Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome should be redefined as ipsilateral renal anomalies: cases of symptomatic atrophic and dysplastic kidney with ectopic ureter to obstructed hemivagina.

Objective: Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome is a rare syndrome characterized by mullerian and renal anomalies. Renal agenesis is classically considered to be part of the definition of OHVIRA syndrome. There are increasing reports that the lack of an ipsilateral kidney on imaging studies is not from true renal agenesis but renal dysplasia and atrophy.

Comparative effects of neonatal diethylstilbestrol on external genitalia development in adult males of two mouse strains with differential estrogen sensitivity.

The effect of neonatal exposure to diethylstilbestrol (DES), a potent synthetic estrogen, was examined to evaluate whether the CD-1 (estrogen insensitive, outbred) and C57 (estrogen sensitive, inbred) mouse strains differ in their response to estrogen disruption of male ExG differentiation. CD-1 and C57BL/6 litters were injected with sesame oil or DES (200 ng/g/5 μl in sesame oil vehicle) every other day from birth to day 10. Animals were sacrificed at the following time points: birth, 5, 10 and 60 days postnatal.

Prenatal diethylstilbestrol induces malformation of the external genitalia of male and female mice and persistent second-generation developmental abnormalities of the external genitalia in two mouse strains.

Potential trans-generational influence of diethylstilbestrol (DES) exposure emerged with reports of effects in grandchildren of DES-treated pregnant women and of reproductive tract tumors in offspring of mice exposed in utero to DES. Accordingly, we examined the trans-generational influence of DES on development of external genitalia (ExG) and compared effects of in utero DES exposure in CD-1 and C57BL/6 mice injected with oil or DES every other day from gestational days 12 to 18. Mice were examined at birth, and on 5-120 days postnatal to evaluate ExG malformations.

Parental beliefs about nocturnal enuresis causes, treatments, and the need to seek professional medical care.

Objective: To better understand parental beliefs regarding the etiology and treatment of nocturnal enuresis (NE).

Methods: A self-administered survey queried parental NE beliefs including perceived etiologies and home behavioral treatments. We assessed for associations between demographic characteristics and propensity to seek medical care for NE.

Sexual differentiation in the male and female mouse from days 0 to 21: a detailed and novel morphometric description.

Purpose: We hypothesized that a significant portion of sexual differentiation of mouse external genitalia occurs postnatally. To establish a baseline of normal development to which genital abnormalities could be compared, we determined morphometric measurements and morphological descriptions of the postnatal period of sexual differentiation in mice from birth to 21 days postnatally.

Materials And Methods: The external genitalia of male and female CD-1® mice were serially sectioned for histological staining.

Specific morphogenetic events in mouse external genitalia sex differentiation are responsive/dependent upon androgens and/or estrogens.

The objective of this study was to perform a comprehensive morphologic analysis of developing mouse external genitalia (ExG) and to determine specific sexual differentiation features that are responsive to androgens or estrogens. To eliminate sex steroid signaling postnatally, male and female mice were gonadectomized on the day of birth, and then injected intraperitoneally every other day with DES (200 ng/g), DHT (1 μg/g), or oil. On day-10 postnatal male and female ExG were dissected, fixed, embedded, serially sectioned and analyzed.

Expression of estrogen receptor alpha and beta is decreased in hypospadias.

Purpose: Estrogenic endocrine disruptors acting via estrogen receptors α and β have been implicated in the etiology of hypospadias. However, the expression and distribution of estrogen receptors α and β in normal and hypospadiac human foreskins is unknown. We characterized the location and expression of estrogen receptors α and β in normal and hypospadiac foreskins.

New insights on the morphology of adult mouse penis.

The adult mouse penis represents the end point of masculine sex differentiation of the embryonic genital tubercle and contains bone, cartilage, the urethra, erectile bodies, several types of epithelium, and many individual cell types arrayed into specific anatomical structures. Using contemporary high-resolution imaging techniques, we sought to provide new insights to the current description of adult mouse penile morphology to enable understanding of penile abnormalities, including hypospadias. Examination of serial transverse and longitudinal sections, scanning electron microscopy, and three-dimensional (3D) reconstruction provided a new appreciation of the individual structures in the adult mouse penis and their 3D interrelationships.

