- Email: [email protected]
Testicular strangulation in children
312
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY
waves varying from 10 to 60 ram. of Hg with regular, forceful peristalis. Ineffectual peristalsis, with low contraction waves and elevated resting pressures, correlated with a poor clinical and x-ray results. This simple test of ureteral function is an additional means of determining whether a ureter can be salvaged when diversion must be performed.---W. Hardy Hendren.
Seven cases were eventually considered irreparable and required urinary diversion procedures. Twelve of the 27 children are now dry without any eomplicatior. . . . W.
UNPREDICTABLE RESULTS ASSOCIATED WITH TREATMENT OF 133 CHILDREN WITH URETERORENAE REFLUX. R. Baker, W .
More than 90 per cent of cases of hypospadias are glandular, subcoronal or have the orifice in the distal one third of the shaft. In the less severe cases operation should be simple and safe. Chordee may not be obvious in the first months of life, but if present at 12 months of age it should be corrected then and the hypospadias repaired at the same time. The basic principle is to use a skin flap on the under surface proximal to the meatus and, after correcting the chordee, to swing the flap forward as an incomplete tube between the corpora and through a tunnel in the glans to a wide vertical meatus. An Ombr6danne preputial flap covers the defect and a perineal urethrostomy is established for 8 days. There has been no fistula, no stenosis and no recurrence of chordee in 18 consecutive cases.--R. B. Zachary.
Maxted, H. McCrystal and T. Kelly. J. Urol. 94:362, 1965. The authors reviewed their experience with 555 children thought to have bladder neck or nrethral obstruction during a period of 8 years. One hundred and thirty-three of these children had ureterorenal reflux. Cases were broken down into those treated by urethral dilatation, operation to relieve distal obstruction, or simply antimicrobial therapy for infection, and they were further subdivided according to the degree of ureteral dilatation seen with reflux. They stress the vagaries of reflux, demonstrating that each group had some patients who were cured and others who were worse with each method of treatment. They point out that one cannot be too dogmatic in discussing the results of a given treatment for reflux. They also point out that the need for defining the degree of reflux and the degree of ureteral dilatation associated with reflux in presenting statistics on this subjeet.--W. Hardy Hendren. EPISPADIAS AND INCONTINENCE: SURGICAL TREATMENT OF r CHILDREN. G. V. Burk-
holder and D. L. Williams. J. Urol. 94: 674, 1965. The authors describe their experience in 27 children with epispadias and complete incontinence, 10 girls and 17 boys treated by reconstruction of the bladder neck and the posterior urethra to achieve an elongated, narrowed outlet. Continence was achieved in 15 of 27 patients, but in 3 there were serious urinary tract complications: chronic infection, calculi, reflux, or upper tract deterioration. Of the 12 classified as failures, 2 had stress incontinence, and 2 were dry at night but wet during the day.
Hardy Hendren. ONE STAGE CORRECTION OF DISTAL HYPOSPADIAS AND OTHER PEOPLE'S FISTULAE,
J. C. Mustardd. Brit. J. Plast. Surg. 18: 413, 1965.
ATRESIA OF THE VAS DEFERENS. K. Devens and G. Muller. Z. Kinderchir. 3:46-52, 1966. Congenital abnormalities of the vas deferens are aplasia, atresia and duplication. These are usually associated with maldevelopment of the kidney. However, such coexistent abnormalities were not observed in the 3 cases described in this paper. In the first case there was a gap between the testis and epididymis (which were lying in the inguinal canal) as well as an atresia of the vas. In the second child the appearances were similar, with bilateral nndescended testicle and an atretic duct on the right side. The third patient had an atresia in the proxinaal part of the vas. The embryologic questions are discussed in detail.--S. Hofmann and H. B.
