Mohamed Fahmy

It was found earlier that a normally functioning testis of the adult guinea pig will lose practically all its germinal epithelium when the testis is elevated from the scrotum into the abdomen; the seminiferous tubules show marked degeneration within a week after confinement of the testis in the abdomen, and within 2–3 weeks the tubules are reduced to shrunken, vacuolated, and empty canals except for a single basal row of nuclei. All spermatogenesis ceases, and the testis shows no spermatogenetic activity as long as it remains in the abdomen. If, however, it is replaced in the scrotum after degeneration of the germinal epithelium has occurred, spermatogenesis is re-established and spermatozoa are again pro- duced

Background: A wide spectrum of complications are reported after male circumcision (MC), the non-aesthetic complications are well known, but the pigmentary complications scale are not reported precisely. Methods: This is a prospective cohort study of 550 circumcised boys; aged from 6 months to 14 years (62% aged 5 years) who were examined and appropriately investigated for the incidence of pigmentary complications after circumcision. Most diagnoses were clinically, but dermoscopy was done for 17 case and a skin biopsy for 14 cases. Patients with personal or family history of vitiligo, or congenital nevi were excluded. Available hospital records details and parents' statements were revised. The main outcome measures are the incidence of different pigmentary complications and circumcision details; data were analyzed by a non-parametric tests including the Mann-Whitney U test. Results: 69 cases had 72 confirmed pigmentary complications discovered at 2-36 months after commencement of circumcision (mean 18). 48 cases had pigmentary complications directly related to MC, 11 cases were probably related and 10 unrelated to MC. The most common lesion is the circular hyperpigmented scar (29 cases); liner hyperpigmented scar in 13, spotted exogenous melanosis in 18 cases, melanocytic nevi (7), hypopigmentation diagnosed in 3 cases, but kissing nevus is the rarest finding (2). Topical corticosteroid was tried in 15 cases, surgical excision of pigmented scar were done for 19 cases, local laser used for 4 resistant cases and reassurance with follow up for the rest. Conclusion: Pigmentary complications after male circumcision are not rare and its management is challenging.

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Abstract Esophageal stricture is the sequel in children with a history of congenital (as in patients with achalasia of the cardia or after primary repair of congenital esophageal atresia) or acquired esophageal stricture, as post corrosive ingestion of solid or liquid caustic agents which is a common accident in children in our country. The aim of this study is to report the safety, efficacy, and long-term results of BD without endoscopy for children in the authors" center (Al –Azher University and Ahmed Maher teaching Hospitals.) Materials and methods: This study includes 28 children 13 girls and 15 boys presented during the last 3 years (from January 2001 to 2004) with a median age of 2.5 years (from 5 months to 7 years). They are divided according to their etiology of stricture into two groups: Group A post corrosive esophageal stricture "PCOS" (16 patients), Group B (12 patients) eight cases with achalasia of the cardia, three children with post colon-by pass esop...

Background: -Fetal and neonatal ovarian cysts are detected frequently by ultrasonography, the presence of this lesion can result in adnexal torsion in utero with autoamputation and ovarian loss. Neonates with ovarian cysts measuring 5 cm or more in its maximum diameter need surgical intervention, laparoscopic technique considered the most appropriate approach for management of such cysts, however, laparoscopic equipment may be unavailable in most centers, has high costs, and demands a long learning curve, especially in newborns. Early surgical intervention through a minilaparotomy for antenatally detected ovarian cyst will be discussed here. Materials and Methods: - Ultrasound scanning during antenatal care for detection of fetal malformation picked up 23 cases of fetal ovarian cysts during the last 3 years. Cysts measuring 5 cm or more in its diameter at the last trimester and cysts with solid mass like area were diagnosed and confirmed in 11 of them. Post-delivery reevaluation don...

