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MP-15.13 Management of Cryptorchidism in Adolescent and Adult Males
MODERATED POSTER SESSIONS
MP-15.13, Table 1. Number Unilateral UDT Bilateral UDT Intra-abdominal UDT Absent testis Orchidopexy Orchidectomy Fowler-Stephens procedure Number Mean age (years) Unilateral Bilateral Intra-abdominal UDT Absent testis Orchidopexy Orchidectomy Fowler-Stephens procedure
12-18 years old 47 87.2% 12.8% 29% 3.2% 93.6% 6.4% 17% Impalpable UDT 31 21.7 67.7% 32.3% 24% 10% 67.7% 32.3% 32.3%
bination of both. Any scar tissue present was excised. Results: Patients were followed up clinically at 3 months 106/106 (100%) and by questionnaire at least one year post-operatively 96/106 (91%). In total 10 patients were lost to follow-up as they had changed their contact details in the intervening period. The questionnaire reviewed overall satisfaction and cosmetic outcome on a self-assessed visual analogue score of 0 (very bad) to 10 (excellent.) Patients were also asked if they had any pain on intercourse, whether any further penile surgery had been required and would they recommend the procedure to a friend. Nine patients (8%) had required a circumcision after the original frenuloplasty. 2 for recurrent frenular problems, 3 for phimosis and 4 for recurrent balanitis and/or genital warts. Of these patients, 3/9 (33%) had undergone prior frenular/ prepucial surgery, possibly reflecting more extensive scar tissue or progressive disease. However, 6/9 patients (67%) would still recommend frenuloplasty to a friend with the same condition as them.There were 9/96 patients (8%) who had suffered minor complications (wound infection, bruising or partial dehiscence) and 2 (2%) had recurrence of frenular pain on erection. Conclusions: Frenuloplasty is a very effective procedure giving excellent functional results and patient satisfaction. It can be recommended to men with frenular pain with a high chance of avoiding circumcision, even in the presence of scarring.
>18 years old 59 78% 22% 9.1% 3.6% 60% 40% 6.8% Palpable UDT 75 20.5 88% 12% 6% 0/67 78.7% 21.3% 2.7%
p-value
0.309 0.179
⬍0.001 0.127
0.024 0.001
0.321 ⬍0.001
MP-15.13 Management of Cryptorchidism in Adolescent and Adult Males Heyns C, Viljoen T Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa Introduction and Objective: Although cryptorchidism should be diagnosed at birth and treated during childhood, in developing countries it is not unusual for patients with undescended testes (UDT) to present in adolescence or adulthood. The aim of this study was to evaluate the management of UDT in patients 12 years or older at the time of treatment. Materials and Methods: In the period January 1999 to December 2010 a total of 504 patients underwent surgery for cryptorchidism at our institution. The clinical data of 106 patients aged 12 years or older at the time of surgery were retrospectively reviewed. Statistical analysis was performed using Mann-Whitney and Fisher’s exact tests where appropriate (p⬍0.05 statistically significant). Results: Conclusions: In the group aged 12-18 compared to the group over 18 years old, orchidopexy rather than orchidectomy was significantly more often performed, even though unilateral and intra-abdominal testes were more common in the younger age group. In the group with impalpable testes compared to palpable testes, UDT were significantly more often bilateral and intra-abdominal, and orchidectomy or Fowler-Stephens orchidopexy was more often performed.
UROLOGY 78 (Supplement 3A), September 2011
MP-15.14 Epidemiology of Urethral Strictures: Temporal Changes in Etiology and Socio-Demographic Determinants Van Der Merwe J, Heyns C, Basson J, Van der Merwe A Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa Introduction and Objective: The aim of this study was to evaluate urethral stricture etiology and socio-demographic determinants in a contemporary cohort of men compared with a similar cohort studied 15 years earlier at our institution. Materials and Methods: A total of 125 men with proven urethral strictures were interviewed April 2007 through March 2008 using a structured questionnaire on demographic, socio-economic and clinical aspects. The findings were compared with those in a cohort of 120 urethral stricture patients seen January through December 1991 at the same institution. Literature review of 32 studies on stricture etiology published 1979 through 2009 (6,122 patients) was performed. Student’s-t and Fisher’s exact tests were used for statistical analysis (p⬍0.05 accepted as significant). Results: The current compared to the previous cohort had a significantly greater proportion with ⬎6 years of schooling (77.5% vs 45.8%), a greater mean number of sex partners (7.3 vs 4.6) and more illegal drug use (20.8% vs 10%). Stricture etiology showed a decrease in urethritis (25.6% vs 45%) and external trauma (16.8% vs 28.3%) and an increase in internal (iatrogenic) trauma (36.8% vs 10%). Mean age was significantly lower in the groups with urethritis and external trauma (46.1 and 36.3 years) compared with iatrogenic trauma or idiopathic etiology (55.5 and 53.8 years, respectively). Urethritis was associated with black ethnicity, greater number of sex partners, lower education level, previous imprisonment and drug use. Detailed literature analysis showed that over the past three decades, urethritis has decreased and idiopathic etiology has increased in first world countries. In third world countries urethritis remains the most common etiology and external trauma is twice as common as in first world countries, with an increase during the past decade. Conclusions: Stricture etiology in this study cohort showed a decrease in urethritis and external trauma, and an increase in iatrogenic causes. In the black group, the proportion of urethritis as etiology remained the same, but there was a shift from external towards iatrogenic trauma and idiopathic etiology. These changes parallel the
