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Byline: Mario. Lima, Simone. D'Antonio, Neil. Salvo, Giovanni. Parente, Beatrice. Randi, Michele. Libri, Tommaso. Gargano, Giovanni. Ruggeri, Vincenzo. Catania Context: Congenital lung malformation (CLM) is a rare developmental anomaly of [...]

Introduction: The uretero-pelvic junction (UPJ) is the most common site of obstruction in the pediatric upper urinary tract, causing hydronephrosis. In our institution, the gold standard approach for hydronephrosis in infants is the One-Trocar-Assisted Pyeloplasty (OTAP). The aim of this study is to evaluate the feasibility of OTAP in terms of efficacy and safety in the first 90 days of life. Methods: We retrospectively reviewed all charts and long-term follow-up of 138 infants treated with OTAP; we selected and examined the ones with a defined diagnosis of severe UJPO and, thus, treated in the first 90 days of life: 28 patients. Indications for early surgery were: antero-posterior pelvic diameter (APD) > 20 mm and an obstructive pattern on renography; impaired echotexture and/or relative renal function < 40% had to be associated. Results: Out of 23 patients, we witnessed one conversion to open surgery (4.35%) and one recurrence (4.35%) of UPJO. The mean pre-surgery APD was 35.2 mm, while the mean post-surgery APD was 17.32 mm. The mean operative time was 133 min. The mean hospitalization time was 7.71 days. The mean average of follow-up was 46.41 months (minimum 1 year). Conclusions: Our experience suggests that OTAP is a valid and feasible technique in terms of safety and efficacy for the early treatment of very young infants affected by UPJO.

Background: The aim of our study was to evaluate long-term patient satisfaction and quality-of-life improvement in grown-up patients treated for pectus excavatum with the Nuss procedure in the pediatric age, searching for correlation between preoperative characteristics and long-term outcomes. Methods: At first, we performed a retrospective analysis of pediatric patients undergoing the Nuss procedure in a 5-year period. We administered, at least 5 years after bar removal, a single-step questionnaire to focus on the assessment of patient satisfaction with operative results. Results: Most patients stated general health and exercise tolerance were improved after the operation. High levels of overall satisfaction were reported after Nuss repair, with 95.6% of patients being either satisfied or very satisfied. Overall, 87.0% of patients stated they would have the operation again. The high overall satisfaction after surgery was not correlated with the deformity severity and the presence of physical symptoms before correction. Conclusions: Patients expressed high levels of satisfaction in terms of self-image and quality of life. Improvement in cosmetic appearance and health in general translated in most patients in an improvement of social life. The degree of postoperative pain after the Nuss procedure is the overriding factor in the patient’s perception of the quality of the postoperative course.

Abstract: Background: Laparoscopic nephrectomy in children has gradually become a reasonable alternative to open nephrectomy and, besides, a retroperitoneal approach seems more logical than transperitoneal approach to perform nephroureterectomy for benign disease, as in open surgery. To further reduce the access-related complications, we propose a retroperitoneal one trocar-assisted nephrectomy (OTAN). We report our experience with minimally invasive OTAN for the treatment of benign renal disease. Methods: A total of 27 OTANs were performed at our institution between 2003 and 2009. The median patient age was 7.6 (range, 2–32 months). Indications for unilateral nephrectomy were multicystic dysplastic kidney (MCDK) in 23 cases (85.2%), dysplastic kidney in 3 cases (11.1%), and reflux nephropathy in 1 case (3.7%). Results: The median operative time from the initial incision to skin closure was 60 min. Perioperative transfusion was not required in any cases. No major perioperative complications developed. Conversion to open surgery was necessary in four cases (14.8%): in three cases for a small working space arising from a peritoneal perforation, and in one case for a difficult visualization of the parenchyma (renal fusion not detected by preoperative ultrasound evaluation). Most patients were allowed oral intake on postoperative day 1. The median hospital stay was 2 (range, 2–3) days; the cosmetic results were excellent. Convalescence was uneventful in all patients. Conclusions: Although the indications for a nephrectomy in case of benign disease remain limited, when a little child has small, poorly functioning kidneys that must be removed, a one trocar-assisted approach for nephrectomy is usefully a safe and effective treatment choice. The procedure can be easily performed through a small incision with minimal morbidity, comparable operative time, and excellent cosmesis without excessive postoperative pain issues, allowing early discharge home.

