Santiago Vallasciani

• MD, FEAPU, Consultant
• Medical Doctor at Sidra Medicine

The restoration of hypospadias remains challenging. Despite all advancements in technology, a significant proportion of cases develop complications (Cimador et al. Nat Rev Urol 10:657–666, 2013). Oral mucosa is harvested from various donor sites, including the inner cheek, lower lip, and, on occasion, the lower surface of the tongue. We have been u...

The Meatal Advancement and Glandular Plasty Incorporated (MAGPI) technique, pioneered by Duckett in 1981, revolutionized the treatment of distal hypospadias. Durham Smith, in his 1997 historical review of hypospadias, recognized MAGPI as an evolutionary culmination of ideas originating from Duplay in 1874 and Beck in 1828. Duckett and Snyder later...

Introduction: Hypospadias management has seen various trends over the years, likely due to the diverse clinical presentations and evolving surgical techniques. However, there is a lack of consensus among pediatric urologists on many aspects of hypospadias management. To address this, our research aims to survey specialists and establish a consensus...

Purpose This paper describes the development and characteristics of a multi-disciplinary spina bifida clinic in Qatar considering the recently revised and globally available Guidelines for the Care of People with Spina Bifida (GCPSB). Methods A retrospective chart review was performed on individuals in Sidra’s multidisciplinary spina bifida clinic...

Introduction Lower urinary tract dysfunction (LUTD) in cerebral palsy (CP) and other neuromuscular diseases can present with chronic retention that leads to hydronephrosis, recurrent urinary tract infections (UTI), and stone formation. Whenever the conservative treatment of LUTD fails for any reason, it is considered to be complicated LUTD, in whic...

Purpose: Management of proximal hypospadias remains challenging. We assessed the results of staged preputial graft repairs (SPG) for proximal hypospadias and hypothesize that post-operative vacuum physiotherapy (VP) improves graft suppleness and overall outcomes. Materials and methods: Retrospective analysis of n = 71 patients with proximal hypo...

Hypospadias displays a variety of phenotypic presentations and is rising in incidence globally, but to date no definitive etiological cause has been identified. Genetic, environmental, and parental factors appear to be involved, and emerging evidence suggests that interaction between these factors likely contributes to the majority of cases (Hyposp...

Introduction: Bladder dysfunction, characterized mainly by chronic retention, leads to progressive hydronephrosis, loss of renal function, recurrent urinary tract infections (UTIs), and stone formation, which are difficult to manage in pediatric patients with neuropathic bladder admitted to palliative care facilities. Vesicostomy is a simple, rever...

Background The management of poorly functioning kidneys (PFK) associated with ureteropelvic junction obstruction (UPJO) is controversial. There is contradictory information about how to best manage these cases: pyeloplasty or nephrectomy? Objective To systematically summarize the available evidence concerning the effects of pyeloplasty on the diff...

Purpose: Compartment Syndrome (CS) has been recognized as a potential factor that worsens testicular viability after detorsion, especially in borderline cases of prolonged ischemia. Fasciotomy of the testicular tunica albuginea to relieve the pressure associated with CS has been proposed to accommodate edema after detorsion, embracing the raw fasc...

Objective the primary correction of male epispadias consists of multiple surgical steps: isolation of the complex corpora-urethral plate, bladder neck plasty if incontinence is associated, tubularization of the urethral plate, correction of dorsal curvature, and skin coverage of the penile shaft. The present video demonstrates our center experience...

Objective: To collect baseline information on the ultrasonographic reporting preferences. Method: A 13-multiple choice questionnaire was designed and distributed worldwide among pediatric urologists, pediatric surgeons, and urologists. The statistical analysis of the survey data consisted of 3 steps: a univariate analysis, a bivariate and a multiva...

Structured Summary Background Estimation of the quality of the urethral plate (UP) seems to be important when assessing postoperative outcomes of hypospadias repair, but its evaluation remains subjective. We developed an objective model aiming to standardize this assessment, proposing a methodology that could be adopted in future studies designed...

