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Purpose: We evaluated the safety and efficacy of emergency exploration of neonatal torsion., Materials and Methods: We retrospectively reviewed the charts of 27 neonates (30 affected testicles) in a 13-year period., Results: Of the 10 testicles that were explored and fixed within 6 hours of discovery 2 (20%) were normal at physical examination at 1 year of followup. Of the remaining 20 testicles 19 were removed. One patient was lost to followup after orchiopexy. No operative or perioperative complications were associated with emergency exploration., Conclusions: Emergency exploration of neonatal torsion is safe and prudent, and may result in higher testicular salvage rates. Given reports of contralateral torsion, we also recommend contralateral orchiopexy.

Previous studies have established normal penile length for patient age and stage of sexual development. To our knowledge penile length has only been determined to date by measuring the stretched distance from the symphysis to the glans tip. Pilot studies at our institution showed that ultrasound corpora cavernosa length determinations were possible using a 7.5 MHz. linear transducer probe. To determine whether ultrasound is a more accurate modality in assessing penile length, male subjects 0 to 24 months old with normal penile anatomy and palpably descended testicles were enrolled in a prospective analysis. Longitudinal ultrasound images of the flaccid penis were obtained from the dorsal surface. The whole corporeal bodies were easily imaged and measured. In a blinded fashion a separate investigator performed a conventional stretched penile length determination. A total of 27 male subjects 1 week to 22 months old was evaluated and 2 were excluded. Corpora cavernosa measurements using ultrasound revealed a mean length of 32.3 +/- 4.7 mm. (range 22.4 to 44.9). Stretched penile lengths of the same subjects revealed a mean length of 46.8 +/- 8.2 mm. (range 31 to 63). Circumcision status (p = 0.036) and age (p < 0.001) significantly correlated with stretched length determinations. Ultrasound measurements did not significantly vary with patient circumcision status or age. Penile length and race were not correlated when using stretched or ultrasound measurements. Ultrasound determination of corporeal body length is possible in young subjects. From infancy to age 22 months ultrasound measurements are not significantly affected by age or the presence of foreskin. Our experience suggests that corporeal body evaluation by ultrasound may offer a more accurate assessment of functional penile length.

We report significant blunt renal injury resulting from 3 traumatic events in 2 boys with the prune-belly syndrome. Manifestations of the syndrome influenced the clinical and radiographic assessment of the urinary tract injuries. Nonoperative management resulted in excellent outcomes without long-term sequelae.

A patient with severe cyclophosphamide cystitis was treated with intravesical silver nitrate instillation to control bleeding. This resulted in apparent reflux and extravasation of the silver nitrate solution with secondary retroperitoneal inflammation. Subsequently, the patient required treatment for a small, fibrotic bladder with persistent reflux. The precautions and recommendations for treatment of such difficult patients are discussed.

Since 1976, 23 patients with cyclophosphamide-induced cystitis were treated. These patients presented with a variety of urinary problems, including incontinence, hematuria and vesicoureteral reflux. Vesicoureteral reflux was found in 9 patients, hydronephrosis in 4 and a contracted fibrotic bladder in 3. Of the 23 patients 18 had undergone a combination of radiation and cyclophosphamide therapy. Based on this experience a general outline is developed for evaluation and treatment of patients with cyclophosphamide-induced cystitis and its potentially severe complications.

Priapism has been reported to occur in 2 to 5 per cent of patients with sickle cell disease. Recently, creation of a percutaneous fistula between the glans penis and the corpora cavernosa has been applied widely in the management of patients with priapism, except in those cases of sickle cell anemia. Reported failures of such shunting procedures in the sickle cell patient has perhaps unduly denied surgical benefits to that population. We have managed successfully 5 such children with sickle cell anemia and priapism without complications by creation of a fistula between the glans penis and the corpora cavernosa. Our treatment plan is presented, which includes early shunting should initial nonoperative treatment fail.

We studied 35 children with voiding dysfunction and detrusor-sphincter incoordination. More than 90 per cent of these patients had a history of repeat urinary tract infections, and medication and surgical treatment of the voiding dysfunction had failed. Of the patients 22 (63 per cent) experienced significant improvement or resolution of the voiding dysfunction when biofeedback was used to teach normal bladder sphincter coordination as part of the over-all treatment regimen. A review of our experience with these patients indicates that with proper patient selection an even higher rate of success may be possible.

