Hypospadias is associated with an increased incidence of "significant" urologic anomali... more Hypospadias is associated with an increased incidence of "significant" urologic anomalies as compared with the general population. Most do not require immediate surgical intervention, but this information may be important in planning the long-term management of the boy, including follow-up and advice given in regard to contact sports. Ultrasonography avoids the possible hazards of intravenous urography and would seem to be the ideal screening test for detecting the urologic anomalies associated with hypospadias. Intravenous urography should be reserved for a selected group of children with hypospadias with abnormal ultrasonograms or urologic symptomatology.
Giant hydronephrosis in children, and particularly in infants, is frequently responsible for abdo... more Giant hydronephrosis in children, and particularly in infants, is frequently responsible for abdominal masses. High dose intravenous urography has proved very useful in studying the degree of pyelocalyceal dilatation, as well as the amount of residual renal parenchyma and the possible recovery of these kidneys. Reparative surgery, rather than primary nephrectomy, should always be considered. Renal transplantation may save those with giant bilateral hydronephrosis who appear now to be beyond the possibility of surgical repair.
Agenesis of the corpus callosum is an uncommon anomaly that exists in complete and partial forms.... more Agenesis of the corpus callosum is an uncommon anomaly that exists in complete and partial forms. It has been associated with other cerebral malformations as well as facial, genitourinary, musculoskeletal, cardiac, and respiratory anomalies.1 Agenesis of the corpus callosum is generally sporadic but it has been reported in several families.2 Ureteroceles frequently occur in association with duplications of the ureters.3 The hereditary occurrence of ureteroceles has been reported in five families.4-8 In this report, we describe two brothers with the simultaneous occurrence of agenesis of the corpus callosum and orthotopic ureteroceles. Two brothers were seen at The Hospital of the Albert Einstein College of Medicine for evaluation of urologic abnormalities.
A 51‐year‐old man with previously diagnosed bilateral anorchia was shown by endocrine investigati... more A 51‐year‐old man with previously diagnosed bilateral anorchia was shown by endocrine investigation of his hypophyseal‐gonadal axis to have functioning testicular tissue. The implications of endocrine evaluation in adult males who have impalpable testes, or those with bilateral anorchia having undergone previous exploratory surgery, are discussed, as is as an organized diagnostic and surgical approach.
The Klippel-Trenaunay syndrome is composed of the triad of unilateral limb hypertrophy, abnormali... more The Klippel-Trenaunay syndrome is composed of the triad of unilateral limb hypertrophy, abnormalities of the deep venous system, and port-wine hemangiomas. An interesting case is presented in which there were multiple abnormalities of the renal veins and intrarenal hemangiomas resulting in renal failure in addition to the usual peripheral abnormalities.
We report on a child with xanthogranulomatous pyelonephritis--an uncommon entity in children. A r... more We report on a child with xanthogranulomatous pyelonephritis--an uncommon entity in children. A review of the literature revealed that in only 18 per cent was the diagnosis made correctly preoperatively. In children the disease is of a focal nature rather than a diffuse one, suggesting that possibly radical surgery would be less necessary for adequate treatment.
Abstract This report details, the first published case of a urethal polyp presenting as a prolaps... more Abstract This report details, the first published case of a urethal polyp presenting as a prolapse through the proximally displaced meatus of a child with hypospadias. Urethal obstruction a symptom common to other urethal polyps, was absent. The congenital ...
Laparoscopic orchiopexy is extremely effective for treating patients with nonpalpable testis. How... more Laparoscopic orchiopexy is extremely effective for treating patients with nonpalpable testis. However, despite the high dissection and wide mobilization it allows in some cases, vessel length prevents the testis from reaching the scrotum. There have been only incidental cases reported in which laparoscopy has been used for vessel transection and testicular mobilization orchiopexy. We reviewed our cases treated with the Fowler-Stephens orchiopexy performed laparoscopically in 1 or 2 stages. We reviewed the records of all boys who underwent laparoscopy for a nonpalpable testis at our institutions since 1992. Patients who underwent testicular vessel transection and orchiopexy performed laparoscopically in 1 or 2 stages were selected for evaluation. Office charts and operative reports were reviewed in detail. Of the 126 nonpalpable testes in 108 patients 51 (40%) were intra-abdominal, including 18 (35%) in 14 patients in whom the Fowler-Stephens procedure was performed laparoscopically. Five testes were treated with a 2-stage procedure, while 11 were managed by laparoscopic mobilization followed by laparoscopic vessel clipping and orchiopexy in 1 stage. In 2 additional patients nearly all dissection was performed laparoscopically but due to extenuating circumstances inguinal incision was required as well. Thus, 13 testes were managed by 1-stage Fowler-Stephens orchiopexy, including all cases since August 1996 which required vessel transection. Two patients were hospitalized postoperatively for prolonged ileus after the second stage. All other 2-stage and all 1-stage cases were managed on an outpatient basis. There were no complications. At a mean followup of 6 months all cases without previous surgery that were managed by laparoscopic orchiopexy are without atrophy and the testes are in a scrotal position. Two testes in which previous surgery had been done atrophied postoperatively. Laparoscopic transection of the testicular vessels is safe in boys with high abdominal testes that do not reach the scrotum after laparoscopic high retroperitoneal dissection. The magnification and wide mobilization of laparoscopy likely allow better preservation of the collateral vascular supply than open exploration. Previous surgery is a risk factor for atrophy. The success rate of 89% overall and 100% in patients who did not previously undergo testicular surgery equals or exceeds that of open orchiopexy in patients with abdominal testes. The 1-stage procedure avoids repeat anesthesia and the extensive, sometimes tedious, dissection that is occasionally required during reoperation.
