[Cohen's uretero-vesical reimplantation in the treatment of primary obstructive mega-ureter]. / La réimplantation urétéro-vésicale selon Cohen dans le traitement du méga-uretère primitif obstructif.

The usual surgical treatment of primary obstructive megaureter consists of ureteral tailoring, according to H. Hendren's procedure, and reimplantation using Politano-Leadbetter technique. The Authors report their experience with trans-trigonal reimplantation (Cohen's ureteroneocystostomy) in case of primary obstructive megaureter. This procedure has been performed either in case of tailored megaureters than in those in which ureteral tailoring was not necessary. Considering its easy handling and safety, Cohen's technique has been indicated as method of choice for ureteral reimplantation even in case of primary obstructive megaureter, basing on successful experience on the treatment of vesicoureteral reflux. A current objection to the trans-trigonal technique for obstructive megaureter is the possibility of a postoperative reflux in the reimplanted megaureter (tailored or not), because of the difficulty in obtaining an adequate submucosal tunnel (unbalanced length/width ratio). The Authors report a 3 year experience on a common surgical treatment of primary obstructive megaureter. 56 cases were treated (bilateral megaureter in 3 cases) by trans-trigonal reimplantation (Cohen's ureteroneocystostomy) in addition to ureteral tailoring (Hendren's technique) in 46 cases or Kalicinski plication in 6. Finally, in 4 cases no tailoring procedure was needed (simple excision of the restricted terminal ureter). No postoperative complications nor cystographic evidence of postoperative reflux have been recorded in all cases (follow-up = 6-36 months), remarking this technique as safe and effective.

Actinomycosis of bladder and intrauterine devices.

PIP: Vesical actinomycosis, though rare, is being discovered more among women who use IUDs. The case study is presented of a 32 year old woman with actinomycosis of the bladder. An analysis of the disease reveals that human actinomycosis is caused primarily by actinomyces israeli. It grows anaerobically and a number of strains are micro-aerophilic. Infection can begin principally in 3 ways: 1) when endogenous actinomyces penetrate damaged tissues following trauma, 2) other infections of foreign bodies, or 3) surgical manipulation. Pelvic actinomycosis is now being seen in women with IUDs. Urinary tract infection seldom occurs, and kidneys are affected more than ureters or the bladder. In appearance, vesical actinomycosis resembles a retropubic mass. It is possible that female organs, when confronted by a foreign body, may make it possible for the development of a undetectable actinomycotic pelvic infection. Treatment for actinomycosis is extensive antibiotic therapy with penicillin, tetracycline, clindamycin, or erythromycin. Surgery may be necessary when the disease produces a large mass and there's a need to drain abscesses, or to extirpate sinus tracts.^ieng

[Ureteral ectopy. The residual stump syndrome]. / Ectopia ureterale. La sindrome del moncone residuo.

Anatomy and symptoms of ureteral ectopy in childhood can greatly vary. In most cases the site of ectopies in the urethral tract, so that a complete excision of the distal ureter is difficult and may cause damage to the sphincteric structures. When lower ureterectomy is performed below iliac vessels, symptoms secondary to residual ectopic ureter are rare. In our experience, residual ureteral stumps were symptomatic in two cases, with continence and micturation disturbances, which were codified as "residual ureteral stump syndrome". Clinical features and treatment are herein reported.

[Valves of the anterior urethra without diverticulum. Description of 3 cases]. / Valvole dell'uretra anteriore senza diverticolo. Descrizione di tre casi.

Anterior urethral valves are rare entities, especially in case they are not associated to urethral diverticulum. Because of their obstructive effects on the urinary tract, they must be searched in case of clinical evidence of lower obstructive uropathy. Three cases of anterior urethral valves without urethral diverticulum are herein reported. Differential diagnosis with urethral diverticula, endoscopic features and treatment are discussed and emphasized.

Inverted papilloma of the ureter: two cases of conservative therapy.

We report 2 cases of inverted urothelial papilloma of the ureter. The second case demonstrates inverted papilloma and papillary transitional cell carcinoma in a single polypoid lesion. Conservative therapy was performed and a follow-up 12 months later shows no evidence of recurrences.

[Morphological findings on the terminal tract of the ureter in patients with vesico-ureteral reflux associated with neurogenic bladder]. / Rilievi morfologici sul tratto terminale dell'uretere in pazienti portatori di reflusso vescico-ureterale associato a vescica neurologica.

