Purpose Percutaneous nephrolithotomy (PCNL) is the recommended treatment for renal stones larger than 20 mm or 10 mm for lower calyx stones. Treating children aged 6 years or younger appears to be more complex. This study compares the success rate and the complications of mini-PCNL (<12F) for complex renal stones in Galdakao-modified supine Valdivia (GMSV) position between children under 6 years old (Group A) and those aged 6 years and older (Group B). Methods We retrospectively analysed patients who underwent mini-PCNL at our centre between 2018 and 2024 for renal stones larger than 2 cm or lower calyx stones exceeding 10 mm using the GMSV position. Preoperative, perioperative, and postoperative data were assessed. The primary outcome was the stone-free rate (SFR) at three months, defined as no residual fragments larger than 4 mm on imaging. Results A total of 36 procedures were performed on 28 patients. The groups differed significantly only in weight, and the median cumulative stone size was similar (p=0.99). The SFR after one procedure was 79% in Group A and 65% in Group B (p=0.46). The SFR after one or more procedures reached 86% and 88%, respectively, p=0.99. The average procedure duration, the hospital stays, and the mean follow-up were comparable. Four major complications (Clavien grade ≥3) occurred, two in each group. Conclusions Mini-PCNL in the GMSV position is effective for treating renal stones in children, regardless of age.

OBJECTIVE:The impact of prenatal diagnosis timing in posterior urethral valves is unclear. We aimed to compare renal function between patients with suspected PUV diagnosed before or after 28 weeks of gestation in a population who underwent systematic T2 and T3 ultrasounds. METHODS:We performed a retrospective analysis of a prospective cohort of patients with prenatally suspected and postnatally confirmed PUV. Patients were stratified by timing of prenatal ultrasound detection of urinary tract abnormalities (T2 vs T3). We compared nadir creatinine and mid-term eGFR (> 5 years of follow-up). RESULTS:72 boys with postnatally confirmed PUV were included. Thirty-seven patients (51%) were diagnosed before 28 weeks' gestation (T2 group). This early group had significantly higher NC values (median 38 vs. 26 μmol/L, p < 0.05) and lower eGFR at mid-term follow-up (median 85 vs. 105 mL/min/1.73 m2, p < 0.05) compared to the T3 group. CONCLUSIONS:PUV suspected during the second trimester of gestation is associated with significantly worse NC and mid-term renal function compared with those suspected later in pregnancy (T3). Reports of prenatal diagnosis of PUV should dichotomize between T2 and T3 diagnoses. The true rate of PUV that could be diagnosed prenatally is higher than expected.

PURPOSE:We evaluated bladder dehiscence after 1-stage delayed closure of bladder/cloacal exstrophy combining bladder plate closure with Kelly procedure, with or without osteotomy. MATERIALS AND METHODS:We conducted a multicenter retrospective study of children with bladder exstrophy or cloacal exstrophy who underwent single-stage closure with Kelly mobilization (October 2015-October 2025), by one surgical team, in France and tertiary centers abroad. The primary end point was bladder dehiscence within 3 months. Secondary end points were early (<3 months) complications. Outcomes were analyzed separately for primary repairs and complex cases. RESULTS:A total of 123 patients were included (110 bladder exstrophy [89%], 13 cloacal exstrophy [11%]; 76 men [62%]). The median age at surgery was 7.1 months (2.9-15.8); median follow-up 54 months (25-82). The reconstruction was a primary repair in 106 children (86%) and redo closure after failed repair in 17/123 (14%). No bladder dehiscence occurred. Early complications arose in 23/123 children (19%), mainly wound-related (15/123, 12%) including infection/dehiscence (n = 6, 5%) and urinary fistula (9/123, 7%). Complications were Clavien-Madadi grade IV (n = 3, 2.4%) III-B (n = 4, 3.3%), III-A (n = 4, 3.3%), and I-B or II (n = 12, 10%). In multivariate analysis, abdominal closure with rectus abdominis muscles midline transposition was the only independent prognostic factor of wound complications (odds ratio 4.47 [1.22-16.37], P = .02). CONCLUSIONS:Single-stage delayed closure combined with Kelly mobilization allows reliable bladder closure with no early dehiscence in bladder/cloacal exstrophy. Early morbidity rate was < 20%, with predominantly low-grade complications. When pubic approximation was difficult, osteotomies or fascial flaps appeared to offer better early parietal outcomes than rectus muscles transposition.

