Long-term psychosexual adjustment of adults born with classic bladder exstrophy.

Background: In literature studies exploring long-term psychosexual development and intimacy of adults living with the complex genitourinary conditions associated with classic bladder exstrophy (BE) are scarce, with small sample sizes and lacking in methodology.

Objective: This study aims to examine areas of potential psychosexual distress in adults born with classic BE to develop targeted clinical interventions.

Study Design: The validated Sexrelation Evaluation Schedule Assessment Monitoring (SESAMO) questionnaire was administered to all BE patients aged ≥18 years operated on in our tertiary referral center during infancy.

Robotic partial nephrectomy for complex kidney cyst in a 4-year old boy: Points of technique.

Complex kidney cysts are rarely observed in childhood. In adult patients, when radiological studies found a suspicious renal lesion, the gold standard is surgical asportation. The robotic surgery is well known as a secure procedure for treatment these patients, and is nowadays a real alternative also for pediatric patients.

Ovotesticular differences of sex development: male or female? Case series.

Background: The choice of the sex of rearing in patients with ovotesticular differences of sex development (OT-DSD) is difficult. The final decision should be given by the patient himself or herself, but families' opinion is not to neglect especially when the diagnosis is precocious and the patient can't give the consent to medical or surgical procedures. How should we behave if the parents refuse to raise a child with genital ambiguity?

Case Presentation: We describe and comment on our multidisciplinary approach in three patients with neonatal diagnosis of OT-DSD.

Psychosexual development management of bladder exstrophy epispadias in complex patients.

Introduction: Bladder-exstrophy-epispadias complex (BEEC) represents a spectrum of urogenital step-wise malformations: epispadias, complete exstrophy, and cloacal exstrophy. Psychosexual development in adolescent patients with BEEC may become especially problematic. At present, there are few contributions in the literature investigating the validity of psychosexual treatment in order to tackle this particularly emotional and personal development phase.

Preputial reconstruction in hypospadias repair.

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.

Qualitative questionnaire on the psychosocial wellbeing of mothers of children with BEEC.

Introduction: The bladder exstrophy-epispadias complex (BEEC) represents a spectrum of malformations that affect the anatomical and functional structure of the urogenital system. The parents of patients affected by this condition are subject to particularly stressful situations, such as worrying about their child's health, long hospital stays, concerns about the health and constant need for personal care for their children, that can profoundly compromise the quality of family life.

Objective: The objective of this explorative qualitative study is to evaluate the social situation and the psychological strategies implemented by the mothers of children between 6 and 10 years of age who are affected by BEEC.

When a lymphatic malformation determines a bowel volvulus: Are clinical status and images always reliable?

Introduction: An acute abdomen in the form of small-bowel volvulus could be a presentation of a lymphatic malformation in childhood.

Case Presentation: A 5year old male was admitted to our Institute for an acute abdomen. Clinical aspects and radiological images were not specific for a certain diagnosis.

Does Preputial Reconstruction Increase Complication Rate of Hypospadias Repair? 20-Year Systematic Review and Meta-Analysis.

Introduction: We performed a systematic review of the literature on preputial reconstruction (PR) during hypospadias repair to determine the cumulative risk of preputial skin complications and the influence of PR on urethroplasty complications, namely, fistula formation and overall reoperation rate of the repair.

Materials And Methods: A systematic search of the literature published after 06/1995 was performed in 06/2015 using the keyword "hypospadias." Only studies on the outcome of PR in children, defined as dehiscence of the reconstructed prepuce or secondary phimosis needing circumcision, were selected.

Perforated appendix with abscess: Immediate or interval appendectomy? Some examples to explain our choice.

Introduction: There are no clear guidelines in the treatment of a perforated appendicitis associated with periappendiceal abscess without generalized peritonitis.

Presentation Of Cases: We retrospectively studied six examples of treated children in order to discuss the reasons of our team's therapeutic approach. Some children were treated with a conservative antibiotic therapy to solve acute abdomen pain, planning a routine interval appendectomy after some months.

Informative nursery rhymes: a pilot study of children's satisfaction.

Background: The aim of this study was to assess, by means of a questionnaire, the level of children's satisfaction relating to three informative charts, including a nursery rhyme, administered to the patient before a medical procedure.

Methods: We created three types of specific informative charts on three medical topics with the double function of informing the child before the medical procedure, and of distracting him/her by means of a nursery rhyme read aloud by the authors. To assess the level of children's satisfaction, we administered the patients a questionnaire.

[Fistulas of the lower urinary tract in children].

