DOCSLIB.ORG

EAU Guidelines on Paediatric Urology 2017

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

EAU Guidelines on Paediatric Urology S. Tekgül (Chair), H.S. Dogan, R. Kocvara, J.M. Nijman (Vice-chair), C. Radmayr, R. Stein Guidelines Associates: M.S. Silay, S. Undre, J. Quaedackers European Society for Paediatric Urology © European Association of Urology 2017 TABLE OF CONTENTS PAGE 1. INTRODUCTION 8 1.1 Aim 8 1.2 Panel composition 8 1.3 Available publications 8 1.4 Publication history 8 1.5 Summary of changes 8 1.5.1 New and changed recommendations 9 2. METHODS 10 2.1 Peer review 10 2.2 Future goals 10 3. THE GUIDELINE 10 3.1 Phimosis 10 3.1.1 Epidemiology, aetiology and pathophysiology 10 3.1.2 Classification systems 10 3.1.3 Diagnostic evaluation 10 3.1.4 Management 10 3.1.5 Follow-up 11 3.1.6 Summary of evidence and recommendations for the management of phimosis 11 3.2 Management of undescended testes 11 3.2.1 Background 11 3.2.2 Classification 12 3.2.2.1 Palpable testes 12 3.2.2.2 Non-palpable testes 13 3.2.3 Diagnostic evaluation 13 3.2.3.1 History 13 3.2.3.2 Physical examination 13 3.2.3.3 Imaging studies 13 3.2.4 Management 13 3.2.4.1 Medical therapy 13 3.2.4.1.1 Medical therapy for testicular descent 14 3.2.4.1.2 Medical therapy for fertility potential 14 3.2.4.2 Surgical therapy 14 3.2.4.2.1 Palpable testes 14 3.2.4.2.1.1 Inguinal orchidopexy 14 3.2.4.2.1.2 Scrotal orchidopexy 15 3.2.4.2.2 Non-palpable testes 15 3.2.4.2.3 Complications of surgical therapy 16 3.2.4.2.4 Surgical therapy for undescended testes after puberty 16 3.2.5 Undescended testes and fertility 16 3.2.6 Undescended testes and malignancy 17 3.2.7 Summary of evidence and recommendations for the management of undescended testes 17 3.3 Hydrocele 17 3.3.1 Epidemiology, aetiology and pathophysiology 17 3.3.2 Diagnostic evaluation 18 3.3.3 Management 18 3.3.4 Summary of evidence and recommendations for the management of hydrocele 18 3.4 Acute scrotum 19 3.4.1 Epidemiology, aetiology and pathophysiology 19 3.4.2 Diagnostic evaluation 19 3.4.3 Management 20 3.4.3.1 Epididymitis 20 3.4.3.2 Testicular torsion 20 3.4.3.3 Surgical treatment 20 3.4.4 Follow-up 20 2 PAEDIATRIC UROLOGY - LIMITED UPDATE MARCH 2017 3.4.4.1 Fertility 20 3.4.4.2 Subfertility 21 3.4.4.3 Androgen levels 21 3.4.4.4 Unanswered questions 21 3.4.5 Summary of evidence and recommendations for the management of acute scrotum in children 21 3.5 Hypospadias 21 3.5.1 Epidemiology, aetiology and pathophysiology 21 3.5.1.1 Epidemiology 21 3.5.2 Risk factors 21 3.5.3 Classification systems 22 3.5.4 Diagnostic evaluation 22 3.5.5 Management 22 3.5.5.1 Indication for reconstruction and therapeutic objectives 22 3.5.5.2 Pre-operative hormonal treatment 23 3.5.5.3 Age at surgery 23 3.5.5.4 Penile curvature 23 3.5.5.5 Urethral reconstruction 23 3.5.5.6 Re-do hypospadias repairs 24 3.5.5.7 Penile reconstruction following formation of the neourethra. 24 3.5.5.8 Urine drainage and wound dressing 24 3.5.5.9 Outcome 25 3.5.6 Follow-up 25 3.5.7 Summary of evidence and recommendations for the management of hypospadias 26 3.6 Congenital penile curvature 26 3.6.1 Epidemiology, aetiology and pathophysiology 26 3.6.2 Diagnostic evaluation 26 3.6.3 Management 26 3.6.4 Summary of evidence and recommendations for the management of congenital penile curvature 27 3.7 Varicocele in children and adolescents 27 3.7.1 Classification systems 27 3.7.2 Diagnostic evaluation 28 3.7.3 Management 28 3.7.4 Summary of evidence and recommendations for the management of varicocele 29 3.8 Urinary tract infections in children 29 3.8.1 Epidemiology, aetiology and pathophysiology 29 3.8.2 Classification systems 29 3.8.2.1 Classification according to site 29 3.8.2.2 Classification according to episode 30 3.8.2.3 Classification according to severity 30 3.8.2.4 Classification according to symptoms 30 3.8.2.5 Classification according to complicating factors 30 3.8.3 Diagnostic evaluation 30 3.8.3.1 Medical history 30 3.8.3.2 Clinical signs and symptoms 30 3.8.3.3 Physical examination 31 3.8.3.4 Urine sampling, analysis and culture 31 3.8.3.4.1 Urine sampling 31 3.8.3.4.2 Urinalysis 32 3.8.3.4.3 Urine culture 32 3.8.3.5 Imaging 32 3.8.3.5.1 Ultrasound 32 3.8.3.5.2 Radionuclide scanning 33 3.8.3.5.3 Voiding cystourethrography 33 3.8.3.6 Bladder and bowel dysfunction 33 3.8.4 Management 33 3.8.4.1 Administration route 33 PAEDIATRIC UROLOGY - LIMITED UPDATE MARCH 2017 3 3.8.4.2 Duration of therapy 33 3.8.4.3 Antimicrobial agents 34 3.8.4.4 Chemoprophylaxis 36 3.8.4.5 Monitoring of UTI 37 3.8.5 Summary of evidence and recommendations for the management of UTI in children 37 3.9 Day-time lower urinary tract conditions 38 3.9.1 Epidemiology, aetiology and pathophysiology 38 3.9.2 Classification systems 38 3.9.2.1 Filling-phase dysfunctions 39 3.9.2.2 Voiding-phase (emptying) dysfunctions 39 3.9.3 