.
  Conclusions: Ketamine uropathy should be strongly considered in young patients presenting with LUTS. Abnormal LFTs are a useful adjunct in identifying Ketamine usage. This retrospective analysis has shown delays in referring to both Urology and addiction services and therefore the need to improve early identification of KUD and form clearer referral pathways.

14.3. Unmoderated Standard ePosters

UP-14.01—Advancing the Diagnosis and Management of Pudendal Nerve Entrapment: The Role of Neurophysiological Studies and Imaging-Guided Infiltrations 

• Fernandes Cláudia ¹, Saavedra Manuel ², Viegas Vanessa ³, Casado Javier ², Ramírez Ana ², Velasco Clara ², Artiles Alberto ⁴, Cidre Miguel ⁴, Luque Cecilia ², Cabañes Lidia ⁴, Vale Luís ¹, Silva Carlos ¹, José Luis ², Lavalle Luis ²
  ¹ São João Local Health Unit, Porto, Portugal, ² La Princesa University Hospital, Madrid, Spain, ³ Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain, ⁴ Hospital Universitario Ramon y Cajal, Madrid, Spain

• Introduction and Objectives: Pudendal nerve entrapment (PNE) diagnosis is not standardized. This leads to a significant delay in diagnosis, impacting quality of life and potentially compromising therapeutic outcomes. The main objective is to find the role of neurophysiological study (NFS) and imaging-guided pudendal nerve infiltration (ImPNI) in PNE diagnosis and patient selection for surgery. The second outcome is evaluating the predictive power of NFS and CT-guided PNI.
  Materials and Methods: A retrospective multicentre study was conducted in the 3 urology departments, including 88 patients with PNE refractory to conservative treatment and referred due to chronic pelvic pain (CPP). Patient data, including NFS results, imaging-guided PNI, and surgical outcomes, were evaluated after a one-year follow-up. A visual analogue scale (VAS) was used to assess intervention response. Test performance metrics for NFS and imaging-guided PNI and binary logistic regression were used to determine their predictive value for postoperative improvement. The ethics committee has been approved.
  Results: A total of 144 CPP patients were analyzed. 88 were diagnosed with PNE. All patients had NFS, and imaging-guided PNI was performed in 69 (78.4%), with 60 (68.2%) showing symptom improvement. Among the 40 patients (85%) who underwent pudendal nerve decompression surgery, 75% improved after surgery, and 20% did not have any response. The combined use of NFS and imaging-guided PNI showed a sensitivity of 79% and a specificity of 85.7%, with PPV of 98% and PNV of 30%. NFS and ImPNI were significant predictors of surgical success with p-values of 0.013 [95%CI: −23.6–−19.9] and 0.003 [95% CI: −20.6–−18.5] respectively. The primary limitations of this study are its retrospective nature and the absence of a control group.
  Conclusions: NFS and imaging-guided PNI are essential and highly reliable tools for diagnosing PNE. Imaging-guided PNI is a valuable predictor of surgical outcomes. These findings enable precise patient selection for surgery, ensuring optimal surgical outcomes.

UP-14.02—AI Med-Lit. Consult: gGAS 

• Talamas Alejandro, Garcia Maurice
  Cedars Sinai, Los Angeles, United States

• Introduction and Objectives: AI can be very useful to help both providers and patients to provide access and better understand health information. A key limitation of existing Large Language Models (LLM) (e.g. ChatGPT), which gather information from the public’s regular use, is lack of certainty about the source, quality, accuracy, and consistency of information that they provide to the User. Additionally with traditional LLMs, a citation of the source of information is not routinely provided or is often generated fictitiously by the LLM. We sought to improve on these limitations by developing our own closed-system LLM “AI Med-Lit. Consult: gGAS” about genital gender affirming surgery (gGAS).
  Materials and Methods: We downloaded exclusively all PubMed indexed literature on gGAS from December 1952 to April 2024 captured using common gGAS keywords as the training set for the LLM’s algorithm. This allowed us to control the source and quality of scientific information it was fed. We designed the algorithm to cite each and every PubMed article on which it based its output. We developed a testing & validation process to confirm the accuracy, consistency, and clarity of its output.
  Results: Testing resulted in confirming that the citations that were provided were accurate and listed every pertinent article, starting from the most recent. Additionally, all information provided was correct and accurate.
  Conclusions: Our BOT is useful for both providers and patients. Our design can be replicated for a limitless number of medical/scientific specialties. Future directions of the project include querying what questions different populations of users ask AI Med Lit. Consult: gGAS to better understand the needs of the people our LLM serves.

UP-14.03—Are All Single-Use Flexible Cystoscopes the Same? Comparison of Deflection and Irrigation Capabilities of Two Different Scopes 

• Abdelrahman Asem, Wiseman Oliver, Saeb-Parsy Kasra, Dragos Laurian
  Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom

• Introduction and Objectives: Flexible cystoscopes have an important role in endourological procedures, with performance characteristics such as deflection and irrigation flow potentially influencing clinical outcomes. A multitude of single-use cystoscopes have been recently introduced on a market traditionally occupied by reusable scopes. This study evaluates the deflection and irrigation capabilities of two different single-use flexible cystoscopes: Ambu aScope 4 Cysto and Macrolux.
  Materials and Methods: In this comparative benchmark study, scope deflection (upward/downward) and irrigation flow were evaluated with free working channel and with different instruments (grasper, needle, guidewire) inserted. Irrigation flow rates (mL/min) were assessed using a saline bag at a height of 60 cm. Mean, median, and standard deviations were calculated for each parameter, and statistical differences were analyzed.
  Results: Deflection: While upwards deflection was similar for both scopes, Ambu had greater downward deflection. For Macrolux the downward deflection with free working channel was 127° vs. 171° for Ambu. Macrolux had higher deflection loss, particularly in downward deflection with all instruments, with a notable 31° loss with the grasper vs. 11° for Ambu. Irrigation Flow: Ambu demonstrated higher mean flow rates. With free working channel, mean flow was 194.67 mL/min for Ambu vs. 180.0 mL/min for Macrolux. A similar trend was observed with instrument insertion, with Ambu maintaining superior irrigation flow. However, standard deviations were slightly higher for Ambu, indicating more variability in irrigation performance.
  Conclusions: Both single-use flexible cystoscopes showed very good deflection and irrigation capabilities, but differences have been noted. In this limited benchmark study Ambu aScope 4 Cysto showed slightly superior deflection and irrigation capabilities and less impairment with instruments via working channel. Further studies involving more scopes may be useful.

UP-14.04—CATHETER II, a Randomised Controlled Trial Comparing the Clinical and Cost Effectiveness of Various Washout Policies Versus No Washout Policy in Preventing Catheter Associated Complications in Adults Living with Long Term Catheters 

• Abdel-fattah Mohamed ¹, Johnson Diana ¹, Cooper David ¹, Constable Lynda ¹, Tripathee Sheela ¹, MacLennan Sara ¹, Cotton Seonaidh ¹, Norrie John ², MacLennan Graeme ¹, Team CATHETER II ¹, Omar Muhammad Imran ¹
  ¹ University of Aberdeen, Aberdeen, United Kingdom, ² University of Edinburgh, Edinburgh, United Kingdom

• Introduction and Objectives: CATHETER II aims to determine if weekly prophylactic saline or acidic catheter washouts in addition to standard long-term catheter (LTC) care improves the outcomes of adults living with LTC compared to standard LTC care only.
  Materials and Methods: CATHETER II was a pragmatic, three-arm, open-label, multi-centre, superiority RCT with internal pilot and embedded qualitative component. A community-based study in the UK recruiting from 21 centres in primary, community, and secondary care and remotely via targeted advertisements. 80 adults with LTC (any type/route) ≥28 days in situ, with no plans to discontinue, and the ability to self-manage the washout and study documentation with or without the help of a carer. All 80 participants received standard LTC care and were randomly allocated (26:27:27) to receive weekly saline washouts or weekly citric acid washouts or no prophylactic washouts for up to 24 months.
  Results: The mean (SD) age was 65 (17) with those in the control group slightly older and similar numbers of males and females in all three groups. LTC blockages (/1000 catheter days) requiring treatment were 9.96, 10.53, and 20.92 in the saline, acidic, and control groups respectively. The incident rate ratio (IRR) favours the washout groups [0.65 (0.24 to 1.77); p-value = 0.33 for saline washout and 0.59 (0.22 to 1.63); p-value = 0.25 for acidic washout], albeit these differences are not statistically significant. Similar results were obtained when the two washout groups were combined in a post-hoc analysis, IRR (0.62 (0.26 to 1.49); p-value = 0.22). The S-CAUTI rate was 8/1000 catheter days (control) and 6.72/1000 (acidic washout), IRR 0.98 (0.54 to 1.78); p-value = 0.93; and 3.71/1000 (saline washout), IRR 0.40 (0.20 to 0.80); p-value = 0.003. Participants in both washout groups had better QoL scores in EQ-5D-5L (0.056 (−0.022 to 0.134); p-value = 0.11 and 0.053 (−0.024 to 0.131); p-value = 0.12) and ICECAP-A (Adult version) (−0.076 (−0.221 to 0.068); p-value = 0.24 and −0.086 (−0.214 to 0.042); p-value = 0.13) than control. However, both findings were not statistically significant.
  Conclusions: The results are favourable, albeit not statistically significant, for lower rates of LTC blockages without a rise in S-CAUTI when employing prophylactic LTC washouts. We recommend an international RCT to ascertain the clinical and cost-effectiveness of prophylactic LTC washouts.

UP-14.05—Epidemiologic, Tomographic, and Infrared Spectroscopic Analysis of Double J Stent Encrustations 

• Bhatti Kamran
  HMC, Alkhor, Qatar

• Introduction and Objectives: Double J stent is a common medical device, and it may become encrusted, causing significant concern. Understanding the composition and associated risk factors for encrusted stents is crucial for appropriate management. Objective: to evaluate the types of DJ encrustation by infrared spectroscopy and correlate them with patient characteristics and computerized tomographic findings.
  Materials and Methods: All encrusted stents surgically removed over a one-year period underwent infrared spectroscopy analysis, and types of encrustations were compared with the patient’s demographic, clinical, and imaging features. For categorical variables, frequency tables were generated, and, for comparing continuous measurements across multiple groups, the Kruskal-Wallis test was used, considering p < 0.05 as statically significant.
  Results: 33 patients were included, the mean age was 46 years, mean BMI was 32.9 ± 8.98 kg/m². The average DJ indwelling time was 8.3 ± 7.78 months. Spectroscopic analysis: 34.3% struvite, uric acid 22.8%, 17.1% calcium oxalate, 11.4% ammonium urate, 5.7% Brushite, 5.7% calcium oxalate dihydrate, and 2.9% protein. Lower urine pH was associated with uric acid encrustations (p = 0.017). Uric acid and urate encrustations presented significantly lower densities on CT readings (p = 0.043). Brushite prevalence was surprisingly high in our series, and, therefore, it has to be considered for early double J encrustation.
  Conclusions: The types of mineral deposits depicted in our study differed from the literature where calcium oxalate is the most common; therefore, other compositions such as struvite and uric acid/ammonium urate should be considered. Urine pH demonstrated an association with uric acid and urate calcifications, which can be predicted by lower densities in CT readings.

UP-14.06—Experience with the Resonance Metal Stent at Hospital Universitario La Paz: A Descriptive Analysis 

• Martínez Pérez Salvador, López Pérez Eduardo, Mainez Rodriguez Juan Antonio, Abad López Pablo, Solano Heranz Pablo, Ayllón Blanco Héctor, Alonso Bartolomé Maria Belén, Casanova Martín Carlos, Gómez Villanueva Alejandra, Yebes Alonso Álvaro Javier, Cansino Alcaide Jose Ramón, Martínez Piñeiro Luis
  Hospital Universitario La Paz, Madrid, Spain

• Introduction and Objectives: Managing obstructive uropathy is challenging, particularly in cases of extrinsic compression due to malignancies or surgical iatrogenesis. Conventional ureteral stents often show limitations under severe compression, requiring frequent replacements and displaying reduced efficacy. The Resonance metal stent offers a more durable and compression-resistant alternative. This study aims to evaluate its impact on renal function, replacement rates, and progression to other forms of urinary diversion.
  Materials and Methods: A retrospective study was conducted at Hospital Universitario La Paz, including all patients who underwent placement or replacement of a Resonance stent between February 2018 and December 2023. Baseline characteristics, indication for placement, replacement rate, pre- and post-placement renal function, progression to other urinary diversions, and mortality were analyzed.
  Results: Nine patients underwent 27 stent placements. The mean age was 76.4 years. Malignant conditions accounted for 66.6% of cases, and benign conditions for 33.4%. A total of 55.5% of patients died, all with malignant disease. The mean time between stent replacements was 9.6 months. Progression to other urinary diversions occurred in 22.2% of patients. Mean serum creatinine improved from 1.96 mg/dL before stent placement to 1.30 mg/dL after, with a mean time to best creatinine of 6.4 months. Replacement was performed as scheduled in 31.3% of cases; in another 31.3%, no replacement was ever required. Replacement due to complicated UTI occurred in 6.3% and due to urinary tract dilation in 18.8%. Regarding physical condition and anesthetic risk (ASA classification), 64.7% were ASA-III, 29.4% ASA-IV, and 5.9% ASA-II. As for functional status (ECOG scale), 47.1% were ECOG-3, 29.4% ECOG-2, and 23.5% ECOG-1, reflecting a generally deteriorated clinical status.
  Conclusions: The Resonance metallic stent demonstrated adequate durability, with a mean replacement interval of 9.6 months and improvement in renal function. However, a considerable proportion of patients required further urinary diversions, highlighting the need to assess its use based on patient prognosis and obstruction progression.

UP-14.07—Hematologic Malignancy with Primary Genitourinary Tract Presentation 

• Alzahrani Turki, Elbahnasawy MAGDY, Alanazi Mshari, Almuzaini Omar, Albalawi Khalid, Yehia Hassan, Alanazi Abdulaziz, Ismail Fakherelddin
  King Salman Armed Forces Hospital, Tabuk, Saudi Arabia

• Introduction and Objectives: Hematologic malignant disorders can manifest in various ways, including rare involvement of the genitourinary tract. These may involve kidneys, bladder or testes but are extremely rare. Understanding and diagnosing these manifestations are crucial for appropriate diagnosis and proper management. Our aim is to explore the genitourinary involvement seen as primary presentation in hematologic malignancy in our hospital.
  Materials and Methods: This case series includes 4 cases; all of them showed primary urologic presentation (testicular in 2 cases, bladder in one and priapistic penis in one) and proved by investigations to harbor hematologic malignancy.
  Results: Case 1: Bladder mass obstructing the left vesicoureteric junction, with hydroureteronephrosis with multiple enlarged lymph nodes surrounding major blood vessels. Cystoscopic biopsies revealed diffuse large B-cell lymphoma. Case 2: Left testicular pain and swelling showed heterogeneous texture and absent blood flow on Doppler ultrasound. Left high inguinal orchiectomy confirmed diffuse large B-cell lymphoma. The patient started systemic treatment using the R-CHOP regimen. Case 3: A 7-year-old male presented with bilateral cervical lymph node enlargement, fever, hepatosplenomegaly and priapism. Laboratory findings indicated pancytopenia. Bone marrow aspiration confirmed Acute Lymphoblastic Leukemia (ALL). The patient underwent the AALL11231 protocol and experienced resolution of priapism. Case 4: An 8-year-old male presented with bilateral testicular swelling, very high leucocytic count with low RBCs and platelet counts. Scrotal Doppler ultrasound revealed enlarged, diffusely hypoechoic hypervascular testes. Abdominal ultrasound confirmed hepatosplenomegaly. Bone marrow aspiration confirmed the diagnosis of ALL.
  Conclusions: We highlight importance of recognizing the rare but distinct possibility of genito-urologic organ involvement as primary presentation for hematologic malignancy. Plan of management in such cases differed completely with need of multidisciplinary approach.

UP-14.08—Hernia en Glissade with Bladder Involvement: Case Series and Review of Non-Surgical Management 

• Elajnaf Mohamed ¹, Pouzi Afiq ², Verma Saurabh ², Mustafa Mohamed ³
  ¹ Ipswich Hospital, Ipswich, United Kingdom, ² James Paget University Hospital, Great Yarmouth, United Kingdom, ³ Lincoln County Hospital, Lincoln, United Kingdom

• Introduction and Objectives: Hernia en glissade is a rare hernia where a retroperitoneal organ, usually the colon or bladder, forms part of the hernial sac wall. Acute cases with urinary retention and decline in renal function require prompt management. When surgical repair of the hernia is high-risk, alternative long-term strategies to manage urinary retention are needed. The incidence of bladder involvement and appropriate management options is still under investigation. This case series reviews two cases and explores conservative management approaches.
  Materials and Methods: We present a series of three cases with hernia en glissade, admitted to two district general hospitals in Norfolk and Suffolk, from the period of 1st January 2024 to 1st April 2025. The patients were all male with an age range of 54–87 years. They had a Rockwood clinical frailty score range of 6–8. Urology referral was requested due to imaging findings of the bladder in a large inguinoscrotal hernia. We conducted a literature review to explore non-surgical management options for patients deemed unfit for definitive surgical repair. Conservative measures, including long term urethral catheter, intermittent catheterisation and abdominal support garments, were assessed for their efficacy in symptom control and prevention of complications.
  Results: All three cases were managed successfully using a long term urethral catheter to decompress the bladder. One patient required flexible cystoscopy for catheterisation due to the large size of the hernia sac, and further exchanges are planned over a guidewire. The patients had significant comorbidities that precluded surgical repair for the hernia. Their clinical course, response to catheterisation, and subsequent follow-up are discussed. While surgical repair remains the definitive treatment, long term catheterisation offers a viable option for patients with high surgical risk.
  Conclusions: Management of hernia en glissade with urinary bladder involvement requires adequate drainage via a urethral catheter. This provides a practical solution for symptom relief in high-risk patients. Long-term management strategies should be individualised based on patient comorbidities and quality of life considerations. Further studies are needed to establish standardised protocols for non-surgical management in this patient population.

UP-14.09—Improving Diagnostic Accuracy in Chronic Pelvic Pain Syndrome: Development and Evaluation of a Physical Examination Algorithm 

• Nomovir Timur, Plekhanova Olga, Faradzhullaeva Valery, Kasyan George
  Moscow Urological Center of Botkin Hospital, Moscow, Russian Federation

• Introduction and Objectives: Chronic pelvic pain syndrome (CPPS) is a multietiological condition associated with various somatic and psychopathological disorders, requiring a comprehensive diagnostic approach. This syndrome must be differentiated from urological, neurological, gynecological, and infectious diseases. Structured physical examination is an essential diagnostic component. To standardize assessment, we developed an algorithm for objective examination of patients with pelvic pain. Our aim was to develop and evaluate the diagnostic value of this physical examination algorithm in CPPS.
  Materials and Methods: A total of 106 patients were examined between 1 December 2024 and 1 March 2025. The study group included 56 patients (17 men, 39 women) with complaints characteristic of CPPS. The control group comprised 50 individuals without pelvic pain (30 women, 20 men). The objective examination included sequential assessment of localized tenderness at anatomical landmarks using the VAS (pubic tubercles, ischial tuberosities, anterior and posterior superior iliac spines, Alcock’s canal, sacrospinous and sacrotuberous ligaments, coccyx, pelvic floor muscles), as well as evaluation of muscle tone, sensory disturbances, and pelvic reflexes. In women, a Q-tip test was performed to diagnose vulvodynia. Physical examination was supplemented with instrumental and laboratory diagnostics, including cystoscopy, urodynamic testing, ultrasound, and pelvic MRI.
  Results: CPPS was confirmed in 46 of 56 patients in the study group. The algorithm correctly diagnosed 41 of these patients, with 5 false-negative results. In 10 patients, CPPS was not confirmed. Combined with control group results (50 individuals without pelvic pain), the total patients without CPPS was 60. The examination was negative in 57 of them, with 3 false-positive results. Calculation of the algorithm’s diagnostic accuracy using a contingency table showed: sensitivity 89%, specificity 94%, positive predictive value 93.2%, negative predictive value 91.9%, accuracy 92.5%, and Laplace coefficient 85%. These findings confirm the algorithm’s high clinical significance in diagnosing CPPS.
  Conclusions: Our approach demonstrated high diagnostic accuracy in verifying chronic pelvic pain syndrome. The indicators of sensitivity, specificity, predictive values, and Laplace coefficient confirm the informativeness and reliability of the method. Its application allows effective differentiation of CPPS and reduces the risk of diagnostic errors. The algorithm can be recommended as a standardized clinical tool for targeted diagnosis of CPPS.

UP-14.10—Improving Pre-Clinic Biochemical Test Completion in a Joint Metabolic Stone Clinic: A QIP Using SMS Reminders to Enhance Patient Engagement 

• Jose Jelin, Pal Pallavi
  Barts Health, London, United Kingdom

• Introduction and Objectives: The incidence and prevalence of nephrolithiasis is increasing globally. Approximately 50% of patients experience recurrence within 10 years. Metabolic testing—including stone analysis, serum biochemistry, and 24-h urine collections—can identify underlying abnormalities and guide targeted interventions to reduce recurrence. However, many patients disengage from further investigation once their acute episode resolves without prioritising follow up. We evaluated whether patients attending a joint stone clinic, staffed by urology and nephrology consultants, were completing recommended metabolic investigations. This clinic is resource-intensive and costly, so ensuring completion of investigations is essential for both cost-effectiveness and optimal patient outcomes.
  Materials and Methods: Ten joint metabolic stone clinics between December 2023 and November 2024 were reviewed, involving 66 patients. For each, we assessed whether key metabolic investigations were completed before their appointment. A panel of 11 recommended tests served as the benchmark. Completion rates were determined by reviewing electronic medical records. To improve compliance, an intervention was introduced: patients received an SMS reminder one month prior to follow-up, prompting them to complete the tests. Effectiveness was measured by comparing test completion rates before and after the intervention.
  Results: The lowest average test completion rates were in February (1.3; 6 patients) and March 2024 (1.75; 8 patients). May and June clinics had 6 patients each, with averages of 2.6 and 3.6. July and August saw slight improvement, with average rate of 5 (8 patients) and 5.7 (7 patients), respectively. September and November clinics had 7 patients with mean completion rates of 4.85 and 5. The smallest clinic was in January 2024 (3 patients), with a mean completion of 6.66. December 2023, the largest clinic (9 patients), had the second-highest rate at 5.44. March 2025 showed the highest mean completion rate of 7 (7 patients).
  Conclusions: After receiving the SMS reminder 1 month prior to the appointment, there was a higher compliance rate with majority of the patient’s attending clinic with the completion of the metabolic tests in comparison to the previous clinics.

UP-14.11—Integrative Clinical Pathway for the Management of Urinary and Bowel Dysfunction in Patients with Multiple Sclerosis 

• Velasco Balanza Clara, Bermejo Marcos Elena, Saavedra Centeno Manuel, Berbegal Serralta Raquel, Álvarez Ruiz Laura, Sánchez Ramírez Ana, Pelari Mici Lira, Viegas Madrid Vanessa, Pérez Fernández María Teresa, Arriaza Gómez María José, Del Río Muñoz Beatriz, Pérez Inmaculada, Aguirre Hernández Clara, Domínguez Gallego Marta, San José Manso Luis Alberto, Meca Lallana Virginia, López-Fando Lavalle Luis
  La Princesa University Hospital, Madrid, Spain

• Introduction and Objectives: Multiple Sclerosis (MS) is a chronic, inflammatory disease of the central nervous system. While known for its neurological symptoms, its broader impacts, such as urinary and fecal continence issues, significantly affect quality of life. These symptoms are often underaddressed, and referral to specialized care remains challenging. This study evaluates the impact of a coordinated clinical pathway for MS patients with urinary or bowel dysfunction, created by a multidisciplinary team to standardize patient care.
  Materials and Methods: A multidisciplinary team at a tertiary hospital, including Neurology, Urology, Gastroenterology, Coloproctology, Physical Medicine and Rehabilitation (PM&R), and MS-specialized nurses, reviewed evidence and developed a clinical pathway with specific referral criteria. This pathway is designed to facilitate early detection, prompt intervention, and optimized patient care. Adherence to this pathway was audited from September 2023 to February 2024. Referrals from Neurology to the specialized departments and between departments were retrospectively reviewed for compliance with the criteria. Additionally, a random sample of MS patients was analyzed to verify if any patients who met referral criteria were not referred.
  Results: In the six months following the pathway’s implementation, 79 referrals were documented. The majority were directed to Urology, mainly for cases of urge urinary incontinence. PM&R received the next highest number of referrals, primarily for mild overactive bladder symptoms. Although less frequent, referrals for fecal incontinence and chronic constipation were made, with patients directed to Coloproctology or Gastroenterology as appropriate. The referral rate rose over the study period. All referrals met the criteria established in the pathway. In a random sample of 167 patients seen in MS-specific Neurology consultations, no patients meeting referral criteria were found to have been overlooked.
  Conclusions: All referrals adhered to established criteria, and the random sample review found no overlooked patients. This indicates the clinical pathway effectively identifies MS patients with urinary or fecal dysfunction and ensures appropriate referral for care. Multidisciplinary management of continence issues in MS patients is vital. This clinical pathway standardizes care and improves management for patients with complex needs.

UP-14.12—Intracorporeal Orthotopic Neobladder Anastomotic Leak After Robotic Surgery: Nightmare with a Novel Minimally-Invasive Solution 

• Bansal Nipun, Panwar Pankaj, Vasudeo Vivek, Chaturvedi Samit, Kumar Anant
  Max Super Speciality Hospital, Saket, New Delhi, India, New Delhi, India

• Introduction and Objectives: Neobladder anastomotic leaks are seen in 2–10% of cases. Most of these cases can be managed conservatively. However, in non-responding cases, some form intervention is needed. Here, we demonstrate successful management of a neobladder anastomotic leak using N-butyl cyanoacrylate (NBCA) glue using percutaneous embolization approach only.
  Materials and Methods: A 53-years-old male diagnosed with muscle-invasive bladder cancer (MIBC) underwent robot-assisted radical cystectomy (RARC) with orthotopic neobladder (ONB) and pelvic lymph node dissection (PLND) with us. Post-operative recovery was uneventful. However, on cystogram at 3 weeks, he had anastomotic leak of significant size. He was kept on per-urethral and suprapubic catheters, and repeat cystogram after another 2 weeks failed to show any sign of improvement. He was taken to the interventional radiology suite, where the leak cavity was treated with an NBCA-lipoidal mixture. This was performed after a gentle tug on the per-urethral catheter to facilitate the adhesion of the leak edges and to prevent the NBCA from leaking into the urinary tract. Immediate cystogram demonstrated successful procedure and no leak. Per urethral catheter was kept for another 1 week.
  Results: Cystogram done 1-week after the administration of NBCA showed no leak with glue opacifying the entire leak cavity. Catheter was then removed, and patient voided successfully. CT urogram with 3D-reconstruction done after 3 months showed no extravasation of contrast from neobladder.
  Conclusions: Failure to manage neobladder anastomotic leaks conservatively usually mandates surgical repair. We used an NBCA-lipiodol mixture via an easy percutaneous embolization approach to seal neobladder-urethral anastomotic leak, offering a minimal-invasive alternative to surgery, ensuring precise delivery, faster healing, and improved outcome. However, this technique looks most fruitful when the intervention duration is short and the leak site is small in size.

UP-14.13—Legislations Across Countries Regarding AI Use in Surgery and Urology 

• Ramadore Shreyaa ¹, Somani Bhaskar ²
  ¹ University of Southampton, Southampton, United Kingdom, ² University Hospital Southampton, Southampton, United Kingdom

• Introduction and Objectives: As artificial intelligence (AI) becomes more integrated into surgical practice, it has showcased how vital clear legislative frameworks and ethical standards are for its use. Global variation regarding regulation of AI use and policies creates challenges for implementation, data governance, and patient safety. We have created a guide exploring how different countries approach the ethical and legal challenges regarding AI use in urology, with a focus on data protection and privacy, algorithm accountability, equity, and clinical validation.
  Materials and Methods: A narrative review with comparative policy analysis was conducted using legal documents, government publications, and academic literature from 2018 to April 2025. The United States, European Union member states, the United Kingdom, Canada, Japan, and India were all included in the study. Regulatory boards (e.g., FDA, MHRA), data protection laws (e.g., GDPR), approval pathways for AI-based medical tools, and the presence of national AI ethics guidelines were all investigated and summarised for this study.
  Results: We found limited AI legal framework, which was limited to selected countries or regions only. These included: GDPR in the EU—data protection framework for how AI systems are designed and implemented, FDA guidelines for medical devices in the USA, ethics boards which emphasised transparency and public trust in the UK and Canada, regulatory sandboxes in Japan, and ICMR’s ethical guidelines for application of AI in healthcare (with a great focus on digital health equity) in India. Ethical concerns regarding bias, informed consent, and clinician responsibility were prevalent across all legal frameworks.
  Conclusions: Ensuring the standardisation of international standards is crucial for the safe and ethical integration of AI in urology, especially given the sensitivity of data which is used in healthcare. This study highlights the need for global cooperation, adaptable frameworks, and ongoing collaboration between software developers, clinicians, and policymakers.

UP-14.14—Optimizing Urology Referrals Through a Quality Improvement Initiative 

• Abdellatif Mohamed, Mondal Subhajit, Singh Sid
  GEH, Coventry, United Kingdom

• Introduction and Objectives: Inappropriate referrals to urology by non-urologists exert significant strain on healthcare resources, impede efficient service delivery, and delay access to care for patients requiring specialist management. This quality improvement initiative aimed to identify key drivers of inappropriate referrals, implement evidence-based interventions, and evaluate their impact on the appropriateness of referrals and overall service efficiency.
  Materials and Methods: A retrospective analysis of referral data from September and October 2024 was conducted at a district general hospital. Referrals were assessed against established urological guidelines to determine appropriateness. Qualitative insights were obtained through surveys and focus group discussions with referring clinicians to identify barriers to adherence to referral standards. Interventions planned include the development and dissemination of a standardized referral pathway tool, targeted educational workshops for non-urology clinicians, and the introduction of a structured triage system. Key performance indicators (KPIs) included the proportion of inappropriate referrals and clinician satisfaction levels.
  Results: Among 220 referrals analyzed, 48 (~22%) were deemed inappropriate, while 130 (~59%) were accepted for outpatient appointments. The analysis revealed three primary drivers of inappropriate referrals: 1. Limited knowledge of urological conditions among referrers. 2. Insufficient adherence to referral guidelines. 3. Suboptimal communication between specialist care providers. These factors contributed to reduced clinic efficiency, an increased workload for urologists managing non-specialist cases, and delayed diagnosis and treatment for patients with genuine urological conditions.
  Conclusions: This study aims to highlight the efficacy of targeted educational interventions and streamlined referral pathways in mitigating inappropriate referrals. The findings underscore the critical importance of enhancing interdisciplinary communication and adherence to referral guidelines to optimize healthcare delivery. Sustained improvements will require continuous education, robust monitoring mechanisms, and iterative refinement of referral protocols. This model is transferrable to other specialties facing similar inefficiencies.

UP-14.15—Predictors of Renal Recovery Following Urinary Tract Diversion in Obstructive Uropathy: A Prospective Observational Study 

• Soni Jaideep, Singh Mahendra, Bhirud Deepak, Navriya Shiv, Choudhary Gautam, Sandhu Arjun
  AIIMS Jodhpur, Lucknow, India

• Introduction and Objectives: Obstructive uropathy (OU) is a common urological emergency associated with significant morbidity. Prompt urinary tract diversion via Double J (DJ) stenting or percutaneous nephrostomy (PCN) is critical for renal function preservation. However, predicting renal recovery post-diversion remains clinically significant. This study aims to identify factors influencing renal function recovery following urinary diversion in acute obstructive uropathy.
  Materials and Methods: This prospective observational study included 177 patients aged ≥16 years with acute OU (bilateral or unilateral with a solitary kidney) and serum creatinine > 2 mg/dL, undergoing urinary diversion (DJ stenting, PCN, PUC, or SPC). Patients with known chronic kidney disease or congenital anomalies were excluded. Key factors analyzed included preoperative serum creatinine, symptom duration, diversion type, complications, hemodialysis need, hospital stay, and comorbidities. Renal recovery was defined as serum creatinine ≤ 1.5 mg/dL at 4 weeks post-diversion.
  Results: Renal recovery was achieved in 59.9% of patients. Significant predictors of recovery included younger age (≤60 years, p = 0.046), absence of diabetes and hypertension, hemoglobin > 12 g/dL, symptom duration ≤ 4 weeks (p < 0.001), lower baseline serum creatinine (p < 0.001), mild hydronephrosis, and preserved corticomedullary differentiation (p < 0.001). Non-recovery was associated with prolonged obstruction, hemodialysis requirement, and severe renal parenchymal loss.
  Conclusions: Younger age, shorter symptom duration, and favorable renal function markers predict renal recovery post-diversion. Long-term follow-up is vital to manage complications and ensure renal stability. Timely intervention and identifying predictive factors are crucial in optimizing renal recovery post-urinary diversion.

UP-14.16—QR Coded Patient Information Leaflet for Greener Urology Outpatient Clinic 

• Chin Yew Fung ¹, Matei Ana ², Hughes Tom ³, Mahmalji Wasim ¹
  ¹ Hereford County Hospital, Wye Valley Trust, Hereford, United Kingdom, ² Birmingham University, Birmingham, United Kingdom, ³ Birmingham Heartland Hospital, Urology, United Kingdom

• Introduction and Objectives: Patient Information Leaflets (PILs) printed in paper form are a commonly used adjunct tool in urology clinics. These help to facilitate the information transfer between doctor and patient. They are detrimental to the environment and costly. Quick Response codes can be used as another option of delivering the leaflets and would reduce the environmental burden.
  Materials and Methods: This pilot study followed the introduction of QR codes of commonly used leaflets sourced from the British Association of Urological Surgeons (BAUS). The study was conducted in a urology clinic at The Hereford County Hospital over a one-month period. The acceptability of the QR codes was recorded. Data such patient demographic and type of leaflet was also documented and tabulated.
  Results: 31 patients required PILs out of which 80% agreed to PILs via QR codes. The mean age of the participating patients was 76. The replacement of paper with QR codes for the one-month period reflects an average estimated saving of 1.88 kg of carbon dioxide emissions and around 238 sheets of paper. The introduction of QR codes has seen an increase in most sectors also including, more recently, the medical industry. They can be used with a wide range of functions within the industry ranging from medical education to patient identification. These can also be more easily distributed in various forms to cater for all needs. Limitations such as the current limited variety of urology PILs available also need to be considered.
  Conclusions: QR codes of the PILs are a generally accepted alternative. The widespread introduction of QR codes reduces the total environmental impact of the paper documents whilst also reducing production costs.

UP-14.17—Smartphone Application Stent Registry with Automatic SMS Reminders Mitigates the Issue of Forgotten Ureteral Stents: A Multi-Centre Retrospective Cohort Study and an EAU Endourology Collaboration 

• Khor Vincent ¹, Somani Bhaskar ², Mohamad Sharin Mohamad Fairuz ³, Fahmy Omar ³, Lee Christopher Kheng Siang ⁴, Mohd Zainuddin Saiful Azli ⁵, Mohd Ghani Khairul Asri ³, Traxer Olivier ⁶, Gauhar Vineet ⁷
  ¹ Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Selangor Darul Ehsan, Malaysia, ² University Hospital Southampton NHS Trust, Southampton, United Kingdom, ³ Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor Darul Ehsan, Malaysia, ⁴ Sunway Medical Centre, Selangor Darul Ehsan, Malaysia, ⁵ Hospital Sultan Idris Shah, Serdang, Selangor Darul Ehsan, Malaysia, ⁶ Assistance-Publique Hôpitaux de Paris, Tenon Hospital, Paris, France, ⁷ Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore

• Introduction and Objectives: In many developing countries, including Malaysia, most hospitals still rely on manual stent registry systems (MSS) to prevent forgotten ureteral stents (FUS), with reported incidence rates as high as 15%. To overcome the limitations of MSS, we developed Malaysia’s first cloud-based smartphone stent registry system (SSS). This study aims to evaluate the effectiveness of SSS in reducing the incidence of FUS compared to the traditional MSS.
  Materials and Methods: Data from two patient cohorts were retrospectively reviewed: 152 patients managed using the MSS and 158 patients managed using the SSS. In the MSS group, patients were provided with physical stent cards indicating the expected date of removal, and stent tracking was performed manually by healthcare staff. In contrast, the SSS digitally recorded each stent episode and sent automated SMS reminders to patients prior to their scheduled stent removal. The primary objective was to compare the incidence of forgotten ureteral stents (FUS) between the two systems.
  Results: The mean (SD) age was 59.26 (12.9) and 59.03 (12.9) years, for MSS and SSS cohorts, respectively. Ureteric stone obstruction was the most common indication for stent placement in the MSS, while post-procedure was the most common in the SSS (p = 0.02). 13.2% of patients had FUS in the MSS cohort, while all patients in the SSS had their stent removed as planned (p < 0.01). As a result, the median (IQR) duration of stent indwelling was longer in the MSS than the SSS cohort [141 (12) vs. 45 (149) days, p = 0.02]. The median (IQR) duration of FUS was 55 (94) days.
  Conclusions: This study demonstrates that the SSS significantly outperforms the MSS in stent tracking, offering a more effective and reliable solution to reduce the incidence of forgotten ureteral stents.

UP-14.18—The Effect of Multi-Specialty Collaboration in Managing Complex Pelvic Pathology: The Experience of a Tertiary Care Centre 

• Chowdhury Atiqur
  Royal Liverpool University Hospital Trust, Liverpool, United Kingdom

• Introduction and Objectives: Cross-specialty collaboration might be logistically difficult, but it is necessary for the best surgical and oncological results. Multiple specialties are frequently needed for complex pelvic procedures, but little is known about how joint-specialty teamwork affects surgical outcomes. The study investigates if surgical techniques combined with interdisciplinary discussion enhance surgical results.
  Materials and Methods: All patients assessed on prospectively collected data for a regional complicated pelvic multidisciplinary team between September 2020 and August 2023 were reviewed retrospectively. With a population of over 2.5 million, the referral coverage region includes all NHS trusts in Merseyside and North Cheshire. The surgical cases were divided into joint-specialty and single-specialty. Results such as complication rates, recurrence, and reoperation were analyzed.
  Results: 238 patients were included. The cause for discussion was gynecological pathology in 119 (51.7%) cases, colorectal in 89 (38.7%), and urological in 16 (7.0%). External referrals were 29 (13.9%) of the cases. Malignant pathologies were 165 (71.7%) cases. 120 operations were performed, of which 74 (61.7%) were performed as joint procedures. The overall R0 rate was 71.1% (59/83), and 30-day postoperative mortality was 1.7% (2/120), and 90-day postoperative mortality was 3.3% (4/120).
  Conclusions: A dedicated MDT for the multi-speciality discussion of advanced pelvic pathology facilitates decision-making by optimising surgical planning and execution, which may improve results. By creating and upholding comparable frameworks across various contexts, standardizing joint surgeries could improve patient care and aid in the management of multi-organ pelvic illness.

UP-14.19—The Harmm Study (Haematuria and Risk of Morbidity/Mortality): A Longitudinal Re-Audit of Emergency Admissions and the Impact of DOACs 

• Jha Anshu, Geraghty Robert, Lavin Victoria
  Freeman Hospital, Newcastle Upon Tyne, United Kingdom

• Introduction and Objectives: With the increasing use of direct oral anticoagulants (DOACs), we conducted a re-audit of emergency haematuria admissions, building on 2014 data to assess changes in management, outcomes, and the impact of anticoagulation.
  Materials and Methods: We retrospectively reviewed emergency haematuria admissions over two periods: January–October 2014 (Audit 1) and June 2021–May 2022 (Re-audit). Both audits assessed reason for admission, anticoagulant indication, length of stay, and treatments received, with the re-audit including 30-day outcomes. Charlson Co-Morbidity Index (CCI) scores were calculated for each patient using admission records. Data were analysed in R using chi-square and Mann-Whitney U tests.
  Results: A total of 138 patients were included in Audit 1 and 112 in the Re-Audit. Anticoagulation rates were similar (48.2% vs. 52.1%, p = 0.70). The median length of stay increased significantly from 3 to 6 days (p < 0.001). Surgical intervention rates remained stable (9.8% vs. 9.3%, p = 0.99). In the Re-Audit, 27% of patients experienced a 30-day adverse event (18 readmissions, 9 deaths), with no significant difference between anticoagulated and non-anticoagulated groups (p = 0.79). Median CCI scores were significantly higher in the Re-Audit cohort (3 [IQR: 1–3.2] vs. 0 [IQR: 0–2], p < 0.001).
  Conclusions: Surgical intervention rates did not differ between patients on DOACs and those on other anticoagulants. However, inpatient stays for patients on antiplatelet therapy increased significantly across audit cycles. The longer hospital stays in the Re-Audit cohort likely reflect a higher comorbidity burden. Importantly, the re-audit revealed a clinically significant 30-day adverse event rate for emergency haematuria admissions, regardless of anticoagulation status or type, underscoring the need for early risk stratification and proactive multidisciplinary management.

UP-14.20—Unicentric Castleman’s Disease in the Retroperitoneum: A Diagnostic Dilemma in the Face of Suspected Malignancy 

• Soni Jaideep, Singh Mahendra, Bhirud Deepak, Navriya Shiv, Choudhary Gautam, Sandhu Arjun
  AIIMS Jodhpur, Lucknow, India

• Introduction and Objectives: Castleman Disease (CD) includes unicentric (UCD) and multicentric (MCD) subtypes, with UCD often presenting as a solitary mass in the mediastinum, neck, or retroperitoneum. Its imaging overlaps with other retroperitoneal tumors complicating preoperative diagnosis. UCD’s hyaline vascular (HV) subtype is most common, typically lacking systemic symptoms, unlike MCD.
  Materials and Methods: A 34-year-old female reported six months of right flank pain. Imaging identified a hypervascular retroperitoneal mass (4.8 × 3.3 × 4.8 cm) near the right renal hilum, suggesting extra-adrenal paraganglioma or lymph node pathology. Robot-assisted excision was performed due to the mass’s proximity to critical structures. Intraoperative findings revealed a highly vascular mass.
  Results: The postoperative course was uncomplicated. The patient experienced prompt pain relief and was discharged in stable condition on postoperative day three.
  Conclusions: This case underscores the importance of integrating advanced imaging, histopathological confirmation, and surgical precision to avoid misdiagnosis. Increased clinician awareness of UCD’s indolent behavior and imaging mimics is critical for optimal outcomes.

UP-14.21—Ureteric Stent Changes in Outpatient Setting: From Pilot Project to New Standard of Care, from Innovation to Patient Satisfaction to Cost Saving Related to Prospective Protocol-Based Outcomes 

• Fernandes Shriya, Pietropaolo Amelia, Frascheri Maria, Grossman Nico, Tear Loretta
  University Hospital Southampton, Southampton, United Kingdom

• Introduction and Objectives: Ureteric stents are inserted for extrinsic compression such as tumours or intrinsic obstruction from strictures and stones. Long-term stent insertion is needed in some patients, which then requires regular stent changes every 6–12 months. Overdue stents can cause complications such as obstruction, sepsis and stent related symptoms (SRS). To reduce the operating room (OR) backlog, we started local anaesthetic (LA) stent changes in outpatient setting, especially for more unfit patients, prospective outcomes of which are presented in this paper.
  Materials and Methods: In a prospective protocol-based pathway, LA stent changes were started (audit number: QI/0093) after patient informed consent. A disposable flexible cystoscope was used in outpatient lithotripsy room, and stent changes were done with application of lidocaine gel. Limited fluoroscopy was used with contrast study to confirm the stent position. Outcomes including success rate, complications, cost saving, and patient satisfaction (via visual analogue scale, VAS) were prospectively collected.
  Results: 83 procedures were performed over a 24-month period (Mar 2023–Feb 2025). Patient counselling and informed choice was given, and VAS scale was used for pain scores (range: 0–10, where 0 was no pain and 10 represented worst pain experienced). 93% (n = 77) procedures were successful, and failures were caused from pain (n = 3) and stent encrustation (n = 3). The mean pain score for patients was 4.1, with 89% (n = 74) patients willing to undergo LA stent change again. There was one post-procedure UTI (1.2%) (Clavien Dindo II). The cost savings related to individual patient were £790, and this corresponded to an overall saving of £65,500, which included cost savings of OR, anaesthetic team and additional members of urology and recovery team. The total number of staff involved in the LA procedure was halved from 8 to 4 people (in outpatients compared to OR). In addition, it allowed the OR slots to be backfilled by other urgent procedures.
  Conclusions: Outpatient local anaesthetic stent changes are a safe, effective, and patient-accepted alternative to operating room procedures, with high success rates and minimal complications. This service delivers significant annual cost savings and frees up valuable theatre capacity for more urgent cases, supporting NHS efficiency and sustainability.

UP-14.22—Virtual Stone Clinics: A Cost-Effective, Sustainable Model for Long-Term Management of Kidney Stone Disease—Outcomes of a Prospective Study 

• Makia Amr, Khalifa Salma, Davis Tanya, Tear Loretta, Somani Bhaskar, Pietropaolo Amelia
  University Hospital Southampton NHS Trust, Southampton, United Kingdom

• Introduction and Objectives: Virtual stone clinics (VSCs) have emerged as a pivotal component in the management of kidney stone disease, offering patients convenient and efficient care, particularly emphasized during the COVID-19 pandemic. This study evaluates the long-term clinical, financial, and environmental impact of a VSC model.
  Materials and Methods: We conducted an analysis of 200 patients from a prospective database managed via VSC, encompassing a total of 817 virtual appointments over a 4-year period. Data collected included demographics, referral indications, clinical outcomes, and resource savings in terms of cost, travel, time, and carbon emissions.
  Results: The cohort had a mean age of 59.5 ± 15.2 years with a male-to-female ratio of 3:2. Most patients (73.5%) were followed for surveillance of asymptomatic kidney stone disease, while the remaining 26.5% were categorized as high-risk. At the end of the follow-up period, 60% remained asymptomatic, 8% were discharged, 15% were escalated to face-to-face consultations due to increased stone burden or patient anxiety, 10% required surgical intervention, and 7% had emergency presentations. Of the 20 patients referred for intervention, 16 underwent surgical procedures (12 SWL, 3 FURSL, 1 URS), while 4 were managed conservatively. The VSC model resulted in a total estimated cost saving of £33,497, averaging £167.485 per patient. An additional £2,451–£2,777.80 was saved in fuel costs, with 26,296.62 km of travel avoided—equivalent to 19,608 min (326.8 h) saved. Estimated CO₂ emission reductions were 3.76 tonnes (petrol) and 4.47 tonnes (diesel).
  Conclusions: Virtual stone clinics offer a sustainable, cost-effective, and clinically viable alternative to traditional face-to-face follow-up for kidney stone disease. The significant economic, time, and environmental savings underscore the potential for VSCs to become a long-term standard in urological outpatient care.

UP-14.23—Zinner’s Syndrome: Unusual Presentation in Adolescent 

• Hekal Yousef ¹, Hekal Jana ¹, Omar El Kasem ², Qasis Adnan ², Magraby Hisham ², Al Mameri Abdulla ², Hekal Ihab ²
  ¹ Mansoura Faculty of Medicine, Mansoura, Egypt, Arab Rep., ² Ain AlKhaleej hospital, Al Ain, United Arab Emirates

• Introduction and Objectives: Acute urine retention in adolescents is uncommon presentation. Infection, trauma are the most common etiology in this age group. Simple work up and management can be concluded in family medicine clinic without urology reference. Zinner’s syndrome (ZN) is rare syndrome. It is presented usually with fertility problem and ejaculatory complaints by adults. Unusual early presentation of ZN in such age group with urological symptoms rather than fertility complaint is addressed in our case. Furthermore acute urine retention in ZN is not listed in literature. Herein, the case is presented as urine retention, first leading sign of ZN in such age. Endoscopic management was carried out successfully.
  Materials and Methods: 17-years old presented with acute urine retention with left testicular pain. No constitutional symptoms. He had normal vital signs. On first assessment aimed to exclude Torsion, trauma and severe UTI. Clinically the testis were normal, and bladder was palpable. Later, laboratory tests did not support infection or any abnormality. Abdominal ultrasound showed the distended bladder and agenesis of left renal unit with a cystic swelling related to the base of the prostate compressing the bladder neck. Urinary catheter was inserted.
  Results: Examination under anesthesia; large cystic bulge was on left prostate base. On cystoscopy: prostatic urethra lumen was deviated to right side and compressed with normal mucosa covering. It compromised its diameter significantly. At the bladder neck there was a bulge on left side with hemi-trigon and right ureteric orifice was normal. Using Lumenis Pulse™ 120H Holmium Laser System, a small incision was created distal to bladder neck by approximate 1 cm and deepen gradually until cloudy content was expressed out. Manual augmented compression of the cyst rectally was carried out [pictures 6–8]. Preserving the bladder neck is guard against retrograde ejaculation. Catheter was removed after 3 days, patient voids spontaneously and satisfied. Residual urine was nil. No testicular pain.
  Conclusions: To best of our knowledge first case of urine retention as presenting symptom of ZN. Age of ZN is always in fertile age group; our case is the first diagnosed case on early adolescent. In addition to the endoscopic urethral management and preserved ejaculatory function, our recommendation is: do not humble the simple sign in such age group, as it may manifest the hidden pathology. Rather than endoscopic, minimal invasive could be a safe intervention and could relieve the obstruction by time.

15. Pediatric Urology

15.1. Moderated Oral ePosters

MP-15.01—Factors Influencing Testicular Salvageability in Torsion Cases: A Retrospective Analysis 

• Elbahnasawy Magdy, Abdel-Fattah Mohamed, Alanazi Abdulaziz, Almuzaini Omar, Almalki Rayan, Alzahrani Turki, Alanazi Mshari, Ismail Fakherelddin, Abolhasan Anas, Aboul-ela Waseem, Zahran Mohamed
  King Salman Armed Forces Hospital, Tabuk, Saudi Arabia

• Introduction and Objectives: Testicular torsion is a urological emergency that requires prompt surgical intervention to preserve testicular viability. Understanding patient characteristics and factors influencing salvageability may guide clinical decision-making. This study aims to evaluate the impact of age, time, and seasonal presentation on testicular salvageability in testicular torsion patients.
  Materials and Methods: A retrospective analysis of testicular torsion cases diagnosed between January 2017 and September 2024 was conducted. The primary outcome was to identify factors affecting testicular salvageability. Factors tested were patient’s age, side affected, duration of torsion, onset of attending to ER (during working hours or not), and season (cold weather vs. hot weather). Univariate and multivariate tests were used for data analysis.
  Results: The study included 34 patients with median (IQR ) age of 15 (15–22) years and affected left and right testis in 18 (53%) and 16 (47%) of patients. Of them, 22 (65%) presented in cold weather, and 50% attended at night time. The median (IQR) duration of torsion was 3.5 (2–5) h. In 24 (70%) patients, the testis was salvaged with bilateral orchiopexy. In univariate analysis, patient age and short duration of torsion statistically have higher probability of testicular salvage (p value = 0.002, 0.003) respectively, whereas side of torsion, day onset, seasonal onset didn’t affect testicular salvageability (p > 0.05). On multivariate analysis, duration was the independent predictor of testicular salvageability [OR = 1.2, 95%CI = 1–1.6, p = 0.02] where age has no impact [OR = 1.1, 95%CI = 0.9–1.2, p = 0.06].
  Conclusions: Multivariate analysis underscores the critical role of early presentation (within 6 h) in enhancing testicular salvageability of torsion cases. The data show trends that suggest higher salvageability rates in cold weather and daytime presentations.

MP-15.02—Outcomes of Nonreduction Versus Reduction Pyeloplasty in the Management of Ureteropelvic Junction Obstruction: A Systematic Review and Meta-Analysis 

• Cobangbang Michelangelo ¹, Chua Michael ², Rivera Kay ¹, Rickard Mandy ², Dos Santos Joana ², Lorenzo Armando ², Kim Jin ², Cunningham Jessie ²
  ¹ St. Luke’s Medical Center, Quezon City, Philippines, ² The Hospital for Sick Children, Toronto, Canada

• Introduction and Objectives: To compare the surgical outcomes between nonreduction and reduction pyeloplasty in the management of ureteropelvic junction obstruction among patients such as postoperative functional outcomes, complication rate, and failure rate through a meta-analysis of comparative studies.
  Materials and Methods: Electronic databases including PubMed, EMBASE, Scopus, and Cochrane Library, including the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials, were searched to identify published literature comparing reduction and nonreduction pyeloplasty in adult and pediatric patients. Data on anteroposterior pelvic diameter, differential renal function, and complications were extracted. Data synthesis and statistical analysis were done using ReviewManager. Random-effects model and standard mean difference were used for calculation of all effect estimates with 95% confidence intervals for extrapolation. This study was registered with PROSPERO (CRD42021288645).
  Results: Five studies were selected for analysis, encompassing 177 renal units, of which 88 cases were reduction pyeloplasty and 89 cases were nonreduction pyeloplasty. Continuous variables were presented as standard mean differences with their 95% confidence intervals. Our overall pooled effect estimates show a statistically significant difference favoring reduction pyeloplasty in terms of postoperative anteroposterior pelvic diameter (SMD = 1.77; 95% CI 0.43, 3.10) and change in APPD (SMD = 1.21; 95% CI 0.07, 2.36). No statistically significant difference was observed for postoperative differential renal function (SMD = 0.27; 95% CI −0.10, 0.64) and change in DRF (SMD = 0.68; 95% CI −0.39, 1.74). Subgroup analyses revealed no statistically significant difference for all functional outcomes. Analysis of both groups revealed no significant difference in terms of postoperative complication rate (RR = 0.91; 95% CI 0.38, 2.16) and failure rate (RR = 1.50; 95% CI 0.28, 8.04).
  Conclusions: The evidence suggests that nonreduction pyeloplasty results in comparable postoperative DRF and change in DRF. Although reduction pyeloplasty results in superior APPD and change in APPD compared to nonreduction pyeloplasty, these findings may be clinically negligible. Complication and failure rates between the two groups are comparable.

MP-15.03—Safety and Efficacy of Combination Therapy in Paediatric Nocturnal Enuresis: A Clinical Outcome Assessment 

• Asif Muhammad, Khan Muhammad
  Lady Reading Hospital, Peshawar, Pakistan

• Introduction and Objectives: The overall prevalence of nocturnal enuresis (bedwetting) is around 15 to 30%. It has significant psychosocial impacts on affected pediatric population. These patients are usually treated conservatively with life style modifications and combination of anticholinergic and antipsychotic medications. Objective of our study is to evaluate the efficacy and safety of combined anticholinergic and antipsychotic therapy in children with persistent nocturnal enuresis.
  Materials and Methods: This cross-sectional study was conducted from January 2024 to December 2024. A total of 100 children aged 5–15 years diagnosed with primary or secondary nocturnal enuresis were included in the study. All patients received a combination of anticholinergic therapy (oxybutynin, 1 to 3 mg orally/day) and low-dose anti psychotic therapy (clomipramine, 25 mg, half tab orally at night time). Patients were followed on week 3, 6 and 12 to assess the treatment outcomes in terms of frequency of dry nights per week, reduction in enuresis episodes, and adverse effects.
  Results: Among the 100 patients 55 were female, and 45 were male; mean age was 9 years. A 75% reduction in enuresis episodes was observed by the end of 12 weeks, while 50% patients were completely dry by the end of this period. Significant improvement was noted in age group more than 10 years, with almost 80% patients reporting complete dryness at the end of 12th week. These drugs were usually safe, and no serious side effects were observed. The most common side effects included mild constipation (12%), drowsiness (8%), and transient mood changes in (3%) cases.
  Conclusions: Combination therapy with anticholinergic and antipsychotic medications is highly effective in reducing the frequency of nocturnal in pediatric patients. These drugs are also safe and cost effective. Further randomized controlled trials are needed to confirm long-term efficacy, safety and optimal dosing strategies.

MP-15.04—Supine Mini Tubeless Percutaneous Nephrolithotomy for Management of Renal Stones in Paediatric Population: A Single-Centre Experience 

• Kumar Nitesh ¹, Somani Bhaskar ²
  ¹ Ford Hospital and Research Centre, Patna, India, ² University Hospital, Southampton, United Kingdom

• Introduction and Objectives: To evaluate the feasibility, safety and outcomes of supine mini tubeless percutaneous nephrolithotomy (PCNL) for managing renal stones in paediatric population.
  Materials and Methods: Pediatric patients (less than 14 years) presenting with renal stone at Ford Hospital and Research Centre between January 2023 and December 2024 were included in the study. Patient demographics, stone parameters, intraoperative variables, postoperative outcomes, stone-free rates (SFR), complications and hospital stay were recorded. Data analysis was done with Xlstat2021.
  Results: Over 2 years 50 paediatric patients were available for analysis. Mean age was 6.45 ± 3.74 years (9 months–14 years). Mean stone size was 15.24 ± 3.92 (10–25 mm), mean Hounsfield Unit was 829.54 ± 161.94 (533–1249), mean operative duration was 38.38 ± 16.71 min. Stone free status was 96% at 3 months; 2 patients needed RIRS for clearance. Mean drop in haemoglobin was 0.51 ± 0.3 g/dL and mean hospital stay was 1.4 ± 0.43 days. All cases were done with 16 Fr sheath, and no nephrostomy tube was placed. Minor Clavien Dindo I/II complications occurred in 12% patients: fever 2 (4%), pain 3 (6%) and 1 (2%) mild ascites which resolved spontaneously. No higher grade Clavien Dindo complications were observed, and no patient required blood transfusions.
  Conclusions: Supine mini tubeless PCNL is a safe and effective strategy for treating paediatric stone disease. It achieves high SFR with early recovery and discharge from the hospital.

MP-15.05—The Management of Poorly Functioning Obstructed Kidney in Children: Is a Pre-Operative Nephrostomy Beneficial? 

• Baron Jodi, Rampersad Barbara
  Eric Williams Medical Sciences Complex, Mt Hope, Trinidad and Tobago

• Introduction and Objectives: Pre-operative percutaneous nephrostomy (PCN) use in poorly functioning kidneys with UPJO has shown varying success in adults and children. The aim of this study is to determine if pre-operative PCN is beneficial in children.
  Materials and Methods: Data was collected retrospectively from 70 patients with UPJO. Patients with a solitary kidney or bilateral procedures were excluded. Kidneys were assessed with renal ultrasound or CT and diuretic renogram. A PCN was inserted if the DRF was <15% or severe HN and cortical thinning were present.
  Results: 18 patients, mean age of 19 months, underwent a PCN (Group 1). 48 patients, mean age of 44 months, had a primary pyeloplasty (Group 2). 4 patients, mean age of 31 months, had primary nephrectomies (Group 3). In Group 1, the initial mean DRF was 18.7% with an APD of 4.5 cm. 14 children proceeded to a pyeloplasty, and a significant increase in mean post-operative DRF, 46.7%, was noted (p value 0.001). 4 failed nephrostomies: 2 required a nephrectomy (mean DRF 1%), and 2 underwent pyeloplasty (mean DRF 29.5%). In Group 2, the initial mean DRF was 30.2% with an APD of 3.29 cm and post operative DRF 41.4%, which was not significant. For Group 3, the mean pre-operative DRF was 5.6% with an average APD of 6.2 cm.
  Conclusions: This study shows that there was a significant improvement of renal function when PCN was placed in younger children with a DRF < 15% or an APD > 4 cm and thus can be considered as a criterion for pre-operative PCN placement in children with UPJO.

15.2. Unmoderated Standard ePosters

UP-15.01—Challenges and Benefits of Transition Appointments for Young Adults with Lifelong Neurourological Needs from Pediatric to Adult Service 

• Silva Pedro, Pinheiro Luis, Gil Miguel, Cunha João, Caceiro Rui, Gomes Alexia, Lanca Miguel, Meireles Ana, Pereira Patricia
  Central Lisbon University Hospital Centre, Lisboa, Portugal

• Introduction and Objectives: Transitioning from pediatric to adult healthcare services presents a complex and critical juncture for young adults with lifelong neurourological needs. We highlight the challenges associated with the transition process for this vulnerable population; recognize the unique requirements of young adults facing neurourological conditions; and emphasize the importance of a well-structured transition plan that accounts for medical, psychological, and social aspects.
  Materials and Methods: In our Medical Center, we began our transition appointments with a multidisciplinary team involving Urology, Pediatric Surgery, and a nursing team in a familiar, comfortable environment, thereby ensuring an efficient and pleasant transition to adult urology. This process allows training and experience sharing of a medical team that is well equipped to deal with patients whose conditions are rare in adult urology. Furthermore, it allows for the acknowledgement of individual patients’ needs, forming an effective treatment plan for each patient in a multidisciplinary environment and allowing interteam surgical management of young patients through surgical procedures infrequent in adult urology.
  Results: In 2 years, through 64 transition appointments, 34 patients were evaluated, averaging 2 appointments per patient, with ages ranging from 17 to 35 years old, the median age being 22.5 years, 19 male and 15 female patients, of which 25 have successfully transitioned to adult urology. At this point, we consider our transition appointments a clear success and a valuable asset in the management of young chronic urological patients, underscoring the importance of a multidisciplinary approach involving healthcare providers, caregivers, and the young adults themselves. Key elements of successful transition appointments include early planning, education, clear communication, and the establishment of adult care providers with experience in neurourological conditions. Additionally, peer support and the utilization of technological tools can aid in easing the transition process.
  Conclusions: In conclusion, the transition of young adults with lifelong neurourological needs from pediatric to adult services is a complex journey filled with challenges and opportunities. By recognizing these challenges and proactively addressing them, healthcare systems can optimize the transition experience, ensuring improved health outcomes, enhanced quality of life and a more seamless transition for this vulnerable population.

UP-15.02—Challenges and Benefits of Transition Appointments for Young Adults with Lifelong Neurourological Needs: Impact on Hospital Care Utilization 

• Silva Pedro, Pinheiro Luis, Gil Miguel, Cunha João, Caceiro Rui, Gomes Alexia, Lanca Miguel, Pereira Patricia, Meireles Ana
  Central Lisbon University Hospital Centre, Lisboa, Portugal

• Introduction and Objectives: Transitioning from pediatric to adult healthcare services is a crucial step for young adults with lifelong neurourological needs. While structured transition appointments aim to provide continuity of care, their impact on hospital care utilization remains an area of interest. This study evaluates whether transition appointments reduce hospital stays and urgent care visits, highlighting their role in improving patient management.
  Materials and Methods: A retrospective analysis was conducted at our medical center, examining patients who underwent transition appointments involving a multidisciplinary team of urologists, pediatric surgeons, and nurses. Data on urgent hospital care visits and days spent in hospital care were collected for a one-year period before and after transition. Average values were used to assess trends in hospital utilization.
  Results: Over two years, 34 patients attended 64 transition appointments, with a median of two appointments per patient. Of these, 25 successfully transitioned to adult urology. Analysis of hospital care utilization revealed that the average number of urgent hospital care visits remained relatively stable, changing from 0.57 before transition to 0.51 after transition appointments. However, the average number of days spent in hospital care decreased from 3.83 before transition to 1.83 after transition, suggesting a reduction in inpatient care needs.
  Conclusions: While the number of urgent hospital visits showed minimal change, a notable reduction in hospital stay duration was observed after transition appointments. These findings suggest that transition programs may contribute to better inpatient management, potentially reducing prolonged hospitalizations. A structured, multidisciplinary transition approach remains essential in optimizing outcomes for young adults with lifelong neurourological conditions. Future research should explore long-term impacts and individualized factors influencing hospital utilization trends.

UP-15.03—Characterization of Clinical and Socioeconomic Factors that May Affect the Timing of Initial Management of Patients with Posterior Urethral Valve 

• Chae Hyunwoong Harry ¹, Skarsgard Erik ², Jin Falla ², AlShalan Abdullah ², Matsell Douglas ², Bone Jeffrey ², Zhang Qian ², Afshar Kourosh ², MacNeily Andrew ², Kim Soojin ², Bae Hans ²
  ¹ University of British Columbia, Vancouver, Canada, ² British Columbia Children’s Hospital, Vancouver, Canada

• Introduction and Objectives: The purpose of our study was to characterize clinical and socioeconomic factors as potential barriers to healthcare access, measured by timing of posterior urethral valve (PUV) management.
  Materials and Methods: We conducted a retrospective study of all PUV patients managed at our institution from January 2010–December 2019. Primary outcomes were time to first imaging (renal ultrasound and/or voiding cystourethrogram) and surgery for PUV. Univariate analyses were utilized for analyses. Socioeconomic factors were assessed using the Canadian Index of Multiple Deprivation (CIMD), which categorizes neighbourhoods across four dimensions: situational vulnerability, residential instability, economic dependency, and ethnocultural composition. Higher CIMD quintiles indicate greater deprivation in each dimension.
  Results: Thirty-four PUV patients were included. Median age at first imaging was 3 (IQR 1–29) days and at surgery was 10.5 (IQR 5–32.8) days. Prematurity occurred in 23.1% (6/26) of patients, and 50% (16/32) were transferred from another hospital. Median patient distance to hospital was 93.6 (IQR 28.3–369.8) km. Median CIMD quintiles were as follows: situational vulnerability 3 (IQR 1–4), residential instability 4 (IQR 2–4), economic dependency 2 (IQR 1–4), and ethnocultural composition 2 (IQR 2–3). Antenatal suspicion of PUV occurred in 54.5% (18/33) and was associated with earlier imaging (p = 0.050) but not earlier surgery. Neonatal intensive care unit (NICU) admission was associated with both earlier imaging (p = 0.004) and surgery (p < 0.001). Imaging and surgery timing were not significantly associated with transfer status, prematurity, hospital distance, or CIMD dimensions.
  Conclusions: Patients with antenatally suspected PUV and those who required NICU admission underwent earlier imaging and surgery. Socioeconomic factors did not seem to be barriers to PUV management in our cohort, though our sample size may have limited our ability to detect subtle associations.

UP-15.04—Comparison of Lower Urinary Tract Symptoms in Patient of Middle Ureteric Calculi Undergoing Stenting Versus Non Stenting After Uncomplicated Ureteroscopy in Children 

• Ahmad Tariq
  Khyber Medical College Peshawar, Pakistan

• Introduction and Objectives: Background: Ureteral stents are commonly used after ureteroscopy for ureteric stones in cases of ureteric injury or simply to maintain patency. However, its need in uncomplicated circumstances is debatable. Ureteral stents cause pain and bothersome lower urinary tract symptoms in adults, but this phenomenon is unknown in children. Aim: To compare LUTS in pediatric patients with middle ureteric calculi undergoing ureteroscopy with and without post-operative stenting.
  Materials and Methods: This retrospective comparative study was carried out at Department of Urology, Unit Khyber Teaching Hospital, Peshawar, from January 2021 to July 2021. The research included children between the ages of 6 and 15 years who were diagnosed with middle ureteric calculi and underwent ureteroscopy. Patients were grouped based on stenting as with stenting (group A) and without stenting (group B). Post-operative LUTS were compared in both groups.
  Results: A total of 86 children were registered. The gender distribution of both groups was not significantly different from each other (Male: 59% vs. 63%, p = 0.72; Female: 41% vs. 37%, p = 0.72). The mean age of the patients did not differ between the two groups as well (9.4 ± 2.1 years vs. 9.1 ± 2.5 years, p = 0.58). Both categories had equal proportion of patients across age brackets (6–8 years: 27% vs. 23%, p = 0.63; 9–11 years: 35% vs. 34%, p = 0.92; 12–15 years: 37% vs. 43%, p = 0.54). Mean stone size was also comparable between non-stented group and stented group (8.7 ± 1.2 mm vs. 8.9 ± 1.5 mm, p = 0.55).
  Conclusions: Both stented and non-stented approaches in pediatric ureteroscopy for ureteral calculi demonstrate similar efficacy in terms of stone clearance and complication rates.

UP-15.05—Comparison of the Efficacy and Safety of Extracorporeal Shock Wave Lithotripsy and Mini Percutaneous Nephrolithotomy in Treating Renal Pelvis Calculus in Infants 

• Ahmad Tariq
  Khyber Medical College Peshawar, Pakistan

• Introduction and Objectives: The study aims to compare the efficacy and safety of Percutaneous Nephrolithotomy (PCNL) and Extracorporeal Shock Wave Lithotripsy (ESWL) in treating renal pelvis calculus in infants.
  Materials and Methods: This randomized controlled trial took place in urology department from July 2023 to July 2024. No external funding was received for this research. A total of 84 infants aged 1 to 12 months with renal pelvis calculus were randomly assigned to one of two groups: PCNL (Group A, n = 56) or ESWL (Group B, n = 28). Patients with severe comorbid illnesses or who had previously undergone renal pelvis calculus surgery were excluded. One month after therapy, stone clearance rates were examined using X-rays and ultrasonography. Postoperative complications included hematuria, urinary tract infections (UTIs), abdominal pain, and urinary tract blockage. The data was analyzed using SPSS with a statistical significance level of p < 0.05.
  Results: The study showed that the stone clearance rate was considerably higher in the PCNL group (92.9%) than in the ESWL group (53.6%) (p = 0.0001). The ESWL group had a greater incidence of postoperative complications, including urinary tract infections (14.3% vs. 0%, p = 0.004) and abdominal pain (10.7% vs. 0%, p = 0.01). Hematuria was more prevalent in the ESWL group, although not statistically significant (p = 0.07).
  Conclusions: PCNL offers higher stone clearance rates than ESWL in infants with renal pelvis calculus. PCNL exhibited notably lower complications than ESWL.

UP-15.06—Conventional vs. Device-Assisted Infant Circumcision: A Systematic Review and Meta-Analysis 

• Kafagi Abdul Hadi ¹, Ibrahim Ahmed ², Shandala Abdulrahman ³, Elmousili Mahmoud ¹, Almarzouq Abdulrahman ⁴, Hamid Zaidi ⁵
  ¹ Manchester NHS Foundation Trust, Manchester, United Kingdom, ² Glangwili Hospital-Hywel Dda University Health Board-NHS Wales, UK., Wales, United Kingdom, ³ Stockport NHS Foundation Trust, Stockport, UK., Manchester, United Kingdom, ⁴ The University of Manchester, Faculty of Biology, Medicine and Health, Manchester, UK., Manchester, United Kingdom, ⁵ Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Oldham, Greater Manchester, UK., Manchester, United Kingdom

• Introduction and Objectives: To compare the safety, efficacy and postoperative outcomes of conventional versus device-assisted techniques in infant circumcision.
  Materials and Methods: Systematic review of all studies up to March 2025. Studies were identified from all major databases including PubMed, Cochrane Library, Scopus and Web of Science. All randomised controlled trials and prospective and retrospective cohort studies comparing conventional scalpel-based and device-assisted infant circumcision were included; studies involving patients older than 18 years were excluded. Primary outcomes were bleeding, bleeding requiring sutures, a surgical site infection, oedema, delayed healing or separation, reoperation or revision, urinary retention and inadequate skin removal. Operative time was assessed as a secondary outcome.
  Results: Twenty-three studies with 23,490 patients contributed to the summative outcome. Device-assisted techniques were statistically superior to conventional techniques for operative time (p < 0.00001), bleeding (p = 0.04), and revision surgery (p = 0.007). Device-assisted techniques showed no statistical difference compared to conventional methods for bleeding requiring sutures (p = 0.08), surgical site infection (p = 0.07), delayed healing (p = 0.34), urinary retention (p = 0.45), oedema (p = 0.59) and inadequate skin removal (p = 0.11).
  Conclusions: There is no absolute superiority for conventional or device-assisted infant circumcision. Device-assisted techniques demonstrated advantages in operative time, bleeding, and revision surgery rates, while other outcomes were comparable. Both approaches have distinct advantages, and technique selection should be guided by clinical context and practitioner experience. Larger, high-quality studies are needed to confirm these findings and inform best practices.

UP-15.07—Effectiveness of Full Length and Cut Percutaneous Nephrostomy in Pediatric Population 

• Ahmad Tariq
  Khyber Medical College Peshawar, Pakistan

• Introduction and Objectives: Purpose of the study is to evaluate the safety and efficacy of full length percutaneous (PCN) versus cut PCN in pediatric population. PCN is performed to establish temporary drainage of obstructed or dilated renal system till definitive management. PCN is well established procedure which is performed under deep sedation, local anesthesia or general anesthesia ultrasound guided or fluoroscopic guided.
  Materials and Methods: Randomized controlled study carried out in 200 children in the Department of Urology, Institute of Kidney Disease, Hayatabad, Peshawar, Pakistan, from January 2020 to April 2022, and analysis was done by using SPSS version 20 to know the efficacy of the cut versus full length PCN in children.
  Results: The efficacy of the cut versus full length PCN in children. This study was carried out over 200 children using cut and full length percutaneous nephrostomy tube, 100 in each group. This study includes 119 males and 81 females of mean age 5.49 + 3.127 years. The cause of obstruction was 61% PUJ obstruction, 55% VUR, 47% obstructed stone, and other causes in 37% patients. Effective decompression of hydronephrosis was noted in 89% in cut length vs. 82% in full end PCN (p < 0.1%). Skin inflammation of 100% with cut end PCN and 20% with full length, 96% of PCN didn’t show any inflammation (p < 0.001%). Dislodgment of PCN was noted multiple times in 54%, two times in 38% and 7% in full length PCN, whereas it is noted two times in 47% and one time in 45% in cut PCN (p < 0.001%). PCN exchange was needed multiple times in 51% patients and two times in 39% patients in full length PCN, whereas it was needed two times in 41% and one time in 50% patients in cut PCN arm (0.001%).
  Conclusions: This study concludes that cut end PCN is more effective in terms of PCN exchange and dislodgement but having more skin inflammation as compared to full length PCN.

UP-15.08—Efficacy and Safety of Mini Percutaneous Nephrolithotomy and Open Pyelolithotomy for Renal Stones in Pediatric Population 

• Ahmad Tariq
  Khyber Medical College Peshawar, Pakistan, Peshawar, Pakistan

• Introduction and Objectives: Background: Pediatric renal stones may lead to pain, urinary obstruction, infection, and long-term renal damage. Although less common in children compared to adults, these stones remain a significant clinical problem. Objective: To evaluate and compare the effectiveness and safety of Mini-PCNL versus open pyelolithotomy in pediatric patients. Study design: A prospective study. Duration and place of study: Department of Urology, Institute of Kidney Diseases, Peshawar, between 01-03-2021 and 31-06-2021.
  Materials and Methods: This prospective analysis, carried out at the Department of Urology, Khyber Teaching Hospital, Peshawar, focused on pediatric patients diagnosed with kidney stones who had underwent either open pyelolithotomy or mini-percutaneous nephrolithotomy (Mini-PCNL) between 01-03-2021 and 31-06-2021 (study duration: 6 months). Patients of either gender aging 6 to 15 years with renal stones diagnosed on plain CT-KUB were enrolled. Efficacy and safety profile of both treatment modalities were compared.
  Results: Of the 61 patients who required intervention for the identified kidney stones in the pediatric patients, 40 underwent mini PCNL, while 21 underwent open pyelolithotomy. Age profile in mini-PCNL group averaged 11.3 years, and open pyelolithotomy group was 10.8 years on average. The mini-PCNL group consisted of 25 patients, of which 62.5% were male patients, while the open pyelolithotomy group had a total of 3 patients, of which 66.7% were male patients. The results obtained from the present study showed that the mini-PCNL group had a higher stone clearance rate of 95% as compared to the open pyelolithotomy group, having a clearance rate of 90.5%. Also, the cases that had mini-PCNL experienced fewer complication rates, including haematuria, postoperative urinary tract infection, and fever, than those who underwent open pyelolithotomy.
  Conclusions: Mini PCNL is a secure and efficient therapy substitute to open pyelolithotomy patients of paediatric age group diagnosed with renal calculi.

UP-15.09—Factors Affecting the Success of PCNL in Infants 

• Ahmad Tariq
  Khyber Medical College Peshawar, Pakistan, Peshawar, Pakistan

• Introduction and Objectives: ABSTRACT PCNL has emerged as safe and successful management tool for renal calculi with minimal renal functional and morphologic implications in infants. However, the experience of PCNL in infantile renal calculi has been seldomly reported from stone belt countries like ours with resource limited settings. Objective: To determine the efficacy and safety profile of PCNL in infants with renal stones.
  Materials and Methods: This descriptive analysis was carried out at Department of Urology, Khyber Teaching Hospital, Peshawar, during the period June 2023 to June 2024. Male and female infants diagnosed with renal stones were enrolled. PCNL was performed, and efficacy was measured in terms of stone free rate determined using ultrasound performed after 24 h of procedure, and complications were measured in terms of excessive blood loss and surgical site infection.
  Results: A total of 94 participants were enrolled. The mean age of the participants was 8.13 ± 2.806 months. Male to female ratio was 1.3:1. Right kidney stones were more prevalent than left (n = 51, 54.3%). Stone free rate (SFR) was recorded in 73 patients (77.7%), surgical site infection was recorded in 21 participants (22.3%), and excessive blood loss in 16 participants (17.0%).
  Conclusions: PCNL is safe and effective tool for the management of renal stones in infants. No significant association was observed between stone free rate and patient clinic-demographic parameters except laterality of the stone.

UP-15.10—Harnessing Transcutaneous Posterior Tibial Nerve Stimulation (TPTNS) to Revitalize Bladder Function in Pediatric Patients with Underactive Bladder 

• Usmani Aamir, Yadav Priyank, Ansari M.S.
  Sanjay Gandhi Post Graduate Institute, Lucknow, India

• Introduction and Objectives: Underactive bladder (UAB) in children is a voiding dysfunction characterized by impaired detrusor contractility, leading to incomplete bladder emptying, elevated postvoid residual (PVR) urine volumes, and associated complications such as urinary tract infections. To the best of our knowledge, there are few similar studies that evaluate effects of TPTNS in management of UAB in children. Our aim was to evaluate the effectiveness of TPTNS in improving bladder function in pediatric patients with UAB who failed conservative management.
  Materials and Methods: This retrospective, non-randomized observational study included 52 pediatric patients with UAB treated with TcPTNS between 2013 and 2022. Patients underwent 12 weekly sessions of TcPTNS, and outcomes were assessed using bladder diary, urodynamic study, and PVR measurement. Patients with recent bladder surgery, pelvic floor interventions, or active infections were excluded.
  Results: Patients were divided into neurogenic and non neurogenic groups. Incontinence significantly decreased in non-neurogenic children after TPTNS, while neurogenic patients showed minimal changes. Improvements in PVR and CIC frequency were notable in the non-neurogenic group. Voided volume and urodynamic parameters showed limited impact. Non-neurogenic patients likely benefited more from TPTNS due to the presence of functional sacral nerve pathways, enabling better neuromodulation effects. While other studies had noted significant outcomes with techniques like sacral neuromodulation (SNM) or intravesical electrical stimulation (IFES), this study hypothesized that TPTNS may be less effective for neurogenic UAB, may be due to compromised sacral pathways. Despite promising results in nonneurogenic cases, the study has several limitations. A small sample size of 52 patients, lack of a control group, and short follow-up duration (2 years) limit statistical power and long-term assessments.
  Conclusions: While TPTNS shows potential as a non-pharmacological treatment for improving bladder function in children with UAB, particularly in reducing PVR, night-time incontinence, and frequency of CIC, further studies with larger sample sizes, long-term follow-up, and control groups are needed to confirm its efficacy and determine the optimal patient populations for this therapy.

UP-15.11—Laparoscopic Pyeloplasty in Infants Is Safe and Effective, a Single Surgeon Experience 

• Naser Md. Fazal ¹, Haider Mominul ², Hasan Shahriar Md ¹, Afroz Roksana ³, Munir Serajum ⁴, Hossain Md. Shohrab ⁴
  ¹ National Institute of Kidney Diseases and Urology (NIKDU), Dhaka, Bangladesh, ² Sir Salimullah Medical College Hospital, Dhaka, Bangladesh, ³ Central Police Hospital, Dhaka, Bangladesh, ⁴ Advanced Centre for Kidney and Urology (ACKU), Dhaka, Bangladesh

• Introduction and Objectives: Laparoscopic A-H pyeloplasty (LP) is a well-accepted treatment for the ureteropelvic junction obstruction (UPJO) in children. However, its effectiveness and safety in infants, particularly below 6 months of age, remain uncertain in Bangladeshi population. To address this we aimed to analyze the outcome of laparoscopic pyeloplasty in 2 months to 12 months old infants.
  Materials and Methods: This is a retrospective study conducted at the Advanced Centre of Kidney and Urology (ACKU), Dhaka, Bangladesh. The records of 117 infants (4 bilateral cases, 121 kidneys) that underwent LP from January 2016 to December 2023 with at least 1 year of follow-up were retrospectively reviewed. The results of pre- and postoperative ultrasound (US) and diuretic renogram (DR), operative details, and complications were analyzed. LP was successfully completed using 3 mm ports and a 3 mm telescope.
  Results: There were complications in 9 children (7.4%); 8 did not require a second intervention; and the final outcome was not affected. One child (0.8%) had a re-obstruction with worsening hydronephrosis (HDN) 2 months after stent removal and underwent successful redo LP. Median follow-up was 2 years; LP was successful in 111 kidneys (94.8%); all had follow-up US, while 84 children had follow-up DR. The tests showed a significant reduction in HDN (mean pre-operative anteroposterior diameter (APD) of renal pelvis, 35.6 mm (SD 13.4) versus mean post-operative APD 12.5 mm (SD 5.7), p < 0.001) and improved drainage in all kidneys. In unilateral cases, there was significant improvement in mean split renal function (SRF) of the operated kidneys (pre-operative 26.1% (SD 8.6) versus post-operative 39.2% (SD 11.4), p < 0.001).
  Conclusions: Over the past 9 years, all pyeloplasties at our institution (ACKU) have been performed by laparoscopy, irrespective of the age or weight of the child. In this large retrospective series, it is demonstrated that infant LP is safe and not only resulted in a significant reduction of hydronephrosis but also in significant functional improvement.

UP-15.12—Mobile-Based Video Recording for Micturition: A Reliable Alternative to Uroflowmetry 

• Usmani Aamir, Mittal Amit, Yadav Priyank, Ansari Mohammed
  Sanjay Gandhi Postgraduate Institute, Lucknow, India

• Introduction and Objectives: Uroflowmetry is a standard, non-invasive method for assessing urinary flow patterns. However, its reliance on specialized equipment and in-clinic visits limits accessibility, especially for children and individuals in remote or underserved areas. This study aimed to assess the reliability and validity of video-based voiding tests compared to traditional uroflowmetry and explore the potential of integrating machine learning to automate diagnostics.
  Materials and Methods: This prospective study included 120 male children, all toilet-trained and referred to our department between February and June 2024. None of the participants had undergone any prior urological interventions. During the first OPD visit, micturition videos of the children were recorded using a smartphone from side and top angles as they voided into a uroflowmetry (UFM) machine. To evaluate the validity, the urinary flow patterns captured in these mobile-recorded micturition videos were compared with uroflowmetry metrics, including Qmax and voided volume. Observations were independently reviewed by two pediatric urologists, one adult urologist, and two residents to assess interobserver variability and ensure consistency across clinicians. Bland-Altman analysis was conducted to measure the agreement between video-based flow assessments and traditional machine-based uroflowmetry results.
  Results: The results highlighted strong interobserver reliability, with flow patterns such as Parabolic, Straight, and Waterfall achieving perfect agreement among clinicians (Intraclass Correlation Coefficient = 1.0). Bland-Altman analysis revealed minimal variability between observers, ensuring reproducibility. Additionally, video-based assessments showed strong correlations with traditional uroflowmetry metrics. Parabolic flow patterns were associated with higher Q-max (peak flow rate), while Dribbling or Waterfall patterns indicated lower Q-max. Moderate correlations between Q-max and voided volume reflected individual variations in bladder capacity and voiding dynamics. Validation studies, such as Han et al. (2020), further confirmed the reliability of video-based recordings (rho = 0.778, p < 0.001), aligning with clinical expectations in pediatric and telemedicine settings. This study is limited by its focus on male pediatric patients, controlled clinical settings, reliance on clinician expertise, and smartphone video quality.
  Conclusions: Mobile-based video uroflowmetry can be a reliable, non-invasive alternative to conventional methods, demonstrating high interobserver agreement and strong correlations with standard metrics. Its adoption in low-income countries could address critical barriers such as cost, equipment availability, and healthcare access.

UP-15.13—Outcomes and Tolerability of Combined Mitrofanoff/Yang-Monti Channels with Ileal Pouch Reconstruction After Pediatric Cystectomy: A Report of Two Cases in North-West Cameroon 

• Ngwa-Ebogo Tagang ¹, Mbouche Landry ², Ngock George ³, Angwafo III Fru ²
  ¹ Faculty of Health Sciences, The University of Bamenda, Bamenda, Cameroon, ² Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon, ³ Mbingo Baptist Hospital, Bamenda, Cameroon

• Introduction and Objectives: Continent urinary diversion using Mitrofanoff and Yang-Monti catheterizable channels, coupled with ileal pouch reconstruction, offers a viable option for pediatric patients with non-functional bladders post-cystectomy. This report evaluates the outcomes and tolerability of these procedures in two children managed at the Regional Hospital Bamenda.
  Materials and Methods: We retrospectively reviewed two pediatric cases who underwent ileal urinary continent pouch reconstruction with catheterizable channels—Mitrofanoff in one and Yang-Monti in the other. Tolerability was assessed based on the ease of self-catheterization. Outcomes included continence, metabolic stability, and postoperative infections, monitored over a 12-month follow-up period. Case 1: A 12-year-old boy with a functional ureterostomy following radical cystoprostatectomy for bladder rhabdomyosarcoma performed four years earlier in another facility. He underwent ileal pouch reconstruction with a Yang-Monti channel due to absence of appendix. CIC was initiated postoperatively without difficulty. He achieved full continence within 3 weeks and maintained electrolyte balance. No urinary tract infections were recorded during follow-up. Case 2: A 9-year-old boy born with bladder exstrophy and a history of multiple failed reconstructive surgeries, presenting with a non-functional bladder. He underwent complete cystectomy, continent ileal reservoir creation, and Mitrofanoff channel using the appendix. He tolerated CIC well, performed independently, and achieved both daytime and nighttime continence. Mild stomal erythema was noted but resolved with conservative care. No metabolic disturbances or infections were reported.
  Results: Both patients tolerated catheterization easily and were compliant with CIC regimens. They remained continent with stable renal function and no significant electrolyte imbalances. No surgical revisions or infections occurred during the 12-month follow-up.
  Conclusions: Combined use of Mitrofanoff/Yang-Monti channels with ileal pouch reconstruction is a safe, effective, and well-tolerated urinary diversion technique for pediatric patients post-cystectomy. These cases highlight its utility in achieving continence and preserving quality of life even in resource-limited settings

UP-15.14—Re-Ablation of the Residual Posterior Urethral Valve: A Single Center Retrospective Study 

• Joarder Md Abdul Baten
  BSMMU, Dhaka, Bangladesh

• Introduction and Objectives: Residual PUV after primary ablation can be responsible for the persistence of urinary symptoms and worsening of renal function in children. This study aims to determine the impact of repeat cystoscopy and subsequent re-ablation of residual PUVs using changes in serum creatinine, uroflowmetry, and ultrasonography.
  Materials and Methods: From April 2022 to August 2023, a study was conducted at the Pediatric Urology Division of BSMMU involving 74 patients with posterior urethral valves. At three months post-diagnosis, 28 patients (37.83%) displayed symptoms, including weak stream (39.3%), straining (10.7%), dribbling (25%), and recurrent fever (3.6%). Among them, 22 had no obstructive remnant leaflets, while 6 (21.4%) did. Serum creatinine levels, Qmax and ultrasound measurements were recorded before valve ablation and at the three-month follow-up. Statistical analysis was performed using SPSS 26, with a p-value of less than 0.05 considered significant. The study received approval from the institutional ethical committee prior to commencement.
  Results: The median age for primary valve ablation was seven years (median [IQR] 7.0 [2.0, 10.7]). Repeat cystoscopy in 37.83% of patients showed a 21.4% prevalence of residual valves. Before the procedure, the mean serum creatinine level was 0.69 mg/dL, with 75% of patients having elevated levels. Significant improvement in creatinine was observed after primary ablation, dropping to 0.6 mg/dL (p = 0.0001), but only minimal improvement was noted after re-ablation (0.57 mg/dL, p = 0.68). Preoperatively, the median Qmax and PVR were 7.7 and 31.0, respectively, improving to 11.2 and 25.0 at three months. Greater dilation was observed in the left renal units (mean: 13.4 mm) compared to the right (mean: 11.9 mm). The left renal unit showed significant improvement after both ablations (p = 0.04), while the right renal unit improved without statistical significance (p = 0.14 and p = 0.29). In summary, early resolution of obstruction leads to better outcomes.
  Conclusions: The prevalence of residual PUVs after primary ablation was 21.4%, with an improvement in the trend of hydronephrosis and serum creatinine after re-ablation of residual valves. Repeat cystoscopy is therefore effective in detecting residual valves and has the added benefit of being both diagnostic and therapeutic.

UP-15.15—Thulium Laser Ablation for Broad-Based Ureteral Fibroepithelial Polyps in a Pediatric Patient: A Case of Minimally Invasive Alternative to Pyeloplasty 

• Chang Ruei-Je
  Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan

• Introduction and Objectives: Fibroepithelial polyps (FEPs) are rare benign mesenchymal tumors of the urinary tract, with upper tract involvement being particularly uncommon. In the pediatric population, they account for less than 0.5% of ureteropelvic junction obstruction (UPJO) cases, with approximately 60 cases reported to date. Clinical presentation is often nonspecific, mimicking more common obstructive uropathies. Due to their rarity, standardized treatment protocols are lacking. While endoscopic resection is increasingly favored, broad-based and multilobulated lesions have traditionally required open or laparoscopic pyeloplasty. We report a pediatric case successfully managed via Thulium laser ablation, demonstrating its potential as a minimally invasive alternative for complex FEPs.
  Materials and Methods: An 11-year-old boy presented with progressive dysuria, urinary frequency, and nocturia, accompanied by intermittent crampy upper abdominal pain, nausea, and vomiting. Renal ultrasound revealed significant left hydronephrosis. Diagnostic ureteroscopy identified broad-based, multilobulated fibroepithelial polyps at the ureteropelvic junction. Flexible ureterorenoscopy with endoscopic ureterotomy and Thulium laser ablation was performed. A double-J stent was placed and removed after 4 weeks. Follow-up imaging at 3 months confirmed resolution of hydronephrosis, and the patient remained symptom-free.
  Results: FEPs are believed to be congenital and often remain asymptomatic until they cause obstruction. While pedunculated lesions are typically treated with Holmium laser excision, broad-based polyps pose a technical challenge. In this case, the use of a Thulium laser allowed precise tissue ablation with minimal thermal spread, facilitating complete removal of the lesion while preserving surrounding structures. No perioperative complications occurred. At 3 months, imaging confirmed no residual obstruction or polyp recurrence.
  Conclusions: This case demonstrates the feasibility and efficacy of Thulium laser ablation in treating broad-based ureteral fibroepithelial polyps in a pediatric patient. The successful outcome suggests that Thulium laser may serve as a minimally invasive alternative to conventional surgery in selected cases, particularly when dealing with complex or multilobulated lesions.

UP-15.16—Using Compound Chamomile Lidocaine Gel in Pediatric Circumcision: A Randomized Controlled Trial 

• Zou Xiangyu, Sun Jie
  Shanghai Children’s Medical Center, Shanghai, China

• Introduction and Objectives: To evaluate the safety and effectiveness of compound chamomile lidocaine gel in children undergoing circumcision.
  Materials and Methods: A multicenter, randomized controlled cohort study was conducted on boys aged 8–18 years. Patients were recruited from three specialized pediatric hospitals and underwent circumcision. Participants were randomly assigned to receive postoperative wound treatment with saline alone or saline combined with compound chamomile lidocaine gel. The primary outcome was the degree of local edema one week after surgery. Secondary outcomes included maximum pain score (VAS) within 2 days postoperatively, wound healing scores, total wound healing time, cosmetic score and patient scale at 4 weeks.
  Results: A total of 180 patients were randomised into the study. In the per-protocol set, the incidence of moderate to severe edema in the intervention group was significantly lower than in the control group (10.59% vs. 24.10%). The VAS was also significantly lower in the intervention group compared to the control group (3.15 ± 1.26 vs. 5.32 ± 1.15), and the wound healing time was notably shorter (11.13 ± 3.99 vs. 12.56 ± 2.62). No significant differences were observed for wound healing scores at 3, 7, and 14 days, cosmetic scores and patient scale at 4 weeks, or infection rates at 7 and 14 days. Three adverse events occurred in the control group and were resolved with outpatient treatment.
  Conclusions: This study establishes that compound chamomile lidocaine gel serves as a safe and effective postoperative therapy for pediatric circumcision, highlighting its promising potential for clinical use.

UP-15.17—What Is the Impact on Differential Renal Function (DRF) After Pyeloplasty Surgery in Pediatric Patients with Prior Low Renal Function? Multicenter Study 

• Tobia Gonzalez Sebastian ¹, Bujons Tur Anna ², Silva Ramos Yna ³, Corbetta Juan ⁴, Fadil Iturralde Jose ⁵, Tobia Gonzalez Ignacio ⁶, Ruiz Javier ⁴, Maiolo Anabella ¹, Quiroz Madariaga Yesica ², Krikorian Jimena¹, Rosito Tiago ³
  ¹ HIAEP Sor Maria Ludovica, La Plata, Argentina, ² Fundacio Puigvert, Barcelona, Spain, ³ Hospital das Clinicas Porto Alegre, Porto Alegre, Brazil, ⁴ Hospital Garrahan, C A Buenos Aires, Argentina, ⁵ Sanatorio Parque, Rosario, Argentina, ⁶ Universidad Nacional de La Plata, La Plata, Argentina

• Introduction and Objectives: Ureteropelvic junction obstruction (UPJO) is a common pathology in pediatric urology practice. Indications for intervention are well established, while the ideal management of children with UPJO in poorly functioning kidneys is still debatable. We aimed in this study to evaluate the outcome of pyeloplasty in patients with UPJO and low DRF function.
  Materials and Methods: We retrospectively evaluated 218 children with congenital UPJO from two tertiary hospitals between 2008 and 2018. We included only those with primary unilateral UPJO and DRF ≤ 20% on diuretic renography. Open dismembered pyeloplasty with stenting was carried out in all. Patients with bilateral UPJO, solitary kidney, DRF above 20%, association with other urinary anomalies; patients who underwent previous renal or ureteric surgeries; and patients with missed follow-up were excluded. Clinical and radiological outcomes of this subgroup of patients were assessed.
  Results: A total of 21 patients (12 boys, 9 girls) with a median age at surgery of 2 years were included. Preoperative DRF ranged from 8 to 20% with a mean of 15% ± 3.5%. The median follow-up period was 2.5 years. Renal ultrasound showed improved HN in 16 patients (4 had a complete resolution) and stable in the remaining 5. Most of the improvement was noted in the first postoperative ultrasonography, 16/21 (76%). Diuretic renography showed improved DRF by 10–15% in 8 patients (38%), while the remaining patients showed stable DRF with a non-obstructive curve with a mean improvement in DRF of 8 ± 5%. No postoperative complications were encountered, and no patient required reintervention during follow-up.
  Conclusions: Children with unilateral UPJO and DRF ≤ 20% have a favorable outcome after pyeloplasty. Improvement of HN in the first postoperative renal ultrasound is a good indicator for success.

16. Penis/Testis/Urethra Cancer—Basic Science

16.1. Moderated Oral ePosters

MP-16.01—Single-Cell and Spatial Transcriptome Analysis Reveals the Potential Therapeutic Targets for Testicular Sex Cord-Stromal Cell Tumors 

• Chen Lei, Xie Yu
  Hunan Cancer Hospital, Changsha, China

• Introduction and Objectives: Testicular sex cord stromal tumor (TSCST) is a rare type of testicular tumor with an unknown molecular mechanism, tumor microenvironment (TME), and limited treatment options. To define the molecular mechanism and identify potential therapeutic targets of TSCST, we aimed to investigate its genetic and cellular characteristics using advanced sequencing techniques.
  Materials and Methods: We combined single-cell RNA sequencing (scRNA-Seq) with single-cell nuclear RNA sequencing (snRNA-Seq) and spatial transcriptomics (ST) from different regions of TSCST tumors. This multi-omics approach allowed us to analyze the expression profiles of immune cells, epithelial-mesenchymal transition (EMT) programs, and other key molecular pathways within the tumor microenvironment.
  Results: Our data revealed significantly low expression of immune-cell genes in tumor areas, indicating an immune-cold tumor environment. We also identified a critical epithelial-mesenchymal transition (EMT) program during tumorigenesis and progression. High expression levels of the androgen receptor (AR) and related genes were observed in tumor cells, suggesting that androgen receptor inhibitors could be potential therapeutic targets. Furthermore, we detected spatial intra-tumor heterogeneity, with the tumor core showing high senescence characteristics. Notably, we identified interactions between tumor cells and macrophages, promoting M2 polarization through the APP-CD74 ligand-receptor pair, which has promising therapeutic prospects for this disease.
  Conclusions: Our comprehensive analysis provides insights into the cold TME, cellular origins, spatial niches, and cell-cell interactions in TSCST. Targeting androgen receptor signaling emerges as a potential therapeutic strategy. Future research should focus on validating these findings and exploring the clinical application of androgen receptor inhibitors in treating TSCST.

17. Penis/Testis/Urethra Cancer—Clinical

17.1. Moderated Oral ePosters

MP-17.01—Impact of a Public Policy Aimed at Decreasing Testicular Cancer Mortality in Chile 

• Walbaum Jonathan, Fuentes Alberto, Rojas Alejandro, Acosta Andres, Antunez Cristobal, Santis Josefa, Moreno Nicolas, Castiglioni Enzo, Manterola Carla, Dominguez Javier
  Pontificia Universidad Católica de Chile, Santiago, Chile

• Introduction and Objectives: Chile has one of the highest worldwide mortalities for testicular cancer (TC) (1.1/100,000). In 2010, a Public Health Policy was introduced in Chile mandating urgent assessment of patients with suspected TC and adequate guideline-based evaluation, treatment and follow-up of patients within predefined timeframes. We review the impact of the implementation of this policy in two large public and private institutions.
  Materials and Methods: Between 2000 and 2022, 1571 patients were treated for TC. We retrospectively analysed a database of both institutions. Mean patient age 29.7 years. Seminoma: 781 (55.2%) and Non-Seminoma: 633 (44.8%). Stage I: 66%, Stage II: 20%, Stage III: 14%. All patients have complete follow-up for time of death. Kaplan-Meyer survival curves were estimated, and Cox-regression analysis was performed to identify factors associated with overall survival including histology, stage, pre or post policy implementation and whether the patient came from the public or private institution.
  Results: Overall survival for the whole cohort was 94% at 10 years. There was a significant improvement in 10-year overall survival after policy implementation (95.8% vs. 87.5% p < 0.001). This was more evident for Non-Seminoma patients compared to Seminoma. Furthermore, we found a significantly improved mortality in patients treated at the private centre (96% vs. 92% p < 0.01). Cox regression for mortality in the whole cohort showed that patients treated after policy implementation (HR 0.50 p < 0.01) and stage (HR 4.02 p < 0.01) were associated with less and increased mortality respectively. For Non-Seminoma patients, stage and post policy implementation also predicted overall mortality, but being treated at a public hospital was also independently associated with a poorer outcome (HR 2.38, p < 0.05).
  Conclusions: The implementation of a Public Health Policy of early assessment and treatment of TC has improved overall survival in Chile. However, there is still space to improve and an urgent need to address inequities in access to adequate health care in public institutions, especially for more complex patients having Non-Seminoma TC.

17.2. Moderated Video ePosters

MVP-17.01—Laparoscopic Bilateral Video Endoscopic Inguinal Lymphadenectomy; Lateral Approach with Deep First Technique, a Novel Approach 

• Gunjan Kamlesh, Kadian Bhopesh
  AIIMS Patna, Patna, India

• Introduction and Objectives: Video-endoscopic inguinal lymphadenectomy (VEIL) has emerged as a minimally invasive alternative to open inguinal lymphadenectomy for managing penile and vulvar cancer with inguinal lymph node involvement. Traditional VEIL techniques involve an anterior or medial approach, but these can present challenges in achieving deep nodal clearance while minimizing complications. We present a novel bilateral VEIL via lateral approach with deep first technique, which enhances surgical precision, improves lymph node yield, and reduces morbidity.
  Materials and Methods: A total of 10 cases of lateral veil were done for penile cancer cases with non-palpable bilateral inguinal nodes over 20 limbs at our centre from January 1, 2024 to March 30, 2025. The selected cases were T1b and above with bilateral, no palpable inguinal lymph nodes. Retrospective analysis was performed on patients who underwent bilateral VEIL using the lateral approach with the deep first technique. We placed closed suction drain on both sides. The lateral approach involves initial dissection of the deep inguinal nodes before proceeding superficially, allowing for better visualization and preservation of critical structures. Operative time, lymph node yield, postoperative complications (lymphedema, skin necrosis, and infection), and oncological outcomes were assessed.
  Results: We removed the drain in all patients when the output was less than 20 mL per day per drain. The operative time ranged from 90 min to 120 min. None of these patients developed vascular injury, neural injury, flap necrosis, or any serious complications. One patient developed wound infection, and one had self-limiting lymphocele. All patients were routinely discharged on POD3/4. Average lymph node yield ranged from 14–32 per side. None of the patients had positive lymph nodes. 6 patients had reactive hyperplasia. One patient’s nodal metastasis on left side, which came out to be negative after VEIL. Oncological outcomes were comparative to the classical VEIL and open modified inguinal lymphadenectomy. As of now all patients are doing well.
  Conclusions: Bilateral VEIL via lateral approach with deep first technique represents a promising modification to standard VEIL, offering enhanced oncological control with a potentially lower complication profile. Further studies with larger cohorts and long-term follow-up are needed to validate its efficacy and safety.

17.3. Residents Forum Moderated Oral ePosters

RF-17.01—The Accuracy and Utility of Artificial Intelligence Chatbots in Delivering Patient-Centred Information on Testicular Cancer 

• Lucas Harrison ¹, Sathianathen Niranjan ², Corcoran Niall ¹
  ¹ Western Health, Melbourne, Australia, ² Austin Health, Melbourne, Australia

• Introduction and Objectives: Testicular cancer is the most frequent solid tumour among young men and often prompts patients and their families to search for information online, including through artificial intelligence (AI) chatbots. However, the quality, accuracy and readability of AI-generated content on testicular cancer remains unclear. This study aims to evaluate the ability of current AI chatbots provide high-quality, understandable, and actionable information about testicular cancer for patients.
  Materials and Methods: 20 common questions about testicular cancer, based on frequently asked questions from the American Cancer Society and Google Trends, were entered into four AI chatbots: ChatGPT (version 3.5), Perplexity, ChatSonic, and Bing AI. Each response was independently evaluated using validated assessment tools. The DISCERN instrument (1–5 scale) was used to measure information quality. The PEMAT tool assessed understandability and actionability (reported as percentages). Readability was measured using the Flesch-Kincaid Readability Score, and misinformation was evaluated using a 5-point Likert scale compared with current clinical guidelines. Word count was also recorded for each response.
  Results: AI chatbot responses demonstrated moderate to high quality, with a median DISCERN score of 3.5 (IQR 3–4). Misinformation was minimal, with a median Likert score of 1.5 (IQR 1–2), suggesting generally accurate content. The median word count per response was 310 (IQR 250–370). Readability was slightly more accessible than expected, with a median Flesch-Kincaid score of 54.6 (IQR 48.2–59.0), corresponding to a 10th–12th grade level. Understandability was high, with a median PEMAT score of 85% (IQR 78–90), but actionability remained low, at 42% (IQR 35–52).
  Conclusions: AI chatbots provide generally accurate, readable and understandable information about testicular cancer, suggesting it has value as a supplemental information source for patients and their families. Yet, the limited actionability highlights a gap in the ability of AI chatbots to offer practical management advice. Further development is needed to enhance the utility of AI tools in clinical education and shared decision-making.

RF-17.02—Video Endoscopic vs. Open Inguinal Lymph Node Dissection: Oncological Outcomes for Penile Cancer Patients over a 15 Year Period 

• Kumar Ranya ¹, Sethia Krishna ², Kumar Vivekanandan ²
  ¹ University of Cambridge, Cambridge, United Kingdom, ² Norfolk and Norwich University Hospital, Norwich, United Kingdom

• Introduction and Objectives: Lymph node metastasis status is the strongest predictive factor for penile cancer survival. The current gold-standard treatment is radical inguinal lymph node dissection (ILND). Though video-endoscopic ILND (VEILND) had shown reduced morbidity in the short term over open ILND (OILND), its oncological efficacy long-term is unproven. We present our long-term oncological follow up of our previously published ILND cohort.
  Materials and Methods: A prospectively collected institutional database was used to determine the outcome in 42 consecutive patients treated for penile cancer in a tertiary referral centre between 2008–2015. Overall and cancer-specific survival was calculated using Kaplan-Meier curves and compared via log-rank test.
  Results: 42 patients underwent 68 ILND (35 OILND vs. 33 VEILND). 13/42 patients were alive at a mean follow-up of 11.3 years. Overall survival for OILND and VEILND were 32% and 30% (p = 0.90), and cancer specific survival were 73% & 75% (p = 0.87) respectively. When stratified by nodal status, CSS for OILND was 77.8%, 85.7%, 50% and 50% (N0, N1, N2 and N3) compared to VEILND, which were 100%, 80%, 75% and 40% respectively (p = 0.80). Thus, there was no significant difference in survival between patients undergoing VEILND and OILND. Moreover, inguinal or pelvic nodal recurrence rate was equivalent in both groups, occurring in 5/22 OILND and 4/20 VEILND patients (p = 1.00).
  Conclusions: To our knowledge, we present the first European report of long-term follow-up demonstrating the oncological safety of VEILND. VEILND has comparable outcomes of recurrence, overall survival and cancer-specific survival, with significantly reduced complication rates and length of stay, in penile cancer at minimum of 8 year and mean 11.3 year follow up.

17.4. Unmoderated Standard ePosters

UP-17.01—BCG Response in NMIBC: Are Histological Subtypes a Game-Changer? 

• Sousa Helena, Lobo João, Alzamora Maria, Campos Jorge, Braga Isaac, Freitas Rui
  IPO Porto, Porto, Portugal

• Introduction and Objectives: Adjuvant immunotherapy with Bacillus Calmette-Guérin (BCG) is considered the gold-standard treatment for high-risk non–muscle-invasive bladder cancer (NMIBC). However, when NMIBC is associated with histological subtypes, the oncological risk is even higher, and the response to intravesical BCG immunotherapy remains uncertain. There are concerns regarding progression to muscle-invasive bladder cancer (MIBC), which is associated with a worse prognosis.
  Materials and Methods: We conducted a retrospective analysis of patients with stage T1 NMIBC who underwent BCG treatment between 2015 and 2024. The aim was to evaluate and compare treatment responses between patients with pure urothelial carcinoma and those with histological subtypes.
  Results: A total of 191 patients were included, of whom 158 had pure urothelial carcinoma (U) and 33 had histological subtypes (HS). The distribution among HS cases was as follows: squamous (39%), glandular (21%), micropapillary (15%), poorly differentiated (6%), plasmacytoid (6%), and multiple subtypes (15%). There were no significant differences between the groups regarding age (70.2 ± 9.8 years) or gender. However, the HS group showed a significantly higher association with carcinoma in situ (CIS) (42.4% vs. 24.2%; p < 0.05). No statistically significant differences were observed between the groups in terms of: Completion of the full BCG regimen: U 49.6% vs. HS 45.2%, p = 0,654. Rate of BCG-unresponsive tumors: U 15.8% vs. HS 21.2%, p = 0,451. Disease recurrence: U 23.4% vs. HS 24.2%, p = 0,919. Progression to MIBC: U 9.6% vs. HS 12.9%, p = 0,388. Subsequent radical cystectomy: U 16.0% vs. HS 21.2%, p = 0,470. Metastasis: U 6.3% vs. HS 3.0%, p = 0,403. NMIBC-related mortality: U 4.7% vs. HS 12.1%, p = 0,114.
  Conclusions: Despite the inherent limitations of the retrospective nature of this study and the potential impact of patient refusal of radical cystectomy on therapeutic decisions, our results suggest that, in NMIBC with histological subtypes who opt against radical cystectomy, an individualized bladder-preserving approach may be a viable option. Stratification based on the proportion of the histological subtype—often not reported in pathology reports—and the identification of specific histological patterns could contribute to better risk assessment and more personalized treatment decision-making for these patients.

UP-17.02—Burnt-Out GCT: Uncovering the Hidden Diagnosis—A Case Series 

• Sousa Helena, Alzamora Maria, Campos Jorge, Braga Isaac, Freitas Rui, Lobo João
  IPO Porto, Porto, Portugal

• Introduction and Objectives: Regressed germ cell tumors (GCTs), also called “burnt out tumor”, are rare phenomena in which the primary testicular tumor regresses spontaneously, however often showing evident metastatic disease. This regression is believed to be driven by immune responses, hypoxia, or spontaneous apoptosis. Additionally, chemotherapy-induced tumor regression can lead to misclassification as a primary extragonadal tumor if the testicular origin is not identified. Early recognition of these cases is crucial to prevent delays in diagnosis and treatment.
  Materials and Methods: A retrospective review (2012–2025) was conducted at a Portuguese reference center for testicular cancer. Clinical presentation, ultrasound findings, tumor markers, treatments, and histopathological results from orchiectomy specimens were analyzed.
  Results: Seventeen patients were analyzed with a confirmed diagnosis of regressed GCT. Only 29.4% of patients had a palpable testicular mass, while 47.1% presented with a retroperitoneal mass. Notably, 41.2% sought medical attention solely for extratesticular symptoms, including lower back pain (23.5%), abdominal pain (29.4%), and gastrointestinal disturbances. Regarding the ultrasound findings, a scrotal nodule was identified in 9 patients (52.9%), while 7 patients (41.1%) exhibited heterogeneous scrotal areas without a clearly defined nodule. At diagnosis, 23.5% of patients had distant metastases, affecting the lungs, brain, mediastinum, or obturator region. 11 patients received pre-surgical chemotherapy. Histopathological analysis of orchiectomy specimens revealed fibrosis (64.7%), microlithiasis (29.4%), necrosis (23.5%), and seminiferous tubule atrophy (11.7%). GCNIS was identified in 41.2% of cases. The most recent patient, diagnosed in 2025, had an elevated M371 test (RQ = 64) at presentation, which decreased to RQ = 8 after three cycles of BEP chemotherapy, indicating treatment response.
  Conclusions: Burnt-out GCTs pose a diagnostic challenge due to their atypical presentation, often leading to delayed recognition. The absence of a palpable testicular tumor in nearly 70% of cases highlights the need for systematic testicular ultrasound in patients with retroperitoneal masses or metastatic disease of unknown origin. Increasing awareness of burnt-out GCTs among urologists and pathologists is essential for accurate diagnosis and timely intervention. Encouraging young men to perform regular testicular self-examinations remains crucial for early detection and improved outcomes.

UP-17.03—Cavernous Hemangioma of the Testis: A Rare Presentation of Testicular Mass and Review of Literature 

• Maciel Rui, Rodrigues Raquel, Amorim Rui, Bastos Samuel, Sabença Ana, Lourenço Miguel, Peralta João, Silva João, Nascimento Maria
  Unidade Local de Saude Gaia e Espinho, Vila Nova De Gaia, Portugal

• Introduction and Objectives: Testicular hemangiomas are rare, benign, vascular tumours that arise within the testicular parenchyma or associated with other intrascrotal structures. Although the majority are asymptomatic, occasionally they can present with pain due to haemorrhage and ischemia and can occasionally be associated with testicular torsion, posing a significant diagnostic and therapeutic challenge, often requiring radical surgical approach.
  Materials and Methods: Consultation of patient’s clinical records.
  Results: 27 year-old African man with no prior relevant history presented to the ER with palpable hard mass in left testis with 2 years of evolution, with 6-day sudden increase in swelling and pain. No other symptoms such as fever, LUTS or haematuria were reported. Physical examination revealed a hardened the left testis, increased in volume and tender to palpation. The right testis was unremarkable. Scrotal ultrasound revealed a heterogeneous left testis, with small, dispersed cystic artefacts, lobulated contours, suggestive of underlying diffuse infiltrative process. Doppler study revealed no vascularization of the mass, suggestive of ischaemia. Preoperative tumour markers were negative. Urgent radical orchiectomy was performed, given the high suspicion for potential malignancy. Histopathological examination revealed a benign looking neoplastic mass constituted by heavily congested dilated blood vessels, without cellular atypia. There are visible areas of ischemic necrosis with recent haemorrhage. Peripherally there are visible fibrin clogged blood vessels with rechannelling phenomena. In the testicular parenchyma there are extensive areas of ischemic necrosis and evidence of recent hemorrhage, with occasional foci of active spermatogenesis. The testicular tunica reveals fibrosis with mild to moderate lymphocytic infiltrate and reactive mesothelial cells in correlation with abundant fibrino-hemorrhagic exudate, compatible with a cavernous hemangioma of the testis.
  Conclusions: Testicular hemangiomas are rare, benign, congenital vascular tumours that originate from the proliferation of vascular endothelial cells and are extremely rare in the intratesticular location, with only about 50 cases described in literature. The presentation at a young age with testicular mass or orchialgia may mimic other more common entities, such as testicular torsion or tumours. Although ultrasound and serum tumour markers can help with differential diagnosis, only histopathological examination of radical orchiectomy specimens can confirm the benign nature of these lesions.

UP-17.04—Does Sperm Banking and Testicular Prosthesis Insertion Cause Operative Delays and Post-Operative Infections in Radical Orchidectomy for Testicular Cancer? 

• Ahmad Talal, Desai Chaitya, Ehsanullah Syed
  Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, United Kingdom

• Introduction and Objectives: British Association of Urological Surgeons (BAUS) recommends offering sperm banking and testicular prosthesis insertion to all men undergoing radical orchidectomy for suspected testicular cancer. There are concerns sperm banking can cause delays to time-critical radical orchidectomy operations in this cohort. Furthermore, post-operative wound infections with testicular prosthesis may delay adjuvant chemotherapy or radiotherapy. Our study evaluated clinical attitudes and timelines towards offering sperm banking and complication rates with testicular prosthesis insertion in patients having radical orchidectomy for suspected testicular cancer.
  Materials and Methods: All patients who underwent radical inguinal orchidectomy for suspected testicular cancer over a 5-year period (2018–2023) at Royal Shrewsbury Hospital were retrospectively reviewed for the following data points: patient demographics, counselling for sperm banking or testicular prosthesis, timeline to radical orchidectomy, and post-operative complications. Exclusion criteria included: patients under 16 years of age and those who underwent an orchidectomy for emergency indications.
  Results: Total of 69 patients were included in the study (mean age: 42.5 years). During pre-operative consultation, 39 patients (56.5%) were offered sperm banking, of which 20 patients (51.3%) accepted it prior to radical orchidectomy. In this cohort, time from pre-operative clinic consultation to radical orchidectomy was on average 18.4 days (range: 9–40 days). In contrast, 49 patients who did not undergo sperm banking waited 19.1 days (range: 2–45 days) between pre-operative clinical consultation and radical orchidectomy. 36 out of 69 patients (52.2%) were offered testicular prosthesis insertion during their pre-operative clinic consultation. 11 patients received prosthesis insertion at time of radical orchidectomy. There were no post operative infections in this cohort. In the remaining 58 patients who did not receive testicular prosthesis, 4 (6.9%) developed post-operative infections, and 1 (1.7%) developed an inguinal hernia.
  Conclusions: Our results show that there is no significant difference in time to radical orchidectomy for patients undergoing sperm banking at our District General Hospital. The risk of post operative infection and subsequent delays in adjuvant treatment is negligible with testicular prosthesis insertion at the time of primary surgery, as determined by re-admission or need for further surgery. These reassuring results validate the BAUS guidance for patients to be appropriately consented in clinic.

UP-17.05—Evaluation of Community Testicular Ultrasound Referrals for Suspected Testicular Cancer—A Review of Appropriateness and Outcome 

• Safdar Haadia, Patel Mya, Sheriff Matin, Masood Shikohe, Burki Javed, Ghumman Faisal
  Medway NHS Foundation Trust, Gillingham, Kent, United Kingdom

• Introduction and Objectives: Testicular cancer accounts for 1% of adult neoplasms and 5% of urological tumors, with 90–95% being germ cell tumors (GCT). Peak incidence occurs in the third and fourth decades. Scrotal ultrasound (US) is the first-line imaging modality for suspected testicular cancer, offering high sensitivity and specificity for mass detection and characterization. This single centre review evaluates the appropriateness of community testicular US referrals, focusing on clinical indications, diagnostic accuracy, and treatment outcomes.
  Materials and Methods: Retrospective review of database was conducted to extract all the rapid access referrals received for testicular lesions (pain/lumps) in a year (December 2022 to December 2023). A total of 132 referrals were received. These referrals were analyzed based on patient age, clinical presentation, and imaging findings. Diagnostic outcomes, including histopathological diagnoses and tumor marker evaluations (AFP, β-hCG, LDH), were assessed. Cases requiring orchiectomy were reviewed to correlate referral indications with confirmed malignancy.
  Results: Patients ranged from 17 to 88 years (mean: 50.6 years). Most referrals (90%) were for painless scrotal swelling or lumps, with 10% for painful swelling. 118 out of 132 (89.5%) patients had benign findings on clinical examination and USS and were taken off the rapid access pathway. Only 8 out of 132 (6%) patients underwent orchiectomy for suspected testicular cancer. Histopathological diagnoses included pure seminoma (5), mixed GCT (1), adenomatoid tumor (1), and one benign case revealing no atypia or malignancy. Tumor markers showed normal AFP & β-hCG in all the patients, whereas only one patient had slightly raised LDH of 529 U/L (Normal Range: 240–480 U/L).
  Conclusions: Scrotal ultrasound remains critical for evaluating suspected testicular cancer. However, inappropriate referrals may lead to unnecessary interventions, placing additional burden on clinical pathways, causing extra stress for patients undergoing these investigations, and increasing healthcare costs. Improved referral protocols, enhanced education for primary care providers, and regular audit processes are essential to optimize resource use, reduce unnecessary investigations, and improve overall patient outcomes.

UP-17.06—Lateralization of Testicular Cancer and Its Clinical Importance 

• Kallinikas Georgios ¹, Zakopoulou Roubini ², Haronis Georgios ¹, Kozyrakis Diomidis ¹, Filios Panagiotis ¹, Konomi Anna Maria ¹, Konstantinopoulos Vasileios ¹, Karmogiannis Athanasios ¹, Bozios Dimitrios ¹, Mitiliniou Despoina ¹, Safioleas Konstantinos ¹, Rodinos Evangelos ¹, Filios Athanasios ¹, Tsoporis James ³
  ¹ Konstantopouleion-Patision Hospital, Athens, Greece, ² General Oncological Hospital of Kifisia-Agioi Anargyroi, Kifisia, Greece, ³ University of Toronto, Toronto, Canada

• Introduction and Objectives: Testicular cancer, though relatively uncommon, is the most prevalent malignancy among males aged 15 to 35 years. Its incidence has notably increased over the past four decades. While several risk factors, such as cryptorchidism and familial history, have been well-documented, the role of tumor laterality—whether the malignancy occurs in the right or left testis—remains an area of active investigation. Interestingly, cryptorchidism, a significant risk factor for testicular cancer, is more commonly observed on the right side, leading to a slightly higher incidence of right-sided testicular cancers. Our study aimed to assess testicular tumor laterality, its relation to cyptorcidism, as well as its correlation with literature-based clinical outcomes.
  Materials and Methods: Our team conducted a retrospective analysis of elective orchiectomies performed at our institution between January 1, 2020, and March 31, 2024. This study specifically examined tumor laterality, aiming to provide possible relation to cryptorchidism as well as further insights into its potential clinical significance.
  Results: Over a nearly five-year period at our care center, 21 orchiectomies were performed, with 14 cases (67%) involving the right testis and 7 (33%) affecting the left (p = 0.189). None of our patients had a history of cryptorcidism. Despite the limitation of a relatively small sample size, this finding suggests a notable lateralization trend. Interestingly, emerging evidence indicates that testicular cancer arising from the right testis may be associated with a less favorable prognosis, underscoring the potential clinical relevance of tumor laterality.
  Conclusions: Emerging evidence suggests that right-sided testicular cancer may be associated with higher incidence as well as a poorer prognosis. While existing literature associates the increased incidence of right-sided testicular cancer with the higher prevalence of right-sided cryptorchidism, our study reveals a distinct pattern: we observed a greater incidence of right-sided testicular cancer independent of cryptorchidism. This finding suggests that other factors, beyond cryptorchidism, may contribute to the laterality of testicular cancer, warranting further investigation into the underlying mechanisms. These findings highlight the need for further large-scale studies to explore the prognostic significance of tumor laterality and its potential implications for clinical decision-making.

UP-17.07—Malignant Hypercalcemia as a Marker of Tumor Progression and Predictive Factor for Total Penectomy in Penile Cancer: A Retrospective Study 

• Lerma Landeros Jesus, Morales Montor Jorge, Martinez Arroyo Carlos, Cantellano Orozco Mauricio, Fernandez Noyola Gerardo, Anceno Alec, Pacheco Gahbler Carlos
  Hospital Gea Gonzalez, Ciudad De Mexico, Mexico

• Introduction and Objectives: Penile cancer presents significant therapeutic and psychological challenges. In many developing countries like Mexico, it is often diagnosed at advanced stages due to late presentation and sociocultural stigma. While early tumors can be treated with organ-sparing surgery, advanced cases may require total penectomy—a procedure with profound functional and emotional consequences. Although lymph node involvement is the main prognostic factor, the role of biochemical markers like malignant hypercalcemia remains underexplored. This study aimed to assess the clinical relevance of malignant hypercalcemia in penile cancer and identify variables associated with total penectomy.
  Materials and Methods: We performed a retrospective, descriptive study of 104 penile cancer patients treated from January 1998 to August 2024 at Hospital in Mexico City. Demographic, clinical, pathological, and laboratory data were collected. The primary outcome was total penectomy. Bivariate comparisons and multivariate binary logistic regression were used to identify independent predictors. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Sample size adequacy was confirmed (α = 0.05, power = 80%).
  Results: The median age was 59 years (IQR: 50–68.5). Malignant hypercalcemia was present in 46.15% of patients overall and in 100% of those with distant metastases. A significant correlation was found between hypercalcemia and recurrence (85.71%), as well as tumor progression. Total penectomy was performed in 29.80% of patients. In multivariate analysis, the presence of fixed lesions (aOR = 154.8; 95% CI: 21.30–1125.08), Buck’s fascia invasion (aOR = 29.13; 95% CI: 1.21–701.9), metastases (aOR = 23.72; 95% CI: 1.83–306.41), and primary tumors classified as T3 (aOR = 16.41; 95% CI: 2.24–120.0) were independently associated with total penectomy. Histologically, squamous cell carcinoma was predominant (88.46%), with a 6.73% metastasis rate and 4.80% recurrence.
  Conclusions: Total penectomy in penile cancer patients is strongly associated with indicators of advanced disease, particularly fixed lesions, local invasion, and metastasis. Malignant hypercalcemia, emerged as a potential marker of tumor progression and poor prognosis, being significantly associated with metastases and recurrence. These findings underscore the importance of early detection, comprehensive staging, and biochemical surveillance. Proactive identification of high-risk patients, including those with hypercalcemia, may improve oncologic outcomes and help guide surgical decision-making in this uncommon but aggressive malignancy.

UP-17.08—Outcomes of Complex Circumcisions for Pre-Cancerous and Cancerous Penile Lesions in a Tertiary Referral Centre: A Retrospective Cohort Study 

• Elmousili Mahmoud ¹, Sangar Vijay ², Abdullah Muhammad ³
  ¹ Wythenshawe Hospital, Manchester, Manchester, United Kingdom, ² The Christie NHS Foundation Trust, Manchester, United Kingdom, ³ Manchester University, Manchester, United Kingdom

• Introduction and Objectives: To evaluate the complication rates of complex circumcisions performed for penile cancer, penile intraepithelial neoplasia (PeIN), and severe lichen sclerosis and to identify any predictors of postoperative complications.
  Materials and Methods: A retrospective cohort study was conducted at a tertiary urology centre. Records of 191 male patients who underwent complex circumcisions between 2014 and 2020 were reviewed. Complex circumcision was defined as circumcision for cancerous or pre-cancerous lesions, condyloma, or severe lichen sclerosis with >50% adherence to the glans. Patient demographics, indications, surgical variables, and complications were analysed. Complications were graded using the Clavien-Dindo classification.
  Results: The overall complication rate was 11%. The most common complications were infection (n = 5) and altered glans sensation (n = 5). Consultant-performed procedures had a significantly higher complication rate (14%) compared to those performed by trainees (2.3%) (p = 0.05), likely reflecting case complexity. No statistically significant associations were found between complications and patient age, indication, cancer stage or grade, type of circumcision, or suture technique. All complications were Clavien-Dindo Grade I or II, and there were no readmissions.
  Conclusions: Complex adult circumcisions, particularly in oncological cases, carry a modest complication risk. While consultant-led procedures had higher complication rates, this likely reflects the referral of more complex pathology. These findings provide a UK-based evidence base for consenting patients undergoing circumcision for malignant or pre-malignant indications.

UP-17.09—Primary Urethral Squamous Cell Carcinoma: Insights and Outcomes from a 27-Year Institutional Experience 

• Zahir Mazyar, Doshi Chirag, Escobar Domenique, Daneshmand Siamak
  USC/Norris Comprehensive Cancer Center, Los Angeles, United States

• Introduction and Objectives: Primary urethral cancer is one of the rarest cancers worldwide, resulting in limited data and ongoing debates about the optimal standard of care. This study aimed to share our institutional experience in treating primary squamous cell carcinoma (SCC) of the urethra, the most common histologic subtype of urethral carcinoma.
  Materials and Methods: Utilizing an IRB-approved urethral cancer database, we conducted a retrospective review, identifying patients diagnosed with primary urethral carcinoma based on International Classification of Diseases codes (ICD-10: C-68 and ICD-9: 189.3). Codes related to “Secondary malignant neoplasm of other urinary organs” were also examined to ensure comprehensive patient identification. Data on patient demographics, baseline characteristics, treatments, and outcomes were extracted and analyzed.
  Results: We identified 68 patients with primary urethral cancer from August 1997 to September 2023, of whom 35 (51.5%) had primary SCC of the urethra. Baseline characteristics are summarized in Table 1. Among the 35 patients, 16 (45.7%) received neoadjuvant chemotherapy, with gemcitabine-based regimens being the most common (N = 8), followed by TIP (paclitaxel, ifosfamide, and cisplatin) in 6 patients. Urethrectomy—total (N = 10) and partial (N = 2)—was the most frequent surgical procedure, followed by penectomy and radical cystectomy. The median follow-up time was 2.4 years. Seventeen (48.6%) patients received adjuvant treatment, primarily TIP combination therapy (N = 5, 29.4%) and pembrolizumab (N = 4, 23.5%). The 5-year recurrence free survival and overall survival rates were 56.8% and 93.8%, respectively.
  Conclusions: Our findings indicate that, while the overall survival of primary urethral SCC patients is relatively favorable, there remains a lack of consensus regarding the standard of care for this malignancy. Additionally, despite the extended timeline of our study, the follow-up duration was relatively short. These results highlight the need for larger multi-institutional studies with longer follow-up periods to establish a clearer standard of care for primary urethral cancer.

UP-17.10—Revolutionizing Penile Cancer Treatment: Efficacy of Videoendoscopic Inguinal Lymph Node Dissection 

• Shetty Rajath, Nayyar Rishi
  AIIMS New Delhi, Delhi, India

• Introduction and Objectives: Inguinal lymph node dissection (ILND) is essential for staging and treatment in penile carcinoma patients. Video-endoscopic inguinal lymphadenectomy (VEIL) was developed to minimize complications for patients requiring bilateral ILND. This study aims to assess the feasibility, safety, and preliminary oncological outcomes bilateral VEIL.
  Materials and Methods: Retrospective single center analysis. All of them underwent a standard VEIL; all procedures followed the standardized technique. Inclusion criteria included penile cancer patients with no palpable lymph nodes and intermediate/high-risk disease.
  Results: The mean age was approximately 46.3 years (35–62 years) and mean lymph node yield of about 9.11 lymph nodes. 66.7% of the cases involved partial penectomy, while 33.3% required total penectomy. The tumor characteristics varied, with 55.6% having T2 stage and 44.4% having T3 stage, while all had adequate margins. Histopathological analysis revealed 44.4% patients with well differentiated SCC and 55.6% patients with moderately-differentiated SCC. There was no HPV involvement. There was also no perineural invasion, while only 11.1% that is one of the patients had lympho-vascular invasion. Lymph node assessment indicates that no patients showed signs of metastasis, with 100% reported as negative in both right and left lymph nodes. No further treatment was indicated for any of the patients. All of the patients are alive with no significant morbidity.
  Conclusions: VEIL appears to provide effective long-term oncological control with reduced morbidity. In the absence of non-invasive stratification techniques like dynamic sentinel node biopsy, VEIL has become a viable option for managing non palpable lymph nodes with higher than T1 disease in penile cancer intermediate/high-risk disease.

UP-17.11—Risk Factors for Very Late Relapse in Testicular Cancer 

• Gonzalez Jimenez David, Martinez Gonzalez Beatriz, Rodriguez Ormaza Ander, García Manzanares Adrián, Boiko Oleksandr, Prieto Millán Sergio, Llorente García Ana, Sanz Casero Joel, Iliuta Florina, Lázaro España Daniel, De La Mata García Jorge, Lecumberri Castaños David
  Hospital Universitario Cruces, Barakaldo, Spain

• Introduction and Objectives: Different studies identify pathological subtype (especially non-seminomatous tumors), advanced stage, absence of adjuvant treatment when indicated, or age as risk factors for very late relapse (more than five years after diagnosis).
  Materials and Methods: A retrospective analysis of patients with testicular cancer who have been followed up at our hospital was conducted, aiming to identify those who would benefit most from continued follow-up beyond the first five years.
  Results: A total of 128 patients were included, of whom 7 (5.46%) experienced a very late relapse, defined as recurrence occurring more than five years after initial follow-up. Non-seminomatous histology was observed in 3 of these 7 patients (42.85%), compared to 44 of 121 patients (36.97%) in the non-relapse group (p = 0.754). The mean age of the overall cohort was 34.9 years (SD 9.4). Patients with VLR had a significantly lower mean age (27.14 years, SD 6.06) compared to those without relapse (35.37 years, SD 9.18; p = 0.021). Logistic regression analysis showed a trend toward a significant association between younger age and very late relapse (OR 0.875; 95% CI: 0.74–1.00; p = 0.026). Among patients with very late relapse, 71.4% (5) had stage I, while 14.3% (1) had stage II, and 14.3% (1) had stage III disease. In comparison, patients without relapse had similar distribution: 72.73% (88) stage I, 18.18% (22) stage II, and 9.09% (11) stage III, with no significant differences between groups (p = 0.883).
  Conclusions: No significant differences were observed in histological subtype or disease stage between patients with very late relapse and those without; however, the small sample size may have influenced these results. A significant trend toward very late relapse was observed. These findings suggest that younger patients may benefit from extended follow-up beyond five years.

UP-17.12—Routine Foreskin Pathology in Adults: Low Yield, High Cost: Time to Change Practice? 

• McLean Kenneth, Gardner Ellen, Kirkwood Kathryn, Laird Alexander, Blackmur James
  Western General Hospital Edinburgh, Edinburgh, United Kingdom

• Introduction and Objectives: Routine pathological assessment of adult circumcision specimens remains widespread despite a low diagnostic yield for premalignant or malignant lesions. As such, recent Royal College of Pathologists guidelines advise against this practice. This study aimed to audit the clinical utility and cost-effectiveness of routine foreskin pathology in adults.
  Materials and Methods: A retrospective audit was conducted of all adult circumcisions (age ≥ 16) performed between January 2015 and February 2025 at a UK tertiary urology service providing regional penile cancer management. Clinical and pathology records were reviewed to identify unexpected cancer diagnoses—defined as cases with no prior biopsy evidence or clinical suspicion of cancer. The number needed to screen (NNS) to detect one cancer was calculated, and pathology costs were estimated based on local processing costs and the pathologist workload score for each sample.
  Results: There were 3602 adult circumcisions performed between 2015 and 2025, with 2.8% (n = 102/3602) cancers detected on pathological assessment. Of these, 78.4% (n = 80/102) had a prior diagnosis or suspicion of penile cancer. Of the 22 without a suspicion of penile cancer, circumcision was predominantly indicated for phimosis (77.3%, n = 17/22) or in the context of inflammation (red patch) or viral warts (22.7%, n = 5/22). The NNS on routine pathology for unexpected cancers was 164, although pathology results only resulted in further treatment for 13.6% (n = 3/22) of patients (all of which consisted of only local ablation or completion circumcision). Therefore, the NSS for identification of penile cancer requiring additional treatment was 704. Rationalising pathology to only clinically suspicious cases was estimated to reduce associated costs by up to 95.8% (£8800 annual saving).
  Conclusions: Pathological assessment after circumcision for known or suspected penile cancer remains important. Routine foreskin pathology after adult circumcision has a low diagnostic yield for unexpected malignancy and rarely alters management. Targeting pathology to clinically suspicious cases may optimise resource use, aligning with national guidelines and delivering substantial cost savings.

UP-17.13—Subinguinal Orchidectomy for Testicular Cancer: Is This the Way Forward or Is It an Unnecessary Innovation? 

• Jacob Dayan
  James Cook University Hospital, Middlesbrough, United Kingdom

• Introduction and Objectives: Subinguinal orchidectomy is a variation of the traditional high inguinal approach for testicular cancer, differing in the level of spermatic cord excision. While the subinguinal approach preserves the inguinal canal and ilioinguinal nerve, concerns remain about residual disease in the proximal cord and its impact on oncological outcomes. This review evaluates oncological outcomes and complications of subinguinal orchidectomy. Subinguinal orchidectomy is a variation of the traditional high inguinal approach for testicular cancer, differing in the level of spermatic cord excision. While the subinguinal approach preserves the inguinal canal and ilioinguinal nerve, concerns remain about residual disease in the proximal cord and its impact on oncological outcomes. This review evaluates oncological outcomes and complications of subinguinal orchidectomy.
  Materials and Methods: A search was conducted across five databases (PubMed, Scopus, Google Scholar, Cochrane Library, Embase). Studies reporting inguinal vs. subinguinal orchidectomies, tumor grade, oncological outcomes, complications, and follow-up were included. Descriptive statistics were performed using Microsoft Excel.
  Results: Of 25 studies screened, two were eligible for review, including data from 264 patients (2000–2024). A subinguinal orchidectomy was done in 54.7% (n = 144) of cases. Unsatisfactory oncological control was observed in 12.5% (n = 18) of subinguinal cases, with 78% (n = 14) due to cancer relapse, 16.5% (n = 3) spermatic cord invasion, and 5.5% (n = 1) positive margins. One study comparing both subinguinal and high inguinal approaches found no differences in oncological outcomes between Stage 1 and Stage 2–4 cancers (p = 0.91, & p = 0.78, respectively). One study reported that 9.5% of patients who underwent subinguinal orchidectomy (n = 4) developed seromas post-operatively.
  Conclusions: Current evidence, though limited, suggests no significant differences in oncological outcomes between subinguinal and high-inguinal orchidectomies. While retrospective studies support this, prospective trials are required to better valuate the oncological risk–benefit ratio of subinguinal orchidectomy.

UP-17.14—Survival and Recurrence After Retroperitoneal Lymph Node Dissection in Nonseminomatous Germ Cell Tumors: A Retrospective, Cohort Study 

• Nayak Brusabhanu, Das Shritosh, Batra Atul, Seth Amlesh
  All India Institute of Medical Sciences, Bhopal, India

• Introduction and Objectives: Nonseminomatous germ cell tumors (NSGCTs) are the predominant solid malignancy affecting young males globally. This study evaluates the 5-year overall survival (OS) and recurrence-free survival (RFS) outcomes following post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) in NSGCT patients at a tertiary center.
  Materials and Methods: A retrospective cohort study was conducted from January 2015 to December 2023, including NSGCT patients who underwent PC-RPLND. Patient demographics, tumor characteristics, operative details, and histopathological findings were analyzed. Survival analysis was performed using Kaplan-Meier curves.
  Results: Among 46 patients included, the majority had mixed nonseminomatous GCTs (84.8%). The 5-year OS rates were 100%, 92.3%, and 86.2% for good, intermediate, and poor-risk groups, respectively. The 5-year RFS rates were 100%, 93.3%, and 73.3% for the same groups. Pathological examination revealed teratoma (54.3%), viable tumors (15.2%), and necrosis (30.4%) in the resected specimens. The recurrence rates were high in the poor-risk patients (23.5%), as compared to good (0%) and intermediate-risk (6.7%) (p = 0.054).
  Conclusions: Our findings demonstrate excellent outcomes in 5-year OS and RFS rates, reflecting advancements in treatment strategies for nonseminomatous GCTs. A multi-disciplinary approach is essential for providing optimum treatment for such patients.

UP-17.15—The Role of Glans Resurfacing in Penile Tumors—A Clinical Case 

• Guerra Ana João, Sousa Tiago, Jarimba Roberto, Figueiredo Susana, Quaresma Vasco, Figueiredo Bárbara, Parada Belmiro, Figueiredo Arnaldo
  Unidade Local de Saúde de Coimbra, Coimbra, Portugal

• Introduction and Objectives: The approach to superficial penile neoplasia is controversial, and there are various therapeutic modalities with non-negligible associated recurrence rates. With the growing trend to abandon non-organ-sparing surgical treatments, glans resurfacing has been considered as an option for treatment of superficial penile tumors. We present the clinical case of a patient with superficial penile neoplasia who underwent glans resurfacing and to describe the respective surgical technique.
  Materials and Methods: To describe the surgical technique of glans resurfacing step by step, an organ-sparing and function-preserving technique in the treatment of superficial penile neoplasia, in the setting of a patient with recurrence.
  Results: We present the case of a patient initially evaluated in a urology consultation after an initial episode of urinary retention probably related to phimosis and tightness of the urethral meatus. On objective assessment, the alterations were suspected of being erythroplasia of Queyrat or balanitis xerotica obliterans, and he underwent a circumcision in November 2020, the histology of which revealed Balanitis Xerotica Obliterans with a focus of high-grade PenIN/PenIN2, p16-positive. After the intervention, he maintained a flat lesion occupying half of the glans, which is why he was referred to the dermatology clinic, where he underwent two sequential treatments with CO2 laser, Imiquimod, for 6 weeks and Clobetasol for around 6 months. As he still had three lesions on the glans and in the sulcus, he underwent a repeat excisional biopsy, incomplete and with positive margins, which showed differentiated PenIN of the foreskin/coronal sulcus and of the glans, and it was subsequently proposed to resurface the glans with a flap from the inner side of the right thigh. The patient was discharged from hospital the day after surgery, having kept his bladder catheter in for 1 month. At 6-month follow-up, he had good healing progress, good sensitivity of the glans, only slightly diminished, but with no functional impact, and good urinary function, with no signs of recurrence.
  Conclusions: The treatment of superficial penile neoplasia is still controversial, with various treatment modalities, tending to be less mutilating, with resurfacing of the glans being an organ-saving approach to consider as it has good functional and oncological control results.

UP-17.16—The Role of Ultrasonic Scalpel in Modified Inguinal Lymph Node Dissection 

• Jin Ye André, Castilho Maria, Rodrigues Joana, Lopes Filipe, Miranda Miguel, Garcia Rodrigo, Oliveira Pedro, Palma Dos Reis José
  Unidade Local de Saúde-Santa Maria, Lisbon, Portugal

• Introduction and Objectives: Penile cancer is recognized for following a stepwise lymphatic dissemination, beginning with the inguinal lymph nodes. The presence of nodal metastasis is the most critical prognostic factor. Radical inguinal lymphadenectomy is associated with considerable morbidity, primarily related to impaired lymphatic drainage. Modified surgical templates aim to reduce complications. The use of sealing devices may reduce lymphatic morbidity. This study aimed to evaluate the role of an ultrasonic scalpel in modified inguinal lymphadenectomy (MILD) and assess its impact on surgery time and post-operative complications.
  Materials and Methods: A retrospective analysis was conducted on penile cancer patients who underwent MILD by the same surgeon between 2018 and 2022. Patients were divided into two groups based on the lymphatic ligation technique used: conventional silk sutures (group A) or an ultrasonic scalpel (group B). Data collected included operative time, drainage output, duration of drain placement, length of hospital stay, and the number of nodes retrieved. Post-operative complications were classified using the Clavien-Dindo scale. Chi-square and Mann-Whitney U tests were used for statistical analysis (p < 0.05), utilizing SPSS version 28.
  Results: Seven patients underwent bilateral MILD, with a mean age of 61.7 years. Group A included three patients, while group B comprised four patients. Mean operative time was shorter in group B (103.8 min) compared to group A (179.7 min). Length of hospital stay was also reduced in group B (9.5 days vs. 11.7 days). Mean drainage output was slightly higher in group B (351 mL vs. 291.7 mL). The mean number of nodes retrieved was comparable (9.7 in group A vs. 10.5 in group B). No statistically significant differences were observed. One patient in group B developed lymphorrhea (Clavien-Dindo grade II), with no other significant complications reported.
  Conclusions: Inguinal lymph node dissection is associated with significant morbidity. Conventional suture ligation may prolong surgical time and contribute to surgeon fatigue. The ultrasonic scalpel demonstrated a trend toward shorter surgery time and hospital stays. Although statistical significance was not reached, these findings suggest that the ultrasonic scalpel may be a viable alternative in MILD. Further research with larger sample sizes is necessary to validate these results and establish definitive conclusions.

17.5. Unmoderated Video ePosters

UVP-17.01—Sentinel Lymph Node Biopsy Using Methylene Blue and Fluorescein Dye in Carcinoma Penis: Low Cost Dual Dye Alternative to Radiotracers 

• Aggarwal Nitish, Kumar Subranshu, Panaiyadiyan Sridhar, Singh Prashant, Seth Amlesh
  AIIMS, New Delhi, India

• Introduction and Objectives: Carcinoma of the penis is a rare but aggressive malignancy, with lymphatic metastasis being the most significant prognostic factor. Accurate staging of inguinal lymph nodes is crucial for treatment planning and survival outcomes. Traditional inguinal lymphadenectomy, while effective, is associated with high morbidity, including lymphedema, wound infections, and skin necrosis. Sentinel lymph node biopsy (SLNB) has emerged as a minimally invasive technique to identify nodal metastases in clinically node-negative (cN0) patients, potentially reducing unnecessary lymphadenectomy while maintaining oncological safety. This video displays the role, accuracy, and clinical impact of SLNB in penile cancer management.
  Materials and Methods: This video includes a review of SLNB technique performed on a cN0 patient with carcinoma penis. The procedure involves injection of dual dye around the penile lesion and intraoperative identification of sentinel lymph nodes using white light & ultraviolet/blue light, and selective excision of the identified nodes. The histopathological evaluation of sentinel nodes was performed to detect micrometastases. The video presentation demonstrates injection techniques, intraoperative lymphatic mapping, and biopsy retrieval.
  Results: SLNB has shown a high sensitivity (80–90%) and a negative predictive value exceeding 90% in detecting micrometastases in cN0 patients. Patients with negative sentinel nodes are able to avoid unnecessary inguinal lymphadenectomy, significantly reducing postoperative complications. The false-negative rate remains a concern, but it has been minimized with refinements such as the use of dual tracers and intraoperative frozen section analysis. Comparative analysis with modified lymphadenectomy suggests that SLNB provides comparable oncological outcomes with significantly lower morbidity. Cost of methylene blue vial—150 rupees (1.74 U.S. dollars). Cost of fluorescein dye vial—100 rupees (1.16 U.S. dollars).
  Conclusions: Sentinel lymph node biopsy is a valuable tool in the management of carcinoma penis, allowing for accurate lymphatic staging with minimal morbidity. While false negatives remain a challenge, advancements in technique and adjunct diagnostic tools have improved its reliability. SLNB offers a promising alternative to routine lymphadenectomy, reducing complications while ensuring adequate oncological control. Further prospective studies and standardization of protocols are required to optimize its clinical application.