Background Prune Belly Syndrome (PBS) is a rare congenital disorder characterized by bilateral intraabdominal undescended testes, abdominal wall flaccidity, and urinary tract dilation. Surgical management of cryptorchidism in PBS is technically challenging due to anatomical and urological anomalies. This study aimed to evaluate outcomes of different orchidopexy techniques, laparoscopic vs. open and one-stage vs. two-stage, in a national multicenter PBS cohort over 30 years. Methods We retrospectively reviewed 56 PBS patients treated between 1990 and 2023 in 22 French centers using data from the MARVU National Registry. Testicular position and size at last follow-up were compared across surgical techniques and staging approaches. Results A total of 87 orchidopexies were performed at a median age of 22 months; 62 (71%) were one-stage and 25 (29%) two-stage. Laparoscopy was used in 25 procedures (29%), more frequently in recent years. At a median follow-up of 7.5 years, 66 testes (76%) were located intrascrotally and 68 (79%) were of normal size. Testicular atrophy was observed in 15 cases (17%) and ectopic positioning in 18 (21%). No significant differences were found in anatomical outcomes based on surgical approach (intrascrotal position: 88% laparoscopic vs. 71% open, p = 0.11) or staging (atrophy: 19% one-stage vs. 12% two-stage, p = 0.54). Limitations include retrospective design and lack of hormonal or fertility data. Conclusions Both one-and two-stage orchidopexies, whether laparoscopic or open, provide comparable anatomical outcomes in PBS-related cryptorchidism. Technique selection should be individualized. Prospective studies are needed to evaluate long-term endocrine and reproductive function.

Posterior urethral valves (PUV) are congenital anomalies characterized by the persistence of mucosal folds in the urethra, leading to various degrees of obstruction. They are the most common cause of lower urinary tract obstruction in fetuses and children, with a severe prognosis, as one-third of affected children develop end-stage renal disease before adulthood. The French National Diagnostic and Care Protocol (NDCP) aim to provide healthcare professionals with guidelines for the optimal diagnostic and therapeutic management of PUV from the fetal stage to adolescence. The guidelines emphasize early diagnosis through prenatal ultrasound and the importance of a multidisciplinary approach involving pediatric urologists, nephrologists, and other specialists. It outlines prenatal interventions such as vesico-amniotic shunting and postnatal surgical options like endoscopic valve ablation to alleviate obstruction and preserve renal function. Long-term follow-up is crucial for monitoring renal function, managing bladder dysfunction, and preventing complications such as urinary tract infections and chronic kidney disease. The guidelines also identify off-label pharmaceuticals and necessary specialty products not typically covered by insurance. By standardizing care pathways and promoting consistent, high-quality care, the guidelines aim to improve the prognosis and quality of life for children with PUV, setting a benchmark for managing this rare condition in pediatric urology.

