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The popularity of (intimate) body piercing has increased as well as the chances of being confronted with (the complications) of it. This article provides information about the various types of intimate body piercings in women, the complications and concerns regarding the treatment of patients with intimate bodypiercings. [ABSTRACT FROM AUTHOR]

Background: Reports on increasing hypospadias trends are based on birth defect registries, which are prone to inaccuracy. We assessed the prevalence of hypospadias precisely, by prospective examination of all newborns in Rotterdam over a 2-year period.Methods: A total of 7292 consecutive male births were examined for the presence of hypospadias, classified by severity.Results: The frequency of hypospadias in newborn boys was 0.73% (53/7292). The rate among live births was 38 per 10 000, which is 6 times the previously reported rate for the Southwestern Netherlands (6.2) (P < 0.0001). This registry excludes glandular hypospadias. Without glandular cases, our rate is 26 per 10 000, which is still 4-fold higher (P < 0.0001). The ratio of minor to major hypospadias was 0.3. In 79% of cases, surgery was indicated.Conclusions: We found a 4-fold higher than expected hypospadias rate, which may be explained by case ascertainment differences. The proportion of major cases was higher than generally assumed. This study provides evidence for substantial geographical differences. Explanations for temporal and geographical differences need to be explored. To monitor hypospadias rates and trends accurately, complete case ascertainment, including standardized classification of severity, is warranted. [ABSTRACT FROM AUTHOR]

We have developed a method of diuretic renography for the assessment of upper urinary tract obstruction in children. A maximal diuresis under standardised conditions is obtained by forced intravenous hydration over a 2-h period prior to renography. We evaluated the predictive value of this method for the clinical and functional outcome in 73 children with apparent unilateral pelviureteric junction obstruction. The predictive value of a nonobstructive pattern was 94%, while the predictive value of an obstructive pattern could not be assessed accurately because the patients concerned subsequently underwent operation. The method is safe and reliable and offers advantages over conventional diuretic renography. [ABSTRACT FROM AUTHOR]

Objectives: Varicocele in adolescent men is one of the most challenging topics in pediatric urology. What should be considered as a good indication for treatment and at what age? Does treatment improve fertility? Can we wait? What is the best surgical and minimal invasive treatment? To answer these questions we provide a guideline to use in daily practice., Methods: We performed a search of the English literature of the last ten years through the Pub Med database using the following key words "varicocele", "diagnosis", "treatment", "fertility" and "adolescent". We then summated and compared the results of these studies., Conclusion: Adolescents with varicocele need regular follow-up including clinical examination and ultrasound measurements of the testis. Those with a persistent discrepancy between left and right testis size of more than 20% over a period of 12 months and those with pain need varicocelectomy independent of patient age, Tanner stage or varicocele size. The peak retrograde flow (PRF) seems to be a good diagnostic non-invasive tool in the follow-up and can be of help to select patients for surgery. PRF=38 cm/s in combination with testicular asymmetry =20% is a reason for surgery independent of age, Tanner stage or varicocele size. PRF<30 cm/s in combination with testicular asymmetry <20% should be followed annually. In case of worsening PRF or asymmetry surgery must be performed. Patients suitable for conservative management should be followed until semen analysis is possible. We present a flow-chart to use in the management of adolescent varicocele. The best results of varicocele treatment are obtained with microscopic subinguinal and laparoscopic lymphatic spearing techniques as shown in a meta-analysis performed in this review.

Penis lengthening pills, stretch apparatus, vacuum pumps, silicone injections, and lengthening and thickening operations are available for men who worry about their penis size. Surgery is thus far the only proven scientific method for penile enlargement. In this article, we consider patient selection, outcome evaluation, and techniques applied. In our view, sexological counseling and detailed explanation of risks and complications are mandatory before any operative intervention.

