OBJECTIVE:To establish a unified terminology and management framework for testicular developmental disorders (TDDs) through a comprehensive review of the literature and an international expert consensus. Although these disorders, ranging from testicular agenesis to regression and dysgenesis, are clinically significant, inconsistent terminology has led to confusion in diagnosis and management. METHODS:Between January and March 2025, a thorough literature review was conducted across PubMed, Scopus, MEDLINE, and Embase to identify studies addressing the definition, histopathology, and management of testicular remnants, vanishing testis, agenesis, streak dysgenetic gonad, hypoplasia, atrophy, and hypotrophy. Findings were summarized and critically analyzed by an informal international expert panel comprising pediatric urologists, endocrinologists, geneticists and pathologists. The consensus process aimed to standardize definitions and management strategies when high-level evidence was lacking. RESULTS:Seven distinct entities were identified within the TDD spectrum. Testicular remnants ("nubbins") and vanishing testes were determined to represent different endpoints of the same regression process, with viable germ cells found in 0-16% of remnants and an overall theoretical malignancy risk below 1%. Dysgenetic gonads associated with Y-chromosome material carried a markedly higher risk (30-50%) of gonadoblastoma, for which prophylactic gonadectomy may be advised. Testicular aplasia and hypoplasia were primarily linked to genetic and hormonal causes, while atrophy and hypotrophy were associated with secondary ischemic or acquired processes. Diagnostic laparoscopy remains the gold standard for non-palpable testis evaluation. CONCLUSIONS:This consensus provides a standardized classification and management framework for TDDs, clarifying previously ambiguous terminology. Most entities demonstrate negligible malignant potential, except for dysgenetic gonads containing Y-chromosome material. The proposed framework enhances diagnostic accuracy, facilitates international comparability, and supports individualized, evidence-based management in pediatric urology.

Antenatal hydronephrosis is the most common prenatal urinary tract abnormality, and some cases, mainly due to ureteropelvic junction obstruction, require surgery. Noninvasive biomarkers are needed to improve diagnosis and guide management. To evaluate urinary exosomal long non-coding RNAs, specifically MALAT1 and HOTAIR, as biomarkers for predicting surgical necessity in children with unilateral antenatal hydronephrosis, and to develop an AI-based predictive model. This retrospective case-control study included 88 children (38 requiring pyeloplasty, 26 non-obstructive dilatation, 24 controls). Urinary exosomes were isolated, and lncRNA expression was quantified by RT-qPCR. Clinical variables included anteroposterior pelvic diameter and split renal function. Diagnostic performance was assessed by ROC analysis and logistic regression. A SVM model was developed integrating biomarker and clinical data, with 5-fold cross-validation and an interactive Shiny web application for clinical translation. Preoperative MALAT1 and HOTAIR levels were significantly elevated compared to non-obstructive dilatation and controls and decreased after surgery (p < 0.001). MALAT1 remained an independent predictor of surgical intervention (OR = 1.272, p < 0.001) in multivariate analysis, alongside APD and SRF. MALAT1 showed an AUC of 0.745 (cut-off: 9.06), and HOTAIR an AUC of 0.685 (cut-off: 11.76). The SVM model achieved 91.9

INTRODUCTION:Treatment of de novo vesicoureteral reflux (VUR) into the transplanted kidney constitutes a clinical challenge. Herein, we present our data on patients who underwent endoscopic subureteric injection for the treatment of VUR following renal transplantation (RT) in our center. METHODS:The patients who underwent endoscopic subureteric injection for VUR into the transplanted kidney after RT in our department between 2008 and 2023 were reviewed retrospectively. Indication for subureteric injection, age, gender, laterality, number of injections, amount of material used, renal failure etiology, auxiliary procedures, and treatment success were noted. All interventions were performed by pediatric urologists who also perform RT. RESULTS:During a median followup of 27.5 months (4-160), 22 patients (17 women, 77.2%) and 23 transplanted ureters (13 right, eight left, one bilateral) were treated with subureteric injections. In all patients, the indications for subureteric injection were recurrent febrile urinary tract infection (UTI), and the grades of VUR varied between 1-4. Patients received a median of 1.65 cc (0.7-2.7) dextranomer-hyaluronic acid copolymer. In total, 10 RTs (eight from living donors, two from cadaveric donors) were performed in another center, whereas 13 RTs were carried out in our center (eight from cadaveric donors and five from living donors). Among the patients who were transplanted in our center, the rate of subureteric injections due to de novo symptomatic VUR after RT was 2.2% (13/593 patients). After subureteric injections, five patients required a second injection due to the recurrence of VUR. Ureteroureterostomy (to the native ureter) was performed in two patients who had further UTIs after the second endoscopic treatment. Eventually, 19/21 patients (90.4%) benefited clinically from the endoscopic treatment and none of the patients underwent re-do ureteroneocystostomy. It is noteworthy that the etiology of renal failure was VUR nephropathy in seven (31.8%) patients. CONCLUSIONS:Subureteric injection provides a high clinical success for the treatment of de novo VUR after RT.

