Background: Anorectal malformations (ARMs) are rare congenital anomalies requiring surgical correction and long-term multidisciplinary care. Despite advances in surgical techniques like posterior sagittal anorectoplasty (PSARP), patients often experience ongoing issues with bowel and urinary function and psychosocial well-being. Aim: To evaluate the long-term outcomes of bowel function, urinary function, and quality of life in patients born with anorectal malformation and treated at our center. Methods: A cross-sectional study evaluated 55 ARM patients treated at the University Hospital of Palermo between 2002 and 2020. Data on clinical characteristics, surgical management, bowel and urinary function, and quality of life were collected using the following validated tools: Rintala Bowel Function Score, PedsQL Family Impact Module, Fecal Incontinence Quality of Life Score, and Lower Urinary Tract Symptoms Questionnaire. Statistical analysis was performed using Fisher’s exact test and ANOVA. Results: Excellent bowel function was observed in 44% of patients, particularly those with low-type ARMs. A bowel management program (BMP) was required in 62% of cases, though 44% of these patients, especially adolescents, showed poor adherence. BMP non-adherence significantly correlated with lower quality of life and worse bowel function (p < 0.01). Bladder dysfunction was noted in 24% of patients, mainly younger ones. Conclusions: Tailored BMPs and transition care are important for long-term success in ARM patients. Adherence to BMPs improves continence and quality of life, highlighting the need for continuous, multidisciplinary follow-up from childhood into adulthood.

Background/Objectives: Endoscopy plays a well know role in managing patients treated for esophageal atresia (EA), allowing the detection and treatment of complications such as anastomotic strictures, gastroesophageal reflux disease, and other structural abnormalities, during the critical first year of life. Nevertheless, we would like to underline the importance of endoscopy early in the follow-up of patients treated for EA, as recommended by guidelines. This study evaluates the role of endoscopy in managing patients treated for esophageal atresia (EA), focusing on the detection and treatment of complications such as anastomotic strictures, gastroesophageal reflux disease, and other structural abnormalities during the critical first year of life. Methods: A retrospective analysis was conducted over 20 years at our institution. Clinical assessments were performed at 3, 6, and 9 months to monitor growth, feeding tolerance, and proton pump inhibitor (PPI) adjustments. Endoscopic evaluations were conducted under general anesthesia around one year of age. Results: Between 2003 and 2023, 84 patients underwent surgical treatment for EA, with complete follow-up data available for 77 patients. Complications occurred in 21 patients (27%), including 4 patients (5.5%) with isolated anastomotic stricture, 8 patients (10%) with reflux esophagitis, 8 patients (10%) affected by both stenosis and reflux, and 1 case (1.5%) of fistula recurrence. Endoscopic dilatations for stenosis were successful, averaging three procedures per patient. Growth parameters were normal in 91% of cases by the first year. Conclusions: Esophagogastroscopy is a safe and effective tool for diagnosing and managing complications after EA repair in infants. The minimally invasive procedure could allow early detection of esophagitis and strictures, offering significant therapeutic benefits. Given these important results, we would like to recommend its use in routine follow-up care.

Background and Objectives: Primary vesicoureteral reflux (VUR) is a common pediatric urological disorder that can lead to significant renal morbidity if undetected or improperly managed. Ultrasound (US) plays a pivotal role in its assessment, providing a radiation-free tool to prenatal assessment, diagnosis, treatment, and long-term follow-up. This study aims to systematically review the literature on the use of US in pediatric primary VUR, emphasizing its applications in prenatal and postnatal diagnosis, intraoperative guidance, and follow-up monitoring. Methods: A systematic review of the literature was performed on PubMed in accordance with PRISMA guidelines. The research strategy used the following keywords: Ultrasound Vesicoureteral reflux, VUR Ultrasound, and VUR Sonography. A total of 2222 records were initially identified. After screening titles and abstracts for relevance, 2165 studies were excluded because they did not focus on ultrasound procedures, did not specify age limits, were redundant, involved non-homogeneous populations, or were unavailable in full text. Results: Prenatal US enables early identification of urinary tract anomalies suggestive of VUR, facilitating targeted postnatal evaluation. Postnatally, contrast-enhanced voiding ultrasound (CEVUS) offers a non-ionizing method for VUR confirmation or exclusion. Intraoperatively, US improves the accuracy and efficacy of bulking agent placement, potentially enhancing surgical outcomes. In follow-up, US remains essential for both conservatively managed and surgically treated patients, enabling timely detection of complications or recurrence. Conclusions: Ultrasound represents a useful tool in the management of pediatric primary VUR, applicable across all clinical stages, avoiding radiation exposure, and improving surgical effectiveness and follow-up management.