Diagnostic evaluation 39 3.9.4 Management 39 3.9.4.1 Standard therapy 39 3.9.4.2 Specific interventions 40 3.9.5 Summary of evidence and recommendations for the management of day-time lower urinary tract conditions 40 3.10 Monosymptomatic enuresis 40 3.10.1 Epidemiology, aetiology and pathophysiology 40 3.10.2 Classification systems 41 3.10.3 Diagnostic evaluation 41 3.10.4 Management 41 3.10.4.1 Supportive treatment measures 41 3.10.4.2 Alarm treatment 41 3.10.4.3 Medication 41 3.10.5 Summary of evidence and recommendations for the management of monosymptomatic enuresis 42 3.11 Management of neurogenic bladder 43 3.11.1 Epidemiology, aetiology and pathophysiology 43 3.11.2 Classification systems 43 3.11.3 Diagnostic evaluation 44 3.11.3.1 Urodynamic studies 44 3.11.3.1.1 Method of urodynamic study 44 3.11.3.1.2 Uroflowmetry 44 3.11.3.2 Cystometry 44 3.11.4 Management 45 3.11.4.1 Investigations 46 3.11.4.2 Early management with intermittent catheterisation 46 3.11.4.3 Medical therapy 47 3.11.4.4 Management of bowel incontinence 47 3.11.4.5 Urinary tract infection 47 3.11.4.6 Sexuality 48 3.11.4.7 Bladder augmentation 48 3.11.4.8 Bladder outlet procedures 48 3.11.4.9 Continent stoma 48 3.11.4.10 Total bladder replacement 48 3.11.5 Follow-up 49 3.11.6 Summary of evidence and recommendations for the management of neurogenic bladder 49 3.12 Dilatation of the upper urinary tract (UPJ and UVJ obstruction) 49 3.12.1 Epidemiology, aetiology and pathophysiology 49 3.12.2 Diagnostic evaluation 50 3.12.2.1 Antenatal ultrasound 50 3.12.2.2 Postnatal ultrasound 50 3.12.2.3 Voiding cystourethrogram 50 3.12.2.4 Diuretic renography 50 3.12.3 Management 51 3.12.3.1 Prenatal management 51 3.12.3.1.1 Antibiotic prophylaxis for antenatal hydronephrosis (ANH) 51 3.12.3.2 UPJ obstruction 52 4 PAEDIATRIC UROLOGY - LIMITED UPDATE MARCH 2017 3.12.3.3 Megaureter 52 3.12.3.3.1 Non-operative management 52 3.12.3.3.2 Surgical management 52 3.12.4 Conclusion 52 3.12.5 Summary of evidence and recommendations for the management of UPJ-, UVJ-obstruction 53 3.13 Vesicoureteric reflux 53 3.13.1 Epidemiology, aetiology and pathophysiology 53 3.13.2 Diagnostic evaluation 54 3.13.2.1 Infants presenting because of prenatally diagnosed hydronephrosis 55 3.13.2.2 Siblings and offspring of reflux patients 55 3.13.2.3 Recommendations for paediatric screening of VUR 55 3.13.2.4 Children with febrile urinary tract infections 56 3.13.2.5 Children with lower urinary tract symptoms and vesicoureteric reflux 56 3.13.3 Disease management 56 3.13.3.1 Non-surgical therapy 56 3.13.3.1.1 Follow-up 56 3.13.3.1.2 Continuous antibiotic prophylaxis 56 3.13.3.2 Surgical treatment 57 3.13.3.2.1 Subureteric injection of bulking materials 57 3.13.3.2.2 Open surgical techniques 57 3.13.3.2.3 Laparoscopy and robot-assisted 58 3.13.4 Summary of evidence and recommendations for t he management of vesicoureteric reflux in childhood 58 3.14 Urinary stone disease 60 3.14.1 Epidemiology, aetiology and pathophysiology 60 3.14.2 Classification systems 60 3.14.2.1 Calcium stones 60 3.14.2.2 Uric acid stones 62 3.14.2.3 Cystine stones 62 3.14.2.4 Infection stones (struvite stones) 62 3.14.3 Diagnostic evaluation 62 3.14.3.1 Imaging 63 3.14.3.2 Metabolic evaluation 63 3.14.4 Management 64 3.14.4.1 Extracorporeal shockwave lithotripsy 65 3.14.4.2 Percutaneous nephrolithotomy (PCNL) 66 3.14.4.3 Ureterorenoscopy 66 3.14.4.4 Open or laparoscopic stone surgery 67 3.14.5 Summary of evidence and recommendations for the management of urinary stones 68 3.15 Obstructive pathology of renal duplication: ureterocele and ectopic ureter 69 3.15.1 Epidemiology, aetiology and pathophysiology 69 3.15.1.1 Ureterocele 69 3.15.1.2 Ectopic ureter 69 3.15.2 Classification systems 69 3.15.2.1 Ureterocele 69 3.15.2.1.1 Ectopic (extravesical) ureterocele 69 3.15.2.1.2 Orthotopic (intravesical) ureterocele 69 3.15.2.2 Ectopic ureter 69 3.15.3 Diagnostic evaluation 70 3.15.3.1 Ureterocele 70 3.15.3.2 Ectopic ureter 70 3.15.4 Management 70 3.15.4.1 Ureterocele 70 3.15.4.1.1 Early treatment 70 3.15.4.1.2 Re-evaluation 71 3.15.4.2 Ectopic ureter 71 3.15.5 Summary of evidence and recommendations for the management of obstructive pathology of renal duplication: ureterocele and ectopic ureter 72 PAEDIATRIC UROLOGY - LIMITED UPDATE MARCH 2017 5 3.16 Disorders of sex development 72 3.16.1 Epidemiology, aetiology and pathophysiology 72 3.16.1.1 Micropenis 73 3.16.2 Diagnostic evaluation 73 3.16.2.1 The neonatal emergency 73 3.16.2.1.1 Family history and clinical examination 73 3.16.2.1.2 Choice of laboratory investigations 74 3.16.2.2 Gender assignment 74 3.16.2.3 Role of the paediatric urologist 75 3.16.2.3.1 Clinical examination 75 3.16.2.3.2 Investigations 75 3.16.3 Management 76 3.16.3.1 Feminising surgery 76 3.16.3.2 Masculinising surgery 76 3.16.4
Recommended publications
  • Webbed Penis