In many cultures, the erect penis has been a symbol of masculine qualities. Because of this symbolism, a penis that is less than average size can cause insecurity or embarrassment. This series reports the authors' 18-year experience in the management of 60 men with a complaint of a small penis. For 44 of these 60 men, counseling was sufficient; the other 16 had surgery, and of these, 9 were satisfied with the result. Despite limitations, the authors conclude that those men who already achieve a penis length of no less than 7.5 cm (2.95 in) in erection, have only limited benefit from penis-enhancing surgery. This particular patient category should therefore be dissuaded from surgery.

The cases of spermatic cord torsion reported here show that this condition may occur even some time after fixation. Three men, aged 22, 30 and 35 years, visited the urologist with complaints of an acute scrotum following earlier orchiopexy for spermatic cord torsion. Different techniques are employed to fixate the testicles after spermatic cord torsion. These cases confirm that Jaboulay's bottleneck procedure is the method of choice for bilateral fixation in patients presenting with this condition.

During the last 40 years more and more myelomeningocele (MMC) patients have survived to adulthood and since the 1980s there is growing interest in sexual functioning of these patients. However, most of what is known about the impact of MMC on sexual functioning pertains to males. We have reviewed the literature pertaining to female sexuality and MMC with regard to sexual development, activity, dysfunction, sexual knowledge and education, pregnancy and delivery, as well as future trends.

Purpose: We explored the applicability of Raman spectroscopy to in situ investigation of bladder wall tissue., Materials and Methods: Bladder wall tissue was obtained from a guinea pig model and frozen sections were used for Raman spectroscopic investigations. From each section 500 to 700 spectra were obtained in a 2-dimensional grid spanning the urothelium, lamina propria and muscle layer. The data set of spectra was subdivided into groups of similar spectra by a cluster analysis algorithm. With each group assigned a different color Raman maps of frozen sections were constructed based on group membership of measured spectra. These maps were then compared with histological and histochemical data obtained from hematoxylin and eosin and immunohistochemical staining for collagen I and III and for smooth muscle actin to correlate Raman spectral features with bladder wall structure and molecular composition., Results: Urothelium, lamina propria and muscle layers could be clearly distinguished based on Raman spectra. Lamina propria spectra were dominated by signal contributions of collagen and the smooth muscle layer showed strong signal contributions of actin. The urothelium had a relatively strong lipid signal contribution., Conclusions: These results and the fact that Raman spectroscopy is rapidly evolving into a technology that can be applied in vivo by thin, flexible fiberoptic catheters indicate that prospects are good for in vivo analysis of the molecular composition of the normal and pathological bladder without biopsies.

It is unknown whether changes in bladder function due to urethral obstruction follow a specific sequence. To answer this, we adapted a small animal model to allow repeated complete pressure-flow studies, enabling individual follow-up of changes in bladder function on urethral obstruction. Obstruction was induced in guinea pigs by placing a silver ring around the urethra. Urodynamic studies were repeated under anesthesia with ketamine/xylazine. Bladders were filled and bladder pressure measured through a single suprapubic catheter. Urine flow rate was measured using an ultrasound probe around the penis. Accurate measurements of bladder pressure and urine flow rates were obtained at 1-week intervals for 11 weeks in individual guinea pigs. In the control animals, the urodynamic parameters did not show significant changes. In the obstructed group, urethral resistance (P(low,ave)) increased from 20 to 35 cm H(2)O after 4 weeks and remained at that level. The maximum flow rate (Q(max)) increased from 0.17 to 0.24 mL/s after 2 to 3 weeks. After this peak, it gradually decreased to lower than the starting value after 10 to 11 weeks. The pressure at maximum flow rate (p(Qmax)) increased from 24 to 47 cm H(2)O after 6 to 7 weeks and thereafter declined. During weeks 1 through 4 of obstruction, unstable contractions were seen. All animals followed a similar sequence of patterns but at variable rates. Our animal model allows complete urodynamic follow-up of individual animals with urethral obstruction. We observed a specific sequence of changes in urodynamic patterns and parameters of bladder function., (Copyright 2001 Wiley-Liss, Inc.)

