OBJECTIVE:To evaluate adolescent satisfaction and decisional regret after hypospadias repair in childhood and to assess associations with anatomical severity, surgical complications, and reoperations. PATIENTS AND METHODS:Adolescents who underwent hypospadias repair in childhood completed a pre-mailed questionnaire before their final pediatric follow-up visit. Satisfaction was assessed using the validated Penile Perception Score (PPS), evaluating meatal location, glans shape, penile skin, and overall appearance. Additional items addressed satisfaction with penile length and straightness, perceived timing of surgery, and decisional regret. Reference data for age-matched healthy controls were derived from published normative material. RESULTS:In total, 176 patients (101 distal, 20 midshaft, and 55 proximal hypospadias) responded (response rate 64%); 51% had undergone at least 1 unplanned reoperation. Median age at primary surgery was 1.4 years and at follow-up, 16.3 years. Dissatisfaction with meatal location, glans, skin, and straightness did not differ between patients and controls. Dissatisfaction with penile length (18.6% vs 0%, P < .01) and overall appearance (11.8% vs 1.6%, P = .03) was more common among patients. PPS scores were generally higher after distal than proximal repair. Dissatisfaction with penile length was more frequent after a Nesbit procedure (26% vs 12%, P = .03). Most patients (89.8%) considered the timing of surgery appropriate; 2.9% reported decisional regret. CONCLUSION:Most adolescents were satisfied with outcomes following early hypospadias repair. Dissatisfaction with penile length and appearance was more frequent among patients, especially after proximal repair. Decisional regret was rare, supporting early surgery combined with structured long-term follow-up and appropriate counseling.

Introduction There is a dearth of data on long-term outcomes, including patient-reported outcomes (PROMs), decisional regret, and complication rates for surgical correction of isolated ventral penile curvature in childhood. Patients and Methods Twenty-six children treated for ventral curvature between 1993 and 2008 were identified; 24 met inclusion criteria (isolated ventral curvature without hypospadias or need for urethral reconstruction). Surgical correction consisted of degloving alone or degloving with Nesbit-like dorsal plication when residual curvature >20° persisted after degloving. PROMs were collected via pre-mailed validated questionnaires after puberty: Danish Prostatic Symptom Score (DAN-PSS) for LUTS, Erection Hardness Score (EHS) for erectile function, Penile Perception Score (PPS) for cosmetic perception, and items assessing decisional regret and perceived appropriateness of surgical timing. Results Curvature was corrected intraoperatively in all 24 patients. Twelve underwent degloving alone and 12 required additional dorsal plication. During long-term follow-up (median 14.2 years), one patient (4%) underwent re-operation for residual curvature, and three (13%) underwent cosmetic revisions; two (8%) underwent cystoscopy for flow concerns. 71% returned PROMs at a median age of 16.2 years. LUTS were uncommon, with low bother scores. Erectile function was favorable: 87% (13/15) reported EHS 4 and 93% (14/15) reported ejaculation. Cosmetic outcomes were favorable, with PPS dissatisfaction rates comparable to controls. Two patients reported dissatisfaction with overall appearance, and one with residual subjective curvature. No patient expressed decisional regret, and 88% felt timing of surgery was appropriate. Conclusion Early surgical correction of isolated ventral penile curvature using degloving with or without dorsal plication provided durable anatomical correction and favorable long-term functional and cosmetic outcomes. These findings support early intervention as an effective approach with sustained patient-perceived benefits.

Purpose Closed spinal dysraphism (CSD) comprises a heterogeneous group of congenital anomalies that may remain asymptomatic or present with neurological and urological dysfunction. This study aimed to evaluate long-term urological outcomes in children with isolated CSD and to compare outcomes between patients managed conservatively and those who underwent spinal cord untethering (SCU). Methods We conducted a retrospective cohort study of children with CSD treated at Helsinki University Hospital between 1990 and 2015. Results Forty-three patients were followed for a median of 11.0 years. Urological symptoms were common, and at some point during follow-up, 21 patients (49%) required urological treatment. At the end of follow-up, 27 patients (63%) required no ongoing urological treatment. Before SCU or during conservative treatment, 82% (32/39) of patients older than three years achieved volitional voiding, and 72% (28/39) were continent; 18% required clean intermittent catheterization (CIC), and 19% (7/39) received bladder-directed therapy. Twenty patients underwent neurosurgical spinal cord untethering, most often due to progressive symptoms. Seventeen patients (85%) had volitional voiding preoperatively, whereas only 10 patients (50%) voided volitionally at the last follow-up after SCU (p = 0.02). At the last follow-up, there was no significant difference in the need for urological treatment between conservatively treated patients and those who underwent SCU. All patients had normal kidney function at the last follow-up. Conclusions A substantial proportion of children with CSD require urological treatment during long-term follow-up. Despite postoperative changes in bladder function, long-term urological treatment needs were similar between conservatively managed patients and those who underwent SCU.

