Waifro Rigamonti

Università degli Studi di Palermo, Palermo, Sicily, Italy

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Publications (60)130.26 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To further expound the available data on the outcome of patients, younger than 18-years old, who have been diagnosed with bladder urothelial neoplasms.
    Journal of pediatric urology. 09/2014;
  • Lorenzo Angelini, Marco Castagnetti, Waifro Rigamonti
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    ABSTRACT: An 18-year-old boy, followed up after seminal-sparing cystectomy for bladder rhabdomyosarcoma, presented complaining of recurrent episodes of left scrotal/inguinal pain arising after orgasms. Full work-up ruled out disease recurrence, but showed enlarged seminal vesicles. Ligation of the vas deferens was unsuccessful. The patient was started on α-blockers to reduce vas contractions with improvement of symptoms. The possible pathophysiology and treatments of this symptom are discussed. © 2014 S. Karger AG, Basel.
    Urologia Internationalis 01/2014; · 1.07 Impact Factor
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    ABSTRACT: To determine the oncological and urological outcomes in patients with bladder/prostate rhabdomyosarcoma according to the type and timing of urinary tract surgery, with emphasis on the role of the Vescia Ileale Padovana (VIP) orthotopic ileal neo-bladder. Retrospective analysis of oncological and urological outcomes of 11 consecutive patients treated at our institution between 1998 and 2012. 2 patients underwent urethrectomy and placement of a heterotopic catheterizable ileal neo-bladder. The membranous urethra was preserved in 9 patients, 6 underwent a primary VIP at the same time of radical cystectomy, 2 a delayed VIP, and one a bilateral cutaneous ureterostomy. Four of these 9 patients experienced disease recurrence including two local recurrences despite negative intraoperative biopsies. Survivors receiving a heterotopic catheterizable ileal neo-bladder or a primary VIP learned to empty their bladder to completion without long-term upper tract deterioration. Both cases undergoing a delayed VIP required clean intermittent catheterization eventually. Erections were reported in 5 of 6 surviving males. A VIP neo-bladder allowed preserving volitional urethral voiding in all the survivors in whom it was placed at the time of radical cystectomy. Nevertheless, local recurrence occurred in 2 of the 9 cases where the membranous urethra was preserved. On the other side, patients undergoing a delayed VIP after achievement of a disease-free status never managed voiding by the urethra. Therefore, a heterotopic reservoir might be a more reliable choice under these circumstances. Erectile function is preserved in the majority of cases.
    The Journal of urology 12/2013; · 3.75 Impact Factor
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    ABSTRACT: We retrospectively reviewed the records of 24 consecutive patients undergoing treatment for ureteral complications after RTx in the period 2001-2012 to determine the timing of presentation of the complications, and their open or endoscopic management. Three patients (12%) had a necrosis of the transplanted ureter soon after RTx. All required open urinary diversion in a native ureter. Ten cases (42%) developed ureteral obstruction. Time of presentation was variable mainly in relation to the underlying cause. Endoscopic treatment was successful in two cases with urinary stones and open surgery in two with mid-ureteral obstruction. Six patients had VUJ stenosis, three underwent open reimplantation, whereas temporary double-J stent placement was successfully performed in the remainder. Eleven patients (46%) had VUR. It seldom presented in the first year after RTx. Endoscopic treatment was attempted in all and was successful in all the six cases without vs. only one of the five with lower urinary tract pathology (p = 0.01). Endoscopic treatment is an option in patients with VUR in the absence of lower urinary tract pathology. It is an option also for the treatment of stones and can be attempted in case of VUJ stenosis. Ureteral necrosis always requires open treatment.
    Pediatric Transplantation 12/2013; · 1.50 Impact Factor
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    ABSTRACT: Failed hypospadias refers to any hypospadias repair that leads to complications or causes patient dissatisfaction. The complication rate after hypospadias repairs ranges from 5-70%, but the actual incidence of failed hypospadias is unknown as complications can become apparent many years after surgery and series with lifelong follow-up data do not exist. Moreover, little is known about uncomplicated repairs that fail in terms of patient satisfaction. Risk factors for complications include factors related to the hypospadias (severity of the condition and characteristics of the urethral plate), the patient (age at surgery, endocrine environment, and wound healing impairment), the surgeon (technique selection and surgeon expertise), and the procedure (technical details and postoperative management). The most important factors for preventing complications are surgeon expertise (number of cases treated per year), interposition of a barrier layer between the urethroplasty and the skin, and postoperative urinary drainage. Major complications associated with failed hypospadias include residual curvature, healing complications (preputial dehiscence, glans dehiscence, fistula formation, and urethral breakdown), urethral obstruction (meatal stenosis, urethral stricture, and functional obstruction), urethral diverticula, hairy urethra, and penile skin deficiency.
