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Introduction
Skills and Expertise
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NUPEP-CACAU
Publications
Publications (62)
Introduction:
Persistent cloaca, defined as confluence of the rectum, the vagina and the urethra into a single common channel, has an estimated incidence of 1/50,000 live births. We describe the buccal mucosa graft vaginoplasty for a 11 year old female with cloaca, who underwent at the age of 11 months a Peña repair. We performed the vaginoplasty...
Objectives:
High-risk bladder pattern can be defined by Urodynamic Evaluation (UE) as overactive bladder with detrusor leak point pressure higher than 40 cmH2O and/or higher filling pressures also above 40 cmH2O. We wanted to evaluate response to treatment in myelomeningocele patients operated in utero in this subgroup.
Patients and methods:
Fro...
Introduction
A challenging situation in proximal hypospadias is the presentation of patients with successful urethroplasty but with persistent or recurrent ventral curvature (VC) after multiple hypospadias repair.
Materials and Methods
We present a 13 year-old boy with 7 previous surgeries (long TIP, Duplay, meatoplasty) to treat hypospadias prese...
Introduction
Diphallia is a rare anomaly. It has a range of appearances from a small accessory penile to complete duplication.
Methods
We present a 2 year-old boy with complete penile duplication. The left penile was the largest. NMR (Nuclear Magnetic Resonance) suggested one corporal body for each penile and VCUG (Voiding Cystourethrogram) showed...
Distal hypospadias is the commonest form of hypospadias. The tubularized incised plate (TIP), though still popular, has been questioned recently due to the high incidence of stenosis and fistula formation. The glanular urethral disassembly (GUD) was inspired by the mobilization principle as described by Koff and the disassembly technique as describ...
Linked article: This Correspondence comments on Lapa et al. Click here to view the article.
Introduction
Antegrade continence enema (ACE) is recommended for patients with fecal incontinence/constipation refractory to conservative management. The Malone ACE utilizes the appendix as a catheterizable channel whereas the Macedo–Malone (MM) precludes the use of the appendix. We aimed to illustrate the MM procedure.
Methods
The left colon is b...
A critica review of In utero MMC repair and bladder function based on own experience and previous publications of the authors
Introduction
The purpose of this study was to determine the incidence of lower urinary tract surgery in patients with myelomeningocele (MMC) operated in utero as well as in the subgroup of patients with a minimum age of 5 years.
Methods
We use a previously published protocol to categorize bladder patterns and propose the treatment: high risk patte...
INTRODUCTION
Distal hypospadias represent the most frequent clinical presentation of hypospadias. In spite of more than 300 techniques available, there is not an ideal approach. We have proposed an alternative procedure based on the combination of minor urethral mobilization and major glans deconstruction and partial disassembly from the corpora, t...
INTRODUCTION
We present a different salvage procedure for penile prosthesis implantation in a De Castro neophallus.
METHODS
A patient with congenital aphallia had been operated at the age of 11. Ten years later he had two non successful attempts of prosthesis implantation. Surgery consisted of adapting the implants into the aortic graft and foldin...
Objective:
To assess the reliability and validity of the Quality of Life Assessment in Spina Bifida (QUALAS), children and teenager's versions (QUALAS C and T, respectively). This is the first self-applicable quality of life assessment tool for patients under 13 years of age, which also addresses the issue of urinary and fecal incontinence.
Metho...
authors describe and present a simple way to treat penile concealment
Introduction:
Vesicostomy should be considered in children with neuropathic bladder in case first-line therapies fail. This simple and reversible procedure can reduce febrile urinary tract infections and protect the upper urinary tract (¹) until more definitive alternatives can be proposed.
We describe in this video how we approach patients that un...
Introduction:
Since 2011 we have been following prospectively myelomeningocele patients treated in utero with particular interest to patients with sphincter weakness/deficiency. We investigated the changes of bladder pattern and upper urinary tract with time in children who underwent in utero repair and had low-pressure incontinence based on urody...
