Introduction: There are scarce papers about the use of fluorescence-guided surgery (FGS) in the open surgical field. This study aimed to assess the usefulness of FGS in an open setting in the pediatric population and to report our preliminary experience using the Rubina^® Lens system. Methods: All patients undergoing ICG fluorescence-assisted open surgery over the period September 2022–September 2023 were enrolled. Each surgical procedure was performed using the Rubina^® Lens for ICG fluorescence visualization. Results: A total of 25 patients, 14 boys and 11 girls with a median age at surgery of 5.8 years-old (range 0–15), were enrolled. Surgical indications were dermoid/epidermoid cysts of the head (n = 7), lymphangiomas of the head/neck (n = 2), thyroglossal duct cysts (n = 7), gynecomastia (n = 3), preauricular fistula (n = 2), second branchial cleft fistula (n = 1), fibrolipoma of the shoulder (n = 1) and myofibroma of the gluteal/perineal region (n = 2). In all procedures, an intralesional injection of 2.5 mg/mL ICG solution using a 30-gauge needle was administered. No adverse reactions to ICG occurred. Median operative time was 68.6 min (range 35–189). The visualization of ICG-NIRF with the Rubina^® Lens was achieved in all cases. No intraoperative complications were reported. Postoperative complications occurred in 3/25 patients (12%), with gynecomastia (n = 1), thyroglossal duct cyst (n = 1) and neck lymphangioma (n = 1), who developed a fluid collection in the surgical site, requiring needle aspiration in outpatient care (Clavien–Dindo 2). Complete mass excision was confirmed with pathology reports. Conclusions: Based on this initial experience, FGS using the Rubina^® Lens was very helpful in open surgery, providing enhanced visualization of anatomy and identification of margins, real-time reliability and low complication rate. It was easy to use, time saving, feasible and clinically safe. Previous experience in MIS is necessary to adopt this technology. The accuracy of the injection phase is important to avoid diffusion of the ICG into the perilesional tissue.

Background and Objectives: Robot-assisted extravesical ureteral reimplantation (REVUR) has been described as valuable alternative to open reimplantation in the pediatric population. This study aimed to report the outcome of REVUR in children with complex obstructed megaureter (COM) needing ureteral dismembering and/or tapering. Materials and Methods: The records of patients with COM, who received REVUR with ureteral dismembering and/or tapering over the last 3 years (2021–2024), were retrospectively reviewed. The inclusion criteria for COM included previous surgery, paraureteral diverticula, or ectopic megaureter. Results: A total of 16 patients (15 boys), with a median age of 7.8 years (range 2–16), were treated over the study period. COM was associated with paraureteral diverticula (n = 6), previous failed endoscopic balloon dilation (n = 4), ectopic megaureter (n = 2), and previous bulking agent endoscopic injection causing iatrogenic ureteral obstruction (n = 4). Presentation symptoms included febrile urinary tract infections (n = 8), flank pain (n = 4), hematuria (n = 2), and pseudo-incontinence (n = 2). All surgical procedures were accomplished robotically without conversions or intra-operative complications. Ureteral tapering was performed in 7/16 (43.7%). The median operative time (including robot docking) was 220 min (range 155–290). The median length of stay was 3.8 days (range 3–7). The indwelling double J stent was removed 4–6 weeks postoperatively. Clavien 2 grade complications occurred postoperatively in 2/16 (12.5%). At median follow-up of 34.5 months, all patients were asymptomatic and showed improved hydroureteronephrosis on ultrasound and improved drainage on diuretic renogram. Conclusions: This study demonstrates that robot-assisted extravesical ureteral reimplantation is a safe and effective treatment for primary obstructive megaureter and other complex ureteral anomalies in our patient cohort. The procedure showed low complication rates, high success rates, and favorable long-term outcomes, supporting the feasibility and effectiveness of robotic surgery for these conditions.

Robot-assisted extravesical ureteral reimplantation (REVUR) was described for the first time in 2004. Since then, the surgical approach of vesicoureteral reflux (VUR) has changed dramatically. The benefits of this technique are great when compared to the laparoscopic or traditional open approaches. A literature search of PubMed was performed to identify articles covering any aspect of REVUR in the pediatric population. A total of 108 papers published over the period 2004–2024 were collected. Of these, 40 studies were considered valuable in terms of obtaining a complete overview of the REVUR technique. This review aimed to describe the current state of the art of REVUR and define it as the new standard technique for surgical management of selected patients with VUR.

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.

Many ozone-based products that promote the healing process of wounds have been released in recent years. In this study, we evaluate a new spray dressing preparation based on stable ozonides with Vitamin E Acetate in children operated for distal hypospadias. Methods: We included all patients with distal hypospadias, who underwent Tubularized Incised Plate Urethroplasty (TIPU) over a 12-month period. The patients were randomized in two groups according to the type of medication: ozonide spray with Vitamin E Acetate (G1); hyaluronic acid cream (G2). After discharge, parents changed the dressing twice a day for 2–3 weeks postoperatively. The patients were evaluated at 7, 14, 21, 30, 60, and 180 postoperative days and thereafter annually. At the end of the treatment, we submitted a satisfaction questionnaire to parents. Results: Eighty-six patients (median age 18 months) were included. The wound healing was significantly faster in G1 compared with G2 (p = 0.001). No adverse skin reactions occurred in either group. Foreskin dehiscence and re-operation rates were lower in G1. Postoperative foreskin retractability was better in G1, with a significantly higher incidence of secondary phimosis in G2. The median treatment costs were significantly lower in G1 compared with G2 (p = 0.001). Group 1 found the spray dressing easy to use, improving patient management and adherence. Conclusions: The new preparation of ozonide-based product adopted promoted faster wound healing compared to conventional dressing. Furthermore, this spray preparation is easy to apply, economical, and simpler to preserve. This is better for parents who do not have to touch the wound to apply the product.