Traumatismo cerrado menor, gran lesión renal en un paciente pediátrico; curación después de caterización ureteral / Minor blunt trauma, major kidney injury in a pediatric patient; healing after ureteral stenting

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A retrospective analysis of mathieu and tip urethroplasty techniques for distal hypospadias repair; A 20 year experience.

OBJECTIVE: We aimed to identify the changes in the application rate of two surgical techniques in distal hypospadias repair in years and compare the most popular two surgical repair techniques for distal hypospadias in terms of surgical outcomes, the factors that affect the outcomes, which were performed over a 20 year period. METHODS: In this study, the records of 492 consecutive patients that had undergone an operation for distal hypospadias in the urology clinic of Ankara between May 1990 and December 2010 using either Mathieu or TIPU surgical techniques were reviewed retrospectively. The patients who had glanular, coronal, and subcoronal meatus, were accepted as distal hypospadias cases. Among the 492 examined medical records, it was revealed that 331 and 161 surgical interventions were performed by using the Mathieu urethroplasty technique (Group-1) and TIP urethroplasty technique (Group-2), respectively. Group-1 was divided into two subgroups; namely Group-1a (patients with primary hypospadias) and Group-1b (patients with previous hypospadias operation). Likewise, Group-2 was divided into two subgroups; namely group-2a and group-2b. The patients' ages, number of previously urethroplasty operations, localization of the external urethral meatus prior to the operation, chordee state, length of the newly formed urethra, whether urinary diversion was done or not, post-operative complications and data regarding the follow-up period were evaluated, and the effects of these variables on the surgical outcome were investigated via statistical analyses. The primary objective of this study is to identify the changes in the application rate of two surgical techniques in distal hypospadias repair over the a 20 year period, and the secondary objectives are to compare the most popular two surgical repair techniques for distal hypospadias in terms of surgical outcomes, and the factors affecting the outcomes. Independent samples t test and Pearson's Chisquare test was used for statistical analysis. p<0.05 was considered as statistically significant. RESULTS: There were no statistically significant differences between the subgroups in terms of age, length of the neo-urethra, number of previously performed urethroplasty operations, surgical success rates, or complications (p>0.05). The concurrent utilization of the cystostomy and urethral stent was significantly more frequent in group-1 (p<0.05; Pearson's Chi-square test). It was determined that over time, TIP urethroplasty has become a more preferred technique for the repair of distal hypospadias. CONCLUSIONS: Both surgical techniques have similar success rates in distal hypospadias cases. TIP urethroplasty has become the method of choice over time.

A retrospective analysis of mathieu and tip urethroplasty techniques for distal hypospadias repair; a 20 year experience / Análisis retrospectivo de las técnicas de uretroplastia de Mathieu y TIP (Tubularized Incision Plate) para la reparación del hipospadias distal. Veinte años de experiencia

OBJECTIVE: We aimed to identify the changes in the application rate of two surgical techniques in distal hypospadias repair in years and compare the most popular two surgical repair techniques for distal hypospadias in terms of surgical outcomes, the factors that affect the outcomes, which were performed over a 20 year period. METHODS: In this study, the records of 492 consecutive patients that had undergone an operation for distal hypospadias in the urology clinic of Ankara between May 1990 and December 2010 using either Mathieu or TIPU surgical techniques were reviewed retrospectively. The patients who had glanular, coronal, and subcoronal meatus, were accepted as distal hypospadias cases. Among the 492 examined medical records, it was revealed that 331 and 161 surgical interventions were performed by using the Mathieu urethroplasty technique (Group-1) and TIP urethroplasty technique (Group-2), respectively. Group-1 was divided into two subgroups; namely Group-1a (patients with primary hypospadias) and Group-1b (patients with previous hypospadias operation). Likewise, Group-2 was divided into two subgroups; namely group-2a and group-2b. The patients' ages, number of previously urethroplasty operations, localization of the external urethral meatus prior to the operation, chordee state, length of the newly formed urethra, whether urinary diversion was done or not, post-operative complications and data regarding the follow-up period were evaluated, and the effects of these variables on the surgical outcome were investigated via statistical analyses. The primary objective of this study is to identify the changes in the application rate of two surgical techniques in distal hypospadias repair over the a 20 year period, and the secondary objectives are to compare the most popular two surgical repair techniques for distal hypospadias in terms of surgical outcomes, and the factors affecting the outcomes. Independent samples t test and Pearson's Chi-square test was used for statistical analysis. p < 0.05 was considered as statistically significant. RESULTS: There were no statistically significant differences between the subgroups in terms of age, length of the neo-urethra, number of previously performed urethroplasty operations, surgical success rates, or complications (p > 0.05). The concurrent utilization of the cystostomy and urethral stent was significantly more frequent in group-1 (p < 0.05; Pearson's Chi-square test). It was determined that over time, TIP urethroplasty has become a more preferred technique for the repair of distal hypospadias. CONCLUSIONS: Both surgical techniques have similar success rates in distal hypospadias cases. TIP urethroplasty has become the method of choice over time

