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The effects of early experimental cryptorchidism and subsequent orchidopexy on the maturation of the guinea pig testicle
ABSTRACTS
148
two with recurrent abdominal pain. Only 16 had pyuria and bacteriuria on the initial visit. Fifty-one of 54 had radiographic evidence of urinary tract calculi, and in the other three spontaneous passage of the stone occurred before x-rays could be obtained. Forty children had a single stone, while 14 had two or more calculi. Four children had bilateral stones. Of the five with obstructive uropathy, four had ureteropelvic junction obstruction and one had severe urethral meatal stenosis. Of four with metabolic disease, one had predisposing calcinosis universalis, one cystinuria, one had renal tubular acidosis, and one had a parathyroid adenoma. Two children developed calculi after prolonged orthopedic immobilization. Of the remaining 43 children, 19 had a family history positive for calculi, but no other cause. Fourteen children passed the stones spontaneously. Of the remaining 27 with idiopathic stone disease, operation was refused in two, and one continued to pass multiple recurrent stones. Four of the five with obstructive uropathv had the anatomical defect corrected with simultaneous urolithotomy and a good result. Two with renal tubular defects underwent urolithotomy and on a strict controlled medical program have had no stone recurrence. The child with calcinosis universalis was untreated and the patient with parathyroid adenoma underwent a pyelolithotomy and parathyroid adenoma removal. The stone analysis on 41 calculi revealed 28 calcium oxalate stones, six cystine and the rest uric acid and calcium phosphate oxalate. In two children with bilateral calculi, stones of different composition were recovered from opposite kidneys. The authors emphasize removal of all calculi, control of infection, and correction of underlying metabolic and anatomic defects for the best resuits.--S. Kim Childhood Urolithiasir in Britain. S. Ghazoli,
patients are discussed briefly and were a heterogeneous group. Treatment was usually by pyelolithotomy, but nephroureterectomy was performed upon eight and partial nephrectomy in four patients. Calculi recurred in 13 of the 120 children. In nine of these, persistent Proteus infection appeared to be a significant predisposing cause.-D.G. Young Acute
Urinary Retention In Children
Caused
by Pyouroter. 6. Coolsoet and C. Cornil. J. Ural. 108:966-968
(December), 1972.
Cases of urinary retention in a 22-mo-old girl and a 3-yr-old boy are reported. An ectopic pyoureter leading to a nonfunctioning upper pole on the left side was the cause of urinary retention in the little girl, and a pyomegaureter and pyonephrotic kidney on the left side was the problem in the boy. In both cases there was complete occlusion of the bladder outlet by the pyoureter. Both patients did well after operation. The authors have not found a similar case prior to this.-.% Kim Urethral Valves. ~3.1. Williams, R.H. Whitaker, TM. Barr&t, and I.E. Keeton. 8r. J. Ural. 45:200210 (April), 1973.
A series of 172 cases of urethral valves is reviewed. One third of the patients presented under the age of 3 mo. A new technique is described for division of the anterior valvular commissure. This consists of withdrawal, under x-ray control, of an insulated diathermy hook which engages and ruptures the membrane. In the management of persistent ureteric dilatation, the merits of, and the indications for loop ureterostomy, terminal ureterostomy, and ureteral tailoring and reimplantation are discussed. Of the 172 boys, 28 (16.2%) have died. Twenty-five of the dead presented under the age of 1 yr. Of 54 boys presenting under 3 mo of age, 22 (40.6:/,) have died.-J. H. Johnston
T.M. Barrof, and D.I. Williams. Arch. Dis. Child. 48:291-295
(April), 1973.
This report is of a further 120 patients of Williams after his previous series of 112. One hundred and ten had upper . _ urinary tract calculi, and in ten patients the calculi were confined to the bladder. Seventy-five per cent of the patients were under 5 yr of age. Ninety-five children had infection on admission, the predominant organisms being the Profeus group. In 12 of the 67 in whom calcium excretion was estimated, hypercalciuria was found. These
The Effects of Early Experimental Cryptorchidism
and
Subsequent
Orchidopexy .on
Maturation of the Guinea Afkinron. 8r. J. Surg. 60:253-258
the
Pig Testicle. P.M. (April), 1973.
