Pediatric Urology

Urological emergencies during pregnancy, though rare, can pose significant risks to both maternal and fetal health. Because of changes in the body during pregnancy, conditions like urinary tract infections (UTIs), pyelonephritis, nephrolithiasis, hydronephrosis, and obstructive uropathy need to be carefully managed. This systematic review aims to evaluate the management strategies, diagnostic challenges, and clinical outcomes associated with urological emergencies in pregnant women. We analyze various diagnostic techniques, including ultrasound and MRI, as well as treatment options, with a focus on ensuring maternal and fetal safety. Our findings highlight the importance of a multidisciplinary approach and suggest recommendations for improving clinical practices in managing these emergencies. The review concludes with a call for standardized guidelines and further research into the long-term outcomes for both mother and fetus. In addition to the early intervention especially fetal minor invasive procedures would enhance its clinical relevance and impact.

Background: Infertility and hormonal alterations can be associated with cancer and venous thrombosis. Varicocele and ovarian varicose veins are related to infertility and venous thrombosis. The objective is to investigate the association between cancer and venous thrombosis with varicose veins beside the germinating glands. Methods: 152 patients were selected from my private practice in a retrospective observational study, 98 of them having been diagnosed with venous thrombosis and 54 of them having been diagnosed with cancer. The diagnosis of ovarian varicose veins and varicocele were made through eco-color-Doppler, considering the minimum diameter of the veins (4.0; 5.0 and 6.0 mm) next to the ovaries and next to the testicles (2.0; 2.5 and 3.0 mm), with a reflux of 0.5 s. Of a total of 14,800 patient, 152 with cancer and profound venous thrombosis were selected (1, 02%). Among these patients 98 were venous thrombosis cases and 54 were cancer cases. When we adopted the minimum diameter in varicocele as 2.0 mm, 2.5 mm and 3.0 mm, the rate was of 96.7%, 83.6% & 55.7% respectively and in ovarian varicose veins as 4.0 mm, 5.0 mm and 6.0 mm, the rate was of 83.5%, 61.5% and 39.6%. Varicose veins next to the testicles and the ovaries are associated to oxidative stress, which can interfere in the hypothalamic-pituitary-gonadal axis, in the immune system and in genetics. The high prevalence of varicose veins next to the germinating glands may play a determinant role in cancer and in venous thrombosis.

To evaluate the effect of parenteral testosterone on penile length, preputial skin and side effects in patients with hypospadias. Materials and Methods: 23 patients with hypospadias were included in this study. An oily solution, each ml of which contained testosterone propionate 25 mg, and testosterone enanthate 110 mg, equivalent to 100 mg of testosterone was given deep intramuscularly 4, 3 and 2 weeks before reconstructive surgery at the dose of 2 mg/kg body weight. Increase in penile length, transverse preputial diameter, and diameter at the base of penis were noted. Basal testosterone levels were obtained before the institution of therapy and on the day of operation. In addition, side effect such as development of pubic hair and delay in bone age was noted. Results: Following parenteral testosterone administration, the mean increase in penile length, transverse preputial diameter and diameter at the base of penis was 1.35±0.40 cm (P<0.001), 1.40±0.47 cm (P<0.001), and 0.72±0.47 cm (P<0.001), respectively. Serum testosterone level after injection was well within normal range for that age. Minimal side effects were noted in form of development of fine pubic hair. We conclude that parenteral testosterone can be safely used to improve the surgical outcome of hypospadias repair.

Complex upper urinary-tract disorders (CUUTD) pose challenges owing to multifactorial etiology. Evidence on hybrid endoscopic-robotic approaches (HERA) remains limited. We evaluated the efficacy, safety, and outcomes of HERA for CUUTD across adult and pediatric populations. We performed a PRISMA-compliant systematic review and single-arm meta-analysis of pooled proportions (Freeman-Tukey transformation) registered in PROSPERO (CRD420251022229). PubMed, Scopus, Web of Science databases were searched for English full-texts only (last searched: June 22, 2025). Inclusion criteria were: randomized controlled trials (RCTs) and non-randomized studies using HERA for CUUTD. Exclusion criteria were: isolated pathologies, single-modality, non-English, and insufficient data. Populations were grouped as adult, pediatric, or mixed. The independent dual review and risk of bias (RoB) assessment used Joanna Briggs Institute checklists. Heterogeneity (I 2) and publication bias (Egger's test) were evaluated. Fourteen retrospective studies (2005-2023) from international centers (n = 95: 26 adults, 44 pediatric, and 25 mixed populations; low bias) were included. In the absence of comparator arms, our findings represent descriptive pooled estimates of efficacy and safety. Pooled stone-free rate was 90.3% (95% CI 82.9-95.8%; I 2 = 75.8%%) and was higher in adults (100%) than in pediatrics (81.8%; p = 0.0082). Obstruction resolution was 100%; although no intraoperative complications were observed, postoperative complications were noted in 11.6% cases, mostly Clavien-Dindo II-IIIa. The reoperation rate was 9.6%, mean operative time was 185.2 min, and the mean hospital stay was 3.5 days. Stone recurrence and obstruction recurrence were noted in 4.2% and 0% cases, respectively. In selected patients and experienced centers, HERA may achieve high SFR and obstruction resolution with acceptable morbidity; however, the overall strength of evidence is low, heterogeneity is substantial, and publication bias was detected. Findings are preliminary and hypothesis-generating. Rigorous prospective comparative studies with standardized outcome definitions and follow-up are needed before drawing firm practice-changing conclusions.

На примере клинического случая молодого пациента с опиоидной зависимостью показано, что микробиомно-ориентированная терапия, включающая деконтаминацию кишечника, трансплантацию фекальной микробиоты и пробиотико-пребиотическую поддержку, может служить дополнительным инструментом стабилизации ремиссии.

To analyze the effect of developed methods of diagnosis and treatment on the improvement of outcomes in patients with secondary spinal deformities associated with hereditary systemic skeletal diseases. Material and Methods. The treatment experience of 36 patients with spinal deformity associated with hereditary systemic skeletal disease is presented. Individual diseases causing secondary scoliosis are characterized. The algorithm of examination and tactics of these patients are presented. Particularities of posterior, anterior, and multifunction surgical approaches are described. Results. The use of combined approaches and new instrumentation provides good outcomes in patients with spinal deformities associated with hereditary systemic skeletal diseases. The mean deformity angle before operation was 105 degrees, after operation -47 degrees. Mean correction in the postoperative period reached 56 %. Conclusion. Wide introduction of the modern segmental instrumentation allowing for multiplane correction of spine deformity along side with application of anterior, posterior, and combined approaches, as well as cooperation of specialists in hereditary systemic skeletal diseases and specialists in spine medicine provide good outcomes in these patients.

Представлены клинические наблюдения двух пациентов с хронической мигренью с аурой, устойчивой к фармакотерапии, у которых регресс симптомов наступил после эрадикации H. pylori и восстановления кишечной микробиоты с использованием трансплантации фекальной микробиоты (ТФМ) и пребиотико-пробиотической поддержки.