OBJECTIVE:The Black-Star® magnetic-end double-J ureteral stent (MEDJUS) is commonly used in pediatric urology, but few studies have analyzed its use in pediatric robotic-assisted laparoscopic pyeloplasty (RALP), particularly with a retroperitoneal approach. The aim was to review our series and analyze possible factors associated with failure of stent insertion or retrieval. STUDY DESIGN:Retrospective review from a prospective database of children who underwent trans-peritoneal RALP (T-RALP) and retroperitoneal (R-RALP) pyeloplasty between 2020 and 2023. Success was defined as the successful insertion MEDJUS during RALP and its removal under local anesthesia. RESULTS:Of the 33 patients who underwent RALP (14 T-RALP, 19 R-RALP), MEDJUS was successfully placed in 23 (74 %) (9 transperitoneal, 14 retroperitoneal), while eight patients had difficulty inserting the stent. In two patients, use of Black-Star® was not attempted (one patient was too tall, surgeon preference in the other). Of the 23 patients in whom MEDJUS was inserted, retrieval failed in five. Overall, successful insertion and retrieval occurred in 58 % of cases. Statistical analysis revealed an association between age and weight, and success of insertion (p values of 0.05 and 0.04, respectively). Moreover, all failures of retrieval occurred in patients who underwent a retroperitoneal approach (p-value 0.04). CONCLUSION:The use of MEDJUS showed good results for RALP. Overall success rate in terms of avoiding a second general anesthesia for stent retrieval was 60 %. Our experience indicates an association between successful stent insertion and increasing age and weight. Additionally, we observed a higher rate of retrieval failure in patients who underwent a retroperitoneal approach. CLINICAL TRIAL REGISTRATION:It is a retrospective study registered at our local ethical committee at Nantes Université "Groupe Nantais d'Ethique dans le Domaine de la Santé" (GNEDS) (23-85-06-300).

INTRODUCTION & OBJECTIVES:The use of transperitoneal robotic-assisted procedures for ureterovesical junction (UVJ) anomalies in pediatric patients is increasing. However, the extra-peritoneal approach potentially less invasive, remains underexplored with robotic approach in pediatric patients. We present our experience of robot-assisted extra-vesical laparoscopic extra-peritoneal UVJ surgery. MATERIALS & METHODS:Extraperitoneal access was made through a 1,5 cm horizontal incision below the umbilicus. Digital dissection was performed under the rectus fascia to the pubic symphysis. The space was further developed under direct vision with laparoscope. The Da Vinci Xi platform was docked after the placement of 4 robotic 8 mm-trocars and an 8 mm assistant port. RESULTS:We performed extraperitoneal robot-assisted laparoscopic UVJ surgery in 3 patients: - Case 1: 9-year-old boy: left-sided ureterectomy, UV reimplantation (UVR) with psoas hitch for a symptomatic mega-ureter. - Case 2: 13-year-old girl: right-sided VUR on a duplex system treated with an extravesical Lich-Gregoir antireflux plasty. - Case 3: 8-year-old boy: left-sided bladder diverticulectomy with UVR. There is no complication above Clavien 2 and no recurrence of febrile UTI during the follow-up period (from 6 to 17 months). CONCLUSIONS:Extra-peritoneal robotic approach for UVJ surgery further for UVR in pediatric urology seems feasible with good short-term result even for the complex ones.

PURPOSE:We present a step-by-step video of periurethral adjustable ACT balloon (PUAB) implantation in children with stress urinary incontinence (SUI) and our preliminary results in a case-series. MATERIALS & METHODS:The case of a 9-year-old girl with primary female epispadias with SUI due to intrinsic sphincter deficiency is presented. The patient underwent a PUAB implantation: each step of the procedure is described in detail in the video. We also report results of our case series, including 3 girls (2 neurogenic bladder and 1 primary epispadias and 2 boys (1 neurogenic bladder and 1 epispadias) with a median age at surgery of 10 years. RESULTS:The balloons were implanted percutaneously under general anesthesia, below the bladder neck, through labia majora or sub scrotal incision, with fluoroscopic and endoscopic control. The preoperative median 24-h pad test was 200 g (100; 800) and decreased to 15 g (10; 30) at 12 months. All patients had urinary continence improvement: three patients had persistent results, the two other had balloon explantation because of balloon erosion or migration but get dry with new balloon implantation or AUS implantation. The median follow-up was 28 months (14-36). CONCLUSION:PUAB implantation appears to be effective in treating SUI in children with neurogenic bladder or epispadias.

