PurposeAugmentation cystoplasty (AC) is a surgical procedure used in adults and children with refractory bladder dysfunction, including a small bladder capacity and inadequate bladder compliance, and in whom conservative and medical treatment has failed. This study was aimed to determine the long-term outcomes of AC in children.MethodsA retrospective analysis was conducted of 42 patients (31 males; mean age, 14.2±6.2 years) who underwent AC for neurogenic and nonneurogenic bladder dysfunction, with a median 12.0±1.5 years of follow-up. All patients underwent AC using the ileum with or without continent reconstruction. Pre-AC, concurrent, and post-AC procedures and complications were analyzed. Patients who underwent ureterocystoplasty, were lost to follow-up, or had less than 10 years of follow-up were excluded. The primary outcomes were the complication and continence rates, the post-AC linear rate of height and weight gain, and renal function. The Student t-test was used to evaluate between-group differences and the paired t-test was used to evaluate longitudinal changes in measured variables.ResultsRenal function was stable or improved in 32 of 42 patients (76.2%), with a post-AC continence rate of 88.1%. Thirty patients (71.4%) required 72 procedures post-AC. There was no statistically significant difference in the mean percentile of height (P=0. 212) or weight (P=0.142) of patients in the pre- and post-AC periods. No cases of bladder perforation or malignancy were detected.ConclusionsWe consider AC to be a safe and effective procedure that does not negatively affect future physical growth, while achieving a good rate of stable renal function. Patients need long-term follow-up to address long-term complications.
AH Kardar, A Tulbah, A Peracha, T Merdad, A Al-Mathami, Primary Carcinoid Tumor of Testis. 1997; 17(2): 223-225 Carcinoid tumors are rather uncommon and about 85% of them occur in the appendix or ileocecal region. When they occur outside the GI tract, they are usually metastatic. A total of 43 cases of pure primary testicular carcinoid tumor have been reported. 1 We report a case of carcinoid tumor of the testis, the diagnosis of which was confused by the FNA diagnosis of Leydig cell tumor, another uncommon type of testicular neoplasm. Verification of the diagnosis was done by immunohistochemistry and electron microscopy. To our knowledge, this is the first case of primary carcinoid tumor of the testis reported from the Middle East. Case ReportA 26-year-old Saudi male student was referred to our hospital with the diagnosis of Leydig cell tumor of the left testis. The patient had presented to an outside hospital with a three-month history of a painless swelling of the left testis. Ultrasound examination revealed the presence of a localized area of suspicious hypoechogenicity and FNA of the lesion was interpreted as a Leydig cell tumor. On examination, we found his left testis to be moderately enlarged in size and hard in consistency without tenderness. The other testis was normal and clinically there were no signs of abdominal metastases and no gynecomastia was found. A left radical orchiectomy was carried out through a groin incision. Tumor markers sent preoperatively (beta human chorionic gonadotrophin, alphafetoprotein, dehydroepiandrosteindione, androsteindione) all came back as normal. Histopathology of the testis was reported as carcinoid tumor of the testis and the margins were free of tumor. There was no history of symptoms of carcinoid syndrome. We performed quantitative estimation of 5-HIAA, gastrointestinal contrast study, chest x-ray and CT of the abdomen. These studies were all normal and there was no evidence of other primary or metastatic carcinoid tumor.Grossly, the tumor measured 4.5 cm in maximum dimension. It was well demarcated from the surrounding uninvolved testis, solid and yellow-tan in color (Figure 1). The spermatic cord and epididymis were normal.Histologically, the tumor was well demarcated from the surrounding testicular parenchyma. The tumor cells were arranged in nests, tubules and trabeculae separated by delicate fibrovascular stroma (Figure 2). The cells were round or polygonal and had eosinophilic granular cytoplasm. The nuclei were round and uniform with evenly dispersed granular chromatin. Focal nuclear pleomorphism was noted. Occasional mitoses were encountered. Immunoreactivity for synaptophysin, chromogranin and cytokeratin was diffusely positive in the tumor cells ( Figure 3).Electron microscopic examination revealed numerous cytoplasmic, membrane-bound electron-dense granules, which were pleomorphic. DiscussionCarcinoid tumors are the most common tumors of the appendix and small intestine. They arise from the epithelium containing argentaffin or argyrophil cells. Up to...
BACKGROUNDOrchidopexy should be performed during the first 18 months of life to decrease the risk of infertility and tumor formation. In our center, the timing of surgical correction varies depending on the availability of an operating room.OBJECTIVESEvaluate whether orchidopexy performed for patients referred to our center is done within the recommended time period and to determine causes for delay.DESIGNRetrospective descriptive study.SETTINGPediatric urology department of a tertiary care center.SUBJECTS AND METHODSWe retrospectively reviewed the charts of patients charts who underwent orchidopexy at our center from 2000 to 2010. We assessed referral time and waiting list time, which were subdivided as follows: from referral to first visit and from first visit to surgery. We included patients younger than 14 years and excluded patients with comorbidities that affected the timing of referral and surgical treatment.MAIN OUTCOME MEASURESReferral time period and waiting list time for surgical correction of patients presented with undescended testis.SAMPLE SIZE128RESULTSAfter exclusion of 32 patients because of comorbidities, we describe 128 who underwent surgery for cryptorchidism at our center. The median (interquartile range, minimum-maximum) for age at surgery was 46.7 months (24.4–83.4, 3.1–248.6]). The median (IQR) referral occurred at an age of 25.3 months (4.1–65.5). The median (IQR) waiting list time was 15.2 months (8.1–23.3). The median (IQR) waiting time from referral to the first visit was 4.1 months (1.0–8.2). The median waiting time from the first visit to surgery was 8.1 months (3.8–17.5).CONCLUSIONSThe age at the time of surgery at our center was far from ideal because of late referrals. A structured program offered by our National Health Service to educate referring physicians is necessary. Community health initiatives must emphasize prompt referral to reduce the impact of delayed surgery.LIMITATIONSLack of data on the type of referring physician (i.e., general practitioner, pediatrician, surgeon, urologist).
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