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Research has been conducted on the substituted 9,10-dihydro-9,10-[1,2]benzenoanthracene-1,4,5,8-tetrones. The results of their synthesis and the study of their antimalarial and anticancer activity are presented.

Prenatal hydronephrosis is one of the most common anomalies detected on prenatal ultrasonography. Patients with prenatal hydronephrosis and ureteral dilation are at increased risk of urinary tract infection (UTI) and continuous antibiotic prophylaxis (CAP) is recommended. However, current guidelines do not define the minimum ureteral diameter that would be considered a dilated ureter in these patients. We evaluate the definition of clinically relevant hydroureter, its association with UTI, and the impact of CAP. Patients with prenatal hydronephrosis from seven centers were enrolled into the Society for Fetal Urology Prenatal Hydronephrosis Registry from 2008 to 2020. Patients with ureteral measurement on ultrasound were included. Patients with ureterocele, ectopic ureter, neurogenic bladder, posterior urethral valves, horseshoe or solitary kidney, known ureteropelvic junction obstruction, or follow-up less than one month were excluded. Primary outcome was UTI. Analyses were performed using Cox regression. Of the 1406 patients enrolled in the registry, 237 were included. Seventy-six percent were male, ureteral diameter ranged from 1 to 34 mm, and median follow-up was 2.2 years. Patients with ureters 7 mm or greater had nearly three times the risk of UTI adjusting for sex, circumcision status, antibiotic prophylaxis and hydronephrosis grade (HR = 2.7, 95% CI: 1.1–6.5, p = 0.03; Figure). In patients who underwent voiding cystourethrogram (VCUG; 200/237), ureteral dilation of 7 mm or more identified patients at increased UTI risk controlling for sex, circumcision status, vesicoureteral reflux and hydronephrosis grade (HR = 2.3, 95% CI: 0.97–5.6, p = 0.06). CAP was significantly protective against UTI (HR = 0.50 (95% CI: 0.28–0.87), p = 0.01). Among patients who underwent VCUG and did not have vesicoureteral reflux, ureteral dilation 7 mm or greater corresponded with higher UTI risk compared to ureteral diameter less than 7 mm on multivariable analysis (HR = 4.6, 95% CI: 1.1–19.5, p = 0.04). This is the first prospectively collected, multicenter study to demonstrate that hydroureter 7 mm or greater identifies a high-risk group for UTI who benefit from antibiotic prophylaxis. In contrast, patients with prenatal hydronephrosis and non-refluxing hydroureter less than 7 mm may be managed more conservatively. [Display omitted] [ABSTRACT FROM AUTHOR]

Purpose: Percutaneous stone surgery can be challenging in spina bifida (SB) patients due to their body habitus and spinal cord anomalies. A safe surgical approach may necessitate acceptance of lower stone-free (SF) rates. We seek to determine if anatomic complexity, as measured by spinal cord curvature and torso length, is associated with SF rates after percutaneous stone surgery in SB patients. We hypothesize that increasing anatomic complexity is associated with lower SF rates following percutaneous stone surgery. Methods: We retrospectively reviewed all cases of percutaneous nephrolithotomy (PCNL) and percutaneous cystolitholapaxy (PC) in patients with SB at our institution. We calculated individual Cobb angles for scoliosis and kyphosis and measured torso lengths to serve as surrogates of anatomic complexity. These parameters were used to test for associations between anatomic complexity and SF rates. Results: A total of 32 procedures were analyzed (15 PCNL, 17 PC). SF rates for PCNL and PC were 60% and 71%, respectively. For both the PCNL and PC cohorts, there was no difference in age, preoperative stone burden, body mass index, operative time, or estimate blood loss between patients deemed SF or not stone free (NSF) after a single procedure. In the PCNL cohort, worsening scoliosis (higher Cobb angle) and lower SF rates trended toward statistical significance (43° vs. 24°, p = 0.058). In the PC cohort, increasing torso length was associated with lower SF rates (34.1 vs. 28.5 cm, p = 0.02). Conclusions: Overall SF rates were modest in this population. Cobb angle measurements of scoliosis and kyphosis as well as torso length are novel tools for objectively defining anatomic complexity in the SB population and may help predict success following stone surgery. [ABSTRACT FROM AUTHOR]

