- Email: [email protected]
Single-stage feminization genitoplasty: An improved technique to avoid hypospadias
255
ABSTRACTS FROM POSTER SESSIONS
There was no significant difference between trauma victims and controls as measured by PBC, PBI, the sum PBC + PBI, TBC, or TAS. There was also no difference between trauma victims’ and controls’ maternal or paternal MI. When trauma patients were stratified by KS, there was a higher proportion with (PBC + PBI) 2 13 in the low-ISS subgroup when compared with the control group (4 of 9 Y4 of 44, P < .OS). The proportion of low ISS patients with a TBC 2 9 approached significance when compared with controls (4 of 10 v 4 of 33, P = .059). In addition, the proportion of trauma victims’ mothers with an MI z 7 was significantly higher than control mothers’ (9 of 54 v 2 of 44). These data support the hypothesis that children who suffer severe accidental injuries are not significantly different from a control population as measured by these tests, in contrast to the subgroup with less severe injuries, who tend toward more behavior abnormalities. In addition, trauma victims were more likely to come from households with maternal depression or illness, as defined by the MI. These differences may be partly responsible for accident patterns, and require further investigation. Falls From Heights in Children: An Urban Liability. C. Musemeche,
M. Barthel, C. Cosentino. and M. Reynolds, Children’s Memorial Hospital, Chicago, IL.
Injuries resulting from falls from heights still constitute a significant portion of urban trauma. There were 1,463 admissions to our pediatric trauma center from 1985 to 1988. Twenty-five percent (368) were secondary to falls. Seventy children fell from heights greater than 10 ft. These 70 children were evaluated in a retrospective review, undertaken to identify risk factors and patterns of injury. Boys less than 5 years of age comprised 70% of those injured. There were almost equal numbers of blacks, whites, and Hispanics. Fifty-four percent of the falls occurred in the home, 36% were from windows, 23% down stairs, and 14% from porches. There were no deaths. Head trauma occurred in 54% and only three had residual neurologic deficits. Thirty-three percent sustained skeletal injuries, and 13% had multiple organ system injury. Chest injury occurred in only one child and abdominal injury in two. Ninety-six percent of these falls were accidental. There was a history of domestic violence in three cases and a history of neglect in five cases. This study demonstrates that falls from heights remain a considerable risk to children in an urban setting. To reduce this risk, the surgeon’s role must extend beyond patient care and should address injury prevention. Involvement with local legislators to mandate window guards and participation in improving public awareness may prevent a significant number of these injuries.
two cases of mild urethral meatal stenosis, and formation of one distal urethrovaginal fistula that was not clinically significant. The method has several advantages. (1) It can be used for all cases of adrenogenital syndrome and for similar anomalies, regardless of the relative positions of the urethral sphincter and the vaginal opening, because there is no cut-back of the sinus. (2) The modified subtunical resection of the phallus is straightforward and preserves the innervation of the clitoris. (3) Use of the sinus to enlarge the urethra allows for better positioning of the meatus and avoids the creation of female hypospadias. (4) The folded foreskin, which contains the openings for the clitoris and the neourethra, simulates the labia minora, the vestibule, and part of the anterior vaginal wall and provides for an ample vagina. The result of this technique is normal-appearing female anatomy. Does Age at Orchiopexy Influence Testicular Position, Postoperative Complications, or the Incidence of Testicular Atrophy7
F. W.J. Hazebroek, S.M.P.F. de Muinck Keizer-Schrama. and J.C. Molenaar, Sophia Children’s Hospital, Grasmus Universiiy. Rotterdam, The Netherlands.
Recommendation of recent years increasingly has been to treat boys with undescended testes at an earlier age, preferably after the age of 2 years. More insight is required into results and complications of orchiopexy carried out in younger boys. The foregoing prompted a prospective study to answer the following questions: (1) What are the postoperative complications? (2) What are the obvious results (position and volume of testis) after orchiopexy and 2 years later? (3) Would age at orchiopexy influence the answers to questions 1and 2? Table 1. Results of the Surgery in Relation to the Procedure
Anorchia, no therapy
Feminization
Genitoplssty:
An Improved
nant Standard
Ricardo Gonzalez, Eduardo Fernandes. and Jaime Vargas. Universit-vof Minnesota Hospital, Minneapolis, MN.