Robotic-assisted laparoscopic surgery has advanced minimally invasive urology. However, the absence of haptic feedback may increase the risk of tissue trauma. This case series evaluates a no-touch technique in robotic-assisted pyeloplasty to minimize urothelial handling and assess its feasibility and short-term outcomes. This retrospective case series reviewed 20 pediatric patients with ureteropelvic junction obstruction treated with robotic-assisted pyeloplasty between 2019 and 2022. In 10 cases, a no-touch urothelium approach was applied to minimize direct tissue handling. Patient selection, surgical details, perioperative outcomes, and follow-up at 6 and 12 months were documented. The no-touch approach was successfully implemented in all cases without intraoperative complications. Median console time was 98 min (IQR: 81–131). Postoperative outcomes were favorable, with significant improvement or resolution of hydronephrosis in all cases. No major complications occurred, and no anastomotic strictures were observed during follow-up. The no-touch technique in robotic-assisted pyeloplasty is a feasible approach that maintains surgical efficiency while minimizing direct urothelial handling. Further studies with larger sample sizes and longer follow-up are needed to validate its potential benefits. This study was approved by the Institutional Review Board of New Children’s Hospital, Helsinki University Hospital (permit nr 5485), Finland.

Objective: Intestinal segments are commonly used in reconstructive urology to create continent or incontinent urinary channels. Initially, the viability of these segments depends on the integrity of the vascular pedicle. We report three patients with catheterizable, or incontinent channels constructed using the spiral Monti technique or incontinent ileovesicostomy all of whom developed postoperative complications involving the vascular pedicle. Material and methods: Patients with documented vascular pedicle injury to a continent or incontinent ileovesicostomy in New Children’s Hospital, Helsinki University Hospital and in Riley Children’s Hospital, Indiana School of Medicine were retrospectively identified and reviewed. Results: In all three cases, the vascular pedicle was transected either electively or during emergency surgery for intestinal volvulus or obstruction, 17 months to 5 years after reconstructive surgery. Despite pedicle loss, all patients retained viable functional channels, supported by collateral blood supply. Follow-up ranging from several months to 19 years confirmed sustained channel viability. Conclusions: These cases suggest that, in select situations, collateral vascularization may be sufficient to preserve the function of a continent stoma despite loss of its primary vascular pedicle.

AIMS:Spina bifida (SB) is a complex condition, predisposing individuals to lifelong challenges in mobility, continence, and overall health. Care modalities are multimodal, and advancements have improved survival, shifting clinical focus towards optimizing long-term function and quality of life. The aim of this systematic review is to outline patient-reported outcome measures (PROMs) used to assess health-related quality of life (HRQOL) and other conditions in transitional SB patients, and to analyze factors influencing the results they provide. METHODS:We conducted a systematic review according to PRISMA guidelines, including sixteen studies with 2009 participants. RESULTS:Participants' ages ranged from 12 to 74 years, with a gender distribution of 59 % female. 72 % used CIC, 48 % had urinary incontinence and 32 % had bowel incontinence. The Pediatric Global Health 7 (PGH-7) and Neurogenic Bladder Symptom Score (NBSS) were the most frequently used tools, capturing general health and bladder-specific outcomes, respectively. The Quality of Life Assessment in Spina bifida (QUALAS) measures emerged as a concise, SB-specific tool addressing physical and psychosocial domains. CIC was linked to improved bladder-specific outcomes, though its effect on overall HRQOL was inconsistent. Mental health, literacy, and transition readiness significantly influenced HRQOL. CONCLUSIONS:The use of PROMs in the treatment and research of individuals with SB proved to be surprisingly variable and fragmented. Disease-specific PROMs, such as QUALAS, are an obvious and necessary response to the problem emphasizing the continuous development of these tools to be more tailored to the target group. When complemented by targeted measures like NBSS, they offer a practical and comprehensive approach in understanding and improving HRQOL in SB patients. Optimizing bladder and bowel management, mental health, and social support remains critical for improving outcomes. LEVEL OF EVIDENCE:III.