Purpose of Review: The goal of this article is to review the current role of robotic ureteral reimplant in pediatric patients, specifically in regard to indications, outcomes, and complications. Recent Findings: Robotic ureteral reimplant has become an increasingly popular alternative to open ureteral reimplant with overall published success rates between 77-100%. In recent years, larger, multi-institutional studies have been conducted revealing lower success rates and higher complications than previously reported, but the procedure still remains safe and effective in the hands of skilled surgeons. The robotic approach offers shorter hospital stay, decreased post-operative pain, and improved cosmesis, but also results in higher healthcare costs. Summary: Robotic ureteral reimplant serves as a minimally invasive alternative to open ureteral reimplant for the properly selected patient in the hands of experience surgeons. [ABSTRACT FROM AUTHOR]

Optimal means to correct ventral curvature (VC) is debated. Our preferred technique for curvature greater than 45° is corporoplasty using tunica vaginalis flap (TVF). We describe our complications with TVF for ventral lengthening. Forty-four boys who underwent ventral lengthening with a corporoplasty with TVF were identified in a prospective database for proximal hypospadias repair by a single surgeon from 2008 to 2021. Corporotomy was performed by incising the tunica albuginea of the corpora cavernosa transversely at the point of maximum curvature. Harvested TVF was tailored to the size of the corporotomy and anastomosed to the edges of the tunica albuginea and on laid to the corporal defect with the mesothelial side of the TVF abutting the erectile tissue. Median age at surgery was 1.0 years (IQR 0.72–1.82). Median follow-up time was 4.9 years (IQR 2.6–8.0). Thirteen patients (27%) were older than 10 years of age at last follow up (median 13.3, range 10–20). Twenty-two boys (50%) received preoperative testosterone. The most common location of the meatus after degloving was penoscrotal (41%). Median VC after degloving was 90° (IQR 80–100). The urethral plate was transected in 43/44 (98%) of boys, improving median VC to 60° (IQR 40–60). After corporotomy, the median longitudinal distracted distance was 15 mm (IQR 12–17). Urethral reconstruction was most commonly achieved with the transverse island preputial flap technique or its modifications (39/44; 89%). Erections were reported in 42 boys (95%). None developed corporal diverticula, and two patients (4.5%) had ascended testis associated with TVF harvest. Seven percent of boys had recurrent ventral curvature (RVC; 3/44). Median RVC was 30° (IQR 30–45). One patient had RVC at the penoscrotal junction (not at site of prior corporoplasty) identified 11 years post operatively at age 15, and underwent dorsal plication. The other 2 patients were diagnosed less than 1 year post operatively. Both patients received testosterone due to small glans size, had double-face tubularized transverse island preputial flap as urethral and ventral skin coverage, and had endocrine and genetic consultation. Both had scarring of the preputial flap and of the corporoplasty. Scar excision and superficial transverse incisions on the tunica albuginea corrected RVC. The five-year outcome of ventral penile lengthening using TVF for corporoplasty is favorable with 7% of boys with RVC, and 4.5% with ascended testes associated with TVF harvest. None developed corporal diverticula. [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: No method currently exists for predicting which young child with a renal or ureteral stone will require surgery as opposed to pass the stone. Our goals were to analyze practice patterns at a major pediatric center and to identify factors that predicted spontaneous stone passage. Method: A retrospective review of all prepubertal patients (≤ 11 years) presenting to our institution from January 2005 to July 2014 with symptomatic nephrolithiasis was performed. Demographic data and stone details were reviewed, including anatomic location, size, and outcomes. Spontaneous stone passage was determined by parental report and/or stone absence on imaging obtained within 6 months after initial diagnosis. Results: A total of 119 eligible patients were identified, with an average age of 88.7 months (4-143). Forty eight (40.3%) patients spontaneously passed their stone and the remaining 59.7% required endoscopic intervention. Overall, 79.0%had symptomatic presentation (flank pain, hematuria) and 39.5%of patientswere obstructing stones. Symptomatic presentation was more common with ureteral (86.5%) than with renal (66.7%) stones, but was not associated with increased passage of stones in general (p-value 0.1765). Of the 48 patientswho spontaneously passed stones, 11 (24.4%) were renal stones compared with 37 (50.0%) ureteral stones. The average size of spontaneously passed stones was 3.5mm (2-8) for renal and 3.4mm (1-7) for ureteral stones. Based on logistic regression, the singlemost important predictor of stone passagewas stone size (p-value <0.001).The odds of passagewere 3.1 times higher for ureteral stones compared with renal stones (p = 0.0070) when not controlling for size. Conclusion: In prepubertal patients, ureteral stones with an average size of 3.5mm or less are more likely to pass spontaneously. Based on this information, watchful waiting is a reasonable option in clinically stable nonseptic patients with renal/ureteral stones of this size. [ABSTRACT FROM AUTHOR]

