Are you Roberto Vagni?

Claim your profile

Publications (3)4.02 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVES: A first experience was carried out in three research centers using a new urethral sling for the treatment of male and female pediatric and young adult population with urinary incontinence caused by neurogenic sphincteric incompetence. METHODS: This was a prospective pilot study of patients with neurogenic sphincteric incompetence needing clean intermittent catheterization. All patients were treated by the implantation of Nephis® mini-sling (Promedon, Argentina) over the proximal urethra. Twenty-eight patients were included, 19 females and 9 males. Mean age was 13.4 (SD 7.8 years). The median follow-up was 16.5 (12-24) months. Urodynamic studies were carried out pre and postoperatively to assess the nature of the incontinence and to quantify the outcomes after implantation. A voiding diary was also used to evaluate the Daytime Dryness Intervals between catheterization. RESULTS: Leak Point Pressure increased from a preoperative mean value of 24.3 cmH2O (SD 6.5) to 51.0 cmH2O (SD14.3) (p<0.0005). The initial mean for Daytime Dryness Interval was 60.4min (SD 9.1) and postoperatively rose to 195.6 (SD 59.4) (p<0.0005). Only one major complication was registered: a sling had to be removed due to erosion in a patient who underwent a concomitant bladder neck reconstruction due to an ectopic ureter repair. CONCLUSIONS: The mini-sling was easy to implant and urodynamic results suggest it is effective in the treatment of neurogenic sphincteric incompetence. This statement is also supported by voiding diary records.
    Archivos españoles de urología 04/2013; 66(3):295-301.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Here we report the results of a review of a prospectively maintained database of the use polyacrylate polyalcohol copolymer (PPC) injection to correct grades IV and V VUR. Materials and Methods: All children with grades IV and V primary VUR that presented with febrile urinary tract infection while on prophylaxis, in a 3-year period, were treated with a sub-ureteral injection of PPC. Institutional ethical approval was obtained. Exclusion criteria were incomplete bladder emptying documented on videourodynamic study, ureteral duplication, paraureteral diverticula, and poor ureteral emptying observed during fluoroscopy and previous open surgical or endoscopic treatment. Pre- and post-operative evaluation included urinalysis, renal and bladder ultrasonography, DMSA scan, and videourodynamic studies. Results: Thirty-three children [36 renal units (RU)] were included with a median age of 57 months (range 7-108). There were 18 boys and 15 girls. Thirty RU had grade IV and 6 grade V VUR. Median follow-up time was 32 months (range 7-58). Reflux was cured in 32/36 RU with the first injection, but another two patients were reimplanted because of dilatation. Complications included early urinary tract infection in seven children, transient lower urinary tract symptoms in five children. Progressive ureteral dilatation was noted in four children and was treated with insertion of a double J stent. Two of these children eventually required an ureteroneocystostomy. Conclusion: The use of PPC to treat grades IV and V vesicoureteral reflux in young children has an overall success rate of 83.3%. Persistent ureteral dilatation was present in 11% associated with high injection volume. Future studies will attempt to maintain a high success rate reducing the volume of injection and the incidence of dilatation.
    Frontiers in Pediatrics 01/2013; 1:32.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Megaprepuce is a congenital penile malformation that includes phimosis and severe ballooning of the internal prepuce. We combined the main technical details of 2 previously reported surgical techniques to simplify the surgical approach. We report the key points of this revisited surgical correction for megaprepuce and the long-term results. Penile reconstruction was performed between March 2004 and March 2009 in 26 children 2 to 19 months old (median age 6) with congenital megaprepuce. Surgical repair consisted of limited preputial resection of the phimotic ring, wide dissection of the outer prepuce to the base of the penis, fixation of the proximal outer prepuce to Buck's fascia to create a new penoscrotal junction, and unfurling and wide tailoring of the inner prepuce in the ventral midline to resurface the whole elongated penile shaft. A bladder catheter was left in place for 5 or 6 days. Only patients with at least 6 months of followup were included in analysis. All patients underwent surgery on an outpatient basis. Operative time was between 50 and 85 minutes. Median followup was 17.6 months (range 6 to 59). Two patients had slight dehiscence of the ventral suture, which healed spontaneously without a scar. In 1 patient transient urethral meatal stenosis developed. The final cosmesis result was adequate in all patients. It is possible to correct megaprepuce and achieve an adequate genital aspect with a simple approach of resurfacing the penis with the unfurled, tailored inner prepuce.
    The Journal of urology 06/2011; 185(6 Suppl):2487-90. · 4.02 Impact Factor