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Objective: To report 2 cases with pediatric penile trauma due to penile zipper injury., Clinical Presentation and Intervention: Two boys presented to the emergency service because of penile zipper injury. The zipper was cut away and removed from the foreskin by cutting the median bar of the sliding piece of the zipper and the zipper teeth with a bone cutter. After opening the zipper teeth, the zipper fell apart, which allowed its removal from their foreskin. There was minimal trauma to the foreskin and the boys were sent home on the same day., Conclusion: Penile entrapment in a zipper is a presentation that may be seen in any emergency department. The 2 boys were treated successfully by cutting the median bar of the sliding piece of the zipper., (Copyright 2006 S. Karger AG, Basel.)

Objectives: To assess and review catheter removal on the first day after transurethral prostatectomy., Subjects and Methods: The study included 431 consecutive patients who underwent transurethral prostatectomy between 2000 and 2003 at a Scarborough General Hospital, Toronto, Canada. The equipment used was a standard resectoscope with a regular loop. No roller ball or other gadget was used. The cutting and coagulation electrical variables were standard at 160 and 60 W for the generator used. The decision to remove the catheters was based on normal vital signs, adequate urine output, absence of clots and acceptable color of the catheter effluent., Results: Catheters were removed in 415 (96.3%) patients on postoperative day 1. Of the 415 patients 332 (80.0%) were discharged on the same day. The criteria for catheter removal on postoperative day 1 were not met in 16 (3.7%) patients and the mean indwelling catheter time was 4.8 +/- 2.4 days and the mean length of hospital stay after surgery was 6.2 +/- 3.3 days. For the entire group, the mean indwelling catheter time was 1.1 +/- 0.8 days and the mean length of hospital stay after surgery was 1.6 +/- 1.5 days. Risk factors which predicted delayed removal were age, postoperative bleeding and several comorbidities, that is coronary heart disease, renal insufficiency and Alzheimer's disease., Conclusions: Removal of the catheter on the first postoperative day after transurethral prostatectomy seems to be feasible, safe and cost-effective without increasing significant morbidity in selected patients., ((c) 2006 S. Karger AG, Basel)

Paraurethral glands of the female urethra, which are assumed to be embryologically homologous to the male prostate gland, are possible origins for diverticular cancer of the urethra. A case of primary adenocarcinoma arising in a female urethral diverticulum is presented. Pathology revealed a columnar/mucinous type adenocarcinoma which stained positively for carcinoembryonic antigen (CEA) and negatively for PSA. Normal paraurethral ducts located near the urethra and normal urethral epithelium also stained positively for CEA. These findings suggest that the adenocarcinoma in our case originated from the paraurethral duct near the urethral lumen.

Two cases of invasive lower ureteric cancer developed following frequent recurrence of superficial bladder tumors in the region of the ureteral orifice. The cancer focus could not be identified in the intramural ureter prior to intravenous urography which revealed hydronephrosis. When bladder tumors repeatedly develop near the ureteric orifice, careful investigations such as ureteral catheterization with a small brush for cytology or ureteroscopy are necessary for the early detection of invasive disease.

A simple, inexpensive pressure-recording balloon system to determine abdominal or rectal sphincter pressures without difficulty is described.

A Monte Carlo simulation study to compare the effect of population form on three methods of nomogram construction was performed by taking 2000 random samples of size 5, 20, 50, 100, and 200 from populations with known percentiles. The 10th percentile was estimated by each of the three construction procedures. The three procedures compared were the upper 95 per cent nonparametric tolerance limit technique, the usual percentile approach, and a method which assumes a Gaussian (normal) distribution. Tenth percentile nomograms, classified by volume voided, were calculated by each of the three procedures for maximum flow rate determinations from 356 normal males of ages 1 to 12 years with body surface areas less than 1.1 m2. Nomograms of the three methods are validated with evaluations from two other groups of male children consisting of known abnormals with radiologically proven urethral obstructions and known normals who had repeated at home uroflow rates. The nonparametric tolerance limit approach gives conservative estimates and is superior in all cases from the standpoint of reducing false-negative results.

A case of epididymal cystadenoma, thought to be a component of the von Hippel-Lindau syndrome, is presented. The syndrome is reviewed, and the importance of long-term urologic follow-up for possible presentation of renal cell carcinoma is discussed.

Cystometry in 21 cases of closed continent bladder exstrophy revealed that 14 patients had a normal reflexic bladder. A simultaneous anal plug electromyogram showed an appropriate response in all patients when correlated with a cystometrogram.

Carbon dioxide urethral pressure profiles were analyzed under the same conditions for 113 spina bifida and 87 non-spina bifida patients categorized by sex and age. Either duplicate or triplicate measurements were obtained from each patient for parameters of continence length, closure pressure and functional length. The degree of reproducibility of each parameter varied depending on age, sex and diagnosis. Except for 1 age-sex category closure pressure exhibited the smallest degree of relative variation for spina bifida patients. Results for non-spina bifida patients were mixed in that the measurement of no one parameter resulted in a uniformly smallest degree of relative variation. Reproducibility based on within patient variability generally was least for the continence length.