OBJETIVO: Identificar los cambios en la tasa de aplicación de dos técnicas quirúrgicas en la reparación del hipospadias distal durante los años, y comparar las dos técnicas más populares de reparación quirúrgica del hipospadias distal realizadas durante 20 años en términos de resultados quirúrgicos y los factores que afectan a los resultados. MÉTODOS: En este estudio revisamos retrospectivamente las historias clínicas de 492 pacientes consecutivos intervenidos por hipospadias distal en la clínica urológica de Ankara entre mayo de 1990 y diciembre de 2010 utilizando las técnicas de Mathieu o TIP. Los pacientes que tenían un meato glandular, coronal o subcoronal se aceptaron como casos de hipospadias distal. Entre los 492 casos, 331 fueron intervenidos con la técnica de Mathieu (Grupo 1) y 161 con la técnica de Uretroplastia TIP (Grupo 2). El grupo 1 se subdividió en dos subgrupos: Grupo 1a (pacientes con hipospadias primario) y Grupo 1b (pacientes con historia de hipospadias intervenido previamente). Igualmente, el Grupo 2 se subdividía en dos subgrupos: Grupo 2a y Grupo 2b. Se evaluaron las edades de los pacientes, el número de uretroplastias previas, la localización del meato uretral externo antes de la operación, el estado de la corda, la longitud de la uretra nuevamente formadas, si se hizo derivación urinaria o no, las complicaciones postoperatorias y los datos relativos al periodo de seguimiento, y se hizo análisis estadístico de los efectos de estas variables en los resultados de la cirugía. El objetivo primario del estudio es identificar los cambios en la tasa de aplicación de las dos técnicas quirúrgicas con los años, y los objetivos secundarios comparar las dos técnicas de reparación del hipospadias distal más populares en términos de resultados quirúrgicos, factores que afectan a los resultados; técnicas que fueron realizadas a lo largo de 20 años. Para el análisis estadístico se utilizaron el test de la t para muestras independientes y el test del Chi cuadrado de Pearson. Se consideró una p > 0,05 como estadísticamente significativa. RESULTADOS: No había diferencias estadísticamente significativas entre los subgrupos en términos de edad, longitud de la neouretra, número de uretroplastias previas, tasa de éxitos o complicaciones (p > 0,05). La utilización concomitante de cistostomía y stent uretral fue significativamente más frecuente en el grupo 1 (p < 0,05; test del Chi cuadrado de Pearson). Se determinó que con el tiempo la Uretroplastia TIP se había convertido en la técnica más preferida para la reparación del hipospadias distal. CONCLUSIONES: Ambas técnicas quirúrgicas tienen tasas de éxito similares en los casos de hipospadias distal. La Uretroplastia TIP se ha convertido con el tiempo en el método de elección

Does a retropulsion prevention device equalize the surgical success of Ho:YAG laser and pneumatic lithotripters for upper ureteral stones? A prospective randomized study.

To establish if a retropulsion prevention device for ureteral stones equalizes surgical success and push-back rates of Ho:YAG laser and pneumatic lithotripters for upper ureteral stones. Patients with upper ureteral stones (n = 267) were treated endoscopically at the Department of Urology between April 2014 and December 2015. Patients were randomly assigned to pneumatic and Ho:YAG laser lithotripters as group-1 and group-2, respectively. Lithotripsy was performed with Stone ConeTM in both groups. The surgical success rate on the first postoperative day was 81.5 % (n = 106) and 90.6 % (n = 116) for group-1 and group-2, respectively, and the difference between the groups was statistically significant (p < 0.05). The relation between stone size and surgical success was statistically significant for both groups (p < 0.01). Surgical success for the stones closer than 2 cm to the UPJ was 23.1 % for the pneumatic group versus 64 % for the laser group (p < 0.01). Lithotripsy time was significantly longer in group-2 (16.48 ± 4.74 min) than group-1 (12.24 ± 3.95 min) (p < 0.01). Ho:YAG laser lithotripsy is more successful than pneumatic lithotripsy for upper ureteral stones and a retropulsion prevention device does not equalize the surgical success of Ho:YAG laser and pneumatic lithotripters for upper ureteral stones on the first postoperative day and one month after surgery. Although the success rate of the first month after surgery is higher in group-2, the difference is not statistically significant.