PURPOSE:It has been suggested that patients with posterior urethral valves (PUV) and a solitary functioning kidney (SFK) have poorer mid-term and long-term renal function than those with 2 functioning kidneys. We compared the mid-term estimated glomerular filtration rate (eGFR) of PUV patients with and without solitary kidneys. MATERIALS AND METHODS:We used the CIRCUP randomized controlled trial database, which included only patients with prenatally suspected, postnatally confirmed PUV. Standardized follow-up included an early dimercaptosuccinic acid (DMSA) scan performed between 1 and 6 months of age. We retrospectively compared mid-term eGFR (>5 years of age) between those with or without findings of solitary functioning renal unit (<10% differential function of a renal unit). eGFR was calculated using the updated Schwartz formula. Comparison between groups was performed using the Mann-Whitney U test. The study respects our national ethics regulations. RESULTS:Sixty-eight PUV patients were included, 20 of whom had SFK. There were no differences in baseline characteristics between both groups, nor in timing of DMSA scan or latest follow-up. The median follow-up was 7 years (IQR: 6-8). The median eGFR in each group was SFK 82.5 (IQR: 55-109) vs 2 functioning kidneys 94.5 (IQR: 71-114). There was no significant difference in mid-term eGFR, nor in the proportion of boys with mid-term eGFR < 90 or eGFR < 60 between the 2 groups. However, nadir creatinine was significantly higher in boys with a mid-term eGFR < 90 as opposed to those with a mid-term eGFR > 90 (P < .01). CONCLUSIONS:In boys with PUV, having only 1 functioning kidney on a DMSA study is insufficient to determine decreased renal reserve.

INTRODUCTION:Establishing a robotic program in pediatric surgery remains challenging, with evidence-based practices still evolving. Over the last five years, robot-assisted surgery (RAS) has become the standard approach for several pediatric indications. This study presents the first national analysis of pediatric RAS in France, aiming to evaluate indications, procedural trends, and technical considerations. METHODS:A retrospective, multi-institutional study was conducted across 11 French centers with active pediatric robotic programs over the period 2007-2020. Clinical and organizational data were collected through standardized questionnaires and centralized database analysis. A Surgical Complexity Score (SCS) was developed to classify procedures. RESULTS:A total of 1401 RAS procedures were performed, including 301 children <15 kg and 93 < 10 kg. Centers handled a median of 1.4 cases/month, with 91 types of procedures performed. The 5 most frequent procedures were pyeloplasty (34 %), nephrectomy (12.7 %), antireflux surgery (9.2 %), ureteral reimplantation (5.7 %), and biliary procedures (5.6 %). Over time, procedural complexity increased, with 204 cases classified as high complexity (SCS 3). A strong correlation was observed between center experience and inclusion of patients <15 kg (r = 0.873; p = 0.0004), while conversion rates (3 %) were not influenced by experience. Twenty-four fellows were trained using standardized curricula and dual-console platforms. CONCLUSIONS:Pediatric RAS has significantly grown in France, proving to be safe and feasible even in infants under 10 kg. Urology remains the main indication, followed by gastrointestinal and biliary surgery. Despite current limitations-especially instrument size-RAS offers advantages in precision, ergonomics, and surgical education. Future innovation may enhance its broader adoption in pediatric surgery.

