A BSTRACT Background: Pelviureteric junction obstruction (PUJO), vesicoureteric reflux (VUR), hypospadias, and undescended testis (UDT) (cryptorchidism) are among the most commonly encountered conditions in pediatric urology practice. However, caregiver online health-seeking behavior for these conditions remains poorly characterized. Objective: To compare symptom-seeking versus treatment-seeking online search behavior for these four conditions globally (2004–2024) and assess the impact of the coronavirus disease 2019 (COVID-19) pandemic. Study Design: Retrospective infodemiology study using Google Trends relative search volume data. Methods: Google Trends were queried globally at monthly resolution for 2004–2024. For each condition, 10 search terms – selected using prespecified criteria of clinical plausibility, lay vocabulary fidelity, and nonredundancy – were divided into symptom-seeking and treatment-seeking groups. A shared anchor term enabled cross-group normalization to yield a monthly symptom-to-treatment (S: T) ratio. Spearman correlation assessed temporal trends; the Kruskal–Wallis test with Bonferroni correction evaluated inter-entity differences. Results: Hypospadias showed the highest treatment-seeking volume and the lowest S: T ratio (0.003 ± 0.027), indicating persistent treatment-dominant searching throughout. UDT demonstrated a significant increasing S: T trend ( ρ =0.845, P = 0.034). PUJO had the highest mean S: T ratio (0.214 ± 0.584), peaking at 1.75 in 2016. VUR returned only seven active months. COVID-19 suppressed PUJO searches while hypospadias remained stable. Inter-entity S: T differences were statistically significant (Kruskal–Wallis H = 7.89, P = 0.048). Conclusions: Significant differences exist in online caregiver health-seeking behavior across the four most common pediatric urological conditions, identifying condition-specific gaps in digital health literacy and targets for focused caregiver education.
A BSTRACT Purpose: A ureter diameter exceeding 6 mm is termed megaureter. This study aimed to evaluate the clinical features of primary non-refluxing megaureter (PNMU) and the importance of ureteral diameter in its management. Methods: Clinical, radiological, and operative findings and long-term outcomes of PNMU followed or operated on between 2011 and 2023 were evaluated retrospectively. Patients with vesicoureteral reflux, a history of lower urinary tract pathology or surgery, and a follow-up <18 months were excluded. Results: Among 32 patients (12.5% female, 87.5% male), 50% were diagnosed prenatally. Twenty-six patients had unilateral, six had bilateral megaureters. Over a mean follow-up of 94.3 ± 53.4 months, 37.5% were managed conservatively, 62.5% required intervention. Nine underwent open surgery, 11 underwent double-J-stenting. Median operation age was comparable between surgical groups ( P > 0.05) but significantly lower in patients with urinary tract infection ( P : 0.007). Ureteral diameter decreased from 10.4 mm (range: 6.2–24.2) to 6.9 mm (range: 0–17) in conservatively managed cases, from 11 mm (range: 8–24.2) to 9 mm (range: 0–19) in double-J-stent group, and from 9.7 mm (range: 6.2–18.8) to 4.3 mm (range: 0–13) in the open surgery group ( P > 0.05). No significant difference was observed among the peak measured ureter diameters in the conservatively managed group (median: 12 mm, range: 9–33), preoperative ureter diameters in the double-J-stent group (median: 12.5 mm, range: 8.8–17), and open surgery group (median: 14 mm, range: 8–31) ( P > 0.05). Conclusion: Ureteral diameter has limited importance in PNMU management. Conservative management may be an option even in advanced dilatations. Postoperative ureteral dilatation may persist at varying levels and durations.
