Pediatric Urology Referral Guidelines
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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. -
Rare Case of Female Behçet's Disease with Urological Involvement
CASE REPORTS Ref: Ro J Rheumatol. 2019;28(2) DOI: 10.37897/RJR.2019.2.6 RARE CASE OF female Behçet’s disease WITH UROLOGICAL INVOLVEMENT Claudia Cobilinschi1,2, Catalin Belinski3, Daniela Opris-Belinski1,2 1„Carol Davila“ University of Medicine and Pharmacy, Bucharest, Romania 2„St. Maria“ Clinical Hospital, Bucharest, Romania 3„Prof. Dr. Dimitrie Gerota“ Emergency Hospital, Bucharest, Romania Abstract Behçet’s disease is a systemic vasculitis with several well-defined organ manifestations, including various mu- cocutaneous features. Among them, the urinary tract involvement is rarely cited, most data focusing on bladder dysfunction due to neuroBehçet. This article presents a rare case of a young female patient with urological complaints that was diagnosed with right ureteral ulceration, later confirmed as vasculitis at the histopathological examination. Urological intervention together with adequate immunosuppression let to the healing of the ulcer- ative lesion. The unusual vasculitic lesion site indicates the complexity of Behçet’s disease that requires careful investigation and treatment. Keywords: Behçet’s disease, ureteral ulceration, ureteral stent, immunosuppressant INTRODUCTION The onset of the disease was in 2013 when the patient presented to her general practitioner (GP) for Behçet’s disease (BD) is a variable size vasculitis repeated febrile episodes that were essentially ves- that can affect both arteries and veins characterized peral, occurring in the afternoon followed by odyno- by recurrent episodes of orogenital ulcers, eye and phagia and painful aphthae on her oral mucosa. Due skin involvement, neurologic manifestations accom- to her prominent ENT symptoms, her GP referred panied by a positive patergy test (1). The genetic the patient to a specialist who prescribed multiple background is best described by HLA B51 positivity antibiotic schemes because of the high suspicion of which associates with a more extensive clinical ex- streptococcal infection. -
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 -
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. -
Surgical Treatment of Urinary Incontinence in Men
Committee 13 Surgical Treatment of Urinary Incontinence in Men Chairman S. HERSCHORN (Canada) Members H. BRUSCHINI (Brazil), C.COMITER (USA), P.G RISE (France), T. HANUS (Czech Republic), R. KIRSCHNER-HERMANNS (Germany) 1121 CONTENTS I. INTRODUCTION VIII. TRAUMATIC INJURIES OF THE URETHRA AND PELVIC FLOOR II. EVALUATION PRIOR TO SURGICAL THERAPY IX. CONTINUING PEDIATRIC III. INCONTINENCE AFTER RADICAL PROBLEMS INTO ADULTHOOD: THE PROSTATECTOMY FOR PROSTATE EXSTROPHY-EPISPADIAS COMPLEX CANCER X. DETRUSOR OVERACTIVITY AND IV. INCONTINENCE AFTER REDUCED BLADDER CAPACITY PROSTATECTOMY FOR BENIGN DISEASE XI. URETHROCUTANEOUS AND V. SURGERY FOR INCONTINENCE IN RECTOURETHRAL FISTULAE ELDERLY MEN VI. INCONTINENCE AFTER XII. THE ARTIFICIAL URINARY EXTERNAL BEAM RADIOTHERAPY SPHINCTER (AUS) ALONE AND IN COMBINATION WITH SURGERY FOR PROSTATE CANCER XIII. SUMMARY AND RECOMMENDATIONS VII. INCONTINENCE AFTER OTHER TREATMENT FOR PROSTATE CANCER REFERENCES 1122 Surgical Treatment of Urinary Incontinence in Men S. HERSCHORN, H. BRUSCHINI, C. COMITER, P. GRISE, T. HANUS, R. KIRSCHNER-HERMANNS high-intensity focused ultrasound, other pelvic I. INTRODUCTION operations and trauma is a particularly challenging problem because of tissue damage outside the lower Surgery for male incontinence is an important aspect urinary tract. The artificial sphincter implant is the of treatment with the changing demographics of society most widely used surgical procedure but complications and the continuing large numbers of men undergoing may be more likely than in other areas and other surgery and other treatments for prostate cancer. surgical approaches may be necessary. Unresolved problems from pediatric age and patients with Basic evaluation of the patient is similar to other areas refractory incontinence from overactive bladders may of incontinence and includes primarily a clinical demand a variety of complex reconstructive surgical approach with history, frequency-volume chart or procedures. -
Springer MRW: [AU:0, IDX:0]
