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A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Surgery".

Deadline for manuscript submissions: closed (20 November 2021) | Viewed by 28582

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Prof. Dr. Giovanni Cobellis

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Department of Pediatric Surgery, University Politecnica of Marche, Ospedale Pediatrico G. Salesi, AOU delle Marche, Via Filippo Corridoni, 11, 60123 Ancona, AN, Italy
Interests: pediatric surgery; laparoscopic surgery; robot-assisted surgery
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Special Issue Information

Dear Colleagues,

Pediatric urology has been developed by many pediatric urologists and pediatric surgeons from all over the world. This Special Issue on Urology in Pediatrics focuses primarily on open and endoscopic surgical techniques. The most noteworthy advance in pediatric urology has been the development of minimally invasive surgery, including endourology, laparoscopy, retroperitoneoscopy, and robotic surgery, which have the advantages of reducing postoperative pain, improving the cosmetic results, and reducing the time of postoperative hospitalization. The authors are invited to discuss the state-of-the-art knowledge on the main pediatric urology techniques, based on literature review and their clinical experience.

Dr. Giovanni Cobellis
Guest Editor

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Keywords

pediatric urology
pediatric surgery
minimally invasive surgery
endourology
laparoscopy
retroperitoneoscopy
robotic surgery

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Published Papers (10 papers)

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Editorial

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3 pages, 143 KiB

Open AccessEditorial

Urology in Pediatrics

by Giovanni Cobellis

Children 2022, 9(3), 337; https://doi.org/10.3390/children9030337 - 2 Mar 2022

Cited by 1 | Viewed by 1382

Abstract

Pediatric urology has been developed by many pediatric urologists and pediatric surgeons from all over the world [...] Full article

(This article belongs to the Special Issue Urology in Pediatrics)

Research

Jump to: Editorial, Other

11 pages, 553 KiB

Open AccessEditor’s ChoiceArticle

Is Vesicostomy Still a Contemporary Method of Managing Posterior Urethral Valves?

by Aybike Hofmann, Maximilian Haider, Alexander Cox, Franziska Vauth and Wolfgang H. Rösch

Children 2022, 9(2), 138; https://doi.org/10.3390/children9020138 - 21 Jan 2022

Cited by 7 | Viewed by 3390

Abstract

In boys with posterior urethral valves (PUVs) the main treatment aim is to preserve long-term bladder and renal function. To determine the effectiveness of secondary vesicostomy in boys with PUVs, the medical records of 21 patients with PUV (2010–2019), divided into two groups (group I: valve ablation; group II: secondary vesicostomy), were reviewed regarding the course of serum creatinine, renal ultrasound, voiding cystourethrogram, urodynamics, postoperative complications, need of further surgery, and long-term solution. The median age of all patients at first follow-up was 11 (9–13) months and at last follow-up 64.5 (39.5–102.5) months. Despite a significant difference of the SWDR score (shape, wall, reflux, and diverticula) (p = 0.014), both groups showed no significant differences preoperatively. Postoperatively, serum creatinine (p = 0.024), grade of vesicoureteral reflux (p = 0.003), side of upper tract dilatation (p = 0.006), side of megaureter (p = 0.004), and SWDR score (p = 0.002) were significantly decreased in group II. Postoperative urodynamic measurements showed comparable results in both groups. Stoma complications were found in three (20%) patients (group II). Eight (53.3%) patients already received a closure of the vesicostomy. Seven out of eight (87.5%) patients were able to micturate spontaneously. Vesicostomy remains a reliable treatment option for boys with PUV to improve bladder function and avoid further damage to the urinary tract. Full article

(This article belongs to the Special Issue Urology in Pediatrics)

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10 pages, 853 KiB

Open AccessArticle

The Effect of Subcutaneous and Intraperitoneal Instillation of Local Anesthetics on Postoperative Pain after Laparoscopic Varicocelectomy: A Randomized Controlled Trial

by Zenon Pogorelić, Tea Gaberc, Miro Jukić, Goran Tintor, Ana Nevešćanin Biliškov, Ivana Mrklić and Ana Jerončić

