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Experience with adnexal torsion in neonates and children is often disappointing. Delay between the first symptoms and operation is important, and adnexal loss the rule. The authors reviewed their experience and the literature to assess the appropriate diagnostic and therapeutic approach. Diagnostic procedures (standard ultrasonography [US], color Doppler US, computed tomography, magnetic resonance imaging, endorectal US, and diagnostic laparoscopy) are discussed; for neonates and premenarcheal girls a specific surgical approach is proposed. Twenty-seven adnexal torsions treated between 1985 and 1995 in the same institution were retrospectively reviewed. Neonatal (7) and premenarcheal cases (20) were separated. The neonatal cases (7) were all operated upon: 4 adnexectomies, 2 oophorectomies, and 1 detorsion with cystectomy were performed. In the premenarcheal group (20) 8 adnexectomies, 6 oophorectomies, 5 detorsions with cystectomy, and 1 salpingectomy were performed. There were only 6 salvaged adnexa in this series. In the neonatal group, US seemed accurate in predicting complicated cases. Prenatal puncture of large (>40 mm) ovarian cysts is possible. The authors advocate a laparoscopic approach in the first days of life of all uncomplicated cysts independent of size in order to increase the percentage salvaged. In ultrasonic complicated cases a delayed operation is proposed in the premenarcheal group, endorectal US will probably become the diagnostic method of choice for complicated ovaries; other methods were disappointing. In order to increase adnexal salvage, the authors recommend a laparoscopic approach in the emergency situation if a clinical examination is positive as well as better medical (pediatricians, gynecologists) and general (girls, parents) information. They suggest controlateral oophoropexy in cases of torsion of a normal adnexum.

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More papers are published on ablative or reconstructive urological minimally invasive surgery. Transperitoneal and retroperitoneal approaches are used with the same results. Transvesicoscopic surgery should rapidly grow to become a standard approach for Cohen reimplantation. It is anticipated that technical progress will provide the opportunity for more paediatric urologists to develop a minimally invasive approach.

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Objectives To assess and compare postoperative bladder dysfunction rates and outcomes after laparoscopic and robot‐assisted extravesical ureteric reimplantation in children and to identify risk factors associated with bladder dysfunction. Patients and Methods A total of 151 children underwent minimally invasive extravesical ureteric reimplantation in five international centres of paediatric urology over a 5‐year period (January 2013–January 2018). The children were divided in two groups according to surgical approach: group 1 underwent laporoscopic reimplantation and included 116 children (92 girls and 24 boys with a median age of 4.5 years), while group 2 underwent robot‐assisted reimplantation and included 35 children (29 girls and six boys with a median age of 7.5 years). The two groups were compared with regard to: procedure length; success rate; postoperative complication rate; and postoperative bladder dysfunction rate (acute urinary retention [AUR] and voiding dysfunction). Univariate and multivariate logistic regression analyses were performed to assess predictors of postoperative bladder dysfunction. Factors assessed included age, gender, laterality, duration of procedure, pre‐existing bladder and bowel dysfunction (BBD) and pain control. Results The mean operating time was significantly longer in group 2 compared with group 1, for both unilateral (159.5 vs 109.5 min) and bilateral procedures (202 vs 132 min; P = 0.001). The success rate was significantly higher in group 2 than in group 1 (100% vs 95.6%; P = 0.001). The overall postoperative bladder dysfunction rate was 8.6% and no significant difference was found between group 1 (6.9%) and group 2 (14.3%; P = 0.17). All AUR cases were managed with short‐term bladder catheterization except for two cases (1.3%) in group 1 that required short‐term suprapubic catheterization. Univariate and multivariate analyses showed that bilateral pathology, pre‐existing BBD and duration of procedure were predictors of postoperative bladder dysfunction (P = 0.001). Conclusion Our results confirmed that short‐term bladder dysfunction is a possible complication of extravesical ureteric reimplantation, with no significant difference between the laparoscopic and robot‐assisted approaches. Bladder dysfunction occurred more often after bilateral repairs, but required suprapubic catheterization in only 1.3% of cases. Bilaterality, pre‐existing BBD and duration of surgery were confirmed on univariate and multivariate analyses as predictors of postoperative bladder dysfunction in this series.