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Miscia ME, Lauriti G, Di Renzo D, Cascini V, Lisi G. Management and outcomes of acute appendicitis in children during the COVID-19 pandemic: a systematic review and meta-analysis. Pediatr Surg Int 2023; 40:11. [PMID: 38017246 PMCID: PMC10684649 DOI: 10.1007/s00383-023-05594-9] [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: 11/03/2023] [Indexed: 11/30/2023]
Abstract
The COVID-19 pandemic has changed the way to manage the emergencies, as people faced fear of the hospitals, with possible delay in the diagnosis. Moreover, clinicians had to rearrange protocols for diagnosis and treatment. We aimed to assess whether COVID-19 pandemic influenced severity of inflammation, management, and outcomes of acute appendicitis (AA), when compared to the pre-COVID era. Using defined search strategy, two independent investigators identified those studies comparing pediatric AA during COVID-19 pandemic versus the pre-COVID-19 period. Meta-analysis was performed using RevMan 5.3. Data are mean ± SD. Of 528 abstracts, 36 comparative studies were included (32,704pts). Time from symptoms onset to surgery was longer during the pandemics compared to the pre-COVID-19 (1.6 ± 0.9 versus 1.4 ± 0.9 days; p < 0.00001). Minimally Invasive Surgery was similar during COVID-19 (70.4 ± 30.2%) versus control period (69.6 ± 25.3%; p = ns). Complicated appendicitis was increased during the pandemics (35.9 ± 14.8%) compared to control period (33.4 ± 17.2%; p < 0.0001). Post-operative complications were comparable between these two groups (7.7 ± 6.5% versus 9.1 ± 5.3%; p = ns). It seems that the COVID-19 pandemic influenced the time of diagnosis, severity of inflammation, and type of surgery. However, the number of post-operative complications was not different between the two groups, leading to the conclusion that the patients were correctly managed. LEVEL OF EVIDENCE: Level 3 Meta-analysis on Level 3 studies.
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Affiliation(s)
- Maria Enrica Miscia
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Via L. Polacchi 11, 66100, Chieti, Italy
- Pediatric Surgery Unit, Spirito Santo" Hospital of Pescara, Pescara, Italy
| | - Giuseppe Lauriti
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Via L. Polacchi 11, 66100, Chieti, Italy.
- Pediatric Surgery Unit, Spirito Santo" Hospital of Pescara, Pescara, Italy.
| | - Dacia Di Renzo
- Pediatric Surgery Unit, Spirito Santo" Hospital of Pescara, Pescara, Italy
| | - Valentina Cascini
- Pediatric Surgery Unit, Spirito Santo" Hospital of Pescara, Pescara, Italy
| | - Gabriele Lisi
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Via L. Polacchi 11, 66100, Chieti, Italy
- Pediatric Surgery Unit, Spirito Santo" Hospital of Pescara, Pescara, Italy
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Ahram DF, Lim TY, Ke J, Jin G, Verbitsky M, Bodria M, Kil BH, Chatterjee D, Piva SE, Marasa M, Zhang JY, Cocchi E, Caridi G, Gucev Z, Lozanovski VJ, Pisani I, Izzi C, Savoldi G, Gnutti B, Capone VP, Morello W, Guarino S, Esposito P, Lambert S, Radhakrishnan J, Appel GB, Uy NS, Rao MK, Canetta PA, Bomback AS, Nestor JG, Hays T, Cohen DJ, Finale C, van Wijk JA, La Scola C, Baraldi O, Tondolo F, Di Renzo D, Jamry-Dziurla A, Pezzutto A, Manca V, Mitrotti A, Santoro D, Conti G, Martino M, Giordano M, Gesualdo L, Zibar L, Masnata G, Bonomini M, Alberti D, La Manna G, Caliskan Y, Ranghino A, Marzuillo P, Kiryluk K, Krzemień G, Miklaszewska M, Lin F, Montini G, Scolari F, Fiaccadori E, Arapović A, Saraga M, McKiernan J, Alam S, Zaniew M, Szczepańska M, Szmigielska A, Sikora P, Drożdż D, Mizerska-Wasiak M, Mane S, Lifton RP, Tasic V, Latos-Bielenska A, Gharavi AG, Ghiggeri GM, Materna-Kiryluk A, Westland R, Sanna-Cherchi S. Rare Single Nucleotide and Copy Number Variants and the Etiology of Congenital Obstructive Uropathy: Implications for Genetic Diagnosis. J Am Soc Nephrol 2023; 34:1105-1119. [PMID: 36995132 PMCID: PMC10278788 DOI: 10.1681/asn.0000000000000132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/18/2023] [Indexed: 03/31/2023] Open
Abstract
SIGNIFICANCE STATEMENT Congenital obstructive uropathy (COU) is a prevalent human developmental defect with highly heterogeneous clinical presentations and outcomes. Genetics may refine diagnosis, prognosis, and treatment, but the genomic architecture of COU is largely unknown. Comprehensive genomic screening study of 733 cases with three distinct COU subphenotypes revealed disease etiology in 10.0% of them. We detected no significant differences in the overall diagnostic yield among COU subphenotypes, with characteristic variable expressivity of several mutant genes. Our findings therefore may legitimize a genetic first diagnostic approach for COU, especially when burdening clinical and imaging characterization is not complete or available. BACKGROUND Congenital obstructive uropathy (COU) is a common cause of developmental defects of the urinary tract, with heterogeneous clinical presentation and outcome. Genetic analysis has the potential to elucidate the underlying diagnosis and help risk stratification. METHODS We performed a comprehensive genomic screen of 733 independent COU cases, which consisted of individuals with ureteropelvic junction obstruction ( n =321), ureterovesical junction obstruction/congenital megaureter ( n =178), and COU not otherwise specified (COU-NOS; n =234). RESULTS We identified pathogenic single nucleotide variants (SNVs) in 53 (7.2%) cases and genomic disorders (GDs) in 23 (3.1%) cases. We detected no significant differences in the overall diagnostic yield between COU sub-phenotypes, and pathogenic SNVs in several genes were associated to any of the three categories. Hence, although COU may appear phenotypically heterogeneous, COU phenotypes are likely to share common molecular bases. On the other hand, mutations in TNXB were more often identified in COU-NOS cases, demonstrating the diagnostic challenge in discriminating COU from hydronephrosis secondary to vesicoureteral reflux, particularly when diagnostic imaging is incomplete. Pathogenic SNVs in only six genes were found in more than one individual, supporting high genetic heterogeneity. Finally, convergence between data on SNVs and GDs suggest MYH11 as a dosage-sensitive gene possibly correlating with severity of COU. CONCLUSIONS We established a genomic diagnosis in 10.0% of COU individuals. The findings underscore the urgent need to identify novel genetic susceptibility factors to COU to better define the natural history of the remaining 90% of cases without a molecular diagnosis.
