OBJECTIVE: To evaluate the clinical efficacy of indocyanine green near-infrared fluorescence (ICG-NIRF) imaging versus conventional surgery for assessing testicular viability and guiding decision-making in pediatric test...OBJECTIVE: To evaluate the clinical efficacy of indocyanine green near-infrared fluorescence (ICG-NIRF) imaging versus conventional surgery for assessing testicular viability and guiding decision-making in pediatric testicular torsion (TT). METHODS: A retrospective analysis was performed on 225 pediatric patients undergoing emergency scrotal exploration for TT between January 2019 and January 2025. Patients were categorized into a conventional surgery group (n = 118) relying on visual grading and an ICG-NIRF imaging group (n = 107). Primary outcomes included intraoperative testicular preservation rates and postoperative success rates. Multivariate Cox regression was utilized to identify factors influencing testicular preservation. RESULTS: Baseline characteristics were comparable between groups. The ICG-NIRF group demonstrated a significantly higher intraoperative preservation rate (74.77% vs. 61.02%, p = 0.028) and postoperative success rate (88.75% vs. 69.44%, p = 0.003) compared to the conventional group. Additionally, the ICG-NIRF group exhibited significantly lower rates of secondary orchiectomy (1.25% vs. 9.72%, p = 0.027) and 6-month testicular atrophy (7.59% vs. 23.08%, p = 0.02). Multivariate analysis confirmed ICG-NIRF application as an independent protective factor for testicular preservation (HR = 0.556, p < 0.001). CONCLUSION: ICG-NIRF imaging provides an objective, real-time assessment of testicular perfusion, significantly improving testicular preservation rates and postoperative outcomes. This technique overcomes the subjectivity of conventional visual methods, offering substantial clinical value for fertility preservation in pediatric TT.
BACKGROUND: The gubernaculum is essential for testicular descent, but its detailed surgical anatomy remains poorly understood. We have previously identified an unrecognized anatomy of the round ligament in female patient...BACKGROUND: The gubernaculum is essential for testicular descent, but its detailed surgical anatomy remains poorly understood. We have previously identified an unrecognized anatomy of the round ligament in female patients with sliding inguinal hernias. OBJECTIVE: This study investigated whether comparable anatomical features exist in the gubernaculum of male cryptorchidism patients, as compared to those identified in female sliding hernias. MATERIALS AND METHODS: We retrospectively analyzed undescended testes located in the inguinal canal that underwent open inguinal orchidopexy between 2016 and 2025. Laparoscopically managed nonpalpable testes and those with suprascrotal testes were excluded. To ensure consistent anatomical evaluation, a standardized surgical protocol supervised by the senior author was applied to all cases. Findings were verified using operative reports and video recordings. After dissecting the processus vaginalis along the internal spermatic fascia (transversalis fascia), the pars infravaginalis gubernaculi were exposed. The relationship between the plica gubernaculi and pars infravaginalis gubernaculi, as well as the site of distal gubernacular fixation, was assessed. RESULTS: A total of 64 undescended testes of 56 patients were included. Video recordings were available for 45 of these 64 testes (70%). A patent processus vaginalis was observed in 60 out of 64 testes (94%), while it was obliterated in two ascending testes and unknown in two. In all 64 testes (100%), the pars infravaginalis gubernaculi was not continuous with the plica gubernaculi, with the transversalis fascia interposed between them. This configuration closely resembled that described previously for sliding inguinal hernias in women. Distal gubernacular fixation was located lateral to the scrotum in 49 testes (77%), at the upper scrotal border in 14 testes (22%), and absent in one testis (1.6%). DISCUSSION: Cryptorchidism is associated with a previously unrecognized discontinuity of the gubernaculi and common abnormal distal gubernacular fixation. These findings challenge the conventional views on gubernacular invagination and suggest that abnormal distal fixation may contribute to failed testicular descent. The study was limited by its single-center, retrospective design, small sample size, and lack of a control group. CONCLUSION: This study identified a previously unrecognized discontinuity of the gubernaculi in cryptorchidism. These findings deepen the understanding of the pathophysiology of testicular descent.
