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PubMed2001

Common urologic problems in children: guides to evaluation and referral, Part II.

A discussion of common urologic problems in children is presented to provide primary physicians with appropriate guidelines for evaluation and referrals. The problems will be discussed in two parts: Part I covered urinary tract infections, voiding dysfunctions, hematuria, and proteinuria. Part II will cover abnormalities found on antenatal renal ultrasonography, hypospadias and other penile anomalies, phimosis, undescended testes, inguinal hernia and hydroceles, and varicoceles. An adage states: "The questions in medicine never change over time--only the answers." Certainly the busy primary care physician may experience the frustration of changing evaluation guidelines established by narrow subspecialties. Guidelines for the evaluation of children with disorders of the genitourinary tract are no exception. The following presentation will address some of the most common childhood urologic problems with a brief discussion of how to evaluate and when to refer for pediatric urologic consultation or management.

Child↗
PubMed1975

Granuloma inguinale in Vietnam: successful therapy with ampicillin and lincomycin.

Thirty-six patients having granuloma inguinale were treated at the 483 USAF Hospital, Cam Ranh Bay, Republic of South Vietnam between October 1970 and September 1971. In 24 cases biopsy of the genital ulcerations revealed Donovan bodies pathognomonic for the disorder. The lesions generally did not heal during tetracycline therapy. All but 2 of the 31 cases treated primarily with ampicillin responded with complete healing of the local lesions which occurred primarily on the penis or in the groin. Of the remaining 2 patients, one responded to a second course of ampicillin and the other patient responded to a two week course of lincomycin after dorsal slit had been performed for partial phimosis and balanoposthitis. The 5 patients who were allergic to penicillin were treated primarily with lincomycin and all responded with complete healing. No previous reference could be found in the literature for the successful use of lincomycin in patients with granuloma inguinale. Further clinical trials with this medication are indicated.

Ampicillin↗
PubMed2001

[Total anterior opacification on the anterior surface of hydrophilic acrylic implanted lens].

We report a case of cloudiness occurring on the anterior surface of a hydrophilic acrylic foldable intraocular lens 1 year following implantation. This was not a case of phimosis of the capsulorhexis; the dondiness seemed secondary to fibroepithelial proliferation. Successful reopening was obtained with YAG laser. No recurrence was observed during the six months of follow-up.

Acrylic Resins↗
PubMedDate not supplied

[Effects of dioxins in the development of malignant tumors and disorders of reproductive health of the population].

The mortality caused by malignant tumors in the town of Chapaevsk, characterized by increased level of dioxins in the environment, is statistically higher than the expected values. For men the relative risk of general morbidity is 1.9 and mortality, 1.8; for lung cancer: morbidity, 3.3 and mortality 3.1; for urogenital cancer: morbidity, 3.6 and mortality, 2.6; for gastric cancer: morbidity 1.9 and mortality, 1.7. In women the morbidity and mortality due to breast cancer (relative risks 1.9 and 2.1, respectively) and cancer of the cervix uteri (relative risks 2.1 and 1.8, respectively) are increased. Changes in the reproductive health of residents of this town are as follows: high incidence of spontaneous abortions, appearance of small-for-date babies, and genital disorders in body (cryptorchidism, phimosis, hypospadia, delayed sexual development).

Adolescent↗
PubMed2002

Adult circumcision outcomes study: effect on erectile function, penile sensitivity, sexual activity and satisfaction.

PURPOSE: Evidence concerning the effect of circumcision on sexual function is lacking. Men circumcised as adults are potentially in a unique position to comment on the effect of a prepuce on sexual intercourse. We examine sexual function outcomes in men who have experienced sexual intercourse in the uncircumcised and circumcised states. MATERIALS AND METHODS: Men 18 years old or older when circumcised were identified by billing records during a 5-year period at an academic medical center. Medical charts were reviewed for confirmation of the procedure and to identify the indication(s). These men were surveyed to assess erectile function, penile sensitivity, sexual activity and overall satisfaction. Data were analyzed using paired t tests to compare category scores before and after circumcision. RESULTS: A total of 123 men were circumcised as adults. Indications for circumcision included phimosis in 64% of cases, balanitis in 17%, condyloma in 10%, redundant foreskin in 9% and elective in 7%. The response rate was 44% among potential responders. Mean age of responders was 42 years at circumcision and 46 years at survey. Adult circumcision appears to result in worsened erectile function (p = 0.01), decreased penile sensitivity (p = 0.08), no change in sexual activity (p = 0.22) and improved satisfaction (p = 0.04). Of the men 50% reported benefits and 38% reported harm. Overall, 62% of men were satisfied with having been circumcised. CONCLUSIONS: Our findings may help urologists better counsel men undergoing circumcision as adults. Prospective studies are needed to better understand the relationship between circumcision and sexual function.

