Scrotal abscess: Varied etiology, associations, and management.

AIM: To report a series of scrotal abscess, a rare problem, their etiology, and management. MATERIALS AND METHODS: A retrospective study of children who presented with scrotal abscess between January 2010 and March 2015, analyzed with respect to clinical features, pathophysiology of spread and management. RESULTS: Eight infants and a 3-year-old phenotypically male child presented with scrotal abscess as a result of abdominal pathologies which included mixed gonadal dysgenesis (MGD) [1]; three anorectal malformations with ectopic ureter [1], urethral stricture [1], and neurogenic bladder [1]; meconium peritonitis with meconium periorchitis [2], ileal atresia [1], and intra-abdominal abscess [1]; posturethroplasty for Y urethral duplication with metal stenosis [1] and idiopathic pyocele [1]. Transmission of the organism had varied routes include fallopian tube [1], urethra ejaculatory reflux [4], hematogenous [2], and the patent process of vaginalis [2]. Two of the nine required extensive evaluation for further management. Treating the predisposing pathology resolved scrotal abscesses in eight of nine patients, one of whom, required vasectomy additionally. Idiopathic pyocele responded to needle aspiration and antibiotics. CONCLUSION: Scrotal abscess needs a high index of suspicion for predisposing pathology, especially in infants. Laparoscopy is safe and effective in the management of the MGD and ectopic ureter.

Modified koyanagi repair for severe hypospadias.

AIM: To report the results of an early series of patients who underwent modified Koyanagi repair for severe hypospadias. MATERIALS AND METHODS: A total of 24 boys (age: 9 months to 11 years) with proximal hypospadias, chordee, and poor urethral plate underwent modified Koyanagi repair between September 2008 and January 2012. Nine boys had associated penoscrotal transposition that was corrected simultaneously. Vascularized parameatal based foreskin flap was used to correct the hypospadias in a single stage. The follow-up ranged from 6 months to 3.5 years. RESULTS: A total of 13 of the 24 children had a good outcome and were voiding normally, while 11 boys developed complications, 3 of which were major and 8 minor. The major complications were complete breakdown (n = 1), meatal and distal neourethral stenosis requiring laying open of distal urethra (n = 1), and glans breakdown (n = 1). The minor complications included fistulae (n = 5), meatal stenosis amenable to dilatation (n = 1), and lateral chordee (n = 1). Majority of the complications were in the initial patients, with successful outcomes in the last 1 year. Most of these complications were successfully managed by minor second procedures. CONCLUSION: Modified Koyanagi repair not only corrects severe hypospadias with chordee but also corrects the associated penoscrotal transposition in a single stage. The results are good once the learning curve is crossed.

Ectopic testis in children: experience with seven cases.

BACKGROUND: Ectopic testis is a rare congenital anomaly in which the testis is abnormally located away from normal line of decent. AIM: To report varied clinical presentation, embryogenesis, and management aspects of ectopic testis with a brief review of the literature. MATERIALS AND METHODS: A retrospective chart review of children with undescended testis from January 2008 to August 2011. RESULTS: Seven children (3.6%) treated for ectopic testes were diagnosed among 190 children operated on for undescended testis. There were five perineal testes, one penile testis, and one transverse testicular ectopic testis. Laparoscopy was the diagnostic and therapeutic modality in transverse testicular ectopia. Other ectopic testes were managed by open orchidopexy. The length of the testicular vessels and vas deferens was adequate in every case. CONCLUSION: Examination of boys with an empty scrotum should include examination of ectopic sites as well. The gubernaculum bulb has preprogrammed growth toward the scrotum unless anatomical blockade prevents its descent. Open orchidopexy reveals normal characteristics of perineal, penile testis, and its elements. Surgical correction for ectopic testis as early as possible facilitates proper psychological development and prevents complications.

Urethral duplication: Experience of four cases.

AIM: Our experience of 4 cases of urethral duplication is reported here. MATERIALS AND METHODS: A retrospective chart review. RESULTS: The age at presentation varied from newborn to 10 years. The clinical presentation ranged from prepubic sinus to diphallus urethra. There were 2 each incomplete duplication with only external openings (Type IA) and complete duplication of Effmann Type IIA2. All underwent complete excision of accessory urethra and corrections of associated anomalies. CONCLUSIONS: Urethral duplications have a varied presentation. At follow up, all are asymptomatic with good cosmetic result.

Surgical complications of Ascaris lumbricoides in children.

AIM: To report the surgical complications of Ascaris lumbricoides infestation in children. MATERIALS AND METHODS: This is a retrospective study and cases of intestinal ascariasis managed conservatively were excluded. RESULTS: Sixteen children presented with Ascariasis sequelae, which included ileal volvulus (n=5), perforations (n=4), intussusception (n=1), biliary ascariasis (n-1) and impacted multiple worm boluses (n=5). Plain abdominal radiographs showed pneumoperitoneum (3), cigar bundle appearance (3) and multiple air and fluid levels (13). Sonography showed floating worms with free fluid (2), sluggish peristalsis and moderate free fluid (7) and intestinal worm bolus (11). The surgical procedures included milking of worms (in all), bowel resection (6), closure of perforation (3) and manual reduction of intussusception (1). Biliary ascariasis was managed conservatively and the progress monitored with sonography. There were 3 deaths all of whom had intestinal volvulus, bowel necrosis and toxemia. CONCLUSION: Sonography can be helpful in diagnosing the presence of worms, its complications and in evaluating response to treatment. Early surgical intervention in those with worm bolus, peritonism, and volvulus may salvage bowel and reduce mortality.