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Distal penile lymphoedema following hypospadias repair: A case report
INTERNATIONAL
In addition to the data presented above, the importance of this study is that it establishes a model for the assessment of changing management strategies among physicians in the treatment of specific disease entities. Since the advantage of nonoperative management for splenic and hepatic trauma was first reported by the pediatric surgical community, increasing utilization of this strategy has been adopted by trauma surgeons who care for adult patients. The use of CT scanning as a better diagnostic modality than peritoneal lavage (to grade organ injury severity) also appears to be supported by this study. Ultrasonography (which is less expensive) may provide equivalent data, but this modality was not evaluated in the present investigation. Finally, the study appears to support the concept that increased experience caring for an illness (trauma v nontrauma center results) increases management efficiency and improves outcome.-Wu1ter.L Chwals GENITOURINARY The Prepuce: Circumcision.
Specialized J.R. Taylor,
Urol77:291-295,
TRACT
Mucosa of the Penis and Its Loss to A.P. Lockwood, and A.J. Taylor. Br J
(January), 1995.
The gross and histological features of the prepuce of 22 adults, obtained at autopsy, were assessed. Skin and mucosa sufficient to cover the penile shaft frequently were missing from the circumcised penis. Missing tissue included a band of ridged mucosa at the junction of true skin and mucosa that contains more Meissner’s corpuscles than smooth mucosa and which exhibits features of specialized sensory mucosa. Circumcision may remove an important component of the sensory mechamsm of the penis.--M.N de la Hunt Distal Penile Lymphoedema A Case Report. P. Gaston
41:97-98, (April),
Following Hypospadias and WIG. Scobie. J R Coil
Repair:
Surg Edinb
1996.
The authors present an unusual case of isolated distal penile lymphoedema 10 years after a two-stage uncomplicated repair of a coronal-type hypospadias with ventral chorde. The swelling at the distal end of the penis had commenced at puberty and progressively caused a poor urinary stream, with spraying and prolonged micturition. Details are given of the subsequent surgery (at age 13); the thickened edematous flaps were excised, and the patient made a satisfactory recovery. The authors discuss genital lymphedema briefly and propose pathophysiology of the disorder in this particular case.-Demck Wtlson-Sforq Ante-Natal Testicular Torsion: Only One Cause of the Testicular Regression Syndrome? J.R. Sutcliffe, D. Wifson-Storey, and NM Smith. J R Co11Surg Edinb 41:99-101, (April), 1996.
Histopathological studies of the tissue excised at orchidectomy requiring exploration for an undescended testis have shown that the terminal nubbin reveals features of the testicular regression syndrome. An intrauterine torsion has been suggested as one possible cause of this. However, because testicular torsion is far more common on the left, this would not explain instances of right-sided or bilateral cases. Therefore, the authors performed a 5-year surgical and pathological review, and confirmed that the left testis was the most commonly affected. Boys with testicular regression syndrome tended to be delivered closer to term, and frequently both testes were present at birth. after which one or both vanished. It was also noted pathologically that in one case in which there was a history of severe testicular trauma, subsequent histological findings were indistinguishable from those of the testicular regression syndrome. Therefore, it is postulated that close-to-term
ABSTRACTS
fetal testes are liable to be intrascrotal and therefore susceptible to direct trauma. This may well play a part in the etiology of the testicular regression syndrome in some cases. The clinical details and results are described in the report.-Demck Wdson-Storq The Pathogenesis of Cryptorchidism sion: A New Hypothesis. D. Cartes,
Br J Urol77:285-290,
and Splenogonadal J.M. Thorup, andJ.
Fuvisveld.
(January), 1995.
