Our experience with ureterocystoplasty in bilateral functional kidneys.

OBJECTIVE: We have reviewed the data of the patients in order to evaluate the effectiveness of our ureterocystoplasty technique in augmentation cystoplasty operation. MATERIAL AND METHODS: Data of a total of 16 patients with bilateral functional kidneys who had undergone augmentation ureterocystoplasty between January 1995 and June 2018 which were retrieved during the retrospective archive scanning were included in the study. Ultrasonography (USG), serum blood urea nitrogen and creatinine values and Technetium-99 DTPA (Tc-99 DTPA) scan were used to evaluate the renal function of the patients. Intravenous pyelography (IVP) and USG were used to evaluate the ureters before surgery. Magnetic resonance (MR) urographies were performed in our center. RESULTS: Of the total 16 patients, 10 were male and 6 were female, while ages ranged from 1 to 24 years. Among 16 patients, the most common cause of neurogenic bladder etiology was meningomyelocele. In the urodynamic studies performed before the operation, it was determined that the bladder capacities of the patients were between 40-180 mL and the bladder compliances were 1.0-4.0 cc/cmH2O. At postoperative 3rd months, it was determined that the bladder capacities of the patients were between 180-330 mL and the bladder compliances were between 6.0-24.0 cc/cmH2O. CONCLUSION: Augmentation ureterocystoplasty seems to be an appropriate technique in which successful results are obtained with appropriate patient selection. Besides, complications that may occur due to use of ileal segment are avoided.

A prospective controlled study to determine the duration of antibiotherapy in the patients with elevated serum PSA levels.

BACKGROUND: The aim of this study was to determine the duration that antibiotherapy should have in order to make total prostate-specific antigen (tPSA) levels decrease to normal ranges in patients without prostatitis symptoms but with total PSA levels around 4.01-9.9 ng/dL. METHODS: A total of 129 male patients were enrolled and divided into either study group (N.=102) or control group (N.=27). The study group received a 21-day treatment with ofloxacin 400 mg/day, while the control group did not receive any treatment. tPSA and free PSA levels were measured on the 7th, 14th and 21st day, and at the 3rd, 6th, and 12th month of the study. tPSA levels and the number of patients whose tPSA levels decreased ≤4.0 ng/dL levels was recorded and analyzed for statistical significance. RESULTS: At 7, 14, and 21 days mean tPSA values were all lower than baseline values and the differences were statistically significant (P<0.05). Of 102 patients 31, 38 and 36 patients had decreased tPSA levels at 7, 14, and 21 days, respectively. But when we compared 7th day mean tPSA levels with days 14 and 21, we found no statistical differences (P>0.05). Sixty-six patients had persistently high tPSA levels and 64 of them underwent prostate biopsy. Prostate cancer was detected in 8 of them (12.5%). CONCLUSIONS: A seven-day course of antibiotherapy is enough to normalize PSA levels in gray-zone patients. If recurrence of PSA increase is seen during follow-up, antibiotherapy can be useful again in those patients who previously benefited from it, while it will prove unnecessary in those who did not have their tPSA level normalized by it.

Comparison of the inguinal and scrotal approaches for the treatment of communicating hydrocele in children.

The inguinal approach is used for the treatment of hydrocele in the pediatric population. Although studies on scrotal orchiopexy have mentioned hernia or hydrocele repair through the same scrotal incision as a part of an orchiopexy procedure, there are a few studies reporting the treatment of isolated communicating hydrocele through a scrotal incision. We retrospectively evaluated and compared the outcomes of inguinal and scrotal approaches for the treatment of communicating hydrocele in boys. The classical inguinal and scrotal approaches to the treatment of communicating hydrocele were performed on 46 and 30 testicular units (in 43 boys and 27 boys, respectively). The patients' charts were reviewed to assess the operative times as well as the immediate and long-term complications during follow-up periods. The patients' ages ranged from 1 year to 8 years (3.6 ± 2.0 years) in the inguinal group and from 1 year to 10 years (mean 4.6 ± 2.8 years) in the scrotal group. Operative time was significantly lower in the scrotal group (p < 0.0001). The early minor complication rate did not differ between the two groups. Furthermore, there were no major complications noted. None of the patients had hydrocele recurrence after a mean follow-up of 6 months. The advantages of the scrotal approach for the treatment of communicating hydrocele are as follows: it is well tolerated, simple, and cosmetically appealing, and it has a short operative time in comparison with the standard inguinal approach. The scrotal incision technique is an effective alternative in communicating hydrocele treatment.