OBJECTIVE To analyze the transitional outcomes of children who underwent Cohen ureteroneocystostomy METHODS Files of patients who underwent UNC between January 2003 and December 2013 and had > 10 years of follow-up were retrospectively reviewed. Demographic and clinical data before surgery were noted. Lower urinary tract dysfunction (LUTD) status was assessed via ICIQ M/F-LUTS, voiding diary and uroflowmetry in all patients. Renal functions, hypertension, proteinuria, febrile/afebrile urinary tract infections(UTIs), and complications associated with pregnancy were noted. RESULTS Two hundred and forty-one patients (140 girls, 58.1%) underwent UNC at a median age of 6.5 years (3-14), and 57.7% underwent bilateral surgery. After a median follow-up of 15 years (1020), median patient age at the last clinic visit was 21 years (18-31). LUTD was detected in 69 function(BBD), presence of renal scar, and older age (>= 7 years) at the time of surgery were significantly associated with LUTD in adulthood. Febrile UTI was detected in 7.9% (19/241) following UNC, whereas 6 needed subureteral injection due to persistent low-grade VUR. No patient developed stage 3 or greater chronic kidney disease, but 11(4.6%) patients developed hypertension and 7(2.9%) had proteinuria. Of 67 sexually active female patients,10(14.9%) had febrile UTIs. Of 49 women in whom pregnancy was observed,4(8.1%) had febrile UTIs, 7(14.2%) had afebrile UTIs and 2(4.1%) had pre-eclampsia during pregnancy, but none had a miscarriage or early labor. CONCLUSION Despite VUR control, the incidence of febrile UTI and pre-eclampsia during pregnancy should not be underestimated. In addition, a quarter of patients face LUTD when they reach adulthood. Female patients with bilateral disease, renal scar, and previous childhood BBD have higher risks for these transitional clinical problems.

BACKGROUND:Long-term outcomes for two-stage repair in the treatment of primary hypospadias is scarce. Thus, we aimed to analyze our clinical data in patients with two-stage primary hypospadias repair. METHODS:Files of 145 boys who underwent two-stage surgery for primary hypospadias repair between September 2001 and October 2017 with >5 years of follow-up were retrospectively reviewed. Demographics, preoperative clinical characteristics, postoperative complications, uroflowmetry findings, the Penile Perception Score (PPS), and the Hypospadias Objective Scoring Evaluation (HOSE) score at the last clinical visit were noted. In addition, the International Index of Erectile Function (IIEF) was used to assess sexual function in post-pubertal patients. RESULTS:Median age at the time of first-stage and second-stage surgeries were 36 (range 12-288) and 42 (range 18-300) months, respectively. Of those, 56.6 % had penoscrotal hypospadias, and 29.6 % had scrotal or perineal hypospadias, while 13.8 % had mid penile hypospadias with uncorrectable curvature/poor urethral plate. Topical dihydrotestosterone was used in 52.4 % (those with glans diameter <14 mm). Preputial graft was used in all cases. Median follow-up after the second-stage was 120 (range 66-224) months. The overall postoperative complication rate was 31.1 % where 29 % underwent reintervention. The most common complication was urethrocutaneous fistula (15.2 %) followed by meatal stenosis (8.3 %), glans dehiscence (6.2 %), residual chordee (4.1 %), partial distal urethral dehiscence (3.4 %), buried penis or skin deformities (2.8 %), urethral stricture (1.4 %), and graft contracture after the first-stage surgery (1.4 %). The median time from second-stage surgery to the first repeat intervention for complications was 11 (range 6-64) months. According to the HOSE and PPS, at least 90 % of the patients appear to have functionally and cosmetically acceptable outcomes. In the assessment of 50 post-pubertal patients, erectile dysfunction (ED) was found in 12 %, of whom 8 % had mild ED and 4 % had moderate ED. Antegrade ejaculation was observed in 46 patients (92 %). Of these patients, 6.5 % experienced dribbling ejaculation at climax instead of normal ejectile ejaculation. CONCLUSIONS:Considering the follow-up results of the post-pubertal patients, our results may indicate that two-stage surgery is a functionally and cosmetically satisfactory option for primary hypospadias repair. Although the overall complication rate is nearly 30 %, most cases can be considered acceptable according to HOSE and PPS. LEVEL OF EVIDENCE:Level II.

