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R S Hurwitz

Publications and source records attributed to R S Hurwitz.

16 recordsLinked to original sources
PubMed2001

How well does contralateral testis hypertrophy predict the absence of the nonpalpable testis?

PURPOSE: We assessed the accuracy of contralateral testis hypertrophy for predicting monorchia in patients with a nonpalpable testis. MATERIALS AND METHODS: From May 1993 to September 1998 we evaluated 60 patients 7 months to 11 years old for a unilateral nonpalpable testis. Four patients were excluded from study who had received human chorionic gonadotropin or had signs of puberty. We correlated contralateral testis hypertrophy, defined as testis volume greater than 2 cc or testis length greater than 2 cm., with presence or absence of the nonpalpable testis. We also recorded the degree to which contralateral testis length less than 2.1 cm. correlated with the presence or absence of the nonpalpable testis. Laparoscopy and open exploration were performed in 52 and 4 cases, respectively. RESULTS: Contralateral testis hypertrophy greater than 2 cm. was noted in 16 patients, including 14 (87.5%) with monorchia and 2 (12.5%) with an intra-abdominal testis. Of the 15 patients with a contralateral measurement of 1.8 to 2.0 cm. 14 had monorchia (93%) and 1 had a tiny ovotestis. Of the 25 patients with a contralateral measurement of less than 1.8 cm. 13 (52%) had testes that were intra-abdominal in 11 and canalicular in 2. The optimal cutoff value for contralateral enlargement was 1.8 cm. (p = 0.00061). The most common laparoscopic finding in patients with contralateral testis hypertrophy greater than 2 cm. was blind ending vessels proximal to the internal ring in 56%. CONCLUSIONS: Contralateral testis hypertrophy is common in patients with a nonpalpable testis. Hypertrophy 1.8 cm. or greater predicts monorchia with an accuracy of about 90%. The finding of contralateral testis hypertrophy provides useful information for preoperative counseling, allowing us to inform parents that the nonpalpable testis is most likely absent. Exploration is still required. Laparoscopy is particularly advantageous in contralateral testis hypertrophy since it was the only procedure required in about half of our cases.

Child↗
PubMed1997

Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children.

PURPOSE: The American Urological Association convened the Pediatric Vesicoureteral Reflux Guidelines Panel to analyze the literature regarding available methods for treating vesicoureteral reflux diagnosed following a urinary tract infection in children and to make practice policy recommendations based on the treatment outcomes data insofar as the data permit. MATERIALS AND METHODS: The panel searched the MEDLINE data base for all articles from 1965 to 1994 on vesicoureteral reflux and systematically analyzed outcomes data for 7 treatment alternatives: 1) intermittent antibiotic therapy, 2) bladder training, 3) continuous antibiotic prophylaxis, 4) antibiotic prophylaxis and bladder training, 5) antibiotic prophylaxis, anticholinergics and bladder training, 6) open surgical repair and 7) endoscopic repair. Key outcomes identified were probability of reflux resolution, likelihood of developing pyelonephritis and scarring, and possibility of complications of medical and surgical treatment. RESULTS: Available outcomes data on the various treatment alternatives were summarized in tabular form and graphically, and the relative probabilities of possible outcomes were compared for each alternative. Treatment recommendations were based on scientific evidence and expert opinion. The panel concluded that only a few recommendations can be derived purely from scientific evidence of a beneficial effect on health outcomes. CONCLUSIONS: For most children the panel recommended continuous antibiotic prophylaxis as initial treatment. Surgery was recommended for children with persistent reflux and other indications, as specified in the document.

Child↗
PubMed1997

Scrotal cystic lymphangioma: the misdiagnosed scrotal mass.

