Management of childhood and adolescent varicocele: experience at Prince Rashid Bin Al-Hassan Hospital-Jordan

The aim of this retrospective study is to evaluate if the early repair of varicocele in children and adolescents can prevent testicular growth arrest and male infertility later on. During a three year period [2004- 2006], 70 children and adolescents with varicocele who were operated on at Prince Rashid Hospital were reviewed [mean age 15 years, 9-19 years]. All patients had been evaluated by a urologist or a pediatric surgeon. High ligation of the internal spermatic vein was carried out either by open retroperitoneal approach or transperitoneal laparoscopic approach. Of the 70 patients 39 had grade II varicocele and 31 had grade III varicocele. In 33 patients [49%], the disease was associated with ipsilateral testicular growth arrest. In seven patients [10%], the disease was associated with impaired seminal fluid analysis parameters, four patients had recurrence of varicocele, and three patients developed hydrocele. Of 33 patients with testicular growth arrest, 32 [97%] regained normal testicular volume post operatively, while six of the seven patients with impaired seminal fluid analysis achieved normal parameters after surgery. Varicocele can affect ipsilateral testicular growth and seminal fluid analysis parameters, which may adversely affect fertility. We recommend early recognition and treatment

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

Splenic snood: a splenopexy option for a wandering spleen in a child, A case report and literature review

Wandering spleen is a rare diagnosis and has been rarely made in children. The diagnosis is usually made at the time of surgery. Splenectomy has been performed in the majority of the reported cases with few reports of successful splenopexy. We report a six year old female who was admitted to pediatric surgical ward with 3 months history of colicky abdominal pain and palpable, nontender hypogastric mass. Clinical, radiological exmanation including abdominal ultrasound, CT scan and liver spleen isotope scan revealed a viable wandering spleen. Laparotomy was performed, the spleen was in the lower abdomen, which was detorsed and determined to be viable. Snood technique splenopexy using vicryl mesh was performed and the enmeshed spleen was anchored in the left upper quadrant. Postoperative isotope scan revealed a viable, normal positioned spleen. We present this rare case in Jordan and we review the literatures

Thoracic trauma in children

This is a retrospective study of 42 children admitted for treatment of thoracic injuries during 5 years period [1990-1995] at King Hussein Medical Centre, Amman, Jordan. Type of injury, age group, sex incidence were recorded. Thirty Children [71.5%] suffered blunt chest trauma. Twenty seven [64%] were males. Mean age was 10 years [1-14 years]. The majority were involved in auto-pedestrain and motor vehicle crashes. Twelve [28.5%] were victims of penetrating injuries. Five cases required thoracotomy, 4 cases required laparotomy and thoracotomy. Nine patients [21%] died. Chest injuries in children are increasing and cause significant mortality. They are common in our country, specially in school age group. Public awareness is mandatory to reduce the incidence of these injuries

Groin hernias and scroto-penile lesions in a defined Jordanian children

To find out the incidence of groin hernias and external genitalia abnormalities in children in the south of Jordan, for referral and for early treatment and to educate the population about the risk and complications of these abnormalities. Male children aged 6-12 years in the city of Tafila were examined at schools. A total of 1748 children underwent careful clinical examination of groin region, penis and scrotum. Out of 1748 examined children, abnormal findings were detected in 320 children [18.30%]. The abnormalities were as follows:- indirect inguinal hernia in 235 children, undescended testes in 37, retractile testes in 22, hypospadias in 13, left varicocele in eight, hydrocele in four, ambiguous genitalia in one. Herniotomy was detected in 56 children with failed herniotomy in two. Orchidopexy was found in four children with failure in two. No child has had surgery for hypospadias or varicocele. Indirect inguinal hernia is common in children. Undescended testes are not uncommon in children, the majority of children are late for treatment. Increased incidence of failure rate of treated children is noted. Education of public and medical staff about these abnormalities is needed to improve the outcome