Background and Objectives: The optimal postoperative urinary diversion strategy after hypospadias repair remains debated, with variability in type, material, and duration. Pediatric-specific data are limited. This systematic review and meta-analysis aimed to evaluate how urinary diversion type and duration affected surgical outcomes after pediatric hypospadias repair. Materials and Methods: A systematic search of PubMed, Embase and Cochrane Library (1995–2025) databases was conducted using PRISMA guidelines and registered in PROSPERO (CRD420251121638). Eligible studies included pediatric patients undergoing hypospadias repair with or without urinary diversion. Primary endpoints were diversion characteristics (type, material, duration); secondary endpoints included postoperative complications and re-operations. Results: A total of 31 studies representing 4261 pediatric patients were analyzed, with 16 included in meta-analysis. Pooled estimates confirmed that bladder catheters were associated with significantly higher rates of general complications (wound/urinary tract infections, swelling, foreskin dehiscence) [p < 0.05] and re-operations [p < 0.05] compared to urethral stents. Conversely, urethral stents showed a greater risk of mechanical complications such as blockage and dislodgement [p = 0.001]. Meta-analysis of stented versus unstented procedures revealed no significant differences in major outcomes (fistula, stenosis, re-operations), although stented repairs showed a modest increase in minor complications. For catheterization length, pooled data suggested no significant advantage of prolonged (>5 days) versus shorter (≤5 days) diversion, despite descriptive analyses indicating more functional and general complications [p < 0.05] and re-operations [p = 0.004] after short diversion and more fistulas after prolonged diversion [p < 0.05]. Conclusions: Urinary diversion strategies significantly affected surgical outcomes after pediatric hypospadias repair. Urethral stents reduced general complications compared with bladder catheters but were prone to mechanical issues. Short diversion increased early complications, while prolonged catheterization increased fistula risk. No single approach proved universally superior; therefore, perioperative management should be individualized according to patient characteristics, hypospadias severity, and intraoperative findings. Further high-quality prospective trials are needed to define optimal diversion protocols.

Pilonidal sinus disease (PSD) is an acquired inflammatory condition of the gluteal cleft predominantly affecting teenagers. We report our 10-year experience adopting this minimally invasive approach, pediatric endoscopic pilonidal sinus treatment (PEPSiT). We retrospectively reviewed all patients, with primary or recurrent PSD, undergoing PEPSiT in the 2016-2025 period. We operated 507 patients (313 boys and 194 girls) with a median age of 15.5 years (IQR 12-18 years). All patients received our postoperative management. Data regarding success rate, healing rate/time, post-operative management, short- and long-term outcome and patient satisfaction were assessed. The post-operative course was painless in 100% of patients (median VAS pain score < 2/10, IQR 1-2). Patient satisfaction was excellent (median score 4.8/5, IQR 4-5). Dressing after surgery was performed with ozone oil products in every patient and in the last 18 months Platelet-Rich Plasma (PRP) has been added to the intra and post-operative care too. Disease recurrence occurred in 53/507 patients (10.4%), mostly within 3 months (range 2 months-23 months), and all were successfully re-operated with PEPSiT with no further recurrence. This study demonstrates that a standardized perioperative protocol, including tailored pre- and post-operative management and structured long-term follow-up, is effective in ensuring favorable clinical outcomes, with negligible pain, high patient satisfaction and a low rate of recurrence.