Search

Preoperative prediction of urinary continence in patients with myelodysplasia requiring augmentation cystoplasty is uncertain. To determine reliable factors to predict postoperative urinary continence, we retrospectively analyzed preoperative videourodynamic parameters and urinary continence outcome in a group of patients with myelodysplasia who underwent augmentation ileocystoplasty.

Primary valve ablation and temporary vesicostomy with delayed valve ablation are alternative initial management procedures in neonates and infants with posterior urethral valves. To investigate whether initial vesicostomy followed by delayed valve ablation and simultaneous vesicostomy closure may lead to more alterations in bladder function than primary valve ablation only we retrospectively compared postoperative urodynamic findings in 2 small groups of patients.

We retrospectively reviewed the results of 3 types of initial management of pelvic fracture urethral disruption in children.

Preoperative and postoperative testicular volume, serum testosterone, follicle-stimulating hormone and luteinizing hormone were determined in 25 patients 8 to 19 years old (mean age 13.2 ± 1.63) with grades 2 and 3 unilateral varicocele. Testicular growth arrest was considered significant when volume loss was greater than 2ml. in the ipsilateral testis compared to the contralateral side. Baseline serum testosterone, follicle-stimulating hormone and luteinizing hormone as well as post-gonadotropin releasing hormone stimulation were determined preoperatively and at 4 to 6 months postoperatively. Data are presented as mean plus or minus standard deviation. Results showed an increase in serum testosterone in Tanner’s stages 1 (p <0.028) and 2 to 3 (p <0.008). No differences were recorded in basal luteinizing hormone and folliclestimulating hormone, as well as maximal follicle-stimulating hormone levels before and after surgery. A decrease of maximal luteinizing hormone response to gonadotropin releasing hormone test was noted postoperatively in pubertal stages 4 to 5, when compared to preoperative values. Postoperative ipsilateral testicular volume increased in all Tanner stages (p <0.045, p <0.008 and p <0.012, respectively).

PurposeUrethral duplication is a rare congenital anomaly. We report the clinical presentation, imaging findings and surgical treatment in 7 boys with incomplete sagittal duplication of the urethra.Materials and MethodsDuplication involved hypospadias in 5 cases (group 1) and a bifid urethra with an accessory preanal tract (Y duplication) in 2 (group 2). Group 1 was treated with 1-stage urethroplasty, including marsupialization of the dorsal orthotopic urethra, ventral-to-dorsal urethrourethrostomy and penile island flap onlay repair to cover the dorsal urethra. In contrast, group 2 was treated with 2-stage urethral reconstruction with detachment and mobilization of the accessory preanal branch in association with a scrotal tubed neourethra followed by urethroplasty as in group 1. In all cases the dorsal penile urethra was located between the corpora cavernosa and surrounded by the tunica albuginea.ResultsA urethrocutaneous fistula developed in 1 of the 5 group 1 patients. In group 2, 1 patient had recurrent penoscrotal meatal stenosis after the 1-stage procedure and 1 had a urethral diverticulum with calculi at the scrotal tubed neourethra 7 years after urethral reconstruction. Six of the 7 patients now void spontaneously through a meatus located normally at the tip of the glans. The remaining patient with a neurogenic bladder is on intermittent catheterization via appendicovesicostomy due to difficult catheterization of the irregular and sensitive neourethra.ConclusionsWhile the ideal surgical management of urethral duplication anomalies remains uncertain, we used a combination of surgical techniques to correct this severe malformation.