From 1987 through 1992, 1,109 primary hypospadias operations were performed at our hospital, of which 374 (33%) were onlay island flap procedures. In contrast, from 1982 to 1987 only 66 of 657 primary hypospadias repairs (10%) were onlay island flaps. The increase in this type of repair stems from the observation that in most cases of hypospadias the urethral plate is not the cause of penile curvature. Intraoperative artificial erection after skin take down revealed that only 50 of the 374 patients (13%) still had a significant bend. After experience demonstrated that the residual bend was not due to a fibrous urethral plate, but rather to a generally mild (20 to 30 degree) corporeal disproportion, correction was achieved by dorsal tunica albuginea plications. We conclude that better healing of the onlay flap to spongiosum supported urethral plate may account for the lower fistula rate (6%) observed with the onlay island flap hypospadias repair, and even in severe cases of hypospadias the urethral plate is usually healthy and it does not require division to produce a straight penis.

Our results support the hypothesis that homozygosity for the specific ESR1 'AGATA' haplotype may increase the susceptibility to the development of male genital abnormalities in response to estrogenic EEDs.

Not applicable.

Testicular tumors are rare in children. In addition, prepubertal testicular tumors (PTT) are fundamentally different from their postpubertal counterparts. We reviewed our 20-year experience with 40 cases to suggest an algorithm for the appropriate surgical approach for patients with PTT. All tumors ultrasonographically suspected of being benign were confirmed to be benign postoperatively. There was a significant difference between median preoperative a-fetoprotein (AFP) levels of infants with yolk sac tumor and teratoma. The majority of our cases were benign, with the most common histopathological subtype being teratoma, as recently reported. Testis-sparing surgery was carried out in five patients with teratoma and three patients with epidermoid cyst. Other than one patient with teratoma, none of the patients developed recurrence or testicular atrophy after testis-sparing surgery. When testis-sparing surgery is considered , our algorithm based on ultrasonographic findings and preoperative AFP levels might be helpful.

No abstract