Concealed arch incision: a cosmetic incision for pelvic surgery in girls.

Introduction: The concealed arch incision is a new cosmetic incision used in pediatric urology to access the lower urinary tract. This study explores the varieties of procedures that can be performed through this new incision on girls.

Materials And Methods: The varieties of lower urinary tract operations performed in 27 girls were evaluated.

How Pediatric Urology Fellowships in the United States are Funded.

Background: We desired to discover how pediatric urology fellowship positions in the United States were funded.

Methods: Approved pediatric urology fellowship directors (25) were contacted by e-mail and asked how the 2 years of fellowship were funded at their institutions.

Results: The response rate of the e-mail questions was 100%.

Design and optimization of an ultra wideband and compact microwave antenna for radiometric monitoring of brain temperature.

We present the modeling efforts on antenna design and frequency selection to monitor brain temperature during prolonged surgery using noninvasive microwave radiometry. A tapered log-spiral antenna design is chosen for its wideband characteristics that allow higher power collection from deep brain. Parametric analysis with the software HFSS is used to optimize antenna performance for deep brain temperature sensing.

Non-invasive measurement of brain temperature with microwave radiometry: demonstration in a head phantom and clinical case.

This study characterizes the sensitivity and accuracy of a non-invasive microwave radiometric thermometer intended for monitoring body core temperature directly in brain to assist rapid recovery from hypothermia such as occurs during surgical procedures. To study this approach, a human head model was constructed with separate brain and scalp regions consisting of tissue equivalent liquids circulating at independent temperatures on either side of intact skull. This test setup provided differential surface/deep tissue temperatures for quantifying sensitivity to change in brain temperature independent of scalp and surrounding environment.

Stable Microwave Radiometry System for Long Term Monitoring of Deep Tissue Temperature.

Background: There are numerous clinical applications for non-invasive monitoring of deep tissue temperature. We present the design and experimental performance of a miniature radiometric thermometry system for measuring volume average temperature of tissue regions located up to 5cm deep in the body.

Methods: We constructed a miniature sensor consisting of EMI-shielded log spiral microstrip antenna with high gain on-axis and integrated high-sensitivity 1.

Padded self-adhesive strap immobilization following newborn bladder exstrophy closure: the Utah straps.

Purpose: Several methods have been described for immobilization of the pelvis following bladder exstrophy closure, which can be challenging to manage. We hypothesized that immobilization can be significantly simplified using a modified mermaid wrap with padded Velcro® straps around the thigh and lower leg.

Materials And Methods: We retrospectively reviewed all patients who underwent bladder exstrophy closure in the newborn period at our institution from 1990 through 2010.

New noninvasive methods to diagnose vesicoureteral reflux.

Purpose Of Review: The undesirable nature of bladder imaging in children for vesicoureteral reflux detection makes the search for noninvasive bladder imaging methods and devices an urgent concern.

Recent Findings: Ultrasound imaging of the bladder aided by contrast agents can be performed without ionizing radiation. However, urethral catheterization and contrast instillation is still necessary.

Parameatal urethral cysts in prepubertal males.

Purpose: Parameatal urethral cyst in boys is an uncommon and often poorly understood condition. We describe the largest known series of 18 prepubertal boys with parameatal cysts.

Materials And Methods: We retrospectively reviewed the charts of all pediatric patients at our institution diagnosed with a penile cyst according to our office database between 1992 and 2010.

Modeling the detectability of vesicoureteral reflux using microwave radiometry.

We present the modeling efforts on antenna design, frequency selection and receiver sensitivity estimation to detect vesicoureteral reflux (VUR) using microwave (MW) radiometry as warm urine from the bladder maintained at fever range temperature using a MW hyperthermia device reflows into the kidneys. The radiometer center frequency (f(c)), frequency band (Deltaf) and aperture radius (r(a)) of the physical antenna for kidney temperature monitoring are determined using a simplified universal antenna model with a circular aperture. Anatomical information extracted from the computed tomography (CT) images of children aged 4-6 years is used to construct a layered 3D tissue model.

