Randomized trial of prophylactic antibiotics vs. placebo after midshaft-to-distal hypospadias repair: the PROPHY Study.

Background: Use of prophylactic antibiotics after stented hypospadias repair is very common, but most research has not identified any clinical benefits of this practice. Only one study has found that postoperative prophylaxis reduces symptomatic urinary tract infections (UTIs). Data from the same trial suggested that prophylaxis may also reduce urethroplasty complications.

Low Serum Testosterone Level Predisposes to Artificial Urinary Sphincter Cuff Erosion.

Objective: To examine the association between decreased serum testosterone levels and artificial urinary sphincter (AUS) cuff erosion.

Materials And Methods: We evaluated serum testosterone levels in 53 consecutive patients. Low testosterone was defined as <280 ng/dL and found in 30/53 patients (56.

Androgen supplementation in rats increases the inflammatory response and prolongs urethral healing.

Objective: To describe the effects of androgens on urethral wound healing, we compared the urethral healing process in castrated Sprague-Dawley rats with and without testosterone supplementation.

Methods: Of 30 castrated male Sprague-Dawley rats, 15 received testosterone cypionate (3 mg/kg; T+ rats). All rats underwent an urethroplasty procedure and were sacrificed at postoperative days 5, 10, and 20.

Analysis of primary urethral wound healing in the rat.

Objective: To analyze the process of urethral healing, which is the basis of urethral reconstructive surgery but remains poorly understood, we have developed a rat model of urethroplasty. Understanding this process may provide strategies to prevent aberrant urethral healing and improve the healing process.

Methods: We performed urethroplasties on 36 male Sprague-Dawley rats.

Early administration of oxybutynin improves bladder function and clinical outcomes in newborns with posterior urethral valves.

Purpose: Abnormal bladder function following posterior urethral valve ablation can lead to deleterious effects on renal function and urinary continence. We performed a pilot study to determine if bladder dysfunction could be ameliorated by the early administration of oxybutynin.

Materials And Methods: We enrolled infants who underwent primary posterior urethral valve ablation by the age of 12 months.

Hemiscrotal agenesis: new variation in a rare anomaly.

Scrotal agenesis is a rarely encountered developmental anomaly of the scrotum, with only 6 cases of complete agenesis reported in published studies. We report, to our knowledge, the first case of hemiscrotal agenesis. The specific embryologic basis of scrotal agenesis is unknown but is likely multifactorial, involving localized androgen insensitivity, localized 5α-reductase deficiency, and/or failure of labioscrotal fold formation.

Active learning: a resident's reflection on the impact of a student-centred curriculum.

Classic medical education pedagogy typically involves the model of an active teacher and a passive student. There has been a shift in education theory to a more student-centred approach, and this is being reflected in resident education. Concepts, such as "competencies," "curricula" and "objectives," are becoming part of the fabric of the residency training equation.

Computer-enhanced visual learning method: a paradigm to teach and document surgical skills.

Innovation: Changes in health care are stimulating residency training programs to develop new methods for teaching surgical skills. We developed Computer-Enhanced Visual Learning (CEVL) as an innovative Internet-based learning and assessment tool. The CEVL method uses the educational procedures of deliberate practice and performance to teach and learn surgery in a stylized manner.

Fetal pyelectasis as predictor of decreased differential renal function.

Purpose: A decreased percent of differential function is a common indication for infant pyeloplasty but there is no recognized fetal ultrasound parameter to predict this deficit. We determined whether there is a correlation between fetal pyelectasis and the newborn percent differential function that may enhance prenatal counseling and guide postnatal evaluation.

Materials And Methods: Our database was queried for fetal and newborn measures with fetal pyelectasis on ultrasound and the percent of differential function on renal scintigraphy.

Newborn society of fetal urology grade 3 hydronephrosis is equivalent to preserved percentage differential function.

Purpose: In newborn hydronephrosis (HN), the level of differential function (%df) measured by diuretic renography (DR) is used to judge the need for pyeloplasty. As DR testing is complex, we sought to determine if grading the level of HN (Society of Fetal Urology grade, SFU Gr) by a simple ultrasound correlates with percentage differential function (%df) and thereby obviates the need to perform DR.

Materials And Methods: Between 1990 and 2003 our institution prospectively enrolled all cases of fetal HN who showed unilateral newborn SFU Gr HN > or =3.

Complete excision or marsupialization of ureteroceles: does choice of surgical approach affect outcome?

Purpose: Two accepted open surgical techniques exist for lower urinary tract reconstruction for ureteroceles, that is complete excision/enucleation and marsupialization/partial excision. To our knowledge it is currently unknown whether 1 method offers better clinical outcomes. We sought to answer this question.

A review of pediatric glans malformations: a handy clinical reference.

Purpose: Lesions of the pediatric glans penis are an uncommon but important aspect of pediatric urological care. We reviewed the available literature on this topic and did not identify a comprehensive reference resource. We compiled our multi-institutional experience with such conditions to prepare a handy clinical reference source.

