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Purpose: To evaluate laparoscopic treatment of symptomatic urachal remnants in children, the authors review their experience analyzing different approaches and results obtained in a 8-year period. Patients and Methods: From July 2005 to September 2013, 12 children underwent 13 interventions for treatment of symptomatic urachal remnants. In four patients, the technique was a laparoscopic-assisted removal of the remnant, in two patients, a laparoscopic-assisted drainage of an urachal abscess, and in seven patients, a laparoscopic excision of the remnant. One patient underwent a double intervention-laparoscopic drainage of an infected urachal remnant and its delayed laparoscopic excision. Results: The laparoscopic-assisted removal of the urachal remnant was performed in two cases of infected urachal sinus, in one case of symptomatic sinus, and in one cases of infected urachal cyst. The laparoscopic-assisted drainage of urachal abscesses was performed in two patients: In one patient, the abscess was because of an infected sinus while in the other patient, the abscess was caused by an infected cyst. Of the seven patients treated with pure laparoscopic technique, one had a symptomatic sinus, another had an association between a symptomatic urachal sinus and an urachal cyst, and five patients had a symptomatic urachal cyst. In all cases, intraoperative or postoperative complications and recurrences did not occur, and the cosmetic results were good. Follow-up ranged from 6 months to 8 years and 8 months. Conclusion: Laparoscopic surgery for symptomatic urachal remnants is safe and reliable in cases of drainage of urachal abscess and in cases of excision of the remnant. Laparoscopy allows a radical excision of the remnants with all the advantages of this procedure. In case of conversion, laparoscopic-assisted technique with minimal incision could be a good alternative to open surgery. [ABSTRACT FROM AUTHOR]

Dog bite injuries are common in children and represent an important health-care problem. Most dog bite injuries involve the face or an extremity. Victims tend to seek medical care quickly. Dog bites to the external genitalia are rarely reported, but they potentially result in morbidity if improperly managed. Morbidity is also directly related to the severity of initial wound. Guidelines for the management of dog bites include irrigation, débridment, antibiotic therapy, consideration of tetanus and rabies immunisation and suture of wounds or surgical reconstruction. Literature review was conducted and focused to analyze the management of dog bite lesions involving external genitalia. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the learning curve of pediatric laparoscopic herniorrhaphy (LH), the authors report a retrospective analysis comparing results obtained with this technique and the traditional herniotomy to determine how many procedures are necessary to obtain the results described in the literature. Patients and Methods: From May 2008 to February 2012, a total of 140 patients (110 boys and 30 girls) with uncomplicated inguinal hernia (IH) consecutively underwent surgery. Patients were divided in two groups: The "Open" group of 83 patients (M:F 64:19) with a mean age of 33.2 months who were operated on with traditional herniotomy and the "Lap" group of 57 patients (M:F 46:11) with a mean age of 34.5 months who were operated on with LH. Operative time and complications of the techniques were analyzed statistically. Results: In the Open group, the mean operative time for mono lateral repair was 35.4±17.7 minutes compared with the Lap group time of 29.9±15.9 minutes; for bilateral repair, the mean operative time for the Open group was 56.2±19.3 minutes compared with the Lap group time of 41.5 ±10.4 minutes. The analysis shows a shorter operative time for the laparoscopic repair for both monolateral (P = 0.73) and bilateral (P = 0.0001) hernia. Recurrences occurred in one (0.9%) patient in the Open group and in two (2.7%) patients in the Lap group (P = 0.577). Conclusions: This experience shows that LH is a reliable technique. Retrospective analysis revealed a shorter mean operative time for the laparoscopic intervention both for monolateral and bilateral IH repair. Recurrences in the Lap group occurred in the first 10 patients treated, and the mean operative time was reached in 20 monolateral LHs and after 15 bilateral herniorrhaphies. From this analysis, the learning curve for the LH needs a minimum of 20 procedures. [ABSTRACT FROM AUTHOR]

Background: Reoperation for failed hypospadias has been considered to be seriously problematic. The dense fibrotic tissue causes difficulties in wound healing and increases the rate of complications. The tubularised incised-plate urethroplasty (TIPU) method has become a preferred method for all varieties of hypospadias in the past decade. However, fistulas are still one of the most common complications of this technique. The aim of this paper was to present the preliminary results of TIPU procedure with double de-epithelised dartos flaps in failed hypospadias repair. Materials and Methods: All patients were treated between January 2009 and August 2010 by the same procedure, utilising TIPU with double de-epithelised dartos flaps. Vascularised ventral dartos flaps harvested from each side of the penis with their vascular supply were transposed to cover the suture line by wrapping them from either side of the penis. Results: There were 21 boys with failed hypospadias: 20 had previously undergone TIPU, and one Koyanagi repair. Patients presented with very large fistulas in four and dehiscence in 17. Repair of the failed hypospadias using TIPU with double de-epithelised dartos flaps was quite successful, with no fistula recurrence or dehiscence observed. Conclusion: The preliminary results showed that TIPU with double de-epithelised dartos flaps is a useful method of successfully repairing failed hypospadias. [ABSTRACT FROM AUTHOR]

Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Cyanoacrylates are tissue glues which polymerize when getting in contact with blood or water, creating a tight closure. It is usually used as octyl or butyl-cyanoacrylate, and in pediatric age it is applied to close tension free wounds, and it is as an alternative to conventional sutures. Its applications are in the management of low fistula-in-ano, or in the treatment of ano-rectal fistula; other uses include endoscopic treatment in the first episode of variceal bleeding, sutureless circumcision, and the closure of laparoscopic trocar site wounds. Lapointe SP et al. had applied n-butyl-cyanoacrylate glue to repair 'early fistulae' which occurred after urethroplasty with a good result. Our experience emphasizes that n-butyl cyanoacrylate may be applied to repair, not only 'early fistulae', but also the long standing ones with good results. OBJECTIVES • To evaluate urethrocutaneous fistula repair after urethroplasty using n-butyl cyanoacrylate (NBCA) in an outpatient setting. • To compare results of application of NBCA in 'early' and long-standing fistulae. PATIENTS AND METHODS • From January 2003 to December 2006, 13 children (mean age 36 months) were treated in our Outpatient Department for urethrocutaneous fistula, which occurred after hypospadias repair. • We analysed the data dividing the patients in two groups: group A comprised six children (mean age 22.6 months) that developed a fistula within 2-3 days of catheter removal after urethroplasty ('early' fistula) and group B comprised seven children (mean age 42.6 months) with long-standing fistulae. • In all patients, a multilayer of NBCA was applied, attaching the edges of the fistula taking care to perform a scarification of the edges of the fistula in patients in group B before the application of the glue. RESULTS • Four patients in group A and three patients in group B had definitive fistula repair (seven of 13), and six of the 13 had fistula recurrence. • Fistulae of ≤2 mm were more easily repaired than fistulae of >2 mm (five of seven vs two of six). • Fistulae that tended to recover were those that responded to the first applications. CONCLUSIONS • In this experience the use of NBCA as a minimally invasive treatment for fistula repair gave good results for repairing fistulae. • These preliminary results encourage the use of NBCA as a first non-surgical attempt to repair urethrocutaneous fistulae especially if the fistula is ≤2 mm. • The failure of this procedure does not compromise a possible subsequent surgical repair. [ABSTRACT FROM AUTHOR]

Background : Ramstedt pyloromyotomy is still the procedure of choice for infantile hypertrophic pyloric stenosis; however, the best way to approach the pylorus is debated. Recent literature reports many comparisons between various open approaches and laparoscopic one. The purpose of this preliminary experience is to show a new approach to infantile hypertrophic pyloric stenosis: single-port, laparoscopic-assisted pyloromyotomy. Methods: Nineteen infants underwent single-port laparoscopic-assisted pyloromyotomy. The approach to the abdominal cavity is performed through a right circumbilical incision, and then a 12-mm trocar is inserted. After the pneumoperitoneum is established, an operative telescope is introduced. Once the telescope is inserted, the pylorus is easily located, and then grasped and exteriorized via the umbilical incision. At this point, conventional Ramstedt pyloromyotomy is performed. Once the pylorus is reintroduced in the abdomen, a new pneumoperitoneum is created to control mucosal integrity and hemostasis. A retrospective statistical analysis was performed to compare patients who underwent this technique to others approached by the same team with right upper quadrant incision or right semicircular umbilical skin-fold incision. Results: In all 19 cases, adequate pyloromyotomy was performed in a good ranging time without any intra- or post-operative complications, achieving excellent early cosmetic results. Conclusions: The feasibility of single-port, laparoscopic-assisted pyloromyotomy obtained in this small sample suggests that this procedure could be an excellent alternative to open or laparoscopic pyloromyotomy as long as it acts as intermediary between the two techniques. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Dog bite, immunoglobulin and pre-exposure vaccination," by N. Pokee and V. Wiwanitkit in the 2015 issue.

The authors discuss the use of cyanoacrylate (CA) glue in pediatric urology. They note the limited applications of CA including wound closure during circumcision, urethrocutaneous fistula repair, surgical incision repair. They see CA as a good alternative to conventional suturing method when it comes to easy, shorter, and safe closure of wound in circumcision.

A letter to the editor is presented in response to the article "Dog bite injuries of genitalia" by N. Pokee and V. Wiwanitkit in the previous issue.