PURPOSE: We report 7 cases of scrotal cystic lymphangioma and review the literature on this unusual lesion, which is often misdiagnosed as other conditions and treated incorrectly. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 7 patients with scrotal cystic lymphangioma treated from 1984 to 1996 at 5 institutions. RESULTS: Mean patient age at presentation was 3 years and painless scrotal swelling was the most common symptom. Physical examination demonstrated an unusual cystic scrotal mass with a normal testis and cord in most patients, and ultrasound in 4 showed a complex septated cystic mass. Preoperative misdiagnosis in all 7 patients included hernia, hydrocele, hematocele, varicocele and possible torsion. In 6 children the lesions were more extensive than expected with deep perineal and/or inguinal involvement, including 2 who also had pelvic and retroperitoneal extension. Incomplete excision led to recurrence in 4 patients. CONCLUSIONS: Scrotal cystic lymphangioma presents as an unusual cystic scrotal mass. Although misdiagnosis has been common, awareness of the characteristic features of this lesion should lead to the correct preoperative diagnosis. When lymphangioma is suspected, imaging of the adjacent inguinal, perineal and pelvic regions should be performed. Complete excision is mandatory to prevent recurrence.

Child, Preschool↗
PubMed1994

Nonsurgical management of threatened upper urinary tracts and incontinence in children with myelomeningocele.

The 2 major urological objectives in treating the child with myelomeningocele are to preserve renal function and achieve continence. We report our success in managing these cases with nonsurgical therapy. From 1981 to 1991, 45 patients with myelomeningocele 1 to 15 years old were evaluated urodynamically before and after initiating nonsurgical treatment. Pretreatment urodynamics identified 2 groups. Group 1 consisted of 31 patients with leak point pressure of 40 cm. water or more of whom 10 had grades II to V/V vesicoureteral reflux and 4 had moderate or severe hydronephrosis. Group 2 consisted of 14 incontinent patients with leak point pressure of less than 40 cm. water and no reflux or hydronephrosis. Both groups were treated with intermittent catheterization, anticholinergic medications and fluid restriction. Within a mean followup of 5.5 years nonsurgical intervention resulted in lowering maximum detrusor pressure at maximum cystometric capacity to less than 40 cm. water in 22 of 31 group 1 patients (71%), and in resolving vesicoureteral reflux in 7 of 10 (70%) and hydronephrosis in 3 of 4 (75%) group 1 patients. Of 4 patients in group 1 with persistent high grade vesicoureteral reflux or severe hydronephrosis 3 (10%) required augmentation cystoplasty. With nonsurgical management 18 patients (40%) were completely continent, 18 (40%) required 2 or less pads daily and 9 (20%) required more than 2 pads daily. Nonsurgical management alone was effective in preserving the upper urinary tract in 90% of patients and it provided satisfactory continence in 80%. Surgical management should be reserved for the minority of patients whose upper tract changes do not resolve and for those whose degree of continence is not satisfactory with nonsurgical management.

Adolescent↗
PubMed1992

Variations in practice among urologists and nephrologists treating children with vesicoureteral reflux.

To analyze the current management recommendations among physicians treating children with vesicoureteral reflux, the American Urological Association Reflux Practice Guidelines Panel surveyed 100 pediatric urologists, 100 general urologists and 100 pediatric nephrologists by questionnaire, and received a 60% response. In the evaluation of a 4-year-old girl with bilateral grade 2 reflux general urologists were more likely than the other 2 groups to recommend cystoscopy and urethral dilation. At followup nuclear cystography was recommended by 76% of pediatric urologists, 48% of general urologists and 71% of pediatric nephrologists, while the latter 2 groups were less likely to recommend any subsequent upper tract evaluation. Pediatric urologists were significantly more likely to recommend antireflux surgery if the child had 1 breakthrough febrile urinary tract infection, poor compliance with medical management or persistent reflux at age 11 years. In a 6-year-old girl with unilateral grade 4 reflux and detrusor instability 44% of pediatric urologists recommended antimicrobial prophylaxis and anticholinergic therapy compared to 12% of general urologists and 6% of pediatric nephrologists. Antireflux surgery was recommended by 29% of pediatric urologists, 60% of general urologists and 59% of pediatric nephrologists. In older girls with persistent grade 2 or 3 reflux pediatric urologists were much more likely to recommend antireflux surgery. In contrast, they were less likely to recommend surgery in young girls and boys with newly diagnosed grade 4 reflux. These data demonstrate significant differences in therapeutic recommendations among pediatric urologists, general urologists and pediatric nephrologists, and suggest the need for outcomes research to determine the optimal management of children with vesicoureteral reflux.