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Affiliation(s)
- Dina F. Ahram
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Tze Y. Lim
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Juntao Ke
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Gina Jin
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Miguel Verbitsky
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Monica Bodria
- Division of Nephrology and Renal Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Byum Hee Kil
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Debanjana Chatterjee
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Stacy E. Piva
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Maddalena Marasa
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Jun Y. Zhang
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Enrico Cocchi
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Gianluca Caridi
- Division of Nephrology and Renal Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Laboratory on Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Zoran Gucev
- Medical Faculty of Skopje, University Children's Hospital, Skopje, Macedonia
| | - Vladimir J. Lozanovski
- Medical Faculty of Skopje, University Children's Hospital, Skopje, Macedonia
- Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Isabella Pisani
- Unità Operativa Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Claudia Izzi
- Division of Nephrology, Department of Obstetrics and Gynecology, ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Barbara Gnutti
- Medical Genetics Laboratory, ASST-Spedali Civili, Brescia, Italy
| | - Valentina P. Capone
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - William Morello
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Guarino
- Department of Woman and Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli,” Naples, Italy
| | - Pasquale Esposito
- Department of Internal Medicine, University of Genoa, Genova, Italy
- Unit of Nephrology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Sarah Lambert
- Yale School of Medicine/Yale New Haven Health System, New Haven, Connecticut
| | - Jai Radhakrishnan
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Gerald B. Appel
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Natalie S. Uy
- Division of Pediatric Nephrology, Department of Pediatric, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Maya K. Rao
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Pietro A. Canetta
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Andrew S. Bomback
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Jordan G. Nestor
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Thomas Hays
- Department of Pediatrics, Division of Neonatology, Columbia University, New York, New York
| | - David J. Cohen
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Carolina Finale
- Nephrology, Dialysis and Renal Transplantation Unit, Azienda Ospedaliera Universitaria Ospedali Riuniti Umberto I, Lancisi, Salesi of Ancona, Ancona, Italy
| | - Joanna A.E. van Wijk
- Department of Pediatric Nephrology, Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
| | - Claudio La Scola
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant'Orsola-Malpighi, Bologna, Italy
| | - Olga Baraldi
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Tondolo
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Dacia Di Renzo
- “Spirito Santo” Hospital of Pescara, Pediatric Surgery of “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Anna Jamry-Dziurla
- Polish Registry of Congenital Malformations, Chair and Department of Medical Genetics, University of Medical Sciences, Poznan, Poland
| | - Alessandro Pezzutto
- Nephrology and Dialysis Unit, Department of Medicine, SS Annunziata Hospital, “G. d'Annunzio” University, Chieti, Italy
| | - Valeria Manca
- Department of Pediatric Urology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Adele Mitrotti
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
- Section of Nephrology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Domenico Santoro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giovanni Conti
- Department of Pediatric Nephrology, Azienda Ospedaliera Universitaria “G. Martino,” Messina, Italy
| | - Marida Martino
- Pediatric Nephrology and Dialysis Unit, Pediatric Hospital “Giovanni XXIII,” Bari, Italy
| | - Mario Giordano
- Pediatric Nephrology and Dialysis Unit, Pediatric Hospital “Giovanni XXIII,” Bari, Italy
| | - Loreto Gesualdo
- Section of Nephrology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Lada Zibar
- Department of Nephrology, University Hospital Merkur, Zagreb, Croatia
- Faculty of Medicine, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia
| | - Giuseppe Masnata
- Department of Pediatric Urology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Mario Bonomini
- Nephrology and Dialysis Unit, Department of Medicine, SS Annunziata Hospital, “G. d'Annunzio” University, Chieti, Italy
| | | | - Gaetano La Manna
- IRCCS Azienda Ospedaliera di Bologna, Nephrology, Dialysis and Kidney Transplant Unit, St. Orsola University Hospital, Bologna, Italy
| | - Yasar Caliskan
- Division of Nephrology, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Andrea Ranghino
- Nephrology, Dialysis and Renal Transplantation Unit, Azienda Ospedaliera Universitaria Ospedali Riuniti Umberto I, Lancisi, Salesi of Ancona, Ancona, Italy
| | - Pierluigi Marzuillo
- Department of Woman and Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli,” Naples, Italy
| | - Krzysztof Kiryluk
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Grażyna Krzemień
- Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - Monika Miklaszewska
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Fangming Lin
- Division of Pediatric Nephrology, Department of Pediatric, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Giuliana and Bernardo Caprotti Chair of Pediatrics, University of Milano, Milano, Italy
| | - Francesco Scolari
- Division of Nephrology and Dialysis, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Enrico Fiaccadori
- Unità Operativa Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Adela Arapović
- Department of Pediatrics, University Hospital of Split, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - Marijan Saraga
- Department of Pediatrics, University Hospital of Split, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - James McKiernan
- Department of Urology, Columbia University Irving Medical Center, New York, New York
| | - Shumyle Alam
- Department of Urology, Columbia University Irving Medical Center, New York, New York
- Division of Pediatric Urology, MUSC Health-University Medical Center, Charleston, South Carolina
