IntroductionPrimary isolated bladder diverticula (PIBD) that are not correlated with the UVJ comprise approximately 10% of all primary bladder diverticulas (PBDs). No guidelines have been established for PIBD repair. It is unknown if infections or voiding dysfunction are impacted by the size of diverticula.PurposeWe evaluated the most effective approach to treating PIBD with respect to diverticula size and objective clinical and urodynamic findings.MethodsWe retrospectively evaluated age, sex, chief complaint, UTI diverticula size, clinical and urodynamic findings, and management of 14 consecutive patients diagnosed with PIBD from 1995 to 2013. Urodynamic studies were performed in all PIBD cases, Post micturition residue (PMR), maximum bladder capacity (MBC), voiding detrusor pressure (Pdet), and pressure flow (Qmax) were all measured. Among patients who underwent surgical repair, resected diverticula wall specimens were sent for pathological evaluation.ResultsTwelve boys and two girls ranging in age from 2 to 15 years (mean, 6.7 years) were included in this study. The mean follow-up duration was 54.2 months (range, 6-120 months). All diverticula were single, and most occurred in posterolateral locations (Figure). In eight patients with PIBD of <3 cm (range, 15e24mm; mean, 18 mm), MBC, P det, and Qmax were within reference ranges. None of the patients had PMR, and most developed only one urinary tract infection (UTI) before admission. All patients underwent close follow-up without surgical intervention. Six patients had diverticula of > 3 cm(range, 32-72 mm; median, 48 mm). Their MBC was lower (72% of predicted value) than the reference range. The P det was significantly higher than that of patients with diverticula of <3 cm and the Qmax was lower in two patients. Four patients had PMR, and all patients developed at least three UTIs before admission to the hospital. This group of patients was treated surgically. All operated children reported improvement after in control urodynamic study over follow-up periods.DiscussionThe diverticula layer lacks the contractility that allows the diverticulum to appropriately void into the bladder. This accounts for the urinary retention and dysfunctional voiding. The patients with diverticula larger than 3 cm had PMR. Members of this group had more than three UTIs. In our series, diverticula of > 3 cm exhibited an MBC that was lower than the predicted values. The detrusor contracts, but the urine enters the diverticula more easily than it enters the bladder neck. This could inhibit bladder enlargement and may explain the lower MBC in this group. This group also had higher Pdet, and their qmax was low. Thus, probably simulating detrusor much higher pressure but undercontractility due to diverticulum. Another possible explanation could be that large PIBD creates a functional obstruction over the bladder neck during voiding.ConclusionPIBD of > 3 cm is characterized by UTI development, functional lower urinary tract symptoms, and disorders of bladder storage or emptying. Surgical repair of these diverticula is associated with improvement of voiding dysfunction and elimination of UTIs.

Aim: This study aimed to investigate the characteristics of the most frequently cited articles published in 3 main journals dedicated to the field of pediatric surgery (Journal of Pediatric Surgery, Pediatric Surgery International and European Journal of Pediatric Surgery). Material and Methods: A search was initiated using the database (1985 - 2006) of the Science Citation Index of the Institute for Scientific Information. The total number of publications and their citation numbers were found and the most cited articles were investigated in detail. A total of 600 (200 from each journal) most cited articles were identified and chosen for further analysis. Results: The total number of citations in these 3 journals was 20 271. The citations of the most cited articles ranged from 10 to 224. The articles were published between 1985 and 2003 and the mean number of citations/article was 33.78. Articles originated from 39 counties and 256 institutions. The leading countries were the United States (203 articles from 75 institutions), Germany (50 articles from 21 institutions), Japan (34 articles from 17 institutions), Switzerland (34 articles from 8 institutions), United Kingdom (32 articles from 19 institutions), and Canada (28 articles from 7 institutions). Of the institutions with the highest number of cited articles, four institutions were from the USA followed by Switzerland with two institutions. The leading topics were the gastrointestinal system (n = 239), respiratory system (n = 94), urology (n = 61) and oncology (n = 56), and diaphragmatic hernia (n = 41) was the most common special topic. There were 42 case reports (7 %) and 75 experimental research articles (12.5 %). Thirty-four authors from 14 countries and 30 institutions had articles in more than one journal. The most cited author was N. S. Adzick from the USA with 224 citations. Conclusion: In this study, we found that the Journal of Pediatric Surgery predominated with the greatest number of cited articles. The most cited articles, authors and institutions originated from the USA and English-speaking countries. The gastrointestinal system, respiratory system, urology and oncology were the leading topics and diaphragmatic hernia was the most common special topic.

This investigation was conducted to evaluate the presence of estrogen and androgen receptors in penile tissues of patients with hypospadias. The biopsy specimens from prepuce, glans, and urethral plate were sampled during the hypospadias surgery in five patients and were analyzed immunohistochemically. Twelve specimens were investigated for the presence of estrogen or androgen receptors (n: 24); the result was negative in 9 (37%) and positive in 15 (63%). Estrogen receptors were present in 10 specimens (42%) (prepuce: 5, glans: 3, and urethral plate: 2). Androgen receptors were present in 5 specimens (21%) (prepuce: 3, glans: 1, and urethral plate: 1). There was expression of both estrogen and androgen receptors in 5 specimens and only estrogen receptors in the remaining 5. Dominant expression of estrogen receptors in penile tissues of children with hypospadias may be the postnatal finding of disrupted estrogen and androgen receptor interaction during the intrauterine development of external genitalia.