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ABSTRACT
Year : 2016  |  Volume : 8  |  Issue : 6  |  Page : 82-89  

Urological anomalies


Date of Web Publication26-Apr-2016

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How to cite this article:
. Urological anomalies. Urol Ann 2016;8, Suppl S2:82-9

How to cite this URL:
. Urological anomalies. Urol Ann [serial online] 2016 [cited 2020 Jul 11];8, Suppl S2:82-9. Available from: http://www.urologyannals.com/text.asp?2016/8/6/82/181196

Management of an unusually high postpubertal presentation of cryptorchidism

Raymond M. Anikwe, Adel A. K. Sayed, K. Baher, Saoud A. Taha


Department of Urology, King Faisal University, Dammam, Saudi Arabia

A high proportion (43%) of post-pubertal presentation of cryptorchid testes was found in 114 patients with undescended testes (UDT). Bilateral presentation of UDT was observed in 25% of patients. Orchiopexy was performed on 75% of post-pubertal cases, the determinant factor for choice of operation being cosmetic and psychological. Follow up results appear to be promising in this environment with low incidence of testicular cancer.

Presented at the: 5 th Saudi Urological Conference

King Fahd Military Medical Complex

22-23 March 1989

Congenital polyps of the posterior urethra

M. Y. Ezzibdeh, A. Al Dayel, S. Egail, I. Al Oraifi


Department of Surgery, Division of Urology, King Fahd Military Medical Complex, Dhahran, Saudi Arabia

Congenital polyps of the posterior urethra are defective protrusions of the urethral floor in the area of the verumontanum and are commonly seen in boys from 3 to 9 years old. We report two cases of congenital urethral polyps in 3 and 4 year old boys presented with difficulty in voiding intermittent retention of urine and haematuria. Ultrasonography of the bladder revealed a pedunculated mass at the level of the bladder neck and voiding cystourethrogram showed a filling defect in the posterior urethra. At cystoscopy, a pedunculated polyp arising from the posterior urethra demonstrated and transurethral polypectomy performed with good result.

Posterior urethral congenital polyps should be considered in children with bladder outflow obstruction and transurethral resection is an effective form of treatment.

Presented at the: 7 th Saudi Urological Conference

Riyadh Armed Forces Hospital

11-12 November 1992

Maldescended testis: Experience with 568 cases

A. Al Jutaili, M. S. Abomelha, S. Orkubi, M. Said, K. Al Otaibi, A. Shaaban


Department of Urology, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia

In a retrospective study, the case notes of 568 patients with maldescended testis treated at Riyadh Armed forces Hospital between January 1983 and July 1995 were reviewed. We found retractile testis in 29 cases and 539 cases with undescended testicles. The age of patients at correction were less than 2 years in 13%, between 2-5 years in 37%, 5-13 years in 27% and post pubertal in 23%. There were 21% with bilateral, 79% unilateral with left to right ratio of 1:1. The total number of testicles operated were 589. The intraoperative location of the testicles were inguinal in most of the cases 487 (83%), intra-abdominal in 18%, ectopic in 5 testicles (0.8%) while 28 testicles diagnosed as agenesis. The operative procedure was one stage in the majority of patients 85%, two stages in 3% and orchidectomy was necessary in 25%. The re-do operation was necessary only in 16 testicles (3%). 424 of operated testicles were followed up. 31 testicles found to be atrophied.

We can conclude that the majority of children with maldescended testis do present after the age of 2 years (87%). Post pubertal presentation (23%) is still a major problem and need more public education.

Presented at the: 9 th Saudi Urology Conference

King Fahad Hospital - Jeddah

14-16 November 1995

Bladder augmentation in children

E. Raboei, R. Luoma


Department of Surgical, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia

Objective: To evaluate the outcome of bladder augmentation in children.

