Risk and protective factors for secondary procedures after endoscopic dilatation of primary obstructive megaureters.

PURPOSE: High-pressure balloon dilatation (HPBD) of the ureterovesical junction with double-J stenting is a minimally invasive alternative to ureteral reimplantation or cutaneous ureterostomy for first-line surgical treatment of primary obstructive megaureter (POM). The aim of our study was to identify the risk factors associated with the need for secondary procedures due to HPBD failure. METHODS: Prospective data were collected from patients who underwent HPBD for POM between 2007 and 2021 at a single institution. The collected data included patient demographics, diagnostic modalities, surgical details, results, and follow-up. Multivariate logistic regression analysis was performed. RESULTS: Fifty-five ureters underwent HPBD for POM in 50 children, with a median age of 6.4 months (IQR: 4.5-13.8). Nineteen patients (37.25%) underwent secondary ureteric reimplantation, with a median of 9.8 months after primary HBPD (95% CI 6.2-9.9). The median follow-up was 29.4 months (IQR: 17.4-71). Independent risk factors for redo-surgery in a multivariate logistic regression model were: progressive ureterohydronephrosis (OR = 7.8; 95% CI 0.77-78.6) and early removal of the double-J stent. A risk reduction of 7% (95% CI 2.2%-11.4%) was observed per extra-day of catheter maintenance. The optimal cut-off point is 55 days, ROC curve area: 0.77 (95% CI 0.62-0.92). Gender, distal ureteral diameter, pelvis diameter, dilatation balloon diameter and preoperative differential renal function did not affect the need for reimplantation. CONCLUSIONS: The use of a double-J stent for at least 55 days seems to avoid the need for a secondary procedure. Therefore, we recommend removing the double-J catheter at least 2 months after the HBPD.

A novel therapy for idiopathic urethritis in children: Local steroid injection.

Idiopathic urethritis (IU) is difficult to manage and there is no standarized therapy. The technique of local steroid injection (LSI) for the treatment of IU in children and the results of the patients undergoing LSI from 2020 to 2021 in a single center are presented. Seven patients with IU underwent LSI. An internal urethrotomy was also performed in two patients with stricture. Complete resolution of symptoms and signs occurred in six patients. The remaining patient did not achieve total remission but did substantially improve symptoms. LSI seems to be an effective alternative for treatment of IU in children.

Distal Urethral Advance and Glanduloplasty (DUAGPI) for Distal Hypospadias: A 15 Years Experience.

BACKGROUND: Meatal advancement with glanduloplasty (MAGPI) has been in the recent years one of the most frequently surgical techniques used for the correction of distal hypospadias. Multiple modifications have been described to improve the results ofthis technique. In 2004 we presented the initial results of the New Modern MAGPI or DUAGPI (distal urethral advancement and glanduloplasty) as a surgical alternative to the original MAGPI. OBJETIVE: The objective of the present study is to evaluate the applicability, safety and the cosmetic results obtained with this technique, as well as the long-term complications. MATERIALS AND METHODS: Retrospective and descriptive study of patients with distal hypospadias, corrected using the DUAPI technique, between 2002 and 2018. SURGICAL TECHNIQUE: Initially, an artificial erection was performed, the absence of curvature in all patients is proven. A skin denudation was performed up to the base of the penis in those children with a bend greater than 30. Second, the distal urethral disconnection was performed at the posterior and lateral urethral level. A glandular triangular section is made to accommodate the distal urethra and to allow a conical appearance with a final glandular. Finally, the fixation of the distal urethral to the glandular tip and the anterior glandular closure is performed. We performed an annual follow-up of all patients. The analysis of all the variables collected during surgery and follow-up was done with SPSS 22 statistical package. RESULTS: 90 patients meet inclusion criteria and were included in the study (32 glandular and 58 coronal). The mean surgical time was 47 minutes (Range: 37-71 minutes). The mean follow-up was 9.4 years (2.1-15 years). 2 patients had meatal stenosis after surgery, 4 mild glandular retraction, and 2 urethrocutaneous fistula. Six of the 8 patients with a complication were successfully reoperated. 92% of the patients and their families were satisfied with the cosmetic result obtained after surgery (83 patients). CONCLUSION: DUAGPI technique is simple, reproducible and optimal for most distal hypospadias. It is a safe technique, with a low complication rate. The final aesthetic result is satisfactory in most cases, with a conical glans and a natural cosmetic appearance.

