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Transition into adulthood is a common issue in many disciplines. However, urology faces additional difficulties due to different models of care and training as well as a wide diversity of pathologies. The goal of this paper is to discuss various aspects of the transition of urological care. This review provides some examples of pathologies that might require special attention of specialists. Most patients with rare diseases must be closely followed up in the long term. However, high-volume conditions may also have a huge impact on the well-being and quality of life in adulthood. Children who are cured due to oncological conditions will probably need additional attention in adulthood. The urological care during childhood is provided by a pediatric urologist, a pediatric surgeon or a urologist, depending on the local regulations and the organization of care. All patients are subsequently referred to a general urologist. Nowadays, a multidisciplinary approach is recommended in many cases, with a pediatric urologist as one of the team members. The patient, caregivers and healthcare professionals must be fully involved and focused on close cooperation to make the transition process smooth and successful.

Purpose: To describe experience with partial nephrectomy combined with brachytherapy as part of the local management of bilateral Wilms tumor (WT) including a review of the available literature.Results (methods and case description): Between 2011 and 2014, three highly selected patients (age nine months, 16 months, and 4 years) with bilateral WT (two synchronous and one metachronous) underwent enucleation and perioperative brachytherapy to the tumor bed. With a minimum follow-up of 5 years, all three patients are in continuous complete remission with preserved kidney function.Conclusions: Although nephron sparing surgery aiming at tumor free-margins remains the gold standard for bilateral WT, tumor enucleation followed by brachytherapy may be considered in carefully selected patients at high risk for end-stage kidney failure. Given the rarity and complexity of the procedure, concentration of care of such patients is mandatory.

Background. Distal penile hypospadias account for about 70% of all cases of hypospadias. There is a variety of operative techniques that could be performed when foreskin reconstruction is an option. The urethral stent is left in the urethra to prevent complications. Objectives. To determine whether the duration of stenting influences the healing of foreskin after distal hypospadias repair. Material and methods. Data from 2 institutions was retrospectively analyzed. Inclusion criteria were as follows: 1) a modified meatal advancement glanuloplasty without tubularization of the urethral plate, 2) foreskin reconstruction and 3) follow-up - 12 months. All other types of reconstruction and re-do procedures were excluded. The period of urethral stenting was determined intraoperatively depending on the surgeon's preferences. Mean age at operation was 23.3 months. The cohort was divided into 3 groups. In Group I (G-I), no catheter was left or it was removed the next day after surgery. In Group II, the catheter was left for more than 5 days. In those 2 groups, the surgery was done by different surgeons. Group III consisted of 35 patients who had a stent for

Summary Introduction Congenital Adrenal Hyperplasia (CAH) is the most common reason for undifferentiated genital appearance in new-borns. Psychosexual outcome in women with CAH has been rarely evaluated, but it seems to be one of the most important factors determining the indications for the surgical treatment of CAH. Objective This is to assess sexual function and the health status (HS) in adult females with CAH who had feminizing genitoplasty in childhood. Material and method The protocol was approved by the Ethical Committee, and the hospital database was searched for patients with CAH who had genitoplasty between 1975 and 2000. 57 adult patients were identified, and 9 (18%) patients agreed to participate in the study. Mean age at operation was 5.4 years, and mean follow-up duration was 10.9 years. The Female Sexual Function Index (FSFI) was used to evaluate sexual function, and the 36-item Short Form Health Survey (SF-36) was used to evaluate their health status (HS). A FSFI score Results All patients in the CAH group had female gender identity. One was homosexual, and one reported not having any sexual activity. In the control group, all patients had female gender identity. All were heterosexual and one reported not having any sexual activity. The sexual function in five domains and total score were similar in both groups. More pain was reported in the CAH group as compared with the control group, and it was statistically significant. In the CAH group, 5/9 patients had FSD. In the control group, 4/10 patients had FSD. The difference was statistically insignificant (p = 0.66). Mean SF-36 score in the CAH group was 47.1 points, while it was 46.7 points in the control group. The testosterone level in all CAH patients was within the normal range (0.13–1.1 ng/ml). The 17-OH progesterone level was above normal range in 5/9 (55.6%) patients with CAH. All women in the CAH group were hormonally treated. In the control group, all patients had a normal testosterone level (0.15–0.68 ng/ml); the 17-OH progesterone level was in normal range in this group. Discussion We compared our results with the literature data, which used the same questionnaires as in our study. Conclusions Health status and sexual function in the traceable CAH patients didn't differ from the control group. Summary Table . FSFI score comparison. FSFI domain Our study Fagerholm et al. Seyam et al. Lesma et al. Desire 4.2 4.0 3.2 4.2 Arousal 4.8 5.1 3.4 3.7 Lubrication 5.1 5,6 3.0 4.0 Orgasm 5.2 4.2 3.8 3.6 Satisfaction 5.2 4.9 2.2 3.7 Pain 4.0 4.7 3.2 4.4 Total FSFI score 27.2 28.7 18.6 23.3