Materials and Methods: 13 children aged 5 months to 12 years follow up 1-12 years. Group A: 7 children with incontinence because of various congenital malformations. Group B: 6 children with renal failure and either iatrogenic or neurogenic bladder dysfunction. 11 ileocystoplasties, 2 ureterocystoplasties and 2 caccocystoplasties were performed. 1 ureterocystosplasty was later on converted to ileocystoplasty. Added procedures were: 7 Young-Dees and 7 continent Mutrofanoff diversions and eleven ureteric reimplantations.

Results: Complications: 1 postoperative death due to hypo-osmolar encephalopathy. 1 serve hyperchloremic acidosis, 3 revisions of Mittrofanoff, f2 children have had recurrent UITs.

Outcome: All in Group A are continent either with normal micturition or CIC, In Group B, the renal function has been stabilized.

Conclusions: In terms of achieving dryness and preserving renal function, bladder augmentation has served its purpose in this heterogeneous group of patients.

Presented at the: 15 th Saudi Urological Conference

King Fahd Hospital - Madinah Al Munawarah

7-9 May 2002 (24-26 Safar 1423)

Incidence of pediatric urological anomalies

M. S. Abomelha, M. T. Said, S. A. Orkubi, A. A. Shaaban, K. E. Al Otaibi


Department of Urology, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia

In neonates, early diagnosis and management of congenital urological anomalies is essential to preserve the premature nephrons which are more susceptible to pressure and infection. Fetal congenital urological anomalies can be diagnosed by the routine use of antenatal ultrasound which thereby helps in early management. The incidence of congenital urological anomalies in Saudi Arabia is 1:302 live births as we have found by screening 21500 pregnant women attending the antenatal clinic between 1987-1990.

We have treated 220 pediatric patients with urological anomalies between 1987-1995. 142 (65%) were boys and 78 (35%) were girls. The most common urological anomalies were PUJ-obstruction 39%, followed by vesico-ureteral reflux in 18%. Renal dysplasia was found in 10% while posterior urethral valve and neurogenic bladder were seen in 9% and 8% respectively. The remaining anomalies which make 16% were as follows: ectopia vesicae, renal agenesis, megaureter and ureterocele. It is of interest that boys were more affected by the common anomalies (PUJ and reflux) than girls and that there was no difference of site affection.

It is concluded that the incidence of urological anomalies in Saudi Arabia is 1:302 live births. The most common anomalies were PUJ-obstruction and reflux. Antenatal ultrasound screening helps in early diagnosis and treatment, as well as contributing to better prognosis.

Presented at the: 11 th Saudi Urological Conference

King Fahd Military Medical Complex - Dhahran

24-26 February 1998 (27-29 Shawwal 1418)

Appraisal of ultrasound screening of fetal urinary tract anomalies

Ennam Raboei


Department of Surgical, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia

Background: Significant urinary tract malformations manifest themselves as failure to thrive, recurrent infections and loss of renal function. Pre-emptive therapy prior to clinical symptoms is ideal. This goal can be facilitated by comprehensive antenatal ultrasound screening.

Objectives: To retrospectively appraise anatenatal ultrasound with reference to urinary tract anomalies, its impact on clinical practice and to detect causes for failure in compliance and follow up.

Methods: Antenatal ultrasound was performed in 19400 out of 23000 babies born between 1992 and 1998. The fate of 128 babies with urinary tract anomalies diagnosed in utero was traced by reviewing all relevant available data.

Results: 1) The incidence of urinary tract anomaly was 7:1000 2) 18 babies (14%) died because of anomalies incompatible with life. 3) Antenatal ultrasound led to early surgery in 38 babies (30%). In spite of prophylaxis, one urosepsis occurred prior to surgery. 4) Antenatal ultrasound was performed in late pregnancy (>30 weeks) in 60% of cases. 5) 17 newborns (13%) with antenatal findings did not have postnatal ultrasound (average post delivery length of stay 12 hours). Seven of them were traced: two underwent surgery, two are on prophylaxis for v-u reflux and three had normal ultrasounds. 6) Ultrasound accurately detected significant fetal uropathies. 7) During the study period a number of babies born without antenatal screening developed late manifestations of urinary tract abnormality. 8) Surgical complications were rare: no kidney was lost or function worsened by surgery. 9) Half of the babies with equivocal indications for surgery were lost to follow up.

