Jeremy Wiygul

Novel Use of the Gigli Saw for Management of Penile Entrapment

INTRODUCTION Penile entrapment is a rare clinical entity requiring urgent and efficient management. If left untreated, it may result in vascular compromise to penile soft tissue structures. Management poses unique challenges to the treating physician through variable presentation as well as the lack of specifically designed treatment options. AIM This article describes the use of the Gigli saw for management of penile entrapment. MAIN OUTCOME MEASURES AND METHODS We employed the Gigli saw to remove an entrapped metallic peno-scrotal constriction ring. RESULTS We successfully removed the entrapped ring with no noted immediate complications. CONCLUSIONS The Gigli saw can be safely used, and represents an easily available and potentially effective option in the management of penile entrapment.

Watchful waiting in benign prostatic hyperplasia.

Purpose of review Watchful waiting is a well known approach to the management of benign prostatic hyperplasia (BPH). In recent years, several large longitudinal studies have published their findings on the natural history of BPH. In addition, several other studies reporting the outcomes of patients randomized to medical treatment versus placebo have been used to extrapolate patients who are at low risk for progression. Recent findings Both longitudinal studies and randomized placebo-controlled trials have confirmed the progressive nature of BPH, with symptom progression being the most common manifestation. Variables such as baseline prostate-specific antigen, prostate volume, symptom score and bother score, decreased flow rate, and increased postvoid residual have all been linked to progression to acute urinary retention and need for surgery. Summary Historically, not much has been known about the natural history of BPH and thus, who would be a good candidate for watchful waiting. In this review, we discuss the natural history of BPH and the outcomes of affected patients managed with watchful waiting, as well as variables predictive of progression.

The inguinal approach to extravesical ureteral reimplantation is safe, effective, and efficient

INTRODUCTION Minimally invasive surgery implies a percutaneous or endoscopic approach rather than an incision, regardless of size. However, open approaches to various procedures using a mini-incision should assume the same appellation. We report our experience with extravesical ureteral reimplant (EVR) performed through an inguinal mini-incision. MATERIALS AND METHODS Patient characteristics of age, gender, and reflux grade were obtained, and outcomes of recurrent urinary tract infection, time of surgery, time of hospitalization and radiographic resolution were assessed. The technique involved a 2 cm incision made in the lowest inguinal skin crease, standard hernia exposure, opening of the floor of the inguinal canal to isolate the ureter, detrussorhaphy. RESULTS 30 girls and 15 boys with a mean age of 64 months (range 20-180), and mean followup of 18 months (range 3-36) underwent unilateral inguinal mini-incision EVR. Reflux grades represented were 7, 13, 18, 5, and 2 for Grades I through V respectively. Common sheath reimplantations were performed in twelve duplicated systems, and tapering performed in three patients. The average time of surgery was 75 min. All but 2 patients were discharged within 24 h; postoperative imaging was normal in all cases. Three patients had febrile UTIs following discontinuation of prophylactic antibiotics. CONCLUSION The inguinal approach to EVR is safe, effective, efficient, and well-tolerated. Through several maneuvers learned as the experience with EVR grew, we present a realizable approach to minimally invasive ureteral reimplantation with application in most pediatric urologic practice.

Isolated hemangioma causing gross painless hematuria in an adolescent male.

Hematuria in children is usually a benign entity, with hypercalciuria being the usual etiology; however, rarer causes also exist, including genitourinary hemangioma. Hemangioma is a benign tumor, which has a tendency to regress spontaneously by the second year of life. Involvement of the urinary tract is rare, and in patients with bladder involvement, an accompanying syndrome such as Sturge-Weber is usually found. However, there are reports of isolated bladder hemangioma in the pediatric population causing isolated gross hematuria. We report a case of bladder hemangioma causing gross painless hematuria in an otherwise healthy 14-year-old boy.

Spontaneous Bladder Perforation in a Neonate

Spontaneous bladder perforation in the newborn setting is a rare clinical phenomenon that can be life threatening if left untreated. Several risk factors have been identified in previously reported cases such as hypoxia and bladder diverticula. We present the first case of neonatal bladder rupture without any identifiable risk factors.