Vesicouterine fistula, a rare cause of genitourinary fistula.

Uterovesical fistulas are rare genitourinary fistulas developing secondary to iatrogenic etiologies. In this article, we report a a post-cesarean vesicouteri fistula with review of the literature.

Acupuncture versus paroxetine for the treatment of premature ejaculation: a randomized, placebo-controlled clinical trial.

BACKGROUND: Acupuncture therapy has been used by many researchers in both male and female sexual dysfunction studies. OBJECTIVE: To determine whether acupuncture is effective as a premature ejaculation (PE) treatment compared with paroxetine and placebo. DESIGN, SETTING, AND PARTICIPANTS: The study was conducted with methodologic rigor based on Consolidated Standards of Reporting Trials (CONSORT) criteria. Ninety patients referred to the urology clinic at a tertiary training and research hospital with PE were included in this randomized controlled trial and randomly assigned into paroxetine, acupuncture, and placebo groups. Heterosexual, sexually active men aged between 28 and 50 yr were included. Men with other sexual disorders, including erectile dysfunction; with chronic psychiatric or systemic diseases; with alcohol or substance abuse; or who used any medications were excluded. INTERVENTION: The medicated group received paroxetine 20 mg/d; the acupuncture or sham-acupuncture (placebo) groups were treated twice a week for 4 wk. MEASUREMENTS: Intravaginal ejaculation latency times (IELTs) and the Premature Ejaculation Diagnostic Tool (PEDT) were used to assess PE. IELTs were calculated by using a partner-held stopwatch. Data were analyzed statistically. RESULTS AND LIMITATIONS: Median PEDT scores of paroxetine, acupuncture, and placebo groups were 17.0, 16.0, and 15.5 before treatment, and 10.5, 11.0, and 16.0 after treatment, respectively (p=0.001, p=0.001, and p=0.314, respectively). Subscores after treatment were significantly lower than subscores before treatment in the paroxetine and acupuncture groups but remained the same in the placebo group. Significant differences were found between mean-rank IELTs of the paroxetine and placebo groups (p=0.001) and the acupuncture and placebo groups (p=0.001) after treatment. Increases of IELTs with paroxetine, acupuncture, and placebo acupuncture were 82.7, 65.7, and 33.1 s, respectively. Extent of ejaculation delay induced by paroxetine was significantly higher than that of acupuncture (p=0.001). The most important limitation of the study was the lack of follow-up. CONCLUSIONS: Although less effective than daily paroxetine, acupuncture had a significant stronger ejaculation-delaying effect than placebo.

Single-institution outcomes of open reconstruction techniques for management of pediatric and adolescent post-traumatic urethral strictures.

OBJECTIVES: To assess the long-term results and efficiency of open reconstruction techniques for pediatric and adolescent post-traumatic urethral strictures. METHODS: A total of 75 patients who had undergone open reconstructive urethroplasty for post-traumatic bulbous or posterior urethral obliterative strictures resulting from pelvic fracture urethral injuries were retrospectively analyzed. The mean patient age was 12.3 years (range 6-17). Of the 75 patients, 38 had a bulbar stricture and 37 had posterior urethral obliteration. Perineal end-to-end anastomotic repair, urethral pull-through, and ureteral tube graft urethroplasty were performed in 54, 20, and 1 patient, respectively. All patients were followed up by medical history and a urinary flow rate evaluation at 6 and 12 months postoperatively. RESULTS: The patients were followed up for 12-94 months (mean 43.2). The urethral strictures were successfully treated with end-to-end anastomotic urethroplasty in 37 (68.5%) of 54 patients, urethral pull-through urethroplasty in 14 (70%) of 20 patients, and ureteral tube graft in 1 patient. The total primary success rate was 69.3% (52 of 75 patients). Recurrent stricture developed in 23 patients. Of these 23 patients, 7 and 11 were successfully treated with secondary end-to-end anastomosis and direct vision internal urethrotomy, respectively. The overall success rate was 93.3% (70 of 75 patients). Five patients with treatment failure were still in follow-up, with direct vision urethrotomy performed, as needed. No penile curvature, penile shortening, or urethral diverticula developed. CONCLUSIONS: The results of our study have shown that open urethral reconstruction techniques are effective for primary and secondary surgical interventions in pediatric and adolescent patients with post-traumatic urethral strictures in experienced centers. These techniques provide excellent long-term results with minimal morbidity.