INTRODUCTION: In adult populations, excess body weight has been associated with an increased risk of adverse clinical outcomes and mortality following kidney transplantation. In contrast, the influence of obesity on tran...INTRODUCTION: In adult populations, excess body weight has been associated with an increased risk of adverse clinical outcomes and mortality following kidney transplantation. In contrast, the influence of obesity on transplantation outcomes among pediatric populations is not yet fully understood. This study aimed to evaluate the association between pre-transplant excess weight and post-transplant outcomes in pediatric kidney transplant recipients. MATERIAL & METHODS: A systematic literature search was performed across PubMed, ScienceDirect, and the Cochrane Library, covering publications up to December 31, 2025. The quality of the included studies was evaluated using the ROBINS-E tool. Statistical analysis was conducted using Review Manager version 5.4. RESULTS: From a total of 1465 records screened, six studies that included 65,483 participants were selected in the meta-analysis. The results indicated that pre-transplant excess weight was significantly associated with an increased risk of acute rejection (OR = 1.09; P = 0.009), delayed graft function (OR = 1.17; P < 0.00001), 1-year graft failure (OR = 1.16; P = 0.0002), and 5-year graft failure (OR = 1.13; P = 0.009). Although 5-year mortality was also higher among recipients with excess weight, this association was not statistically significant (OR = 1.08; P = 0.11). CONCLUSION: Pediatric patients with pre-transplant excess weight had higher post-transplant odds of acute rejection, delayed graft function, and both 1-year and 5-year graft failure compared to those without excess weight. These findings highlight the importance of assessing and managing excess weight prior to kidney transplantation to help prevent adverse outcomes in the future.
Yan JH, Chang XF, Dong KR
… +15 more, Wang J, Qin H, Yang W, Xu M, Zhang YZ, Zhang JG, Wu YM, Zhao Q, Wang JF, Su Y, Gao J, Meng DG, Liu JC, Song HC, Wang HM
BACKGROUND: Synchronous multifocal bilateral Wilms tumor (mBWT) is rare. This study aimed to evaluate long-term outcomes in children with mBWT and to identify treatment-related risk factors for renal impairment. METHODS:...BACKGROUND: Synchronous multifocal bilateral Wilms tumor (mBWT) is rare. This study aimed to evaluate long-term outcomes in children with mBWT and to identify treatment-related risk factors for renal impairment. METHODS: Patients with synchronous mBWT were identified from a multicenter retrospective cohort. Multifocal disease was defined radiologically as the presence of more than two discrete nodules, each measuring >1 cm in diameter, in one or both kidneys before neoadjuvant chemotherapy (NAC). Survival outcomes and long-term renal function were assessed. Renal impairment was defined as an estimated glomerular filtration rate <90 mL/min/1.73 m. RESULTS: Fifty-six patients with mBWT were included. Ten patients (17.8%) underwent one-step bilateral surgery and (82.2%) underwent staged procedures. Overall, nephron-sparing surgery (NSS) was performed on 100 of 112 renal units (89.2%). After a median follow-up of 6 years, the 5-year overall survival (OS) and event-free survival (EFS) rates were 86.8% and 77.1%, respectively. No significant differences in OS or EFS were observed between patients treated with bilateral NSS and those treated with NSS + total nephrectomy (TN). Renal impairment occurred in 18 patients (32.1%), with 17 developing new-onset or progressive dysfunction during follow-up. Multivariable analysis identified one-step bilateral surgery and collecting system involvement requiring reconstruction as independent risk factors for renal impairment. CONCLUSION: In patients with synchronous mBWT, multifocality alone should not be considered an indication for TN. Staged bilateral NSS appears to be associated with less renal impairment than one-step bilateral surgery or TN + NSS.
BACKGROUND: Foetal megacystis (FM) may be associated with a wide range of conditions beyond posterior urethral valves (PUV). This study aimed to describe the outcomes of FM cases, excluding PUV, in order to better unders...BACKGROUND: Foetal megacystis (FM) may be associated with a wide range of conditions beyond posterior urethral valves (PUV). This study aimed to describe the outcomes of FM cases, excluding PUV, in order to better understand the long-term consequences of these conditions and improve prenatal counselling. METHODS: This retrospective multicentre study, conducted between 2009 and 2023, included pregnant women referred for suspected FM across three foetal medicine units. Patients with confirmed PUV, diagnosed either postnatally or through pathological examination following medical termination of pregnancy (MToP) or intrauterine foetal death (IUFD), were excluded. FM was defined as a longitudinal bladder diameter ≥7 mm between 10 and 14 gestational weeks (GW) or as an enlarged bladder that does not empty during examination for at least 40 min after 14 GW. Maternal information, ultrasound findings, genetic testing results, final diagnoses, and follow-up data were collected. Both MToP and IUFD cases were included. RESULTS: Among 170 referrals, 96 cases of FM without PUV were confirmed: 31 (32.3%) live-born children, 49 (51%) MToP, and 16 (16.7%) IUFD. Overall, 66/96 (68.75%) cases were referred during the first trimester. Earlier gestational age at diagnosis was strongly associated with poor outcomes (p < 0.001 overall; p = 0.004 for males), even after excluding MToP cases (p < 0.001). All IUFD cases involved first trimester diagnoses, with 12.5% showing chromosomal anomalies. MToP occurred after a first trimester diagnosis in 83.7% of cases. Among the 31 live-born infants, four were 46, XX foetuses: two had polymalformative syndromes responsible for neonatal deaths, one had transient urinary retention, and one had bilateral vesicoureteral reflux (VUR) requiring surgery. Among the 27 live-born male infants, one neonatal death occurred. Among the remaining 26, nine (34.6%) had no urinary issues, 12 (46%) had uni- or bilateral VUR, one (3.8%) had chronic intestinal pseudo-obstruction, one (3.8%) had a VACTERL syndrome, and three (11.5%) had neurogenic bladders, one of whom required kidney transplantation. In this subgroup, VUR was significantly associated with third trimester pelvicalyceal dilatation (p = 0.047). CONCLUSION: This 15-year retrospective analysis confirms the heterogeneous diagnoses and prognoses associated with FM when PUV are excluded. FM in females may indicate a poorer prognosis, while VUR is common in males. Detailed prenatal ultrasound findings may help distinguish cases with favourable outcomes from those with poorer prognosis. Postnatal imaging and renal assessment remain essential.
