Biomedical subjects

Joseph G Borer

Publications and source records attributed to Joseph G Borer.

18 recordsLinked to original sources

PubMed2007

Robotic surgery in the pediatric airway: application and safety.

OBJECTIVE: To assess the application and safety of transoral robotic surgery in the pediatric airway. DESIGN: An institutional review board-approved study. Experimental laryngeal surgery was performed on 4 pediatric cadaver larynxes as controls. Application of robotic equipment for laryngeal surgery was attempted on 5 patients. SETTING: Tertiary care pediatric medical center. PATIENTS: Five patients with laryngeal cleft and 4 pediatric cadaver larynxes. INTERVENTIONS: (1) The da Vinci Surgical Robot (Intuitive Surgical Inc, Sunnyvale, Calif) was used on 4 cadaver larynxes and assessed for the dexterity, precision, and depth perception that it allowed the surgeon during laryngeal surgery. Procedures were documented with still and video photography. (2) The da Vinci Surgical Robot was used through a transoral approach to attempt repair of a laryngeal cleft in 5 pediatric patients who were under spontaneously breathing general anesthesia. RESULTS: (1) Use of the surgical robot on cadaver larynxes provided great dexterity and precision, delicate tissue handling, good 3-dimensional depth perception, and relatively easy endolaryngeal suturing. (2) The surgical robot could not be used for repair of laryngeal cleft on 3 patients owing to limited transoral access. However, 1 patient with a type 1 laryngeal cleft and 1 patient with a type 2 laryngeal cleft underwent transoral robotic repair with great success. CONCLUSIONS: Surgical robots provide the ability to manipulate instruments at their distal end with great precision, increased freedom of movement, and excellent 3-dimensional depth perception. The size of the equipment can be a limiting factor with regard to the application and success of the transoral approach to airway surgery. We believe that further advances in device technology and a new generation of robotic equipment will facilitate the incorporation of surgical robotics in the advancement of minimally invasive endoscopic airway surgery.

Adolescent↗

PubMed2006

Bladder and external urethral sphincter function after prenatal closure of myelomeningocele.

PURPOSE: We compared urodynamic findings in patients who underwent prenatal closure of myelomeningocele with those of patients who underwent postnatal closure, and equivalent lower urinary tract evaluations. MATERIALS AND METHODS: Urodynamic studies of 5 patients (2 boys, 3 girls) who underwent prenatal closure of myelomeningocele were compared to those of 88 patients with similar level lesions who underwent repair postnatally between 1979 and 2002. RESULTS: All 5 patients in the prenatally treated cohort had lower lumbosacral lesions on neurological examination. These patients displayed no evidence of electromyographic activity, indicating complete denervation of the external sphincter. In comparison 34 of the 88 patients in the postnatal cohort (39%) lacked sphincter activity at newborn examination, with similar findings noted at 1-year evaluation. In terms of bladder function all 5 patients in the prenatal cohort exhibited detrusor overactivity, compared to 33 of the 88 patients (38%) in the postnatal cohort at the newborn examination, with similar findings at 1-year evaluation. CONCLUSIONS: Fetal closure of myelomeningocele is associated with a higher incidence of complete denervation of the external urethral sphincter and detrusor overactivity compared to postnatal closure. Patients who undergo this novel procedure should undergo urodynamic studies in the immediate newborn period and should be under close postnatal surveillance to document possible tethering of the spinal cord, urinary incontinence and increased detrusor pressures.

Child, Preschool↗

PubMed2006

Neurogenic bladder dysfunction after sacrococcygeal teratoma resection.