Effect of thioglycolic acid instillation to stop hair growth on the urethral mucosa after urethroplasty with hairy skin in a rat model.

OBJECTIVE: The aim of this study was to investigate the impact of thioglycolic acid on normal urethral mucosa. METHODS: Twenty-four rats were used. Three control and three study groups were formed each consisting of 4 rats. Controls groups were given 0.9% NaCl and study groups received thioglycolic acid instillation. The groups were allocated according to the time of urethral resection and the number of thioglycolic acid instillations (2, 4 or 8 instillations). The urethras of the rats were resected and examined under a light microscope in control and study groups 1, 2 and 3 on days 15, 30 and 60. RESULTS: There was no difference in the urethral mucosa of rats in the study or control groups, and no differences were found when the study groups were compared to each of the other groups at the microscopic level. CONCLUSION: The application of thioglycolic acid is an easy and inexpensive way of clearing urethral hair and does not cause pathological changes in the normal urethral mucosa.

Our 21-year experience with the Thiersch-Duplay technique following surgical correction of penoscrotal transposition.

OBJECTIVES: To assess surgical techniques applied after surgical correction of penoscrotal transposition and their complications. METHODS: The medical records of 64 patients with a mean age of 4.1 years (range 1-24) who underwent surgical correction for penoscrotal transposition and subsequent Thiersch-Duplay urethroplasty in the last 21 years were evaluated retrospectively. RESULTS: All cases underwent Thiersch-Duplay urethroplasty following reconstruction of penoscrotal transposition after a minimum interval of 6 months. Following Thiersch urethroplasty, 41 (64%) cases with successful outcomes had glandular meatuses. Of the remaining 23 (36%) patients 15, 7 and 1 patients underwent second operations for urethrocutaneous fistulas, meatal regressions and urethral diverticulum, respectively. Eleven of 15 patients underwent primary fistula repair and 4 patients, turnover fistula repair. These patients had glandular meatuses following fistula repair. Seven cases with meatal regression and breakdown of the neourethra were reoperated on by using double-face urethroplasty, onlay island flap urethroplasty and free-tube urethroplasty techniques. Finally, all patients had glandular meatuses. One patient with urethral diverticulum underwent successful diverticulum excision and meatoplasty. CONCLUSIONS: Thierch urethroplasty is the most commonly performed technique after surgical correction of penoscrotal transposition; however, additional procedures are needed for the management of its complications.

Retrospective analysis of the results obtained by using Mathieu and TIP urethroplasty techniques in recurrent hypospadias repairs.

OBJECTIVE: To determine the effect of Mathieu and tubularized incised plate (TIP) urethroplasty techniques on the outcome of repair in recurrent hypospadias. MATERIAL AND METHODS: A total of 78 patients who had undergone surgical correction by either Mathieu or TIP urethroplasty after unsuccessful hypospadias surgery were enrolled in this study. Cases were divided into two groups according to the operation technique performed. Surgical success rate of the techniques and the prognostic significance of age, type of diversion used, caliber and length of new urethra, and the number of previous operations were analyzed statistically. RESULTS: Mathieu and TIP urethroplasties were performed in 57 and 21 patients, respectively. No statistically significant relation was found between the groups for age, length of new urethra created, caliber of the urethra, urinary diversion used, mean operation success rates and number of previous operations. From within-group analysis, Mathieu urethroplasty was found to have a statistically significant relationship with the number of previous operations (P=0.025, Mann-Whitney U-test). CONCLUSIONS: Age, length and caliber of new urethra, and diversion type used seem to have no effect on the success rate of Mathieu and TIP urethroplasty in recurrent hypospadias restoration. The success of the Mathieu operation diminished proportionally to the number of previous failed surgeries.

Our 23-year experience in urethrocutaneous fistulas developing after hypospadias surgery.

OBJECTIVES: To determine the role of the fistula characteristics on the outcomes of repair in urethrocutaneous fistulas that develop after hypospadias surgery. METHODS: A total of 160 patients who had undergone urethrocutaneous fistula repair after hypospadias surgery were enrolled in this study. The prognostic significance of the site, size, and number of fistulas, number of the previous operations, and the techniques applied were analyzed by the appropriate statistical methods as the parameters of the study. RESULTS: The fistulas were localized at the distal, mid, or proximal penile region in 69 (43.2%), 60 (37.5%), and 31 (19.2%) patients, respectively. No statistically significant relation was found between the fistula site and the success rate (P >0.05). The fistula size (2 mm or less versus greater than 2 mm) and the number of fistula repairs (single versus two or more) also did not affect the outcome (P >0.05, Pearson chi-square and Fisher's exact tests). CONCLUSIONS: The site, size, and number of the fistula repair seemed to have no impact on the success rate. Well-known aspects of the modern hypospadias surgery (eg, delicate tissue handling, instruments, point coagulation, and vascularity of the tissues) probably play a role in the outcome.

