Hair coil strangulation of the penis.
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Child↗
Biomedical subjects
S G Docimo
Publications and source records attributed to S G Docimo.
Metabolic complications secondary to obstruction of a Kock pouch afferent limb.
Metabolic complications are frequently seen following urinary diversion with an intestinal segment. Afferent limb complications are noted in 10% of patients undergoing continent Kock urinary diversion. We present a patient with cloacal exstrophy with developed significant hypocalcemic tetany and metabolic acidosis related to a nondraining afferent limb of a Kock pouch created to achieve continence.
Adolescent↗
Immunohistochemical description of nitric oxide synthase isoforms in human clitoris.
PURPOSE: Our aim was to identify and localize nitric oxide synthase isoforms in the human clitoris in support of the hypothesis that nitric oxide mediates erectile function in this organ. MATERIALS AND METHODS: Nitric oxide synthase immunohistochemistry studies specific for neuronal, inducible and endothelial isoforms of the enzyme were performed on human clitoral tissue obtained from 4 patients (3 with female pseudohermaphroditism and 1 with true hermaphroditism) at feminizing genitoplasty and from 1 phenotypically normal woman at autopsy. RESULTS: Neuronal nitric oxide synthase immunoreactivity was detected in nerve bundles and fibers coursing within the glans clitoris and corpora cavernosa of the clitoris, predominating in the latter tissue. Specific inducible nitric oxide synthase immunoreactivity was not identified. Endothelial nitric oxide synthase immunoreactivity was detected in vascular and sinusoidal endothelium of these tissues with a predominance in the glans clitoris. CONCLUSIONS: The presence and anatomical localizations of nitric oxide synthase isoforms in the human clitoris indicate that nitric oxide is generated in this organ. These data suggest that nitric oxide may be involved in the erectile physiology of the clitoris as a modulator of clitoral smooth muscle activity. Functional studies are required to support this hypothesis.
Child↗
Testicular implants.
Testicular implants have been in use for more than 50 years with an excellent record of safety and efficacy. The controversy concerning the use of silicone prosthetics in breast implants also affected testicular implants. There is no conclusive evidence associating connective tissue disorders, autoimmunity, or malignancy with silicone implants. Studies show silicone leakage from these implants, but long-term follow-up is required to identify the significance of this finding. Saline-filled silastic shell testicular prostheses will be implanted as part of an ongoing study to monitor various safety parameters, as required by the Food and Drug Administration.
Biocompatible Materials↗
Renal ultrasonography in newborns with prenatally detected hydronephrosis: why wait?
PURPOSE: Published reports suggest the need to delay renal ultrasound for at least 1 week after birth to avoid a false-negative study due to oliguria. This recommendation has become standard. Considering the recent shift toward expectant management of prenatal hydronephrosis, there may be no advantage to the increased sensitivity of a delayed study. MATERIALS AND METHODS: Radiology records were reviewed for a 5-year period to identify renal ultrasound studies performed within 48 hours of birth. RESULTS: Of 101 neonates known to have hydronephrosis on prenatal ultrasound who underwent sonography within 48 hours of birth 33 had a normal study (including mild hydronephrosis) and documented followup studies. None of these patients had a significant obstructive renal lesion within the first year of life. One child had an obstructive pattern on diuretic renography at age 18 months after previous studies were unremarkable. Cystography in 26 patients demonstrated vesicoureteral reflux in 4 (14.3%). CONCLUSIONS: These data suggest that 1) there is no contraindication to early neonatal renal ultrasonography and 2) voiding cystourethrography is indicated for all infants with a history of prenatal hydronephrosis.
Female↗
Telementoring of laparoscopic procedures: initial clinical experience.