The histopathologic, pharmacologic and urodynamic results of mesenchymal stem cell's injection into the decompensated rabbit's bladder.

OBJECTIVES: We researched the survival of bone marrow-derived mesenchymal stem cells (MSCs) and the results of MSCs' injected into decompensated bladders in a rabbit model. METHODS: Partial bladder neck obstruction (PBNO) and subsequent decompensation of the bladder was achieved by wrapping the bladder neck with autologous rectus fascia. In the first aspect of the experiment 18 rabbits underwent MSC injection into the decompensated bladder to prove the survivability of injected MSCs. For this purpose MSCs were isolated, transfected with Green Fluorescent Protein (GFP), and injected into the detrusor layer. Once viability was assessed in the first phase, an additional 10 rabbits underwent PBNO in the second phase. Five of these animals underwent subsequent MSC injection (group 3, stem cell) and 5 did not (group 2, obstruction). Both groups were compared to 5 controls (group 1). Urodynamics were performed in all groups. After the animals were sacrificed the groups were compared via morphometric analysis, contractile response to carbachol and KCl, and muscarinic receptor type analysis. RESULTS: On morphometric analysis, collagenous area rates were 43, 53 and 37% in group 1, 2 and 3, respectively. There was no statistically significant difference between groups in terms of bladder weight, bladder capacity and vesical pressure. The contractile effects of KCl and muscarinic agonist carbachol were significantly higher in groups 1 and 3 than group 2. The response to carbachol was antagonized by muscarinic M(1) and M(3) receptor antagonist pirenzepine and abolished by muscarinic M(3) receptor antagonist 4-DAMP in all groups. CONCLUSIONS: The injection of MSCs decreased the collagenous area, increased detrusor contractility. Functional M(3) receptors were also expressed in MSCs-injected bladder smooth muscle as well as in control group.

Intralymphatic delivery of platinum-based chemotherapeutics is possible: an experimental study.

PURPOSE: Systemic chemotherapy regimens with cisplatinum have been associated with several toxicities. Thus, a loco-regional therapy approach may greatly reduce the toxicity. For this purpose, we designed this experimental study to investigate whether local chemotherapeutic injection is superior to systemic cisplatinum injection for retroperitoneal lymph nodes. METHODS: A total of 48 male Wistar rats were included to the study. Rats were divided into six groups. In the first three groups, systemic applications of cisplatinum, carboplatinum and oxaliplatin were performed, respectively. In the last three, local administration of cisplatinum, carboplatinum and oxaliplatin was performed, respectively. One hour after the chemotherapeutic agent applications, retroperitoneal lymph nodes were dissected and platinum concentrations were analyzed. RESULTS: When compared with systemic route, achieving higher platinum concentrations in the local chemotherapeutic application groups was the most spectacular result of the study. Serum platinum concentrations were also lower in the local application groups than systemic ones. When we compared local and systemic applications between three chemotherapeutic agents, the most significant concentration difference was seen in carboplatinum group. CONCLUSION: The results of this study demonstrate that intralymphatic delivery of cisplatinum, carboplatinum and oxaliplatin leads to higher drug concentrations in the retroperitoneal lymph nodes when compared with intravenous administration.

Feasibility of MR urography in patients with urinary diversion.

