Testicular Volume in a Cohort of Prepubertal Indian Children.

CONTEXT: There are orchidometer-based testicular volume nomograms for Indian children; however, accurate and reliable values measured by ultrasound are lacking. AIMS: The aim of this study was to (1) measure the testicular volumes of boys from birth to 8 years and generate reference values and (2) to identify factors if any that may influence variation in testicular volumes. SETTINGS AND DESIGN: This was a prospective observational study conducted on 320 children in the Department of Pediatric Surgery, Christian Medical College, Vellore, India. SUBJECTS AND METHODS: A total of 320 boys without any genital abnormalities were studied. The testes were scanned using a linear transducer, and the length, width, and depth of each testis were recorded. Testicular volume was calculated using Lambert's equation - length × width × depth × 0.71. STATISTICAL ANALYSIS USED: Mean testicular volumes and standard deviation for every year of age were calculated. The centile values for testicular volume were computed using R software. RESULTS: Age-specific nomogram of each testis was created separately. Interobserver variability of the measurement was shown to be up to 0.3 ml. No difference was demonstrated in the testicular volumes between the right and left testis. No correlation was found between body weight and body mass index with testicular volume. From the data on differences in size between the two sides, a volume differential index of 27% corresponds to the 95th centile. CONCLUSIONS: Reference values have been created for testicular volumes in prepubertal Indian children that could be used to assess the effects of disease and surgical interventions in this age group.

Urethro vaginal injuries associated with pelvic fracture - A spectrum of clinical presentation and management.

BACKGROUND: Blunt trauma to the paediatric pelvis is associated with urethral rupture, sometimes even without a bony fracture. While such rupture of the male urethra has received considerable mention, female urethral injury is both less common and has received less attention. OBJECTIVE: We describe 4 cases of urethro vaginal injury associated with pelvic fracture, its varied presentations and the modalities employed in its management. PATIENTS AND METHODS: A retrospective study was done to identify 4 patients who presented to our institution between 2007 and 2018. All 4 girls suffered a loss of a urethral segment ranging from the distal urethra (n = 2) to complete urethral loss (n = 2) and rupture of the bladder neck in one. All 4 girls also had associated vaginal injury resulting in varied clinical presentation including total urinary incontinence, urocolpos, vaginal voiding via an acquired hypospadias and urinary retention with late onset haematocolpos. All were managed initially with SPC and three of them underwent urethral substitution with Monti ileal tube in two and vestibular mucosal flap in one. The hypospadiac neo-meatus was continent and was left alone. The ruptured vagina was repaired by rectus muscle interposition, direct suturing, posterior vaginal U flap or colonic patch. An appendicular Mitrofanoff was added for safety in 2 girls. RESULTS: Follow up was done till June 2019 (range 1-12 years). All patients voided satisfactorily and were fully continent. Normal menstrual function was present in the 3 post pubertal children. CONCLUSION: A traumatic force capable of causing urethral injury may often result in associated vaginal injury and should not be overlooked. Thus urinary retention is not the only presentation of urethral injury in girls. Fistulation to the vagina may result in continent or incontinent vaginal voiding if the vagina has not been transected and urocolpos/haematocolpos in those with vaginal transection. Various modalities maybe employed to maintain continuity of the urethra and vagina including use of bowel and local flaps.

Paediatric mucormycosis: tailoring surgical strategies to compliment antifungal chemotherapy. Different strokes for different folks.

Children manifesting soft-tissue fungal infections are uncommonly seen, more so the subgroup of invasive soft-tissue mucormycosis. Invasive fungal infections in various organs respond differently and are often complicated by an immune-compromised host. Repeated and aggressive clearance of disease till an infection-clear margin is obtained is the mainstay of surgical therapy. This is coupled with appropriate antifungal therapy and the management of any underlying medical conditions. From our experience, we propose a surgical algorithm for therapy of soft-tissue mucormycosis in children.