Ureteropelvic junction obstruction can cause significant changes in the upper urinary tract (UUT). Although pyeloplasty may successfully restore normal flow through the UPJ, those modifications do not resolve immediately and may persist. We aimed to characterize the sonographic remodeling pattern of the UUT following successful pyeloplasty. Prospective multicenter study, including pediatric patients status post-pyeloplasty (2021–2022) with standardized US assessments at 2, 6 and 9 months, 1 and 2 years after double J stent removal. The primary outcome was the percentage reduction in anteroposterior diameter (APD) of the renal pelvis compared to baseline. 31 patients, median age at surgery was 6.5 months (IQR 6.5–105.5). Median preoperative APD was 24 mm (21–31 mm), with median reductions of 30

Background Introduction There are numerous reasons that justify the development of a fertility preservation program in pediatrics. These include various conditions such as oncology, transgender care, recurrent benign conditions, autoimmune diseases, genetic causes, and others like Differences in Sexual Development (DSD). Currently, the leading cause is pediatric oncofertility, which focuses on patients who will undergo some type of gonadotoxic treatment due to oncological disease. Thanks to new therapeutic alternatives, the life expectancy after chemotherapy for childhood cancer has significantly increased over the past decade, making fertility one of the main concerns Case or Series Materials and Methods We present the first series of cases advised and treated at the Italian Hospital of Buenos Aires by the fertility preservation team between February 2021 and february 2024. Each patient underwent a complete multidisciplinary evaluation. The best fertility strategy was selected according to feasibility, time available for implementation, age, the degree and severity of the underlying disease, and its prognosis.Results During the study period, we performed fertility cryopreservation treatments in 16 patients. The average age was 16.8 years (age range: 12 to 17). The underlying diagnoses were: 4 Ewing sarcomas, 4 femoral osteosarcomas, 1 clavicular osteosarcoma, 1 dysgerminoma, 2 borderline ovarian tumor, 2 lymphomas, 1 desmoplastic tumor, and 1 transgender patient. All 16 patients were evaluated and counseled by a multidisciplinary team including oncology, endocrinology, pediatric surgery, pediatric urology, reproductive medicine, and pediatric/adolescent gynecology to define the best preservation strategy. The fertility preservation strategies were: 40% ovarian stimulation and oocyte aspiration, 46% ovarian tissue cryopreservation, and 14% semen cryopreservation. In all cases, patients with oncological disease began chemotherapy on schedule, with no delays. The transgender patient resumed hormone therapy after preservation. Comments Conclusion It is essential to have a multidisciplinary fertility preservation program to ensure early referral and implement the best preservation strategy. The greatest missed opportunity for effective preservation treatment is the lack of or delayed referral. It is necessary to continue incorporating patients with other conditions that require counseling and evaluation for future fertility preservation

Background Introduction Adnexal masses in pediatrics have multiple etiologies, including neoplastic ones. They can present in various ways, from incidental findings to clinical symptoms. They may be benign or malignant, requiring accurate evaluation and treatment to optimize outcomes. Objective: To provide a comprehensive overview of adnexal masses operated on at a high-complexity university hospital. Case or Series Materials and Methods A retrospective descriptive study. Patients under 18 years of age with adnexal masses operated on at our center (2014–2024) were included. Variables analyzed: demographic data, age, form of presentation, ultrasound size of the lesion, pathological anatomy.Results A total of 128 patients were included: 4 neonates, 18 prepubertal, and 16 postpubertal. Neonatal cases were diagnosed via prenatal ultrasound. In prepubertal and postpubertal cases, consultation was due to abdominal pain in 73 cases, ultrasound findings in 57, and abdominal mass in 1 case. The main diagnostic method was ultrasound, with an average diameter of 54 mm. There were 63 scheduled surgeries and 65 emergency surgeries, of which 40% were adnexal torsions. Tumor markers were requested in all cases, with 5 returning positive. Cystectomy was performed in 104 patients (81%), and oophorectomy in 22 (17%). Open surgery was performed in 14% of cases, with the remainder performed laparoscopically. Ovarian tissue cryopreservation was done in 3 cases. One patient required reoperation due to hemoperitoneum, and another was managed conservatively due to a drop in hematocrit. Pathological anatomy revealed various types of cysts. Neonatal: simple cysts; prepubertal: mature teratoma, followed by hemorrhagic cysts; postpubertal: hemorrhagic luteal cyst, followed by mature teratoma. Additionally, two dysgerminomas, three borderline tumors, and one immature teratoma were identified—all postpubertal. Two contralateral recurrences (mature teratoma and borderline tumor) were recorded and resolved with ovary-sparing surgery. Comments Conclusion Adnexal masses in girls and adolescents encompass a wide range of pathological diagnoses, with symptoms that can be variable and nonspecific. This descriptive study reveals heterogeneity in age, presentation, and histopathological diagnosis. Benign pathology was the most common, and ovarian parenchyma preservation was achieved in a high percentage of cases.

