The one-step strategy is associated with 68.5% success in a single operation, whereas 31.5% will need a second repair. We recognize that meatal problems are mostly associated with fistulae and diverticula; therefore, we recommend a final acceptable proximal glandar opening that will not compromise the neourethra.

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Objective:To use anthropometric measurements to compare nutritional status in children with neurogenic bladder dysfunction secondary to meningomyelocele who underwent enterocystoplasty and those who did not undergo surgery.Methods:A case-control study was conducted in 20 children, divided into two groups: those who had enterocystoplasty (Group A) and those who did not undergo surgery (Group B), matched for genre and age. Weight, height, arm circumference, and triceps skinfold thickness were the parameters used. Nutritional assessment was determined by calculating the indexes, based on age and genre. Classification was based on the percentile and the results were compared with the reference values.Results:The mean age was 6.41 years in Group A and 6.35 years in Group B. The interval between surgery and evaluation was 11 months. The following measures were found for Group A: 80% of children were eutrophic, a percentage 30% greater than that in Group B; arm muscle circumference was adequate in 40% of patients, a percentage 20% greater than that in Group B; arm muscle area was adequate in 90%, a percentage 30% greater than that in Group B. Values in Group B were as follows: for triceps skinfold thickness, 60% of patients had values above the mean, a percentage 20% greater than that in Group A; for arm fat index, 60% of patients were above the mean value, 40% greater than in Group A.Conclusion:Patients who had undergone enterocystoplasty showed better nutritional status, while the control group presented higher fat indexes in anthropometric measures. However, the differences between groups were not statistically significant.

Ectopic penis is usually associated with penoscrotal transposition, and it is rarely observed in isolation. We report a surgical approach for an extremely rare case. A 10-year-old male patient with bilateral cryptorchidism and ectopic penis and scrotum in perineal area, with no penoscrotal transposition, representing an association not yet described in literature. A previous orchiopexy failed due to ectopic scrotum. By means of an inverted Y incision, the penis was mobilized and a perineal skin flap in form of a testicular sac was prepared. Finally orchiopexy was performed. The surgery was essential to treat cryptorchidism and to improve the self-image of the patient.

We report on a 16-year-old male with paratesticular rhabdomyosarcoma who underwent retroperitoneal lymph node dissection due to a stage I tumor (normal retroperitoneal computed tomoghaphy). The surgical finding was three enlarged nodes, positive for metastatic disease. Patient was referred to adjuvant chemotherapy. This case suggests that the Intergroup Rhabdomyosarcoma Study Group IV protocol is subject to questions regarding adolescents with paratesticular rhabdomyosarcoma, and that negative retroperitoneal CT does not preclude the need of lymph node dissection.

PURPOSEComplex primary Hypospadias repair that deserve urethral plate division is treated mostly in two steps, but not necessarily in two surgeries. Our aim in this review was to recheck our long-term results with a onestage strategy we published in the past based on simultaneous reconstruction of the urethral plate with dorsal buccal mucosa graft and onlay transverse preputial flap anastomosis protected in the end by a tunica vaginalis flap (the three-in-one concept). MATERIAL AND METHODSWe found 35 patients operated with primary scrotal, penoscrotal and perineal Hypospadias between March 2002 and June 2008. We reviewed all charts active in follow-up and made phone interviews for those not seen for the last 24 months. We investigated parameters such as UTI occurrence, fistula, residual curvature, meatal stenosis, urethral diverticula, urethral dehiscence, orchitis and parental perception. RESULTSSurgical complications occurred in 11 patients (31%) and are listed: 4 meatal stenosis, 4 diverticula, 5 fistulas and 2 residual penile curvatures (total 42%). Meatal dilatation was successful in 2 cases that reflected in 2 fistula resolution. The reoperation rate was 25.7% and consisted mostly of simple procedures like fistula closure, meatotomy and complex diverticula repair in 3 cases. Two patients presented recurrent orchitis and UTI but were associated with infrequent voiding characteristics. End parental perception after treatment was excellent for 57% (20 patients) and good or acceptable for the rest. CONCLUSIONSWe concluded that one-step strategy as here described is associated with 69% chance of one single operation without any complication to treat complex Hypospadias forms, whereas 25.7% will need a second repair. We recognize that meatal problems are mostly associated with fistula and diverticula and therefore we recommend a final acceptable proximal glandar opening that may not compromise the neourethra.

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