Children 2021, 8(11), 1051; https://doi.org/10.3390/children8111051 - 13 Nov 2021

Cited by 7 | Viewed by 3084

Abstract

Background: The main goal of the present randomized clinical trial was to investigate the effects of subcutaneous administration of two different local anesthetics at trocar incision sites at the abdominal wall in combination with intraoperative intraperitoneal instillation of local anesthetics, on the character of postoperative pain, in adolescents who underwent laparoscopic varicocelectomy. Methods: A total of 60 patients with a median age of 16 years, who received laparoscopic varicocele repair, were included in this randomized clinical trial. The patients were randomly assigned to three study groups receiving 2% lidocaine, 0.5% levobupivacaine, or the control group. The Visual Analogue Scale (VAS) was used by a blinded nurse at four different time points (2, 6, 12 and 24 h after the surgery) to measure pain intensity. Results: The significant effect of time on the pain intensity (p = 0.001) was found. Additionally, the interaction between time and different local analgesics (p < 0.001) was observed. In patients in whom 0.5% levobupivacaine has been used, significantly lower VAS pain scores were recorded at each time point assessed, in comparison with the patients who received 2% lidocaine or the patients from the control group in whom no local anesthetic was applied (p < 0.001). Furthermore, in patients in whom 2% lidocaine was administrated, significantly lower pain levels according to VAS were reported than in those from the control group, except for the time point at 24 h after surgery when pain levels were comparable. Concerning the postoperative pain control, the number of patients who requested oral analgesics postoperatively was significantly lower in the group of patients in whom local anesthetic was administrated intraoperatively (2% lidocaine—n = 4, 20%; 0.5% levobupivacaine—n = 1, 5%) compared to the patients who did not receive any local anesthetic during the surgery (n = 13; 65%) (p < 0.001). Conclusion: A significant reduction in postoperative pain intensity and analgesics consumption in patients undergoing laparoscopic varicocelectomy who received intraoperative local anesthetic was observed. The best effect on postoperative pain intensity, according to the VAS score, was achieved by 0.5% levobupivacaine. Full article

(This article belongs to the Special Issue Urology in Pediatrics)

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7 pages, 224 KiB

Open AccessArticle

Bladder Dysfunction and Re-Absorbable Bulking Agent Affect Success Rate in Children Underwent Endoscopic Treatment for Vesicoureteral Reflux: A Long-Term Follow-Up Study

by Raffaella Cocomazzi, Alessia Salatto, Vittoria Campanella, Valentina Pastore, Cosetta Maggipinto, Gabriella Aceto and Fabio Bartoli

Children 2021, 8(10), 875; https://doi.org/10.3390/children8100875 - 1 Oct 2021

Cited by 2 | Viewed by 1578

Abstract

This paper is designed to evaluate the results (at long-term follow-up of) children affected by dilating VUR. Our attention was focused on how VUR grade, laterality, bladder dysfunction (BD), the double renal system, and the type of bulking substance may affect VUR resolution in the long-term period. The charts of 93 children with dilating VUR who underwent endoscopic treatment (ET) and with a minimum post-operative follow-up of 7 years were reviewed (mean follow-up time was 9.6 + 1.4). The majority of patients had severe and bilateral VUR. Polydimetilsiloxane or hyaluronic acid/dextranomer (PDS or Ha/Dx) were used as bulking agents. VUR persistence following endoscopic injection was independent with respect to grade, laterality, duplex renal system, and BD. However, the rate of VUR persistence was significantly higher in children with BD. Children treated with Ha/Dx had a higher rate of VUR persistence. This research demonstrated that ET of VUR is also effective at very long term follow up (and without the development of significant complications). We also showed that patients treated with absorbable bulking agents such as Ha/Dx may experience a higher recurrence rate at the long-term follow-up). We also confirm that the only preoperative condition affecting VUR recurrence was bladder dysfunction. Full article

(This article belongs to the Special Issue Urology in Pediatrics)

