Sex determination based on the analysis of a contemporary Polish population's palatine bones: a computed tomography study of 1,200 patients.

BACKGROUND: The aims of the present study were to assess whether the hard palate reveals any measurable sex-related differences, and to create a mathematical model which would differentiate between males and females using hard palate measurements alone. MATERIALS AND METHODS: The present study was conducted on 1,200 archived sinus computed tomography (CT) scans. Each cranial measurement was taken twice by the same observer, and in cases of any discrepancies, the mean of the two values was recorded. Twenty per cent of randomly chosen samples were re-measured by an observer who did not partake in assessing the samples the first time. Logistic regression was used to derivate two mathematical formulas which would calculate the probability of a skull being male. RESULTS: The studied group comprised 1,200 head CT's (627 female; 52.3%). The mean age of the group was 43.5 ± 17.4 years - no age difference between sexes was noted (p = 0.37). All of the performed measurements were significantly (p < 0.0001) larger in males than in females. The mathematical formula based on the "orale-spina nasalis posterior" (O-SNP) distance alone had a reliability rate of 68.35%. The equation based on the depth of the right greater palatine canal (GPC), the O-SNP distance and the anterior width of the palatal arch (AWPA) had a reliability rate of 78.37%. CONCLUSIONS: The most prominent sexually dimorphic parameters were the O-SNP, the GPC depth and the AWPA. The mathematical models presented in the current study can be used to successfully distinguish between sexes during forensic examination.

Wrap plication of megaureter around normal-sized ureter for complete duplex system reimplantations.

PURPOSE: A duplex collecting system is a common congenital renal tract abnormality associated with different clinical problems. We describe our experience with ureteral reimplantations of a complete duplex collecting system where 1 megaureter needing recalibration and 1 normal-sized ureter coexisted. Recalibration of the megaureter was done by wrap plication around the normal-sized ureter. MATERIALS AND METHODS: Operative logs and case notes were reviewed of consecutive children with a complete duplex collecting system treated with wrap plication of the megaureter around the normal-sized ureter and reimplantation between 1997 and 2010. Reoperation, vesicoureteral reflux and obstruction rates were assessed. RESULTS: A total of 25 children underwent wrap plication and ureteral reimplantation. Of the cases 19 (76%) were completely successful and 6 (24%) needed reoperation. Three children (12%) had persistent high grade vesicoureteral reflux, 2 (8%) underwent endoscopic correction and 1 (4%) underwent repeat reimplantation of the duplex system. Three children (12%) had postoperative obstruction and 2 (8%) underwent endoscopic incision of the ureteral orifice. In 1 child (4%) a nonfunctioning lower moiety of the kidney developed, which was managed by heminephrectomy. CONCLUSIONS: Wrap plication of a megaureter around the normal-sized ureter before reimplantation seems to be a relatively safe method in the surgical management of children with a complete duplex collecting system of the kidney. Sufficient spatulation of the lower pole ureter seems to be crucial.

The influence of the menstrual cycle on the result of brain examination with hydrogen magnetic resonance spectroscopy - a pilot study.

BACKGROUND AND PURPOSE: Hydrogen magnetic resonance spectroscopy (1HMRS) is nowadays one of the basic tools for noninvasive brain metabolism assessment. The study focuses on the important problem of the influence of hormone fluctuation during the menstrual cycle on brain metabolism, assessed by 1HMRS for clinical diagnostics. MATERIAL AND METHODS: In 11 healthy regularly menstruating women, 1HMRS was performed at the start (phase I), in the middle (phase II) and at the end (phase III) of the menstrual cycle. The relative concentration ratios of 12 brain metabolites in every woman in all cycle phases were examined, in 6 different volumes of interest (VOIs). Finally, statistically significant differences in relative metabolite ratios between the phases examined in given locations were sought. RESULTS: Statistically significant relations between menstrual cycle phases and relative ratios of 4 metabolites - Lac/Cr, NAA/Cr, Glx1/Cr and Glx2/Cr - in different brain locations were found. In all locations, mean NAA/Cr ratios were greater in phase I compared to the other phases. A similar relationship was found for Glx1/Cr ratio in one location (left occipital lobe). For Lac/Cr and Glx2/Cr ratios, a higher mean ratio value was obtained in phase II compared to phases I and III in the right occipital lobe and left basal ganglia, respectively. CONCLUSIONS: Menstrual cycle phase should be considered in planning a date and interpretation of 1HMRS examination, performed for the verification of a disease manifesting as brain metabolite disturbances in the 1HMRS spectrum.

