Use of cyanoacrylate tissue adhesive under a diaper

OBJECTIVE

To examine the utility of cyanoacrylate tissue adhesive (Dermabond, Ethicon, Somerville, NJ, USA; an effective means of epithelial skin closure) under a diaper (i.e. constantly exposed to bodily fluids) in 25 children (not toilet-trained) undergoing inguinal surgery.

PATIENTS AND METHODS

A retrospective review of charts between July 1998 and July 2000 was used to identify children who were not toilet-trained and who had undergone inguinal surgery (e.g. orchidopexy, hernia and hydrocele repair). In addition to the type of surgery, the method of closure was also assessed; in all cases reported the subcutaneous tissues were approximated with 4/0 polyglactin suture. From July 1998 to October 1999 all epithelial skin was closed with 5/0 poliglecaprone, benzoin, sterile strips and collodion; from October 1999 to July 2000 all skin was closed with cyanoacrylate tissue adhesive.

RESULTS

The chart review identified 45 boys (mean age 15.3 months, range 1-26) of whom 26 (57%) had undergone either inguinal hernia or hydrocele repair, and 19 (42%) who had undergone orchidopexy. These procedures resulted in a total of 52 incisions in the 45 children. Of the 52 incisions, 27 were closed with suture and 25 with cyanoacrylate adhesive. All patients were followed up at 2 weeks; there were no instances of infection or wound dehiscence in either group. The incisions were cosmetically identical at 3 months of follow-up.

CONCLUSION

Cyanoacrylate adhesive is a safe and effective method of skin closure that can be used under a diaper.

Management of penile toilet seat injury--report of two cases

Blunt trauma to the penis is an uncommon injury in young children. We present two cases of blunt penile trauma secondary to mechanical compression from a toilet seat.

Utility of biofeedback for the daytime syndrome of urinary frequency and urgency of childhood

OBJECTIVES

To evaluate in a preliminary study the utility of biofeedback for the treatment of the daytime syndrome of urinary frequency and urgency of childhood, a benign, self-limited condition with symptoms that can last for months or years. Observation is a commonly recommended approach to this syndrome because medications and other forms of therapy are often not effective.

METHODS

During a 2-year period, 89 children (34 boys and 55 girls) presented with this syndrome. Patient age ranged from 4 to 11 years, and duration of symptoms ranged from 1 to 38 months. All children were evaluated with a history, physical examination, urinalysis and culture, and renal and bladder ultrasound scanning. After the evaluation, the parents were offered either observation or surface patch electromyography biofeedback for the problem.

RESULTS

Overall, 84 parents (94.3%) selected biofeedback for their child. After 1 month of biofeedback, 34.5% of children were able to achieve a 2 to 4-hour voiding interval. After 2 to 4 months of biofeedback, another 51.2% of patients experienced the same improvement. Overall, 85.7% of children who underwent biofeedback had symptom improvement. In 14.3% of children, no symptom improvement was noted after 4 months of biofeedback and these children were considered nonresponders.

CONCLUSIONS

The results of this study suggest that biofeedback may be a treatment option for this disorder and warrants further investigation.

Lesch-Nyhan syndrome presenting as acute renal failure secondary to obstructive uropathy

Lesch-Nyhan syndrome is a rare genetic disorder characterized by mental retardation, self-mutilation, choreoathetosis, and hyperuricemia. The disease is caused by a mutation in the hypoxanthine-guanine phosphoribosyltransferase gene and is transmitted as a sex-linked recessive disorder. Since hyperuricemia is the primary metabolic problem caused by a hypoxanthine-guanine phosphoribosyltransferase mutation, urologic evaluation and treatment is often necessary for children with this disease. We report a 3-year-old boy who presented with anuric renal failure secondary to bilateral obstructing uric acid calculi. The evaluation of T lymphocytes revealed a hypoxanthine-guanine phosphoribosyltransferase mutation consistent with Lesch-Nyhan syndrome. The diagnosis and urologic management of this disorder is discussed.

DNA organization in patients with a history of cryptorchidism

OBJECTIVES

Cryptorchidism is associated with infertility, even in those patients with unilateral undescended testes. The mechanism for this infertility is not understood. We demonstrated recently that in mice, a stable nuclear matrix, a structural component of the nucleus that organizes DNA, is necessary for proper embryogenesis. We tested the hypothesis that spermatozoa from cryptorchid patients had unstable nuclear matrices.

METHODS

Semen samples from 7 patients with a history of undescended testes and decreased fertility were tested for sperm nuclear matrix stability using our halo assay.

RESULTS

All 7 patients were found to have unstable nuclear matrices, as compared with controls.