A new technique for feminization genitoplasty is presented. Foley catheters are placed inside the bladder and the vagina to facilitate detachment of the vagina from the urethra. The urogenital sinus is preserved as the distal urethra. A modified subtunical reduction of the clitoris is performed, and the foreskin is used to simulate the labia minora and to create part of the anterior vaginal wall. The clitoris and the neourethra are exteriorized through two separate openings on the foreskin. The posterior wall of the vagina is created from a V-flap of the perineal skin. Since January 1987, this technique has been used to treat eight children, aged 3 months to 12 years. The cosmetic and functional results have been excellent; the vagina is ample. Complications were
c cases 1%)
7 (3.5)
2 (5)
3 (4)
2 (3)
8 (4)
2 (5)
4 (5)
2 (31
46 (23)
15 (36)
18 (22)
13 (18)
130 (66)
20 149)
55 (67)
55 (75)
orchiopexy,
high scrotal Standard orchiopexy, low scrotal Fowler Stephens, high scrotal
2 (11
0 (0)
l(l)
l(l)
2 (1)
2 (5)
0 (0)
0 (0)
1 (0.5)
0 IO)
1 (1)
0 (0)
41 (1001
82 1100)
Testis fixation outside inguinal canal Macrovascular testis
Technique
to Avoid Hypospadias.
B Cases (%I
Excision funicular rem-
transplantation Single-Stage
A Cases 1%)
A+B+C Cases1%)
Procedure
Total
196 (100)
73 (1001
During the study period, 170 boys with 196 undescended testes underwent surgery, divided in three age groups: A (1 to 2 years), B (2 to 6 years), C (6 to 12 years). Table 1 shows results of the surgery in relation to procedure. Wound-related complications occurred in 10 of the 196 operations (5%), usually secondary to infection. These complications had no effect on subsequent position or volume of the testes. In 179 of the 196 operations the testis could be placed in either a high (49) or low (130) scrotal position. At the time of follow-up examination (r2 years postoperatively), 2% of the operated testes had atrophied (there was no age-group relation). Approximately half of the testes that had been affixed high in the scrotum were found in a low scrotal position at the time of follow-up. The age at which orchiopexy
was carried
out did not influence
the operative
ABSTRACTS FROM POSTER SESSIONS
There was no significant difference between trauma victims and controls as measured by PBC, PBI, the sum PBC + PBI, TBC, or TAS. There was also no difference between trauma victims’ and controls’ maternal or paternal MI. When trauma patients were stratified by KS, there was a higher proportion with (PBC + PBI) 2 13 in the low-ISS subgroup when compared with the control group (4 of 9 Y4 of 44, P < .OS). The proportion of low ISS patients with a TBC 2 9 approached significance when compared with controls (4 of 10 v 4 of 33, P = .059). In addition, the proportion of trauma victims’ mothers with an MI z 7 was significantly higher than control mothers’ (9 of 54 v 2 of 44). These data support the hypothesis that children who suffer severe accidental injuries are not significantly different from a control population as measured by these tests, in contrast to the subgroup with less severe injuries, who tend toward more behavior abnormalities. In addition, trauma victims were more likely to come from households with maternal depression or illness, as defined by the MI. These differences may be partly responsible for accident patterns, and require further investigation. Falls From Heights in Children: An Urban Liability. C. Musemeche,
M. Barthel, C. Cosentino. and M. Reynolds, Children’s Memorial Hospital, Chicago, IL.
Injuries resulting from falls from heights still constitute a significant portion of urban trauma. There were 1,463 admissions to our pediatric trauma center from 1985 to 1988. Twenty-five percent (368) were secondary to falls. Seventy children fell from heights greater than 10 ft. These 70 children were evaluated in a retrospective review, undertaken to identify risk factors and patterns of injury. Boys less than 5 years of age comprised 70% of those injured. There were almost equal numbers of blacks, whites, and Hispanics. Fifty-four percent of the falls occurred in the home, 36% were from windows, 23% down stairs, and 14% from porches. There were no deaths. Head trauma occurred in 54% and only three had residual neurologic deficits. Thirty-three percent sustained skeletal injuries, and 13% had multiple organ system injury. Chest injury occurred in only one child and abdominal injury in two. Ninety-six percent of these falls were accidental. There was a history of domestic violence in three cases and a history of neglect in five cases. This study demonstrates that falls from heights remain a considerable risk to children in an urban setting. To reduce this risk, the surgeon’s role must extend beyond patient care and should address injury prevention. Involvement with local legislators to mandate window guards and participation in improving public awareness may prevent a significant number of these injuries.
