Segmental Testicular Infarction Associated to Torsion: First Case Report in Childhood.

Testicular torsion in children is not uncommon emergency problem which occur due to twist in the spermatic cord leading to ischemia or infarction to testicle. Hemorrhagic infarction can occur following testicular torsion is globally; however, in extremely rare situation, such infarction can be segmental. Segmental testicular infarction (STI) was reported in an infant due to epididymitis and a newborn with STI in 1 testicle with complete infarction in the contralateral testicle due to birth trauma.

Fertility and sexuality issues in congenital lifelong urology patients: male aspects.

Purpose: To review existing literature about fertility and sexuality of boys born with complex congenital genitourinary anomalies.

Methods: A Pubmed review was performed in December 2018 to identify the most relevant original manuscripts regarding male complex congenital conditions affecting the urogenital system in male patients including spina bifida (SB), bladder exstrophy-epispadias complex (BEEC) and hypospadias. A comprehensive review was drafted exploring sexual dysfunction from a medical, psychosexual, surgical and reproductive point of view during transition from childhood (or adolescence) to adulthood.

Outcomes of percutaneous transluminal angioplasty for pediatric renovascular hypertension.

Background: Up to 10% of hypertensive children will have renovascular disease. Where medical therapy fails to control the hypertension, endovascular techniques can improve renal perfusion. The purpose of this study was to assess the efficacy of angioplasty in controlling renovascular hypertension (RVH) in children.

Does routine ultrasound change management in the follow-up of patients with vesicoureteral reflux?

Introduction: Children with vesicoureteral reflux (VUR) usually need a renal ultrasound (RUS). There is little data on the role of follow-up RUS in VUR. We evaluated the impact of follow-up RUS on the change in clinical management in patients with VUR.

Surgical management of pediatric urinary incontinence.

The surgical management of pediatric urinary incontinence secondary to neurogenic bladder and congenital anomalies is challenging, and continues to evolve with new surgical innovations. The goal of these surgical procedures is to achieve complete and socially acceptable urinary dryness, while preserving volitional voiding where possible, without causing damage to the upper tracts. This review focuses on recent studies and highlights the pros and cons of these advances, based on our experience.

Update on the management of disorders of sex development.

A number of factors have contributed to a sharp increase in the number of publications related to disorders of sex development (DSD) in the past 5 years, namely: the establishment of a consensus in 2006 about nomenclature, investigations and the need to treat these patients in a multidisciplinary setting; increase of the knowledge base about genetic mechanisms of normal and abnormal sex development; critical appraisal about the timing and nature of genital surgery in patients with DSD. Herein, the authors present a comprehensive review with up-to-date data about the approach to the newborn with ambiguous genitalia as well as the diagnosis and management of the most common DSD.

Surgical treatment of high urogenital sinuses using the anterior sagittal transrectal approach: a useful strategy to optimize exposure and outcomes.

Purpose: Surgical management of the high urogenital sinus remains challenging. The anterior sagittal transrectal approach provides optimal exposure, facilitates vaginal dissection and separation from the urethra, and allows reconstruction of the bladder neck musculature. In this study we report our initial experience with this technique.

Diagnosis and management of congenital rectourethral fistula in a child with long tubular duplication of the colon and Klippel-Feil syndrome.

We describe a unique association of congenital rectourethral fistula with long tubular duplication of the colon in a boy with Klippel-Feil syndrome and Sprengel deformity. He presented with a rectourethral fistula after surgical repair of a tubular duplication of the terminal ileum, colon, and proximal rectum. Preoperative identification of the fistula was challenging and was only achieved after cystoscopy with injection of methylene blue under pressure through Foley catheters placed into the anus and distal stoma of a colostomy.

Can we spare removing the adrenal gland at radical nephrectomy in children with wilms tumor?

Purpose: In patients with Wilms tumor indications for adrenalectomy are not well-defined. Following the rationale for preserving the adrenal gland in cases of other renal malignancies we determined predictors of adrenal involvement and the impact of adrenalectomy on retroperitoneal recurrence.

Materials And Methods: We retrospectively reviewed the record of patients who underwent surgical resection as primary treatment for Wilms tumor between 1990 and 2008 at 2 Canadian pediatric centers.

The Ventral V-plasty: a simple procedure for the reconstruction of a congenital megaprepuce.

A buried penis secondary to a megaprepuce is defined clinically by a phimosis, failure of the corporal bodies to inhabit a variably deficient penile shaft skin and a basal hemispheric ballooning of the penis during micturition. Anatomically, it describes a condition in which a normal phallus is trapped within normal prepubic connective tissue by the excessive skin of a megaprepuce and a variable abundance of dartos fascia. Many surgical procedures have been described to correct this deformity, suggesting that no single method has a clear advantage.

Outcome of antibiotic prophylaxis discontinuation in patients with persistent vesicoureteral reflux initially presenting with febrile urinary tract infection: time to event analysis.

Purpose: The use of antibiotic prophylaxis for preventing urinary tract infections has recently been called into question. Some studies support discontinuation of antibiotic prophylaxis in selected groups of children with vesicoureteral reflux. We report on the outcome of this practice in a cohort of patients assembled based on initial presentation with a febrile urinary tract infection.

Bilateral ureteral reimplantation at primary bladder exstrophy closure.