Conclusions: 1) Enhanced education to improve compliance with the antenatal screening program and subsequent follow up is needed. 2) Neonatal abdominal ultrasound should be performed on all unbooked deliveries. 3) Urinary tract surgery in early infancy is safe. Therefore, in equivocal indications aggressive therapy may be justified in preference to an expectant approach particularly where compliance is poor and loss to follow up is considerable.

Presented at the: 13 th Saudi Urological Conference

14-17 February 2000 (09-12 Dhu Al Qa'dah 1420)

Riyadh Armed Forces Hospital

Postnatal outcome of in-utero detected urinary tract abnormalities

F. H. Osman, A. Reda, H. Al Arman, A. Farag


Departments of Urology and Radiology, King Abdulaziz Airbase Hospital, Armed Forces Hospital, Dhahran, Saudi Arabia

To aim of this study was to assess the postnatal outcome of fetal urinary tract abnormalities detected by routine antenatal ultrasound examination.

Forty fetuses with any degree of dilatation of the renal pelvis or other renal tract anomalies were followed up with serial ultrasound examinations in utero and postnatally to determine the risk of uropathy. Final diagnosis was made by postnatal investigations: ultrasound, nuclear medicine and contrast radiological studies.

A correct diagnosis was established in 26 of the 40 cases (65%) hydronephrosis (11), pyelectasis (7), unilateral renal agenesis (2), megacalycosis (3), posterior urethral valve (1) and hyperechoic kidneys (2). Transitory urinary tract dilatation was found in 14 cases (35%). The antenatal ultrasound demonstration of urinary tract abnormalities does not always signify true obstructive uropathy. Unilateral disease, pyelectasis and megacalycosis were associated with a good prognosis.

Presented at the: 11 th Saudi Urology Conference

King Fahd Military Medical Complex - Dhahran

24-26 February 1998 (27-29 Shawwal 1418)

Antenatally detected hydronephrosis: Diagnosis and treatment

Mohammed S. Abomelha


Department of Urology, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia

The use of routine antenatal ultrasound screening during pregnancy did help a lot in recognizing congenital anomalies of the fetus at an early state. Among these anomalies are those of the urinary tract. Around 80% of the urinary tract anomalies are associated with hydronephrosis. The incidence of urinary tract anomalies in Saudi Arabia was found to be 3.3/1000 birth and 86% of these were associated with hydronephrosis. The treatment of fetal hydronephrosis is controversial. The use of standard radiological investigation of the renal function in the first weeks of the neonate is not accurate. This makes the decision of medical or surgical treatment difficult for the treating physician. Recent studies in the nineties suggest close observation as the treatment of choice. Around 25% of the neonate may need surgical intervention, which can be picked up very easy without further damage to the kidney. Our experience with 220 infants with congenital urological problem showed 39% PUJ type hydronephrosis, 18% vesico-ureteric reflux, 10% cystic-dysplastic kidneys, 9% posterior urethral valve and 8% neurogenic bladder. The treatment of PUJ type hydronephrosis was close observation in 73% and surgical correction in 27%. Long-term follow up showed resolution and improvement in 70% and 30% of the observation group. The results of surgical correction were 66% and 34% with no significant difference between the two groups.

It is concluded that the incidence of urological anomalies in Saudi Arabia is 3.3 per 1000 birth. Neonatal hydronephrosis is often not associated with obstruction. Initial radiological tests for assisting hydronephrosis are not accurate and should not be used as indication for surgery. Hydronephrosis is a relatively benign condition, which improved by time. Close follow up is necessary to identify the sub-group, which need surgery. Non-surgical treatment with close observation is safe and recommended.