Adult↗
PubMed2002

[Diagnosis and treatment of penile cancer].

BACKGROUND: Penile cancer is a rare malignancy in Norway with about 40 new cases each year. MATERIAL AND METHODS: An overview on diagnosis and treatment of penile cancer is given and the guidelines from the European Association of Urology are presented. RESULTS: Phimosis and poor genital hygiene are pre-disposing conditions for penile cancer. Condylomata acuminatum and leukoplakia should be regarded as premalignant lesions. The superficial form of penile cancer should be treated by laser, surgery or radiotherapy. When the cancer infiltrates into corpus cavernosum or corpus spongiosum, or the tumour displays a poorly differentiated histology, a partial or total amputation of the penis has to be performed. Inguinal lymphadenectomy is recommended in patients presenting with a tumour > or = pT2 or if the histology reveals a moderately or poorly differentiated cancer. Five-year survival rate is about 80% for patients with localised tumour, and about 50% in patients with regional lymph node metastasis. INTERPRETATION: We recommend that the treatment of penile cancer is performed in the regional hospitals.

Carcinoma in Situ↗
PubMed2002

Day-case inguinal herniotomy in Chinese children: retrospective study.

OBJECTIVE: To review the results of day-case procedures performed for inguinal hernia or hernia-hydrocele complex in Chinese children. DESIGN: Retrospective study. SETTING: Day Surgery Centre of a district hospital, Hong Kong. PATIENTS: Medical records of 255 consecutive paediatric patients admitted to the Day Surgery Centre for inguinal herniotomy between July 1993 and December 1997 were reviewed. A telephone survey was conducted to assess any long-term morbidity relating to the operation. MAIN OUTCOME MEASURES: Patient demographics, success of day-case herniotomy, short-term and long-term morbidity. RESULTS: There were 230 boys and 25 girls with a mean age of 8.8 years (range, 3 months to 18 years). Seven patients had bilateral herniotomy for bilateral hernia and 14 had circumcision for co-existing phimosis. Eight boys developed recurrence and three had a contralateral inguinal hernia. Postoperative ascent of the testis occurred in three patients, one of whom required orchidopexy. The unplanned admission rate was 1.6%, all for poor pain control. There were four herniotomy wound complications (two haematomas and two infections) and two circumcision wound haemorrhages. CONCLUSIONS: Day-case inguinal herniotomy is safe and acceptable to Chinese children. Given these satisfactory results, paediatric patients with inguinal hernia can be safely managed with ambulatory surgery performed by suitably experienced surgeons.

Adolescent↗
PubMed2002

[A case of acid burn of the penis].

A 27-year-old man presented to our hospital complaining of multiple mild injuries sustained in an attack of violence at the workplace. He had received chemical burns to the penis induced by hydrochloric acid and had developed severe phimosis. He complained of pain on erection and ballooning during urination. The foreskin was partially resected with foreskin grafting for the stricture. The postoperative outcome was favorable and his symptoms were relieved.

Adult↗
PubMed2002

Use of capsular tension ring in phacoemulsification. Indications and technique.

The capsular tension ring (CTR) was originally introduced to reinforce the zonule in eyes with zonular dehiscence and to prevent capsular phimosis in eyes at risk for postoperative capsular shrinkage. Since then, other designs and applications have been developed and described. Modified CTRs with shields can be used in eyes with iris coloboma. A CTR with loops is intended for scleral fixation. Studies are underway to determine if the presence of the CTR helps avoid or limit capsular opacification. A number of different insertion techniques with the aid of manipulators, injectors and traction sutures have been described. We have developed a technique that is particularly effective in cases of zonular dehiscence due to its low solicitation to the damaged bag.

Humans↗
PubMed2003

[Day Surgery. Five years of experience and activity].

