INTRODUCTION AND OBJECTIVES:Urological complications are common after kidney transplantation (KTx), mostly in the form of ureterovesical obstruction or leakage. Routine ureteral stenting was previously shown to reduce these complications on the expense of other complications such as urinary tract infections (UTI). There is no consensus on optimal duration of stents, and relevant literature on this topic is lacking. The aim of this systematic review is to summarize and compare the incidences of stent-related complications using short (<2 weeks; SD) and long (≥2 weeks; LD) stent duration after pediatric KTx. MATERIAL AND METHODS:A systematic search in Embase, MEDLINE, Cochrane, and clinicaltrial.gov was performed. Studies reporting on children (0-18 years) undergoing KTx with intraoperative ureteral stenting with at least one month follow up were included. Data on surgical and outcome characteristics were extracted. RESULTS:From a total of 322 articles, 14 studies were included, reporting on 971 pediatric KTx of whom 411 were female (42%). Sample sizes ranged from 32 to 146 patients. Mean or median age at time of transplantation ranged from 3.36 to 14.7 years. A systematic synthesis approach was used to summarize results. Of the four comparative studies, only one showed significantly more post-transplant UTIs in the LD group, without a significant difference in other urological complications. CONCLUSIONS:Due to lack of good quality studies, it remains uncertain whether a short stent duration is safer and more feasible for reducing the incidence of stent-related complications in pediatric KTx, while also preventing stenosis or leakage at the ureterovesical anastomosis.

Objetivo Este estudio analiza los enfoques diagnósticos y terapéuticos de la enuresis nocturna (EN) a nivel global, destacando las variaciones en las prácticas actuales. Materiales y métodos El Grupo de Trabajo de Urología Pediátrica de la Sección de Jóvenes Urólogos Académicos (YAU)/Asociación Europea de Urología (EAU) realizó una encuesta en línea con 18 preguntas, dirigida a especialistas en urología, urología pediátrica, pediatría, nefrología y uroterapia que tratan la EN. La encuesta recopiló datos demográficos y detalles sobre las estrategias diagnósticas y terapéuticas utilizadas. Las respuestas se analizaron mediante estadística descriptiva. Resultados La mayoría de los encuestados trabajan en hospitales universitarios o públicos, y los urólogos pediátricos representan el grupo más numeroso (43,6%). Un porcentaje significativo tenía entre 11 y 20 años de experiencia en el tratamiento de la EN. El abordaje inicial priorizaba estrategias conductuales y uroterapia (84,5%), y la desmopresina era la medicación de primera línea (23,8%). La mayoría iniciaba el tratamiento a los 5-6 años. Se observó el uso generalizado del diario miccional (82,0%), y un uso inconsistente de la evaluación de las vías respiratorias (52,1%). El uso de pruebas diagnósticas era variable; la ecografía del tracto urinario (53,65%) y el análisis de orina (51,5%) se empleaban para detectar anomalías subyacentes. Las derivaciones a psicología eran frecuentes en los casos de enuresis secundaria (58,9%). Conclusiones Existen variaciones significativas en el manejo de la EN a nivel mundial, influenciadas por las prácticas regionales, la experiencia del especialista y el enfoque de cada especialidad. Los hallazgos resaltan la necesidad de establecer directrices estandarizadas y mejorar la educación sobre evaluaciones integrales, incluyendo los factores relacionados con el sueño. La colaboración internacional y la elaboración de guías unificadas podrían mejorar la coherencia y optimizar los resultados de los pacientes.

El objetivo de este estudio era proporcionar una perspectiva global de las prácticas actuales de terapia hormonal (TH) en niños con testículos no descendidos (TND).Se difundió un cuestionario en línea sobre TH, patrones de derivación y orquidopexia a través de varias redes sociales relacionadas con la urología pediátrica.En total respondieron 283 personas, proporcionando una muestra de 54 países. La mayoría (84%) no prescribía TH para TND, principalmente debido a la escasez de pruebas científicas (76%). Entre los que utilizaban TH, la razón más común era TND bilateral (62%). No hubo una preferencia clara en el tipo de administración (50% inyección intramuscular, 50% aerosol nasal). La preferencia por GnRH fue ligeramente mayor que la preferencia por HCG (50% frente a 32%). No se utilizó un esquema de tratamiento estandarizado. La mayoría de los encuestados (67%) consideran que todas las formas de TND deberían ser tratadas por un urólogo o cirujano pediátrico. El 87% sigue las recomendaciones de las guías actuales y realiza la orquidopexia entre los 6 y los 18 meses de edad.

