Pamela Ellsworth

Sexual abuse: another causative factor in dysfunctional voiding

Dysfunctional voiding is thought to be a learned disturbance. We report on 18 patients with onset of dysfunctional voiding after childhood sexual abuse. We believe that the possibility of sexual abuse should be considered in the evaluation of a child with new onset of voiding dysfunction or of an adult presenting with long-term voiding dysfunction.

Evaluation and Risk Factors of Latex Allergy in Spina Bifida Patients: Is it Preventable?

Allergic reactions to latex, varying from urticaria to life-threatening IgE-mediated anaphylaxis, have been described in patients with spina bifida. In a study of 50 patients 60% had a latex allergy identified by history, a radioallergosorbent test and/or a skin prick test. Latex allergic patients had undergone statistically more surgical procedures than nonallergic patients (9.5 versus 6.7) with a p value of 0.03. The presence of latex allergy did not correlate with the number of intra-abdominal procedures (1.9 versus 1.4) or with the number of years on clean intermittent catheterization (7.7 versus 5.9). These results suggest that latex allergy is acquired through multiple exposures due to breakdown of blood tissue barriers. Therefore, we recommend that all patients with spina bifida undergoing surgery be evaluated for latex allergy and that all surgical procedures in spina bifida patients, from the time of birth, be performed in a latex-free environment.

HISTOLOGICAL EVALUATION OF THE TESTICULAR NUBBIN IN THE VANISHING TESTIS SYNDROME

PURPOSEnWe reviewed histopathological studies of the testicular nubbins associated with the vanishing testis syndrome, and determined whether surgical removal is indicated based on the histological findings.nnnMATERIALS AND METHODSnBetween 1983 and 1997 a unilateral testicular nubbin consistent with a vanishing testis was excised in 29 patients an average of 28.6 months old. We retrospectively reviewed the gross pathology reports and microscopic slides, and prospectively performed histochemical stain analysis.nnnRESULTSnGross evaluation of the specimens revealed an identifiable cord structure in the majority of cases with the vas deferens most commonly identified in 72.4%. No recognizable testicular elements were present in any nubbin. In 3 cases the original pathology report identified cells with features consistent with Leydig cells, which immunohistochemical staining revealed to be atrophied cremasteric muscle fibers.nnnCONCLUSIONSnIn this series testicular nubbins in vanishing testes contained no viable testicular tissue. Since the risk of testicular cancer in an undescended testis is 8 to 10% and the incidence of viable testicular tissue in these nubbins ranges from 0% in our series to 11% in others, there is only a 0 to 1.1% risk of testicular cancer in the nubbin. Thus, surgical removal may not be warranted.

HISTOLOGICAL ANALYSIS OF URETHRAL HEALING AFTER TUBULARIZED INCISED PLATE URETHROPLASTY

PURPOSEnTubularized incised plate urethroplasty has rapidly gained popularity for treating hypospadias. It is presumed that healing occurs with the postoperative migration of epithelial cells into the incised urethral plate. We describe the time course and histology of the healing urethral wound in an animal model after dorsal incision and stenting.nnnMATERIALS AND METHODSnA procedure was developed for use in an immature porcine model. The ventral aspect of the urethra was opened and a dorsal incision was made in the urethra to the level of the corpus spongiosum. The urethra was then catheterized and closed ventrally. Animals were sacrificed at intervals of 1, 2, 3, 5, 7, 14 and 21 days. Slides were made from multiple cross sections taken from each penis, and stained with hematoxylin and eosin, and Masson trichrome before analysis.nnnRESULTSnMigration of epithelial cells into the dorsal epithelial defect was evident on postoperative day 2 with apparent complete re-epithelialization by postoperative day 5. Regions of increased fibroblastic activity were observed in the subepithelial stroma below the incised area on postoperative day 3 and early collagen deposition was noted in these areas when stained with Masson trichrome. These areas appeared to organize and by postoperative day 21 there was little evidence of increased fibroblastic activity or excess collagen deposition.nnnCONCLUSIONSnUrethral healing after incision and tubularization over a catheter in our model occurred through normal re-epithelialization without excess collagen deposition or scarring.

The retained penile prosthesis reservoir: a risk.

Complications associated with penile prostheses include malfunction, infection, and patient dissatisfaction. We present a rare complication of a retained abdominal reservoir eroding into the bladder and causing irritative voiding symptoms several years after the removal of the penile components of a three-piece penile prosthesis.

Modifiable Factors to Decrease the Cost of Robotic-Assisted Procedures

In 2000, the US Food and Drug Administration approved the da Vinci Surgical System® for use in the United States. Since that time, the number of surgical robotic systems throughout the United States has continued to grow. The costs for using the system include the initial purchase (

SURGICAL TREATMENT OF VERRUCOUS CARCINOMA OF THE BLADDER UNASSOCIATED WITH BILHARZIAL CYSTITIS: CASE REPORT AND LITERATURE REVIEW

1 million to

PRIAPISM IN A 15-YEAR-OLD BOY WITH CONGENITAL DYSERYTHROPOIETIC ANEMIA TYPE II (HEREDITARY ERYTHROBLASTIC MULTINUCLEARITY WITH POSITIVE ACIDIFIED SERUM LYSIS TEST)

2.3 million) plus annual maintenance fees (

Surgical Management of Vesicoureteral Reflux

100,000 to

Hypospadias Repair in the 1990s

150,000) and the cost of limited-use or disposable instruments. Increasing the number of procedures that are performed using the robotic system can decrease the per-procedure costs. Two modifiable factors that contribute to increasing the annual caseload are increasing the number of surgeons capable of using the system and having a properly educated perioperative nursing team. An educated surgical team decreases turnover time, facilitates proper flow of each surgical procedure, and is able to actively and passively solve intraoperative problems.