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Summary Introduction Endoscopic laser-puncture or electrosurgical incision are the most commonly used minimaly invasive approaches for the treatment of the ureterocele. Both techniques are mainly successful in decompressing of ureteroceles, but the consequence of such treatment may be formation of de novo vesicoureteral reflux and febrile urinary tract infection which could impact the final results. Objective To compare outcomes of treatment of two endoscopic techniques used in management of neonatal patients with intravesical ureterocele. Study design A case records of 64 neonates who underwent endoscopic procedures for intravesical ureterocele, performed at our institution from January 2005 to January 2021, were retrospectively reviewed. The patients were divided in two groups depending on used endoscopic procedure. The first group (n = 41) consisted of patients who underwent electrosurgical incision of the ureterocele, while the second group (n = 23) consisted of patients in whom 6 to 8 laser-punctures of the ureterocele were performed. The groups were compared in regards to outcomes of treatment, with special emphasis on de novo vesicoureteral reflux and the need for further treatment and surgery. Results Median follow-up was 7.5 (IQR 3, 11.5) and 3.5 (IQR 1.5, 5) years in the electroincision and laser-puncture groups, respectively (P = 0.017). No significant differences between the groups in regards to medians of duration of surgery (12 min vs. 11 min, P = 0.670), length of hospital stay (2 days in both groups, P = 0.988) or postoperative obstruction (n = 1 vs. n = 0, P > 0.999) were recorded. Ureterocele decompression was achieved after endoscopic treatment in 87.9% and 100% of the patients in electrosurgery and laser-puncture groups, respectively (P = 0.150). Five patients (12.1%) from electrosurgery group required endoscopic retreatment. The laser-puncture group had a significantly decreased rate of de novo vesicoureteral reflux (8.7% vs. 58.5%; P = 0.0001) and lower incidence of subsequent surgery due to de novo vesicoureteral reflux (50% vs. 62.5%; P = 0.727). Conclusion Both electrosurgical incision and laser-puncture endoscopic techniques are safe and effective in relieving the obstruction. Laser-puncture technique is associated with significantly lower incidence of de novo vesicoureteral reflux and accordingly fewer invasive procedures for neonatal patients. Summary Table 1 . Treatment outcomes between the investigated groups. Group I Group II P Electroincision (n=41) Laser-puncture (n=23) Complications, n (%) 3 (7.2) 0 0.547 a Intraoperative 1 (2.4) 0 Postoperative 2 (4.8) 0 Endoscopic retreatment, n (%) 5 (12.1) 0 0.150 a De novo VUR, n (%) 24 (58.5 2 (8.7) Grade I 0 0 0.0001 a Grade II 0 1 Grade III 31 1 Grade IV 15 0 Grade V 6 0 a Fisher exact test.

Objective: The aim of this study was to compare the outcomes of high ligation in adolescents with varicocele between open and laparoscopic surgical approaches. Design: Retrospective study. Setting: The study was conducted from January 2012 to January 2018, with median follow-up of 36 months, in the division of pediatric surgery at tertiary- care hospital. Patients: Data of 537 adolescents who underwent varicocelectomy were classified into two groups, depending on surgical approach. Intervention: Open or laparoscopic varicocelectomy. Main outcome measures: Indications for surgery, complications, duration of surgery, hospital stay, and recurrences rate. Results: The median age of the patients was 15 years. The median (IQR) duration of surgery was 12 (11, 15.3) min in laparoscopic and 25 (10, 30) min in open group (P

Vesicoureteral reflux (VUR) is an abnormal movement of urine from the bladder into ureters or kidneys. It may present before birth as prenatal ureterohydronephrosis, an abnormal widening of the ureter, or with a urinary tract infection (UTI) or acute pyelonephritis. The International Reflux Grading system classifies VUR into 5 grades depending on the degree of retrograde filling and dilatation of the renal collecting system.1 Vesicoureteral reflux is estimated to occur in 1%–3% of children.1 Younger children are more prone to VUR because of the relative shortness of the submucosal ureters. In children with UTIs, the incidence of VUR is 29% in boys and 14% in girls.2 Although VUR is more common in boys antenatally, in later life there is a definite female preponderance with 85% of patients being female.1,2 Traditionally, if medical management with low-dose antibiotic prophylaxis failed, the only alternative was open surgery.3 In recent years, endoscopic subureteral transurethral injection (STING) has become a first-line therapy for children with VUR because of its high success rates and a very low incidence of complications.1,3–5 Since Matouschek’s initial description of the subureteral injection technique in 19816 and the first clinical series reported by O’Donnell and Puri in 1984,7 it has evolved into a therapeutic alternative to open surgery. Injectable agents, such as Teflon, bovine collagen and Macroplastique, have all been used; however, concerns about efficacy and safety have limited their use.1,3,8 Since the approval of dextranomer/hyaluronic acid copolymer (Deflux), endoscopic management of VUR has become an established alternative treatment in children.1,9 Both dextranomer and hyaluronic acid are biocompatible, which means that they do not cause clinically important reactions within the body. In fact, hyaluronic acid is produced and found naturally within the body.1,9 We present our results of endoscopic treatment using the subureteral Deflux injection (SDIN) for VUR in children at our institution.

PURPOSE: Testicular rupture is a very rare entity in children and adolescents. The aim of this study was to evaluate the outcomes of surgical repair after testicular rupture in children. METHODS: Between January 2000 and January 2010 seven patients were operated on because of testicular rupture. Mean age at the time of the accident was 15 years. In all patients, an emergency scrotal ultrasonography showed a rupture of the testicular capsule with a surrounding hematocele. Surgical exploration was performed to evacuate the hematocele and repair the ruptured testis. RESULTS: Mean follow-up was 4.9 years. Average hospital stay was 2 days. Mean time between surgery and the initial trauma was 35 h. There were no major complications. Control ultrasound imaging showed that the tunica was repaired and Doppler signal confirmed vascularity in all patients. There were no significant differences in size between the right and left testes. There were no recorded cases of testicular atrophy. Semen analysis showed normospermia 6 months after surgery and anti-sperm antibodies count was within normal limits in all patients. CONCLUSION: Prompt surgical intervention is crucial. Ruptured testis can be salvaged, with a high success rate, if surgical repair is performed within 72 h of testicular injury.