Three-Dimensional Virtual Sonographic Cystoscopy for Detection of Ureterocele in Duplicated Collecting Systems in Children.

OBJECTIVES: Ureterocele is a sac-like dilatation of terminal ureter. Precise anatomic delineation is of utmost importance to proceed with the surgical plan, particularly in the ectopic subtype. However, the level of ureterocele extension is not always elucidated by the existing imaging modalities and even by conventional cystoscopy, which is considered as the gold standard for evaluation of ureterocele. This study aims to evaluate the accuracy of three-dimensional virtual sonographic cystoscopy (VSC) in the characterization of ureterocele in duplex collecting systems. METHODS: Sixteen children with a mean age of 5.1 (standard deviation 1.96) years with transabdominal ultrasonography-proven duplex system and ureterocele were included. They underwent VSC by a single pediatric radiologist. All of them subsequently had conventional cystoscopy, and the results were compared in terms of ureterocele features including anatomy, number, size, location, and extension. RESULTS: Three-dimensional VSC was well tolerated in all cases without any complication. Image quality was suboptimal in 2 of 16 patients. Out of the remaining 14 cases, VSC had a high accuracy in characterization of the ureterocele features (93%). Only the extension of one ureterocele was not precisely detected by VSC. CONCLUSIONS: The results of this study suggest three-dimensional sonography as a promising noninvasive diagnostic modality in the evaluation of ectopic ureterocele in children.

Ointment Fistulography: Introducing a Novel Technique for Single or Multiple Urethrocutaneous Fistula Diagnosis After Hypospadias Surgery.

INTRODUCTION AND OBJECTIVE: Hypospadias is a common congenital malformation of the male genital tract. The most frequent complication after hypospadias repair is urethrocutaneous fistula.1 Its incidence has been reported up to 35% worldwide.2 The diagnosis of these fistulas is sometimes challenging particularly with tiny and multiple fistulas. Usually, parents complain of urinary spraying, sprinkling, or passing a single stream of urine from the undersurface of the penis after the surgery. Urethrocutaneous fistulas are not always visible on physical examination. Locating the fistula and status of the surrounding skin is very important in order to choose the surgical repair technique.3 The patency and anatomy of the distal urethra should also be determined before the repair surgery.4 That is why urologists usually use retrograde urethrography or cystoscopy to find the location of fistula. However, these modalities have their own risk for children and are not always helpful. Sometimes the contrast media inserted can clog some fistulas especially near the glans and preclude the diagnosis. We present an easy technique to screen for urethrocutaneous fistulas after hypospadias surgery. TECHNIQUE: In this technique (Video 1), an antibiotic ointment is inserted through the meatus while the base of the penis is held; the ointment is then gently pushed through the meatus. As shown in the video, the ointment will protrude through the fistulas anywhere along the shaft. This technique can also be performed reversely as the ointment inserted from the fistulas will protrude from the meatus. For younger children under the age of 3, we exclusively perform this technique under anesthesia on the repair surgery day, whereas in toddlers we perform this technique in the office and once again under anesthesia right before the repair surgery. RESULT: This technique shows even tiny and multiple fistulas not detectable on physical examinations. We have used this technique in our clinic and have not missed any fistulas. The diameter of the protruded ointment in reverse fistulography is an indicator of the distal urethral diameter. Therefore, in case of narrow ointment diameter, distal urethral strictures should be suspected as correction of distal obstruction is an important determinant in the success rate of fistula repair surgery.5 CONCLUSION: We suggest this diagnostic technique as a safe, inexpensive, easy, office-based, feasible, and reproducible method. Negative urine culture is not required for this examination. Also, there is no need to insert contrast media as in retrograde urethrography or induce anesthesia as in cystoscopy. We believe this simple technique help urologists around the world to diagnose this common complication of hypospadias surgery without the need for special equipment.

The mobile technology era: Potential benefits in pediatric urology.

Mobile technology has been increasingly used in the world of medicine. We describe an application of mobile phones in the evaluation of urinary symptoms in infants, neonates, and toddlers. We believe this is a cheap, accessible and easy-to-use solution in pediatric urology for physicians and nurses around the world. In this video, we demonstrate some unique features of various anatomic and functional pediatric urology conditions, which are detectable in voiding clips taken by a cellphone camera.

Future Prospects for Human Tissue Engineered Urethra Transplantation: Decellularization and Recellularization-Based Urethra Regeneration.

