659 Paediatric and adolescent varicocele repair: Experience of 84 cases at a single university

656 THE IMPACT UROGENITAL

OF PRENATAL ANDROGENS SINUS DEVELOPMENT IN THE

Yucel

L.

S., Baskin

University of California United States

San Francisco,

Department

ON VAGINAL FEMALE MOUSE

of Urology,

AND

San Francisco,

INTRODUCTION & OBJECTIVES: The level of the confluence of the vagina and common urogenital sinus is germane for the surgical reconstruction in patients with inappropriate prenatal androgen exposure. We studied the effects of different doses of prenatal androgens on the development of urogenital sinus and the location of the vaginal confluence in a mouse model. MATERIAL & METHODS: Timed pregnant mice were exposed to testosterone propionate (TP). From gestational days 14 through 18, at 0 (control) 2, 5 and 10 mg. On gestational day 19, the genital tubercles and internal genitalia were examined grossly and with immunohistochemistry for the presence of virilization. Three dimensional (3D) computer reconstruction and plastic cast injection molds of the urogenital sinus were performed in selected specimens. RESULTS: Microscopic serial analysis confirmed the spectrum of virilization which occurred in - 98% of the TP treated female foetuses. Plastic cast injection showed that affected females had a longer urogenital sinus and shorter vagina in a dose dependant manner. Histological sections revealed that the bladder neck moved proximally at higher doses of TP. 3D reconstruction images demonstrated significant confluence area migration proximally under increasing levels of TP. CONCLUSIONS: Prenatal exposure to increasing levels of androgen causes elongation of urogenital sinus in a female mouse foetus. In the mouse model, the confluence area moves proximally together with the bladder neck in dose dependant manner.

657 OUR EXPERIENCE ON CALCULI IN PAEDIATRIC

ENDOSCOPIC POPULATION

Dogan

S., Akdogan

S., Tekeul

Hacettepe Turkey

S., Keskin

University

Faculty

SURGERY

B.; Baseskioglu

of Medicine,

FOR

URETERAL

B., Sahin A

Department

of Urology,

Ankara,

INTRODUCTION & OBJECTIVES: By the development of smaller calibrated instruments, choice of treatment for ureteral calculi in paediatric population has become endoscopic more than open surgery. This study aims to present our experience on endoscopic surgery for ureteral calculi in paediatric population. MATERIAL & METHODS: rigid ureteroscopy for ureteral

We included 35 children calculi between November

who were treated with 1997 and June 2003.

RESULTS: The mean age of the children was 6.2 (l-14) years. The mean followup duration was 12 (2-30) months. Fifteen patients were male and 20 were female. The stone was in the distal ureter in thirty-three cases and in the proximal ureter in 2 cases. 7.5 F, 8F and 10F rigid ureteroscope was used for access into the ureter. For distal ureteral stones Holmium YAG laser was used in 29 cases, pneumatic lithotripter in 2 and forceps extractor for 2 cases. Both of two stones in the upper ureter were pushed back. The mean stone size was 8 mm. The mean duration of anaesthesia was 46.6 min (15-90). In all cases fragmentation was achieved during the operation. Except the push-back cases, stone free rate after single-stage procedure was 82% (27/33). With the repeating procedures in the remaining 6 cases, success rate became 97% (32/33). In push-back cases, the stone free state was proved after ESWL. Ureteral perforation occurred in two cases. The stone migrated out of ureter in one case while this case was managed conservatively and in the other one first; a ureteral catheter was placed than ureteroscopy was performed in other session and the stone was fragmented with laser. Double J stent in 3 1 cases and ureteral catheter in 4 cases was placed after the procedure. Ureteral catheters were removed at postoperative forty-eighth hours and double J stents were removed at postoperative fourth week under sedative anaesthesia. CONCLUSIONS: In the paediatric age group as in adults, ureteroscopy lithotripsy is safe and effective particularly in the lower ureteral stones.

and laser

658 CONTINENT VESICOSTOMY (MITROFANOFF THE APPENDIX OR THE ILEUM: COMPARING WM.,

Capizz

PRINCIPLE) THE RESULTS

A., Zin M., Sciobica F., Passerini Glaze1 G., Rigamonti

Istituto di Urologia,

Dipartimento

di Scxnze

Oncologiche

e Chimrgichc,

USING

659 PAEDIATRIC EXPERIENCE

W.

