Hamdan Alhazmi

Peristeen anal irrigation as a substitute for the MACE procedure in children who are in need of reconstructive bladder surgery

INTRODUCTION We evaluate the efficacy of the Peristeen (Coloplast A/S, Kokkedal, Denmark) transanal irrigation (TAI) system, as a stool cleansing mechanism, to gain stool continence in children who need reconstructive bladder surgery and have fecal incontinence. METHODS We prospectively evaluated children with neuropathic bladder and bowel dysfunction who were intended for reconstructive bladder surgery and the Malone antegrade continence enema (MACE) procedure. All patients were started on the Peristeen TAI system at least 3 months before surgery to assess their response. Each patients bowel function, frequency of using the system, satisfaction (and that of their parents) and diaper independency were evaluated before and after reconstructive surgery. RESULTS We included 18 patients (11 female, 7 male) who were evaluated from April 2006 to the present. The mean age of the group was 7.6 years (range: 4-15). Fifteen patients (83.3%) showed complete dryness from stools. Of the 15 patients, 8 (53.3%) were able to be diaper-free, while 6 continued wearing diapers due to fear of soiling and 1 due to urinary incontinence. The patients underwent reconstructive bladder surgery and continued to use the Peristeen TAI system with the same results postoperatively. The main limitation of this study is the small number of patients included, although this is a very specific patient group. CONCLUSION Our initial results suggest that the Peristeen TAI system is a successful conservative substitute for the MACE procedure in children who require reconstructive bladder surgery.

Percutaneous nephrolithotomy in children: A preliminary report.

Objectives: The recurrence of pediatric nephrolithiasis, the morbidity of repeated open surgical treatment as well as our experience in percutaneous nephrolithotomy (PNL) in adult patients, all derived us to shift to PNL for managing renal stones >1.5 cm in pediatric patients. Our aim of this study is to evaluate the safety and efficacy of PNL in pediatric patients. Materials and Methods: During the period of the month between May 2011 and April 2013, 38 children (47 renal units) underwent PNL for renal stones 1.5-5 cm in length. Patient demographics, stone characteristics, and clinical outcome were prospectively studied. Data of those who underwent conventional and tubeless PNL were compared. Median follow-up period was 12 months (range: 6-24). Results: The median age at presentation was 8-year (range: 3-12). The operative time ranged from 30 to 120 min (median 90). Overall stone clearance rate was 91.5% after single PNL. The median hospital stay was 3 days. Auxiliary procedures were successful for the remaining 4 patients (nephroscopic clearance in one and shockwave lithotripsy in 3). Tubeless PNL was performed in 17 renal units with a comparable outcome to conventional ones. The perioperative complications were noted in 5/47 (10.6%) of all procedures (Clavien Grade II in 4 and Clavien Grade IIIa in 1) and were managed conservatively. Conclusions: Percutaneous nephrolithotomy for renal stones in pediatric patients is safe and feasible if performed by a well-experienced endourologist. Tubeless PNL is a better choice for children.

Laparoscopic versus open orchiopexy in the management of peeping testis: A multi-institutional prospective randomized study

OBJECTIVE Peeping testis is an inconsistently palpable/seen undescended testis that migrates back and forth at the internal inguinal ring. Both open and laparoscopic orchiopexy are effective forms of management. The present study aimed to evaluate the efficacy and safety of both approaches. PATIENTS AND METHODS Between September 2007 and January 2012, 46 peeping inguinal testes were randomly treated with either open (25 cases) or laparoscopic (21 cases) orchiopexy procedures. Spermatic vessels were preserved for all cases. Operative details, postoperative morbidity and final testicular site and size were recorded. RESULTS The median age of the children was 2.5 years (range 0.5-12.0). The follow-up period ranged from 1.0 to 5.5 years. Of these testes, 20 in the open surgery group and 19 in the laparoscopic group maintained correct intrascrotal position (P = 0.428). Re-do orchiopexy was indicated for two cases in the surgical group (P = 0.493). No cases of testicular atrophy or hernia were encountered. CONCLUSION Open and laparoscopic orchiopexy procedures for peeping testes are fairly comparable. However, laparoscopy is relatively more effective, as two re-do orchiopexies were required in the open surgical group.