    Nature Reviews Urology 08/2013; · 4.79 Impact Factor
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    ABSTRACT: We report the results in patients with obstructed upper pole ectopic ureters in duplex systems undergoing dismembered extravesical reimplantation of the upper pole ureter alone. Between 01/2007 and 03/2012, 11 patients with an upper pole ectopic ureter (1 bilateral) diagnosed following the antenatal detection of hydronephrosis and showing preserved function on renal scintigraphy in a dilated upper moiety, underwent a dismembered reimplantation of the ectopic upper pole ureter as follows. The ureter was identified, separated from the lower pole ureter, and divided just above the bladder. The distal stump was suture closed, while the proximal segment was mobilized, tapered as necessary, and reimplanted using an extravesical technique. Twelve ectopic ureters were reimplanted. Median (range) patient age at surgery was 8 (3-48)months. Ureteral tapering was performed in 11 ureters, by infolding in 9 and using an excisional tailoring in the single case undergoing bilateral reimplantation. After a median (range) follow-up of 17 (6-50)months, all patients were asymptomatic. Eleven reimplanted ureters showed improving hydroureteronephrosis, no obstruction on diuretic scintigraphy, and no evidence of reflux on indirect radionuclide cystography. One reimplanted ureter developed worsening hydroureteronephrosis after excisional tailoring of the ureter and partial nephrectomy was performed. Extravesical reimplantation of the upper pole ureter is an option in dilated upper pole ectopic ureters with good function. Separating the upper and lower pole ureters proximally to the bladder does not jeopardize the ureteral blood supply and allows leaving the lower pole ureter undisturbed. Excisional ureteral tailoring should be avoided.
    Journal of Pediatric Surgery 02/2013; 48(2):459-63. · 1.38 Impact Factor
  • Marco Castagnetti, Evisa Zhapa, Waifro Rigamonti
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    ABSTRACT: PURPOSE: We compared complication rates, urinary symptoms and cosmetic outcomes, as perceived by parents, among patients undergoing one of four repairs for proximal hypospadias associated with curvature. PATIENTS AND METHODS: Ninety-three patients were operated between 2004 and 2010. Repairs included the tubularised incised plate (n=26) or the onlay island flap urethroplasty (n=31) in cases requiring no urethral plate (UP) transection, whereas the onlay island flap on albuginea (n=18) or the 2-stage repair (n=18) in those requiring UP transection. Complications were assessed by chart review. A customized questionnaire and the Pediatric Penile Perception Score (PPPS) were administered to parents to evaluate their perception of urinary symptoms and cosmetic outcomes, respectively. RESULTS: After a median (range) follow-up of 4.5 (2.2-8.4) years, complications developed in 21 (23%) patients without any difference among the procedures, or between cases requiring and not requiring UP transection. Parents of 75 (80%) patients participated in the survey, without difference among repairs (p=0.35). Reported urinary symptoms were not different among repairs. On PPPS, the only difference concerned the question about penile length (p=0.03), which score was significantly better in the techniques requiring UP transection (p=0.05). The 2-stage repair had significantly better scores in the question about penile length and overall PPPS than all the other techniques. CONCLUSIONS: Overall complication rates were comparable among repairs and did not increase after UP transection. Urinary symptoms, as reported by parents, were comparable among the procedures. Perceived penile length was significantly better after UP transection. The 2-stage repair yielded the best cosmetic results.
    The Journal of urology 11/2012; · 3.75 Impact Factor
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    ABSTRACT: A 3-year-old boy presented with an asymptomatic intertesticular mass increasing in size. Plasma tumor markers (α-fetoprotein and β-human chorionic gonadotrophin) were negative. The mass had a pattern similar to testicular parenchyma but no discernable blood flow on scrotal Doppler ultrasound. Magnetic resonance imaging scan showed that it reached the posterior urethra after passing through the right corpus cavernosum with a progressive tapering extending into the pelvis. The mass was excised surgically and histologically found to be consistent with a dermoid cyst. Such rare benign lesions should be considered in the differential diagnosis of painless scrotal masses in children. Its anatomy was accurately defined by magnetic resonance imaging and was essential to minimize the risk to adjacent structures.