Purpose: Bladder augmentation (BA) is the gold standard treatment to increase compliance and treat neurological detrusor overactivity (DO) in children with neurological bladder refractory to medical treatment. In pediatrics, bivalve cystoplasty (Clam) is preferred to supratrigonal cystectomy. Our initial aim was to evaluate the re-intervention rate and long-term outcomes of BA in relation to Clam in children. The secondary aim was the evaluation of refractory DO during follow-up after Clam cystoplasty. Methods: A retrospective analysis was performed including all patients < 18 years of age operated for BA with Clam for neurological bladder (01/2004 to 01/2023). Pre- and postoperative urodynamics were performed. Results: Twenty-six patients (14 girls and 12 boys) underwent surgery for BA. The median age was 8 years (IQR: 5-12). The causes of Neurogenic Low Urinary Tract Dysfunction were spina bifida in 8 patients, Hinman syndrome in 8 patients and sacral agenesis in 8 patients. The ileum was used in 100% of cases and 8 children had continent catheterizable channels inserted (29.6%). The overall re-intervention rate was 41% (11/27) for median follow-up of 7 years (IQR: 4-12). The rates of early and late complications > Clavien 2 were 11% and 22% respectively. BA resulted in significant postoperative improvements (at 1, 5, 10 and 15 years) in compliance (P = 0.0332), detrusor overactivity (DO) (P = 0.032) and bladder capacity [167 mL preoperatively and 425 mL at 15 years (P < 0.0001)]. No refractory DO was identified, and no second augmentation procedure was required during the follow-up period. Two children had a Bricker (7%) due to cognitive impairment preventing self-catheterizing. Conclusion: BA with clam cystoplasty seems a safe and effective treatment for children with neurological bladder. The re-intervention rate is comparable to current literature, and long-term urodynamic parameters demonstrate sustained improvements. The absence of refractory DO and additional augmentation procedures highlight the favorable long-term outcomes of this surgical approach. (c) 2025 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Introduction and objectives Currently, in the field of pediatric urology, the primary aim of surgical approaches for the treatment of renal stone disease is to provide a stoneless state through minimally invasive methods, and to prevent the damage that such stones may cause in the urinary system and stone recurrence. The aim of this study was to evaluate the efficacy and safety of RIRS and the factors affecting its success in the surgical treatment of renal stones in pediatric patients. Methods Data from 357 pediatric and 368 renal units were collected retrospectively. The recorded parameters were age, gender, location and burden of the stone, and presence of postoperative residual stones. Results The stone location was the upper pole in 28 (7.6 %) patients, the middle pole in 44 (12 %), the pelvis in 98 (26.6 %), the lower pole in 139 (37.8 %), and multiple locations in 59 (16 %) patients. A stoneless state was achieved in 277 (75.3 %) units, while 91 units (24.7 %) had residual stones at the end of the first month. In the multivariate analysis, the development of residual stones was found to be significantly associated with age (odds ratio [OR], 1.123; p = 0.012) and stone location (OR, 3.142; p = 0.018). Discussion RIRS is an endourological procedure with a high success rate in the achievement of a stoneless state in both pediatric and adult age groups, with an 82-100 % success rate reported in various studies. A full stoneless state was achieved in 277 (75.3 %) units after the initial RIRS in the present study, and full stone clearance was achieved in 304 units after the second RIRS session, with a success rate of 82.6 %. A limitation of our study is that it was not performed by a single surgeon, and stone samples could not be taken from all patients for stone analysis. Conclusion RIRS has also been associated with a high success rate in the endoscopic treatment of renal stones and is an efficient and safe method with a minimal rate of complications, especially in the pediatric age group.

Background: Abdominal and pelvic closure remains a challenge during bladder exstrophy initial repair. We aimed to report on the feasibility and results of a novel technique of bilateral obturator osteotomy. Methods: Retrospective study of prospective collected data of children who underwent single-stage delayed bladder exstrophy closure combined with RSTM (Radical Soft Tissue Mobilization) for BEEC (Bladder Exstrophy Epispadias Complex) by the same team at different institutions between December 2017 and May 2021. When pubic approximation was not feasible at the end of the procedure, bilateral obturator osteotomy was performed through the same approach, consisting in bilateral divisions of the ilio-pubic rami, ischio-pubic rami, obturator membrane, and detachment of the internal obturator muscle. Pubic bone fragments were approximated together on the midline. Immobilization in a thermoformed posterior splint was indicated for 3 weeks. The main outcome criterion was the bladder dehiscence rate at 6 months, assessed by physical inspection. Secondary outcome criteria included neurovascular obturator pedicle injury, analyzed during orthopedic physical examination, wound or bone infections, gait acquisition, reported by parents and evaluated during medical examination, and vascular penile impairment, judged by penile and glans coloration. Results: 17 children (11 males, 6 females) were included, at a median age of 2 months [1-33]; and representing 29% (17/58) of the children with bladder exstrophy who underwent the same surgical approach during the time of study. There was no postoperative bladder dehiscence with a median followup of 34 months [6-47]. No complication was observed. Pelvic X-rays showed bilateral normal ossification process. Neither gait abnormality, nor clinical indication of obturator nerve deficiency was observed during follow-up. Conclusion: When pubic bones approximation is not possible, bilateral obturator osteotomy is a useful adjunct in bladder exstrophy closure, feasible by the pediatric urologist through the same approach, and not requiring external fixator. Level of Evidence: IV.