A BSTRACT Purpose: Salivary cortisol is a validated, non-invasive biomarker of hypothalamic–pituitary–adrenal axis activity and surgical stress. Evidence on perioperative cortisol kinetics in children undergoing laparoscopic surgery is limited. This study evaluated temporal salivary cortisol trends and compared stress responses between low- and standard-pressure pneumoperitoneum (PP) in children undergoing laparoscopic surgery. Methods: In this prospective randomized trial, 101 children scheduled for laparoscopic surgery were allocated to low-pressure PP (6-8 mmHg) or standard-pressure PP (9-11 mmHg) using block randomization. Salivary cortisol was measured preoperatively and at 6, 12, 24, 48, and 72 h postoperatively using enzyme-linked immunosorbent assay. Hemodynamic and respiratory parameters, pain scores, time to resume feeding, and hospital stay were recorded and analyzed. Results: Ninety-three children completed the study (low-pressure: n = 47; standard-pressure: n = 46). Baseline cortisol levels were comparable (median: 5.94 vs. 4.96 nmol/L, P = 0.662). Across the cohort, cortisol showed a biphasic pattern: A rise peaking at 12 h, decline at 24 h, and secondary increase at 48 h, remaining above baseline at 72 h. No significant differences were observed between groups, though the low-pressure group had slightly higher cortisol at 12 h, and the standard-pressure group at 48 h. Hemodynamic and ventilatory parameters remained stable, and recovery outcomes – including pain, feed resumption, and hospital stay – were similar. Conclusion: Salivary cortisol is a reliable, noninvasive marker of perioperative stress in children undergoing laparoscopic surgery with a consistent postoperative trajectory. Within 6–11 mmHg, PP pressure did not influence stress response, intraoperative physiology, or short-term recovery.
A BSTRACT The coexistence of bilateral multicystic dysplastic kidneys (MCDKs) and high anorectal malformation with pouch colon is exceptionally rare. The combination results in a nonsurvivable condition due to complete renal failure, posing complex diagnostic and management challenges. A full-term male neonate presented with absent anal opening, limb and auricular deformities, and progressive anuria since birth. Antenatal history was unavailable. Clinical examination revealed bilateral clubfoot and normal male genitalia. Laboratory evaluation showed steadily worsening renal function. Ultrasound demonstrated bilateral MCDK with multiple cysts and gross hydronephrosis. A high-divided sigmoid colostomy was performed, and intraoperatively, a Type IV pouch colon was identified. Despite supportive management, including percutaneous nephrostomy, no urine output was achieved. Given the confirmed diagnosis of bilateral nonfunctioning kidneys and poor prognosis, the family opted for termination of care and support. This case highlights the diagnostic and ethical challenges associated with managing rare, fatal congenital anomalies in neonates. Early antenatal detection, when available, may facilitate better parental counseling and decision-making.
A BSTRACT Background: Pediatric genitourinary trauma constitutes a significant proportion of childhood trauma, with unique anatomical and clinical considerations. While conservative management has become standard for stable patients in pediatric solid organ injuries, data regarding the management of genitourinary trauma in children is sparse. This study aims to characterize the spectrum, treatment strategies, and outcomes of pediatric genitourinary trauma in a tertiary care center in India. Methods: A prospective observational study was conducted between August 2018 and March 2022. Children under 12 years with documented genitourinary trauma were enrolled. Exclusion criteria included thermal injuries. Demographic details, clinical, radiological, and operative data, and their outcomes were recorded. Injuries were graded as per the American Association for the Surgery of Trauma criteria. Outcomes were monitored over 3 years. Statistical analysis was performed using Epi Info™ 7.2.2.2. Results: Out of 62 admitted patients of trauma, 30 patients were included in the study (M: F = 4:1) with a mean age of presentation of 6.5 years. Different modes of injury were fall from height, road traffic accidents, and other causes included sexual assaults and post-circumcision complications. Renal trauma was the most common type, primarily Grade IV injuries. Bladder trauma ranged from Grade I–V. Conservative treatment was effective in 74% of cases. Operative interventions were performed in eight patients. Complications occurred in 26%, predominantly among higher-grade injuries. However, statistical analysis revealed no significant correlation between injury grade and outcomes ( P = 0.15). Conclusion: Pediatric genitourinary trauma, though infrequent, often results in favorable outcomes even in high-grade injuries. Grade of injury does not correlate with the outcome in high-grade injuries in stable children.