[Commentary on Symptoms severity profile and expectations in hyperactive bladder patients. VHEXPECTA Study.] / Comentario sobre perfil de severidad sintomática y expectativas en pacientes con vejiga hiperactiva. Estudio VHEXPECTA.

Estimado Editor: Escribimos esta carta en relación al artículo publicado en su revista el pasado mes de Julio de 2020, por Castro-Díaz et al., titulado "Perfil de severidad sintomática y expectativas en pacientes con vejiga hiperactiva. Estudio VHEXPECTA" (1), y que hemos leído con gran interés. A propósito de este trabajo creemos conveniente ampliar la información ofrecida por sus autores, y plantear una serie de consideraciones por nuestra parte.

Estimado Editor: Escribimos esta carta en relación al artículo publicado en su revista el pasado mes de Julio de2020, por Castro-Díaz et al., titulado "Perfil de severidad sintomática y expectativas en pacientes convejiga hiperactiva. Estudio VHEXPECTA" (1), y que hemos leído con gran interés. A propósito de estetrabajo creemos conveniente ampliar la información ofrecida por sus autores, y plantear una serie deconsideraciones por nuestra parte.

Transcutaneous sacral electrical stimulation versus oxibutynin for the treatment of overactive bladder in children.

BACKGROUND: Nowadays there is still no ideal treatment for paediatric overactive bladder. Initial management measures (urotherapy and constipation control), resolve 40% of cases. The second line of treatment in overactive bladder is anticholinergic drugs, above all oxybutynin. Although most patients improve with these therapies, the complete resolution rate is around 30-40%. Sacral transcutaneous electrical nerve stimulation has recently emerged as a new alternative in the management of patients with refractory paediatric overactive bladder. However, only a few studies have been done to compare the effectiveness of this therapy versus conventional drugs. OBJETIVE: The objective of the present study is to compare, in children with overactive bladder, the efficacy of the sacral transcutaneous electrical nerve stimulation versus oxybutynin therapy. MATERIALS AND METHODS: We performed a prospective and randomized study of patients with diagnosis of overactive bladder treated with sacral transcutaneous electrical nerve stimulation versus oxybutynin, during the period July 2018-July 2020. Patients refractory to standard urotherapy and constipation management randomly received one of the therapeutic alternatives. Treatment was maintained for 6 months. RESULTS: 86 patients were included in the study: 40 patients received electrotherapy (group 1) and 46 patients received oxybutynin (group 2). Before starting the treatment assigned both groups were comparable related to the voiding symptomatology as well as the severity of the overactive bladder. Sacral transcutaneous electrical nerve stimulation was significantly more effective than oxybutynin, with a higher percentage of complete resolution of symptoms in the management of paediatric overactive bladder. VOIDING DIARY: All the parameters obtained with the voiding calendar significantly improved in both groups at the end of the treatment. The increase in MaVV was significantly higher in group-1. DVISS (DYSFUNCTIONAL VOIDING AND INCONTINENCE SCORING SYSTEM): We observed a progressive decrease in the mean score obtained in the DVISS questionnaire over time in both groups. This decrease was significantly higher in group-1 compared to group-2 (p < 0.005). The mean value obtained in the DVISS questionnaire in group-1 was 6 (interquartile range: 3-9) at the end of the treatment (lower than the diagnostic cut-off point for daytime condition in the DVISS, 8.5). In group-2, the mean value obtained in the DVISS questionnaire was 10 (interquartile range: 8.75-13.25), higher than the cut-off point. COMPLICATIONS: A greater number of adverse effects was obtained in group-2 (26.1% versus 15%, p < 0.05). Constipation (n: 6, 10.9%), and abdominal pain (n: 2,4.3%) were the most frequent adverse effects in this group. The adverse events reported in group-1 were contact dermatitis (n: 1.2%) and fecal losses [2] or urgency [5]. CONCLUSION: Oxybutynin and sacral transcutaneous electrical nerve stimulation are both effective therapies in the management of paediatric overactive bladder. However, electrotherapy has been shown to be a more effective therapy with a complete clinical resolution rate in a larger number of patients. Furthermore, the rate of adverse effects secondary to electrotherapy is significantly lower than those treated with oxybutynin.

Update on sacral neuromodulation and overactive bladder in pediatrics: A systematic review. / Puesta al día en neuromodulación y vejiga hiperactiva en pediatría: una revisión sistemática.