Presented at the: 14 th Saudi Urological Conference

King Fahad Military Medical Complex - Dhahran

13-15 February 2001 (19-21 Dhu Al Qa'dah 1421)

Acute scrotum in boys

A. El Tahawy, R. Sayed, E. El Tahawy, Z. El Abdin


Department of Urology, King Fahad Hospital, Hofuf, Al Hassa 31982, Saudi Arabia

Background: Acute scrotum is a potential urologic emergency.

Objective: To emphasize the importance of early diagnosis and treatment of acute scrotum.

Patients and Methods: 45 boys under the age of 12 years were referred to the Urology Department with acute scrotum in the 5 years. After clinical, laboratory and radiological examinations, testicular exploration was needed in 32 cases.

Results: Torsion was found in 28 cases, 7 of which were gangrenous and required orchidectomy due to late presentation and treatment; orchidopexy was performed for viable tests and medical treatment for the rest of the cases.

Conclusion: Early presentation, diagnosis and management are essential to save the testis in case of torsion.

Presented in the: 11 th Saudi Urology Conference

King Fahd Military Medical Complex - Dhahran

24-26 February 1998 (27-29 Shawwal 1418)

Surgical correction of ambiguous genitalia

Faris M. Ayyat


Department of Urology, Saudi Aramco Health Service, Dhahran, Saudi Arabia

Objectives: To review the results of cliteroplasty (61), vaginoplasty (24) and colovaginoplasty (4) in the last decade (January 1991 to December 2001).

Materials and Methods: 63 patients with AG were admitted to Dhahran Health Center (DHC), 57 newborns with Adrenogenital Syndrome (AGS), all were 46 xx, 6 patients with Testicular Feminization Syndrome (TFS), all had 46 xy, patients underwent Clitroplasty (61) before discharge with preservation of the skin, mucosa and the neurovascular bundle of the phallus. M-shaped perineal skin flap was used in the last 5 years (14 patients) the youngest patient was 2 years old and 10 patients had an inverted skin flap. 4 patients of TFS had colo-vaginoplasty and gonadal removal (17, 19, 20 and 21 years old) and 2 patients were reared as males, have satisfactory penile size and had hypospadias repair.

Results: Clitroplasty with glanuloplasty (4 cases) were cosmetically more preferred to clitrectomy, M-skin flaps had less stenosis and better appearance than the inverted flaps. The preserved skin and mecosa of the phallus were used for reconstruction of the labia. 2 patients with inverted U-flaps had blood transfusion, one colo-vaginoplasty had a revision because of severe stenosis at the anastomotic site and no dilation was necessary.

Conclusion: Cliteroplasty is the recommended method for citeromegaly. With glans reduction if deemed necessary. M-flaps vaginoplasty have less complication than inverted flaps regarding stenosis at the site of the anastomosis and better appearance than the inverted U-flaps especially the direction and proximity of the viginal introitus to the anus.

Presented at the: 15 th Saudi Urological Conference

King Fahd Hospital - Madinah Al Munawarah

07-09 May 2002 (24-26 Safar 1423)

Continent urinary diversion/augmentation in children

Michael P. Leonard


Department of Urology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada

This lecture will briefly overview the intestinal segments which may be utilized to create continent urinary constructs and/or be applied as augmentation material for lower urinary tract reconstruction in children. An overview of the varied continent stomal constructs applied in pediatric practice will also be undertaken. The focus of the lecture will be on the metabolic consequences and potential long-term complications of bowel use in the lower urinary tract in children. In particular, such issues as potential growth impairment and malignancy will be addressed. At the completion of the lecture, the following objectives will be reached.

An appreciation of the varied intestinal segments and continent urinary diversion constructs which may be applied in reconstruction of the pediatric lower urinary tract

An understanding of the metabolic consequences of utilizing different bowel segments in urinary tract reconstruction

Knowledge of the potential long-term consequences of bowel use in the pediatric lower urinary tract, including growth impairment and malignancy.