Purpose The increasing incidence of pediatric nephrolithiasis is a growing concern and its association with obesity continues to be an area of debate. We present data on urine chemistries of overweight/obese children compared to those with a normal body mass index and history of urolithiasis treated at a single institution in the United States, and assess risk factors. Materials and Methods We retrospectively identified 110 stone forming patients who underwent 24-hour urine collection and stratified them according to the Centers for Disease Control and Prevention definitions of overweight/obese (body mass index above 85th/95th percentile). Absolute urine collection quantities were compared between groups. Stone risk factors were analyzed according to Litholink® specified reference ranges. Results Compared to patients with low or normal body mass index, overweight and obese patients had lower body surface area adjusted citrate (242 mg/1.73 m 2 vs 315 mg/1.73 m 2 , p = 0.03), lower urine phosphate (12 mg/kg vs 14 mg/kg, p = 0.04), lower urine magnesium (1.2 mg/kg vs 1.6 mg/kg, p = 0.01) and increased incidence of hypercalciuria (31% vs 11%, p = 0.02). Differences in urine citrate, phosphate and magnesium were not apparent when analyzing stone risk factors. There was no association between body mass index and urine pH. Conclusions Overweight and obese stone forming children have decreased levels of urine citrate, phosphate and magnesium compared to patients with normal body mass index. The incidence of hypercalciuria is increased in overweight/obese patients. In contrast to findings in adults, there is no association between urine pH and body mass index. [ABSTRACT FROM AUTHOR]

