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Post-operative care includes nasogastric tube drainage of the stomach and intravenous fluids are required until normal gastrointestinal function is reestablished. Post-operative antibiotics may be given for prophylaxis against wound infection if indicated.

Failure of the viteline duct to regress results in anomalies that may require resection to prevent or treat complications. The risk of post-operative complications, notably wound infection, is low and the outcome of surgery is excellent. Successful use of a laparoscopic approach for these anomalies has been reported.

Penile surgery should always be performed under general anaesthetic. Local anaesthetic techniques can also be used to provide good intra-and post-operative analgesia and a caudal epidural is the standard. This is probably not required for meatoplasty or preputial plasty. Sutures for this surgery should be absorbable monofilaments such as Monocryl. The author always uses round-bodied or taper-point needles.

Post-operative recovery from all orchidopexy procedures is rapid, with return to full activity within a few days. Sports may need to be restricted for 1–2 weeks and the boy is reviewed again at 6–12 months to ensure atrophy has not occurred. Boys with primary maldescent (especially bilateral) and those with impalpable testes would be advised to return at 14 years of age for review of pubertal development and discussion about prognosis for cancer and fertility.

Complications that are most frequent are wound infection or haematoma, both of which can be avoided by meticulous haemostasis at operation and leaving the waterproof dressing in place for at least a week. The risk of testicular atrophy should be less than 5% and in most series it is 1–2%. Depending on the method used to fix the testis in the scrotum, there is a small risk of retraction of the testis back into the groin, requiring secondary orchidopexy.

The estimated risk of testicular cancer (between 15 and 40 years) is approximately 5–10 times higher than in a normal testis, although most pediatric surgeons anticipate the orchidopexy in early infancy (<1 year of age) may avoid this.

The estimated risk of infertility is about 30% for bilateral undescended testes and lower (but not normal) for unilateral cases. Whether these risks will disappear with early surgery remains unknown at this time. Because epididymal anomalies are commonly associated with cryptorchidism, it is likely that a small number of boys may be infertile subsequently because of epididymal-testicular dissociation, even if germ cell maturation is normal.

Long-term follow-up studies of treated varicoceles have shown a small but almost invariable recurrence rate. With the Palomo technique, performed either open or by laparoscopy, the recurrence rate is between 5 and 16%. It is significantly lower when the testicular artery is ligated together with the vein, but the development of a post-operative hydrocele occurs more often when the artery is ligated. Tauber’s antegrade sclerotherapy is an effective and also minimal invasive method, that is even easier and faster to perform as the laparoscopic procedure. The recurrence rate after 1 year is, in our hands, 6% but repeated sclerotherapy can easily be performed, and the testicular artery is spared.

Duplication of the renal pelvis and ureters is the commonest anomaly of the upper urinary tract. It occurs in approximately 0.8% of the population and in 1.8–4.2% of pyelograms. Commonly these are asymptomatic. However, they can challenge the diagnostic acumen with a wide variety of manifestations.

The objective of pyeloplasty is to achieve a dependent, adequate calibrated watertight pelvi-ureteric junction. There are different techniques available to repair a PUJ obstruction. The dismembered Anderson-Hynes pyeloplasty is suitable for the majority of patients with PUJ obstruction. Use of double-J ureteral stents has virtually eliminated ureteral leaks and early obstructions.

The vast majority of patients treated with any one of the standard pull-through procedures achieve satisfactory continence and function with time. The attainment of normal continence is dependent on the intensity of bowel training, social background and respective intelligence of patients. Mental handicap, including Down syndrome, is invariably associated with long-term incontinence.

We have used augmentation cystoplasty utilizing ileal patch for years with a negligible complication rate and satisfactory results with respect to the bladder compliance and capacity in the long-term followup. None of our patients needed secondary augmentation due to increased contractile activity.

Even after ileal segment is isolated from the gastrointestinal tract it retains its absorbable and secretory properties. As a result of the electrolyte exchange hyperchloremic metabolic acidosis may develop. The extent of the electrolyte exchange depends on the amount of intestinal surface area in contact with urine and the time that the urine remains in contact with the intestine. However, the patients with normal renal function prior to augmentation have adequate compensatory mechanisms and do not have significant problems with acute metabolic changes. Those patients who developed persistent severe metabolic changes have to be evaluated for insufficient bladder empting.

Duplication of the renal pelvis and ureters is the commonest anomaly of the upper urinary tract. It occurs in approximately 0.8% of the population and in 1.8–4.2% of pyelograms. Commonly these are asymptomatic. However, they can challenge the diagnostic acumen with a wide variety of manifestations.