PURPOSE: SCT treatment in newborns consists of surgery and selective chemotherapy. Few reports document urological sequelae using this approach. This review focuses on the urological and neurourological findings following SCT treatment in the newborn period. MATERIALS AND METHODS: We reviewed the records of all infants with SCT resected in early infancy who underwent urodynamic evaluation for bladder dysfunction between 1986 and 2004. The radiological, neurological and urodynamic findings, and postoperative incontinence management were analyzed. RESULTS: We analyzed UDS of 14 patients who presented with urinary infection or incomplete bladder emptying after SCT resection. At the time of UDS an abnormal neurological examination was noted in 5 patients (36%). Detrusor overactivity was seen in 8 patients, underactivity in 2 and normal activity in 4. Abnormal urethral sphincter EMG potentials were observed in 7 of 13 patients (54%). Five of 13 patients (38%) had sphincter dyssynergia during voiding. Consequently, CIC was needed in 11 of the 14 patients (79%) to empty the bladder, of whom 5 also required anticholinergics to improve detrusor compliance and dryness. Only 3 patients voided spontaneously with normal bladder and sphincter function, of whom 2 were toilet trained. Hydronephrosis was seen in 6 patients and reflux was noted in 7 (including 5 of 6 with hydronephrosis). Antireflux surgery was performed in 6 patients, all of whom had up to grade 4 reflux due to recurrent urinary tract infection. One girl with grade 2 reflux had spontaneous resolution. CONCLUSIONS: SCT and its treatment can produce neurourological dysfunction of the lower urinary tract with high grade reflux, and abnormal bladder and urethral function. Complete assessment, including urodynamic studies, is imperative preoperatively and postoperatively. Constant vigilance is required to maintain as near normal bladder function as possible and to prevent upper urinary tract injury.

Adolescent↗

PubMed2006

Pediatric robot assisted laparoscopic dismembered pyeloplasty: comparison with a cohort of open surgery.

PURPOSE: We assessed the usefulness of RALP in children and compared an age matched cohort undergoing OPN to RALP for safety, efficacy, operative time, blood loss, in-hospital narcotic use and LOS. MATERIALS AND METHODS: We performed a retrospective case-control study from 2000 to 2004 of 33 patients undergoing RALP and 33 undergoing OPN. Average age of each group was not significantly different (RALP 7.8 years vs OPN 7.6 years, p = 0.75). Mean followup of RALP and OPN groups was 10 and 21 months, respectively. RESULTS: Etiology of the obstruction was not significantly different. Mean operative time was significantly less for OPN (181 minutes vs 219 minutes for RALP, p = 0.031). As RALP experience increased, operative times improved and approached the OPN experience. RALP complications included 1 patient requiring reoperative surgery vs no complications in the OPN group (p = 0.15). Patients undergoing RALP had a mean LOS of 2.3 days compared to 3.5 days for OPN (p <0.001). Total narcotic requirements were significantly less in the RALP group (p = 0.001). All patients in the OPN and 31 in the RALP group had either resolution of hydronephrosis, improvement in drainage or relief of symptoms. CONCLUSIONS: We documented the safety and efficacy of RALP in children. RALP showed advantages of decreased hospital stay, decreased narcotic use and operative times approaching those of open surgery. RALP is an option for pyeloplasty, and as robotic technology improves, this method of repair may become the minimally invasive treatment of choice.

Adolescent↗

PubMed2006

Robotic surgery for ureteropelvic junction obstruction.

PURPOSE OF REVIEW: Robotic surgery for ureteropelvic junction obstruction is an evolving technique. We review the current literature related to this technique and discuss the current technique and outcomes of robotic pyeloplasty. RECENT FINDINGS: Recent advances in robotic-assisted surgery have allowed the successful completion of complex reconstructive procedures in the pediatric population, including the robotic-assisted laparoscopic pyeloplasty. Robotic-assisted laparoscopic pyeloplasty can be performed by either a transperitoneal or a retroperitoneal approach. Overall, the procedure is safe, efficacious, and may have particular benefits over open surgery. SUMMARY: The evolution of laparoscopic surgery in pediatric urology has been limited by the challenge of laparoscopic suturing. Robotic systems may offer the means to overcome this major impediment of laparoscopic surgery. The results of this review demonstrate that robotic-assisted laparoscopic pyeloplasty is safe, technically feasible, and efficacious in the pediatric population, and may be comparable to a contemporary series of open pyeloplasty. As the technology continues to evolve, the efficiency of the robotic system is likely to improve; however, the ultimate role of robotic-assisted or computer-assisted surgical systems remains unclear. To further determine the role of robotic systems in the management of ureteropelvic junction obstruction, rigorous prospective research is needed that combines surgical and technical outcomes with overall subjective or cosmetic outcome and economic analysis.

