We evaluated the differences in demographic characteristics of patients with and without underlying crossing renal vessels (CRVs) operated for unilateral symptomatic ureteropelvic junction obstruction (UPJO). We identified the features of patients who had undergone open, laparoscopic and robotically assisted laparoscopic pyeloplasty at our institution from July 2000 to January 2021. The ratio of renal parenchymal thickness (RPT; ratio between the kidney with UPJO and the healthy kidney), pelvic diameter and kidney functions were recorded. A total of 641 patients were operated for UPJO; 448 were male (69.8%) and 193 (30.1%) were female; 257 had right-side (40%) and 384 (60%) left-side disease. Fifty-eight patients (9%) were found to have CRV (operated on to treat CRV). The age at diagnosis was 6.51 ± 5.09 years in the CRV (+) group and 1.82 ± 1.37 years in the CRV (À) (p < 0.001). The age at surgery was 8.00 ± 4.71 and 4.27 ± 3.54 years, respectively (p < 0.001). At the time of diagnosis, the RPT measurement was significantly better in CRV (+) compared to CRV (À) group (0.71 ± 0.2 vs. 0.64 ± 0.23, p = 0.043) and initial renal functions were 45.53 ± 8.99% and 42.99 ± 11.65% in CRV (+) and (À) groups respectively. At the time of surgery, the RPTs were 0.60 ± 0.24 and 0.63 ± 0.21 in CRV (+) and (À) groups and these values were also correlated with split renal functions (36.28 ± 15.81% and 41.80 ± 14.26%, respectively).Renal functions were significantly decreased in CRV (+) group (p = 0.027). Significant parenchymal improvements were noted during the first postoperative year. The RPTs were 0.71 ± 0.2 and 0.77 ± 0.19 in the CRV (+) and CRV (À) groups, respectively (p = 0.27) in that time; the improvements continued to increase to postoperative third year (0.74 ± 0.20 and 0.78 ± 0.19 respectively; p = 0.939). In patients with CRVs, renal functions seemed to be preserved in the early stages, however it should be kept in mind that sudden obstruction and loss of kidney function might develop in the follow up period.
Penile glans amputation is a rare and catastrophic complication of circumcision. Reconstruction of the penile glans was indicated following amputation. Our report discusses a novel technique for reconfiguration of the amputated penile glans of a 5-year-old male admitted 6 months following a complicated circumcision. The parents complained of severe meatal stenosis and penile disfigurement. The penis was 3 cm long. Complete penile degloving was performed. The distal part of the remaining penis was prepared by removing fibrous tissue. Dartos flaps, which had been placed on the dorsal side by the previous surgery center, were divided into two similar parts from the ventral side and opened to both sides at the top of the penis, such as a curtain, and a glanular collar-like structure was obtained by bringing 5 cm × 3 cm buccal mucosa. This structure was covered on the penis as glans, and the freed urethra with the spongiosum was sutured here. The patient was taken to hyperbaric oxygen therapy in the postoperative period. The patient’s glans-like cosmetic structure was observed during follow-up, and the patient was urinating normally. This is the first surgical repair technique to use this method in the literature. The use of a dartos flap covered with a buccal mucosal graft is a successful and simple procedure with acceptable cosmetic and functional results for the late reconfigurating a neoglans shape after a glans penis amputation when the penile size is suitable.
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