Introduction Les ballonnets ajustables péri-urétraux (BAPU) ont montré leur efficacité dans le traitement de l’incontinence urinaire (IU) d’effort chez l’adulte. Les résultats préliminaires d’une étude prospective récente ont montré la faisabilité et l’efficacité de l’implantation des BAPU en population pédiatrique.L’objectif de cette présentation vidéo est la description par étape de l’implantation de BAPU chez l’enfant.Les résultats d’une série de 5 cas sont également rapportés. Méthodes La vidéo décrit par étape la mise en place de BAPU chez une patiente de 9ans avec un épispadias primitif non traité. En préopératoire, cette patiente présente une IU d’effort (60g/j). Le bilan urodynamique montre une vessie compliante, une pression de clôture urétrale maximale à 18cmH20.Nous rapportons les résultats de 5 patients : 3 filles (2 vessies neurologiques [VN], 1 épispadias primitif[EP]) et 2 garçons (1 VN, 1 EP). Les 3 patients avec VN sont au cathétérisme intermittent (CI). Le garçon présentant un épispadias avait eu une cervicoplastie. Résultats Les BAPU sont implantés de part et d’autre du col vésical, sous contrôle scopique et endoscopique. La médiane du nombre d’ajustements nécessaire est 3 (1–7).La médiane préopératoire des Pad-test/24h était de 200g (Q1 100 ; Q3 800) diminuant à 15g (Q1 10 ; Q3 30) à 12 mois postopératoire.La patiente avec épispadias est sèche sans protection à 3 mois. Le suivi médian est de 15 mois (3–30).Deux patients avec une VN et au CI ont présenté une érosion puis explantation d’un des ballonnets à 9 (fille) et 12 mois (garçon).Les patients avec une vidange vésicale par les voies naturelles (épispadias) ne rapportent aucune dysurie, ne présente pas de résidu post-mictionnel en postopératoire. Conclusion L’implantation de BAPU est peu invasive et semble efficace dans les cas d’IS chez l’enfant mais avec un risque d’érosion plus important chez ceux au CI.