BACKGROUND:Catheterizable continent channels (CCC) provide means for urinary continence when urethral catheterization is not feasible. However, some patients present with stomal incontinence warranting further interventions. The purpose of this study is to evaluate the effectiveness of endoscopic injection (EI) of bulking agent (Deflux©) as a minimally invasive treatment for CCC incontinence and to explore patient-specific variables influencing outcomes in a pediatric cohort. METHODS:Hospital's pediatric urology procedure registry was retrospectively reviewed to identify all patients with a CCC and at least one EI of bulking agent for the leakage of the stoma at our institution between 2001 and 2021. The postoperative outcomes were assessed three months after the procedure and annually thereafter. RESULTS:A total of 21 children and young adults were included with CCC indications including neurogenic bladder (n = 13), bladder or cloacal exstrophy (n = 5) and other conditions (n = 3). The most common channel type was appendicovesicostomy (n = 7) followed by Monti tube (n = 5), spiral Monti (n = 3), ureter (n = 3), and other types (n = 3). The median age at first EI was 9.7 years (IQR 8.2-15.1) with a median follow-up time of 4.0 years (IQR 1.2-6.7). At follow-up, 11 patients (52 %) achieved continence. Surgical correction was ultimately required in nine patients (43 %) due to incontinence and in three patients for other reasons. No patient (0 %) experienced long term benefit from >1 injections. CONCLUSION:Endoscopic injections offer a minimally invasive option and can be considered a first-line approach for treating CCC incontinence. However, surgical correction remains necessary for some patients. In our material, re-injections were ineffective.

OBJECTIVES:To assess long-term lower urinary tract symptoms (LUTS) in post-pubertal patients operated on for hypospadias during infancy. PATIENTS AND METHODS:We analysed patient-reported LUTS in 176 post-pubertal patients born between 1991 and 2003, who underwent early hypospadias repair at a median age of 1.4 years (IQR 1.1-1.9). At their last follow-up visit, patients returned pre-mailed questionnaires evaluating LUTS before transitioning from the pediatric unit. The results were compared to a healthy control group. We also assessed the impact of hypospadias severity on voiding and storage symptoms. RESULTS:At a median age of 16.3 years, 19 % of patients had undergone stricture treatment following hypospadias repair. Frequent (often/always) or severely disturbing (moderate/major) voiding or storage symptoms were rare and comparable to controls according to DAN-PSS questionnaire (p > 0.05 for all comparisons). Most symptoms were mild, and the occurrence of mild symptoms varied between patients and controls. The severity of hypospadias did not affect the occurrence of voiding or storage symptoms. The occurrence of bothersome LUTS was also similar between patients with and without prior stricture treatment (p > 0.5 for all). CONCLUSION:Most patients reported satisfaction with their urinary function after urethroplasty, indicating that long-term LUTS do not significantly increase following hypospadias when complications including strictures are identified and managed. To enable long-term outcomes after childhood hypospadias surgery, structured follow-up is essential to detect and treat such complications.

OBJECTIVE:To present data on sexual function in post-pubertal patients after hypospadias surgery in childhood. PATIENTS AND METHODS:We assessed 169 (96 distal, 20 midshaft, 53 proximal) patients with hypospadias born between 1991 and 2003, who underwent surgery before the age of 5 years. At a median (interquartile range) follow-up age of 16.2 (16.0-16.8) years, participants completed a pre-mailed sexual function questionnaire, including the Erection Hardness Score (EHS) during the last control visit. Dorsal Nesbit-like plication was used for curvature correction in 62 patients. Previously published normative data served as controls. RESULTS:All patients reported having erections; 73% achieved EHS 4 (completely hard and fully rigid). In patients with distal hypospadias, EHS 4 was reported in 68% of cases, 85% of midshaft and 79% of proximal cases. Among those with and without curvature correction by Nesbit-like plication, EHS 4 was reported in 72% and 74%, respectively. The proportion reporting EHS 4 exceeded that of published controls (P < 0.01). Penile straightness during erection was reported by 95% of patients overall, with no significant differences across hypospadias subtypes or curvature correction status. Only one patient reported pain during ejaculation; none reported pain during erection. Ejaculation was reported by 95% of participants. CONCLUSION:Adolescents who underwent early hypospadias repair reported favourable sexual function outcomes, including high rates of erectile rigidity and ejaculatory function. Neither hypospadias severity nor the need for curvature correction affected these outcomes. These findings support the long-term sexual well-being of patients undergoing surgery for hypospadias in childhood.

