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Biomedical subjects

E F Reda

Publications and source records attributed to E F Reda.

At least 19 recordsLinked to original sources
PubMed2001

Psychosocial adaptation of middle childhood boys with hypospadias after genital surgery.

OBJECTIVE: To compare the psychosocial adaptation of boys with hypospadias after genital surgery to a community sample. METHODS: Boys (6 to 10 years) with a history of hypospadias repair (n = 175) were compared with a community sample (n = 333) in a postal questionnaire survey using the Child Behavior Checklist. RESULTS: Few significant differences between cases and controls emerged. Boys with hypospadias were (slightly) lower in social involvement but did not perform more poorly in school. Boys with hypospadias displayed fewer externalizing behavior problems than controls, but a significant difference in nocturnal enuresis was not detected. Level of behavior problems did not differentiate hypospadias severity subgroups, but greater surgical and hospitalization experiences were associated with increased internalizing problems. Poorer cosmetic appearance of the genitals was associated with worse school performance. CONCLUSIONS: Surgically corrected hypospadias should not be considered a risk factor for poor psychosocial adaptation in childhood, but emotional problems increase with the number of hospital-related experiences.

Child↗
PubMed2000

Correction of penoscrotal transposition: a novel approach.

PURPOSE: Penoscrotal transposition is a rare anomaly resulting in a partial or complete positional exchange between the penis and the scrotum. Time-honored repairs of penoscrotal transposition rely on the creation of rotational flaps to mobilize the scrotum. We offer a radically different approach to this anomaly by transposing the penis and not the scrotum to its normal anatomical location. MATERIALS AND METHODS: Transposition of the penis was performed in 15 patients. The penis is degloved followed by correction of the chordee. A suprapubic buttonhole is created in an anatomically correct location for the penis. The degloved phallus is then delivered into this buttonhole. The shaft skin is mobilized and transposed to resurface the penile shaft. A midline scrotoplasty completes the first stage. The scrotum is never transposed and scrotal rotational flaps are unnecessary. RESULTS: All 15 patients have had an excellent cosmetic outcome. There have been no cases of vascular compromise to the shaft or scrotal skin. CONCLUSIONS: This novel approach produces superior cosmetic results and should be used in all cases of penoscrotal transposition.

Child↗
PubMed1999

Laparoscopic Fowler-Stephens orchiopexy for the high abdominal testis.

PURPOSE: Laparoscopic orchiopexy is extremely effective for treating patients with nonpalpable testis. However, despite the high dissection and wide mobilization it allows in some cases, vessel length prevents the testis from reaching the scrotum. There have been only incidental cases reported in which laparoscopy has been used for vessel transection and testicular mobilization orchiopexy. We reviewed our cases treated with the Fowler-Stephens orchiopexy performed laparoscopically in 1 or 2 stages. MATERIALS AND METHODS: We reviewed the records of all boys who underwent laparoscopy for a nonpalpable testis at our institutions since 1992. Patients who underwent testicular vessel transection and orchiopexy performed laparoscopically in 1 or 2 stages were selected for evaluation. Office charts and operative reports were reviewed in detail. RESULTS: Of the 126 nonpalpable testes in 108 patients 51 (40%) were intra-abdominal, including 18 (35%) in 14 patients in whom the Fowler-Stephens procedure was performed laparoscopically. Five testes were treated with a 2-stage procedure, while 11 were managed by laparoscopic mobilization followed by laparoscopic vessel clipping and orchiopexy in 1 stage. In 2 additional patients nearly all dissection was performed laparoscopically but due to extenuating circumstances inguinal incision was required as well. Thus, 13 testes were managed by 1-stage Fowler-Stephens orchiopexy, including all cases since August 1996 which required vessel transection. Two patients were hospitalized postoperatively for prolonged ileus after the second stage. All other 2-stage and all 1-stage cases were managed on an outpatient basis. There were no complications. At a mean followup of 6 months all cases without previous surgery that were managed by laparoscopic orchiopexy are without atrophy and the testes are in a scrotal position. Two testes in which previous surgery had been done atrophied postoperatively. CONCLUSIONS: Laparoscopic transection of the testicular vessels is safe in boys with high abdominal testes that do not reach the scrotum after laparoscopic high retroperitoneal dissection. The magnification and wide mobilization of laparoscopy likely allow better preservation of the collateral vascular supply than open exploration. Previous surgery is a risk factor for atrophy. The success rate of 89% overall and 100% in patients who did not previously undergo testicular surgery equals or exceeds that of open orchiopexy in patients with abdominal testes. The 1-stage procedure avoids repeat anesthesia and the extensive, sometimes tedious, dissection that is occasionally required during reoperation.

Child↗
PubMed1998

Laparoscopic orchiopexy: procedure of choice for the nonpalpable testis?