INTRODUCTION: The aims of this study were to determine the diagnostic value of MR urography and to compare the T2- and T1-weighted MR urography techniques in patients with urinary diversion. METHODS: We retrospectively reviewed 19 MR urograms in 14 patients (13 male and one female, 8-77 years old, mean age: 54.2) with urinary diversion. Magnetic resonance urography examinations were performed with 1.5-T MR scanners. In addition to T2- and T1-weighted MR urography techniques, conventional T1- and T2-weighted axial and coronal sequences were also obtained. Collecting systems were evaluated in five segments (right proximal and distal collecting system, left proximal and distal collecting system and conduit or reservoir). Imaging features of the urinary collecting systems were evaluated with T2- and T1-weighted MR urography images. The clinical, laboratory data and follow-up imaging findings were regarded as standard. A cross table was formed to determine sensitivity, specificity and accuracy of MR urography techniques. RESULTS: T2-weighted MR urography, T1-weighted MR urography and combination of these two techniques could demonstrate 89.01, 87.65 and 93.83% of all collecting system segments, respectively. For the detection of the pathologic urinary segments, sensitivity, specificity and accuracy were 100, 95.29 and 95.6% in T2-weighted MR urography and 100, 93.42 and 93.82% in T1-weighted MR urography, respectively. Sensitivity, specificity and accuracy were 100% in combined T2- and T1-weighted MR urography technique. CONCLUSION: Magnetic resonance urography is an effective imaging method for the evaluation of the urinary system in patients with urinary diversion. T2-weighted MR urography alone has high sensitivity, specificity and accuracy, does not require intravenous contrast medium and can be obtained in 3-5 min. However, T1-weighted MR urography may provide additional information in some cases.

Association between the androgen levels and erectile function, cognitive functions and hypogonadism symptoms in aging males.

PURPOSE: Aging in men is characterized by a moderate decrease in plasma testosterone (T) levels. However, the association between partial androgen deficiency of the aging male and clinical symptoms and the ideal screening test are controversial. In this study, we investigated the association between the androgen levels and erectile function, cognitive functions and hypogonadism symptoms in aging males. MATERIALS AND METHODS: We investigated the association between total (TT), calculated free (FT) and bioavailable (BT) testosterone, and various clinical and laboratory parameters in 103 healthy males, 50-80 years old. Biochemical assessment was done after overnight fasting. Questionnaires were used to test for hypogonadism symptoms, erectile and cognitive functions. RESULTS: TT levels were not correlated with aging in this study. However, FT and BT were found to decrease with age due to rising sex hormone binding globulin. TT levels were strongly correlated with FT and BT levels (respectively p = 0.0001, p = 0.0001). TT, FT and BT were only correlated with cognitive functions (p = 0.012, p = 0.004, p = 0.02 respectively). There was no correlation between TT, FT and BT levels and erectile function and hypogonadism symptoms. CONCLUSION: T values in our study sample did not correlate with clinical signs and symptoms of hypogonadism. Thus, according to our data, symptoms in the aging male should not be indiscriminately assigned to a decrease in TT, FT or BT levels.

The effect of intravesical acetylsalicylic acid instillation on tissue prostaglandin levels after partial bladder outlet obstruction in rabbits.

AIMS: To examine whether obstruction changes the expression of prostaglandins (PGs) in bladder, intravesical low-dose aspirin could be used as a new route of drug administration, this way of administration influences PGs' expression, and contractile function of the bladder is protected after treatment. METHODS: Eighteen rabbits were divided into three groups. Sham-operated group (group 1) included 6 rabbits. Twelve rabbits were partially obstructed for 70 days. Six of these 12 rabbits not receiving any treatment constituted obstructed group (group 2). The remaining six rabbits received 2 mg/kg/day aspirin (group 3). One rabbit in each group was evaluated on 1st, 7th, 14th, 28th, 42nd, and 70th days following obstructive surgery. After scarification, the percentage of collagenous area and concentrations of PGE2 and PGF2-alpha were measured. Contractile responses to field stimulation (EFS), carbachol, and potassium chloride (KCl) were determined. RESULTS: Wet tissue PGE2 and PGF2-alpha levels were higher in obstructed group than the other groups. Aspirin decreased the percentage of collagenous area in group 3 compared to the group 2, but this difference was not statistically significant. The strips from aspirin groups resulted in better contractile response to cholinergic stimulation with KCl, but this difference was not statistically significant between the obstructed and aspirin groups. Similarly, carbachol did not elicit significantly greater concentration-dependent contraction in strips from obstructed group compared to those from aspirin groups. Maximum responses to EFS were not significant in aspirin group compared to those from obstructed group. CONCLUSIONS: Intravesical aspirin may have protective effect on partially obstructed bladder.