ABSTRACTPurposeTo evaluate possible problems during pregnancy or delivery in women with pediatric bladder augmentation.MethodsEleven of 59 women, who had undergone bladder augmentation in our pediatric hospital during 1990–2019, had given birth in our hospital district afterwards and their obstetrical records were evaluated.ResultsMedian age at first delivery was 32 years (range 26–42). Six patients had myelomeningocele, two had bladder exstrophy and the remainder had VATER association, epispadias or traumatic paraplegia with vesicovaginal fistula. The patients had altogether 18 children (all singletons). Catheterizations were performed through continent stoma in six cases and through urethra in five cases. None of the patients needed an indwelling catheter before delivery. Antibiotic prophylaxis was initially in use during two pregnancies. Symptomatic urinary tract infections (UTIs) developed for five mothers in 11 pregnancies without prophylaxis and prophylaxis was continued after UTI in these cases. Three of the five mothers with UTI were treated with intravenous antibiotics due to pseudomonas infection (three infections) or pyelonephritis (one).Two patients with myelomeningocele delivered vaginally (one woman three times and one woman once). In the remaining 14 cases a cesarean section (CS) was performed (two urgent and one emergency CS). A urologist was present in seven CSs. Some difficulties accessing the uterus were reported in seven surgeries. There were 10‐term, three late‐preterm and one very preterm delivery. In four cases the information on gestational age was unavailable. Six newborns had respiratory problems, two had severe asphyxia. One newborn had myelomeningocele like her mother.ConclusionsRisk for UTIs during pregnancy is high in bladder augmentation patients, hence prophylactic antibiotics are justified. A multidisciplinary team should be involved in the planning of delivery. When indicated for obstetrical or urological reasons, an elective cesarean section with a urologist present may be the most rational option for many, although vaginal delivery is possible in selected patients.

Cryptorchidism presents with an incidence of 1-5% with potential long-term implications on future fertility and overall health. This review focuses on surgical treatment modalities, their impact on testicular development, and function while addressing the Nordic consensus statement as well as current European Association of Urology (EAU) and American Urological Association (AUA) guidelines. Congenital and acquired cryptorchidism present distinctive challenges in surgical management, with different implications for fertility. While congenital cryptorchidism entails a risk to fertility and warrants early intervention, both retractile testes and acquired cryptorchidism also pose risks to fertility potential, underscoring the importance of evaluating treatment options. Testicular location and the child’s age form the basis of a practical classification system for undescended testicles. Early diagnosis by clinical examination enables timely treatment. Imaging is reserved for selected cases only. Following guidelines, orchidopexy is recommended between 6-12 months of age for congenital cryptorchidism. Evidence increasingly suggests the benefits of early surgery for promoting testicular health and fertility potential. Current surgical options range from open to laparoscopic techniques, with the choice largely determined by the location and accessibility of the undescended testicle. The advancement in laparoscopic approaches for non-palpable testes underscores the evolving landscape of surgical treatment. Sequential surgeries may be required depending on the mobility of the undescended testes. More research is needed to explore both the potential and limitations of hormonal therapy, which is secondary to surgical treatment and can selectively have a role as adjunct to surgery. Long-term follow-up is imperative to evaluate fertility outcomes, risk of testicular malignancy, and psychological impact. By integrating current guidelines with the latest evidence, this review intends to facilitate a comprehensive understanding of cryptorchidism, thereby optimizing patient management and outcomes.

(1) Background: Antenatal hydronephrosis (AHN), detected in approximately one percent of prenatal ultrasounds, is caused by vesicoureteral reflux (VUR) in 15–21% of cases, a condition with significant risks such as urinary tract infections and renal scarring. Our study addresses the diagnostic challenges of VUR in AHN. Utilizing renal ultrasonography and scintigraphy, we developed a novel scoring system that accurately predicts high-grade VUR, optimizing diagnostic precision while minimizing the need for more invasive methods like voiding cystourethrogram (VCUG); (2) Methods: This retrospective study re-analyzed renal ultrasonography, scintigraphy, and VCUG images from infants admitted between 2003 and 2013, excluding cases with complex urinary anomalies; (3) Results: Our analysis included 124 patients (75% male), of whom 11% had high-grade VUR. The multivariate analysis identified visible ureter, reduced renal length, and decreased differential renal function (DRF) as primary predictors. Consequently, we established a three-tier risk score, classifying patients into low, intermediate, and high-risk groups for high-grade VUR, with corresponding prevalences of 2.3%, 22.2%, and 75.0%. The scoring system demonstrated 86% sensitivity and 79% specificity; (4) Conclusions: Our scoring system, focusing on objective parameters of the visible ureter, renal length, and DRF, effectively identifies high-grade VUR in AHN patients. This method enhances diagnostics in ANH by reducing reliance on VCUG and facilitating more tailored and less invasive patient care.

