Boris Chertin

Does delaying pyeloplasty affect renal function in children with a prenatal diagnosis of pelvi-ureteric junction obstruction?

Objective u2002To evaluate retrospectively children with an antenatal diagnosis of pelvi‐ureteric junction (PUJ) obstruction who required pyeloplasty for deteriorating renal function during the follow‐up, specifically assessing the recovery of function after surgery.

The use of laparoscopy in intersex patients

The management of intersex patients is a challenge. Although in the majority of patients the diagnosis may be made on the basis of cytogenetic and biochemical tests, there is a selective group of patients with difficulties in the establishment of final diagnosis and gender assignment. Since laparoscopy has been used in the management of impalpable gonads in the normal male population, it may be an alternative method for the diagnosis and surgical management of intersex patients. Thus we have evaluated our experience with laparoscopy in intersex population. Over the last 10xa0years (1995–2005) more than 80 intersex patients underwent surgical correction at our department. Out of those, 14 patients with a median age of 3xa0years (range 2–18xa0years) underwent laparoscopic surgery. Laparoscopic gonadectomy with subsequent estrogen replacement was performed following gonadal biopsy in five patients with androgen insensitivity syndrome (AIS). In three patients with mixed gonadal dysgenesis (MGD) gonadal biopsy was performed. In two of those the initial diagnosis was changed to true hermaphroditism, and they underwent removal of ovotestis from one side and orchidopexy of the normal testis on the other. In one patient with MGD, timed gonadectomy following laparoscopic biopsy was performed due to malignant potential of the streak gonads. In two patients with persistent müllerian duct syndrome (PMDS), laparoscopic orchidopexy was performed following gonadal biopsy. Three patients with total gonadal dysgenesis (TGD) underwent laparoscopic gonadectomy and one with true hermaphroditism underwent laparoscopic biopsy followed by bilateral inguinal orchiectomy with preservation of the ovarian tissue. Our data show that the laparoscopic gonadal biopsy remains the only way to obtain morphologic gonadal structure and to establish a final diagnosis in doubtful cases. Magnification and easy access to the pelvic cavity allow removal of gonads or ductal structures with the advantages of minimally invasive procedure.

Dorsal tunica albuginea plication to correct congenital and acquired penile curvature: a long‐term follow‐up

Authors from Jerusalem evaluated the long‐term efficacy of a tunica albuginea dorsal plication technique in the treatment of congenital and acquired curvature of the penis. They assessed their experience in 83 patients aged 1‐8 years who underwent this procedure over a 10‐year period. They found it to be a simple technique with considerable long‐term efficacy.

Pregnancy-induced vesical decidualized endometriosis simulating a bladder tumor

Vesical endometriosis accounts for approximately 1% of all discovered cases of endometriosis. We report the first case of a 36-year-old woman with pregnancy-associated decidual changes within bladder endometriosis that are clinically presented as a rapidly growing bladder tumor. Cystoscopy, with subsequent cold cup biopsy and fulguration, revealed a solitary, red-brown, nodular lesion, which turned to be a decidualized endometriosis of the urinary bladder. Delivery and postdelivery follow-up was uneventful and no recurrence was diagnosed.

Altered renin–angiotensin system gene expression causes renal hypoplasia in the rats with nitrofen-induced diaphragmatic hernia

The association between renal hypoplasia and pulmonary hypoplasia in congenital diaphragmatic hernia (CDH) has become recently appreciated. However, the underlying mechanisms responsible for this association are still unknown. Renin–angiotensin system (RAS) plays an important role in renal and somatic growth, angiogenesis and reproduction. We hypothesized that abnormal expression of RAS components may be responsible for renal hypoplasia in CDH. We therefore designed this study to examine the gene expression of main components of RAS in the kidney of nitrofen-induced CDH in the rat. Pregnant rats were exposed to either olive oil or 100xa0mg of nitrofen on day 9.5 of gestation. Foetuses were recovered at term and divided into three groups: control (n=8), nitrofen without CDH (n=8) and CDH (n=8). Reverse transcription polymerase chain reaction was performed to evaluate the relative amount of angiotensinogen (AGT), angiotensin II type 1 receptor with 1a and 1b subtypes (AT1aR and AT1bR), angiotensin II type 2 receptor (AT2R), angiotensin-converting enzyme (ACE) and renin expression in the kidney. AT1aR, AT1bR, AT2R, AGT and renin levels were significantly decreased in the kidney of CDH rats compared with controls. We did not find a significant difference in ACE between CDH animals and controls. Our data show that the downregulation of RAS may play an important role in the pathogenesis of renal hypoplasia in the nitrofen-induced CDH.