| | - Marcin Zaniew
- Department of Pediatrics, University of Zielona Góra, Zielona Góra, Poland
| | - Maria Szczepańska
- Department of Pediatrics, FMS in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Szmigielska
- Department of Pediatrics and Nephrology, Medical University of Warsaw, Warsaw, Poland
| | - Przemysław Sikora
- Department of Pediatric Nephrology, Medical University of Lublin, Lublin, Poland
| | - Dorota Drożdż
- Department of Pediatric Nephrology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | | | - Shrikant Mane
- Yale Center for Mendelian Genomics (YCMG), New Haven, Connecticut
| | | | - Velibor Tasic
- Medical Faculty of Skopje, University Children's Hospital, Skopje, Macedonia
| | - Anna Latos-Bielenska
- Polish Registry of Congenital Malformations, Chair and Department of Medical Genetics, University of Medical Sciences, Poznan, Poland
| | - Ali G. Gharavi
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
| | - Gian Marco Ghiggeri
- Division of Nephrology and Renal Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Laboratory on Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Anna Materna-Kiryluk
- Polish Registry of Congenital Malformations, Chair and Department of Medical Genetics, University of Medical Sciences, Poznan, Poland
| | - Rik Westland
- Department of Pediatric Nephrology, Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
| | - Simone Sanna-Cherchi
- Department of Medicine, Division of Nephrology, Columbia University, New York, New York
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Cascini V, Lauriti G, Di Renzo D, Miscia ME, Lisi G. Ureteropelvic junction obstruction in infants: Open or minimally invasive surgery? A systematic review and meta-analysis. Front Pediatr 2022; 10:1052440. [PMID: 36507128 PMCID: PMC9727311 DOI: 10.3389/fped.2022.1052440] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The historical gold standard treatment for ureteropelvic junction obstruction (UPJO) was the open Anderson-Hynes dismembered pyeloplasty (OP). Minimally invasive surgery (MIS) procedures, including laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP), have been reported to achieve better outcomes (i.e., decreased morbidity, reduced postoperative pain, superior esthetic results, and shortened length of hospital stay, LOS), with a success rate similar to OP. The main limitation of the MIS approach is the age and weight of patients, limiting these procedures to children >1 year. This study aims to evaluate the feasibility and benefits of MIS pyeloplasty compared to OP to surgically treat UPJO in children <1 year of age. MATERIALS AND METHODS A systematic review was independently performed by two authors. Papers comparing both techniques (MIS pyeloplasty vs. OP) in infants were included in the meta-analysis. Data (mean ± DS or percentage) were analyzed using Rev.Man 5.4 A p < 0.05 was considered significant. RESULTS Nine studies (eight retrospective and one prospective) meet the inclusion criteria. A total of 3,145 pyeloplasties have been included, with 2,859 (90.9%) OP and 286 (9.1%) MIS. Age at operation was 4.9 ± 1.4 months in OP vs. 5.8 ± 2.2 months in MIS, p = ns. Weight at surgery was 6.4 ± 1.4 kg in OP vs. 6.9 ± 1.4 kg in MIS, p = ns. Operative time was 129.4 ± 24.1 min for OP vs. 144.0 ± 32.3 min for MIS, p < 0.001. LOS was 3.2 ± 1.9 days for OP vs. 2.2 ± 0.9 days for MIS, p < 0.01. Postoperative complications were present in 10.0 ± 12.9% of OP vs. 10.9 ± 11.6% in MIS, p = ns. Failure of surgery was 5.2 ± 3.5% for OP vs. 4.2 ± 3.3% for MIS, p = ns. CONCLUSION The development of miniaturized instruments and technical modifications has made MIS feasible and safe in infants and small children. MIS presented a longer operative time than OP. However, MIS seemed effective for treating UPJO in infants, showing shortened LOS compared to OP. No differences have been reported with regard to the incidence of postoperative complications and failure of pyeloplasty. Given the low quality of evidence of the meta-analysis according to the GRADE methodology, we would suggest limiting MIS procedures in infants to only those high-volume centers with experienced surgeons.
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Affiliation(s)
- Valentina Cascini
- Pediatric Surgery Unit, "Spirito Santo" Hospital of Pescara, Pescara, Italy
| | - Giuseppe Lauriti
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Pediatric Surgery Unit, "Spirito Santo" Hospital of Pescara, Pescara, Italy
| | - Dacia Di Renzo
- Pediatric Surgery Unit, "Spirito Santo" Hospital of Pescara, Pescara, Italy
| | - Maria Enrica Miscia
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Pediatric Surgery Unit, "Spirito Santo" Hospital of Pescara, Pescara, Italy
| | - Gabriele Lisi
- Department of Medicine and Aging Science, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Pediatric Surgery Unit, "Spirito Santo" Hospital of Pescara, Pescara, Italy
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Miscia ME, Lauriti G, Di Renzo D, Riccio A, Lisi G, Lelli Chiesa P. Esophageal Atresia and Associated Duodenal Atresia: A Cohort Study and Review of the Literature. Eur J Pediatr Surg 2021; 31:445-451. [PMID: 32987434 DOI: 10.1055/s-0040-1716884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Esophageal atresia (EA) is associated with duodenal atresia (DA) in 3 to 6% of cases. The management of this association is controversial and literature is scarce on the topic. MATERIALS AND METHODS We aimed to (1) review the patients with EA + DA treated at our institution and (2) systematically review the English literature, including case series of three or more patients. RESULTS Cohort study: Five of seventy-four patients with EA had an associated DA (6.8%). Four of five cases (80%) underwent primary repair of both atresia, one of them with gastrostomy placement (25%). One of five cases (20%) had a delayed diagnosis of DA. No mortality has occurred. Systematic Review: Six of six-hundred forty-five abstract screened were included (78 patients). Twenty-four of sixty-eight (35.3%) underwent primary correction of EA + DA, and 36/68 (52.9%) underwent staged correction. Nine of thirty-six (25%) had a missed diagnosis of DA. Thirty-six of sixty-eight underwent gastrostomy placement. Complications were observed in 14/36 patients (38.9 ± 8.2%). Overall mortality reported was 41.0 ± 30.1% (32/78 patients), in particular its incidence was 41.7 ± 27.0% after a primary treatment and 37.0 ± 44.1% following a staged approach. CONCLUSION The management of associated EA and DA remains controversial. It seems that the staged or primary correction does not affect the mortality. Surgeons should not overlook DA when correcting an EA.