Cystinuria contributes in formation of urinary stones. But, it has been reported that cystinuria is diagnosed when someone experiences with cystine stones. Therefore, early diagnosis of this condition is important. Thus, the objective of the study was to determine the optimum pH and temperature for crystallization of urine cystine in-vitro. Cystinuria solutions were prepared with the concentrations of 40, 60, 70, 75, 80, 90, 100 and 120 mg/dL. The pH of each solution was changed with the addition of acetic acid. Then solutions were exposed to temperature +4°C and 37°C, for 15, 30 and 45min. The sediments were observed microscopically for cystine crystals formation. Then acetone was added to

Surgical outcomes of laparoscopic dismembered pyeloplasty in children with giant hydronephrosis secondary to ureteropelvic junction obstruction. J Pediatr Urol. 2011 Sep 12 [Epub ahead of print] We read the article with interest and congratulate the authors of the study. However one point needs clarification. The authors mention that 2 children (out of 8) with giant hydronephrosis, due to ureteropelvic junction obstruction, presented with a febrile urinary tract infection. They also mention that preoperative percutaneous nephrostomy (PCN) was not placed in any patient. We do not agree with this approach and always place a PCN to drain infected urine before proceeding with pyeloplasty.

Background: Wilms 'tumor, also known as nephroblastoma, is a rare form of renal malignancy. This neoplasm mainly affects children. It is extremely uncommon in adults. As a result, the diagnosis and treatment of this neoplasm are more challenging due to its unexpected nature outside of pediatric populations. We present a case of an adult woman who was found to have a mass in her right kidney. The mass was subsequently diagnosed as Wilms 'tumor. Case Presentation: A 20-year-old woman was admitted to emergency ward due to severe and complicated viral gastroenteritis. Abdominal ultrasound and CT scan incidentally detected a mass lesion measuring 34 × 27 mm located in the middle portion of the right kidney. Neither signs of invasion into adjacent structures nor metastasis were noted. The patient did not show any typical symptoms of Wilms 'tumor, such as flank pain or hematuria. Subsequently, a radical nephrectomy was performed. Histopathological examination and immunohistochemical analysis were conducted. Finally, the diagnosis of Wilms 'tumor was confirmed. Conclusion: In adult patients who don't present with known clinical symptoms, or in those who have imaging features of low-stage renal cell carcinoma (RCC), it is crucial to also consider the possibility of Wilms 'tumor in the differential diagnosis. Wilms 'tumor can occasionally mimic the radiologic as well as clinical aspects of other, more common kidney tumors. Therefore, careful evaluation and inclusion of this rare neoplasm in the diagnostic workup is mandatory. This approach can also help avoid misdiagnosis. The preferred surgical treatment for unilateral Wilms 'tumor is radical nephrectomy.

Inhaltsübersicht: A. Zweck der Strafe und soziale Wiedereingliederung; B. Antrag auf vorzeitige Vollstreckung der Nebenstrafe der Ausweisung; 1. Nebenstrafe der Ausweisung; 2. Rechtlicher Rahmen für den Antrag auf vorzeitige Vollstreckung der Nebenstrafe der Ausweisung in Portugal; 2.1. Zusammenhang; 2.2. Formale Voraussetzungen; 2.3. Materielle Voraussetzungen; 2.3.1. Kontext; 2.3.2. Günstige Prognose über das künftige Verhalten des Verurteilten: Erfordernis der besonderen Prävention; 2.3.2.1. Umfang; 2.3.2.2. Die besonderen Umstände des Falles; 2.3.2.3. Das frühere Leben des Verurteilten; 2.3.2.4. Die Persönlichkeit des Verurteilten; 2.3.2.5. Die Entwicklung des Verurteilten während der Vollstreckung der Freiheitsstrafe; 2.3.3. Vereinbarkeit der vorzeitigen Vollstreckung der Nebenstrafe der Ausweisung mit den Werten der Verteidigung der Ordnung und des sozialen Friedens: Erfordernis der allgemeinen Prävention; 2.4. Begründete Stellungnahme des Gefängnisdirektors und Anhörung des Verurteilten.

Climate change significantly threatens public health, especially in sub-Saharan Africa (SSA), with underexplored impacts on urological health. Rising temperatures, water scarcity, and ecological shifts have fuelled increasing rates of kidney stones, urinary tract infections (UTIs), chronic kidney disease (CKD), and urogenital schistosomiasis in the region. Despite clear evidence linking dehydration and environmental factors to these conditions, major adaptation strategies from the World Health Organisation (WHO), the African Union (AU), and national governments largely neglect this issue. Critical gaps include limited diagnostic capacity, low public awareness, inadequate funding, and a shortage of specialists. This study highlights the need to integrate urological health into climate frameworks, invest in water and sanitation infrastructure, expand research and surveillance, and run targeted public health campaigns. A coordinated approach across health, water, environment, and education sectors is vital for climate-resilient health systems and long-term health equity in SSA.

Objectives. Nocturnal enuresis is a common pediatric problem, the etiology of which is unclear. In the present study, vitamin B 12 and folate levels were measured in children with nocturnal enuresis and compared with those in healthy control group children to investigate whether there was any relation with enuresis and neurogenic maturation as a first time in the literature. Methods. In this cross-sectional study, we included thirty children (16 girls, 14 boys) who had presented with primary nocturnal enuresis (PNE) complaints in the study group and 31 children (13 girls, 18 boys) in the control group. Body weight and height measurements were obtained and complete blood counts and vitamin B 12 and folate levels were measured in all children. Results. No difference was found in age, height, and weight between study and control groups. Also the mean levels of the hemoglobin, hematocrit, and mean corpuscular volume (MCV) were not different between the two groups. Significantly lower mean vitamin B 12 and folate levels were found in the enuresis group compared with the control group. Conclusions. Further studies are needed to clarify B 12 and folate deficiency in larger series so that these tests can be included in routine investigations of enuretic children.

Background:Hypospadias is one of the commonest congenital anomaly in boys which requires either a single stage repair or staged repair. The success of the procedure depend upon the type, anatomy, experience of the surgeon, method of repair and preoperative hormonal stimulation. Aim: The aim of the study was to evaluate the various preoperative factors responsible for outcome of single stage repair in distal penile, mid penile and proximal penile hypospadias. Methods: There were 48 patients in this observational study which were divided into two groups. Group A comprised of 24 patients with glanular and coronal hypospadias while Group B comprised of 16 patients with distal penile, 5 mid penile and 3 proximal penile types with minimal chordae. All the 24 (50%) patients in group A underwent meatal advancement and glanuloplasty incorporated (MAGPI) repair while in group B 15 (31.25%) patients underwent Tabularized Incised Plate (TIP) repair and 9 (18.75%) patients underwent combined TIP...

