BACKGROUND: Surgical site occurrences (SSO) contribute to the morbidity and cost of postoperative complications. In adult and pediatric surgical literature, enthusiasm for incisional negative pressure wound therapy (iNPWT) on closed surgical incisions has been ongoing. OBJECTIVE: The aim of this pilot study is to report the early outcomes of iNPWT in reconstructive pediatric and young adult urologic surgery. STUDY DESIGN: This is a pilot prospective cohort study at a single, tertiary care, free-standing children's hospital. Wound complication outcomes with use of iNPWT are compared to a historical cohort that underwent routine incision closures. A multivariate logistic regression model was used to predict the risk of composite SSO within the first 30 days after surgery. RESULTS: On univariate analysis, the percentage of patients experiencing SSO fell from 24.0 % to 6.9 % with introduction of iNPWT (p = 0.065). On multivariate analysis, compared to the pre-iNPWT group, placement of iNPWT was associated with a reduction in risk of composite SSO [OR 0.084 (0.009-0.415, p = 0.01]. DISCUSSION: Strengths of this study are that it was prospective in nature and there was consistency in iNPWT placement and management throughout the study period. Until more reliable biological markers of SSO risk are available, we believe that interventions to prevent SSO must be broadly applied. One limitation is that the financial and physical cost of having an iNPWT placed could not be measured for each individual patient. CONCLUSION: In this pilot study, iNPWT was found to be a successful intervention to reduce SSO in reconstructive pediatric and young adult urology patients. Use of iNPWT could be considered for all, but perhaps particularly in those with a baseline high risk of SSO, including those with obesity or connective tissue disorders.