Scrotal injuries during neonatal circumcision.

OBJECTIVE: To report very rarely encountered scrotal injuries during neonatal circumcision. Hospitals and physicians in the authors' country are mandated to report circumcision complications to the Ministry of Health. Those reports include the discharge summary from the emergency room or the admitting department. This is believed to be the first case series describing scrotal injuries during ritual circumcision. PATIENTS AND METHODS: Reports of all circumcision complications between 2007 and 2014 were evaluated. Retrieved data on cases of scrotal injuries included patient's age, time between injury and hospital admission, nature of the injury, and administered treatment. RESULTS: Twelve of a total of 489 reports of circumcision injuries involved the scrotum (2.5%). All circumcisions were performed during the neonatal period, and the infants were admitted on the day of injury. The only related genital injury was significant shortage of penile skin reported in six patients. Scrotal exploration and skin closure in the operating room was undertaken in six cases, five under general anesthesia. Suture closure in the emergency department was performed in three patients, and the scrotal skin was left to heal with secondary intention in three other patients. Scrotal content injury that extended to the tunica vaginalis of the testis was noted in one exploration. DISCUSSION: The injuries sustained by the 12 study infants were mostly superficial and are not expected to cause long-term damage, although half of the patients required treatment under general anesthesia in the operating room or under sedation in the emergency department. While all reported patients emerged unscathed from the anesthetic procedures, the possible immediate complications of anesthesia as well as its long-term effects are not to be taken lightly, especially when treating a newborn. Further education of medical providers as well as performers of ritual circumcisions may help lower the risk of this rare injury as well as other more severe complications. CONCLUSION: Scrotal injury during neonatal circumcision is rare. While half of the 12 reported patients required exploration in the operating room, the injuries were mostly superficial and did not involve scrotal content, although they often involved extensive resection of penile skin.

Augmentation ureterocystoplasty: is it the preferred choice?

BACKGROUND: Various methods of urinary bladder augmentation have been attempted in order to try and achieve adequate bladder capacity, urinary continence, control urinary tract infection and preserve the upper urinary tract; however, long-term complications have been unavoidable. OBJECTIVE: To evaluate our experience with ureterocystoplasty as to whether it is the preferred method for bladder augmentation to achieve continence and preserve the upper urinary tract. DESIGN: Retrospective study. SETTING: Paediatric urology unit, Dana Children's hospital, Tel Aviv Medical Center (affiliated to the Sackler School of Medicine), Tel Aviv University. SUBJECTS: Four children; three girls, one boy, mean age 7.3, range (3-14) years. Two had neurogenic bladder due to occult spinal dysrraphism, the other two had non-neurogenic neurogenic bladder. The indications for surgery were urinary incontinence with recurrent urinary tract infections in all patients, one also had upper tract dilatation. INTERVENTIONS: All underwent augmentation ureteroplasty, two required nephrectomy due to non-functioning kidney, two required clean intermittent catheterizatiom postoperatively. MAIN OUTCOME MEASURES: Urinary continence, bladder capacity, vesicoureteral reflux, renal function tests, urinary tract infection rate and surgical complications encountered. RESULTS: In a mean follow-up period of 24 (6-46) months, all of the patients achieved urinary continence, two of the patients who have a normal bladder outlet are continent and void spontaneously with no residual urine. The other two patients are continent on clean intermittent catheterization. Only one episode of urinary tract infection was seen, none of the patients are currently on prophylactic antibiotics. The urinary bladder in all patients is spherical with good capacity and no vesicoureteral reflux was demonstrated. The upper urinary tracts are stable and the renal function tests are normal. CONCLUSION: Ureterocystoplasty is our preferred choice of bladder augmentation in patients with small, inelastic, poor compliant bladder with at least a moderately dilated ureter. Complications normally seen with enterocystoplasties are minimal.

The effect of surgically induced weight reduction on the serum levels of the cytokines: interleukin-3 and tumor necrosis factor.

BACKGROUND: Morbid obesity and malnutrition have both been demonstrated to have deleterious effects on the immune function. Cytokines are immunomodulatory peptides that have profound effects on immune function. To the authors' knowledge, the effect of surgically induced weight reduction on the cytokine levels has yet not been studied. In the present study, the authors determined the effect of surgically induced weight reduction on the levels of the cytokines interleukin-3 (IL-3) and tumor necrosis factor-alpha (TNF-alpha). METHODS: 14 patients undergoing silicone ring vertical gastroplasty were included in the study (mean BMI 48.85 kg/m2; range 38.1-52.0 kg/m2). Determination of the IL-3 and TNF-alpha levels was performed preoperatively and 14 days and 6 months postoperatively, when all patients had lost 25% to 30% of their preoperative weight. RESULTS: The IL-3 values before the procedure, and 14 days and 6 months after, were as follows: 9.69 +/- 1.82, 9.36 +/- 1.28, and 8.42 +/- 1.26 pg/mL, respectively (P < 0.05 preoperative versus 6 months postoperative level). The preoperative TNF-alpha levels showed a wide distribution. For this reason, the patients were divided into two groups: Group A with preoperative values >10 pg/mL and Group B with values <10 pg/mL. In Group A, a significant decrease from the preoperative level of 24.46 +/- 6.83 to 7.59 +/- 4.56, and 6.69 +/- 5.46 pg/mL was measured at 14 days and 6 months postoperatively, respectively (P < 0.05). In Group B, the TNF-alpha levels were not significantly changed and were 5.45 +/- 2.26, 7.59 +/- 4.56, and 8.82 < or = 6.27 pg/mL, respectively. CONCLUSION: The present study demonstrates a significant decrease in the levels of the cytokines, IL-3 and TNF-alpha. These changes can be responsible for alteration of the immune function after surgically induced weight reduction.