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PubMedDate not supplied

[Long-term non-deforming urinary infections in childhood. 2. Proposed treatment and results].

In the second part of the Authors work, they report the results obtained in the treatment of 85 female children with recurrent non malformative urinary tract infections. The first group of 15 female children had been treated with phenoxybenzamine and urinary chemyotherapycs with little satisfaction. The other two groups, both of which consisted of 35 children, one group was treated with only chemyotherapycs and the other with chemyotherapycs associated to oxybutynin chloride. The best results were obtained in the last group regarding the improvement of the symptoms and earlier and higher incidence of sterilization of the urine. At the same time in this group the maximum cystometric capacity and vesical compliance were brought back to normal and the detrusorial instability disappeared.

Anti-Infective Agents, Urinary↗

PubMedDate not supplied

[Ureterocele: study of 66 cases observed in 60 children].

Ureterocele is an unfrequent urinary malformation in pediatric age, but frequently it is clinically severe. Ureterocele in a double pyelo-ureteral system often presents very difficult treatment problems not uniformely dealt with. Authors report their experience with 66 ureteroceles observed in 60 children; more than a half of which were less than one year old. In the authors experience simple ureterocele does'nt give any surgical problem. On the contrary ectopic ureterocele, almost always associated with a pyeloureteral duplication, frequently gives some problems of surgical treatment. Treatment is always individualized but in our experience the best results have been achieved with unroofing of the ureterocele and upper heminephoureterectomy in one stage. This treatment can be used successfully in the majority of ectopic ureteroceles in pediatric age.

Adolescent↗

PubMedDate not supplied

[Gastroesophageal reflux update].

Authors describe importance of anatomical and functional factors in ethiopatogenesis of G.E.R., diagnostic iter and methods. Importance of 24-hour computerized pH-metry in pediatric age is particularly stressed out. Medical and surgical therapeutic procedures are emphasized.

Antacids↗

PubMedDate not supplied

[Long-term non-malformative urinary infections in children. (I)].

Non malformative long term urinary tract infections affect above all the female sex. The specific anatomic conditions explain only in part the predisposition for the female sex. Other determinants are the individual susceptibility and bacterial virulence. The authors studied 169 pediatric patients with recurrent urinary tract infections; of which 159 where females. The study of the blood group in 70 patients showed a net predominance of the groups B and AB. About one-third of the patients studied presented a scarce symptomatology or complete absence. The urodynamic study in 120 patients has revealed an abnormal pattern in more than 80% of the cases. According to the authors the abnormal urodynamic pattern is related to the long-term infection and is reversible in the cases which are curable. In about one-third of the cases with long-term infections which are resistent to the therapy, the cystoscopy has revealed a cystitis cystica. The study carried out by the authors permits precise indications on the specific tests that must be effectuated in this particular type of pathology and the indications of treatment.

Adolescent↗

PubMedDate not supplied

[Hydronephrosis in infancy and childhood].

Hydronephrosis in infancy and childhood is almost always congenital. In 80% of the cases is due to ureteropelvic junction obstruction, in 20% is due to anomalous renal vessels sometimes associated to ureteropelvic junction obstruction. The authors analyze their experience in the surgical treatment of this urinary malformation during a ten years period (1971-1981). 119 hydronephrosis out of 105 patients were operated on. The surgical procedures were successful in 93% of the 119 operated hydronephrosis and in 80% of the giant hydronephrosis. Primary nephrectomy was carried out in only 5% of the operated hydronephrosis (6/119). The Authors stress the importance of early diagnosis to improve surgical results.

Child↗

PubMedDate not supplied

[Cryptorchidism: anomalies of excretory ducts and azoospermia].