Treating pediatric incontinence can be challenging. Many surgical procedures are available with v... more Treating pediatric incontinence can be challenging. Many surgical procedures are available with variable success and complications. Endoscopic injection of bulking agents into an incompetent bladder neck was first described using Teflon and most currently using Deflux. We compared the results of bladder neck injection using Deflux and Teflon to manage urinary incontinence in children. A retrospective study was performed in children who underwent primary endoscopic injection of Teflon or Deflux to the bladder neck. Patients with prior bladder neck surgery were excluded. Data were collected on underlying anatomical pathology, preoperative bladder capacity, endoscopic approach, quantity of bulking agent and outcome. Dry was defined as 3 hours or greater awake without wetting. Wet was defined as the need for a pad or diaper. A total of 34 patients underwent primary injection of bulking agents, including 32 via a retrograde approach and 2 via a combined antegrade-retrograde approach. A total of 20 children with a mean age of 2.7 years were injected with Teflon and 11 were injected with Deflux. One of the 20 Teflon injected patients was dry more than 6 months. One of the 14 Deflux injected patients was dry at 3 months in the daytime, another 2 improved at 3 months (antegrade/retrograde in 1) but worsened at 6 months and another was dry after a second injection. All 4 improved children had age appropriate bladder capacity. The volume of injected agent was 1 to 10 cc. No complications were seen. Five children per group underwent subsequent open continence surgery. Bladder neck injection of bulking agents is a generally ineffective therapy for incontinence. While neither the number of injections nor the bulking agent used affected the results, adequate bladder capacity and antegrade injection with Deflux heralded short-term improvement. Patients with exstrophy consistently did poorly.
Hypospadias is associated with an increased incidence of "significant" urologic anomali... more Hypospadias is associated with an increased incidence of "significant" urologic anomalies as compared with the general population. Most do not require immediate surgical intervention, but this information may be important in planning the long-term management of the boy, including follow-up and advice given in regard to contact sports. Ultrasonography avoids the possible hazards of intravenous urography and would seem to be the ideal screening test for detecting the urologic anomalies associated with hypospadias. Intravenous urography should be reserved for a selected group of children with hypospadias with abnormal ultrasonograms or urologic symptomatology.
Giant hydronephrosis in children, and particularly in infants, is frequently responsible for abdo... more Giant hydronephrosis in children, and particularly in infants, is frequently responsible for abdominal masses. High dose intravenous urography has proved very useful in studying the degree of pyelocalyceal dilatation, as well as the amount of residual renal parenchyma and the possible recovery of these kidneys. Reparative surgery, rather than primary nephrectomy, should always be considered. Renal transplantation may save those with giant bilateral hydronephrosis who appear now to be beyond the possibility of surgical repair.
Agenesis of the corpus callosum is an uncommon anomaly that exists in complete and partial forms.... more Agenesis of the corpus callosum is an uncommon anomaly that exists in complete and partial forms. It has been associated with other cerebral malformations as well as facial, genitourinary, musculoskeletal, cardiac, and respiratory anomalies.1 Agenesis of the corpus callosum is generally sporadic but it has been reported in several families.2 Ureteroceles frequently occur in association with duplications of the ureters.3 The hereditary occurrence of ureteroceles has been reported in five families.4-8 In this report, we describe two brothers with the simultaneous occurrence of agenesis of the corpus callosum and orthotopic ureteroceles. Two brothers were seen at The Hospital of the Albert Einstein College of Medicine for evaluation of urologic abnormalities.
A 51‐year‐old man with previously diagnosed bilateral anorchia was shown by endocrine investigati... more A 51‐year‐old man with previously diagnosed bilateral anorchia was shown by endocrine investigation of his hypophyseal‐gonadal axis to have functioning testicular tissue. The implications of endocrine evaluation in adult males who have impalpable testes, or those with bilateral anorchia having undergone previous exploratory surgery, are discussed, as is as an organized diagnostic and surgical approach.