Pressure-induced alopecia in pediatric patients following prolonged urological surgeries: The case reports and a review of literature

Postoperative alopecia has been reported as a rare complication after prolonged immobilization during general anesthesia. The constant pressure on the scalp is causative and may be exacerbated by hypoxemia or hypotension. There is a correlation between the length surgery duration under anesthesia and the development of permanent alopecia. Regular head turning schedules and vigilance for the condition should be used as prophylaxis to prevent permanent alopecia.

Congenital anterior urethrocutaneous fistula: Two case reports and review of literature.

Congenital anterior urethrocutaneous fistula (CAUF) of the male urethra is a rare anomaly. CAUF can be defined as a urethral fistula in which the urethra and external urethral meatus are intact, typically with intact prepuce and no history of any penile trauma (including surgical trauma).We report 2 cases of CAUF to highlight this pathology with hints of the published similar cases in the literatures and discuss the surgical reconstruction ways for management.

Biofeedback as single first-line treatment for non-neuropathic dysfunctional voiding children with diurnal enuresis

INTRODUCTION Non-neurogenic dysfunctional voiding (NDV) accounts for a significant portion of pediatric urology outpatient clinic visits. Biofeedback (BF) is a promising, non-invasive modality for treating children with DV and daytime wetting. Our objective was to investigate BFs efficacy as a single first-line treatment for children with NDV and diurnal enuresis. METHODS A retrospective cohort study was conducted with a total of 61 consecutive patient records from January 2009 to March 2016. All children with NDV who had BF as first-line treatment were included. Full urological histories, physical examinations, dysfunctional voiding symptom score (DVSS), urine analysis, ultrasound (US), and uroflowmetry (UFM), and electromyogram (EMG) were performed and recorded for all patients before and after finishing the last BF cycle. The patients satisfaction scale was also obtained. RESULTS The mean age was 10±2.6 years. Most patients (80.3%) were females. The presenting symptoms were diurnal enuresis, urinary tract infections, and voiding discomfort in 52 (85.2%), 16 (26.2%), and 38 (62.3%) patients, respectively. Six months after the last BF cycle, there was a statistically significant objective improvement in US and UFM+EMG findings with the disappearance of EMG signals in 40 of 61 (65.5%) patients. There was also a significant subjective symptomatic improvement, as the mean DVSS had decreased from 14 to 7.9 (p=0.003). Forty-seven patients (77%) were satisfied, while only eight (13.1%) were not. CONCLUSIONS BF is considered a potentially effective, single first-line treatment modality for children with DV and diurnal enuresis. Long-term outcome assessments are needed to assess the childrens compliance and symptom recurrence.

Hospital acquired blood stream infection as an adverse outcome for patients admitted to hospital with other principle diagnosis

Background: Hospital acquired infections (HAI) have emerged as an important public health problem and are a leading cause of morbidity and mortality worldwide. They affect both developed and resource-poor countries and constitute a significant burden both for the patient and for the health care system. Specific objectives in this study are assessment of HAI rate among patients admitted with other principle diagnosis, to identifying the causative agents of hospital acquired infections and to identify some possible risk factors associated with each type of infection, both health related and non-health related. Patients and Methods: The study was done on selected diagnosis groups during year 2010. The infections were found among 250 patients (43.6% males) have been exposed to episodes of infections. Median age of patients was 56. Data were abstracted from the archived patients’ files in medical record department using the annually infection control log-book prepared by the infection control department. The Data collected were demographic information about the patients (age and sex), clinical condition (diagnosis and the length of hospital stay) and possible risk factors for infection as smoking, diabetes mellitus, hypertension and exposure to invasive devices or exposure to surgical procedures. Results: Liver diseases 22.8%, cardiac diseases 22.8%, Gastro-Intestinal System diseases 20%, urinary system diseases 13.6%, and endocrinal disorder 13.6% Prostate gland diseases 7.2%. Episodes of infections caused by 9 types of organisms divided into 47.2% for blood stream infection and 52.8% for other types. 66% acquired blood stream infection were exposed to central venous line. Conclusion: Most common type of HAIs was blood stream infections. Liver, cardiac diseases and gastro-intestinal diseased patients show more proportion of HAIs while urinary system and prostate disease patients show less proportion of HAIs. Gram negative bacilli were the most common organisms found in our study (60%).