Parameters of the carbon dioxide urethral pressure profilometry were examined in detail previously for reproducibility within subjects. In the current study we have extended that analysis to determine the relationship of these parameters between patient subgroups. Mean values for non-spina bifida male subjects showed the same pattern of increase across age groups, regardless of the measured parameter. These increases were significant for continence and functional lengths but not for closure pressure. Male subjects with spina bifida showed mixed responses across age but age was not a statistically significant factor for any of the 3 parameters. Female subjects were quite uniform in the mean values across age for continence and functional lengths regardless of diagnosis. Mean values for female subjects were not uniform for closure pressure and tended to decrease with age in contrast to continence and functional lengths. The parameter continence length has a between subject standard deviation that is relatively stable across age, sex and pathology, and may be used for a basis of comparison. However, standard deviations for functional length is least variable in most subgroups of sex, age and diagnosis.

The methodology of the "Pressure-Flow-Perfusion System' used in the "Whitaker Test' was examined for factors which influence intrinsic resistance of that system. Considerable pressure changes were incurred by varying the concentration of sodium diatrizoate, perfusing needle, temperature and flow rates. For each renal pressure-flow-perfusion test, the resistance must be determined because of the effect of each variable in altering the intrinsic resistance.

Good correlation of glomerular filtration rate (GFR) measured isotopically from plasma disappearance of Tc-99m-DTPA (Sn) was shown with inulin clearance, creatinine clearance, and graded radionuclide imaging. The isotopic GFR is a simple, urineless technique not requiring continuous infusion that enables one to perform simultaneous renal imaging with one radiotracer.

Water urethral closure pressure profiles were evaluated in 66 women for reproducibility between sequential studies in patients and 3 observers.

Loss of the ureter after transplantation is uncommon and is difficult to manage. A Boari flap can be used to replace the ureter. The authors describe two patients with total ureteral loss. In each a Boari flap was used, to create a pyelocystostomy in one case and a calicecystostomy in the other. Both patients had greatly reduced serum creatinine levels and no urinary tract infections 14 and 18 months, respectively, after operation.

Using a model of the urethra designed to ensure a predictable pressure profile along its length, we investigated optimal parameters for gas and water profilometry. In gas profilometry, the response characteristics of the machine, attributable to the highly compressible nature of gas, were shown to be the most important determinants of accuracy. Gas and water profilometry have drawbacks that make clinical results inaccurate. However, if all measuring parameters are carefully recorded and considered when a pressure profile is analyzed, system error can be decreased from 62 to 5% by using the optimal pull and flow rates determined by this study.

A case of Y-type urethral duplication is described with urethrograms showing the anterior and posterior channels arising from the prostatic urethra. Postmortem studies revealed the dominant posterior channel and its relationships to the stenotic anterior channel and anus.

We have described two circumcised children who developed a urethral fistula caused by long hairs constricting and ulcerating the penis. These cases are presented to remind physicians to examine the infant's penis when he presents with a swollen glans, abnormal urinary stream, and a parent with long hair.

An unusual form of crossed renal ectopia is presented. Both kidneys are at the same level on the same side with fusion throughout their entire lengths.

Two 46,XY phenotypic female siblings, aged 1 1/2 and 8 1/2 years, have peculiar facies, cardiac, renal, musculoskeletal, and ectodermal anomalies, short stature, streak gonads, and mild developmental delay. Previous reported cases of 46,XY gonadal dysgenesis have not had major associated malformations. These children present a new constellation of anomalies unlike those seen in other types of gonadal dysgenesis and represent a new familial syndrome of 46,XY gonadal dysgenesis.

This study shows that the response time between an actual event and a recorded event on a urethral pressure profile is a function of gas flow rate and gas circuit volume. Response times varied from 1.8 to 10.8 sec. Considerable variation was noted between flow setting and actual gas flow; therefore, calibration of the instrument's gas flow meter is recommended.

A form-fitting glans condom has been developed for use in small uncircumcised males with neurogenic bladders to avoid the problems inherent with diapers. The method to make the glans condom and early successful use in 19 of 33 patients are noted.

A case of Y-type urethral triplication is reported. Urethrograms and urodynamics revealed the stenotic anterior urethras and a functional posterior urethral channel with a normal urethral pressure profile.

A variant between caudal and regression and Vater syndromes is presented which was significant anomalies of the genitourinary tract. The patient has a normal 46XX karyotype with the following urogenital anomalies: solitary pelvic kidney with megacalycosis, high ureteral bud or diverticulum, and ectopic insertion of the ureter into the proximal urethra; as well as, sacral agenesis, vaginal atresia, aberrant gonadal tissue, and uterine agenesis.

The urethral pressure profiles for 36 patients were analyzed specifically for continence zone by 3 techniques: 1) triangle, 2) planimeter and 3) weight. Graphically, the best agreement was between the weight and planimetry methods but, statistically, there was a significant difference among techniques except for the subgroup that had the smallest continence area.

The relationship of the onset of continence, staged surgical procedures and continence length was investigated in 21 patients with closed continent exstrophy. Continence occurred within a year of operation in 13 patients and 10 of these 13 patients had a Young-Dees urethroplasty and Marshall-Marchetti-Krantz suspension. In 11 of these 13 patients the continence length was greater than 1 cm. In the remaining 8 patients continence was delayed beyong a year. Only 1 of these 8 patients had undergone both bladder neck procedures and in 5 patients the continence length was greater than 1 cm.