Introduction Failed hypospadias repair remains a challenging issue in pediatric urology due to tissue loss, scarring, and complex anatomy. Oral mucosal grafts (OMGs) have become reliable options for urethral reconstruction in salvage cases. This study aims to evaluate the long-term functional and cosmetic outcomes of staged oral mucosal graft urethroplasty in children who have previously undergone unsuccessful hypospadias repairs. The goal was to assess the durability of the surgery through puberty and adolescence using standardized outcome measures. Materials and Methods A retrospective cross-sectional study was conducted assessing children who underwent staged oral mucosal graft (OMG) urethroplasty between January 2007 and December 2013 at our institution. In 2024, patients were evaluated for long-term functional and cosmetic outcomes using clinical examination, uroflowmetry, the Hypospadias Objective Scoring Evaluation (HOSE) score, and the Penile Perception Score (PPS). Results The mean age at first-stage surgery was 7.9 ± 2.8 years. At a minimum of 10-year follow-up from definitive final surgery, uroflowmetry showed a functionally patent neourethra in 62 patients (91.2%), with a mean Qmax of 12.6 ± 3.4 mL/s. Bell-shaped curves were seen in 27 (39.7%), while obstructive curves were identified in 6 patients (8.8%). The mean HOSE score was 10.3 ± 1.9, and the mean PPPS score was 9.4 ± 1.2, indicating satisfactory functional and cosmetic outcomes. The most common complication was urethrocutaneous fistula, occurring in 11 patients (16.1%). Overall, complications were observed in 21 patients (30.8%), and only four patients (13%) required redo grafting. Discussion Achieving good short-term results in hypospadias repair is encouraging, but long-term follow-up into adolescence remains essential. Redo hypospadias procedures, especially in children, present unique challenges, making staged oral mucosal graft (OMG) urethroplasty a dependable choice. Long-term urinary outcomes were favorable, with most patients maintaining good flow. Cosmetic satisfaction was high regarding penile skin and urethral appearance, although dissatisfaction with penile length persisted, highlighting the need for realistic counseling. Patient-reported scores matched objective evaluations, confirming the durability of staged OMG repairs. Overall, OMG urethroplasty offers stable functional and cosmetic results, supporting its continued use in reoperative pediatric hypospadias. Conclusion Oral mucosal graft urethroplasty provides excellent long-term functional and cosmetic outcomes in children with failed hypospadias repairs. The high HOSE and PPPS scores, along with a low complication rate and durability through puberty, adolescence, and early adulthood, support OMG as a preferred tissue substitute in complex reoperative hypospadias surgeries.
Introduction Persistent cloaca is a rare congenital malformation that can present with significant phenotypic variability. A subset of female cloaca patients presents with significant abdominal distension and deficient abdominal musculature, representing a distinct “prune belly-like" phenotype with unique challenges for neonatal care and surgical management. Objectives We aimed to describe this cohort and its implications for pre- and post-natal interventions. Materials and Methods A retrospective review of female patients diagnosed with persistent cloaca at a single institution between January 2010 and May 2026 with abdominal features consistent with prune belly syndrome (PBS) was performed. Data concerning prenatal diagnoses and interventions, neonatal course, surgical procedures, and imaging or exam findings were collected. Results Seventy-five patients with persistent cloaca were identified, of whom eight met the inclusion criteria. Mean gestational age was 34w2d (±22d) and median age at last follow up was 5.5 years [2.6-10.9 years]. All patients were White, six of Hispanic ethnicity. All required intubation immediately after birth for severe neonatal respiratory distress and/or pulmonary hypoplasia and had a median NICU stay of 106 days [80, 189], significantly longer than the median stay of persistent cloaca without PBS features (34.5 days [19, 60], p = 0.001). Additionally, all patients with PBS features were found to have hydrocolpos and/or megacystis on postnatal imaging, only present in 43% of those without PBS features. The patients were all managed with cutaneous vesicostomy and colostomy, except for one who died within 24 hours of birth. Mean common channel length was 3.8 ± 1.9cm; six patients have undergone definitive repair at a median age of 2.5 years [1.2-3.4]. Recurring features between patients included hydronephrosis or hydroureteronephrosis (8/8), grade V vesicoureteral reflux (4/8), some degree of Müllerian duplication (5/8), chronic kidney disease stage 4 or 5 (4/8), and orthopedic anomalies (5/8). Conclusions This series defines a unique prune belly cloacal phenotype characterized by abdominal wall attenuation alongside complex medical and surgical comorbidities. Findings support the mechanical disruption model of prune belly syndrome in which in-utero urinary tract obstruction and distension impair development of the abdominal wall. These patients face high rates of respiratory compromise at birth, prolonged neonatal intensive care, and delayed definitive cloacal repair compared with the broader persistent cloaca population.
