Surgical outcome of different types of primary hypospadias repair during three decades in a single center.

OBJECTIVE: To evaluate the surgical outcome of different techniques of primary hypospadias repair in a single department. METHODS: We retrospectively evaluated the medical files of all patients who had undergone primary hypospadias repair at our department during the past 3 decades (1978-2009). RESULTS: A total of 820 patients were divided into 3 groups. The first group of 309 patients (37.7%) had glanular hypospadias, the second group of 398 patients (48.5%) had distal hypospadias, and the third group of 113 patients (13.8%) had proximal hypospadias. Of these 820 patients, 67 (8.2%) required corpoplasty to straighten the penis. In the first group, 67 (21.7%) children underwent meatal advancement or meatoplasty, 211 (68.3%) underwent meatal advancement and glanduloplasty, 8 (2.6%) underwent tubularized incised plate hypospadias repair, and 23 (7.4%) underwent Mathieu flap hypospadias repair. In the second group, 196 (49.2%) underwent Mathieu hypospadias repair, 38 (9.5%) underwent tubularized incised plate repair, 142 (35.7%) underwent meatal advancement and glanduloplasty, and 22 (5.5%) underwent onlay-type hypospadias repair. In the third group, 28 (24.8%) underwent 2-stage hypospadias repair, 85 (75.2%) underwent single-stage surgery (including 68 [60.2%] onlay and 11 [9.7%] tubularized island flap), and 6 (5.3%) underwent tubularized incised plate hypospadias repair. Immediate complications developed in 46 (14.9%) in the first, 123 (30.9%) in the second, and 66 (58.4%) in the third group; 38 (4.6%) required additional surgery during or after adolescence. CONCLUSION: Our data have shown that despite the numerous techniques used for hypospadias surgery, the incidence of complications is still high in patients who undergo hypospadias repair.

Transperitoneal laparoscopic radical nephrectomy is an effective procedure for large (more than 7 cm) renal masses.

PURPOSE: We aimed to evaluate our experience with the transperitoneal radical nephrectomy (TLRN) in patients with large (more than 7 cm) renal mass to determine if this procedure can be recommended as a reference standard for treating large renal masses. PATIENTS AND METHODS: Of 213 patients who underwent TLRN in both institutions we have reviewed medical files of 35 who had large than 7 cm renal masses. Operative time, blood loss, conversion rate, pathologic tumor type, and oncologic outcome were evaluated. RESULTS: The mean tumor size was 10.1 cm (range: 7 to 19 cm). Mean blood loss during surgery was 388 mL (range: 150 to 600 mL). In 2 patients with 16 cm renal masses the operation was converted to hand-assisted technique as planned upon the surgery after ligation and transsection of the vascular pedicel to facilitate kidney dissection from surrounding tissue. In 1 patient the operation was converted to the open technique. Twenty-two (62.8%) patients had renal cell carcinoma and the remaining 13(37.5%) patients had other types of the renal tumors. Mean hospital stay was 4.36 days (range: 3 to 7 d). Median follow-up after the surgery was 29 months (range: 8 to 60 mo). Three patients who underwent cytoreduction nephrectomy died whereas receiving immunotherapy 3, 8, and 11 months, respectively, after surgery. One patient developed a local tumor recurrence and 2 developed remote metastasizes. CONCLUSIONS: Our data show that TLRN is an effective procedure for the removal larger than 7 cm renal tumors. In those patients with exceptionally big tumors planned conversion to the hand-assisted technique after laparoscopic ligation of the renal vessels enabling easier renal dissection whereas preserving the advantages of minimally invasive procedure.

Iatrogenic bladder diverticula following caesarean section.

The incidence of the bladder injury may increase following multiple caesarean sections. We report the first case, to the best of our knowledge, of iatrogenic bladder diverticula, which developed following caesarean section. The diagnosis of the bladder diverticula was made during work up due to recurrent urinary tract infections (UTI). Transvesical diverticulectomy, which was performed, resulted in complete resolution of the UTI. Seven years follow-up was uneventful.

Fibroepithelial polyp of the bladder neck in children.

Benign fibroepithelial polyps of the prostatic urethra and bladder are rare congenital lesions most commonly diagnosed in the paediatric population because of diverse urinary symptoms. We report two such cases: one, in a 2-year-old boy who presented with haematuria and voiding difficulties and the other in a 5-year-old boy with acute urinary retention. Imaging and endoscopic studies confirmed the presence of polypoid lesions. Following transurethral resection of these lesions, the diagnosis of a congenital fibroepithelial polyp was rendered by pathologic evaluation. These children are now free of the urinary symptoms and imaging studies are unremarkable 1 and 5 years later. Since these lesions have the potential for recurrence, long-term follow-up is warranted.

Pregnancy-induced vesical decidualized endometriosis simulating a bladder tumor.

Vesical endometriosis accounts for approximately 1% of all discovered cases of endometriosis. We report the first case of a 36-year-old woman with pregnancy-associated decidual changes within bladder endometriosis that are clinically presented as a rapidly growing bladder tumor. Cystoscopy, with subsequent cold cup biopsy and fulguration, revealed a solitary, red-brown, nodular lesion, which turned to be a decidualized endometriosis of the urinary bladder. Delivery and postdelivery follow-up was uneventful and no recurrence was diagnosed.