Prevalence of the Onodi cell in the Polish adult population: an anatomical computed tomography study.

BACKGROUND: Onodi cell is a posterior ethmoid air cell with the optic canal bulging into it; the common position of the bulge is into the sphenoid sinus, usually immediately posterior to the posterior ethmoid air cells. Variable pneumatisation patterns lead to various structures of lamellae and sinuses occasionally exposing important nerves and vessels, such as the optic and vidian nerves, internal carotid artery and cavernous sinus. In clinical practice, special imaging techniques are used to navigate through the paranasal sinuses and hence avoid injury to these structures. This study is aimed to determine the prevalence of the Onodi cell in the Polish population and compare it with other reported occurrences. MATERIALS AND METHODS: A retrospective analysis of 296 computed tomography (CT) scans of patients treated in Krakow, Poland, using a Siemens Somatom Sensation 16 spiral CT scanner. No contrast medium was administered. RESULTS: The Onodi cell was found in 31 out of the 296 patients, or approximately 10.5%, consistent with the majority of research reporting on Onodi variants. Additionally, there was one presentation of a bilateral Onodi cell in a male patient. No statistically significant difference was found between the male and female populations with a positive identification of the variant (p = 0.095, Chi2 test). CONCLUSIONS: This study helped approximate the Onodi variant prevalence of 10.47%, falling within a commonly reported range 8-14%. This gives clinicians and surgeons a better understanding of this variant's structure and significance, and therefore an opportunity to improve treatment outcomes and research.

A computed tomography comprehensive evaluation of the ostium of the sphenoid sinus and its clinical significance.

BACKGROUND: The purpose of this research was to evaluate the size of the sphenoid sinuses' ostia, the distance between them and the distance between the medial margin of the ostia and the median line in the Polish adult population. MATERIALS AND METHODS: The analysis was undertaken as a retrospective study of 296 computed tomography (CT) scans of patients (147 females, 149 males) with no comorbidities in their sphenoid sinuses. The paranasal sinuses were investigated by using Spiral CT Scanner (Siemens Somatom Sensation 16), in the option Siemens CARE Dose 4D, without administering any contrast medium. Having obtained transverse planes, multiplans reconstruction tool was used in order to glean sagittal and frontal planes. RESULTS: The average size of both sphenoid sinus ostia was 0.31 cm for both genders (for females ranging from 0.1 to 0.5 cm and from 0.1 to 0.6 cm for males). The mean distance between both sphenoid sinus ostia was 0.6 cm for both genders (the range for females was 0.1-1.4 cm, whereas 0.1-1.8 cm for males). The average distance between the medial margin of the ostium and the median line was 0.32 cm for both genders (0.31 cm for females in the range of 0-0.9 cm and 0.32 cm for males in the range of 0-1 cm). CONCLUSIONS: Intraoperative identification of the sphenoid sinus ostia might prove difficult and their inadequate excision could lead to potential iatrogenic complications, hence detailed anatomical descriptions are still warranted in specific populations in order to perform safe and effective procedures.

The dimensions of the sphenoid sinuses: evaluation before the functional endoscopic sinus surgery.

BACKGROUND: The following study aimed to evaluate the dimensions (anteroposterior, transverse and vertical) of the sphenoid sinuses in the adult population. MATERIALS AND METHODS: The study was conducted as a retrospective analysis of the computed tomography (CT) scans of the paranasal sinuses of 296 patients (147 females and 149 males), who did not present any pathology in the sphenoid sinuses. The CT scans of the paranasal sinuses were done with the spiral CT scanner, without using any contrast medium. After obtaining transverse planes, frontal and sagittal planes were created using secondary reconstruction tool. RESULTS: The anteroposterior dimension was found to be 2.65 cm on average, in the range of 0.5-4.3 cm. The transverse dimension was on average 1.98 cm, ranging from 0.5 cm to 4.9 cm. The average vertical dimension was found to be 2.1 cm, in the range of 0.7-3.7 cm. CONCLUSIONS: Due to the high incidence of the anatomical variants of the paranasal sinuses, a CT scan is recommended in all patients before a planned surgery in order to avoid the potential iatrogenic complications. Dimensions of the sphenoid sinuses might point towards more at risk variants, but there is still a substantial amount of research that needs to be done in that aspect.