Background: Recent decades have seen changes in the urological treatment of myelomeningocele (MMC). We aimed to evaluate the urological outcomes in post-pubertal patients and to clarify associations with walking status, hydrocephalus, and sex. Methods: A retrospective study of 103 MMC patients at their final pediatric urological control. Urological procedures, the necessity for Clean Intermittent Catheterization (CIC) and anticholinergic medication, the state of continence, renal ultrasound findings, and serum creatinine values were assessed. Results: The median age of the patients was 18 years (IQR 16.7-19.6), with 51 (49.5%) being female. Renal function was preserved in all but of one, who presented with mild hydronephrosis. 38 patients walked without assistance, 46 used wheelchairs. Most patients (93%) utilized CIC, and 83% had interventions for overactive or poorly compliant bladder, including anticholinergic medication (47%), Botox treatments (35%), or bladder augmentation (36%). Nearly half (45%) had undergone bladder neck procedures. Continence status revealed 55% fully continent, 18% were rarely incontinent, and 26% were incontinent daily, with most episodes limited to droplet leakage. Incontinence was not associated with the ambulatory status, hydrocephalus, or sex (p = 0.08, >0.99, and 0.07 respectively). Conclusions: Renal function was effectively maintained with our treatment strategy; however, daily incontinence episodes occurred in one out of four patients, with an additional 18% experiencing occasional rare incontinence episodes. Incontinence, when present, was mostly mild. We found no association between patient characteristics, treatment approach, and continence. Emphasizing incontinence treatment becomes a mainstay in future studies.

ObjectiveTo assess the cumulative rates of re‐operations after hypospadias repair and evaluate long‐term surgical outcomes at a tertiary paediatric urology centre.Patients and MethodsRetrospective analysis of 293 boys born between 1991 and 2003 undergoing hypospadias surgery was conducted. The study included 274 patients: 165 with distal, 34 with midshaft, and 75 with proximal hypospadias. Kaplan–Meier methods were used to evaluate the re‐operation data.ResultsThe median age at primary surgery was 1.3 years, with a median follow‐up of 14.4 years. The overall re‐operation rate was 48.2%, with approximately half of the problems detected within the first 3 months after surgery. The risk of re‐operation was correlated with hypospadias severity, with 5‐ and 15‐year re‐operation risks at 39.3% and 51.8%, respectively. Limitations of the study include its retrospective nature and variations in surgical techniques from current standards.ConclusionThere is a significant risk of unplanned re‐operations following hypospadias repair, increasing with the severity of the original condition. This underscores the need for extended follow‐up and effective communication with patients and their families about the likelihood of requiring multiple surgeries for optimal outcomes.

Introduction: Bladder augmentation is an option to protect kidneys and treat incontinence in frequent neurogenic and congenital non-neurogenic disorders. However, patients may need also other procedures to treat incontinence or to aid catheterizations. In addition, the patients are prone to complications.Objective: To evaluate complications or additional surgeries in augmentation cystoplasty according to the etiology of the bladder dysfunction. Study design: Data on additional surgical procedures related to bladder augmentation were collected from 128 patients who had undergone enterocystoplasty between 1990 and 2019, with a median age of 10.1 years (IQR 7.2-12.8) and a follow-up time of 11.8 years (IQR 5.7-18.6) after augmentation.Results: Eighty-three patients had a neurogenic disease, and 45 patients had a non-neurogenic disease. Bladder neck operations were performed either at the time of or after augmentation for 62 patients (48.4%), more commonly in the non-neurogenic than neurogenic group <0.01. In addition, continent stoma operations in 56 (36.8%) patients were more common in the non-neurogenic group (p < 0.01). Ten patients received kidney transplantation (four in the neurogenic, six in the non-neurogenic group); seven of these patients originally had dysplastic kidneys, two developed nephrological kidney disease, and one had hydronephrosis and renal insufficiency at the time of diagnosis of neurogenic bladder.Surgical problems resulting from bladder augmentation were treated in 28 patients (21.8%). The risk for surgical treatment because of complications was 4%, 17%, 24%, 27% and 27% at 1, 5, 10, 15 and 20 years follow up respectively. Complications were more common in patients in non-neurogenic than in patients with neurogenic group (p < 0.01). However, the greater proportion of continent stomas in non-neurogenic group explained the difference (Fig.). The most frequent complication requiring surgery during follow-up was bladder stones, which occurred in 24 (18.8%) patients. The first stone was treated at a median of 3.3 years (range 0.3-14.2) after augmentation. Stones were more common in patients with a continent stoma than without (p < 0.01). Other indications for surgical treatment were as follows: obstructive ileus in five patients, reduced bladder capacity in three patients, bladder perforation in two patients and lobulated bladder with infections in one patient.Conclusions: The risk for surgical treatment was about 27% in 20 year follow-up after bladder augmentation, because of augmentation related complications. The most prevalent complication was bladder stone, that was mainly associated with continent stomas. Continent stomas were most prevalent in patients with nonneurogenic diagnosis.