A BSTRACT Background: Esophageal atresia (EA), with or without tracheoesophageal fistula, remains associated with substantial early mortality and long-term morbidity. Reported incidence and outcomes vary across Asia, but interpretation is complicated by differences in case capture, referral pathways, diagnostic capacity, and neonatal intensive care availability. Methods: We performed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020-aligned systematic narrative review of observational studies from Asian countries published up to March 2024 (PubMed and Google Scholar). Studies reporting incidence, associated anomalies, morbidity, or mortality were included. Findings were synthesized descriptively and presented stratified by study base (population-based vs. hospital-based) and resource setting (World Bank income proxy). Risk of bias was assessed using a generic domain-based framework (D1–D6). Results: Thirty-four studies (3304 infants) were included. Six population-based studies reported incidence ranging from 6.17 to 20.30 per 100,000 live births. Hospital-based reports documented 921 associated anomalies, most commonly gastrointestinal (36%) and cardiovascular (27%). Mortality across 19 cohorts ranged from 2% to 83%. Morbidity profiles differed by setting: in higher-resource cohorts, reported events were dominated by gastroesophageal reflux and anastomotic stricture, whereas in lower-resource cohorts, septicemia (47% of events) and wound infection (10%) were prominent. Conclusion: EA incidence in Asia is within international ranges, but published outcomes vary widely and should be interpreted descriptively given referral and ascertainment differences, variable anomaly detection, heterogeneous definitions, and limited follow-up. Priorities include strengthening prenatal detection and referral, improving neonatal stabilization and safe transport, standardizing perioperative care with infection prevention, and establishing feasible long-term follow-up supported by a pragmatic action framework.
Background:Gastrointestinal (GI) tract atresias occur in approximately 1 in 2000 live births and frequently present with associated congenital anomalies. This study aimed to determine the frequency and spectrum of associated anomalies in neonates with GI atresias and provide screening recommendations. Materials and Methods:A retrospective analysis was conducted on 150 neonates with congenital GI atresia at a tertiary pediatric surgery referral center over 7 years. All patients underwent systematic screening, including echocardiography, abdominal ultrasonography, cranial ultrasonography, and radiographic evaluation. Demographics, atresia type, associated anomalies, and in-hospital outcomes were evaluated. Results:The cohort comprised esophageal atresia/tracheoesophageal fistula in 33.3%, anorectal malformations in 34%, duodenal atresia in 18%, jejunoileal atresia in 10%, colonic atresia in 2.7%, and pyloric atresia in 2%. Associated anomalies were present in 87.3% of patients. Cardiovascular anomalies were most common (57.3%), followed by genitourinary (50%), central nervous system (19.3%), and limb (12.7%) anomalies. Atrial septal defect was the most frequent cardiovascular finding. Overall, in-hospital mortality was 14%. Sepsis was the leading cause of death (33%). Prematurity and low birth weight were significant mortality predictors, while the presence of associated anomalies was not. VACTERL association (66% mortality) was identified as a high-risk subgroup. Conclusions:GI atresias are frequently associated with multisystem anomalies, particularly involving the cardiovascular and genitourinary systems. Systematic screening for associated anomalies is recommended in all neonates with GI atresia for comprehensive care planning. While anomalies are highly prevalent, prematurity and low birth weight remain the primary determinants of mortality.