Ossifying renal tumor of infancy is a rare lesion, with only 2 cases reported in the literature. We report an additional case, and review its presentation and histological findings.

Nephroblastoma and renal stone disease are seen infrequently in children. We report on a 2-year-old girl with bilateral nephroblastoma and a simultaneous staghorn calculus in 1 kidney.

Serum from 20 children with urinary tract infections and proved cystitis cystica has been examined for antibody to a panel of established cell lines derived from normal urothelium and transitional cell carcinomas of the bladder. Antibody-dependent cytotoxicity was measured with serial dilutions of patient serum and lymphocytes from normal healthy adults as effector cells. The reaction was quantitated by the release of 51chromium from labeled target cells. The patients were grouped according to the duration of symptoms, the presence or absence of reflux, and the presence or absence of upper tract changes or scarring. No differences between test and control subjects were detected.

Condyloma acuminatum has been recognized as venereal disease in adults but it has not always been similarly identified in children. We review our experience with 30 children with condylomata acuminata. Of the 14 children evaluated more than half have been determined to have a sexual etiology for the lesion. Recommendations for evaluation and treatment of children with condylomata acuminata are reviewed.

The hypertelorism-hypospadias syndrome has been reported previously in 19 affected male patients. In addition, 21 affected boys in 16 families have been evaluated at our center. Genitourinary anomalies other than hypospadias were observed frequently and included cryptorchidism, vesicoureteral reflux and minor upper urinary tract variations. An increased incidence of other developmental defects involving major organ systems also was observed. Since urologists are among the first physicians to evaluate these children, they should recognize this syndrome as an indication to initiate a thorough multisystem evaluation.

Cutaneous vesicostomy has proved to be a useful form of temporary diversion in children. We report our experience with 35 patients who underwent diversion for either lower tract dysfunction or obstruction. In only 1 child did vesicostomy appear to be of questionable value in adequately draining the upper urinary tracts. Renal functional improvement or stabilization was observed in the remaining 34 children. Complications occurred in 14 patients, with urinary tract infections of a clinically serious nature being observed in 6. Our experience tends to confirm vesicostomy to be an effective, simple and easily reversible means to treat selected conditions in infants and children. Complications are encountered but they have been managed effectively.

Children with posterior urethral valves and significant changes in the upper urinary tracts generally respond to initial fulguration of the valves and decompression of the bladder. Infrequently, a higher grade of obstruction of the ureters will develop after initial treatment. We report on 2 such children with this particular clinical course and discuss the management. The response of our patients indicates that acute obstruction at the ureterovesical junction is, in some cases, temporary and may not require longer term supravesical diversion procedures for proper management.

During the last 19 years 40 girls with urethral prolapse have been seen at our medical center. Treatment has ranged from nonoperative approaches to excision of the prolapsed urethra. A comparison of the treatment modalities indicates that patients undergoing early local excision of the prolapse have the lowest complication rate and shortest hospital stay.

A prospective study was established to identify the incidence of vesicoureteral reflux in the siblings of patients with reflux. Of 78 patients with reflux 104 siblings were screened with an awake voiding cystogram and 34 (32 per cent) were found to have reflux. Of these 34 siblings 25 (73 per cent) had no abnormal voiding symptoms or history of urinary tract infection. The highest incidence of reflux was found in the siblings of those patients with radiographic evidence of renal scarring. Early detection and followup in this high risk group may be a vital tool in determining more about the natural history of vesicoureteral reflux and its relationship to renal damage.

Our clinical experience with 47 pediatric patients with stones is reviewed. Surgical therapy was standard with successful stone manipulation in 12 of 13 patients. In 91 per cent of our patients factors causing or predisposing to stone disease were discovered. A thorough metabolic evaluation, including an oral calcium loading test in 20 children, proved to be helpful. A new patient subgroup relating unexplained hematuria to eventual stone formation is described. Our protocol for metabolic evaluation and recommendations for treatment based on the results of such an evaluation are given. We have found the metabolic evaluation of the child with stones meaningful and particularly helpful in planning subsequent therapy for these patients.