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1.
J Pediatr Surg ; 42(11): 1882-6, 2007 Nov.
Article in English | MEDLINE | ID: mdl-18022440

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the effectiveness of a new approach to repair the giant prostatic utricle (pseudovagina) associated with proximal hypospadias. METHODS: Three patients with giant prostatic utricle associated with proximal hypospadias sought medical advice in our department from 1998 to 2003. The giant prostatic utricles were repaired using the novel approach of divesting of utricular mucosa followed by muscular tunnel obliteration through the opening of the pseudovagina in the dorsal lithotomy position. RESULTS: Follow-up ranges from 3 to 8 years. The divesting of the prostatic utricle mucosa was successful, and the pseudovagina muscular tunnel was closed completely in all 3 patients. One patient underwent urethroplasty and another repair of urethrocutaneous fistula at the same setting. The third patient underwent a second-stage urethroplasty separately. On follow-up, both the urethral reconstruction and the pseudovagina repair remained successful in all the patients. CONCLUSIONS: The technique of the divesting of the prostatic utricle mucosa and closure of the muscular wall is an effective alternative approach for repairing giant prostatic utricles. It is safe and simple. The surgical exposure is very good.


Subject(s)
Abnormalities, Multiple/surgery , Hypospadias/surgery , Prostate/abnormalities , Urogenital Abnormalities/surgery , Urologic Surgical Procedures, Male/methods , Abnormalities, Multiple/diagnosis , Adolescent , Follow-Up Studies , Humans , Hypospadias/diagnosis , Male , Mucous Membrane/surgery , Muscle, Smooth/surgery , Plastic Surgery Procedures/methods , Risk Assessment , Sampling Studies , Time Factors , Treatment Outcome , Urogenital Abnormalities/diagnosis
2.
J Pediatr Surg ; 41(1): e7-9, 2006 Jan.
Article in English | MEDLINE | ID: mdl-16410097

ABSTRACT

PURPOSE: The aim of the study was to evaluate the effectiveness of a new technique to repair penile torsion in children. METHODS: Eighteen boys with penile torsion were evaluated in our department from 1989 to 2003. Eleven had associated hypospadias, 4 had chordee without hypospadias, and 3 had torsion only. The direction of rotation was counterclockwise in 16 cases and clockwise in 2 cases. Torsion was repaired in 6 patients by degloving the penis and reattaching the dartos and the skin (comparative group). In 11 patients (1 with prior repair), the torsion was corrected by suturing the lateral edge of the corpus cavernosum to the pubic periosteum (study group). Two patients were not treated. RESULT: Follow-up ranges from 6 months to 7 years. All of the 11 cases in the study group had satisfactory correction of the penile torsion. All of the urethroplasties for hypospadias were successful. In the comparative group, none of 6 patients had satisfactory correction of the rotation. CONCLUSION: The technique of degloving the penis and reattaching the skin cannot reliably correct penile torsion in our experience. Lateral suturing of tunica albuginea to the pubic periosteum to repair penile torsion appears to be a better technique.


Subject(s)
Penile Diseases/surgery , Suture Techniques , Child , Child, Preschool , Humans , Male , Retrospective Studies , Torsion Abnormality/surgery , Treatment Outcome , Urogenital Surgical Procedures/methods
3.
J Urol ; 174(5): 1999-2002, 2005 Nov.
Article in English | MEDLINE | ID: mdl-16217377

ABSTRACT

PURPOSE: Congenital mid ureteral stricture is rare. We report 7 cases, and discuss the differences in preoperative evaluation and surgical management compared to other obstructive entities. MATERIALS AND METHODS: Medical records and imaging studies of 7 children identified with mid ureteral strictures between 1998 and 2002 were reviewed retrospectively. Five newborns presented with prenatal hydronephrosis, and 2 children presented at age 15 years, one in the course of evaluation of blunt trauma, and one due to pain and abdominal mass. Imaging studies included renal ultrasound, voiding cystourethrography, radionuclide renography and computerized tomography. All patients underwent retrograde pyelography. Pathological examination of each specimen was undertaken at the respective institutions. RESULTS: Prenatal hydronephrosis was the most common presentation. There were no urinary tract infections. All patients had significant obstruction on the affected side. No patient had vesicoureteral reflux. After imaging but before surgery the urinary obstruction was believed to be at the ureteropelvic junction in 4 patients and the ureterovesical junction in 2, and secondary to posterior urethral valves in 1. At cystoscopy all of the affected ureters had a normally located and normally configured orifice. Retrograde pyelography led to an accurate diagnosis of mid ureteral narrowing in all patients. Six patients underwent ureteroureterostomy, all of whom had satisfactory outcomes. In 1 of these patients contralateral nephrectomy was performed due to nonfunction of the multicystic dysplastic kidney. The remaining patient underwent nephrectomy for ipsilateral end stage kidney disease and hydronephrosis. In this patient the ureters were stenotic and suggested asymmetry in the thickness of the muscular coat, perhaps secondary to extrinsic compression. CONCLUSIONS: Congenital mid ureteral stricture is rare. Renal ultrasound and radionuclide renography alone do not reliably demonstrate the site of obstruction. Retrograde pyelography at the time of surgical correction of presumed ureteral obstruction is an important adjunct for correctly identifying the site of narrowing in the affected ureteral segment, unless the ureter has been imaged with another modality.