The bladder exstrophy-epispadias complex (BEEC) is a congenital abnormality that involves the abdominal wall, bony pelvis, urinary tract, external genitalia, and in the worse cases, also the gastrointestinal tract. The severity-spectrum of the BEEC comprises the mildest form, isolated epispadias, the classic bladder exstrophy, and the most severe form, cloacal exstrophy, which is often referred to as the OEIS complex (omphalocele, exstrophy, imperforate anus, and spinal defects). This chapter attempts to give comprehensive outlines of the current management, focusing on classic bladder exstrophy. It is clear that there is a lack of universal guidelines. The results of different approaches are still taken with precautions as from the beginning the malformations are far from homogenous with consistent findings. The long-term results on the function and quality of life of these children further on in their adult lives underline the importance of lifelong follow-up and the need for more clinical research, including larger cohorts, to enable expert centres to give an objective global view of the results of different approaches and management. The complexity of managing the exstrophy is secondary to the difficulty of reconstructing a compliant and functional vesico-sphincteric complex. Adding to this challenge is the reconstruction of functional genitalia. Tremendous progress has been achieved in surgical procedures to reconstruct bladder exstrophy over the last two decades. The main targets are to achieve a voiding urethra with good bladder capacity and functional genitalia. These difficult targets should be achieved together with preserving the upper urinary tract. Many surgical options are suggested to reach these targets. The controversies between staged reconstruction and primary complete repair are still valid and ongoing. Nevertheless, the majority of exstrophy surgeons accept the surgical principle that mobilisation of the pelvic soft tissue is essential in any bladder exstrophy procedure. This chapter describes two strategies used in two European high-volume centres. The most recently reported results are encouraging regarding the possibility of volitional continence when applying modern reconstruction techniques. Meanwhile, the incidence of progressive or severe hydronephrosis and/or renal scarring has been reported in up to a third of the patients in specialised centres after bladder exstrophy reconstruction. Balancing volitional continence and low-voiding pressure is the most problematic task in exstrophy. The clinical outcomes relating to continence need to be completed by critically evaluating bladder function, especially in children not under clean intermittent catheterisation (CIC). The major target of this evaluation is the early detection of a high-risk bladder so the upper tract avoids any irreversible deterioration of kidney function. When initiating the treatment of bladder exstrophy, it is important to include the therapeutic option of CIC. This should be discussed with the patients and their families so that it can be safely utilised when necessary. The other challenge is genital reconstruction, both in boys and girls. In boys, there is still a crucial lack of long-term results on erectile function after reconstructions. The current long-term studies clearly emphasise the major sexual dysfunction in men operated on for exstrophy. Studies on fertility in men and women are now available. We hope that new surgical methods and increased centralisation of care by multidisciplinary teams will improve the long-term results in these patients.

Introduction Le sphincter urinaire artificiel (SUA) fait parti de l’arsenal thérapeutique pour la prise en charge de l’incontinence urinaire d’effort neurogène (IUE). Il n’existe que quelques cas de R-SUA autour du col de la vessie chez des patients pédiatriques. Nous présentons une vidéo étape par étape de l’implantation d’un R-SUA au niveau du col de la vessie chez un garçon de 12ans souffrant d’une incontinence urinaire d’effort (IUE) neurogène sévère liée à une insuffisance sphinctérienne (IS). Méthodes Les examens préopératoires comprenaient une échographie de la vessie et des voies urinaires supérieures qui n’a révélé aucune anomalie. Un examen urodynamique a également été réalisé, qui a révélé une pression de clôture urétrale maximale à 20cmH2O, un détrusor acontractile et une compliance normale avec une capacité de 500mL. Le garçon était capable d’effectuer l’ASI et d’atteindre son scrotum gauche. Résultats Une approche transpéritonéale à cinq trocards a été réalisée à l’aide d’un robot Da Vinci® Xi standard à quatre bras en position de Trendelenburg de 20°. La manchette du SUA a été placé autour du col de la vessie, le réservoir a été laissé dans l’espace de Retzius. Une cystoscopie peropératoire avec un optique de 70° a été réalisée pour s’assurer de la position de la manchette au niveau du col de la vessie et confirmer l’absence de lésion du col de la vessie. Le SUA a été désactivé à la fin de l’intervention. Le temps opératoire a été de 190minutes. Le SUA a été activée 6 semaines plus tard. À 12 mois, le garçon était complètement sec entre les sondages. Conclusion L’implantation d’un R-SUA au niveau du col de la vessie chez un garçon semble faisable, en suivant les mêmes étapes et principes que la chirurgie ouverte avec taux de continence équivalents à court terme.