OBJECTIVES: Sacral electrical stimulation has been used for more than a century as an alternative therapy for adult urinary syndromes. In the literature, several studies have validated the efficacy of this technique based on clinical and urodynamic criteria. Nevertheless, few studies have shown beneficial results in children with overactive bladder. MATERIAL AND METHODS: We performed a systematic review of studies assessing the impact of sacral electroestimulation treatment on overactive bladder in children. The search identified 389 potentially eligible items. Of them, 14 studies published between 2001and 2019 met the study criteria and were selected for systematic review. RESULTS: All of papers included in this review individually demonstrated a high efficiency rate with good shortterm results, as well as safety in its use due to its minimalrate of adverse effects. However, the comparison of the results obtained in all of them was not possible because the high variety and heterogeneity in the different studies. The main limitation is that there is still no standard protocol for the application of this therapy in the pediatric population. CONCLUSION: This review revealed the promising benefits of sacral electroneuromodulation in pediatric patients with overactive bladder. However, more studies with strictly meet pediatric overactive bladder diagnosis and management criteria should be done to protocolize and clarify the effectiveness of this therapeutic approach.

OBJETIVO: La estimulación eléctrica a nivel sacro ha sido usada durante más de un siglo como una alternativa terapéutica más en el manejo de los síndromes urinarios entre la población adulta. A lo largo de la literatura múltiples estudios han corroborado la eficacia de esta técnica, basándose en resultados clínicos y criterios urodinámicos. Sin embargo, son escasos los estudios que analizan los potenciales beneficios de esta modalidad terapéutica en niños con vejiga hiperactiva.MATERIAL Y MÉTODOS: Realizamos una revisión sistemática de los estudios que analizan el impacto de la electroestimulación nerviosa sacra en el tratamiento de la vejiga hiperactiva en pediatría. La búsqueda identificó 389 trabajos potencialmente elegibles. De entre todos ellos, 14 estudios publicados entre 2001 y 2019 reunieron los criterios adecuados para ser seleccionados y formaron parte de la presente revisión sistemática. RESULTADOS: Todos los estudios incluidos en esta revisión demostraron de forma individual la alta eficacia y unos buenos resultados a corto plazo con esta terapia, así como su seguridad, dada la baja tasa de efectos adversos de la misma. Sin embargo, la comparación de estos resultados en todos estos estudios no fue posible, debido a la gran variedad y heterogeneidad en la metodología y la forma de expresión de los resultados entre todos ellos. El motivo que genera esta gran diversidad de resultados entre los diferentes trabajos incluidos en esta revisión es la falta de un protocolo estándar para la aplicación de esta terapia en la población pediátrica.CONCLUSIÓN: En conclusión, esta revisión revela los prometedores beneficios de la electroterapia nerviosaa nivel sacro en los pacientes pediátricos con vejiga hiperactiva. Sin embargo, es necesario realizar más estudios que analicen los efectos de este tratamiento. La metodología de los mismos deberá ser estricta, con unos criterios estandarizados sobre la inclusión de los pacientes, el diagnóstico de vejiga hiperactiva, y la medición de la eficacia obtenida. Así, será posible realizar protocolos de aplicación de esta modalidad terapéutica, y sus efectos podrán ser esclarecidos.

[Comparative analysis of the treatment of mid-shaft and distal hypospadias according to Snodgrass surgical repair and Mathieu technique.] / Reparación quirúrgica de los hipospadias medios y distales: análisis comparativo entre la técnica de Snodgrass versus técnica de Mathieu.

OBJECTIVE: The objective of this study is to perform an analysis of the patients who underwent middle and distal penile hypospadias repair using the two most widely used techniques in our Pediatric Urology Unit. MATERIAL AND METHODS: We perform a retrospective analysis of patients with a diagnosis of middle penile and distal penile hypospadias and operated by the Snodgrass or Mathieu technique, between 2011 and 2016 ensuring minimal follow-up of one year. We will analyze the use of each one, the results obtained, and the possible factors that could influence their success rate. RESULTS: A total of 80 patients were included in the study, with a median age of 28 months at surgery (Range: 11 to 151). There were 34 patients (42.5%) with Snodgrass technique and there were 46 patients (57.5%) with Mathieu technique. We have not identified statistically significant differences in complications between both surgical techniques. The percentage of fistulas is higher in Snodgrass urethroplasty (12.1% vs 8.9%), decreasing in the last years of the series, at the same time meatal stenosis is higher in Snodgrass technique (3% vs 2.2%) while the meatal retraction is higher in the urethroplasty of Mathieu (20% vs 15.2%). CONCLUSIONS: The exhaustive selection of patients seems the key in the succesful correction of these types of hypospadias. Despite both techniques are comparable in terms of the type of patient in which they could be applied and both techniques present similar rates in terms of fistulas and stenosis/retractions of the neomeatus (most frequent complications in this type of repairs), we consider that the characteristics of the patient should be prioritized before the preference of the surgeon to reach higher success rates.

