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Contini G, Mele E, Barneschi AC, Esposito C, Castagnetti M. Voiding cystourethrography in patients undergoing endoscopic decompression of duplex system ureteroceles: to do or not to do? Pediatr Surg Int 2024; 40:103. [PMID: 38598017 PMCID: PMC11006722 DOI: 10.1007/s00383-024-05665-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To assess the role of voiding cystourethrography (VCUG) in patients with duplex system ureterocele (DSU) undergoing endoscopic decompression (ED). MATERIALS AND METHODS This is a retrospective study of 75 consecutive patients with DSU undergoing ED [median (range) age, 6 (1-148) months]. Patients were divided into 3 groups, 33 with a VCUG showing vesicoureteral reflux (VUR) before ED (VUR-group), 22 with a VCUG negative for VUR (No-VUR-group), and 20 who did not undergo a VCUG (No-VCUG-group). Secondary surgery (SS) rate was compared among groups. RESULTS Groups were comparable for baseline characteristics. SS rate was 82% (27/33) in VUR-group vs. 32% (7/22) in the No-VUR-group (p = 0.0001), and 25% (5/20) in the No-VCUG-group (p = 0.001 vs. VUR-group, and 1 vs. No-VUR-group). In the VUR-group, 9 patients underwent preemptive endoscopic treatment of VUR during ED and SS rate was 44% (4/9) vs. 96% (23/24) in the remainder, p= 0.003. In the No-VCUG-group, a VCUG was performed during follow-up in 9/15 patients and showed reflux in all, although only 2 of these developed a (single) urinary tract infections. CONCLUSIONS SS rate was significantly higher in patients with preoperative VUR. Instead, it was not significantly different between patients without VUR and those who did not undergo a VCUG before ED, despite all the latter who underwent a VCUG during follow-up had evidence of VUR generally in the absence of symptoms. In our opinion, a VCUG could be limited to patients developing symptoms after ED. If a VCUG is performed before ED, a preemptive treatment of VUR should be taken into consideration.
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Affiliation(s)
- Giorgia Contini
- Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Ermelinda Mele
- Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Andrea Celeste Barneschi
- Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Ciro Esposito
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
| | - Marco Castagnetti
- Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy.
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padua, Italy.
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Collura G, D'Ippolito G, Lopes Mandes AL, Innocenzi M, Del Prete L, Mele E, Barneschi AC, Castagnetti M. Vacuum-assisted Mini-percutaneous Nephrolithotomy for 2-3-cm Renal Stones: A Comparative Study with Retrograde Intra-renal Surgery. J Pediatr Surg 2024; 59:412-415. [PMID: 37973416 DOI: 10.1016/j.jpedsurg.2023.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To compare vacuum-assisted percutaneous nephrolithotomy (VAmini-PCNL) with retrograde intra-renal surgery (RIRS) for the treatment of renal stones measuring 2-3 cm in diameter. MATERIAL AND METHODS This retrospective study included children receiving treatment for pyelocalyceal stones of 2-3 cm in diameter from November 2018 to September 2022. Consecutive patients undergoing VAmini-PCNL after 2020 were compared with a historically matched group undergoing RIRS. VAmini-PCNL was performed using a 12-Ch nephroscope through a 16-Ch vacuum ClearPetra access sheet. RIRS was performed using a flexible ureteroscope through a ureteral sheath. The endpoints included the need for pre-stenting, duration of surgery, complications, stone-free rate (SFR), and need for secondary procedures. RESULTS The patients were grouped into two with 15 patients for each group. VAmini-PCNL group was not different from the RIRS one for age at surgery [median (range) 6.6 (1-12)years vs. 7.7 (1.5-14)years], and stone diameter [median (range) 2.4 (2.0-2.9)cm vs. 2.3 (2.1-2.8)cm] and density [median (range) 577.5 (421-1068) vs. 541.5 (462-927) Hunsfield Units]. Pre-stenting was necessary in five RIRS patients (33 %). The median duration of surgery was 85.3 (76-112)min for VAmini-PCNL vs. 150.6 (132-167)min for RIRS, p = 0.00001. No major complications were observed. The SFR was 100 % after VAmini-PCNL and 60 % after RIRS, p = 0.02. All residual fragments were removed with a second RIRS. CONCLUSION VAmini-PCNL was feasible and safe in children aged >1 year. It allowed for a significantly higher SFR despite a significantly shorter operative time than RIRS, which also requires pre-stenting in one-third of patients and a second RIRS in 40 % of cases. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Giuseppe Collura
- Paediatric Urology Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
| | | | - Ana Ludy Lopes Mandes
- Paediatric Urology Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Michele Innocenzi
- Paediatric Urology Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Laura Del Prete
- Paediatric Urology Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Ermelinda Mele
- Paediatric Urology Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | | | - Marco Castagnetti
