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Ureterocele is a cystic dilatation of the intravesical submucosal ureter, with an obstructed orifice. Endoscopic treatment is one of the most common option for surgical treatment. In intravesical ureterocele, the punctures must be made just above the junction between the ureterocele and the bladder floor. We commonly use a 8–9.8 Fr cystoscope, with a 5 Fr working channel, a metallic needle for bulking agent injection 3.7 Fr. In selected cases we also use electric or laser probes to decompress the ureterocele. When evidence of decompression is verified and vesicoureteral reflux is excluded, antibiotic prophylaxis is stopped. If, despite decompression, a large ureterocele is subsequently obstructing the bladder neck a surgical excision is necessary. Forty-four patients (92%) were treated endoscopically. Ureterocele puncture was performed with a metallic needle for bulking agent injection in 30 cases (63%), with a laser fiber in 7 cases (15%), with an electrified ureteral catheter in 4 cases (8%), and with Bugbee in 3 cases (6%). A success rate after one procedure was achieved in 40 children (83%). Adequate opening of the ureterocele with complete decompression of the reno-ureteral system is the goal of endoscopic treatment. An overaggressive incision or puncture could result in an increased chance of secondary vesicoureteral reflux. [ABSTRACT FROM AUTHOR]

Urolithiasis is a common disorder born with the first hominids and the earliest texts describing symptoms date back to 3200 BC in Mesopotamia. The symptoms have always been the same, whereas the possibility of treatment has changed throughout the history. Gaius Plinius Secondus, known as Pliny the Elder, in his work "Naturalis Historia," described the pain produced by a urinary stone as an excruciating torment. When there was not an effective remedy, could this atrocious torment change the lives and choices of men? When the affected people were kings, powerful, or artists, could renal colic affect their political decisions or their artistic works? I answer positively to these questions. I will set some historical facts to demonstrate this. We will see how the surgical treatment of urolithiasis contributed to separating medicine from surgery in medieval Europe. I will tell how an archer's life was saved by perineal lithotomy surgery. I will try to prove that Michelangelo Buonarroti left traces of his stone disease in the Sistine Ceiling. Finally, I will connect the foundation of Rome, capital of the Kingdom of Italy, to bladder stones. A cultural-scientific game, not a historical treatise, in which I will try to connect some important events to urinary calculi.

Background: External compression is used for pectus carinatum (PC) treatment, but many patients are noncompliant. Costal cartilage resection (CCR) has been described as an alternative, but these approaches sacrifice the internal thoracic arteries (ITA). We aim to assess the feasibility of CCR sparing ITA comparing thoracoscopic and subcutaneous endoscopic approaches., Methods: Twelve pigs were used as models for surgical PC correction and randomized for 2 groups: thoracoscopy (T) and subcutaneous (subpectoralis) endoscopy (SP). In both groups, CCR from 3rd 4th and 5th ribs was performed avoiding ITA damage. ITA preservation was confirmed by Doppler-ultrasound as well as postmortem injection of methylene blue. Four persons evaluated the procedures being difficult, using a 6-item modified validated scale., Results: In both techniques, the procedure was accomplished in all animals sparing ITAs. CCR was faster in T than in SP (49±5 vs. 65±16minutes, p<0.05). T was classified as easier than SP (p<0.001) with a significantly higher score for all items, especially better image and tissue handling., Discussion: Sparing the ITAs during CCR for correction of PC is feasible in a porcine model and might be a goal in humans. The thoracoscopic approach allows for a faster and easier procedure., (Copyright © 2016 Elsevier Inc. All rights reserved.)