A range of epididymal and vasal anomalies (EVA), varying from ductal patency aberrations to abnormal attachments of the epididymis to the testis or even complete absence, exists in boys with cryptorchidism, but there are few studies of normal controls for comparison. In the present study anatomy of testicular-epididymal relationships were recorded in 517 cryptorchid patients (423 unilateral and 94 bilateral) and in 192 boys who underwent inguinal exploration for inguinal hernia or hydrocele. The postmortem anatomic relationship of the testis and epididymis in 50 adults was also examined. The operative findings were divided into two groups: simple variants of normal and forms of complete anatomic disconnection of the spermatic ducts (EVA). We were unable to find EVA in the control groups. In contrast EVA was present in the 20% of cryptorchid patients. The incidence was 16.5% in unilateral cryptorchidism and 26% in bilateral cases, in 17% of whom the EVA was bilateral. According to the literature and our previous study azoospermia is present in about 18-20% of adults operated upon in childhood for bilateral cryptorchidism. Our present study may suggest that azoospermia in adults operated on for bilateral cryptorchidism could be partially related to some forms of bilateral occlusion or interruption of the spermatic ducts.

Adult↗

PubMedDate not supplied

[Nonpalpable testis: current diagnostic and therapeutic trends].

Management of the nonpalpable testis often represent a significant diagnostic and therapeutic challenge for the pediatric surgeon. A variety of imaging studies may locate nonpalpable testis and include ultrasound, CT, MRI, gonadal vasography, and herniography, but none is completely reliable in locating a gonad or proving its absence. Laparoscopy has the advantage of great reliability in locating testes or proving their absence and can be coupled with surgical management; the laparoscopic findings determine the subsequent operative steps. Accurate knowledge of testis location facilitates development of an appropriate surgical strategy either laparoscopic or laparoscopic-assisted or open procedure. The Authors report their preliminary experience with laparoscopy in 30 patients (age range 2-5 years) with 34 nonpalpable testes: 18 testes were intraabdominal, 7 canalicular, 9 atrophic or absent. Out of the 18 intraabdominal testes 2 patients underwent orchiectomy (very small testes), 1 patient testis detorsion and 15 internal spermatic vessels clipping and cutting (first step of staging Fowler-Stephens orchidopexy). At the moment 8 patients, after a 8-10 months interval, underwent second staged vas-based orchidopexy with good results as judged by size and throphism of the relocated testes. An inguinal exploration has been made in 7 patients: 4 orchiectomy (hypo-atrophic testis), 3 standard orchidopexy. In 9 patients the testis were absent. In order to have a good-sized adolescent scrotal pouch, insertion of an infant-size testicular prosthesis is recommended for children with a vanishing or absent testis, if the parents agree.

Algorithms↗

PubMedDate not supplied

[Acute scrotum in children: analysis of 265 consecutive cases].

"Acute scrotum" in infants and children is generally due to testicular torsion, torsion of the appendix of testis or acute orchi-epididymitis. However they are other less frequent causes of "acute scrotum". The differential diagnosis is often very difficult. 265 consecutive cases of acute scrotum are reviewed. 47% of the all patients presented torsion of the appendix of testis, 26% torsion of testis and 26% acute orchi-epididymitis. The torsion of testis was most frequent in children under 1 year (67%), in the older patients the torsion of appendix of testis was most frequent (46% in patients 1-6 years old, 57% in patients over 6 years). The value and limit of ultrasound, scrotal scintigraphy and doppler ultrasound are discussed and an algorithm for the diagnosis of causes of acute scrotum is presented. In equivocal cases, early surgical exploration may be necessary to exsclude torsion of testis and to prevent testicular loss.

Acute Disease↗

PubMedDate not supplied

[Varicocele: an epidemiological study and indications for treatment].

The varicocele is still the most common correctable cause of male infertility. The epidemiologic studies revealed a gradually increasing incidence of varicocele in patients 10 to 18 years old, as height at the end of puberty as that of the adult male population. The pediatric varicocele is often associated with smaller and hypotrophic testis which presents also histological and progressive changes. Surgical correction of a varicocele in the adult usually produces poor results. In order to improve the fertility rate in adulthood an early varicocelectomy has been suggested. On the basis of our own studies and after a review of the literature, we conclude that all grade III varicoceles and grade II associated with testicular hypotrophy must be early operated on. This hearing provides a higher fertility rate and can prevent the reduced fertility associated with delayed varicocelectomy.