BACKGROUND: To assess the feasibility of telementoring, a clinical telepresence system was developed. METHODS: Telementoring was attempted in 14 advanced and 9 basic urologic laparoscopic procedures. The remote surgeon located in a control room (> 1,000 feet from operating room) supervised an inexperienced surgeon. Mentoring was accomplished with real-time video images, two-way audio communication, a robotic arm used to control the videoendoscope, and a telestrator. The patient outcome, complications, and operative time were assessed and compared to patients undergoing matched procedures in which the experienced surgeon was working side by side with the primary surgeon. RESULTS: The overall telementoring success rate was 95.6% (22/23 cases) with no increase in complications. Telementoring of a laparoscopic radical nephrectomy failed secondary to improper positioning of the robotic arm. Operative times compared between telementored and traditionally mentored procedures were not statistically different for basic procedures but were longer for advanced cases. CONCLUSIONS: Telementoring of laparoscopic procedures is safe and feasible. Further clinical studies are needed prior to implementing telementoring in surgical training.
Education, Medical↗
Testicular descent and ascent in the first year of life.
Ascent of the intrascrotal testis to an undescended position has been described, but it remains controversial. A case of a 1-year-old with bilateral ascended testes is presented. These testes were documented by a pediatric urologist to have been intrascrotal on two prior occasions. The right testis was intra-abdominal, and the left was peeping at the internal ring. Ascent has generally been seen in older children with a history of retractile testis and has never been reported to result in a testis located in an intra-abdominal position. This represents a rarely reported early testicular ascent, the mechanism of which is different than that of older children.
Cryptorchidism↗
Bladder exstrophy from childhood into adult life.
Exstrophy of the bladder is rare and the incidence of bladder exstrophy is calculated to be from 1 per 30,000 to 50,000 live births with male to female ratio ranging from 1.5-5 to 1(1-4). It was found that persistence or overgrowth of the cloacal membrane on the lower anterior abdominal area, prevents normal mesenchymal ingrowth. This causes divergence of the lower abdominal muscular structures and forces the genital ridges to fuse caudal to the cloacal membrane. The stage of ingrowth of the urorectal septum at the time of rupture determines whether one will produce an exstrophic urinary tract alone (classic bladder exstrophy or epispadias) or cloacal exstrophy with the hindgut interposed between the hemibladders.
Adolescent↗
Early experience with telerobotic surgery in children.
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Child↗
Telesurgical consultation.
PURPOSE: We evaluated the feasibility of "telesurgical" consultation during laparoscopic surgery. Telesurgical consultation is a distinct application of telemedicine in which a surgeon at a primary operating site can consult another experienced surgeon or colleague for complex and/or unexpected problems encountered during surgery. MATERIALS AND METHODS: Telesurgical consultation was used in 6 complex laparoscopic cases, including upper pole nephrectomy, diagnostic laparoscopy with inguinal hernia repair, orchiectomy, gastric augmentation with bladder suspension, bladder reconstruction and ureteral lithotomy. RESULTS: In each case an experienced laparoscopic surgeon at the primary operative site consulted a surgical specialist at the remote site who had expertise in the particular procedure being performed. All procedures were accomplished successfully without intraoperative or post-operative complications. CONCLUSIONS: Complex laparoscopic procedures that normally require a surgical specialist can be performed successfully by an experienced laparoscopic surgeon consulting a remote specialist via the tele-operative system.
Adolescent↗
Concealed umbilical stoma: description of a modified technique.
PURPOSE: We describe a technique for creating a concealed umbilical stoma. MATERIALS AND METHODS: The base of the umbilicus is used as a superiorly based skin flap that is incorporated into the spatulated stoma. Six patients have undergone diversion using this technique. The stoma was constructed from appendix in 4 cases, stomach in 1 and tapered ileum in 1. RESULTS: All patients achieved an easily catheterizable hidden umbilical stoma, are dry on clean intermittent catheterization and have had no stomatitis or peristomal hernia. CONCLUSIONS: This technique for creating a concealed umbilical stoma preserves the native appearance of the umbilicus and combines a superior cosmetic result with an easily catheterizable stoma.
Adolescent↗
Ureteral graft in urological reconstruction: clinical experience and review of the literature.
We report 7 cases in which grafts of ureter were used as tube and patch segments in urethral reconstruction and formation of a continent catheterizable stoma. The ureteral grafts survived without long-term stricture in all cases. Meticulous preparation of the graft and recipient bed is required for success, as previously demonstrated experimentally. When available, ureter is an excellent source of tissue for urological reconstruction.
Adolescent↗
Laparoscopic orchidopexy in the prune belly syndrome: a case report and review of the literature.
