Background/Objectives: Multiple sclerosis (MS) is a chronic, demyelinating, inflammatory, and degenerative disease of the nervous system that may present in childhood or adolescence, defined as Pediatric-Onset Multiple Sclerosis (POMS). Among its diverse clinical manifestations, neurogenic bowel dysfunction (NBD), including chronic constipation and fecal incontinence, represents a distressing condition with a substantial impact on quality of life (QoL). Despite its clinical relevance, the evidence on bowel dysfunction in pediatric MS remains limited. The objective of this case series was to evaluate bowel dysfunction and its management in a pediatric MS cohort, and to assess whether it is associated with QoL. Methods: We reported the data on the urological and bowel conditions and on the quality of life of our pediatric patients affected by MS and urological dysfunction. We considered MS patients with urinary symptoms who were referred to our department between January 2019 and January 2024, only including individuals with symptoms onset before 18 years of age. In our series, the demographic and clinical data were reviewed, and patients were re-evaluated via telephone interview at least one year after initiation of treatment. The International Consultation on International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), Pediatric Bowel Management Scoring Tool (PBMST), and Pediatric Quality of Life Inventory (PedsQL, young adults’ version) were used to assess urinary and bowel function and related QoL outcomes. Results: Six patients (four females, two males; median age 14.5 years) were included. Bowel symptoms were reported in four cases (66.6%), predominantly constipation. The PBMST scores indicated overall fair bowel management, while the mean PedsQL score was 62.8/100, with poorer scores observed for the non-adherent patients. Conclusions: Bowel dysfunction constitutes an underrecognized but clinically significant manifestation in pediatric MS. Its early identification and adherence to a structured bowel management program seems to be crucial for optimizing symptom control and preserving quality of life. Standardized questionnaires represent effective, non-invasive tools for assessment and longitudinal monitoring.

Vesicoureteral reflux (VUR) management in children with neurogenic bladder dysfunction (NBD) remains a clinical challenge. Total endoscopic management (TEM), combining intradetrusor Onabotulinum Toxin-A (BTX-A) and subureteric dextranomer/hyaluronic acid (Deflux^(R)) injection, offers a minimally invasive alternative. The aim of this retrospective study is to evaluate the long-term effectiveness of TEM. Inclusion criteria: symptomatic II–V grade VUR (also I in bilateral VUR) in NBD children with follow-up ≥12 months. Nineteen patients were enrolled, 24 ureters (grade I–II: 2, grade III–V: 22); 5 patients (20.8%) had bilateral VUR. Mean age at surgery: 7.6 years (1.3–17). No complications were reported. TEM was effective in 11 patients (57.9%), 3/11 requiring a second TEM treatment. VUR resolution appeared in 14 ureters (58.3%), downgrading in 6 (42.9%), persistence in 4 (28.6%). Among non-responders’ patients (8/19, 42.1%), five (26.3%) required bladder augmentation (one combined with ureteral reimplantation), one (5.3%) underwent reimplantation, and two (10.5%) continued conservative management. At bladder biopsy, 11 patients (57.9%) had chronic inflammation, 8 (42.1%) showed fibrosis; no difference in success rate was recorded. All responders required repeated BTX-A injections. Mean follow-up: 3.2 years (range 1–4.7). In selected patients, TEM appears to be a safe and effective strategy, potentially delaying or avoiding major reconstructive surgery.