Cryptorchidism is one of the most common reasons for pediatric urology referral and one of the few pediatric urologic conditions in which there are established AUA guidelines that recommend orchiopexy be performed before 18 months of age. While access to timely orchiopexy has been studied previously, there is no current study with data from a national clinical database evaluating timely orchiopexy after the AUA guidelines were published. Additionally, prior studies on delayed orchiopexy may have included patients with an ascended testis, which is a distinct population from those with true undescended testicles. [Display omitted] To evaluate in a national, clinical database if timely orchiopexy improved after the AUA guidelines were published in 2014. In particular, we aim to evaluate a younger group of patients, 0–5 years of age, in an effort to account for potential ascending testes. Using Cerner Real-World Data™, a national, de-identified database of 153 million individuals, we analyzed pediatric patients undergoing orchiopexy in the United States from 2000 to 2021. We included males 0–18 years old and further focused on the subset 0–5 years. Primary outcome was timely orchiopexy, defined as age at orchiopexy less than 18 months. Predictor variables included race, ethnicity and insurance status. Statistical analyses were performed using logistic regression. Of the total 17,012 individuals identified as undergoing orchiopexy, 9274 were ages 0–5 at the time of surgery. Comparing time periods pre and post AUA guidelines (2000–2014 versus 2015–2021), we found a significant difference in the proportion of timely orchiopexy (51% versus 56%, respectively; p < 0.0001) (Figure). In multivariable analyses, Hispanic (OR = 0.65, p < 0.0001), African American (OR = 0.74, p < 0.0001), and Native American males (OR = 0.66, p = 0.008) were less likely to have timely orchiopexy compared to non-Hispanic White males. Individuals without insurance (OR = 0.81, p = 0.03) or with public insurance (OR = 0.88, p = 0.02) were less likely to have timely orchiopexy as compared to those with private insurance. Nearly a decade after publication of the AUA cryptorchidism guidelines, a large proportion of patients are still not undergoing orchiopexy by 18 months of age. This is the first study to show that timely orchiopexy has improved among patients 0–5 years, but the majority of patients are still not undergoing timely orchiopexy. Health disparities were apparent among Hispanic, African American, Native American, and uninsured males, highlighting the need for further progress in access to pediatric surgical care. [ABSTRACT FROM AUTHOR]

Patients with spina bifida are at risk for developing bladder and renal deterioration secondary to increased bladder storage pressures. To determine the association of home bladder volume and pressure measurements (home manometry) to: 1) detrusor storage pressures on urodynamics (UDS); and 2) the presence of Society of Fetal Urology (SFU) grades 3–4 hydronephrosis on renal bladder ultrasound in patients with spina bifida. Data were prospectively collected on patients with spina bifida and neurogenic bladder requiring clean intermittent catheterization. Patients used a ruler and typical catheterization equipment to measure bladder pressures and volumes at home. Home measurements were compared to UDS detrusor pressures and SFU hydronephrosis grade. Detrusor pressure <20 cm H 2 O at 50% maximal cystometric capacity (MCC) on UDS was used as a measure of safe storage pressures on UDS; conversely, detrusor pressure >20 cm H 2 O was used a measure to capture both unsafe storage pressures and those with potential for unsafe storage pressures. Receiver-operator characteristic curves and area under curve (AUC) were calculated to depict the association between home manometry variables with detrusor pressures on UDS and SFU grades 3–4 hydronephrosis. Included were 52 patients with a median age of 10.3 years (interquartile range 6.3–14.4 years). Three home manometry measurements (maximum bladder pressure, bladder pressure at maximum catheterized volume, and mean bladder pressure) > 20 cm H 2 O were sensitive for Pdet >20 cm H 2 O at 50% MCC. Maximal bladder pressure >20 cm H 2 O was the most sensitive among home manometry measures (sensitivity 100%, specificity 70%, AUC 0.92 for Pdet >20 cm H 2 O at 50% MCC on UDS; sensitivity 100%, specificity 62%, AUC 0.89 for SFU grade 3–4 hydronephrosis). None of the patients who had maximum home bladder pressure <20 cm H 2 O had SFU grades 3–4 hydronephrosis; conversely, individuals with maximal home bladder pressure >20 cm had a wide range of hydronephrosis grades. None of the patients with maximal home bladder pressure <20 cm H 2 O had grade 3–4 hydronephrosis. Home measurements of maximal bladder pressure, bladder pressure at maximum catheterized volume and mean bladder pressure of >20 cm H 2 O were all sensitive for Pdet >20 cm H 2 O at 50% MCC on UDS. Home manometry is an inexpensive and simple technique to identify patients at risk for and to monitor individuals at high risk of upper tract dilation, without incurring significant cost or morbidity. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective To assess the awareness and readiness of both spina bifida patients and parents regarding the transition process before transitioning, with a secondary aim that included identifying potential factors associated with successful transition. Methods All children aged ≥14 years requiring long-term care were prospectively enrolled. Questions designed by pediatric and adult urologists and an adolescent health specialist addressing the awareness of long-term follow-up and the desire to learn more about transitioning were administered by nursing staff at regularly scheduled clinic appointments. All spina bifida patients evaluated in the past 5 years were identified, and clinical factors associated with transitioning were compared. Statistical analysis using the Fisher exact test and the chi-square test were used to compare patients' and parents' responses and categorical variables between patients transitioned and those eligible. P <.05 was considered significant. Results A total of 33 surveys were prospectively collected. Twenty-two percent of parents and 40% of patients said they never wanted to transition ( P = .28). Parents had thought about transitioning more than the patients (88.9% and 40%, respectively; P = .002). Of the 97 patients eligible for transition, 34% had a transition plan. The only significant predictor of transitioning to adult care was a previous history of stones ( P = .03). Conclusion Transitioning to adult urologic care is a necessity for many, and parents are significantly more aware of transitioning than the patient. Acknowledging and understanding the concerns of patients and families will help optimize the transition to adult urologic care. [ABSTRACT FROM AUTHOR]