BACKGROUND: The aim of this paper is to evaluate the management of an integrated unit of Day Surgery in a General Surgery Department. METHODS: An outline of the first 5 years of activity is presented. Setting of investigation: little provincial hospital. Patients have been selected on a basis of Day Surgery specific features: a total of 1,294 patients. Pathologies treated: inguinal hernias, phlebectasias, phimosis, borsitis, arthritic cysts, tendon cysts, carpal tunnel, Dupuytren's disease ("crispatura tendinum"), lymphadenitis, mammary nodules, hemorrhoids, hydroceles, varicoceles, adipomas. Patients' selection parameters, surgical operation type and modalities, postoperative course, protected discharges from hospital, follow-up and complications have all been carefully recorded. RESULTS: The most numerous operations were related to hernial pathology (54.32%) and to adipomas (10.81%). The form of anesthesia was mainly loco-regional. Only 4 cases (0.3%) had to be hospitalized for the night after operation. COMPLICATIONS: 1 serious wound infection, needing removal of the hernial prosthesis; 1 painful "tumefaction" on the inguinal wound for hernioplastic operation; 3 "seromas" in inguinal hernioplastics. CONCLUSIONS: Advantages of Day-Surgery: cut in health costs due to the reduction of admissions to hospital; reduction in hospital infections and in surgical wounds; reduction in drug use; thinning of waiting lists; increase of available beds for other pathologies; reduction of disability days; high appreciation index.

Adolescent↗
PubMedDate not supplied

[Epidemiology of urologic pediatric emergencies in our hospital, 1990].

The article's objective is to study the epidemiological patterns which define the paediatric urological emergencies within the area of influence of our hospital. To this end, 187 protocols of the paediatric emergencies attended by the urologist in 1990 were retrospectively reviewed. The most frequently observed pathologies were balanitis-phimosis, acute scrotum and genito-urinary injuries. A clear relationship of the type of disease to the patient's age and treatment, as well as some time-related variations were observed. About 40% of all cases could had been treated at a non-emergency outpatient clinic.

Adolescent↗
PubMed1992

Hydrophilic expanders for the congenital anophthalmic socket.

The congenitally contracted socket often poses a challenging management problem; early surgery may be necessary in spite of the attendant difficulties. A series of patients is presented, with particular emphasis upon the use of a new hydrophilic expander in the severely contracted socket, to illustrate our current management protocol. Factors pertinent to orbital development and growth are discussed. Two types of contracted sockets are identified that appear to correlate with the presence or absence of an eye or ocular remnant. Use of a hydrophilic expander in the severely contracted anophthalmic socket with marked lid phimosis has enabled subsequent fitting and retention of a hard conformer in many of these cases, thus obviating early interventional surgery.

Adolescent↗
PubMedDate not supplied

[Psychological aspects of genital surgery in childhood].

Although the children's urogenital surgery is discipline in expansion which successfully solves even the most complicated anomalies of urogeniral tract, only lately there is enough attention paid on the psychological aspects of these anomalies and surgical operation on genitals. The boys with hypospadias, phimosis and other congenital anomalies represent a risky group for the difficulties in forming the sexual identity and for the appearance of different psychopathology in their childhood and later in life. The surgical operation itself presents a traumatic situation for the child and it may discredit the later psychosexual development of these boys in a great deal. The priority is increasing the sensitivity of children's surgeons for these problems, not only for modernizing the surgical operation, considering the knowledge of normal psychological stages of development, but also for recognizing the psychological phenomena on time and for the consultative joining of the appropriate experts. It is very important to work with these children's parents in view of offering them help for better accepting their child's organic problem, to be less anxious on account of the anomaly and the operation itself and to be more able for better understanding of their child's feelings and his experience. The child's actual psychological condition and his later psychosexual development depend to a great extent on their parent's correct attitude. The caustical survey of the boys with hypospadias illustrates some of the psychological problems which appear with children who had an reparation of hypospadias.

Child↗
PubMed2003

[Original dorsal plasty of the glans in distal hypospadias].

