Joseph G. Barone

Urethral prolapse: four quadrant excisional technique.

BACKGROUND Urethral prolapse is a condition that occurs when urethra mucosa evaginates beyond the urethra meatus, resulting in vascular congestion and edema of the prolapsed tissue. Young females with this clinical entity often present with peri-vaginal bleeding and swelling. Urethral prolapse can be diagnosed by its typical clinical appearance and should not be confused with other causes of peri-vaginal bleeding, most importantly, sexual abuse. CASE We retrospectively evaluated the charts of three girls, ages 4, 6, and 8, who presented complaining of vaginal blood spotting. On examination, a ring of congested, edematous tissue was seen prolapsing through the urethral meatus in each patient. All patients did not respond to medical management and required surgical removal of the tissue. We herein discuss and evaluate their management and our four quadrant excisional technique. CONCLUSION Urethral prolapse can be definitively diagnosed without laboratory or radiographic evaluation by demonstrating that the edematous tissue surrounds the meatus circumferentially. Initial treatment consists of parental reassurance, observation, and warm soaks. If the prolapse does not demonstrate improvement, excision of the prolapsing tissue may be necessary. We believe that our surgical technique facilitates removal of the prolapsed tissue and anastomosis of the residual urethral mucosa.

Novel assay for determining DNA organization in human spermatozoa: implications for male factor infertility

OBJECTIVES To present a novel assay for determining DNA organization in fertile human spermatozoa and establish morphometric parameters for these samples. The three-dimensional organization of DNA within a cell nucleus is intimately related to cellular function. For example, it has recently been demonstrated that normal sperm DNA organization may be necessary for successful in vitro fertilization in the mouse. METHODS Semen from 12 fertile volunteers was tested for sperm DNA organization using our nuclear matrix stability assay. Sperm DNA then underwent computerized digital image analysis and standards of normal were established. RESULTS Sperm DNA organization was constant in all samples tested. Normal parameters established included mean nuclear matrix diameter (9.17 +/- 1.59 microm), mean DNA halo diameter (20.56 +/- 2.53 microm), mean halo area (66.88 +/- 7.92 microm(2)), and mean nuclear matrix area (32.98 +/- 4.3 microm(2)). CONCLUSIONS This assay may be used to determine DNA organization in a semen sample. Defining sperm DNA organization may be important clinically, because normal DNA organization is necessary for normal cellular function.

Pediatric pyogenic granuloma of the glans penis

Pyogenic granulomas are benign vascular proliferations of the skin and mucous membranes. We present a case report of a 13-year-old uncircumcised boy with phimosis and a pyogenic granuloma of the glans penis. The relationship between these lesions, phimosis, smegma, and circumcision is discussed. When the lesion is found in conjunction with phimosis, consideration should be given for circumcision. Close follow-up to rule out recurrence is necessary.

Childhood infundibular stenosis.

Infundibular stenosis is a rare condition marked by dilation of one or more calices proximal to a stenotic infundibulum. Contrary to older reports, more recent information suggests that progressive renal dysfunction occurs in a significant number of these patients. We present a case of incidentally discovered infundibular stenosis. On the basis of the existing published reports, we make several recommendations. Close monitoring for a decline in renal function secondary to hyperfiltration injury is essential, and a worsening should prompt referral to a pediatric nephrologist. Progressive hydronephrosis should be corrected surgically, although proof of effect on the disease process is lacking in the evidence-based reports.