Two groups of normal Hartley strain guinea pigs were used. At the age of 7 days when the testes had not yet reached the scrotum, one group was made either unilaterally or bilaterally cryptorchid; the second group acted as controls. Orchiopexy was performed at different ages before and after puberty, and biopsies
149
ABSTRACTS
were taken initially and at subsequent occasions. The results showed that cryptorchidism caused arrest of development as judged by tubular size and spermatogenic index. Subsequent orchiopexy at ages up to and beyond puberty allowed development to continue to active spermatogenesis. It is known that the natural undescended testicle of man often does not achieve normal development after surgical treatment. It would seem likely that, unlike the experimental cryptorchid, the natural cryptorchid testicle of man is initially abnormal. This initial abnormality, as well as causing infertility, might also be an important etiological factor in the failure of descent of the testicle.-J. Lari The Effect of Unilateral Experimental Cryptorchidism and
Subsequent
Orchidopexy
Upon
Maturation of the Contralateral Scrotal Testicle of the Guinea Pig. P.M. Atkinson. Br. J. Surg. 60: 258-260
(April), 1973.
A study was made to find the effect of experimental unilateral cryptorchidism on the opposite scrotal testicle. Twenty-eight Hartley strain guinea pigs were made experimentally unilaterally cryptorchid at the age of 7 days. A similar number was used as controls. Orchiopexy was then performed at different ages before and after puberty. Biopsies were taken of the opposite scrotal testis at the time of the orchiopexy and at the postpubertal age of 120 days. The guinea pig reaches puberty at 8 1 days of age. The experiment showed that the contralateral scrotal testis matured normally and there was no difference between the test cases and the controls. In man, however, the contralateral scrotal testicle of unilaterally cryptorchid patients often show incomplete development. It is suggested that this work gives support to the concept that there may be an inherent testicular abnormality, in unilaterally cryptorchid patients, which is often bilateral.J. Lari Orchiolysir:
Correction of
the
Undescended
TesticleWithout Fixation. C. WiNioms. Br. J. Ural. 45: 437 (August), 1973.
The author describes the routine technique of orchiopexy but makes the point that fixation of the testis in the scrotum is unnecessary. However, he passes a suture through the testis and brings it out through the scrotal skin but manages to resist the temptation to tie a knot in it.-J.H. Johnston
Management
of
the
Undescended
Testis.
George T. Klouber. Can. Med. Assoc. J. 108:11291131 (May), 1973.
The author urges that operative correction of undescended testis be performed before the boy is 6 yr of age.-Colin C. Ferguson Genital Reconstruction in the Female With the Adrenogenital Syndrome. H.M. Spence and T.D. Allen. 8r. J. Ural. 45: 126130
(April), 1973.
A technique for genital reconstruction in girls with the adrenogenital syndrome is described. Introitoplasty is performed by dissecting up an inverted perineal skin flap. The urogenital sinus is laid open and the apex of the flap is sutured to the posterior margin of the vaginal opening. Clitoroplasty is carried out through a dorsal incision, excising the redundant dorsal foreskin. The shaft and crura of the clitoris are excised, leaving only the glans which is sutured to the inferior margin of the pubis. The blood supply of the glans is dependent on soft-tissue collaterals, and this has proved to be adequate. It is recommended that operation be performed about the age of 1 yr, assuming the metabolic state is satisfactory.--/. H. Johnston Primary Vaginal
Stones. N.1. Miller. Obstet.
Gynecol. 41:459-460
(March), 1973.
This is a case report
of a 17-year-old
severely
retarded female with a large vaginal stone. The author notes that most stones are associated with a vesicovaginal fistula, and there is one reported literature case associated with an ectopic ureter. Only five cases are found in the literature without fistula, three in spastic retarded children, one in a patient with congenital vaginal septum, and one after cicatricial occlusion of the vaginal introitus. Primary stones are usually found in association with incontinent bedridden patients. There is vaginal contamination with urine and feces and overgrowth of urea-splitting organisms.-.% Kim
MUSCULOSKELETAL Nontmumatic
Atlantoaxial
SYSTEM Dislocation
Children. B.C. Morar and N. Balochandran. Orthop. 92:220-226 Twelve
patients
in Clin.
(May), 1973. with
spontaneous
atlanto-
The group included one with proved and one with suspected eosinophilic granuloma. Diagnosis is made by the clinical picture of a child with a stiff neck
axial dislocation
were studied.
