Complications after common sheath reimplantation in pediatric patients with complicated duplex system.

OBJECTIVE: To report our experience of common sheath reimplantation (CSR) for ectopic ureterocele (EU) combined with ureteral duplication, describing success rates and postoperative complications, along with risk factors for developing postoperative incontinence. METHODS: When the upper tract approach is not indicated in patients with EU, a bladder-level approach, involving either CSR or total reconstruction, is the remaining option. However, concerns exist about the high morbidity of bladder-level approaches. We retrospectively examined the postoperative results of 39 patients who underwent CSR between January 2001 and December 2012. Risk factors for the development of postoperative incontinence and decreases in differential renal function (DRF) were additionally analyzed. RESULTS: The median age at operation was 16.5 months. After CSR, upper urinary tract dilatation decreased in 36 patients (92.3%). During a median follow-up of 75.9 months, an additional operation was required in 7 patients (17.9%). Postoperative incontinence developed in 3 patients (7.7%). Median preoperative DRF was significantly lower in the postoperative incontinence group (P = .004). DRF decreased postoperatively in 5 of 36 patients (13.9%). No preoperative factors were related to the decrease in DRF. No patient developed hypertension or proteinuria. CONCLUSION: CSR decompressed the upper urinary tract effectively in our EU patients. Postoperative incontinence does not seem to be related to operation factors, but with preoperative DRF. When the upper tract approach is not indicated, CSR is a reasonable alternative. Total reconstruction is unnecessary as the remnant upper pole kidney after CSR does not lead to complications.

Penile paraffinoma: A surgical challenge

OBJECTIVE: The authors share their experience on four different cases of penile paraffinoma surgically treated at the Bicol Medical Center from January 2011 - September 2014. METHODOLOGY: Four patients with subcutaneous injection of foreign body (Vaseline, petroleum jelly or Baby oil) into their penises were treated. The authors applied two kinds of technique: anterolateral thigh pedicle flap and scrotal advancement flap, depending on the skin defect after excision of the paraffinoma. Outcomes measured were immediate post-operative complications (flap necrosis, hematoma, infection) and 3 months post-operative follow-up (contracture, pain on erection, improvement in sexual function and acceptable cosmetic appearance). RESULTS: All patients had a relatively uneventful post-operative course. There were no instances of flap necrosis, bleeding, hematoma or dysuria. Morbidity was minimal and no secondary surgical intervention was done. All had acceptable cosmetic appearance based on the satisfaction of both the patients and the surgeons. All reported decrease in pain during erection, except for one, who underwent scrotal advancement flap, complaining of vague penoscrotal pain when his penis was erect. CONCLUSION: Penile paraffinoma remains a reconstructive surgical challenge requiring application of varying techniques depending on the pre-operative foreign body involvement.