Agenesis of the sphenoid sinus and a single sphenoid sinus: a computed tomography anatomical evaluation.

BACKGROUND: Sphenoid sinuses are pneumatic spaces within the body of the sphenoid bone. Their development begins in the prenatal life and continues until the adulthood. Agenesis of the sphenoid sinuses is a situation in which they are undeveloped. On the other hand, a single sphenoid sinus lacks the presence of the main septum, leading to the formation of a single antrum. Contemporary use of transnasal transsphenoidal approaches for the pituitary surgery, as well as functional endoscopic sinus surgery urges medical professionals to be well acquainted with the aforementioned variant. MATERIALS AND METHODS: Paranasal sinuses of 300 patients (150 females, 150 males) were evaluated using computed tomography, without the use of contrast medium. Inclusion criteria involved absence of any identifiable pathology within the sphenoid sinuses and age over 18 years. Subgroup analysis involved probing for potential sources of heterogeneity, namely gender. RESULTS: In the whole research material of 300 patients, agenesis of the sphenoid sinuses was noted in 1% of the patients. No statistically significant differences were noted between the absence of the sphenoid sinuses and gender (p = 0.999). A single sphenoid sinus was found in 0.33% of the patients. There were no statistically significant differences found between the presence of fully developed sphenoid sinuses and gender (p = 0.498). CONCLUSIONS: Both agenesis of the sphenoid sinuses and a single sphenoid sinus are rare anatomical variants. Adequate planning for transsphenoidal surgeries with preoperative medical imaging is of essence in order to perform a safe and quality procedure.

Protrusion of the carotid canal into the sphenoid sinuses: evaluation before endonasal endoscopic sinus surgery.

BACKGROUND: Many reports have previously indicated the vast number of anatomical variations of the sphenoid sinuses, e.g. presence of the recesses. Notwithstanding, there are a few crucial neurovascular structures directly neighbouring with the sinuses. The following research aimed to evaluate frequency prevalence of the carotid canal's protrusion into the sphenoid sinuses in adult population. MATERIALS AND METHODS: Computed tomography (CT) scans of the paranasal sinuses of 296 patients (147 females, 149 males) were analysed in this retrospective study. The patients did not present any pathology in the sinuses. Spiral CT scanner Siemens Somatom Sensation 16 was used in the standard procedure in the option Siemens CARE Dose 4D. RESULTS: Protrusion of the carotid canal was found in the majority of the patients - 55.74%, more frequently in males (65.1% of the patients) than in females (46.26% of the patients). The said variant - regardless of gender - was noted more often bilaterally (41.55% of the cases: 29.93% females, 53.02% males) than unilaterally (14.19% of the cases: 16.33% females, 12.08% males). In the unilateral type (regardless of gender), the protrusion was more common for the left sphenoid sinus - 10.81% of the patients (12.24% females, 9.4% males) than for the right - 3.38% of the patients (4.08% females, 2.68% males). CONCLUSIONS: Complicated structure of the paranasal sinuses, derived from the high prevalence of their anatomical variations, may perplex routine surgical interventions. Henceforth, referral for a CT scan is imperative in order to abate the risks associated with an invasive procedure in the said region.

Long-term results of bulking agent injection for persistent incontinence in cases of neurogenic bladder dysfunction.

PURPOSE: We evaluated the effectiveness of bladder neck injection as a supplementary treatment for persistent low pressure incontinence after unsatisfactory fascial sling procedures in patients with neurogenic lower urinary tract dysfunction. MATERIALS AND METHODS: A total of 89 patients with neurogenic lower urinary tract dysfunction underwent fascial sling procedures between 1992 and 2005. Because of unsatisfactory results, 27 patients received endoscopic injection of a bulking agent. All patients included in the study underwent urodynamic examination after the sling procedure, which revealed persistent low pressure transurethral leakage of urine. We retrospectively analyzed the endoscopic approach used to administer the bladder neck injection, method of postoperative catheterization and number of injections given. Efficacy of bladder neck injection was graded by the patient and the urologist. RESULTS: After a median followup of 8 years (range 2.5 to 14) only 2 patients (7%) were continent after having received a single injection of bulking agent. A total of 12 patients (44%) were given a second injection and 8 (30%) were given a third injection but these subsequent injections did not result in continence. Of the patients 16 (59%) eventually underwent bladder neck surgery, 2 (7%) were dry and 8 (30%) accepted the inconvenience. Two patients underwent ileocystoplasty and 1 patient underwent botulinum A toxin (Botox(R)) injection due to decreased bladder capacity and poor bladder compliance. Neither the endoscopic approach nor the method of postoperative catheterization affected the success rate. CONCLUSIONS: Bladder neck injection after failure of primary sling procedures has limited value in patients with neurogenic lower urinary tract dysfunction. Repeat bladder neck injection yields no additional benefits.