Introduction
Prostatic utricle cysts result from incomplete regression of Mullerian duct structures and occur most frequently in males with perineal or peno-scrotal hypospadias. Utricular cysts may present with various signs and symptoms including urinary tract infection, pain and post-void incontinence, a palpable abdominal mass or recurrent epidi...
Introduction:
The Renin-Angiotensin-Aldosterone System (RAAS) has been suggested as a possible marker of renal injury in chronic diseases. This study proposes to analyze the serum and urinary markers of the RAAS in myelomeningocele patients with renal function abnormalities detected on DMSA.
Material and methods:
Seventeen patients followed in o...
INTRODUCTION
Bladder exstrophy remains one of the most challenging abnormalities in pediatric urology. We propose bladder neck transection and bladder augmentation with a catheterizable reservoir technique to achieve continence after previous anatomic reconstruction in stages.
METHODS
At the age of 5-6 years, we offer the transection of bladder ne...
Introduction:
We present an alternative procedure for distal hypospadias consisting of urethral mobilization and partial glandar disassembly, namely GUD (glandar urethral disassembly) technique.
Materials and methods:
A subcoronal circumcision exposes distal dysplastic urethra. We incise the Buck´s fascia on both sides of urethra releasing it pa...
Introduction
We present an alternative procedure for distal hypospadias consisting of urethral mobilization and glandular disassembly, named GUD-technique.
Material and Methods
After circumcision and exposure of distal dysplastic urethra, it is entirely mobilized from corpora and glans. Glans is deconstructed and incised in midline producing two w...
Purpose:
In utero myelomeningocele (MMC) closure is a valid alternative to postnatal repair with unclear benefits to bladder function. We compared the bladder status in patients that underwent fetal MMC surgery and postnatal repair.
Materials and methods:
We retrospectively reviewed our database: Group 1 consisted of in utero surgery and group 2...
This chapter present in details the step-by-step procedure of Macedo ideal catheterizable reservoir
Introduction:
After the successful results of in utero myelomeningocele (MMC) repair presented by the Management of Myelomeningocele Study, the concept of fetal surgery was introduced in our institution in 2011. Since then, we have been able to follow prospectively a group of patients with attention to urological care. In the present study, we wer...
INTRODUCTION: Fetal MMC repair has shown advantages towards postnatal repair procedure in regards to less ventriculoperitoneal shunt need and better motor status as suggested by the MOMS study. The urological fate of the patient, with particular attention to bladder function is not yet thoroughly understood. Herein we systematically evaluate the ef...
This is the presentation of a new technique for distal hypospadias based on urethral mobilization and grandad urethral disassembly
Objectives
To evaluate the first 100 cases of in utero myelomeningocoele (MMC) repair and urological outcomes in a prospective analysis aiming to define possible improvement in bladder function.
Patients and methods
We used a protocol consisting of a detailed medical history, urinary tract ultrasonography, voiding cystourethrography, and urodynami...
We report a case of secondary urinary reconstruction of previously separated conjoined twins with exstrophic bladder and urinary incontinence. Patients were male and aged 13-year-old. Twin one had a history of failed enterocystoplasty that extruded and was visible like an exstrophic neobladder. He underwent a procedure to close bladder neck and rec...
Introduction:
Y-type urethral duplication describes the condition in which a functional urethra is implanted in the rectum, and there is also a dysplastic topic urethra which produces mostly urinary dribbling. These patients are at risk of urinary tract complications and UTI. We aimed to present the surgical steps of a case treated by ASTRA approa...
Introduction and objective:
Urethral duplication is a rare congenital anomaly, with roughly 200 cases reported in the literature (1). It is more frequent in males, with few cases reported in females. The clinical presentation differs according to the anatomical variant present. The duplication most commonly occurs in the sagittal plane with one ur...
Introduction:
Severe genital abnormalities such as urogenital sinus and urethral duplication with ectopic urethra in the rectum represent a major challenge in reconstructive urology.
Objective:
We aimed to review our cases presenting with functional ectopic urethra implanted in the rectum that were treated through an ASTRA approach.
Methods:
W...