Background Lower urinary tract symptoms (LUTS) are common in childhood and are associated with impaired health-related quality of life. The Pediatric Incontinence Questionnaire (PinQ) is a validated, disease-specific, reflective patient-reported outcome measure developed in English. No health-related quality of life (HRQoL) instrument currently exists for Danish children with LUTS. Objective To translate and cross-culturally adapt the original English version of the PinQ into Danish and evaluate the internal consistency and reliability of the Danish version. Methods This cross-sectional study was conducted at two pediatric outpatient clinics in Denmark. The 20-item self-reported PinQ was translated into Danish and culturally adapted according to Beaton’s standardized methodology. Internal consistency was assessed using Cronbach’s α. Results Between February and October 2025, 55 children with non-neurogenic LUTS were included. The median age was 6.9 years (IQR 6.3-8.0), and 54.5% were males. Internal consistency was high, with Cronbach’s alphas of 0.86 at baseline and 0.88 at retest. Test-retest reliability demonstrated satisfactory stability, with an overall intraclass correlation coefficient of 0.92 (95% CI: 0.86-0.95, p < 0.001). A substantial item-level floor effect was observed. Conclusion The original English PinQ was successfully translated and culturally adapted into Danish. The Danish PinQ demonstrated high internal consistency and reliability as an instrument for assessing HRQoL in Danish children with LUTS.
As increasing numbers of women pursue careers in medicine and surgery, the paediatric urology workforce is progressively approaching gender parity. However, women continue to face specific barriers to career advancement, including conscious and unconscious gender bias, stereotypes, challenges in achieving work–life balance, limited mentorship, and barriers to leadership.This article summarizes the first session specifically focused on women’s experiences and challenges in paediatric urology, presented during the European Society for Paediatric Urology (ESPU) Congress in Vienna in September 2025. A pre-session survey of female paediatric urologists was conducted to assess current perceptions of barriers to professional development, identify potential solutions, and explore future directions.The article also reviews the evolution of female representation within paediatric urology organizations, including the ESPU, as well as within clinical departments and leadership positions over recent years. Based on the discussions and survey findings, strategies to promote the empowerment, career advancement, and professional development of women in paediatric urology are proposed.