A new computer enhanced visual learning method to train urology residents in pediatric orchiopexy: a prototype for Accreditation Council for Graduate Medical Education documentation.

Purpose: Residency programs must continue to restructure teaching and assessment of surgical skills to improve the documentation of Accreditation Council for Graduate Medical Education competencies. To improve teaching and documenting resident performance we developed a computer enhanced visual learning method that includes a curriculum and administrative reports. The curriculum consists of 1) study of a step-by-step surgical tutorial of computer enhanced visuals that show specific surgical skills, 2) a checklist tool to objectively assess resident performance and 3) a log of postoperative feedback that is used to structure deliberate practice.

Ultrasound fails to delineate significant renal pathology in children with urinary tract infections: a case for dimercapto-succinic acid scintigraphy.

Purpose: Routine radiological evaluation in children with urinary tract infections includes ultrasound. Additional dimercapto-succinic acid scintigraphy in this setting is a common but not routine practice to determine whether there is parenchymal injury. Because dimercapto-succinic acid scintigraphy involves further time, expense and radiation, we determined whether ultrasound findings could substitute for dimercapto-succinic acid scintigraphy.

Office management of pediatric primary nocturnal enuresis: a comparison of physician advised and parent chosen alternative treatment outcomes.

Purpose: We compared the remission of pediatric primary nocturnal enuresis in groups of children who used a physician advised practice plan vs a parent chosen alternative.

Materials And Methods: Between January 2004 and January 2006 there were 119 patients with primary nocturnal enuresis enrolled in this prospective, nonrandomized study. For this study primary nocturnal enuresis was defined as wetting at night during sleep during any 6-month interval without any known causative problem.

Incidence based fetal urological counseling using the virtual pediatric urology registry: importance of insignificant fetal pyelectasis (sonographically evident renal pelvis).

Purpose: Since 1985, counseling for fetal renal pelvic dilatation has been done to determine whether there is need for newborn urological evaluation. This is likely if the anteroposterior width of the renal pelvis exceeds categorical cutoffs, ie 4 mm or greater before gestational age 33 weeks, or 7 mm or greater after 33 weeks. Cases below these categorical cutoffs are deemed not to merit newborn testing.

Intravesical electrotherapy for neurogenic bladder dysfunction: a 22-year experience.

Purpose: Intravesical electrotherapy was previously shown to be effective for improving bladder capacity and compliance. We evaluated our 22-year experience with this therapy in patients with neurogenic bladder.

Materials And Methods: The charts of 405 patients who received intravesical electrotherapy were reviewed.

Clinical urological outcomes following primary tethered cord release in children younger than 3 years.

Purpose: Current practice at our institution is to recommend tethered cord release at diagnosis to prevent the onset or worsening of symptoms. Tethered cord release is frequently performed in children younger than 3 years who often have no urological manifestations. To our knowledge there are currently no long-term data on urological outcomes in this age group.

Multi-institutional experience with PIC cystography--incidence of occult vesicoureteral reflux in children with febrile urinary tract infections.

Objectives: It has been reported that all children with febrile urinary tract infections (FUTIs) and normal voiding cystourethrogram (VCUG) findings show occult reflux (vesicoureteral reflux [VUR]) when examined by cystography performed with positioning of the instillation of contrast at the ureteral orifice (PIC cystography). In this study, we evaluated the reproducibility of this finding using a prospective multi-institutional collaborative examination to determine whether PIC-VUR is as common in such cases as previously shown.

Methods: From March 2002 to October 2003, four institutions performed PIC cystography consecutively and prospectively in pediatric cases of FUTI (greater than 101 degrees F) who had not shown VUR by conventional VCUG.

Bladder neck fistula after the complete primary repair of exstrophy: a multi-institutional experience.

Purpose: The major goals of complete primary repair of exstrophy (CPRE) are the re-creation of normal anatomy which allows bladder cycling and to reduce the number of future procedures necessary to achieve continence. It is unclear whether CPRE is associated with a higher bladder neck fistula rate than the traditional staged repair. We review a multi-institutional experience with the CPRE technique to evaluate the rate of bladder neck fistula.

Clean intermittent catheterization in genitally sensate children: patient experience and health related quality of life.

Purpose: Clean intermittent catheterization (CIC) has proven successful for bladder emptying in children without genital sensation with success rates of 94% to 100% in select groups. A subset of the pediatric population requires CIC for bladder dysfunction, yet has normal genital sensation. This study was designed to assess our experience with CIC in genitally sensate children and the health related (HR) quality of life (QOL) for them and their families.

Snodgrass hypospadias repair with vascularized dartos flap: the perfect repair for virgin cases of hypospadias?

Purpose: Since its introduction, the Snodgrass hypospadias repair has been applied to virtually all forms of hypospadias repair. However, fistula rates have still been reported to be as high as 5% from large center, multiple surgeon studies and 16% from smaller center studies. We report on the use of the Snodgrass repair in conjunction with routine use of a vascularized dartos flap and 2-layer closure of the neourethra from multiple institutions.