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To evaluate whether systematic scoring of pictures is really superior to subjective evaluation in the assessment of cosmetic results of distal hypospadias surgery, and whether any differences exist in subjective evaluation among the operating surgeon, the parents of the child, and a third party not previously involved in the care of the patient.Twenty-seven patients undergoing distal hypospadias repair by either the Snodgrass or Mathieu technique were enrolled. Cosmetic results of surgery were scored from 0 to 10 by one of each child's parents and by three surgeons. The latter assessed the results blindly on pictures taken during the outpatient visits; one used a systematic scoring system while the other two including the operating surgeon used subjective scoring. The four scores were compared using the Kendall W coefficient of concordance.Overall, there was excellent concordance among the four observers (P0.0001). The Snodgrass repair allowed for significantly better cosmetic results overall.In distal hypospadias, subjective evaluation of overall penile appearance can be as reliable as an evaluation made using a systematic scoring system. There seems to be excellent concordance among the subjective evaluations of different observers.

Objective To report long-term donor site outcome after mandibular labial mucosa graft (LMG) harvesting in children. Material and methods Donor site outcome was evaluated after a follow-up of at least 5 years in 30 patients ≤14 years of age at surgery undergoing mandibular LMG harvesting for urethral reconstruction. Outcome domains considered included intra-oral donor site scarring, alteration in salivary flow, peri-oral numbness and tightness of the mouth. Results After a median follow-up of 8 years (range 6–11.8 years), at a median age at evaluation of 13.4 years (range 9–22.2 years), 16 (53%) of the patients reported to feel a thickening at the harvesting site, none reported alterations in the salivary flow, and one patient each reported tightness of the mouth and peri-oral numbness. None of the patients reported symptoms to be bothersome enough to seek treatment. Conclusion LMG harvest is safe in children and associated with minimal long-term intra-oral symptoms.

We report four cases of leukemia (three chronic myeloid and one T-cell acute lymphoblastic) presenting with priapism in children 9- to 13-year old. All of them presented with hyperleukocytosis, and three had anemia plus thrombocytosis. All patients underwent chemotherapy and two had leukopheresis. In all cases, priapism was managed conservatively. Erection required up to 13 days to start improving but none of the patients developed clinical evidence of long-term erectile dysfunction. Based on these cases, conservative management of priapism in children with leukemia might be adequate and not lead to long-term erectile dysfunction.

We report short and long-term donor site outcomes after oral mucosa graft harvesting for urological reconstruction in a large series of patients including children, and identify possible risk factors for an untoward long-term outcome.A total of 78 patients were evaluated. Short-term outcomes included time to restore normal oral diet, perioral sensory defect/discomfort and jaw opening impairment occurring within 4 weeks of surgery. Long-term outcomes included donor site scarring, perioral sensory defect and jaw opening impairment occurring more than 1 year postoperatively. Long-term outcomes were assessed via a questionnaire administered to patients and on clinical examination by an oral surgeon. Outcomes were compared in children (younger than 12 years at surgery) and adults, and with regard to harvesting site, graft length, length of followup and other variables.Two-thirds of the patients returned to a normal oral diet within 3 days postoperatively (range 1 to 8). All patients complained of perioral sensory defect/discomfort postoperatively, and 26% had jaw opening impairment. After a median followup of 7.6 years (range 1 to 13.2) perioral sensory defect was the most common complication observed (28%) in cases formally evaluated by an oral surgeon. The sensory defect was seldom perceived by the patients and never required treatment. It was statistically more common in patients undergoing surgery as adults, whereas none of the other variables proved significant.Oral mucosa graft harvesting is safe irrespective of age. About a quarter of patients, more commonly adults, will have a long-term perioral sensory defect. However, the defect is never perceived as bothersome.