OBJETIVO: El objetivo de este estudio es realizar un análisis de los pacientes intervenidos de hipospadias peneanos medios y distales mediante la realización de las dos técnicas más ampliamente utilizadas en nuestra unidad de Urología Pediátrica: técnica de Mathieu versus técnica de Snodgrass. MATERIAL Y MÉTODOS: En este trabajo se realiza un análisis retrospectivo de los pacientes con diagnóstico de hipospadias peneano medio y peneano distal, intervenidos mediante la técnica de Snodgrass o técnica de Mathieu, entre los años 2011 y 2016. El seguimiento mínimo de los pacientes, para formar parte de este estudio, fue de 1 año. Analizamos la tasa de empleo de cada técnica quirúrgica, los resultados obtenidos con cada una de ellas, y los factores que podrían influir en la tasa de éxito de las mismas. RESULTADOS: Un total de 80 pacientes fueron incluidos en el estudio. El 42,5% (34 pacientes) fueron intervenidos según la técnica de Snodgrass y el 57,5% (46 pacientes) según la técnica de Mathieu. La edad media de los pacientes en el momento de la intervención fue de 28 meses (Rango: 11-151). No existieron diferencias estadísticamente significativas entre las complicaciones de ambas técnicas quirúrgicas. El porcentaje de fístulas fue más elevado en la uretroplastia de Snodgrass (12,1% vs 8,9%). Esta complicación sufrió una disminución progresiva en los últimos años de la serie. Así mismo la estenosis meatal también fue más frecuente en la técnica de Snodgrass (3% vs 2,2%) mientras que la retracción meatal se presenta más frecuentemente tras una corrección según técnica de Mathieu (20% vs 15,2%). CONCLUSIONES: A pesar de ser técnicas comparables en cuanto a indicación, resultados y complicaciones presentando tasas similares en cuanto a fistulas y estenosis/ retracciones del neomeato (complicaciones por excelencia en este tipo de reparaciones), la selección de pacientes según las características del pene, debe ser prioritaria sobre la preferencia del cirujano.

Atypical presentation of Leydig cell tumour in three prepubertal patients: diagnosis, treatment and outcomes.

Background Testicular tumours are uncommon in children, accounting for only 1% of all childhood tumours. Prepubertal Leydig cell tumours actively secrete testosterone and as a result, patients typically present with isosexual precocious pseudopuberty, this being the first cause of consultation. We present three cases of Leydig cell tumours in prepubertal patients with an atypical presentation. Methods We studied three cases of Leydig cell tumours in prepubertal boys, who either consulted for testicular asymmetry or were incidentally found to have the tumour in the absence of systemic signs of systemic hyperandrogenism or precocious puberty. In all cases, a well-circumscribed testicular mass was found by testicular ultrasound. The diagnosis was confirmed by histology. In all three cases, testicular enucleation was performed with satisfactory follow-up. Results Following the surgical procedure, during the follow-up, all patients showed a normal testicular volume in comparison with the contralateral testis. No complications were seen during follow-up. Conclusions A testicular ultrasound in children developing asymptomatic testicular asymmetry might be recommended due to its possible hormonal action locally. An early testicular ultrasound, testicular swelling discrepancies, tumour size and androgen production are key factors in the prognosis and management of this type of tumour.

Dermal regeneration sheet Integra® in management of recurrent Urethrocutaneous fistula after hypospadias surgery.

