10 Years' Experience in Balanitis Xerotica Obliterans: A Single-Institution Study.

INTRODUCTION: Balanitis xerotica obliterans (BXO) is uncommon in children. Diagnosis of the condition is almost always clinical and supported by histology. Our aim was to evaluate the outcomes of children undergoing circumcision for BXO and explore the correlation between surgical and histological findings. MATERIALS AND METHODS: A 10-year retrospective review (2007-2017) of all children, aged 16 and less, undergoing circumcision at a tertiary teaching hospital was conducted. Statistical analysis was performed using Fisher's exact test. RESULTS: BXO occurred in 91/1025 (8.9%) children. The highest incidence of BXO was in the 5 to 10 age group (13.3%; p < 0.0001). The commonest symptom was foreskin scarring (62.6%). Intraoperatively, involvement of foreskin alone was seen in 26.4%, foreskin and meatus in 47.2%, and foreskin, meatus, and glans in 26.4%. Preoperatively, 24.2% of patients were prescribed steroid cream. Histologically, all patients showed microscopic changes confirming BXO. A total of 87.9% of patients only had a circumcision, and 11% required a meatal procedure along with the circumcision. Postoperatively, 19.8% of patients required a further procedure after an average duration of 5.8 months (range: 2-12 months); the majority of whom (83.3%) were prescribed postoperative steroid cream. CONCLUSION: Clinical correlation by surgeons has a high degree of accuracy (>90%). Meatal involvement is more common than previously reported. The use of pre- or postoperative steroids does not obviate the need for further surgical procedures. Patients can have recurrent symptoms 1 year following surgery, and prolonged follow-up is necessary.

An 18 years' review of exomphalos highlighting the association with malrotation.

INTRODUCTION: This was a retrospective 18 years' review of infants with exomphalos with particular attention to its association with malrotation. MATERIALS AND METHODS: We reviewed all exomphalos cases presenting to our neonatal surgery unit, from October 1991 to September 2009. Data were presented as median and range values. Categorical data were analyzed using Fisher's exact tests and P value of ≤0.05 was considered as significant. RESULTS: Forty-two infants with exomphalos (E. major 23, E. minor 19) were treated during this period. The incidence of surgically confirmed malrotation was 45% in E. major and 31% in E. minor. CONCLUSION: The association of malrotation in exomphalos major and exomphalos minor infants is alarmingly high and supports the need to actively exclude this abnormality, either operatively or radiologically.

Congenital thyroid teratoma: a case with persistent neuroglial involvement of cervical lymph nodes.

A case of congenital thyroid teratoma with nodal spread is reported. Primary surgery was performed on a female infant on the 6th day of life. The thyroid mass was removed in toto, and an adjacent 1.2 cm lymph node was also removed. Histology showed solid and cystic teratoma with a variety of elements including prominent neurological tissue that was neuroblastoma-like in places. Residual compressed non-neoplastic thyroid tissue was identified in the subcapsular plane. The lymph node was largely replaced by neuroglial tissue that was cellular in some areas and showed intrasinusoidal growth and some mitotic activity. Recurrent cervical lymphadenopathy gradually developed, commencing a few months after surgery. Excision of cervical nodes was undertaken at 9 months of age. About 13 nodes up to 2 cm in diameter were excised. Most of the specimens consisted of reactive lymph nodes, but in three of the smaller nodes, there were subcapsular and sinusoidal masses of focally cellular neuroglial tissue, again with occasional mitoses. This tissue stained strongly for glial fibrillary acidic protein, in addition to expressing neural markers. The lymph node "deposits" were interpreted as "displaced" lesional tissue rather than metastases in the usual, aggressive sense. The girl remains well at 5 years of age.

Management of the colonised shunt.

A system of management is described for colonised hydrocephalus shunts. If organisms have reached the lateral ventricles as well as the valve chamber, the shunt must be removed and the ventricles drained externally with instillation of a suitable antibiotic until the fluid is sterile. If the ventricular fluid is not infected the shunt can safely be replaced at the same operation, using a site on the opposite side of the head. The operation has been performed 12 times without reinfection.

The silastic urethral ligature: an aid to catheter management.

A technique is described for improving catheter control in patients with neuropathic bladder who have inadequate sphincter tone to retain an indwelling catheter without leaking or to remain dry with a regime of intermittent catheterisation. The urethra or bladder neck is narrowed by one or more ligatures of silastic tubing. 24 patients were operated upon. Results were excellent in 6, satisfactory in 5 and a failure in 13. Successful results are easier to achieve in males than females. In the latter, an alternative method of narrowing the bladder outlet would be preferable. The operation does not spoil the operative field for a possible future artificial sphincter insertion.