    Webbed Penis

    Kathmandu University Medical Journal (2010), Vol. 8, No. 1, Issue 29, 95-96 Case Note Webbed penis: A rare case Agrawal R1, Chaurasia D2, Jain M3 1Resident in Surgery, 2Associate Professor, Department of Urology, 3Assistant Professor, Department of Plastic and Reconstructive Surgery, MLN Medical College, Allahabad (India) Abstract Webbed penis belongs to a rare and little-known defect of the external genitalia. The term denotes the penis of normal size for age hidden in the adjacent scrotal and pubic tissues. Though rare, it can be treated easily by surgery. A case of webbed penis is presented with brief review of literature. Key words: penis, webbed ebbed penis is a rare anomaly of structure of Wpenis. Though a congenital anomaly, usually the patient presents in late childhood or adolescence. Skin of penis forms the shape of a web, covering whole or part of penis circumferentially; with or without glans, burying the penile tissue inside. The length of shaft is normal with normal stretched length. Phimosis may be present. The penis appears small without any diffi culty in voiding function. Fig 1: Penis showing web Fig 2: Markings for double of skin on anterior Z-plasty on penis Case report aspect Our patient, a 17 year old male, presented to us with congenital webbed penis. On examination, skin webs Discussion were present on both lateral sides from prepuce to lateral Webbed penis is a developmental malformation with aspect of penis.[Fig. 1] On ventral aspect, the skin web less than 60 cases reported in literature. The term was present from prepuce to inferior margin of median denotes the penis of normal size for age hidden in the raphe of scrotum.
  • “If We Could Change Ourselves, the Tendencies