Child↗
PubMed1991

Pediatric urinary incontinence.

A clear understanding of the current concepts, pathophysiology, and typical symptoms of voiding dysfunction and pure nocturnal enuresis usually allows the clinician to distinguish these troublesome but benign problems from true underlying pathological conditions of the urinary tract. If a careful history confirms that wetting is the only symptom, and the pattern of wetting is consistent with uninhibited bladder contractions, or if the wetting occurs only during sleep, initial empiric treatment rather than invasive investigation is our preference. On the other hand, if the wetting is associated with infection or persistent dysuria, or if the history or pattern of wetting is suggestive of anatomic or neurogenic causes, a complete investigation of the urinary tract is necessary prior to initiating therapy.

Child↗
PubMed1990

The necessity of contralateral surgical exploration in Wilms tumor with modern noninvasive imaging technique: a reassessment.

Surgical exploration of the contralateral kidney in unilateral Wilms tumor has been the standard of surgical practice. During the last decade advances in noninvasive imaging techniques (ultrasound, computerized tomography and magnetic resonance imaging) have led to more accurate definition of intrarenal pathological conditions. The intuitive question presently is whether contralateral exploration remains mandatory in Wilms tumor patients. We reviewed the records of 52 consecutive children at our institutions who underwent radiological and operative staging of the Wilms tumor from 1979 to 1988. All 48 evaluable patients underwent either preoperative computerized tomography, ultrasound and/or magnetic resonance imaging. Five bilateral Wilms tumors were diagnosed preoperatively and confirmed surgically, whereas extensive operative exploration of the contralateral kidney in the other 43 cases of radiologically diagnosed unilateral disease failed to reveal any contralateral abnormality. Thus, in all patients preoperative radiological investigation was accurate to stage the disease regarding bilaterality. With modern imaging techniques and effective chemotherapy, extensive contralateral renal exploration may no longer be mandatory to manage Wilms tumor.

Child, Preschool↗
PubMed1990

Easy method of upper-pole heminephroureterectomy in duplex systems in children.

An easy method of upper-pole heminephroureterectomy is described in which a finger is inserted into the dilated upper collecting system, and the upper pole is removed by dissecting directly against the collecting system using finger guidance. This approach prevents entry into the lower-pole collecting system, minimizes blood loss, and maximizes preservation of normal renal tissue. Easy access to the lower ureter through the same incision is facilitated by the use of the Sims vaginal retractor.

Child↗
PubMed1988

The role of percutaneous nephrostomy in the management of obstructing candidiasis of the urinary tract in infants.

We report on 5 neonates with obstructive urinary tract candidiasis in whom percutaneous nephrostomy had a major role in management. The advantages of percutaneous nephrostomy in this setting include prompt drainage of the obstructed renal pelvis or ureter, direct access to obtain specimens from the renal pelvis to confirm the diagnosis, direct irrigation of the fungus balls with amphotericin B and an access route for fragmentation of fungus balls by guide wire manipulation. In 3 cases percutaneous placement of the nephrostomy tube was successful in obtaining and maintaining access to the renal pelvis, while in 2 surgical intervention was required because of problems maintaining placement of the percutaneous catheters. Percutaneous nephrostomy with antegrade amphotericin B irrigation, coupled with systemic antifungal therapy, is the mainstay of treatment. The usefulness of ultrasonography in the early diagnosis of renal candidiasis also is emphasized.