Prenatal hydronephrosis (PNH) is one of the most common congenital anomalies and can increase the risk of developing a urinary tract infection (UTI) in the first two years of life. Continuous antibiotic prophylaxis (CAP) has been recommended empirically to prevent UTI in children with PNH, but its use has been controversial. We describe the incidence of UTI in children with isolated PNH of the renal pelvis without ureteral dilation. Our objective was to compare patients receiving and not receiving CAP and determine whether CAP is beneficial at preventing UTI in children with isolated PNH. Children with confirmed PNH were enrolled between 2008 and 2020 into the Society for Fetal Urology Hydronephrosis Registry. Children with isolated dilation of the renal pelvis without ureteral or bladder abnormality were included. The primary outcome was development of a UTI, comparing patients who were prescribed and not prescribed CAP. In this cohort of 801 children, 76% were male, and 35% had high grade hydronephrosis (SFU grades 3–4). CAP was prescribed in 34% of children. The UTI rate among all children with isolated PNH was 4.2%. Independent predictors of UTI were female sex (HR = 13, 95% CI: 3.8–40, p = 0.0001), intact prepuce (HR = 5.1, 95% CI: 1.4–18, p = 0.01) and high grade hydronephrosis (HR = 2.0, 95% CI: 0.99–4.0, p = 0.05; Table) on multivariable analysis. For patients on CAP, the UTI rate was 4.0% compared to 4.3% without CAP (p = 0.76). The risk of UTI during follow-up was not significantly different between patients who received CAP and patients who were not exposed to CAP; adjusting for sex, circumcision status and hydronephrosis grade (HR = 0.72, 95% CI: 0.34–1.5, p = 0.38). In sub-group analysis of patients at higher risk of UTI (uncircumcised males, females and high grade hydronephrosis), CAP use was not associated with a statistically significant reduction in UTI. The overall UTI rate in children with isolated PNH is very low at 4.2%. In the overall population of patients with isolated PNH, CAP was not associated with reduction in UTI risk, although the limitations in our study make characterizing CAP effectiveness difficult. Clinicians should consider risk factors prior to placing all patients with isolated PNH on CAP. Summary Table. Univariate and multivariable analysis of urinary tract infection (UTI) risk among children with isolated prenatal hydronephrosis. Summary Table No. UTI/total No. (%) Univariate p value Multivariable model HR (95% CI) p value CAP No 23/529 (4.3) 1.0 (Ref) Yes 11/272 (4.0) 0.84 0.72 (0.34–1.5) 0.38 Overall 34/801 (4.2) Males circumcised 3/364 (0.84) 1.0 (Ref) Males uncircumcised 12/244 (4.9) 0.0001 5.1 (1.4–18) 0.01 Females 19/190 (10) 0.0001 13 (3.8–44) 0.0001 Missing circumcision status 3 Hydronephrosis Grade Low grade 16/496 (3.2) 1.0 (Ref) High grade 17/280 (6.1) 0.06 2.0 (0.99–4.0) 0.05 Missing grade 25 [ABSTRACT FROM AUTHOR]