Introduction: Clitoroplasty constitutes an important step in feminizing surgery for congenital adrenal hyperplasia (CAH) (1). In this video we present a technique that aims to preserve clitoral sensitivity and engorgement while minimizing the risk of neurovascular lesion. Materials and methods: We present a video of a three-year-old girl with history of CAH classical form, PRADER-III, who underwent clitoroplasty. After an initial endoscopic evaluation of the urogenital sinus, the clitoris was degloved and a rectangular incision was made on the ventral corpora cavernosa 15mm above the corpora bifurcation and 0.5 mm below the coronal sulcus. The cavernous tissue was partially resected. The upper and lower borders of the rectangular gap were closed by a 5-0 PDS running suture similar to the Mikulicz technique. Next, the edge of the glans was deepithelialized to reduce its size. For improved clitoral positioning, the clitoris was sutured to the pubic fat. From that point onward the procedure followed that of a standard vaginoplasty using the en-bloc technique (2-4). Thus far we have performed this technique in 33 patients, with 31 of them being girls with CAH and 2 being women with clitoral hypertrophy. Conclusion: Corporoplasty is a simplified technique for clitoroplasty, with the advantage being that is faster and safer than the technique that involves the dissection of the neurovascular bundle. In addition, corporoplasty has the possible benefit of preserving the cavernosal blood flow that permits the engorgement of the clitoris during sexual arousal.

Male circumcision involves removing the foreskin that normally covers the glans of the penis . It is practised for social, cultural and medical reasons including HIV prevention. There is currently an increased interest in male circumcision services, since three randomized controlled trials have confi rmed that circumcision reduces the risk of acquiring HIV infection in males . This surgery is one of the oldest and most common surgical procedures performed globally. It is estimated that one in three males worldwide are circumcised, with almost universal coverage in some settings. However, in low income settings, circumcision is trivialized and sometimes done by an untrained traditional medical practitioner in the community. Adequate training of all persons engaging in circumcision is fundamental. In order to raise awareness and reduce cases of circumcision made by untrained practitioners, health campaigns are one of the modalities. The general objective of the circumcision campaign was to provide quality care of circumcision to the population done by skilled and trained

Introduction: Hypospadias surgery has a failure rate ranging from 10% for distal cases to over 30% for proximal cases. However, real-world outcomes may be worse, as some complications emerge late in puberty or are underreported. The expectations for surgical success have evolved, shifting from basic urinary and sexual functionality to achieving a normal penile appearance. Bias in research favors retrospective studies with short follow-ups, and qualitative research remains scarce. This review describes complications following hypospadias surgery, their management, and prognosis. Methodology: A non-systematic critical review of existing literature on hypospadias complications and surgical management was conducted. Results: Common complications include urethrocutaneous fistulae (UCF), glans dehiscence (GD), urethral stenosis (US), urethral diverticulae (UD), urine spraying, and recurrent curvature (RC). UCF is the most frequently reported complication, treated through multilayer closure with vascularized flap coverage. GD occurs more frequently in proximal hypospadias, requiring glans reformatting and tissue augmentation. US often manifests as meatal stenosis or neourethral strictures, requiring meatoplasty or staged urethroplasty. UD arises from loose urethral segments subjected to high urinary flow resistance and is managed via excision or remodeling. Urine spraying is linked to insufficient glans fusion or meatal irregularities, sometimes requiring surgical correction. RC is a significant complication impacting sexual function, requiring individualized correction through dorsal plication or ventral lengthening.

BACKGROUND Cryptorchidism is associated with alteration of fertility potential. The aim of this study is to evaluate mid/long-term morphology and volume of the operated testis for undescended testes by using elastosonography. MATERIALS AND METHODS The medical records of consecutive patients who had received orchiopexy at the Authors&#39; Institution between January 2014 and January 2017 were retrospectively considered. The patients enrolled in the study were divided into different groups depending on their age at the time of the procedure and on the time elapsed from it. The radiological and surgical examinations examined position, volume and trophism of both testes. RESULTS During the study period 270 patients received surgery; only 34 patients complied with the inclusion criteria: 19 with right orchiopexy and 15 with left orchiopexy (P &gt; 0.05) (P = 0.57). The mean testicular volume of the operated testis was 0.59 ± 0.32 ml, while the mean testicular volume of non-operated testi...

Objective: To evaluate the results of simple closure using bilateral anterior pubic osteotomy to achieve a tension-free approximation of the pubis and abdominal wall in patients with bladder exstrophy. Patients and methods: A prospective study carried out between 2006 and 2009 included 15 patients (13 boys and 2 girls; age range 3-47 months). Of these patients, three had recurrent exstrophy while 10 were operated primarily. An elective surgical technique was used for all patients, which included dissection of the exstrophic bladder from the abdominal wall, closure of the bladder and reconstruction of the urethra, then dissection of the rectus muscle and sheath lateral to the attachment of muscle to pubic bone, which makes osteotomy of the superior pubic ramus easy, thus facilitating closure. Results: For closure of the bladder and anterior abdominal wall the results were excellent for all patients soon after surgery, but there was soft-tissue infection in two patients. Of all 15 patients, one had incomplete bladder dehiscence and another had a vesico-cutaneous fistula; both needed surgical intervention later. Conclusions: Simple closure with anterior pubic osteotomy is a feasible and effective means to facilitate both bladder and abdominal closure for patients with bladder exstrophy. It is advantageous in being a rapid procedure, and can be completed by the paediatric urologist.

