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Biomedical subjects

N Capozza

Publications and source records attributed to N Capozza.

At least 37 records · Page 2Linked to original sources
PubMed1997

Occult spinal dysraphism: neurogenic voiding dysfunction and long-term urologic follow-up.

From 1976 to 1994, we followed 55 children with occult spinal dysraphism (OSD). The average age at diagnosis was 4.5 years (range: 24 days - 21 years). In 13 cases the OSD was associated with anorectal anomalies. Urologic symptoms were present at diagnosis in 24 children (43%), but urinary incontinence affected all patients in the evolution of the OSD. At diagnosis, all children underwent complete neurourologic and urodynamic evaluation. Nine required early neurosurgical correction, before 3 years of age. During follow-up, intermittent clean catheterization was started in all patients. Vesicoureteral reflux was present or developed in 17 patients: 15 underwent endoscopic procedures and 2 required bladder augmentation because of upper-tract and renal-function deterioration. Endoscopic treatment for urinary incontinence was performed in 3 children. At long-term follow-up (6 to 18 years), socially acceptable continence was achieved in 78% of the children; renal failure occurred in 8. The long-term results were analyzed in order to compare the evolution of urinary continence and renal function in children with OSD with or without neurosurgery.

Adolescent↗
PubMed1997

Long-term results of distal urethral advancement glanuloplasty for distal hypospadias.

PURPOSE: In 1987 we developed distal urethral advancement and glanuloplasty, a surgical technique specifically intended for coronal and subcoronal hypospadias repair that involves moving the distal urethra 0.5 to 1 cm., Y shaped meatoplasty and glanuloplasty. MATERIALS AND METHODS: From January 1987 to December 1992, 271 boys 9 months to 14 years old (mean age 2.5 years) underwent repair of distal coronal and subcoronal hypospadias, including distal urethral advancement and glanuloplasty in 135 (49.8%). RESULTS: Long-term results in 118 cases were determined at 4 to 9 years of followup (mean 6.3). In 112 cases (95%) good functional and cosmetic results were achieved, while in 6 (5%) complications required surgical repair, including meatal stenosis in 3 (2.5%), fistulas in 2 (1.7%) and complete glanuloplasty disruption in 1. We evaluated outcomes in 19 postpubertal patients 15 to 20 years old and noted no psychological or sexual problems as a consequence of hypospadias repair. CONCLUSIONS: Long-term followup confirms the validity of distal urethral advancement and glanuloplasty for correcting a large number of coronal and subcoronal hypospadias cases.

Adolescent↗
PubMed1996

Early detection of bladder dysfunction following posterior urethral valves ablation.

Urinary incontinence following Posterior Urethral Valves (PUV) ablation has been attributed in the past to sphincter injury, but it is nowadays accepted that bladder dysfunction (BD) plays a determinant role. In order to assess BD evolution, we have evaluated, from 1982 to 1994, 48 boys with PUV by urodynamics (UD) studies. Age of the patients ranged from 10 months to 15 years. A total of 65 examinations were performed. We considered four groups: 0-3 years; 4-7 years; 8-12 years and > 12 years. Uninhibited detrusor contractions (instability), end filling pressure (EFP), bladder capacity and voiding detrusor pressure were evaluated in order to assess the presence of BD distinguishing it in: hypercontractility, hypocontractility and low-compliant bladder. The results collected confirm a high percentage of BD in PUV boys (71%) and the evolution of hypercontractility versus hypocontractility in 60% of patients considered.

Adolescent↗
PubMed1996

[Retractile testis and gliding testis. Two distinct clinical entities].