This meta-analysis of published reports of 111 boys with splenogonadal fusion found that 31% had cryptorchidism. Of these, 59% were bilateral, 26% had right intraabdominal testes, and 65% had left intraabdominal testes. Of those with continuous splenogonadal fusion, 44% had cryptorchidism. Solely cryptorchid cases with splenogonadal fusion reportedly had bilateral absence of both legs, imperforate anus, spina bifida, diaphragmatic hernia, and hypospadias. The authors put forward the hypothesis that the mechanism of crytorchidism is more complex in splenogonadal fusion and represents failure of an earlier phase of development. The basic abnormality may be in the connections of the diaphragmatic ligaments caused by abnormal midline development in the third to fourth week of gestation.-MN. de la Hunt The Long-Term With Primary D.A. Canning,
Outcome of Posterior Urethral Valves Treated Valve Ablation and Observation. G.H.H. Smith, S.L. Schubnan, et al. J Ural 155:1730-1734, (May),
1996. The authors believe that primary valve ablation with observation is the preferred management for posterior urethral valves. However, debate continues as to the role of high diversion. Therefore, an examination was made of the long-term outcome of a large series of patients treated with primary valve ablation and compared with the outcome of high dlversion andvesicostomy. The records of 100 patients treated with primary valve ablation (74%), vesicostomy (13%), or high diversion (9%) before 1985 were reviewed. The median follow-up period was 11.2 years. Overall, 13% of patients had end-stage renal disease by age 15 years. Three patients initially treated with valve ablation and three initially treated with vesicostomy later underwent high diversion, but none benefited from the secondary procedure. Four patients initially treated with valve ablation subsequently underwent vesicostomy, but only one benefited. Bladder storage capacity was well preserved. Diurnal urinary continence developed in 46% of patients at age 10 years, and only one remained incontinent after age 20 years. One patient with diversion who awaits transplantation has a small contracted bladder. Recent urodynamic studies in 10 cases of delayed urinary continence have not shown decreased bladder compliance or capacity. Kaplan-Meier analysis of outcomes of the different treatments indicated no statistical difference in patient age at the time end-stage renal disease developed. However, a comparison of the number of surgical procedures in the different treatment groups showed a significant increase in the amount of surgery in infants with diversion. These results were equivalent to those of the best published series, many of which strongly advocate high diversion. By avoiding diversion, in most cases bladder function is preserved and the need for bladder augmentation is decreased.-George W. Holcomb, Jr Vesical Neck Reconstruction in Patients With the ExstrophyEpispadias Complex. D.R. McMahon, M.P. Cam, D.A. Husmann, et al. J Urol 155:1411-1413. (April), 1996.
The authors evaluated the factors critical in achieving urinary continence in patients with the exstrophy-epispadias complex. A total of 51 patients with epispadias and 33 with classic bladder
In addition to the data presented above, the importance of this study is that it establishes a model for the assessment of changing management strategies among physicians in the treatment of specific disease entities. Since the advantage of nonoperative management for splenic and hepatic trauma was first reported by the pediatric surgical community, increasing utilization of this strategy has been adopted by trauma surgeons who care for adult patients. The use of CT scanning as a better diagnostic modality than peritoneal lavage (to grade organ injury severity) also appears to be supported by this study. Ultrasonography (which is less expensive) may provide equivalent data, but this modality was not evaluated in the present investigation. Finally, the study appears to support the concept that increased experience caring for an illness (trauma v nontrauma center results) increases management efficiency and improves outcome.-Wu1ter.L Chwals GENITOURINARY The Prepuce: Circumcision.
Specialized J.R. Taylor,
Urol77:291-295,
TRACT
Mucosa of the Penis and Its Loss to A.P. Lockwood, and A.J. Taylor. Br J
(January), 1995.
The gross and histological features of the prepuce of 22 adults, obtained at autopsy, were assessed. Skin and mucosa sufficient to cover the penile shaft frequently were missing from the circumcised penis. Missing tissue included a band of ridged mucosa at the junction of true skin and mucosa that contains more Meissner’s corpuscles than smooth mucosa and which exhibits features of specialized sensory mucosa. Circumcision may remove an important component of the sensory mechamsm of the penis.--M.N de la Hunt Distal Penile Lymphoedema A Case Report. P. Gaston
41:97-98, (April),
Following Hypospadias and WIG. Scobie. J R Coil
Repair:
Surg Edinb
1996.
The authors present an unusual case of isolated distal penile lymphoedema 10 years after a two-stage uncomplicated repair of a coronal-type hypospadias with ventral chorde. The swelling at the distal end of the penis had commenced at puberty and progressively caused a poor urinary stream, with spraying and prolonged micturition. Details are given of the subsequent surgery (at age 13); the thickened edematous flaps were excised, and the patient made a satisfactory recovery. The authors discuss genital lymphedema briefly and propose pathophysiology of the disorder in this particular case.-Demck Wtlson-Sforq Ante-Natal Testicular Torsion: Only One Cause of the Testicular Regression Syndrome? J.R. Sutcliffe, D. Wifson-Storey, and NM Smith. J R Co11Surg Edinb 41:99-101, (April), 1996.
