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Aim of the Study: Urge incontinence is considered to be a dysfunctional pathology of social interest due to the psychological and relational implications of such disability, the elevated number of affected patients and the consequent treatment costs. We propose an innovative non-pharmacological and non-invasive care methodology: Frequency rhythmic electrical modulation system (F.R.E.M.S.) therapy (FT), based on the administration of electric fields of monophasic pulsed, negative, asymmetric current, generated by a neurostimulator with the characteristics of low variable frequency, high voltage and very low impulse duration., Material and Methods: 30 patients were studied with urodynamic evaluation and radiological diagnostic techniques, and underwent 2 cycles of 15 days therapy, with a 12 months follow-up., Results: In 93% of cases, we obtained a positive result, with either disappearance or improvement of symptoms., Conclusion: Although the Authors believe that clinical results deserve further neurohistological and immunohistochemical studies, in order to define the anathomophysiological and biochemical changes induced by FT, they propose it as a possible alternative to traditional pharmacological therapy and electrical stimulation.

Introduction: Most of the primitive cystic neoplasms arising in the retrorectal presacral space are congenital. Presacral epidermoid cysts are classified as a type of developmental cysts, resulting from an error during the embryogenesis. They have a slowly-progressive growth that only lately can cause clinically remarkable symptoms. Most patients are middle-aged women. They are often asymptomatic. The discovery is almost always casual. It happens during controls like US, CT MRI, gynecological visit. The surgical treatment must be effected for a correct diagnosis of nature of the lesion and to remove the mass. In fact, infective complications may occur and the increasing volume of the cyst can give clinical symptoms. Posterior approach is indicated for low or mid presacral space tumors; it is the most commonly followed route. The abdominal approach may be adequate for large developmental cysts., Case Report: A case of an incidentally found large presacral epidermoid cyst in a young woman, which was excised through an abdominal approach is reported.

Background: A trend toward avoidance of a defunctioning colostomy at emergency large-bowel surgery has been placed in recent years. The surgical management of patients with acute colonic disease has been evolving from multiple to single operations with a reduced use of colostomy., Methods and Results: One hundred four consecutive non-selected patients underwent surgery for left-sided large bowel emergencies between 1980-2003. Defunctioning colostomy was performed in 10 out of 58 resection-anastomosis procedures. Thirty-seven patients underwent Hartmann procedure, 9 received only diverting colostomy. Postoperative morbidity was 28.8%. Postoperative mortality 8.2%. Anastomotic leak occurred in 1 and 6 patients with and without defunctioning colostomy respectively. Four out of the 6 patients without colostomy needed reintervention, while patient with covering colostomy underwent conservative treatment. Six (10.5%) out 56 patients with colostomy experienced major stoma related complications and underwent reintervention., Discussion: Although there is general acceptance of one-stage surgery for right-sided colon emergencies, the surgical management of left-side large bowel obstruction and peritonitis remains controversal. Risk of anastomotic dehiscence associated with large-bowel anastomosis in unfavourable circumstance must be balanced against the high complications and low closure rates of a temporary colostomy., Conclusion: Primary resection and anastomosis without diverting colostomy for left-sided acute obstruction and peritonitis may be performed in selected patients. Diffuse purulent and faecal peritonitis are contraindications to one-stage surgery being necessary a two- stage procedure with loop or end colostomy. Colostomy remain a valid surgical option when high risk of dehiscence is suspected.