The gliding testis is a testicle located below the external ring, can be manipulated to the upper scrotum, but is prone to ascend to its original position. Histologic changes can be detected in these gonads by 7 years of age. We evaluated 427 consecutive prepubertal boys referred for cryptorchidism. One hundred and twenty-three had classical undescended, 71 ectopic, 55 retractile, and 178 (mean age 6 years 2 moths) gliding testes. The gliding testes were smaller than controlaterals in 24% of boys. All gliding testes were unilateral whereas bilaterality was 85% in the retractile group (p < 0.0001), 17.5% in the undescended (p < 0.001), and 10% in the ectopic group (p < 0.01). A history for one or more of the following: orchidopexy (3), hormonal treatment (5), late testicular descent (9), spermatic cord torsion (5), testicular pain (10), actual retractile testes (20) or actual gliding testis (58), was present in 93 (52.2%) of the fathers of the gliding group. Forty-seven (81%) paternal gliding testes were hypotrophic. Seventy-five boys with gliding testis underwent initial hormonal therapy with transient benefit, and 57 were operated on. Two anatomical findings are typical of the gliding testis: the absence of the gubernaculum and a processus vaginalis partially patent from the upper scrotum to the mid groin area. This feature explains the mobility of the gliding testis from the external ring to the upper scrotum. The absence of the gubernaculum may be responsible for a higher incidence of spermatic cord torsion in this population. The gliding testis is a distinct entity, representing the mildest degree of a true undescended testis. As hormonal treatment gives only transient results, orchidopexy should be considered before testicular damage occurs.

Buserelin↗
PubMed1996

[Combined heart-kidney transplantation in pediatric age].

A case of simultaneous heart and kidney transplantation is presented in a 12 years old girl. The patient suffered from dilated cardiomyopathy and end-stage kidney disease. Bilateral vesico-renal refluxes were corrected at the same time of the duplex transplantation. A multiorgan harvesting from a pediatric 8 years old donor was utilized. Follow-up is 40 months. Cytomegalovirus (CMV) infection and acute tubular necrosis from haemoglobinuria were transient complications. Hemolysis from bypass and extracorporeal circulation was involved as pathogenetic factor of the acute tubular necrosis. Cardiac and renal function remain excellent and the child is fully recovered and resumed a normal and active life. Combined heart and kidney transplantation may be of benefit in selected patients, also in pediatric age.

Age Factors↗
PubMed1995

Endoscopic treatment of vesico-ureteric reflux and urinary incontinence: technical problems in the paediatric patient.

OBJECTIVE: Bovine collagen has been successfully used for the endoscopic treatment of urinary incontinence (UI) and vesico-ureteric reflux (VUR) in children for more than 8 years, although its long-term efficacy has sometimes been questioned. Its failure is generally ascribed either to technical difficulties or to instability of collagen at the site of the implant. To assess the efficacy of the procedure we evaluated the children treated at this hospital between 1990 and 1993. PATIENTS AND METHODS: A total of 156 children, aged 5 months to 13 years, were treated for VUR. Over the same period, 25 patients aged between 2 and 14 years (nine with neuropathic bladder and 16 with exstrophy-epispadias complex who were still incontinent after bladder neck reconstruction) had periurethral or pericervical glutaraldehyde cross-linked bovine collagen injection for UI. Five more children with exstrophy-epispadias complex (aged 1-3 years) underwent periurethral collagen injection to stimulate bladder enhancement and allow subsequent bladder neck reconstruction. RESULTS: In children treated for VUR, a single injection proved successful in 72.2% of cases (127 ureters); a second collagen injection raised the success rate to 81%. Continence improved in all nine neuropathic bladders and in 10 of 16 children with exstrophy-epispadias complex treated for UI after bladder neck reconstruction. In four of the five exstrophy-epispadias complex patients who were treated to stimulate bladder enhancement, bladder capacity increased by 25%. CONCLUSIONS: Endoscopic treatment of VUR seems to be a valid alternative to open surgery, even though concerns remain about the long-term efficacy of collagen implantation. An important distinction should be made between early and late failure of the procedure. Early failure, which we define as persistence of reflux, is usually due to incorrect technique or technical difficulties. Late failure, or recurrence of reflux, which has previously been attributed to the biodegradability of collagen, seems to be due to the displacement of the injected collagen. Micturition itself or high bladder pressure (such as detrusor instability) could be responsible for the displacement of the injected collagen medially and distally, where it can no longer support the submucosal ureteric tunnel. In the treatment of urinary incontinence, both the implant technique and the choice of the site of injection seem to have a considerable effect on the results. In our experience, endoscopic collagen injection is effective in the treatment of both urinary incontinence and VUR in paediatric patients. Accurate selection of patients and technical adjustments and refinements are essential to obtain the best results.

Adolescent↗
PubMed1995

Urinary continence in Müllerian duct anomalies.