Do we really need three-dimensional convex inguinal hernia meshes?

PURPOSE: The aim of our study was to assess the anatomical variability in the curvature of the muscles in inguinal region and to determine the necessity of using three-dimensional convex-shape hernia meshes in spite of typical flat ones. METHODS: The group analyzed consisted of 180 patients with no abnormalities in inguinal region: 30 males and 30 females for every subgroup, with decreased, normal, and increased BMI. For every patient a 3D software model of muscles in the inguinal region was built, based on the segmentation of pelvic CT images and its outer surface determining the shape of the hernia mesh was created. Correlation was tested between the diameter of sphere describing the shape, the height of mesh top, and BMI. The optimal number and diameter of prefabricated hernia mesh set was obtained. RESULTS: Only a moderate correlation (r = - 0.32) was found between the diameter of sphere and BMI in females and between the height of the mesh top and BMI in females (r = 0.43) and in the whole group of patients (r = 0.33). Accepting fitting error < 5 mm for 62 from 180 cases there was no need to use a convex-shape hernia mesh, for the other cases one of 3 prefabricated hernia meshes with diameters: 854 mm, 434 mm, 298 mm was sufficient. CONCLUSIONS: For about one-third of patients a commonly used flat hernia mesh is adequate, for the rest of the cases one of 3 convex-shape meshes is sufficient.

Management of ureteropelvic junction obstruction in children-a roundtable discussion.

The investigation, management and follow-up of paediatric ureteropelvic junction obstruction is not standardized. The Young Pediatric Urology Committee of the European Society of Pediatric Urology interviewed five experts in the field on various aspects of management and compared this with published literature.

The unique case of adrenocortical malignant and functioning oncocytic tumour.

UNLABELLED: Adrenocortical oncocytoma is extremely rarely found. Only a little more than thirty cases of adrenal oncocytoma, mainly nonfunctioning and benign, have been reported in the literature. Adrenal mass 150 x 160 x 172 mm in size and enlarged periarterial lymph nodes were found in CT examination performed in 51-year-old male. Main complaints: weight loss, general asthenia and abdominal pain. PHYSICAL EXAMINATION: elevated blood pressure (180/120 mmHg), no features typical of Cushing's syndrome. Abnormal laboratory findings: oral glucose tolerance test revealed diabetes, elevated serum dehydroepiandrosterone-sulfate (1101.9 microg/dl; normal, 59-452), elevated serum cortisol following overnight 1 mg dexamethasone test (5.1 microg/dl; normal, <1.8), increased urinary excretion of 17- hydroxycorticosteroids (18.1 mg/24 h; normal, 2.0-7.0) with pathological response to high-dose dexamethason test (16.6 mg/24). On laparotomy, the lesion was considered unresectable because of evident - confirmed by intraoperative ultrasound - tumour infiltration of the inferior caval vein. The large biopsy specimen was obtained for histological examination in which tumour fulfilled criteria proposed by Bisceglia et al. for adrenocortical oncocytic borderline tumour. On immunohistochemistry, the lesion showed cytoplasmic reaction for cytokeratin, vimentin and synaptophysin. The presented case appears to be the first malignant and functioning adrenocortical oncocytic tumour reported and confirms the complexity of its biology.

Quantification of image contrast of infarcts on computed tomography scans.

