Inverted y on V meatourethroplasty for distal penile hypospadias: our experience in Queen Rania Al-Abdulla hospital for children

The aim of this study was to evaluate patients with Distal Penile Hypospadias who were treated by Inverted Y on V Meatourethroplasty regarding success rate, complications and cosmesis. This was a retrospective study, carried out at Queen Rania Al-Abdulla Hospital for Children from April 2010 to June 2012. Forty four patients with distal Penile Hypospadias without chordee underwent Inverted Y on V Meatourethroplasty. Age of the patients ranged from one and half year to eight years. Mean age was four and half years. Patients were followed up to 18 months post surgery. Thirty three patients [75%] had excellent results without any complications and excellent cosmetic result, while complications were seen in 11 patients, with retracted meatus in six cases [13.6%], fistula in four [9%], and complete disruption in one case [2.3%]. Inverted Y on V Meatourethroplasty can be used successfully for Distal Penile hypospadias repair with excellent cosmetic result, complications rate remains acceptable but we need further evaluation and more experience with this technique

Vesicoureteric reflux in children: a 13-years experience

We review our thirteen year's experience [1997 and 2009] with surgical treatment of vesicoureteric reflux [VUR] at King Hussein medical center, pediatric surgery section. All files of patients who underwent intravesical cross-trigonal uretric reimplantation for VUR, between January 1997 and December2009 in our hospital were reviewed. Demographic details, reflux grade, bilaterality, radiological investigations, surgical approach and outcome were analyzed. 334 patients with VUR [grade II to V] underwent uretric reimplantation during the study period. 47.6% of the patients were males and 52.4% were female. The patients were between two and a half months to fourteen years of age. 11.7% were less than one year of age and 61% < 5years. 294 [88%] of the patients were classified as primary VUR and 40[12%] as secondary. The duration of follow up was from 8 months to 13 years. Persistent VUR requiring re-do ureteral reimplantation in 18 [5.4%] cases, and nephrectomy due to end- stage renal disease [ESRD] were performed in 33 [9.8%] patients. Successful rate was achieved in 90.2% of cases. The most frequent clinical abnormality leading to the diagnosis of VUR is UTI; the ultimate objective of treatment of VUR is to prevent infection, to allow normal growth and to prevent permanent renal parenchyma damage

Pediatric urolithiasis: incidence and surgical treatment

To report our experience with pediatric urinary tract stones to determine the frequency and location of urinary stone in the urinary tract system. All files of patients who underwent open surgery for stone between 1997 until 2009 at King Hussein Medical Center, Pediatric Surgery division were reviewed. Demographic features as well as location of stone, morbidity, associated abnormalities, surgical approach and outcome were analyzed. During the study period, 74 open stone operations were performed in our hospital. The mean age of the patient was 3.6 years, 19[25.6%] patients were females. Infant with stones represented 24.3% of the total. The stones were in the kidneys in 46[62%] patients, the ureter in [12%] and, the bladder in [25.6%]. Associated urogenital abnormalities were detected in four cases, including ureteropelvic junction obstruction and anatomic urinary bladder abnormality. Surgical approaches to urolithiasis in children continue to evolve, with open surgery being reserved for particular and complex cases. The use of ESWL and endourological methods of treatment for urolithiasis in children must be generalized

Safety and efficacy of topical epinephrine solution 1/100,000 in hypospadias surgery