OBJECTIVE To systematically review previous reports and thus determine the functional outcome after pyeloplasty in children with unilateral hydronephrosis due to pelvi-ureteric junction obstruction, and the possible variables that could affect it. METHODS We searched Medline/PubMed, Embase, and Web of Science for articles in English published from 1966 to 2007, using both ‘medical subject headings’ and ‘free text’ protocols. Abstracts, full texts, and bibliographies of pertinent papers were reviewed to select studies of scintigraphic renal function before and after pyeloplasty. The postoperative change in scintigraphic renal function was assessed in relation to presentation (antenatal vs postnatal), timing of surgery (early vs delayed), age at surgery, and preoperative ultrasonography (US) and scintigraphic findings. RESULTS Thirty-six studies (2.1% of the initial search) were eventually selected for review. Studies were generally of poor scientific quality and very heterogeneous in their indications for surgery and follow-up protocols. Postoperative function showed a wide variability. Symptomatic patients diagnosed postnatally seemed to have a greater chance of functional improvement after surgery than asymptomatic patients diagnosed antenatally. The chance of improvement seemed also to be greater in patients with moderately rather than severely impaired preoperative function. Otherwise, the improvement seemed unrelated to the age at surgery, the preoperative US findings, or the excretion pattern on renal scintigraphy. Of patients having delayed surgery >97.5% had preserved function afterward. CONCLUSIONS Patients with moderately impaired preoperative function and those diagnosed postnatally because of symptoms are those with the greatest likelihood of having a functional improvement after surgery.

We review our experience with renal manifestations in pediatric patients with the tuberous sclerosis complex, and offer recommendations for urological counseling, followup and treatment of these patients.We reviewed clinical notes on 41 patients with the tuberous sclerosis complex followed at our institution from childhood. Patient data were gathered in a database focusing on renal involvement. The latter was assessed by periodic clinical evaluations and ultrasound. The risk of renal involvement was evaluated in relation to patient age, genotypic pattern and number of extrarenal manifestations.Overall, 15 patients (36.6%) had renal involvement. The latter increased with age and was more common in cases with TSC2 genotypic pattern or multiple extrarenal manifestations. Angiomyolipomas were the most common lesions (11 patients), followed by renal cysts (2) and polycystic kidney disease (2). Cystic lesions were the most common in patients younger than 16 years. Renal failure developed in the 2 patients with polycystic kidney disease by the 2nd decade of life. Overall, treatment was required in 2 cases of symptomatic angiomyolipoma. Both patients were female, and had multiple extrarenal manifestations and bilateral renal involvement. One patient underwent open surgery at age 21.3 years and 1 underwent radiological embolization at age 23.4 years.Pediatric patients with the tuberous sclerosis complex should undergo urological evaluation and followup. Although most of the lesions remain silent during childhood, the incidence of renal involvement increases with age. The need for treatment is highest in females with multiple extrarenal manifestations and bilateral renal involvement.

We evaluated clinical and biological variables, and their meaning as reliable markers of chronic interstitial nephropathy in a selected group of children with prenatally detected hydronephrosis who underwent pyeloplasty because of congenital unilateral ureteropelvic junction obstruction.We reviewed the clinical, prenatal and postnatal ultrasonographic, and scintigraphic records of children for whom intraoperative biopsy records were available. We performed histological analysis, and evaluated tubulointerstitial immunostaining for vimentin and alpha-smooth muscle actin, and the immunohistochemical and mRNA expression of the renin-angiotensin system peptides and transforming growth factor-beta1.The children were divided in 2 groups according to the absence (group 1) or presence (group 2) of chronic interstitial nephropathy in the biopsy. Patients in group 2 were significantly younger at prenatal diagnosis (p = 0.031), and had decreased split renal function (p = 0.005) and worse drainage (p = 0.035) on preoperative diuretic renography. No differences were found in terms of degree of hydronephrosis, or its prenatal and postnatal variation. Group 2 biopsies exhibited greater immunostaining for alpha-smooth muscle actin and vimentin (p = 0.004 and p = 0.047, respectively), and transforming growth factor-beta1 mRNA levels (p = 0.06). Vimentin and alpha-smooth muscle actin positivity correlated with renin, angiotensin II receptors 1 and 2, and transforming growth factor-beta1 mRNA levels, and all correlated with preoperative split renal function and post-void washout.In congenital unilateral ureteropelvic junction obstruction chronic interstitial nephropathy and poor postoperative recovery seem to be associated with an earlier diagnosis of hydronephrosis, functional loss greater than 10% and worse scintigraphic drainage. Moreover, there is a strong correlation between molecular fibrogenic markers and histologically and scintigraphically demonstrated renal damage.