Background Crossing vessels (CVs) are common in older children and adults with hydronephrosis but no gold standard exists on how to treat this condition. The final decision is made intraoperatively by the surgeon. Objectives To assess the outcome of the laparoscopic dismembered pyeloplasty with translocation of the CVs in children and adults. Material and methods Prospectively collected data from 3 departments was reviewed. Inclusion criteria were: 1) a transperitoneal laparoscopic approach; 2) dismembered pyeloplasty; and 3) the same operating pediatric urologist (RC) or urologist (TS). In the case of CVs, pyeloplasty with vessel transposition (children) or with cephalad translocation (adults) was performed. Forty-eight children and 41 adults met these criteria. Patients were divided into 4 groups: children with (group 1A) and without (group 1B) CVs, and adults with (group 2A) and without (group 2B) CVs. Any surgical reintervention at the uretero-pelvic junction (UPJ) was deemed a failure. Results The overall reintervention rate was 3/48 (6.25%) in children and 2/41 (4.9%) in adults (p > 0.05), and involved the following: 4 endopyelotomies and 1 redo pyeloplasty. Crossing vessels were identified in 28/48 (58%) children and 12/41 (29%) adults. The mean operation time was 152 min in group 1A and 161 min in group 2A (p > 0.5). Reintervention was needed in 2/28 patients in group 1A and in 1/12 patients in group 2A (p > 0.05). There was no difference in the failure rate between group 1A and group 1B, nor between group 2A and group 2B (p > 0.05). Conclusions Crossing vessels should be meticulously looked for during pyeloplasty in older children and adults. Dismembered laparoscopic pyeloplasty (LP) with dorsal transposition or cephalad translocation are comparable methods in terms of success rate for the treatment of UPJ obstruction in these patients.

Lower urinary tract symptoms (LUTS) in children is a frequent occurring problem, together with astma the most frequent disease at pediatric age. For many children LUTS is a chronic condition with a major impact on the quality of life. Adequate treatment is needed and useful to enhance quality of life, prevent LUTS at later age and protect the upper urinary tracts in case of co-existing vesico-ureteric reflux. The advice to wait and see is outdated This manuscript tries to give an overview of the current management of LUTS in children.

Background Prevalence of lower urinary tract dysfunction (LUTD) in children is between 6 and 9% with urinary incontinence (UI) being one of the most common symptom. Various aspects of lower urinary tract symptoms (LUTS) Anatomical anomalies of the urinary tract as well as neurogenic underlying pathology can results in LUTS. Comorbidities and long-term consequences of the LUTD for the female patients as well as genetic issues are also briefly discussed. The role of the bladder neck Thanks to urodynamics, we have learnt a lot about the lower urinary tract function, but the role of the bladder neck in the pathophysiology of LUTS in children is not clear. Secondary bladder neck hypertrophy is a well-described pathology, but there is no standardized treatment for this phenomenon. Primary bladder neck dysfunction has already been defined by the International Children’s Continence Society. Refractory UI in girls Uniform diagnostic protocols are used in these girls with UI. Treatment consists of standard urotherapy, additional interventions, and pharmacotherapy in selected cases. Those with refractory UI require careful reassessment to look for the unrecognized disorders. Invasive urodynamics should be done in those patients. Ultrasound of the bladder neck region and the pelvic floor can be helpful, but its interpretation is very subjective. In a small group bladder neck insufficiency can be found and those might benefit from a surgical intervention. Future perspective Strict criteria of the bladder neck insufficiency in children must be defined. Early surgical intervention in girls with bladder neck insufficiency might reduce the long period of intensive conservative treatment.

