You have accessJournal of UrologyPediatrics1 Apr 2013V569 ROBOTIC ASSISTED LAPAROSCOPIC IPSILATERAL URETEROURETEROSTOMY TO MANAGE AN ECTOPIC URETER IN A PEDIATIC PATIENT Kristin A. Greco, David Hatch, and Derek Matoka Kristin A. GrecoKristin A. Greco Maywood, IL More articles by this author , David HatchDavid Hatch Maywood, IL More articles by this author , and Derek MatokaDerek Matoka Maywood, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1965AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ipsilateral ureteroureterostomy has been used to treat duplication anomalies of the urinary tract in the pediatric patient. Our objective is to demonstrate the techniques used in robotic surgical management of an ectopic ureter. METHODS An 8 year-old female presented to our pediatric urology clinic with complaints of persistent day and night time incontinence. Her exam was notable for perineal excoriation from being persistently damp. Cystoscopy and bilateral retrograde pyelograms demonstrated a complete duplication of her right collecting system. The lower pole empties into her bladder in an orthotopic position. The upper pole ureter was found to enter the distal uretha. A robotic assisted laparoscopic ipsilateral ureteroureterostomy was performed. A ureteral stent was placed prior to the robotic portion of the procedure. Four ports were placed (three robotic ports and one assistant port). The ureters were identified as they coursed along the psoas muscle. They were dissected free from surrounding attachments. Traction sutures were placed within the upper pole ureter for manipulation. The upper pole ureter was divided and spatulated. A 2 cm ureterotomy was made in the lower pole ureter. The anastomosis was performed using 5-0 monocryl suture in the running fashion. The distal ectopic ureter was ligated at the level of the trigone and excised. A 7 mm round Jackson Pratt drain was left in place. RESULTS The surgery was uncomplicated. The patient was discharged home on postoperative day 2 after an uneventful hospital stay. She was dry immediately after surgery. She continues to do well and is dry at 1 year of follow-up. CONCLUSIONS Robotic surgical techniques can be successfully applied to management of ectopic ureter in a pediatric patient. Robotic assisted laparoscopic ipsilateral ureteroureterostomy is a minimally invasive surgery that has no need for bladder reconstruction, thus reducing post-operative bladder symptoms such as urge, frequency and spasms. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e233-e234 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kristin A. Greco Maywood, IL More articles by this author David Hatch Maywood, IL More articles by this author Derek Matoka Maywood, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyOncology (TCC & Adrenal) & Teaching Techniques1 Apr 2012V873 ROBOTIC MANAGEMENT OF OBSTRUCTED RETROCAVAL URETER Evalynn Vasquez, Anthony Polcari, David A. Hatch, and Thomas M.T. Turk Evalynn VasquezEvalynn Vasquez Maywood, IL More articles by this author , Anthony PolcariAnthony Polcari Maywood, IL More articles by this author , David A. HatchDavid A. Hatch Maywood, IL More articles by this author , and Thomas M.T. TurkThomas M.T. Turk Maywood, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.967AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Retrocaval ureter is a rare congenital anomaly that usually presents in the third or fourth decade with symptoms of obstruction from external compression by the inferior vena cava. Our objective is to demonstrate robotic surgical management of an obstructed retrocaval ureter. METHODS A 40-year-old male with known right retrocaval ureter underwent percutaneous nephrolithotomy for a staghorn calculus in the ipsilateral kidney. Postoperative computed tomography reconfirmed hydroureteronephrosis to the level of L3 where the ureter deviated medially behind the inferior vena cava. The patient returned after several weeks for robot assisted laparoscopic ureteroureterostomy. An open ended ureteral stent was placed cystoscopically before robotic repair was performed. Four ports (two 12 mm and two 8mm) were placed and triangulated to the point of obstruction. Using a transperitoneal approach, the proximal ureter was dissected to the point at which it coursed posterior to the vena cava. From inferiorly, the dissection was carried to a point distal to the site at which the ureter emerged from behind the vena cava. After transecting and spatulating both segments of the ureter, a stented ureteroureterostomy was performed. The retrocaval portion of the ureter was left in place. A drain was brought through the inferior port site. RESULTS The procedures (cystoscopy and robotic ureteroureterostomy) took 262 minutes. Estimated blood loss was 50mL. The patient was discharged home on postoperative day 2 after the drain and Foley were removed. CONCLUSIONS Robotic surgical techniques can be successfully applied to challenging genitourinary conditions such as a retrocaval ureter. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e355 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Evalynn Vasquez Maywood, IL More articles by this author Anthony Polcari Maywood, IL More articles by this author David A. Hatch Maywood, IL More articles by this author Thomas M.T. Turk Maywood, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Spontaneous endometriosis is an estrogen-dependent, progressive and painful disease that affects a variety of nonhuman primates, including several species of baboons (Papio sp.). This case documents multimodal management of severe endometriosis in a captive female baboon within a zoological institution. An 18-yr-old, intact female Guinea baboon (Papio papio) was found to have an enlarged uterus. Fifteen months post ovariohysterctomy, scarring associated with endometrial tissue resulted in ureteral strictures, bilateral hydronephrosis, and azotemia. Cystoscopic placement of bilateral ureteral stents with fluoroscopy was performed and resulted in short-term clinical improvement. The animal's condition declined and euthanasia was elected 4 mo after ureteral stent placement. Severe endometriosis with secondary inflammation resulting in bilateral hydroureter and hydronephrosis, as well as concurrent cystitis, ureteritis, and pyelonephritis were confirmed at necropsy. Despite possible complications, ureteral stents can be considered a useful therapeutic option in patients with ureteral disease.

