Presentation of Posterior Urethral Valves in Saudi Arabia in the 90's.

To evaluate the age and mode of presentation of patients with posterior urethral valves (PVU) in the antenatal and postnatal periods, we analyzed the files of 108 patients with the diagnosis of PUV in four referral hospitals in Riyadh, Saudi Arabia from 1989 to 1999. Of the study patients, 29 (27%) were antenatally discovered, 41 (38%) in the first year of life and 38 (35%) after the first year of life. The mode of presentation was by antenatal ultrasound in 29 (27%) patients, urinary tract infection in 33 (30.4%) patients, poor urinary stream in 35 (32.4%) patients, retention of urine in neonatal life in eight (7.4%) patients and symptoms of renal impairment in three (2.8%) patients. We conclude that the antenatal detection rate of PUV in our study patients is less than the international one (70%), despite the fact that most of the antenatal follow-ups were done in centers where ultrasound was available for routine antenatal work up. This calls for more vigilance by the radiologists and obstetricians to enhance the rate of detection of PUV.

Clean intermittent catheterization in Saudi children. Suggestion for a common protocol.

In the last thirty years, clean intermittent catheterization of urinary bladder has proven to be one of the most important advances in Urology. Clean intermittent catheterizationis already utilized in the Kingdom of Saudi Arabia, but the materials and the methods in use are not always the most appropriate. The acceptance of the long-term treatment with clean intermittent catheterization among Saudi families does not seem to be adequate. Moreover, the knowledge and the agreement about clean intermittent catheterization by Saudi Medical Community, and even among Urologists, does not seem to be satisfactory everywhere. We analyzed many different catheters and their cost. We prepared a list of suggestions about clean intermittent catheterization materials and methods. Following this protocol, the majority of the parents of our patients, properly informed and trained, do now understand very well the aims and the advantages of the method. Consequently we realized the problems are not necessarily coming from the patients and their families, but eventually from the inadequacy of our educational and supportive system. In this review, we present our common protocol for clean intermittent catheterization in children, hoping to avoid some mistakes and improve the quality of life of these patients. As cultural background, on the base of our own experience, we reanalyze the principles, indications, results, contraindications, and complications of clean intermittent catheterization in children.

Female circumcision.

It is uncertain when female circumcision was first practiced, but it certainly preceded the founding of both Christianity and Islam. A review of past and current historical, popular and professional literature was undertaken, and 4 types of female circumcision were identified. Typically female circumcision is performed by a local village practitioner, lay person or by untrained midwives. Female genital mutilation is not accepted by any religious or medical opinion, and is a violation of human rights against helpless individuals who are unable to provide informed consent and who must therefore be protected through education and legislation. Complications of female circumcision can present after many years. Any medical practitioner (either for adult or pediatric) can be confronted with this issue of female circumcision, even in countries where this custom is not present, thus mandating the understanding of this complex issue.

Urinary tract infection in childhood. A practical approach and pediatric urologists point of view.

Urinary tract infection is a common problem in infants and children; it is the 2nd most common infection in children; moreover, morbidity is not limited to the acute period of illness. Urinary tract infection may also result in renal scarring which has the potential for diminished renal function and hypertension. The significant morbidity from urinary tract infection in early childhood has led to our current recognition of the importance of early diagnosis, prompt antibiotic treatment, and thorough evaluation of urinary tract infections in young children with documented urinary tract infection. Especially important are the differences in urinary tract infection between adults and children that emphasize that children are not "little adults" and they need different management. The risk of renal scarring is greatest in infants and may be progressive if there is a delay in diagnosis and management of urinary tract infections in children. Normal anatomy and physiology of the urinary tract with unidirectional urinary flow and complete emptying at regular reasonable intervals should protect children from urinary tract infections. A normal child should not have urinary tract infection. The obvious goals of urinary tract infection management are to provide symptomatic relief and to prevent renal damage. In the meantime to be able to prevent the recurrences of urinary tract infection, we have to evaluate the patient more, looking for any structural or functional predisposing factors. Treatment of underlying voiding dysfunction and constipation is an essential component of successful management of urinary tract infections in children. We will elaborate on urinary tract infection in children and concentrate mainly on the pediatric urologists' point of view and our practical approach to this problem.

Plastibell: A quick technique to decrease the distress of neonatal circumcision.

Full text is available as a scanned copy of the original print version.

Anterior sagittal transanorectal approach and Passerini-Glazel procedure: two surgical techniques combined for severely masculinized adrenogenital syndrome.

Full text is available as a scanned copy of the original print version.