A. Gökdemir

Safer circumcision in patients with haemophilia: the use of fibrin glue for local haemostasis

To evaluate the efficacy and the reduced costs of factor concentrates in circumcision by using fibrin glue in patients with haemophilia.

Fetus in fetu

By: DeRuiter, Corinne

CLINICAL RESULTS WITH ANTERIOR DIAGONAL ILIAC OSTEOTOMY IN BLADDER EXSTROPHY

PURPOSE We report our clinical experience with anterior diagonal iliac osteotomy in 10 patients who underwent surgery for bladder exstrophy. Technique and long-term results are discussed. MATERIALS AND METHODS A total of 10 boys 1 month to 9 years old with bladder exstrophy underwent this procedure during a 2-year period. RESULTS None of the patients had bladder closure dehiscence or prolapse after the operation. There were neither infectious complications nor injury to the vessels or nerves in any case. Blood loss was minimal for anterior diagonal iliac osteotomy. The only significant complication in our series was the polypropylene erosion of the urethra, necessitating endoscopic removal in 1 patient 1 month postoperatively. All patients had wide diastasis of the pubis preoperatively (average pubic distance 53.3 cm., average pubic ratio 0.9). At surgery suturing the symphysis after bilateral osteotomy resulted in a satisfactory symphyseal approximation and tension-free closure of the abdominal wall was easily achieved in all cases. Radiological studies at a mean followup of 34.6 months (range 14.8 to 49.5) revealed significant recurrent diastasis of the pubic bones in all but 1 patient in whom bone grafts were applied between the iliac fragments. Mean interpubic distance was 42 cm. and mean pubic ratio was 0.6 at long-term followup. CONCLUSIONS Diagonal osteotomy may correct the principal bony deformity in exstrophy and enables initial symphyseal approximation. Pubic diastasis may recur, probably due to opening forces generated by soft tissue elements of the pelvis.

Safer and much cheaper circumcision using fibrin glue in severe haemophilia.

Summary. Circumcision is a traditional ceremony for Muslims and Jewish people. In order to reduce the high cost of factor concentrates, we administered locally manufactured heat‐treated fibrin glue during operation. Circumcision can be performed safely and is much cheaper using fibrin glue plus a small amount of factor concentrates.

Evaluation of the Lower Urinary Tract Function in Caudal Duplication (Dipygus) Anomaly

Caudal duplication is a rare anomaly with less than 30 reported cases. For those patients who also have double bladders, there are not enough data regarding the function of the lower urinary tract. A boy with caudal duplication anomaly was evaluated fluoroscopically and urodynamically. The results of the evaluation showed that the bladders were filling and emptying synchronously with normal and almost identical detrusor pressures. The child did not require either or both bladders to be resected. Because the level of the duplication in dipygus cases varies, thorough evaluation of the lower urinary tract, including urodynamics, should be considered for every case.

Reconstruction of penile shaft amputation: is microvascular re-anastomosis mandatory?

penile amputation 12 mm proximal to the coronal sulcus. The same repair was used, again with no arterial anastomosis. At 12 days after surgery a partial necrosis that developed over the glans was debrided with the necrotic preputial tissue. The urethral catheter was removed after 16 days and the patient voided uneventfully. The glans healed completely by 6 weeks with minimal contraction; the cosmetic result was acceptable at 2 months (Fig. 2).