Laparoendoscopic Single-Site Varicocele Repair in Adolescents—Initial Experience at a Single Institution

BACKGROUND AND PURPOSE Laparoendoscopic single-site (LESS) varicocele repair is a modification of standard laparoscopic varicocele repair that uses a single port. We describe our initial experience with LESS varicocele repair. PATIENTS AND METHODS During a 1-year period, all patients who presented for varicocele repair underwent LESS repair. We evaluated our initial experience by determining operative time, operative and postoperative complications, and overall cost of the procedure. RESULTS A total of 11 adolescents underwent LESS varicocele repair. There were no intraoperative complications, and there were no conversions to open surgery or traditional laparoscopy. Estimated blood loss was minimal, and mean operative time was 66.9 minutes (range 48-91 min). The varicocele was corrected in all cases. During the 4 to 14 month follow-up, there was no recurrence, testis atrophy, or hernia in any patient. One subclinical hydrocele developed postoperatively that has not been repaired. CONCLUSION Our experience with LESS varicocele repair in adolescents suggests it to be a safe and effective method for varicocele repair in adolescents.

Voiding Dysfunction in the Female Patient: Is the “Syndrome” Paradigm Valid?

Voiding dysfunction in the female patient significantly affects the patient’s quality of life. The condition is poorly understood, has varied etiology and clinical presentation, and lacks standard definitions with no consensus on diagnostic criteria. It consists of a constellation of symptoms involving both phases of the micturition cycle. Appropriate diagnosis and treatment of female lower urinary tract symptoms (LUTS) is of paramount importance. However, the differentiation of female LUTS into various syndromes is currently controversial. This article comprehensively reviews the commonly encountered female non-neurogenic LUTS (overactive bladder, interstitial cystitis, and painful bladder syndrome); discusses the contemporary management of these syndromes; and emphasizes a syndromic approach to the condition.

Management of inguinal cerebrospinal fluid leak after communicating hydrocele repair in a child with spina bifida

Abstract Children with ventriculoperitoneal shunts undergoing communicating hydrocele repair are at increased risk of postoperative complications, including hydrocele recurrence, shunt injury, infection, and meningitis. This is the first case report of a child with a ventriculoperitoneal shunt who developed a cerebrospinal fluid leak through the inguinal incision after hydrocele repair. Management included placing the child in the Trendelenburg position and sealing the leak with cyanoacrylate tissue adhesive.

Untethering an unusual cause of kidney injury in a teenager with Down syndrome.

Acute kidney injury (AKI) is characterized by the acute nature and the inability of kidneys to maintain fluid homeostasis as well as adequate electrolyte and acid-base balance, resulting in an accumulation of nitrogenous waste and elevation of serum blood urea nitrogen and creatinine values. Acute kidney injury may be a single isolated event, yet oftentimes, it results from an acute chronic kidney disease. It is critical to seek out the etiology of AKI and to promptly manage the underlying chronic kidney disease to prevent comorbidities and mortality that may ensue. We described a case of a 16-year-old adolescent girl with Down syndrome who presented with AKI and electrolyte aberrance.Abdominal and renal ultrasounds demonstrated a significantly dilated bladder as well as frank hydronephrosis and hydroureter bilaterally. Foley catheter was successful in relieving the obstruction and improving her renal function. However, a magnetic resonance imaging was pursued in light of her chronic constipation and back pain, and it revealed a structural defect (tethered cord) that underlies a chronic process that was highly likely contributory to her AKI. She was managed accordingly with a guarded result and required long-term and close monitoring.

Evaluation of Flank Pain

The urologist frequently evaluates patients with flank pain and diagnoses and treats conditions that may have local or systemic ramifications. Nonurologic causes for the pain always are considered during the initial evaluation. Although the history and physical examination are the most important aspect of the evaluation, laboratory and diagnostic tests help confirm the diagnosis. Since this is a commonly encountered clinical problem, all practitioners should have some familiarity with the diagnosis and management of flank pain.

Urodynamics in the early stages of spinal cord compression from prostate adenocarcinoma

Acute urinary retention developed in 2 patients with a history of prostate cancer. Urodynamic evaluation revealed autonomic dysfunction, which contrasted with a prior urodynamic study, indicating a possible spinal lesion. Radiographic evaluation led to early diagnosis and treatment of spinal cord compression from metastatic prostate adenocarcinoma. We discuss the diagnostic role of urodynamics in such cases.