BACKGROUND: Urethrocutaneous fistula UCF is the most common complication following surgical repair of hypospadias. Currently, the surgical technique mostly used to prevent recurrence employs preputial dartos or testicular tunica vaginalis flaps as a urethral covering. However, autologous tissues are limited in patients with multiple surgeries, and the use of biomaterials as a urethral coverage may represent a good alternative. OBJECTIVE: The goal of the present study is to assess the results and complications of recurrent UCF correction using a dermal bovine regeneration sheet as a urethral covering. MATERIALS AND METHOD: From May 2016 to January 2019, all patients with recurrent UCF of the authors center were repaired using this technique. The inclusion criteria were patients who had undergone one or more unsuccessful UCF repair surgeries and the absence of preputial tissue. The informed consent has been signed by all the patients. Patients were examined in outpatient consultations where their urinary stream was evaluated and a physical examination of the penis was conducted. RESULTS: A total of 12 patients and 13 UCFs were included in the study. The median follow-up was 18 months, (range: 4-26), and only two patients (15%) developed a recurrence of UCF. No complications were observed in the remaining patients (85%) during their evolution. No patient developed a fibrosis increase or loss of elasticity of the tissues in contact with the dermal matrix. CONCLUSION: The use of an Integra® sheet as a urethral covering during urethral fistula surgery appears to be a safe, effective, and easily reproducible option. However, prospective studies with larger numbers of patients should be performed to corroborate these results.

[Analisys of non-neurogenic lower urinary tract dysfunction patterns controlled in a Pediatric urodynamic unit.] / Análisis de los patrones de disfunción del tracto urinario inferior no neurógena controlados en una unidad de urodinámica pediátrica.

OBJECTIVES: Between 7-10% of schoolagechildren are seen by specialists for non-neurogeniclower urinary tract dysfunction (LUTD). The objective ofour study is to classify these functional alterations in difused for the diagnosis and treatment in each pattern. MATERIAL AND METHODS: We reviewed patients referredto our Urodynamic Unit for suspected LUTD for3 years; We reviewed epidemiological data, supplementarytest and treatments. We classified these patientsaccording to their diagnosis and we stablished a LUTDpattern. We analyzed the incidence of each pattern andthe differences in the management. RESULTS: We studied 96 patients. The mean age was7.91 years; with 53.1% children and 46.9% girls. Themost frequent symptom was diurnal urinary loss (75%),being also the most common reason for consultation(65%). 35.4% had bladder and bowel dysfunction (constipation35.4% and/or fecal incontinence 12.5%). Theprevalence of overactive bladder (56.4%), followed by:hypoactive bladder (21.9%), uncoordinated urination(6.3%), frequent urination syndrome (6.3%), urinary incontinencewith Laughter (5.2%) and post-void dribbling(2.1%). 51% of the patients presented a postponing habit.In 41.7%, the pathology was resolved with conservativemeasures. 52.1% of patients required anticholinergicsand 11.4% other therapies such as biofeedback. CONCLUSIONS: LUTD is a common disorder that maybe underestimated. The prognosis is favorable in mostcases but serious long-term complications such as renalfailure may occur. The symptoms of LUTD can negativelyaffect the child's psychosocial development. The advancesin the knowledge of this pathology and the differentpatterns of dysfunction have allowed an advance inthe treatment, making it more and more behavioral andpreventive. Patients who do not improve with standardurotherapy recommendations should be referred to specificunits for proper diagnosis and treatment.

OBJETIVOS: El 7-10% de niños en edadescolar son vistos por Disfunción del Tracto Urinario Inferior(DTUI) de origen no neurogénico. Nuestro objetivoes clasificar estas alteraciones en diversos patrones deDTUI y analizar su incidencia; además de describir lastécnicas utilizadas para su diagnóstico y tratamiento.MATERIAL Y MÉTODOS: Revisamos los pacientes remitidosa nuestra Unidad de Urodinámica por sospecha deDTUI durante 3 años; recogiendo datos epidemiológicos,pruebas y tratamientos y los clasificamos según supatrón de DTUI analizando la incidencia de cada unoy las diferencias su manejo. RESULTADOS: Estudiamos 96 pacientes. La edad mediafue 7,91 años; siendo el 53,1% niños y el 46,9%niñas. El síntoma más frecuente fueron pérdidas urinariasdiurnas (75%), siendo también el motivo de consultamás frecuente (65%). El 35,4% tenían clínica vésico-intestinal (estreñimiento 35,4% y/o pérdidas fecales12,5%). El patrón más frecuente fue la vejiga hiperactiva(56,4%), seguida de: vejiga hipoactiva (21,9%),micción no coordinada (6,3%), síndrome de micciónfrecuente (6,3%), incontinencia de la risa (5,2%), incontinenciade esfuerzo (4,2%) y goteo posmiccional(2,1%). El 51% presentan hábito posponedor. En el41,7% se resolvió el cuadro con medidas conservadoras,precisando anticolinérgicos en el 52,1% y otrasterapias como biofeedback en el 11,4%. CONCLUSIONES: La DTUI es un trastorno común quepuede ser infravalorado. Aunque el pronóstico es favorableen la mayoría de los casos, pueden ocurrir complicacionesserias a largo plazo como fallo renal y puederepercutir negativamente en el desarrollo psicosocial.Los avances su conocimiento y los distintos patrones dedisfunción permiten avanzar en el tratamiento haciéndolomás conductual y preventivo. Los pacientes que nomejoran con uroterapia standard deben ser remitidos aUnidades específicas para su diagnóstico y tratamiento.