Children with giant congenital melanocytic nevi (GCMN) pose a great challenge to pediatric and reconstructive surgeons because they have to cover the widely exposed area after its excision. A variety of treatment options exist for the management of such cases. In this retrospective review of a selected group of children who had a GCMN of their abdominal walls managed with implantation of tissue expanders (TEs) for staged reconstruction, patients were evaluated with respect to complications and general and esthetic criteria for patient and parent satisfaction. The purpose was to study the feasibility of use of TEs in the management of children who had GCMN, with special emphasis on the complications and children's and parents' satisfaction. Retrospective data from the 12 patients' charts, operative data of 86 surgical procedures, and follow up visits were analyzed using the Student's t test, and P < .05 was considered statistically significant. In a period of 4 yea...

The normal relationship between the scrotum and penis during fetal development is controlled by several genetic and hormonal factors, and impairment of this positional relation results in a wide spectrum of positional congenital anomalies. This a cohort study analysing 63 cases of penoscrotal anomalies (PSAs) according to severity and other associated malformations to provide a simple classification for recognising, describing and categorizing cases that may require surgical correction. Between 2005 and 2013, 63 diverse cases of penoscrotal positional anomaly were detected and analysed based on their hormonal profile and other associated anomaly. A wide variety of PSAs were included in the study, 11 cases were of major PST with complete penoscrotal transposition in three, incomplete in eight, and minor degree in 45 cases, which are symmetrical (bilateral) in 29, sixteen are asymmetrical, 4 had midline scrotlisation, and 3 had wide penoscrotal distance. Associated genitourinary anoma...

Abstract: Favorable outcomes have been achieved without transfusion, but perioperative transfusions are frequently given to prepare sickle cell anaemia children for surgery and to p revent perioperative morbidity in patient with sickle cell anaemia . Ninty children (ASA physical status 2-3) with sickle cell anaemia undergoing elective surgery were investigated to compare the rate of perioperative outcome . The chidren randomly assigned into 3 groups; each group thirty chidren (n=30);(group1) with no transfusion therapy,(group2) with conservative therapy regimen which designed to increase the hemoglobin level by blood transfusion to 10 gm/dcl regardless of the percentage of hemoglobin S and (group 3) with aggressive transfusion regimen which designed to decrease the haemoglobin S level to less than 35% and increasae the hemoglobin level by blood transfusion to 10 gm/dcl. We found that the severity of the disease, compliance with the protocol, and types of operations were similar in t...

Background: Whatever the method and timing of surgery, a high proportion of children with bladder exstrophy (BE) will continue to suffer from urinary incontinence even in a specialised centers. In this study a modified Duhamel’s rectal pouch with ureterorectostomy done for 19 children, they followed up for efficacy and safety of this new diversion. Materials and Methods: Seventeen boys and two girls, aged from four to eight years (mean 5.5), had several unsuccessful operations for BE. All selected to have good renal function and no other congenital anomalies, but were incontinent for urine and had a small contracted or prolapsed bladder. They underwent urinary diversion to a rectal bladder using the Duhamel’s pullthrough technique, where the sigmoid colon opened into the back of the anal canal above dentate line, making use of anal sphincter to control both urine and stool. All were investigated and followed up for six years (2-8). Results: In this group of patients, follow-up revea...

The familial cases of dysplasia epiphysealis hemimelica (DEH), or Trevor's disease, are thought to represent dominant carpotarsal osteochondromatosis (DCO). Only three families affected by DCO have been reported so far in the literature. We report a fourth family: a 10-year-old girl, her father, and his cousin. Unlike the other reported cases of DCO this family had no carpal or upper limb epiphyseal osteochondromas and many of the other reported associations. The only consistent associated finding in our cases was the presence of multiple parosteal osteochondromatous proliferations. The findings of our cases are, therefore, unique in many ways. These cases may represent a variant of dominant carpotarsal osteochondromatosis or may represent a new entity.