AbstractObjectivesTo show that robot‐assisted laparoscopic cutaneous continent urinary diversion (RALCCUD) is feasible and safe; however, data on clinical outcomes in adults are lacking.Materials and methodsWe conducted a retrospective study of all adults who underwent RALCCUD between 2017 and 2022 at a single tertiary reference centre.Patient characteristics, clinical information and perioperative outcomes were recorded. All patients underwent pre‐ and postoperative urodynamic evaluations.Functional outcomes were evaluated at 3 months, then yearly. Continence was defined as no stomal or urethral leakage.ResultsTwelve patients, mostly women (n = 11), median (IQR) age 47.4 (19–57) years underwent RALCCUD (four Mitrofanoff, four Yang‐Monti and four Casale). The main indication for surgery was inability to perform intermittent self‐catheterization through the native urethra.Eleven patients (92%) had neurogenic lower urinary tract disease caused by spinal cord injury or spinal dysraphism.Median (IQR) operative time was 313 (285–367) min. Four patients (33%) underwent concomitant procedures: three supratrigonal cystectomy (SC) with augmentation cystoplasty (AC) and one artificial urinary sphincter (AUS). No conversions to an open approach were required. Median (IQR) follow‐up was 51 (40–61) months. One early postoperative complication occurred (Clavien grade III). The late postoperative complication rate was 17%, with three complications occurring in three patients.At the last follow‐up, all patients could self‐catheterize through the tube, and the stomal and urethral continence rate was 100%.ConclusionRALCCUD is feasible and safe in adults, with a high rate of stomal and urethral continence and a low complication rate.

Introduction Ureteroscopy (URS) can be proposed as first-line therapy for the management of pelvic stones from 10 to 20 mm and for lower ureteric stones in children. However, little is known about the success and the morbidity of URS in young children. Ureteroscopic treatment may present matters in young children because of the small size of the pediatric kidney and the small size of the collecting system. Objective To assess safety and efficacy of URS for the treatment of urinary stones in children aged of 5 years or less. Study design After the institutional ethical board approval was obtained, we conducted a retrospective, analytic, multicentric study that included all URS performed between January 2016 and April 2022 in children aged of 5 years or less. In this non-comparative case series, anonymized pooled data were collected from 7 tertiary care centers of pediatric patients. Endpoints were the one-session SFR at 3 months and per and postoperatives complications. Descriptive statistics were applied to describe the cohort. Results Eighty-three patients were included. For them, 96 procedures were performed at the median age of 3.5 years (IQR: 0.8-5) and median weight of 14 Kg (6.3-23). Median stone size was 13 mm (4-45). There were 65 (67 %) renal stones treated with flexible URS, most of which were in the renal pelvis (30%) and in the lower calix (33 %). A ureteral access sheath was used in 91 % procedures. Preoperative ureteral stent was placed in 52 (54 %) of patients. None of patients had ureteral dilatation. The single-session SFR was 67.4 % (56.3 and 89.2 % for flexible URS and semi-rigid URS respectively) and children require 1.4 procedures to achieve complete stone clearance. The overall complication rate was 18.7 %, most of them were minor (Clavien I-II). Intraoperative perirenal extravasation (Clavien IIIb) due to forniceal rupture was documented in 6.2 % of cases, related to an increased intrapelvic pressure (IPP) performed in a closed pelvicalyceal system. Discussion Pediatric urologists should be aware of forniceal rupture based on the presence of extravasation of contrast during endourological procedures especially when they have difficulties to reach lower caliceal stone in small patient. Conclusion URS in patients aged of 5 years or less, is a complex minimally invasive procedure with reasonable efficacy and low morbidity. Intrarenal stones treated by RIRS in young children carries the risk of additional procedures to complete stone clearance.

Total nephrectomies for the treatment of Wilms’ tumor (WT) are more and more performed by laparoscopy, although indications for this approach following the UMBRELLA guidelines are currently very restrictive. The purpose of this study was to assess the compliance to the criteria of the UMBRELLA protocol for minimally invasive approach of WT. This retrospective multicenter study included children operated on by laparoscopic total nephrectomy for suspected WT before 2020. Imaging was reviewed centrally. Fifty-six patients (50 WT and 6 nephrogenic rests) were operated on at a median age of 3.3 ± 2.6 years. Thirteen (23