    Journal of Pediatric Surgery 08/2012; 47(8):1618-21. · 1.38 Impact Factor
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    ABSTRACT: OBJECTIVE: We assessed outcomes and need for secondary surgery after primary trans-urethral puncture (TUP) or upper pole partial nephrectomy (UPPN) in duplex system ureterocele (DSU) patients undergoing management that disregards vesicoureteral reflux and upper pole function. SUBJECTS AND METHODS: Between 2003 and 2010, 41 DSU <1 year underwent TUP (n = 32) or UPPN (n = 9). Postoperatively, additional investigations and surgery were limited to cases showing persistent hydroureteronephrosis or developing recurrent febrile urinary tract infections (UTI). Outcome parameters included upper tract decompression, UTI after decompression, continence status, and secondary surgery rate. Preoperative variables were compared between patients who required secondary surgery and those who did not. RESULTS: Additional surgery was required for persistent hydroureteronephrosis in 20% of cases after TUP vs none after UPPN. After decompression, 4 female patients developed recurrent febrile UTI and 2 required additional surgeries. No case suffered from urinary incontinence. After a median (range) follow-up of 46 (17-102) months, TUP or UPPN was the only surgery required in 32 (78%) cases irrespective of preoperative variables. CONCLUSION: UPPN seems more effective than TUP in decompressing severely dilated urinary tracts. After decompression, disregarding VUR status and upper pole function, TUP or UPPN is the only procedure required in 80% of DSU cases, regardless of preoperative variables.
    Journal of pediatric urology 07/2012; · 1.38 Impact Factor
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    ABSTRACT: Observation is a conservative management option in infants with nonrefluxing hydronephrosis, primary nonrefluxing megaureter and ureterocele diagnosed postnatally following antenatal detection of hydronephrosis. Antibiotic prophylaxis might be a sensible regimen under these circumstances to prevent UTI in this population who are potentially at increased risk. However, studies examining the efficacy of prophylactic antibiotics are sparse in this setting. For each condition, prophylactic policies seem extremely variable, and UTI rates vary widely with comparable rates reported between patients followed on and off antibiotics. Overall, antibiotic prophylaxis seems unnecessary in patients with isolated low-grade hydronephrosis. Patients with high-grade nonrefluxing hydronephrosis seem at increased risk of UTI, with risk further increasing in patients with associated ureteral dilatation (hydroureteronephrosis) irrespective of the presence of a ureterocele. Obstruction might be an additional independent risk factor, but the diagnosis of obstruction is often possible only in retrospect. The data available suggest that infants are the most at risk of UTI during the first 6 months of life, particularly if they undergo catheterization during workup examinations. Thus, antibiotic prophylaxis might be prudent during the first 6-12 months of life in patients with high-grade hydronephrosis and hydroureteronephrosis with or without ureterocele, and particularly before completion of the diagnostic workup. Paediatric urologists are urged to embark on controlled trials to compare patients followed with and without antibiotic prophylaxis.
    Nature Reviews Urology 05/2012; 9(6):321-9. · 4.79 Impact Factor
  • Marco Castagnetti, Waifro Rigamonti
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    ABSTRACT: From 2007 to date, fi ve boys with bladder exstrophy underwent this pre-emptive treatment of inguinal hernia at our institution. None has developed a recurrence after a median (range) follow-up of 29 (5 – 46) months. This approach avoids any manipulation of the inguinal canal, which is an advantage per se, but may be even more important in children with bladder exstrophy given the relatively high risk of hernia recurrence reported [ 1,2 ] . Furthermore, the presence of a pelvic diastasis makes the pelvic dissection of the cord easier than in normal children with a closed pelvic ring. The same procedure can also possibly be performed in children with a congenital inguinal hernia undergoing other procedures that require dissection of the perivesical space, e.g. ureteric re-implantation or ureterocoele repair.
    BJU International 04/2012; 109(8):1270-5. · 3.05 Impact Factor
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    ABSTRACT: Upper pole histology has been poorly investigated in duplex system ectopic ureters and ureteroceles. We aimed to determine the differences in histology between the conditions, and to identify clinical markers of renal damage. Twenty-two patients undergoing partial nephrectomy between 2001 and 2007 for poorly functioning upper poles associated with ectopic ureters (n = 11) or ureteroceles (n = 11) were considered. Histology was classified into three groups: normal, chronic interstitial nephritis (CIN), and dysplasia. Clinical and radiological variables were compared between the two conditions and between cases with normal and abnormal histology. Of the 22 upper pole specimens, 9 had normal histology, 8 dysplasia, and 5 CIN. Statistical analysis failed to show any significant difference in preoperative variables or histology between ectopic ureters and ureteroceles, and in preoperative variables between cases with normal and abnormal histology. We did not find significant differences in the histology of upper poles associated with ectopic ureters and ureteroceles. Histology was normal in more than one-third of patients, although the poles were poorly functioning. We hypothesize that these poles were hypoplasic rather than dysplasic. We failed to identify predictors of histological damage. Hence, the latter cannot be considered a factor guiding our decision-making.