BACKGROUND:Urogenital tuberculosis (UGTb) is the second most common form of extrapulmonary Tb. We aimed to evaluate the clinical consequences in our 20-year experience of UGTb. METHODS:We retrospectively reviewed the files of consecutive patients diagnosed with UGTb through microbiological methods between January 2001 and April 2021 in our centre. Clinical and demographic data of the patients were assessed. Surgical procedures during the disease course were also noted. RESULTS:A total of 46 patients (26 males) having a median age of 48.5 (16-82) years were diagnosed with UGTb. The most frequent complaint at admission was lower urinary tract symptoms (LUTS), followed by nonspecific symptoms, macroscopic hematuria, flank pain, scrotal swelling, and infertility. A history of pulmonary Tb was present in 10 patients. The kidney was the most affected organ, followed by ureter, bladder, and testis/epididymis. Bladder involvement and admission with LUTS was significantly higher in elderly patients (≥60 years), whereas the rate of nonspecific symptoms was significantly higher in younger patients (≤40 years). Eleven patients required surgical interventions including nephrectomy (n = 5), nephroureterectomy (n = 2), orchiectomy (n = 1), epididymectomy (n = 1), distal ureterectomy + ureteroneocystostomy (n = 1), and epididymovasostomy (n = 1). Among the 32 patients with at least 12 months of follow-up (median 114 months, range: 12-180) four had ongoing LUTS, 5 had chronic kidney disease, one had end-stage renal disease, and one had azoospermia. CONCLUSIONS:UGTb affected the upper urinary tract with a fair chance of renal function deterioration in addition to LUTS and infertility. These conditions may impair the patient's long-term quality of life. Elderly patients were also more prone to bladder involvement, and approximately one-quarter of patients with UGTb required surgical intervention.

OBJECTIVE:To analyze the postoperative complications, reintervention rates, as well as long-term urinary and cosmetic outcomes in our patients who underwent two-stage re-do hypospadias repair. METHODS:Files of 122 boys who underwent two-stage surgery for re-do hypospadias repair between June 2001 and October 2017 with > 5 years of follow-up were retrospectively reviewed. Demographics, preoperative clinical characteristics, postoperative complications, uroflowmetry findings, the Penile Perception Score (PPS), and the Hypospadias Objective Scoring Evaluation (HOSE) score at the last clinical visit were noted. RESULTS:Patients had undergone a median 2 (range 1-8) prior surgeries. Of these patients, 46.7% had mid penile hypospadias with a poor urethral plate/uncorrectable chordee, 44.3% had penoscrotal hypospadias, and 9% had scrotal or perineal hypospadias. Lower lip (78, 63.9%), a combination of cheek and lower lip (21, 17.2%), cheek (14, 11.5%), and upper lip (9, 7.4%) were the donor sites for the graft. After a median 121 (range 66-204) months of follow-up, the overall complication rate was 36.8%, and 23.8% required further intervention. Glans dehiscence (12.3%) was the most common complication, followed by urethrocutaneous fistula (10.7%), meatal stenosis (10.7%), residual chordee (6.6%), buried penis or skin deformities (6.6%), distal urethral dehiscence (4.9%), graft contracture after first stage (2.5%), urethral stricture (1.6%), complete urethral dehiscence (0.8%), and urethral diverticulum (0.8%). Median interval from second-stage repair to the repeat intervention for complications was 10 (range 4-30) months. According to the HOSE and PPS, almost 90% of the patients denoted functional and cosmetically acceptable outcomes. CONCLUSION:Two-stage repair is a viable alternative for the most challenging re-do hypospadias cases, with almost 90% satisfaction and a quarter requiring reintervention.

