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A new one-stage operation for correction of the more severe degrees of proximal hypospadias is described. This allows for the correction of chordee and maintains a dual vascular supply to the urethral flap derived from periurethral and pedicle blood vessels. This technique allows for correction of chordee and urethroplasty, and avoids the need for combination or staged repairs.

While techniques for initial orchiopexy are well known, descriptions of a surgical approach to the more difficult reoperative case are scarce. We describe 25 patients undergoing reoperative orchiopexy following prior herniorrhaphy, hydrocelectomy or attempted orchiopexy. A technique of en bloc spermatic cord mobilization from an inferior approach is detailed. This approach is designed to minimize the potential for spermatic cord injury during reoperation, and has proved to be safe and reliable.

A review was done of 29 patients diagnosed with sacrococcygeal teratoma between 1978 and 1991. Urological disorders included total urinary retention (6 patients), hydronephrosis (6), hydrocele (4) and undescended testis (1). Ultrasonography and voiding cystourethrography were performed on the 6 patients in total urinary retention. These studies revealed cystic retrorectal lesions frequently with intralesional calcifications, and anterior and superior displacement of the bladder. Bladder wall trabeculation occurred in 2 of these 6 patients, and 4 had moderate or severe hydronephrosis. Upper urinary tract dilatation was found in 2 patients not in total retention. Hydronephrosis appeared to be related to poor bladder emptying and presumably high intravesical pressures, since each case resolved spontaneously after tumor resection. No primary upper tract anomalies were identified.

Tunica vaginalis on a vascular pedicle was tubularized and used as a urethra to repair hypospadias in three difficult cases. This is the first report of tunica vaginalis utilized for a urethral reconstruction in humans. This new surgical technique is described.

A total of 97 newborns with apparent ureteropelvic junction obstruction was evaluated from mid 1984 to 1989. Evaluation and management are described. Of these patients 39 with an affected kidney showing good initial differential function (greater than 35%) by diethylenetriaminepentaacetic acid scan and 2 showing diminished function (less than 35%) were followed nonoperatively. Six patients (15%) eventually required pyeloplasty for diminishing function (4), urinary tract infections (1) or symptoms of colic (1). The 4 patients with diminishing function improved after pyeloplasty to at least the initial level. A total of 12 patients with good initial function (greater than 35%) of the affected kidney underwent early pyeloplasty (within 6 weeks of diagnosis). They were compared to the similar group of patients managed nonoperatively and followed by sequential renal scans. Eventual changes in percentage differential function in the nonoperative and early surgery groups were +2.8% and +4.1%, respectively. Changes in extraction factor were +0.8% (nonoperative group) and +0.9% (surgery group). No statistically significant difference was found. In the kidney with apparent ureteropelvic junction obstruction and good function, an initial nonoperative approach with sequential renal scan followup and pyeloplasty as needed appears to be reasonable and has resulted in no permanent loss of function.

Between 1981 and 1989, 28 infants less than 6 months old with posterior urethral valves underwent ultrasound evaluation as part of the initial evaluation at our hospital. The single ultrasound feature that correlated with subsequent renal function was the status of corticomedullary differentiation. The presence of corticomedullary junctions in at least 1 kidney in 17 infants was always associated with a serum creatinine level of 0.8 mg./dl. or less in long-term followup. Of 11 patients with absent corticomedullary differentiation 7 had eventual creatinine levels of greater than 0.8 mg./dl. with 5 of them suffering clinically significant renal insufficiency. An association between vesicoureteral reflux and absent corticomedullary junctions was also found.

A surgical technique of partial detrusorectomy (autoaugmentation) for creation of a diverticular bulge of the dog bladder is described. The method is designed to serve as a bladder augmentation without using bowel. We describe the technique, results with dogs and its clinical application. Partial detrusorectomy appears to function as an autoaugmentation that can be performed reliably in dogs, offers potential advantages over bowel segments, and is a potential alternative to enterocystoplasty in selected patients.

A surgical technique is described in which detrusor muscle over the entire dome of the bladder is excised while leaving the bladder epithelium intact. A large epithelial bulge is created, which functions to augment the storage properties of the bladder without using bowel, and it is referred to as "autoaugmentation". Seven patients have undergone autoaugmentation of whom 5 have excellent clinical results while 1 has modest improvement. The remaining patient was a technical failure. Postoperative urodynamics in 5 patients demonstrated improved bladder capacity in 3 and markedly improved bladder storage pressures in 4 compared to preoperative studies. The technical aspects of the procedure and patient management are discussed. Autoaugmentation offers potential advantages over enterocystoplasty, is simple to perform, does not preclude future enterocystoplasty if needed and may be a reasonable alternative to conventional augmentation in selected patients.