Peristeen(®) transanal irrigation in paediatric patients with anorectal malformations and spinal cord lesions: a multicentre Italian study.

AIM: In paediatric and adult patients with neurogenic bowel, transanal irrigation (TAI) of the colon has gained popularity due to the introduction of a specifically designed device. The aim of this pilot study was to present the results of TAI using the Peristeen(®) TAI system in a group of paediatric patients with anorectal malformation (ARM) and congenital or acquired spinal cord lesions (SCLs). METHOD: Eight Italian paediatric surgery and spina bifida centres participated in the study. The inclusion criteria were age between 6 and 17 years, weight above 20 kg and unsatisfactory bowel management. Patients with chronic inflammatory bowel disease, mental disability and surgery within the previous 3 months were excluded. At the beginning of treatment (T0) and after 3 months (T1) the Bristol scale, a questionnaire assessing bowel function, and two questionnaires on quality of life (QoL) for patients aged 6-11 years (CHQ-pf50) and 12-17 years (SF36) were administered. RESULTS: Eighty-three patients were enrolled, and seventy-eight completed the study (41 ARMs, 37 SCLs). At T1, constipation was reduced in ARMs from 69% to 25.6% and in SCLs from 92.7% to 41.5%, faecal incontinence in ARMs from 50% to 18.6% and in SCLs from 39% to 9.8% and flatus incontinence in ARMs from 20.9% to 9.8% and in SCLs from 31.7% to 10%. At T0, the Bristol Stool Scale types were 1-2 in 45% of ARMs and 77.5% of SCL patients, whereas at T1 types 1-2 were recorded in only 2.5% of SCL patients. QoL improved in both groups. In the younger group, a significant improvement in QoL was recorded in ARM patients for eight of nine variables and in SCL patients for seven of nine variables. CONCLUSION: This study showed that Peristeen TAI resulted in a significant time reduction in colonic cleansing, increased independence from the carer and improved QoL in paediatric patients with ARMs and SCLs.

[Epididymal anomalies in cryptorchism and in persistent peritoneo-vaginal duct]. / Anomalie dell'epididimo nel criptorchidismo e nella persistenza del dotto peritoneo-vaginale.

BACKGROUND: Various percentage incidences (36-75%) of the duct system morphologic alterations in cryptorchidism syndrome have been reported in the literature. Etiopathogenic factors, responsible for this syndrome, are yet to be specified, as is their correlation with testicular descent in the scrotum and peritoneal-vaginal duct regression. METHODS: In a prospective multicentric study we have documented seminal duct anatomy in 566 children, undergoing inguinal or scrotal surgical exploration due to acute scrotal syndrome (group A, "control group"), cryptorchidism (group B), and peritoneal-vaginal duct patency syndromes (group C), for a total of 726 testicles. On the basis of anatomical configurations, explored testicles have been subdivided into three groups: normal testicles (type I), suspension anomalies (type II), obstruction anomalies (type III). Prevalence of the above anatomical configurations in the various groups has been statistically evaluated by the chi 2 test. RESULTS: Results have highlighted a significant prevalence (p < or = 0.01) of severe duct system obstructive anomalies (type III) in children with cryptorchidism (group B) and in children with vaginal duct patency (group C). These results can justify the hypothesis of a close correlation between testicle embryologic migration process in the scrotal sac and seminal duct development; this latter seems furthermore correlated with peritoneal duct regression. CONCLUSIONS: The drawn conclusion is that duct system morphologic alterations in cryptorchidism, due to their seriousness and incidence, can condition final fertility capability.