To evaluate the histological characteristics of decellularized human urethra after transplantation into the rat omentum and compare in vivo cell seeding with perfusion-based and cell sheet urethral regeneration. Eight adult human male urethras accompanied with the surrounding corpus spongiosum were obtained. The tissues were decellularized with detergent-based method. The efficacy of decellularization and extracellular matrix preservation was evaluated by several techniques. Decellularized scaffolds were transplanted into the omentum of 12 male rats and located into the scrotum. Biopsies were taken 1, 3, and 6 months postoperatively to assess the natural recellularization. Mesenchymal stem cells obtained from preputial tissue were seeded with perfusion-based and cell sheet techniques as well. Immunohistochemical staining with α-actin, cytokeratin AE1/AE3, synaptophysin, and CD31 antibodies were performed. Removal of nuclear components and preservation of biomechanical properties was confirmed. In-vivo recellularization revealed promising results in progressive angiogenesis and cell seeding of epithelium-like cells in the lining of the urethra as well as smooth muscle cells in the wall structure. In-vitro urethral regeneration revealed that cell sheet engineering was the technique of choice compared to perfusion-based technique. This study may paw the road for clinical application of acellular urethral matrix with the surrounding corpus spongiosum in urological reconstructive surgery.

In vivo human corpus cavernosum regeneration: fabrication of tissue-engineered corpus cavernosum in rat using the body as a natural bioreactor.

PURPOSE: Few researches have been conducted to develop an ideal method for tissue engineering of corpus cavernosum. We produce a decellularized human corpus cavernosum scaffold and investigate the in vivo cell seeding of the scaffold after transplantation into the rat omentum. METHODS: Eight adult human male corpus cavernosum were obtained in sterile condition. After dissecting the urethra, corpus cavernosum was decellularized by inserting an 18-gauge needle into the body of the tissue. The gauge was connected to a peristaltic pump to circulate the detergents in the corpus. Several assessments were performed to evaluate the efficacy of decellularization and extracellular matrix (ECM) preservation. A section of decellularized scaffold was washed several times and transplanted into the omentum of 4 male healthy Sprague-Dawley rats and located into the scrotum. Biopsies were taken 1, 3, and 6 months after transplantation. Histological examination, SEM, and immunohistochemical staining were performed to assess the efficacy of natural recellularization. RESULTS: The results of the examinations performed prior to transplantation revealed a decellularized ECM resembling to the native tissue with normal pits that may be appropriate for further in vivo cell seeding. Histopathology examination of the biopsies after transplantations confirmed successful cell seeding with endothelium-like cells in different time points. CD34 staining was dominant in the short-time biopsies, while CD31 staining was higher than CD34 in long-term specimens. CONCLUSION: The feasibility of natural bioreactor in recellularizing corpus cavernosum was confirmed. This technique may have the potential to facilitate homologous transplantation for repair of corpus defects.

Long-term Impacts of Concurrent Posterior Urethral Valve Ablation and Bladder Neck Incision on Urinary Continence and Ejaculation.

OBJECTIVE: To assess the long-term impacts of bladder neck incision (BNI) on continence and ejaculatory function of adults who underwent concurrent posterior urethral valve (PUV) ablation and BNI during childhood. MATERIALS AND METHODS: A retrospective chart review was performed to find all adult patients with relevant history. All patients had undergone BNI at 6 o'clock proximal to the verumontanum with caution to leave the adventitia and verumontanum untouched. Charts were reviewed and attempts were made to contact those ≥18 years old for follow-up. Patients were specifically evaluated for lower urinary tract symptoms and ejaculatory condition. RESULTS: Among patients treated for PUV between 1998 and 2015 in our center, 21 were ≥18 years old at the time of assessment. Until February 2016, we were able to contact 18 patients, all of whom agreed to participate. Mean age was 21.1 ± 2.9 years with a mean follow-up of 12.5 ± 4.8 years. None of those contacted had incontinence or dry ejaculations. All considered their ejaculations normal and only one complained of weak ejaculations. Four of 5 patients who consented to perform a semen analysis had normal tests and 1 had low sperm count with abnormal motility. CONCLUSION: BNI is not associated with additional risk of incontinence and dry ejaculation in early adulthood and preserves antegrade ejaculation. Concomitant valve ablation with BNI may provide additional benefits in care of PUV children, especially those with prominent bladder neck and poor bladder function at presentation.