Martin Salö

Aim: To compare the postoperative outcomes in children with appendicitis diagnosed at the first visit versus after multiple visits overall and among children with complicated appendicitis. Methods: We identified children aged < 15 years diagnosed with appendicitis between 2018 and 2023. Children were classified as having a single visit (SV) or multiple visits (MV) and in those with and without complicated appendicitis. Results: Of 739 children with appendicitis, 614 (83%) were in the SV group versus 125 (17%) in the MV group. Complicated appendicitis occurred in 28% (95% CI, 25–32) and 36% (95% CI, 28–45), respectively ( p = 0.074). The median number of operations was 1 in both groups ( p = 0.327), and median hospitalization was 2 days in both groups ( p = 0.061). Among 217 children with complicated appendicitis, 172 (79%) were in the SV group and 45 (21%) in the MV group. The median number of operations was 1 in both groups ( p = 0.586), while median hospitalization was 5 versus 6 days, respectively ( p = 0.196). Conclusion: Complicated appendicitis was more frequent after multiple visits, but diagnosis after multiple visits was not associated with more operations or longer hospitalization. For selected children, observation and planned reassessment may be a reasonable alternative to extensive investigations.

Aim: Urinary tract infection ( UTI ) is the most common and significant complication after voiding cystourethrography ( VCUG ) but the reported incidence in children varies highly. Therefore, the aim of this study was to evaluate the rate and possible risk factors for UTIs after VCUG . Method: A multicentre retrospective cohort study of children < 15 years of age undergoing VCUG between 2017 and 2022 was conducted. Lower UTI (cystitis) and febrile UTI (pyelonephritis) within 14 days of VCUG were registered, defined by clinical assessment and a positive urinary culture. Results: One thousand and one examinations were included (median age 1 year, 52% boys). Previous febrile UTI was present in 58%. Pathology was found in 47% of children, of which 83% had vesicoureteral reflux (VUR). Post VCUG UTI occurred in 34 (3.4%) children within 14 days, of which 60% were within 7 days and 88% were febrile. Only dilating VUR increased the risk for post VCUG UTI (adjusted odds ratio 5.4 [2.6–8.7] p < 0.001). Conclusion: There was a low rate of post VCUG UTIs. Since children with dilated VUR are at risk for chronic kidney injury, targeted interventions after VCUG could possibly lower additional UTIs in this group.

Purpose: Boys with genetic syndromes have an increased risk of undescended testes (UDT), but laparoscopic findings and outcomes after two-stage Fowler-Stephens orchiopexy (FS2) are rarely reported. This study aims to compare laparoscopic findings and results after FS2 between syndromic and non-syndromic boys. Methods: A retrospective cohort study on boys with UDT who underwent laparoscopy between 2014 and 2024. Syndromic and non-syndromic patients were compared regarding age at surgery, bilaterality, type of UDT, and atrophy rate after FS2. Results: In total, 190 boys with 298 testicles underwent laparoscopy. Of these, 42% were found to be intra-abdominal, 23% were vanishing testes and in 22% of cases, a testicular nubbin was found. Bilateral ( p < 0.001) and intra-abdominal UDT ( p < 0.01) were significantly more common in children with syndromes, whereas testicular nubbin was less common ( p < 0.01). The median age at laparoscopy was higher in the group with syndromes. Atrophy occurred in 20% of all testicles undergoing FS2, with no significant difference in outcome between groups ( p > 0,05). Conclusion: Syndromic boys present with more severe UDT but achieve comparable outcomes after FS2. Early diagnosis and individualized management are essential to preserve testicular viability in this high-risk group.

Aim: To explore the possibility of reducing the diagnostic burden in children with prenatally detected unilateral ureteropelvic junction obstruction. Methods: Children with unilateral ureteropelvic junction obstruction (2012–2020) were identified from a prenatal hydronephrosis registry. The frequency of adverse events, predictors for event‐free follow‐up beyond 1 year of age, and examination burden in children with conservatively managed unilateral ureteropelvic junction obstruction were assessed. Adverse events included febrile urinary tract infections, > 10% decline in differential renal function, or both, leading to surgery. Follow‐up ended at clinical conclusion or surgical decision. Results: Forty‐seven children were included, with a follow‐up of median 22.5 (2–115, min‐max) months. Overall, 43% (20/47) had no adverse events. Adverse events occurred within 2 years in 85% (23/27). Predictors of event‐free follow‐up beyond 1 year were a postnatal anteroposterior diameter < 15 mm at 12 months ( p < 0.001) or a stable anteroposterior diameter during the first year ( p = 0.04). Patients without adverse events underwent a median of eight (3–26, min–max) diagnostic imaging examinations. Conclusions: In children with antenatally detected ureteropelvic junction obstruction, 43% had no adverse events, but a substantial examination burden. Predictors of a non‐eventful trace, useful in guidelines, were a postnatal anteroposterior diameter < 15 mm or stable at 12 months.