    Pediatric Surgery International 11/2011; 28(3):309-14. · 1.22 Impact Factor
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    ABSTRACT: The aim of this study was to analyze the complication rate in male bladder exstrophy (BE) patients undergoing flap or graft urethroplasty for the repair of resultant hypospadias after epispadias repair. We retrospectively reviewed the charts of 22 male BE patients who underwent 24 urethroplasties for resultant hypospadias between 2000 and 2009. Median patient age was 4.2 (range, 1.5-26.5) years, and median follow-up was 7.5 (range, 0.8-10.3) years. Meatal location after epispadias repair was midshaft in 6 cases and proximal shaft in 15. Complications were compared in relation to meatal position, type of urethroplasty (no graft vs graft), use of second-layer coverage of the urethroplasty, and use of suprapubic diversion. Overall, complications developed in 12 (50%) patients, including 10 urethrocutaneous fistulas and 2 urethroplasty dehiscence. Univariate analysis failed to show any differences between complicated and uncomplicated cases in all the variables. Only the 3 cases undergoing a 2-stage repair had fully successful outcomes. Urethroplasty in patients with BE has a high complication rate. Quality of local tissue and presence of scarring are possibly the 2 major determinants of a poor outcome. A staged repair seems the safest, although this commits the patient to 2 procedures.
    Journal of Pediatric Surgery 10/2011; 46(10):1965-9. · 1.38 Impact Factor
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    ABSTRACT: To report our experience with surgical management of gynecological issues in postpubertal female patients born with classic bladder exstrophy (BE). Retrospective review of clinical charts. Tertiary pediatric urology unit. 16 postpubertal female BE patients. Cosmetic surgery to the external genitalia, widening of vaginal introitus, and treatment of pelvic organ prolapse. patient satisfaction and additional gynecological problems during follow-up. Eight cases (14-43 years old) underwent cosmetic procedures. All resulted in improved cosmesis, but one case complained of reduced erogenous sensitivity after clitoridoplasty. Five cases (17-20 years old) underwent widening of the vaginal introitus. The modification was as short as possible to avoid any foreshortening of the dorsal vaginal wall. Three cases 33-45 years old presented with pelvic organ prolapse. All were sexually active. One had already given birth. All the three had previously been submitted elsewhere to a posterior vaginal cutback and one to hysterectomy. Two are still awaiting further treatment due to recurrent prolapse. Female BE patients can seek advice to improve the appearance of the external genitalia at any ages. Clitoridoplasty should be considered carefully, because it may harm erogenous sensitivity. Problems with the vaginal introitus typically present at around 20 years of age, probably when BE patients become sexually active. Opening too widely the introitus can cause a foreshortening of the posterior vaginal wall, predisposing to pelvic organ prolapse. Treatment of pelvic organ prolapse is difficult.
    Journal of pediatric and adolescent gynecology 02/2011; 24(1):48-52. · 0.90 Impact Factor
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    ABSTRACT: High-voltage electrical burns on genitalia and perineal areas are very rare and only sporadic reports are available in the literature with often confusing diagnoses and inconspicuous treatment protocols. Although the surgical treatment of extremities lesions is well established and includes appropriate debridement, temporary wounds coverage, and final adequate soft-tissue reconstruction, management of genital lesions remains controversial and challenging. The authors present a rare case of severe high-voltage electrical injury with involvement of upper extremities and complex lesions localized to the genitalia and perineal region. Treatment required a multidisciplinary approach including the plastic surgery and the urologic and andrologic teams.
    Journal of burn care & research: official publication of the American Burn Association 01/2011; 32(6):e168-71. · 1.54 Impact Factor
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    ABSTRACT: A portable and removable thoraco-pelvic orthosis for patient immobilization after neonatal primary bladder exstrophy closure is described. The device is made of a polyethylene shell, moulded at 170°C, coated inside with a 5 mm pad of plastazote and works applying a constant gentle pressure on the hips.