The management of the testicles in the prune belly syndrome can be problematic after the neonatal period. Laparoscopic orchidopexy has been used for the intra-abdominal testis with success. A case of bilateral laparoscopic orchidopexy in a child with prune belly syndrome is presented. The testes were brought to the scrotum without division of the spermatic vessels, taking advantage of the extensive intra-abdominal dissection possible laparoscopically. This case demonstrates that therapeutic laparoscopic procedures are possible in the prune belly syndrome and that laparoscopic orchidopexy may have promise in older affected children or in those requiring no other concomitant surgery.
Cryptorchidism↗
Laparoscopic bladder augmentation using stomach.
We present a case of bladder augmentation with stomach, via a laparoscopic approach. The patient was a 17-year-old girl with sacral agenesis and a poorly compliant bladder. A wedge of stomach, based on the right gastroepiploic pedicle, was obtained using a stapled technique. The bladder was opened and the gastric segment was sutured in place. A needle suspension was also carried out. Three months later, the patient was dry and catheterizing every 4 hours. Laparoscopic bladder augmentation is technically feasible and, in the properly selected patient, may be the preferred technique for creation of a compliant high-volume urinary reservoir.
Adolescent↗
The results of surgical therapy for cryptorchidism: a literature review and analysis.
PURPOSE: The literature was reviewed to consolidate the diverse success rates reported for orchiopexy. MATERIALS AND METHODS: A total of 64 articles pertaining to 8,425 undescended testicles was reviewed and found to contain evaluable data. Success was defined as scrotal position and lack of atrophy. RESULTS: Success rates by anatomical testicular position were 74% for abdominal, 82% for peeping and 87% for canalicular testes, and 92% for those located beyond the external ring. Success rates by procedure were 89% for inguinal, 67% for Fowler-Stephens, 77% for staged Fowler-Stephens, 81% for transabdominal, 73% for 2-stage and 84% for microvascular orchiopexy. CONCLUSIONS: The significant failure rate for proximal testes suggests that efforts to improve orchiopexy should continue.
Child↗
Laparoscopic orchiopexy for the high palpable undescended testis: preliminary experience.
PURPOSE: We attempted to apply laparoscopic orchiopexy to the high palpable testis. MATERIALS AND METHODS: Nine patients (12 testicles) were treated who ranged from 13 months to 13 years old. Laparoscopic techniques were used to mobilize the spermatic vessels and transfer the testis into the scrotum. RESULTS: Unilateral cases were completed in an average of 2.6 hours and bilateral cases in 3.0 hours with no complications. Tests maintained an intrascrotal position with no atrophy during a followup of 1 to 12 months. CONCLUSIONS: Laparoscopic orchiopexy for the high palpable undescended testis is possible with minimal morbidity and good short-term results.
Child↗
Hysterectomy by the transvaginal approach after intestinal bladder augmentation and psoas hitch reimplantation.
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Adult↗
A heterotopic autoinnervated urinary neosphincter.
Twenty-six female adult New Zealand white rabbits underwent surgical denervation of a gracilis muscle to study the possibility of developing an autologous neosphincter innervated by the pudendal nerve. The study was conducted in 2 phases. In both Phase I and Phase II, the study group had the motor nerve to the gracilis, a branch of the obturator nerve and the pudendal nerve coapted in the perineum. The control group was left denervated. In Phase I, all muscle flaps were wrapped around the urogenital sinus. In Phase II, the muscle flaps were returned to their anatomic location. With bulbocavernosus reflex testing, 89% of the reinnervated group and 60% of the denervated group from Phase I and 86% of the reinnervated group and none of the denervated group from Phase II had a contractile response in the muscle flap. In Phase II, histologic examination of the gracilis muscle was suggestive of an early change in muscle myofiber physiology from fast twitch to slow twitch in the reinnervated group only. In the rabbit, a transplanted vascularized muscle flap, cross-innervated by the pudendal nerve has a reproducible response to bulbocavernosus reflex testing. This suggests that a transplanted muscle might be able to assume some of the characteristics of the voluntary urinary sphincter. The rabbit is a useful model in which to investigate the potential of the heterotopic neosphincter.
Animals↗