- Paediatric Urology Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
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Barneschi AC, Betto G, Zanovello N, Rigamonti W, Bianco M, Morlacco A, Dal Moro F. Robotic partial nephrectomy for complex kidney cyst in a 4-year old boy: Points of technique. J Pediatr Urol 2022; 18:710-711. [PMID: 36171165 DOI: 10.1016/j.jpurol.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/25/2022] [Accepted: 09/09/2022] [Indexed: 12/14/2022]
Abstract
Complex kidney cysts are rarely observed in childhood. In adult patients, when radiological studies found a suspicious renal lesion, the gold standard is surgical asportation. The robotic surgery is well known as a secure procedure for treatment these patients, and is nowadays a real alternative also for pediatric patients. The challenges in children surgery are linked to anesthesiologic gestion, smaller operative fields, the need of specific instruments and more delicate tissue handling. We present a step-by-step video description of a robotic partial nephrectomy for a renal multicystic mass in a 4 year-old child.
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Affiliation(s)
- Andrea Celeste Barneschi
- Urology Clinic-Pediatric Urology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova
| | - Giovanni Betto
- Urology Clinic-Pediatric Urology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova
| | - Nicola Zanovello
- Urology Clinic-Pediatric Urology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova
| | - Waifro Rigamonti
- Urology Clinic-Pediatric Urology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova
| | - Marta Bianco
- Urology Clinic-Pediatric Urology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova
| | - Alessandro Morlacco
- Urology Clinic-Pediatric Urology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova.
| | - Fabrizio Dal Moro
- Urology Clinic-Pediatric Urology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova
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Morlacco A, Mancini M, Soligo M, Zattoni F, Calpista A, Vizzielli G, Patti R, Mandato FG, Barneschi AC, Zattoni F, Iafrate M, Dal Moro F. Relevance of the Endoscopic Evaluation in the Diagnosis of Bladder Pain Syndrome/Interstitial Cystitis. Urology 2020; 144:106-110. [PMID: 32619597 DOI: 10.1016/j.urology.2020.06.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the relevance of the endoscopic evaluation in clinically suspected cases of Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC), using ESSIC criteria, established in 2008 by the European Society for the Study of Interstitial Cystitis (ESSIC). METHODS We included all patients who underwent endoscopic evaluation between January 01, 2015 and October 31, 2019 for clinical suspicion of BPS/IC. Collected data included demographic and baseline clinical features, endoscopic appearance (prior and after hydrodistension), and bladder wall biopsy results, both defined according to ESSIC criteria. Data were cross tabulated to define ESSIC phenotypes, while subgroups and multivariate analyses were carried out to assess the influence of clinical variables on ESSIC phenotypes. RESULTS Fifty-two subjects were included, mainly women (92%). Median age at evaluation was 45 (32.9-58.2) years. At hydrodistension, 21 patients (42%) had positive and 29 (58%) had negative findings. Grade 2-3 glomerulations were found in 18 patients, while Hunner lesions were reported only in 1 patient. Positive results at biopsy were found in 24 pts (51.1%), while negative in 23 (48.9%). Overall, the positive and negative concordance between hydrodistension and biopsy results was 78%. No significant differences in ESSIC subtypes were found after stratification based on clinical features and at multivariate analysis. Retrospective design is the main limitation. CONCLUSION Cystoscopy with hydrodistension and biopsy do have a role in the diagnostic pathway of BPS/IC. However, results should be considered in the clinical context of the individual patient.
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Affiliation(s)
- Alessandro Morlacco
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
| | - Mariangela Mancini
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Matteo Soligo
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Fabio Zattoni
- Urology Clinic, University of Udine and University Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Arturo Calpista
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Giuseppe Vizzielli
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Rosario Patti
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Francesco Gerardo Mandato
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Andrea Celeste Barneschi
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Filiberto Zattoni
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Massimo Iafrate
- Urology Clinic, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Fabrizio Dal Moro
- Urology Clinic, University of Udine and University Hospital "Santa Maria della Misericordia", Udine, Italy
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