Subject(s)
Congenital Abnormalities/diagnosis , Diagnostic Imaging/methods , Hydronephrosis/diagnosis , Ureteral Obstruction/congenital , Ureteral Obstruction/diagnosis , Adolescent , Congenital Abnormalities/surgery , Cystoscopy/methods , Female , Follow-Up Studies , Humans , Hydronephrosis/surgery , Immunohistochemistry , Infant , Infant, Newborn , Male , Retrospective Studies , Risk Assessment , Sampling Studies , Severity of Illness Index , Treatment Outcome , Ultrasonography, Doppler , Ureteral Obstruction/surgery , Urinalysis , Urodynamics , Urography/methods , Urologic Surgical Procedures/methods
4.
Transplantation ; 80(4): 466-70, 2005 Aug 27.
Article in English | MEDLINE | ID: mdl-16123719

ABSTRACT

BACKGROUND: Pediatric kidney graft survival rates have improved in the United States. This study evaluates early and late risk factors for cadaveric graft loss in pediatric recipients. METHODS: From January 1994 to December 2002, 2,597 primary cadaveric kidney-alone transplants (donor age 5-45 years, recipient age 2-20 years) were reported to the United Network for Organ Sharing (UNOS). The analysis includes follow-up information based on OPTN data as of October 14, 2003. Odds ratio of early graft loss and relative risk of late graft loss are estimated using logistic regression and Cox proportional hazards model, respectively. RESULTS: Graft survival rates significantly improved during 1999-2002 (95% and 79% at 1-year and 3-years, respectively) compared with those of 1994-1998 (88% and 76% at 1-year and 3-years, respectively) (log rank P=0.02). After adjusting for other variables, the factors that significantly affected early transplant outcome adversely within 3 months posttransplant were prolonged cold ischemia time (>36 hours, odds ratio [OR]=3.38 vs. 0-36 hours) and young recipient age (2-5 years old, OR=2.02 vs. 6-12 years). Beyond 3 months, significant risk factors were African-American recipients (relative risk [RR]=1.93 vs. others), teenage recipients (13-20 yrs, RR=1.50 vs. 6-12 yrs), and patients with focal glomerulosclerosis (FGS) (RR=1.27 vs. others). CONCLUSIONS: The short-term graft survival rate of pediatric cadaveric kidney transplants has significantly improved, yet the long-term outcome has changed little. The long-term outcomes for teenagers (13-20 yrs), patients with FGS, and African-Americans lag significantly behind other groups. In order to improve long-term graft survival in these high-risk patients, newer preventive or treatment strategies must be developed.


Subject(s)
Graft Survival , Kidney Transplantation , Acute Disease , Adolescent , Adult , Black or African American/statistics & numerical data , Age Factors , Cadaver , Child , Child, Preschool , Female , Follow-Up Studies , Graft Rejection/epidemiology , Humans , Incidence , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Proportional Hazards Models , Retrospective Studies , Risk Factors , Time Factors , Transplantation, Homologous , United States/epidemiology
5.
Urology ; 66(1): 170-3, 2005 Jul.
Article in English | MEDLINE | ID: mdl-15993479

ABSTRACT

OBJECTIVES: To compare the access to urologic care for a child with cryptorchidism insured by Medi-Cal versus one insured by private insurance. Medi-Cal (California State Medicaid) is a joint state and federal health insurance program that plays a significant role in providing healthcare coverage to low-income children. METHODS: A total of 54 randomly chosen urology offices throughout California were surveyed by telephone to determine whether the office accepted pediatric patients, accepted Medi-Cal, and when the earliest appointment date would be for a patient with Medi-Cal versus one with private insurance. RESULTS: Of the 46 practices that accepted pediatric patients, 96% offered a new patient appointment to a child with private insurance, but only 41% were willing to offer an appointment to a child with Medi-Cal (P < 0.0001). Of the offices that would not see a child with Medi-Cal, 75% were unable to recommend a urology office that might accept Medi-Cal. CONCLUSIONS: Children insured by Medi-Cal have significantly less access to necessary urologic care compared with children with private insurance.