Presented at the: 18 th Saudi Urological Conference

King Abdulaziz University Hospital

20-23 February 2006 (21-24 Muharram 1427)

Bladder augmentation in children: Inherent problem and future directions

Ashraf Tarek Hafez 1,2

1 Department of Pediatric Urology, Mansoura Urology and Nephrology Center, Mansoura, Egypt, 2 Department of Urology, King Fahad National Guard Hospital, Riyadh, Saudi Arabia

Purpose: Intestinal bladder augmentation is the most widely applied technique. However, long-term metabolic consequences, stone formation and risk of spontaneous perforation are significant problems, especially in children who have an intrinsically long life expectancy. In a pilot study we developed a cell transfer technology for populating demucosalized colonic segments with bladder urothelium. This process was achieved through aerosol transfer of a single cell suspension consisting of bladder urothelial cells, smooth muscle cells and fibrin glue onto demucosalized colonic segments. We further evaluate this new concept in a controlled study.

Materials and Methods: The study was performed on 20 piglets (20 kg). In all animals 50% of the bladder with excised, and a 10 cm segment of the sigmoid was isolated. Animals were then equally divided into 5 groups of: 1) colocystoplasty only, 2) demucosalized colocystoplasty, 3) demucosalized colocystoplasty plus covering of the demucosalized sigmoid with fibrin glue only, 4) aerosol application of fibrin glue with single cell suspension of urothelial cells only to the demucosalized colon, and 5) aerosol application of fibrin glue with urothelial and smooth muscle cells to the demucosalized colon. The 4 corners of the augmented segments were marked with 5-zero polypropylene sutures. Animals were sacrificed 6 weeks later and the surface area of the augmented segment was measured. Segments were submitted to histological and immunohistochemical analysis.

Results: The surface area of the augmented segments showed an increase in group 1 animals, stabilization in groups 4 and 5, and marked reduction in groups 2 and 3. On hematoxylin and eosin, and Masson trichrome staining all group 1 animals showed normal colonic epithelium of the augment. All animals in groups 2 and 3 showed excessive scarring with urothelial coverage only at the augment periphery, while the central augment area showed no epithelium. Segments from groups 4 and 5 showed confluent epithelial covering with no fibrosis. There was no evidence of colonic epithelial re-growth in any animal in groups 2 to 5. Cytokeratin 7 and uroplakin III staining demonstrated complete coverage of the augmented segment with urothelium only in groups 4 and 5.

Conclusions: The addition of aerosolized cells of urological origin is a viable augmentation approach that appears to achieve the much sought after inhibition of intrinsic fibrosis and contraction of colonic segments when incorporated into the urinary tract without this cellular component. Moreover, this technique appears to provide a histologically normal, confluent urothelium, which sets the stage for prevention of the well-documented biochemical aberrations inherent in augments containing gastrointestinal epithelium.

Presented at the: 18 th Saudi Urological Conference

King Abdulaziz University Hospital

20-23 February 2006 (21-24 Muharram 1427)

Chemical ablation of the bladder urothelium and intestinal de-epithelialization in augmentaiton cystoplasty: An experimental study

Safwat E. Abou Hashem, Ali Kandeel, Salah Mostafa, Ahmed M. Gaballa


Department of Urology, King Fahad Hospital, Al Baha, Saudi Arabia

Interposing intestinal segment in the urinary tract in augmentation cystoplasty or ileal neobladder may lead to metabolic complications as that of altered solute reabsorption by the intestine from the urine that it contains.

Objective: In an experimental study, the effect of protamine sulphate and urea treatments on the bladder epithelium and mucosa of the intestinal segments used in augmentation cystoplasty using ileal segment was evaluated.

Materials and Methods: Three groups of dogs (5 dogs in each one) were used in the study, all groups underwent augmentation cystoplasty using ileal segment. The first one (group) was a control group with no treatments after operation, the bladder was filled with normal saline and emptied after 30 minutes and the catheter was removed. The second group (group II) was treated through infusion of the augmented bladder by 5 mg/ml protamine sulphate for 15 minutes then the bladder was emptied and filled with urea at concentration of 100 gm/L solution for 15 minutes then emptied and the catheter is removed. The third group (group III) was infused with the two drugs but in a double concentration. Biopsies from the intestinal and bladder segments were taken immediately after augmentation cystoplasty and after an interval of one month and evaluated microscopically for epithelial changes. At the same time, 24 hours urine was collected for determination of urine mucoproteins among studied groups.