18. Penis/Testis: Benign Disease

18.1. Moderated Oral ePosters

MP-18.01—Assessing Theatre Efficiency and Patient Satisfaction in a Relocated Andrology Service 

• Gibson John ¹, Mubarak Mohamed ², Pearce Ian ¹, Modgil Vaibhav ¹
  ¹ Manchester University NHS Foundation Trust, Manchester, United Kingdom, ² Health Education North East, Newcastle, United Kingdom

• Introduction and Objectives: Following the recent COVID pandemic, the UK NHS was left with an unprecedented elective surgical backlog with the greatest burden being in Trauma and Orthopaedics, followed by Urology. To address this, so called “cold” elective surgical sites were developed to deliver high volume surgical work without the intrinsic issues of competing with the medical and surgical non-elective admission workload. We aimed to assess theatre efficiency following the relocation of our andrology service to such a site and to canvas patient satisfaction following inflatable penile prosthesis (IPP) procedures.
  Materials and Methods: Data was retrospectively collected between October 2023 and February 2025, comprising 82 theatre lists and 340 cases. Key operational metrics documented included on-the-day cancellations, delayed starts, list overruns, overall % theatre utilisation, day-case rates and 30-day readmission rates. In parallel, a qualitative survey was conducted in 2024 among 70 IPP patients, with 59 respondents rating their pre-operative, intra-operative, and post-operative experiences on a five-point Likert scale.
  Results: Across the 82 theatre lists, a total of 340 cases were recorded, with a theatre utilisation rate of 81.2%. Operational inefficiencies included 32 cases with on-the-day cancellations, 30 theatre lists experienced delayed starts (mean delay: 21.8 min) and 19 lists overran (mean time: 36.9 min). Day-case rates were 73.5%, and 30-day readmission rates were 1.18%. The case mix was predominantly andrological, constituting 79.9% of the procedures. In the IPP subset, patient-reported satisfaction scores were robust, with pre-operative experiences rated at 4.81, the day-of-surgery experience at 4.73, and post-operative care at 4.58 out of 5. These findings highlight the operational performance and high level of patient satisfaction achieved with IPP services during the transition to a “cold site”.
  Conclusions: The overall theatre performance in the new “cold site” environment is promising, with an impressive utilisation rate of 81.2% and a low cancellation frequency. Although this falls short of the GIRFT aspiration of 85% utilisation, these figures do highlight the operational strength of the service. Moreover, the high patient satisfaction ratings among the IPP cohort underscore that high-quality care is maintained throughout the patient journey in a reconfigured service environment.

MP-18.02—The Management of Suspected Testicular Torsion: An Australian Perspective 

• Li Thomas ¹, Huynh Roy ², Darbari-Kaul Rhea ², Ly Mark ², Ahmadi Nariman ¹
  ¹ Chris O’Brien Lifehouse, Sydney, Australia, ² Canterbury Hospital, Sydney, Australia

• Introduction and Objectives: Acute testicular pain is a common cause of emergency presentation. Given the organ threatening nature of testicular torsion, it is the main differentiation diagnosis of concern. Whilst this pathology is typically managed by urologists, in many areas of Australia, particularly rural centres, urological input is either insufficient or absent. In these cases, general surgeons are often tasked with this responsibility instead. Despite being primarily a clinical diagnosis, ultrasound is often used as an adjunct in excluding testicular torsion; however, its availability in more regional areas is very limited. The purpose of this study was to determine whether subspecialty referral and ultrasound accessibility resulted in any difference in the outcomes of patients presenting with testicular pain.
  Materials and Methods: A review was conducted of patients presenting to Canterbury Hospital emergency department between 2019 and 2023. Inclusion criteria were all patients presenting with acute testicular pain. Between 2019 to 2021, these patients were referred to general surgery, and, between 2021 and 2023, referrals were made to urology. Outcomes between patients referred to these subspecialties and whether ultrasound was performed were compared. 111 (29.2%) patients presented at times when ultrasound was available compared to 269 (70.8%) presenting when unavailable.
  Results: During the review period, 521 patients presenting with acute testicular pain. 380 were referred for subspecialty review; urology received 282 referrals (54.1%), and general surgery received 239 referrals (45.9%). Rates of surgical exploration were no different between subspecialties (17.6% vs. 17.6%; p = 1.00) with comparable bilateral exploration rates (30.0% vs. 32.4%; p = 0.832). There was no difference in orchidectomy rate (p = 0.072), wound infection (p = 0.165), recurrence of pain (p = 0.197) or post-operative haematoma (p = 0.197). Of patients who proceeded to exploration, 18 (26.5%) presented when ultrasound was available, and 50 (73.5%) when unavailable. There was no difference in the rates of negative exploration (p = 0.519).
  Conclusions: There is no evidence to suggest that acute scrotal pain is managed significantly differently between general surgery and urology. Ultrasound availability also did not seem to change patient outcomes. This suggests areas without access to urological subspecialty input or ultrasound can still be effectively managed.

18.2. Residents Forum Moderated Oral ePosters

RF-18.01—To Evaluate Various Aetiologies of Chronic Orchialgia and Its Response to Multimodal Therapy: A Prospective Observational Study 

• Jha Prasoon, Kaushal Devashish, Madhavan Kumar, Yadav Dhirendra
  All India Institute of Medical Sciences, Bhopal, India, Bhopal, India

• Introduction and Objectives: Chronic orchialgia, one of the most vexing urologic conditions, is defined as chronic or intermittent scrotal pain lasting at least three months and significantly interfering with daily activities. Despite accounting for 2.5–4.8% of urologic clinic visits, no current established guidelines exist for its diagnosis and management. This study aims to identify the etiologies of chronic orchialgia and determine the decrease in patients’ pain symptoms using changes in Visual Analog Scale (VAS) scores following various treatment options. Objective: The primary objective is to identify the etiologies of chronic orchialgia and evaluate the change in VAS scores following different treatment modalities.
  Materials and Methods: This prospective observational study included 181 patients aged 18–80 years presenting with chronic orchialgia to the urology outpatient department. An institutional chronic orchialgia investigation protocol was followed, including urine analysis, ultrasound of the scrotum in all patients and USG scrotum with Doppler, serum PSA and USG abdomen and KUB in selected patients. Patients were initially treated with NSAIDs for two weeks along with physical scrotal supporter. If symptoms were not resolved, tricyclic antidepressant therapy was started for 90 days, and changes in VAS score were noted.
  Results: Most patients (48.6%) were aged 21–30 years, with a mean age of 31.73 ± 11.84 years. The mean duration of symptoms was 24.26 ± 38.17 months, with a median of 8 months. Varicocele (35.4%) and idiopathic causes (24.3%) were the predominant etiologies. There was a significant reduction in VAS score from 3.64 ± 1.66 at presentation to 1.17 ± 1.09 after three months (p < 0.001). Medical management using a protocol of NSAIDs followed by Tri-cyclic Antidepressant was the primary treatment modality (87.3%), with surgical interventions employed in 5.5% of cases.
  Conclusions: This study is one of the largest prospective studies addressing chronic orchalgia. It highlights the diverse etiologies of chronic orchialgia and the effectiveness of medical management in reducing pain, as evidenced by significant reductions in VAS scores.

18.3. Unmoderated Standard ePosters

UP.18.01—Comparative Analysis of Microsurgical Varicocelectomy with or without Intraoperative Microvascular Doppler Ultrasound 

• Gvasalia Badri, Dukuzov Deni, Kindarov Islam, Arsanukaev Imam, Nazarenko Ruslan, Pushkar Dmitriy
  Botkin Hospital, Moscow, Russian Federation

• Introduction and Objectives: It is estimated that varicocele exists in about 15% of the general male population. The incidence of chronic orchialgia caused by varicocele is up to 10%. In our comparative study we assessed the effectiveness of microsurgical varicocelectomy with and without the use of intraoperative microvascular dopplerography.
  Materials and Methods: The study included 83 patients who underwent microsurgical varicocelectomy. The patients were divided into two groups: group 1 included 43 patients who underwent intervention with intraoperative use of micro-Doppler and group 2–40 patients without it being used. All operations were performed by one surgeon (his experience is more than 500 interventions). A comparative analysis of the number of removed veins and arteries was carried out based on the results of the morphological report.
  Results: The average number of ligated internal spermatic veins was 13.67 ± 6.41 and 11.52 ± 5.63 in groups 1 and 2, respectively, while the average number of preserved arteries was 1.96 ± 0.87 and 1.73 ± 0.86 in the same groups, respectively, which was significantly higher in the group where Dopplerography was used. 30 (69.8%) and 21 (52.5%) of the patients had complete ease from pain, 11 (25.5%) and 16 (40.0%) of the patients experienced partial ease, while 2 (4.7%) and 3 (7.5%) patients showed no change in chronic pain in the groups with and without the use of Doppler ultrasound, respectively. According to this, patients from the 1st group had a better result in resolving chronic pain (p = 0.033). During a median follow-up of 12 months (range 10–29), 25 cases (89.2%) showed a significant reduction in pain, and 3 (9.8%) had no change in pain by subjective VAS scoring. Of cases with a significant reduction in pain, 15 (53.5%) had complete resolution, and 19 (67.9%) had a 50% or greater reduction. Objective PIQ-6 analysis showed a significant reduction in pain in 78.6% of patients at 6 months postoperatively, in 82.1% at 1 year, in 82.1% at 2 years.
  Conclusions: Microsurgical varicocelectomy using Doppler ultrasound monitoring is an effective method for treating varicocele, leading to identification of a larger number of vessels and achieving significant ease of scrotal pain.

UP.18.02—A New Surgical Technique for Correction of Residual Penile Deformity During Penile Prosthesis Implantation in Patients with Peyronie’s Disease 

• Gvasalia Badri, Gorobets Yuri, Chesnov Dmitriy, Babaev Mikhail, Pushkar Dmitriy
  Botkin Hospital, Moscow, Russian Federation

• Introduction and Objectives: The combination of Peyronie’s disease (PD) with erectile dysfunction (ED) is considered an indication for the implantation of penile prostheses. We offer a new simplified technique for the correction of residual penile deformity during penile prosthesis implantation.
  Materials and Methods: For the application of the new technique, Dr Gvasalia B. has invented a new cavernotome, which consists of two main metal elements, the main body of the cavernotome in the form of a metallic bougie in which a special guiding channel is made, and the second element is a stylet with two different types of cutting tips in the form of a cone in the longitudinal and transverse direction. During the procedure a cavernotome is inserted into the cavernous bodies, and incomplete rotational movements in the fibrosis zone are performed with manual control, i.e. internal incisions are made on the tunica albuginea. From May 2022 to February 2024, 18 patients with Peyronie’s disease and erectile dysfunction underwent this novel surgery. In 15 cases, there was a dorsal erectile deformity of more than 60 degrees and, in 3 cases, hourglass deformity. Preoperative assessment included the International Index of Erectile Function erectile function (IIEF-EF) score, penile duplex and penile curvature angle measurement. Postoperative self-reports, penile deformity, IIEF-EF scores and the Patient Global Impression of Improvement (PGI-I) questionnaire were assessed every 8 weeks.
  Results: The average age was 61 years. The average period of postoperative follow-up was 7 ± 3.3 months. In all cases, correction of the deformity of the penis was achieved. Residual deviation of 10–15 degrees occurred in 5 patients. When measuring the length of the penis before and after the internal incisions, the average difference was 11 ± 4.7 mm. There was not a single case of prosthetic infection, necrosis of the glans. The mean level of satisfaction with surgery measured using the visual analogue scale was 91.67 ± 22.16.
  Conclusions: In our opinion, this novel technique provides the excellent results in penile prosthetics in patients with penile deformity and erectile dysfunction, significantly shortens the operation time and reduces the risk of postoperative complications.

UP.18.03—Apocrine Hidrocystoma of Foreskin: A Rare Benign Cystic Lesion 

• Han Lin Aung, Potter Laura, Bardapure Mallikarjun, Oshevire-Bini Charles, Yanqiang Lu
  Royal Shrewsbury Hospital, Shrewsbury, United Kingdom

• Introduction and Objectives: Apocrine hidrocystoma is a benign cystic lesion originates from apocrine glands of skin and a rare occurrence on penile foreskin. Upon review of literature, only 13 cases of apocrine hidrocystoma involving external genitalia have been reported worldwide. We write a case report given its rare occurrence on the penile foreskin.
  Materials and Methods: Case Presentation: A 50 year old gentleman was seen and referred by a GP doctor for the finding of a growth on the foreskin over last 18 months, which was gradually increasing in size. His main complaint was some discomfort during sexual intercourse. Upon examination, a multiloculated cystic lesion 2 × 1 cm approximately was noted at the frenulum of foreskin, which was smooth and not tender, along with a tiny cyst at 6 o’clock close to the external urethral meatus. Skin over the cyst appeared unremarkable. Given these findings, patient was counselled and consented for circumcision and biopsy of cyst, which was performed under local anaesthesia. Histological evaluation found a couple of large unilocular spaces in dermis lined by a double layer of epithelial cells. Decapitation secretion was seen in some luminal cells, and no evidence of atypia or malignancy was noted. The histological features were consistent with an apocrine hidrocystoma.
  Results: Discussion: In literature review, most patients are adults between 30 and 70 years of age. Most involve the foreskin followed by the shaft. Histopathologically, these cysts are mainly composed of an inner layer of single or double layer of secretory columnar epithelium with decapitation secretion lying above an outer myoepithelial cell layer. Immunohistochemically, outer myoepithelial cells are positive for alpha-smooth muscle actin and p63, and inner epithelium is positive for CK7 and CK18.3. Excision usually in the form of circumcision is generally curative. Recurrence has never been reported in literature, albeit it is possible in theory. There is no literature report about malignant transformation as well.
  Conclusions: We report a case of a 50-year-old gentleman with apocrine hidrocystoma of foreskin. The main reason for submitting this case report is because incidence of apocrine hidrocystoma on foreskin is rare upon literature review.

UP.18.04—Lyz2 Mediates Testicular Senescence Induced by Chronic Inflammation Through the Nf-κB Signaling Pathway 

• Mao Shanhua ¹, Xu Chenyang ², Fang Zujun ², Zhou Yiwen ², Zheng Pengfei ¹
  ¹ Fudan University Huashan Hospital, Shanghai, China, ² Huashan Hospital, Fudan University, Shanghai, China

• Introduction and Objectives: This study established a testicular senescence model in male mice to determine the reproductive and endocrine functional phenotypic changes associated with testicular aging. Through testicular transcriptomic sequencing, we explored the key molecular mechanisms of testicular senescence and identified novel biomarkers related to this condition.
  Materials and Methods: We selected C57BL/6 male mice at six age groups ranging from 3 to 24 months. Testicular aging phenotypes were determined through fertility experiments, testicular histopathological analysis (HE staining), serum testosterone level assessments, and epididymal sperm analysis using CASA. Key molecular changes in testicular aging were explored using transcriptomic sequencing. Preliminary immunohistochemical validation was performed on testicular specimens from male mice along with human testicular specimens from eight different age groups ranging from 19 to 83 years.
  Results: A natural aging model of C57BL/6 male mice was established and categorized into six groups based on age: 3 months, 6 months, 10 months, 14 months, 18 months, and 24 months. Fertility phenotype assessments indicated a continuous decline in mating success, pregnancy rates, and progeny numbers with increasing age. Notably, sperm motility was significantly reduced in older mice compared to younger ones, and serum testosterone levels began to decline from 14 months of age. HE staining revealed a gradual increase in the interstitial space of seminiferous epithelium starting at 14 months, with a notable decrease in luminal sperm, especially pronounced by 24 months. Transcriptomic analysis showed that genes overexpressed in older mice were primarily enriched in immune response-related pathways. Immunohistochemical staining of testicular samples confirmed significant upregulation of LYZ2, FETUB, and CCL8 in aging testes. Additionally, molecules associated with the NF-κB signaling pathway, including NF-κB1, NF-κB2, and RelA (p65), as well as inflammatory factors IL-1β and TNF-α, were upregulated in the testes of aged mice (24 months).
  Conclusions: Testicular senescence significantly affects the health and quality of life of middle-aged and elderly men, with inflammation as a key driver. Our model revealed a consistent phenotype of diminished fertility and endocrine function, highlighting the critical role of immune response in testicular aging. LYZ2, FETUB, and CCL8 may induce testicular senescence through NF-κB-mediated inflammation and could serve as potential biomarkers for testicular aging.

UP.18.05—Management and Outcome of Fournier Gangrene in a Nigeria Hospital 

• Idowu Najeem
  Ladoke Akintola University of Technology, Ogbomoso, Nigeria

• Introduction and Objectives: Fournier gangrene is a polymicrobial soft tissue infection of the genito-perineal region of the body. It is relatively rare but life threatening. The aim of this study was to discuss the management and outcome of Fournier gangrene.
  Materials and Methods: The records of patients that were managed as cases of Fournier gangrene between 2020–2024 were retrieved from the hospital medical record department. The information collated from these files includes socio-demographic data, clinical features, modality and outcome of treatment. Descriptive analysis was done by using SPSS version 23.
  Results: Although 15 patients were admitted and managed as Fournier gangrene, only 13 patients had complete data and were analyzed. The age distribution was between 21–80 years with a mean of 41.1 +/ 15.7SD. All the patients were male, and all of them presented in emergency with clinical features of sepsis, identified in 3 patients. The wound culture of the remaining 7 patients (53.8%) could not be retrieved. Fournier gangrene severity index (FGSI) score of the investigated subjects showed a range of 2–12 with a mean of 7.6 +/ 3.1SD. Concerning definitive wound care, six patients (46.2%) had spontaneous wound closure due to relative small size of the defect. Five patients (38.5%) had primary wound closure under spinal anesthesia. The remaining two patients with FGSI scores of 9 and 11 underwent reconstructive procedures, which were scrotal advancement flap+gracili muscle flap + split thickness skin graft.
  Conclusions: The average FGSI score was 7. There was no mortality. The most commonly involved part was the scrotum, while the rarest was the penis. Prompt response and adequate resuscitation are required for good outcome as observed in this study.

UP.18.06—Multimodal Treatment of Patients with Peyronie’s Disease 

• Chesnov Dmitriy, Gorobets Yuri, Kasyan Gevorg, Pushkar Dmitriy, Gvasalia Badri
  Botkin Hospital, Moscow, Russian Federation

• Introduction and Objectives: Peyronie’s disease (PD)—localized penile lesion possibly associated with micro-trauma during intercourse and an abnormal wound-healing process. It is associated with penile pain, curvature, and shortening and contributes to erectile dysfunction, which affects the quality of life. The aim of this study was to evaluate the outcomes in men undergoing the application of intralesional interferon α2b (IFNα2b) with concurrent penile traction therapy (PTT) for the treatment of Peyronie disease (PD).
  Materials and Methods: 60 patients (mean age = 37.6 ± 14.1 years, range 21–68) diagnosed were selected for this study with clinically and ultrasound confirmed Peyronie’s disease treated in one center between January 2022 and June 2023. The main symptoms included penile deformity (94%), penile pain (20–70%). All patients were in the stable phase of the disease (mean duration = 26 months), curvature less than 50°, and no erectile dysfunction. 60 patients diagnosed with PD have been categorized into two groups. Of these, 30 patients (group A) were treated for 16 months as follows: intralesional interferon α2b (IFNα2b) (5 million units IFNα2b diluted in 10 mL NaCl 0.9% twice weekly for 12 weeks, total 24 injections) + penile traction therapy. The other 30 patients (group B) received penile traction therapy for 16 months. PTT were recommended to use the device for 6 to 9 h daily. All men were in the chronic phase of PD (mean duration = 26 months), curvature less than 50°, and no erectile dysfunction (mean IIEF score = ±5).
  Results: The results showed a significant reduction in curvature compared to baseline in both groups (PTT+IFNa2b—18°, PTT alone—12°), p < 0.05. In group A, in 6 and 18 months after treatment, there was reduction in fibrous plaque volume 37.6% and 70.6%, respectively. There was also a mean increase in elongated penile length in group A by 8.4 ± 3.5 mm and in group B by 6.3 ± 2.7 mm, p = 0.56.
  Conclusions: Our results showed that a long-term multimodal medical therapy (interferon injection associated with penile traction therapy) is statistically effective to treat PD patients. Furthermore, this study confirms that the best treatment modality for PD is a combination therapy. Further multicentre studies in this direction are needed.

UP.18.07—Nanofat and Microfat Injections in the Treatment of Peyronie Disease: A Prospective Pivotal Study 

• Berdondini Elisa ¹, Silvani Mauro ², Gacci Mauro ³, Maiolino Giuseppe ⁴
  ¹ Sedes Sapientiae Clinic, Turin, Italy, ² Center for Urethral and Genital Surgery, Turin, Italy, ³ University of Florence, Florence, Italy, ⁴ Lyx Institute of Urology, Madrid, Spain

• Introduction and Objectives: In the chronic phase, Peyronie’s disease (PD) manifests as scar tissue and chronic inflammation of the tunica albuginea, leading to aesthetic changes and functional limitations. Autologous fat grafting has long been used to treat scar tissue symptoms due to its regenerative cells, and the injectable products of adipose tissue, microfat, and nanofat, have shown regenerative potential. The study aims to evaluate and compare the effectiveness of nanofat and microfat injections in PD patients regarding reduction of penile curvature, improvement in erectile function, and overall satisfaction.
  Materials and Methods: A prospective study was conducted on consecutive patients with PD from 2019 to 2024 treated with multiple nanofat (Nanofat group or NG) or microfat injections (Microfat group or MG). Inclusion criteria included male patients aged 18–80, with PD for at least 6 months, any penile deformity, one or more palpable albugineal plaques/nodules, and recent sexual activity. Exclusion criteria were drug-resistant end-stage erectile dysfunction, previous penile surgery for PD. We statistically compared preoperative variable, curvature degree (CD) reduction, IIEF-5 score increase, and overall satisfaction (OS) in and between the groups using appropriate nonparametric statistical tests.
  Results: We enrolled 59 pts: 26 in NG and 33 in MG. In NG, a higher percentage of patients with no prior PD treatment was found (33.3% vs. 11.5%, p = 0.02); more NG patients had a history of extracorporeal shock wave lithotripsy with intracavernous injections (23.1% vs. 3.0%) and atypical deformities with curvature (42.3% vs. 12.1%, p = 0.03). NG had a higher preoperative CD (35° vs. 30°, p = 0.02) and less frequent penile pain (46.2% vs. 75.8%, p = 0.02). Both groups showed significant improvements in CD, IIEF-5 scores, and pain at the 4-month follow-up (Table 1). MG group had greater median OS (7 vs. 4, p < 0.001) and better reduction in CD (−15° vs. −10°, p < 0.001) but similar median IIEF-5 score improvement (+3 vs. +2, p = 0.07). No perioperative or postoperative complications were reported.
  Conclusions: Nanofat and microfat injections are safe and effective treatments for PD. Microfat results in a greater reduction in curvature and higher overall satisfaction.

UP.18.08—Patient Satisfaction Following Orchiectomy and Testicular Prosthesis Placement: A Retrospective Evaluation 

• Silva Pedro, Pinheiro Luis, Gil Miguel, Cunha João, Caceiro Rui, Gomes Alexia, Lanca Miguel, Pereira Patricia, Meireles Ana
  Central Lisbon University Hospital Centre, Lisboa, Portugal

• Introduction and Objectives: Testicular loss can significantly impact a patient’s psychological and physical well-being. Testicular prosthesis placement after orchiectomy aims to restore body image and self-esteem. This study aimed to evaluate overall satisfaction among patients who received a testicular prosthesis and to identify key areas where the prosthesis had the greatest perceived impact.
  Materials and Methods: We conducted a retrospective analysis of patients who underwent orchiectomy and subsequent placement of a testicular prosthesis in the last 2 years. Patients completed a detailed questionnaire assessing satisfaction across several domains: general satisfaction, aesthetic appeal, comfort, emotional well-being, and self-esteem. Additionally, patients were asked whether they would recommend the prosthesis to others and provided feedback on prosthesis characteristics such as size, weight, and rigidity.
  Results: A total of 15 patients were included. The average overall satisfaction score was 4.1 out of 5. Scores for prosthesis aesthetics (mean 4.5) and emotional well-being (mean 4.3) were notably high, followed by self-esteem (4.1) and comfort (3.9). The majority of patients (73%) stated they would recommend a testicular prosthesis, while 20% responded “maybe” and 7% responded “no.” Patients reported the greatest benefits in terms of emotional and psychological well-being, with physical comfort and prosthesis characteristics (such as rigidity or weight) having less influence on overall satisfaction.
  Conclusions: Patients who underwent testicular prosthesis placement after orchiectomy reported high satisfaction, particularly regarding emotional and aesthetic outcomes. The prosthesis appears to play a significant role in improving psychological health and self-image, supporting its continued use and discussion during preoperative counseling. Future work may further optimize prosthesis design based on patient-reported outcomes to enhance comfort and personalization.

UP.18.09—Penile Calciphylaxis: Risk Factors, Clinical Presentation, and Survival in a Multicenter Case Series 

• Vega Tepos Ignacio, Moreno Ortega Jose, Hernandez Gonzalez Karime, Alvarado Alejandro
  Corporativo de Hospitales Sa. de CV., Córdoba, Veracruz, Mexico

• Introduction and Objectives: Calciphylaxis is a clinical syndrome characterized by arteriolar medial calcification, subintimal proliferation, thrombotic cutaneous ischemia, necrotic skin ulceration, and a high mortality rate. Aim: To describe the clinical presentation, treatment, and survival outcomes. Study Design: Observational, descriptive, longitudinal case series.
  Materials and Methods: A retrospective study was conducted from January 2010 to August 2024, including patients diagnosed with penile calciphylaxis at the urology department of Corporativo de Hospitales and UMAE No. 14, Veracruz, Mexico. Clinical presentation, comorbidities, treatment modalities, and survival were evaluated.
  Results: 15 patients (aged 54–82 years, mean 64 years) were identified. All had long-standing diabetes (>20 years) and were on renal replacement therapy (peritoneal dialysis or hemodialysis). One patient was excluded from the analysis due to refusal of surgical intervention and subsequent loss to follow-up. Management included: Wound care and antimicrobial therapy: 100% Surgical debridement: 40% Partial penectomy: 2 cases (13.3%), partial glansectomy with skin grafting: 1 patient. Untreated due to death: 2 patients (1 with COVID-19, 1 with chronic kidney disease complications). Overall mortality was 78.6%, with a mean survival of 3–4 weeks.
  Conclusions: In our case series, we observed that rapid and timely intervention, along with the extent of ischemic compromise, may significantly reduce mortality rates in patients with penile calciphylaxis. Early surgical debridement of necrotic tissue and limited resections were associated with improved outcomes, yet surgical management remains a challenge due to the disease’s aggressive progression and high postoperative morbidity. Notably, the use of skin grafts in localized lesions could represent a viable alternative to radical procedures (e.g., total penectomy), potentially preserving function and reducing psychological impact. However, graft viability must be carefully assessed in the context of ongoing microvascular disease. Crucially, multidisciplinary collaboration with nephrology is indispensable to address the underlying metabolic derangements (e.g., hyperparathyroidism, hyperphosphatemia). Medical optimization—including phosphate binders, sodium thiosulfate, and parathyroid hormone modulation—is vital to improve survival probabilities, as surgical treatment alone is insufficient without systemic control. Further studies are needed to standardize protocols for graft use in early-stage lesions and to define the optimal timing of surgical intervention in conjunction with medical therapy.

UP.18.10—Penile Septal Haematoma: Current Insights Into a Rare Trauma 

• Gkaliamoutsas Stefanos, Stasinou Theodora, Grey Benjamin, Hattab Anas, Modgil Vaibhav
  Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, United Kingdom

• Introduction and Objectives: Penile septal haematoma is a rare penile trauma involving blood accumulation within the inter-corporeal septum without complete tunica albuginea rupture. Unlike classic penile fractures, which present with an audible “pop,” immediate detumescence, and swelling, septal haematomas manifest more subtly with penile discomfort, a palpable mass, or delayed penile curvature. This narrative review examines the limited available literature on penile septal haematoma, focusing on its clinical presentation, diagnostic challenges, management, and outcomes.
  Materials and Methods: A literature search was conducted using PubMed and Google Scholar with the key words: “penile trauma,” “penile septal haematoma,” “penile intra-cavernous haematoma,” and “penile injury.” Inclusion criteria encompassed case reports, retrospective studies, and clinical reviews on penile septal haematoma. Studies on penile fractures without septal involvement were excluded.
  Results: The review identified few cases of penile septal haematoma, reflecting its rarity and diagnostic challenges. To date, only two published case reports specifically describe penile septal haematoma—one with septal rupture and one without penile structural fracture. In a study of 650 Peyronie’s disease patients, three had septal cystic lesions later confirmed as liquefied haematomas. Clinical presentation varies, including penile mass, delayed curvature, or erectile dysfunction. MRI is crucial in distinguishing septal haematomas from Peyronie’s disease and neoplasms. Due to its rarity, there is no consensus on management, which ranges from conservative treatment and ultrasound-guided aspiration to surgical intervention. Delayed diagnosis may lead to fibrosis, resulting in curvature or erectile dysfunction requiring further treatment.
  Conclusions: Penile septal haematoma is rare and underreported, with variable clinical manifestations often lacking the dramatic signs of penile fracture. MRI plays a key role in diagnosis. Management options include observation, aspiration, or surgery, depending on severity. Increased use of high-resolution imaging may improve detection, and greater awareness among urologists and radiologists can facilitate early diagnosis and appropriate intervention, reducing long-term complications.

UP.18.11—Peyronie’s Disease: Surgical Treatment with Autologous Tunica Vaginalis of Testis 

• Uddin Md, Zaman Md
  Dhaka Medical College, Dhaka, Bangladesh

• Introduction and Objectives: Peyronie’s disease (PD) is a progressive disorder of the connective tissue of tunica albuginea of the penis that produces abnormal curvature, painful erections and different degrees of erectile dysfunction. Men with PD also suffer from psychological distress, sexual life and overall quality of life. Medical treatment has minimum role for correcting curvature. Surgery is the gold standard treatment of Peyronie’s disease. Partial excision or incision and grafting is important procedure when Peyronie’s disease presents with large plaque, good erection with or without medications, significant penile curvature more than 60 degrees and penile shortening. We used tunica vaginalis in our patients. Objectives: To share our experiences to highlight the tunica vaginalis grafting procedures with outcome and patient satisfaction in our series.
  Materials and Methods: In this retrospective study from January 2018 to January 2025, total 37 patients, aged 30 to 62 years, median 39 years with PD, underwent surgical treatment at Dhaka Medical College and some private clinics. All patients had significant curvature more than 60 degrees during erection. All patients had adequate sexual function with or without drugs. During the operation, plaque was incised or partially excised, and neurovascular bundle (NVB) was preserved. Autologous tunica vaginalis graft of testis was harvested and patched to the defect. All patients followed up every 3 months in the first year and 6 months subsequently. Postoperative intercourse satisfaction and overall satisfaction measured by IIEF-5. Data was collected regarding correction of curvature, sexual functions and complications.
  Results: 26 patients underwent incision and 11 patients underwent partial excision with tunica grafting. 32 patients (86.48%) showed straightening, 5 patients (13.51%) had shortening. 6 patients (1.21%) developed erectile dysfunction, 2 patients (5.4%) complained of pain, 3 patients (8.10%) complained sensory changes. Overall 33 patients (98.18%) were satisfied post operatively. Majority of patients in our series had curvature correction and normal appearance erection with minimum complication.
  Conclusions: We conclude that autologous tunica vaginalis grafting procedure is a safe, convenient and effective treatment option.

19. Prostate Cancer—Basic Science

19.1. Moderated Oral ePosters

MP-19.01—A Precision Diagnostic and Therapeutic Platform for Prostate Cancer Based on Intelligent Nucleic Acid Nanomachines 

• Zhong Xingyu, Xie Tianci, Wang Shaogang, Xia Qidong
  Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China

• Introduction and Objectives: The increasing incidence of prostate cancer (PCa) necessitates precise diagnosis and treatment to improve patient outcomes. Current diagnostic tools, such as PSA tests, MRI and biopsy, have limitations in specificity, cost, and invasiveness. Also, the available PCa targeted therapies and their effectiveness are limited. One of the common reasons for both is oversimplified response to biological signals and difficulty in dealing with the complex tumor environment. Nanotechnology holds promise for precision medicine, but intelligent systems capable of autonomous analysis and response to tumor complexity are still needed for refined PCa diagnosis and treatment.
  Materials and Methods: First, machine learning identified PCa-specific targets, forming a 3-dimensional (3D) diagnostic panel at the DNA-RNA-protein level. A molecular encoding machine was then constructed to convert the various biological signals into a unified output. This output was synthesized and reported by a nucleic acid logic device, which simulates the computation of traditional silicon-based chips. Finally, the CRISPR-Cas system/nano-framework was employed to create a diagnostic and delivery platform activated by upstream signals to enable precision diagnosis and therapy for PCa. Blood and tissue samples from 36 pairs of PCa and BPH patients were collected for diagnostic tests.
  Results: A 3D diagnostic panel was developed to include GSTP1 methylation, miR-153, miR-183, and PSA. A Three-way Junction-incorporated Double Hairpin molecular encoder was engineered to unify signals, facilitating the encoding and autonomous computation of up to eight molecular signals, with a signal-to-noise ratio of 320. The CRISPR-Cas sensitively amplified signals with a detection limit down to 0.01%. The intelligent nanomachine achieved a diagnostic sensitivity of 95% and specificity of 94% in tissue samples and sensitivity of 90% and specificity of 87% in blood samples. Additionally, a DOX-loaded nucleic acid framework-based delivery system was established, selectively targeting and eradicating tumors.
  Conclusions: We present a new diagnostic and therapeutic platform for PCa using intelligent nucleic acid nanomachines. This platform enables detailed tumor analysis and targeted responses, offering high sensitivity, biocompatibility, and cost-effectiveness. The findings may support new strategies in precision PCa diagnosis and treatment.

MP-19.02—Anticancer Potential of Eurycoma longifolia Nanoparticles in PC-3 Prostate Cells 

• Rahman Eka ¹, Kania Nia ²
  ¹ Medical and Health Science Faculty, Lambung Mangkurat University, Banjarmasin, Indonesia, ² Medical and Health Science, Lambung Mangkurat University, Banjarmasin, Indonesia

• Introduction and Objectives: Prostate cancer ranks as the fifth most common cause of cancer-related deaths globally and is the second most common cancer diagnosis among males. Reactive oxygen species (ROS) are significant contributors to DNA, protein, and lipid damage actively contributing significantly to the onset and spread of prostate cancer. Prostate cancer and other cancer cells have been shown to be susceptible to the cytotoxic and antiproliferative properties of E. longifolia Jack roots. Specifically, the quassinoid compound eurycomanone has shown the ability to induce apoptosis. This study aims to characterize and evaluate E. longifolia Jack nanoparticles (ELN) for their potential as an anti-prostate cancer agent against PC-3 cells.
  Materials and Methods: Nanoparticles were synthesized by introducing chitosan and 0.4% (sodium tripolyphosphate) Na-TPP (sodium tripolyphosphate) to the E. longifolia Jack extract solution. Subsequently, characterization was conducted using a particle size analyzer (PSA) and a zeta potential analyzer (ZPA), with microscopic observations made through transmission electron microscopy (TEM). Key results were obtained through the WST-8 assay for cytotoxicity on PC-3 cells. Flow cytometry assessed intracellular ROS and apoptosis, while qRT-PCR analyzed the gene expression of p27 and PTEN.
  Results: The study showed that ELN was successfully characterized as a nanoparticle. It reduced cell viability, increased cell inhibition, decreased ROS levels, induced apoptosis, and upregulated p27 and PTEN gene expression, with 150 μg/mL being the optimal concentration.
  Conclusions: This study demonstrates that E. longifolia Jack nanoparticles have the potential to inhibit prostate cancer cells (PC-3) by reducing ROS, inducing apoptosis, and increasing the expression of p27 and PTEN genes. Further investigation and testing are required to fully examine ELN’s potential as a therapeutic agent against prostate cancer, as this study has demonstrated.

MP-19.03—Mixed Exposure to Endocrine Disrupting Chemicals Promotes Prostate Cancer Progression: Based on Exposome Epidemiology, Preclinical Validation, and Transcriptomic Studies 

• Wu Yuwei, Qiu Shi
  West China Hospital, Sichuan University, Chengdu, China

• Introduction and Objectives: Prostate cancer (PCa) presents substantial treatment challenges, particularly in patients with chronic exposure to environmental pollutants, such as endocrine-disrupting chemicals (EDCs).
  Materials and Methods: To illuminate the exposome characteristics of EDCs, we undertook a prospective cohort study of 61 patients with PCa, including 15 with disease progression during follow-up. Exposome-transcriptome framework, with preclinical in vivo and in vitro models, was used to assess the mixed biological effect of EDCs on PCa progression and multiomics-derived signature. The direct interaction between EDCs and target proteins has been validated with chemical proteomics.
  Results: Among the 10 identified EDCs, the levels of bisphenols, phthalates, and perfluoroalkyl were elevated in patients with biochemical recurrence. BPA, MEHP, and PFNA were combined to form MIXC, which was associated with increased proliferation and decreased apoptosis in PCa tissues. In vivo studies have shown that mice exposed to MIXC developed larger tumor volumes and exhibited altered treatment responses. We revealed multiomics-derived signature of PCa progression and also identified interactions between protein target, integrin β1, with MIXC molecules.
  Conclusions: These findings clarify how environmental EDC exposure drives prostate cancer progression, addressing a key research gap and improving therapeutic approaches.

MP-19.04—Prostate Super-Resolution Ultrasound Imaging: A World First Experience of Near-Microscopic Computer Aided Depiction of Normal and Abnormal Tissue Domains 

• McNeill Alan ¹, Gallagher Kevin ¹, Butler Mairead ², Papageorgiou Georgios ², Mobberley Andrew ², Grigorescu Raluca ¹, Keanie Julian ¹, Good Daniel ¹, O’ Donnell Marie ¹, Sharma Abhishek ¹, Leslie Nicholas ², Lu Weiping ², Sboros Vassilis ²
  ¹ NHS Lothian, Edinburgh, United Kingdom, ² Heriot Watt University, Edinburgh, United Kingdom

• Introduction and Objectives: We have developed and tested super resolution ultrasound imaging (SRUI)—a new imaging tool that depicts organs at microscopic resolution, unlike any other imaging modality. It is not the same technique as micro-ultrasound. SRUI provides direct histology-like displays of the prostate. Our aim is to investigate feasibility of imaging prostate cancer (PCa), understand PCa associated SRUI characteristics and investigate the feasibility of machine assisted scoring of prostate scans for PCa using SRUI.
  Materials and Methods: Transrectal contrast (Luminity^® (Lantheus Medical Imaging, MA, USA)) enhanced ultrasound (CEUS) videos were collected from patients (n = 20) with confirmed PCa, prior to undergoing radical prostatectomy (RP), with full ethical approval. Novel, patented image processing applied to the CEUS data generated SRUI maps of less than 50 µm resolution. The SRUI maps produced were compared with post-RP pathology in order to identify multiple SRUI parameters associated with normal and abnormal tissue; five of these parameters (structural, dynamical and textural characteristics of blood flow) were combined to heat maps with regions scored 1 (no cancer) to 5 (highly likely cancer).
  Results: SRUI maps display the distribution and blood dynamics of the entire vascular tree within the prostate to capillary level. Features identified in SRUI maps demonstrated features of microvascular blood flow and vessel structure (vessel density, vessel tortuosity, heterogeneity, entropy, fractal dimension, blood flow and velocity), which correlated with cancer with statistical significance. The detail and resolution of the images are unlike any radiological imaging of the prostate seen to date. Five SRUI biomarkers were combined to generate a single imaging scoring region, 1–5 indicating the likelihood of cancer. 15 scans were suitable for heat map generation representing 21 cancer regions of Gleason > 3 + 3. A score of at least 4/5 was seen in all prostate cancer regions confirmed on post-RP pathology.
  Conclusions: The SRUI maps are unlike any current medical images of the prostate. They provide new information, simultaneously capturing structural and functional behaviour at microscopic resolution. The SRUI identification of different tissue domains at microscopic level has the potential to enable high-specificity characterisation of prostate pathophysiology.

19.2. Residents Forum Moderated Oral ePoster

RF-19.01—Prognostic Value of BRCA1 Mutations in Prostate Cancer Patients from the Republic of Bashkortostan 

• Loginova Maria, Kagirova Evelina, Muhamadeev Radmir, Asadullina Dilara, Asfandiyarov Erik, Pavlov Valentin
  Bashkir State Medical University, Ufa, Russian Federation

• Introduction and Objectives: Prostate cancer is one of the most common malignancies in men and a leading cause of male cancer-related mortality worldwide. This study aimed to assess the frequency and spectrum of BRCA1 mutations in prostate cancer patients using real-time polymerase chain reaction (PCR).
  Materials and Methods: The study included 282 patients with histologically confirmed prostate cancer. Genomic DNA was extracted from peripheral blood samples using standardized commercial kits. Mutation detection was performed via real-time PCR with allele-specific probes.
  Results: Pathogenic BRCA1 variants were identified in 22 patients (7.8%), underscoring the clinical relevance of genetic screening in this population. The most frequent mutation was the frameshift variant c.5266dup (p.Gln1756Profs), detected in 14 patients (5.0%). This known founder mutation results in a truncated, non-functional protein and has been linked to aggressive disease. The second most common variant was the missense mutation c.181T>G (p.Cys61Gly), found in 5 patients (1.8%). This alteration disrupts the zinc-binding RING domain of BRCA1, impairing its E3 ubiquitin ligase activity, BARD1 interaction, and DNA damage response. Additionally, the frameshift mutation c.4035del (p.Glu1346fs), leading to protein truncation, was detected in 3 patients (1.1%).
  Conclusions: This study demonstrates that BRCA1 mutations are present in a clinically significant subset of prostate cancer patients, supporting the integration of molecular diagnostics into routine clinical practice. Further research should explore the functional impact of these mutations, their predictive value, and their implications for precision oncology treatment strategies.

19.3. Unmoderated Standard ePosters

UP-19.01—A Systematic Review Assessing Lymphocele: An Unexpected Complication of Robotic Prostate Surgery 

• Shergill Kainaat
  Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, United Kingdom

• Introduction and Objectives: Prostatectomy is a highly effective surgical treatment for prostate cancer, often combined with pelvic lymphadenectomy (PLND) to assess lymph node status. While generally successful, the procedure carries a risk of complications, including lymphocele formation. The purpose of this thorough analysis is to determine the risk factors that lead to the formation of lymphoceles after prostate surgery and to investigate evidence-based treatment options to improve patient outcomes by optimizing treatment and enhancing early diagnosis. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 standards are adhered to in this systematic review.
  Materials and Methods: For relevant studies and research, we looked via PubMed, PubMed Central (PMC), Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, Science Direct, Science Open, My Science Work, and Google Scholar for a 4-year period. We screened according to inclusion/exclusion criteria and considered pertinent titles, abstracts, full-text reading, and quality. To check for bias, we used relevant quality rating tools. At first, we found 3,430 objects. We removed publications that did not adhere to the criteria.
  Results: Eighteen of the thirty-seven studies that were assessed were included in this evaluation; the other nineteen were excluded on the grounds of poor quality. After robot-assisted radical prostatectomy (RARP), lymphocele formation is influenced by factors such as lymph node resection, absence of postoperative drains, obesity, and ISUP-GGG grades.
  Conclusions: Preventive measures include lymphatic sealing during surgery, selective use of postoperative drains, and the implementation of peritoneal flaps, which have demonstrated success in reducing lymphocele incidence without increasing surgical time or cost. Additionally, encouraging early ambulation and optimizing perioperative fluid management can help minimize lymphocele formation. Further research is essential to refine these strategies, enhance patient outcomes, and minimize healthcare burdens.

UP-19.02—Cellular Nucleotide Pool Imbalance Renders ATM-Deficient Prostate Cancer Cells to PARG Inhibition 

• Xin Zhixiang, Ren Shancheng
  Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China

• Introduction and Objectives: Mutations affecting Ataxia Telangiectasia Mutated (ATM) are prevalent in prostate cancer. Although Poly (ADP-ribose) polymerase (PARP) inhibitors are effective in patients with breast cancer susceptibility gene (BRCA) 1 mutations, they seem to be less active in tumors with ATM mutations, underscoring the need for alternative treatment strategies. Mutations affecting Ataxia Telangiectasia Mutated (ATM) are prevalent in prostate cancer. Although Poly (ADP-ribose) polymerase (PARP) inhibitors are effective in patients with breast cancer susceptibility gene (BRCA) 1 mutations, they seem to be less active in tumors with ATM mutations, underscoring the need for alternative treatment strategies.
  Materials and Methods: Here, through a chemical synthetic lethality screen, we discovered that ATM deficient prostate cancer cells are hypersensitive to Poly (ADP-ribose) glycohydrolase (PARG) inhibition.
  Results: Selectively in ATM-knockout cells, we show that PARG inhibition induces more PARylation accumulation, causing cells to accumulate in S phase of the cell cycle and DNA damage. Mechanistically, this reflects a pyrimidine pool disequilibrium in ATM deficient cells and requires PARG to maintain the PARylation balance during replication. Replenishment of exogenous nucleotides is sufficient to reduce the PARylation level and fully rescue the phenotype upon PARG inhibition. Similarly, depletion of cytosolic nucleotides upon inhibition of de novo pyrimidine synthesis triggers PARylation activity and combines synergistically with the PARG inhibition in wild-type cells. Finally, we demonstrate in vivo activity of PARG inhibition in xenograft mouse models with complete ATM loss.
  Conclusions: Collectively, our work outlines a fresh biomarker-guided therapeutic strategy that is poised for clinical translation.

UP-19.03—Development of a Novel Dual Targeting Therapy for Cancer and Cancer-Associated Fibroblasts in Liver Metastasis of Castration-Resistant Prostate Cancer 

• Kimura Shoichi ¹, Iwano Satoshi ¹, Kuchimaru Takahiro ², Sato Yuichiro ¹, Mukai Shoichiro ¹, Sawada Atsuro ¹, Kamoto Toshiyuki ¹
  ¹ University of Miyazaki, Miyazaki, Japan, ² Jichi Medical University, Tochigi, Japan

• Introduction and Objectives: Liver is the most lethal site of metastatic castration-resistant prostate cancer (mCRPC). In aggressive CRPC with liver metastasis, upregulation of the MET gene [encoding hepatocyte growth factor (HGF) receptor] has been reported. In the tumor microenvironment, HGF produced by cancer-associated fibroblasts accelerates cancer progression via MET activation. Here, we aimed to establish a treatment for CRPC liver metastasis by targeting both MET and HGF activation.
  Materials and Methods: Mouse hormone-sensitive PC cells (Tramp-C2) were subcutaneously injected into castrated nude mouse and the mouse CRPC cell line CRTC2 was established. CRCT2/luc cells were injected into the spleen of castrated nude mice, and liver metastasis was confirmed 2 weeks later. mRNA expression was determined by microarray analysis and compared between non-metastatic and metastatic CRTC2/luc (mCRCT2/luc) cells. The effects of MET inhibitor (MET-I: JNJ-38877608, 30 mg/kg, p.o.) alone and in combination with HGF activator inhibitor (HGFA-I: SRI-31215, 5 mg/kg, i.v.) on liver metastasis in the mouse model were analyzed. Histological evaluation was also performed. Additionally, co-culture experiments were conducted using CRTC2 and the mouse fibroblast cell line NIH3T3, and the effect of dual inhibition of MET and HGF activation was analyzed.
  Results: Microarray analysis revealed increased expression of HGF, MET, HPN, and HGFAC (fold changes of 101.83, 23.31, 104.11, and 19.3) in liver metastasis (m-CRCT2/luc). Upon analyzing the effects of MET-I and HGFA-I on liver metastasis in the mouse model, significantly better efficacy was observed in the dual-inhibition group (MET-I+HGFA-I) than in the control or in MET-I monotherapy (p = 0.011 and 0.047, respectively). Histologically, the tumor area was significantly reduced, and intratumoral necrosis was evident in the dual-inhibition group, while MET phosphorylation in cancer cells was markedly downregulated. Under co-culture conditions with CRTC2 and NIH3T3 cells, cancer cell proliferation was most strongly inhibited by the dual inhibition. The analysis of co-culture compared with analysis without NIH3T3 highlighted the significance of additional HGFA-I.
  Conclusions: Significant efficacy of dual inhibition of MET and HGF activation was observed in CRPC liver metastasis. MET and HGF activating proteases have potential as significant target molecules.

UP-19.04—Diurnal Variation in Urinary Extracellular Vesicles in Prostate Cancer 

• Manley Kate ¹, Gihawi Abraham ², Smith Stephanie ¹, Goel Rahul ¹, Jupp Orla ², Brewer Dan ², Clark Jeremy ², Mills Rob ¹, Cooper Colin ², Ofagbor Ojone ¹
  ¹ Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom, ² University of East Anglia, Norwich, United Kingdom

• Introduction and Objectives: Urinary extracellular vesicles (EVs) are emerging as promising biomarkers for prostate cancer (PCa). Previous studies indicate that circulating plasma EVs undergo dynamic structure, quantity, and size changes throughout the day. Circadian rhythms regulate core clock-controlled genes (CCGs) that influence EV formation and hormone release, affecting kidney function and EV structure. The expression of CCGs is crucial for the cell cycle, DNA modification, and metabolism, with disruptions often implicated in cancer progression. Additionally, metabolic changes linked to circadian rhythms can alter EVs’ lipid and protein profiles and influence cellular stress response timing. This study investigates diurnal variation in RNA transcript expression within EVs from the urine of PCa patients compared to participants with no evidence of cancer (NEC).
  Materials and Methods: We collected RNA from morning (8 AM) and evening (8 PM) urine samples from patients with biopsy-proven PCa (≥Gleason 3 + 3, n = 5) and NEC (n = 6). RNA yields were quantified using Qubit fluorometry and gene expression analysis with the Affymetrix GeneChip Microarray System. Significant genes were identified based on an absolute log2 fold change > 1 and a false discovery rate (FDR)-adjusted p-value (q) < 0.05. Pathway analyses of significantly upregulated and downregulated genes were performed using clusterProfiler and gprofiler2.
  Results: No significant differences in RNA yields were observed between AM and PM samples in either group (paired t-test). However, the mean RNA yield in cancer PM samples (8.5 ng) was significantly higher than in NEC PM samples (0.89 ng; p = 0.0416, unpaired t-test). A comparison of AM/PM expression data found no dysregulated differentially expressed genes in NEC samples; however, in PCa samples, 220 upregulated and 6 downregulated transcripts were significantly different in PM samples compared to AM samples. Pathway analysis indicated significant enrichment in energy metabolism, mitochondrial function, and EV-related pathways.
  Conclusions: These findings demonstrate diurnal variation in urinary EV expression in PCa patients, suggesting heightened metabolic activity of tumour cells in the evening. These findings have implications for using urinary EVs as biomarkers for PCa diagnosis and treatment, suggesting that the timing of sample collection may impact analysis.

UP-19.05—Immunoprofiling in Advanced Prostate Cancer: A Prospective Multi-Cohort Study of Circulating Immune Responses 

• Velasco Balanza Clara, Sánchez Ramírez Ana, Saavedra Centeno Manuel, Pelari Mici Lira, Galera Paloma, Pacheco Santos María, Alfranca González Arantzazu, Toquero Díez Patricia, Celada Luis Guillermo, Albers Acosta Eduardo, Zapatero Almudena, Colomer Ramón, Romero-Laorden Nuria, San José Manso Luis Alberto
  La Princesa University Hospital, Madrid, Spain

• Introduction and Objectives: The tumor immune microenvironment (TIME) is crucial for understanding how tumors respond to prostate cancer (PC) therapies and the mechanisms underlying potential resistance. Analyzing immune cell populations in peripheral blood could serve as a prognostic or predictive biomarker. Objective: To characterize the immune phenotype in advanced prostate cancer, including high-risk localized PC, metastatic hormone-sensitive prostate cancer (mHSPC), and castration-resistant prostate cancer (CRPC).
  Materials and Methods: A prospective multi-cohort study was initiated in September 2021 at La Princesa University Hospital. The study included three cohorts: cohort A consisted of patients with high-risk localized PC; cohort B included those with mHSPC; and cohort C comprised patients with CRPC. A customized panel of 47 immune subpopulations was designed for the study. Peripheral blood samples were collected before therapy initiation, during treatment, and after progression. Immune phenotyping was performed using flow cytometry, with data analysis conducted in FlowJo software. Ethical approval was obtained, and all participants provided informed consent. Preliminary analyses were conducted using univariate and multivariate models to assess differences in the immune profiles between the mHSPC and CRPC cohorts.
  Results: 49p/100p have been recruited: 34p mHSPC and 15p CRPC. Median age 72 years at diagnosis (range 52–91). All cases had basal blood sample, and 82% had collected sample pre-cycle 3 during standard therapy. 31p/49p had received androgen receptor targeted therapies (ARTA) vs. 12p/49p that received chemotherapy. 28p/49p had Gleason ≥ 8, and 21/49p were de novo mHSPC, bone metastases being the most frequent site (45% only bone, 27% nodal and bone metastases, 24% only nodal, 4.1% visceral). We found statistically significant differences in the CD3+CD8+CXCR4+ and CD3+CD8+PSGL1+ subpopulation, higher in CRPC vs. HSPC patients after treatment (95% CI [0.03, 0.26], p = 0.019 and p = 0.04 respectively). NK cells CD56-KIR+ are lower in CRPC vs. HSPC subset with a statistically significant reduction after therapy in CRPC vs. HSPC setting (p < 0.01) in the MV model.
  Conclusions: Understanding the dynamics of CD8+ CXCR4/PSGL1 and NK CD56-KIR+ cells is crucial for developing strategies in immunotherapy and management of diseases where T-cell migration plays a critical role. These results may explain an exhausted TIME in the CRPC setting, which could be associated with worse prognosis.

UP-19.06—Impact of SARS-CoV-2 Infection in Multiparametric Prostate MRI 

• Manera Alekseja ¹, Morselli Simone ², Sebastianelli Arcangelo ³, Nicoletti Rossella ³, Moscardi Luisa ², Ciaralli Elena ⁴, Catucci Claudia Lucia ⁴, Serni Sergio ³, Gacci Mauro ², Li Marzi Vincenzo ⁵, Alberti Andrea ⁴
  ¹ AOU Senese, Siena, Italy, ² University of Florence, Florence, Italy, ³ Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy, ⁴ Careggi Hospital, University of Florence, Florence, Italy, ⁵ Le Scotte Hospital, University of Siena, Siena, Italy

• Introduction and Objectives: The COVID-19 pandemic, caused by coronavirus 2 (SARS-CoV-2) infection, has spread worldwide since 2020. Symptomatic infection is mainly characterized by severe acute respiratory syndrome but can lead to multiple organ failure and death. SARS-CoV-2 used angiotensin-converting enzyme 2 (ACE2) receptor and the cell surface transmembrane protease serine 2 (TMPRSS2) to enter into target host cells. In a recent study, it has been proved that TMPRSS2 and ACE2 are expressed in both lung and prostate tissues, with higher relative TMPRSS2 expression in prostate epithelial cells. The aim of the present study is to compare prostate inflammation by mpMRI before and after SARS-CoV-2 infection in 20 men.
  Materials and Methods: Our monocentric retrospective study includes 20 patients, divided in two groups: group I includes 10 patients who performed mpMRI before and after testing positive for SARS-CoV-2 nasopharyngeal swab. Group II includes 10 patients who performed two mpMRI 12 months apart, without contracting SARS-CoV-2 disease between the first and second examination, demonstrated by negative nasopharyngeal swab. mpMRI images were prospectively interpreted by 4 expert radiologists, assigning a score of 1–5 for T2WI, a score of 1–5 for DWI, and positive and negative for DCE-MRI according to PI-RADS v2.1, and determined the overall PI-RADSv2.1 assessment category for PZ and TZ.
  Results: After SARS-CoV-2 infection, 4 patients (40%) had one PIRADS 2 lesion at mpMRI; 1 patient (10%) had one PIRADS 3 lesion; 5 patients (50%) had one PIRADS 4 lesion (p = 0.033). The total evaluation of PIRADS lesion recognized by mpRMI after SARS-CoV-2 infection results statistically significant (p = 0.033). 6 patients with positive NP swab (60%) had a PRECISE score 3 and 4; patients (40%) have a PRECISE score 4. The PRECISE score’s median was 3.4 for the patients with positive NP swab, and it was 3 for the patients with negative NP swab.
  Conclusions: Our study indicates that patients after SARS-CoV-2 infection have an increase in PRECISE score. This suggests an increase in inflammation of the prostate, with the association of clinical symptoms. Despite this, SARS-CoV-2 infection doesn’t appear to be associated with an increased incidence of prostate cancers, although larger series are required to draft definitive conclusion.

UP-19.07—LOC100271832 EGene Is Highly Expressed in PC-3 Prostate Cancer Cells Undergoing Autophagy Following in Vitro Treatment with Doxazosin 

• Pavithran Nevil ¹, Al Jehani Rajai ², Thompson Cecil ¹, Mumtaz Faiz ¹
  ¹ Royal Free London NHS Foundation Trust, London, United Kingdom, ² University College of London, London, United Kingdom

• Introduction and Objectives: In vitro treatment of prostate cancer (PCa) cell lines with doxazosin has shown to induce autophagy through dynamin-mediated endocytic pathway. We conducted next generation transcriptome analysis to measure the gene expression levels in PC-3 cell lines following exposure to doxazosin.
  Materials and Methods: PC-3 (androgen-resistant PCa Cell line) cells were cultured in F-12 HAM culture medium supplemented with foetal bovine serum and 1% penicillin/streptomycin at 37C, 5% CO₂. After 24 h incubation, the cells were treated with 37 µM doxazosin or control (water) for 24 h or 48 h before total RNA was extracted using Trizol reagent. Quality control of extracted RNA was evaluated using formaldehyde agarose gel electrophoresis, Agilent Tape Station electropherogram and NanoDrop spectrophotometric analysis. Whole transcriptome sequencing was performed using Illumina sequencing for the entire transcriptome, accounting for over 30,000 genes. Data was analysed using BasespaceTM (Illumina.com) for log2 ratio of fold-changes in gene expression between doxazosin-treated and control PC-3 cells. We also examined changes in gene expression of 14 gene families.
  Results: 24 h exposure: Over 250 named-genes had 2-fold increase in control versus doxazosin-treated group. When the parameters were set to 3-fold changes and 4-fold changes, there were 39 named genes and 3 other genes, respectively. MAP7D3 and COL6A3 had ×4 fold-reduction, whilst LOC344887 had ×4 fold-increase in expression. 48h exposure: Over 350 named-genes had 2-fold increase. At 3-fold changes and 4-fold changes, there were 85 named-genes and 18 other genes, respectively. Specific genes with over 5-fold changes included EGR1 and HSPA6 (×5 fold), LOC100271832 and MIR1256/SLC25A3 (×9 fold) and CD3D (×10 fold). CD3D gene and MIR1256/SLC25A3 had a reduction in the log2 ratio; only LOC100271832 gene had a 9.77-fold increase.
  Conclusions: The LOC100271832, a yet uncharacterized gene and expressed only at low levels in several tissues in humans, exhibited 9.77 increase in fold change. Further studies into understanding the functions of this yet uncharacterized gene and the protein expressed by this gene could shed light into novel signalling pathways in androgen-resistant PCa.

UP-19.08—Prostate Cancer Diagnosis and Management: Current Practices in Africa, a Consultant-Based Survey 

• Biyouma Marcella ¹, Gebreselassie Habtemichael Kaleab ², Abdelkerim Nedjim Saleh ³, Ziba Ouima ⁴, Nwaha Makon Stephane ¹, Anteneh Tadesse Kifle ⁵, Taofiq Olayinka Mohammed ⁶, Kotokai Cassell III Ayun ⁷, Bencherki Youssef ⁸, Idrissa Sissoko ⁹, Mbwambo Orgeness Jasper ¹⁰, Mahamat Mahamat Ali ¹¹, Aboutaieb Rachid ¹², Ngwa-Ebogo Titus ¹³, Khassim Ndoye Alain ¹⁴, Oluwabunmi Olapade-Olaopa Emiola ¹⁵, Angwafo III Fru Fobuzshi ¹⁶
  ¹ Hôpital Laquintinie de Douala, Yaoundé, Cameroon, ² Worabe Comprehensive Specialized Hospital, Worabe, Ethiopia, Worabe, Ethiopia, ³ Université d’Adam Barka d’Abéché (UNABA),Abéché/Tchad, Abéché, Chad, ⁴ Yalgado Ouédraogo Teaching Hospital in Ouagadougou, Ouagadougou, Burkina Faso, ⁵ P.C.E.A Chogoria Hospital, Chogori, Chogori, Kenya, ⁶ University of Ilorin Teaching Hospital, Ilorin, Nigeria, ⁷ John F Kennedy Medical Centre, Monrovia, Liberia, ⁸ University Hospital Center Ibn Rochd, Casablanca, Morocco, ⁹ Kati University Hospital, Kati, Mali, ¹⁰ Kilimanjaro Christian Medical University College, Moshi, Kenya, ¹¹ Faculty of Human Health Sciences, University of N’djamena, N’djamena, Chad, ¹² Faculté de Médecine et de Pharmacie, Université Hassan II de Casablanca, Casablanca, Morocco, ¹³ Faculty of Health Sciences University of Bamenda, Bamenda, Cameroon, ¹⁴ Faculté de Médecine, de Pharmacie et d’Ondo-stomatologie, Université Cheikh Anta Diop, Dakar, Senegal, ¹⁵ College of Medicine, University of Ibadan, Ibadan, Nigeria, ¹⁶ Faculty of Medicine and Biomedical Sciences of University of Yaoundé I, Yaoundé, Cameroon

• Introduction and Objectives: In Africa, prostate cancer poses significant diagnostic and treatment challenges due to limited access to diagnostic tools and healthcare resources. This survey aimed to assess current prostate biopsy practices, patient classification methods, and available therapeutic means among African urologists to propose strategies for improved screening, diagnosis, and management.
  Materials and Methods: A web-based, self-administered questionnaire was distributed to urologists in 58 African centers, focusing on biopsy practices, cancer diagnosis, management, and treatment protocols. After pretesting and validation, data collection spanned six weeks, followed by duplicate elimination and arithmetical analysis, with results expressed in absolute, mean, or percentage values.
  Results: Feedback was received from 58 centers across diverse African regions, including Central, Southern, West, East Africa, and Madagascar, comprising general, private, and university hospitals. Prostate cancer emerged as the most frequent urological cancer in all regions studied. The assay for prostate-specific antigen (PSA) was available in nearly all centers. Biopsy techniques varied, with ultrasound-guided biopsies being the most common (30 centers), followed by digital-guided (20 centers) and MRI-guided biopsies (5 centers). One center lacked the expertise to perform biopsies. Radiological workup availability was high, with CT available in 56 centers, MRI in 54, PET scans in 14, and scintigraphy in 29. Treatment capabilities varied, with 53.4% of centers able to perform radical prostatectomies, 86.2% offering radiotherapy, and 94.8% providing medical castration. Among the centers, 56 performed fewer than 5 radical prostatectomies per month, while only 2 centers performed between 5 and 10 per month.
  Conclusions: It is important to standardize prostate cancer diagnosis and treatment protocols across Africa while improving access to advanced diagnostic technologies and treatment facilities. Implementing these changes could enhance early detection, improve treatment outcomes, and reduce the burden of prostate cancer in Africa.

UP-19.09—Prostate Cancer Treatment—10-Year Review of Therapeutic Decision-Making in a Tertiary Center 

• Ferreira Ana ¹, Lourenço Miguel ², Sabença Ana ², Maciel Rui ², Peralta João ², Bastos Samuel ², Silva João ², Nascimento Maria ², Dias Jorge ², Xambre Luis ²
  ¹ Instituto Português de Oncologia de Coimbra, Coimbra, Portugal, ² Unidade Local de Saúde Gaia-Espinho, Vila Nova De Gaia, Portugal

• Introduction and Objectives: Over the last 10 years, the treatment of prostate cancer (PCa) has evolved significantly, driven by the introduction of new drugs and the optimization of already established therapies. PCa patients exhibit great heterogeneity, making risk stratification essential to defining the best therapeutic approach. Objectives: Analyzed how therapeutic choices for PCa have evolved during the last ten years in the institution.
  Materials and Methods: Retrospective study composed by all new diagnosis of PCa in the institution between October 2014 and October 2024. Patients were categorized according to the risk groups defined by the EAU, with data extracted from electronic medical records and analyzed using SPSS software.
  Results: A total of 1,478 patients were included, with a mean age of 69.18 ± 7.79 years. Among low-risk patients, during the years examined, surgery showed a decreasing trend (30% in 2015 vs. 7% in 2024), while active surveillance became predominant (25% in 2015 vs. 85% in 2024, p = 0.01). For the intermediate-risk group, radiotherapy ± hormone therapy (RT ± HT) was the most common treatment (42.1%), followed by surgery (40.2%), with an increasing trend toward the first one (p < 0.01). Age influenced the choice between curative and palliative treatment (p < 0.01). In high-risk N0 patients, HT ± RT was the main choice (58.3%), while surgery was performed in 18%, without a defined trend over the years. Since 2023, 12 patients have received treatment with ARTA (abiraterone) combined with HT ± RT. In N1M0 patients, RT + HT was predominant (40.4%), with combination with ARTA growing since 2023 (66.7%). Chemical or surgical castration was chosen in 30% of cases, considering age (p = 0.01) and ECOG (p = 0.03). There was no statistical difference in the choice between curative and palliative treatment (p = 0.53). For M1 patients, most remained under observation or castration (43.2%). However, ARTA has been increasingly adopted in combination with HT ± RT ± QT (41.4%), with age being a determining factor (p < 0.01).
  Conclusions: Surgery has been chosen less frequently, favoring surveillance (low risk) and RT + HT (intermediate and high risk). The use of ARTA has increased and is being increasingly incorporated into the treatment of eligible N+ and M+ patients.

UP-19.10—The Impact of Body Mass Index and Lipid Profile on Survival Rates in Metastatic Hormone-Sensitive Prostate Cancer: Systematic Review and Meta-Analysis 

• Warli Syah ¹, Kadar Dhirajaya ¹, Prapiska Fauriski ¹, Siregar Ginanda ¹, Abshor Muhammad Rifqi ², Sari Dewi ¹, Sari Mutiara ¹, Tala Zaimah ¹
  ¹ Universitas Sumatera Utara, Medan, Indonesia, ² Universitas Indonesia, Medan, Indonesia

• Introduction and Objectives: The impact of metabolic factors, particularly body mass index (BMI) and lipid profile, on survival outcomes in metastatic hormone-sensitive prostate cancer (mHSPC) remains unclear. This systematic review and meta-analysis aim to evaluate the prognostic significance of BMI and lipid profile in mHSPC patients.
  Materials and Methods: A literature search was conducted across PubMed, Scopus, and Cochrane databases for studies examining BMI and lipid profile in mHSPC survival outcomes. Hazard ratios (HR) were pooled using RevMan 5.4, and risk of bias was assessed using the Newcastle-Ottawa Scale.
  Results: Five studies met the inclusion criteria, and three were included in the meta-analysis [U1]. Meta-analysis findings indicate that higher BMI (>25 kg/m²) is associated with improved survival in mHSPC patients (HR: 0.80, 95% CI: 0.67–0.96, p = 0.02). Subgroup analysis revealed no statistically significant association [U2] for BMI 25–29.9 kg/m² (HR: 0.92, p = 0.55) or BMI > 30 kg/m² (HR: 0.83, p = 0.21). No significant association was found between lipid profiles and survival outcomes. The analysis demonstrated minimal heterogeneity (I² = 0%).
  Conclusions: Higher BMI appears to be a protective factor in mHSPC, supporting the “obesity paradox.” However, lipid profiles do not significantly impact survival. Further research is needed to explore underlying metabolic mechanisms and refine risk stratification in mHSPC management.

UP-19.11—The Rising Significance of Long Non-Coding RNA (IncRNAs): Paving the Way for Prostate Cancer Innovations 

• Usmani Aamir, Singh Uday, Gautam Naveen, Srivastava Aneesh, Sureka Sanjoy
  Sanjay Gandhi Post Graduate Institute, Lucknow, India

• Introduction and Objectives: Prostate cancer (PCa) is the second most diagnosed cancer in the males. Although PSA being used as an early diagnostic test for the PCa, PSA gives the false positive result, and there is need to develop a more precise biomarker for identification of PCa at early stage. The present study has planned to investigate the potential of long non-coding RNAs (lncRNAs) as biomarkers for prostate cancer (PCa) using liquid biopsies.
  Materials and Methods: This 18-month prospective observational study included a total of 150 participants, divided into three groups: 50 patients with prostate cancer (PCa), 50 with benign prostatic hyperplasia (BPH), and 50 healthy controls (HC). The expression levels of three long non-coding RNAs (lncRNAs)—MALAT1, SChLAP1, and FR0348383—were analyzed in plasma and urine samples from all participants. Additionally, their expression was examined in prostate cancer tissue samples from subsets of the PCa and BPH groups (n = 49 and n = 5, respectively).
  Results: Our study demonstrated a significant overexpression of MALAT1 in plasma, urine, and prostate cancer tissue compared to the BPH and HC groups (p = 0.001). Receiver operating characteristic (ROC) curve analysis yielded an area under the curve (AUC) of 0.718 (p < 0.001) for MALAT1. With a defined cut-off value of 10.5, MALAT1 exhibited a diagnostic accuracy with sensitivity and specificity exceeding 90% for distinguishing prostate cancer cases from controls. Similarly, SChLAP1 was markedly overexpressed in plasma and prostate cancer tissue. In contrast, FR0348383 displayed elevated expression levels in urine and tissue, albeit with lower statistical significance. The identification of novel PCa-associated lncRNAs may facilitate the discovery of potential therapeutic targets for treatment. Andes-1537, an FDA-approved candidate for clinical trials, was specifically designed to target mitochondrial long non-coding RNA (mtlncRNA). Comprehensive loss-of-function and gain-of-function studies on a large scale are essential to establish the causal roles of lncRNAs in disease pathogenesis. Therapeutic approaches such as antisense oligonucleotides (ASOs) and small interfering RNA (siRNA) have been employed to target disease-associated lncRNAs.
  Conclusions: IncRNAs hold promise as diagnostic and therapeutic biomarkers for prostate cancer. However, limitations such as small sample size, cross-sectional design, and lack of functional validation necessitate further large-scale studies to confirm their clinical relevance.

UP-19.12—The Study of Mitochondrial Complex I and Intensity of Lipid Peroxidation in Tumor Tissues of the Men with Prostate Tumors 

• Chigogidze Teimuraz ¹, Alibegashvili Manana ², Babuadze Keso ², Ramishvili Liana ², Sepiashvili Bela ², Gabunia Nino ¹, Gordeziani Manana ², Kotrikadze Nanuli ²
  ¹ Ivane Javakhishvili Tbilisi State University, Faculty of Medicine, Tbilisi, Georgia, ² Ivane Javakhishvili Tbilisi State University, Faculty of Exact and Natural Sciences, Tbilisi, Georgia

• Introduction and Objectives: Mitochondria are an important source for production of reactive oxygen species (ROS) that eventually cause oxidative stress. Electron transfer chain situated on the inner membrane of mitochondria and especially I and II respiratory complexes represent the main sources responsible for production of the mitochondrial ROS during oxidative phosphorylation. It’s already established that mitochondrial ROS play an important role in cell proliferation and survival. The aim of the work was to study the alterations of the mitochondrial complex I activity and intensity of lipid peroxidation in tumor tissues of the men with prostate tumors (benign, malignant).
  Materials and Methods: Tumor tissue samples of the men with benign hyperplasia of prostate (BHP) and the men with cancer of prostate (CaP) served as material for the studies. Number of patients was 15 in each study group. Mean age of the patients was 60–75 years. The clinical stage of the disease was determined based on the rectal, histomorphological, and ultrasound examinations of the prostate gland in Urology National Center, Tbilisi, Georgia. Spectrophotometric and enzyme linked immunosorbent assay (ELISA) methods have been used for the studies. Intensity of lipid peroxidation was evaluated through the assessment of alterations in malonic dialdehyde (MDA) concentrations, as the major and valuable indicator of peroxidation processes.
  Results: Our investigations have shown that the activity of respiratory complex I was sharply increased in malignant tumor tissue samples compared to benign hyperplasia. There are also obvious changes regarding the MDA concentrations in malignant tumor cells in comparison to benign tumor. In malignant tumor samples MDA levels were about twice higher that of benign sample indices.
  Conclusions: From the gained results we suppose that reactive oxygen species produced in mitochondria play an important role in development of prostate cancer. It appears that in order to increase the rate of cell proliferation and promote metastasis, tumor cells significantly affect the certain processes inside the cells that eventually are responsible for adaptation to hypoxia.

20. Prostate Cancer—Clinical Advanced

20.1. Moderated Oral ePosters

MP-20.01—Gut Microbiota-Derived Aminoadipic Acid Promotes Castration Resistance of Prostate Cancer via Activating Akt-Foxo1-Pck2 Mediated Gluconeogenesis 

• Liu Yufei
  Huashan Hospital, Fudan University, Shanghai, China

• Introduction and Objectives: Gut microbiota and microbiota-derived metabolites can influence cancer progression. But how they are related to castration resistance of prostate cancer (CRPC) remains unclear.
  Materials and Methods: Castration resistant (n = 89) and hormone sensitive (n = 139, control) prostate cancer patients were enrolled. 16s rRNA sequencing was used to examine the gut microbiota; untargeted or targeted LC-MS was used to examine microbiota-derived metabolites in gut, serum, and prostate. CRPC animal model based on transgenic mouse was established; gut microbiota transplantation and metabolites administration were used to verify the role of CRPC patient’s gut microbiota and microbiota-derived metabolites on prostate cancer progression. CRPC cell model based on 22RV1 and C4–2 cell lines was established to explore and verify the underlying mechanism about the effects of microbiota-derived metabolites on CRPC. This study was approved by Institutional Review Board of Huashan Hospital, Fudan University.
  Results: Gut Firmicutes and Clostridia were increased in CRPC patients. Gut microbiota-derived Aminoadipic Acid (AA) was increased in CRPC patient’s gut, serum and prostate. By establishing CRPC mouse model, we used gut microbiota transplantation and antibiotic treatment experiment to demonstrate that gut AA level was microbiota-dependent. AA administration to CRPC mice accelerated the prostate cancer growth and progression. We also found AA increased the mice’s intestinal permeability via elevating the expression of cytokines MMP10 and CCL19 in intestinal epithelium, which enabled it to transfer from gut to serum and to prostate. By establishing CRPC cell lines, we proved that AA under limited glucose condition could activate PCK2-based gluconeogenesis via Akt-Foxo1 pathway, which promoted cancer cells’ invasion and migration.
  Conclusions: We provided new insights about the mechanism of CRPC from perspective of gut microbiota and its metabolites. Microbiota transplantation or intervention may become a novel approach to manipulate CRPC.

MP-20.02—Huangqi Derived Exosome Like Nanoparticles Exert Therapeutic Effects on Prostate Cancer by Inducing Ferroptosis and Modulating the Polarization of Macrophages 

• Xia Qidong, Sun Jianxuan, An Ye, Wang Shaogang
  Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

• Introduction and Objectives: In recent years, medicinal herb derived exosome like nanoparticles (MELNs) have demonstrated significant therapeutic efficacy in the treatment of various diseases. To date, there have been no published reports on the application of MELNs in the treatment of prostate cancer (PCa).
  Materials and Methods: Huangqi derived exosome like nanoparticles (HELNs) were isolated from fresh Huangqi via gradient centrifugation. The cytotoxic effects of HELNs on PCa cells were validated through CCK8, colony formation, and transwell assays. RNA sequencing analysis revealed that PCa cells exhibited enrichment in ferroptosis-related pathways following HELNs intervention. The levels of reactive oxygen species, lipid peroxidation, and Fe²⁺ were measured. Single-cell sequencing was employed to examine the immune landscape of the tumor microenvironment after HELN intervention, and the core immune cells identified were validated both in vitro and in vivo through PCR, Western blot, and flow cytometry.
  Results: HELNs exhibited cytotoxicity against PCa cells, reducing cell viability to around 50% following a 24-h intervention at a concentration of 64 µg/mL. In a concentration-dependent manner, HELNs curtailed cell migration, invasion, and colony formation capabilities. Moreover, they induced a dose-dependent escalation in intracellular ROS, lipid peroxidation, and Fe²⁺ levels within PCa cells, concurrently diminishing the expression of GPX4. In vivo experiments substantiated HELNs’ therapeutic efficacy against PCa and their capacity to downregulate GPX4 protein expression. Single-cell sequencing unveiled that HELNs prompted M1-type polarization of macrophages in the TME, enhancing their functionality and intercellular communication. In vitro assays confirmed that HELNs augmented the expression of M1 macrophage markers while diminishing M2 markers. Flow cytometry in vivo further corroborated the HELNs’ ability to reverse M2 macrophage polarization in the TME.
  Conclusions: HELNs can induce ferroptosis in PCa cells and promote M1-type polarization of macrophages in the TME to exert anti-PCa effects. Our study offers new insights and perspectives for the application of MELNs in cancer therapy.

MP-20.03—Impact of Progression-Directed Therapy in Patients with Oligoprogressive Castration-Resistant Prostate Cancer on Overall Survival and Progression-Free Survival 

• Lee Sang Hee ¹, Yoo Eun Sang ¹, Kim Hyun Tae ¹, Kim Bum Soo ¹, Kang Jun-Koo ¹, Kwon Tae Gyun ², Jo Mun Gyeong ¹, Kim Tae-Hwan ², Choi Seock Hwan ², Ha Yun-Sok ², Chung Jae-Wook ²
  ¹ Kyungpook National University Hospital, Daegu, Republic of Korea, ² Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea

• Introduction and Objectives: Oligoprogressive lesions are observed in a subset of patients who progress to castration-resistant prostate cancer (CRPC), while all other lesions remain controlled by ongoing systemic therapy. Recent studies have shown that progression-directed therapy (PDT) delays disease progression, enhances the efficacy of subsequent systemic therapy, and exhibits acceptable tolerability with minimal PDT-related adverse events in patients with oligoprogressive CRPC. However, the impact of PDT on overall survival (OS) and progression-free survival (PFS) has not been sufficiently reported. This study aimed to evaluate the impact of PDT for oligoprogressive CRPC on the overall survival and progression-free survival.
  Materials and Methods: This retrospective study included 40 patients diagnosed with oligoprogressive CRPC. PDT was performed with the intention of treating all progressive sites identified through conventional imaging using radiotherapy. A comparative analysis of CRPC patients who underwent PDT with or without additional first-line systemic treatment for CRPC (PDT group; n = 15) and those who underwent additional first-line systemic treatment only (non-PDT group; n = 25) was carried out. The former group included seven patients who underwent PDT with continuation of existing systemic therapy (PDT-A group) and eight patients who underwent PDT along with the addition of new anti-cancer treatments (PDT-B group). The Kaplan–Meier method was used to assess failure-free survival of first-line systemic therapy for CRPC, PFS, and OS.
  Results: The PSA response was better in the PDT group compared to the non-PDT group. The median time to failure of first-line systemic therapy for CRPC was 31.6 months in the PDT group and 14.9 months in the non-PDT group (p = 0.022). PFS was significantly higher in the PDT-B group compared to the non-PDT group (p = 0.046). The median OS was 50.0 months in the PDT group and 34.0 months in the non-PDT group (p = 0.029).
  Conclusions: In patients with oligoprogressive CRPC, PDT may have a beneficial effect on PFS and OS.

MP-20.04—Predictive Model Combining Clinical and MRI Data for Detecting Clinically Significant Prostate Cancer Using Elastic Fusion Registration 

• Tran Trung Thanh ¹, Filleron Thomas ², Bert Julien ¹, Malavaud Bernard ²
  ¹ University of Western Brittany, Nam Dinh, Vietnam, ² Toulouse Cancer Institute-Oncopole, Toulouse, France

• Introduction and Objectives: Prostate cancer (PCa) is the most commonly diagnosed malignancy in men and a leading cause of cancer-related death worldwide. Given the rising global incidence (1.4 million cases in 2020 and an estimated 2.9 million by 2040), it is crucial to improve risk assessment tools to reduce unnecessary biopsies. Tools based solely on clinical data, such as the Prostate Cancer Prevention Trial (PCPT) risk calculator, offer mediocre accuracy (AUC: 0.56–0.72), while early attempts to incorporate MRI suffered from limited datasets and imprecise targeting methods. Objective: To use clinical and MRI data from a large cohort of biopsies obtained by elastic fusion registration (EFR) to develop a model predicting clinically significant prostate cancer (csPCa), defined as ISUP grade ≥ 2.
  Materials and Methods: A cohort of 1,550 patients who underwent biopsy without a prior diagnosis (January 2018–March 2023) was analyzed. Variables included: age, PSA level (ng/mL), family history of prostate cancer (yes/no), history of negative biopsy, prostate volume, and the maximum PI-RADS score. Data were split into a training set (80%) and a test set (20%). The primary outcome was the presence of cancer on biopsy.
  Results: The model demonstrated excellent discriminative performance: AUC: 0.81, sensitivity: 61.4%, specificity: 87.1%, accuracy: 73.6%, PPV: 84.0%, and NPV: 67.0%. In the validation cohort of 310 patients, it would have avoided 100 unnecessary biopsies (32.3%) while still detecting 128 (87.1%) of the 147 cancers identified through EFR.
  Conclusions: The model showed strong discriminatory power in predicting csPCa risk. Combining clinical variables and MRI data (PI-RADS score, prostate volume) facilitated risk stratification. We propose this validated tool as a means to reduce unnecessary procedures through accurate risk stratification.

MP-20.05—Response Evaluation Criteria for Neoadjuvant Hormonal Therapy in Prostate Cancer Based on Magnetic Resonance Imaging: A Multicenter Retrospective Study 

• Wang Miao, Yang Jingxin, Li Chunmei, Guo Hongqian, Liu Ming
  Beijing Hospital, Beijing, China

• Introduction and Objectives: MRI changes occur after neoadjuvant hormonal therapy (NHT) for prostate cancer (PCa), but standardized diagnostic criteria to evaluate therapeutic response is lacking. We aim to propose a categorical scoring system for standardized diagnosis and response evaluation for PCa after NHT and to validate its feasibility.
  Materials and Methods: A board consisted of radiologists and urologists from multi-center built a five-point scoring system (the novel system) through a consensus meeting, with the DWI sequence as the primary sequence. Then a retrospective study including patients with intermediate- or high-risk PCa who underwent radical prostatectomy (RP) following NHT between January 2018 and December 2023 from 2 tertiary hospitals was conducted. MRI scanning was conducted in all patients before and after NHT, and a score was assigned according to the novel system. The reference standard was defined using postoperative pathological results. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) were calculated to assess the diagnostic performance of the novel system.
  Results: A total of 308 patients were included (median age, 70 years [IQR, 65–74 years]). A score of 1 was present in 20.1% (62); a score of 2, in 3.9% (12); a score of 3, in 14.6% (45); a score of 4, in 29.9% (92); and a score of 5, in 31.5% (97). With the score of 3 as a cutoff, the sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) to predict favorable pathological response were 84%, 91%, 69%, 96%, and 0.87, respectively, compared with 87%, 63%, 37%, 95% and 0.8, respectively, for Nadir PSA before RP.
  Conclusions: MRI scoring with the novel system shows potential, with accurate evaluation of response after neoadjuvant hormonal therapy.

MP-20.06—Trp-M8 Protein Is Associated with Metastasis in Prostate Cancer 

• Olagunju Tunde ¹, Ikuerowo Stephen ¹, Omisanjo Olufunmilade ¹, Jeje Emmanuel ²
  ¹ Lasuth, Lagos, Nigeria, ² Luth, Lagos, Nigeria

• Introduction and Objectives: Prostate cancer is a major cause of morbidity and mortality. Screening, diagnosis, monitoring, prognosis, and recurrence have been done with the use of PSA; this has drawbacks especially in detecting metastasis. TRPM8, which is preferentially expressed in prostate, has been considered to be a useful tissue biomarker in detecting metastasis. TRPM8 is a non-selective calcium cation channel protein expressed in prostate tissues and prostate cancer cells and involved in physiological processes related to cancer, such as proliferation, survival, and metastasis. Our objective is to evaluate a relationship between prostatic TRP-M8 expression and clinicopathologic features in patients undergoing prostate biopsy.
  Materials and Methods: Between June 2023 and July 2024, a total of 79 patients had prostate biopsies. The specimens were separated into two: one for TRP-M8 analysis, which was preserved in an RNA later stabilization solution, and the other for histopathological analysis. The histopathological analysis of the prostate tissues was done by same pathologist, while the TRP-M8 expression level for the prostate tissues was done using the GENESIG EASY RNA extraction protocol, and TRP-M8 primer via real time PCR analysis. The expression levels were also done by the same molecular scientist.
  Results: All seventy-nine patients had TRP-M8 expression levels assessed. 30 Patients had benign features on histology with a mean TRP-M8 expression of 8.6597Cq, while 48 patients had malignant findings with a mean TRP-M8 expression of 7.8877Cq, and 1 patient had prostatic intraepithelial neoplasia with TRP-M8 expression of 13.45Cq. There was no significant association between TRP-M8 expression and histological findings (p = 0.329). 24 participants had metastasis with a mean expression of 8.4475Cq, and also 24 had no metastasis with a mean expression of 7.3279Cq. There was a positive association of TRP-M8 expression levels and metastasis (p = 0.012).
  Conclusions: TRP-M8 may be an important tissue biomarker in evaluating patients with prostate cancer, as it is significantly related to metastasis.

20.2. Residents Forum Moderated Oral ePosters

RF-20.01—Whole Genome Sequencing as an Integrated Framework for Diagnosis, Therapy, and Prognostic Stratification: Advancing Precision Medicine in Indonesia 

• Negara Edvin ¹, Daryanto Besut ¹, Seputra Kurnia ¹, Agustriawan David ²
  ¹ Universitas Brawijaya, Malang, Indonesia, ² Indonesia International Institute for Life Science, Jakarta, Indonesia

• Introduction and Objectives: Prostate cancer demonstrates marked ethnic variability, yet personalized clinical pathways remain inadequately studied. Genomic sequencing data, analyzed through bioinformatics frameworks, can decode patient-specific molecular signatures, bridging the gap between ethnicity-driven risk stratification and tailored therapeutic protocols.
  Materials and Methods: The whole-genome sequencing (WGS) dataset was generated using Illumina sequencing technology, supported by a bioinformatics pipeline. Prostate tissue samples were collected from patients undergoing surgical resection for prostate cancer. Following DNA extraction and protein isolation, DNA quality was assessed and prepared for sequencing. Raw next-generation sequencing (NGS) data underwent quality evaluation via FastQC and Samtools. Somatic variants were identified using MuTect2, followed by functional annotation with ANNOVAR and Ensembl’s Variant Effect Predictor (VEP). The WGS data were aligned to the human reference genome (GRCh38), and SNP alterations were visualized using the Integrative Genomics Viewer (IGV). Subsequent genomic analyses integrated patient medical records to enhance diagnostic accuracy. All statistical analyses were conducted using R software.
  Results: Bioinformatics analysis identified genetic variations in multiple genes associated with prostate cancer pathogenesis. Diagnostic-related genes include SRD5A2 (rs1047303), CYP19A1 (rs1870050), BNC2 (rs16934641), and BRCA2 (rs144848). Therapeutic targets encompass SRD5A2 (rs1047303), CYP19A1 (rs743572 and rs2486758), CYB5A (rs10459592), and SLCO1B1 (rs4149056). Prognostic markers comprise SLCO1B3 (rs4149117), SLCO2B1 (rs12422149), ARRDC3 (rs2939244), FLT1 (rs9508016), SKAP1 (rs6054145), FBXO31 (rs7830622), BNC2 (rs16934641), TACC2 (rs3763763), ALPK1 (rs2051778), EGF (rs4444903), TGFBR2 (rs3087464), LSAMP (rs13088089), CCL17 (rs223899), PSMD7 (rs2387084), MON1B (rs284924), IRS2 (rs7986346), CASP3 (rs48622396), BMP5 (rs3734444), and ANRIL (rs10757278). These genetic variants will be analyzed in conjunction with patient medical records to develop an AI-driven algorithm. The integration of artificial intelligence is anticipated to enhance genomic accuracy, enabling more effective and personalized therapeutic strategies for prostate cancer.
  Conclusions: Comprehensive genomic sequencing validates DNA sequence variations across multiple prostate cancer-associated genes. Artificial intelligence (AI) enhances diagnostic precision by integrating genomic data with patient medical records, enabling data-driven clinical decision-making and optimizing therapeutic strategies for prostate cancer management.

20.3. Unmoderated Standard ePosters

UP-20.01—68ga-PSMA-617 PET/CT and 68ga-Nt PET/CT for Prostate Cancer Imaging: A Comparative Study and First Attempt of a Molecular Imaging Probe Targeting Ntsr1 in Humans 

• He Jiawei, Cai Yi
  Central South University Xiangya Hospital, Changsha, Hunan, China

• Introduction and Objectives: We performed the first human imaging with 68Ga-NT PET/CT and evaluated the imaging efficacy of 68Ga-PSMA-617 PET/CT and 68Ga-NT PET/CT in prostate cancer.
  Materials and Methods: This prospective cohort study included 23 patients with pathologically confirmed prostate adenocarcinoma. The patients were divided into two subgroups based on whether they had undergone endocrine therapy prior to radical prostatectomy (RP). All patients underwent both 68Ga-PSMA-617 PET/CT and 68Ga-NT PET/CT before RP, and the diagnostic efficacy of the imaging results was evaluated. Imaging results for various lesions in the RP specimens were analyzed, and the lesion detection rates for 68Ga-NT PET/CT and 68Ga-PSMA-617 PET/CT were calculated. Finally, primary lesion samples were obtained to validate the protein expression levels of PSMA and NTSR1.
  Results: Among all prostate cancer cases, 68Ga-PSMA-617 PET/CT showed significantly higher diagnostic sensitivity (82.6% vs. 4.3%; p = 0.0006) and lesion detection rate (88.9% vs. 3.2%; p < 0.0001) than 68Ga-NT PET/CT. In untreated cases, 68Ga-PSMA-617 PET/CT had superior sensitivity (92.9% vs. 0%; p = 0.0013) and lesion detection rate (94.7% vs. 0%; p = 0.0012) compared to 68Ga-NT PET/CT. In contrast, in cases treated with endocrine therapy, 68Ga-PSMA-617 PET/CT sensitivity dropped to 66.7% with an 80% lesion detection rate, while 68Ga-NT PET/CT sensitivity increased to 11.1% with an 8% lesion detection rate. Both specificity and positive predictive value for 68Ga-NT PET/CT were 100%. Immunohistochemical (IHC) staining revealed that the median PSMA IHC score in untreated cases was 7 (range: 1–9), significantly decreasing after endocrine therapy (p = 0.034). The median NTSR1 IHC score was 1 (range: 0.25–2) in untreated cases, rising significantly to 3 (range: 2–3.8) after endocrine therapy (p = 0.0074).
  Conclusions: This study shows that 68Ga-PSMA-617 PET/CT has superior sensitivity and lesion detection rates for diagnosing prostate cancer compared to 68Ga-NT PET/CT. After endocrine therapy, the diagnostic performance of 68Ga-PSMA-617 PET/CT declined, while 68Ga-NT PET/CT improved, likely due to reduced PSMA and increased NTSR1 expression. Given the short duration of endocrine treatment in these patients, 68Ga-NT PET/CT may have potential for re-staging, re-evaluation, and monitoring post-treatment relapse, especially as treatment duration increases.

UP-20.02—Bispecific Engineered Extracellular Vesicle Targeting Steap1 and Cd3 to Activate T-Cell Anti-Tumor Immunity in Prostate Cancer 

• Xia Qidong, Sun Jianxuan, An Ye, Wang Shaogang
  Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

• Introduction and Objectives: Prostate cancer (PCa) is one of the most common malignancies in men. PCa is a kind of cold tumor, characterized by poor T-cell infiltration and activation, as well as an immunosuppressive tumor microenvironment dominated by regulatory T cells (Tregs) and myeloid-derived suppressor cells (MDSCs). These features limit the efficacy of immune checkpoint inhibitors (ICIs) and other immunotherapies. To overcome this, strategies aimed at converting PCa into a “hot tumor”—with enhanced T-cell activation and infiltration—are urgently needed. Extracellular vesicles (EVs) have emerged as a promising alternative to cell-based therapies in cancer immunotherapy, offering advantages in biocompatibility and targeted delivery. To address this, we propose a bispecific EV (BsEV) platform designed to enhance both tumor targeting and immune activation in PCa.
  Materials and Methods: We genetically engineered dendritic cells (DCs) to produce bispecific EVs (EVs-aSTEAP1-aCD3) by co-expressing two functional modules: aSTEAP1 scFv for targeting STEAP1, which is specifically expressed in PCa; CD3 for activating and recruiting T cells. The EVs were intravenously administered in tumor-bearing models, and their biodistribution, immune modulation, and premetastatic niche inhibition were systematically evaluated.
  Results: EVs-aSTEAP1-aCD3 exhibited robust accumulation in PCa tissues post-injection, demonstrating enhanced tumor tropism. CD3 on EVs effectively activates CD3, recruiting T cells to tumor tissues and activating tumor-infiltrating lymphocytes.
  Conclusions: This proof-of-concept study establishes bispecific EVs as a versatile platform for cancer immunotherapy, capable of dual targeting of tumors and T cells. The modular design of EVs-aSTEAP1-aCD3 highlights its adaptability to diverse tumor antigens and potential for patient-specific customization, paving the way for next-generation EV-based therapies. By enhancing T-cell activation and infiltration, this approach holds promise for transforming prostate cancer from a “cold” to a “hot” tumor, thereby improving therapeutic outcomes.

UP-20.03—Comparative Real-World Analysis of Apalutamide and Enzalutamide in M1a Hormone-Sensitive Metastatic Prostate Cancer 

• Romero Crespo Alfonso, Marti Flores Juan Manuel, Fernandez Siles Javier, España Navarro Rodrigo, Perez Serrano Cora, Hernandez Alcaraz David, Morales Jimenez Pedro, Garcia Galisteo Emilio
  Hospital Regional Universitario Malaga España, Malaga, Spain

• Introduction and Objectives: The TITAN trial demonstrated significant survival benefits in patients with hormone-sensitive metastatic prostate cancer (mHSPC) but excluded those with exclusively lymph node metastases (M1a). This has led to heterogeneous management strategies. Our study aimed to compare biochemical response and safety of Apalutamide and Enzalutamide in M1a patients. Additionally, we present real-world data from a broader Apalutamide-treated mHSPC cohort to reinforce external validity.
  Materials and Methods: We performed a retrospective analysis of mHSPC patients treated from 2020 to 2024. For the M1a subgroup, 13 patients received Apalutamide, and 18 received Enzalutamide. Demographics, PSA kinetics at 1 and 3 months, adverse events (graded per CTCAE v5.0), and treatment discontinuation rates were analyzed. The complete Apalutamide cohort (n = 48) was also reviewed descriptively.
  Results: In M1a patients, PSA decline > 90% at 3 months was observed in 76.9% (Apalutamide) and 88.9% (Enzalutamide). PSA < 0.2 ng/mL was achieved in 69.2% and 83.3%, respectively. Grade ≥ 3 adverse events were reported in 7.7% of the Apalutamide group and 22.2% in the Enzalutamide group. Treatment discontinuation due to toxicity occurred in 7.7% vs. 16.7%, respectively. In the full Apalutamide cohort (n = 48), the most frequent adverse events were fatigue (27.1%), rash (16.7%), hot flushes (14.6%), and hypertension (4.2%), mostly grade 1–2. Grade 3 toxicity and discontinuation both occurred in 12.8%. No deaths or radiological progression were reported during the follow-up (median 16.9 months).
  Conclusions: In M1a mHSPC patients, both Apalutamide and Enzalutamide demonstrated high rates of early PSA response. Enzalutamide showed a trend toward greater biochemical efficacy but was associated with higher rates of severe toxicity and treatment discontinuation. Real-world experience with Apalutamide in a larger unselected mHSPC cohort supports its consistent efficacy and tolerability. Further prospective studies are needed to clarify the optimal approach in this underrepresented subgroup.

UP-20.04—Engineered Bacterial Outer Membrane Vesicles Targeting PSMA for Drug Delivery and Enhanced Prostate Cancer Immunotherapy 

• Sun Jianxuan, Xia Qidong, Ma Siyang, Wang Shaogang
  Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

• Introduction and Objectives: Bacterial outer membrane vesicles (OMVs) are highly immunogenic nanovesicles that can robustly stimulate macrophages and activate immune microenvironment. Moreover, they can be modified to target tumor cells and deliver drugs. In our research, we developed genetically engineered OMVs whose surface has been modified by insertion of the Prostate Specific Membrane Antigen (PSMA)-binding peptide (PBP) to precisely target and treat prostate cancer.
  Materials and Methods: We transformed the pGEX-4T-1-ClyA-PBP-HA plasmid into msbB mutant W3110, a K12-derived E. coli strain and extracted PBP-OMVs via gradient centrifugation. Then we encapsulated Docetaxel (DXT) into the PBP-OMVs through electroporation. Isolated PBP-OMVs were examined by TEM and NTA. The stability of PBP-OMVs were evaluated by Zeta-potential. The safety, tumor targeting and tumor killing ability were subsequently assessed in vitro and in vivo respectively.
  Results: The engineered PBP-OMV can accumulate in the tumor tissue through its PSMA-targeting ability and be internalized into the tumor cells, subsequently releasing DXT, leading to the killing of tumor cells. Confocal microscopy images showed that PBP-OMVs effectively bound to the plasma membrane of RM1-PSMA+, while OMVs had limited RM1-PSMA+ cell membrane binding. At 12 h after the intravenous administration of PBP-OMVs@Cy5.5, a strong fluorescence signal was observed at the tumor site, whereas the signal was markedly weaker with free Cy5.5. Ex vivo imaging of excised tumors confirmed the enhanced accumulation of POMVs. In flow cytometry analysis, a significantly M1-polarized cell increase and M2-polarized cell decrease were observed after PBP-OMVs treatment. qPCR also showed that indexes indicating M1-polarization were elevated after PBP-OMVs treatment.
  Conclusions: In summary, the PBP-OMV we developed can target prostate tumor tissues and promote M1-type polarization of macrophages in the TME to exert anti-PCa effects.

UP-20.05—Impact of Adverse Effects of Next-Generation Antiandrogens on the Clinical Course of Advanced Prostate Cancer 

• Morales Pinto Stalin Fabricio ¹, Zarrud Ismail ², Alberca Arcos Fernando ², Herrera Imbroda Bernardo ²
  ¹ University Hospital Virgen de la Victoria Málaga-España, Málaga, Spain, ² Virgen de la Victoria University Hospital, Málaga, Spain

• Introduction and Objectives: Advanced prostate cancer primarily affects older and potentially frail patients. The adverse effects associated with next-generation antiandrogens (NGAAs) may influence disease progression. The aim of this study was to quantify the clinical impact of these adverse effects on the course of the disease.
  Materials and Methods: A retrospective observational study was conducted involving 179 patients diagnosed with hormone-sensitive metastatic prostate cancer (mHSPC), non-metastatic castration-resistant prostate cancer (nmCRPC), and metastatic castration-resistant prostate cancer (mCRPC), all treated with next-generation antiandrogens. The study was performed at the Hospital Universitario Virgen de la Victoria in Málaga, Spain, between 1 January 2020 and 31 December 2024. A descriptive observational analysis and survival analysis were conducted using SPSS version 21.
  Results: The median age was 72 years (IQR 64–78), and the median PSA level at diagnosis was 14 ng/dL (IQR 4–81). The median follow-up time was 17 months (IQR 10–26), and the overall survival was 20 months (IQR 9–30). Regarding treatment, 51.4% of patients (92) received apalutamide, 31.8% (57) received enzalutamide, and 16.8% (30) received abiraterone. A total of 68.7% (123 patients) had an ECOG performance status of 0. Adverse events were reported in 39.7% (71 patients), of which 47.4% (37) were CTCAE grade 1, 21.8% (17) grade 2, 24.1% (19) grade 3, and 6.4% (5) grade 4. The most frequently reported adverse effects were: fatigue: 21.8% (17 patients), cutaneous rash: 17.9% (14 patients), hypertension: 14.1% (11 patients), neurological symptoms: 6.4% (5 patients), lower limb edema: 3.8% (3 patients), among others. Laboratory abnormalities were observed in 20.6% (37 patients), with the most common being: elevated liver enzymes: 42.7% (17 patients), thyroid dysfunction: 27.8% (10 patients), glucose metabolism disorders: 6.5% (2 patients). In total, 19% (34 patients) required permanent treatment discontinuation, 4.5% (8 patients) had temporary interruption, and 3.9% (7 patients) required dose reduction to 50%.
  Conclusions: Next-generation antiandrogens are generally safe and associated with manageable and identifiable adverse events. Most side effects can be addressed effectively, resulting in a favorable impact on the clinical course of advanced prostate cancer.

UP-20.06—Longitudinal Change in Castration-Resistant Prostate Cancer Biomarker De Ritis Ratio Can Reflect Tumor Progression 

• Mitsui Yozo, Hori Shunsuke, Uetani Masato, Yamabe Fumito, Kobayashi Hideyuki, Nakajima Koichi
  Toho University Faculty of Medicine, Tokyo, Japan

• Introduction and Objectives: In recent years, the treatment concept for castration-resistant prostate cancer (CRPC) has changed dramatically to a more aggressive strategy including upfront therapy. Factors that accurately reflect tumor progression and predict patient prognosis generally play important roles in selection of such potent therapeutic options. This study examined whether aspartate transaminase (AST)-to-alanine aminotransferase (ALT) ratio, also termed De Ritis ratio, and its change during the course of treatment in CRPC patients is associated with tumor condition and lethality.
  Materials and Methods: Clinical data from 130 CRPC patients (81 metastatic, 49 non-metastatic) were retrospectively evaluated. AST/ALT ratios at the time of prostate cancer (PC) diagnosis, androgen deprivation therapy (ADT), CRPC diagnosis, and the final follow-up examination after CRPC treatment were calculated for each. The prognostic capability of AST/ALT ratio for overall survival (OS) was analyzed using the Kaplan-Meier method and a Cox hazard model.
  Results: The median AST/ALT ratio at the time of PC diagnosis was 1.517, and the optimal value for predicting lethality defined by the receiver operating curve was 1.467. AST/ALT ratio decreased once during ADT and then elevated in a stepwise manner with cancer progression. Metastatic CRPC patients had a significantly higher AST/ALT ratio at the time of PC diagnosis as compared with those without metastasis (1.600 and 1.375, respectively), while the difference was not apparent after CRPC diagnosis (Fig B). Median AST/ALT ratio at the time of PC diagnosis during the follow-up period in surviving patients was 1.423, which did not change longitudinally, whereas that in patients later deceased was significantly greater (1.620) and further elevated following diagnosis of CRPC diagnosis. Kaplan-Meier curve results indicated significantly worse OS in patients with an AST/ALT ratio ≥1.467, which was confirmed by multivariate analysis.
  Conclusions: AST/ALT ratio was found to be a useful prognostic predictor for CRPC patients that longitudinally reflects both cancer progression and biological aggressiveness from the time of PC diagnosis.

UP-20.07—Microbiota of the Urethra of Patients with Prostate Cancer 

• Akinyemi Samuel, Pavlov Valentin, Urmantsev Marat
  Bashkir State Medical University, Ufa, Russian Federation

• Introduction and Objectives: Prostate cancer is the second most common cancer and the sixth leading cause of cancer-related deaths globally. Approximately 16% of cancer cases can be attributed to specific microbial associations in the body. Recent research has increasingly shown that alterations in the prostate microbiota, both in terms of quality and quantity, may significantly impact the onset, progression, and prognosis of prostate cancer. The purpose of our work was to study the microbial composition of the posterior wall of the urethra in patients with prostate cancer. Prostate cancer is the second most common cancer and the sixth leading cause of cancer-related deaths globally. Approximately 16% of cancer cases can be attributed to specific microbial associations in the body. Recent research has increasingly shown that alterations in the prostate microbiota, both in terms of quality and quantity, may significantly impact the onset, progression, and prognosis of prostate cancer. The purpose of our work was to study the microbial composition of the posterior wall of the urethra in patients with prostate cancer.
  Materials and Methods: A smear from the posterior wall of the urethra was examined in patients aged 53–78 years with a diagnosis of prostate cancer. Standard bacteriological methods and mass spectrometry (MALDI-TOF MS) were used to identify bacteria to the species. DNA was isolated from all samples for genome-wide sequencing to study the urethral microbiome in prostate cancer.
  Results: As a result of the study, it was found that 82% of the subjects had no growth of microorganisms on nutrient media. At the same time, the growth of bacteria Staphylococcus hominis (20% of the total number of identified microorganisms), Staphylococcus epidermidis (15%), Escherichia coli (15%), Klebsiella pneumoniae (15%), Staphylococcus haemolyticus (10%), Enterococcus avium (5%), Staphylococcus saprophyticus (5%), Botrytis cinerea (5%), Neurospora sitophila (5%), Candida albicans (5%).
  Conclusions: This results show that the bacteriological method only detects a small part of the microbiome associated with prostate cancer. It is especially important to conduct genome-wide sequencing for a comprehensive study of the microbial composition, leading to improved diagnostic capabilities.

UP-20.08—Oncological Outcomes from Pathological N1 Prostate Cancer—An 18 Year Single Centre Experience 

• Sharma Abhishek ¹, Gallagher Kevin ¹, Good Daniel ², Brennan Rory ¹, McNeill Alan ¹
  ¹ Western General Hospital, Edinburgh, United Kingdom, ² Princess Royal University Hospital, Brighton, United Kingdom

• Introduction and Objectives: The role of lymphadenectomy is controversial in prostate cancer. There is a general trend in moving away from pelvic lymph node dissection in lieu of molecular imaging with PSMA-PET. We wished to evaluate oncological outcomes in our local cohort of patients.
  Materials and Methods: Between 2006 and 2024, node positive prostatectomies (laparoscopic and robotic) performed in a single centre were reviewed. A combination of prospective and retrospective databases held in our institution for patient follow up purposes was interrogated. Additional retrospective review of electronic medical records was performed. Only patients with 10 year follow up were included in this study (i.e. from 2015 or before).
  Results: In total, 548 patients underwent pelvic lymphadenectomy in combination with their prostatectomy for their prostate cancer; of these, 27/548 (5%) had N1 disease. PSA nadir (PSA < 0.2) was observed in 18/27 (67%) of patients. Salvage treatments were required in 17/27 (63%) of patients. Patients who had salvage radiotherapy (4/27) all ended up on androgen deprivation therapy (ADT). Overall survival was 67% at 10 years or longer follow up, and prostate cancer specific mortality (PCSM) was 19% during this time period. In the group of patients that died from prostate cancer, median survival was 8 years (ranging from 2–11 years). Of note, one patient with T3bN1 disease was able to defer ADT for 18 years.
  Conclusions: Whilst lymph node metastasis is a poor prognostic feature, patients with lymph node metastasis still have a remarkably long survival after treatment, often with a significant period avoiding salvage treatments. In this group of patients, lymph node dissection is likely beneficial. Selecting patients that benefit from lymphadenectomy, however, remains a challenge, even in the era of modern molecular imaging.

UP-20.09—Optimizing Outcomes in Locally Advanced Prostate Cancer: The Transformative Role of Neoadjuvant Androgen Deprivation Therapy Prior to Robot-Assisted-Radical Prostatectomy in Emerging Economies 

• Bansal Nipun, Panwar Pankaj, Vasudeo Vivek, Chaturvedi Samit, Anudu Joesph, Kumar Anant
  Max Super Speciality Hospital, Saket, New Delhi, India, New Delhi, India

• Introduction and Objectives: Locally advanced prostate cancer (LAPC), defined as cT3-T4 or cN1 disease, lacks a standardized management approach. In South Asia, limited acceptance of radiation therapy, coupled with inadequate follow-up awareness, positions robot-assisted radical prostatectomy (RARP) as a preferred comprehensive treatment, which enables pathological evaluation and alleviates LUTS. Neoadjuvant androgen deprivation therapy (NADT) offers a promising strategy to enhance outcomes and cancer control post-RARP.
  Materials and Methods: We retrospectively analysed 167 patients with locally advanced prostate cancer (LAPC) who underwent robot-assisted radical prostatectomy (RARP) between January 2016 and June 2024. All included patients received neoadjuvant androgen deprivation therapy (ADT) for 3 months prior to surgery and had a minimum follow-up duration of 12 months postoperatively. Outcomes assessed included PSA levels, biopsy Gleason score, clinical stage, type of NADT/androgen receptor pathway inhibitors (ARPi), pathological stage, surgical margin status (PSM), biochemical recurrence (BCR), PSA on follow-up at regular intervals and continence rates.
  Results: Neoadjuvant therapy included ARP inhibitors combined with ADT in 20.35% of patients, while 40.11% received ADT alone. Clinical staging revealed cT3b in 56.28% of cases, followed by cT3a (20.35%), cT2c (15.5%), and cT4 (7.78%), with clinically positive nodes (cN1) observed in 29.9% of patients. In contrast, final pathological staging showed pT3b in only 19.76% and pN1 in 12.58% (21 patients), indicating a trend toward pathological downstaging. Positive surgical margins were observed in 10.8%. Continence rates were 85.12% at 3 months and 93.41% at 6 months. BCR was noted in 16.16% at 3 months. A significant reduction in nodal staging was seen in the NADT group (p = 0.00015). 2.9% required early salvage radiotherapy at 6 months.
  Conclusions: Neoadjuvant ADT followed by RARP is feasible and effective for locally advanced prostate cancer in improving surgical, oncological and functional outcomes.

UP-20.10—Prediction of Contralateral Extraprostatic Extension in Unilateral High-Risk Prostate Cancer 

• Lee Sang Hee ¹, Yoo Eun Sang ¹, Kim Hyun Tae ¹, Choi Seock Hwan ², Ha Yun-Sok ², Kim Bum Soo ¹, Kang Jun-Koo ¹, Kwon Tae Gyun ², Kim Tae-Hwan ², Chung Jae-Wook ², Jo Mun Gyeong ¹
  ¹ Kyungpook National University Hospital, Daegu, Republic of Korea, ² Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea

• Introduction and Objectives: Accurate prediction of contralateral extraprostatic extension (EPE) in unilateral high-risk (HR) prostate cancer (PCa) is crucial for decision-making in RP in nerve-sparing (NS) strategies. This study aimed to predict EPE on contralateral side of prostate in patients with unilateral HR disease.
  Materials and Methods: This retrospective study analyzed 132 consecutive patients diagnosed with unilateral HR PCa on preoperative evaluation who underwent robot-assisted RP by a single surgeon between August 2018 and February 2024. Unilateral HR PCa was defined as unilateral EPE and/or seminal vesicle invasion (SVI) on multiparametric magnetic resonance imaging (mpMRI) and/or International Society of Urologic Pathologists score (ISUP) 4–5 on prostate biopsy. Patients with bilateral EPE or SVI on mpMRI, bilateral ISUP ≥ 4, or PSA > 20 with organ-confined disease on mpMRI and ISUP ≤ 3 were excluded. This study evaluated the presence of EPE on final pathology contralateral to the prostatic lobe with unilateral HR PCa. The Wilcoxon and Fisher’s exact tests were used to compare continuous and nominal variables according to the presence or absence of contralateral EPE.
  Results: At final pathology, a total of 50 patients (37.9%) had organ confined disease and bilateral EPE was found in 9 patients (6.8%). The rates of EPE on the ipsilateral (dominant) and contralateral (nondominant) side were 59.8% (79/132) and 8.3% (11/132), respectively. Bilateral NS strategies (incremental or full) were performed in 65 patients (49.2%), while a unilateral nondominant NS was performed in 57 cases (43.2%). Compared to individuals with contralateral organ-confined disease, patients with contralateral EPE had higher maximum percentages of tumor length in a positive core (80.9% vs. 59.3%, p = 0.011), total positive core rate (51.2% vs. 22.2%, p = 0.018), and PSA density (0.52 vs. 0.35, p = 0.030).
  Conclusions: In this study, contralateral EPE was correlated with the maximum percentage of tumor length in a positive core, total positive core rate, and PSA density in patients with unilateral HR PCa. This study suggests performing a personalized NS strategy in well-selected patients with unilateral HR PCa in the era of personalized surgery.

UP-20.11—Prognostic Value of the Computer-Aided Diagnostic System Bonenavi as an Imaging Biomarker for Metastatic Castration-Sensitive Prostate Cancer on Bone Scan Images 

• Miyoshi Yasuhide ¹, Muraoka Kentaro ², Uemura Hiroji ³, Ohta Junichi ⁴, Kobayashi Kazuki ⁵, Makiyama Kazuhide ², Saigusa Yusuke ², Kawahara Takashi ³
  ¹ Kanagawa Prefectural Ashigarakami Hospital, Ashigarakami-gun, Japan, ² Yokohama City University, Yokohama, Japan, ³ Yokohama City University Medical Center, Yokohama, Japan, ⁴ Yokohama Municipal Citizen’s Hospital, Yokohama, Japan, ⁵ Yokosuka Kyosai Hospital, Yokosuka, Japan

• Introduction and Objectives: BONENAVI is software designed to automatically calculate the automated bone scan index (aBSI) and quantify the number of bone metastases on bone scan. We conducted an investigator-initiated prospective study to navigate prognosis for metastatic castration-sensitive prostate cancer (mCSPC) using BONENAVI.
  Materials and Methods: Eligible patients were assigned to one of two treatment groups: androgen deprivation therapy (ADT) combined with abiraterone acetate and prednisolone (the AA group) or ADT alone (the ADT group). The primary objective was to evaluate the prognostic value of the median aBSI in predicting progression-free survival (PFS) in the AA group. Secondary objectives included assessing the prognostic value of median aBSI for PFS across all patients, as well as in the ADT group, and evaluating the prognostic utility of aCHAARTED classifications based on BONENAVI.
  Results: Informed consent for this study was obtained from 98 patients between February 2018 and September 2022. All 98 patients were registered, and a total of 93 patients were included in the full analysis set. The AA group consisted of 57 patients (61.3%), while the ADT group included 36 patients (38.7%). Median aBSI was not significantly associated with PFS in the AA group, the ADT group, or overall patient cohort. Patients with aCHAARTED high-volume disease (HVD) exhibited worse PFS compared to those with low-volume disease (LVD) in both the overall cohort and the AA group; however, these differences were not statistically significant. In contrast, patients with aCHAARTED HVD in the ADT group had significantly worse PFS compared to those with LVD (HR = 2.59, 95% CI: 1.06–6.33, p = 0.031). The three-year survival rates for patients with aCHAARTED HVD and LVD were 20.0% and 47.0%, respectively. Median survival times were 60.4 months for patients with HVD and 144.3 months for those with LVD.
  Conclusions: The median aBSI could not predict the prognosis in mCSPC patients. However, the aCHHARTED classifications derived from BONENAVI may provide valuable insights into predicting PFS in mCSPC patients undergoing ADT. aCHAARTED classifications may play a pivotal role in survival prediction and shared decision-making between patients and physicians regarding treatment strategies for mCSPC.

UP-20.12—Suvmax Threshold for Identifying Needle Biopsy-Diagnosed Grade Group 1 Prostate Cancer Patients at Risk of Post-Surgical Upgrade Using 18f-PSMA PET/CT 

• Li Han, Wang Miao
  Beijing Hospital, Beijing, China

• Introduction and Objectives: Accurately determining whether prostate cancer (PCa) patients diagnosed with International Society of Urological Pathology (ISUP) grade 1 through needle biopsy will experience pathological upgrading is vital for making informed treatment decisions. This study seeks to explore the relationship between pathological upgrading in ISUP grade 1 PCa and the Maximum Standardized Uptake Value (SUVmax) derived from 18Fluorine-labeled prostate-specific membrane antigen (18F-PSMA) PET/CT. Additionally, it aims to identify appropriate SUVmax thresholds to support clinical decision-making and minimize the risk of overtreatment.
  Materials and Methods: This retrospective cohort study enrolled 38 patients who had a Prostate Imaging Reporting and Data System (PI-RADS) score of 3 or above from a prospective cohort. All patients underwent preoperative 18F-PSMA PET/CT imaging, were diagnosed with ISUP grade 1 PCa based on biopsy results, and subsequently received postoperative whole-slide pathology evaluation. The relationship between SUVmax and pathological upgrading was assessed using multivariate regression, and the SUVmax threshold for predicting upgrading was determined via receiver-operating-characteristic (ROC) curve analysis.
  Results: This retrospective cohort study enrolled 38 patients who had a Prostate Imaging Reporting and Data System (PI-RADS) score of 3 or above from a prospective cohort. All patients underwent preoperative 18F-PSMA PET/CT imaging, were diagnosed with ISUP grade 1 PCa based on biopsy results, and subsequently received postoperative whole-slide pathology evaluation. The relationship between SUVmax and pathological upgrading was assessed using multivariate regression, and the SUVmax threshold for predicting upgrading was determined via receiver-operating-characteristic (ROC) curve analysis.
  Conclusions: The SUVmax threshold value from 18F-PSMA PET/CT offers significant predictive value for pathological upgrading in ISUP grade 1 PCa. This threshold offers a more reliable approach for guiding clinical decisions and minimizing overtreatment, thus improving patient management.

UP-20.13—Ultra-Low PSA as a Prognostic Marker in Metastatic Castration-Resistant Prostate Cancer: Our Center’s Experience with Enzalutamide 

• González Jiménez David, Oskar Estradé Suarez, Sanz Casero Joel, Boiko Oleksandr, Llorente García Ana, Prieto Millán Sergio, Iliuta Florina, García Manzanares Adrián, Rodriguez Ormaza Ander, De La Mata García Jorge, Lázaro España Daniel, Lecumberri Castaños David
  Hospital Universitario Cruces, Barakaldo, Spain

• Introduction and Objectives: A post-hoc analysis of the TITAN study demonstrated that, among patients treated with apalutamide, achieving ultra-low PSA levels was associated with improved overall survival, progression-free survival, and time to progression. Similar benefits were also observed in patients who reached PSA levels between 0.02 and 0.2 ng/mL.
  Materials and Methods: A retrospective evaluation of the response to enzalutamide in 17 patients with mCRPC treated at our hospital was conducted.
  Results: Eight patients (47%) achieved a PSA nadir < 0.02 ng/mL, while two patients (11.75%) reached a PSA nadir between 0.02 and 0.2 ng/mL. The remaining seven patients (41.25%) had a PSA nadir > 0.2 ng/mL. No cases of progression under enzalutamide were observed in the group with PSA nadir < 0.02 ng/mL. In the group with PSA nadir between 0.02 and 0.2 ng/mL, one patient (50%) experienced disease progression. Among those with PSA nadir > 0.2 ng/mL, progression occurred in 5 patients (71.4%). This difference was statistically significant (p = 0.018).
  Conclusions: A deeper PSA response, particularly achieving a nadir < 0.02 ng/mL, was associated with a lower rate of disease progression. These findings support the prognostic value of PSA nadir levels in patients with mCRPC treated with enzalutamide.

21. Prostate Cancer—Clinical Localized

21.1. Moderated Oral ePosters

MP-21.01—A Novel Prostate Cancer-Specific Fluorescent Probe Based on Extracellular Vesicles Targeting Steap1 Applied in Fluorescence Guided Surgery 

• Sun Jianxuan, Xia Qidong, Xu Jinzhou, Wang Shaogang
  Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

• Introduction and Objectives: Radical prostatectomy with pelvic lymph node dissection is the best treatment for intermediate- to high-risk localized prostate cancer (PCa). However, conventional white light surgery has difficulties in identifying tumor boundary and micrometastases intraoperatively. Fluorescence guided surgery (FGS) can solve the above difficulties but lacks tumor-specific near-infrared fluorescent (NIRF) probes in PCa. STEAP1 was an ideal target in PCa treatment and imaging.
  Materials and Methods: A high-affinity single-chain antibody against STEAP1 was screened by phage display technology. Through plasmid construction, lentiviral packaging and infection of target cells, engineered modified HEK293T cells with high expression of STEAP1 single-chain antibody on their membrane surface were successfully constructed, and the extracellular vesicles targeting STEAP1 produced by these cells were extracted. The highly efficient near-infrared fluorescent molecule S0456 was loaded into the targeting vesicles by electroporation to construct S0456@AS-EVs, and the safety and targeting ability of S0456@AS-EVs were verified in vivo and ex vivo, respectively.
  Results: In vitro and in vivo studies both showed S0456@AS-EVs were safe and showed strong targeting ability to PCa in various mouse xenograft models. S0456@AS-EVs could clear rapidly from blood (half-time of 4.29 h) and remain in the STEAP1 positive tumor tissues for more than 72 h with the highest tumor background ratio (TBR) of 3:1, which was superior to ICG, free S0456, ICG@Ctrl-EVs, and S0456@Ctrl-EVs (p < 0.01). Finally, S0456@AS-EVs were applied in FGS on intramuscular model, and the tumors were resected under white light and fluorescence respectively. Compared with white light surgery, mice undergoing FGS had lower positive margin rate and better postoperative survival (p = 0.0342).
  Conclusions: A novel PCa-specific fluorescent probe S0456@AS-EVs was successfully constructed, which showed good targeting and safety in vitro and in vivo. Compared with conventional white light surgery, fluorescence-guided surgery with S0456@AS-EVs significantly reduced the positive margin rate and improved postoperative survival in nude mice.

MP-21.02—A Single-Arm, randomized Phase I/IIa Trial of the Novel PSMA Targeted Fluorescent Contrast Agent DGPR1008 for Intraoperative Fluorescence Imaging in Prostate Cancer 

• Yang Xuecheng ¹, Li Shengxian ¹, Zhang Mingxin ¹, Jia Yuefeng ¹, Zhao Jing ², Xu Ying ²
  ¹ The Affiliated Hospital of Qingdao University, QINGDAO, China, ² SIGNDO Biotechnology, Suzhou, China

• Introduction and Objectives: DGPR1008, a novel PSMA-targeted fluorescent contrast agent, can “illuminate” invisible tumors during prostate cancer surgery, helping doctors see tumor boundaries and reduce positive surgical margins. This single-arm, open-label Phase I/IIa trial aimed to assess its safety and efficacy for intraoperative imaging in radical prostatectomy.
  Materials and Methods: The trial was conducted in China from June-December 2024 and is still ongoing. In Phase I, we evaluated the safety, tolerability and pharmacokinetics of DGPR1008 in 32 healthy volunteers with 24 received DGPR1008, 8 received placebo, and divided into four dose groups: 0.01 mg/kg (n = 6 + 2), 0.02 mg/kg (n = 6 + 2), 0.04 mg/kg (n = 6 + 2), 0.08 mg/kg (n = 6 + 2). In Phase IIa, we evaluated the safety, tolerability, and efficacy in 24 prostate cancer patients. Patients were administered DGPR1008 at 0.02 mg/kg (n = 12) and 0.04 mg/kg (n = 12) 24 h before surgery.
  Results: In Phase I, DGPR1008 was well-tolerated. 12 TEAE events (elevated triglycerides, diarrhea, sinus bradycardia, infusion–site reactions) were in 10 cases; all TEAEs were Grade 1–2. In 19 prostate cancer patients in Phase IIa, the negative predictive value (NPV) and positive predictive value (PPV) were 57.14% and 92.31% in the 0.02 mg/kg group, 74.51% and 97.44% in the 0.04 mg/kg group. In 15 patients, the positive coincidence rate of 27 additional resected sites (margins) illuminated by fluorescence was 83.33%. Ten lymph nodes, which were pathologically confirmed as positive from 10 patients, were all illuminated by fluorescence during the operation, and the sensitivity was 100%.
  Conclusions: This study showed that using DGPR1008 for prostate cancer intraoperative visualization at the current optimal dose (0.04 mg/kg, 24 h pre-op) was safe and feasible. DGPR1008 guided fluorescence imaging can identify positive margins, lymph node metastases in the prostatectomy bed. We’ll explore different drug-administration time windows further.

MP-21.03—A Single-Center Open-Label Single-Arm Study Evaluating Efficacy and Safety of DGPR, a Novel Near-Infrared PSMA-Targeted Fluorescent Contrast Agent, for Intraoperative Fluorescence Imaging of PSMA-Positive Prostate Cancer 

• Shen Gang, Li Peng, Pu Jinxian
  The Fourth Affiliated Hospital of Soochow University (Suzhou Dushu Lake Hospital), Suzhou, China

• Introduction and Objectives: PSMA-targeting near-infrared (NIR) fluorescence-guided surgery (FGS) is conducive to intraoperative real-time identification of prostate cancer. We aim to explore the safety, efficacy of DGPR, a novel NIR PSMA-targeted fluorescent contrast agent, in FGS of prostate cancer.
  Materials and Methods: This study was granted approval by the ethics committee at The Fourth Affiliated Hospital of Soochow University. Patients newly diagnosed with prostate cancer (Gleason score ≥ 7) were eligible for enrollment. All patients had a laparoscopic radical prostatectomy using DGPR (SIGNDO Biotechnology Laboratories, Suzhou, China). Four dose cohorts were studied: 0.06 mg/kg administered 24 h preoperatively (A), 0.03 mg/kg administered 24 h preoperatively (B), 0.03 mg/kg administered 12 h preoperatively (C), 0.045 mg/kg administered 24 h preoperatively (D). The primary endpoint is safety. The secondary outcome is efficacy of DGPR for detection of prostate cancer in near-infrared imaging.
  Results: From July 21, 2023 to January 12, 2024, 14 eligible PCa patients were included. Total 32 adverse events (AEs) were observed. One patient (7.1%) presented four serious adverse events (SAEs), including urinary fistula, infected lymphocele, wound complications and acute exacerbations of COPD, which were cured with medical treatment. All AEs and SAEs were adjudged to possess no association with the administration of DGPR. Compared with other dose cohorts, in dose cohort B, DGPR showed the highest sensitivity (80.6%) to detect PCa in vivo. Furthermore, dose cohort B provided the highest target-to-background ratio through all phases of tumor imaging, including in-vivo (during the surgery) and ex vivo on the gross and fixed tissue. DGPR allowed real-time visualization of tumor-positive surgical margins with a sensitivity of 90% in vivo and 100% ex vivo.
  Conclusions: DGPR is safe and well tolerated and has the potential for the intraoperative identification of primary prostate cancer and positive surgical margins. A dose of 0.03 mg/kg DGPR administered 24 h preoperatively is a safe and feasible procedure.

MP-21.04—Acute Side Effects of Hypofractionated Radiotherapy with Pelvic Nodal Treatment for Prostate Cancer: MR-Linac vs. Conventional Linac 

• Senyurek Sukran ¹, Oymak Saliha ², Atasoy Ali ², Duman Merve ¹, Sezen Duygu ¹, Kilic Durankus Nulifer ¹, Beduk Esen Caglayan Selenge ², Bolukbasi Yasemin ¹, Saglam Yucel ², Selek Ugur ¹
  ¹ Koc University, School of Medicine, Istanbul, Türkiye, ² VKV, American Hospital, Istanbul, Türkiye

• Introduction and Objectives: We conducted a comparative analysis of acute urinary and intestinal toxicities in prostate cancer patients treated with hypofractionated radiotherapy (RT), including pelvic nodal irradiation, comparing Magnetic Resonance Linear Accelerator (MR-Linac) and conventional linear accelerator (Conv-Linac) techniques.
  Materials and Methods: We retrospectively analyzed 72 prostate cancer patients treated between January 2021 and December 2024 with definitive hypofractionated RT, including pelvic nodal irradiation. The prescribed doses by image guided intensity modulated radiotherapy were: 66 Gy (intraprostatic lesion), 60 Gy (whole prostate and involved seminal vesicles), 50 Gy (uninvolved seminal vesicles), 55 Gy (positive lymph nodes), and 44 Gy (elective nodal field) in 20 fractions. Toxicities were assessed using CTCAE v5.0, and urinary function was evaluated via the International Prostate Symptom Score (IPSS). IPSS was assessed at the simulation and the completion days of radiotherapy to determine the percentage change in urinary symptoms.
  Results: Of the patients, 45.8% received MR-Linac and 54.2% Conv-Linac treatments. Dose escalation to 66 Gy was achieved in 26 MR-Linac cases versus 4 Conv-Linac cases. MR-Linac yielded significantly lower doses to organs at risk: rectum D1cc (5290 cGy vs. 6075 cGy, p < 0.001), rectum D0.1cc (6022 cGy vs. 6215 cGy, p = 0.016), and sigmoid Dmax (3298 cGy vs. 4688 cGy, p < 0.001). Proctitis incidence was significantly reduced with MR-Linac (grade ≥ 2: 3% vs. 30.7%, p < 0.001). Dysuria rates (36.3% vs. 53.8%, p = 0.138) and mean increasing percentage in IPSS (66.87% vs. 87.14%, p = 0.403) did not differ significantly between the groups.
  Conclusions: MR-Linac enables safe delivery of pelvic nodal hypofractionated RT with significantly reduced intestinal toxicity and comparable urinary outcomes, even with dose escalation.

MP-21.05—Comparative Effectiveness of Robot-Assisted vs. Open Prostatectomy: A Real-Life Nationwide Study 

• Robert Grégoire ¹, Bladou Franck ¹, Blin Patrick ², Jové Jérémy ², Piazza Laurent ¹, Hayes Nathalie ¹
  ¹ Bordeaux University Hospital, Bordeaux, France, ² Bordeaux Pharmaco Epidemiology, Bordeaux, France

• Introduction and Objectives: Robot-assisted radical prostatectomy (RARP) was introduced over twenty years ago and is now the most widely practiced type of prostate cancer surgery in most developing countries despite no long-term evidence of benefit. Our objective was to compare long-term progression-free survival (PFS) and overall survival (OS) between patients undergoing robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP).
  Materials and Methods: A cohort study was designed in the French nationwide claims database with a follow-up of 5 to 8 years. All men undergoing surgery for prostate cancer between 2012 and 2015 were selected. RARP cohort included all men (n = 10,040) from hospitals using a robot for at least 95% of their surgeries. ORP cohort included all men (n = 17,911) from hospitals without robot equipment. PFS and OS were compared using Cox proportional hazards model for 1:1 matched patients on high-dimensional propensity score (hdPS) and for all patients adjusted on inverse probability treatment weighting (IPTW) using the hdPS.
  Results: 5,677 men could be matched with a median follow-up of 6.7 years. PFS and OS were longer with RARP compared to ORP (HR = 0.85 [95% CI: 0.79–0.91, p < 0.001] and 0.79 [0.68–0.92, p = 0.003], respectively). Index hospitalisation duration was shorter for RARP (6.7 ± 4.0 days vs. 9.9 ± 5.0 days, p < 0.01). At follow-up, care for urinary incontinence and erectile dysfunction was less frequent with RARP (29.7% vs. 37.3%; p < 0.01 and 52.1% vs. 56.3%; p < 0.01, respectively). Results were similar with all patients after IPTW adjustment except no difference for erectile dysfunction care.
  Conclusions: Compared to ORP, RARP performs better with respect to long-term survival outcomes and urinary complications.

MP-21.06—Exploratory Study on the Value of Ck5/6 Rapid Immunohistochemistry in Rapid Frozen Section Diagnosis of Prostate Targeted Biopsy Specimen 

• Wang Miao ¹, Lv Zhengtong ¹, Wang Xuan ¹, Hou Huimin ², Liu Longteng ¹, Zhang Wei ¹, Liu Ming ¹
  ¹ Beijing Hospital, Beijing, China, ² Beijing, Beijing, China

• Introduction and Objectives: Prostate biopsy remains the gold standard for preoperative diagnosis of prostate cancer (PCa). While recent studies have explored strategies for performing radical prostatectomy (RP) without prior biopsy, the issue of false positives in imaging findings cannot be entirely eliminated. The application of rapid frozen section (RFS) diagnosis to targeted biopsy specimens may reduce the number of biopsy cores required and potentially enable same-session RP. This study investigated the feasibility of CK5/6 rapid immunohistochemistry (RIHC) as an adjunctive diagnostic tool and evaluated its accuracy.
  Materials and Methods: This single-center prospective study enrolled 124 patients between October 2022 and September 2023. Eventually, clinical and pathological information from 116 patients was analyzed. For each patient, one biopsy core was obtained from both targeted and non-targeted regions for RFS diagnosis and CK5/6 RIHC testing. Two pathologists independently performed the diagnoses. The diagnostic accuracy of CK5/6 RIHC and its influencing factors were assessed using the remaining frozen tissue and conventional immunohistochemistry (IHC) as the reference standard.
  Results: A total of 232 biopsy specimens from 116 patients were analyzed. Final pathological diagnosis confirmed PCa in 117 cases (50.4%). RFS alone identified 101 cases (43.5%) as PCa, 101 (43.5%) as benign, and 25 (10.8%) as indeterminate. Among CK5/6-negative cases by RIHC, all 115 (100%) were also negative on conventional IHC and were ultimately diagnosed as PCa. The concordance between RIHC and conventional IHC was excellent (Kappa = 0.92, p < 0.001). Junior pathologists diagnosed 102 cases (44.0%) as PCa, 95 (40.9%) as benign, and 35 (15.1%) as indeterminate. With RIHC assistance, diagnostic certainty improved to 113 PCa cases (49.1%), 117 benign cases (50.4%), with only 1 (0.4%) remaining indeterminate. Interobserver agreement between junior and senior pathologists significantly increased (Kappa = 0.525, 95% CI 0.426–0.613 for RFS alone; Kappa = 0.902, 95% CI 0.875–0.923 for RIHC) when incorporating RIHC (both p < 0.001).
  Conclusions: CK5/6 RIHC demonstrates clinical feasibility and high diagnostic accuracy in prostate targeted biopsy evaluation. Its incorporation significantly improves diagnostic confidence, particularly for less experienced pathologists. These findings support the potential of RIHC as a valuable adjunct to frozen section diagnosis. Further validation through multicenter studies with larger cohorts is warranted.

MP-21.07—Focal IRE Therapy for Selected Patients with Prostate Cancer Using Irreversible Electroporation: First Middle East Medical Center Experience 

• Bulbul Muhammad, Khouzami Riad, Zein Marwan
  American University of Beirut Medical Center, Beirut, Lebanon

• Introduction and Objectives: Total gland treatment with radical surgery or radiation is the standard of care to treat localized prostate cancer, but they have major potential side effects, mainly loss of ejaculation, erectile dysfunction and urinary incontinence. Focal therapy in prostate cancer aims at treating the well defined cancer lesion, sparing the rest of the gland, thus preserving function and avoiding the side effects of total gland therapy. We report our experience, the first in the Middle East, in treating patients with localized prostate cancer using Irreversible Electroporation.
  Materials and Methods: 31 selected patients with localized prostate cancer were treated. All patients had suspicious mp-MRI and underwent MR/US Fusion prostate biopsies. All patients had PSA < 15 ng/mL, had intermediate risk Gl 7; 3 + 4 or 4 + 3. 29 patients had single positive lesion, and two patients had bilateral lesions. All patients were done as outpatient under general anesthesia with muscle relaxation using the NanoKnife, providing Irreversible Electroporation (IRE) to destroy the tumor lesion with a good margin. Foley was kept for 24 h, and all patients were discharged on alpha blockers and antibiotics. Follow up regimen included PSA and MRI at 6 months and one year along with a biopsy at one year.
  Results: All patients tolerated the procedure well. Two patients required re catheterization for retention, and two had hematuria. There was no change in erectile function in all patients, but three patients reported ejaculation changes. None of the patients complained of any urinary incontinence. PSA dropped in all patients at 6 months, and the MRI showed impressive treatment effect. PSA rose in 5 patients between 6 months and one year. Four of 12 biopsies at one year showed recurrent cancer. One in-field and 3 out of field. Three had Robotic Assisted Radical Prostatectomy, and one radiation therapy. All data will be presented in detail.
  Conclusions: Focal therapy using IRE, in the properly selected patients, can provide good cancer control and save the patients the side effects of whole gland therapy that stays with the patient and affects QOL. Patients must understand that recurrence will happen and must accept the concept of salvage therapy.

MP-21.08—MRI Target Boost Low Dose Rate Prostate Brachytherapy—Intermediate Term Biochemical Results 

• Kastner Christof, Whitney Diane, Russell Simon, Gregory Deborah, Martin Henno, Gatfield Elinor
  Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom

• Introduction and Objectives: We review biochemical, dose and side effect results one year post treatment for patients for whom we changed best practice to using MRI target boost in Low Dose Rate (LDR) prostate brachytherapy.
  Materials and Methods: A retrospective review undertaken of dose to specific dominant intraprostatic lesions (DILs) and corresponding PSA response in 202 whole prostate brachytherapy patients indicated a strongly statistical significant relationship between suboptimal DIL dose and a slow biochemical response at 12 to 18 months post implant, irrespective of whole prostate dose. MRI-US fusion, AI contouring and DIL focussed boost were implemented to the LDR theatre process to increase efficiency and precision. The aim was to deliver a consistent Biological Effective Dose (BED) to tumour to brachytherapy patients equivalent to and greater than that of PACE SABR. Biochemical, dose and side effect data were collected for patients for whom we changed practice to boost DIL with extra seeds during whole prostate LDR.
  Results: 7% historic whole prostate patients didn’t achieve prescription dose to DIL, and 10% demonstrated slow PSA fall rate (<80%) at 12 months. Intermediate term biochemical results indicate that all focussed boost patients achieve higher than prescription dose to DIL and corresponding improved biochemical response. PSA at 12 months shows a steeper fall rate, consistently exceeding 80%. No increase in IPSS urinary, IEFF erectile dysfunction or EPIC26 bowel toxicity score was identified.
  Conclusions: Implementing change to best practice to use diagnostic MR and biopsy histology to accurately identify and boost DILs to specific recommended dose objectives means that LDR brachytherapy delivers the highest dose to tumour compared to any current external beam radiotherapy schedule available to this cohort of patients, including PACE SBRT. This translates to confidence in a predictable good PSA response. This gives confidence to extend LDR brachy to higher grade organ confined disease. The finding that dose to DIL, rather than whole prostate, is the driving factor to consistent good PSA fall rate after brachytherapy treatment would be a significant consideration for salvage or focal brachytherapy.

MP-21.09—Predictive Model for Pathological Upgrading of ISUP Grade Group 1 Prostate Cancer After Radical Prostatectomy 

• Li Han
  Beijing Hospital, Beijing, China

• Introduction and Objectives: Patients initially diagnosed with International Society of Urological Pathology (ISUP) Grade Group 1 prostate cancer (PCa) via needle biopsy may harbor higher-grade disease that becomes evident after radical prostatectomy, a phenomenon known as pathological upgrading. Identifying patients at risk of upgrading can significantly impact clinical decision-making and patient management.
  Materials and Methods: We retrospectively analyzed data from 5,363 patients with biopsy-confirmed ISUP Grade Group 1 PCa from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly divided into training (70%) and validation (30%) cohorts. Univariate and multivariate logistic regression analyses were performed on the training cohort to identify predictive factors for pathological upgrading. A predictive model was subsequently constructed incorporating age, race, prostate-specific antigen (PSA) level, clinical stage, number of positive biopsy cores, interval from biopsy to surgery, and tumor diameter. The predictive accuracy of the model was evaluated using receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and calibration curves.
  Results: The constructed predictive model exhibited satisfactory predictive performance with an ROC area under the curve (AUC) of 0.72 in the validation cohort. Calibration curves demonstrated good agreement between predicted probabilities and actual observed outcomes, and decision curve analysis indicated significant clinical utility. Furthermore, Kaplan-Meier analysis revealed that patients stratified into high-risk and low-risk groups based on the model experienced significantly different survival outcomes, with low-risk patients showing superior survival (p < 0.05).
  Conclusions: Our predictive model effectively identifies ISUP Grade Group 1 PCa patients at higher risk of pathological upgrading post-radical prostatectomy, assisting clinicians in better patient counseling and individualized management.

MP-21.10—Prognostic Impact of Seminal Vesicle Mucosal Invasion in Pt3b Prostate Cancer Following Radical Prostatectomy 

• Kim Jae Yeon, Lee Dan Bee, Song Won Hoon, Lee Seung Soo, Nam Jong Kil, Park Sung-Woo
  Pusan National University Yangsan Hospital, Yangsan-si, Republic of Korea

• Introduction and Objectives: The extent of seminal vesicle invasion (SVI) in prostate cancer can be classified into muscle layer invasion (SVI-muscle) and mucosal layer invasion (SVI-mucosa). This study aimed to evaluate the prognostic significance of the extent of SVI after radical prostatectomy.
  Materials and Methods: SVI-mucosa data were prospectively collected since 2014. Among 1,659 radical prostatectomy specimens from 2014 to 2023, 259 cases (15.6%) with extraprostatic SVI were enrolled. A total of 252 cases with available follow-up data were included in the final analysis.
  Results: SVI-mucosa was identified in 63 cases (25.0%), and SVI-muscle was identified in all 252 cases. Extracapsular extension was present in nearly all SVI cases (99.6%). The mean tumor volume percentage in final specimens was significantly higher in patients with SVI-mucosa (50%) compared to those without it (35%) (p < 0.001). A high Gleason score (≥8) was more common in men with SVI-mucosa (p = 0.021). Only 10 (5.3%) and 4 (6.3%) patients with and without SVI-mucosa, respectively, received adjuvant therapy (p = 0.544). Biochemical recurrence-free survival did not significantly differ between men with SVI-mucosa and those with SVI-muscle alone (log-rank test, p = 0.309). The 5-year metastasis-free survival and prostate cancer-specific survival rates were 86.0% vs. 91.6% (p = 0.654) and 99.5% vs. 100% (p = 0.865) in patients with and without SVI-mucosa, respectively.
  Conclusions: The prognosis of patients with SVI is not uniformly poor. SVI-mucosa was associated with more aggressive pathological features. In most cases, SVI-muscle appears to develop first following extracapsular extension, with subsequent progression to SVI-mucosa. However, the presence of SVI-mucosa, an advanced status of SVI, did not significantly impact biochemical recurrence and metastasis-free survival rates.

MP-21.11—Radical Prostatectomy without Prior Biopsy: The Black Horse in the Race!! 