This monography covers the current state of the Intermittent Pneumatic Compression (IPC) technology. The special accent is made on the volumetric pneumopressing (VP), which is the modern modification of this method, developed in Ukraine under the supervision of Igor V. Tarshinov, Sc.D. The history of IPC starts with the works of R. Boyle in the XVII century. In the beginning of the XX century, the appearance of pulsating compression and multilocular pneumatic cuffs were the important milestones in IPC method development. The pressure wave massage became a classic sign of IPC. The achievement of balance between the capabilities of medical equipment and the needs of medical practice coincided with the rise of evidence-based medicine. Under these conditions, the IPC method is still intensively improving. In 1989-1992 I. Tarshinov offered VP as the modern IPC modification. This technology features the complex mechanism, holistic approach in the practical application and focus on the stimulation of sanogenesis. For the further IPC development, the Institute for Healthcare Technologies ITO “Nove u medytsyni” (IHT “New in medicine”) was created in Ukraine in 1992. The Institute performs the following activities: develops, assembles, and sells the VP devices provides the pilot clinical trials and organizes multicenter research in cooperation with the specialized state medical institutions publicly promotes the VP method by publishing scientific articles and holding lectures for medics and non-specialists provides medical services The Institute maintains the research and scientific cooperation with the following institutions, belonging to the Ministry of Health of Ukraine and the National Academy of Medical Sciences of Ukraine: Shalimov National Institute of Surgery and Transplantology Scientific Research Institute of Clinical and Experimental Neurology and Psychiatry Bohomolets National Medical University Shupyk National Medical Academy of Postgraduate Education Ukrainian Scientific Research Institute of Medical Rehabilitation and Balneology Danylevsky Institute of Endocrine Pathology Problems National Cancer Institute Main Military Medical Clinical Center “MMCH” of the Ministry of Defence of Ukraine National Antarctic Scientific Center of Ukraine State Olympic Sports Training Center Performing its research activities, the ITO follows its own initiatives, accepts governmental contracts and participates in international scientific cooperation. During the years of work, the Institute investigated the following issues: tactics and strategy of disease management ways of combining medical programs nuances of action of the pressure wave on the human organism algorithms of customized prescription evaluation of patient reactions efficiency prediction The progressive research led by the Institute cover the VP application with diabetes mellitus (since 1995), spinal traumas (1998), hypertension (2002), eye diseases (2007), vegetative (1999), mental (2006) and copulative (2009) disorders. The Institute owns 53 patents in Ukraine and Russian Federation and has published over 165 scientific publications. The Institute researchers received the state, foreign and international awards, including World Intellectual Property Organization Medal for Inventors (2003) and Intellectual Property Enterprise Trophy (2006). The new approach to the IPC capabilities appeared due to the use of improved therapeutic devices such as “Bioregulator-004M” with modifications “Bio-1”, “Bio-2”, “Bio-5” in combination with vacuum cups, accessories for eye muscle training and spinal traction. The ITO researchers singled out the hardware parameters that were important for users: number of program modes and application zones possibility of modifying the usage modes number and size of cuff chambers fixture design and pressure control convenience in control and repair cost of spare parts After comparing 4 Ukrainian and 9 foreign analogs, the authors offered a new IPC device classification to consider the range of their therapeutic capacity. The Ukrainian devices have the following advantages: more than 120 preset programs, flexible pressure regulation, large multipurpose transformable pneumatic mattress and special cap-like cuff for head. Devices may access all body zones. A nurse may autonomously control and regulate 8 out of 10 massage wave parameters, which increases the number of possible therapeutic modes. The product line includes devices for hospital or home use only, but each device implements all the VP possibilities. Unlike the devices made in USA, Israel or EU countries, the Ukrainian devices are used to address all the complex of patient’s diseases at a time. The devices are easy-to-operate, in spite of performing many functions. In view of the latest information, the Institute specialists have formed a modern approach on the VP action mechanism. The mechanical compression of soft tissues causes reactions on the local and global hemodynamics and lymphodrainage, changes in rheology and blood composition, and activation of metabolism. Mechanical stimulation of sensory receptors leads to reflex reaction of the autonomic and central nervous systems. The VP-caused processes in the system of humoral and nervous regulation facilitate sanogenesis. The VP mechanism of action includes the specific processes, due to which the method may be used for treating the specific illnesses. The following results may be achieved: reduction of blood viscosity and swelling, elimination of toxins, myorelaxation, regeneration, metabolic improvement, moderate hypotension, immunomodulation, analgesic, anti-inflammatory, hypoglycemic and sedative effects. The authors of the book have set the highlights to be addressed in the nearest years. In accordance with the peer-reviewed publications, the IPC method is being used for the prevention of deep vein thrombosis and venous thromboembolism; in treating the chronic venous insufficiency, ischemia and edema of limbs; post traumatic and sports rehabilitation. By the experience of the ITO specialists, the list of diseases, addressed by the IPC, must be completed with arterial hypertension, back pain, joint lesions, brain ischemia, multiple sclerosis, erectile dysfunction, diabetes mellitus, eye diseases, fire traumas. The usage of VP method should receive further investigation in treating vegetative and mental disorders, lung diseases, and in the sphere of gerontology. The contraindications should be revised. The statistical analysis of ITO clinical work, based on 14000 cases (patients aging from 2 to 95, main between 50-80), showed that an average patient suffers from 1.5 principal diseases and 4.3 coexistent diseases. The main disease categories to be treated using the VP method were locomotor lesions, limb vascular diseases, circulatory and nervous dysfunctions and diabetes mellitus. The integral therapeutic effectiveness during 2010-2014 was as follows: effective in 82.8-90.1% of cases, weak efficiency in 9.9-17.2% of cases. The list of referenced publications includes 67 foreign and 74 Ukrainian sources, published within 1976-2014. This book is for doctors who use the IPC (VP) method, as well as for the developers of medical devices, scientists, researchers, and health officials and professionals.

Background: Circumcision is the most common surgical procedure performed in boys through out the world. Meatal stenosis is one of its late complications. Objective: The aim of the present study is to see the effectiveness of use of lubricants vaseline-petrelium jelly) during arumcision meatal stenosis. Methodology: A randomized control trial was performed, in which two groups of boys younger than two years old underwent circumcision according to dissection (sleeve) method. The parents in the study groups were strictly instructed to use petroleum jelly on the meatus and circumcision site at every morning or after each diaper change where necessary for three months. On the other hand parents in the control group were instructed not to use any lubricants or topical medication on the same site. The boys were followed up regularly and evaluated for meatal stenosis, bleeding and infection. Results: A total of 120 boys were recruited & in each group comprised of 60 boys. None of the boys in the study group develop meatal stenosis , but 6(10%) in the control group develop meatal stenosis (p< 0.05 ). Infection of the circumcision site was seen in 1 (0.6%) and 3 (5%) children in the lubricant and control groups, respectively (p<0.05) and bleeding was seen in 3 (5.0%) and 6(10.0%) respectively. Conclusion: Based on the findings of this study, it seems logical to use a lubricant jelly for prevention of post circumcision meatal stenosis and other complications. [

Introduction: Treatment of the cryptorchid testicle is justified due to the increased risk of infertility and malignancy as well as the risk of testicular trauma and psychological stigma on patients and their parents. Approximately 20% of cryptorchid testicles are impalpable. In these cases, the laparoscopic technique is the method of choice for diagnosis and treatment. Materials and Methods: From 1 April 2009 to 31 October 2010, 37 testicles of 30 patients were submitted to diagnostic laparoscopy for impalpable testes. This was a prospective study seeking the diagnostic accuracy and therapeutic outcomes of use of laparoscopy in impalpable testes. Age, operative techniques, complications, the cosmetic aspect and outcomes were also recorded. Results: Mean age was 6.64 ± 3.96 years and 23% cases were bilateral. Twenty-one cases had primary orchiopexy, 9 had 1st stage Fowler-Stephens (FS) procedure, 3 had 2nd stage FS, 13 cases needed inguinal exploration and there was one vanishing testicles. Average operating time was 40 min for diagnostic laparoscopy, 90 min for unilateral and 120 min for the bilateral cases. Two of the patients had late postoperative complications e.g. one uretereral obstruction and one recurrence. Conclusions: In pediatric age group, the laparoscopic approach is safe and feasible. The purpose of study is to see whether the laparoscopic procedure presents excellent results in terms of diagnosis and therapy of the impalpable testis.