Purpose: We present our experience with orthotopic continent urinary diversion following radical cystectomy due to genitourinary rhabdomyosarcoma in children not responding to radiotherapy or chemotherapy.Materials and Methods: Four children with persistent genitourinary rhabdomyosarcoma underwent radical cystectomy with reconstruction of an orthotopic ileal neobladder.Results: Average followup was 50.7 months. One patient died at 12 months postoperatively due to pulmonary recurrence. All patients were able to void completely at regular intervals. Renal function was normal in all patients. Average reservoir capacity was 250 ml. Daytime and nighttime urinary continence was achieved in all patients.Conclusions: The orthotopic continent urinary diversion is technically feasible even in small children. It represents a safe long-term option and offers good quality of life after disfiguring surgery. In fact, patients are able to void spontaneously through the urethra.

Background. We report on a single-institutional experience with renal transplantation in patients with severe lower urinary tract dysfunction (LUTD) who underwent bladder augmentation or urinary diversion, and assess the long-term results. Methods. From September 1987 to January 2005, 255 patients (161 male and 94 female), 7 months to 39 years old of age (median age at time of transplantation 14 years), received 271 kidney transplants. Etiology of end-stage renal disease was LUTD in 83 cases. Among these patients, 24 had undergone bladder augmentation or urinary diversion. Results. We identified two groups of patients surgically treated due to LUTD: group 1 included 16 patients (eight male, eight female) aged 4 to 39 years (median 19 years) with bladder augmentation, whereas in group 2, seven patients (five male, two female) 7 months to 31 years old (median 17 years) with incontinent urinary diversion were reported. In the first group, surgical complications after kidney transplantation included one urinary fistula, one ureteral stenosis. Three patients of second group developed recurrent urinary tract infection. Cumulative graft survival rates of all patients transplanted was 69.4% after 15 years, whereas in the two investigated groups, group 1 and group 2, was 80.7% and 55.5% respectively (P=NS.). Conclusions. Drainage of transplanted kidneys into an augmented bladder or urinary diversion is an appropriate management strategy when the native bladder is unsuitable. Kidney transplantation in patients with bladder augmentation or urinary diversion for LUTD let achieve similar results to those obtained in the general population with normal lower urinary tracts.

This study was undertaken to determine the role of aquaporin 2 (AQP2) in the impaired urinary concentrating capacity observed in patients who underwent pyeloplasty because of congenital unilateral hydronephrosis as a result of pyeloureteral junction disease. Twelve children (mean age, 8 +/- 2 mo) were examined in the study. From day 1 to day 5 after surgery, the urine was collected separately from pyelostomy draining only from the postobstructed kidney and from the bladder catheter draining mostly from the contralateral kidney used as internal control. After pyeloplasty, the postobstructed kidney was characterized by a reduced urinary excretion of AQP2 (approximately 54%) associated with polyuria that persisted from day 1 to day 5 (433 +/- 58 versus 310 +/- 74 ml/24 h at day 1; 326 +/- 44 versus 227 +/- 26 ml/24 h at day 5). In parallel, urine osmolality from the postobstructed kidney was significantly reduced compared with the contralateral kidney (111 +/- 12 versus 206 +/- 49 at day 1; 136 +/- 24 versus 235 +/- 65 mOsm/kg at day 5). Creatinine clearance from the postobstructed kidney was not significantly different compared with the contralateral kidney throughout the 4 d after surgery. However, on day 5, creatinine clearance from the postobstructed kidney became significantly lower. Prostaglandin E2 in the urine from postobstructed kidneys was found to be twofold higher than in the contralateral samples (26.0 +/- 6.7 versus 13.5 +/- 2.5 at day 5). It is concluded that (1) the selective downregulation of AQP2 in postobstructed kidney may account for the higher excretion of hypotonic urine, and (2) the local increase in prostaglandin E2 synthesis in postobstructed kidney may be involved in AQP2 downregulation and in maintaining a GFR similar to that of the contralateral kidney.