Undescended testis (UDT, cryptorchidism) is the most frequent genital anomaly in boys. However, its treatment varies widely throughout the world. This second part of our roundtable discussion aims to continue to ask global experts to express their attitudes towards several case scenarios of UDT in order to explore the rationale for their clinical decisions. As the European Association of Urology - Young Academic Urologists Pediatric Urology Working Group, we believe that this roundtable series will facilitate colleagues all over the world to reflect and improve their practices regarding the treatment of UDT.

OBJECTIVES:To analyze the management strategies in the children who had treatment-resistant dysfunctional voiding (DV). METHODS:Among 75 children with DV who underwent pelvic floor biofeedback therapy (BF) between 2013 and 2020, 16 patients (14 girls, 87.5%) with a mean age of 9.81 ± 2.53 years that showed incomplete clinical response following urotherapy and initial BF sessions were retrospectively reviewed. The demographic and clinical characteristics, DVSS, and uroflowmetry parameters were recorded before and after the initial BF sessions. Subsequent treatments after initial BF and clinical responses of patients were noted. RESULTS:Clinical success was observed in one patient by addition of an anticholinergic and in three patients with combination of salvage BF sessions and anticholinergics, whom had predominant overactive bladder (OAB) symptoms. The success rate of TENS alone and in combination with other treatment modalities was 88.8% (8/9 patients). In addition, salvage BF sessions (range 2 to 3) enabled clinical success in five (50%) of 10 cases as a combination with anticholinergics or TENS. In case of incomplete emptying without OAB, adequate clinical response to Botulinum-A was observed during an average follow-up of 29 months in two boys who did not respond to alpha-blockers, even though one required repeat injection after 10 months. The total clinical success rate was 87.5% (14/16 patients) after a median follow-up of 24 months. VV-EBC and Qmax increased by a mean of 30.89% and 7.13 mL/min, respectively, whereas DVSS decreased by a mean of 8.88 points and PVR-EBC decreased by a median of 19.04%. CONCLUSIONS:Our findings showed that clinical success in resistant DV was achieved by various combination treatments in the majority of children. However, a small group may still have persistent, bothersome symptoms despite multiple treatment modalities.

Objective To analyze the transitional outcomes of children who underwent Cohen ureteroneocystostomy(UNC) due to vesicoureteral reflux(VUR). Methods Files of patients who underwent UNC between January 2003 and December 2013 and had>10 years of follow-up were retrospectively reviewed.Demographic and clinical data before surgery were noted.Lower urinary tract dysfunction(LUTD) status was assessed via ICIQ M/F-LUTS,voiding diary and uroflowmetry in all patients.Renal functions, hypertension,proteinuria,febrile/afebrile urinary tract infections(UTIs),and complications associated with pregnancy were noted. Results Two hundred and forty one patients (140 girls,58.1%) underwent UNC at a median age of 6.5 years (3-14),and 57.7% underwent bilateral surgery.After a median follow-up of 15 years (10-20),median patient age at the last clinic visit was 21 years (18-31).LUTD was detected in 69 (28.6%) patients.Bilateral disease,female gender,history of childhood bladder bowel dysfunction(BBD),presence of renal scar, and older age(≥ 7 years) at the time of surgery were significantly associated with LUTD in adulthood.Febrile UTI was detected in 7.9%(19/241) following UNC,whereas six needed subureteral injection due to persistent low-grade VUR.No patient developed stage 3 or greater chronic kidney disease,but 11(4.6%) patients developed hypertension and 7(2.9%) had proteinuria.Of 67 sexually active female patients,10(14.9%) had febrile UTIs.Of 49 women in whom pregnancy was observed,4(8.1%) had febrile UTIs,7(14.2%) had afebrile UTIs and 2(4.1%) had preeclampsia during pregnancy, but none had a miscarriage or early labor. Conclusion Despite VUR control,the incidence of febrile UTI and preeclampsia during pregnancy should not be underestimated.In addition,a quarter of patients face LUTD when they reach adulthood.Female patients with bilateral disease,renal scar,and previous childhood BBD have higher risks for these transitional clinical problems.

