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BackgroundThe endourological technique is a safe and effective approach in the treatment of large stones in the pediatric population with congenital malformations.IntroductionThe VACTERL association is a group of congenital malformations that include vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula with atresia, renal defects, and radial upper limb dysplasia. Renal anomalies are found in approximately 90% of patients.Materials and MethodsWe present a case of a 7-year-old girl with VACTERL association and cloacal malformations, undergoing multiple surgeries with subsequent Mitrofanoff continent appendico-vesicostomy. She presented at our attention for centimetric left ureteral and inferior pyelo-calyceal stones. She underwent flexible ureteroscopy with laser lithotripsy of both stones. A ureteral catheter and a nephrostomy tube have been left at the end of the procedure.ResultsThe ureteral catheter was removed in the 2nd post-operative day, the tubes were removed after a nephrostogram in the 8th post-operative day. The patient is stone-free. No complications were observed in the post-operative time.ConclusionsEndoscopy is the method of choice for the management of pediatric urolithiasis with complex renal calculi, due to its low incidence of major complications and a high stone-free rate.

Background Urolithiasis is a frequent complication in a heterotopic reservoir and the surgical management could be a difficult problem. Open surgery is not recommended in patients with multiple previous surgeries. A less invasive technique, such as the endourologic procedures, would allow high stone-free rate and low surgical morbidity. Introduction Stone formation in the reservoir is a well-known complication of urinary diversion. The incidence of lithiasis in patients with continent urinary diversion is reported as 12–52.5%. Most patients will have multiple physical factors, such as immobility, need for self-catheterization and poor urine drainage, so that it is not certain that an intestinal reservoir is the cause of stones on its own. The management of urolithiasis in continent urinary diversion can be challenging and could be a difficult problem to solve. A less invasive technique, such as the endourologic procedures, is desiderable, especially in patients with kidney transplant and low immune defence. Materials and Methods We present the case of a 59-year-old woman with previous history of spina bifida and with neurogenic bladder. At a pediatric age, she underwent incontinent urinary diversion using a sigmo-colic conduit. For several years she had been suffering from kidney stones and recurrent urinary infections, which led to a left nephrectomy for pyonephrosis, subsequent deterioration of renal function and dialysis. In 2004, we performed an atypical continent and self-catheterizable reservoir using the previous colic conduit detubularized and ileum-cecal tract with Mitrofanoff system conduit of 14 Fr size. Finally, kidney transplant was carried out as last surgical procedure. Recently she has come to our attention for multiple and large reservoir stones. Surgical Technique preliminary exploration of the continent pouch with flexible cystoscope. Percutaneous access with Endovision° direct control through the afferent conduit with 8 Fr flexible ureteroscope. Dilation of percutaneous tract with pneumatic baloon and positioning 30 Fr Amplats sheet. Lithotripsy, with ultrasound and ballistic sources, was performed and the residual fragments were removed with grasping. At the end of the procedure, after controlling the complete clearance with flexible nephroscope and X-ray a percutanous 12 Fr catheter and a 12 Fr Foley in the Mitrofanoff conduit were inserted. Results No fever or increase serum creatinine were observed in the post-operative time. On day 3, we removed the percutaneous foley and after 7 days we performed a cystography with a normal pouch configuration; no leakage or residual fragments were observed. The woman was discarge and returned to usual self-catheterization. The first 3-month post-operative control was regular; no infections or pain were reported. Conclusions In special cases, like this one, the percutaneous procedure is preferred to open surgery for a best control of the pouch and a simple complete clearence of the fragments.