Amphotericin B↗
PubMed1987

Chordee without hypospadias: complications and management of the hypoplastic urethra.

The surgical correction of chordee without hypospadias may be difficult and result in significant intraoperative and postoperative complications, especially when there is an associated hypoplastic type I urethra. Between 1981 and 1985 we treated 13 patients with this condition. Of the cases 9 had a type I urethra, 3 had type II and 1 had type III, according to the Devine-Horton classification. Postoperatively, glanular tilt persisted in 3 patients, ventral tethering was present in 2 and a fistula developed in 2, for a 54 per cent complication rate. Of the 7 complications 5 occurred in type I cases. Complications may arise from preserving or attempting to preserve a thin hypoplastic urethra. When the paper-thin type I urethra is associated with an abnormal meatus, the entire dysplastic urethra should be reconstructed. If the meatus is normal, clinical judgment must dictate which type I urethras may be preserved and which must be reconstructed.

Adolescent↗
PubMed1987

Cloacal exstrophy: a report of 34 cases.

A clinical review is presented on 34 patients with cloacal exstrophy who were seen between 1963 and 1986. The patients were separated into 2 main groups: classical cloacal exstrophy (type I) and variant cloacal exstrophy (type II). In the classical cases 3 surface patterns were recognized: A-hemibladders confluent cranial to the bowel, B-hemibladders lateral to the bowel and C-hemibladders confluent caudal to the bowel. Surgical reconstruction was performed in 24 patients, with a 50 per cent survival rate. However, there was marked improvement in survival from 22 per cent between 1963 and 1978 to 90 per cent between 1979 and 1986.

Abnormalities, Multiple↗
PubMed1987

Cloacal exstrophy and cloacal exstrophy variants: a proposed system of classification.

A coding system that documents the abnormalities within the cloacal exstrophy complex is presented. Analysis allows the classification of these abnormalities into classical and variant series in a logical manner. The application of the coding system to selected reported material is described and it demonstrates the similarities between apparently divergent cases.

Abnormalities, Multiple↗
PubMed1986

The anatomical course of the neurovascular bundles in epispadias.

References on the anatomical course of the neurovascular bundles of the penis in epispadias are rare. We studied the anatomy of the neurovascular bundles in 5 patients undergoing primary epispadias repair and 13 adolescents undergoing correction of erectile deformities. In all primary cases the neurovascular bundles were truly lateral as they ran along the distal and middle portions of the corporeal bodies, and became anterolateral only proximally. The bundles were identified in only 5 of 13 secondary cases and were in the same position as in the primary cases. Knowledge of this anatomy is important to protect these structures from surgical injury in cases of epispadias and exstrophy.

Adolescent↗
PubMed1982

Vaginal urethra, clitoral hypertrophy and accessory phallic urethra: a rare syndrome of female pseudohermaphroditism.

The rare syndrome of idiopathic female pseudohermaphroditism with vaginal urethra, clitoral hypertrophy and accessory phallic urethra is commonly associated with urinary tract obstruction. We report a new case and discuss the characteristic features. The embryogenesis of this condition seems to involve complex interactions between the müllerian duct and urogenital sinus rather than hormonal causes. Treatment is aimed at correcting the masculinized appearance of the genitalia and relieving the frequently present urinary obstruction.

Abnormalities, Multiple↗
PubMed1978

Excessive proliferation of peripelvic fat of the kidney.

Excessive proliferation of the peripelvic fat of the kidney (EPPF) is a benign process with an innocuous effect on the patient. However, this condition may assume major clinical significance by producing pyelocalyceal deformities that may be mistaken for true renal masses. Rarely, EPPF may masquerade as a renal pelvic tumor. We present the second reported case of EPPF simulating a renal pelvic tumor and review the history as well as the characteristic radiographic and sonographic features of this condition.

Adipose Tissue↗