    Pediatric Surgery International 12/2010; 26(12):1229-32. · 1.22 Impact Factor
  • Waifro Rigamonti, Marco Castagnetti
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    ABSTRACT: To describe a modified onlay preputial island flap (OIF) urethroplasty to also be used in patients requiring urethral plate transection for penile straightening. A total of 14 cases with primary severe hypospadias underwent the modified OIF urethroplasty as follows. After skin degloving, the corpora cavernosa were dissected ventrally. The urethral plate was mobilized and, if curvature >30° persisted, transected just proximally to the coronal sulcus. A pedicled preputial island flap was elevated and placed as an onlay to create the neourethra. It was sewn to the margins of the urethral plate proximally and distally. In contrast, in the portion of the shaft without a plate, it was sewn directly to the albuginea of the corpora cavernosa with 2 parallel suture lines. Glanuloplasty and skin closure followed as in standard onlay repairs. After a median follow-up of 7 months (range 5 to 27), 3 patients (21%) developed complications requiring additional surgery (1 simple fistula, 1 partial urethroplasty breakdown, and 1 ballooning of the neourethra). None of the remaining patients presented with residual curvature or voiding problems, according to the parental report. The results of the present preliminary experience suggest that OIF urethroplasty can also be performed in cases requiring urethral plate transection. It can be accomplished by suturing the preputial flap directly to the albuginea of the corpora cavernosa. Although we acknowledge that a larger number of cases and longer follow-up are necessary, we believe this technique should be incorporated into the armamentarium of hypospadiologists.
    Urology 12/2010; 77(6):1498-502. · 2.42 Impact Factor
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    ABSTRACT: We evaluated the association between MCP-1, CCR2, RANTES, and CCR5 gene polymorphisms and upper urinary tract infection in 273 children recruited in Northeast Italy. Statistical analysis of RANTES-403 G>A genotype frequencies showed that children carrying the RANTES-403 G allele are at higher risk for urinary tract infection, irrespective of vesicoureteral reflux.
    The Journal of pediatrics 12/2010; 157(6):1038-1040.e1. · 4.02 Impact Factor
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    ABSTRACT: We assessed LUTS at least 12 months after RTx in patients without evidence of lower urinary tract dysfunction (non-urologic) that had been anuric for at least six months before RTx. No bladder recycling was performed before RTx. LUTS were evaluated using a questionnaire. Clinical records were also reviewed. LUTS in anuric patients were compared with those in non-anuric patients. Fourteen anuric patients fulfilled the inclusion criteria. Median age at RTx was 11 (5-21) yr, median duration of anuria before RTx 24 (7-46) months, and median post-RTx follow-up 2.7 (1.9-10.2) yr. Daytime symptoms were exceptional. Nocturia was the most common symptom (10 patients). Only one patient reported symptoms to affect her quality of life. One patient experienced a febrile UTI and none graft failure. LUTS (nocturia) proved unrelated to duration of anuria, length of follow-up, and presence of (nocturnal) polyuria. LUTS were not statistically different in patients anuric and non-anuric before RTx. Non-urologic patients suffer from long-term storage symptoms, particularly nocturia. LUTS, however, do not seem to increase the risks of urinary infections or graft failure and appear to occur irrespective of the presence of anuria before RTx. Bladder recycling before RTx seems unnecessary.
    Pediatric Transplantation 11/2010; 14(7):859-62. · 1.50 Impact Factor
  • Evisa Zhapa, Waifro Rigamonti, Marco Castagnetti
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    ABSTRACT: We describe an adolescent female patient born with a complex genitourinary malformation including bilateral duplex system and duplication of the müllerian structures (bicornuate uterus and septate vagina). She presented with a symptomatic hydrosalpinx. The typical imaging of this condition is described along with the issues associated with the differential diagnosis in this complex scenario. The diagnosis of hydrosaplinx should be suspected in patients with complex genitourinary malformations and a pelvic fluid collection. Associated genital and renal anomalies are noted in 30% of cases.
    Journal of Pediatric Surgery 11/2010; 45(11):2265-8. · 1.38 Impact Factor

Publication Stats

276 Citations
130.26 Total Impact Points

Institutions

  • 2013
    • Università degli Studi di Palermo
      Palermo, Sicily, Italy
  • 2006–2013
    • University-Hospital of Padova
      Padua, Veneto, Italy
  • 2008
    • San Bortolo Hospital
      Vicenza, Veneto, Italy
  • 2004–2007
    • University of Padova
      • Department of Pediatrics
      Padua, Veneto, Italy