Enterocystoplasty: The long-term effects on bone mineral density.

Background: Studies show that enterocystoplasty has a negative effect on bone mineral density (BMD). The aim of this study was to investigate the long-term impact of enterocystoplasty on BMD. We used dual energy x-ray absorptiometry (DEXA) scans to determine BMD and identify patients with osteopenia and osteoporosis who are at potential long-term risk for fracture.

Germ cell tumor in an adolescent with extensive testicular microlithiasis: concerns regarding future management.

We report on a 14-year-old boy with bilateral testicular microlithiasis and a right-sided testicular tumor. Tumor markers alpha-fetoprotein (AFP) and β-human chorionic gonadrotropin (β-hCG) levels were elevated and orchiectomy revealed a mixed germ cell tumor consisting of embryonal carcinoma, yolk sac tumor, choriocarcinoma, and mature teratoma. The patient had no evidence of metastatic disease.

Colovaginoplasty using the Yang-Monti modification.

Objective: Bowel vaginoplasty is particularly difficult in patients who are extremely obese or those with an android pelvis. This report evaluates the use of the Yang-Monti principle as a viable alternative in the reconstruction of these patients.

Methods: Upon retrospective chart review of patients who underwent bowel replacement vaginoplasty between 1980 and 2008, 4/60 were identified who underwent the Yang-Monti modification.

Endoscopic management of vesicoureteral reflux in adult women.

Objective: • To describe our endoscopic management of adult women with vesicoureteral reflux (VUR) and associated outcomes.

Patients And Methods: • We retrospectively identified 19 adult women who presented for the endoscopic treatment of VUR from November 2001 to January 2008. • Each patient was diagnosed with VUR by voiding cystourethrogram or nuclear cystourethrogram after an episode of pyelonephritis or recurrent urinary tract infections with renal scarring on ultrasound.

Overnight urethral stenting after tubularized incised plate urethroplasty for distal hypospadias.

Objectives: The duration of urethral stenting after tubularized incised plate (TIP) urethroplasty for hypospadias varies among surgeons. Typically the catheter is left for up to 7 days with the goal of minimizing post-operative complications. We describe our experience with overnight stenting for distal TIP hypospadias repair.

The clinical utility and safety of the endoscopic treatment of vesicoureteral reflux in patients with duplex ureters.

Objective: A systemic review of published literature on the use of bulking agents in the treatment of vesicoureteral reflux (VUR) in patients with duplex systems was performed in order to evaluate the diagnostic challenges; determine success rates, and compare with use in single systems; and evaluate safety, in particular of Deflux.

Methods: A PubMed/Medline search was conducted for index articles discussing duplex ureters published in 1963-2007. All types of publications were included.

Endoscopic management of vesicoureteral reflux in women presenting with pyelonephritis.

Purpose: Vesicoureteral reflux is not usually considered a major cofactor in acute pyelonephritis in women. However, there is a subset of individuals in whom reflux must be considered in the evaluation of acute pyelonephritis. We sought to evaluate the effectiveness of endoscopic treatment for vesicoureteral reflux in this subset of patients.

Sexual function following bowel vaginoplasty.

Purpose: We review our 23-year experience with bowel vaginoplasty, with particular attention to postoperative quality of life and sexual function.

Materials And Methods: We reviewed the records of 57 patients who underwent bowel replacement vaginoplasty between 1980 and 2004. A total of 42 patients had the Mayer-Rokitansky syndrome, of whom 6 had varying forms of intersexuality, 6 had undergone surgery for pelvic malignancy, 1 had aphallia, 1 had cloacal exstrophy and 1 was the survivor of a conjoined twin separation.

The urological care and outcome of pregnancy after urinary tract reconstruction.

Objective: To assess the obstetric and urological outcomes during and after pregnancy following urinary tract reconstruction, as pregnancies after such surgery can have a significant effect on the function of the reconstructed urinary tract, and the reconstruction can significantly affect the delivery of the fetus.