We assess the effect of the prune-belly syndrome (PBS) on renal transplantation outcome. Six renal transplantations were performed in five boys affected by PBS (median age 5.8+/-2.1 years, median weight 13.6+/-2.4kg). Renal graft survival, graft function, lower urinary tract dysfunction, urinary tract infections (UTIs), associated complications and patients' survival after 1 and 5 years of follow-up were analysed. The rate for 1-5-year graft survival was 66.7% (mean serum creatinine 98-103 micromol/l). The surgical treatment of the documented bladder obstruction (two patients) and the severe abdominal wall deficit (one patient) led to a reduction of UTI: the patients maintained their native urinary tract and none received prophylactic antibiotics. The lack of abdominal wall musculature led to severe mechanical complication in one patient, but Monfort's abdominal wall reconstruction was able to restore the graft's function. The outcome of patients with PBS who undergo renal transplantation is good. Before the transplant, an accurate assessment of urinary tract anomalies and deficiency of the abdominal wall musculature is mandatory, to program the appropriate treatment and obtain a good long-term prognosis for the renal graft.

There is some controversy about the safety of renal transplantation in patients with an augmentation cystoplasty because of the possibility of urinary tract infection in immunosuppressed patients leading to pyelonephritis and graft loss. Nevertheless, it is now well known that in patients with a small volume and poorly compliant bladder, reconstructive bladder surgery (augmentation cystoplasty or continent reservoir) creates a low-pressure and compliant reservoir, which protects the upper urinary tract and restores a functional lower urinary tract. Graft survival is not adversely affected when a kidney transplant is drained into a reconstructed bladder. When bowel segments are used for augmentation, a voiding modality with clean intermittent self-catheterization does not increase the risk of urinary tract infections, even in immunosuppressed patients.

A growing body of evidence identifies the renin-angiotensin system as a key factor in the onset and progression of renal damage in chronic partial obstruction, which often represents a complex diagnostic challenge. A prospective study was undertaken to evaluate the role of captopril mercaptoacetyltriglycine-3 (MAG-3) renography as an early diagnostic test of obstruction. We report the results in a subgroup of children who underwent surgical correction for pyeloureteral obstruction.Pyeloplasty was performed in 12 patients, including 10 males, 2 to 72 months old (median age 7) with unilateral hydronephrosis, including normal renal function and blood pressure. Basal and captopril enhanced diuretic renography with 99mtechnetium MAG-3 was performed within 24 hours using the same hydration and diuretic stimulus (0.75 mg./kg. furosemide), and 0.75 mg./kg. captopril was administered orally 60 to 90 minutes before scintigraphy.No adverse effects or modifications of the blood pressure were observed after captopril administration. The diuretic response was deeply worsened by angiotensin converting enzyme inhibition in each hydronephrotic kidney even when the basal study was only slightly abnormal (15-minute washout basal -27 +/- 16%, after captopril -9 +/- 13, p0.005). After surgical correction the diuretic washout during angiotensin inhibition appeared normal in all patients (15-minute washout -56 +/- 14%). Separate renal function and parenchymal transit of MAG-3 were not modified by angiotensin converting enzyme inhibition, preoperatively or postoperatively.Our data confirm the influence of angiotensin on the kidney excretory system in human hydronephrosis and suggest a role for captopril enhanced diuretic renography in the early diagnosis of pyeloureteral obstruction. Further work is needed to evaluate angiotensin converting enzyme inhibition as a protective agent in obstructive nephropathy.

Autologous buccal mucosa alone or combined with bladder mucosa was used as a free graft for urethral reconstruction in 8 patients with hypospadias. Of these patients 3 with medium penile hypospadias and chordee received a buccal mucosa graft alone and 5 with severe hypospadias received a combined buccal/bladder mucosa graft. Followup at 6 to 18 months showed no complications apart from a fistula in 1 patient with a buccal mucosa graft alone. Our initial results are encouraging. Buccal mucosa seems to be a good material for hypospadias repair.

