Imaging review of penile pathologies encountered in the emergency department.

While penile pathology is uncommon, prompt diagnosis and treatment of emergent and urgent penile pathology are necessary to prevent complications. This paper will review the imaging findings of the most common critical penile pathologies, including traumatic, vascular, infectious, foreign body-related, and urethral pathology, in addition to penile prosthesis complications. Each entity will be discussed in the context of presentation and treatment and complications of each pathology will be discussed.

Robot-Assisted Laparoscopic Reoperative Repair for Failed Pyeloplasty in Children: An Updated Series.

PURPOSE: Reoperative pyeloplasty is commonly used in children with recurrent obstruction after pyeloplasty. We previously reported on reoperative robot-assisted laparoscopic repair for failed pyeloplasty in 16 children and concluded that short-term and intermediate outcomes were comparable to open reoperative repair. In this updated series we describe longer term outcomes from an extended study. MATERIALS AND METHODS: We retrospectively reviewed outcomes of consecutive children with prior failed primary pyeloplasty who underwent robot-assisted laparoscopic reoperative repair at a single institution from January 2008 to June 2018. RESULTS: Overall, 36 children 0.6 to 15.2 years old (median 3.7) underwent robot-assisted laparoscopic reoperative repair (pyeloplasty in 31, ureterocalicostomy in 5) at a median of 24.3 months (range 3.9 to 136.7) after primary repair. Median reoperative time was 285.0 minutes (range 207 to 556) and median length of stay was 1 day (1 to 8). Crossing vessels were present in 8 of 30 children (26.7%) with prior open repair and in 0 of 6 with prior minimally invasive repair. Clavien-Dindo grade 1 to 2 perioperative complications occurred in 4 children (11.1%) and grade 3 to 5 complications in 2 (5.6%). Median followup was 35.3 months (range 1.4 to 108.3), with 18 children (50.0%) being followed for more than 3 years. Postoperative ultrasound in 34 children revealed improvement in 31 (91.2%), stability in 2 (5.9%) and worsening hydronephrosis in 1 (2.9%). All 11 children undergoing preoperative and postoperative diuretic renography demonstrated stable or improved differential renal function. All children were symptom-free at last followup. CONCLUSIONS: To our knowledge, this is the largest series of robot-assisted laparoscopic reoperative repair for failed pyeloplasty in children. Our results indicate the feasibility, efficacy, safety and durability of this procedure.

The Correlation between Serial Ultrasound and Diuretic Renography in Children with Severe Unilateral Hydronephrosis.

PURPOSE: While serial renal ultrasound is often used as an alternative to functional renal imaging in children followed for hydronephrosis, it is unclear whether a lack of hydronephrosis progression safeguards against loss of renal function. In this study we characterize the association between findings on serial renal ultrasound and diuretic renography in children with severe unilateral hydronephrosis. MATERIALS AND METHODS: We retrospectively reviewed imaging among patients younger than 18 years old with a history of severe unilateral hydronephrosis, 2 renal ultrasounds and 2 diuretic renograms. Each pair of renal ultrasounds was interpreted by an independent blinded diagnostic radiologist and compared to a contemporaneous diuretic renogram. Change in hydronephrosis was considered as 1) a change in hydronephrosis grade or 2) any change by radiologist interpretation. A 5% or greater change in split differential function was considered significant. Chi-square and Spearman correlation analyses were performed. RESULTS: A total of 85 children were evaluated. Increased hydronephrosis was noted in 11.8% of children by grade and 32.9% by radiologist interpretation. Split differential renal function worsened by 5% or more in 17.6% of children. Overall, 13.3% of children with stable or decreased hydronephrosis demonstrated worsening split differential function at an average of 11.8 months. When renal ultrasound and diuretic renograms were directly compared, the Spearman correlation was poor (r = 0.24, 95% CI 0.03 to 0.43). CONCLUSIONS: The overall correlation between imaging modalities was poor, and 13.3% of children with stable or decreased hydronephrosis had worsening of split differential renal function. These findings are important to consider when counseling nonoperatively managed children followed without diuretic renography.

Impact of resident call eligibility on major discrepancy rate.

RATIONALE AND OBJECTIVES: The Resident Review Committee (RRC) recently changed the policy concerning first-year resident call. Our study is intended to evaluate whether the additional 6 months of training before a resident's first call made a significant difference in the resident's ability to provide patient care. To evaluate this, we assessed the discrepancy rates between preliminary interpretations made by residents and final reports by attendings. MATERIALS AND METHODS: All cross-sectional imaging interpreted by on-call residents (5 PM to 8 AM) during the first 6 months of call duties was reviewed for discrepant findings between the preliminary resident report and the final interpretation by an attending. Only major discrepancies were evaluated. A major discrepancy was defined as a change made to the resident preliminary report by an attending radiologist where a delay in communicating that finding had the potential to negatively affect clinical outcomes. Major discrepancy rates between groups were then compared. RESULTS: During the second 6 months of the 2008-2009 academic year, first-year residents interpreted 3331 studies. Fifty-nine of those were declared to be discrepancies after an attending over-read, a rate of 1.8%. During the first 6 months of the 2009-2010 academic year, second-year residents interpreted 4649 studies with 49 discrepancies, a rate of 1.0%. This difference is statistically significant (P = .008). CONCLUSIONS: The recent RRC policy change requiring 6 additional months of training before assuming independent on-call responsibilities has significantly decreased the major discrepancy rate at our institution.