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Efficiency of combined diffusion weighted imaging and conventional MRI in detection of clinically nonpalpable undescended testes. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2016.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Shehata SM, Shehata SMK, A Baky Fahmy M. The intra-abdominal testis: lessons from the past, and ideas for the future. Pediatr Surg Int 2013; 29:1039-45. [PMID: 23995239 DOI: 10.1007/s00383-013-3406-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The intra-abdominal testis (IAT) has been always an enigma for both diagnosis and treatment. Imaging techniques are known for low sensitivity for localizing the IAT. It has been universally accepted that the gold standard for localizing the IAT is diagnostic laparoscopy. Orchiopexy techniques for IAT are complicated and attended with a higher rate of failure and complication than those for the palpable testis. For the low-lying abdominal testis, a one-stage procedure without interruption of the vessels has a high success rate. The Prentiss maneuver bridges the borders of normal pathway to gain a straighter course to the scrotum. The interruption of the main vascular supply of the testis, depending on collateral circulation, has been used for many years but with questionable effects on the microscopic delicate structure of the testis. Microvascular autotransplantation was intended to avoid this effect, but it is technically demanding and requires special expertise. The principle of traction has been used in the past but was abandoned due to high rate of atrophy. Recently, traction has been revisited with a new approach with very encouraging results. The key to success in any technique for orchiopexy is the complete absence of tension.
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Affiliation(s)
- Sameh M Shehata
- Pediatric Surgery, Alexandria University, Alexandria, Egypt,
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Feasibility and safety of monopolar diathermy as an alternative to clip ligation in laparoscopic Fowler-Stephens orchiopexy. J Pediatr Surg 2012; 47:1907-12. [PMID: 23084205 DOI: 10.1016/j.jpedsurg.2012.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 04/01/2012] [Accepted: 04/19/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE The aims of the study were to study the effect of Fowler-Stephens orchiopexy (FSO) on testicular histology and to assess the feasibility of using monopolar diathermy as an alternative to clip ligation during laparoscopic FSO. PATIENTS AND METHODS The study included 20 patients with 20 intraabdominal testes and short vessels managed by laparoscopic-staged FSO. Biopsies were taken from intraabdominal testes during the first and second stages of the procedure for histologic comparison. The patients in the study were divided into 2 groups according to the method of dividing the testicular vessels in stage 1. The first 13 patients (group A) were managed by clip ligation of the vessels, whereas monopolar diathermy was used in the following 7 patients (group B). RESULTS Biopsy findings at stage 2 revealed an overall reduction in both the total number of germ cells per tubule and mean diameter of seminiferous tubules, whereas there was no statistically significant difference between the results in groups A and B. CONCLUSION The seminiferous cells can withstand (survive) dividing the main blood supply of the testis during FSO. The monopolar diathermy can be used as an alternative to clipping during laparoscopic procedures, having the advantages of lower expenses and using smaller instruments.
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Abstract
Since the introduction of minimal access surgery to general surgeons in the 1980s, pediatric surgeons have been employing this innovative technology to perform surgery on children. Video technology and miniaturized instruments have brought the laboratory to the operating room; in many cases several small incisions are the only access necessary to perform complicated procedures that would otherwise require a large wound. Additional benefits of minimal access surgery may include reduced postoperative analgesic requirements, shortened length of stay, and faster resumption of normal activities. Increased operative costs offset some of these gains. The pediatric surgical community has embraced minimal access techniques for some operations; others remain controversial.
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Affiliation(s)
- Jeffrey L Zitsman
- Children's Hospital of New York Presbyterian, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA.
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Touiti D, Ameur A, Beddouch A, Oukheira H, Taobane H. [Role of celioscopy in the assessment and treatment of non-palpable testis in adults. Report of 2 cases]. ANNALES D'UROLOGIE 2001; 35:353-5. [PMID: 11774770 DOI: 10.1016/s0003-4401(01)00059-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The authors reported two cases of impalpable testis in young mens. Laparoscopy is useful in both the diagnosis and the management of impalpable testes. Intraabdominal testicles can be removed laparoscopically if atrophic or can be partly devascularized by spermatic vessel clipping if apparently normal. A second-stage vasal-based orchidopexy can then be performed once adequate testicular reperfusion via the the defferential pedicle is believed to have occurred.