This study aimed to assess the cosmetic and sexual outcomes of childhood hypospadias repair after puberty. Among 672 patients who underwent hypospadias repair between 2001 and 2017, 243 sexually active patients were included in the study. At their last visit, cosmetic and sexual evaluation were done through the Penile Perception Score, the Hypospadias Objective Scoring Evaluation, IIEF, MSHQ-EjD. The levels of erectile dysfunction(ED) severity were determined according to erectile function domain of IIEF. The median follow-up after the last surgery was 16 [IQR (13-18)] years, and median patient age at the time of study was 19.67 [IQR(18-22)] years. Patients were divided into two subgroups as follows: Group I; Repairs using grafts (n = 120, 49.4%) and Group II; Graft-free repairs (n = 123, 50.6%). The rate of dissatisfaction with penile appearance was higher in Group I (16.7% vs. 4.9%, p = 0.003). Mild ED was more frequent in Group I (14.2% vs. 3.3%, p = 0.007); while none of the patients had either moderate or severe ED. Other domains of sexual function were observed to be similar in both groups. The need for unwanted interventions due to complications, and surgeries requiring grafts were found to be risk factors for ED development and dissatisfaction with penile appearance in adulthood. Those who underwent graft-free hypospadias repair experience better cosmetic and sexual outcomes when compared to grafted repairs, yet, satisfactory results were achieved in almost 90% of the grafted repairs.

We aimed to investigate the urinary caspase-3 and cytochrome c levels in patients with unilateral antenatal hydronephrosis and to determine whether changes in urinary biomarker levels could be useful for both predicting the need for surgical intervention due to ureteropelvic junction obstruction (UPJO) and postoperative surgical success. Sixty-five children with a history of unilateral antenatal hydronephrosis and postnatal anteroposterior diameter ≥ 10 mm were included in this prospective case–control study between January 2013 and December 2021. The obstruction group consisted of 33 patients (28 boys, 84.8

Ectopic kidneys, with a prevalence of 1/1000-4000, often manifest in the pelvic region, can be complicated with problems such as ureteropelvic junction (UPJ) obstruction. This video article presents a case of open pyeloplasty in a 15-month-old infant with a pelvic kidney, emphasizing technical details for educational purposes. The patient was prenatally diagnosed with pelvic kidney hydronephrosis at 22 weeks of gestation, progressing to grade 4 postnatally. MAG-3 scintigraphy confirmed UPJ obstruction, warranting open pyeloplasty. A Pfannenstiel incision provided access to the Retzius space. The ureter was dissected, revealing the adhered renal pelvis. Stay sutures facilitated dissection, and 5/0 polyglactin sutures were strategically placed due to anatomical anomalies. Ureteropelvic anastomosis was performed using 6/0 PDS sutures. A 3-Fr Double J catheter preceded the closure of the renal pelvis. The procedure was concluded with meticulous layer closure. The operation lasted for 50 min, with minimal blood loss (10 mL). Drain was removed on postoperative day 2, and the patient was discharged. Ureteral stent was removed at 4 weeks. A 3-month follow-up ultrasound revealed a notable reduction in hydronephrosis, with an anteroposterior diameter of 6 mm. This video article elucidates the nuances of open pyeloplasty in pelvic kidneys and serves as a valuable resource for residents and fellows. The concise procedure, with a brief operative time and minimal blood loss, indicates the efficacy of the surgery.