Paediatric urolithiasis is increasing globally, with metabolic abnormalities as a key contributing factor. However, standardized protocols for metabolic evaluation in children are lacking. This study assessed current practices and knowledge among paediatric urologists worldwide. An international survey was distributed in Spanish and English, gathering data on clinician demographics and metabolic evaluation strategies. A total of 194 clinicians from 49 countries responded. Only 11% routinely performed metabolic evaluations, and while 78% requested stone analysis, just 46% ordered 24-h urine studies. In 84% of cases, paediatric nephrologists were responsible for evaluations, with urologists involved in fewer than 25%. Knowledge of spot urine indices varied, and only 55% recognized crystalluria as a lithogenic risk factor. Fewer than one-third felt confident interpreting metabolic results or initiating treatment. These findings highlight inconsistent practices and limited involvement of paediatric urologists, underscoring the need for clearer guidelines and targeted education to enhance metabolic assessment in stone disease.

La urolitiasis pediátrica está en aumento a nivel mundial, siendo las alteraciones metabólicas un factor clave en su etiología. Sin embargo, actualmente no existen protocolos estandarizados para el estudio metabólico en la población infantil. Este estudio evaluó las prácticas clínicas actuales y el conocimiento entre urólogos pediátricos de todo el mundo. Se distribuyó una encuesta internacional en español e inglés, recopilando datos sobre el perfil de los médicos y las estrategias utilizadas en la evaluación metabólica.Un total de 194 clínicos de 49 países respondieron. Solo el 11% realizaba de forma rutinaria evaluaciones metabólicas, y aunque el 78% solicitaba el estudio del cálculo, solo el 46% pedía estudios de orina de 24h. En el 84% de los casos, los nefrólogos pediátricos se encargan de realizar esta evaluación, con una participación de los urólogos inferior al 25%. El conocimiento sobre índices basados en muestras de orina aislada fue variable, y solo el 55% reconocía la cristaluria como un factor de riesgo litogénico. Menos de un tercio se sentía capacitado para interpretar los resultados metabólicos o iniciar el tratamiento.Estos hallazgos evidencian una práctica clínica heterogénea y una escasa implicación de los urólogos pediátricos, lo que resalta la necesidad de establecer guías claras y de implementar programas de formación específicos dedicados a mejorar la evaluación metabólica en la litiasis urinaria infantil.

Introducción El reflujo vesicoureteral (RVU) puede tener efectos duraderos en los individuos afectados, especialmente en las mujeres. Su relación con la infección del tracto urinario (ITU) ha sido bien documentada y existe un riesgo adicional durante el embarazo, donde las ITU son más problemáticas. Objetivo Analizar la información disponible en la literatura para identificar los factores asociados a las complicaciones en el embarazo de mujeres con antecedente de RVU en la infancia. Métodos Se realizó una revisión sistemática de la literatura en PubMed, MEDLINE, Embase y Cochrane Library identificando todos los artículos publicados sobre las complicaciones del embarazo en mujeres con antecedente de RVU en la infancia hasta enero del 2024. (ID de registro PROSPERO: CRD42024550470). Los criterios de selección incluyeron todos los artículos originales en inglés que informaban sobre las complicaciones del embarazo (morbilidad materna y fetal) en mujeres con antecedente de RVU en la infancia. Tras el cribado y la evaluación de la elegibilidad, 17 artículos cumplieron los criterios de inclusión PICO. Resultados Se encontraron 1060 artículos, de los cuales permanecieron 17, evaluando 2349 mujeres con antecedente de RVU en la infancia, 1167 embarazadas con un total de 2206 embarazos. En comparación con la población obstétrica general, los resultados mostraron una mayor tasa de complicaciones relacionadas con el embarazo (en particular, infección febril del tracto urinario, hipertensión gestacional, preeclampsia) en presencia de cicatrices renales, incluso si las mujeres se habían sometido a cirugía antirreflujo en la infancia, pero no en aquellas con RVU persistente de bajo grado. Conclusiones A pesar de la falta de ensayos controlados aleatorizados prospectivos más amplios con seguimiento a largo plazo, basándonos en los hallazgos de esta revisión sistemática, concluimos que se debe recomendar un seguimiento estrecho durante el embarazo en mujeres con RVU de alto grado persistente o cicatrices renales, incluso si el RVU se ha resuelto.

