Complaints of Men with Uncorrected Distal Hypospadias.

Purpose: The few available reports regarding adults living with distal hypospadias give disparate views of the functional and aesthetic impact of this penile birth defect when it is not corrected. We reviewed symptoms and findings in consecutive men with unrepaired distal hypospadias and report those observations.

Material And Methods: Men with uncorrected hypospadias were queried regarding urinary symptoms, sexual dysfunction, and aesthetic concerns.

Insulin-Like Peptide 3 (INSL3) Serum Concentration During Human Male Fetal Life.

Insulin-like peptide 3 (INSL3), a protein hormone produced by Leydig cells, may play a crucial role in testicular descent as male INSL3 knockout mice have bilateral cryptorchidism. Previous studies have measured human fetal INSL3 levels in amniotic fluid only. To measure INSL3 serum levels and mRNA in fetal umbilical cord blood and fetal testes, respectively.

Recurrence after management of meatal balanitis xerotica obliterans.

Introduction: We review outcomes after management of meatal balanitis xerotica obliterans (BXO). The primary outcome was recurrent meatal BXO.

Methods: A database comprising mostly hypospadias patients was queried for meatal BXO.

Management of Urethral Strictures After Hypospadias Repair.

Strictures of the neourethra after hypospadias surgery are more common after skin flap repairs than urethral plate or neo-plate tubularizations. The diagnosis of stricture after hypospadias repair is suspected based on symptoms of stranguria, urinary retention, and/or urinary tract infection. It is confirmed by urethroscopy during anticipated repair, without preoperative urethrography.

Patient Reported Outcomes in Preoperative and Postoperative Patients with Hypospadias.

Purpose: Current outcome tools for hypospadias have limited focus on the caregiver or patient perspective of important patient centered outcomes. In this study we collaborated with patients, caregivers, and lay and medical experts to develop and pilot a patient reported outcome measure for hypospadias.

Materials And Methods: We developed a patient reported outcome measure based on systematic review of the literature and focus group input.

Glans size is an independent risk factor for urethroplasty complications after hypospadias repair.

Introduction: We hypothesized small glans size could increase urethroplasty complications (UC) following hypospadias repair. To test this, we measured glans width at its widest point in consecutive patients with hypospadias, and following a protocol for surgical decision-making, we then assessed post-operative UC using pre-determined definitions. We now report analysis of glans size as a potential additional independent risk factor for UC after hypospadias repair.

Coronal fistula repair under the glans without reoperative hypospadias glansplasty or urinary diversion.

Background: Coronal fistulas present a potential dilemma in management. Successful closure requires reoperative glansplasty when there is only a thin band of tissue separating the urethral meatus from the fistula, indicating glans dehiscence. However, we avoided reoperative glansplasty during coronal fistula repair when the glans wings remained well-fused, given the increased risk for complications, including recurrent fistula, following reoperative glansplasty.

Duration of follow-up to diagnose hypospadias urethroplasty complications.

Objective: We report the time when hypospadias urethroplasty complications (UC) were diagnosed postoperatively.

Methods: The time UC occurred after primary distal and proximal TIP and TIP reoperations was obtained from prospectively maintained databases in consecutive patients. UC included fistulas, glans dehiscences, meatal stenoses, neourethral strictures and diverticula.

Objective use of testosterone reveals androgen insensitivity in patients with proximal hypospadias.

Objective: We report preoperative testosterone stimulation based on glans width measurements in patients with midshaft and proximal hypospadias, revealing androgen resistance in those with proximal hypospadias.

Methods: Patients had maximum glans width measured preoperatively. Those <14 mm initially received 2 mg/kg testosterone cypionate intramuscularly for two to three doses, with the aim of increasing glans width ≥ 15 mm.

Glans penis width in patients with hypospadias compared to healthy controls.

Purpose: There are no reports of systematically-measured penile dimensions in boys with varying extents of hypospadias. To determine reference values, we prospectively measured maximum glans width in patients undergoing distal and proximal hypospadias repair as well as newborns undergoing elective circumcision.

Methods: The maximum glans diameter was measured in consecutive boys aged 0-24 months presenting for newborn circumcision (controls), or repair of distal (distal shaft or glanular) and proximal (proximal shaft to perineal) hypospadias.

Urethral strictures following urethral plate and proximal urethral elevation during proximal TIP hypospadias repair.

Introduction: We previously described urethral plate (UP) dissection and urethral mobilization from the corpora cavernosa to achieve or facilitate straightening ventral curvature while preserving the UP for TIP in boys with proximal hypospadias. The original patients had similar complications to those undergoing proximal TIP without UP elevation. Subsequently an increased occurrence of neourethra strictures in those with UP elevation and urethral mobilization was recognized, and is now reported.

Introducing the HOPE (Hypospadias Objective Penile Evaluation)-score: a validation study of an objective scoring system for evaluating cosmetic appearance in hypospadias patients.

Objective: To determine the reliability and internal validity of the Hypospadias Objective Penile Evaluation (HOPE)-score, a newly developed scoring system assessing the cosmetic outcome in hypospadias.

Patients And Methods: The HOPE scoring system incorporates all surgically-correctable items: position of meatus, shape of meatus, shape of glans, shape of penile skin and penile axis. Objectivity was established with standardized photographs, anonymously coded patients, independent assessment by a panel, standards for a "normal" penile appearance, reference pictures and assessment of the degree of abnormality.

Prevalence and risk factors for renal scars in children with febrile UTI and/or VUR: a cross-sectional observational study of 565 consecutive patients.

Purpose: To determine prevalence and risk factors for renal scar in children referred for urologic assessment of febrile UTI and/or VUR.

Methods: Pre-determined risk factors for renal scar were prospectively recorded in consecutive patients referred for UTI/VUR. Age, gender, VUR grade, and reported number of febrile and non-febrile UTIs were analyzed with logistic regression to determine risk for focal cortical defects on non-acute DMSA.

Randomized, double-blind, placebo-controlled trial of polyethylene glycol (MiraLAX®) for urinary urge symptoms.

Objective: Polyethylene glycol (PEG) is common first-line therapy for urinary symptoms despite minimal evidence-based support. We performed a randomized, double-blind, placebo-controlled study of PEG for initial treatment of overactive bladder (OAB) symptoms in children.

Patients And Methods: Patients aged >3 years underwent baseline urinary symptom questionnaire (USQ, scored 0-16), bowel symptom questionnaire (scored 0-20) and abdominal X-ray (KUB).

Initial results for combined orchiectomy and prosthesis exchange for unsalvageable testicular torsion in adolescents: description of intravaginal prosthesis placement at orchiectomy.

Purpose: Historically the placement of testicular prosthesis during orchiectomy for torsion is delayed despite reports of safe prosthesis placement during mastectomy and orchiectomy for cancer as well as the removal of infected penile prostheses. We describe our experience with intravaginal testicular prosthesis at orchiectomy in adolescents with torsion.

Materials And Methods: Consecutive pubertal patients undergoing exploration for torsion from 2010 to 2011 were offered orchiectomy with staged prosthesis or combined orchiectomy and prosthesis exchange for nonsalvageable testis.