Müllerian duct remnants (MDRs) are present in a male pseudohermaphroditic form characterized by failure of the müllerian duct to regress due to insufficient production or peripheral action of müllerian inhibiting substance. The MDR can be asymptomatic but it often results in infections, stones and voiding troubles. Furthermore, it may develop into a neoplasm. Therefore, surgery is mandatory for large MDRs and symptomatic patients. Laparoscopic removal is described.

PurposeBladder exstrophy has recently become one of the several congenital malformations detectable prenatally by fetal ultrasonography, which implies the necessity of a correct prognostic evaluation of quality of life on which therapeutic termination of pregnancy may depend within the temporal limits stated by the law. While maintaining a preeminently informative role, prenatal counseling has gained increasing relevance for the quality of life long-term prognosis in adults affected by bladder exstrophy, particularly in regard to urinary continence, and sexual and reproductive problems in male and female individuals. We report a case of bladder exstrophy diagnosed at 22 week of gestation, and comprehensively review the literature on prenatal diagnostic tools and procedures as well as long-term followup in such cases.Materials and MethodsAt week 22 of gestation a woman underwent prognostic counseling due to the diagnosis of fetal bladder exstrophy made by prenatal ultrasound. After counseling the parents elected pregnancy termination. In addition, literature data were analyzed in regard to quality of life and bladder exstrophy.ResultsWe believe that the rarity of the prenatal diagnosis of this abnormality has resulted in the lack of a comprehensive review of necessary counseling criteria.ConclusionsWe suggest what we consider to be a valid counseling approach for parents after a prenatal diagnosis of bladder exstrophy.

•Vaginal paraurethral leiomyomas are uncommon benign tumors of the female genitourinary tract.•The recurrence and transformation into malignant condition are rare.•Diagnosis is based on histopathological examination; MRI and US can be useful to define the size and localization.•Management requires surgical vaginal excision; however, abdominal approach could be considered.

Pregnancy and childbirth are considered risk factors for the development of diastasis recti abdominis (DRA). This anatomical change could be on the basis of stress urinary incontinence (SUI). Aim of this study was to assess the relationship between the value of DRA and SUI, in order to understand, if a specific abdominal rehabilitation might be indicated.

The management of a “Complex Abdomen” (CA) and the choice of the best way or technique to deal with it is still a challenge for surgeons. When there are the criteria to define an abdomen as a complex one, whether in emergency or elective surgery, the abdomen may need to remain open to allow access for re-operation and time for decompression. The use of an “Open Abdomen” (OA) as a surgical option permits an easy re-exploration, the control of the abdominal contents, the reduction of the risk of intra-abdominal hypertension (IAH) and consequent Abdominal Compartment Syndrome (ACS) and the preservation of the fascia for closure of the abdominal wall [1–4]. Many different techniques have been described to manage the OA and the Temporary Abdominal Closure (TAC) [5–7]. This kind of approach to the CA, well known by pediatric surgeons and widely used in the management of large gastroschisis, is now used also in other situations. We describe our experience with the Bogotà bag in one young man and three children affected by different pathologies, in the first and third one the OA was necessary because of a massive peritonitis due to acute appendicitis while in the last two cases a congenital digestive malformation was present at birth. The Bogotà bag technique is safe, easily managed and less expensive than other techniques and can be safely used in children and young adults.

•Cholecystectomy is the only effective treatment for gallbladder polyps.•Asymptomatic lesions smaller than 1 cm in size should be annually monitored by ultrasound.•Surgical resection should be reserved for asymptomatic polyps larger than 1 cm or symptomatic patients.•Ultrasound screening of the gallbladder is recommended in metachromatic leukodystrophy.