Long-Term Outcomes of Distal Hypospadias Repair: A Patients' Point Of View.

PURPOSE: To assess the long-term outcomes of patients treated for distal hypospadias. Assessment of long-term follow-up for a homogeneous population with hypospadias is difficult and there has consequently been a paucity of publications in this regard. MATERIALS AND METHODS: A retrospective review was carried out to compile cases of distal hypospadias operated at our center between 1990 and 1999 according to the MAGPI procedure. Four parameters were evaluated based on four validated questionnaires: Health-related quality of life (SF-36), Genital self-perception (PPS), Self-esteem (Rosenberg Self-Esteem Scale), and Erectile function (IIEF). RESULTS: A total of 77 patients who had undergone MAGPI surgery for hypospadias during the specified period were selected. Sufficient clinical data were available for 51 patients and only 15 of these patients were included, after a median follow-up of 22 years (20-26). Their outcomes were compared with those for a population of 15 matched circumcised men and 15 matched uncircumcised men. No significant difference was found between the patients and the control groups in terms of the score for quality of life (p = .29). There were, however, significant differences in the scores for self-perception of the penile cosmetic appearance (13.3 vs. 15.8; p < .01), self-esteem (30.6 vs. 35.8; p < .01), and erectile function (31.4 vs. 33.7; p = .04) between the patients and the controls. Lower self-esteem correlated with poor genital self-perception (r  = .92). CONCLUSION: This study confirms that adult patients operated for distal hypospadias have poor genital self-perception. This poor genital perception correlated with lower self-esteem.

Urine Contamination in Nontoilet-trained and Uncircumcised Boys.

OBJECTIVE: To assess any differences between the initial and midstream urine samples from nontoilet-trained, uncircumcised boys. Contamination during urine collection makes the diagnosis of urinary tract infections (UTIs) difficult in nontoilet-trained children, especially in uncircumcised boys. Whether the contamination comes mainly from the initial stream or the contact between urine and perineal skin is not known in this population. MATERIALS AND METHODS: A prospective diagnostic study between early and midstream urine samples was conducted on asymptomatic patients with no suspicion of UTI. The clean void method was performed in nontoilet-trained boys under general anesthesia. The exclusion criteria were circumcision, older than 3 years of age, recent antibiotics treatment, and recent UTI. Urinalysis and urine culture were performed, allowing a comparison between early and midstream urine samples. RESULTS: Forty-four patients were enrolled in the study, and 31 satisfactory samples were obtained. A higher contamination rate was found in the early stream (n = 16; 51%) than in the midstream (n = 5; 16%) (P < .01). The positive culture from the early stream sample was statistically associated with a lower age (P = .02). The contamination rate of the first stream is 3-fold higher than for the midstream when collecting urine for urine culture. CONCLUSION: The clean void method in nontoilet-trained, uncircumcised boys provides low-quality urine samples for both early and midstream urine samples. The benefit of catching midstream urine samples for the diagnosis of UTI in this population is even more important when the children are young.

Delayed-onset Ureteral Obstruction and Calcification Masquerading as Renal Colic Following Deflux Injection.

Vesicoureteral reflux is a common disorder in children, and its management has changed entirely as a result of widespread use of endoscopy procedures to inject filler materials. Complications with this type of treatment, particularly ureteral obstruction, are rare. Very few patients with delayed obstruction have been reported in the literature. We here present the case of an 8-year-old girl who exhibited symptoms of febrile renal colic and renal distension more than 5 years after undergoing endoscopic treatment. This is the first reported case of atypical late presentation combining pyelonephritis with ureteral obstruction and calcification.