148
two with recurrent abdominal pain. Only 16 had pyuria and bacteriuria on the initial visit. Fifty-one of 54 had radiographic evidence of urinary tract calculi, and in the other three spontaneous passage of the stone occurred before x-rays could be obtained. Forty children had a single stone, while 14 had two or more calculi. Four children had bilateral stones. Of the five with obstructive uropathy, four had ureteropelvic junction obstruction and one had severe urethral meatal stenosis. Of four with metabolic disease, one had predisposing calcinosis universalis, one cystinuria, one had renal tubular acidosis, and one had a parathyroid adenoma. Two children developed calculi after prolonged orthopedic immobilization. Of the remaining 43 children, 19 had a family history positive for calculi, but no other cause. Fourteen children passed the stones spontaneously. Of the remaining 27 with idiopathic stone disease, operation was refused in two, and one continued to pass multiple recurrent stones. Four of the five with obstructive uropathv had the anatomical defect corrected with simultaneous urolithotomy and a good result. Two with renal tubular defects underwent urolithotomy and on a strict controlled medical program have had no stone recurrence. The child with calcinosis universalis was untreated and the patient with parathyroid adenoma underwent a pyelolithotomy and parathyroid adenoma removal. The stone analysis on 41 calculi revealed 28 calcium oxalate stones, six cystine and the rest uric acid and calcium phosphate oxalate. In two children with bilateral calculi, stones of different composition were recovered from opposite kidneys. The authors emphasize removal of all calculi, control of infection, and correction of underlying metabolic and anatomic defects for the best resuits.--S. Kim Childhood Urolithiasir in Britain. S. Ghazoli,
patients are discussed briefly and were a heterogeneous group. Treatment was usually by pyelolithotomy, but nephroureterectomy was performed upon eight and partial nephrectomy in four patients. Calculi recurred in 13 of the 120 children. In nine of these, persistent Proteus infection appeared to be a significant predisposing cause.-D.G. Young Acute
Urinary Retention In Children
Caused
by Pyouroter. 6. Coolsoet and C. Cornil. J. Ural. 108:966-968
(December), 1972.
Cases of urinary retention in a 22-mo-old girl and a 3-yr-old boy are reported. An ectopic pyoureter leading to a nonfunctioning upper pole on the left side was the cause of urinary retention in the little girl, and a pyomegaureter and pyonephrotic kidney on the left side was the problem in the boy. In both cases there was complete occlusion of the bladder outlet by the pyoureter. Both patients did well after operation. The authors have not found a similar case prior to this.-.% Kim Urethral Valves. ~3.1. Williams, R.H. Whitaker, TM. Barr&t, and I.E. Keeton. 8r. J. Ural. 45:200210 (April), 1973.
A series of 172 cases of urethral valves is reviewed. One third of the patients presented under the age of 3 mo. A new technique is described for division of the anterior valvular commissure. This consists of withdrawal, under x-ray control, of an insulated diathermy hook which engages and ruptures the membrane. In the management of persistent ureteric dilatation, the merits of, and the indications for loop ureterostomy, terminal ureterostomy, and ureteral tailoring and reimplantation are discussed. Of the 172 boys, 28 (16.2%) have died. Twenty-five of the dead presented under the age of 1 yr. Of 54 boys presenting under 3 mo of age, 22 (40.6:/,) have died.-J. H. Johnston
T.M. Barrof, and D.I. Williams. Arch. Dis. Child. 48:291-295
(April), 1973.
This report is of a further 120 patients of Williams after his previous series of 112. One hundred and ten had upper . _ urinary tract calculi, and in ten patients the calculi were confined to the bladder. Seventy-five per cent of the patients were under 5 yr of age. Ninety-five children had infection on admission, the predominant organisms being the Profeus group. In 12 of the 67 in whom calcium excretion was estimated, hypercalciuria was found. These
The Effects of Early Experimental Cryptorchidism
and
Subsequent
Orchidopexy .on
Maturation of the Guinea Afkinron. 8r. J. Surg. 60:253-258
the
Pig Testicle. P.M. (April), 1973.