Results: Serum electrolytes, urea nitrogen and creatinine were within normal values in all groups of the study. The use of protamine sulphate and urea as chemical de-epithelialization agents for the bowel segment had led to atrophy of the mucosal villi and decrease number of goblet cells significantly so decreasing the absorptive capacity of the villi and secretory capacity of the goblet cells. Mucoprotein measurement immediate and at one month postoperatively showed that there was insignificant difference in mucoprotein in urine of 24 hours immediate postoperative between all groups. On the other hand, there was a significant difference between all groups after one month. Also, mucoprotein secretion in group II was significantly less than that of group 1 (p < 0.05). While as regard mucoprotein secretion in group III, the decrease was highly significant than that in group I and II (p < 0.001).

Conclusion: De-epithelialization of both the bladder and intestinal segments occurred promptly by using protamine sulphate and urea. This is supposed to be followed by re-epithelialization by transitional epithelium later on. These results were confirmed by the decreased mucoprotein secretion in urine. This approach may be of possible use as a chemical ablation for the intestinal mucosa used in the augmentation cystoplasty or ileal neobladder and as a possible treatment alternate for bladder carcinoma in situ.

Presented at the: 18 th Saudi Urological Conference

King Abdulaziz University Hospital

20-23 February 2006 (21-24 Muharram 1427)

Antenatal hydronephrosis

Michael P. Leonard


Department of Urology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada

This lecture will discuss the topic of antenatal hydronephrosis. Although other causes will be touched on briefly, the primary focus will be on the issue of indeterminate neonatal hydronephrosis (INH)/ureteropelvic junction obstruction (UPJO). Specifically, a review of criteria utilized to differentiate between INH and UPJO will be undertaken. In addition, a review of several clinical series examining the utility of these criteria will occur. At the completion of the lecture, the following objectives will be reached:

Understanding of the methods by which antenatal hydronephrosis is detected and defined

Knowledge of the assessment protocol for children with antenatal hydronephrosis

Appreciation of the criteria by which one attempts to differentiate INH and UPJO.

Presented at the: 18 th Saudi Urological Conference

King Abdulaziz University Hospital

20-23 February 2006 (21-24 Muharram 1427)

Wilted orchids: Where are the delays preventing testicular torsion salvage

Ahmed H. Al Mathami, M. Moazin, M. P. Leonard


Department of Urology, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia, Division of Pediatric Urology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada

Purpose: Testicular torsions remain a urological emergency but diagnosis may be delayed. The most important factor in salvage of the testis is the time interval between the onset of symptoms and detorsion. This study was undertaken to better stimulate where the delays in management occurred and to provide recommendations to improve testicular salvage rates.

Materials and Methods: A chart review of 233 boys with acute unilateral scrotal pain assessed between 1990 and 2000 at Children's Hospital of Eastern Ontario, Canada. Only patients with a surgically proven diagnosis of testicular torsion were included in the study. The diagnosis of acute testicular torsion was determined when the spermatic cord was found torted within the tunica vaginalis at the time of surgical exploration. Patients were divided into two groups: Group 1 - Patients in whom the testicle was salvaged with normal testicular volume on subsequent follow up. Group 2 - Patients with a non-salvageable testicle or a testicle that atrophied postoperatively.

The following time intervals were determined:

T-initial - onset of pain until presentation to a primary care physician.

T-specialist - from presentation to primary care physician until referred to a specialist.

T-surgery - from presentation to the specialist until time of surgery.

The time intervals were measured and analyzed for an association with testicular salvage rates.