Pre-Testicular, Testicular, and Post- Testicular Causes of Male Infertility Fotios Dimitriadis, George Adonakis, Apostolos Kaponis, Charalampos Mamoulakis, Atsushi Takenaka, and Nikolaos Sofikitis Abstract Infertility is both a private and a social health problem that can be observed in 12–15% of all sexually active couples. The male factor can be diagnosed in 50% of these cases either alone or in combination with a female component. The causes of male infertility can be identified as factors acting at pre-testicular, testicular or post-testicular level. However, despite advancements, predominantly in the genetics of fertility, etiological factors of male infertility cannot be identi- fied in approximately 50% of the cases, classified as idiopathic infertility. On the other hand, the majority of the causes leading to male infertility can be treated or prevented. Thus a full understanding of these conditions is crucial in order to allow the clinical andrologist not simply to retrieve sperm for assisted reproduc- tive techniques purposes, but also to optimize the male’s fertility potential in order to offer the couple the possibility of a spontaneous conceivement. This chapter offers the clinical andrologist a wide overview of pre-testicular, testicular, and post-testicular causes of male infertility. F. Dimitriadis Department of Urology, School of Medicine, Aristotle University, Thessaloniki, Greece e-mail: [email protected] G. Adonakis • A. Kaponis Department of Ob/Gyn, School of Medicine, Patras University, Patras, Greece C. Mamoulakis Department of Urology, School of Medicine, University of Crete, Crete, Greece A. Takenaka Department of Urology, School of Medicine, Tottori University, Yonago, Japan N. Sofikitis (*) Department of Urology, School of Medicine, Ioannina University, Ioannina, Greece e-mail: [email protected] # Springer International Publishing AG 2017 1 M. -
Interstitial Cystitis/Painful Bladder Syndrome
What I need to know about Interstitial Cystitis/Painful Bladder Syndrome U.S. Department of Health and Human Services National Kidney and Urologic Diseases NATIONAL INSTITUTES OF HEALTH Information Clearinghouse What I need to know about Interstitial Cystitis/Painful Bladder Syndrome U.S. Department of Health and Human Services National Kidney and Urologic Diseases NATIONAL INSTITUTES OF HEALTH Information Clearinghouse Contents What is interstitial cystitis/painful bladder syndrome (IC/PBS)? ............................................... 1 What are the signs of a bladder problem? ............ 2 What causes bladder problems? ............................ 3 Who gets IC/PBS? ................................................... 4 What tests will my doctor use for diagnosis of IC/PBS? ............................................................... 5 What treatments can help IC/PBS? ....................... 7 Points to Remember ............................................. 14 Hope through Research........................................ 15 Pronunciation Guide ............................................. 16 For More Information .......................................... 17 Acknowledgments ................................................. 18 What is interstitial cystitis/painful bladder syndrome (IC/PBS)? Interstitial cystitis*/painful bladder syndrome (IC/PBS) is one of several conditions that causes bladder pain and a need to urinate frequently and urgently. Some doctors have started using the term bladder pain syndrome (BPS) to describe this condition. Your bladder is a balloon-shaped organ where your body holds urine. When you have a bladder problem, you may notice certain signs or symptoms. *See page 16 for tips on how to say the words in bold type. 1 What are the signs of a bladder problem? Signs of bladder problems include ● Urgency. The feeling that you need to go right now! Urgency is normal if you haven’t been near a bathroom for a few hours or if you have been drinking a lot of fluids. -
Urethral Stone: a Rare Cause of Acute Retention of Urine in Men
