Predictors of testicular viability in testicular torsion
Abstract Aim Testicular torsion (TT) requires prompt diagnosis and treatment to avoid testicular loss. Most studies have focused on the ideal work up to rule TT out in cases of acute scrotum. We attempted here to define objective criteria to select between orchidopexy and orchidectomy in patients undergoing surgery for TT. Patients and methods Fifteen boys with a median age at presentation of 7.8 (range 6.4–12) years undergoing surgical treatment for TT underwent color-Doppler ultrasound (CDU) preoperatively, and a bleeding test intraoperatively. Duration of preoperative history, degree of torsion, CDU findings and degree of bleeding were analyzed. Results Salvageability was independent of …
Transurethral incision of duplex system ureteroceles in neonates: does it increase the need for secondary surgery in intravesical and ectopic cases?
OBJECTIVE To evaluate the relevance of ureterocele ectopia and associated reflux on the outcome of duplex system ureteroceles (DSU) after neonatal transurethral incision (TUI). PATIENTS AND METHODS The study included 41 neonates with a diagnosis of DSU; the ureterocele was ectopic in 24 (58%). Before TUI, vesico-ureteric reflux (VUR) was present in 13 lower moieties (32%) and seven contralateral ureters (17%). TUI was always performed within the first month of life. The follow-up and management were tailored for each patient from the findings at ultrasonography, voiding cysto-urethrography and renal scintigraphy. Results of intravesical and ectopic DSU were compared using Fisher's exact tes…
Benign penile skin anomalies in children: a primer for pediatricians
Abstract BACKGROUND: Abnormalities involving the skin coverage of the penis are difficult to define, but they can significantly alter penile appearance, and be a cause of parental concern. DATA SOURCES: The present review was based on a nonsystematic search of the English language medical literature using a combination of key words including "penile skin anomalies" and the specific names of the different conditions. RESULTS: Conditions were addressed in the following order, those mainly affecting the prepuce (phimosis, balanitis xerotica obliterans, balanitis, paraphimosis), those which alter penile configuration (inconspicuous penis and penile torsion), and lastly focal lesions (cysts, nev…
Evolving management of adolescent varicocele
Abstract Objective To review the evolution in indications for treatment and treatment modalities for adolescent varicocele at our centre, and evaluate the impact of varicocelectomy on final outcome. Patients and methods Between 1995 and 2006, we treated 242 left varicoceles. Preoperative assessment included clinical evaluation, measurement of testicular volumes, and colour-Doppler ultrasound (CDUS). A subinguinal varicocelectomy was performed in 124 patients (group A), and a laparoscopic non-artery-sparing Palomo procedure in the remaining 118 (group B). In group B patients, CDUS was also used to investigate the functional anatomy of varicocele, and all the veins found to be refluxing were …
Is the stripping technique a tissue-sparing procedure in large simple ovariancysts in children?
Abstract Background Stripping of the cystic wall is performed by gynecologists to treat large ovarian cysts. Information in the pediatric population is poor. We prospectively evaluated the pathologic specimens of large ovarian cyst to determine whether the stripping technique is a tissue-sparing procedure even in this age. Methods We evaluated 5 patients. Samples were taken from the intermediate part of the cystic wall and from the layer covering the cyst during excision. The presence of ovarian tissue adjacent to the cyst wall, and the morphological features of the surrounding tissue were both evaluated. Pelvic ultrasound follow-up was also performed. Results Patients' mean age was 4.5 yea…
Re: A New Suture Material for Hypospadias Surgery: A Comparative Study
Megauretere primitivo: long-term outcome.
Preputial reconstruction in hypospadias repair
Summary Objective In principle, the prepuce can be reconstructed during hypospadias repair, but the procedure has not gained wide acceptance and preputial reconstruction (PR) is surrounded by several controversies. Material and methods A review is provided of the technique for PR, how PR combines with the other steps of hypospadias repair, the risks of complications related to the urethroplasty and specific to PR, and the results of PR with particular regard to the relevance for the patient and his family. Results PR can be important for patients requiring hypospadias repair and their parents. It can be performed in almost all patients with distal hypospadias except perhaps those with the m…
Work-related upper limb musculoskeletal disorders in paediatric laparoscopic surgery. A multicenter survey.