Introduction: Kidney transplantation (KT) is the standard of care for children with end-stage kidney disease. When the donor's kidney is right-sided, the graft can be placed ipsilaterally using an inverted kidney allograft (IKA) technique, facilitating the anastomosis of a shorter renal vein and renal hilum spatial orientation with anterior positioning of the urinary tract. We aimed to compare the safety and efficacy of IKA and standard anatomical position (AP) in pediatric KT. Methods: We performed a retrospective study of all patients ≤18 years of age who underwent KT at the Hospital Italiano de Buenos Aires (January 2010 to December 2021). A comparative analysis of baseline demographics, urologic and vascular complications, graft survival, and one-year creatinine clearance was performed between patients with IKA and those with AP allografts. Results: Overall, 157 KT were performed: 61 were IKA and 96 were in the AP. Median age at transplantation was nine years (range 118). Allografts from cadaveric donors were more frequently implanted using the IKA technique (p≤0.001). No significant difference in urologic (16.4% vs. 13.5%, p=0.79) or vascular complication rates (1.2% vs. 5.2%, p=0.47) were observed. Median one-year creatine clearance was similar between the groups (73.1 ml/min/m2 vs. 75.3 ml/min/m2). Graft survival and overall mortality rates were comparable between groups. Conclusions: In the largest study of its kind, we observed that the IKA technique did not increase the risk of urologic or vascular complications and yielded comparable one-year graft survival and creatine clearance. This approach appears to be feasible when the AP is not ideal.

INTRODUCTION:Kidney transplantation (KT) is the standard of care for children with end-stage kidney disease. When the donor's kidney is right-sided, the graft can be placed ipsilaterally using an inverted kidney allograft (IKA) technique, facilitating the anastomosis of a shorter renal vein and renal hilum spatial orientation with anterior positioning of the urinary tract. We aimed to compare the safety and efficacy of IKA and standard anatomical position (AP) in pediatric KT. METHODS:We performed a retrospective study of all patients ≤18 years of age who underwent KT at the Hospital Italiano de Buenos Aires (January 2010 to December 2021). A comparative analysis of baseline demographics, urologic and vascular complications, graft survival, and one-year creatinine clearance was performed between patients with IKA and those with AP allografts. RESULTS:Overall, 157 KT were performed: 61 were IKA and 96 were in the AP. Median age at transplantation was nine years (range 1-18). Allografts from cadaveric donors were more frequently implanted using the IKA technique (p≤0.001). No significant difference in urologic (16.4% vs. 13.5%, p=0.79) or vascular complication rates (1.2% vs. 5.2%, p=0.47) were observed. Median one-year creatine clearance was similar between the groups (73.1 ml/min/m2 vs. 75.3 ml/min/m2). Graft survival and overall mortality rates were comparable between groups. CONCLUSIONS:In the largest study of its kind, we observed that the IKA technique did not increase the risk of urologic or vascular complications and yielded comparable one-year graft survival and creatine clearance. This approach appears to be feasible when the AP is not ideal.