• Karmakar Saurav ¹, Gopalakrishna R K ², Kanjilal Subir ¹
  ¹ B R Singh Hospital, Dumdum, India, ² Fortis Institute of Kidney Disease and Research Centre, Kolkata, India

• Introduction and Objectives: Modern imaging techniques can now predict advanced prostate cancer with a high level of certainty. Prostate biopsy, whether performed via a transperineal or transrectal approach, carries significant risks, including morbidity and mortality. Severe complications may occur in up to 2% of patients and can include urinary retention, hematuria, rectal bleeding, and sepsis. Consequently, prostate biopsy delays the time from diagnosis to definitive treatment, often placing a considerable psychological burden on patients and leading to increased preoperative anxiety. We conducted a prospective observational study involving patients undergoing radical prostatectomy for prostate cancer without a prior biopsy.
  Materials and Methods: We performed a prospective observational study from January 2022 to June 2024, conducting 15 cases during this period. Patient selection criteria included: (i) suspicious digital rectal examination (DRE), (ii) PSA ≥ 10 ng/mL, (iii) high suspicion of prostate cancer on multiparametric MRI (mpMRI) with a PI-RADS score of 4 or 5, and (iv) high suspicion of prostate cancer on PSMA-PET imaging (CT or MRI), indicated by localized uptake of the PSA ligand. The primary outcome of our study was to assess the diagnostic accuracy for clinically significant prostate cancer, defined as an International Society of Urological Pathology (ISUP) grade > 1, following radical prostatectomy based solely on clinical and imaging criteria. Secondary outcomes include the diagnostic accuracy of mpMRI and PSMA-PET imaging in predicting lymph node metastases without biopsy-proven prostate cancer.
  Results: All patients with elevated PSA levels, a suspicious digital rectal examination, and a high likelihood of prostate cancer based on preoperative mpMRI and PSMA-PET imaging were diagnosed with clinically significant prostate cancer. In fact, applying the inclusion criteria of our study, most patients were diagnosed with highly aggressive and locally advanced prostate cancer.
  Conclusions: Our study indicates that radical prostatectomy without prior biopsy is feasible for diagnosing clinically significant prostate cancer when appropriate preoperative risk stratification, including mpMRI and PSMA-PET imaging, is applied.

MP-21.12—Suprapubic vs. Urethral Catheters Post Robotic-Assisted Radical Prostatectomy 

• Xu Jennifer ¹, Moon Daniel ², Dundee Philip ², Chan Yee ², Woon Dixon ², Troy Andrew ², Jack Gregory ², Bolton Damien ², Liodakis Peter ²
  ¹ Austin Health, Melbourne, Australia, ² Epworth Healthcare, Melbourne, Australia

• Introduction and Objectives: Urinary drainage post robotic assisted radical prostatectomy (RARP) is critical to allow urinary diversion and preservation of the vesicourethral anastomosis. Traditionally, this purpose is served by placement of an indwelling urethral catheter (UC). However, UC can cause postoperative discomfort, penile pain, and bladder spasms, and results in significant functional limitations. The aim of this project is to assess patient experience with a suprapubic catheter (SPC) versus UC post RARP.
  Materials and Methods: This is a prospective study of patients undergoing RARP from August to December 2024 in Australia. Patients in group 1 received SPC, and group 2 received UC post RARP according to surgeon practice. At the time of trial of void (TOV), patients completed a questionnaire addressing pain associated with their catheter using the Visual Analogue Scale (VAS), and social impact, number of consultations, or use of pharmacological agents to manage catheter-associated issues were also assessed. Early continence was assessed using pad weights over 24-h period at 1 and 6 weeks post TOV, and early urethral stricture rates assessed at 3 months.
  Results: 71 patients were recruited into the study with 41 patients in group 1 and 30 patients in group 2. Group 1 had a lower VAS score compared to group 2 (1.70 vs. 3.53, p = 0.001), lower rates of reported bothersome symptoms (39% vs. 67%, p = 0.035), and less impact on social activities (56% vs. 23% reported no impact on social activity, p = 0.014). The rate of pharmacological use was lower in group 1 (29% vs. 40%, p = 0.345); however, rate of additional consults required to manage SPC was higher (29% vs. 27%, p = 0.950), although these results did not reach statistical significance. Group 1 had less incontinence over 24 hours at 1 week (124g vs. 146g, p = 0.171) and 6 weeks (43g vs. 92g, p = 0.139) post TOV compared to group 2. Urethral stricture rate at 3 months was 0 for group 1 vs. 7% for group 2 (p = 0.094).
  Conclusions: These preliminary results support SPC as a feasible alternative to UC post RARP for improved patient experience and early incontinence rates with no compromise on urethral stricture rates. Larger cohort randomized studies are required to confirm these findings.

21.2. Moderated Video ePosters

MVP-21.01—A Surgical Challenge of Dual Reservoir Penile Prosthesis During Robotic-Assisted Radical Prostatectomy 

• Pon Avudaiappan Arjun ¹, Prabhakar Pushan ¹, Martinez Orlando Brito ¹, Bokhari Akram ², Martinez Daniel ³, Raja Iyub Mohamed Javid ¹, Manoharan Murugesan ¹, Sakthivel Deerush Kannan ¹
  ¹ Miami Cancer Institute, Baptist Health South Florida, Miami, United States, ² University of Hai’l, Hai’l, Saudi Arabia, ³ Baptist Health South Florida, Miami, United States

• Introduction and Objectives: Robotic-assisted laparoscopic radical prostatectomy (RALP) is widely regarded as the standard treatment for prostate cancer. However, performing RALP can be particularly challenging in patients who have undergone penile prosthesis implantation. The challenge becomes even more pronounced when the patient has a dual reservoir prosthesis, which is partially deflatable. In this video, we present our experience managing a patient with a partially deflatable double reservoir penile prosthesis during RALP.
  Materials and Methods: We outline the surgical technique for performing RALP while preserving the penile prosthesis reservoir.
  Results: Video Clip: Step 1: Preservation of the pseudo-capsule around the penile prosthesis reservoir. During the bladder mobilization, the penile prosthesis reservoirs were identified. Following adequate dissection and lateralization of the partially deflatable reservoir, the bladder was mobilized while preserving the integrity of the pseudo-capsule. This approach minimizes the risk of inadvertent damage to the reservoir. Step 2: Realignment of the instrument and camera arm. After successfully dissecting the reservoir to lateralize, the instrument and camera arms were repositioned medially and burped down to reduce the risk of reservoir injury. Surgical precision with controlled movements and limiting the range of the instrument arm through continuous visualization are essential in this context.
  Conclusions: Performing RALP in patients with a penile prosthesis, particularly with a partially deflatable double reservoir, presents a significant surgical challenge. Preserving the pseudo-capsule during reservoir dissection may help mitigate the risk of injury. Additionally, due to the limited tactile feedback during robotic surgery and reduced operative space, medially realigning the instrument arm and lowering the camera can reduce potential harm to the reservoir. Maintaining surgical precision and minimizing the operative arm’s range of motion is crucial. In some cases, the removal of the penile prosthesis may be considered.

21.3. Residents Forum Moderated Oral ePosters

RF-21.01—Comparison of Standard Posterior Reconstruction Technique with New Technique Developed by Our Center During Robot-Assisted Radical Prostatectomy 

• Akinyemi Samuel, Pavlov Valentin, Urmantsev Marat
  Bashkir State Medical University, Ufa, Russian Federation

• Introduction and Objectives: Robot-assisted radical prostatectomy was proposed to improve functional outcomes in comparison with retropubic radical prostatectomy or laparoscopic radical prostatectomy. We comprehensively review the anatomic and functional changes occurring post prostatectomy along with the reconstructive techniques. The rationale of posterior musculofascial plate reconstruction during radical prostatectomy is to shorten the time to reach urinary continence recovery and to reduce the risk of bleeding and anastomosis leakage.
  Materials and Methods: A total of 100 patients (mean age 67 years) with localized prostate cancer were included in the study. All patients were divided into two groups. In the group 1 (n = 50) the standard technique of the VUA was used, while in the group 2 (n = 50) the two-layer posterior reconstruction was done. The impact of urinary incontinence on the quality of life was analyzed using the ICIQ-SF questionnaire 1, 3 and 6 months after operation. On postoperative days 5–7, all patients underwent cystography to assess the tightness of the VUA.
  Results: One month after RARP in the group 1, the mean score of ICIQ-SF questionnaire was 6.72, compared to 1.7 in group 2 (p = 0.01). After 3 and 6 months, the respective values were 4.1 vs. 1.3 (p = 0.03) and 2.1 vs. 1.0 (p = 0.05), respectively. Cystography revealed no extravasation of the contrast.
  Conclusions: The results of a retrospective comparative study suggest that a two-layer posterior reconstruction of the VUA during RARP, being a simple method, provides better continence rate one month postoperatively compared to standard technique, although larger randomized clinical trials are needed.

RF-21.02—Rethinking ePLND During Radical Prostatectomy: A Critical Look at Outcomes and Updating a Nomogram to Predict Lymph Node Invasion in Prostate Cancer 

• Kumar Ranya ¹, Quinn Olivia ², Patel Amit ³, Kumar Prakrit ⁴, Kumar Vivekanandan ²
  ¹ University of Cambridge, Cambridge, United Kingdom, ² Norfolk and Norwich University Hospital, Norwich, United Kingdom, ³ Oxford University Hospital NHS Trust, Oxford, United Kingdom, ⁴ University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom

• Introduction and Objectives: Extended pelvic lymph node dissection (ePLND) is a frequent cause of morbidity in radical prostatectomy (RP) patients. Hence, in concordance with EAU guidelines, indication for ePLND should be based on validated nomograms to predict the risk of lymph node invasion (LNI). The Briganti 2017 nomogram is most appropriate in our cohort because most patients were diagnosed via systematic biopsies, invalidating future nomograms utilising mpMRI data. We aim to (1) assess the clinical impact of LNI on biochemical failure and overall survival in our population; (2) perform the first UK-based external validation of the Briganti nomogram; (3) update the nomogram for applicability to UK practice.
  Materials and Methods: From 1551 prostate cancer patients who underwent RP, 286 had ePLND between 2010–2021 in a tertiary referral centre. A multivariate logistic regression (MVA) was used to predict LNI from optimal weightage of the Briganti variables, forming the updated UK-tailored Briganti 2017 nomogram (NB17).
  Results: Of 286 patients, 23 (8.0%) had LNI. More lymph node positive patients had PSA failure at 2 months (7/23 vs. 23/263, p = 0.019) and latest follow up (10/23 vs. 46/263, p = 0.005). However, with a mean follow up of 5.5 years, overall survival in patients with and without LNI were similar (95.6% vs. 96.1%, p = 1.00). Application of the Briganti 2017 nomogram, with a 7% threshold, to our population results in 5.9% of patients below the cut-off having LNI. This is unsatisfactory as per Briganti’s definition (1.5% LNI rate). Further, our statistically-refined NB17 nomogram with a cutoff of 4% showed superior predictive accuracy to the Briganti nomogram within our population (area under Receiver-Operating-Characteristic curve = 0.785 vs. 0.666; p = 0.018). NB17 avoids 59 unnecessary ePLNDs (156 vs. 215), boosting specificity (40.7% vs. 18.3%) whilst missing no additional LNI-positive patients (3.3% LNI rate).
  Conclusions: Our data showed only 8% of our RP patients had LNI. Though they experience biochemical failure more frequently, their survival is equivalent to LNI-negative patients. Hence, there is a call to decrease the number of RP patients subject to the morbidity of ePLND. Since the Briganti nomogram has suboptimal predictive accuracy in our population, we recommend adoption of our updated NB17 nomogram to limit unnecessary ePLNDs without missing additional LNI-positive patients. External validation is required.

21.4. Unmoderated Oral ePosters

UP-21.01—10-Year Oncological Outcomes of EBRT vs. HIFU for Stage II Prostate Cancer: A Multicenter Chang Gung Research Database (CGRD) Study with Inverse-Probability-of-Treatment Weighting (IPTW) Analysis 

• Yeh Hsing-Tsuo
  Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan

• Introduction and Objectives: To evaluate oncological outcome of external beam radiation therapy (EBRT) versus high-intensity focused ultrasound (HIFU) in patients with stage II prostate cancer.
  Materials and Methods: We retrospectively reviewed patients with stage II prostate cancer from the Chang Gung Research Database spanning the years 2005 to 2022. Inverse probability of treatment weighting (IPTW) method was performed to achieve baseline equivalence in age, PSA, CCI score, stage, HTN, CAD, DM. Oncology outcomes were assessed using IPTW-adjusted Kaplan-Meier curves.
  Results: Total of 176 EBRT and 244 HIFU procedures were identified. EBRT group has higher overall mortality (9.2% compared to 16.7% after IPTW; standardized difference 0.224) and cancer specific mortality (5.4% compared to 9.2% after IPTW; standardized difference 0.144) after IPTW adjustment. An overall survival benefit is observed in the HIFU group for all stage II prostate cancer cases, with a particularly significant advantage in the stage IIa subgroup after IPTW adjustment (p = 0.032). Although the cancer-specific survival benefit slightly favors the HIFU stage IIa subgroup after IPTW adjustment, it does not reach statistical significance (p = 0.069).
  Conclusions: HIFU demonstrates improved overall survival compared to EBRT in patients with stage II prostate cancer, particularly in the stage IIa subgroup after more than 10 years of follow-up. Although not statistically significant, cancer-specific survival still slightly favors the HIFU IIa subgroup. Further randomized prospective studies are needed to evaluate the oncological outcomes of different prostate cancer treatment modalities.

UP-21.02—A Practical Framework for Testosterone Therapy in Hypogonadal Men with a History of Prostate Cancer: A Consensus Statement from the BSSM 

• Edison Marie ¹, Kirby Michael ², Hackett Geoffrey ³
  ¹ BURST Research Collaborative, London, United Kingdom, ² British Society for Sexual Medicine, Staffordshire, United Kingdom, ³ Aston University Medical School, Birmingham, United Kingdom

• Introduction and Objectives: The use of testosterone replacement therapy (TRT) in men with a history of prostate cancer has long been considered controversial. However, growing evidence suggests that, in appropriately selected patients, TRT can be both safe and effective. Despite this, many clinicians remain uncertain about when and how to initiate therapy in this complex group. This consensus work aims to bridge that gap by providing practical, evidence-informed guidance for clinical use. Objectives: To provide clinicians with a structured, pragmatic framework for evaluating, initiating, and monitoring TRT in men previously treated for prostate cancer, based on an expert consensus developed by the British Society for Sexual Medicine (BSSM).
  Materials and Methods: A multidisciplinary panel reviewed the existing literature, including randomised trials, retrospective studies, meta-analyses, and international guidelines and combined this with clinical expertise to develop a set of expert consensus-based recommendations. The emphasis here is on real-world applicability in routine clinical settings.
  Results: The consensus outlines a stepwise clinical approach to TRT, including timing of initiation, cancer risk stratification, MDT review, and baseline and follow-up investigations. TRT is considered appropriate for men with stable low- to intermediate-risk disease who are experiencing significant symptoms of testosterone deficiency. Monitoring protocols include regular PSA, haematocrit, and symptom reassessment. Practical guidance is also included in navigating borderline or high-risk cases, shared care with primary providers, and when to pause or discontinue therapy. While long-term data in high-risk groups remain limited, emerging studies suggest that, with careful selection and oversight, TRT may be safe even in more complex cases.
  Conclusions: This consensus provides a practical and implementable pathway for clinicians managing hypogonadism in men with a history of prostate cancer. The recommendations are designed to support decision-making in everyday practice, reduce unwarranted variation in care, and improve quality of life for affected men. As evidence evolves, structured consensus documents like this one will help clinicians navigate uncertainty with greater confidence.

UP-21.03—A Prospective, Randomized, Cross-over Trial to Assess Patient Preference for Goserelin Microsphere Versus Goserelin Implant in Prostate Cancer: Interim Results 

• Wang Xuegang, Xing Jinchun, Chen Bin, Zhang Kaiyan, Wu Zhun
  The First Affiliated Hospital of Xiamen University, Xiamen, China

• Introduction and Objectives: Androgen deprivation therapy (ADT), particularly gonadotropin-releasing hormone (GnRH) agonists like goserelin, remains a cornerstone in prostate cancer management. While the goserelin implant (Zoladex^® 3.6 mg) requires subcutaneous administration via a 16G needle (1.6 mm outer diameter) every 28 days, the goserelin microsphere formulation (LY01005 3.6 mg) is administered intramuscularly using a narrower 21G needle (0.8 mm outer diameter) at the same interval. Although phase III data (NCT04563936) confirmed comparable efficacy and safety between these formulations, patient preference remains unexplored. This study evaluates patient preference for the two formulations of goserelin.
  Materials and Methods: In this ongoing crossover trial (NCT06385847), 60 prostate cancer patients are randomized 1:1 to receive either goserelin implant (s.c., 3.6 mg every 28 days for 2 cycles) followed by goserelin microsphere (i.m., 3.6 mg every 28 days for 2 cycles), or vice versa. The primary endpoint is patient preference assessed via questionnaire post-treatment. Secondary endpoints include preference rationale, injection tolerability (assessed via Visual Analogue Scale [VAS]), testosterone suppression, adverse events (AEs), and health-related quality of life (HRQoL).
  Results: Among 35 enrolled patients, 20 completed both treatment periods and were evaluable. No participants reported “no preference”. Goserelin microsphere was preferred by 19 (95%) patients versus 1 (5%) patient for the goserelin implant (p < 0.0001). After adjusting for period effects via the Prescott test, the preference for goserelin microsphere remained statistically significant (one-sided p = 0.0445). Key factors driving this preference were reduced injection pain, easier administration, less pruritus and less hyperhidrosis. Moreover, mean VAS scores for injection pain were significantly lower for the goserelin microsphere (1.73) than the implant (2.50, p = 0.032). Additionally, first-dose injection anxiety was significantly greater for the goserelin implant (p = 0.0015), with only patients receiving the goserelin implant reporting “severe anxiety”. Adverse events were consistent with the known safety profile of each drug.
  Conclusions: Interim findings demonstrate a strong patient preference for the goserelin microsphere formulation over the goserelin implant, primarily due to less injection pain and simpler administration. Ongoing enrollment will further validate these results.

UP-21.04—A Refined Histopathologic Analysis for Pt3b Prostate Cancer: Clinical Implications for Customized Surgical Design 

• Bang Sungun, Jeon Jinhyung, Kim Do Kyung, Kwon Jong Kyou, Cho Kang Su
  Yonsei University College of Medicine, Seoul, Republic of Korea

• Introduction and Objectives: Seminal vesicle invasion (SVI) is a high-risk factor for prostate cancer. SVI is observed in various patterns, yet no standardized method exists for evaluating its extent. Therefore, we analyzed the clinical characteristics of pT3b prostate cancer and conducted a refined histopathologic analysis of seminal vesicle (SV) specimens to closely examine the extent and pattern of SVI and assess its clinical implications.
  Materials and Methods: A single surgeon’s database on robotic radical prostatectomy from July 2020 to December 2024 was retrospectively reviewed, identifying 73 patients staged as pT3b. Preoperative clinicopathological data and image review was performed. A refined histopathologic analysis was conducted to assess the presence of SV stromal invasion, peri-SV soft tissue involvement, and the surgical margin status of peri-SV soft tissue. The number of harvested and positive lymph nodes (LNs) was also examined.
  Results: Among the 73 patients, 35 (47.9%) were clinically staged as cT3b, while the remaining 38 patients were preoperatively diagnosed as cT3a or lower. Prostatectomy specimens revealed bilateral SVI in 33 patients (45.2%). Notably, peri-SV soft tissue invasion was observed in 54 patients (74.0%), among whom clear surgical margins were secured in 49 (90.7%), while 5 (9.3%) had positive margins. Vas deferens invasion was present in 25 patients (34.2%). After excluding 7 patients who had received preoperative androgen deprivation therapy and 8 who had not undergone pelvic lymph node dissection (PLND), 58 patients remained for analysis of PLND. Twenty-five (43.1%) had LN metastasis. The mean number of harvested LNs was 15.46 (3–34), and the mean number of involved LNs was 1.06 (0–16). Gleason grade group 4 or 5 (p = 0.011), peri-SV soft tissue invasion (p = 0.043), vas deferens invasion (p = 0.024) and lymphovascular invasion (p < 0.001) were significantly associated with pelvic LN metastasis.
  Conclusions: In pT3b patients, the high rate of peri-SV soft tissue involvement highlights the thorough completeness of tumor removal, including meticulous resection of peri-SV soft tissue. Given that preoperative clinical staging does not reliably indicate or predict pT3b status, an aggressive surgical approach is warranted.

UP-21.05—An Initial Case Series Experience of Rectal Spacer Use for Prostate Radiotherapy 

• Rajesh Revvand ¹, Lee Zac ², Ng Shaun ², Li Jingqiu ¹, Chan Thomas ¹, Tiwari Raj ¹
  ¹ Sengkang General Hospital, Singapore, Singapore, ² Nanyang Technological University, Singapore, Singapore

• Introduction and Objectives: Prostate cancer is the most common cancer in Singaporean men. Radiotherapy is a treatment for prostate cancer with known rectal toxicity in up to 30% of patients. The utilisation of rectal spacers has emerged as a promising strategy to reduce rectal toxicity. In this case series, we demonstrate the early learning curve of rectal spacer implantation, investigate factors affecting procedural difficulty and report our outcomes.
  Materials and Methods: We retrospectively analysed consecutive patients treated with radiotherapy following hydrogel rectal spacer insertion between May 2024 and March 2025 at Sengkang General Hospital. Spacer placement was performed transperineally under ultrasound guidance as day surgery. All patients had a magnetic resonance imaging (MRI) done post-procedure to confirm spacer position and for treatment planning. Data including demographics, prior benign prostate hyperplasia surgeries (BPH), pathological features (extra-prostatic extension (EPE) status, tumour (T stage)), procedural details (operation time, deployment success), post-procedure MRI findings including optimal placement, post-spacer prostate to rectal wall distance (PRWD) and radiation-related toxicities (Common Terminology Criteria for Adverse Events v5.0). Statistical comparisons (Mann-Whitney U test) assessed associations between prior BPH surgeries, EPE and difficulty of the procedure.
  Results: The cohort comprised 18 patients (median age 70 years). Gleason Grade Group distribution included 13 patients in Groups 2–3 and 5 in Group ≥ 4. All patients underwent successful spacer deployment with a mean operative time of 14 min 53 s. Post-procedure MRI revealed a mean PRWD of 13.04 mm (range: 6.33 mm to 18.45 mm). 3 patients had prior BPH procedures, and 6 patients had EPE. In both instances, there were no significant differences in operation time or deployment failures. Post-procedure MRI confirmed optimal spacer positioning in 17 of the cases, and in 1 case there was intra-prostatic capsular injection of the spacer. Grade 2 rectal toxicity occurred in 1 patient. No other rectal toxicities were reported.
  Conclusions: The early learning curve of rectal spacer injection is both feasible and safe. Neither did prior BPH procedures nor EPE affect the procedural difficulty. The high rate of optimal spacer positioning and low incidence of significant radiation side effects support the increased use of rectal spacers.

UP-21.06—Cardiovascular Effects of Androgen Deprivation Therapy in Prostate Cancer Patients: A Prospective Study 

• N Ragavan
  Apollo hospitals, Chennai, India

• Introduction and Objectives: Prostate cancer is prevalent among men, and Androgen Deprivation Therapy (ADT) remains a cornerstone in managing advanced stages of this disease. However, ADT has been associated with cardiovascular side effects, raising concerns, especially in populations with a high baseline risk for cardiovascular diseases. This study aims to investigate the impact of ADT on cardiac function over a short-term follow-up in prostate cancer patients.
  Materials and Methods: This prospective observational study was conducted at the Department of Urology, Apollo Hospital, Chennai, India, over a 24-month period from December 2022 to January 2025. Seventy prostate cancer patients (mean age 68.1 ± 8.4 years) who required ADT were recruited and classified into treatment groups receiving Degarelix (Leuprolide and Goserelin, or bilateral orchiectomy). Echocardiographic evaluations, Hs Trop-I, NT Pro-BNP, ECG monitoring, and lipid profile assessments were conducted pre-treatment (M1) and at three months post-therapy (M2).
  Results: Echocardiographic analysis demonstrated a statistically significant reduction in LVEF% (63.2 ± 3.3 to 61.3 ± 4.0, p < 0.001) and GLS% (16.4 ± 2.4 to 15.1 ± 2.3, p < 0.001) after three months of ADT. Additionally, significant ECG findings included QRS (98.9 ± 21.4 to 103.2 ± 24.3 ms, p = 0.016) and QTc prolongation (413.6 ± 40.8 to 425.7 ± 47.2 ms, p = 0.017). The lipid profile analysis indicated elevated total cholesterol (161.8 ± 42.7 to 175.7 ± 38.9 mg/dL, p = 0.008), triglycerides (140.6 ± 60.9 to 153.9 ± 75.1 mg/dL, p = 0.044), and HDL (41.4 ± 11.1 to 43.8 ± 10.6 mg/dL, p = 0.013). There was no statistically significant change in SBP, DBP, or serum electrolyte levels.
  Conclusions: This study confirms that ADT in prostate cancer patients is associated with early cardiovascular changes, including reduced cardiac function and myocardial injury markers (Hs Trop-I, NT Pro-BNP), within the first three months of therapy. These findings underscore the need for cardiac evaluation before and during ADT treatment in prostate cancer patients, particularly for those with preexisting cardiovascular risk factors. Further longitudinal studies with larger sample sizes are warranted to substantiate these findings and to guide clinical monitoring protocols.

UP-21.07—Clipless Robot-Assisted Retzius-Sparing Radical Prostatectomy—A Study on Its Safety Profile and Outcomes 

• Carbin Joseph Danny Darlington ¹, Antonoglou Georgios ¹, Harmouche Celine ², Abou Chedid Wissam ¹
  ¹ Royal Surrey County Hospital, Guildford, United Kingdom, ² Ashford and St.Peters NHS Foundation Trust, Chertsey, United Kingdom

• Introduction and Objectives: Retzius sparing RARP (RS-RARP) is a modification of the standard RARP technique that traditionally requires clips to control the pedicles. We aimed to retrospectively analyse the operative, oncological and functional outcomes of this altogether ‘clipless’ approach to RS-RARP from our centre.
  Materials and Methods: The study was conducted as a retrospective audit in our department. We included consecutive patients who underwent clipless-RS-RARP in our centre from February 2023 to December 2023. The clipless RS-RARP was done with the Da Vinci Xi system in all cases (primary surgeon-author WAC). No clips were used in these procedures, and the preoperative, intraoperative and postoperative data were recorded with at least 3 months of follow-up. Continence was defined as zero pad usage.
  Results: A total of 138 patients underwent RS-RAP using the clipless technique during the study period. The median age was 64 years, with a median BMI of 27.25 kg/m². 88.41% were ISUP 1–3 group patients. 82.61% were cT2, 17.39% were cT3, and 13.77% had median lobe in MRI. Mean console time was 99 min, with 81.16% having bilateral nerve spare, 17.39% unilateral spare, and 1.45% having none. 38.41% were fit to be discharged on the same day/evening of admission/surgery. There were no major complications (Clavien Dindo [CD] ≥ 3) or postoperative bleeding. The margin positivity rate was 19.7%, of which 60.1% were stage ≥ pT3a. The continence rates were 86.2% at 6 weeks, 89.1% at 3 months and 93.4% at 6 months. The potency and biochemical recurrence rates were 79% and 3.6%, respectively, at six months.
  Conclusions: Clipless RS-RARP is a safe procedure with good oncological and early continence recovery. This modification avoids clip-related complications without the expense of any higher complication rates compared to a standard RARP.

UP-21.08—Complications of Prostate Puncture (Prostate Biopsy) 

• Pavlov Valentin, Urmantsev Marat, Akinyemi Samuel
  Bashkir State Medical University, Ufa, Russian Federation

• Introduction and Objectives: Prostate biopsy is the gold standard for diagnosing prostate cancer. However, the procedure carries risks of complications, including infections, bleeding, and urinary retention. This analyzes recent research regarding complications from prostate biopsy procedures. Examines the safety aspects between transrectal and transperineal methods in combination with modern antibiotic prevention strategies and technological innovations including MRI guidance and robotic-assisted biopsy.
  Materials and Methods: This review followed PRISMA guidelines, analyzing 124 studies from 2023 to 2025, focusing on studies with ≥100 patients. Thematic analysis identified trends in complications, prophylaxis, and procedural advances.
  Results: Transrectal ultrasound-guided biopsy (TRUS-Bx) has a higher infection risk, with sepsis rates of 0.5% to 9.4%, largely due to fluoroquinolone resistance. Transperineal biopsy (TP-Bx) reduces this risk to less than 1% by avoiding rectal flora. Combination therapies like fosfomycin with ciprofloxacin lower infection rates from 5.8% to 0.5%, while rectal swab-guided prophylaxis further improves safety. MRI-targeted TP-Bx increases cancer detection (71.8% vs. 43.7% for TRUS-Bx) and reduces unnecessary biopsies. Robotic-assisted TP-Bx minimizes complications, with urinary tract infection rates as low as 0.4%. TP-Bx under local anesthesia is well tolerated but has a higher urinary retention rate (2.1%). High costs of MRI fusion and robotic biopsy limit access in low-resource settings. Future research should focus on cost-effective TP-Bx strategies and antibiotic-sparing approaches.
  Conclusions: TP-Bx and targeted prophylaxis are safer options than TRUS-Bx. Advances in imaging, antibiotics, and techniques have improved safety and accuracy. Clinicians should weigh patient risks, resources, and resistance patterns when choosing biopsy methods.

UP-21.09—Evaluation of High-Intensity Focused Ultrasound (S-HIFU) and Hemi-HIFU for Radiorecurrent Prostate Cancer 

• Maillard Cyriel ¹, Mebroukine Samy ¹, Robert Grégoire ¹, Pasticier Gilles ², Bladou Franck ¹
  ¹ Bordeaux University Hospital, Bordeaux, France, ² Clinique Tivoli-Ducos, Bordeaux, France

• Introduction and Objectives: Radiorecurrent prostate cancer presents a therapeutic challenge, with limited effective and non-invasive treatment options. Salvage radical prostatectomy (SRP) is associated with high morbidity, while high-intensity focused ultrasound (S-HIFU) has emerged as a promising alternative. This study evaluates the oncological and functional outcomes of S-HIFU in patients with recurrence after radiotherapy, comparing the efficacy and safety of total S-HIFU and hemi-S-HIFU.
  Materials and Methods: This retrospective single-center study included 138 patients treated with S-HIFU between August 2006 and October 2023 for local recurrence of prostate cancer after radiotherapy. Patients received either total S-HIFU, hemi-S-HIFU, or ultrafocal treatment, depending on tumor location. Inclusion criteria included biochemical recurrence (nadir PSA + 2 ng/mL) and absence of metastases. Disease progression was defined as a PSA increase greater than 2 ng/mL above the nadir post-HIFU, initiation of salvage hormone therapy, or positive biopsies. Progression-free survival (PFS), metastasis-free survival (MFS), and cancer-specific survival (CSS) were analyzed using Kaplan-Meier and Cox regression methods. Complications were classified according to Clavien-Dindo’s classification.
  Results: At 5 years, PFS was 43.6%, MFS 85%, and CSS 95%. Pre-S-HIFU PSA and an ISUP grade ≥ 5 were independent predictive factors for PFS. No significant difference was observed between total S-HIFU and hemi-S-HIFU for PFS and MFS, suggesting comparable efficacy between these approaches. In terms of safety, 93 patients (67%) experienced complications, of which 57 (41%) were severe (Clavien-Dindo ≥ 3). Severe complications were more frequent after total S-HIFU than hemi-S-HIFU (48% vs. 29%, p = 0.0313), indicating better functional tolerance for hemi-S-HIFU.
  Conclusions: S-HIFU is a safe and effective treatment option for local recurrences after radiotherapy, with comparable oncological efficacy between total and hemi-S-HIFU. Hemi-S-HIFU stands out for its reduction in severe complications, making it an attractive approach for localized recurrences. Incorporating predictive factors, such as pre-S-HIFU PSA and ISUP grade, could enhance patient selection for this treatment.

UP-21.10—Fast-Pro: Feasibility and Safety of Immediate Radical Prostatectomy Following Intraoperative Diagnosis of Prostate Cancer via Frozen Section Analysis During Targeted Biopsy 

• Liu Ming, Lv Zhengtong
  Beijing Hospital, Beijing, China

• Introduction and Objectives: Prostate cancer (PCa) is a prevalent malignancy among elderly men, highlighting the need for efficient diagnostic and treatment strategies. Traditional two-stage protocols may delay surgical intervention and increase patient anxiety. This study aims to evaluate the feasibility and safety of an integrated clinical pathway utilizing biparametric MRI (bp-MRI) and 18F-PSMA PET/CT, combined with targeted biopsy and intraoperative frozen section analysis, to facilitate immediate radical prostatectomy.
  Materials and Methods: This single-center, single-arm, prospective clinical trial was conducted from February 2022 to September 2024 and approved by the Ethics Committee of Beijing Hospital (2022BJYYEC-041-02). Eighty-two patients with high clinical suspicion of PCa based on abnormal bp-MRI and/or 18F-PSMA PET/CT findings were included in the final analysis. Inclusion criteria included age ≤ 80 years, clinical stage T2-3aN0-1M0, and willingness for radical prostatectomy following biopsy. Targeted biopsies were performed under anesthesia, with intraoperative frozen section pathology conducted immediately. Patients diagnosed with PCa underwent robot-assisted laparoscopic radical prostatectomy; if frozen pathology was negative or inconclusive, conventional biopsy was performed.
  Results: The study included 82 patients with a median age of 70 years, a median PSA level of 7.78 ng/mL, and 69.5% having PI-RADS 4 or 5 scores. MRI identified 109 lesions, while PSMA PET/CT was positive in 89% of patients, detecting 91 lesions. Targeted biopsy had a 72% positive rate, reaching 83.9% when MRI and PET/CT findings were concordant. Frozen pathology had 100% specificity and PPV. Following radical prostatectomy, 26 cases were upgraded, and 9 downgraded in ISUP grading, with 86.3% staged as T2c or higher. Postoperative PSA levels decreased significantly (average 0.0025 ng/mL), and the biochemical recurrence rate was low (3.22%), highlighting the effectiveness of the diagnostic and treatment pathway.
  Conclusions: This study demonstrates that combining prostate bp-MRI and PSMA PET-CT guided targeted biopsy with intraoperative rapid frozen pathology improves diagnostic accuracy and allows for immediate surgical intervention, thereby reducing patient anxiety and optimizing healthcare resources. Further validation in multi-center studies is warranted.

UP-21.11—From Active Surveillance to Treatment: Patterns of Care in a Multicentre Irish Cohort 

• Sullivan Maria, Flynn Robert, Casey Rowan, Thomas Arun
  Tallaght University Hospital, Drogheda, Ireland

• Introduction and Objectives: Active surveillance (AS) is the preferred management strategy for favourable-risk prostate cancer. It is designed to prevent overtreatment and mitigate the adverse effects of radical interventions while safely monitoring for disease progression. Despite its effectiveness progression rates and patient outcomes may differ across healthcare systems depending on resources and monitoring practices. This study evaluates the progression rates, disease characteristics, and outcomes of men on AS within both public and private healthcare settings in Ireland.
  Materials and Methods: We conducted a retrospective cohort study of 350 men enrolled in active surveillance across two major Dublin hospitals: Tallaght University Hospital and Beacon Hospital between 2018 and 2024. Data was extracted from electronic records, histopathology reports, and the National Integrated Medical Imaging System (NIMIS). The primary outcome being the need for active intervention due to clinical or radiologic progression. Additional secondary outcomes included patient, biopsy and MRI characteristics also the nature and frequency of follow-up diagnostics. Comparisons were made between public and private healthcare settings to assess differences in progression and treatment transitions.
  Results: The mean patient age was 68 years. The median Gleason grading at diagnosis was Gleason 6, and MRI grading was PIRADS 3. Progression rates based on PSA trends, MRI progression or biopsy upgrading varied between 13–25% between centers and years; of these, ultimately 10–15% transitioned to active treatment ADT, radiotherapy or prostatectomy. The median time on AS before progression was 3 years. Follow-up practices were resource dependent, with the availability of repeat imaging limiting the timeliness of follow-up of patients in the public system.
  Conclusions: Active surveillance remains a reliable approach for managing favourable-risk prostate cancer, enabling the majority of men to delay or avoid treatment and its associated morbidity. Nevertheless, a proportion of patients will ultimately require treatment as their disease advances. Despite resource limitations in public care such as delayed MRI access, progression rates were comparable to the private sector. Suggesting AS can be resilient if core monitoring is preserved. Investments in diagnostic tools like multiparametric MRI can potentially promote equitable treatment options for all patients in each sector, ultimately optimising long-term outcomes for patients on active surveillance.

UP-21.12—Impact of Dynamic Contrast-Enhanced MRI Sequences on Treatment Eligibility and Planning in Suspected Prostate Cancer: Secondary Analysis from the PRIME Trial 

• Asif Aqua, Study Group PRIME
  University College London, London, United Kingdom

• Introduction and Objectives: Multiparametric MRI (mpMRI) with dynamic contrast-enhanced (DCE) sequences has become the international standard of care for prostate cancer diagnosis. DCE may influence treatment eligibility and planning decisions, from surgical approach to radiotherapy and brachytherapy targeting. We aimed to evaluate this in a prospective clinical trial, PRIME.
  Materials and Methods: PRIME (NCT04571840) was an international, multicentre trial involving 22 centres across 12 countries. We enrolled men with suspected prostate cancer (PSA ≤ 20 ng/mL, no prior biopsy) between April 2022 and September 2023. In this pre-specified secondary analysis, virtual multidisciplinary team (MDT) meetings reviewed 488 patients. Each MDT comprised radiologists, urologists, and oncologists. Clinicians were initially blinded to DCE and made treatment decisions using only biparametric MRI (bpMRI: T2-weighted and diffusion-weighted imaging) and bpMRI-specific biopsy results (if applicable). After unblinding to DCE (and DCE-specific biopsy if performed), treatment decisions were re-evaluated. MDTs considered eligibility and planning for radical prostatectomy (including nerve-sparing approach, bladder neck sparing, and Retzius sparing), focal therapy (treatment extent and energy source), and radiotherapy/brachytherapy (target volume delineation and rectal spacer use).
  Results: DCE influenced treatment decisions in 31 patients (6.4%): 21 (4.3%) had eligibility changes, 15 (3.1%) had planning changes, and 5 (1.0%) had both. Among 119 radical prostatectomy candidates, nerve-sparing recommendations changed in 6 (5.0%), while no changes were observed for bladder neck or Retzius sparing. Of 41 patients eligible for focal therapy, energy source changed in 1 (2.4%) patient, with no changes in treatment extent. Among 145 radiotherapy or brachytherapy candidates, 6 (4.1%) had changes in target volume delineation, and 3 (2.1%) had rectal spacer modifications. Active surveillance eligibility changed in 7 (1.4%) patients.
  Conclusions: Overall, in patients undergoing investigation for suspected prostate cancer, DCE did not make a large difference in treatment eligibility or planning. However, when considering patients chosen for individual treatment modalities, there was a benefit in a small subset of patients.

UP-21.13—Oncological Outcomes from Pathological T3b Prostate Cancer—An 18 Year Single Centre Experience 

• Sharma Abhishek ¹, McNeill Alan ¹, Gallagher Kevin ¹, Good Daniel ², Brennan Rory ¹
  ¹ Western General Hospital, Edinburgh, United Kingdom, ² Princess Royal University Hospital, Brighton, United Kingdom

• Introduction and Objectives: Locally advanced prostate cancer has traditionally been regarded a non-surgical entity. Such patients are treated preferentially with non-surgical modalities in many units. There is increasing evidence, however, of good outcomes from surgery in a selected group of these patients.
  Materials and Methods: Between 2006 and 2024, the final pathology from all radical prostatectomies (laparoscopic and robotic) performed in a single centre was reviewed. Patients with pathological T3b disease were included in the study. The sources of data were a combination of prospective and retrospective databases held in the institution for patient follow up purposes. Electronic patient records were used to complete the dataset.
  Results: In total, 265 patients from a cohort of over 3000 had T3b disease on final pathology. 195 (74%) patients had PSA nadir (PSA of 0.1 ng/mL or less); 26% failed to nadir. We subsequently looked at long-term oncological outcomes (patients with > 5 years of follow up). Of the 137 patients, 65 (47%) of patients did not require any salvage treatments over a follow up period between 5–18 years, and 73 (53%) of patients required additional treatments, of which 37 (27%) had salvage radiation. Overall survival in this cohort was 85% (224/261), and prostate-cancer specific mortality (PCSM) was 7%. In patients who died from prostate cancer, median survival was 7 years (ranging from 3–18 years).
  Conclusions: Radical surgery remains a viable option in men with T3b prostate cancer. As this was a non-randomised study, a selection bias may have been present, and perhaps men with more bulky disease may have been sent preferentially for non-surgical treatment. The PCSM in this high-risk cohort is in keeping with contemporary literature.

UP-21.14—Prognostic Potential of cfDNA in PSA Progression Following Radical Prostatectomy 

• Alfambra Héctor, Figueras Marcel, Mengual Lourdes, Ingelmo-Torres Mercedes, Roldán Fiorella, Padullés Bernat, Paredes Pilar, Amseian Gary, Mases Joel, Ribal María José, Izquierdo Laura, Alcaraz Antonio
  Hospital Clínic Barcelona, Barcelona, Spain

• Introduction and Objectives: The current prediction of disease recurrence following radical prostatectomy (RP) for localized prostate cancer (PCa) predominantly relies on clinicopathological parameters, which exhibit limitations in prognostic accuracy. This study aimed to evaluate the potential utility of circulating cell-free DNA (cfDNA) levels and fragmentation patterns as prognostic biomarkers in patients exhibiting progressive prostate-specific antigen (PSA) following primary treatment for localized PCa, encompassing both persistent PSA and biochemical recurrence (BR).
  Materials and Methods: A single-centre cohort of twenty-nine high-risk localized PCa patients was prospectively enrolled between February 2022 and May 2023. Peripheral blood samples were collected prior to robotic RP. Quantification of cfDNA concentration was performed using the Quant-it PicoGreen dsDNA Assay kit, and fragment size analysis was conducted utilizing the Agilent 2200 TapeStation System.
  Results: The mean PSA level at diagnosis was 9.4 ng/mL. Pathological staging revealed 7 patients (24.1%) with pT2 and 22 patients (75.9%) with pT3. At the first postoperative PSA assessment (six weeks), 9 patients (31%) exhibited detectable PSA, and 4 patients (20%) experienced BR during a mean follow-up period of 18.4 months. No statistically significant associations were identified between cfDNA levels or fragmentation patterns and established clinicopathological variables. However, a non-significant trend towards elevated cfDNA levels and shorter fragment lengths was observed in patients with detectable postoperative PSA compared to those with undetectable PSA.
  Conclusions: The findings of this pilot study suggest a tendency towards increased cfDNA fragmentation in PCa patients with persistent PSA following RP. Notably, patients experiencing biochemical recurrence demonstrated comparable cfDNA levels and fragmentation patterns to those without recurrence. Further investigation in larger cohorts is warranted to elucidate the clinical utility of liquid biopsy-derived biomarkers in predicting PSA persistence in localized PCa patients.

UP-21.15—Radiation’s Residue: Understanding the Impact of Prior Pelvic Radiation Therapy on Radical Prostatectomy Outcomes: An NSQIP Database Study 

• Nasrallah Oussama, Al Hattab Moustafa, Ghandour Yara, Sebai Towfik, El Hajj Albert
  American University of Beirut Medical Center, Beirut, Lebanon

• Introduction and Objectives: Prostate cancer is the most common solid tumor in males worldwide and the second leading cause of death. The primary treatment of prostate cancer varies according to patients as they may undergo surgery or minimally invasive or ablative methods, radiotherapy, and cryotherapy. The choice of treatment route would depend on patient preference and other factors, which may influence the decision of undergoing surgery or other modalities such as comorbidities and anticoagulation dependance, abdominal surgical history, or prior pelvic radiotherapy. In our study we aim to evaluate the effect of pelvic radiotherapy on the surgical outcomes of radical prostatectomy.
  Materials and Methods: The ACS-NSQIP database was reviewed from 2019–2022, for patients that underwent radical prostatectomy (CPT codes: 55810, 55812, 55815, 55840, 55842, 55845, 55866). Statistics were used to describe baseline characteristics, intra-operative and post-operative complications, shown in Table 1. Multivariate logistic regression was conducted while adjusting for appropriate baseline characteristics in a stepwise fashion.
  Results: A total of 30,643 patients with prostate cancer were included in the analysis in which 261 patients have received previous pelvic radiotherapy either for prostate cancer or other malignancies. It was demonstrated that pelvic radiotherapy posed a significantly higher risk of intra-operative and post-operative outcomes and complications, which include surgical site infections, rectal injury, anastomotic leaks, urinary leaks and fistulas. Additionally, patients with pelvic radiotherapy showed increased risk of prolonged post-operative NPO or NG tube use, and hospital stay. The results are shown in Table 2. Limitations of our study included the reason behind the exposure to radiotherapy: prostate cancer or other malignancies. Other limitations included the absence of prostate size in the patient demographics and missing data, which may affect the outcomes in the final analysis.
  Conclusions: The exposure of the pelvis to radiation therapy and namely the prostate and its surroundings directly affected post-operative and intra-operative outcomes and increased the risk of complications in patients undergoing radical prostatectomy. Patients were shown to be at an increased risk of intra-operative rectal injury and anastomotic leaks detected either intra-operatively or post-operatively.

UP-21.16—Single Centre Experience of Robot Assisted Radical Prostatectomy with CMR Versius^® Robotic Surgical System 

• Prakash Pradeep
  Yashoda Superspeciality Hospital and Cancer Institute, Ghaziabad, India

• Introduction and Objectives: We present our experience of RARP with CMR Versius^® surgical system and assess the outcomes and cost-effectiveness compared to Da Vinci^® surgical system.
  Materials and Methods: Consecutive patients undergoing RARP in our department between July 2023 to October 2024 were included. Operative time, docking time of system, anastomosis time, blood loss and other parameters were assessed. Postoperative recovery data and follow up data including days to socially acceptable continence (defined as single diaper use in 24 h) were recorded.
  Results: Seventeen patients underwent RARP during the study period. The median age was 67 years (range 58–73), and the median BMI was 31.4 (range 26.8–39.1). The median prostate size was 48 g (range 28–80), and median PSA was 8.9 ng/dL (4.7–18.2). The median operating time was 290 min (range 240–330), and median vesicourethral anastomosis time was 50 min (range 40–60). The median docking time was 15 min (range 10–25). The median blood loss was 350 mL (250–750 mL), and 2 patients (11.7%) required blood transfusion. The robotic malfunction was limited to errors in instruments bedside units, which were 5 times in first case which came down to zero by fourth case. There were no major intraoperative or postoperative complications, and median hospital stay was 4 days (range 4–6). The median time for return to socially acceptable continence was 10 days (range 3–30). The median cost of RARP at our center was 4470 USD (4117–5085 USD) as compared to average 7500 USD for RARP in India with Da Vinci^® Surgical system.
  Conclusions: To our knowledge, this is the largest reported series of RARP on CMR Versius^® system in India. It is feasible and safe to perform RARP with this system with comparable perioperative and functional recovery outcomes and significant cost benefits compared to Da Vinci^® system. The errors encountered during the surgery lead to longer operating times initially, but they improve gradually with technical modifications as we get accustomed to the system.

UP-21.17—Single-Port Versus Multi-Port Robot-Assisted Radical Prostatectomy: A Systematic Review and Meta-Analysis 

• Ficarra Vincenzo ¹, Romito Ilaria ², Sorce Gabriele ¹, Maravigna Debora ², Foti Mauro ¹, Mottrie Alexander ³, Abdollah Firas ⁴, Briganti Alberto ⁵, Salonia Andrea ⁵, Montorsi Francesco ⁵, Giannarini Gianluca ⁶, Lo Giudice Arturo ¹, Rossanese Marta ¹
  ¹ Department of Human and Pediatric Pathology “Gaetano Barresi”, Urologic Section, Messina, Italy, ² University of Messina, Messina, Italy, ³ Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium, ⁴ Henry Ford Hospital, Detroit, United States, ⁵ Vita-Salute San Raffaele University, Milan, Italy, ⁶ Ospedale Santa Maria della Misericordia, Udine, Italy

• Introduction and Objectives: Single-port robot-assisted radical prostatectomy (SP-RARP) has emerged as a minimally invasive alternative to the established multi-port approach (MP-RARP) for the treatment of localized prostate cancer. While early data suggested advantages of SP-RARP in reducing post-operative pain and length of stay (LoS), recent studies reported conflicting results. This systematic review and meta-analysis aimed to compare perioperative, functional, and oncologic outcomes between SP-RARP and MP-RARP, providing updated evidence for clinical decision-making and health technology assessment.
  Materials and Methods: This systematic review was conducted following PRISMA 2020 guidelines, with the protocol registered in PROSPERO (CRD 42025616519). Medline and Scopus databases were searched up to December 2024, identifying comparative studies of SP-RARP versus MP-RARP. Outcomes assessed included lymph node dissection (LND), estimated blood loss (EBL), operative time, LoS, catheterization time, complication and readmission rates, post-operative pain, continence, potency, and oncologic results. Meta-analyses were performed using random- or fixed-effect models depending on heterogeneity.
  Results: Twenty-six comparative studies involving 2,972 SP-RARP and 2,800 MP-RARP patients were included. No randomized controlled trials were identified. Meta-analyses showed that SP-RARP was associated with significantly lower EBL (SMD = 0.518; p = 0.004), shorter LoS (SMD = 1.127; p < 0.0001), shorter catheterization time (SMD = 0.964; p = 0.004), and reduced post-operative pain (SMD = 0.199; p = 0.011). However, patients undergoing MP-RARP were more likely to receive pelvic LND (OR = 2.810; p = 0.013) and had higher lymph node yields. No significant differences were observed in operative time, nerve-sparing rates, complications, readmissions, continence or potency recovery at 3–6 months, or early oncologic outcomes including positive surgical margins and biochemical recurrence.
  Conclusions: SP-RARP appears to offer peri-operative advantages over MP-RARP in terms of blood loss, pain control, and hospital stay while maintaining equivalent functional and early oncologic outcomes. However, SP-RARP is associated with lower lymphadenectomy rates and higher disposable costs. The lack of randomized evidence and potential confounders such as surgical approach heterogeneity limit definitive conclusions. Further high-quality studies and cost-effectiveness analyses are warranted to support broader adoption of SP technology.

21.5. Unmoderated Video ePosters

UVP-21.01—A Simplified Modification of the Lateral Approach in Nerve-Sparing Robotic Radical Prostatectomy: Technical Description and Early Experience 

• Karavitakis Markos, Grivas Nikos, Zabaftis Christos, Tsela Smaragda, Nikitakis Fiippos, Tsogka Sissy, Ntoutsias Alexandros
  Lefkos Stavros, Athens, Greece

• Introduction and Objectives: The lateral approach to nerve-sparing robotic radical prostatectomy enables optimal preservation of the neurovascular bundles and the anterior pubovesical complex while minimizing thermal energy use. Despite its functional advantages, its adoption has been limited by technical complexity and difficulties in reproducibility. Our objective is to present a simplified variation of the lateral approach that facilitates reproducibility and learning while maintaining the anatomical and functional benefits of the original technique.
  Materials and Methods: We describe a step-by-step technical adaptation of the lateral approach. Ιn the classical right lateral approach, dissection begins directly at the seminal vesicle, passing through the triangular anatomical window bordered medially by the bladder, anteriorly by the base of the prostate and laterally by the neurovascular bundle, while preserving the surrounding venous plexus. In our variation, the dissection starts laterally with blunt technique, gradually exposing the lateral surface of the prostate and performing an early and high release of the neurovascular bundles. Dissection is then extended posteriorly toward the seminal vesicles. All other key steps—bladder neck dissection, apical dissection, full preservation of the detrusor apron, and dissection of the anterior pubovesical complex and Santorini plexus and anastomosis—remain unchanged.
  Results: We describe a step-by-step technical adaptation of the lateral approach. Ιn the classical right lateral approach, dissection begins directly at the seminal vesicle, passing through the triangular anatomical window bordered medially by the bladder, anteriorly by the base of the prostate, and laterally by the neurovascular bundle, while preserving the surrounding venous plexus. In our variation, the dissection starts laterally with blunt technique, gradually exposing the lateral surface of the prostate and performing an early and high release of the neurovascular bundles. Dissection is then extended posteriorly toward the seminal vesicles. All other key steps—bladder neck dissection, apical dissection, full preservation of the detrusor apron, dissection of the anterior pubovesical complex and Santorini plexus and urethrovesical anastomosis—remain unchanged.
  Conclusions: Our modified lateral approach appears to retain the advantages of the original technique while offering greater ease of learning and standardization. Further results will be shared upon maturation of follow-up data.

UVP-21.02—An Initial Experience of Rectal Spacer Use for Prostate Radiotherapy: An Instructional Video 

• Ng Shaun Wei Cher ¹, Lee Gin Kai Francis Zac ¹, Rajesh Revvand ², Li Jingqiu ², Chan Thomas ², Tiwari Raj Vikesh ²
  ¹ Lee Kong Chian School of Medicine, Singapore, Singapore, ² Sengkang General Hospital, Singapore, Singapore

• Introduction and Objectives: Prostate cancer is the most common cancer in Singaporean men. Radiotherapy is a treatment modality with known rectal toxicity in up to 30% of patients. The utilisation of rectal spacers is a promising strategy to reduce rectal toxicity. In this video series, we demonstrate the learning curve of rectal spacer implantation with a technique discussion, investigate factors affecting procedural difficulty and report our outcomes.
  Materials and Methods: We retrospectively analysed patients treated with radiotherapy following rectal spacer insertion between May 2024 and March 2025. Spacer placement was performed transperineally under ultrasound guidance. Magnetic resonance imaging (MRI) was done post-procedure to confirm spacer position. Data included demographics, prior benign prostate hyperplasia surgeries (BPH), pathological features (extra-prostatic extension (EPE), tumour (T stage)), procedural details (operation time, deployment success), post-procedure MRI findings (optimal placement, post-spacer prostate to rectal wall distance (PRWD)) and radiation-related toxicities (Common Terminology Criteria for Adverse Events v5.0). Statistical comparisons (Mann-Whitney U test) assessed associations between prior BPH surgeries, EPE and difficulty of the procedure. Video footage of the patients was recorded, with emphasis on procedural steps and techniques to ensure accurate placement of the rectal spacer deployment needle.
  Results: The cohort comprised 18 patients (median age 70 years). Gleason Grade Group distribution included 13 patients in Groups 2–3 and 5 in Group ≥ 4. All patients underwent successful spacer deployment with a mean operative time of 14 min 53 s. Post-procedure MRI revealed a mean PRWD of 13.04 mm (range: 6.33 mm to 18.45 mm). 3 patients had prior BPH procedures, and 6 patients had EPE. In both instances, there were no significant differences in operation time. Post-procedure MRI confirmed optimal spacer positioning in 17 of the cases and 1 case of intraprostatic injection. Grade 2 rectal toxicity occurred in 1 patient.
  Conclusions: The learning curve of rectal spacer injection is both feasible and safe, as highlighted by the ease of operative techniques and safety procedures. Neither did prior BPH procedures nor EPE affect the procedural difficulty. The high rate of optimal spacer positioning and low incidence of radiation side effects support the increased use of rectal spacers.

UVP-21.03—Puboprostatic Complex Preserving Dorsal Venous Complex Ligation in Robotic-Assisted Radical Prostatectomy—Operative and Functional Outcomes 

• Pon Avudaiappan Arjun ¹, Martinez Orlando Brito ¹, Bokhari Akram ², Raja Iyub Mohamed Javid ¹, Prabhakar Pushan ¹, Manoharan Murugesan ¹, Sakthivel Deerush Kannan ¹
  ¹ Miami Cancer Institute, Baptist Health South Florida, Miami, United States, ² University of Hai’l, Hai’l, Saudi Arabia

• Introduction and Objectives: The early selective dorsal vein complex (DVC) ligation technique with preservation of the puboprostatic ligament (PPL) aims to improve functional outcomes, i.e., continence rate after robot-assisted laparoscopic radical prostatectomy (RALP). By selectively suturing the DVC while preserving the PPL, this approach helps maintain the external urethral sphincter (EUS) complex. This technique reduces the risk of bleeding and improves continence by securing the DVC stitch while preserving the puboprostatic ligament for anchoring vesicourethral anastomosis. This study evaluates the feasibility and outcomes of this modified surgical technique.
  Materials and Methods: The puboprostatic-sparing DVC ligation technique involves starting the suture at the midpoint of the PPL and passing it anteriorly across the DVC complex. The suture is then directed posteriorly across the DVC and returned to the entry point, carefully avoiding disruption of the PPL. The technique provides a secure stitch with good hemostasis while preserving the PPL, which can later be anchored during vesicourethral anastomosis. Standard nerve-sparing RALP steps, including apical dissection, were performed as usual. Between 2017 and 2022, 373 patients underwent RALP using this technique. Data were collected on intraoperative blood loss and continence rates at 3 and 12 months postoperatively.
  Results: The mean age of patients undergoing RALP was 65.3 years. The average operative time was 168.4 (±28.3) minutes, with mean blood loss reported at 76.4 (±49.2) cc. Continence rates at 3 months postoperatively were 83.1% (n = 310), and, at 12 months, they were 96.8% (n = 361). A majority (85.3%) of patients underwent nerve-sparing RALP. Notably, no intraoperative complications were reported.
  Conclusions: The early modified DVC ligation technique in RALP is safe and practical. It provides a secure stitch with good hemostasis while preserving the PPL. This technique is associated with high continence rates at 3 and 12 months postoperatively and demonstrated no intraoperative complications, indicating its feasibility and potential for improved functional recovery.

22. Prostate Cancer—Detection

22.1. Moderated Oral ePosters

MP-22.01—A Head-to-Head Comparison of Micro-Ultrasound Guided Cognitive Prostate Biopsy and Conventional Robotic Assisted MRI-Fusion Prostate Biopsy in an Asian Setting 

• Li Jingqiu, Cheng Christopher, Lim Benjamin, Lim Yong Wei, Neo Shu Hui, Palaniappan Sundaram, Lee Lui Shiong, Tiwari Raj, Chan Thomas
  Sengkang General Hospital, Singapore, Singapore

• Introduction and Objectives: Micro-ultrasound (MicroUS)-guided prostate biopsy (MUB) has emerged as a non-inferior alternative to magnetic resonance imaging (MRI)-targeted biopsy (MTB) for detecting clinically significant prostate cancer (csPCa, Gleason grade group ≥ 2). MicroUS is a novel high-resolution ultrasound technology that operates at 29MHz, allowing for free-hand transperineal prostate biopsies. Suspicious lesions are classified using the Prostate Risk Identification using MicroUS (PRI-MUS) system (score 1–5). Compared to conventional methods, microUS offers a cost-effective and accurate biopsy platform, granting urologists greater procedural autonomy. Our primary aim is to evaluate the diagnostic performance of MUB in comparison to MTB for the detection of csPCa. Secondary aims include: (1) assessing microUS’s capability to identify MRI-invisible lesions and (2) determining the differential accuracy between MTB and saturation biopsy (SB).
  Materials and Methods: Biopsy-naïve men with clinical suspicion of prostate cancer were prospectively enrolled from January to March 2025. All patients had multiparametric MRI prior to biopsy. They underwent transperineal cognitive MUB by surgeon 1 (blinded to MRI, targeting PRI-MUS ≥ 3) followed by transperineal MTB and SB using the Biobot MonaLisa system by surgeon 2 in the same setting (targeting PIRADS ≥ 3). The diagnostic performance of MUB and MTB in detecting csPCa was compared for non-inferiority (predefined difference: 10%). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MUB were assessed with reference to MTB. The differential accuracy of MTB and SB was evaluated.
  Results: Among 21 enrolled men, MUB detected more csPCa compared to MTB (42.9% versus 38.1%, respectively; absolute difference 4.8%), meeting non-inferiority criteria. Relative to MTB, MUB achieved 85.7% sensitivity, 85.7% specificity, 92.3% PPV, and 75% NPV. Notably, 33.3% of patients had MRI invisible lesions biopsied on MUB, of whom 85.7% were csPCa. However, MUB missed MRI-visible lesions in 9.5% of patients who had csPCa. SB identified csPCa in 38.1% of the cases. Targeted biopsies had marginally better detection (differential accuracy: 9.5%) versus SB.
  Conclusions: In this first study in Asian patients, MUB is non-inferior to MTB in detecting csPCa. In addition, MUB was able to detect clinically significant MRI-invisible lesions in 28.6% of patients. MicroUS is an accurate and safe alternative to conventional MTB.

MP-22.02—A Highly Sensitive Methylation Assay for Prostate Cancer Diagnosis 

• Zhong Xingyu, Xie Tianci, Wang Shaogang, Xia Qidong
  Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China

• Introduction and Objectives: Prostate cancer (PCa) is the second most prevalent malignancy in men globally, contributing significantly to disease burden. Early diagnosis is critical to patient treatment and prognosis. DNA methylation is among the earliest molecular changes in tumors, making it a vital biomarker for early diagnosis. Advances in liquid biopsy technology have enabled non-invasive diagnostics, particularly through the methylation analysis of circulating tumor DNA (ctDNA), facilitating early PCa detection. However, the low abundance of methylation signals in biological fluids presents challenges, as traditional PCR methods exhibit limited sensitivity, while high-throughput sequencing is costly and not conducive to widespread clinical use. Thus, there is an urgent need for sensitive, specific and cost-effective methylation detection methods to enhance early and precise PCa diagnosis.
  Materials and Methods: Machine learning techniques were utilized to identify specific methylation sites from extensive PCa and normal control cohorts. A novel methylation-specific RPA system was developed to amplify bisulfite-treated ctDNA, subsequently enhanced by the CRISPR-Cas system to increase site specificity and biosignal amplification. Accordingly, a “Highly-specific ctDNA Methylation Liquid Biopsy” platform was established, and blood and urine were collected from 61 PCa patient and 30 healthy control clinical trials.
  Results: The newly developed platform demonstrated feasibility for detection under thermostatic conditions, achieving a discrimination index above 500 and a detection limit below 0.005%. A panel of seven genes—ALOX12, ANGPTL2, GSTP1, HAPLN3, HOXD3, TAC1, and ADCY4—was identified, with significant differential methylation confirmed in plasma samples (p < 0.05). A refined diagnostic panel comprising GSTP1, TAC1, and ADCY4 exhibited 88% sensitivity and 87% specificity in testing 91 samples of blood and urine. Stratification analyses indicated the potential of this platform for early PCa diagnosis (Gleason ≤ 7, 4 < PSA < 10, or PI-RADS < 3). Besides, the detection time of the platform is down to 4.5 h, and the average cost is $7.5.
  Conclusions: We have developed a convenient, methylation-based diagnostic platform for PCa that combines rapidity, high specificity, and non-invasiveness. The platform has the potential to significantly aid in the early diagnosis and monitoring of PCa, offering considerable clinical application value.

MP-22.03—A Machine Learning Approach for Predicting Prostate Cancer Gleason Grade Group at Radical Prostatectomy 

• Pantazis Lampros ¹, Bendre Hersh ¹, Nayan Madhur ², Velmahos Constantine ¹, An Clemens ¹, Hunter Alexandra ¹, Dahl Douglas ¹, Wu Chin-Lee ¹, Wszolek Matthew ¹, Salari Keyan ¹, Feldman Adam ¹
  ¹ Massachusetts General Hospital, Boston, MA, United States, ² New York University Medical Center, New York, NY, United States

• Introduction and Objectives: Prostate cancer grade misclassification on prostate biopsy remains common and can significantly impact risk stratification (RS) and management. The objective of this study was to develop a machine learning (ML) model to predict prostate cancer grade group (GG) at radical prostatectomy (RP).
  Materials and Methods: We identified patients in our institutional TRUS fusion biopsy database who underwent RP. We defined a 3-class ordinal outcome measure: GG1, GG2-3, or GG4-5 on RP. The cohort was split into training and test sets (70/30%). Important predictors were selected using the Boruta algorithm. 3 ML models were trained and tuned with 5-fold cross validation: Ordinal Forest, Ordinal Logistic Regression, and Ordinal CART decision tree. Model performance was evaluated on the test set and compared to biopsy GG and NCCN RS, where low, intermediate, and high risk predicted GG1, GG2-3, and GG4-5, respectively. Performance was assessed with the quadratic weighted kappa (QWK), macro area under receiver operating curve (ROCAUC), accuracy, macro/micro F1 scores.
  Results: 559 patients were identified, of which 85 (15.2%) had GG1, 391 (69.9%) GG2-3, and 83 (14.8%) GG4-5 prostate cancer at RP, with 25% (140/559) biopsy misclassification. The most important predictors identified by Boruta included highest biopsy GG, NCCN Risk Group, GG of the primary biopsy target, PSA, and a weighted score calculated as the sum of biopsy regions per GG, each multiplied by its GG value. The best performing model was the Ordinal Forest with 0.588 (95%CI:0.359–0.664) QWK, 0.826 (0.774–0.891) ROCAUC. NCCN RS and biopsy GG predicted RP pathology with 0.512 (0.367–0.633) and 0.531 (0.417–0.664) QWK, respectively.
  Conclusions: Our models outperformed standard of care biopsy GG and NCCN RS in predicting prostate cancer GG at RP and demonstrated strong overall predictive ability. These findings suggest that ML algorithms can significantly enhance RS and help guide prostate cancer management.

MP-22.04—A Photoactivatable Methylation Detection System Enables Cost-Effective Liquid Biopsy for Prostate Cancer Diagnosis 

• Zhong Xingyu, Xiong Yifan, Yang Yuxuan, Zhong Mingliang, Xia Qidong, Wang Shaogang
  Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China

• Introduction and Objectives: Prostate cancer (PCa), with rapidly rising incidence among male malignancies, requires early detection to improve outcomes. DNA methylation, the earliest tumorigenic molecular marker, offers promise for non-invasive diagnosis via blood/urine circulating tumor DNA (ctDNA). However, conventional methylation detection methods (PCR, sequencing) face limitations in accuracy, cost, and clinical feasibility. This study aimed to develop a rapid, low-cost, and sensitive methylation detection platform for PCa liquid biopsy.
  Materials and Methods: A PCa-specific methylation panel was bioinformatically curated from methylomics databases. A one-pot detection system integrating photoactivated amplification and CRISPR-Cas12a was engineered to directly quantify bisulfite-converted methylated DNA. Probes targeting key methylation loci were optimized using synthetic DNA and PCa cell lines. Clinical validation was performed on 85 blood/urine samples from Tongji Hospital (PCa patients vs. healthy controls).
  Results: Using simulated methylated DNA, we verified the photoactivated CRISPR-Cas signal sensing platform possesses good signal amplification and can accurately identify trace methylation sites submerged in normal DNA with a discriminatory degree of 302. A PCa-specific methylation sites were screened in the DNA methylomics database, and a 6-gene diagnostic panel for PCa was constructed, including GSTP1, HOXA7, ADCY4, AOX1, RASSF5, and SFRP5. Methylation-specific PCR probe systems were constructed for each methylation site, and the method was validated in cell lines to sensitively distinguish PCa methylated DNA with a detection limit of down to 0.005%. On this basis, a one-pot assay for the rapid detection of tumor methylated DNA was constructed by combining with RPA thermostatic amplification technology, which can shorten the detection time to 2.5 h. In 85 body fluid (blood or urine) samples from PCa patients and healthy volunteers, the method showed a sensitivity of 89% and a specificity of 85%.
  Conclusions: Altogether, we here constructed a novel photoactivatable DNA methylation detection system, bridging the gap between high-sensitivity and low-cost, which is difficult to balance in conventional methods. The system, combined with a specific methylation diagnostic panel and thermostatic amplification technology, can realize rapid and precise diagnosis of PCa, and is of great clinical promotion significance in PCa liquid biopsy.

MP-22.05—An AI-Augmented Logistic Regression Model for Prostate Cancer Diagnosis: Integrating Race-Specific Gene Expression Profiling with Deep Feature Optimization 

• Negara Edvin ¹, Daryanto Besut ¹, Seputra Kurnia ¹, Agustriawan David ², Ahmad Muhammad ³
  ¹ Universitas Brawijaya, Malang, Indonesia, ² Universitas Multimedia Nusantara, Jakarta, Indonesia, ³ Universiti Malaysia Perlis, Perlis, Malaysia

• Introduction and Objectives: Prostate cancer (PCa) exhibits pronounced racial disparities in incidence, with Black men in the United States demonstrating an incidence rate approximately 1.8-fold greater than their White counterparts, according to recent epidemiological data. Current diagnostic approaches relying on prostate-specific antigen (PSA) screening remain critically limited by insufficient specificity, while many emerging machine learning approaches overlook the critical influence of race-specific variations in molecular profiles for predictive modeling.
  Materials and Methods: This study introduces a race-aware prostate cancer (PCa) detection framework designed to enhance diagnostic accuracy and equity through optimized feature selection. Leveraging RNA-seq (STAR-aligned count data) and clinical phenotype data from The Cancer Genome Atlas (TCGA) cohort (n = 554 patients), we developed a multi-stage feature selection pipeline integrating: 1. Differential Gene Expression (DGE) analysis, 2. Receiver Operating Characteristic (ROC) curve evaluation, and 3. Gene Set Enrichment Analysis (GSEA). This pipeline identified a 9-gene biomarker panel strongly enriched in prostate carcinogenesis pathways. To address racial disparities in model generalizability, the framework was trained on White population data and rigorously validated on a Black patient subset, employing synthetic minority oversampling (SMOTE) and cost-sensitive learning for dataset balancing.
  Results: The optimal model, leveraging a 9-gene biomarker panel, demonstrated 95% diagnostic accuracy in the White cohort and 96.8% accuracy in the Black cohort. Despite the Black population exhibiting marginally higher classification performance, a 4% fairness gap was identified through Demographic Parity fairness metrics, highlighting disparities in equitable outcomes. These results underscore the clinical validity of race-specific biomarkers, illustrating how biologically driven feature selection not only enhances diagnostic performance but also advances computational interpretability and resource efficiency.
  Conclusions: This study introduces a race-aware prostate cancer (PCa) detection framework that enhances diagnostic precision through biologically informed biomarker selection. By mitigating misclassification risks inherent in demographically invariant models, the framework underscores the necessity of incorporating race-specific transcriptional signatures into machine learning-driven diagnostics. Beyond improving early detection, the approach facilitates personalized therapeutic stratification, aligning with broader goals to advance equitable precision oncology in prostate cancer management.

MP-22.06—Comparative Performance of the CamPROBE Double Freehand Local Anaesthesia Transperineal Biopsy Device Versus in Line Guides for Detection of Significant Prostate Cancer—A Two Centre Study 

• Ahmed Adham ¹, Thorman Hannah ¹, Shah Syed ², Miah Saiful ², Gnanapragasam Vincent ³
  ¹ West Suffolk Hospital, Bury St. Edmunds, United Kingdom, ² Cambridge University Hospitals, Cambridge, United Kingdom, ³ University of Cambridge, Cambridge, United Kingdom

• Introduction and Objectives: The CamPROBE double freehand device offers a versatile alternative to proprietary in-line devices for local anaesthetic transperineal prostate biopsies (LATP). Here we present a 2-centre audit of its performance for first LATP and compared to prior use of an in-line, US attached biopsy device.
  Materials and Methods: The outcomes of 2 centres who adopted the CamPROBE were compared to a retrospective series of biopsies using an in-line attached device (Precision Point-PP) (June 2024–March 2025). All surgeons were new to CamPROBE and mentored for 3–4 cases before practicing independently. Primary outcomes were first biopsy significant cancer detection defined as ³Grade Group 2 (GG2) & composite ³ NICE Cambridge Prognostic Group 2 (CPG2). We also compared accuracy using biopsy target positivity rates. All procedures were by image guidance including sectoral ± target sampling.
  Results: Data from Centre 1 (100 CamPROBE vs. 100 PP first biopsies) was analysed and then validated in Centre 2 (38 CamPROBE vs. 44 PP). There were no significant differences in either centre for pre-biopsy PSA, T stage or proportion of PIRAD 4–5 lesions. In Centre 1 significant cancer (³GG2) yield was 57/100 (57.0%) with the PP device and 60/100 (60.0%) using CamPROBE (p = 0.66). Detection of ³CPG2 disease was 62/100 (61.0%) with PP and 62/100 (62.0%) using CamPROBE (p = 0.88). Biopsy target positive rates were 57/90 (63.0%) with PP and 57/82 (70.0%) using CamPROBE (p = 0.39). Data from Centre 2 was identical and validated no differences in cancer detection performance. Here ³GG2 yield was 33/44 (68.1%) with the PP device and 28/38 (71.0%) using CamPROBE (p = 0.89). Detection of ³CPG2 disease was 30/44 (75.0%) with PP d and 27/38 (73.6%) with CamPROBE (p = 0.07). Target positive rates were 26/39 (67.0%) with PP and 27/33 (82.0%) using CamPROBE (p = 0.14). Per procedure device costs were estimated at 50–75% lower for CamPROBE procedures with LA usage (measured in Centre 1) at a median of 16 mls (range 8–26).
  Conclusions: These data from 2 separate centres demonstrate the real-world efficacy and efficiency of the CamPROBE for LATP biopsies. CamPROBE offers comparable cancer detection and target positive rates to in-line devices and with potentially significantly lower cost and LA usage.

MP-22.07—Cross-Sectional Study and Mendelian Randomization Study Exploring the Associations of Serum Folic Acid and Risk of Prostate Cancer 

• Mao Ruijie ¹, Xia Long ¹, Shuai Wenlong ¹, Xiong Guobing ²
  ¹ Graduate School, North Sichuan Medical College, Nanchong, China, ² 1. The Affiliated Sanya Central Hospital, Hainan Medical University. 2. Graduate School, North Sichuan Medical College. 3. Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital., Sanya, China

• Introduction and Objectives: Folic acid offers significant benefits for preventing numerous diseases since it is a crucial part of the carbon metabolic cycle of DNA methylation, synthesis, and repair. However, some research has indicated that taking too much folic acid can have the opposite effect. Previous research has been somewhat disputed regarding the association between blood folic acid levels and prostate cancer, and further research is needed to investigate the relationship.
  Materials and Methods: The cross-sectional data from the National Health and Nutrition Examination Survey were analyzed using a logistic regression model, with subgroup analysis done. To investigate the impact of varying folic acid levels on prostate cancer, blood folic acid levels were stratified concurrently. Simultaneously, a two-sample and multivariate Mendelian randomization analysis method is utilized to investigate the relationship between the two further, while different database sources are changed to verify.
  Results: In logistic regression model 1 with uncontrolled variables, blood folate concentration was positively correlated with the incidence of prostate cancer (OR = 1.010; 95% CI: 1.001–1.020, p = 0.026); there was no statistical significance in the partially adjusted and fully adjusted models. Prostate cancer risk increased gradually as blood folic acid levels rose in Model 1, which stratified folic acid levels. High levels of folic acid raised the risk of prostate cancer in every logistic regression model. According to the Mendelian randomization study, the two had no statistically significant association.
  Conclusions: The findings confirm that high levels of folic acid may increase the risk of prostate cancer.

MP-22.08—Deep Learning Network Enhances Imaging Quality of Low-B-Value Diffusion-Weighted Imaging and Improves Lesion Detection in Prostate Cancer 

• Liu Zheng, Gu Wei-jie, Dai Bo
  Fudan University Shanghai Cancer Center, Shanghai, China

• Introduction and Objectives: Diffusion-weighted imaging with higher b-value improves detection rate for prostate cancer lesions. However, obtaining high b-value DWI requires more advanced hardware and software configuration. Here we use a novel deep learning network, NAFNet, to generate a deep learning reconstructed (DLR1500) images from 800 b-value to mimic 1500 b-value images and to evaluate its performance and lesion detection improvements based on whole-slide images (WSI).
  Materials and Methods: We enrolled 303 prostate cancer patients with both 800 and 1500 b-values from Fudan University Shanghai Cancer Centre between 2017 and 2020. We assigned these patients to the training and validation set in a 2:1 ratio. The testing set included 36 prostate cancer patients from an independent institute who had only preoperative DWI at 800 b-value. Two senior radiologists and two junior radiologists read and delineated cancer lesions on DLR1500, original 800 and 1500 b-value DWI images. WSI were used as the ground truth to assess the lesion detection improvement of DLR1500 images in the testing set.
  Results: After training and generating, within junior radiology doctors, the diagnostic AUC based on DLR1500 images is not inferior to that based on 1500 b-value images (0.832 (0.788–0.905) vs. 0.821 (0.747–0.899), p = 0.824). The same phenomenon is also observed in senior radiology doctors. Furthermore, in the testing set, DLR1500 images could significantly enhance junior radiology doctors’ diagnostic performance than 800 b-value images (0.848 (0.758–0.938) vs. 0.752 (0.661–0.843), p = 0.043).
  Conclusions: DLR1500 DWIs were comparable in quality to original 1500 b-value images within both junior and senior radiology doctors. NAFNet based DWI enhancement can significantly improve the image quality of 800 b-value DWI and therefore promote the accuracy of prostate cancer lesion detection for junior radiology doctors.

MP-22.09—Diagnostic Performance of 68ga-PSMA-PET and MRI Fusion-Based Cognitive Biopsy in Patients with Suspected Prostate Cancer: A Pilot Study 

• Kumar Sanjay, Kumar Rakesh, Kaushal Seema, Khairwa Hemant, Chhabra Swesha
  All India Institute of Medical Sciences, Delhi, India

• Introduction and Objectives: Prostate cancer (PCa) diagnosis faces challenges due to the low specificity of PIRADS 3–5 scores. A more precise imaging modality could reduce unnecessary biopsies. This study evaluates 68Ga-PSMA-PET and MRI fusion based cognitive biopsy for detecting and localizing clinically significant PCa, aiming to improve biopsy guidance and diagnostic accuracy.
  Materials and Methods: This pilot diagnostic accuracy study included patients with suspected PCa based on elevated prostate-specific antigen (PSA) levels and suspicious lesions (PIRADS ≥ 3) on multiparametric MRI (mpMRI). A total of 26 patients underwent PSMA-PET/MRI, followed by both PSMA-PET/MRI-based cognitive biopsy and TRUS fusion biopsy. The primary objective was to evaluate the accuracy of PSMA-PET/MRI in guiding biopsy decisions.
  Results: The study included 26 male patients with suspected prostate carcinoma and serum PSA levels between 4–15 ng/mL. The median age was 63 years (IQR: 55–69), and the median serum PSA was 8.05 ng/mL (IQR: 6.0–11.7). Imaging assessments using 68Ga PSMA-PET/MRI reveal notable diagnostic performance, particularly in sensitivity and negative predictive value (NPV). The modality exhibits a high sensitivity of 100%, specificity at 75% and a positive predictive value (PPV) of 25.0% and an overall accuracy of 76.9%. The negative predictive value (NPV) was 100%, indicating that 68Ga PSMA-PET/MRI has a high sensitivity for detecting clinically significant prostate cancer. These results suggest that 68Ga PSMA-PET/MRI could be an effective tool for guiding targeted biopsies in patients with elevated PSA levels and suspected prostate cancer.
  Conclusions: Our study highlights the potential of PSMA-PET/MRI fusion imaging as an effective diagnostic tool for refining patient selection for biopsy in suspected prostate cancer (PCa) cases. Its ability to differentiate between clinically significant and insignificant cancers offers a promising approach to mitigate unnecessary biopsies, thereby reducing patient morbidity and healthcare burden. The high negative predictive value (NPV) of 68Ga PSMA-PET/MRI supports its role as a valuable preliminary screening tool, minimizing redundant biopsy procedures while maintaining diagnostic accuracy.

MP-22.10—Evaluating Interobserver Variability in Reporting of Surgical Margin Status in Men Undergoing Radical Prostatectomy: Analysis from the IP8-Fluoresce Study 

• Morris Samuel ¹, Mayor Nikhil ², Silvanto Anna ³, Haider Aiman ³, Ahmed Hashim ², Fiorentino Francesca ⁴, Winkler Mathias ²
  ¹ Imperial College Healthcare NHS Trust, London, United Kingdom, ² Division of Surgery, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom, ³ Department of Pathology, University College London Hospitals NHS Foundation Trust, London, United Kingdom, ⁴ Division of Surgical Interventions, Diagnostics and Device, Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom

• Introduction and Objectives: Significant interobserver variability is known to exist in reporting of Gleason scores on both prostate biopsy and radical prostatectomy specimens. Discrepancy in reporting of surgical margin status between standard-of-care reporting and second-read reporting by central uro-pathologists is less commonly described, and yet surgical margin status is commonly used as an indicator of surgical quality. Here, we report level of agreement between first-read pathology reporting and second-read central review from radical prostatectomy specimens obtained as part of the IP8-FLUORESCE study.
  Materials and Methods: IP8-FLUORESCE was a multicentre, prospective, paired-cohort study comparing margin assessment with fluorescence confocal microscopy to gold-standard histopathology. Specimens underwent standard-of-care histopathological analysis, where margin status and length (if positive) were reported. Immunohistochemistry was permitted upon request. All slides were then pseudo-anonymised and underwent a second-read by a central uropathologist who was blinded to the first-read report. Agreement between the two assessments is reported using Cohen’s Kappa coefficient (k). McNemar’s test was used to assess any asymmetry in margin status classification between the groups.
  Results: 160 patients consented, four of which were excluded (two non-prostate cancer, two technical error). Of the remaining 156 cases, 130 underwent a second-read central review. The central review led to reclassification as a positive margin in 4 cases and a negative margin in 19. 40.8% of cases (53/130) were classified as positive by the first read reporting compared to 29.2% (38/130) reported by the central review. Overall agreement was 82.2% (k = 0.62 [95% CI 0.48–0.76]). There was significant asymmetry in margin classification between the pathology reports (p = 0.0026).
  Conclusions: Significant interobserver variability exists in the reporting of prostatectomy specimens. This highlights the need for caution when using surgical margin status as an indicator of surgical quality. To enhance reliability, standardised reporting protocols should be implemented. This should include regular assessment of local interobserver agreement rates. When conducting diagnostic accuracy studies using histopathological margin status as an endpoint, consideration should be given to involving multiple independent reviewers for margin assessment.

MP-22.11—Global Disparities in Prostate Cancer Burden: Temporal Dynamics and Socioeconomic Correlates (1990–2021) 

• Zhou Xianghong, Jin Yuming, Qiu Shi
  West China Hospital, Sichuan University, Chengdu, China

• Introduction and Objectives: Prostate cancer persists as a leading cause of male cancer morbidity worldwide, necessitating updated evaluations of its evolving epidemiology. This study synthesizes three decades of data to clarify inconsistencies in prior reports, quantify spatiotemporal trends, and elucidate associations between disease burden and sociodemographic development.
  Materials and Methods: Leveraging Global Burden of Disease (GBD) 2021 data, we analyzed absolute case counts, mortality, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) for incidence (ASIR), mortality (ASMR), and DALYs (ASDR) across 204 countries or areas. Temporal trends were assessed via average annual percentage change (AAPC), joinpoint regression, and Age-Period-Cohort (APC) modeling. Correlations between ASRs and the Socio-demographic Index (SDI) were quantified using Pearson’s coefficients.
  Results: From 1990 to 2021, global prostate cancer cases surged by 215% (1.1 million to 3.5 million), deaths by 127% (294,000 to 668,000), and DALYs by 112%. ASIR exhibited a marginal rise (AAPC = 0.15, 95% CI: 0.05–0.25), contrasting with declining ASMR (AAPC = −0.83, 95% CI: −0.92–−0.74) and ASDR (AAPC = −0.75, 95% CI: −0.82–−0.68). High-SDI regions demonstrated elevated ASIRs alongside decreasing ASMR/ASDR, whereas low-SDI regions faced concurrent rises in all ASRs, with mortality rates 2.1-fold higher than high-SDI areas in 2021. Joinpoint analyses identified inflection points: ASIR peaked in 2010 before plateauing, while ASMR/ASDR declines accelerated post-2015. APC models revealed age-specific risk transitions, with incidence peaking earlier (85–89 age group) and period effects driving incidence reductions after 2017. Cohort patterns showed mortality risk reductions across successive generations.
  Conclusions: While mortality and DALY rates decline globally, rising incidence and absolute burden signal persistent challenges, particularly in low-resource settings. The diverging trajectories between high- and low-SDI regions highlight systemic inequities in healthcare access, early detection, and treatment efficacy. These findings mandate tailored interventions, prioritizing resource allocation and evidence-based policies to mitigate disparities in prostate cancer outcomes.

MP-22.12—Impact of Routine Histopathological Examination on Management of Prostate Cancer Patients Undergoing Transurethral Resection of the Prostate (TURP) or Holmium Laser Enucleation of the Prostate (HoLEP) 

• Sid Ahmed Momen, Nkwam Nkwam, Solomon Elshadaie, Ani Victor, Sardar Sayeed
  Princess Royal University Hospital, King’s College Hospital NHS Trust, London, UK, London, United Kingdom

• Introduction and Objectives: Patients with biopsy-proven prostate cancer often undergo channel transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate (HoLEP) to relieve bladder outlet obstruction prior to radiotherapy. Resected tissue is routinely sent for histopathological analysis despite an existing cancer diagnosis. We aimed to evaluate whether such post-TURP/HoLEP histology yields findings that alter planned oncological management, given the additional time, cost, and resource utilization involved.
  Materials and Methods: We retrospectively identified 30 patients with known prostate adenocarcinoma who underwent channel TURP or HoLEP between 2020 and 2023 at our center prior to scheduled radiotherapy. All had preoperative biopsy-confirmed cancer and were discussed at a specialist multidisciplinary team meeting with a plan for androgen deprivation therapy (ADT) and external beam radiotherapy. Patient data were collected, including age, prostate-specific antigen (PSA) level, resected tissue weight, histopathology results, and any changes in treatment plan prompted by histological findings. Histopathology processing cost and pathologist time were also analyzed.
  Results: The median age was 76.5 years (range 56–89), median PSA 14.2 ng/mL (range 1.9–411), and median prostate tissue resected 19.3 g (range 0.4–159). Histological analysis of resected chips showed benign prostatic tissue in 21 cases (70%) and prostate cancer in 9 cases (30%). Crucially, none of the histological findings led to a change in the intended oncological management for any patient. All patients continued with their pre-planned ADT and radiotherapy courses, with no escalation of therapy based on TURP/HoLEP pathology. The estimated cost per specimen for histopathological examination was £65.35, totaling £1,829.80 for 30 cases. This consumed approximately 15 h of consultant pathologist time. Extrapolating over 126 similar cases in a two-year period, routine histology would incur ~£8,234 in costs and 2.6 working days of pathologist time. These resources yielded no change in patient outcomes in our cohort.
  Conclusions: In this series of prostate cancer patients, routine histopathological examination of bladder outlet surgery specimens did not influence postoperative oncological management. Given the non-trivial cost and manpower involved, our findings suggest that omitting routine histology could be considered in select cases (particularly those with high-risk disease already established), to improve efficiency without compromising care. Larger studies are warranted to confirm when histology can be safely omitted.

MP-22.13—Innovative Personalised Prioritisation Pathway for Improved Timely Prostate Cancer Diagnosis in Scotland 

• Bhatt Jaimin, Ibrahim Ibrahim, Santoni Nicola, Iqbal Rizwan, Chambers Fiona, Black Douglas, Patel Amit, Salji Mark
  Queen Elizabeth University Hospital, Glasgow, United Kingdom

• Introduction and Objectives: Prostate Cancer is one of the most common cancers diagnosed in men worldwide and is the number 1 cancer found in men in Scotland and the UK. Increased awareness and backlog from COVID pandemic have caused a significant rise in prostate cancer referrals. Traditional pathways in Scotland are based on Urgent Cancer Suspected Referrals from GP to Urology Departments, usually based on PSA or abnormal prostate examination findings, all who compete for limited clinic slots without any prior consideration of individual cases. A new innovative prioritisation pathway, Filters and Cascades, was designed, piloted and audited based on personalised patient factors.
  Materials and Methods: Under the new pathway, men referred to urology were subject to 6 algorithms based on age, PSA level and patient factors (e.g., UTI) at the time of GP referral and either ‘cascaded’ straight to test (MRI prostate/bone scan/CT scan) (Cascade 1 = PSA > 100, all ages get bone scan, Cascade 2 = PSA 20–100, age < 80, no UTI get MRI + bone scan, Cascade 3 = high PSA < 20, no UTI get MRI prostate) or ‘filtered’ to appropriate outcomes (Filter 1, UTI, Filter 2 PSA < 20 men age > 80, Filter 3 normal PSA abnormal prostate exam). Further filters/cascades were built for MRI and biopsy results, so that the most at-risk groups would be seen fastest and cascaded further/commenced on treatment sooner, while normal MRI cases would get automated letters saving clinic slots. A 3-month pilot was conducted and data collected prospectively and compared with the traditional pathway with 3-month historic cohort.
  Results: The 3-month-pilot recruited 389 men compared to historic cohort of 283. Significant reduction in wait from GP referral was noted with median times (days) of 2 (from 40) for first contact, 13 (from 52) for MRI scan and 27 (from 72) for biopsy (p < 0.002). For metastatic cases, time from referral to start of hormone treatment improved to 32 (from 90 days). 88% of metastatic cases met 62-day treatment targets with new pathway, compared to 17% before.
  Conclusions: Filters and Cascades have been highly successful in personalising and prioritising prostate cancer diagnosis and is being introduced across Scotland as an Optimal Pathway under Scottish Cancer Network’s Clinical Management Pathway for Prostate Cancer.

MP-22.14—Integrating Multi-Cohort Machine Learning and Clinical Validation to Explore Peripheral Blood mRNA Diagnostic Biomarkers for Prostate Cancer 

• Zhong Xingyu, Yang Yuxuan, Xiong Yifan, Zhong Mingliang, Xia Qidong, Wang Shaogang, Gong Xi
  Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China

• Introduction and Objectives: The global incidence of prostate cancer (PCa) has been rising annually, and early diagnosis and treatment remain pivotal for improving therapeutic outcomes and patient prognosis. Concurrently, advancements in liquid biopsy technology have facilitated disease diagnosis and monitoring, with its minimally invasive nature and low heterogeneity positioning it as a promising approach for predicting disease progression. However, current liquid biopsy strategies for PCa predominantly rely on prostate-specific antigen (PSA), which lacks specificity and compromises diagnostic accuracy. Thus, there is an urgent need to identify novel liquid biopsy biomarkers to enable early and precise PCa diagnosis.
  Materials and Methods: We integrated 12 machine learning algorithms to construct 113 combinatorial models, screening and validating an optimal PCa diagnostic panel across five datasets from TCGA and GEO databases. Subsequently, the biological feasibility of the selected predictive model was verified in one prostate epithelial cell line and five PCa cell lines. Robust RNA diagnostic targets were further validated for their expression in plasma samples to establish an RNA-based liquid biopsy strategy for PCa. Finally, plasma samples from PCa and benign prostatic hyperplasia (BPH) patients at Wuhan Tongji Hospital were collected to evaluate the strategy’s clinical significance.
  Results: Differential analysis identified 1,071 candidate mRNAs, which were input into the integrated machine learning framework. Among the 113 combinatorial models, the 9-gene diagnostic panel selected by the Stepglm[both] and Enet[alpha = 0.4] algorithms demonstrated the highest diagnostic efficacy (mean AUC = 0.91), including JPH4, RASL12, AOX1, SLC18A2, PDZRN4, P2RY2, B3GNT8, KCNQ5, and APOBEC3C. Cell line experiments further validated AOX1 and B3GNT8 as robust RNA biomarkers, both exhibiting consistent PCa-specific expression in human plasma samples. In liquid biopsy analyses, AOX1 and B3GNT8 outperformed PSA in diagnostic accuracy, achieving a combined AUC of 0.92. Notably, these biomarkers also demonstrated diagnostic utility in patients with ISUP ≤ 2.
  Conclusions: Through an integrated machine learning approach and clinical validation, we developed an RNA-based diagnostic panel for PCa. Specifically, we identified AOX1 and B3GNT8 as novel liquid biopsy biomarkers with promising clinical diagnostic value. These findings provide new targets and insights for early and precise PCa diagnosis.

MP-22.15—MRI-Guided Biopsy Versus 24-Core Transperineal Systematic Biopsy for Clinically Significant Prostate Cancer Detection: Final Results of the Randomized Controlled Trial (Smart) 

• Chiu Peter Ka-Fung ¹, Yu Wei-Ling ¹, Chan Wilson Hc ², Lee Lee Fung ³, Ho Brian Sh ⁴, Ip Chi Ho ⁵, Yu Jeffrey Man-Hin ⁶, Wong Francis Ch ², Wong Julius Ho-Fai ¹, Lo Ka Lun ¹, Leung Clarence Lh ⁷, Mak Christy Wh ⁷, Tam Adrian Ch ⁸, Lam Wayne ⁹, Kwok Sze Wan ¹⁰, Hong Cindy Yl ¹, Kong Angel Wy ¹, Yee Chi Hang ¹, Teoh Jeremy Yuen Chun ¹, Ng Chi Fai ¹, Collaborators Smart Study ¹
  ¹ The Chinese University of Hong Kong, Hong Kong, China, ² North District Hospital, Hong Kong, China, ³ United Christian Hospital, Hong Kong, China, ⁴ University of Hong Kong, Hong Kong, China, ⁵ Princess Margaret Hospital, Hong Kong, China, ⁶ Pamela Youde Nethersole Eastern Hospital, Hong Kong, China, ⁷ Kwong Wah Hospital, Hong Kong, China, ⁸ Queen Elizabeth Hospital, Hong Kong, China, ⁹ Department of Surgery, The University of Hong Kong, Hong Kong, China, ¹⁰ Prince of Wales Hospital, Hong Kong, China

• Introduction and Objectives: The PRECISION trial showed that MRI-guided prostate cancer (PCa) diagnosis was superior to 12-core transrectal ultrasound-guided (TRUS) systematic biopsy. The EAU guidelines recommend transperineal (TP) biopsy, and more biopsy cores can be taken under TP approach (≥24 cores) in the Ginsburg protocol under local anaesthesia. This study aims to compare the detection of clinically significant PCa (csPCa) using MRI-guided TP biopsy approach and the 24-core TP systematic biopsy.
  Materials and Methods: This multicenter, phase III, randomized controlled trial (NCT04685928) involved patients from 8 hospitals. Patients with elevated PSA 4–20 ng/mL with or without abnormal digital rectal examination (DRE) were randomized in a 1:1 manner to MRI-arm or TP-arm. Patients in MRI-arm received multiparametric MRI prostate (mpMRI), followed by MRI-targeted biopsy and 12-core systematic TP biopsy if PI-RADS score ≥ 3. No biopsy was performed if PI-RADS score was 1–2. In TP arm, all patients received 24-core TP systematic biopsy (TP-arm) via 2 perineal skin punctures and free-hand approach. All biopsies in both arms were performed under local anaesthesia without sedation. The primary outcome was the detection rates of csPCa, defined as ISUP grade group ≥ 2 PCa.
  Results: A total of 502 participants underwent randomization from May 2021 to November 2023, with 17 withdrawals after randomization. Median PSA, prostate volume and PSA density were 7.0 (IQR 5.3–10.3) ng/mL, 54.0 (39.0–70.0) ml, and 0.14 (0.10–0.21) ng/mL/mL, respectively. In MRI-arm, 43.8% (109/249) had PI-RADS score ≤ 2 and avoided biopsy. The primary outcome, csPCa, was detected in 23.3% (58/249) of MRI-arm and 27.7% (70/253) of TP-arm (p = 0.26). For secondary outcome, detection of csPCa in MRI-arm with only targeted biopsy was 20.5% (51/249) comparing with 27.7% (70/253) in TP-arm (p = 0.06). With more biopsies performed in TP-arm, more ISUP group 1 cases were detected in TP-arm (14.6%, 37/253) than MRI-arm (9.2%, 23/249) (p = 0.07).
  Conclusions: There was no statistically significant difference in the detection of csPCa in MRI-arm and 24-core TP-arm. MRI approach is preferred as it significantly reduced unnecessary biopsies and diagnosis of insignificant PCa. However, if MRI is not easily available, an extended TP systematic biopsy is a valid alternative for csPCa detection.

MP-22.16—Prostate Health Index Combined with Pi-Rads Score Enhances Prostate Cancer Diagnosis: Insights from a Large Chinese Cohort 

• Zhong Xingyu, Xiong Yifan, Yang Yuxuan, Wang Shaogang, Xia Qidong
  Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China

• Introduction and Objectives: Prostate cancer (PCa), a leading malignancy in men, necessitates accurate early detection to optimize outcomes. Conventional PSA testing is constrained by low specificity, underscoring the need for improved biomarkers. The Prostate Health Index (PHI), validated in Western populations since 2012, demonstrates superior diagnostic accuracy over PSA; however, its clinical utility in Asian cohorts remains underexplored.
  Materials and Methods: We retrospectively analyzed clinical diagnostic data from patients with prostate cancer (PCa) or benign prostatic hyperplasia (BPH) treated at Tongji Hospital in Wuhan between January 2022 and December 2024. Participants who underwent PSA, PHI testing, and biopsy were included, while exclusion criteria encompassed concurrent infectious diseases or other malignancies. Demographic and clinical parameters—including age, total PSA (tPSA), free PSA percentage (fPSA%), PHI, PI-RADS scores, prostate volume, and histopathological results—were extracted. Receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and regression analyses were performed to evaluate diagnostic performance metrics and clinical utility across methodologies.
  Results: A total of 2,091 patients were analyzed, including 724 PCa cases (83.8% were clinically significant PCa [csPCa]) and 720 MRI-evaluated individuals. ROC analysis revealed PHI’s superior diagnostic efficacy for PCa (AUC = 0.854) over tPSA, fPSA%, and [−2]proPSA (p2PSA). PHI consistently outperformed other biomarkers in csPCa (AUC = 0.879) and PSA gray zone (4–10 ng/mL) subgroups (AUC = 0.777), with statistical significance (p < 0.001). At a cutoff value of 47.15, PHI exhibited optimal diagnostic performance for csPCa (sensitivity = 81.05%, specificity = 82.61%). Regression analysis in the MRI cohort identified PHI and PI-RADS as independent diagnostic markers, with their combined model achieving an AUC of 0.938. DCA further demonstrated that PHI-PI-RADS integration provided a more reliable determinant for biopsy decision-making compared to individual parameters.
  Conclusions: This study presents novel evidence supporting PHI’s diagnostic value in a Chinese population. PHI consistently outperformed conventional PSA across diverse clinical scenarios, reinforcing its utility for PCa detection. Notably, Asian patients exhibited higher PHI diagnostic thresholds compared to Western populations, highlighting the necessity of population-specific diagnostic criteria. Ultimately, the combination of PHI and PI-RADS scoring emerges as a promising strategy for precise prostate cancer diagnosis and biopsy necessity assessment.

MP-22.17—Recalibrating Prostate Cancer Diagnostics in 5-Alpha Reductase Inhibitor Users: A Meta-Analysis of 38 Studies 

• Harrison Gregory ¹, Lamb Benjamin ²
  ¹ Whittington Hospital, London, United Kingdom, ² Royal London Hospital, London, United Kingdom

• Introduction and Objectives: Prostate cancer diagnosis in patients using 5-alpha reductase inhibitors (5-ARIs) is complicated by PSA suppression and MRI inaccuracies. This meta-analysis aims to evaluate recalibrated diagnostic thresholds to improve detection accuracy and reduce unnecessary biopsies in these patients.
  Materials and Methods: We conducted a PRISMA-guided meta-analysis of 38 studies (2015–2024). Inclusion Criteria: Population: Men aged ≥40 on 5-ARI therapy with PSA, MRI, or biopsy outcome data. Intervention: Quantitative assessment of PSA suppression, PSAD thresholds, PIRADS score, mpMRI characteristics, or biopsy detection rates. Comparison: Non-5ARI users, or studies adjusting diagnostic thresholds in treated vs. untreated patients. Outcomes: Clinically significant prostate cancer detection rates, PSAD performance, MRI lesion visibility or ADC variability. Exclusion Criteria: Case reports, editorials, non-English written publications, reviews without original patient data, and studies not specifying 5-ARI exposure status. Statistical analyses were performed using ‘R’ software incorporating random-effects models, bootstrap methods and heterogeneity metrics (I2).
  Results: 1. PSA Suppression (15 studies, n = 2,864): PSA levels were reduced by 51% (95% CI: 47–55%, I² = 38%), and prostate volume decreased by 21% (95% CI: 18–24%, p < 0.001). A ×1.8 PSA adjustment reduced diagnostic misclassification by 8% (95% CI: 5–11%). 2. MRI Adjustments (8 studies, n = 4,213 lesions): ADC values increased by 10–14% in 5-ARI users (95% CI: 10–14%, I² = 67%). 3. PSAD Performance (6 studies, n = 568): A PSAD of ≥0.12 ng/mL/cm³ had 92% sensitivity (95% CI: 89–94%) for detecting clinically significant cancer in PI-RADS 3 lesions.
  Conclusions: The ×1.8 PSA correction aligns PSA levels with prostate volume changes, reducing unnecessary referrals and ensuring PSAD calculations are incorporating the volume reduction after MRI measurement. Elevated ADC values in 5-ARI users may obscure tumor detection, requiring specific scanner ADC threshold adjustments. A PSAD of ≥0.12 ng/mL/cm³ is valuable in stratifying biopsy decisions for PI-RADS 3 lesions, improving diagnostic specificity. Moderate heterogeneity was observed for PSA suppression (assay variability) and high heterogeneity for ADC adjustments (scanner/PI-RADS differences). The proposed thresholds need further prospective validation. Adopting the ×1.8 PSA correction and using PSAD ≥0.12 ng/mL/cm³ for PI-RADS 3 lesions can improve diagnostic accuracy in 5-ARI users; further validation is required.

MP-22.18—Retrospective Comparison of Conventional Transrectal and 29-Mhz Micro-Ultrasound-Guided Biopsy for Prostate Cancer Detection at a German University Hospital 

• Giesen Imogen ¹, Arndt Katharina ², Al Sliman Rashid ², Thews Nikita ¹, Borgmann Hendrik ², Struck Julian ², Heinrichs Anna ²
  ¹ Medical School Theodor Fontane (MHB), Brandenburg a.d. Havel, Germany, Brandenburg An Der Havel, Germany, ² University Hospital Brandenburg an der Havel, Brandenburg An Der Havel, Germany

• Introduction and Objectives: Prostate cancer (PCa) is the most frequently diagnosed malignancy among men in Germany. Diagnostic evaluation includes digital rectal examination (DRE), measurement of prostate-specific antigen (PSA), and imaging. However, the definitive diagnosis relies on histopathological assessment of prostate biopsy specimens. In 2022, the ExactVu™ 29-MHz micro-ultrasound system was introduced at the University Hospital Brandenburg an der Havel (UKB) to improve lesion targeting and biopsy accuracy. This study aimed to compare the detection rates of PCa and clinically significant PCa (csPCa) between micro-ultrasound-guided biopsy (MiB) and conventional biopsy (CB) in patients with suspected PCa.
  Materials and Methods: Biopsy-naive patients (≥18 years) who underwent a prostate biopsy with at least 10 systematic biopsy cores between February 2020 and February 2024 at UKB were retrospectively analyzed. Patients with previously confirmed PCa were excluded. CsPCa was defined as Gleason Grade Group ≥ 2, based on ISUP recommendations. To minimize confounding, propensity score matching (PSM) was applied using age, PSA level, prostate volume, and DRE findings as matching variables. Following matching, detection rates of PCa and csPCa were compared between MiB and CB groups using chi-square and Wilcoxon rank-sum tests. Statistical significance was defined as p < 0.05.
  Results: A total of 540 patients were included post-matching (MiB: n = 282; CB: n = 258). No significant differences were observed regarding median age (67 vs. 66 years, p = 0.093), PSA levels (7 ng/mL in both groups, p = 0.10), suspicious DRE findings (46% vs. 39%, p = 0.3), prostate volume (median 40 mL, p = 0.9), or positive family history (10% vs. 8.1%, p = 0.4). The MiB group demonstrated a significantly higher detection rate of PCa (58.5% vs. 48.5%, p = 0.024 and csPCa (33.3% vs. 23.6%, p = 0.02) compared to the CB group.
  Conclusions: Micro-ultrasound-guided biopsy was associated with significantly improved detection rates for both overall PCa and csPCa at UKB. These findings highlight the potential of MiB to enhance diagnostic precision in clinical practice. Our study further confirms the recently published results of the OPTIMUM trial, supporting the clinical benefit of micro-ultrasound in PCa diagnostics.

MP-22.19—Risk of Prostate Cancer in Asian American Men 

• Chan Victor, Huang Karen, Barish Matthew, Ziemba Yonah, Hall Simon, Chan David
  Northwell Health, Lake Success, United States

• Introduction and Objectives: There is discordance in screening for prostate cancer (PC) in Asian American men (AA). Previous recommendations suggest the PSA threshold for screening AA should be lowered to 2.5 ng/mL. Epidemiologically, the risk of PC is lower amongst AA. Previous studies regarding PC in AA were insufficiently powered. To validate previous findings, we report on the largest cohort of AA undergoing prostate biopsies.
  Materials and Methods: With IRB approval, retrospective analyses were conducted in a large AA community practice from 2009 to 2024. 1565 AA and non-Asian men (NA) underwent prostate biopsies for PSA elevation and/or abnormal prostate MRI. Retrospective chart reviews were performed to analyze biopsy outcomes for 964 AA and 601 NA. Specifically, PSA, prostate volume (PV), calculated PSA density (PSAD), and pathology reports were evaluated. Pearson’s chi-square test, Mann-Whitney U test, and logistic regression were used.
  Results: Median PSA for AA and NA were not significantly different: 6.34 ng/mL (IQR 5.03–8.73 ng/mL) vs. 6.76 ng/mL (IQR 4.96–9.86 ng/mL) (p = 0.27). AA had a significantly lower incidence of PC than NA (46.2% vs. 64.2%, p < 0.001). AA have 52.2% lower odds than NA for PC (p < 0.001). AA had smaller median PV and higher median PSAD than NA: 43 cc (IQR 31.75–58.75 cc) vs. 47 cc (IQR 34–68 cc) (p < 0.001); 0.16 ng/mL² (IQR 0.11–0.23 ng/mL²) and 0.14 ng/mL² (IQR 0.09–0.23 ng/mL²) (p = 0.018). Gleason grade group (GG) distributions were not different between the two groups (p = 0.40). Patients over age 70 have double the odds of GG > 2 (p < 0.001).
  Conclusions: AA screened with standard thresholds had lower incidence of PC than NA. Though AA had smaller PV and higher PSAD, they were not at a greater risk of PC. We propose using standard PSA cutoffs for both groups in screening for PC to reduce unnecessary testing and procedures for AA. Life expectancy, however, for Asian American men is 82.4 compared to 74.8 for American men. Given that GG > 2 is more common after age 70, AA should be screened longer due to their longevity. Further studies are needed to confirm and understand these differences.

MP-22.20—Role of Confirmatory General Anaesthetic Transperineal Biopsy in Patients Considering Active Surveillance for Prostate Cancer: A Single-Centre Retrospective Review 

• Elhammadi Moustafa, Kapadia Nidhi, Hussain Mudassir, Arumainayagam Nimalan, Mikhail Michael, Tadtayev Surgey, Janardanan Sarosh
  Ashford and St Peter’s Hospital NHS Foundation Trust, Chertsey, United Kingdom

• Introduction and Objectives: Previous studies have shown that 29–38% of men diagnosed with prostate cancer via transrectal biopsy (TRB) and initially considered for active surveillance (AS) are later found to have higher-grade disease on confirmatory transperineal sector biopsy (TPSB). At our centre, local anaesthetic transperineal (LATP) biopsy is the standard diagnostic approach, with confirmatory general anaesthetic transperineal biopsy (GATP) routinely performed prior to initiating active surveillance to ensure accurate risk stratification. We aim to retrospectively review the results of confirmatory GATP done at our centre to highlight the rate of Gleason Grade Group (GGG) upgrading and the proportion of men who proceeded to radical treatment following confirmatory GATP.
  Materials and Methods: Between September 2022 and March 2025, 93 patients underwent confirmatory GATP. The mean age was 65.6 years, and all biopsies were performed within 12 months of diagnosis, with a mean interval of 6.5 months.
  Results: GGG upgrading was observed in 33 patients (35.4%), including 7 with a primary Gleason pattern 4. Of those upgraded, 24 proceeded to radical treatment. An additional 4 patients underwent radical treatment despite no GGG upgrade due to higher tumour burden and younger age. Another 4 patients discontinued AS based on personal preference. Among 29 patients with clinically significant cancer on GATP, 17 had disease in anterior zones—areas potentially under-sampled during initial LATP. Multivariable logistic regression including age, PSA, PSA density (PSAd), prostate volume, PIRADS score, and interval to GATP identified age (OR 1.08, p = 0.052) and PIRADS score (OR 2.10, p = 0.060) as the strongest predictors of upgrading, though statistical significance was narrowly missed. PSA, PSAd, prostate volume, and biopsy timing were not significantly associated with upgrading.
  Conclusions: Confirmatory GATP detected clinically significant disease in over one-third of patients considered for active surveillance, reinforcing its role in optimising patient selection. Upgrading was more likely in older patients, those with PIRADS ≥ 4 lesions, and lesions located in the anterior zone, highlighting the need for thorough sampling of these areas during initial biopsy.

MP-22.22—Sensitivity/Specificity per Target Quadrant vs. Whole Prostate of Biparametric MRI-Based Transperineal Prostate Biopsy 

• Hanna George ¹, Albnhawy Ahmed ¹, Wazir Adonis ¹, Yousaf Azka ², Wanis Michael ¹
  ¹ Surrey and Sussex Healthcare NHS Trust, Redhill, United Kingdom, ² University College London Hospitals NHS Foundation Trust, London, United Kingdom

• Introduction and Objectives: Biparametric MRI (BpMRI) in prostate cancer is gaining approval due to lower cost and shorter scans [NICE report 2022]. BpMRI has similar accuracy to multiparametric MRI (MpMRI) for significant cancer (csPCa), possibly fewer false positives. At PIRADS ≥ 3, BpMRI and MpMRI had similar sensitivity (88.6% vs. 89.4%) and specificity (58.6% vs. 57.7%) [Twilt et al. 2025]. Meta-analysis [Oerther et al. 2022] showed rising positive predictive value (PPV) for ISUP ≥ 2 cancer with PIRADS 3 (16%), 4 (59%), 5 (85%), and increasing detection of any cancer (PIRADS 3: 34%, 4: 70%, 5: 97%). This audit assessed the biopsy number of core compliance and BpMRI accuracy per quadrant vs. whole prostate by PIRADS.
  Materials and Methods: Between October 2022 and September 2023, 569 patients at Surrey and Sussex Healthcare NHS Trust (SASH) underwent transperineal biopsy (LATP) (age 43–87). Analysis included 492 with pre-biopsy BpMRI, with another 77 excluded. Biopsy for negative MRI/PIRADS 3 followed EAU guidelines. Results were incorporated in a spreadsheet with core numbers, positive MRI quadrants, PIRADS, Gleason scores (overall/target), and cancer detection rates. csPCa was defined as a Gleason score (GS) ≥ 7, except 4 GS 6 cases treated radically (extensive disease/capsule breach on BpMRI).
  Results: Targeted lesions were mostly PIRADS 5 (55%), 4 (26%), and 3 (19%). Mean total cores were 25 (7 from the target). Whole prostate BpMRI analysis shows higher sensitivity (87.5%) but lower specificity (41.67%) for detecting csPCa than quadrant analysis (83.5% sensitivity, 47.46% specificity). PPVs for csPCa in PIRADS 3 (42.8% vs. 32.8%), 4 (79.3% vs. 75.86%), and 5 (86.2% vs. 82.9%) are also higher with whole prostate vs. target quadrant analysis. Thus, whole prostate analysis is better at identifying csPCa, while target quadrant analysis is better at ruling it out.
  Conclusions: SASH LATP core numbers were slightly above target but improved. SASH BpMRI sensitivity/specificity matched literature for BpMRI/MpMRI. SASH BpMRI PPVs were comparable, with stronger PIRADS 3&4 values. BpMRI offers similar diagnostic results to MpMRI with lower cost and shorter scans, thus improving investigative efficiency.

MP-22.23—Trans-Perineal MR/US Fusion Prostate Biopsy: Evaluating the Benefits of Targeted Biopsy Alone vs. Targeted Plus Random Biopsy in Diagnosing Clinically Significant Disease 

• Bulbul Muhammad, Khouzami Riad, El Hajj Albert, Nasrallah Ousama
  American University of Beirut Medical Center, Beirut, Lebanon

• Introduction and Objectives: Multi-parametric MRI (mp-MRI) has become a standard practice prior to prostate biopsy and with ultrasound fusion allows precise and accurate targeted prostate biopsies (TPB). The role of random biopsies in the diagnosis of prostate cancer and clinically significant prostate cancer is yet to be determined. We aim to describe the value and significance of target and random biopsies with TPB in 464 patients at our institution.
  Materials and Methods: Between July 2019 and January 2024, 464 patients underwent trans-perineal MRI-targeted with ultrasound fusion. The detection of prostate cancer (PCa) and clinically significant prostate cancer (csPCa) was compared between MRI-targeted biopsy (TB) and combined biopsy (CB). Cancer severity was assessed using the grade group system, based on Gleason scores, with Grade Group 1 indicating low-grade cancer and Grade Groups 2–5 indicating higher grades. Clinically significant PCa (csPCa) was defined as Gleason score > 6 or Grade Group ≥ 2.
  Results: PCa was diagnosed in 253/464 patients (54.5%) and HGPIN/ASAP in 11 patients (2.3%) by targeted biopsy. Combining target with random biopsies led to cancer diagnosis in 264/464 patients (56.9%) with total increase as compared to TB alone of 11 patients (2.4%, p < 0.001) and an increase in csPCa detection by 7 patients (1.5%). The combined biopsy led to cancer upgrading to a higher-grade group vis-à-vis TB alone in 9 men (1.9% of all patients). The use of CB biopsy led to a higher detection of ISUP Grade Group 1 and 2 prostate cancer than target biopsy alone with p = 0.046 and 0.025 respectively. There was no significant difference in cancer detection for other ISUP Grade Group. Comparing TB and CB according to the PIRADS score showed significant difference in cancer detection among patients with PIRADS 4 (p = 0.008), and no significant difference in PIRADS 3 lesions possibly due to small sample size and no difference in PIRADS 5 lesions.
  Conclusions: CB seems to have no significant benefit in the diagnosis of prostate cancer in patients with a PIRADS 5 or PIRADS 3 lesion detected on mp-MRI. Patients with PIRADS 4 lesions may benefit from random biopsies with a significant increase in detection rate of 4.2%.

22.2. Moderated Video ePosters

MVP-22.01—Micro-Ultrasound-Guided Cognitive Transperineal Biopsy of the Prostate: A Step-by-Step Guide 

• Li Jingqiu, Lim Benjamin, Neo Shu Hui, Lim Yong Wei, Palaniappan Sundaram, Lee Lui Shiong, Cheng Christopher, Tiwari Raj, Chan Thomas
  Sengkang General Hospital, Singapore, Singapore

• Introduction and Objectives: Micro-ultrasound (MicroUS) is a novel high-resolution ultrasound technology operating at 29 MHz. This increased frequency enables detailed visualization of prostate tissue ductal architecture, facilitating the detection of structural changes associated with prostate cancer and allowing real-time transperineal biopsy. Lesions are evaluated using the Prostate Risk Identification using MicroUS (PRI-MUS) scoring system (score 1–5), which correlates with the Prostate Imaging Reporting and Data System (PI-RADS). MicroUS-guided prostate biopsy has emerged as a non-inferior alternative to magnetic resonance imaging (MRI)-targeted biopsy for diagnosing clinically significant prostate cancer. In this video, we demonstrate our clinical experience performing MicroUS-guided cognitive transperineal prostate biopsy.
  Materials and Methods: Under general anesthesia (GA), the patient is positioned in lithotomy position, with the anus at the edge of the bed. The scrotum is elevated using tape to fully expose the perineum. After cleansing the perineal skin with iodine, the MicroUS probe is gently inserted into the rectum and advanced until the mid-prostate is centered on the screen. The probe is swept from the right lateral border to the left lateral border of the prostate to visualize the entire gland and calculate its volume. Both the transition zone and peripheral zone are carefully assessed using the PRI-MUS score. Lesions with a PRI-MUS score ≥ 3 are targeted for biopsy. A biopsy needle is then inserted through the perineal skin under real-time MicroUS guidance to sample the identified lesions. Once all biopsies are acquired, the ultrasound probe is removed. Alternatively, this procedure can be performed under local anesthesia (LA) by anesthetizing the perineal soft tissue and the peri-apical triangle. The biopsy technique remains the same as described above.
  Results: From January to March 2025, 23 patients underwent MicroUS-guided transperineal prostate biopsies at our institution. Of these, 22 procedures were performed under GA, and one under LA. The mean operative time was 15.1 min (SD: 4.9 min). All patients were discharged the same day, with no intraoperative or postoperative complications reported.
  Conclusions: MicroUS-guided transperineal prostate biopsy represents a recent advancement in prostate cancer diagnostics. While further validation of its diagnostic accuracy is warranted, our video demonstrates the procedure can be safely performed under either GA or LA.

22.3. Residents Forum Moderated Oral ePosters

RF-22.01—Concordance of Bpmri and mpMRI in Assessment of Radiological Staging, Extra-Capsular Extension and Key Prostate Cancer Involvement Sites—An Analysis of the Prime Trial 

• Ng Alexander, Study Group PRIME
  University College London, London, United Kingdom

• Introduction and Objectives: MRI is widely used for prostate cancer diagnosis, staging and treatment planning. It is hypothesised that the contrast sequence may aid in evaluation of extracapsular extension (ECE) and key anatomical structures. This analysis examines concordance between biparametric (bpMRI) and multiparametric MRI (mpMRI) in staging and assessing involvement of key structures.
  Materials and Methods: PRIME (NCT04571840) was a prospective, multicentre, level 1 evidence trial evaluating whether bpMRI was non-inferior to mpMRI for detecting clinically significant prostate cancer. Radiologists first reported bpMRI (no contrast), then reviewed mpMRI after unblinding. MRI T stage was assessed using TNM classification. Likelihood of ECE, bladder neck, seminal vesicle, urethral sphincter and rectal wall involvement was assessed on a standardised 1–5 Likert scale. Clinically important changes were defined as changes from T2 to ≥T3 or T3 to ≥ T4, or changes in structure involvement from scores 1–3 (lower-equivocal) to 4–5 (likely-highly likely), between bpMRI and mpMRI, in both directions.
  Results: Across 490 patients (median age 65 years, PSA 5.6 ng/mL), 182/490 (37.1%) had non-suspicious findings on bpMRI and mpMRI. Contrast led to clinically important staging changes in 5/308 (1.6%), including upstaging from T2 to T3 (4/308, 1.3%) and downstaging from T4 to T3 (1/308, 0.3%). Changes in ECE suspicion occurred in 10/308 (3.2%), while seminal vesicle and urethral sphincter involvement increased in 1/308 (0.3%), each. Contrast did not affect bladder neck or rectal wall involvement.
  Conclusions: Contrast leads to a clinically important change in staging or involvement of key structures in only a minority of patients.

RF-22.02—Development and Validation of a Novel Technique for Precise Diagnosis of DNA Mutations in Prostate Cancer 

• Zhong Xingyu, Xie Tianci, Xia Qidong, Wang Shaogang
  Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China

• Introduction and Objectives: The rising incidence of prostate cancer (PCa) underscores the need for accurate diagnostic and monitoring techniques to inform treatment decisions and enhance patient outcomes. DNA mutations play a pivotal role in PCa progression and are critical for therapeutic guidance. Traditional detection methods, such as PCR and high-throughput sequencing, face challenges of low sensitivity and high costs, highlighting the urgent need for convenient, sensitive, and cost-effective mutation detection methods for PCa precise diagnosis and monitoring.
  Materials and Methods: A DNA mutation detection system was developed that eliminates purification and single-stranded conversion, utilizing the ME I and CRISPR-Cas12a systems. Bioinformatics were employed to analyze PCa mutation sites and design specific fluorescent probes. Mutation detection was performed across PCa tissues to establish a standard curve. Then, we created a streamlined platform for DNA extraction, amplification, and detection by integrating the ME I/CRISPR-Cas12a system with a thermostatic amplification method. Finally, samples from 56 PCa patients with DNA mutations were collected for clinical diagnostic.
  Results: The ME I/CRISPR-Cas12a system demonstrated direct detection of mutated DNA with a discriminatory factor of 278.4. The method successfully identified eight mutation types with a discriminatory factor reaching 184. We designed and validated probe systems targeting 3 PCa mutation sites (ATM, BRCA2, CHEK2) in mimic samples, achieving discrimination factors between 154 and 310. The integrated platform, combined with thermostatic amplification, showed a detection limit of less than 0.01% for BRCA2 mutations, with an assay cost of approximately $9.50 and a processing time of about 30 min—50% shorter than traditional methods. The platform effectively detected BRCA2 mutations in 56 PCa patients, achieving 100% sensitivity, with the detected mutation abundance in line with the high-throughput sequencing results.
  Conclusions: We have developed a direct DNA mutation detection system that obviates purification and single-stranded conversion, capable of detecting various mutations (ATM, BRCA2, CHEK2) with high sensitivity and rapid turnaround. This diagnostic platform is suitable for point-of-care surveillance in PCa, combining precision, simplicity, and affordability, thereby offering significant clinical potential for PCa diagnosis and monitoring.

RF-22.03—Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging in Preoperative Staging of Prostate Cancer 

• Boiko Oleksandr ¹, Estrade Oskar ¹, Prieto Sergio ¹, Llorente Ana ¹, Sanz Joel ¹, Iliuta Florina ¹, Gonzalez David ¹, Garcia Adrian ¹, Rodriguez Ander ¹, DeLaMata Jorge ¹, Lazaro Daniel ¹, Garcia-Olaverri Jorge ¹, Lecumberri David ¹, Boiko Mykola ²
  ¹ University Hospital Cruces, Barakaldo, Spain, ² Androcenter Medical Center, Kyiv, Ukraine

• Introduction and Objectives: Multiparametric magnetic resonance imaging (mpMRI) is widely utilized in both the diagnosis of prostate cancer (CaP) and in pre-treatment staging for surgical or other therapeutic interventions. The aim of this study was to evaluate the accuracy of mpMRI in the pre-treatment staging of CaP.
  Materials and Methods: A retrospective analysis was conducted on patients who underwent robotic-assisted radical prostatectomy (RARP) at a public medical center between January 2022 and January 2024. The findings regarding lesion localization and extent, obtained through mpMRI, were compared with the histopathological results of the surgical specimen after RARP. We assessed the correct staging rate according to TNM, as well as the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI for detecting bilateral involvement, extracapsular extension, and seminal vesicle invasion. Patients with a Gleason score of 6 were excluded.
  Results: A total of 391 patients, with a mean age of 66.5 ± 5.8 years, were included in the analysis. MpMRI accurately staged only 26.7% of the cases. Understaging occurred in 61.5% of patients, while overstaging was observed in 11.8%. For detecting extracapsular extension, mpMRI demonstrated a sensitivity of 24.4%, specificity of 93.3%, positive predictive value (PPV) of 52.3%, and negative predictive value (NPV) of 80.4%. The sensitivity for detecting seminal vesicle invasion was 18.1%, with a specificity of 98.9%, PPV of 50.5%, and NPV of 91.9%. Bilateral involvement was identified with a sensitivity of 36.9%, specificity of 61.5%, PPV of 91.2%, and NPV of 8.2%.
  Conclusions: MpMRI shows limitations in staging CaP, particularly in detecting bilateral involvement, extracapsular extension, and seminal vesicle invasion. Its use for treatment planning should be approached with caution and may benefit from the addition of other prognostic tools to optimize diagnostic accuracy.

RF-22.04—Novel MRI-US Fusion, Transperineal Prostate Biopsies Under Local Anaesthesia, Utilising Electromagnetic Needle Tracking: 4-Year Outcomes of Vecto^® Prostate Biopsy 

• Kumar Ranya ¹, Fletcher Peter ², De Santis Marta ³, Barrett Tristan ⁴, Kastner Christof ⁴
  ¹ University of Cambridge, Cambridge, United Kingdom, ² East and North Hertfordshire NHS Trust, Stevenage, United Kingdom, ³ University Hospitals of Morecambe Bay NHS Trust, Kendal, United Kingdom, ⁴ Cambridge University Hospitals, Cambridge, United Kingdom

• Introduction and Objectives: EAU guidelines recommend that suspected prostate cancer patients undergo pre-biopsy MRI and a targeted biopsy approach. MRI/US fusion transperineal prostate biopsy is an established procedure, possible to perform under local anaesthetic. Vecto^® prostate biopsy utilises electromagnetic (EM) needle tracking via a transperineal approach, in order to achieve high targeting accuracy, precision and patient comfort. Here, we evaluate the 4 years deployment of this technique.
  Materials and Methods: Vecto^® utilises BiopSee^® fusion software (Medcom, Germany), EM tracking technology (Vtrax, Civco) and transrectal US (Fujifilm, Japan). A stepper mounted rectal US probe provides stable image fusion, limiting prostate distortion and patient discomfort. Local anaesthesia is delivered via a 2-point transperineal approach to the skin, pelvic floor muscles and periapical space. Real-time monitoring of the electromagnetically tracked coaxial needle sheath guides the operator to the pre-contoured target lesions, indicating when optimal alignment for biopsy is achieved. Moreover, recorded biopsies can be used for future image guided treatment. The targeting accuracy and patient-reported outcomes of patients undergoing the procedure between September 2020 and 2024 in two centres were evaluated.
  Results: 161 patients underwent a Vector prostate biopsy, targeting 191 lesions in total. Detection of prostate cancer in Likert 4&5 biopsies is 95% (N = 114/120), with csPCa detected in 82% (N = 98/120). Targeted biopsies of Likert 5 lesions have resulted in positive cores in over 93% of cases (N = 71/76). The procedure has proven to be well tolerated, with more than 80% reporting no or minimal pain (85.0%, N = 73/86), discomfort (84.0%, N = 72/86) and embarrassment (96.0%, N = 83/86). Complications were rare: a single patient was admitted for a proven infection, and two have required catheterisation for urinary retention.
  Conclusions: Vecto^® prostate biopsy has proven to be a well-tolerated procedure with excellent biopsy accuracy and precision, with minimal post operative complications.

RF-22.05—Radiology Learning Curve in Predicting Extraprostatic Extension Using Magnetic Resonance Imaging 

• Rolig Braden, Brown James, De Rosa Paige, Bell Sarah
  University of Iowa, Iowa City, United States

• Introduction and Objectives: We investigate whether a learning curve was present for radiologists in predicting extraprostatic extension (EPE) after widespread adoption of pre-operative MRI before radical prostatectomy.
  Materials and Methods: All patients undergoing MRI-guided prostate biopsy and radical prostatectomy between 2017 and 2020 were retrospectively reviewed. Demographics, MRI findings, and final pathology were analyzed. Binary variables were created to standardize MRI results: (1) Explicit EPE seen, (2) Concern for EPE/Capsule Bulging/Capsule Abutment seen, and (3) Any concerning finding suggestive of EPE. EPE was defined as any patient with final pathology of ≥T3a. The MRI findings and pathologic stage were compared to determine test characteristics for detecting EPE on MRI. The cohort was split between two time periods, 2017–2018 and 2019–2020. The underlying rates of EPE, the incidence of radiology calls pertaining to EPE, and the test characteristics were compared between the time periods.
  Results: Among 111 patients, 7 patients (6%) had EPE seen, and 42 patients (38%) had radiologic findings concerning for EPE such as capsule bulging or abutment on MRI. 32 patients (29%) had pathologic EPE (≥T3a). The underlying rates of EPE were similar in each period (29% and 29%). While not statistically significant, the incidence of radiologist read of EPE and concern for EPE/Bulging/Abutment notably increased over time. Explicit mention of EPE increased from 5% to 8% (p = 0.70). Calling of features concerning for EPE such as capsule abutment or bulging increased from 32% to 45% (p = 0.17). When grouping these together, reads of any concern for EPE on MRI increased from 37% to 53% (p = 0.09). The sensitivity for any concerns detecting EPE via MRI increased from 50% to 64% whereas specificity and accuracy declined from 68% to 51% and 63% to 55%, respectively, between 2017–2018 and 2019–2020.
  Conclusions: Even though the rates of underlying pathologic EPE remained constant between the two time periods, the incidence of radiologist call of characteristics associated with EPE increased over time. The sensitivity increase suggests that a learning curve may have been present for radiologists predicting EPE once MRI was widely used for surgical planning. Conversely, the decline in specificity and accuracy may suggest radiologists began over-calling findings as time progressed.

RF-22.06—Review of the Imaging Pathway for Patients Newly Diagnosed with Prostate Cancer: Is There a Role for PET Scan in Initial Investigations 

• Stewart Charles, Buddu Sayeuri, Ceylan UmutDeniz
  Torbay Hospital, Torbay, United Kingdom

• Introduction and Objectives: Under our standard pathway, patients with a newly diagnosed high risk prostate cancer will undergo a staging CT and bone scan. Many patients go on to have an additional PET scan if it is thought the results of this would alter their management options. With an increase in the availability of PET CT in our trust, there could be a role for PET in the standard pathway.
  Materials and Methods: 274 patients were identified with a new diagnoses of prostate cancer between October 2023 and October 2024. Those with no histological evidence of prostate cancer or with low risk (CPG 1—Gleason 3+3, PSA < 10, T2 or below) were excluded. The remaining 235 men had their hospital notes, investigations and imaging analysed.
  Results: Mean age of 74.5 years. 86% WHO performance status 0 or 1. 47% Gleason 4+4 or above at diagnosis. 23% had metastatic disease on CT staging scan, and 20% had a positive bone scan. On the current pathway 32 (14%) patients underwent assessment with a PET CT scan. Of those, 13 were negative, 16 were positive, and staging/management changed because of the scan. Only 3 patients with positive PET CTs had their staging/management remain the same.
  Conclusions: At present 14% of our patients are undergoing a PET CT in addition to their standard staging scans. The vast majority of these (90%) are leading to a change in management. A modified pathway identifying suitable patients for a PET scan first line could reduce resource use, radiation exposure and environmental impact from multiple hospital visits. Ultimately this will lead to a more streamlined diagnostic pathway with reduced delays to treatment.

RF-22.07—Risk Factors for Incidental Prostate Cancer Following Surgery for Benign Prostatic Enlargement: A Systematic Review and Meta-Analysis 

• Cormio Angelo ¹, D’Andrea David ², Matsukawa Akihiro ³, Dematteis Alessandro ⁴, Alfarhan Ahmed ⁵, Miszczyk Marcin ⁶, Roessler Navid ⁷, Alqahtani Abdulrahman ⁸, Mancon Stefano ⁹, Tsuboi Ichiro ¹⁰, Rajwa Paweł ¹¹, Falagario Ugo ¹², Sanguedolce Francesca ¹², Busetto Gian Maria ¹², Bettocchi Carlo ¹², Carrieri Giuseppe ¹², Cormio Luigi ¹², Galosi Andrea ¹, Kimura Takahiro ³, Shariat Shahrokh ²
  ¹ Università Politecnica delle Marche, Ancona, Italy, ² Medical University of Vienna, Vienna, Austria, ³ The Jikei University School of Medicine, Tokyo, Japan, ⁴ AOU Città della Salute e della Scienza at Molinette Hospital, Torino, Italy, ⁵ Prince Saud Bin Jalawi Hospital, Al Ahsa Health Cluster, Al Ahsa, Saudi Arabia, ⁶ Faculty of Medicine, WSB University, Dąbrowa Górnicza, Dąbrowa Górnicza, Poland, ⁷ Medical University Center Hamburg-Eppendorf, Hamburg, Germany, ⁸ Ministry of Health Saudi Arabia, Second Health Cluster, Riyadh, Saudi Arabia, ⁹ Humanitas University, Milano, Italy, ¹⁰ Shimane University Faculty of Medicine, Shimane, Japan, ¹¹ Centre of Postgraduate Medical Education, Warsaw, Poland, ¹² Università di Foggia, Foggia, Italy

• Introduction and Objectives: The diagnosis of incidental prostate cancer (IPC) is not uncommon in patients undergoing surgery for benign prostate enlargement (BPE). We aimed to evaluate the potential risk factors for IPC, which remain unclear.
  Materials and Methods: A comprehensive search of MEDLINE, Embase, and Web of Science databases was conducted in January 2025 to retrieve studies assessing IPC risk. Pairwise meta-analyses were performed using a random-effects model, pooling adjusted odds ratios (ORs) with 95% confidence intervals (CIs) retrieved from multivariable analyses. Risk of bias was assessed using the ROBINS-I tool (PROSPERO: CRD42024588776).
  Results: A total of 25 studies, comprising 247,966 patients, were included. IPC was detected in 6,748 patients, with proportions across the studies ranging from 2.2% to 49.6%. Clinical factors significantly associated with an increased risk of IPC included PSA level (OR: 1.03; 95% CI: 1.01–1.05; p = 0.01), PSA density > 0.15 ng/mL/cc (OR: 3.02; 95% CI: 1.50–6.07; p = 0.01), age (OR: 1.05; 95% CI: 1.01–1.08; p = 0.01), and higher body mass index (BMI) (OR: 1.10; 95% CI: 1.02–1.18; p = 0.01). Prostate volume, diabetes, and dyslipidemia were not. The use of 5-ARIs was associated with a significantly reduced risk of IPC (OR: 0.53; 95% CI: 0.33–0.85; p = 0.01). Limitations include study heterogeneity, retrospective design, and incomplete reporting of relevant variables.
  Conclusions: Elevated PSA, high PSA density, older age, and higher BMI were associated with an increased risk of IPC following BPE surgery. Conversely, a decreased risk of IPC was observed among patients who had been using 5-ARIs for LUTS prior to BPE surgery. Our findings might assist in determining which patients can avoid unnecessary tests before surgery. Further studies are required to clarify risk factors for clinically significant IPC.

RF-22.08—The Impact of Radiologist Experience on Clinically Significant Prostate Cancer Detection on Biparametric and Multiparametric MRI—An Analysis of the Prime Trial 

• Ng Alexander, Study Group PRIME
  University College London, London, United Kingdom

• Introduction and Objectives: Prostate MRI interpretation is an expert skill with a steep learning curve. Limited evidence exists on how experience affects cancer detection in prospective trials. This analysis evaluates radiologist experience in detecting clinically significant prostate cancer (csPCa) using biparametric (bpMRI) and multiparametric MRI (mpMRI).
  Materials and Methods: PRIME (NCT04571840) was an international, prospective, multicentre, level 1 evidence trial assessing if bpMRI was non-inferior to mpMRI for csPCa detection. Radiologists first reported bpMRI (without contrast), then reviewed mpMRI after unblinding. MRIs were scored using Likert and PI-RADS v2.1 systems, with lesions scoring ≥ 3 undergoing MRI-targeted biopsies. Radiologists were divided into tertiles from least to most experienced by scan volume and years of experience (Table 1).
  Results: Across 22 international centres, 30 radiologists interpreted MRIs locally. The median [IQR] number of prostate MRIs reported per year was 600 [288–938], and number of years of experience was 10 [7–15]. Of 490 patients included in the study, there were 143 cases of csPCa (29.2%). When stratified by the number of scans interpreted per year, in those reporting between 501–999 scans annually, the addition of contrast only identified two additional cases of csPCa (bpMRI (32.5%, 37/114) vs. mpMRI (34.2%, 39/114)). When stratified by the total years of experience, the addition of contrast identified two additional cases of csPCa in those with < 15 years of experience (bpMRI (30.5%%, 93/305) vs. mpMRI (31.1%, 95/305)).
  Conclusions: Amongst experienced radiologists, there was no significant difference in csPCa detection between the most and least experienced radiologists within the PRIME trial.

RF-22.09—Utility of PSMA PET/CT for Staging of Favourable Risk Intermediate Risk Prostate Cancer 

• Fu Ming Hei ¹, Hong Anne ², Wong Lih Ming ¹, Taubman Kim ¹, Sutherland Tom ¹
  ¹ St Vincent’s Hospital Melbourne, Melbourne, Australia, ² Austin Health, Melbourne, Australia

• Introduction and Objectives: PSMA PET/CT has superior detection of metastases to conventional imaging for staging prostate cancer (PCa) as shown in the landmark proPSMA trial. However, the number of patients with favourable intermediate risk disease (Grade Group 2 [GG2]/Gleason 3 + 4) was only 6% (n = 2). The aim of this report is to assess the utility of staging PSMA-PET/CT for GG2 PCa.
  Materials and Methods: A retrospective review of patients with GG2 PCa who underwent PSMA-PET/CT for staging between 2019–2024 was conducted. Baseline patient characteristics, biopsy and imaging (MRI and PSMA PET) parameters were assessed. ANOVA analysis and linear regression were used to assess the relationship between SUVmax and PIRADS scores, % Gleason 4 pattern, PSA and age. The number needed to treat (NNT) analysis was performed to determine the number of scans required to detect any metastatic lesions.
  Results: 137 patients between two tertiary metropolitan hospitals were identified. Median age at diagnosis was 66 years (IQR 62–77). They had a PSA of 6.1 ng/mL (IQR 4.6–9.3), and most underwent prostate biopsy transperineally (97.8%). A median of 27 cores was analysed with 7 cores (IQR 5–12) demonstrating PCa. 20% of cores (IQR 10–30) were Gleason pattern 4. MRI was available for 129 patients, which demonstrated PIRADS scores of 0–2,3,4 and 5 in 16.1%, 5.1%, 47.4% and 25.5% respectively. On PSMA PET scan, 23 patients had no abnormalities detected. Of the remainder, the SUVmax of the index lesion was available for 112 cases, 7.5 (IQR 4.6–14.2). There was no significant difference in SUVmax score across PIRADS categories (n = 92, p = 0.064), Gleason 4 percent (p = 0.81), PSA (p = 0.07) or age (p = 0.22). Five patients (3.6%) demonstrated avidity suspicious for metastatic disease on PSMA PET, four of which were regional nodal metastasis and one rib metastasis. NNT for GG2 patients with any metastases was 28.
  Conclusions: There were higher rates of radiologically suspicious lesions on PSMA PET/CT than previously reported. Given the NNT for this is 28, accessibility and health economic concerns should be considered when using PSMA-PET/CT as primary staging in GG2 disease. It remains to be seen if PSMA PET/CT can improve risk stratification for patients with GG2 PCa, and further analyses with prospective studies are required.

22.4. Unmoderated Standard ePosters

UP-22.01—AGREE II Quality Assessment of National and International Clinical Practice Guidelines on Prostate Cancer Management by the OPTIMA Consortium 

• Sakalis Vasileios ¹, Bhattacharya Yagnaseni ², Beyer Katharina ³, Murray Charlotte ², Smith Emma Jane ⁴, Willemse Peter-Paul ⁵, Gandaglia Giorgio ⁶, Boissier Romain ⁷, Borkowetz Angelika ⁸, Dabestani Saeed ⁹, Leenen Renee ¹⁰, Vilaseca Antoni ¹¹, Maresca Gianluca ¹², Teoh Jeremy ¹³, Gómez Rivas Juan ¹⁴, Rajwa Pawel ¹⁵, Lardas Michael ¹⁶, Grivas Nikolas ¹⁷, Van Den Broeck Thomas ¹⁸, Pradere Benjamin ¹⁹, Schouten Natasha ²⁰, Tandogdu Zafer ²¹, Evans-Axelsson Susan ²², Maclennan Steven ², Thomas Marlene ²³, Briganti Alberto ⁶, Bjartell Anders ²⁴, Cornford Phil ²⁵, Kruger Hagen ²⁶, N’Dow James ², Roobol Monique ¹⁰, Consortium OPTIMA ²⁷, Omar Muhammad Imran ²
  ¹ Hippokrateion General Hospital of Thessaloniki, Urology, Thessaloniki, Greece, ² University of Aberdeen, Aberdeen, United Kingdom, ³ Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands, ⁴ European Association of Urology Guidelines Office, Arnhem, Netherlands, ⁵ Dept. of Urology, Cancer Center, University Medical Center Utrecht, Utrecht, Netherlands, ⁶ Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy, ⁷ Department of Urology and Renal transplantation, APHM, Aix-Marseille Université, France, ⁸ Department of Urology, Technische Universität Dresden, Germany, ⁹ Department of Urology, Kristianstad Central Hospital, Region Skane, Kristianstad, Sweden and Department of Translational Medicine, Section Division of Urological Cancers, Lund University, Lund, Sweden, ¹⁰ Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands, ¹¹ Servicio de Urología, Hospital Clínic de Barcelona, Barcelona, Spain, ¹² Department of Urology, Aberdeen Royal Infirmary, Aberdeen, United Kingdom, ¹³ S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China, ¹⁴ Department of Urology, Hospital Clinico San Carlos, Madrid, Spain, ¹⁵ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria, ¹⁶ Department of Urology, Metropolitan General Hospital, Athens, Greece, ¹⁷ Department of Urology, Netherlands Cancer Institute, Amsterdam, Netherlands, ¹⁸ Department of Urology, University Hospitals Leuven, Leuven, Belgium, ¹⁹ Department of Urology, La Croix Du Sud Hospital, Quint Fonsegrives, France, ²⁰ European Association of Urology Guidelines Office, Arnhem, Netherlands, ²¹ Department of Urology, University College London Hospitals, London, United Kingdom, ²² Bayer AG, Berlin, Germany, ²³ Roche, Basel, Switzerland, ²⁴ Department of Translational Medicine, Lund University, Lund, Sweden, ²⁵ Department of Urology Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom, ²⁶ Medical Affairs, Pfizer, Berlin, Germany, ²⁷ European Association of Urology, Arnhem, Netherlands

• Introduction and Objectives: Prostate Cancer (PCa) Clinical Practice Guidelines are a valuable resource for routine care, yet their quality may vary despite a common evidence base. To date, no study has evaluated this quality. As part of the OPTIMA project, we assessed the most frequently used national and international PCa guidelines using the AGREE II tool.
  Materials and Methods: Two assessors independently assessed the quality of the identified Clinical Practice Guidelines using the AGREE II tool. The AGREE II comprises 23 items organized into 6 domains, rated on a 7-point scale (1: strongly disagree to 7: strongly agree). The total score of the appraisal was the mean value of the two assessments. The agreement between assessors’ scores was calculated using the Interclass correlation coefficient. Four key recommendations were compared among the Clinical Practice Guidelines to assess consistency.
  Results: Sixteen Clinical Practice Guidelines were assessed using their latest available version (cut off April 2024). The EAU, S3LL PCa, KCE, NCCN, and NPV guidelines received the highest overall scores with mean domain score 82.4% (range: 75.5–88.3%). The AFU, AUA, and NICE received a mean domain score 77.6% (range: 73.7–84.0%). Below average were the ESMO, the localised and systemic CPPC ASCO, the NVU with mean domain score 58.4% (range: 43.5–76.3%). Reasons for scoring below average included: inadequate information about the methodology applied, limited scope of the guideline and limited patient engagement. The highest interrater variability was observed in NVU (ICC: 0.58) and the lowest in AFU-L (ICC: 0.84). When examining the scores of each domain, ‘Clarity of Presentation’ (Domain 4) achieved the highest score with a mean of 86.9% ±12.6. The domain with the lowest score was Applicability (Domain 5), with a mean of 48.3% ± 24.8. The ICC was calculated 0.72 (±0.08).
  Conclusions: This is the first study in which comprehensive quality assessment of majority International and National Clinical Practice Guidelines was undertaken, and key recommendations were compared to assess consistency. Our study shows that the majority of International and National Clinical Practice Guidelines demonstrate high-quality standards when assessed using the AGREE II evaluation tool. Those Clinical Practice Guidelines that did not meet the expected standards could be improved by adopting several key recommendations outlined by our study.

