Management and outcome of complex hypospadias repairs.

Purpose: Repeated attempts at surgical repair of hypospadias may leave the penis scarred, hypovascular and shortened. We report on the clinical outcomes of our repaired complex hypospadias cases, often referred to as hypospadias cripples.

Materials And Methods: We evaluated the records of 137 children and young adults from January 1980 through December 2002 who were referred to us after multiple unsuccessful hypospadias repairs.

Results of 265 consecutive proximal hypospadias repairs using the Thiersch-Duplay principle.

Purpose: We review the evolution of the concept of tubularization of the urethral plate and our results in the repair of proximal hypospadias.

Materials And Methods: A total of 281 children born with proximal hypospadias underwent Thiersch-Duplay urethroplasty with or without a midline incision of the urethral plate between 1989 and 1998. Followup data were available in 265 children.

Small cell carcinoma arising from the proximal urethra.

Primary neuroendocrine carcinomas of the lower urinary tract are distinctly rare, locally aggressive neoplasms with a high rate of metastasis. We present a case of primary small cell carcinoma of the urethra occurring in a 64-year-old man. The clinical, histological and immunohistochemical features of urethral small cell carcinoma are highlighted with respect to the differential diagnosis of neuroendocrine and other urethral tumors.

20-year experience with iatrogenic penile injury.

Purpose: We review our experience with the management of iatrogenic penile injuries. Apart from circumcision, serious damage to the penis can occur following hypospadias repair, surgery for priapism or total loss of the penis following surgical repair of bladder exstrophy.

Materials And Methods: A retrospective analysis of patients with iatrogenic penile amputation referred to us between 1980 and 2000 was undertaken.

Broad based tension-free synthetic sling for stress urinary incontinence: 5-year outcome.

Purpose: The use of nonabsorbable synthetic material has been questioned due to reports of erosion and infection. We present the 5-year followup outcome of stress urinary incontinence (SUI) treated using polypropylene mesh as a pubovaginal sling.

Materials And Methods: A retrospective analysis was performed of 58 consecutive patients who underwent pubovaginal sling procedures using polypropylene mesh since April 1996 for types II and III SUI at our institution.

The role of gadolinium enhanced magnetic resonance imaging for children with suspected acute pyelonephritis.

Purpose: The diagnosis of pyelonephritis is primarily clinical. However, the history and physical findings can be confusing in children, leading to adjunctive nuclear renal cortical scintigraphic studies (99mtechnetium dimercapto-succinic acid [DMSA]) to confirm the diagnosis. Nonetheless, ambiguity occurs when differentiating between acute pyelonephritis and chronic scarring.