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1.
J Urol ; 165(6 Pt 2): 2363-5, 2001 Jun.
Article in English | MEDLINE | ID: mdl-11371979

ABSTRACT

PURPOSE: We explore the possibility of gaining suitable vesical capacity and continence in bilateral single ureters without having to resort to urinary diversion or bladder neck reconstruction. MATERIALS AND METHODS: In the last 10 years we treated 6 girls with bilateral ectopic ureters, and 2 with a single kidney and urethral ectopic ureter. Both ureters were ectopic in the urethra in 3 cases, and 1 ureter was inserted in the urethra and 1 in the bladder neck in the other 3. Preoperative examinations included ultrasonography, cystography, excretory urography and endoscopy in all cases, and magnetic resonance imaging in 2. Patient age at intervention ranged from 1 month to 8 years. RESULTS: Cross-trigonal reimplantation of the ectopic ureters through a correctly positioned neomeatus was performed in 7 cases. In 2 patients it was impossible to reach the ureteral insertion from inside the bladder (1 ureter in 1 and both ureters in 1), and so the distal tract of these ureters was resected extravesically as close as possible to the urethra. One patient with a single kidney also had an anorectal malformation and a rectovaginal fistula. She had pelvic renal ectopia and the ureter was inserted beneath the urogenital diaphragm causing minimal bladder capacity. Therefore, a sigmoid neobladder with appendicostomy was constructed according to the Mitrofanoff principle. A Young-Dees bladder neck plasty was done in 2 patients at the same time as ureteral reimplantation and 3 years later in 1. Followup urodynamics revealed more than acceptable continence. Bladder capacity was insufficient in only 1 polyuric patient. CONCLUSIONS: A bladder with bilateral ureteral ectopia is not necessarily useless, and the majority of patients can achieve normal bladder function and capacity along with normal transurethral voiding and satisfactory continence.


Subject(s)
Choristoma/physiopathology , Ureter , Urethral Diseases/physiopathology , Urinary Bladder Diseases/physiopathology , Urinary Bladder/physiopathology , Female , Humans , Infant , Infant, Newborn , Urination/physiology , Urodynamics
2.
J Pediatr Surg ; 34(12): 1836-8, 1999 Dec.
Article in English | MEDLINE | ID: mdl-10626867

ABSTRACT

BACKGROUND/PURPOSE: Vesico-ureteric reflux (VUR) is a common problem in children with neuropathic bladder. Lesser-degree VUR may be manageable by intermittent catheterization or by anticholinergics, but higher grades usually require surgical treatment. If left untreated, two thirds of such patients may experience deterioration of the upper renal tracts. The aim of this study was to compare the results of the STING (Subureteric Teflon Injection) technique with surgical ureteric reimplantation as treatment for VUR in neuropathic bladder. METHODS: From January 1981 to December 1996, 58 children with NB (81 ureters) were treated for VUR. STING and Cohen ureteroneocystotomy were performed in 40 and 41 ureters, respectively. Mean age was 4.5 years (STING) and 5.1 years (Cohen). RESULTS: Twenty-nine of 40 refluxing ureters (72.5%) were cured by STING, whereas Cohen eradicated reflux in 39 of 41 ureters (95.5%). No complications were observed in either group. All the ureters in which STING failed were treated successfully by Cohen ureteroneocystostomy. The 2 ureters still refluxing after surgical reimplantation were cured successfully by a single STING. The mean follow-up was 6.8 years in the Cohen group and 4.8 years in the STING group. During follow-up, no recurrence was observed in patients cured by open reimplantation. In the STING group, 2 previously cured ureters showed recurrence of VUR: both were treated successfully by a further STING. CONCLUSIONS: Open ureteral reimplantation is more effective than STING in correcting VUR in children with neuropathic bladder dysfunction. Nevertheless, the good success rate, the relative technical simplicity, outpatient nature, and rapid recovery point to STING as a safe and effective procedure for the initial treatment of VUR. Failure of STING does not preclude a successful open operation.