Humans↗

PubMed2005

Pediatric retroperitoneal laparoscopic partial nephrectomy: comparison with an age matched cohort of open surgery.

PURPOSE: We assessed the clinical usefulness of laparoscopic retroperitoneal partial nephrectomy (LRPN) in children by comparing an age matched cohort of pediatric patients undergoing open partial nephrectomy (OPN) to those undergoing LRPN for safety, efficacy, operative time, blood loss, inpatient narcotic use and length of hospitalization. MATERIALS AND METHODS: A retrospective case-control study was performed of 1 group undergoing LRPN (treatment arm) and 1 undergoing OPN (controls) between 1997 and 2003. The 14 patients in each group were matched by age (mean 1.9 years in LRPN group vs 2.2 years in OPN group, p = 0.98) and gender. RESULTS: All patients had duplication anomalies. Mean operative time was 194 minutes in the LRPN group and 193 minutes in the OPN group (p = 0.83). The single complication in the LRPN group was a urinoma that did not require intervention. There were no complications in OPN group. LRPN patients had a mean hospitalization of 1.7 days compared to 4.7 days in OPN patients (p = 0.001). Intraoperative narcotic requirements were higher in the LRPN group (0.59 vs 0.22 mg/kg, p = 0.04). Postoperative narcotic requirements were significantly less in the LRPN group (0.44 vs 1.53 mg/kg, p = 0.04). Similar findings were noted in a subanalysis of patients younger than 2 years. All patients had documented postoperative ipsilateral renal growth. Mean followups in the treatment and control groups were 26 and 25 months, respectively. CONCLUSIONS: Retroperitoneal laparoscopic partial nephrectomy in small children was shown to be safe and effective. It had equivalent operative times, and decreased postoperative narcotics and hospitalization relative to the open approach, and, therefore, is a potentially advantageous technique.

Case-Control Studies↗

PubMed2005

Balanitis xerotica obliterans in boys.

PURPOSE: Balanitis xerotica obliterans (BXO) is a chronic dermatitis of unknown etiology most often involving the glans and prepuce but sometimes extending into the urethra. We report our 10-year experience with BXO in pediatric patients. MATERIALS AND METHODS: Our pathology database was queried for all tissue diagnoses of BXO from 1992 to 2002. Available charts were reviewed and patient presentation, clinical and referral history, operative procedure(s) and postoperative course were recorded. RESULTS: A total of 41 patients had a tissue confirmed diagnosis of BXO. Median patient age was 10.6 years. Of the patients 85% were 8 to 13 years old and all had referrals available for review. The most common referral diagnoses were phimosis (52%), balanitis (13%) and buried penis (10%). No patient had the diagnosis of BXO at referral. Of the patients 19 (46%) underwent curative circumcision or redo circumcision and had no recurrence at a mean followup of 12.5 months (range 1 to 57). A total of 11 patients (27%) had BXO involvement of the meatus and underwent circumcision combined with meatotomy or meatoplasty. Nine patients (22%) required extensive plastic operation(s) of the penis, including buccal mucosa grafts in 2. CONCLUSIONS: The incidence of BXO in pediatric patients may be higher than previously reported, with the diagnosis rarely made by pediatricians. Our study demonstrates that older patients, those with BXO involvement of the meatus and those with a history of surgery for BXO tend to have a more severe and morbid clinical course.

Balanitis↗

PubMed2005

Early outcome following complete primary repair of bladder exstrophy in the newborn.