Introduction:-
Splenogonadal fusion is a rare congenital malformation that involves an abnormal connection between the spleen and the gonad. It manifests itself as a mass consisting of splenic and testicular or ovarian tissue. Splenogonadal fusion has been classified into two types; continuous, where there is a direct connection between spleen and gonad; and discontinuous, where ectopic splenic tissue is attached to the gonad, but there is no connection to the spleen. Many cases had an associated other anomalies either genital or systemic.
Case report:-
A 9 months old boy presented with an absent right testicle, physical examination revealed an impalpable right testicle and relatively large left testicle with an disjointedly  mass at its upper pole. Ultrasonography showed completely absence of any shadow for the right testicle along its course, left testicle of  20 Χ 5Χ 9mm, and the other testicular mass of 7.9 Χ5.7mm. Through a transverse left inguinal incision the left testicle with the adjacent mass were delivered. The small mass had a vascular stalk connected to the spleen, and the testicle embedded with splenic tissue under its tunica. The management of this case and  literature review will be discussed.

Conclusion:-
This the first case to be recorded of  a baby had a rare variant of splenogonadal fusion, continuous and discontinuous type with a contralateral absent testicle, the challenge in this case is the impossibility to excise the testicle embedded with splenic tissue, which should be preserved.

• Excellent guide to rare congenital genitourinary anomalies
• Offers simplicity on a complex subject
• Includes numerous informative illustrations
• Will serve as an excellent reference
Patients with rare diseases, affecting less than 1 in 2000 persons, frequently experience delays or errors in diagnosis, sometimes with tragic consequences. Even after the diagnosis has been established, the quality of health care delivered is often poor. This book, which is both textbook and atlas, covers the full range of rare congenital genitourinary anomalies encountered in males and females, many of which have previously been described only in sporadic case reports. In the case of the more established anomalies, variants are presented. For each anomaly, information is provided on incidence, similar cases, clinical presentation, diagnosis, possible management and outcome. Informative supporting illustrations are presented for each anomaly, and the book will serve as an excellent reference for all pediatricians, urologists and surgeons who are responsible for the care of such patients.
Content Level » Professional/practitioner
http://www.amazon.com/Rare-Congenital-Genitourinary-Anomalies-Illustrated/dp/3662436795/ref=sr_1_1?ie=UTF8&qid=1422885583&sr=8-1&keywords=rare+genitourinary+anomalies&pebp=1422885592799&peasin=3662436795

Background: - Children who had extensive abdominal wall vascular anomalies face three common reconstructive options: either tolerating the complications of these lesions, exposure to repeated laser therapy session with its sequelae, or excision followed by a color-matched skin graft. The use of serial tissue expansion and excision of the affected skin offers a potentially better option under the right circumstances. Tissue expanders have broad applicability but are not without complications.
Objective: To study the versatility of use tissue expanders in the management of children who had extensive vascular anomalies in their abdominal wall with special emphasis to the complications and children and parental satisfaction.
Material and Methods: - Retrospective data collection of 12 patient charts, operative data of 84 operative procedures and follow up visits. Statistical analysis done using Student t test significance and P < 0.05 was considered statistically significant.
Results: - Using 35 different sizes tissue expanders and 84 operative procedures in 9 boys and 3girls aged from 2 to 12 years with different types of abdominal wall vascular anomalies revealed an overall complications rate of 20%, Child and parental satisfaction was found to be good overall.
Conclusion:-Tissue expander is a useful and feasible tool for reconstruction of the abdominal wall with extensive vascular anomalies in children, parents and children satisfactory and body image is acceptable.

This case describes a neonate who developed a genital prolapse on the third day of
life, in obvious association with a meningocele. The prolapse in this case was reduced
by gentle manipulation, although a minority of cases require surgical intervention.
Neonatal genital prolapse is rare but is often associated with congenital spinal defects
and meningocele. Now that more infants with these disabilities are surviving, cases of
associated genital prolapse are likely to be seen more frequently.