Purpose: This study aimed to investigate the rate of re-ascent requiring re-operation after primary orchidopexy and to investigate eventual differences between the inguinal and scrotal approach as well as other potential predictors for re-ascent. Methods: A retrospective cohort study of children treated for undescended testis (UDT) with orchidopexy between 2018 and 2022 was conducted. The primary outcome was re-ascent requiring re-operation, and the secondary outcome was atrophy rate. Independent variables were age, underlying conditions, side, surgical approach, operation time, bilaterality, congenital/ascended UDT, presence of scrotal hypoplasia, presence of a patent processus vaginalis, division of external oblique, and suture of the testis. Univariate and logistic regression were used to evaluate differences between groups and risk for re-ascent. Results: A total of 662 testes in 554 patients were included. Re-operation occurred in 6% (7% with inguinal approach, 3% with scrotal approach, p = 0.04). Re-operation was associated with younger age, congenital UDT, and inguinal approach, but neither of these variables remained significant in multivariate analyses. Atrophy occurred in one testis. Conclusion: The rate of re-ascent was 6% and the atrophy rate was 0.15%. A larger study may find predictors for re-ascent but with very low absolute risk. The lower rate of re-ascent with the scrotal approach is probably due to selection bias.

Aim: To investigate underlying factors for previously reported shortcomings in child health centres' (CHC) referral process of boys with undescended testicles.Methods: A total of 386 physicians working at Swedish CHCs were surveyed regarding their knowledge about undescended testicles and their clinical management. Multivariate regression analyses were performed to identify risk factors of non‐adherence to guidelines and self‐reported lack of clinical skills.Results: The overall knowledge of the health benefits of undescended testicle surgery was high (89%), while two‐thirds were unaware of surgery being recommended <1 year of age. One‐fifth of respondents had never received guidance on examination techniques. Male gender (adjusted odds ratio [aOR] 0.51, 95% confidence interval [95% CI] 0.31–0.86), education in paediatrics (aOR 0.37, 95% CI 0.18–0.76) and more experience (aOR 0.02, 95% CI 0.01–0.09) significantly decreased the risk of unfamiliarity with examinations. More experience decreased the risk of stating the incorrect indications for undescended testicle surgery (aOR 0.17, 95% CI 0.03–0.95) and finding examinations difficult (aOR 0.22, 95% CI 0.07–0.72). Medical education outside Nordic countries was a risk factor for unawareness of guidelines (aOR 2.06, 95% CI 1.21–3.51).Conclusion: The knowledge and confidence level of the study population varied widely. The results indicate a need for further theoretical and practical education among Swedish CHC physicians.

Purpose: Pelvoureteric junction obstruction (UPJO) is a common cause of hydronephrosis in children but no previous studies have evaluated differences between boys and girls operated with pyeloplasty. This study aimed to evaluate potential differences between sexes in children operated with pyeloplasty for PUJO in terms of presentation, surgery, and long-term results. Methods: Data was retrospectively collected from all children operated on with pyeloplasty between January 2002 and December 2020. Data contained several variables covering presentation, surgery, and long-term results. Results: In total, 194 patients were included of which 126 (64.9%) were boys. There were no significant differences in prenatal findings, pelvic dilation on ultrasound, function of the affected kidney, surgical method, obstruction type, resolution of hydronephrosis, or improvement of function. Boys presented with pain more often than girls (47.4 vs 25.0%, p < 0.01) while girls were more prone to infections preoperatively (17.2 vs 7.0%, p = 0.04). All nine patients requiring reoperation were boys (p = 0.03). Conclusion: Girls with UPJO seem to experience infections as presenting symptoms more often than boys, while boys significantly more often present with pain. There is also a higher percentage of boys needing reoperation.

Background: Costs and a low total number of cases may be obstacles to the successful implementation of a paediatric robotic surgery programme. The aim of this study was to evaluate a decade of paediatric robotic surgery and to reflect upon factors for success and to consider obstacles.Materials and Methods: All children operated on with robotic‐assisted laparoscopic surgery between 2006 and 2016 were included in a retrospective, single‐institutional study in Lund, Sweden.Results: A total of 152 children underwent robotic surgery during the study time with the most frequent procedures being fundoplication (n = 55) and pyeloplasty (n = 53). Procedure times decreased significantly during the study period. Overall, 18 (12%) of the operations were converted to open surgery, and seven (5%) patients required a reoperation.Conclusions: Despite a low volume of surgery, we have successfully introduced robotic paediatric surgery in our department. Our operative times and conversion rates are continuously decreasing.