Pediatric urology’s representation at the 2023 AUA Annual Meeting proved a major success, culminating in an engaging and inspiring Societies for Pediatric Urology (SPU) annual meeting. Drs Candace Granberg and Casey Seideman deserve huge congratulations for organizing a dynamic conference exploring cutting-edge topics. The overarching theme centered around the future of pediatric urology, with emphasis on novel surgical techniques for management of rare conditions, innovative thinking and technologies, and training the next generation of pediatric urologists.

With respect to emerging technology, at the SPU annual meeting, Dr Jonathan Ellison described the growing adoption of the high-power laser, Moses technology, and the thulium laser.^1,2 In the surgical management of pediatric kidney stone disease, the advantages of better stone clearance with thulium laser must be delicately balanced with the potential higher risk of thermal injury.² One of the pediatric plenary sessions highlighted different surgical approaches to the management of pediatric urolithiasis based on stone size and location. Work led by the multi-institutional PKIDS (Pediatric KIDney Stone) Care Improvement Network has underscored the importance of comparative effectiveness research in optimizing the delivery of surgical care for children with kidney stones.³

Dr Daniel Keefe presented on how our specialty can harness the power of artificial intelligence with applications such as image analysis, predictive modeling, and development of clinical algorithms.^4-6 Artificial intelligence truly represents team science, requiring robust collaboration and the sharing of information among our colleagues.

Dr Janelle Fox provided an update on the efficacy of percutaneous tibial nerve stimulation (PTNS) in the treatment of overactive bladder in children. Incorporating PTNS more regularly into pediatric practice can offer treatment for drug-refractory patients and afford a viable management option for patients with a larger body habitus. Challenges with PTNS to address in the near future include inconsistency in determining success, titrating settings, and defining appropriate maintenance therapy.

In recent years, telehealth has emerged as a mainstay for delivering care to children. Benefits include timely access to care, extending provider’s reach, increased convenience for families, and a positive financial impact with reduced time off work/school and minimizing the carbon footprint. Finkelstein et al reported that 96% of video visits demonstrate complete case management, yet 3.5% of families seeking pediatric urology care still lack digital access.⁷ As a result, we need to continue identifying ways to overcome barriers to care while also focusing on opportunities for developing best practices in this nascent area of medicine.

The AUA Annual Meeting also focused on the future for our pediatric patients, specifically the uncertain political climate in which gender-affirming care for minors can be delivered at the state level. Drs Kelly Swords and Diana Bowen stressed that we need to ensure multidisciplinary collaborations for gender diverse children⁸ and advocacy for transgender children as outlined in the AUA Statement on Transgender Care.⁹

In addition, we examined the future of our workforce, questioning whether we are training the right number of pediatric urology fellows. At the moment, not all pediatric fellowship positions are filling each year, but there currently seems to be equipoise in supply and demand for pediatric urologists nationwide. Maintaining high quality in training programs is of utmost importance. Work presented by Danzig et al reminds us that as new fellowship graduates transition to practice, we need to ensure they are prepared to treat their patients independently, confidently, and safely.¹⁰

Furthermore, the field of pediatric urology must prioritize growing diversity. Pediatric urology fellowship trainees are now reaching gender parity, but representation among those underrepresented in medicine remains more stagnant. Dr Shannon Cannon emphasized early exposure to pediatric urology in medical training, encouraging medical students to see themselves in our profession, and cultivating an environment that both welcomes and uplifts people from a variety of backgrounds.

In her SPU Presidential Address, Dr Elizabeth Yerkes shared that the SPU has developed 3 new task forces centered around diversity, equity, and inclusion, global surgery, and education. Dr Yerkes has also created the new ENCOMPUS (Engagement and Community in Pediatric Urology Societies) program, comprised of small support groups among pediatric urologists in various stages of their careers to foster community and well-being.

This year’s Meredith Campbell Lecture was given by Dr Mark Cain, who concentrated on the career trajectory in pediatric urology. Dr Cain spoke of 5 different stages throughout one’s career, emphasizing that the journey is never straight. We not only need to uphold the classic trifecta—to teach, to innovate, and to operate—but we need to do so while integrating with what we value most in life. Dr Cain accentuated the values of intellectual curiosity, mentorship, innovation, integrity, and stoking passion for our field in a new generation of learners through hands-on education and mentorship.

Dr Jonathan Routh delivered the annual John Duckett Memorial Lecture at the plenary session, speaking on “Innovation by Necessity: Improving Urodynamics for Children with Spina Bifida.” With his expertise in the care of children with spina bifida, Dr Routh stated that urodynamics (UDS) in this patient population has great promise in the ability to characterize bladder function. On the other hand, there are shortcomings in the interpretation of UDS, not the least of which is the possibility of cognitive bias, and we must do better for our patients. Machine learning has the potential to improve our utilization of UDS in the management of spina bifida and remains a growing opportunity for improving care for our pediatric patients.

The pediatric plenary sessions rounded out with a debate on the management of vesicoureteral reflux. Panelists recognized that vesicoureteral reflux remains a heterogeneous and dynamic disease, and patient care should be tailored to the individual patient based on risk factors (ie, detection secondary to antenatal hydronephrosis vs after a febrile UTI). Moreover, the panel stressed the importance of long-term management, partnering with our pediatric nephrology colleagues to detect nephropathy early.

Overall, this year’s SPU annual meeting confirmed the future of pediatric urology is quite bright as we continue to uphold our missions in patient care, research, advocacy, quality improvement, and education.