UP-22.02—An Audit of Transperineal Prostate Biopsies: Assessing Our Hit Rate and Evaluating the Need to Standardize the Practice 

• Al-Gburi Saleh, Atayi Andrew, Wong Kee
  Wirral University Teaching Hospitals, Wirral, United Kingdom

• Introduction and Objectives: This study evaluates the hit rate of local anesthetic transperineal biopsies (LATP), assessing current practices and potential complications.
  Materials and Methods: In the first audit cycle, we retrospectively analyzed 200 patients who underwent LATP biopsies over five months (January–May 2023). Based on findings, we modified our local protocol by discontinuing prophylactic antibiotics, performing targeted ± systematic biopsies for PIRADS 2 and 3, and restricting PIRADS 4 and 5 cases to targeted biopsies only. A second audit cycle prospectively assessed 67 patients over three months (June–September 2024).
  Results: In the first cycle, the average patient age was 71 years, with a mean prostate size of 51cc, PSA density of 0.34, and PSA level of 16.32. Hit rates were 93.8% for PIRADS 5, 89.4% for PIRADS 4, and 64% for PIRADS 3, with an overall hit rate of 87%. The mean number of biopsy cores per procedure was 20, with no reported complications. In the second cycle, the overall hit rate was 85%, with PIRADS 5 and 4 achieving 94% and 79% hit rates, respectively. The average core count per procedure decreased to 12, again with no complications.
  Conclusions: By optimizing our LATP biopsy approach, we maintained comparable diagnostic accuracy while reducing biopsy cores from 20 to 12 and eliminating prophylactic antibiotics. This adjustment enhances patient comfort, reduces histopathology workload, and lowers NHS costs.

UP-22.03—Analysis of Results of Transperineal Prostate Biopsies Using Artemis Fusion at the Panama Clinic (2020–2025) 

• RUIZ LETICIA, SHAW ANDREA
  The Panama Clinic, Panama City, Panama

• Introduction and Objectives: Timely detection of prostate cancer is crucial for defining treatment strategies. The Artemis technology enables elastic fusion of multiparametric magnetic resonance imaging (mpMRI) and ultrasound to guide transperineal prostate biopsies. This retrospective study at The Panama Clinic (2020–2025) evaluates the correlation between clinical, imaging, and histopathological findings, determining the cancer detection rate based on PIRADS classification.
  Materials and Methods: This was an observational, descriptive, and retrospective study. Patients included underwent transperineal prostate biopsy using the semi-robotic Artemis™ arm, Profuse™ software for prostate segmentation and region of interest (ROI) identification, and Terason ultrasound with a biplanar transducer. Complete records of PSA levels, PSA density, prostate volume, PI-RADS score, maximum lesion diameter, and Gleason/ISUP grading were required. Biopsies were performed under general anesthesia with a single preoperative antibiotic dose. Patients undergoing additional biopsies for purposes other than prostate cancer detection were excluded. Cancer detection was determined based on histopathology reports.
  Results: A total of 100 biopsies were analyzed between February 2020 and January 2025. The median patient age was 65 years. The median PSA level was 6.7 ng/mL, PSA density was 0.15 ng/mL/cc, prostate volume was 40 mL, and lesion size was 12 mm. No enemas or oral antibiotics were administered pre- or post-operatively; only a single intravenous preoperative dose was used. Cancer detection rates were: PIRADS 2 (0%), PIRADS 3 (46%), PIRADS 4 (77%), and PIRADS 5 (91%), with an overall detection rate of 76%. Gleason scores for positive biopsies were GG1 (33%), GG2 (20%), GG3 (17%), GG4 (27%), and GG5 (3%), indicating that 67% of detected cancers were clinically significant. No infectious complications were reported.
  Conclusions: Prostate cancer detection using transperineal biopsy with Artemis fusion increased with the PIRADS score: 46% for PIRADS 3, 77% for PIRADS 4, and 91% for PIRADS 5. No patients experienced infectious complications. These findings support the integration of Artemis-guided transperineal biopsy into national protocols, contributing to a more accurate and earlier diagnosis of prostate cancer.

UP-22.04—Are We Picking up Too Many Insignificant Cancers? An Audit of Our Management of PIRADS 3 Lesions 

• Mustafa Mohamed ¹, KATTUB HAYDAR ¹, Suraparaju Lokesh ¹, Shenoy Vinod ², Senada Peter ²
  ¹ JPUH, Great Yarmouth, United Kingdom, ² James Paget University Hospitals, Great Yarmouth, United Kingdom

• Introduction and Objectives: It is now universally recognized that many prostate cancers are over-diagnosed and over-treated. The European Randomized Study of Screening for Prostate Cancer (ERSPC) from 2009 evidenced that, to save one man from death of prostate cancer, over 1,400 men had to be screened, and 48 had to undergo treatment. MP-MRI can also reduce over-diagnosis of clinically insignificant prostate cancer and improve detection of clinically significant cancer. Clinically insignificant prostate cancer (PC) can be defined as a cancer, which will not affect the patient during the natural course of his lifetime. The indolent course of localised low-grade PC (Gleason 6 ) means that active surveillance (AS) is considered a good treatment option.
  Materials and Methods: Retrospective data collection of all diagnosed prostate ca patients with Gleason 3+3 = 6 in our hospital; from January 2023 until October 2023. MRI and review of PIRADS score. PSAD review. Pick up of insignificant prostate ca can create anxiety, will require follow up and invasive investigations and has bearing on NHS resources. National standards showed that pick up of insignificant prostate ca should be less than 25%, so we would like to compare our results to national standards.
  Results: Total new diagnosed number of cases of prostate ca from Jan 2023 to October 2023 was 227. 39 patients out of 227 (17.8%) were diagnosed with Gleason 3+3 = 6. 15 out of 39 (38.46%) cases MRI showed PIRADS 3 lesions. 13 out of 39 (33.3%) MRI showed PIRADS 4 lesions. 5 out of 39 (12.82%) MRI showed PIRADS 5 lesions. 4 out of 39 (10.25%) MRI showed PIRADS 3/4 lesions. One out 39 was PIRADS 2, MRI was PIRADS 2 and was already on AS for GLEASON 3 + 3. One out of 39 had no MRI and was incidentally found Gleason 3+3 in TURP specimen. For PIRADS 3 MRI, we have divided them into subgroups based on PSAD.
  Conclusions: Our prostate ca diagnosis practice and records are very good compared to national standards.

UP-22.05—Assessing Confidence and Competence in Digital Rectal Examination Among Foundation Year 2 Trainees in the North West Deanery 

• Elmousili Mahmoud
  Wythenshawe Hospital, Manchester University Foundation Trust, Manchester, United Kingdom

• Introduction and Objectives: Digital Rectal Examination (DRE) is a core clinical skill that all newly qualified doctors are expected to perform competently. Despite this, most DREs are reportedly undertaken by relatively inexperienced doctors. This study aimed to evaluate the training, experience, and confidence of Foundation Year 2 (FY2) doctors in performing DREs across the North West (NW) deanery.
  Materials and Methods: A questionnaire was developed and distributed to FY2 doctors during their first rotation within the NW deanery. The survey captured data on prior training, frequency of performing DREs, and self-assessed confidence in various components of the examination.
  Results: A total of 55 trainees responded. While 98% had received DRE training in medical school, only 5% had received additional training during FY1. Prior to qualification, 82% had performed a DRE, with 87% doing so fewer than five times. Since qualification, 35% and 60% reported performing DREs at least weekly or monthly, respectively. Notably, only 18% of these examinations were supervised or followed by a senior review. Confidence levels varied significantly. While 55–80% of trainees felt confident assessing the nature of PR bleeding and identifying stool in the rectum, only 13% felt confident in identifying rectal lesions. Confidence in prostate examination was also limited, with only 15–27% comfortable describing its characteristics.
  Conclusions: There is a clear gap in both experience and confidence among FY2 doctors in performing DREs, particularly in detecting rectal pathology and prostate assessment. These findings highlight the need for enhanced and structured training during the foundation programme to bridge this competence gap.

UP-22.06—Can Surveillance Biopsy Be Omitted in Active Surveillance for mpMRI-Negative Prostate Cancer? 

• Pantazis Lampros, Bendre Hersh, Feng Aileen, Hunter Alexandra, Patel Neel, Dahl Douglas, Wszolek Matthew, Efstathiou Jason, Salari Keyan, Feldman Adam
  Massachusetts General Hospital, Boston, MA, United States

• Introduction and Objectives: Forgoing surveillance biopsies in patients on Active Surveillance (AS) with a negative multiparametric MRI (mpMRI) has been proposed; however, data on serial mpMRI for detecting progression to clinically significant prostate cancer (csPCa) over time is limited.
  Materials and Methods: Under IRB approval, we identified patients in our institutional AS database with grade group (GG) 1 PCa, baseline mpMRI within 6 months of diagnosis, and at least 1 additional prostate biopsy and mpMRI. For each follow-up mpMRI with a unique biopsy occuring within 6 months of it, we estimated performance metrics for csPCa (GG ≥ 2) detection per mpMRI. Positive mpMRI was defined as PIRADS ≥ 3. Next, in the negative baseline mpMRI subgroup, we performed Kaplan Meier analysis of mpMRI progression-free survival (PFS) and biopsy csPCa PFS.
  Results: 371 patients met selection criteria with a median follow-up of 4.6 (IQR: 2.9–6.7) years. Among 381 follow-up mpMRIs evaluated, csPCa progression was detected in 36% of patients with a sensitivity of 91.7% (95% CI: 85.3–95.4) and NPV of 88.4% (95% CI: 79.9–93.6). In patients with a negative baseline mpMRI, sensitivity and NPV were 85.2% (95% CI: 67.5–94.1) and 90.2% (95% CI: 77.5–96.1), respectively. 58% of patients with a negative baseline mpMRI had eventual mpMRI progression at a median time of 3.7 (IQR: 1.8–8.5) years, and 31% had biopsy progression.
  Conclusions: In AS patients, surveillance mpMRI has good sensitivity and NPV for detecting progression to csPCa; however, approximately 12% with a negative mpMRI will still have csPCa. Notably, more than half of patients with negative baseline mpMRI will eventually develop a PIRADS ≥3 lesion on follow-up mpMRIs. These data support continued surveillance imaging in those with negative baseline mpMRI and consideration of biopsy even when surveillance mpMRI is negative.

UP-22.07—Clinical Utility of the Selectmdx Urinary Biomarker Test in Prostate Cancer Risk Stratification and Decision-Making: A Single-Institution Experience 

• Malicoat Johnny, Brown James
  University of Iowa, Iowa City, IA, United States

• Introduction and Objectives: The SelectMDx test is a non-invasive urinary biomarker assay that evaluates mRNA expression levels of DLX1 and HOXC6, genes associated with high-grade prostate cancer, to help identify patients at increased risk for clinically significant disease. Prior studies have demonstrated SelectMDx’s ability to improve risk stratification and reduce unnecessary biopsies in men with elevated PSA and/or abnormal digital rectal exams. We sought to evaluate its predictive utility and clinical influence at a single tertiary care center by assessing: (1) whether SelectMDx accurately identified high-risk patients and (2) whether its results impacted downstream clinical decision-making.
  Materials and Methods: We retrospectively reviewed data from 23 patients who underwent SelectMDx testing in 2024. Data collected included patient age, pre-test PSA levels, prostate MRI findings, biopsy or prostatectomy status post-testing, and confirmed pathology. The mean age was 67 years. Among the cohort, 9 patients had biopsy-proven Gleason 3+3 prostate cancer prior to testing. Patients were stratified based on SelectMDx results into high- or low-risk groups.
  Results: Eighteen of 23 patients (78.3%) were classified as high risk by SelectMDx, with a mean predicted high-grade cancer probability of 32% and low-grade probability of 27%. Of these, 10/18 (55.6%) underwent biopsy after testing, and 5/10 (50%) were upstaged to Gleason 3 + 4 or higher (including one patient upstaged to 5 + 5). Only one patient underwent prostatectomy. All five patients classified as low risk did not undergo further biopsy or prostatectomy.
  Conclusions: In this small cohort, SelectMDx identified high-risk patients with modest accuracy, with 27% (5/18) ultimately demonstrating higher-grade disease on biopsy. However, its influence on clinical decision-making was limited: a significant proportion of patients classified as high risk did not proceed with further diagnostic or therapeutic interventions. This suggests that, while SelectMDx may offer supplementary risk stratification in select clinical contexts, it is not currently driving management in a consistent or guideline-aligned fashion. Patient preference, provider discretion, and institutional patterns may play larger roles in decision-making. Further studies are warranted to evaluate how biomarker-based tools can be better integrated into shared decision-making processes in prostate cancer care.

UP-22.08—Comparative Analysis of Ginsburg Protocol and RAPID Pathway in Transperineal Prostate Biopsy for Cancer Detection 

• OSHEVIRE-BINI CHARLES, Han Lin Aung
  Royal Shrewsbury Hospital., Shrewsbury, United Kingdom

• Introduction and Objectives: Transperineal prostate biopsy is increasingly adopted for its safety and ability to detect prostate cancer, particularly in anterior zones, compared to transrectal approaches. The Ginsburg Protocol, involving systematic sampling of all prostate zones, and the RAPID (Rapid Assessment for Prostate Imaging and Diagnosis) Pathway, which uses targeted biopsies with systematic Peripheral Zone (PZ) sampling, offer distinct diagnostic strategies. This study aimed to identify the prostate zone with the highest cancer detection rate using the Ginsburg Protocol and compare its outcomes with a simulated RAPID Pathway, focusing on detection rates and complications.
  Materials and Methods: A retrospective analysis was conducted on 465 patients undergoing transperineal prostate biopsy using the Ginsburg Protocol (12–24 cores, systematic sampling across anterior, mid, and posterior sectors) from January 2024 to November 2024. Data included age, PSA levels, PIRADS scores, MRI abnormalities, and biopsy results by zone (Gleason Grade Groups). The RAPID Pathway was simulated using MRI abnormality and PZ data, involving targeted biopsies (4 cores per MRI-suspicious lesion) and systematic PZ sampling, with a 10% biopsy avoidance rate for low-risk MRI findings (PIRADS 1–2). Zonal detection rates, overall detection, clinically significant cancer (GG2–GG5), and complications were compared.
  Results: Mean age was 68.7 years (range 37–87), with PSA levels from 0.85 to 1929 ng/mL (mean 19.61). PIRADS 4–5 scores were present in 78% of patients. The Ginsburg Protocol detected cancer in 71.2% (331/465) of patients, with 45.2% (210/465) having clinically significant cancer (GG2–GG5). The Right PZ had the highest detection rate at 29.7% (138/465), followed by the Left PZ at 27.7% (129/465). Complications occurred in 7.5% (35/465), including vasovagal reactions, acute retention of urine, and one sepsis case. The simulated RAPID Pathway biopsied 419 patients, detecting cancer in 60.1% (252/419), with 38.2% (160/419) being GG2–GG5. The Right PZ remained the highest detection zone (29.7%). Complications were estimated at 4% (17/419).
  Conclusions: The Ginsburg Protocol maximizes cancer detection, particularly in the PZ, but increases complications. The RAPID Pathway reduces overdiagnosis and complications, making it suitable for screening, while Ginsburg is ideal for high-risk patients requiring comprehensive sampling.

UP-22.09—Comparison of Multiparametric MRI and 18f-PSMA-PET/CT for Intraprostatic Grading and Local Staging in Men with Unfavourable Intermediate- and High-Risk Prostate Cancer Who Underwent Robotic Radical Prostatectomy—An Analysis of Three European Prostate Cancer Centers of Excellence (EPCCE) 

• Bußhoff Isabelle ¹, Handke Analena Elisa ², Al-Monajjed Rouvier ¹, Palisaar Rein-Jüri ², Arsov Christian ³, Witjes Wim ⁴, Bjartell Anders ⁴, Boschheidgen Matthias ¹, Rau Tilmann T. ¹, Esposito Irene ¹, Antoch Gerald ¹, Noldus Joachim ², Schimmöller Lars ¹, Giesel Frederik ¹, Novruzov Emil ¹, Albers Peter ¹, Radtke Jan Philipp ¹
  ¹ Uniklinik Düsseldorf, Düsseldorf, Germany, ² Marien Hospital Herne, Herne, Germany, ³ Elisabeth-Krankenhaus Rheydt, Mönchengladbach, Germany, ⁴ European Association of Urology Research Foundation, Arnhem, Netherlands

• Introduction and Objectives: Multiparametric magnetic resonance imaging (mpMRI) has high specificity for detection of extraprostatic extension (EPE) and seminal vesicle invasion but limited sensitivity. Prediction of ISUP grade group (GG) is controversial. [18F]PSMA-1007 positron emission tomography/computed tomography (PET/CT) may be more accurate in determining T staging and is promising to predict clinically significant prostate cancer (csPC). Within a European multicenter registry (EPCCE), we aimed to assess the diagnostic performance of [18F]PSMA-1007 imaging in comparison to mpMRI.
  Materials and Methods: Between March 2021 and March 2023, 65 treatment-naïve patients with biopsy-proven unfavourable intermediate- or high-risk PC undergoing mpMRI and [18F]PSMA-1007 PET/CT scan before RARP were prospectively enrolled. The imaging accuracy of [18F]PSMA-1007 PET/CT and mpMRI for intraprostatic tumour extent and localisation was evaluated on the basis of the 27-region PI-RADS scheme. The accuracy of EPE was validated via histopathological examination of whole-mount RP specimens. The sensitivity, specificity, positive (PPV) and negative predictive value (NPV), and accuracy were calculated. Spearman`s regression coefficient and box plots were deployed for the analysis of predictive value of SUV metrics of PET/CT and apparent diffusion coefficient (ADC) of mpMRI for ISUP GG, respectively.
  Results: Among 65 RP specimens, 22 had EPE, and 349 PC lesions were identified, 324 of which were csPC (ISUP GG ≥ 2). Per-lesion sensitivity, specificity, PPV, NPV, and accuracy for csPC were 58%, 81%, 50%, 86%, and 75% with [18F]PSMA-1007 and 35%, 97%, 78%, 81%, and 80% with mpMRI (p = 0.05). Accuracy for EPE detection did not differ significantly ([18F]PSMA-1007: 64%, mpMRI: 72%, p = 0.22). Spearman’s coefficient for SUVmax was 0.47 (p < 0.001) vs. 0.13 (p = 0.39) for ADCmean. All csPC had SUVmax ≥ 5. SUVmax correlated significantly with ISUP GG, whereas ADCmean did not.
  Conclusions: Both modalities showed comparable but limited accuracy for EPE detection. Hence, preoperative additional use of [F]PSMA-1007 imaging aids in the prediction of csPC. An updated EPCCE registry analysis will be presented.

UP-22.10—Cost-Benefit Analysis of Multiparametric MRI in the Diagnosis of Prostate Cancer 

• Montuenga Fernández Isabel, Vázquez Valdés Sonia, Peral Parra Diego, Sánchez Novo Olga, García-Loarte Gómez Eduardo, Teigell Tobar Julio, Morales Palacios Nelson, Ortiz Vico Francisco Javier, Tamayo Ruiz Juan Carlos
  Hospital Universitario Príncipe de Asturias, Alcalá De Henares, Madrid, Spain

• Introduction and Objectives: Prostate cancer is the most common malignant neoplasm in men. Traditionally, systematic randomized prostate biopsy has been the gold standard for diagnosis, though it presents limitations in detecting clinically significant tumors. Multiparametric magnetic resonance imaging (mpMRI) improves patient selection for biopsy. We evaluated the economic and clinical impact of mpMRI in detecting clinically significant prostate cancer (csPCa) in patients who underwent mpMRI prior to biopsy.
  Materials and Methods: A total of 300 patients with suspected csPCa were analyzed at our center, all of whom underwent mpMRI. Of these, 142 patients with suspicious findings or high clinical suspicion were biopsied. Total costs and cost per successful diagnosis were compared based on patient selection guided by mpMRI.
  Results: The total cost of the mpMRI-based approach was €320,400, whereas the projected cost without prior mpMRI selection would have been €360,000, representing an 11% saving (€39,600). A total of 158 unnecessary biopsies were avoided, reducing invasive procedures and associated risks by 52.6%. Among the 142 patients who underwent biopsy, 101 cases of csPCa were confirmed, yielding a detection rate of 34%. In a scenario without mpMRI, an estimated 96 cases would have been detected, with a detection rate of 32%. The cost per successful diagnosis using mpMRI was €3,172, compared to €3,750 without mpMRI, indicating greater efficiency in resource allocation.
  Conclusions: mpMRI reduces unnecessary biopsies and optimizes patient selection without compromising the detection of csPCa. It lowers the cost per successful diagnosis and represents a cost-effective diagnostic strategy in the management of prostate cancer.

UP-22.11—Diagnosis of Prostate Cancer by Detecting Pca3 in Voided Urine Sample by Using Resistive Sensors: A Preliminary Study 

• Chandra Shoubhik ¹, Ghagane Shridhar ², Nerli Rajendra ³
  ¹ Shriram Care Hospital Bilaspur, Chhattisgarh, India, Bilaspur, India, ² KLE Academy of Higher Education and Research (Deemed-to-be-University), Belagavi, India, ³ J N Medical College, KLE Academy of Higher Education and Research (Deemed-to-be-University), Belagavi, India

• Introduction and Objectives: Prostate cancer antigen 3 (PCA3) is a long noncoding RNA (lncRNA) that is expressed only in prostate cells, and PCA3 levels in the malignant tissue generally far exceed levels in benign tissue. The aim of the study was to develop a 2-port resistive sensor device for the detection of a wide range of concentrations (0.1 to 100 ng/mL) of PCA3 and to report the feasibility of detecting PCA3 in voided urine samples in patients with and without PCa.
  Materials and Methods: The biosensor was fabricated, and the device was characterized for the detection of PCA3 in a wide range of concentrations (0.1 to 100 ng/mL). Voided urine samples were collected from males ≥ 50 years of age presenting with lower urinary tract symptoms. Based on serum PSA values, a transrectal biopsy of the prostate was performed in all patients with a serum PSA ≥ 4 ng/mL. The histopathological report was used to classify the patients into two groups, namely PCa and benign. Urine specimens (30–50 mL) were collected, centrifuged, and urinary sediments were washed before being centrifuged again. The supernatant collected was subject to biosensor testing.
  Results: A total of 42 patients with serum PSA ≥ 4 ng/mL were included in the study. Voided urine samples were collected for biosensor tests to detect PCA3 in all. All patients underwent transrectal ultrasound-guided biopsy. The patients were divided into two groups, namely the prostate cancer group and the benign group. A total of 30 patients met all the criteria for further analysis and included 15 patients each with prostate cancer and benign histology. The age of the patients was clinically as well as statistically insignificant in both the groups. Serum PSA as well as PCA3 sensor results were statistically significant and higher in patients with PCa.
  Conclusions: Our research presents a novel resistive sensor based on reduced graphene oxide (RGO) for the detection of the PCA3 RNA in voided urine samples. This novel sensor is a simple, portable and efficient method for detecting PCA3. This sensor would help in early diagnosis as well as indicate a need for prostate biopsy in patients with suspected PCa.

UP-22.12—Diagnostic Accuracy and Complication Rates of Transperineal Fusion Prostate Biopsy: Our Experience 

• Giannakodimos Ilias ¹, Moulavasilis Napoleon ², Kratiras Zisis ¹, Kaltsas Aris ¹, Belogiannis Konstantinos ³, Zacharias Ioannis-Georgios ³, Stravodimos Konstantinos ², Chrisofos Michael ¹, Fragkiadis Evangelos ²
  ¹ Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece, ² National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece, ³ Medical Faculty of Athens University, Greece, Athens, Greece

• Introduction and Objectives: Transperineal prostate biopsy can achieve comparable diagnostic accuracy to the transrectal approach while offering a significantly lower risk of infection and rectal bleeding. This study aims to evaluate the diagnostic performance and complication rates associated with transperineal Fusion prostate biopsy.
  Materials and Methods: Biopsy naïve patients presenting with PSA levels between 4 and 10 ng/mL and suspicious lesions detected on multiparametric magnetic resonance imaging (mp-MRI) were enrolled in this study and underwent transperineal FUSION-guided prostate biopsy. Totally, 12 systematic biopsies were taken along with 2–4 targeted biopsies on each lesion, based on the size of the lesion. One month after biopsy, complication rates were assessed via telephone follow-up, and histopathological results were collected from the Pathology Department.
  Results: Totally, 101 patients were included in the analysis. The mean patient age was 67.8 ± 6.8 years, with a mean PSA level of 7.1 ng/mL. 23 patients (23.5%) had diabetes mellitus, 25 patients (25.5%) were receiving anticoagulant therapy, 17 patients (23%) exhibited a positive digital rectal examination, and 19 patients (19.4%) had a family history of prostate cancer. Regarding imaging findings, 63 patients (64.3%) had a single lesion, 28 patients (28.6%) had two lesions, and 7 patients (7.1%) had three lesions detected on mp-MRI. Prostate cancer was identified in 59 patients (65.6%) and was found clinically significant in 44 patients (48.9%). Clinically significant prostate cancer was identified in 41 patients (45.6%) through targeted biopsy and in 26 patients (28.9%) through systematic biopsy. Post-biopsy complications were observed in 79 patients (82.3%) including hematuria in 67 patients (69.8%), hemospermia in 48 patients (62.3%), and bloody stools in 4 patients (4.2%). No incidence of post-biopsy fever, emergent hospitalization or death was recorded.
  Conclusions: Transperineal fusion-guided prostate biopsy demonstrates high diagnostic efficacy in the detection of clinically significant prostate cancer while maintaining a favorable safety profile. This technique should be considered the preferred method due to its increased diagnostic accuracy and low complication rates. Further large-scale studies are warranted to validate these findings and refine diagnostic strategies for prostate cancer detection.

UP-22.13—Diagnostic Efficacy of 68ga-PSMA-PET/CT Scan as a Single Staging Modality in Prostate Cancer: Evidence from a Tertiary Healthcare Centre 

• Kumar Sanjay ¹, Seth Amlesh ², Kumar Rakesh ¹, Sharma Sanjay ¹, Kaushal Seema ¹, Aggarwal Vaibhav ¹, Lokesh Lokesh ¹
  ¹ All India Institute of Medical Sciences, Delhi, India, ² All India Institute of Medical Sciences, New Delhi, Delhi, India

• Introduction and Objectives: To explore whether the new 68Ga-PSMA-PET/CT (Gallium-68 prostate-specific membrane antigen positron emission tomography-computed tomography) scan could be used as a single imaging modality over conventional imaging.
  Materials and Methods: This prospective study was conducted in the Department of Urology, AIIMS, New Delhi, included 169 of 285 registered patients after obtaining informed consent. Patients with biopsy-proven intermediate and high-risk prostate adenocarcinoma were enrolled from July 2019 to May 2023. They underwent multiparametric MRI (mpMRI) Technetium 99m-methyl diphosphonate (99mTc-MDP) bone scan, and CT as a conventional staging, followed by 68Ga-PSMA-PET/CT. Furthermore, we evaluated the diagnostic efficacy, sensitivity, and specificity of 68Ga-PSMA-PET/CT with conventional imaging.
  Results: The mean age of patients was 65.5 years, and the median serum PSA was 23.08 ng/mL. Most patients (147) were high-risk, and 22 were intermediate risk. Among them, 90 underwent robotic-assisted radical prostatectomy. PSMAPET/CT showed statistically significant superiority in detecting regional lymph node invasion (37.8% vs. 18.3%), non-regional lymph node invasion (17.2% vs. 5.9%), and bony metastasis (23% vs. 16.5%). It had comparable efficacy to conventional imaging for seminal vesicle involvement and visceral metastasis. PSMA PET/CT upstaged N and M status in 10.6% and 8.8% of patients, respectively. In these 8.8% of upstaged M1 cases, there was a shift in the treatment approach from curative to palliative intent.
  Conclusions: 68Ga-PSMA-PET/CT exhibits superior detection rates over conventional imaging, particularly for regional lymph node, bone, and distant metastases. This modality significantly improves staging accuracy, which is essential for precise and timely treatment planning, thereby playing a critical role in the detection and management of prostate cancer.

UP-22.14—Diagnostic Performance of the Primary Score and Derived Model for 18f-PSMA PET/CT in Clinically Significant Prostate Cancer Using Whole-Mount Sections as Reference 

• Xiong Shuaitao, Liu Ming, Wang Miao
  Beijing Hospital, Beijing, China

• Introduction and Objectives: The 68Ga prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT)-based PRIMARY-score has a good diagnostic performance for clinically significant prostate cancer (csPCa). The aim of this study is to externally validate the diagnosis performance of the PRIMARY-score on 18F-PSMA PET/CT at a lesion level with the whole-mount histopathology as reference and to develop a novel model to reduce false positive rate.
  Materials and Methods: From September 2019 to May 2024, a total of 123 men who underwent preoperative magnetic resonance imaging (MRI), 18F-PSMA PET/CT and radical prostatectomy (RP) were included for analysis. MRI was evaluated according to Pl-RADS v2.1, and 18F-PSMA PET/CT was evaluated according to the PRIMARY-score at both the patient level and lesion level. Univariable logistic and regression ridge regression were used to develop a diagnosis model. The sensitivity, specificity, negative predictive value, and positive predictive value were calculated.
  Results: Among all 123 patients, 261 PCa lesions were found, of which 165 were csPCa. The per-lesion sensitivity was 78.58%, 64.24%, and 83.03% for PRIMARY-score, PI-RADS, and a combination of PRIMARY-score and PI-RADS, respectively. The per-lesion sensitivity was 71.07%, 65.09%, and 81.64% for PRIMARY-score, PI-RADS, and a combination of PRIMARY-score and PI-RADS, respectively. The novel model got as good sensitivity as the PRIMARY-score, but its false positive rate was significantly lower than the PRIMARY-score (38.13% vs. 6.47%, p < 0.001). One insignificant PCa patient with PRIMARY-score 5 was found.
  Conclusions: The PRIMARY-score can be used for the PCa diagnosis with 18F-PSMA PET/CT, with a better diagnostic value over PI-RADS for csPCa, but the SUV threshold for PRIMARY-score 5 needs to be re-selected. The combination use of the PRIMARY score and PI-RADS could help improve NPV and sensitivity for csPCa compared with PI-RADS alone. A PRIMARY-score and SUVmean based model could further reduce FPR of 18F-PSMA PET/CT diagnosis, which might have the potential in reducing unnecessary biopsies and assisting biopsy-free RP.

UP-22.15—Diagnostic Value, Safety, and Patient-Reported Outcomes of Total Free-Hand LATP Biopsy Technique 

• Eleftheriadou Aikaterini ¹, Collins Charlotte ¹, Kannapiran Dilaaniy ¹, Antara Faria ¹, Janardanan Sarosh ¹, Mikail Michael ¹, Arumainayagam Nimalan ², Bunce Katarina ¹, Prescott Holly ¹, Varghese Shymol ¹, Darlington Carbin Danny ¹, Elhammadi Moustafa ¹
  ¹ Ashford and St Peter’s Hospital, Chetsey, United Kingdom, ² Ashford and St Peter’s Hospitals, Chertsey, United Kingdom

• Introduction and Objectives: Prostate biopsy is the key diagnostic modality for detecting prostate cancer, with the USS-guided transperineal approach being preferred, performed under local (LATP) or general anaesthesia. During LATP, transperineal access systems can be used to stabilise the biopsy needle with the ultrasound probe. However, these devices are expensive, non-reusable, and may restrict clinicians, who often prefer the total free-hand approach (tF-LATP) for better access to prostatic zones. We aim to assess the pain tolerability, diagnostic value and safety of tF-LATP technique.
  Materials and Methods: Patients undergoing tF-LATP for suspected prostate cancer from June 2022 to July 2024 were included, following informed consent. A single consultant performed all F-LATP procedures across two institutes. Data on PSA levels, prostate size, previous prostate mpMRI findings, cancer detection, need for further biopsy, tolerability and complications were collected using a standardised data sheet. Pain levels were assessed using Visual Analog Scale (VAS) scores at rectal probe insertion and immediately post-biopsy.
  Results: 75 patients underwent tF-LATP, with a median age of 67 years (IQR 11 years). Prostate size data were available for 66 patients, averaging 56.05 cc (SD 26.8). PSA levels were recorded for all 75 patients with a mean of 22.72 ng/mL (SD 78.33, Range 1.7–594 ng/mL). During the procedure, the VAS ranged from 1 to 4, with a mode of 2. Post-procedure VAS scores ranged from 1 to 2, with a mode of 1. There were no instances of urinary retention, sepsis or haematuria requiring admission, and no patients required re-biopsy for under-sampling or conversion to guided biopsies. The number of cores taken per patient had a median of 23 (range 11–42, IQR 10). Cancer stage based on MRI was recorded for 67 patients as follows: T2a (n = 18), T2b (n = 8), T2c (n = 34), T3a (n = 3), T3b (n = 4). Thirty-one (41.3%) patients had a negative biopsy, while 44 tested positive (58.7%) for prostate cancer.
  Conclusions: The tF-LATP technique demonstrates excellent safety, diagnostic efficacy, and satisfactory tolerability. With its cost-effectiveness and enhanced accessibility to all prostatic lobes, clinicians are encouraged to integrate this technique more widely into clinical practice to maximise its advantages.

UP-22.16—Does Size of Pi-Rads 3 Lesions Play a Role in Prostate Cancer Detection in Transperineal Prostate Biopsies? 

• Kyriakides Andreas ¹, Nikolaou Nikos ¹, Theodorou Tasos ¹, Milad Ziad ¹, Karaolides Theocharis ¹, Samarinas Michael ², Gravas Stavros ³
  ¹ General Hospital of Nicosia, Nicosia, Cyprus, ² General Hospital of Larissa, Larissa, Greece, ³ Medical School, University of Cyprus, Nicosia, Cyprus

• Introduction and Objectives: PI-RADS 3 lesions have an uncertain risk of Prostate Cancer (PCa), and there is a lack of evidence regarding the optimal biopsy strategy for PI-RADS 3 lesions. The aim of the study was to investigate the impact of lesion size in terms of maximum diameter and (for the first time) volume and how it can be used to avoid unnecessary biopsies.
  Materials and Methods: Between November 2022 and January 2025, 54 patients with a total of 73 PI-RADS 3 lesions on multiparametric prostate Magnetic Resonance Imaging (mpMRI) underwent fusion transperineal prostate biopsies (both targeted and systematic). Only patients without previous fusion prostate biopsies were included in the study. Results of mpMRI were reported according to the PI-RADS v.2.1 score by dedicated radiologists, and the maximum diameter and the volume of the lesion were recorded alongside the histological result obtained from targeted biopsies of the lesion. The optimal cut-points balancing sensitivity and specificity were identified on the Receiver Operating Characteristic Area Under the Curve (ROC-AUC) using the “best threshold” from the ROC package.
  Results: Mean patient age was 67.9 years (range 51 to 80) and mean PSA was 7.6 ng/mL (range 3.3 to 21.5). In total, biopsies from 24 lesions detected PCa (32.8%). Lesions with a diameter ≥ 1.75 cm had a significantly different PCa detection rate compared to smaller lesion. Similarly, volumes ≥ 0.7 mL showed a trend toward a higher detection rate. Despite the low ROC-AUC, these cut-off values may still have clinical relevance in stratifying biopsy decisions.
  Conclusions: Lesion size may still assist in decision-making for PI-RADS 3 lesions, despite the limited diagnostic accuracy as reflected in the ROC-AUC. Our findings suggest that certain size thresholds may help in identifying patients less likely to benefit from biopsy. Larger prospective studies are needed to validate these findings and refine thresholds.

UP-22.17—Evaluating the Impact of PSA Density on Clinically Significant Prostate Cancer Detection in PIRADS-3 Lesions—A Single-Centre Study 

• Safdar Haadia, Sheriff Matin, Burki Javed, Ghumman Faisal, Bhat Tahir
  Medway NHS Foundation Trust, Gillingham, United Kingdom

• Introduction and Objectives: Prostate Cancer is one of the most prevalent malignancies among men. The Prostate Imaging Reporting and Data System (PIRADS) is used for characterization of prostate lesions on multiparametric MRI, categorizing findings from PIRADS 1 to 5. PIRADS 3 lesions represent an intermediate or equivocal risk of clinically significant prostate cancer, often posing a diagnostic challenge. This study aims to evaluate the impact of Prostate-Specific Antigen (PSA) density on the detection of clinically significant prostate cancer specifically in men with PIRADS-3 lesions, with the goal of improving risk stratification and decision-making in this indeterminate group.
  Materials and Methods: A retrospective cohort study was performed on patients referred to our cancer centre between January 2024 and June 2024. A total of 194 patients with PIRADS-3 lesions were included in the analysis. Clinical data, including PSA levels, prostate volume, and biopsy outcomes, were systematically reviewed.
  Results: Among the 194 patients, the median PSA was 5.86 ng/mL (range 0.33–34.19), with a median prostate volume of 62 cc (range 4–401). The cohort’s median PSA density (PSAD) was 0.12 (range 0.01–1.14). Biopsies were performed on 101 patients, revealing malignancy in 45 patients (44.6%). Among them, 23 patients (51.1%) had clinically significant prostate cancer (csPCa, Gleason score ≥ 7). Notably, lower prostate volume and higher PSAD were significantly associated with the presence of csPCa. In patients with PSAD < 0.15, 10% harbored csPCa, whereas, in the cohort with PSAD ≥ 0.15, 32% were diagnosed with cancer, with 20% diagnosed with csPCa. Multivariable analysis confirmed that PSAD > 0.15 was independently associated with a higher likelihood of harboring clinically significant prostate cancer.
  Conclusions: Elevated PSA density is a significant predictor of clinically relevant prostate cancer in patients with PIRADS-3 lesions. This study underscores the importance of integrating PSAD into clinical decision-making for prostate cancer screening and management.

UP-22.18—Evaluation of Predictive Factors for Positivity in MRI/Ultrasound Fusion-Guided Prostate Biopsy 

• Morales Pinto Stalin Fabricio ¹, García Góngora Beatriz ², Santos Pérez De La Blanca Rocío ², Herrera Imbroda Bernardo ²
  ¹ University Hospital Virgen de la Victoria Málaga-España, Málaga, Spain, ² Virgen de la Victoria University Hospital, Málaga, Spain

• Introduction and Objectives: In Spain, 33,769 new cases of prostate cancer were diagnosed in 2023. MRI/ultrasound fusion-guided prostate biopsy is strongly recommended by clinical guidelines for patients with suspected prostate cancer, regardless of prior biopsy history. However, its use remains limited in clinical practice. The aim of this study is to identify factors associated with a positive pathological result in fusion-guided prostate biopsy.
  Materials and Methods: A retrospective study was conducted on 756 patients who underwent fusion-guided prostate biopsy between September 2020 and September 2024 at Hospital Universitario Virgen de la Victoria. Statistical analysis was performed using univariate and multivariate Cox regression analysis.
  Results: The median age was 66.18 years (SD ± 6.90), and the median PSA level was 8.52 ng/mL (SD ± 6.02). A prior prostate biopsy had been performed in 78.2% (591 patients). The mean prostate volume was 59.74 cc (SD ± 32.20). Univariate analysis identified the following factors significantly associated with a positive biopsy result: Age > 65 years (66.7% vs. 33.3%, p < 0.0001, chi²). PSA density > 0.15 ng/mL/cc (55.8% vs. 44.2%, p < 0.0001, chi²). Palpable tumor on digital rectal examination (79.5% vs. 51.3%, p < 0.0001, chi²). Peripheral lesion location on mpMRI (62.7% vs. 37.3%, p < 0.0001, chi²). PIRADS ≥ 4 lesions (87.9% vs. 13.0%, p < 0.0001, chi²). Multivariate analysis confirmed the following as independent predictors of a positive biopsy result: Age > 65 years (HR 1.03; 95% CI: 1.02–1.05, p < 0.001). PSA density > 0.15 ng/mL/cc (HR 2.23; 95% CI: 1.35–3.68, p = 0.001). Peripheral lesion location on mpMRI (HR 1.72; 95% CI: 1.39–2.13, p < 0.001). PIRADS ≥ 4 lesions (HR 1.56; 95% CI: 1.15–2.11, p < 0.0001).
  Conclusions: Age over 65, PSA density greater than 0.15 ng/mL/cc, peripheral lesion location, and PIRADS 4–5 findings on multiparametric MRI are predictive factors for a positive pathological outcome in MRI/ultrasound fusion-guided prostate biopsy.

UP-22.19—Evaluation of the Knowledge of Patients Followed in the Urology Department Regarding Prostate Cancer Screening 

• BOURGOU Ibrahim, HERMI Amine, SAADI Ahmed, SAIDANI Bilel, MOKADEM Seif, AYED Haroun, CHAKROUN Marouene, BEN SLAMA Mohamed Riadh
  University of Tunis El Manar, Faculty of Medicine of Tunis., Tunis, Tunisia

• Introduction and Objectives: Prostate cancer (PCa) screening, although still debated regarding its benefit–risk ratio, is increasingly publicized and encouraged through various means at different levels. But can we talk about a true awareness of this concept among Tunisian patients?
  Materials and Methods: Our study aimed to assess the knowledge of patients followed in the urology department regarding prostate cancer screening and the pathology itself. This study was conducted between January 2024 and March 2024. A questionnaire on patients’ socio-educational status, their knowledge of PCa, the methods of PCa screening, and its benefits for the patient was completed by 50 male patients aged over 50, followed in our department.
  Results: The average age of participants in this study was 62.1 years. One in five patients had a university-level education. A personal history of prostate cancer was found in 8% of the cases. Our study showed that 78% of participants had heard of prostate cancer screening, mostly through the media (television, radio) at 32%, followed by social media at 24%. Only 16% of the participants identified the combination of rectal examination and PSA testing as methods for screening PCa. One in five participants (20%) reported having been screened for PCa by a rectal examination with PSA testing at least once in the past five years. Only 6% of participants reported having received any informational support about PCa screening. A statistically significant correlation was found between knowledge of PCa and its screening and the patient’s origin (rural, urban), educational level, and personal history of PCa (p = 0.004, 0.001, and 0.0001, respectively).
  Conclusions: Prostate cancer screening still appears to be a concept with limited presence in the public health awareness of the Tunisian population. The role of the medical community requires better involvement at various levels of the country’s health structure.

UP-22.20—Follow up of Atypical Small Acinar Proliferation (ASAP) on MRI-Fusion Targeted and Saturation Biopsies of Prostate in the MRI-Era 

• Zeng Ding ¹, Lai Kah Wai ¹, Wang Kaiying ¹, Tham Sin Mun ², Chua Wynne ¹, Wang Ziting ¹, Ang Bertrand ¹, Chiong Edmund ¹, Tsang Woon Chau ¹, Voon Marcus Min Shen ¹
  ¹ National University Hospital, Singapore, Singapore, Singapore, ² Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

• Introduction and Objectives: ASAP occurs in 5% of prostate biopsies. Current recommendation is for a repeat biopsy within 3–6 months of initial diagnosis as 30–40% may develop prostate cancer (CaP) within a 5-year period. The natural history of these patients diagnosed following targeted and saturation biopsies (TPBx), in the MRI-era, remains unclear. Our aim is to follow-up these patients and determine their risk of CaP.
  Materials and Methods: From 2015 to 2024, we collected prospective single-centre data of consecutive patients who underwent TPBx. 1,155 cases of TPBx were performed for PI-RADS ≥ 3 lesions. 47 patients (of total 49 cases of TPBx) yielded histology of ASAP. 5 were excluded as their follow-up was <6 months. 34 patients were followed up with PSA testing 6–12 months, and a repeat MRI scan was performed if PSA was rising. Repeat TPBx was recommended if there was a similar or new lesion on repeat imaging.
  Results: Overall TPBx cancer detection rate was 60.0%, and CS rate (group grade ≥ 2) was 42.6%. In the ASAP cohort, 6.1% (3/49) patients had no target lesions, 44.8% (22/49) PI-RADS 3, 46.9% (23/49) PI-RADS 4 and 2.0% (1/49) PI-RADS 5 lesions. 16.3% (8/49) ASAP was found in initial targeted cores only and 81.6% (40/49) in saturation cores only. 2% (1/49) ASAP was found in both targeted and saturation cores. 34 patients were followed up for a median 24.5 months (IQR 13–38.5), and 8 were lost to follow up. Median age 67 yrs (IQR 62–69.5), PSA 7.33 mg/mL (IQR 5.06–11.24) and PSA density 0.15 ng/mL² (IQR 0.11–0.20). 21/34 had stable PSA. 13/34 repeated MRI scan for rising PSA, of which 46.1% (6/13) PIRADS scoring remained unchanged, 53.8% (7/13) downgraded and 0% (0/13) upgraded. In the repeated MRI group, 9/13 continued with PSA surveillance, and 4/13 had a repeated TPBx. Out of all 5 patients with repeat biopsies, 20% (1/5) and was detected to have CS cancer. This was on the original lesion, and there was no new de novo cancer. 2 patients had ASAP again on saturation core only.
  Conclusions: Cancer detection was 2.9% (1/34) during ASAP follow-up. Patients with ASAP on index biopsy will not need a repeat biopsy within 1 year. We recommend follow-up with PSA surveillance and a repeat MRI if PSA is rising and a repeat biopsy for suspicious lesions.

UP-22.21—High Serum PSA and Prostate Biopsy: An Audit of Diagnostic Accuracy and Clinico-Pathological Correlation 

• Choudhary Gautam, Rathor Jitendra, Navriya Shivcharan, Sandhu Arjun, Singh Mahendra, Rao Meenakshi, G Anju, Yadav Taruna
  AIIMS Jodhpur, Jodhpur, India

• Introduction and Objectives: Managing prostate cancer (PCa) involves understanding diagnostic and therapeutic strategies. High serum PSA (>4 ng/mL), abnormal DRE, and high PIRADs MRI scores trigger prostate biopsy. This retrospective study analysed the relationship between pre-biopsy PSA levels and histopathological outcomes in patients undergoing prostate biopsy and robot-assisted radical prostatectomy (RARP) at a tertiary care centre.
  Materials and Methods: This study reviewed data from patients who underwent TRUS-guided prostate biopsy and RARP from January 2020 to May 2024 excluding metastatic PCa. Demographic details, clinical presentations, radiological findings, biochemical parameters, and biopsy reports were analysed using SPSS.
  Results: Out of 347 patients, 94.8% presented with lower urinary tract symptoms, and 61% had suspicious DRE findings. However, 12.3% (26 of 211) with abnormal DRE findings had benign histopathology, highlighting the limitations of DRE as a standalone diagnostic tool. PIRADS score in mpMRI did not match with the prostate biopsy findings. The mean PSA in patients with benign histopathology was 11.45 ng/mL, dropping to 6.7 ng/mL after 6–12 weeks of follow-up. Benign prostatic hyperplasia (BPH) and different types of prostatitis were common histopathological findings. In patients with localized PCa (mean PSA: 16.48 ng/mL), 92 underwent RARP, with 45.2% experiencing an upgrade in final biopsy results, and 2 patients had BPH. Post-RARP, 72 patients had a PSA < 0.09 ng/mL at 6 weeks, and 84 were pad-free at 3 months.
  Conclusions: Elevated PSA often leads to biopsy, but benign conditions can also raise PSA levels in our region. A comprehensive approach combining clinical, radiological, and patient-specific factors is essential for improving diagnostic accuracy and reducing unnecessary biopsies. The RARP outcomes were comparable to or better than similar-risk group patients, probably due to modifications in electrocautery uses. Final biopsy upgrades emphasize the importance of definitive surgical pathology for accurate risk stratification. These insights can enhance the ability to predict clinically significant PCa, leading to better clinical decisions and improved patient outcomes.

UP-22.22—Impact of Repeated Prostate-Specific Antigen Testing on Management Patterns and Personal Healthcare Spending for Prostate Cancer: A Population-Based Study of 166,848 National Health Insurance Claims in South Korea from 2010 to 2020 

• Ko Young Hwii ¹, Park Hong Seok ², Cho Hyun Yee ²
  ¹ Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea, ² Korea University Hospital, Seoul, Republic of Korea

• Introduction and Objectives: To estimate the impact of prostate-specific antigen (PSA) testing strategies on prostate cancer (PCa) treatment in terms of treatment patterns and healthcare costs.
  Materials and Methods: Using 10 years of health insurance data on newly registered cases of PCa from 2010, we compared (1) the macroscopic treatment choice between localized and systemic diseases and (2) the average of individual medical expenses between localized and systemic treatments between the PSA-screened (defined as at least three PSA tests during a minimum of two years before registration) and PSA non-screened groups (when the first PSA test was performed within three months before registration).
  Results: Of the 166,848 men diagnosed with PCa during the study period, 26.7% met the criteria for the PSA screened, and 42.2% were classified in the non-screened counterparts (the remaining 25.5% were classified as PSA-undetermined). Localized treatments including surgery (45.6% vs. 33.8%, p < 0.001) and radiotherapy (17.04% vs. 14.88%, p < 0.001) were performed more frequently in the PSA-screened population, with marginal trend in focal therapy (0.82 vs. 0.29%, p = 0.034). Conversely, systemic treatments including hormone therapy (42.32% vs. 59.66%, p < 0.001), chemotherapy (0.99% vs. 2.73%, p = 0.05), and androgen receptor-targeted agents (0.5% vs. 1.37%, p = 0.002) were more common in the non-screened population. While the cost for localized modalities including non-robotic surgery or radiation therapy that were performed between 2016 and 2020, when government-determined medical prices rose to a level similar to the present, were similar between groups, the expense for hormone therapy and androgen receptor-targeted agents was significantly higher in the PSA non-screened group associated with its prolonged usage.
  Conclusions: According to nationwide health insurance data from modern PCa management, PSA screening strategies can increase local treatment and reduce individual medical spending on long-term systemic treatment without increasing the cost of localized treatment modalities after medical prices materialize.

UP-22.23—Implementation and Outcomes of a Nurse-Led Urology Diagnostic Hub 

• Hyett Victoria, Lieberman Christopher, Tan Lieo Juin, Reid Sarah, Fede Spicchiale Claudia
  University Hospital Monklands, Airdrie, United Kingdom

• Introduction and Objectives: Prostate cancer represents the single most common malignancy in the male population, accounting for 28% of all new cancer diagnoses within the UK. Its timely diagnosis and management remain critical challenges within NHS Scotland. To ensure adherence to national targets, a ‘Diagnostic Hub’ was established within NHS Lanarkshire, prioritising standardised diagnostic pathways and nurse-led triage to improve wait times and patient experience. The Diagnostic Hub features a protocolised triage system incorporating prostate cancer risk calculators and frailty assessments while integrating the pillars of realistic medicine. Radiology requests are initiated via e-IRMER trained staff with dedicated appointments. Regular multidisciplinary review and monthly service audits ensure dynamic optimisation. This project evaluates the implementation and effectiveness of this nurse-led model.
  Materials and Methods: Following introduction of the Hub, the number of patients receiving a prostate cancer diagnosis via a suspicion of cancer pathway and starting treatment within 62 days was reviewed over an 8 month period between January and August 2024. This was compared to historical local and contemporaneous national cancer wait time performance.
  Results: During the audit duration, prostate cancer 62-day pathway performance rose from 52% to 90.5% in comparison to a monthly average of 60% in 2023. Monthly performance in 2024 surpassed 2023 consistently from February onwards. Between April 2023 and September 2024, patients breaching the 62-day target fell from 17 to fewer than 2, and those waiting over 100 days decreased from 15 to 0 by May 2024. Sustained reductions were driven by targeted interventions across University Hospitals Monklands, Hairmyres, and Wishaw. In August 2024, NHS Lanarkshire was ranked the highest-performing mainland Scottish health board for prostate cancer diagnostics. This marked the sixth consecutive month of improvement.
  Conclusions: The introduction of a nurse-led Urology Diagnostic Hub has led to significant and sustained improvements in cancer wait time performance. Through efficient triage, protected radiology, and multidisciplinary collaboration, NHS Lanarkshire has become national leaders in prostate cancer diagnostics. This model demonstrates a scalable and effective strategy for reducing delays and improving patient care across urological cancer services.

UP-22.24—Implementing a Nurse-Led Urology Diagnostic Hub: A Scalable Model to Improve Prostate Cancer Pathways 

• Leiberman Christopher, Tan Lieo Jiun, Lee Xiang Wei, Ramsay Alison, Reid Sarah
  University Hospital Monklands, Airdrie, United Kingdom

• Introduction and Objectives: Timely diagnosis and treatment of urological cancers remain a global healthcare priority. In the UK, increasing pressure on diagnostic services challenges compliance with national cancer waiting time targets. In response, NHS Lanarkshire established a nurse-led Urology Diagnostic Hub, integrating innovative triage strategies and dedicated diagnostic access. This abstract evaluates the model’s impact on prostate cancer pathway performance and explores its potential as a replicable framework for other health systems.
  Materials and Methods: A nurse-led triage system—Active Clinical Referral Triage (ACRT)—was implemented, incorporating prostate cancer risk calculators, frailty assessments, and shared decision-making via the realistic medicine framework. Radiology access was streamlined through e-IRMER-trained staff, with ringfenced MRI and bone scan slots. A multidisciplinary performance-focused approach included weekly patient tracking list (PTL) meetings and monthly audits to monitor and refine the pathway.
  Results: Between January and August 2024, compliance with the 62-day prostate cancer target rose from 52% to 90.5%, in contrast to a decline during the same period in 2023 (from 55.6% to 48%). The Hub maintained superior monthly performance from February onward, peaking with a +42.5% improvement in August. Patients waiting > 62 days without diagnosis fell from 17 to fewer than 2, and long waits (>100 days) were eliminated by May 2024. Sustained pathway improvement was observed across all three regional hospitals. In August 2024, NHS Lanarkshire achieved 88.5% compliance, exceeding the national average by 47% (41.3%), ranking it the top-performing mainland health board in Scotland for the sixth consecutive month.
  Conclusions: The nurse-led Urology Diagnostic Hub represents a successful and scalable intervention for improving prostate cancer pathways. By combining nurse-led triage, protected diagnostics, and continuous multidisciplinary oversight, NHS Lanarkshire achieved dramatic and sustained improvements in cancer waiting times. This model supports wider adoption across diverse healthcare systems aiming to enhance access, equity, and efficiency in urological cancer care.

UP-22.25—Initial Clinical Experience with Cognitive Fusion-Guided Transperineal Prostate Biopsy Using a Hand-Free Technique 

• Saavedra Centeno Manuel, Cogorno Wasylkowski Leopoldo, Pelari Mici Lira, Sánchez Ramírez Ana, Velasco Balanza Clara, Celada Luis Guillermo, Casado Varela Javier, López-Fando Lavalle Luis, Albers Acosta Eduardo, Quicios Dorado Cristina, Bocardo Fajardo Gloria, Costal Martin, San José Manso Luis Alberto
  La Princesa University Hospital, Madrid, Spain

• Introduction and Objectives: Cognitive fusion transperineal prostate biopsy is a reliable and more cost-effective diagnostic method compared to real-time fusion biopsy. This study analyzes our initial experience with cognitive fusion-guided transperineal biopsies in a tertiary care setting.
  Materials and Methods: A retrospective analysis was conducted on transperineal prostate biopsies performed using the BD transperineal access system and the hand-free technique. The first 27 cases were reviewed, excluding those without visible lesions on multiparametric MRI (mpMRI). Clinical and analytical variables such as age, total PSA, PSA density, and prostate volume were assessed. The rate of positive index lesions was evaluated.
  Results: Eighteen patients with suspicious mpMRI findings were included. The mean patient characteristics were: age 69 years, total PSA 9.7 ng/mL, PSA density 0.23, and prostate volume 60 cc. Digital rectal examination (DRE) was suspicious in three cases. MRI findings revealed 3 PI-RADS 3 lesions, 6 PI-RADS 4, and 9 PI-RADS 5. Prostate cancer was diagnosed in 66% of patients (12/18). Histopathological results were: ISUP Grade Group 1 in 4 patients, Grade Group 2 in 3, Grade Group 3 in 3, Grade Group 4 in 1, and Grade Group 5 in 1. The median number of biopsy cores obtained was 16 (range 8–20), with an average of 2.7 cores targeting the index lesion. Four patients (33%) had negative biopsies in the index lesion but positive findings in systematic (random) sampling. These positive cores did not correspond to the index lesion identified on MRI. Overall, 92% (28/32) of index lesion-targeted cores were positive in patients with confirmed cancer. Five patients (18%) experienced complications: two vasovagal syncope episodes, two cases of hematuria, and one case of acute urinary retention. No infectious complications were reported.
  Conclusions: Despite a limited sample size, our detection rate aligns with current literature. Cognitive fusion transperineal biopsy is feasible in general hospital settings but demands accurate mpMRI interpretation and proficiency in transrectal ultrasound, underscoring the importance of proper training and a defined learning curve. In our series, systematic sampling remains necessary. A higher procedural volume is needed to better assess its diagnostic accuracy.

UP-22.26—Integration of the Cally Index in the Diagnosis of Clinically Significant Prostate Cancer in Pi-Rads V2 Category 3 Patients: A Pre-Biopsy Perspective 

• Horsanali Mustafa, Yalcin Mehmet, Sandal Kerim
  Izmir Bakırçay University, İzmir, Türkiye

• Introduction and Objectives: This study aims to assess the effectiveness of the CALLY index, which includes C-reactive protein (CRP), albumin, and lymphocyte counts, in predicting clinically significant prostate cancer before the transrectal biopsy procedure in patients with PI-RADS v2 category 3 lesion in multiparametric prostate magnetic resonance imaging.
  Materials and Methods: We retrospectively analysed 76 patients who underwent multiparametric prostate magnetic resonance imaging and prostate biopsy for elevated PSA and PI-RADS v2 category 3 lesions. Data included demographics, pathology findings, and CALLY index values. The CALLY index was calculated using the formula: [(Lymphocyte (cells/μL) × Albumin (g/dL))/(CRP (mg/dL) × 10⁴)]. Statistical analyses, including ROC curve evaluation, determined the CALLY index threshold for significant cancer prediction.
  Results: The mean CALLY index was calculated as 4.20 ± 0.56. 29 (38.2%) patients diagnosed with prostate adenocarcinoma after biopsy. Significant negative correlations were identified between the CALLY index and prostate volume (R: −0.292, p = 0.010), PSA density (R: −0.420, p < 0.001), histopathological diagnosis of prostate cancer (R: −0.546, p < 0.001), and International Society of Urological Pathology (ISUP) grade (R: −0.568, p < 0.001). Patients diagnosed with prostate cancer had a significantly lower mean CALLY index before the biopsy compared to those with benign conditions (p < 0.001). ROC analysis identified a threshold value of 1.45 with a sensitivity of 82.8% and a specificity of 80.9% for the CALLY index. When age, BMI, smoking status and comorbidities were set as covariates in multivariate analyses, we observed that these variables did not significantly affect the CALLY index. Multivariate analyses confirmed the independence of the CALLY index as a predictive marker to detect clinically significant prostate cancer before the biopsy procedure.
  Conclusions: The CALLY index shows promise as an easily applicable and non-invasive biomarker that can significantly predict patient outcomes in detecting clinically significant prostate cancer in patients at risk for prostate cancer. By incorporating this biomarker into other currently accepted clinical practices, unnecessary prostate biopsies may be avoided.

UP-22.27—Local Anesthetic MRI-Cognitive Transperineal Prostate Biopsy: A Prospective Evaluation from a Single Institution 

• Canbolat Muhammed, Dağlı İsa, Çayırlı Abdullah, Öztürk Erdem
  University of Health Sciences, Dr.Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Türkiye

• Introduction and Objectives: This study aimed to evaluate the outcomes of MRI-cognitive transperineal prostate biopsy (TP-Bx) performed under local anesthesia in our institution.
  Materials and Methods: A total of 101 patients with PIRADS ≥3 lesions who were eligible for biopsy were prospectively evaluated. All patients underwent MRI-cognitive transperineal prostate biopsy under local anesthesia, concurrently with systematic biopsy. For each suspicious lesion targeted via cognitive guidance, 3 to 4 core samples were obtained. MRI-cognitive and systematic biopsy results were evaluated separately. All specimens were histopathologically analyzed and graded according to the ISUP classification.
  Results: The mean patient age was 65.9 years, mean PSA level was 11.5 ng/mL, PSA density was 0.22 ng/mL², and mean BMI was 26.8 kg/m². MRI findings reported PIRADS 3 lesions in 39% of cases, PIRADS 4 in 45%, and PIRADS 5 in 16%. When both MRI-cognitive TP-Bx and systematic biopsy results were considered together, prostate adenocarcinoma was detected in 57 patients (56%), and clinically significant prostate cancer (ISUP ≥ 2) was observed in 39 patients (39%). When only MRI-cognitive TP-Bx results were considered, prostate adenocarcinoma was diagnosed in 41 patients (40%), with clinically significant cancer found in 35 patients (35%). When only systematic biopsy results were analyzed, 55 patients (54%) were diagnosed with prostate adenocarcinoma, and 34 of them (34%) had clinically significant prostate cancer.
  Conclusions: MRI-cognitive TP-Bx performed under local anesthesia is an effective diagnostic method with high targeting accuracy and favorable detection rates for clinically significant cancers. Due to its anatomically accessible approach, MRI-cognitive TP-Bx provides a successful and promising alternative for the diagnosis of clinically significant prostate cancer.

UP-22.28—Local Anesthetic Transperineal Prostate Biopsy: Does It Affect Uroflowmetry Results? 

• Dağlı İsa, Uzel Tuncel, Çayırlı Abdullah, Duvarcı Mehmet, Öztürk Erdem, Canbolat Muhammed
  University of Health Sciences, Dr.Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Türkiye

• Introduction and Objectives: Transperineal prostate biopsy (TP-Bx) is increasingly preferred due to its lower infection risk and improved clinically significant prostate cancer detection rates. The European Association of Urology (EAU) recommends TP-Bx as a first-line diagnostic tool when feasible. Its feasibility under local anesthesia provides both clinical and economic advantages. However, acute urinary retention (AUR) remains a significant post-procedure concern.
  Materials and Methods: A prospective observational study was conducted with 74 patients. TP-Bx was performed under local anesthesia using a freehand technique. Uroflowmetry parameters, including maximum urinary flow rate (Qmax, mL/s), average urinary flow rate (Qave, mL/s), voided volume (Vv, mL) and post-void residual volume (PVR), were assessed before and after the procedure to evaluate its impact on voiding function.
  Results: The average changes in Qmax and Qave between pre and post procedure were 1.78 ± 4.33 and 0.63 ± 1.70, respectively. A significant reduction in Qmax and Qave was observed after TP-Bx (p < 0.001). PVR increased after TP-Bx (p < 0.001); however, these changes were mild and did not require catheterization.
  Conclusions: With increasing experience, TP-Bx has become safer. The use of local anesthesia reduces anesthesia-related complications, and the historically feared risk of AUR appears lower than previously assumed. These findings support TP-Bx as a safe and effective diagnostic approach.

UP-22.29—Mismatch-Related Diagnostic Accuracy and Peri-Procedural Complication Rates of MRI-Fusion Targeted Index Lesions’ Biopsy in Prostate Cancer Diagnostic—A Bi-Center, Prospective Clinical Comparison 

• Popescu Razvan, Predoiu Gabriel, Petca Razvan, Petrisor Geavlete, Multescu Razvan, Mares Cristian, Georgescu Dragos, Geavlete Bogdan
  ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

• Introduction and Objectives: Magnetic resonance imaging (MRI) advances in identifying prostate index lesions consistently improved prostate cancer detection by facilitating the use of fusion-targeted biopsies. However, the recommended number of biopsy cores from index lesions remains controversial. A comparative analysis of biopsy mismatch rate and safety profile characterizing single versus 3 cores biopsy per fusion-identified lesion was performed.
  Materials and Methods: 84 cases were included in a bi-center, prospective clinical trial and consecutively divided in equal numbers in the two study arms undergoing single and respectively 3 cores’ fusion biopsy. The inclusion criteria consisted of PSA level ≥ 4 ng/mL and PI-RADS grade 3–5 prostate multiparametric contrast MRI-detected lesions. Patients in Group A underwent index lesions’ fusion-guided 3 cores’ biopsy followed by 12 cores’ systematic prostate biopsy. In Group B, a single core fusion-targeted biopsy was applied, with a subsequently similar systematic biopsy protocol.
  Results: No statistically significant differences were determined concerning the mean age (63.81 versus 64.12 years, p = 0.23), PSA level (7.66 versus 7.49, p = 0.29) and number of PI-RADS grade 3–5 lesions (2.83 versus 2.87, p = 0.38). The mean number of fusion-guided index lesion’ core biopsies (8.65 versus 2.82, p = 0.021) as well as the overall (fusion and systematic) mean number of biopsies (20.65 versus 14.87, p = 0.038) were significantly higher in Group A. The peri-procedural complications’ rate (prolonged fever, acute urinary retention, hematuria, hemospermia, rectal bleeding and sepsis) was significantly reduced in Group B (24.39% versus 44.18%, p = 0.027). The rate of fusion biopsy mismatch cores was significantly decreased in Group A (3.22% versus 7.75%, p = 0.033), due to the reduced sensitivity concerning PI-RADS grade 3 targeted lesions (2.41% versus 6.89%, p = 0.026). No statistically significant difference was established with regard to PI-RADS 4 targeted index lesions (0.80% versus 0.86%, p = 0.18), and no mismatch biopsies were described for PI-RADS 5 lesions.
  Conclusions: The single-core fusion-guided biopsy followed by systematic prostate biopsy significantly reduced peri-procedural morbidity when compared to the 3 cores’ alternative. Similar diagnostic accuracy was determined for PI-RADS 4 and 5 index lesions, while sensitivity was reduced in a limited but yet statistically significant proportion of PI-RADS 3 lesions, emphasizing biopsy mismatch.

UP-22.30—Negative Multiparametric MRI and Clinically Significant Prostate Cancer: Histopathological and Prognostic Implications 

• Montuenga Fernández Isabel, Vázquez Valdés Sonia, Peral Parra Diego, Sánchez Novo Olga, García-Loarte Gómez Eduardo, Teigell Tobar Julio, Morales Palacios Nelson, Ortiz Vico Francisco Javier, Tamayo Ruiz Juan Carlos
  Hospital Universitario Príncipe de Asturias, Alcalá De Henares, Madrid, Spain

• Introduction and Objectives: Multiparametric magnetic resonance imaging (mpMRI) has enhanced the detection of clinically significant prostate cancer (csPCa), influencing therapeutic decisions and histopathological outcomes following radical prostatectomy. However, cases of csPCa still occur in patients with negative mpMRI, raising questions about their prognosis and histological characteristics. This study aims to analyze histopathological findings following radical prostatectomy and their relationship with preoperative mpMRI results.
  Materials and Methods: A retrospective analysis was conducted on 300 patients who underwent mpMRI between 2019 and 2022. Prostate biopsies were performed in patients with PI-RADS 4 or 5 lesions using saturation technique, while, in those with PI-RADS 3, the indication for biopsy was assessed based on comorbidities. Additionally, biopsies were performed in patients with negative mpMRI but high clinical suspicion (abnormal digital rectal examination, PSA kinetics, or family history). Clinically significant prostate cancer was defined as ISUP grade ≥ 2. Patients diagnosed with csPCa were treated with radiotherapy or radical prostatectomy. The ISUP grade group, pathological stage, and lymph node involvement were evaluated in surgical specimens and compared according to tumor visibility on mpMRI.
  Results: A total of 142 biopsies (47%) were performed, detecting csPCa in 49 cases (27%). Of these, 5 cases (13%) involved lesions not visible on mpMRI, while 44 cases (86%) were mpMRI-detectable. Radical prostatectomy was performed in 25 patients. No statistically significant differences were observed in ISUP grade distribution or lymph node involvement between patients with positive or negative mpMRI (p > 0.05). However, the pathological stage was significantly higher in tumors visible on mpMRI (p = 0.04).
  Conclusions: Patients with csPCa not detected by mpMRI tend to present with lower pathological staging after radical prostatectomy, suggesting a potentially more favorable prognosis. These findings underscore the importance of integrating mpMRI with clinical factors and biomarkers to optimize the selection of candidates for biopsy and surgical treatment.

UP-22.31—Preliminary Results of Transperineal Cognitive Targeted Biopsy (Cog-Tbx) + Systematic Biopsy (Sbx) vs. Transperineal MRI-Ultrasound Cognitive Targeted Biopsy 

• Abdallah Mohamed, Al RAshdi Hilal
  Sultan Qaboos Cancer Care and Research Center, University Medical City, Muscat, Oman

• Introduction and Objectives: The role of systematic biopsy (SBx) in addition to transperineal MRI-ultrasound cognitive targeted biopsy (Cog-TBx) remains debated. This study aims to determine whether omitting SBx in favor of Cog-TBx alone reduces the detection of clinically insignificant prostate cancer while maintaining the detection rates of clinically significant cases.
  Materials and Methods: This prospective study was approved by the Institutional Review Board and Ethics Committee (Project ID: CCCRC-89-2024). A total of 30 patients with elevated PSA levels (≥3 ng/mL) and MRI-detected lesions (PIRADS ≥ 3) underwent transperineal biopsy. Group 1 (n = 15): Patients underwent both Cog-TBx and SBx. Group 2 (n = 15): Patients underwent Cog-TBx alone. The primary endpoint was the detection rate of clinically insignificant prostate cancer (Gleason 3+3). Secondary endpoints included the detection rate of clinically significant prostate cancer (ISUP grade ≥ 3), tumor burden parameters (maximum tumor invasion, mean tumor invasion, cumulative tumor length, percentage of invaded cores), and biopsy-related tolerance (complication rates, duration of hematuria/hemospermia, post-biopsy urinary infections, unplanned visits, and hospitalizations). Quality of Life (QoL), urinary and sexual function, and procedural pain were also assessed.
  Results: Clinically significant prostate cancer was detected in 10 patients in Group 1 and 9 patients in Group 2, demonstrating no statistically significant difference between the two groups. Detection rates of clinically insignificant cancer (Gleason 3+3) were 4 patients in Group 1 and 1 patient in Group 2. Although a trend toward reduced detection of clinically insignificant cases was observed in the Cog-TBx-only group, the difference was not statistically significant due to the small sample size. Tolerance, QoL outcomes, and complication rates were comparable between both groups.
  Conclusions: Preliminary findings suggest that transperineal MRI-ultrasound cognitive targeted biopsy alone may be adequate for detecting clinically significant prostate cancer while potentially reducing the detection of clinically insignificant disease. Further studies with larger cohorts are warranted to confirm these findings and refine biopsy strategies to optimize prostate cancer diagnosis.

UP-22.32—Prevalence of Prostate Cancer Among Men Undergoing TRUS Guided Prostatic Biopsies, with Correlation of Serum PSA Levels and Distribution of Gleason Grade Groups: A Single Tertiary Care Centre Experience 

• N Ragavan, Shah Saloni
  Apollo hospitals, Chennai, India

• Introduction and Objectives: Prostate cancer remains a significant global health concern, and serum Prostate-Specific Antigen (PSA) levels are widely used for diagnosis and monitoring, though it lacks specificity. In India, prostate biopsy is usually recommended for serum PSA levels above 4 ng/mL. This study aimed to correlate serum PSA levels, prostate cancer prevalence, and Gleason grade groups, with emphasis on patients with serum PSA levels between 4.1 and 10 ng/mL.
  Materials and Methods: We reviewed all Transrectal ultrasound guided prostate core biopsies received from January 2018 to June 2023. Patients with inadequate tissue, unavailable PSA data and post-treatment biopsies were excluded. Serum PSA levels were categorised and correlated with Gleason grade groups.
  Results: Among 734 patients, 56.3% (n = 413) were malignant, with a median PSA of 25.9 ng/mL, and 43.7% (n = 321) were benign, with a median PSA of 9.9 ng/mL. In the malignant cohort (n = 413), 65.9% had Gleason grade groups 3, 4 and 5, including three patients with neuroendocrine carcinoma. Patients with PSA levels between 4.1 and 10 ng/mL (n = 231), 64% were benign, and 36% were malignant, of which 39.6% belonged to higher histological grades. Among patients with PSA > 4 ng/mL in the benign cohort, 5.6% had granulomatous prostatitis, and 94.4% had subacute to chronic inflammation or hyperplastic changes.
  Conclusions: We highlight the vital role of serum PSA levels in conjunction with biopsy studies to diagnose prostate cancer. A comprehensive approach considering PSA levels alongside Gleason scores, digital rectal exam findings, and advanced imaging is crucial for improving diagnostic accuracy and patient outcomes.

UP-22.33—Quality and Accuracy of MRI Fusion Diagnostic Needle Biopsies Performed Using the Camprobe Device—Double Free-Hand Transperineal Prostate Biopsy 

• Qalawena Muhamed ¹, Carrie Anne ¹, Croitoru Radu ¹, Genchev Tsvetlin ¹, Ormanov Dimitar ¹, Maddan Asyraf ¹, Gutue Stefan ¹, Kostyuk Mykhaylo ¹, Richardson Fiona ¹, Gnanapragasam Vincent J ², Smith Lee ³, Ilie Petre Cristian ¹
  ¹ NNUH based at QEHKL, KingsLynn, United Kingdom, ² Cambridge Urology Translational Research and Clinical Trials Office, Cambridge University Hospitals NHS Foundation Trust, United Kingdom, Cambridge, United Kingdom, ³ Public Health at Anglia Ruskin University, Cambridge, United Kingdom

• Introduction and Objectives: The CamProbe is a low-cost, simple, and double freehand method for local anaesthetic transperineal biopsies (LATP) that offers significant flexibility in accessing different areas of the prostate without the limitations of an in-line guide. This characteristic makes it particularly suitable for facilitating MRI targeting, where lesions may be located in various parts of the prostate. To date, no data has been published on the use of the CamProbe in testing its ability to perform such biopsies. This study aims to evaluate the clinical safety, performance, diagnostic yield, and accuracy of the CamProbe LATP device. Additionally, we compare the efficacy of MRI–USS fusion-targeted biopsies to cognitive fusion biopsies.
  Materials and Methods: We prospectively collected data from 64 consecutive transperineal prostate biopsies performed using the CamProbe device between October 2023 and April 2024. The biopsies were conducted by two urology consultants, either as targeted biopsies (MRI-USS fusion or cognitive fusion) or systematic biopsies. For seven patients without identifiable MRI targets, only systematic biopsies were performed. Biopsy data were recorded on the Healthium^® digital platform. Ethical approval was obtained from our local institution.
  Results: Patient ages ranged from 40 to 80 years (median 69), with PSA levels ranging from 1.4 to 883.4 ng/mL (median 8.2). There were no infections, and no patients required admission due to complications, though one patient required catheterization. A total of 1,536 biopsy cores were taken, all providing informative histopathological results. Cancer was detected in 48/64 (75%) of cases: 14.0% had Grade Group (GG) 1, 31.3% had GG2, 17.2% had GG3, and 12.5% had ≥GG4. Among 57 biopsy-naïve cases, 44 (77.1%) were newly diagnosed with cancer. MRI-USS fusion was used in 31 cases, detecting cancer in 24 (77.4%), while MRI cognitive biopsies were performed in 26 cases, detecting cancer in 20 (76.9%). There was no significant difference in detection rates between MRI fusion and cognitive approaches (p = 0.96).
  Conclusions: The CamProbe’s double freehand technique is safe, effective, and facilitates MRI targeting with high diagnostic yields. Both MRI-USS fusion and cognitive fusion methods provided similar detection rates, making the CamProbe an efficient tool for urologists, especially at the start of their learning curve.

UP-22.34—Real World Data in Transperineal Cognitive Biopsy for the Diagnosis of Clinically Significant Prostate Cancer 

• Acuña Jose ¹, Soublett Oscar ¹, Neira Rodrigo ¹, Eltit Ignacio ²
  ¹ Hospital DIPRECA, Santiago, Chile, ² Hospital Felix Bulnes, Santiago, Chile

• Introduction and Objectives: Currently, the use of multiparametric resonance imaging (mpMRI) is recommended in men with suspected prostate cancer (PCa), prior to a prostate biopsy. It is recommended to prefer a transperineal approach. There is no evidence to support one guidance technique over another (cognitive, elastic fusion or in-bore). Since April 2020, in our center we have adopted transperineal cognitive biopsy (TPcB), plus standard sampling for the diagnosis of PCa. The objective of this study is to describe the detection rates of clinically significant PCa (csPCa) in patients undergoing TPcB. In addition, describe the overall rate of detected PCa and complications of the procedures.
  Materials and Methods: Cross-sectional study of consecutive cases undergoing TPcB between April 2020 and July 2024 with abnormal mpMRI, defined as a PI-RADS score ≥ 3. Data from the mpMRI, the procedure, and the pathology study were reviewed. A positive result for PCa was defined as ISUP ≥ 2. The procedures were performed with cognitive guidance, taking a minimum of 3 cores to the target lesion, with a “double-freehand” technique, without using a needle guide, with a BK^® Flexfocus 800 ultrasound system and a biplanar transducer.
  Results: 300 transperineal biopsies were performed. Cases with PSA ≥ 100 ng/mL, cases without mpMRI prior to biopsy, and patients biopsied with negative mpMRI (PIRADS ≤ 2) were excluded. 239 cases remained to be studied. Mean age was 66.23 years (SD ± 8.6); the main indication for biopsy was an elevated PSA (81%). Median PSA was 5.9 ng/mL (IQR 4.46). The overall detection rate of csPCa was 51.04%. According to PI-RADS, the detection rates of csPCa/PCa were PI-RADS 3: 24.66%/38.36%, PI-RADS 4: 58.77%/77.19%, and PI-RADS 5: 71.15%/82.69%. There were 2 complications consisting of acute urinary retention (0.8%). There were no infectious complications.
  Conclusions: Transperineal cognitive biopsy has good detection rates for PCa and csPCa, comparable with published studies. Its high level of safety is noteworthy, as no infections occurred in our series. With these results, we believe it is appropriate to recommend the transperineal route as a standard for prostate biopsy, which can be safely combined with cognitive guidance for sample acquisition.

UP-22.35—Reassessing the Value of Routine Pathology in Transurethral Resection of the Prostate (TURP) 

• Gardner Ellen, McLean Kenneth, Laird Alexander, Kirkwood Kathryn, Blackmur James
  Western General Hospital, Edinburgh, United Kingdom

• Introduction and Objectives: Recent guidance from the Royal College of Pathologists challenges the rationale for pathology of channel Transurethral Resection of the Prostate (TURP) in patients with known prostate cancer and questions the value of routine pathology for patients without clinical suspicion of malignancy. Furthermore, newer treatments for bladder outflow obstruction, such as green light laser prostatectomy, do not provide specimens for routine pathological assessment. This study aimed to audit the clinical and cost implications of routine pathology for TURP.
  Materials and Methods: This was a retrospective audit of all TURPs performed between January 2018 and February 2025 at a UK tertiary urology service. Clinical and pathology records were reviewed to highlight channel TURPs (defined as TURPs in the context of pre-operative clinical, radiological or histological evidence of prostate cancer) and presumed benign TURPs. The number needed to screen (NNS) to detect one cancer was calculated, and pathology costs were estimated based on local processing costs and the pathologist workload score for each sample.
  Results: There were 1437 TURPs performed between January 2018 and February 2025. Pre-operatively 201/1437 (14.0%) patients had known prostate cancer, undergoing channel TURP where pathological results would not alter management. Of the 1236 TURPs performed for urinary symptoms resulting from presumed benign prostatic enlargement, 57 (4.6%) patients had a diagnosis of prostate cancer made. Watchful waiting or surveillance was undertaken in 75.4% (n = 43/57) patients, with others receiving either hormonal (12.3%, n = 7/57) or curative treatments (12.3%, n = 7/57). The number needed to screen for unexpected cancer was 22 although the number needed to screen for clinically significant unexpected cancer was 103. Halting routine pathology for channel TURPs was estimated to reduce pathology-associated costs for TURPs by 14.1% (£900 annual saving).
  Conclusions: Routine pathology in channel TURPs offers limited clinical value while incurring substantial cost. The low detection rate of unexpected cancers supports Royal College of Pathologists’ guidance for a more selective approach to histopathological analysis. Further work is underway to define a reliable method to target pathology services towards identification of clinically significant unexpected cancer.

UP-22.36—Refining Prostate Cancer Detection: Does Systematic Biopsy Add Value to MRI-Targeted Transperineal Biopsy? 

• Nafie Shady
  University Hospitals of Northamptonshire, Kettering General Hospital, Kettering, United Kingdom

• Introduction and Objectives: Transperineal (TP) prostate biopsy paired with multiparametric MRI (mpMRI) has significantly improved prostate cancer (PCa) detection. However, the necessity of performing systematic biopsy (SB) alongside MRI-targeted biopsy remains debated. This study evaluates whether excluding SB compromises the detection of clinically significant prostate cancer (csPCa).
  Materials and Methods: We retrospectively reviewed consecutive data from 180 men with elevated PSA or abnormal digital rectal examination and positive mpMRI findings (PI-RADS ≥ 3) who underwent TP biopsy between October 2023 and October 2024 at Kettering General Hospital. Each prostate was divided into six sectors for targeted sampling. Each biopsy included six MRI-targeted cores and four SB cores from MRI-negative areas. Diagnostic outcomes for csPCa (Gleason ≥ 3 + 4) were assessed.
  Results: The mean age was 70 years (range: 46–85), median PSA was 18.5 ng/mL (range: 1–364), and mean prostate volume was 53.7 cc (range: 15–350). MRI-targeted biopsy identified csPCa in 78% (140/180) and Gleason 3+3 in 13% (23/180), achieving 88% sensitivity and 82% negative predictive value. However, SB detected additional cancers in 16 patients (9%) overlooked by targeted biopsies. Of these, 7 patients (4%) had csPCa (six Gleason 3 + 4, one Gleason 4 + 5). The remaining 9 cancers (5%) were Gleason 3 + 3 with limited clinical significance.
  Conclusions: MRI-targeted TP biopsies demonstrate robust diagnostic performance; however, omitting systematic biopsy risks missing 4% of csPCa, particularly in MRI-negative areas. Refining MRI-targeting protocols and identifying subgroups where systematic biopsies may be safely reduced could optimise diagnostic pathways and minimise invasive sampling.

UP-22.37—Stabilized Transperineal Software Based Fusion Biopsy of Prostate: Initial Results from a Tertiary Care Center 

• Kaushal Rohit, Khan Umar, Vasudeo Vivek, Chaturvedi Samit, Kumar Anant, Bansal Nipun
  Max SuperSpeciality Hospital, Saket, New Delhi, India, New Delhi, India

• Introduction and Objectives: Transrectal prostate biopsy has been associated with infections and risk of sepsis. There has been a gradual shift towards the transperineal route. Addition of software-based MRI-TRUS fusion has been cited to improve overall and clinically significant cancer detection rates. We present our initial experience with the stabilized transperineal software-based fusion biopsy of prostate.
  Materials and Methods: Patients with elevated total serum PSA identified either incidentally or through opportunistic screening, as well as those with a prior negative transrectal biopsy, an abnormal digital rectal examination, or multiparametric MRI of the prostate indicating PIRADS 3, 4, or 5 lesions, were included. They underwent MRI-TRUS fusion prostate biopsy under general anesthesia on BK5000 (GE Healthcare, USA) Ultrasound machine using Brachytherapy grid on a stabilized platform under a single dose of intravenous 3rd generation cephalosporin administered at induction time. Targeted biopsies from suspicious lesions, along with systematic cores, were obtained in all cases.
  Results: Total 83 patients were included. Overall cancer detection rate was 72.2% (60/83). 68.3% was the clinically significant cancer detection rate (41/60). 5 of 7 (71.4%) patients with prior negative biopsy were positive for cancer. 32 patients had an anterior lesion; of them 29/32 were positive for malignancy, of which 47% were clinically significant cancers. Clinically significant cancer detection rate was highest amongst PIRADS 4 lesions. Most of the positive biopsies were from the targeted cores. 5/83 patients developed acute urine retention on same post operative day requiring catheterization for few days. No other complications were observed.
  Conclusions: Stabilized transperineal software based fusion biopsy of prostate is an attractive revolutionary alternative to the routine TRUS guided biopsy especially for patients with very anterior or small lesions or with prior negative biopsies, with better yield for cancer detection rate and almost zero sepsis risk. Additionally, systematic cores did not provide any additional diagnostic value, as the majority of positive findings were identified through targeted biopsies. Therefore, the routine use of systematic biopsies may be avoided.

UP-22.38—Step-by-Step Guide to Transperineal Systematic Prostate Biopsy 

• Abdallah Mohamed ¹, AL Rashdi Hilal ²
  ¹ Sultan Qabous Comprehensive Cancer Care and Research Center (University Medical City), Muscat, Oman, ² Sultan Qabous Cancer Care and Research Center (SQCCCRC), University Medical City, Muscat, Oman

• Introduction and Objectives: Transperineal prostate biopsy (TPBx) has emerged as a superior alternative to the transrectal approach, significantly reducing infection rates while improving cancer detection, particularly in anterior and apical prostate regions. This study presents a structured, step-by-step approach to systematic transperineal biopsy, highlighting procedural efficiency, safety, and diagnostic accuracy.
  Materials and Methods: A prospective cohort of patients with elevated PSA (≥3 ng/mL) and/or abnormal DRE findings underwent transperineal systematic prostate biopsy under ultrasound guidance. The stepwise methodology included: Patient Positioning & Anesthesia: Lithotomy or supine position under local or general anesthesia. Ultrasound & Template Setup: Biplanar transrectal ultrasound (TRUS) with a stepper-mounted grid template for systematic mapping. Biopsy Execution: 12–24 core sampling targeting the right and left anterior, middle and posterior zones.
  Results: Cancer Detection: Clinically significant cancer (ISUP grade ≥ 2): This shows high detection accuracy, particularly in anterior lesions. Clinically insignificant cancer (Gleason 3 + 3): Lower detection rates compared to transrectal biopsy, minimizing overtreatment. Safety & Tolerance: Sepsis rate: 0% (compared to 1–3% in transrectal approaches). Post-procedure urinary retention: <5%, managed conservatively. Mean procedural pain score: Well-tolerated with local anesthesia.
  Conclusions: Transperineal systematic prostate biopsy is a safe, effective, and standardized approach for prostate cancer diagnosis. It offers enhanced anterior zone sampling, reduces the risk of infectious complications, and minimizes the overdiagnosis of low-risk cancers. Standardizing this technique will further improve diagnostic precision and patient outcomes.

UP-22.39—Stockholm 3 as a Reflex Test in Patients with Elevated PSA 

• Kılıç Mert ¹, Esen Barış ², Palaoğlu Erhan ¹, Tilki Derya ³, Esen Tarık ², Madendere Serdar ¹, Canda Abdullah ², Balbay Mevlana ²
  ¹ VKV American Hospital, Istanbul, Türkiye, ² Koç University School of Medicine, Istanbul, Türkiye, ³ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany

• Introduction and Objectives: Stockholm3 is used as a reflex test that aims to reveal the risk of clinically significant prostate cancer (csPCa) in patients with elevated PSA. We herewith present our first results using this new biomarker.
  Materials and Methods: The study included patients aged 40 to 80 who had one or more of the following conditions: elevated PSA (>1.5 ng/mL), suspicious digital rectal examination findings, suspicious multiparametric MRI findings. Patients under active surveillance were excluded. Patients with a Stockholm3 score ≥ 11 and ≥15 were assessed as being at high risk for csPCa, respectively. Biopsy was recommended for the patients with PIRADS 3–5 lesions on multiparametric MRI. The patients with PIRADS 1–2 lesions were usually followed up.
  Results: 177 tests were evaluated. The median age was 62. The median PSA prior to Stockholm3 was 4.8 ng/mL, median PSA density was 0.08 ng/mL, median Stockholm3 score was 10 (3–67). Overall 88 (49.7%) men received a prostate MRI. 152 men had a PSA ≥3, while 92 had a Stockholm3 ≥ 11 and 62 a Stockholm3 >15. Of 9 patients with a Stockholm3 ≥11 and PIRADS ≥ 4, 7 underwent prostate biopsy, 1 of 7 (14.3%) had csPCa. Of 8 patients with Stockholm3 ≥ 15 and PIRADS ≥ 4, 6 underwent prostate biopsy, 1 of 6 (16.7%) had csPCa. Among 24 patients with Stockholm3 ≥ 11 and PIRADS 3, 10 underwent prostate biopsy, and none had PCa. Using a Stockholm3 threshold of 11 and 15 would have decreased the number of MRIs by 39.5% (92 compared to 152) and by 56.6% (66 compared to 152), as compared to PSA ≥ 3 ng/mL for MRI indication. In patients with a negative MRI (PIRADS 1–2) and a Stockholm3 < 15, no csPCa was detected. Among 21 patients with a PSA level between 1.5–2.9 ng/mL, only 2 had Stockholm3 ≥ 11, both had PIRADS < 4, they did not undergo biopsy.
  Conclusions: In patients with high Stockholm3 risk but negative mpMRI results, follow-up in short intervals seems to be appropriate. In the high-risk group with a positive MRI, the biopsy data needs maturation. Additionally, the utilization of Stockholm3 can decrease the number of MRIs in comparison to PSA levels of 3 ng/mL or higher.

UP-22.40—Strategic Sampling in Transperineal Prostate Biopsy: Evaluating the Benefits of Targeted Biopsy Alone vs. Targeted Plus Random Biopsy 

• Nasrallah Oussama, Bulbul Muhammad, Nasr Rami, El Hajj Albert, Bachir Bassel, Fawaz Mohammad, Herrera Maya, Al Hattab Moustafa, El Mir Mohamad, Watfa Mohamad, Khouzami Riad
  American University of Beirut Medical Center, Beirut, Lebanon

• Introduction and Objectives: Multi-parametric MRI (mp-MRI) has become a standard practice prior to prostate biopsy, and the incorporation of ultrasound fusion allowed precise and accurate targeted prostate biopsies (TPB). The role of random biopsies in the diagnosis of prostate cancer and clinically significant prostate cancer is yet to be determined. We aim to describe the value and significance of random biopsies with TPB in 464 patients at our institution.
  Materials and Methods: Between July 2019 and January 2024, 464 patients underwent trans-perineal MRI-targeted with ultrasound fusion using the Koelis Machine, and random prostate biopsies at AUBMC. The detection of prostate cancer (PCa) and clinically significant prostate cancer (csPCa) was compared between MRI-targeted biopsy (TB) and combined biopsy (CB) in patients with suspected PCa. Cancer severity was assessed using the ISUP grade group system, based on Gleason scores. Clinically significant PCa (csPCa) was defined as Gleason score > 6.
  Results: PCa was diagnosed in 253 (54.5%) by targeted biopsy. Combining target with random biopsies led to cancer diagnosis in 264 (56.9%), with total increase as compared to TB alone of 11 patients (2.4%, p < 0.001), and an increase in csPCa detection by 7 patients (1.5%) shown in Table 1. The combined biopsy led to cancer upgrading to a higher-grade group vis-à-vis TB alone in 9 men (1.9% of all patients). The use of CB biopsy led to a higher detection of ISUP Grade Group 1 and 2 prostate cancer than target biopsy alone with p = 0.046 and 0.025 respectively. There was no significant difference in cancer detection for other ISUP Grade Group shown in Table 2. Comparing TB and CB according to the PIRADS score showed significant difference in cancer detection among patients with PIRADS 4 (p = 0.008), and no significant difference in PIRADS 3 lesions possibly due to small sample size and no difference in PIRADS 5 lesions as shown in Table 3.
  Conclusions: CB seems to have no significant benefit in the diagnosis of prostate cancer in patients with a PIRADS 5 or PIRADS 3 lesion detected on mp-MRI. Patients with PIRADS 4 lesions may benefit from random biopsies with a significant increase in detection rate of 4.2%.

UP-22.41—Targeted Versus Targeted Plus Random Transperineal Prostate Biopsy in Patients with a Single Lesion on MRI: Is There Added Value? 

• Nasrallah Oussama, Bulbul Muhammad, Nasr Rami, El Hajj Albert, Bachir Bassel, Fawaz Mohammad, Herrera Maya, El Mir Mohamad, Al Hattab Moustafa, Watfa Mohamad, Khouzami Riad
  American University of Beirut Medical Center, Beirut, Lebanon

• Introduction and Objectives: Standardization of multi-parametric MRI (mp-MRI) prior to prostate biopsy and the incorporation of ultrasound fusion allowed precise and accurate targeted prostate biopsies. Random biopsies, still performed as routine, are taken from the ipsilateral and contralateral side of the prostatic lesion. We aim to determine the added value of combined biopsies (random biopsies plus target) compared to targeted biopsy only in patients with a single lesion on mp-MRI.
  Materials and Methods: A total of 464 patients had Trans-perineal biopsies with MR fusion using the Koelis Machine. 196 patients had a single unilateral MRI lesion, underwent target and random biopsy at our institution between July 2019 and January 2024. Biopsy results of Target biopsy alone (TB), Combined biopsy (CB) (targeted and random cores from both sides), TB + ipsilateral − random biopsy (TB+ipsi), and TB + contralateral − random biopsy (TB+contra) were analyzed. The relative contribution of these biopsy sites to the detection of significant prostate cancer was identified using targeted biopsy as a reference. McNemar test was used to compare cancer detection based on the location of the random biopsy.
  Results: The cancer detection rate in TB alone was 54.6% compared to CB (58.7%) (p = 0.005). Also, TB+ipsi had a detection rate of 56.6% (p = 0.046) and TB+contra of 57.1% (p = 0.025) when compared to TB alone. For clinically significant prostate cancer (csPCa), only CB and TB+contra showed significant increase in cancer detection (p value: CB = 0.01, TB+contra = 0.046) when compared to TB alone (Table 1). When comparing TB, CB, TB+Ipsi, TB+contra according to the PIRADS score of the single lesion, there was no significant difference in patients with a single PIRADS 5 or PIRADS 3 lesion. However, there was a significant difference in cancer detection among patients with PIRADS 4 (p = 0.018), in CB compared to TB (Table 2).
  Conclusions: CB and TB+contra seem to have a benefit in diagnosis of clinically significant prostate cancer in patients with a single lesion detected on mp-MRI. CB seems to have a significant benefit in the diagnosis of prostate cancer in patients with a single PIRADS 4 lesion on mp-MRI; however, there is no benefit from taking random biopsies in patients with a single PIRADS 5 lesion.

UP-22.42—The Additional Diagnostic Value of Systematic Biopsies to MRI-Targeted Biopsies in the Detection of Prostate Cancer—An Analysis of the Prime Trial 

• Ng Alexander, Study Group PRIME
  University College London, London, United Kingdom

• Introduction and Objectives: Systematic biopsies (SB) are often used alongside MRI-targeted biopsies (MRI-TB) for prostate cancer diagnosis, but their value remains uncertain. This analysis investigates the additional diagnostic contribution of SB to MRI-TB in detecting clinically significant prostate cancer (csPCa).
  Materials and Methods: PRIME (NCT04571840) was a prospective, international, multicentre, level 1 evidence trial assessing the non-inferiority of biparametric (bpMRI) to multiparametric MRI (mpMRI) for csPCa detection. Lesions scoring ≥ 3 on Likert or PI-RADS v2.1 received 4-core MRI-TB. Patients with unilateral MRI lesions underwent 6-core contralateral SB, whilst those with non-suspicious MRIs and PSA density ≥ 0.15 ng/mL/mL received 12-core SB.
  Results: Across 490 men (median age 65 years, PSA 5.6 ng/mL), 65.1% (319/490) underwent biopsy. Of these, 31.8% (156/490) received MRI-TB and SB, and 2.2% (11/490) received SB alone. 60.5% (193/319) of biopsies were performed transperineally, with 81.5% (260/319) using image fusion. There were 143 cases of csPCa (29.2%). bpMRI-TB alone detected 96.5% (138/143), and SB detected an additional 2.1% (3/143) of csPCa cases. mpMRI-TB alone detected 97.9% (140/143), and SB detected an additional 2.1% (3/143) of csPCa cases. Thus, 98% of SB were unnecessary. In men with non-suspicious MRIs, SB detected no additional csPCa but identified clinically insignificant prostate cancer (ciPCa) in 7.4% (11/148) and 7.2% (11/152) of patients that would have been reassured as having no cancer by bpMRI-TB and mpMRI-TB, respectively.
  Conclusions: In an international, prospective trial, SB has a minor additive role to MRI-TB in the detection of csPCa and increases ciPCa detection. Contralateral SB should be omitted.

UP-22.43—The Prostate Urine Risk (PUR) Score and Prediction of Disease Progression 

• Manley Kate ¹, Smith Stephanie ¹, Al Kadhi Omar ¹, Hayhoe Antonietta ², Traka Maria ², Jupp Orla ³, Klyvyte Gabija ¹, Mills Rob ¹, Clark Jeremy ³, Brewer Dan ³, Mithen Richard ², Cooper Colin ³, Ofagbor Ojone ¹
  ¹ Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom, ² Quadram Bioscience, Norwich, United Kingdom, ³ University of East Anglia, Norwich, United Kingdom

• Introduction and Objectives: The Prostate Urine Risk (PUR) Score is a diagnostic tool for prostate cancer (PCa) that analyses extracellular vesicle-derived RNA in urine to predict cancer presence before imaging or biopsy. Four PUR scores are returned for each patient, indicating the probability of normal tissue (PUR-1), low-risk (PUR-2), intermediate-risk (PUR-3), and high-risk (PUR-4) PCa. As PCa is heterogeneous, a mixture of these scores can exist in a single prostate, with the sum always being 1. PUR has been shown to predict outcomes for men on active surveillance up to five years post-diagnosis with PUR-4 significantly associated with time to progression. The ESCAPE study was a randomized double-blinded trial which examined the impact of dietary glucoraphanin on prostate gene expression in men on active surveillance. PUR scores for this cohort of patients were collected at diagnosis (T0) and 12 months (T12). 10-year clinical follow-up was undertaken to determine predictive potential of PUR for men on active surveillance.
  Materials and Methods: Local Ethical Approval for the study was granted. Clinical data from 49 patients in the ESCAPE study were used to assess disease progression and cancer-specific mortality. Progression was defined by changes in biopsy histology, MRI stage, or PSA progression leading to active surveillance discontinuation. PUR scores at T0 and T12 were correlated with progression data.
  Results: Median follow-up was 10.1 years. One patient died (non-PCa related), and 44.8% (n = 22) progressed. Time to progression was a median of 4.3 years. Patients with a T12 PUR-4 score > 0.174 had higher progression rates than those with T12 PUR-4 < 0.174 (log-rank test, p < 0.05).
  Conclusions: This study supports the long-term prognostic value of the PUR score for men on active surveillance, leading to easier identification of high risk to progression individuals.

UP-22.44—Transperineal Saturation Prostate Biopsy Through a Single Access Point as a Safe and Efficient Method for Cancer Detection 

• Gutierrez Tapia David, Rios Melgarejo Carlos, López Almaraz Luis, García Padilla Miguel, Pulido Contreras Enrique
  Asociación Nacional de Urologos egresados de la Raza, ANUER, León, Guanajuato, Mexico

• Introduction and Objectives: Transperineal prostate biopsy has surged as an alternative for transrectal prostate biopsy, offering similar cancer detection rate with a lower rate for infectious complications. Although the medium number of cores to obtain is 12, the optimal number of cores to obtain still remains in debate, especially when we talk about saturation biopsy and the complications that come with it. The objective of our study was to establish the safety of a transperineal saturation prostate biopsy through a single access port without the use of any prophylactic antibiotics nor any type of bowel preparation, as a method for prostate cancer detection.
  Materials and Methods: We evaluated 261 patients who underwent a transperineal saturation prostate biopsy for cancer detection in our center in Leon, Guanajuato. Patients did not receive any type of prophylactic antibiotic or bowel preparation, and the procedure was performed under sedation. We had a four week follow up for evaluation of possible complications, as well as for evaluating the pathology report.
  Results: The median age and the median PSA levels were 68 years old and 12.9 ng/dL. Our biopsies resulted in a median of 25 cores. 4.5% of patients presented with infectious complications, 4 required hospitalization, among them we had 1 case of sepsis that resolved with the use of IV antibiotics. Of our patients with positive biopsy results 56 patients (39%) underwent radical prostatectomy. Among them upgrading was seen on 28 RP specimen (50%); only 21 (37.5%) had a Gleason biopsy/RP specimen concordance.
  Conclusions: Our method for performing transperineal saturation prostate biopsies through a single port access is safe, with a low number of complications and detection rates similar to those presented with fusion biopsies.

UP-22.45—Trends in Prostate Cancer Outcomes by Socioeconomic Status: A Population-Based Analysis from Scotland 

• Leiberman Christopher, Tan Lieo Jiun, Lee Xiang Wei, Ramsay Alison, Reid Sarah
  University Hospital Monklands, Airdrie, United Kingdom

• Introduction and Objectives: Prostate cancer is one of the most commonly diagnosed cancers among men in Scotland, but outcomes vary significantly by region and socioeconomic status. This study investigates geographic and deprivation-based disparities in prostate cancer incidence, stage at diagnosis, and mortality trends in Lanarkshire compared to national figures, with the aim of identifying priority areas for targeted intervention.
  Materials and Methods: Data were extracted from the Scottish Cancer Registry and LanQIP Cancer Dashboard for the period 2016–2021. Age-sex standardised incidence and mortality rates (EASR per 100,000 population) were analysed by health board locality and Scottish Index of Multiple Deprivation (SIMD) quintile. Trends in cancer staging at diagnosis and three-year rolling averages for mortality were used to identify disparities.
  Results: Prostate cancer incidence varied across Lanarkshire, with the North locality reporting the highest rate (172.6 per 100,000) and Bellshill among the lowest (120.3). Elevated incidence was observed in Airdrie, Coatbridge, and Camglen. Late-stage diagnosis was significantly more common in deprived areas. Stage 4 cancers accounted for 30% of all diagnoses in Lanarkshire (vs. 28.6% nationally), rising to 32.7% in Coatbridge and 32.4% in Motherwell. In Camglen, over 65% of cases were diagnosed at Stage 3 or 4. Mortality trends revealed further disparities. While North Lanarkshire demonstrated stable or declining mortality across SIMD quintiles, South Lanarkshire saw rising rates in both the most and least deprived groups. Lanarkshire as a whole experienced increased mortality in three of five SIMD quintiles, diverging from national trends, which showed improvement among the most deprived groups but worsening outcomes in middle and least deprived populations.
  Conclusions: Socioeconomic deprivation remains a significant determinant of prostate cancer outcomes in Scotland. Higher incidence, later-stage diagnosis, and increasing mortality in deprived communities highlight the urgent need for targeted public health strategies. Enhanced awareness, equitable diagnostic access, and region-specific interventions are essential to narrow the gap in prostate cancer outcomes and promote health equity.

UP-22.46—Why Are Men of African Heritage at Higher Risk for Prostate Cancer? 

• Musa Haruna ¹, Mamoulakis Charalampos ², Omar Muhammad Imran ¹
  ¹ University of Aberdeen, Aberdeen, United Kingdom, ² University of Crete, School of Medicine, Heraklion, Crete, Greece

• Introduction and Objectives: Prostate cancer (PCa) is a significant public health challenge for men of African heritage, where it remains the most commonly diagnosed cancer and the leading cause of cancer related mortality. Understanding the risk and prognostic factors that contribute to this high disease burden is essential for informing effective prevention strategies and shaping health policy. This review aims to summarise the current evidence of these factors in men of African heritage.
  Materials and Methods: An extensive literature search was conducted using the Medline, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov to identify relevant publications between 1st June and 11th June 2024. After abstract and full-text screening, 40 articles met the inclusion criteria of this review, and the evidence from these studies was summarised.
  Results: This review identified a significant association between PCa risk and chromosome 8q24 (p < 0.00032). Obese men were found to have a 1.52–1.70-fold increased risk of developing high-grade PCa (p = 0.032). Additional risk factors positively associated with PCa included older age, smoking, alcohol consumption (all p < 0.0001), family history of cancer (p = 0.008), and serum vitamin D deficiency (<20 ng/mL; p = 0.04). The review also identified associations between PCa risk and factors such as chronic aspirin use, a history of prostatitis, and sexually transmitted infections (STIs). Elevated prostate-specific antigen (PSA) levels (>4 ng/mL) were strongly linked to PCa (p < 0.0001), as was the presence of high-grade prostatic intraepithelial neoplasia (p < 0.0001), a sensitive marker of disease progression. The review also identified that PCa patients with shortened leukocyte telomere length tend to have a poor prognosis. Additionally, erythroblast transformation specifics dependent biomarker was identified as a standard predictive indicator for the aggressive disease. A high Gleason score, advanced clinical stage (Stages III and IV), and the presence of lymphatic or vascular invasion were identified as adverse prognostic factors.
  Conclusions: The higher incidence of PCa among men of African heritage is strongly associated with genetic susceptibility, particularly variants on chromosome 8q24. Lifestyle related factors such as obesity, smoking, alcohol consumption, STIs, and vitamin D deficiency also contribute to increased PCa risk in this population.

UP-22.47—Role of Systematic Biopsies in Suspected Carcinoma Prostate Patients and Analysis of Gleason Grade Group Concordance Between the Biopsy and Histopathology Report Following Radical Prostatectomy 

• Banerjee Avijit, Ali Mohamad, Sharma Gopal, Gautam Gagan
  Medanta, Gurugram, Kolkata, India

• Introduction and Objectives: In biopsy-naïve patients with suspicious lesions on MRI, magnetic resonance (MR) targeted biopsy of the lesion and systematic biopsy are currently considered the standard of care. However, this mandate has never been studied in the Indian population. This study compares the ability of MR-targeted versus systematic biopsies to detect clinically significant prostate cancer (csPC) and analyse Gleason grade group concordance between these biopsies with the final histopathology report (HPE) following robot-assisted radical prostatectomy (RARP).
  Materials and Methods: We analysed data of patients suspected of PC (raised PSA or abnormal DRE) who underwent MR-TRUS fusion prostate biopsy and RARP at our centre from December 2017 to July 2024. All patients underwent mpMRI prostate followed by MR-TRUS fusion prostate biopsy (PIRADS ≥ 3). The primary objective was to compare the diagnostic accuracy of targeted and systematic biopsies for csPC. Additionally, we determined Gleason grade group discrepancies between the biopsies with the final HPE following RARP.
  Results: 597 patients underwent fusion biopsy, and 342 (57.3%) were positive for PC. Of these 342 patients, 256 (74.9%) had csPC and 132 (51.6%) underwent RARP. The sensitivity, specificity and PPV of systematic biopsy were 95.7%, 72.9% and 93.1% respectively and for targeted biopsy were 93.1%, 81.4% and 95.7% respectively to detect csPC. Performing only targeted biopsies would miss 91/342 (26.6%) csPC lesions and detect 19/342 (5.6%) additional tumours. The Gleason score of systematic biopsies when compared with the final HPE post-RARP, showed upgradation of 88%, 25.5%, 12%, 9.1% of Gleason scores 3 + 3, 3 + 4, 4 + 3 and 4 + 4 respectively and a down-gradation of 9.1%, 36%, 54.6%, 100%, 100% of Gleason scores 3 + 4, 4 + 3, 4 + 4, 5 + 4, 5 + 5 respectively. Similarly for targeted biopsies it showed upgradation of 100%, 37.9%, 13.6%, 50% of Gleason scores 3 + 3, 3 + 4, 4 + 3 and 4 + 4 respectively and a down-gradation of 5.2%, 31.8%, 25%, 50% of Gleason scores 3 + 4, 4 + 3, 4 + 4, 4 + 5 respectively.
  Conclusions: Targeted biopsy has superior specificity/PPV compared to systematic biopsy. Higher Gleason grade groups in targeted biopsies have more concordance with final HPE than TRUS biopsy. However, performing only targeted biopsies would lead to under-detection of csPC lesions with lower concordance with final HPE in lower Gleason grade group patients.

23. Reconstruction

23.1. Moderated Oral ePosters

MP-23.01—”The Perineal Apron”: Novel Flap for Repairing Recto-Urethral and Perineal Fistulae 

• Gil-Vernet Alfredo ¹, Cespedes Manuel ¹, Cámara Cristina ², Ropero Jordi ³, Sola Carles ¹, Bastarós Juan María ¹
  ¹ Parc Sanitari Sant Joan de Déu, Barcelona, Spain, ² Hospital Del Mar, Barcelona, Spain, ³ Hospital Universitari Vall d’Hebrón, Barcelona, Spain

• Introduction and Objectives: Urethro-rectal fistulae are becoming more frequent as a result of the multimodal therapies indicated for the treatment of prostatic and colorectal malignancies. Infected bulbar urethral stricture with periurethral abscess draining into the perineum is the origin of multiple fistulous tracts that form a watering-can perineum. In addition irradiated fields and infected tissues pose a further difficulty in resolving these complex urinary tract fistulae. The original idea of using the adipose tissue adjacent to the posterior aspect of the scrotum as a flap to help in the closure of these types of complex fistulae came from the late Professor Jose María Gil-Vernet (1922–2020†), who named it “the Perineal Apron” due to its excellent vascularity based in both superficial perineal arteries, mobility and local extension. Our experience in closing recto-urethral and perineal fistulae using the “Perineal Apron” is exposed while claiming the authorship of the procedure to the late Master.
  Materials and Methods: Between March 2000 and February 2025, 10 patients have been operated on to close urethro-rectal and perineal fistulae with the help of the “Perineal Apron”. The fistula etiology was abdomino-perineal amputation (2), laparoscopic radical prostatectomy (2), laparoscopic rectal cancer resection (1), prostatic transurethral resection after external radiotherapy (1), laceration of a rectal cannula (1), and perineal abscess secondary to bladder catheterization (3). A flap was created with the adipose tissue that surrounds the perineo-scrotal area and interposed between the previously closed fistula orifices, or in the case of a residual pelvic cavity the adipose flap was transferred to fill it completely.
  Results: Complete resolution of the fistulae was achieved in all patients, and no recurrence has been observed during the follow up. None of the patients had significant post-operative complications.
  Conclusions: The “Perineal Apron” flap has the advantages of its proximity to the lesion, availability and good vascularity, which makes it highly reliable. Unlike the gracilis flap, the mobilisation of the “Perineal Apron” flap is easier, quicker and does not involve any disruption of the donor site.

MP-23.02—3-Year Retrospective Review of Penile Paraffinoma Case Outcomes in a Single Institution Tertiary Hospital in the Philippines 

• Condeno Clarice, Abalajon Mark Joseph, Gaston Charles Anthony
  East Avenue Medical Center, Quezon City, Philippines

• Introduction and Objectives: The practice of injecting foreign substances to enhance body contour is prevalent in Southeast Asia, Korea, and parts of Eastern Europe and are often performed by non-medical personnel to increase penile size, based on misconceptions about sexuality and satisfaction. However, the body is unable to metabolize these foreign materials, leading to a foreign body reaction, which can result in scarring, pain, penile deformity, sexual dysfunction, and ulceration.
  Materials and Methods: A retrospective study was conducted on forty-seven (47) patients who underwent reconstructive surgery for penile paraffinomas at East Avenue Medical Center between 2022 and 2024. The Boyke Classification System for sclerosing lipogranuloma was used to guide preoperative planning. Surgical procedures, complications, and postoperative outcomes were recorded at 1-, 3-, 6-, and 12-months follow-up.
  Results: Patients with lower Boyke classifications (I and II) experienced shorter operative times, less blood loss, and lower complication rates. In contrast, patients with higher Boyke classifications (III and IV) required more complex reconstructive procedures, such as grafts and flaps, and had longer operative times, higher blood loss, and higher complication rates. Although no significant correlation was found between Boyke classification and IPSS, there was a strong negative correlation between Boyke classification and IIEF indicating that extensive penile paraffinomas involvement negatively impacted overall sexual function and satisfaction.
  Conclusions: Despite the limited sample size, this study offers valuable insights into the surgical management and outcomes of penile paraffinomas in the Philippines. It emphasizes the need for further research on this specific urological condition to develop evidence-based guidelines and healthcare initiatives that improve patient care.

MP-23.03—A Prospective Analysis of Satisfaction with Decision and Decisional Regret in Men Implanted with an Artificial Urinary Sphincter 

• Persu Cristian, Popescu George, Ciofu Irina, Chirca Narcis Marian, Cartas Remus, Jinga Viorel
  ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

• Introduction and Objectives: The artificial urinary sphincter (AUS) is established as the gold therapeutic standard for post prostatectomy incontinence. There is a long history of usage of this device, and recent years brought significant improvements in reliability and reduction of complications. We aim to evaluate in a systematical manner the perception of our patients with the decision to have an AUS implanted, immediately and after one year.
  Materials and Methods: We translated and adapted two validated English language questionnaires, the Satisfaction with Decision Scale (SDS) and Decisional Regret Scale (DRS). On the SDS, 1 means lowest satisfaction, while 5 means the highest degree of satisfaction. On the DRS, 1 represents the lowest decisional regret, while 5 means the highest level of regret. The forms were administered to the patients during the first visit after activation and at the one year follow up visit. Our patients were implanted with either the AUS 800 or the Rigicon Conti Classic devices. A retrospective analysis of objective results and complications was made, and the correlation with the questionnaires was analyzed using Student’s t-test with a p value < 0.05 considered significant.
  Results: Our database includes 31 AUS patients for which follow up data is available. At the moment of data analysis, the mean time since surgery was 26.3 ± 16.7 months. The SDS score was 2.68 ± 1.30 after activation and 3.42 ± 1.15 after one year, p = 0.02. The DRS score was 3.5 ± 1.14 after activation and 2.6±1.07 after one year, p = 0.0025. After one year, the SDS was 3.48 ± 1.09 in the subgroup with complications and 3.16 ± 1.89 in the subgroup with no complications, p = 0.29. The DRS was 2.84 ± 1.29 in the subgroup with complications and 2.68 ± 1.25 in the subgroup where no complications were reported.
  Conclusions: Patient perceptions are not significantly associated with objective data, thus increasing the necessity to be specifically evaluated. Shortly after activation, our patients showed lower satisfaction and higher regret towards their decision. After one year, despite some of them encountering surgical complications, the satisfaction rate increased while the decision regret lowered. This aspect should be discussed with the patient before his surgery. Satisfaction rates should become part of any scientific report of the outcomes of AUS implantation.

MP-23.04—Application of Regenerative Technologies in the Prevention of Relapse of Augmentation Urethroplasty 

• Le Tkhu Chang, Shamsov Bedil, Pavlov Valentin, Kazikhinurov Rustem, Kazikhinurov Albert, Khasanov Azat
  Bashkir State Medical University, Ufa, Russian Federation

• Introduction and Objectives: In recent years, the implementation of cell technologies shows effectiveness and encouraging results in various branches of medicine. One of the promising methods is the use of multipotent mesenchymal stem cells from the stromal-vascular fraction (SVF) of autologous adipose tissue. The mechanism of action is due to the presence of pericytes and endotheliocytes in SVF that promote neoangiogenesis. Objectives. Perform a comparative analysis of the clinical efficacy of augmentation urethroplasty using oral mucosa according to standard procedures with and without injection of SVF obtained from autologous fat tissue.
  Materials and Methods: From January 2019 to December 2023 115 augmentation urethroplasty with the use of oral mucosa were carried out, which 49 patients were treated with injections of stromal vascular fraction (SVF) obtained from autologous fat tissue. Patients are examined according to clinical recommendations. Age, etiology, localization, comorbidity and extent of stricture in both groups were comparable. The average age of patients was 50 ± 17 years. The mean length of stricture was 5.5 ± 2.5 cm. SVF was injected under the tissue of the recipient area (more often under the tunica albuginea of corpus cavernosum), the anastomosis area and under fixed oral graft. The diagnostic criteria for relapses were: Qmax < 12 mL/s, X-ray reduction of urethra narrowing ≤ 16 Ch, necessity of dilation or second surgical intervention.
  Results: The frequency of relapses over 12 months in the group of patients, who had operated with the usage of SVF, was 6.1% (3 patients) and 15.1% (10 patients) with standard procedures at comparable observation times.
  Conclusions: The use of stroma-vascular fraction (SVF) obtained from autologous adipose tissue allows to improve short-term and long-term results of augmentation urethroplasty techniques.

MP-23.05—Artificial Urinary Sphincter (Aus) Erosion: A 10-Year Retrospective Analysis of Incidence and Risk Factors 

• Abdelrahman Asem, Thiruchelvam Nikesh
  Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom

• Introduction and Objectives: Artificial Urinary Sphincter (AUS) implantation is a standard treatment for severe stress urinary incontinence. However, erosion remains a major complication, often necessitating explantation and revision surgery. This study examines AUS erosion incidence and identifies key risk factors to improve clinical decision-making and improve patient outcomes.
  Materials and Methods: A retrospective review was conducted on 112 AUS implantations from 1 December 2014 to 21 October 2024 as part of the SAFER study (EAU-sponsored Systematic Assessment of Artificial Urinary Sphincter Failure and Erosion Recovery). The primary outcome was erosion incidence, with secondary outcomes assessing risk factors such as prior surgeries, treatments, and patient comorbidities.
  Results: AUS erosion occurred in 14 cases (12.5%). Significant risk factors included: previous AUS implantation (8 patients had ≥ 1 prior implantation); prior prostate cancer treatment (8 patients, including prostatectomy or radiotherapy); smoking history (7 patients, active or past smokers); hypertension (6 patients); prior sling placement (4 patients); prior BPH treatment (3 patients, including HoLEP or TURP); prior urethroplasty (3 patients); history of erosion (2 patients); diabetes mellitus (1 patient); lung disease (1 patient); older age (>60 years).
  Conclusions: AUS erosion remains a significant challenge, particularly in patients with prior implantation and comorbidities like hypertension, smoking, and previous urological interventions. Identifying risk factors is key to improving patient selection, surgical planning, and postoperative care. Risk mitigation should focus on optimized perioperative management, refined surgical techniques, and close monitoring of high-risk patients. Further research is needed to enhance predictive models and develop better management strategies for erosion prevention and treatment.

MP-23.06—Buccal Mucosa Graft Dropped to the Floor, Now What? 

• Massouh Ragheb, Gómez Reynaldo
  Hospital del Trabajador, Santiago, Chile

• Introduction and Objectives: Buccal mucosa is the most common tissue used as grafts in reconstructive urology, particularly for urethral reconstruction. Despite their widespread use, the management of accidentally contaminated grafts (ACGs) remains poorly addressed. This study aimed to assess the microbiological contamination of ACGs and evaluate the efficacy of 2% chlorhexidine (CHX) as a decontamination agent. Buccal mucosa is the most common tissue used as grafts in reconstructive urology, particularly for urethral reconstruction. Despite their widespread use, the management of accidentally contaminated grafts (ACGs) remains poorly addressed. This study aimed to assess the microbiological contamination of ACGs and evaluate the efficacy of 2% chlorhexidine (CHX) as a decontamination agent.
  Materials and Methods: A prospective, descriptive and analytic study was conducted on 12 patients undergoing urethral surgery with BMG. Graft segments were analyzed for baseline microbiota (Fragment 1), contamination after a 3-min floor exposure (Fragment 2), and post-decontamination with CHX (Fragment 3). A final sample was obtained after graft placement in the urethra (Fragment 4). Microbiological cultures were performed for all samples.
  Results: Baseline microbiota (Fragment 1) was identified in 75% of cases, exclusively with oral commensal microorganisms. Similarly, 75% of floor-exposed samples (Fragment 2) were positive, but no pathogenic microbes were identified; thus, there was no contamination. CHX-treated fragments (Fragment 3) demonstrated complete eradication of all microorganism. Grafts implanted in the urethra (Fragment 4) exhibited a 25% positive rate, consistent with oral commensal flora.
  Conclusions: This study shows that, if a BMG falls to the floor, it can be safely used after proper cleansing. Also, that buccal mucosa ACGs have low contamination rates and demonstrate the efficacy of CHX in decontaminating ACGs. Further research is needed to confirm clinical safety of our findings.

MP-23.07—Buccal Mucosa Graft Urethroplasty for Female Urethral Stricture: Medium-Term Results in Our Experience 

• Berdondini Elisa ¹, Silvani Mauro ², Gacci Mauro ³, Maiolino Giuseppe ⁴
  ¹ Sedes Sapientiae Clinic, Turin, Italy, ² Center for Urethral and Genital Surgery, Turin, Italy, ³ Univerisity of Florence, Florence, Italy, ⁴ Lyx Institute of Urology, Madrid, Spain

• Introduction and Objectives: Female urethral stricture (FUS) is relatively rare, affecting 3–8% of women with bladder outlet obstruction. Diagnosing FUS is challenging due to its nonspecific symptoms, including frequency, urgency, poor urinary flow, dribbling, incomplete emptying, recurrent infections, and dyspareunia. Management traditionally involves urethral dilatation, urethrotomy, or self-catheterization, but these approaches may cause further fibrosis. Urethroplasty has emerged as a promising surgical option, though there is a lack of standardized protocols for diagnosis and treatment.
  Materials and Methods: This retrospective study reviewed 54 women diagnosed with non-obstructive FUS who underwent buccal mucosa graft urethroplasty (BMGU) between 2017 and 2024 at a single center. FUS confirmed by clinical assessment, urethrocystoscopy, and other diagnostic tests. Exclusion criteria included complete obstructive stricture and concurrent urethral pathologies. FUS was diagnosed based on clinical history, physical examination, urethral calibration (<14F), uroflowmetry, abdominal ultrasound, and urine culture. Postoperative follow-up included symptom assessment, uroflowmetry, and urethral calibration at regular intervals for one year, then annually. Success was defined by restored urinary flow and symptom resolution without the need for further procedures. Recurrence was identified based on symptoms, uroflowmetry (Qmax < 10 mL/s), and physical examination.
  Results: A total of 54 patients, with a mean age of 51.4 years, were treated with BMGU: 13 dorsal and 41 ventral. Despite the cause of stricture, all patients had previously undergone repeated urethral dilatations. Postoperative results showed that 51 patients (94.5%) were able to void with a mean Qmax of 26.2 mL/s and a mean PVR of 12 mL. One patient developed recurrent urethral stricture, and one developed urethral fistula, who were treated with redo urethroplasty. One patient had recurrent obstruction but with urethral caliber of 18 Ch, and the urodynamic exam showed detrusor hypocontractility. None developed urinary incontinence, and 100% of sexually active patients regained sexual function within 6 months.
  Conclusions: BMG urethroplasty is an effective and safe technique for treating FUS, providing excellent long-term outcomes in terms of urinary and sexual function. Although there is no consensus on the optimal surgical approach for FUS, this study contributes valuable insights into the management of this condition, demonstrating the effectiveness of this technique for both distal and proximal.

MP-23.08—Comparative Analysis of Dorsal and Ventral Onlay Urethroplasty for Female Urethral Stricture 

• Kore Rajiv, Dhakne Babasaheb
  Warana Institute of Uro-Surgery, Kolhapur, India

• Introduction and Objectives: Previously underdiagnosed condition female urethral stricture (albeit increasingly being reported) is repaired with two placement approaches. The literature addressing comparison of these approaches is sparse. This study evaluates and compares the outcome of dorsal and ventral onlay female urethroplasty.
  Materials and Methods: Out of the 50 patients undergoing female urethroplasty, 36 completed minimum of 30 months of follow-up. The study period was between July 2015 and June 2024. They were grouped into two cohorts—1. Dorsal onlay (DO) and 2. Ventral onlay (VO). The quantitative analysis of these cohorts was done using measurable parameters such as AUA symptom score (AUASS), including AUA quality of life score (AUA-QOL), uroflowmetry (Q-max), and post void residue in ultrasound (PVR), both during the diagnostic evaluation and follow-up. Technically, DO was done with an inverted U incision around the meatus and dissection in subpubic space followed by dorsal urethrotomy, while the ventral onlay was done through a longitudinal anterior vaginal incision and ventral urethrotomy. In both groups, a buccal mucosal graft was used. Statistical analysis was done using two-independent-sample t-test.
  Results: There were 21 and 15 patients in DO and VO, respectively. Both the cohorts were matched in average age (53 and 47 years, respectively), length of stricture (15 and 17 mm, respectively), and etiology. The commonest etiology was iatrogenic in both. Operating time was comparable (average 96 and 90 min, respectively). There was no incontinence in either group, but wound bleeding in one patient of DO and UTI in two of VO. The t-test showed no statistical difference in improvement in the measurable parameters in DO and VO, the p-value being 0.783, 0.929, and 0.656 in AUASS, Q-max, and AUAQOL, respectively, and only a minor difference in improvement in PVR. There were two symptomatic recurrences in DO and one in VO (success rate of 90.5% and 93%, respectively). There were distinct technical nuances making DO more suitable for distal strictures and VO for proximal.
  Conclusions: The outcome of both DO and VO approaches was efficacious, comparable and with fewer complications. There were distinct technical advantages, making them more suitable for different locations of female urethral strictures.

MP-23.09—Do Prior Endoscopic Interventions Aggravate the Complexity of Stone-Induced Ureteral Strictures? 

• He Qiyu, Zhou Liang, Wang Kunjie
  West China Hospital, Sichuan University, Chengdu, China

• Introduction and Objectives: The impact of failed endoscopic treatment on the characteristics of ureteral strictures (US) requiring salvage reconstruction remains unclear. This study examines how prior endoscopic interventions affect the complexity of stone-related US.
  Materials and Methods: This prospective study included patients with stone-related US who underwent reconstructive surgery at West China Hospital (January 2022–March 2024). Stricture length was measured intraoperatively using a graduated ureteral catheter. Surgical approaches were classified as simple (ureteroureterostomy, pyeloplasty, reimplantation) or complex (oral mucosa graft, Boari flap, ileal ureter substitution). Patients were followed for at least 1 year. Success was defined as obstruction resolution and hydronephrosis improvement; failure included persistent obstruction or need for further intervention. Pearson’s correlation and multivariate regression were used to analyze associations and control for confounding variables.
  Results: This study analyzed 342 patients with stone-related US, 76.6% in the upper-mid ureter. Prior endoluminal treatments (21.9%) were associated with longer strictures (2.0 cm vs. 1.0 cm) and greater complexity. Treated cases more often required complex reconstructions, like oral mucosa grafts (47.7% vs. 15.2%), while untreated cases favored simpler approaches, such as ureteroureterostomy (80.1% vs. 47.7%). For distal US, reimplantation was preferred in untreated cases (65.5% vs. 37.4%), while ileal ureter substitution was more common in treated cases (24.9% vs. 0.0%). Treated patients had longer operative times (216 vs. 192 min), but success rates were similar (87.25%).
  Conclusions: Prior endoluminal treatment independently predicted US complexity. While reconstruction success rates were similar, patients with prior endoluminal treatment had longer strictures, required more complex reconstructions, experienced longer surgeries, and had higher perioperative complication rates. This highlights the need to carefully consider the risks and benefits of endoluminal treatment in decision-making.

MP-23.10—Medium Term Outcome Analysis of Urethroplasty for Female Urethral Stricture 

• Kore Rajiv, Dhakne Babasaheb
  Warana Institute Of Uro-Surgery, Kolhapur, India

• Introduction and Objectives: Many centers are achieving favorable outcomes with the reconstruction of female urethral stricture. However, follow-up studies are scant. Our goal is to share the medium-term outcome of buccal mucosal graft (BMG) female urethroplasty.
  Materials and Methods: The study period was between March 2015 and September 2024. Out of the 50 patients undergoing urethroplasty, only those who completed 60 months of follow-up were included. The diagnostic evaluation included clinical examination (AUA symptom score—AUASS, including AUA quality of life score (AUA-QOL), uroflowmetry (Q-max), ultrasound (PVR), voiding cystourethrogram (VCUG), calibration, and urethro-cystoscopy). The patients were followed annually with AUASS, including AUA-QOL, Q-max, and PVR. Other tests (VCUG, calibration, and urethrocystoscopy) were done only if indicated. The statistical analysis was done using the paired t-test and 95% confidence intervals.
  Results: There were 28 patients (with minimum follow-up of 60 months) having mean age of 45 years (IQR 27–75). Stricture etiology was iatrogenic, infective, and idiopathic in 17 (60.7%), 10 (36%), and 1(3%) respectively. Seventeen (60.7%) patients had previously undergone urethral dilatation. The location was 15 (53.5%), 10 (36%), 2 (3.5%) in distal, mid, and proximal urethra, respectively. There was 1 pan-urethral stricture. The average length was 12 mm (IQR 8–34). The AUASS, Q-max, PVR improved from mean of 21 to 6, 5 mL/s to 27 mL/s, 166 mL to 10 mL, respectively. AUA-QOL improved from 5 to 1. Two patients suffered urinary tract infection, and one patient had postoperative wound bleed. There were 2 recurrences at 6 and 13 months of follow-up. The result of paired T test showed that improvement in the AUA symptom score, Q-max, and PVR mean values (with mean standard error) was from 21.333 (0.7314) to 5.952 (0.2437), from 4.810 (0.5328) to 26.619 (1.5576), and from 182.11 (8.871) to 12.37 (1.808), respectively. It was statistically significant (p-value = 0.000).
  Conclusions: BMG female urethroplasty is safe and effective with fewer complications. This study suggests sustained favorable medium-term outcome with 93% success rate. The limitations of the study were its small sample size, which is expected for this condition, and its retrospective nature. A multicenter prospective study with a collectively larger sample size would establish its long-term efficacy.

MP-23.11—Multifactorial Predictors of Urethral Stricture Recurrence Following Urethroplasty: A Prospective Analysis from a Protocol-Driven Regional Reconstructive Cohort 

• Joshi Sachin, Desai Devang
  Toowoomba Base Hospital, Toowoomba, Australia

• Introduction and Objectives: Urethroplasty remains the definitive treatment for urethral stricture disease; however, recurrence poses an enduring clinical challenge. The aetiology of recurrence is likely multifactorial, yet existing data are limited by retrospective designs, heterogeneity in surgical technique, and inconsistent follow-up. We aimed to identify independent predictors of stricture recurrence in a prospective cohort managed by a single fellowship-trained reconstructive urologist, employing protocolised surgical and follow-up practices within a regional hub framework.
  Materials and Methods: All adult male patients undergoing urethroplasty from January 2017 to October 2024 were prospectively enrolled across multiple regional institutions. Data collected included demographic parameters (age, diabetes, smoking status), prior interventions (urethrotomy, dilation, clean intermittent self-catheterisation), and stricture characteristics (aetiology, length, location, obliterative status). Recurrence was defined as symptomatic deterioration requiring secondary intervention. Multivariable logistic regression and Fisher’s exact test were utilised to evaluate associations with recurrence.
  Results: A total of 188 patients (216 stricture presentations) were analysed. The overall success rate, defined as symptomatic resolution without reintervention, was 89.6% over a median follow-up of 21 months (range: 6–60). Active smoking significantly increased recurrence risk (OR 2.70 [1.58–5.21]), as did a history of prior urethrotomy (OR 2.13 [1.06–4.28]); both p < 0.05. Radiation-associated strictures had the highest recurrence risk among all aetiologies (OR 17.33 [1.19–253.19]; p = 0.037). Distal penile strictures involving the fossa navicularis/meatus demonstrated greater recurrence than mid-bulbar strictures (OR 2.90 [1.14–7.37]; p = 0.026). Diabetes mellitus, obliterative stricture status, stricture length, prior dilation, and CISC were not statistically significant predictors (p > 0.05). All procedures were performed using standardised techniques by a single reconstructive surgeon, providing methodological consistency rarely observed in existing literature.
  Conclusions: This prospective, surgeon-controlled series demonstrates that smoking, prior urethrotomy, radiation aetiology, and distal stricture location are independent predictors of recurrence. The absence of association with diabetes, stricture length, or obliteration challenges some historical assumptions. Importantly, this study affirms that high-fidelity reconstructive outcomes are achievable within regionalised care models when delivered by subspecialised expertise under consistent protocol. These findings may inform patient selection, counselling, and health system design, particularly in resource-limited or decentralised settings.

MP-23.12—Musculocutaneous Latissimus Dorsi Phalloplasty with Concurrent Transvaginal Female Genitalia Removal in Transgender Female to Male Patients 

• Djinovic Rados, Slavkovic Milan
  Sava Memorial Hospital, Belgrade, Serbia

• Introduction and Objectives: Phalloplasty is a vital component of gender-affirming surgery for transgender men. The musculocutaneous latissimus dorsi (MLD) flap offers a reliable technique for constructing a neophallus with suitable size and functional outcomes. Traditionally, female genitalia removal is performed in a separate procedure. This study evaluates the outcomes of performing MLD phalloplasty concurrently with transvaginal hysterectomy, bilateral adnexectomy, and colpocleisis.
  Materials and Methods: A retrospective review was conducted on 75 transgender men who underwent three-stage MLD phalloplasty with simultaneous transvaginal female genitalia removal in the first stage between 2018–2024. All patients had at least 12 months of testosterone therapy and 12 months of follow-up post-final stage. Surgical technique, complications, functional and aesthetic outcomes, and patient satisfaction were assessed.
  Results: The mean patient age was 27.6 years. The average neophallus measured 14.8 cm in length and 14.2 cm in girth. Complications included urethral stricture (25.3%), fistula (5.3%), and partial or total flap necrosis (3.9%). At 38 months follow-up, 76% could void while standing, 84% reported preserved erogenous sensation (through the clitoris at the base of the phallus), and 90.6% expressed satisfaction with aesthetic outcomes. The third stage (penile prosthesis implantation) was completed in 64% of patients.
  Conclusions: Simultaneous MLD phalloplasty and female genitalia removal is a feasible and efficient approach in transgender men, reducing the number of surgical sessions and hospitalizations without increasing complication rates. High levels of patient satisfaction and favorable functional results support its broader adoption. Further studies are needed to refine urethral reconstruction and assess long-term outcomes.

MP-23.13—Peyronie’s Disease in Specific Cases—Minimally Invasive Surgical Approach with Vacuum Physiotherapy 

• Djinovic Rados, Slavkovic Milan
  Sava Memorial Hospital, Belgrade, Serbia

• Introduction and Objectives: This retrospective study assesses a minimally invasive surgical technique for treating Peyronie’s disease (PD) combined with postoperative vacuum physiotherapy. The technique aims to correct penile deformity by tunical lengthening and restoring sexual function without the use of grafts to reduce complications such as postoperative penile retraction.
  Materials and Methods: Forty-four patients aged from 31–74 (mean 49) were operated on from 2013 to 2024; inclusion criteria were isolated, strip-like plaques on longitudinal tunic fibres, or the ones smaller than 1.5 cm, good erection and strong motivation to apply postoperative physiotherapy. A lower sagittal penile skin incision was used to approach the tunica albuginea by unilateral, paraurethral neurovascular bundle mobilisation and penile eversion. The plaque was treated by multiple superficial incisions along its length with the aim of correcting the deformity and maximally preserving erectile tissue. A drain was placed, the wound reconstructed by layers, and the elastic, self-adhesive compressive dressing was applied and fixed for 5–6 days. Ten to fourteen days after the surgery, patients were advised to start with vacuum physiotherapy intermittently for 15–20 min, 2–3 times per day for at least 6 months, to prevent penile retraction and maintain the light.
  Results: We succeeded in following 32 patients, with a mean follow-up of 3 years. The outcome was accessed by the reduction of the curvature: 63% of patients had complete correction of the deformity, 22% had mild, and another 13% had moderate residual curvature, while 9% had recurrence with penile shortening. One patient developed de novo erectile dysfunction. Three patients eventually required reintervention, including penile prosthesis implantation. Most patients retained erectile function, with 78.3% resuming intercourse. Patient satisfaction was high (82%), and most avoided further intervention. Temporary penile numbness occurred in 31.8%.
  Conclusions: Superficial plaque incision by tunical attenuation, combined with vacuum therapy, offers an effective alternative to grafting in early PD. It achieves both structural correction and functional preservation with a relatively low complication rate. Further long-term studies with larger populations are needed to confirm durability and optimise patient selection.

MP-23.14—Pneumovesical Vesicovaginal Fistula Repair: Lessons Learned from an Initial Series of 25 Patients 

• Jeon Byeong Jo ¹, Tae Bum Sik ¹, Oh Cheol Young ², Park Jae Youn ¹, Bae Jae Hyun ¹
  ¹ Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea, ² Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea

• Introduction and Objectives: This study aims to share experiences and outcomes of laparoscopic pneumovesical repair for vesicovaginal fistulas (VVF).
  Materials and Methods: A retrospective review of medical records from a single institution over 10 years was conducted. The focus was on patients who underwent VVF repair using a pneumovesical approach with three 5 mm laparoscopic ports. The study evaluated perioperative parameters, postoperative outcomes, and complication rates to assess the efficacy and safety of this surgical method. Cumulative sum (CUSUM) analysis was used to determine the learning curve based on operative time.
  Results: Of 26 patients with VVF, 23 (88.5%) had successful fistula closure after the first surgery. One patient required open surgery conversion due to challenges in maintaining pneumovesicum, and two experienced recurrences, although successful repairs were achieved in subsequent surgeries. The average patient age was 47.4 years, with a mean operative time of 99.9 min. The postoperative hospital stay averaged 9.1 days, and catheterization lasted about 11 days. The CUSUM chart indicated a learning curve, with fluctuations until the 19th case, followed by a consistent upward pattern.
  Conclusions: Of 26 patients with VVF, 23 (88.5%) had successful fistula closure after the first surgery. One patient required open surgery conversion due to challenges in maintaining pneumovesicum, and two experienced recurrences, although successful repairs were achieved in subsequent surgeries. The average patient age was 47.4 years, with a mean operative time of 99.9 min. The postoperative hospital stay averaged 9.1 days, and catheterization lasted about 11 days. The CUSUM chart indicated a learning curve, with fluctuations until the 19th case, followed by a consistent upward pattern.

MP-23.15—Single-Stage Panurethroplasty with Split-Thickness Skin Grafts Harvested from the Thigh: Technique Description and 48-Month Follow-up Results 

• Basile Greta ¹, Bucca Bruno ¹, Gobbi Luca Matteo ¹, Dalpiaz Orietta ², Gozzi Christian ³
  ¹ Sapienza University of Rome, Rome, Italy, ² Hochsteiermark Hospital, Leoben, Austria, ³ City Clinic, Bolzano, Italy

• Introduction and Objectives: This study evaluates the feasibility and clinical outcomes of single-stage dorsal onlay urethroplasty using split-thickness skin grafts (STSG) harvested from the thigh as a surgical option for panurethroplasty.
  Materials and Methods: From July 2019 to November 2023, we treated 10 patients with urethral strictures ≥ 10 cm at a single center using a single-stage dorsal onlay technique with STSG harvested from the thigh using an electric dermatome. Patients underwent preoperative and postoperative assessments. Follow-up evaluations included uroflowmetry at 1, 6, 24, and 48 months, as well as the IIEF-5 and IPSS-QoL questionnaires at 48 months.
  Results: The median patient age was 59 years. The median stricture length was 10 cm. A suprapubic catheter was present in 80% of cases. Urethral strictures were located in 40% of penile and 60% of bulbar-penile regions. The median operative time was 188 min (IQR 52.5). The median hospital stay was 5 days (IQR 1.75). The median catheter indwelling time was 21 days. At 1 month postoperatively, the median Qmax was 28.5 mL/s, and PVR was 20 mL. At 6 months, Qmax was 23.5 mL/s, and PVR was 20 mL. At 24 months, Qmax was 22 mL/s, and PVR was 30 mL. At 48 months, Qmax was 20 mL/s, and PVR was 20 mL. At 48 months, the median IIEF-5 score was 23 (IQR 10.75), the IPSS score was 3 (IQR 4.25), and the QoL score was 1 (IQR 1).
  Conclusions: Single-stage panurethroplasty with STSG is a feasible, effective, and durable surgical option. Larger studies are needed to validate these findings.

MP-23.16—Single-Stage vs. Staged Repair of Proximal Hypospadias: Outcomes in 35 Patients at a Tertiary Referral Hospital 

• Joshi Pankaj, Kirugo Keagan
  Urokul, Pune, India

• Introduction and Objectives: Proximal (severe) hypospadias presents a surgical challenge, and the optimal repair strategy remains debatable. Surgeons can choose a single-stage urethroplasty or a planned two-stage approach. A single-stage repair avoids multiple operations and offers a quicker overall correction, whereas a staged repair allows correction of severe curvature and tissue deficiencies in steps. Given the lack of consensus on which technique yields superior outcomes, we compared complication rates and patient satisfaction between single-stage and staged repairs in primary proximal hypospadias.
  Materials and Methods: We reviewed 35 patients with primary proximal hypospadias (no prior hypospadias surgery) who underwent repair at our institution over a 10 year period. Of these, 17 patients received a single-stage repair and 19 patients underwent a two-stage repair. All cases involved a proximal urethral meatus (penoscrotal or more proximal). We recorded postoperative complications—including urethrocutaneous fistula, stricture, and wound dehiscence—and assessed patient or parent satisfaction with cosmetic and functional outcomes. Complication rates and satisfaction scores were compared between the single-stage and staged groups.
  Results: Complication rates were comparable between the single-stage and staged repair groups. The incidence of postoperative urethrocutaneous fistulas and other complications showed no statistically significant difference between the two techniques. Patient (or parent) satisfaction was likewise high and nearly equal in both cohorts. Both groups achieved satisfactory cosmetic appearance and urinary function, with no notable differences in subjective outcome scores. In summary, neither approach demonstrated a clear advantage in terms of complication frequency or patient-reported satisfaction.
  Conclusions: In this series of primary proximal hypospadias repairs, single-stage and staged techniques yielded similar outcomes. Both approaches achieved equivalent complication rates and patient satisfaction. These findings suggest that either surgical strategy can be appropriate for proximal hypospadias. The choice of single-stage versus staged repair may be guided by individual case factors and surgeon expertise, as both methods appear equally effective in producing favorable clinical and patient-centered results.

MP-23.17—Two-Stage Bulbo-Membranous Buccal Mucosa Graft Urethroplasty 

• Djinovic Rados, Slavkovic Milan
  Sava Memorial Hospital, Belgrade, Serbia

• Introduction and Objectives: This retrospective study evaluates the efficacy and outcomes of two-stage buccal mucosal graft (BMG) urethroplasty in the treatment of long bulbo-membranous urethral strictures/obstruction with severe spongiofibrosis; it is the alternative to direct anastomotic repair or permanent perineostomy.
  Materials and Methods: Between 2008 and 2023, a cohort of 23 male patients (mean age: 59 ± 7 years) underwent two-stage BMG urethroplasty. Etiologies included post-traumatic (7), iatrogenic (4) and repeated failed urethroplasty (12 patients). The inclusion criteria were long-segment stricture or complete urethral obliteration, where direct anastomotic repair was impossible or would cause severe penile curving. After excision of the fibrotic urethra and identification of the proximal segment, a buccal mucosal graft of the average length 7 cm was quilted to the defect from the membranous to the healthy bulbar urethra. The edges of the buccal mucosa were joined to the perineal skin, forming a temporary perineostomy; the graft was treated with topical ointments all the time till the next surgery. Perineostomy was closed 6 or more months later by tubularization under local or regional anaesthesia. The catheter was removed three weeks postoperatively.
  Results: Thirteen out of 23 patients were followed up for a mean of 42 months. Ten of these (76.9%) maintained satisfactory voiding function as assessed by symptom-based anamnesis and video assessment of urination. Three experienced recurrences of stricture. One case of urethrocutaneous fistula resolved spontaneously with prolonged catheterization. Erectile function was preserved in all patients.
  Conclusions: Two-stage BMG urethroplasty can be a reliable and effective technique for managing long and severe bulbs-membranous urethral strictures with dense spongiofibrosis, where direct anastomosis is not viable. It represents a valuable alternative to perineostomy or single-stage repair in challenging reconstructive settings.

