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Nephrolithiasis is a rare disease in children. For many years children with kidney stones have been managed like "small adults", but there are significant differences between the pediatric and the adult age in clinical presentation, etiology and treatment. Management of this condition in children has some peculiarities with respect to the adult, as it is often the sign of an underlying metabolic abnormality. Some of these metabolic alterations can lead to serious consequences, such as chronic renal failure, if not adequately diagnosed and treated. Moreover, stones in children with a metabolic abnormality can recur throughout their life, with the need for repeated surgical procedures over the years. So a systematic approach to every child with nephrolithiasis is mandatory to diagnose metabolic defects and establish a personalized therapy. Even the surgical approach in the child has changed significantly over the last two decades: open surgery has now been almost completely replaced by minimally invasive surgery due to the miniaturization of endoscopic instruments and technical advancements in optical and lithotripters systems. The goal is to obtain a stone-free status with the lowest number of minimally invasive procedures and with no complications. Many breakthroughs in our understanding of the physiopathology of renal stones and in surgical technology have been made over the last decades, but the best approach to use in a child with nephrolithiasis remains a true challenge for pediatric nephrologists and urologists.

Although both the TIP and the Mathieu repair allow good results in terms of urinary function after distal hypospadias repairs, the TIP technique seems more likely to be associated with urine flow pattern abnormalities. The actual clinical relevance of this finding remains ill defined.

Fetal lower urinary tract obstruction (LUTO) is associated with high mortality and postnatal morbidity caused by lung hypoplasia and impaired kidney function. Specific diagnostic features that can guide clinical approach and decisions are lacking; thus, the European Reference Network for Rare Kidney Diseases established a work group to develop recommendations regarding the clinical definition, diagnosis and management of prenatally detected LUTO. The work group recommends the use of antero-posterior diameter of renal pelvis as the most reliable parameter for suspecting obstructive uropathies and for suspecting prenatal LUTO in the presence of fetal megacystis. Regarding prenatal and postnatal prognosis of fetuses with LUTO, the risk of fetal and neonatal death depends on the presence of oligohydramnios or anhydramnios before 20 weeks' gestation, whereas the risk of kidney replacement therapy cannot be reliably foreseen before birth. Parents of fetuses with LUTO must be referred to a tertiary obstetric centre with multidisciplinary expertise in prenatal and postnatal management of obstructive uropathies, and vesico-amniotic shunt placement should be offered in selected instances, as it increases perinatal survival of fetuses with LUTO.

Facing the emergency of COVID-19 in one of the first red zones in Italy, we would like to remark about the significant impact that this infection brought to our Departments of Pediatric Surgery/Urology in our hospital (Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano). We hope that our message will help other hospitals facing this world emergency.COVID-19 infection exploded in China in November 2019, becoming a pandemic infection in March 2020. The majority of the National Health Systems did not expect such a dramatic scenario, but they had to adapt their systems to this new situation. Despite a reduced number of involved patients compared to adults, COVID-19 has brought changes also in the management of the pediatric population.Our System Before the Infection Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico is a general hospital with an area dedicated to neonates, children, and mothers. It counts 900 beds, with a maternal area of 320 beds and 6.000 deliveries per year. All the disciplines are represented in the hospital, including transplants and trauma. There are 58 adult ICU beds and 5 pediatric ICU beds plus 23 neonatal ICU beds.Before the infection, the Departments of Pediatric Surgery/Urology counted on average 3.000 surgical procedures in children per year, with a dedicated area of 28 beds. In the system, specialists dedicated to this assessment are 2 professors, 3 senior consultants, 4 consultants, 2 senior registrars, and 3 registrars. The Paramedic system includes 8 pediatric nurses, 7 general nurses, and 3 healthcare assistants. The departments, being in a University Hospital, count also on 3 fellows and 2 medical students. The system is also provided by dedicated anaesthetists for the area of Maternal-Children activities. All the neonatal surgical cases are admitted in a different dedicated Neonatal Department counting 58 beds (23 ICU).The Maternal-Neonatal-Pediatric Department is one of the largest in Europe. In this department many procedures of fetal surgery are performed. In particular, in our department, the first fetal treatment of spina bifida with minimal invasive approach in Europe was performed in June 2018. It is also one of the 4 departments in Europe for fetal treatment with tracheal plug for congenital diaphragmatic hernia. It is the main Italian referral center for low urinary tract obstructions and vesico-amniotic shunting.The following procedures are offered to neonates, infants, and children: elective surgery for major surgery or routine minor surgery, emergencies, oncology, and neonatal surgery. Patients are prepared with preop evaluation usually 2 weeks before the operation. Minor surgeries (65% of the procedures) are managed with day-surgery, while patients undergoing major surgery are usually admitted the day before for preparation to surgery. Major surgery records a waiting list of 35 days and a

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The Kelly procedure is feasible in a vast array of BE patients, but may be formidable, especially in secondary phalloplasties. It allows for complete reconfiguration and lightening of the penis, but exposes to potentially catastrophic complications, such as partial or complete penile loss. Longer follow-up is needed to assess the results in terms of continence.