Chronic constipation as a causative factor for development of varicocele in men: a prospective ultrasonographic study.

OBJECTIVE: The purpose of this study was to determine the role of chronic constipation in the etiopathogenesis of varicocele in men. METHODS: In this prospective study, group 1 included 25 male patients who had symptoms of chronic constipation for a mean duration +/- SD of 17.0 +/- 20.3 months (range, 3-96 months), and group 2 included 26 male subjects without any symptoms associated with constipation. All subjects were evaluated by both physical examination and scrotal ultrasonography. For the plexus pampiniformis (PP) veins, a mean diameter exceeding 2 mm and reflux for more than 1 second were accepted as suggestive findings for varicocele, as described previously. RESULTS: Left varicocele was detected in 13 (52%) of the 25 patients in group 1 and in 5 (19%) of the 26 subjects in group 2 (P = .02). The mean diameters of the left PP veins were 2.58 +/- 0.97 mm (range, 1.2-4.3 mm) in group 1 and 1.71 +/- 0.53 mm (range, 1.0-3.0 mm) in group 2 (P < .001). A significant difference was detected between the two groups for varicocele prevalence and the mean diameter of the left PP veins. CONCLUSIONS: Chronic constipation is a significant causative factor for the development of left varicocele, which may be attributable to the accompanying distention of the sigmoid colon and distal part of the descending colon, with resultant compression of the left testicular vein in the retroperitoneum. Therefore, we propose routine ultrasonographic examinations for the possible development of varicocele in men with chronic constipation.

Proteus syndrome with multiple genitourinary abnormalities.

Proteus syndrome is a rare hamartomatous disorder comprising a broad spectrum of congenital malformations and overgrowth of multiple tissues. Some rare urogenital malformations have been reported before. This case is unique for the presence of multiple genitourinary anomalies including retroperitoneal cystic mass, intra-abdominal testicle with hematoma and ureterovesical stricture apart from common clinic findings of proteus syndrome.

Scrotal sonographic findings in equestrians.

OBJECTIVE: Sports-related injuries are among the major causes of testicular trauma. In this study, we aimed to determine sonographically whether chronic urogenital trauma during horse riding increases the prevalence of scrotal sonographic abnormalities. To our knowledge, there are no studies in the literature that have focused on this topic. METHODS: Group 1 included 26 male riders with a mean age +/- SD of 31 +/- 2.9 (range, 26-38) years and with a mean riding experience of 5 +/- 2.6 (range, 1-10) years, whereas group 2 included 26 healthy nonriding men with a mean age of 31 +/- 3.2 (range, 26-41) years. After the clinical evaluation, all patients underwent scrotal sonographic examination. RESULTS: The prevalence of overall scrotal sonographic abnormalities in group 1 was significantly higher than that in group 2 (77% versus 38%; P < .05). The detected sonographic findings in group 1 were varicocele (46%), hydrocele (19%), testicular cyst (4%), epididymal cyst (35%), testicular calcification (19%), epididymal calcification (8%), scrotal calculus (8%), and inhomogeneity of parenchymal echo texture (4%). However, only varicocele (19%), epididymal cyst (19%), testicular calcification (12%), and scrotal calculus (4%) were detected in group 2. Between the 2 groups, the difference was significant for varicocele prevalence (P < .05) and marginally significant for hydrocele prevalence (P = .051). CONCLUSIONS: We recommend scrotal sonographic examination of equestrians when they have a palpable mass or related symptoms, the etiology of which was found in our study to be closely related to horse riding.

A huge unusual mass on the penile skin: acrochordon.

Acrochordons are flesh-coloured pedunculated lesions which occur in areas of skin folds. Although they are common in other sites of the body, we report the first case of huge penile acrochordon in the literature. Clinical, pathological and surgical findings of this lesion were presented and discussed.

Management of post-traumatic arterial priapism in children: presentation of a case and review of the literature.

In this article, a 9-year-old boy with arterial priapism is presented. The patient was managed with the conservative measures including imipramine hydrochloride and a favorable outcome was achieved after 2 months of follow-up. The pathophysiology, diagnostic tools and treatment alternatives are discussed.