Chronic constipation: facilitator factor for development of varicocele.

AIM: To evaluate the possible relationship between varicocele and chronic constipation. METHODS: Between April 2009 and May 2010, a total of 135 patients with varicocele or constipation and 120 healthy controls were evaluated. Patients were divided into two groups. In both groups detailed medical history was taken and all patients were examined physically by the same urologist and gastroenterologist. All of them were evaluated by color Doppler ultrasonography. All patients with constipation, except for the healthy controls of the second group, underwent a colonoscopy to identify the etiology of the constipation. In the first group, we determined the rate of chronic constipation in patients with varicocele and in the second group, the rate of varicocele in patients with chronic constipation. In both groups, the rate of the disease was compared with age-matched healthy controls. In the second group, the results of colonoscopies in the patients with chronic constipations were also evaluated. RESULTS: In the first group, mean age of the study and control groups were 22.9 ± 4.47 and 21.8 ± 7.21 years, respectively (P < 0.05). In the second group, mean age of the study and control groups were 52.8 ± 33.3 and 51.7 ± 54.3 years, respectively (P < 0.05). In the first group, chronic constipation was observed in 8 of the 69 patients with varicocele (11.6%) and 3 out of 60 in healthy controls (5%), respectively. In this regard, there was no statistical significance between varicocele patients and the healthy control (P = 0.37). In the second group, varicocele was observed in 16 of the 66 patients with chronic constipation (24.24%) and 12 out of 60 in healthy controls (20%) respectively. Similarly, there was no statistical significance between chronic constipation and healthy controls (P = 0.72). Internal/external hemorrhoids were detected in 4 of the 16 patients with chronic constipation and varicocele, in the second group. In the remaining 50 patients with chronic constipation 9 had internal/external hemorrhoids. In this regard, there was no statistical significance between chronic constipation and healthy controls (P = 0.80). CONCLUSION: Chronic constipation may not be a major predictive factor for the development of varicocele, but it may be a facilitator factor for varicocele.

Testosterone relaxes human internal spermatic vein through potassium channel opening action.

OBJECTIVES: To investigate the relation of testosterone-induced relaxation with smooth muscle K+ channels in human internal spermatic veins. Testosterone induces relaxation in human isolated internal spermatic veins, and this effect decreases in high-grade varicocele (recently reported). METHODS: The responses of isolated internal spermatic veins from patients with varicocele were recorded isometrically using a force displacement transducer. After contracting the venous rings with 45 mM KCl, relaxation with testosterone (0.1-300 µM) was recorded in the absence or presence of large conductance calcium-activated K+ channel and the voltage-sensitive K+ channel inhibitor tetraethylammonium, adenosine triphosphate-sensitive K+ channel inhibitor glibenclamide, voltage-dependent inward rectifier K+ channel inhibitor barium chloride, and voltage-sensitive K+ channel inhibitor 4-aminopyridine. RESULTS: Testosterone induced relaxation in human isolated internal spermatic veins in the absence of inhibitors (maximal effect 52.88±6.72, n=24). Although tetraethylammonium, barium chloride, and 4-aminopyridine did not alter the testosterone-induced relaxant responses, GLI inhibited these responses. CONCLUSIONS: These results have demonstrated that testosterone induces relaxation in human isolated internal spermatic veins of patients with varicocele by way of adenosine triphosphate-sensitive K+ channels.

Modified psoas hitch with Lich-Gregoir onlay technique for the reconstruction of lower ureter during gynecologic or obstetric operations.