Subject(s)
Endoscopy , Polytetrafluoroethylene/therapeutic use , Replantation , Ureter/surgery , Urinary Bladder, Neurogenic/complications , Vesico-Ureteral Reflux/therapy , Adolescent , Child , Child, Preschool , Humans , Infant , Male , Polytetrafluoroethylene/administration & dosage , Retrospective Studies , Treatment Outcome , Vesico-Ureteral Reflux/etiology , Vesico-Ureteral Reflux/surgery
5.
Pediatr Med Chir ; 16(2): 181-2, 1994.
Article in Italian | MEDLINE | ID: mdl-8078797

ABSTRACT

Intraabdominal lymphangiomas are rare. A five-year-old girl with abdominal lymphangiomas was successful treated by excision of the mass and resection of short segment of small bowel. We present a case report.


Subject(s)
Lymphangioma, Cystic/pathology , Mesentery/pathology , Peritoneal Neoplasms/pathology , Child, Preschool , Female , Humans , Lymphangioma, Cystic/surgery , Mesentery/surgery , Peritoneal Neoplasms/surgery
6.
Eur J Pediatr Surg ; 2(3): 152-3, 1992 Jun.
Article in English | MEDLINE | ID: mdl-1498105

ABSTRACT

Vesico-ureteral reflux (VUR) is a relatively frequent and severe complication in neuropathic bladder, therefore it must be ruled out in every case, and prevented whenever possible. The Spina Bifida Center of our Institute is presently following 220 patients with neuropathic bladder, who undergo a periodical clinical and instrumental evaluation. Urodynamics has proved essential in detecting risk factors for VUR: small capacity bladders with reduced compliance, increased outlet resistance, and detrusor instability. Forty-eight cases of VUR, 38 of which were severe, were detected in a total of 166 patients reviewed for this paper. All patients with VUR were treated conservatively, attaining complete remission or improvement in 21 cases. Ten underwent surgical treatment owing to recurrent pyelonephritis or pyelo-renal reflux with severe dilatation, despite a standard pharmacological trial.


Subject(s)
Spinal Dysraphism/complications , Urinary Bladder, Neurogenic/surgery , Vesico-Ureteral Reflux/surgery , Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Male , Postoperative Complications/etiology , Spinal Dysraphism/surgery , Urinary Bladder, Neurogenic/etiology , Urodynamics/physiology , Vesico-Ureteral Reflux/etiology
7.
Eur J Pediatr Surg ; 2(3): 162-4, 1992 Jun.
Article in English | MEDLINE | ID: mdl-1498108

ABSTRACT

The authors present a case of pyloric and duodenal obstruction in an 8-year-old child, resulting from accidental ingestion of sulfuric acid. A marked pyloric and duodenal cicatrizing stenosis resulting from ingestion of sulfuric acid is seen infrequently, especially in pediatric age. Sulfuric acid produces a coagulation necrosis of the gastric mucosa and submucosa, and the process may involve the entire thickness of the gastric wall, with subsequent ulceration and fibrosis. This dynamic pathophysiologic event imposes postponement of surgical intervention because of various time length between ingestion of acid and onset of gastric outlet obstruction (17 days to 5 years). Clinical features included postprandial epigastric distress, repeated non-bilious vomiting, and marked weight loss. The authors also discuss the various surgical procedures that were employed to relieve the obstruction. Notwithstanding a potential risk of malignant evolution, a gastro-jejunostomy is the treatment of choice because of the age of the patient, and good postoperative results are confirmed by barium studies.


Subject(s)
Burns, Chemical/surgery , Duodenal Obstruction/chemically induced , Duodenum/injuries , Gastric Mucosa/drug effects , Pyloric Stenosis/chemically induced , Stomach/injuries , Sulfuric Acids/poisoning , Burns, Chemical/diagnosis , Child , Cicatrix/diagnosis , Cicatrix/surgery , Duodenal Obstruction/diagnosis , Duodenal Obstruction/surgery , Gastric Mucosa/surgery , Gastroenterostomy , Humans , Male , Pyloric Stenosis/diagnosis , Pyloric Stenosis/surgery , Ultrasonography
8.
Cir Pediatr ; 4(1): 8-11, 1991 Jan.
Article in Spanish | MEDLINE | ID: mdl-1904256

ABSTRACT

In the past eight years, we observed 23 cases of neonatal urethral obstruction: 15 posterior urethral valves, one urethral polyp, two urethral diverticula, one penile urethra hypoplasia, two syringoceles, one scafoid urethra, one urethral agenesis in Prune Belly syndrome. In most cases a prenatal diagnosis of uropathy had been made by ultrasonography that allowed a faster diagnosis and possibly a long-term better prognosis in those patients in which early treatment reduced postnatal damage. In all patients endoscopic resection was performed under direct view. In 14 of them endoscopic treatment solved the problem, while further surgery on the upper urinary tract was needed in the others. We had no stenotic nor other-short and medium-term complications. The incidence of renal dysplasia is high with posterior urethral valves, while upper urinary tract damages are sensibly less frequent with more distal obstructions.