It seems that scrotal maldevelopment is underestimated in the medical literature; this could be attributed to the associated major congenital anomalies, which will be eventually end with early babies loss, as an abortion or stillbirth, without proper reporting and investigations. But reader will see the variety of cases that we will discuss which exceeding the whole number of reported cases in literature. The distinctive role of the scrotum in men physiology, sexual psychiatry and wellbeing should trigger researching the developmental deviation of this organ and the trials of its management. Proper positioning of cryptorchid testicle in a hypoplastic or genetic scrotal sac is extremely impossible. Scrotal maldevelopment may be manifested with an obvious complete agenesis of the scrotal apparatus, but partial and bizarre presentation of minimal degree of scrotal wall hypoplasia is usually escape proper diagnosis. Most cases of agenesis are syndromic, but hypoplasia is commonly sporadic, either unilateral or bilateral. The scrotal development is highly related to the normal testicular growth and descend; so most cases are associated with either cryptorchid or ectopic testicles. Our trial of treating cases of hypoplasia medically; by local testosterone therapy will be highlighted, and other modalities of surgical scrotoplasty will be discussed.

Omphalitis will be discussed under the following headings:
• Neonatal omphalitis
• Adult omphalitis
– Bacterial
– Non bacterial
• Rare types of omphalitis
Nomenclature: Belly Button Infection of Newborns.
Definition: Omphalitis term usually applied for the bacterial neonatal umbilical stump infec- tion, but other types of specific and non specific umbilical infection are roughly called omphalitis. It is an infection of the umbilicus and/or sur- rounding tissues, and it is predominantly a dis- ease of the neonate, characterized by discharge from the umbilical cord stump with surrounding induration, erythema, and tenderness

Whatever this part of the body will be kept and cared, or it will be removed and discard, we have to confess that the prepuce is exquisitely designed, highly vascularised and innervated with a complex of specialised erogenous structures that are vital to natural and normal sexual function. Anatomy of the prepuce is unique from many aspects; firstly, as the prepuce removed early from a majorities of infants in many communities, so its anatomy is not well known among many physicians. Secondly, the prepuce after delivery is in continuous development till puberty, so its anatomy is diverse at different stages of life, and lastly preputial skin and muscles had no underneath attachments, the prepuce have to contract, retract and return back to cover the glans through a sequence of sloping muscle fibers. It is astounding that the complex nature of the prepuce (or the fact that it is not a simple fold of skin) was not described until 1991 and that this did not appear in the mainstream medical media until 1996. Genital autonomy is a recent issue emerged to refers to a person's being left to make their own informed decision about whether or not to have his intact or "natural" genital, and this mainly concerned with the importance of prepuce. There is no previous distinctive description of the different sections of the prepuce as an unrivalled organ. Herein we will describe separately, and in details, five parts of the prepuce; outer skin (with its three parts: base, body and tip), preputial meatus, inner mucosa, frenulum and balanopreputial sac. Preputial surface anatomy and morphology Balanopreputial Seperation (Preputial sac) Preputial Musculature Preputial blood supply Preputial nerve supply Normal preputial variations Most of the textbooks or research papers describing prepuce are not inclusive, and usually deal with the prepuce from the point of either its removal along circumcision or preservation to compete against this deeply rooted procedure. Steve Scott indicated that most physicians were ignorant of the anatomy and physiology of the genital structures they were routinely removing from infants and children 1. The prepuce is remarkably thin, dark, and loosely connected to the rest of penile skin. It has features of true skin but is devoid of subcutaneous adipose tissue, without associated hair follicles and few sweat glands are present in the superficial dermis.