AIMS: We retrospectively review patients who underwent ureteral implantation with a psoas hitch during obstetric or gynecologic operations and describe a new modification. METHODS: Between December 1997 and May 2005, 20 patients between 26 and 56 years underwent ureteral reimplantation by using the nonrefluxing, extravesical Lich-Gregoir onlay technique with psoas hitch at our institution by the same reconstructive surgery team. Additionally, we used a urethral catheter balloon as a landmark for the bladder mucosa and fixed the bladder to the psoas tendon by using the balloon. We performed 14 ureteral reimplantations during the surgery as intraoperative reconstruction. In 6 patients, delayed reconstruction of the ureter was performed a few days following the previous operation. RESULTS: For intraoperative and delayed reconstructions, the mean operation time for ureteral reimplantation was 24 and 75 min. We took out the urethral catheter on the second operative day and the anastomotic drain on the third. The average hospital stay was 5.7 days. No cases of chronic flank pain, recurrent pyelonephritis, persistent severe hydronephrosis or compromised renal function occurred. No patient required reoperation. CONCLUSIONS: Modified psoas hitch ureteral reimplantation is an effective and safe way of reconstruction for treating defects in ureteral length.

Adult posterior urethral valve: a case report.

INTRODUCTION: Posterior urethral valve (PUV) is a congenital obstructive defect of the male urethra with an incidence of 1/8,000 to 1/25,000 live births. PUV is the most common cause of lower urinary tract obstruction in neonates. The diagnosis of PUV is usually made early, and PUV cases have rarely been detected in adults. CASE PRESENTATION: Here we report the case of a 35 years old man presented with obstructive urinary symptoms. In spite of bladder neck rejection uroflowmetry pointed out infravesical obstruction with max. flow rate 9 ml/s and average flow rate 6 ml/s in uroflowmetry. During cystoscopy mild bladder trabeculation and resected bladder neck were seen. While the cystoscope was taken off, PUV were obtained. CONCLUSION: Since PUV is a rare condition in adults and the diagnosis of PUVs is also difficult in these groups we must consider this situation during evaluation of adult patients with obstructive symptoms especially during cystourethroscopy.

Laparoscopy-assisted tubeless percutaneous nephrolithotomy in previously operated ectopic pelvic kidney with fragmented J-J stent.

Nephrolithiasis management within an ectopic kidney presents a challenge to the urologists. Several treatment modalities are possible in this group of patients. Although percutaneous nephrolithotomy (PNL) is an accepted treatment modality in anatomically normal kidneys, ectopic pelvic kidneys require a different and more complicated approach for PNL. We recently treated a 24-year-old patient with calculus and an encrusted J-J stent fragment in pelvic ectopic kidney with a previous history of open pyelolithotomy. Laparoscopy-assisted tubeless percutaneous nephrolithotomy was performed. The technique and the patient characteristics are reported.

Testosterone might cause relaxation of human corpus cavernosum by potassium channel opening action.

OBJECTIVES: To investigate the effect of testosterone on contractile tone of endothelium-denuded human corpus cavernosum strips. Human studies designed to examine a possible relaxant effect of testosterone on corpus cavernosal circulation are lacking. METHODS: Testosterone (0.1-300 microM) was added cumulatively to organ baths after precontraction of isolated human corpus cavernosum strips (n = 5) with KCl (45 mM). Testosterone-induced responses were tested in the presence of nonselective, large, conductance Ca(2+)-activated and voltage-sensitive K(+) channel inhibitor tetraethylammonium (1 mM), adenosine triphosphate-sensitive K(+) channel inhibitor glibenclamide (10 microM), voltage-dependent inward rectifier K(+) channel inhibitor barium chloride (30 microM) and voltage-sensitive K(+) channel inhibitor 4-aminopyridine (1 mM). RESULTS: Testosterone (0.1-300 microM) produced relaxation in human corpus cavernosum (maximum relaxation 65.4% +/- 3.3% of KCl-induced contraction) that reached a maximum at a concentration of 300 microM. Testosterone-induced relaxation was significantly attenuated by glibenclamide, but it was not affected by the other K(+) channel inhibitors (tetraethylammonium, barium chloride, or 4-aminopyridine). CONCLUSIONS: Testosterone might induce relaxation in human isolated corpora cavernosa strips by activation of smooth muscle adenosine triphosphate-sensitive K(+) channels. This finding suggests that testosterone, in addition to its known endothelial action, might regulate erectile function locally by its action on the smooth muscle of the human corpus cavernosum.

Splenogonadal fusion in adults: presentation of three cases and review of the literature.

