William J. Cromie

Testicular salvage and age-related delay in the presentation of testicular torsion

Testicular torsion represents a continuing source of morbidity among male patients. Early diagnosis and surgical exploration improve testis salvage but even this approach will result in orchiectomy if there is excessive delay in patient presentation. A 10-year retrospective review of testicular torsion was performed. The interval between onset of scrotal pain and presentation to the emergency department was determined. A specific age-related delay in presentation was identified between patients less than 18 years old (group 1, median delay 20 hours) and those greater than 18 years old (group 2, median delay 4 hours, p less than 0.001). At exploration 44 per cent of the group 1 patients required orchiectomy versus 8 per cent in group 2. Patients less than 18 years old are a high risk group for testicular loss after torsion and represent more than 90 per cent of the orchiectomies performed. We believe that this group should be targeted for improved health education, emphasizing early evaluation of scrotal pain to improve testicular salvage.

Cecal tubularization: lengthening techniquefor creation of catheterizable conduit

The creation of a continent, catherizable stoma is an integral component of successful continent urinary diversion. A technique is described which allows lengthening of a continent appendicovesicostomy. This technique extends the applications for the Mitrofanoff principle of urinary tract reconstruction.

The Mitrofanoff principle: an alternative form of continent urinary diversion.

The Mitrofanoff procedure for continent urinary diversion was described in 1980. This principle has been expanded upon and used to achieve continent urinary diversion in virtually any indicated clinical setting. We report 3 cases treated by the Mitrofanoff principle to illustrate the spectrum of clinical situations to which it is applicable. The Mitrofanoff principle represents a viable form of continent urinary diversion.

Urethral Valve Incision Using A Modified Venous Valvulotome

Anterior and posterior urethral valves have been treated with a variety of methods. The gold standard for treatment of posterior urethral valves is direct vision transurethral fulguration with the patient under general anesthesia. We report a bi-institutional experience using an adapted venous valvulotome to incise the obstructing valve leaflets. During the last 4 years 15 patients were treated, 4 with anterior and 11 with posterior urethral valves. There were no complications associated with this technique, and we believe that this is a safe and simple treatment option.

Single polypoid cystitis cystica and glandularis presenting as benign bladder tumor

A case report of a ten-year-old boy with a benign polypoid bladder tumor is presented. The rarity of benign or malignant bladder tumors in children is reviewed, as well as the possible etiology of this unique lesion.

Bilateral synchronous neonatal torsion of spermatic cord

A case of synchronous bilateral spermatic cord torsion in a neonate is presented. While testicular salvage is variable in this entity, surgical intervention is necessary for any hope of testicular preservation.

Rectal Duplication as a Cause of Neonatal Bladder Outlet Obstruction and Hydronephrosis

Duplication of the rectum is a rare embryogenic event with only 70 cases reported in the literature. These lesions manifest as bowel obstruction, hemorrhage, fistula formation, pain or palpable mass. We report a case of bladder outlet obstruction with severe bilateral hydronephrosis caused by rectal duplication.

Torsion of a Spermatocele: A Case Report and Review of the Literature

We report a case of torsion of a spermatocele in an adolescent. This condition has been described previously in adults. We recommend its consideration in the differential diagnosis of the acute scrotum in adolescents.

Single ectopic ureter: unusual presentation in adult male.

We present a case of an unusual and late presentation of a single ectopic ureter in an adult male. The patient presented with gross painless hematuria. The left ureter draining a dysplastic kidney terminated in the ipsilateral seminal vesicle.

COMPUTERIZED BODY TOMOGRAPHY IN NEONATAL RENAL VEIN THROMBOSIS

Abstract Renal vein thrombosis in children can be a diagnostic and therapeutic dilemma for the clinician. Guided by information obtained by standard intravenous contrast studies as well as serial computerized body tomography, the correct diagnosis was made, and effective conservative management was carried out.