- Email: [email protected]
Morphology and histochemistry of infant testes in the prune belly syndrome
INTERNATIONAL
926
Children’s Hospital of Pittsburgh from 1982 to 1990. There were 37 patients aged 14 months to 20.5 years (mean, 11.5 years). The adult side-viewing duodenoscope (Olympus JFlT) was used for all procedures. ERCP was used in pancreatic disease for: (1) idiopathic, recurrent pancreatitis; (2) pancreatitis associated with biliary anomalies; (3) pancreatitis following pancreatic surgery; (4) pancreatitis following orthotopic liver transplantation; (5) traumatic pancreatitis; and (6) pancreatitis associated with cystic fibrosis. ERCP was used in biliary tract disease for: (1) cholestasis following orthotopic liver transplantation; (2) cholestasis associated with Crohn’s disease; (3) hepatic trauma; (4) biliary hypoplasia; and (5) biliary dyskinesia. The procedure was successful in 92% of patients. Abnormalities were detected in 58% of the patients, half of whom required surgical intervention for the pancreatic or biliary ductal abnormality that was found. The only complication was mild pancreatitis occurring in 3 patients (8%). ERCP is a safe, useful procedure in the evaluation of children with pancreaticobiliary disorders.-Richard R. Ricketts GENITOURINARY
TRACT
Management of an Impalpable Testis: The Role of Laparoscopy. F. P6loquin, G. Kiruluta, and E. Quiros. Can J Surg 34:587-
590, (December), 1991. The use of laparoscopy through a small infraumbilical incision permits noninvasive exploration of the pelvic fossae. The vas deferens as well as the spermatic vessels can be identified either with the testicle or as a blind ending structure with an absent (vanishing) testis. Twenty-six laparoscopies were performed on 19 boys with unilateral impalpable testis and seven with bilateral impalpable testes between 1987 and 1988, inclusive. Sixteen boys had a unilateral testis or bilateral testes located at the internal ring and were subsequently managed successfully by orchidopexy. In five boys, the blood vessels and vas deferens were atrophic and no exploration was carried out. In three other boys, the vas and spermatic vessels were found passing through the internal ring and were explored. Two boys had intraabdominal testes. In one an orchiectomy was performed because the testis was atrophic. In the second case (bilateral) one side had a one-stage Fowler-Stephens orchidopexy and the other side had a two-stage orchidopexy. Laparoscopy is the best method of locating the impalpable testis, and depending on these findings, no further surgery or a simple inguinal exploration or abdominal incision is needed for the management of this condition.--Sigmund H. Ein
Morphology and Histochemistry of Infant Testes in the Prune Belly Syndrome. C.A. Massad, M.B. Cohen, B.A. Kogan, et al. J
Urol 146:1598-1600, (December), 1991. Testicular biopsy samples from three boys 5.5, 6, and 7 months old with the prune-belly syndrome and intraabdominal testes were examined morphologically and phenotypically for the presence of alkaline phosphatase. Findings were compared with those in agematched autopsy controls. All patient specimens demonstrated atypical germ cells with large nuclei and prominent nucleoli and intense alkaline phosphatase staining localized to the cytoplasmic membrane. The presence of these testicular abnormalities suggests that a developmental arrest is fundamental to the pathogenesis of the undescended testes associated with the prune belly syndrome. The similarity of the histological appearance of these testes to that of intratubular germ cell neoplasia suggests that long-term follow-up of these patients for the development of invasive germ cell tumors is important.-George I+! Holcomb, Jr
ABSTRACTS
Single-Stage Correction of Posterior Hypospadias (178 Cases). Comparison of Three Techniques: Free Skin Graft, Free Bladder Mucosal Graft, Transverse Pedicle Preputial Graft. J.S. Valla, P. Takvorian, H. Dodat, et al. Eur J Pediatr Surg 1:287-290,
(October), 1991. A multicenter, retrospective study of 178 children operated on for posterior hypospadias is presented. Three techniques were used for single-stage repair of posterior hypospadias: free skin grafts, free bladder mucosal grafts, and pedicle preputial grafts. Free skin grafts (15 cases) resulted most frequently in complications and, particularly, in severe strictures. Therefore, it is concluded that this technique should be abandoned. Pedicle preputial grafts (133 cases) provided the most favorable results and should be used whenever the dimensions of the prepuce are sufficient for urethroplasty. Results with bladder mucosal grafts were not as good (30 cases) as with preputial grafts, but this technique remains the only solution when the meatus is in a very posterior position and for children who have already undergone multiple operations. Minor cosmetic operations were performed only for hypospadias repaired by the pedicle flap technique (4 cases), the most common cause being excess skin on the ventral aspect.-Thomas A. Angerpointner Renal Transplantation in Children With Posterior Urethral Va1ves.J.E. Bryant, D.B. Joseph, E.C. Kohaut, etal. J Urol146:1585-
1587, (December), 1991. The outcome of renal transplantation in 18 children with a diagnosis of posterior urethral valves was compared to 18 matched children with nonobstructed renal failure to identify the disadvantages of renal transplantation into the valve bladder. There was no statistical difference in patient survival. The 5-year graft survival rate was 62.3% in children with posterior urethral valves and 48% in the control group. The difference was not statistically significant (P = .32). A statistically significant increase in serum creatinine from 1.2 to 2.2 mg/dL was noted in the patients with posterior urethral valves, which was not seen in the control group (P = .0009). The clinical significance of this finding is unknown.-George U/ Holcomb, Jr Ureteral Reimplantation: A Comparison of Results With the Cross-Trigonal and Politano-Leadbetter Techniques in 120 Patients. K.A. Burbige. J Ural 146:1352-1353, (November), 1991.