This book provides all pediatric surgery trainees and other professionals involved in the care of childhood surgical disease a hands-on guide to the management of typical common clinical pathologies, as well all possible rare anomalies affecting the prepuce.
This book presents more than 300 full-color illustrations, covering the whole spectrum of congenital and acquired diseases affect the human prepuce, allowing the reader to apply their knowledge to real-life situations and assess their level of expertise.
As the prepuce discarded along the mankind history, and still sacrificed in some communities, it wasn’t either demonstrable, repeatable for elaborated studies, little data are available about its normal structure, or the natural deviations affecting it as a congenital anomalies or as an acquired diseases.
Aiming to settle down the argument about genital cutting; this book emerge as an attempt to review the progress made in the understanding of some interesting anatomy, embryology and pathology of this freestanding unique organ; “The Prepuce” in male and female.
There is no point in looking for new ideas in old stuff, but this book review our accumulated old knowledge about prepuce, with a plural of newly detectable variations, anomalies and diseases cumulated to the author after dealing with thousands of the prepuces along 40 years of practice.
This illustrative book discusses the normal embryology, anatomy, functions, normal variations and diseases affecting the prepuce. It also explores other rare anomalies and diseases of the prepuce as well as many unreported cases. In addition to the male prepuce, the book also discusses the female prepuce (hood) in order to elucidate some lights in normal and abnormal prepuce.  A separate section covers the frenulum and its anomalies.

Male circumcision, is practised for religious, social, cultural and medical reasons, it is one of the oldest and most common surgical procedure performed globally. It is estimated that one-third of males worldwide are circumcised, 2/3rd of whom are Muslim. The procedure is most commonly practiced in the Muslim world, Israel (where it is near-universal for religious reasons), the United States, and parts of Southeast Asia and Africa. It is relatively rare in Europe, Latin America, parts of Southern Africa, and most of Asia. Circumcision is performed approximately 1.2 million times each year in the United States. The most important argument against circumcision is the permanent change of anatomy, histology and function of the penis, with potential complications, with a rates reported to be low in developed countries, whereas it may be up to 85% when circumcision is carried out by traditional circumcisers, rather than by medically trained professionals in developing countries. In some studies reporting the complications of circumcision, primary haemorrhage was the most common (52%), whereas infection, meatal stenosis, incomplete circumcision, penile oedema, glanular injury, penile adhesions, iatrogenic hypospadias and urethral injuries were also detected at different rates. There may be a minor complications after circumcision which cannot be avoided even when the procedure is undertaken by specialised pediatric surgeons or urologist, in a properly equipped centres; specially if the child or his penis is congenitally abnormal, the obvious examples are, circumcising a child with an excessive suprapubic fat or a child with webbed penis or microphallus. After practicing circumcision, and managing other's complication for a thousands of boys along 35 years in a country like Egypt, (with about 90% circumcision rate), I found parents had a great urge to do this surgery even for a handicapped or critically ill child, with a possible higher rate of complications. So the best way to minimise complications of MC and to compete against its serious impaction in man health, is to standardise MC procedure, to mind both families and physicians about potential complications and how they could mange it early. The spectrum of post MC complications is so wide to be discussed, so we will just spot some light over the common as well the uncommon complications, which usually raise a debate about its management. There are different sets to classify MC complications: Either early, or late, minor or major, local or systemic, rare or common. So the best way, in my opinion, to minimise complications of MC and to compete against its serious impact in man's health is to standardise the procedure, specially in the communities which will

Male circumcision, is practised for religious, social, cultural and medical reasons, it is one of the oldest and most common surgical procedure performed globally. It is estimated that one-third of males worldwide are circumcised, 2/3rd of whom are Muslim. The procedure is most commonly practiced in the Muslim world, Israel (where it is near-universal for religious reasons), the United States, and parts of Southeast Asia and Africa. It is relatively rare in Europe, Latin America, parts of Southern Africa, and most of Asia. Circumcision is performed approximately 1.2 million times each year in the United States.
The most important argument against circumcision is the permanent change of anatomy, histology and function of the penis, with potential complications, with a rates reported to be low in developed countries, whereas it may be up to 85% when circumcision is carried out by traditional circumcisers, rather than by medically trained professionals in developing countries. In some studies reporting the complications of circumcision, primary haemorrhage was the most common (52%), whereas infection, meatal stenosis, incomplete circumcision, penile oedema, glanular injury, penile adhesions, iatrogenic hypospadias and urethral injuries were also detected at different rates.