Introduction The horseshoe kidney is the most frequent renal anomaly, with a prevalence of 0.25% and amale to female ratio of 3:1. Although the pathogenesis remains controversial, the consequences of the impaired urinary drainage are well known: up to two third of patients present with urinary stasis, infection and urolithiasis. Percutaneous nephrolithotomy (PCNL) is a successful procedure for urolithiasis in horseshoe kidneys. Materials and Methods A 9-year-old patient with a 4-cm stone associated with horseshoe kidney underwent Percutaneous nephrolithotomy (PCNL). During the procedure, a flexible uretheroscopy was performed in order to obtain a complete vision and an optimal management of the procedure. Results At the end of the procedure, the patient was stone-free. We reported no hemorrhagic complications, no pain and no infection. The patient was discharged after 48 hours. Conclusions The procedure is safe and effective, as long as the surgeon pays attention to the recommendations below.

An ageing general population, increase in average life span and prevailing benign prostatic hypertrophy bring an increasing number of elderly men to surgery for cervico-urethral obstruction. Given the small but significant morbidity of TURP, recently new mini-invasive techniques have been introduced for BPH, laser therapy being the most popular. The authors report on the different methods for delivering laser energy to the prostate, discussing the benefits and defects. They also present their personal experience with 44 patients aged over 75 years subjected to Nd:YAG laser prostatectomy from 1992 until today. In these patients transurethral laser evaporation, as suggested by Narayan and al., produced significant symptomatic and clinical results with low morbidity and invasiveness. The authors therefore believe that this kind of therapy may improve management of the elderly patient with BPH.

The Authors review their own surgical series about retropubic and perineal radical prostatectomy performed in 1993–2002 ys, with particular attention for risk factors of biochemical recurrence of disease.

We report a case of Churg-Strauss syndrome, with bilateral ureteral involvement. We describe the endourological approach to the disease and we also discuss the literature about this argument.

From January 1987 to June 1990, 40 previously untreated patients, 60–85 years old (mean 76.7 years) with C and D stage (according to AUS) prostatic adenocarcinoma, were administered analogous LH-RH goserelin and the non-steroid antiandrogen flutamide. The patients were followed until June 1992. 9 patients died from the disease. The treatment was well tolerated in 68% of the cases (27 patients); in the other 13 patients, the administration of flutamide caused secondary effects (gastro-intestinal intolerance, alterations of hepatic function). The administration of goserelin did not cause any secondary effect. The local response (assessed by transrectal echography) was good and in 31 cases consisted of a regression of the initial area from 25 to 50%. The performance status improved in 16 patients. 12 patients had a remission of pain. In all the patients, from the third month of treatment, the testosteronemia remained under 0.8 ng/ml; the prostatic alkaline phosphatase and the prostatic specific antigen presented a good correlation with the clinical evolution of the disease.

We present the results of our analysis on the operative efficiency of the Day Hospital since it opened on 27/04/92 in the Division of Urology of ULSS 4 Parma. This study has been performed by comparing both median stays in hospital for the numerically more representative surgical operations (prostatectomy, TURP, TURV) and by using the DRG system. The DRG specific cost for every hospitalization has also been calculated. Both systems show an increase in the number of treated cases and a decrease in the average hospitalization. This positive trend has been confirmed by the analysis of the costs.

We report the case of a 56-year-old male suffering from acute urine retention after a period of increasing dysuria. Physical examination, TRUS and CT showed the presence of a multilocular cystic mass in the space above the prostate and behind the bladder. Pathological findings following surgical exploration indicated a Müllerian duct cyst, few cases of which have been reported in literature. We performed surgery because malignancy was suspected and it was impossible to drain off all the cystic fluid due to the multilocular nature of the cyst. Moreover, cystic adenocarcinomas originating from Müllerian duct remnants have been reported. We agree with other authors that a percutaneous approach should be standard treatment in these cases, leaving open surgery for more complex cases.

We report a case of epididymis liposarcoma in a 76-year-old man, who about 6 months before had noted an oval, painless, well delimitable, non-light transmitting right hemiscrotal swelling apparently separated from the didymus. There was no inguinal lymphoadenopathy. A radical orchiectomy was performed. On the basis of clinical staging, that displayed neither local involvement, nor distant metastases, we believe, in accordance with literature, this surgical management can achieve definitive cure; other resolutions will be undertaken in case of relapse.