Background/Objectives: Undescended testis (UT) is a common congenital urological condition in boys, with an incidence of 2–8%. Orchiopexy is the recommended surgical treatment for UT, ideally performed before 12 months of age, with a latest window of 18 months. Testicular torsion (TT) is a pediatric urological emergency, occurring in 3.8 per 100,000 boys. While both UT and TT are common conditions individually, their co-occurrence in children under 18 months is rare and represents a challenging clinical scenario, especially when diagnosis and treatment are delayed, increasing the risk of testicular necrosis. Methods: This report describes two cases of testicular torsion in undescended testes in infants under 1 year of age. Both patients were presented to the hospital more than 24 h after symptom onset. Such delay led to the possibility of testicular salvage being lost due to necrosis. The first case involved a 10-month-old infant with bilateral undescended testis, who underwent orchiectomy after 36 h of torsion. The second case involved a 7-month-old baby, where a delayed diagnosis led to orchiectomy following 36 h of torsion. Both children were previously on the waiting list for orchiopexy, and in both cases contralateral orchiopexy was performed. A review of the literature on PubMed using the key-words “cryptorchid”, “undescended testis”, and “testicular torsion” revealed 36 cases of UT complicated by TT in children under 18 months, showing a high incidence of orchiectomies due to delayed diagnosis. Conclusions: Testicular torsion in undescended testis in children under 18 months is rare but associated with a high risk of gonadal necrosis. The key to improving testicular salvage rates is timely diagnosis and intervention, ideally within 6 h of symptom onset. Delayed presentation due to atypical clinical signs, such as inguinal swelling or nonspecific symptoms, complicates early detection and thus testicular salvage. Therefore, it is crucial for both parents and pediatricians to recognize the potential for torsion in cryptorchidic patients, emphasizing the importance of early surgical intervention, including orchiopexy, to prevent torsion and its associated complications.

Background/Objectives: This study aims to develop and validate a reproducible training model, built using common hospital items, for laparoscopic inguinal hernia repair with an intracorporeal suturing approach, specifically focusing on iliopubic tract redress in pediatric patients. Methods: Pediatric surgery residents and consultants were instructed on model building and engaged in training sessions. They practiced for four weeks with the handcrafted model and completed a post-simulation survey. The time taken to conclude the training task and the modified Objective Structured Assessment of Technical Skills score were compared between the initial and last sessions at the end of the training period. Additionally, the time required by consultants to perform the laparoscopic procedure in vivo, intraoperative complications, and recurrence rates were analyzed from the time they started the training. Results: A feasible model was created using a colostomy dressing support, Penrose drains, Foley catheters, feeding tubes, and surgical gloves to simulate. The sample involved a total of twelve residents and five consultants with an average age of 33 years old. All participants successfully completed the task during the session. Since the consultants started their training on the model, the operative results for laparoscopic inguinal hernia repair in the theater have improved. Conclusions: Training experience on this model led to improve laparoscopic skills such as cutting and dissection and intracorporeal tying and knotting. This study confirms that training outside clinical practice can significantly benefit laparoscopic proficiency and safety in vivo.

Background: Oral propranolol (OP) is the first-line treatment for complicated and high-risk infantile hemangiomas (IH). However, the optimal timing of treatment initiation in preterm infants remains uncertain, as current recommendations generally discourage administration before 45 weeks of corrected gestational age (CGA). We aimed to evaluate the safety and feasibility of early OP administration in selected preterm infants or term newborn with complicated high-risk IH. Methods: We retrospectively reviewed patients treated with OP for IH at a tertiary referral center between January 2023 and April 2026. Patients were divided according to CGA at treatment initiation into an early-treatment group (<45 weeks CGA) and a standard-timing group (≥45 weeks CGA). Clinical characteristics, treatment modalities, and adverse events were collected and compared between groups. Results: Seventy-five patients were included: 9 received early OP (mean CGA at treatment initiation 38 weeks + 3 days) and 66 that started treatment at or after 45 weeks CGA. Early-treated infants showed a higher prevalence of complicated IH at diagnosis (88.9% vs. 4.5%). No major adverse events, including clinically significant bradycardia, hypotension, arrhythmias, respiratory complications, or treatment discontinuation, occurred in either group. Transient asymptomatic hypoglycemia occurred in five patients, all belonging to the standard-timing group, and resolved with feeding. Treatment duration was comparable between groups. Conclusions: Early OP administration before 45 weeks CGA may represent a feasible and well-tolerated option in selected preterm infants and term newborn with complicated high-risk IH when initiated in a protected neonatal setting with careful monitoring. These findings may suggest individualized risk-based decision-making in selected cases, rather than routine treatment before current age thresholds.