Purpose To report on about LUTS after renal transplant (RTx) in pre-RTx anuric patients without associated urological malformations. Material and Methods Transplanted patients were considered for study if they had been anuric before transplant for at least 6 months, had no urological cause for their renal failure, were neurologically normal, had at least 12 months of follow-up after transplant, and were older than 5 years at follow-up. LUTS were evaluated using a questionnaire adapted from previous scoring systems in order to assess storage and voiding symptoms, bowel habit, and possible effect of symptoms on the patient's quality of life. Results Fourteen patients fulfilled the inclusion criteria. Median age at RTx was 11 (5-21) years, median duration of anuria before RTx 24 (7-46) months, and median post-RTx follow-up 2.7 (1.9-10.2) years. Thirteen cases presented a normal daytime voiding rate (5 to 7 times a day). One case presented episodes of daytime wetting and 4 suffered of urgency. None of the patients complained of a weak stream or about the need for straining during micturition. Ten cases (71%) presented nicturia and 1 occasional episodes of enuresis, nicturia was unrelated to length of follow-up. Twelve cases had a normal bowel habit. Only 1 patient reported that the symptoms affected her quality of life. Conclusions Pre-RTx anuric patients without associated urological malformation can present long-term storage symptoms. Nicturia was present in 71% of our cases irrespective of the length of follow-up.

Introduction Chemokines play a key-role in leukocytes recruitment in the site of inflammation, through the interaction with trans-membrane receptors. Genes that codify these chemokines and their receptors may present polymorphisms, which influence the proteins' level of expression and/or function. We have recently described an increased susceptibility to the development of acute pyelonephritis in children with interleukin 8 –251A > T polymorphism, presenting the first episode of upper urinary tract infection. Functional polymorphism of RANTES chemokine and its receptor CCR5 have been also identified. Material and Methods We carried out an association study of RANTES-403 G > A and CCR5Δ32 in 273 children with the first episode of upper urinary tract infection (UTI). Control population was represented by 326 blood umbilical cord DNAs coming from the same geographic area. Results Statistical analysis showed that RANTES-403 G > A phenotypic frequencies in the UTI group significantly differed from those of the control population (p = 0,007). A significant difference persisted when the genotype AA + GA was compared with the GG one (p = 0,002). Furthermore, comparing the frequencies observed in acute dimercaptosuccinic acid scan (DMSA)-positive and DMSA-negative patient with those observed in controls, a significant difference did emerge (p = 0,023 and p = 0,008 respectively). In addition, RANTES-403 G > A polymorphism frequency was significantly different in patients with vesico-ureteric reflux compared with the control population (p = 0,020). No difference were observed in the genotype distribution of CCR5Δ32 polymorphism. Conclusions Our results show that RANTES-403GG genotype is associated with an increased susceptibility to upper urinary tract infection.

Purpose Bladder exstrophy (BE) in females can be considered as a variant of a urogenital sinus. As for the latter, total urogenital complex mobilization (TUM) has been proposed as an option in the surgical repair of the condition. We report on our experience with the use of the TUM in female cases of BE. Material and Methods Two female cases of BE underwent repair by TUM. Of the two cases, one was a primary neonatal repair and the other a secondary repair 30 days after a previous failed attempt. TUM involved mobilization of the vagina and bladder template as a single unit. The urethra was created by tabularization of the urethral plate adherent to the dorsal aspect of the vagina. The pelvic diaphragm anterior to the rectum was opened and the complex made by urethra and vagina repositioned in the proper anatomical positions deep in the perineum. The pelvic diaphragm was then reconstructed anterior to the urogenital complex. Results Both BE closures were successful. TUM allowed for a proper positioning of the vagina and urethra deep in the perineum, in a tension-free manner and without any need for skin flaps. Retrusion of the urethral meatus was observed in one case for a partial dehiscence of the urethroplasty. Conclusions TUM allows for a more normal positioning of the urethra and vagaina in the anterior pelvic diaphragm during BE repair in females. This might increase the chance to achieve continence at a later age and reduce the long-term morbidity due to the horizontal orientation of the vagina.

Purpose It is controversial whether osteotomy by restoring a more normal pelvic anatomy might improve the final outcome of bladder exstrophy (BE) repairs. We compared the functional orthopaedic and urological outcome in BE patients treated with and without osteotomy. Material and Methods Orthopaedic and urological outcome was compared in 8 BE patients treated with osteotomy and 6 BE patients treated without osteotomy. Orthopaedic evaluation included an assessment of pubic bones dissymmetry, bending of the spine, presence of Trendelemburg or Thomas sign, and presence of out-toeing. Pubic diastasis was ruled out with a plain x-ray of the pelvis. A Pediatric Orthopedic Society of North America (POSNA) questionnaire was administered to every child or his/her caregiver to assess functional outcome. Urological evaluation included an assessment of contemporary continence status and required continence surgery. Results All patients presented a pubic diastasis. This was in median 49 (24 – 66) mm in patients treated without osteotomy and 42 (25 – 101) mm in those treated with osteotomy (p = 0.3). There was no difference either in the orthopaedic outcome or in any features of the POSNA questionnaire. Nor was there a difference in the final continence rate or in the number of additional continence procedures required. Conclusions Although osteotmy is an essential step in the treatment of many BE patients in order to achieve a tension-free closure of the bladder and the abdominal wall, our preliminary RESULTS suggest that it does not improve the eventual orthopaedic or urological outcome of BE.