9 pages, 456 KiB

Open AccessArticle

The Utilization of an Opioid-Free Anesthetic for Pediatric Circumcision in an Ambulatory Surgery Center

by Laura E. Gilbertson, Chhaya Patel, Shuvro De, Wendy Lo, Michael Garcia-Roig and Thomas M. Austin

Children 2021, 8(8), 678; https://doi.org/10.3390/children8080678 - 3 Aug 2021

Cited by 8 | Viewed by 2512

Abstract

Circumcision is one of the most common urologic procedures performed at pediatric ambulatory centers. Emerging data on the short- and long-term effects of perioperative opioid administration has highlighted the importance of an opioid-free anesthetic regimen. We sought to evaluate the effectiveness of an opioid-free anesthetic in pediatric circumcision and its correlation with ambulatory surgery center efficiency. Patients, 3 years of age and younger, who underwent circumcision or circumcision revision by two surgeons pre and post introduction of an opioid-free anesthetic fast-track regimen at an outpatient surgical center were included. There were 100 patients included in this analysis, with 50 patients in each cohort. On univariate analysis, fast-tracking was associated with a decrease in median combined in-room and post-anesthesia care unit times (102.5 vs. 129.0 min, p-value < 0.001). This difference continued after multivariable analysis with an adjusted median combined in-room and post-anesthesia care unit time difference of −15.6 min (95% CI −34.2 to −12.7 min, p-value 0.018). In addition, the fast-track cohort received less intraoperative morphine equivalents without an increase in post-operative analgesic administration or change in postoperative questionnaire score. This demonstrates that opioid-free anesthesia may be used effectively in pediatric circumcision while also allowing for significant time savings for surgical centers. Full article

(This article belongs to the Special Issue Urology in Pediatrics)

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11 pages, 5527 KiB

Open AccessEditor’s ChoiceArticle

Pyelonephritis in Pediatric Uropathic Patients: Differences from Community-Acquired Ones and Therapeutic Protocol Considerations. A 10-Year Single-Center Retrospective Study

by Giovanni Parente, Tommaso Gargano, Stefania Pavia, Chiara Cordola, Marzia Vastano, Francesco Baccelli, Giulia Gallotta, Laura Bruni, Adelaide Corvaglia and Mario Lima

Children 2021, 8(6), 436; https://doi.org/10.3390/children8060436 - 23 May 2021

Cited by 19 | Viewed by 2961

Abstract

Pyelonephritis (PN) represents an important cause of morbidity in the pediatric population, especially in uropathic patients. The aim of the study is to demonstrate differences between PNs of uropathic patients and PNs acquired in community in terms of uropathogens involved and antibiotic sensitivity; moreover, to identify a proper empiric therapeutic strategy. A retrospective study was conducted on antibiograms on urine cultures from PNs in vesicoureteral reflux (VUR) patients admitted to pediatric surgery department and from PNs in not VUR patients admitted to Pediatric Emergency Unit between 2010 and 2020. We recorded 58 PNs in 33 patients affected by VUR and 112 PNs in the not VUR group. The mean age of not VUR patients at the PN episode was 1.3 ± 2.6 years (range: 20 days of life–3 years), and almost all the urine cultures, 111 (99.1%), isolated Gram-negative bacteria and rarely, 1 (0.9%), Gram-positive bacteria. The Gram-negative uropathogens isolated were Escherichia coli (97%), Proteus mirabilis (2%), and Klebsiella spp. (1%). The only Gram-positive bacteria isolated was an Enterococcus faecalis. As regards the antibiograms, 96% of not VUR PNs responded to beta-lactams, 99% to aminoglycosides, and 80% to sulfonamides. For the VUR group, mean age was 3.0 years ± 3.0 years (range: 9 days of life–11 years) and mean number of episodes per patient was 2.0 ± 1.0 (range: 1–5); 83% of PNs were by Gram-negatives bacteria vs. 17% by Gram-positive: the most important Gram-negative bacteria were Pseudomonas aeruginosa (44%), Escherichia coli (27%), and Klebsiella spp. (12%), while Enterococcus spp. determined 90% of Gram-positive UTIs. Regimen ampicillin/ceftazidime (success rate: 72.0%) was compared to ampicillin/amikacin (success rate of 83.0%): no statistically significant difference was found (p = 0.09). The pathogens of PNs in uropathic patients are different from those of community-acquired PNs, and clinicians should be aware of their peculiar antibiotic susceptibility. An empiric therapy based on the association ampicillin + ceftazidime is therefore suggested. Full article