Purpose: We theorized that progressive bladder dysfunction due to clinical diagnoses such as outlet obstruction occurs as a result of cyclical oxidative stress events. We hypothesized that measurement of F2-isoprostane, a marker of lipid peroxidation, could serve as a biomarker of oxidative stress in the murine bladder. Materials and Methods: At age 5 to 6 weeks oophorectomized female mice were subjected to 1 of 2 bladder injury models, that is partial bladder outlet obstruction or acute bladder distension. The time points studied after injury included 4, 8 and 16 weeks after obstruction, and 0 to 48 hours after acute bladder distension. In a separate group short-term repetitive acute bladder distension was performed every other day for 14 days. Bladder samples were analyzed for F2-isoprostane using gas chromatography and mass spectroscopy. Mean tissue F2-isoprostane levels were compared. Results: F2-isoprostane increased significantly after 4 weeks of partial bladder outlet obstruction from 1.46 ng/gm in controls to 2.31 ng/gm at 4 weeks (p = 0.01). Eight and 16 weeks after partial bladder outlet obstruction F2-isoprostane remained significantly elevated (2.39 and 2.48 ng/gm, respectively). Acute bladder distension resulted in a significant increase in F2-isoprostane immediately after distension compared to controls (1.6 vs 0.75 ng/gm, p = 0.04). In mice that underwent repetitive acute bladder distension F2-isoprostane did not change. Conclusions: Measurement of tissue F2-isoprostane in the bladder reflects the progression of oxidative stress, primarily in chronic injury models such as partial bladder outlet obstruction. The usefulness of F2-isoprostane measurements in shorter term injury models requires further study. [ABSTRACT FROM AUTHOR]

Skin entrance doses for voiding cystourethrogram (VCUG) have not been well characterized in the literature. Radiation exposure is measured as either dose area product (DAP) or air kerma, which estimates the effective dose, but does not accurately reflect absorbed dose at skin level. The objective of this study was to measure the skin entrance dose during fluoroscopic VCUG study in pediatric patients using single point dosimeters. Pediatric patients undergoing fluoroscopic VCUG were prospectively enrolled in our study. Landauer NanoDot™OSLD dosimeters were affixed to the skin overlying the sacrum to measure skin entrance dose. The fluoroscopic unit was set to the following parameters: low dose setting, skin-to-source distance of 54 cm, pulsed fluoroscopy at 3 frames/sec. Forty-four patients with a median age of 13.6 months (IQR 3.7–42.3) were enrolled. Median fluoroscopic time was 54 s (IQR 36–72). The median values absorbed dose by dosimeter and air kerma were 0.32 mGy (IQR 0.13–0.56, range 0.01–2.9) and 0.24 mGy (IQR 0.14–0.37), respectively. There was a positive correlation between the air kerma and absorbed dose (r = 0.69, p < 0.001) and fluoroscopy time and absorbed dose mGy (r = 0.60, p < 0.001). Absorbed dose was independent of age, body mass index and body surface area (p = 0.19, p = 0.57 and p = 0.16, respectively). Median whole body effective dose was 0.04 mSv (IQR 0.02–0.7). Overall, the absorbed dose received by the dosimeter remained low at a median of 0.32 mGy (range 0.01–2.91). These values are remarkably low and well within the accepted radiation exposure norms. Our radiologists follow a strict protocol to reduce the overall radiation emitted during a VCUG. These measures include setting the x-ray source at a low dose mode, collimating to the smallest area possible, and using pulsed fluoroscopy at 3 frames/sec. Limitations to this study include a slight variability in technique of VCUG between different technicians and providers, for which we cannot control. The radiation dose absorbed at the skin entrance and uniform whole body effective dose is low for a single VCUG when utilizing strict parameters. While newer non-ionizing technologies continue to emerge, our data is encouraging and will serve as a valuable tool when educating parents regarding radiation doses associated with a VCUG. Summary Table Radiographic parameters with VCUG measuring dose area product, air Kerma, dose absorbed at skin level and effective dose. Summary Table Mean Median Fluoro time (sec) 55.6 ± 29.6 54 (IQR 36–79.8) Dose area product (mGy∗m2) 12.8 ± 22.7 5.3 (IQR 3.1–8.3) Air Kerma (mGy) 0.57 ± 1.0 0.24 (IQR 0.14–0.37) Dose absorbed (mGy) 0.55 ± 0.66 0.32 (IQR 0.13–0.56) Effective dose (mSv) – whole body 0.09 ± 0.20 0.04 (IQR 0.02–0.07) [ABSTRACT FROM AUTHOR]

