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Objective: To assess the cumulative rates of re‐operations after hypospadias repair and evaluate long‐term surgical outcomes at a tertiary paediatric urology centre. Patients and Methods: Retrospective 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. Results: The 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. Conclusion: There 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. [ABSTRACT FROM AUTHOR]

To investigate the long-term functional outcomes and complications after continent cutaneous diversion with the Lundiana pouch. Patients and Methods Complications, re-operations, renal function, and continence were ascertained from patient charts. Outcome variables were validated by a second and independent review of the patient files. Results A complication of Clavien-Dindo grade ≥III, including unscheduled re-admissions, occurred in 45/193 patients (23%) at ≤90 days of surgery. At a median follow-up of 13 years, 105/193 patients (54%) had undergone at least one reoperation, with uretero-intestinal stricture being the most prevalent cause [28 patients (15%)]. Re-operations were more prevalent in patients operated during the first half of the study period than during the second half (2000-2007; 62% vs 47%; P = 0.03), and they were also more frequent in patients who underwent surgery for benign causes than in patients who underwent surgery for malignancy (60% vs 51%; P = 0.04). Continence was achieved in 172/188 patients (91%). In all, 16% of all patients required revisional surgery of the outlet to remain continent with an easily catheterisable pouch or to address stomal stenosis. The mean decrease in estimated glomerular filtration rate was more pronounced in patients with benign indications for urinary diversion than in those with malignancies, even after adjusting for younger age at surgery and longer follow-up in the former group (22 vs 11 mL/min/1.73 m2; P < 0.006). A disinterested third-party assessment revealed 10 postoperative complications, 17 reoperations during follow-up, and seven occasions of hospitalisation due to pyelonephritis (included in data above) not recorded at the primary data review. Conclusions The Lundiana pouch is associated with a high risk of reoperation, although the functional results are good. Independent review by a third party increased the validity of the outcome data. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the depth of transurethral resections of bladder tumour ( TURBT), residual cancer rates and up-staging rates in a contemporary Australian series. Materials and Methods Specimen reports from a single, major reporting pathology centre, servicing a group of urological oncologists in Sydney were obtained for TURBTs performed between October 2008 and February 2013. We examined the depth of TURBT, rates of repeat- TURBT (re- TUR) and residual cancer rates at the 3-6 month check cystoscopy. Results One thousand and two hundred and nine transurethral resection specimens retrieved during this period were analysed. There were 162 (13.4%) T1 specimens and 631 (52.2%) Ta specimens, 218 (34.5%) of which were high grade. Muscularis propria was present in 506 (41.9%) specimens in total and in 151 (39.7%) of 380 high-risk specimens (high grade Ta, T1). Of the 380 high-risk non-muscle-invasive tumours, 85 (22.4%) proceeded to re- TUR. Of the 48 T1 specimens and 37 Ta high grade specimens that proceeded to re- TUR, 7 (14.6%) and 1 (2.7%) respectively were upstaged to muscle-invasive disease. Rates of residual disease/early recurrence at 3-6 months was significantly better for those with re- TUR compared to those without 56.8% vs 82.5% ( P < 0.001) for Ta high grade and 39.6% vs 84% ( P = 0.028) for T1 tumours respectively. Conclusion Re- TUR rates in high-risk non-muscle-invasive bladder cancer are low. However in a contemporary series, the upstaging rates are low, but residual cancer rates high, supporting the need for re- TUR in this population. [ABSTRACT FROM AUTHOR]

Objective To determine the re-operation rate on the distal ureter after upper pole heminephrectomy with incomplete ureterectomy. Patients and methods The case notes from one institution were reviewed retrospectively; 60 upper pole heminephrectomies with incomplete ureterectomy were undertaken in 39 girls and 16 boys (mean age at primary surgery 27 months, range 3–88). Results Thirty-two children (58%) had an antenatal diagnosis while 12 (22%) presented with a urinary tract infection (UTI) and six (11%) with urinary incontinence. Twenty-nine of the 60 renal units (48%) had an associated ureterocele and in nine (15%) the ureter was ectopic. Ten infants (18%) underwent initial puncture of a ureterocele. Five patients (8%), all females, required lower urinary tract re-operation. The indications for secondary surgery were recurrent UTIs in all and a prolapsed ureterocele in one. All five had ultrasonographic evidence of a dilated ureteric stump. Reflux into the retained stump was detected in one child. Conclusions The re-operation rate for a redundant ureteric stump in this series was 8%. The risk of injury to the good ureter may outweigh the benefits of a complete ureterectomy. [ABSTRACT FROM AUTHOR]