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Purpose: We report the results in patients with obstructed upper pole ectopic ureters in duplex systems undergoing dismembered extravesical reimplantation of the upper pole ureter alone., Methods: Between 01/2007 and 03/2012, 11 patients with an upper pole ectopic ureter (1 bilateral) diagnosed following the antenatal detection of hydronephrosis and showing preserved function on renal scintigraphy in a dilated upper moiety, underwent a dismembered reimplantation of the ectopic upper pole ureter as follows. The ureter was identified, separated from the lower pole ureter, and divided just above the bladder. The distal stump was suture closed, while the proximal segment was mobilized, tapered as necessary, and reimplanted using an extravesical technique., Results: Twelve ectopic ureters were reimplanted. Median (range) patient age at surgery was 8 (3-48)months. Ureteral tapering was performed in 11 ureters, by infolding in 9 and using an excisional tailoring in the single case undergoing bilateral reimplantation. After a median (range) follow-up of 17 (6-50)months, all patients were asymptomatic. Eleven reimplanted ureters showed improving hydroureteronephrosis, no obstruction on diuretic scintigraphy, and no evidence of reflux on indirect radionuclide cystography. One reimplanted ureter developed worsening hydroureteronephrosis after excisional tailoring of the ureter and partial nephrectomy was performed., Conclusions: Extravesical reimplantation of the upper pole ureter is an option in dilated upper pole ectopic ureters with good function. Separating the upper and lower pole ureters proximally to the bladder does not jeopardize the ureteral blood supply and allows leaving the lower pole ureter undisturbed. Excisional ureteral tailoring should be avoided., (Copyright © 2013 Elsevier Inc. All rights reserved.)

A 3-year-old boy presented with an asymptomatic intertesticular mass increasing in size. Plasma tumor markers (α-fetoprotein and β-human chorionic gonadotrophin) were negative. The mass had a pattern similar to testicular parenchyma but no discernable blood flow on scrotal Doppler ultrasound. Magnetic resonance imaging scan showed that it reached the posterior urethra after passing through the right corpus cavernosum with a progressive tapering extending into the pelvis. The mass was excised surgically and histologically found to be consistent with a dermoid cyst. Such rare benign lesions should be considered in the differential diagnosis of painless scrotal masses in children. Its anatomy was accurately defined by magnetic resonance imaging and was essential to minimize the risk to adjacent structures., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background/purpose: The aim of this study was to analyze the complication rate in male bladder exstrophy (BE) patients undergoing flap or graft urethroplasty for the repair of resultant hypospadias after epispadias repair., Methods: We retrospectively reviewed the charts of 22 male BE patients who underwent 24 urethroplasties for resultant hypospadias between 2000 and 2009. Median patient age was 4.2 (range, 1.5-26.5) years, and median follow-up was 7.5 (range, 0.8-10.3) years. Meatal location after epispadias repair was midshaft in 6 cases and proximal shaft in 15. Complications were compared in relation to meatal position, type of urethroplasty (no graft vs graft), use of second-layer coverage of the urethroplasty, and use of suprapubic diversion., Results: Overall, complications developed in 12 (50%) patients, including 10 urethrocutaneous fistulas and 2 urethroplasty dehiscence. Univariate analysis failed to show any differences between complicated and uncomplicated cases in all the variables. Only the 3 cases undergoing a 2-stage repair had fully successful outcomes., Conclusions: Urethroplasty in patients with BE has a high complication rate. Quality of local tissue and presence of scarring are possibly the 2 major determinants of a poor outcome. A staged repair seems the safest, although this commits the patient to 2 procedures., (Copyright © 2011 Elsevier Inc. All rights reserved.)

We describe an adolescent female patient born with a complex genitourinary malformation including bilateral duplex system and duplication of the müllerian structures (bicornuate uterus and septate vagina). She presented with a symptomatic hydrosalpinx. The typical imaging of this condition is described along with the issues associated with the differential diagnosis in this complex scenario. The diagnosis of hydrosaplinx should be suspected in patients with complex genitourinary malformations and a pelvic fluid collection. Associated genital and renal anomalies are noted in 30% of cases., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Purpose: Penile amputation in children is rare. If the amputated organ cannot be salvaged, standard treatment options include sex reassignment or creation of a penoid with a musculocutaneous flap. We describe our experience with phallic reconstruction after amputation., Methods: Between 2005 and 2007, we observed 3 patients with penile amputation. All presented a flat pubic scar and a severe urethral stricture for which urinary diversion had been performed in two. The first step of the procedure was penile augmentation. The latter included dissection and advancement of the residual erectile tissue by either division of the suspensory ligament (n = 2) or detachment of the corpora cavernosa from the pubic bones. Then, meatal advancement was attempted and combined with a staged oral mucosa urethroplasty, if necessary. Finally, skin coverage was achieved using local flaps (n = 2) or a free graft harvested from the inguinal region. In 2 patients, a pseudoglans was sculptured from the pubic scar., Results: In no case the procedure could be performed in a single stage. In one patient, 2 additional cosmetic revisions were required. Good penile augmentation was achieved in all the 3 cases. All patients presented at least nocturnal erections and reported to be satisfied with the cosmetic results., Conclusions: Our experience suggests that an attempt to phallic reconstruction by retrieval of any residual erectile tissue might be worthwhile before embarking on a penile replacement. In a few cases, this may allow recreation of a penis with good cosmesis and function.

Female hypospadias is a rare malformation. We report on an unusual case that presented with a urethral dimple in the perineum in association with a pelvic soft tissue sarcoma compressing and displacing the urethra. The diagnosis was made by cystoscopy, and, as the patients remained asymptomatic, no treatment was eventually required for her urologic malformation. This is, to our knowledge, the first reported case of female hypospadias associated with a perineal urethral dimple. The possible pathogenesis of the malformation is discussed also in relation to the simultaneous presence of a pelvic mass.

Adenomyomatosis of the gallbladder (ADMG) is defined as an acquired disease characterized by localized or diffuse hyperplastic extensions of the mucosa into, and often beyond, the thickened gallbladder muscular layer (Rokitansky-Aschoff's sinuses). In recent years, attention has been drawn to its malignant potential. The occurrence of ADMG has never been reported in children. The authors report the case of a 5-year-old boy with symptomatic ADMG, who was successfully treated by laparoscopic cholecystectomy.