    “If We Could Change Ourselves, the Tendencies

    10/10/17 GENDERED INEQUALITY: DECONSTRUCTING BARRIERS TO ENABLE SENSITIVE SYSTEMIC “IF WE COULD CHANGE OURSELVES, PRACTICE WITH DIVERSE PEOPLE AND THE TENDENCIES IN THE WORLD RELATIONSHIPS WOULD ALSO CHANGE.” ANNE PROUTY - MAHATMA GANDHI OCTOBER 2017 AUSTRALIAN ASSOCIATION FOR FAMILY THERAPY ANNUAL CONFERENCE ADELAIDE, AUSTRALIA GLOBAL “GENDER” (Binary) Gender Inequities DEADLY CUTTING EDGE * MISERABLE TO PROMOTE SOCIAL JUSTICE * REAL ADVOCATE FOR CLIENTS SEX AND GENDER 2007 “YogyAkArtA Principles”: 28 Principles oF the THE WORLD HEALTH ORGANISATION HAS RECOGNISED ApplicAtion oF International HumAn Rights LAw in SEX AND GENDER GLOBALLY AS CORE SOCIAL RelAtion to SexuaL Orientation DETERMINANTS OF PHYSICAL AND MENTAL HEALTH and Gender Identity 64 AND WELL-BEING 44 • LGBTI are 11% of Australians as of 20146 • www.YogyAkArtAprinciples.org • GENDER Keynote/YogyAkArtA principles_en.pdF • 1.7% oF AustrAliAns Are estimated to be Intersex (AustraliAn HumAn Rights Commission) • 2% oF people globAlly estimAted to be non-binAry gender • 34% oF LGBTI AustrAliAns hide their identity when accessing services 1 10/10/17 ApproAches to IDENTITY SociAl Justice MultiPLe CulturaL Communities • WHO DEFINES WHOM? Human Diversity within Communities/Contexts • EACH PERSON’S EXPERIENCE? Human Diversity Across LifesPans • BY INTERACTING WITH EACH OTHER? • INTERACTING BY PROXY AND VIA COMMUNITIES? INTERSECTIONALITY INTERSECTIONALITY - IDENTITIES INTERSECTIONALITY - IDENTITIES SEX &/OR GENDER ID ETHNIC ID SEX &/OR GENDER ID ETHNIC ID SEXUAL ORIENTATION SPIRITUAL
  • Guidelines on Paediatric Urology S

    Guidelines on Paediatric Urology S

    Guidelines on Paediatric Urology S. Tekgül (Chair), H.S. Dogan, E. Erdem (Guidelines Associate), P. Hoebeke, R. Ko˘cvara, J.M. Nijman (Vice-chair), C. Radmayr, M.S. Silay (Guidelines Associate), R. Stein, S. Undre (Guidelines Associate) European Society for Paediatric Urology © European Association of Urology 2015 TABLE OF CONTENTS PAGE 1. INTRODUCTION 7 1.1 Aim 7 1.2 Publication history 7 2. METHODS 8 3. THE GUIDELINE 8 3A PHIMOSIS 8 3A.1 Epidemiology, aetiology and pathophysiology 8 3A.2 Classification systems 8 3A.3 Diagnostic evaluation 8 3A.4 Disease management 8 3A.5 Follow-up 9 3A.6 Conclusions and recommendations on phimosis 9 3B CRYPTORCHIDISM 9 3B.1 Epidemiology, aetiology and pathophysiology 9 3B.2 Classification systems 9 3B.3 Diagnostic evaluation 10 3B.4 Disease management 10 3B.4.1 Medical therapy 10 3B.4.2 Surgery 10 3B.5 Follow-up 11 3B.6 Recommendations for cryptorchidism 11 3C HYDROCELE 12 3C.1 Epidemiology, aetiology and pathophysiology 12 3C.2 Diagnostic evaluation 12 3C.3 Disease management 12 3C.4 Recommendations for the management of hydrocele 12 3D ACUTE SCROTUM IN CHILDREN 13 3D.1 Epidemiology, aetiology and pathophysiology 13 3D.2 Diagnostic evaluation 13 3D.3 Disease management 14 3D.3.1 Epididymitis 14 3D.3.2 Testicular torsion 14 3D.3.3 Surgical treatment 14 3D.4 Follow-up 14 3D.4.1 Fertility 14 3D.4.2 Subfertility 14 3D.4.3 Androgen levels 15 3D.4.4 Testicular cancer 15 3D.5 Recommendations for the treatment of acute scrotum in children 15 3E HYPOSPADIAS 15 3E.1 Epidemiology, aetiology and pathophysiology
  • Testicular Prosthesis in Paediatric Urology: Current Concepts and Available Alternatives