Eckstein. TESTICULAR STRANGULATION IN CHILDREN. J. B. McFarland. Brit. J. Surg. 53:110, 1966. In a 15 year period, 1948-1962, 61 cases were treated, 36 being due to torsion of the
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY spermatic cord, 19 to torsion of a vestigial appendage, 4 to incarceration and 2 of unknown etiology. The incidence was highest during the first year of life (15 cases) but there was also another b u t more widely based peak at puberty (21 cases aged 13 to 16). Intravaginal torsion occurred in 23 of 36 cases, b u t all 3 cases of extravaginal torsion were found in babies under 1 year of age. All the infarctions due to strangulated hernia occurred in babies under or just over 1 year of age. In 18 of 36 cases of torsion the testis was preserved, in 9 of which viability was in doubt at operation. Of these 9 there was good recovery in 4, but a hypotrophie testis resulted in 9~. Three of these patients had subsequent suppuration requiring orehideetomy. This finding supports the view that "every effort should be made to preserve the testis, even when there is doubt as to its viability." If the testis remains black some minutes after untwisting, the tuniea albuginea is incised to see if there is bleeding. Even if spermatogenesis is lost some endocrine function may b e preserved; A serotal incision is recommended when the diagnosis of torsion is clear and fixation of the opposite testis is also a d v i s e d . -
R, B. Zachary. TESTICULAR TUMOnS IN CHILDREN. Robert
Houser, Robert J. Izant and Lester Persky. Amer. J. Surg. 110:876-892, 1965. Testicular tumors are classified according to the scheme proposed by Friedman and Moore, and Dixon and Moore. These consists of 2 main groups: germinal tumors and nongerminal tumors. The gemainal tumors are divided into: seminoma, embryonaI carcinoma, embryonal carcinoma with teratocarcinoma and choriocarcinoma, orehioblastoma and teratoma. Nongerminal tumors are divided into: interstitial cell tumors, gonadal cell tumors, adenocareinoma of the rete testis, rhabdomyosarcoma, other sarcomas, lymphoblastonm and cavernous hemangioma. Of 599 cases reported in the literature to date, 221 were considered sufficiently well documented for classification and review. One h u n d r e d thirty-four eases were germinal tumors and 81 nongerminal, leaving 6 with uncertain diagnosis; thus the percentage of
~13
germinal tunmrs (60 per cent) is lower than that in adults (95 per cent). Seminoma is rare or nonexistent in children, though common later in undeseended testis. Fifty-eight cases, the largest group were embryonal cell carcinoma and the average age at operation 30.5 months. There were also 45 cases of orehioblastoma or adenoearcinoma with clear cells. The treatment advocated is orchiectomy through a groin incision. Neither x-ray therapy nor node dissection is considered to give statistically significant improvement of results. These 2 types of tmuor have a similar prognosis markedly influenced by the age of the patient at operation. Thirty-nine of 54 cases under 2 years old were considered cured and only 8 of 30 over 2 years old. T h e r e were 30 cases of teratoma and though this tumor should be considered potentially malignant in children, there are no recorded cases of it having metastasized in this age group. The conmmnest nongerminal tmnor is the interstitial cell tmnor (40 cases). These present as cases of sexual precocity rather than a testicular mass. They are benign and are treated with orchiectomy through a scrotal incision. Twenty-one cases were gonadal stromal tumors considered based on either precursors of Sertoli cells or from stromal cells related to the Leydig cells. All but 4 occurred under 1 year of age and all should be considered benign and treated with simple orchiectomy. There were insufficient cases in the other groups to draw conclusions, though 8 of 15 cases of "sarcoma" are reported alive and well. Of the 30 cases in the total group who died and are recorded in sufficient detail it is of interest to note that 21 died within a year, 8 more within 2 years and only one survived as long as 3 % years after diagnosis, The ease histories of 6 patients treated in Cleveland are given with microphotographs. An extensive bibliography is appended to this excellent review.--NeviUe K. Connolly MANAGEMENT OF TESTICULAR TUMORS IN CHILDREN. W. J. Staubitz, T. C. Jewctt,
Jr., I. V. Magoss, W. G. Schenk, Jr. and S. Phalakornkule. J. Urol. 94:683, 1965. The authors review their experience with 7 malignant testicular tumors in children. Six were embryonal carcinomas and I a teratoma. In 1 case the primary tumor was iden,~
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY
waves varying from 10 to 60 ram. of Hg with regular, forceful peristalis. Ineffectual peristalsis, with low contraction waves and elevated resting pressures, correlated with a poor clinical and x-ray results. This simple test of ureteral function is an additional means of determining whether a ureter can be salvaged when diversion must be performed.---W. Hardy Hendren.
