Encrusted cystitis managed with multimodal therapy.

Encrusted cystitis is a rare chronic inflammatory condition of the bladder. The case of a male patient with dysuria and gross hematuria accompanied by the passage of stone fragments is presented. Multimodal therapy was undertaken. He was treated with Renacidin (citric acid mixture) irrigation as an inpatient. One month later, he underwent cystourethroscopy and was determined to have residual stone and fibrosis of the prostatic urethra. The patient was then treated with cystolitholapaxy and visual internal urethrotomy. This multimodal treatment resulted in resolution of his stone burden at follow-up.

Utility of an intra-operative cystogram with a simulated voiding phase after endoscopic treatment of vesicoureteral reflux.

PURPOSE: To assess the utility of intraoperative cystogram with a simulated voiding phase after endoscopic treatment of vesicoureteral reflux (VUR). METHODS: From September 2003 to June 2005, 24 children underwent injection of deflux for the treatment of VUR. A total of 38 ureters were treated. After deflux injection, our most recent 14 patients had a cystogram with simulated voiding phase to assess for the presence of VUR. All patients were scheduled for a voiding cystourethrogram (VCUG) three months postoperatively to assess for persistent reflux. The surgery was considered a success only if patients did not demonstrate reflux on their postoperative VCUG. RESULTS: Of the 24 patients undergoing deflux injection, 14 had complete resolution of their VUR. Eight patients had persistent VUR and 2 patients were lost to follow-up. A total of 38 ureters were injected. Twenty-seven ureters no longer refluxed, while 8 ureters continued to reflux and 3 ureters were lost to follow-up. Fourteen patients had an intra-operative cystogram with simulated voiding phase. The intra-operative cystogram with simulated voiding phase was negative in all patients except for one patient who demonstrated the presence of de novo contralateral VUR. There were 7 true negatives on intra-operative cystogram with a simulated voiding phase and 6 false negatives. CONCLUSIONS: Our results of endoscopic treatment of VUR compare well to the results reported by others in the literature. An intra-operative cystogram may demonstrate unsuspected contralateral reflux but does not appear to predict the success of deflux injections.

Testicular lymphoma: a case report.

This case report describes a 67-year-old man with testicular lymphoma. The typical symptom in patients when first seen with testicular lymphoma is a painless enlargement of the testicle. However, this patient had a long history of progressively worsening weakness in his right arm and leg, as well as a sudden onset of chest pain and dyspnea. Upon initial examination of this patient, a large mass was discovered in the scrotal and inguinal region on the right side. The patient subsequently underwent a right radical orchiectomy. When the diagnosis of lymphoma was confirmed, a proper chemotherapy regimen was initiated. This case report reviews the case, diagnosis, and management of testicular lymphoma.

Asymptomatic advanced pediatric papillary renal cell carcinoma presenting as a pulmonary embolus.

Renal cell carcinoma in the pediatric population is a rare disease. A limited number of cases of renal cell carcinoma exist worldwide in the pediatric population. Reported herein is a case of a 17-year-old female who presented to an outside hospital with gross hematuria and shortness of breath. She was found to have a pulmonary embolus on computed tomography scan. After further imaging, a large renal mass with renal vein and vena cava involvement was observed. Intraoperatively, the tumor demonstrated extensive invasion of the wall of the vena cava.

Impact of patient age on distal hypospadias repair: a surgical perspective.

OBJECTIVES: To assess whether the age at which the initial hypospadias repair is performed influences the complication rate of hypospadias repair. METHODS: The records of 325 consecutive patients who underwent initial hypospadias repair were reviewed. The patients with glanular and coronal hypospadias underwent repair with either meatoplasty and glanuloplasty or a glans approximation procedure. Patients with subcoronal hypospadias and penile hypospadias underwent repair with tubularized incised plate urethroplasty. The patients were divided into 6-month age groups, and the complication rates were analyzed by age group using the chi-square test. RESULTS: A total of 325 hypospadias repairs were performed from January 1999 to January 2005 by a single surgeon. Of the 325 cases, 194 tubularized incised plate procedures were performed, 69 meatoplasty and glanuloplasty procedures were performed, and 53 glans approximation procedures were performed. Nine tubularized island flap urethroplasties performed for penoscrotal hypospadias were excluded because we did not perform a significant number of proximal urethroplasties. Nineteen patients (6.0%) developed urethrocutaneous fistulas and six (1.9%) demonstrated dehiscence. Overall, 2 patients (2.2%) who underwent surgical repair within the first 6 months of age developed complications compared with 23 patients (10.3%) who underwent initial hypospadias repair when they were older than 6 months of age (P = 0.006). CONCLUSIONS: Tubularized incised plate, meatoplasty and glanuloplasty, and glans approximation urethroplasty are all excellent options for the surgical correction of hypospadias in the appropriately selected patient. The results of our study have indicated that complications are minimized when hypospadias repair is performed when the patient is 4 to 6 months of age.