Histopathological studies of the tissue excised at orchidectomy requiring exploration for an undescended testis have shown that the terminal nubbin reveals features of the testicular regression syndrome. An intrauterine torsion has been suggested as one possible cause of this. However, because testicular torsion is far more common on the left, this would not explain instances of right-sided or bilateral cases. Therefore, the authors performed a 5-year surgical and pathological review, and confirmed that the left testis was the most commonly affected. Boys with testicular regression syndrome tended to be delivered closer to term, and frequently both testes were present at birth. after which one or both vanished. It was also noted pathologically that in one case in which there was a history of severe testicular trauma, subsequent histological findings were indistinguishable from those of the testicular regression syndrome. Therefore, it is postulated that close-to-term
ABSTRACTS
fetal testes are liable to be intrascrotal and therefore susceptible to direct trauma. This may well play a part in the etiology of the testicular regression syndrome in some cases. The clinical details and results are described in the report.-Demck Wdson-Storq The Pathogenesis of Cryptorchidism sion: A New Hypothesis. D. Cartes,
Br J Urol77:285-290,
and Splenogonadal J.M. Thorup, andJ.
Fuvisveld.
(January), 1995.
This meta-analysis of published reports of 111 boys with splenogonadal fusion found that 31% had cryptorchidism. Of these, 59% were bilateral, 26% had right intraabdominal testes, and 65% had left intraabdominal testes. Of those with continuous splenogonadal fusion, 44% had cryptorchidism. Solely cryptorchid cases with splenogonadal fusion reportedly had bilateral absence of both legs, imperforate anus, spina bifida, diaphragmatic hernia, and hypospadias. The authors put forward the hypothesis that the mechanism of crytorchidism is more complex in splenogonadal fusion and represents failure of an earlier phase of development. The basic abnormality may be in the connections of the diaphragmatic ligaments caused by abnormal midline development in the third to fourth week of gestation.-MN. de la Hunt The Long-Term With Primary D.A. Canning,
Outcome of Posterior Urethral Valves Treated Valve Ablation and Observation. G.H.H. Smith, S.L. Schubnan, et al. J Ural 155:1730-1734, (May),
1996. The authors believe that primary valve ablation with observation is the preferred management for posterior urethral valves. However, debate continues as to the role of high diversion. Therefore, an examination was made of the long-term outcome of a large series of patients treated with primary valve ablation and compared with the outcome of high dlversion andvesicostomy. The records of 100 patients treated with primary valve ablation (74%), vesicostomy (13%), or high diversion (9%) before 1985 were reviewed. The median follow-up period was 11.2 years. Overall, 13% of patients had end-stage renal disease by age 15 years. Three patients initially treated with valve ablation and three initially treated with vesicostomy later underwent high diversion, but none benefited from the secondary procedure. Four patients initially treated with valve ablation subsequently underwent vesicostomy, but only one benefited. Bladder storage capacity was well preserved. Diurnal urinary continence developed in 46% of patients at age 10 years, and only one remained incontinent after age 20 years. One patient with diversion who awaits transplantation has a small contracted bladder. Recent urodynamic studies in 10 cases of delayed urinary continence have not shown decreased bladder compliance or capacity. Kaplan-Meier analysis of outcomes of the different treatments indicated no statistical difference in patient age at the time end-stage renal disease developed. However, a comparison of the number of surgical procedures in the different treatment groups showed a significant increase in the amount of surgery in infants with diversion. These results were equivalent to those of the best published series, many of which strongly advocate high diversion. By avoiding diversion, in most cases bladder function is preserved and the need for bladder augmentation is decreased.-George W. Holcomb, Jr Vesical Neck Reconstruction in Patients With the ExstrophyEpispadias Complex. D.R. McMahon, M.P. Cam, D.A. Husmann, et al. J Urol 155:1411-1413. (April), 1996.
The authors evaluated the factors critical in achieving urinary continence in patients with the exstrophy-epispadias complex. A total of 51 patients with epispadias and 33 with classic bladder