Introduction Accurate identification of infarcts in non-contrast computed tomography (NC-CT) scans of the brain is fundamental in the diagnosis and management of patients with stroke. Quantification of image contrast properties at the boundaries of ischemic infarct regions in NC-CT can contribute to a more precise manual or automatic delineation of these regions. Here we explore these properties quantitatively. Methods We retrospectively investigated 519 NC-CT studies of 425 patients with clinically confirmed ischemic strokes. The average and standard deviation (SD) of patients' age was 67.5 ± 12.4 years and the average(median)±SD time from symptoms onset to NC-CT examination was 27.4(12)±35.7 h. For every scan with an ischemic lesion identified by experts, the image contrast of the lesion vs. normal surrounding parenchyma was calculated as a difference of mean Hounsfield Unit (HU) of 1-5 consecutive voxels (the contrast window width) belonging to the lesion and to the parenchyma. This contrast was calculated at each single voxel of ischemic lesion boundaries (previously delineated by the experts) in horizontal and vertical directions in each image. The distributions of obtained horizontal, vertical and both contrasts combined were calculated among all 519 NC-CTs. Results The highest applicative contrast window width was identified as 5 voxels. The ischemic infarcts were found to be characterized by 6.60 HU, 8.28 HU and 7.55 HU mean values for distributions of horizontal, vertical and combined contrasts. Approximately 40-50% of the infarct boundary voxels were found to refer to the image contrast below 5 HU. Conclusion Low image contrast of ischemic lesions prevents accurate delineation of the infarcts in NC-CT.

Uroflowmetry in children--is it necessary to repeat the study in a single patient?

UNLABELLED: Uroflowmetry, as the only non-invasive urodynamic means of assessing the function of the lower urinary tract is widely used in children. A possible psychological influence on the results is the reason why uroflowmetry is often repeated in the same patient. OBJECTIVES: The investigation was conducted to compare parameters of repeated uroflowmetry in a single child with the results of single uroflowmetry performed in a group of children. The goal of the study was to evaluate the efficacy of a single uroflow procedure in children. MATERIAL AND METHODS: A single uroflowmetric study was performed in 44 children aged from 9 - 11 years (mean 10 yrs). Out of the group one child was chosen who had 32 successive uroflow attempts. The range and average values of the uroflowmetric parameters were compared in both groups. Pearson's correlation coefficient was used for calculation and for a comparison of the uroflowmetric parameters of both groups (significance level p < 0.05). RESULTS: Average values of the voided volume, maximal and average flow were lower in the 32 attempts of a single child than in the control group (44 attempts). The values of the Pearson's correlation coefficient were ranged from 0.2 to 0.4 for flow/voided volume ratio and from 0.4 to 0.8 for flow time/voided volume ratio in both groups. There were no differences between the values in both groups apart from flow time/voided volume correlation (significance level p < 0.05). CONCLUSION: Repetition of uroflowmetric study does not seem to improve the efficacy of the modality in assessing voiding function in children.

Training potential in minimally invasive surgery in a tertiary care, paediatric urology centre.

BACKGROUND: Minimally invasive surgery (MIS) is being utilized more frequently as a surgical technique in general surgery and in paediatric urology. It is associated with a steep learning curve. Currently, the centre does not offer a MIS training programme. It is hypothesized that the number of MIS procedures performed in the low-volume specialty of paediatric urology will offer insufficient training potential for surgeons. OBJECTIVE: To assess the MIS training potential of a highly specialized, tertiary care, paediatric urology training centre that has been accredited by the Joint Committee of Paediatric Urology (JCPU). STUDY DESIGN: The clinical activity of the department was retrospectively reviewed by extracting the annual number of admissions, outpatient consultations and operative procedures. The operations were divided into open procedures and MIS. Major ablative procedures (nephrectomy) and reconstructive procedures (pyeloplasty) were analysed with reference to the patients' ages. The centre policy is not to perform major MIS in children who are under 2 years old or who weigh less than 12 kg. RESULTS: Every year, this institution provides approximately 4300 out-patient consultations, 600 admissions, and 1300 procedures under general anaesthesia for children with urological problems. In 2012, 35 patients underwent major intricate MIS: 16 pyeloplasties, eight nephrectomies and 11 operations for incontinence (seven Burch, and four bladder neck procedures). In children ≥2 years of age, 16/21 of the pyeloplasties and 8/12 of the nephrectomies were performed laparoscopically. The remaining MIS procedures included 25 orchidopexies and one intravesical ureteral reimplantation. DISCUSSION: There is no consensus on how to assess laparoscopic training. It would be valuable to reach a consensus on a standardized laparoscopic training programme in paediatric urology. Often training potential is based on operation numbers only. In paediatric urology no minimum requirement has been specified. The number of procedures quoted for proficiency in MIS remains controversial. The MIS numbers for this centre correspond to, or exceed, numbers mentioned in other literature. To provide high-quality MIS training, exposure to laparoscopic procedures should be expanded. This may be achieved by centralizing patients into a common centre, collaborating with other specialities, modular training and training outside the operating theatre. CONCLUSION: Even in a high-volume, paediatric urology educational centre, the number of major MIS procedures performed remains relatively low, leading to limited training potential.