(This article belongs to the Special Issue Urology in Pediatrics)

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11 pages, 3043 KiB

Open AccessArticle

Uretero-Pelvic Junction Stenosis: Considerations on the Appropriate Timing of Correction Based on an Infant Population Treated with a Minimally-Invasive Technique

by Mario Lima, Niel Di Salvo, Andrea Portoraro, Michela Maffi, Giovanni Parente, Vincenzo Davide Catania and Tommaso Gargano

Children 2021, 8(2), 107; https://doi.org/10.3390/children8020107 - 4 Feb 2021

Cited by 5 | Viewed by 2232

Abstract

There is no univocal consensus about timing of intervention and best surgical approach for infants with asymptomatic uretero-pelvic junction obstruction (UPJO). We conducted a retrospective analysis of patients undergoing one-trocar-assisted pyeloplasty (OTAP) in a 13 year range period by creating two homogenous groups (indications for surgery were the same for all patients): patients operated on in the first 90 days of life (34 patients; Group 1) and patients operated on between 3 and 12 months of life (34 patients; Group 2). We observed no statistically significant differences between groups in regard to mean operative time, conversion rate to open surgery, mean hospital stay, early complications (urinary leakage) rate and mean antero-posterior diameter (APD) reduction rate. Moreover, no statistical improvement was seen between groups in regard to separate renal function (SRF) at 1-year-follow-up renogram. Thanks to the HSS calculated before and 1 year after surgery, we registered an important improvement in Group I patients (p = 0.023). In our study, there was no significant evidence, in terms of intraoperative data and early postoperative outcomes, between patients who underwent an early pyeloplasty and those who underwent a delayed correction. Nevertheless, we registered a significant improvement in those patients with an impaired SRF that underwent an early surgical correction, especially in terms of urinary flow. Even though this study cannot definitely establish the superiority of early timing of correction, it is evident that further research is needed to clarify this aspect. Full article

(This article belongs to the Special Issue Urology in Pediatrics)

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11 pages, 2105 KiB

Open AccessSystematic Review

De Novo Vesicoureteral Reflux Following Ureterocele Decompression in Children: A Systematic Review and Meta-Analysis Comparing Laser Puncture versus Electrosurgical Incision Techniques

by Sachit Anand, Tanvi Goel, Apoorv Singh, Nellai Krishnan, Prabudh Goel, Devendra Kumar Yadav and Minu Bajpai

Children 2022, 9(1), 10; https://doi.org/10.3390/children9010010 - 24 Dec 2021

Cited by 4 | Viewed by 2651

Abstract

Background: The available endoscopic techniques for ureterocele decompression include laser puncture (LP), electrosurgical incision (ES), and cold-knife incision. This systematic review was performed to compare the efficacy of LP versus ES techniques with special emphasis on de novo VUR. Methods: Four databases were systematically searched by the authors. The inclusion criteria were all comparative studies in which ureterocele decompression was performed by either LP or ES endoscopic techniques. Outcomes including the incidence of de novo VUR, the need for endoscopic retreatment of the ureterocele, and the need for secondary surgical procedures were studied. Risk ratios (RR) were calculated for all outcomes and the Mantel-Haenszel method was utilized for the estimation of pooled RR. The methodological quality was assessed by the Downs and Black scale. Results: Five studies were considered for systematic review, while four of them were included in the meta-analysis. Out of 202 children, 67 developed de novo VUR. Significantly lower rates of reflux were observed in the LP group vis-a-vis ES group (RR = 0.17, 95% CI 0.09 to 0.32, p < 0.00001). Endoscopic retreatment rates (n = 20) demonstrated no significant difference among the two patient groups (RR = 0.66, 95% CI 0.26–1.68, p = 0.38). A total of 46 secondary procedures were performed in 170 children, mostly ureteral re-implantations, with a significantly lower need of secondary surgeries following LP versus ES (RR = 0.26, 95% CI 0.13–0.49, p < 0.0001). The risk of bias in the included studies was low-to-moderate. Conclusions: When compared to the ES technique, the LP technique is associated with a significantly low incidence of de novo VUR and requirement for secondary surgeries (particularly anti-reflux surgeries). Endoscopic retreatment rates showed no significant difference between the two techniques. However, due to the moderate risk of bias in two out of four included studies, randomized controlled trials are needed in the future. Full article