Patients And Methods: We retrospectively reviewed the obstetric and urological history of 11 patients (12 pregnancies; 10 singletons and one twin) with previous urinary reconstruction, delivered between 1989 and 2003. Antepartum and postpartum urological function and obstetric outcomes were investigated.

Hypospadias repair in adults: adventures and misadventures.

Purpose: To evaluate long-term results and complications we reviewed the records of 42 consecutive men 18 to 47 years old (mean age 22.5) who underwent hypospadias repair between 1979 and 1999.

Materials And Methods: The study population was divided into groups 1 consisting of 8 patients without previous hypospadias surgery, 2 consisting of 12 who underwent 1 or more procedures in childhood but in whom local tissue was relatively intact and 3 consisting of 22 who underwent multiple unsuccessful hypospadias repairs with various degrees of penile deformity and loss of local tissue.

[Vaginal reconstruction in girls and young adults].

Objective: There are many different approaches to vaginal reconstruction. Methods include simple dilatation, skin grafts techniques, amnion grafts and the use of bowel segments for vaginal replacement.

Method: We herein discuss the most common surgical techniques and present our series of 15 patients who underwent intestinal vaginoplasty with either sigmoid colon or cecum.

The Malone antegrade continence enema procedure in the management of patients with spina bifida.

Background: In patients with spina bifida, traditional bowel management programs such as suppositories, retrograde enemas, and manual disimpaction have been largely unsatisfactory. The Malone antegrade continence enema (ACE) procedure has largely changed our approach to bowel management in this patient group.

Study Design: Over a 3-year period between January 1994 and January 1997, 27 patients with spina bifida underwent the Malone ACE procedure at our institutions.

Vaginal replacement in children and young adults.

Purpose: Absence of the vagina in the pediatric population most commonly results from congenital abnormalities, such as the Mayer-Rokitansky syndrome but it may also be seen after treatment for pelvic tumors, such as rhabdomyosarcoma, and in patients who have had previous gender reassignment. We review our experience using bowel for vaginal replacement in a group of children and young adults to assess outcome and satisfaction.

Materials And Methods: From 1980 to 1996 we evaluated 31 patients 1 to 20 years old who required vaginal replacement.

Bladder neck closure in association with continent urinary diversion.

Bladder neck closure is not a standard part of continent urinary diversion. When bladder augmentation and continent urinary diversion are done simultaneously, it is frequently convenient and advantageous to leave the native bladder neck intact as long as there is a reasonable degree of intrinsic continence. Even in patients with marginal control the effect of lowering intravesical pressure and increasing intravesical volume will often produce acceptable continence.

Pregnancy after orthotopic continent urinary diversion.

Continent urinary diversion has become a common form of bladder management for the female exstrophy patient in whom primary reconstruction has failed. Reported are the results of successful pregnancies in four young adult females, who had previously undergone a flap vaginoplasty as part of earlier management and more recently a continent right colonic urinary reservoir with a perineal stoma (Indiana pouch). Pregnancy in each of these patients was characterized by several urinary tract infections, cervical prolapse and mild to severe maternal hydronephrosis.

Eosinophilic cystitis in children.

Eosinophilic cystitis is an uncommon inflammatory disorder of the urinary bladder which causes irritative voiding symptoms and may mimic rhabdomyosarcoma radiographically. In children, eosinophilic cystitis has been previously reported to be self-limiting and requires no specific therapy. Reported herein is a case of a nine-year-old girl in whom eosinophilic cystitis recurred following antireflux surgery, raising the question of an association of eosinophilic cystitis with local trauma such as bladder surgery.

Intracorporeal cavernosa streptokinase as adjuvant therapy in the delayed treatment of idiopathic priapism.

Late treatment of priapism may be associated with unsuccessful aspiration and irrigation of the corpora cavernosa. In such cases intracorporeal instillation of streptokinase resulted in dramatic improvement in detumescence. A subsequent venous shunt procedure achieved good results.