Ectopic perineal testicle: Case report and review of literature.

A small subset of males presenting with cryptorchidism are found to have ectopic testes. The most common location for an ectopic testicle is the superficial inguinal pouch, but there are several other possibilities, necessitating a thorough physical exam. A 4-month-old term male presented for evaluation of a nonpalpable right testicle. Examination revealed an ectopic right testicle located in the perineum. The patient underwent successful right orchiopexy. Ectopic testes are rare but remain in the differential diagnoses for patients with cryptorchidism. Patients should undergo prompt orchiopexy to avoid potential complications and allow maximal preservation of testicular function.

Renal artery angiography in pediatric trauma using a national data set.

INTRODUCTION: With limited pediatric renal trauma management literature, treatment pathways for children have been extrapolated from the adult population. A shift to non-operative management has led to higher renal preservation rates; however, characterization of endovascular intervention in the pediatric trauma population is lacking. OBJECTIVE: This study uses the National Trauma Data Bank (NTDB), to evaluate renal outcomes after use of renal artery angiography. We hypothesized that patients undergoing renal artery angiography for renal trauma are unlikely to require additional surgical interventions. STUDY DESIGN: All children ≤18 years old treated for traumatic renal injuries from 2012 to 2015 were identified by the Abbreviated Injury Scaled Score (AISS) codes in the NTDB. AISS codes were converted to American Association for Surgery of Trauma (AAST) grades. ICD-9 codes were used to identify patients that had renal artery angiography, and additional renal interventions such as nephrectomy, partial nephrectomy, percutaneous nephrostomy tube or ureteral stent placement. RESULTS: 536,379 pediatric trauma cases were in the NTDB from 2012 to 2015, with 4506 renal injury cases identified. A total of 88 patients had renal artery angiography (ICD-9 88.45). Only 10% (n = 9) of patients who received renal artery angiography underwent an additional urological intervention. Of those nine, two patients were excluded due to renal angiography taking place after nephrectomy was performed. The remaining seven patients had high grade laceration (AAST grade 4-5). Overall, two patients underwent post angiography nephrectomies, two patients had partial nephrectomies, one percutaneous nephrostomy tube was placed (prior to partial nephrectomy), one aspiration of a kidney (prior to ureteral stent placement), and three had ureteral stent placements. DISCUSSION: The limitations of this study include: the NTDB is a national dataset that is not population based, inclusion is limited to the first hospitalization, inaccuracies exist in encounter coding, and the database is lacking laterality of the renal injury. Based on nonspecific nature of ICD-9 coding for angioembolization, we are unable to discern the number of cases that subsequently had angioembolization after or at the time of angiography. CONCLUSION: Renal artery angiography in children remains a rare procedure, 88/4,506, in children with renal trauma. In pediatric trauma cases that undergo renal artery angiography additional procedures are more common with higher grade injuries. Further studies are needed to create pediatric specific trauma management algorithms.

Splenogonadal fusion: A rare finding during routine orchiopexy.

Splenogonadal fusion remains a rare congenital anomaly, with limited reports in the literature. It is important to be aware of this benign condition as orchiectomy can result from confusion with malignant processes. We present a case of splenogonadal fusion in a 12-month-old healthy male with history of cryptorchidism found at the time of surgery.

Robotic Assisted Surgery in Pediatric Urology: Current Status and Future Directions.

The evolution of robotic surgical technology and its application in Pediatric Urology have been rapid and essentially successful. Further development remains limited in three key areas: procedural inefficiencies, cost and integration of surgical and clinical information. By addressing these challenges through technology and novel surgical paradigms, the real potential of surgical robotics in pediatric, as well as adult applications, may ultimately be realized. With this evolution, a continued focus on patient-centered outcomes will be essential to provide optimal guidance to technical innovations.

Radiation exposure during continuous and pulsed fluoroscopy.

UNLABELLED: Abstract Background and Purpose: Previous studies using pulsed fluoroscopy have shown variable effects on radiation exposure because of the ramp and trail effect in older C-arm systems. This study compares radiation delivered in pulsed and continuous modalities using a modern C-arm system. MATERIALS AND METHODS: Thermoluminescent dosimeters (TLDs) positioned in three body locations directly measured radiation dose during simulated ureteroscopy. Thirty pedal activations were administered using a pulsed or continuous mode to visualize an implanted guidewire and a radiopaque stone. TLD absorbed radiation and image quality were compared between imaging modes. RESULTS: Pulsed fluoroscopy delivered less radiation compared with continuous fluoroscopy at each site: Anterior skin (0.10 vs 0.26 mGy, P<0.001), kidney (0.15 vs 0.40 mGy, P<0.001), and posterior skin (0.92 vs 2.62 mGy, P<0.001). Mean fluoroscopy time differed between continuous and pulsed modes (12.5 vs 3.0 seconds; P<0.001). Fluoroscopy time positively correlated with radiation exposure at all sites: Anterior skin (0.017 mGy/s, R(2)=0.90), left kidney (0.026 mGy/s, R(2)=0.96), and posterior skin (0.18 mGy/sec, R(2)=0.98). When evaluated by blinded urologists, 100% of reviewers felt pulsed images were adequate to identify guidewire position and 90.5% felt pulsed images were adequate for stone localization. CONCLUSION: Pulsed fluoroscopy reduced fluoroscopy time by 76% and radiation dose by 64% compared with continuous fluoroscopy. Pulsed fluoroscopy images were adequate for most tasks of ureteroscopy and should be considered for reduction of radiation during ureteroscopy.

Prostate specific antigen levels and prostate cancer detection rates in patients with end stage renal disease.

PURPOSE: Patients with end stage renal disease plus prostate cancer are ineligible to receive a renal transplant at most centers until an acceptable cancer-free period is demonstrated. To our knowledge previously established prostate specific antigen reference ranges have not been validated in patients with end stage renal disease. We determined age stratified 95th percentile prostate specific antigen reference ranges and the prostate cancer detection rate at specific prostate specific antigen intervals for patients with end stage renal disease. MATERIALS AND METHODS: We retrospectively reviewed the records of 775 male patients with end stage renal disease on the waiting list for a renal transplant who had undergone a serum prostate specific antigen test. Prostate specific antigen was stratified by age at the time of the blood test and 95th percentile reference ranges were calculated for each decade. A total of 80 patients underwent prostate biopsy for increased prostate specific antigen and/or abnormal digital rectal examination. The cancer detection rate was calculated for specific prostate specific antigen reference ranges. RESULTS: The age specific 95th percentile prostate specific antigen references ranges were 0 to 4.0 ng/ml for ages 40 to 49 in 137 patients, 0 to 5.3 ng/ml for ages 50 to 59 in 257, 0 to 10.5 ng/ml for ages 60 to 69 in 265 and 0 to 16.6 ng/ml for ages 70 to 79 years in 69. The cancer detection rate was 44%, 38% and 67% for prostate specific antigen 2.5 to 4.0, 4 to 10 and greater than 10 ng/ml, respectively. CONCLUSIONS: In our study population of patients with end stage renal disease age stratified prostate specific antigen was higher than in the general population. The cancer detection rate was increased in our patients with end stage renal disease compared to that in patients with normal renal function at specific prostate specific antigen intervals. Lower prostate specific antigen cutoffs may be appropriate to recommend prostate biopsy in patients with end stage renal disease.