A new operative technique - extra renal ureterocalycostomy for correction of PUJ obstruction in a horseshoe kidney.

The authors describe a novel operative technique in a child with PUJ obstruction in a horseshoe kidney, where a pyeloplasty was clinically indicated but unsafe because of insufficient length of ureter and predicted technical difficulty in transposing large renal vessels coursing to the renal hilum. During the operation, there was a favourably positioned extra renal lower pole calyceal infundibulum identified, of similar dimensions to the spatulated ureter and this was chosen for an end to side tension free anastomosis. As far as the authors are aware this technique of extra renal ureterocalycostomy has not been described before.

Normal anatomy of the external urethral meatus in boys: implications for hypospadias repair.

UNLABELLED: Both papers in this section relate to the always difficult subject of hypospadias repair. One of them describes the anatomy of the external urethral meatus, and the other a technique for repairing coronal or subcoronal hypospadias. OBJECTIVE: To investigate the normal external urethral meatal anatomy in boys, and to examine the proportional relationship between meatal length and degree of ventral glans closure. PATIENTS AND METHODS: In all, 92 boys with presumed normal penile anatomy were considered eligible for the study; 17 were not assessed because either the boy or parents declined to participate, leaving 75 boys (mean age 6.9 years, range 0.3-15) who completed the study. Photographic records of the meatal appearance were obtained and meatal height and ventral glans closure measured using ophthalmic callipers. RESULTS: All 75 boys in the study had a vertical slit-like meatus that commenced at the tip of the penis and ran ventrally. The mean (sd) vertical meatal length was 5.4 (1) mm and the mean length of ventral glans closure was 4.7 (1.2) mm. There was an age-dependent increase in meatal length and a similar association was identified for the length of ventral glans closure. There was also a statistically significant proportional relationship between meatal length and length of glans closure (r = 0.36, confidence interval 0.14-0.54, P < 0.002). CONCLUSION: The position and size of the external urethral meatus in normal boys is consistent, and ventral glans closure is equal to or slightly less than meatal length. These data might be of interest to hypospadiologists in their efforts to reconstruct normal glanular anatomy.

Ballooning of the foreskin and physiological phimosis: is there any objective evidence of obstructed voiding?

OBJECTIVES To determine whether physiological phimosis with or without ballooning of the prepuce is associated with noninvasive urodynamic or radiological evidence of bladder outlet obstruction. PATIENTS AND METHODS From August 2001 to October 2002 all boys with a foreskin problem and referred to one paediatric surgeon were assessed in special clinics. Those with physiological phimosis were recruited for the study and had upper tract and bladder ultrasonography (US), followed by uroflowmetry and US-determined postvoid residual urine volumes (PVR). Data were compared between boys with and with no ballooning of the prepuce. The project was approved by the local research ethics committee and informed consent was obtained from all study participants. RESULTS In all, 54 patients were referred for circumcision; 32 boys with physiological phimosis completed the uroflow and US investigations. Ballooning of the foreskin was present in 18 boys (mean age 6.8 years, range 3-12); 14 had physiological phimosis with no ballooning (mean age 6.5 years, range 4-11). Upper tract US and bladder wall thickness were normal in all boys. The mean maximum urinary flow rate (Q(max)) was not significantly different in boys with ballooning and those without (mean 15.3 mL/s, sd 4.4, range 9-24, vs 15.4, sd 2.9, range 10.7-20, P = 0.96). In addition, all Q(max) values were within the normal range when correlated with voided volume and compared with age-related nomograms. Most boys had flow rate patterns showing a normal bell-shaped curve; a few (9%) had subtle changes in the flow-rate profile, with either a plateau-type curve or slow initial increase in flow and prolonged time to achieve Q(max). The two groups had comparable mean PVRs (3.5 mL, sd 5.1, range 0-18 with ballooning vs 6.1, sd 10.7, range 0-38 without, P = 0.37). Only one patient had a marginally abnormal PVR. CONCLUSIONS Physiological phimosis with or without ballooning of the prepuce is not associated with noninvasive objective measures of obstructed voiding. Minor abnormalities in the flow-rate pattern in this patient group deserve further study.