SPECIALTY SOCIETIES: Urological Society of India Congress Presentation Summary

By: Aseem Shukla, MD, Children’s Hospital of Philadelphia, Pennsylvania | Posted on: 18 May 2023

A perusal of my practice calendar at the Children’s Hospital of Philadelphia will consistently display a 2-week block extending from late January into early February. It has been so for nearly a decade, though at an elevated level of importance over the last 4 years. Why so?

The end of January means that the International Bladder Exstrophy Collaboration that the late Richard Grady and I initiated at the Civil Hospital in Ahmedabad, India, gathers, as it has for 15 years. Operative surgeons from 4 major children’s hospitals, dozens of observer surgeons seeking an immersive learning experience in bladder exstrophy, and a team of anesthesiologists, orthopedic surgeons, geneticists, nurses, and researchers join hands in a bid to address the global surgical burden of that rare disease.

As the 10 days in Ahmedabad end, our team journeys to the host city of the annual Urological Society of India Conference (USICON). For 2023, the venue was the contemporary designed, spacious A-Dot Convention Center in metropolitan Delhi—a venue where a scientifically rigorous, meticulously organized, and comprehensive schedule encompassing all urological specialties awaited.

I was asked to address 2 areas, both of which comprise an area of my specialty interest: hypospadias and the robot-assisted ureteral reimplantation to address vesicoureteral reflux.

Tasked to provide “My 2 cents” on hypospadias complications, I began with a simple accounting of the genealogy of hypospadias repairs (Figure 1). I explained that while there are many options for a hypospadias repair, it is important that pediatric urologists limit their armamentarium to certain repairs for which they can demonstrate reproducible results. For me, this means that I utilize the Thiersch-Duplay primarily, and island onlay and simple meatal advancements occasionally, for distal repairs and the 2-stage approach for proximal hypospadias with severe chordee.

Figure 1. Genealogy of hypospadias repairs (credit: Douglas A. Canning).

The crux of my discussion thereafter focused on emerging data from my institution and many others about the importance of greater transparency in reporting results after hypospadias repair.1 This greater commitment to accuracy in data reporting has led to a significant insight: most complications after hypospadias repairs do not appear soon after surgery. Indeed, at the Children’s Hospital of Philadelphia, we’ve found that 53% of all complications after hypospadias surgery were detected only after the first postoperative year, with the median time to complication after distal hypospadias repairs a surprising 83 months. At USICON, I asserted that any surgical outcomes report after hypospadias repair should be considered very preliminary and nonconclusive until 5 or 6 years have elapsed after surgery.

My next presentation was a video-assisted discussion of the technical nuances of the robot-assisted laparoscopic extravesical ureteral reimplantation. This procedure continues to polarize pediatric urologists due to its perceived technical challenges and potential for adverse outcomes if done incorrectly. As I’ve reported individual and multi-institutional experiences confirming that the procedure is safe, reproducible, and successful, I was asked to present a step-by-step approach to the procedure.2

During a video presentation curated by my colleague, Karl Godlewski, I outlined how the ureter is accessed posterior to the broad ligament in girls, the ureter is safely mobilized, and then a detrusor trough is created. I then offered some experiential insights into how the bladder detrusor muscle may be safely approximated over the ureter (Figure 2). We discussed how a 5:1 detrusor tunnel-to-ureteral diameter reimplant can be completed, consonant with what Leadbetter and Politano discussed decades ago as the gold standard.

Figure 2. Still shot from video demonstrating robot-assisted extravesical ureteral reimplantation.

Figure 3. Part of the AUA delegation to Urological Society of India Conference–Delhi. Left to right: Jaspreet Sandhu, Karl Godlewski, Pramod Reddy, and Aseem Shukla.

The USICON continues to evolve into a premier gathering of urologists from all over South Asia, and I interacted with urologists from India, Bangladesh, Nepal, Sri Lanka, Maldives, and other countries in the region. Accompanied by other US-based faculty urologists, such as Dr Jaspreet Sandhu from Sloan Kettering and Dr Pramod Reddy from Cincinnati Children’s Hospital, our entire AUA delegation appreciated the incredible hospitality, spirited discussions, and bidirectional learning—in the best tradition of robust scientific meetings—that we experienced (Figure 3).

  1. Long CJ, Chu DI, Tenney RW, et al. Intermediate-term followup of proximal hypospadias repair reveals high complication rate. J Urol. 2017;197(3 Pt 2):852-858.
  2. Sahadev R, Spencer K, Srinivasan AK, Long CJ, Shukla AR. The robot-assisted extravesical anti-reflux surgery: how we overcame the learning curve. Front Pediatr. 2019;7:93.