Subject(s)
Cryptorchidism/therapy , Health Services Accessibility/statistics & numerical data , Insurance, Health , Medicaid , Urology , California , Child , Humans , Male , Private Sector
6.
J Pediatr Surg ; 38(9): 1329-32, 2003 Sep.
Article in English | MEDLINE | ID: mdl-14523814

ABSTRACT

BACKGROUND/PURPOSE: Traumatic urethral injury in girls is rare, and there is no consensus on its management. The authors report their 22-year experience. METHODS: Forty girls presented with urethrovaginal fistula. Twenty-six girls presented with cystostomy tube in place, whereas 17 girls presented with complete urinary incontinence. Incision and dilatation of the obliterated urethra was carried out in 7 patients. Vaginal repair of urethrovaginal fistula was performed in 4 patients. Transpubic reconstruction of the urethra using a modified Young-Dees-Leadbetter procedure with simultaneous repair of the urethrovaginal fistula was performed in 35 patients (once in 27, twice in 5, and 3 times in 3 patients). RESULTS: Follow-up in 40 girls averaged 3.5 years. Twenty-nine patients have regained normal urinary control, and 11 patients have mild stress urinary incontinence. Four patients were lost to follow-up. CONCLUSIONS: Simple dilation of the obliterated urethra can reestablish satisfactory urethral patency if the obliterated segment is short. The vaginal approach to urethrovaginal fistula may be successful in patients without concomitant urethral stricture or in those with stricture amenable to simple dilation. The transpubic approach remains the method of choice for repairing complete urethral disruption and severe urethral stricture, especially when associated with urethrovaginal fistula.


Subject(s)
Urethra/injuries , Urethral Diseases/etiology , Urethral Diseases/surgery , Adolescent , Child , Child, Preschool , Cystostomy , Dilatation , Female , Fistula/etiology , Fistula/surgery , Humans , Infant , Urethral Stricture/etiology , Urethral Stricture/therapy , Urinary Incontinence/etiology , Vaginal Fistula/etiology , Vaginal Fistula/surgery
7.
Acad Radiol ; 9(11): 1305-21, 2002 Nov.
Article in English | MEDLINE | ID: mdl-12449363

ABSTRACT

Dual-modality imaging is a technique in which computed tomography (CT) or magnetic resonance imaging is combined with positron emission tomography or single-photon emission CT to acquire structural and functional images with an integated system. The data are acquired in a single procedure; the patient remains on the scanner table while undergoing both x-ray and radionuclide studies to facilitate correlation between the structural and functional images. The resulting data can aid in localization, enabling more specific diagnosis than can be obtained with a conventional imaging study. In addition, the anatomic information can be used to compensate the correlated radionuclide data for physical perturbations such as photon attenuation, scatter radiation, and partial volume errors. Thus, dual-modality imaging provides a priori information that can improve both the visual quality and the quantitative accuracy of the radionuclide images. Dual-modality imaging systems are also being developed for biologic research involving small animals. Small-animal dual-modality systems offer advantages for measurements that currently are performed invasively with autoradiography and tissue sampling. By acquiring data noninvasively, dual-modality imaging permits serial studies in a single animal, enables measurements to be performed with fewer animals, and improves the statistical quality of the data.


Subject(s)
Magnetic Resonance Imaging/instrumentation , Radionuclide Imaging/instrumentation , Systems Integration , Tomography, X-Ray Computed/instrumentation , Animals , Equipment Design , Heart Diseases/diagnostic imaging , Humans , Magnetic Resonance Imaging/methods , Neoplasms/diagnostic imaging , Physiology , Radionuclide Imaging/methods , Tomography, Emission-Computed/instrumentation , Tomography, Emission-Computed/methods , Tomography, X-Ray Computed/methods
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