Kidney transplantation (KT) is the treatment of choice for children with end-stage kidney disease. Double J stenting (DJS) has been proposed to reduce the risk of major urologic complications. However, its efficacy remains conflicting, with existing evidence limited. We aimed to evaluate the incidence of urologic and vascular complications, graft loss, and creatinine clearance in pediatric patients undergoing KT with DJS versus those without DJS. We retrospectively reviewed all pediatric patients who received KT at our institution (January 2010–December 2021). The baseline demographics, urologic and vascular complications, graft loss, and creatinine clearance at the 1-year follow-up were collected and compared between the DJS and non-DJS groups. Indications for DJS placement included the presence of unresolved uropathies posing a persistent risk to the urinary tract, anuric patients, and cases involving uretero-ureteral anastomosis. Overall, 156 KT were identified: 84 underwent KT with DJS placement, while 72 did not receive a stent. The incidence of urologic complications was higher in the DJS group than in the non-DJS group (20.8

Introduction Resolution of underlying urinary tract anomalies prior to kidney transplantation in patients with end stage renal disease (ESRD) secondary to uropathy, has been historically supported under the argument that this would help prevent infectious complications and graft loss. We propose to perform earlier kidney transplantation with a transient vesicostomy, deferring resolution of the uropathy to the post- transplantation period. The aim of this study was to evaluate the outcomes of kidney transplantation in children with a vesicostomy. Material and methods A retrospective, multicenter study was performed including all patients under 18 years of age who underwent kidney transplantation with a vesicostomy, between January 2005 and December 2020 and had at least one year of follow up. Data related with the indication and timing of vesicostomy, time until transplantation, post-transplantation complications, urinary tract infections (UTI) and graft survival rate were collected. Results Of the 758 transplantations performed in the study period, 16 patients met the inclusion criteria. Mean age at transplantation was 58 months (range 20-151), and mean weight was 13.5 Kg (range 8.4-20). Mean time from vesicostomy to kidney transplantation was 30 months (range 0-70). There were 2 (12.5%) ureteral complications that required reoperation. Eighteen episodes of UTI were identified in 8 patients (50%), accounting for 0.4 UTIs per patient-year of follow-up. UTIs did not lead to graft loss in any of the cases. Urinary tract reconstruction was performed in 5 patients (31.3%) at an interval of 1-91 months post-transplantation. After a mean follow-up of 44.8 months (range 13-200) from transplantation, patients with vesicostomy had a mean creatinine clearance of 86.6 ml/min/1.73 m2, 2 , with a mean serum creatinine level of 0.6 mg/dl. Graft survival rate was 100%. Discussion Early kidney transplantation into a vesicostomy permits a resolution of the ESRD, avoiding deleterious effects related to dialysis. With a low rate of UTIs, we found no graft loss due to infectious complications. This strategy permits careful planning and better timing for the urinary tract reconstruction without delaying kidney transplantation. Conclusion Kidney transplantation in pediatric patients with vesicostomy seems to be a safe and effective strategy. UTI rate was similar to that reported in the literature of patients with corrected urinary anomalies undergoing kidney transplantation without urinary diversion.

Introduction. The trans population in Argentina represents 0.43%. Our objective was to describe the characteristics of trans and non-binary children and adolescents. Population and methods. A cross-sectional study was designed. The population was all trans or nonbinary persons under 24 years of age seen by an interdisciplinary team in a tertiary university hospital from January 2019 to May 2023. The sample was obtained from the database of patients seen by reviewing electronic medical records (EMR). Results. The EMRs of 107 individuals were analyzed; the average age at first consultation was 15.3 years, and the age of self-perceived transgender identity was 11.1 years. Seventy-two percent perceived themselves as having a trans male identity; in 89.7%, their gender expression was by their self-perception, and 46.3% had a bisexual sexual orientation. Seventy-six percent acknowledged having family support; 87.3%, school support; and 92.5%, peer support. 44.8% had a hormonal strategy, 14.1% had surgery, 57.1% had mental health intervention, and 29.1% received psychiatric medication. Only three patients (2.8%) detransitioned their gender identity. Conclusion. Most individuals were trans men and perceived good support from their environments. Almost half received a hormonal strategy; less than a quarter received a surgical intervention; more than half received a mental health intervention. The detransition was infrequent.

