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Penile lengthening after previous repair of epispadias
ABSTRACTS Epididymal Abnormalities Associated With Undescended Testis. F. F. Marshall and D. W. Shermeta. J Urol 121:341-
343, (March), 1979. In a prospective study of 42 patients with undescended testes 15 (36%) had epididymal abnormalities. These anomalies were divided into 3 groups, Including agenesis of the epididymis, atresia of the epididymis, and loop or elongated epididymis. In the second group atresia could occur at the head, body or tail of the epididymis.--George Holcomb, Jr. Urethral Strictures in Boys. M. D. Gibbons, W. W. Koontz, Jr., and M. J. V. Smith. J Urol 121.217-220, (February), 1979.
A review of the experience with urethral strictures during a 15-yr period is reported. A total of 22 strictures was found in 20 boys whose ages range from 9 mo to 16 yr. Secondary strictures developed in two boys after dilatation of the primary stricture. Iatrogenic strictures were found in 14 patients or nearly two-thirds of the total. Three were traumatic, the etiology of one was unknown and there were four patients with congemtal soft strictures or membranes. All of the iatrogenic strictures occurred in the anterior urethra and seven followed cystoscopy. Fulguration of posterior urethral valves resulted in one stricture, two long anterior strictures developed after dilatation of the primary narrowing and five occurred subsequent to hypospadias repair. There were no strictures following perineal urethrostomy or correction of imperforate anus. The present policy is to dilate mild anterior strictures and to perform patch graft urethroplasties for single localized anterior strictures that have required more than two dilatations. Two-stage urethroplasty is more effective for longer, denser or deeper strictures. Posterior strictures secondary to bulbomembranous urethral rupture are more amenable to treatment after primary urethral realignment and cystostomy, using either the Badenoch or two-stage posterior urethroplasty. George Holcomb, Jr Penile Lengthening After Previous Repair of Epispadias.
W. H. Hendren. J Urol 121 527-534, (April), 1979. Unsatisfactory appearance and function of the penis are common after repair of complete epispadias. Reoperation can benefit the majority of these patients according to the author. The pr,nciples of repair in secondary cases as well as primary cases include wide mobilization of the corpora to gain length, resection of dorsal chordee to straighten the shaft, augmentation of urethral length with a graft, secure closure of the corpora over the urethra to avoid a fistula, wide mobilization of the mons to place hair-bearing skin in proper location, and Z-plasty closure. This manuscript contains several excellent drawings that Illustrates the operative technique.--George Holcomb, Jr. Cecil Urethroplasty With Concurrent Scrotoplasty for Repair of Hypospadias. M Marshall, Jr, S. H. Johnson/H,
S. E. Price, Jr.. and D. H Barnhouse. J Urol 121:335-338, (March), 1979. During 13 yr, about 8% of 234 patients operated upon for hypospadias presented surgical problems of reconstruction of
627
the urethra from the urethral meatus proximal to the penoscrotal junction. These cases commonly are referred to as perineal or penoscrotal hypospadias. The problem occurs when the urethral groove fails to develop adequately and the scrotal folds have failed to rotate caudally. This hypospadias is in contrast to penoscrotal or distal hypospadias, when the urethral groove is developed but fusion is incomplete. In these patients, the Cecil procedure bas been used but modified to extend the urethra from behind the penoscrotal junction to the glans at the second stage of the urethroplasty. The modification consists of rotating the scrotum caudally from its high location. The tension and acute angulation that contributed to frequent complications prewously associated with such attempts have been avoided and results are satisfactory.--George Holcomb, Jr. MUSCULOSKELETAL SYSTEM The Association Between Congenital Elevation of the Scapula and Diastematomyelia. U. B Von Bazan. J Bone
Joint Surg 61 B:59-63, (February), 1979. This reports the previously unsuspected association of diastematomyelia in a group of 46 children observed to have congenital elevation of the scapula (Sprengel's shoulder). In four patients, positive identification of dlastematomyelia was made and the condition was suspected to be present in a further five cases. The literature is revlewed.--M. G. H. Smith Spine Fusion for Spondylolysis and Spondylolisthesis in Children. F. C. Sherman, R. K. Rosenthal, and J. E. Hall.
Spine 4:59-67, (January-February), 1979. Eighty-one children who had undergone spine fusion for symptomatic spondylolysis and spondylolisthesis were studied. History, physical findings, and x-ray studies were reviewed. Spastic cerebral palsy and multisegmental fusions predisposed to nonunion, but the data did not show that the degree of listhesis nor the postoperative management, whether ambulatory, spica cast or bedrest, made any difference. Three patients had deep wound infections; two of whom had undergone previous skeletal traction in an attempt to reduce the degree of spondylolisthesis. Five patients had transient neurologic complications. Two patients had psychiatric disorders in the spica cast. Four patients postoperatively showed a progression of the degree of spondylolisthesis. Sixty-six patients had mild to no postoperative pain with two patients having severe postoperative pain. Sixty patients had no postoperative radicular pain. Seventy-four patients were able to participate in some degree of athletics, postfusion. Twelve patients had defimle roentgenographic nonunion; all of whom had multiple level fusions. There were no nonunions shown in the single level fusion techniques, although the criteria for roentgenographic fusion was not defined. The presence or absence of a total laminectomy, (Gill-type), made no statistical difference. This was a statistical review of the surgical clinical picture of spondylolisthesis in children.--Anthony H. Alter Kyphosis in Childhood and Adolescence. R. B. Winter and J. E. Hall. Spine 3:285-308, (December), 1978.