Müllerian duct congenital anomalies such as Rokitansky-Mayer syndrome, Urogenital Sinus, Vaginal Atresia and Cloacal Malformation are relatively uncommon (1-5% of born female newborns). The complexity of these malformations has taken great interest regarding mainly the surgical procedure available for correction of genital abnormalities. However, the problem of urinary incontinence is still underestimated, and continence is often a goal difficult to achieve. Authors report 11 cases of congenital anomalies of Müllerian duct differentiation which have been observed in the last decade in pediatric age with special regard to preoperatory diagnostic procedures, urinary continence valuation after surgical correction, therapy chances for continence, considering the psychological implication of this unresolved abnormality in everyday-lifetime.

Adolescent↗
PubMed1995

[Wolfram syndrome. Peculiar urologic aspects].

The 6-year follow-up of a patient affected by Wolfram's syndrome, a rare disease characterized by diabetes insipidus (DI), diabetes mellitus (DM), optic atrophy (OA), neurosensory deafness (D), atony of the urinary tract and other abnormalities (DIDMOAD or Wolfram's syndrome), is described. Our patient has diabetes insipidus, diabetes mellitus, abnormal audiograms, without subjective evidence of hearing loss, and dilatation of the urinary tract. Diagnosis was suspected at the age of 8 years. Diabetes mellitus was the first manifestation and treatment with insulin was necessary. Desmopressin therapy decreased dramatically the daily urinary output. In view of the significant morbidity and mortality from renal failure associated with recurrent urinary infections, we have drawn special attention to the urological manifestations of the syndrome. During the follow-up, the patients underwent some investigations, such as renal ultrasound and echotomography and cystourethroscopy. Outstanding results of these studies are severe bilateral hydronephrosis with dilatated ureters and loss of renal tissue. The particular finding is the presence of posterior urethral valves with obstructed bladder. The anatomical outlet obstruction are variable and may be disastrous. There may be failure to thrive, sepsis, anemia be disanal failure. In such instances corrective surgery could improve bladder and ureteral functions.

Adolescent↗
PubMed1994

[Primary enuresis in children. Which treatment today?].

Nowadays enuresis is a problem that pediatric urologists are often called to treat, since it affects 15 to 30% of school-age children. In 85% of affected children bedwetting is monosymptomatic, not accompanied by other voiding disorders or daytime incontinence. Treatment of choice is still highly controversial, as the physiopathology is not yet fully understood and the pathogenesis is multifactorial: genetic and psychological factors, sleep disorders, urinary reservoir abnormalities, urine production disorders can all play a part. Behavioural treatments (psychotherapy, bladder training and biofeedback, electric alarm) and pharmacological therapy (tricyclic antidepressants, anticholinergics, DDAVP) have been used with variable results. In our 1 year experience (54 enuretic children) DDAVP proved to be effective in reducing the number of wet nights per week in 79% of cases. Acupuncture, which we have been using for many years, also gave good results in 55% of treated patients. Long term success of DDAVP and acupuncture was respectively 50 and 40%. We discuss the probable pathophysiology and present our own results and those reported in the literature. It has to be stressed that an accurate diagnostic selection of patients and a better understanding of physiopathology are the basis of effective treatment of enuresis.

Acupuncture Therapy↗
PubMed1993

Glutaraldehyde cross-linked bovine collagen in exstrophy/epispadias complex.

We injected endoscopically 0.75 to 2.5 cc of cross-linked bovine collagen at the 3, 9 and 12 o'clock positions of the urethra or bladder neck of 9 children with epispadias and 7 with exstrophy. This procedure was performed in 10 children who were still incontinent after a Young-Dees operation. In 6 girls collagen was injected submucosally before bladder neck surgery to increase outlet resistance and to gain bladder capacity. A repeat injection was given to 3 patients after 1 year. Continence improved in 9 of the 10 cases injected after surgery of the bladder neck. Of the 6 children who underwent collagen treatment before reconstruction of the lower urinary tract capacity increased an average of 47% in 2 years in 5 and the procedure failed in 1. Submucosal injection of collagen is helpful in modulating outflow resistance and increasing bladder volume after primary closure of exstrophic bladders. Patients with small bladders following closure, who would otherwise be candidates for augmentation cystoplasty, may gain adequate bladder size with collagen injection.

Adolescent↗
PubMed1993

Female genito-urethroplasty and submucosal periurethral collagen injection as adjunctive procedures for continence in the exstrophy-epispadias complex. Preliminary results.

