M. David Gibbons

Management of the Abdominal Undescended Testicle

Of the orchiopexies performed for abdominal undescended testicles 85 per cent have resulted in satisfactory testicular growth and position. Three-fourths of these cases were in boys with the prune belly syndrome. We are satisfied with our recent experience using the Fowler-Stephens procedure to salvage intra-abdominal undescended testicles. An analysis of the failures in 5 testes early in this series, resulting in partial atrophy, has helped us to avoid technical errors through attention to the following details: 1) preservation of a broad pedicle of peritoneum overlying the mobilized vas, 2) avoidance of any dissection of the spermatic cord and 3) high ligation of the spermatic vessels well above the point of confluence of the vas and spermatic vessels. Although the Fowler-Stephens procedure has some risk of testicular ischemia and atrophy we believe it to be the preferred way to gain mobility on a short tethering gonadal vascular pedicle.

Ectopic vas deferens.

Two infants with ectopia of the vas deferens are described. To date 11 cases have been reported, comprising a total of 13 ectopic vas insertions, 2 of which are bilateral. A classification of 2 types of ectopic vas is presented with a discussion of their relationship to ureteral ectopias. An embryological hypothesis of a proximal vas precursor segment of the wolffian duct is related closely to Stephens theory of ureteral development.

Single Vaginal Ectolpic Ureter: A Case Report

Abstract The seventh case of a female subject with a single, unilateral ectopic ureter draining to the vagina is reported. The renal unit was located in the renal fossa, whereas in 3 of the 7 cases reported it was within the pelvis. Although ectopia with ureteral duplication is not an uncommon anomaly the single ectopic ureter in the female subject is the rarest form of ureteral ectopia. Use of phenazopyridine hydrochloric acid as an excretory marker was most helpful in locating the vaginal orifice.

An Anterior Extraperitoneal Muscle-Splitting Approach for Pediatric Renal Surgery

We describe the successful use of an anterolateral, muscle-splitting technique. In the pediatric patient impressive exposure allows for renal pelvic and distal ureteral operations, obviating the necessity for a secondary lower incision. Additional benefits of this incision have been minimal nerve root irritation, incisional pain and muscular weakness.

Obstructive Uropathy and Nephrogenic Diabetes Insipidus in Infants

The syndrome of acute post-obstructive nephrogenic diabetes insipidus is a rare phenomenon. The lesion is acquired during the pre-diuretic phase, owing to antidiuretic hormone resistance of the distal tubule as well as a severe concentrating defect. The diuretic phase after relief of obstruction can result in a massive, sustained and life-threatening diuresis. Sodium restriction and thiazide diuretics produce a mild volume contracted state, enhancing sodium and water reabsorption, primarily in the proximal tubule and possibly in the distal tubule owing to aldosterone. The recognition and differentiation of this unique pyloric syndrome from other more common post-obstructive diuretic states are important for all urologists who are responsible for the care of children.

Neuroblastoma masquerading as congenital ureteropelvic junction obstruction

A case of perirenal neuroblastoma causing intrarenal obstruction of the pelvis of the kidney presented as a small hydronephrosis at 3 days of age. The tumor grew rapidly over the next 48 hr, diagnosis was confirmed by ultrasonography, and the mass was removed surgically.

A modification of the MAGPI procedure

Since its description in 1981, the MAGPI procedure has rapidly assumed a major role in the repair of coronal and subcoronal hypospadias without chordee. Success with this procedure depends upon careful attention to detail and proper patient selection. Despite heeding these caveats the authors have noted occasional patients who, following completion of a MAGPI, have a disturbing fishmouth quality to the meatus. Herein is described a simple modification that seems to improve the cosmetic results when this situation is encountered.