Background:This study assessed the association between median raphe deviation types and the clinical severity of distal hypospadias, proposing deviation as a surgical landmark correlated with urethral hypoplasia and corpus spongiosum divergence. Materials and Methods:A retrospective analysis was conducted on 70 patients with distal hypospadias treated between 2023 and 2024 at two tertiary care centers. Preoperative evaluation documented the meatal position, raphe type, and level of deviation. The intraoperative findings included the length of urethral hypoplasia and the degree of corpus spongiosum divergence. All patients underwent tubularized incised plate urethroplasty using the hypospadias penile skin landmark technique. Results:Median raphe deviation was present in 82.8% of cases (P < 0.0003), predominantly on the right side (67.3%). Four types were identified: Type I (49), Type II (no deviation, 12), Type III (7), and Type IV (2). Urethral hypoplasia >1 cm with spongiosum divergence was observed in 40 patients. A significant association was observed between raphe type and reclassified meatal position (χ2 = 35.86, df = 6, P < 0.00001). Conclusions:Median raphe deviation is a reliable anatomical marker of distal hypospadias severity. Its correlation with urethral hypoplasia and spongiosum divergence underscores its value in surgical planning, complexity prediction, and outcome optimization.
Background:Pediatric vascular malformations are rare, heterogeneous disorders increasingly driven by somatic mutations affecting key molecular pathways, particularly the PI3K-AKT-mTOR and RAS-MAPK signaling cascades. Advances in genomic profiling have enabled the use of targeted pharmacological therapies, but the available evidence remains fragmented. Objective:To systematically review the clinical outcomes and safety of genotype-directed targeted systemic therapies in pediatric patients with genetically characterized vascular malformations. Methods:A systematic literature search was conducted in PubMed, Embase, and Scopus from database inception to November 21, 2025. Eligible studies included case reports, case series, cohort studies, and prospective investigations reporting genotype-directed targeted therapy in patients aged 0-18 years. Data on genetic alterations, targeted therapies, clinical and radiologic outcomes, and adverse events were extracted and synthesized qualitatively. Results:Fifty-two studies were included, reporting pediatric patients from the neonatal period to 18 years of age. The most frequently identified genetic alterations involved the PI3K-AKT-mTOR and RAS-MAPK pathways, predominantly PIK3CA and RAS-pathway mutations. Sirolimus, alpelisib, and trametinib were the most commonly used targeted agents. Many patients demonstrated clinical improvement and radiologic stabilization or lesion reduction following targeted therapy. Grade 3-4 adverse events were uncommon and generally manageable with dose modification or temporary treatment interruption. Conclusions:Genotype-directed targeted therapies appear to provide clinical and radiologic benefit in pediatric vascular malformations with acceptable safety profiles. However, the current evidence is largely derived from observational studies and requires prospective validation through standardized investigations.
Classical bladder exstrophy (CBE) is characterised by a hallmark anatomical sign of the low-lying umbilicus. We report a case of CBE exhibiting a normally placed umbilicus. This anatomical variation contradicts the usual low-lying umbilicus in CBE and may offer favorable cosmetic and surgical implications.
We report the first documented case of nodular hidradenoma arising from the nipple-areolar complex in a 9-year-old male. Excision of an enlarging breast lump was performed, and histopathology confirmed solid-cystic eccrine hidradenoma with clear margins. Although benign, it can mimic malignancy clinically and radiologically and warrants complete excision.
Background:Proximal Penile Hypospadias (PPH) pose significant functional and cosmetic challenges. While two-stage repair is the traditional approach, single-stage techniques are increasingly used with favorable outcomes. Objective cosmetic assessment remains difficult; thus, the modified Pediatric Penile Perception Score (PPPS), incorporating phallic length and a meatal-glans complex, offers a simplified yet structured evaluation method. This study compares the functional and cosmetic outcomes of single-stage versus staged urethroplasty. Materials and Methods:This randomized observational study included 46 patients aged 6 months to 12 years with PPH and chordee >15°, excluding those with syndromic features, penoscrotal transposition, penile skin disease, or prior circumcision. Patients were randomized into single-stage (n = 24) and staged (n = 22) urethroplasty groups. Functional (complication-based) and cosmetic (modified PPPS score-based) outcomes were evaluated at 3 months postoperatively. Cosmetic evaluation was done both by a surgeon and by a parent. Results:Both the groups were age-matched, though anatomical variation remained. Urethrocutaneous fistula was the most common complication, occurring at similar rates (58.3% single-stage vs. 54.5% staged; P = 0.796). Meatal stenosis/retraction was more frequent in the single-stage group (16.7%), but not statistically significant (P = 0.110). Cosmetic scores for phallus and meatal-glans complex favored single-stage repair, while overall appearance slightly favored staged repair. Conclusion:Both approaches yielded comparable functional outcomes. Single-stage repair showed better results in specific cosmetic domains, while staged repair offered marginally higher overall satisfaction. Parents were more critical in evaluating overall appearance, while surgeons evaluated meatal-glans complex scores more effectively.