The Klippel-Trenaunay syndrome is composed of the triad of unilateral limb hypertrophy, abnormali... more The Klippel-Trenaunay syndrome is composed of the triad of unilateral limb hypertrophy, abnormalities of the deep venous system, and port-wine hemangiomas. An interesting case is presented in which there were multiple abnormalities of the renal veins and intrarenal hemangiomas resulting in renal failure in addition to the usual peripheral abnormalities.
We report on a child with xanthogranulomatous pyelonephritis--an uncommon entity in children. A r... more We report on a child with xanthogranulomatous pyelonephritis--an uncommon entity in children. A review of the literature revealed that in only 18 per cent was the diagnosis made correctly preoperatively. In children the disease is of a focal nature rather than a diffuse one, suggesting that possibly radical surgery would be less necessary for adequate treatment.
Abstract This report details, the first published case of a urethal polyp presenting as a prolaps... more Abstract This report details, the first published case of a urethal polyp presenting as a prolapse through the proximally displaced meatus of a child with hypospadias. Urethal obstruction a symptom common to other urethal polyps, was absent. The congenital ...
Laparoscopic orchiopexy is extremely effective for treating patients with nonpalpable testis. How... more Laparoscopic orchiopexy is extremely effective for treating patients with nonpalpable testis. However, despite the high dissection and wide mobilization it allows in some cases, vessel length prevents the testis from reaching the scrotum. There have been only incidental cases reported in which laparoscopy has been used for vessel transection and testicular mobilization orchiopexy. We reviewed our cases treated with the Fowler-Stephens orchiopexy performed laparoscopically in 1 or 2 stages. We reviewed the records of all boys who underwent laparoscopy for a nonpalpable testis at our institutions since 1992. Patients who underwent testicular vessel transection and orchiopexy performed laparoscopically in 1 or 2 stages were selected for evaluation. Office charts and operative reports were reviewed in detail. Of the 126 nonpalpable testes in 108 patients 51 (40%) were intra-abdominal, including 18 (35%) in 14 patients in whom the Fowler-Stephens procedure was performed laparoscopically. Five testes were treated with a 2-stage procedure, while 11 were managed by laparoscopic mobilization followed by laparoscopic vessel clipping and orchiopexy in 1 stage. In 2 additional patients nearly all dissection was performed laparoscopically but due to extenuating circumstances inguinal incision was required as well. Thus, 13 testes were managed by 1-stage Fowler-Stephens orchiopexy, including all cases since August 1996 which required vessel transection. Two patients were hospitalized postoperatively for prolonged ileus after the second stage. All other 2-stage and all 1-stage cases were managed on an outpatient basis. There were no complications. At a mean followup of 6 months all cases without previous surgery that were managed by laparoscopic orchiopexy are without atrophy and the testes are in a scrotal position. Two testes in which previous surgery had been done atrophied postoperatively. Laparoscopic transection of the testicular vessels is safe in boys with high abdominal testes that do not reach the scrotum after laparoscopic high retroperitoneal dissection. The magnification and wide mobilization of laparoscopy likely allow better preservation of the collateral vascular supply than open exploration. Previous surgery is a risk factor for atrophy. The success rate of 89% overall and 100% in patients who did not previously undergo testicular surgery equals or exceeds that of open orchiopexy in patients with abdominal testes. The 1-stage procedure avoids repeat anesthesia and the extensive, sometimes tedious, dissection that is occasionally required during reoperation.
Treating pediatric incontinence can be challenging. Many surgical procedures are available with v... more Treating pediatric incontinence can be challenging. Many surgical procedures are available with variable success and complications. Endoscopic injection of bulking agents into an incompetent bladder neck was first described using Teflon and most currently using Deflux. We compared the results of bladder neck injection using Deflux and Teflon to manage urinary incontinence in children. A retrospective study was performed in children who underwent primary endoscopic injection of Teflon or Deflux to the bladder neck. Patients with prior bladder neck surgery were excluded. Data were collected on underlying anatomical pathology, preoperative bladder capacity, endoscopic approach, quantity of bulking agent and outcome. Dry was defined as 3 hours or greater awake without wetting. Wet was defined as the need for a pad or diaper. A total of 34 patients underwent primary injection of bulking agents, including 32 via a retrograde approach and 2 via a combined antegrade-retrograde approach. A total of 20 children with a mean age of 2.7 years were injected with Teflon and 11 were injected with Deflux. One of the 20 Teflon injected patients was dry more than 6 months. One of the 14 Deflux injected patients was dry at 3 months in the daytime, another 2 improved at 3 months (antegrade/retrograde in 1) but worsened at 6 months and another was dry after a second injection. All 4 improved children had age appropriate bladder capacity. The volume of injected agent was 1 to 10 cc. No complications were seen. Five children per group underwent subsequent open continence surgery. Bladder neck injection of bulking agents is a generally ineffective therapy for incontinence. While neither the number of injections nor the bulking agent used affected the results, adequate bladder capacity and antegrade injection with Deflux heralded short-term improvement. Patients with exstrophy consistently did poorly.
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