Seven cases were eventually considered irreparable and required urinary diversion procedures. Twelve of the 27 children are now dry without any eomplicatior. . . . W.
UNPREDICTABLE RESULTS ASSOCIATED WITH TREATMENT OF 133 CHILDREN WITH URETERORENAE REFLUX. R. Baker, W .
More than 90 per cent of cases of hypospadias are glandular, subcoronal or have the orifice in the distal one third of the shaft. In the less severe cases operation should be simple and safe. Chordee may not be obvious in the first months of life, but if present at 12 months of age it should be corrected then and the hypospadias repaired at the same time. The basic principle is to use a skin flap on the under surface proximal to the meatus and, after correcting the chordee, to swing the flap forward as an incomplete tube between the corpora and through a tunnel in the glans to a wide vertical meatus. An Ombr6danne preputial flap covers the defect and a perineal urethrostomy is established for 8 days. There has been no fistula, no stenosis and no recurrence of chordee in 18 consecutive cases.--R. B. Zachary.
Maxted, H. McCrystal and T. Kelly. J. Urol. 94:362, 1965. The authors reviewed their experience with 555 children thought to have bladder neck or nrethral obstruction during a period of 8 years. One hundred and thirty-three of these children had ureterorenal reflux. Cases were broken down into those treated by urethral dilatation, operation to relieve distal obstruction, or simply antimicrobial therapy for infection, and they were further subdivided according to the degree of ureteral dilatation seen with reflux. They stress the vagaries of reflux, demonstrating that each group had some patients who were cured and others who were worse with each method of treatment. They point out that one cannot be too dogmatic in discussing the results of a given treatment for reflux. They also point out that the need for defining the degree of reflux and the degree of ureteral dilatation associated with reflux in presenting statistics on this subjeet.--W. Hardy Hendren. EPISPADIAS AND INCONTINENCE: SURGICAL TREATMENT OF r CHILDREN. G. V. Burk-
holder and D. L. Williams. J. Urol. 94: 674, 1965. The authors describe their experience in 27 children with epispadias and complete incontinence, 10 girls and 17 boys treated by reconstruction of the bladder neck and the posterior urethra to achieve an elongated, narrowed outlet. Continence was achieved in 15 of 27 patients, but in 3 there were serious urinary tract complications: chronic infection, calculi, reflux, or upper tract deterioration. Of the 12 classified as failures, 2 had stress incontinence, and 2 were dry at night but wet during the day.
Hardy Hendren. ONE STAGE CORRECTION OF DISTAL HYPOSPADIAS AND OTHER PEOPLE'S FISTULAE,
J. C. Mustardd. Brit. J. Plast. Surg. 18: 413, 1965.
ATRESIA OF THE VAS DEFERENS. K. Devens and G. Muller. Z. Kinderchir. 3:46-52, 1966. Congenital abnormalities of the vas deferens are aplasia, atresia and duplication. These are usually associated with maldevelopment of the kidney. However, such coexistent abnormalities were not observed in the 3 cases described in this paper. In the first case there was a gap between the testis and epididymis (which were lying in the inguinal canal) as well as an atresia of the vas. In the second child the appearances were similar, with bilateral nndescended testicle and an atretic duct on the right side. The third patient had an atresia in the proxinaal part of the vas. The embryologic questions are discussed in detail.--S. Hofmann and H. B.
