- Email: [email protected]
Technical refinements for ureterorenoscopy in the management of ureteric calculi in children
ESPU Meeting 2007 Operative details were recorded as well as post-operative bladder neck function.
RESULTS During the 33 month period, 4 patients with neurogenic bladder, (2 girls), had bladder neck closure using the intravesical technique. The median age at surgery was 10 years (range 10-19y). 3 patients had previously already undergone a bladder augmentation and Mitrofanoff and so only
S89 1 required this procedure at the same time as the bladder neck closure. There were no peri-operative complications. After 6, 6, 19 and 24 months of follow-up (mean¼14m), all the patients are dry by day and night using the Mitrofanoff with ease.
CONCLUSIONS The intravesical approach improves the surgical exposure of the bladder
neck making the technique safe and straightforward to perform. It facilitates the separation between both ends (bladder neck and urethra), allowing to interpose some tissue. All the patients in this study are dry, but in view of the numbers and short term follow up further analysis is required. We recommend this novel technique as an option for the bladder neck closure.
# S02-3 (V)
TECHNICAL REFINEMENTS FOR URETERORENOSCOPY IN THE MANAGEMENT OF URETERIC CALCULI IN CHILDREN ¨ L, Fatih C ¨ KSEL, Serkan DOGAN* and Ahmet SAHIN Serdar TEKGU ¸ANAKLI, Serdar YU Hacettepe University School of Medicine, Department of Urology, Ankara, TURKEY - * Uludag University School of Medicine, Department of Urology, Bursa, TURKEY
PURPOSE To report our evolving experience with ureterorenoscopy in the treatment of pediatric ureteric stones.
using Ho:YAG energy. The mean stone size was 7.8 mm (4-20 mm) and follow up was between 1 to 38 months (mean 14 months).
RESULTS
distal 4 cm up to 10 F has evolved to water dilatation using Perez-Castro irrigation pump in last 2 years.Use of Nitinol baskets replaced the grasping forceps. The average operative time is markedly shortened.
MATERIAL AND METHODS Between 1997-2006, 60 ureteroscopic interventions were performed in 54 children (28 male, 26 female) aged 12 months to 14 years (mean 5.3 years). We used rigid ureterorenoscopes (7.5/8/10 F) for all and Ho:YAG laser in 51, pneumatic lithotripsy in 3 and forceps extractor in 4 procedures. Two of 4 proximal ureteric stones were pushed back and treated with ESWL, and 2 were grasped with Nitinol basket at renal pelvis and fragmented
The overall stone free rate after a single session of ureterorenoscopy was 88%. All but one patient were stone free following an auxiliary procedure with a final success rate of 98%. Ureteric perforation was noted in 4 patients and 2 were treated conservatively while two had undergone an open surgery. A JJ stent or ureteric catheter was left in place routinely; we still like to use stenting even in uncomplicated procedures. Routine dilatation using balloon or dilators for the
CONCLUSIONS Ureteroscopy and lithotripsy using Ho:YAG laser is an effective and safe method for the treatment of ureteric stones seen in children. With increasing experience more proximal and bigger size stones can easily be treated with less complications. In our practice URS is the first line treatment for almost all ureteric stones.
# S04-7 (V)
SURGICAL MANAGEMENT OF PENILE AMPUTATION Waifro RIGAMONTI, Cesare TIENGO* and Marco CASTAGNETTI University Hospital of Padua, Department of Urology, Section of Paediatric Urology, Padova, ITALY - * University Hospital of Padua, Department of Plastic Surgery, Padova, ITALY
PURPOSE Penile amputation in children is rare and its management difficult due to the paucity of tissue available for reconstruction and the presence of local inflammation secondary to urine extravasation.
MATERIAL AND METHODS We report on two cases treated after penile amputation. The latter was due to attempted circumcision in one and ritual
amputation for treatment of epilepsy in a village of a developing country in the other. Both patients presented about 2 years after injury and one had had a perineal urethrostomy. Mobilization of the corpora with section of the suspensor ligament was performed for penile lengthening. The urethra was recreated with a buccal mucosa graft in a case, whereas urethral advanced was performed in the other. Buccal mucosa grafting was performed as second stage. Skin coverage was obtained with a vascularised local flap or a graft harvested from the inguinal region,
respectively. In the case receiving the skin graft the shaft was covered with a layer of adipose tissue mobilised from the scrotum in order to enhance graft adhesion and future mobility of the graft.