Background:Foreign body ingestion (FBI) is common in children, with 10%-20% requiring endoscopic intervention and 1% requiring surgery. Despite its frequency, evidence supporting the use of laxatives in FBI is scarce, limited to case reports, case series, and expert opinions. This pilot randomized controlled trial (RCT) evaluated the feasibility of a larger RCT assessing polyethylene glycol (PEG) versus placebo in pediatric FBI. Methods:Children aged 1-18 years with the FBI were randomized to receive PEG (1 g/kg/day) or aspartame placebo (8 mg/kg/day) until foreign body passage or a maximum of 7 days. Feasibility outcomes included recruitment, retention, adherence, acceptability, and tolerability. The primary efficacy outcome (hypothesis-generating) was foreign-body transit time. Results:Among 69 children (71 FBIs), retention was 100%, and adherence was 96%. The acceptability and satisfaction scores were high (4.9/5 and 4.7/5, respectively). No adverse events were reported. The mean FB transit time was shorter in the PEG group than in the placebo (55.8 ± 39.3 vs. 86.8 ± 66.9 h; P = 0.032; Cohen's d ≈ 0.54). The reduction in FB transit time appeared more pronounced in children >10 years (53.7 ± 12.7 vs. 112.8 ± 45.3 h; P < 0.001; Cohen's d ≈ 1.77). Conclusion:A randomized trial of PEG in pediatric FBI is feasible, well accepted, and safe. Preliminary findings suggest PEG may enhance foreign body transit, particularly in older children, supporting the rationale for a larger, adequately powered RCT.
Infantile renal tuberculosis (TB) associated with an ectopic ureter is extremely rare. We report an 11-month-old infant with a left nonfunctioning kidney associated with gross hydroureteronephrosis and an ectopic ureter who was diagnosed with renal TB unexpectedly on histopathology. This case highlights the importance of histopathological evaluation, particularly in endemic areas.
Urethrovaginal fistula (UVF) in children is rare and surgically challenging. We present an 11-year-old girl with UVF managed successfully with fistula closure reinforced with a bovine pericardial patch.
Biliary atresia (BA) is a progressive, fibro-obliterative cholangiopathy of infancy that constitutes the leading cause of neonatal cholestasis and remains the primary indication for pediatric liver transplantation. While the Kasai portoenterostomy (KPE) is the standard initial surgical intervention, anatomical variations, particularly in the vascular architecture at the porta hepatis, can present considerable technical difficulties. This paper details a case of type IIa BA associated with a type III portal vein anomaly, identified intraoperatively during the KPE procedure. The case highlights the importance of recognizing vascular variants to facilitate precise dissection, minimize the risk of vascular injury, and optimize both immediate surgical and long-term transplant outcomes.
