Institutions which provide the basis for contemporary children's specialty units and pediatric clinical care first developed in the nineteenth and early twentieth centuries. These reflected efforts to care for urban populations of children brought together by the forces of industrialization and were often the work of altruistic individuals, typically but not exclusively, well-to-do women, who were motivated by compassion for children. Their primary mission was often to provide an acceptable level of charity care to poor children in their communities. This is, in fact, still the case for many major children's hospitals worldwide.

The concept that children are unique patients with particular developmental, physiological and psychological needs, for whom a demonstrably better outcome could be obtained with specialized medical care came more recently. With particular regard to children's surgical care, events detailed in Chapter 1 by Dr. Hendren (North America) and Dr. O'Donnell (Europe/UK) gave rise to what we recognize as contemporary pediatric surgery by the mid twentieth century. Specialization and credentialing were progressively driven by the view that the quality of care for children was improved by having practitioners fully dedicated to children, by providing focused professional training for individuals interested in childhood disease, and by creating a children's specific environment for the delivery of that care. The wider medical community has not been free of controversy over these points. Perceived economic threat and fear of professional or institutional loss remain powerful forces even today when we discuss issues like regionalization or consolidation of certain services.

The second edition of this book attempts to bring together and analyze what we currently know about the long-term effects of conditions and operative procedures in pediatric surgery and urology. The subject of long-term outcomes has been relatively neglected in the past. However, the realization that there is an ever-expanding cohort of children reaching maturity with a variable legacy from childhood surgical problems has prompted a more critical and detailed study of outcomes with the aim of optimizing current surgical practice. Encouragingly, all major international pediatric surgical meetings now include data on long-term outcomes. Furthermore, in the decade since the first edition of this text was conceived, the quality and relevance of the data are substantially more robust. Much more is now known about long-term function and quality of life. Data on outcomes provide a barometer for healthcare, indicating its efficacy, safety, acceptability, and sometimes its cost-effectiveness. Such data will be used increasingly to shape public policy and guide surgical practice. Perhaps, more than in any other field of surgery, it is necessary for pediatric surgeons and urologists to look critically at long-term outcomes and the effect these have on the quality of life of their patients and their families.

By inviting contributions from leading experts around the world including the USA, Europe, Australia, and Japan, we have collected together critical analyses of the literature, framed within the context of a wealth of institutional and personal experience. We are grateful to our many authors for their outstanding efforts.