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Affiliation(s)
- Maria Enrica Miscia
- Pediatric Surgery Unit, Department of Medicine and Aging Science, University Gabriele d'Annunzio of Chieti Pescara Pescara, Italy
| | - Giuseppe Lauriti
- Department of Pediatric Surgery, Department of Medicine and Aging Science, University Gabriele d'Annunzio of Chieti and Pescara, Chieti, Abruzzo, Italy.,Department of Pediatric Surgery, Ospedale Civile dello Spirito Santo, Pescara, Abruzzo, Italy
| | - Dacia Di Renzo
- UO Chirurgia Pediatrica, Ospedale Civile dello Spirito Santo, Pescara, Abruzzo, Italy
| | - Angela Riccio
- Department of Pediatric Surgery, Department of Medicine and Aging Science, University Gabriele d'Annunzio of Chieti and Pescara, Chieti, Abruzzo, Italy
| | - Gabriele Lisi
- Pediatric Surgery Unit, Department of Medicine and Aging Science, University Gabriele d'Annunzio of Chieti Pescara Pescara, Italy
| | - Pierluigi Lelli Chiesa
- Department of Pediatric Surgery, Department of Medicine and Aging Science, University Gabriele d'Annunzio of Chieti and Pescara, Chieti, Abruzzo, Italy.,Department of Pediatric Surgery, Ospedale Civile dello Spirito Santo, Pescara, Abruzzo, Italy
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Miscia ME, Lauriti G, Riccio A, Di Renzo D, Cascini V, Lelli Chiesa P, Lisi G. Minimally invasive vascular hitch to treat pediatric extrinsic ureteropelvic junction obstruction by crossing polar vessels: A systematic review and meta-analysis. J Pediatr Urol 2021; 17:493-501. [PMID: 33775572 DOI: 10.1016/j.jpurol.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/24/2020] [Revised: 02/12/2021] [Accepted: 03/04/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Vascular hitch (VH) gained an increasing success in treating ureteropelvic junction obstruction (UPJO) by crossing vessels (CV) in pediatrics. AIMS OF THE STUDY We aimed: (i) to compare laparoscopic VH versus laparoscopic dismembered pyeloplasty (DP) to treat UPJO by CV; (ii) to review possible amelioration given by a robot-assisted procedure. METHODS Using defined search strategy, three investigators identified all studies on laparoscopic VH. Those studies comparing VH versus DP or versus robot-assisted VH were included in the meta-analysis. The meta-analysis was conducted using RevMan 5.3. Data are mean ± SD. RESULTS Systematic review - Of 2783 titles/abstracts screened, 43 full-text articles were analyzed. Twelve studies on laparoscopic VH (298 pts) reported 98.3% success rate, with 1.3% intra-operative complications. Meta-Analysis - Five studies compared laparoscopic VH versus laparoscopic DP (277 pts). Operative time was reduced in VH (102.5 ± 47.5min) compared to DP (165.7 ± 53.7min; p < 0.00001). Complications were similar (VH 4/119 pts, 3.4 ± 1.2% versus DP 15/158 pts, 9.5 ± 6.8%; p = ns). Hospital stay was shortened in VH (1.1 ± 0.9dd) versus DP (3.3 ± 3.2dd; p < 0.0001; Summary Figure). The success rate was comparable (VH 115/118 pts, 97.5 ± 1.6% versus DP 157/158 pts, 99.4 ± 0.5%; p = ns). Two prospective studies compared robot-assisted VH to laparoscopic VH (53 pts). No differences were found among complications (robot-assisted VH 0/13 pts, 0% versus laparoscopic VH 1/40 pts, 2.5%; p = ns) and success rate (robot-assisted VH 13/13 pts, 100% versus laparoscopic VH 39/40 pts, 97.5%; p = ns). DISCUSSION Several studies have been reported long-term results of laparoscopic VH in children. However, few papers demonstrated its superiority over laparoscopic DP to treat extrinsic UPJO. In the present study, we found similar incidence of complications and success rates when comparing VH versus DP. Nonetheless, the operative time and the length of hospital stay were significantly reduced in VH compared to DP. An increasing number of surgeons performed robotic-assisted VH, reporting promising outcomes. However, only a couple of studies compared robot-assisted VH to laparoscopic VH, with a similar incidence of complications and success rate in both procedures. The main limitations of the study were related to the slight number of papers included and to their quality, since all of them were retrospective studies or prospectively followed-up cohort of patients. CONCLUSIONS Laparoscopic VH seems to be a safe and reliable procedure to treat UPJO by CV. The procedure appeared quicker than laparoscopic DP, with shortened hospital stay. Further studies are needed to corroborate these results and to establish amelioration given by a robot-assisted procedure.