Background:The management of differences of sexual development (DSD) in India is uniquely influenced by sociocultural norms, legal ambiguities, delayed presentation, and limited access to structured multidisciplinary care. International consensus statements, while scientifically robust, often lack contextual applicability to the Indian healthcare and societal landscape. Objective:The objective of this study was to develop India-specific, ethically sound, and practically implementable consensus guidelines for the management of children with DSD, balancing medical needs, child rights, parental concerns, and medico-legal responsibilities. Methodology:A modified Delphi process was undertaken. Twenty-three multidisciplinary experts participated in iterative rounds of anonymized deliberation and consensus-building, followed by structured discussions moderated by the Directorate General of Health Services, Ministry of Health and Family Welfare. Consensus was defined as agreement by at least two-thirds of participants. The finalized recommendations underwent administrative vetting and were formally ratified by the Government of India. Results:Strong consensus was achieved on standardized terminology, diagnostic pathways, principles of sex assignment, indications and timing of medical and surgical interventions, psychosocial support, and documentation practices. Central to the guidelines is the establishment of Local Multidisciplinary Committees at designated centers, with defined escalation to state and national apex committees. The guidelines emphasize regulated, indication-based interventions, informed parental participation, and protection against unsafe or unregulated practices. Conclusion:These India-specific consensus guidelines provide a uniform, ethically robust, and legally supported framework for DSD management. By integrating multidisciplinary oversight with sociocultural realities, they offer a balanced approach that safeguards child welfare, supports families, and promotes consistent, accountable, and acceptable care across diverse Indian healthcare settings.
Background:Cloacal exstrophy (CE) is among the most complex congenital anomalies, involving multiple organ systems and requiring multidisciplinary care. While surgical and clinical advances have been significant, no comprehensive analysis of research trends, collaboration, and thematic evolution exists. Bibliometric analysis can map the scientific landscape, highlighting key contributors, gaps, and emerging directions. Objective:The objective of this study was to conduct a bibliometric and scientometric assessment of cloacal exstrophy research, evaluating publication trends, authorship, institutional productivity, collaborations, and thematic evolution from 1959 to 2025. Materials and Methods:A systematic bibliometric analysis of the Scopus database (August 2025) was performed. Data were analyzed using Scopus tools, VOSviewer (v1.6.20) for visualization, and Bibliometrix (v4.1.2) for indicators. Metrics included publication output, co-authorship networks, institutional and international collaborations, keyword co-occurrence, and citation analysis. Results:A total of 289 publications were identified between 1959 and 2025, with a peak in 2011 (15). Original articles comprised 75%. The USA led output (162, 56%), with Johns Hopkins institutions contributing most (176). Gearhart was the most prolific author (46, h-index 14). The Journal of Urology and Journal of Pediatric Surgery were the main publication outlets. Thematic evolution progressed from descriptive studies to surgical outcomes, prenatal diagnosis, and refinements. The most cited work addressed gender identity considerations. Conclusions:CE research is concentrated in specialized US centers, showing thematic shifts aligned with advances in fetal medicine and surgery. The observed bibliometric patterns suggest a relatively established research structure within the field. Future efforts should strengthen international collaboration and address adult outcomes and novel therapeutic strategies.
Introduction:Bladder dysfunction in children can result in recurrent urinary tract infections (UTIs), incontinence, and progressive renal impairment. The Mitrofanoff procedure (MP) facilitates clean intermittent catheterization (CIC), promoting effective bladder emptying and reducing the risk of renal deterioration. However, data on long-term outcomes of this procedure remain limited in developing countries. This study was undertaken to address this gap and evaluate renal function and quality of life (QOL) following the MP in this population. Aims:To describe mid to long term renal function and QOL in children after MP and to analyze risk factors that influence these outcomes. Methodology:A retrospective longitudinal cohort study was conducted on children who underwent the MP between 2008 and 2023 with at least 6 months of follow-up. Renal function (estimated glomerular filtration rate, chronic kidney disease staging), QOL (Pediatric Incontinence Questionnaire scores), continence status, and CIC compliance were evaluated. Factors influencing renal outcomes were analyzed. Results:Sixty-two children were included (mean age 7.5 years; mean follow-up 3.2 years). Renal function remained stable or improved in 48 (77.4%) and deteriorated in 14. Recurrent UTIs resolved in 35 of 45 affected children. CIC compliance was observed in 48 (77.4%) and was strongly associated with better renal outcomes. Social continence was achieved in 60 children, and QOL improved in 58 (93.5%). Conclusion:The MP, combined with consistent CIC, effectively preserves renal function and enhances QOL in children with bladder dysfunction. Noncompliance with CIC and recurrent UTIs remain key risk factors for renal deterioration.
