Circumcision Decision: Prominence of Social Concerns

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PEDIATRIC UROLOGY

formed with the patient under local anesthesia and in an outpatient setting, vasoepididymostomy is a much longer procedure and it usually requires use of a general anesthetico Multiple epididymal incisions must be made to detect sperm in the expressed fluid. The anastomosis is end to side and it is performed with microsurgical techniques. The mucosa of the vas is sutured to the edges of the incised epididymal tubule. The author does not present data on the success of this procedure. G. F. S. 11 figures, 3 tables, 11 references

PEDIATRIC UROLOGY Association of Supernumerary Nipples With Renal Anomalies V. MAGGYESSY AND K. MEHES, Department of Pediatrics, County Hospital, Gyor, Hungary J. Ped., 111: 412-413 (Sept.) 1987 The authors evaluated 8,308 infants and children 1 week to 16 years old for the presence of supernumerary nipples. Of the children 84 (53 boys) had 1 or more supernumerary nipples, for

a prevalence among unselected patients of 1.01 per cento Simultaneously, 2,462 consecutive neonates were examined and 21 infants (14 boys) had supernumerary nipples, with an incidence of 0.8 per cent. Of the entities reported the most frequent were hydronephrosis (5 patients), megaureter (2), multicystic kidney (2), hypoplastic kidney (1) and Wilms tumor (1). There appeared to be a fairly strict congruence in laterality of the accessory nipple and the renal anomalies observed. While these data are at variance with the experience in the United States and Israel, it appears that Eastern European white subjects have a higher incidence of renal abnormalities associated with supernumerary nipples. W. J. C. 2 tables, 7 references

Supernumerary Nipples a:nd Renal Anomalies in Neonates

R. D. KENNEY, J. L FLIPPO AND E. B. BLACK, Departments of Pediatrics and Radiology, Charlotte Memorial Hospital, Charlotte, North Carolina Amer. J. Dis. Child., 141: 987-988 (Septo) 1987 The authors examined 2,035 term infants and detected supernumerary nipples in 49. Of this group only 1 patient had a renal anomaly on examinationo However, only 4 of the 49 patients with supernumerary nipples were white. Since previous associations reported between supernumerary nipples and renal anomalies were presumably in white European and Israeli patients it appears that racial differences could account for the occurrence of renal anomalies in different patient populations. W. J. C. 1 table, 14 references

Omphalocele, Cryptorchidism, and Brain Malformations F. HADZISELIMOVIC, J. W. DUCKETT, H. SCHNAUFER AND D. HUFF, Divisions

M. SNYDER, Ill, L. of Urology, General Surgery and Pathology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

J. Pedo Surg., 22: 854-856

1987

A total of 19 male infants died of a large omphalocele and 52 per cent had associated cryptorchidism. Two groups were recognized: 1) 11 patients had omphalocele without brain malformation and an incidence of undescended testes not significantly different from the normal population, and 2) 8 patients had ornphalocele, brain malformations and cryptorchidism. The authors suggest that the triad of omphalocele, cryptorchidism and brain malformations (the OCB syndrome) supports an association between this occurrence and involvement of the hypothalamic-pituitary-gonadal axis. Similiarly, it is important to realize that whenever omphalocele and cryptorchidism are found, the occurrence of brain malformations or neural defects should be considered. W. J. C. 3 tables, 15 references

Editorial comment. The association between omphalocele and serious abnormalities of the brain has not been stressed previously, at least to my knowledge, and it is impressive that more than half of the patients in this series had both malformations. The central nervous system certainly must be assessed carefully in such patients. As far as the association between omphalocele and cryptorchism is concerned, it always has surprised me that even some of the patients had normal testis descent. I have always interpreted this as meaning that the omphalocele occurs relatively late in development after perhaps some formation of enough intact abdominal wall to allow the intra-abdominal pressure to be in the normal range or at least high enough to provide whatever stimulus for testis descent that the intra-abdominal pressure factor contributes. L. R. K. Abdominoscrotal Hydrocele: A Cause of Abdominal Mass in Children: A Case Report and Review of the Literature A.

H. KHAN AND S. YAZBECK, Department of Surgery, Hopital Ste-Justine, University of Montreal, Montreal, Quebec, Canada

J. Ped. Surg., 22: 809-810 (Septo) 1987 Abdominoscrotal hydrocele is rare in children. The condition arises by the continued accumulation of secretion in the tunica vaginalis, resulting in abdominal extension of the scrotal hydrocele. In most cases this presents as an intra-abdominal mass associated with a hydroceleo With compression of the mass the hydrocele will increase in size and vice versao The authors recommend that abdominoscrotal hydrocele be considered in the differential diagnosis of lower abdominal masses in childreno w. J. C. 2 figures, 4 references Ci:Jrcumcision Decision: Prominence of Social Concerns Mo S. BROWN AND C. A. BROWN, Departments of Perinatology and Nursing, Children's Hospital at St. Luke's Hospital, Denver, Colorado Pediatrics, 80: 215-219 (Aug.) 1987 Approximately a decade ago the American Academy of Pediatrics and the American College of Pediatrics and Gynecology published policy statements against routine circumcision in newborns. However, numerous investigators have noted that there is little change in the circumcision decision when the