Subject(s)
Urethral Obstruction/etiology , Diverticulum/complications , Humans , Infant, Newborn , Polyps/complications , Radiography , Spinal Dysraphism/complications , Urethra/abnormalities , Urethral Diseases/complications , Urethral Neoplasms/complications , Urethral Obstruction/diagnostic imaging , Vesico-Ureteral Reflux/complications
9.
Minerva Pediatr ; 41(4): 167-71, 1989 Apr.
Article in Italian | MEDLINE | ID: mdl-2770641

ABSTRACT

The quantity variations of glycosaminoglycans (GAGS) in urothelial samples from patients with malformations presenting infectious, obstructive or lithiasis signs have been investigated. They showed a highly significant deficiency in GAGS in patients with recurrent infections of the urinary ways, a more limited deficiency in sufferers from lithiasis and values within the normal range in patients with obstructive malformations.


Subject(s)
Glycosaminoglycans/analysis , Urinary Bladder/analysis , Urologic Diseases/physiopathology , Child , Child, Preschool , Epithelium/analysis , Female , Glycosaminoglycans/physiology , Humans , Infant , Male , Urinary Tract/abnormalities , Urinary Tract Infections/physiopathology
11.
Pediatr Med Chir ; 9(2): 201-7, 1987.
Article in Italian | MEDLINE | ID: mdl-3658804

ABSTRACT

The authors describe their experience on the surgical treatment of ureterocele in the pediatric age. The anatomic and clinical features which condition the choice between various therapeutic solutions are presented. All problems concerning any kind of different surgical approach are discussed, stressing the importance of the endovesical radical treatment.


Subject(s)
Ureterocele/surgery , Age Factors , Child , Endoscopy , Humans , Nephrectomy , Radiography , Ureterocele/diagnostic imaging , Ureterostomy , Urinary Bladder/surgery
12.
An Esp Pediatr ; 20(6): 597-603, 1984 Apr 15.
Article in Spanish | MEDLINE | ID: mdl-6742636

ABSTRACT

A protocol has been applied to all our patients consulting for nocturnal enuresis who also presented daytime wetting or urge to void, to rule out obstructive uropathies. Our protocol includes voiding cystourethrogram, IVP, cystometry and endoscopy. 64 females and 46 males, 4 to 14 year-old, were studied between 1980 and 1983. Obstructive urethral uropathy was ruled out in 37 females (58%) and 32 males (69%). The most common treatments in these patients were endoscopic resection (Bugbee) of posterior urethral valves in boys and resection of the distal ring in girls. All other associated diseases or malformations were treated according to their etiology. Results, analyzed through a questionnaire sent to parents, were good in 77% of the patients treated for obstruction. In conclusion we think that daytime wetting and urge to void are very frequently the emerging symptoms of a hidden uropathy, in most cases obstructing proximal or distal urethra. Surgical treatment can lead to a good cure rate.


Subject(s)
Enuresis/etiology , Urologic Diseases/diagnosis , Adolescent , Child , Child, Preschool , Endoscopy , Enuresis/therapy , Female , Humans , Male , Urethra/abnormalities , Urethra/surgery , Urethral Obstruction/complications , Urethral Obstruction/diagnosis , Urethral Obstruction/surgery , Urinary Bladder Diseases/physiopathology , Urologic Diseases/complications
13.
Pediatr Med Chir ; 4(4): 423-4, 1982.
Article in Italian | MEDLINE | ID: mdl-7170215

ABSTRACT

The authors report a case of a primary torsion of the omentum in an eleven-year old child who had been operated with a diagnosis of acute appendicitis. They take the opportunity to re-examine this idiopathic lesion with a review of world literature and case reports and they discuss the etiology, pathogenesis and pathology. The importance for the surgeon to inspect the omentum in all the so-called "negative" acute abdomen is enhanced.


Subject(s)
Omentum , Appendicitis/diagnosis , Child , Diagnosis, Differential , Humans , Male , Peritoneal Diseases/diagnosis , Peritoneal Diseases/etiology , Torsion Abnormality
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