PURPOSE: Multiple approaches exist for the management of the nonpalpable testis. With the use of diagnostic laparoscopy widely accepted in the setting of the nonpalpable testis we have found laparoscopic orchiopexy to be an efficient and logical extension. To evaluate its use we report our experience with laparoscopic orchiopexy to treat 44 nonpalpable testes in 36 patients. MATERIALS AND METHODS: We retrospectively reviewed the medical records of all patients who underwent laparoscopic orchiopexy for a 2 1/2-year period. Modifications of the surgical technique are described. RESULTS: The left testis was affected in 18 boys, the right in 9 and both in 9. At laparoscopy 8 testes were at the internal ring or were peeping and the remainder were intra-abdominal. One patient underwent a unilateral 1-stage Fowler-Stephens orchiopexy, and 3 unilateral and 1 bilateral 2-stage Fowler-Stephens orchiopexy. Two patients underwent laparoscopically assisted orchiectomy. The remaining 31 patients underwent laparoscopic orchiopexy without division of the spermatic vessels. At followup (mean 6 months) all testes are without atrophy, and 39 of 42 (93%) are in an acceptable scrotal position. There are 3 testes (7%) high in the scrotum. CONCLUSIONS: Laparoscopic orchiopexy is a logical extension of diagnostic laparoscopy for the evaluation and treatment of the nonpalpable testis. The low incidence of complications and 93% success rate underscore the feasibility of this procedure. It is our procedure of choice for the treatment of nonpalpable testis.

Child↗
PubMed1998

Single and multiple dermal grafts for the management of severe penile curvature.

PURPOSE: Conventional techniques result in chordee correction in the majority of patients. However, some with extensive chordee require further treatment to correct persistent extraordinary penile curvature. Our practice has been to treat this condition with interpositional dermal grafting. We review our experience with this procedure. MATERIALS AND METHODS: During a 5-year period dermal grafts harvested from the nonhair-bearing inguinal skin fold were placed in 51 patients with a mean age of 29 months. The primary diagnosis was penoscrotal or perineal hypospadias in 36 patients (hypospadias cripple in 4), the exstrophy-epispadias complex in 3, mid shaft or distal hypospadias with severe chordee in 10 and chordee without hypospadias in 2. A total of 49 patients (96%) underwent staged urethroplasty. RESULTS: One graft was placed in 29 patients (57%), 9 (18%) received 1 graft and underwent a Nesbit plication, (14%) received 2 grafts, 5 (10%) received 2 grafts and underwent dorsal plication, and 1 (2%) received 3 grafts. Second stage urethral reconstruction was done using a Thiersch-Duplay tube in the majority of cases. In 5 patients mild residual chordee was easily corrected at the time of second stage repair. CONCLUSIONS: In a staged repair the first priority of the initial stage is to achieve a straight phallus. While our experience indicates that a single dermal graft is sufficient in approximately 57% of cases, when it does not result in complete straightening, we have had success with placing additional graft(s) and/or performing dorsal plication. We believe that the additional penile length achieved with dermal grafting results in a dependent phallus and cosmesis preferable to that of plication only.

Adolescent↗
PubMed1995

Gender development in boys born with hypospadias.

Fetal testicular androgens in several mammalian species are responsible for the sexual differentiation of both the genitalia and the brain, the latter effect being related to behavioral sex-dimorphisms. Because prenatal endocrine abnormalities can be inferred from genital defects, studies of individuals born with anomalies potentially elucidate the contribution of androgens to the development of gender-related variation in human behavior. This study concerns the gender-role behavior of middle childhood boys (ages 6-10 years; n = 175) born with hypospadias, an androgen-related genital anomaly. Parents completed standardized gender behavior questionnaires in a postal survey. Hypospadias subjects did not show consistent differences from a community control group (n = 333) in feminine behavior, but significant, small, increases in masculine behavior were found. Severity of the hypospadias was unrelated to gender-role behavior. A number of surgery-related hospitalizations, however, were correlated with increased gender-atypical behavior. It is concluded that the hypoandrogenization associated with hypospadias does not interfere with the development of gender-typical masculine behavior.

Abnormalities, Multiple↗
PubMed1995

Intraoperative spermatic venography reconsidered.

We review our most recent experience with varicocelectomy and post-ligation venography in 58 adolescents as followup to our previously reported series. A single injection venogram confirmed the completeness of varicocele ligation in 82% of cases while 2 or more injections were required in the remainder. Venography was not performed in 8 cases because of technical difficulties in 5 or surgeon choice in 3. The recurrence rate was 8.6% and was not statistically significant whether or not venography was performed (p = 0.86). Although intraoperative spermatic venography is technically simple and safe, in our series its efficacy in diminishing the recurrence rate after varicocelectomy was unproved.

Adolescent↗
PubMed1994

The importance of catheter size in the achievement of urinary continence in patients undergoing a Young-Dees-Leadbetter procedure.