Testicular torsion in children is not uncommon emergency problem which occur due to twist in the spermatic cord leading to ischemia or infarction to testicle. Hemorrhagic infarction can occur following testicular torsion is globally, however, in extremely rare situation such infarction can be segmental. Segmental testicular infarction (STI) was rep...

PURPOSE Lower lip and cheek are commonly used sources of buccal mucosa grafts for urethroplasty. In recent years, aiming to improve the donor site morbidity, our preference changed to the use (ULG). The aim of this video is to illustrate the technical details of the ULG harvesting for children. MATERIAL AND METHODS The inner surface of the upper l...

Introduction: Surgical treatment of vesicoureteral reflux is required after conservative treatment has failed. However, there is a controversy if fibrosis related to previous attempts of dextranomer/hyaluronic acid (Dx/Ha) injection increases the risk of surgical difficulty and postoperative complications. Therefore, the purpose of our study was to...

Background: Robotic-assisted pyeloplasty surgery has become the preferred approach of ureteropelvic junction obstruction (UPJO) in pediatrics. However, to our knowledge, there is limited data on the learning curve for robotic-assisted pyeloplasty in children and no similar study from Saudi Arabia. Aims: The objective of the study was to evaluate t...

Purpose Augmentation cystoplasty (AC) is a surgical procedure used in adults and children with refractory bladder dysfunction, including a small bladder capacity and inadequate bladder compliance, and in whom conservative and medical treatment has failed. This study was aimed to determine the long-term outcomes of AC in children. Methods A retrosp...

Background: Almost one-fifth of the population of Saudi Arabia lives in rural areas and may still lack access to specialty healthcare. Because of the growing demand for telehealth services, we initiated the virtual clinic (VC) concept for new referrals to the pediatric urology clinic (PUC), the primary tertiary care unit in Riyadh. Methods: We c...

Background: Orchidopexy should be performed during the first 18 months of life to decrease the risk of infertility and tumor formation. In our center, the timing of surgical correction varies depending on the availability of an operating room. Objectives: Evaluate whether orchidopexy performed for patients referred to our center is done within t...

Background: Robotic surgery in pediatric patients is performed in our center since 2013. This study aims to analyze the evolution of Robotic Assisted Laparoscopic Pyeloplasty (RALP) in our center to investigate its feasibility and safety compared with Open Pyeloplasty (OP) technique. Methods: In this retrospective study, patients aged 2 to 14 ye...

Objective: Hypospadias is a congenital defect, which affects normal development of the male urogenital external tract. In this malformation, the urethral orifice of the penis is positioned ventrally, thus interfering with normal urination and creating, in some adults, problems during sexual intercourse. Heritability of hypospadias has been shown i...

Hypospadias surgery has had a continuous evolution along time. The wide spectrum of hypospadias anomalies and the many options available for hypospadias reconstruction continue to challenge the urological, pediatric surgical, and plastic surgical skills of the pediatric urologist. In the preoperative assessment, the use of hormone adjuvant therapy...

Bladder carcinoma (BC) is the second most common malignancy of the urinary tract in males after prostate cancer. Diagnosis is usually subsequent to patients‘ report of blood in the urine (macrohematuria) frequently without pain. Yet, macrohematuria may be also associated to other bladder conditions such as stones, infections, or benign tumors, and...

Lower urinary tract malignancies are very rare in pediatric age and highly uncommon in the first two decades of life; indeed, according to most available reports, their incidence among all affected patients if far lower that 1%. In fact, the sum of all patients for all bladder tumours in available scientific literature is just a few hundreds. These...

The authors declare that there is no conflict of interests regarding the publication of this paper.

A case of vesico-ureteral obstruction after endoscopic treatment of left high-grade vesico-ureteral reflux with polydimethylsiloxane is presented. Despite its low invasiveness, endoscopic vesicoureteral reflux treatment presents complications. Ureteral obstruction was evidenced in different series ranging from 0.2 to 8.33%. In the present case, we...