Splenogonadal fusion (SGF) is a rare congenital anomaly in boys and girls. It commonly presents as a testicular mass treated with an unnecessary orchiectomy. We present 3 cases of SGF diagnosed in adulthood and discuss the published literature focusing on several aspects of this rarity. These cases of SGF of both types presented with the usual complaints. In our first case, orchiectomy was performed since the left testis was hypoplastic and testicular neoplasm could not be ruled out. The testicles could be preserved in the latter 2 cases. The second case is the continuous-type SGF associated with contralateral testicular aplasia and, to our knowledge, this is the first reported case of continuous SGF associated with testicular aplasia. Knowledge of this entity may help prevent unnecessary orchiectomy.

Effect of scrotal incision orchiopexy on serum inhibin B levels and comparison with classic inguinal orchiopexy.

OBJECTIVES: Inhibin B reveals Sertoli cell activity. After our previous findings of an increase in inhibin B succeeding classic inguinal orchiopexy, we sought to determine the changes in endocrine parameters after scrotal orchiopexy in patients with cryptorchidism and to compare these findings with the results of classic orchiopexy. METHODS: A total of 50 boys with an undescended testis, 32 unilateral and 18 bilateral, were included in the present study. Scrotal orchiopexy was performed in all of them. Before and 6 months after orchiopexy, the serum basal inhibin B and other serum hormonal levels were measured in all patients. RESULTS: The mean serum basal inhibin B levels had significantly increased and the other reproductive hormonal levels had not changed at 6 months after successful scrotal orchiopexy in our 50 patients (P = 0.016). Within the subgroups, the increase in inhibin B levels was significant in only those 2-9 years old with a unilateral undescended testis. The increase in inhibin B in those 10-12 years old with unilateral or bilateral undescended testis resulted from the start of puberty. No significant difference was found in terms of an increase in inhibin B after classic and scrotal orchiopexy. CONCLUSIONS: The measurement of inhibin B levels could be used as a follow-up parameter after orchiopexy. The serum inhibin B level increases after scrotal incision orchiopexy just as after classic inguinal orchiopexy. The increased level of inhibin B might indicate that the orchiopexy has been beneficial.

Evaluation of urinary inverted papillomas: a report of 13 cases and literature review.

Inverted papilloma (IP) of the urothelium accounts for 2.2% of urothelial neoplasms. The aim of this study was to report the results of 13 patients with urinary IP, pointing out the clinical features, presentations, treatment options and outcomes. The mean age and mean follow-up periods of the patients were 60.23 +/- 3.25 (range, 44-81) years and 30 (range, 6-42) months, respectively. There was no coexistence of urothelial carcinoma with IP at presentation. Cystoscopy showed a solitary papillary tumor in the bladders of 11 patients and solid pedunculated tumors in the remaining two patients. The site of development was the bladder in 12 cases (92%) and ureter in one (8%) case. Transurethral bladder tumor resection was performed in 12 cases. For the case with IP in the ureter, nephroureterectomy was performed. Pathologic examination demonstrated that seven of the 13 cases were of the trabecular type and six were of the glandular type. Of the 13 cases, two (7%) had recurrence, at 1 year and 1 month and 1 year and 5 months from initial resection. The male to female ratio was 5.5:1. Initial symptoms included macroscopic hematuria in five cases, microscopic hematuria in four, and dysuria and microscopic hematuria in three; one case was asymptomatic. IPs of the urinary bladder are benign tumors that can be treated successfully by transurethral resection and fulguration of the tumor bed. In addition, these lesions must be followed up closely for recurrence and malignant transformation.

Effect of biofeedback treatment on spinning top urethra in children with voiding dysfunction.

