A prospective audit of hypospadias correction in a regional paediatric surgery centre.

Aim: To prospectively review the management and treatment of hypospadias in a single regional centre, and in particular, to assess the spectrum of cases treated, techniques used and to determine the nature of the complications.

Methods: One hundred and fifty-three consecutive boys undergoing hypospadias repair during a 36-month period were included in the study. Information was collected prospectively and included the site of the urethral meatus, presence of chordee, surgical technique employed, use of urinary diversion, and the prescription of postoperative antibiotics and analgesics.

Surgical management of ambiguous genitalia.

The surgical management of children born with ambiguous genitalia has always been difficult, subject to evolving attitudes and techniques, and at times controversial. Standard protocols have stressed the need for early diagnosis, gender assignment, and appropriate surgery in infancy.(1) In recent years some authors, backed by patient support groups, have claimed that such surgery is damaging or mutilating and, as it is essentially cosmetic, should not be performed until the fully informed consent of the patient could be obtained-that is, when the child becomes "Gillick competent".

The Pippi Salle procedure for neurogenic urinary incontinence in childhood: a three-year experience.

Aim: A three-year retrospective study was performed to assess the place of the Pippi Salle bladder neck repair in the treatment of neurogenic bladder incontinence in both sexes in childhood.

Method: All children who underwent the procedure between November 1995 and November 1998 were studied retrospectively. There were 18 children: 12 with spina bifida, 5 with sacral agenesis and 1 with an idiopathic neurogenic bladder.

Hyperammonaemia due to Klebsiella infection in a neuropathic bladder.

A boy with a neuropathic bladder and a single hydronephrotic kidney developed hyperammonaemic encephalopathy during a urinary tract infection with Klebsiella oxytoca. Although particularly associated with Proteus infections and prune belly syndrome, hyperammonaemia can complicate infection with any urease-producing bacteria if there is urinary stasis.

The use of the detrusorrhaphy for vesico-ureteric reflux: the way forward?

Objective: To assess the outcome of all detrusorrhaphies carried out for simple single-system vesico-ureteric reflux (VUR) in children at one institution over a 4-year period.

Patients And Methods: Twenty-nine patients (11 boys, 18 girls, 43 renal units; mean age at presentation 23 months; range, antenatal to 72 months) were analysed in two groups. Group 1 comprised those undergoing asynchronous bilateral procedures (two patients, four units) and unilateral procedures (15 patients, 15 units), and group 2, those undergoing synchronous bilateral procedures (12 patients, 24 units).