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Affiliation(s)
- D Touiti
- Service d'urologie, hôpital militaire Mohamed V, Rabat, Maroc
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Abstract
The role of laparoscopy with regards to the undescended testicle has been hotly debated since the late 1970s and early 1980s when it was realized that the abdominal testicle could be visualized with the laparoscope. Many enthusiastically embraced the laparoscope for diagnosis and localization of the impalpable undescended testicle, whereas others staunchly maintained that laparoscopy was overly invasive and really facilitated little with regards to orchidopexy. Diagnostic laparoscopy, when compared with the other modalities, holds its own well with regards to accuracy and efficacy. In the early 1990s, the role of laparoscopy expanded to include performance of orchidopexy. It would be naive to believe that the debate cooled with the evolution of laparoscopic orchidopexy. Over the years, since introduction of the operation, there have been many institutions that have examined the role of laparoscopic orchidopexy quite critically. In many people's minds, laparoscopic orchidopexy is a clear competitor to open orchidopexy for the impalpable undescended abdominal testicle; in a few people's minds, it has become the gold standard.
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Affiliation(s)
- G H Jordan
- Department of Urology, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Sousa A, Gayoso R, Lopez-bellido D, Reboredo J, Perez-valcarcel J, Fuentes M. Surg Laparosc Endosc Percutan Tech 2000; 10:420-422. [DOI: 10.1097/00019509-200012000-00019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mikaelsson C, Arnbjörnsson E, Lindhagen T, Montgomery A, Kullendorff CM. Routine laparoscopy for nonpalpable testes? J Laparoendosc Adv Surg Tech A 1999; 9:239-41. [PMID: 10414539 DOI: 10.1089/lap.1999.9.239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There are still no accepted criteria for the selection of patients with nonpalpable testes for laparoscopy versus a primary surgical exploration. We here report our experience using routine laparoscopy in such patients. The aim was to determine whether laparoscopy should be the first operative intervention or follow an inguinal exploration. Included in the study were 61 boys with 69 nonpalpable testes. Thirty-three testes were found in the abdomen, and 36 testes were extra-abdominal or nonexistent. If an exploration of the inguinal region had been the initial surgical intervention, six testes would have been found, making laparoscopy unnecessary. On the other hand, in the search for 63 missing testes, laparoscopy saved the patients from laparotomy or an extensive inguinal exploration. We conclude that an accurate knowledge of testis, vas, and vessel location gained by laparoscopy facilitates the selection of an appropriate surgical strategy, saving at least 51% of patients from laparotomy or an extensive inguinal exploration.
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Affiliation(s)
- C Mikaelsson
- Department of Paediatric Surgery, University Hospital, Lund, Sweden
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Baillie CT, Fearns G, Kitteringham L, Turnock RR. Management of the impalpable testis: the role of laparoscopy. Arch Dis Child 1998; 79:419-22. [PMID: 10193255 PMCID: PMC1717744 DOI: 10.1136/adc.79.5.419] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE To evaluate the use of laparoscopy in the management of the impalpable testis. DESIGN A retrospective analysis of the clinical findings, interventions, and outcome in 87 consecutive boys undergoing laparoscopy for 97 impalpable testes. RESULTS Fifty seven testes were either absent (n = 35) or present as a small remnant (n = 22), which was removed at contemporaneous groin exploration. There were 27 intra-abdominal testes, including four hypoplastic testes, which were removed laparoscopically. The 13 remaining viable testes were located in the groin. Conventional orchidopexy followed laparoscopy for 21 testes, and was successful in 17 cases. Two stage laparoscopically assisted Fowler Stevens orchidopexies were performed for 13 intra-abdominal testes, with eight satisfactory results. Ultrasound evaluation significantly reduced the number of conventional orchidopexies following laparoscopy. IMPLICATIONS Laparoscopy is a rational and safe approach for precise localisation of the impalpable testis. Laparoscopically assisted two stage orchidopexy is a successful treatment procedure for intra-abdominal testes.
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Affiliation(s)
- C T Baillie
- Department of Paediatric Surgery, Royal Liverpool Children's Hospital, UK
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Abstract
The surgeon should be aware of the extensive applications of endoscopic surgery in the pediatric patient. The ability to provide surgical care in association with either outpatient or short-stay hospitalizations appear to be cost-effective and appropriate state-of-the-art medical care. Because the array of surgical instruments continues to evolve, new and innovative endoscopic procedures will continue to become increasingly available.