The article discusses issues concerning the application of sacral modulation in the treatment of dysfunctional elimination syndrome in children. Topics covered include the U.S. Food and Drug Administration's (FDA) approval of the technique for adult patients in 1997, study on the improvement in urinary incontinence and frequency/urgency of urination and the opinion that there should be strict criteria for patient selection to undergo sacral neuromodulation.

The article discusses treatment of high grade renal trauma American Association for the Surgery of Trauma (AAST) grade IV/V in children. Hemodynamic stability, accurate radiographic staging and the presence of associated organ injuries should be considered for operative management in pediatric renal trauma. Case studies are also highlighted. Conservative and nonoperative management of hemodynamically stable, high grade renal trauma may decrease the risk of nephrectomy.

Epithelioid hemangioma is a rare vascular lesion consisting of capillaries and inflammatory infiltrate containing lymphocytes, and mast cells. The presentation of penile epithelioid hemangioma has been previously described in the adult literature; however, few cases have been reported in the pediatric population. Herein we present a case of penile epithelioid hemangioma in a 15-year-old patient with regrowth following surgical resection, requiring more extensive surgical excision with urethral reconstruction. This rare case highlights the importance of a proper diagnosis and complete microscopic removal. [ABSTRACT FROM AUTHOR]

Objective: To study the effect of testicular vessel division on testicular volume during laparoscopic staged Fowler Stephens orchiopexy (LSFSO).Methods: Testicular dimensions were prospectively measured intraoperatively at both first (S1) and second stages (S2) of LSFSO, and with scrotal ultrasound 3-12 months postoperatively. Testicular volumes were compared to reference ranges. Volume changes were tracked with a change of >20% considered clinically significant.Results: A total of 52 nonpalpable testes treated with LSFSO between 2008 and 2018 were included in the study. After a median follow-up of 6.8 (3-91.3) months, 46 (88.5%) testes were palpable in a scrotal location without adjunctive procedures and 39 (75%) maintained vascular flow on duplex ultrasound. One testis retracted to an inguinal position and was successfully treated with inguinal orchiopexy for an overall success of 90.4% (47/52). Of 36 testes with intra- and postoperative testicular volume documentation, only 2 (5.6%) had significant volume loss after S1. Both testes had catch-up growth after S2. Eight (22.2%) testes had significant volume loss after S2. At follow-up, 24 (66.7%) testes were smaller than the mean for age, of which 20 (83.3%) were small at baseline. Only 41.7% of testes larger than mean for age at follow-up, were small at baseline (P = .02).Conclusion: Significant testicular volume loss does not occur after testicular vessel division at S1, but expected in approximately 1 quarter of testes after S2. We propose that testicular atrophy after LSFSO is primarily due to defective testicular development and rarely due to vascular compromise during S2. [ABSTRACT FROM AUTHOR]