Prasad Godbole

Endourethral injection of bulking agents for urinary incontinence in children

To assess the early and late outcome of endourethral injection with bulking agents in children with urinary incontinence (a neuropathic bladder or exstrophy‐epispadias complex), by reviewing our experience over a 5‐year period.

Foreskin preputioplasty and intralesional triamcinolone: a valid alternative to circumcision for balanitis xerotica obliterans

BACKGROUND We previously reported our short-term experience of foreskin preputioplasty as an alternative to circumcision for the treatment of foreskin balanitis xerotica obliterans (BXO). In this study, we aimed to compare this technique with circumcision over a longer period. METHODS Between 2002 and 2007, boys requiring surgery for BXO were offered either foreskin preputioplasty or primary circumcision. The preputioplasty technique involved triradiate preputial incisions and injection of triamcinolone intralesionally. Retrospective case-note analysis was performed to identify patient demographics, symptoms, and outcomes. RESULTS One hundred thirty-six boys underwent primary surgery for histologically confirmed BXO. One hundred four boys opted for foreskin preputioplasty, and 32, for circumcision. At a median follow-up of 14 months (interquartile range, 2.5-17.8), 84 (81%) of 104 in the preputioplasty group had a fully retractile and no macroscopic evidence of BXO. Of 104, 14 (13%) developed recurrent symptoms/BXO requiring circumcision or repeat foreskin preputioplasty. In the circumcision group, 23 (72%) of 32 had no macroscopic evidence of BXO. The incidence of meatal stenosis was significantly less in the foreskin preputioplasty group, 6 (6%) of 104 vs 6 (19%) of 32 (P = .034). CONCLUSION Our results show a good outcome for most boys undergoing foreskin preputioplasty and intralesional triamcinolone for BXO. There is a small risk of recurrent BXO, but rates of meatal stenosis may be reduced.

Investigating febrile UTI in infants: is a cystogram necessary?

OBJECTIVE Current imaging recommendations for investigating any infantile febrile urinary tract infection (UTI) are ultrasound scan (US), micturating cystourethrogram (MCUG) and dimercaptosuccinic acid (DMSA) scan. The aim of this retrospective cohort study was to determine the need and indications for MCUG in the investigation of a first febrile infantile UTI, as doubts have been raised over its benefit. PATIENTS AND METHODS Information on 427 infants who had undergone US, MCUG and DMSA following a first febrile UTI was prospectively recorded. The infants were divided into two groups: A (354) with normal renal US and B (73) with abnormal US. DMSA findings were correlated with findings on MCUG. Main outcome measures were incidence of recurrent UTIs, change in management or intervention as a result of MCUG, and outcome at discharge. RESULTS Only 21/354 (6%) infants in Group A had both scarring on DMSA and vesicoureteric reflux (VUR), predominantly low-grade on MCUG. In Group B (abnormal US), 23/73 (32%) had scarring on DMSA and vesicoureteric reflux, predominantly high grade on MCUG. Of the infants with non-scarred kidneys, 73% had dilating reflux. Successful conservative treatment was performed in 423 infants, and 4 infants in Group B required surgery. CONCLUSION We recommend US and DMSA in all infantile febrile UTI cases. Where US is normal, MCUG should be reserved for those cases with abnormal DMSA. Where US is abnormal, MCUG should be performed irrespective of findings on DMSA scan. A randomized prospective study is necessary to evaluate this further.

Cystoscopy assisted transvesical biopsy of prostatic rhabdomyosarcoma

The treatment of prostatic rhabdomyosarcoma (RMS) depends on tumour stratification based on site and histology. An increasing range of cytogenetic, molecular, and immunohistochemistry studies are required. This is difficult to achieve using standard cystoscopic biopsies alone. We present a 5‐year‐old male, diagnosed with a prostatic RMS. He underwent cystoscopy to confirm the diagnosis and at the same time tissue was obtained for histology using laparoscopic graspers via a STEP™ Port inserted percutaneously into the apex of his bladder. Histology and cytogenetics confirmed an embryonal botryoid RMS for which he received chemotherapy followed by a radical prostatectomy for residual disease. Pediatr Blood Cancer. 2010;55:583–586.

Care and Conditions of the Uncircumcised Phallus

Understanding of the natural history of separation of the inner surface of the intact prepuce from the glans is paramount to the care of the uncircumcised penis. As emphasized by the authors, all too often, the child (and over anxious parent) is referred to specialists by even the most knowledgeable medical practitioner for circumcision due to inability to retract, residual adhesions, infection of cyst (almost always smegma). In Western countries like the USA, where historically circumcision has been the norm, educating the families about this natural process of prepucial separation right from birth, and essentially reassuring them that time and a hands-off approach for the foreskin is all that is necessary in the long run, should be reinforced. Whether families and referring physicians will concur, is conjecture.

Disorders of Male External Genitalia: Problems of the Penis and Foreskin

The management of foreskin conditions varies amongst medical practitioners from observation to circumcision. A number of conditions may affect the foreskin and may lead to a specialist referral. This chapter deals with common foreskin problems, their etiology and management in primary/emergency care. Indications for referral will be highlighted. Circumcision will be dealt with in another chapter.

Achondroplasia: should the urinary tract be evaluated in children?

Materials and methods Twenty-six patients with achondroplasia and a mean age of 14 years (7–18) referred to the orthopaedic clinic for potential limb lengthening surgery underwent a health assessment. An MRI scan was performed in the presence of neurological and/or urological symptoms. Six patients with confirmed spinal stenosis were referred for urological assessment, 4 of which had urological symptoms. Non-invasive urodynamics were carried out in all including bladder pre and post micturition volumes and uroflowmetry.