BACKGROUND: We hereby report ventral flap aided glans urethral disassembly (V- GUD), for a retracted coronal meatus due to glans dehiscence after a failed hypospadias repair. METHODS/TECHNIQUE: Children with subcoronal m...BACKGROUND: We hereby report ventral flap aided glans urethral disassembly (V- GUD), for a retracted coronal meatus due to glans dehiscence after a failed hypospadias repair. METHODS/TECHNIQUE: Children with subcoronal meatus following failed hypospadias repair underwent G-TIP during 2015-2019 and V-GUD during 2020-2024. For V-GUD perimeatal skin flap was marked; a stay stitch was placed to aid in distal urethral mobilisation; glans wings were raised; glans was further divided at 12 O' clock position; the mobilised urethra was anchored and glansplasty was done using 6-0 PDS sutures. An 8Fr silastic Foley's catheter was left indwelling for 7 days. Dressing and catheter were kept for 7-days. RESULTS: During the study 51 children underwent G-TIP while 46 underwent V-GUD. In G-TIP group there were 10/51 complications (4 fistulae, 4 stenosis and 2 glans dehiscence). This was significantly higher (Fishers p = 0.03) than that found in V-GUD group (2/46; 2 stenosis). Uroflowmetry showed bell-shaped curve in 42/46 who underwent V-GUD while only in 22/51 who underwent G-TIP (p = 0.001). Cosmesis was not significantly different between groups. CONCLUSION: V-GUD hypospadias repair is useful in advancing a retracted coronal meatus due to glans dehiscence after a failed hypospadias repair. Larger comparative studies with longer follow-up are warranted. IRB APPROVAL: IEC-NI/24/Feb/92/41.
INTRODUCTION: This study aimed to investigate the association between preoperative renal pelvis urine density (RPUD) measured on non-contrast computed tomography (CT) and the risk of postoperative infectious complication...INTRODUCTION: This study aimed to investigate the association between preoperative renal pelvis urine density (RPUD) measured on non-contrast computed tomography (CT) and the risk of postoperative infectious complications in pediatric patients undergoing retrograde intrarenal surgery (RIRS). METHODS: This multicenter retrospective cohort included 78 pediatric patients (aged 2-17 years, median 10) who underwent RIRS for renal stones. Demographic characteristics, stone features, and operative parameters were recorded. Patients were categorized into two groups based on the presence or absence of postoperative infectious complications, defined according to systemic inflammatory response syndrome criteria. RESULTS: Postoperative infection occurred in 9 patients (11.5%). The groups were similar in age, sex, and laterality, but upper calyceal stone location was more frequent in the infection group (p = 0.013). Stone volume was significantly higher in the infection group [938.3 mm (628.3-2387.6) vs. 571.8 mm (377.0-1026.3); p = 0.044], whereas stone density showed no difference. RPUD was markedly higher in the infection group [32 HU (23-32) vs. 11 HU (5-17); p < 0.001]. ROC analysis identified 20 HU as the optimal cut-off [AUC = 0.994 (95% CI: 0.980-1.000), sensitivity 100%, specificity 97.1%). Multivariable analysis revealed RPUD as the only independent predictor of infection (OR: 2.144, 95% CI: 1.200-3.831, p = 0.010). CONCLUSION: Elevated preoperative RPUD is strongly associated with postoperative infectious complications in pediatric RIRS. RPUD measurement on preoperative CT provides a simple, noninvasive, and highly accurate tool for infection risk stratification.
In bladder exstrophy (BE), the umbilical cord is attached to the superior edge of the bladder plate and is usually discarded, leaving patients without a visible umbilicus. We describe a technique that preserves the umbil...In bladder exstrophy (BE), the umbilical cord is attached to the superior edge of the bladder plate and is usually discarded, leaving patients without a visible umbilicus. We describe a technique that preserves the umbilical cord during primary BE repair to reconstruct a natural-appearing umbilicus without additional skin incisions. The preserved umbilical vein embedded in Wharton's jelly is passed retrogradely through a preperitoneal tunnel to a midline skin opening and secured to create a stable umbilical depression. In five neonates followed for a median of 5 years, all achieved stable cosmetic results with no technique-related complications or need for revision.