Adolescent↗

PubMedDate not supplied

[Current trends in the treatment of varicocele].

A varicocele first develops in early adolescence and it can negatively affect testicular growth, histology and function. The use of early varicocelectomy to prevent severe testicular damage and sub-infertility in adulthood seems to be incontrovertible. However there is a difference of opinion as to the proper surgical procedure of varicocele ablation. To date, the inguinal and high retroperitoneal approaches are the most commonly accepted methods. However significant postoperative morbidity is common, with a recurrence rate ranging from 1 to 25% and return to normal activity often is prolonged. This considerations have prompted many to search for alternative techniques. The Authors performed laparoscopic clipping and division of the internal spermatic vein or the internal spermatic vessels in 55 adolescents to treat varicocele. Indications for the operation were third degree varicocele and second degree with testicular hypotrophy. At a mean 6 months follow-up, they did not observe either relapses or complications; no hydrocele was noted and testicular size did not decrease in any patient. In the Authors' experience and opinion, laparoscopic varicocelectomy is a simple, safe, effective and minimally invasive surgical procedure and it can be proposed as a viable alternative to open traditional surgical methods.

Adolescent↗

PubMedDate not supplied

[Varicocele in childhood and adolescence and other testicular anomalies: an epidemiological study].

Although in the last years varicocele has being recognized with increasing frequency in the adolescents, it is still neglected in pediatric age. Recently several epidemiologic studies revealed an increasing incidence of varicocele in patients between 10 and 16 years, as high at the end of puberty as that of the adult male population. Our study has been carried out on 9861 students, aged between 11 and 18 years, in order to evaluate the effective incidence of the varicocele in pediatric and adolescent age and, at the same time, disclose other possible testicular anomalies in so called "normal" boys. Our study showed that the incidence of varicocele is related to sexual maturation and is time-related with a final incidence of 16%. Left testicular hypotrophy is rather common in primary varicocele and is also time and grade related. Cryptorchidism has been found in 2% of the examined students; 0.4% of them have not been yet operated on. We have been able to discover a rather high incidence of retractile testes (4.7%), always associated with testicular hypotrophy. Finally 7.5% of our examined students presented an unilateral testicular hypotrophy (volume less than 30% of the contralateral normal testis) in complete absence of local pathology.

Adolescent↗

PubMedDate not supplied

[Cryptorchidism and fertility: an assessment in adulthood].

Impairment of fertility rate has been found to be associated with cryptorchidism. In this study we assessed the fertility of 172 adult subjects with unilateral and bilateral cryptorchidism who underwent surgical correction in pediatric age. Fertility has been evaluated by sperm analysis. Moreover test of function of spermatozoa membrane (swelling-test) and the research of antisperm antibodies (spermmar test) were carried out. The report presents data demonstrating that the fertility rate in patients with bilateral cryptorchidism is markedly reduced if compared with subjects affected by unilateral cryptorchidism. Azoospermia is present in 18% of bilateral cryptorchids. The timing of surgery and the anatomical position of the cryptorchid testes do not seem to affect the fertility rate.

Adolescent↗

PubMedDate not supplied

[Current trends in the treatment of malformative uropathies].

Urinary tract malformations are common malformations. Surgical correction is very often required to normalize the urinary tract and to prevent renal function deterioration or to ameliorate a compromised renal function. The results of the surgical management have had a considerable improvement in the last decades. Three mechanisms worked at this regard: 1) the possibility of antenatal ultrasound diagnosis; 2) a better knowledge of the natural postnatal evolution; 3) the long-term results of the surgical treatment. Referring to literature's data and especially to a wide personal experience, the Author outlines the correct indications for surgery and the most effective surgical procedures in the management of the most important urinary tract malformations.

Female↗

PubMedDate not supplied

[Protruding ears: the indications for surgical treatment].