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Affiliation(s)
- Maria Enrica Miscia
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, Chieti-Pescara, Italy; Department of Pediatric Surgery, "Spirito Santo" Hospital, Pescara, Italy
| | - Giuseppe Lauriti
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, Chieti-Pescara, Italy; Department of Pediatric Surgery, "Spirito Santo" Hospital, Pescara, Italy.
| | - Angela Riccio
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, Chieti-Pescara, Italy; Department of Pediatric Surgery, "Spirito Santo" Hospital, Pescara, Italy
| | - Dacia Di Renzo
- Department of Pediatric Surgery, "Spirito Santo" Hospital, Pescara, Italy
| | - Valentina Cascini
- Department of Pediatric Surgery, "Spirito Santo" Hospital, Pescara, Italy
| | - Pierluigi Lelli Chiesa
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, Chieti-Pescara, Italy; Department of Pediatric Surgery, "Spirito Santo" Hospital, Pescara, Italy
| | - Gabriele Lisi
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University, Chieti-Pescara, Italy; Department of Pediatric Surgery, "Spirito Santo" Hospital, Pescara, Italy
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Di Fabrizio D, Lisi G, Lauriti G, Di Renzo D, Lannutti A, Marino N, Lelli Chiesa P. Conversion Rate in Pediatric Robotic-Assisted Surgery: Looking for the Culprit. J Laparoendosc Adv Surg Tech A 2020; 30:315-321. [PMID: 31976805 DOI: 10.1089/lap.2019.0653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Introduction: Robotic-assisted surgery (RAS) is increasingly used in adulthood but its application in pediatric population is limited. We report our initial experience in pediatric RAS, focusing on conversions to analyze their causes. Methods: All pediatric patients who underwent RAS between June 2015 and April 2019 were included, analyzing demographics, comorbidities, previous surgery, and intraoperative surgical and anesthetic parameters. A three-arms robotic technique was used in all cases. Additional laparoscopic ports were added, when needed. The surgical team did not change during the program, whereas the anesthesiology team varied. Results: Thirty-nine patients (23 females, 16 males; mean age ± SD = 9.33 ± 4.73 years [range = 1-16]; mean weight ± SD = 35.2 ± 20.0 kg [range = 9-85]) underwent 40 different procedures (18 gastrointestinal, 15 urogynecological, 5 oncological, and 2 miscellaneous). Three procedures (7.5%) were converted to open surgery for inadequate working space (two marked bowel distension and one insufficient hepatic retraction). Converted patients were of significant lower age (mean ± standard error of mean [SEM] = 2.97 ± 1.03 versus 9.83 ± 0.77 years, P = .01) and lower weight (mean ± SEM = 11.83 ± 1.74 versus 35.47 ± 3.16 kg, P = .03). The two groups did not differ statistically for duration of facial mask ventilation before intubation (mean ± SEM = converted 10.67 ± 2.33 versus completed 10.31 ± 0.91 minutes), neuromuscular block dosage (rocuronium; mean ± SEM = converted 0.46 ± 0.06 mg/kg versus completed 0.62 ± 0.03 mg/kg) and in the type of bowel preparation (mechanical and/or pharmacological). Discussion: Conversion rate in initial pediatric RAS program is acceptable. In children, the need for conversion is mainly because of inadequate working space, particularly in smaller children, but it seems not to be influenced by measurable anesthetic factors or different regimen for bowel preparation.
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Affiliation(s)
- Donatella Di Fabrizio
- Pediatric Surgery Unit, Civil Hospital "Santo Spirito" of Pescara-Department of Aging Science, University "G. d'Annunzio" of Chieti-Pescara, Pescara, Italy
| | - Gabriele Lisi
- Pediatric Surgery Unit, Civil Hospital "Santo Spirito" of Pescara-Department of Aging Science, University "G. d'Annunzio" of Chieti-Pescara, Pescara, Italy
| | - Giuseppe Lauriti
- Pediatric Surgery Unit, Civil Hospital "Santo Spirito" of Pescara-Department of Aging Science, University "G. d'Annunzio" of Chieti-Pescara, Pescara, Italy
| | - Dacia Di Renzo
- Pediatric Surgery Unit, Civil Hospital "Santo Spirito" of Chieti-Pescara, Pescara, Italy
| | - Angela Lannutti
- Anesthesia and Intensive Care Unit, Civil Hospital "Santo Spirito" of Pescara, Pescara, Italy
| | - Nino Marino
- Pediatric Surgery Unit, Civil Hospital "Santo Spirito" of Chieti-Pescara, Pescara, Italy
| | - Pierluigi Lelli Chiesa
- Pediatric Surgery Unit, Civil Hospital "Santo Spirito" of Pescara-Department of Aging Science, University "G. d'Annunzio" of Chieti-Pescara, Pescara, Italy
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7
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Di Renzo D, Persico A, Lisi G, Miscia ME, Lauriti G, Sassano G, Lelli Chiesa P. Contrast-enhanced ultrasonography (CEUS) in the follow-up of pediatric abdominal injuries: value and timing. J Ultrasound 2020; 23:151-155. [PMID: 31919814 DOI: 10.1007/s40477-019-00423-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022] Open
Abstract
AIMS Primary aim was to investigate the value and safety of contrast-enhanced ultrasonography (CEUS) during follow-up (FU) of splenic, hepatic and renal post-traumatic injuries in a pediatric population. Secondary aim was to extrapolate appropriate timing of FU-CEUS. METHODS In a retrospective study, post-traumatic parenchymal injuries diagnosed with CT or CEUS, were subjected to non-operative management and followed with CEUS. RESULTS Forty-six patients were enrolled, with isolated or combined injuries, for a total of 30 splenic, 15 hepatic and 12 renal injuries. At admission 42/46 patients underwent CT and 4/46 underwent CEUS. During FU a total of 65 CEUS were performed: 16 within 72 h to check delayed active bleeding or parenchymal rupture; 24 between 5 and 10 days post admission, to pose indication to active mobilization or to discharge; 21 between 20 and 60 days post admission to document complete healing of the lesion or pose indication to discharge in most severe injuries. No complications related to CEUS were encountered. CONCLUSIONS CEUS is valuable and safe to follow patients with post-traumatic abdominal injuries, even if further data are needed for renal injuries. We propose a tailored approach based on injury grade and clinical course: in the first 3 days only in case of delayed bleeding or rupture suspect; between 5 and 10 days post trauma to ensure a safe active mobilization and/or pose indication to discharge, and over 20-30 days post trauma to pose indication to discharge in most severe injuries or document complete healing and permit return to sport activities.