Abstract Background Surgeons are at risk for developing work-related musculoskeletal symptoms (WMS). The present study aims to examine the physical factors and their association with WMS among pediatric laparoscopic surgeons. Methods A questionnaire consisting of 21 questions was created and mailed to 25 pediatric laparoscopic surgeons (LG). 23/25 surgeons (92%) completed the survey. The questionnaire was analyzed and then split into 2 groups. Group 1 (LG1) included surgeons with greater laparoscopic experience, and group 2 (LG2) included surgeons with less important laparoscopic experience. In addition, we constructed and sent to the same surgeons a similar questionnaire focused on WMS aft…
Antibiotic prophylaxis in antenatal nonrefluxing hydronephrosis, megaureter and ureterocele
Observation is a conservative management option in infants with nonrefluxing hydronephrosis, primary nonrefluxing megaureter and ureterocele diagnosed postnatally following antenatal detection of hydronephrosis. Antibiotic prophylaxis might be a sensible regimen under these circumstances to prevent UTI in this population who are potentially at increased risk. However, studies examining the efficacy of prophylactic antibiotics are sparse in this setting. For each condition, prophylactic policies seem extremely variable, and UTI rates vary widely with comparable rates reported between patients followed on and off antibiotics. Overall, antibiotic prophylaxis seems unnecessary in patients with …
Discrepancy between power-Doppler voiding urosonography and voiding cystourethrography is not relevant for the management of primary vesicoureteric reflux
The aim of this study was to assess if discrepancy between power-Doppler voiding urosonography (PD-VUS) and voiding cystourethrography (VCUG) affects the management of patients with primary vesicoureteric reflux (VUR).Fifty-six children with suspected or known VUR were assessed both by PD-VUS and VCUG. Two independent observers, both pediatric surgeons, each aware of the results of only one imaging modality, advised children's management according to present care standards. Agreement between diagnostic findings at the two imaging modalities and between therapeutic advice of the two observers was evaluated using kappa statistics.PD-VUS diagnosed VUR in 3 patients and 6 ureteral units more th…
Urethrocutaneous fistula repair after hypospadias surgery
To evaluate and compare the success rates of simple and layered repairs of urethrocutaneous fistulae after hypospadias repair.The charts of 72 children who developed fistulae after hypospadias repair were reviewed; 39 had a simple closure of the fistula, whereas 32 had a 'pants over vest' repair, in all cases after excluding an impairment of urine outflow.The success rate at the first attempt was 74% for simple closure and 94% for the layered repair; at the second attempt it was 80% and 100%, the difference being statistically significant for both repairs.Although probably far from an optimal technique for repairing urethrocutaneous fistulae, the pants-over-vest repair allows a good success…
Associazione stenosi del giunto pielo-ureterale e reflusso vescica-ureterale omolaterale. Aspetti di fisiopatologia, diagnosi e terapia
Double-J stent insertion across vesicoureteral junction--is it a valuable initial approach in neonates and infants with severe primary nonrefluxing megaureter?
Abstract Objectives To evaluate the role of double- J stent insertion in perinatally detected primary nonrefluxing megaureters as a method to temporize treatment in patients with impaired renal function or to prevent function loss in patients treated expectantly, but deemed at high risk of deterioration. Methods Two neonates and 8 infants with a ureter greater than 10 mm and an obstructive excretion pattern, including 3 cases with renal function less than 40%, were selected to undergo double- J stent insertion for a 6-month period. Patients underwent surgery if the ureter redilated and the excretion pattern was obstructive at reassessment 3 months after stent removal. Results Stents were pl…
Esplorazione inguinale “open” nel vanishing testis intracanalicolare. E' sempre necessaria dopo laparoscopia diagnostica?
The hemodynamic approach to evaluating adolescent varicocele
During adolescence, the risk of developing a varicocele increases. Prevalence is less than 1% in boys aged younger than 10 years, but approaches that of the general adult population (about 15%) during puberty. For adolescent males with varicoceles, surgical risk factors have not yet been clearly delineated and clinical severity correlates poorly with prognosis. Fortunately, the widespread use of Doppler ultrasonography is transforming the diagnostic work-up for this demographic. A continuous reflux detected by color Doppler ultrasound (CDUS) is thought to have a negative prognostic value and evidence suggests that a peak retrograde flow above 38 cm per second is a powerful predictor of lack…
Complications of trans-anastomotic externalised stents in open pyeloplasty: influence of the method of placement, the duration of stenting, and the associated bladder drainage
To assess the influence of the method for stent placement, the duration of stenting, and the presence of bladder drainage on the complication rate of open pyeloplasty. Patients and methods: Complications were, retrospectively, compared in 228 consecutive open pyeloplasties performed at institution A using a trans-pyelostomic 6-Fr splint/stent for 5 days and no bladder drainage, and 150 consecutive open pyeloplasties performed at institution B using a trans-nephrostomic 6-Fr splint/stent for 9 days plus bladder drainage. Results: Median age at surgery was comparable between groups. The overall complication rate was 13% and was comparable at the two institutions, but for the presence of perio…
