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A two-vessel umbilical cord (or single umbilical artery) is a perinatal finding that may be detected in infants with congenital or chromosomal abnormalities. Its presence has been associated with an increased risk of genitourinary defects. The urologic anomalies that typically are associated with a two-vessel cord often are minor and self-limiting. These defects usually can be detected perinatally in routine prenatal screening ultrasonographic examinations. The neonatal physical examination, an additional postnatal ultrasonography, and possibly a voiding cystourethrogram will be sufficient to complete the screening for genitourinary abnormalities in children with a single umbilical artery. Infants with two-vessel umbilical cords do not require additional screening for genitourinary defects, unless the imaging or amniocentesis detects a genitourinary abnormality. This review details the history of two-vessel cords and the associated genitourinary anomalies.

Primitive neuroectodermal tumor (PNET) of the kidney is a rare entity with high malignant potential. Of the reported cases of renal PNET, patients presented with metastatic disease and had a poor response to therapy. The authors describe a rare case of an organ-confined primary PNET arising from the kidney in a 16-year-old girl who presented with vague abdominal pain. Tumor behavior and treatment modalities are discussed.

Laparoscopy was performed on 107 patients 8 months to 18.5 years old (mean age 46.9 months) with 119 nonpalpable testes. The procedure accurately determined the location of the gonad in 95.3% of the patients, while 16 were spared formal surgical exploration with the laparoscopic visualization of blind-ending spermatic vessels and vasa deferentia. Additionally, patency of the internal inguinal ring, determined laparoscopically, was an accurate predictor of testicular salvageability. We advocate the use of laparoscopy for all boys with a nonpalpable gonad in conjunction with operative intervention if necessary.

To evaluate long-term results and complications we reviewed the records of 42 consecutive men 18 to 47 years old (mean age 22.5) who underwent hypospadias repair between 1979 and 1999.The study population was divided into groups 1 consisting of 8 patients without previous hypospadias surgery, 2 consisting of 12 who underwent 1 or more procedures in childhood but in whom local tissue was relatively intact and 3 consisting of 22 who underwent multiple unsuccessful hypospadias repairs with various degrees of penile deformity and loss of local tissue.Complications were noted in 3 of 8 (37.5%), 5 of 12 (41.67%) and 14 of 22 (63.6%) patients in groups 1 to 3, including 3 (100%), 4 (80%) and 10 (71.4%), respectively, in whom secondary surgery was successful in the long term. A patient in group 2 and 2 in group 3 await further surgery, while 2 in group 3 were lost to followup. Overall primary complications developed in 22 of the 42 men (52.3%) and 5 of the 22 (22.7%) had secondary complications. There was long-term success in 37 of 42 cases (88.1%).The results of hypospadias repair in adulthood differ from the results of similar procedures in childhood. Although the various techniques are similar, there is clearly a difference in terms of wound healing, infection, complication rates and overall success. Adults undergoing hypospadias repair must be counseled on all of these variables to avoid unreasonable expectations.

The koro syndrome is a psychiatric disorder characterized by acute anxiety and a deep-seated fear of shrinkage of the penis and its ultimate retraction into the abdomen, which will cause death. Concurrence of the koro (genital retraction) syndrome with a pathological condition of the urogenital system has rarely been described. We report a case of koro associated with infertility. Within 3 weeks of treatment with haloperidol the classic symptoms of koro disappeared. To our knowledge this case represents the sixth report of the koro syndrome associated with urogenital pathology and the first report of its association with infertility.

Acute epididymitis and orchitis result in pain and swelling of the contents of the scrotal sac. The differential diagnoses include torsion of the spermatic cord, torsion of the appendix testis, hernia, hydrocele, and trauma. All providers of pediatric health care should understand the etiology and recognize the presenting signs and symptoms of epididymitis and orchitis, conditions that must be distinguished promptly in the emergency setting to avoid the risk of gonadal loss or unnecessary scrotal exploration. Epididymitis results from inflammation of the epididymis with resultant pain, swelling, and redness of the scrotal skin. Most often a specific cause cannot be identified, although it has been hypothesized that both viral and coliform bacterial infections can inflame the epididymis.

We report on 2 cases of congenital urethrocutaneous fistulas in otherwise normalchildren. There were no associated congenital anomalies. Satisfactory surgical results were obtained. Potential causes are discussed.