To evaluate the safety and the efficacy of topical epinephrine solution 1/100,000 in hypospadias surgery. Prospective study of 143 patients with variant types of hypospadias aged between 1-14 years who underwent different procedures for correction of hypospadias over 12 months period [August 2004-August 2005] were included in the study. Topical epinephrine solution 1/100,000 was used in 103 patients [group I], 40 patients were operated without topical epinephrine solution 1/100,000 [group II]. Heart rate, blood loss, skin ischemia, formation of haematoma operative time and wound infection were evaluated. Tourniquet was used in group I only for erection test in four patients with proximal penile hypospadias and two with penoscrotal hypospadias, Minimal use of bipolar diathermy in four patients, with complicated hypospadias where extensive dissection took place, was needed. There was minimal blood loss [average 5ml], and a negligible increase in heart rate and no skin ischemia. The average operative time was 100 minutes [range from 50 -150]. Tourniquet and bipolar diathermy were used in 36 patients in group II with average blood loss of [25m1]. The average operative time was 135 minutes [range from 60-185]. In group I, one patient developed hematoma after accidental trauma 5-days Post-operatively at home, 23 patients were discharged in the same day with or without urethral stent, 70 patients were discharged within 1 to 3 days post-operatively with urethral stent, 10 patients had 7-10 days hospital stay for major hypospadias repair with urinary catheter and suprapubic catheter for urinary diversion. One patient had wound infection. The majority of patients in group II were admitted for 7-10 days with urinary catheter. Few patients had suprapubic catheter as well for urinary diversion. Two patients had wound infection and four patients had post operative bleeding. Topical epinephrine solution 1/100000 is safe, decreases bleeding and wound hematoma in hypospadias surgery. It eliminates the need of tourniquet, minimizes the use of bipolar diathermy, and decreases the operative time, early hospital discharge and minimal complications

Anorectal malformation incidence and significance of associated anomalies

To determine the incidence and types of associated anomalies in children with anorectal malformations. One hundred and sixteen patients, with anorectal malformations seen at King Hussein Hospital between 1982-1996, were reviewed for associated genitourinary and other systems anomalies. Assessment of these anomalies was done by clinical, radiological, sonography and isotope scan. Out of 116 patients with anorectal malformation, high imperforate anus was found in 44.8% [male: 42, female: 10], and low anorectal anomaly in 55.2% [male: 26, female: 38]. Genitourinary abnormalities were encountered in 38 patients. Associated congenital defects were seen in 45 patients: Urinary tract [24%], Cardiac [4.3%], Sacrum and vertebral deficit [8.6%], Genital [8.6%], Limbs [9.4%], Cloaca [5%], Esophageal Artesia [5%], Down's syndrome [3.4%], Hydrocephalus [1.7%], Potter syndrome [0.8%], and others [10.3%]. We observed that the incidence of associated anomalies was highest in males with high anorectal malformations [56%], and lowest [10%] in those females with low anorectal anomaly. Of the hundred and sixteen patients, 68 were males and 48 were females. The genitourinary tract is the most serious and the commonest site to have associated defects in patients with anorectal malformations. The higher the malformation the more frequent is the associated anomalies with severe urologic problem. Early diagnosis and treatment should be carried out to prevent sequale of fatal associations

Torsion of the testis: a review of 14 cases

To evaluate our experience in dealing with testicular torsion in neonates and children. this is a retrospective review of 14 medical records for children admitted for surgical treatment of testicular torsion during the period between 1996-2002 at King Hussein Medical Center. Clinical symptoms, time of presentation, age, diagnostic methods, intervention and outcome were recorded. Two neonates and 12 children underwent surgical exploration for testicular torsion. Eight patients presented with sudden onset of unilateral testicular pain, swelling, and tenderness. Six patients came with absence of one or more of these symptoms. Ten patients presented after 14 hours of onset of symptoms. Doppler U/S failed to prove the diagnosis in 4 out of 5 cases. Two cases were diagnosed initially as incarcerated inguinal hernia and one case as acute hydrocele. All underwent surgical exploration. Salvage of testis was successful in only 6 patients [43%]. The other 8 patients, two of them were neonates had necrotic testes. All patients who presented at 12 hours or less from onset of symptoms were successfully treated. early time of presentation of children with testicular torsion less than 12 hours, and immediate exploration based on clinical suspicion are the key for testicular salvage. Neither age nor U.S doppler should override decision to operate in case of suspicion

Angiomatoid malignant fibrous histiocytoma. a case report and review of the literature

This is to report a twelve-year-old male patient who presented with a mass on the medial aspect of his left arm. The mass was noticed six years earlier and was slowly growing. The family sought medical advice only because of local numbness. The mass was totally excised and the histological diagnosis was angiomatoid malignant fibrous histiocytoma. This is a rare soft tissue neoplasm in children that we feel worth publishing