Cavan

Padova, Italy

University

INTRODUCTION & OBJECTIVES: To evaluate the results of continent vesicostomy according to the Mitrofanoffprinciple using the appendix compared to the retubularised ileum (Yang-Monti). MATERIAL & METHODS: From January 1997 to December 2002, 55 patients (age 4-77 years, mean 2X years) underwent continent vesicostomy according to the Mitrofanoffprinciple at our Institution: the appendix was used in 39 cases, ileum in 15, and sigma in 1 case. The underlying indications were: bladder exstrophy (12 cases), neuropathic bladder (1 I), urinary incontinence following previous surgery (1 I), pelvic cancer (9), posterior urethral valve or congenital urethral hypoplasia (4), reconstruction of an orthotopic neo-bladder after previous eterothopic urinary diversion (4) and miscellaneous (4). An augmentation cystoplasty was simultaneously performed in 29 cases and an ileal neobladder in 14: in these cases an original anti-reflux mechanism was routinely created by hitching the anterior wall of the reconstructed bladder to the anterior abdominal wall, so as to enroll the vesicostomic channel. Cutaneous stomas were located at the umbelicus in 52 cases and at the right lower abdominal quadrant in 3, Mean follow-up (range) was 46 months (7 71). The patients were divided into 2 groups: group A (39 cases) with appenchcovesicostomy and group B (15 cases) with ileovesicostomy. RESULTS: Group A: we complained significant trans-Mitrofanoff incontinence in 2139 (5.1%) patients and problematic catheterization in 4139 (10.5%). The patients suffering incontinence refused intervention and remain incontinent. Of the patients with difficult catheterization 1 had stoma1 stenosis resolved with dilatation, 2 had bladder-level stenosis successfolly treated respectively with endoscopic incision and surgical revision and 1 had angulated conduit resolved surgically. Group B: we found significant incontinence in 4115 (26.6%) and problematic catheterization in 4/15 (26.6%). The incontinence required 5 surgical revisions, after which I patients gained perfect continence and the rest significant improvements. Difficult catheterization was due to stoma1 stenosis in 2 cases (treated with 3 surgical revision), to bladder level stenosis (associated to angulation of the double flap of ileum) III 2 cases which were resolved with 1 endoscopic incision and 2 surgical revisions. The complication rate was significantly higher in group B respect to group A (csquare < 0.5) CONCLUSIONS: The appendix is the conduit of choice for a continent vesicostomy according to Mitrofanoffs principle, with a significantly smaller incidence of complications if compared to retubularised ileum according to Yang-Monti technique.

S., Acar

AND ADOLESCENT OF 84 CASES AT A SINGLE D., Bozlu

of Mersin

M., iilger

S., Domk

School of Medicine,

E., Akbay

Urology,

REPAIR:

VARICOCELE UNIVERSITY E

Mersin,

Turkey

INTRODUCTION & OBJECTIVES: The main goal of treatment of the paediatric and adolescent varicoceles is preservation of fertility. Therefore, the ideal technique for varicocele repair should include preservation of optimal testicular function, elimination of the varicocele and lower complication rates. The aim of this study was to review long term results of varicocele surgery, and also compare complication rates of the surgical techniques in boys with varicocele. MATERIAL & METHODS: The study included 84 boys with clinical palpable varicocele, ranging in age from 7 to 19 years, who underwent varicocele surgery at the University of Mersin School of Medicine. Varicocelectomies were performed using a microscope in 34 boys, a loop magnification in 24 and no magnification in 26 boys by either a subinguinal or inguinal approach. Postoperative complications in all patients, and total motile sperm count (TMC) in 23 adolescents were recorded and compared from preoperatively to postoperatively. RESULTS: Of the boys, 46 (54.8%) had left unilateral varicocelectomy, and 38 boys (45.3%) had bilateral varicocelectomy. The mean postoperative follow-up was 15.6 +lO.l months (4 to 48). In the adolescents, TMC increased from 19.1 h5.9 million to 64.4 i15.8 million postoperatively, revealing statistically significant difference (p=O.O09). No postoperative hematoma or infection was observed in all patients. Postoperative complication rates according to the techniques are given in the table. Varicocelectomy

techniques

Microscopic (n=34) Loop magnification (n=24) No magnification (n=26)

# Recurrence (%)

# Hydrocele

0 (0%) 1(4.1%) 3 (11.5%)

0 (0%) 1(4.1%) 2 (7.7%)

The highest recurrence rate and hydrocele were observed magnification when comparing the recurrence and hydrocele technique (p=O.O4 and p=O.l, respectively).

(%)

#Atrophy

(%)

0 (0%) 0 (0%) 0 (0%) in the patients using no rates of the microsurgical

CONCLUSIONS: Paediatric and adolescent varicocelectomy is safely method with very low recurrence and complication rates. Our study suggests that postoperative recurrence and hydrocele rates significantly decrease as using higher magnification such as microscope.

European

Urology

Supplements

3 (2004)

No. 2, pp, 167