Ureteric obstruction occurs in about 1% of cases undergoing endoscopic treatment of vesicoureteric reflux (VUR). It usually develops shortly after treatment. We report on a case of obstruction occurring 1 year after subureteric injection of calcium hydroxyapatite. Obstruction was progressive and eventually required open ureteric reimplantation. Ureteric obstruction can occur also in the long-term after endoscopic treatment of VUR and even in the absence of symptoms. Although it is so rare as to make long-term follow-up of all treated cases cost ineffective, physicians should be aware of such complications, especially while testing new bulking agents.

Purpose To describe four patients affected with a congenital absence of the penis (aphallia, penile-agenesis) and no gender reassignment and treated with a one-stage male-genitoplasty in infancy Material and methods Four patients, 7 months to 3 years old, had been reared as male. The urethra entered the anterior rectum in all. Three were untouched and one had bilateral ureterostomies. Three presented with classical aphallia and one had a rudimentary micro-phallus with no urethra and a single corpus-cavernosum. In the youngest patient, an anorectal-malformation and recurrent orchiepididymites were associated. Anterior-sagittal-transanorectal-approach (3 cases) or Pena-approach (1 case) were utilized to divide the rectal-urethra. Subsequently using a lithotomy position, a new-urethra, using bladder/buccal mucosa grafts, and a new-phallus fashioned from a quadrangular abdominal skin-flap, were performed Results Preliminary results after 5 and 3 years and 9 and 2 months, show that the phalloplasty was successful in all. One patient required a perineal urethrostomy because of a penile urethral stricture. One had a dehiscence of the dorsal penile suture, resulting in an epispadiac appearance. The other 2 are able to void through an urethral meatus at the tip of their new phallus Conclusions We report our preliminary surgical outcomes in a limited number of patients, showing good results with phalloplasty and some complications regarding the urethroplasty. Surgical technique of early phalloplasty may be improved in the future.However, we are convinced that retaining the male gender in 46XY individuals born with aphallia is the right approach and social, psychological and physical reasons justify early phallic reconstruction in infancy, waiting for possibly definitive treatment in adulthood

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 suspensory ligament was performed for penile lengthening. The urethra was recreated with a buccal mucosa graft in one case whereas urethral advancement 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 urethroplasty with buccal mucosa, and mid-shaft in the other. In both cases the skin underwent severe retraction. Conclusions Corpora mobilization combined with section of the suspensory ligament is effective in achieving a good penile length. The urethra can be reconstructed using buccal mucosa in a staged procedure. Skin coverage remains a problem.

Highlights • There are no clear guidelines in the treatment of a perforated appendicitis associated with localized abscess. • Our team’s therapeutic choice, also with presence of coprolith, is the initial conservative case management followed by a routine interval appendectomy. • Interval appendectomy should be performed not later than 4 months after discharge., Introduction There are no clear guidelines in the treatment of a perforated appendicitis associated with periappendiceal abscess without generalized peritonitis. Presentation of cases We retrospectively studied six examples of treated children in order to discuss the reasons of our team’s therapeutic approach. Some children were treated with a conservative antibiotic therapy to solve acute abdomen pain, planning a routine interval appendectomy after some months. Others, instead, underwent an immediate appendectomy. Discussion By examining these examples we wanted to highlight how the first approach may be associated with shorter surgery time, fewer overall hospital days, faster refeeding and minor complications. Conclusion Our team’s therapeutic choice, in the case of a perforated appendicitis with an abscess and coprolith is an initial conservative case management followed by a routine interval appendectomy performed not later than 4 months after discharge.