Continence is the main goal in the treatment of patients with bladder exstrophy and prognosis is necessarily long-term. Over an 8-year period, 44 patients presented with bladder exstrophy and/or incontinent epispadias. Twenty-five bladder closures (7 secondary), 23 male urethroplasties, 19 bladder neck (BN) reconstructions and 6 bladder augmentations were performed in these patients. In 18 children 2 additional procedures were employed in the last 3 years: female genito-urethroplasty (15) and submucosal periurethral collagen injection (11). Eight children underwent both procedures. Genito-urethroplasty and collagen injection were performed before BN reconstruction in 6 and 5 cases respectively, in order to increase bladder outlet resistance. The submucosal injection was performed at 3, 9 and 12 o'clock in the BN or sphincteric urethra, using 0.75 to 2.5 ml of cross-linked bovine collagen. Continence in the children who underwent the complete staged reconstruction was good in 58%, fair in 32% and poor in 11%. Following female genito-urethroplasty and periurethral collagen injection, bladder capacities increased by 25%. These complementary procedures are effective in increasing outlet resistance and bladder capacity in patients with exstrophy and/or epispadias; they may improve continence and lessen the need for further bladder augmentation.

Bladder Exstrophy↗
PubMed1991

Effectiveness of trigonoplasty to treat primary vesicoureteral reflux.

Among the surgical procedures to treat vesicoureteral reflux trigonoplasty is a conservative technique that preserves the integrity of the vesicoureteral junction. Since its introduction in 1984 by Gil Vernet it gained only little attention in small series. Between 1986 and 1989 we performed trigonoplasty in 51 children 4 months to 13 years old, of whom 47 had primary vesicoureteral reflux. Our study includes 44 patients who have sufficient followup and 69 refluxing units. Reflux was grade II in 25 units, grade III in 39 and grade IV in 5. Patients were arbitrarily divided into 2 age groups: less than (13) and greater than (31) 3 years old. All children underwent standard preoperative assessment. The operation, with technical modifications (absorbable sutures in all cases and muscular incision added in 12), was performed after failed conservative treatment in all patients except 5 who were operated on at diagnosis. Surgery was successful in 97.7% of the patients and in 92.3% of the children less than 3 years old. The only recurrence was noted on 1 side of a 2-year-old child who had had grade IV bilateral reflux. Considering that reimplantation threatens the integrity of the vesicoureteral junction and endoscopic injections still have unclear side effects, indications for trigonoplasty can be extended to higher grades of reflux if ureteral tapering is not required and a sufficient intramural length of ureter can be obtained.

Adolescent↗
PubMed1991

Distal hypospadias repair by urethral sliding advancement and Y-V glanuloplasty.

Different techniques are available today for repairing distal (coronal and subcoronal) hypospadias but none is universally recommended. We developed the technique of a distal urethral advancement glanuloplasty operation that is specifically intended for distal hypospadias repair even with mild chordee. Mobilization of the distal urethra is performed for 1.0 to 1.5 cm. after subcoronal circumcision and a deep Y-shaped incision of the glans. The mobilized urethra is dorsally split and slid forward to the tip of the dart of the glans previously prepared. Glanuloplasty is performed using the 2 lateral flaps of glans tissue. From January 1987 to December 1989 we used this technique in 74 cases of distal hypospadias with mild or no chordee (patient age 18 months to 9 years, mean 3.5 years). A transurethral catheter was left indwelling for 3 to 4 days. Hospitalization time was 5 (plus or minus 1.5) days. Results after 4 to 40 months of followup are encouraging cosmetically and functionally. All patients were cured. In 3 cases (4%) meatal stenoses occurred requiring meatotomy and in 8 boys meatal dilations were performed on an outpatient basis. In 1 case (1.3%) a fistula developed, which was subsequently repaired without further complications. This operation may be successfully used in most cases of distal hypospadias, with a low complication rate and excellent cosmetic results. It also may be used if mild chordee is present, thus reducing the indications for flip-flap urethroplasty in those cases when meatal advancement procedures may not be effective.

Child↗
PubMed1991

Early diagnosis and treatment of spinal dysraphism to prevent urinary incontinence.