    Testicular Prosthesis in Paediatric Urology: Current Concepts and Available Alternatives

    Review Article Testicular Prosthesis in Paediatric Urology: Current Concepts and Available Alternatives Nitin Sharma, M. Bajpai and Shasanka Shekhar Panda Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029, India Abstract: Prosthesis is an artificial material used as a replacement for its natural counterpart. Use of testicular prosthesis in pediatric urology is limited and indications are well defined. In this review we tried to find out and summarize the current indications and available options in pediatric urology for these prosthesis. Keywords: Testicular prosthesis, Orchidometer, Anorchia Prosthesis is an artificial material used as a replacement for c). Torsion its natural counterpart. Use of testicular prosthesis in pediatric d). Dysplasia urology is limited and indications are well defined. In this e). Dysgenesis review we tried to find out and summarize the current f). Intersex disorders requiring male genitoplasty indications and available options in pediatric urology for these B). Assessment of the size of prosthesis required: prosthesis. An extensive PubMed, Medline and Google scholar search was done to see the available literature and This entirely depends upon the age at placement of the current practice. For the purpose of simplicity the subsequent prosthesis and the scrotal development. The assessment of discussion is under following heads: the volume of testis is done using an instrument called as Orchidometer/ Orchiometer. The orchidometer was introduced Indications for the first time by Swiss pediatric endocrinologist Prof. Assessment of size required Andrea Prader1 of university of Zurich in 1966. It consists of Timing a string of twelve numbered wooden or plastic beads (some Procedure time referred as Prader's balls, medical worry beads or Complications endocrine rosary) of increasing size from one to twenty-five Evolution and currently available options milliliters (Fig 1).
  • Guidelines on Paediatric Urology S

    Guidelines on Paediatric Urology S

    Guidelines on Paediatric Urology S. Tekgül, H. Riedmiller, E. Gerharz, P. Hoebeke, R. Kocvara, R. Nijman, Chr. Radmayr, R. Stein European Society for Paediatric Urology © European Association of Urology 2011 TABLE OF CONTENTS PAGE 1. INTRODUCTION 6 1.1 Reference 6 2. PHIMOSIS 6 2.1 Background 6 2.2 Diagnosis 6 2.3 Treatment 7 2.4 References 7 3. CRYPTORCHIDISM 8 3.1 Background 8 3.2 Diagnosis 8 3.3 Treatment 9 3.3.1 Medical therapy 9 3.3.2 Surgery 9 3.4 Prognosis 9 3.5 Recommendations for crytorchidism 10 3.6 References 10 4. HYDROCELE 11 4.1 Background 11 4.2 Diagnosis 11 4.3 Treatment 11 4.4 References 11 5. ACUTE SCROTUM IN CHILDREN 12 5.1 Background 12 5.2 Diagnosis 12 5.3 Treatment 13 5.3.1 Epididymitis 13 5.3.2 Testicular torsion 13 5.3.3 Surgical treatment 13 5.4 Prognosis 13 5.4.1 Fertility 13 5.4.2 Subfertility 13 5.4.3 Androgen levels 14 5.4.4 Testicular cancer 14 5.4.5 Nitric oxide 14 5.5 Perinatal torsion 14 5.6 References 14 6. Hypospadias 17 6.1 Background 17 6.1.1 Risk factors 17 6.2 Diagnosis 18 6.3 Treatment 18 6.3.1 Age at surgery 18 6.3.2 Penile curvature 18 6.3.3 Preservation of the well-vascularised urethral plate 19 6.3.4 Re-do hypospadias repairs 19 6.3.5 Urethral reconstruction 20 6.3.6 Urine drainage and wound dressing 20 6.3.7 Outcome 20 6.4 References 21 7.
  • Level Estimates of Maternal Smoking and Nicotine Replacement Therapy During Pregnancy