PURPOSE: Complete primary repair of bladder exstrophy (CPRE) represents a paradigm shift from the staged approach for surgical management. We present early clinical outcomes in our patients following CPRE. MATERIALS AND METHODS: From 1996 to 2004 all newborns with bladder exstrophy were treated with CPRE within 48 hours of birth. We reviewed parameters including transfusions (packed red blood cells), urethral meatal position, complications, findings on renal ultrasound and renal scan, and post-CPRE procedures and infections. RESULTS: A total of 16 boys and 7 girls were treated with CPRE. Followup ranged from 8 to 96 months. Twelve boys (75%) and 2 girls (29%) received packed red blood cells at CPRE (p = 0.066). The tubularized urethral plate could not be brought to the penile tip, resulting in hypospadias in 9 of 11 boys (82%) with the running suture technique and only 1 of 5 boys (20%) with the interrupted technique (p = 0.036). Of the 23 patients 6 had a total of 8 complications after CPRE. Vesicoureteral reflux was present in 17 of 23 patients. After CPRE a total of 93 endoscopic/surgical procedures (median 4, range 0 to 16 per patient) were performed. Five patients had 1 to 4 episodes of pyelonephritis, 16 of 23 had 1 or more episodes of asymptomatic bacteriuria and 5 had cortical defects on renal scan. CONCLUSIONS: We recommend that urethral closure during CPRE be performed with interrupted suture technique to prevent hypospadias. An aggressive approach should be taken toward reflux in the setting of urinary infection. Consideration should be given for repair of all aspects of the defect during CPRE, including bilateral ureteral reimplantation.

Bladder Exstrophy↗

PubMed2005

Magnetic resonance imaging of pelvic musculoskeletal and genitourinary anatomy in patients before and after complete primary repair of bladder exstrophy.

PURPOSE: We characterize pelvic soft tissue and bony anatomy of patients before and after complete primary repair of exstrophy (CPRE). MATERIALS AND METHODS: We evaluated 15 measurements on pelvic magnetic resonance imaging (MRI) in patients who underwent CPRE without osteotomy at our institution from 1996 to 2004. MRI protocols included axial, sagittal and coronal fast spin echo proton density sequences. Measurements were compared before and after CPRE using a paired t test, and between patients after CPRE, and age and gender matched controls using linear regression adjusting for the matched case-control groups. Patients older than 3 years with continent intervals longer than 3 hours after CPRE were compared to age and gender matched controls using linear regression. RESULTS: A total of 29 MRIs in 18 patients with exstrophy were available for analysis. Median patient age at postoperative MRI was 25 months (range 4 to 36). The configuration of the post-CPRE pelvis was significantly different from that of controls in all parameters measured including wider symphyseal diastasis (34.5 mm vs less than 1 mm) and more obtuse iliac wing (121 degrees vs 98 degrees), puborectalis (94 degrees vs 49 degrees) and ileococcygeus angles (111 degrees vs 98 degrees ). The anatomy of continent patients after CPRE was not significantly different from that of controls in most parameters measured. CONCLUSIONS: Comparison of the pelvic anatomy in patients before and after CPRE suggests that after CPRE patients have parameters that more closely approximate, but are still significantly different, from those of control patients. Patients with greater than 3-hour continent intervals after CPRE have anatomic parameters most similar to those of age matched controls.

Bladder Exstrophy↗

PubMed2005

Bladder growth and development after complete primary repair of bladder exstrophy in the newborn with comparison to staged approach.

PURPOSE: We assessed bladder growth and dynamics following complete primary repair of bladder exstrophy (CPRE) compared to the staged approach. MATERIALS AND METHODS: We reviewed the records of 16 boys and 7 girls who underwent CPRE within 3 days of life from 1996 to 2004 and compared them to the records of 8 boys and 6 girls treated with a staged repair from 1979 to 1996. Screening methods included voiding cystourethrogram, radionuclide cystogram and urodynamic study. We estimated growth curves for bladder capacity following repair in each group, and compared percent predicted bladder capacity (PPBC), compliance and detrusor overactivity between the CPRE and staged repair groups following bladder neck reconstruction. RESULTS: Bladder capacity in the staged repair group was 69.8 ml (95% CI 46.7-104.4) immediately after bladder neck reconstruction and increased by 15.0% per year thereafter (95% CI 6.2-24.5, p = 0.002). In the CPRE group bladder capacity was 29.0 ml (95% CI 21.3-39.5) initially and increased by 28.9% per year thereafter (95% CI 17.4-41.5, p <0.001). PPBC started at 45.6% (95% CI 35.7-55.5) and increased 1.2% per year (95% CI -1.1-3.5, p = 0.29) following repair for all genders and surgery groups. Compliance was 124.4% (95% CI 22.6-310.7, p = 0.01) greater in the CPRE group at all times following repair. Detrusor overactivity was present in 0 of 19 patients in the CPRE group and 6 of 13 (46%) in the staged group (exact p = 0.002). CONCLUSIONS: Within the CPRE group bladder stability was universal, and sphincter electromyography was normal suggesting no neuromuscular compromise of the pelvic floor. At early followup, our results suggest that PPBC is equivalent irrespective of gender or management. Further objective evaluation is needed in both groups.