Purpose
To develop a rabbit experimental study to test the hypothesis that surgical repair of hypospadias with severe ventral curvatures might be completed in one stage, if a graft, such as buccal mucosa, could be placed over the tunica vaginalis flap used in corporoplasty for ventral lengthening, with the addition of an onlay preputial island flap...
Purpose:
A major complication of in utero myelomeningocele (MMC) repair is premature delivery. The prematurity rate in MOMS study was 79%, with a mean gestational age (GA) at birth of 34 weeks. Considering this particular aspect of prenatal surgery group, we speculated if prematurity could also influence the urological outcome.
Material and metho...
Objective:
Aphallia is a rare penile congenital abnormality. The aim of this systematic review was to assess all available literature on neophalloplasty in infancy with an interest in technical alternatives and clinical outcome.
Materials and methods:
We performed a Pubmed search using the terms: neophalloplasty, neophallus, and phalloplasty, an...
Background:
Primary congenital bladder diverticulum (PCBD) is related to a deficient detrusor layer allowing out-pouching of the bladder mucosa through the inadequate muscularis wall. We aimed to review our experience with symptomatic PCBD in order to correlate clinical findings with anatomical aspects and to present late outcome.
Materials and Me...
Aims:
We evaluated the long-term results with a left antegrade continence enema (LACE) approach: "Macedo-Malone (MM) procedure" to define parameters such as clinical durability of the technique and patients' compliance with the method.
Methods:
We reviewed the medical records of all patients that underwent the MM procedure in our institution sin...
Penile agenesis is a rare congenital abnormality with an incidence of 1 in 30 million births. We want to demonstrate in this video a new technique of neophalloplasty based on two transverse skin flaps from lower abdominal wall.
The patient was placed into a prone position; the urethral meatus was found inside the rectum, 2 cm from the anal border....
Aphallia is a rare congenital abnormality with an incidence of 1 in 30 million births. In this video, we demonstrate implantation of a penile prosthesis in a neophallus performed 10 years previously in a patient aged 21.
Through a midline perineal incision aiming to reach the inferior surface of the pubic arch, we created a 16-cm tunnel for prosthe...
We categorized bladder patterns and principles of treatment applied to patients who underwent myelomeningocele repair during gestation in a prospective urological assessment.
We performed urinary tract ultrasound, voiding cystourethrogram and urodynamic evaluation. We then categorized patients into 4 patterns, including normal, high risk (overactiv...
Complete female epispadia (CFE) is a rare congenital anomaly occurring in 1 of 500,000 live births. The goals of CFE management include achieving continence, while protecting the kidneys, and creating functional, cosmetic external genitalia.
We demonstrate in this video the steps of the surgery and present midterm follow-up of a 6-year-old child wi...
Congenital adrenal hyperplasia (CAH) resulting from deficient 21-hydroxylase activity is an autosomal recessive disorder with an incidence of 1:5000-25,000 in Caucasian populations. Despite various techniques to treat CAH, total urogenital mobilization (TUM) has gained popularity. This technique has low morbidity, and can be performed by the perine...
The tunica vaginalis has been used in hypospadias repair in different ways, either as a graft or a flap. The potential benefits of using a virgin source of tissue in genital area but away from the main surgical field (urethra) confirm its versatile role as a barrier layer, part ofurethroplasty and as a way to restore corpora integrity after corporo...
AimsTo report our data on initial urological presentation after in utero myelomeningocele (MMC) closure.MethodsA prospective urological assessment at first presentation was designed for patients that had undergone in utero MMC closure and referred to our urological facility. The protocol consisted of detailed medical history, renal sonography, void...
The tunica vaginalis has been used in hypospadias repair in different ways, either as a graft or a flap. The potential benefits of using a virgin source of tissue in genital area but away from the main surgical field (urethra) confirm its versatile role as a barrier layer, part of urethroplasty and as a way to restore corpora integrity after corpor...
Lymphatic filariasis (LF) causes a wide range of clinical signs and symptoms, including urogenital manifestations. Transmission control and disability/morbidity management/control are the two pillars of the overall elimination strategy for LF. Lymph scrotum is an unusual urological clinical presentation of LF with important medical, psychological,...