Results: 18 patients had records complete enough for assessment. The patients ranged in age from 1 month to 17 years (mean 12 years). Independent samples T test revealed a significant difference in T-initial between salvageable and unsalvageable tests (p < 0.0001). T-specialist (p < 0.0001) and T-surgery (p < 0.0001) were also significantly different between the two groups. The former was primarily due to misdiagnosis by the primary care physician; the latter because in some cases, surgery was performed semi-electively due to late presentation.

Conclusions: Testicular torsion resulted in the loss of 26% of affected testicles (38 patients) in our series. The main factor associated with loss of the testicle was the time between the onset of symptoms until presentation to a primary care physician. However, in a significant number of patients (18%) testicular loss was due to misdiagnosis by the primary care physician. Our quest to improve the salvage rates for testicular torsion should be directed at two main educational efforts. Firstly, school health education classes should discuss the important implications of acute scrotal pain to increase the patient's awareness of this problem. Secondly, medical students/primary care physicians should be made aware of the importance of timely assessment of acute scrotal pain to rule out testicular torsion. Such education efforts will hopefully result in earlier presentation, recognition and management of testicular torsion, with an increase in salvage rate.

Presented at the: 16 th Saudi Urological Conference

King Faisal Specialist Hospital and Research Centre

2-4 March 2004 (11-13 Muharram 1425)

Acute scrotum in children: Which etiology is common?

Sameer Munshi, Samer Al Oraifi, Mohamed A. Gomha, A. Al Jaser


Department of Urology, Security Forces Hospital, Riyadh, Saudi Arabia

Objective: The aim of this study is to review our experience in children admitted with acute scrotum to the Security Forces Hospital.

Materials and Methods: Thirty-one boys with a mean age of 9.7 ΁ 4 years (range 2-16) presented with acute scrotum to the Emergency Room of Security Forces Hospital between 1997 and August 2003. Diagnosis was based on evaluation by clinical assessment, urine analysis and culture, CBC, color Doppler ultrasonography and other investigations when appropriate. Patients' charts were reviewed as regards to clinical presentation, investigations, management and outcome during follow up.

Results: The acute scrotum was localized to the right side in 14 patients (45.2%) and to left side in 17 (54.8%). Final diagnoses were epididymitis/epididymo-orchitis in 23 (74.2%), torsion of appendix of testis/epididymitis in 5, torsion of testis in 1, intermittent torsion of testis in 1 and Henoch Schnlein pupura (HSP)-related acute scrotum in 1. Fever defined as temperature 37.5 was present in 13/23 (56.5%) of patients with epididymitis/epididymo-orchitis, while it was observed in the patient of torsion and 2 of the 5 patients with torsion of the appendix and the patient with HSP. Urine culture was positive in only one patient with epididymo-orchitis. Among the epididymitis/epididymo-orchitis patients, 3 had meatal stenosis and one had mullerian cyst and hypospadius repair complicated by stricture urethra. All patients received IV antibiotics and analgesia. Four of the 5 patients with torsion of appendix of testis or epididymis were treated by excision when diagnosed during exploration. The patient with torsion underwent detorsion and bilateral orchiopexy. The patient with intermittent torsion was planned for bilateral orchiopexy. Follow up data are available for 21 patients with a mean duration of 4 ΁ 4.96 months (range 0.2-16) with normal improved local status. Ten patients underwent ultrasonography that was normal in 9 and showed swollen epididymis in one.

Conclusions: Epididymitis/epididymo-orchitis are the most common etiology of acute scrotum in children. Absences of positive urine culture in the majority of cases suggest non-infectious etiology. Torsion of appendix of testis/epididymis is not uncommon and exploration could be avoided if diagnosis is well defined pre-operatively.

Presented at the: 18 th Saudi Urological Conference

King Abdulaziz University Hospital

20-23 February 2006 (21-24 Muharram 1427)

Orchiopexy for the palpable undescended testis in children: A comparison of a single prescrotal incision to the traditional inguinal approach

M. Al Mandil, A. E. Khoury, S. Daves, W. Farhat


Department of Urology, The Hospital for Sick Children, Toronto, ON, Canada

Aim of the Work: Described in 1989, prescrotal orchiopexy is an alternative approach to the palpable UDT owing to potentially better cosmesis, less pain and reduced operative time. However, no studies compared the outcome of prescrotal orchiopexy compared to the traditional inguinal approach. In there, we compare the two approaches including operative parameters, outcome and complications.