Spinal dysraphism represents a very rare congenital anomaly of the spinal cord and cauda equina, often associated with cutaneous sacral lesions. This condition results in distorsion of neural tissue, possibly leading to vesical dysfunction and urinary incontinence. A series of 12 children with spinal dysraphism (4 lipomeningoceles with tethered cord, 3 tight filum terminale, 2 dermal sinuses, 2 arachnoid cysts, 1 anterior meningocele) observed during the last 6 years is presented. The patients are divided into two groups: group A includes 5 infants (age range 4 months-2 years) and group B 7 older children (4-12 years). All 7 patients of group B were referred for urinary incontinence as their chief complaint; only 1 had evidence of a skin lesion while 3 had a club foot. In group A, 4 had skin lesions (2 asymptomatic and 2 dermal sinuses referred after several episodes of meningitis) and the 5th child had a club foot. The diagnosis was made by myelo-CT scan in the earlier 4 and by magnetic resonance imaging in the more recent 8 cases. All 12 children were operated. In group B, the patients' urinary incontinence persisted but did not worsen (3 were stable and 4 had slightly improved); in group A, 2 were dry (follow-up greater than 2 years), 1 could not be accurately evaluated because he was less than 2 years of age, and the 2 who suffered from meningitis were incontinent. Early diagnosis and neurosurgical treatment of spinal dysraphism may prevent urinary incontinence. Accurate urodynamic, neurophysiologic, and neuroradiologic evaluation of children with severe voiding anomalies or club foot is recommended even if no lumbosacral cutaneous lesions are present.

Child↗
PubMed1991

[The treatment of nocturnal enuresis. A comparative study between desmopressin and acupuncture used alone or in combination].

During the period from March to September 1989, 40 children suffering from primary nocturnal enuresis, aged between 5 and 14 years, were included in a study to assess the comparative therapeutical efficacy of DDAVP and acupuncture. Children were divided into four groups of 10: group A was treated with DDAVP, group B was treated with acupuncture, group C was treated with DDAVP and acupuncture and group D was treated with placebo (control). The trial design included 3 periods: observation (2 weeks), treatment (8 weeks) and follow-up (4 weeks). Nineteen children completed the study. The efficacy of treatment, which was expressed as a percentage of dry nights, was high in both the DDAVP and acupuncture groups, when used separately. The combined treatment of DDAVP and acupuncture appeared to be the most efficacious both in terms of the percentage of dry nights at the end of treatment and in relation to the stability of results, even after the end of the study. The paper gives a detailed analysis of correlations between type of treatment and urinary osmolarity.

Acupuncture Therapy↗
PubMed1990

Endoscopic manipulation of ureteral calculi in children by rigid operative ureterorenoscopy.

To date, rigid operative ureterorenoscopy with ultrasound lithotripsy for the treatment of ureteral calculi has been performed only in adults or older children. The size of the instrument with the working channel for the ultrasound probe has been considered unsuitable for delicate anatomical structures, such as those of children younger than 4 years. We performed 8 ureterorenoscopic examinations in 7 patients (3 boys) 3 to 8 years old and have demonstrated that the 11.5F ureteroscope can be inserted without difficulty into the ureteral meatus of a 3-year-old boy. Introduction of the instrument is facilitated by the use of the Perez-Castro irrigation pump. This procedure does not lead to any urethral or ureteral damage, nor is vesicoureteral reflux shown on a postoperative cystogram. This technique allows extracorporeal shock wave lithotripsy to be extended also to small children, offering the possibility of easy and successful management of any residual steinstrasse.

Child↗
PubMed1990

Bladder instability and enuresis treated by acupuncture and electro-therapeutics: early urodynamic observations.

The authors report the results of a study on 20 children suffering from a particular type of enuresis, associated with bladder instability, characterized by uninhibited contractions of the detrusor muscle. The children selected showed symptoms of enuresis, frequency, urinary urgency and a positive urodynamic test. This test was performed on 11 patients before and after acupuncture. In 16 out of 20 children, the authors observed a net increase in the intensity and frequency of uninhibited bladder contractions 30 minutes after acupuncture. At 60 minutes the contractions decreased and at 24 hours they had practically disappeared. Clinically, a gradual elimination of enuresis has been observed in 11 cases and an improvement in the other 7. From these early observations, the efficiency of acupuncture in suppressing uninhibited bladder contractions seems to be proved, even though the therapeutic mechanism has yet to be clarified.

Acupuncture Therapy↗