MP-23.18—Urinary Function After Masculinising Gender Affirmation Surgery—Metoidioplasty with Hook-Up: Insights from a One-Year Uroflowmetry Studies 

• Tinajero Juan Diego, Oliver Rachel, Di Taranto Giuseppe, Flint Richard, Ahmed Jeffrey, Zachou Alexandra, Djordjevic Miroslav
  Chelsea Centre for Gender Surgery. Chelsea and Westminster Hospital NHS Trust., London, United Kingdom

• Introduction and Objectives: Metoidioplasty with hook-up is a gender-affirming surgical procedure aimed at masculinizing genitalia while enabling patients to void while standing. There is little information on how the surgery leads to changes in urinary flow dynamics and the development of lower urinary tract symptoms (LUTS). This study aims to analyze the impact on urinary dynamics postoperatively, assessing changes in uroflowmetry at 3, 6, and 12 months and the incidence of associated complications.
  Materials and Methods: We retrospectively analyzed data from 36 patients with a formal diagnosis of gender dysphoria, fulfilling the WPATH criteria for genital surgery, who underwent metoidioplasty with hook-up and vaginectomy between January 2023 and July 2024. Preoperative and postoperative uroflowmetry values, including Qmax and PVR, were collected at 3, 6, and 12 months. Statistical analysis was conducted using paired t-test to assess the significance of changes in Qmax and PVR between preoperative and postoperative time points.
  Results: Twenty patients were included, mean age was 32 years (range: 21–52), and mean follow-up was 9.15 months (range 16.2–3.2). Preoperatively, mean Qmax was 27.54 mL/s (range: 11.5 to 53 mL/s) and mean PVR was 20.15 mL (range: 0 to 81 mL). Only 3 (15%) patients reported LUTS. At 3 months, Qmax decreased to 16.84 mL/s (p = 0.003), with a slight increase in mean PVR to 23.33 mL. At 6 months, Qmax improved to 19.62 mL/s (p = 0.03), while PVR increased to 73.87 mL. By 12 months, Qmax improved to 21.45 mL/s, approaching preoperative levels, and PVR decreased to 47 mL. The development of LUTS was common, with 35% of patients experiencing dribbling and one patient developing obstructive symptoms with a flat uroflow who is pending further investigations. Fistulas were noted in 3 patients, with 2 patients requiring secondary procedures.
  Conclusions: Metoidioplasty with hook-up significantly impacts urinary dynamics, resulting in a reduction in Qmax and an increase in PVR in the postoperative period. While Qmax tends to improve over time, returning close to preoperative levels by 12 months, PVR remains elevated. The changes in urinary dynamics and the development of postoperative obstructive LUTS highlight the need for thorough preoperative counseling and postoperative follow-up to address.

23.2. Moderated Video ePosters

MVP-23.01—Feminizing Genitoplasty in Prader Stage 3 Disorders of Sex Development: A Step-by-Step Surgical Video 

• Yadav Mithilesh, Nayak Prasant, Rathod Vivek, Muhammad Huzaifa
  All India Institute of Medical Sciences, Bhubaneshwar, India

• Introduction and Objectives: Disorders of sex development (DSD) present unique surgical challenges, particularly in cases of 46 XX individuals with congenital adrenal hyperplasia (CAH) and Prader Stage 3 virilization. Feminizing genitoplasty, including vaginoplasty, introitoplasty, and clitoroplasty, aims to restore both functional and aesthetic genital anatomy while preserving neurovascular integrity. Objective: This video presentation demonstrates a step-by-step surgical approach to feminizing genitoplasty in a Prader Stage 3 DSD patient, highlighting key technical considerations, challenges, and outcomes.
  Materials and Methods: A perineal approach was utilized for vaginoplasty, ensuring adequate vaginal canal depth and positioning. Introitoplasty was performed to create a well-proportioned vaginal opening, and clitoroplasty involved nerve-sparing reduction to maintain sensory function. The video provides detailed intraoperative steps, including tissue dissection, flap techniques, and suturing methods, along with preoperative planning and postoperative care considerations.
  Results: The procedure resulted in a well-formed, functional, and aesthetically appropriate external genitalia with preserved clitoral sensation and adequate vaginal depth. Intraoperative blood loss was minimal, and no major complications were encountered. The patient demonstrated satisfactory early postoperative healing, with long-term outcomes dependent on hormonal therapy and ongoing follow-up.
  Conclusions: This video serves as a valuable educational tool for urologists, gynecologists, and reconstructive surgeons, emphasizing the technical refinements necessary in managing DSD cases with Prader Stage 3 virilization. A multidisciplinary approach involving surgeons, endocrinologists, and psychologists is critical for optimizing functional, anatomical, and psychosocial outcomes in such patients.

MVP-23.02—Salvage Vaginoplasty with Single-Port Robot Assisted Tubularized Urachus Peritoneal Hinge Flap: Technique Highlights, Outcomes, and an Evidence-Based Proposal for How and When to Use (and Not Use!) Peritoneum with Vaginoplasty 

• Garcia Maurice, Talamas Alejandro, Dadashian Eman, Sandhu Sandeep, Smith Shannon, Mallavarapu Samhita, Stelmar Jenna, Yuan Nance, Gupta Amit, Kim Hyung
  Cedars Sinai, Los Angeles, United States

• Introduction and Objectives: Currently, only two published gender-affirming vaginoplasty techniques describe using peritoneal tissue to contribute to the neovaginal canal: The modified Davydov technique, first described by Zhao et al. (2019), and the Tubularized Urachus-Peritoneal Hinge Flap, described by Garcia et al. (2022). Today, many providers use the Davydov technique at the time of primary vaginoplasty, while other providers argue that use of peritoneum is not necessary at the time of primary vaginoplasty. We use peritoneum (urachus-flap) only for salvage surgery. We report urachus hinge-flap technical innovations, and clinical outcomes at 1.5-years postoperatively. We also review the literature to determine whether there is evidence to support using peritoneum at time of primary vaginoplasty.
  Materials and Methods: We review our single-port robot-assisted urachus hinge flap technique to augment neovaginal depth following primary vaginoplasty. We also review technical innovations to maximize neovaginal depth with primary vaginoplasty using only penile and scrotal skin. We present our literature review and posit a theory that explains why, regardless of PV technique, mean neovaginal depth is 11–13 cm in all series.
  Results: Our mean neovaginal depth after salvage urachus hinge flap technique is 12.5 cm (range 11–14.2) at 409 days post-op, comparable to the Davydov technique. With primary vaginoplasty using only penile and scrotal skin, our mean depth is 12.5 cm, which is comparable to other series. We use video to show how, with the Davydov technique, rectum and bowel are pulled deep into the pelvis post-op, which increases risk of bowel injury at time of salvage surgery with intestine.
  Conclusions: By the techniques described herein, we are able to achieve comparable vaginal depth as other groups that use the “pull-through” technique. We suggest that peritoneum is only rarely necessary at primary vaginoplasty and should be reserved for use as a salvage surgery if needed. As a salvage technique, the urachus flap is a safer alternative to the Davydov technique, because the urachus flap does not involve bowel or yield adhesions that complicate “post-peritoneal vaginoplasty salvage intestinal vaginoplasty”.

23.3. Unmoderated Standard ePosters

UP-23.01—Impact of Prior Urethral Dilatation or Direct Visual Internal Urethrotomy (Dviu) on the Outcome of Anterior Urethroplasty 

• Naz Kanwal, Abidi Syed Saeed
  Sindh Institute of Urology and Transplantation, Karachi, Pakistan

• Introduction and Objectives: Male urethral stricture disease is a prevalent and debilitating condition in urologic practice, often leading to significant morbidity and impaired quality of life. While initial management strategies such as urethral dilatation and direct visual internal urethrotomy (DVIU) are commonly employed, their long-term efficacy remains suboptimal, with high recurrence rates necessitating definitive surgical intervention. Urethroplasty has emerged as the gold standard for durable repair, offering superior success rates and reduced recurrence compared to minimally invasive techniques. However, the impact of prior urethral instrumentation—specifically dilatation or DVIU—on the outcomes of anterior urethroplasty remains a topic of ongoing debate. Existing literature presents conflicting evidence, with some studies suggesting that prior interventions increase surgical complexity due to fibrosis, extended stricture length, and vascular compromise, while others report negligible effects on long-term success. This study aims to address this clinical ambiguity by evaluating whether a history of urethral dilatation or DVIU influences intraoperative challenges (e.g., blood loss, operative duration, fibrosis) and postoperative success rates in patients undergoing anterior urethroplasty. By investigating these relationships, our findings seek to guide clinical decision-making, optimize patient selection, and underscore the importance of timely referral for definitive surgical management.
  Materials and Methods: A prospective cohort study was conducted at our institute (August 2021–February 2022). Sixty-six patients were stratified into Group A (no prior surgery, n = 33) and Group B (prior DVIU/dilatation, n = 33). Preoperative assessments included uroflowmetry and urethrography. Intraoperative parameters (blood loss, operative time, fibrosis) and postoperative success (uroflowmetry > 15 mL/s at 3 months) were analyzed. Statistical significance was set at p ≤ 0.05.
  Results: Group B demonstrated significantly higher intraoperative blood loss (66.67% vs. 15.16%, p < 0.001), prolonged operative time (78.79% vs. 12.12%, p < 0.001), and increased fibrosis (75.76% vs. 3.03%, p < 0.001) compared to Group A. Despite these challenges, success rates were comparable (Group A: 96.97%, Group B: 87.88%, p = 0.163). Trauma was the predominant etiology in both groups (81.81% vs. 60.60%).
  Conclusions: Prior urethral instrumentation increases intraoperative complexity but does not significantly compromise urethroplasty success when performed by experienced surgeons. Early referral for definitive management may reduce procedural challenges.

UP-23.02—”DVIU vs. Non-Transecting Urethroplasty in Short Bulbar Strictures: 1-Year Patient-Reported Outcomes” 

• N Sanjith, Chawla Arun, Gali Kasi
  Kasturba Medical College, Manipal, Mahe Deemed To Be University, Udupi, India

• Introduction and Objectives: To compare the objective and subjective outcomes of direct vision internal urethrotomy (DVIU) and non-transecting urethroplasty in the treatment of non-traumatic, short-segment bulbar urethral strictures over a one-year follow-up period, utilizing uroflowmetry parameters and patient-reported outcome measures (PROMs).
  Materials and Methods: A prospective observational study was conducted on patients with bulbar urethral strictures ≤ 2 cm. Patients were categorized into three groups: DVIU, Non-Transecting Anastomosis (NTA), and Augmented NTA (ANTA). Primary outcome measures included the Objective assessment with uroflowmetry and Subjective assessment with USS-PROM, IPSS, CLSS, SHIM and MSHQ questionnaires at 3, 6, and 12 months. Statistical analysis was performed using the Friedman and Kruskal-Wallis tests to compare outcomes across groups.
  Results: A total of 79 patients were enrolled, with 31 undergoing DVIU, 21 NTABU/HM (Non Transecting Anastomotic Bulbar Urethroplasty/Heineke-Mikulicz stricturoplasty), and 27 ANTABU (Augmented Non Transecting Anastomotic Bulbar Urethroplasty). The mean (SD) age was 54.91 (14.84) years, and stricture length was 1.69 (0.31) cm. At one-year follow-up, improvements in Qmax, USS-PROM, IPSS, and CLSS scores were significantly higher in the NTABU/HM and ANTABU groups (p < 0.001). Quality of life (EQ-5D) was highest in ANTABU (p = 0.038), while DVIU group had superior EQ (p = 0.003) and EJF (p < 0.001) scores. Patient satisfaction (USS PROM) was highest in NTABU/HM (90.48%) and ANTABU (92.59%) versus DVIU (70.97%) (p = 0.05). Post-void dribbling occurred in 22% of ANTABU and 14.2% of NTABU/HM patients at one month but resolved by six months. The one-year recurrence rate was 25% for DVIU, with only one failure in NTABU/HM and none in ANTABU (p < 0.001).
  Conclusions: Non-transecting urethroplasty techniques demonstrate significantly better one-year outcomes compared to DVIU in terms of Qmax improvement, symptom relief, quality of life, and patient satisfaction, with markedly lower recurrence rates in the management of short segment non traumatic obliterative bulbar urethral strictures. DVIU better preserves postoperative sexual function, while NTA techniques show comparatively higher albeit acceptable rates of long term postoperative sexual dysfunction.

UP-23.03—A Case Series on Distal Urethral Stricture and Fossa Navicularis Strictures Treated by Transurethral Buccal Graft Inlay Urethroplasty (Nikolavsky Technique) with Short- to Medium-Term Follow-up: A Preliminary Experience Study in the Philippines 

• Dino Kenneth Charles, Abalajon Mark Joseph, Andutan Raul Carlo Guido, Arellano Oyayi, Gaston Charles Anthony, Fe Jeremiah
  East Avenue Medical Center, Quezon City, Philippines

• Introduction and Objectives: Buccal Mucosal Graft (BMG) for urethral reconstruction has paved the way for the changes in reconstructive urologic surgery with new surgical techniques being developed for treatment of various urethral strictures including distal penile and fossa navicularis strictures (FNS). A surgical technique developed by Nikolavsky et al. was created to help avoid inherent technical difficulties and surgical complications associated with traditional reconstructive techniques. This study aims to describe in detail the technique of transurethral buccal graft inlay urethroplasty (Nikolavsky technique) for the repair of anterior urethral strictures located at distal urethra and fossa navicularis and discuss its outcomes in the six patients included in this case series.
  Materials and Methods: A retrospective review from June 2021–October 2024 was compiled who underwent transurethral BMG inlay urethroplasty (Nikolavsky technique). Outcomes measured include retrograde urethrogram, uroflowmetry and IPSS scoring. In this study 6 patients, mean age of 50, underwent transurethral BMG inlay urethroplasty (Nikolavsky technique) from June 2021 to September 2024. Mean follow up was 22 months with a range of 1 to 30 months.
  Results: Based on the results gathered, the mean postoperative Qmax is 19 mL/s, the mean IPSS score is at 7. All six patients in this study had successful outcomes. None of the patients underwent a redo urethroplasty or a DVIU/dilatation.
  Conclusions: The transurethral BMG inlay urethroplasty technique is an easily reproducible technique of repairing strictures located in the urethral meatus, fossa navicularis or the distal penile urethra, with good outcomes on short term to medium term follow-up.

UP-23.04—A Proposed Urachus-Based Peritoneal Hinge-Flap for Bladder Augmentation: Illustrated Surgical Technique and Fresh-Cadaver Based Surgical Video 

• Garcia Maurice, Talamas Alejandro, Harmon Derek
  Cedars Sinai, Los Angeles, United States

• Introduction and Objectives: The current standard for bladder augmentation is to use de-tubularized bowel. While plentiful, a significant limitation with this technique, however, is bowel tissue’s natural production of mucus, which contributes to various complications: outlet obstruction, catheter obstruction, resulting incomplete emptying, and infection. We developed a novel peritoneal salvage-vaginoplasty technique utilizing a urachus-based peritoneal flap, harvested from the anterior bladder wall and bladder dome, and flipped backwards (like a hinge) to connect to the posterior edge of the foreshortened neovaginal canal (Smith and Garcia, Sex Med, 2022). Our flap has three layers, each with its own blood supply (peritoneum, urachus, and transversalis fascia), and appears to survive based on our vaginoplasty data. The aim of this work is to describe the technique, address key considerations, and describe trial using a fresh-cadaver.
  Materials and Methods: A medical illustration was directed to illustrate the proposed surgical technique. A fresh cadaver was used to trial the proposed technique as illustrated. After the flap elevation, the bladder was divided far anteriorly and posteriorly, and the flap was sutured into place. The bladder was filled and emptied with saline 3X to assess for leakage.
  Results: Flap dimensions equaled what is harvested during salvage vaginoplasty surgery: 24 × 8 cm (192 cm³). The flap was sutured into place in 2 layers (peritoneum to mucosa, and transversalis to muscularis). The augmented bladder was water-tight.
  Conclusions: This technique is simple to perform and yields a surface-area comparable to use of bowel—without needing to fold segments of graft together. Importantly, it does not produce mucus. Some key considerations are: 1. Technique? (this can be done easily by Lap/Robot); 2. Absorptive electrolyte imbalances? (electrolyte absorption is mostly by visceral peritoneum, whereas our flap is parietal peritoneum); and 3. Does the flap contract? Unknown, but likely even less than with vaginoplasty; 4. Would the flap balloon? Also unlikely, given the urachus and transversalis layers, but it could be re-enforced with a biologic graft. Next steps are trials in animal models to assess potential histologic changes.

UP-23.05—A Proposed Urachus-Based Peritoneal Hinge-Flap for Repair of Genito-Urinary and Recto-Vesical, Urethral and Vaginal Fistulae in Men and Women 

• Talamas Alejandro, Garcia Maurice, Pagliarulo Vicenzo, Zaliznyak Michael, Dadashian Eman, Smith Shannon
  Cedars Sinai, Los Angeles, United States

• Introduction and Objectives: We developed a pedicled urachus-based peritoneal hinge-flap for gender-affirming salvage vaginoplasty (Smith and Garcia, Sex Med, 2022) and have found the technique simple and durable. We considered other uses for this versatile, well-vascularized pedicle flap and found that this flap can be useful to cover the repair site for various lower urinary tract, rectal and vaginal fistulae, as well. The flap can be rotated on either side of the bladder, or between the bladder and rectum, or on either side of vagina, to cover and reinforce a variety of common fistula repair sites. Our objective was to describe the flap, its anatomic margins, and report on our experience using it in 7 cases.
  Materials and Methods: The flap contains three layers, each with an independent blood supply: peritoneum, urachus/medial umbilical ligaments, and Transversalis fascia. The flap is taken just lateral to the medial umbilical ligaments and can be elevated caudally as far as the posterior wall of the bladder, depending on the length needed. When harvested from the level of the umbilicus, 24 cm of flap length can be reliably achieved. Flap width (at mid-length) is 8–9 cm. Maximum caudal reach of the flap is to the level of 2–3 cm from the perineum.
  Results: We have used this flap to cover 1 bladder diverticulum excision site (endoscopic circumferential excision & Robotic flap harvest; video provided), 4 colo-vesical repair sites (3 Robotic, 1 lap), and 2 vesico-vaginal fistulae (Robotic). In each case, the flap easily reached the repair site and was sutured into place, without detectable sequellae. We cover the repair site with the peritoneal surface of the flap.
  Conclusions: As shown in Figure 1, the flap’s anatomic location and dissection are very familiar to urologist laparoscopic surgeons. The flap’s reliable blood supply, long available length, and ability to rotate the flap as desired make it a useful adjunct to complex repairs for urologists to consider.

UP-23.06—A Radiographic Description of the Distance from the Urethral Meatus to the Anal Verge in cis and Transgender Women: An MRI-Based, Anatomic Description of a Cause for Higher UTI Rates in Transgender Women 

• Talamas Alejandro, Garcia Maurice, Smith Jasmine, Shiang Alexander, Dadashian Eman
  Cedars Sinai, Los Angeles, United States

• Introduction and Objectives: Patients undergoing vaginoplasty for gender-affirmation require reconstruction of their anatomy. One key anatomic structure is the urethra position. It is known that transgender women (TW) are more likely to develop urinary tract infections as compared to cisgender women (CW) (12% vs. 29%). Several considerations of an elevated risk could be related to the anatomic differences between a natal vulva and reconstructed vulva, the differences in commensal bacteria present in the vaginal canal and the need for repetitive dilation and douching for transgender women. No published reports have evaluated the anatomic difference between CW vulvar anatomy as compared to transgender women’s vulvar anatomy (extrapolated from natal male anatomy), specifically evaluating the distance between the urethral meatus and anal verge.
  Materials and Methods: We reviewed MRI scans of individuals with natal male and female anatomy to determine the distance of the native urethra (in CW) and neourethral meatus (in TW, extrapolated from natal male anatomy). The distance was calculated as a direct line between these two structures. Statistical analysis using an unpaired T-Test was used.
  Results: MRIs of 25 CW with normal genital anatomy and 28 individuals with natal male anatomy (surrogate for TW) were reviewed. Mean distance from the urethral meatus to the anal verge was found to be 42.6 ± 6.4 mm (range: 32.5–55.9 mm) in cisgender female anatomy, and mean distance from the neourethral meatus position for TW to the anal verge based on natal male anatomy was 33.5 ± 6.1 mm (range: 24.6–52.9 mm) (p < 0.0001).
  Conclusions: We note a difference in the distance of the neourethral meatus to the anal verge in transgender women as compared to cisgender women. This anatomic difference can be potential cause for increased UTI rates in addition to other factors. This shows the importance of reducing bacterial burden by voiding regularly throughout the day, and also after dilation, douching, and vaginal intercourse, and finally the importance of wiping away from the urethra to prevent bacterial colonization.

UP-23.07—A Rare Tumor Originating from a Flap After Urethroplasty: Epithelioid Inflammatory Myofibroblastic Tumor/Sarcoma 

• Sürmeli Bahattin ¹, Sabuncu Kubilay ², Horuz Rahim ², Albayrak Selami ²
  ¹ Medipol University, İstanbul, Türkiye, ² İstanbul Medipol University, İstanbul, Türkiye

• Introduction and Objectives: Flap-based urethroplasty is a reconstructive option for long-segment urethral strictures, especially when local tissue is insufficient. Although rare, malignant transformation in skin flaps used for urethral reconstruction has been reported. Chronic inflammation and prolonged irritation may predispose to neoplastic changes in these areas.
  Materials and Methods: Case Report: A 53-year-old male presented in 2017 with severe lower urinary tract symptoms (LUTS), ongoing since childhood. Uroflowmetry showed a Qmax of 5 mL/s, voided volume of 230 cc, and post-void residual (PVR) of 100 cc. He had a history of two internal urethrotomies and one episode of acute urinary retention. Retrograde urethrography (RGU) showed an 8 cm diffuse anterior urethral stricture. Physical examination suggested balanitis xerotica obliterans (BXO). A meatotomy and urethroplasty using a laterally pedicled ventral penile skin flap (Orlando flap) were performed. Three months postoperatively, uroflowmetry normalized (Qmax: 23 mL/s), with no complications. At year three, segmental strictures were detected at the bulbar urethra and proximal flap; DVIU was applied to the bulbar site. No further intervention was needed. Seven years after the initial surgery, the patient presented with penile pain, swelling, and terminal hematuria. MRI revealed a dense lesion resembling an infected cyst or urethral diverticulum. Due to persistent symptoms, surgical excision was performed. Intraoperatively, a pedunculated, solid mass protruding into the urethral lumen was excised. Pathology confirmed an epithelioid inflammatory myofibroblastic tumor/sarcoma. At the four-month follow-up, MRI revealed local recurrence. Urethrectomy and adjuvant radiotherapy were suggested following uro-oncology council discussion.
  Results: Inflammatory myofibroblastic tumors (IMTs) are rare mesenchymal neoplasms, especially in the urethra. Chronic inflammation, presence of hair follicles, and prolonged local irritation may contribute to malignant transformation in skin flaps. This case is, to our knowledge, the first to report an IMT originating from a penile flap used in urethroplasty.
  Conclusions: This case emphasizes the importance of considering malignancy in post-urethroplasty lesions that do not respond to conservative management. Radiological imaging may be inconclusive; surgical exploration and histopathological examination remain essential. Long-term follow-up is critical due to recurrence potential.

UP-23.08—Application of Artificial Intelligence Technology to Identify Prognostic Risk Factors for the Development of Unsuccessful Outcomes of Urethroplasty 

• Gvasalia Badri ¹, Babaev Mikhail ¹, Chelidze Irakliy ¹, Maslakov Artem ², Kasyan Gevorg ¹, Bogdanov Andrey ¹, Pushkar Dmitriy ¹
  ¹ Botkin Hospital, Moscow, Russian Federation, ² Moscow Engineering Physics Institute, Moscow, Russian Federation

• Introduction and Objectives: Urethral stricture is the second most common cause of obstructive urination disorders in men after prostate diseases. The percentage of postoperative complications remains high, according to various authors, from 6.2 to 43%. The purpose of our study was to evaluate the main risk factors for the development of unsuccessful outcomes of urethroplasty using artificial intelligence technology and apply this prognostic system to improve the results of urethral surgery.
  Materials and Methods: All parameters of 1000 patients who underwent urethroplasty performed by one surgical group from 2005 to 2019 with an average follow-up period of more than 2 years were taken as input values when creating the neural network, and the outcomes of surgical treatment of these patients were taken as output values. The initial data was a database that presented information about each patient in the form of a multidimensional vector, characterized by 57 parameters: clinical examination data, laboratory studies, concomitant pathology, urethroplasty technique, length of urethral stricture, etiology, localization etc. As a result of the study, an artificial intelligence system was obtained in which each entered prognostic parameter corresponded to the degree of its significance in a particular postoperative outcome.
  Results: The most significant factors influencing the postoperative outcomes of urethroplasty were preoperative parameters indicating inflammatory process and impaired immune balance, as well as the stricture length and recurrent nature of stricture. The most significant prognostic factors were: stricture length (OR: 1.133, 95% CI: 1.068–1.301, p < 0.05), neutrophil-to-lymphocyte ratio (OR: 1.008, 95% CI: 1.001–1.009, p < 0.05), platelet-to-lymphocyte ratio (OR: 1.097, 95% CI: 1.045–1.121, p < 0.05), systemic immune-inflammatory index (OR: 1.061, 95% CI: 1.022–1.108, p < 0.05) and recurrent stricture (OR: 1.105, 95% CI: 1.009–1.299, p < 0.05). Artificial intelligence showed higher accuracy (0.78 vs. 0.70), sensitivity (0.82 vs. 0.77) and specificity (0.75 vs. 0.45) than standard regression analysis in predicting urethroplasty outcomes.
  Conclusions: The application of this trained neural network will allow predicting the risk of urethroplasty failure. Preoperative correction of significant parameters, where possible, will increase the probability of successful outcomes. Data from other urethral surgery centers can be used for training to improve the predictive capabilities of this artificial intelligence programme.

UP-23.09—Augmentation Gastrocytoplasty: 30 Years Later 

• Campos Rodrigo ¹, Vila Pedro ², Gomez Reynaldo ¹
  ¹ Hospital del Trabajador, Santiago, Chile, ² Hospital Virgen de las Nieves, Granada, Spain

• Introduction and Objectives: Gastrocytoplasty became popular in the 1990s due to the clinical benefits it offers compared to other intestinal segments, such as a lower risk of infections, reduced stone formation, and less intestinal mucus production. However, subsequent reports have indicated the risk of bladder malignancy in the long term. We present our long-term experience comparing the incidence of malignancy in patients who underwent augmentation using stomach versus those augmented with other bowel segments. Gastrocytoplasty became popular in the 1990s due to the clinical benefits it offers compared to other intestinal segments, such as a lower risk of infections, reduced stone formation, and less intestinal mucus production. However, subsequent reports have indicated the risk of bladder malignancy in the long term. We present our long-term experience comparing the incidence of malignancy in patients who underwent augmentation using stomach versus those augmented with other bowel segments.
  Materials and Methods: A retrospective review was conducted of patients who underwent bladder augmentation using an intestinal segment between 1990 and 1995. All patients were monitored annually with clinical follow-up, laboratory test, ultrasound, and cystoscopy.
  Results: A total of 18 patients underwent bladder augmentation using colon (10 cases), stomach (6 cases) and ileum (2 cases). The average age was 30 years (16–55), with 17 males and 1 female. The median follow-up for the entire series was 31 years (16–32). None of the patients augmented with colon or ileum developed bladder malignancy. Of the six patients augmented with stomach, one presented atrophy of the gastric segment a few months post-surgery and was re-augmented with ileum. Of the remaining five patients, three were diagnosed with poorly differentiated tubular adenocarcinoma at 15, 30, and 31 years of follow-up, and 2 of them died from metastasis.
  Conclusions: Gastrocytoplasty is associated with a significant risk of bladder malignancy in the long term and therefore should be contraindicated.

UP-23.10—Bridging Guidelines and Practice: Determining Adherence of Filipino Urologists to the AUA and EAU Urethral Stricture Treatment Guidelines 

• Chio Elliri Aleeja, Unas Janssen Dion, Gaston Charles Anthony, Abalajon Mark Joseph
  East Avenue Medical Center, Quezon City, Philippines

• Introduction and Objectives: Urethral stricture disease (USD) is a common but often neglected condition that narrows the urethra, causing urinary issues. Management of USD follows guidelines from organizations like the European Association of Urology (EAU) and the American Urological Association (AUA). This study aims to compare management practices and challenges among Filipino urologists and assess adherence to international standards.
  Materials and Methods: This is a cross-sectional study using a survey questionnaire, formulated by the authors, based on common-practice studies performed in different various countries including the Philippines. The questionnaire was divided into the following points of interest for this study: (1) demographic profile, (2) clinical practice parameters, (3) diagnostic work up and disease management, (4) postoperative follow-up and defining success or failure of intervention.
  Results: Urologists aged 30 to 39 reported the highest number of stricture cases, with 38% seeing over 20 patients in a year. Most of these cases were handled by urology residents-in-training, and 92% of urologists used retrograde urethrograms for USD cases. Fewer urologists preferred KUB ultrasounds, and this choice was similar across all age groups. A significant 81.3% of Filipino urologists recommended urethral rest before surgery, with no notable differences among groups. Most did not perform urethroplasty for strictures, but 53% who did were aged 30–39. Urban urologists were more likely to perform DVIU for certain stricture types than rural ones. Only 9.3% followed EAU and AUA guidelines for catheter use post-surgery. Additionally, 57% did not advise self-catheterization after DVIU. A majority adhered to guidelines for post-urethroplasty assessments, while 43.6% planned one-year follow-ups post-surgery.
  Conclusions: The AUA and EAU guidelines offer evidence-based recommendations for best clinical practice in patients with stricture disease. Though majority of Filipino urologists adhere to these recommendations, there are still some, especially those in the provinces and those who are not affiliated with training institutions, who have variations in their own private practices. Non-adherence to guidelines is often due to the lack of exposure to stricture cases in one’s area of practice. Despite these variations in practice, Filipino urologists do look to the guidelines for support and follow most of the recommendations, if not in their entirety.

UP-23.11—Can We Advise Our Patients When It Is Best to Have an Artificial Urinary Sphincter Implanted? 

• Segui Moya Elena, Muzammil Humdi, Alhasso Ammar
  Western General Hospital. NHS Lothian, Edinburgh, United Kingdom

• Introduction and Objectives: The Artificial Urinary Sphincter (AUS) is the gold standard for post-prostatectomy incontinence. However, surgical implantation of the AUS is not without complications, and the timing of implantation remains controversial. We evaluated the factors that affect the survival of the AUS after radical prostatectomy (RP) and radiotherapy (RT).
  Materials and Methods: Ninety-six prostate cancer patients who underwent AUS between 2011 and 2020 were included. Comorbidities (hypertension (HTN) or diabetes mellitus (DM)) were assessed. Complications were divided into mechanical, erosion, infection and subcuff atrophy. A primary comparison was made between patients who did not receive RT and those who received RT at any time. The second analysis was done for patients who had RT followed by salvage RP and those who had RP followed by salvage RT. Kaplan-Meier was used for AUS survival with SPPSv29.
  Results: Sixty-seven patients underwent radical prostatectomy (RP) followed by AUS, and twenty-nine patients received radiotherapy (RT). Eighteen of these patients underwent salvage-RT and eleven salvage-RP. The median age was similar in both groups (76.85 vs. 77.45), and the mean follow-up was 9.45 years. Comorbidities were found to be associated with complications by 17% for HTN (HR 95% 1.17 [0.61–2.26], p-value 0.62) and 27% for DM (HR 95% 1.27 [0.60–2.68], p-value 0.52). Complications: 1) Non-RT group vs. RT: No differences were found: mechanical (15 versus 3, p = 0.11), erosion (3 versus 2, p = 0.6), and sub-cuff atrophy (8 cases vs. 3 cases, p = 0.81). Only the infection was higher in the RT group, with a p-trend value (p = 0.08). 2) Salvage-RT group vs. Salvage-RP: Seven complications were found in the salvage-RT (3 infections, two cuff atrophy, and two mechanical) and five in the salvage-RP (one infection, one cuff atrophy, one mechanical, and two erosions) (p = 0.73). AUS Survival: AUS survival was found to be higher in the non-RT group in the first 20 months after the implant surgery. The salvage-RT group had higher AUS survival than salvage-RP (62 months (95% CI [13.8–111.9]) vs. 29.8 months (95% CI [0–64])).
  Conclusions: We can advise patients that those who have RP followed by salvage-RT will have better AUS survival than those who have RT followed by salvage-RP.o.

UP-23.12—Clitoroplasty in Congenital Adrenal Hyperplasia Patient 

• Pedrosa Rui, Guerra Ana, Rodrigues Carla, Temido Paulo, Figueiredo Arnaldo
  ULS Coimbra, Coimbra, Portugal

• Introduction and Objectives: Congenital adrenal hyperplasia (CAH) is an autosomal recessive disease and can be divided into two major types, classic and nonclassic. The most common cause of CAH is the lack of the enzyme protein known as 21-hydroxylase. Patients with classic CAH present glucocorticoids deficiency, requiring daily supplementation, and overproduction of androgens, which leads to ambiguous genitalia such as enlarged clitoris and shallow vagina, menstrual irregularity and infertility issues.
  Materials and Methods: This surgical video was recorded in April of 2024 and the procedure was performed by two surgeons of our uro-genital reconstruction team, a urologist and gynecologist. Before surgery, an informed consent was signed by patient ensuring that none of clinical data or video images allowed patient identification.
  Results: A 44 years old woman with congenital adrenal hyperplasia secondary to 21-hydroxylase deficiency was referred to gynecology consult complaining with dyspareunia secondary to enlargement of clitoris cavernous corpus during sexual intercourse resulting in vagina occlusion. This patient presented previous genital surgeries such as clitoroplasty at 3 years old, vulvovaginoplasty at 11 years old and labia majora plasty at 12 years old. In this case, a clitoroplasty with corpus cavernous reduction was proposed. The surgery time was 70 min with estimated blood loss of approximately 50 mL. In the beginning of surgery, a bladder catheter was placed. In the end, no drain was left, and absorbable suture was used in skin. In the second day postoperative the bladder catheter was removed, and patient was discharged. In postoperative consultation, patient mentioned no complications during recovery at home and showed satisfaction regarding surgical outcome in terms of aesthetic and function.
  Conclusions: Enlarged cavernous corpus of clitoris in this patient was causing sexual distress affecting her quality of life. Performing this surgery allowed to reduce this enlargement during sexual intercourse without damaging sensitive nerves and vascular structures essential to clitoris function. This surgery’s success is measured by patient’s satisfaction with aesthetic and functional outcomes.

UP-23.13—Comparing Ventral and Dorsal Oral Mucosal Graft Urethroplasty in Female Urethral Stricture: A Systematic Review and Meta-Analysis 

• Ergul Rifat ¹, Bicer Melih ¹, Ortac Mazhar ¹, Aydinoglu Tunc ¹, Ekerhult Teresa ², Tonyali Senol ¹, Ozervarli M. Firat ¹
  ¹ Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye, ² Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Gotenburg, Sweden

• Introduction and Objectives: Reconstructive surgical options have become an alternative for female urethral stricture. Dorsal and ventral methods using oral mucosa grafts have been described, but their superiority over each other has not been evaluated. In this meta-analysis, the outcomes of dorsal and ventral techniques with oral mucosa graft in female urethroplasty have been compared.
  Materials and Methods: A systematic search of PubMed, Scopus and Web of Science databases was performed according to the PRISMA. Manuscripts published until February 2025 that reported the use of dorsal or ventral surgical approaches with oral mucosa grafts in female urethroplasty included. Success, determined based on the recurrence rate, was analyzed and compared between both groups. The definition of recurrence was established as the development of a stricture during the follow-up period that would require surgical intervention. Data on the number of participants, patient age, follow-up duration, type of graft used, surgical technique, success rates, and reported complications were presented.
  Results: Of 320 identified studies, 25 met inclusion criteria: 12 assessed dorsal, 9 ventral, and 4 compared both techniques. The dorsal and ventral groups had comparable median ages (42.3 vs. 44.4 years). Median follow-up was 18.1 months for dorsal and 26.6 months for ventral. The meta-analysis, including four comparative cohort studies, showed no significant difference in surgical success between the dorsal (62/69 patients) and ventral (93/103 patients) techniques (OR = 0.84, 95% CI: 0.30–2.36, p = 0.74). The pooled success rates for the dorsal and ventral techniques were 92.1% (95% CI: 89.1–95.1) and 95.5% (95% CI: 92.8–98.2), respectively, with no significant heterogeneity. The Z-test comparison showed no significant difference between dorsal and ventral techniques (Z = -1.65, p = 0.099). No major (Clavien-Dindo grade ≥ 3) complications were reported. A total of 4 cases of stress urinary incontinence complications were reported in the ventral approach, while 2 cases were reported using the dorsal approach.
  Conclusions: This meta-analysis confirms that both dorsal and ventral approaches are effective for treating female urethral stricture, with high success rates. While the ventral approach shows a slightly higher success rate, the difference is minimal. Surgical approach selection should depend on patient factors and surgeon expertise to achieve optimal outcomes.

UP-23.15—Cost-Effective and Safe Robot-Sewn Ileoileal Anastomosis During Intracorporeal Robotic-Assisted Radical Cystectomy: A UK First Series 

• Bhatt Nikita, Parmar Kalpesh, Johnson Mark, Nambiar Arjun
  Newcastle Hospitals NHS Foundation Trust, Newcastle, United Kingdom

• Introduction and Objectives: Complete intracorporeal robotic reconstruction is increasingly performed following robotic-assisted radical cystectomy (RARC). While vesicourethral and ureteroileal anastomoses are routinely robot-sewn, bowel anastomoses are often completed using endostaplers, significantly adding to the cost of an already expensive procedure. This study aimed to establish a cost-effective robot-sewn ileoileal anastomosis technique during RARC and audit initial outcomes.
  Materials and Methods: A prospective cohort study was conducted at a single center, involving two surgeons performing RARC, one of whom employed robot-sewn ileoileal anastomosis. Bowel segments were isolated using monopolar scissors for bowel dissection and vessel sealer (TM) for mesentery division. The anastomosis was created using two semicircular single-layer Stratafix (TM) running sutures. Outcomes included time to complete anastomosis (from identifying terminal ileum to closure of mesenteric window), cost, peri-operative and post-operative complications.
  Results: Between October 2023 and December 2024, 40 RARCs were performed, 25 of which included robot-sewn ileoileal anastomosis. The median time for the anastomosis was 40 min (IQR 36–48), with a median operative time of 5.5 h (IQR 5–5.75). Blood loss was 100 mL (IQR 50–200), time to bowel movement was 6 days (IQR 5–6.25), and length of stay was 8 days (IQR 6–9). For stapled anastomoses, times were longer: 47.5 min (IQR 41.25–51.75) and 5.8 h (IQR 5.6–6), respectively. No anastomotic leaks occurred, and the readmission rate was 16%.
  Conclusions: This first UK series of robot-sewn ileoileal anastomosis during RARC demonstrated safety, efficacy, and significant cost savings (£8 vs. £1419). These outcomes align with European reports, warranting further studies to validate widespread adoption.

UP-23.16—Dorsal Inlay Skin Flap Urethroplasty for Penile Strictures: Expanding the Reconstructive Arsenal 

• Joshi Sachin, Ravichandran Kapilan, Desai Devang
  Toowoomba Base Hospital, Toowoomba, Australia

• Introduction and Objectives: Distal penile urethral strictures present a formidable reconstructive challenge due to limited structural support and tenuous distal vascularity. Flap-based substitution urethroplasty is preferred in this region, though ventral positioning is associated with sacculation, stasis, and recurrent infections. Dorsal grafting, as described by Asopa, leverages the tunica albuginea for stability but traditionally requires extensive urethral mobilisation. This study introduces a novel hybridised approach: a dorsal inlay skin flap urethroplasty utilising a ventral access route, combining the vascular advantages of flap-based reconstruction with the structural reliability of dorsal support.
  Materials and Methods: This technique is being evaluated within a prospective cohort at a regional reconstructive centre. A well-vascularised dorsal penile skin flap is harvested, transposed through a ventral urethrotomy, and secured dorsally to the incised urethral plate and tunica albuginea. The approach avoids circumferential urethral mobilisation and preserves native vascularity. Outcomes include flow rate, symptom resolution, and complication rates.
  Results: To date, seven patients (mean age 54 years) have been treated utilizing this technique. Notably, over fifty percent had previously undergone unsuccessful urethral procedures. The mean follow-up period is 7.5 months. The average improvement in maximum urinary flow rate (Qmax) was +8.2 mL/s, with patients reporting significant symptomatic relief, particularly in terms of urinary flow and stream quality. Importantly, no perioperative or postoperative complications were observed. All patients continue to receive ongoing follow-up within a structured prospective database.
  Conclusions: This technique offers a reproducible solution for complex distal strictures by combining the vascular benefits of flap-based repair with the dorsal stability of graft techniques. Early results demonstrate excellent functional outcomes and an encouraging safety profile. While long-term data are pending, the dorsal inlay skin flap urethroplasty represents a valuable addition to the reconstructive armamentarium, particularly for revision cases and anatomically complex presentations.

UP-23.17—Dual-Endoscope Joint Technology of Laparoscopy and Ureteroscopy with Lingual Mucosa Graft Ureteroplasty for Ureteral Stricture 

• Xiong Guobing ¹, Liu Guihong ², Wang Jingtai ², Chen Guoqiang ²
  ¹ 1. Department of Urology, The Affiliated Sanya Central Hospital, Hainan Medical University, No. 1154 Jiefang Road, Tianya District, Sanya, Hainan Province, 572022, China. 2. Division of Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People, Sanya, China, ² Department of Urology, The Affiliated Sanya Central Hospital, Hainan Medical University, No. 1154 Jiefang Road, Tianya District, Sanya, Hainan Province, 572022, China., Sanya, China

• Introduction and Objectives: To evaluate the preliminary effect of laparoscopy & ureteroscopy joint dual-view technology of lingual mucosa ureteroplasty on outcomes of complex ureteral reconstruction.
  Materials and Methods: We retrospectively reviewed all patients who underwent dual endoscopes joint of lingual mucosa ureteroplasty between October 2024 and January 2025. The reconstruction was performed by laparoscopic transabdominal technique, with the stricture site identified under the guidance of flexible ureteroscopy direct vision and light source, and lingual mucosa was obtained simultaneously at the same single lateral lithotomy position. Ureteroscopy was performed with an 11.5 Fr ureteral access sheath to check the graft anastomosis quality and patency, and then a 6 Fr D-J stent was inserted. The perioperative data were analyzed.
  Results: All 7 ureteral stricture patients (2 female, 5 male) underwent combined laparoscopy and ureteroscopy of lingual mucosa ureteroplasty successfully, with no conversion-to-open surgery or intraoperative complications. Four patients had undergone ureteroscopy holmium: YAG laser lithotripsies. All had undergone multiple ureteral D-J stent insertions with poor effects. One patient had anatomical solitary kidney. Patient’s mean (range) age was 43.3 (24 to 61) years. Mean stricture length was 2 (1 to 3) cm with severe peri-ureteral fibrosis. Mean operating time was 209.14 (140 to 255) minutes, including 30 min for harvesting the lingual mucosa. Mean estimated blood loss was 28.57 (15–50) mL. Follow-up time was 4.43 (3 to 6) months. One patient had ureteral anastomotic leakage caused by urinary catheter blockage. Urinary catheter indwelling time was 4 to 10 days, and ureteral stent was 4 to 8 weeks. Postoperative renal function improved significantly, and medical imaging showed that the lingual mucosae at the anastomotic sites grew well, ureter lumen was patent, and hydronephrosis obviously relieved (2 cases grade I, 5 cases grade 0). Satisfactory healing was achieved in tongue donor sites of all patients. No recurrence of ureteral stenosis was found.
  Conclusions: Laparoscopy & ureteroscopy joint technology of lingual mucosa ureteroplasty is a feasible and effective technique for treating complicated ureteral strictures and can achieve accurate stricture localization and immediate anastomosis quality and patency verification. However, these preliminary results need to be further validated in a larger series with a longer follow-up.

UP-23.18—Effectiveness of Coaptite Injections for Managing Stomal Incontinence in Patients with Continent Cutaneous Urinary Diversions 

• Ku Josh, Doshi Chirag, Dadabhoy Anosh, Zahir Mazyar, Xia Leilei, Ginsberg David, Daneshmand Siamak
  USC/Norris Comprehensive Cancer Center, Los Angeles, United States

• Introduction and Objectives: Incontinence at the stoma of continent cutaneous urinary diversions (CCUDs) is a well-documented complication. The usage of urethral bulking agents in treating stomal incontinence after CCUD has been proposed but seldom reported. In this study, we discuss our experience using Coaptite, an FDA approved urethral bulking agent, to treat incontinence following CCUD.
  Materials and Methods: We reviewed 16 patients from an IRB-approved database who received Coaptite injections between 2012 and 2024. Ten had CCUDs, four had native bladders with diversions, and two had neobladders revised with urethrectomy and diversion. Coaptite was injected (2–3 cc) near the efferent limb-reservoir junction, with subsequent injections given as needed. Outcomes were categorized as: full continence (FC), improved continence (IC), or no improved continence (NIC).
  Results: 16 patients were injected with Coaptite between 2012 and 2024 to treat stomal urinary incontinence after CCUD and were followed for a mean time of 39 months (median 37) post-injection. Of the 16 total patients, 8 demonstrated FC (50%), 5 had IC (31%), and 3 had NIC (19%). The mean time between catheterizations for patients with full continence was 4.83 h (median 5 h). The mean number of injection sessions was 2.25 (median 2, range 1–6). The average time between injection sessions was 3.8 months. The median time between the patient’s initial diversion surgery and injection was 11.5 months. A total of 36 injection sessions were performed, with an average of 2.25 sessions per patient. Of the 36 sessions, 8 established lasting FC, 15 established FC or satisfactory continence before losing efficacy over time, 9 improved continence to a level unsatisfactory to the patient immediately following treatment, and 1 was reported to have no effect. For the patients that experienced loss in efficacy overtime, the average time between the injection and return of incontinence complications was 7.1 months. Only one underwent surgical revision for their unresolved incontinence complications following a Coaptite injection.
  Conclusions: This series demonstrates Coaptite’s potential in treating CCUD-related incontinence, with 81% of patients experiencing improved continence and 62% achieving full continence. These results support the usage of Coaptite as a minimally invasive treatment for CCUD related incontinence.

UP-23.19—Establishing Robotic Reconstructive Urology Services in a UK Based Unit 

• Bhatt Nikita, Harding Christopher, Johnson Mark, Rai Bhavan, Nambiar Arjun
  Newcastle Hospitals NHS Foundation Trust, Newcastle, United Kingdom

• Introduction and Objectives: Robotic minimally invasive surgery (RMIS) is now the standard approach for prostatectomy and cystectomy, demonstrating improved functional outcomes, reduced blood loss, complications, and hospital stay. Adoption of RMIS in functional and reconstructive urology (FRU) has been hindered by factors such as cost, limited familiarity/training opportunities and insufficient evidence of benefit. We present our experience of establishing a robotic reconstructive service in the UK NHS.
  Materials and Methods: A retrospective review of all RMIS cases performed by a single surgeon with dual training in FRU and robotic pelvic oncology. Data on procedure types, indications, patient demographics, length of stay (LoS), and outcomes were collected from 2022–2024.
  Results: Of 212 RMIS, 148 (69%) were oncology cases, while 64 (30%) were benign reconstructive procedures (year one 83% vs. 17%; year two 68% vs. 32%; year three 62% vs. 38%). Ureteric reimplantation/reconstruction was the most common benign procedure (n = 17), followed by benign cystectomy (n = 9) and colposuspension (n = 8). The median age for oncology RMIS patients was 65 years (60–69 years) with 88% men, and benign RMIS was 53 years (41–63 years) with 60% women. The median LoS for reconstructive cases was 4 days (2–8.5 days).
  Conclusions: This initial data showcases the expanding role of robotic surgery in FRU. The integration of robotic pelvic oncology with reconstruction offers a valuable pathway to achieve proficiency and help expand the range of procedures that can be offered in a robotic reconstructive practice while maintaining proficiency and quality. Procedure cohorts will evolve with time, altering the balance between oncology and benign numbers.

UP-23.20—Evaluation of Quality of Life and Sexual Function on Stricture Patient After Urethroplasty: A Meta Analysis 

• Bethavany Paulus, Parardya Aga
  Balaraja General Hospital, Tangerang, Indonesia, Tangerang, Indonesia

• Introduction and Objectives: Urethroplasty is a definitive surgical treatment for urethral stricture disease. While the procedure often improves urinary function, its effects on sexual function and quality of life. This meta-analysis seeks to evaluate these outcomes using patient-reported measures.
  Materials and Methods: The meta-analysis was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors conducted thorough searches in databases including Urologia Internationalis, Scopus, Google Scholar, and clinical trial registries. These meta-analysis findings from multiple studies evaluate postoperative outcomes in men undergoing urethroplasty. Validated tools (USS-PROM and MSHQ) were used to quantify these effects.
  Results: A total of 39 patients completed both the preoperative and the postoperative questionnaire at a median interval of 93 days. The USS-PROM was completed twice within a short period of time by 30 patients (20 patients preoperative and 10 patients postoperative); the median interval was 20 days. Pearson correlation coefficients showed no statistical significant correlation between lower urinary tract symptoms (LUTS) scores and maximum flow rates. LUTS scores (Q1–6) decreased from a preoperative mean of 14.77 to a postoperative mean of 4.80 (p < 0.001). The mean scores for question 7 and Peeling’s voiding picture (Q8) decreased in a similar way, respectively, from 1.97 to 0.61 (p < 0.001) and from 3.61 to 1.94 (p < 0.001). Regarding the scores for Peeling’s voiding picture (Q8), 84% of the patients had a diminution of ≥1 point, 52% had a diminution of ≥2 points and 24% had a diminution of 3 points. The EuroQol visual analogue scale (Q14) scores increased significantly (p = 0.003) reflecting an improvement in quality of life, whereas the scores for question 15 (urge incontinence) decreased significantly (p = 0.010) indicating better bladder control. However, the scores for the MSHQ-EjD short form (questions 16–19), which assess ejaculatory dysfunction, did not show significant changes after surgery.
  Conclusions: Urethroplasty led to significant improvements in lower urinary tract symptoms and patient quality of life, although no significant changes were observed in ejaculatory function.

UP-23.21—Fournier’s Gangrene: A Five-Year Review of 17 Cases in a Tertiary Hospital in Nigeria 

• Okeke Chike ¹, Ogbobe Uchechukwu ², Odo Chinonso ², Ulebe Augustine ², Onyebum Okechukwu ²
  ¹ Mersey and West Lancashire Teaching Hospitals NHS Trust, Merseyside, United Kingdom, ² Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria

• Introduction and Objectives: Fournier’s gangrene is a rapidly-progressing necrotizing fasciitis of the scrotum/perineum. If not recognised and treated on time, it is often associated with high mortality and morbidity. This study was aimed at characterizing this disease in our environment and describing the management outcomes in our institution.
  Materials and Methods: This was a retrospective study of all patients who presented with Fournier gangrene over a five-year period from January 2020 to December 2024 in Alex-Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria. Patients’ case notes were retrieved to collate data. Data was analysed with SPSS version 26 IBM SPSS Statistics for Windows (IBM Corp., Armonk, New York).
  Results: Twenty-two patients presented with Fournier’s, but seventeen patients with complete data were included. All were males. The mean age of patients was 55.82 ± 22.09 years, while the mean duration of symptom before presentation was 11.24 ± 9.40 days. The median duration of admission was 30.50 (IQR 70.25) days. The mean Fournier’s Gangrene Severity Index (FGSI) was 4.06 ± 2.63. The combination of genital pain and swelling were the most common presenting symptoms, 10 (58.8%). In terms of the source of the gangrene, 9 (52.9%) were from scrotal pathologies, followed by anorectal sources in 5 (29.4%). Diabetes Mellitus (DM) was the most common predisposing factor accounting for 3 (17.6%) followed by human immunodeficiency virus (HIV) 2 (11.8%). Nine (52.9%) of patients, however, did not have any predisposing factors. In terms of wound care, the mean number of wound debridement was 1.75, 13 (76.5%) had secondary wound closure, only 1 (5.9%) had skin graft. Two patients (11.8%) had colostomy, and 14 (82.4%) had urethral catheterization. The mortality rate was 12%. Of the mortalities, both had an FGSI of 9. In one, the predisposing factor was HIV complicated with chronic renal failure and died after 8 days, while the other had alcohol as a predisposing factor and died after 2 days of admission.
  Conclusions: Diabetes Mellitus and HIV were common identifiable risks factors, but majority of the patients did not have predisposing factors. Surgical debridement was the mainstay of treatment. Many of the patients had secondary wound closure. Mortality was noted in patients who had high FGSI.

UP-23.22—Ileal Conduit Urinary Diversion for Benign Diseases, Indications and Outcomes from a Single Functional Urology Unit in 10 Years 

• Ghonaimy Ahmed, Ireland Anna, Inyang Ekpeno, Chitteti Pragnitha, Nadeem Mehwash, Fulford Simon
  James Cook university Hospital, South Tees NHS Trust, Middlesbrough, United Kingdom

• Introduction and Objectives: Ileal conduit (IC) is the most common modality for urinary diversion after radical cystectomy for bladder cancer worldwide. In benign conditions with lower urinary tract dysfunction, it is considered the last resort after failure of conservative and minimally invasive approaches. We aimed to evaluate indications and complications of IC done for benign diseases in our unit in a 10-year period.
  Materials and Methods: Retrospective data was collected for Open IC performed for benign conditions between 2014 and 2023. Patient demographics, co-morbidities, indications, duration of hospital stay, peri-operative complications were analysed.
  Results: 59 patients (Male: 25, Female: 34; mean age: 58.7 years) were included. The most common indication was bladder pain syndrome (n = 20, 33.8%) followed by neuropathic lower urinary tract dysfunction (NLUTD) and revision of previous diversion types: 10 cases each (16.9% each). Other indications include persistent non-neurogenic urinary incontinence in 4 cases, ketamine cystopathy in 3 cases. IC was preceded with simple cystectomy in 25 females and cysto-prostatectomy in 20 males (total cystectomy cases of 47, 79.6%). The histology of these bladders revealed picture of chronic inflammation only with no evidence of malignancy in 40 (88.88%). The rest of the patients showed squamous metaplasia in 5 (11.11%). 25% (5 out of 20) of all male patients showed histological evidence of prostate cancer in their prostates after simple cysto-prostatectomy. 38 patients (64.4%) did not show any significant post-operative complications. Post-operative paralytic ileus was recorded in 4, wound complications in 6, and bowel leak in 2 cases. The most common long term complications (after 6 months) were recurrent UTI (10%) and stoma related complications (10%) (6 cases each). Ureteric stricture occurred in 3 cases, and pyocystis was recorded in 3/14 of the non-cystectomy cohort.
  Conclusions: Open IC diversion is a valid option for benign conditions and can achieve good long term results with acceptable complication rates in experienced hands. Our data suggests that simultaneous cystectomy/cysto-prostatectomy should be considered whenever possible.

UP-23.23—Inflatable Penile Prothesis Implantation in Musculocutaneous Latissimus Dorsi Neophallus 

• Djinovic Rados, Slavkovic Milan
  Sava Memorial Hospital, Belgrade, Serbia

• Introduction and Objectives: Inflatable penile prosthesis (IPP) implantation into a musculocutaneous latissimus dorsi (MLD) neophallus represents the final and critical step in total phallic reconstruction for transgender men. This study evaluates the outcomes, surgical technique, and complications associated with IPP implantation following MLD phalloplasty.
  Materials and Methods: A retrospective analysis was conducted on 91 transgender men who underwent three-component IPP placement after MLD flap phalloplasty between 2014 and 2024. Data included patient demographics, surgical parameters, complications, and satisfaction assessed through follow-up questionnaires.
  Results: The mean age at implantation was 34.7 years, with an average interval of 13.3 months between phalloplasty and prosthesis placement. The mean neophallus length and girth were 15.8 cm and 14.1 cm, respectively. Complications occurred in 25.2% of patients, including mechanical failure (16.4%), infection requiring explantation (5.5%), and cylinder erosion (3.2%). Despite this, 90.1% of patients reported satisfaction with prosthesis function and aesthetics, 81.3% could engage in penetrative intercourse, and 78% achieved orgasm.
  Conclusions: IPP implantation in an MLD neophallus offers excellent functional and aesthetic outcomes when performed as part of a carefully staged surgical protocol. The use of tailored fixation techniques and preoperative optimization contributed to high satisfaction and manageable complication rates. These findings support the MLD flap as a robust option for prosthesis-ready neophallus construction in gender-affirming surgery.

UP-23.24—Intra-Operative Retrograde Urethrogram: A Single Centre Experience 

• Ng Tiffany, Lau Wei Da
  Khoo Teck Puat Hospital, National Healthcare Group (Singapore), Singapore, Singapore

• Introduction and Objectives: Retrograde-Urethrography (RUG) is an essential diagnostic tool for urethral pathologies, aiding in surgical planning (1, 2). The results tend to be more accurate when performed by the primary urologist, due to familiarity with the patient’s symptoms and signs and corresponding them with the urethrogram (3). In our institution, we introduce the utilisation of Intra-Operative Urethrogram (IOU) prior to the start of surgery. The patient lies supine with the C-arm fluoroscopy angled at 20-degrees counter-clockwise over the genitalia. Images are taken and evaluated concurrently, while contrast is being administered via a 12Fr Foley’s catheter. This method is efficient and minimises patient re-positioning. The aim is also to frequency of hospital visits and time to surgery. We aim to assess the practicality and effectiveness of IOU in facilitating surgical planning for urethral strictures. Additionally, identify factors that may influence the use of IOU.
  Materials and Methods: Seven cases of urethral strictures that underwent IOU, were selected. We compare intra-operative findings with that of IOU, and analysed its effectiveness, pros and cons for surgical planning.
  Results: Of seven cases, three cases only underwent IOU, while four had both pre-operative RUG and IOU (RUG/IOU). Two of the IOU-only cases involved short-segment strictures, and one was a case of meatal stenosis. IOU was performed in the RUG/IOU cases due to inadequate information from prior RUG or long intervals from the last imaging (18, 32 months). 2 of the RUG/IOU patients had more complex strictures requiring IOU for further assessment. IOU accurately identified the site of pathology and aligned with the intra-operative observations in all cases. The pros of IOU are its simplicity to perform, streamlining both evaluation and treatment in the same setting, comfort to patients and diagnostic accuracy. However, there may not be an adequate setting to counsel patients, especially in complex cases or if findings were unexpected. Surgeons would also require access to fluoroscopy intra-operatively and training to interpret images.
  Conclusions: IOU has several key advantages, especially for patients who have simple urethral strictures and are committed to surgical intervention. It is less ideal in complex urethral stricture cases when counselling and surgical planning are essential.

UP-23.25—Low Incidence of Recurrent Bladder Neck Stenosis After Artificial Urinary Sphincter Surgery 

• Frost Anastasia, Dragova Mariya, Tufail Mughees, Herath Mahendra, Andrich Daniela, Mundy Anthony
  UCLH, London, United Kingdom

• Introduction and Objectives: Bladder neck stenosis (BNS) is a known complication of prostate cancer surgery and can be difficult to manage. We report outcomes in patients who developed BNS after prostate treatment who went on to have artificial urinary sphincter (AUS) implanted for urinary incontinence and show they can be managed without need for intermittent self-dilatation (ISD) if stenosis can be stabilised.
  Materials and Methods: From prospective database of patients who had AUS implanted 2006–2024, 156 patients had BNS diagnosis. 149 had previous treatment for prostate cancer (16 radiotherapy/HIFU, 67 prostatectomy, 66 radiotherapy and prostatectomy). 7 had TURP for benign disease. All had diagnostic cystoscopy to confirm BNS. Patients performing ISD were told to stop for 3 months and then bladder neck calibre assessed with flexible cystoscopy. If bladder neck more than 14Fr we proceed with AUS.
  Results: Of 156 patients, 119 (76.3%) required urethral dilatation (UD) before AUS implanted. 30 patients identified as having quick recurrence of BNS were treated by redo vesico-urethral-anastomotic (VUA) urethroplasty before AUS. Of 24 (15.4%) patients performing ISD before AUS surgery, 8 needed to continue ISD after AUS was implanted (6 due to concomitant urethral strictures). In those performing ISD before AUS, 5 (20.8%) needed UD for BNS at mean of 48 months (range 6–120 months) following AUS implant. In 132 patients not performing ISD, 8 (6%) needed UD at a mean of 47 months (range 7–144 months). 3 patients required subsequent UD at 2 year intervals. 25 AUSs were removed for infection/erosion. 17 removed for erosion at mean of 17 months (range 1–52 months), 8 for infection after mean of 7 months (range 0.5–24 months). The erosion rate of performing ISD was 16% vs. 10% in non-ISD group; however, time to erosion was similar in the 2 groups (ISD 16 months vs. non-ISD 17 months).
  Conclusions: If BNS can be stabilised with dilatation or ISD, it is safe to proceed with AUS implant. In those with quick recurrence of stenosis, redo-VUA is a viable option in patients without radiotherapy, before AUS implant. Overall recurrence of flow limiting stenosis is low, with need for UD 4 years after the AUS surgery, and just 1.3% of patients required to do ISD for dilating BNS.

UP-23.26—Neglected Bladder Exstrophy in Adulthood: A Rare Clinical Observation with Preserved Genitourinary Function 

• Taha Zariouh, Othmane Mouslim, Achraf Chatar, Mohammed Amine Lakmichi, Zakaria Dahami, Ismail Sarf
  Chu Mohamed 6 Marrakech, Morocco, Marrakech, Morocco

• Introduction and Objectives: Bladder exstrophy is a rare congenital anomaly involving the failure of closure of the anterior bladder wall and lower abdominal wall. It is typically diagnosed and corrected in infancy. Adult cases without any prior surgical intervention are exceptional and raise complex diagnostic and therapeutic challenges.
  Materials and Methods: We report the case of a 26-year-old man with no significant medical history, presenting with congenital bladder exstrophy that had never been treated. Clinical examination revealed exposed bladder mucosa through a midline abdominal wall defect below the umbilicus, with constant urinary leakage. The patient reported preserved erectile function and no significant lower urinary tract symptoms. Laboratory investigations showed stable renal function (creatinine 6.68 mg/L, urea 0.31 g/L) and normal electrolytes. CRP was mildly elevated (4 mg/L), and urinalysis revealed a polymicrobial infection. Blood cultures were negative. Cross-sectional imaging confirmed the diagnosis, revealing a wide abdominal wall defect with herniation of bladder tissue and ureters. A marked pubic diastasis (75 mm) was present, along with right-sided microlithiasis and a retroaortic dilated left renal vein. Earlier imaging also revealed urine drainage through a scrotal opening and an ectopic insertion of the left ureter.
  Results: This case represents a unique scenario of adult bladder exstrophy in the absence of prior surgical correction. The combination of preserved renal and sexual function, along with the absence of severe infection or upper urinary tract compromise, is unusual. The significant anatomic alterations, including pubic diastasis and bladder herniation, necessitate a complex, staged surgical approach. Management should be multidisciplinary, focusing on restoring continence, reconstructing the abdominal wall, protecting renal function, and preserving quality of life.
  Conclusions: Unrepaired bladder exstrophy in adulthood is extremely rare. This case emphasizes the importance of personalized, multidisciplinary care, especially when patients present late with relatively preserved function. It also highlights the remarkable physiological adaptation possible in untreated congenital anomalies.

UP-23.27—Optilume^® Balloon Dilatation for Urethral Stricture Disease: The New Endoscopic Gold Standard? A UK Institutional Review of Multiple Stricture Aetiologies and Characteristics 

• Pineda Turner Andrew ¹, Karanjia Rustam ¹, Watts Izzy ², Chetwood Andrew ³
  ¹ NHS Frimley Health Foundation Trust, Frimley, United Kingdom, ² Imperial College Healthcare NHS Trust, London, United Kingdom, ³ Frimley NHS Foundation Trust, Frimley, United Kingdom

• Introduction and Objectives: Optilume^® balloon dilatation has shown encouraging results for men with urethral stricture disease. However, the initial ROBUST trials had strict inclusion criteria, and there is limited published data outside of clinical trial settings. We present our patient case series to demonstrate its efficacy across all patient and stricture demographics.
  Materials and Methods: Between February 2022–September 2024, patients who underwent Optilume^® balloon dilatation for urethral stricture disease with >6 months follow-up were analysed. Demographics, stricture characteristics and number of prior treatments were gathered. Stricture aetiology was divided into idiopathic, iatrogenic, radiotherapy/brachytherapy and bladder neck contracture. Primary outcome was the need for reintervention and/or restarting self-dilatation. Cox regression analysis was performed to generate hazard ratios and identify associations with failure.
  Results: 31 patients underwent Optilume^® dilatation during this period. Median follow up was 22.8 months [range 6.7–38.2]. Median patient age was 67 [range 21–86], stricture diameter 6Fr [range 3–16], stricture length 3 cm [range 1–5] and prior number of treatments 2 [range 0–13]. There was no statistically significant association for time to failure with lumen size (HR 0.99, p = 0.934), number of previous treatments (HR 1.02, p = 0.897), stricture length (HR 0.82, p = 0.578) or any individual aetiology. At the time of reporting, 24/31 (77%) patients were reintervention free.
  Conclusions: Optilume^® balloon dilatation can provide excellent functional outcomes across multiple stricture aetiologies, particularly in patients unsuitable or wishing to avoid the morbidity of urethroplasty. Larger datasets are required to help identify stricture characteristics and aetiologies that may be associated with better functional outcomes.

UP-23.28—Penile Paraffinoma and Siliconoma: A Penile Augmentation Fairytale Gone Bad! 

• Thomas Charalampos ¹, Kartsaklis Panagiotis ², Vandorou Nefeli ², Konstantinidis Charalampos ³
  ¹ General hospital of Corinth, Corinth, Greece, ² General Hospital of Patras “O Agios Andreas”, Patras, Greece, ³ National Rehabilitation Center, Athens, Greece

• Introduction and Objectives: Penile augmentation with injections of liquid paraffin and implantation of silicon beads is a common practice in some Balkan countries. Paraffinomas and siliconomas are the result of the foreign body reaction, which occurs in almost every case, having a tremendous and sometimes catastrophic effect, due to serious infection and penile deformities. We present a case of paraffinoma and siliconoma after a failed penile augmentation and the operative technique we applied for penile reconstruction.
  Materials and Methods: A 40-year-old male presented at the ER with penile pain due to paraphimosis. The patient had undergone a penile augmentation operation with silicon beads implantation and liquid paraffin injections throughout the penile shaft a few weeks before.
  Results: The patient was immediately admitted and underwent an emergency radical circumcision with extended excision of fibrotic scirrhous masses and removal of eroded silicon beads. A negative pressure drainage was placed along with a typical mummy wrap. Frequent wound changes followed, but, due to foreskin necrosis at the site of sutures, sub-coronally, the patient underwent a wound-freshening 2 weeks after the operation. Patient had a good post-operative healing, without the need of further intervention, or any major complication such as a fistula formation, and 2 months after the first operation he reports a pain-free successful intercourse.
  Conclusions: Penile paraffinomas and siliconomas can occur after a failed penile augmentation injection of liquid paraffin and silicon beads implantation. Most of the time such interventions are performed by non-medical personnel. The choice of a plastic reconstructive treatment depends on the extent of the paraffinoma and siliconoma. If it is limited to the foreskin, a radical circumcision, excising the fibrotic tissue and any foreign body, is sufficient, but, if it extends to the skin of the penile shaft, a plastic defect coverage with a graft, autologous or mesh, is required. If serious complications are present, such as urethral fistulas, auxiliary reconstructive procedures should be performed.

UP-23.29—Postoperative Imaging After Urethroplasty: Utilization Patterns and Influencing Factors 

• Ortiz Nicolas, Lyons Cassandra, Gonzalez Miranda Luis, Tuong Mei
  University of Virginia, Charlottesville, United States

• Introduction and Objectives: Postoperative urethral imaging (POUI) is commonly performed before catheter removal following urethroplasty, despite limited guidance from existing guidelines. Emerging evidence suggests POUI may be unnecessary in patients with uncomplicated postoperative courses. This study aims to evaluate patterns of POUI use and identify factors influencing its selective or routine application among Urologists who perform urethroplasty.
  Materials and Methods: A survey was distributed to practicing Urologists via social media and direct email to members of the Society of Genitourinary Reconstructive Surgeons (GURS) between August and September 2024. The survey assessed demographics, practice characteristics, training background, and POUI preferences. Respondents were categorized as routine POUI (rPOUI) users or selective/no POUI (sPOUI) users. Descriptive statistics and Fisher’s exact tests were used for analysis.
  Results: Of the 67 respondents, 45 (67.2%) routinely use POUI, while 13 (19.4%) use it selectively, and 9 (13.4%) do not use it at all. The most commonly used modality was voiding cystourethrography (VCUG, 60.3%), followed by retrograde urethrography (RUG, 37.9%). Imaging was typically performed by the surgeon (66.7%) and driven by personal preference (92.4%). Practice setting (Academic vs. Private vs. Other, p = 0.019) and fellowship training experience (p < 0.001) were significantly associated with POUI utilization. The primary reason cited by sPOUI users for omitting imaging was the belief that it is unnecessary (63.6%). Other reasons included inconvenience, radiation concerns, limited fluoroscopy access, and reliance on patient-reported outcomes.
  Conclusions: While most Urologists routinely perform POUI after urethroplasty, a substantial minority selectively use or omit imaging altogether. The decision to obtain POUI is influenced more by institutional culture and fellowship training than by surgeon experience or patient logistics. Given that most POUI is surgeon-performed and preference-driven, selective imaging protocols may optimize resource use and reduce unnecessary radiation exposure without compromising patient outcomes.

UP-23.30—Resurfacing of Lichen Sclerosus: A New Way to Manage Lichen Sclerosus with Urethral Stricture 

• Islam Mohammad
  National Institute of Kidney Diseases and Urology, Urology and Transplant Foundation of Bangladesh, Dhaka, Bangladesh

• Introduction and Objectives: Patients with Lichen Sclerosus involving external urethral meatus usually undergo urethral reconstruction with oral mucosal graft leaving the LS in situ, resulting in recurrent meatal stenosis, urethral stricture, and re-operations even in experienced hands. This study addresses replacing the LS involving the Glans and Penile skin with a non-genital split-thickness skin graft alongside urethroplasty using Oral Mucosal Graft. Objective: To compare the recurrence of LS, success rate of urethroplasty, complications of Split thickness skin grafting and patients’ satisfaction between groups.
  Materials and Methods: This prospective randomized clinical study was carried out from January’21 to December’23 in tertiary care hospitals in Bangladesh (NIKDU and UTFB). Sixty patients of anterior urethral stricture with LS were randomized into two groups: 30 patients in each group. In group A, patients underwent single stage OMG urethroplasty, while patients in group B underwent single stage OMG urethroplasty with complete excision of Lichen sclerosus and grafted the area with non-genital split-thickness skin graft. For all participants, we assessed changes in maximum urinary flow rate, post void residual urine, International Index of Erectile Function (IIEF-5) score and success rate after 24 months of treatment. Results were analyzed using SPSS 26 and Microsoft Excel 2019.
  Results: The follow-up period was 24 months on average. There was neither appearance of LS in genitals nor meatal stenosis in OMG urethroplasty with STSG group, thus eliminating the most distal obstruction factor and significantly improving urinary functions and overall quality of life. Patients with OMG urethroplasty only had an 80.0% success rate, while patients with OMG urethroplasty with STSG had an 88.9% success rate. In group A, 16.0% (4 out of 25 patients) had meatal stenosis, as opposed to 0% in group B. Among the 48 patients without meatal stenosis, 91.7% of surgery was successful. 92% of people were satisfied with their cosmesis. Around 70% of patients were satisfied with sexual activity.
  Conclusions: Replacement of LS with non-genital STSG on glans and penis can enhance the urethroplasty success rate.

UP-23.31—Scrotal Inversion Vaginoplasty for a Patient Diagnosed with Gender Dysphoria: A First in the Philippines 

• Condeno Clarice ¹, Arellano Oyayi ¹, Gaston Charles Anthony ¹, Unas Janssen ¹, Andutan Raul Carlo ¹, Reyblat Polina ², Brown Ashley ², Abalajon Mark Joseph ¹
  ¹ East Avenue Medical Center, Quezon City, Philippines, ² Kaiser Permanente-Los Angeles Medical Center, Los Angeles, United States

• Introduction and Objectives: We present the first gender affirming surgery (GAS) performed in a Philippine government hospital for a patient with gender dysphoria (GD), a condition recognized by the DSM-V and ICD-10 as causing distress due to the mismatch between gender identity and assigned sex. This paper aims to demonstrate the safe and competent provision of GAS within the public health sector and to improve local awareness of GD and its management.
  Materials and Methods: The patient was positioned in dorsal lithotomy under general anesthesia. An inverted-V incision was made 4 cm above the anus. A full-thickness scrotal skin graft was harvested to construct vaginal cavity over a vaginal dilator. Both testicles were removed, and a Lowsley retractor was used to dissect the space between the prostate and rectum (Denonvillier’s area) to create the neovaginal cavity. The corpus spongiosum was separated, the corpora cavernosa dissected, and the glans’ neurovascular bundle plicated and sutured to the rectus fascia. The neoclitoris was formed from dorsal portion of glans with preserved neurovasculature. The reduced, shortened, and spatulated urethra was placed below the neoclitoris. The skin flap was inverted and advanced into the neovaginal cavity to form its walls. The labia majora were closed in a layered fashion. An antibiotic-ointment-soaked-vaginal-pack was left in the neovagina.
  Results: The case took 420 min. EBL was 500 mL. Vaginal pack and Foley catheter were removed on the 6th day after surgery. Vaginal self-dilation protocol was initiated after vaginal pack removal. Douching until discharge lessens. The patient was followed up weekly for the 1st month, then monthly thereafter. No noted complications such as vaginal hematoma, fistula, graft failure, infection, incontinence, and regret.
  Conclusions: Although the Philippines exhibits a degree of LGBTQI+ inclusivity, access to gender affirming care is severely limited by factors like insufficient healthcare policies, a scarcity of trained professionals, absence of legal gender identity recognition, and financial burdens. This case, detailing the first publicly subsidized GAS in the Philippines, highlights the importance of making such treatments more accessible to enhance the physical and mental health of transgender Filipinos.

UP-23.32—Shallow-Depth Vaginoplasty/Vulvoplasty: Patient Discussion, Surgical Options, and Surgical Technique 

• Garcia Maurice, Talamas Alejandro, Sandhu Sandeep, Mallavarapu Samhita
  Cedars Sinai, Los Angeles, United States

• Introduction and Objectives: This study investigates the growing preference for shallow depth vaginoplasty (SDV) among transgender women seeking genital gender-affirming surgery, focusing on the desire to create a recessed vulva without a vaginal canal. Previous research identified key priorities for transgender women, including the elimination of visible genital anatomy associated with their assigned birth sex, achieving normal female genital appearance, and preserving genital sensation for orgasm. This paper introduces a new decision making tool and a novel surgical technique for SDV that does not involve the creation of a vaginal canal, offering a simpler, natural appearing and patient base preference alternative.
  Materials and Methods: A retrospective analysis of transgender women undergoing SDV was conducted, incorporating data from consultations and surgical outcomes. A patient decision-making aid tool was developed to guide patients in their choice of procedure, highlighting risks and benefits with 15 outcome categories to help patients decide between SDV and FDV (full depth vaginoplasty). The surgical technique involves the use of penile skin to create a natural-appearing vaginal introitus, with options for additional scrotal skin (graft or flap) use when necessary. Postoperative satisfaction was assessed across three domains: sexual function, genital appearance, and pain control.
  Results: Approximately 50% of patients who seek feminizing genital surgery opt for SDV. The majority of these patients prioritize the ability to avoid long-term dilation and douching. Post-operative satisfaction with SDV was reported to be high, with patients achieving satisfactory sexual function, genital appearance, and recovery times. The technique of using either full-thickness scrotal grafts or pedicled scrotal flaps for the introitus creation resulted in consistently favorable outcomes, particularly when the pedicled flap method was employed.
  Conclusions: SDV offers an effective and satisfactory option for transgender women who choose not to undergo the creation of a vaginal canal. This technique eliminates the need for dilation and douching, addressing a critical concern for many patients. With thorough preoperative counseling and clear patient education, SDV can provide a fulfilling solution for those seeking a non-canal-based vaginoplasty. The terminology used to describe these procedures should reflect patient preferences and be inclusive of their needs and concerns.

UP-23.33—Significant Reduction in Neourethra Stricture and Fistula Incidence Among Transgender Men After Phalloplasty with Urethral Lengthening—A Review of Outcomes, Prevention Strategies, and a New Device 

• Garcia Maurice, Talamas Alejandro, Dadashian Eman, Mallavarapu Samhita, Stelmar Jenna, Sandhu Sandeep, Smith Shannon
  Cedars Sinai, Los Angeles, United States

• Introduction and Objectives: After phalloplasty with urethral lengthening (P+UL), the vast majority of complications relate to the neourethra: urinary retention, infection and incontinence from neourethral strictures (NUS) and urethral fistulae (UF). Published rates of neourethral stricture vary between 40% and >80%. The risk of urethral stricture is the main reason many men forego P+UL. There are no effective surgical technique or post-op intervention described to significantly reduce high NUS/UF rates. Our objectives are to evaluate incidence of NUS and UF in trans men after primary 2-stage P+UL at our center and to describe our theory for why NUS/UF occur so commonly and describe a new device.
  Materials and Methods: Chart review of all patients undergoing gender-affirming primary P+UL at our center: 6/2017 to 12/2023. Describe a proposed etiology and 4 specific NUS/UF prevention techniques we adhere to and record our NUS & UF rates and compared these to the literature.
  Results: 67 patients completed second-stage phalloplasty: 32/64 (50%) P+UL, and 32/64 (50%) P-UL. Our standard NUS/UF prevention strategies: 1. We widen the urethral flap with clitoris-shaft skin at the junction of pars-pendulosa/pars fixa; 2. We leave a ¼” Penrose drain in the neourethra, not a Foley, after Stage 1; 3. We support the base of the phallus with gauze × 3 mo. post-op, to prevent kinking. Our hypothesis of NUS commonly occurs in the neourethra proximal to the phallus base because this area is subject to ischemia from kinking due to the heavy downward weight of the phallus. The “Manny Pack”: a wearable that hides and supports the phallus upright at all times. Directed to use 3 months after Stage I and Stage 2. Before introducing “Manny Pack” (22/32 P+UL): NUS: 3/22 (14%) developed NUS (2/3 with UF) and required surgery. UF: 7/32 (22%) developed UF, and of these 4/7 (57%) cases required surgery, while 3/7 (43%) resolved conservatively. After introducing “Manny Pack” (10/32 P+UL): NUS and UF incidence = 0%; mean follow-up > 1.6 years.
  Conclusions: Our NUS and UF rates suggest that the preventive measures we describe are effective. The “Manny Pack” post-op care device we describe appears especially effective. Ongoing studies will assess multi-center outcomes.

UP-23.34—Sphincter Preservation for Perineo/recto-Urethral Fistula Repair, Modification of Technique 

• Fuziwara Seiichi, Zapot Juan, Hernandez Narciso
  IMSS, Mexico, Mexico

• Introduction and Objectives: Recto/perineo-urethral fistula is a rare condition, and the management is complex; there is no gold standard to treat this condition, and many of these patients need multiple surgical procedures. The risk of urinary incontinence exists up to 70% of the patients; preserving the sphincter will prevent this consequence.
  Materials and Methods: We present a case of perineo-urethral fistula repair with preservation of the sphincter and anterior wall of the urethra. It’s a 78 male patient with history of colorectal cancer, he underwent neoadjuvant chemotherapy and radiotherapy, he underwent pelvic exenteration, in 6 months he developed perineo-urethral fistula.
  Results: Patient under general anesthesia, in lithotomy position, midline of the perineal incision, perineal body was dissected, the posterior urethra is mobilized until the triangular ligament, the fistula is dissected, and the urethra is cut only in the posterior part, preserving form 4 to 8 h, so the sphincter is preserved, the urethral reconstruction is tension free end-to-end anastomotic urethroplasty with 4-0 PDS in the posterior aspect. Cystoscopy was done after the urethral dissection to confirm sphincter preservation. The gracilis flap harvest was performed by the same surgical team, with a standard previously described technique.
  Conclusions: Recto/perineo-urethral fistula repair with gracilis muscle interposition is an excellent tool for complex cases and feasible for concomitant urethral reconstruction, preservation of the anterior wall of the urethra and sphincter, preventing the risk of incontinence.

UP-23.35—Surgical Technique to Treat Female Urethral Diverticula Preserving Continence 

• Berdondini Elisa ¹, Gacci Mauro ², Silvani Mauro ³, Maiolino Giuseppe ⁴
  ¹ Sedes Sapientiae Clinic, Turin, Italy, ² University of Florence, Florence, Italy, ³ Center for urethral and genital surgery, Turin, Italy, ⁴ Lyx Institute of Urology, Madrid, Spain

• Introduction and Objectives: Urethral diverticula (UD) is a relatively rare condition in adult women, characterized by a pouch-like outpouching from the urethra. Despite various techniques being described for its treatment, there is no universally accepted gold standard. We propose a surgical technique to preserve the urethral sphincter, ensuring continence while effectively treating UD.
  Materials and Methods: Between 2018 and 2024, 30 patients with symptomatic UD were treated using this technique. Inclusion criteria were symptomatic UD, while asymptomatic UD and paraurethral masses not connected to the urethra were excluded. Diagnostic workup included clinical history, physical examination, abdominal ultrasonography, urine analysis and culture, and contrast-enhanced magnetic resonance (MRI). Surgical technique: a urethro-cystoscopy is made to confirm the location of the diverticulum based on preoperative MRI. The vaginal wall is opened, and the periurethral fascia is incised in the midline to create two flaps. A lateral urethrotomy is performed to completely resection the ostium. The UD is detached from the tissue, and only the external area is removed. The medial area of the UD, fused to the periurethral fascia, is sutured to the periurethral flap on the opposite side. A 16F silicone Foley catheter is placed. Follow-up included physical examination and urine culture every four weeks during the first postoperative year, followed by annual check-ups.
  Results: The mean age of patients was 41.2 ± 10 years. The locations of the diverticula were as follows: 4 (13.3%) in the distal, 24 (73.4%) in the middle, and 4 (13.3%) in the proximal urethra. Urethral diverticula were simple in 24 (80%) cases and horseshoe-shaped in 6 (20%) cases. Histological findings included chronic inflammation in 27 (90%) cases, squamous metaplasia in 22 (73.3%), and fibrosis in 6 (20%). No perioperative or postoperative complications were observed. At a mean follow-up of 65.3 months, all patients (100%) had normal voiding patterns, and none developed incontinence.
  Conclusions: Our technique provides a minimally invasive surgery for UD while preserving continence. The procedure demonstrated a high success rate, with no periop or postop complications and no cases of incontinence or infections in the follow-up period. Further studies with longer-term follow-up are necessary to validate this approach’s long-term outcomes.

UP-23.36—With Gender Affirming Vaginoplasty, Do We Place the Neoclitoris in the Correct Anatomic Location? Results of Anatomic and MRI-Based Studies and a Novel Surgical Technique for Orthotopic Placement 

• Garcia Maurice, Talamas Alejandro, Dadashian Eman, Mallavarapu Samhita, Stelmar Jenna, Sandhu Sandeep, Smith Shannon
  Cedars Sinai, Los Angeles, United States

• Introduction and Objectives: Transwomen undergoing vaginoplasty prioritize having a “normal appearing” vulva, comparable to ciswomen. A review of the literature and online surgical videos shows that the standard surgical technique is (after penectomy) to anchor the neoclitoris to the stump of the oversewn penile crura. However, we noticed that in this location the clitoris appeared to be too far posterior, as compared to cisgender vulvas. We hypothesized that the true orthotopic position is more cephalad.
  Materials and Methods: 10 cisgender women and 10 transgender men (intact birth-genitalia) were examined to palpate the position of the glans clitoris relative to the pubic symphysis. Pelvic MRI studies of 25 cisgender women (age < 40 & >40) were reviewed to determine the position of the glans clitoris relative to the pubic symphysis. The location of the mid-point of the glans clitoris was measured relative to the inferior edge of the pubic symphysis. We describe our DNVB-splitting technique for anchoring the neoclitoris in the correct (orthotopic) location.
  Results: In all 20/20 subjects the glans clitoris was palpated over pubic symphysis and was always (100%) medial to the insertion of the Adductor longus tendon. The average distance from the inferior-edge of the pubic symphysis to the center of the glans was 2.6 cm ± 0.3 cm (range: 2.0–3.3 cm). At midline, 2.6 cm anterior to the inferior edge of the pubic symphysis, we create a 1.5 cm² window through the DNVB, splitting it with the blunt tip of a Kelly clamp. We anchor the neoclitoris to periosteum using two 3-0 Vicryl sutures. The redundant DNVB is anchored to Scarpa’s fascia at midline with 5-0 PDS. There were no DNVB injuries or complications.
  Conclusions: To create a more normal appearing vulva, the clitoris should reside medial to the adductor longus muscle, which is 2.6 cm anterior to the inferior edge of the pubic symphysis. Our simple DNVB-splitting technique is simple and safe. Anchoring can be accomplished using our novel, simple, anatomy-based technique.

23.4. Unmoderated Video ePosters

UVP-23.01—”Watering-Can” Perineum After Failed Buccal Mucosal Urethroplasty 

• Gil-Vernet Alfredo ¹, Cespedes Manuel ¹, Ropero Jordi ², Diaz Franklin ¹
  ¹ Parc Sanitari Sant Joan de Déu, Barcelona, Spain, ² Hospital Universitari Vall d’Hebron, Barcelona, Spain

• Introduction and Objectives: Failed urethroplasty, together with severe complications such as watering-can perineum associated with chronic urinary tract infection, is a reconstructive challenge, especially if the patient is young, and consequently a perineal urethrostomy should be avoided.
  Materials and Methods: A 19-year-old male patient suffering from complex and multi-operated bulbar urethral stricture, which led to multiple suppurative perineo-scrotal fistulae, is presented. The accompanying video depicts step-by-step a technique of one-stage bulbo-membranous urethroplasty based on a ventral biaxial epilated scrotal flap (“BAES-flap”).
  Results: A complex bulbar and membranous urethral stenosis complicated with infected urethro-cutaneous fistulae has been corrected as a one-stage procedure, and a three-year follow-up is presented.
  Conclusions: Urethroplasty with biaxial epilated scrotal flap (“BAES-flap”) is a useful technique to solve complex cases of urethral stenoses when other urethroplasties have already failed. In this case the “BAES-flap” may provide a convincing resource to be included in the armamentarium of the reconstructive surgeon.

UVP-23.02—A Simple, Safe, Anatomy-Based Surgical Technique for Dissection of the Vaginal Canal Space During Full-Depth Vaginoplasty, and a Novel Surgical Instrument to Increase Safety 

• Garcia Maurice, Talamas Alejandro, Sandhu Sandeep, Dadashian Eman, Shiang Alexander, Lin Jasmine, Mallavarapu Samhita, Smith Shannon
  Cedars Sinai, Los Angeles, United States

• Introduction and Objectives: When vaginoplasty includes creation of a vaginal canal to create the typical 12–14 cm. long canal space, the desired surgical dissection plane is through the anterior portion of the central tendon (perineal body) and then along, just anterior to, Denonvillier’s Fascia (DVF), up to the peritoneal reflection at the Pouch of Douglas. The key complication with this dissection is injury to the rectum (incidence 1–4%, though likely under-reported), which often results in recto-vaginal fistula and canal loss. There is no published “gold standard” technique for this dissection. Many non-urologist surgeons also perform FDV, many of whom are not familiar with urologic anatomy and instruments. The aims of this video are to: 1. Highlight the anatomic basis for the technique we describe, to illustrate that it is simple, safe, and reliable, and that mastery of this technique can obviate the need for dependence on Lap/robotic approaches. 2. We also describe our clinical outcomes. 3. Suggested technical “pearls”, and 4. We describe a novel surgical instrument that we designed based on this technique.
  Materials and Methods: Intra-op video and illustration-based description of our surgical technique and standard and customized instruments. Clinical outcomes for all consecutive GAS vaginal canal dissections performed over a 6-year period are reported.
  Results: A total of 224 consecutive canal dissections were performed, of which 65/224 were salvage colon vaginoplasty (i.e. had a prior vaginal canal dissection). All (100%) patients had follow-up > 4 mo. The incidence of rectal injury was 1/224 (0.4%) in a patient with prior pelvic fracture. After the first 40 patients, we discontinued use of pre-op bowel prep. There were no urinary tract injuries (0%). The highlight of our technique is to use a 16 Fr male urethral sound to push the prostate posteriorly, and rotate its apex anteriorly, to allow incision of DVF safely on the surface of the posterior prostate apex. In synchrony with the removal of the urethral sound, a retractor is delivered anterior to DVF, to allow gentle blunt dissection of the plane.
  Conclusions: Our anatomy-based technique affords an exceedingly low complication rate and is simple, safe, and obviates the need for lap/robotic approaches.

UVP-23.03—Advancing Boundaries: Robotic Techniques in Augmentation Ileocystoplasty with Mitrofanoff Procedure 

• Singh Abhishek, Patel Saket, Ganpule Arvind, Sabnis Ravindra, Desai Mahesh
  Muljibhai Patel Urological Hospital, Nadiad, India

• Introduction and Objectives: A small-capacity bladder can be congenital or acquired and is often associated with high intravesical pressures causing risk of upper tract damage due to reflux or backpressure. Bladder augmentation is considered when conservative and medical therapies fail or when high intravesical pressure threatens renal function. Robotic augmentation is gaining traction due to better visualization, precise dissection and suturing, reduced blood loss, decreased postoperative pain, shorter hospital stays, quicker return to function. While robotic technique is still new, ideal candidates would be those with neurogenic bladder, refractory detrusor overactivity, or small capacity bladder with preserved bladder neck function, often used in pediatric and young adult patients, where long-term benefits of minimally invasive surgery are particularly desirable.
  Materials and Methods: Case with distinct clinical presentation has been narrated who underwent robotic augmentation ileocystoplasty with Mitrofanoff procedure. Intraoperative video was edited to highlight key technical steps. Patient confidentiality was strictly maintained, and informed consent was obtained. Additionally, details on early course in hospital have been highlighted.
  Results: Case demonstrated hereby shows the importance of adapting surgical techniques to clinical and anatomical scenario. Studies show comparable outcomes to open surgery, reduced pain and length of stay but longer operative times but improving with experience. Despite its shortcomings, growing body of literature supports its feasibility, safety, and outcomes, particularly in high-volume centers and in pediatric and neurogenic bladder patients. While robotic augmentation cystoplasty is still considered a relatively niche and evolving technique, especially compared to open surgery, use in complex reoperative cases (e.g., post-radiation, prior surgeries) is still debated. Long-term data on outcomes like stone formation, metabolic complications, and malignancy risk are still emerging.
  Conclusions: The robotic approach is favored for its enhanced precision, superior visualization, reduced blood loss, shorter hospitalization, and expedited recovery. However, surgical success was also closely linked to the operating surgeon’s expertise and their ability to execute the technique. While robotic surgery gives superior results in terms of patient outcomes, advanced robotic skills and experience in reconstructive urology are critical.

UVP-23.04—Double Cylinder Inflatable Penile Prosthesis Insertion in Transgender Men 

• Talamas Alejandro, Garcia Maurice, Dadashian Eman, Shiang Alexander, Lin Jasmine, Sandhu Sandeep, Mallavarapu Samhita, Smith Shannon
  Cedars Sinai, Los Angeles, United States

• Introduction and Objectives: Transgender men undergoing phalloplasty commonly desire erection with inflatable penile prosthesis (IPP) insertion. All U.S. FDA-approved IPP’s are designed for cisgender anatomy. There is no gold-standard IPP-insertion technique post-phalloplasty. For men seeking phalloplasty who do not prioritize urinating from the tip of their penis, phalloplasty without urethral lengthening (P-UL) offers similar cosmetic and functional outcomes as p + UL, but with a significantly lower risk-profile. A 1.5 cm long distal urethra affords normal cosmesis/appearance. Implant of a testicle prosthesis at Stage 1 phalloplasty creates a capsule-lined pocket for the IPP pump during IPP implant at Stage 3. The absence of neourethra within the shaft affords sufficient room within the shaft for 2-cylinders, instead of just one. Our goals are to describe our technique for insertion of a 2-piece IPP in transgender men using a fused, double-cylinder technique and to evaluate our outcomes over a 6-year period.
  Materials and Methods: Retrospective chart review of TM undergoing IPP insertion post-phalloplasty at our center over 6-years.
  Results: A total of 28 patients underwent 34 IPP implants between April/2017-Oct/2023 (mean age = 40.8 years ± 13.8 (SD)). 17/28 (60.7%) patients underwent phalloplasty with urethral lengthening, and 11/28 (39.3%) had P-UL. All had ipsilateral testicle prosthesis implant beforehand. IPP implants were with the AMS 700™ 3-piece (first 5/34 = 14.7%; all 1 cylinder) or AMS Ambicor™ 2-piece IPP (all subsequent 29/34 = 85.3%; [22/29 (76%) = 1 cylinder & 7/29 (24%) = 2 cylinders). 2/34 IPPs required explant (5.9%): for infection, 1/38 (2.9%); and for traumatic-injury wound-dehiscence 3-weeks post-op: 1/38 (2.9%). Our technique for 2-piece IPP insertion in TM after P-UL. Both cylinders are fitted completely into a Dacron vascular graft, which is secured to Obturator ramus with 2-0 Ethibond sutures. The IPP pump fits into the explanted testicle site.
  Conclusions: Our “2-cylinders in a single sock” technique has key advantages: 1. Our pre-IPP ipsilateral testicle implant expands the neoscrotum and ensures a thick, smooth capsule-lined pocket to protect the pump. 2. The Dacron vascular-graft fuses and allows anchoring of both cylinders, to increase stability/reduce risk of migration. 3. Two-cylinders yield a more symmetric-appearing, fuller erection (+17% erection girth). 4. Our small single 4-cm incision at the scrotum-edge provides adequate exposure and hides scar, for good cosmesis.

UVP-23.05—Gender-Affirming Vaginectomy by Vaginal Introitus Excision and Vaginal Canal Vaporization: Surgical Technique and Technical Pearls 

• Garcia Maurice, Talamas Alejandro, Sandhu Sandeep, Dadashian Eman, Shiang Alexander, Lin Jasmine, Mallavarapu Samhita, Smith Shannon
  Cedars Sinai, Los Angeles, United States

• Introduction and Objectives: In our experience the majority of trans-masculine patients seeking genital gender affirming surgery desire genital reconstruction that includes vaginectomy. The traditional technique for vaginectomy, learned from gynecologists, is excisional. This approach is associated with excessively high blood loss, transfusion-rates, and complications. Within the field of transgender reconstructive surgery, there is no agreed-upon “gold standard” nor published detailed description of surgical technique, and many appear to still perform the excisional technique. With the advent of Lap/robotic surgery, innovative surgeons have demonstrated that the canal can be excised robotically with persistently high transfusion rates and risk of complications. The aims of this video are to describe a simple, safe, and reliable, entirely trans-perineal technique with excision of only 3-cm depth from the introitus, followed by electrocautery vaporization of the canal and suture closure over a wound drain. We also describe our clinical outcomes with this technique and share how we manage patients post-op to achieve exceedingly low complication rates.
  Materials and Methods: Intra-op video and illustration-based description of our surgical technique and standard and customized instruments. Clinical outcomes for all consecutive GAS vaginal canal dissections performed over a 7-year period are reported. We require patients have had hysterectomy >2.5 months beforehand. With a speculum in place, we use a ball-tip Bovie, set to 70-CUT, to vaporize, with the patient in steep Trendelenburg. Persistent bleeding is controlled with a 5-0 PDS figure-of-eight using a Stratt needle-driver. We leave a 15 Fr round drain in place and close the canal with 5-6 2-0 PDS sutures. We leave the drain for 7–10 days, till output is <2 cc for 48 h.
  Results: A total of 166 consecutive vaginectomies were performed at our center. Our complications: Blood transfusion: 2/166 cases (1.2%). Last consecutive 142 cases: (0%). Rectal injury: 0/166 (0%). Urinary tract injury: 0/166 (0%). Bowel Injury: 0/166 (0%). Mucocele (requiring surgical revision): 3/166 (1.8%).
  Conclusions: Our anatomy-based technique affords an exceedingly low complication rate, and is simple, safe, and obviates the need for lap/robotic approaches. The simplicity of this technique makes it more accessible to centers with limited resources. Importantly, patients are better-served by avoiding un-necessary lap surgery.

UVP-23.06—Laparoscopic Ileal Ureter Reconstruction Combining the Yang-Monti Technique with Boari Flap for the Management of Complete Ureteral Avulsion 

• Karavitakis Markos, Grivas Nikos, Zabaftis Christos, Tsela Smaragda, Nikitakis Fiippos, Tsogka Sissy, Ntoutsias Alexandros
  Lefkos Stavros, Athens, Greece

• Introduction and Objectives: Complete ureteral avulsions are a rare but severe complication. The Yang-Monti technique, originally described for open surgery, offers a solution for extensive ureteral defects through the use of ileal segments. Although its application in laparoscopic surgery is rare, this technique offers potential advantages in terms of recovery and patient outcomes. This video presents a rare case of laparoscopic ureteral reconstruction using the Yang-Monti technique for a complete avulsion of the left ureter.
  Materials and Methods: A 42-year-old male with a history of complete ureteral avulsion during endoscopic lithotripsy underwent laparoscopic ureteral reconstruction using the Yang-Monti technique. After adhesiolysis, the avulsed ureter was mobilized and resected. A 7.5 cm segment of ileum was isolated and tubularized after longitudinal incisions in three equal parts. This newly created tubular structure was used to bridge the ureteral defect. Anastomoses were performed between the ileal conduit and both the renal pelvis and bladder, with a Boari flap created to optimize bladder mobilization. Stapled side-to-side enteroenteric anastomosis was used to restore bowel continuity.
  Results: The total operative time was 300 min, with an estimated blood loss of 120 mL. The patient was discharged on postoperative day 7, and the pigtail stent was removed 3 weeks postoperatively. At the 6-month follow-up, the patient demonstrated reduction of hydronephrosis, stable renal function, and no symptoms of urinary obstruction.
  Conclusions: Laparoscopic ureteral reconstruction using the Yang-Monti technique is feasible and offers a minimally invasive alternative to open surgery for extensive ureteral injuries. Further case series are needed to fully establish its long-term efficacy and safety.

UVP-23.07—Reduction of Dysphoria-Causing Erections in Transgender Women—A Novel Surgical Technique Utilizing Crural Artery Ligation 

• Garcia Maurice, Talamas Alejandro, Dadashian Eman, Sandhu Sandeep, Shiang Alexander, Lin Jasmine, Mallavarapu Samhita, Smith Shannon
  Cedars Sinai, Los Angeles, United States

• Introduction and Objectives: Transgender women (TW) awaiting vaginoplasty can experience erections despite hormone therapy and bilateral orchiectomy (BO), aggravating gender dysphoria, and pain. Given delays pre-vaginoplasty, strategies must be developed to aid TW who experience erections. To date, no surgical technique to abrogate erections has been described. Crural vein ligation has been shown to improve venous-leak ED. We propose ligation of crural artery to diminish erections in TW and describe our surgical technique.
  Materials and Methods: We offered TW undergoing pre-vaginoplasty bilateral orchiectomy (BO) and who had erection-related dysphoria the option to undergo crural artery ligation. We evaluated changes in erection quality and timing of erections (spontaneous, with sexual arousal, and with sexual stimulation), and post-op dysphoria and satisfaction with our surgical technique.
  Results: 12 TW underwent BO with crural ligation. Of these, 7/12 (58%) underwent ligation and excision of the cavernosal artery bilaterally. Mean follow-up was 150 days (range 33–397 days). 7/7 (100%) reported cessation of spontaneous erections and erections with sexual arousal. 5/7 (71%) reported no rigid erection with self-stimulation, and 2/7 (29%) did not engage in any physical stimulation either alone or with a partner. 2/7 (29%) tried partnered stimulation, and 2/2 (100%) did not achieve a rigid erection. Dysphoria improved in all patients undergoing crural artery ligation. Our technique using a median perineal incision, the crura are identified. The cavernosal artery is identified with Doppler, and its proximal location within the crus is marked. Crural ligation: Where the cavernosal artery is located, the crus is ligated 4X with 0-Ethibond sutures. Crural artery ligation: The crus is incised, and the crural artery is dissected, ligated, and excised. Doppler confirms occlusion of arterial flow distally.
  Conclusions: Crural ligation alone was not as effective as directly ligating/excising the cavernosal artery. Crural incision and artery ligation/excision alone resulted in elimination of spontaneous erections and with sexual arousal. By this technique, physical stimulation still resulted in mild tumescence for some but never rigid erections. This is simple and reduces dysphoria-related erections in TW. Further studies are warranted.

UVP-23.08—Robot-Assisted Bilateral Ileal Ureter Placement with Augmentation Cystoplasty in Genitourinary Tuberculosis: A Modified Surgical Approach 

• R Bharath, Kalra Sidhartha, Bolar Siddhant, Mudhol Rajat, LN Dorairajan, K S Sreerag, Ghorai Rudra, N L Bharath
  Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

• Introduction and Objectives: To evaluate the feasibility, technical aspects, and outcomes of robot-assisted bilateral ileal ureter placement with augmentation cystoplasty in a patient with genitourinary tuberculosis. To evaluate the feasibility, technical aspects, and outcomes of robot-assisted bilateral ileal ureter placement with augmentation cystoplasty in a patient with genitourinary tuberculosis.
  Materials and Methods: A 37-year-old seropositive male presented with bilateral flank pain, increased frequency of micturition, and dysuria for one year. Contrast-enhanced CT (CECT) revealed bilateral hydroureteronephrosis with abrupt ureteric narrowing. Intravenous pyelogram (IVP) showed a right ureteric stricture from the PUJ and a left ureteric stricture extending from the left superior sacroiliac (SI) joint. Cystography indicated a reduced bladder capacity of 100 mL. The surgical plan involved initial bilateral percutaneous nephrostomy (PCN) placement, followed by robotic-assisted left ileal ureter anastomosis and augmentation cystoplasty in the Trendelenburg position. The right ileal ureter anastomosis was performed with the patient repositioned in the left lateral decubitus position.
  Results: The procedure was successfully completed with a console time of 240 min and an estimated blood loss of 300 mL. The patient’s bowel function recovered by postoperative day (POD) 4, and he was discharged on POD 10 without complications. A bilateral PCN nephrostogram confirmed unobstructed contrast flow into the bladder. The left DJ stent was removed retrograde and the right DJ stent antegrade on POD 32. Bilateral PCN and suprapubic catheter (SPC) were removed on POD 36, followed by per-urethral catheter (PUC) removal on POD 38. The patient was initiated on clean intermittent catheterization (CIC) and maintained good urinary function.
  Conclusions: This modified robotic approach required only a single redocking to accommodate patient repositioning. Precise assessment of stricture length preoperatively and intraoperatively was crucial for determining the required ileal segment length. Ureter identification was particularly challenging due to dense periureteric fibrosis and adhesions, but meticulous robotic-assisted dissection facilitated a successful outcome. The robotic approach proved beneficial in enhancing precision, reducing surgical trauma, and ensuring a smooth postoperative recovery.

UVP-23.09—Robot-Assisted Bilateral Ureterovesical Re-Anastomosis Following Bilateral Ureteric Stricture Subsequent to Robotic Radical Cystectomy and Neobladder Surgery 

• Kılıç Mert ¹, Madendere Serdar ², Balbay Derya ¹
  ¹ Koç University, Istanbul, Türkiye, ² VKV American Hospital, Istanbul, Türkiye

• Introduction and Objectives: We present our case with robot-assisted bilateral uretero-vesical re-anastomosis of a patient who had undergone robotic radical cystectomy and neobladder surgery before.
  Materials and Methods: A 76 years-old male patient had robotic radical cystectomy and neo-bladder surgery due to bladder cancer in the year 2022. In the post-operative first month, double-J stents were removed. After six months, bilateral ureteral stricture and frequent urinary tract infections occurred. Bilateral nephrostomy catheterization and antegrade double-J stent replacement procedures were performed. Despite these treatments, the symptoms persisted, and robot-assisted bilateral uretero-vesical re-anastomosis was planned.
  Results: Firstly, enterolysis was done. Wallace-type previous uretero-vesical anastomosis site was defined by using Indocyanine Green (ICG). Right distal ureter was incised, and a flexible ureterorenoscope was replaced. A stone of 6 mm was removed from the upper calyx. Then, bilateral new uretero-vesical anastomoses were done on 4.8 French double-J stents.
  Conclusions: With minimally invasive techniques, challenging cases can be performed, and even complications can be resolved.

UVP-23.11—Urethral Flap Advance for Glans Reconstruction After Partial Penectomy 

• Fuziwara Seiichi, Hernandez Narciso, Zapot Juan, Jimenez Luis
  IMSS, Mexico, Mexico

• Introduction and Objectives: The objective and rationale for organ preservation in penile cancer include not compromising oncological control and preserving as much of the penis as possible. It is optimal for the treatment of patients with carcinoma in situ, Ta and T1 (1–3).
  Materials and Methods: This is a urethral flap advance for glans reconstruction after partial penectomy technique (2). A tourniquet is placed at the base of the penis. It begins with a circumferential incision, dissection through the Dartos fascia, and identifying the urethra. Posteriorly identify and ligate the neurovascular bundle. Then, the urethra is dissected circumferentially, approximately 2.5 cm proximally, to perform a ventral spatulation of 2 to 2.5 cm. We plicate the urethra dorsally to the corpora cavernosa with interrupted sutures, all the circumference, placing a U-shaped suture at the apex. After, plicate the prepuce to the distal edge leaving half a centimeter of raw area to simulate a balano-preputial groove. At the end, place the Foley catheter, and remove it seven days later.
  Results: From August 2022 to January 2025, we have performed 18 partial penectomies with urethral flap advance reconstruction. The mean operating time for the partial penectomy was 55 min (45–70 min); for 10 patients we performed bilateral superficial inguinal lymph node dissection. From the 18 patients, 12 were T1a, 4 T1b and two patients T2.
  Conclusions: This technique is another alternative for organ preservation surgery after penile cancer, with excellent cosmetics results, potentially avoiding meatus stricture, and preservation function, without compromising the oncological results.

UVP-23.12—Complex Bladder Fistula Reparation After Radical Prostatectomy in a Radiated Patient 

• Abad Rodriguez-Hesles Carlota, Garcia-Baquero Garcia-Paredes Rodrigo
  University Hospital Puerta Del Mar, Cadiz, Spain

• Introduction and Objectives: Radical prostatectomy in previously irradiated patients always entails a higher rate of postoperative complications. The poorer vascularization of tissues increases the risk of urinary fistulas, primarily at the urethrovesical anastomosis. In these cases, when conservative measures fail, reconstructive surgery becomes a surgical challenge.
  Materials and Methods: We present the surgical video of a robotic repair of a complex vesical fistula in a patient who had previously undergone robotic radical prostatectomy (pT2cN0M0 Gleason 7 (3 + 4)) along with a synchronous anterior rectal resection (pT3N2bM0) and definitive colostomy, having also received prior radiation therapy for the latter condition. Initially, the fistula was managed with bilateral nephrostomy, prolonged bladder catheterization, and drainage of the urinoma in the rectal resection bed, without success after 20 days of hospitalization. Preoperative cystoscopy and CT scan revealed a 4 cm defect in the bladder floor, with its edges in close contact with both ureteral orifices. The surgery required continuous improvisation, involving a complete midline longitudinal section of the bladder, resection of the previous urethrovesical anastomosis, anterior rotation and closure of the posterior bladder wall to isolate the urinoma, a new urethrovesical anastomosis on the anterior aspect of the bladder, bilateral ureteral reimplantation, and an interpositional omentoplasty.
  Results: The immediate postoperative course was uneventful. After two weeks, a follow-up cystography showed a minimal leakage at the posterior aspect of the bladder reconstruction. After five weeks, the bladder catheter was removed, and the patient currently presents with moderate incontinence (200 mL daily).
  Conclusions: Vesical fistula repair in patients who have undergone radical prostatectomy with prior radiotherapy requires a surgical approach adaptable to intraoperative findings. The presented technique proved to be an effective option; however, the possibility of requiring a cystectomy should always be considered and communicated before surgical planning.

24. Renal Transplantation

24.1. Moderated Oral ePosters

MP-24.01—Association Between Genotypes and Tacrolimus Pharmacokinetic Parameters in Patients on Co-Prescription of Pharmacokinetic Boosting Drugs After Renal Transplantation 

• Pattanaik Smita, Naithani Priyanka, Singh Sheetal, Panwar Ritika, Nasika Venkata Kanaka Naga Kathik, Atri Savita, Patial Ajay, Sharma Neeru, Kenwar Deepesh, SP Shiva, Singh Sarbpreet, Sharma Ashish
  Post Graduate Institute of Medical Education and Research, Chandigarh, India

• Introduction and Objectives: Tacrolimus, a commonly used immunosuppressant post-transplantation, exhibits interindividual variability in pharmacokinetics influenced by genetic factors such as CYP3A5, PXR, and POR polymorphisms. Pharmacokinetic-boosting drugs are prescribed to patients with high tacrolimus dose requirements or to reduce the cost of treatment. Understanding these associations can optimise tacrolimus dosing strategies. Tacrolimus, a commonly used immunosuppressant post-transplantation, exhibits interindividual variability in pharmacokinetics influenced by genetic factors such as CYP3A5, PXR, and POR polymorphisms. Pharmacokinetic-boosting drugs are prescribed to patients with high tacrolimus dose requirements or to reduce the cost of treatment. Understanding these associations can optimise tacrolimus dosing strategies.
  Materials and Methods: This was a prospective observational study. 54 out of 350 patients needed the co-prescriptions PK-boosting drugs during their routine treatment at our center. The relationship between their genotypes and tacrolimus pharmacokinetic parameters was assessed, and the data for the first 15 days post-transplantation are presented here.
  Results: The SNP analysis was performed in a retrospective manner, and 52 out of 54 patients were found to be CYP3A5 expressers; 18 homozygous (*1/*1) and 34 heterozygous (*1/*3), whereas 2 patients were CYP 3A5 non-expressors (*3/*3). The last two patients were prescribed boosting purely for economic reasons, though the rest of the cohort was due to high dose requirements in the immediate post-transplantation period. The difference between the CYP3A5 expressors and nonexpressors for tacrolimus C0, C0/dose, and C0/dose/kg/day was not computed as there was a gross imbalance between the groups (52 vs. 2). No significant associations were found with PXR NR112, ABCB1 SNPs (ABCB11236C>A, ABCB13435C>A, and ABCB12677C>T polymorphisms. However, POR*28 SNP showed significant associations. On day 2, POR*28 SNP correlated with increased C0 levels and decreased C0/dose (p = 0.007, p = 0.009). Similar patterns were observed on day 7 (p = 0.027, p = 0.022). Significant associations were also noted on day eight between C0/dose/kg/day (p = 0.049) and on day 12 between dose/kg/day and C0/dose/kg/day (p = 0.002, p = 0.013). On day 15, significant associations were found between dose/kg/day and C0/dose/kg/day (p < 0.0001, p = 0.012).
  Conclusions: In patients on co-prescription of PK-boosting drugs post-transplantation, POR*28 showed significant associations with tacrolimus pharmacokinetic parameters, indicating a potential role in individualizing tacrolimus dosing. Further studies are warranted to explore clinical implications of this finding.

MP-24.02—Outcomes of Single-Vessel vs. Multiple-Vessel Grafts in Robot-Assisted Kidney Transplantation at a High-Volume Tertiary Hospital 

• Jha Mrigank, Mitra Shaunak, Desai Pragnesh, Kaushal Rohit, Chaturvedi Samit, Kumar Anant, Bansal Nipun
  Max Super Speciality Hospital, Saket, New Delhi, New Delhi, India

• Introduction and Objectives: Multiple vessels in donor kidney pose technical challenges in robotic kidney transplantation. This study aims to compare the surgical and functional outcomes between single vessel and multiple vessel grafts in robotic kidney transplants performed at our high-volume center.
  Materials and Methods: A retrospective study was conducted on 259 recipients who underwent robot-assisted kidney transplantation between January 2018 and December 2024. Of these, 203 patients received single vessel grafts (Group A), while 56 received multiple vessel grafts (Group B). In multivessel grafts, all efforts were made to combine multiple arteries into a single vessel to allow easy anastomoses to the recipient’s vessel. Demographic data, donor profiles, ischemia times, vascular reconstruction techniques, and postoperative creatinine values at postoperative day 1 (POD-1), POD-7, POD-30, and POD-90 were compared.
  Results: Cold ischemia time was higher in Group B (91.78 ± 58.04 min) compared to Group A (68.01 ± 22.25 min), but the difference was not statistically significant (p = 0.0639). Rewarm ischemia times were comparable between the groups. Multiple vessel grafts had to undergo various reconstruction techniques. 41 patients underwent pantaloon (pajama) reconstruction, end-to-side reimplantation in 8, direct implantation of separate vessels in 2, and extracorporeal repair with internal iliac artery graft in 5 patients. However, postoperative clinical outcomes were comparable between the 2 groups. Postoperative renal functions demonstrated no statistically significant difference between the groups at any time point, indicating equivalent short-term graft function.
  Conclusions: Robotic kidney transplantation with multiple-vessel grafts yields results as good as those with single-vessel cases, supporting its feasibility and safety in highly-experienced centers. Multiple vessels should be converted into single vascular stump to minimize the rewarm ischemia time. Cold ischemia time may be longer in multiple vessel cases due to additional reconstruction steps, but this does not translate into inferior short-term graft function.

MP-24.03—Initial Experience of 10 Cases with Extra-Peritoneal Robot-Assisted Kidney Transplant (eRAKT): A Propensity-Matched Comparison with the Transperitoneal Approach 

• Kushwaha Swapnil ¹, Aggarwal Amit ¹, Chaturvedi Samit ², Kumar Anant ²
  ¹ Max Super Speciality Hospital, New Delhi, India, ² Max Super Speciality Hospital, Saket, New Delhi, India

• Introduction and Objectives: Traditionally, Robot-assisted kidney transplantation (RAKT) is performed using a transperitoneal approach, which requires steep Trendelenburg positioning, potentially leading to cardiorespiratory, bowel and ocular complications. To address these concerns, an extraperitoneal technique has been developed to better simulate open kidney transplant while minimizing morbidity and complications. This study evaluates the feasibility, technical aspects and outcomes of extraperitoneal RAKT (eRAKT) and compares them with the conventional transperitoneal approach using propensity-matched analysis.
  Materials and Methods: Ten patients who underwent eRAKT were compared with a propensity-matched group of 20 patients with transperitoneal approach. Both approaches were performed by the same robotic surgeon, using the Da Vinci Xi robotic surgical systems (Intuitive Surgical, Sunnyvale, CA, USA). Key operative parameters, graft function, and postoperative outcomes were recorded and analyzed. 2: 1 matching was conducted based on the age, sex, BMI, graft kidney GFR and graft number of vessels. After induction of anaesthesia, and positioning the patient, a 5-cm Pfannenstiel incision is made and the extraperitoneal space is developed. Alexis access platform is placed and four robotic ports and one assistant port is placed and the robot is docked. The external iliac artery and vein are carefully dissected. The kidney is then wrapped in a jacket full of ice and then introduced into the extraperitoneal space, the robot is redocked, and venous and then arterial anastomoses are performed using 6–0 GORE-TEX sutures.
  Results: Comparison between the extraperitoneal and transperitoneal approaches showed that eRAKT resulted in faster return of bowel function (mean 1.3 vs. 2.9 days, p < 0.0001) and significantly lower drain output on the first three postoperative days (mean 131.5 vs. 786 mL, p < 0.0001). Pain scores were also lower for eRAKT patients on Days 0, 1, and 2 (mean VAS score 10.2 vs. 14.8, p < 0.0001). While no statistically significant differences were observed in blood loss, rewarm ischemia and vascular anastomosis time, or graft function. The eRAKT group showed more consistent tacrolimus levels in the therapeutic range in early postoperative period.
  Conclusions: eRAKT mimics the open kidney transplant in a minimally invasive manner, with similar functional outcomes of graft but with reduced morbidity and minimal complications.

24.2. Moderated Video ePosters

MVP-24.01—Robotic Reconstruction of Transplant Kidney Ureteric Strictures: A Unique Conundrum 

• Vasudeo Vivek, Panwar Pankaj, Chaturvedi Samit, Kumar Anant
  Max Super Speciality Hospital Saket, New Delhi, India

• Introduction and Objectives: Ureteric obstruction in kidney transplant (KT) is reported to occur in 2–10% of cases. Open surgical reconstruction is the standard primary treatment or treatment after failed endoscopic intervention. Reports of robotic reconstruction in such settings are limited.
  Materials and Methods: We present three cases, transplant kidney ureter stricture managed with robotic redo graft ureteroneocystostomy, robotic ureteropyelostomy to native ureter, and Y-V plasty.
  Results: Case 1: 36 years male had open KT in August 2019, presented with graft dysfunction secondary to transplant ureteric stricture. Robotic Redo Ureteroneocystosomy was done. Case 2: 37 years female presented 6 months after robotic live KT with graft ureteric stricture. Robotic Uretero Pyelostomy to native ureter was done. Case 3: 49 years male presented 9 months after open KT with Pelvi ureteric junction obstruction. He had bilateral grade 4–5 reflux. Due to reflux, native ureter was not used for reconstruction, and a Y-V plasty was planned.
  Conclusions: Robotic reconstruction for graft kidney ureteric stricture is feasible and has excellent outcomes. Choice of procedure depends upon residual length of graft ureter proximal to stricture and status of native bladder and ureter.

MVP-24.02—Managing Right Donor Kidney with Triple Vessel and Angiomyolipoma: An Innovative Approach in Robot-Assisted Kidney Transplant 

• Kushwaha Swapnil¹, Aggarwal Amit ¹, Chaturvedi Samit ², Maheshwari Ruchir ², Kumar Anant ²
  ¹ Max Super Speciality Hospital, New Delhi, India, ² Max Super Speciality Hospital, Saket, New Delhi, India

• Introduction and Objectives: One major challenge in RAKT is handling renal allografts with multiple vessels, which may increase rewarm ischemia time and subsequent development of ATN. Transplanting kidneys affected by renal tumors is typically discouraged, though there have been cases where AML-affected kidneys were successfully transplanted after the mass was excised. In this video, we demonstrate our innovative technique and outcome of managing AML and triple vessel allograft in RAKT using an internal iliac artery autograft.
  Materials and Methods: A 50-year-old male patient was planned for RAKT. Preoperative evaluation of the donor identified three renal arteries on the right kidney and two on the left. A computed tomography scan revealed a 3 × 3 cm AML at the lower pole of right kidney. Radio-isotope renogram study revealed equal function of both kidneys, 54.2 and 45.2 mL/min on the right and left side respectively. A decision was made to take the right kidney laparoscopically for transplantation and remove the mass at bench dissection. The surgery was divided into three distinct steps. Step 1 was the robotic retrieval of the internal iliac artery autograft from the recipient. Step 2 involved bench dissection, which included ex-vivo vascular reconstruction to anastomose three renal arteries with internal iliac artery autograft, and excision of AML with renorrhaphy. The final step involved single anastomosis of renal artery with the recipient’s external iliac vessels.
  Results: The use of the internal iliac artery autograft allowed us to perform a single arterial anastomosis, avoiding the need for multiple arterial anastomosis. Cold and rewarm ischemia times were 100 and 36 min, respectively. Both the donor and recipient experienced uneventful intraoperative and postoperative courses. The recipient’s kidney function remained stable, with no complications related to the AML over a follow-up period of 20 months.
  Conclusions: Our innovative technique in RAKT using an internal iliac artery autograft offers an effective solution by reducing rewarm ischemia time similar to that of a single-vessel kidney transplant. Incidental or asymptomatic small renal masses in donor kidneys can be considered for transplantation after excision in bench surgery.

MVP-24.03—Novel Extraperitoneal Robot-Assisted Kidney Transplant (eRAKT): Technical Appraisal and Outcomes 

• Kushwaha Swapnil ¹, Aggarwal Amit ¹, Chaturvedi Samit ², Maheshwari Ruchir ², Kumar Anant ²
  ¹ Max Super Speciality Hospital, New Delhi, India, ² Max Super Speciality Hospital, Saket, New Delhi, India

• Introduction and Objectives: In recent years, the adoption of robot-assisted kidney transplantation (RAKT) has significantly increased. Conventionally, RAKT has been performed using a transperitoneal approach. However, growing interest has led to the development of an extraperitoneal technique designed to more closely mimic the conditions of open kidney transplantation. In this video, we describe the surgical steps and techniques of multi-port extraperitoneal RAKT (eRAKT).
  Materials and Methods: Patient was positioned at 10o degree Trendelenburg and a 6-cm Pfannensteil incision was made. Extraperitoneal space was developed with a Spacemaker PDBⓇ balloon. ALEXISⓇ access device was placed and four standard robotic and one assistant port inserted. The external iliac artery and vein were carefully dissected after sweeping the peritoneum. The kidney was then wrapped in a jacket full of ice and introduced into the extraperitoneal space via ALEXISⓇ port. The venous and arterial anastomoses were performed using 6-0 GORETEXⓇ sutures. After vascular anastomosis, the Trendelenberg position was slightly increased from 10o to 30o to displace the bowel cranially and flip the kidney to lateral side to perform ureterovesical anastomosis. Results: eRAKT with living donor nephrectomy has been performed successfully for ten patients without any complications or conversions. The mean total operative time and the time spent in port placement and bed preparation time were 288 ± 35.2 and 50.8 ± 8.43 minutes, respectively. Mean vein and artery anastomosis times were 18.5 ± 4.03 and 17.5 ± 3.04 minutes, respectively. All grafts were perfused well and serum creatinine levels returned to normal between 4-7 days. The extraperitoneal approach is associated with overall decreased post-operative ileus (1.3 ± 0.48 days), pain scores (10.2 ± 1.75 on VAS), and drain output (131.5 ± 34.16 mL). Tacrolimus levels were consistently in the therapeutic range in the early postoperative period. Mean creatinine levels were 1.01 ± 0.17 mg/dL at 3 months of follow-up.
  Conclusions: eRAKT mimics the open kidney transplant in a minimally invasive manner, with similar functional outcomes of graft but with reduced morbidity and minimal complications. These findings suggest that eRAKT is a safe and feasible alternative for patients, enhancing recovery while maintaining effective graft function.

24.3. Residents Forum Moderated Oral ePosters

RF-24.01—Incidence and Management of Nephrolithiasis in Ireland’s Transplant Population 

• Maher Philip, Ryan Paul, Davis Niall
  Beaumont University Hospital, Dublin, Ireland., Dublin, Ireland

• Introduction and Objectives: De novo nephrolithiasis in transplanted patients can have severe consequences. The reliance on a single kidney coupled with patients being immunosuppressed and often co morbid can result in delayed and complex presentations.
  Materials and Methods: A search strategy from 01.01.2000 to 31.03.2025 of the National Kidney Registry was implemented to include all de novo nephrolithiasis patients.
  Results: The incidence of de novo nephrolithiasis in transplanted kidneys was 41 out of 4135 transplants, 0.99%. The mean time from transplant to stone detection was 11 years with the average stone size being 11 mm. Stone distribution was evenly split with 21 intrarenal and 20 ureteric. 16 patients (39%) presented emergently, all of which were decompressed with nephrostomy insertion prior to definitive management. 7/41 were definitively managed via retrograde ureteroscopy with a stone free survival rate (SFS) of one year of 57%. 11/41 were managed via PCNL with an average SFS of 84.6% at one year. 1/41 were managed with antegrade ureteroscopy with a 100% SFS rate at one year. Open surgery was performed on 2/41 with a 100% SFS rate at 1 year. ESWL was performed in 1 case with an SFS of 0%. 13/41 of patients were managed conservatively with the remaining 5 patients managed by way of decompression only (2 nephrostomy; 2 retrograde JJ sent; 1 antegrade JJ stent), all of which had an SFS rate of 0% at one year.
  Conclusions: De novo nephrolithiasis is an infrequent condition. In the emergency population that receives nephrostomy decompression, definitive management should be considered via an antegrade approach given the improved SFS rates. In the elective cohort, a retrograde approach should still be considered first line to minimize damage to the renal parenchyma given the patient’s dependance on a solitary functioning kidney.

RF-24.02—Robotic-Assisted vs. Open Recipient Kidney Transplants: A Systematic Review and Meta-Analysis of Surgical Efficacy and Patient Outcome 

• Christanto Roberto ¹, Rasyid Nur ², Situmorang Gerhard ¹
  ¹ Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia, ² Faculty of Medicine, Universitas Indonesia, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia

• Introduction and Objectives: Background: Kidney transplantation is a critical treatment for end-stage renal disease (ESRD), offering significant improvements in quality of life and survival rates compared to dialysis. Recent advancements in surgical techniques have introduced robotic-assisted kidney transplantation (RAKT) as an alternative to traditional open recipient kidney transplantation (ORKT). This systematic review and meta-analysis aims to compare these two approaches in terms of surgical efficacy and patient outcomes. Aim: To provide a comprehensive comparison between RAKT and ORKT regarding their surgical efficacy and patient outcomes, thus guiding clinical decisions and optimizing patient care.
  Materials and Methods: This systematic review and meta-analysis followed PRISMA guidelines. A comprehensive literature search was conducted across PubMed, Cochrane Library, and Scopus to identify relevant studies published up to January 2025. Inclusion criteria required studies to compare RAKT and ORKT in terms of operative time, blood loss, hospital stay length, graft survival, patient survival, and postoperative complications. Data extraction and quality assessment were performed independently by two reviewers. Statistical analyses were conducted using Review Manager software.
  Results: Eight studies met the inclusion criteria, encompassing various designs, including randomized controlled trials, cohort studies, and retrospective reviews. The meta-analysis indicated that RAKT generally resulted in longer operative times (mean difference: 0.85 h), slightly increased blood loss (mean difference: 0.37 L), and marginally longer hospital stays (mean difference: 0.10 days). Immediate graft function was better in ORKT (mean difference: −6.42). Postoperative complications showed no significant difference between the two methods (OR: 1.01). However, patient survival favored ORKT (OR: 11.65).
  Conclusions: While RAKT presents a promising advancement in kidney transplantation, ORKT demonstrates superior outcomes in key areas like patient survival and immediate graft function. Future research should focus on refining robotic techniques, enhancing surgical training, and evaluating the long-term benefits and cost-effectiveness of RAKT. For now, RAKT should be considered selectively, ensuring patient-specific factors and surgical expertise are taken into account to optimize outcomes.

24.4. Unmoderated Oral ePosters

UP-24.01—A Novel Donor Right Renal Vein Extension Method in Living Donor Kidney Transplantation 

• Yuksel Yucel ¹, AKIN Yigit ², Tumer Erbay ¹, Demirbakan Kenan ¹, Akdogan Mehtap ¹, Mese Bulent ¹
  ¹ Sanko University School of Medicine, Gaziantep, Türkiye, ² Izmir Katip Celebi University School of Medicine, Izmir, Türkiye

• Introduction and Objectives: Hemodialysis and peritoneal dialysis are renal replacement therapies, while the method that extends both the quality of life and the duration of life is kidney transplantation (KT). In both deceased and living donor KT, surgeons prefer the left kidney more than the right due to the length of the renal vein. In KT, where right kidney is used as a graft, delayed graft function and graft loss due to vascular reasons in the early period are more common than in the left kidney. Here, we describe a novel donor right renal vein extension method for living donor KT. We wanted to share our experience of lengthening the short renal vein by performing native nephrectomy on the recipient patient and adding the data of the native kidney to the graft kidney.
  Materials and Methods: Between June 2021 and August 2024, 152 kidney transplants were performed, and 27 patients were included in the study. All patients were divided into 3 groups: Group 1: No vein extension. Group 2: Right native nephrectomy (NN) vein addition. Group 3: Left native nephrectomy vein addition. Surgical procedure was performed by same team as recipient patient underwent NN, and short renal vein was lengthened by adding vein of the native kidney to the graft kidney (Figure 1). The same surgical team performed the recipient and donor surgeries. All donor nephrectomies were performed laparoscopically. Patient data recorded and compared in groups including cold and warm ischemia time, delayed graft function, and graft loss.
  Results: The mean age was 42.4 years, the anastomosed vein length and the longest renal vein were in group 3. Delayed graft function was not seen in group 2 and group 3. Graft loss was seen in one patient in group 2. Kidney functions were similar between the groups. There was no difference between the groups for complications.
  Conclusions: We believe successful results can be obtained without graft loss during follow-up if the length of the anastomosed vein is at least 42 mm for successful renal perfusion in eligible cases. A graft of native renal veins can be used to extend the renal vein in the right kidney.

UP-24.02—A Tale of Tacrolimus Toxicity Due to the Hacked Liver System—Attention to Detail Reveals the Perpetrator 

• Pattanaik Smita, Zula Priyadarshini, Gysley Belmin, Kenwar Deepesh, Singh Sarbpreet, SP Shiva, Sharma Ashish
  Post Graduate Institute of Medical Education and Research, Chandigarh, India

• Introduction and Objectives: Fluconazole-Tacrolimus interactions are well known, but Ritonavir’s additional effect is revealed here. This case underscores the need to check for Ritonavir co-administration in renal transplant PLHA patients with high tacrolimus levels, providing valuable insight for TDM specialists. Informed consent, including publication, was obtained.
  Materials and Methods: Case Presentation: A 52-year-old kidney transplant recipient arrived at a busy emergency department with difficulty walking, myalgia, trouble swallowing, weakness, altered mental state, headache, loss of appetite, drowsiness, and painful ulcers. Lab results painted a concerning picture of sky-high Tacrolimus C0 levels of 139 ng/mL, elevated serum creatinine (3.08 mg/dL), electrolyte imbalances, and hyperglycemia. The medical team stopped his immunosuppressant drugs, HAART and antimicrobials, and initiated supportive care. A review of his history uncovered recent Fluconazole use for oral candidiasis, which he initially overlooked. Despite preemptively reducing Tacrolimus by 50%, levels remained dangerously high.
  Results: The mystery unraveled when TDM physicians discovered that his HAART regimen was mistakenly switched from dolutegravir and lamivudine to atazanavir and ritonavir, potent CYP3A4 inhibitors that significantly increased Tacrolimus levels. After five days of stopping Tacrolimus, the patient’s C0 levels finally began to decline. Complete uneventful clinical recovery was observed once the C0 dropped to 13 ng/mL with the serum creatinine reaching a baseline of 2.1 mg/dL. On the 10th day of admission, Tacrolimus was reintroduced with a starting dose of 0.25 mg BD. From the patient’s perspective, he was more concerned about weakness and abdominal discomfort, unaware of the drug interaction.
  Conclusions: This case highlights the importance of reviewing potential drug interactions before prescribing and dispensing.

UP-24.03—Assessing the Risk of Skin Cancer in Renal Transplant Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis 

• Abu Haweeleh Mohannad ¹, Hamdan Ahmad ¹, Aboumarzouk Omar ²
  ¹ Qatar University, College of Medicine, Doha, Qatar, ² Surgical Research Section, Urology Department, Hamad Medical Corporation, Doha, Qatar

• Introduction and Objectives: Skin cancer is a major concern among chronic kidney disease (CKD) patients, especially those undergoing renal transplantation. Immunosuppressive therapy increases susceptibility to both melanoma and non-melanoma skin cancers. This meta-analysis evaluates the incidence and risk factors of skin cancer in CKD patients, highlighting geographic variations, demographic influences, and the impact of immunosuppression.
  Materials and Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Scopus, Embase, and Cochrane databases were searched for studies published between 2016 and 2023. Studies assessing skin cancer incidence in CKD patients were included. Data extraction focused on study characteristics, patient demographics, skin cancer prevalence, and risk factors. A random-effects meta-analysis was performed, and the Newcastle–Ottawa Scale assessed the risk of bias.
  Results: Sixteen studies, encompassing 151,987 patients, met the inclusion criteria. The pooled prevalence of non-melanoma skin cancer (NMSC) was 5.7% (95% CI, 1.1–10.3%), with a standardized incidence ratio (SIR) of 4.32 (95% CI, 4.10–4.50), highlighting a significantly elevated risk among CKD patients. Melanoma had a pooled prevalence of 0.25% (95% CI, 0.11–0.39%) and an SIR of 1.92 (95% CI, 1.85–1.99). Geographic analysis revealed higher NMSC risk in North America (SIR 39.22, 95% CI, 29.6–51.7) and Europe (SIR 20.64, 95% CI, 2.82–150.9), while melanoma risk was highest in Asia (SIR 9.09, 95% CI, 2.27–36.37). Male gender, older age, prolonged sun exposure, and Caucasian ethnicity were key risk factors. Immunosuppressive therapies, particularly calcineurin inhibitors and long-term steroid use, significantly increased skin cancer risk.
  Conclusions: CKD patients, especially transplant recipients, have an elevated skin cancer risk. Regular dermatological screening, optimized immunosuppressive therapy, lifestyle modifications, and patient education are crucial for prevention. Further studies with larger cohorts and longer follow-ups are needed to enhance risk assessment and improve surveillance strategies.

UP-24.04—Pre-Transplant Hypogonadism and Renal Graft Survival 

• Patel Surina, Chahal Mehreet, Aslot Vivek, Mainland Natalie, Carsel Alex, Nadiminty Nagalakshmi, Sindhwani Puneet
  University of Toledo College of Medicine and Life Sciences, Toledo, United States

• Introduction and Objectives: Hypogonadism is a prevalent finding among patients with End Stage Renal Disease (ESRD) and is linked to poorer outcomes including higher rates of graft failure. Previous literature suggests that low levels of testosterone can normalize after renal transplantation, but factors influencing this recovery require further investigation. The study aims to (1) evaluate the resolution rate of pretransplant hypogonadism in male kidney transplant recipients, (2) assess its association with graft failure, and (3) determine whether comorbidities, such as diabetes, influence hypogonadism resolution post-transplant.
  Materials and Methods: The study population included 329 male patients transplanted between January 2017 and September 2023. The primary outcome of interest was total serum testosterone levels. Hypogonadism is defined by total testosterone levels below 300 ng/dL. 114 patients in our study were found to be hypogonadal pre-transplant. Specific analyses investigated the association between both graft failure and diabetes with hypogonadism. Chi-square tests and Fisher’s exact tests were performed to assess statistical significance.
  Results: Overall prevalence of pretransplant hypogonadism in our cohort was 114/329 (34.7%) patients. In 329 patients with available information, 103 (30%) patients had diabetes, and 226 (69%) patients were without diabetes. There was no significant association found on chi square analysis between diabetes status and hypogonadism in male transplant patients (p = 0.069). Among 114 patients with pre and post transplant testosterone levels available and graft function at 1 year, 59 (52%) were eugonadal post transplant, while 55 (48%) remained hypogonadal at 6 month follow up. Only 1 (2%) patient that was eugonadal post transplant faced graft failure, while 8 patients (15%) with unresolved hypogonadism experienced graft failure. Fisher’s Exact test demonstrated a significant association between post transplant eugonadism and graft failure (p = 0.0140). Furthermore, there was no significant correlation between diabetes status and the resolution of hypogonadism post-txp (p = 0.399).
  Conclusions: In this cohort, men with pre-transplant hypogonadism had a significantly higher incidence of kidney graft failure. In addition, our findings demonstrate diabetes status does not significantly influence hypogonadism in male transplant patients. Our study indicates that hypogonadism may be an important risk factor for future graft dysfunction. Larger studies are needed to delineate role of uncorrected hypogonadism in kidney allograft survival.

UP-24.05—Regional Supra-Clavicular Block Versus Local Anesthesia in Creation of an Arterio-Venous Fistula. Does It Really Matter??? 

• Desai Viraj, Frederick Victor Coelho, Patel Deep, Singh Abhishek, Shete Nitiraj, Sabnis Ravindra
  Muljhibhai Patel Urological Hospital, Nadiad, India

• Introduction and Objectives: The preferred hemodialysis access method for patients with end-stage renal failure is arteriovenous fistulae (AVF). They do, however, frequently fail early. Long-term hemodialysis therapy requires good vascular access; however, certain anesthetic methods have a direct impact on venous diameter and intra- and post-operative blood flow. In this study we aimed to compare the effects of regional anesthesia (RA) supraclavicular block VERSUS local anesthesia (LA) in the creation, maturation and cannulation rates of arterio-venous fistulae.
  Materials and Methods: A total of 126 patients who were diagnosed with chronic renal failure were subjected to AVF creation. They were divided into 2 groups: Group 1 (supraclavicular block) guided by ultrasound (US), and Group 2 (LA-G) underwent local infiltration. We measured the AVF blood flow in both groups at 2 distinct times, as well as the brachial and radial artery measurement as well as the diameter of the cephalic vein before and after the regional anesthesia. Additionally, each group’s primary failure rate was noted and compared.
  Results: Post creation of the AVF, a good palpable thrill was present in the local and regional anesthesia arm in 93.88% (46/49) and 74/77 (96.1%) (p value—0.569). At 2 months of follow up, the patency rate of the AVF was 89.8% (44/49) in the local and 89.61% (69/77) in the regional arm, which was not statistically significant. 41/47 (83.67%) of the AVFs cases in the local arm and 65/77 (84.42%) in the block arm were finally cannulated for dialysis (p value—0.912). The time period after creation of the AVF when the fistula was cannulated for dialysis was statistically significant, 6.68 weeks (RA) versus 10.05 weeks (LA) p value—<0.001. The patency at the end of one year was, however, significantly higher in the local group, 91.84% versus 59.72% in the block arm (p value—<0.001).
  Conclusions: The US-guided supraclavicular block did not increase AVF blood flow significantly more than local infiltration and did not significantly decrease the primary failure rate of the AVF after 2 months. However, the time to cannulate the AVF for dialysis was significantly shorter in the regional anesthesia arm.

UP-24.06—Undesirable Consequences of Kidney Transplantation: Graft Nephrectomy 

• Yuksel Yucel ¹, AKIN Yigit ², Tumer Erbay ¹, Demirbakan Kenan ¹, Akdogan Mehtap ¹
  ¹ Sanko University School of Medicine, Gaziantep, Türkiye, ² Izmir Katip Celebi University School of Medicine, Izmir, Türkiye

• Introduction and Objectives: Graft nephrectomy (GN) is a rarely discussed but technically challenging procedure performed following kidney transplant failure. This study aimed to evaluate the surgical indications, timing, complications, and mortality-related factors in patients who underwent GN at our transplant center.
  Materials and Methods: We retrospectively reviewed 34 patients who underwent GN between June 2021 and December 2024. Patients were categorised into emergency and elective GN groups based on surgical indications. Clinical data, laboratory parameters, operative findings, and outcomes were analysed and compared between the two groups.
  Results: Among the 165 kidney transplants performed during the study period, GN was required in 34 cases. The mean age of patients was 42.3 years, with a male-to-female ratio of 24:10. Nineteen patients underwent emergency GN, and 15 had elective procedures. Mortality was significantly higher in the emergency group (47.3%) compared to none in the elective group (p = 0.012). Major vascular injuries occurred in three patients during elective GN, two of whom required vascular reconstruction with cadaveric grafts. Hemophagocytic syndrome (HPS) was identified as a unique indication for GN in seven patients, of whom three survived.
  Conclusions: GN is a complex and high-risk surgical intervention, particularly in emergency settings. Early elective surgery, when indicated, may reduce morbidity and mortality. Special attention should be paid to vascular risks during GN, especially in right kidney grafts with short venous stumps. In selected conditions such as HPS or graft intolerance syndrome, GN may offer a survival advantage and facilitate future transplantation.

25. Sexual Dysfunction

25.1. Moderated Oral ePosters

MP-25.01—10 Years Follow-up Outcomes of Pelvic Floor Muscle Rehabilitation for Premature Ejaculation Treatment: Analysis of a Multicentre Retrospective Study 

• Pastore Antonio Luigi ¹, Al Salhi Yazan ², Fuschi Andrea ¹, Maruccia Serena ³, Suraci Paolo Pietro ¹, Sequi Manfredi Bruno ¹, Valenzi Fabio Maria ¹, Carbone Antonio ¹
  ¹ Sapienza University of Rome, Faculty of Pharmacy and Medicine Dept. of Medico-Surgical Sciences and Biotechnologies Urology Unit, ICOT Latina, Latina, Italy, ² Sapienza University of Rome, Faculty of Pharmacy and Medicine, Latina, Italy, ³ ASST San Paolo e San Carlo Hospital, Dept. of Urology, Milan, Milan, Italy

• Introduction and Objectives: The aim of the study was to evaluate the 10 years follow-up outcomes of pelvic floor muscle (PFM) rehabilitation in subjects suffering from lifelong and acquired premature ejaculation. To evaluate PE, patients were investigated with intravaginal ejaculatory latency time (IELT) and the self-report Premature Ejaculation Diagnostic Tool (PEDT). The primary outcomes endpoints were the IELT change and the score reported at the PEDT.
  Materials and Methods: This retrospective study evaluated 193 subjects with PE diagnosis (lifelong no.128, mean age 25.9 y.o.; acquired no. 65, mean age 37.2 y.o.). A total of 191 pts out of 193 (98%) completed the rehabilitative protocol, and all 191 pts attended the 10 years follow-up. At baseline evaluation, all included subjects reported a latency time ≤ 60 s and PEDT score > 11. All participants completed a 12-week program of PFM rehabilitation, including physio-kinesiotherapy treatment, biofeedback. The effectiveness of intervention was evaluated by comparing the geometric means of IELT times and PEDT scores observed from baseline to 6 and 12 months during the intervention and at 24, 36, 48, 60 and 120 months postintervention, using a paired sample 2-tailed t-test, including the associated 95% confidence intervals.
  Results: 191 subjects completed the PFM rehabilitation protocol with 36 sessions of PFM under a physiotherapist’s control. All patients reported a significant improvement of the ejaculatory time with a mean IELT of 188.7 s and PEDT score of 2.4 at the 12-week endpoint of the intervention (p < 0.0001). Of the 191 participants who completed the 10-years follow-up, 83%, 79%, 78%, 71%, and 68% maintained satisfactory and significant results (ejaculatory latency time and PEDT score) through the follow-up times at 24, 36, 48, 60 months, and final 10 years follow-up after the PFM training, respectively.
  Conclusions: This study is the first on PE treatment with so large number of patients and such long-term follow-up (10 years). The results observed are significant and were maintained significantly through the entire follow-up time. PFM rehabilitation in premature ejaculation represents an effective and safe therapy with lasting results. Funding: None. Clinical Trial Registration Number: UNIV LSLTURO 5468/2017. RCT: No. Subjects: Human. Ethics Committee: UNIV LSLTURO 5468/2017. Helsinki: Yes. Informed Consent: Yes.