Introduction: Treatment of the cryptorchid testicle is justified due to the increased risk of infertility and malignancy as well as the risk of testicular trauma and psychological stigma on patients and their parents. Approximately 20% of cryptorchid testicles are impalpable. In these cases, the laparoscopic technique is the method of choice for diagnosis and treatment. Materials and Methods: From 1 April 2009 to 31 October 2010, 37 testicles of 30 patients were submitted to diagnostic laparoscopy for impalpable testes. This was a prospective study seeking the diagnostic accuracy and therapeutic outcomes of use of laparoscopy in impalpable testes. Age, operative techniques, complications, the cosmetic aspect and outcomes were also recorded. Results: Mean age was 6.64 ± 3.96 years and 23% cases were bilateral. Twenty-one cases had primary orchiopexy, 9 had 1st stage Fowler-Stephens (FS) procedure, 3 had 2nd stage FS, 13 cases needed inguinal exploration and there was one vanishing testicles. Average operating time was 40 min for diagnostic laparoscopy, 90 min for unilateral and 120 min for the bilateral cases. Two of the patients had late postoperative complications e.g. one uretereral obstruction and one recurrence. Conclusions: In pediatric age group, the laparoscopic approach is safe and feasible. The purpose of study is to see whether the laparoscopic procedure presents excellent results in terms of diagnosis and therapy of the impalpable testis.

Background: This study explores the associations between pediatric adverse events (PAEs) and both hospital and patient characteristics within the inpatient hospital setting, specifically focusing on Neonatal Blood Stream Infection (NBSI) as defined by pediatric quality indicators (PDIs) from the Agency for Healthcare Research and Quality (AHRQ). This research aims to answer questions regarding the relationship between hospital characteristics and patient demographics with the occurrence of NBSI. Methods: This study utilized discharge data from the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Databases (KID) for the year 2019. Bivariate and multivariate logistic regression models were employed to analyze patient-level encounters of NBSIs. The analysis examined various factors including hospital size, location, and teaching status, as well as patientspecific variables such as gender, age, race, service lines, payment sources, and major operating room procedures. Results: The results indicate that Public and Private not-for-profit hospitals showed significantly lower odds of experiencing NBSIs when compared to Private investor-owned hospitals, as did smaller, rural, and nonteaching hospitals when compared to large hospitals. Additionally, individual factors such as gender, age, race, service lines, payment sources, and types of major operating room procedures were found to have varying levels of significance in relation to NBSI. Conclusions: This study provides important insights into PAEs within the inpatient hospital setting, particularly focusing on NBSIs within the PDI framework. The findings highlight critical areas for the development of evidence-based interventions and guidelines, which are essential for clinicians and policymakers. Ultimately, this study contributes to the understanding and improvement of pediatric patient safety by emphasizing the necessity for targeted strategies to mitigate the risk of NBSI.

While Wilms tumors (WT) typically present solely with an abdominally palpable mass, rare cases exhibiting vascular tumor growth can also present with circulatory problems. Here, we report the case of a 2.5-year-old girl presenting with upper venous congestion and arterial hypertension as the primary symptoms of intraventricular tumor growth exhibiting remarkable tubular and perfused morphology. Clinical situation stabilized after initiation of neoadjuvant chemotherapy (NAC) with actinomycin D and vincristine, followed by surgical resection via laparotomy and sternotomy supported by cardiopulmonary bypass and deep hypothermia. Our results highlight the previously reported feasibility of this approach, even in primarily unstable patients.

The study of the comparative morphology of humans and mammals - laboratory animals used in experimental studies, is of great importance for improving diagnostic and therapeutic measures in clinical medicine. The study of histotopography and morphoarchitectonics of ontogenetic transformations of the lower urinary tract of humans and laboratory mice in a comparative aspect is relevant for the development of simultaneous morphological scientific directions - tissue engineering, molecular medicine and reconstructive xenotransplantation.
Aim of the study. To determine the main patterns and chronological sequence of prenatal ontogenesis of organs and structures of the lower urinary tract of humans and laboratory mice.
Material and methods. The study was conducted on 14 series of consecutive histological sections of human embryos and pre-fetuses aged from 4 to 11 weeks of intrauterine development (IUD) and 15 series of histological sections of laboratory mouse embryos and pre-fetuses. The material was used from the collection of the Department of Histology, Cytology and Embryology of the Bukovina State Medical University. A complex of morphological research methods was applied (anthropometry, morphometry, microscopy, three-dimensional computer reconstruction, statistical analysis). To compare the periods of prenatal development of humans and laboratory mice, periodization according to the Carnegie stages (CS) was used.
Results. In both species, at the IUD stage CS 11, hematopoietic foci in the mesoderm of this provisional organ were detected. During the subsequent stages CS12-14, the epithelium lining it becomes multilayered, an increase in cell density is noted, which may be associated with the increasing functional demands placed on this structure. The features of the syntopy of the allantois at the stage CS16 of human embryos (end of the 5th week of gestation) and laboratory mouse (day 12 of gestation) are characterized by its location between the umbilical arteries, and its caudal part is connected to the urogenital sinus, which has not yet been completely separated from the rudiment of the rectum. In human and laboratory mouse embryos up to the stage of development CS23, processes of atrophy of the allantois are observed, which is transformed into a cellular cord, and together with the reduced remnant of the yolk sac is located among the structures of the umbilical cord. During the morphological analysis of the features of the development of the urinary bladder of the laboratory mouse, the ratio of the thickness of its membranes was determined using morphometry of histological preparations, as well as on 3D reconstructions of serial consecutive sections of the lower urinary tract. It was established that from the stage of development CS17 to CS23 in the laboratory mouse, the size of the urinary bladder increases 12 times. Features of the proliferation and differentiation of the muscular membrane of the urinary bladder of the laboratory mouse are observed, which are characterized by a wave-like process that begins from the cranial part of the organ laying (CS17 embryos) and is directed in the caudal direction (CS19 embryos). During the stage CS21, the development of smooth myocytes increases the total thickness of the muscular membrane. At stage CS23, all parts of the bladder of a laboratory mouse demonstrate a developed muscular coat, in which unidirectional bundles of muscle fibers can be distinguished, which indicates the beginning of the formation of muscle layers and, in particular, the bladder detrusor muscle.
Conclusions. 1. Comparison of the patterns of morphogenesis of the lower urinary tract in humans and laboratory mice using the Carnegie scale of prenatal development periods demonstrates the similarity of stage ontogenetic transformations, but at the microscopic level, differences were found that indicate a less differentiated bladder detrusor muscle and a relatively faster time of formation of the definitive structure of the urinary bladder. 2. In human and laboratory mouse embryos at the CS23 stage, the structures of the urinary bladder acquire the features of a definitive organ. 3. The general trends of differentiation of the muscular membrane of the urinary bladder of the laboratory mouse have a wave-like character: the process begins from the cranial part of the bladder lining and is directed in the caudal direction. 4. The ratio of layers of the bladder wall of a laboratory mouse at CS17 was: 55% - the lamina propria of the mucous membrane, 5% - its epithelial lamina (urothelium), 5% - the adventitia (or serous) membrane, 35% - the muscularis mucosa. At the stage of CS23, there is a decrease in the relative thickness of the adventitia (or serous) membrane and an increase in the muscularis mucosa of the bladder to 70% relative to its wall.

