Which procedure should be chosen as a salvage operation in anterior hypospadias cases, meatal-based or onlay island flap? A comparative analysis.

We compared the outcome of flip-flap procedure (Mathieu procedure) with onlay island urethroplasty after previously failed repairs in anterior hypospadias cases. Charts of patients who underwent salvage flip-flap ( n=58) and onlay procedure ( n=24) were reviewed. Age range was 3-19 years (mean: 9+/-4.1) and 2-30 years (10.3+/-5.2) in the onlay and Mathieu groups, respectively ( p>0.05). In the onlay group, the flap was prepared from penile skin and preputial tissue in 5 and 19 cases, respectively. The meatal-based flap was laterally directed in 7 cases in the Mathieu group. The mean number of prior operations was greater in the onlay group when compared with the Mathieu group (1.85+/-1.53 vs. 1.41+/-0.65, respectively) although the difference was not statistically significant (Student's- t test, p>0.05). A total of 14 out of 58 (24.1%) and 6 out of 24 (25%) cases resulted in fistula formation in the Mathieu and island flap groups, respectively. Comparison of the rates of fistula formation did not reach statistical significance (Pearson chi(2), p=0.934). Skin dehiscence in one case and burying of the penis in another patient due to inadequacy of skin for coverage, occurred as complications in the onlay group. Splitting of the glans in 1, dehiscence of skin in 1 patient and complete breakdown of the neourethra in 1 case were the complications encountered in the Mathieu group. Both Mathieu and onlay island procedures have similar success rates as a salvage operation in anterior hypospadias cases if proper patient selection is done. The onlay procedure has been more commonly performed after a failed Mathieu procedure and the reverse rarely occurs.

Calyceal fornix rupture during cystography.

We report the first case of calyceal fornix rupture due to cystography in the literature. We recommend that instillation of all the contrast material should be attentively traced by the fluoroscope during cystography.

Outcome of pull-in procedure in children with severe post-disruption posterior urethral strictures.

A total of 17 children aged 5 to 15 years with the diagnosis of posttraumatic posterior urethral stricture were operated upon using a pull-in procedure during the last 9 years. Among the diagnostic tools, synchronous inspection of both the anterior and posterior urethra by cystoscopy yielded the most valuable information. A success rate of 70% was achieved with the procedure plus postoperative re-catheterization. A pedunculated tube prepared from the scrotal skin cured 2 patients after a series of failed operations. Difficult voiding occurring after removal of the stent due to an inappropriate pressure gradient created between the bladder neck and urethra usually benefits from short-term catheterization. Mild chordee was present in 1 patient. Ejaculation and erection were present in 3 children who reached puberty.

A rare cause of cystic testicular mass in an infant--cystic dysplasia of the testis.

In this article, a 6-month-old infant with cystic dysplasia of the testis (CDT) is presented. Although different genitourinary abnormalities associated with CDT have been reported, this is the first case of the association of CDT with penoscrotal hypospadias, unilateral undescended testicle, bilateral scrotal hernia, small and hypocompliant bladder and urethral obstruction. Orchiectomy was carried out for the treatment of this rare cause of testicular cystic mass.

Retrovesical echinococcal cyst causing renal failure and nocturnal enuresis in a child.

Although retrovesical hydatid cysts are observed in adulthood albeit very rarely, to our knowledge there is no case reported in childhood. In the current case, a huge retrovesical hydatid cyst caused obstructive uropathy, polydipsia, and secondary nocturnal enuresis in a child. Because the retrovesical hydatid cyst was firmly adherent to the neighboring structures, partial cystectomy could be performed. Perioperative and postoperative complications did not occur, and the symptoms relieved in the early postoperative period.

An unusual cause of urinary retention: a primary retrovesical echinococcal cyst.

We present a patient with symptoms of frequency, a mild decrease in urinary stream, and urinary retention due to a huge hydatid cyst located in the retrovesical region. Chest radiography and abdominal computed tomography did not reveal any other site of hydatid disease involvement. Since the cyst was in intimate contact with the seminal vesicles and the vasa deferentia, part of the hydatid sac wall adherent to these structures was left behind during the surgical excision. The patient was free of voiding symptoms, and no other episode of urinary retention had occurred at 6 months of follow-up. Pelvic computed tomography did not reveal recurrence of hydatid disease at 6 months postoperatively.

Isolated renal and retroperitoneal hydatid cysts.

Four patients (3 male, 1 female) with isolated renal and 1 female patient with isolated retroperitoneal cysts were reviewed. The mean age of the patients was 46 (25-64). The most common presenting symptom was pain. Two cases were discovered incidentally by the observance of renal calcification on abdominal x-ray. Indirect hemagglutination test was positive in all cases but eosinophilia was present only in 1 (20%) case. Nephrectomy was performed to 1 patient who presented with hydaturia and had a large communicating cyst involving most of the kidney. Total cystectomy was performed in other renal cysts. Total cystectomy with wide excision of the involved muscle was performed to the retroperitoneal hydatid cyst. Patients were followed by an average of 23.8 (9-50) months with indirect hemagglutination test and USG. No evidence for recurrence was found up to date.

Malignant gonadal stromal tumor with bulky metastasis at diagnosis.

A 63-year-old man underwent inguinal orchiectomy for painless enlargement of the left testis. The diagnosis of malignant gonadal stromal tumor was made on the basis of morphology and immunohistochemical studies. At computed tomography there was bulky retroperitoneal metastasis. The patient then underwent retroperitoneal lymphadenectomy and received 6 courses of platinum-based chemotherapy at the end of which complete response was documented. However, at 18 months' follow-up, computed tomography revealed recurrent retroperitoneal metastasis. The patient was put on chemotherapy regimen again. But he developed pulmonary metastasis and died 28 months after the initial diagnosis. The clinical course of this patient suggests that malignant gonadal stromal tumor, if metastatic at diagnosis, may have a poor prognosis against most aggressive treatment approaches.

A prostaglandin synthesis inhibitor, diclofenac sodium in the treatment of primary nocturnal enuresis.

Various treatment modalities have been used in Primary Nocturnal Enuresis (PNE) and pharmacotherapy is widely accepted. Prostaglandins increase detrusor pressure, decrease urethral pressure and lead to sodium excretion. They also antagonize hydro-osmotic effect of vasopressin by competing with this hormone. According to these functions of prostaglandins it is suggested that inhibition of prostaglandin synthesis may have value in the management of PNE. We evaluated the efficacy or oral diclofenac sodium treatment in 78 patients. We conclude that diclofenac sodium, an inhibitor of prostaglandin synthesis, is a good alternative agent for nocturnal enuresis particularly as a supplementary treatment combined to Imipramine, with 60% complete response and 13.3% recurrence rate.