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Affiliation(s)
- Dacia Di Renzo
- Pediatric Surgery, "G. D'Annunzio" University of Chieti and "Spirito Santo" Hospital of Pescara, Via Fonte Romana n.8, 65124, Pescara, Italy.
| | - Antonello Persico
- Pediatric Surgery, "G. D'Annunzio" University of Chieti and "Spirito Santo" Hospital of Pescara, Via Fonte Romana n.8, 65124, Pescara, Italy
| | - Gabriele Lisi
- Pediatric Surgery, "G. D'Annunzio" University of Chieti and "Spirito Santo" Hospital of Pescara, Via Fonte Romana n.8, 65124, Pescara, Italy
| | - Maria Enrica Miscia
- Pediatric Surgery, "G. D'Annunzio" University of Chieti and "Spirito Santo" Hospital of Pescara, Via Fonte Romana n.8, 65124, Pescara, Italy
| | - Giuseppe Lauriti
- Pediatric Surgery, "G. D'Annunzio" University of Chieti and "Spirito Santo" Hospital of Pescara, Via Fonte Romana n.8, 65124, Pescara, Italy
| | - Giulia Sassano
- Pediatric Surgery, "G. D'Annunzio" University of Chieti and "Spirito Santo" Hospital of Pescara, Via Fonte Romana n.8, 65124, Pescara, Italy
| | - Pierluigi Lelli Chiesa
- Pediatric Surgery, "G. D'Annunzio" University of Chieti and "Spirito Santo" Hospital of Pescara, Via Fonte Romana n.8, 65124, Pescara, Italy
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8
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Pizzuti G, Di Renzo D, Persico A, Lelli Chiesa P. Spontaneous regression of cystic dysplasia of the rete testis in an 18-month-old boy: the key role of ultrasonography. J Ultrasound 2019; 24:81-84. [PMID: 31190172 DOI: 10.1007/s40477-019-00391-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022] Open
Abstract
Cystic dysplasia of the rete testis (CDT) is a rare cause of scrotal swelling in children. It is a congenital disorder and it can be associated with other genitourinary abnormalities. At present, there is no clear consensus on treatment. Surgical approach has traditionally been the treatment of choice, while, more recently, conservative approach has been applied, justified by the benign nature of the lesion and after few cases of spontaneous regression have been documented. Ultrasonography, supported by negative tumor markers, plays a key role in the diagnostic work up and during observational follow-up. We report a further case of spontaneous regression of suspected CDT in an 18-month-old boy, who has been followed with clinic and ultrasonographic checks.
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Affiliation(s)
- Giada Pizzuti
- Pediatric Surgery Unit, "G. d'Annunzio" University of Chieti, "Spirito Santo" Hospital of Pescara, Via Fonte Romana n.8, 65124, Pescara, Italy
| | - Dacia Di Renzo
- Pediatric Surgery Unit, "G. d'Annunzio" University of Chieti, "Spirito Santo" Hospital of Pescara, Via Fonte Romana n.8, 65124, Pescara, Italy.
| | - Antonello Persico
- Pediatric Surgery Unit, "G. d'Annunzio" University of Chieti, "Spirito Santo" Hospital of Pescara, Via Fonte Romana n.8, 65124, Pescara, Italy
| | - Pierluigi Lelli Chiesa
- Pediatric Surgery Unit, "G. d'Annunzio" University of Chieti, "Spirito Santo" Hospital of Pescara, Via Fonte Romana n.8, 65124, Pescara, Italy
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9
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Cascini V, Di Renzo D, Guerriero V, Lauriti G, Lelli Chiesa P. Zinner Syndrome in Pediatric Age: Issues in the Diagnosis and Treatment of a Rare Malformation Complex. Front Pediatr 2019; 7:129. [PMID: 31024871 PMCID: PMC6465625 DOI: 10.3389/fped.2019.00129] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/19/2019] [Indexed: 11/29/2022] Open
Abstract
Zinner syndrome (ZS) is the association of congenital seminal vesicle cysts and ipsilateral upper urinary tract anomalies, such as multicystic displastic kidney (MCDK). This condition is rare in pediatric age and both diagnosis and treatment are challenging. The aim of this study was to analyze the issues in diagnosis, management, and treatment of ZS in pediatric age. The medical records of two patients with ZS were examined. Furthermore, a review of the literature on this topic in pediatric age was performed. In our experience the diagnosis of ZS was incidentally achieved in the first months of life, as a consequence of studies performed for a prenatal diagnosis of MCDK. The first patient presented unspecific and transient symptoms, the second infant was completely asymptomatic. They were conservatively treated, with a long-term follow-up planned at least until adolescence. Fifty cases of ZS in pediatric age have been reported in the literature up to now. Only 12/50 were diagnosed in the first year of life. The diagnosis was demanding, as the clinical presentation was unspecific and the results at imaging studies needed a differential diagnosis with other retrovesical masses. More than 80% of these cases were asymptomatic at long-term follow-up. Therefore, a conservative management of ZS has been accepted for asymptomatic or poorly symptomatic patients, with occasional, transient, and unspecific symptoms, such as urinary tract infections or orchyepididimytis. As the surgical management is challenging, it is proposed only in those symptomatic patients. In conclusion, ZS is rare in pediatric age. However, it should be considered in the differential diagnosis of cystic masses within the pelvis in males with ipsilateral renal anomalies. A conservative treatment with a long-term follow-up is a safe option in the management of asymptomatic or poorly symptomatic patients, thus reserving the surgical approach only in those cases with symptoms.