Introduction: Obstructive uropathies refer to anatomical impediments to normal urinary flow. They are predominantly caused by congenital malformations of the urinary tract and occasionally complicated by obstructive urinary stones. This study aims to elucidate the epidemiological and diagnostic facets of obstructive uropathies.
Patients and Method: This retrospective, descriptive study was conducted over six years, from January 1, 2018, to December 31, 2023, at the pediatric surgery department of Albert Royer Children's Hospital in Dakar, Senegal. The study focused on the frequency of obstructive uropathies, the sex ratio, discovery contexts, types and locations of uropathies, and associated malformations.
Results: Among the 29,935 children received in the department during the study period, 130 cases of obstructive uropathies were documented, equating to a hospital incidence of 0.43%. The mean age of patients was 42.53 months, ranging from one day to 15 years. Infants constituted the largest affected group, at 47.69%. The cohort included 106 males and 24 females, rendering a sex ratio of 4.41. The antenatal diagnosis was confirmed in 27 patients (20%). Uretero-hydronephrosis emerged as the predominant clinical indication. Postnatally, urinary disorders prompted consultation in 36% of cases. Ultrasound examinations were performed universally. Additionally, VUCG was conducted in 49% of patients to identify lower urinary tract obstructions, while 39% underwent urological CT scan for upper tract obstruction etiology. Renal distress with electrolyte imbalance was evident in 8% of cases. Concurrent urogenital pathologies were present in 18% of cases. Notably, posterior urethral valves accounted for 39%, pyeloureteric junction obstruction for 31%, obstructive caliceal and pelvic lithiasis at 8%

Objective. To analyze the penile and urethral meatus biometry and its correlation with meatoplasty during endoscopic resections. We also propose a new classification for urethral meatus morphology.Materials and Methods. We prospectively studied 105 patients who underwent prostate and bladder transurethral resections. We performed standardized measurement of penile and urethral meatus biometry followed by penile photo in the front position. The need to perform meatoplasty or dilatation during resectoscope introduction was registered. Data were analyzed comparing the correlation between two groups: without intervention (Group A) and with intervention (Group B).Results. We observed in Group A and Group B, respectively, the average length of urethral meatus of 1.07 cm versus 0.75 cm (p&lt;0.001) and average width of urethral meatus of 0.59 cm versus 0.38 cm (p&lt;0.001). Considering the morphology of the urethral meatus, we propose a new classification, in the following groups: (a) typi...

Objectives: To evaluate histological alterations in prepuce of patients with phimosis submitted to topic treatment with betamethasone in association with hyaluronidase. Materials and Methods: We studied sixty patients (mean age 4.5), presenting true phimosis and treated with a topical treatment with betamethasone cream (0.2%) + hyaluronidase. The parents of seven of these patients opted for circumcision (control group). The other fi fty-three patients were submitted to clinical treatment. The samples were stained with Weigert's resorcin-fuchsin (analysis of the elastic fi bers) and Picro-Sirius Red, for analysis of the collagen. The volumetric density of the elastic fi bers was determined by stereological methods. Results: Only eight (15%) of the fi fty-three patients submitted to topical treatment presented failure, being indicated for circumcision (histological analysis). We observed an increase of the collagen type III of the patients submitted to topical treatment. The quantifi cation showed a reduction of the volumetric density of the prepuce's elastic fi bers of the patients submitted to the cream treatment, when compared to the control group (p = 0.056). The volumetric density of the elastic fi bers of the prepuce at the group not submitted to topical treatment showed an average of 14.60% (11.06 to 21.64%); in the group submitted to the cream treatment, the volumetric density of the elastic fi bers of the prepuce showed an average of 10.34% (3.45 to 17.9%). The topical treatment of phimosis with betamethasone 0.2% + hyaluronidase had a success rate of 85%. Patients with failure of the topical treatment with steroid had histological alterations in the prepuce.

Background: Holmium:YAG (Ho:YAG) laser lithotripsy has broadened the indications for ureteroscopic stone managements in adults but few evidence is currently available in the pediatric population. Objective: This paper aimed to assess the outcome of Ho:YAG laser lithotripsy during retrograde ureteroscopic management of ureteral stones in different locations in children. The medical records of 149 patients (71 boys and 78 girls; median age 9.2 years) treated with Ho:YAG laser ureteroscopic lithotripsy in 5 international pediatric urology units over the last 5 years were retrospectively reviewed. Exclusion criteria included patients with renal calculi and/or with a history of ipsilateral stricture, renal failure, active urinary tract infection or coagulation disorder. Results: Stones were treated with dusting technique in all cases (Figure ). The median stone size was 10.3 mm [range 5-17]. Stones were located in the distal ureter in 77 cases (51.7%), in the middle ureter in 23 (15.4%) and in the proximal ureter in 49 (32.9%). The median operative time was 29.8 minutes [range 20-95]. Intraoperative complications included 5 bleedings (3.3%) and 7 stone retropulsions (4.7%). Overall stone free rate was 97.3%. Overall postoperative complications rate was 4.0% and included 2 cases of stent migration (1.3%) (Clavien II) and 4 residual stone fragments (2.7%) that were successfully treated using the same technique (Clavien IIIb). On multivariate analysis, re-operation rate was significantly dependent on the proximal stone location and presence of residual fragments >2 mm (p=0.001). Discussion: Our study is one of the largest pediatric series among those published until now. Our series reported a shorter operative time, a higher success rate and a lower postoperative complications rate compared with previous series. A limitation of our study is that stone-free rates may be somewhat inaccurate using US and plain X-ray compared to CT; our 97.3% success rate may be overestimated since no CT scan was done postoperatively to check the stone free rate. Other limitations of our paper include its retrospective nature, the multi-institutional participation and the heterogeneous patient collective. The Ho:YAG laser ureteroscopic lithotripsy seems to be an excellent first line treatment for children with ureteral stones, independently from primary location and size. However, patients with proximal ureteral stones and residual fragments >2 mm reported a higher risk to require a secondary procedure to M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 2 become stone-free. Combination of techniques as well as appropriate endourologic tools are key-points for the success of the procedure regardless of stones' size and location.

Circumcision is one of the commonest surgeries performed worldwide. Yet it is not without complications. It is performed by medical and non-medical persons. A 12 year old boy presented with a severe penile deformity comprising of micropenis and distal urethral fistula following a circumcision performed at the age of 2 years by a? Quack… The patient underwent repair for the same and achieved a near normal penis. Considering the vast amount of complications associated with these surgeries, stricter norms as to who should operate and where should such a procedure be done has to be relooked. Also the absolute indications for circumcision must also be revisited as the fundamental purpose of prophylactic circumcision has not been statistically supported completely from the review of literature.

This case relates to an infant with Turner syndrome harboring the Y chromosome (TS+Y) and explores the boundaries of parental decision-making. Traditionally, gonads have been surgically removed in early childhood in this condition because of the risk of gonadoblastoma and potential malignant transformation. However, in the case discussed here, the infant’s parents do not wish for surgery. In other differences of sex development resulting in intersex traits (increasingly termed congenital Variations of Sex Characteristics; VSC), some institutions report a shift in the last decade away from early surgical management, in favor of allowing children to be involved in decision making when they are old enough to participate meaningfully. But should that approach change when there is a risk of malignancy? Two commentaries are presented. One outlines ethical considerations around early surgery in the case of VSC, highlighting implications for the child’s bodily integrity and future sexual and reproductive autonomy. A second commentary analyzes the case in terms of pediatric ethics, medical uncertainty, and the zone of parental discretion. Both commentaries conclude that given a lack of adequate data to demonstrate net harms in delaying intervention, and some prospective benefit, it could be reasonable to defer surgery in accordance with the parental request.