Open Journal of Urology, 2020, 10, 145-151 https://www.scirp.org/journal/oju ISSN Online: 2160-5629 ISSN Print: 2160-5440 Urethral Stone: A Rare Cause of Acute Retention of Urine in Men Ahmed Ibrahimi*, Idriss Ziani, Jihad Lakssir, Hachem El Sayegh, Lounis Benslimane, Yassine Nouini Department of Urology A, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco How to cite this paper: Ibrahimi, A., Zia- Abstract ni, I., Lakssir, J., El Sayegh, H., Benslimane, L. and Nouini, Y. (2020) Urethral Stone: A Urethral stones are a very rare form of urolithiasis, they most often originate Rare Cause of Acute Retention of Urine in from the upper urinary tract or bladder, and are rarely formed primarily in Men. Open Journal of Urology, 10, 145-151. the urethra, it is formed on a urethral anatomical pathology in the majority of https://doi.org/10.4236/oju.2020.105016 cases. The clinical symptomatology is very variable ranging from simple dy- Received: March 12, 2020 suria with penile pain to acute retention of urine. Smaller stones can be ex- Accepted: April 23, 2020 pelled spontaneously without intervention, but larger stones or complicated Published: April 26, 2020 stones or those developed on an underlying urethral anatomical pathology Copyright © 2020 by author(s) and require surgical treatment. The minimally invasive treatment should be the Scientific Research Publishing Inc. preferred route for the surgical treatment of this disease when feasible. We This work is licensed under the Creative report the case of a young man with no particular pathological history who Commons Attribution International License (CC BY 4.0). -
Evaluation of Additional Anomalies in Concomitance of Hypospadias And
Türkiye Çocuk Hastalıkları Dergisi 222 Özgün Araştırma Original Article Turkish Journal of Pediatric Disease Evaluation of Additional Anomalies in Concomitance of Hypospadias and Undescended Testes Hipospadias ve İnmemiş Testis Birlikteliğinde Ek Anomali Sıklığının Değerlendirilmesi Ufuk ATES, Gülnur GÖLLÜ, Nil YAŞAM TAŞTEKİN, Anar QURBANOV, Günay EKBERLİ, Meltem BİNGÖL KOLOĞLU, Emin AYDIN YAĞMURLU, Tanju AKTUĞ, Hüseyin DİNDAR, Ahmet Murat ÇAKMAK Ankara University Medical School, Pediatric Surgery Department, Pediatric Urology Division, Ankara, Turkey ABSTRACT Objective: Hypospadias is a common genitourinary system (GUS) anomaly in boys occurring in 1 of 200 to 300 live births. Undescended testes is frequently detected among accompanying anomalies in cases with hypospadias. Especially in proximal hypospadias and bilateral cases, this association may indicate sexual differentiation disorders. The aim of the study was to evaluate the togetherness of additional anomalies in hypospadiac children with undescended testes. Material and Methods: Between 2007 and 2016, data of 392 children who underwent surgery for hypospadias were evaluated retrospectively. Urethral meatus was present at scrotal and penoscrotal in 65 cases (16.6%) and glanular, coronal, subcoronal and midpenile in 327 cases (83.4%). The cases were divided into two groups as those with both testes in the scrotum and those with undescended testes, and the anomalies were recorded. Results: The mean age of the children with proximal hypospadias was 21 months (6-240 months). Of the children with proximal hypospadias, 26 (40%) had undescended testes and 39 (60%) had testes in the scrotum. Undescended testes were detected bilaterally in 17 patients (65.4%) and unilaterally in nine patients (34.6%) in the undescended testes group. -
Penile Anomalies in Adolescence
Review Special Issue: Penile Anomalies in Children TheScientificWorldJOURNAL (2011) 11, 614–623 TSW Urology ISSN 1537-744X; DOI 10.1100/tsw.2011.38 Penile Anomalies in Adolescence Dan Wood* and Christopher Woodhouse Adolescent Urology Department, University College London Hospitals E-mail: [email protected]; [email protected] Received August 13, 2010; Revised January 9, 2011; Accepted January 11, 2011; Published March 7, 2011 This article considers the impact and outcomes of both treatment and underlying condition of penile anomalies in adolescent males. Major congenital anomalies (such as exstrophy/epispadias) are discussed, including the psychological outcomes, common problems (such as corporal asymmetry, chordee, and scarring) in this group, and surgical assessment for potential surgical candidates. The emergence of new surgical techniques continues to improve outcomes and potentially raises patient expectations. The importance of balanced discussion in conditions such as micropenis, including multidisciplinary support for patients, is important in order to achieve appropriate treatment decisions. Topical treatments may be of value, but in extreme cases, phalloplasty is a valuable option for patients to consider. In buried penis, the importance of careful assessment and, for the majority, a delay in surgery until puberty has completed is emphasised. In hypospadias patients, the variety of surgical procedures has complicated assessment of outcomes. It appears that true surgical success may be difficult to measure as many men who have had earlier operations are not reassessed in either puberty or adult life. There is also a brief discussion of acquired penile anomalies, including causation and treatment of lymphoedema, penile fracture/trauma, and priapism. -