Morphology of the external genitalia of the adult male and female mice as an endpoint of sex differentiation.

Adult external genitalia (ExG) are the endpoints of normal sex differentiation. Detailed morphometric analysis and comparison of adult mouse ExG has revealed 10 homologous features distinguishing the penis and clitoris that define masculine vs. feminine sex differentiation.

Adherence to antibiotic prophylaxis in children with vesicoureteral reflux.

Vesicoureteral reflux (VUR) affects approximately 1% of children and may predispose a child with a bladder infection to develop pyelonephritis and renal scarring. To prevent these potential sequelae, one accepted treatment option for VUR includes low-dose continuous antibiotic prophylaxis (CAP) to maintain urine sterility until the condition resolves. Despite the widespread use of CAP, little data exists regarding adherence to long-term antibiotic therapy.

Sacrifice of accessory pudendal arteries in normally potent men during robot-assisted radical prostatectomy does not impact potency.

Aim: Whether or not sacrificing accessory pudendal arteries (APAs) during radical prostatectomy affects potency has been an ongoing source of concern. Herein, we present our potency results relative to sacrificing APAs in normally pre-potent men following robot-assisted radical prostatectomy (RARP).

Methods: The distribution of APAs and clinical characteristics were prospectively recorded in 200 consecutive patients undergoing RARP with a cautery-free technique.

Quantitative and qualitative analysis of the recovery of potency after radical prostatectomy: effect of unilateral vs bilateral nerve sparing.

Objectives: To analyse the impact of a approximately 50% reduction of cavernous nervous tissue on the qualitative and quantitative recovery of sexual function after unilateral (UNS) and bilateral (BNS) nerve-sparing robotic radical prostatectomy (RALP), by evaluating these differences in two groups treated with cautery and a cautery-free technique (CFT).

Patients And Methods: UNS was defined as wide-excision of one neurovascular bundle (NVB). Only men aged < or =65 years with preoperative International Index of Erectile Function (IIEF-5) scores of > or =22 were included.

Zero positive surgical margins after radical prostatectomy: is the end in sight.

Positive surgical margins represents incomplete resection by the surgeon, and the elimination of positive margins represents the only clinical feature during radical prostatectomy that can lead directly to improved cancer outcomes. The introduction of new robot-assisted technology and technical refinements has led to declines of positive surgical margins. Although margins induced by incomplete cancer resection by the surgeon have been reduced for organ-confined disease, the 'Holy Grail' of zero margins is not yet attainable in prostatectomy, and is more problematic in cancer that has penetrated beyond the prostate.

Single institution 2-year patient reported validated sexual function outcomes after nerve sparing robot assisted radical prostatectomy.

Purpose: To identify surgeon specific factors for preserving sexual function (and minimize patient related factors) we report 2-year potency outcomes in men 65 years or younger with normal preoperative sexual function undergoing nerve sparing robot assisted laparoscopic radical prostatectomy.

Materials And Methods: Between July 2004 and February 2006, 200 consecutive patients underwent robot assisted laparoscopic radical prostatectomy by 1 surgeon. Inclusion criteria were age 65 years or younger with normal baseline 5-item International Index of Erectile Function score of 22 to 25 and complete 2-year followup.

Overcoming obstacles: nerve-sparing issues in radical prostatectomy.

Purpose: To review, compare, and contrast recovery of potency after robot-assisted radical prostatectomy with specific regard to thermal and excisional nerve injury. Our goal was to compare intensity of injury and ability to recover potency in order to stratify risk by injury type.

Methods: We compare potency outcomes in our first 500 consecutive cases of robot-assisted radical prostatectomy.

Nerve-sparing techniques in open and laparoscopic prostatectomy.