Introducción y objetivos Las complicaciones urológicas tras el trasplante renal (TxR) son frecuentes, siendo las más comunes la fuga urinaria y la obstrucción ureterovesical. El uso sistemático del catéter ureteral ha demostrado previamente reducir estas complicaciones, aunque puede conllevar otras complicaciones como las infecciones del tracto urinario. Actualmente, no existe un consenso claro sobre la duración óptima del catéter ureteral, y la evidencia disponible al respecto es limitada. El objetivo de esta revisión sistemática es sintetizar y comparar la incidencia de complicaciones urológicas según la duración del catéter ureteral tras el TxR pediátrico, diferenciando entre corta (<2 semanas) y larga duración (≥2 semanas). Material y métodos Se realizó una búsqueda sistemática en Embase, MEDLINE, Cochrane y ClinicalTrials.gov. Se incluyeron los estudios que informaban sobre niños (0-18 años) sometidos a TxR con colocación intraoperatoria de catéter ureteral con al menos un mes de seguimiento. Se extrajeron datos sobre las características quirúrgicas y de los resultados. Resultados De un total de 322 artículos, se incluyeron 14 estudios que informaban sobre 971 TxR pediátricos, de los cuales 411 fueron realizados en mujeres (42%). El tamaño de la muestra osciló entre 32 y 146 pacientes. La edad media o mediana en el momento del trasplante osciló entre 3,36 y 14,7 años. Se utilizó un enfoque de síntesis sistemática para resumir los resultados. De los 4 estudios comparativos, solo uno mostró un número significativamente mayor de infecciones del tracto urinario postrasplante en el grupo de larga duración, sin una diferencia significativa en otras complicaciones urológicas. Conclusiones Debido a la escasez de estudios de alta calidad, aún no es posible determinar con certeza si el uso de catéteres ureterales de corta duración es más seguro y eficaz para reducir la incidencia de complicaciones asociadas al catéter en el TxR pediátrico, sin aumentar el riesgo de estenosis o fuga a nivel de la anastomosis ureterovesical.

OBJECTIVE:This study assessed global diagnostic and therapeutic approaches to nocturnal enuresis (NE), highlighting current practices and variations. MATERIALS AND METHODS:An 18-question survey by the European Association of Urology (EAU) Young Academic Urologist (YAU) Paediatric Urology Working Group targeted clinicians managing NE. Distributed online, it reached Urologists, Pediatric Urologists, Pediatricians, Nephrologists, and Urotherapists. The survey collected demographic data and details on diagnostic and treatment practices. Responses were analyzed using descriptive statistics. RESULTS:Most respondents worked in university or government hospitals, with pediatric urologists forming the largest group (43.6%). A significant portion had 11-20 years of NE management experience. Initial treatment favored behavioral strategies and urotherapy (84.5%), with desmopressin as a common first-line medication (23.8%). Most clinicians initiated treatment at ages 5-6. Bladder diaries were widely used (82.0%), while airway assessments were inconsistent (52.1%). Diagnostic test usage varied, with urinary tract ultrasonography (53.65%) and urinalysis (51.5%) employed to identify underlying abnormalities. Psychological referrals were common for secondary enuresis (58.9%). CONCLUSION:NE management varies globally due to regional practices, clinician experience, and specialty focus. The findings emphasize the need for standardized guidelines and education on comprehensive assessments, including sleep-related factors. International collaboration and guideline development could enhance consistency and improve patient outcomes.

The objective of this study was provide an overview of current practices on hormonal therapy (HT) in children with undescended testes (UDT). An online questionnaire about HT, referral patterns, and orchidopexy was spread via several (social media) networks involved in pediatric urology. A total of 283 individuals responded, with 54 countries sampled. The majority (84%) did not prescribe HT for UDT, predominantly due to a paucity of scientific evidence (76%). Among those who use HT, main reason was bilateral UDT (62%). There was no clear preference in administration type (50% intramuscular injection, 50% nasal spray). GnRH was slightly more favoured over HCG (50% vs. 32%). No standardized schedule was used. Most respondents (67%) felt all forms of UDT should be treated by either a pediatric urologist or -surgeon. Eighty-seven percent follow the current guidelines and perform orchidopexy between 6-18 months of age.

Objective To identify any self-reported differences or attitudes towards certification, publication, or practice patterns between adult urology and paediatric general surgery-trained paediatric urology providers. There are no known published differences in clinical/operative/research outcomes in either group. Methods An 18-item cross-sectional survey was compiled through the EAU Young Academic Urologists (YAU) office and disseminated to a trans-Atlantic convenience sample of current practising paediatric urologists. This was created using a mini-Delphi method to provide current semi-quantitative data relating to current opinions and attitudes of this cohort. Results A total of 228 respondents completed the survey, with female respondents representing 37% and 34% for urology and paediatric general surgery, respectively. Nearly 90% overall respondents felt that a full 2-year paediatric fellowship program was very important and 94% endorsed a collaborative dedicated paediatric urology on call service, with 92% supporting the joint development of transitional care. Urology managed higher numbers of bedwetting ( p = 0.04), bladder bowel dysfunction ( p = 0.02), endourological procedures ( p = 0.04), and robotics ( p = 0.04). Paediatric general surgery managed higher numbers of laparoscopic reconstruction ( p = 0.03), and posterior urethral valve ablation ( p = 0.002). Conclusion This study represents the first time that a cross-sectional cohort of paediatric urologists from different training backgrounds were compared to assess their productivity, practice patterns and attitudes. Paediatric urology is in a unique position to have two contributing specialities, with the ability to provide optimal transitional and lifelong care. We believe that there should be a strong emphasis on collaboration and to remove any historically-created barriers under policies of equity, diversity and inclusivity.