Though specifically concerning the condition of TS +Y, this discussion provides a framework to consider the ethical boundaries of parental decision making when it comes to genital surgery in children who have VSC.

An abnorma1 chromosome No. 2 was found in the case of a child with an imperforate anus, a recto-vaginal fistula, unilateral atresia of the inner canal, and deformity of the external ear. G-banding studies revealed an insertion of a segment of the short arm into the long arm in one of the chromosomes No. 2 of the proband, the apparent result of a de novo phenomenon of chromosome rearrangement.

To examine the effects of bowel management on urinary incontinence in patients with spina bifida associated with overactive bladder (OAB) and detrusor sphincter dyssynergia (DSD). The research was carried out during the period 2014-2017. A total of 35 patients (group 1) were administered bowel management combined with anticholinergic medication therapy and clean intermittent catheterization (CIC) and 35 patients (group 2) were treated only with anticholinergic medication therapy and CIC. Bowel management included daily enema, laxative application and a special diet, with the aim of treating constipation, evaluated according to the Roma III criteria and echosonographically determined transversal rectal diameter. The effects of the administered bowel management on urinary incontinence were assessed according to the mean dry interval between two CICs for all patients. All patients were followed up for 1 year, during which data were prospectively collected. There was no statistically significant difference with regard to age, gender and baseline clinical features between the two groups. In group 1, the mean AE SD dry interval between two CICs was 150.0 AE 36.4 min, and group 2 it was 101.3 AE 51.6 min. There was a significant difference in urinary incontinence, i.e. in the mean dry interval, between the two groups (P < 0.001). Administering bowel management considerably increased the mean dry interval, thus greatly alleviating the symptoms of urinary incontinence. For this reason, bowel management should form an integral part of the treatment of patients with spina bifida and OAB and DSD.

To examine the effects of bowel management on the frequency of urinary infections in spina bifida patients. The research was carried out from 2014 to 2017, with the recruitment process from June 2014 to March 2016. The first group consisted of 35 patients who were administered bowel management combined with anticholinergic medication therapy and clean intermittent catheterization (CIC). The second group consisted of 35 patients who were treated only with anticholinergic medication therapy and CIC. Bowel management included daily enema, laxative application, and a special diet, with a view to treating constipation that was estimated on the basis of Roma III criteria and echosonographically determined transversal rectal diameter. The effects of the administered bowel management on urinary infections were estimated on the basis of the number of urinary infections before and after the administered therapy. The observation period of every patient was 1 year. Results: There were no significant statistical differences regarding age, gender, and baseline clinical features between the two groups. In the group treated with bowel management combined with anticholinergic medication therapy and CIC, the average number of urinary infections was 0.3 ± 0.5 SD, whereas in the group treated exclusively with anticholinergic medication therapy and CIC the average number of urinary infections was 1.1 ± 1.0 SD. There was a statistical difference regarding urinary infections, that is the average number of urinary infections between these two groups of patients (p<0.001). Administering bowel management considerably decreases the frequency of urinary infections, and should form an integral part of treatment of spina bifida patients. Average number of urinary infections in groups with and without bowel management.

To examine the effects of bowel management on urinary incontinence in patients with spina bifida associated with overactive bladder (OAB) and detrusor sphincter dyssynergia (DSD). The research was carried out during the period 2014-2017. A total of 35 patients (group 1) were administered bowel management combined with anticholinergic medication therapy and clean intermittent catheterization (CIC) and 35 patients (group 2) were treated only with anticholinergic medication therapy and CIC. Bowel management included daily enema, laxative application and a special diet, with the aim of treating constipation, evaluated according to the Roma III criteria and echosonographically determined transversal rectal diameter. The effects of the administered bowel management on urinary incontinence were assessed according to the mean dry interval between two CICs for all patients. All patients were followed up for 1 year, during which data were prospectively collected. There was no statistically significant difference with regard to age, gender and baseline clinical features between the two groups. In group 1, the mean AE SD dry interval between two CICs was 150.0 AE 36.4 min, and group 2 it was 101.3 AE 51.6 min. There was a significant difference in urinary incontinence, i.e. in the mean dry interval, between the two groups (P < 0.001). Administering bowel management considerably increased the mean dry interval, thus greatly alleviating the symptoms of urinary incontinence. For this reason, bowel management should form an integral part of the treatment of patients with spina bifida and OAB and DSD.

To examine the effects of bowel management on the frequency of urinary infections in spina bifida patients. The research was carried out from 2014 to 2017, with the recruitment process from June 2014 to March 2016. The first group consisted of 35 patients who were administered bowel management combined with anticholinergic medication therapy and clean intermittent catheterization (CIC). The second group consisted of 35 patients who were treated only with anticholinergic medication therapy and CIC. Bowel management included daily enema, laxative application, and a special diet, with a view to treating constipation that was estimated on the basis of Roma III criteria and echosonographically determined transversal rectal diameter. The effects of the administered bowel management on urinary infections were estimated on the basis of the number of urinary infections before and after the administered therapy. The observation period of every patient was 1 year. Results: There were no significant statistical differences regarding age, gender, and baseline clinical features between the two groups. In the group treated with bowel management combined with anticholinergic medication therapy and CIC, the average number of urinary infections was 0.3 ± 0.5 SD, whereas in the group treated exclusively with anticholinergic medication therapy and CIC the average number of urinary infections was 1.1 ± 1.0 SD. There was a statistical difference regarding urinary infections, that is the average number of urinary infections between these two groups of patients (p<0.001). Administering bowel management considerably decreases the frequency of urinary infections, and should form an integral part of treatment of spina bifida patients. Average number of urinary infections in groups with and without bowel management.

Severe (grades IV and V) vesicoureteral reflux (VUR) is a risk factor for acute pyelonephritis, renal scars, and renal failure. This study evaluates albumin and N-acetylglucosaminidase (NAG) urinary excretion, and renal concentrating ability as screening tools to select patients for voiding cystourethrogram (VCUG). Children (111 M, 52 F) aged 10.97 ± 21.17 months (mean + SD), diagnosed with UTI, and who had undergone renal ultrasound and a VCUG, underwent a desmopressin test and had albumin/creatinine and NAG/creatinine urinary excretion measured. Urine osmolality was significantly lower in 27 children with severe VUR (375.3 ± 171.8 mOsm/kg; mean + SD) compared to 100 patients with normal VCUG (611.5 ± 175.8 mOsm/kg), p < 0.001, and to 36 patients with VUR grades I to III (636.2 ± 180.2 mOsm/kg), p < 0.001. NAG/creatinine ratio was significantly elevated in 20 children with severe VUR (26.4 (28.3) U/g); median and interquartile range compared to 67 children with normal VCUG (10.8 (17.9) U/g), p = 0.003, and to 20 patients with VUR grades I to III (7.6 (21.1) U/g), p = 0.009. Conclusions: Urinary osmolality is significantly decreased and urinary excretion of NAG is significantly increased in patients with severe VUR. These tests could select patients for VCUG to assess for severe VUR. What is Known: • Severe vesicoureteral reflux (SVUR) may contribute to renal damage. Severe vesicoureteral reflux is diagnosed by voiding cystourethrogram and represents about 10% of all patients with VUR. Currently, there are no reliable tests used prior to VCUG to help on the decision of obtaining a VCUG to diagnose SVUR. What is New: • This study shows that renal tubular markers (concentrating ability and N-acetylglucosaminidase (NAG) excretion) are useful tests prior to voiding cystourethrogram to screen for severe vesicoureteral reflux. • This study suggests the use of renal concentrating ability and urinary N-acetylglucosaminidase (NAG) excretion to screen for severe vesicoureteral reflux before requesting a voiding cystourethrogram.