Non-invasive vesicoureteral reflux imaging.

Objective: To evaluate non-invasive and non-ionizing methods of determining the presence of vesicoureteral reflux (VUR) and to preview upcoming ideas that have the potential of finding VUR non-invasively.

Materials And Methods: We performed a PubMed search using the terms 'vesicoureteral reflux/radiography', 'vesicoureteral reflux/ultrasonography' and 'magnetic resonance imaging/urologic disease'. We also included information from a recent American Academy of Pediatrics meeting and our own research.

250 consecutive unilateral extravesical ureteral reimplantations in an outpatient setting.

Purpose: Unilateral extravesical ureteral reimplantation is comparable to intravesical procedures and more effective than subureteral injection to resolve vesicoureteral reflux. Initial reports showed that the procedure could be feasibly done on an outpatient basis. We present further data on a large series of consecutive, planned, outpatient unilateral extravesical ureteral reimplantations.

Is there a learning curve for subureteric injection of dextranomer/hyaluronic acid in the treatment of vesicoureteral reflux?

Objective: To answer the question: 'Is there a learning curve associated with a subureteric injection of Deflux(®)?'

Materials And Methods: We retrospectively reviewed charts of patients who received subureteric injection of dextranomer/hyaluronic acid (Deflux(®){AQ2}) (225 procedures) for treatment of vesicoureteral reflux (VUR) by four surgeons. The study included 55 patients, 82 ureters, who had postoperative follow-up with a voiding cystogram or nuclear medicine cystogram. Exclusion criteria were prior anti-refluxing procedures, duplicated collecting systems, and non-achievement of a negative intraoperative cystogram.

A method to improve patient access in urological practice.

Purpose: Studies to improve patient access to care have generally involved office based primary care practices or highly managed systems. Surgical practices differ in their referral nature, the common need for imaging at the first appointment and the need to schedule subsequent surgical procedures. We determined whether new patient access to care can be improved in a surgical practice.

Penile torsion correction by diagonal corporal plication sutures.

Penile torsion is commonly encountered. It can be caused by skin and dartos adherence or Buck's fascia attachments. The authors suggest a new surgical approach to solve both problems.

Incidence of postoperative infections in non-immunocompromised pediatric patients with low absolute neutrophil counts preoperatively.

Purpose: To discover the incidence of postoperative surgical site infections in non-immunocompromised pediatric patients with an absolute neutrophil count (ANC) < or = 1,000 preoperatively.

Methods: Office and hospital charts of consecutive patients with preoperative ANC < or = 1,000 undergoing elective surgery over a three-year period were reviewed for evidence of postoperative surgical site infection.

Results: Six of 200 patients with preoperative ANCs < or = 1,000 developed a postoperative surgical site infection, an infection rate of 3.

Variation in diethylenetriamine pentaacetic acid and mercaptoacetyltriglycine renal scans: clinical implications of interobserver and intraobserver differences.

Purpose: Diethylenetriamine pentaacetic acid and mercaptoacetyltriglycine renal scans are commonly used to evaluate infants and children with hydronephrosis to assess for changes in kidney function and drainage. We evaluate the certified nuclear medicine technologist intraobserver and interobserver variability of data processing in diuretic renal scan interpretation of the percent differential function of the right kidney so that true physiological changes can be understood by the clinician.

Materials And Methods: A total of 30 renal scans (diethylenetriamine pentaacetic acid in 20 patients and mercaptoacetyltriglycine in 10) were randomly selected for evaluation by 3 technologists who processed the scan data for each patient on 5 different occasions at least 1 week apart.

Genitourinary anomalies of pediatric FG syndrome.