Introduction Complex urological anomalies often require continued care as patients reach adulthood. Adequate transition for adolescents with ongoing urological care needs is critical to allow for seam-less care in adult hospitals. Studies have shown that this can lead to improved patient and parental satisfaction, and lower utilisation of unplanned inpatient beds and emergency department visits. There is currently no ESPU-EAU consensus on the adequate mechanism and very few individual pa-pers examining the role of urological transition for these patients in a European setting. This study aimed to identify current practice patterns in paediatric urologists providing adolescent/transi-tional care, to assess their opinions towards formal transition and to look for variations in care. This has implications for long-term patient health and specialist care. Methods An 18-item cross-sectional survey was compiled and pre-approved through the EAU-EWPU and ESPU board offices prior to dissemination to all registered ordinary members affiliated with the ESPU. This was created using a mini-Delphi method through the EWPU research meetings to provide current semi-quantitative data relating to current opinions and attitudes of this cohort. Results A total of 172 respondents (55% paediatric general surgery; 45% urology) across 28 countries completed the survey. The majority of respondents were in practice >10 years and spent >80% time in paedi- atric urology. There was no formal transition process according to 50% respondents and over half of those that did have less than 1/month, with <10% using validated questionnaires. More than two-thirds re- spondents continued to provide care after transi- tion, as >70% units had no designated corresponding adult service. Furthermore, 93% paediatric believe formal transition service to be very important, using a multidisciplinary framework. A pareto chart demonstrated 10 specific conditions to be of most interest in transition to adulthood. Conclusion This is the first study to assess the requirements of paediatric urologists for adequate transitional care, however due to the nature of the survey's distribu- tion, this was a non-scientific poll based on a con- venience sample of respondents. It is critical that dual-trained or adult-trained urologists with a spe- cific interest in paediatric urology work with current paediatric urologists in a multidisciplinary fashion to facilitate early transition based on the adolescent's developmental and biopsychosocial requirements. National urological and paediatric surgical societies need to make transitional urology a priority. The ESPU and EAU should collaboratively consider developing transitional urology guidelines to allow framework by which this can occur.

Background: Radical removal of the ureter is not routinary performed during nephrectomy/hemineprectomy, distal ureteral stump syndrome may follow. Case summary: A 17-year-old male with urinary malformation history came to the emergency department for abdominal pain and tenesmus. Imaging revealed a huge abdominal mass, compatible with a massively dilated residual ureteral stump resulting from heminephrectomy operation performed 7 years before for a complete right duplex system with hypoplasia of the upper right system. A robotic procedure was planned and the stump, which was ectopic and drained into the seminal vesicles, was successfully removed. The patient was discharged after recovery; he was followed up for one year after surgery without any complications. Conclusion: Ureteral stumps rarely require reoperation, but our case suggests a need for long-term follow-up. Robotic-assisted excision showed to be a safe and effective technique for surgical management of a massively dilated ectopic stump in the pediatric population.

The health emergency linked to the Sars-Cov-2 infection represented an absolutely new problem for all health professionals. In particular, the information regarding the spread of the virus in the pediatric field and its manifestations are still incomplete. In this paper we present a case of neonatal infection which, as far as we know, represents one of the few published cases and which occurred in a patient who came to our attention for acute abdomen from intestinal perforation. The perforation was caused by Meckel's diverticulum, an event considered infrequent in the first year of life and almost exceptional in the neonatal period. This case required particular management, putting pediatric surgeons in front of new and difficult to solve problems. New onset clinical events, such as this one described, represent an opportunity for sharing useful data for the creation of universal protocols for the management of patients with problems that are becoming common and of which little is known.

Echinococcosis is a parasitic zoonosis in which humans are involved as an intermediate host. It is a very common pathology in the areas of Eastern Europe and Asia, where the main activity is represented by pastoralism and animal breeding. In humans, the most frequently affected sites are the liver (60–70%) and lungs (20–30%), manifesting themselves with symptoms such as abdominal pain, coughing, dyspnea, hemoptysis, up to cases of anaphylactic shock. In Italy it is not a common disease with an incidence of 2:100.000 inhabitants, and it's extremely rare in pediatric population. In this work we presented a case of a 11-years male patient came for a persistent cough, to whom was found a giant cystic mass in the thorax. Serological tests confirmed the diagnosis of echinococcosis. Patient underwent to thoracotomy to remove the cyst and he begun the antiparasitic therapy. Post-operative outcome was good and the patient is, until now, free of problems. Echinococcosis is a challenging problem for a pediatric surgeon, especially in non-endemic area, not only because it is not a common disease in pediatric population, but also for the surgical management that can presents some difficulties and complications in the post-operative course.