Patients and Methods: Between January 2004 and March 2007, a single center, single surgeon experience with patients undergoing prescrotal orchiopexy (63 orchiopexies) was retrospectively analyzed and compared to another's surgeon contemporary age-matched patients undergoing inguinal orchiopexy. Prescrotal orchiopexy was performed with a single incision and the external oblique was not opened. Data were compared relating to demographics and complications.

Results: A total of 63 and 53 orchiopexies were performed in each the prescrotal group (mean age 4.6 yrs) and the inguinal group (mean age 4.7 yrs), average operative time for the prescrotal and inguinal group were 34 and 64 minutes respectively. Follow up ranged between 2 and 36 months. Although complications between both groups were statistically insignificant, there were two cases of inguinal hernias post surgery in the prescrotal group.

Conclusions: A single prescribed incision for the palpable undescended testis is a viable approach in selected patients. It is well tolerated, cosmetically pleasing and associated with less operative time. Despite the limitations of sample size, prescrotal orchiopexy may be associated with 3% risk for postoperative hernia.

Presented at the: 20 th Saudi Urological Conference

King Fahad Hospital of the University - Tabuk

18-20 March 2008

The average age of orchidopexy and the reasons for delay of the operation

Abdulrahman Babaeer, Abdullah Alkhayat, M. S. Mithani, Mohammed Zamakhshary, Ahmed Alshammari


Department of Urology, King Saud University Hospital, Riyadh, Saudi Arabia

Introduction: The European Association of Urology recommends to perform orchidopexies at 12 to 18 months of age. We have noticed an increasing number of patients presenting at an older age for orchidopexies. It is not clear if reasons behind this are related to access to care or other reasons. Our primary objective was to determine the average age at orchidopexy. The secondary objectives were to identify the reasons for such delay and to determine the percentage of patients undergoing their operations at an age below 18 months.

Methodology: Patients undergoing primary orchidopexies between January 2005 and October 2008 were included. Patients undergoing redo orchidopexy, and those with initial diagnosis of retractile testis were excluded. Mean age at: orchidopexy, referral to our clinic, actual first clinic visits and mean age at booking for OR were determined. Waiting times from time of referral to the first clinic visit (W1) and from time of booking to the time of surgery (W2) were calculated in months. A comparison with regards to waiting times was performed based on inborn vs out-born status and the presence of other medical problems.

Results: Three hundred and seven orchidopexies were performed. Of those 79 were excluded. In the 228 included orchidopexies, the mean age at orchidopexy was 36.5 (+/1 add standard deviation) months. Only 90 (39.5%) of the orchidopexies were performed below the age of 18 months. The mean age at referral, diagnosis and surgery were 24.8, 27.9 and 31.6 months, respectively. W1 was 3.1 months and W2 was 4.9 months.

In the 85 (37.3%) out-born patients, there was a statistically significant difference in the age at first referral 41.8 vs 14.7 months (p = 0.0005). The mean age at surgery was 50 months vs 28.4 months for out-born vs inborn in KAMC (p = 0.073).

Not surprisingly in the 25 (11%) patients with major medical problems, there was a statistically significant difference in W2 compared to healthy children 8.1 vs 4.5 months (p = 0.002). However, the mean age at surgery was not statistically different, 41.6 vs 35.8 months (p = 0.66I).

Conclusion: The majority of our patients are not undergoing their operations within the acceptable age. Surprisingly, health care access does not seem to be the main culprit for the delay. A public health approach with a health education intervention is needed at the family and primary health care level.

Presented at the: 22 nd Saudi Urological Conference

King Faisal Specialist Hospital and Research Centre

15-18 March 2010




 

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