Eckstein. TESTICULAR STRANGULATION IN CHILDREN. J. B. McFarland. Brit. J. Surg. 53:110, 1966. In a 15 year period, 1948-1962, 61 cases were treated, 36 being due to torsion of the
INTERNATIONAL ABSTRACTS OF PEDIATRIC SURGERY spermatic cord, 19 to torsion of a vestigial appendage, 4 to incarceration and 2 of unknown etiology. The incidence was highest during the first year of life (15 cases) but there was also another b u t more widely based peak at puberty (21 cases aged 13 to 16). Intravaginal torsion occurred in 23 of 36 cases, b u t all 3 cases of extravaginal torsion were found in babies under 1 year of age. All the infarctions due to strangulated hernia occurred in babies under or just over 1 year of age. In 18 of 36 cases of torsion the testis was preserved, in 9 of which viability was in doubt at operation. Of these 9 there was good recovery in 4, but a hypotrophie testis resulted in 9~. Three of these patients had subsequent suppuration requiring orehideetomy. This finding supports the view that "every effort should be made to preserve the testis, even when there is doubt as to its viability." If the testis remains black some minutes after untwisting, the tuniea albuginea is incised to see if there is bleeding. Even if spermatogenesis is lost some endocrine function may b e preserved; A serotal incision is recommended when the diagnosis of torsion is clear and fixation of the opposite testis is also a d v i s e d . -
R, B. Zachary. TESTICULAR TUMOnS IN CHILDREN. Robert
Houser, Robert J. Izant and Lester Persky. Amer. J. Surg. 110:876-892, 1965. Testicular tumors are classified according to the scheme proposed by Friedman and Moore, and Dixon and Moore. These consists of 2 main groups: germinal tumors and nongerminal tumors. The gemainal tumors are divided into: seminoma, embryonaI carcinoma, embryonal carcinoma with teratocarcinoma and choriocarcinoma, orehioblastoma and teratoma. Nongerminal tumors are divided into: interstitial cell tumors, gonadal cell tumors, adenocareinoma of the rete testis, rhabdomyosarcoma, other sarcomas, lymphoblastonm and cavernous hemangioma. Of 599 cases reported in the literature to date, 221 were considered sufficiently well documented for classification and review. One h u n d r e d thirty-four eases were germinal tumors and 81 nongerminal, leaving 6 with uncertain diagnosis; thus the percentage of
~13
germinal tunmrs (60 per cent) is lower than that in adults (95 per cent). Seminoma is rare or nonexistent in children, though common later in undeseended testis. Fifty-eight cases, the largest group were embryonal cell carcinoma and the average age at operation 30.5 months. There were also 45 cases of orehioblastoma or adenoearcinoma with clear cells. The treatment advocated is orchiectomy through a groin incision. Neither x-ray therapy nor node dissection is considered to give statistically significant improvement of results. These 2 types of tmuor have a similar prognosis markedly influenced by the age of the patient at operation. Thirty-nine of 54 cases under 2 years old were considered cured and only 8 of 30 over 2 years old. T h e r e were 30 cases of teratoma and though this tumor should be considered potentially malignant in children, there are no recorded cases of it having metastasized in this age group. The conmmnest nongerminal tmnor is the interstitial cell tmnor (40 cases). These present as cases of sexual precocity rather than a testicular mass. They are benign and are treated with orchiectomy through a scrotal incision. Twenty-one cases were gonadal stromal tumors considered based on either precursors of Sertoli cells or from stromal cells related to the Leydig cells. All but 4 occurred under 1 year of age and all should be considered benign and treated with simple orchiectomy. There were insufficient cases in the other groups to draw conclusions, though 8 of 15 cases of "sarcoma" are reported alive and well. Of the 30 cases in the total group who died and are recorded in sufficient detail it is of interest to note that 21 died within a year, 8 more within 2 years and only one survived as long as 3 % years after diagnosis, The ease histories of 6 patients treated in Cleveland are given with microphotographs. An extensive bibliography is appended to this excellent review.--NeviUe K. Connolly MANAGEMENT OF TESTICULAR TUMORS IN CHILDREN. W. J. Staubitz, T. C. Jewctt,
Jr., I. V. Magoss, W. G. Schenk, Jr. and S. Phalakornkule. J. Urol. 94:683, 1965. The authors review their experience with 7 malignant testicular tumors in children. Six were embryonal carcinomas and I a teratoma. In 1 case the primary tumor was iden,~