Bladder Exstrophy↗

PubMed2005

Intermittent testicular torsion: diagnostic features and management outcomes.

PURPOSE: Intermittent testicular torsion (ITT) is a poorly characterized condition but harbors potentially serious implications with regard to testicular viability. We report better characterization of the diagnostic features of ITT. MATERIALS AND METHODS: We performed a retrospective review of all patients 1 to 18 years old seen from 1997 to 2003 at our institution diagnosed with ITT. Patients with acute scrotal pain and spontaneous resolution who underwent bilateral testicular fixation were included in the study. RESULTS: A total of 50 patients meeting the inclusion criteria were identified with mean age at presentation of 12.2 years (range 4 to 17). The mean number of painful episodes before surgery was 4.3 (range 1 to 30). The most common presenting features were severe pain of rapid onset and resolution. Nausea and/or vomiting was reported in a quarter of the patients. Finding of a horizontal lie of the testes on examination was significantly associated (p <0.05) with the existence of the bell-clapper deformity. All patients underwent surgical fixation of the testes. There were no postoperative complications. Of 38 patients (97%) for whom followup was available 37 had complete resolution of symptoms (mean followup 7.9 months). CONCLUSIONS: ITT should be a diagnostic consideration in patients who present with recurrent acute scrotal pain with rapid spontaneous resolution. Recurrent severe pain with rapid onset and resolution seems to be highly characteristic. Horizontal lie on examination is highly correlated with the bell-clapper deformity at surgical exploration. Surgery may be recommended in these patients as it appears to result in pain relief in the majority, is likely to prevent future testicular infarction and is associated with low morbidity.

Adolescent↗

PubMed2005

Testicular hypotrophy does not correlate with grade of adolescent varicocele.

PURPOSE: Testicular hypotrophy is the most widely accepted indication for correcting adolescent varicocele. Previous studies in adolescents have shown a relationship between increasing grade of varicocele and the likelihood of testicular hypotrophy. As this relationship has significant clinical implications, we studied the correlation between grade and testicular volume disproportion in our adolescent varicocele population. MATERIALS AND METHODS: We reviewed the adolescent varicocele database at our institution. A total of 168 patients 8 to 21 years old were studied. We routinely calculated testis volumes using scrotal ultrasound. Testicular disproportion was calculated using the equation [(size of unaffected testis) - (size of affected testis)]/(size of unaffected testis) x 100%. Disproportion was categorized as less than 10%, 10% to 20% and more than 20%. Varicoceles were graded by an attending urologist with the patient standing, using the system of Dubin and Amelar. Analysis of variance and Pearson chi-square indicated no significant differences in volume differential between varicocele grades. RESULTS: Mean +/- SD volume differential was 18% +/- 15% for grade I, 25% +/- 20% for grade II and 19% +/- 14% for grade III. ANOVA revealed no significant difference in mean volume differential between the 3 varicocele grades (p = 0.10). When categorizing patients into 3 levels of volume differential (less than 10%, 10% to 20%, more than 20%) no significant correlation was observed between varicocele and volume differential (p = 0.48, chi-square test). CONCLUSIONS: Grade of varicocele does not correlate with presence or severity of testicular disproportion in adolescent boys with varicocele as measured by scrotal ultrasound.