CONCLUSIONS

This preliminary study suggests that one factor in the decreased fertility of cryptorchid patients may be unstable sperm nuclear matrices.

Evaluation of the utility of video-urodynamics in children with urinary tract infection and voiding dysfunction

OBJECTIVE

To assess the use of video-urodynamic studies (VUDS) in children with urinary tract infection (UTI) and symptoms of voiding dysfunction (frequency, urgency, incontinence), to ascertain whether VUDS significantly assists in diagnosis and deciding treatment.

PATIENTS AND METHODS

Over a 16-month period, all children seen at our centre with a UTI in conjunction with previous symptoms suggestive of voiding dysfunction underwent free and pressure-flow VUDS. Forty-two children underwent VUDS and 38 (mean age 9 years, range 4-16, 15 male, 23 female) had sufficient information to be included in the study.

RESULTS

All children had a prior history of voiding dysfunction (mean 55 months). Only five patients were found to have reflux and three of these had associated detrusor instability. In addition, 24 of 33 patients who did not have reflux had abnormalities on urodynamic study, the most common problem being detrusor instability in 17 of 24 patients. Other abnormalities included sphincter dyssynergia (five patients), poor bladder compliance (two) and hypersensitivity on bladder filling (three).

CONCLUSION

VUDS can provide information about the aetiology of UTI and voiding dysfunction in children that cannot be obtained from any other source. The results of VUDS can be used to select specific treatments, to avoid inappropriate therapy and to identify children who may benefit from follow-up studies despite normal findings on voiding cystourethrography. From these results, we believe that VUDS should be considered for children with UTI and voiding dysfunction.

Diagnosis and management of malignant perirenal schwannoma

Malignant retroperitoneal schwannoma is an extremely rare tumor, with only six cases previously reported occurring in the perirenal space. We herein report the seventh case. A 50-year-old woman presented with an abdominal mass suggestive of renal cell carcinoma by standard preoperative evaluation. The tumor required surgical exploration and pathologic evaluation for diagnosis. The final histologic diagnosis was made with the aid of electron microscopy and immunohistochemical staining with antibodies for S-100 protein.

Cystic renal disease and tuberous sclerosis in infants

We describe 2 infants who presented with autosomal dominant-like polycystic kidney disease. Evaluation revealed that both children had tuberous sclerosis, with resulting cystic kidney disease. This diagnosis should be suspected in infants who present with bilateral, large renal cysts, and no family history of autosomal dominant polycystic kidney disease.

Occult bilateral ectopic vaginal ureters causing urinary incontinence: diagnosis by computed tomography

Diagnosis of an ectopic, infrasphincteric ureter can be difficult because the renal moiety drained by the ectopic ureter is often small and functions poorly. We present a 6-year-old girl with urinary incontinence caused by bilateral vaginal ectopic ureters that were not seen on excretory urography or renal sonography and were diagnosed only by contrast-enhanced computerized tomography.

Symptomatic tumors affecting the urinary tract in children with neurofibromatosis

PURPOSE

We determined the need for urological screening in children with neurofibromatosis.

MATERIALS AND METHODS

Of 96 children with neurofibromatosis treated at our institution 6 (6.2%) had a symptomatic tumor that affected the urinary tract.

RESULTS

There were 5 plexiform neurofibromas and 1 prostatic rhabdomyosarcoma. Five children had a palpable abdominal mass and 3 required urinary diversion.

CONCLUSIONS

Since most morbidity resulted because tumors were advanced by the time symptoms developed, we suggest that children with neurofibromatosis be screened annually with medical history, physical examination, urinalysis and serum chemistry studies for tumors that affect the urinary tract.

Vena cava resection during post chemotherapy lymphadenectomy for testis tumor

Two patients underwent retroperitoneal lymphadenectomy after chemotherapy for non-seminomatous germ cell testis tumor. A dense desmoplastic tissue reaction between the infrarenal vena cava and perivascular lymphatic tissue prohibited removal of the nodal packet from the vena cava in both cases. We herein discuss two techniques for vena cava resection in these difficult cases.

A "flipped" kidney in utero in an infant with a double collecting system and a Gartner's duct cyst with a vaginal ectopic ureter

We report an infant with two unique anatomic abnormalities. A "flipped" kidney in utero is described with the association of a Gartner's duct cyst and a vaginal ectopic ureter with a duplicated collecting system.