    Level Estimates of Maternal Smoking and Nicotine Replacement Therapy During Pregnancy

    Using primary care data to assess population- level estimates of maternal smoking and nicotine replacement therapy during pregnancy Nafeesa Nooruddin Dhalwani BSc MSc Thesis submitted to the University of Nottingham for the degree of Doctor of Philosophy November 2014 ABSTRACT Background: Smoking in pregnancy is the most significant preventable cause of poor health outcomes for women and their babies and, therefore, is a major public health concern. In the UK there is a wide range of interventions and support for pregnant women who want to quit. One of these is nicotine replacement therapy (NRT) which has been widely available for retail purchase and prescribing to pregnant women since 2005. However, measures of NRT prescribing in pregnant women are scarce. These measures are vital to assess its usefulness in smoking cessation during pregnancy at a population level. Furthermore, evidence of NRT safety in pregnancy for the mother and child’s health so far is nebulous, with existing studies being small or using retrospectively reported exposures. Aims and Objectives: The main aim of this work was to assess population- level estimates of maternal smoking and NRT prescribing in pregnancy and the safety of NRT for both the mother and the child in the UK. Currently, the only population-level data on UK maternal smoking are from repeated cross-sectional surveys or routinely collected maternity data during pregnancy or at delivery. These obtain information at one point in time, and there are no population-level data on NRT use available. As a novel approach, therefore, this thesis used the routinely collected primary care data that are currently available for approximately 6% of the UK population and provide longitudinal/prospectively recorded information throughout pregnancy.
  • MANAGEMENT of CONCEALED PENIS in CHILDREN Mohamed A

    MANAGEMENT of CONCEALED PENIS in CHILDREN Mohamed A

    AAMJ, Vol. 6, N. 2, April, 2008 ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ MANAGEMENT OF CONCEALED PENIS IN CHILDREN Mohamed A. Abdel Aziz, Samir H.Gouda, Sayed H.Abdalla, Sabri M. Khaled, and Ahmed T. Sayed Paediatric Surgery, Urology, And Plastic Departments, Faculty of Medicine, Al-Azhar University, Cairo. ------------------------------------------------------------------------------------------------- SUMMARY Objectives: A concealed penis or inconspicuous penis is defined as a phallus of normal size buried in prepubic tissue (buried penis), enclosed in scrotal tissue (webbed penis), or trapped by scar tissue after penile surgery (trapped penis). We report our results using a standardized surgical approach that was highly effective in both functional and cosmetic terms. Materials and Methods: From April 2003 to October 2007, Surgery for hidden penis from multiple causes was performed in 80 children. Their age ranged from 10 months to 8 years (mean 4.2 years). Tacking sutures were taken from the subdermis of the ventral penoscrotal junction to the tunica albuginea in some cases. A combination procedure with tacking of the penopubic subdermis to the rectus fascia, penoscrotal Z plasty, circumcision revision or lateral penile shaft Z plasty also was performed in some patients. Results: Cosmetic improvement was noted in all cases except one patient that needed re- fixation of the Buck’s fascia to the dermis without significant complications. Conclusions: Surgery for hidden penis achieves marked aesthetic and often functional improvement. Degloving the penis to release any abnormal attachment then fixing the Buck’s fascia to the dermis of the skin has an essential role in preventing penile retraction in most cases. INTRODUCTION Concealed or inconspicuous penis is an uncommon condition that may present from infancy to adolescence.
  • Single Scrotal Incision Orchiopexy - a Systematic Review ______Hugo Fabiano Fernandes Novaes, José Abraão Carneiro Neto, Antonio Macedo Jr, Ubirajara Barroso Júnior

    Single Scrotal Incision Orchiopexy - a Systematic Review ______Hugo Fabiano Fernandes Novaes, José Abraão Carneiro Neto, Antonio Macedo Jr, Ubirajara Barroso Júnior

