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Re: Higher Incidence of Hypospadias in Monochorionic Twins
Urological Survey Pediatric Urology Re: Combined Creatinine Velocity and Nadir Creatinine: A Reliable Predictor of Renal Outcome in Neonatally Diagnosed Posterior Urethral Valves R. Coleman, T. King, C. D. Nicoara, M. Bader, L. McCarthy, H. Chandran and K. Parashar Department of Paediatric Surgery and Urology, Birmingham Children’s Hospital, Birmingham, United Kingdom J Pediatr Urol 2015; 11: 214.e1ee3. doi: 10.1016/j.jpurol.2015.04.007
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26062970 Editorial Comment: Creatinine velocity (CV) is defined as the slope of the rise or fall of the line of serum creatinine in the first 5 days following bladder drainage. The slope of the line represents the rate of change of serum creatinine expressed as mmol/l per day. In this series 62 boys with posterior urethral valves were assessed during the first 30 days of life, with 9.4 years of followup. Boys with both risk factors, ie CV greater than 3 and nadir creatinine (NC) 0.85 mg/dl, had a 100% risk of chronic renal insufficiency, compared to 11 of 17 patients with 1 risk factor and 3 of 41 with neither risk factor. Taken together, CV and NC may provide an even better indicator than NC alone in boys with valves. Douglas A. Canning, MD
Re: Hymenal Anomalies in TwinsdReview of the Literature and Case Report €ger, M. Gerber and C. Klein R. Watrowski, C. Ja Division of Gynecology and Obstetrics, St. Josefskrankenhaus Academic Teaching Hospital, University of Freiburg, Freiburg, Germany Eur J Pediatr 2014; 173: 1407e1412. doi: 10.1007/s00431-013-2123-3
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23933671 Editorial Comment: The authors present a case of microperforate hymen in a pair of 16-year-old dizygotic twins, both of whom required hymenal incision. They review an additional 10 cases of sisters and twins, and 3 cases of sisters with perforate or microperforate hymen. When we identify imperforate hymen in 1 sibling, we should be looking for it in the rest. Douglas A. Canning, MD
Re: Higher Incidence of Hypospadias in Monochorionic Twins R. Visser, N. C. Burger, E. W. van Zwet, Y. Hilhorst-Hofstee, M. C. Haak, J. van den Hoek, D. Oepkes and E. Lopriore Division of Neonatology, Department of Pediatrics, Division of Fetal Medicine, Department of Obstetrics and Departments of Biostatistics, Clinical Genetics and Urology, Leiden University Medical Center, Leiden, The Netherlands Twin Res Hum Genet 2015; 18: 591e594. doi: 10.1017/thg.2015.55
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26271273
0022-5347/16/1953-0738/0 THE JOURNAL OF UROLOGY® Ó 2016 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
738
j
www.jurology.com
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2015.12.034 Vol. 195, 738-740, March 2016 Printed in U.S.A.
PEDIATRIC UROLOGY
739
Editorial Comment: The authors reviewed 350 monochorionic and 303 dichorionic male twins. The incidence of hypospadias was 4% in monochorionic and 1% in dichorionic twins. In 11 of the 15 twin couples hypospadias occurred in the twin with the lowest birth weight. The rate of hypospadias in boys who were small for gestational age was 10%, compared to 2% for boys who were appropriate for gestational age. In multivariate analysis monochorionicity and small for gestational age were independently associated with hypospadias. This study supports the theory that nutrients and gonadotropins may be insufficient for the normal development of 2 pairs of male gonads in twin pregnancies due to inadequate placentas or unequal placental sharing.1 Douglas A. Canning, MD 1. Fredell L, Lichtenstein P, Pedersen NL et al: Hypospadias is related to birth weight in discordant monozygotic twins. J Urol 1998; 160: 2197.