A review of 120 children who underwent ureteral reimplantation by the cross-trigonal or Politano-Leadbetter technique is presented. Overall success rates (no postoperative reflux or ureteral obstruction) were 96.7% for the Politano-Leadbetter method and 97.8% for the cross-trigonal technique. There were no failures using either method in patients operated upon for primary vesicoureteral reflux.-George W Holcomb, Jr Nonsurgical Management of Primary Vesicoureteral Reflux in Complete Ureteral Duplication: Is it Justified? D.S. Peppus, S.J. Skoog, D.A. Canning, et al. J Ural 146:1594-1595, (December),
1991. The treatment of 56 children with vesicoureteral reflux and complete duplication of the collecting system, including 14 who had complete bilateral duplication, is reviewed. A total of 70 refluxing duplicated systems was analyzed. Of the patients 18% demonstrated spontaneous resolution of reflux within 42 months, 23% are currently stable on prophylactic antibiotics, and 57.1% underwent surgical correction. Spontaneous resolution of reflux occurred in 58% of the children with grades I to III/V reflux. In comparing the group with reflux and duplication with a group with
926
Children’s Hospital of Pittsburgh from 1982 to 1990. There were 37 patients aged 14 months to 20.5 years (mean, 11.5 years). The adult side-viewing duodenoscope (Olympus JFlT) was used for all procedures. ERCP was used in pancreatic disease for: (1) idiopathic, recurrent pancreatitis; (2) pancreatitis associated with biliary anomalies; (3) pancreatitis following pancreatic surgery; (4) pancreatitis following orthotopic liver transplantation; (5) traumatic pancreatitis; and (6) pancreatitis associated with cystic fibrosis. ERCP was used in biliary tract disease for: (1) cholestasis following orthotopic liver transplantation; (2) cholestasis associated with Crohn’s disease; (3) hepatic trauma; (4) biliary hypoplasia; and (5) biliary dyskinesia. The procedure was successful in 92% of patients. Abnormalities were detected in 58% of the patients, half of whom required surgical intervention for the pancreatic or biliary ductal abnormality that was found. The only complication was mild pancreatitis occurring in 3 patients (8%). ERCP is a safe, useful procedure in the evaluation of children with pancreaticobiliary disorders.-Richard R. Ricketts GENITOURINARY
TRACT
Management of an Impalpable Testis: The Role of Laparoscopy. F. P6loquin, G. Kiruluta, and E. Quiros. Can J Surg 34:587-
590, (December), 1991. The use of laparoscopy through a small infraumbilical incision permits noninvasive exploration of the pelvic fossae. The vas deferens as well as the spermatic vessels can be identified either with the testicle or as a blind ending structure with an absent (vanishing) testis. Twenty-six laparoscopies were performed on 19 boys with unilateral impalpable testis and seven with bilateral impalpable testes between 1987 and 1988, inclusive. Sixteen boys had a unilateral testis or bilateral testes located at the internal ring and were subsequently managed successfully by orchidopexy. In five boys, the blood vessels and vas deferens were atrophic and no exploration was carried out. In three other boys, the vas and spermatic vessels were found passing through the internal ring and were explored. Two boys had intraabdominal testes. In one an orchiectomy was performed because the testis was atrophic. In the second case (bilateral) one side had a one-stage Fowler-Stephens orchidopexy and the other side had a two-stage orchidopexy. Laparoscopy is the best method of locating the impalpable testis, and depending on these findings, no further surgery or a simple inguinal exploration or abdominal incision is needed for the management of this condition.--Sigmund H. Ein
Morphology and Histochemistry of Infant Testes in the Prune Belly Syndrome. C.A. Massad, M.B. Cohen, B.A. Kogan, et al. J
