Jorge Caffaratti

Conservative treatment of phimosis in children using a topical steroid

OBJECTIVESnFrom 1997 through 1998, we conducted a prospective study to evaluate the long-term outcome of using topical steroids in the treatment of childhood phimosis.nnnMETHODSnBoth the parents and their children were instructed to apply 0.05% betamethasone cream topically twice a day for 1 month and to retract the prepuce after the fifth day of treatment. Results were evaluated at the end of the treatment and 6 months later.nnnRESULTSnOne hundred thirty-seven boys were evaluated. The median age was 5.4 years. At initial presentation, 61 boys had a phimotic but retractable prepuce, 37 had a nonretractable phimotic ring, and 39 had a pinpoint opening. Patients with a history of previous forcible foreskin retractions were considered to have secondary phimosis. By 6 months following treatment, 90% (124 children) had an easily retractable prepuce without a phimotic ring. No differences were seen in the response rate between those with primary and secondary phimosis. In all cases, the treatment was well tolerated without local or systemic side effects. All the patients with persistent or recurrent phimosis were found to be noncompliant with the suggested daily foreskin care.nnnCONCLUSIONSnTopical steroid for the treatment of phimosis is a safe, simple, and inexpensive procedure that avoids surgery and its associated risks. It is effective both in primary and in secondary phimosis. We emphasize the importance of proper and regular foreskin care and hypothesize on the mechanism of action of the steroids.

Prevention of vesicoureteral reflux at the time of complete primary repair of the exstrophy-epispadias complex.

Introduction: With Mitchells technique it is possible to perform bladder closure, reconstruction of epispadias and the bladder neck in one single procedure in an exstrophy patient. However the most common postoperative complication is pyelonephritis secondary to vesicouretral reflux. Reflux is closely linked to bladder exstrophy due to an abnormal anatomic development of the distal ureteral segment and to a pathologic bladder disposition. This problem is normally solved in subsequent surgical procedures. Technical considerations: We decided to apply the technique described by Gil-Vernet as a first step of a bladder exstrophy repair following the Mitchells technique. This ureteral advancement by means of trigonoplasty is a simple surgical procedure for vesicouretral reflux that preserves the intrinsic and extrinsic periureteral musculature. It is quite a short procedure that has yielded rates of success over 90%. Conclusions: The realization of this antireflux technique together with the primary closure could avoid later surgical correction in patients whose have had multiple operations.

Efficiency of endoscopic treatment for vesico-ureteric reflux in adults.

To evaluate the results of our experience with endoscopic management of vesico‐ureteric reflux (VUR) in adults, and to describe factors and complications that might contribute to the failure of the technique.

Testicular Tumours in Infancy and children

Abstract Introduction Prepubertal testicular tumours are different from those that appear during adulthood. Traditionally, they were considered to be malignant, however benign testicular tumours are actually more frequent at this age. Materials and methods We analysed our experience in the treatment of testicular tumours in children ≤xa013, with the intention of evaluating the use of partial orchiectomy. From 1984 to 2008, we diagnosed and treated 15 testicular tumours in children at our centre. We examined the therapeutic approach employed, underlining the possibility of testicular conservation in selected patients and we have analysed the results. Results The clinical presentation in 80% of the cases was an increase in testicle size with palpable mass. We performed 4 radical orchiectomies (27%) and 11 tumourectomies (73%). All the benign lesions in the final pathological anatomy were treated with tumourectomy: four epidermoid cysts, one hemangioma, one lipoma, one fibrous hamartoma, one juvenile granulosa tumour and one splenogonadal fusion. We also successfully and conservatively treated two cases of teratoma. The cases that received radical treatment were a yolk sac tumour (Stage I), two mixed germ cell tumours and one gonadoblastoma. Conclusions There are more cases of benign testicular tumours than malignant tumours during puberty. In the event of a palpable testicular mass with negative tumour markers, conservative treatment by means of a tumourectomy may be considered. However, the lesion must be removed completely to prevent recurrence.

Kidney transplants in patients with bladder augmentation: correlation and evolution

ObjectiveTo review the literature, analyse the evolution of kidney transplants (KT) in patients with bladder augmentation (BA) and investigate the relation between BA and KT.Materials and methodsSix patients with a history of severe lower urinary tract dysfunction and BA, received a KT at our Unit between 1993 and 2003. Three had moderate renal failure at the moment of the BA. The remaining three had end stage renal failure.ResultsWith a follow-up of 7xa0years (mean) we have a patient survival of 100% and a graft survival of 83%. No complications occurred between the BA and the KT. The few KT complications were not related to BA.ConclusionWhen a bladder dysfunction is present, it should be treated before KT. In noncompliant bladders, BA is the best treatment. This can be done to try to avoid end stage renal failure or only to prepare the lower urinary tract for reception of the transplant. The presence of a BA did not worsen the evolution of the KT.

Tratamiento quirúrgico del complejo extrofia-epispadias: Revisión y conceptos actuales

SURGICAL TREATMENT OF EXSTROPHY-EPISPADIAS COMPLEX. REVIEW AND NEW CONCEPTS Since earlier descriptions the surgical management of the bladder exstrophy and epispadias complex (BEEC) has experimented gradual changes in the search for good aesthetic and functional results. The initial urinary diversion and bladder plate removal has evolved under various authors either by improving or supplementing the above described advances, until reaching the staged functional closure and more recently the complete primary BEEC closure. These later techniques allow to obtain encouraging continence indexes and successful aesthetic results; the low incidence and complexity of this condition however, advises both in terms of early management and later complications that this should be managed in reference centres. Sharing on this spirit of technique combination in search for a satisfactory result for exstrophic newborns and inspired by Leadbetter’s contribution to Young-Dees’s procedure for vesicoureteral reflux (VUR) correction, we have added a new step to the complete primary BEEC closure known as the Mitchell’s technique by performing Gil-Vernet’s trigonoplasty to prevent VUR, closely associated to bladder exstrophy. We believe VUR can be prevented right from the first surgical approach in the exstrophic newborn.

ESR1 promoter polymorphism is not associated with nonsyndromic cryptorchidism

The ESR1 promoter microsatellite (TA)n was reported as a potential functional polymorphism. In a case-control study, we were unable to demonstrate any association between (TA)n and nonsyndromic cryptorchidism in Italian and Spanish study populations.