Purpose: We present the outcomes of children who underwent concurrent complete primary repair of bladder exstrophy and bilateral ureteral reimplantation vs those undergoing bladder exstrophy repair alone, focusing on the rate of postoperative febrile urinary tract infections.

Materials And Methods: We performed complete primary repair of bladder exstrophy with bilateral ureteral reimplantation using a cephalotrigonal technique in 15 patients (group 1) and without bilateral ureteral reimplantation in 23 patients (group 2). Postoperative assessment included ultrasound and voiding cystourethrogram in all patients.

Hypospadias in males with intrauterine growth restriction due to placental insufficiency: the placental role in the embryogenesis of male external genitalia.

Our aim was to define the association between early onset intra-uterine growth restriction (IUGR) due to placental insufficiency and hypospadias in males. We prospectively studied a cohort of small-for-gestational age (SGA) male infants with hypospadias managed by a multidisciplinary team over a 5-year period. Thirty SGA male infants were diagnosed with hypospadias/abnormal genitalia after birth, and four of them were diagnosed antenatally.

Do patients with classic bladder exstrophy have fecal incontinence? A web-based study.

Objectives: To explore the occurrence of fecal incontinence in patients with classic bladder exstrophy (CBE) by administering a web-based pilot study.

Methods: A questionnaire assessing fecal continence status was devised. Questions included demographics, age to achieve toilet training for bowels, and the patient perception of the degree of fecal soiling during day and night, if present.

Comparison of flank, dorsal lumbotomy and laparoscopic approaches for dismembered pyeloplasty in children older than 3 years with ureteropelvic junction obstruction.

Purpose: Selecting a surgical approach for correction of ureteropelvic junction obstruction in children is mostly driven by surgeon preference, and includes laparoscopy, flank incision and dorsal lumbotomy. Comparative analyses focusing on operative time, hospital stay and complications are lacking.

Materials And Methods: We retrospectively reviewed the charts of 41 consecutive patients older than 3 years who underwent laparoscopic pyeloplasty by a single surgeon between 2005 and 2008.

Open versus laparoscopic staged Fowler-Stephens orchiopexy: impact of long loop vas.

Purpose: There is a paucity of literature on factors associated with testicular atrophy following second stage laparoscopic Fowler-Stephens orchiopexy. We hypothesized that dissection of a long looping vas during this procedure could compromise testicular blood supply, leading to testicular atrophy.

Materials And Methods: Following an initial laparoscopic testicular vessel ligation, a second stage Fowler-Stephens orchiopexy was performed in 73 testes (laparoscopic in 61, open in 12).

Tubularized incised plate urethroplasty for distal hypospadias: A literature review.

The tubularized incised plate (TIP) urethroplasty or Snodgrass procedure has gained worldwide acceptance for distal hypospadias repair due to its low complication rate, good cosmetic result, and technical simplicity. As a result, several articles have been published concerning various aspects and subtle variations of this procedure. The aim of this review is to critically and systematically analyze the published complication rates of TIP repair for distal hypospadias in children.

Risk factors for recurrent ureteropelvic junction obstruction after open pyeloplasty in a large pediatric cohort.

Purpose: Recurrent ureteropelvic junction obstruction after open pyeloplasty is a serious complication for which treatment remains challenging. We identified risk factors for persistent obstruction.

Materials And Methods: We retrospectively reviewed the charts of 401 children who underwent open dismembered pyeloplasty between 1997 and 2005.

Current status of bladder neck reconstruction.

Purpose Of Review: This paper reviews the literature over the last 3 years on bladder outlet procedures for children with urinary incontinence. The multitude of procedures and need for concomitant bladder augmentation indicates that there is no ideal surgical option for these children.

Recent Findings: The results of bladder neck slings with or without bladder augmentation have been reported in some key studies during this review period.

Maternal luteoma of pregnancy presenting with virilization of the female infant.

Background: Virilization in female newborns typically results from congenital adrenal hyperplasia, requiring immediate diagnosis and treatment. We report a rare cause of virilization, maternal pregnancy luteoma, responsible for virilization of both a newborn and the mother. Luteomas are usually asymptomatic tumour-like ovarian lesions of pregnancy that secrete androgens in only 25% of cases.

Management of priapism in a child with sickle cell anemia; successful outcome using epidural analgesia.

Purpose: To describe the successful management of priapism secondary to sickle cell anemia in a child using neuraxial analgesia provided via an epidural catheter.

Clinical Features: A seven-year-old male presented with chest crisis and priapism which, following hemoglobin electrophoresis led to a new diagnosis of sickle cell anemia. Epidural management was attempted as an alternative to surgery after failure of more conventional medical and surgical methods to treat the priapism.

Pediatric renal cell carcinoma: single institution 25-year case series and initial experience with partial nephrectomy.

Purpose: RCC represents less than 2% to 6% of pediatric renal tumors. Few reports of long-term outcomes exist. We sought to determine the presentation, treatment and outcome of patients at our institution.

Prospective evaluation of remote, interactive videoconferencing to enhance urology resident education: the genitourinary teleteaching initiative.

Purpose: Changes in referral patterns and resource allocation into Centers of Excellence affect the educational experience of urology trainees by altering resident exposure to patients and clinicians, especially at sites where subspecialty deficiencies exist. Access to educators at Centers of Excellence using interactive videoconferencing technology may facilitate residency training objectives and enhance trainees' overall educational experience. We prospectively evaluated the implementation of this technology at tertiary care teaching centers to enhance urology resident education.