Chordee without hypospadias (CWH) is a group of conditions which share the peculiarity of ventral bending of the penis and a glanular meatus. During the years many attempts to classify CWH have been proposed, based either on anatomical or intraoperative findings. After reviewing most of the published series on CWH, the authors suggest abandoning th...

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 e...

Introduction: Acquired megalourethra (AMU) after repair of proximal hypospadias can be a serious complication. An observational retrospective study of its incidence among different types of repair was performed. Materials and methods: Clinical charts of patients operated on for proximal hypospadias were reviewed. Inclusion criteria: all primar...

Lower urinary tract tumours are uncommon in paediatrics. Transitional cell carcinoma of the bladder (TCCB) is rarely found in the first two decades of life and is exceptional under 10 years of age. The present series aimed to expand the number of reported cases in the literature. In 1984-2007, six patients (four male, two female), aged 6, 9, 12, 13...

Our purpose was to evaluate patients who underwent failed hypospadias repair. We evaluated 4 different groups of patients who underwent failed hypospadias repair. Group 1: patients who underwent only urethral surgery; group 2: patients who underwent only corpora cavernosa surgery; group 3: patients who underwent urethral and corpora cavernosa surge...

The oral mucosa (OM) is a popular substitute for urethroplasty. The aim of this study was to investigate oral morbidity and patient satisfaction in a homogeneous group of patients who underwent OM harvesting. This study is a prospective analysis of 350 patients who underwent OM harvesting from a single cheek. The graft was harvested in an ovoid sha...

Prenatal exposures to endocrine-disrupting chemicals (EDCs) are suspected risk factors in the etiology of hypospadias. The aim of this case-control study was to test the hypothesis of an association between maternal environmental exposures to EDCs and hypospadias in the offspring. Detailed questionnaire data on occupational and dietary exposures to...

We report our retrospective, nonrandomized, single center experience with modified tubularized incised urethral plate repair, consisting of grafting the incised urethral plate before tubularization, as first introduced 10 years ago. Indications, technical points and results are described. From 1997 to 2007 at our unit 1,095 cases of hypospadias wer...

We compared the results of hypospadias repair using polyglytone versus polydioxanone to evaluate the potential benefit of using a suture with a rapid absorption time. A total of 100 patients 8 to 24 months old affected by distal isolated penile hypospadias were considered for this study. Patients were randomized and assigned to 2 different groups a...

Congenital megalourethra is a very rare malformation, which has 2 anatomical variants, scafoid and fusiform. The etiology of this malformation is still a matter of discussion. A surgical approach is proposed here, which has been successfully used in the case of a boy affected by scafoid megalourethra.

Meatal advancement with glanuloplasty incorporated (MAGPI) is an appropriate approach for most glanular and coronal hypospadias. The very low incidence of complications with this technique (i.e., fistulas, meatal regression and stenosis) makes MAGPI very competitive if compared with other approaches proposed for similar anatomical defects. In certa...

A large number of children affected by hypospadias and undescended testis (UDT) are characterized facially by a large forehead with frontal bossing, telecanthus and broad flat nasal bridge. These traits are classically part of the clinical spectrum of the Opitz-GBBB and other syndromes. The aim of this study was to test the hypothesis that the pres...

A concealed penis is defined as a phallus of normal size buried in prepubic tissue (buried penis), enclosed in scrotal tissue (webbed penis), or trapped by scar tissue after penile surgery (trapped penis). We report our results using a standardized surgical approach that was highly effective in both functional and cosmetic terms. From January 2002...

In the early '80s, tubularized preputial flap has been intensively used for proximal hypospadias. Even if not yet used today, there are a conspicuous number of patients treated in that time that today present with obstructive symptoms. In this paper, authors propose an initial experience of an alternative strategy to the complete re-do. Three patie...

Combined buccal and bladder mucosa represents the only reconstructive solution for panurethral strictures by Lichen Sclerosus (LS) in which the need to remove the diseased urethral mucosa and to reconstruct a long and circumferential urethral tract, collides with the limit of buccal mucosa harvesting and with the lack of others substitutive tissues...