Adolescent↗

PubMed2004

Current management of bladder exstrophy.

Bladder exstrophy is a complex anomaly involving the urinary, genital, and intestinal tracts and the musculoskeletal system. The diagnosis is made typically at the newborn examination or on fetal ultrasonography that is performed by an experienced observer. Management of bladder exstrophy presents several challenges, beginning with initial repair using the more conventional staged approach or the recently re-popularized complete primary repair technique. Major goals in the management of bladder exstrophy are preservation of normal kidney function, close observation for development of adequate bladder function including urinary continence, and provision of acceptable cosmesis and function of the external genitalia. This article provides a brief overview of bladder exstrophy and a detailed description of modern management.

Bladder Exstrophy↗

PubMed2004

Is adolescent varicocele a progressive disease process?

PURPOSE: We determined whether there was evidence of progression in either varicocele grade or testicular volume differentials over time in our adolescent varicocele population. MATERIALS AND METHODS: A total of 41 boys 7.3 to 19 years old (mean age 13.7, SD 2.5) were seen at sequential visits. At each visit varicocele grade was determined by the attending urologist and ultrasound calculated testicular volume differential was determined by an attending ultrasonographer. A senior staff statistician performed statistical analysis of the sequential data. RESULTS: The varicocele grade data were analyzed using the nonparametric Wilcoxon test and no significant evidence of progression on sequential visits was demonstrated. Similarly, the serial volume differential data were assessed using the paired t test and no significant evidence for progression of testicular volume differentials was demonstrated. CONCLUSIONS: In our study population neither varicocele grade nor change in testicular volume differentials increased over time in a statistically significant manner. These results argue against the concept that adolescent varicocele is a progressive disease process.

Adolescent↗

PubMed2003

A nuclear form of the heparin-binding epidermal growth factor-like growth factor precursor is a feature of aggressive transitional cell carcinoma.

Heparin-binding epidermal growth factor-like growth factor (HB-EGF), a member of the ErbB receptor ligand family, exists in distinct molecular forms with disparate biological activities. Previous studies have shown that the HB-EGF precursor, proHB-EGF, localizes to the cytoplasm of transitional cells of the human bladder urothelium and that the soluble form of the growth factor is an autocrine urothelial cell mitogen. In this study, we identify a potential role for proHB-EGF in transitional cell carcinoma (TCC) of the bladder. In an analysis of 33 TCC specimens and 8 normal controls, proHB-EGF, identified using an antibody directed against the cytoplasmic tail domain, localized to cell nuclei in a manner that correlated positively with tumor stage and grade (P < 0.001). The ability of proHB-EGF to localize to the nucleus was independently confirmed in a TCC cell line (TCCSUP), in which approximately 40% of transfected proHB-EGF was found to reside in the nuclear compartment. In Kaplan-Meier survival analysis, TCC patients with >20% proHB-EGF-positive cell nuclei demonstrated markedly reduced survival compared with patients with <20% proHB-EGF-positive nuclei (P < 0.005, log-rank test). In multivariate analysis, nuclear localization of proHB-EGF of >20% was an independent prognostic indicator of disease-specific mortality. This is the first report in any cell type that HB-EGF is capable of translocating to the cell nucleus. In addition, our findings suggest that nuclear proHB-EGF may play a role in disease progression in bladder cancer and possibly other cancers.

Aged↗

PubMed2003

Fibroepithelial polyps causing ureteropelvic junction obstruction in children.