(This article belongs to the Special Issue Urology in Pediatrics)

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8 pages, 1578 KiB

Open AccessBrief Report

Prolonged Indwelling Urethral Catheterization as Minimally Invasive Approach for Definitive Treatment of Posterior Urethral Valves in Unstable Premature Babies

by Silvia Ceccanti, Daniela Pepino, Antonella Giancotti, Ester Ricci, Silvia Piacenti and Denis A. Cozzi

Children 2021, 8(5), 408; https://doi.org/10.3390/children8050408 - 18 May 2021

Cited by 1 | Viewed by 4789

Abstract

Premature newborns with posterior urethral valves (PUV) may present with medical conditions taking priority over definitive surgical care. We encountered three of such cases who underwent initial bladder decompression via transurethral catheterization and waited 2–3 weeks until they were fit enough for voiding cysto-urethrography to confirm PUV. An unexpected good urinary flow and negligible residual urine volume were documented during micturition, suggestive of valve disruption induced by insertion and prolonged duration of indwelling urethral catheter drainage. Cystoscopy documented non-obstructing remnant leaflets. Non-operative treatment may be considered as a viable alternative therapeutic option for PUV in tiny babies facing prolonged intensive care unit stay. Full article

(This article belongs to the Special Issue Urology in Pediatrics)

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8 pages, 20154 KiB

Open AccessCase Report

Detubularized Ureterosigmoidostomy for the Creation of Continent Neobladder in Children: Cases Report and Review of the Literature

by Edoardo Bindi, Michele Ilari, Giovanni Torino, Francesca Mariscoli, Fabiano Nino, Giovanni Cobellis and Ascanio Martino

Children 2021, 8(4), 279; https://doi.org/10.3390/children8040279 - 5 Apr 2021

Cited by 3 | Viewed by 2615

Abstract

Introduction: To report our experience in continent urinary diversions, we describe two cases we treated performing detubularized ureterosigmoidostomy. In children, in the case of malformations or neoplastic diseases affecting the bladder, the need for a cystectomy is not so frequent. When cystectomy becomes mandatory, there is a need to create a continent bladder diversion. Mainz pouch II and Cologne pouch are procedures that utilize a detubularized sigma as a reservoir in order to build up a continent neo-bladder. Materials and methods: This is a retrospective study performed at the Pediatric Surgical Unit of the Salesi Children’s Hospital. In this work, we reviewed data about two patients who underwent surgery for the creation of a sigmoid neo-bladder by the Mainz pouch II and Cologne pouch techniques. Results: In our experience, we treated a girl who was affected by a bladder’s rabdomiosarcoma and a girl born with a bladder exstrophy and treated at birth abroad. In both patients, a complete cystectomy was performed and a continent neo-bladder was created by a detubularized ureterosigmoidostomy. In the first case, we performed the Mainz pouch II technique and in the second, the Cologne pouch technique. Discussion: Different techniques have been developed with the main goal of the creation of an orthotopic neo-bladder, which has to be a low pressure reservoir with a continent sphincteric mechanism. Detubularized ureterosigmoidostomy is a good choice in pediatric patients. Our study, according to other works, shows that these procedure are safe with good long-term outcomes. Full article

(This article belongs to the Special Issue Urology in Pediatrics)

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