VARIATIONS IN TIMING OF ELECTIVE ORCHIDOPEXY.

INTRODUCTION: Undescended testis or cryptorchidism is detected in 3% of full-term male newborns, and inup to 33% of preemies. As the testicular descent may sometimes resolve spontaneously during first months of life, cryptorchidism is found in 1% of boys one year old. According to Consensus of Nordic experts in. pediatric urology regarding cryptorchidism the optimal period for surgery is 12-18 months of age. The goal of this study was to identify the age of patients with congenital undescended testis at the time of surgery. MATERIAL AND METHODS: A retrospective study included all the cases of cryptorchid patients who had undergone orchidopexy in the period from 2007 to 2014. The patients'. age and the place of residence were analyzed. RESULTS: A total of 637 patients (722 orchidopexies) underwent the elective operative treatment of undescended testis during the observed period. The analysis revealed that only 144 (22.60%) of cryptorchid infants were operated on within their first 18 months of life. In the group of 359 patients from* the urban environment, 101 (28.13%) were operated under the age of 18 months. Among the 278 patients from the rural enviornment, 43 (15.46%) were 18 months and younger at the time of surgery. CONCLUSION: The timing of surgical treatment of undescended testis in the study period was far from the recommended optimal time. It is evidently necessary to plan and provide additional information for pediatricians and parents about the current view on cryptorchidism and consequences of the late treatment.

[Prepuce in boys and adolescents: what when, and how?].

INTRODUCTION: The prepuce envelops the glans as a variant of a mucocutaneous tissue presenting with a lot offunctions, the most important of them being to protect the infant's glans from feces and ammonia in diapers, to protect the glans from abrasions and trauma throughout life, and to provide sufficient skin in erection. Circumcision was recognized as a method of solving foreskin problems a long time before Christ. Practicing male circumcision in history was customary several thousand years ago and has spread worldwide. Today it depends on races, and it is often an initiation ceremony near the age of puberty. In everyday practice in pediatric urology outpatient department the foreskin problems have been noticed as a phimosis in 9.91% cases and prepuce adhesions in 3.98%. Congenital anomalies are present in different numbers. Other problems, such as paraphimosis, balanoposthitis, are recorded as accidental cases. Over-all prepuce pathology can be observed in 12%-25% of patients. The article presents a review of foreskin conditions, clinical manifestation, therapy and arguments for patient's benefits. CLINICAL PRESENTATION: The term phimnosis describes a foreskin that is unable to retract. It is necessary to distinguish normal anatomic situation in neonate and infantile period, when prepuce has not been separated yet from true pathologic phimosis due to fibrosis and sclerosis. Up to six years of age the tip of the prepuce is elastic and might be retracted by gentle manipulations. In cases when the foreskin is trapped behind the glans penis and cannot be pulled back to normal position, paraphimosis is present and can be treated as a medical emergency by manual manipulation, or by dorsal slit (incision). Many studies have demonstrated that frequency of urinary tract infection increases in uncircumcised males and that is a reason for routine circumcision. The others are against routine circumcision. The contraindications are newborns, especially prematurely born. and congenital penile anomalies. Condition in which the frenulunm of penis is short with consequent restriction of movement of the prepuce can be easily treated by frenulotomy. Hooded prepuce is a condition of incomplete circumferential formation of foreskin with a dorsal component present and ventral component absent. In cases without any penile anomalies this is only a cosmetically unattractive appearance and could be corrected by circumcision. Infection of the foreskin due to bacterial colonization could be both prevented and treated easily However, an infection due to peno-preputial incisions in adolescent age is serious and has to be cured promptly. CONCLUSION: As a part of external genitalia, the foreskin has a lot of functions. Despite its natural role many advocates routine circumcision due to problematic condition that can develop. Routine circumcision is not generally recommended. Improved education for physicians and parents with regard to the foreskin development and management is required.