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An analysis of different techniques for distal hypospadias repair: The price of perfection
ABSTRACTS
Fourteen boys with acute lymphoblastic leukemia who had been treated with combination chemotherapy (Prednisone, Vincristine, Methotreaxate and 6/Mercaptopurine) were followed prospectively to assess the affect of this regimen on gonadal function. The interval between discontinuation of chemotherapy and the most recent endocrine evaluation ranged from 2 mo to 8.5 yr (median 5.5 yr). Throughout the follow-up period, all patients had normal testicular function as determined by Tanner staging at physical examination and by serum gonadotropin and testosterone levels. Semen samples from six patients were unremarkable except for one sperm count that fell in the low normal range. These results indicate that the administration of antileukemic chemotherapy can be compatible with normal gonadal d e v e l o p m e n t . E.S. Wiener Early Hypospadias Repair. C. B. Manley and E. S. Epstein. J Urol 125:698-700, (May), 1981.
Preliminary experience suggests that repair should be done as early as possible, preferably at about 1 yr of age. The authors report their experience during the past 2 yr with 17 boys under 18 mo of age, 10 of which had a one-stage repair for distal hypospadias, and the remaining seven underwent a two-stage repair for penoscrotal or perineal hypospadias. There were no complications nor any apparent technical disadvantages in this small group, but there was a definite difference in the postoperative emotional reaction of these younger patients from the older boys with greatly diminished or absent fearful responses to the presence of doctors or nurses.--George Holcomb, Jr. The Denis Browne Repair for Hypospadias: A Review of 14 Years of Consecutive Experience. B. J. Donnelly and J. B.
Prenderville. J Uro1125:706-707, (May), 1981 Seventy-two consecutive boys with hypospadias treated by Denis Browne method during a 14-yr period are reviewed. A primary fistula occurred in only four patients and a stricture was found in three boys. Because of this low incidence of complications, the continued use of this technique is advised.--George Holcomb, Jr.
1053
and Horton-Devine flip-flap urethroplasty. The overall complication rate was 16.6% with 9.5% of the cases requiring additional urethral reconstruction. All complications occurred following procedures designed to extend the urethral meatus to the tip of the glans. In contrast, no complications occurred following urethral advancement or Allen-Spence repairs (O/19 ).--George Holcomb, Jr. Endoscopic Management of Urethral Strictures. H. N. Noe.
J Urol 125:712-714, (May), 1981. The management of urethral strictures in children prior to urethroplasty has involved dilatation and internal urethrotomy. Low success rates with these modalities led to the evaluation of visual urethrotomy and intralesional steroid injection. O f 12 patients so managed, 10 achieved an excellent result with two classified as having good results initially. These two cases were ultimately converted into the excellent category following repeat procedures. Non-invasive urinary flow rates proved invaluable in the m a n a g e m e n t and assessment of these patients, and the success of their t r e a t m e n t . George Holcomb, Jr. MUSCULOSKELETAL
SYSTEM
Massive Osteolysis in an Infant. J. Abrahams, D. Ganick,
E. Gilbert, and J. Wolfson. A m J Roentgenol 135:10841086, (November), 1980. A 14-too-old male presented with a right groin mass and refusal to walk. A 13 x 7 x 4 cm soft tissue mass and firm 1-2 cm right nodes were present in the right groin. Radiographs revealed osteolysis of both pubic, right ilium and ischium, and sacrum with a healing fracture of the ischium. Review of a radiograph taken at age 1 mo demonstrated a small lyric lesion in the right pubis. A radionuclide bone scan revealed no areas of increased activity. Lymphography at age 30 mo revealed abnormal lymph vessels throughout the pelvis. A biopsy revealed replacement of normal bone by vascular channels of varying size lined by hyperplastic endothelium. The authors state that this represents the youngest case report of massive osteolysis and suggest lymphangiography as a means of determining prognosis and extent of disease.--Randall IV. Powell
Experience with the Belt-Fuqua Hypospadias Repair. T. HI.
Hensle and D. L. Mollitt. J Urol 125:703-705, (May), 1981.
Treatment of Pronation Contractures of the Forearm in Cerebral Palsy by Changing the Insertion of the Pronator Radii T e r e s . H. T. Sakellarides, M. A. Mital, and W. D.
Thirty boys with distal and midshaft hypospadias and chordee treated with a modified Belt-Fuqua procedure from 1977 to 1979 are analyzed in this series. The overall complication rate was 10% with only two fistulas and one distal stricture. All patients had an excellent functional result. The absence of midline scars and the glandular meatus resulted in a superior cosmetic appearance.--George Holcomb. Jr. An Analysis of Different Techniques for Distal Hypospadias Repair: The Price of Perfection. C. Mills, J. McGovern,
D. Mininberg, J. Coleman, E. Muecke, and E. D. Vaughan, Jr. J Urol 125:701-702, (May), 1981. Four common surgical procedures used in 42 boys are analyzed. The four operations included urethral advancement, Allen-Spence urethroplasty, Ombredanne flip-flap
Lenzi. J Bone Joint Surg 63A:645-652, (April), 1981. Twenty-two patients with cerebral palsy pronation contractures of the forearm were treated by a posterior transfer of the pronator radii teres to the anterolateral border of the radius, converting it from a pronator to a supinator. Indications include the usual pathophysiologic conditions, satisfactory sensation, stereognosis, intelligence, and home conditions necessary for complete cooperation with the program. An intelligence quotient less than 70 was an absolute contraindication for the procedure. Complications included two fractures of the radius until the technique was modified to drill a smaller hole in the radius for insertion of the tendon transfer. The results took a forearm range of motion average from - 3 5 to 0 ~ supination to a postoperative status of 20-70 ~ for an average gain of 46 ~. N o patient lost
Fourteen boys with acute lymphoblastic leukemia who had been treated with combination chemotherapy (Prednisone, Vincristine, Methotreaxate and 6/Mercaptopurine) were followed prospectively to assess the affect of this regimen on gonadal function. The interval between discontinuation of chemotherapy and the most recent endocrine evaluation ranged from 2 mo to 8.5 yr (median 5.5 yr). Throughout the follow-up period, all patients had normal testicular function as determined by Tanner staging at physical examination and by serum gonadotropin and testosterone levels. Semen samples from six patients were unremarkable except for one sperm count that fell in the low normal range. These results indicate that the administration of antileukemic chemotherapy can be compatible with normal gonadal d e v e l o p m e n t . E.S. Wiener Early Hypospadias Repair. C. B. Manley and E. S. Epstein. J Urol 125:698-700, (May), 1981.