Purpose: We established the longitudinal changes in bladder contractility and compliance as a result of urethral obstruction using a guinea pig model., Materials and Methods: Obstruction was induced in guinea pigs by a silver ring around the urethra. Urodynamic studies were performed longitudinally in individual animals. Bladder contractility and compliance were calculated from the measured bladder pressure and urine flow rate., Results: Bladder contractility developed in distinct phases. It reached a maximum 200% increase after an average of 3.25 weeks concomitant with an almost 2-fold increase in urethral resistance, remained 150% to 200% increased during weeks 4 to 7 and then decreased to starting levels again, while urethral resistance remained almost 2-fold increased. Bladder compliance decreased by 80% during the first 3 weeks and continued to decrease to 5% of its original value after 10 to 11 weeks., Conclusions: Our data indicate that as a result of obstruction bladder function passes through a specific sequence of stages, including first a compensatory increase in contractility, then a stabilization phase and finally a decompensation state. In contrast bladder compliance shows a continuous decrease. The data suggest that for assessing how far a bladder has deteriorated due to obstruction a combination of functional and structural data may be warranted.

Purpose: Detrusor instability and hyperreflexia are characterized by involuntary detrusor contractions in the filling phase of the voiding cycle. The diagnosis is made when urodynamic evaluation reveals such contractions. To compare patients and evaluate treatment a method is needed to quantify the degree of instability. We developed an instability parameter based on the area under the curve of involuntary detrusor contractions on conventional filling cystometry., Materials and Methods: We developed an automatic method to calculate the area under the curve of involuntary detrusor contractions in conventional filling cystometry. Logistic regression was used to construct decision rules to differentiate stable from unstable bladders. These rules, derived from a group of 100 children, were applied to a second group of 77 who were independently assessed by 3 urodynamics experts., Results: Typically 88% of the second group were correctly classified as stable or unstable by the automatic procedure. In the unstable subgroup there was poor correlation between the calculated instability parameter and the instability score assigned by the experts. Most likely this difference occurred because the experts based their opinion mainly on the amplitude of the highest unstable contraction and the percentage of filling time that instability was found., Conclusions: The proposed method of automatically grading detrusor instability based on the area under detrusor contractions differs from the intuitive method used by experts. Since no standard is available, it cannot be concluded which method is better. Our proposed method is objective and it results in a single physical value.

A 2-year-old boy presented with an atypical renal mass with extension into the pyelocalyceal system and distal ureter which was diagnosed initially as xanthogranulomatous pyelonephritis (XGP). The final diagnosis was intrapelvic Wilms tumor extending into the ureter. In the literature, only three patients have been described with Wilms tumor extending into the ureter, none of whom had a continuous extension into the distal ureter.

Distribution and regulation of androgen receptor expression during fetal and neonatal virilization of the rat fetus was assessed by immunohistochemistry. In mesonephric duct derivatives the androgen receptor expression became evident first in the efferent ductules and epididymis (on fetal day 14), subsequently in the vas deferens and finally in the seminal vesicle. Mesenchymal cells of the urogenital tubercle were positive for androgen receptors from fetal day 14 onwards. In the mesenchymal cells of the prostate anlagen, androgen receptor positive cells were found first on fetal day 16. Administration of 5alpha-dihydrotestosterone to pregnant rats from day 11 to day 20 of gestation caused a stabilization of the wolffian duct in female fetuses. The androgen receptor expression pattern became similar as found in mail fetuses, and showed an increase in density and in frequency of androgen receptor positive cells. Administration of the androgen antagonist flutamide during the same interval caused a reduction in density and frequency of androgen receptor positive cells in male fetuses. These findings indicate that androgens enhance the expression of androgen receptors in the developing rat genital tract by induction of androgen receptor positive cells, and by increasing the frequency. The developmental pattern of androgen receptor expression in the rat mesonephric duct system reflects the androgen-responsiveness of the ducts, and is consistent with induction of the androgen receptor along the ducts by testosterone reaching these structures in an exocrine fashion.