PURPOSE:To investigate the need and efficacy of treatment of bladder neck procedures in patients with neurogenic bladder and augmentation.METHODS:The hospital database was reviewed for patients undergoing enterocystoplasty because of neurogenic bladder during 1990-2019. Diagnoses of patients as well as frequency, type, and efficacy of treatment of sphincter insufficiency were evaluated.RESULTS:Thirty-seven of 87 patients (43%) underwent surgery because of sphincter insufficiency. The median age at bladder augmentation was 11.9 years (IQR 8.5-14.8), and at the last control, 21.8 years (IQR 18.9-31.1). Bladder neck injections (BNI) were performed for 28 patients, fascial sling operation for 14 patients, and bladder neck closure (BNC) was done for five females. Full continence was achieved in 10/28 (36%) patients with one or repeat BNIs and 9/14 (64%) with sling operation. The outcome of BNIs and sling operations was similar in both sexes. All five female patients with BNC became continent. At the end of follow-up, 64 (74%) patients were dry, 19 (22%) had occasional incontinence episodes, and 4 (5%) had daily incontinence episodes necessitating pads.CONCLUSIONS:Treatment of sphincter insufficiency is challenging in patients with bladder augmentation and neurogenic disease. Only 74% of our patients became fully continent despite treatments for sphincter insufficiency.

Background Retrovesical cysts present with varying etiologies. We initiated this study to provide insights into retrovesical cysts in boys through a case series and systematic literature review and to aid in treatment alternatives. Materials and methods Case series of seven patients from the in-hospital register with a systematic literature review on retrovesical cysts in children. Results We identified seven patients from the in-hospital register during 2005–2020 and eighty-two patients from the literature review. The literature review showed that children’s retrovesical cysts are mainly asymptomatic before puberty. Those detected earlier in childhood present mostly with renal abnormalities. In our series, retrovesical cysts derived from three distinct etiologies with different treatment modalities. Asymptomatic cysts do not need excision and are to be followed up through puberty, but in the case of an ectopic ureter, nephroureterectomy is optional. Symptomatic retrovesical cysts may demand surgical excision. Ultrasonography is usually sufficient for diagnosis, but MRI provides better anatomical delineation and aids in surgical planning. Conclusions Retrovesical cysts in boys are benign conditions associated with abnormal development of the ureter and kidney. Ultrasonography is sufficient for diagnosis, with MRI giving further detail for surgical planning. Treatment consists of cyst excision, heminephrectomy/nephrectomy, transurethral canalization, or excision of prostatic utricle, depending on etiology. Asymptomatic cases are to be followed up through puberty, but in cases of an ectopic ureter, nephroureterectomy is preferred.

(1) Background: This study investigated the introduction of pediatric robot-assisted pyeloplasty in a low-volume centre with reference to open pyeloplasty with regards to operative times, length of stay (LOS) and outcomes and cost analysis. (2) Methods: Data from 10 consecutive robot-assisted pyeloplasties was compared retrospectively to an age and weight matched cohort of open pyeloplasties operated on during two previous years. Operative times were analyzed in conjunction with LOS, outcomes and cost-analysis from patient records. (3) Results: Operative times remain longer in robot-assisted pyeloplasties (168 (IQR 68) vs. 141 (IQR 51) min), but patients are discharged from the hospital earlier and may return to daily activities earlier. In our hospital, the difference in LOS levels to some degree the cost difference between operations. (4) Conclusions: Robot-assisted pyeloplasty can be safely and economically introduced and maintained in a low-volume centre.