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Objectives: To describe a modified onlay preputial island flap (OIF) urethroplasty to also be used in patients requiring urethral plate transection for penile straightening., Methods: A total of 14 cases with primary severe hypospadias underwent the modified OIF urethroplasty as follows. After skin degloving, the corpora cavernosa were dissected ventrally. The urethral plate was mobilized and, if curvature >30° persisted, transected just proximally to the coronal sulcus. A pedicled preputial island flap was elevated and placed as an onlay to create the neourethra. It was sewn to the margins of the urethral plate proximally and distally. In contrast, in the portion of the shaft without a plate, it was sewn directly to the albuginea of the corpora cavernosa with 2 parallel suture lines. Glanuloplasty and skin closure followed as in standard onlay repairs., Results: After a median follow-up of 7 months (range 5 to 27), 3 patients (21%) developed complications requiring additional surgery (1 simple fistula, 1 partial urethroplasty breakdown, and 1 ballooning of the neourethra). None of the remaining patients presented with residual curvature or voiding problems, according to the parental report., Conclusions: The results of the present preliminary experience suggest that OIF urethroplasty can also be performed in cases requiring urethral plate transection. It can be accomplished by suturing the preputial flap directly to the albuginea of the corpora cavernosa. Although we acknowledge that a larger number of cases and longer follow-up are necessary, we believe this technique should be incorporated into the armamentarium of hypospadiologists., (Copyright © 2011 Elsevier Inc. All rights reserved.)

We report a case of fused testes in a patient with transverse testicular ectopia and persistent Mullerian duct syndrome. A laparoscopy performed to confirm the diagnosis showed a single vas deferens on the left side. Treatment included excision of the Mullerian remnant through a left inguinal incision and orchidopexy of the fused testes via the left inguinal canal after sectioning of the right internal spermatic vessels. Follow-up ultrasound has so far confirmed viability of both testes., (Copyright 2010 Elsevier Inc. All rights reserved.)

Objective: To present a modified VQZ-plasty technique to create a catheterizable stoma appearing as a normal-looking neoumbilicus that may be used in selected bladder exstrophy (BE) patients., Methods: A catheterizable conduit is created according to the Mitrofanoff principle. An asymmetric V flap, with the base at the level selected as the upper margin of the neoumbilicus, is created and incorporated into the spatulated appendix. Then a Q flap is developed parallel to the shorter margin of the V flap, rotated, and anastomosed to the upper edge of the appendix and to the free margin of the V flap on the contralateral side. The skin gap is filled by a rotational flap overlying the emerging appendix and stoma site., Results: To date the technique has been used in 2 BE patients. After a follow-up of 10 and 6 months, respectively, both have good cosmetic and functional results, with an easily catheterizable stoma., Conclusions: The described technique allows for the creation of a nearly ideal stoma that looks like a normal neoumbilicus in selected BE patients yet without an umbilicus and requiring the placement of a catheterizable conduit.

Ureteric obstruction occurs in about 1% of cases undergoing endoscopic treatment of vesicoureteric reflux (VUR). It usually develops shortly after treatment. We report on a case of obstruction occurring 1 year after subureteric injection of calcium hydroxyapatite. Obstruction was progressive and eventually required open ureteric reimplantation. Ureteric obstruction can occur also in the long-term after endoscopic treatment of VUR and even in the absence of symptoms. Although it is so rare as to make long-term follow-up of all treated cases cost ineffective, physicians should be aware of such complications, especially while testing new bulking agents.