Purpose: The FG syndrome, also known as Opitz-Kaveggia syndrome, is an X-linked disorder characterized by developmental delay, congenital hypotonia, characteristic facial appearance, relative macrocephaly and anomalies affecting the genitourinary, gastrointestinal and musculoskeletal systems. Genitourinary abnormalities in the FG syndrome include cryptorchidism, hypospadias, inguinal hernia, hydrocele and occasional anomalies of renal or ureteral development. To our knowledge no previous study has systematically evaluated the genitourinary aspects of the disorder.

New onset of hydroceles in boys over 1 year of age.

Aim: The presentation, and medical and surgical management of all new onset non-congenital hydroceles in boys older than 1 year of age were examined. Of particular interest was the outcome of those patients who presented with a non-communicating hydrocele that developed after the first year of life and was managed conservatively.

Methods: All patients older than 12 months of age who were evaluated as outpatients with the diagnosis of hydrocele from January 1994 to January 2001 were identified.

Has the growth and development of subspecialization in pediatric urology affected scholarly activity?

Purpose: How has academic productivity changed in a decade in the American Academy of Pediatrics Section on Urology? Do academic pursuits slow as section members become older? What is the average number of publications yearly by section members? What percent of research is funded in pediatric urology? Has change occurred with multiple authorships?

Materials And Methods: American Academy of Pediatrics Urology Section active memberships for 1993 and 2003 were obtained. A PubMed study was performed by reviewing all manuscripts published by American Academy of Pediatrics Section on Urology active members for 1991 to 1993 and 2001 to 2003. The data recorded were author, year, PubMed identification number, the number of authors, financial support and journal.

Minimally invasive pediatric nephrectomy.

Purpose Of Review: Since the first laparoscopic pediatric nephrectomy was performed in 1992, many articles have reported the feasibility of minimally invasive nephrectomy, heminephrectomy, and nephroureterectomy in children. This article reviews the literature related to minimally invasive nephrectomy, including robot-assisted surgery, and its complications published between November 2002 and November 2004.

Recent Findings: The retroperitoneoscopic approach to nephrectomy and nephroureterectomy continues to prove successful in the pediatric population, although the transperitoneal approach is beneficial in combined upper and lower tract procedures.

Endoscopic treatment of vesicoureteral reflux.

Purpose Of Review: The treatment of vesicoureteral reflux in children has seen a shift from invasive surgery to endoscopic management in recent years. Early studies demonstrate favorable outcomes but do not reach the success of surgery. Subspecialization also may play a role in the successful outcomes of all reflux management.

Does surgical subspecialty care come with a higher price?

Purpose Of Review: Pediatric surgical specialization has been occurring over the past few decades to improve the outcomes of pediatric surgical care. There is sparse data to support the benefit to children from these educational efforts of these dedicated individuals. This literature review focuses on recent studies and the data documenting improvement in pediatric surgical care.

Cytogenetics of a pediatric unclassified sex cord-stromal tumor of the testis: a case report.

Unclassified sex cord-stromal tumors account for a small proportion of pediatric testicular tumors and, while most are clinically benign, some have demonstrated malignant potential. Histological findings do not correlate well with clinical behavior and, while cytogenetics may aid in both diagnosis and predicting clinical behavior, these data on sex cord-stromal tumors are scarce. We describe an unclassified sex cord-stromal tumor occurring in the testis of a prepubertal male without evidence of metastasis that had a previously unreported 54,XY,+3,+7,+9,+12,+13,+18,+19,+20 karyotype.

Serum potassium and creatinine changes following unstented bilateral ureteral reimplantation in children.

Purpose: We assess the incidence of electrolyte and creatinine changes following unstented bilateral ureteral reimplantation and attempt to identify associated risk factors.

Materials And Methods: A total of 107 consecutive children with bilateral vesicoureteral reflux underwent bilateral unstented ureteral reimplantation. Study exclusion criteria were plication or tapering of any ureter, age less than 1 year and/or baseline serum creatinine greater than twice normal for age.