Reconstruction of an Amputated Glans Penis With a Buccal Mucosal Graft: Case Report of a Novel Technique

Penile amputation is a rare catastrophe and a serious complication of circumcision. Reconstruction of the glans penis may be indicated following amputation. Our report discusses a novel technique for reconfiguration of an amputated glans penis 1 year after a complicated circumcision. A 2-year-old male infant presented to us with glans penis amputation that had occurred during circumcision 1 year previously. The parents complained of severe meatal stenosis with disfigurement of the penis. Penis length was 3 cm. Complete penile degloving was performed. The distal part of the remaining penis was prepared by removing fibrous tissue. A buccal mucosal graft was applied to the distal part of the penis associated with meatotomy. The use of a buccal mucosal graft is a successful and simple procedure with acceptable cosmetic and functional results for late reconfiguration of the glans penis after amputation when penile size is suitable.

Anuria in a 9-Month-Old Infant Resulting from Ureteral Cystine Stones

Pediatric urolithiasis and calcular anuria in early infancy are rare. Cystine stones may develop in utero or during early infancy. We report the case of a female 9-month-old infant with obstructive anuria resulting from cystine stones in a single functioning unit. She presented to the emergency department owing to the absence of micturition for 3 days. Radiological investigations revealed four left ureteral stones and an atrophic right kidney resulting from a calcular obstruction. Her laboratory values were as follows: serum creatinine 6.7 mg/dl, Na 132 mEq/l, K 6 mg/dl, and hematocrit 32%. An urgent percutaneous nephrostomy tube was inserted into the left side for urinary drainage, and her serum levels of creatinine and K returned to normal within 3 days. A left ureterolithotomy was the final management. Stone analysis revealed pure cystine crystals.

Utility of ultrasonography in the evaluation of renal scarring using dimercaptosuccinic acid scan as the gold standard

Dimercaptosuccinic acid [DMSA] is considered the most sensitive tool for diagnosis of renal scars. This study was done to evaluate the utility of renal ultrasound scanning in detection of renal scars in children with urinary tract infection [UTI] compared to DMSA scan as the gold standard. During 4 years period, we evaluated 202 children with UTI for detection of renal scars using ultrasound and DMSA renal scanning. All patients underwent renal ultrasound and DMSA scan for detection of renal scars. Renal scars were classified into diffuse or focal types. The data were statistically analyzed to evaluate the sensitivity and specificity of renal ultrasound in detection of renal scars. Two hundred and two patients [404 renal units] scanned with ultrasound and DMSA for detection of renal scars. Male to female ratios were 1:1.8 [71 males and 131 females]. DMSA proved the presence of scars in 145 units [35.89%], Ultrasound was able to detect scars in 52 units out of 145 with sensitivity; specificity, PPV, and NPV ultrasound in detection of scars were 35.68%, 91.12%, 69.33%and 71.73%, respectively. DMSA scan detect focal scars in 85 units while diffuse one in 60 units. Ultrasound was able to detect focal scars in 20 out of 85 units [23.5%] with sensitivity, specificity, PPV, and NPV were 23.5%, 94.3%, 52.6% and 82.2% respectively. While diffuse scars in 32 units out of 60 [53.3%] with sensitivity, specificity, PPV, and NPV were53.3%, 98.5%, 86.5%and 92.5%, respectively. Although ultrasonography has a good specificity for detection of renal scarring compared with DMSA scan. Ultrasonography cannot replace DMSA scan in the evaluation of focal renal scarring. However ultrasound might be used for selection of the cases that should be underwent DMSA renal scan