[Renal neoplasms in children with tuberous sclerosis]. / Nowotwory nerek u dzieci ze stwardnieniem guzowatym.

Two cases of 14 and 11 years old children with tuberous sclerosis were admitted to Department of Paediatric Surgery in Wroclaw and Department of Paediatric Hematology and Oncology in Lublin because of renal tumors. Radical nephrectomy was performed in both cases. Histopathological diagnosis revealed malignant rhabdoid tumor (MRT) in a 14 years old boy and benign angiomyolipoma in the latter case. The authors stress the rarity of MRT in older children and successful treatment due to nephrectomy and maintenance chemotherapy.

[Imaging of kidney fibro-lipomatosis]. / Diagnostyka obrazowa fibrolipomatozy nerek.

The purpose of this study is to promote a deeper understanding of problems connected with the issue of fibrolipomatosis among a large number of physicians. This pathology is of a great importance in the diagnostic process, both due to its high incidence rate, and to the fact that in some cases it imitates diseases that require surgical intervention. Kidney fibrolipomatosis is well-known to radiologists, but other specialists' knowledge of this pathology is rather limited. The prevalence of abdominal cavity US examinations, performed by various specialists, makes it necessary to draw physicians' attention to this disease.

[Videorentgenocinematographic analysis of pharyngeal phase in the act of swallowing]. / Badania wideorentgenokinematograficzne fazy gardlowej aktu polykania.

The course of the pharyngeal phase was analysed in physiological conditions. The mobility of anatomical structures taking part in the phase was evaluated, taking into consideration the time sequence in which the elements of the phase followed. To objectify the evaluation of the analysed phenomena, authors of this paper proposed and used linear and time parameters also used by other authors involved with these issues.

[Video-roentgen cinematographic evaluation of pharyngeal phase disorders during swallowing in patients after partial laryngectomy due to localized supraglottic cancer]. / Wideorentgenokinematograficzna ocena zaburzen fazy gardlowej aktu polykania u chorych po operacjach czesciowego usuniecia krtani z powodu raka o lokalizacji nadglosniowej.

Videorentgenocinematographic examinations of swallowing were conducted on 81 patients after partial laryngectomy and on 35 subjects being a control group. Resection of piriform recess, a part of base of the tongue, the hyoid bone or its part is the factor that causes intensified difficulty during swallowing and increase in the frequency of the occurrence of aspiration. The results of videorentgenocinematographic examinations indicate that the shape and mobility of the tongue and the mobility of remaining after the surgery parts of the larynx have the greatest influence on the efficient swallowing in patients who have undergone partial laryngectomy due to cancer initially located in the supraglottic area. The larynx mobility is closely related to the remaining of the hyoid bone. The importance of remaining the possibly non-deformed structure and mobility of the tongue during partial laryngectomy involves the issue of reconstruction of defects occurred during the surgery. Videorentgenocinematographic examinations confirm the effectiveness of the method involving reconstruction of defects in a part of the base of the tongue with a vascular pedicle flap of the submandibular gland.

Epispadias in boys with an intact prepuce.

OBJECTIVE: To present an overview of the clinical presentation and pathological anatomy, and the results of surgical correction of 7 cases of epispadias with intact prepuce; a rare condition that has only occasionally been reported in literature. PATIENTS AND METHODS: A retrospective search was performed in the surgical and diagnoses database between 1991 and 2011. Seven cases of epispadias with intact prepuce were identified. Five presented as a webbed and buried penis, 1 as phimosis and 1 with suspicion for congenital anomaly of the genitalia. RESULTS: In 3 of 7 cases, epispadias was suspected or diagnosed at first presentation and could be surgically corrected in the first intervention. In the other 4 cases, epispadias was discovered during surgery, requiring an additional intervention to perform epispadias repair in 3 cases. One boy was diagnosed with glandular, 3 with coronal, 1 with shaft and 2 with penopubic epispadias. Epispadias repair was successful with regard to cosmesis and erectile function. Five patients developed normal continence after surgery, 1 after intensive urotherapy. An under average penile length was the main reported problem during follow-up. CONCLUSION: In the diagnostic process for a concealed penis, the possibility of epispadias should be considered. If epispadias is suspected or confirmed, epispadias repair can occur in the first intervention, reducing the number of additional interventions. Epispadias with intact prepuce appears to have a better prognosis concerning urinary continence compared to classical epispadias.