Abstract. Testicular torsion or torsion of the spermatic cord is one of the most serious urological conditions. It causes testicular injury, which potentially leads to male subfertility. The turning of the spermatic cord and spermatic structures around themselves results in biochemical and histological changes; however, following testicular detorsion, tissues undergo reperfusion that causes more severe damage than that induced by ischemia. Since the primary causes of testicular damage are reactive oxygen species production, an increase in intra-mitochondrial calcium concentration and an increased rate of cellular apoptosis, different medications may potentially be effective. It seems that several medications, experimentally and sometimes clinically, serve an adjuvant role in the cellular damage that occurs following ischemia-reperfusion. Antioxidants, calcium channel blockers, phytotherapeutical medicinals, anaesthetics, hormones and platelet inhibitors may potentially create a solid basis for an adjuvant restoring therapy and ameliorate testicular function following torsion. The current study aimed to review the relevant literature and discuss the actions of a number of molecules that may protect the testes during ischemia/reperfusion injury.

Background Neuromodulation is the application of electrical stimulation on nerve fibers to modulate the neuronal activity. Its use for chronic constipation and fecal incontinence has increased in popularity over the past few years. Invasive and noninvasive techniques are currently available. We reviewed the current literature on the application of the neuromodulation techniques in the management of chronic constipation and fecal incontinence in children. Materials and Methods A search of Healthcare Database Advanced Search, Embase, Medline, and Cochrane database was performed in accordance with PRISMA guideline. Terms used in the search included neuromodulation, nerve stimulation, fecal/fecal incontinence, incontinence, constipation, children, and pediatric/pediatric. Results Two-hundred forty-one papers were screened. Fourteen papers were included for the systematic review: seven were selected for the ISNM (implantable sacral nerve modulation) technique, one for the transcutaneous tibial nerve stimulation), one for the transcutaneous sacral nerve modulation), and five for the transcutaneous interferential sacral nerve stimulation. Results showed an overall improvement in constipation symptoms in 79 to 85.7% of patients, resolution of symptoms in 40%, reduced use of ACE stoma/transanal irrigation system in 12.5 to 38.4%, and improvement in incontinence symptoms in 75%. High complication rate was reported (17–50%) in the ISNM group. No complications were reported in the non-invasive group. Conclusion Neuromodulation is a promising tool in the management of constipation refractory to medical treatment and fecal incontinence in children. Noninvasive techniques provide good results with no complications. A longer term follow-up will provide more information regarding patient compliance and sustainability of benefits of these new techniques.

Vescico-Ureteral Reflux (VUR) is a common condition in childhood, caused by a congenital anomaly at the Vescico-Ureteral Junction (VUJ) level. It seems that the main cause could be an abnormal embryological development occurred during the early stage of fetal life.Refluxing ureteral endings show structural and functional anomalies: previous studies have shown a significant decrease in alfa actin, miosin and desmin contents as well as an high rate of atrophy and muscular degeneration with disorganized muscular fibres. The roles played by Cajal cells and Connexin 43 in generating peristaltic waves appears to be fundamental for the physiological VUJ function and activity. Attention was focused also on the congenital muscular deficiency of the RUs, on regard to general morphology, smooth muscle cells architecture, inflammatory markers and the distribution of collagen composition.This review will discuss and investigate the importance of the modified configuration of Sarcoglycan (SG) sub complex (particularly the deficiency of the ε-SG and the increased expression of the α-SG), the role played by Cajal Cells, the intravescical tunnel length to ureteral diameter ratio as possible causes of the functional alterations in the refluxing ureteral ends leading towards the VUJ incompetence.

Aim: This systematic review analyzed outcomes in thoracoscopic “primary” repair of type-C esophageal atresia. Materials and Methods: The Healthcare Database Advance Search, Embase, Medline, and Cochrane databases in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were researched by 2 independent reviewers. Non-English, mixed procedures (open/thoracoscopic) and staged-repair articles were excluded. Results: Between 2000 and 2018, 173 articles were identified of which 14 met the inclusion criteria and 382 neonates analyzed. Lowest reported age and weight were 28 gestational weeks and 830 g, respectively (gestational weeks: 28 to 41 wk; birth weight: 830 to 3960 g), with 136/382 (36%) having associated comorbidities. All procedures were performed in Cuschieri modified decubitus position with 3 ports (3.5 to 5 mm) and 30-degree scopes. Azygos vein sparing approach was reported in 4/14 (28.5%) articles; and if divided 70% preferred sealing/diathermy devices. Preferences for fistula ligation were sutures in 5/13 (38%) articles, clips or hemlock in 4/13 (30.7%), sutures with clips in 4/13 (30.7%) and no data in 1/14. Transanastomotic tubes placement was reported in 9/14 articles (others no data). Chest tube placement was preferred in 9/12 (75%) articles; 3/12 no chest tubes; and 2/14 no data. Intraoperative complications were reported in 9/382 (2.3%) neonates—respiratory instability (5/9), endoclip displacement (2/9), and anastomotic leak requiring conversion (2/9). Conversion to open thoracotomy was reported in 12/14 articles in 37/382 (9.6%) neonates. Postoperative complications were reported in 94/382 (25%); 79/94 (84%) anastomotic strictures, 40/94 (42.5%) anastomotic leaks and 5/94 (5.3%) recurrent fistulation. There were 17/382 (4.4%) lethal outcomes (cardiopulmonary failure, sepsis, and 1 intraoperative tracheal rupture). Conclusions: Thoracoscopic “primary” repair of type-C esophageal atresia is feasible in premature/term neonates with a 1:10 conversion rate. Around one third surgeons prefer azygous sparing approach and three fourth placement of chest tubes, but there is no unanimity on the fistula ligation technique. The procedure has morbidity in one fourth patients and 5% mortality.

The US finding of a simple cyst at the operative site after LPN is common during follow-up, with an incidence of ~50% in our series. In regard to aetiology, probably a seroma takes the place of the removed hemi-kidney. There was no correlation between cyst formation and type of surgical technique adopted. As there was no correlation between cysts and clinical outcomes, renal cysts after LPN can be managed conservatively, with periodic US evaluations.

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The use of routine postoperative dilatations does not significantly improve surgical outcomes following PSARP in ARM.