Two groups of normal Hartley strain guinea pigs were used. At the age of 7 days when the testes had not yet reached the scrotum, one group was made either unilaterally or bilaterally cryptorchid; the second group acted as controls. Orchiopexy was performed at different ages before and after puberty, and biopsies
149
ABSTRACTS
were taken initially and at subsequent occasions. The results showed that cryptorchidism caused arrest of development as judged by tubular size and spermatogenic index. Subsequent orchiopexy at ages up to and beyond puberty allowed development to continue to active spermatogenesis. It is known that the natural undescended testicle of man often does not achieve normal development after surgical treatment. It would seem likely that, unlike the experimental cryptorchid, the natural cryptorchid testicle of man is initially abnormal. This initial abnormality, as well as causing infertility, might also be an important etiological factor in the failure of descent of the testicle.-J. Lari The Effect of Unilateral Experimental Cryptorchidism and
Subsequent
Orchidopexy
Upon
Maturation of the Contralateral Scrotal Testicle of the Guinea Pig. P.M. Atkinson. Br. J. Surg. 60: 258-260
(April), 1973.
A study was made to find the effect of experimental unilateral cryptorchidism on the opposite scrotal testicle. Twenty-eight Hartley strain guinea pigs were made experimentally unilaterally cryptorchid at the age of 7 days. A similar number was used as controls. Orchiopexy was then performed at different ages before and after puberty. Biopsies were taken of the opposite scrotal testis at the time of the orchiopexy and at the postpubertal age of 120 days. The guinea pig reaches puberty at 8 1 days of age. The experiment showed that the contralateral scrotal testis matured normally and there was no difference between the test cases and the controls. In man, however, the contralateral scrotal testicle of unilaterally cryptorchid patients often show incomplete development. It is suggested that this work gives support to the concept that there may be an inherent testicular abnormality, in unilaterally cryptorchid patients, which is often bilateral.J. Lari Orchiolysir:
Correction of
the
Undescended
TesticleWithout Fixation. C. WiNioms. Br. J. Ural. 45: 437 (August), 1973.
The author describes the routine technique of orchiopexy but makes the point that fixation of the testis in the scrotum is unnecessary. However, he passes a suture through the testis and brings it out through the scrotal skin but manages to resist the temptation to tie a knot in it.-J.H. Johnston
Management
of
the
Undescended
Testis.
George T. Klouber. Can. Med. Assoc. J. 108:11291131 (May), 1973.
The author urges that operative correction of undescended testis be performed before the boy is 6 yr of age.-Colin C. Ferguson Genital Reconstruction in the Female With the Adrenogenital Syndrome. H.M. Spence and T.D. Allen. 8r. J. Ural. 45: 126130
(April), 1973.
A technique for genital reconstruction in girls with the adrenogenital syndrome is described. Introitoplasty is performed by dissecting up an inverted perineal skin flap. The urogenital sinus is laid open and the apex of the flap is sutured to the posterior margin of the vaginal opening. Clitoroplasty is carried out through a dorsal incision, excising the redundant dorsal foreskin. The shaft and crura of the clitoris are excised, leaving only the glans which is sutured to the inferior margin of the pubis. The blood supply of the glans is dependent on soft-tissue collaterals, and this has proved to be adequate. It is recommended that operation be performed about the age of 1 yr, assuming the metabolic state is satisfactory.--/. H. Johnston Primary Vaginal
Stones. N.1. Miller. Obstet.
Gynecol. 41:459-460
(March), 1973.
This is a case report
of a 17-year-old
severely
retarded female with a large vaginal stone. The author notes that most stones are associated with a vesicovaginal fistula, and there is one reported literature case associated with an ectopic ureter. Only five cases are found in the literature without fistula, three in spastic retarded children, one in a patient with congenital vaginal septum, and one after cicatricial occlusion of the vaginal introitus. Primary stones are usually found in association with incontinent bedridden patients. There is vaginal contamination with urine and feces and overgrowth of urea-splitting organisms.-.% Kim
MUSCULOSKELETAL Nontmumatic
Atlantoaxial
SYSTEM Dislocation
Children. B.C. Morar and N. Balochandran. Orthop. 92:220-226 Twelve
patients
in Clin.
(May), 1973. with
spontaneous
atlanto-
The group included one with proved and one with suspected eosinophilic granuloma. Diagnosis is made by the clinical picture of a child with a stiff neck
axial dislocation
were studied.