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Implementing a robotic urological surgery program requires institutional support, and necessitates a comprehensive, detail-oriented plan that accounts for training, oversight, cost and case volume. Given the prevalence of robotic surgery in adult urology, in many instances it might be feasible to implement a pediatric robotic urology program within the greater context of adult urology. This involves, from an institutional standpoint, proportional distribution of equipment cost and operating room time. However, the pediatric urology team primarily determines goals for volume expansion, operative case selection, resident training and surgical innovation within the specialty. In addition to the clinical model, a robust economic model that includes marketing must be present. This review specifically highlights these factors in relationship to establishing and maintaining a pediatric robotic urology program. In addition, we share our data involving robot use over the program's first nine years

Identifying cutaneous manifestations associated with systemic diseases is a crucial task for dermatologists and other providers in the outpatient and inpatient settings. Here, we present a rare case of postictal petechiae occurring after a generalized tonic-clonic seizure in a patient with poorly controlled epilepsy. This case illustrates a unique and underrecognized entity that may serve as the only cutaneous clue to assist in the diagnosis of recent seizure activity.

Objectives To describe postoperative complications after robot‐assisted laparoscopic urological surgery in children, and identify potential predictors of these complications by analysing the outcomes of a large‐volume single‐surgeon experience. Patients and Methods We reviewed our institutional database to identify all robot‐assisted laparoscopy (RAL) cases performed between December 2007 and December 2017. Patients were grouped into three cohorts based on the anatomical location of the procedure: upper urinary tract (kidney and renal pelvis); lower urinary tract (ureter); and lower urinary tract reconstruction with bowel (bladder reconstruction). A descriptive analysis of baseline characteristics, intra‐operative variables and postoperative outcomes was carried out. All complications were graded using the Clavien–Dindo scale, and grouped based on type and time of occurrence (<30, 30–90, >90 days). Multivariable logistic regression analysis was performed to identify predictors of high‐grade complications (Clavien–Dindo grade ≥ III). We also measured complication rates based on year of surgery and surgical caseload. Results Our database included a total of 326 patients, of whom 57% (n = 186) underwent upper urinary tract procedures, 30% (n = 97) ureteric procedures, and 13% bladder reconstruction. The median follow‐up for each procedure was 13, 11 and 57 months, respectively. Of the total, 10 cases were converted to an open approach and excluded from further analysis. The most common types of complication in all groups were infections (urinary tract infections) and urinary complications (urine leaks and urolithiasis). Bladder reconstructive procedures, which require the use of bowel, presented the highest rate of high‐grade complications (32%). Length of hospital stay (LOS; odds ratio [OR] 1.33, confidence interval [CI] 1.16–1.53), estimated blood loss (EBL) in surgery (OR 1.01, CI 1.002–1.019) and operating time (OR 1.004, CI 1.002–1.006) were all associated with increased odds of high‐grade complications on multivariate analysis (P < 0.05). Conclusions In this single‐surgeon series, we have described the most commonly encountered complications after RAL in paediatric urology, finding rates similar to the complication rates reported in the current literature on other surgical approaches. In addition, LOS, operating time and EBL, which are probable surrogates of case complexity, were associated with increased odds of high‐grade complications.