A lower urinary tract fistula consist in an abnormal connection between bladder, urethra and adjacent abdominal organs or skin. There are several types of urinary fistulas in paediatric age and they may be congenital or acquired. Etiology may be due to embriological defects, infectious processes, malignant tumours, pelvic irradiation as well as complications following surgical procedures, especially postsurgical repair of hypospadia or epispadia.

Bladder urothelial neoplasms in pediatric age: experience at three tertiary centers.

Introduction: Urothelial bladder neoplasms (UBN) typically occur in patients in their sixth or seventh decade of life while they are infrequent in children and young adults. They occur in 0.1-0.

Oncologic outcome and urinary function after radical cystectomy for rhabdomyosarcoma in children: role of the orthotopic ileal neobladder based on 15-year experience at a single center.

Purpose: We determined the oncologic and urological outcomes in patients with bladder/prostate rhabdomyosarcoma according to the type and timing of urinary tract surgery, with emphasis on the role of the Padua orthotopic ileal neobladder.

Materials And Methods: We retrospectively analyzed oncologic and urological outcomes of 11 consecutive patients treated at our institution between 1998 and 2012.

Results: Two patients underwent urethrectomy and placement of a heterotopic catheterizable ileal neobladder.

Ureteral complications after renal transplant in children: timing of presentation, and their open and endoscopic management.

We retrospectively reviewed the records of 24 consecutive patients undergoing treatment for ureteral complications after RTx in the period 2001-2012 to determine the timing of presentation of the complications, and their open or endoscopic management. Three patients (12%) had a necrosis of the transplanted ureter soon after RTx. All required open urinary diversion in a native ureter.

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.

Dismembered extravesical reimplantation of dilated upper pole ectopic ureters in duplex systems.

Purpose: We report the results in patients with obstructed upper pole ectopic ureters in duplex systems undergoing dismembered extravesical reimplantation of the upper pole ureter alone.

Methods: Between 01/2007 and 03/2012, 11 patients with an upper pole ectopic ureter (1 bilateral) diagnosed following the antenatal detection of hydronephrosis and showing preserved function on renal scintigraphy in a dilated upper moiety, underwent a dismembered reimplantation of the ectopic upper pole ureter as follows. The ureter was identified, separated from the lower pole ureter, and divided just above the bladder.

Primary severe hypospadias: comparison of reoperation rates and parental perception of urinary symptoms and cosmetic outcomes among 4 repairs.

Purpose: We compared complication rates, urinary symptoms and cosmetic outcomes as perceived by parents of patients undergoing 1 of 4 repairs for proximal hypospadias associated with ventral curvature.

Materials And Methods: A total of 93 patients underwent hypospadias repair between 2004 and 2010. In patients requiring no urethral plate transection the repair consisted of tubularized incised plate urethroplasty (26 patients) or onlay island flap urethroplasty (31).

Scrotal dermoid extending to the posterior urethra through a corpus cavernosum in a child.

A 3-year-old boy presented with an asymptomatic intertesticular mass increasing in size. Plasma tumor markers (α-fetoprotein and β-human chorionic gonadotrophin) were negative. The mass had a pattern similar to testicular parenchyma but no discernable blood flow on scrotal Doppler ultrasound.

Duplex system ureterocele in infants: should we reconsider the indications for secondary surgery after endoscopic puncture or partial nephrectomy?

Objective: We assessed outcomes and need for secondary surgery after primary trans-urethral puncture (TUP) or upper pole partial nephrectomy (UPPN) in duplex system ureterocele (DSU) patients undergoing management that disregards vesicoureteral reflux and upper pole function.

Subjects And Methods: Between 2003 and 2010, 41 DSU <1 year underwent TUP (n = 32) or UPPN (n = 9). Postoperatively, additional investigations and surgery were limited to cases showing persistent hydroureteronephrosis or developing recurrent febrile urinary tract infections (UTI).

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.

Preperitoneal repair of inguinal hernia.

From 2007 to date, fi ve boys with bladder exstrophy underwent this pre-emptive treatment of inguinal hernia at our institution. None has developed a recurrence after a median (range) follow-up of 29 (5 – 46) months. This approach avoids any manipulation of the inguinal canal, which is an advantage per se, but may be even more important in children with bladder exstrophy given the relatively high risk of hernia recurrence reported [ 1,2 ] .

Clinico-pathological correlation in duplex system ectopic ureters and ureteroceles: can preoperative work-up predict renal histology?

Purpose: Upper pole histology has been poorly investigated in duplex system ectopic ureters and ureteroceles. We aimed to determine the differences in histology between the conditions, and to identify clinical markers of renal damage.

Methods: Twenty-two patients undergoing partial nephrectomy between 2001 and 2007 for poorly functioning upper poles associated with ectopic ureters (n = 11) or ureteroceles (n = 11) were considered.