two cases of mild urethral meatal stenosis, and formation of one distal urethrovaginal fistula that was not clinically significant. The method has several advantages. (1) It can be used for all cases of adrenogenital syndrome and for similar anomalies, regardless of the relative positions of the urethral sphincter and the vaginal opening, because there is no cut-back of the sinus. (2) The modified subtunical resection of the phallus is straightforward and preserves the innervation of the clitoris. (3) Use of the sinus to enlarge the urethra allows for better positioning of the meatus and avoids the creation of female hypospadias. (4) The folded foreskin, which contains the openings for the clitoris and the neourethra, simulates the labia minora, the vestibule, and part of the anterior vaginal wall and provides for an ample vagina. The result of this technique is normal-appearing female anatomy. Does Age at Orchiopexy Influence Testicular Position, Postoperative Complications, or the Incidence of Testicular Atrophy7
F. W.J. Hazebroek, S.M.P.F. de Muinck Keizer-Schrama. and J.C. Molenaar, Sophia Children’s Hospital, Grasmus Universiiy. Rotterdam, The Netherlands.
Recommendation of recent years increasingly has been to treat boys with undescended testes at an earlier age, preferably after the age of 2 years. More insight is required into results and complications of orchiopexy carried out in younger boys. The foregoing prompted a prospective study to answer the following questions: (1) What are the postoperative complications? (2) What are the obvious results (position and volume of testis) after orchiopexy and 2 years later? (3) Would age at orchiopexy influence the answers to questions 1and 2? Table 1. Results of the Surgery in Relation to the Procedure
Anorchia, no therapy
Feminization
Genitoplssty:
An Improved
nant Standard
Ricardo Gonzalez, Eduardo Fernandes. and Jaime Vargas. Universit-vof Minnesota Hospital, Minneapolis, MN.
A new technique for feminization genitoplasty is presented. Foley catheters are placed inside the bladder and the vagina to facilitate detachment of the vagina from the urethra. The urogenital sinus is preserved as the distal urethra. A modified subtunical reduction of the clitoris is performed, and the foreskin is used to simulate the labia minora and to create part of the anterior vaginal wall. The clitoris and the neourethra are exteriorized through two separate openings on the foreskin. The posterior wall of the vagina is created from a V-flap of the perineal skin. Since January 1987, this technique has been used to treat eight children, aged 3 months to 12 years. The cosmetic and functional results have been excellent; the vagina is ample. Complications were
c cases 1%)
7 (3.5)
2 (5)
3 (4)
2 (3)
8 (4)
2 (5)
4 (5)
2 (31
46 (23)
15 (36)
18 (22)
13 (18)
130 (66)
20 149)
55 (67)
55 (75)
orchiopexy,
high scrotal Standard orchiopexy, low scrotal Fowler Stephens, high scrotal
2 (11
0 (0)
l(l)
l(l)
2 (1)
2 (5)
0 (0)
0 (0)
1 (0.5)
0 IO)
1 (1)
0 (0)
41 (1001
82 1100)
Testis fixation outside inguinal canal Macrovascular testis
Technique
to Avoid Hypospadias.
B Cases (%I
Excision funicular rem-
transplantation Single-Stage
A Cases 1%)
A+B+C Cases1%)
Procedure
Total
196 (100)
73 (1001
During the study period, 170 boys with 196 undescended testes underwent surgery, divided in three age groups: A (1 to 2 years), B (2 to 6 years), C (6 to 12 years). Table 1 shows results of the surgery in relation to procedure. Wound-related complications occurred in 10 of the 196 operations (5%), usually secondary to infection. These complications had no effect on subsequent position or volume of the testes. In 179 of the 196 operations the testis could be placed in either a high (49) or low (130) scrotal position. At the time of follow-up examination (r2 years postoperatively), 2% of the operated testes had atrophied (there was no age-group relation). Approximately half of the testes that had been affixed high in the scrotum were found in a low scrotal position at the time of follow-up. The age at which orchiopexy
was carried
out did not influence
the operative