Introduction Long-term outcomes of disorders of sex development (DSD) following masculinizing genitoplasty remain inadequately defined, particularly regarding transition through puberty into adult social, reproductive, and sexual roles. This study aimed to comprehensively evaluate the long-term domains in males with DSD following surgery in childhood. Methods After ethical approval, DSD males aged ≥18 years post-genitoplasty were assessed for surgical, hormonal, urinary, sexual, fertility-related, and psychosocial outcomes. Information was obtained through structured interviews, clinical examination, semen parameters (WHO standards) and validated tools—including the International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF). Subgroup analysis was performed across three 46,XY DSD etiological categories: partial androgen insensitivity syndrome (PAIS), 5α-reductase deficiency (5αRD), and Other variants (OV) [46, XX Testicular, ovotesticular, dysgenetic forms]. Results All 12 participants identified as male, were comfortable in their gender role, with heterosexual orientation. Nine voided standing and three sitting, with overall satisfaction regarding voiding. Six were married and sexually active, and two had fathered five children spontaneously. Among seven who provided semen samples, five had sperm in the ejaculate, all with asthenozoospermia. Serum Leutinizing hormone (LH), Follicular Stimulating hormone (FSH) and testosterone levels were normal in most patients, whereas normal inhibin B was observed in only 2.Subgroup analysis demonstrated significant differences in testosterone across PAIS (n=5), 5αRD (n=2), and OV (n=4), with highest levels in 5αRD and lowest in OV. PAIS showed best preserved gonadal function parameters; sperm count and Inhibin FSH ratio (IFR), 5αRD partial preservation, and OV consistently poorer outcomes. Concerns regarding penile size were reported by 10 (83.3%), and severe ED was present in 8/12 (66.7%) per IIEF. All participants reported satisfactory psychosocial adjustment; eight were employed and four were students.Correlation analyses revealed no significant association between testosterone and SPL (p=0.494) and only non-significant positive trends between Sertoli-cell markers(inhibin B p = 0.324; IFR p = 0.221) and sperm count. Median SPL was 2.0:2.5:3.5 cm in PAIS:5αRD:OV; median sperm count was 28:18:0 million/ml. Penile length and erectile scores were comparable across groups, while sperm output was lowest in OV. Discussion This single-centre longitudinal study provides rare long-term data on post-genitoplasty outcomes in DSD males. Gonadal and Sertoli-cell dysfunction were most pronounced in dysgenetic variants, whereas PAIS demonstrated a more favourable endocrine and functional profile. Conclusion Most participants maintained stable male identity and psychosocial functioning. Gonadal and sexual function was highest in PAIS, reduced in 5αRD, and markedly impaired in OV.
BACKGROUND:Congenital undescended testis (CUDT) is the most common urogenital anomaly in boys and is associated with impaired fertility potential and an increased risk of testicular malignancy later in life. International guidelines recommend orchiopexy between 6 and 18 months of age; however, regional data from Latin America remain scarce. OBJECTIVE:To evaluate the timing of orchiopexy in children with CUDT in Latin America. STUDY DESIGN:Multicenter retrospective observational study including patients younger than 18 years with CUDT who underwent orchiopexy between January 1, 2023, and December 31, 2025, across participating Latin American centers. In an exploratory secondary analysis, a hierarchical multivariable logistic regression model, accounting for clustering by participating hospital, was used to assess factors independently associated with orchiopexy after 18 months of age. RESULTS:A total of 4481 patients from 14 countries and 31 centers were included. The median age at orchiopexy was 50 months (IQR 24-90), with a mean age of 60.5 months (95% CI 59.3-61.7). Only 18.2% of patients underwent surgery at or before 18 months of age, whereas 81.8% were treated after the recommended timeframe. The proportion treated by 18 months ranged from 4.7% in one participating hospital in Uruguay to 62.0% in one participating hospital in Argentina. Significant differences in age at surgery were observed across participating hospitals (p < 0.001). Among patients treated after 18 months, delayed referral and healthcare access barriers were the most frequently reported associated factors. In the hierarchical multivariable analysis accounting for clustering by participating hospital, intra-abdominal testicular location remained independently associated with lower odds of orchiopexy after 18 months of age (OR 0.71, 95% CI 0.55-0.91), whereas surgeon specialty, hospital level, and laterality were not independently associated with delayed orchiopexy. CONCLUSIONS:More than 80% (more than four out of five) of children with CUDT treated at participating hospitals across Latin America underwent orchiopexy later than recommended by current international guidelines. These findings highlight an important gap in timely access to care and underscore the need for strategies that promote earlier diagnosis, prompt referral, and timely surgical treatment.