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Affiliation(s)
- T E Lobe
- Section of Pediatric Surgery, University of Tennessee, Memphis, USA
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Merguerian PA, Mevorach RA, Shortliffe LD, Cendron M. Laparoscopy for the evaluation and management of the nonpalpable testicle. Urology 1998; 51:3-6. [PMID: 9610548 DOI: 10.1016/s0090-4295(98)00083-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the usefulness of laparoscopy for the diagnosis and treatment of the nonpalpable testicle and to evaluate the results of laparoscopic orchidopexy. METHODS We retrospectively reviewed the charts of 91 laparoscopies performed over a period of 4 years. We reviewed the following parameters: findings, complications, patency of the processus vaginalis, appearance of the cord structures, and the success of the different procedures performed for the intra-abdominal testicle. RESULTS Fourteen patients had bilateral and 77 unilateral nonpalpable testicles. The mean age of the patients was 39.5 +/- 50.8 months. There were three laparoscopic complications (3.2%) one of which was a major bowel laceration. Laparoscopy defined the intra-abdominal anatomy accurately in 90 of the 91 cases Of the 26 intra-abdominal testicles above the ring, a one-stage laparoscopic orchidopexy was performed in five and a single-stage standard orchidopexy in seven. All of these testicles remain viable and are in good position. Eight patients underwent a staged Fowler-Stephens orchidopexy with laparoscopic clipping of the spermatic vessels as the first stage. Of these, a second-stage open orchidopexy was performed in five and a laparoscopic orchidopexy in three. Testicular atrophy occurred in two of the patients who underwent the second-stage open orchidopexy. Three one-stage Fowler-Stephens orchidopexies were performed with testicular atrophy occurring in two of these testicles. Laparoscopic orchiectomy was performed on two patients. CONCLUSIONS Laparoscopy is a valuable tool in the diagnosis and treatment of the nonpalpable testicle. Laparoscopic orchidopexy may decrease the rate of testicular atrophy since most of these can be performed laparoscopically in one stage, thus preserving the vascular supply.
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Affiliation(s)
- P A Merguerian
- Division of Urology, Hospital for Sick Children, Toronto, Ontario, Canada
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Law GS, Pérez LM, Joseph DB. Two-stage Fowler-Stephens orchiopexy with laparoscopic clipping of the spermatic vessels. J Urol 1997; 158:1205-7. [PMID: 9258174 DOI: 10.1097/00005392-199709000-00136] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE We report the outcome of a staged approach to the intra-abdominal testicle and provide baseline data on operative time, postoperative course and testicular survival. MATERIALS AND METHODS We retrospectively reviewed the records of 441 boys (547 undescended testes). There were 105 boys (24%) with 124 nonpalpable testes (23%). All patients underwent laparoscopy. Ligation of spermatic vessels was performed as stage 1 on 20 abdominal testes (4%) in 18 boys (4%). Stage 2 orchiopexy was done using an open technique. RESULTS Two-stage orchiopexy in 18 boys included a bilateral procedure in 2, of which 1 was asynchronous and 1 was synchronous. Average operative time was 55 minutes for stage 1 and 67 minutes for stage 2. Stage 1 and 2 procedures were performed on an outpatient basis in 18 and 17 (94%) boys, respectively. There were no complications after stage 1 and 1 wound infection developed after stage 2. One testis with no vas deferens was determined to be nonviable at stage 2. The remaining 19 testes (95%) were considered viable at a followup of 6 months or greater. Viability was based on testicular size and consistency similar to those of the contralateral testis. CONCLUSIONS Laparoscopic ligation of spermatic vessels as a stage 1 procedure is a natural extension of laparoscopy. A staged approach provides adequate viability of the intra-abdominal testis.
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Affiliation(s)
- G S Law
- Department of Pediatric Urology, University of Alabama, Birmingham Children's Hospital, USA
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Law GS, Perez LM, Joseph DB. Two-Stage Fowler-Stephens Orchiopexy With Laparoscopic Clipping of the Spermatic Vessels. J Urol 1997. [DOI: 10.1016/s0022-5347(01)64428-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G. Stanford Law
- From the Department of Pediatric Urology, University of Alabama at Birmingham Children's Hospital, Birmingham, Alabama
| | - Luis M. Perez
- From the Department of Pediatric Urology, University of Alabama at Birmingham Children's Hospital, Birmingham, Alabama
| | - David B. Joseph
- From the Department of Pediatric Urology, University of Alabama at Birmingham Children's Hospital, Birmingham, Alabama
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Wacksman J, Billmire DA, Lewis AG, Sheldon CA. Laparoscopically assisted testicular autotransplantation for management of the intraabdominal undescended testis. J Urol 1996; 156:772-4. [PMID: 8683780 DOI: 10.1097/00005392-199608001-00058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE The intra-abdominal testis continues to present a considerable urological challenge and the approach to its management continues to evolve. We report our initial experience with laparoscopically assisted testicular autotransplantation. MATERIALS AND METHODS An intra-abdominal testicle was identified laparoscopically in 5 patients who subsequently underwent testicular autotransplantation. RESULTS The success rate was 100% and median operative time was 5 hours. All patients were discharged home the day after surgery with no complications and a good result. CONCLUSIONS Because of success with this technique, this procedure offers significant advantages (decreased hospital stay and lower morbidity) than an open or 2-stage Fowler-Stephens approach.