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Affiliation(s)
- Valentina Cascini
- Department of Pediatric Surgery, Spirito Santo Hospital of Pescara, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Dacia Di Renzo
- Department of Pediatric Surgery, Spirito Santo Hospital of Pescara, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Vittorio Guerriero
- Department of Pediatric Surgery, Spirito Santo Hospital of Pescara, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Giuseppe Lauriti
- Department of Pediatric Surgery, Spirito Santo Hospital of Pescara, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Pierluigi Lelli Chiesa
- Department of Pediatric Surgery, Spirito Santo Hospital of Pescara, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy.,Department of Medicine and Aging Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
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10
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Rizzo R, Lisi G, Marino N, Lauriti G, Di Renzo D, Lelli Chiesa P. Robot-assisted resection of gastric duplication cysts in a child: a detailed case report. Pediatr Med Chir 2018; 40. [PMID: 30514076 DOI: 10.4081/pmc.2018.203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/30/2018] [Indexed: 11/23/2022] Open
Abstract
Gastric duplication cysts (GDCs) represent 4-9% of alimentary tract duplications. Early diagnosis and surgical excision are essential to avoid morbidity or neoplastic degeneration. Roboticassisted excision of GDCs has never been described in childhood. We report an asymptomatic male patient with 2 gastric cystic masses at ultrasonography (US)-study (diameter 25mm and 8mm), increasing in size at follow-up. At 20 months of age, magnetic- resonance-imaging-scan confirmed 2 round gastric masses (44×35mm and 16×12mm, respectively). Two months later, an elective robotic-assisted excision of GDCs was completed without complications. The patient was discharged at day 6 after procedure. Histology confirmed the diagnosis of GDCs. At a 2-year follow- up, US-study did not evidence any issue. In this first reported case of robotic-assisted cystectomy for CGD in childhood, the procedure seems safe, effective, and feasible. This approach improves the movements of the surgical instruments with better 3- D visualization in comparison with the laparoscopic approach.
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Affiliation(s)
- Riccardo Rizzo
- Department of Pediatric Surgery, "Spirito Santo" Hospital, Pescara; "G. d'Annunzio" University, Chieti-Pescara.
| | - Gabriele Lisi
- Department of Pediatric Surgery, "Spirito Santo" Hospital, Pescara; "G. d'Annunzio" University, Chieti-Pescara.
| | - Nino Marino
- Department of Pediatric Surgery, "Spirito Santo" Hospital, Pescara; "G. d'Annunzio" University, Chieti-Pescara.
| | - Giuseppe Lauriti
- Department of Pediatric Surgery, "Spirito Santo" Hospital, Pescara; "G. d'Annunzio" University, Chieti-Pescara.
| | - Dacia Di Renzo
- Department of Pediatric Surgery, "Spirito Santo" Hospital, Pescara; "G. d'Annunzio" University, Chieti-Pescara.
| | - Pierluigi Lelli Chiesa
- Department of Pediatric Surgery, "Spirito Santo" Hospital, Pescara; "G. d'Annunzio" University, Chieti-Pescara.
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Marte A, Pintozzi L, Cretì G, Chiesa PL, Renzo DD, Gasparella M, Maggio GD, Bagnara V, Merlini E, Tadini B, Caldarulo E, Sangiorgio L, Battaglino G, Nappo SG, Caione P. Long-Term Follow-Up of Testicular Microlithiasis in Children and Adolescents: Multicenter Prospective Cohort Study of the Italian Society of Pediatric Urology. Eur J Pediatr Surg 2017; 27:155-160. [PMID: 26962678 DOI: 10.1055/s-0036-1572552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction Testicular microlithiasis (TM), characterized by the presence of intratubular calcifications in a single or both the gonads, is an uncommon entity with unknown etiology and outcome in pediatric and adolescent age. In this study, the results of a multicenter long-term survey are presented. Materials and Methods From 11 units of pediatric urology/surgery, patients with TM were identified and yearly, followed up in a 7-year period, adopting a specific database. The recorded items were: age at diagnosis, presenting symptoms/associated abnormalities, ultrasonographic finding, surgery and histology at biopsy, if performed. Results Out of 85 patients, 81 were evaluated yearly (4 patients lost to follow-up). TM was bilateral in 66.6% of the patients. Associate genital abnormalities were present in 90%, more frequently undescended/retractile testis (23.4%) and varicocele (22.2%). TM remained unchanged at 4.7 years follow-up in 77 patients (93.8%) and was reduced in 4 patients after 1 to 5 years of inguinoscrotal surgery. Orchiectomy was performed in three patients (3.7%), one for severe testicular hypoplasia and two for seminoma (2.5%), respectively, concurrent and metachronous to diagnosis of TM. Tumorectomy with parenchymal sparing surgery was performed in a teratoma associated with TM. Conclusion TM is a controversial entity, often associated with several inguinogenital features, which rarely can recover. Testicular malignancy, although present in TM, has not proven definitively associated to microliths. Proper counseling, yearly ultrasound, and self-examination are long-term recommended.