Minimal invasive surgery (MIS) has developed tremendously during the last 20 years. Nowadays, a wide spectrum of ablative and reconstructive procedures in urology can be done in adults as well as in children. MIS has been proven to be a safe and effective technique regardless of the age of a patient, provided it is done by a well prepared team. MIS has its disadvantages and limitations. In this article the differences between adults and children in different aspects of MIS are described. The current status of MIS in paediatric urology is provided. The authors show their own experience in laparoscopic surgery for the treatment of congenital and acquired anomalies of the urogenital tract. The future of MIS in paediatric urology is briefly discussed. Proper training is crucial to reduce the complication rate and to improve the results. The numbers of laparoscopic procedures in childhood are relatively low. Therefore, there is a need for concentration of the MIS care to ensure surgeons’ exposition to higher volumes, which can improve the quality of care.

To present an overview of the clinical presentation and pathological anatomy, and the results of surgical correction of 7 cases of epispadias with intact prepuce; a rare condition that has only occasionally been reported in literature. A retrospective search was performed in the surgical and diagnoses database between 1991 and 2011. Seven cases of epispadias with intact prepuce were identified. Five presented as a webbed and buried penis, 1 as phimosis and 1 with suspicion for congenital anomaly of the genitalia. In 3 of 7 cases, epispadias was suspected or diagnosed at first presentation and could be surgically corrected in the first intervention. In the other 4 cases, epispadias was discovered during surgery, requiring an additional intervention to perform epispadias repair in 3 cases. One boy was diagnosed with glandular, 3 with coronal, 1 with shaft and 2 with penopubic epispadias. Epispadias repair was successful with regard to cosmesis and erectile function. Five patients developed normal continence after surgery, 1 after intensive urotherapy. An under average penile length was the main reported problem during follow-up. In the diagnostic process for a concealed penis, the possibility of epispadias should be considered. If epispadias is suspected or confirmed, epispadias repair can occur in the first intervention, reducing the number of additional interventions. Epispadias with intact prepuce appears to have a better prognosis concerning urinary continence compared to classical epispadias

Renal damage and renal failure are among the most severe complications of spina bifida. Over the past decades, a comprehensive treatment strategy has been applied that results in minimal renal scaring. In addition, the majority of patients can be dry for urine by the time they go to primary school. To obtain such results, it is mandatory to treat detrusor overactivity from birth onward, as upper urinary tract changes predominantly start in the first months of life. This means that new patients with spina bifida should be treated from birth by clean intermittent catheterization and pharmacological suppression of detrusor overactivity. Urinary tract infections, when present, need aggressive treatment, and in many patients, permanent prophylaxis is indicated. Later in life, therapy can be tailored to urodynamic findings. Children with paralyzed pelvic floor and hence urinary incontinence are routinely offered surgery around the age of 5 years to become dry. Rectus abdominis sling suspension of the bladder neck is the first-choice procedure, with good to excellent results in both male and female patients. In children with detrusor hyperactivity, detrusorectomy can be performed as an alternative for ileocystoplasty provided there is adequate bladder capacity. Wheelchair-bound patients can manage their bladder more easily with a continent catheterizable stoma on top of the bladder. This stoma provides them extra privacy and diminishes parental burden. Bowel management is done by retrograde or antegrade enema therapy. Concerning sexuality, special attention is needed to address expectations of adolescent patients. Sensibility of the glans penis can be restored by surgery in the majority of patients. Electronic supplementary material The online version of this article (doi:10.1007/s00467-008-0780-7) contains supplementary material, which is available to authorized users.

All patients were treated with clean intermittent catheterisation (CIC), antimuscarinic agents, and antibiotic chemoprophylaxis from birth onwards in order to prevent obstructive uropathy and to preserve renal function. To secure low intra-vesical pressure, antimuscarinic agents were administered (oxybutynin, sometimes replaced by tolterodine if necessary). If conservative management failed a sling and (auto) augmentation was offered. Our definition of 'continent' is when a patient can retain urine and can void normally. Our definition of 'dry' is when a patient is on catheterisation without requiring pads.

Annual Meeting of the Society for Research into Hydrocephalus and Spina Bifida Meeting