Background: Sacrococcygeal teratoma (SCT) is a rare neonatal tumor that typically requires early surgical intervention. Advances in prenatal imaging have improved early detection, yet data on long-term urinary outcomes remain scarce. Objective: This study aimed to evaluate functional outcomes in patients with prenatally diagnosed SCT and to explore whether early diagnosis combined with multidisciplinary care at a tertiary referral center influences urinary comorbidities or other sequelae. Methods: We retrospectively reviewed prenatally diagnosed SCT patients who underwent surgery between 2010 and 2021. A minimum follow-up of three years was required. Clinical, surgical, histological, and functional outcomes were analyzed. Correlations between urinary comorbidities and prenatal findings, tumor histology, size, Altman type, and surgical approach were explored. Results: Twenty-four patients were included. Most tumors were classified as Altman type I (66.7%), and half of the cases showed immature histology. Urinary comorbidities were identified in 3/24 (12.5%) patients, primarily in those with immature tumors and larger lesions, although they did not emerge as statistically significant predictors (rs = −0.37, p = 0.08; rs = 0.33, p = 0.17, respectively). No consistent association emerged between prenatal imaging findings, tumor stage, or surgical approach and urinary outcomes. Conclusion: Timely prenatal diagnosis and centralized multidisciplinary management may contribute to favorable long-term functional outcomes in SCT patients. Despite the lack of predictive value of prenatal imaging for urinary morbidity in this cohort, its role remains vital for early detection, surgical planning, and comprehensive patient care. Further prospective studies with larger cohorts are needed to clarify risk factors for functional impairment and improve prognostication in this population.

Background: Neurogenic bladder (NB) in children may lead to recurrent urinary tract infections (UTIs), renal deterioration, and a reduced quality of life. Clean intermittent catheterization (CIC) is the standard of care, but in some patients, CIC may be unfeasible due to anatomical, sensory, or compliance issues. Button cystostomy (BC) has emerged as a minimally invasive, bladder-preserving alternative. This study aimed to assess the feasibility, safety, and outcomes in the long-term of BC in pediatric NB patients. Methods: Retrospective analysis was conducted on children with NB who underwent endoscopic BC placement between January 2020 and December 2024 in a tertiary pediatric center. Demographic data, operative time, complications, and follow-up outcomes were collected. All procedures used an endoscopic approach with cystoscopic guidance for safe device placement. Results: Thirty-three patients (25 males; median age 7.96 years) underwent BC placement. Most had spinal dysraphism (63.6%). The mean operative time was 48.5 ± 6 min. During a mean follow-up of 2.1 ± 1.4 years, five patients (15.2%) had febrile UTIs and two had minor leakage. No major complications occurred. Four buttons were removed due to clinical improvement (N = 1), the fashioning of a continent derivation (N = 1) and implantation of a sacral neuromodulator (N = 2); two patients accepted CIC. Satisfaction was reported by 93.9% of families. Conclusions: BC is an effective, minimally invasive alternative for urinary drainage in children with NB, even when compared to continent diversion techniques such as the Mitrofanoff, due to its lower invasiveness, greater feasibility, and lower complication rate. Broader adoption may be warranted, but prospective studies are needed to confirm long-term outcomes.

Objectives: Congenital lung malformations (CLM) encompass a heterogeneous group of conditions increasingly diagnosed prenatally. While surgical resection is widely adopted, the surgical approach is progressively shifting toward minimally invasive techniques. However, concerns persist regarding the feasibility of thoracoscopy in very young infants. This study aimed to compare thoracoscopic and open surgical resection of CLM and to evaluate temporal trends in surgical approach. Methods: A retrospective review was conducted of all patients undergoing surgical resection for CLM at a tertiary pediatric referral center between January 2011 and December 2025. Patients were grouped according to surgical approach (thoracoscopy vs. thoracotomy). Temporal trends were assessed, and a subgroup analysis including patients undergoing elective anatomical lobectomy was performed to compare perioperative outcomes. Appropriate statistical tests were applied. Results: A total of 219 patients were included. Thoracoscopic resection was performed in 90/219 (41.1%) cases and thoracotomy in 122/219 (55.7%), with a small proportion undergoing alternative approaches. Temporal trend analysis demonstrated a significant increase in thoracoscopic surgery over time, rising from 25.25% in 2011–2018 to 32.65% in 2019–2021 and reaching 77.78% in 2022–2025 ( p < 0.001). In the subgroup of patients undergoing anatomical lobectomy ( n = 138), thoracoscopy was associated with perioperative outcomes comparable to thoracotomy, with no significant differences in operative time, length of stay, or postoperative complications. Conclusion: These findings support the progressive adoption of thoracoscopic surgery for CLM and demonstrate that, following an institutional learning curve, minimally invasive resection can be safely performed even in early infancy.