Cisti endoaddominali nel neonato: un enigma diagnostico
Management of hydrocele in adolescent patients
Hydrocele is defined as an abnormal collection of serous fluid in the potential space between the parietal and visceral layers of the tunica vaginalis. In the majority of affected adolescents, hydrocele is acquired and is idiopathic in origin. The pathogenesis of idiopathic hydrocele is thought to be an imbalance in the normal process of fluid production and reabsorption. The diagnosis is usually clinical. Taking a thorough history is essential to rule out any fluctuation in size, which is an indication of a patent processus vaginalis. Scrotal ultrasonography is mandatory in nonpalpable testicles to rule out a subtending testicular solid mass requiring inguinal exploration. Otherwise, open …
Laparoscopic surgery of deferential reflux in pediatric and adolescent varicocele
BACKGROUND: This study aimed to assess whether deferential reflux in pediatric and adolescent varicocele can be successfully treated laparoscopically. MATERIALS AND METHODS: Since 2001 at our institution, 148 boys were evaluated for a left varicocele. Preoperatively,all the patients underwent ultrasound scan assessment of testicular volume and color-Doppler US (CDUS)to rule out reflux into the internal spermatic vein (ISV), deferential vein, or cremasteric vein. Boys with ISV reflux were treated by laparoscopic transperitoneal Palomo; boys with isolated deferential reflux or associated to ISV reflux were laparoscopically managed adding to the former procedure, coagulation or clipping of ref…
Chirurgia delle ipospadie prossimali: quale tecnica utilizzare?
Anatomia vascolare ecografica ed efficacia dell’eco-colordoppler nella diagnosi differenziale del varicocele
Pieloplastica open mininvasiva con approccio lombare posteriore: 20 anni di esperienza
Diagnostic laparoscopy in a Gartner's duct cyst
Gartner's duct cysts associated with renal dysgenesis are rare malformations and represent a diagnostic challenge. We report on one such case in which final diagnosis was achieved by laparoscopy and discuss the possible role of minimally invasive surgery in the management of this condition.
Preemptive hydrocelectomy in subinguinal varicocelectomy
<i>Background/Aims:</i> The hydrocele rate is very low after microsurgical subinguinal varicocelectomy, but microsurgical expertise is not always available in pediatric centers. We describe a modified technique to reduce the hydrocele rate after subinguinal varicocelectomy performed without an operating microscope. <i>Methods:</i> A retrospective review was performed of 142 non-microsurgical subinguinal varicocelectomies performed at a single pediatric center. In 96 patients, varicocelectomy was combined with the excision and eversion of the tunica vaginalis (‘pre-emptive hydrocelectomy’) while in the remaining 46 cases the vaginalis was left untouched. <i>Resu…
The role of Doppler ultrasonography in determining the proper surgical approach to the management of varicocele in children and adolescents
In a study from Italy, colour-Doppler ultrasonography was a reliable diagnostic tool in the preoperative assessment of patients with varicocele. The authors also found that it helped to distinguish those who could be treated laparoscopically from those who should be treated by microsurgical subinguinal ligature. OBJECTIVE To investigate whether colour Doppler ultrasonography (CDUS) is a reliable diagnostic tool for selecting patients with varicocele to undergo either laparoscopy or open microsurgical subinguinal ligation. PATIENTS AND METHODS In a 3-year period, 42 boys affected by left varicocele were evaluated before surgery by inguinal and scrotal CDUS. Using this method it was possible …
Failed hypospadias in paediatric patients
Failed hypospadias refers to any hypospadias repair that leads to complications or causes patient dissatisfaction. The complication rate after hypospadias repairs ranges from 5-70%, but the actual incidence of failed hypospadias is unknown as complications can become apparent many years after surgery and series with lifelong follow-up data do not exist. Moreover, little is known about uncomplicated repairs that fail in terms of patient satisfaction. Risk factors for complications include factors related to the hypospadias (severity of the condition and characteristics of the urethral plate), the patient (age at surgery, endocrine environment, and wound healing impairment), the surgeon (tech…
A new laparoscopic approach to varicocele in children and adolescent
Urethrocutaneous fistula repair after hypospadias surgery
OBJECTIVE To evaluate and compare the success rates of simple and layered repairs of urethrocutaneous fistulae after hypospadias repair. PATIENTS AND METHODS The charts of 72 children who developed fistulae after hypospadias repair were reviewed; 39 had a simple closure of the fistula, whereas 32 had a 'pants over vest' repair, in all cases after excluding an impairment of urine outflow. RESULTS The success rate at the first attempt was 74% for simple closure and 94% for the layered repair; at the second attempt it was 80% and 100%, the difference being statistically significant for both repairs. CONCLUSIONS Although probably far from an optimal technique for repairing urethrocutaneous fist…