UNLABELLED: The long-term follow-up of patients operated for hypospadias often reveals progressive recession of the neo-meatus, even when it is initially correctly situated. MATERIAL AND METHOD: To overcome this disadvantage, we decided to prolong the glanular groove by longitudinally incising the distal quarter of the dorsal surface of the glans. Transverse suture then defines the margins of the neo-meatus, creates or deepens the glanular groove and promotes the formation of a thick anterior wall which deeply covers a short triangular Mathieu flap. The foreskin is systematically reconstructed. Bladder drainage is ensured by an urethral stent attached to the glans for 7 days. Treatment can now be performed as an outpatient procedure. From 1992 to June 2002, 374 children, with a mean age of 25 months (range: 10 to 129 months) were treated by this technique, with foreskin reconstruction in 307 cases. The preoperative position of the meatus was posterior glanular in 31 cases (83%), peno-glanular in 191 cases (52%) and anterior penile in 152 cases (40.7%). RESULTS: All patients were reviewed with a mean follow-up of 19 months (range: 1 to 123 months). The position of the meatus was normal apical in 309 cases (82.6%): glanular: middle: 41 cases (11%); posterior: 14 cases (17%), peno-glanular: 1 case, dorsal: 6 cases (1.6%), not specified: 3 cases (tight phimosis). COMPLICATIONS: 25 fistulas (6.7%), 4 stenoses (1.1%). DISCUSSION: The usual glanular urethroplasty, by simple suture of the margins, often results in a large meatus situated in the middle of the glans. When the meatus is placed below the glans, recession can lead to an anterior penile meatus. Dorsal glanuloplasty, by elongating and deepening the glanular groove, while preserving the urethral plate, allows the construction of a solid wall around the neourethra, reducing the risks of recession and enlargement of the meatus which retains a split-like appearance and ensures a good stream. Systematic foreskin reconstruction probably also plays a role in the quality of healing. CONCLUSION: This dorsal glanuloplasty, which corrects the penis and urinary stream in more than 80% of cases without any major disadvantages, is a useful technique in hypospadias repair.

Child, Preschool↗
PubMed1992

[Kallmann's syndrome in a child--a case report].

The patient was a male child 6 years and 6 months old. He visited our hospital because of bilateral cryptorchism and true phimosis. Since he was found to have fairly small testis, micropenis, and anosmia, endocrinological examination was performed. The plasma levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH) were at the lower limit of normal values. LH gave a low reaction to the LH-releasing hormone test, while the reaction of FSH was near the lower limit of normal values. In the human chorionic gonadotropin test, there was no rise in the plasma levels of testosterone. Nor was there any reaction to the venous olfactory test with Alinamine (thiamine propyldisulfide). Accordingly, the patient was diagnosed as having Kallmann's syndrome. A search of the literature reveals few reports that deal with Kallmann's syndrome in infancy. Early diagnosis seems to be of significance, however, to institute early appropriate treatment to prompt the development of proper secondary sexual characteristics and ensure normal future fertility.

Child↗
PubMedDate not supplied

Risks and relevance of preputial reconstruction in hypospadia repair.

AIM: To assess the risks related to preputial reconstruction and its relevance for parents of children undergoing hypospadias repair. MATERIALS AND METHODS: One-hundred-and-eighty-six children with distal hypospadias underwent circumcision or preputial reconstruction during the hypospadias repair. The type of procedure was chosen according to anatomical conditions and parents preferences after a careful explanation of possible related risks. Postoperative complications, outcomes, parents' satisfaction were assessed comparing circumcised and uncircumcised patients. RESULTS: No statistical differences in urethral complications were found between the two groups. Urethral or meatal strictures occurred in 11 (6.9%) cases after preputioplasty and in 2 (7.4%) cases after circumcision. Fistulas occurred in 8 (5%) cases after preputial reconstruction and in 1 (3.7%) after circumcision. Preputial reconstruction involved 6 cases (3.7%) of dehiscence and 10 of phimosis (6.2%) as specific complications of this procedure. After a mean follow-up of 3.7 years all the parents stated to be satisfied of the cosmetic results. CONCLUSION: Preputial reconstruction is feasible in many patients with distal hypospadias and it should be considered in accordance with parents' preferences. Parents should be informed that this procedure involves an increased risk of complications in hypospadias repair.

Humans↗
PubMed1992

[Arndt-Gottron scleromyxedema. Case report and review of therapeutic possibilities].

We report on a 54-year-old patient with an 11-year history of Arndt-Gottron scleromyxoedema. We found typical lichenoid papules, diffuse skin thickening and skin hardening. Clinical and laboratory investigations revealed a monoclonal gammopathy of the IgG1 type, normal histology of the bone marrow and normal urine. Therefore, a diagnosis of monoclonal gammopathy of undetermined significance was recorded. Phimosis and stenosis of the urethra were the only other pathologic findings. Systemic treatment with chlorambucil and PUVA had little beneficial effect on the skin thickening after 9 months.

Biopsy↗