The decline of axillary lymph node dissection in breast cancer. Evolution of its indication over the last 20 years. / El declive de la linfadenectomía axilar en el cáncer de mama. Evolución de su indicación durante los últimos 20 años.

INTRODUCTION: In last 20 years, lymph node staging procedures in breast cancer have been modified. The objective of this study is to describe the evolution of these procedures at our hospital. METHODS: A prospective observational study that included women with breast cancer who were treated surgically between 2001 and 2017. Four groups were identified according to the therapeutic regimen and 3 study periods defined by the lymph node dissection. RESULTS: 1319 patients met the inclusion criteria. Primary conservative surgery was the most frequent therapy (54.13%), and 615 (46.62%) axillary lymph node dissections (ALND) were performed in the 20-year study period. The percentage of ALND decreased progressively over time, going from 91% in the first period to 34% in the last period. The futile ALND fell to 6.6% in the last year. In the primary conservative surgery, no futile ALND was performed in the last two years. CONCLUSION: The introduction of sentinel lymph node biopsy and the ACOSOG Z0011 criteria have modified the indication for ALND. Thus, ALND without involvement have been reduced, thereby avoiding the associated morbidity. The study demonstrates the progressive decrease in the indication of lymphadenectomy in the different study groups, similar to reports by other authors. Several clinical trials have described that these changes have not negatively impacted survival.

[Integra™ artificial sheet as urethral covering during surgery for hypospadias sequel.] / Lámina artificial Integra® como cobertura uretral durante la cirugía de secuela de hipospadias.

Estimado Editor: Escribimos esta carta en relación al artículo publicado en su revista el pasado mes de Diciembre de 2017, por Tardáguila Calvo et al., titulado "Reconstrucción genital con dermis artificial Integra® tras resección radical en un niño con linfangiomatosis difusa" (1), y que hemos leído con gran interés. A propósito de este trabajo creemos conveniente ampliar la información de los autores compartiendo nuestra experiencia previa (2,3).

Estimado Editor: Escribimos esta carta en relación al artículo publicado en su revista el pasado mes de Diciembre de 2017, por Tardáguila Calvo et al., titulado "Reconstrucción genital con dermis artificial Integra® tras resección radical en un niño con linfangiomatosis difusa" (1), y que hemos leído con gran interés. A propósito de este trabajo creemos conveniente ampliar la información de los autores compartiendo nuestra experiencia previa (2,3).

Negative Pressure Wound Therapy for a Complicated Abdominal Laparotomy in Neonatal Necrotizing Enterocolitis: A Case Report.

Necrotizing enterocolitis (NEC) is the most common surgical emergency in neonatal intensive care units, and patients who require surgery have high mortality and morbidity rates. The utility of negative pressure in the management of adults with complicated abdominal wounds has been documented, but there are few reports describing the use of negative pressure wound therapy (NPWT) in children or following neonatal surgery. The case of a 6 day old, 5-weeks premature neonate with NEC is presented. An exploratory midline laparotomy was performed on day 3 of life owing to rectal bleeding and abdominal distension that did not respond to gastric decompression, bowel rest, and intravenous antibiotics. Ten (10) cm of necrosis in the distal ileum were noted and resected; in addition, an ileostomy was performed, and a Penrose drain was left in the surgical site. On postoperative day 5, the laparotomy dehisced. Continuous NPWT (50 mm Hg) was initiated and changed owing to patient tolerance to intermittent therapy (5 minutes on, 30 seconds off) at 80 mm Hg. By postoperative day 11, granulation tissue formation was complete. No surgical procedures were required for the complete closure of the abdominal wall, and no adverse reactions were noted. The baby was discharged from the hospital on postop day 15. In this patient, the use of negative pressure was found to be safe and facilitated management of a complicated abdominal wound in the presence of a stoma and the formation of healthy granulation tissue. Additional research is needed to help clinicians provide optimal, evidence-based care for dehisced wounds in this vulnerable population.