    REVIEW Article Vol. 39 (3): 305-311, May - June, 2013 doi: 10.1590/S1677-5538.IBJU.2013.03.02 Single scrotal incision orchiopexy - a systematic review _______________________________________________ Hugo Fabiano Fernandes Novaes, José Abraão Carneiro Neto, Antonio Macedo Jr, Ubirajara Barroso Júnior Section of Pediatric Urology, Division of Urology Bahiana School of Medicine and Federal University of Bahia and Federal University of São Paulo ABSTRACT ARTICLE INFO _________________________________________________________ ___________________ Objective: To conduct a systematic review on single scrotal incision orchiopexy. Key words: Materials and Methods: A search was performed using Pubmed, through which 16 ar- Cryptorchidism; Orchiopexy; ticles were selected out of a total of 133. The following conditions were considered ex- Scrotum; Surgical Procedures, clusion criteria: other surgical methods such as an inguinal procedure or a laparoscopic Operative approach, retractile testes, or patients with previous testicular or inguinal surgery. Results: A total of 1558 orchiopexy surgeries initiated with a transcrotal incision were Int Braz J Urol. 2013; 39: 305-11 analyzed. Patients’ ages ranged between 5 months and 21 years. Thirteen studies used __________________ high scrotal incisions, and low scrotal incisions were performed in the remainder of the studies. In 55 cases (3.53%), there was a need for inguinal incision. Recurrence was ob- Submitted for publication: served in 9 cases, testicular atrophy in 3, testicular hypotrophy in 2, and surgical site in- December 18, 2012 fections in 13 cases. High efficacy rates were observed, varying between 88% and 100%. __________________ Conclusions: Single scrotal incision orchiopexy proved to be an effective technique and is associated with low rates of complications.
  • The History of Microsurgery in Urological Practice

    The History of Microsurgery in Urological Practice

    Chen-1 The History of Microsurgery in Urological Practice Mang L. Chen1, Gregory M. Buncke2 and Paul J. Turek3 1G.U. Recon, San Francisco, CA, 94114 2The Buncke Clinic, San Francisco, CA 94114 3The Turek Clinic, Beverly Hills, CA 90210 Correspondence to: Mang Chen, MD G.U. Recon 45 Castro St, Suite 111 San Francisco, CA 94114 Tel: 415-481-3980 Email: [email protected] Chen-2 Abstract Operative microscopy spans all surgical disciplines, allowing human dexterity to perform beyond direct visual limitations. Microsurgery started in otolaryngology, became popular in reconstructive microsurgery, and was then adopted in urology. Starting with reproductive tract reconstruction of the vas and epididymis, microsurgery in urology now extends to varicocele repair, sperm retrieval, penile transplantation and free flap phalloplasty. By examining the peer reviewed and lay literature this review discusses the history of microsurgery and its subsequent development as a subspecialty in urology. Keywords: urology, microsurgery, phalloplasty, vasovasostomy, varicocelectomy Chen-3 I. Introduction Microsurgery has been instrumental to surgical advances in many medical fields. Otolaryngology, ophthalmology, gynecology, hand and plastic surgery have all embraced the operating microscope to minimize surgical trauma and scar and to increase patency rates of vessels, nerves and tubes. Urologic adoption of microsurgery began with vasectomy reversals, testis transplants, varicocelectomies and sperm retrieval and has now progressed to free flap phalloplasties and penile transplantation. In this review, we describe the origins of microsurgery, highlight the careers of prominent microsurgeons, and discuss current use applications in urology. II. Birth of Microsurgery 1) Technology The birth of microsurgery followed from an interesting marriage of technology and clinical need.
  • A Rare Case of Polyorchidism in a Cat with Four Intra&

    A Rare Case of Polyorchidism in a Cat with Four Intra&

    Reprod Dom Anim doi: 10.1111/rda.12461 ISSN 0936–6768 Short Communication A Rare Case of Polyorchidism in a Cat with Four Intra-abdominal Testes J Roca-Ferrer, E Rodrıguez, GA Ramırez, C Moragas and M Sala Centre Veterinari Bonavista, Cornella de Llobregat, Catalonia, Spain Contents Polyorchidism, the presence of more than two testes, Polyorchidism is a rare congenital anomaly defined as the is an uncommon congenital anomaly both in human presence of more than two histologically proven testes. We and veterinary medicine. The first reports of polyorchi- report a case of a 9-month-old European cat with four intra- dism in veterinary medicine were concerned with the abdominal testes. The diagnosis was performed by means of finding of supernumerary testes in horses as incidental ultrasonography, intra-operative examination and histological events during castration (Earnshaw 1959) while in confirmation. The case reported here presents an extremely humans the first case was reported during a routine rare anomaly, as no previous studies in veterinary medicine have reported the presence of four testes. This case suggests autopsy in 1670 (Bergholz and Wenke 2009). The that supernumerary testes should be included as differential number of cases reported in the literature is very low. diagnoses for intra-abdominal masses. In veterinary medicine, five cases have been published up to now, as illustrated in Table 1. In human medicine, 140 cases have been reported (Bergholz and Wenke Introduction 2009). In both veterinary and human medicine, the most Cryptorchidism, the failure of one or both testes to common case of polyorchidism is the presence of a descend into scrotum, is a common congenital abnor- single supernumerary testis (triorchidism).
  • Answer Key Chapter 1