The aim of this paper is to describe the distinctive ultrasound findings of a case of vaginal bleeding caused by the presence of a foreign body. We present the case of an infant who consulted for vaginal bleeding and foul-smelling discharge. The ultrasound revealed signs of vaginal distension due to heterogeneous-hematic contents and parietal thickening. At Doppler examination, a striking finding of increased vascularization limited to the upper two-thirds of the vaginal wall was found, which was initially interpreted as a sign of local inflammation suggesting the presence of an underlying foreign body. At direct vaginoscopic examination remains of toilet paper in the vaginal fundus were found. The presence of a foreign body in the vagina is an uncommon cause of discharge and vaginal bleeding in pediatrics, therefore, this etiology should be kept in mind when the adequate clinical context arises. Doppler ultrasound represents a first-line complementary method when this entity is suspected.

OBJECTIVE To analyze the outcomes of patients undergoing upper-pole heminephrectomy surgery and to assess the different variables that may have an impact on outcome, specifically regarding morbidity and the need for further surgeries. MATERIALS AND METHODS A retrospective study of patients who underwent laparoscopic upper-pole heminephrectomy for a nonfunctional moiety between August 2007 and December 2019 was conducted at 3 centers. A total of 130 patients met the inclusion criteria. A transperitoneal approach was used. The following variables were evaluated: (1) preoperative: presentation, presence of ureterocele and history of ureterocele incision, hydronephrosis grade, presence of vesicoureteral reflux (VUR), and differential renal function (DRF) on renal scintigraphy; and (2) postoperative outcomes: Doppler ultrasound, renal scintigraphy, complications, febrile urinary tract infection, lower urinary tract symptoms, and need for further surgery. Findings were considered statistically significant at P <.05. RESULTS Postoperative complications were observed in 5 patients (3.8%). Six patients (4.6%) needed further surgeries after heminephrectomy. The presence of ureterocele and VUR was related with the need for further surgeries odds ratio (OR) 4.91, P =.0415) and the occurrence of postoperative febrile urinary tract infection (OR 2.81, P =.0376). A 13.9% incidence of lower urinary tract symptoms was found with no difference between patients with ureterocele and those with an ectopic ureter. Renal scintigraphy showed a median decrease in DRF of 2.7%. No patient had complete loss of function. CONCLUSION Laparoscopic upper-pole heminephrectomy showed to be a feasible and safe procedure. In most patients this surgery will be the definitive procedure. Patients with both VUR and ureterocele will need special consideration. No significant loss of function in the remaining lower moiety was found. (C) 2021 Elsevier Inc.

Preoperative planning is essential to secure the best surgical outcome when the anatomy of the patient is altered or unknown. Conjoined twins are the perfect example of this paradigm. The development of image processing technology and virtual navigation can help overcome several anatomical barriers and prevent surgical complications, specially in this infrequent patients.

The determining factors in surgical decision-making are not always clear, especially when they occur in asymptomatic patients. Objective: to analyze the correlation between presumptive preoperative diagnosis and the intraoperative finding. Determine if there are factors that can influence discrepancy.

Venous vascular malformations can be located in the genital region (GVM), resulting in cosmetic deformities and functional limitations secondary to associated symptoms. Objective: To review all cases of GVM in our female pediatric population and evaluate the result of conservative percutaneous treatment.

Purpose: Here we report the results of a review of a prospectively maintained database of the use polyacrylate polyalcohol copolymer (PPC) injection to correct grades IV and V VUR. Materials and methods: All children with grades IV and V primary VUR that presented with febrile urinary tract infection while on prophylaxis, in a three -year period, were treated with a subureteral injection of PPC. Institutional ethical approval was obtained. Exclusion criteria were incomplete bladder emptying documented on videourodynamic study, ureteral duplication, paraureteral diverticula and poor ureteral emptying observed during fluoroscopy and previous open surgical or endoscopic treatment. Pre- and post-operative evaluation included urinalysis, renal and bladder ultrasonography, DMSA scan and videourodynamic studies. Results: 33 children (36 renal units) were included with a median age of 57 months (range 7 to 108). There were 18 males and 15 girls. 30 renal units had grade IV and 6 grade V VUR. Median follow-up time was 32 months (range 7 to 58). Reflux was cured in 32/36 renal units with the first injection, but another 2 patients were reimplanted because of dilatation. Complications included early urinary tract infection in 7 children, transient lower urinary tract symptoms in 5 children. Progressive ureteral dilatation was noted in 4 children and was treated with insertion of a double J stent. Two of these children eventually required an ureteroneocystostomy. Conclusions: The use of PPC to treat grades IV and V vesicoureteral reflux in young children has an overall success rate of 83,3%. Persistent ureteral dilatation was present in 11% associated with high injection volume. Future studies will attempt to maintain a high success rate reducing the volume of injection and the incidence of dilatation.