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medical advantages and disadvantages of prophylactic circumcision have been presented to parents. In this study 124 parents were surveyed prospectively soon after deciding on circumcision to learn their reasons for making the decision. No attempt was made to discuss the issue before the procedure to avoid influencing the parents. The role of the physician in the circumcision decision can be influential. In a study by Patel circumcisions were performed in 20 per cent of the cases when physicians opposed it and in 100 per cent when the physician favored it. Social reasons for circumcision were predominant. The circumcision status of the father correlated statistically with the circumcision decision (p <0.0001). Other social concerns included the appearance of the penis and perceived future ridicule by siblings or schoolmates. The parental decision for or against circumcision appears to be emotional rather than rational. The authors suggest that physicians avoid trying to influence the decision either way and they urge that medical information be presented and not misrepresented. R. C. N. 4 tables, 17 references

Rudimentary Testes Syndrome Revisited Endocrine Pediatric Unit, Faculte de Medecine Cochin, Hopital Saint Vincent de Paul, Paris, France

A. ACQUAFREDDA, J. VASSAL AND J.-C. JOB,

Pediatrics, 80: 209-214 (Aug.) 1987 The rudimentary testes syndrome is defined as microgenitosomia with 2 well differentiated but extremely hypoplastic testes and apparently normal chromosomes. Sixteen patients 1 day to 9 years old were referred for investigation of markedly hypoplastic male genitalia. Parameters investigated included chromosomal studies, testicular factors, biopsy, testosterone levels, Leydig cell stimulation with human chorionic gonadotropin and luteinizing hormone-releasing hormone, and luteinizing hormone stimulation. Of the 16 patients studied 13 had micropenis with hypospadias of varying degree and 3 had micropenis alone. Two of the boys investigated had mothers who were sisters. On the basis of this fact the authors speculate that the process may be X-linked. The number of reported cases of the rudimentary testes syndrome is small but it appears probable that congenitally hypoplastic testes is one of a broad spectrum of clinical syndromes, including the various types of testicular dygenesis and prenatal testicular regression in individuals with a morphologically normal XY karyotype. Differentiation may not be possible before adolescence in some patients. R. C. N. 2 tables, 19 references

Torsion of an Undescended lntraabdominal Benign Testicular Teratoma

S. H. EIN, Division of General Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada J. Ped. Surg., 22: 799-801 (Sept.) 1987 The author reports on a 4-year-old boy with a nonpalpable left testis who presented with left lower quadrant pain and bladder symptoms. Evaluation, including a computerized tomography scan, revealed a calcified pelvic tumor on the left

side. At laparotomy a benign testicular teratoma had undergone torsion and infarction in the intra-abdominal position. Simple orchiectomy was the treatment of choice. Benign testicular teratomas are the most common neoplasm in boys with cryptorchidism. W. J. C. 2 figures, 10 references

RADIOLOGY, NUCLEAR MEDICINE AND SONOGRAPHY Dehydration, Antidiuretic Hormone and the Intravenous Urogram M. TREWHELLA, M. FORSLING, D. RICKARDS AND P. DAWSON, Department of Radiology, Princess Mary Royal Air Force Hospital, Halton; Departments of Physiology and Radiology, The Middlesex Hospital, London and Department of Radiology, Royal Postgraduate Medical School, Hammersmith Hospital, London, United Kingdom

Brit. J. Rad., 60: 445-447 (May) 1987 A regimen of dehydration for several hours before excretory urography (IVP) is a traditional part of patient preparation for this procedure. The theoretical basis for dehydration is that the elevated levels of antidiuretic hormone produced as a result will enhance the reabsorption of water from the distal and collecting tubules of the kidney, thereby concentrating urinary contrast agent to produce a radiographically denser, although perhaps less well distended, pyelogram. Since plasma osmolality and blood antidiuretic hormone levels provide an index of the degree of dehydration, the authors monitored both in some routinely dehydrated patients who were undergoing an IVP to test the effectiveness of dehydration in producing the theoretically required increase in antidiuretic hormone concentration. The results indicate that dehydration of outpatients as typically practiced by radiology departments does not affect plasma antidiuretic hormone levels. Furthermore, the act of contrast agent administration causes a rapid increase in plasma antidiuretic hormone concentration higher than would be expected in any case from modest dehydration, since the likely effect on circulating antidiuretic hormone of attempted dehydration is dwarfed by the physiological response to a contrast agent. It is considered that such efforts are entirely superfluous. With this in mind, and because routinely dehydration appears to be ineffective in practice and possibly dangerous, the authors suggest that it should be abandoned. N. V. R. 1 figure, 3 tables, 15 references

Volume Expansion Diuretic Renal Scan in Urinary Tract Obstruction R. HOWMAN-GILES, R. UREN, L. P. ROY AND R. B. FILMER,

Departments of Nuclear Medicine, Nephrology and Urology, The Children's Hospital, Camperdown, New South Wales, Australia

J. Nucl. Med., 28: 824-828 (May) 1987 Diuretic radionuclide renal scans ·are a modification of conventional renography, in which a diuretic is injected intravenously to distinguish dilated, nonobstructive hydronephrotic systems from those with significant mechanical obstruction. However, this technique has a false positive and indeterminate