Impact of second-layer coverages on complication rates in primary tubularized incised plate urethroplasty (TIPU) for distal and midpenile hypospadias repair: a systematic review Marta Pezzoli, Mattia Lo Re, Virginia Carletti, Lorenzo Masieri, Alberto Mantovani Pediatric Surgery International, 2025 This systematic review assesses the impact of different second-layer coverage techniques on complication rates following primary tubularized incised plate urethroplasty (TIPU) for distal and midpenile hypospadias. A systematic search of PubMed, EMBASE, Cochrane Central, and Scopus was conducted in August 2024. Studies were included if they reported outcomes of single- or double-layer neourethral coverage in primary TIPU for distal or midpenile hypospadias. A narrative synthesis was performed due to study heterogeneity. Forty studies met inclusion criteria. In distal hypospadias, single-layer coverage yielded urethrocutaneous fistula (UCF) rates below 10% in most cases. Meatal stenosis reached 33.3% but was uncommon with dorsal dartos (DD) flaps. Double-layer coverage, especially with double DD flaps, showed lower UCF rates (0–12)% and minimal stenosis. For midpenile hypospadias, single-layer coverage showed higher UCF rates (0–36.4%), with DD flaps performing worse (12.5–36.4%) than tunica vaginalis (TV) flaps (0–3.1%). Double-layer techniques consistently reduced UCF to < 5%, with double DD flaps showing no fistula or stenosis. In conclusion, second-layer coverage, particularly double layer, reduces complications in TIPU. The DD flap remains most commonly used due to its accessibility, while the technically demanding TV flap shows promising results. Further high-quality data are needed to identify the optimal technique.
Intravesical Botulin Toxin-A Injections for Neurogenic Bladder Dysfunction in Children: Summary Update on Last 10 Years of Research Andrea Zulli, Virginia Carletti, Alberto Mantovani, Maria Angela Cerruto, Luca Giacomello Toxins, 2024 Neurogenic bladder dysfunction (NB) represents a challenge in pediatric urology. Intravesical botulin toxin-A (BTX-A) bladder injection is part of the armamentarium for the treatment of this condition, usually after failed first-line medical strategies and before the escalation to more invasive options such as neuromodulation or augmented cystoplasty in severe cases. However, there is still a lack of consensus about the appropriate treatment modality for the pediatric population. A review of the last 10 years’ research was performed on the PubMed database by two authors. Articles doubly selected and meeting the inclusion criteria were collected and analyzed for their study type, demographics, neurological disease(s) at diagnosis, BTX-A treatment modality and duration, previous treatment, clinical and urodynamic parameters, adverse events, outcomes, and follow-ups. A total of 285 studies were initially selected, 16 of which matched the inclusion criteria. A cohort of 630 patients was treated with BTX-A at a median age of 9.7 years, 40% of which had a diagnosis of myelomeningocele. The results of the selected publications show the overall efficacy and safety of BTX-A injections in children and confirmed BTX-A as a valuable strategy for NB treatment in pediatric population. Nevertheless, up to now, the literature on this topic offers scarce uniformity among the published series and poor protocol standardization.
Management of Kidney Stones Using RIRS Lorenzo Masieri, Alfonso Crisci, Alberto Mantovani, Chiara Cini, Simone Sforza Minimally Invasive Techniques in Pediatric Urology Endourology Laparoscopy and Robotics, 2022