Dorsal hood prepuce is a common congenital anomaly of the penis. Neoplasms of the prepuce are very rarely seen in children. We present an interesting case of a penile myofibroma encountered during circumcision of a dorsal hood foreskin in an 8-month-old infant.

William F. Friedman's first public appearance as a cryptologist was short, with the start of testimony at a trial of wartime German and Indian conspirators. The article quotes the short testimony verbatim and provides some commentary on it.

In the wake of poor performance in the Spanish-American War, the United States created the basis for a modern military intelligence organization. This included communications intelligence (COMINT). The first major use of the nascent COMINT capability was along the Mexican Border during the Mexican Revolution. When General John Pershing commanded a punitive expedition to chase down Pancho Villa, he took COMINT facilities with him.

Congenital urinary tract anomalies occasionally result in end-stage renal disease and the need for renal transplantation. A child with congenital uropathy needs thorough evaluation before transplantation in order that potential problems with urinary storage and drainage may be identified and corrected. Kidney transplant survival is improving among children with and without urological anomalies. Careful attention to congenital uropathy can greatly minimize the potential for complications and allograft loss.

Renal cell carcinoma is an uncommon renal tumor in children, comprising between 1.8% and 6.3% of all malignant renal tumors of childhood (whereas renal cell carcinoma is the commonest renal tumor in adults). We describe a 15-year-old girl with chronic renal failure secondary to renal dysplasia and branchio-oto-renal syndrome, who received a cadaveric renal transplant at 8 years of age from a 25-year-old male donor. She developed severe chronic rejection 4 years after the transplant. A transplant nephrectomy was performed because of persistent gross hematuria. Histopathology of this graft showed chronic severe rejection and papillary necrosis. A fortuitous finding was a 1.5-cm renal cell carcinoma at one of the poles. We suggest that tumors which occur more commonly in adults and less commonly in children must be considered in children receiving adult organ transplants.

Several factors influence the decision about which type of urinary drainage is best for any given patient. In a patient who has undergone cystectomy, supravesical drainage is required. However, many patients with upper tract urinary diversion have bladders that can be rehabilitated to provide adequate urinary storage. In most patients who have not had a cystectomy, the bladder can be augmented with bowel to achieve a suitable capacity. The urethral resistance component of continence can be achieved using bladder neck reconstruction, periurethral injection, or artificial urinary sphincter. Intermittent catheterization may be required following lower tract reconstruction. When reconstruction is possible, the native bladder is usually the best option for kidney transplant drainage. In general, one should provide an effective, low-pressure means of urine drainage that the patient can manage. With improvements in surgical technique and with better immunosuppressive regimens, kidney transplantation can be performed safely in patients with abnormal lower urinary tracts. Using appropriate bladder rehabilitation or supravesical diversion can preserve and even improve a patient’s life style.

The American Association of Pediatric Urology initiated a Pediatric Urological Manpower Study in 1991. A 24-question survey was distributed to the members of the Society of Pediatric Urology and the American Academy of Pediatrics Section on Urology. The objective of the questionnaire was to obtain information related to fellowship training, regional distribution of pediatric urologists, and practice patterns and attitudes. As of December 31, 1991, 345 questionnaires were distributed, and 244 (71%) were completed and entered into a computer program. The number of pediatric urologists was evenly distributed among 3 consecutive 10-year age groups ranging between age 31 and 60 years. The majority (78%) of urologists practicing 100% pediatric urology were between 31 and 50 years old. Approximately 60% of the responders practiced full-time (100%) pediatric urology and 59% of this group were university based. Pediatric urologists were practicing in 42 states and the District of Columbia. Based upon the United States Department of Commerce 1990 census, the number of pediatric urologists practicing in each state in relation to the total pediatric (less than 18 years old) populations was determined. The number of pediatric urology fellowships has steadily increased since the mid 1950s. Currently, more than 10 fellows are trained annually. Of the 172 responders practicing at least 75% pediatric urology 24% indicated that practice was "too busy" and 53% indicated that practice was "just right." Approximately 44% of the responders were considering adding a partner: 21 indicated that they planned to add a partner in 1 year, 65 in 5 years and 10 in 10 years. Hopefully, the Pediatric Urological Manpower Study will serve as a useful instrument for assessing the pediatric practice patterns and training needs in the United States, thereby enhancing the quality of urological care for children.

Nine boys were found to have hypospadias despite the presence of a complete prepuce. The urethral meatus was in the subcoronal position in six boys, the distal shaft position in one boy and on the corona glandis in two boys. Although it is generally thought that boys with hypospadias have a dorsal hooded prepuce resulting from incomplete development of the ventral phallus, we have found hypospadias in boys with complete preputial development. Thus, physicians who perform circumcision should fully retract the prepuce to detect occult hypospadias before completing the procedure. Parents of newborns with hypospadias and a complete prepuce should be told, before circumcision, that preputial tissues may be needed to repair the hypospadias.