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Introduction Ureteropelvic junction obstruction is the most common pediatric obstructive uropathy. Retroperitoneal lap- aroscopic-assisted dismembered pyeloplasty (OTAP) combines the advantages of a retroperitoneal approach with the high success rate of the open technique. A modification of the OTAP, using a posterior muscle-sparing incision to approach the kidney, is described. Surgical technique With the patient placed in prone position, a transverse 15-mm-long skin incision is made. A 12-mm bal- loon Hasson trocar with operative telescope is inserted after the Gerota’s fascia has been opened. The ureteropelvic junction is exteriorized and a traditional dismembered pyeloplasty is performed. Discussion The posterior approach allows a quick and easy access to the renal lodge and does not require the incision of abdominal wall muscles and the parietal peritoneum does not interfere with the procedure. Furthermore, the exteriorization of the ureteropelvic junction is easy, because the space between its natural position and the skin is short, consisting only in subcutaneous tissue. Conclusion The posterior modified approach to the kidney for OTAP procedure is a good option, as an alternative to lum- botomic lateral access, allowing a good visualization of the kidney lodge, together with easy and rapid exteriorization of the ureteropelvic junction.

Background Female vaginoplasty reconstruction, by choice, is usually performed with adjacent tissue. However in some clinical conditions such as high urogenital confluence sinus, cloacal malformation with extreme vaginal hypoplasia, local tissue may not be available. When vaginal replacement is performed in pediatric patients intestinal segments is preferred to non-operative procedures that require continuative dilations. However mucus production, malignant transformation risk and diversion colitis are important side effects. Technique We present a nouvel technique for vaginoplasty in a female child presenting with an isolated urogenital sinus malformation without virilization. The patient at 20 months underwent vaginoplasty using tubularized bladder mucosal graft. Results Surgical procedure was devoid of complications. Pubertal development occurred at age of 15. She underwent regular follow up until 18 years of age. At this age we performed clinical evaluation: absence of vaginal introitus stenosis and good cosmetic results were observed. Then she underwent vaginoscopy with multiple biopsies. Pathology examination of the bladder mucosal graft evidenced a normal structure of the mucosa, with a stratified squamous epithelium. Discussion Different techniques are taken into account for vaginal reconstruction according to the severity and to the type of malformation. We describe the use of bladder mucosal graft with favorable results after long term follow-up.