- Email: [email protected]
DISCUSSION: ANTERIOR SAGITTAL TRANSANORECTAL APPROACH TO THE POSTERIOR URETHRA IN THE PEDIATRIC AGE GROUP
0022-5347/98/1603-1178$03.00/0 THEJOURNAL OF UROLOGY Copyright 8 1998 by AMERICMUROL~CICAL ASSOCUTION, INC.
Vol. 160,1178,September 1998 Printed in U.S.A.
DISCUSSION Dr. George lilauber. In regard to microlithiasis, a review of the literature would probably lead to the conclusion that this condition is most likely premalignant. I think that it is already reported in the literature that for medical, legal and ethical reasons you must stress to the families the need for followup. Doctor Lee, we did not see the statistics on what percentage of the men you approached were willing to come back and be tested. I suspect that this may be biased a bit more toward infertile men. Dr. Peter A. Lee. There is no question that most data are biased because men who are concerned about fertility are more likely to retUrn. Many in the larger cohort, and there are more than 1,000 men, no longer live in western Pennsylvania, and so we are concentrating on those who do live there. About 40% of the men said on the questionnaire that they were willing to return. Of those in western Pennsylvania to date about 80%of those we contacted have been willing to return. Dr' Robe* Kay' I like to thank for bringing the problem of microlithiasis to our attention. The first distinction is that prepubertal children are different than pubertal children. An adult who is 21 years old is not the same as a child who is 7 months old. There are 3 of 28 cases in the literature, accounting for approximately 11%. I think that f o ~ ~ o w uofp month or an average of 27 months is really too short. What do you think is happening in this particular testicle to cause microlithiasis? Dr. Peter D. Furness, ZIZ. Obviously from other organ systems we can draw conclusions that calcific deposits do not necessarily result in malignant degeneration. It is a natural process for the body to get rid of dead tissues. If they cannot be cleared properly, then calcific deposits may result. In response to the association of this condition with a malignant condition, I think that it is still premature to make any conclusions, because I agree with you that testicles are different in children and adults. Our supposition when we first studied this condition was that there may have been testicular tumors in children, which is why we looked at them. Dr. David A. Diamond. Doctor Lee, in regard to the anatomical site of the undescended testis, is there any correla-
tion between the site of origin of the unilateral cryptorchid testis, and the hormonal and semen parameters? Doctor Lee. We found to our disappointment that a fair number of the operative notes do not clearly provide the preoperative location of the testis. We intend to do that with semen parameters at some point. Looking at the larger paternity data we presume that there is a correlation between the testes that were above the internal ring and increased infertility based on paternity. Doctor Flack. I think that it was interesting that torsion of the undescended testis occurred mostly in patients with cerebral palsy. I have a general belief that these patients have a different type of mdescended testicle, which is mostly related t o spasticity of the cremasteric muscle. It is not usually associated with a hernia. that I presented were not in D,..David Riden. me 6 patients with cerebral palsy, mereis a large historical base for that group of cases. One patient who was 18 years old had the Dandy-Walker syndrome and presented late. I agree that he may have had a spastic cremasteric muscle. However, this was the largest series that I could find of noncerebral palsy cases' and Dr. A. do your data to stratify patients according to age at orchiopexy? If so, what were the differences in the Doctor Lee. We have enough data on paternity to stratify. To date there is no effect on age at orchiopexy in those who Or are Dr. James J . YOO. Rib has been used for penile reconstruction since the 1940s. This practice has stopped because of the c u ~ - ~ a t uofthe re rib and because it requires multiple surgeries. Mr. David F. M. Thomas. Have YOU looked for other Y deoxyribonucleic acid in these individuals? Dr. Thomas F. Kolon. In 2 patients a small portion of Y deoxyribonucleic acid showed up on the short arm of the Y chromosome. Certainly there must be some more examination on the rest of the Y chromosome. Also, in the X chromosome we need to look at the area of XP-21.
1178
Vol. 160,1178,September 1998 Printed in U.S.A.
DISCUSSION Dr. George lilauber. In regard to microlithiasis, a review of the literature would probably lead to the conclusion that this condition is most likely premalignant. I think that it is already reported in the literature that for medical, legal and ethical reasons you must stress to the families the need for followup. Doctor Lee, we did not see the statistics on what percentage of the men you approached were willing to come back and be tested. I suspect that this may be biased a bit more toward infertile men. Dr. Peter A. Lee. There is no question that most data are biased because men who are concerned about fertility are more likely to retUrn. Many in the larger cohort, and there are more than 1,000 men, no longer live in western Pennsylvania, and so we are concentrating on those who do live there. About 40% of the men said on the questionnaire that they were willing to return. Of those in western Pennsylvania to date about 80%of those we contacted have been willing to return. Dr' Robe* Kay' I like to thank for bringing the problem of microlithiasis to our attention. The first distinction is that prepubertal children are different than pubertal children. An adult who is 21 years old is not the same as a child who is 7 months old. There are 3 of 28 cases in the literature, accounting for approximately 11%. I think that f o ~ ~ o w uofp month or an average of 27 months is really too short. What do you think is happening in this particular testicle to cause microlithiasis? Dr. Peter D. Furness, ZIZ. Obviously from other organ systems we can draw conclusions that calcific deposits do not necessarily result in malignant degeneration. It is a natural process for the body to get rid of dead tissues. If they cannot be cleared properly, then calcific deposits may result. In response to the association of this condition with a malignant condition, I think that it is still premature to make any conclusions, because I agree with you that testicles are different in children and adults. Our supposition when we first studied this condition was that there may have been testicular tumors in children, which is why we looked at them. Dr. David A. Diamond. Doctor Lee, in regard to the anatomical site of the undescended testis, is there any correla-
tion between the site of origin of the unilateral cryptorchid testis, and the hormonal and semen parameters? Doctor Lee. We found to our disappointment that a fair number of the operative notes do not clearly provide the preoperative location of the testis. We intend to do that with semen parameters at some point. Looking at the larger paternity data we presume that there is a correlation between the testes that were above the internal ring and increased infertility based on paternity. Doctor Flack. I think that it was interesting that torsion of the undescended testis occurred mostly in patients with cerebral palsy. I have a general belief that these patients have a different type of mdescended testicle, which is mostly related t o spasticity of the cremasteric muscle. It is not usually associated with a hernia. that I presented were not in D,..David Riden. me 6 patients with cerebral palsy, mereis a large historical base for that group of cases. One patient who was 18 years old had the Dandy-Walker syndrome and presented late. I agree that he may have had a spastic cremasteric muscle. However, this was the largest series that I could find of noncerebral palsy cases' and Dr. A. do your data to stratify patients according to age at orchiopexy? If so, what were the differences in the Doctor Lee. We have enough data on paternity to stratify. To date there is no effect on age at orchiopexy in those who Or are Dr. James J . YOO. Rib has been used for penile reconstruction since the 1940s. This practice has stopped because of the c u ~ - ~ a t uofthe re rib and because it requires multiple surgeries. Mr. David F. M. Thomas. Have YOU looked for other Y deoxyribonucleic acid in these individuals? Dr. Thomas F. Kolon. In 2 patients a small portion of Y deoxyribonucleic acid showed up on the short arm of the Y chromosome. Certainly there must be some more examination on the rest of the Y chromosome. Also, in the X chromosome we need to look at the area of XP-21.
1178