Hirschsprung's disease (HD) is a major cause of congenital bowel obstruction in children. Classical management includes stoma creation, a pull-through procedure, and restoration of bowel continuity. Colostomy may be also pulled through directly at second operation. Since the first report of a single stage (SS) primary pull-through without colostomy...

Primary gastrointestinal perforations have an incidence of between 1% and 3% in NICU patients. The 3 Centers participating in this study cover nearly 40% of the NICU population of the Lazio Region--Italy. The aim of this study is to discuss factors affecting survival in patients affected by a primary intestinal perforation. From 1991 to 2001, 67 ca...

Hypospadias surgery is one of the most difficult areas in pediatric urology and has been characterized by constant evolution. Some of the surgical techniques proposed in the past are now considered inadequate because of an unacceptable complication rate or poor functional and aesthetic results. The key for assessing a surgical technique (or a parti...

The true incidence of urethral involvement in patients with genital lichen sclerosus (LS) is unknown. We review the epidemiology and discuss the pathogenesis of LS and urethral stricture diseases. During the period 1991-2002, of 925 patients who underwent urethroplasty for anterior urethral stricture, 130 patients (14%) received the diagnosis of LS...

Long term follow-up of a prenatally diagnosed hydronephrosis usually extends no longer than the first two years of life. During this period spontaneous reduction occurs in most of the dilatations, not sustained by obstruction or reflux. Late recurrence of hydronephrosis is considered to be unusual. The aim of the present work has been to verify the...

Although the use of surgical staples is a well established practice in intestinal tract surgery on adults, their role in biliodigestive anastomoses in adults and children has been more limited. The Authors describe a 12-year-old girl with a type-IV choledochal cyst, who was successfully treated with cyst excision and Roux-en-Y hepaticojejunostomy c...

Bronchogenic cyst a bronchopulmonary foregut malformation. An intramural esophageal localization has rarely been reported in respect to more common esophageal duplications or leiomyoma. The authors describe a case of bronchogenic cyst of the esophageal wall in a 3 years old girl. It was an misdiagnosed cause of dysphagia and was revealed by endosco...

The authors reviewed two groups of patients with ureteropelvic junction obstructión divided by age and mode of presentation: patients with neonatal asymptomatic hydronephrosis diagnosed by prenatal ultrasonography and patients with symptomatic hydronephrosis. It was assumed that in these patients we are observing a continuous spectrum of the same p...

Bilateral renal vein thrombosis after an appendectomy has never been reported in the pediatric literature. We describe the case of a 10-year-old boy who developed this very unusual complication following appendectomy for gangrenous appendicitis with peritonitis. Color duplex Doppler is the most appropriate investigation to allow correct diagnosis a...

The term "ureteropelvic junction disease" defines any form of hydronephrosis consequent to a congenital anomaly of the ureteropelvic junction. It is one of the most common congenital urological anomalies. Over one third of patients have an associated uropathy. The etiology is not clear: an error in the embryonic development with consequent abnormal...

We describe the case of a 6-year-old boy who presented post-renal anuria and renal failure five days after appendectomy and drainage of a periappendicular abscess. Only mild dilatation of the urinary tract was observed on ultrasound and small calculi were documented at the ureterovesical junction bilaterally. Diuresis was restored by the insertion...

We evaluated the feasibility of urethroplasty using a free peritoneal graft in a rabbit model. In 12 male rabbits a urethral defect was created by excising a 3 x 5 mm. portion of the ventral urethral surface. The defect was immediately repaired with a free peritoneal graft harvested via a left flank incision. There were 2 intraoperative deaths and...

The authors report a case of membranous atresia of the esophagus. Diagnosis of this rare malformation was made intraoperatively, and resection and primary anastomosis were performed immediately. A brief review of the literature is included on the various types of esophageal atresia.

We describe a case of H-type rectovaginal fistula associated with the Currarino triad (anorectal stenosis, sacral defect, presacral mass). Presenting symptoms included passage of feces per vaginam, signs of intestinal subocclusion without perianal inflammation, left leg paresis and foul-smelling urine. An anterior sacral meningocele was repaired at...