During the last 8 years 49 patients have undergone urinary tract reconstruction at our institution to manage urinary incontinence. Of these patients 25 underwent a Young-Dees-Leadbetter procedure, of whom 13 boys and 6 girls were available for followup. Average patient age was 12.2 years and mean followup is 30.2 months. Augmentation cystoplasty was required in 14 cases. All 12 patients (100%) undergoing tubularization over an 8F catheter attained diurnal continence, and 92% are completely continent day and night. Furthermore, the 6 patients in whom augment capacities attained were less than the expected volume for age were also completely continent when tubularization was performed over an 8F catheter. We conclude that creation of a narrow (8F) Young-Dees-Leadbetter bladder neck tubularization leads to an increased likelihood of diurnal and nocturnal continence but precludes spontaneous unaided voiding to completion. Furthermore, achievement of urinary continence appears to be less dependent on bladder capacity when it is coupled with a narrow Young-Dees-Leadbetter tubularization.

Adolescent↗
PubMed1994

Endoscopic management of bladder calculi following augmentation cystoplasty.

OBJECTIVES: We sought to evaluate the effectiveness and utility of an endoscopic approach to calculi that develop in the bladders of children following augmentation cystoplasty. In addition, we aimed to determine the indications for open vesicolithotomy. METHODS: We reviewed our experience between 1981 and 1993 with 26 children who formed bladder calculi following augmentation cystoplasty. Data were retrieved retrospectively with respect to management approach and outcome. RESULTS: Nineteen cases were managed cystoscopically using simple extraction and/or electrohydraulic lithotripsy; 3 cases required open vesicolithotomy and four calculi passed spontaneously. Complete stone extraction was achieved after a single endoscopic treatment in every case approached in this fashion. Every patient resumed preoperative voiding patterns and there were no infections, strictures, or other complications. Calculi reformed in 4 patients and were successfully managed endoscopically. CONCLUSIONS: An endoscopic approach to bladder calculi is a safe and effective method of managing this increasingly prevalent problem in children following augmentation cystoplasty even in the presence of a reconstructed bladder neck. Open vesicolithotomy should be reserved for the very large stone burden.

Adolescent↗
PubMed1992

Accessory and ectopic scrotum with VATER association.

Scrotal ectopia or accessory scrotum are both rare conditions. This report describes a neonate with both abnormalities, who also has elements of the VATER association. This constellation of anomalies has not been previously described.

Abnormalities, Multiple↗
PubMed1992

Contrast-induced central nervous system toxicity after radiographic evaluation of the lower urinary tract in myelodysplastic patients with ventriculoperitoneal shunts.

Routine urological evaluation of children with myelomeningocele helps to identify those at risk for upper urinary tract deterioration. We report on 2 patients with ventriculoperitoneal shunts who had intraperitoneal rupture of the bladder. Reflux of contrast media via or around the ventriculoperitoneal shunt into the cerebral ventricles occurred in both patients, resulting in severe neurological insult.

Brain Diseases↗
PubMed1989

Complications of bladder mucosal graft.

A bladder mucosal graft for urethral reconstruction was performed on 79 patients who had complicated conditions in which local penile or preputial skin was not available. The major and minor complication rates for this procedure were 15.2 and 43 per cent, respectively, the latter representing mucosal glanular protrusion obviated by a technical alteration. Given the difficulty of these cases these complication rates are deemed acceptable in such patients.

Humans↗
PubMed1988

Hypospadias.

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Humans↗
PubMed1987

Acquired undescended testes.

Three cases of reascent of a previously unequivocally documented descended testis have been encountered. Chorionic gonadotropin treatment was initially attempted in each child and was successful in causing descent of the involved testis in one. The testes of the other two boys were successfully brought down surgically. Possible causes for testicular reascent are presented and the pertinent literature is reviewed. These cases illustrate the need for continued diligence and interval examination of the pediatric scrotum throughout childhood.

Child↗
PubMed1986

Traumatic ureteropelvic disruption in the child.

Traumatic disruption of the ureter from the pelvis is a rare injury of the child's urinary tract that probably results from extreme hyperextension of the trunk. The child may be remarkably free from other injuries whereas such trauma is usually lethal in the adult. Hydronephrosis may not occur immediately. Three cases are reported.

Child, Preschool↗
PubMed1986

Bladder mucosa graft for construction of male urethra.

A graft of bladder mucosa was used to construct the urethra in 35 males. Most were complicated hypospadias cases. In all patients there was insufficient prepucial or penile shaft skin available to use for making a substitute urethra. The bladder mucosa worked well in every case. There were no fistulas. There was no case with stenosis of the anastomosis between the graft and the patient's own urethral tissue. The one possible disadvantage encountered in using bladder mucosa was its tendency to become edematous and irritated if the graft was redundant at the meatus, a situation that is not encountered with grafts made from prepucial skin or skin taken from a remote area. Revision of the meatus was required in six patients. It is the experience of the authors that a free graft that is covered by two well vascularized layers, subcutaneous tissue, and skin, fares as well or better than a graft with a vascular pedicle.

Adolescent↗