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We aimed to evaluate the safety and efficacy of RALP for UPJO in a heterogeneous pediatric population. The medical records of all patients with UPJO who underwent RALP over the last 6 years and completed at least 6 months of follow-up, were retrospectively reviewed. Data included age, sex, laterality, weight, preoperative and postoperative ultrasound and renal scintigraphy results, operation time, complications, length of hospital stay. We separately examined two groups: low-weight children (< 10 kg) and those who underwent RALP after failed pyeloplasty. One hundred patients with a median age of 18 months (range 2-216) underwent RALP. The median weight was 10 kg (range 4-90). The median operative time, including docking and console time, was 75 min (range 40-183). The median hospital stay was one day (range: 1-3). Ninety-eight percent of the patients showed improvement or stable hydronephrosis on postoperative imaging, with a better drainage curve on dynamic radionuclide scans. In two patients, the hydronephrosis worsened. One patient's ipsilateral UVJ was obstructed, and the other patient's UPJO recurred. The operative time was shorter in the low-weight group (p < 0.001), but the length of hospital stay and success rate were not different. Neither the hospital stay nor the success rate of redo RALP patients differed significantly from a control group of primary RALP patients. Our data show that RALP might be utilized as a universal approach in pediatric patients with UPJO.

Various urological examinations require temporary urethral catheter insertion. For the paediatric population, this procedure can induce pain, cause distress to the patients and parents and could defer the family from further evaluation or treatment. 1 In recent years, medical clowns (MCs) have been investigated as an alternative to sedation or analgesics during invasive and stress inducing procedures in the paediatric population. In a previous publication, we have shown that utilisation of MCs as an integral part of the surgical team, decreases child's anxiety, shortens recovery time and lowers overall medical costs, in penile surgery patients. 2 Our findings are supported by current literature showing MC to be helpful during additional invasive procedures as venipuncture or line insertion, linking MC to improved pain and anxiety scores. [2][3][4][5]

Introduction The use of double J stents (DJS) is common practice during robotic reconstructive surgeries in the pediatric population. Some studies claimed that a small stent diameter is prone to obstruction and migration, thus might increase the number of post-op complications. The aim of this study was to evaluate whether the use of a small stent size leads to higher complication rate following robotic reconstructive surgery in children. Methods We have retrospectively reviewed the medical files of patients, who underwent reconstructive robotic surgery with insertion of 3Fr or 4Fr DJS over a 3-year period, from two medical centers. The data included demographics, operation type, DJS size, post-op complications and duration of hospital stay. Results The study included 47 patients, 33 (70.2%) were male. The mean age was 34 months (range 3-192 months). 3Fr DJS was used in 13 (27.7%) patients and 4Fr stent was utilized in the remaining 34 (72.3%) children. 3Fr stents were more frequently used in younger children (14 vs 42 months, p < 0.01). There were 3 (6.4%) stent-related post-op complications, two leaks in the 4Fr stent group and one stent migration in the 3Fr group. No statistically significant difference in post-operative complication rate, was found between the two DJS groups (p = 0.631). No correlation was found between DJS size and type of complication (r = 0.238, p = 0.107 for dislodgement; r = − 0.130, p = 0.382 for leaks, respectively). Conclusions Our data show that the use of small DJS size does not lead to increased post-op complication rate and is safe and durable in pediatric robotic surgery.

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