Pediatric Urology Practice Research Articles

Current Concepts in the Perinatal Diagnosis and Management of Hydronephrosis

Perinatal urology has become a significant facet of pediatric urologic practice. This article reviews the approaches to the diagnosis of prenatal hydronephrosis and its typical sonographic appearances in relation to the underlying pathology. A review of the outcomes of prenatal uropathology serves as a basis on which to interpret reports of prenatal intervention for hydronephrosis. A critical review of the experience of prenatal intervention is conditionally supportive of its benefits, but this view must be tempered by a recognition of the inherent risk to the mother and fetus. Included within this view is a recognition that not all hydronephrosis is caused by obstruction. More specific prognostic indicators of renal and pulmonary functional reserve are critically needed to permit appropriate patient selection. This must be coupled with more rigorous assessment of outcomes and complete reporting of the results. Continued basic and clinical research is important in developing these data. A management strategy for hydronephrosis in the prenatal and postnatal periods is presented, based on the goal of permitting maximal renal as well as pulmonary development in utero and in the newborn period.

Treatment of congenital urethral stenosis (urethral ring) in children. Optic internal urethrotomy in the congenital bulbar urethral stenosis in boys

Congenital urethral stenosis in boys occurs at the junction of the entodermal primary urethra and ectodermal secondary urethra. Endoscopically this lesion is recognized as a ring-form stenosis just distal to the external urethral sphincter. It has been considered as rare congenital anomaly in American literature. But in our experience congenital urethral stenosis is an important cause of recurrent urinary tract infections, enuresis, pollakisuria or hematuria in pediatric urological practice. It also disturbs spontaneous healing of vesicoureteral reflux. The most effective treatment of this lesion is optic internal urethrotomy under direct vision. We would like to report our experience of optic internal urethrotomy for congenital urethral stenosis in boys. From 1974 to 1986, 226 boys with congenital bulbar urethral stenosis were treated in our clinic. Optic internal urethrotomy was performed using a Sachse urethrotome with a 10 or 13 Fr. sheath. Of the 176 ureters with vesicoureteral reflux, spontaneous disappearance of reflux after optic internal urethrotomy was noted in 62.5% of Grade I-II, 65.0% of Grade III, 28.9% of Grade IV and 16.7% of Grade V ureters. These spontaneous disappearance rates were significantly higher than those of primary vesicoureteral reflux in Grade III, IV and V ureters. Of the drug-resistant enuretic boys with a congenital bulbar urethral stenosis, enuresis disappeared or ameliorated in 69.4% after optic internal urethrotomy. Furthermore, urinary tract infections were mostly prevented by optic internal urethrotomy, irrespective of the presence or absence of vesicoureteral reflux. Our results support the view that congenital urethral stenosis (urethral ring) is an important clinical entity in pediatric urology.

On the issue of uroflowmetry in children

In the present work we consider uroflowmetry as a promising method of functional diagnostics in pediatric urological practice. Uroflowmetry is a method based on the measurement of volume urinary flow rate (VUR). The following parameters are recorded graphically: duration of urination, average urine flow rate, urine flow rate in the first second, time of reaching maximum urine flow rate, maximum urine flow rate and bladder volume.

Pediatric Office Procedures

The practice of pediatric urology has changed much during the last 25 years. Procedures that were once done only on inpatients are now done as ambulatory cases, comprising more than 60 per cent of all surgery. This trend has continued, with even more cases being done as office procedures. These consist of circumcision, meatotomy for stenosis, lysis of labial adhesions, and meatal dilatation after hypospadias repair. If an operation is done with attention to detail, it can be completed with minimal complications, although, as evidenced with circumcision, those that do occur can carry significant morbidity and even cause death. The primary limiting factor for performing procedures in the office is the comfort of the patient. The procedure, by necessity, has to entail minimum pain and great ease in obtaining hemostasis and requires a cooperative patient and family. Therefore, even as the number of operations performed on an out-patient basis increases, there are a finite number of cases suitable for the office.

Device for uroflowmetry in children

It is known that uroflowmetry has significantly expanded the diagnostic capabilities of urological studies. There is no doubt about the need for widespread use of uroflowmetry in daily pediatric urological practice.

Pediatric Urologic Surgery

This surely is one of the finest operative texts yet produced and it will remain for some decades the most comprehensive and authoritative guide for all those tempted to operate on the urological problems of children. The timing of the production of this beautifully produced book is excellent as it coincides appropriately with the retirement from active paediatric urological practice of the senior author, Innes Williams, who has done more than anyone for this subject. Furthermore, it is only in the last year or two that techniques of this rapidly expanding specialty have become standardised although where there are still considerable controversies, as, for example with hypospadias, the book provides good coverage of many different techniques. Many operations such as penile lengthening and paediatric transplantation are not easily found elsewhere. Although the more complicated procedures in paediatric urology should not be performed by those who have not had adequate training in both urology and paediatric surgery, here at least is advice on how to perform safely virtually all operations one is likely to encounter. The illustrations must be singled out for their excellence and it is pleasing to see the radiologists and anaesthetists writing as part of the team. Here is a book by internationally renowned experts that although expensive, as are all such good books, will be a prize possession for all those interested in this subject.

Isolated torsion of penis Report of 6 cases

Torsion of the penis as an isolated anomaly has rarely been reported. Six such cases seen in a pediatric urologic practice within a two and one-half-year span suggest that it is not as rare as has been hitherto suggested. The embryologic abnormality appears to be an isolated skin and dartos defect, since the torsion is completely remedied by simply freeing the penile shaft of its investing tissue. The ease of achieving a normal appearance would appear to justify its surgical correction.

Hypospadias: 10 year review of outcome of treatment in pediatric urological practice

Introduction: Hypospadias and its surgical correction is a challenging urologic discipline. Various surgical procedures for correction of this anomaly have evolved, in order to reduce complication rate and improve cosmetic outcome. The aim of this study is to review the complication rate and cosmetic outcome in patients who had hypospadias surgery at Ahmadu Bello University Teaching Hospital, Zaria. Patients and Methods: The case records and clinical appearance of 54 patients with hypospadias who had surgery between June1998 and June 2008 were reviewed. The effect of different variables on the overall complication rates were evaluated, including: the degree of chordee; the urethral meatal site after correction of any penile curvature; the age of the patient at surgery; the source of the neourethra; and tubularization of the flap. Result: The mean age of the patients was 1.97 (0.5-12) years. Most patients had their repair at 2 years of age. Twenty-six had distal hypospadias while twenty-eight were mid penile or proximal hypospadias. Distal hypospadias have a better outcome than proximal hypospadias. Onlay flaps have lower stricture and fistula compared with tubularized flaps. Repairs are done recently at earlier age with equal or better outcome. Conclusion: Skin flap procedures have had sufficiently extensive use to support the feasibility of a one-stage repair of different types of hypospadias. Snodgrass is gaining popularity in recent times, and more procedures are likely to evolve in order to improve cosmetic outcome.