Purpose: Megaprepuce is a congenital penile malformation that includes phimosis and severe ballooning of the internal prepuce. We combined the main technical details of 2 previously reported surgical techniques to simplify the surgical approach. We report the key points of this revisited surgical correction for megaprepuce and the long-term results.Materials and Methods: Penile reconstruction was performed between March 2004 and March 2009 in 26 children 2 to 19 months old (median age 6) with congenital megaprepuce. Surgical repair consisted of limited preputial resection of the phimotic ring, wide dissection of the outer prepuce to the base of the penis, fixation of the proximal outer prepuce to Buck's fascia to create a new penoscrotal junction, and unfurling and wide tailoring of the inner prepuce in the ventral midline to resurface the whole elongated penile shaft. A bladder catheter was left in place for 5 or 6 days. Only patients with at least 6 months of followup were included in analysis.Results: All patients underwent surgery on an outpatient basis. Operative time was between 50 and 85 minutes. Median followup was 17.6 months (range 6 to 59). Two patients had slight dehiscence of the ventral suture, which healed spontaneously without a scar. In 1 patient transient urethral meatal stenosis developed. The final cosmesis result was adequate in all patients.Conclusions: It is possible to correct megaprepuce and achieve an adequate genital aspect with a simple approach of resurfacing the penis with the unfurled, tailored inner prepuce.

Transitional cell carcinoma of the bladder has a high incidence in adults, but it is uncommon in children and adolescents. Hematuria is the most common symptom of presentation and vesical ecography the preferred diagnostic method. The diagnosis and treatment is performed with cystoscopy and endoscopic resection. We describe two patients: an 18 years old male, who presented with a pediculated tumor on the posterior bladder wall and a 15 years old female with a 1 cm long tumor on the posterior wall too; both were removed under endoscopic control. In both patients superficial transitional cell carcinoma was the final diagnosis and are disease free 3 and 5 years later. A review of the available literature was performed to clarify if this type of tumors must be considered malignant and try to define how long and by which way these patients must be controlled.

Purpose We present our experience in the posterior bladder approach using laparoscopic techniques to place an Artificial Urinary Sphincter (AUS). Material and Methods : From 1990 to 2006. 132 pediatric patients with urinary incontinence underwent artificial urinary sphincter placement. In the last 4 years we used the posterior laparoscopic bladder approach in 8 patients to dissect the bladder neck under direct vision. There were 6 female and 2 male patients with a mean age of 8,7 years (range:3-20) and mean weight of 29,5 kg (range:14-72). The etiology of incontinence in all the patients was myelodysplasia. 3 patients had simultaneous surgical procedures. In 2 cases a laparoscopic Malone procedure was done and in the third we performed a subureteral endoscopic injection of bulking agent. After a complete laparoscopic exposure of the posterior and lateral walls of the bladder neck, a Phannestiel incision was made to place the components of the AUS-800. Results The mean follow up was 23 months (range:3-38). The average surgical time was 188 minutes (range 145-220), mean oral feeding begun at 17,4 hs postop. (range 3-24) and hospital stays from operation until discharge were 1,4 days (range 1-2). We had no intraoperative complications. One patient presented with a bilateral uretero vesical obstruction after the cuff activation that required an extravesical reimplantation. Conclusions The laparoscopic dissection of the bladder neck is safe and secure. It is not technical demanding and it gives the possibility to dissect the posterior wall of the bladder neck under direct vision. The RESULTS in achieving continence are similar to those reported in the literature.

The role of laparoscopy in children with adrenal tumors has not been fully defined because of the low incidence and variability of this condition. We report our experience with laparoscopic adrenal surgery.