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Undescended testis (UDT, cryptorchidism) is the most frequent genital anomaly in boys. However, its treatment varies widely throughout the world. This second part of our roundtable discussion aims to continue to ask global experts to express their attitudes towards several case scenarios of UDT in order to explore the rationale for their clinical decisions. As the European Association of Urology – Young Academic Urologists Pediatric Urology Working Group, we believe that this roundtable series will facilitate colleagues all over the world to reflect and improve their practices regarding the treatment of UDT. [ABSTRACT FROM AUTHOR]

Undescended testis (UDT, cryptorchidism) is the most common congenital anomaly of the genital tract. Despite its high incidence, the management of UDT varies between specialties (urology, pediatric surgery, pediatric urology, pediatric endocrinology). Therefore, as the European Association of Urology – Young Academic Urologists Pediatric Urology Working Group, we requested experts around the world to express their own personal approaches against various case scenarios of UDT in order to explore their individual reasoning. We intended to broaden the perspectives of our colleagues who deal with the treatment of this frequent genital malformation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate, by using scanning electron microscopy (SEM), the possible alterations of the foreskin connective tissue in patients with true phimosis submitted to topical treatment with betamethasone and hyaluronidase ointment.Materials and Methods: We studied 15 patients (mean 5.3 years old) submitted or not to topical application of betamethasone 0.2% and hyaluronidase cream. For qualitative analysis of the connective tissue, we studied 5 samples from each foreskin, with 2 mm length. The samples were submitted to fixation for SEM by immersing tissue fragments in a modified Karnovsky solution for 48 hours at 4°C. The obtained acellular preparations were then processed for high-vacuum SEM, and observations were performed on a LEO 435 (Zeiss, Oberkochen, Germany) scanning electron microscope with an acceleration voltage of 15 to 20 kV.Results: Parents of 7 children did not agree with the clinical treatment and opted for circumcision directly. These patients served as the control group (nontreated). Eight patients submitted to topical treatment could not expose the glans and were referred for circumcision. In SEM, with a magnification of 5000×, we observed important differences in the organization of the collagen and elastic system fibers when comparing treated and nontreated patients with betamethasone and hyaluronidase. Treated patients presented a different organization of collagen with a clear decrease in the elastic system fibers.Conclusion: The treatment of phimosis with betamethasone + hyaluronidase showed changes in the structure of the foreskin with a decrease of elastic system fibers, which is characteristic of the healing processes. [ABSTRACT FROM AUTHOR]

Purpose: Success of hipospadias surgery depends, among other factors, on good quality of the prepuce. Androgen stimulation is suppose to improve cosmetic results and reduce complication rates after Hypospadias correction. Herein, we evaluate the collagen and elastic fibers of the prepuce after testosterone stimulation. Material and Methods: Twenty-six boys (4 to 120 months old) were divided at random into two groups prior to hipospádias correction. Group 1 (G1) did not receive any treatment while the boys in group 2 (G2) used 1% propionate of testosterone cream on the penis twice a day for 30 days prior to surgery. During surgery a fragment of the prepuce was taken and sent to histological evaluation. Collagen fibers were evaluated with Masson''s trichrome, and Elastic fibers with resorcin-fucsin of Weigert. Results: Both groups were similar according to age and Hypospadias classification. Testosterone-treated foreskins (G2) had lower homogeneity (p=0.001) and surface density of the collagen fibers (0.3 ± 0.1 collagen fibers) than those untreated (G2) (0.4 ± 0.1 collagen fibers) (p<0.001). Testosterone treated children had a more homogeneous pattern (p=0.008) and the same surface density of the elastic fibers evaluated with resorcin-fucsin of Weigert than the untreated group. Conclusions: The use of 1% testosterone propionate cream produced a more immature collagen fibers and more homogeneous pattern of the elastic fibers which may be an important factor in producing a better scar formation with consequent less complication rates and better aesthetic results. [Copyright &y& Elsevier]

Purpose: Many studies have advocated the advantages of the use of androgen stimulation prior to Hypospadias surgery, with special interest in the increase in penile size, improvement of cosmetic results and reduction of complications. Herein, we demonstrate the histological effects of testosterone in neovascularization. Material and Methods: Twenty-six boys (4 to 120 months old) were divided at random into two groups prior to hipospádias correction. Group 1 (G1) did not receive any treatment while the boys in group 2 (G2) used 1% propionate of testosterone cream on the penis twice a day for 30 days prior to surgery. During surgery a fragment of the prepuce was taken and sent to histological evaluation. The number and volume density of the blood vessels were obtained using von Willebrand factor. Results: Both groups were similar according to age and Hypospadias classification. Testosterone-treated foreskins (G2) had an increased absolute numbers of blood vessels (8.5 ± 1.3 vessels/field) when compared with untreated prepuce (G1) (4,8 ± 1,8 vasos/campo) (p<0.001). It also had an increased blood vessel volume density (50.5% ± 7.8 vessel/points) compared to untreated subjects (G1) (24.8% ± 8.6 vessel/points) (p<0.001). Conclusions: The use of 1% testosterone propionate cream on the penis prior to Hypospadias surgery induces neovascularization, in absolute numbers and volume density. This data objectively proves the subjective finds of better vascularization after androgen stimulation prior to Hypospadias correction. [Copyright &y& Elsevier]

Objective: To evaluate the influence of prune belly syndrome (PBS) on the development of penises in human fetuses.Methods: We studied 39 human fetuses (including 4 with PBS) aged 11-22 weeks post conception. We measured the length and width of the free portion and penis root and the penis total length (PTL). In 21 fetuses of the control group and in 3 with PBS we analyze the penile with histochemical and immunohistochemical methods. The total penile area, area of corpora cavernosa, area of corpus spongiosum, and thickness of tunica albuginea were measured by stereological method. Means were compared using the Kolmogorov-Smirnov and ANOVA test (P <.05).Results: We did not observe difference in PTL (P = .999) when we compared the control group (4.69-29.77 mm, mean = 16.2 mm; SD = 6.34 mm) with the PBS (12.23-23 mm, mean = 16.16; SD = 4.99). The total penile area (P = .002), the area of corpora cavernosa (P = .023) and the area of corpus spongiosum (P = .004) had a significant increase when comparing the PBS with the control group.Conclusion: In fetuses with PBS there is no change in the length of the penis but we observed a low rate of growth in all the other histologic parameters analyzed, suggesting that PBS impacts the penile development. [ABSTRACT FROM AUTHOR]