Objective: To elucidate whether diminished levels of androgen receptor (AR) are the underlying cause for the development of hypospadias by determining AR levels in the foreskins of boys with hypospadias., Patients and Methods: The content of AR was determined by a sensitive immunoblotting technique in extracts from preputial tissue obtained from 15 patients (mean age 2.5, SD +/- 1.5 years) with hypospadias and from seven controls (mean age 2.5, SD +/- 1.5 years). Immunoreactivity of the protein was measured by densitometry., Results: No significant difference in mean AR content was found between those boys with hypospadias (2.1 +/- 0.9 fmol/mg protein, +/- SD) and the age-matched control group (2.2 +/- 0.3 fmol/mg protein). Stratification by the severity of hypospadias (distal and proximal on the shaft, and penoscrotal hypospadias) showed that the severity was not related to tissue AR levels., Conclusion: It is unlikely that hypospadias is caused by a decreased expression of AR.

Prenatal diagnosis, management and outcome were studied retrospectively in 24 cases of unilateral and bilateral uretero-pelvic junction obstruction (UPJO). Moderate-to-marked pelvic dilatation was documented in 19 out of 24 cases. The low morbidity and mortality observed in this study are probably determined by the late (third trimester) detection of UPJO, resulting in an underestimation of the prevalence of more severe renal pathology. Amniotic fluid was increased in 4 out of 14 cases of unilateral UPJO and in 5 out of 10 cases of bilateral UPJO, the underlying mechanism of which is still unclear. There was no oligohydramnios. The incidence of extrarenal structural pathology was low, i.e., 3 out of 24 cases. A close agreement could be demonstrated between pre- and postnatal sonographic grading of pelvic dilatation. However, postnatal ultrasonic grading of pelvic dilatation correlated poorly with the degree of functional obstruction as determined by IVP and lasix renography. Despite the severity of pelvic dilatation in the majority of cases, enlarged kidneys were revealed by postnatal clinical examination in only three instances, underlining the importance of prenatal sonographic detection of UPJO.

Urethral advancement is a less well known technique for the repair of distal hypospadias. We treated 37 patients with a median age of 3 years for coronal and subcoronal hypospadias, with excellent results.

The gonadal functions were studied in 54 patients with disseminated nonseminomatous testicular tumors who had been subjected to combination chemotherapy (cisplatin, vinblastine, and bleomycin [PVB]) and surgery (hemiorchiectomy, retroperitoneal lymph node dissection or removal of retroperitoneal residual tumor after chemotherapy) and in 17 patients with a stage I tumor subjected to hemiorchiectomy exclusively. In the patients treated with chemotherapy, the plasma testosterone levels remained at the lower limit of normal and the luteinizing hormone (LH) levels remained elevated for 2 years after completion of treatment. The follicle-stimulating hormone (FSH) levels also remained significantly elevated, but showed a tendency to decrease after 2 years. Semen analysis was performed in 25 patients; of the other patients, 18 had no antegrade ejaculation, eight had undergone a vasectomy and three patients did not cooperate. Before treatment, 72% of the patients showed azoo- or oligozoospermia; 2 years after discontinuation of the chemotherapy, 48% had azoo- or oligozoospermia while 28% had more than 60 X 10(6) spermatozoa/mL. However, interestingly the proportion of patients with azoospermia had increased from 4% to 28%. In the course of this study, eight pregnancies occurred; one ended in an early spontaneous abortion; the other seven pregnancies ran an uncomplicated course. Seven healthy children were born. In 17 patients with a stage I tumor treated by hemiorchiectomy only, the testosterone, LH and FSH levels were also observed for 2 years; until 2 years after treatment, the testosterone levels remained lower and the FSH levels remained higher than normal. Insufficiency of the Leydig's cells in the unaffected gonad appeared to be responsible for the altered hormone concentrations in the blood.