MP-25.02—Association Between Insulin Resistance Markers (Tyg, Tyg-BMI, Tg/hdl) and Testosterone Deficiency in Men 

• Lee Jun Ho ¹, Choi Jae Duck ¹, Lee Dong-Gi ², Min Gyeong Eun ², Chung Kyung Jin ³
  ¹ Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea, ² Department of Urology, Kyung Hee University School of Medicine, Seoul, Republic of Korea, ³ Gachon Univ. Gil Hospital, Incheon, Republic of Korea

• Introduction and Objectives: While testosterone deficiency (TD) has been associated with impaired glucose tolerance, limited research has focused on the association between insulin resistance markers and TD. We evaluated the association between TD and insulin resistance markers, including the triglyceride-glucose (TyG) index, TyG-BMI, and triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL). Additionally, we sought to identify which marker is the best predictor of TD in men.
  Materials and Methods: Data were analyzed from 3,225 men who participated in health checkups. Insulin resistance markers were calculated as follows: TyG = Ln(TG [mg/dL] × fasting glucose [mg/dL]/2); TyG-BMI = TyG index × BMI; TG/HDL = TG/HDL. TD was defined as total testosterone < 3.5 ng/mL. We used Pearson correlation to assess the relationship between testosterone and these markers, followed by binary logistic regression to determine odds ratios (ORs) for TD across quartiles of TyG, TyG-BMI, and TG/HDL. The cut-off points for these markers were determined using receiver operating characteristic (ROC) curves. All analyses adjusted for confounders, including age, BMI, blood pressure, LDL cholesterol, and HbA1c.
  Results: TD was found in 734 men. There was a significant negative linear correlation between testosterone and all three insulin resistance markers (TyG, TyG-BMI, and TG/HDL). TyG-BMI showed the strongest correlation (correlation coefficient > 0.3), while TyG and TG/HDL showed weaker correlations (correlation coefficient < 0.3). The ORs for TD increased significantly with higher quartiles of all markers, but TyG-BMI showed the strongest association. After adjusting for confounders, the OR for TD in the highest quartile of TyG-BMI was 2.45 (95% CI: 1.68–3.57, p < 0.001) compared to the lowest quartile. The OR for TG/HDL in the highest quartile was 1.94 (95% CI: 1.31–2.87, p < 0.001), and, for TyG, it was 1.67 (95% CI: 1.17–2.39, p < 0.001). The ROC curve analysis showed that TyG-BMI had the highest area under the curve (AUC = 0.736), followed by TG/HDL (AUC = 0.711) and TyG (AUC = 0.689). Cut-off values were 8.64 for TyG, 217.79 for TyG-BMI, and 2.45 for TG/HDL.
  Conclusions: TyG-BMI was the most strongly correlated with TD and demonstrated the highest predictive value. TyG-BMI may be a useful, cost-effective tool for identifying men at risk of TD.

MP-25.03—Clinical and Patient Reported Outcomes of Inflatable Penile Prosthesis Insertion in Men Under 35 Years Old 

• Cao Yuqing ¹, Shah Mohammad ², Osinibi Elizabeth ², Ralph David ², Lee Wai Gin ²
  ¹ University College London, London, United Kingdom, ² University College Hospital at Westmoreland Street, London, United Kingdom

• Introduction and Objectives: Penile prosthesis implantation due to its irreversible nature is generally reserved as a last resort for older men with end-stage erectile dysfunction (ED). As natural erections will no longer be possible, the decision in young men is not taken lightly. To date, we are lacking in studies reporting patient satisfaction and its acceptability in young men.
  Materials and Methods: Using a retrospective electronic search within our clinical coding systems, we identified men under 35 with an inflatable penile prosthesis (IPP) inserted at a tertiary centre between March 2016–August 2024. The aetiologies, patient characteristics, investigations, multidisciplinary team (MDT) involvement, and clinical outcomes were extracted. Patient-reported outcome measures (PROMs) were then collected with the Satisfaction Survey for Inflatable Penile Implant (SSIPI), a validated questionnaire.
  Results: We identified 109 men with IPP inserted for ED (46%), phalloplasty (32%), and ischaemic priapism (23%). Of the men with ED or priapism, 62/73 underwent IPP insertion, and 11/73 a malleable prosthesis. Median age at IPP insertion was 29 (IQR = 26–32). 52/62 had complete relevant data available for analysis with 4.6 years (IQR = 1.9–7.2) length of follow-up. 87% did not experience operative complications. 46% of men with psychogenic ED had pre-operative psychosexual counselling, and 77% Nocturnal Penile Tumescence (NPT) test. SSIPI completion rate was 28/62, 82% were somewhat or very satisfied with their IPP overall, and 72% of the 25/28 men who had attempted sexual intercourse were similarly satisfied.
  Conclusions: IPP insertion is an acceptable form of treatment for young men that have exhausted medical and psychosexual options. Careful counselling and multidisciplinary involvement are key to adequately gear patient expectations contributing to satisfaction.

MP-25.04—Efficacy and Safety of on-Demand Therapy with Clomipramine/sildenafil Combination Compared to on-Demand Therapy with Clomipramine or Sildenafil Alone in Patients with Premature Ejaculation: A Prospective, Randomized, Double-Blinded, Active Controlled, 3-Treatment Arm, Parallel, Multi-Center, Phase 3 Trial 

• Moon Du Geon ¹, Ryu Ji Kan ², Lee Won Ki ³, Kim Jae Hun ⁴, Park Heung Jae ⁵
  ¹ Korea University Guro Hospital, Seoul, Republic of Korea, ² Inha University, Incheon, Republic of Korea, ³ Hallym University, ChoonCheon, Republic of Korea, ⁴ Suncheonhyang Hosp, Seoul, Republic of Korea, ⁵ KangBuk Samsung Medical Center, Seoul, Republic of Korea

• Introduction and Objectives: We assessed the efficacy and safety of on-demand therapy with clomipramine 15 mg/sildenafil 50 mg combination compared with clomipramine or sildenafil alone in men with PE without ED.
  Materials and Methods: This prospective, randomized, double-blinded, active-controlled, 3-treatment arm, multi-center trial enrolled 795 men with PE without ED. Subjects were recruited between October 2019 and April 2022 at 24 institutions in Korea. PE was defined as (1) history on DSM-V, (2) PEDT ≥ 11 score, and (3) IELT < 3 min. Subjects were divided into three groups: clomipramine 15 mg (group A, n = 265), sildenafil 50 mg (group B, n = 266) and clomipramine 15 mg/sildenafil 50 mg (group C, n = 264). During 12 weeks, stopwatch measured IELT and patients reported outcomes (PEP, PGIC) were measured. Any treatment-emergent adverse events (TEAEs) were also recorded.
  Results: Over 12 weeks, IELT increased by 191.72 ± 12.72 s (p < 0.001), 168.35 ± 12.29 s (p < 0.001), and 279.41 ± 20.06 s (p < 0.001) in group A, B and C, respectively. Increase of IELT was significantly greater in group C than in group A or group B (each p < 0.001). In PEP score, the improvement rates were 91.46%, 85.59%, and 96.10% in groups A, B, and C, respectively. Improvement rate of PEP score was higher in group C than group A or B (p = 0.037 and <0.001, respectively). In PGIC score, the improvement rates were 41.87%, 34.50%, and 54.98% in groups A, B, and C, respectively. Improvement rate of PGIC score was higher in group C than group A or B (p = 0.004 and <0.001, respectively). TEAEs occurred in 17.36%, 16.17%, and 25.00% of groups A, B, and C, respectively. TEAEs in group C seemed to occur more frequently than in groups A or B, but there was no statistical difference between groups (p = 0.098). TEAEs occurred in order of headache (9.09%), nausea (7.58%), flushing (7.95%) and dizziness (3.41%) in group C. Almost all TEAEs were mild to moderate (99.58%), and there was no serious TEAE.
  Conclusions: On-demand therapy with clomipramine 15 mg/sildenafil 50 mg combination showed better results in terms of IELT, PEP and PGIC and was similar in safety, compared to that with clomipramine 15 mg or sildenafil 50 mg alone.

MP-25.05—Efficacy of GPA (Glans Penis Augmentation) with Distal PGE (Penile Girth Enhancement) by HA (Hyaluronic Acid) for the Treatment of PE (Premature Ejaculation) 

• Moon Du Geon ¹, Ahn Sun Tae ¹, Park Min Gu ², Park Heung Jae ³
  ¹ Korea University Guro Hospital, Seoul, Republic of Korea, ² Korea University Anam Hospital, Seoul, Republic of Korea, ³ KangBuk Samsung Medical Center, Seoul, Republic of Korea

• Introduction and Objectives: GPA with HA has been accepted for treatment of PE, nonresponsive for conventional treatment. PGE also has an effect to decrease IELT. We aimed to evaluate the efficacy of GPA with distal PGE for the treatment of PE.
  Materials and Methods: A total of 12 patients of PE, IELT < 3 min were enrolled in this study. GPA was done firstly with submucosal injection of 4–6 mL of HA evenly whole glans surface and assessed change of IELT. 3 months later, 10 mL of HA was injected circularly at distal penile girth. Changes of IELT were assessed at 6 months later. Before GPA, 12 weeks after GPA and 12 weeks after distal girth enhancement with HA, IELT, 5 scale patient satisfaction on penile shape, sexual satisfaction and any adverse reactions were assessed.
  Results: In all patients, distal penile girth was significantly increased by 25.95 ± 13.71 mm. Preoperative mean IELT was 101.54 ± 69.72 s. 12 weeks after GPA, mean IELT significantly increased to 251.4 ± 72.3 s. Another 12 weeks after distal PGE, mean IELT increased additionally, 325.38 ± 120.76 s. 18/20 (90%) of patients were satisfied in penile shape and sexual satisfaction. In 3 patients of residual HA from previous PGE 5 years ago and a patient of initial deformity, 1,500U of hyaluronidase successfully dissolved the HA. In 7 patients of PE, all pts showed over 3 min of IELT at 6 months. No serious adverse events (AEs) were reported.
  Conclusions: GPA effectively increased IELT, and additional distal PGE with HA further increased IELT. In contrast to total PGE with HA, distal PGE with HA did not induce unsatisfactory displacement of HA or distortion of penis. Hyaluronidase is useful for initial correction of deformity and dissolution of later remnants several years ago.

MP-25.06—Piezo-Electric Extracorporeal Treatment with Low Intensity Shock-Wave Therapy (LI-ESWT) in the Management of Erectile Dysfunction: A Single-Center Experience 

• Salvaggio Marco ¹, Castellucci Roberto ¹, Faieta Alessio ¹, Ferrari Riccardo ², Ferrari Giovanni ², Piccinini Cristian ², De Nunzio Cosimo ³, Cindolo Luca ²
  ¹ Casa di Cura Villa Stuart-Private Hospital, Roma, Italy, ² Hesperia Hospital, Modena, Italy, ³ Sapienza Università di Roma, Roma, Italy

• Introduction and Objectives: Erectile dysfunction is a prevalent condition affecting male sexual health, with a multifactorial etiology. Low-intensity extracorporeal shock wave therapy (LI-ESWT) has emerged as a potential regenerative treatment option. This study evaluates the efficacy of LI-ESWT using a piezoelectric generator in a single-center cohort.
  Materials and Methods: A retrospective analysis was conducted on patients treated with LI-ESWT for ED at our center. Inclusion criteria: males aged 30–80 years, ED for at least 6 months, baseline IIEF-EF score between 11 and 25, serum testosterone between 300–1,000 ng/dL, and HbA1c ≤ 7.5% in diabetic patients. Exclusion criteria: neurologic or psychogenic ED, untreated hypogonadism, penile anatomical abnormalities or prior penile surgery, hemophilia, high thrombotic risk, active penile neoplasm, or history of major pelvic surgery (Table 1). All patients received 8 weekly sessions, each delivering 10,000 shocks at 15 Hz and 90 mJ. Efficacy was assessed via pre- and post-treatment (8-week) scores using the Sexual Health Inventory for Men (SHIM), International Index of Erectile Function (IIEF-5), and Erection Hardness Score (EHS). Statistical analysis was performed to evaluate changes over time.
  Results: A total of 94 men were included in the analysis. Mean (SD) increase the in score of questionnaires evaluated at 8-week was clinically and statistically significant with an overall improvement of +5.49, +5.47 and +1.18 points (p-value < 0,0001) in IIEF-5, SHIM, EHS questionnaires, respectively. At the 12-month follow-up, 80 patients (85%) completed the evaluation, while 14 (15%) were lost to follow-up. No statistically significant changes were recorded at 12 months, with questionnaire stability and final scores of 16.38 (IIEF-5), 15.32 (SHIM), and 2.87 (EHS). Treatment effects remained substantially improved from baseline (Figure 1). Only 8% of patients had retreatment.
  Conclusions: According to the European Association of Urology and Società Italiana di Andrologia guidelines, LI-ESWT may be considered for selected patients with vasculogenic ED, particularly those who are not responsive or only partially responsive to phosphodiesterase type 5 inhibitors (PDE5i). LI-ESWT using a piezoelectric generator demonstrated significant and sustained improvements in erectile function, as measured by scientific questionnaires. The therapy appears to be a promising non-invasive option for patients with ED, with long-term benefits observed up to 12 months post-treatment.

MP-25.07—Presentation and Management of Inguinal Hernias (IH) in Patients with Inflatable Penile Prosthesis (IPP) with or without Herniation of Reservoir 

• Shah Mohammad, Al-Mitwalli, Abdullah
  University College of London Hospital, London, United Kingdom

• Introduction and Objectives: IPP using a 3-piece prosthesis is preferred surgery for erectile dysfunction. It consists of a reservoir typically placed in the retropubic space. While IH is common, there is lack of literature addressing the presentation and management of IH in patients with an IPP. Given close proximity of reservoir or tubing to inguinal region, careful planning is crucial when considering IH repair. We present surgical consideration and case series of IH repair ipsilateral to IPP reservoir.
  Materials and Methods: All patients who underwent IH repair in the presence of an IPP were reviewed. Data from clinic, imaging, and operations were analyzed to provide descriptive statistics. Inclusion: IH ipsilateral to an IPP reservoir or IH after ipsilateral reservoir removal. Exclusions: IH contralateral to IPP reservoir. Direct and indirect IH were assessed intraoperatively relating to Hasselbach triangle.
  Results: 15 cases included, with mean age at IPP and IH repair of 56.3 and 60.1 years respectively. The mean time between IPP and IH repair was 55.1 months. At IPP surgery prior to IH presentation, reservoir placement was done via same incision (retropubic space) in 93% of included cases with remaining 1 case having a separate incision. All IH presented with reducible groin swelling, and 40% had palpable reservoir. All IH repairs were elective open surgery with Prolene mesh used in 93% of cases and remaining 1 case: plication suture only. Direct IH were noted in 67% (N = 10) of cases categorised further into 1. direct IH with herniated reservoir (DR) (n = 6); 2. direct IH without herniated reservoir (DH) (n = 2); 3. direct IH previously removed reservoir (DNR) (n = 2). All patients maintained functional IPP at follow-up with andrology. Two patients experienced recurrent hernias and underwent robotic or laparoscopic repair.
  Conclusions: IH ipsilateral to reservoir placement following IPP is rare. However, careful surgical planning is essential to ensure successful hernia repair while protecting the reservoir. If the reservoir is palpable prior to surgery, it will likely be within the surgical field. Resitting the reservoir is a safe procedure that, based on our experience, does not increase the risk of infection or compromise the functionality of the implant.

MP-25.08—What’s up with Our Patients 5 Years After Nerve-Sparing Radical Prostatectomy and 3 Years After Finishing Penile Rehabilitation Study Programs? 

• Bannowsky Andreas ¹, Bannowsky Sabine ¹, Ückert Stefan ²
  ¹ Hospital Diepholz, Diepholz, Germany, ² Hannover Medical School, Hannover, Germany

• Introduction and Objectives: Several strategies are published for postoperative erectile function rehabilitation after nerve-sparing radical prostatectomy (nsRP). The aim of our study was to evaluate the use of any ED-treatment or the adherence to study protocol medication 3 years after the end of the initiated rehabilitation program.
  Materials and Methods: 124 patients (mean age 69 years) from 3 different rehabilitation studies after nsRP with a regular dose of different PDE5-inhibitors (sildenafil/vardenafil/tadalafil) were enrolled for this evaluation. The regular initial follow-up of all of the 3 studies was 24 months. We performed a questionnaire sent to all enrolled patients of these studies 3 years after the end of the study/5 years after nsRP. The survey consists of different questions, e.g., if and what kind of ED-treatment the patients still use. Further questions dealt with the reasons to end the study medication or switch to any other treatment.
  Results: 91 patients (73.4%) completed and returned the questionnaire. 51 patients (56%) had stopped medical ED-treatment therapy completely at the time of the survey because of different reasons (completely restored erectile function without any medication 12%, subsequent ineffectiveness of the medication 8.8%, progressive disease of prostate cancer 7.7%, subsequent comorbidities 27.5%). From the remaining 48 patients, only 21 patients (23%) still using only PDE5-inhibitors (daily or on demand). 16 patients (17.5%) using penile injection therapy, 3 patients MUSE (3.2%) and 8 patients VCD (with/without PDE5-inhibitors) (8.8%).
  Conclusions: 5 years after nsRP/3 years after the end of the different rehabilitation studies, most of the patients (56%) don’t use any ED-medication anymore due to different reasons. Only 12% of the patients after being enrolled in rehabilitation programs for 24 months are still reporting a restored erectile function 5 years after nsRP without any medication.

25.2. Unmoderated Standard ePosters

UP-25.01—Application of Regenerative Technologies in the Treatment of Peyronie Disease: Corporoplasty with the Use of Pericardium Allograft 

• Le Tkhu Chang, Kazikhinurov Albert, Shamsov Bedil, Kazikhinurov Rustem, Pavlov Valentin, Khasanov Azat
  Bashkir State Medical University, Ufa, Russian Federation

• Introduction and Objectives: Surgical treatment of Peyronie’s disease is resorted to in copulatory dysfunction. Despite the great complexity and risks, lengthening techniques are the choice of the surgeon and the patient. The main aspects determining the choice of a graft are elasticity, extensibility, strength, and hypoallergenic. The high risk of erectile dysfunction in corporoplasty with the use of transplants reaches 60%. One of the promising methods is the use of multipotent mesenchymal stem cells of the stromal vascular fraction (SVF) of autologous adipose tissue.
  Materials and Methods: Pericardial allograft (Alloplant^®) was used as a graft for corporoplasty. A preliminary assessment of physical properties of the graft was studied. The extensibility was approximately equal, both in the longitudinal and transverse directions. We observed the elongation of the centimeter section without loss of strength to 2 cm; the tensile strength was 2.6 kgf/cm². Incision and grafting with a pericardial allograft were performed on 28 patients with Peyronie’s disease, without erectile disorders. In addition, the cavernous tissue and the tunica albuginea of corpus cavernosum of seven patients were injected with SVF. The transplant was covered with SVF. The average age of patients was 53 ± 12.3 years. Patients were examined according to clinical recommendations: questionnaire on the ICEF-5 scale, PDQ, pharmacodopplerography of the penis with photofixation of the penis in 3 perspectives, measurement of deviation using a screen protractor. The average angle of deviation of the penis was 87.5° (55–120°).
  Results: Satisfactory cosmetic results (the presence of a residual deviation of less than 10 degrees) were achieved in 93%. The development of de novo erectile dysfunction of varying degrees was observed in 6 patients (28.6%) in the corporoplasty group (21 patients). Two patients had the development of persistent erectile dysfunction with a violation of the veno-occlusive mechanism. The conservative methods were ineffective; therefore, the implantation of penile prosthetic is required. In the group of pericardial corporoplasty using SVF (7 patients), only one patient had the development of mild de novo erectile dysfunction with the effect of conservative therapy.
  Conclusions: The use of allograft pericardium and SVF in corporoplasty is a safe, effective and affordable method of surgical treatment of patients with Peyronie’s disease.

UP-25.02—Comparative Predictive Value of Total and Free Testosterone in Young Men with Erectile Dysfunction 

• Al Dayel Adel
  Men’s Health Clinic, Dammam, Saudi Arabia

• Introduction and Objectives: Erectile dysfunction (ED) in young men has multifactorial etiologies, with androgen deficiency playing a pivotal role. Guidelines recommend measuring morning testosterone to assess hypogonadism; however, it remains unclear whether morning (AM) versus afternoon (PM) levels—or free versus total testosterone—are more associated with ED in this population. This study aimed to characterize testosterone levels in young men with ED, compare these levels to normative ranges, and evaluate the predictive value of both free and total testosterone for ED diagnosis.
  Materials and Methods: A retrospective analysis was conducted on a cohort of 500 young men (ages 20–40 years) diagnosed with ED. Total testosterone measurements were obtained in either the AM or PM; free testosterone was available for a subset. Descriptive statistics (mean, standard deviation, median) were calculated and compared with established normative values. Associations between hormone levels and ED were examined using correlation analysis and logistic regression modeling, with odds ratios (OR) and 95% confidence intervals (CI) computed. Predictive performance was evaluated via receiver operating characteristic (ROC) analysis, with significance set at α = 0.05.
  Results: The mean total testosterone among ED patients was ~13 nmol/L (SD ~5), with AM levels averaging ~14 nmol/L and PM levels ~12 nmol/L. Approximately 30% of patients had total testosterone below 10 nmol/L and 10% below 8 nmol/L—values lower than expected in a healthy population. Both AM and PM testosterone levels showed a significant inverse association with ED. Logistic regression analysis indicated that each 1 nmol/L increase in testosterone was associated with a 10–15% reduction in ED odds (OR ≈ 0.85, p < 0.001). The predictive accuracy, as determined by ROC analysis, was modest (AUC ~0.70), and free testosterone demonstrated similar predictive performance to total testosterone.
  Conclusions: Young men with ED exhibit lower average testosterone levels compared to normative data, with a substantial subset meeting biochemical criteria for hypogonadism. Both AM and PM measurements are significantly associated with ED, with PM levels showing a slightly larger deficit. Furthermore, free and total testosterone performed similarly in predicting ED. These findings underscore the clinical utility of hormonal evaluation in the work-up of ED and suggest flexibility in testing time without compromising diagnostic sensitivity.

UP-25.03—Corporal Length Distribution in Penile Implant Surgery: A Framework for Setting Realistic Expectations 

• Ortiz Nicolas, Lyons Cassandra, Gonzalez Miranda Luis, Tuong Mei, Charles David, Smith Ryan
  University of Virginia, Charlottesville, United States

• Introduction and Objectives: Inflatable penile prosthesis (IPP) implantation remains the gold standard treatment for patients with refractory erectile dysfunction (ED). Although most patients are satisfied with restored sexual function, perceived penile shortening continues to be the most frequently reported long-term concern, with up to 70% of men noting a reduction in length. While previous studies have explored the link between preoperative stretched penile length (SPL) and optimal prosthesis sizing, no standardized framework currently exists to guide expectation management. This study introduces a corporal length distribution chart to enhance both preoperative and postoperative counseling.
  Materials and Methods: A retrospective review of the Coloplast penile prosthesis database from 2014 to 2024 was conducted. Corporal length (CL) was calculated by combining the lengths of the implanted cylinder and rear-tip extenders (RTEs). Descriptive statistical analysis was performed, and a bar graph was created to depict the distribution of implant sizes.
  Results: A total of 55,066 prosthetic devices were analyzed. Corporal length ranged from 12 cm to 32 cm, with a mean length of 20.89 cm (SD = 2.21). The 10th and 95th percentiles were 18 cm and 24.25 cm, respectively, indicating that 85% of implants fell within this range.
  Conclusions: Implant lengths displayed a normal distribution, with an average of approximately 21 cm, consistent with prior studies. The proposed corporal length distribution chart may serve as a practical resource for setting appropriate patient expectations during preoperative consultations.

UP-25.04—Effect of Surgical Timing on Sexual Function Recovery After Penile Fracture 

• Hermi Amine, Kastalli Selim, Saadi Ahmed, Saidani Bilel, Mokadem Seif, Ayed Haroun, Chakroun Marouene, Ben Slama Mohamed
  Charles Nicolle hospital, Tunis, Tunisia

• Introduction and Objectives: Penile fracture is a rare urological emergency resulting from traumatic rupture of the tunica albuginea of the corpus cavernosum, typically following a sudden deviation of the erect penis. The aim of our study was to investigate the impact of the surgery timing on the recovery of sexual functions after penile fracture.
  Materials and Methods: A retrospective, descriptive, and analytical single-center study including 73 patients who underwent surgery for penile fracture. The study was conducted between January 2006 and June 2024. All patients reported normal erectile function prior to the onset of the penile fracture. The patients were divided into two groups based on the time elapsed between the injury and the surgery (within the first 24 h or after). All patients were followed up for 6 months, and the sexual function was assessed using the IIEF-5 (International Index of Erectile Function), the Erection Hardness Score (EHS) at the end of 6 months.
  Results: The median age of the patients was 42 years, with a range from 24 to 84 years. The most common mechanism was forceful self-manipulation/masturbation, reported in 36 patients (50%). Coital misstep (“false step during intercourse”) was noted in 25 cases (34%), and trauma of other origins accounted for the remaining 12 cases (16%). The average time between the occurrence of the fracture and surgical intervention was 19 h (ranging from 3 h to 5 days), with 80% of patients undergoing surgery within the first 24 h. At the 6-month follow-up, all patients who underwent early surgical repair demonstrated preserved sexual function. No statistically significant difference was found between the early (<24 h) and delayed (>24 h) surgery groups in terms of erectile function outcomes (IIEF-5 score: p = 0.9080; EHS: p = 0.616).
  Conclusions: Early surgical intervention remains the standard for penile fracture. In our study, surgical timing with no significant impact of the surgery timing on functional outcomes. Prompt repair is advised, even in late presentations.

UP-25.05—Erectile and Ejaculatory Function Outcomes Following Surgical Management of Penile Fracture 

• Atteya Mohamed ¹, Hamdi Ashraf ¹, Shawky Omar ², Ramez Mohamed ¹
  ¹ Urology & Nephrology Center, Mansoura University, Mansoura, Egypt, Arab Rep., ² Faculty of Medicine, Mansoura University, Mansoura, Egypt, Arab Rep.

• Introduction and Objectives: The current management of penile fracture is immediate surgical repair to decrease the probability of long-term complications, such as erectile dysfunction. The delay in the treatment of penile fracture can lead to long-lasting sexual dysfunction. We present our data on sexual function outcomes following surgical management of penile fracture as well as the possible effect of penile degloving of penis on ejaculatory functions.
  Materials and Methods: We retrospectively reviewed our surgical records for patients who underwent surgical repair of penile fracture between January 2018 and December 2022. Patients were contacted by phone to visit our outpatient clinic for evaluation. Preoperative condition of erection was evaluated using the single-question self-report of ED. Preoperative condition of ejaculation was evaluated by asking the patient about the duration before ejaculation. Patients were asked to fill out two questionnaires to evaluate the postoperative condition of erection and ejaculation: IIEF-5 questionnaire and PEDT questionnaire.
  Results: We analyzed data of 46 patients. Mean patients’ age at time of surgery was 45.6 ± 12. Three (6.5%) patients reported having ED before penile fracture, and 16 (34.8%) patients reported having premature ejaculation before penile fracture. Median size of the tear was 10 (IQR: 5–10) mm. Median duration from penile fracture to presentation to emergency room was 10.5 (IQR: 7.25–18.5) h. Median follow up duration was 29 (IQR: 12–48) months. Mean IIEF-5 score 20 ± 4.2. In addition, median PEDT score was 5 (IQR: 1–7). Erectile function was correlated with age at presentation and time from penile fracture to surgery.
  Conclusions: Early surgical treatment of penile fracture is necessary to decrease the rate of complications and particularly affection of erectile function. Degloving of the penis during repair can affect glans sensation on long term follow up with possible effect on ejaculatory function.

UP-25.06—Evaluation of the Relationship Between Glans and Penile Anatomy and Premature Ejaculation 

• Ceylan Oğzuhan, Dağlı İsa, Canbolat Muhammed, Duvarcı Mehmet, Hamidi Nurullah, Uzel Tuncel
  University of Health Sciences, Dr.Abdurrahman Yurtaslan Ankara Oncology Research and Training Hospital, Ankara, Türkiye

• Introduction and Objectives: The aim of this study was to evaluate the relationship between the anatomy of the penis and glans penis and premature ejaculation (PE).
  Materials and Methods: This study was conducted between October 2022 and April 2024 by prospectively recording the data of 204 patients who presented to our clinic with complaints of premature ejaculation (PE) and 200 patients who presented to the clinic for any reason but did not have PE. The presence of PE was assessed using the intravaginal ejaculation latency time (IELT) and the premature ejaculation diagnostic tool (PEDT). The age, IELT, PEDT, penile lengths, mucosal lengths, frenulum lengths, maximum circumference of the glans penis, and minimum circumference of the glans penis of all patients were recorded. Additionally, the frenulum-mucosal ratio (FMR), frenulum-penis ratio (FPR), mucosa-penis ratio (MPR), ratio of the maximum circumference of the glans penis to the frenulum (GFR), and the ratio of the minimum circumference (narrow) of the glans penis to the maximum circumference (wide) of the glans penis (NWR) were also recorded.
  Results: The mean age of the participants in the study was 41.9 ± 13.5 years. It was determined that the mean ages and the maximum circumference of the glans penis were similar between the two groups. When the PE group and the control group were compared, it was found that the median penile length (120 mm in the PE group vs. 130 mm in the control group, p = 0.011), the mean frenulum length (19.8 mm in the PE group vs. 22 mm in the control group, p = 0.001), and the median mucosal length (15 mm in the PE group vs. 20 mm in the control group, p < 0.001) were statistically significantly shorter in the PE group. It was also found that the minimum circumference of the glans penis was longer in the PE group compared to the control group (60 mm in the PE group vs. 50 mm in the control group, p < 0.001). Additionally, there was a positive correlation between frenulum length and IELT (r = 0.160, p = 0.022), a positive correlation between FMR and IELT (r = 0.191, p = 0.006), and a negative correlation between GFR and IELT (r = −0.171, p = 0.015).
  Conclusions: Compared to patients without PE, it can be stated that patients with PE had shorter frenulum, mucosa, and penile lengths, while the minimum circumference of the glans penis was longer.

UP-25.07—Exploring Multiparametric MRI (mpMRI) of the Prostate Beyond Diagnosis and Staging: Identifying Accessory Pudendal Arteries (APAs) & Correlation with Functional Outcomes 

• Al-Mitwalli, Abdullah, Shah Mohammad
  UCLH, London, United Kingdom

• Introduction and Objectives: mpMRI is integral for diagnosis and staging of prostate cancer. mpMRI guides surgical planning for robotic assisted radical prostatectomy (RARP) prior to bilateral nerve sparing (BNS) surgery. Penile arterial supply is from pudendal artery in most anatomical variants; APA are present in almost 40%. Functional significance of APA remains unclear and debatable. Dynamic contrast enhancement (DCE) of mpMRI offers opportunity to identify APAs. We explore mpMRI parameters including APA presence to assess impact on erectile function (EF) after BNS RARP.
  Materials and Methods: Consecutive mpMRI prior to BNS RARP over a 6-month period were reviewed by an expert vascular uro-radiologist blinded to the surgical details, surgeon and functional outcomes. Prospective EF outcomes using International Index EF—EF Domain (EFD) tool were recorded at baseline (BL) and 6 months postop (6M). Urinary outcomes: pads/day. Poor quality mpMRI and biparametric MRI were excluded. Quality based on DCE/field of view. Imaging parameters recorded: 1. APA. 2. Rate of baseline enhancement/after contrast for prostate (PRT)/corpora (CRT). 3. Membranous Urethral Length (MUL). 4. Prostate volume ml (PV).
  Results: Total of 76 MRI reviewed. Exclusions: 39. Included: 37 patients. Median age 62 years (IQR 57–66). APA present in 22 patients (11 right, 10 left, and 1 bilateral). 12 branches of obturator A, 6 inferior vesical A, and 4 anterior divisions of internal iliac A. Mean BL and 6M EFD scores were higher when APA were present (Table 1). This was not statistically significant. Linear regression of BL and 6M EFD against PRT, CRT, and PV shows that none are statistically significant. Linear regression of pads/day showed MUL as a predictor with marginal statistical significance (R-squared = 0.1036, p = 0.0556). To assess correlation we dichotomized the 6M EFD scores into ≤15 and those >15. The mean PRT and CRT for 6M dichotomised IIEF-EFD were shown to be statistically significant as shown in Table 2 using Wilcoxon rank-sum test.
  Conclusions: It is possible to delineate APAs from DCE of preoperative mpMRI. There is a difference in EFD scores between APA presence and absence, although not statistically significant. Further research needed to assess functionality of APA and other imaging markers on EF outcomes.

UP-25.08—Female Sexual Function and Quality of Life After Pelvic Floor Surgery: A Cross-Sectional Prospective Study 

• Ausheva Bella, Kasyan George, Pushkar Dmitry
  Russian University of Medicine, Moscow, Russian Federation

• Introduction and Objectives: Pelvic disorders involve a variety of different conditions such as bladder and bowel dysfunctions along with pain or sexual problems. The problem of sexual dysfunction is one of the symptoms associated with pelvic organ prolapse that motivates women to seek medical attention. The objective of this study is to assess the severity and prevalence of sexual dysfunction in patients with pelvic floor disorders.
  Materials and Methods: A study was conducted from March to October 2024 in the female urology department of a tertiary public university center. A total of 150 patients admitted for the pelvic surgery were screened; data of 105 patients were collected and analyzed. All patients completed questionnaire PISQ 12 (Pelvic Organ Prolapse Incontinence Sexual Questionnaire) prior to surgery.
  Results: The total number of patients operated was 105, with an average age of 55.7 years (±12.6). The mean value of the PISQ 12 questionnaire was 31.6 ± 6.85 with a maximum value of 48.0. Patients who completed the questionnaire were diagnosed with stress urinary incontinence (44.8%), a mixed (41.0%), and pelvic organ prolapse (26.7%). 9.2% of women with pelvic dysfunction “never” experienced sexual desire, 18.4% experienced sexual desire “seldom”. Pain during sexual intercourse was frequent—3 points. 2.7%—“always” experienced pain during sexual intercourse, 2.7%—“usually”, 28.0%—“sometimes”, 29.3%—“often”, 37.3%—“never”. Episodes of loss of urine during intercourse were observed on average, often (3 points; 5.3%—“always”, 16.0%—“often”, 17.3%—“sometimes” lost urine during intercourse), but urinary or fecal incontinence rarely affected sexual activity. The genital prolapse in 66.7% of women was always considered the primary reason for avoiding sexual intercourse. The percentage of women with negative emotions during sex was 36.0%. As sexual abstinence is recommended for all patients to reduce the risk of dyspareunia in the postoperative period, a long-term follow-up study of the sexual function in postoperative female patients at least 2–3 months after surgery is necessary.
  Conclusions: Patients with pelvic disorders most often experienced pain during sexual intercourse and urinary incontinence. Sexual dysfunction increases with age and pelvic disorders such as urinary incontinence and pelvic organ prolapse.

UP-25.09—Identifying the Erectile Function Improvement Through Surgical Treatment of Varicocele: Findings from a Retrospective Cohort Study 

• Mao Shanhua, Zheng Pengfei, Zhou Yiwen
  Huashan Hospital, Fudan University, Shanghai, China

• Introduction and Objectives: Varicocele, affecting 10–15% of the male population, is closely associated with compromised sperm quality, testicular insufficiency, and manifestations of hypogonadism. Emerging evidence indicates that varicocelectomy may ameliorate erectile function; however, comprehensive and robust analyses of this potential association remain scarce. This retrospective study aimed to investigate alterations in erectile function, as assessed by the International Index of Erectile Function-5 (IIEF-5), among patients who underwent surgical management of varicocele.
  Materials and Methods: A retrospective review was conducted on male patients aged 18–50 diagnosed with varicocele and treated with surgical varicocelectomy between April 2018 and November 2018. A total of 58 patients were included in the analysis. Erectile function was assessed preoperatively and six months postoperatively using IIEF-5 scores. Patients were stratified into groups based on the surgical technique employed to facilitate comparative analyses of outcomes. Statistical methods focused on evaluating changes in IIEF-5 scores and examining their clinical relevance.
  Results: Postoperative IIEF-5 scores demonstrated a modest overall increase, from 20.72 ± 3.33 preoperatively to 20.91 ± 3.48 six months postoperatively (p = 0.3153). Although the change in total IIEF-5 scores did not reach statistical significance, a detailed subdomain analysis revealed a significant improvement in Question 3 (sexual satisfaction), with scores increasing from 3.17 ± 0.79 to 3.43 ± 0.80 (p < 0.05). This notable finding suggests that patients were able to sustain their erectile function for longer durations during sexual intercourse following surgery, thereby indicating improved stability of erections. Subgroup comparisons based on surgical techniques demonstrated no significant differences in erectile function outcomes.
  Conclusions: Varicocelectomy shows potential benefits in enhancing sexual satisfaction, as evidenced by the significant improvement in IIEF-5 Question 3 scores, suggesting better sustainability of erections during intercourse. Although overall erectile function scores showed no significant changes, these findings highlight the selective impact of varicocelectomy on specific domains of sexual health. This study underscores its therapeutic potential in addressing sexual performance beyond overall erectile function. Further well-designed prospective studies with larger cohorts are warranted to validate these findings, explore underlying mechanisms, and refine clinical strategies for managing varicocele-related sexual dysfunction.

UP-25.10—Penile Prosthesis Replacement Surgery with Bilateral Distal Erosion Reconstruction 

• Albarran Carlos, Gomez Borja, Isa Manuel, Rodriguez Ruth, Alvarez Silvia, Moreno Ana, Ginel Ignacio, Encina Clara, Yubero Carmen, Yang Fanyi, Antolin Alfredo
  12 Octubre Universitary Hospital, Madrid, Spain

• Introduction and Objectives: The implantation of a penile prosthesis is a well-established therapeutic option for the management of erectile dysfunction, and its indication has been increasing in our clinical practice. With prolonged use over the years, mechanical complications such as bilateral distal rupture of the corpora cavernosa may occur. The correct identification of this complication is essential for planning a timely surgical intervention that restores the functional integrity of the device. However, due to its low prevalence, it can pose a surgical challenge, complicating the selection of the most appropriate reconstructive technique to optimize functional outcomes and minimize the risk of recurrence.
  Materials and Methods: A 63-year-old male with erectile dysfunction secondary to retrorectal schwannoma surgery performed in 1982. A penile prosthesis was implanted and required replacement on two occasions (the most recent in 2011), with the original reservoir left in place. The patient presented with prosthesis malfunction, with rapid deflation after inflation. On physical examination, bilateral perforation of the corpora cavernosa in its distal region was observed, which was confirmed by pelvic MRI. A prosthesis replacement was performed with distal reconstructive surgery.
  Results: Step-by-step description of the surgical technique, detailing the key aspects of the procedure. At the one-year follow-up, the patient presented with a normally functioning prosthesis.
  Conclusions: It is crucial to identify complications that, although rare, can lead to prosthesis malfunction. Distal cavernotomy with primary closure of the defect and prosthesis replacement is a valid option for patients with distal perforation of the corpora cavernosa.

UP-25.11—Randomized Prospective Study on the Efficacy of Training in the Administration of Intraurethral Alprostadil 

• Martínez Pérez Salvador, Yebes Alonso Álvaro Javier, Fernández Pascual Esaú, Solano Heranz Pablo, Alonso Bartolomé Maria Belén, Ayllón Blanco Héctor, Martínez Piñeiro Luis, Sánchez De La Morena Yuste Carmen, García Yonte Juan Luis, Aguilar Ramírez María Pilar, Casanova Martín Carlos, Gómez Villanueva Alejandra, Campuzano Pérez María
  Hospital Universitario La Paz, Madrid, Spain

• Introduction and Objectives: The prevalence of erectile dysfunction (ED) refractory to monotherapy with phosphodiesterase type 5 inhibitors (PDE5i) is estimated at 30–40%. These patients often require combination therapies such as intraurethral alprostadil (IAU). This study aims to assess whether specialized training in IAU administration improves functional outcomes and patient satisfaction.
  Materials and Methods: An interim analysis of a randomized prospective study was conducted between June 2022 and December 2023 at Hospital Universitario La Paz. Patients with ED refractory to PDE5i monotherapy were randomized into a control group and a training group. The control group received standard medication instructions according to the technical datasheet. The training group received instruction from specialized nursing staff on proper handling and administration of IAU. Functional outcomes were assessed using the IIEF-EF scale at various time points, along with satisfaction surveys and adverse event monitoring at all visits.
  Results: A total of 23 patients were included (mean age 65 ± 7.3 years, mean BMI 29 ± 2.8). Comorbidities included hypertension (69.6%), dyslipidemia (65.2%), diabetes (36.4%), and smoking history (74%). The etiology of ED was predominantly vascular (73.9%), followed by post-surgical pelvic causes (17.4%) and Peyronie’s disease (13%). No significant differences were found between groups in baseline characteristics. Baseline IIEF-EF scores were 9.9 ± 3.9 in the control group and 10.4 ± 5 in the training group (p = 0.81). After one month, the control group scored 11.8 ± 4.7, while the training group reached 15.1 ± 4.6. The improvement in IIEF-EF was +1.25 ± 1.75 in the control group versus +4.7 ± 3.5 in the training group (p = 0.006). After the first month, training was offered to the control group; 66% accepted, with a subsequent IIEF-EF improvement of +5.7 ± 2.7. Five patients discontinued treatment due to side effects (pain/irritation). Overall satisfaction at three months was 8.5 ± 2.2.
  Conclusions: Specialized nurse-led training in the administration of IAU significantly improves functional outcomes, is safe, and results in high patient satisfaction. These findings highlight the importance of structured training in optimizing treatment for patients with refractory ED.

UP-25.12—Response to Erectile Dysfunction Treatment After Non-Nerve-Sparing Robot-Assisted Radical Prostatectomy 

• Gurung Sumita
  University College London, London, United Kingdom

• Introduction and Objectives: Erectile function recovery is known to be significantly lower following non-nerve-sparing (NNS) robot-assisted radical prostatectomy (RARP) compared to nerve-sparing RARP. Despite this, there is a notable lack of contemporary research evaluating the efficacy of post-operative treatment options—such as phosphodiesterase type 5 inhibitors (PDE5i), vacuum erection devices (VED), and intracavernosal injections (ICI)—in patients who have undergone NNS RARP.
  Materials and Methods: This is a retrospective review of patients who underwent NNS RARP at a high-volume referral centre over a 7-year period (2018–2024). The inclusion criteria were: NNS RARP and at least two follow-up visits in the andrology clinic. Patients who had prior prostate cancer treatments (such as radiotherapy or focal therapy) were excluded. Efficacy was defined as erections sufficient for penetrative intercourse, as reported by the patients. Patient demographics, comorbidities, and International Index of Erectile Function-5 (IIEF-5) scores were recorded.
  Results: A total of 404 patients met the inclusion criteria, with a mean age of 63.3 years, a mean BMI of 28, and a mean follow-up period of 29.2 months. The mean preoperative IIEF-5 score was 14, while the postoperative score was 6.5. Among the cohort, 301 patients received PDE5i (on-demand Sildenafil, 100 mg, and/or Tadalafil, 20 mg), with only 1.6% (n = 5) responding to treatment. VED was used by 319 patients, of whom 24.5% (n = 78) resumed sexual activity. ICI with alprostadil was administered to 159 patients, with a 35% (n = 56) success rate. 29 reported pain, and 4 had prolonged, painful erections. A second-line ICI (aviptadil/phentolamine) was used in 42 patients, with 50% (n = 21) achieving resumption of sexual activity. Ultimately, 6.9% (n = 28) of patients received a penile implant.
  Conclusions: This study evaluated the effectiveness of post-operative erectile dysfunction treatments in patients undergoing NNS RARP. The response to PDE5i was minimal, suggesting it should not be used as a standalone treatment in this population. The use of VED proved successful in up to a quarter of patients. Starting with second-line treatments, ICI may lead to quicker resumption of sexual activity.

UP-25.13—Optimising Peyronie’s Disease Management in the NHS: Reducing Delays and Improving Patient Pathways 

• Ralston Charlotte, Rooney Helen, Johnston Allan
  Glasgow Royal Infirmary, Glasgow, United Kingdom

• Introduction and Objectives: Peyronie’s disease is a connective tissue disorder characterised by fibrous plaques in the penis leading to curvature, pain and erectile dysfunction (ED). Within the NHS, access to specialist treatment is limited, with many patients waiting prolonged wait times before seeing an Andrologist at specialist unit. This study aimed to assess service efficiency and improve patient assessment in order to optimise treatment pathways.
  Materials and Methods: A retrospective review was performed on patients referred for Peyronie’s disease management at Glasgow Royal Infirmary before implementing service improvements. Key variables included time to first and second clinic visits, completion rates of the International Index of Erectile Function (IIEF), use of clinical photographs, need for ED treatment, and treatment outcomes. Following the review, patient information leaflets and clinic proformas were introduced to enhance documentation and streamline assessments.
  Results: A total of 54 patients were reviewed, mean age 58. The average time from referral to the first clinic visit was 214 days; 16.67% of patients had IIEF completed. A significant proportion (64.81%) required a second clinic visit, with an average waiting time of 248 days, 71.43% needed follow-up for photographic documentation, accounting for 46%of all referrals. Additionally, 60% of second-clinic patients required further evaluation for erectile dysfunction (ED) treatment, with 46.3% of total referrals necessitating follow-up for ED management. Following implementation of pre-clinic patient information leaflet and clinic proforma, data completion significantly improved, as did the need for a second clinic appointment.
  Conclusions: The study effectively evaluated patient flow and highlighted a substantial delay in patient care pathways, with over two-thirds of patients requiring a second clinic visit. The prolonged time between appointments suggests potential inefficiencies in scheduling and resource allocation. The high proportion of patients requiring additional assessment for photos and ED treatment indicates a need to streamline initial evaluations to reduce unnecessary follow-ups. Implementation of the patient information leaflets and clinic proformas has allowed the improvement of this patient pathway optimising clinical treatment where possible. Further analysis of economic savings needs to be conducted.

UP-25.14—Usefulness of a New Index of Depressive Symptoms-Dhea-S/cortisol Ratio-in Patients with LOH Symptoms 

• Wakita Haruhiko, Ishikawa Keisuke, Kanda Takashi, Narita Shuichiro, Anno Yuta, Taniguchi Ayumu, Uesaka Yuka, Nozaki Taiji, Shirai Masato, Tsujimura Akira
  Juntendo University Urayasu Hospital, Urayasu, Japan

• Introduction and Objectives: Depressive symptoms associated with LOH syndrome have garnered significant social attention, particularly in the context of absenteeism and presenteeism. However, it is well-established that LOH symptoms do not necessarily correlate with serum testosterone levels. Conversely, elevated cortisol levels and reduced dehydroepiandrosterone sulfate (DHEA-S) levels are frequently observed in individuals with depression, making these biomarkers promising indicators for symptom evaluation. This study aimed to investigate the relationship between depressive symptoms and the DHEA-S/cortisol (D/C) ratio in a large cohort of patients presenting with LOH symptoms.
  Materials and Methods: This study included 2,950 patients treated at our department and affiliated institutions. The mean age of participants was 47.5 ± 0.2 years, the mean serum testosterone level was 5.37 ± 0.04 ng/mL, and the mean D/C ratio was 33.9 ± 0.5. Symptom scores were as follows: AMS 39.5 ± 0.2, SHIM 12.2 ± 0.1, IPSS 8.9 ± 0.1, and BDI score for depressive symptoms 11.4 ± 0.1. The study primarily focused on the following: (1) the correlation between serum testosterone levels and the D/C ratio, (2) the relationship between the D/C ratio and the AMS and BDI scores, and (3) the evaluation of symptom scores (AMS, SHIM, IPSS, and BDI) in relation to the D/C ratio after adjusting for age.
  Results: No significant correlation was observed between serum testosterone levels and the D/C ratio (p = 0.489). The D/C ratio showed a significant negative correlation with both the AMS (r = −0.61; p = 0.001) and BDI scores (r = −0.089; p < 0.001). Trend analysis revealed a statistically significant reduction in the D/C ratio as the severity of AMS and BDI increased (Ptrend < 0.001). Moreover, no correlation was found between serum testosterone levels and the AMS or BDI scores. After adjusting for age, the only symptom score significantly associated with the D/C ratio was the BDI score (β = −0.058, p = 0.001).
  Conclusions: The D/C ratio was considered to be extremely useful as a new indicator of depression, a typical symptom of LOH.

26. Stones—Evaluation & Medical Management

26.1. Moderated Oral ePosters

MP-26.01—Non-Invasive Prediction of Stone Composition Using Hounsfield Units (HUs) and Urinary pH in Radiolucent Stones 

• Hussain Mushtaq, Alawadi Abdulla, Armitage Charlotte, Smith Yuko
  Queen Elizabeth Hospital, Birmingham, United Kingdom

• Introduction and Objectives: Radiolucent urinary stones, primarily uric acid and struvite calculi, present diagnostic challenges due to overlapping imaging features. Accurate differentiation is critical for guiding therapy: alkalinization for uric acid stones versus antimicrobials for infective stones. Within the NHS, prolonged waiting times for surgical interventions—often exceeding 6 months for elective stone procedures—frequently delay definitive management, exacerbating patient morbidity and stone-related complications. Early non-invasive identification of stone composition could enable immediate initiation of targeted medical therapy (e.g., urinary alkalinization or antibiotic regimens), circumventing delays in surgical care. This study evaluates the diagnostic utility of Hounsfield Units (HU) and urine pH in distinguishing these stone types, with the goal of streamlining treatment pathways and reducing reliance on delayed procedural interventions.
  Materials and Methods: This retrospective study included 110 patients with radiolucent renal stone. Data collected included stone composition, Hounsfield Unit (HU) from non-contrast computed tomography, urinary pH levels, and infection markers (urine nitrites and leucocytes). Patients with mixed-composition or radio-opaque stones were excluded. Comparative analysis was performed between uric acid and struvite stone groups to assess diagnostic parameters.
  Results: A total of 110 patients with radiolucent renal calculi were analyzed. Of these, 65 were confirmed as uric acid stones and 45 as struvite stones. Uric acid stones demonstrated significantly lower Hounsfield Units (mean 432 ± 98 vs. 694 ± 182; p < 0.001) and more acidic urine pH (median 5.5 vs. 6.7; p < 0.001). Infection markers strongly favoured struvite stones, with nitrite positivity in 82% (37/45) of struvite cases compared to 24% (16/65) of uric acid cases, and leucocyte positivity in 84% (38/45) vs. 38% (25/65). Diagnostic thresholds of HU ≤ 500 + pH ≤ 5.5 identified uric acid stones with 87% sensitivity and 83% specificity, while HU > 500–1000 + pH > 7 predicted struvite stones with 85% accuracy.
  Conclusions: Uric acid stones exhibit significantly lower HU values and acidic urine pH compared to struvite stones. A diagnostic threshold of HU ≤ 500 + pH ≤ 5.5 identified uric acid stones with 87% sensitivity, while HU > 500–1000 + pH > 7 predicted struvite stones with 85% specificity. These parameters reduce reliance on invasive stone analysis and optimize therapy selection.

MP-26.02—Demographics, Metabolic Evaluation, and Surgical Intervention Rates in Calcium Phosphate Stone Formers: A 7-Year Follow-up Study 

• Elbassyiouny Ahmed ¹, Estaphanous Peter ², Sarmah Piyush ²
  ¹ University Hospital of Coventry and Warwickshire, Coventry, United Kingdom, ² University Hospital of Coventry and Warwickshire, Coventry, United Kingdom

• Introduction and Objectives: Recurrent calcium phosphate stones pose significant challenges in urolithiasis management. This study aims to evaluate the demographics, metabolic characteristics, and surgical intervention rates among patients with recurrent calcium phosphate stones over a 7-year follow-up period.
  Materials and Methods: A total of 385 patients with calcium phosphate stones were analysed retrospectively. Demographic data included age, gender, and ethnicity. Metabolic parameters, such as serum calcium levels, urine calcium, and urine oxalate, were assessed. Stone recurrence rates and surgical intervention frequencies were evaluated, including the time to recurrence and the proportion requiring repeat surgical procedures.
  Results: The average patient age was 50.1 years. Ethnic backgrounds were predominantly White British (304) and South Asian (33). Metabolic evaluation revealed elevated serum calcium levels (>2.60 mmol) in 3.1% of patients, hypercalciuria (>7.5 mmol) in 13.5%, and hyperoxaluria (>460 mmol) in 4.9%. Recurrence occurred in 110 patients (28.6%), with a median time to recurrence of 3.92 years. 58 patients (15.1%) required surgical intervention after initial diagnosis of calcium phosphate stone.
  Conclusions: This study sheds light on the ongoing clinical challenges associated with recurrent calcium phosphate stones. The findings emphasize the importance of addressing recurrence through comprehensive long-term management strategies, including metabolic evaluation, preventive measures, and tailored interventions, to optimize patient care and reduce the burden of surgical treatments.

MP-26.03—Do Lifestyle Factors Independently Impact the Incidence of Urolithiasis? A Nationwide Cohort Study 

• Park Hong Seok ¹, Ahn Suntae ¹, Kim Jong Wook ¹, Oh Mi Mi ¹, Moon Du Geon ¹, Cho Hyunyee ²
  ¹ Korea University Guro Hospital, Seoul, Republic of Korea, ² Korea University Anam Hospital, Seoul, Republic of Korea

• Introduction and Objectives: Metabolic syndrome is associated with a higher risk of kidney stones, yet there is limited longitudinal research on whether lifestyle factors—such as smoking, drinking, and physical activity—impact stone incidence independently. This study aims to investigate the association between lifestyle factors and urolithiasis incidence using a national health screening cohort.
  Materials and Methods: The National Health Insurance Service-National Health Screening database was utilized (NHIS-2022-2-156). The cohort consisted of 514,866 health screening examinees from 2009 to 2015, with exclusions for prior urolithiasis, congenital kidney disease, malignancy, kidney transplantation, and eGFR < 60. Cox proportional hazards regression, adjusted for age, BMI, sex, comorbidities, and eGFR, was used to assess the hazard ratio (HR) of incident stones across physical activity, smoking, and drinking categories. This study received approval from the Ethical Committee of the Korea University Hospital.
  Results: A total of 286,175 examinees, contributing 1,958,105 person-years of follow-up, were eligible for the study. Among these, 12,403 subjects developed kidney stones. Table 1 shows the association between lifestyle factors and stone development. Multivariate analysis revealed an increased risk of kidney stones among current smokers (HR, 1.097; 95% CI, 1.042–1.155; p = 0.0004) and ex-smokers (HR, 1.221; 95% CI, 1.163–1.281; p < 0.0001), whereas light to moderate drinking (HR, 0.934; 95% CI, 0.896–0.975; p = 0.0017) and heavy drinking (HR, 0.911; 95% CI, 0.836–0.992; p = 0.0317) were associated with a decreased risk of stone development. The relationship between exercise and kidney stones was equivocal.
  Conclusions: Smoking was found to independently increase the risk of stone development. However, drinking appeared to reduce the risk, while the impact of physical activity on stone formation was inconclusive.

MP-26.04—Enhanced Consent and Patient Counselling Using Surgassist Virtual Reality for Patients Undergoing Shockwave Lithotripsy: Prospective Outcomes from a University Teaching Hospital 

• Reynolds Phoebe, Somani Bhaskar, Pietropaolo Amelia, Tear Loretta, Davis Tanya, Bamerni Dara
  Southampton University Hospital, Cornwall, United Kingdom

• Introduction and Objectives: To discover the effectiveness of VR in improving patient understanding and enhancing the consent procedure for patients undergoing extracorporeal shockwave lithotripsy (SWL). The primary outcomes measured include patient knowledge, pain perception, and emotional well-being.
  Materials and Methods: For this prospective study (ERGO 92019), patients with kidney stone disease (KSD) undergoing SWL were given a VR headset before their treatment. The VR glasses visually explained the SWL process (3 min) and its success and complications through an audio explanation linked to a 3D animation. The content followed the patient information leaflet (PIL) from European and British associations. Participants were provided with three questionnaires that covered pain, anxiety, and patient understanding of SWL via the VR enhanced consent (one questionnaire each).
  Results: 100 patients completed all three questionnaires. 68 patients reported an improved understanding of SWL with VR, and the overall improvement in patient understanding was statistically significant (p < 0.001). Participants also found the VR headset significantly more helpful and accessible and felt more confident explaining the procedure. 66 participants preferred VR to current teaching methods, and 81 firmly favoured using VR for future procedures. Findings also demonstrated a positive emotional impact, with participants reporting more positive and fewer negative emotions after VR use.
  Conclusions: Our study showed that incorporating VR into the consent process effectively improves patient understanding and experience, with widespread approval. VR improved the psychological well-being of patients undergoing surgical procedures, highlighting the potential for VR to play a significant role in enhancing consent.

MP-26.05—Gut Microbiota Diet Index and Kidney Stone Risk in Individuals Aged 40 and Above: Cross-Sectional Analysis 

• Xiao Yunfei ¹, Gao Shunyu ², Lin Tao ²
  ¹ Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, ² West China Hospital, Sichuan University, Chengdu, China

• Introduction and Objectives: Given the contentious relationship between gut microbiota and kidney stones, we investigated the association between the Dietary Index for Gut Microbiota (DI-GM) and the prevalence of kidney stones in a nationally representative sample from the United States.
  Materials and Methods: We analyzed data from 20,469 participants in the National Health and Nutrition Examination Survey (NHANES). A multivariate logistic regression model was used to identify the correlation between DI-GM scores and kidney stone incidence, supplemented by smooth curve fitting for further exploration. To validate our findings, we performed subgroup analyses, interaction tests, and sensitivity analyses.
  Results: In this study, the average age of participants with kidney stones (59.75 ± 11.52 years) was higher than that of participants without stones (57.81 ± 11.66 years). In the fully adjusted multivariable logistic regression model, each unit increase in DI-GM scores was associated with a 5% reduction in kidney stone incidence (OR = 0.95; 95% CI: 0.92–0.98; p < 0.001). When comparing DI-GM groups, the fourth group demonstrated a 21% reduction in kidney stone incidence relative to the first group (OR = 0.79; 95% CI: 0.70–0.89; p < 0.001). A smoothed curve fit revealed a negative linear relationship, and both subgroup and the robustness of these findings was confirmed by sensitivity analyses.
  Conclusions: Our findings indicate a linear association between DI-GM scores and the incidence of kidney stones, with higher DI-GM scores linked to a lower incidence of kidney stones.

MP-26.06—Lack of Renal Function Improvement Following Intervention for Nephrolithiasis in Elderly and Diabetic Chronic Kidney Disease Patients from Diverse Multiethnic Urban Population 

• Tsang Derrick ¹, Gladwin Jessica ², Proag Khelanjalee ¹, Constantinou Zoe ², Graham Stuart ¹, Fan Stanley ¹, Yaqoob Magdi ¹, Green James ¹, Pal Pallavi ¹, Choo Xuan ²
  ¹ Barts Health NHS Trust, London, United Kingdom, ² Queen Mary University of London, London, United Kingdom

• Introduction and Objectives: Stone disease is a recognized risk factor for chronic kidney disease (CKD) due to prolonged obstruction, repeat urinary tract infections, and direct epithelial damage causing scarring and fibrosis. Urological interventions like shockwave lithotripsy (ESWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL) aim to preserve renal function. However, renal function may not always improve post-intervention, especially in patients with CKD stage 3–5 pre-intervention. This study aims to identify factors in patients who remain in CKD stage 3–5 post-intervention, focusing on diabetes mellitus (DM), ethnicity, age, and socioeconomic deprivation.
  Materials and Methods: A retrospective review was conducted on patients who underwent stone intervention (ESWL, URS, PNCL) in 2018, 2019, and 2022 at a multi-ethnic NHS Trust in UK. Renal function change was dependent on estimated glomerular filtration rate (EGFR) at pre-intervention and 1-year follow-up. EGFR outcomes were categorized as “declined” (change ≤ −2), “stable” (change > −2 but ≤5), and “improved” (change > 5). Patient records were reviewed for DM, age, and self-reported ethnicity. Home address postcodes were compared against the English index of deprivation data (2019) to determine the index of multiple deprivation decile (IMDD). Chi-square tests assessed associations between EGFR change and DM, age, ethnicity, and IMDD.
  Results: 1086 patient records were reviewed. 192 patients had CKD3–5 at stone intervention, but only 141 had follow-up blood tests. 69 (48.9%) were diabetic. DM proportions in declined, stable, and improved groups were 58.5%, 63.0%, and 29.6%, respectively, with a significant association between DM and worsening CKD (p = 0.007). No significant association was found between EGFR changes and ethnicity (p = 0.563). Age deciles showed significant association (p = 0.0025); declining EGFR had a median age of 68 years, improved EGFR had a median age of 59 years. Most CKD stage 3–5 patients were 60–70 years old (38.3%) and in IMDD 3. No significant association was found between IMDD and EGFR changes (p = 0.18).
  Conclusions: Diabetes and older age are significant predictors of renal function decline at 1 year post-stone intervention in CKD3–5 patients. Younger patients are more likely to show EGFR improvement. Ethnicity and socioeconomic deprivation did not significantly influence EGFR. Increased monitoring and specific treatments to slow CKD progression should be incorporated into future guidelines for elderly diabetic patients.

MP-26.07—Managing Residual Renal Lithiasis by Combined Citrate Treatment—An Alternative for Improving Flexible Ureteroscopy and Holmium Laser Lithotripsy Stone-Free Outcomes 

• Geavlete Bogdan, Ene Andrei, Bulai Catalin, Geavlete Petrisor, Popescu Razvan, Ene Cosmin
  ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania, Bucharest, Romania

• Introduction and Objectives: Within the pathophysiology of calcium oxalate, uric acid and cystine lithiasis, alkaline citrates contribute, as metabolic pathways, to urine alkalinization, correct hypocitraturia and inhibit the production of calcium oxalate crystals. The study evaluated the impact of potassium and magnesium citrate and pyridoxine combination oral treatment on residual renal stone fragments.
  Materials and Methods: 198 patients undergoing flexible ureteroscopy and holmium laser lithotripsy for kidney stones of 1–2 cm were enrolled in a prospective, randomized-controlled study. Extracted calculi were examined crystallographically by X-ray diffraction and infrared spectroscopy. Native abdominal CT scan evaluated residual stones. As selection criteria, cases of calcium oxalate, calcium phosphate, uric acid or mixed composition of these were included, with confirmed postoperative residual stone fragments up to 6 mm in diameter. Group A followed a hygienic-dietary regimen developed by crystallographic analysis and potassium and magnesium citrate and pyridoxine combination oral treatment. Group B followed exclusively a hygienic-dietary regimen. Periodic assessments were conducted at 3, 6, 9, and 12 months.
  Results: Preoperative stone composition-related case proportions and mean pH values were statistically similar in the two series. A statistically significant increase (p < 0.01) of the mean pH was revealed in the study group. A statistically significant increase of citraturia values was constantly determined in Group A (p < 0.01). At the 3-month evaluation, the stone-free rate in Group A was 83.17%, whereas it was 69.07% in Group B (p = 0.02). The ability to expel stones was 35.64% vs. 22.68% (p = 0.045). After 6 months, the results revealed an 86.14% stone-free rate in Group A vs. 73.2% (p = 0.023) and an ability for expelling of 36.61% vs. 24.74% (p = 0.036). The final evaluation performed at 12 months revealed 90.1% stone free rate in Group A vs. 77.32% in Group B (p = 0.015) with an ability for expelling of 41.58% in Group A vs. 25.77 in Group B (p = 0.019).
  Conclusions: The administration of the citrate-pyridoxine combination has proven superior results to the conventional hygienic-dietary regime in terms of the stone-free rate and the expulsion rate in successive evaluations up to 1 year of postoperative residual renal lithiasis cases secondary to flexible ureteroscopy.

MP-26.08—Toward Label-Free and Rapid Urine Diagnosis for Renal Calculi with Deep Learning-Enabled Plasmon-Enhanced Raman Spectroscopy 

• He Qiyu, Zhou Liang, Wang Kunjie
  West China Hospital, Sichuan University, Chengdu, China

• Introduction and Objectives: This study aims to develop and evaluate a label-free, rapid diagnostic tool for urolithiasis using a homogeneous plasmon-enhanced Raman biosensor (PERB) integrated with the least absolute shrinkage and selection operator (LASSO) and artificial neural network (ANN) algorithms, termed LASSO-ANN-PERB.
  Materials and Methods: The PERB was fabricated via a five-step self-assembly process, featuring gold-coated polystyrene spheres on a quartz substrate to enhance Raman signals. Urine samples from 40 healthy volunteers and 62 urolithiasis patients were analyzed using confocal Raman microscopy. Spectral data were processed with LASSO to select key vibrational features, which were then fed into a supervised ANN for classification. Diagnostic performance was assessed through fivefold cross-validation, receiver operating characteristic (ROC) curves, and confusion matrices, with practical feasibility tested on 16 additional clinical samples.
  Results: The LASSO-ANN-PERB achieved a diagnostic accuracy of 92.2%, with a sensitivity of 91.9% and specificity of 92.5% in distinguishing urolithiasis patients from healthy subjects, validated by an area under the ROC curve (AUC) of 0.92. In a clinical scenario with 16 unknown samples, it correctly identified 15 (accuracy 93.8%) within 30 min, outperforming traditional urinalysis. The biosensor demonstrated robust reproducibility and stability, with homogeneous field enhancements improving signal consistency across samples.
  Conclusions: The LASSO-ANN-PERB offers a highly accurate, rapid, and label-free approach for urolithiasis diagnosis through vibrational analysis of urine. Its integration of plasmon-enhanced Raman spectroscopy with advanced machine learning enables sensitive detection of subtle spectral differences, suggesting potential for broader clinical application in noninvasive fluid biopsy and real-time diagnostics.

MP-26.09—Virtual Stone Clinic Experience over 9 Years: Clinical Outcomes, Cost Reduction, and Post-COVID Adaptation 

• Makia Amr, Davis Tanya, Tear Loretta, Hughes Tom, Somani Bhaskar, Pietropaolo Amelia, Khalifa Salma
  University Hospital Southampton NHS Trust, Southampton, United Kingdom

• Introduction and Objectives: We introduced the Virtual Stone Clinic (VSC) in 2014 as a nurse-led, telephone-based service for monitoring patients with asymptomatic renal calculi or those at high risk of recurrent kidney stone disease (KSD). This study aimed to assess the long-term impacts of the VSC model, excluding the COVID-19 pandemic years.
  Materials and Methods: A retrospective audit was conducted on patients referred to the VSC from March 2014 to April 2020 and January to December 2023. Patients managed between May 2020 and December 2022 were excluded. Collected data included demographics, follow-up outcomes, escalation to face-to-face (F2F) clinics or surgical intervention, and clinic cost savings.
  Results: A total of 490 patients were managed over 1,285 appointments (2.6 ± 1.3 appointments per patient). The mean age was 58.1 ± 15.3 years, with a male-to-female ratio of approximately 3:2. Most referrals were for surveillance of asymptomatic small renal stones. Of the cohort, 252 patients (52%) remained under active VSC follow-up, 122 (25%) were discharged, 19 (4%) had emergency admissions, and 97 (20%) were referred for F2F review or intervention. Interventions included 29 SWL, 4 URSL, and 1 PCNL. The combined estimated clinic cost saving was £45,503.
  Conclusions: Over almost a decade, the VSC model has demonstrated consistent efficacy and safety, lowering face-to-face load and health care costs. It promotes the integration of telemedicine as a long-term approach in outpatient urological care.

26.2. Residents Forum Moderated Oral ePoster

RF-26.01—Adiposity Increases the Risk of Kidney Stone Disease Through Alterations in Renal Morphology and Urine Sodium Excretion 

• Lovegrove Catherine ¹, Thanaj Marjola ², Aggarwal Prashant ¹, Basty Nicolas ², Whitcher Brandon ², Bell Jimmy ², Thomas Louise ², Howles Sarah ¹
  ¹ University of Oxford, Oxford, United Kingdom, ² University of Westminster, London, United Kingdom

• Introduction and Objectives: Increasing body-mass-index (BMI) and waist-to-hip ratio (WHR) increase kidney stone disease (KSD) risk. Observational studies suggest that adiposity influences kidney size. We hypothesised that adiposity alters renal morphology to cause KSD.
  Materials and Methods: We studied 3D-MRI data from the UK Biobank (N = 52,951) and used ICD9/10, OPCS3/4, primary care, and self-report codes to identify 1,601 prevalent and 95 incident KSD cases. We investigated relationships between renal morphology, adipose depots, and incidence of KSD using linear regression, Cox-proportional hazards models, and Least Absolute Shrinkage and Selection Operator regression. To investigate causal pathways, we performed Mendelian randomisation using summary statistics from genome-wide association studies of KSD (24,167 cases; 876,673 controls, UK Biobank/FinnGen), BMI and WHR (N = 806,834 and N = 697,734, respectively, UK Biobank/GIANT consortium), and urine sodium concentration (N = 446,237, UK Biobank).
  Results: Prospective observational analyses using linear regression and Cox-proportional hazards models revealed associations of renal sinus fat volume and KSD (hazard-ratios = 1.28, 1.29, 95–confidence-intervals (CI) = 1.05–1.55, 1.05–1.59, left and right kidney, respectively, p < 0.05). Least Absolute Shrinkage and Selection Operator regression with stability selection identified that BMI, WHR, and urinary sodium concentrations were determinants for renal sinus fat volumes. Mendelian randomisation analyses revealed that higher urine sodium excretion causally increases KSD risk (odds-ratio = 5.39, 95% CI = 3.03–9.56, p = 2.63 × 10⁻⁸); higher BMI, but not WHR, increases urine sodium excretion (ß = 0.10, SE = 6.57 × 10⁻³, p = 1.62 × 10–49) and that increased natriuresis mediates ~36% of BMI’s effect on KSD risk.
  Conclusions: This study integrates imaging and genetic data to demonstrate that alterations in adiposity influence renal fat depots and cause altered urinary sodium excretion to increase KSD risk. Our findings suggest that therapies targeting adiposity-related natriuresis may prevent KSD.

26.3. Unmoderated Standard ePoster

UP-26.01—Urinary Glyphosate Levels and Kidney Stone Incidence: A Combined Clinical and Network Toxicology Approach 

• Xiao Yunfei ¹, Gao Shunyu ², Lin Tao ²
  ¹ Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, ² West China Hospital, Sichuan University, Chengdu, China

• Introduction and Objectives: This study investigates the association between glyphosate exposure and kidney stone prevalence and further explores the mechanisms by which glyphosate may contribute to the development of kidney stone disease.
  Materials and Methods: We conducted a cross-sectional study using data from 49,693 participants in the National Health and Nutrition Examination Survey (2013–2018). Multivariable logistic regression models were employed to assess the relationship between glyphosate exposure and kidney stone disease. An integrated bioinformatics approach, combining network toxicology and molecular docking, was used to identify potential toxicological targets and elucidate the molecular mechanisms through which glyphosate may promote kidney stone formation.
  Results: Urinary glyphosate concentration is positively associated with kidney stone prevalence. In the fully adjusted model, glyphosate exposure in the fourth quartile was associated with a 53% higher risk of kidney stones compared to the first quartile (OR = 1.53, 95% CI: 1.03, 2.28). Systematic analysis of multiple databases identified 41 targets related to glyphosate exposure and kidney stone disease. Using STRING and Cytoscape tools, top 5 hub targets were selected, including MMP9, PTGS2, ESR1, EGFR, and MAPK3. Enrichment analysis indicated that glyphosate primarily influences multiple pathways, including immune responses, endocrine resistance, proteoglycans in cancer, calcium signaling, and relaxin signaling.
  Conclusions: Glyphosate is positively associated with the formation of kidney stones and contributes to the development of kidney stone disease through multiple mechanisms. These mechanisms provide new perspectives for the formulation of strategies aimed at the prevention and treatment of kidney stones.

UP-26.02—Antibiotic Prophylaxis Strategies for Treatment of Urinary Stones—Tailoring Guidelines to Clinical Practice 

• Ayran Mona ¹, Yahya Duha ¹, Dib Nidaa ¹, Alayoub Malda ¹, De La Rosette Jean ², Laguna Pes Pilar ², Yilmaz Mesut ², Koçak Mehmet ¹, Pavlov Valentin ³, Zeng Guohua ⁴, Anastasiadis Anastasios ⁵
  ¹ Istanbul Medipol University, Istanbul, Türkiye, ² Istanbul Medipol Mega University Hospital, Istanbul, Türkiye, ³ Bashkir State Medical University, Ufa, Russian Federation, ⁴ The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China, ⁵ University Hospital of Thessaloniki, Thessaloniki, Greece

• Introduction and Objectives: Urinary stones affect up to 15% of the world’s population and have a recurrence rate of 50% at 10 years. Antibiotic strategies are put in place for prophylaxes of urinary tract infections including septicaemia following stone treatment. We performed a review on the antibiotic prophylaxis strategies in urinary stone management. Hence, we discuss how the recommendations on antibiotic prophylactic strategies made in urinary stone guidelines are implemented in clinical practice within different communities and patient characteristics.
  Materials and Methods: The following search terms were used: “guidelines”, “antibiotics”, “profylaxis”, “kidney”, “renal”, “ureter”, “urolithiasis”, “urinary stones”, “PCNL”, “SWL”, “URS”, “open surgery”, “laparoscopy”, “robotics” and ‘stones’. Only articles presenting primary data, such as case series and randomized controlled trials, were included. Details concerning therapeutic approach and clinical outcome were gathered. The outcome of the findings from clinical practice was positioned within the framework of recommendations in (inter)national guidelines.
  Results: Risk factors for infectious complications related to urinary stone treatment allow patients to be categorized into low risk or high risk for infection. While guidelines present recommendations based on the ‘standard patient’ in different scenarios for SWL, PCNL and URS only, they do not include patients with specific co-morbidities such as patients with (severe) DM, (super)obese patients, the old and fragile, during pregnancy, paediatric patients, patients with renal anomalies or urinary diversion, or immunocompromised patients. Adherence to guidelines is often poor, shows significant institutional and geographical differences, and is based on limited evidence.
  Conclusions: Guidelines on Urinary stones poorly reflect daily clinical practice. They only capture the ‘standard patient’ and omit a large proportion of special situations and high risk patients. We should pursue a personalized approach, which integrates patient history and current clinical status. Geographical factors and ethnicity, antibiotic resistance patterns, and the microbioma should also be implemented in our antibiotic plans. This enhances the effectiveness of prophylaxis and aligns with antibiotic stewardship principles by optimizing treatment while reducing unnecessary antibiotic use. Artificial Intelligence may overcome current limitations and provide a tailored antibiotic strategy.

UP-26.03—Association Between High-Density Lipoprotein and Kidney Stones in Americans Aged ≥ 20 Years Old: A Cross-Sectional Analysis of NHANES 2007–2018 

• Xiao Yunfei ¹, Yang Yaqing ², Lin Tao ²
  ¹ Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, ² West China Hospital, Sichuan University, Chengdu, China

• Introduction and Objectives: To verify whether high-density lipoprotein (HDL) is associated with the prevalence of kidney stones in American adults.
  Materials and Methods: We conducted a cross-sectional study of participants aged ≥20 years using the data drawn from the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2018. The participants who have a history of kidney stones and laboratory test data of HDL were involved. Multivariable logistic regression analysis and spline smoothing were used to elucidate the associations between HDL and renal calculi with confounders adjusted, including gender, age, race, education, marital, poverty income ratio, body mass index, smoking, alcohol, high blood pressure, diabetes, congestive heart failure, high cholesterol, cancer, gout, vigorous activity, moderate activity, taking antilipidemic drugs, energy, HEI-2015 total score, taking diuretics. Stratified and interactions analysis was performed to explore whether some variables modified the relationship between them.
  Results: Ultimately, a total of 30,969 participants were eligible. The results of logistic regression showed that the prevalence of nephrolithiasis had a negative relationship with HDL in the fully adjusted model (OR = 0.805, 95% CI 0.715 to 0.907, p < 0.001). Additionally, compared with the first quartile, the population in the fourth quartile of HDL had a lower kidney stones incidence (OR = 0.869, 95% CI 0.761 to 0.993, p = 0.039). Spline smoothing revealed that lower HDL level was associated with higher kidney stones prevalence. Additionally, the association could be modified by race.
  Conclusions: HDL has a significant negative relationship with the prevalence of kidney stones. Namely, a higher concentration of HDL is associated with a lower risk of kidney stones.

UP-26.04—Comparison of 5 Methods for Measuring Urinary pH at Home: Electronic Meters vs. Paper Strips 

• Garcés Marina, Campillo Pedro
  Hospital Vinalopó, Elche, Spain

• Introduction and Objectives: Repeated urinary pH measurement is an important tool for preventing the formation of certain types of stones, as it provides information about recurrence risk and effectiveness of medical treatment. For this reason, it is appealing for patients to have a device for accurate home determination of urinary pH. Objective: To compare the results from five different manual devices with the results from the reference technique.
  Materials and Methods: 72 fresh second morning void urine samples were collected from patients with previous or current history of lithiasis and from healthy volunteers from a lithiasis reference hospital in Alicante, Spain, during November 2024. Measurements were performed by a single urologist using five different models of manual pH meters purchased from a well-known general online shopping platform: two paper strip meters (Just Fitter (18€) and Simplex Health (10€)) and three electronic meters (Pancellent (17€), Yummici (8.5€), and GuDoQi (QBY) (17€)). Results were compared against simultaneous determinations from the hospital’s laboratory Siemens Clinitek Novus machine (Siemens AG, Munich, Germany). The degree of correlation between results was studied by calculating the intraclass correlation coefficient (ICC).
  Results: ICC for Just Fitter paper strip meter was 0.792 (95% confidence interval [CI] 0.685–0.865). For Simplex Health paper strip meter was 0.830 (95% CI 0.723–0.895). For Pancellent electronic meter was 0.873 (95% CI 0.804–0.919). For Yummici electronic meterwas 0.866 (95% CI 0.780–0.918). For GuDoQi electronic meter was 0.848 (95% CI 0.555–0.93).
  Conclusions: All five meters tested showed good correlation (ICC > 0.75), with electronic meters being superior to paper strips, and Pancellent brand being the closest to our reference test. According to these results, manual meters, especially electronic ones, may be considered an acceptable alternative to frequent hospital urinary pH measurement.

UP-26.05—Conservative Management of Staghorn Calculi: Long Term Follow-up Outcomes from a Single Tertiary Centre 

• Popple Georgia, Bhangu Kiran, Berridge Christopher, Subramonian Kesavapilla
  Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom

• Introduction and Objectives: Conservatively managing complex and co-morbid patients with staghorn calculi has an evolving evidence base in more recent years. Classically outcomes were poor an early subset of our cohort suggested conservative management can have reasonable outcomes and may avoid significant operative risk. We sought to establish the longer-term outcomes and present a larger series of conservatively managed patients.
  Materials and Methods: Inclusion criteria were those with partial or complete staghorn stones planned for conservative management. Patients were collated on a prospectively maintained database with subsequent retrospective analysis of outcomes including follow-up duration, survival, UTIs, complications, reasons for intervention, decrease in renal function and split function imaging.
  Results: 51 patients were included in the study. Median follow-up was 9 years with 71% of the cohort deceased. Of those deceased median survival was 7.5 years (range 3–11). Disease specific mortality appears to be low at 5.8% noting many community deaths, which may incur bias until cause is established. A quarter of patients experienced complications including sepsis, perinephric abscesses and renal colic with only 9.8% of the cohort had surgical intervention (including radiological drainage). There was a significant decrease in eGFR but not in split function on DMSA/MAG3, possibly indicative of co-morbidity and general deterioration rather than stone specific complication. Almost two-thirds of patients experience culture proven UTIs.
  Conclusions: Conservative management of staghorn calculi is a good option for the complex patient whose co-morbidities present a greater risk to life than their stone disease. This data may help counselling of such patients in a decision-making process.

UP-26.06—Evaluation of Stone and Pelvic Urine Culture in Predicting Urosepsis in PCNL Patients: A Prospective Observational Study 

• Ram Ishwar, Rai Nandan
  Dr RMLIMS, Lucknow, India

• Introduction and Objectives: Sepsis-related to PCNL affects 0.3% to 9.3% patients. There is no common consensus on the role of stones, pelvic urine, and bladder urine in predicting urosepsis, hence the study.
  Materials and Methods: A prospective non-randomized follow-up observational study conducted from August 2022 to April 2024 on 300 adult patients undergoing PCNL. Preoperative risk for Systemic Inflammatory Response Syndrome (SIRS)/urosepsis was evaluated, and pre-op midstream urine culture [pre-op MSUC], renal pelvic urine culture [RPUC], intraoperative stone culture [IOSC] and postoperative midstream urine culture [post-op MSUC] at 24 h post-op were evaluated.
  Results: Of 300 patients, 22 [7.33%] developed SIRS. Eight [2.67%] patients had preoperative MSUC positivity, 18 [6%] patients had RPUC positivity, 21 [7%] patients had IOSC positivity, 14 [4.67%] patients had post-op MSUC positivity and 8 [2.67%] patients had blood c/s positivity. Blood transfusion, increased operative room time [ORT], prior ipsilateral surgery, prolonged post-op hospital stay, higher PCN indwelling time, and increasing clave in grade complication were significantly associated with the development of urosepsis. IOSC was the most sensitive and specific in predicting the SIRS/urosepsis. The most frequently isolated microbe from the upper urinary tract was E. coli, sensitive to nitrofurantoin and resistant to Ciprofloxacin.
  Conclusions: A significant number of patients do develop SIRS post-PCNL, even with all aseptic precautions. Stone culture & sensitivity (c&s) were more specific than MSUC and RPUC in predicting urosepsis. Risk factors for urosepsis in PCNL must be addressed to reduce urosepsis. Prophylactic empirical use of 3rd generation cephalosporin instead of Ciprofloxacin is recommended.

UP-26.07—Impact of Impaired Kidney Function on the Risk of Kidney Stone Disease: Evidence from One-Sample and Two-Sample Mendelian Randomization Analyses 

• Chi Yuan ¹, Linna Sha ², Xia Jiang ², Zhongyu Jian ³
  ¹ Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China., Chengdu City, China, ² Department of Nutrition and Food Hygiene, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, Sichuan, China., Chengdu, China, ³ Department of Urology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China., Chengdu, China

• Introduction and Objectives: The relationship between impaired kidney function [low estimated glomerular filtration rate (eGFR) and chronic kidney disease (CKD)] and kidney stone disease (KSD) remains controversial. This study aims to elucidate the causal effect of impaired kidney function on the risk of developing KSD.
  Materials and Methods: We assessed both linear and non-linear associations between impaired kidney function—measured by decreased eGFR and CKD—and the risk of KSD. To achieve this, we conducted individual-level analyses using the UK Biobank (UKB) and performed Mendelian randomization (MR) analyses with summary-level genome-wide association study (GWAS) data. Both one-sample and two-sample MR approaches were applied in European and transethnic populations, incorporating Causal Analysis Using Summary Effect estimates (CAUSE), inverse variance weighted, MR-Egger, weighted median, weighted mode, and MR-Pleiotropy RESidual Sum and Outlier methods.
  Results: In two-sample MR analyses, genetically predicted lower eGFR was associated with a reduced risk of KSD (CAUSE: OR = 0.78, 95% CI: 0.71–0.85, p = 0.003), and CKD was similarly linked to a lower risk of KSD (CAUSE: OR = 0.89, 95% CI: 0.83–0.97, p = 0.046). These associations were consistent across transethnic populations (eGFR: CAUSE, OR = 0.78, 95% CI: 0.69–0.87, p = 0.019; CKD: CAUSE, OR = 0.85, 95% CI: 0.77–0.94, p = 0.047) and across multiple MR methods. Importantly, MR-Egger intercept tests provided no strong evidence of directional pleiotropy (p > 0.05), supporting the robustness of the findings. One-sample MR analysis further corroborated these results, demonstrating that each 10 mL/min/1.73 m² decrement in genetically predicted eGFR was associated with a 30% lower risk of KSD across all models (OR: 0.70, 95% CI: 0.63–0.78), with consistent results in sensitivity analyses. Additionally, no substantial evidence was found for a non-linear causal relationship between genetically predicted eGFR and KSD (p for non-linearity > 0.05). Similarly, CKD was associated with a significantly lower risk of KSD (HR: 0.73, 95% CI: 0.65–0.81) in both primary and sensitivity analyses.
  Conclusions: Our findings suggest that genetically predicted impaired kidney function may be associated with a reduced risk of KSD, with no significant evidence of a non-linear causal relationship. Further research is warranted to elucidate the underlying biological mechanisms driving this association.

UP-26.08—Kidney Parenchymal Volume Loss and Functional Loss After Percutaneous Nephrolithotomy 

• Charukumchon Warit, Attawettayanon Worapat, Chalieopanyarwong Virote
  Prince of Songkla University, Korhong, Thailand

• Introduction and Objectives: Urolithiasis is a common and growing public health concern worldwide and is associated with an increased risk of kidney function decline. The kidney is the most frequently affected site, with an estimated prevalence of 5–10%. The treatment of choice for renal calculi is percutaneous nephrolithotomy (PCNL). During PCNL, the kidney undergoes a Grade IV injury due to tract access, which can result in parenchymal volume loss and impaired function. This study aimed to evaluate the extent of parenchymal volume loss and renal functional outcomes following PCNL.
  Materials and Methods: This study included 36 patients who underwent single-tract percutaneous nephrolithotomy (PCNL). All patients underwent preoperative and postoperative computed tomography (CT) imaging, with follow-up CT performed 3 to 6 months after the procedure. Patients who developed postoperative complications related to stone burden were excluded from the analysis. Parenchymal kidney volume was measured using three-dimensional volume-calculating software. Both kidney volume and functional outcomes were evaluated and analyzed.
  Results: The mean patient age was 60.1 years, with a mean preoperative glomerular filtration rate (GFR) of 84 mL/min/1.73 m². The median estimated blood loss was 100 cc, and the median stone burden was 4.4 cm³. Amplatz sheath sizes of 28 Fr, 26 Fr, and 24 Fr were used in 24 patients (67%), 7 patients (19%), and 4 patients (11%), respectively. The mean postoperative GFR was 84.5 mL/min/1.73 m², with a median GFR preservation of 99.5%. None of the patients developed acute kidney injury (AKI) postoperatively. The mean preoperative and postoperative ipsilateral GFRs were 36.4 and 36.3 mL/min/1.73 m², respectively, with a median GFR loss of 1.2 mL/min/1.73 m². The median preoperative ipsilateral kidney volume was 130.8 cm³, which decreased to 124.4 cm³ postoperatively, reflecting an annual parenchymal loss of 4.6 cm³ or approximately 3.3%. The contralateral kidney volume remained stable, with a median preoperative and postoperative volume of 149.9 cm³ and 149.5 cm³, respectively, indicating a negligible median annual volume change of –0.5 cm³.
  Conclusions: PCNL is a safe and effective procedure for the management of renal calculi. Postoperatively, the affected kidney demonstrates a small reduction in volume with minimal impact on ipsilateral renal function.

UP-26.09—Predictive Model for Stone-Free Rate After Flexible Ureteroscopy: Novel Scoring System Validation Gea Nasa 

• Martinez-Arroyo Carlos, Anceno Alec
  General Hospital Manuel Gea Gonzalez, Mexico City, Mexico

• Introduction and Objectives: Nephrolithiasis has high recurrence rates, requiring multiple interventions. Flexible ureteroscopy (fURS) with laser lithotripsy is a key treatment, but predicting the stone-free rate (SFR) remains challenging (73–93.2%). To improve accuracy, the GEA-NASA score (Number, Angle, Size, Anatomy) was developed in 2018 at Hospital General Manuel Gea González. Unlike RUSS and S-ReSc, it integrates key anatomical and clinical factors.
  Materials and Methods: Retrospective study; 477 patients from 2016–2024. Inclusion criteria required renal stone removal; exclusions involved incomplete records. Variables included demographics, stone characteristics, anatomical anomalies, and Hounsfield unit density. The primary outcome was stone-free rate (SFR). Bivariate analysis assessed associations between independent variables and SFR, using odds ratios (OR) with 95% confidence intervals (CI). The GEA-NASA score was evaluated based on predefined criteria. Number (N): 1 point single stone, 2 points multiple stones. Angle (A): 1 infundibulopelvic angle > 45° or stone outside the lower calyx; 2 points if <45°. Size (S): 1 for stones < 2 cm³; 2 for >2 cm³. Anatomy (A): 1 for anatomical abnormalities.
  Results: The median patient age was 46 years (IQR 34–58). The presence of multiple stones significantly reduced SFR (OR = 0.31, p = 0.0001). Stone size > 2 cm³ was associated with lower SFR (OR = 0.51, p = 0.002), while lower pole location and infundibulopelvic angle < 45° showed strong associations with residual stone burden (OR = 0.05, p < 0.0001). Patients with a score of 3 had an SFR of 93.66% (OR = 9.95, p < 0.0001), while a score of 6 or higher correlated with significantly lower SFR (27.65%, OR = 0.05, p < 0.0001). Comparisons with RUSS, S-ReSc, and RIRS scores demonstrated that GEA-NASA provided superior prediction accuracy, with an overall accuracy of 88.68%, precision of 92.5%, and sensitivity of 92.5%.
  Conclusions: This validation study confirms that GEA-NASA is a reliable and efficient tool for predicting SFR post-fURS. Its simplicity and high predictive value make it a valuable addition to clinical practice, allowing for improved patient selection, surgical planning, and postoperative management. Integrating this model into routine urological assessment may enhance patient outcomes and reduce recurrence rates, optimizing endourological management of nephrolithiasis.

UP-26.10—Reassessing ESWL: Effectiveness, Safety, and Predictive Factors in Renal Lithiasis Management 

• Romero Crespo Alfonso, Fernandez Ordoñez Machimbarrena Sara, Losa Calero Jesus, España Navarro Rodrigo, Molina Diaz Patricia, Caballero Cobos Rocio, Garcia Galisteo Emilio
  Hospital Regional Universitario Malaga España, Malaga, Spain

• Introduction and Objectives: Extracorporeal shock wave lithotripsy (ESWL) remains a non-invasive treatment option for renal stones. However, its role in the management of kidney stones is increasingly debated in the era of endourology. This study aims to evaluate the efficacy, safety, and predictors of success of ESWL in patients with renal (kidney) stones treated over a one-year period in a tertiary referral center.
  Materials and Methods: We conducted a retrospective observational study including 200 patients treated with ESWL for renal stones in 2021. Data collected included medical history, stone characteristics (size, location), treatment outcomes, and complications. Associations between clinical variables and treatment success were analyzed using chi-squared and Student’s t-tests. Success was defined as stone-free status (residual fragments < 5 mm) without need for additional procedures.
  Results: The cohort included 200 patients (mean age: 53 years; 55% male). Mean stone size was 13.8 mm; 69% were located in the renal pelvis and 26% in the lower calyx. A single-session resolution was achieved in 31% of patients, and 37% had successful clearance within 3 months. Overall, 59% reached stone-free status. Additional procedures were required in 30% of cases, mainly due to ESWL failure (67%), patient preference (18%), or poor tolerance (15%). Complications included renal colic (36%), hematuria (19%), steinstrasse (6.5%), urinary tract infection (6.5%), and one case of renal hematoma. Stone size was significantly associated with single-session success (p < 0.01), overall resolution (p < 0.01), and clearance within 3 months (p < 0.01). The presence of a prior urinary diversion was positively associated with treatment success (p = 0.035). No significant associations were found between complications and stone location (p = 0.55) or between treatment success and age, Hounsfield units, or energy level used.
  Conclusions: ESWL remains an effective and safe option for managing renal stones, achieving complete resolution in more than half of patients and showing a low rate of serious complications. Our results support the continued use of ESWL as a valid therapeutic strategy in carefully selected patients with renal lithiasis.

UP-26.11—Role, Effectiveness, Cost Efficiency, Sustainability, and Outcomes of Using Telemedicine in Endourology: A Systematic Review of Literature 

• Khalifa Salma ¹, Makia Amr ¹, Somani Bhaskar ²
  ¹ University Hospital Southampton NHS Trust, Southampton, United Kingdom, ² UHS NHS Trust, Southampton, United Kingdom

• Introduction and Objectives: The role of telemedicine (TM) in endourology has expanded significantly over the past decade, demonstrating benefits for both patient satisfaction and healthcare efficiency. We wanted to look at the role and effectiveness of using these technological innovations in Endourology.
  Materials and Methods: A systematic review was performed using the PRISMA framework and PICO statement. Search was done for all English language articles, over several databases, from inception to Aug 2024. The inclusion criteria focused on studies involving patients with kidney stone disease (KSD) and reporting outcomes related to healthcare delivery, cost savings, and environmental sustainability (green credentials).
  Results: A total of 933 articles were initially identified, and, after screening of titles, abstracts and full texts, 10 articles were finally included (Table 1). Of these articles, 8 showed a cost saving, 9 showed a greener credential of using TM. All included studies showed a positive impact of TM either in terms of reduced time to access urology services, enhancing acute and follow-up efficiency, time to decision making or treatment, patient satisfaction and safety. Most studies showed more than one clinical and/or organizational benefit in the patient pathway.
  Conclusions: Our review shows that telemedicine in endourology demonstrates multiple benefits, including cost savings, environmental sustainability, and improved healthcare delivery. The included studies highlight enhanced access to services, faster decision-making, and high patient satisfaction and safety. Given the pressures on the NHS and existing waiting times, more should be done to adapt and adopt this technological revolution.

UP-26.12—Stone Composition Variation in a Diverse Urban Population: Investigating the Influence of Ethnicity and Socioeconomic Deprivation on Stone Type 

• Tsang Derrick ¹, Choo Xuan ², Constantinou Zoe ², Proag Khelanjalee ¹, Graham Stuart ¹, Fan Stanley ¹, Yaqoob Magdi ¹, Green James ¹, Pal Pallavi ¹, Gladwin Jessica ²
  ¹ Barts Health NHS Trust, London, United Kingdom, ² Queen Mary University of London, London, United Kingdom

• Introduction and Objectives: The aim of this study is to investigate whether stone composition is influenced by genetic factors, represented by ethnicity, or environmental factors represented by socioeconomic deprivation. By analysing a large cohort of stone formers in an ethnically diverse urban population in East London, UK, we aim to identify trends among our stone patients and ask what causes specific stones—genetic or environmental?
  Materials and Methods: A retrospective analysis of patients undergoing stone interventions in 2018, 2019, 2022 was performed at multi-hospital NHS Trust in East London. Patient electronic records were reviewed for stone composition and postcodes, which were compared against the English index of deprivation data (2019). Multinominal logistical regression analysis was performed to observe for statistical significant association between stone type, index of multiple deprivation decile (IMDD) and ethnicity.
  Results: A total of 1086 patients in 2018, 2019, and 2022 were reviewed, and 716 were identified with stone analysis results. The most common stone types are calcium oxalate (67.6%). Ethnicity had 1.6× more impact on determining overall stone type compared to IMDD. Particularly, ethnicity had 2.4×, and 1.7× more influence on cystine and struvite stones respectively. IMDD had 2.6× and 2.1× more influence on uric acid stones and calcium oxalate respectively.
  Conclusions: Ethnicity and IMDD have influence on specific stone types. This is consistent with existing knowledge on certain stones with established genetic link like cystine stones. Interestingly uric acid and calcium oxalate stones appear to have more environmental influence, which may be contributed by possible dietary differences among different IMDD.

UP-26.13—The Initial Management of Renal Colic—Do We Inappropriately Prescribe Analgesia? 

• Cox Justin ¹, Satkunabalan Maduri ¹, Adesunloro Lawrence ¹, Mondal Subhajit ², Damola Adebiyi ¹
  ¹ George Eliot Hospital, Nuneaton, United Kingdom, ² Urology, George Eliot Hospital, Nuneaton, United Kingdom

• Introduction and Objectives: Renal colic is the hallmark symptom of ureteric calculi, driven by ureteric peristalsis and obstruction. Timely and effective analgesia is crucial and should even be initiated prior to confirmatory imaging in cases with a high clinical suspicion. NSAIDs are the recommended first-line agents, as supported by BAUS and NICE guidelines, offering superior efficacy and fewer adverse effects. Paracetamol may be used adjunctively, while opioids are reserved for cases where NSAIDs and IV paracetamol are contraindicated or ineffective, due to their limited benefit and side effects. Inadequate analgesia can compromise patient outcomes, prolong discomfort and admission, and increase the need for rescue medication. This project looks to evaluate analgesia prescribing in the management of renal colic.
  Materials and Methods: A retrospective review was conducted on 94 patients admitted with renal colic to a UK hospital between September 2024 and February 2025. Patient records and drug charts were reviewed to assess prescribing patterns, timeliness of analgesia, and subsequent management. The BAUS standards for management of acute ureteric colic were used as the reference.
  Results: We found that NSAIDs were prescribed as first line in only 37% of patients, but were typically administered on the day of admission (range: 0–12 days). Notably, 23% of patients did not receive any NSAIDs during their hospital stay. Medical expulsive therapy was employed in 33% of cases, with the remainder undergoing elective or emergency surgical intervention. Reattendance for pain management occurred in 11% of cases, all of whom had been discharged with an NSAID supply.
  Conclusions: This study has identified inappropriate prescribing of analgesia in renal colic, particularly in the failure to utilise NSAIDs as first line. We therefore initiated awareness campaigns to educate our resident doctors as part of a quality improvement project. This included educational interventions particularly for clerking/admitting residents and clearer prescribing protocols, and we intend to perform regular re-evaluation to align clinical practice with national standards and optimise patient care.

UP-26.14—Time-Restricted Feeding with High-Fat Diet Slows Weight Gain and Reduces Renal Calcium Oxalate Crystal Formation without Reducing Energy Intake—Experimental Studies 

• Xiao Yunfei ¹, Bai Yunjin ², Yang Yaqing ¹, Wang Jia ¹, Lin Tao ¹
  ¹ West China Hospital, Sichuan University, Chengdu, China, ² Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China

• Introduction and Objectives: Renal calcium oxalate stones are closely linked to lipid metabolism disorders. A long-term high-fat diet (HFD) can lead to obesity and various metabolic disorders, which significantly contribute to stone formation. Recent studies indicate time-restricted feeding (TRF) plays a crucial role in enhancing metabolic homeostasis and preventing metabolic diseases. However, their impact on kidney stone formation has yet to be investigated.
  Materials and Methods: We examined the differences in calcium oxalate crystal formation in mouse kidneys through glyoxylic acid (Gly) modeling on HFD mouse models subjected to both ad libitum (Ad) and TRF. TRF mitigated weight gain, improved blood lipid metabolism disorders, and reduced lipid deposition in the liver and kidneys, alleviating pathological damage. The TRF group compared to the Ad group exhibited lower urinary concentrations of oxalate and calcium ions, which corresponded with a reduction in the expressions of OPN and CD44, leading to decreased oxalate crystal formation. Gly intervention in the Ad resulted in increased expressions of TNF-α and IL-6 in the kidneys, leading to an imbalance between oxidation and antioxidants. In contrast, the TRF showed significant improvement, which is potentially linked to the activation of the PI3K-AKT pathway. The night-time TRF, which more aligns with the natural work and rest rhythms of mice, produced more pronounced effects than day-time TRF. The expression of NR1D1 in kidneys was closely related to stone formation.
  Results: [Combine methods and results by summarizing the approach and immediately stating the main findings.].
  Conclusions: TRF can improve lipid metabolism and inhibit the formation of renal calcium oxalate stones, and TRF interventions that align with biological rhythms demonstrate particularly significant effects.

UP-26.15—Validation of Artificial Neural Network Based Software to Predict Spontaneous Ureteral Stone Passing 

• Haghpanah Abdolreza, Salehi Khatoni Mohammad, Dehghani Anahita
  Shiraz University of Medical Sciences, Shiraz, Iran, Islamic Rep.

• Introduction and Objectives: Urinary system stones, with a 5.7% prevalence in our country, heavily burden the healthcare system. Correct decision-making in treatment choice, reducing unnecessary hospitalizations and surgeries, is crucial and guided by the Association of Kidney and Urinary Surgeons of Europe and America. Utilizing updated factors in a deep machine learning artificial intelligence network, we aim to develop accessible software to predict the spontaneous passage of ureteral stones.
  Materials and Methods: Using Morgan’s formula, 384 patients were randomly selected from Shahid Faqihi Hospital (2015–2019). They were divided into training (260) and validation (124) groups. Patient data, including white blood cell count, neutrophil-lymphocyte-platelet ratios, urine protein levels, diabetes status, stone location and size, degree of hydronephrosis, inflammation, perirenal fat accumulation, and ureter thickness, were collected and analyzed using R software (version 3.4.3).
  Results: The study examined 746 participants: 491 males (65.8%) and 255 females (34.2%), aged 18–85 (mean = 45.38 years, SD = 13.326). Prevalence rates for diabetes mellitus, hypertension, and chronic kidney disease were 6.3%, 8.8%, and 2.9%, respectively. Stone analysis revealed 50.1% had a single stone, with variability in side, location, and hydronephrosis degree. Stone measurements showed substantial heterogeneity. Laboratory findings indicated variability in hematological and biochemical parameters. Correlation analyses identified significant relationships between stone passage and factors such as stone location, distance to the ureterovesical junction (UVJ) and ureteropelvic junction (UPJ), stone length, and width. Gender and diabetes mellitus showed no significant correlation. An artificial neural network model predicted ureteral stone passage with 62.2% accuracy for the training sample and 65.5% for the testing sample. Stone length was the most significant predictor.
  Conclusions: This study of 746 participants provides critical insights into demographics, medical conditions, and stone characteristics. The male-predominant sample with a diverse age range highlights conditions like hypertension and diabetes mellitus. The analysis underscores the need for individualized treatment approaches, revealing significant correlations between stone location and passage. An artificial neural network model showed moderate accuracy in predicting stone passage, with stone length being the key predictor. These findings emphasize the complexity of stone disease and the necessity for tailored treatment and advanced predictive models in clinical practice.

UP-26.16—WhatsApp-Assisted Telemedicine for Ureteral Stone Management: A Pilot Study 

• Butticè Salvatore ¹, Caldarera Emanuele¹, Ozervarli M. Firat ², Tefik Tzevat ², Ergul Rifat ²
  ¹ Paolo Borsellino Hospital, Marsala, Italy, ² Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye

• Introduction and Objectives: This pilot study evaluates the reliability of using WhatsApp as a telemedicine tool for monitoring patients with ureteral stones, aiming to reduce unnecessary hospital visits while ensuring timely detection of emergencies and enhancing overall patient care.
  Materials and Methods: This retrospective study analyzed prospectively collected data. Patients diagnosed with ureteral stones via CT in the emergency department were included. Exclusion criteria were solitary kidney, fever, leukocytosis, or urinoma. Tamsulosin and Diclofenac were routinely administered to patients, with Ketorolac, 10 mg, prescribed as needed for pain management. Analgesic use was categorized based on the total number of Ketorolac doses taken over a 5-day period: low use (<5), medium use (5–10), and high use (>10). A WhatsApp-based monitoring protocol was implemented, with patients submitting data every 5 days for a total follow-up period 30 days (Figure 1). Emergency situations were explained, and hospital visits were advised when necessary. Patients developing fever were evaluated with blood and urine tests, and all received DJ stent placement due to complicated UTIs.
  Results: Of 99 patients, 26 received DJ stent placement (21 due to fever, 1 for work-related reasons, 4 for pain). 39 patients were followed for one month, while 34 passed their stones spontaneously. The cohort included 51% males, with 50.5% right-sided stones. Stone locations were: 39.4% proximal, 35.4% mid, and 25.3% distal ureter. Mean age was 59.3 ± 9.1 years, BMI 25.1 ± 3.8, and stone size 6 ± 1.4 mm. Average time to DJ placement was 15.1 ± 6.7 days, while stone passage occurred at 13.8 ± 8.1 days. VAS scores decreased significantly over time (p < 0.01). Analgesic requirements decreased significantly from day 5 to day 30 (p < 0.01). Patient satisfaction varied over time: At day 5, 84.8% of patients were satisfied, 14.1% were partially satisfied, and 1% were not satisfied. At day 30, 37.3% were satisfied, 55.8% partially satisfied, and 6.9% not satisfied. No unexpected adverse events reported.
  Conclusions: WhatsApp-based telemedicine effectively reduced unnecessary hospital visits while ensuring timely interventions for ureteral stone complications. This approach demonstrated reliable patient monitoring with decreased pain scores and analgesic needs, highlighting its potential for outpatient management.

27. Stones—Surgical Treatment

27.1. Moderated Oral ePosters

MP-27.01—A Novel Small Fragment Removal System Holds Promise to Improve Stone Extraction During Lithotripsy 

• Mandla Masithembe ¹, Wellman Mark ¹, John Jeff ², Lazarus John ¹
  ¹ University of Cape Town SA, Claremont, South Africa, ² WSU, East London, South Africa

• Introduction and Objectives: To describe a novel small fragment removal system (SFRS), which is hypothesized to improve kidney stone fragment removal during laser lithotrypsy. The SFRS consists of three parts: a Syphon Ureteric Access Sheath (SUAS), a Dual Action Pump (DAP) and an Agitator. This clinical trial aims to assess the SFRS’s impact on intra-renal pressure (IRP) and irrigant flow rate compared to a traditional UAS and its stone fragment removal capabilities.
  Materials and Methods: Patients who met the inclusion criteria were enrolled in this prospective single arm seamless Phase 1 and 2 clinical trial. The primary objective of Phase 1 was to evaluate the safety of the SFRS in terms of intra-renal pressure (IRP) changes. In Phase 2 we attempted to evaluate the device’s efficacy in removing stone fragments. During standard laser lithotripsy, the DAP and Syphon UAS were compared to a conventional UAS in terms of irrigant flow and IRP at baseline and during fluid bolus administration. Additionally, the percentage of stone fragments removed using the SFRS with the Agitator introduced (in place of the fURS) was assessed.
  Results: Twelve (n = 12) patients were enrolled. The SFRS showed lower baseline IRP—20.8 vs. 24.6 mmHg for the traditional UAS (p = 0,004). During fluid boluses the IRP was lower for the SFRS at 23.5 vs. 75.2 mmHg (p = 0,0002). Greater irrigant flow was seen with the SFRS of 39.2 vs. 34.9 mL/min (p = 0.002). Mean pre-op stone volume was 238 mm³ (range 70–562 mm³), compared to 1.4 mm³ post-op (range 0–8 mm³).
  Conclusions: The novel SFRS holds clinical promise to improve patient safety by reducing IRP with a significant reduction in IRP during fluid bolus administration. It also has the potential to improve visibility via a significant increase in irrigant flow. Lastly, the SFRS was able to remove the overwhelming majority of stone fragments.

MP-27.02—An Evidence-Based Ex Vivo as Well as Clinical Usage Prospective Comparison of Single-Use Versus Reusable Flexible Ureteroscopes in Renal Lithiasis Real-Time Treatment 

• Bragaru Marius, Bulai Catalin, Geavlete Petrisor, Multescu Razvan, Popescu Razvan, Geavlete Bogdan
  “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

• Introduction and Objectives: The objective of this prospective study was to conduct a comparative analysis of two recently developed flexible reusable ureteroscopes and a single-use device, both in intraoperative and ex vivo conditions. The comparison was based on concomitant objective and subjective data.
  Materials and Methods: A total of 60 cases of renal calculi 1–2 cm underwent flexible ureteroscopy and holmium laser lithotripsy using two reusable digital models (Olympus URF-V and Olympus URF-V2) vs. one single-use model (Pusen Medical Uscope UE3022), in equal numbers. A ureteral access sheath was used in all cases. At the end of each procedure, the surgeon evaluated on a 5-point scale the visibility and manoeuvrability of the used ureteroscope. To simulate real working settings as accurately as possible, the reusable scopes were previously utilized but thoroughly inspected before the examination to confirm that their functioning was not compromised.
  Results: No statistically significant change was determined regarding image quality between the USCOPE UE3022 (visibility score 4.8, 4.7, and 4.8, p > 0.4) and the reusable URF-V and URF-V2. Similar manoeuvrability score (4.2) was established for UscopeUE3022 and URF-V2, but a substantially poorer outcome for URF-V (3.8, p = 0.03). Irrigation was comparable on reusable scopes and more than 50% improved for single-use scopes. This difference was measured with both an empty working channel and a fibre laser placed through it. The influence of various accessory instruments over deflection of the flexible ureteroscopes was emphasized the superiority of the single-use UscopeUE3022, followed by the reusable URF-V2 and lastly by the URF-V. Most importantly, inserting a 270-micron Holmium laser fibre produced a practically insignificant deflection loss for the single-use scope, while the Zero-tip basket resulted in equally higher deflection losses for the reusable ones.
  Conclusions: Reusable and single-use flexible ureteroscopes are roughly comparable in visibility and manoeuvrability. The single-use type has greater irrigation flow and deflection amplitude, thus presumably providing more resources in challenging situations.

MP-27.03—Automatic Adjustment of Intrarenal Pressure Using an Intelligent Pressure Control System During Retrograde Intrarenal Surgery for Large Staghorn Renal Stones: A Case Series 

• Seno Doddy ¹, Friska Jeni ², Siregar Moammar ¹, Afriansyah Andika ¹, Mirza Hendy ¹, Purnomo Nugroho ¹
  ¹ Persahabatan General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia, ² Persahabatan General Hospital, Jakarta, Indonesia

• Introduction and Objectives: Elevated intrarenal pressure (IRP) during retrograde intrarenal surgery (RIRS) increases the risk of postoperative sepsis, particularly in patients with large or staghorn renal stones. This study evaluates the use of an intelligent irrigation-suction system with automated IRP regulation during RIRS in high stone burden cases.
  Materials and Methods: Eight patients with renal stones > 2 cm—including staghorn and bilateral calculi—underwent RIRS using a pressure-controlled irrigation-suction system with real-time IRP monitoring. All procedures were performed under general anesthesia. DJ stents were removed, and a 12/14 Fr, 40–50 cm ureteral access sheath with pressure sensor was placed. Retrograde pyelography was performed, followed by flexible ureteroscopy and laser lithotripsy using Thulium Fiber Laser (TFL). The system dynamically adjusted irrigation (100–200 mL/min) and suction (8–36 mmHg) to maintain IRP ≤ 20 mmHg. All patients received IV cefotaxime 3 × 1 g. Outcomes were assessed via intraoperative findings, CT on postoperative day (POD) 1–2, and Clavien-Dindo classification.
  Results: The mean stone burden was 44.0 mm (range: 21–66 mm), with HU ranging from 397 to 1367. Mean IRP was 13.6 mmHg (range: 10.5–19.2 mmHg), consistently maintained below the 30 mmHg safety threshold. The stone-free rate was 100%, confirmed intraoperatively by endoscopic clearance and postoperatively via CT imaging. No mucosal injury, hemorrhage, or parenchymal trauma was observed. Postoperative recovery was uneventful in all cases, with no fever, sepsis, or complications exceeding Clavien-Dindo Grade 0. All procedures were completed without conversion or reintervention. Patients were discharged within 48 h after surgery.
  Conclusions: Intelligent IRP regulation during RIRS provides safe pressure control, minimizes infectious risks, and supports complete stone clearance in large renal calculi. This technique may expand the role of RIRS in cases traditionally treated by percutaneous surgery.

MP-27.04—Changing the Narrative of Bilateral Stone Management: 8-Year Journey of a Novel Approach to Simultaneous Bilateral Percutaneous Nephrolithotomy (Sb-PCNL) 

• Mandawala Nimashi ¹, Herath Miyasi ², Parana Palliyaguruge Kalana ³
  ¹ Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, Sri Lanka, ² Base Hospital Kahawatta, Colombo, Sri Lanka, ³ District General Hospital Negombo, Colombo, Sri Lanka

• Introduction and Objectives: Renal calculi represent a significant and rising global health burden. Bilateral renal stones, treated traditionally via staged interventions, contribute substantially to patient morbidity and healthcare expenditure. Simultaneous bilateral percutaneous nephrolithotomy (SB-PCNL) presents a promising alternative, potentially reducing cumulative hospitalization and anesthesia exposure while maintaining efficacy. This study evaluates the safety, efficiency, and clinical outcomes of SB-PCNL in a Sri Lankan cohort.
  Materials and Methods: A prospective descriptive study was conducted among 63 patients with bilateral renal stones who underwent SB-PCNL from January 2016 to August 2024 across five geographically diverse Sri Lankan hospitals. A novel operative technique was utilized: both sides were cleaned and draped simultaneously, and bilateral punctures were made at the outset. The less complex side was dealt with first, and neither the operating table nor the image intensifier was altered from the original position. The higher Guy’s Stone Score (GSS) between the two kidneys was used for assessment. Data on stone characteristics, operative parameters, stone-free rates (SFRs), and postoperative outcomes were analyzed.
  Results: The mean age was 47.4 ± 12.3 years, with a male predominance (74.6%). The mean stone size was 1.38 ± 0.84 cm, with the largest measuring 5.3 cm. Mean operative time was 57.3 ± 12.6 min, showing a decreasing trend over the study period. Mean hospital stay was 2.07 ± 0.46 days, with earlier discharges observed in private sector settings. The overall SFR was 92.1%, with residual fragments in 7.9% of cases—mainly associated with high-density stones (>1200 HU) and lower calyceal locations. A weak positive correlation (r = 0.27) was observed between GSS and operative time. Stone composition analysis in 16 patients revealed calcium oxalate (predominantly monohydrate) as the most common type, with a single patient having bilateral uric acid stones.
  Conclusions: SB-PCNL is a safe and effective option for bilateral renal stones, achieving high SFRs with reduced hospitalization and morbidity. Variability in discharge timelines highlights the need for standardized postoperative protocols. Future studies should explore flexible nephroscopy and adjunctive techniques for improved stone clearance. A randomized controlled trial comparing SB-PCNL with staged procedures is warranted to establish definitive clinical guidelines.

MP-27.05—Clinical Outcomes Among the Patients with Renal and Upper Ureteric Calculus Undergone Treatment with Dornier Delta III-Extracorporeal Shockwave Lithotripsy (ESWL): A Retrospective Study 

• Sreenivasan Sreerag, Thakor Poojan, Narayanan Dorairajan, Kumar Hari, Kalra Sidhartha, Ghorai Rudra
  Jawaharlal Institute of Postgraduate Medical Education and Research Pondicherry, Pondicherry, India

• Introduction and Objectives: Urolithiasis, characterized by the formation of stones in the kidney, ureter, and bladder, is a prevalent urological condition. Extracorporeal Shockwave Lithotripsy (ESWL) is a widely accepted non-invasive treatment for renal and upper ureteric stones. The Dornier Delta III, an advanced ESWL machine, has introduced improved shockwave technology and imaging capabilities. Despite these advancements, there is limited research on the clinical performance of the Dornier Delta III.
  Materials and Methods: This retrospective cohort study was conducted from November 2020 to December 2023. It included patients with renal and upper ureteric calculi who underwent ESWL with the Dornier Delta III. Data collection focused on patient demographics, stone characteristics, and pre-and post-procedure details. Clinical outcomes such as stone clearance, complications, and additional interventions were analyzed.
  Results: Of the 1,158 patients, 91.5% achieved complete stone clearance. The median calculus size was 1.15 cm, with 956.6 Hounsfield Units (HU). Complications occurred in 3.1% of overall cases. Complete clearance rates were 92%, 92.1%, and 93.1% for upper, mid, and lower calyx calculus respectively. For upper ureteric calculi, 87.5% achieved complete clearance. Larger stones (median 1.8 cm) and those with higher HU values (median 1050) were associated with incomplete clearance and a higher likelihood of further intervention.
  Conclusions: This is the first study of Dornier Delta III that demonstrated high efficacy in treating renal and upper ureteric calculi, with high clearance rate and low complication rates. ESWL remains an effective, non-invasive option for stones smaller than 2 cm, especially when the stone size and HU are considered.

MP-27.06—Comparative Efficacy and Safety of ESWL with Ultrasonic Burst Versus RIRS for the Treatment of Renal Calyceal Calculi 

• Pattnaik Prashant ¹, Deshpande Akshay ¹, Pattnaik Satyajeet ², Manek Parth ¹
  ¹ Bombay Hospital Institute of Medical Sciences, Mumbai, India, ² Dr Pattnaik’s SS Hi Tech Urology Hospital, Mumbai, India

• Introduction and Objectives: Managing calyceal stones, including upper, mid, and lower calyceal calculi measuring ≤ 1 cm, presents a clinical challenge for urologists. Extracorporeal Shock Wave Lithotripsy (ESWL) is a non-invasive technique that effectively fragments calculi using shock waves. Recent advancements in ESWL, particularly the use of ultrasonic burst technology, have improved fragmentation and expulsion efficiency. This study compares the efficacy and safety of ESWL performed under ultrasonic burst technology in addition to an electromagnetic lithotripter against Retrograde Intrarenal Surgery (RIRS). Real-time monitoring during ESWL allows for immediate assessment of stone fragmentation, potentially enhancing clinical outcomes.
  Materials and Methods: This prospective, randomized observation was conducted at our institute and enrolled 270 patients, with 150 undergoing ESWL and 120 undergoing RIRS for calyceal calculi < 1 cm. The primary outcome was the stone-free rate (SFR) at 3 months post-procedure. Secondary outcomes included complication rates assessed using the Clavien-Dindo classification and patient-reported quality of life metrics through validated questionnaires.
  Results: At 3 months, the stone-free rate was achieved in 82% of the ESWL group compared to 78% in the RIRS group, indicating a marginally better efficacy for ESWL in treating calyceal stones (p = 0.08). Regarding safety, the ESWL group demonstrated fewer complications, with only 8% of patients experiencing complications classified as Clavien-Dindo grade II or higher. In contrast, 15% of RIRS patients faced similar complications (p < 0.05). Notably, the RIRS group had a higher incidence of Clavien-Dindo grade III complications, primarily related to intraoperative bleeding and prolonged hospitalization, underscoring the advantages of ESWL in terms of safety.
  Conclusions: ESWL with ultrasonic burst technology, conducted under ultrasound guidance, presents a marginally more effective and significantly safer alternative to RIRS for the treatment of upper, mid, and lower calyceal stones. These findings suggest that ESWL could be considered a preferred treatment modality, particularly in patients at higher risk for complications. Further studies are warranted to validate these results and refine treatment protocols to optimize patient outcomes.

MP-27.07—Comparative Study of Thulium Fiber Laser vs. Holmium Laser with Moses Technology for Ureteric Stones in Semirigid Ureteroscopy: A Randomised Controlled Single-Centre Trial with a 2 Year Follow Up 

• Singh Abhishek, Shah Aruj, Gupta Ankit, Ganpule Arvind, Sabnis Ravindra, Desai Mahesh
  Muljibhai Patel Urological Hospital, Nadiad, India

• Introduction and Objectives: Ho:YAG laser lithotripsy is the gold standard in ureteroscopy. In vitro studies have demonstrated superiority of TFL laser’s dusting ability and stone ablation. However, there are concerns about the possibility of stricture formation. Aim is to assess the safety and effectiveness of the new TFL in stone lithotripsy with a 2 y follow up to assess stricture formation.
  Materials and Methods: A single-centre, prospective RCT of 80 adult patients with ureteric calculus and normal upper tract anatomy. Stone characteristics were calculated using pre-operative CT IVP/KUB. MOSES 2.0 Pulse 120H Holmium laser (Lumenis) was used for lithotripsy with energy settings of 1 J/10 Hz. (Max 1 J/12 Hz). In the other arm, 60 Watt SuperPulse TFL at 0.1 J/100 Hz (Max 0.1 J/200 Hz) was used for lithotripsy. X-ray and CT KUB were performed on post-operative days 1 and 30 respectively to document stone clearance. CT IVP was performed to assess for ureteric strictures in patients with hydronephrosis on sonography and/or symptoms. Patients were followed up for a period of 2 years.
  Results: The two arms were comparable for baseline characteristics. The stone fragmentation rate (SFR), lasing time and complication rate were comparable. On a Likert scale, severe deterioration of vision during lithotripsy was noted in 2.5% TFL cases and 7.5% Holmium cases. On one month follow up, 2 cases in Holmium arm had residual calculus, which had to be managed endoscopically. The rate of stricture formation in TFL arm was no different from Holmium arm at 2 year follow up.
  Conclusions: TFL is associated with comparable lasing time and stone fragmentation rate. Better endoscopic vision with TFL may be attributed to smaller fiber size and better energy efficiency. No difference in rate of ureteric strictures was noted at 2 years follow up.

MP-27.08—Comparison of Ultrasound-Guided and Fluoroscopy-Guided Percutaneous Nephrolithotomy: A Five-Year Single-Center Study Comparison of Ultrasound-Guided and Fluoroscopy-Guided Percutaneous Nephrolithotomy: A Five-Year Single-Center Study 

• Malahela Adnan ¹, Novianda Andhika ², Manurung Mega Anara ², Atmoko Widi ³, Birowo Ponco ³, Rasyid Nur ³, Aslim Octoveryal ²
  ¹ Pringsewu General Hospital, Lampung, Indonesia, ² Ibu Fatmawati Soekarno General Hospital, Surakarta, Indonesia, ³ Dr. Cipto Mangunkusumo National Referral General Hospital, Jakarta, Indonesia

• Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) is a recognized method for the management of renal calculi. The optimal guidance method between ultrasound and fluoroscopy is still a subject of debate. The principle of minimizing radiation exposure through the ALARA approach is also significantly taken into account. This research evaluates the efficacy and safety of ultrasound-guided versus fluoroscopy-guided percutaneous nephrolithotomy (PCNL) within a single center over a five-year duration.
  Materials and Methods: A retrospective cohort analysis was conducted on patients who underwent PCNL between 2018 and 2023. Patients were divided into two groups: those undergoing US-guided PCNL and those undergoing fluoroscopy-guided PCNL. The evaluated outcomes included stone-free rates (SFRs), duration of fluoroscopy usage, and intraoperative radiation exposure.
  Results: A total of 658 patients were included, with 563 undergoing US-guided procedures and 95 undergoing fluoroscopy-guided procedures. The SFRs were similar across the two groups (p > 0.05). In contrast, the US-guided group demonstrated significantly reduced fluoroscopy usage duration, effective dose, and radiation exposure (p < 0.05). The operative time was significantly reduced in the ultrasound-guided procedure, even though it necessitated a greater number of punctures (p < 0.05). The complication rates were comparable across both groups.
  Conclusions: Ultrasound-guided percutaneous nephrolithotomy (PCNL) is an effective and safe alternative to fluoroscopy-guided PCNL, offering the additional benefit of eliminating radiation exposure. Ultrasound-guided percutaneous nephrolithotomy (PCNL) is an effective and safe alternative to fluoroscopy-guided PCNL, offering the additional benefit of eliminating radiation exposure.

MP-27.09—Development of a Novel Clinical Prediction Model for the Number of ESWL (Extracorporeal Shock Wave Lithotripsy) Sessions Needed for Stone Clearance 

• Li Tsz Man, Menzies-Wilson Richard, Turney Benjamin
  Churchill Hospital, Oxford, United Kingdom

• Introduction and Objectives: Extracorporeal Shock Wave Lithotripsy (ESWL) is the recommended treatment for renal stones ≤ 20 mm or ureteric stones ≤ 10 mm, according to the European Association of Urology guideline. Predicting the number of ESWL sessions required to achieve treatment success is valuable for patient counselling, resource planning, and improving cost-effectiveness. We aim to develop a novel prediction model for the number of ESWL sessions needed to treat urolithiasis.
  Materials and Methods: Eligible patients aged ≥16 years who underwent ESWL within the Oxford University Hospitals Trust from January 2013 to June 2021 were included in this retrospective cohort study. Patient demographics, stone characteristics, and ESWL variables were extracted at the first ESWL session for each stone episode. Univariate and multivariate analyses were conducted using Stata BE (version 18.0).
  Results: A total of 5,711 stone episodes were included, 1,201 (21%) of which achieved treatment success with ESWL. 67% (n = 808) of patients required only one ESWL session. Univariate analysis using Poisson regression identified age, stone size, stone location, number of shocks, Storz Medical Lithotripsy Index (SMLI), and focus of the shockwave as statistically significant predictors of the number of ESWL sessions. These variables were subsequently included in a multivariate analysis. Size of stone, location of stone (kidney/ ureter), SMLI and focus of shockwave were found to be statistically significant predictors of the number of ESWL session.
  Conclusions: The ability to predict the number of ESWL sessions required is a valuable tool for shared decision-making and identifying the most suitable treatment for urolithiasis. To date, this is the first study to attempt such prediction. The next phase involves developing a probability calculator for clinicians to integrate into daily practice.

MP-27.10—Does Intermittent Flash Fluoroscopy Reduce Radiation Exposure During Endourological Procedures? A Prospective Cohort Study 

• Leiberman Christopher, Mokool Leenesh, Lee Xiang Wei, Nalagatla Sarath
  University Hospital Monklands, Airdrie, United Kingdom

• Introduction and Objectives: Endourological procedures such as rigid (RURS) and flexible ureteroscopy (FURS) often rely on fluoroscopic guidance, exposing both patients and staff to ionising radiation. In line with the ALARA (As Low As Reasonably Achievable) principle, this study evaluated the impact of intermittent flash fluoroscopy versus continuous screening on radiation exposure and fluoroscopy time.
  Materials and Methods: A prospective study of 50 RURS and FURS procedures using intermittent flash fluoroscopy was compared with retrospective data from 32 procedures using continuous screening. Data collected included cumulative dose (CD), dose area product (DAP), fluoroscopy time (FT), and effective dose (ED). Safety and intraoperative complications were recorded. Radiation doses were converted using a Monte Carlo-derived coefficient of 0.18 for urological procedures.
  Results: Intermittent fluoroscopy reduced FT by 66.4% (14.2 s vs. 42.3 s) and ED by 68.4% (0.18 mSv vs. 0.57 mSv) compared to continuous screening. The effect was most pronounced in FURS cases (ED: 0.20 vs. 0.84 mSv). No intraoperative complications occurred in either group. Compared with national reference values from the FLASH study, the intermittent group had significantly lower DAP and FT. Statistical analysis confirmed significance using both unpaired t-tests (ED p = 0.002; FT p = 0.0004) and Mann-Whitney U tests (ED p = 0.005; FT p = 0.00016).
  Conclusions: Intermittent flash fluoroscopy is a safe and effective strategy for significantly reducing radiation exposure during endourological procedures, without compromising clinical outcomes. These findings support wider adoption of this technique in urology, particularly in high-volume centres and training environments, to protect both patients and staff from cumulative radiation risk.

MP-27.11—Endoscopic Combined Intrarenal Surgery Versus Multi-Tract Percutaneous Nephrolithotomy for Complex Renal Stones 

• Elshal Ahmed, Allam Khaled, Elsawy Amr, Ibrahiem El-Houssieny, Elnahas Ahmed
  Mansoura Urology & Nephrology Center, Mansoura, Egypt, Arab Rep.

• Introduction and Objectives: This study compared the perioperative outcomes of ECIRS (Endoscopic Combined Intrarenal Surgery) and multi-tract PCNL (Percutaneous Nephrolithotomy) in the treatment of complex renal stones.
  Materials and Methods: This was a randomized controlled trial (RCT) that included patients with complex renal stones (Guy’s stone score 3 or 4). Eligible patients were randomized to ECIRS in the Galdakao-Modified Supine Valdivia (GMSV) position or multi-tract PCNL in prone position. Demographic, clinical characteristics, perioperative complications, and stone-free rates (SFR) were compared.
  Results: Eighty-four patients were included (29 in ECIRS group and 55 in PCNL group). SFR were comparable between both groups (69% vs. 61.8% respectively, p = 0.516). Overall postoperative complications were less in ECIRS (24%) versus 45.5% in PCNL group, but the difference was not significant (p = 0.056). Operative time was significantly shorter in ECIRS group (90 min) compared with 140 min in PCNL group, p < 0.001. Blood loss was significantly lesser in ECIRS group (hemoglobin drop 1.4 g/dL compared with 2.2 g/dL in PCNL group, p = 0.012). The need for blood transfusion was less (13.8% in ECIRS compared with 34.5% in PCNL group, p = 0.043). Another advantage of ECIRS was shorter radiation time (mean radiation time of 4 min in ECIRS compared with 6.6 min in PCNL group, p = 0.011). Postoperative hospital stay was comparable for both groups (mean of 2 days, p = 0.286). The need for auxiliary procedures was comparable (31% in ECRIS group and 38.2% in PCNL group, p = 0.151).
  Conclusions: Both ECIRS and multi-tract PCNL were effective treatment options for the management of complex renal stones. However, ECIRS was proved to be safer because of less blood loss and the need for blood transfusion in addition to lower radiation exposure.

MP-27.12—Flexible Ureteroscopy for Renal Stones with Non-Suction Conventional Ureteral Access Sheath (CUAS) vs. Flexible and Navigable Suction Ureteral Access Sheaths (FANS) in a Multicentre Real World Experience: Is It Finally Time to Bury the Non-Suction Ureteral Access Sheath? A EAU Endourology Analysis with FANS Collaborative Group 

• Yuen Steffi ¹, Mazzon Giorgio ², Dewan Samyek ², Rasheed Maryam ³, Kulkarni Shailesh ³, Brusa Davide ⁴, Fontana Francesco ⁴, Fong Khi Yung ⁵, Sarica Kemal ⁶, Farahat Yasser ⁷, Chew Ben ⁸, Bhojani Naeem ⁹, Somani Bhaskar ¹⁰, Choong Simon ², Castellani Daniele ¹¹, Gauhar Vineet ¹²
  ¹ S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China, Hong Kong, Hong Kong, China, ² Institute of Urology, University College Hospitals of London, London, United Kingdom, London, United Kingdom, ³ Department of Urology, King, Barking, Havering and Redbridge University Hospitals NHS Trust, London, United Kingdom, London, United Kingdom, ⁴ Department of Urology, Santissima Trinità Hospital, ASL Novara, Borgomanero, Italy, Borgomanero, Italy, ⁵ Department of Urology, Singapore General Hospital, Singapore, Singapore, Singapore, ⁶ Department of Urology, Medical School, Biruni University, Istanbul, Turkey, Istanbul, Türkiye, ⁷ Endo-Urology & Minimally Invasive Surgery, Sheikh Khalifa Hospital, Dubai, UAE., Dubai, United Arab Emirates, ⁸ Department of Urology, University of British Columbia, Vancouver, Canada, Vancouver, Canada, ⁹ Division of Urology, University of Montreal Hospital Center, Montreal, QC, Canada, Montreal, Canada, ¹⁰ Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK, Southampton, United Kingdom, ¹¹ Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Italy., Ancona, Italy, ¹² Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore, Singapore

• Introduction and Objectives: To compare peri- and postoperative outcomes of Conventional Ureteric Access Sheaths (CUAS) versus Flexible And Navigable suction ureteric access Sheaths (FANS) in Retrograde Intra-Renal Surgery (RIRS) for renal stones.
  Materials and Methods: In this multicentric, real world, prospective study, 529 adult patients undergoing RIRS across 19 centers were enrolled between August 2023 and January 2024. Of these, 263 underwent RIRS using FANS and 265 with CUAS. After propensity score matching (PSM) for age, gender, and stone volume, 184 patients per group were matched for analysis. Outcomes included stone-free rate (SFR), intraoperative parameters, and postoperative complications assessed within 30 days.
  Results: Post-PSM, baseline characteristics were well-balanced. The FANS group demonstrated significantly longer lasing (17.94 vs. 15.28 min, p = 0.017) and ureteroscopy time (37.48 vs. 30.08 min, p < 0.001) but similar total surgical time. The use of stone retrieval baskets and postoperative stenting was significantly lower in the FANS group. 30-day stone-free status was higher with FANS (98.9% vs. 89.1%, p < 0.001), with significantly lower reoperation rates (16.3% vs. 71.0%, p = 0.009). Overall complication rates were low and comparable between groups.
  Conclusions: Higher 30-day stone-free status and lower reintervention rates with FANS suggest that CUAS utility in RIRS may not be as beneficial. Reduced calyceal injuries combined with less use of baskets and accessories make FANS a useful intraoperative tool for those performing RIRS with access sheaths. Along with low postoperative pain score and reduced need for postoperative stenting in selected FANS patients, these findings favour using FANS with appropriate training over CUAS.

MP-27.13—Impact of Ureteric Stent Removal Timing Following PCNL: A Single-Centre Retrospective Review 

• Leiberman Christopher, Tan Lieo Jiun, Azman Nurul, Lee Xiang Wei, Nalagatla Sarath
  University Hospital Monklands, Airdrie, United Kingdom

• Introduction and Objectives: Ureteric stents are commonly placed following percutaneous nephrolithotomy (PCNL) to support urinary drainage and reduce early complications. However, indwelling stents may cause discomfort, lower urinary tract symptoms, and increase infection risk. The optimal timing for stent removal post-PCNL remains undefined. This study evaluates whether earlier or delayed stent removal influences rates of emergency department (ED) attendance or hospital readmission.
  Materials and Methods: A retrospective review was conducted of all PCNL procedures performed at a single tertiary centre. Patients were categorised into four groups based on the timing of post-operative stent removal: Group 1: Day 1; Group 2: Days 2–3; Group 3: Days 4–5; Group 4: >5 days. Patient demographics, stone laterality and size, and unplanned healthcare visits (ED attendance and hospital admission) were recorded. Statistical analysis was performed using Fisher’s exact test.
  Results: Forty-three patients underwent PCNL and stenting: Group 1 (n = 4), Group 2 (n = 16), Group 3 (n = 9), and Group 4 (n = 14). Median age ranged from 56 to 67 years; stone size was similar across groups (median 1.6–2.0 cm). ED attendances were recorded in 6 patients (14%): 4 in Group 2 (25%) and 2 in Group 4 (14%). Hospital admissions occurred in 2 patients (12.5%) in Group 2. No unplanned care was recorded in Groups 1 or 3. Pairwise comparisons showed no statistically significant differences in ED visits or hospitalisation between groups (all p > 0.26).
  Conclusions: Timing of ureteric stent removal following PCNL was not associated with significant differences in emergency care utilisation in this single-centre review. Although Group 2 showed a numerically higher rate of ED visits and admissions, results did not reach statistical significance. Post-PCNL stent removal as early as post-op day 1 may be safely considered for selected patients without increasing risk of unplanned care, potentially improving patient comfort and reducing stent-related morbidity.

MP-27.14—Laparoscopic-Assisted Mini-PCNL for the Management of Renal Stones in Paediatric Patients with Ectopic Kidneys 

• Memon Imran, Jatt Javed Altaf, Arain Ahsan, Memon Waqar Ahmed, Jatoi Tamoor Ahmed
  Liaquat University of Medical & Health Sciences, Hyderabad, Pakistan

• Introduction and Objectives: Ectopic kidneys, though rare, complicate the management of urinary stones due to their abnormal anatomical positioning. Standard stone removal techniques, such as percutaneous nephrolithotomy (PCNL), often present technical challenges and a heightened risk of complications in these patients. Laparoscopic-assisted mini-PCNL represents a promising alternative for addressing renal stones in ectopic kidneys, particularly in the pediatric population where reducing surgical trauma is essential. This case series presents the outcomes of four pediatric patients with ectopic kidneys who underwent this innovative procedure.
  Materials and Methods: Ten paediatric patients with diagnosed ectopic kidneys and symptomatic nephrolithiasis were treated with laparoscopic-assisted mini-PCNL. Inclusion criteria consisted of patients with renal stones larger than 1 cm. Laparoscopic assistance was used to enhance visualization and ensure safe access to the kidneys, minimizing the risk of injury to adjacent structures. The procedures were performed using a 12F mini-nephroscope, with laser lithotripsy employed for stone fragmentation. Data collection focused on operative time, stone clearance rates, complications, and follow-up results. Institutional ethical approval was obtained, and informed consent was secured from the guardians of the patients.
  Results: All 10 patients successfully completed laparoscopic-assisted mini-PCNL without intraoperative or significant postoperative complications. The average operative time was [89–94] minutes, and the mean stone size was 2.0 cm. Complete stone clearance was confirmed through postoperative imaging, and recovery was uneventful, with minimal discomfort and no instances of infection or significant bleeding. Follow-up evaluations conducted six months postoperatively indicated that all patients remained stone-free, with no recurrence of symptoms. The laparoscopic assistance facilitated precise puncture of the ectopic kidney, reducing the risk of injury to surrounding organs and vascular structures.
  Conclusions: Laparoscopic-assisted mini-PCNL represents a promising advancement in the treatment of renal stones in pediatric patients with ectopic kidneys. This technique offers improved visualization and precise access, leading to high stone clearance rates and minimal complications.

MP-27.15—Outcomes and Complications of Mini Percutaneous Nephrolithotomy (PCNL): A Retrospective Review of 1500 Consecutive Cases” 

• Asif Muhammaad, Khan Muhammaad
  Lady Reading Hospital, Peshawar, Pakistan

• Introduction and Objectives: Standard treatment for renal stones of more than 2 cm size is PCNL (standard/mini). the objective of our study is to share of experience of a large series of 1500 consecutive cases of mini PCNL.
  Materials and Methods: This is retrospective review of 1500 cases of Mini PCNL performed from September 2022 to December 2024. All patients admitted through out door clinic of Urology department, Lady Reading Hospital, Peshawar, Pakistan. Non contrast CT KUB was performed on every patient. After written and informed consent, all patients underwent Mini PCNL in prone position. Karl Storz 12 Fr nepheroscope and Swiss pneumatic lithoclast were used. Stones fragments were removed via water pressure pump. A 6/4fr double J stent was passed at the end of the procedure, removed on 14 post op day once stone was cleared on Xray KUB/CT KUB.
  Results: The mean age was 35.5 ± 12 years, with a male-to-female ratio of 2.5:1. The mean stone size was 18.2 ± 5.5 mm, with 40% located in the lower pole, 10% in the upper pole, 30% in the middle pole, and 20% in the renal pelvis. The average operative time was 58.3 ± 18.2 min. Average blood loss was 150 mL ± 60 mL. The stone-free rate was 91.5%. The average hospital stay was 36 ± 8.5 h. Analgesic requirements were low, with 30% of patients requiring pain medication. Overall complications rate was 15.4%, while most of the complications were grade I and II type according to Clavien-Dindo classification. Including bleeding requiring transfusion (3%), fever in (12%), urinary tract infection (UTI) (8.4%), and sepsis (5%), all were managed conservatively. PCS injury occurred in 0.5% cases managed with DJ/nephrostomy. Angioembolization for bleeding vessel was required in 0.3% cases. Only one patient required nephrectomy for life threatening hematuria.
  Conclusions: Our study concluded that Mini PCNL is highly effective with stone free rate of more than 90%, less operative time and shorter hospital stay, and reduced complications rate. Our team is now more comfortable with Mini PCNL as compared to Standard PCNL. Most of the cases are performed in single tract, and stone fragments retrieval is extremely easy via water pressure pump.

MP-27.16—Preference of Retrograde Intrarenal Surgery Among Physicians Alters Stone Management Strategies 

• Chang Ching-Hsin, Yang Tzung-Dau
  Taipei Medical University Hospital, Taipei, Taiwan

• Introduction and Objectives: Upper urinary tract calculi represent a prevalent clinical issue in contemporary urological practice, particularly with the expanded use of minimally invasive interventions. Retrograde intrarenal surgery (RIRS) provides multiple advantages in managing upper urinary tract stones, prompting reconsideration of traditional methods such as extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL). This study aimed to evaluate real-world clinical practice patterns for RIRS by comparing its utilization with PCNL and ESWL among urologists with varying procedural preferences.
  Materials and Methods: A retrospective chart review was conducted at a single university hospital involving 8–12 urologists. From July 2015 through October 2024, 9,355 patients diagnosed with renal and ureteral calculi were managed using ESWL, ureteroscopic lithotripsy (URSL), PCNL, and RIRS. Open and laparoscopic lithotripsy cases were excluded due to their low incidence. Patient demographics and preoperative data were systematically collected.
  Results: Within our urology department, the monthly frequency of RIRS procedures rose to 5.07 ± 4.38 (mean ± SD), constituting 19.6% of total stone procedures by 2024. Urologists grouped by their preference towards RIRS demonstrated a significantly greater proportion of RIRS (p = 0.001) and a correspondingly reduced proportion of ESWL (p < 0.001) compared with non-preference peers. Additionally, the seasonal ratio of RIRS to total stone surgeries was notably higher among surgeons preferring RIRS compared to their counterparts (22.39% ± 9.18 vs. 9.26% ± 2.33; p = 0.001). Despite operational disruptions due to the COVID-19 pandemic (2021–2022), the preference group identified and treated more calculi using RIRS (5.57 ± 2.13 per 1,000 outpatient visits) and performed more total stone procedures (37.56 ± 21.80 per 1,000 outpatient visits), rates 2.98 and 1.63 times higher, respectively, than the non-preference group.
  Conclusions: The increasing adoption of RIRS substantially influences urological management strategies for upper urinary tract stones, particularly among urologists exhibiting a strong preference for this technique. Nevertheless, the considerable associated expenses—such as disposable endoscopic equipment, handling charges, and high-powered laser systems—represent substantial economic barriers, particularly since these costs are not reimbursed under current National Health Insurance policies. Further studies are required to elucidate the underlying motivations driving these evolving surgical preferences.

MP-27.17—Prospective Comparison of Single Step Amplatz Dilatation vs. Conventional Alken Metal Dilatation During PCNL 

• Prakash Pradeep
  Yashoda Super Speciality Hospital and Cancer Institute, Ghaziabad, India

• Introduction and Objectives: Sequential Amplatz dilatation is reported to lead to more blood loss than conventional coaxial metal dilatation technique, due to repeated dilator exchange. To avoid this and with the aim to reduce radiation exposure time, we started using single step dilatation using 24 Fr Amplatz dilator. We present a prospective comparison of these two dilatation techniques and perioperative outcomes.
  Materials and Methods: It was a prospective comparative study involving adult patients between 18–50 years having cumulative stone size between 20–39 mm. Patient having cumulative stone size ≥ 4 cm, Staghorn calculus, and history of previous surgery in same kidney were excluded. Operative time (from cystoscopy to nephrostomy placement/wound closure), radiation exposure time, haemoglobin drop, hospital stay, and complications were compared. All the data were entered in a data sheet and analysed at the end of study.
  Results: During 3-year study duration (July 2021 to June 2024), 198 patients were included, 98 in the metal dilatation group (Group 1), and 99 patients in single step dilatation group (Group 2). Mean ages between the two groups were comparable (34.2 vs. 33.6 years, p = 0.57). The mean stone size in Group 1 was 29.12 ± 5.16 mm and 30.09 ± 5.14 mm in Group 2 (p = 0.18). The mean operative time was 69.2 ± 20.9 min in Group 1 vs. 66.4 ± 19.4 min in Group 2 (p = 0.34). The mean radiation exposure time was significantly lower in single step dilatation group (6.27 ± 0.8 min vs. 8.04 ± 0.9 min, p < 0.0001). The need for Nephrostomy placement was also significantly lower in single-step dilatation group (20 vs. 45, p = <0.001). Haemoglobin drop was comparable between the groups (1.4 ± 0.35 vs. 1.33 ± 0.3, p = 0.06). Overall hospital stay and complications were also similar between the groups.
  Conclusions: Single step dilatation method using Amplatz dilator is as effective as multistep Alken metal dilatation and associated with lower radiation exposure time. The overall operative time, hospital stay are similar, and it is not associated with increased blood loss or complications.