Post-traumatic posterior urethral injuries in children are rare events. Their management algorithms are extrapolations from adult literature and they continue to pose a difficult challenge for pediatric urologists. Not much data for age-related feasibility of an end-to-end urethroplasty are available. This study was designed to validate a simple preoperative radiographic score to predict the type of surgical repair for traumatic posterior urethral strictures in children. This retrospective study was conducted in a tertiary care center in northern India between 2000 and 2015. All patients under 15 years with traumatic bulboprostatic stricture disease were included. Preoperative voiding cystourethrogam (VCUG) and retrograde urethrogram (RGU) films were used to calculate the gapometry index (G/U index), defined as the length of urethral gap divided by the bulbar urethral length. This index was then analyzed for two patient groups based on the anatomical approach employed for achieving ...

Objectives: To evaluate the results obtained with the technique of distal spermatic vessel ligation in children with upper or intra-abdominal undescended testis. Methods: Analysis of cryptorchid patients treated with Koff-Sethi technique for orquiopexy. Patient series: 15 children with uni-or bilateral cryptorchidism. Postoperative gonad viability was evaluated on the basis of clinical data, physical examination and testicular scintigraphy. Results: Mean age was 5.4 years. Cryptorchidism was unilateral in 10/15 (67%) patients and bilateral in 5/15 (33%). The total number of testicles operated was 25. Of these, 19/25 (76%) required ligation of the spermatic vessels performed according to the Koff-Sethi technique. Eighteen (98%) gonads remained well positioned in the scrotum and one remained in a high position. Late evaluation revealed that 14/19 (74%) testicles had normal consistency and volume upon palpation and 3/19 (16%) were atrophic. Two patients did not return for late reevaluation. Scintigraphy demonstrated good testicular perfusion in 14/17 (82%) gonads evaluated. The patient with bilateral ligation of the spermatic vessels had good perfusion in both gonads. Conclusions: Distal spermatic vessel ligation (Koff-Sethi technique) is safe and useful for the treatment of high cryptorchid testicles.

Nephrogenic adenoma is a rare lesion that consists of epithelial cells arranged in tubular form, resembling tubules in the renal medulla, and is found usually in the urinary bladder although it can occur anywhere in the transitional epithelium of the lower urinary tract. The first case of nephrogenic adenoma of the urinary bladder was reported before the first kidney transplantation, and the lesion has been reported in patients with and without renal transplantation. The origin of cells in nephrogenic adenoma is debated and has been postulated to arise from cells of embryonic origin or from metaplasia secondary to chronic irritation or from implantation of allograft cells in patients with kidney transplantation. The long-term outcome and potential to convert into malignancy are not established, and therefore, there are no recommendations on how to follow up these patients. We present a case of a patient who was found to have nephrogenic adenoma of the urinary bladder during his second kidney transplantation from a cadaveric donor. He had undergone living donor kidney transplantation previously which subsequently failed. The patient did not manifest any symptoms of nephrogenic adenoma. During a follow-up period of 5 years, he has not manifested any symptoms related to nephrogenic metaplasia. Histopathological examination 5 years after the second transplantation did not show any malignant change. It can be concluded that nephrogenic adenoma is likely to behave in benign fashion post kidney transplantation.

Nephrogenic adenoma is a rare lesion that consists of epithelial cells arranged in tubular form, resembling tubules in the renal medulla, and is found usually in the urinary bladder although it can occur anywhere in the transitional epithelium of the lower urinary tract. The first case of nephrogenic adenoma of the urinary bladder was reported before the first kidney transplantation, and the lesion has been reported in patients with and without renal transplantation. The origin of cells in nephrogenic adenoma is debated and has been postulated to arise from cells of embryonic origin or from metaplasia secondary to chronic irritation or from implantation of allograft cells in patients with kidney transplantation. The long-term outcome and potential to convert into malignancy are not established, and therefore, there are no recommendations on how to follow up these patients. We present a case of a patient who was found to have nephrogenic adenoma of the urinary bladder during his seco...

Purpose: We analyzed the development of the area of the penis and erectile structures (corpora cavernosa and corpus spongiosum) and the thickness of the tunica albuginea during the fetal period (13 to 36 weeks after conception) in humans to establish normative patterns of growth. Materials and Methods: We studied 56 male human fetuses at 13 to 36 weeks after conception. We used histochemical and morphometric techniques to analyze the parameters of total penile area, area of corpora cavernosa, area of corpus spongiosum, and thickness of tunica albuginea in the dorsal and ventral regions using ImageJ software (National Institutes of Health, Bethesda, Maryland). Results: Between 13 and 36 weeks after conception the area of the penis varies from 0.95 to 24.25 mm 2 . The area of the corpora cavernosa varies from 0.28 to 9.12 mm 2 , and the area of the corpus spongiosum varies from 0.14 to 3.99 mm 2 . The thickness of the tunica albuginea varies from 0.029 to 0.296 mm in the dorsal region and from 0.014 to 0.113 mm in the ventral region of the corpora cavernosa. Conclusions: We found a strong correlation between the total penile area, corpora cavernosa and corpus spongiosum with fetal age (weeks following conception). The growth rate was more intense during the second trimester (13 to 24 weeks of gestation) compared to the third trimester (25 to 36 weeks). Tunica albuginea thickness also was strongly correlated with fetal age and this structure was thicker in the dorsal vs ventral region.

Toilet training is an important developmental milestone for toddlers, because the ability to control the urge to urinate and defecate begins to develop at this time. At present, many mothers work outside the home, so there is less time to stimulate children&#39;s toilet training. The purpose of this study was to determine the relationship between mother&#39;s support and toilet training success in toddlers aged 18-36 months at Posyandu Jemunang Pandanrejo Wagir Malang. The design of this research is correlation analytic with the cross sectional approach. The research sample is 30 respondents with a total sampling technique. The research instrument was a questionnaire filled out by mothers who had toddlers aged 18-36 months. The results showed that most of the mother&#39;s support was in the category of good support (66.67%). The success of toilet training is partly in the success category (53.33%). The results of data analysis using Spearman rank (rho) obtained 0.614, significant va...