No abstract

No abstract

* At the time of this consultation, these definitions are not included in the current ICS terminology. RECOMMENDATIONS OF THE INTERNATIONAL SCIENTIFIC COMMITTEE 2. EVALUATION The following phrases are used to classify diagnostic tests and studies: • A highly recommended test is a test that should be done on every patient. This section should also be read in conjunction with the relevant committee reports. RECOMMENDATIONS OF THE INTERNATIONAL SCIENTIFIC COMMITTEE 6. ANORECTAL PHYSIOLOGY TESTING Endocoil MRI has high accuracy for detecting anal sphincter injury but is second line after endoanal ultrasound. Patients with faecal incontinence may benefit from assessment with MRI, particularly those with anorectal malformations and/or previous anal sphincter surgery. Defaecography may be useful and is recommended in patients with faecal incontinence, who have failed conservative therapies, and are possible candidates for laparoscopic ventral rectopexy. * Consider CONTINENCE PRODUCTS for temporary support during treatment Recent VVF Primary simple Consider Catheter, evaluate weekly Established VVF Primary complex Healed Persistant leakage Recurrence Post-irradiation Vaginal repair Consider timing Surgical repair Consider timing Consider interposition material If small, consider catheter, evaluate weekly Surgical repair 6-12 months Consider interposition material Surgical repair Consider timing Consider interposition material Assess fistula closure & assess continence status MANAGEMENT OF IATROGENIC URETERIC FISTULAE HISTORY CLINICAL ASSESSMENT MANAGEMENT* PRESUMED DIAGNOSIS Extra-urethral vaginal urinary leakage and/or signs of ureteric obstruction Clinical examination Urethro-cystoscopy Imaging (Xray/CT/ MRI, US) Evaluate upper urinary tract obstruction * Consider CONTINENCE PRODUCTS for temporary support during treatment Ureterovaginal fistula Endoluminal technique (stenting, nephrostomy) for at least 6 weeks Unable to stent (initially)... Re-evaluate for fistula closure, ureteric obstruction Persisting fistula or ureteric obstruction Ureteric reimplantation (open, laparoscopic or robotic) Healed Long-term follow-up for stricture and hydropephrosis * Consider CONTINENCE PRODUCTS for temporary support during treatment Patient education, adequate fibre diet and fluid intake; regular bowel care, preferably ± 3 times a week

Urodynamic studies have become a major tool in evaluating lower urinary tract dysfunction in children. There are many subtleties in performing these studies in children in juxtaposition to adults; therefore, adaptations specific to children must be made to achieve accurate and reproducible results. Uniformity in how the studies are conducted from center to center will allow for healthier transparency and enhanced comparison of results in both clinical and research situations.

No abstract

In addition to procedures that bring the meatus to a more terminal position, those that bring it more ventral can be performed without negatively affecting psychosexual adjustment. Hypospadias patients were reluctant to seek advice for problems and, therefore, they should be followed through adolescence.

No abstract

Purpose: We studied the degree of agreement between hypospadias patient and surgeon satisfaction with the cosmetic surgical result, and the relation between penile length, m e a d position and patient satisfaction.Materials and Methods: Cosmetic and functional results in 35 boys with hypospadias were assessed, and a standardized questionnaire was completed by patients and surgeon.Results: There was hardly any agreement between patient and surgeon satisfaction with patient penile appearance. Patients were less satisfied than the surgeon. No significant correlation was noted between penile satisfaction and penile length. Patients with a retracted meatus were less satisfied with the meatal position than those with a glanular meatus. Of the 35 patients 4 underwent repeat surgery aRer our study.Conclusions: Hypospadias surgeons should explicitly ask if patients are satisfied and they should follow patients through adolescence.KEY WORDS: penis; hypospadias; surgery, plastic Corrective surgery of hypospadias, that is reconstructing the urethra and straightening the penis, is necessary to ensure voiding in the standing position and unhampered adult sexual functioning. Another important goal of hypospadias surgery is the achievement of a cosmetic penile appearance that is as normal as possible. Others who studied long-term results of hypospadias surgery reported patient satisfaction with the penile appearance or surgeon satisfaction with the surgical result.'-6 To our knowledge only Schwobel et a1 have previously assessed hypospadias patient and surgeon satisfaction with the cosmetic r e~u l t .~ Of the 27 patients 92% judged the cosmetic result to be satisfactory or excellent and all had a satisfactory or excellent cosmetic result, as judged by Schwobel et al. 7 Unfortunately, from these data it is impossible to determine the degree of agreement between patient and surgeon satisfaction, and only the position of the urethral meatus was considered in judgingthe surgical result. These previous studies made no distinction between satisfaction with functional result and cosmetic penile appearance. It was not known if hypospadias patients were satisfied with the same aspects of penile appearance as the surgeon. It seems essential to know whether hypospadias patients and surgeons consider the same aspects of penile appearance to be important to determine if patient treatment or counseling should be adjusted. Therefore, we evaluated in a standard manner the level of agreement between hypospadias patient and surgeon satisfaction with different asof patient penile appearance, and the relation between physid ChamCtenstics (penile length and meatal position) and satisfaction with penile appearance in hypospadias patients. PATlENTS AND METHODS Patients.Of the 458 patients treated for hypospadias between 1980 and 1992 at the Sophia Children's Hospital 113 who were 9 to 18 years old at the onset of our Study Previ2Z~oronal 703ously underwent terminal procedures, which split, core or tunnel through the glans to create a true t...