Re: Prevalence, Repairs and Complications of Hypospadias: An Australian Population-Based Study F. J. Schneuer, A. J. Holland, G. Pereira, C. Bower and N. Nassar Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney St. Leonards, and Discipline of Paediatrics and Child Health, Children’s Hospital at Westmead, Sydney Medical School, University of Sydney Westmead, New South Wales and Telethon Kids Institute, University of Western Australia, Crawley, Western Australia, Australia, and Yale Center for Perinatal, Pediatric and Environmental Epidemiology, School of Public Health, Yale University, New Haven, Connecticut Arch Dis Child 2015; 100: 1038e1043. doi: 10.1136/archdischild-2015-308809
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26310454 Editorial Comment: This population based study reviewed 3,186 boys with hypospadias between 2001 and 2010. Overall prevalence was 35.1 per 10,000 live births and remained constant during the study period. Rates of anterior, middle and proximal hypospadias were 41.3%, 26.2% and 5.8%, respectively, and location was unspecified in 27%. Postoperatively complication rate, to include fistulas and strictures, was 13% overall but higher (33%) in proximal cases. Complications were noted in 52.3% of cases at 1 year of followup and continued to manifest for up to 5 years. Age at primary repair did not affect the outcome. The frequency of late complications suggests that boys who have undergone hypospadias repair should be followed for more than 5 years from the last operation before presuming that no further complications will ensue. Douglas A. Canning, MD
Re: Further Analysis of the GlanseUrethral MeatuseShaft (GMS) Hypospadias Score: Correlation with Postoperative Complications A. M. Arlen, A. J. Kirsch, T. Leong, B. H. Broecker, E. A. Smith and J. M. Elmore Department of Pediatric Urology, Children’s Healthcare of Atlanta, and Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia J Pediatr Urol 2015; 11: 71.e1ee5. doi: 10.1016/j.jpurol.2014.11.015
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25797855
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26062970 Editorial Comment: Creatinine velocity (CV) is defined as the slope of the rise or fall of the line of serum creatinine in the first 5 days following bladder drainage. The slope of the line represents the rate of change of serum creatinine expressed as mmol/l per day. In this series 62 boys with posterior urethral valves were assessed during the first 30 days of life, with 9.4 years of followup. Boys with both risk factors, ie CV greater than 3 and nadir creatinine (NC) 0.85 mg/dl, had a 100% risk of chronic renal insufficiency, compared to 11 of 17 patients with 1 risk factor and 3 of 41 with neither risk factor. Taken together, CV and NC may provide an even better indicator than NC alone in boys with valves. Douglas A. Canning, MD
Re: Hymenal Anomalies in TwinsdReview of the Literature and Case Report €ger, M. Gerber and C. Klein R. Watrowski, C. Ja Division of Gynecology and Obstetrics, St. Josefskrankenhaus Academic Teaching Hospital, University of Freiburg, Freiburg, Germany Eur J Pediatr 2014; 173: 1407e1412. doi: 10.1007/s00431-013-2123-3
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23933671 Editorial Comment: The authors present a case of microperforate hymen in a pair of 16-year-old dizygotic twins, both of whom required hymenal incision. They review an additional 10 cases of sisters and twins, and 3 cases of sisters with perforate or microperforate hymen. When we identify imperforate hymen in 1 sibling, we should be looking for it in the rest. Douglas A. Canning, MD
Re: Higher Incidence of Hypospadias in Monochorionic Twins R. Visser, N. C. Burger, E. W. van Zwet, Y. Hilhorst-Hofstee, M. C. Haak, J. van den Hoek, D. Oepkes and E. Lopriore Division of Neonatology, Department of Pediatrics, Division of Fetal Medicine, Department of Obstetrics and Departments of Biostatistics, Clinical Genetics and Urology, Leiden University Medical Center, Leiden, The Netherlands Twin Res Hum Genet 2015; 18: 591e594. doi: 10.1017/thg.2015.55
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26271273
0022-5347/16/1953-0738/0 THE JOURNAL OF UROLOGY® Ó 2016 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
738
j
www.jurology.com
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2015.12.034 Vol. 195, 738-740, March 2016 Printed in U.S.A.
PEDIATRIC UROLOGY
739
Editorial Comment: The authors reviewed 350 monochorionic and 303 dichorionic male twins. The incidence of hypospadias was 4% in monochorionic and 1% in dichorionic twins. In 11 of the 15 twin couples hypospadias occurred in the twin with the lowest birth weight. The rate of hypospadias in boys who were small for gestational age was 10%, compared to 2% for boys who were appropriate for gestational age. In multivariate analysis monochorionicity and small for gestational age were independently associated with hypospadias. This study supports the theory that nutrients and gonadotropins may be insufficient for the normal development of 2 pairs of male gonads in twin pregnancies due to inadequate placentas or unequal placental sharing.1 Douglas A. Canning, MD 1. Fredell L, Lichtenstein P, Pedersen NL et al: Hypospadias is related to birth weight in discordant monozygotic twins. J Urol 1998; 160: 2197.
Re: Prevalence, Repairs and Complications of Hypospadias: An Australian Population-Based Study F. J. Schneuer, A. J. Holland, G. Pereira, C. Bower and N. Nassar Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney St. Leonards, and Discipline of Paediatrics and Child Health, Children’s Hospital at Westmead, Sydney Medical School, University of Sydney Westmead, New South Wales and Telethon Kids Institute, University of Western Australia, Crawley, Western Australia, Australia, and Yale Center for Perinatal, Pediatric and Environmental Epidemiology, School of Public Health, Yale University, New Haven, Connecticut Arch Dis Child 2015; 100: 1038e1043. doi: 10.1136/archdischild-2015-308809
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26310454 Editorial Comment: This population based study reviewed 3,186 boys with hypospadias between 2001 and 2010. Overall prevalence was 35.1 per 10,000 live births and remained constant during the study period. Rates of anterior, middle and proximal hypospadias were 41.3%, 26.2% and 5.8%, respectively, and location was unspecified in 27%. Postoperatively complication rate, to include fistulas and strictures, was 13% overall but higher (33%) in proximal cases. Complications were noted in 52.3% of cases at 1 year of followup and continued to manifest for up to 5 years. Age at primary repair did not affect the outcome. The frequency of late complications suggests that boys who have undergone hypospadias repair should be followed for more than 5 years from the last operation before presuming that no further complications will ensue. Douglas A. Canning, MD
Re: Further Analysis of the GlanseUrethral MeatuseShaft (GMS) Hypospadias Score: Correlation with Postoperative Complications A. M. Arlen, A. J. Kirsch, T. Leong, B. H. Broecker, E. A. Smith and J. M. Elmore Department of Pediatric Urology, Children’s Healthcare of Atlanta, and Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Georgia J Pediatr Urol 2015; 11: 71.e1ee5. doi: 10.1016/j.jpurol.2014.11.015
Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25797855