RESULTS In both cases there was no penis visible before surgery. Section of the suspensory ligament allowed good lengthening of the penis in both patients. Final position of the urethral meatus was at the tip of the penis in the patient undergoing
RESULTS During the 33 month period, 4 patients with neurogenic bladder, (2 girls), had bladder neck closure using the intravesical technique. The median age at surgery was 10 years (range 10-19y). 3 patients had previously already undergone a bladder augmentation and Mitrofanoff and so only
S89 1 required this procedure at the same time as the bladder neck closure. There were no peri-operative complications. After 6, 6, 19 and 24 months of follow-up (mean¼14m), all the patients are dry by day and night using the Mitrofanoff with ease.
CONCLUSIONS The intravesical approach improves the surgical exposure of the bladder
neck making the technique safe and straightforward to perform. It facilitates the separation between both ends (bladder neck and urethra), allowing to interpose some tissue. All the patients in this study are dry, but in view of the numbers and short term follow up further analysis is required. We recommend this novel technique as an option for the bladder neck closure.
# S02-3 (V)
TECHNICAL REFINEMENTS FOR URETERORENOSCOPY IN THE MANAGEMENT OF URETERIC CALCULI IN CHILDREN ¨ L, Fatih C ¨ KSEL, Serkan DOGAN* and Ahmet SAHIN Serdar TEKGU ¸ANAKLI, Serdar YU Hacettepe University School of Medicine, Department of Urology, Ankara, TURKEY - * Uludag University School of Medicine, Department of Urology, Bursa, TURKEY
PURPOSE To report our evolving experience with ureterorenoscopy in the treatment of pediatric ureteric stones.
using Ho:YAG energy. The mean stone size was 7.8 mm (4-20 mm) and follow up was between 1 to 38 months (mean 14 months).
RESULTS
distal 4 cm up to 10 F has evolved to water dilatation using Perez-Castro irrigation pump in last 2 years.Use of Nitinol baskets replaced the grasping forceps. The average operative time is markedly shortened.
MATERIAL AND METHODS Between 1997-2006, 60 ureteroscopic interventions were performed in 54 children (28 male, 26 female) aged 12 months to 14 years (mean 5.3 years). We used rigid ureterorenoscopes (7.5/8/10 F) for all and Ho:YAG laser in 51, pneumatic lithotripsy in 3 and forceps extractor in 4 procedures. Two of 4 proximal ureteric stones were pushed back and treated with ESWL, and 2 were grasped with Nitinol basket at renal pelvis and fragmented
The overall stone free rate after a single session of ureterorenoscopy was 88%. All but one patient were stone free following an auxiliary procedure with a final success rate of 98%. Ureteric perforation was noted in 4 patients and 2 were treated conservatively while two had undergone an open surgery. A JJ stent or ureteric catheter was left in place routinely; we still like to use stenting even in uncomplicated procedures. Routine dilatation using balloon or dilators for the
CONCLUSIONS Ureteroscopy and lithotripsy using Ho:YAG laser is an effective and safe method for the treatment of ureteric stones seen in children. With increasing experience more proximal and bigger size stones can easily be treated with less complications. In our practice URS is the first line treatment for almost all ureteric stones.
# S04-7 (V)
SURGICAL MANAGEMENT OF PENILE AMPUTATION Waifro RIGAMONTI, Cesare TIENGO* and Marco CASTAGNETTI University Hospital of Padua, Department of Urology, Section of Paediatric Urology, Padova, ITALY - * University Hospital of Padua, Department of Plastic Surgery, Padova, ITALY
PURPOSE Penile amputation in children is rare and its management difficult due to the paucity of tissue available for reconstruction and the presence of local inflammation secondary to urine extravasation.
MATERIAL AND METHODS We report on two cases treated after penile amputation. The latter was due to attempted circumcision in one and ritual
amputation for treatment of epilepsy in a village of a developing country in the other. Both patients presented about 2 years after injury and one had had a perineal urethrostomy. Mobilization of the corpora with section of the suspensor ligament was performed for penile lengthening. The urethra was recreated with a buccal mucosa graft in a case, whereas urethral advanced was performed in the other. Buccal mucosa grafting was performed as second stage. Skin coverage was obtained with a vascularised local flap or a graft harvested from the inguinal region,
respectively. In the case receiving the skin graft the shaft was covered with a layer of adipose tissue mobilised from the scrotum in order to enhance graft adhesion and future mobility of the graft.
RESULTS In both cases there was no penis visible before surgery. Section of the suspensory ligament allowed good lengthening of the penis in both patients. Final position of the urethral meatus was at the tip of the penis in the patient undergoing