MP-27.18—Standard Percutaneous Nephrolithotomy in the Era of Miniaturization—An Audit from a Tertiary Care Center 

• Soni Jaideep, Choudhary Gautam, Navriya Shiv, Bhirud Deepak, Singh Mahendra, Sandhu Arjun
  AIIMS Jodhpur, Lucknow, India

• Introduction and Objectives: To evaluate how standard operating procedures (SOPs), modification in puncture techniques, advancements in preoperative imaging to better understand calyceal anatomy have revitalized standard percutaneous nephrolithotomy (PCNL) for large kidney stones (>2.5 cm).
  Materials and Methods: At our center, renal stones are managed with extracorporeal shock wave lithotripsy (ESWL), per cutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS) according to stone characteristics and patient profile. Renal stones larger than 2.5 cm are managed with standard PCNL. In this retrospective study 766 patients undergoing standard PCNL at a tertiary healthcare center from January 2018 to December 2023 having complete records were included. Data on demographics, stone characteristics, operative details, and outcomes were assessed using SPSS v26, with ethical approval ensuring confidentiality.
  Results: Mean age was 43.75 ± 16.0 years; 69.7% were male. Mean stone size was 3.8 ± 1.2 cm, with 46.7% complex (Guy’s Stone Score [GSS] ≥ 2). Using a 24 ± 3 Fr sheath and 1.3 tracts per procedure, operative time averaged 92.5 ± 20.3 min. Stone clearance was 91.3%, with significant intraoperative bleeding (requiring transfusion) in 1.7%. Overall complication rate was 16.4%, and hospital stay averaged 3.6 ± 1.2 days; 8.7% required additional interventions, including RIRS in 44.3% of those cases.
  Conclusions: Modern standard PCNL achieves high clearance (91.3%) with minimal morbidity, reaffirming its role for large stones despite mini-PCNL’s rise.

MP-27.19—Suction-Assisted Mini Percutaneous Nephrolithotomy in Anomalous Kidneys: An EAU-Endourology Multicentre Prospective Study 

• Lim Ee Jean ¹, Fong Khi Yung ¹, Yuen Steffi ², Castellani Daniele ³, Herrmann Thomas ⁴, Somani Bhaskar ⁵, Gauhar Vineet ⁶
  ¹ Singapore General Hospital, Singapore, Singapore, ² Chinese University of Hong Kong, Hong Kong, China, ³ Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy, ⁴ Spital Thurgau AG, Frauenfeld, Switzerland, ⁵ University Hospitals Southampton NHS Trust, Southampton, United Kingdom, ⁶ Ng Teng Fong General Hospital, Singapore, Singapore

• Introduction and Objectives: We aimed to evaluate perioperative outcomes of suction mini percutaneous nephrolithotomy (SM-PCNL) in anomalous kidneys in a multicenter, real-world study and assess variations based on positioning, lithotripsy modality, and renal anomalies.
  Materials and Methods: This was a prospective study across 15 centers from January–December 2024 of adults undergoing SM-PCNL for renal stones in anomalous kidneys. Patients with normal anatomy, non-suction PCNL, or incomplete data were excluded. Stone-free rate (SFR) was assessed via a 30-day non-contrast CT, categorizing outcomes as 100% stone-free (Grade A), residual fragments ≤ 4 mm (Grade B), or fragments > 4 mm/multiple (Grade C, requiring reintervention).
  Results: We included 287 patients for analysis. Malrotation (65.5%) was the most common anomaly, followed by duplex systems (25.1%), horseshoe kidneys (8.4%), and ectopic kidneys (1.0%). Median stone size was 1.7 cm. Supine positioning was used in 54.4%. Lithotripsy was performed with Holmium laser (50.9%), Thulium fiber laser (11.1%), or pneumatic lithotripsy (26.1%). Intraoperative stone clearance was reported in 95.4%. At 30-day follow-up, 93.4% were totally stone-free (Grade A), 5.6% had residual fragments ≤ 4 mm (Grade B), and 1.0% required reintervention (Grade C). Complication rates were low, with no transfusions or pleural injuries. Sepsis requiring ICU admission occurred in only 0.7%.
  Conclusions: Our study on SM-PCNL in adults with anomalous kidneys shows that a combination of laser with suction sheaths in achieved 100% single-stage stone-free status in 93.4% of cases with negligible complications and very low reintervention in very short operative times. This is the first multicenter prospective real-world study highlighting its benefit in these patients.

MP-27.20—Utility and Challenges of Flexible and Navigable Suction Ureteral Access Sheath (FANS) vs. Suction Mini-PCNL in Children: A Comparative Analysis 

• Lim Ee Jean ¹, Yuen Steffi Kar Kei ², Somani Bhaskar Kumar ³, Herrmann Thomas R.W. ⁴, Sarica Kemal ⁵, Tur Anna Bujons ⁶, Madarriaga Yesica Quiroz ⁶, Ragoori Deepak Reddy ⁷, Fong Khi Yung ¹, Tursunkulov Azimdjon N. ⁸, Tanidir Yiloren ⁹, Traxer Olivier ¹⁰, Castellani Daniele ¹¹, Gauhar Vineet ¹², Teng Roy Zen Sing ¹
  ¹ Singapore General Hospital, Singapore, Singapore, ² S.H. Ho Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China, ³ University Hospital Southampton NHS Foundation Trust, Southamptom, Southampton, United Kingdom, ⁴ Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland, Frauenfeld, Switzerland, ⁵ Biruni University Hospital, Turkey, Turkey, Türkiye, ⁶ Autonomous University of Barcelona, Urology Department, Fundació Puigvert, Spain, Barcelona, Spain, Spain, ⁷ Asian institute of nephrology and urology, Hyderabad, India, Hyderabad, India, ⁸ AkfaMedline Hospital, Tashkent, Uzbekistan, Tashkent, Uzbekistan, ⁹ Medicana Atasehir Hospital, Istanbul, Turkey, Istanbul, Türkiye, ¹⁰ Sorbonne University, Paris, France, ¹¹ Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Italy, Italy, Italy, ¹² Ng Teng Fong General Hospital, Singapore, Singapore, Singapore

• Introduction and Objectives: Pediatric kidney stone disease poses unique challenges due to smaller anatomical structures and the need to minimize morbidity. This study compares the efficacy and safety of retrograde intrarenal surgery (RIRS) with Flexible and Navigable Suction Ureteral Access Sheath (FANS-UAS) and Suction Mini-Percutaneous Nephrolithotomy (SM-PCNL) in children with renal stones ≤ 2 cm, focusing on stone-free rates (SFR), operative efficiency, and perioperative outcomes.
  Materials and Methods: A prospective, multicenter study analyzed 96 pediatric patients (50 FANS-UAS, 46 SM-PCNL) from eight centers. Inclusion criteria were age ≤ 16 years, normal renal anatomy, and stone burden ≤ 2 cm. Outcomes included SFR (assessed via 30-day non-contrast CT scan), operative time, complications, and hospital stay. Two multivariable regression analyses were performed to identify predictors of SFR and overall complications. FANS-UAS utilized 10–12Fr sheaths with laser lithotripsy, while SM-PCNL employed 18Fr sheaths with laser/pneumatic devices.
  Results: FANS-UAS demonstrated comparable SFR to SM-PCNL (66.0% vs. 58.7% for zero fragments) but with shorter operative times (42.5 vs. 82.5 min, p = 0.025) and hospital stays (2 vs. 3 days, p < 0.001). FANS was preferred for multiple stones (28% vs. 0%, p = 0.005). Both techniques maintained low intrarenal pressure and high intraoperative visualization rates (>90%). Complication rates were similar (12.0% vs. 8.7%, p = 0.845).
  Conclusions: Both FANS-UAS and SM-PCNL are suitable for managing large stone burdens in children, though FANS-UAS appears advantageous for multiple stones. Age is not a limiting factor for either technique, and findings suggest that BMI may influence the choice of approach. Ultimately, the surgeon’s experience and comfort level each technique remain crucial determinants of procedural success and complication rates for stones up to 2 cm in normal pediatric kidneys.

27.2. Moderated Video ePosters

MVP-27.01—Flexible Ureteroscopy via Supra Pubic Puncture—A Point of Technique Video 

• Desai Viraj, Patel Deep, Ganpule Arvind, Sabnis Ravindra
  Muljhibhai Patel Urological Hospital, Nadiad, India

• Introduction and Objectives: Ureteroscopy is a cornerstone procedure in urological practice, widely recognized as a primary surgical intervention for addressing urinary stones in the kidneys and ureters. Flexible ureteroscopy through a retrograde perurethral route is well established and widespread technique, but previous literature has not described the technique of flexible ureteroscopy through suprapubic route. Flexible Ureteroscopy by antegrade route is well described technique for the management of ureteric calculi in ileal conduit; along with that, it is also particularly valuable for patients with an ectopic ureteral orifice after ureteral reimplantation, renal transplant, ileal conduit, or neobladder. Suprapubic access, specifically, is an alternative entry point into the urinary system that offers unique advantages in specific clinical situations. This video will discuss the point of technique of flexible ureteroscopy via suprapubic puncture.
  Materials and Methods: Flexible Ureteroscopy was done in a patient with urethral stricture, with a left sided DJ stent in place. BioRad (TM) flexible ureteroscope with a ureteral access sheath used to access the ureter via supra pubic route.
  Results: Successful flexible ureteroscopy done via suprapubic route after cannulation of the previously placed DJ stent. Successful stone clearance with stone free rate of 100 percent and early recovery and discharge. Faster recovery as compared to PCNL, which would otherwise have been done in absence of suprapubic access.
  Conclusions: Supra-pubic flexible ureteroscopy is an important surgical technique that provides a safe and effective approach for the management of urolithiasis by offering an alternative access route apart from antegrade ureteroscopy, it can be particularly useful in cases where retrograde ureteroscopy is difficult or contraindicated. With advancements in urotechnology and surgical techniques, the success rate of this procedure continues to improve, providing patients with a less invasive treatment option and faster recovery although understanding the technique, patient selection, and potential risks is essential for optimal surgical outcomes.

MVP-27.02—Revolutionary Clearpetra FANS Sheath in Ureteroscopy 

• Chin Yew Fung, Mahmalji Wasim
  Hereford County Hospital, Wye Valley Trust, Hereford, United Kingdom

• Introduction and Objectives: Flexible ureteroscopy can be challenging, particularly due to poor visualisation and the delivery of safe calculi lithotripsy. The Clearpetra Flexible and Navigation Suction (FANS) Sheath is making major breakthroughs by providing improved visualisation of intrarenal anatomy via effective suction of debris and pus during operations and allowing the clearing of calculus dust and large fragments post-lithotripsy. Through this surgical video abstract, we demonstrate the utility of the FANS sheath in a few complex stone cases, achieving effective stone clearance.
  Materials and Methods: The demonstrated cases are performed by local urology department primary stone surgeon. Our local urology stone unit using set up as follows: 7.5Fr Urofino flexible ureteroscopy, Clearpetra FANS sheath, Lumenis Holmium lasering system, Endo flow Rocamed irrigation system. Clearpetra FANS sheath has a suction connection attached to the sieve bottle while joining into Neptune suction system.
  Results: We are showing two complex cases utilising the Clearpetra FANS sheath system: Case 1 is a 75-year-old gentleman with infected left renal pelvis calculi who was stented prior to his definite flexible ureteroscopy and laser lithotripsy. Patient ureteroscopy revealed significant debris and pus occluding vision within the renal pelvis. By activating the suction system and advancing the sheath opening into the renal pelvis, the debris was easily and effectively cleared, thereby improving our vision. The flexibility of the sheath allows it to adapt to the angulation of the ureteroscope, enabling safe deployment into the renal calyx as well. The suction power can be adjusted accordingly depending on the size of the debris required to be evacuated. Case 2 is a lady with a significant stone burden of 4 × 1 cm calculi in her left kidney. Once the calculi were fragmented and dusted, the FANS sheath also efficiently cleared the calculi dust and larger calculi fragments without requiring stone baskets and removal of ureteroscopy out of the sheath. These larger fragments were collected into filtering sieve bottle and will be sent for stone analysis.
  Conclusions: Through these two cases, we have demonstrated Clearpetra FANS sheath has effective troubleshooting otherwise complex cases if using routine access sheath, in terms of clearing of intrarenal calculi dust and debris.

27.3. Residents Forum Moderated Oral ePoster

RF-27.01—Balancing Simplicity and Accuracy: A Clinically Practical Model for Predicting Prolonged RIRS Operative Time 

• Hu Wei-Shiang, Lin Yi-Sheng, Hsu Jow-Yu, Tung Min-Che, Ou Yen-Chuan
  Tung’s Taichung MetroHarbor Hospital, Taichung City, Taiwan

• Introduction and Objectives: Retrograde intrarenal surgery (RIRS) is a common treatment for kidney stones, but prolonged operative time (≥90 min) increases complications and resource use. Existing predictive models (STONE Score, Guy’s Score, RUSS Score) are complex and less clinically practical. This study aims to identify key predictors of prolonged operative time and develop a simplified model.
  Materials and Methods: A retrospective study analyzed RIRS patients, defining prolonged operative time as ≥90 min. Statistical analyses included: Univariate Analysis: Comparing stone and patient characteristics between operative time groups (<90 min vs. ≥90 min). Multivariable Logistic Regression: Identifying independent predictors. ROC Curve Analysis: Assessing predictive performance. Cut-off Determination: Using Youden’s J index for optimal cut-off values. Model Development: Creating a simplified risk score based on significant predictors.
  Results: Among 142 patients, univariate analysis showed significant differences in stone size (p < 0.001), stone number (p = 0.003), and Inferior Pole Angle (IPA) (p < 0.001) between groups. Multivariable analysis confirmed stone size (OR = 1.34, p = 0.029) and IPA (OR = 0.91, p < 0.001) as independent predictors. Model Development: A simplified RIRS risk score was constructed using two key variables: stone size (≥16 mm) IPA (≤60°). Patients were classified into three risk groups: Low risk (0–2 points): Suitable for RIRS. Moderate risk (3–4 points): RIRS feasible with experienced surgeons. High risk (5–6 points): High likelihood of prolonged operative time; consider PCNL. Predictive Performance: The simplified model (stone size & IPA) achieved an AUC of 0.792, with sensitivity 69.0%, specificity 84.5%, PPV 81.7%, and NPV 73.2%. It performed comparably to STONE Score (AUC = 0.809) and Modified STONE Score (AUC = 0.807) and slightly lower than RUSS Score (AUC = 0.868). Validation: The RIRS risk score correlated significantly with operative time (p < 0.001). Mean operative times by risk group: Low risk: 72.5 ± 18.3 min. Moderate risk: 98.4 ± 22.1 min. High risk: 124.2 ± 30.7 min.
  Conclusions: This simplified model provides a practical and effective tool for predicting prolonged RIRS operative time, which can guide surgical decision between RIRS and PCNL. Further validation across diverse populations is recommended.

RF-27.02—Between a Rock and a Hard Stent: Successes and Failures in Emergency Ureteric Stenting Under Local Anaesthetic 

• Stimler Batya, Simpson Richard, Gkentzis Agapios
  Royal Bolton Hospital, Bolton, United Kingdom

• Introduction and Objectives: Emergency ureteric stents are traditionally inserted under General Anaesthetic (GA) in theatre. Here, we review our single centre data on emergency ureteric stenting under local anaesthetic (LA). Benefits of LA stent insertion include enabling the procedure for patients unfit for GA and the flexibility to perform it outside of an operating theatre, in a procedure room. We review successes and failures and propose factors contributing to unsuccessful stent insertion under LA.
  Materials and Methods: A retrospective analysis was conducted using Electronic Patient Records and data from our stent registry. Over a 14-month period (January 2024–March 2025), 31 emergency LA ureteric stent insertions were attempted for 28 patients: 25 were successfully inserted, and 6 were unsuccessful or incorrectly placed.
  Results: Of 28 patients, 13 (46%) were male, and 15 (54%) female, with a median age of 63 years (range: 32–86). Median time from decision to stent to procedure was 4 h. 25 (81%) LA stent insertions were successful in 23 patients, including 13 (56%) for obstructing ureteric stones: 8 proximal (mean: 8.5 mm), 1 mid (10 mm), and 4 distal (mean: 5.5 mm). Of those, 10 were septic, 1 had deteriorating renal function, and 2 had uncontrolled pain. The remaining 10 were for other causes of obstruction: symptomatic pelvi-ureteric junction (PUJ) obstruction (2), malignancy (2), sepsis with hydronephrosis (2), urinoma (2), emphysematous pyelonephritis (1), ureteric stricture (1). 21 were unilateral, and 2 bilateral. Of the 6 unsuccessful cases (19%), 3 (50%) involved >10 mm PUJ stones. Other causes included inability to visualise ureteric orifices due to large vascular prostate (1), accidental upward migration of the stent (1), and a terminated bilateral attempt due to patient discomfort (1). Four (67%) unsuccessful cases were in male patients and 2 (33%) in females.
  Conclusions: LA stent insertion is a valuable emergency option, avoiding GA when it is unsuitable for frail patients and facilitating the procedure in a non theatre space. Based on our studied cohort, larger PUJ stones appear more likely to result in unsuccessful LA stenting. Stenting males is more technically challenging due to the prostate and longer urethra. Consideration of patient comfort is also crucial, particularly for bilateral attempts.

RF-27.03—Comparing Laser Versus Mechanical Lithotripsy in Suction Mini-Percutaneous Nephrolithotripsy for Kidney Stone Disease: A Prospective Multicenter Real-World Study from the Global Stumps Registry 

• Cormio Angelo ¹, Castellani Daniele ¹, Somani Bhaskar ², Fong Khi ³, De La Rosette Jean ⁴, Yuen Steffi ⁵, Gadzhiev Nariman ⁶, Kalathia Jaisukh ⁷, Tak Gopal ⁸, Agrawal Madhu Sudan ⁹, Tokas Theodoros ¹⁰, Mishra Dilip ¹¹, Herrmann Thomas ¹², Gauhar Vineet ¹³
  ¹ Università Politecnica delle Marche, Ancona, Italy, ² University Hospital Southampton NHS Trust, Southampton, United Kingdom, ³ National University of Singapore, Singapore, Singapore, ⁴ Istanbul Medipol University, Istanbul, Türkiye, ⁵ The Chinese University of Hong Kong, Hong Kong, Hong Kong, China, ⁶ Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation, ⁷ Fortune Urology Clinic, Botad, India, ⁸ Muljibhai Patel Urological Hospital, Nadiad, India, ⁹ S. N. Medical College, Agra, India, ¹⁰ General Hospital Hall i.T, Tirol, Austria, ¹¹ Pushpanjali Hospital, Agra, India, ¹² Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland, ¹³ Ng Teng Fong General Hospital, Singapore, Singapore

• Introduction and Objectives: Suction-assisted miniaturized percutaneous nephrolithotomy (mini-PCNL) is a well-established technique for renal stone treatment with high efficacy and low morbidity. However, the comparative safety and effectiveness of laser versus non-laser lithotripsy in this setting remain unclear. We aimed to compare perioperative outcomes, complications, and stone-free rates (SFRs) of lasers versus mechanical lithotripsy.
  Materials and Methods: This multicenter study enrolled adult patients with kidney stones undergoing suction mini-PCNL (14–22 Fr) from March to November 2024. Patients were divided into Group 1 (laser lithotripsy) and Group 2 (non-laser). Propensity score matching (2:1) was based on age, sex, Guy’s stone score, and surgical position. Outcomes included intraoperative details, complications (Clavien-Dindo), and SFRs (based on 30-day low-dose CT). Multivariable logistic regression analyses assessed predictors of complete stone clearance (Grade A) and complications.
  Results: After matching, 748 patients were included (448 laser, 300 non-laser), with comparable baseline and stone characteristics. Lithotripsy and operative times were significantly shorter in the non-laser group (12 vs. 18 min and 37 vs. 45 min, respectively; p < 0.001). Intraoperative stone-free status was higher in Group 2 (91.3% vs. 80.7%, p < 0.001). Blood transfusions (3.3% vs. 0.2%, p = 0.01), pelvic perforation, and pleural injury were more common in the non-laser group. Infectious complications, hospital stay, and 72-h readmission were comparable. At 30-day CT scan, Grade A SFR was 87.7% (Group 2) vs. 82.1% (Group 1), with no significant difference in reintervention rate. Multivariable analyses identified fluoroscopy combined with ultrasound puncture (OR 0.31), skin-to-stone distance > 8 cm (OR 0.51), and sheath size < 20 Fr (OR 0.46) as predictors of lower odds of grade A SFR, while single-step tract dilatation was associated with higher odds (OR 3.8). Factors associated with higher odds of all complications included combined ultrasound-fluoroscopy puncture (OR 2.21), serial non-metal dilatation (OR 2.86), and larger stone volume (OR 1.03).
  Conclusions: Laser and non-laser energy sources are both effective in suction mini-PCNL. Non-laser lithotripsy offers shorter operative times and marginally higher SFRs but also at higher rates of blood transfusions. Individualized energy selection remains crucial for optimal outcomes in mini-PCNL.

RF-27.04—Does the Height of the Irrigation Fluid Affect the Intrarenal Pressure Using Diss? An Ex-Vivo Experimental Study 

• Musayelyan Arkadya ¹, Pietropaolo Amelia ², Tsaturyan Arman ¹, Martinez Begona ³, Ventimiglia Eugenio ⁴, Liatsikos Evangelos ⁵, Muradyan Armen ¹, Kallidonis Panagiotis ⁵, Prontera Pier ⁶, Yuen Steffi ⁷, Gauhar Vineet ⁸, Traxer Olivier ⁹, Somani Bhaskar ¹⁰, Lattarulo Marco ¹¹, Grigoryan Hayk ¹
  ¹ Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia, ² University Hospital Southampton NHS Foundation Trust, Southhampton, United Kingdom, ³ University Hospital del Vinalopo, Alicante, Spain, ⁴ Division of Experimental Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy, ⁵ University of Patras, Patras, Greece, ⁶ Sapienza Università di Roma, Taranto, Italy, ⁷ SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China, ⁸ Ng Teng Fong General Hospital, Singapore, Singapore, ⁹ GRC N°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France, ¹⁰ University Hospital Southampton NHS Foundation Trust, Southampton, Southhampton, United Kingdom, ¹¹ Santissima Annunziata Hospital, Taranto, Italy

• Introduction and Objectives: Intrarenal pressure management is one of the key concepts in retrograde intrarenal surgery (RIRS). The aim of the current study was to evaluate the effect of the height of the irrigation fluid on the intrarenal pressure using 2 single-use digital flexible ureteroscopes with an integrated direct-in-scope suction (7.5Fr PU3033AH or the 9.2Fr PU400A (ZhuHai Pusen Medical Technology Co, Ltd, Zhuhai, China)) under different irrigation conditions.
  Materials and Methods: An experimental ex vivo study was performed using a freshly harvested porcine upper urinary system (kidney together with the proximal ureter). All measurements were performed using two 3 L saline bags fixed at the level of 100 cm, 140 cm, and 60 cm above the working table. The trials were performed with gravity, manual pump, and automated pump irrigation systems. Evaluated parameters included initial intrarenal pressure, pressure decrease after 1 s of suctioning, time required to collapse the porcine pelvicalyceal system, time required to regain the initial IRP.
  Results: With the use of the automated pump, the height of the irrigation did not affect the IRP after 1 s of suctioning, the time required to regain the IRP and to collapse the PCS. As for gravity and manual pump irrigation, increasing the height of the irrigation fluid resulted in an increase in IRPs. The increase of the height of the irrigation fluid shortened the filling time of the hand pump. The fastest time of 2–3 s was recorded with the 7.5Fr scope with the irrigation set at 140 cm and the slowest with the 9.2Fr scope and irrigation at 60 cm.
  Conclusions: The impact of height of the irrigation fluid depends hugely on the irrigation system used. In cases when automated pump is used, no changes in IRP are expected with the change of the height of the irrigation fluid. In contrast, using a gravity irrigation, higher IRPs were observed with the higher levels of the irrigation fluid. As for manual pumping, the increase of the height of the irrigation fluid shortened the filling time of the hand pump, having less impact on IRP.

RF-27.05—Flexible and Navigable Suction Ureteral Access Sheaths to Treat Impacted Mid/Upper Ureteral Stones: A Prospective Pilot Study from EAU Endourology 

• Fernandes Shriya ¹, Tsaturyan Arman ², Harutyunyan Marat ³, Fanarjyan Sergey ⁴, Liatsikos Evangelos ⁵, Kallidonis Panagiotis ⁶, Pietropaolo Amelia ¹, Somani Bhaskar ¹
  ¹ University hospital Southampton, Southampton, United Kingdom, ² Yerevan State Medical University, Yerevan, Armenia, ³ Erebouni Medical Center, Yerevan, Armenia, ⁴ EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, Arnhem, Netherlands, ⁵ Advancing Suction and Pressure and Innovative Research in Endourology (ASPIRE), Yerevan, Armenia, ⁶ University of Patras, Patras, Greece

• Introduction and Objectives: To evaluate the feasibility and initial outcomes of flexible and navigable suction ureteral access sheaths (FANS) in treating mid/upper ureteral stones.
  Materials and Methods: A prospective observational study was performed including patients harboring an impacted mid/upper ureteral stone and receiving flexible ureteroscopic lithotripsy (fURSL) with FANS in a period from November 2024 till April 2025. The main outcome variable was the immediate and 1-month stone free rate (SFR). Secondary outcomes were surgery duration, intraoperative bleeding, injury of the ureter either with the laser firing or the FANS, and postoperative complications.
  Results: In total 21 patients, 13 males (62%) and 8 females (38%), with a median age of 46 (38.5–56.5), were included. Median ureter stone size was 15 mm (11.5–17.5 mm) with a median Hounsfield unit of 1090 (915–1435 HU). Out of all ureteral stones, 19 (90.5%) were located in the upper and 2 in the mid ureter. In 7 patients (33.3%) concomitant kidney stones were present. Preoperative drainage either with a stent (76.2%) or a percutaneous nephrostomy (14.3%) was undertaken in 19 patients (90.5%). In 11 cases (52.4%) and 5 cases (23.8%), the 7.5Fr PU3033AH direct-in-scope-suction (DISS) and 9.2Fr PU400A DISS ureteroscope were used. In majority of cases, 13 patients (61.9%), a 10/12Fr FANS was preferred. Holmium laser lithotripsy was performed in all cases. The median duration of surgery was 46 min (37.5–60 min). Intraoperative minor injury of the ureteral wall with the laser fiber occurred in 2 cases and hematuria in 1 case. Postoperative fever was reported in 3 cases (14.3%), whereas no patient developed postoperative sepsis. The intraoperative SFR was documented by surgeons in 20 patients (95.2%). The 1-month zero fragment SFR was reported 18 patients (85.7%), whereas in 2 patients (9.5%) a single fragment of <2 mm was noted.
  Conclusions: Our initial data demonstrate that flexible URSL with FANS for impacted mid/upper ureteric stones is feasible and carries high SFR with low risk of postoperative complications. Further large-scale studies are required to prove our data and evaluate the rate of postoperative ureteral strictures.

RF-27.06—Handling of Ureteral Access Sheaths: A Simple, yet Essential Technique to Reduce Intrarenal Pressures 

• Grigoryan Hayk ¹, Pietropaolo Amelia ², Tsaturyan Arman ¹, Musayelyan Arkadya ¹, Harutyunyan Marat ¹, Muradyan Armen ¹, Ventimiglia Eugenio ³, Liatsikos Evangelos ⁴, Kallidonis Panagiotis ⁴, Somani Bhaskar ², Prontera Paolo ⁵, Lattarulo Marco ⁶
  ¹ Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia, ² University Hospital Southhampton NHS Foundation Trust, Southhampton, United Kingdom, ³ Division of Experimental Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy, ⁴ University of Patras, Patras, Greece, ⁵ Santissima Annunziata Hospita, Taranto, Italy, ⁶ Santissima Annunziata Hospital, Taranto, Italy

• Introduction and Objectives: During the RIRS procedure the surgeon manipulates with the ureteroscope and the access sheath, which might affect the outflow and subsequently the IRP. The aim of the current study was to evaluate the effect of the handling of the distal end of the ureteral access sheaths on the management of intrarenal pressures.
  Materials and Methods: The current study utilized an ex-vivo experimental set-up performed on a porcine urinary system. Five single-use digital flexible ureteroscopes were used for this purpose: 6.3 Fr HU, 7.5 Fr HU and 9.0 Fr Hugemed (Hu30M, HU30S and HU30) ureteroscopes, and 7.5 Fr and 9.2 Fr Pusen (PU3033AH, PU400A) ureteroscopes. The IRP measurements were performed with the digital flexible ureteroscopes only and with 9.5/11.5 Fr and 12/14 Fr UASs together with flexible digital ureteroscopes. The main variable of interest was the handling of the distal end of the ureteral access sheath termed as high (30 cm above), middle (15 cm above) and low (at the kidney level) handle position.
  Results: The highest maximal intrarenal pressures were recorded with the 9.2 Fr PU400A Pusen scope in all settings, whereas the 6.3 Fr HU30M HugeMed scope demonstrated the lowest IRP. Minor differences were noted between the measurements with no UAS and with UAS in high position resulting in 9.1%, 7.8%, 7.8%, 7.8% and 10% decrease for 6.3 Fr, 7.5 Fr and 9.0 Fr HugeMed and 7.5 Fr and 9.2 Fr Pusen ureteroscopes, respectively. Decreasing the handle of the UAS to middle position and low position resulted in significant decline of IRPs, 40% and 70% for 6.3Fr scope, 33.3% and 66.7% for 7.5 Fr and 9.0 Fr HugeMed (HU30S and HU30) and 7.5 Fr Pusen (PU3033AH), and 16.7% and 50% for 9.2 Fr ureteroscopes, respectively.
  Conclusions: The lowest IRPs were recorded with the 6.3 Fr HU30M Hugemed ureteroscope, whereas PU400A was associated with the highest IRPs. High position of the distal end of the UAS demonstrates minor IRP decline as compared to settings without UAS. Decrease the handle of the UAS incrementally decreases the IRP for all evaluated ureteroscopes. The surgeons should be aware about the importance of handling of UAS in intrarenal pressure regulation.

RF-27.07—Laser Fibers and Baskets. How Do They Affect Suction and Intrarenal Pressures Using the Novel Single Use Flexible Direct-in-Scope Suction Urtereoscopes? 

• Grigoryan Hayk ¹, Prontera Paolo ², Tsaturyan Arman ¹, Oliviero Alberto ³, Muradyan Armen ¹, Ventimiglia Eugenio ⁴, Liatsikos Evangelos ⁵, Kallidonis Panagiotis ⁵, Somani Bhaskar ⁶, Pietropaolo Amelia ⁶
  ¹ Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia, ² Santissima Annunziata Hospita, Taranto, Italy, ³ Università degli Studi di Genova, Milan, Italy, ⁴ Division of Experimental Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy, ⁵ University of Patras, Patras, Greece, ⁶ University Hospital Southhampton NHS Foundation Trust, Southhampton, United Kingdom

• Introduction and Objectives: Recent literature has demonstrated the essential role of suction devices in retrograde intrarenal surgery. The aim of the current study was to evaluate the intrarenal pressures (IRP) and suction properties of novel 7.5 Fr PU3033AH and 9.2 Fr PU400A (ZhuHai Pusen Medical Technology Co, Ltd, Zhuhai, China) flexible ureteroscopes with direct-in-scope suction (DISS) feature with the unoccupied working channel and with different working instruments.
  Materials and Methods: We performed an ex-vivo experimental study on a fresh porcine kidney. Experimental measurements were performed with an unoccupied working channel, with 200 μm and 272 μm laser fiber and with 1.8Fr nitinol basket. The evaluated parameters included irrigation flow rates with gravity irrigation and automated pump, maximal intrarenal pressure without suctioning, pressure decrease time required to collapse the porcine pelvicalyceal system, and time required to regain the initial IRP.
  Results: The flow rates and intrarenal pressures were significantly high with the unoccupied working channel both for 7.5 Fr and 9.2 Fr DISS scopes. The highest IRP of 38 mmHG was recorded with the 9.2 Fr scope under 100 mmHG irrigation pressure. Irrespective of the irrigation system used, the introduction of working instruments significantly reduced the IRP for both 7.5 Fr and 9.2 Fr DISS scopes. Longer time was required to collapse the pelvicalyceal system and regain the basal intrarenal pressure when working instruments were used. The thicker the diameter of the instrument, the more impact on flow rate, IRP, collapse of the system, and regain of the pressure was observed. The latter trends were less pronounced with the 9.2 Fr scope with wider 5.1 Fr working channel.
  Conclusions: Intrarenal pressures and suction properties vary significantly depending on the diameter of the working instrument. With the larger diameter of the working instruments, the worsening of the irrigation and aspiration properties of the scopes can be expected.

RF-27.08—Retrospective Analysis of Endoscopic Combined Intrarenal Surgery (ECIRS) in the Prone Split-Leg vs. Modified Valdivia-Galdakao Positions at a Tertiary Hospital in Mexico City 

• Lerma Landeros Jesus, Martinez Arroyo Carlos, Morales Montor Jorge, Cantellano Orozco Mauricio, Fernandez Noyola Gerardo, Anceno Alec, Cervantes Zorrilla Ricardo, Pacheco Gahbler Carlos
  Hospital Gea Gonzalez, Ciudad De Mexico, Mexico

• Introduction and Objectives: The primary objective in the surgical treatment of urolithiasis is to achieve a stone-free status, with endoscopic methods contributing to the minimization of open surgery. Endoscopic combined intrarenal surgery (ECIRS), introduced in 2008 using the modified Valdivia-Galdakao position, allows optimal transurethral access. Studies suggest that the prone split-leg position may offer comparable outcomes, providing sufficient space for nephroscopy, adequate stone-free rates (SFR), and lower injury risk.
  Materials and Methods: This retrospective study analyzed patients undergoing ECIRS with dual-energy lithotripsy (Shockpulse SEmr) between April 2023 and August 2024. Procedures used 20–22 Fr access sheaths, a 7 Fr digital flexible ureteroscope for retrograde access, 11/13 Fr ureteral access sheaths, and holmium laser lithotripsy (0.8 J, 15 Hz, 12 W). Stone-free status was defined as no residual stones or fragments ≤ 4 mm. Outcomes between prone split-leg and modified Valdivia-Galdakao positions were compared.
  Results: Eleven patients were included: 54.5% prone, 45.5% supine. Complete staghorn calculi appeared in 33.3% (prone) and 66.6% (Valdivia-Galdakao). Mini-percutaneous nephrolithotomy was used in 66.6% of prone and 33.3% at the others. Standard PCNL was performed in 40% of prone vs. 60%. Operative times averaged 113.3 min (prone) vs. 138 min (supine); lithotripsy time was 50 min in both. Average stone volume was 4.12 cm³ (prone) vs. 5.64 cm³, with similar densities (990 HU vs. 974 HU). SFR was 50% in both groups. Complications (CLAVIEN-DINDO II) occurred in 9% of cases per group. Descriptive statistics and a Pearson coefficient of 0.98 showed a strong correlation between both positions with no significant differences (p > 0.05). Boxplots and histograms showed only minor distributional differences.
  Conclusions: The modified Valdivia-Galdakao and prone split-leg positions demonstrated comparable SFRs and complication rates. The Valdivia-Galdakao group managed more complex staghorn cases, while the prone position yielded shorter operative times. Differences in sheath sizes were noted, with more 22 Fr sheaths in Valdivia cases. Ultimately, positioning should be based on surgeon preference, patient anatomy, and stone complexity.

RF-27.09—Stent-Related Symptoms Before and After Ureteroscopic Lithotripsy: Does Surgery Alone Impact the Outcomes? 

• Grigoryan Hayk ¹, Tsaturyan Arman ¹, Keller Etienne Xavier ², Mancon Stefano ³, Pietropaolo Amelia ⁴, Kocharyan Lusine ¹
  ¹ Yerevan State Medical University after Mkhitar Heratsi, Yerevan, Armenia, ² University Hospital of Zürich, Zurich, Switzerland, ³ IRCCS Humanitas Research Hospital, Milan, Italy, ⁴ University Hospital Southhampton NHS Foundation Trust, Southhampton, United Kingdom

• Introduction and Objectives: Stent-related symptoms can significantly affect the patients and reduce the quality of life of patients. The aim of the current study was to evaluate the perception and severity of stent-related symptoms (SRS) in patients preceding and following retrograde intrarenal surgery (RIRS).
  Materials and Methods: A prospective observational study was performed including patients harboring single or multiple renal stones undergoing ureteral stenting and scheduled for an RIRS considered eligible from January 2023 till July 2024. For each patient, stent-related symptoms (SRS) were evaluated at 3 timepoints: preoperatively on the day of RIRS, as well as on the 1st and 7th postoperative day following the RIRS with the stent still in place. Stent-related symptoms including bladder pain, flank pain, hematuria, urgency, frequency, nocturia, and urge incontinence using a visual analog scoring (VAS) system.
  Results: Total of 57 patients were included. In the evaluation of SRS, the patients reported a significant rise in back pain at day 1 after RIRS (mean 2.25 on a scale of 0 to 5) compared to preoperatively (2.06), with a significant decrease of back pain at day 7 after RIRS (1.68) (p = 0.003). This translates to 25% of patients with strong-to-severe back pain preoperatively, 39% at day 1 and 7% at day 7 after RIRS (p < 0.001). A similar pattern (raise of symptoms on day 1 after RIRS, decrease of symptoms at day 7 after RIRS) was observed for bladder pain, frequency, and urge incontinence (all p < 0.001). As for urgency and nocturia, these SRS steadily decreased from baseline to day 1, and in turn from day 1 to day 7 after RIRS (p = 0.004 and p = 0.003, respectively). Hematuria was the only SRS which did not show any significant differences over the 3 evaluated timepoints.
  Conclusions: We found worsening of the SRS in patients on postoperative day 1 following RIRS procedure. A statistically significant improvement of the SRSs was demonstrated from postoperative day 1 to day 7. Hematuria was the only symptom not affected over the 3 evaluated timepoints.

RF-27.10—Technical Feasibility, Challenges and Clinical Outcomes of Supracostal Upper Pole Puncture in Supine Percutaneous Nephrolithotomy (PCNL) Under Spinal Anesthesia: Our Experience at a Tertiary Care Institute in a Tier 2 City in South India 

• Kumar Pravin, T Gnansekaran, P Prabakaran, J Induja, M Anbalagan, Richard Sam
  Madurai Medical College and Hospital, Madurai, India

• Introduction and Objectives: Supine Percutaneous Nephrolithotomy (PCNL) has become increasingly popular among urologists; however, the feasibility and safety of supracostal punctures in supine PCNL is still a subject of debate. Accessing the upper pole through supine PCNL is a safe method, yet the supracostal approach carries a higher risk of thoracic complications. Despite these concerns, existing evidence supports this technique as it outweighs the potential drawbacks. We aimed to evaluate the technical feasibility and challenges of supracostal upper pole puncture in supine PCNL under spinal anaesthesia.
  Materials and Methods: A prospective analysis of 24 patients was carried out who underwent supracostal upper pole puncture in supine PCNL under spinal anaesthesia between August 2024 and December 2024 at our institution.
  Results: Out of 24 patients, 5 were female. The average stone size measured 2.39 cm, and the mean surgical duration was 50 min and 26 s, with most of the procedures (21) being performed tubeless. Upper pole puncture was successfully performed in 19 cases, with careful angulation to navigate rib interference and minimize the risk of pleural injury, demonstrating its feasibility in supine PCNL. 5 patients had a lower pole tract with an accessory upper pole tract. One patient had a calyceal diverticular stone removed successfully. The average decrease in haemoglobin levels was 0.46 gm/dL, and none of the patients needed a blood transfusion. A significant number of patients (87.5%) were categorized as ASA class II. None of the patients had any intra-operative or post-operative complications. The average duration of hospitalization was 2.85 days. The stone clearance rate in this series was 91.66%.
  Conclusions: When performed by skilled professionals, supracostal upper pole puncture in supine PCNL under regional anaesthesia is a viable, safe, and effective method that results in minimal complications while attaining high rates of stone clearance. Additionally, patients receiving regional anaesthesia are able to follow the surgeon’s directions, which improves the harmony between the surgeon, anaesthetist, and patient.

27.4. Unmoderated Standard ePosters

UP-27.01—Comparative Effectiveness of Extracorporeal Shock Wave Lithotripsy (ESWL) for Post Percutaneous Nephrolithotomy (PCNL) Residual Versus Primary Renal Stones 

• Hussain Mushtaq, Naz Kanwal, Abidi Syed Saeed
  Sindh Institute of Urology and Transplantation, Karachi, Pakistan

• Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) is the preferred treatment for large renal calculi (≥2 cm); however, residual stone rates range from 10% to 60%. Management options for these residual stones include extracorporeal shock wave lithotripsy (ESWL), flexible ureteroscopy, or repeat PCNL. ESWL remains the least invasive treatment, though stone density (≥1000 Hounsfield Units [HU]) is a predictor of poor outcomes. This study compares the stone-free rate (SFR) of ESWL in patients with post-PCNL residual stones versus those with primary renal stones of equivalent size.
  Materials and Methods: A prospective cohort study was conducted at our institute from January to June 2022. A total of 108 patients with renal calculi (5–15 mm) were enrolled and categorized into two groups: Group A (post-PCNL residual stones, n = 54) and Group B (primary renal stones, n = 54). ESWL was performed by a single surgeon, and patients were followed up with ultrasonography and X-ray KUB at eight weeks to assess stone clearance.
  Results: The mean age was 39.04 ± 11.3 years in Group A and 36.26 ± 10.9 years in Group B. Male predominance was observed in both groups (71% vs. 67%). The mean stone size was comparable (1.18 ± 0.25 cm vs. 1.16 ± 0.30 cm), while stone density was slightly higher in the post-PCNL group (1132.07 ± 444.7 HU vs. 1028.00 ± 299.0 HU). Patients with post-PCNL residual stones required fewer ESWL sessions (1.28 ± 0.55 vs. 1.58 ± 0.64). Stone-free rates were significantly higher Group A (88.9%) compared to Group B (55.6%) (p < 0.01).
  Conclusions: ESWL demonstrated a 1.7-fold higher success rate for post-PCNL residual stones than for primary renal stones of the same size. These findings suggest that ESWL may be a preferred treatment for post-PCNL residual stones, with outcomes less influenced by stone composition and density.

UP-27.02—High-Power vs. Low-Power Holmium Laser Lithotripsy: A Single-Surgeon, Single-Centre Comparative Study on Lower Pole Renal Stones Treatment 

• Gaur Ashwini
  University Hospitals of North Tees and Hartlepool NHS Foundation Trust, Stockton On Tees, United Kingdom

• Introduction and Objectives: Holmium laser lithotripsy is a well-established modality for the treatment of lower pole renal stones. Advancements in laser technology have introduced high-power Holmium lasers, which are proposed to enhance stone fragmentation efficiency and procedural outcomes compared to traditional low-power systems. However, clinical benefits of high-power lasers in lower pole renal stones remain a subject of debate. This study aims to compare the outcomes of high-power versus low-power Holmium laser in the treatment of lower pole renal stones.
  Materials and Methods: Prospectively kept data of all cases done by the author from September 2017 till December 2023 was reviewed retrospectively. 2 groups were created: group A for high power high frequency 100 w pulse modulated laser and group B for Low power low frequency 50 w holmium laser. Laser settings were 1 J and 30–53 Hz and 0.3 J and 53 Hz in group A and 1 J, 12 Hz and 0.4 J and 12 Hz. For all cases digital flexible ureterorenoscope was used.
  Results: In group A, 54 patients had 60 procedures for lower pole renal stones, while, in group B, 42 patients had 45 procedures. Mean age in group A was 55.85 ± 14.45 (21–84) and in group B 57.3 ± 15.8 (27–86). Mean stone size in Group A was 13.01 ± 6.61 and in group B was 13.2 ± 8.8 mm. Time taken was 72.31 ± 37.2 in group A and 78.99 ± 33.83 in group B. 10/54 (18.5%) patients had residual stones in group A, while in group B 15/42 (35.71%) had residual stones. Mean duration of stay was 0.3 ± 0.8 days in group A and in group B 1.1 ± 2.3 days. Duration of stent post op was 17.7 ± 8.3 (3–36) in group A and 15.2 ± 7.9 (0–36) in B. 2/60 (3.3%) in group A had sepsis or temperature post op, and none needed ITU admission, while 3/45 (6.6%) had sepsis in group B of these. 1 patient had 2 episodes and grew E. coli and fungus in urine from kidney twice, and 1 had h/o recurrent UTIs.
  Conclusions: High-power laser lithotripsy improves stone-free rate in comparison to low-power laser for lower-pole renal stones.

UP-27.03—Nephrostomy and DJ Stent in Obstructed Kidneys: A Head-to-Head Comparison 

• Hussain Mushtaq, Shafiq Muhammad Umair, Smith Yuko, Subramonian Kesavapilla
  Queen Elizabeth Hospital, Birmingham, United Kingdom

• Introduction and Objectives: In patients presenting with acute kidney injury (AKI) or septic obstructed kidneys, temporary renal drainage is often required to alleviate symptoms and prevent further damage. Both nephrostomy and ureteric stenting are commonly used techniques. Prolonged waiting times due to NHS pressures may then result a delay to definitive treatment. While existing literature suggests that both procedures yield comparable outcomes in terms of sepsis management, less is known about other clinical outcomes. This audit aims to compare outcomes between nephrostomy and DJ stent placement, focusing on spontaneous stone passage, time to stone clearance, readmission rates, and the need for additional interventions.
  Materials and Methods: This was a retrospective case note study of patients undergoing emergency decompression with either ureteric stent or nephrostomy at our trust in 2024. Data collected included patient demographics, stone characteristics, time to stone clearance, readmissions, and the number and type of subsequent interventions. Patients with incomplete stone episodes were excluded.
  Results: A total of 117 patients were included: 58 underwent nephrostomy, and 59 received ureteric stents. Median age was 57.5 years in the nephrostomy group and 53 years in the stent group. Males comprised 64% and 80% of the nephrostomy and stent groups, respectively. Median maximum stone diameter was 7 mm in both groups. Stone size distribution showed <5 mm stones in 29% of nephrostomy patients and 34% of stented patients. Among stented patients, 100% required ureteroscopy, whereas 34% of nephrostomy patients passed stones spontaneously. In patients with ureteric stones ≤ 5 mm, spontaneous passage occurred in 47% of those treated with nephrostomy. Mean time to stone clearance was shorter in the nephrostomy group (92 vs. 185 days), although readmission rates were higher (2.8 vs. 1.8 times per patient). Among nephrostomy patients, 26% were managed with ESWL and 66% with ureteroscopy, while all stented patients underwent ureteroscopy.
  Conclusions: This audit suggests that nephrostomy, rather than stent insertion, may offer clinical benefits including higher spontaneous stone, reduced need for stone procedures, and faster stone clearance. The significantly higher spontaneous passage rate in patients with ureteric stones ≤ 5 mm suggests that nephrostomy should be preferred in this subgroup.

UP-27.04—A Comparative Randomized Controlled Trial on Conventional Stent Placement vs. No Stent After Uncomplicated URSL for Proximal and Distal Ureteric Calculi < 1 cm 

• Agarwal Varun ¹, Rayani Hará ¹, Chawla Arun ², Hegde Padmaraj ¹, Bhaskara Sunil ²
  ¹ Kasturba Medical College, Manipal, Udupi, India, ² Kasturba Medical College, Udupi, India

• Introduction and Objectives: Patients undergoing URSL with ureteral stents encounter a broad spectrum of lower urinary tract symptoms (LUTSs) that impact their quality of life. This study aims to evaluate patient outcomes following uncomplicated URSL with the omission of stents and investigate its practicality, potentially mitigating stent-related morbidity in patients undergoing URSL.
  Materials and Methods: A single center randomized controlled trial was conducted enrolling patients with ureteric calculi. Ethical committee approval obtained. As per inclusion and exclusion criteria, 78 individuals were recruited and randomized into two groups, Group 1: No stent group; Group 2: Stented group. Uncomplicated URSL was defined by a post-ureteroscopic lesion scale (PULS) of 2 or less and the absence of residual fragments, as verified during endoscopic and fluoroscopic examination. Dysuria and flank pain were recorded using the visual analogue scale (VAS). Lower urinary tract symptoms (LUTS) were evaluated using the IPSS and Quality of Life (QOL) Questionnaire, both preoperatively and at the four-week follow-up. Operative time, analgesic requirement for more than 3 days, unplanned emergency visits, readmissions, and the necessity for secondary procedures were evaluated. Statistical analysis utilized Student’s t-test and Mann-Whitney U test for continuous variables and chi-squared test for categorical data.
  Results: 39 patients studied in each group. Mean (SD) creatinine levels (mg/dL) were 0.89 (0.17) in No Stent group and 0.93 (0.12) in the Stented group (p = 0.317). The mean (SD) stone size (mm) was 6.83 (2.05) for the No Stent group and 7.22 (1.68) for the Stented group (p = 0.356). Mean stone density (HU) was 797 (281) in the No Stent group and 807 (268) in the Stented group (p = 0.885). Stone location distribution in the No Stent group (distal, mid, proximal ureter) was 29, 4, and 6, while, in the Stented group, it was 23, 3, and 13 patients respectively (p = 0.181). At the 4th week follow-up postoperatively, the No Stent group showed significantly lower scores of dysuria (p < 0.001), storage LUTSs (p < 0.001), Total IPSS (p < 0.001), voiding LUTS (p < 0.009) with significantly better Quality of Life (p < 0.001). Five patients in the Stented group required analgesics for more than three days, and three had unplanned visits, with one readmission, compared to none in the No Stent group.
  Conclusions: Omitting stent placement in uncomplicated URSL is associated with significantly improved patient-reported outcomes, without increasing morbidity, complications, or compromising procedural efficacy.

UP-27.05—A Prospective Comparative Study Between Retrograde Intrarenal Surgery vs. Supine Mini Percutaneous Nephrolithotomy for Single Upper Ureteric Stones > 10 Mm 

• Kumar Nitesh ¹, Somani Bhaskar ²
  ¹ Ford Hospital and Research Centre, Patna, India, ² University Hospital, Southampton, United Kingdom

• Introduction and Objectives: To compare retrograde intrarenal surgery (RIRS) and supine mini percutaneous nephroli-thotomy (smPCNL) in the management of upper ureteric stones larger than 10 mm.
  Materials and Methods: Patients with upper ureteric stones (above L4 vertebra transverse process) larger than 10 mm at Ford Hospital and Research Centre between January 2023 and June 2024 were included in the study and were operated with either RIRS (group A) or smPCNL (group B) based on the informed consent and patients’ decision. Patient demographics, stone parameters, intraoperative variables, postoperative outcomes, stone-free rates (SFR), and complications were recorded, and the two groups were compared.
  Results: Over 18 months, 140 patients (70 in each group) were available for comparison. Both the groups were comparable in terms of patient’s demographics and the stone parameters. For RIRS and smPCNL, the mean stone size was 13.87 ± 3.69 and 14.21 ± 3.47 mm (p = 0.329), mean operative duration was 42.52 ± 28.37 and 30.69 ± 18.55 min (p = 0.0001), mean drop in haemoglobin at 24 h was 0.44 ± 0.96 and 0.69 ± 0.92 g/dL (p = 0.364), and postoperative hospital stay was 0.92 ± 0.68 and 1.13 ± 0.76 days, respectively. The SFR (at 3 months post-surgery) was 94.2% for RIRS and 98.57% for smPCNL (p = 0.084), and complications rate (Clavien-Dindo ≥ II) was 2.88% for both groups. Primary access was not possible in 30% of patients in RIRS leading to staged intervention.
  Conclusions: RIRS and smPCNL are safe and effective surgical alternatives for managing upper ureteric stones larger than 10 mm. smPCNL offers a single stage solution and equivalent results with RIRS for the large upper ureteric stones.

UP-27.06—A Two-Step Tract Dilation Technique in Totally Ultrasound-Guided Percutaneous Nephrolithotomy Could Be Used Safely, Avoiding the Exposure to Radiation 

• Gutierrez Tapia David, Pulido Contreras Enrique, Garcia Padilla Miguel, Rios Melgarejo Carlos
  Asociacion Nacional de Urologos Egresados de la Raza, ANUER., León, Guanajuato., Mexico

• Introduction and Objectives: The objective of this study is to assess the safety and effectiveness of the two-step tract dilation technique in totally ultrasound guided percutaneous nephrolithotomy vs. the One-Shot dilation guided with fluoroscopy.
  Materials and Methods: We evaluated the data of 100 patients who had undergone percutaneous nephrolithotomy from February 2019 to January 2023, and divide them into two groups according to the technique used for the tract dilation. The patients that had undergone a totally ultrasound guided two-step tract dilation technique were classified as Group 1, and patients who undergone a fluoroscopy guided One-Shot dilation as Group 2. The 2-step dilation technique has 2 steps. Step 1: Under ultrasound guidance, using an extra stiff wire, we make a 14 FR minitract in order to do an anterograde nephroscopy; prior to the withdrawal of the access sheath, we measure the distance of the skin to calyx tract. Step 2: We use an Amplatz 26 Fr dilator to dilate the tract 1 cm above our skin to calyx distance and put on the access sheath.
  Results: Body mass index (BMI) was greater in group 1 (31.7 vs. 28.7 kg/m²; p = 0.002); so was the stone burden (10,935.69 vs. 5,460.86 mm³; p = 0.006). In group 1 fluoroscopy time was nonexistent (0 vs. 29.4 seg; p < 0.005). Complications in group 1 were present in 13 patients, 12 of them were a Clavien-Dindo 1-2 and 1 Clavien-Dindo 3a: residual ureteral stone that required ureteroscopy. In group 2, complications were present in 7 patients; Clavien-Dindo 1 and 2, there were no complications 3b, 4 or 5 in either group. Supine position was the most used. There was no difference between the hemoglobin decline in both groups. We evaluated the effectiveness of the treatment using a simple CT scan a month after the procedure, having a global stone free rate of 76% (Group 1, 74% vs. Group 2, 78%; p = 0.81).
  Conclusions: The two-step tract dilation technique in totally ultrasound guided percutaneous nephrolithotomy is a technique with an adequate safety profile, avoiding the exposure to radiation, without compromising the stone free rate of the procedure.

UP-27.07—A UK and Ireland Study: Variation in Perioperative Aspirin Management Prior to ESWL 

• Armstrong Aisling, Tyson Matthew, McAuley Laura
  Southern Health and Social Care Trust, Armagh, United Kingdom

• Introduction and Objectives: ESWL is a mainstay treatment modality in urolithiasis due to its minimally invasive nature and relatively low complication rates. Despite this, the EAU suggests that the hazard ratio of perinephric haematomas increases up to 4.2 following ESWL treatment for those on anticoagulant or anti-thrombotic medication. Therefore, EAU consider ESWL high risk for bleeding. Their recent guidelines indicate that the perioperative management of aspirin should be guided by risk stratification and discussions with medical colleagues. Consequently, room is left for interpretation and variation depending on Physician-Urologist preferences. The aim of the study was to understand the current perioperative management of aspirin in patients pending ESWL in the UK and Ireland.
  Materials and Methods: Both fixed and mobile lithotripter sites were contacted n = 45. Questionnaires were completed via email and over the telephone. Responses were collected from 24 units, n = 21 UK and n = 3 Ireland. This yielded a response rate of 53.3% (n = 24).
  Results: Across the 5 regions, 6 different regimens were generally described for patients on 75 mg aspirin, while patient on doses > 75 mg broadly encountered 4 different management regimes.
  Conclusions: In this study of aspirin use in the perioperative management of ESWL in 24 UK and Irish centres, a great disparity between management protocols across the isles was highlighted. These findings demonstrate that, to develop a more homogeneous approach, there is a potential need for a national audit of ESWL complication rates across the different practices identified, aiming to gather an evidence base for the management of aspirin in ESWL.

UP-27.08—Analysis of Postoperative Complications of Percutaneous Nephrolithotomy in Patients with a High Comorbidity Index 

• Montuenga Fernández Isabel, Vázquez Valdés Sonia, Peral Parra Diego, Sánchez Novo Olga, Sánchez Pellejero Alejandro, Golmayo-Muñoz Delgado Eva, Ortiz Vico Francisco Javier, Tamayo Ruiz Juan Carlos
  Hospital Universitario Príncipe de Asturias, Alcalá De Henares, Madrid, Spain

• Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) is the procedure of choice for the treatment of large-volume kidney stones. However, it is not without risk of complications. The objective of this study was to analyze the complications associated with PCNL in patients with a high comorbidity index and to compare them with those observed in patients with a low comorbidity index.
  Materials and Methods: A retrospective analysis was conducted on 152 patients who underwent PCNL between January 2017 and October 2024. The Charlson Comorbidity Index was used to define comorbidity status, allowing classification into two groups: patients with a low comorbidity index (<3—Group 1) and those with a high comorbidity index (≥3—Group 2). Complication rates, types of complications, and their severity (according to the Clavien-Dindo classification) were assessed. Categorical variables were compared using the chi-square test, and quantitative variables were analyzed with the Student’s t-test after assessing distribution with the Kolmogorov-Smirnov test.
  Results: Postoperative complications were observed in 39 patients (26%) following PCNL. The most frequent complications were bleeding (43%) and urinary tract infection (46%). Regarding severity, 33% of complications were classified as Clavien-Dindo grade I and 53% as grade II. In terms of comorbidity, 88 patients (58%) had a Charlson Index < 3, and 64 patients (42%) had an Index ≥ 3. Comparative analysis revealed no statistically significant differences in complication rates (p = 0.508), types of complications (p = 0.090), severity of complications (p = 0.157), postoperative hemoglobin levels (p = 0.359), or length of hospital stay (p = 0.693).
  Conclusions: In our series, percutaneous nephrolithotomy did not result in a higher complication rate in patients with a high comorbidity index and can therefore be considered as safe a procedure as in patients with a lower comorbidity burden.

UP-27.09—Analysis of the Efficacy and Safety of Retrograde Intrarenal Surgery (RIRS) in High-Comorbidity Patients 

• Montuenga Fernández Isabel, Vázquez Valdés Sonia, Peral Parra Diego, Sánchez Novo Olga, Sánchez Pellejero Alejandro, Golmayo-Muñoz Delgado Eva, Ortiz Vico Francisco Javier, Tamayo Ruiz Juan Carlos
  Hospital Universitario Príncipe de Asturias, Alcalá De Henares, Madrid, Spain

• Introduction and Objectives: To evaluate the absence of significant differences in stone-free rate (SFR), residual stone size (RSS), and postoperative complications between high- and low-comorbidity patients undergoing retrograde intrarenal surgery (RIRS) for the treatment of renal and proximal ureteral calculi.
  Materials and Methods: A retrospective observational study was conducted on 277 RIRS procedures performed at our center between January 2017 and December 2023. The sample was stratified into two groups: Group A (low comorbidity, Charlson index < 3) and Group B (high comorbidity, Charlson index ≥ 3). Postoperative complications and residual fragments were assessed via computed tomography at 3 months post-treatment. SFR was defined as the presence of residual fragments <4 mm in maximum diameter. Categorical variables were compared using the chi-square test, while quantitative variables were analyzed using the Student’s t-test or Mann-Whitney U test, depending on their distribution as determined by the Kolmogorov-Smirnov test.
  Results: Out of 277 patients who underwent RIRS, 159 (57.4%) belonged to the low-comorbidity group and 118 (42.6%) to the high-comorbidity group. Initial stone size was comparable between the groups (A: 14.6 ± 6.7 mm vs. B: 15.4 ± 8 mm). The SFR was 52.6% in Group A and 50.8% in Group B (p > 0.05). No significant differences were observed in RSS (A: 4.1 ± 5.9 mm vs. B: 4.3 ± 5.6 mm), stone size reduction (A: 76% vs. B: 72%), or need for reintervention (A: 14.5% vs. B: 9.3%). No complications were reported in 83% of patients. The most common complications were infection (A: 11.9% vs. B: 9.3%) and ureteral injury (A: 11.9% vs. B: 3.4%), with no statistically significant differences between groups (p > 0.05).
  Conclusions: High-comorbidity patients exhibit comparable three-month efficacy and complication rates following RIRS to those observed in patients with lower comorbidity.

UP-27.10—Comparative Analysis of Nephrolithometry Scoring Systems in Predicting Stone-Free Rates After Mini-Percutaneous Nephrolithotomy (Mini-PCNL): A 104-Case Study 

• Ben Saad Hamda, Sakly Aymen, Dimassi Elyes, Khmakhem Yassine, Bahria Ayoub, Sidhom Weal, Zakhama Walid, Binous Yassine
  Taher Sfar Hospital, Mahdia, Tunisia

• Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) is a well-established treatment for renal calculi, while mini-PCNL offers a minimally invasive approach with lower complication rates. Predicting stone-free rates (SFR) post-PCNL is critical for evaluating surgical outcomes. Nephrolithometric scoring systems, including Guy’s score, S.T.O.N.E. score, CROES nomogram, and s-ReSC, are used to predict SFR; however, their comparative predictive accuracy in mini-PCNL remains understudied. Objectives: This study aims to evaluate and compare the predictive performance of four nephrolithometry scoring systems—Guy’s score, S.T.O.N.E. score, CROES nomogram, and s-ReSC—in forecasting stone-free rates following mini-PCNL for patients with renal stones.
  Materials and Methods: A retrospective analysis was conducted on 104 patients who underwent mini-percutaneous nephrolithotomy (mini-PCNL) between January 2022 and July 2024 in the urology department of Tahar Sfar Hospital, Mahdia, Tunisia. Preoperative imaging and intraoperative findings were used to calculate nephrolithometry scores for each patient using four systems: Guy’s score, S.T.O.N.E. score, CROES nomogram, and s-ReSC. Postoperative stone-free rate (SFR) was assessed via non-contrast CT scans at one-month follow-up. Statistical Analysis Receiver operating characteristic (ROC) curve analysis was employed to evaluate the correlation between each scoring system and SFR. Predictive accuracy was determined by calculating the area under the curve (AUC) for each model.
  Results: The mean patient age was 49.1 years, with an average stone size of 28.61 mm and mean Hounsfield unit (HU) density of 902.6. The overall stone-free rate (SFR) was 52.9%. Among 104 patients, Guy’s score classifications were: Guy I (42.9%), Guy II (12.9%), Guy III (15.7%), and Guy IV (28.6%). Stone locations included renal pelvis (20%), lower calyx (22.9%), pelvic stones with caliceal extensions (30%), and staghorn calculi (25.7%). The CROES nomogram demonstrated the strongest correlation with SFR (AUC = 0.726), followed by the S.T.O.N.E. score (AUC = 0.701), s-ReSC score (AUC = 0.692), and Guy’s score (AUC = 0.643). The CROES nomogram also exhibited superior sensitivity and specificity compared to other scoring systems.
  Conclusions: The CROES nomogram most accurately predicted mini-PCNL stone-free rates, outperforming S.T.O.N.E., s-ReSC, and Guy scores. It shows promise as the optimal preoperative tool for patient counseling. Prospective multicenter studies are needed to validate its clinical utility in mini-PCNL outcomes.

UP-27.11—Comparative Outcomes of Mini Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery for Renal Stones (10–20 mm): A Prospective Quasi-Randomized Study 

• Abul Maryam ¹, AlGhurair Ahmad ², Alhelal Saud ³, El-Nahas Ahmed R. ⁴, Aldousari Saad ⁵, Salem Shady ⁶
  ¹ Kuwait Institute for Medical Specializations, Kuwait City, Kuwait, ² Farwaniya Hospital - Urology Unit, Ministry of Health, Kuwait, Kuwait City, Kuwait, ³ Sabah Al-Ahmad Urology Centre, Kuwait, Kuwait City, Kuwait, ⁴ Urology and Nephrology Center, Mansoura University, Egypt Adan Hospital, Ministry of Health, Kuwait, Kuwait City, Kuwait, ⁵ Sabah Al-Ahmad Urology Centre, Kuwait Department of Surgery (urology division), Faculty of Medicine, Kuwait University, Kuwait, Kuwait City, Kuwait, ⁶ Sabah Al-Ahmad Urology Centre, Kuwait Urology Department, Faculty of Medicine, Menofia University, Egypt, Kuwait City, Kuwait

• Introduction and Objectives: According to European Urology Association (EUA) guidelines, both mini-PCNL and flexible ureteroscopy (FURS) are recognized as equivalent alternatives for treating renal stones sized 10–20 mm. This study aims to compare the efficacy and safety of mini-PCNL and FURS in treating renal stones measuring 10–20 mm.
  Materials and Methods: Participants aged over 18 years with renal stones measuring 10–20 mm and eligible for mini-PCNL or FURS were included. Patients were offered both treatment options and made their own decisions regarding the procedure. A total of 82 participants were enrolled, with 40 undergoing FURS and 42 opting for mini-PCNL. The primary outcome measured was the Single Treatment Stone-Free Rate (SFR), assessed through imaging. Secondary outcomes included stent placement, length of hospital stay, blood transfusions, and surgical complications.
  Results: The results indicate no clinically significant differences in age, gender, number of stones, and their locations. Stones in the PCNL group were slightly larger than in the FURS group (14.9 ± 3.5 mm vs. 12.2 ± 1.9 mm) with p-values of 0.0007. Operative times were shorter in FURS (85.5 ± 31 min) than in PCNL (109.5 ± 33 min with p-values of 0.0015). The stone-free rate was comparable, with 35 patients (87.5%) in the FURS group and 37 patients (88.8%) in the PCNL group with p-values of 1, and all patients with residual stones were cleared in second procedure. The need for stenting differed; in the PCNL group, 24 patients (57.14%) required a stent, while, in the FURS group, 32 patients (80%) needed one, with a p-value of 0.034. No patients required transfusion; however, the Hb drop was higher in the PCNL group (0.9 ± 1.3 g/L) vs. (0.4 ± 0.5 g/L) in FURS, with a p-value of 0.002.
  Conclusions: Our study demonstrated that both PCNL and FURS achieved comparable stone-free rates with minimal complications. PCNL was associated with a statistically lower requirement for double-J stenting, suggesting it may be a more favorable option regarding stenting needs while maintaining effective outcomes.

UP-27.12—Comparison of Post-Operative Pain Between Standard Versus Mini-Percutaneous Nephrolithotomy 

• Asif Muhammad, Khan Muhammad
  Lady Reading Hospital, Peshawar, Pakistan

• Introduction and Objectives: Patients experience less postoperative pain in mini percutaneous nephrolithotomy as compared to standard percutaneous nephrolithotomy. Objective of our study is to compare postoperative pain between standard vs. mini percutaneous nephrolithotomy.
  Materials and Methods: A comparative cross-sectional study was conducted at the Urology Department, Lady Reading Hospital, Peshawar, from 9 June 2023 to 9 June 2024. A total of 140 patients with kidney stones (more than 10 mm) were randomly allocated in two groups. Patients of group A were subjected to mini PCNL (22FR tract), while group B was subjected to standard PCNL (30FR tract). Both groups were assessed postoperatively to determine the intensity of pain on Visual Analogue Score (VAS).
  Results: In group A mean age was 36.3 + 8.5 years, and in group B it was 38.9 + 10.1 years (p = 0.096). Males in group A were 57.1% compared to 70% in group B (p = 0.114). 14.5 + 3.7 mm was mean size of stone in group A compared to 15.5 + 3.3 mm in group B (p = 0.071). The mean BMI of group A was 26.3 + 3.5 kg/m² compared to 26.2 + 3.3 kg/m² in group B (p = 0.893). 14.3% in group A were diabetic compared to 17.1% in group B (p = 0.642). 8.6% in group A were hypertensive compared to 11.4% in group B (p = 0.573). 12.9% in group A were smokers compared to 24.3% in group B (p = 0.082). On follow-up, the mean postoperative pain on the visual analogue scale in the mPCNL group was 2.5 + 0.9 compared to 3.1 + 1.1 in the sPCNL group (p < 0.001).
  Conclusions: Mini PCNL is associated with less postoperative pain than standard PCNL. We recommend taking into account the side effects of both procedures; more randomized control trials with larger samples size is to be conducted.

UP-27.13—Comparison of Retrograde Intrarenal Surgery (RIRS) and Percutaneous Nephrolithotomy (PCNL) for Renal Stones Measuring 15–30 mm: Outcome and Safety Analysis 

• Montuenga Fernández Isabel, Vázquez Valdés Sonia, Peral Parra Diego, Sánchez Novo Olga, Sánchez Pellejero Alejandro, Golmayo Muñoz-Delgado Eva, Ortiz Vico Franciso Javier, Tamayo Ruiz Juan Carlos
  Hospital Universitario Príncipe de Asturias, Alcalá De Henares, Madrid, Spain

• Introduction and Objectives: The aim of this study was to compare the outcomes of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in the management of renal stones measuring 15–30 mm, with a particular focus on evaluating whether RIRS can provide comparable outcomes in patients with contraindications or challenges to percutaneous access.
  Materials and Methods: A retrospective analysis was conducted on 207 patients with renal calculi measuring 15–30 mm, treated with either PCNL or RIRS between 2017 and 2024. Patients were stratified into four groups based on stone size and procedure type: Group A: 15–20 mm, RIRS; Group B: 15–20 mm, PCNL; Group C: 20–30 mm, RIRS; Group D: 20–30 mm, PCNL. Comparisons were made between Groups A vs. B and C vs. D in terms of stone-free rate (defined as residual fragments <4 mm), reintervention rate, residual stone size, and complication rate.
  Results: Among the 207 patients, 67 (32%) were in Group A, 50 (24%) in Group B, 43 (21%) in Group C, and 47 (23%) in Group D. Comparison A vs. B: No statistically significant differences were observed in the stone-free rate (A: 52% vs. B: 48%; p = 0.121), reintervention rate (A: 58% vs. B: 42%; p = 0.905), residual stone size (p = 0.223), or complication rate (A: 52% vs. B: 48%; p = 0.488). Comparison C vs. D: Similarly, no significant differences were found in the stone-free rate (C: 49% vs. D: 51%; p = 0.890), reintervention rate (C: 35% vs. D: 65%; p = 0.124), or complication rate (C: 41% vs. D: 59%; p = 0.457). However, PCNL resulted in significantly smaller residual stone sizes in patients with stones measuring 20–30 mm (p = 0.039).
  Conclusions: In our series, RIRS and PCNL demonstrated comparable outcomes in terms of stone-free rate and complication rate for renal stones measuring 15–30 mm. PCNL showed a significant advantage in reducing residual stone size in cases with larger stone burden (>20 mm), suggesting it may be a preferable option in this subgroup of patients.

UP-27.14—Comparison of Stone-Free Rate and Surgical Outcomes Between Non-Pre-Stented and Pre-Stented Patients Undergoing Retrograde Intrarenal Surgery (RIRS) for Renal Stones: A Randomised, Open-Label, Non-Inferior Controlled Trial 

• Sharma Amit, Alam Parvez
  All India Institute of Medical Sciences, Raipur, CG, India, Raipur, CG, India

• Introduction and Objectives: We present a study comparing the outcomes of patients with renal stone(s) < 20 mm undergoing RIRS without pre-stenting and pre-stenting 2 weeks before RIRS.
  Materials and Methods: This Randomised, Open Label, Non-inferior Control Trial was done in the Urology Department of a tertiary care institute from April 2023 to February 2025 after clearance from Ethics Committee and included patients with renal stone(s), single or multiple of size less than 20 mm who underwent RIRS. CONSORT guidelines were followed. The calculated sample size was 240 patients who were randomly assigned (block randomization) into two groups: Group 1 underwent RIRS without pre-stenting, and, in Group 2 patients, a stent was placed under C-arm guidance two weeks prior to RIRS. The data was compiled and analysed to compare SFR (stone-free rate), operative time, surgical complications, and hospital stay between the 2 groups using Microsoft Excel (IBM SPSS Statistics version 26.0).
  Results: There were 240 patients with 120 in each group. Both groups were well-matched in terms of demographic and stone-related characteristics. The SFR was significantly better in the stented group (82.5% vs. 65.5%; p = 0.003). Placement of UAS was slightly easier in the stented group (80%), though not statistically significant (p = 0.132). The average operative time was 50 min in the non-stented group and 46.5 min in the stented group, though not statistically significant (p = 0.154). The average hospital stay was similar for both groups; the non pre-stented group had more prevalence of fever (20%). On univariate analysis, males had considerably higher odds of stone clearance compared to females (OR, 1.965) but not statistically significant (p = 0.053). Stones in the pelvis were found to have better stone clearance (OR, 2.336; 95% CI, 0.980–5.568; p = 0.055).
  Conclusions: Preoperative stenting improves UAS placement success rates and SFRs while reducing complications such as postoperative fever. However, it is also associated with irritative urinary symptoms. These findings support the selective use of preoperative DJ stenting in RIRS to optimize surgical outcomes while minimizing patient discomfort.

UP-27.15—Comparison of the Effectiveness of Minimally Invasive Approaches to the Treatment of Nephrolithiasis 

• Samchuk Pavlo, Reznikov Hennadii, Krasiuk Oleksii
  Bogomolets National Medical University, Kyiv, Ukraine

• Introduction and Objectives: We have analyzed the effectiveness of minimally invasive methods (ESWL, FURS, mini PCNL) for the surgical treatment of 997 patients with renal calculi.
  Materials and Methods: Depending on the method of intervention, patients were divided into groups: Group I (n = 318 (31.9%))—patients treated with ESWL; Group II (n = 557 (55.9%))—patients treated with the FURS method; Group III (n = 122 (12.2%))—patients treated with the mini PCNL method. Patients of group I were divided into subgroups: group I-A included 107 patients (10.7%)—the density of calculi did not exceed 1000 HU, group I-B included 211 patients (10.7%)—the density of calculi was more than 1000 HU.
  Results: In patients with calculus sizes of 7–11 mm, the lowest complication rate (5.6 + 2.2%) was observed during ESWL in patients of group I-A. In patients of group II, the complication rate was slightly higher and amounted to 7.0 + 1.1% (p ≥ 0.05). The highest incidence of complications in patients with calculus size up to 11 mm developed at a density above 1000 HU (group I-B) and ESWL. In patients with calculus sizes of 12–17 mm who underwent ESWL, a high incidence of complications was found, regardless of density. At a calculus density of <1000 HU, complications developed in 40.7 + 4.8% of patients and at a density of ˃1000 HU in 59.7 + 3.4% (p ≤ 0.05). In patients undergoing FURS with calculus sizes of 12–17 mm, the incidence of complications was 11.5 + 1.3% (≤0.05). Patients with stone sizes of 12–17 mm who underwent mini PCNL had a significantly lower incidence of complications (2.5 + 1.4%) compared to all other treatment methods.
  Conclusions: The lowest complication rate (5.6%) was observed during ESWL in the presence of calculi 7–11 mm in size with a density of up to 1000 HU, which makes it the method of choice in this category of patients. In patients with a stone size of 12–17 mm, FURS and mini PCNL had a significantly lower percentage of complications and were more effective. Mini PCNL can be considered as a universal method for the treatment of all types of kidney stones, given the low rate of complications and high efficiency.

UP-27.16—Comparative Study of Efficacy of TFL Lithotripsy in Dusting Mode vs. Fragmentation Mode for Ureteric Stones: A Randomised Controlled Single Centre Trial 

• Desai Viraj, Singh Abhishek, Shah Aruj
  Muljhibhai Patel Urological Hospital, Nadiad, India

• Introduction and Objectives: Both dusting and fragmentation with extraction approaches to ureteroscopic stone treatment are effective. In the Ho:YAG milieu, ‘dusting’ has been associated with shorter procedure time, reduced risk of ureteral trauma, and use of fewer consumable devices, but it may not be effective for all stone compositions and risks retained stone material. ‘Fragmentation’ has superior immediate stone free rates, and fragments can be sent for stone analysis but is technically more intensive. The study aims to compare the two methods in TFL lithotripsy.
  Materials and Methods: A single-center prospective RCT of 80 adult patients with single ureteric calculus (<1.5 cm). Stone characteristics were calculated using pre-operative CT IVP/ KUB. Patients underwent semirigid ureteroscopy (7.5 Fr) with Urolase-SP 35 Watt TFL lithotripsy. Patients were equally randomized using a computer generated software to fragmentation or dusting modes. Postoperatively CT KUB was performed at 1 month.
  Results: The two arms were comparable for baseline characteristics. Energy utilized per unit volume of stone (laser efficacy in J/mm³) was significantly higher in fragmentation mode (p = 0.021). Ablation speed (mm³/s) was also much faster in fragmentation mode (p = 0.016).
  Conclusions: For the given fixed settings of 10 W in TFL, fragmentation achieves faster ablation rate and better laser efficacy while maintaining a comparable stone free rate.

UP-27.17—Dance of the Clearpetra (Tm)-Flexible and Navigable Suction Ureteric Access Sheath Improves Stone-Free Rates 

• Humayun-Zakaria Nada, Gaballa Nader, Padmanaban Hrishikesh, Devarajan Raghu
  University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom

• Introduction and Objectives: Technological advancements in the use of LASERs for endoluminal endourology have facilitated stone fragmentation and ‘dusting’. Additionally, flexible and navigable suction (FANS) ureteric access sheaths (UAS) represent a significant breakthrough in retrograde intrarenal surgery, providing enhanced manoeuvrability and effective stone fragmentation and removal/clearance during flexible ureteroscopy (fURS).
  Materials and Methods: We retrospectively analysed data of 113 patients that underwent fURS for upper ureteric ± intrarenal stone from February 2024 to March 2025. In this video, we demonstrate the effective use of the 10 Fr/40 cm Clearpetra TM UAS suction capability to extract fragments. We show single person capability (with no assistance) using simultaneous irrigation and suctioning of fragments “dancing” to the withdrawal of ureteroscope to facilitate catching in the container.
  Results: The mean stone size was 10.4 mm (±SD: 5.16) with the most common site as lower renal calyx (n = 47) with left to right ratio of 1.9:1. JJ ureteric stents (with strings attached) were placed in 74% cases (following self-removal in 4–5 days), with 11% undergoing flexi-guided removal and the remainder with no stent. Patients had a follow up period of 3–6 months with CT scan imaging to check residual stone. No follow up was arranged if stone clearance was considered optimal intraoperatively. 2 patients were booked for PCNL due to large pelvicalyceal stone size and incomplete clearance.
  Conclusions: These findings suggest that FANS-UAS enhances surgical outcomes by offering higher stone-free rates, reduced operation times, and improved safety profile. The ability to single-handedly control inflow irrigation while providing efficient suctioning positions FANS-UAS as a promising technique in the evolving landscape of endourological procedures.

UP-27.18—Development of a Machine Learning Model to Predict Treatment Success of Kidney Stones Using Flexible Ureterorenoscopy 

• Ben Saad Hamda, Sakly Aymen, Bahria Ayoub, Khmakhem Yassine, Sidhom Weal, Zakhama Walid, Binous Yassine
  Taher Sfar Hospital, Mahdia, Tunisia

• Introduction and Objectives: Flexible ureterorenoscopy (URS) is a safe, effective kidney stone treatment. Outcomes depend on patient- and stone-specific factors. Machine learning (ML) enhances clinical decision-making through predictive models, improving procedural success forecasting. Advances in URS tools and ML integration optimize treatment planning and accuracy. Objectives: Development and comparative analysis of machine learning algorithms as interpretable tools for predicting outcomes of kidney stone treatment via flexible ureterorenoscopy.
  Materials and Methods: This cohort study analyzed 203 patients, evaluating variables including age, sex, BMI, comorbidities (renal insufficiency, hypertension, diabetes), and stone characteristics (size, location). Five supervised machine learning algorithms—Random Forest, AdaBoost, K-Nearest Neighbors (KNN), Stochastic Gradient Descent (SGD), and Support Vector Machine (SVM)—were trained to predict procedural success (binary classification: stone-free vs. residual stones). The dataset was divided into 80% training and 20% testing subsets for validation. Hyperparameter tuning was performed via GridSearchCV to optimize model performance. Predictive accuracy was assessed using Python’s Scikit-learn library, with metrics including precision, recall, F1-score, accuracy, and AUC (area under the curve). The models aimed to identify factors influencing treatment outcomes in flexible ureterorenoscopy.
  Results: The study cohort comprised 203 patients, with a mean age of 51 years. The success rate following flexible ureterorenoscopy (URS) was 77.3% (157 patients), defined as complete stone clearance. The mean stone length and width were 17.8 ± 8.2 mm and 13.2 ± 6.2 mm, respectively, with an average Hounsfield unit (HU) density of 888.3 ± 379. The machine learning models demonstrated the following prediction accuracies for stone-free status: Random Forest (76%), AdaBoost (73%), SVM (73%), K-Nearest Neighbors (KNN, 76%), and SGD Classifier (72%). The Random Forest model exhibited robust performance, accurately predicting stone-free outcomes for all patients without residual fragments. It achieved the highest F1-score (86%), a harmonic mean of precision and recall, closely followed by the SVM model. Additionally, the highest sensitivity (true positive rate) was observed with the Random Forest, SVM, and KNN algorithms.
  Conclusions: Machine learning models aid clinicians in optimizing kidney stone treatment via flexible ureteroscopy. Integrated with deep learning, these models enhance outcome prediction accuracy, enabling early detection, refined prognostics, and novel treatment/prevention strategies.

UP-27.19—ECIRS: Five Core Framework to Standardise and Enhance Procedural Outcome 

• Alagappan Kumarappan ¹, Yiie Huern Seo ², Yeon Wee Ooi ³, Yeap KW Eugene ¹, Ragupathy Yovendran ¹, Nagarajan Threttiben ¹, Tan KW Kaven ¹, Manoharan Devindran ⁴
  ¹ Penang General Hospital, Klang, Malaysia, ² Hospital Kuala Lumpur, Kuala Lumpur, Malaysia, ³ Hospital Sultanah Bahiyah, Alor Setar, Malaysia, ⁴ Island Hospital, Penang, Malaysia

• Introduction and Objectives: ECIRS has evolved as an effective technique combining supine PCNL and flexible URS, offering potential advantages over conventional prone PCNL. Despite its benefits, it lacks a standardised approach. We propose a 5 core strategy to standardise ECIRS practice as demonstrated in this video.
  Materials and Methods: As per imaging standard in ECIRS, CT with excretory phase to assess the symmetry of excretion, filling defects, calyceal selection for puncture, line of axis for stone access. Secondly, marking the posterior axillary line with the patient in standing position at the ward. This precaution is essential to avoid inadvertent colon injury. Thirdly optimization of positioning is crucial for effective imaging and procedural flow. Modified Valdivia-Galdakao position combining supine positioning with a slight tilt and securing the arms across the body provides optimal access while preventing artifacts from the metal bed edge that can obscure the renal anatomy and impede fluoroscopic clarity. Fourthly, a rendezvous approach, merging access from supine PCNL and flexible URS to achieve a secure guidewire passage. Retrograde access is established to opacify the pelvicalyceal system, followed by guidewire and flexible ureteroscope. Upon puncture, needle entry is confirmed, and the guidewire is retrieved to facilitate tract dilation. Simultaneous antegrade and retrograde approaches enhance the accuracy of calyceal access, reducing operative time and minimizing the risk of perforation, higher stone-free rates. Finally appropriate safety measures is essential to ensure optimal healing, minimize complications, and maintain unobstructed urine flow. Placement of a ureteric stent or a malecot catheter is an option as it helps prevent ureteral obstruction due to edema or residual fragments, facilitates drainage, and reduces the risk of postoperative infection. In selected cases with minimal trauma and complete stone clearance, a totally tubeless approach may be appropriate.
  Results: This video outlines the comprehensive 5 core framework that enhances visualisation, access, stone clearance while minimising complications. We have performed 21 cases in our centre using this approach from 2023 through 2024, and the results will be published imminently.
  Conclusions: Utilising the mnemonics ECIRS (Excretory, Colon, Imaging, Rendezvous, Safety) offers a structured, evidence-based method to maximize the efficacy and safety to improve outcomes in complex endourologic stone management.

UP-27.20—Efficacy and Safety of Thulium Laser Lithotripsy in Impacted Ureteric Stones and the Necessity of Ureteric Stenting: Prospective Randomized Trial 

• Rammah Ahmed ¹, Essam Mohamed ², Lotfy Mohamed ¹, Saad Ismail ¹, Kasem Ayman ¹
  ¹ Kasr Alainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt, Arab Rep., ² 6th October University, Cairo, Egypt, Arab Rep.

• Introduction and Objectives: Flexible ureteroscopy and laser lithotripsy (FURL) is an effective management for impacted ureteric stones with high stone free rate. The safety of thulium laser lithotripsy in impacted ureteric stones has no consensus. Traditionally, for impacted ureteral stones, a ureteral stent is inserted for a while until proper ureteral healing is anticipated. A more acceptable theory is that ureteral healing relies mainly on the inflammatory response inside the ureteral wall and the fibrosis during stone impaction. The stent has nothing to add if the latter was de-facto organized. Therefore, we aimed to evaluate the safety of flexible ureteroscopy and thulium laser lithotripsy for impacted ureteric stones and the necessity of ureteric stenting in such cases.
  Materials and Methods: The patients with impacted ureteric stones managed with flexible ureteroscopy and thulium laser were randomized into two groups (stented vs. non-stented). Definition of ureteral impaction: the stone is with mucosal adhesions and associated with hydronephrosis. The need for ureteral stenting will be assessed through the cases in the non stented group that would need an auxiliary jj stenting procedure during follow up. Kidney ultrasound was done for the non stented group after one week of the procedure or in case of emergence of ipsilateral loin pain then again at three months and six months after surgery for both groups. CTUT scan after 4 weeks for assessing ipsilateral hydronephrosis and stone free rate (SFR) was documented.
  Results: 55 patients with impacted ureteric stones were included in the study with mean age 47.02 ± 7.32 years. Mean stone size was 1.1 ± 0.25 cm. Mean stone density was 873.3 ± 117.45 HU. All patients were managed with FURL after randomization into to stented (29 patients) vs. non-stented (26 patients) groups. Both groups showed no significant differences as regard stone size, site, operative time, lasing time, laser power and SFR. 2 patients in non-stented group needed stenting during follow up due to hydronephrosis and fever. At the end of 6 months follow up, no patient in both groups documented ureteric stricture.
  Conclusions: FURL is safe treatment for impacted ureteric stones. Routine ureteric stenting in such cases needs to be reviewed.

UP-27.21—Endoscopic Combined Intrarenal Surgery as Primary Treatment in a Patient with Staghorn Stone 

• Saldivar Alberto, Perez Soriano Alan, Toledo Diaz Mario, Arguelles Morales Genaro, Delgado Corral Aaron, Martinez Correa Adrian, Vieyra Valdez Omar, Santiago Ruben, Perez Becerra Rodrigo, Osornio Sanchez Victor, Trujillo Ortiz Luis, Garza Sainz Gerardo, Gomez Brenda
  Hospital Regional de Alta Especialidad de Ixtapaluca, México, Mexico

• Introduction and Objectives: Endoscopic Combined Intrarenal Surgery (ECIRS) is a standardized and versatile technique that integrates retrograde and antegrade approaches for managing complex renal lithiasis. This one-step treatment ensures high stone-free rates while maintaining a low incidence of complications, offering significant advantages over traditional methods. Objective: This study aims to demonstrate the safety, efficacy, and technical nuances of ECIRS in treating complex urolithiasis. The video highlights procedural tips and benefits that optimize outcomes and minimize complications.
  Materials and Methods: A 54-year-old female with a history of diabetes mellitus and hypertension presented with right renoureteral colic. Imaging studies revealed a 12 × 10 mm obstructive ureteral stone and a complex staghorn stone (37 × 12 × 38 mm, 1124 HU) in the left kidney. Initial management included a semi-rigid ureteroscopy for the ureteral stone. Subsequently, ECIRS was performed using a modified Valdivia-Galdakao position. Two surgical teams operated simultaneously: one team conducted retrograde laser lithotripsy using a flexible ureteroscope, while the other achieved percutaneous access to the lower calyx under ultrasound and fluoroscopic guidance. Balloon dilation (26 Fr) allowed for effective pneumatic and laser lithotripsy. Complete stone clearance was confirmed intraoperatively. A double J stent was placed without nephrostomy.
  Results: The patient was discharged within 24 h without complications. Postoperative CT imaging confirmed the absence of residual stones, achieving a 100% stone-free status. The metabolic profile revealed hypocitraturia managed with oral potassium citrate therapy.
  Conclusions: ECIRS is a safe, effective, and reproducible technique that achieves high stone-free rates (approximately 97%) in a single session. Its success lies in the combined retrograde and antegrade approaches, simultaneous use of dual lithotripsy technologies, and reduced operative times. This case underscores the utility of ECIRS in managing complex urolithiasis with minimal morbidity.

UP-27.22—Enhancing Precision and Safety in Challenging Upper Pole Punctures for PCNL: A Prospective Analysis of the Valsalva Maneuver 

• Memon Imran ¹, Jatt Javed Altaf ², Jatoi Tamoor Ahmed ², Memon Waqar Ahmed ², Arain Ahsan ²
  ¹ Liaquat University of Medical & Health Sciences Jamshoro, Hyderabad, Pakistan, ² Liaquat University of Medical & Health Sciences, Hyderabad, Pakistan

• Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) has long been the preferred procedure for treating big kidney stones. However, gaining access to the upper pole calyx during PCNL can be particularly difficult, raising the risk of complications such as pleural injury or hemorrhage while also lengthening the surgery. This study investigates the possibility of using the Valsalva maneuver—a technique routinely used to control intrathoracic pressure—to improve the accuracy and safety of upper pole punctures in these difficult situations.
  Materials and Methods: The prospective study comprised 300 patients who had PCNL with upper pole access between 2021 and 2024. These patients were separated into two groups: Group A (150 patients), who employed the Valsalva maneuver during the puncture phase, and Group B (150 patients), who used the usual puncture procedure. We assessed numerous clinical outcomes, including puncture accuracy, access time, total procedure duration, radiation exposure (measured by fluoroscopy time), and any intraoperative or postoperative problems, hemoglobin levels before and after surgery to determine blood loss, hospital stay length, and stone removal success.
  Results: Group A had a greater rate of successful puncture accuracy (92% vs. 78% in Group B). In Group A, the time necessary to get access to the higher pole was reduced by around 25%, making the process faster. There were significantly fewer problems in this group, with pleural injuries occurring in only 3% of cases, as opposed to 12% in Group B. Importantly, patients in Group A were exposed to less radiation, and the entire operational time was lowered. Blood loss was lower in Group A, and these patients recovered faster, as demonstrated by shorter hospital stays and fewer postoperative problems like pneumothorax or infections. In terms of stone clearance, both groups had identical success rates, with Group A patients recovering faster and having fewer remaining stones.
  Conclusions: This study suggests that the Valsalva maneuver can significantly enhance both the safety and precision of upper pole punctures in PCNL, particularly in challenging cases. By improving access time, reducing the risk of complications, and promoting faster recovery, this simple yet effective technique may prove to be a valuable addition to standard PCNL procedures.

UP-27.23—Evolution of RIRS Implementation for Stone Treatment at Hupa: Six-Year Outcomes 

• Montuenga Fernández Isabel, Vázquez Valdés Sonia, Peral Parra Diego, Sánchez Novo Olga, Sánchez Pellejero Alejandro, Golmayo-Muñoz Delgado Eva, Ortiz Vico Francisco Javier, Tamayo Ruiz Juan Carlos
  Hospital Universitario Príncipe de Asturias, Alcalá De Henares, Madrid, Spain

• Introduction and Objectives: To evaluate the outcomes of retrograde intrarenal surgery (RIRS) for the treatment of renal and proximal ureteral calculi following its introduction in 2017. The effectiveness of the technique was assessed in terms of stone-free rate (SFR), residual stone size (RSS), and stone size reduction (SSR), as well as the complication rate.
  Materials and Methods: A retrospective observational study was conducted on 277 RIRS procedures performed between January 2017 and December 2023. The sample was stratified into three groups: Group A (first 92 patients), Group B (next 92 patients), and Group C (last 93 patients). At three months postoperatively, all patients underwent CT imaging to assess RSS, SFR, and SSR. SFR was defined as the presence of residual fragments <4 mm in maximum diameter. Categorical variables were compared using the chi-square test, and quantitative variables were analyzed using ANOVA or the Kruskal-Wallis test, depending on the distribution assessed via the Kolmogorov-Smirnov test.
  Results: Data from 277 patients who underwent RIRS were analyzed; their preoperative characteristics are summarized in Table 1. Statistically significant differences were found in postoperative complication rates (A: 28.3%, B: 14.1%, and C: 8.6%; p = 0.001). No significant differences were observed in RSS (A: 4.18 ± 5.93 mm vs. B: 3.09 ± 4.8 mm vs. C: 4.56 ± 6.2 mm), SFR (A: 55.4% vs. B: 43.5% vs. C: 43%), or SSR (A: 72% vs. B: 80% vs. C: 72%).
  Conclusions: The implementation of RIRS for stone treatment at our center has proven to be a safe technique, with a significantly decreasing complication rate over time. It has also demonstrated effectiveness, with a trend toward improved SFR and greater stone size reduction, although these findings were not statistically significant.

UP-27.24—Factors Predicting Hospital Revisit and Readmission Within 2 Weeks Following Percutaneous Nephrolithotomy—A Prospective Observational Study 

• Tinaikar Aishwarya, Chawla Arun, Hegde Padmaraj, Pillai Bhaskara Sunil, Gunashekhar Vijay
  Kasturba Hospital Manipal, MAHE University, Manipal, India

• Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) is the standard of treatment for renal stones 2 cm and above with higher stone clearance and less complication. The reported incidence of revisit and readmission rates following PCNL is around 10% according to retrospective analysis. The primary objective of this study was to assess the revisit rates and readmission rates within 14 days following PCNL and to analyse the factors associated with it prospectively.
  Materials and Methods: The prospective study was conducted in a university teaching hospital and enrolled 431 consecutive patients undergoing PCNL for renal calculi. Patient factors, stone factors (stone score), and intra-operative data were recorded. On discharge patients were explained and counselled about common symptoms related to stent and procedure. All patients revisiting urology OPD/emergency and getting readmitted within 14 days after discharge were studied. A descriptive and univariate analysis was done using SPSS v23 (IBM Corp.) software. Statistical significance calculated using Student’s t-test and chi-squared test.
  Results: Of the 431 patients, the revisit rate was 6.3% and readmission rate of 5.3%. Infective and bleeding complication were predominant diagnosis among revisited and readmitted. Out of 23 patients readmitted 21 patients had Clavien Dindo score of 2 and above. Four out of 23 patients underwent angioembolization. Factors such as post operative complication with Clavien Dindo 2 and above and blood transfusion were significantly associated with revisit and readmission. ASA grade > 3 (p = <0.002), Charlson comorbidity Index > 2 (p = 0.004) was statistically significant for readmission. Recent history of urosepsis (29%) (p = 0.006), low haemoglobin: 11.86 ± 2.18 (p = 0.002), stone volume: 3993 ± 4784 (p = 0.004), complex stone (S.T.O.N.E score > 7), prolonged operative time: 85.48 ± 32.31 (p = 0.003) were significantly associated for complications.
  Conclusions: Higher Charlson comorbidity index, ASA III, large complex kidney stone, longer operative time, and post-operative bleeding complications with blood transfusion predicted revisit and rehospitalization. Infective and haemorrhagic complication was most common cause for both revisit and readmission. Clinicians must recognize these high-risk factors early in course of treatment and counsel patients accordingly.

UP-27.25—Factors Predicting the Successful Deployment of 9.5/11.5 Fr Ureteral Access Sheath (UAS) in RIRS 

• Shah Chaitya, Paharwar Vivek, Nathani Akshay, Singh Abhishek, Ganpule Arvind, Batra Rohan, Patil Abhijit, Sabnis Ravindra, Desai Mahesh
  MPUH, Nadiad, Nadiad, India

• Introduction and Objectives: The ureteral access sheath (UAS) is widely used in patients undergoing Retrograde Intra-renal surgery (RIRS) to facilitate multiple re-entries, increase visibility, and reduce operative time. However, failure rates of ureteroscopy due to a difficult, impassable ureter range from 8% to 10%, and approximately 22% of patients fail to insert a standard UAS. This study looked into the CT based predictive factors for the successful deployment of the 9.5/11.5 French (F) UAS during the retrograde intrarenal surgery (RIRS).
  Materials and Methods: We examined the clinical information from 339 flexible ureteroscopy patients. A number of computed tomography (CT)-based measurements, such as ureteral thickness, ureteral diameter, presence of ureteritis, and contrast excretion, were studied. Additionally, information on the patient and stone characteristics were gathered. Using SPSS software, the factors predicting the failure of the UAS placement were noted and verified.
  Results: From 339 patients included in this study, 47 patients (13.86%) failed to pass through the UAS. Rest 292 patients underwent RIRS in a single sitting following successful placement of UAS. We identified 3 factors that showed statistical significance in predicting the deployment of the 9.5/11.5 Fr UAS deployment. One was the lower border ureteral diameter (p-value of 0.038) and the other two factors being lower ureteral wall thickness (p-value of 0.037) and presence of ureteritis (p-value of 0.043). The other factors that were analysed included upper ureteral thickness and diameter, the location and the density of the stone, presence of perinephric fat stranding, and manner of contrast excretion.
  Conclusions: We think that our research paves the way for a prospective trial that is multicentric. To appropriately advise patients preoperatively about the number of procedures they might require and to avoid the financial loss associated with a failed UAS insertion, it is imperative to identify the factors leading to a failed primary RIRS and UAS insertion.

UP-27.26—Flexible and Navigable Suction Ureteral Access Sheath (FANS) Versus Suction Mini-PCNL in Children: A Comparative Analysis 

• Yuen Steffi ¹, Lim Ee Jean ², Fong Khi Yung ², Kalathia Jaisukh ³, Somani Bhaskar ⁴, Herrmann Thomas ⁵, Castellani Daniele ⁶, Gauhar Vineet ⁷
  ¹ S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China, Hong Kong, China, ² Department of Urology, Singapore General Hospital, Singapore, Singapore, Singapore, ³ Fortune Urology Clinic, Botad, Gujarat, India, Gujarat, India, ⁴ Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK, Southampton, United Kingdom, ⁵ Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland, Frauenfeld, Switzerland, ⁶ Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Italy., Ancona, Italy, ⁷ Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore, Singapore

• Introduction and Objectives: Pediatric kidney stone disease poses unique challenges due to smaller anatomical structures and the need to minimize morbidity. This study compares the efficacy and safety of RIRS with Flexible and Navigable Suction Ureteral Access Sheath (FANS) and Suction Mini-Percutaneous Nephrolithotomy (SM-PCNL) in children with renal stones ≤ 2 cm, focusing on stone-free rates (SFR), operative efficiency, and perioperative outcomes. Pediatric kidney stone disease poses unique challenges due to smaller anatomical structures and the need to minimize morbidity. This study compares the efficacy and safety of RIRS with FANS and SM-PCNL in children with renal stones ≤ 2 cm, focusing on SFR, operative efficiency, and perioperative outcomes.
  Materials and Methods: A prospective, multicenter study analyzed 96 pediatric patients (50 FANS, 46 SM-PCNL) from eight centers. Inclusion criteria were age ≤ 16 years, normal renal anatomy, and stone burden ≤ 2 cm. Outcomes included SFR (assessed via 30-day non-contrast CT scan), operative time, complications, and hospital stay. Two multivariable regression analyses were performed to identify predictors of SFR and overall complications.
  Results: RIRS with FANS demonstrated comparable SFR to SM-PCNL (66.0% vs. 58.7% for zero fragments) but with shorter operative times (42.5 vs. 82.5 min, p = 0.025) and hospital stays (2 vs. 3 days, p < 0.001). FANS was preferred for multiple stones (28% vs. 0%, p = 0.005). Complication rates were similar (12.0% vs. 8.7%, p = 0.845). Limitations include a small sample size, non-randomized design, and short follow-up.
  Conclusions: RIRS with FANS and SM-PCNL are effective for pediatric urolithiasis up to 2 cm, with FANS offering advantages in complex stone anatomy and reduced operative time. Surgeon expertise and patient-specific factors should guide technique selection. Further larger randomized trials are needed to validate these findings and refine indications.

UP-27.27—Holmium MOSES Laser Versus Thulium Fiber Laser for Ureteroscopic Management of 1–2 cm Kidney Stones: A Prospective Randomized Controlled Trial 

• Elmansy Hazem ¹, Mousa Ahmed ¹, Blahitko Oksana ¹, Tablowski Thomas ¹, Berjaoui Mohamad B. ², Khan Nawsheen ¹, Hodhod Amr ³, Alaradi Husain ¹, Alotaibi Khaled ¹, Abdul Hadi Ruba ¹, Zakaria Ahmed S. ¹, Alhelal Saud ¹
  ¹ Northern Ontario School of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada, ² University of Toronto, Toronto, ON, Canada, ³ King Abdulaziz Medical City, National Guard Hospital Affairs, Riyadh, Saudi Arabia

• Introduction and Objectives: We aimed to compare the laser efficiency and clinical outcomes of two widely used systems—the holmium MOSESTM laser and the thulium fiber laser (TFL)—in the ureteroscopic management of 1–2 cm renal calculi.
  Materials and Methods: In this ongoing randomized controlled trial (RCT), we included 71 patients who underwent flexible ureteroscopy (f-URS) for a solitary 1–2 cm kidney stone between August 2022 and July 2024 at our institution. Patients were randomized to undergo treatment with either the holmium MOSES™ laser or TFL. All patients had postoperative computed tomography (CT) scans at 1 month and 3 months. Patient demographics and stone parameters were recorded, including stone site, size, volume, and density. Intraoperative data were collected and analyzed, including total operative time, ureteroscopy time, lasing time, total energy delivered, and stone composition. We recorded the presence of residual stones and the percentage of stone volume reduction. Ablation efficiency was calculated by dividing the energy utilized (J) by the stone volume (mm³). The ablation speed was calculated by dividing the stone volume (mm³) by the lasing time (s). Patients with a stone size of 0 cm were deemed stone-free.
  Results: The MOSESTM and TFL groups comprised 35 and 36 patients, respectively, with no significant differences in baseline patient demographics or stone characteristics between the cohorts. The two modalities had comparable total energy, laser time, efficacy, and ablation speeds. Ablation efficiency was 25.7 J/mm³ in the MOSESTM group and 30 J/mm³ in the TFL group (p = 0.98). Additionally, ablation speed was 1.1 mm³/s in the MOSESTM group and 0.89 mm³/s in the TFL group (p = 0.26). No differences were observed in stone-free or retreatment rates.
  Conclusions: The MOSESTM and TFL laser systems demonstrate comparable efficacy for lithotripsy of renal calculi during f-URS, with neither technology showing a distinct clinical advantage.

UP-27.28—Holmium:YAG vs. Thulium Fiber Laser in Retrograde Intrarenal Surgery: A Retrospective Comparative Study of Efficacy and Safety 

• Trefiletti Giuseppe ¹, Maugeri Orazio ¹, Di Grazia Eugenio ², Malacasa Alessandro ¹, Brischetto Sergio ³, Lucchesi Federico ¹, Lo Giudice Antonio ¹, Cimino Sebastiano Diego ¹
  ¹ Azienda Ospedaliero-Universitaria “G.Rodolico-San Marco”, Catania, Italy, ² Casa di Cura Villa Azzurra, Siracusa, Italy, ³ Ospedale Umberto I, Siracusa, Italy

• Introduction and Objectives: Laser technology plays a pivotal role in retrograde intrarenal surgery (RIRS). While Holmium:YAG (Ho:YAG) remains the gold standard, the thulium fiber laser (TFL) has emerged as a promising alternative. This study aims to compare the clinical outcomes, efficiency, and safety of Ho:YAG versus TFL in RIRS for solitary renal stones measuring 15–25 mm.
  Materials and Methods: A two-centers retrospective observational study was conducted on 38 patients who underwent RIRS between January 2023 and December 2023. Patients were divided into two groups based on the laser used: Ho:YAG (n = 20) and TFL (n = 18). Baseline characteristics, stone features, and renal function parameters were comparable between groups. Primary endpoints included stone-free rate (fragment smaller than 4 mm—SFR) and operative time (min). Secondary outcomes were laser-on time (min), ablation speed (mm³/min), ablation efficiency (J/mm³), total energy delivered (kJ), intra-/postoperative complications, and re-intervention rate. Stone clearance was assessed at 1 month using NCCT.
  Results: Our results show as: Laser-on time was significantly shorter with Ho:YAG (11.7 vs. 19.5 min, p = 0.008). Furthermore Ho:YAG also demonstrated higher ablation speed (3.9 vs. 1.6 mm³/min, p < 0.001) and better ablation efficiency (5.95 vs. 11 J/mm³, p = 0.001) compared to TFL. Total energy delivered was higher in the TFL group (20.5 vs. 13.9 kJ) with respect to Ho:YAG group, although it was not statistically significant. SFR was 85% in the Ho:YAG group and 86.4% in the TFL group (p = NS). No major complications or re-interventions were reported.
  Conclusions: Both Ho:YAG and TFL are safe and effective for RIRS in treating mid-sized renal stones. However, Ho:YAG demonstrated superior ablation performance and shorter laser time. Despite the theoretical advantages of TFL, no significant clinical benefit was observed. To further validate and interpret these findings, future studies on larger populations and with detailed stone composition analysis are warranted.

UP-27.29—Laser Analysis for Stone Treatment (LAST): An Ex-Vivo Comparative Study of Magneto Holmium:YAG and Fiber Dust Thulium Fiber Lasers: Primary Effects on Ablation, Propulsion, Fragmentation, and Heat Generation Using Phantom Urologic Stones 

• Luna Alfonso Victor ¹, Tan Karl Marvin ¹, Sta Ana John Christopher ¹, Gauhar Vineet ², Yuen Steffi Kar Kei ³, Traxer Olivier ⁴
  ¹ Veterans Memorial Medical Center, Quezon City, Philippines, ² Ng Teng Fong General Hospital, Singapore, Singapore, ³ Chinese University of Hong Kong, Hong Kong, Hong Kong, China, ⁴ Progressive Endourological Association for Research and Leading Solutions (PEARLS), Paris, France

• Introduction and Objectives: This ex-vivo study aims to compare the retropulsion, fragmentation efficiency, heat generation and crater generation of MAGNETO Ho:YAG using three pulse modulation settings: The standard, MAGNETO setting, Virtual Basket setting, and comparing with Thulium Fiber using both short and long pulse laser settings, in gypsum-based phantom stones at three energy levels (0.5 J, 1 J, and 2 J) and 2 types of laser (200 µm and 550 µm). Aim is to compare which laser and settings are best for the lithotripsy of urinary stones for clinical application.
  Materials and Methods: Gypsum (100 g) and water (50 mL) mixture cured forming stones 0.5 cm square dimension. Quanta System MAGNETO Holmium-YAG Laser (Cyber Ho 150W Magneto) and Thulium Fiber Laser (TFL) Tools: High-speed camera for capturing retropulsion, acrylic water bath box, stone immersion with laser access, digital thermometer.
  Results: Retropulsion: TFL (short pulse) and Ho:YAG Magneto demonstrated slightly more consistent and reduced retropulsion trends. Ablation efficiency: TFL short pulse had significant higher ablation efficiency than Ho:YAG Standard and Virtual Basket. Heat generation: TFL long pulse had significant higher temperature than all Ho:YAG settings. TFL short noted more heating than Ho:YAG Standard Fragmentation time: TFL short and Ho:YAG MAGNETO significant reduced fragmentation time compared to Ho:YAG Standard. Laser efficacy: TFL short pulse had significant greater efficacy than all Ho:YAG modes.
  Conclusions: The Ho:YAG MAGNETO setting is superior for stone treatment. TFL had high ablation efficiency and fragmentation speed but greater thermal rise, potential for safety concerns in clinical application. The Ho:YAG MAGNETO setting balances performance and safety, with faster fragmentation time than both TFL long and Ho:YAG standard modes, competitive ablation efficiency similar to TFL short but less heat generation observed with TFL. Findings support Ho:YAG MAGNETO as an optimized laser setting that bridges efficacy and safety for clinical laser lithotripsy.

UP-27.30—Outcomes of Flexible Ureteroscopy and Lasertripsy (FURSL) Between Low and High-Power Laser for Renal Stones: Comparative Outcomes from an Endourology Tertiary Referral Centre 

• Fernandes Shriya, Grossman Nico, Frascheri Maria, Hossaini Badr, Somani Bhaskar
  University hospital Southampton, Southampton, United Kingdom

• Introduction and Objectives: Low-power (LP) and high-power (HP) lasers are commonly used in ureterorenoscopic stone removal, with HP lasers reportedly reducing operative times while maintaining comparable stone-free rates (SFR) and complication rates. However, most evidence stems from retrospective, multicenter studies prone to bias from surgeon variability. This study evaluates prospective outcomes from a single surgeon to minimize these biases.
  Materials and Methods: Data from consecutive patients undergoing flexible ureterorenoscopic laser renal stone removal (FURSL) by a single surgeon at a teaching hospital (2012–2024) were reviewed. Patients were divided into LP laser (20 W) (Group A, n = 109) and HP laser (≥50 W) (Group B, n = 368) groups. Collected data included patient demographics, stone characteristics, intra- and postoperative outcomes, SFR, and complications by the Clavien-Dindo system.
  Results: In total, 478 patients underwent FURSL, with 109 (23%) in Group A and 368 (77%) in Group B. Groups were similar in demographics, stone size (10 vs. 9.3 mm), and pre-stenting rates (39% vs. 41%), though Group A had shorter preoperative stent indwelling times (60 vs. 90 days). Operative times (57 vs. 40 min; p < 0.001), the use of ureteral access sheaths (68% vs. 54%; p = 0.012), and postoperative stents (98% vs. 87%; p < 0.001) were less in the HP laser group. Both groups had similar overall postoperative complication rates (7.3 vs.5.2%; p = 0.4), severity of complications (p = 0.2), and infectious complications (6.4 vs. 2.4%; p = 0.06). The SFR was similar between groups (84 vs. 88%; p = 0.7).
  Conclusions: HP lasers significantly reduce operative times and postoperative stent use while achieving comparable SFR and complication rates, with a trend toward fewer infectious complications.

UP-27.31—Outcomes of Ultrasound Guided Mini PCNL in Pregnant Women 

• Han Lin Aung ¹, Naung Yan ², Oshevire-Bini Charles ¹, Yanqiang Lu ¹
  ¹ Royal Shrewsbury Hospital, Shrewsbury, United Kingdom, ² Mandalay General Hospital, Mandalay, Myanmar

• Introduction and Objectives: Urolithiasis is the most common cause of non-obstetrical acute abdomen in pregnant ladies with incidence of 1–10%. Although 70–80% of calculi will pass spontaneously with conservative management, 20–30% of patients will need some forms of intervention. Although European Association of Urology Guidelines suggested an emergency ureteric stent insertion or percutaneous nephrostomy, these measures are associated with poor tolerance and multiple exchanges due to rapid encrustation. We performed 10 cases of ultrasound guided mini PCNL on pregnant women with urolithiasis, who failed to respond to conservative management in different hospitals in Mandalay.
  Materials and Methods: From January 2019 to December 2023, total 10 pregnant ladies with pelvic stones or upper ureteric stones underwent ultrasound guided mini-PCNL under spinal or epidural anaesthesia by a single urologist. All these patients were initially managed conservatively but with no success and did not agree to have nephrostomy or ureteric stent insertion. Each patient was thoroughly counselled and consented for mini PCNL. 6 patients underwent mini PCNL under spinal anaesthesia, and 4 patients had epidural anaesthesia. Storz mini PCNL nephroscope (12 F, 12′) and Holmium laser were used for all cases. Stone clearance was confirmed by direct visualization. All mini PCNL were tubeless with only ureteric stent. Follow up US scan performed after 1 month, and ureteric stent was removed later.
  Results: All patients had proven urolithiasis. Average weeks of gestation at the time of surgery was 17 (±3.4) weeks. Mean operation time from the start of puncture to completion of ureteric stent insertion was 35 (±10) minutes. Average stone size was 1.1 (±0.45) cm. Minimal blood loss with no major complications (sepsis, bleeding, or organ injury) was encountered. All patients were discharged on second postoperative day. Upon recheck ultrasound scan, all patients had complete stone clearance. Two patients had mild residual hydronephrosis, which completely resolved on next follow up scan in 3 months.
  Conclusions: Mini-PCNL is viable and safe treatment option for carefully selected pregnant women with urolithiasis. To achieve optimal outcomes, it should be conducted in experienced centers, with adequate expertise, comprehensive patient counseling, and a multidisciplinary approach.

UP-27.32—Patient-Reported Outcomes and Procedural Experience with Magnetic JJ Stents: A Prospective Single-Centre Evaluation 

• G Nityanandan, Alhijana Hakeem, Yehia Abdallah Mohamed, Matondo Melody
  Wrexham Maelor Hospital, Wrexham, United Kingdom

• Introduction and Objectives: While ureteric stents remain a cornerstone of modern endo-urological practice, traditional stents are frequently associated with discomfort, infection risk, and invasive removal procedures. Magnetic JJ stents (Urotech, Black-Star^®) have emerged as an innovative alternative, enabling atraumatic outpatient removal without the need for flexible cystoscopy. This study prospectively evaluates patient experience, peri-procedural outcomes, and complication rates following magnetic stent use in a real-world clinical setting.
  Materials and Methods: From September to November 2024, 62 patients undergoing endo-urological procedures at our institution were fitted with magnetic JJ stents. Removal was performed in an outpatient setting using a magnetic retrieval device by a trained urology nurse practitioner. Patient experience was assessed using a modified stent symptom questionnaire and visual analogue scales (VAS), capturing data on pain during removal, antibiotic use, hospital re-attendance, willingness for repeat use, and overall satisfaction.
  Results: Magnetic stent removal was successfully completed in all cases. Pain during removal was reported by 9 patients (14.5%). Post-procedural antibiotics were required in 3 cases (4.8%), and 2 patients (3.2%) necessitated hospital re-attendance. Among patients with prior exposure to non-magnetic stents (n = 50), 69% reported reduced pain with magnetic stents, while 8% reported no difference. Overall, 74.2% of patients expressed willingness to receive a magnetic stent again, with only 4.8% declining. Patient satisfaction was high, with 83.9% reporting they were mostly satisfied with their experience.
  Conclusions: Magnetic JJ stents offer a meaningful improvement in the way we manage ureteric stents—making the experience simpler, more comfortable, and far less invasive for patients. Most patients in our study reported less pain, were satisfied with their overall experience, and would choose a magnetic stent again. For clinicians, the ability to remove stents easily in an outpatient setting without the need for cystoscopy not only saves resources but also streamlines care. In our setting, this translated to a cost saving of over £200 per patient, primarily due to reduced need for flexible cystoscopy and procedural time. These findings highlight the value of magnetic stents as a practical, patient-friendly, and economically sound option in everyday urological practice.

UP-27.33—PCNL Outcomes for Renal Calculi: A Comparison Between Patients with and without Prior Kidney Surgery 

• Ben Saad Hamda, Sakly Aymen, Khaldi Syrine, Bahria Ayoub, Khmakhem Yassine, Sidhom Weal, Zakhama Walid, Binous Yassine
  Taher Sfar Hospital, Mahdia, Tunisia

• Introduction and Objectives: Urinary stone disease is a recurrent condition associated with an increased risk of repeat surgical intervention. Percutaneous nephrolithotomy (PCNL) remains the gold-standard treatment for renal stones larger than 2 cm. However, the safety and efficacy of PCNL in reoperated kidneys—whether previously treated via open surgery or prior PCNL—remain debated. Objectives To compare the efficacy and morbidity of PCNL in treatment-naïve kidneys versus those with a history of prior renal stone surgery.
  Materials and Methods: This prospective cohort study analyzed 245 patients undergoing PCNL (August 2018–December 2023), stratified into Group 1 (no prior ipsilateral surgery, n = 171), Group 2 (open lombotomy history, n = 45), and Group 3 (prior PCNL, n = 31). All procedures used Modified Valdivia positioning by a single surgeon. Demographics, stone characteristics (size/location), urinary anatomy, operative metrics, complications (Clavien-Dindo), and stone-free rates (SFR; defined as residual fragments < 4 mm on 1-month CT) were compared. Outcomes focused on efficacy (SFR) and morbidity to assess prior renal surgery’s impact on PCNL safety and success.
  Results: Mean ages across groups (Group 1: 49.4 ± 15.8; Group 2: 53.6 ± 11.5; Group 3: 50.8 ± 16.9; p = 0.2) and baseline comorbidities (chronic kidney disease, hypertension, solitary kidney, ASA scores) were comparable. Stone burden (p = 0.88) and density (p = 0.97) showed no differences, though stone location varied (p = 0.018). Group 2 (prior open surgery) had prolonged fluoroscopy (223.1 ± 33.2 s vs. 161.5 ± 52.4 in Group 1, 172.3 ± 30.5 in Group 3; p < 0.001) and operative times (138.2 ± 38.9 min, p < 0.001). Immediate stone-free rates (SFR) were 74.8% (Group 1), 72.1% (Group 2), and 77.4% (Group 3) (p = 0.945), rising to 81.9%, 79.1%, and 83.9% at 1 month (p = 0.857). Complication rates (Clavien-Dindo), hemoglobin drop (p = 0.082), and hospital stays (Group 2: 2.5 ± 1.2 days vs. 2.2 ± 1.0 and 1.9 ± 1.1; p = 0.07) showed no significant differences. Prior renal surgery (open or PCNL) did not reduce SFR or safety but influenced procedural complexity.
  Conclusions: PCNL on re-operated kidneys may pose technical challenges, prolonging fluoroscopy and operative times. However, efficacy and morbidity resemble outcomes in non-operated kidneys. Surgical expertise is critical in such cases to ensure optimal results.

UP-27.34—Percutaneous Nephrolithotomy in Patients Aged 70 and Older: Is It Safe? A 10-Year Single-Centre Experience 

• Leiberman Christopher, Mokool Leenesh, Lee Xiang Wei, Nalagatla Sarath
  University Hospital Monklands, Airdrie, United Kingdom

• Introduction and Objectives: With increasing life expectancy, the prevalence of renal stone disease in older adults is rising. While percutaneous nephrolithotomy (PCNL) is the gold standard for large renal calculi, concerns persist regarding its safety in elderly patients due to comorbidities and frailty. This study evaluates the safety, feasibility, and outcomes of PCNL in patients aged 70 years and above.
  Materials and Methods: A retrospective review of PCNLs performed by a single consultant surgeon from November 2009 to February 2020 was conducted. Patients ≥ 70 years were included. Data on demographics, Charlson Comorbidity Index (CCI), stone complexity, operative details, and postoperative outcomes were collected. Statistical analysis used ANOVA and chi-squared tests, with p < 0.05 considered significant.
  Results: A total of 72 patients (mean age 75; 45% male) were included. Of these, 17 (25%) were aged ≥80. Mini-PCNL was used in 41% of cases from 2017 onward. Stone clearance rate was 80.5% (6 of 12 staghorn stones cleared). Overall complication rate was 33.3%, including fever (23.6%), sepsis (6.9%), and transfusion (6.9%). Two patients (2.7%) required ITU admission. No intraoperative visceral injuries occurred; one mortality (1.4%) was recorded over 10 years. There was no significant association between complication rates, stone clearance, or length of stay with age group (p = 0.3) or CCI score (p = 0.4). The majority of complications were Clavien-Dindo grade I–II.
  Conclusions: PCNL can be performed safely and effectively in patients over 70, including octogenarians and those with multiple comorbidities. With appropriate preoperative assessment and intraoperative planning, elderly patients can achieve high stone clearance with acceptable morbidity. These findings support broader use of PCNL in the ageing population and underscore the importance of experience, careful selection, and multidisciplinary perioperative care.

UP-27.35—Perirenal Hematoma Following Ureterorenoscopic Lithotripsy (URSL): Lesson Learnt from an Unusual Complication 

• Shetty Rajath, Balabolu Mounika, Jain Siddharth
  AIIMS New Delhi, Delhi, India

• Introduction and Objectives: Perirenal hematoma (PRH) is a recognized complication following various urological and interventional procedures, including percutaneous nephrolithotomy (PCNL), shock wave lithotripsy (SWL), and ureteroscopy with lithotripsy (URSL). PRH may also occur spontaneously or due to trauma. Clinically, it presents with severe ipsilateral flank pain, fever, and a significant decline in hemoglobin levels, often necessitating urgent medical intervention. Several risk factors contribute to PRH development, including severe hydronephrosis, a thin renal cortex, prolonged operative duration, and pre-existing comorbidities such as hypertension or anticoagulation therapy.
  Materials and Methods: A comprehensive review of clinical cases and literature on PRH was conducted to analyze the incidence, risk factors, diagnostic tools, management strategies, and preventive measures associated with PRH. Imaging modalities, including computed tomography (CT) and ultrasonography, were evaluated for their effectiveness in diagnosing PRH. Various treatment approaches, ranging from conservative management to interventional procedures such as arterial embolization or surgical exploration, were reviewed.
  Results: Findings indicate that PRH is often associated with vascular injury caused by direct mechanical trauma, increased renal pressure, or coagulation abnormalities. Imaging studies play a crucial role in identifying and classifying hematomas based on size and severity. Management strategies are determined by the patient’s hemodynamic stability. Stable patients respond well to conservative management, including bed rest, pain control, and blood transfusions if necessary. However, in cases of significant hematoma with hemodynamic instability, interventional radiology techniques such as arterial embolization are effective, with surgical intervention reserved for refractory cases. Preventive measures, including careful surgical technique, preoperative risk assessment, and intraoperative hemostasis, are essential in reducing PRH incidence.
  Conclusions: PRH is a critical complication following urological interventions, requiring timely recognition and appropriate management. Conservative approaches are effective for stable cases, while embolization and surgery are reserved for severe cases. Preventive strategies, such as meticulous surgical techniques and preoperative risk evaluation, are crucial for minimizing PRH occurrence. Future research should focus on refining surgical approaches and developing advanced hemostatic technologies to further reduce PRH incidence and improve patient outcomes.

UP-27.36—Predicting the “Difficult” Ureter During Ureteroscopic Lithotripsy or Retrograde Intrarenal Surgery (RIRS) 

• Katsikatsos Panagiotis ¹, Moulavasilis Napoleon ¹, Kotrotsios Konstantinos ², Kalfountzos Christos ¹, Douroumis Konstantinos ¹, Frangkiadis Evangelos ¹, Mitropoulos Dionysios ¹
  ¹ Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece, ² National and Kapodistrian University of Athens, Medical School, Athens, Greece

• Introduction and Objectives: Ureteroscopy, when performing ureterolithotripsy for ureteric stones or RIRS for kidney stones, may be difficult or impossible in some cases. In these cases, prestenting of the ureter is a viable option, and a second ureteroscopy is performed after several days. We retrospectively reviewed the predisposing factors for difficult ureteroscopies.
  Materials and Methods: Between January 2024 and December 2024, a total of 119 patients underwent ureteroscopy for ureteric and kidney stones. Mean patient age was 58.4 years (range 23 to 87), and male to female ratio was 1.2:1. Data from medical records included information on various factors such as age, gender, body mass index, comorbidities (diabetes mellitus [DM], hypertension [HT], dyslipidemia [DL]), history of abdominal surgery, and radiotherapy history. Also, clinical characteristics such as location, size, and density (according to Hounsfield Units) of the stones were recorded. We defined stone free rate (SFR) as the presence of stone ≤ 4 mm on a follow up ultrasound and KUB x-ray 1 month after surgery. Difficult ureteroscopy was defined as the inability to insert the ureteric sheath or the ureterorenoscope (rigid or flexible) into the ureter at surgery time.
  Results: The incidence of difficult ureteroscopy was 25/119 cases (21%). Multivariate regression analysis revealed that the prevalence of difficult ureter is associated with the following risk factors: female gender (OR 2.87; 95% CI 1.13–7.3; p = 0.024), ureteric stone ≤ 10 mm in major axis (OR 0.0870; 95% CI 0.0112–0.675; p = 0.004), and history of radiotherapy (OR 6.15; 95% CI 1.26–29.9; p = 0.012). Concerning stone free rate, there is interrelation with ureteric stones ≤ 10 mm (OR 4.07; 95% CI 1.5–11; p = 0.004), and higher stone free rates were reported in stones in ureter than those located in the renal pelvis.
  Conclusions: Difficult ureter is associated with female gender, ureteric stones ≤ 10 mm, and patients’ history of radiotherapy. In these patients, prestenting should be considered preoperatively. Moreover, stone free rate is higher in patients with ureteric stones than renal stones and predominantly with a major axis ≤ 10 mm.

UP-27.37—Predictive Factors of Stone-Free Status in Isolated Lower Pole Renal Stones: Insights from a Retrospective Cohort 

• Guebbas Salim, Chatar Achraf, Hnawi Yousra, Nadir Mohamed, Lakmichi Mohamed Amine, Dahami Zakaria, Sarf Ismail
  Mohammed VI University Hospital, Marrakech, Morocco

• Introduction and Objectives: The treatment of lower pole renal stones involves various techniques, including flexible ureterorenoscopy (fURS), percutaneous nephrolithotomy (PCNL), and shock wave lithotripsy (SWL). Achieving a stone-free status is often influenced by multiple factors. This study aims to identify the predictive factors for stone-free outcomes in patients with lower pole stones, irrespective of the treatment approach used.
  Materials and Methods: This retrospective study included patients treated for isolated lower pole renal stones between January 2019 and January 2024. Treatment options, including fURS, PCNL, and SWL, were analyzed. Predictive factors such as stone size, location, and patient characteristics were assessed. Stone-free status was defined as the absence of visible stone fragments ≥ 2 mm on post-treatment imaging. Data analysis was performed using statistical tests, including chi-square, Mann-Whitney, and Student t-test, with a significance level of p < 0.05.
  Results: Seventy-two cases of isolated lower pole renal stones were examined in the study. Among the 72, 26 cases were treated with flexible ureteroscopy (fURS), while 46 cases were treated with percutaneous nephrolithotomy (PNL). The overall stone-free rate was 80.6%, with 92.3% in the fURS group and 73.9% in the PNL group. There were no significant associations between stone-free status and age, gender, hypertension, diabetes, stone size, stone density, or the number of stones. In particular, treatment success was not significantly correlated with stone density measured in Hounsfield units (p = 0.61). Stone composition was statistically associated with outcomes (p = 0.003), with a better stone-free rate for calcium oxalate stones compared to stones with mixed and infectious composition. Similarly, urinary pH correlated with stone-free status (p = 0.045) with neutral or alkaline pH correlating with better outcome. No other clinical/radiological parameters could predict stone-free status.
  Conclusions: Preoperative metabolic evaluation should be considered a key factor influencing the therapeutic strategy for isolated lower pole stones, alongside stone size and density. Improving the prediction of stone composition before surgery may also help optimize patient selection and surgical outcomes.

UP-27.38—Predictive Factors of Urosepsis After Flexible Ureterorenoscopy in the Treatment of Upper Urinary Tract Stones 

• Ben Saad Hamda, Sakly Aymen, Hlaoui Mohamed Ali, Khmakhem Yassine, Bahria Ayoub, Sidhom Weal, Zakhama Walid, Binous Yassine
  Taher Sfar Hospital, Mahdia, Tunisia

• Introduction and Objectives: Endourology techniques, including flexible ureteroscopy (FURS), are frequently employed to treat kidney stones, a prevalent condition that presents a significant public health challenge. This practice is becoming more prevalent as a result of the development of more potent and effective lasers. However, the nature of postoperative complications remains ambiguous, with urosepsis being identified as a severe complication. In the context of kidney stone treatment, the aim of this study is to determine the predictive factors of urosepsis following FURS.
  Materials and Methods: Between August 2018 and February 2024, we conducted a retrospective investigation on 269 patients who underwent flexible ureteroscopy at the urology department of Mahdia for the treatment of kidney stones. Prior to FURS, it was mandatory for all patients to undergo a urinary culture test. Prophylactic antibiotics based on cephalosporins were administered to all patients with a negative urine culture. In the event of a positive urine culture, appropriate antibiotic treatment was required.
  Results: The study cohort (mean age: 51.9 years, male predominance: sex ratio 1.06) revealed hypertension (33.5%) as the most common comorbidity, with urological malformations in 46%. Preoperative urine cultures (96.7% of patients) identified Klebsiella pneumoniae (2.9%) and E. coli (2.6%). Stones were predominantly radiopaque (73.2%), with 48.4% classified as Guy’s stone score 1; 46.8% measured 10–20 mm. Surgery duration was <45 min in 60.7% of cases. Postoperatively, 26.4% had residual stones, 78.1% required double-J stents, 10% had positive urine cultures, and 7.4% developed urosepsis (2.6% readmitted). Univariate analysis linked postoperative urosepsis to preoperative urinary infection (p < 0.001), urological/renal malformations (p = 0.02, p = 0.04), positive urine culture (p = 0.01), stone burden (p = 0.03), surgery duration (p < 0.001), and prior antibiotic use (p < 0.001). Multivariate analysis identified prolonged preoperative drainage (p = 0.015), surgery duration (p = 0.037), and prior antibiotic use (p = 0.009) as independent predictors. Key findings highlight modifiable risk factors (surgical duration, drainage period) and clinical markers (urinary infections, anatomical anomalies) for urosepsis, underscoring the need for tailored perioperative management in flexible ureterorenoscopy.
  Conclusions: The nomogram developed in this study is capable of predicting the likelihood of postoperative urosepsis by integrating preoperative and intraoperative risk factors. Consequently, it aids urologists in the prevention of severe complications resulting from infection following surgery.

UP-27.39—Propensity Score Matching of Suction vs. Non-Suction Mini Percutaneous Nephrolithotomy (mPCNL) 30 Day Outcomes from a Real World Multicentre Prospective Study. A European Association of Urology (EAU) Endourology and Asian Urological Society of Endoluminal Surgery and Technology (AUSET) Collaboration 

• Pek Xiang Wen Gregory ¹, Yuen Steffi Kar Kei ², Castellani Daniele ³, Kalathia Jaisukh ⁴, Fong Khi Yung ⁵, Somani Bhaskar Kumar ⁶, Herrmann Thomas ⁷, Gauhar Vineet ⁸, Registry Suction Technology Utility In Mini-PCNL Study (STUMPS) ⁹
  ¹ Ng Teng Fong General Hospital, Singapore, Singapore, ² S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China, Hong Kong, Hong Kong, China, ³ Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Via Conca 71, 60126, Ancona, Italy, Ancona, Italy, ⁴ Fortune Urology Clinic, Botad, Gujarat, India, Gujarat, India, ⁵ Department of General Surgery, Singapore General Hospital, Singapore, Singapore, Singapore, ⁶ Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK, Southampton, United Kingdom, ⁷ Department of Urology, Spital Thurgau AG, Kantonsspital Frauenfeld, Pfaffenholzstrasse 4, CH 8501, Frauenfeld, Switzerland. Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, South Africa. Hannover Medical School, Hannover, Germany, ⁸ Ng Teng Fong General Hospital, Singapore, Singapore, Singapore, ⁹ Asian Institute of Nephrology and Urology, Chennai, Chennai, India

• Introduction and Objectives: Mini percutaneous nephrolithotomy (mPCNL) has equivalent stone free rates (SFR) compared with standard PCNL. The latest EAU guidelines suggest that there is evidence for using suction as a complementary tool during mPCNL. We report 30 day perioperative outcomes between suction (smPCNL) and non-suction mPCNL.
  Materials and Methods: This was a prospective, multicentre, investigator-initiated study by 20 surgeons from 14 countries who performed both smPCNL and non-suction mPCNL from January to December 2024. The primary outcome was to assess complete stone free status (Grade A) on a 30-day CT scan. Optimal propensity score matching (PSM) covariate was achieved with absolute standardized mean difference (ASMD) < 0.1 at a caliper width of 0.004. Outcomes were analyzed using either T-test or Mann-Whitney U test. Categorical data between groups were analyzed using chi-squared test.
  Results: Of 1915 patients (1534 smPCNL, 381 non-suction), PSM yielded 664 smPCNL and 309 non-suction patients. Baseline characteristics and stone characteristics including Guy’s stone score, Hounsfield units, largest stone diameter, and stone location were well matched. Both groups showed high 30-day 100% SFR (i.e., Grade A) (85% vs. 87%, OR 0.9 [CI 0.59–1.37], p = 0.637). SmPCNL group had shorter operative time (42 vs. 57 min, p < 0.001), high intraoperative SFR determined by visual inspection or fluoroscopy (82.6% vs. 69.6%, p < 0.001), and lower blood transfusion rates (1.4 vs. 3.6%, p = 0.044). Infectious complications did not differ. On multivariate analysis, stone volume (OR 0.93, 95% CI [0.89; 0.97], p = 0.002), fluoroscopy associated with ultrasound guided access (OR = 0.44, 95% CI [0.26; 0.73], p = 0.002), and sheath size < 20 Fr (OR = 0.4, 95% CI [0.21; 0.74], p = 0.004) were factors significantly associated with lower odds of Grade A SFR.
  Conclusions: Suction in mPCNL improves intraoperative stone clearance rates and reduces operative time but does not impact 30-day SFR or infectious complications. Mini-PCNL can safely achieve zero residual fragments with and without the use of suction sheath in high percentage of cases. This information allows surgeons to adopt and tailor the surgery based on the availability of armamentarium.

UP-27.40—Reducing Ureteroscopy Waiting Times Through Case Validation and a Targeted “Booster Week” Initiative 

• Tai Justina Cheh Juan, Tien Tony, Pal Pallavi, Atalar Kerem, Kinghorn Stephen, Graham Stuart, Bastianpillai Christopher
  Whipps Cross University Hospital, Barts Health NHS Trust, London, United Kingdom

• Introduction and Objectives: Ureteroscopy waiting lists across the UK’s National Health Service (NHS) continue to expand due to increasing demand, staffing constraints, and limited operating theatre capacity. Delays in treating ureteric stones can result in persistent pain, complications, and loss of renal function. This quality improvement project aimed to reduce the ureteroscopy waiting list across two NHS hospitals through a waiting list validation process and a high-volume “Ureteroscopy Booster Week”.
  Materials and Methods: A multidisciplinary team consisting of four consultant urologists and a urology stone specialist nurse reviewed all patients on the ureteroscopy waiting list (extracted in November 2024). Patients were assessed based on clinical indication, date of stent insertion (if applicable), and most recent imaging. Repeat CT-KUB scans were arranged for patients with outdated imaging. Patients who no longer required treatment, declined intervention, or had already been managed elsewhere were removed from the list. Following validation, a one-week “booster” surgical initiative was implemented, with two operating lists running in parallel for five consecutive days. Patients were prioritized by clinical urgency. The primary outcome was the net reduction in waiting list size.
  Results: The initial waiting list comprised of 339 patients. Validation alone reduced the list by 50.4%. During the booster week, an additional 59 ureteroscopies were performed across 10 theatre sessions, resulting in a further 21.4% reduction. Post-intervention, the waiting list stood at 123 patients—representing an overall reduction of 63.7%.
  Conclusions: A structured validation process combined with a dedicated high-output surgical week substantially reduced the ureteroscopy backlog. This scalable, resource-efficient approach may be adopted by other institutions facing similar pressures on elective surgical services.

UP-27.41—RIRS with Fan Sheath in Complex Renal Stones with Altered Anatomy: A Minimally Invasive Solution Better than Miniperc in Challenging Cases 

• Kumar Pravin
  Vijaya Hospital, Madurai, India

• Introduction and Objectives: The management of kidney stones in complicated cases poses considerable difficulties, especially when anatomical abnormalities, multiple stones, or high-risk patients are involved. Although Mini-PCNL has gained acceptance for treating complex renal stones, it carries certain disadvantages in kidneys with altered anatomy. Retrograde Intrarenal Surgery (RIRS) utilizing a FAN sheath has surfaced as a less invasive option and greater flexibility within the renal collecting system. This method has demonstrated encouraging results in technically challenging conditions where Mini-PCNL would be difficult.
  Materials and Methods: This case series involves five patients who presented with kidney stones in complex anatomical conditions. One patient had a large renal cyst that was obscuring the puncture window for PCNL. Another patient with ADPKD had stones where the cysts were compressing the collecting system, making puncture (either fluoroscopic or ultrasound-guided) challenging. A third patient had a supernumerary kidney, where RIRS/FANS scored over Mini-PCNL. Another patient had an ectopic pelvic kidney and a PUJ stone, for whom RIRS proved to be more effective than Mini-PCNL. The final patient had numerous stones located in various calyces in both kidneys, which were effectively cleared using RIRS.
  Results: All five patients successfully underwent RIRS with FAN sheath, achieving effective stone clearance without major complications. The case of a supernumerary kidney with renal calculi was successfully treated with flexible ureteroscopy, which allowed precise navigation despite the abnormal anatomy. Across all cases, intrarenal pressure was well maintained, operative time was optimized, and recovery was uneventful.
  Conclusions: RIRS with a FAN sheath is a more adaptable solution for managing renal stones in complex scenarios. It ensures effective stone clearance with minimal complications, making it a preferable alternative to Mini-PCNL in challenging cases with altered anatomy.

UP-27.42—Single-Session Bilateral Supine Percutaneous Nephrolithotomy: Safety and Efficacy 

• Rohiem Mahmoud ¹, Nafie Mohamed ², Ali Mostafa ³, Fawzy Ahmed ³, Ibrahim Nesreen ¹, Ali Ahmed ³, Gabr Ahmed ⁴
  ¹ Port-Said university hospitals, Port-Said, Egypt, Arab Rep., ² Zagzig university hospitals, Zagazig, Egypt, Arab Rep., ³ Minia University, Minia, Egypt, Arab Rep., ⁴ NHS GGC, GLASGOW, United Kingdom

• Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) is considered the first choice for treating kidney stones larger than 2 cm. The aim of this study is to evaluate the safety and efficacy of single-session supine bilateral percutaneous nephrolithotomy (BPCNL) in patients with bilateral renal stones.
  Materials and Methods: We retrospectively identified patients from February 2019 to July 2023 with bilateral renal stones between 2 and 5 cm on each side, mainly in the renal pelvis, that had been treated with single-session supine BPCNL. CTKUB was used to determine the stone size and the maximum stone diameter. Preoperative information, including demographics and stone characteristics, intraoperative and perioperative results, and procedure-related problems, was all evaluated. The stone-free rate was accepted when remaining fragments of ≤ 2 mm were discovered by a computed tomography scan.
  Results: Fifty-two patients with bilateral renal stones measuring 2:5 cm in their maximum dimension for each side who had been treated with single-session supine BPCNL were included in the study; a statistically significant difference in serum creatinine level was detected on day 1 postoperatively (p < 0.0001) compared with the baseline values that became insignificant at 1 week and 1 month postoperatively (p = 0.403 and 0.471 respectively). Also, statistically significant difference in glomerular filtration rate was detected at day 1 postoperatively (p < 0.0001) compared with the baseline values that became insignificant at 1 week and 1 month postoperatively (p = 0.95 and 0.07, respectively), implicating early renal affection that shortly returned to normal values. The mean operative time for both sides was 126.5 ± 22.9 min, and the mean hemoglobin drop after the procedure was 1.9 ± 0.99 g/dL. The primary stone-free rate was 75%, with 11.6% of the remaining patients having residual insignificant stones > 2 mm but still less than 6 mm. Finally, 13.4% of the patients needed ancillary procedures. Grade I complications occurred in 9 patients (17.3%), grade II in 8 patients (15.3%), and grade IIIA in 2 patients (3.8%).
  Conclusions: Single-session supine bilateral PCNL is both safe and effective for patients with bilateral renal stones. However, this is a complex procedure that should only be performed by expert surgeons in a tertiary center.

UP-27.43—The Risk of Post-Operative Sepsis in Patients Undergoing Interventions for Upper Urinary Tract Stones: A Study from the ACS NSQIP Database 

• Ierides Solon, Bjazevic Jennifer, Alotaibi Tariq, Razvi Hasan
  Western University, London, Ontario, Canada

• Introduction and Objectives: The incidence of urinary stone disease is rising, accompanied by increasing patient comorbidities and frailty, potentially elevating post-operative complication risks. We aimed to quantify up to 30-day post-operative urinary sepsis rates following ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) and to identify predictive risk factors using the American College of Surgeons National Surgical Quality Improvement Database (NSQIP).
  Materials and Methods: We analyzed NSQIP data (2005–2023) for coded URS and PCNL procedures. Data included demographics, comorbidities, pre-operative labs, procedural details, and post-operative sepsis incidence (≥2 SIRS criteria). Chi-squared tests assessed sepsis trends, and multivariate logistic regression identified risk factors.
  Results: Among 4,366 procedures (3,702 URS, 664 PCNL), sepsis occurred in 1.25% of URS and 0.80% of PCNL cases, with a rising trend in URS (p = 0.05). Predictors of post-operative sepsis across the whole cohort included a higher American Society of Anesthesiologists (ASA) score, active smoking status and dialysis. Prior bleeding disorders (OR 1.288, p = 0.003), diabetes (OR 0.236, p = 0.017), congestive heart failure (OR 1.268, p = 0.031), outpatient status (OR 0.299, p = 0.038) and longer hospital stay pre-surgery (OR 1.187, p = 0.013) were associated with sepsis following URS but not PCNL.
  Conclusions: The overall incidence of post-operative sepsis following URS and PCNL remains low; however, a trend towards increasing rates of sepsis among patients undergoing URS was noted. Several pre-operative patient characteristics were also identified as potential risk factors. Further investigation should be conducted to determine the reason(s) for this increasing trend and to aid in the development of reliable predictive models to help mitigate the risk of post-operative sepsis in this patient population.

UP-27.44—The Role of Stone Culture in Patients Undergoing Mini-Percutaneous Nephrolithotripsy for Kidney Stone Disease. Results from a Large Single Center Series 

• Cormio Angelo ¹, Ratnayake Runeel ², Castellani Daniele ¹, De Palma Domenico ², Fiorella Ruggiero ², Sciancalepore Francesca ², Auciello Mario ³, Albino Giuseppe ³, Falagario Ugo ², Carrieri Giuseppe ², Cormio Luigi ²
  ¹ Università Politecnica delle Marche, Ancona, Italy, ² Università di Foggia, Foggia, Italy, ³ Ospedale L. Bonomo, Andria, Italy

• Introduction and Objectives: To assess the impact of positive stone cultures (SC) on infectious complications following mini (Amplatz sheath: 17.5 Ch) percutaneous nephrolithotripsy (PCNL) for kidney stones. To assess the impact of positive stone cultures (SC) on infectious complications following mini (Amplatz sheath: 17.5 Ch) percutaneous nephrolithotripsy (PCNL) for kidney stones.
  Materials and Methods: A retrospective analysis was conducted on 458 patients who underwent mini-PCNL in a single center (February 2020–December 2024). Preoperative positive mid-stream urine culture (MUSC) was treated as per sensitivity. Patients were classified according to stone culture (SC) results as negative (Group 1: 383 patients) and positive (Group 2: 75 patients).
  Results: Groups 1 and 2 had similar baseline characteristics, except for median age (63.7 vs. 55.7 years), the proportion of females (45.2% vs. 70.7%%), the proportion of patients with indwelling ureteral stent (12.3% vs. 33.3%), and proportion of positive MSUC (7.6% vs. 40%). Surgical time was similar in the 2 groups, and there was no significant difference in infectious complications (5.3% vs. 9.4%, p = 0.32), but patients in Group 2 had longer median hospital stays (4 vs. 3 days). The concordance of pathogens between MSUC and SC was observed in 30.8% (8/26) of cases. Postoperative bloodstream cultures were found positive in 3/12 patients, with pathogen concordance between SC and bloodstream culture in 2 patients. Multivariable regression analysis identified diabetes (OR 2.44), female gender (OR 3.08), and indwelling preoperative stent (OR 4.22) as significant predictors of positive SC.
  Conclusions: Mini-PCNL showed a low rate of infectious complications with no difference between patients having positive or negative SC. SC can be useful to guide postoperative antibiotic therapy, considering the low rate of pathogen concordance between MSUC and SC.