High retrocaval ureter: An unexpected intraoperative finding during robotic redo pyeloplasty

Urology Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia b Pediatric Urology Division, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia University of Texas Southwestern, Dallas, TX, USA d Pediatric Urology Division, Surgery Department, King Khalid University Hospital, Riyadh, Saudi Arabia e Pediatric Urology Division, Surgery Department, National Guard Hospital, Riyadh, Saudi Arabia f King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia Nursing Affairs Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

Renal oxalate stones in children with Zellweger spectrum disorders

Peroxisomal biogenesis disorders due to PEX gene defects are classified into many subgroups, of which Zellweger spectrum disorders (ZSDs) represent the major subgroup. The ZSDs are clinical and biochemical disorders divided into three phenotypes: neonatal, adolescence, or adult. Clinical presentations vary with severity of the condition. Metabolic abnormalities occur due to functional peroxisomal defects that could be detected in blood and urine. No cure or definitive management exists to date; only supportive and palliative measures are applied to prevent worse sequelae. We experienced a case of oxalate renal stones in a patient with ZSD. This patient had hyperoxaluria and hyperglycolic aciduria with clinically associated clues that correlate with urinary oxalate load. Urinary oxalate and glycolate excretion were assessed. Radiological workup revealed renal involvement with urolithiasis and nephrocalcinosis. Urinalysis and ultrasonography for stones and hyperoxaluria should be used to screen patients with ZSD for early intervention to prevent renal damage.

Timing of orchidopexy at a tertiary center in Saudi Arabia: reasons for late surgery

BACKGROUND Orchidopexy should be performed during the first 18 months of life to decrease the risk of infertility and tumor formation. In our center, the timing of surgical correction varies depending on the availability of an operating room. OBJECTIVES Evaluate whether orchidopexy performed for patients referred to our center is done within the recommended time period and to determine causes for delay. DESIGN Retrospective descriptive study. SETTING Pediatric urology department of a tertiary care center. SUBJECTS AND METHODS We retrospectively reviewed the charts of patients charts who underwent orchidopexy at our center from 2000 to 2010. We assessed referral time and waiting list time, which were subdivided as follows: from referral to first visit and from first visit to surgery. We included patients younger than 14 years and excluded patients with comorbidities that affected the timing of referral and surgical treatment. MAIN OUTCOME MEASURES Referral time period and waiting list time for surgical correction of patients presented with undescended testis. SAMPLE SIZE 128 RESULTS After exclusion of 32 patients because of comorbidities, we describe 128 who underwent surgery for cryptorchidism at our center. The median (interquartile range, minimum-maximum) for age at surgery was 46.7 months (24.4–83.4, 3.1–248.6]). The median (IQR) referral occurred at an age of 25.3 months (4.1–65.5). The median (IQR) waiting list time was 15.2 months (8.1–23.3). The median (IQR) waiting time from referral to the first visit was 4.1 months (1.0–8.2). The median waiting time from the first visit to surgery was 8.1 months (3.8–17.5). CONCLUSIONS The age at the time of surgery at our center was far from ideal because of late referrals. A structured program offered by our National Health Service to educate referring physicians is necessary. Community health initiatives must emphasize prompt referral to reduce the impact of delayed surgery. LIMITATIONS Lack of data on the type of referring physician (i.e., general practitioner, pediatrician, surgeon, urologist).