Background: Standard protocol for post-pyeloplasty monitoring in children and natural course of hydronephrosis resolution have not been well defined. We aimed to analyze critical time intervals and risk factors in the long-term clinical outcomes of children who were operated for ureteropelvic junction obstruction. Methods: Files of patients who underwent open dismembered pyeloplasty between January 2000 and December 2012 and had a >= 10 years follow-up were retrospectively reviewed. Changes in SFU hydronephrosis grade, pelvis anteroposterior diameter (APD), renal parenchymal thickness, split renal functions (SRF) on MAG-3 scan as well as development of hypertension and proteinuria were noted. Complete resolution was defined as SFU grade 0-1 or APD <= 10 mm or >= 50 % APD decrease. Results: Overall, 223 patients (161 boys, 72.1 %) with a median age of 9 (range 1-185) months underwent unilateral pyeloplasty, whereas 14 patients (13 boys, 92.8 %) with a median age of 4 (range 2-39) months underwent bilateral pyeloplasty. Median follow-up was 13 (range 10-22) years. Complete resolution was observed in 190 patients (85.2 %). None of the cases required re-do pyeloplasty. Regarding unilateral cases, postoperative changes in hydronephrosis reached a plateau at the 60th month. Also, there was no significant difference regarding SRF between the 12th month and the 60th month (p > 0.05). Hypertension developed after a median period of 12 years in 13 (5.4 %) of the patients, while proteinuria developed in four (1.6 %) patients. Bilateral disease (HR: 2.518, p = 0.034) was found to be a significant determinant for development of hypertension and/or proteinuria. Conclusions: Our results indicated that ultrasonographic findings stabilized after the 60th month postoperatively, and SRF remained stable between the postoperative 12th and the 60th months. The risk of developing hypertension and/or proteinuria was 2.5 times greater in bilateral cases. Level of Evidence: Level II.

Background: To assess the effect of age at hypospadias surgery on emotional and behavioural problems, somatic symptoms, irritability, and penile perception. Methods: We retrospectively identi fied the patients who underwent single distal hypospadias surgery and age -matched healthy controls were included. There were two further subgroups according to the age at the time of hypospadias repair ( <2 vs. >2 years). The Strengths and Dif ficulties Questionnaire (SDQ), Revised Children's Anxiety and Depression Scale (RCADS), Affective Reactivity Index (ARI), Level 2 Somatic Symptom Scale, and Penile Perception Score (PPS) scale were used. The groups were compared using multivariate variance analysis (MANOVA). Results: Both groups consisted of 70 patients (mean age 14.0 +/- 0.2 years, for both), while there were 34 patients in the hypospadias groups who underwent surgery at <2 years of age. Depressive, panic, separation anxiety, social phobia, and somatic complaint symptom scores of the hypospadias group were lower than those of the control group. Obsessive -compulsive symptom levels were signi ficantly higher in patients who underwent hypospadias surgery at >2 vs. <2 years of age. Additionally, PPSs rated by the surgeon were signi ficantly higher in the former. A multivariate linear regression model indicated that panic disorder symptom scores predicted child PPS in the hypospadias group. Limitations include retrospective design. Conclusions: Single hypospadias surgery seems not to have a negative impact on emotional and behavioural status. Children who underwent distal hypospadias surgery after 2 years of age had higher levels of obsessive -compulsive symptoms. Following emotional status may help the early diagnosis of future psychopathologies. Type of Study: Retrospective comparative study. Level of Evidence: III. (c) 2023 Elsevier Inc. All rights reserved.

Undescended testis (UDT, cryptorchidism) is the most common congenital anomaly of the genital tract. Despite its high incidence, the management of UDT varies between specialties (urology, pediatric surgery, pediatric urology, pediatric endocrinology). Therefore, as the European Association of Urology - Young Academic Urologists Pediatric Urology Working Group, we requested experts around the world to express their own personal approaches against various case scenarios of UDT in order to explore their individual reasoning. We intended to broaden the perspectives of our colleagues who deal with the treatment of this frequent genital malformation.