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MP-15.13, Table 1. Number Unilateral UDT Bilateral UDT Intra-abdominal UDT Absent testis Orchidopexy Orchidectomy Fowler-Stephens procedure Number Mean age (years) Unilateral Bilateral Intra-abdominal UDT Absent testis Orchidopexy Orchidectomy Fowler-Stephens procedure
12-18 years old 47 87.2% 12.8% 29% 3.2% 93.6% 6.4% 17% Impalpable UDT 31 21.7 67.7% 32.3% 24% 10% 67.7% 32.3% 32.3%
bination of both. Any scar tissue present was excised. Results: Patients were followed up clinically at 3 months 106/106 (100%) and by questionnaire at least one year post-operatively 96/106 (91%). In total 10 patients were lost to follow-up as they had changed their contact details in the intervening period. The questionnaire reviewed overall satisfaction and cosmetic outcome on a self-assessed visual analogue score of 0 (very bad) to 10 (excellent.) Patients were also asked if they had any pain on intercourse, whether any further penile surgery had been required and would they recommend the procedure to a friend. Nine patients (8%) had required a circumcision after the original frenuloplasty. 2 for recurrent frenular problems, 3 for phimosis and 4 for recurrent balanitis and/or genital warts. Of these patients, 3/9 (33%) had undergone prior frenular/ prepucial surgery, possibly reflecting more extensive scar tissue or progressive disease. However, 6/9 patients (67%) would still recommend frenuloplasty to a friend with the same condition as them.There were 9/96 patients (8%) who had suffered minor complications (wound infection, bruising or partial dehiscence) and 2 (2%) had recurrence of frenular pain on erection. Conclusions: Frenuloplasty is a very effective procedure giving excellent functional results and patient satisfaction. It can be recommended to men with frenular pain with a high chance of avoiding circumcision, even in the presence of scarring.
>18 years old 59 78% 22% 9.1% 3.6% 60% 40% 6.8% Palpable UDT 75 20.5 88% 12% 6% 0/67 78.7% 21.3% 2.7%
p-value
0.309 0.179
⬍0.001 0.127
0.024 0.001
0.321 ⬍0.001
MP-15.13 Management of Cryptorchidism in Adolescent and Adult Males Heyns C, Viljoen T Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa Introduction and Objective: Although cryptorchidism should be diagnosed at birth and treated during childhood, in developing countries it is not unusual for patients with undescended testes (UDT) to present in adolescence or adulthood. The aim of this study was to evaluate the management of UDT in patients 12 years or older at the time of treatment. Materials and Methods: In the period January 1999 to December 2010 a total of 504 patients underwent surgery for cryptorchidism at our institution. The clinical data of 106 patients aged 12 years or older at the time of surgery were retrospectively reviewed. Statistical analysis was performed using Mann-Whitney and Fisher’s exact tests where appropriate (p⬍0.05 statistically significant). Results: Conclusions: In the group aged 12-18 compared to the group over 18 years old, orchidopexy rather than orchidectomy was significantly more often performed, even though unilateral and intra-abdominal testes were more common in the younger age group. In the group with impalpable testes compared to palpable testes, UDT were significantly more often bilateral and intra-abdominal, and orchidectomy or Fowler-Stephens orchidopexy was more often performed.
UROLOGY 78 (Supplement 3A), September 2011
MP-15.14 Epidemiology of Urethral Strictures: Temporal Changes in Etiology and Socio-Demographic Determinants Van Der Merwe J, Heyns C, Basson J, Van der Merwe A Stellenbosch University and Tygerberg Hospital, Tygerberg, South Africa Introduction and Objective: The aim of this study was to evaluate urethral stricture etiology and socio-demographic determinants in a contemporary cohort of men compared with a similar cohort studied 15 years earlier at our institution. Materials and Methods: A total of 125 men with proven urethral strictures were interviewed April 2007 through March 2008 using a structured questionnaire on demographic, socio-economic and clinical aspects. The findings were compared with those in a cohort of 120 urethral stricture patients seen January through December 1991 at the same institution. Literature review of 32 studies on stricture etiology published 1979 through 2009 (6,122 patients) was performed. Student’s-t and Fisher’s exact tests were used for statistical analysis (p⬍0.05 accepted as significant). Results: The current compared to the previous cohort had a significantly greater proportion with ⬎6 years of schooling (77.5% vs 45.8%), a greater mean number of sex partners (7.3 vs 4.6) and more illegal drug use (20.8% vs 10%). Stricture etiology showed a decrease in urethritis (25.6% vs 45%) and external trauma (16.8% vs 28.3%) and an increase in internal (iatrogenic) trauma (36.8% vs 10%). Mean age was significantly lower in the groups with urethritis and external trauma (46.1 and 36.3 years) compared with iatrogenic trauma or idiopathic etiology (55.5 and 53.8 years, respectively). Urethritis was associated with black ethnicity, greater number of sex partners, lower education level, previous imprisonment and drug use. Detailed literature analysis showed that over the past three decades, urethritis has decreased and idiopathic etiology has increased in first world countries. In third world countries urethritis remains the most common etiology and external trauma is twice as common as in first world countries, with an increase during the past decade. Conclusions: Stricture etiology in this study cohort showed a decrease in urethritis and external trauma, and an increase in iatrogenic causes. In the black group, the proportion of urethritis as etiology remained the same, but there was a shift from external towards iatrogenic trauma and idiopathic etiology. These changes parallel the
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