DNA organization in human spermatozoa

Previous studies from this laboratory on hamster spermatozoa have demonstrated that rodent sperm DNA is packaged into the sperm nucleus in a specific manner by nuclear structures. The entire genome is organized into DNA loop domains attached at their bases to a sperm nuclear matrix, the skeletal structure of the nucleus. When nuclei are completely decondensed, the nuclear matrix dissipates, and the entire genome remains anchored to a single structure located at the base of the tail, termed the nuclear annulus. Here, we have extended these studies to human sperm nuclei, which were found to be similar to hamster. Human sperm DNA was found to be organized into loop domains attached at their bases to a nuclear matrix. The average size of the human sperm halo of DNA surrounding the extracted sperm nucleus (made up of DNA loop domains) was about 50% smaller than those that have been reported for somatic cells (this corresponds to an approximate loop domain size of 26.8 +/- 2.1 kb). Human sperm DNA also remained anchored to the base of the tail when completely decondensed, indicating the existence of a nuclear annulus-like structure in human spermatozoa; but, unlike the hamster nuclear annulus, the human annulus could not be isolated because of its structural instability when separated from the tail. Using human centromere repeats as a probe for in situ hybridization, we examined the packaging of individual DNA sequences within the sperm nucleus. These studies demonstrate that human sperm DNA is highly organized by nuclear structures.

Etiology of acute urinary retention following benign anorectal surgery

The etiology of acute urinary retention following benign anorectal surgery is unknown. We performed bedside urodynamic evaluation on nine patients who developed acute urinary retention after benign anorectal surgery. A bladder contraction was demonstrated in all patients, which suggests that the retention is due to bladder outlet obstruction and not bladder acontractility. These findings have important implications for preventing and treating acute urinary retention following anorectal surgery for benign disease.

Treatment of paraphimosis using the "puncture" technique

The puncture technique is a simple method that aids in the manual reduction of the paraphimotic foreskin. We present a case that describes how we are currently using the technique in our pediatric patients.

A simple technique for intraoperatively stenting a transected ureter

We present a simple technique for intraoperative stenting of a transected ureter. This method does not require cystoscopy, or a separate incision in the bladder or skin.

Urodynamics in the early stages of spinal cord compression from prostate adenocarcinoma

Acute urinary retention developed in 2 patients with a history of prostate cancer. Urodynamic evaluation revealed autonomic dysfunction, which contrasted with a prior urodynamic study, indicating a possible spinal lesion. Radiographic evaluation led to early diagnosis and treatment of spinal cord compression from metastatic prostate adenocarcinoma. We discuss the diagnostic role of urodynamics in such cases.

Diagnosis and staging of bladder cancer

The need for prompt diagnosis and accurate staging of bladder cancer cannot be over-emphasized, as delays in diagnosing the tumor are clearly associated with a poor prognosis. Accurate staging using the American Joint Committee system is essential if clinicians are to compare the results of different therapies.

Writing competition winner: Robert Wood Johnson pouch

Traditional treatment for muscle invasive bladder cancer requires the creation of an abdominal stoma for urinary diversion. The authors report a technique for orthotopic bladder substitution. This paper was the 1991 winner of the MSNJ Writing Competition.

Squamous cell cancer of the larynx in an intravenous drug user with AIDS

We present the case of a 29-year-old intravenous drug user with AIDS and squamous cell cancer of the larynx. Profound immunosuppression was evident by an OKT4:OKT8 ratio of 0.1. Simultaneous treatment of the laryngeal cancer by laser vaporization and treatment of immunosuppression with zidovudine resulted in no tumor recurrence after one year.

Familial polyposis coli & Gardner's syndrome

Familial polyposis coli and Gardner's syndrome are genetically inherited defects causing multiple adenomatous polyps of the colon with a propensity for malignant degeneration. To emphasize that neoplasm of the ampulla of Vater is the most frequently reported extracolonic gastrointestinal neoplasm, we present a case report and a review of the literature.

Aseptic synovitis

We report the first case of aseptic synovitis that occurred after a titanium knee prosthesis failed. This complication should be considered when a patient with a titanium prosthesis develops tenderness, erythema, and swelling of that joint.

Steatocystoma multiplex with bilateral preauricular sinuses in four generations

A rare case of steatocystoma multiplex and bilateral preauricular sinuses in four generations is presented along with a review of the literature. The cause, pathogenesis, and treatment of steatocystoma multiplex is discussed. Steatocystoma multiplex (SCM) is a rare clinical disorder characterized by numerous recurrent cutaneous cysts. Since the first case described by Bosellini in 1898, both nonfamilial and autosomal dominant inheritance patterns have been described. There have been at least 13 well-documented nonfamilial cases. However, since Noonjin and Reynolds in 1948 first described the autosomal dominant inheritance pattern, only 4 well-documented familial cases have been reported. To date, there has been one case report of SCM in four generations, and that case was not associated with any other anomaly. The present case describes the occurrence of SCM in association with bilateral preauricular sinuses in multiple generations.