OBJECTIVE To assess the incidence of concomitant vesicoureteral reflux (VUR) in unilateral cases of ureteropelvic junction obstruction (UPJO) and to identify factors that predict VUR. METHODS Files of 381 pediatric patients who underwent unilateral pyeloplasty between 2000 and 2017 were retrospectively reviewed. A total of 270 patients with available data and >= 5 years of follow-up were eligible for this study. Demographic parameters, preoperative hydronephrosis grade, renal pelvis anteroposterior diameter (APD), renal parenchymal thickness (PT), split renal functions on MAG-3 scan and VUR status were noted. The patients were divided into two groups: those with concomitant VUR (group I, n: 24, 8.9%) and those without VUR (group II, n: 246, 91.1%). RESULTS Among 270 patients (205 boys, 75.9%) with a median age of 4 months (2-98), 197 (72.9%) had antenatal hydronephrosis. Median follow-up was 11 years (5-22). Among 24 patients with concurrent VUR, 6 (25%) had grade II VUR, whereas grade III-V VUR was detected in 18 (75%). Of these, 12 (50%) had ipsilateral VUR, 3 (12.5%) had contralateral, and 9 (37.5%) had bilateral VUR. In a median 137-month follow-up, spontaneous VUR resolution was observed in 6 (25%) patients, whereas 15 (62.5%) patients underwent endoscopic subureteral injection and 3 (12.5%) patients ureteroneocystostomy, respectively. Preoperative APD [35.5, (Inter Quantile Range) IQR (27.6-36.0) vs 26.5 IQR (25.0-35.0), P = .004] were significantly higher in group I, whereas group I had significantly lower PT [3.7, IQR (3.4-6.4) vs 5.8 IQR (4.4-6.1), P = .026]. Predictive factors for concomitant VUR were presentation with febrile UTI (odds ratio (OR): 2.769, P = .048), PT <3.95 mm (OR: 1.367, P = .043), and APD >28.8 mm (OR: 1.035, P = .001). CONCLUSION Our results indicated that concomitant VUR and UPJO might be detected in 1 out of every 11 patients undergoing pyeloplasty, while some type of surgical intervention for VUR was required in 75% of these patients. Thus, voiding cystourethrogram prior to pyeloplasty may be limited in those presenting with febrile urinary tract infection, having higher APD and lower PT on preoperative urinary ultrasonography.

Purpose To evaluate the demographic and clinical characteristics of patients who visited our transitional urology (TU) outpatient clinic formed by pediatric urologists with urology background within the first year upon its establishment. Methods Files of 130 consecutive patients who visited our TU outpatient clinic, which was established in 01 March 2021, between 01 March 2021 and 01 March 2022 were retrospectively collected. Patients were divided into two groups: those with a previous follow-up in our pediatric urology department (Group I, n: 81, 62.3%) and those who were followed up in other clinics during childhood (Group II, n: 49, 37.7%) afterwards. Demographic characteristics, complaints at admission, previous medical history, and management plans at the recent clinical visit were noted. We defined a successful and smooth transition from childhood to adult care as not being without follow-up within the first year after the age of 18 years and not requiring extraordinary medical assistance (e.g., emergency room visits, hospitalization, intensive care unit admissions) from the last urological control to the TU outpatient clinic visits. Results The most common diagnoses were vesicoureteral reflux (n: 32, 24.6%), neuropathic bladder accompanied by spina bifida (n: 31, 23.8%), obstructive uropathy (n: 25, 19.2%), hypospadias (n: 20, 15.3%), non-neurogenic lower urinary tract dysfunction (n: 19, 14.6%), and bladder exstrophy (n: 8, 6.1%). The distribution of primary diagnosis in the two patient groups was similar. The median time from the last pediatric urology visit to the current TU clinical visit was significantly longer in Group II (12 vs. 60 months, p < 0.001),consequently, the median patient age at admission was significantly higher in Group II (21 vs. 23 years, p = 0.020). The rate of a successful and smooth transition was 86.4% in Group I, whereas Group II had a completely unsuccessful transition period. Upon admission to TU outpatient clinic, the requirement of a surgical intervention was lower in Group I (21% vs. 38.8%, p = 0.028).Also,the need for medical treatment changes was higher in Group II (9.9% vs. 53.1%, p < 0.001). Conclusion Our findings emphasize the importance of patient referral to a TU clinic that deal with lifelong problems of congenital genitourinary diseases. Delays in receiving medical or surgical treatments during transition from childhood to adulthood may be associated with higher need for subsequent surgical interventions in this vulnerable patient population.