Stephen R. Shapiro

Lower Extremity Complications of the Lithotomy Position: Prevention and Management

We describe 2 unusual and serious complications of the lithotomy position, anterior compartment syndrome and peroneal nerve palsy. The methods of management and prevention are discussed.

Surgical treatment of the “buried” penis

The buried penis occurs in a spectrum which varies from slight with only ventral webbing to almost complete burying of the penis dorsally in the prepubic fat pad and ventrally in the scrotum. From 1979 to 1985, the author operated on 80 children with these problems. Indications for surgery varied from unsatisfactory appearance of the penis before or after circumcision to almost complete concealment of the penis. Satisfactory cosmetic and functional results were achieved in most cases utilizing several surgical principles. The limitations of these procedures and their possible complications are described.

Complications of Hypospadias Repair

Any surgeon performing hypospadias repair must be prepared to manage the surgical complications. From January 1976 to December 1982, 176 cases of hypospadias treated with a number of different operations were critically analyzed for complications. There were no complications in 143 cases (81 per cent). However, there were 44 surgical complications in the remaining 33 patients (19 per cent), which included stricture formation (11), urethral fistula (11), severe skin edema (2), subcutaneous hematoma (2), persistent chordee (2), scrotal abscess (1) and bladder calculus (1). Treatment of the various complications is discussed along with suggestions on how to avoid them. When only 3 operations are considered (meatal advancement and glanuloplasty, flip-flap procedure and free graft tubed urethroplasty), surgical repair of all types of hypospadias was accomplished, without any complications in 89 per cent of the cases. The results of hypospadias repair have improved because of the availability of these more reliable procedures that provide a lower incidence of complications and improved cosmetic appearance.

Chylous ascites following retroperitoneal lymphadenectomy. Report of 2 cases with guidelines for diagnosis and treatment

Two cases of chylous ascites following retroperitoneal lymphadenectomy are presented. The first case, a 3‐year‐old girl, underwent a right radical nephrectomy and retroperitoneal lymph node dissection for Wilms tumor. Chylous ascites developed postoperatively and resolved after 3 months of supportive therapy. The second case, a 45‐year‐old woman, underwent a right radical nephrectomy and retroperitoneal lymph node dissection for renal carcinoma. Chylous ascites occurred postoperatively and resolved after a single paracentesis. Diagnosis, evaluation, and therapeutic modalities are outlined and the literature is reviewed.

Focal Infarction of the Testicle in a Child Simulating Testicular Tumor

Enlargement of an undescended testicle in a 6 1/2-month-old-child resulted in radical orchiectomy. Pathological diagnosis was focal infarction of the testicle. This disorder must be considered in the differential diagnosis of testicular enlargement in the infant and child.

Free Graft Patch 1-Stage Procedure to Repair Penile Hypospadias Unsuitable for the Flip-Flap Procedure: Indications and Experience

From January 1983 to December 1985, 14 procedures were performed in which a free graft of skin from either the foreskin or elsewhere was substituted for the flipped flap in the repair of hypospadias. This obviates the problem of thin skin below the urethral meatus, since a flipped flap in such a case will result in devascularization of the flap. Moderate chordee was not necessarily a contraindication to the use of this procedure, provided the chordee could be corrected without moving the meatus proximally. Cosmetic and functional results have been good, and there was only 1 urethral fistula. Nevertheless, because of the need for a scrotal flap of fat to prevent fistula formation and to ensure vascularization of the graft, and because of the availability of a vascularized flap from the foreskin in most cases, the free graft patch procedure is best reserved for cases in which the foreskin is either absent or deficient.

Anuria in Infants and Children

The urologist may be involved in the initial evaluation of a child with anuria. In our experience the most common cause of anuria in neonates was perinatal hypoxia and in older children it was the hemolytic uremic syndrome. Obstructive uropathy as a cause of anuria in infants and children appears to be uncommon.

Nonrenovascular renal hypertension in children.

Hypertension in children has been reported with increasing frequency because of increased awareness of its occurrence by clinicians. Renovascular lesions have been stressed in the past. However, in recent years, a number of nonrenovascular renal lesions have received attention and form the basis for this report. Unilateral chronic atrophic pyelonphritis, segmental unilateral pyelonephritis, the Ask-Upmark kidney, and unilateral renal hypoplasia have been associated with curable hypertension. The subject of juxtaglomerular cell hyperplasia, which has variably been reported in these cases, is reviewed. Ureteral obstruction, in the form of uretero-pelvic or ureterovesical junction obstruction, solitary renal cysts, the unilateral multicystic kidney, renal trauma, and renal tumors (Wilms tumor and juxtaglomerular cell tumors) may also be associated with hypertension in children. Pheochromocytoma must be ruled out in all cases. Because of renewed interest, these nonrenovascular renal causes of hypertension are now likely to be diagnosed with increased frequency.

Nonobstructive anuria in children: hemolytic uremic syndrome

The hemolytic uremic syndrome (HUS) must be considered as a cause of oligo-anuria in a previously healthy young child. This syndrome consists of a viral-like prodromal illness, followed by acute renal failure, thrombocytopenia, and an abnormal blood smear with fragmented erythrocytes. Awareness of this syndrome will permit earlier diagnosis and management and will minimize unneccessary investigation in the anuric child.