343, (March), 1979. In a prospective study of 42 patients with undescended testes 15 (36%) had epididymal abnormalities. These anomalies were divided into 3 groups, Including agenesis of the epididymis, atresia of the epididymis, and loop or elongated epididymis. In the second group atresia could occur at the head, body or tail of the epididymis.--George Holcomb, Jr. Urethral Strictures in Boys. M. D. Gibbons, W. W. Koontz, Jr., and M. J. V. Smith. J Urol 121.217-220, (February), 1979.
A review of the experience with urethral strictures during a 15-yr period is reported. A total of 22 strictures was found in 20 boys whose ages range from 9 mo to 16 yr. Secondary strictures developed in two boys after dilatation of the primary stricture. Iatrogenic strictures were found in 14 patients or nearly two-thirds of the total. Three were traumatic, the etiology of one was unknown and there were four patients with congemtal soft strictures or membranes. All of the iatrogenic strictures occurred in the anterior urethra and seven followed cystoscopy. Fulguration of posterior urethral valves resulted in one stricture, two long anterior strictures developed after dilatation of the primary narrowing and five occurred subsequent to hypospadias repair. There were no strictures following perineal urethrostomy or correction of imperforate anus. The present policy is to dilate mild anterior strictures and to perform patch graft urethroplasties for single localized anterior strictures that have required more than two dilatations. Two-stage urethroplasty is more effective for longer, denser or deeper strictures. Posterior strictures secondary to bulbomembranous urethral rupture are more amenable to treatment after primary urethral realignment and cystostomy, using either the Badenoch or two-stage posterior urethroplasty. George Holcomb, Jr Penile Lengthening After Previous Repair of Epispadias.
W. H. Hendren. J Urol 121 527-534, (April), 1979. Unsatisfactory appearance and function of the penis are common after repair of complete epispadias. Reoperation can benefit the majority of these patients according to the author. The pr,nciples of repair in secondary cases as well as primary cases include wide mobilization of the corpora to gain length, resection of dorsal chordee to straighten the shaft, augmentation of urethral length with a graft, secure closure of the corpora over the urethra to avoid a fistula, wide mobilization of the mons to place hair-bearing skin in proper location, and Z-plasty closure. This manuscript contains several excellent drawings that Illustrates the operative technique.--George Holcomb, Jr. Cecil Urethroplasty With Concurrent Scrotoplasty for Repair of Hypospadias. M Marshall, Jr, S. H. Johnson/H,
S. E. Price, Jr.. and D. H Barnhouse. J Urol 121:335-338, (March), 1979. During 13 yr, about 8% of 234 patients operated upon for hypospadias presented surgical problems of reconstruction of
627
the urethra from the urethral meatus proximal to the penoscrotal junction. These cases commonly are referred to as perineal or penoscrotal hypospadias. The problem occurs when the urethral groove fails to develop adequately and the scrotal folds have failed to rotate caudally. This hypospadias is in contrast to penoscrotal or distal hypospadias, when the urethral groove is developed but fusion is incomplete. In these patients, the Cecil procedure bas been used but modified to extend the urethra from behind the penoscrotal junction to the glans at the second stage of the urethroplasty. The modification consists of rotating the scrotum caudally from its high location. The tension and acute angulation that contributed to frequent complications prewously associated with such attempts have been avoided and results are satisfactory.--George Holcomb, Jr. MUSCULOSKELETAL SYSTEM The Association Between Congenital Elevation of the Scapula and Diastematomyelia. U. B Von Bazan. J Bone
Joint Surg 61 B:59-63, (February), 1979. This reports the previously unsuspected association of diastematomyelia in a group of 46 children observed to have congenital elevation of the scapula (Sprengel's shoulder). In four patients, positive identification of dlastematomyelia was made and the condition was suspected to be present in a further five cases. The literature is revlewed.--M. G. H. Smith Spine Fusion for Spondylolysis and Spondylolisthesis in Children. F. C. Sherman, R. K. Rosenthal, and J. E. Hall.
Spine 4:59-67, (January-February), 1979. Eighty-one children who had undergone spine fusion for symptomatic spondylolysis and spondylolisthesis were studied. History, physical findings, and x-ray studies were reviewed. Spastic cerebral palsy and multisegmental fusions predisposed to nonunion, but the data did not show that the degree of listhesis nor the postoperative management, whether ambulatory, spica cast or bedrest, made any difference. Three patients had deep wound infections; two of whom had undergone previous skeletal traction in an attempt to reduce the degree of spondylolisthesis. Five patients had transient neurologic complications. Two patients had psychiatric disorders in the spica cast. Four patients postoperatively showed a progression of the degree of spondylolisthesis. Sixty-six patients had mild to no postoperative pain with two patients having severe postoperative pain. Sixty patients had no postoperative radicular pain. Seventy-four patients were able to participate in some degree of athletics, postfusion. Twelve patients had defimle roentgenographic nonunion; all of whom had multiple level fusions. There were no nonunions shown in the single level fusion techniques, although the criteria for roentgenographic fusion was not defined. The presence or absence of a total laminectomy, (Gill-type), made no statistical difference. This was a statistical review of the surgical clinical picture of spondylolisthesis in children.--Anthony H. Alter Kyphosis in Childhood and Adolescence. R. B. Winter and J. E. Hall. Spine 3:285-308, (December), 1978.