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Affiliation(s)
- Antonio Marte
- Division of Pediatric Surgery, Second University of Naples, Naples, Italy
| | - Lucia Pintozzi
- Division of Pediatric Surgery, Second University of Naples, Naples, Italy
| | - Giuseppe Cretì
- Division of Pediatric Urology, "Casa Sollievo della Sofferenza" Hospital, IRCCS-San Giovanni Rotondo, Italy
| | - Pierluigi Lelli Chiesa
- Division Pediatric Surgery, "Santo Spirito" Hospital-G. D'Annunzio University-Chieti-Pescara, Pescara, Italy
| | - Dacia Di Renzo
- Division Pediatric Surgery, "Santo Spirito" Hospital-G. D'Annunzio University-Chieti-Pescara, Pescara, Italy
| | - Marco Gasparella
- Division of Pediatric Surgery, Hospital of Treviso-Padua University, Treviso, Italy
| | - Giovanni Di Maggio
- Department of Medical Sciences, Surgery and Neuroscience, Siena University, Siena, Italy
| | - Vincenzo Bagnara
- Unit of Pediatric Surgery, "G.B. Morgagni" Hospital, Catania, Italy
| | - Emilio Merlini
- Division of Pediatric Urology, S. Anna Hospital, Torino, Italy
| | - Barbara Tadini
- Division of Pediatric Urology, S. Anna Hospital, Torino, Italy
| | | | - Luciano Sangiorgio
- Unit Pediatric Urology, "SS. Antonio e Biagio e Cesare Arrigo" Hospital, Alessandria, Italy
| | | | | | - Paolo Caione
- Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Di Renzo D, Aguiar L, Cascini V, Di Nicola M, McCarten KM, Ellsworth PI, Chiesa PL, Caldamone AA. Long-Term Followup of Primary Nonrefluxing Megaureter. J Urol 2013; 190:1021-6. [DOI: 10.1016/j.juro.2013.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 03/04/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Dacia Di Renzo
- Division of Pediatric Surgery, D'Annunzio University and Spirito Santo Hospital, Chieti-Pescara, Italy
| | - Liza Aguiar
- Division of Pediatric Urology, Brown University and Hasbro Children's Hospital, Providence, Rhode Island
| | - Valentina Cascini
- Division of Pediatric Surgery, D'Annunzio University and Spirito Santo Hospital, Chieti-Pescara, Italy
| | - Marta Di Nicola
- Department of Biomedical Sciences/Statistics, D’Annunzio University of Chieti, Chieti-Pescara, Italy
| | - Kathleen M. McCarten
- Division of Diagnostic Imaging and Pediatrics, Brown University and Hasbro Children's Hospital, Providence, Rhode Island
| | - Pamela I. Ellsworth
- Division of Pediatric Urology, Brown University and Hasbro Children's Hospital, Providence, Rhode Island
| | - Pierluigi Lelli Chiesa
- Division of Pediatric Surgery, D'Annunzio University and Spirito Santo Hospital, Chieti-Pescara, Italy
| | - Anthony A. Caldamone
- Division of Pediatric Urology, Brown University and Hasbro Children's Hospital, Providence, Rhode Island
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13
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Di Renzo D, Persico A, Sindici G, Lelli Chiesa P. Testicular Teratoma, Mimicking a Simple Testicular Cyst, in an Infant. Urology 2013; 82:701-3. [DOI: 10.1016/j.urology.2013.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 03/04/2013] [Accepted: 03/09/2013] [Indexed: 11/16/2022]
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Cascini V, Lisi G, Di Renzo D, Pappalepore N, Lelli Chiesa P. Irreducible indirect inguinal hernia containing uterus and bilateral adnexa in a premature female infant: report of an exceptional case and review of the literature. J Pediatr Surg 2013; 48:e17-9. [PMID: 23331833 DOI: 10.1016/j.jpedsurg.2012.09.065] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 08/02/2012] [Accepted: 09/29/2012] [Indexed: 11/17/2022]
Abstract
Indirect inguinal hernia is the most common congenital anomaly in the pediatric age group. About 15-20% of hernias in infant girls contain ovary, sometimes with a Fallopian tube. The presence of the uterus incarcerated with the adnexa is a very unusual occurrence in female infants with normal kariotype and phenotype, being commonly associated with several disorders of sex development. The surgical repair of this form of hernia is more difficult than a common herniorrhaphy because of the adhesions between the organs and the wall of the sac and the risk of damage during their freeing. We present a rare case of irreducible indirect inguinal hernia containing uterus and bilateral adnexa (fallopian tubes and ovaries) in a premature female infant, discussing the etiopathogenesis and the surgical features of this disorder.
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Affiliation(s)
- Valentina Cascini
- Department of Pediatric Surgery, G. d'Annunzio University of Chieti-Pescara, via dei Vestini 31, 66013 Chieti, Italy.
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Abstract
PURPOSE We evaluated which clinical factors influence the outcome of primary transurethral puncture for ureterocele. MATERIALS AND METHODS A total of 45 patients (47 ureteroceles) underwent primary transurethral incision between 1994 and 2008 at 2 institutions. Age at and mode of presentation, upper tract status, ureterocele site, preoperative vesicoureteral reflux and the corresponding upper pole or kidney function were analyzed to identify which factors influenced the need for secondary surgery. RESULTS Transurethral puncture was the only treatment in 24 of 45 patients (53%) while 21 (47%) required further surgery. After transurethral puncture secondary surgery was required in 56% of patients who presented prenatally vs 27% of those who presented postnatally (p = 0.165), in 18% with a single system vs 58% with a duplex system (p = 0.036), in 30% with intravesical vs 63% with ectopic ureterocele (p = 0.039) and in 61% vs 37% with ureterocele units with vs without preoperative vesicoureteral reflux (p = 0.148). Fisher's 2-tailed exact test revealed an inconsistent distribution of negative prognostic factors, including duplex systems, ectopic ureterocele and vesicoureteral reflux at presentation, in prenatally vs postnatally and in asymptomatically vs symptomatically presenting subgroups. CONCLUSIONS Upper tract status and ureterocele site influence the outcome of primary transurethral puncture as a definitive procedure. After puncture secondary surgery is least likely in patients with a single system and intravesical ureterocele.
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Affiliation(s)
- Dacia Di Renzo
- Department of Pediatric Surgery, D'Annunzio University of Chieti, Italy
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Di Renzo D, Pappalepore N, Colangelo M, Chiesa PL. Bilateral scrotal abscesses caused by Klebsiella pneumoniae in a newborn. J Pediatr Surg 2010; 45:E19-20. [PMID: 20223303 DOI: 10.1016/j.jpedsurg.2010.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 01/01/2010] [Accepted: 01/02/2010] [Indexed: 11/16/2022]
Abstract
The management of acute scrotal swelling can be challenging in neonatal age, with scrotal infections being great mimickers of testicular torsion. Only a few unilateral cases of scrotal abscess have been previously reported, mostly caused by Staphylococcus and Salmonella. We describe the case of a newborn who developed bilateral scrotal abscesses caused by Klebsiella pneumoniae and discuss the rarity of the case, regarding both the bilaterality and the pathogen, never reported before.
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Affiliation(s)
- Dacia Di Renzo
- Pediatric Surgery Unit, G.d'Annunzio University of Chieti, Chieti, Italy.
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