OBJECTIVES: Spinning top urethra (STU) deformity arises secondary to detrusor instability, leading to an increase in the intravesical pressure against a closed sphincter. We retrospectively analyzed the effect of biofeedback treatment on STU in children with dysfunctional voiding. METHODS: A total of 121 patients with STU and voiding dysfunction were enrolled in this study. The patients divided into two groups. Group 1 (n = 49) were treated with simple bladder retraining with timed voiding, and group 2 (n = 72) were treated with biofeedback therapy. Voiding cystourethrography was performed 6 and 12 month later to determine the status of the STU after both therapies. RESULTS: The patient age range was 5 to 13 years (mean 8.1 +/- 1.9) in group 1 and 5 to 13 years (mean 8.2 +/- 1.7) in group 2. Group 1 consisted of 41 girls and 8 boys; group 2 consisted of 63 girls and 9 boys. Voiding cystourethrography revealed vesicoureteral reflux in 39 and 59 children in groups 1 and 2, respectively. The improvement rates of the biofeedback therapy in children with STU and vesicoureteral reflux were significantly greater than the children treated with timed voiding at 6 months and 1-year of follow-up. CONCLUSIONS: For children admitted to urology clinics with urinary infection or complaints thought to be an unstable urinary bladder, proximal urethral dilation called STU is detected at a high frequency. It should be remembered that this situation can be related to vesicoureteral reflux and urinary bladder instability. Biofeedback training is a simple, effective, and well-tolerated treatment modality for these children.

Long-term outcome of scrotal incision orchiopexy for undescended testis.

OBJECTIVES: To perform a prospective study to evaluate the success of scrotal incision orchiopexy in children with a palpable undescended testis within the inguinal canal or beyond the external inguinal ring with or without inguinal hernia. METHODS: A total 204 scrotal orchiopexies were performed in 166 patients with a primary undescended testis. These children were followed up for an average of 29.4 months to document the testicular position and size. RESULTS: The scrotal orchiopexy technique was successful in 192 testes; the remaining 12 testes required conversion to traditional inguinal orchiopexy because of inadequate mobilization. Of 108 children (128 testes) in whom the testis was distal to the external inguinal ring, this technique was successful in 104 (124 testes). The success rate was 96.9% (124 testes of 128), and only 4 patients (four testes) required conversion to a traditional inguinal incision. The average operative time was 15 minutes in this group. In the other group with 58 children (76 testes) with a testicular location within the inguinal canal, conversion to the traditional inguinal orchiopexy was performed in 8 patients (eight testes). The success rate in this group was 89.5% (68 of 76 testes). The average operative time was 21 minutes in these patients, and follow-up ranged from 16 to 68 months (average 29.4). All testes were satisfactorily positioned in the scrotum, and no testicular atrophy developed. CONCLUSIONS: The results of our study have shown that scrotal orchiopexy is simple, safe, and effective in selected cases compared with the standard two-incision approach in the treatment of the palpable undescended testis.

Results of biofeedback treatment on reflux resolution rates in children with dysfunctional voiding and vesicoureteral reflux.

OBJECTIVES: It is well known that a relationship exists between vesicoureteral reflux (VUR) and dysfunctional voiding, and the spontaneous resolution rate in older children is lower than the rate in younger children. In this study, we analyzed our experience with biofeedback treatment in older children with confirmed voiding dysfunction and VUR and investigated the effect of this treatment on the reflux resolution rates in these children. METHODS: A total of 78 children, 5 to 14 years old (mean age 9), with voiding dysfunction and VUR detected by voiding cystourethrography were treated with biofeedback therapy. Voiding cystourethrography was performed 6 months after completion of the biofeedback program to determine the reflux status. The treatment results were also documented as subjective and objective improvements. RESULTS: The reflux in 98 units (20 bilateral) was grade 1 in 26, grade 2 in 32, grade 3 in 28, and grade 4 in 12. At 6 months of follow-up, VUR had resolved on voiding cystourethrography in 62 units (63%), the grade had improved in 28 units (29%), and the reflux had remained unchanged in 8 units (8%). Among the older children treated with biofeedback, we also observed improvements in nocturnal enuresis (82%), daytime wetting (70%), constipation (78%), frequency (76%), infrequency (64%), urgency (71%), staccato voiding (81%), flattened voiding (81%), bladder overactivity (82%), detrusor sphincter dyssynergia (77%), spinning top urethra (67%), and urinary tract infection (80%). CONCLUSIONS: Biofeedback therapy is applicable in older children with dysfunctional voiding and VUR and yields greater resolution rates than the historical resolution rates.