Vesico-ureteral reflux (VUR) associated to neurogenic bladder dysfunctions is well known as pathologic entity; in particular, its radiologic and urodynamic aspects have been widely debated in recent years, even in infancy and childhood. In our study, histologic features of the vesico-ureteral junction have been investigated in a group of patients with neurogenic bladder and VUR, who underwent antireflux surgery. Structural aspects of these vesico-ureteral junctions have been then compared to refluxing junctions taken from non-neurogenic bladders and non-refluxing junctions from normal bladders.

[Morphologic findings on the terminal tract of the ureter in patients with primary vesico-ureteral reflux]. / Rilievi morfologici sul tratto terminale dell'uretere in pazienti portatori di reflusso vesico-ureterale primitivo.

Primary vesico-ureteral reflux (V.U.R.) in children has been widely investigated in several reports in the last two decades, but the morphologic aspects of refluxing vesico-ureteral junction are still incompletely codified or incompletely described. The authors report the results of a histologic study on the terminal refluxing ureter in a group of 20 patients with primitive V.U.R., random chosen from a series of over 400 subjects who underwent antireflux surgery for primitive V.U.R. at the Pediatric Surgery Department of the University of Bologna. Connections between muscular hypertrophy and reflux degree are herein reported and discussed.

Rhabdomyosarcoma of the diaphragm in a 4-year-old girl.

Rhabdomyosarcoma of the diaphragm is a very rare entity, especially in childhood. A case of a 4-year-old girl is reported. The mass extended completely into the abdominal cavity, causing problems in differential diagnosis with other abdominal masses. Dimensions, structure and limits of the mass had been outlined by several examinations (IVP, sonography, CT, angiography), but its actual nature could not be shown, so that a surgical exploration was needed. A pedunculated, well-capsulated mass, arising from the left diaphragmatic portion, was found. A complete excision could be performed and histologic findings were compatible with rhabdomyosarcoma of the diaphragm.

Sigmoid volvulus in children: a case report.

Sigmoid volvulus in childhood is a rare entity. Dolichosigmoid, i.e. an abnormally long sigmoid flexure, and or absence of mesosigma are predisposing factors in most cases. A case of a 9-year-old black male child is reported. The patient presented with the typical symptoms and, at operation, a necrotic segment of the sigma of huge dimensions was found. Volvulus consisted of three complete counterclockwise rotations of the proximal on the distal tract.

[Papilloma of the bladder in childhood. Description of a case]. / Il papilloma vescicale in età pediatrica. Descrizione di un caso.

Epithelial tumours of the bladder are very rare entities in childhood. A case of a bladder papilloma in a 10 years old boy is herein reported. Basing on this observation, the pathological, therapeutic and prognosis aspects are mainly discussed.

[Combination of oxybutynin chloride (Ditropan) with intermittent catheterization in the treatment of neurogenic bladder in childhood: results on continence]. / Associazione dell'ossibutinina cloridrato (Ditropan) al cateterismo intermittente nel trattamento della vescica neurologica in età pediatrica: risultati sulla continenza.

Nowadays Intermittent Catheterization (I.C.) is considered the treatment of choice in patients with neurogenic bladder dysfunction, because of its easy handling and good results. Renal function preservation, urinary tract infections prevention and continence can be achieved by this method. In particular, I.C. per sè improves continence quality in many cases, but, in the majority of them the best results can be obtained by drug therapy addition, having in mind a more direct action on to detrusor compliance and/or bladder neck tone. Oxybutynin Chloride (Ditropan)(-) is the first choice drug, even in childhood, in cases of neurogenic bladder dysfunction, for its anticholinergic, antispastic and analgesic properties. From 1978, 48 children with neurogenic bladder have been treated by I.C. Out of them, 27 have had drug therapy (Oxybutynin Chloride-Ditropan) in addition to I.C., according to indications of clinical, radiologic and urodynamics findings. Results on continence are discussed.

Os penis.

The presence of os penis in man is very rare. To date only 11 cases have been published. A close study of these cases shows their extreme heterogeneity. We think that the os penis should be considered as a heterotopic bone structure similar to that found in the animal world. To confirm this we present our personal case study.

Abdominoscrotal hydrocele in childhood. Case report and review of the literature.

Abdominoscrotal hydrocele in infancy and childhood is a very rare entity. A review of the literature reveals only five cases at this stage. Symptoms are often poor and non-specific and the mass must be differentiated from other abdominal ones; to achieve this, I.V.P., cystography and sonography play an important role. Total excision is necessary to obtain permanent cure.