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Affiliation(s)
- J Wacksman
- Division of Pediatric Urology, Children's Hospital Medical Center, University of Cincinnati, Ohio, USA
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Wacksman J, Billmire DA, Lewis AG, Sheldon CA. Laparoscopically Assisted Testicular Autotransplantation for Management of the Intra-Abdominal Undescended Testis. J Urol 1996. [DOI: 10.1016/s0022-5347(01)65811-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jeffrey Wacksman
- From the Divisions of Pediatric Urology and Plastic Surgery, Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - David A. Billmire
- From the Divisions of Pediatric Urology and Plastic Surgery, Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Alfor G. Lewis
- From the Divisions of Pediatric Urology and Plastic Surgery, Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Curtis A. Sheldon
- From the Divisions of Pediatric Urology and Plastic Surgery, Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
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Ciampalini S, Lissiani A, Belgrano E. Laparoscopic orchiectomy. Urologia 1996. [DOI: 10.1177/039156039606300324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Laparoscopy has proved to be the most reliable technique in the diagnosis and treatment of nonpalpable testis found in almost 20% of cryptorchid cases. Possible applications are laparoscopic exploration in order to visualise a vanishing testis, Fowler-Stephens orchidopexy and orchiectomy. In orchiectomy, the use of laparoscopy is indicated in adults with single nonpalpable testis, while it is reasonable to use it in severely compromised cases when there is a bilateral nonpalpable testis. Finally it should be used when severe testicular hypotrophy is found. We performed laparoscopic orchiectomy in 6 men at the Departments of Urology of Sassari and Trieste from 1991 to 1996. The mean time of the operation was 1 hour and 50 mins with 1 day hospitalisation. No complications occurred.
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Affiliation(s)
- S. Ciampalini
- Istituto di Clinica Urologica - Ospedale di Cattinara - Università degli Studi - Trieste
| | - A. Lissiani
- Istituto di Clinica Urologica - Ospedale di Cattinara - Università degli Studi - Trieste
| | - E. Belgrano
- Istituto di Clinica Urologica - Ospedale di Cattinara - Università degli Studi - Trieste
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Matsuda T, Terachi T, Yoshida O. Laparoscopy in urology: present status, controversies, and future directions. Int J Urol 1996; 3:83-97. [PMID: 8689517 DOI: 10.1111/j.1442-2042.1996.tb00489.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- T Matsuda
- Department of Urology, Kansai Medical University, Moriguchi, Japan
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Poppas DP, Lemack GE, Mininberg DT. Laparoscopic orchiopexy: clinical experience and description of technique. J Urol 1996; 155:708-11. [PMID: 8558711 DOI: 10.1016/s0022-5347(01)66506-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE We reviewed the experience, early followup and technique of laparoscopic treatment of the nonpalpable undescended testis at our institution. MATERIALS AND METHODS Charts of patients who underwent laparoscopic treatment of an intra-abdominal testis from September 1992 to October 1994 were reviewed. RESULTS A total of 13 laparoscopic orchiopexies was performed on 11 children with nonpalpable undescended testes. In 10 cases sufficient length was gained on the spermatic vessels using laparoscopic dissection to perform tension-free orchiopexy without the need for division of the spermatic vessels. CONCLUSIONS When localization of an intra-abdominal testis is confirmed, orchiopexy can be performed safely with minimal morbidity using a laparoscopic approach. Length of hospital stay and postoperative morbidity may be improved in comparison to traditional techniques.
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Affiliation(s)
- D P Poppas
- Department of Urology, James Buchanan Brady Foundation, New York Hospital-Cornell Medical Center, New York, USA
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Affiliation(s)
- Inderbir S. Gill
- Division of Urology, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, and Division of Urology, Department of Surgery and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Ralph V. Clayman
- Division of Urology, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, and Division of Urology, Department of Surgery and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Elspeth M. McDougall
- Division of Urology, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, and Division of Urology, Department of Surgery and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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Affiliation(s)
- Y L Homsy
- Division of Pediatric Urology, University of Montreal, Quebec, Canada
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