    Answer Key Chapter 1

    Instructor's Guide AC210610: Basic CPT/HCPCS Exercises Page 1 of 101 Answer Key Chapter 1 Introduction to Clinical Coding 1.1: Self-Assessment Exercise 1. The patient is seen as an outpatient for a bilateral mammogram. CPT Code: 77055-50 Note that the description for code 77055 is for a unilateral (one side) mammogram. 77056 is the correct code for a bilateral mammogram. Use of modifier -50 for bilateral is not appropriate when CPT code descriptions differentiate between unilateral and bilateral. 2. Physician performs a closed manipulation of a medial malleolus fracture—left ankle. CPT Code: 27766-LT The code represents an open treatment of the fracture, but the physician performed a closed manipulation. Correct code: 27762-LT 3. Surgeon performs a cystourethroscopy with dilation of a urethral stricture. CPT Code: 52341 The documentation states that it was a urethral stricture, but the CPT code identifies treatment of ureteral stricture. Correct code: 52281 4. The operative report states that the physician performed Strabismus surgery, requiring resection of the medial rectus muscle. CPT Code: 67314 The CPT code selection is for resection of one vertical muscle, but the medial rectus muscle is horizontal. Correct code: 67311 5. The chiropractor documents that he performed osteopathic manipulation on the neck and back (lumbar/thoracic). CPT Code: 98925 Note in the paragraph before code 98925, the body regions are identified. The neck would be the cervical region; the thoracic and lumbar regions are identified separately. Therefore, three body regions are identified. Correct code: 98926 Instructor's Guide AC210610: Basic CPT/HCPCS Exercises Page 2 of 101 6.
  • Testicular Volume Measurement: Comparison of Prader Orchidometer, Ultrasound Scan and Water Displacement a Dissertation Submitted By

    Testicular Volume Measurement: Comparison of Prader Orchidometer, Ultrasound Scan and Water Displacement a Dissertation Submitted By

    TESTICULAR VOLUME MEASUREMENT: COMPARISON OF PRADER ORCHIDOMETER, ULTRASOUND SCAN AND WATER DISPLACEMENT A DISSERTATION SUBMITTED BY DR MBAERI, TIMOTHY UZOMA MBBS (Port Harcourt) DEPARTMENT OF SURGERY NNAMDI AZIKIWE UNIVERSITY TEACHING HOSPITAL, NNEWI TO THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PART FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE FINAL FELLOWSHIP OF THE MEDICAL COLLEGE IN SURGERY (FMCS) JUNE 2011 1 DECLARATION I hereby declare that the research project leading to this dissertation was actually carried out by me under the guidance of my supervisors. The work has neither been presented in part nor in full to any other College for a Fellowship; also it has not been submitted elsewhere for publication. ..................................................... DR MBAERI TIMOTHY UZOMA 2 DEDICATION I DEDICATE THIS WORK TO MY DEAR WIFE AMAKA WHO BORE THE BURDEN OF MY NEGLECT IN THE COURSE OF MY PROGRAMME, HER PATIENCE, PRAYERS AND ENCOURAGEMENT. TO MY PARENTS MR. AND MRS. REUBEN IBEBUKA MBAERI WHO INSPITE OF ALL ODDS MADE ME QUALIFY AS A DOCTOR IN THE FIRST PLACE. 3 CERTIFICATION This is to certify that I supervised Dr Mbaeri Timothy Uzoma in carrying out the research project leading to this dissertation titled “Testicular volume measurement: Comparison of Prader orchidometer, ultrasound scan and water Displacement” Signed ......................................................................................... Prof. Mbonu O.O. MB (Lond), FRCS(Ed), FRCS(C), FWACS, FMCS. Consultant Urologist Department of Surgery Nnamdi Azikiwe University Teaching Hospital Nnewi. Signed ............................................................................................ Prof. Orakwe J.C. FMCS, FWACS Consultant Urologist Head Department of Surgery Nnamdi Azikiwe University Teaching Hospital Nnewi. Signed............................................................................................. Prof. Nwofor A.M.E. FMCS, FWACS Consultant Urologist Dean Faculty of Medicine Nnamdi Azikiwe University .