UP-27.45—Towards Standardized Outcomes in Mini-PCNL: A Prospective Single-Centre Evaluation of Pentafecta Criteria for Renal Stones ≤ 3 cm 

• Kumar Siddhant, Chawla Arun, Pillai Sunil, Hegde Padmaraj, Agarwal Varun
  Kasturba Medical College, Manipal, Udupi, India

• Introduction and Objectives: There is a lack of a standardized tool to objectively quantify the results of mini-Percutaneous Nephrolithotripsy (PCNL), especially in this era of laser lithotripsy. Pentafecta outcomes have been defined in literature for radical prostatectomy, radical cystectomy and for partial nephrectomy. This study proposes a Pentafecta outcome model for mini-PCNL, designed to capture both efficacy and safety in a single composite measure and promote consistency in clinical reporting.
  Materials and Methods: A single centre prospective observational study was undertaken from January 2024 to March 2025. 180 adult patients willing and consented for PCNL with maximum stone size 3 cm were enrolled in the study. Pentafecta outcomes were defined as: clinically insignificant stone residue at 4 weeks post surgery on NCCT KUB. With complications less than modified Clavien Dindo grade 2 tubeless PCNL, no ancillary procedures, eGFR coming to >95% of pre operative value at the end of 4 weeks. Univariate and multivariate logistical analyses were performed using SPSS.
  Results: A total of 180 patients were included in the analysis, with Pentafecta achieved in 62% of cases. Patients attaining Pentafecta were more likely to have single stones (p < 0.01) and require single punctures (p < 0.01). Pelvic calculi demonstrated the highest stone-free rates (p < 0.05). Multivariable logistic regression identified stone volume as an independent predictor, with volumes > 500 mm² associated with reduced likelihood of achieving Pentafecta (OR 2.4). Stone clearance rates were comparable between the Thulium and Holmium subgroups. The mean preoperative eGFR was 97.3 ± 29.3 mL/min/1.73 m², which declined to 84.4 ± 24.0 mL/min/1.73 m² on postoperative day one but recovered to 96.9 ± 24.5 mL/min/1.73 m² at one-month follow-up. Although renal function significantly worsened immediately postoperatively, it returned to near-baseline levels within a month, showing a trend toward improvement. Complications included one patient requiring angioembolization for a pseudoaneurysm, one readmission for febrile UTI, and two early stent removals due to stent-related pain.
  Conclusions: We conclude that Pentafecta for PCNL is a composite tool to evaluate the quality and efficacy of surgery. It would also help as a self-assessment tool to gauge a surgeon’s learning curve.

UP-27.46—Tubed vs. Tube’less’ Supine PCNL-Remote Hospital in Cornwall Experience 

• Mohsin Hadi ¹, Iqbal Nadeem ²
  ¹ Royal Cornwall Hospital, TRURO, United Kingdom, ² Newham University Hospital, LONDON, United Kingdom

• Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) is the standard of care for removing large kidney stones (>2 cm). The decision to place or not place a tube differs among clinicians; historically, a nephrostomy was placed to provide tamponade to the PCNL tract or to allow early relook if there are significant residual fragments.
  Materials and Methods: We reviewed records of PCNL procedures for kidney stone. 45 patients (only supine PCNL included) between January 2018 till June 2024. We looked for electronic charts and theatre time records. Variables such as age, gender, stone size, stone complexity score, stone free status, operative time, operation related complications, and duration of hospital stay were recorded in Excel.
  Results: Mean age in tubeless group was 60.9 years, and in tubeless PCNL group it was 58.6 years. Stone free rates in tubed and tubeless PCNL patients were similar (69% and 72.2% respectively). Mean operation time was 154.5 min in tubed and 146.2 min in tubeless PCNL group (p value < 0.01). Hospital stay was significantly lower in tubeless PCNL group (3.2 versus 2.1 days, p value < 0.03).
  Conclusions: Stone free status similar in both tubed and tubeless supine PCNL. Complications rates were similar in both tubed and tubeless PCNL. Hospital stay and operative time are significantly lower in tubeless supine PCNL.

UP-27.47—Ultrasound Guided Percutaneous Nephrolithotomy: Is It Better than Fluoroscopic Guided Percutaneous Nephrolithotomy? 

• Mughal Rameez Ahmed
  Benazir Bhutto Hospital, Islamabad, Pakistan

• Introduction and Objectives: Ultrasound guided renal puncture is safe and effective to obtain access to renal collecting system during PCNL. This study aims to compare ultrasound vs. fluoroscopy guided PCNL in terms of safety, efficacy and cost effectiveness.
  Materials and Methods: This was a prospective randomized study done between December 2022 to December 2023. After obtaining approval from hospital ethical committee, total of 110 patients were selected, but 100 met inclusion criteria. 50 patients were assigned to ultrasound guided PCNL group, and 50 to fluoroscopy PCNL group by computer generated randomization. Procedure done by a single surgical team with the assistance of researcher. Preoperatively, age, sex, ASA health status, ultrasound and non contrast CT scan were done for all patients. Guy’s stone score calculated for all and stone load defined. Post operatively, blood transfusion, changes in hematocrit, stone free rates, complications by Clavien-Dindo scoring, and hospital stay were noted. Data analyzed using SPSS version 25, and p value less than 0.05 considered significant.
  Results: Renal punctures were successful in all cases in both groups. All cases in ultrasound group had single puncture attempt and single working tract, whereas multiple puncture attempts were required in some patients in fluoroscopy group (p value 0.006). However, ultrasound reduced the time needed for puncture, 22.45 ± 6.95 s vs. 68.28 ± 56.76 s (p value < 0.001). Mean duration of access was also less in ultrasound group, 3.92 ± 0.72 min vs. 4.03 ± 0.77 min (p value 0.460). Stone free rate was almost equal in both groups. Mean Hb change postoperatively 0.23 g/dL in ultrasound group vs. 0.55 g/dL in fluoroscopy group. 6.38 ± 3.84 min was mean fluoroscopy time.
  Conclusions: Ultrasound has clear advantage over fluoroscopy in PCNL with zero radiation exposure having same outcomes as conventional PCNL with accurate renal punctures.

UP-27.48—Ureteral Access Sheath or Percutaneous Nephrostomy During Flexible Ureteroscopy: Which Is Better? 

• Abdelrahman Moaz ¹, Alhefnawy Mohamed ², Abo-Elnasr Hosam ², Eldib Helmy ²
  ¹ East Lancashire Hospitals NHS Trust, Blackburn, United Kingdom, ² Benha University, Benha, Egypt, Arab Rep.

• Introduction and Objectives: Studies in literature discussed the drawbacks of the ureteral access sheath use in flexible ureteroscopy and in the same time mentioned the benefits of ureteral access sheath in decreasing the incidence of urosepsis and better stone free rate. In the current study we aim to compare between percutaneous nephrostomy tube (PCN) insertion before flexible ureteroscopy and conventional ureteral access sheath (UAS) flexible ureteroscopy in terms of safety, efficacy and perioperative outcomes.
  Materials and Methods: In all, 100 patients aged 20 to 67 years with upper ureteric stones and mild hydronephrosis or renal pelvic stones less than 20 mm with mild hydronephrosis were randomized into 2 groups: patients undergoing PCN insertion before flexible ureteroscopy and patients undergoing conventional UAS flexible ureteroscopy. Patients with active urinary tract infection, urinary diversions or malformations, and uncontrolled coagulable status were excluded. Peri-operative data were recorded. This study was conducted on 50 PCN group and 50 UAS group. Age varied from 20.0 to 67.0 years. Males consisted of more than half of study groups, 52% of PCN group and 66% of UAS group. Weak significant difference was found in need for ureteral pre-operative stenting between groups (8% with PCN vs. 22% with UAS, p 0.04995).
  Results: There was no significant difference between two groups in intra-operative complications (mucosal injury, failed operation, perforation, false passage and conversion to other procedure), but there was significant difference in bleeding between the groups (6% with PCN vs. 22% with UAS, p = 0.021). There was no significant difference between two groups in post-operative complications (infection, fever, pain, hematuria, other complications, stone free rate, readmission and stent duration), but there was significant decrease in operative time (48.85 ± 13.861 in PCN group versus 56.82 ± 14.61 in UAS group, p = 0.0003).
  Conclusions: Our suggested technique (ultrasound guided PCN insertion in lower calyx before flexible ureteroscopy) demonstrates superior outcomes in terms of the main outcome of our study, such as a higher success rate (SFR) and fewer complications, particularly reduced bleeding with shorter operative time compared to using ureteral access sheath. Notably, these improvements are achieved without a significant increase in other complications.

UP-27.49—Ureteral Injuries in Ureteroscopy and Its Predisposing Factors 

• Servin Fonseca Karen, Maldonado Alcaraz Efrain
  Colegio Mexicano de Urologia Nacional, Mexico City, Mexico

• Introduction and Objectives: Upper urinary tract lithiasis can become complicated with ureteral injuries during treatment. Current studies do not mention the frequency and degree of lesions in a general way, which is why there is an underdiagnosis. The objective is to determine the frequency of ureteral injuries in ureteroscopy and its predisposing factors.
  Materials and Methods: Cross-sectional, prospective, observational and descriptive study, with a sample of 383 patients, of which 94 patients have been included. The recordings obtained from the surgery are analyzed to identify ureteral injuries and are reported on a data collection sheet, as are the patient, procedure, and urinary stone variables that could potentially predict the presence of ureteral injury. Injuries were assessed according to Olivier Traxer’s classification.
  Results: The average age was 52 years (range 43–63), 58% were women (61.7%), the average stone size was 9 mm (range 6–15), 56% of patients had previous endourologic surgery (59.6%), 12% with ureteral stricture (12.7%), 1.5 months since the last ureteral manipulation (1.3), 66% had a JJ stent prior to surgery (70.2%), 9% had previous open surgeries such as pyelolithotomy or ureterolithotomy (9.6%), surgical time was 50 min (30–60), 21 patients had ureteral injury, as protective factors carrier of JJ stent, history of endourologic and open surgery, and risk factors positive urine culture, longer surgical time, size major stone, 20 patients had grade 1 injury and one patient grade 2.
  Conclusions: Two out of every 10 patients undergoing ureteroscopy develop some type of ureteral injury that is not reported in the patient’s postoperative notes. There are factors that appear to be both protective and risk factors for developing a ureteral injury; however, the sample size must be expanded to establish significance, so the study continues until the necessary population is reached.

UP-27.50—Utility of the Guy’s Stone Score in Stratifying Stone Complexity and Predicting Outcomes of Percutaneous Nephrolithotomy 

• Montuenga Fernández Isabel, Vázquez Valdés Sonia, Peral Parra Diego, Sánchez Novo Olga, Sánchez Pellejero Alejandro, Golmayo Muñoz-Delgado Eva, Ortiz Vico Francisco Javier, Tamayo Ruiz Juan Carlos
  Hospital Universitario Príncipe de Asturias, Alcalá De Henares, Madrid, Spain

• Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) is the treatment of choice for patients with large-volume nephrolithiasis. The Guy’s Stone Score (GSS) provides a stratification system to assess case complexity and predict surgical outcomes. This study aims to evaluate the outcomes of PCNL based on GSS in our patient cohort.
  Materials and Methods: A retrospective analysis was conducted on 152 patients who underwent PCNL between January 2017 and October 2024. Patients were categorized into four groups according to the GSS (I, II, III, and IV). The stone-free rate was defined as the presence of residual fragments < 4 mm. Clinical, surgical, and postoperative variables were analyzed using chi-square, ANOVA, and Kruskal-Wallis tests, depending on data distribution assessed by the Kolmogorov-Smirnov test.
  Results: The distribution according to GSS was as follows: 69 patients (46%) in Group I, 48 (32%) in Group II, 2 (1.3%) in Group III, and 32 (21%) in Group IV. Mean initial stone size increased progressively with higher GSS (p = 0.001). The stone-free rate was inversely related to stone complexity, achieving 66% in Group I, 31% in Group II, and lower values in higher-complexity groups (p = 0.001). The need for reintervention also correlated with GSS, with 26% in Group I and 41% in Group IV (p = 0.001). No significant differences were observed in postoperative complications or length of hospital stay (p > 0.05), although postoperative hemoglobin levels varied significantly according to GSS (p = 0.030).
  Conclusions: The Guy’s Stone Score proves to be a valuable predictor of surgical complexity and PCNL outcomes, as higher scores were associated with increased rates of residual fragments and need for reintervention. These findings highlight the importance of proper preoperative stratification and individualized surgical planning.

UP-27.51—Vacuum Assisted F-URS in Abnormal Kidney: A Comparative Study 

• Popescu Razvan ¹, Petca Razvan ¹, Predoiu Gabriel ¹, Babita Catalin ¹, Geavlete Bogdan ², Jinga Viorel ¹
  ¹ Prof. Dr. Th. Burghele Clinical Hospital, Bucharest, Romania, ² Saint John Clinical Emergency Hospital, Bucharest, Romania

• Introduction and Objectives: Flexible ureteroscopy with suction (URSFs) is a minimally invasive technique for managing renal lithiasis. This prospective comparative study examines the differences between URSFs in patients with normal and abnormal anatomical kidneys.
  Materials and Methods: The study comprised 74 patients analyzed between 01.01 and 31.12.2024 at Prof. Dr. Th. Burghele Clinical Hospital. They were divided into 2 Groups (Group 1: 37 cases—normal kidneys, and Group 2: 37 with malformations, including 25 identified with horseshoe kidneys and 12 with ectopic kidneys). The comparison investigation examined fluoroscopy time, intervention length, surgical complication rates, stone-free rate, urinary infection occurrences, stone distribution, and using the JJ stent preoperatively and postoperatively.
  Results: The gender distribution was uniform in both groups, with 22 females (59.5%) and 15 males (40.5%). The stone laterality was comparable across the two groups: 48.6% in the left kidney and 51.4% in the right kidney. Preoperative infections occurred more frequently in individuals with renal malformations (37.8% compared to 27%). Preoperatively, a JJ stent was inserted in 28 cases (75.7%) of patients with normal kidneys and in 34 cases (91.9%) of patients with deformed kidneys. The incidence of failure to access the stone was greater in defective kidneys (16.2% compared to 5.4%). The operative time was longer in patients with malformed kidneys, averaging 81.95 min., in contrast to 68.35 min. for those with normal kidneys (p = 0.001). The fluoroscopy time was also longer (77.7 s compared to 63.56 s—p = 0.16), indicating heightened technical complexity. Surgical complications exhibited no statistically significant differences (13.5% vs. 5.4%, p = 0.456), and the residual stone rate was similarly statistically insignificant (18.9% vs. 10.8%, p = 0.16).
  Conclusions: Patients with renal malformations had longer operative time and fluoroscopy exposure, but there was no increased incidence of surgical complications or statistically significant differences in stone-free rates.

UP-27.52—Lesson Learned from 120 Cases of Ureteroscopy in Children 

• Azli Mohsen ¹, Brahmi Miloud ², Bouhnik Abdelhalim ³, Benrabah Rabah ¹
  ¹ Kouba Hospital, Algiers, Algeria, ² Louna Hospital, Algiers, Algeria, ³ Kouba Hospital, Algiers, Algeria

• Introduction and Objectives: Minimally invasive treatment has become the gold standard for the management of urolithiasis in children. The incidence of urolithiasis in children varies across the globe; however, it is estimated at 1–2% of all cases of urolithiasis. While the incidence is low compared to the adult population, there is a documented increase in the last two decades. We evaluated the results of fragmentation of urolithiasis in children using ureteroscopy and highlighted its role in the treatment of urolithiasis in children by evaluating feasibility, safety and effectiveness.
  Materials and Methods: The study involved 120 children performed at the Dr Mohamed Seghir Nekkache Hospital in Algiers between September 2016 and December 2019. The children were treated by ureteroscopy after a nephro-pediatric consultation in order to rule out any metabolic or anatomical abnormalities. Our patients were followed up by a multidisciplinary team. The chronology of this follow-up was at 1, 3, 6 and 12 months and then annually.
  Results: The average age of patients was 7 years, with extremes ranging from 1 to 17 years. The average stone size was 14.33 mm a range of 10 to 20 mm and an estimated density of 1104 HU ranging from 550 to 1600 HU. The average operating time was 53 min ranging from 28 to 110 min. All the children were treated with ureteroscopy as follows: 49% by SRURS (Semi Rigid Ureteroscopy) and 51% by FURS (Flexible Ureteroscopy). The immediate success rate was 92.5%. We identified 5.8% of cases with surgical complications, which were minimal. The recurrence rate after a mean follow-up of 16 months was 22.5%.
  Conclusions: The minimally invasive treatment of urolithiasis in children is an effective and safe option to minimize the operating time and the duration of convalescence with rapid reintegration of the child in their school environment. The results are encouraging both in terms of the stone free rate and in terms of complications, which were mostly minimal. Additional efforts must be made to improve the prevention component. The generalization and demystification of minimally invasive techniques are essential to achieve optimal care for children with urinary stone.

27.5. Unmoderated Video ePosters

UVP-27.01—A Case Demonstration of the Safety and Effectiveness of Steerable Ureteroscopic Renal Evacuation (SURE) Using the CVAC Set: Point of Technique 

• Singh Abhishek, Pathak Niramya, Ganpule Arvind, Sabnis Ravindra, Desai Mahesh
  Muljibhai Patel Urological Hospital, Nadiad, India

• Introduction and Objectives: Renal stone can be treated with a flexible ureterorenoscope, which uses laser lithotripsy for stone fragmentation and basketing for stone removal or stone dusting; both the techniques increase procedural time with risk of residual stones with its subsequent issues like infections, renal colic, need of secondary procedures for stone removal, readmissions and new stone formation. To increase the stone clearance with active and passive irrigation and suction can be helpful. We aim to show the safety and effectiveness of this novel technique by studying the primary objective of evaluating stone clearance with an NCCT scan and secondary objective of safety analysis.
  Materials and Methods: We have selected one case for video demonstration and noted the perioperative details. Patient is a 44 years old gentleman with bilateral renal stones. We used the CVAC^® set which is a second-generation device that integrates direct vision into the steerable irrigation-aspiration catheter design, obviating the need for a separate ureteroscope for the procedure. The CVAC set includes two main components: the sterile, single-use CVAC Aspiration System and the reusable CVAC Image Processor. The CVAC Aspiration set has hydrophilic outer coating with 250-degree flexion, 11.9 Fr outer diameter and 7 Fr working channel. The laser used is UROLASE SP+ Thulium Fiber Laser 60 W (IPG, Photonics) with initial fragmentation mode settings of 1 J, 20 Hz. The access sheath used was 12/14 Fr Boston Scientific Access sheath. The patient underwent bilateral Double J stent placement to passively dilate the ureter, followed by bilateral sequential Retrograde Intrarenal Surgery 2 weeks later.
  Results: This patient had operative times of less than 60 min on both the sides and had complete clearance on the right side with renal concretions on left side on 30-day NCCT scan and had postoperative fever for 2 days which settled with antibiotics. We have similarly operated thirty-two more cases where we used this device. All patients have had good postoperative recovery with 20 patients having complete clearance and 13 patients having partial clearance; two patients had postoperative UTI.
  Conclusions: Use of SURE system using the CVAC set results in good stone clearance rates and less postoperative complications.

UVP-27.02—Combining Robot-Assisted Ureterolithotomy and Flexible Ureteroscopic Stone Removal Through Ureterotomy Site for Patient with Ipsilateral Renal and Large Ureteral Stones 

• Choi Jaeduck, Yoo Tag Keun, Kang Jung Yoon, Lee Jun Ho, Jung Hyuk-Dal
  Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea

• Introduction and Objectives: Management of patients with concurrent large ureteral and renal stones within a single procedure has been a challenge for urological surgeons. We report our experience of robot-assisted ureterolithotomy and flexible ureteroscopic stone removal through ureterotomy site and its efficacy for patient with ipsilateral renal and large ureteral stones.
  Materials and Methods: Between January 2021 and February 2025, ten patients underwent combined robot assisted ureterolithotomy and flexible ureteroscopy through ureterotomy site for unilateral large upper ureteral and renal stones. The transperitoneal approach was used in all patients using four 8 mm robotic trocars and one additional 5 mm trocar in the lateral position. We assessed the stone free status in 1 month following the procedure.
  Results: There were no conversions to open surgery. No intraoperative or postoperative complications were found. Mean operative time was 80.4 min (range 58–110 min). Mean sizes of ureter stones and renal stones were 17.4 mm (range 12–24 mm) and 8.1 mm (range 5–12 mm). Stent indwelling time was 4 weeks in all patients. The stone free rate after single procedure was 100% in all patients.
  Conclusions: Combining robot assisted ureterolithotomy and flexible ureteroscopy through ureterotomy site is safe and effective method for managing patients with concurrent renal and large ureteral stones.

UVP-27.03—Endoscopic Renal Parenchyma Tunnel Cauterization for the Management of Hemorrhage Using a 3-Fr Basket 

• Lezrek Mohammed ¹, Tazi Hicham ¹, El Yazami Oussama ¹, Yacoubi Souhail ¹, El Anzaoui Jihad ²
  ¹ Al Ghassani Hospital, Fes, Fes, Morocco, ² Military Hospital Moulay Ismail, Meknes, Morocco

• Introduction and Objectives: We present a video of our experience of endoscopic cauterization of the percutaneous parenchyma tunnel using a 3-Fr Basket.
  Materials and Methods: A 46-years-old female patient presented 4-cm right renal stone, programmed for PCNL. Under general anesthesia, the patient is placed in our standard position, the split-leg modified lateral position. A 24 Amplatz sheath percutaneous access is performed through a middle calyx. Endoscopic vision is not perfect secondary to a mild bleeding. Exploration of the parenchyma tunnel finds an active bleeding. Cauterization of the tract is decided an endoscopic electrode is not available. A 3-Fr Basket with a rounded tip is used. The current is passed in the basket by connecting the electrode of the electro-cautery unit pen with the inner metallic wire of the basket. In this case it is applied to the metallic tightening screw. The tip of the Amplatz sheath is retracted just outside the parenchyma tunnel. The basket metallic round tip is applied to the bleeding spots in the parenchyma, which are coagulated, until there is no more bleeding, and the vision is clear.
  Results: The electric cauterization of the percutaneous parenchyma tunnel was possible in few minutes. The endoscopic view has improved and became clear, which had allowed continuing the procedure. Control of the parenchyma tunnel at the end of the procedure showed a perfect hemostasis. This renal tunnel parenchyma cauterization can be used in the beginning of the PCNL procedure, if the Amplatz sheath tamponade is not sufficient, to have a clear vision during the procedure. Otherwise, it can be performed at the end of the procedure, to limit postoperative bleeding, especially during a tubeless PCNL, when the nephrostomy tube won’t be placed. Alternatives that can be used instead of an endoscopic electrode: a basket, a ureteral catheter with its steel stylet, a hydrophilic guidewire.
  Conclusions: The basket was successfully transformed into a cutting/coagulation electrode that was used through the Nephroscope. Electric cauterization of the percutaneous parenchyma tunnel was successful. It had allowed continuing the procedure. Will it be effective on large bleeding? More experience and studies are needed.

UVP-27.04—I Need a Longer Amplatz Sheath 

• Lezrek Mohammed ¹, Tazi Hicham ¹, El Yazami Oussama ¹, Yacoubi Souhail ¹, El Anzaoui Jihad ²
  ¹ Al Ghassani Hospital, Fes, Fes, Morocco, ² Military Hospital Moulay Ismail, Meknes, Morocco

• Introduction and Objectives: During PCNL, a longer Amplatz sheath is needed (large or obese patient, or a large hydronephrosis), but only standard ones are available. What is the solution? We present a video of our experience of technique how to make on the spot a longer Amplatz sheath.
  Materials and Methods: A patient presenting lower pole multiple stones, in a mal-rotated right kidney. The kidney and the lower calyx are at the limit of a standard length Amplatz sheath. A longer sheath is not available. For a longer Amplatz sheath, the 22-Fr working sheath is introduced (telescoped) into the first centimeters of a larger 24-Fr sheath. The new sheath is set beside the nephroscope and cut to the same length of the working shaft of the nephroscope. The new sheath is introduced over the Amplatz dilator of the smaller sheath.
  Results: It was possible to have a longer sheath, by telescoping 2 sheaths, which allowed to reach the calyx with the stone. 2 sheaths with 4-Fr difference can be used. However, it is better to use just 2-Fr difference: to force a 22-Fr into a 24-Fr one. It will be tighter, without risk of dismantlement of the sheaths into the patient. The only limitation is there is a step, when passing between sheaths, during introduction of the nephroscope.
  Conclusions: Telescoping 2 sheaths allowed to have a longer one and solve a per-operative problem.

28. Training and Education

28.1. Moderated Oral ePosters

MP-28.01—AI Guide and Applications in Urology: What Do the Clinicians Need to Know? 

• Ramadore Shreyaa ¹, Somani Bhaskar ²
  ¹ University of Southampton, Southampton, United Kingdom, ² University Hospital Southampton, Southampton, United Kingdom

• Introduction and Objectives: Artificial intelligence (AI) is becoming more prevalent in medical fields. With advancements in machine learning (ML), deep learning (DL), natural language processing (NLP), and computer vision, AI offers promising tools to improve diagnostic accuracy, treatment planning, and surgical precision. To better navigate these platforms, we have created a guide to better understand which platforms would be beneficial for specific aspects of urological practice.
  Materials and Methods: This study conducted a narrative review and comparative analysis of peer-reviewed literature from 2015 to April 2025 across PubMed and Embase. Keywords included “artificial intelligence,” “machine learning,” “urology,” “prostate cancer,” “urolithiasis,” and “robotic surgery.” Selected articles were evaluated for the type of AI used, application area, clinical outcomes, and limitations. Studies focusing on diagnostic tools, predictive models, and surgical assistance were prioritised. This data was summarised into a user-friendly guide format aimed at clinicians who would like to integrate the use of AI into their practice.
  Results: We found a small number (n = 10) of useful resources for urology, which are currently in clinical use. Some notable resources currently being used in urology include: “Quantib”, a platform focused on interpreting radiological findings, “Tempus”, which uses clinical records and molecular data to guide cancer therapy using AI, and “Proximie”, a platform used to enhance remote surgical collaboration and guidance via AI.
  Conclusions: AI is on track to revolutionise urology (and surgery in general) by improving patient outcomes and clinical efficiency. However, due to challenges regarding algorithm transparency, data privacy and clinical validation, this may take time to evaluate the pros and cons in practice. Further research is needed to standardise AI integration and address ethical concerns. This study shows how these concerns are being addressed by different platforms and how AI use can be applied at different points of the patient’s care and can enhance their experience.

MP-28.02—National Insights on Ergonomics Awareness, Training Gaps, and Workload Impact Among UK Urologists 

• Jha Anshu, Robertson Sophie, Luk Angus
  Freeman Hospital, Newcastle Upon Tyne, United Kingdom

• Introduction and Objectives: Work-related musculoskeletal disorders (WRMDs) are a significant yet often overlooked occupational hazard for surgeons worldwide. Urologists, frequently at the forefront of technological advancement, face distinct ergonomic challenges—operating in open, laparoscopic, or robotic modalities. While the physical consequences of these demands are increasingly acknowledged, there remains a global disparity in how surgical ergonomics are addressed within health systems, training curricula, and theatre environments. This study draws on a national survey of UK urologists to examine not only the burden of WRMDs but also systemic gaps in ergonomic training, equipment access, and cultural prioritisation—issues that resonate across international surgical communities.
  Materials and Methods: A national survey of UK urologists was conducted via the British Association of Urological Surgeons (BAUS). Responses were analysed across several domains, including MSK symptoms, perceived impacts on clinical performances, time off work, access to ergonomic resources, and engagement with preventative strategies.
  Results: Among 98 respondents, 93% reported MSK pain from surgery in the past year, with over half experiencing symptoms in ≥50% of cases. MSK pain negatively impacted surgical performance in 63% of respondents; one in ten reported cancelling or postponing operations due to WRMD. Over five years, 20% took time off due to MSK issues, with 8.1% requiring more than a week off. Ergonomics support was limited. 17% knew of ergonomic equipment in their theatres, and 41% of those used it over 50% of the time. 32% had no awareness of any ergonomic tools. Just 9.2% had received any formal ergonomics training—none through national training programs. Despite this, 91% agreed ergonomics should be formally taught in the curriculum. Notably, 14.3% have reduced or plan to reduce their workload due to WRMD, with 4% planning early retirement.
  Conclusions: WRMD is highly prevalent within urology and is further influenced by limited ergonomic infrastructure, training, and awareness. While the physical burden on surgeons is evident, opportunities to strengthen prevention strategies at the cultural and systemic levels remain underutilised. These findings support the need for formal ergonomic education, enhanced access to theatre adaptations, and the development of national guidelines to promote surgeon well-being and long-term workforce sustainability.

MP-28.03—The Contribution of Personalized Video Feedback to Robotic Partial Nephrectomy Training in Realistic 3D Tumor Kidney Models: Design, Production and Implementation 

• Sarikaya Ahmet Furkan, Tarim Kayhan, Koseoglu Ersin, Ozkan Arif, Aykanat Ibrahim Can, Esen Baris, Karaarslan Umut Can, Muduroglu Mustafa, Kanli Sevval, Kiremit Murat Can, Kordan Yakup, Balbay Mevlana Derya, Esen Tarik, Aydin Serdar, Canda Abdullah Erdem
  Koc University, Istanbul, Türkiye

• Introduction and Objectives: Traditional surgical training relies on a master-apprentice model, but limitations such as restricted working hours and evolving surgical techniques have led to the integration of simulation-based training. 3D printing has emerged as a valuable tool for enhancing surgical education, offering patient-specific anatomical models that improve skill acquisition. Additionally, personalized video feedback may further refine training outcomes. This study investigates the impact of 3D-printed renal models and video-based feedback on skill acquisition in robotic partial nephrectomy training.
  Materials and Methods: Forty urology residents without prior robotic surgery experience participated in this study. After completing a standardized theoretical and simulation-based training program, they performed partial nephrectomy on 3D-printed kidney models. The participants were randomly assigned to two groups: one received personalized video feedback based on their recorded surgical performances, while the other proceeded without feedback. Their surgical performance was evaluated based on dissection time, renorrhaphy time, total console time, and the amount of healthy renal parenchyma removed.
  Results: Initial comparisons between junior and senior residents showed no significant differences in their first operations, demonstrating that e-learning and proficiency-based simulation training effectively equalized skill levels before transitioning to 3D model-based training. This suggests that structured preparatory training with objective performance targets can enhance learning outcomes in surgical simulation. Additionally, 3D-printed models provide a significantly more cost-effective alternative to cadaveric and animal-based training, making high-quality surgical education more accessible and scalable. Residents who received video feedback demonstrated a greater percentage improvement in dissection time compared to the control group (46.63% vs. 23.62%, p = 0.043). The amount of healthy renal parenchyma removed significantly decreased in the video feedback group (p = 0.048), indicating improved surgical precision. No significant differences were observed in renorrhaphy times between the two groups, suggesting that video feedback primarily enhanced dissection skills.
  Conclusions: The integration of 3D-printed anatomical models with personalized video feedback enhances skill acquisition in robotic partial nephrectomy training. Video feedback significantly improves surgical precision by reducing unnecessary parenchymal removal and accelerating dissection time. These findings support the use of patient-specific 3D models and targeted feedback as cost-effective and scalable strategies to optimize surgical education and shorten the learning curve for complex procedures.

MP-28.04—What a Pain! Ergonomics and Work-Related Musculoskeletal Disorder Within Urological Subspecialties 

• Robertson Sophie, Jha Anshu, Luk Angus
  Freeman Hospital, Newcastle, United Kingdom

• Introduction and Objectives: Work-related musculoskeletal disorder (WRMD) is an acknowledged global problem within the surgical workforce. It can significantly impact both the surgeon and the patient, increasing waiting times and impacting quality of life. This study aimed to examine the prevalence and characteristics of WRMDs across urological subspecialties in the UK and to explore associated workplace practices and coping mechanisms.
  Materials and Methods: A survey was completed by UK Urologists via a national, professional urology society. Data was collected on demographics, musculoskeletal (MSK) symptoms & impact from operating and was separated by sub speciality: Endourology, uro-oncology, functional, andrology, core.
  Results: A total of 98 responses were received, 71M:27F. The majority of respondents were consultants (67%) from across the UK. Most had > 10 years’ experience in their sub speciality (69%). Speciality breakdown: endourology (41%), uro-oncology (18%), functional (9%), andorology (7%), core (25%). Eye strain was common across all subspecialties (except robotics), with 65% wearing glasses or contact lenses. Among those regularly exposed to ionising radiation, 88% reported consistent use of lead aprons, and 58% did not use protective eyewear during these procedures. Within each subspeciality there are differing WRMD results. For endourology, back and shoulder pain were the most prevalent—84% experiencing pain up to 100% of the time and experience pain in all domains. Laparoscopic—100% had neck and shoulder pain (25–100% of the time) and experienced pain in all domains. 9%, 20% and 17% of surgeons performing endo, core and open urological surgery respectively reported having to cancel or postpone surgery due to WRMD over the past year. In comparison, robotic surgery had more favourable ergonomic outcomes, in all the domains, majority of responses never had any pain (except occasional back and hand/wrist pain), and there was a 0% cancellation rate. Oral analgesia and stretching exercise were the most prevalent coping mechanisms amongst all subspecialities apart from open surgery where they did not use coping mechanisms.
  Conclusions: WRMDs are prevalent across all urological sub-specialities. These findings support the need for ergonomic interventions, improved protective practices, and incorporation of subspecialty-specific ergonomics training into the national curricula.

28.2. Moderated Video ePosters

MVP-28.01—A Vegetal Model for Teaching/Learning Percutaneous Tract Dilation 

• Lezrek Mohammed ¹, Tazi Hicham ¹, Yacoubi Souhail ¹, El Yazami Oussama ¹, El Anzaoui Jihad ²
  ¹ Al Ghassani Hospital, Fes, Fes, Morocco, ² Military Hospital Moulay Ismail, Meknes, Morocco

• Introduction and Objectives: We present a video of our experience of percutaneous tract creation on vegetable and fruit models, for initial learning of percutaneous tract dilation. Showing a demonstration of a training on a piece of a winter-squash. We present a video of our experience of percutaneous tract creation on vegetable and fruit models, for initial learning of percutaneous tract dilation. Showing a demonstration of a training on a piece of a winter-squash.
  Materials and Methods: For percutaneous tract dilation training, a piece of winter squash of 10/15 cm is placed on a glass jar. Puncture with an 18-Gauge needle, a guidewire is inserted and coiled in the jar. Sequential dilation to 12 Fr. The central Amplatz catheter is inserted, then “one shot” dilation is performed with a 24 Fr Amplatz dilator and sheath. Other vegetables were tried for the dilation: eggplant, grapefruit and similar, butternut, squash, yellow melon.
  Results: The winter-squash model is simple and rapid to set up. It is economical, by using very cheap and available material. Insertion of a safety guidewire and all the other techniques of dilation could be used in this model. Furthermore, this model can be used in classrooms, meetings, workshops. 3 or 4 participants can learn on the same model. It allows beginners the initial feeling of the tract dilation and dilator progression. Models based on other vegetables and fruits are tried. They all allow training on different dilators and access for mini or standard PCNL access. Hard skin vegetables give more difficulties and produce a similar feeling of the real percutaneous dilation. These models have been used in many workshops in Morocco, Senegal, Cameroon, Mali, EULIS Paris 2019, Pakistan, Qatar… Evaluations submitted by training session participants revealed a high degree of satisfaction with model effectiveness in the training of percutaneous tract dilation. In addition, participant that are routinely doing PCNL evaluated that this model gives a similar feeling of dilator progression in real percutaneous tract dilation.
  Conclusions: The vegetable and fruit models allow beginners the initial feeling of the tract dilation and dilator progression. It can be used in classrooms and workshops. However, further studies are needed for validation.

28.3. Residents Forum Moderated Oral ePosters

RF-28.01—Determinants of Burnout and Satisfaction Among UK Urology Trainees: A Narrative Review 

• Jacob Dayan
  James Cook University Hospital, Middlesbrough, United Kingdom

• Introduction and Objectives: Burnout is a pressing challenge faced by surgical trainees, driven by increasingly demanding workloads, poor work life balance, and a lack of training opportunities as per the latest RCSEng surgical workforce report. UK urology trainees face specific pressures, including the increasing on-call duties and academic demands as well as a perception of poor pay which impact wellbeing and job satisfaction. Understanding burnout and trainee satisfaction is vital for retaining a motivated future workforce. This review aims to identify the determinants of burnout and satisfaction among Urology trainees.
  Materials and Methods: A systematic literature search was conducted across PubMed, Google Scholar, Scopus, and Embase. Studies investigating burnout and satisfaction among UK urology trainees were included, with no restrictions on study design. Descriptive statistics were carried out using Microsoft Excel.
  Results: 143 articles were screened, and two studies involving data from 75 urology trainees were included. One study of 49 trainees reported burnout (63.5%, n = 31) as a major factor influencing decisions to leave the specialty, alongside rota gaps leading to increased on-calls (57%, n = 28), poor pay (55%, n = 27), and inadequate resources affecting care quality (55%, n = 28). Twenty-four trainees considered leaving urology. The second study assessed the Reboot C intervention in coping with burnout, finding a mean burnout score of 15 among urology trainees, indicating moderate burnout levels.
  Conclusions: Burnout negatively impacts UK urology trainees, leading to dissatisfaction and potential attrition. Key determinants for burnout include rota gaps, inadequate pay, and unavailability of resources. Interventions like Reboot C show potential in mitigating burnout, but further research and targeted strategies are needed to improve trainee wellbeing and retention while addressing the above determinants.

RF-28.02—The Impact of Stress Beliefs on Physiological and Cognitive Responses to Acute Stress in Urology Trainees 

• Ong Kelly ¹, Hotton Matthew ², Cashman Helen ³, Doherty Ruth ⁴, Rochester Mark ⁴, Wadhwa Karan ⁵, Biyani Chandra ⁶, Cooper Lilli ⁷
  ¹ Whipps Cross Hospital, London, United Kingdom, ² Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, Oxford, United Kingdom, ³ St James’ Hospital, Leeds, United Kingdom, ⁴ Norfolk & Norwich University Hospital, Norfolk & Norwich, United Kingdom, ⁵ Broomfield Hospital, Broomfield, United Kingdom, ⁶ Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom, ⁷ REAL Clinic, London, United Kingdom

• Introduction and Objectives: Stress beliefs significantly shape physiological and cognitive responses. This study investigates how Beliefs About Stress Scale (BASS) scores and trait anxiety influence these responses during acute stress.
  Materials and Methods: Sixty-six urology trainees (43 male, 23 female) completed BASS and trait anxiety questionnaires. Physiological response in the form of heart rate variability (HRV) measures was monitored continuously, and cognitive flexibility was assessed using the Stroop test. Acute stress was induced using the validated Trier Social Stress Test (TSST), a three-phase protocol encompassing anticipatory, interview, and arithmetic tasks. Generalised linear models were used to investigate the relationships between BASS/trait anxiety scores and HRV during stress, whilst accounting for demographic differences. Their impact on Stroop interference will also be considered as a secondary outcome.
  Results: Preliminary analyses revealed limited relationships between BASS scores, trait anxiety, and stress outcomes. Spearman correlation analyses showed a moderate positive association between negative BASS scores and HRV measures. Specifically, higher negative beliefs were significantly correlated with smaller reductions in HRV (RMSSD: rho = 0.368, p = 0.002; pNN50: rho = 0.267, p = 0.003), suggesting that, as negative beliefs increase, HRV suppression during stress diminishes. There was no correlation of Stroop interference with BASS scores.
  Conclusions: Initial results showed that higher negative stress beliefs were associated with smaller reductions in HRV during acute stress, suggesting attenuated physiological stress responses. This counterintuitive finding challenges traditional views on stress beliefs and highlights the need for further research into tailored stress management interventions in high-stakes environments such as urology training.

28.4. Unmoderated Standard ePosters

UP-28.01—Characteristics of the Learning Curve in Laparoscopic Surgery Training for Young Trainees 

• Kamijo Chihiro, Yan Lingbo, Ebina Koki, Higuchi Madoka, Miyata Haruka, Kikuchi Hiroshi, Kon Masafumi, Matsumoto Ryuji, Osawa Takahiro, Hotta Kiyohiko, Konno Atsuhi, Abe Takashige
  Hokkaido University, Sapporo, Japan

• Introduction and Objectives: We have been analyzing the motion features of surgical devices by tracking and recording infrared markers attached to forceps during wet lab training using porcine organs to acquire laparoscopic surgical skills (Ebina K. Abe T et al. Surg Endosc 2021; Ebina K. Abe T et al. Langenbecks Arch Surg 2022). This study aimed to investigate the characteristics of the initial learning curve in laparoscopic surgical skills among young trainees.
  Materials and Methods: 10 participants who completed five training sessions were included in the present study. The training tasks consisted of tissue dissection around a porcine aorta and renal parenchymal closure. The infrared markers attached to the surgical devices were tracked and recorded at 120 Hz by a MotionCapture camera to measure surgical devices dynamics such as movement distance, velocity, and angle of rotation, etc. The characteristics and learning curves of the motion features of surgical devices in a novice group of six trainees with 0–9 laparoscopic surgical experiences were compared and analyzed with those of the experts.
  Results: Task time (40.0 min at first trial vs. 25.2 min at fifth trial, p < 0.05) and path length (41.2 m vs. 26.8 m, p < 0.05) significantly improved but did not reach the level of the expert surgeons who had performed over 100 cases. Values are presented as means, and statistical analysis was performed using Student’s t-test. No significant improvement was observed in speed-related parameters of both forceps, indicating the absence of a learning curve in this aspect (2.2 cm/s vs. 2.4 cm/s, p = 0.56). In renal parenchymal closure, the angler length of the left needle holder relative to the trocar axis decreased but did not reach the level of experienced surgeons. On the other hand, the angler length of the right needle holder decreased (1745.4 degrees vs. 924.5 degrees, p < 0.01) and reached the level of the experts.
  Conclusions: The novice group exhibited a learning curve in task completion time, forceps trajectory length, and angler length relative to the trocar, showing improvement in efficiency-related parameters. However, further training is required to achieve improvement in speed-related parameters.

UP-28.02—Diagnosis and Treatment of Urethral Stricture: Implementation of Guidelines into Clinical Practice 

• Abalı Tunahan ¹, Altınay Samet ¹, Kaçtan Çağrı ², Kocak Mehmet ¹, Albayrak Selami ³, Horuz Rahim ³, Laguna Pes Pilar ³, De La Rosette Jean ³, Vosoughi Oktay ¹
  ¹ Istanbul Medipol University, İstanbul, Türkiye, ² Institution Medipol Mega University Hospital, İstanbul, Türkiye, ³ Medipol Mega University Hospital, İstanbul, Türkiye

• Introduction and Objectives: Whereas standards in the diagnosis and treatment of urethral stricture are well-defined, remarkably substantial variations in handling urethral strictures exist. A comprehensive survey was undertaken to assess differences in clinical practice and their adherence to (inter)national guidelines in the diagnosis and treatment of urethral strictures.
  Materials and Methods: An online survey via Survey Monkey was sent to Turkish Urology Association members and was open for responses for 2 weeks, with two reminders. Data collection and statistical evaluation were centralized, and descriptive statistics were used.
  Results: 222 out of 2,078 participants took part in the survey (response rate 11%). Most respondents aged 30–45 years. In the assessment, uroflowmetry, cystourethroscopy and retrograde urethrography were used by 90%, 61% and 26% of respondents, respectively. Urologists in academic centers used these investigative methods considerably more often. The proportion of blind dilatation with metal bougies was higher (46.31%) than with plastic dilaters over the guidewire (23.15%) or single use urethral catheters (27.09%). No noteworthy correlation was found between years of practice and material preference (p = 0.39). Conversely, methods other than metal bougies were more used in academic centers (p = 0.04). For management of 1–2 cm primary bulbar urethral strictures, 7.39% of participants favored urethroplasty, while 77.83% preferred Direct Vision Internal Urethrotomy (DVIU) followed by a urethral dilatation schedule. Urologists working in an academic setting performed considerably more urethroplasty procedures (p = 0.01). Furthermore, 75.86% performed DVIU ≥ 4 times for stricture recurrences, and 79.3% commended periodic dilatation post-DVIU.
  Conclusions: The diagnostic and therapeutic approaches regarding (un)complicated urethral strictures are often not in line with recommendations from current (inter)national guidelines. The use of retrograde urethrography is low while metal bougies continue to be widely used for urethral dilatation. The number of urologists performing urethroplasty remains low, and therefore repetitive procedures of DVIU and dilatation are more common than expected. Urologists in academic centers more often follow guideline recommendations compared to non-academic counterparts.

UP-28.03—Improving Student Engagement and Opportunities During Urology Placements by Facilitating Independent Learning 

• Carey Charles
  Manchester University NHS Foundation Trust, Manchester, United Kingdom

• Introduction and Objectives: Lacking a urology ward was preventing students from identifying patients to learn from and therefore benefiting from key educational opportunities. This quality improvement project (QIP) aimed to empower students to independently review and learn from patients during their urology placement.
  Materials and Methods: Students were asked to highlight issues with their learning at the mid-point of their five week urology placement during cycle one of the QIP. They were then given access to a list containing patient locations and learning opportunities. Students participating in cycle two were given access to the list and a urology syllabus during their placement induction. The quantitative and qualitative impacts of these interventions were examined at the end of their placement.
  Results: The baseline questionnaire was answered by 19 cycle one students, of which 15 (78.9%) reported difficulty finding patients to assess. After the patient list was introduced, 14 (93.3%) stated that this intervention helped them achieve all of their learning objectives. 13 (86.7%) stated that the list helped them speak to and examine patients significantly. Qualitative analysis showed that the list generated improvements in four distinct domains: identifying and locating patients to learn from, using time efficiently, achieving educational goals and developing key skills. 12 students participating in cycle two provided feedback about the influence of the patient list and syllabus on their learning. 11 (91.7%) reported that the list helped meet their learning objectives and 9 (75.0%) stated that it helped them find patients to review. Almost all respondents felt that the syllabus identified topics that needed strengthening. Qualitative data showed that many would have struggled to find patients to learn from without these interventions.
  Conclusions: The patient list and urology syllabus consistently improved student engagement and learning in multiple domains. Similar interventions should be trialled in other urology units and adapted for other specialties.

UP-28.04—Lost in Translation: Assessing the Readability of Urology Outpatient Clinic Letters 

• Leiberman Christopher, Lee Xiang Wei, Nalagatla Sarath
  University Hospital Monklands, Airdrie, United Kingdom

• Introduction and Objectives: Effective communication is central to high-quality healthcare. In Scotland, the average adult reading age is 9–11 years. Despite this, many patients struggle to understand medical correspondence, with 40–80% of information forgotten immediately and up to 50% recalled incorrectly. Recognising this, the Academy of Medical Royal Colleges (2018) and Good Medical Practice (2020) advocate for writing outpatient letters directly to patients, using language they can understand. NHS guidance recommends a reading age target of 9–11 years for clinical communication.
  Materials and Methods: Clinic letters from a single consultant-led urology outpatient clinic were analysed using Microsoft Word’s Flesch-Kincaid readability tool, which calculates reading ease and estimated US school grade levels. Letters were stratified by author grade (Consultant, Registrar, SHO) and whether they were addressed to the patient or GP.
  Results: Thirty outpatient letters were included (13 Consultant, 12 Registrar, 5 SHO). Only 6 letters (20%) were addressed to the patient, with the remaining 80% directed to the GP, and patients were not routinely copied in. The overall median Flesch reading score was 57 (range 48–72), equivalent to a US Grade 10, or a reading age of 14–15 years—well above the recommended target. Letters written by consultants had the highest readability (median score 60; age 12–13), while Registrar (score 55; age 15–16) and SHO letters (score 55; age 17–18) were more complex.
  Conclusions: This study highlights a mismatch between the readability of outpatient clinic letters and the NHS-recommended standards for accessible communication. Most letters were written for GPs and not shared with patients, and, when analysed, the median reading level far exceeded the average patient’s reading age. Consultant letters were closest to the readability target, while more junior doctors produced less accessible communication. These findings underscore the need for system-wide adoption of patient-centred writing practices, training in health literacy, and the implementation of readability tools in everyday clinical documentation to enhance patient understanding and engagement.

UP-28.05—Reducing Surgical Harm: A Quality Improvement Audit of Urology Morbidity and Mortality Meetings 

• Obudi Sara ¹, Anandkumar-Sreevidya Gopikaa ¹, Ajzajian Jirayr ¹, Kodera Ahmed ²
  ¹ Worcestershire Acute NHS Trust, Alexandra Hospital, Redditch, United Kingdom, ² Worcestershire Acute NHS Trust, Redditch, Redditch, United Kingdom

• Introduction and Objectives: Morbidity and Mortality (M&M) meetings provide a structured forum to identify clinical errors, adverse outcomes, and system failures in a non-punitive environment. By analysing contributory factors and assigning responsibility for learning and action, M&M meetings promote accountability and continuous improvement. Aiding in minimising the recurrence of similar incidents and fostering a culture of safety. Ultimately reducing surgical harm and improving patient care outcomes. Our primary objective was to assess the quality of our case presentations in accordance with guidelines set by the Royal College of Surgeons (RCS) of England. Our secondary objective was to develop an intervention to address areas of weakness.
  Materials and Methods: A retrospective review assessed the standard of patient case presentations at our M&M meetings over 12 months. The depth of clinical analysis, contributory factors, and the effectiveness of the identified learning points in guiding future harm reduction and improving patient safety were analysed. A standardised framework for case presentation was developed to address identified weaknesses in relation to the established guidelines. We then conducted a re-audit to assess our adherence to this framework.
  Results: This audit revealed suboptimal compliance with several RCS standards. Clear documentation of contributory factor analysis was identified in only 13% of the cases discussed. The Standard of Care was insufficiently evaluated for all 89 cases presented in this time. Grading of Preventable Harm and identification of Key Learning points from each case appeared limited or absent. Following the implementation of a structured framework based on the RCS England guidance, a re-audit showed 100% compliance with key standards.
  Conclusions: The original audit demonstrated significant deficiencies in the structure and learning value of our M&M meetings, limiting their potential to drive quality improvement and reduce surgical harm. Our intervention addressed these shortcomings and enhanced the consistency, accountability, and educational value of our meetings. We aim to consistently audit our practice to ensure standards are maintained across rotational workforce changes. We encourage other centres to adopt this framework to improve the quality of their M&M analysis and ultimately reduce surgical harm.

UP-28.06—Trends in the Career Choices of Urology Graduates: The Example of an Emerging Country 

• Guebbas Salim, Mouslim Othmane, Chatar Achraf, Taouhid Mohamed, Lakmichi Mohamed Amine, Dahami Zakaria, Sarf Ismail
  Mohammed VI University Hospital, Marrakech, Morocco

• Introduction and Objectives: Urology plays a crucial role in the diagnosis and treatment of urinary tract and reproductive system disorders. Graduates from the Faculty of Medicine and Pharmacy of Marrakech (FMPM) have contributed significantly to this specialty in Morocco, especially in the southern cities. The main objective of this study is to evaluate their professional choices, sector of activity, geographical distribution. The other objective is to analyse the reasons behind these choices.
  Materials and Methods: All graduates from the Faculty of Medicine and Pharmacy of Marrakech were included in this single-center, cross-sectional study. We selected those who chose urology as their specialty. Data were collected through a graduate census and an online questionnaire. Key variables included the year of graduation, sector of activity, region of installation, and motivations for career choices. SPSS was used for Statistical analyses.
  Results: Out of the 2041 graduates, 30 chose urology as their specialty, representing about 1.5%. The analysis revealed a predominant practice in the public sector, with 47% of urologists working in public institutions, compared to 23% in the private sector. A centripetal distribution was observed geographically, with the highest concentration in urban areas like Marrakech-Safi. Regarding the reasons for choosing urology, 80% of respondents cited a strong passion for surgical medicine, particularly urological surgery. Other motivations included fascination with the specialty’s technical aspects and a desire to address complex medical challenges. Private sector urologists were motivated by professional independence and financial rewards, while public sector urologists focused on public health, serving underserved populations, job stability, and professional development.
  Conclusions: This study highlights the centripetal distribution of urology graduates from the FMPM, with a strong preference for urban regions and the public sector. The reasons behind sector choice reflect a balance between personal aspirations (such as financial independence) and professional values (such as contributing to public health). These findings offer important insights for the training and support of future urology professionals in Morocco and other emerging countries.

UP-28.07—What Traits and Skills Do Urology Programs Value in Medical Students? A Cross-Sectional Survey of Canadian Urology Program Selection Committee Members 

• Niakani Sepehr ¹, Aubé-Peterkin Mélanie ²
  ¹ McGill University, Montreal, Canada, ² McGill University Health Center, Montreal, Canada

• Introduction and Objectives: Clerkship is a critical period when medical students explore specialties and develop clinical skills. It also enables programs to evaluate students for residency selection. Surveys of residency programs have revealed that performance during an elective is the most essential criterion for choosing trainees. We aim to identify the traits and skills most valued by programs, as they are often implied but rarely assessed directly.
  Materials and Methods: Using the Canadian Medical Education Directives for Specialists (CanMEDS) framework, we created 21 attributes. Next, we designed a best-worst scaling survey via the Lighthouse Studio Software where respondents selected the best and worst choices among 5 options across 21 randomized sets of questions. The survey was distributed to Canadian urology programs in February 2025 and closed in March after two reminders. Using the Hierarchical Bayes method, we estimated the relative importance of each attribute at both the individual and aggregate levels. Scores are presented on a probability scale summing to 100 with 95% confidence intervals (CI), where higher scores indicate greater perceived importance and reflect selection likelihood within the survey.
  Results: Respondents included 8 program directors, 4 urologists, and 1 resident (n = 13). The top three attributes were “Demonstrating appropriate behaviour” (12.43 [11.86, 13.00]), “Exhibiting reliability and independence” (9.66 [8.48, 10.86]), and “Seeking out responsibilities” (9.60 [7.87, 11.32]). The lowest three were “Effective presentation skills during journal clubs” (0.28 [0.00, 0.70]), “Incorporating evidence on health disparities in urology” (0.093 [0.011, 0.18]), and “Discussing barriers to care and proposing solutions” (0.034 [0.0039, 0.064]). Among the CanMEDS roles, Professional and Leader were prioritized (9.86 and 8.13, respectively), while Scholar and Health Advocate ranked lowest (0.17 and 1.79, respectively).
  Conclusions: Our results illustrate the importance of integrity, reliability, and initiative when completing urology electives, while there is a low emphasis on research and advocacy. The low ranking of health advocacy suggests it may not be prioritized in clerkship evaluations, highlighting an opportunity for greater integration into medical education. Despite the limited sample size (n = 13), this study offers valuable insight into urology selection criteria, helping students prepare for rotations and residency applications.

29. Trauma

29.1. Moderated Oral ePosters

MP-29.01—Urethral Catheterisation Device (UCD^®) for Difficult Catheter Insertion in the Emergency Department 

• Williams Zoe ¹, Ayeni Femi ², Kang Song ¹, Combes Alexander ¹, McClintock George ¹, Saad Jeremy ¹, Shanmugasundaram Ramesh ¹, Bhoopathy Varun ¹, March Brayden ¹, Thangasamy Isaac ¹, Jeffery Nicola ¹
  ¹ Nepean Hospital, Sydney, Australia, ² The University of Sydney, Nepean Clinical School, Sydney, Australia

• Introduction and Objectives: Catheter-associated urethral injury (CAUI) occurs in 13.4 per 1000 catheterised males. A urethral catheterisation (UC) device with an integrated guidewire (Urethrotech UCD^®) can facilitate safe and successful UC by non-urologists when first-line techniques are unsuccessful. This study assesses the implementation of a protocol for difficult urethral catheterisation (DUC) incorporating the UCD^® in an Australian Emergency Department and evaluates the cost-effectiveness of this approach.
  Materials and Methods: A prospective trial was conducted over 12 months in an Australian tertiary hospital Emergency Department. For the first 6 months, referrals to urology for assistance with male DUC or management of CAUIs were audited. For the second 6 months, a protocol for male DUC was implemented and trialled. The protocol initiated UCD^® use after failed male UC with a 16 Fr catheter. The cost of urology involvement for assistance with male DUC and CAUI care was obtained from the hospital Finance Department.
  Results: In the 6-months without the DUC protocol, there were 13 referrals to urology for assistance with male DUC or CAUI management. Urology attended to perform UC over a guidewire in 9 patients using blind technique (n = 5) or guided by bedside flexible cystoscopy (n = 4). CAUIs during this period included urosepsis (n = 3), false passages (n = 2), urethral strictures (n = 1), and periurethral bleeding (n = 1). The complications required urology admission (n = 7), a period of UC and outpatient trial of void (n = 4), or rigid cystoscopy (n = 1). After introduction of the DUC protocol, the UCD^® was used in 9 patients and was successful in 7 patients (78%). Correspondingly, there were fewer referrals to urology for assistance with male DUC (n = 2) and fewer cases of CAUI (n = 2). Urology attended to perform UC aided by bedside flexible cystoscopy in 2 patients. CAUIs during this period included a bulbar urethral mucosal flap (n = 1) and a prostatic urethra false passage (n = 1). The mean cost of DUC-related care for patients for whom the UCD^® was trialled (successfully or unsuccessfully) was $1003 per patient, compared with a mean cost of $2154 for DUC-related care when UCD^® was not used.
  Conclusions: The UCD^® is a successful UC technique and reduces patient morbidity, referrals to urology services, and health system costs.

29.2. Unmoderated Standard ePosters

UP-29.01—Optimizing Outcomes in Testicular Trauma: A Systematic Review of Surgical and Conservative Approaches 

• Chang Ruei-Je
  Chang Gung Memorial Hospital, Taoyuan, Taiwan

• Introduction and Objectives: Testicular trauma, although relatively rare, represents a urological emergency with significant implications for testicular viability, endocrine function, and future fertility. The optimal management approach—surgical versus conservative—remains controversial, particularly in cases with equivocal imaging findings or borderline clinical presentations. This systematic review aimed to compare the clinical outcomes of surgical and conservative management of testicular trauma, focusing on testicular salvage, endocrine function, fertility outcomes, and complication rates.
  Materials and Methods: A systematic literature search was conducted using PubMed, Scopus, and the Cochrane Library to identify studies published up to 2015 that compared surgical and conservative treatment in testicular trauma. Inclusion criteria comprised studies reporting outcomes including testicular salvage rates, serum testosterone levels, semen analysis, and complication profiles. The quality of included studies was assessed using the AMSTAR tool.
  Results: Ten studies with a total of 280 patients were included in the analysis. Surgical management, primarily indicated for tunica albuginea rupture or large intratesticular hematomas, resulted in higher testicular salvage rates. Conservative management was effective for minor injuries, such as contusions or small hematomas, and was associated with fewer immediate postoperative complications. Long-term outcomes—including endocrine and fertility parameters—were comparable between both groups. However, the incidence of delayed testicular atrophy was notably higher in conservatively managed patients. Surgical intervention remains the preferred approach in severe testicular trauma, particularly in patients with sonographic or intraoperative evidence of rupture or significant hematoma. Early exploration facilitates tissue preservation and reduces the risk of orchiectomy. While conservative treatment may be suitable for less severe injuries, it carries a higher risk of delayed complications, including testicular atrophy. Despite differing initial management strategies, long-term reproductive and hormonal outcomes appear similar. Careful patient selection and shared decision-making are critical to optimizing outcomes.
  Conclusions: Management of testicular trauma should be guided by injury severity. Surgical treatment offers superior salvage in severe cases, whereas conservative management remains appropriate for selected minor injuries. Future prospective trials are necessary to establish evidence-based guidelines for optimal care.

UP-29.02—Outcomes and Consequences of Traumatic Transurethral Catheterization: Mid Term Follow up from a Prospective Registry from 5 University Hospitals 

• Alrais Mahmoud ¹, Calik Gokhan ², Laguna Pes Maria Del Pilar ¹, Kocak Mehmet ¹, Horuz Rahim ², Albayrak Selami ², De La Rosette Jean ¹, M.S. Ashour Shaban ¹, Alrifaai Mohamad Aosama ¹, Al Chaabawi Abdullah ¹, Abdi Ali Ibrahim ¹
  ¹ Istanbul Medipol University, Istanbul, Türkiye, ² Medipol Mega Hospital, Istanbul, Türkiye

• Introduction and Objectives: An estimated 25% of inpatients undergo transurethral catheterization of which some are traumatic. The primary aim is to obtain information from persons involved in the traumatic catheterization and learn about their background and expertise. We also aimed to learn about the outcome of the complicated catheterizations and possible long-term consequences.
  Materials and Methods: This prospective, cross-sectional questionnaire-based study conducted in 5 University Hospitals was designed to capture data on traumatic catheterizations. A traumatic catheterization was defined as catheterization that necessitates intervention of a urologist (in training) following a failed attempt. At 1 year after the traumatic catheterization, patients were followed by telephonic interview. Information was collected about the patient’s current health profile, need for continued transurethral catheter, presence of short or long-term urethral complications.
  Results: 46 patients experienced a traumatic catheterization. The average age of patients was 61 years (range 6–88) with a male:female ratio of 4:1. Most patients suffered from male LUTS (n = 25) followed by cardiovascular comorbidity (n = 15), endocrine disorder including DM (n = 7), and neurological disorders (n = 3). Most cases are from inpatient wards (n = 41). Post catheterization complications in males included mainly UTI (n = 16), urethral strictures (n = 9), and urinary retention (n = 14). At midterm 9 patients died from unknown causes, 2 patients required permanent catheterization, 4 patients required prostate surgery (TURP or laser treatment), 11 patients needed optical urethrotomy. Post catheterization complications in females were only UTI (n = 5). The traumatic catheterizations were reported by urologists or urologists in training (n = 21), cardiologists (n = 5), oncologists (n = 3), emergency (n = 4), internal medicine (n = 3), anaesthesiology (n = 3), nephrologists (n = 2), pediatrics (n = 2), pulmonology, geriatrics, and ICU (n = 3).
  Conclusions: While labelled a low complex procedure, transurethral catheterization can result in significant complications. Most traumatic catheterizations are done by urologists, most probably because they are consulted for complicated cases. Most patients are high risk cases needing consequent treatments including urethral repairs. This calls for risk stratification in transurethral catheterization in combination with dedicated training programs and protocols to increase the knowledge of catheterizations and consequently reduce the complication rate.

30. Voiding Dysfunction

30.1. Moderated Oral ePosters

MP-30.01—Assessing the Capability of ChatGPT in Interpreting Uroflowmetry Studies and Developing Clinical Management Plans 

• Almazeedi Abdulrahman ¹, Almarzouq Ahmad ², Yaiesh Said ¹, AL-shaiji Tariq ¹
  ¹ Jaber Alahmad Hospital, Kuwait City, Kuwait, ² Sabah Alahmad Urology center, Department Of Surgery, Urology Unit, Kuwait

• Introduction and Objectives: Uroflowmetry is a key diagnostic test in assessing and diagnosing lower urinary tract symptoms. ChatGPT is a large language model that generates human-like text responses based on user prompts, showing potential in healthcare data analysis. The use of Al has shown promising findings in interpreting radiological studies in urology and pathology specimens. The study aims to evaluate ChatGPT ability to interpret uroflowmetry studies and formulate appropriate management plans, comparing its performance to that of expert humans.
  Materials and Methods: We included patients aged 18–85 who had undergone a uroflowmetry study between March and June 2024. A standardized template, which included patient demographics, presenting symptoms, and a printout of the uroflowmetry study, was inputted to ChatGPT (version 4o) and was prompted to analyze the uroflow shape pattern, readings of the void volume, Qmax, flow time, average flow (Qavg), time to maximum flow, and the PVR obtained using u/s ultrasound at the end of the uroflowmetry study. The uroflowmetry study, clinical impression, and management plans were compared with those of 2 expert urologists to assess the concordance.
  Results: Data were collected from 100 patients, with the majority being female 60% and a mean age of 38 years. ChatGPT demonstrated a concordance rate of 94.3% for the uroflowmetry graph’s shape pattern. The voided volume, Qmax, flow time, Qavg, and time to maximum flow showed a concordance rate of 91.2%. The concordance rate for the clinical impression was 88.5% and for management plans was 85.8%. Overall concordance including shape, parameters, impression and management was 90.85%.
  Conclusions: ChatGPT achieved high concordance rates when compared to expert interpretations of uroflowmetry studies, clinical impressions, and management plans. These findings highlight the potential of AI software to support clinical decision-making in urology and warrant further research to explore its broader applications and integration into clinical workflows.

MP-30.02—Can ChatGPT Interpret Urodynamic Studies and Formulate Clinical Management Plans? 

• Almazeedi Abdulrahman ¹, AlBoloushi Noor ², Abdullah Ali ², Yaiesh Said ¹, AL-shaiji Tariq ¹, Almarzouq Ahmad ³
  ¹ Jaber Alahmad Hospital, Kuwait City, Kuwait, ² Jaber Alahmad Hospital Kuwait, Kuwait City, Kuwait, ³ Sabah Alahmad Urology Center, Department Of Surgery, Urology Unit, Kuwait

• Introduction and Objectives: Urodynamic studies (UDS) are an integral diagnostic test in urology. The use of artificial intelligence (Al) in healthcare has shown great potential with a growing body of evidence of superiority in the fields of radiology and pathology. This study aims to compare UDS traces interpretation using ChatGPT to expert human interpretation. In addition, treatment plan formulation by ChatGPT will be compared to experts.
  Materials and Methods: We conducted a comparison between ChatGPT analysis and expert urologist assessments of UDS traces. Inclusion criteria were patients aged 18–85 who underwent UDS between March and September 2024. UDS traces were selected based on the clarity and completeness rather than specific patient demographics, age, gender, or pre-existing diagnoses. Each case included patient basic demographic details (age and gender) and chief complaint to provide clinical context. The selected UDS trace components as well as nomograms were analyzed independently by both ChatGPT and expert urologists. A diagnosis and treatment plan were then formulated by ChatGPT systematically and compared to those of the experts. The concordance of each parameter was evaluated and analyzed. Institutional board review approval was obtained.
  Results: We analyzed 100 traces, majority of which were females (75%), with a mean age of 49. ChatGPT interpretations of urodynamic studies were compared to expert urologists, assessments for each parameter, diagnosis, and management decision using a binary concordance system (0 = no match, 1 = match). During the filling phase, ChatGPT demonstrated high concordance rates with expert assessments: bladder capacity (96%), compliance (90%), leakage (88%), sensation (87%), EMG readings (85%), and uninhibited detrusor contractions (80%). In the voiding phase, high concordance was calculated for voided volume (93%), Qmax (80%), while moderate concordance was observed for Pdet at Qmax (66%), after-contractions (62%), and bladder contractility index (60%). ChatGPT’s diagnostic conclusions matched expert opinions in 77% of cases, and agreement on clinical management plans was achieved in 76%. The overall concordance rate was 80%.
  Conclusions: This exploratory study demonstrates that ChatGPT showed high concordance rates with expert interpretation of UDS. Similarly, the suggested treatment plan was highly concordant with human expert plans and paves the way for further studies to unlock such potentials.

MP-30.03—Differences in Functional Brain Regions in Patients with Interstitial Cystitis/Painful Bladder Syndrome: A Resting-State Functional Magnetic Resonance Imaging Study 

• Meng Lingfeng, Zhang Yaoguang
  Beijing Hospital, Beijing, China

• Introduction and Objectives: To explore alterations in the brain function of elderly patients with interstitial cystitis/bladder pain syndrome (IC/BPS) during the resting state.
  Materials and Methods: This study prospectively recruited 7 patients with IC/BPS who were admitted to the Urology Department of Beijing Hospital from December 2023 to May 2024 as the experimental group and concurrently selected 12 healthy individuals as the control group. After enrollment, each subject underwent an rs-fMRI scan. The data were processed with MATLAB. The present study employed a paired sample t-test to analyze the discrepancies in gray matter volume among the two groups of subjects. The brain functional activities of the subjects were analyzed by regional homogeneity (ReHo) and low-frequency amplitude (ALFF) algorithms. Grounded on the acquired abnormal brain regions, further functional connectivity (FC) analysis was carried out to explore the connectivity patterns among the functional brain regions.
  Results: No significant differences were observed in age (T = −0.68, p = 0.536) or gender (c2 = 0.019, p = 0.891) between the experimental group and the control group. In contrast to the control group, the ALFF value of the left superior parietal lobe (MNI: x, y, z = −21, −66, 60; T = 12.5305) was elevated in elderly IC/BPS patients, and the ReHo value of the left precuneus (MNI: x, y, z = −9, −54, 63; T = 9.4103) was also increased. Through FC analysis, it was revealed that elderly IC/BPS patients exhibited significantly lower FC values between the left superior parietal lobule and the central sulcus (MNI: x, y, z = 21, 15, 3; T = −27.8356 ), as well as between the left anterior cingulate and the left posterior cingulate gyrus (MNI: x, y, z = −12, 0, 42; T = −8.7389 ) in comparison with the control group.
  Conclusions: In contrast to normal individuals, IC/BPS patients demonstrate functional aberrations in the left superior parietal lobule and the left precuneus. Moreover, a decrease in functional connectivity is observed between the left superior parietal lobule and the central sulcus, as well as between the left precuneus and the left posterior cingulate gyrus. These abnormal functional alterations in the brain might be implicated in the maintenance and development of symptoms in IC/BPS patients.

MP-30.04—Does Prior Male Sling Affect the Outcomes of Artificial Urinary Sphincter? A Systematic Review and Meta-Analysis 

• Mohamed Tarek ¹, Ramez Mohamed ², Irshid Baha’ Aldeen Bani ³, Deameh Mohammad Ghassab ⁴, Elhashamy Hamza ⁵
  ¹ United Lincolnshire Teaching Hospitals NHS Trust, Lincoln, UK, Lincoln, United Kingdom, ² University of Texas MD Anderson Cancer Center, Houston, Texas, USA, Houston, United States, ³ Princess Basma Teaching Hospital, Irbid, Jordan, Jordan, Jordan, ⁴ Prince Hamza Hospital, Amman, Jordan, Jordan, Jordan, ⁵ Assiut University, Assiut, Egypt, Egypt, Egypt, Arab Rep.

• Introduction and Objectives: Post prostatectomy incontinence is one of the most distressing complications affecting quality of life. Treatment options include observation, pelvic floor training, urethral bulking agents, male urethral sling (MUS), and artificial urinary sphincter (AUS). Despite the success of MUS in appropriately selected patients, a decline in the degree of improvement is noticed over time. An AUS may be an effective treatment option for patients who continue to experience incontinence after sling placement. However, whether the prior sling complicates the outcome of subsequent AUS remains controversial. This study aims to assess the impact of prior MUS on AUS outcomes.
  Materials and Methods: PRISMA statement guidelines were followed. A comprehensive literature search was conducted across PubMed, Cochrane Library, Scopus and Web of Science databases. The primary outcome analyzed was AUS revision due to either mechanical failure or non-mechanical failure caused by cuff erosion, infection or urethral atrophy.
  Results: Four studies comparing between de novo AUS placement and AUS placement after prior MUS with a total number of 1050 patients were included. No statistically significant difference was found between the two groups regarding device revision (RR = 0.84 [0.05–15.5], p = 0.91). In addition, no statistically significant difference was found between the two groups in terms of non-mechanical failure (RR = 0.86 [0.40–1.81], p = 0.68).
  Conclusions: AUS placement remains a viable treatment option for men with persistent or recurrent SUI after prior MUS.

MP-30.05—Optimization of Sacral Neuromodulation Therapy: Clinical Outcomes and Patient Suitability Exploration of Variable Frequency Mode: A Prospective Multi-Center Study 

• Meng Lingfeng ¹, Wen Wei ², Shi Benkang ³, Luo Deyi ⁴, Ren Lijuan ⁵, Liao Limin ⁶, Chen Qi ⁷, Wang Qingwei ⁸, Zhang Yifei ⁹, Gu Yinjun ¹⁰, Wei Zhongqing ¹¹, Zhang Yaoguang ¹
  ¹ Beijing Hospital, Beijing, China, ² Shanghai General Hospital, Shanghai, China, ³ Qilu Hospital of Shandong University, Jinan, China, ⁴ West China Hospital, Sichuan University, Chengdu, China, ⁵ The First Hospital of Shanxi Medical University, Taiyuan, China, ⁶ China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing, China, ⁷ The Second Affiliated Hospital of Xi’an Jiaotong University, Xian, China, ⁸ The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, ⁹ The First Affiliated Hospital of Anhui Medical University, Hefei, China, ¹⁰ Renji Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China, ¹¹ The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China

• Introduction and Objectives: The aim of this study was to optimize sacral neuromodulation (SNM) therapy by evaluating the clinical outcomes of the variable-frequency (VF) mode and to explore the suitability of this mode for different patient populations with lower urinary tract symptoms (LUTS).
  Materials and Methods: A prospective clinical trial was conducted involving 55 patients with LUTS, who were randomized to receive either constant frequency (CF) or VF SNM treatment over a 12-week period. The efficacy of both modes was assessed using a comprehensive set of indicators, including Quality of Life (QoL), Visual Analogue Scale (VAS), and Overactive Bladder Symptom Score (OABSS). Logistic regression analysis was employed to identify patient characteristics that are predictive of better outcomes with the VF mode. A nomogram web tool was developed to assist clinicians in selecting the most appropriate SNM frequency mode for individual patients.
  Results: The VF mode showed superior improvement rates across most monitored parameters compared to the CF mode. However, logistic regression revealed counterintuitive findings: patients with higher BMI, more comorbidities, more LUTS-related symptoms, or a diagnosis of Neurogenic Lower Urinary Tract Dysfunction (NLUTD) were less likely to benefit from the VF mode. The developed nomogram web tool demonstrated good discriminative ability with an area under the receiver operating characteristic curve (AUC) of 0.833 for both training and validation groups.
  Conclusions: The study provides evidence that, while VF SNM may offer enhanced clinical benefits, its effectiveness varies among patient populations. The identification of patient characteristics associated with treatment outcomes is crucial for the personalized application of SNM therapy. The nomogram web tool facilitates the clinical decision-making process, promoting precision medicine in LUTS treatment. Further research is needed to better understand the mechanisms underlying the observed patient responses to different SNM frequency modes.

MP-30.06—Perineal vs. Penoscrotal Approach for Artificial Urinary Sphincter Implantation: A Comparative Analysis 

• Mohamed Tarek ¹, Irshid Baha’ Aldeen Bani ², Elhashamy Hamza ³, Ramez Mohamed ⁴, Deameh Mohammad Ghassab ⁵
  ¹ United Lincolnshire Teaching Hospitals NHS Trust, Lincoln, UK, Lincoln, United Kingdom, ² Princess Basma Teaching Hospital, Irbid, Jordan, Jordan, Jordan, ³ Assiut University, Assiut, Egypt, Egypt, Egypt, Arab Rep., ⁴ University of Texas MD Anderson Cancer Center, Houston, Texas, USA, Houston, United States, ⁵ Prince Hamza Hospital, Amman, Jordan, Jordan, Jordan

• Introduction and Objectives: Stress urinary incontinence in men significantly impacts quality of life, and the artificial urinary sphincter (AUS) remains the standard treatment for moderate to severe cases. AUS implantation is commonly performed using either the perineal or penoscrotal (transscrotal) approach. These techniques differ in anatomical access and surgical exposure, leading to ongoing debate regarding their respective advantages and limitations. This study aimed to compare the perioperative and postoperative outcomes of the perineal and penoscrotal approaches for AUS implantation in men.
  Materials and Methods: A comprehensive literature search was conducted using PubMed, Scopus, Web of Science, and the Cochrane Library. Studies comparing the two surgical techniques and reporting outcomes such as cuff size, operative time, dry pad rates, social continence, complications, AUS removal, or revision rates were included.
  Results: Four observational studies with a total of 481 patients met the inclusion criteria. The perineal approach was associated with significantly larger cuff sizes (OR = 0.24 [0.1–0.54], p = 0.0006) and higher rates of dry pads (OR = 1.7 [1.08–2.65], p = 0.02). In contrast, the penoscrotal approach was correlated with shorter operative times (MD = 28.73 [10.15–47.3], p = 0.02) and lower rates of AUS removal (OR = 2.98 [1.53–5.8], p = 0.001), while complications and social continence outcomes did not differ significantly between the two techniques.
  Conclusions: The perineal and penoscrotal approaches demonstrated comparable efficacy regarding complications and long-term device functionality. However, the perineal approach favored better dry pad outcomes and larger cuff sizes, whereas the penoscrotal method offered decreased operative times and fewer removals. Surgical decision-making should be individualized, taking into account patient characteristics and surgeon experience.

MP-30.07—The Botox Effect: Lasting Relief for Overactive Bladder Patients—Clinical Outcomes from a High-Volume Center 

• Khalil Waqas, Sheikh Mazhar, Ghosh Dhruba, Islam Jawad
  Blackpool Victoria Hospitals, Blackpool, United Kingdom

• Introduction and Objectives: Overactive bladder (OAB) significantly impairs quality of life, with epidemiological studies showing 59.2% of affected patients experience bothersome symptoms. This retrospective study evaluated intravesical Botulinum Toxin A (Botox) in 51 refractory OAB patients at Blackpool Victoria Hospital, demonstrating 72% efficacy (24% complete resolution), aligning with EAU guidelines recommending Botox for third-line treatment. The safety profile was excellent, with only 7.8% UTIs, supporting NICE recommendations.
  Materials and Methods: Following BAUS protocol, we reviewed 51 consecutive cases (39 female, 12 male) receiving 200 IU (90.2%) or 300 IU (9.8%) Botox injections. Data extraction from Nexus hospital records included: Pre/post-procedure symptom diaries; patient-reported outcomes (0–10 scale); complications (UTIs, retention); follow-up interviews assessed duration of effect and satisfaction.
  Results: Efficacy: 72% responded (37% ≥80% improvement), matching EAU-reported 60–80% success rates—Duration: 39.5% maintained 6–8 month benefit, exceeding BAUS benchmarks—Safety: −7.8% UTIs (vs. 15–20% in NICE audits) − 21.1% ISC rate (consistent with EAU figures).
  Conclusions: Our outcomes validate EAU/NICE/BAUS standards, confirming Botox as: 1. Highly effective (72% response) 2. Durable (6–8 months benefit) 3. Safe (low complication profile).

MP-30.08—The Efficacy and Safety of Sacral Neuromodulation with Variable Frequency Stimulation Mode Compared with Constant Frequency Stimulation Mode in the Treatment of Refractory Lower Urinary Tract Dysfunction—A Multicenter, Prospective, Randomized, Double-Blind, Crossover Study in China 

• Meng Lingfeng ¹, Li Jiayi ², Wang Qingwei ³, Wei Zhongqing ⁴, Shi Benkang ⁵, Luo Deyi ⁶, Ren Lijuan ⁷, Liao Limin ⁸, Chen Qi ⁹, Gu Yinjun ¹⁰, Zhang Yifei ¹¹
  ¹ Beijing Hospital, Beijing, China, ² Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, ³ The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, ⁴ The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China, ⁵ Qilu Hospital of Shandong University, Jinan, China, ⁶ West China Hospital, Sichuan University, Chengdu, China, ⁷ The First Hospital of Shanxi Medical University, Taiyuan, China, ⁸ China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing, China, ⁹ The Second Affiliated Hospital of Xi’an Jiaotong University, Xian, China, ¹⁰ Renji Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China, ¹¹ The First Affiliated Hospital of Anhui Medical University, Hefei, China

• Introduction and Objectives: Variable frequency stimulation (VFS) is a new mode of sacral neuromodulation (PINS, China), which can provide alternating electrical stimulation between high and low frequencies according to the clinical symptoms of patients and automatically change the frequency during the stimulation process. The aim of this study is to evaluate the efficacy and safety of VFS in the treatment of overactive bladder (OAB) symptoms.
  Materials and Methods: A prospective, randomized, blinded, 2 × 2 cross-controlled study was conducted. Successfully enrolled patients had the device switched off for 7 ± 3 days (baseline period). Then the patients were randomly divided into group A and group B according to the ratio of 1:1. The patients in group A were treated according to the sequence of constant frequency stimulation (CFS)—shutdown-VFS, and the patients in group B were treated according to the sequence of VFS -shutdown-CFS. The patients were followed up at 6, 12, 18 and 24 weeks, and the stimulation mode was changed at 12 weeks. The voiding diary, subjective scores, patient satisfaction and adverse events were collected at baseline and each follow-up point to evaluate the efficacy and safety of VFS.
  Results: A total of 57 patients were enrolled, including 29 patients in group A and 28 patients in group B. There was no significant difference in demographic data between the two groups. At the 24th week, the micturition frequency of group A and group B decreased by 7.26 ± 7.68 times (p = 0.001) and 3.18 ± 4.04 times (p = 0.001), respectively, which were significantly improved compared with the baseline period, and there was a significant difference between the two groups (p = 0.017). At the 24-week follow-up, the urination volume, urinary incontinence times and subjective scores in Group A and Group B were significantly improved compared with the baseline (all p < 0.05), but there was no significant difference between the two groups (all p > 0.2). The incidence of adverse events was 5.26%.
  Conclusions: The VFS mode of SNM is not inferior to traditional CFS mode in the improvement of OAB symptoms, which can effectively improve the symptoms of patients. However, the most suitable stimulation parameters for different patients still need to be studied.

30.2. Moderated Video ePosters

MVP-30.01—Robotic Mitrofanoff Procedure with Autologous Pubovaginal Sling in Neurogenic Incontinence 

• Mudhol Rajat, Kalra Sidhartha, Bolar Siddhant, Dorairajan L.N, KS Sreerag, Ghorai Rudra Prasad, R Bharath
  Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, Pondicherry, India

• Introduction and Objectives: This video presents the surgical management of an obese female with intrinsic sphincter deficiency and paraparesis, rendering perurethral CIC unfeasible. It demonstrates tension-free Mitrofanoff channel in the setting of thick abdominal pannus, highlighting preoperative planning, intraoperative technical modifications, and the use of indocyanine green (ICG) dye to assess vascularity.
  Materials and Methods: A 21-year-old obese female (BMI: 31 kg/m²) presented with continuous urinary and faecal incontinence and bilateral lower limb weakness after D11-L3 laminectomy for spinal teratoma a year ago. Examination revealed a patulous urethra. Videourodynamics showed a hyposensory bladder and intrinsic sphincter deficiency. Due to obesity, perineal hypoesthesia, and challenges with perurethral CIC, a robotic Mitrofanoff appendicovesicostomy with a pubovaginal sling using an autologous tensor fascia lata graft was planned to achieve continence and facilitate CIC. The robotic approach improved precision, maneuverability, and recovery. A tension-free Mitrofanoff channel was created by dropping down the bladder, removing one row of staples to extend channel length, and using the umbilicus as the catheterization site to bypass the thick pannus. Intraoperative indocyanine green (ICG) dye assessed vascularity. Robotic ports were placed in a semicircular configuration above the umbilicus, with assistant ports on each side. The procedure was performed in a low lithotomy position, allowing seamless completion of both the Mitrofanoff and pubovaginal sling.
  Results: The total operative time was 180 min, with an estimated blood loss of 200 mL. Postoperative recovery was uneventful, and the patient was discharged on day 6 with a Foley catheter and IFT in the Mitrofanoff channel, both removed after two weeks. The patient subsequently performed CIC comfortably through the Mitrofanoff. At 3-month follow-up, she remained completely continent and reported being highly satisfied with her ability to perform CIC with ease.
  Conclusions: This video highlights the effectiveness of Robotic Mitrofanoff appendicovesicostomy and autologous pubovaginal sling in achieving continence and improving quality of life in complex cases of obesity, paraparesis, and intrinsic sphincter deficiency. The meticulous preoperative planning, technical modifications, and use of intraoperative ICG dye ensured optimal outcomes, demonstrating how robotic precision and innovation can overcome anatomical challenges in reconstructive urology.

MVP-30.02—Sacral Anterior Root Stimulator: Surgical Technique for Extradural Implantation 

• Gómez Reynaldo, Massouh Ragheb, Velarde Laura
  Hospital del Trabajador, Santiago, Chile

• Introduction and Objectives: The anterior sacral root neurostimulator (SARS) is an electronic implantable device, which allows the suprasacral spinal cord injured (SCI) patient to voluntarily control micturition, defecation, and erection. Intradural and extradural implant technique has been described. In this video we show the extradural approach.
  Materials and Methods: Surgical technique: Under general anesthesia, the patient is placed in the prone position with exposure of buttocks and both feet. A sacral canal laminectomy is performed exposing the sacral nerves. Careful dissection inside the S2-S4 nerves in the vicinity of the spinal ganglion allows to separate the posterior (sensitive) from the anterior (motor) fibers. Intraoperative selective stimulation is performed, identifying and mapping peripheral (somatic) responses—plantar flexion (S2), big toe flexion (S3), perianal contraction (S4)—and visceral responses—bladder contraction and elevation of arterial blood pressure (S3–S4). The sensory fibers are then divided (selective posterior rhizotomy), placing the stimulating electrodes around the preserved anterior motor roots. One electrode is placed encompassing both left S3–S4, another both the right S3–S4 and a double electrode around both S2 roots. Subsequently, with the patient in lateral decubitus position, the electrode wires are tunneled towards the receiving antenna, implanted in an infra-mammary subcutaneous pocket. The Case: A completely rehabilitated and self-sufficient 49-year-old male with a complete T8 paraplegia, who has urinary incontinence due to refractory neurogenic overactive bladder with detrusor contractions of up to 80 cmH₂O at 200 mL of bladder filling on urodynamics, associated with urine leakage. Normal urethrocystoscopy.
  Results: No complications occurred. First voiding test was performed on the 6th postoperative day, and on the 9th day a urodynamic evaluation with programming of the neurostimulator was performed, training the patient in the use of the device. In subsequent visits, programming adjustments were made. At 12 months of follow-up, the patient was continent, free of catheterizations and urinary tract infections, using the SARS for voiding with physiological postvoid residual and with a high degree of satisfaction.
  Conclusions: Selective posterior sacral rhizotomy associated with the SARS implant using the extradural technique is a feasible and effective procedure for the suprasacral spinal cord injured patient to achieve satisfactory voluntary control of urination.

30.3. Residents Forum Moderated Oral ePosters

RF-30.01—A Systematic Review of Autonomic Dysreflexia During Urodynamics in Patients with Spinal Cord Injury 

• Khanna Yash, Huynh Tran Ngoc An, Manohar Paul
  Monash Health, Melbourne, Australia

• Introduction and Objectives: Urodynamics are a key tool in assessing lower urinary tract dysfunction in spinal cord injury (SCI). However, as with many forms of urological intervention in those with SCI, it carries risk of autonomic dysreflexia (AD). This systematic review aims to ascertain the incidence and predictors of autonomic dysreflexia during urodynamic investigation, in those with SCI. Prior reviews have evaluated incidence of autonomic dysreflexia from iatrogenic urological triggers broadly—this review will be the first to assess risk of AD during urodynamics specifically.
  Materials and Methods: This systematic review was conducted following PRISMA guidelines and prospectively registered on PROSPERO (CRD420251000507). Ovid MEDLINE and Embase databases were searched via search terms ‘Autonomic Dysreflexia’ AND ‘Urodynamics’. Narrative synthesis was performed as heterogeneous definitions of AD and study populations precluded meta-analysis.
  Results: Of a total 204 articles screened, 17 were included in this systematic review. Of these 17 included studies, 12 reported on incidence of AD during urodynamics, with reported incidence varyingly broadly from 7.9–90.9%. In studies reporting SCI above T6 specifically, AD incidence during urodynamics varied from 42.5–83.7%, while, in studies reporting incidence in SCI below T6, incidence varied from 5.9–82.3%. There were heterogeneous results regarding predictors of AD during urodynamics: level of injury was generally predictive of AD incidence, completeness of injury and patient age did not predict AD incidence but did predict its severity, and data regarding urodynamic predictors (detrusor overactivity, detrusor-sphincter dyssynergia, compliance, and detrusor pressures) was conflicting. Varying definitions of AD accounted for the heterogeneous results (17 included studies used 8 different definitions of AD). Studies reported high proportion of silent/asymptomatic AD (38–63%); hence, some authors suggested continuous/beat-to-beat cardiac monitoring during urodynamics in SCI patients to allow early identification/intervention for AD.
  Conclusions: This systematic review identified high incidence of AD during urodynamics, although results regarding predictors of AD were variable. Clinicians should consider continuous cardiac monitoring during urodynamics in at-risk SCI patients and remain vigilant to risk of AD even in SCI below T6. Future studies should aim to adopt a universal definition of AD and be prospective, to permit statistical synthesis and meta-analysis to conclusively define predictors of AD during urodynamics.

RF-30.02—PI3K-Akt Signaling Downregulation: A Potential Breakthrough in Alleviating Bladder Outlet Obstruction Induced Bladder Dysfunction 

• Chang Yu-Hsiang, Hsieh Yi-Ying, Wong Shing-Mei, Chen Yi-Hui, Chang Shang-Jen, Chueh Jeff Shih-Chih
  National Taiwan University Hospital, Taipei, Taiwan

• Introduction and Objectives: Bladder outlet obstruction (BOO) is a prevalent cause of bladder dysfunction. While resveratrol has shown therapeutic potential in improving bladder damage, its effectiveness in treating BOO-induced bladder dysfunction remains uncertain. This study aims to assess therapeutic efficacy of resveratrol in treating BOO-induced bladder dysfunction and explore the underlying mechanisms.
  Materials and Methods: A total of 33 female 8-week-old rats were randomly assigned to three groups: sham surgery (n = 9), BOO (n = 14), and BOO+resveratrol (n = 10). Following the BOO procedure on day 0, the BOO+resveratrol group received oral resveratrol (10 mg/kg/day) for 28 days. Urodynamic studies (UDS) were performed on all rats on day 28. After the UDS, bladder tissues were collected for histological analysis, including H&E staining and Masson’s staining. Additionally, three specimens from each group were sent for mRNA sequencing. Bioinformatics analyses, including Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment, and protein-protein interaction (PPI) network analyses, were conducted.
  Results: Histological analysis revealed that BOO caused a flattening of the urothelium and thinning of the detrusor muscle with loosely arranged muscle bundles, indicative of bladder remodeling. Resveratrol treatment alleviated these changes. Functionally, the BOO group showed significant increases in bladder weight, larger bladder capacity, increased post-void residual urine, and elevated threshold pressure. Notable improvements in urodynamic parameters were observed after resveratrol treatment. mRNA sequencing and bioinformatics analysis identified 783 upregulated and 620 downregulated differentially expressed mRNAs (DEmRNAs) following BOO surgery. Resveratrol significantly altered gene expression, with 892 upregulated and 333 downregulated DEmRNAs. GO and KEGG analyses suggested that resveratrol counteracted the structural and functional changes induced by BOO, primarily through downregulation of the PI3K-Akt signaling pathway, which reduced extracellular matrix accumulation and fibrosis. PPI analysis highlighted Espl1 as a critical node, showing upregulation in the BOO group compared to the sham group, and downregulation in the BOO+resveratrol group compared to the BOO group.
  Conclusions: Our studies showed that resveratrol alleviated BOO-induced bladder dysfunction by downregulating the PI3K-Akt signaling pathway, which helped reduce extracellular matrix accumulation and fibrosis. Additionally, the gene Espl1 was identified as a potential target, offering a promising avenue for developing innovative treatment strategies for BOO-induced bladder dysfunction.

RF-30.03—Proteomics Analysis Reveals Pathways Involved in Human Umbilical Cord Mesenchymal Stem Cells Alleviating Bladder Outlet Obstruction-Induced Bladder Dysfunction 

• Hsieh YiYing, Chang Yu-Hsiang, Chang Shang-Jen
  National Taiwan University Hospital, Taipei, Taiwan

• Introduction and Objectives: Bladder outlet obstruction (BOO) is a known contributor to bladder dysfunction. Previous studies have demonstrated the efficacy of mesenchymal stem cells (MSCs) in ameliorating BOO-induced bladder dysfunction. This study aimed to investigate the proteomic profiles of a BOO rat model, with and without treatment using human umbilical cord mesenchymal stem cells (hUCMSCs), to elucidate the molecular mechanisms underlying their therapeutic effects.
  Materials and Methods: 32 eight-week-old female rats were randomly assigned to three groups: sham operation (n = 10), BOO (n = 11), or BOO with hUCMSC injection (n = 10, 2 × 10⁶ cells). On day 28, post-BOO procedure, phosphate-buffered saline (PBS) or hUCMSCs were injected into the bladders of the BOO and hUCMSC groups, respectively. Bladder tissues were harvested on day 56 following urodynamic studies. Three samples per group underwent proteomics analysis using a Vanquish Neo UHPLC system coupled with an Orbitrap Fusion Lumos Tribrid mass spectrometer equipped with a nanospray ion source. Raw mass spectrometry data were processed with PEAKS 11.5 software against the UniProt reviewed database. Differentially expressed proteins were subjected to Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses.
  Results: Compared to the sham group, the BOO group exhibited significantly impaired urodynamic parameters. Following hUCMSC treatment, BOO-induced bladder dysfunction improved markedly. Of 2,510 identified proteins, 2,452 were validated for statistical analysis. KEGG analysis of differentially expressed proteins in the hUCMSC-treated versus BOO groups revealed significant involvement of multiple pathways, including PI3K-Akt signaling, AMPK signaling, fatty acid metabolism, and cell cycle regulation. Additionally, pathways associated with alcoholic liver disease, fatty acid degradation, Hippo signaling, hepatitis C, oocyte meiosis, and adipocytokine signaling were also enriched.
  Conclusions: These findings align with bulk mRNA sequencing results, highlighting the involvement of the PI3K-Akt and AMPK signaling pathways in the therapeutic effects of hUCMSCs on BOO-induced bladder dysfunction. The results provide molecular insights into the mechanisms underlying hUCMSC-mediated bladder repair and suggest potential targets for future therapeutic strategies.

30.4. Unmoderated Standard ePosters

UP-30.01—Altered Brainstem Functional Connectivity in Female Multiple Sclerosis Patients with Voiding Dysfunction 

• Santoso Anugrah ¹, Salazar Betsy ², Bernard Jessica ³, Colbert Kevin ⁴, Hoffman Kristopher ², Lincoln John ⁵, Khavari Rose ²
  ¹ Dr. Soetomo General Academic Hospital/ Universitas Airlangga, Surabaya, Indonesia, ² Houston Methodist Hospital, Houston, United States, ³ Texas A&M University, College Station, United States, ⁴ Texas A&M College of Medicine, Houston, United States, ⁵ The University of Texas Health Science Center at Houston, Houston, United States

• Introduction and Objectives: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system. A common complication of MS is neurogenic lower urinary tract dysfunction (NLUTD), affecting 10% of patients at diagnosis and up to 90% over time. Key brainstem regions are known to regulate lower urinary tract function. This study examines brainstem connectivity in female MS patients voiding dysfunction (VD), comparing them to healthy volunteers.
  Materials and Methods: We included nine female MS patients (mean age: 54.8 years) with symptomatic VD and ten healthy female volunteers (mean age: 28.9 years). Prior to scanning, all subjects had their bladders fully emptied. Most scans were conducted on a 7T MRI scanner, except for two MS patients using a 3T scanner due to safety concerns with metallic implants. Each session included anatomical imaging and functional MRI scans following warm water infusion into the bladder. Data preprocessing and analysis were done using CONN toolbox in SPM12 software (MATLAB). We conducted seed-to-voxel analysis using predefined regions of interest (ROIs) based on prior studies, including midbrain ROI 1 (Montreal Neurological Institute (MNI) coordinates = [−6, −15, 6]), midbrain ROI 2 (MNI coordinates = [12, −22, −12]), periaqueductal gray (PAG, MNI coordinates = [4, −33, −19]), and pontine micturition center (PMC, MNI coordinates = [2, −34, −32]). Contrast maps were then generated using nonparametric statistics at a voxel significance threshold of p < 0.05.
  Results: Compared to healthy volunteers, MS patients with VD displayed distinct connectivity patterns across four ROIs (Figure 1). During full bladder state, midbrain ROIs 1 and 2 demonstrated negative connectivity with interoceptive processing regions, including insular cortex and frontal operculum. PAG showed positive connectivity with the precentral and postcentral gyri and the anterior cingulate gyrus, while PMC displayed negative connectivity with the cerebellum. During the empty bladder state, midbrain ROIs 1 and 2 showed negative connectivity with areas of default network, whereas PAG exhibited positive connectivity with the cerebellum.
  Conclusions: These initial findings offer insight into the brainstem’s functional connectivity in women with MS and VD, potentially deepening our understanding of the underlying mechanisms and enabling more precise therapeutic interventions.

UP-30.02—Artificial Urinary Sphincter (AUS) in Neuropathic Stress Urinary Incontinence (SUI), Indications, Outcomes and Complications, 10-Year-Experience in the Golden Jubilee Regional Spinal Cord Injuries Centre in the UK 

• Ghonaimy Ahmed, Harrington Megan, Lopolito Adriana, Stephenson Jennifer, Nadeem Mehwash, Fulford Simon
  James Cook University Hospital, South Tees NHS Trust, Middlesbrough, United Kingdom

• Introduction and Objectives: The artificial urinary sphincter (AUS) is the method of choice in patients with stress urinary incontinence due to neurogenic lower urinary tract dysfunction (NLUTD). The aim is to assess the indications, outcomes and complications of AUS implantation in cases of neuropathic SUI in our centre in 10 years.
  Materials and Methods: In the period between 2014 to 2024, we collected the data of patients who had AUS implantation due to SUI secondary to neurogenic reasons.
  Results: In the study period, 17 AUS devices were implanted for 3 females and 14 males with age range from 27 to 67 years (mean age 46 years). 9 of the AUS were de-novo cases, and 8 were replaced devices. Sphincter cuffs were inserted around bladder neck (BN) except in 4 patients (3 bulbar and 1 trans-corporeal). Activation of the device was needed only in 7 cases in our patients cohort. NLUTD was caused by spinal cord injury in 9 cases (T11/12 in 3 patients, T4/5 in 2 patients, T8 in 1 patient, CES in 3 patients), Spina bifida in 5 patients, stroke in 1 patient, neuropathic bladder secondary to post AP resection in 1 patient, spinal AV malformation was reported in 1 patient, but accurate level was not found in the available records. No formal PROM follow up has taken place, but continence and patient satisfaction rates have been good. Intraoperative bladder injury was reported in 1 patient. Early post-operative wound infection complicated only one patient. De-novo storage LUTS and UUI happened in 1 case. Urethral erosion was reported in 6 patients (35%): 5 of them had BN cuffs, and only 1 had bulbar cuff. All cases of erosion were ISC users. 1 of the female patients needed initial GA pump activation due to difficult manipulation in clinic. The same patient needed replacement of the balloon due to mechanical failure and incisional hernia repair later.
  Conclusions: AUS implantation is a safe and effective treatment for neuropathic SUI with high patient satisfaction. Revision surgery is not uncommon but is generally successful. Due to challenges with these patients, adequate counselling and surgical experience are essential for satisfactory results.

UP-30.03—Association Between Multiple Heavy Metal Exposures and Overactive Bladder 

• Wang Jinbao, Wei Qiang
  West China Hospital, Sichuan University, Chengdu, China

• Introduction and Objectives: We aim to explore the relationship between urinary heavy metals and overactive bladder (OAB) among U.S. adults in this study.
  Materials and Methods: Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2005–2018. Concentrations of heavy metals in urine were determined by laboratory tests and corrected for urinary creatinine by ln transformation. Assessment of OAB was obtained from questionnaires. The association between each urinary heavy metal and OAB was first explored using multivariate logistic regression, followed by nonlinear correlation analyses and smoothed curve fitting, with stratified analyses and interaction tests for age and sex. In addition, methods such as weighted quantile sum (WQS) regression were implemented to explore the relationship between exposure to heavy metals and OAB.
  Results: A total of 9086 participants were included in this study. Multifactorial logistic regression analysis showed that cobalt (Co), lead (Pb), cadmium (Cd), and uranium (Ur) were positively associated with the risk of developing OAB, whereas barium (Ba) and thallium (Tl) were negatively associated with OAB. Nonlinear correlation analysis showed that the unit concentrations of Ba and Tl and the risk of OAB were not linear, and Pb, antimony (Sb), tungsten (Tu), Ur, and Cd showed significant positive correlations with OAB. Weighted quantile sum (WQS) regression showed that OAB risk increased with increasing quartiles of the WQS index (odds ratio (OR) 1.202, 95% confidence interval (CI) 1.064, 1.357), with Cd showing the strongest positive correlation with OAB. When the correlation was defined as negative, an increase in the quartile of the WQS index corresponded to a 14.3% reduction in OAB risk (OR 0.857, 95% CI 0.778, 0.943), with Ba standing out as the most dominant.
  Conclusions: Urinary heavy metals are significantly associated with OAB risk among U.S. adults. The metal contributing most to the positive correlation with OAB risk is Cd.

UP-30.04—ChatGPT Follows Standardized Terminology & Practices on Urodynamics’ Interpretation: The New Virtual Functional Urologist 

• Almazeedi Abdulrahman ¹, AlBoloushi Noor ², Abdullah Ali ², Almarzouq Ahmad ³, AL-shaiji Tariq ¹, Yaiesh Said ¹
  ¹ Jaber Alahmad Hospital, Kuwait City, Kuwait, ² Jaber Alahmad Hospital Kuwait, Kuwait City, Kuwait, ³ Sabah Alahmad Urology center, Department Of Surgery, Urology Unit, Kuwait

• Introduction and Objectives: ChatGPT’s ability to provide concise clinical assessments and evaluations has improved and so has its ability to learn and research true resources and references. Urodynamic studies’ good practices and terminology have been described and published by the International Continence Society (ICS) and are recommended for practitioners. We report on ChatGPT’s ability to analyze urodynamic traces correctly before and after teaching it the ICS best practices and terms for urodynamics, cystometry and pressure-flow studies.
  Materials and Methods: We chose at random urodynamic traces including cystometries and pressure-flow studies conducted and assessed at our institution by functional urology experts. ChatGPT 4o was used, and it was asked to analyze the same traces twice: first batch without instruction to use certain resources or teaching, and the second batch after it was taught and instructed to use the ICS standards. Parameters analyzed include components of the urodynamics traces as well as select nomograms, overall diagnosis and devising a management plan accordingly. Concordance with expert opinion before and after teaching ChatGPT was calculated, and statistical significance of the teaching was calculated using McNemar’s test.
  Results: We analyzed a total of 100 urodynamic traces of different etiologies, of which 75% were of female patients. With regards to assessments of filling cystometry results, ChatGPT did not exhibit any improvement or regression in its ability to correctly diagnose dysfunctions in sensation (p = 1), cystometric capacity (p = 0.1336), bladder compliance (p = 0.4795), urinary incontinence (p = 0.3711), and electromyography (EMG) synergy or dyssynergia (p = 0.7728). The only parameter that reached some statistical significance was ChatGPT’s ability to identify uninhibited detrusor contractions after teaching it (p = 0.07). In a similar manner, ChatGPT’s ability to assess voided volume, detrusor pressure at maximal flow (Pdet@Qmax), maximum urinary flow rate (Qmax), and identify after contractions remained unchanged after instruction and teaching (p > 0.1), as well as its ability to calculate the bladder contractility index (p = 0.25), provide an overall diagnosis (p = 1) and formulate an appropriate management plan (p = 0.13).
  Conclusions: Our findings underscore ChatGPT’s emerging utility in functional urology as a consistent, adaptable tool with the potential to support clinical education and decision-making.

UP-30.05—Clean Intermittent Catheterization: Barriers and Patient Reluctance 

• Bianchi Daniele ¹, Rosato Eleonora ¹, Pletto Simone ¹, Terzoni Stefano ², Abbate Nunzia ¹, Fanara Fabrizio ¹, Finazzi Agrò Enrico ¹
  ¹ Faculty of Medicine and Surgery, Tor Vergata University, Rome, Italy, ² Department of Biomedical Sciences for Health, Milan University, Milan, Italy

• Introduction and Objectives: Clean intermittent catheterization (CIC) is a validated and widely accepted tool in managing both neurogenic and non-neurogenic patients presenting with voiding dysfunction. Currently, very few concerns on this well known, established, and widely recognized procedure attract our attention. A critical aspect is still represented by patient reluctance and barriers in accepting CIC. Aim of our scoping review was to identify the reasons affecting and limiting patient adherence to CIC.
  Materials and Methods: We conducted a literature search on PubMed using the terms [clean intermittent catheterization] AND [learning OR teaching OR reluctance]. Papers reporting on chronic transurethral CIC for voiding dysfunction in adults were included. Studies simply reporting on CIC technique or author personal experiences were excluded.
  Results: After removing duplicates, 504 articles were identified. After abstracts screening according to the inclusion criteria, a total of 45 articles were selected and considered for the review. The included papers were classified into the following categories: education and nurses, general practitioner role, role of media, family role, and patients. Most of papers focused on patient education performed by nurses, including the question if starting it from a referral centre and then move to peripheral offices, or—on the contrary—schedule the teaching directly in smaller and dedicated centres. A fundamental aspect to be considered is patient ability in performing the manouvre, and some papers aimed to define score criteria to screen and select neurologic patients in routine practice. Also, the role of family has been investigated in providing the patient with both psychological and practical support. Recently, an increasing attention to the role of web tutorials and smartphone apps has been reported in the literature. Few papers focused on general practitioners education and involvement, and this may also play an important role.
  Conclusions: Despite the huge efforts already dedicated to CIC education in routine clinical practice, exploring the current limitations may be of help in taking further actions to discourage patients from dropping out. The present scoping review lays the foundations for our future project of a multicentre survey, followed by a Delphi consensus.

UP-30.06—Clinical Approach to Nocturia and Factors Influencing Treatment Effectiveness 

• Ben Saad Hamda, Hamdouni Wadiee, Tabka Mohamed Helmi, Ktari Kamel, Toufahi Mounir
  Fattouma Bourguiba Hospital, Monastir, Tunisia

• Introduction and Objectives: We aimed to evaluate the therapeutic approach to nocturia in routine practice and the factors affecting treatment success.
  Materials and Methods: We included patients presenting with lower urinary tract symptoms, primarily nocturia, who were prospectively followed in the urology department of Monastir. Nocturia was defined as waking at least once per night to urinate. The primary criterion for treatment success was defined as a >50% reduction in nocturia episodes, assessed through a voiding diary one month after treatment initiation. Quality of life related to lower urinary tract symptoms was evaluated using the IPSS (International Prostate Symptom Score).
  Results: A total of 82 patients were included in the study. The average number of nocturnal voids was 3.1 per night. The most commonly preferred therapeutic options were alpha-blockers (54.3%), followed by anticholinergics (32.6%). Hypertension (p = 0.03), diabetes (p = 0.01), and sleep apnea syndrome (p = 0.05) were identified as independent factors associated with treatment failure for nocturia.
  Conclusions: Patients with comorbidities such as diabetes mellitus, hypertension, and sleep apnea syndrome are more resistant to nocturia treatment. A multidisciplinary approach is necessary for these patients to improve their quality of life.

UP-30.07—Efficacy of Sacral Neuromodulation in the Majority Male and Elderly Veteran Population 

• Olawoyin Olamide, Choksi Ankur, Foster Harris
  Yale School of Medicine, New Haven, United States

• Introduction and Objectives: To evaluate the efficacy of sacral neuromodulation (SNM) in patients at the Veterans Affairs Medical Center (VAMC) with a primary diagnosis of overactive bladder (OAB) with and without urge incontinence (UI), and idiopathic nonobstructive urinary retention.
  Materials and Methods: We performed a retrospective cohort review of patient at the VAMC who underwent a trial of SNM between January 2017 and December 2024. Patient demographics, indication for surgery, urodynamics evaluation, concurrent diagnosis of BPH, compliance with programming, and >50% symptoms improvement from baseline after 6 months from second stage device implantation were evaluated.
  Results: 45 patients underwent a trial of SNM at the VAMC between 2017 and 2024. Indications included OAB with UI in 15/45 patients, without UI in 24/45, and idiopathic nonobstructive urinary retention in 6/45 patients. Average age of the patients was 71 years, and, typical of the VA population, the majority were male (82%) and White (87%). 67% of patients had the diagnosis confirmed by urodynamics prior to device implantation. 84% of patients reported >50% improvement 2 weeks after Stage 1 and subsequently underwent Stage 2 implantation. At 6 months follow up of patients who underwent Stage 2 implantation, 61% of patients reported continued improvement in their symptoms including 67%, 53%, and 75% in those with OAB with UI, OAB without UI, and urinary retention, respectively.
  Conclusions: Eighty-four percent of VAMC patients who underwent stage 1 sacral neuromodulation for either OAB with or without UI and idiopathic urinary retention proceeded to second stage implantation, 61% in this group reported continued >50% improvement in their symptoms at 6 months. The group with the highest success rate at 6 months was those who had OAB with UI and urinary retention. The overall success rate is lower than previously reported 85% sustained improvement in the general population. Notably, the mean age in these studies was 51 years, and the majority of patients were female compared to the mean age of 71 years and 82% male population in this VAMC cohort. SNM can be an effective treatment option in the veteran population with standard indications.

UP-30.08—Evaluation of an Electronic Frequency-Volume Chart in Hospitalized Patients with Traumatic Neurogenic Lower Urinary Tract Dysfunction 

• Gomez Illanes Reynaldo, Humerez Wayar Valeria, Massouh Skorin Ragheb
  Hospital del Trabajador, Santiago, Chile

• Introduction and Objectives: Neurogenic lower urinary tract dysfunction (NLUTD) significantly impairs the quality of life of trauma patients. Voiding monitoring is essential for effective management. While frequency-volume charts (FVCs) are validated and widely used, manual paper-based documentation is often inaccurate and burdensome. This study aimed to evaluate the use of an automated electronic FVC in adult patients with NLUTD. Our hypothesis is that this device is not inferior in terms of accuracy to the gold standard manual registration and provides better usability features.
  Materials and Methods: Nursing staff received structured training for standardized use of a novel electronic voiding diary device (Minze Diary Pod^®, Minze Health^®, Nederlands). Inpatients completed a three-day voiding diary using the electronic device and three-day traditional paper-based chart. The daily average voided volume recorded by each method was compared. Usability was assessed through a structured electronic survey, developed by four urologists and completed by the nursing staff.
  Results: From July 2024 to March 2025, 36 inpatients were enrolled, of which 87% were males, and mean age was 55 years. Diagnoses included paraplegia (58%), tetraplegia (21%), traumatic brain injury (11%), polytrauma (5%), and pelvic fracture (5%). The median daily urinary volume was 2006 mL (IQR: 1567–3319) manually, and 1657 mL (IQR: 1442–2079) with the electronic device (p = 0.3945). Usability assessment showed that 43% of staff found the device easy to use, 78% rated it as manageable, and 50% would recommend its use in current clinical practice.
  Conclusions: The electronic device is not inferior to the gold standard manual FVC in terms of accuracy in voided volume measures, and was well received by the nursing staff. It appears to be a feasible, user-friendly tool with the potential to complement conventional voiding registries in the management of NLUTD. Further research is warranted to validate its clinical utility.

UP-30.09—Laparoscopic Pudendal Nerve Entrapment Decompression with Neuromodulation Implantation by Pelvic Intraoperative Neuromonitoring (pIOM^®) 

• Fernandes Cláudia ¹, Saavedra Manuel ², Ramírez Ana ², Velasco Clara ², Casado Javier ², Vale Luís ¹, Celada Guillermo ², Silva Carlos ¹, José Luis ², Lavalle Luis ²
  ¹ São João Local Health Unit, Porto, Portugal, ² La Princesa University Hospital, Madrid, Spain

• Introduction and Objectives: Pudendal nerve entrapment syndrome (PNES) is a rare condition that causes chronic pelvic pain and may involve voiding dysfunction. PNES diagnosis often requires neurophysiological testing. Surgical intervention becomes necessary when conservative treatments are ineffective. In cases of concurrent voiding dysfunction, pudendal neuromodulation is integrated to enhance functional recovery. We aim to describe a laparoscopic approach to pudendal nerve decompression aided by intraoperative neuromonitoring (pIOM) for optimized outcomes.
  Materials and Methods: From 2021 to 2023, 10 PNES patients underwent laparoscopic decompression with pIOM^®. We present a case of a 37-year-old woman with chronic pelvic pain, defecatory dysfunction, and chronic urinary retention managed by clean intermittent catheterization. Clinical presentation, neurophysiological testing, and response to pudendal nerve infiltration confirmed the PNES diagnosis. This procedure utilized pIOM^® to support anatomical precision and avoid nerve injury and pudendal neuromodulation to regulate the genitourinary and gastrointestinal systems.
  Results: pIOM^® facilitated precise nerve identification, improving surgical accuracy and reducing iatrogenic risk. Post-surgery, 60% of patients reported significant relief, 20% moderate improvement, and 20% no change (10 patients in 2 years). The presented patient experienced complete pain relief, normal defecatory function, and achieved spontaneous micturition, supported by pudendal neuromodulation.
  Conclusions: Pelvic intraoperative neuromonitoring (pIOM) enhances the effectiveness of pudendal nerve decompression surgery by improving nerve identification and avoiding injury, ultimately supporting better clinical outcomes. Pudendal neuromodulation significantly improves quality of life post-surgery in patients with overactive bladder, urinary retention, and defecatory dysfunction.

UP-30.10—Lower Urinary Tract and Sexual Dysfunctions in Patient Referring for Migraine with and without Aura: Data from an Academic High Volume Center 

• Pastore Antonio Luigi ¹, Fuschi Andrea ¹, Valenzi Fabio Maria ¹, Sequi Manfredi Bruno ¹, Suraci Paolo Pietro ¹, Al Salhi Yazan ², Carbone Antonio ¹
  ¹ Sapienza University of Rome, Faculty of Pharmacy and Medicine Dept. of Medico-Surgical Sciences and Biotechnologies Urology Unit, ICOT Latina, Latina, Italy, ² Sapienza University of Rome, Faculty of Pharmacy and Medicine, Latina, Italy

• Introduction and Objectives: Migraine is a pervasive neurobiological headache disorder that is caused by increased excitability of the central nervous system (CNS). Migraine represents one of the most disabling medical disorders. The diagnosis is based on the headache’s characteristics and associated symptoms. Migraine without aura is the most common form of migraine in both children and adults, while 15% to 33% of migraineurs experience aura. Aura is a fully reversible, gradual focal neurological phenomenon involving most commonly visual, sensory, speech and/or motor symptoms. This study investigated the correlation between migraines, Lower Urinary Tract Symptoms (LUTS) and Sexual Dysfunction (SD).
  Materials and Methods: This study enrolled patients referring to neurological outpatient clinic, suffering from migraine. The patients were divided into control group (patients with no prior diagnosis of migraine) and migraine group. This latter group was further subdivided into two subgroups based on the presence or absence of aura. All patients were investigated with self-administered questionnaires (IPSS, SF.OAB-q, IIEF-5, MSHQ, ICIQ-FLUTS, ICIQ-UI, FSI, MIDAS). Subjects with other neurological disorders, prior pelvic and/or prostatic surgery, in treatment with alpha-blocker and/or antimuscarinic drug, and aged <18 and >50 y.o. were excluded from the study.
  Results: We prospectively enrolled 235 patients and divided these subjects into Group C (control) and Group M (migraine) with 119 (81 female, 38 male) and 116 (75 female, 41 male) patients, respectively. Group M was subdivided into Group Ma (with aura) and Group Mw (without aura). Particularly, a significant correlation was found between the MIDAS score and the SF-OAB-Q, IEEF-5, and FSI scores. Higher MIDAS scores were directly correlated with higher SF-OAB-q and lower IEEF-5 and FSI scores. IPSS was also higher in Group M, even not statistically significant (6.2 p = 0.12). The mean MIDAS score in Group Ma was 15,4 and 16,3 in Group Mw. In group Ma, the mean SF-OAB-Q, IEEF-5, and FSI scores were 28.1, 17.4, and 19.2 and 26.9, 18.2 and 20.3 in Group Mw, respectively.
  Conclusions: This study shows a statistically significant correlation between OABq and MIDAS score. Furthermore, OAB and SD were found to be more prevalent in patients suffering from migraine with aura.

UP-30.11—Optimizing Diagnostic Precision and Treatment Approaches for Young Men with LUTS: The Role of Urodynamic Studies 

• Navriya Shiv, Jain Jaydeep, Chaudhary Gautam, Singh Mahendra, Bhirud Deepak, Sandhu Arjun
  AIIMS, Jodhpur, Jodhpur, India

• Introduction and Objectives: To evaluate the effectiveness of urodynamic studies (UDS) in refining diagnoses and guiding management strategies for lower urinary tract symptoms (LUTS) in young men, compared to initial clinical assessments.
  Materials and Methods: This retrospective study analyzed data from 210 young men (under 45 years) with LUTS who underwent UDS between June 2019 and December 2023. Patients were selected from a database of 1421 UDS conducted at a tertiary care center. Inclusion criteria were men under 45 with LUTS, excluding those with neurological diseases, urethral stricture, acute prostatitis, urethral/vesical calculus, genitourinary tuberculosis, history of lower urinary tract surgery, meatal stenosis, infective or malignant lesions, and positive urine cultures. Multichannel UDS were performed according to International Continence Society standards, assessing various urodynamic parameters. Pre- and post-UDS diagnoses and treatment modalities were compared.
  Results: Empirical treatments included antibiotics (37.14%), α-adrenergic antagonists (34.76%), β3 agonist (4.76%), anticholinergics (5.24%), behavioural therapy (12.38%), and combination therapy (25%). Post-UDS, treatments adjusted to α-adrenergic antagonists (35.71%), β3 agonist (9.05%), anticholinergics (2.38%), combination therapy (13.33%), with 36 receiving behavioral therapies (counselling, hydration restriction, and timed voiding), 23 catheterization, and 33 undergoing surgery.
  Conclusions: UDS improves diagnostic accuracy and helps treatment, emphasizing its crucial role in managing refractory LUTS in this demographic. It has a pivotal role in patients with pre-UDS diagnosis of overactive bladder, where more than 68% patients had change in diagnosis and management.

UP-30.12—Predictive Risk Factors Associated to De Novo Lower Urinary Tract Symptoms Onset After Robot Assisted Radical Prostatectomy: A Prospective Multicenter Study 

• Pastore Antonio Luigi ¹, Fuschi Andrea ¹, Valenzi Fabio Maria ¹, Sequi Manfredi Bruno ¹, Suraci Paolo Pietro ¹, Al Salhi Yazan ², Lombardo Riccardo ³, De Nunzio Cosimo ³, Carbone Antonio ¹
  ¹ Sapienza University of Rome, Faculty of Pharmacy and Medicine Dept. of Medico-Surgical Sciences and Biotechnologies Urology Unit, ICOT Latina, Latina, Italy, ² Sapienza University of Rome, Faculty of Pharmacy and Medicine, Latina, Italy, ³ Sapienza University of Rome, Faculty of Psychology and Medicine, Sant’Andrea Hospital, Dept. of Urology, Rome, Italy

• Introduction and Objectives: Lower Urinary Tract Symptoms (LUTS) are frequently observed in men above the age of 45 with bothering symptoms with a great impact on their quality of life. A significant number of patients undergoing Robot Assisted Radical Prostatectomy (RARP) develop LUTS such as storage symptoms and Urinary Incontinence (UI). Our study aimed to identify the principal predictive factors correlated to the onset of LUTS in patients undergone RARP.
  Materials and Methods: Our prospective study enrolled patients with localized prostate cancer underwent RARP. Exclusion criteria were the presence of pre-operative Detrusor Overactivity (DO), UI, neurogenic bladder dysfunction, and previous treatment with radiotherapy. PSA, smoking habit, and BMI were evaluated pre-operatively, and the patients were divided in 3 groups according to their age range. Every subject was investigated with a Urodynamic Study (UDS), which was performed pre-operatively and postoperatively after 3, 6 and 12 months.
  Results: On the initial 180 eligible patients investigated with pre-operative UDS, only 93 subjects were enrolled according to the exclusion criteria and pts were prospectively divided in three age groups: Group A (36 patients with age ranging from 46 to 53 years), Group B (26 patients with age ranging from 54 to 61 years) and Group C (31 patients with age range from 62 to 71 years). Group A showed DO in 15%, 11% and 7% (p < 0.05) of the patients at the 3, 6, and 12-month postop UDS, respectively. The Group B reported DO in 20%, 17% and 11% (p < 0.05), at the 3, 6 and 12 months UDS, respectively. In the Group C we observed DO (p < 0.05) in 30%, 26%, and 20% of patients at 3, 6, and 12 months, respectively. In those who developed DO, mean BMI was 29.7, (p < 0.05), and 58% of patients were smokers (p < 0.05), while, in patients without de novo DO, mean BMI was 24.9, and 21% of subjects were smokers.
  Conclusions: Our study suggests that BMI, age, and smoking habit were statistically significant factors directly correlated with the development of de novo DO (p < 0.05) in patients underwent RARP.

UP-30.13—Sacral Neuromodulation Outcomes in Neuro-Urological Patients—A Center Experience 

• Pedrosa Rui, Lorigo João, Guerra Ana, Figueiredo Bárbara, Temido Paulo, Figueiredo Arnaldo
  ULS Coimbra, Coimbra, Portugal

• Introduction and Objectives: Sacral neuromodulation is a well-established treatment option for patients with non-neurogenic overactive bladder and non-obstructive urinary retention. Recently there is growing evidence that sacral neuromodulation (SNM) is an effective and safe option in the treatment of selective neurogenic lower urinary tract dysfunction. This study aimed to characterize the neurogenic patients that were submitted to sacral neuromodulation and its outcomes.
  Materials and Methods: This was a retrospective cross-sectional study of neurogenic patients who underwent sacral neuromodulation between November 2017 and April 2023. All data was collected from patients’ clinical reports after obtaining informed consent.
  Results: In this period 16 patients with neurological diseases were submitted to sacral neuromodulation, 12 were female (%), and 4 were male (%), with a median age of 53.5 years (range: 31–72). Concerning urological diagnosis, 8 patients presented refractory overactive bladder (OAB) with urinary incontinence, 6 were diagnosed with non-obstructive urinary retention (NOUR) and 2 patients had both diagnoses. The most common neurological diagnosis was multiple sclerosis (8 patients (50%)) followed by spinal cord injury with incomplete lesions (3 patients (18.8%)) and transverse myelitis (2 patients (12.5%)). Currently, concerning the 6 patients with NOUR, 3 present complete response (no clean intermittent catheterisation (CIC) is needed) (50%), 2 had CIC daily number reduced by half (33.3%) and one had returned to the same number of CIC as previously (16.7%). Regarding patients with OAB, 3 out of 8 are asymptomatic (37.5%), 4 present partial response (main improvement was in frequency and incontinence with worse control of urinary urgency) (50%), and one patient has the same symptoms as prior to SNM (12.5%). The 2 patients with NOUR with concomitant OAB present partial response (reduction of number of CIC, improvement of urinary incontinence and modest response in urgency and frequency).
  Conclusions: Sacral neuromodulation showed satisfactory outcomes treating refractory neurogenic lower urinary tract dysfunction. This treatment option can improve quality of life of well-selected neurogenic patients.

UP-30.14—Systematic Review of Current Treatments for Urethral Stricture 

• Abad Rodríguez-Hesles Celia ¹, Yuste Mascarós Virginia ¹, Toyos Del Catillo Fátima ¹, Velasco Amador Miguel Ángel ¹, Sanchez Tamayo Javier ¹, Abad Vivas-Perez Jose Ignacio ², Arrabal Martin Miguel ¹
  ¹ Hospital Clinico San Cecilio, Granada, Spain, ² Hospital Clinico Torrecárdenas, Almería, Spain

• Introduction and Objectives: Urethral stricture is a common condition that obstructs urination and significantly impacts patients’ quality of life. Effective treatment selection requires an accurate diagnosis to characterize the stricture before intervention. The choice of treatment depends on key factors such as location, length, etiology, and prior treatments. Currently, three main therapeutic approaches are available: dilation, urethrotomy, and urethroplasty. This systematic review evaluates the effectiveness of current treatment options for urethral stricture.
  Materials and Methods: A systematic review was conducted following PRISMA guidelines. A total of nine studies were included, selected from PubMed, Embase, and the Cochrane Library databases. The most effective search combination was: (“Urethral stenosis”) AND ((“urethroplasty”)) OR (“urethral dilation”) OR (“urethrotomy”)). Strict inclusion and exclusion criteria were applied, limiting the selection to studies published from 2015 to the present and focusing on adult patients (>18 years).
  Results: The effectiveness of urethrotomy and dilation using Amplatz was similar, with no significant differences in recurrence rates. However, urethrotomy showed superiority (p < 0.05) in terms of maximum urinary flow (Qmax). The effectiveness of urethrotomy decreased with repeated procedures. Urethroplasty was significantly more expensive than urethrotomy (mean cost difference of $2,148) but did not show a clear advantage in quality-adjusted life years (QALY). While urethrotomy was the most cost-effective option, urethroplasty had a significantly lower need for reintervention (p = 0.02).
  Conclusions: Given the frequency, impact, and cost of urethral stricture, selecting the appropriate treatment is crucial. Current treatments show limited success rates, often requiring multiple reinterventions and yielding unsatisfactory results. The hierarchy of definitive treatments follows this order: urethroplasty > urethrotomy > dilation. The findings highlight the need for continued advancements in treatment options to achieve more definitive and long-lasting solutions.

UP-30.15—Systematic Review of Potential Treatments for Urethral Stricture Based on (Bio)3D Printing 

• Abad Rodríguez-hesles Celia ¹, Yuste Mascarós Virginia ¹, Zambudio Munuera Alberto ¹, Millán Ramos Irene ¹, Martinez Moreno Daniel ², Marchal Corrales Juan Antonio ³, Abad Vivas-Perez Jose Ignacio ⁴, Arrabal Martin Miguel ¹
  ¹ Hospital Clinico San Cecilio, Granada, Spain, ² Centro Investigación Biomédica Granada, Granada, Spain, ³ Universidad de Granada, Granada, Spain, ⁴ Hospital Clinico Torrecárdenas, Almería, Spain

• Introduction and Objectives: Urethral stricture significantly impacts quality of life, and current treatments often yield limited success. Novel therapeutic options with strong scientific evidence are needed, with (bio)3D printing emerging as a promising alternative.
  Materials and Methods: A systematic review was conducted following PRISMA guidelines. Three studies were identified through PubMed, Embase, Scopus, and Web of Science using the terms: (“urethral stenosis”) AND ((“3D bioprinting”) OR (“3D printing”)). Given the limited literature, broader inclusion criteria were applied, considering both human and animal studies without date restrictions.
  Results: Three bioengineered urethral structures were identified: A porous bacterial cellulose scaffold seeded with lingual keratinocytes. A 50:50 spiral scaffold of poly (ε-caprolactone) (PCL)/poly (lactide-co-caprolactone) (PLCL) with urothelial and smooth muscle cells in a hydrogel. A circular hydrogel-based structure with bladder smooth muscle cells and a gelatin methacrylate (GelMA)/alginate blend. All studies aimed to enhance biocompatibility and cell viability. Two studies designed 3D-printed urethral structures, likely offering better outcomes than the third study’s linear scaffold. Only one study involved an animal model, providing preliminary insights for future human applications.
  Conclusions: 3D printing-based designs could guide future research due to their well-defined printing methods, which remain underexplored. Selecting a urethra-like structure with suitable mechanical properties and cell viability is key before printing. Further refinement is needed to preserve urethral architecture. Currently, the literature on 3D printing for urethral stricture is scarce. Additional studies are essential to assess its potential as a viable therapeutic alternative.

UP-30.16—The Benefits and Harms of Prophylactic Catheter Washouts Compared with Standard Care in the Management of Catheter Associated Urinary Tract Infections and Catheter Blockage in Adults Living with Long-Term Catheters: A Systematic Review with Meta-Analysis 

• Wong E-Shuen ¹, Omar Muhammad Imran ¹, Young Catriona ², Yuan Yuhong ³, Abdel-Fattah Mohamed ¹
  ¹ University of Aberdeen, Aberdeen, United Kingdom, ² NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, United Kingdom, ³ Western University, Ontario, Canada

• Introduction and Objectives: Prophylactic washouts are often recommended to patients living with long-term catheters (LTCs) with the aim of reducing LTC associated adverse events such as catheter blockage and symptomatic catheter associated urinary tract infection (S-CAUTI). This systematic review summarises current evidence on the benefits and harms of regular prophylactic catheter washouts for adults using LTCs.
  Materials and Methods: Literature search was conducted using MEDLINE, EMBASE, CINAHL and CENTRAL (database inception to June 2024) for RCTs and quasi-RCTs comparing prophylactic catheter washouts to standard care, or different catheter washout solutions to each other. The review followed the methodology as per the Cochrane Handbook. Certainty of evidence was assessed with the GRADE approach. Detailed methods in the PROSPERO protocol (CRD42024553575).
  Results: Seven RCTs (340 participants) were included. Pooled analysis found lower S-CAUTI rates in saline washout groups than no washout groups [MD = −0.10 (95%CI −0.50–0.29)] (p = 0.61). Abdel-Fattah 2024 similarly reported lower S-CAUTI rates in their saline group compared to the no washout group [IRR = 0.40 (0.20–0.80); p = 0.003]. Furthermore, the review found lower S-CAUTI rates in any washout groups compared to no washout groups [MD = −0.05 (95%CI −0.42–0.32)] (p = 0.79). Pooled analysis also found reduced odds of catheter blockage in acidic washout groups than saline washout groups [OR = 0.51 (95% CI 0.25–1.03)] (p = 0.06). Airaksinen 1979 also found increased odds of greater encrustation in their no washout group compared to their saline group [OR = 0.62 (95% CI 0.17–2.25)] (p = 0.46). Pooled analysis also found that any washouts had reduced haematuria incidence [RR = 0.99 (95% CI 0.87–1.12)] (p = 0.86) compared to no washouts. Abdel-Fattah 2024 reported that washout groups had higher EQ-5D-5L scores than no washout groups, with the saline group MD = 0.056 (97.5% CI −0.022–0.134) (p = 0.11) and acidic group MD = 0.053 (97.5% CI −0.024–0.131) (p = 0.12) compared to the no washout group, suggesting that washout groups had higher quality of life (QoL) than no washout groups.
  Conclusions: Prophylactic catheter washouts may have more benefits and less harms than previously thought. Patients more prone to LTC blockage may benefit from acidic washouts, while those susceptible to S-CAUTI may be more suitable to saline washouts. Tailoring the type of prophylactic washout to patients’ needs may improve their QoL. However, current evidence is of low certainty; therefore, international robust RCTs abiding by SPIRIT and CONSORT guidelines are required.

UP-30.17—The Role of Urodynamic Study in Pudendal Nerve Entrapment Syndrome 

• Fernandes Cláudia ¹, Medina Alberc ², Morales Juan ³, Viegas Vanessa ⁴, Casado Javier ⁵, Cidre Miguel ², Vale Luís ¹, Silva Carlos ¹, José Luis ⁵, Lavalle Luis ⁵
  ¹ São João Local Health Unit, Porto, Portugal, ² Hospital Universitario Ramon y Cajal, Madrid, Spain, ³ Universidad Autónoma de Nuevo León, Autonomous University Of Nuevo León, Mexico, ⁴ Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain, ⁵ La Princesa University Hospital, Madrid, Spain

• Introduction and Objectives: Pudendal nerve entrapment is a rare cause of pelvic pain that can be associated with lower urinary tract symptoms (LUTS). The LUTS incidences among PNE patients and the urodynamic study (UDS) role are underexplored. This study aims to explore the role of the UDS in PNE diagnosis and describe the prevalence of LUTS in this population.
  Materials and Methods: This retrospective, multicentric, cross-sectional study analyzed 144 patients with suspected PNE syndrome between 2016 and 2024. Electronic medical urology records of chronic pelvic pain patients were evaluated. The diagnosis of PNE was established based on neurophysiological tests (NFS) and response to pudendal nerve block. Complaints of LUTS were recorded, and UDS was systematically performed as part of the diagnostic course. PNE patients with LUTS who underwent surgery were evaluated considering LUTS and pain improvement at 12 months postoperatively.
  Results: A total of 87 patients (60.4%) were diagnosed with PNE. Among them, 51% reported LUTS, with a similar prevalence in women (56%) and men (55%). A statistically significant difference was found between gender and UDS dysfunction (p = 0.013), with underactive detrusor predominance in women (44%) and bladder outlet obstruction in men (40%). LUTS were more prevalent in patients with CPP from other causes, in both females (p = 0.027) and males (p = 0.030). UDS dysfunctions showed a statistically significant difference between PNE and other CPP causes only in females (p = 0.023). Female PNE patients have more UDS anomalies in comparison to CPP from other causes. Of the PNE patients with LUTS, only 24 (60%) underwent surgery, and 11 (45.8%) experienced symptom improvement. In the univariate analysis, UDS results did not predict LUTS improvement after surgery (p = 0.680).
  Conclusions: LUTS are highly prevalent in PNE and detectable in UDS. Assessing urinary symptoms is crucial in PNE evaluation. Urodynamic tests help clarify if LUTS stems from PNE or other CP causes. However, UDS findings do not predict LUTS improvement after surgery.

UP-30.18—The Value of Repeated Interventions in Artificial Urinary Sphincter Long-Term Functioning 

• Tomilov Andrey, Veliev Evgeniy, Golubtsova Elena, Kasyan Gevorg
  Botkin Hospital, Moscow, Russian Federation

• Introduction and Objectives: Despite the development of biotechnology, the artificial urinary sphincter, with all its disadvantages, currently keeps the leading position in the treatment of men stress urinary incontinence. This work is focused on the importance of revision interventions in artificial urinary sphincter functioning.
  Materials and Methods: Both primary and secondary artificial urinary sphincter interventions in 67 consecutive patients from 2004 to 2024 at a single center were recorded and analyzed. Non-infectious and infectious causes of revisions were counted separately. In the first case, a single-stage intervention—replacement—was performed. In the case of infection-related complications, multiple interventions were performed, including removal and delayed reimplantation. ICIQ-UI SF questionnaire was used for quality of life assessment. Risk factors were identified using regression analysis.
  Results: At a median follow-up of 60.4 months (IQR 11.2–114.0 months), a total of 102 artificial urinary sphincter interventions were performed, including 67 (65.7%) primary interventions and 35 (34.3%) revisions. The mean age of patients at the time of primary surgery and revision was 67.5 ± 8.1 years and 71.8 ± 9.8 years, respectively. Thirteen non-infectious and 13 infectious complications that led to revision were registered. The main causes of revisions were cuff erosion and fluid deficiency. Nineteen patients (28.4% of all primary implantations) underwent revisions; 12 of them were repeated revisions. Of the 35 revisions, 10 (28.5%) were due to iatrogenic complications. There were no significant differences in the number of pads used, urine loss, and ICIQ-UI SF scores when comparing the results of primary and secondary interventions. The presence of diabetes mellitus was associated with trend toward higher rate of AUS replacement (OR: 3.62, 0.81–16.22 95% CI, p = 0.10).
  Conclusions: At long-term follow-up, up to one-third of patients require artificial urinary sphincter revision, with a significant proportion of iatrogenic complications. No differences in quality of life and urinary loss were found between primary and revision surgery.

UP-30.19—Transient Acute Urinary Retention After Herpes Zoster Virus Infection 

• Thomas Charalampos ¹, Samarinas Michael ², Diamantis Georgios ³, Emmanouil Dimitra ⁴, Manthos Prokopios ⁴, Rapidi Christina-Anastasia ⁴, Konstantinidis Charalampos ³
  ¹ General hospital of Corinth, Corinth, Greece, ² Aristotle University of Thessaloniki, Thessaloniki, Greece, ³ National Rehabilitation Center, Athens, Greece, ⁴ General Hospital of Athens “G.Gennimatas”, Athens, Greece

• Introduction and Objectives: Herpes zoster is a common viral disease characterized by a painful dermatomal rash. Although its neurological complications are well-documented, acute urinary retention (AUR) is a rare presentation. We report seven cases—six women and one man—who developed AUR within days to weeks after herpes zoster infection.
  Materials and Methods: Seven patients (mean age: 75.1 years; range: 68–83) presented with voiding dysfunction following a herpes zoster outbreak. Rash distribution included right buttock (n = 2), left buttock (n = 1), right-sided T10–S4 dermatomes (n = 3), and bilateral S2–S4 involvement (n = 1). External genitalia were unaffected. Laboratory results including urine analysis and cultures were within normal limits. All patients had post-void residual (PVR) volumes > 400 mL and required placement of an indwelling catheter.
  Results: Urodynamic studies revealed detrusor hypocontractility in five patients and acontractility in two. Management included clean intermittent catheterization, antiviral therapy, and analgesia. After a median of 7 weeks (range: 6–9), all patients resumed spontaneous voiding and discontinued catheterization.
  Conclusions: Several mechanisms may contribute to herpes zoster–related urinary retention: (a) direct viral invasion of the bladder wall (herpetic cystitis); (b) retrograde viral spread causing neuritis and detrusor areflexia; (c) herpetic myelitis affecting suprasacral segments, leading to detrusor overactivity; (d) involvement of thoracolumbar sympathetic nuclei, increasing sphincter tone. Clinicians should consider herpes zoster in the differential diagnosis of new-onset AUR, particularly in elderly patients with sacral dermatomal involvement. Prompt assessment—including urological history, physical examination, and bladder scanning—is critical for diagnosis. Management involves antiviral agents, pain control, and temporary catheterization. Most patients recover fully within two months.

UP-30.20—Urethral Bulking Agents and Pelvic Floor Muscle Training for the Treatment of Stress Urinary Incontinence in Female Patients with Multiple Sclerosis 

• Antoniadis Georgios ¹, Tsikopoulos Ioannis ², Tsionga Aikaterini ³, Galanoulis Konstantinos ¹, Bousdroukis Nikolaos ¹, Samarinas Michail ⁴
  ¹ Urology Department, General Hospital of Larissa, Greece, ² Royal National Orthopaedic Hospital, Neurourology, London, United Kingdom, ³ 1st Urology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece, ⁴ 2nd Urology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece

• Introduction and Objectives: This study assesses the efficacy of urethral bulking agents (UBA) and pelvic floor muscle training (PFMT) for managing stress urinary incontinence (SUI) in female patients with multiple sclerosis (MS). SUI, caused by involuntary urine leakage during increased abdominal pressure, is prevalent among women with MS, severely impacting quality of life. Traditional treatments may not suit MS patients due to potential complications, highlighting the need for less invasive options like UBAs, which increase urethral tissue volume, and PFMT, which strengthens pelvic muscles. Despite promising outcomes, their efficacy in MS-related SUI is under-researched.
  Materials and Methods: This nine-month study involved 14 female MS patients with moderate SUI, divided into two groups to evaluate UBA and PFMT effectiveness. UBAs, administered via injections, enhance urethral resistance, while PFMT uses guided exercises to improve pelvic control. Outcomes were assessed by urinary pad usage, ICIQ-SF scores, and quality of life metrics, measuring reductions in incontinence and symptom severity.
  Results: 14 patients were recruited, equally allocated in the two groups. Both groups showed significant improvement. Daily pad usage decreased to 0–1 in both groups, with reduced symptoms and better quality of life scores. UBA provided quicker relief, while PFMT offered sustainable benefits. Two PFMT participants discontinued follow-up due to MS complications, highlighting adherence challenges in progressive conditions.
  Conclusions: UBA and PFMT are effective options for SUI in MS patients, enhancing symptom control and quality of life. UBA may provide faster results, whereas PFMT supports long-term management. This study underscores the importance of individualized, multimodal approaches to optimize outcomes for women with MS-related SUI, though further research is needed for long-term validation.

31. Nursing Submissions

31.1. Moderated Oral ePosters

NMP-31.01—A Novel Scoring System and Timer Based Repositioning Protocol to Reduce Well-Leg Compartment Syndrome (WLCS) in Patients Undergoing Prolonged Surgery 

• Chua Deanna, Law Quincy, Shuqin Ye, Eapen Sneha, Lim Jun Hui, Tiwari Raj
  Sengkang General Hospital, Singapore, Singapore

• Introduction and Objectives: Patients undergoing prolonged pelvic surgery may develop compartment syndrome in lower limbs in the absence of trauma or pre-existing vascular disease known as Well-Leg Compartment Syndrome (WLCS). Although uncommon it has devastating consequences for postoperative recovery including loss of limb or disability. Our primary aim was to create a novel scoring system for WLCS preoperative risk assessment and run a timer based repositioning protocol for patients undergoing prolonged pelvic surgery. Secondary aim was to assess feasibility and surgeon satisfaction.
  Materials and Methods: We recruited Colorectal, Urology and Plastics Surgery patients undergoing prolonged surgery in lithotomy or Trendelenburg position at Sengkang General Hospital from July to December 2024. Preoperative novel WLCS score was calculated based on 3 parameters, body mass index (BMI) ≥ 25, age < 3 and preexisting peripheral vascular disease or venous insufficiency with each category scoring 1 point. Range 0–3 points. Intraoperatively timer based repositioning was performed once operative time reached 4 h, for 15 min each time. Repositioning was defined as levelling the patient and lowering the calves to the level of the heart or lower. Postoperatively repositioned patients were assessed once daily till postoperative day 3 looking for signs or symptoms of WLCS. Feasibility, satisfaction and surgical disruption of the protocol were assessed by surveying nurses and doctors involved before and after the study.
  Results: 484 patients were recruited. There were zero WLCS cases. WLCS score was 0 in 50%, 1 in 45%, 2 in 4% and 3 in 0% of patients. 12% of patients required repositioning of whom 90% were repositioned once. Preoperative WLCS score did not correlate with number of repositioning. Surveys revealed high levels of feasibility and satisfaction with low levels of perceived disruption amongst surgeons, anesthetists and perioperative nurses. The majority were willing to continue the WLCS protocol beyond the end of the study.
  Conclusions: WLCS scoring and timer-based repositioning are both measures which should be performed for all patients undergoing prolonged pelvic surgery to adequately triage patients and keep risks of post procedure WLCS low. These measures have proven to be feasible, satisfactory and with minimal disruption to the performance of prolonged surgeries.

31.2. Unmoderated Standard ePosters

NUP-31.02—Uroconnect: Nurturing Men’s Wellness Together 

• Chengodu Thilakavathi
  Epworth Healthcare, Eltham, Australia

• Introduction and Objectives: At present, prostate cancer is estimated to be the most commonly diagnosed cancer for males and for Australia overall. With an estimated 26,368 cases diagnosed in 2024, prostate cancer is estimated to account for 28% of the cancers to be diagnosed in males for the year. Despite the high diagnostic rates, evidence has shown that there has been a lack of supportive care for men with Prostate Cancer. This review will demonstrate that there is an evident gap for provision of support to men with Prostate Cancer in terms of psychosocial care requirements, lack of support groups and the initiation of the grassroots program. Furthermore, the review will reveal how the initiation of support groups, by the men themselves, became significant to the health and wellbeing of these men.
  Materials and Methods: A literature search of MEDLINE, EMBASE and CINAHL databases including studies evaluating patient, oncological or treatment of factors against one of five mental wellbeing outcomes: depression, anxiety, fear of cancer recurrence, masculinity and body image perception were conducted.
  Results: 4 themes were identified: Attitudes of Health Practitioners; Initiation of Support; Reason for Support; and Grassroots Support. These are discussed with strategies and current approaches to wellness for men with Prostate Cancer.
  Conclusions: The reviewed literature highlights the significant psychological, emotional, and social benefits of men’s support groups for individuals dealing with prostate cancer. These groups serve as vital spaces for shared experiences, emotional validation, information exchange, and coping strategies. Despite the traditionally stoic attitudes often associated with masculinity and men’s health, support groups have proven to reduce feelings of isolation and improve overall well-being. However, participation remains limited due to persistent stigma, cultural norms surrounding masculinity, and lack of awareness. Additionally, most studies have focused on in-person or structured clinical settings, with fewer exploring digital or peer-led alternatives, which could widen access. Future research should aim to address these barriers by exploring culturally sensitive approaches, evaluating the long-term outcomes of support group involvement, and leveraging technology to create more inclusive and accessible support systems. Healthcare professionals should also be encouraged to actively recommend such groups as part of holistic prostate care.