Autosomal Dominant Medullary Cystic Kidney Disease (ADMCKD)
Autosomal Dominant Medullary Cystic Kidney Disease (ADMCKD) Author: Doctor Antonio Amoroso1 Creation Date: June 2001 Scientific Editor: Professor Francesco Scolari 1Servizio Genetica e Cattedra di Genetica, Istituto per l'infanzia burlo garofolo, Via dell'Istria 65/1, 34137 Trieste, Italy. [email protected] Abstract Keywords Disease name Synonyms Diagnostic criteria Differential diagnosis Prevalence Clinical description Management Etiology Genetic counseling References Abstract Autosomal dominant medullary cystic kidney disease (ADMCKD) belongs, together with nephronophthisis (NPH), to a heterogeneous group of inherited tubulo-interstitial nephritis, termed NPH-MCKD complex. The disorder, usually first seen clinically at an average age of 28 years, is characterized by structural defects in the renal tubules, leading to a reduction of the urine–concentrating ability and decreased sodium conservation. Clinical onset and course of ADMCKD are insidious. The first sign is reduced urine– concentrating ability. Clinical symptoms appear when the urinary concentrating ability is markedly reduced, producing polyuria. Later in the course, the clinical findings reflect the progressive renal insufficiency (anemia, metabolic acidosis and uremic symptoms). End-stage renal disease typically occurs in the third-fifth decade of life or even later. The pathogenesis of ADMCKD is still obscure and how the underlying genetic abnormality leads to renal disease is unknown. ADMCKD is considered to be a rare disease. Until 2000, 55 affected families had been described. There is no specific therapy for ADMCKD other than correction of water and electrolyte imbalances that may occur. Dialysis followed by renal transplantation is the preferred approach for end-stage renal failure. Keywords Autosomal dominant medullary cystic disease, medullary cysts, nephronophthisis, tubulo-interstitial nephritis Disease name Diagnostic criteria Autosomal dominant medullary cystic kidney The renal presentation of MCKD is relatively disease (ADMCKD) non-specific. -
Diagnosis and Management of Urinary Incontinence in Childhood
Committee 9 Diagnosis and Management of Urinary Incontinence in Childhood Chairman S. TEKGUL (Turkey) Members R. JM NIJMAN (The Netherlands), P. H OEBEKE (Belgium), D. CANNING (USA), W.BOWER (Hong-Kong), A. VON GONTARD (Germany) 701 CONTENTS E. NEUROGENIC DETRUSOR A. INTRODUCTION SPHINCTER DYSFUNCTION B. EVALUATION IN CHILDREN F. SURGICAL MANAGEMENT WHO WET C. NOCTURNAL ENURESIS G. PSYCHOLOGICAL ASPECTS OF URINARY INCONTINENCE AND ENURESIS IN CHILDREN D. DAY AND NIGHTTIME INCONTINENCE 702 Diagnosis and Management of Urinary Incontinence in Childhood S. TEKGUL, R. JM NIJMAN, P. HOEBEKE, D. CANNING, W.BOWER, A. VON GONTARD In newborns the bladder has been traditionally described as “uninhibited”, and it has been assumed A. INTRODUCTION that micturition occurs automatically by a simple spinal cord reflex, with little or no mediation by the higher neural centres. However, studies have indicated that In this chapter the diagnostic and treatment modalities even in full-term foetuses and newborns, micturition of urinary incontinence in childhood will be discussed. is modulated by higher centres and the previous notion In order to understand the pathophysiology of the that voiding is spontaneous and mediated by a simple most frequently encountered problems in children the spinal reflex is an oversimplification [3]. Foetal normal development of bladder and sphincter control micturition seems to be a behavioural state-dependent will be discussed. event: intrauterine micturition is not randomly distributed between sleep and arousal, but occurs The underlying pathophysiology will be outlined and almost exclusively while the foetus is awake [3]. the specific investigations for children will be discussed. For general information on epidemiology and During the last trimester the intra-uterine urine urodynamic investigations the respective chapters production is much higher than in the postnatal period are to be consulted.