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Treatment of pilonidal sinus disease with conventional excision techniques is associated with recurrence up to 20 to 30% (primary closure) or with prolonged healing that might last months (closure by secondary intention). Endoscopic pilonidal sinus treatment (EPSiT) is gaining increasing popularity. This systematic review aims to summarize and evaluate the reported outcomes of pediatric EPSiT (PEPSiT) to date. Systematic search was performed for all studies on PEPSiT in patients younger than 18 years, pertaining to demographics, technique, and outcomes. Fisher's test was used to assess the associations between success/recurrence rates and different approaches (fistuloscope vs. cystoscope, different wound care protocols). A total of 320 patients (9 studies, 2018–2022) with a weighted mean age of 15.7 years and follow-up duration of 13.5 months were included. PEPSiT was successful in 290 patients (90.9%) with weighted mean time to healing of 4.1 weeks. Recurrence was reported in 29 patients (9.1%) with weighted mean time to recurrence of 4.6 months. Outcomes were not significantly altered by the use of fistuloscope versus pediatric cystoscope (p = 1.0), or with perioperative laser epilation (p = 0.06), or postoperative regular shaving, depilatory creams, light pulse, or laser (p = 0.31). The weighted mean operative time was 38 minutes and hospital stay was 16 hours. Summary of available evidence confirms that PEPSiT is safe and effective. Added to its noninvasiveness, PEPSiT's pooled outcomes appear superior to those of numerous conventional techniques. Comparison with conventional techniques, particularly off-midline flap and semi-closure procedures, is, however, lacking. The superiority of PEPSiT needs to be confirmed in future comparative studies, including cost–benefit analysis. [ABSTRACT FROM AUTHOR]

Surgical abnormalities of the adnexa in children and adolescents include a variety of ovarian and paraovarian lesions ranging from benign functional cysts to malignant tumors, torsion of the ovary and/or the fallopian tube, and adnexal infectious lesions ranging from salpingitis to tubo‐ovarian abscesses. Presentations vary from asymptomatic pelvic masses to acute abdomen, and some ovarian tumors might present with precocious puberty or virilization. Acute pain might be caused by hemorrhage or rupture of ovarian or paraovarian cysts, adnexal torsion or adnexal infection. Differential diagnosis of adnexal masses should include peri‐appendiceal abscess in all age groups, and endometriomas and ectopic pregnancy in adolescents. This review provides guidance on the differentiation between adnexal abnormalities, based on important clues from clinical assessment and diagnostic workup, and ultimately on the decision making about the need for surgery, its level of urgency, and the type of surgery to clinicians of all specialties involved in the care of young females. Synopsis: An overview of the most important aspects of the surgical disorders of adnexa in children and adolescents. [ABSTRACT FROM AUTHOR]

Obstructive vaginal and uterine anomalies including imperforate hymen, transverse vaginal septum, and vaginal and/or cervical atresia or aplasia, might rarely present in infancy or childhood with hydrocolpos and/or hydrometra but they usually go unrecognized until presentation with amenorrhea and hematocolpos and/or hematometra in puberty. They should always be included in the differential diagnosis of a suprapubic and/or introital mass; in the latter case, vaginal vascular malformations and vaginal tumors should also be considered. Uterovaginal aplasia typically manifests with amenorrhea in puberty and needs to be differentiated from complete androgen insensitivity syndrome and gonadal dysgenesis of genetic males. Uterine fusion anomalies usually present with fertility and/or obstetrical complications in adulthood. However, a unicornuate uterus with a blind rudimentary contralateral horn containing functioning endometrium, and didelphys or septate uterus with a deviating obstructive septum might present in childhood or puberty with sequelae related with secretions or menstrual retention. This review provides a collective account of the most clinically important information about vaginal and uterine anomalies in childhood and adolescence for clinicians involved in the care of young females with the aim to provide guidance in appropriate evaluation and management. Synopsis: An overview of the most important aspects of the surgical anomalies of the vagina and the uterus in children and adolescents. [ABSTRACT FROM AUTHOR]

Background: There is an endless debate on whether androgens mediate testis descent through developmental changes in the gubernacular or the cranial suspensory ligament. Objective: To investigate the relation of any possible morphologic changes in the genital mesentery, that is, the system of genital peritoneal folds including the gubernacular and cranial suspensory ligaments, with the event of testis non‐descent in rats prenatally exposed to the antiandrogen flutamide. Materials and methods: Time‐pregnant Sprague Dawley rats received flutamide (100 mg/kg/d) or vehicle subcutaneously on gestational days 16‐17. Flutamide‐treated male offspring (n = 67), and vehicle‐treated male (n = 34) and female (n = 28) offspring were surgically explored under microscope on postnatal day 50. Testicular position was examined bilaterally. Dimensions of genital mesentery parts were also assessed bilaterally. Association of flutamide‐induced morphologic changes with descended (n = 61) and undescended (n = 50; 33 cryptorchid and 17 ectopic) testes was investigated with logistic regression analysis. Results: The male genital mesentery comprised a cranial and a caudal fold converging on the vas deferens. Flutamide resulted in enlarged cranial and reduced caudal folds. Of all flutamide‐induced alterations, the increased length of the posterior fixation of the cranial fold and the decreased length of the gubernacular ligament of the caudal fold were found to independently increase the odds of testis non‐descent. Testicular ectopy, unlike cryptorchidism, was associated with a short gubernacular ligament only. The female genital mesentery consisted of a cranial fold only. Conclusion: Our findings showed a combined contribution of both cranial and caudal folds of the genital mesentery to testis non‐descent, through an abnormally long mesentery root and an abnormally short gubernacular ligament, respectively. Inhibition of male‐specific development of the genital mesentery with flutamide did not result in a feminized architecture. [ABSTRACT FROM AUTHOR]