PURPOSE: Fibroepithelial polyps are benign mucosal projections that can be found throughout the urinary system. We review our experience with fibroepithelial polyps of the ureteropelvic junction in children to define more clearly this entity and its outcome following treatment. METHODS: We reviewed the records of all children with fibroepithelial polyps causing ureteropelvic junction obstruction treated at our institution between December 1967 and February 2002. RESULTS: Nine patients 6 weeks to 9 years old had 11 ureteropelvic junction obstructions secondary to fibroepithelial polyps, representing a 0.5% incidence of all ureteropelvic junction obstructions seen during that period. The majority of the patients were male (89%) and had obstruction on the left side (78%). Only 22% of the patients had a diagnosis of obstructing polyps suggested preoperatively. All patients underwent dismembered pyeloplasty but 1 required subsequent nephrectomy due to progressive loss of renal function. All lesions were characterized microscopically by polypoid projections of fibrous tissue covered by epithelium and demonstrating varying degrees of inflammation. No recurrences were seen during a mean followup of 44 months. CONCLUSIONS: Fibroepithelial polyps are rare lesions that cause ureteropelvic junction obstruction in children, primarily in males and on the left side. Filling defects were diagnosed preoperatively in 22% of the patients in this series. Excision and dismembered pyeloplasty were curative, and recurrences were not observed. The etiology of this disease remains obscure.

Child↗

PubMed2002

Rate and predictors of spontaneous resolution of prenatally diagnosed primary nonrefluxing megaureter.

PURPOSE: We assessed clinical and ultrasound predictors of the spontaneous resolution of prenatally diagnosed, primary nonrefluxing megaureter. MATERIALS AND METHODS: Primary nonrefluxing megaureter was prenatally diagnosed in 54 neonates from 1993 to 1998, including 15 in whom it was bilateral (69 megaureters). Median followup period from birth to the last radiology examination was 25.8 months (range 2.3 to 72). RESULTS: Of the patients 10 underwent surgical repair for severe hydroureteronephrosis, including decreasing renal function on diuretic renography in 1, and an episode of bilateral obstruction and acute renal failure in 1. Hydroureteronephrosis resolved in 39 cases (72%) and persisted in 5 at 30 to 72 months of followup. Laterality, gender and retrovesical ureteral diameter had no significant effect on the resolution rate (p >0.05). Mean initial ureteral diameter in patients with resolution was less than in those without resolution and in those who underwent surgery (0.8 versus 1.15 and 1.32 cm., respectively). Presenting hydronephrosis grade was a significant predictor of the resolution rate (p = 0.03). Grades 1 to 3 hydronephrosis resolved at a median age of 12.9, 23.9 and 34.6 months, respectively (range 4.1 to 66). In patients in whom grades 4 and 5 hydronephrosis resolved the median age at resolution was 48.5 months. CONCLUSIONS: Most cases of prenatally diagnosed, primary nonrefluxing megaureter resolve spontaneously. Grades 1 to 3 hydronephrosis tend to resolve between ages 12 and 36 months. For these grades followup intervals may be progressively elongated after a pattern of improving hydronephrosis has been established. In children with grade 4 or 5 hydronephrosis, or a retrovesical ureteral diameter of greater than 1 cm. the condition may resolve slowly and require surgery.

Child↗

PubMed2002

Testicular volume: comparison of orchidometer and US measurements in dogs.

PURPOSE: To compare the accuracy and precision of orchidometer and ultrasonographic (US) measurements of testicular volume in a canine model. MATERIALS AND METHODS: Volume measurements of 18 canine testes were obtained by using Prader and Rochester orchidometers. Testes were scanned with two linear-array US transducers with imaging frequencies of 6-13 MHz and 5-10 MHz. For each transducer, testicular volumes were calculated by using three formulas: length (L) x width (W) x height (H) x 0.52, L x W(2) x 0.52, and L x W x H x 0.71. Testes were weighed following bilateral orchiectomies. True testicular volume was determined by using the formula volume = weight/density. Paired t tests were used to assess whether mean measurement biases differed significantly from zero. The relationship between true and measured volume was evaluated with a linear regression model. RESULTS: US volume measurements demonstrated lower variability and better linear fit compared with orchidometry (R(2) = 0.75-0.90 vs R(2) = 0.14-0.38). The formula L x W x H x 0.71 had the smallest mean bias relative to true volume with use of either transducer over the entire volume range. CONCLUSION: US methods of testicular volume measurement are more accurate and precise than orchidometry. The formula L x W x H x 0.71 provides a superior estimate of testicular volume and should be used in clinical practice.

Animals↗