Open and laparoscopic radical prostatectomy is a safe and effective treatment for organ-confined prostate cancer with excellent cancer control and quality of life outcomes. We present current nerve-sparing techniques used in open, laparoscopic and robot-assisted prostatectomy to maximize postoperative potency. We review the literature and describe important anatomical landmarks and technical aspects that differentiate between approaches.

Transperitoneal robotic-assisted laparoscopic radical prostatectomy and inguinal herniorrhaphy.

Patients undergoing radical prostatectomy are at increased risk of development of post-operative inguinal hernias (IH). We present the largest series of transperitoneal combined robotic-assisted laparoscopic prostatectomy (RALP) and IH. After IRB approval, data from patients undergoing RALP at two centers were prospectively entered into a database and analyzed.

Prostate volume estimation using the ellipsoid formula consistently underestimates actual gland size.

Purpose: Historically estimating prostate volume by transrectal ultrasound underestimates actual prostate weight. We quantified and determined whether trends could be identified to predict or understand the underestimation.

Materials And Methods: The characteristics transrectal ultrasound volume, pathological prostate weight and dimensions in 181 patients were entered into an electronic spread sheet.

Anatomic excision of anterior prostatic fat at radical prostatectomy: implications for pathologic upstaging.

Introduction: After exposure of the retropubic space, the surgeon commonly dissects the fat overlying the prostate and usually discards it. We have previously described the importance of dissecting this fat to completely visualize the dorsal venous complex (DVC) and prostatic apex. In this study, we describe a technique to dissect and remove the anterior prostatic fat pad (APF) and its anatomic and pathologic significance.

Spread of thermal energy and heat sinks: implications for nerve-sparing robotic prostatectomy.

Background And Purpose: During nerve-sparing robot-assisted laparoscopic prostatectomy, nerve injury caused by thermal energy is a concern. Using a porcine model, we studied thermal spread and queried whether vessels such as the prostatic pedicle may act as a heat sink, reducing the spread of thermal energy.

Materials And Methods: Monopolar (MP) and bipolar (BP) cautery was applied laparoscopically on the anterior abdominal wall surface of six pigs with the da Vinci robot.

Combined inguinal hernia repair with prosthetic mesh during transperitoneal robot assisted laparoscopic radical prostatectomy: a 4-year experience.

Purpose: Inguinal hernias are detected in 20% to 30% of patients undergoing radical prostatectomy. We report our experience with concomitant transperitoneal robot assisted laparoscopic radical prostatectomy and intraperitoneal inguinal herniorrhaphy using prosthetic mesh.

Materials And Methods: A retrospective review was performed of the medical records of 533 consecutive robot assisted laparoscopic radical prostatectomies performed by 1 surgeon from June 2002 to April 2007.

[Radical robot prostatectomy: oncological outcomes].

Objectives: To review the current literature on oncologic outcomes following robot-assisted laparoscopic radical prostatectomy.

Methods: A systematic MEDLINE search was performed to retrieve articles relating to oncologic outcomes with robot-assisted laparoscopic prostatectomy. Two reviewers independently selected studies, assessed their methodological quality and extracted data.

Salvage robot-assisted radical prostatectomy with pelvic lymph node dissection after cryotherapy failure.

We report the first case of post-cryotherapy salvage radical prostatectomy for local recurrence performed laparoscopically with the da Vinci robot. Total operative time was 210 minutes and blood loss was 50ml. There were no intraoperative or postoperative complications.

One-stage urethral reconstruction for stricture recurrence after urethral stent placement.

Purpose: We report our 8-year experience with 1-stage open urethral reconstruction in 10 patients with recurrent bulbar and/or membranous strictures after UroLume urethral stent placement.

Materials And Methods: Ten consecutive referral patients underwent preoperative contrast imaging and urethroscopy followed by primary anastomotic repair or substitution urethroplasty, with concomitant open UroLume removal (when the stent was still present). Postoperative evaluation included contrast imaging 3 weeks after surgery, urethroscopy 4 months after surgery, uroflowmetry, and American Urological Association symptom score assessment.