Preliminary experience suggests that repair should be done as early as possible, preferably at about 1 yr of age. The authors report their experience during the past 2 yr with 17 boys under 18 mo of age, 10 of which had a one-stage repair for distal hypospadias, and the remaining seven underwent a two-stage repair for penoscrotal or perineal hypospadias. There were no complications nor any apparent technical disadvantages in this small group, but there was a definite difference in the postoperative emotional reaction of these younger patients from the older boys with greatly diminished or absent fearful responses to the presence of doctors or nurses.--George Holcomb, Jr. The Denis Browne Repair for Hypospadias: A Review of 14 Years of Consecutive Experience. B. J. Donnelly and J. B.
Prenderville. J Uro1125:706-707, (May), 1981 Seventy-two consecutive boys with hypospadias treated by Denis Browne method during a 14-yr period are reviewed. A primary fistula occurred in only four patients and a stricture was found in three boys. Because of this low incidence of complications, the continued use of this technique is advised.--George Holcomb, Jr.
1053
and Horton-Devine flip-flap urethroplasty. The overall complication rate was 16.6% with 9.5% of the cases requiring additional urethral reconstruction. All complications occurred following procedures designed to extend the urethral meatus to the tip of the glans. In contrast, no complications occurred following urethral advancement or Allen-Spence repairs (O/19 ).--George Holcomb, Jr. Endoscopic Management of Urethral Strictures. H. N. Noe.
J Urol 125:712-714, (May), 1981. The management of urethral strictures in children prior to urethroplasty has involved dilatation and internal urethrotomy. Low success rates with these modalities led to the evaluation of visual urethrotomy and intralesional steroid injection. O f 12 patients so managed, 10 achieved an excellent result with two classified as having good results initially. These two cases were ultimately converted into the excellent category following repeat procedures. Non-invasive urinary flow rates proved invaluable in the m a n a g e m e n t and assessment of these patients, and the success of their t r e a t m e n t . George Holcomb, Jr. MUSCULOSKELETAL
SYSTEM
Massive Osteolysis in an Infant. J. Abrahams, D. Ganick,
E. Gilbert, and J. Wolfson. A m J Roentgenol 135:10841086, (November), 1980. A 14-too-old male presented with a right groin mass and refusal to walk. A 13 x 7 x 4 cm soft tissue mass and firm 1-2 cm right nodes were present in the right groin. Radiographs revealed osteolysis of both pubic, right ilium and ischium, and sacrum with a healing fracture of the ischium. Review of a radiograph taken at age 1 mo demonstrated a small lyric lesion in the right pubis. A radionuclide bone scan revealed no areas of increased activity. Lymphography at age 30 mo revealed abnormal lymph vessels throughout the pelvis. A biopsy revealed replacement of normal bone by vascular channels of varying size lined by hyperplastic endothelium. The authors state that this represents the youngest case report of massive osteolysis and suggest lymphangiography as a means of determining prognosis and extent of disease.--Randall IV. Powell
Experience with the Belt-Fuqua Hypospadias Repair. T. HI.
Hensle and D. L. Mollitt. J Urol 125:703-705, (May), 1981.
Treatment of Pronation Contractures of the Forearm in Cerebral Palsy by Changing the Insertion of the Pronator Radii T e r e s . H. T. Sakellarides, M. A. Mital, and W. D.
Thirty boys with distal and midshaft hypospadias and chordee treated with a modified Belt-Fuqua procedure from 1977 to 1979 are analyzed in this series. The overall complication rate was 10% with only two fistulas and one distal stricture. All patients had an excellent functional result. The absence of midline scars and the glandular meatus resulted in a superior cosmetic appearance.--George Holcomb. Jr. An Analysis of Different Techniques for Distal Hypospadias Repair: The Price of Perfection. C. Mills, J. McGovern,
D. Mininberg, J. Coleman, E. Muecke, and E. D. Vaughan, Jr. J Urol 125:701-702, (May), 1981. Four common surgical procedures used in 42 boys are analyzed. The four operations included urethral advancement, Allen-Spence urethroplasty, Ombredanne flip-flap
Lenzi. J Bone Joint Surg 63A:645-652, (April), 1981. Twenty-two patients with cerebral palsy pronation contractures of the forearm were treated by a posterior transfer of the pronator radii teres to the anterolateral border of the radius, converting it from a pronator to a supinator. Indications include the usual pathophysiologic conditions, satisfactory sensation, stereognosis, intelligence, and home conditions necessary for complete cooperation with the program. An intelligence quotient less than 70 was an absolute contraindication for the procedure. Complications included two fractures of the radius until the technique was modified to drill a smaller hole in the radius for insertion of the tendon transfer. The results took a forearm range of motion average from - 3 5 to 0 ~ supination to a postoperative status of 20-70 ~ for an average gain of 46 ~. N o patient lost