Circumcision remains as one of the most controversial topics in current medical practice. The most important argument against circumcision is the permanent change of anatomy, histology and function of the penis, with potential complications, which were reported to be low in developed countries, whereas the rate of complication may be up to 45% when circumcision is carried out by traditional circumcisers rather than by medically trained professionals in developing countries. In some studies reporting the complications of circumcision, primary haemorrhage was the most common (52%) complica- tion, whereas infection, meatal stenosis, incomplete circumcision, penile oedema, glanular injury, penile adhesions, iatrogenic hypospadias and urethral injuries were also detected at different rates.
There are minor complications after circumcision that cannot be avoided even when the procedure is undertaken by specialized paediatric surgeons or urologists in properly equipped centres, especially if the child or his penis is congenitally abnormal, for example, circumcising a child with excessive suprapubic fat or a child with webbed penis or microphallus.

A stark contrast exists between the physiologic importance of the umbilicus during development and after birth. During development, the umbilical cord functions as a channel allowing blood flow between the placenta and fetus, it also serves an important role in the development of the intestine and the urinary system. After birth, once the umbilical cord falls off, no evidence of these connections should be present, except the umbilical scar, as landmark of the previously exist cord. Nevertheless, umbilical disorders are frequently encountered in pediatric surgery. It has been estimated that 30% of births have some type of umbilical cord finding. These disorders range from the very common umbilical hernia to infections such as omphalitis, which can be life threatening, and from simple straightforward anatomy like granuloma, to a complicated and sophisticated malformations; like vitellointestinal and urachal anomalies. Most patients with umbilical problems present with a mass or drainage from the umbilicus. An understanding of the anatomy and embryology of the abdominal wall and umbilicus is important to identify and properly treat common as well rare complicated conditions.

Penile torsion is a debatable condition as no consensus exists on its definition, or on its management. It is a rotational defect of the penile shaft, resulting in an abnormal penile twisted on its axis. The degree of torsion is measured as the angle between a line passing through the urethral meatus and the midline of the scrotum. Recent studies have shown that the dartos, which is the smooth muscle layer lying under the skin, might be responsible for penile torsion and curvature, associated or not with other congenital penile malformations 1. The dartos tissue is considered a superficial fascia, located immediately under the genital skin 2. The composition of fibro muscular dartos tissue along the penile shaft determines elasticity of the subcutaneous tissue and the skin mobility. Any structural change in organization of these components may influence these characteristics, and might therefore be responsible for torsion/chordee. Different therapeutic possibilities exist. There is no consensus on goldstandard treatment for penile torsion, curvature, or chordee. A few rules are based on common sense: the correction of torsion is important, it is even to preserve the genital sensitivity and potency. Torsion as a stand-alone condition is usually asymptomatic. Whether treatment is needed or not becomes purely esthetic. Many techniques using flaps or penile degloving have been described when correction is desired, all of them being reported in small series 3. The least invasive technique, which is most often sufficient to correct mild torsion, consists in penile deglovement, with resection of disorganization dartos tissue, that could be aberrant, thereby usually correcting the problem. When deglovement is insufficient, some other pathologic mechanism than pure dartos might be involved. In this technique, which was applied for 15 child aged 2 to 6 years, penile degloving, dissection and resection of the anchoring dysplastic dartos fascia with fixation of the root of the penis in the proper position by applying non absorbable stitches between the Bucks fascia and subcutaneous penile skin results in an acceptable penile look in 13 cases. Two patients with severe degree of torsion had a partial but non satisfactory results, and they scheduled for another technique. References: 1. Spinoit AF, Van Praet C, Groen LA, Van Laecke E, Praet M, Hoebeke P. Congenital penile pathology is associated with abnormal development of the dartos muscle: a prospective study of primary penile surgery at a tertiary referral center.
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