Urol 146:1598-1600, (December), 1991. Testicular biopsy samples from three boys 5.5, 6, and 7 months old with the prune-belly syndrome and intraabdominal testes were examined morphologically and phenotypically for the presence of alkaline phosphatase. Findings were compared with those in agematched autopsy controls. All patient specimens demonstrated atypical germ cells with large nuclei and prominent nucleoli and intense alkaline phosphatase staining localized to the cytoplasmic membrane. The presence of these testicular abnormalities suggests that a developmental arrest is fundamental to the pathogenesis of the undescended testes associated with the prune belly syndrome. The similarity of the histological appearance of these testes to that of intratubular germ cell neoplasia suggests that long-term follow-up of these patients for the development of invasive germ cell tumors is important.-George I+! Holcomb, Jr
ABSTRACTS
Single-Stage Correction of Posterior Hypospadias (178 Cases). Comparison of Three Techniques: Free Skin Graft, Free Bladder Mucosal Graft, Transverse Pedicle Preputial Graft. J.S. Valla, P. Takvorian, H. Dodat, et al. Eur J Pediatr Surg 1:287-290,
(October), 1991. A multicenter, retrospective study of 178 children operated on for posterior hypospadias is presented. Three techniques were used for single-stage repair of posterior hypospadias: free skin grafts, free bladder mucosal grafts, and pedicle preputial grafts. Free skin grafts (15 cases) resulted most frequently in complications and, particularly, in severe strictures. Therefore, it is concluded that this technique should be abandoned. Pedicle preputial grafts (133 cases) provided the most favorable results and should be used whenever the dimensions of the prepuce are sufficient for urethroplasty. Results with bladder mucosal grafts were not as good (30 cases) as with preputial grafts, but this technique remains the only solution when the meatus is in a very posterior position and for children who have already undergone multiple operations. Minor cosmetic operations were performed only for hypospadias repaired by the pedicle flap technique (4 cases), the most common cause being excess skin on the ventral aspect.-Thomas A. Angerpointner Renal Transplantation in Children With Posterior Urethral Va1ves.J.E. Bryant, D.B. Joseph, E.C. Kohaut, etal. J Urol146:1585-
1587, (December), 1991. The outcome of renal transplantation in 18 children with a diagnosis of posterior urethral valves was compared to 18 matched children with nonobstructed renal failure to identify the disadvantages of renal transplantation into the valve bladder. There was no statistical difference in patient survival. The 5-year graft survival rate was 62.3% in children with posterior urethral valves and 48% in the control group. The difference was not statistically significant (P = .32). A statistically significant increase in serum creatinine from 1.2 to 2.2 mg/dL was noted in the patients with posterior urethral valves, which was not seen in the control group (P = .0009). The clinical significance of this finding is unknown.-George U/ Holcomb, Jr Ureteral Reimplantation: A Comparison of Results With the Cross-Trigonal and Politano-Leadbetter Techniques in 120 Patients. K.A. Burbige. J Ural 146:1352-1353, (November), 1991.
A review of 120 children who underwent ureteral reimplantation by the cross-trigonal or Politano-Leadbetter technique is presented. Overall success rates (no postoperative reflux or ureteral obstruction) were 96.7% for the Politano-Leadbetter method and 97.8% for the cross-trigonal technique. There were no failures using either method in patients operated upon for primary vesicoureteral reflux.-George W Holcomb, Jr Nonsurgical Management of Primary Vesicoureteral Reflux in Complete Ureteral Duplication: Is it Justified? D.S. Peppus, S.J. Skoog, D.A. Canning, et al. J Ural 146:1594-1595, (December),
1991. The treatment of 56 children with vesicoureteral reflux and complete duplication of the collecting system, including 14 who had complete bilateral duplication, is reviewed. A total of 70 refluxing duplicated systems was analyzed. Of the patients 18% demonstrated spontaneous resolution of reflux within 42 months, 23% are currently stable on prophylactic antibiotics, and 57.1% underwent surgical correction. Spontaneous resolution of reflux occurred in 58% of the children with grades I to III/V reflux. In comparing the group with reflux and duplication with a group with