Protruding ears is a common abnormality sometimes causing psychological problems. The most common type of prominent ears shows failure of the anthelix to fold, conchal widening and overcupping of helical margin. Psychological programs are indications to correction. The goal of surgical treatment is restore conchoscaphal angle and/or anthelical fold. In our experience, Stenström otoplasty and/or recession of conchal cartilage by suture the concha to mastoid periostium are effective in 95% of the patients. These technique are, in our opinion, easy and rapid procedures, have very few complications, and give excellent aesthetic results.

Adolescent↗

PubMedDate not supplied

[Acute scrotum in pediatric age: analysis of 265 consecutive cases].

"Acute scrotum" in infants and children is generally due to testicular torsion, torsion of the appendix of testis or acute orchiepididymitis. However they are other less frequent causes of "acute scrotum". The differential diagnosis is often very difficult. 265 consecutive cases of acute scrotum are reviewed. 47% of the all patients presented torsion of the appendix of testis, 26% torsion of testis and 26% acute orchiepididymitis. The torsion of testis was most frequent in children under 1 year (67%), in the older patients the torsion of appendix of testis was most frequent (46% in patients 1-6 years old, 57% in patients over 6 years). The value and limit of ultrasound, scrotal scintigraphy and doppler ultrasound are discussed and an algorithm for the diagnosis of causes of acute scrotum is presented. In equivocal cases, early surgical exploration may be necessary to exclude torsion of testis and to prevent testicular loss.

Acute Disease↗

PubMedDate not supplied

[Primary varicocele: a substimated pathology in pediatrico-adolescent age].

Idiopathic varicocele is a neglected entity in classic pediatric textbooks. Yet vast epidemiologic studies revealed that the incidence of varicocele gradually increases in patients between 10 and 15 years old and is comparable to that of the adult male population. Clinically, the pediatric varicocele is often associated with smaller and hypotrophic testis; histologically it also is associated with pathological and progressive changes of the testis. We report on the preliminary results of a personal epidemiologic study and a comparative follow-up to value the efficacy of surgical correction in two groups of adolescent and adult patients. Early recognition and treatment of a severe varicocele with testicular hypotrophy may help to prevent in adults the infertility associated with this condition.

Adolescent↗

PubMedDate not supplied

[Varicocele: epidemiologic study and indications for its treatment].

The varicocele is still the most common correctable cause of male infertility. The epidemiologic studies revealed a gradually increasing incidence of varicocele in patients 10 to 18 years old, as height at the end of puberty as that of the adult male population. The pediatric varicocele is often associated with smaller and hypotrophic testis which presents also histological and progressive changes. Surgical correction of a varicocele in the adult usually produces poor results. In order to improve the fertility rate in adulthood an early varicocelectomy has been suggested. On the basis of our own studies and after a review of the literature, we conclude that all grade III varicoceles and grade II associated with testicular hypotrophy must be early operated on. This hearing provides a higher fertility rate and can prevent the reduced fertility associated with delayed varicocelectomy.

Adolescent↗

PubMedDate not supplied

[Modern trends in the treatment of varicocele].

A varicocele first develops in early adolescence and it can negatively affect testicular growth, histology and function. The use of early varicocelectomy to prevent severe testicular damage and sub-infertility in adulthood seems to be incontrovertible. However there is a difference of opinion as to the proper surgical procedure of varicocele ablation. To date, the inguinal and high retroperitoneal approaches are the most commonly accepted methods. However significant postoperative morbidity is common, with a recurrence rate ranging from 1 to 25% and return to normal activity often is prolonged. This considerations have prompted many to search for alternative techniques. The Authors performed laparoscopic clipping and division of the internal spermatic vein or the internal spermatic vessels in 55 adolescents to treat varicocele. Indications for the operation were third degree varicocele and second degree with testicular hypotrophy. At a mean 6 months follow-up, they did not observe either relapses or complications; no hydrocele was noted and testicular size did not decrease in any patient. In the Authors' experience and opinion, laparoscopic varicocelectomy is a simple, safe, effective and minimally invasive surgical procedure and it can be proposed as a viable alternative to open traditional surgical methods.

Adult↗